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The 1.0 metre f/4 fast-slew Zadko Telescope was installed in June 2008 approximately seventy kilometres north of Perth at Yeal, in the Shire of Gingin, Western Australia. Since the Zadko Telescope has been in operation it has proven its worth by detecting numerous Gamma Ray Burst afterglows, two of these being the most distant `optical transients' imaged by an Australian telescope. Other projects include a contract with the European Space Agency (ESA) to image potentially hazardous near Earth asteroids (2019), monitoring space weather on nearby stars (2019), and photometry of a transit of Saturn's moon Titan (2018). Another active Zadko Telescope project is tracking Geo-stationary satellites and attempting to use photometry to classify various space debris (defunct satellites). The Zadko Telescope's importance as a potential tool for education, training, and public outreach cannot be underestimated, as the global awareness of the importance of astronomy (and space science) as a context for teaching science continues to increase. An example of this was the national media coverage of its contribution to the discovery of colliding neutron stars in 2017, capturing the imagination of the public. In this proceeding, I will focus on the practical aspects of managing a robotic Observatory, focusing on the sustainability of the Observatory and the technical management involved in hosting different commercial projects. I will review the evolution of the Observatory, from its early, single instrument, state to its current multi-telescope and multi-instrument capabilities. I will finish by outlining the future of the Observatory and the site., 5 pages, to appear into Revista Mexicana de Astronomia y Astrofisica Conference Series

Internal systems for quality and safety were assessed in 89 hospitals in six European states, by external teams using standardised criteria and procedures, as part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project. The assessments were made primarily to identify the current use of quality management systems in the sample hospitals, and also to demonstrate a potential tool for comparable assessment of hospitals in general. The large majority of the hospitals had a formal, documented infrastructure to manage quality and safety, but a significant minority had no designated mission, programme or coordination. In two-thirds of hospitals, the governing body was active in defining policy and programmes for improvement, and received reports on quality, safety and patient satisfaction at least once a year. The brief on-site assessments identified systematic variations, within and between countries, in structures and processes of governance and to document the uptake of best practice. Unacceptable variations in practice could be reduced, to the benefit of consumers and providers, by developing and publishing basic organisational standards relevant to all European states. The simple assessment criteria designed for this project could be developed into a practical tool for self-assessment, peer review or benchmarking of hospitals across national borders. This assessment, combined with explicit, relevant and achievable standards, could provide a vehicle to promote the voluntary uptake of best practice and consistency in quality and safety among hospitals in Europe.

In autumn 1996, under the Presidency of Dr Robert Kendell, the College decided to mount a campaign to tackle the stigmatisation of people with mental illnesses. In 1997, a working party proposed goals, content, process and a 5-year governance. Other campaigns, both here and abroad, have either generically addressed ‘mental health problems' (e.g. Mind's ‘Respect’ Campaign) or targeted a specific mental illness, e.g. the World Psychiatric Association's anti-stigma campaign in respect of people with schizophrenia. Our working party decided that it might be timely to recognise the differences in public attitudes to the variety of mental illnesses. The campaign thus addressed six categories of mental illness: anxiety disorders, depressive disorders, schizophrenia, the dementias, eating disorders, and drug and alcohol misuse/addiction. Target populations were identified as doctors, children and adolescents, the workplace, the media and the general public. The working party had also secured funding and arranged for a survey, in July 1998, by the Office for National Statistics of opinions of the British public concerning people with these mental illnesses (Crisp et al, 2000). The Campaign started on 7 October 1998. Since that time, and drawing upon our survey findings within its initial literature review (Kelly, 1999) the Department of Health mounted its own anti-stigma campaign, ‘Mind Out for Mental Health’, which addressed a similar range of mental illnesses.

Summary A third of a million adults in the UK sleepwalk while a million suffer from night terrors. In both conditions the individual is unaware of the fullness of their surroundings and is totally focussed in their concern or activity. Doctors are only likely to become involved if the individual comes to harm or seeks help or if other people are inconvenienced or threatened. The constitutional basis of the disorder is beyond doubt, although the actual expression may be related to stressful life-events resulting from an individual’s personality, relationships and circumstances. Treatment may include the provision of a secure environment, counselling, and the use of benzodiazepines and serotonin re-uptake inhibitors.

Our 5-year long campaign to reduce the stigmatisations of and discriminations against people with mental illnesses, launched as an outline endeavour in October 1998, is now in its third year. This update is intended to reveal that since 1998 we have been constructively busy and are poised to go public’ in major ways. We are now therefore appealing to the membership at large to join in the tasks. To this end we have been busy generating a tool kit that you may wish to draw upon and a series of proposed projects, some of which are already underway and some of which you may be able to pick up on or adapt for local purposes, in addition to any of your own initiatives.

Summary The free movement of doctors within the European Community demands harmonization of standards of medical practice and carries major implications of an undergraduate and postgraduate educational kind. These have begun to be addressed by the first three Medical Directives and also by a series of reports produced by the Advisory Committee on Medical Training to the European Community. This Committee was established in 1975 in order to provide informed agreed advice to the Commission. Many tasks remain to be tackled. A system of mutual inspection of the examination processes and standards in Member States should be established. Control must be exercised over the numbers of doctors produced since educational resources, including numbers of patients available for study, are limited. Thus, excellent standards of medical practice can only be developed and maintained if the primacy of clinical skills derived from the study of patients is recognized as essential in this respect. In some Member States at the present time there are many unemployed and therefore presumably deskilled doctors.

Eighteen psychiatric trainees from St George's Hospital were placed in three local general practices for periods of six months each. The aim was to broaden their postgraduate education by an experience of primary care and to test the feasibility of such a scheme. Their assessments of the placement were canvassed by postal questionnaire. All considered the experiment a success but there were a number of problems. Resistance among the trainees was much greater than expected. Some of the relationships in practice posed problems for them and the ongoing demands of their psychiatric training exceeded the practices' expectations. Supervision by the GP trainers was rated very highly and old knowledge returned rapidly.

AIM: To describe various symptoms other than pain among consecutive patients on the waiting list for possible coronary revascularisation in relation to estimated severity of chest pain. DESIGN: All patients were sent a postal questionnaire for symptom evaluation. SUBJECTS: All patients in western Sweden on the waiting list in September 1990 who had been referred for coronary angiography or coronary revascularisation (n = 904). RESULTS: 88% of the patients reported chest pain symptoms that limited their daily activities to a greater or lesser degree. Various psychological symptoms including anxiety and depression were strongly associated with the severity of pain (P < 0.001), as were sleep disturbances (P < 0.001), and dyspnoea and various psychosomatic symptoms (P < 0.001). Nevertheless only 44% of the patients reported chest pain as the major disruptive symptom, whereas the remaining 56% reported uncertainty about the future, fear, or unspecified symptoms as being the most disturbing. CONCLUSIONS: In a consecutive series of patients on the waiting list for possible coronary revascularisation, half the participants reported that uncertainty and fear were more disturbing than chest pain.

The theme of this book is the public's perception, often stigmatising, of mental illnesses and the impact this can have on compliance with pharmacological methods of treatment. This is considered in relation to strategies for tackling stigmatisation and related discrimination against medical

In October 1991 the then Secretary of State for Health, William Waldegrave, appointed Sir Bernard Tomlinson to act as adviser on health services in London. Early on it was agreed that Sir Bernard would also take account of the role of these services in teaching and research. Previous reports have focused on one or other aspect, e.g. the Todd Report (1966) and Flowers Working Party Report (1979) primarily considered teaching and research while the report of the London Health Planning Consortium (1979) mainly addressed provision of services. While the former two reports have been followed by extensive change in the organisation of medical academic activities in London, there has been much less change in health care delivery. For instance, primary care and community care are still seriously deficient in parts of London while high technology hospital based medical practice, sometimes providing a nationwide service, has survived and sometimes continued to develop in an entrepreneurial way. The problem is riven by academic and professional concerns of nationwide relevance and importance.

Medical practice can be reframed in terms of research and teaching, possessing and using the relevant knowledge, skills and attitudes. The doctor's curiosity and the diagnostic challenges of medical practice (and in particular of psychiatry) demand a capacity to think systematically, measure comprehensively and accurately and analyse the information obtained within the consultation as a preamble to management and treatment. The word ‘doctor’ means ‘teacher’ and the same communication skills are essential to both professions. Psychiatric practice is especially dependent upon them. They are also often essential for good clinical research.

Although converting-enzyme inhibition is of established value in the management of patients with severe chronic congestive heart failure, troublesome adverse reactions occur frequently during the course of treatment and may cause physicians to interrupt effective therapy. The three most common adverse reactions that are seen in patients with heart failure following treatment with captopril and enalapril (symptomatic hypotension, functional renal insufficiency, hyperkalaemia) are predictable consequences of interfering with the homeostatic functions of the renin-angiotensin system, which evolved millions of years ago to preserve life in sodium-depleted states. It is not surprising, therefore, that these untoward effects can be prevented or reversed by increasing the dietary intake of salt or reducing the dose of concomitantly administered diuretics; their occurrence rarely requires discontinuation of drug therapy. Recognition of this link between sodium balance and the adverse effects of converting-enzyme inhibition is important, because most patients with severe heart failure who experience such untoward reactions can nevertheless be expected to improve clinically during long-term therapy, if effective treatment is not interrupted.

Summary The communication skills basic to good medical practice are, for many of us, unnatural. The authors attempt to address aspects of the matter with particular reference to communication across ethnic boundaries.

Summary Seventeen anorexia nervosa patients were examined dentally and their dietary histories and eating habits studied. Analysis of the data confirmed earlier observations dental deterioration associated with anorexia nervosa. The deterioration included a pattern of enamel dissolution in cases of vomiting, regurgitation, and/or the consumption of large amounts of citrus fruits; and an altered caries response due to abnormal carbohydrate consumption. Despite the patient's probably insistent denial of 'anorectic' eating habits, the general practitioner should consider the existence of anorexia nervosa in the presence of such abnormal features, especially in young women. The relationship of these findings to larger populations with similar eating habits is discussed.

I took up my present appointment at St. George's Hospital Medical School in 1967 and found myself with friendly colleagues and a tradition of undergraduate teaching of psychiatry extending back to the immediate post-war period. This tradition had also been expressed in the textbook Psychological Medicine, written and revised over successive years by Guttman, Curran and Partridge, and in more recent years by Peter Storey, currently a senior colleague here. The book is hallmarked by its clarity of expression and the richness of its clinical observation, and has for long been a favourite with both undergraduates and postgraduates.

Communication is a major aspect of medical practice in such areas as the consultation, counselling, team work, management duties, health education and teaching. Many communication skills essential to the clinical consultation are different from those used in everyday life. They require an understanding of the doctor/patient relationship and of the self as well as of others. They also require a subserving repertoire of specific behavioural skills. The present paper sets out to emphasize this pervasive importance of communication skills in medical practice and to suggest some educational goals and objectives for those skills of particular relevance to the consultation. It describes one attempt to pursue these within the author's own school despite the piecemeal nature of such teaching. In Britain great emphasis is placed on the importance of clinical skills and this is reflected in the priority given to them in the final professional examination, and yet their communication aspects are rarely well defined within the curriculum or directly assessed. The author advocates the teaching and assessment of communication skills as a continuous process throughout undergraduate and postgraduate medical education for clinical practice.

Twenty-seven male anorexics have been followed up over 2–20 yr (mean 8 yr) and their outcome assessed. This has been compared with outcome in female patients with similar pictures at presentation ( Burns and Crisp , 1984). Features of the family and personal history and clinical aspects of the disease at presentation were compared with outcome and a number found to be significantly associated with it. Poor relationship with parents during childhood and the absence of normal adolescent sexual behavior and fantasy premorbidly were strongly predictive of a poor outcome. Long duration of illness, previous treatment and greater weight loss during illness were also associated with poor outcome, although no specific dietary behaviour was predictive. The remarkable similarity in outcome pattern between the male and female prompts re-evaluation of some theories of the nature of the role of sexual conflicts in anorexia nervosa.

Rate of weight gain, together with metabolic rate before and after a glucose meal, were studied in a group of 15 female anorexia nervosa patients as their weight was being restored to normal levels. The previously obese anoretic patients gained weight more rapidly, on the same food intake, than those who were of normal weight before their illness began. The increase in metabolic rate (as treatment progressed) was less in the previously obese patients, who also showed a tendency for the metabolic rate to increase less after a glucose meal than the patients with no history of obesity. The thermic effect of glucose was greater in patients with anorexia nervosa than in a comparable control group of six female students.

Psychiatry has expanded rapidly as a medical discipline in the last two decades but has not always been able to recruit sufficient young doctors of ability to its ranks. In view of recent governmental and professional reports on future medical practice we set up a study group comprising members from academic, NHS, sub-specialty, community and in-training psychiatry to examine the present tasks, attractions and constraints within a career in psychiatry and propose possible improvements for further consideration. In marrying these views to foreseeable developments we are sensitive to the requirement to take into account both the needs of the community and the job satisfaction of the future psychiatrist. To this end we indicate briefly our views concerning the attractions that a career in psychiatry currently has for the good graduate and ways in which the provision of interest and stimulation, educationally and professionally, can be increased so as to attract psychiatrists of high calibre both to general adult psychiatry and to areas of the specialist services which are at present unpopular. Finally, we propose a pattern of psychiatric services which we believe will embody both a useful and an attractive specialized job and interesting educational goal for future medical practitioners.

Ophthalmic outpatients without physical signs have been shown, as a group, to be significantly more anxious and depressed than a control group. They also have a higher incidence of somatic complaints of a kind commonly made by patients with psychiatric 'disorder'. There was a higher incidence of past psychiatric history in the proband group, and they also gave a greater subjective assessment of recent conscious life stress.

Summary The Eysenck Personality Inventory, the Middlesex Hospital questionnaire, and forearm blood-flow were used to measure aspects of psychological status in forty-one patients with the irritable bowel syndrome, who were compared in this respect with twenty-five matched psychoneurotic subjects and with a general population. The results show a positive association between psychoneurotic disorder and the irritable bowel syndrome.

Ophthalmologists of intelligence and experience should expect to play an active part in the educational life of their communities, by contributions to medical society programs, by sharing in discussions, or by talks before laymen. The writer or speaker who has no “literary phase” in his makeup will fail to present his testimony with due force. An interest in general literature of the better sort tends toward finer workmanship in medical writings. Robert Louis Stevenson, Michael Foster, and Thomas Henry Huxley are quoted as examples of elegance and clearness. The problems of ophthalmic journalism in the United States are discussed, and emphasis is laid upon the importance for physicians of training in literature and in foreign languages. Abbreviated from an address read before the Chicago Ophthalmological Society, January, 1928.

The Middlesex Hospital Questionnaire (M.H.Q.) is a brief self-rating inventory with eight questions on each of six scales—\`anxiety' (Anx), \`phobic' (Pho), \`obsessional' (Obs), \`somatic' (Som), \`depression' (Dep) and \`hysteria' (Hys). In the present study the M.H.Q. was administered to a sample of 778 persons, mainly between 40 and 65 years, who were on the list of a general practice. The distributions of scores obtained on each of the six scales are displayed. The locations of the means and the spread of the results are considered suitable for a measure designed for the detection of high scorers. Positive correlations with age are shown with the scores on the \`depression', and even more with the \`somatic' scales. The majority of scales produce higher scores with females, but the sex difference itself varies noticeably with age, being greater in the 50-54 age group. `Hysteria' apart, the scales all show a positive correlation with each other, varying from 0.28 to 0.56.

Behaviour therapy is conducted in this department under combined general psychiatric and behaviour therapist supervision. Patients considered suitable for behaviour therapy are first assessed clinically at a phenomenological and psychodynamic level. On the basis of this assessment an appropriate symptom or number of symptoms are selected for treatment by behaviour therapy. The patient is thereafter observed by the original clinician and assessed at regular intervals. Meanwhile the behaviour therapist treats the specific symptom or symptoms.

Summary Anorexia nervosa is best construed as a phobic avoidance response to the psychosocial maturational implications of adolescent weight. Within this state, surrender to the impulse to eat and consequent weight gain is associated with panic, depression and sometimes specific intense fear of loss of control. So long as the avoidance posture can be maintained the experience of such turmoil is largely avoided. Complicated ritualistic behaviour may arise to promote and secure the posture. However, its unrewarding and lonely nature still increasingly leaves the individual liable to the experience of depression. Established treatment procedures often assist recovery from the illness but intractable cases arise and it is amongst these that the majority of deaths occur either from inanition or suicide. The basis for the changes characteristically induced by leucotomy is complex. The procedure often leads to reduced tension and release of appetitive behaviour. This is taken to be due to some direct effect of the cerebral lesion and possibly the intervention may also be construed by some patients as a licence to behave differently. In patients with anorexia nervosa such appetitive release can be expected to promote considerable weight gain. However, the adverse psychological implications of such weight gain for the patient do not appear always to be so immediately or easily relieved. They may still experience panic, shame or depression and new patterns of social avoidance, or vomiting behaviour may develop. Intensive help of a psychotherapeutic and rehabilitative kind is then still required if the patient is to have the best chance of adjusting healthily to her newly found potential for a more normal nutritional status. Four patients who have undergone such treatment are described in this paper. It is concluded that leucotomy has a small but definite place in the treatment of patients with intractable anorexia nervosa.

IN CONTRAST to earlier investigators (Pardee, 1941; Stephens, 1941; Emmanuel, 1956) more recent workers (Crisp, 1965a, 1967; Oberdisse, Solbach & Zimmerman, 1965; Klinefelter, 1965; Crisp & Stonehill, 1967) have reported that some of their patients with anorexia nervosa have high serum cholesterol levels. Crisp (1965a, b, 1967) in a study of eighty patients (Nos. 1-80) has also emphasized that anorexia nervosa is predominantly a state of severe chronic carbohydrate starvation having its origins in the patient's phobia of and consequent need to avoid normal adolescent weight. Such patients who will have initially turned to eating supposedly 'non-fattening' foods such as as cheese, fruit, meat and salad, may later surrender to their increasing impulse to eat carbohydrate by having binges. They may start to vomit in relation to their binges and conceal and deny one or both these aspects. Usually such binges also alternate with phases when the patient stops eating altogether. Such cycles may recur every 24 hr or may span several weeks. These complex and often interrelating patterns of feeding make it more than usually difficult to assess the past dietary intake. Meanwhile, a further study by Crisp et al. (1967) has confirmed that thirty-seven female patients aged 14-33 with anorexia nervosa had significantly higher serum cholesterol levels (P

The conduct of this survey has brought home to us the great diversity which exists in the amount, content and methods of teaching psychiatry in U.K. medical schools today. No two schools are quite alike in the type of staff facilities, in the allocation of teaching time in the several years of the course, or in the persons available to act as teachers. After two trial runs, we evolved a schedule of inquiry which has enabled us to compare schools in a number of respects in which reasonably reliable and quantifiable data were available. This report necessarily concentrates upon those aspects in which the various schools can be compared with each other: it does not do justice to the full detail of all the teaching given in any one school. In particular, we have deliberately confined our attention to teaching which is given to all students, whether they take advantage of it or not. Except for some observations on organized periods of elective study, we have not dealt with the extra opportunities which arc available in a number of schools for students who go out of their way to seek additional experience in psychiatry. Our schedule of inquiry was discussed by one of us personally with the psychiatrist responsible for teaching in every school except one—a London part-time teacher who remained obdurately “too busy” to comply with this request. It was found necessary, in the majority of cases, to supplement our interview and the schedule return by further inquiries; in a few particulars, and in respect of certain schools, we are still left in some uncertainty as to the accuracy of the information given to us. This report is submitted, however, as the best approximation possible within the limitations of our survey.

Summary Serum gonadotrophins and gonadal steroids were measured in six unmarried female patients with anorexia nervosa before and during treatment by feeding and psychotherapy, which led to restoration of weight to matched population mean levels. In three patients whose premorbid weight was normal, hormonal levels during treatment were initially low, but as weight was regained gonadotrophic levels increased and one patient showed cyclical activity. In three other patients who were premorbidly obese gonodotrophic levels did not appear to increase over the period of investigation. With the exception of one patient whose menstrual cycles were resumed during the period of investigation, gonadal steroid levels in general appeared to remain low although, subsequently, regular monthly menstrual bleeding occurred in some of these patients.

Summary An initial clinical observation that patients with externally located cardiac pacemakers are more distressed and depressed than those with internally sited pacemakers has been confirmed. The total patient group is also characterized by its tendency to report that it does not worry about getting an incurable illness. At the same time, it is evident to others that it does have such an illness. Those patients who acknowledge that they did worry in this way were found to score significantly higher on several scales of a standardized psychoneurotic index than did the overall ‘pacemaker’ population. Possible reasons for the greater psychological distress displayed by the group of patients with external pacemakers are discussed.

Headache is a symptom referable to many causes other than ocular. The most important of these are briefly discussed, among others increased intracranial tension, nasal accessory sinuses, gastrointestinal disorders, neurologic causes, fatigue, and allergy. Headache is directly due to eyestrain in a large percentage of cases. The paper does not lend itself to abstracting. Read before the American Academy of Ophthalmology and Otolaryngology, in Cincinnati, on September 17, 1935, as part of a symposium on this subject.