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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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Cymulate snaps up $70M to help cybersecurity teams stress test their networks with attack simulations – TechCrunch

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The cost of cybercrime has been growing at an alarming rate of 15% per year, projected to reach $10.5 trillion by 2025. To cope with the challenges that this poses, organizations are turning to a growing range of AI-powered tools to supplement their existing security software and the work of their security teams. Today, a startup called Cymulate — which has built a platform to help those teams automatically and continuously stress test their networks against potential attacks with simulations, and provide guidance on how to improve their systems to ward off real attacks — is announcing a significant round of growth funding after seeing strong demand for its tools.

The startup — founded in Tel Aviv, with a second base in New York — has raised $70 million, a Series D that it will be using to continue expanding globally and investing in expanding its technology (both organically and potentially through acquisitions).

Today, Cymulate’s platform covers both on-premise and cloud networks, providing breach and attack simulations for endpoints, email and web gateways and more; automated “red teaming”; and a “purple teaming” facility to create and launch different security breach scenarios for organizations that lack the resources to dedicate people to a live red team — in all, a “holistic” solution for companies looking to make sure they are getting the most out of the network security architecture that they already have in place, in the worlds of Eyal Wachsman, Cymulate’s CEO.

“We are providing our customers with a different approach for how to do cybersecurity and get insights [on]  all the products already implemented in a network,” he said in an interview. The resulting platform has found particular traction in the current market climate. Although companies continue to invest in their security architecture, security teams are also feeling the market squeeze, which is impacting IT budgets, and sometimes headcount in an industry that was already facing a shortage of expertise. (Cymulate cites figures from the U.S. National Institute of Standards and Technology that estimate a shortfall of 2.72 million security professionals in the workforce globally.)

The idea with Cymulate is that it’s built something that helps organizations get the most out of what they already have. “And at the end, we provide our customers the ability to prioritize where they need to invest, in terms of closing gaps in their environment,” Wachsman said.

The round is being led by One Peak, with Susquehanna Growth Equity (SGE), Vertex Ventures Israel, Vertex Growth and strategic backer Dell Technologies Capital also participating. (All five also backed Cymulate in its $45 million Series C last year.) Relatively speaking, this is a big round for Cymulate, doubling its total raised to $141 million, and while the startup is not disclosing its valuation, I understand from sources that it is around the $500 million mark.

Wachsman noted that the funding is coming on the heels of a big year for the startup (the irony being that the constantly escalating issue of cybersecurity and growing threat landscape spells good news for companies built to combat that). Revenues have doubled, although it’s not disclosing any numbers today, and the company is now at over 200 employees and works with some 500 paying customers across the enterprise and mid-market, including NTT, Telit, and Euronext, up from 300 customers a year ago.

Wachsman, who co-founded the company with Avihai Ben-Yossef and Eyal Gruner, said he first thought of the idea of building a platform to continuously test an organization’s threat posture in 2016, after years of working in cybersecurity consulting for other companies. He found that no matter how much effort his customers and outside consultants put into architecting security solutions annually or semi-annually, those gains were potentially lost each time a malicious hacker made an unexpected move.

“If the bad guys decided to penetrate the organization, they could, so we needed to find a different approach,” he said. He looked to AI and machine learning for the solution, a complement to everything already in the organization, to build “a machine that allows you to test your security controls and security posture, continuously and on demand, and to get the results immediately… one step before the hackers.”

Last year, Wachsman described Cymulate’s approach to me as “the largest cybersecurity consulting firm without consultants,” but in reality the company does have its own large in-house team of cybersecurity researchers, white-hat hackers who are trying to find new holes — new bugs, zero days and other vulnerabilities — to develop the intelligence that powers Cymulate’s platform.

These insights are then combined with other assets, for example the MITRE ATT&CK framework, a knowledge base of threats, tactics and techniques used by a number of other cybersecurity services, including others building continuous validation services that compete with Cymulate. (Competitors include the likes of FireEye, Palo Alto Networks, Randori, AttackIQ and many more.)

Cymulate’s work comes in the form of network maps that detail a company’s threat profile, with technical recommendations for remediation and mitigations, as well as an executive summary that can be presented to financial teams and management who might be auditing security spend. It also has built tools for running security checks when integrating any services or IT with third parties, for instance in the event of an M&A process or when working in a supply chain.

Today the company focuses on network security, which is big enough in itself but also leaves the door open for Cymulate to acquire companies in other areas like application security — or to build that for itself. “This is something on our roadmap,” said Wachsman.

If potential M&A leads to more fundraising for Cymulate, it helps that the startup is in one of the handful of categories that are going to continue to see a lot of attention from investors.

“Cybersecurity is clearly an area that we think will benefit from the current macroeconomic environment, versus maybe some of the more capital-intensive businesses like consumer internet or food delivery,” said David Klein, a managing partner at One Peak. Within that, he added, “The best companies [are those] that are mission critical for their customers… Those will continue to attract very good multiples.”

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Open-source password manager Bitwarden raises $100M – TechCrunch

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Bitwarden, an open-source password manager for enterprises and consumers, has raised $100 million in a round of funding led by PSG, with participation form Battery Ventures.

Founded initially back in 2015, Santa Barbara, California-based Bitwarden operates in a space that includes well-known incumbents including 1Password, which recently hit a $6.8 billion valuation off the back of a $620 million fundraise, and Lastpass, which was recently spun out as an independent company again two years after landing in the hands of private equity firms.

In a nutshell, Bitwarden and its ilk make it easier for people to generate secure passwords automatically, and store all their unique passwords and sensitive information such as credit card data in a secure digital vault, saving them from reusing the same insecure password across all their online accounts.

Bitwarden’s big differentiator, of course, lies in the fact that it’s built atop an open-source codebase, which for super security-conscious individuals and businesses is a good thing — they can fully inspect the inner-workings of the platform. Moreover, people can contribute back to the codebase and expedite development of new features.

On top of a basic free service, Bitwarden ships a bunch of paid-for premium features and services, including advanced enterprise features like single sign-on (SSO) integrations and identity management.

Bitwarden

It’s worth noting that today’s “minority growth investment” represents Bitwarden’s first substantial external funding in its seven year history, though we’re told that it did raise a small undisclosed series A round back in 2019. Its latest cash injection is indicative of how the world has changed in the intervening years. The rise of remote work, with people increasingly meshing personal and work accounts on the same devices, means the same password is used across different services. And such poor password and credential hygiene puts businesses at great risk.

Additionally, growing competition and investments in the management space means that Bitwarden can’t rest on its laurels — it needs to expand, and that is what its funds will be used for. Indeed, Bitwarden has confirmed plans to extend its offering into several aligned security and privacy verticals, including secrets management — something that 1Password expanded into last year via its SecretHub acquisition.

“The timing of the investment is ideal, as we expand into opportunities in developer secrets, passwordless technologies, and authentication,” Bitwarden CEO Michael Crandell noted in a press release. “Most importantly, we aim to continue to serve all Bitwarden users for the long haul.”

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downgrade the ‘middle-men’ resellers – TechCrunch

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As well as the traditional carbon offset resellers and exchanges such as Climate Partner or Climate Impact X the tech space has also produced a few, including Patch (US-based, raised $26.5M) and Lune (UK-based, raised $4M).

Now, Ceezer, a B2B marketplace for carbon credits, has closed a €4.2M round, led by Carbon Removal Partners with participation of impact-VC Norrsken VC and with existing investor Picus Capital. 

Ceezer ’s pitch is that companies have to deal with a lot of complexity when considering how they address carbon removal and reduction associated with their businesses. Whie they can buy offsetting credits, the market remains pretty ‘wild-west’, and has multiple competing standards running in parallel. For instance, the price range of $5 to $500 per ton is clearly all over the place, and sometimes carbon offset resellers make buyers pay high prices for low-quality carbon credits, pulling in extra revenues from a very opaque market.

The startup’s offering is for corporates to integrate both carbon removal and avoidance credits in one package. It does this by mining the offsetting market for lots of data points, enabling carbon offset sellers to reach buyers without having to use these middle-men resellers.

The startup claims that sellers no longer waste time and money on bespoke contracts with corporates but instead use Ceezer’s legal framework for all transactions. Simultaneously, buyers can access credits at a primary market level, maximizing the effect of the dollars they spend on carbon offsets.

Ceezer says it now has over 50 corporate customers and has 200,000 tons of carbon credits to sell across a variety of categories.
 and will use the funds to expand its impact and sourcing team, the idea being to make carbon removal technologies more accessible to corporate buyers, plus widen the product offering for credit sellers and buyers.

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