999 resultados para Formation continue médecins de famille


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The influence of premetallization surface preparation on the structural, chemical, and electrical properties of Au-nGaN interfaces has been investigated by x-ray photoemission spectroscopy (XPS), current-voltage measurement (I-V) and cross-section transmission electron microscopy (TEM). XPS analysis showed that the three GaN substrate treatments investigated i.e., ex situ hydrofluoric acid etch, in situ anneal in ultrahigh-vacuum (UHV), and in situ Ga reflux cleaning in UHV result in surfaces increasingly free of oxygen contamination. XPS and TEM characterization of Au-nGaN formed after the three premetallization surface treatments show that HF etching and UHV annealing produce abrupt, well-defined interfaces. Conversely, GaN substrate cleaning in a Ga flux results in Au/GaN intermixing. I-V characterization of Au¿nGaN contacts yields a Schottky barrier height of 1.25 eV with a very low-ideality factor and very good contact uniformity for the premetallization UHV anneal, while the Ga reflux cleaning results in a much lower barrier (0.85 eV), with poor ideality and uniformity. I-V and XPS results suggest a high density of acceptor states at the surface, which is further enhanced by UHV annealing. These results are discussed in the context of current models of Schottky barrier formation.

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The reggie/flotillin proteins are implicated in membrane trafficking and, together with the cellular prion protein (PrP), in the recruitment of E-cadherin to cell contact sites. Here, we demonstrate that reggies, as well as PrP down-regulation, in epithelial A431 cells cause overlapping processes and abnormal formation of adherens junctions (AJs). This defect in cell adhesion results from reggie effects on Src tyrosine kinases and epidermal growth factor receptor (EGFR): loss of reggies reduces Src activation and EGFR phosphorylation at residues targeted by Src and c-cbl and leads to increased surface exposure of EGFR by blocking its internalization. The prolonged EGFR signaling at the plasma membrane enhances cell motility and macropinocytosis, by which junction-associated E-cadherin is internalized and recycled back to AJs. Accordingly, blockage of EGFR signaling or macropinocytosis in reggie-deficient cells restores normal AJ formation. Thus, by promoting EGFR internalization, reggies restrict the EGFR signaling involved in E-cadherin macropinocytosis and recycling and regulate AJ formation and dynamics and thereby cell adhesion.

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Background: Bacteria form a biofilm on the surface of orthopaedic devices, causing persistent and infection. Little is known about biofilms formation on bone grafts and bone substitutes. We analyzed various representative materials regarding their propensity for biofilm formation caused by Staphylococcus aureus.Methods: As bone graft beta-tricalciumphosphate (b-TCP, CyclOsTM) and as bone substitute a tantalum metal mesh (trabecular metalTM) and PMMA (Pala-cosTM) were investigated. As test organism S. aureus (strain ATCC 29213) was used. Test materials were incubated with bacterial solution of 105 colony-forming units (cfu)/ml at 37°C for 24 h without shaking. After 24 h, the test materials were removed and washed 3 times in normal saline, followed by sonication in 50 ml Ringer solution at 40 kHz for 5 minutes. The resulting sonication fluid was plated in aliquots of 0.1 ml onto aerobe blood agar with 5% sheep blood and incubated at 37°C with 5% CO2 for 24 h. Then, bacterial counts were enumerated and expressed as cfu/ml. All experiments were performed in triplicate to calculate the mean ± standard deviation. The Wilcoxon test was used for statistical calculations.Results: The three investigated materials show a differing specific surface with b-TCB>trabecular metal>PMMA per mm2. S. aureus formed biofilm on all test materials as confirmed by quantitative culture after washing and sonication. The bacterial counts in sonication fluid (in cfu/ml) were higher in b-TCP (5.1 x 106 ± 0.6 x 106) and trabecular metal (3.7 x 106 ± 0.6 x 106) than in PMMA (3.9 x 104 ± 1.8 x 104), p<0.05.Conclusion: Our results demonstrate that about 100-times more bacteria adhere on b-TCP and trabecular metal than on PMMA, reflecting the larger surface of b-TCP and trabecuar metal compared to the one of PMMA. This in-vitro data indicates that bone grafts are susceptible to infection. Further studies are needed to evaluate efficient approaches to prevent and treat infections associated with bone grafts and substitutes, including modification of the surface or antibacterial coating.

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Jusqu'à aujourd'hui la recherche en psychothérapie a essentiellement exploré quatre questions clés : 1) la psychothérapie est-elle efficace?; 2) quelle forme de psychothérapie est la plus efficace ? ; 3) quelle forme de psychothérapie est efficace pour quel patient? et 4) qu'est-ce qui permet à la psychothérapie d'être efficace? Si l'efficacité de la psychothérapie est désormais reconnue, la recherche empirique n'a jamais permis de désigner une approche psychothérapeutique comme étant la plus efficace de toutes. Les questions de l'indication différentielle des formes de psychothérapie selon les pathologies, et celles concernant les processus de la thérapie, qui permettraient d'en prédire le résultat, n'ont pas trouvé à ce jour de réponse définitive.

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Morphologically differentiated Spodosols usually occur in the Coastal Plain of the South of Bahia and North of Espírito Santo. They are found in profiles known as "muçungas", i.e. sandy soils that accumulate water. In these areas, two kinds of Spodosols, different from those in the Restinga area, can be found: Spodosols with E albic horizon (white muçunungas) and without this horizon (black muçunungas). Eight soil profiles with spodic characteristics were collected and described in order to evaluate differences in the formation process of Barreiras and Restinga Spodosols in the South of Bahia. The soil profiles were also characterized chemically, physically and mineralogically. Additionally, texture and chemical analysis, Fe and Al extraction by sodium dithionite-citrate-bicarbonate (DBC), acid ammonium oxalate and sodium pyrophosphate, ammonium oxalate extract optic density (DOox), sulphuric acid attack, and X ray difractometry of the clay fraction were performed. In the Spodosols of the Barreiras area, fragipan was found the spodic layers. Cemented B spodic horizon were observed in the white muçunungas, and granular structure and dark color from the surface in the black muçunungas. There was no fragipan or hard spodic horizon in the Restinga Spodosol. This soil is acid, dystrophic and alic, with sandy texture and high clay percentages in the spodic horizons. The CEC, based on H + Al, is predominantly represented by the organic matter. The most representative components of the mineral phase of the clay fraction are kaolinite and possibly vermiculite traces with interlayered hydroxy. Chemical, physical, morphological and mineralogical differences were observed between the Barreiras and Restinga environments. The black and white muçunungas differ in morphologic and chemical properties only.

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Summary Skin, and more precisely the epidermis, plays a crucial role in our survival since it constitutes our first line of defense against our environment. A subtle equilibrium between proliferation and differentiation of keratinocytes, the main epidermal cell type, provides a continous self-renewal of the epidermis, maintaining the integrity of this protective barrier. It is now well established that pertubation of the normal balance between proliferation and differentiation can induce development of several diseases including cancer. The aim of my thesis was first to characterize new genes involved in the differentiation process of keratinocytes and the formation of the epidermis. We show that cornulin, encoded by the c1orf10 gene, is a new marker of epidermal differentiation, mainly expressed in the suprabasal layers of the epidermis. Structurally, cornulin belongs to the "fused genes" protein family and contains a functional calcium-binding domain as well as two repeated sequences of 60 amino acids, the function of which remain unknown. The second part of my work aimed to identify new proteins interacting with CYLD. When mutated, CYLD is responsible for cylindromatosis, a predisposition to benign tumors of skin appendages mainly located on the scalp. CYLD is implicated in the NF-κB signalling pathway. We have identified HBO1 and p30, two nuclear proteins, as potential CYLD partners. Since CYLD was described as a negative regulator of NF-icB-mediated transcription, we have tested the putative effect of HBO1 and p30 on the regulation of this signalling pathway. We have shown that only HBO1 is able to inhibit NF-κB-mediated transactivation. The mechanism of action of HBO1 is still under investigation but our results suggest that an unknown cofactor is involved in this process. Résumé La peau est cruciale à notre survie car elle est notre première ligne de défense contre notre environnement. L'épiderme qui forme cette barrière protectrice entre le corps et l'environnement extérieur est continuellement renouvelé suite aux agressions physiques, chimiques et biologiques répétées qu'il subit. Le but de ce renouvellement étant de garantir l'intégrité de cette barrière. Le keratinocyte est le principal type cellulaire trouvé dans l'épiderme. La formation d'une barrière active dépend essentiellement de la faculté des kératinocytes à proliférer et à se différencier. Il est aujourd'hui admis que tout déséquilibre entre l'activité de prolifération et de différenciation des kératinocytes est la cause du développement de plusieurs maladies, dont certains cancers. Le but de ce travail de thèse était, dans un premier temps d'identifier ou de caractériser de nouveaux gènes impliqués dans le processus de différenciation afin de mieux comprendre la formation de l'épiderme. Noús avons ainsi démontré que la cornulin, produit du gène c1orf10, est un nouveau marqueur de la différenciation épidermique, principalement exprimé dans les couches suprabasales de l'épiderme. D'un point de vue structural, nous avons montré que cette protéine appartient à la famille des « fused gene » et qu'elle possède un domaine de liaison au calcium qui est fonctionnel et deux séquences répétées de 60 acides aminés dont la fonction est encore inconnue. La seconde partie de cette thèse était dédiée à l'étude de la cylindromatose, une prédisposition génétique à la formation de tumeurs bénignes, principalement localisées sur la tête et due à des mutations du gène CYLD. Nous avons cherché de nouvelles protéines qui interagissent avec CYLD afin de mieux caractériser les voies de signalisation impliquées dans le développement de la maladie. Nous avons ainsi identifiés deux nouveaux partenaires potentiels de CYLD ; HBO1 et p30 CYLD ayant été décrit comme un régulateur négatif de la transcription médiée par NF-κB; nous avons testé l'implication de HBO1 et p30 au niveau de cette activité transcriptionnelle. Nous montrons que seul HBO1 est capable d'inhiber la transactivation d'un gène rapporteur régulé par NF-κB. Le mécanisme d'action de HBO1 n'est pas encore connu, néanmoins nos résultats suggèrent l'intervention d'un cofacteur qui reste à déterminer.

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The authors are discussing the results of the international literature with regards to referrals between ambulatory physicians. There are still few studies on this problem and the methodologies used are often too different to make valid comparisons. However, the earned results suggest more questions than they give answers to the determinants of the referral process. This can be explained by the multidimensionality of factors which are involved in the decision to refer a patient to another practitioner, particularly by the complex interaction between the characteristics of each patient, practitioner and the sanitary system itself.

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Cet article présente une pratique de consultation psychanalytique développée par des psychologues tra- vaillant en milieux éducatifs et pédagogiques. Les auteurs se réfèrent à des concepts issus de l'école de psychanalyse britannique de la relation d'objet pour monter comment le processus de «présence théra- peutique » peut améliorer et enrichir les interventions en milieu scolaire. Les bénéfices engendrés par une « présence thérapeutique » sur les lieux scolaires et éducatifs et les défis rencontrés seront discutés. Des illustrations cliniques ainsi que des exemples issus de notre pratique avec les enfants, leur famille et les professionnels de l'enfance, que ce soit dans les écoles primaires et secondaires, les garderies, les services spécialisés ou les lieux de formation serviront d'illustration des concepts théoriques présentés.