Background: Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance first identified during pregnancy. Delays in diagnosis and challenges in management can lead to serious adverse outcomes for the mother and child. As rates of GDM diagnosis increase worldwide, health systems and maternity services have become increasingly strained, especially with new restrictions around in-person care due to the current COVID-19 pandemic. Mobile health (mHealth) has increasingly shown promise for management of chronic disease, driven by smartphone adoption and increased internet connectivity. The aim of this work is to evaluate the adoption and multidisciplinary care coordination of an mHealth platform called M♡THer in a cohort of women with first-time diagnosis of GDM Methods: A mHealth platform for GDM management was developed incorporating a smartphone application, clinician portal, and secure cloud data storage. Forty participants with a first-time diagnosis of GDM were recruited to use the app during their pregnancy. User attitudes from clinicians and women were captured through post-hoc surveys, and app-usage metrics. Results: Clinicians and women indicated satisfaction and ease of use of the mHealth platform, with some technological challenges around wireless connectivity. Blood glucose reviews and antenatal contact were higher with use of the M♡THer app as compared with a matched historical sample Conclusion: The M♡THer mHealth platform is a new comprehensive tool for healthcare of women with GDM, and may provide an effective new avenue to enhance multidisciplinary care in the face of COVID-19 disruptions and challenges to traditional care pathways.

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The objective of this research was to investigate a strategy for designing and fabricating computer-manufactured socket inserts that were embedded with sensors for field monitoring of limb-socket interactions of prosthetic users. An instrumented insert was fabricated for a single trans-tibial prosthesis user that contained three sensor types (proximity sensor, force sensing resistor, and inductive sensor), and the system was evaluated through a sequence of laboratory clinical tests and two days of field use. During in-lab tests 3 proximity sensors accurately distinguish between don and doff states; 3 of 4 force sensing resistors measured gradual pressure increases as weight-bearing increased; and the inductive sensor indicated that as prosthetic socks were added the limb moved farther out of the socket and pistoning amplitude decreased. Multiple sensor types were necessary in analysis of field collected data to interpret how sock changes affected limb-socket interactions. Instrumented socket inserts, with sensors selected to match clinical questions of interest, have the potential to provide important insights to improve patient care.

High activity may reduce fluid volume loss compared with low activity. Intermittent doffing may provide volume accommodation for transtibial prosthesis users with pin suspension. Clinical relevance Prosthetists should query their patients about the intensity of activity they conduct when advising them on limb volume management. Patients using sockets with pin suspension may be able to offset limb fluid volume loss by periodically doffing the prosthesis.

The purpose of this research was to conduct a preliminary effort to identify quantitative metrics to distinguish a good socket from an oversized socket in people with trans-tibial amputation. Results could be used to inform clinical practices related to socket replacement. A cross-over study was conducted on community ambulators (K-level 3 or 4) with good residual limb sensation. Participants were each provided with two sockets, a duplicate of their as-prescribed socket and a modified socket that was enlarged or reduced by 1.8 mm (~6% of the socket volume) based on the fit quality of the as-prescribed socket. The two sockets were termed a larger socket and a smaller socket. Activity was monitored while participants wore each socket for 4wk. Participants’ gait; self-reported satisfaction, quality of fit, and performance; socket comfort; and morning-to-afternoon limb fluid volume changes were assessed. Visual analysis of plots and estimated effect sizes (measure as mean difference divided by standard deviation) showed largest effects for step time asymmetry, step width asymmetry, anterior and anterior-distal morning-to-afternoon fluid volume change, socket comfort scores, and self-reported measures of utility, satisfaction, and residual limb health. These variables may be viable metrics for early detection of deterioration in socket fit, and should be tested in a larger clinical study.

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A prosthesis user may also make more frequent sock adjustments if fit is not right, or he/she may doff the prosthesis more often or longer to allow fluid volume recovery and offset daily volume loss. How prosthesis users feel about their socket fit and how they accommodate volume changes is important information for practitioners treating patients with limb loss. Practitioners traditionally use self-report information during clinical visits to educate the patient about accommodation methods, make socket adjustments, and determine when a new prosthesis is needed. However, information collected by self-report may be affected by issues such as recall, perception, and social desirability. 3.4 As a result, the practitioner may have to try several different adjustments in order to correct comfort and fit problems. This iterative approach to solving socket fit issues can be time consuming, costly, and potentially detrimental to the prosthesis user's residual limb health. Electronic sensors have been developed to monitor prosthesis use and provide practitioners and patients with an objective record of wear. 5,6 Proximity sensors mounted to the socket brim or embedded within the socket wall have been used previously to detect the presence of the residual limb within the socket. The sensors produced reliable data but consumed too much power to be practical for long-term field use. The purpose of this study was to extend from prior work and develop a portable sensor that measured when the prostheses was donned and doffed and that was capable of long-term (i.e., 2-wk) monitoring. We tested hypotheses that there would be no significant differences between self-report and electronically recorded start of day, end of day, and day durations, and that weekly prosthesis use would differ from weekend prosthesis use among people with transtibial amputation. We also characterized the frequency of socket releases and their durations, as well as doff durations for sock changes using the electronic sensor. From self-report data, we characterized start-of-day sock thicknesses and frequency of sock changes.