Evaluation of Mucociliary Clearance by Three Dimension Micro-CT-SPECT in Guinea Pig: Role of Bitter Taste Agonists

Different image techniques have been used to analyze mucociliary clearance (MCC) in humans, but current small animal MCC analysis using in vivo imaging has not been well defined. Bitter taste receptor (T2R) agonists increase ciliary beat frequency (CBF) and cause bronchodilation but their effects in vivo are not well understood. This work analyzes in vivo nasal and bronchial MCC in guinea pig animals using three dimension (3D) micro-CT-SPECT images and evaluates the effect of T2R agonists. Intranasal macroaggreggates of albumin-Technetium 99 metastable (MAA-Tc99m) and lung nebulized Tc99m albumin nanocolloids were used to analyze the effect of T2R agonists on nasal and bronchial MCC respectively, using 3D micro-CT-SPECT in guinea pig. MAA-Tc99m showed a nasal mucociliary transport rate of 0.36 mm/min that was increased in presence of T2R agonist to 0.66 mm/min. Tc99m albumin nanocolloids were homogeneously distributed in the lung of guinea pig and cleared with time-dependence through the bronchi and trachea of guinea pig. T2R agonist increased bronchial MCC of Tc99m albumin nanocolloids. T2R agonists increased CBF in human nasal ciliated cells in vitro and induced bronchodilation in human bronchi ex vivo. In summary, T2R agonists increase MCC in vivo as assessed by 3D micro-CT-SPECT analysis

Improving Global Education and Outcome Evaluation in Orthopaedic Trauma Surgery

This thesis explored how to improve global education and outcome evaluation in orthopaedic trauma. The aims of this thesis were to: (1) Highlight efforts to improve education in global orthopaedic trauma surgery and better understand the timeline and techniques for knowledge and skill transfer, and (2) Investigate a framework for understanding injury-related variation in longer-term patient reported outcome after musculoskeletal trauma. In the first part of this thesis, we focused on education in global orthopaedic trauma. First, we highlighted the value of assessing injury burden and variations in practice patterns, and illustrated how this relates to performing needs assessments in a low-income country. Then, we described the role of continuing medical education programs in low-income countries and applicability to both knowledge and skill transfer. In the second part of this thesis, we focused on improving outcome evaluation in orthopaedic trauma patients