WO2022229931A1

WO2022229931A1 - Wearable medication adherence and patient monitoring device

Info

Publication number: WO2022229931A1
Application number: PCT/IB2022/054012
Authority: WO
Inventors: Dawn PRICE
Original assignee: Price Dawn
Priority date: 2021-04-29
Filing date: 2022-04-29
Publication date: 2022-11-03
Also published as: GB202318024D0

Abstract

A wearable device for wearing by a patient in receipt of medication, comprising components of a medication and patient monitoring unit (MPMU) including: an interactive visual display unit (VDU), an interactive audio platform (AP) and a plurality of sensor units (SUs); and comprising components of an operating unit (OU) including: a processing unit (CPU) and memory, a wireless communication unit (WCU), a power supply unit (PSU) and an energy storage unit (ESU) wherein a plurality of sensor units comprises at least one dehydration sensor unit (DHSU).

Description

WEARABLE MEDICATION ADHERENCE AND PATIENT MONITORING DEVICE This disclosure relates to a wearable medication adherence and patient monitoring device (MPM) for supporting a patient in receipt of medication treatment, more particularly for improving a healthcare outcome of the patient, through improved medication adherence (MA), a method for the manufacture thereof, the use thereof, in particular in a method for supporting a patient in receipt of medication treatment, a data processing system and network communication system comprising the device and associated aspects. Background The single most important healthcare intervention for treating and preventing disease conditions in the UK and elsewhere is providing medicines. Despite this, the World Health Organisation estimates that worldwide 50% of people do not take medications as intended (indicated as non-adherence, NA); and that NA accounts for 57% of an estimated US$500Bn wasted from suboptimal medications use. NA is also a frequent cause of impairment, hospitalisation, increased morbidity and mortality including higher risk of suicide, longer time to remission, psychiatric emergencies, poor mental performance and low satisfaction with life. Any single one of these outcomes should be considered to be unsafe practice and a failure of effective medication treatment. There is a need to support patients in managing medications, and most urgently patients managing multiple medications, and those with multiple conditions, memory problems, a learning difficulty or age-related challenges. The scale of this problem was reported in a study in 2017 which identified that in the UK, 49% of older people over 65 years are taking 5 or more medicines a day (20+ doses per day). The MaPPs system (Medicines: A Patient Profile Summary) is used by healthcare to support patients with medication. Healthcare staff register patients onto the MaPPs system that creates a bespoke patient account detailing the patient’s medications and information including what the medication is and what it has been prescribed for, how to take it, possible SEs and warnings and cautions. Nevertheless, a patient taking medication is at risk of deterioration in physical or mental wellbeing (PPMW) which may be due to NA, a SE or ADR, inappropriate medication or an unrelated factor, and of which the patient may be unaware, or if aware, the patient may fail to self-manage or may self-manage incorrectly. It is an object of the present disclosure to provide personalised technology for patients in receipt of medication, to promote medication adherence, for example in case that a patient is rationally or intentionally or is unintentionally failing to adhere to medication. It is a further object to provide personalised technology for a patient to promote patient safety, for example to identify whether a patient is experiencing a deterioration in physical or mental wellbeing (PPMW); more particularly to identify whether a deterioration in PPMW is due to NA, a SE or ADR, inappropriate medication or an unrelated factor; and yet more particularly to identify or facilitate in identifying whether a deterioration in PPMW can be addressed by patient self-management, or requires medication review, and the urgency of such review. Medication monitoring in clinical practice is currently delivered with patients attending periodic review appointments. Current practice relies on a rolling review system. There is a need to identify patients in need of urgent medication review in order to free up clinic, staff and facility time currently taken up with patients satisfactorily managing appropriate medication. Preferably the technology enables patients to live independently as they wish within their own homes and beyond, transforms medication review pathways and provides support for early intervention that prevents decline or deterioration in PPMW. Summary Aspects of this disclosure provide a personalised device and systems to encourage medication adherence (MA) and/or promote patient safety, by providing for the patient a clearer picture of medication and of MA incorporated as a marker (marker-of-self (MoS)) of medication actually taken, and/or by providing for the patient a clearer picture of satisfactory management of appropriate medication (self-treatment) derived from monitoring by means of the device, patient markers of MA and patient markers of physical and mental wellbeing (PPMW) and distinguishing risk, onset or incidence of NA, SE or ADR, more particularly permitting timely detection thereof and where necessary providing for intervention with appropriate corrective measures, for example patient measures or HP measures. Healthcare professionals (HP) frequently unnecessarily change or discontinue medication, increase dose or add concomitant medication to address what appears to be a poor medication response in a patient who in reality has an adherence problem. Such unnecessary prescribing is a potential risk to patient safety. Thus, devices and systems herein are configured to fundamentally support de-prescribing, that is to say reducing or stopping medication that may no longer be of benefit or may be causing harm. It is an object of the invention to distinguish risk, onset or incidence of NA, including under-medication or over-medication, SE or ADR, inappropriate mediation of other PPMW concern. We have found that markers of PPMW might identify a deterioration in PPMW but without identifying as resultant or as causal. We have moreover found that a triangulation approach enables the ranking or categorising of resultant deterioration and causal deterioration. We have more particularly found that fundamental to this is the triangulation of markers including markers of dehydration, more particularly markers including dehydration and at least 2 of patient voice, patient visual appearance or behaviour, and vital signs markers including heart rate or pulse (HR), body temperature (BT and breathing or respiration rate (RR). When a patient is feeling thirsty, their body is likely already dehydrated, because thirst mechanism lags behind actual level of hydration. Losing body water without replacing it results in the blood becoming more concentrated. This causes the heart rate to increase to maintain blood pressure, and it triggers kidneys to retain water (hence, decreased urination). Thus although dehydration is causal, a patient may be aware of increase in heart rate, which is in fact resultant, before being aware of feeling thirsty. This can result in incorrect corrective measures being taken, and indeed incorrect medication being prescribed. Less water in a patient’s system also hinders the body’s ability to regulate temperature, which can lead to hyperthermia, or a body temperature that’s well above normal. And because fluid levels in the brain lower, they affect mood, memory and coordination. Thus although dehydration is causal, a patient may initially be aware of increase in body temperature, or problems with mood, memory and coordination may be observed, which are in fact resultant, before being aware of feeling thirsty. This can result in incorrect corrective measures being taken, and indeed incorrect medication being prescribed. Dehydration can be relatively easily corrected by patient self-management including taking in fluids and rehydrating, however is more dangerous in the elderly who may have cognitive impairments and swallowing difficulties, whereby self-treatment rehydrating can be difficult, and can be fatal if a patient can’t rehydrate and dehydration becomes extreme. Dehydration may be induced by one of a number of medications, notably diuretic drug groups. Statistics indicate that 7% of UK acute hospital admissions are due to 4 diuretic drug groups (BP tablets, diuretics, kidney medications and gastric bleed medications). According to a first aspect there is provided a wearable device for wearing by a patient in receipt of medication, comprising an attachment unit (AU) configured to be secured, or for securing, to a patient and comprising components of a medication and patient monitoring unit (MPMU) including: an interactive visual display unit (VDU), an interactive audio platform (AP) and a plurality of sensor units (SUs); and comprising components of an operating unit (OU) including: a processing unit (CPU) and memory, a wireless communication unit (WCU), a power supply unit (PSU) and an energy storage unit or energy storage cell(s) (ESU, ESCs), wherein a plurality of SUs comprises at least one dehydration SU (DHSU). Suitably a DHSU is for sensing one or more markers of patient hydration level or dehydration. A DHSU herein is adapted for monitoring or detecting patient dehydration and/or for monitoring patient hydration. The device herein and units thereof, more particularly SUs herein, are non-invasive, more particularly is/are configured for external wear, and/or for locating and operating externally to the skin and body cavities of the patient. Preferably an SU is configured for non-invasively sensing markers of PPMW, preferably is configured for locating and operating externally to the skin and body cavities of the patient. The device herein comprises one or a plurality of attachment unit(s) (AU(s)) configured for wearing of the device or part thereof on or about a member or body part of said patient, suitably on or about the arm, wrist or hand, more particularly an arm-patch or armband, wrist-patch or wristband, hand-patch, finger-patch or ring, and may comprise one or a plurality of AU configured for attaching a part of the device to an item of patient apparel, such as clothing, accessories such as a further patient device and the like. In embodiments the interactive visual display unit (VDU) comprises a visual display (VD) and a VD patient interaction (PI) tool (VDTOOL) comprising touchscreen, touchpad or button record tools or voice activation. In embodiments the interactive audio platform (AP) comprises an audio output unit, herein speaker unit (SPK), and an audio PI unit, herein microphone unit (MIC), more particularly comprising audio PI tool (MICTOOL), for example touchscreen, touchpad or button record tools or voice activation. In embodiments the AP is an audio-visual platform and additionally comprises a video-camera PI unit comprising a video-camera (CAM) more particularly comprising video-camera PI tool (CAMTOOL), for example touchscreen, touchpad or button record tools or voice activation. In embodiments a plurality of sensor units (SUs) comprises a plurality of biomarker SUs configured for sensing patient biomarker(s) of PPMW and optionally at least one biometric SU configured for patient identification wherein each SU comprises an interface for sending data and/or signals to the OU, and optionally additionally for receiving data and/or signals from the OU. The device herein comprising VDU, AP and SUs in combination is configured for monitoring markers of MA and biomarkers of patient physical and mental wellbeing (PPMW). The device permits monitoring in non- clinical setting, i.e. in ambulatory setting, in real-time. The device is suitably configured for VD and/or audio and/or audio-visual patient interaction (PI) and MPMC interaction (CI) wherein each of VD and SPK comprises an interface for receiving data and/or signals from the OU and each of VDTOOL and MIC and optionally additionally CAM comprises an interface for sending data and/or signals to the OU. More particularly, the device comprises an interactive visual display unit (VDU) and/or interactive audio platform (AP) for bidirectional MPM dose and response function, i.e. medication reminder and response, engaging both HP, e.g. directly or indirectly, and patient, more particularly for visual and/or audio communication to patient, e.g. from a MPM centre (MPMC) including database and/or HP and by PI. The device provides guaranteed delivery of reminder, and patient engagement in the reminder process. In embodiments the AP provides monitoring function, more particularly patient voice monitoring and optionally additionally patient visual monitoring configured for patient voice analysis and optionally additionally for patient behavioural analysis and/or patient neuromuscular analysis as an indicator of MA and/or PPMW or deterioration thereof. An AP suitably comprises a microphone (MIC) or an acoustic sensor (AS) configured to generate voice signals. Voice signals include signals of voice or of a marker of voice. MIC or AS as hereinbefore defined may be comprised in a voice analysis SU. In embodiments AP comprises/is an audio-visual platform comprising MIC and/or AS and videocamera CAM configured to generate visual signals, more particularly for visual analysis of patient during interaction (PI). The device comprising CAM facilitates correlation of voice analysis and visual analysis for enhanced monitoring. A plurality of SUs herein are suitably selected from a dehydration SU (DHSU) together with one or more SUs selected from circulatory SU(s) including cardiac or cardiovascular SU(s) (CSU(s)) and blood pressure SU(s) (BPSU(s)), body temperature SU(s) (BTSU(s)), respiratory SU(s) (RSU(s)) and combinations thereof, more particularly a dehydration SU (DHSU), together with a heart-rate SU or pulse SU (CSU or HRSU), and a body temperature SU (BTSU) and optionally additionally a blood pressure SU (BPSU). In embodiments the WCU comprises an interface for accessing at least one communications network and communicating data and/or signals between the device and a remote address, more particularly between the device and a MPM centre (MPMC). In embodiments of the device herein, the VDU and AP are configured for displaying and for receiving interaction between patient (PI) and a centre for medication adherence and patient monitoring (MPMC) (CI), relating to MA, more particularly medication reminder and medication status, and relating to PPMW, and for communicating data and signals relating thereto by means of the WCU between the device and the MPMC, and the VDU, AP and SUs in combination are configured for monitoring markers of MA and biomarkers of patient physical and mental wellbeing (PPMW) and for communicating data and signals relating thereto by means of the WCU between the device and the MPMC. The wearable device herein comprises wearable electronics configured to interface with a patient-wearer of the device. In embodiments the OU comprises one or a plurality of peripheral interface(s) with a plurality of input peripherals configured to send data and/or signals to the OU and a plurality of output peripherals configured to receive data and/or signals from the OU. In embodiments the input peripherals comprise VDTOOL, MIC, CAM and SUs and each thereof comprises an interface for sending data and/or signals to the OU. In embodiments the input peripherals are comprised in a triangulation source environment of the MPMU configured to send data and/or signals relating to and indicative of MPM to the OU from at least three sources including PI, more particularly VD, patient voice and/or vocalisation and patient visual, and PPMW for local or remote triangulation thereof. In embodiments the output peripherals comprise VD and SPK and CAM wherein optionally additionally CAM and/or one or a plurality of SUs are input/output peripheral(s) and each thereof comprises an interface for receiving data and/or signals from the OU. In embodiments the output peripherals (and input/output peripheral(s)) are comprised in a triangulation control environment of the MPMU configured to receive data and/or signals relating to MPM from the OU for direct or indirect control of said triangulation source environment and/or for controlling SU data and/or signal output. In embodiments the device comprising SUs herein is an intra-responsive device. Sensor output to a microprocessor causes the microprocessor to access data routine(s), correlation routine(s), status routine(s), threshold routine(s) and/or escalation/alert routine(s) comprised in the memory, make a determination of data compliance, and in case of a determination of NA or of threshold MA or escalation MA, to output to RCU for initiation of triangulation responsive control request to VD and/or SPK and/or same or different SU and/or escalate for remote monitoring and intervention. In embodiments the SU is configured to output all sensor data and the RCU is competent for determination of data compliance. In a further aspect there is provided a device herein programmed to run an MPM triangulation routine for the performance of an MPM triangulation source task, comprising: receiving (e.g. in RCU) status update comprising data and/or signals from at least one input peripheral or input-output peripheral; validating against a threshold or historic value or identity; if validated as within threshold, “no change” or “valid change”, signing off and end routine; OR if non-validated as “outside threshold” or “invalid change” in value or identity generating (e.g. in RCU) a responsive control task and issuing to at least one output peripheral or input/output peripheral(s) for the activation thereof to obtain data and/or signals responsive to non-validated data and/or signals and input (e.g. to RCU), for example from the same or different input peripheral DH data in response to non-validated voice signal or non-validated BT signal; validating against a threshold or historic value or identity; if validated as “within threshold” or “no change” and “no further responsive control task required or available”, providing a triangulation source report and issuing to OU OR if non-validated as “outside threshold” or “invalid change” in value or identity, generating a next-level responsive control task or if no next-level task, providing a triangulation source report and issuing to OU for triangulation of source data and/or signals; and triangulating (in OU) triangulation source data and/or signals comprising status update data and/or signals and data and/or signals responsive thereto and identifying validated triangulation source(s) and non- validated source(s). In embodiments the device is further programmed to run an escalation routine for the performance of a monitoring action task comprising generating and issuing to at least one output peripheral or input/output peripheral(s) for the activation thereof and monitoring operation thereof and to at least one input peripheral or the at least one input/output peripheral for the activation thereof and receiving of monitoring PI or patient biomarker data and/or signals relating to non-validated sources or validated sources of concern; and input (e.g. to RCU), In embodiments the device is further programmed to run an intervention/alert routine including identifying input peripheral data and/or signals comprising an intervention value or identity and comparing with a plurality of pre-set values (pre-sets) to identify intervention/alert required; generating (e.g. in the OU) one or more alerts for the management of medication and/or of a deterioration in PPMW; and instructing a corrective measure task. Corrective measure tasks may include alerting the patient and/or MPMC and instructing remedial action such as medication intervention and/or urgent monitoring appointment with HP. Triangulation systems and methods are various and known in the art. Preferably local and/or remote triangulation herein is with use of one or more triangulation algorithms. In a further aspect there is provided a device or a kit for a device herein, comprising a plurality of modules and one or more (patient) AUs therefor, wherein a module comprises any one or more units or part(s) thereof and may be wearable independently of one or more additional modules, comprising a patient AU herein or is mountable on a wearable AU herein. A device or a kit for a device herein may comprise a plurality of modules, which may be configured on a single or a plurality of AUs herein In a further aspect there is provided a wearable component of the device herein, e.g. comprising one or a plurality of unit(s) and/or part(s) thereof and/or modules. In embodiments a device, AU, unit, module or part thereof is flexible such as conformable, more particularly is configured for conformal contact with patient skin. In such embodiments an SU comprises a contact sensor configured for contact with skin. In a further aspect there is provided a device or kit or component herein for use in healthcare, more particularly in monitoring MA and PPMW for a patient in receipt of medication for one or more medical conditions for example any condition listed in the International Classification of Diseases. Particularly significant conditions are e.g. chronic conditions or disorders such as medication for diabetes, pulmonary and cardiac including COPD, cancer, mental health including psychiatric such as schizophrenia, palliative care, transfer therapy, contraception, neurology and the like and combinations with other medications. In a further aspect there is provided a method for the manufacture of a device herein. In a further aspect there is provided a method for promoting medication adherence and/or medication safety comprising securing the wearable device herein to a patient, operating at least one dehydration sensor by issuing a task initiating light emission, sample collection, electrical signal emission or other means as hereindefined, determining in real time a value of a marker of dehydration, comparing to a pre-set or historic or threshold value, validating, if non-validated initiating responsive control, wherein comparing and validating are carried out by DHSU or by communication to a responsive control unit RCU and sending a report. The method for promoting medication safety empowers a patient’s confidence in medication and may reduce intentional NA. In a further aspect there is provided a system for medication adherence and patient monitoring comprising a device as hereinbefore defined comprising a plurality of medication adherence and patient monitoring units (MPMUs) as hereinbefore defined, wherein the system comprises of at least a processor, a memory in communication with the processor, a communication module, a display and a database wherein the device and database communicate through wireless communication means. DEFINITIONS The term “medication adherence” (MA) herein refers to medication-taking behaviour, more particularly the extent to which a patient takes medication correctly, as intended or prescribed, at the correct time and in the correct manner, for example the extent to which a patient understands and complies with medication- taking directions, monitors medication supplies remaining and reorders, and the patient’s motivation for such behaviours and the like. Conversely the term “non-adherence” (NA) herein, also termed non-compliance, refers to non-optimal MA, i.e. incorrect medication-taking behaviour, more particularly the extent to which medication is not taken or is taken incorrectly by a patient, for example taken at incorrect time or taken in incorrect manner (e.g. dose, time, frequency) e.g. over-medication or under-medication, supplies not monitored, poor motivation or patient is non-compliant. SEs of medication, overmedication and ADR are many and various depending on medication, such as beta-blockers and antipsychotics such as clozapine, patient and multiple other factors and complications, examples include stroke, depression, drowsiness, heart rhythm/ bradycardia/ ECG disturbance. Total body water is the total volume of water in the body (TBW) and provides an estimate of the water content of the body as a percentage of total weight. The relative hydration state of the body is related to TBW. A patient herein may be an adult or child, in receipt of medication for a medical condition. A patient may be assisted by a carer or someone acting on their authority. A healthcare professional (HP) herein encompasses any healthcare provider such as a clinician or equivalent having direct contact with patients, prescriber or independent prescriber, or any person acting under their authority, including MPMC personnel specially trained to undertake monitoring and institutional care personnel such as hospital, medical practice, pharmacy and residential care personnel. Medication herein is medication supervised by or prescribed for a diagnosed medical condition, unless indicated otherwise. Medication includes any medicine, therapy or treatment plan requiring supervision or signature by a HP as hereinbefore defined, whether indicated to or licensed for a condition, off-label medication or unlicensed medication, and may include over the counter (OTC) medication, and medication available without prescription according to national law in a given country. Medication herein also includes personalised medicine, to be taken in a manner considered safe behaviour for a patient, for example in the case that a patient cannot manage evidence-based medication treatment regime, and may be developed using clinical decision support, and may be developed from MPM using the device herein. Off-label or unlicensed medication is medication which is prescribed to treat a medical condition other than that for which its use is authorised. For example an authorisation for a medication prescribed to treat a medical condition does not include authorisation to continue use once the condition is effectively treated, to prevent recurrence of that condition or to prevent onset of a risk condition, and is thus considered “off-label” if prescribed for such continued or preventative use; medication authorised for treatment of depression which is also effective in treating neuropathic pain is prescribed “off-label” for such treatment of neuropathic pain. Embodiments herein may be generally applicable in the case of any new or existing medication such as in the case of a decision on a suitable new medication for a patient, in the case of a review of an existing medication taken by said patient, which may be a periodic review or prompted by a change in the patient’s condition, in case of deciding on a long term medication for a patient progressing from an acute medication. “Data” or a “signal” herein may be data or a signal which is in electronic and/or optical and/or electromagnetic radiation form and/or is capable of electronic and/or optical and/or electromagnetic radiation transmission and/or reading. The term “a plurality” of any referenced item herein refers to any whole number integer value more than one and up to a maximum value which will be apparent to one of ordinary skill in the art or a value of “all”. A plurality may be two or may be three to six such as four or five, or may be seven to ten such as eight or nine or may be a whole number integer in excess of ten. An interface herein is hardware comprising an input or output or a direct and/or indirect connection or coupling of an input and an output, i.e. I-O connection or coupling, more particularly comprising electrical and/or optical circuitry and/or a wireless interface such as a remote network communications interface such as WCU as hereinbelow defined or an SR-RF interface comprising a suitable antenna, transmitter, receiver or transceiver. Electrical and/or optical circuitry herein is suitably selected from pins, tracks, traces, wires, waveguides and equivalents as known in the art and combinations thereof. An I-O connection may additionally comprise one or a plurality of placed components such as processor(s), bus(es), SR-RF modules, antenna(e), transmitter(s) and receiver(s) and the like. Input(s), output(s) and I- O connection(s) are suitably comprised in one or a plurality of integrated circuit(s) (IC(s)). An SR-RF antenna, transmitter, receiver or transceiver is suitably a placed component in an IC or is comprised in a SR-RF IC or SR-RF chip or module. In embodiments the device is a short range device (SRD), more particularly wherein the OU and SUs comprise connectivity for short-range short-wavelength radio frequency (SR-RF) communication, i.e. is SR- RF enabled, more particularly comprises a short-range wireless communication unit (SR-WCU), more particularly for nanonetwork or nanoscale network communication, near-field communication (NFC), wireless body area network communication (WBAN) or wireless personal area network (WPAN) communication both including wireless infrared communication, wireless USB, BluetoothTM or ZigBee communications. A MIC herein may be variously referred as an acoustic sensor, microphone, voice sensor or vocal sensor unit which terms are interchangeable. In embodiments one or both of MIC and an SU is an acoustic sensor unit (ASU or AS) configured to generate high fidelity patient audio signals in the frequency range of human speech and/or human vocalisation, for voice and/or vocal analysis indicative of MA and/or ME. Suitably MIC comprises one or a plurality of ASUs, microphone units or arrays which is/are directly or indirectly responsive to voice or vocalisations or marker thereof such as cough, movement or vibration, preferably comprises at least one high fidelity ASU or microphone unit (HiFiMIC). A HiFiMIC is characterised by high fidelity in the frequency range of human speech or vocalisation, preferably configured to generate a high fidelity audio signal for example for voice analysis and remote monitoring, more particularly to transmit audio PI or patient MA communication for voice analysis and detecting changes relating to PPMW. In embodiments one or more SU(s) herein comprise a sensor material or a sensor system comprising a combination of material(s) which is a smart material or a smart system which is responsive to a patient stimulus by a response comprising a reversible measurable material property change. A sensor material or system may be coupled to or integrated with one or more components for outputting the response as data and/or signal(s), for example the sensor output may be in the form of electricity or electrical energy or of a measurable material property. Preferably the response is self-powered or is powered by the stimulus, more particularly the sensor material or system is an active, most particularly an active electrical, sensor material or system. An active sensor is configured to generate a stimulus response in response to a patient stimulus which serves as the output signal without the need of an additional energy source. An electrical sensor is configured to generate an electric current in response to a patient stimulus. BRIEF DESCRIPTION OF FIGURES Figure 1 illustrates a device comprising VDU, AP and SUs herein; Figures 2 is an example triangulation flow scheme operated by a RCU in a device of Figure 1 Detailed Description In embodiments SU(s) herein is/are embedded or concealed in the AU and/or the MPMU. Suitably a biomarker SU herein more particularly a DHSU is comprised in a part of the MPMU or the AU which is configured for operation by patient touch, such as the VDTOOL, an AP control such as volume control, (video) call initiate or accept and the like. In embodiments a DHSU is comprised at a skin-contacting inner face of the AU or is comprised at an external surface of the AU, preferably proximal to MIC or AS or comprised in a touchscreen or touchpad portion of VDU such as a VDU input tool (VDTOOL) or CAMTOOL or a part of the device which is configured for touch-operation such as an operating button, e.g. power on/off, volume or the like. This enables sensing of markers of dehydration by analysis of sweat, produced at the body surface, or by analysis of breath, exhaled during patient vocal interaction or speech with the device or with MAMC by means of the device. In embodiments a DHSU is comprised at a body-contacting inner face of the AU, preferably positioned to detect a dehydration marker, for example at a skin-contacting inner face positioned to contact patient skin. This enables sensing of markers of dehydration by direct or optical contact with the patient’s body, for example skin, more particularly by analysis of sweat, produced at the body surface or of conductivity of skin or analysis of light or radiation reflected from the body surface. A DHSU comprised at an inner skin-contacting face of the AU is suitably positioned in manner to detect a consistent and strong signal, for example by means of adhesive patch, or of skin-wetting patch, preferably having conformal properties resembling human skin such as a gel patch or bio e-skin. An adhesive patch, wetting-patch or bio e-skin provides intimate contact of sensor and skin, for example eliminating air pockets and the like. In alternative or additional embodiments, a DHSU is comprised in association with CAM and/or MIC herein, for example positioned to sample patient breath, for example for analysis of breath, exhaled during patient vocal interaction or speech with the device or with MAMC by means of the device. Suitably a DHSU is embedded in CAM or MIC or thereabout or proximal thereto. In alternative or additional embodiments, a DHSU is comprised in association with a part of the device configured for patient touch or to contact patient exhaled breath, for example positioned to sample patient sweat or exhaled breath, for example for analysis thereof during patient interaction with the device by touch or proximity to mouth or nose. Suitably a DHSU is embedded in a touchscreen, touchpad or control of VDTOOL, CAMTOOL, MICTOOL or in one or more MIC or proximal thereto. Preferably an embedded DHSU comprises a breath or sweat sensor in flex circuit board form with biological and chemical sensor arrays that detect biological or chemical species including bacteria, ammonia and glucose, lactate, sodium and body temperature, configured for generating electrical signals on contact with sweat, and amplification and filtering thereof, and optionally calibrating using skin temperature. An embedded DHSU may comprise onr or more hygrometers. A dehydration SU (DHSU) may be configured to detect one or a number of markers of body hydration or Total Body Water, such as pH of sweat or exhaled breath, conductivity or concentration of sweat, reflectivity of skin, bioimpedance and the like. A dehydration SU may be calibrated to give an absolute hydration value or may compare with historic values to detect a change in hydration. For example by measuring the sweat resistance or conductivity to an applied current and determining an ion concentration. By comparison with historic values, a change in ion concentration and hence in hydration can be detected. In embodiments a DHSU is configured to detect a marker selected from: - mechanical detection of change in mechanical properties of the skin, more particularly elasticity and/or texture; - light-based detection comprising irradiation of skin, for example wherein the DHSU comprises an optical emitter and detector or array, such as a laser configured for casting light patterns through the skin, more particularly configured for measuring changes in blood glucose as an indicator of decreasing water volume, optionally wherein the device is programmed with an algorithm correcting for medical conditions or variables that can induce glucose increase/decrease such as diabetes, nutrition, etc.; - chemical analysis of bodily fluids sampled outside the body such as breath, saliva and sweat, more particularly for sensing markers of change in chemical composition such as mineral or electrolyte content (e.g. sodium, potassium), small molecules (e.g. lactates) or proteins, for example conductivity of sweat increases and decreases with sodium concentration as a marker of dehydration, or changes in concentration of sweat as a marker of total water volume in the body (TBV), more particularly wherein the DHSU comprises a set of electrodes for passing a current; or pH of fluid for example alkaline pH of breath as a marker of ammonia present in breath and indicative of dehydration - pH detection of skin, as a marker of the transition from acidic (normal hydrated skin) to basic (dehydrated skin), optionally wherein the device is programmed with an algorithm correcting for medical conditions or variables that can induce dryness of skin such as natural dryness or eczema; Electrical circuits for sensing concentration of ions in solution are known in the art. A DHSU herein may be configured for sensing changes in proton/ionic conduction (e.g. resistive), charge transfer as a measure of ionic concentration, or dielectric constant (e.g. capacitive), or frequency (e.g. impedance). A bioimpedance DHSU herein comprises a configuration of electrodes for contacting the patient’s skin together with an AC current/signal generator for introducing an electrical signal of a particular frequency or multiple frequencies through one electrode placed on the skin and a signal detector for detecting the signal at the other electrode, more particularly change in voltage over time. Hydration correlates positively with the magnitude of the voltage response of the skin impedance circuit. Configurations are known in the art such as www.edn.com/sensing-body-dehydration/. A colorimetric DHSU may be configured for optical image analysis of sweat sample, more particularly to quantitate concentration thereof or water loss, for example, as known in the art. An optical DHSU may be configured for monitoring pH or refractive index of skin or a fluid sample, or chloride, lactate or glucose content of fluid, more particularly indicating water content thereof. A colorimetric DHSU may comprise an array of microfluidic channels or micro capillaries comprising colour-responsive materials responsive to electrolytes, small molecules or proteins present in sweat or breath sample, for example as taught in Koh et al Sci Transl Med.2016 November 23; 8(366). More particularly a DHSU is configured for sensing or monitoring one or a combination of bio signals of the patient, more particularly one or more of a bioelectrical, bioimpedance, biochemical, biomechanical, bioacoustic, biooptical or biothermal signal(s) of the patient. A DHSU or part thereof is suitably a miniaturised or nanoSU configured for embedding in an AU herein. In embodiments a dehydration SU herein may comprise a chemical or electrochemical or electrical sensor for example configured to detect or monitor chemical components of body fluids including sweat or breath, such as glucose level, pH, presence, absence or concentration or density of chemical species, analytes or fluid such as mineral salts for example of sodium or potassium, ammonia or ammonium (NH3 or NH4). In embodiments a DHSU may comprise an electrical or optical sensor, such as comprising electrodes, or light emitters and receivers, or may comprise a colorimetric sensor, a pH sensor, a conductivity sensor, an impedance sensor, a radiation sensor for example for analysing parameters of dehydrated skin or tissue such as mechanical or optical parameters thereof. In embodiments the wearable device is configured for daytime and/or night-time wear, more particularly 24/7 wear, and to encourage adherence to wearing, e.g. the device is sized and shaped to permit of 24 hour wear. More particularly the device is a prescription wearable or precautionary wearable or advisory wearable, e.g. is configured for continuous wearing such as to ensure the safety of the patient or of a person other than the patient. Hydration measurement systems which are commercially available and for medical use are slow, invasive, not reusable, and non-real-time. For example, medical methods determine total body water and electrolyte levels from plasma sampling. This is because of the difficulty in accurate hydration data from non-invasive markers of dehydration. Non-invasive hydration monitoring technologies have been proposed in the literature, for example monitoring concentration of sweat, change in optical reflectance of skin, change in body weight etc, which rely on comparative markers and calibration by algorithm, for example taking into account subject, conditions etc. Development of a commercial non-invasive hydration sensor depends on a commercial need. The sports and leisure market presents a ready market for development of a sensor which can be based in small part on measurement and in large part on input of information relating to intensity and duration of effort, with associated algorithms computing an estimated resulting body water loss. For example, dehydration loss through exercise is accompanied by continually and progressively impacted physiological processes, such as heart rate and core temperature which progressively increase with duration and intensity of exercise, while blood volume, stroke volume, cardiac output and skin blood flow all progressively decrease. In the context of sport, dehydration results from the thermal regulation of the body through sweating. These can be readily calibrated using existing sporting and leisure technology such as heart rate and intensity monitor e.g. FitBit TM, taking into account ambient temperature, relative humidity, exertion of the subject, radiant heat or other radiation exposure, convection by air current, whether measured on exposed skin or clothed skin, assumptions on water intake and electrolyte intake, heat acclimatization, body composition, age, fitness level, body temperature, heart rate, blood oxygen level and genetics among others. In embodiments the device herein comprises a plurality of DHSUs for detecting a plurality of different markers of hydration, more particularly comprises two or three DHSUs each for detecting a different marker of dehydration. Preferably a plurality of DHSUs comprises a DHSU comprised at an external surface of the AU proximal to MIC or AS or CAM configured for sampling patient breath, and one or both of a DHSU comprised in a touchscreen or touchpad portion of CAM, CAMTOOL, VDU or VDTOOL and a DHSU comprised at a skin-contacting inner face of the AU.. Preferably a plurality of DHSUs comprises a DHSU for monitoring pH of breath, for example for monitoring ammonia in breath or other marker as hereinbefore defined, and a DHSU for monitoring sweat for a marker of dehydration such as conductivity, pH or other marker as hereinbefore defined, and an optical or mechanical DHSU for monitoring skin for a marker of dehydration such as reflectance, elasticity or other marker as hereinbefore defined and the like. Moreover the sport and leisure market need is for one off or short duration monitoring of hydration. In contrast the present MAM device is envisaged for 24/7 wear. Accordingly the device herein is robust to daily operations including showering and bathing, cooking, sleeping and the like. In embodiments the wearable device is water resistant or water-proof, for example the device or a unit or module or component is a sealed device or unit or module, which comprises a seal which is liquid and/or gaseous fluid impermeable, and/or fine particle impermeable seal, which may be integral or detachable, for example a water resistant or water proof seal or shield such as a cover or casing, membrane, gasket or the like or a combination thereof. A device may comprise a plurality of same or different seals or a seal may comprise a plurality of same or different portions. Preferably OU and optionally additionally one or more MPMU units are embedded in the AU which is a liquid and gaseous fluid and fine particle-impermeable body or a part thereof which is liquid and gaseous fluid-impermeable and fine particle-impermeable or are mounted on the AU and are sealed thereabout by a liquid and gaseous fluid-impermeable and fine particle-impermeable seal. Any one such seal or shield may shield the interactive AP or part thereof, more particularly the MIC(s) and/or SPK(s). Preferably the AP or a component such as MIC(s) and/or SPK(s) comprise a gasket, more preferably configured at an aperture. This is configured to prevent ingress of fluid, fine particles or the like, such as water, steam and dust. A shield may be integral with the device, for example a device comprising embedded units mounted in a moulded, e.g. silicone, mounting or may be separate for example a clip-on shield for the device or a part thereof. In embodiments herein, a wearable device may comprise one or more detachable units or modules which are water sensitive, for example detachable AP or part thereof, e.g. MIC, CAM and/or SPK and/or DHSUs. Preferably such detachable units are provided external to a device seal herein, whereby the detachment thereof leaves the device seal intact. In embodiments MIC, SPK and CAM comprise a liquid fluid impermeable and fine particles impermeable and optionally additionally gaseous fluid impermeable seal, for example a water-repellent permeable membrane such as a permeable PTFE membrane. In embodiments one or more DHSU(s) or parts thereof are configured to sample patient liquid or gaseous fluids and are provided external to a device seal or the AU herein. Thereby a DHSU is configured to sample breath, sweat and the like. In embodiments a DHSU comprises a fluid sampling and/or sensor part and a separate or integral processing part. In embodiments a fluid sampling and/or sensor part of a DHSU is comprised external to a liquid and gaseous fluid-impermeable seal of the DHSU or the AU. A fluid sampling and/or sensor part is preferably selected from a surface or reservoir such as a membrane, filter, absorption pad such as a sweat patch, a microcapillary or array such as a microfluidic array of channels, a reservoir or chamber which may be porous e.g. meso or nanoporous reservoir or substrate and the like for sampling patient fluid. A fluid sampling and/or sensor part may be profiled, for example cup-shaped, concave or recessed to facilitate maximal contact with the surface of a fingertip or optionally together with optionally including inwardly spiralling recesses or channels to focus incident breath inwardly of the sampling and/or sensor part, i.e. minimise deflection outwardly of the sampling part and/or sensor. A fluid sampling and/or sensor part may be disposable or may be removed for cleaning, drying or flushing for example the DHSU comprises a pump or vacuum generator for flushing or evacuation of the sampling and/or sensor part. A fluid sampling and/or sensor part may be configured to interface with a separate processing part. A separate or integral sensor part may be wipe-clean. In embodiments, a DHSU or a part thereof configured for sampling sweat, more particularly a sampling and/or sensor part thereof is configured for contacting a part of the patient’s skin, most particularly the fingertip. In embodiments, a DHSU or a part thereof configured for sampling breath, more particularly a sampling and/or processing part thereof is configured to lie in the path of exhaled breath of the patient, more particularly in the path of exhaled nasal breath or mouth breath. In embodiments, a sampling and/or sensor part of a DHSU configured for sampling patient exhaled nasal breath is comprised in an internal-nasal AU configured for locating internally within a nostril, for example comprises an adhesive band or patch or membrane or resiliently deformable band which is configured to mount internally within or at the opening of a nostril. In embodiments one or more units are provided external to a sealed device, more particularly one or more units comprising apertures or surfaces which are permeable to gaseous and liquid fluids such as water, moisture, body fluids including sweat, breath and the like. In embodiments a device herein comprises data-share, which may be by SR-RF interface as hereindefined or data and/or signal transfer unit such as BluetoothTM or other wireless or wired connectivity between the OU and one or more integral or detachable unit(s) or module(s). Preferably such unit(s) comprise a short-range wireless communication (SR-WCU), as hereinbefore defined, suitably for data-share with the device or part thereof, such as OU or RCU, which may be by SR- RF interface as hereindefined or data and/or signal transfer unit such as BluetoothTM or other wireless or wired connectivity. In embodiments a DHSO comprises a sampling and/or sensor part as hereinbefore defined comprising an SR-RF interface for communicating data and/or signals to a processing part thereof for SR-RF connectivity. One or more units or parts thereof including circuitry such as input(s) and/or output(s) and I-O or I/O connections may be embedded in AU or in another unit, e.g. a biomarker or biometric SU, for example DHSU may be embedded in VD or in VDTOOL or CAMTOOL, a piezoelectric or triboelectric EHU may be embedded in VDTOOL or in any part of the device which requires the application of pressure for operation. A unit or part thereof may be embedded beneath an optically or acoustically transparent part, e.g. layer for example an external surface of AU. A SU herein may be integral with the device or separate therefrom and in direct circuit, wired or wireless data connectivity, optionally attachable thereto by means of a wearable-attachment. In embodiments one or a plurality of SUs are embedded in the AU of a device or module herein, and in communication with the OU by wireless connectivity, e.g., SR-RF, or by printed or optical circuitry e.g. IC. In embodiments a MPMU herein is detachable from the AU, further comprising cooperating mountings on the MPMU and the AU, which may be mutually engageable, for example comprise a push-fit mounting. In embodiments the device is wearable on the a patient limb, member or body part more particularly an arm, upper arm, lower arm, wrist or hand or part thereof or a combination thereof, more particularly one or more AUs comprises an armband or patch, wristband or patch, finger ring or patch or combination thereof In embodiments said AU is selected from a band to encircle a patient limb, member or body part or a further wearable device and a clip, clasp or cleat to attach to an item of apparel or a further wearable device and the like, such as a band or strap, wrist bracelet, ankle bracelet, neckband or necklace, tether, buckle, fabric clip, mating cleat attachment for attaching to a cooperating attachment on a further wearable device and the like. For example the device or a module or unit is selected from an ankle or wrist device such as an ankle or wrist band or bracelet, a jewellery item such as a necklace, pin, clip or brooch, ring or finger attachment, fob device such as a button hole fob device or tether-and-pocket- device such as a watch-fob style, pocket watch-style device and the like. A band may be deformable or resiliently deformable such as elastic. A band may be a closed loop such as annular or generally annular band or may be an elongate linear strap comprising cooperating secure, i.e. permanent, or releasable, i.e. temporary, fastenings or clasp or the like at ends thereof, optionally provided in two cooperating parts. Suitably a patient AU is configured for wearing in physical and/or optical contact with a patient, more particularly in physical and/or optical skin-contact. A patient attachment may be loose-fitting or close-fitting and/or configured for conformal skin contact for example may comprise stretchable, soft, porous and/or flexible polymer, hydrogel and/or elastomer materials. Alternatively or additionally, an AU may be adhesive e.g. configured for gentle adhesion to the patient body, suitably comprises a silicone based adhesive. Alternatively or additionally the AU may comprise one or a plurality of resiliently deformable flexible bands such as elastic silicon bands which may be secured to or comprise the OU and MPMU, for looping around a further wearable device, patient member or body part or item of apparel. An AU herein comprises a surface enclosing a body. The surface comprises a display face and a contact face. A display face is configured to face outwardly to the patient body, e.g. for viewing of the VD, and includes side edges or faces. The contact face is configured to face inwardly to and to contact, e.g. physically or optically or acoustically or by radiation, and optionally to encircle or adhere to, a member or body part of the patient. Units or parts thereof herein may be comprised on or in the surface, such as the VDU and AP or parts thereof. Embedded units or parts herein such as OU are embedded within the surface and/or body such as recessed or partially or fully enclosed. PSU(s) and SU(s) or parts thereof are comprised at or in a surface or embedded within the body, for example a solar EHU may be comprised in the viewing face; a thermal EHU or an SU may be comprised in the contact face. An AU surface and/or body herein may comprise same or different material or combinations of materials, e.g. may comprise different materials in a plurality of layers, zones or phases, for example selected from transparent, such as optically or acoustically transparent, cushioning such as gel (e.g. silicone), insulating, embedding, hydrophobic, adhesive and/or smart material and the like. For example, transparent, adhesive, cushioning or smart material may be comprised at the contact face or a part thereof, and/or optically or acoustically transparent material may be comprised at the viewing face or a part thereof and/or SR-RF insulating material and/or hydrophobic material may be comprised at the surface and/or electrically insulating (opaque), SR-RF transparent (lucent), embedding and/or smart material and combinations thereof may be comprised in the body. In embodiments the device herein is configured for monitoring MA both directly, by PI and reporting, and indirectly by monitoring markers of PPMW. In embodiments the device is configured for distinguishing when a patient is under-medicating, over-medicating or receiving medication which is not appropriate and suffering symptoms of a condition, and when a patient is receiving appropriate medication but may not be adequately self-managing the medication or is showing signs of a SE of or ADR to medication. It can be hard to assess where a patient sits on this curve, and the patient may not communicate this. Accordingly the device herein enables providing by means of the VDU and AP a MoS of medication actually taken. Advantageously a MoS empowers patients and promotes MA. In further embodiments the device herein is configured for providing by means of the AP and SUs a marker of satisfactory management of appropriate medication (MoMan or MoMM). Advantageously a MoMan or MoMM may be incorporated as a notification delivered by VDU or AP for patient self-treatment and empowers patient confidence and promotes MA and reduces instances of nocebo, and reduces the risk of SE or ADR. Moreover MoMan or MoMM may be incorporated as an indicator for the MPMC to distinguish and identify risk of NA, SE or ADR and whether self-treatment or intervention is appropriate and providing for intervention with appropriate corrective measures. Preferably SUs are input/output peripherals comprised in a MPMU comprising a responsive control unit (RCU) comprising a controller and memory, and are configured to send data and/or signals to the RCU and to receive data and/or signals from the RCU. The RCU is programmed to run triangulation algorithms on such input data and/or signals and to generate data and/or signals according to the algorithms. The responsive control unit (RCU) herein is configured to receive data and/or signals relating to PPMW from SUs and AS or MIC and optionally additionally camera (CAM), identify anomalies and generate MoMMs, for example for patient reassurance, generate notifications, for example for self-treatment or intervention, and/or MPM signals for example to power up a SU, AS or MIC and initiate a monitoring routine. The RCU may be configured to receive data and/or signals indicating MA from VDU and MIC or from a remote address such as an instance of MPMC. The RCU is configured to communicate data and/or signals to the OU for transmission to MAMC. Body Temperature sensing or monitoring: A BTSU herein may be configured to detect rising or elevated body temperature. Rising BT can indicate/be a marker of dehydration, a potential SE of a medication such as a diuretic. Rising BT can also indicate an infection such as COVID-19. A single timepoint body temperature check may fail to pick up elevated temperature. A BTSU is competent to monitor body temperature over the course of a period of time. The device configured for monitoring MA can indicate adherence to any of the above medications, and conversely can indicate NA, which can help to establish a rising body temperature is not the result of a SE of medication. CAM and MIC or AS – video and voice detection: The device herein suitably supports voice and facial recognition factors for identifying changes e.g. drowsiness that can provide safety alert due to over medication or stroke so provide early warnings of potential fall. Speech as a neuromuscular performance, is affected by the physiological state of the individual which can affect the processes of respiration, voice and articulation as well as motor control and planning that goes into speaking. Monitoring speech as audio input is non-invasive and enables remote monitoring of a patient. In embodiments, audio response input herein provides an indication of MA and/or ME, such as non- adherence or abnormal response to medication. For example, slurred speech may be a marker of stroke, monotone voice or slowed speech may be a marker of depression onset, detection of drowsy features in voice analysis may be a marker of overmedication by a patient taking medication to slow heart rate, such as beta-blockers. Thus audio response input is a critical parameter for a patient biomarker such as heart rate. Moreover change in eye movement may be a marker of deterioration in PPMW, This may include, maintained eye positioning, reduced or heightened responsiveness such as slowed eye movement, rapid eye movement or eyelid control. For example fatigue of the tonic fibres causes ‘quiver’ eye movements, in which saccades are followed by slow drifts back to centre, because the tonic fibres cannot sustain the eccentric position. In embodiments an AP herein is an audio-visual platform, and further comprises a camera or videocamera. Visual interaction/contact between patient and MPMC further assists with monitoring PPMW. In embodiments CAM is configured to run an algorithm for recording patient eye movements. Preferably OU or MPMA is configured to run an algorithm for analysing change in eye movements. More particularly a change in eye movement is a marker of a deterioration PPMW, more particularly deterioration in or reduced brain function. Most particularly such algorithm is calibrated to indicate a change in eye movement as a marker of dehydration. This is because a change in eye movement can reveal when a patient is compromised, for example by fatigue or dehydration, even if the patient can’t recognize it themselves. The device comprising AP comprising CAM and MIC or AS herein is competent for monitoring voice and video signals for drowsiness or tiredness. Voice data and/or signals indicate changes in speed, pitch and tone of voice. This can indicate onset of a depression which can indicate that the patient is not accurately or truthfully reporting adherence to medication for treatment of depression, onset of dehydration or fatigue indicating possible myocarditis. SU data and/or signals can point to HR, BT or hydration-specific deteriorations in PPMW, and can be used in combination or in combination with PI and voice and video data and/or signals to anticipate or eliminate specific concerns. Cardiovascular sending or monitoring: A cardiovascular SU herein may be configured to detect or monitor tachycardia (increased HR or pulse) or myocarditis (a persistently abnormal elevated HR or pulse). Tachycardia is a heart rate of more than 100 beats per minute. The heart normally beats at a rate of 60 to 100 times per minute, and the pulse (felt at the wrist, neck or elsewhere) matches the rate of contractions of the heart. Tachycardia can be a marker of a normal response to anxiety, fever, rapid blood loss, mild dehydration or strenuous exercise, a side effect of “stimulant” foods, drinks and substances (coffee, tea, alcohol, chocolate, tobacco) or of medication such as diuretics. Tachycardia which may be relatively easily corrected by patient self-treatment such as taking in fluids and rehydrating, thereby restoring a healthy blood volume. Myocarditis signs and symptoms include chest pain, fatigue, shortness of breath, and arrhythmias and requires urgent medical attention. It has the potential to lead to heart failure, heart attack, stroke and arrhythmias. Myocarditis can be a marker of a viral infection, in which case it may be accompanied by elevated BT, an ADR to a medication such as clozapine, or of a more general inflammatory condition. VDU and AP – MA monitoring: MA data and signals indicate whether a patient is at risk of a deterioration in PPMW due to NA. An indication of NA or a trend to NA can be informed by data relating to risks associated with NA to the medication in question, for example drowsiness or confusion in combination with NA to clozapine. Triangulation: The device herein comprising VDU, AP and SUs in combination for monitoring of MA and PPMW is configured for triangulation of data and/or signals from multiple sources as markers of MA, PI and PPMW. Triangulation herein employs algorithms configured for analysis of data and signals and identifying whether markers of MA, PI and PPMW are indicative of NA, a SE or an ADR and the nature thereof. Voice markers of drowsiness or tiredness detected in combination with markers of dehydration indicates a more complex condition than a voice marker alone, such as excess dehydration; in embodiments the device herein is configured to run algorithms to establish excess dehydration and if so to issue an alert for immediate clinical intervention, more particularly wherein the device comprises MIC or voice detection SU in combination with DHSU. Rising body temperature leading to fever and sweating also causes dehydration, and can be a potential SE of chemotherapy. In this case, the device configured for monitoring for dehydration alone is not indicative, In embodiments the device herein comprises DHSU in combination with BTSU for monitoring dehydration in combination with rising BT, more particularly can indicate chemotherapy induced fever and is a medical emergency. Preferably the device comprising DHSU in combination with BTSU is configured to run algorithms configured to establish a combination of dehydration and rising BT and issue an alert for immediate clinical intervention. Rising body temperature can indicate a potential ADR comprising a subclinical infection such as agranulocytosis which may be induced by one of a number of medications, such as chemotherapy medication or clozapine, with potential to lead to more serious issues. In embodiments the device comprising DHSU in combination with BTSU is configured to run algorithms configured to establish a combination of rising body temperature and medication carrying agranulocytosis risk (chemotherapy, clozapine) and issue an alert for immediate clinical intervention. Agranulocytosis may be accompanied by rapid HR or rapid breathing. Preferably the device herein further comprises a pulmonary SU such as a heart rate SU (HRSU) or breathing rate SU (BRSU). Preferably the device herein comprising DHSU in combination with BTSU and with HRSU and/or BRSU is configured to run algorithms configured to establish a combination of rising body temperature and medication carrying agranulocytosis risk (chemotherapy, clozapine) and initiate a request to HRSU and/or a BRSU for HR and BR data, whilst issuing an alert for immediate clinical intervention. Rising body temperature accompanied by dehydration and an increase in HR, can indicate reflex tachycardia with potential to lead to palpitations and if sustained, to contribute to cardiac adverse event including sudden cardiac death. In embodiments the device herein comprising DHSU in combination with BTSU and HRSU is configured to run algorithms configured to establish a combination of rising body temperature, increased HR and dehydration and issue an alert for immediate clinical intervention. The relationship between body temperature, heart rate and respiratory rate in children https://emj.bmj.com/content/26/9/641 teaches that body temperature as an independent determinant of heart rate, causes an increase of approximately 10 beats per minute per degree centigrade. Body temperature is also an independent determinant of respiratory rate. In embodiments the device herein is configured to run algorithms comprising a quantification of increase in HR and BR per degree centigrade increase in BT, for example an increase in HR of the order of 5-10 beats per minute, more particularly to determine whether any tachycardia or tachypnoea is caused solely by fever, or whether there may be an element of concurrent shock or of NA or undermedication, SE, ADR, inappropriate medication or another factor. Algorithms may be configured for identifying changes or deviations from normal, such as trending towards or exceeding threshold pre-set values and persistence thereof. Changes or deviations may be identified by comparison such as overlay of data or signals. Thereby instances of NA, SE, ADR and other cause of PPMW may be identified. As a result the patient is confident of early detection of onset of SE or ADR, and is confident to adhere to medication as intended. Patient safety is also increased against any such NA, SE or ADR or inappropriate medication, and also by increased MA and improved management of the condition being treated. The flow scheme (Figure 2) indicates some triangulation operations of the device. Preferably the device is configured to access digitised medication data, including digitised medication reminder charts personal to a patient as disclosed in WO/2021/079358 (Price), the contents of which are incorporated herein by reference. As disclosed in WO2021/079358, the VDU and/or AP are suitably configured to present visual and/or audio medication dose reminders and to receive visual and/or audio PI responsive to said reminders. The device provides guaranteed delivery of reminder, and patient engagement in the reminder process. In embodiments the MIC or AS is configured for generating high fidelity voice signals for analysis of voice or a marker of voice as an indicator of MA and of PPMW. Preferably MIC or AS is configured to generate signals having reproducible tone, pitch or speed of voice, or having reproducible frequency and words, syllables or sounds per second. Speakers vary their speed of speaking according to contextual and physical factors. A typical speaking rate for English is 4 syllables per second but in different emotional or social contexts the rate may vary, one study reporting a range between 3.3 and 5.9 syl/sec, as disclosed in Arnfield, S.; Roach; Setter; Greasley; Horton (1995). "Emotional stress and speech tempo variability". Proceedings of the ESCA/NATO Workshop on Speech Under Stress: 13–15, the contents of which are incorporated herein by reference. Acoustic analysis software tools are available on the internet such as Praat (https://www.fon.hum.uva.nl/praat/ ), SIL Speech Analyzer (https://software.sil.org/speech-analyzer/) or SFS (https://www.phon.ucl.ac.uk/resource/sfs/). Preferably voice analysis comprises one or more of the following features spectral analysis, pitch analysis, formant analysis, intensity analysis, jitter, shimmer, voice breaks, cochleagram, or excitation pattern, comparative signal overlay. More preferably voice analysis comprises invoice technology (integrated VOIce analysis of satellite communications embedded in time and safety critical environments, https://business.esa.int/projects/ivoice). iVOICE will use existing signal processing and machine learning capabilities developed for linguistic analysis of speech for investigation of its paralinguistic properties, to monitor the health and psychological state of individuals by measurements made from audio recordings of their speech. This approach has many advantages to offer. Speech, as a neuromuscular performance, is affected by the physiological state of the individual which can affect the processes of respiration, voice and articulation as well as motor control and planning that goes in to speaking. In turn, the emotional state of individuals or their response to workload or stressful situations can affect their physiological state. Speaking is a natural part of many work and operational activities, while recordings of speech are easy to make, are non-invasive and generally accepted as necessary as part of communication whether in the carrying out of a job or in day-to-day communication. In embodiments the device is configured for universal wireless connectivity, more particularly satellite connectivity, preferably the WCU comprises a plurality of communications interfaces including at least one universal communications interface, most preferably at least one satellite communications interface. Such technical feature provides for transmission of a high-fidelity signal, enabling transmission to MPMC and detailed analysis of patient voice or voice marker as an indicator of MA or PPMW. As a result, MPMC can timely detect markers of the onset of detrimental levels of deterioration in patient PPMW, such as fatigue, confusion etc. and intervene with appropriate corrective measures. In “Fatigue Monitoring and Collision Avoidance” International Mining, January 2018, the contents of which are incorporated herein by reference, is disclosed the invoice system commercialised by WOMBATT (https://wombatt.net/), a voice-based driver fatigue prediction and detection system invented by the Centre for Space Medicine at University College London. The voice analysis system, iVOICE, has been developed at the Centre for Space Medicine at University College London (UCL) to gauge a person’s level of tiredness simply by listening to his or her voice for some seconds. iVOICE was developed under contract to the European Space Agency as part of research into systems to monitor the physical and mental health of future space flight crew. The iVOICE system works by first getting to know the voice characteristics of each individual driver so that it can identify small changes to their voice occurring over the working day which indicate increasing fatigue. This is similar to the way humans detect fatigue in the voice – we notice tiredness most easily in people well known to us than with strangers whom we have just met for the first time. On published tests, iVOICE was able to detect significant fatigue with an accuracy of 90% once tuned to individual voices. Being just a software algorithm iVOICE can be installed wherever there is a capability to make voice recordings onto a computer, either in bespoke systems installed in vehicles, or via existing telecommunication channels to a system in the cloud. In embodiment the AP is an audio-visual platform comprising a front-facing camera (CAM). Such technical feature enables additional visual analysis of the patient and patient behaviour. Personal mobile devices commonly comprise a front-facing camera for recording images of a user and a rear-facing camera for recording images of subjects other than the user. The quality in megapixels of the rear-facing camera far surpasses the front-facing camera, for example if the back facing camera has 12 megapixels, and the front has 7 megapixels (MP), there is almost twice the image quality in the back facing camera. The Samsung Galaxy Ultra has 108MP rear-facing camera and 40MP front-facing camera. In embodiments the AP comprises a front-facing camera comprising rear-facing specification components, such as lens, sensor, pixelation, aperture and the like. Preferably the front-facing camera comprises at least 8MP, for example comprises megapixels in the range 8–108MP, more particularly in the range 12 or 40-108MP, for example 12MP, 16MP, 20MP, 40MP, 48MP or 108MP. A SU may be configured for sensing or monitoring one or a combination of biosignals of the patient, more particularly one or more of a bioelectrical, bioimpedance, biochemical, biomechanical, bioacoustic, biooptical or biothermal signal(s) of the patient. A signal of the patient is a marker of MA or PPMW. An SU is suitably a miniaturised or nanoSU configured for embedding in an AU herein. A cardiovascular SU (CSU) herein may comprise any cardiovascular sensor as known in the art, for example configured for sensing or monitoring heart rhythm, heart rate, heart rate variability, blood pressure (BP) including systolic, diastolic and mean arterial, blood volume pulse, stroke volume, cardiac output, ventricular ejection time, pre-ejection period and the like. A CSU may comprise an electrical or optical sensor, such as or electrodes, light emitters and receivers. A signal of a patient may be electrical impedance, optical stimulus or the like. Pulse and respiratory rate sensors include pressure sensitive sensors, for example known as resus sensors. In embodiments a CSU is an electrocardiogram (ECG), impedance cardiogram (ICG) or photoplethysmogram (PPG). In embodiments a CSU is comprised at a body-contacting inner face of the AU, preferably positioned to detect a cardiovascular marker, for example proximal to an artery. This enables sensing of markers of dehydration by analysis of sweat, produced at the body surface, or by analysis of breath, exhaled during patient vocal interaction or speech with the device or with MAMC by means of the device. A CSU may be positioned in manner to detect a consistent and strong signal, for example by means of adhesive patch, or of skin-wetting patch, preferably having conformal properties resembling human skin such as a gel patch or bio e-skin. An adhesive patch, wetting-patch or bio e-skin provides intimate contact of sensor and skin, for example eliminating air pockets and the like. A cardiovascular marker or signal is a marker of a condition such as bradycardia, tachycardia, or the like. Such conditions may be associated with, for example a SE of or ADR of or an indication of NA to medication such as cardiac medication for example beta-blockers. A frequent side effect of Clozapine™ is tachycardia (increased heart rate or pulse), with potential to lead to palpitations and if sustained, to contribute to cardiac adverse event including sudden cardiac death. Suitably a sensor herein is specific to heart rate as a biomarker. A heart rate monitor may be configured in SR-RF communication with a fitted pacemaker. Falling heart rate or blood pressure is a marker or indicator of orthostatic hypotension. Orthostatic hypotension carries a fall-risk in particular for the elderly. A CSU may be configured to detect falling HR or BP, on the basis of which the RCU is configured to generate a patient notification such as “Get up slowly, take your time” or to generate a clinical intervention notification such as an alert to MPMC ahead of adverse event such as a patient fall. A BTSU herein may comprise any body temperature sensor as known in the art for sensing or monitoring body temperature. A BTSU may be a mechanical thermometer for example comprising a heat responsive solid, liquid or gas, an electrical temperature sensor such as a thermistor comprising a thermally sensitive resistor, a thermocouple, resistance thermometer, or silicon bandgap sensor, non-contact thermocameras which may incorporate a themopile or infra-red sensor, such as a microbolometer sensor, pyroelectric sensor or ferroelectric sensor, chemical sensor including polylactic acid (PLA). Body temperature is a marker of ADRs such as agranulocytosis, and of SEs such as dehydration and fever. In embodiments a BTSU is comprised at a skin-contacting inner face of the AU. This enables sensing of body temperature by direct or optical contact with the patient’s body. It is known in the art to detect or monitor by means of an acoustic sensor or microphone, signals of speech as a marker of depression, for example as disclosed in “Acoustic differences between healthy and depressed people”, Wang et al, BMC Psychiatry 19, Article number:300 (2019) or as a marker of fatigue, for example as disclosed in the review “Fatigue Monitoring and Collision Avoidance: Voice analysis fatigue monitoring”, Paul Moore, International Mining, Jan 2018. In embodiments an AS or MIC is configured to detect or monitor acoustic features of patient voice selected from fundamental frequency, loudness, speed, pitch or tone as markers of drowsiness, mood, confusion, memory problems, alertness, or the like. Preferably an AS or MIC generates a voice signal suitable for analysis of voice markers selected from one or more of loudness or power spectrum of voiced sound or pressure of voiced sound or of vocal vibration, frequency or duration of voiced sound such as syllables per second, fundamental frequency and the like. Local or remote analysis of voice markers indicates symptoms indicative of PPMW, for example anxiety, depression, panic attack, stress, dehydration, fever, stroke and the like. Symptoms are for example indicative of NA to medication for psychosis, panic disorder, obsessive-compulsive disorder, schizophrenia, bipolar disorder, sleep disorders and the like, SEs and ADRs associated with antipsychotic medication such as e.g. anti-anxiety medication, antidepressants, psychotropics such as clozapine, mood stabilisers or stimulants, chemotherapy medications and diuretic medications and the like. In embodiments AS is comprised at a skin-contacting inner face of the AU and is configured to detect vocalisations or marker thereof such as cough, movement or vibration transmitted within the body or is comprised at an external surface of the AU, positioned to optimally detect speech patterns with minimal distortion, noise etc., in the usual manner for positioning a MIC in a wearable. The one or more additional sensors which may be provided in addition to one or more DHSUs herein may be selected from one or more of body temperature sensor, heart rate sensor such as an ECG as hereinbefore defined together with one or a plurality of a pulse rate sensor such as pulse oximeter, blood pressure (BP) sensor, respiratory rate (RR) sensor, oxygen saturation sensor (SpO₂) or CO₂ sensor, pH sensor, electrodermal activity sensor (EDA), accelerometer, height sensor, sleep sensor, appetite sensor such as a calorie counter, step counter. A sensor may be for loss of balance such as for example a movement sensor, accelerometer and/or height sensor. A steps-tracker or activity-tracker SU may detect or monitor steps or activity as critical parameter for respiratory rate or oxygen saturation as a marker of lung function associated with a condition such as COPD, e.g. inhaler use vs distance walked (number of steps). An SU herein is preferably an auto-sensor, i.e. an autocontrolled sensor, e.g. is controlled by a controller comprised in the SU and/or RCU and may be centrally and/or remotely controlled, e.g. by OU and/or MPMC. An SU or AS comprised at an inner skin-contacting face of the AU is suitably positioned in manner to detect a consistent and strong signal, for example by means of adhesive patch, or of skin-wetting patch, preferably having conformal properties resembling human skin such as a gel patch or bio e-skin. An adhesive patch, wetting-patch or bio e-skin provides intimate contact of sensor and skin, for example eliminating air pockets and the like. In embodiments the AU has mechanical properties resembling human skin, for example has comparable conformability, mechanical strength, conduction, insulation, membrane or barrier properties and is lightweight. In embodiments an SU or AS comprises a triboelectric, ferroelectric or piezoelectric sensor mechanism. In embodiments an SU comprises a bio e-skin such as a ferroelectric or piezoelectric bio e-skin. In embodiments an AU comprises electrical and/or optical circuitry and/or SR-RF communication environment housed in an AU material or substrate. More particularly AU comprises an environment or substrate for units of the OU and MPMU or parts thereof. An AU is suitably a functional environment, such as an energy storage environment, a power supply environment such as an energy harvesting environment, a communication (network) environment, more particularly an optically or electrically wired or wireless environment such as a network-on-a-chip, NFC or WBAN or WPAN (e.g. Bluetooth) environment, or an intra-responsive MPM triangulation environment. For example the AU body and/or AU surface comprises wearable energy storage material and/or wearable PSS material such as energy harvesting material which is suitably stretchable and editable, suitably comprising electrode nanowires or nanofibers or core-shell yarn thereof, wearable SR-RF conducting material and/or wearable networked, preferably intra-responsive MPMU units, i.e. in electrical, optical and/or data and control signal network communication with or between a plurality of units herein. Such environment(s) is/are suitably distributed having regard to units of the device herein. Such material may be discrete and interconnected or continuous throughout the AU or a part thereof coextensive with a plurality of units. Such material may be provided in 2D or 3D or stacked array with units or may comprise units embedded therein. In an embodiment there is provided a wearable embedded integrated MPM device comprising an OU as hereindefined and input and output peripherals comprising MPMU units as herein defined, housed within an AU which comprises a housing body and a housing surface having a viewing face and a contact face, wherein the VDU is embedded at and within the viewing face and the AP is embedded within the viewing face and/or the body and/or an AS is embedded at and/or within the contact face, and wherein one or a plurality of SU(s) are embedded at and/or within the contact face and/or within the body, wherein the AU provides an NFC, WBAN or WPAN environment and a plurality of units or parts comprise NFC, WBAN or WPAN interface and/or a plurality of units or parts thereof are comprised in an optically or electrically wired or wireless network or environment, more particularly a mixed output and input network or environment, most particularly a VD, SPK, VDTOOL, CAM, MIC and SU(s) network or environment comprising a system- on-a-chip housed within the AU body and surface. Hardware herein provides a device comprising a wearable wireless network-on-a-chip (NoC) comprising units embedded in an AU body comprising a shaped flexible, semi-flexible and/or rigid chip substrate, and/or within an AU surface and networked by wireless communication channels connecting units and ICs which may be chiplets or other chip architecture as herein defined. UNITS & MODULES: A unit herein may be defined by identity of hardware and/or software making up the unit, i.e. not by physical location thereof. Unit hardware may be co-located, grouped or distributed across a plurality of same and/or different units and/or modules. Unit hardware may be shared by a plurality of units. References to a “unit” or “U” include a collection of one or more parts or components (which may be provided at different locations). A unit herein suitably comprises one or a plurality of ICs (each) comprising a processor, memory and general purpose input/output pins (GPIOs) for peripherals (optionally integrated in a microprocessor), PSU or is comprised in a PSS, and may include a signal processor such as DSP, analogue, mixed signal or SR-RF signal processor, wireless interface e.g. SR-RF module and/or remote network communications module such as WCU and peripherals integrated on an IC or chip or microcontroller (MCU) or a SoC, comprising a communications subsystem such as a bus architecture or switching fabric connecting on-chip components, or micro-electromechanical system (MEMS). An IC or SoC may be an application specific standard product (ASSP) or application specific integrated circuit (ASIC) or a field programmable gate array (FPGA). Peripherals include visual display, visual display input tool, speaker, microphone or sensor(s) and may be on-chip or networked. An SU suitably comprises an IC with on- or off-chip sensor, DSP core and on- or off-chip SR-RF module or transceiver or transmitter and receiver or wired interface or circuitry for input and output. In embodiments an SU is responsive and comprises transmitter and receiver or transceiver. Such hardware enables triangulation control of SU. An operating unit (OU) herein may be comprised on one or more IC’s. An OU may be configured in various ways, such as, but not limited to a MCU, computer on a chip, system-on-chip (SoC), system-on-module (SoM), central processing unit or processor or microprocessor with its required peripherals and/or any other computer capable of executing a set of computer instructions. Preferably the OU is configured as or is comprised in a SoC, or MCU. An SoC or MCU combines control on a single chip e.g. of a plurality of MPMU units. Such hardware enables rapid and efficient operation and low power usage. Preferably a MCU herein comprises a plurality of input and output connection pins. Preferably input and output pins are coupled to input peripherals, output peripherals and input/output peripherals directly or via an RCU. POWER SOURCE: In embodiments an SU is at least partially triboelectric, piezoelectric, thermoelectric or solar powered. Preferably the device, and/or one or a plurality of units or modules herein is partially or fully self-powered or self-sustained, more particularly comprises one or more energy harvesting units (EHUs) for example for harvesting biomechanical, force or kinetic energy, heat or light energy and the like, coupled with one or a plurality of energy storage units or cells (ESCUs, ESCs), such as one or more capacitor(s), super capacitor(s) or rechargeable battery(ies) or cell(s), and optionally additionally one or a plurality of wireless energy receivers (WERs) such as inductive, capacitive or magnetodynamic WER(s), i.e. near field, and/or resonant inductive or RF or microwave or laser WER(s)), i.e. mid-field or far-field e.g. electric current, magnetic induction, air charging and the like WER(s). Thereby the device may operate with infrequent or no need for charging operation by the patient. Proceedings of the IEEE Vol.103, No.4, April 2015, p665-681, Misra et al. “Flexible Technologies for Self- Powered Wearable Health and Environmental Sensing”, the contents of which are incorporated herein by reference, discloses high-efficiency nanostructured energy harvesters and storage capacitors, new sensing modalities that consume less power, low power computation, and communication strategies, and novel flexible materials that provide form, function, and comfort for integration into a unified wearable device. A Smart ECG may comprise CNT – PDMS nano ECG patch electrodes. Self-powered wearable sensor units as hereindefined are known in the art, the contents of which are incorporated herein by refence, including: Sensors disclosed in “Self powered wearable electronics based on moisture enabled electricity generation”, Shen et al, Advanced Materials, 30(18), May 3, 2018: in embodiments an SU and/or EHU is positioned proximal to AS or MIC or is comprised in a touchpad portion of VDU such as a VDTOOL input tool herein, and comprises moisture-dependent conducting nanowire network, more particularly configured to generate moisture-dependent voltage for self-powering, for example by means of diffusive flow of water in TiO₂ nanowire networks, by contact with patient breath or skin; “Self-powered wearable graphene fibre for information expression”, Liang et al, Nano Energy, 32, Feb 2017, 329-335: an SU or EHU comprises a moisture enabled breathing monitor, more particularly a graphene fibre hydroelectric power generator; Self-powered energy harvesting units as hereindefined are known in the art the contents of which are incorporated herein by reference including: https://ieeexplore.ieee.org/abstract/document/7110423 https://pubs.acs.org/doi/abs/10.1021/acsenergylett.7b01237, https://link.springer.com/chapter/10.1007/978-1-4419-7384-9_2, https://pubs.acs.org/doi/abs/10.1021/acsnano.5b01478 and https://ieeexplore.ieee.org/abstract/document/8793142. In embodiments an EHU comprises organic photovoltaics (OPVs). Known for their high flexibility, lightweight, and scalable fabrication methods these have recently attained power conversion efficiencies of over 17% and are excellent candidates to power these next-generation wearable devices. DHSU: In embodiments an SU or EHU comprises a triboelectric self-powered respiration sensor for exhaled gases configured to detect concentration of trace NH3 as a marker, for example comprising (Ce) doped triboelectric films, for example as taught in “An integrated flexible self-powered wearable respiration sensor”, Wang et al, Nano Energy, 63, June 2019, the contents of which are incorporated herein by reference. An As or MIC herein may comprise an SU for detecting breath ammonia for example as taught in “A novel approach to monitor ammonia in exhaled breath”, Geerthy et al, ICCSP, 2-4 April 2015, https://ieeexplore.ieee.org/document/7322546 , “What is ammonia breath and is it a symptom of CKD”, Fresenius Kidney Care, https://www.freseniuskidneycare.com/thrive-central/ammonia-breath the contents of which are incorporated herein by reference. Non invasive dehydration sensors are disclosed in EP3212060A, and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327088/ A DHSU configured for monitoring sweat rate may be for example as taught in https://www.nature.com/articles/srep04103. A DHSU herein may be for example as disclosed in “Sensing body dehydration”, Balaji, Jong and Chen, 13 December 2017 https://www.edn.com/sensing-body-dehydration/ and further disclosures referenced therein, the contents of which are incorporated herein by reference, as hereinbelow. In embodiments a wearable dehydration SU may be selected from: a biochemical dehydration SU configured to monitor chemical components of the patient’s perspiration, for example as disclosed in US2018/0263539 “Wearable sensor arrays for in-situ body fluid analysis”, Javey et al, University of California and “Fully integrated wearable sensor arrays for multiplexed in-situ perspiration analysis”, Gao et al, Nature, 529, 509–514(2016); a biooptical dehydration SU may be selected from: a colorimetric sensor coupled with optical image analysis configured for optical image analysis of captured sweat to quantitate water loss including pH and concentration of both chloride and lactate, for example as disclosed in “A soft, wearable microfluidic device for the capture, storage and colorimetric sensing of sweat”, Koh et al, Sci Transl Med.2016 November 23, 8(366); a light source and polarization means configured for emitting and polarizing light of a first wavelength to irradiate tissue, a light detector to detect reflected light, and a processor to derive a tissue hydration parameter and therefrom to determine a body hydration index, for example as disclosed in EP3212060A1 Koninklijke Phillips NV. Such SU is configured for an optical evaluation of the reflectivity of tissue indicating the dryness thereof. Well hydrated tissue is wet and shiny and reflects more light than dehydrated tissue. The light source may be one or more LEDs emitting light of wavelength 660nm or 940nm. The SU is conveniently positioned on the contact face of the AU contacting the skin of the patient. Preferably the AU blocks ambient light at the skin of the patient adjacent the contact face. A DHSU may be: an optical sensor comprising an LED for irradiating skin and tissue and detecting reflected radiation, see for example WO2019210105; a pH sensor, more particularly a sensor for monitoring or detecting pH based biomarkers, such as a pH biomarker sensor for detecting ammonia in exhaled breath. In embodiments a dehydration SU herein is configured for monitoring conductivity of sweat as an indication of mineral content (sodium, potassium) which decreases with dehydration. Conductivity of sweat varies with sodium concentration and can be an indirect measurement of dehydration. In a further embodiment a dehydration SU herein is configured for monitoring density of sweat as an indication of water volume in the body. An SU may comprise sensing electrodes configured for quantifying one or a plurality of analytes in sweat, for example with high sensitivity in the physiologically relevant range. An SU may comprise iontophoresis electrodes configured to induce sweat excretion together with sensing electrodes for analysis thereof, for example as disclosed in US2018/0070870, University of California; In a further embodiment, a dehydration SU herein is configured for monitoring sedentary dehydration through bio-impedance analysis, indicating total volume of water in the body (TBW) and hydration state thereof, comprising an IC configured for signal generation, impedance reading and dehydration indication, embedded in the AU together with electrically conducting contacts such as copper contacts disposed on the inward or inner face of the AU for direct skin contact, for example as disclosed in Balaji, Jong and Chen above. A self-powered wearable BTSU herein may comprise: a thermoelectric generator with multisensory system allowing continuous and simultaneous monitoring temperature humidity and activity of human body entirely by human body heat for example as disclosed in https://www.sciencedirect.com/science/article/abs/pii/S0306261920307625 or https://www.sciencedirect.com/science/article/abs/pii/S221128552030330X; and/or a Micro Super Capacitor (MSC) driven wearable sensors for personal health monitoring for example as disclosed in https://www.sciencedirect.com/science/article/pii/S2588842019301191. A self-powered wearable HRSU may comprise a triboelectric nanogenerator, power management circuit and HRSU and signal processing unit and Bluetooth module. The device harnesses inertia from human walking into electric power , and is an enabled body sensor network as disclosed in https://pubs.acs.org/doi/abs/10.1021/acsnano.7b02975. A self-powered MIC or AP herein may comprise piezoelectric bio e-skin nanofibers, for example as disclosed in “Human skin interactive self-powered wearable piezoelectric bio e-skin by electrospun poly-L- lactic acid nanofibers for non-invasive physiological signal monitoring”, Sultana et al, J. Mat. Chem, B, Issue 35, 2017 and “Electrospun gelatin nanofiber based self-powered bio e-skin for health care monitoring”, Ghosh et al, Nanoenergy, 36, 166-175. Bio-e-skins are flexible and lightweight and possess favorable mechanosensitivity (PLA based e-skin ∼22 V N−1, gelatin base e-skin ∼0.8 V kPa−1. A piezoelectric pressure sensor comprising gelatin nanofibers provided nanoscale ferro– and piezo–electricity (d33~−20 pm/V). Such e-skin may enable detecting subtle movement of muscle in the internal organs such as oesophagus, trachea, motion of joints and arterial pressure by recognition of strains on human skin without using any external power source, more particularly capable of monitoring human physiological signals such as throat and wrist pulse and muscle movement when a person is speaking. A method for manufacture of the device or a module therefor herein suitably comprises providing or forming an AU about a MAMU and OU, or individual units or parts thereof as hereindefined, for example by extrusion, 3D and/or 4D printing or moulding such as injection moulding. 3D and 4D printing techniques include extrusion such as fused deposition modelling, vat photopolymerisation such as stereolithography, powder bed fusion, digital light projection, material or binder jetting, multi-jet modelling, selective laser sintering, electron beam melting, sheet lamination, directed energy deposition or combinations thereof. Units may be laid up prior to, during and/or subsequent to forming the attachment. Units or modules herein are suitably assembled on a scaffold, optionally laid up on a release surface or release web, reel or spool, and an attachment formed thereabout. A device or module may be manufactured as a discrete device or module, which may be a continuous band or an elongate band having securing means at ends thereof. A plurality of same or different devices and/or modules may be manufactured on or in form of a web, reel or spool thereof e.g. for efficient manufacture and convenient handling, with subsequent separation into discrete devices or modules. For example, units may be laid up in a first clean area and transported to a printing or extrusion area for forming the AU thereabout. Units or modules or part thereof may be manufactured, prior to, simultaneously with and/or subsequent to manufacturing the attachment, using any known or novel techniques for example using 3D or 4D printing technique. Printing of a smart material herein may be by 4D printing which comprises 3D printing with programming of a time-dependent, i.e. dynamic, structural response to an external stimulus, such as for example printing a SMM material at non-ambient stimulus conditions, such as elevated temperature, with a desired memory response e.g. shape, deformation, volume or the like. Circuitry or ICs may be printed for example by etching, hot stamping or screen printing or 3D techniques. The method employs polymers, plastics, ceramics, metals including alloys, inorganic materials including glass and the like as known in the art and as hereinbefore defined and combinations thereof. There is further provided a device herein, when obtained or obtainable by the method In Figure 1 is illustrated a wearable device comprising an attachment unit (AU) (1), comprising embedded therein the operating unit (not shown) and VDU (2), SPK (31) and MIC (32). Acoustic sensor (AS) (15a) may be present for dedicated voice analysis, and may be a dedicated HiFiMIC comprised adjacent MIC (32) or may comprise a smart sensor material or layer of material comprised embedded in the skin- contacting inner face of the AU (1) for mechanical voice detection. HRSU (15b) comprises a smart sensor material or layer of material disposed embedded in the inner skin-contacting face of the AU (1) positioned to detect pulse. BTSU (15c) comprises a further smart sensor material or layer of material disposed embedded in the inner skin-contacting face of the AU (1). A plurality of DHSUs (15d) are comprised integral with and surrounding MIC (32), integral with a touch screen portion or controls portion of VDU (2) or VDTOOL and at a skin-contacting face of AU (1). In Figure 2 is illustrated a triangulation flow scheme for clinical example of health monitoring with self- treatment notification to overcome medication ADR vs clinical intervention notification to MPMC. The algorithm illustrates the following example medication groups • Chemotherapy (chemo) for cancer • Diuretics for heart failure and high blood pressure: hypertension HR SU is active at each medication reminder and monitoring interval. HR markers monitored and signals sent to RCU. RCU applies algorithms for comparison with threshold HR values. If threshold not exceeded HRSU powered down except IF medication is chemotherapy, signal sent to power up BTSU and DHSU. IF RCU determines increased heart rate detected (heart rate signals exceed threshold). RCU issues control signals to • Initiate voice PI prompt to VDU/SPK • Power up HiFiMIC/AS (and optionally CAM) to active mode, activate voice monitoring; Voice signals captured and transmit to voice analysis unit (VAU) to determine marker values or voice signal overlay and identify deviations etc, VAU or RCU applies algorithms to marker values or deviations, including threshold voice deviations analysis of voice markers for values outside thresholds, deviation from normal values e.g. of speed (syllables / sec), pitch or tone (frequency) indicating drowsiness/confusion/lack of alertness • Power up dehydration SU (DHSU), e.g. DHSU = NH3 breath monitor power up for monitoring simultaneous with voice monitoring, breath monitored and DH markers monitored, signals transmitted to RCU • Power up Body Temp SU (BTSU), activate body temperature monitoring; body temperature markers monitored and data/signals transmitted to RCU. RCU receives signals: RCU applies algorithms for comparison with threshold values. If threshold values not exceeded for any unit, signal sent to power unit down. • If HR marker value persistently outside threshold values, intervention notification issued to MPMC • If Voice markers indicate drowsiness, if medication is a diuretic and if dehydration is indicated, RCU issues intervention notification to MPMC, and issues signals to MIC or AS to continue monitoring over the course of 4 hours • If Dehydration indicated and BT outside threshold values, RCU issues triangulation data to OU, data and signal transmitted to MPMC to initiate intervention, and issues patient self-management signal to VDU and AP, e.g. Patient advised to take fluids; RCU issues signal to DHSU to continue Monitoring over time 4 hours • If No dehydration, DHSU e.g. NH3 breath monitor to power down/sleep mode Dehydration as a SE is treatable and preventable • Body water affects HR and blood pressure (BP) • Frequent SE of chemotherapy medication, 80% of patients encounter a SE of vomiting/diarrhoea • Frequent occurrence with elderly patients – making up the widest prescribed drug and dehydration leads to hospital admission https://www.ncbi.nlm.nih.gov/books/NBK555956/ https://www.nutrition.org.uk/nutritionscience/life/dehydrationelderly.html • In case of mild or severe indication of dehydration, RCU issues signal to DHSU for ongoing monitoring of dehydration and as and when marker notifies, RCU issues signal to VDU and AP to issue a patient self-treatment notification such as “Grab a glass of water and rehydrate” Some triangulation examples include 1) Chemotherapy medication: High BT and fever/sweating cause dehydration. Therefore a DHSU alone is not sufficient to identify. BTSU monitoring is required. If BT marker is outside threshold levels RCU issues emergency intervention notification 2) Diuretics: Dehydration is more dangerous in elderly with cognitive impairments and swallowing difficulties, where self-treatment rehydrating can be difficult (for example due to physical immobility/dexterity) so voice recognition technology monitors drowsiness/tiredness and when it establishes excess dehydration marker, sends a notification for immediate clinical intervention. 3) Body Temperature. Rising-body temperature can indicate potential agranulocytosis e.g. clozapine induced agranulocytosis, chemotherapy induced agranulocytosis 4) Heart rate. Persistently abnormal high heart rate can indicate potential clozapine induced myocarditis. EXAMPLES Example 1 - A frequent side effect of many medications including chemotherapy treatments and Clozapine™ (schizophrenia medication) is increase in body temperature during first 28 days, indicating a sub-clinical reaction with potential to lead to more serious side effects. Rising-body temperature can indicate potential agranulocytosis e.g. clozapine induced agranulocytosis, chemotherapy induced agranulocytosis. A large number of drugs[2] have been associated with agranulocytosis, including antiepileptics (such as carbamazepine and valproate), antithyroid drugs (carbimazole, thiamazole, and propylthiouracil), antibiotics (penicillin, chloramphenicol and trimethoprim/sulfamethoxazole), H2 blockers (cimetidine, famotidine, nizatidine, ranitidine),[3] ACE inhibitors (benazepril), cytotoxic drugs, gold salts, analgesics (aminophenazone, indomethacin, naproxen, phenylbutazone, metamizole), mebendazole, allopurinol,[4] the antidepressants mianserin and mirtazapine, and some antipsychotics (the atypical antipsychotic clozapine[5] in particular). Clozapine users in the United States, Australia, Canada, and the UK must be nationally registered for monitoring of low WBC and absolute neutrophil counts (ANC). Early diagnosis is paramount and is made after a complete blood count, a routine blood test. In patients that have no symptoms of infection, management consists of close monitoring with serial blood counts, withdrawal of the offending agent (e.g., medication), and general advice on the significance of fever. A device embodying the invention comprises a BTSU for sensing or monitoring body temperature as a marker of PPMW. The temperature monitoring sensor is sensitive to temperature in the range of human body temperatures, specifically 35°C - 42°C. Temperature readings are processed locally or remotely. On detecting abnormal temperature, RCU issues a task to DHSU to monitor for dehydration. Local or remote processing against temperature and dehydration routines indicates notification to patient to self-support or to MPMC for clinical intervention and determination of temperature increase as non-medication related or the result of a possible adverse event caused by medication, such as diuretic effect. From this determination an investigation for agranulocytosis can be expedited or routine. Example 2 - A frequent side effect of many medications including chemotherapy treatments and Clozapine™ (schizophrenia medication) is tachycardia (increased heart rate or pulse), with potential to lead to palpitations and if sustained, to contribute to cardiac adverse event including sudden cardiac death. Such medications include drugs used to treat cancer; antibiotics, such as penicillin and sulfonamide drugs; some anti-seizure medications; and some illegal substances, such as cocaine. A device embodying the invention comprises a HRSU for sensing or monitoring heart rate as a marker of PPMW. A heart rate monitor is configured in SR-RF communication with a fitted pacemaker. HR readings are processed locally or remotely. On detecting abnormal HR, RCU issues a task to DHSU to monitor for dehydration. Local or remote processing against HR and DH routines indicates notification to patient to self-support or to HP for clinical intervention and determination of persistently abnormal high HR as non-medication related or the result of a possible adverse event caused by medication such as diuretic effect. From this determination an investigation for tachycardia can be expedited or routine. Example 3 – A frequent SE of many medications is dehydration and/or elevated body temperature among other SEs and ADRs which can manifest in drowsiness or lethargy which in turn can affect a patient’s voice. Changes in voice changes are also a common symptom of depression, and other symptoms of a condition which is being treated, and can therefore indicate NA. It is important to distinguish a case of SE or ADR from a case of NA. A device embodying the invention incorporating a HiFi MIC records a patient’s voice (initial recording) and analyses voice patterns for pitch, tone and speed of voice. Vocal monitoring continues during treatment with clozapine, and voice patterns are compared with patterns from the initial recording. A medication adherent patient would be expected to display improved speech patterns (raised pitch and tone, increased speed). On detecting a change comprising a lowering in pitch and tone and slowing in speed of speech, RCU issues a task to DHSU to monitor for dehydration and may issue a task to BTSU to monitor body temperature. The change is indicative of first signs of depression, indicating possible non-adherence to medication. This may necessitate a patient notification to take medication and/or an urgent medical intervention to establish the reason for NA and take corrective measures. However the voice symptoms may be indicative of a possible SE or adverse medication event such as dehydration, stroke or agranulocytosis. Concomitant detection of dehydration and elevated body temperature enables distinguishing an SE such as dehydration or ADR such as possible agranulocytosis. Example 4 - Triangulation: Patient undergoing Chemotherapy: Displaying high temperature/fever and sweating causing dehydration – DHSU returns indication of dehydration, triangulation with BTSU confirming elevated body temperature indicates a medical emergency, and notification issued for immediate clinical intervention.

Claims

CLAIMS 1 A wearable device for wearing by a patient in receipt of medication, comprising one or a plurality of attachment unit(s) (AU(s)) configured for wearing of the device or part thereof on or about a member or body part of said patient and comprising components of a medication and patient monitoring unit (MPMU) including: an interactive visual display unit (VDU), an interactive audio platform (AP) comprising a and a plurality of sensor units (SUs) configured for sensing one or more biomarkers of patient physical and mental wellbeing (PPMW); and comprising components of an operating unit (OU) including: a processing unit (CPU) and memory, a wireless communication unit (WCU) for accessing at least one communications network and communicating data and/or signals between the device and a remote address, more particularly between the device and a MPM centre (MPMC), a power supply unit (PSU) and an energy storage unit (ESU) wherein a plurality of sensor units comprises at least one dehydration sensor unit (DHSU) for sensing one or more markers of patient hydration level or dehydration.

2. The wearable device as claimed in claim 1 additionally comprising a heart-rate SU or pulse SU (CSU or HRSU), and a body temperature SU (BTSU).

3. The wearable device as claimed in any one or a combination of claims 1 and 2 wherein the interactive visual display unit (VDU) comprises a visual display (VD) and a VD patient interaction (PI) tool (VDTOOL) comprising touchscreen, touchpad or button record tools or voice activation.

4. The wearable device as claimed in any one or a combination of claims 1 to 3 wherein the interactive audio platform (AP) comprises an audio output unit, herein speaker unit (SPK), and an audio PI unit, herein microphone unit (MIC), more particularly comprising audio PI tool (MICTOOL), for example touchscreen, touchpad or button record tools or voice activation.

5. The wearable device as claimed in any one or a combination of claims 1 to 4 wherein the AP is an audio-visual platform and additionally comprises a video-camera PI unit comprising a video-camera (CAM) more particularly comprising video-camera PI tool (CAMTOOL), for example touchscreen, touchpad or button record tools or voice activation.

6. The wearable device as claimed in any one or a combination of claims 1 to 5 wherein sensor units (SUs) comprises an interface for sending data and/or signals to the OU, and optionally additionally for receiving data and/or signals from the OU.

7. The wearable device as claimed in any one or a combination of claims 1 to 6 wherein a DHSU is comprised in association with a part of the device configured for patient touch or contacting patient exhaled breath, positioned to sample patient sweat or exhaled breath and comprises a breath or sweat sensor in flex circuit board form with biological and chemical sensor arrays that detect biological or chemical species including bacteria, ammonia and glucose, lactate, sodium and body temperature, configured for generating electrical signals on contact with sweat, and amplification and filtering thereof, and optionally calibrating using skin temperature.

8. The wearable device as claimed in any one or a combination of claims 1 to 7 wherein the at least one DHSU is comprised at a skin-contacting inner face of the AU comprised in an adhesive patch, or skin- wetting patch, or a gel patch or bio e-skin having conformal properties resembling human skin.

9. The wearable device as claimed in any one or a combination of claims 1 to 8 wherein the at least one DHSU is an optical DHSU embedded in an inner face of the AU beneath an optically transparent skin- contacting face of the AU, and comprising light or radiation emitter and detector.

10. The wearable device as claimed in any one or a combination of claims 1 to 9 wherein the at least one DHSU is comprised at an external surface of the AU, proximal to MIC or AS or CAM.

11. The wearable device as claimed in any one or a combination of claims 1 to 10 wherein the at least one DHSU is comprised at an external surface of the AU, comprised or embedded in a touchpad portion of VDU or a VDU input tool (VDTOOL), or operation button.

12. The wearable device as claimed in any one or a combination of claims 1 to 11 wherein the at least one DHSU is comprised at an external surface of the AU, comprised or embedded in a touchscreen or touchpad portion of CAM or a CAM operation tool (CAMTOOL).

13. The wearable device as claimed in any one or a combination of claims 1 to 12 wherein the at least one DHSU comprises a chemical or electrochemical or electrical sensor, configured to detect or monitor chemical components of body fluids including sweat or breath, selected from glucose level, pH, presence, absence or concentration or density of chemical species, analytes or fluid selected from mineral salts including sodium or potassium, ammonia or ammonium (NH3 or NH4).

14. The wearable device as claimed in any one or a combination of claims 1 to 13 wherein the at least one DHSU comprises an electrical, pH, conductivity or impedance sensor comprising a set of electrodes and/or probe and transmitter and configured to apply a current to patient gaseous or liquid fluid selected from breath, sweat and saliva, or to patient skin.

15. The wearable device as claimed in any one or a combination of claims 1 to 14 wherein the at least one DHSU comprises an optical sensor, colorimetric sensor, or a radiation sensor comprising a light emitter and receiver, for analysing parameters of skin for dehydration, more particularly reflectance or mechanical properties such as elasticity.

16. The wearable device as claimed in any one or a combination of claims 1 to 15 comprising two DHSUs configured for detecting or monitoring two different markers of dehydration.

17. The wearable device as claimed in any one or a combination of claims 1 to 16 comprising a DHSU comprised at an external surface of the AU proximal to MIC or AS or CAM configured for sampling patient breath, and one or both of a DHSU comprised in a touchscreen or touchpad portion of CAM, CAMTOOL, VDU or VDTOOL and a DHSU comprised at a skin-contacting inner face of the AU.

18. The wearable device as claimed in any one or a combination of claims 1 to 17 which is configured for continuous daytime and optionally additionally night time wear wherein OU and one or more MPMU units are embedded in the AU which is a liquid and gaseous fluid-impermeable and fine particle- impermeable body or a part thereof which is liquid and gaseous fluid-impermeable and fine particle- impermeable or are mounted on the AU and are sealed thereabout by a liquid and gaseous fluid- impermeable and fine particle-impermeable seal.

19. The wearable device as claimed in any one or a combination of claims 1 to18 wherein MIC, SPK and CAM and one or more DHSU(s) comprise a liquid fluid impermeable and fine particles impermeable and optionally additionally gaseous fluid impermeable seal, for example a water-repellent permeable membrane such as a permeable PTFE membrane.

20. The wearable device as claimed in any one or a combination of claims 1 to 19 wherein a DHSU comprises a fluid sampling part and a separate or integral sensor part, wherein a fluid sampling part is comprised external to a liquid and gaseous fluid-impermeable seal of the DHSU or the AU.

21. The wearable device as claimed in any one or a combination of claims 1 to 20 wherein a DHSU comprises a fluid sampling part selected from a surface or reservoir such as a membrane, filter, absorption pad such as a sweat patch, a microcapillary or array such as a microfluidic array of channels, a reservoir or chamber which may be porous e.g. meso or nanoporous reservoir or substrate and the like for sampling patient fluid.

22. The wearable device as claimed in any one or a combination of claims 1 to 21 wherein a DHSU comprises a fluid sampling part which is profiled, selected form cup-shaped, concave or recessed to facilitate maximal contact with the surface of a fingertip or optionally together with optionally including inwardly spiralling recesses or channels to focus incident breath inwardly of the sampling part, i.e. minimise deflection outwardly of the sampling part.

23. The wearable device as claimed in any one or a combination of claims 1 to 22 wherein a DHSU or a part thereof configured for sampling sweat, more particularly a sampling part thereof is configured for contacting the patients skin, most particularly a fingertip.

24. The wearable device as claimed in any one or a combination of claims 1 to 23 wherein a DHSU or part thereof configured for sampling breath, more particularly a sampling part thereof is configured to lie in the path of exhaled breath of the patient, more particularly in the path of exhaled nasal breath or mouth breath.

25. The wearable device as claimed in any one or a combination of claims 1 to 24 wherein a DHSU or a sampling part thereof configured for sampling patient exhaled nasal breath is comprised in an internal- nasal band configured for locating internally within a nostril.

26. The wearable device as claimed in any one or a combination of claims 1 to 25 which comprises one or more SR-RF interfaces or SR-RF wireless connectivity for data and/or signal transfer between the OU and one or more integral or detachable unit(s) or module(s).

27. The wearable device as claimed in any one or a combination of claims 1 to 26 wherein at least one DHSO comprises a sampling and/or sensor part which is integral with the device and is comprised external to a gaseous and/or liquid fluid-impermeable seal or which is provided as a remote module of the device and which comprises an SR-RF interface for communicating data and/or signals to a processing part thereof comprised integral with the device optionally within a gaseous and/or liquid fluid-impermeable seal thereof.

28. The wearable device as claimed in any one or a combination of claims 1 to 27 wherein a unit or part thereof is embedded beneath an optically or acoustically transparent part, layer or an external surface of AU.

29. The wearable device as claimed in any one or a combination of claims 1 to 28 which is wearable on the arm, wrist or hand or part thereof wherein one or more AUs comprises an armband or patch, wristband or patch, finger ring or patch or combination thereof.

30. The wearable device as claimed in any one or a combination of claims 1 to 29 or a kit therefor, comprising a plurality of modules and one or more (patient) AUs therefor, wherein a module comprises any one or more units or part(s) thereof and may be wearable independently of one or more additional modules, comprising a patient AU herein or is mountable on a wearable AU herein.

31. The wearable device or kit as claimed in Claim 30 wherein at least one modules is a DHSU or part thereof, on a single or a plurality of AUs herein

32. A wearable component of the wearable device as claimed in any one or a combination of claims 1 to 30, comprising one or a plurality of unit(s) and/or part(s) thereof and/or modules.

33. The wearable device or kit or component as claimed in any one or a combination of claims 1 to 32 for use in monitoring MA and PPMW for a patient in receipt of medication for a condition selected from diabetes, pulmonary and cardiac including COPD, cancer, mental health including psychiatric such as schizophrenia, palliative care, transfer therapy, contraception, neurology.

34. A method for the manufacture of the wearable device as claimed in any of claims 1 to 33.

35. The wearable device of any one or a combination of claims 1 to 32 when programmed to run an MPM triangulation routine for the performance of an MPM triangulation source task, comprising generating values for a plurality of markers of PPMW and patient interaction markers and comparing with pre-set, historic or threshold values, validating and optionally issuing a task for generation of additional marker values, and running algorithms to identify whether non-validated values are indicative of NA or deterioration in PPMW, more particularly SE, ADR, or medication ineffective, and reporting.

36. The wearable device of any one or a combination of claims 1 to 32 which is an intra-responsive device wherein SU output to a microprocessor causes the microprocessor to access a plurality of data routine(s), correlation routine(s), status routine(s), threshold routine(s) and/or escalation/alert routine(s) comprised in the memory, make a determination of data compliance, and in case of a determination of NA or of threshold MA or escalation MA, to output to RCU for initiation of triangulation responsive control request to VD and/or SPK and/or CAM and/or same or different SU and/or escalate for remote monitoring and intervention, wherein SUs are configured to output sensor data and SUs and/or RCU are competent for determination of data compliance.