Wearable Technologies for Healthy Ageing: Prospects, Challenges, and Ethical Considerations.

Digital technologies hold promise to modernize healthcare. Such opportunity should be leveraged also to address the needs of rapidly ageing populations. Against this backdrop, this paper examines the use of wearable devices for promoting healthy ageing. Previous work has assessed the prospects of digital technologies for health promotion and disease prevention in older adults. However, to our knowledge, ours is one of the first attempts to specifically address the use of wearables for healthy ageing, and to offer ethical insights for assessing the prospects of leveraging wearable devices in this context. We provide an analysis of the considerable opportunities associated with the use of wearables for healthy ageing, with a focus on the five domains of intrinsic capacity: locomotion, sensory functions, psychological aspects, cognition, and vitality. We then highlight current limitations and ethical challenges of such approach to healthy ageing, including issues related to access, inclusion, privacy, surveillance, autonomy, and regulation. We conclude by discussing the implications of our analysis in light of current debates on the ethics of digital health, and suggest measures to address the identified challenges.

Utilisation of citrus compost-based growing media amended with Trichodermaharzianum T-78 in Cucumismelo L. seedling production.

Two citrus composts (C1: composed of 40% citrus wastes, 20% sludge obtained from a citrus industry waste-water treatment facility and 40% green residues; C2: composed of 60% citrus wastes and 40% green residues, and no sludge) and their water extracts amended with Trichodermaharzianum T-78 (T. harzianum T-78) were assayed in order to verify if these composts could act as a partial substitute for peat-based growing media as well as enhance suppressiveness against Fusarium wilt in the production of melon (Cucumismelo L.) seedlings at greenhouse nurseries. Over a 43-day growth cycle of melon seedlings, measurements were taken of the nutriactive effect (the capability of a substrate to express additional and/or synergistic nutritional and biostimulating effects), the pathogen incidence (percentage of fresh weight loss of melon plants grown on treatments infected with Fusariumoxysporum with respect to the same treatment without inoculation of the phytopathogen) and the trend of the T.harzianum T-78 population. A nutriactive effect was observed in the tested citrus compost-based growing media (96% and 112% plant weight increase with respect to peat for C1Th and C2Th, respectively). Pathogen incidence was significantly lower in C2Th than peat (12% compared to 33%), while no difference was observed in C1Th. The T.harzianum T-78 population showed a significant decrease at the first sampling time compared to the initial quantity (from 10(6) to 10(5)CFUg(-1)), but later recovered over time. These results demonstrate that the combination of citrus compost and T.harzianum T-78 can be a viable alternative to peat and can minimise the application of chemicals necessary to control Fusarium wilt in greenhouse nurseries for melon seedling production.

Pharmacodynamic evaluation of a PEGylated analogue of human growth hormone releasing factor in rats and pigs.

The aim of this study was to assess the in vivo efficacy of monoPEGylated GRF(1-29)NH(2) having one PEG(5000) chains attached to either lysine 12 or 21 as compared to the GRF(1-29)NH(2) in rats and pigs. This analogue termed GRF-1PEG(5000) was tested after a single intravenous administration in rats and after a single intravenous or subcutaneous injection in pigs. After 1 h administration, GH concentrations returned to values close to controls in the group of rats injected with GRF(1-29)NH(2). In animals injected with the same dose of GRF-1PEG(5000), the AUC values corresponding to the whole period 0.5-48 h and particularly to the 0.5-8 h period were higher than in the placebo or in the GRF(1-29)NH(2) groups. Interestingly, two additional peaks were observed at about 6 and 8 h following administration. An increase in the response of the endogenous GH peaks was also observed in pigs administered GRF-1PEG(5000) by intravenous route. When GRF-1PEG(5000) was administered subcutaneously to pigs, a significant increase, as compared to placebo and GRF(1-29)NH(2,) in both GH and IGF-I levels was observed. This new analogue might find therapeutic application in paediatric growth hormone deficiency or in aging.

[The Consiglio Nazionale delle Ricerche (National Research Council - C. N. R.) and the Italian medicine during fascism]. / Il Consiglio Nazionale delle Ricerche e la medicina Italiana nel periodo fascista.

The foundation of C. N. R. in 1923 created in Italy a new public system of research, different from the university one. During fascism, the contribution of C. N. R. to the development of medical research in Italy was very poor. This was mainly due to insufficient means: structures and money. Moreover, the scientists who carried on medical research within the C. N. R. were the same who already held strong university positions, which mean a complete dependence on the academic system. The ideology of fascism also contribute to the weakness of the Italian medical research promoted by the C. N. R.. According to fascist view, science, and for its nature and aims above all medicine, had to addressed to technical, practical, or much better, social achievements. Consequently, the policy of medical research at the C.N.R. was to improve social or political medicine, mainly hygiene. This was in harmony with the demographic policy, which means the policy of reinforcement of "Italian race", and positive eugenics that fascism tried to pursue.

Pharmacokinetic study in rats after single intravenous and oral administrations of [14C]-ITF-296.

Pharmacokinetics of [14C]-ITF-296 and its metabolites, ITF-1124 and ITF-1577, were studied in rats after a single intravenous (2.5 mg/kg) and oral (10 mg/kg) administration. Radioactivity was measured by LSC while unchanged drug and its metabolites in plasma were assayed by an HPLC-UV method. The absorption of [14C]-ITF-296 after oral administration is practically complete. Elimination of radioactivity occurs mainly in urine (higher than 80%) and the recovery of the dose (higher than 95%) takes place up to 96 h after both treatments. Both by i.v. and p.o. route the results show that the radioactivity is largely excreted in the bile and reabsorbed in the intestine. The tissue distribution study indicates that there is no accumulation or localization of radioactivity in the major organs or blood and no radioactivity levels are found 96 h after either treatment. In addition, whole body autoradiography confirms the tissue distribution pattern, showing no differences between albino and pigmented rats.

14C-NaVP and 14C-PEV repeated dose study in rat. Pharmacokinetic study in rats after repeated oral administrations of 14C-valproic acid sodium salt and 14C-valproic acid pivaloyl oxymethyl ester.

The absorption, excretion and tissue distribution of radioactivity after repeated oral equimolar doses of 14C-valproic acid sodium salt (NaVP) or 14C-valproic acid pivaloyl oxymethyl ester (PEV) was investigated in male rats treated once a day for 14 consecutive days. The 14th day plasma time-course of radioactivity after PEV administrations was characterised by a slow absorption rate with a delayed peak (tmax 2 h, Cmax 7.52 +/- 1.35 microg eq./ml), followed by a plateau lasting up to 8 h. After NaVP treatment, the main peak of radioactivity was observed 0.5 h after administration (Cmax 8.30 +/- 1.26 microg eq./ml) followed by a secondary peak due to biliary enterohepatic recycling. Starting from 4 h onwards, radioactivity levels after PEV treatment were higher than those after NaVP (AUCtau = 113.3 h.microg eq./ml after PEV vs 71.9 h.microg eq./ml after NaVP), but concentrations declined with similar terminal half-lives (52.8 h for PEV and 49.7 h for NaVP). Radioactivity recovered (0-432 h interval) in urine accounted for 79.3% (PEV) and 56.1% (NaVP) while, in faeces accounted for 9.1% (PEV) and 26.1% (NaVP) of total administered dose (14 days). The difference is attributable to a higher excretion of radioactivity in the bile for NaVP. The missing fraction in the total radioactivity balance is probably excreted in expired air, as observed in single dose studies. Radioactivity excreted in bile (0-8 h interval of the last 14th day) accounted for 5.1% (NaVP) and 0.23% (PEV) of the total administered dose (14 days). A possible explanation of this difference may be a different metabolism pattern for the two compounds. The negligible biliary excretion observed after PEV administration is probably due to an inhibition of the glucuronation of valproic acid (or other metabolites) caused by the pivalic acid. Due to the presence of the enterohepatic recycle, the radioactivity levels in intestine, 0.5 and 2 h after administration, were higher after NaVP administration. According to higher plasma levels, the radioactivity concentrations in liver, kidneys and some fat tissues were found to be slightly higher after PEV administration. At 120 h after the last treatment of both compounds, relevant tissue concentrations were observed in mesenteric lymphnodes, perirenal and brown fat. The tissue-plasma radio activity ratio appeared quite similar for the two compounds.

Pharmacokinetic study in dogs and monkeys after single intravenous and oral administrations of [14C]-ITF-296.

Pharmacokinetics of [14C]-ITF-296 and its metabolites, ITF-1124 and ITF-1577, were studied in dogs and monkeys after a single intravenous (2.5 mg/kg) and oral (10 mg/kg) administration. Radioactivity was measured by LSC while unchanged drug and its metabolites in plasma were assayed by an HPLC-UV method. The absorption of [14C]-ITF-296 after oral administration is practically complete both in dogs and in monkeys. The determination of unchanged drug and its metabolites shows quite a similar profile in dogs and monkeys for ITF-296 and ITF-1124 and a different time-course for ITF-1577. Elimination of radioactivity occurs mainly in urine (namely 70-80%) for both species and the recovery of the dose (higher than 90%) takes place up to 96 h after both treatments.

Simultaneous determination of atenolol and chlorthalidone in plasma by high-performance liquid chromatography. Application to pharmacokinetic studies in man.

An HPLC method developed to detect in a single run both atenolol and chlorthalidone, extracted from plasma, using two detectors (UV for chlorthalidone and fluorometric for atenolol) connected in series, is described. The drugs were separated on an ODS column at room temperature using a 0.05 M sodium dodecyl sulphate in phosphate buffer (pH 5.8)-n-propanol (95:5, v/v) solution, delivered at a flow-rate of 1.3 ml/min. Having ascertained the sensitivity (10 ng/ml of both drugs) and the intra-day reproducibility (pre-study validation), the reliability of the method was verified by inter-day assays (within-study validation) carried out during the analysis of plasma samples collected from healthy volunteers after single-dose treatment with atenolol+chlorthalidone tablets (pharmaceutical preparations containing 100+25 mg and 50+12.5 mg of the two drugs, respectively).

Reductive metabolism and its role in the disposition of the hydroxamic angiotensin-converting enzyme inhibitor idrapril calcium in rat.

1. The metabolism of 14C-idrapril calcium, the prototype of a new class of angiotensin-converting enzyme inhibitors, was studied in rat after a single intravenous administration. Plasma, urine, faeces, and bile were assayed for total and hplc-fractionated radioactivity. 2. Only one major metabolite (M1, 2-sarcosinamide-cis-1,2-cyclohexanedicarboxylamide) was observed, along with idrapril, in plasma. Three metabolites (M1, M2, cis-1,2-cyclohexanedicarboxylic acid, and M3, a glucuronate derivative of M1) were present in 0-8-h urine, unchanged idrapril being the most abundant product. In bile, two metabolites (M1, M3), but not the parent compound, were found. 3. In conclusion intravenous idrapril undergoes hepatic reduction to M1 and hydrolysis to M2. M1 can be glucuronated to M3 and both are partially excreted in the bile and further processed in the gut to reabsorbable radioactive species.

Pharmacokinetics of recombinant human luteinizing hormone after intravenous, intramuscular, and subcutaneous administration in monkeys and comparison with intravenous administration of pituitary human luteinizing hormone.

To assess the pharmacokinetics of recombinant human LH (rhLH) in monkeys, we measured serum LH levels after single iv injection and after single and repeated doses by the im or sc route. A single iv bolus of 400 IU/kg rhLH or pituitary hLH (phLH) in six cynomolgus monkeys resulted in parallel concentration-time curves. The initial and terminal half-lives of rhLH (0.8 and 11 h) were comparable to those of phLH (0.6 and 10 h). The serum levels of phLH were consistently higher due to the fact that the immunological dose of phLH was higher. Administration of increasing iv doses of rhLH (10, 63, and 400 IU/kg) to six monkeys showed that the pharmacokinetics are linear over this dose range. The total clearance for the two higher doses was 0.03 L/h.kg. Systemic bioavailability was 50% after a single sc injection of 400 IU/kg and 61% after a single im injection of the same dose. The peak concentration (180 IU/L) after im injection was reached after 2.7 h. This was higher and sooner than after sc injection (110 IU/L after 5.3 h). The terminal half-life by both routes was similar to that seen after iv injection (11 h). Daily sc or im administration of 63 IU/kg for 7 days confirmed these findings. There was no accumulation of rhLH. Some monkeys developed antibodies, especially after repeated administration. They were excluded from the analysis. No significant local or systemic adverse events occurred.

Nasal formulations of ketorolac tromethamine: technological evaluation--bioavailability and tolerability in rabbits.

This paper describes the development of a novel formulation of the powerful non narcotic analgesic ketorolac tromethamine. This drug is given orally three to four times/day to deliver a total of 30 to 60 mg of drug. Higher doses cannot be given orally because of gastrointestinal side effects and intramuscular injections, three times/day must then be used. The need for injections limits the drug to a clinical setting. Nasal delivery offers a method of achieving the high blood levels of repeated intramuscular injections in a formulation that can be easily applied by the patients. Four formulations were evaluated in "in vitro" and "in vivo" rabbit tests. The best formulation consisted of a 5% solution of ketorolac tromethamine containing 0.3% sodium glycocolate as a known mucosal drug absorption enhancer. Ketorolac applied in this way had a bioavailability greater than 80%. The controlled release nature of nasal delivery also doubled the drug's apparent half life. The drug formulation was stable in three-months stability tests and produced minimal nasal irritation.

Pharmacokinetics of glucosamine in man.

The pharmacokinetics of glucosamine sulfate (CAS 29031-19-4) was investigated in 6 healthy male volunteers (2 per administration route) using 14C uniformly labelled glucosamine sulfate and administering it in single dose by intravenous (i.v.), intramuscular (i.m.) or oral route. The results show that after i.v. administration the radioactivity due to glucosamine appears in plasma and is rapidly eliminated, with an initial t1/2 of 0.28 h. 1-2 h after administration the radioactivity due to glucosamine disappears almost completely and is replaced by a radioactivity originating from plasma proteins, in which glucosamine or its metabolites are incorporated. This radioactivity reaches a peak after 8-10 h and then declines with a t1/2 of 70 h. About 28% of the administered radioactivity is recovered in the urine of the 120 h following the administration and less than 1% is recovered in the feces. After i.m. administration similar pharmacokinetic patterns are observed. After oral administration a proportion close to 90% of glucosamine sulfate is absorbed. Free glucosamine is not detectable in plasma. The radioactivity incorporated in the plasma proteins follows pharmacokinetic patterns which are similar to those after i.v. or i.m. administration, but its concentration in plasma is about 5 times smaller than that after parenteral administration. The AUC after oral administration is 26% of that after i.v., or i.m. administration. The smaller plasma levels of radioactivity after oral administration are probably due to a first pass effect in the liver which metabolizes a notable proportion of glucosamine into smaller molecules and ultimately to CO2, water and urea.(ABSTRACT TRUNCATED AT 250 WORDS)

Local tolerability and pharmacokinetic profile of a new transdermal delivery system, diclofenac hydroxyethylpyrrolidine plaster.

Flector plaster is a new transdermal delivery system medicated with diclofenac hydroxyethylpyrrolidine salt, an NSAID which seems to possess suitable physiochemical properties for easy release by the plaster matrix for percutaneous absorption. The paper deals with local tolerability and pharmacokinetic (percutaneous absorption) studies carried out both on animals and on volunteers. The results obtained in the safety studies demonstrate the absence of local skin reactions and of sensitization phenomena. The kinetic evidence, obtained at the steady-state, reveals a profile typical of a sustained-release formulation, able to maintain constant plasma levels of the drug up to the next application (12 h). The amount of drug bioavailable for targeting the sites of action is effectively lower than via the oral route, however the estimated absorbed dose of 5-10 mg per application appears to be adequate for the foreseen therapeutic use, taking into account the great advantage in having no undesirable side effects.

Pharmacokinetics of recombinant human follicle stimulating hormone after intravenous, intramuscular, and subcutaneous administration in monkeys, and comparison with intravenous administration of urinary follicle stimulating hormone.

Recombinant human follicle stimulating hormone (r-hFSH; Gonal-F) is a new human FSH produced by a genetically engineered mammalian cell line (Chinese Hamster Ovary cells). To assess and compare its pharmacokinetics with urofollitropin (u-hFSH; Metrodin), extracted from the urine of postmenopausal women, we performed a cross-over study in 12 monkeys. They received 10 IU/kg iv of u-hFSH and r-hFSH. Then all received a single 10 IU/kg dose im and sc of r-hFSH. In the third phase, six monkeys received 10 IU/kg/day im of r-hFSH for 7 days when the six others received the same regimen subcutaneously. Blood was withdrawn at predetermined time points, and FSH serum concentrations were measured by an immunoenzymetric assay. Data were analyzed individually by fitting a two-compartment pharmacokinetic model for the intravenous routes and a one-compartment first-order absorption model for the intramuscular and subcutaneous routes. After intravenous administration of u-hFSH and r-hFSH, mean FSH concentration-time curves were almost parallel. AUC0-infinity was significantly smaller after r-hFSH (846 IU.hr-1/liter +/- 125) than after u-hFSH (1377 IU.hr-1/liter +/- 236) (p < 0.005; analysis of variance), because the u-hFSH immunological dose was greater (8.77 IU/kg) than the r-hFSH immunological dose (6.94 IU/kg). Thus total clearance for r-hFSH (0.008 liter/hr/kg +/- 0.001) and for u-hFSH (0.007 liter/hr/kg +/- 0.001) was almost similar. Distribution half-lives (1.5 hr +/- 0.1 and 1.8 hr +/- 0.4) and terminal half-lives (15.3 hr +/- 3.8 and 15.5 hr +/- 5.1) for r-hFSH and u-hFSH were similar.(ABSTRACT TRUNCATED AT 250 WORDS)

Linearity of levodropropizine, a new antitussive drug, in the healthy volunteer.

The object of this study was to determine whether the pharmacokinetics of levodropropizine were linear. Twelve healthy adult male volunteers received oral doses use of 30, 60 and 90 mg of levodropropizine. A cross-over design was used. With the exception of Cmax, and AUC the pharmacokinetics of levodropropizine in the dose range studied are similar. The relationship between the doses and AUCs and the statistical comparison of AUCs (Anova test and Westlake test) confirm that in the range 30-90 mg the plasma pharmacokinetics of levodropropizine are linear.

Capillary gas chromatographic determination of epomediol in human plasma and urine using a rapid solid-phase extraction.

A simple and precise method for the quantitation of epomediol in human plasma and urine is described. Each biological sample is added with the internal standard and applied directly to an Extrelut-1 solid-phase column. After absorption the column is eluted with chloroform and the eluate is evaporated to dryness. The residue, reconstituted in ethanol, is analysed by capillary gas chromatography. No interferences from possible metabolites or endogenous constituents can be noted. The method has been applied to human pharmacokinetic studies: the results of a subacute administration to volunteers are presented.

Biochemical host response to interferon-beta.

To assess influence of host response to interferon-beta (IFN-beta), on biochemical parameters, beta 2-microglobulin (beta 2-M) and neopterin were evaluated in 15 and 12 patients respectively before and 24 h after 1-46 X 10(6) IU intravenously (i.v.) IFN-beta given every other day. In 4 additional patients, both molecules were determined before and after 24, 48, 72, and 96 h of weekly IFN-beta injections. Serum beta2-M levels significantly increased 24 h after IFN-beta administration in the overall group of 15 patients treated with the alternate day schedule (p = 0.003) as well as in the group of patients treated with the weekly schedule (p = 0.00003). Maximum induction of beta 2-M was observed 24 h after a single weekly IFN-beta injection, but the levels of this protein 72 h after still remained significantly higher than baseline values (p = 0.001). This demonstrates the progressive accumulation of beta 2-M in the circulation produced by the continuous IFN administration. Nevertheless, in patients treated with both IFN treatment schedules, a clear correlation between the increments of beta 2-M and the IFN-beta doses was observed (p = 0.00002 and p = 0.0016 for the alternate day and the weekly schedule respectively). Furthermore the under curve area (AUC) of 48 h beta 2-M levels after IFN administration significantly rose (p less than 0.05) with increasing IFN doses in 4/6 patients. In spite of the accumulation of beta 2-M in the circulation, the overall serum values of this protein 24 h after each successive IFN-injection, in the 15 patients receiving the alternate-day treatment, were significantly higher than before the immediate preceding dose both in patients with initially normal and those with initially high base levels (p = 0.00055 and p = 0.011, respectively). As with beta 2-M, neopterin levels significantly rose during IFN treatment (p less than 0.05) in the group of patients as a whole. After single weekly IFN-beta injections, maximum induction of neopterin was observed 24 h after administration, then the levels of this molecule slowly declined towards the baseline levels, but 96 h after, its levels were still significantly elevated (p less than 0.00001). Neopterin induction was not related to IFN-beta doses, but the levels of this molecule both before and after IFN administration were correlated with an increase in the number of IFN injections (p = 0.0006 and p = 0.0009, respectively).(ABSTRACT TRUNCATED AT 400 WORDS)

Disposition of premazepam, an anti-anxiety pyrrolodiazepine, in the cynomolgus monkey.

The plasma levels, tissue distribution and the urinary elimination of total radioactivity and of unchanged premazepam were determined in cynomolgus monkeys given intravenously the 14C labelled pyrrolo diazepine. Following the i.v. injection, both total 14C and the unchanged drug disappeared from the central compartment in a biphasic manner with terminal half-lives of 11.9 and 3.7 h respectively. Elimination occurred mainly via the kidneys with 58% of the administered 14C and 16% of premazepam recovered in 48 h. Tissue distribution of radioactivity (whole-body autoradiography) showed as target tissues the emunctory organs and the melanin rich choroid of the eyes and the traiv follicles. Interestingly, five min after the i.v. dose the distribution of premazepam in the brain indicated an homogeneous diffusion in the different areas with a preferential affinity for the grey matter.

Pharmacokinetics of a slow-release preparation of ketoprofen lysine in man.

The lysine salt of 2-(3-benzoylphenyl)propionic acid (ketoprofen lysine) was administered at the dose of 160 mg either in two conventional capsules (Artrosilene) or in one slow-release capsule in a randomized sequence to 8 volunteers. Serum and urine concentrations of ketoprofen were determined by HPLC. The slow-release preparation had a bioavailability greater than 90% as compared with the conventional capsule and produced lower and longer lasting ketoprofen serum levels. These results suggest that two daily administrations of the new formulation should be suitable for therapeutic use.