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Having two systems of psychiatric diagnosis creates unnecessary confusion therefore it would be desirable to achieve increased consistency between ICD-11 and DSM-5. Unfortunately, however, DSM-5 has included many controversial suggestions that have weak scientific support and insufficient risk–benefit analysis. As a result ICD-11 should learn from the DSM-5 mistakes rather than repeating them.
The in situ ion irradiation capability of Argonne’s HVEM-Tandem User Facility has been employed to study effects of 1.5 MeV Kr+ irradiation and 300 kV electron irradiation on the crystallization of as-deposited and of partially crystallized 40 nm thick films of CoSi2. Ion fluxes ranged from 8.5×1014 to 6.8×1015 m−2s−1 for which beam heating effects may be neglected. The maximum electron flux at 300 kV was 0.8×1023 m−2S−1. The maximum temperature at which crystalline CoSi2 is amorphized by the ion irradiation of flux = 6.8×1015 m−2s−1 is between 250 and 280 K. At higher temperatures amorphous material crystallizes by growth of any preexisting crystals and by classical nucleation and growth, with radial growth rates which are proportional to ion flux. The average degree of transformation per ion is 4×10−26 m3 per ion. Thermally induced crystallization of as-deposited films occurs above approximately 420 K. For ion doses at least as low as 3.4×1016 m−2 ion irradiation at 300 K promotes thermal crystallization at 450 K, by virtue of enhanced apparent nucleation and at large doses, by enhanced growth rate.
Royal College of Obstetricians and Gynaecologists (RCOG)
Setting standards to improve women's health is the core philosophy ofthe Royal College of Obstetricians and Gynaecologists. This theme is central to our principal functions of training and standard setting in obstetrics and gynaecology. The organisation has almost 12000 Members and Fellows and just under 50% work outside the UK. Members work in 90 separate countries and the potential network of influence is considerable. This article will focus on issues of training and development delivered under the auspices of the RCOG but developed specifically for the under-resourced areas where Millennium Development Goals 4 and 5 present major challenges.
Historically, many postgraduate doctors came to the UK to work and train within the NHS. Such an experience was not time limited and often provided the trainee with a skewed experience of the discipline. Successful trainees would return home with new clinical and management skills and a postgraduate examination certificate. Membership of the RCOG would enable such doctors to develop a lifelong relationship with the facilities of the college.
However, recently such opportunities have decreased owing to a rapid expansion of British medical graduates. Opportunities, coordinated by the RCOG, now allow a limited number of overseas doctors to work under supervision for up to 2 years. It is anticipated that shortly some more senior doctors will come to the UK for exposure to subspecialty and special interest work. Such experiences allow the trainers to become part of a competency-based training assessment process.
The DSM–V development process started with a grand ambition to provide a ‘paradigm shift’ in psychiatric diagnosis, based initially on the identification of biological markers. This is clearly unattainable, and so energy has now been diverted into developing other major changes, including the development of dimensional ratings and the formal diagnosis of prodromal and subthreshold disorders. It is argued that this process could lead to false positive ‘epidemics’ with harmful excessive treatments. The better, more modest, alternative is to reassess the text descriptions of the disorders and join with ICD–11 in creating a single nested system for both DSM–V and ICD–11.
Dysthymia has been reconceptualised in recent years from a personality disorder to a chronic affective disorder. It is incorporated into both the DSM and ICD diagnostic systems. Method. The members of the WPA Dysthymia Working Group combined the results of their manual literature searches with a search using Medline.
Available data are summarised under the headings of classification, epidemiology, validity, comorbidity, course and outcome, pharmacotherapy and psychotherapy. The coexistence of major depressive disorder, constituting ‘double depression’ is of particular importance.
Improved knowledge of this disorder has led to a more positive approach to treatment, in which antidepressants can usefully be complemented by psychosocial measures. A high proportion of cases remain unrecognised in most populations, leading to prolonged morbidity and distress, much of which is now treatable.
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