Health Care Professionals' Attitudes Toward, and Experiences of Using, a Culture-Sensitive Smartphone App for Women with Gestational Diabetes Mellitus: Qualitative Study.

BACKGROUND: The increasing prevalence of gestational diabetes mellitus (GDM) among women of different ethnic backgrounds provides new challenges for health care professionals, who often find it difficult to provide information about the management of this disease to such individuals. Mobile health (mHealth) may act as a useful tool for blood sugar control and care process enhancement. However, little is known about health care professionals' experiences and attitudes toward the use of mHealth for women with GDM. OBJECTIVE: The aim of this study was to explore how health care professionals perceived the provision of care to pregnant women who managed their GDM using the culture-sensitive Pregnant+ app in a randomized controlled trial. METHODS: Individual interviews with 9 health care professionals providing care for women with GDM were conducted. Braun and Clark's method of thematic content analysis inspired the analysis. This study included health care professionals who were primarily responsible for providing care to participants with GDM in the Pregnant+ randomized controlled trial at 5 diabetes outpatient clinics in Oslo, Norway. RESULTS: Health care professionals perceived mHealth, particularly the Pregnant+ app, as an appropriate tool for the care of women with GDM, who were described as individuals comprising a heterogeneous, motivated group that could be easily approached with health-related information. Some participants reported challenges with respect to provision of advice to women with different food cultures. The advantages of the Pregnant+ app included provision of information that women could access at home, the information provided being perceived as trustworthy by health care professionals, the culture sensitivity of the app, and the convenience for women to register blood sugar levels. Technical problems, particularly those associated with the automatic transfer of blood glucose measurements, were identified as the main barrier to the use of the Pregnant+ app. Strict inclusion criteria and the inclusion of participants who could not speak Norwegian were the main challenges in the recruitment process for the randomized controlled trial. CONCLUSIONS: The findings of this study suggest that mHealth is a useful tool to enhance the care provided by health care professionals to women with GDM. Future mobile apps for the management of GDM should be developed by a trustworthy source and in cooperation with health care professionals. They should also be culture sensitive and should not exhibit technical problems.

Evaluation of porphyrin loaded dry alginate foams containing poloxamer 407 and ß-cyclodextrin-derivatives intended for wound treatment.

Dry alginate foams intended for antibacterial photodynamic therapy (aPDT) of infected wounds were prepared. aPDT is a treatment modality involving light of appropriate wavelength, oxygen and a photosensitizer (PS) to produce radicals that attack biological targets (e.g. bacteria). The hydrophobic 5,10,15,20-tetrakis(4-hydroxyphenyl)porphyrin (THPP) was chosen as a model PS and loaded into the foams. The foams contained a poloxamer (Pluronic F127) and/or ß-cyclodextrin (ßCD)-derivatives, i.e. methylßCD (MßCD), heptakis(2,6-di-O-methyl)-ßCD (HkßCD) or hydroxypropylßCD (HPßCD).The physical characteristics of the various foams prepared and the THPP load, release and photostability were evaluated. All the foams were thin and flexible and could easily be handled and cut to fit a potential wound. Fast disintegration were observed for dry foams in water or phosphate buffered saline, while in Hanks' balanced salt solution the foams absorbed liquid without losing their integrity. All the foams had a similar THPP load of 0.12-0.13% w/w. The presence of ßCD-derivatives improved THPP release, however, no differences were observed between the different types of ßCD-derivatives evaluated. THPP loaded into the foams was photolabile, which induced a color change combined with fading. Alginate foams formulated with PF127, ßCD-derivatives and THPP demonstrated applicability as delivery vehicles for PSs in aPDT of wounds.

3D Cell Culture in Alginate Hydrogels.

This review compiles information regarding the use of alginate, and in particular alginate hydrogels, in culturing cells in 3D. Knowledge of alginate chemical structure and functionality are shown to be important parameters in design of alginate-based matrices for cell culture. Gel elasticity as well as hydrogel stability can be impacted by the type of alginate used, its concentration, the choice of gelation technique (ionic or covalent), and divalent cation chosen as the gel inducing ion. The use of peptide-coupled alginate can control cell-matrix interactions. Gelation of alginate with concomitant immobilization of cells can take various forms. Droplets or beads have been utilized since the 1980s for immobilizing cells. Newer matrices such as macroporous scaffolds are now entering the 3D cell culture product market. Finally, delayed gelling, injectable, alginate systems show utility in the translation of in vitro cell culture to in vivo tissue engineering applications. Alginate has a history and a future in 3D cell culture. Historically, cells were encapsulated in alginate droplets cross-linked with calcium for the development of artificial organs. Now, several commercial products based on alginate are being used as 3D cell culture systems that also demonstrate the possibility of replacing or regenerating tissue.

Ionically gelled alginate foams: physical properties controlled by type, amount and source of gelling ions.

A new and flexible method for preparation of dry macroporous alginate foams with the capability of absorbing physiological solutions has been developed, which may find use within areas such as wound healing, cell culture, drug delivery and tissue engineering. The present study demonstrates how the gelation rate of the alginate and degree of ionic crosslinking can be utilized to control the physical foam properties. The rate of released Ca(2+)/Sr(2+) gelling ions available for interaction with the alginate was influenced by the concentration and physical characteristics of CaCO3/SrCO3 particles. The method of preparation of such foams allows, as described herein, tailoring of the pore structure, hydration properties and mechanical integrity in a manner not possible by other techniques.

In situ gelation for cell immobilization and culture in alginate foam scaffolds.

Essential cellular functions are often lost under culture in traditional two-dimensional (2D) systems. Therefore, biologically more realistic three-dimensional (3D) cell culture systems are needed that provide mechanical and biochemical cues which may otherwise be unavailable in 2D. For the present study, an alginate-based hydrogel system was used in which cells in an alginate solution were seeded onto dried alginate foams. A uniform distribution of NIH:3T3 and NHIK 3025 cells entrapped within the foam was achieved by in situ gelation induced by calcium ions integrated in the foam. The seeding efficiency of the cells was about 100% for cells added in a seeding solution containing 0.1-1.0% alginate compared with 18% when seeded without alginate. The NHIK 3025 cells were allowed to proliferate and form multi-cellular structures inside the transparent gel that were later vital stained and evaluated by confocal microscopy. Gels were de-gelled at different time points to isolate the multi-cellular structures and to determine the spheroid growth rate. It was also demonstrated that the mechanical properties of the gel could largely be varied through selection of type and concentration of the applied alginate and by immersing the already gelled disks in solutions providing additional gel-forming ions. Cells can efficiently be incorporated into the gel, and single cells and multi-cellular structures that may be formed inside can be retrieved without influencing cell viability or contaminating the sample with enzymes. The data show that the current system may overcome some limitations of current 3D scaffolds such as cell retrieval and in situ cell staining and imaging.

Storage of oral fluid as dried spots on alginate and chitosan foam - a new concept for oral fluid collection.

BACKGROUND: In recent years, there has been a major focus on analyzing drug substances from dried µl volumes of biological fluids, commonly known as dried matrix spotting. RESULTS: 10 µl oral fluid, spiked with five basic drugs, was collected and stored as dried spots on alginate and chitosan foam, and subsequently dissolved; the drugs were thereafter isolated with electromembrane extraction and analyzed by LC-MS. The correlation coefficients were above 0.9885 for all drugs in the range 25-1000 ng/ml. The reported RSD values were below 15%. CONCLUSION: Storage of oral fluid as dried spots on alginate and chitosan foam have been investigated for the first time. The extract obtained after electromembrane extraction was directly compatible with LC-MS, and apparently free from coextracted matrix components.

Ionically gelled alginate foams: physical properties controlled by operational and macromolecular parameters.

Alginates in the format of scaffolds provide important functions as materials for cell encapsulation, drug delivery, tissue engineering and wound healing among others. The method for preparation of alginate-based foams presented here is based on homogeneous, ionotropic gelation of aerated alginate solutions, followed by air drying. The method allows higher flexibility and better control of the pore structure, hydration properties and mechanical integrity compared to foams prepared by other techniques. The main variables for tailoring hydrogel properties include operational parameters such as degree of aeration and mixing times and concentration of alginate, as well as macromolecular properties such as the type of alginate (chemical composition and molecular weight distribution). Exposure of foams to γ-irradiation resulted in a dose-dependent (0-30 kGy) reduction in molecular weight of the alginate and a corresponding reduction in tensile strength of the foams.