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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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Pinterest tests online events with dedicated ‘class communities’ – TechCrunch

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Pinterest is getting into online events. The company has been spotted testing a new feature that allows users to sign up for Zoom classes through Pinterest, while creators use Pinterest’s class boards to organize class materials, notes and other resources, or even connect with attendees through a group chat option. The company confirmed the test of online classes is an experiment now in development, but wouldn’t offer further details about its plans.

The feature itself was discovered on Tuesday by reverse engineer Jane Manchun Wong, who found details about the online classes by looking into the app’s code.

Currently, you can visit some of these “demo” profiles directly — like “@pinsmeditation” or “@pinzoom123,” for example — and view their listed Class Communities. However, these communities are empty when you click through. That’s because the feature is still unreleased, Wong says.

When and if the feature is later launched to the public, the communities would include dedicated sections where creators will be able to organize their class materials — like lists of what to bring to class, notes, photos and more. They could also use these communities to offer a class overview and description, connect users to a related shop, group chat feature and more.

Creators are also able to use the communities — which are basically enhanced Pinterest boards — to respond to questions from attendees, share photos from the class and otherwise interact with the participants.

When a user wants to join a class, they can click a “book” button to sign up, and are then emailed a confirmation with the meeting details. Other buttons direct attendees to download Zoom or copy the link to join the class.

It’s not surprising that Pinterest would expand into the online events space, given its platform has become a popular tool for organizing remote learning resources during the coronavirus pandemic. Teachers have turned to Pinterest to keep track of lesson plans, get inspiration, share educational activities and more. In the early days of the pandemic, Pinterest reported record usage when the company saw more searches and saves globally in a single March weekend than ever before in its history, as a result of its usefulness as a online organizational tool.

This growth has continued throughout the year. In October, Pinterest’s stock jumped on strong earnings after the company beat on revenue and user growth metrics. The company brought in $443 million in revenue, versus $383.5 million expected, and grew its monthly active users to 442 million, versus the 436.4 million expected. Outside of the coronavirus impacts, much of this growth was due to strong international adoption, increased ad spend from advertisers boycotting Facebook and a surge of interest from users looking for iOS 14 home screen personalization ideas.

Given that the U.S. has failed to get the COVID-19 pandemic under control, many classes, events and other activities will remain virtual even as we head into 2021. The online events market may continue to grow in the years that follow, too, thanks to the kickstart the pandemic provided the industry as a whole.

“We are experimenting with ways to help creators interact more closely with their audience,” a Pinterest spokesperson said, when asked for more information.

Pinterest wouldn’t confirm additional details about its plans for online events, but did say the feature was in development and the test would help to inform the product’s direction.

Pinterest often tries out new features before launching them to a wider audience. Earlier this summer, TechCrunch reported on a Story Pins feature the company had in the works. Pinterest then launched the feature in September. If the same time frame holds up for online events, we could potentially see the feature become more widely available sometime early next year.

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Twitter will bring back verification – TechCrunch

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Twitter prepares to hand out more blue checkmarks, YouTube suspends OANN and Discord is raising a big funding round. This is your Daily Crunch for November 24, 2020.

The big story: Twitter will bring back verification

Twitter paused its blue checkmark verification system in 2017 as it faced controversy over who gets verified — specifically over the decision to verify the organizer of the infamous and deadly white supremacist rally in Charlottesville.

Since then, Twitter has done occasional verifications for medical experts tweeting about COVID-19 and candidates running for public office, but it hasn’t brought back the program in a systematic way.

Now Twitter says it will relaunch verification in 2021, and that it’s currently soliciting feedback on the policy. Initially, verification will focus on six types of accounts: government officials, companies/brands/nonprofits, news, entertainment, sports and activists/organizers/other influential individuals.

The tech giants

YouTube suspends and demonetizes One America News Network over COVID-19 video — YouTube said, “After careful review, we removed a video from OANN and issued a strike on the channel for violating our COVID-19 misinformation policy.”

Instagram businesses and creators may be getting a Messenger-like ‘FAQ’ feature — This new feature will allow people to start conversations with businesses or creators’ accounts by tapping on a commonly asked question within a chat.

Fortnite adds a $12 monthly subscription bundle — The $11.99 monthly Fortnite Crew fee entitles players to a full season battle pass, 1,000 monthly bucks and a Crew Pack featuring an exclusive outfit bundle.

Startups, funding and venture capital

Discord is close to closing a round that would value the company at up to $7B — The new funding comes just months after a $100 million investment that gave the company a $3.5 billion valuation.

Dija, a new delivery startup from former Deliveroo employees, is closing in on a $20M round led by Blossom — Few details are public about Dija, except that it will offer convenience and fresh food delivery using a “dark” convenience store mode.

Marie Ekeland launches 2050, a new fund with radically ambitious, long-term goals —  Ekeland used to be an investor at French VC firm Elaia, where she backed adtech firm Criteo.

Advice and analysis from Extra Crunch

As edtech grows cash rich, some lessons for early stage — The valuation bumps for both Duolingo and Udemy underscore just how much investor confidence there is in edtech’s remote learning boom.

Working to understand C3.ai’s growth story — As its IPO looms, how quickly did C3.ai grow in its October quarter?

Decrypted: Apple and Facebook’s privacy feud, Twitter hires Mudge, mysterious zero-days — Zack Whittaker’s latest roundup of cybersecurity-related news.

(Extra Crunch is our membership program, which aims to democratize information about startups. And until November 30, you can get 25% off an annual membership.)

Everything else

Biden-Harris team finally get their transition .gov domain — This comes after the General Services Administration gave the green light for the Biden-Harris team to transition from political campaign to government administration.

India bans 43 more Chinese apps over cybersecurity concerns — India is not done banning Chinese apps.

The Daily Crunch is TechCrunch’s roundup of our biggest and most important stories. If you’d like to get this delivered to your inbox every day at around 3pm Pacific, you can subscribe here.

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Twitter to relaunch account verifications in early 2021, asks for feedback on policy – TechCrunch

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Twitter announced today it’s planning to relaunch its verification system in 2021, and will now begin the process of soliciting public feedback on the new policy ahead of its implementation. Under the policy, Twitter will initially verify six types of accounts, including those belonging to government officials; companies, brands and nonprofit organizations; news; entertainment; sports; and activists, organizers and other influential individuals. The number of categories could expand in time.

Twitter’s verification system, which provides a blue checkmark to designate accounts belonging to public figures, was paused in 2017 as the company tried to address confusion over what it meant to be verified.

The issue at the time was that Twitter had verified the account belonging to Jason Keller, the person who organized the deadly white supremacist rally in Charlottesville, Virginia. In response to the wave of criticism directed at Twitter as a result of this action, the company defended its decision by pointing to its policies around account verification, which explained its blue badges were awarded to accounts of “public interest.”

Critics argued that genuinely noteworthy figures were still struggling to get their own accounts verified, and that verifying a known white supremacist was not something that should ever be in the “public interest.” As a result, Twitter in November 2017 decided to pause all account verifications.

The following year, the company announced work on the verification system would be placed on a longer, more indefinite hold, so Twitter could direct its resources to focus on election integrity. That proved to be a significant undertaking, as it turned out.

Though the company this year verified medical experts tweeting about COVID-19 and labeled candidates running for public office, these efforts were managed in more of a one-off fashion.

Now, with the 2020 U.S. presidential election having wrapped, and with a transition underway, Twitter says work on its new verification system will finally resume.

The company today shared a draft of its new verification policy in order to gain public feedback. The policy details more specifically which accounts can be verified and introduces additional guidelines that could limit some accounts from receiving the blue badge.

For example, Twitter says the account must be “notable and active,” and the badge won’t be awarded to any accounts with incomplete profiles. Twitter will also deny or remove verification badges from otherwise qualified individuals if their accounts are found to be in repeated violation of the Twitter Rules.

The company additionally admitted it had verified accounts over the years which should not be, as based on these guidelines. To correct this, Twitter will begin to automatically remove badges from accounts that are inactive or have incomplete profiles, to help it streamline its work going forward.

The policy also lays out specifics about how it will determine whether an account in a supported category will qualify.

For example, news organizations will have to adhere to professional standards for journalism, and independent or freelance journalists will need to provide at least three bylines in qualifying organizations published in the last six months. Entertainers will need to be able to point to credits on their IMDb page or to references in verified news publications. Government officials will need to show a public reference on an official government website, party website or multiple references by news media. Sports figures will have to appear on team websites, rosters or in sports data services like Sportradar. There are a few other ways to be verified in these categories, too.

The guidelines for public figures are more detailed, as they must meet two different criteria for “notability” — one that quantifies their Twitter activity and another that highlights their off-Twitter notability, like a Wikipedia page, Google Trends profile, profile on an official advocacy site and more.

“We know we can’t solve verification with a new policy alone — and that this initial policy won’t cover every case for being verified — but it is a critical first step in helping us provide more transparency and fairer standards for verification on Twitter as we reprioritize this work,” a company announcement stated. “This version of the policy is a starting point, and we intend to expand the categories and criteria for verification significantly over the next year,” it noted.

Twitter users will be able to offer feedback on the new verification policy starting today, November 24, 2020, and continuing through December 8, 2020. The policy is being made available in English, Hindi, Arabic, Spanish, Portuguese and Japanese. Users can either respond to the survey Twitter has posted or they can choose to tweet their feedback publicly, using the hashtag #VerificationFeedback.

In addition, Twitter says it’s working with local non-governmental organizations and its Trust and Safety Council to gain a range of other perspectives.

After December 8, 2020, Twitter will train its team on the new policy and introduce the final version by Decemeber 17, 2020. The verification system itself, which will include a new public application process, will begin in early 2021.

Though Twitter is giving itself time to make policy changes based on public feedback, it had already begun to develop the underlying technology for the verification application process.

Twitter confirmed to TechCrunch this June it was in the process of building a new in-app system for requesting verification. The feature had been found buried in the app’s code by reverse engineer Jane Manchun Wong, who tweeted a screenshot of a new option, “Request Verification,” that appeared under Twitter’s account settings. At the time, Twitter wouldn’t confirm when the new system would go live.

Though not everyone will qualify for verification, Twitter says it’s working on other features that will help to better distinguish accounts on its platform. Also in 2021, the company will introduce new account types and labels that will help Twitter users identify themselves on their profiles. More details on these features will be announced in the weeks to come, Twitter says.

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