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Apple Watch ECG app: How it works and what it means for the future of health

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Apple has long been positioning the iPhone and the Apple Watch as wellness devices — hardware that can help you track markers of fitness including exercise, step count, and even sleep and ‘mindfulness minutes’.

ALSO: Apple Watch ECG app launches today with watchOS 5.1.2 update

But now it’s taking that a step further by adding the sort of heart-monitoring technology more usually of interest to doctors — making it available to anyone with a wrist and a few hundred dollars to spare.

While previous versions of the Apple Watch have been able to measure a wearer’s heart rate, the Apple Watch 4 takes a big step up with its electrocardiogram (ECG or EKG depending on where you are) functionality — which is now live.

Thanks to the new functionality, the Apple Watch will be able to keep an eye on your heart in two ways. First, the Watch’s optical heart sensor quietly measures the wearer’s heart rhythm in the background. If it detects an irregular heartbeat, the Watch flashes up a message warning that you might have a condition known as atrial fibrillation, and so might like to consider a trip to the doctor. Secondly, electrodes in the new model’s crown and back sapphire crystal allow the Watch wearer to take an ECG themselves; again, an alert is delivered if there are signs of atrial fibrillation.


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So what’s the big deal with atrial fibrillation?

Atrial fibrillation, also known as AF or AFib, is a condition where the electrical signals that control the heart go awry. In a normal heart, the signal that tells the heart to beat comes from an area known as the sinoatrial node, and spreads out around the heart from there. The signal should be steady and regular, but in atrial fibrillation the signal to beat is generated outside of the sinoatrial node, and at random, giving someone with the condition an irregular pulse.

While that might not sound worrying, the irregular heart rhythm means the atrium doesn’t pump out blood as it should. The blood hangs around in the upper part of the heart for too long, and clots may form — clots that may ultimately end up in the brain, causing a stroke.

Apart from the irregular heartbeat, someone with atrial fibrillation may have no other symptoms — they may only become aware they have the condition after ending up in hospital. A study published last year found that a stroke was the first symptom of atrial fibrillation in one in five people with the condition, and that around one third of people who were at higher risk of AF had the condition, but hadn’t been diagnosed.

According to the Heart Study (Apple-sponsored research by Stanford University) the Watch was able to identify people with atrial fibrillation 98 percent of the time, and those with normal heart rhythm 99 percent.

SEE OUR SPECIAL FEATURE: Can technology save the NHS?

Atrial fibrillation is a condition that mainly affects the over-65s — although it can affect younger people too, they’re far less likely to experience the condition. One side effect of Apple’s new ECG feature may be that — as Apple Watch users are typically younger – it could lead to a wave of younger people visiting their doctor after a bout of atrial fibrillation. As atrial fibrillation largely hasn’t largely been picked up in a younger population before, because they’re not screened for it in the same way as over 65s, there’s been very little research done on how best to treat them.

“Atrial fibrillation is an important health issue that affects a lot of people, so there’s a lot of sense in trying to recognise people with atrial fibrillation. But what I think is the challenge is that we don’t know enough about the early stage of the disease to really guide people on what treatment to have,” says cardiologist and researcher Rohin Francis.

“The majority of all our information on atrial fibrillation has been in people who have been diagnosed opportunistically or who have had a stroke or mini-stroke, and often it’s something that we’ll find after they’ve had another problem, so we don’t have any real evidence on well patients — particularly younger patients — who might have a bit of atrial fibrillation from time to time.

“If we detect a short run of atrial fibrillation in someone that is otherwise fit and well and doesn’t have major risk factors for stroke otherwise, we don’t know whether they would benefit from the same treatment as someone who’s, say, elderly and has other risk factors, or who has already had a stroke,” Francis says.

Nonetheless, by bringing this sub-population of patients to medical attention, Apple is likely to inspire significant research into how to treat early stage atrial fibrillation in younger patients, particularly as the sheer number of Apple Watch users and the data they bring is likely to be many times what a conventional medical trial could generate.

There are other potential benefits from the Apple’s ECG feature too. As well as finding previously-undiagnosed people with atrial fibrillation, it could help track those already on treatment for the condition. By checking in with the ECG feature, patients with AF could keep their doctors up to date on whether starting a new treatment or swapping to a different medication has decreased the frequency of their atrial fibrillation.


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There are already some caveats to the Watch’s ECG feature, however: it is not to be used by people under 22, for example. The FDA also stipulates that the ECG Watch shouldn’t be used as a replacement for normal medical workup. “The ECG data displayed by the ECG app is intended for informational use only. The user is not intended to interpret or take clinical action based on the device output without consultation of a qualified healthcare professional.. [it] not intended to replace traditional methods of diagnosis or treatment,” it said.

Also, in around 10 percent of cases, the Stanford research found the Watch was unable to read people’s rhythm at all — meaning some Watch wearers who have atrial fibrillation may still go undiagnosed.

What’s next for the Watch’s ECG?

Apple’s Watch is a one-lead ECG, making it a very blunt instrument — it’s only set up to measure the heart’s activity at one point. It can detect atrial fibrillation, but detecting atrial fibrillation isn’t actually that hard: any doctor (and even most medical students) will be able to detect it just by taking a patient’s pulse.

With just one lead, the Watch’s ECG means it won’t become a substitute for a full 12-lead workup that doctors use to diagnose cardiac problems. However, there are other conditions that it could potentially be used to diagnose in future, such as other types of supraventricular tachycardia. Thanks to Apple’s ECG functionality, we could be witnessing the beginning of an era of home diagnostics: a time when a diagnosis is handed down by a device on the wrist, not a doctor in a clinic.

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Facebook knows Instagram harms teens. Now, its plan to open the app to kids looks worse than ever – TechCrunch

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Facebook is in the hot seat again.

The Wall Street Journal published a powerful multi-part series on the company this week, drawing from internal documents on everything from the company’s secretive practice of whitelisting celebrities to its knowledge that Instagram is taking a serious toll on the mental health of teen girls.

The flurry of investigative pieces makes it clear that what Facebook says in public doesn’t always reflect the company’s knowledge on known issues behind the scenes. The revelations still managed to shock even though Facebook has been playing dumb about the various social ills it has sown for years. (Remember when Mark Zuckerberg dismissed the notion that Facebook influenced the 2016 election as “crazy?”) Facebook’s longstanding PR playbook is to hide its dangers, denying knowledge of its darker impacts on society publicly, even as research spells them out internally.

That’s all well and good until someone gets ahold of the internal research.

One of the biggest revelations from the WSJ’s report: The company knows that Instagram poses serious dangers to mental health in teenage girls. An internal research slide from 2019 acknowledged that “We make body image issues worse for one in three teen girls” — a shocking admission for a company charging ahead with plans to expand to even younger and more vulnerable age groups.

As recently as May, Instagram’s Adam Mosseri dismissed concerns around the app’s negative impact on teens as “quite small.”

But internally, the picture told a different story. According to the WSJ, from 2019 to 2021, the company conducted a thorough deep dive into teen mental health, including online surveys, diary studies, focus groups and large-scale questionnaires.

According to one internal slide, the findings showed that 32% of teenage girls reported that Instagram made them have a worse body image. Of research participants who experienced suicidal thoughts, 13% of British teens and 6% of American teens directly linked their interest in killing themselves to Instagram.

“Teens blame Instagram for increases in the rate of anxiety and depression,” another internal slide stated. “This reaction was unprompted and consistent across all groups.”

Following the WSJ report, Senators Marsha Blackburn (R-TN) and Richard Blumenthal (D-CT) announced a probe into Facebook’s lack of transparency around internal research showing that Instagram poses serious and even lethal danger to teens. The Senate Subcommittee on Consumer Protection, Product Safety, and Data Security will launch the investigation.

“We are in touch with a Facebook whistleblower and will use every resource at our disposal to investigate what Facebook knew and when they knew it – including seeking further documents and pursuing witness testimony,” Senators Blackburn and Blumenthal wrote. “The Wall Street Journal’s blockbuster reporting may only be the tip of the iceberg.”

Blackburn and Blumenthal weren’t the only U.S. lawmakers alarmed by the new report. Sen. Ed Markey (D-MA), Rep. Kathy Castor (D-FL), and Lori Trahan (D-MA) sent Facebook their own letter demanding that the company walk away from its plan to launch Instagram for kids. “Children and teens are uniquely vulnerable populations online, and these findings paint a clear and devastating picture of Instagram as an app that poses significant threats to young people’s wellbeing,” the lawmakers wrote.

In May, a group of 44 state attorneys general wrote to Instagram to encourage the company to abandon its plans to bring Instagram to kids under the age of 13. “It appears that Facebook is not responding to a need, but instead creating one, as this platform appeals primarily to children who otherwise do not or would not have an Instagram account,” the group of attorneys general wrote. They warned that an Instagram for kids would be “harmful for myriad reasons.”

In April, a collection of the same Democratic lawmakers expressed “serious concerns” about Instagram’s potential impact on the well-being of young users. That same month, a coalition of consumer advocacy organizations also demanded that the company reconsider launching a version of Instagram for kids.

According to the documents obtained by the WSJ, all of those concerns look extremely valid. In spite of extensive internal research and their deeply troubling findings, Facebook has downplayed its knowledge publicly, even as regulators regularly pressed the company for what it really knows.

Instagram’s Mosseri may have made matters worse Thursday when he made a less than flattering analogy between social media platforms and vehicles. “We know that more people die than would otherwise because of car accidents, but by and large, cars create way more value in the world than they destroy,” Mosseri told Peter Kafka on Recode’s media podcast. “And I think social media is similar.”

Mosseri dismissed any comparison between social media and drugs or cigarettes in spite of social media’s well-researched addictive effects, likening social platforms to the auto industry instead. Naturally, the company’s many critics jumped on the car comparison, pointing to their widespread lethality and the fact that the auto industry is heavily regulated — unlike social media.

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Twitter Super Follows has generated only around $6K+ in its first two weeks – TechCrunch

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Twitter’s creator platform Super Follows is off to an inauspicious start, having contributed to somewhere around $6,000 in U.S. iOS revenue in the first two weeks the feature has been live, according to app intelligence data provided by Sensor Tower. And it’s made only around $600 or so in Canada. A small portion of that revenue may be attributed to Ticketed Spaces, Twitter’s other in-app purchase offered in the U.S. — but there’s no way for this portion to be calculated by an outside firm.

Twitter first announced its plans to launch Super Follows during its Analyst Day event in February, where the company detailed many of its upcoming initiatives to generate new revenue streams.

Today, Twitter’s business is highly dependent on advertising, and Super Follows is one of the few ways it’s aiming to diversify. The company is also now offering a way for creators to charge for access to their live events with Ticketed Spaces and, outside the U.S., Twitter has begun testing a premium product for power users, called Twitter Blue.

Image Credits: Twitter

But Super Follows, which targets creators, is the effort with the most potential appeal to mainstream users.

It’s also one that is working to capitalize on the growing creator economy, where content creators build a following, then generate revenue directly through subscriptions — decreasing their own dependence on ads or brand deals, as a result. The platforms they use for this business skim a little off the top to help them fund the development of the creator tools. (In Twitter’s case, it’s taking only a 3% cut.)

The feature would seem to make sense for Twitter, a platform that already allows high-profile figures and regular folks to hobnob in the same timeline and have conversations. Super Follows ups that access by letting fans get even closer to their favorite creators — whether those are musicians, artists, comedians, influencers, writers, gamers or other experts, for example. These creators can set a monthly subscription price of $2.99, $4.99 or $9.99 to provide fans with access to bonus, “behind-the-scenes” content of their choosing. These generally come in the form of extra tweets, Q&As and other interactions with subscribers.

Image Credits: Twitter

At launch, Twitter opened up Super Follows to a handful of creators, including the beauty and skincare-focused account @MakeupforWOC; astrology account @TarotByBronx; sports-focused @KingJosiah54; writer @myeshachou; internet personality and podcaster @MichaelaOkla; spiritual healer @kemimarie; music charts tweeter @chartdata; Twitch streamers @FaZeMew, @VelvetIsCake, @MackWood1, @GabeJRuiz and @Saulsrevenge; YouTubers @DoubleH_YT, @LxckTV and @PowerGotNow; and crypto traders @itsALLrisky and @moon_shine15; among others. Twitter says there are fewer than 100 creators in total who have access to Super Follows.

While access on the creation side is limited, the ability to subscribe to creators is not. Any Twitter iOS user in the U.S. or Canada can “Super Follow” any number of the supported creator accounts. In the U.S., Twitter has 169 million average monetizable daily active users as of Q2 2021. Of course, only some subset of those will be iOS users.

Still, Twitter could easily count millions upon millions of “potential” customers for its Super Follow platform at launch. Its current revenue indicates that, possibly, only thousands of consumers have done so, given many of the top in-app purchases are for creators offering content at lower price points.

Image Credits: Sensor Tower

Sensor Tower notes the $6,000 in U.S. consumer spending on iOS was calculated during the first two weeks of September (September 1-14). Before this period, U.S. iOS users spent only $100 from August 25 through 31 — a figure that would indicate user spending on Ticketed Spaces during that time. In other words, the contribution of Tickets Spaces revenue to this total of $6,000 in iOS consumer spending is likely quite small.

In Canada, the other market where Super Follow is now available to subscribers, Twitter’s iOS in-app purchase revenue from September 1 through September 14, was a negligible $600. (This would also include Twitter Blue subscription revenue, which is being tested in Canada and Australia.)

Worldwide, Twitter users on iOS spent $9,000 during that same time, which would include other Ticketed Spaces revenues and tests of its premium service, Twitter Blue. (Twitter’s Tip Jar, a way to pay creators directly, does not work through in-app purchases).

Unlike other Twitter products that developed by watching what users were already doing anyway — like using hashtags or retweeting content — many of Twitter’s newer features are attempts at redefining the use cases for its platform. In a massive rush of product pushes, Twitter has recently launched tools not just for creators, but also for e-commerce, organizing reading materials, subscribing to newsletters, socializing in communities, chatting through audio, fact-checking content, keeping up with trends, conversing more privately and more.

Twitter’s position on the slower start to Super Follows is that it’s still too early to make any determinations. While that’s fair, it’s also worth tracking adoption to see if the new product had seen any rapid, out-of-the-gate traction.

“This is just the start for Super Follows,” a Twitter spokesperson said, reached for comment about Sensor Tower’s figures. “Our main goal is focused on ensuring creators are set up for success and so we’re working closely with a small group of creators in this first iteration to ensure they have the best experience using Super Follows before we roll out more widely.”

The spokesperson also noted Twitter Super Follows had been set up to help creators make more money as it scales.

“With Super Follows, people are eligible to earn up to 97% of revenue after in-app purchase fees until they make $50,000 in lifetime earnings. After $50,000 in lifetime earnings, they can earn up to 80% of revenue after in-app purchase fees,” they said.

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Facebook revamps its business tool lineup following threats to its ad targeting business – TechCrunch

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Facebook today is announcing the launch of new products and features for business owners, following the threat to its ad targeting business driven by Apple’s new privacy features, which now allow mobile users to opt out of being tracked across their iOS apps. The social networking giant has repeatedly argued that Apple’s changes would impact small businesses that relied on Facebook ads to reach their customers. But it was not successful in getting any of Apple’s changes halted. Instead, the market is shifting to a new era focused more on user privacy, where personalization and targeting are more of an opt-in experience. That’s required Facebook to address its business advertiser base in new ways.

As the ability to track consumers declines — very few consumers are opting into tracking, studies find — Facebook is rolling out new features that will allow businesses to better position themselves in front of relevant audiences. This includes updates that will let them reach customers, advertise to customers, chat with customers across Facebook apps, generate leads, acquire customers and more.

The company earlier this year began testing a way for customers to explore businesses from underneath News Feed posts by tapping on topics they were interested in — like beauty, fitness, and clothing, and explore content from other related businesses. The feature allows people to come across new businesses that may also like, and would allow Facebook to create its own data set of users who like certain types of content. Over time, it could possibly even turn the feature into an ad unit, where businesses could pay for higher placement.

But for the time being, Facebook will expand this feature to more users across the U.S., and launch it in Australia, Canada, Ireland, Malaysia, New Zealand, Philippines, Singapore, South Africa, and the U.K.

Image Credits: Facebook

Facebook is also making it easier for businesses to chat with customers. They’re already able to buy ads that encourage people to message them on Facebook’s various chat platforms — Messenger, Instagram Direct, or WhatsApp. Now, they’ll be able to choose all the messaging platforms where they’re available, and Facebook will default the chat app showcased in the ad based on where the conversation is most likely to happen.

Image Credits: Facebook

The company will tie WhatsApp to Instagram, as well, as part of this effort. Facebook explains that many businesses market themselves or run shops across Instagram, but rely on WhatsApp to communicate with customers and answer questions. So, Facebook will now allow businesses to add a WhatsApp click-to-chat button to their Instagram profiles.

This change, in particular, represents another move that ties Facebook’s separate apps more closely together, at a time when regulators are considering breaking up Facebook over antitrust concerns. Already, Facebook interconnected Facebook’s Messenger and Instagram messaging services, which would make such a disassembly more complicated. And more recently, it’s begun integrating Messenger directly into Facebook’s platform itself.

Image Credits: Facebook

In a related change, soon businesses will be able to create ads that send users directly to WhatsApp from the Instagram app. (Facebook also already offers ads like this.)

Separately from this news, Facebook announced the launch of a new business directory on WhatsApp, allowing consumers to find shops and services on the chat platform, as well.

Another set of changes being introduced involve an update to Facebook Business Suite. Businesses will be able to manage emails through Inbox and sending remarketing emails; use a new File Manager for creating, managing, and posting content; and access a feature that will allow businesses to test different versions of a post to see which one is most effective.

Image Credits: Facebook

Other new products include tests of paid and organic lead generation tools on Instagram; quote requests on Messenger, where customers answer a few questions prior to their conversations; and a way for small businesses to access a bundle of tools to get started with Facebook ads, which includes a Facebook ad coupon along with free access to QuickBooks for 3 months or free access to Canva Pro for 3 months.

Image Credits: Facebook

Facebook will also begin testing something called “Work Accounts,” which will allow business owners to access their business products, like Business Manager, separately from their personal Facebook account. They’ll be able to manage these accounts on behalf of employees and use single-sign-on integrations.

Work Accounts will be tested through the remainder of the year with a small group of businesses, and Facebook says it expects to expand availability in 2022.

Other efforts it has in store include plans to incorporate more content from creators and local businesses and new features that let users control the content they see, but these changes were not detailed at this time.

Most of the products being announced are either rolling out today or will begin to show up soon.

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