As is becoming the trend, the portion of Apple's WWDC conference dedicated to the Apple Watch featured a heavy focus on the watch's health and fitness features, which continue to be the wearable's hallmark feature set. 

"Apple Watch is designed to help you live a healthier life," CEO Tim Cook said, "and people are absolutely loving the fitness capabilities, the health capabilities, the quick access to information, and even the ability to swim with it."

The biggest update to the Apple Watch health and fitness suite was an integration between the watch and fitness equipment at the gym. Brands like LifeFitness, Matrix, TechnoGym, Star Trac, Cybex, Schwinn, and StairMaster, which sell 80 percent of the country's fitness equipment, will start to roll out Apple Watch-integrated equipment this fall.

"When you use gym equipment it has data the Apple Watch doesn’t have, and the Watch has data the gym equipment doesn’t have, so you end up with numbers like calories and distance that don’t quite match," Apple VP of Technology Kevin Lynch said. "In WatchOS 4 we’ve come up with a great solution to this. We’re enabling, for the first time, two-way data exchange in real time with gym equipment. You’ll be able to simply tap your Apple Watch on an NFC reader in your gym equipment, and your Watch will automatically launch the workout app. Then your heart rate is read by the watch and sent to the equipment, and data like incline and speed is sent from the equipment to your watch. So now all the information matches, it’s much easier and it’s a lot more accurate."

Another update is to the Apple Watch's coaching features, which will now be more personalized to the user, telling them what achievements they might be close to, reporting how close they are to matching yesterday's metrics, and even calculating achievable goals based on past performance. The graphic that displays when the rings are closed or an achievement is reached have been updated to be flashier.

Swimming tracking has been improved by automatically adding sets when the swimmer takes a break at the end of a lane. Apple has also added high-intensity interval training to the Watch and it's now possible to set up a queue of workouts to fire one after another, which could be helpful for something like triathlon training. 

Finally, the watch is adding native Bluetooth to be able to communicate with third party devices. Lynch specifically mentioned continuous glucose monitoring from Dexcom as an app that will benefit from this new feature. Dexcom has an Apple Watch app at the moment, but it currently requires the phone to be in range. Now the Watch and the CGM will be able to communicate directly.

Apple has hired Sumbul Desai, MD, clinical associate professor of medicine at Stanford. Desai is also vice chair of the Department of Medicine and chief digital officer at Stanford Center for Digital Health.

Desai will serve in a senior role at Apple in what appears to be a growing healthcare team, CNBC reported on June 8, adding she would continue to see patients at Stanford.

Apple executives have not released what role Desai will play, whether she might join the team working on ResearchKit, HealthKit and CareKit, or work on an unrelated project.

At Stanford, Desai created ClickWell Care, a telemedicine project. She guided the project’s focus on improving access to primary care, and within a year, between 55 percent and 60 percent of clinic visits were virtual. Desai has also been responsible for promoting the use of various digital health devices, as well as overseeing projects that involved the Apple Watch.

The hiring of Desai continues Apple’s penchant for recruiting Silicon Valley talent.

In August 2016, Apple acquired Gliimpse, a personal health data startup that lets users create, read and share personal health records. The financial terms of the deal were not disclosed.

However, Gliimpse founder and CEO Anil Sethi went to work at Apple after the sale. He continues to work there. His title, according to his LinkedIn page: Director, Health Technologies.

Around the same time, Apple recruited Rajiv Kumar, a pediatric endocrinologist from Stanford Children’s Health. Employing Apple HealthKit, Kumar built a monitoring system for teenage type 1 diabetes patients. The app transmits blood glucose readings to an Apple device and then sends them to the patient’s medical record.

Apple continues to invest in healthcare projects, but remains hush-hush while they are in development.

Desai serves as vice chair of the Department of Medicine, Strategy and Innovation at Stanford Hospital and Clinics, where she leads product strategy, design and deployment of virtual care and digital offerings.

Before turning to medicine, Desai spent the first several years of her career at The Walt Disney Company, where she worked on strategy and business development.

Three years in the making, and Dreem has come true. The sleep-tracking wearable, made by Paris and San Francisco-based startup Rythm is now available for pre-order. Along with the public debut of Dreem, Rythm also announced the company’s funding to date stands at $22 million, an $11 million increase since they last raised money in March 2016.

The $499 Dreem headband uses dry polymer electrodes to track a user’s brain activity during sleep, generating data for analysis on an internal CPU. The device– which the company describes as “designed to feel like loungewear” – also actively works to help users fall asleep and have more restful slumber by emitting a series of subtle, precise sounds directly to the inner ear via a process called bone-conduction technology. A companion app allows users the ability to visualize sleep patterns and history. The product is scheduled to start shipping to customers this fall.

Dreem has been through hundreds of iterations, the company said, and early tests of the product in limited release showed a decrease in the time it took users to fall asleep as well as a lengthened time spent in deep sleep.  

"Rythm started with one single idea — to monitor and influence brain activity based on auditory stimulation to enhance sleep quality," Rythm CEO and cofounder Hugo Mercier said in a statement. "Now after our successful beta program, we have validated the science and learned from more than 500 users on what the headband can do. The launch of Dreem is a breakthrough moment and we are thrilled to get our product to consumers so they can get on the path to better sleep."

Mercier first began toying with the idea of a sleep wearable when studying for his masters at Ecole Polytechnique. The company was founded in 2014, and went on to have a well-known design firm (fuseproject) onboard with the development on Dreem. The company’s scientific advisory board also boasts some big names in digital health, including Stanford University’s neuroscience professor David Eagleman (who is also founder and CSO of neurocognitive assessment software company BrainCheck), and Dr. Emmanual Mignot, who is the director of Stanford’s Sleep Center.

"Rythm has developed technology that has the potential to change how people perceive their sleep, while also giving users new tools to improve their well-being," Mignot said in a statement. "The vision of the company and the team behind Dreem is exceptional. To have a solution like Dreem that makes sophisticated medicine accessible to anyone represents a powerful step forward."

Hacking into the growing sleep tech market is apparently a dream of many. It was the topic du jour at the Consumer Electronics Show in January, Apple just recently acquired sleep startup Beddit a month after the company’s sleep expert left.

However, the sleep space has been notoriously difficult area to stay successful in. Just this week, Silicon Valley sleep-monitoring company Hello shut down, even though it had been a much-hyped and well-funded startup since its landmark crowdfunding campaign in 2014. 

As promised, Nokia has officially launched its suite of consumer digital health tools that formerly lived under the Withings name. Along with the connected scale, blood pressure monitor, thermometer and activity tracker, Nokia has also released a digital program for chronic condition management called the Patient Care Platform and an updated version of the Health Mate app.

The technology company has moved relatively quickly into the digital health market, and he launch comes just four months after Nokia first revealed it would be offering a connected health ecosystem. Nokia announced it was interested in the space a little over a year ago, and acquired Withings a few weeks later. And while digital health is just the company’s latest iteration, consumers seem ready for it.

“What is very striking for us as we ran our latest research is 80 percent of the consumers we surveyed already think Nokia is carrying digital health products,” Cedric Hutchings, Nokia’s vice president of digital health told MobiHealthNews. “This let us know that this is the perfect time to offer our full products portfolio under the Nokia brand. For us, it is a very important week.”

The full product line is available on the company’s website and major retailers including Best Buy, Amazon, Bed, Bath and Beyond. In a few months, the devices will be available in physical locations of CVS stores, Target, Babies R Us and Apple stores.

The products aren’t entirely new, of course. The company launched the connected scale and a smart, FDA-cleared thermometer under Withings last June, and also indicated they would look beyond the direct to consumer space with the announcement of a project with Helsinki University Hospital to develop remote patient monitoring solutions.

The Health Mate app connects Nokia’s entire digital health offering, pulling together data to create detailed reports on activity, sleep, weight and blood pressure.

“The app also has coaching, which is a big new feature for us," said Hutchings. "It can be used to set multi-week goals and use the content-based coaching to drive actionable insights, and it's really breaking the gap between patient and doctor and making sure they use their devices."

While Hutchings wouldn’t reveal the extent of how the coaching worked (such as the degree of human or AI components) he did say Nokia plans to continue building out the app to incorporate findings from collaborations with major medical institutions involved in the development of the new devices, including Scripps, the Mayo Clinic, the University of Pennsylvania and Stanford MedX.

Parallel to the consumer device launch, Nokia has been testing the Patient Care Platform in Europe, which integrates the full Nokia portfolio of devices to provide near-real time data to patients and their care team to help support diagnosis, manage or prevent chronic illness and, ultimately, deliver targeted care.

“Eventually, we will be expanding what the app and our devices can do, by linking with more programs to empower patient care, but now we are focusing on the consumers and patient first,” said Hutchings. “Part of the vision here is to enable much more prevention, earlier in treatment, by meeting much more of human beings’ needs when it comes to taking control of their health and having a long-term impact.”

Nokia’s foray into consumer digital health products is reminiscent of Philips Healthcare’s launch of clinically-validated health-monitored devices last summer. The device and platform are similar, as is the approach to early-stage health management.  While Philips has a deep reach into the clinical space with a range of remote monitoring and telemedicine delivery products, Nokia isn’t quite venturing that far yet.

“We’ve been working on this initial transition for a months, and the complexity of making a change this way means its just part of the equation to do it in a sound way before we transition to another phase,” said Hutchings. "We had this very intense period of preparation, this whole global swap of products, and we're excited to be back in the consumer market, back into consumer hands and, in a broader sense for Nokia, into consumer health."

As we’ve reported regularly for the past several months, Fitbit has made increasingly targeted moves to wedge itself deeper into the healthcare ecosystem. No longer able to rely on the consumer market alone to stay financially healthy, the company has continually upped the ante to prime itself as a digital health company in its own right.

There have been many efforts as of late, including developing more sophisticated wearablesto enable tracking of more varied biometric data, participating in a large amount of clinical research, making itself a regular fixture in many corporate wellness programs and merging their digital health and enterprise health sectors into one. And now, as CNBC reports, the company is working to make itself a part of the booming “sleep tech” market by developing tools to help diagnose and monitor sleep apnea, a common condition that is marked by shallow breathing and pauses in respiration during sleep.  

While it isn’t yet known exactly what form that will take, Fitbit already has much of the technological capabilities to start building such a device. Conor Heneghan, the company’s lead research scientist told CNBC they are exploring the use of heart rate monitoring and optical technologies to track changes in oxygen levels. By shining a light into the skin, the technology can detect the difference between highly oxygenated red blood and that which is more blue due to less oxygen saturation. If the levels fluctuate during the night, it could indicate sleep apnea. 

"We'd perform a useful public service by alerting users to the fact that they have a problem," Heneghan told CNBC.

It’s obvious why Fitbit, which has suffered declines in sales and products shipped in the last few quarters, would want to get into sleep tech. The space has been heating up for the last year, and it was decreed the hottest topic at CES 2017. Even Apple is betting on it, with the acquisition of Beddit in May. The market for sleep apnea is expected to hit $6.7 billion in the next four years, and many digital health companies such as ResMedhave enjoyed considerable success with their connected, medical-grade devices to diagnose and treat the condition.

It’s also unknown whether Fitbit would seek to develop a diagnostic device, one that works as a prompt to get people to seek medical attention. Additionally, they could be working on something that monitors treatment adherence and effectiveness, and any such device would require different regulatory pathways.  

Heneghan told CNBC Fitbit is currently working with sleep labs to learn how prototypes to detect sleep apnea are performing. If they can develop a device that stands up to accuracy standards of existing sleep apnea-detecting tests and devices (digital or otherwise), the company expects to bring a product to market within a year.  

In the connected health space, hardware is becoming less and less important as sensors become commodified, according to two panelists at HXRefactored, a conference held in Boston this week. Instead, companies should focus on software, user experience, algorithms, and data analysis.

“Dare to be a software company,” Propeller Health CTO Greg Tracy said, offering advice to other startups. “At the end of the day, most of those sensors are becoming commodities. Bluetooth is ubiquitous, it’s all over the place, everything is getting instrumented. It’s more important to find insight in all of that data, rather than obsess over sensors themselves.”

Another panelist, Aron Semle, is CEO of UpBed, a company working on a sensor platform that would monitor nursing home residents and alert caregivers when they’re out of bed wandering, with the goal of helping prevent falls. 

UpBed is a sensor company that doesn’t make any sensors — they rely entirely on partners for hardware. Their main partner at present is smart textile company Sensoria.

“There’s a bunch of companies that are saying 'we’re going to manufacture wearable platforms, then we’re going to hand it out to the market and let people develop vertical-specific solutions like us'. So the benefit to us is it takes away a bunch of the risk of developing that hardware and that platform and we can focus on capitalizing the solution, which in my opinion is the real value of iOT,” Semle said. “These OEM companies are fairly new, so if you approach them with a vertically specific solution and you have a unique way to go to market and capture that market share, you can get some pretty good deals. They’re looking for those use cases so they can further promote their platform. Now’s a good time to get in. A few years from now, when they have some established customers, it might be a little harder.”

That said, Semle cautioned, it is important to protect yourself from too much dependency on a single hardware partner.

“We picked a hardware provider and work with them to accelerate, but under the hood we actually work with two others,” he said. “So we have three total we can switch to, because that’s a liability for us if they get bought or go away, or some new technology comes out and we want to be able to leverage it.”

Ana Maiques, the CEO of Neuroelectrics, was the final panelist and her product – a headpiece that combines an EEG and neural stimulation to treat mental health conditions – is pretty wrapped up in the hardware. But even Maiques agreed that banking on holding onto that edge is a mistake.

“Every time I go to an event I see a Chinese or Korean company copying some part of the device,” she said. “If I spend millions to get through the FDA, and the next day there’s another manufacturer, you have to protect the know-how of how you stimulate the brain, so even if they copy the device they won’t be able to get the same efficacy in patients. It’s the know-how you have to protect.”

Finally, Tracy said, his company has found that hardware isn’t the way to a patient’s heart either.

“It’s a mistake to just fall in love with your hardware and think that that’s the end of it, because truthfully the patients don’t care about your hardware. The patients want to play in the park with their kids. They want to go back to work,” he said. “… We started out as a technology company, thinking we could build a sensor and throw technology at problems. It turns out it’s a super hard problem. We’re really well known for our sensors, but … to actually deliver value in a complicated space like healthcare, especially respiratory, it turns out there’s a lot there that is unrelated to the wearables and the sensors.”

As virtual private assistants like Amazon’s Alexa become smarter, more popular and more useful, why not give it them tools to recognize emotions? That seems to be the thinking behind Israel-based Beyond Verbal, which makes voice recognition software to analyze human emotion and health indicators, releasing a cloud-based API engine to integrate with virtual private assistants (VPAs).

The intention for Beyond Verbal’s latest project is to make one’s connected home more sensitive, so to speak, rather than a sounding board that simply takes request after request. Operating on the knowledge that vocal intonations represent 35 to 40 percent of emotions conveyed in human communication, Beyond Verbal set out to eliminate the emotional blind spots of VPAs. The company’s Emotional Analytics technology takes 10 seconds of raw voice input and analyzes it for mood and attitude, then factors in that information with the user’s request. For example, if someone asks their VPA to play music, the Beyond Verbal-enabled bot will take note of the person’s emotional state  – say, stressed out – and respond with a list of calming music choices.

“Today’s digital world is rapidly transforming the way we interact with our technology and each other. Virtual private assistants have begun to take on a personalized experience,” Beyond Verbal CEO Yuval Mor said in a statement. “We are very excited for this next step in fusing together the breakthrough technology of AI and Beyond Verbal’s Emotions Analytics, providing unique insight into personalized tech and remote monitoring.”

Beyond Verbal, which was founded in 2012, has made a name for itself with its straightforward consumer technology built on years of hard science research. The company is actually the product of several research projects spanning 21 years, and the company has collected more than 2.5 million emotion-tagged voices in more than 40 languages to analyze human emotions. It launched its Beyond Wellness API in 2014, which turns any smartphone or mic-equipped wearable device into an emotional wellbeing sensor using technology that doesn’t consider the actual content or context of spoken word, but instead studies intonation in the voice. The company has two free, consumer-facing apps, Moodie and Empath, and one for clinicians called Beyond Clinic.

Just getting VPAs accustomed to their owner’s emotions is the first step, Mor said. Eventually, they want to layer in insights from their ongoing research on vocal biomarkers of health conditions, which has recently ramped up. The company has been working with the Mayo Clinic, Scripps, Haddassah Medical Center in Jerusalem and Tel Aviv University and others to expand research into health-indicating vocal intonations. In September, Beyond Verbal launched a research platform to identify physiological markers through the voice that may indicate various health-related issues called the mHealth Research Platform, the company will enable collaboration with other institutions, medical centers and commercial organizations.

Beyond Verbal is one of several health tech companies making moves to leverage VPAs as of late.In February, Lenovo Health and Orbita launched a voice-enabled home health assistant. As of last March, people who use Amazon’s VPA can launch the WebMD skill on any Alexa-enabled device (such as the Echo, Echo Dot and Amazon Fire TV) and ask a question about a range of health-related topics including conditions, medication, tests and treatments. Alexa will respond with WebMD-sourced answers in easy-to-understand language. 

In April, Merck and Amazon partnered up to launch a developer competition to incent startups and developers to create apps that harness Amazon’s Alexa technologies for people with type 2 diabetes. Boston Children's Hospital officially launched its partnership with Amazon Echo that same month, giving the voice-powered home appliance a new "skill" that will allow it to give simple health advice to parents about their children's' fever and medication dosing. Called KidsMD, the Alexa app is just the first step in a plan to bring Boston Children's medical knowledge to the consumer space, according to Chief Innovation Officer John Brownstein.

But all those are built on spoken requests, and Beyond Verbal wants to go deeper by actually recognizing health conditions rather than waiting for their owner to ask about it by name.

“In the not so far future, our aim is to add vocal biomarker analysis to our feature set, enabling Virtual Private Assistants to analyze your voice for specific health conditions,” Mor said in a statement.

Virtual reality has moved from science fiction to marketable consumer product astonishingly quickly, partly because the incorporation of the smartphone into the technology makes it accessible, if not ubiquitous. It’s looking more and more like those who bet that virtual reality is here to stay, and not a flash-in-the-pan trend, made the smart bet.
 
But what about in healthcare? Could a technology primarily associated with gaming turn out to be a serious therapeutic tool? Well, a growing number of doctors, researchers, and entrepreneurs think it can. Some are even starting to collect efficacy data to that effect. In May, Kalorama reported that the virtual and augmented reality market in healthcare grew from $525 million in 2012 to an estimated $976 million in 2017.
 
Virtual reality is showing promise in treating pain, phobias, post-traumatic stress disorder, smoking cessation, and even at the dentist’s office. Below, we’ve rounded up 15 VR use cases, the companies or research institutions that are investigating them, and the successes they’ve had so far. Read on for the whole list.
 
1. Surgical Training
 
As far as medical understanding and technological advancements have come, educating current and prospective doctors is still largely done the old-fashioned way: books, tests, pens and paper.  Virtual reality enthusiasts aren’t standing for it, especially when it comes to training medical professionals for surgery.

Fed up with the almost comical-sounding current method of surgical training, – which take place at a few specialized centers around the country and requires the use of expensive artificial body parts – a few innovators are offering a new option.
 
Osso VR, which just raised $2 million, provides software that creates a virtual operating room on VR platforms like Oculus Rift/Touch or the HTC Vive. Practicing surgeries in virtual reality allows surgeons to get in more reps, particularly on complicated procedures.

"Right now the way they’re doing it is people have these devices in their trunks, you can only fit like one in and they drive around with hundreds of dollars in disposable, simulated bones to allow people to practice one procedure once," founder and CEO (and trained orthopedic surgeon) Dr. Justin Barad said last year in a presentation at Health 2.0. "I’ve done surgeries where I just sat there reading the instruction manual like we were putting together IKEA furniture because people don’t have a training option that’s something like this. So I really hope this is the future of medical training to increase patient safety, decrease complications, and increase the learning curve for complex medical devices."

Chicago-based Level EX is another surgical training innovator. Airway EX, the company's first app, is a surgical training simulator built by video game developers and physicians from real footage of surgeries. It was launched in beta in October 2016 and available for free on iOS and Android, and the app offers physicians the opportunity to perform virtual airway surgery on realistic patients – which are detailed down to their pores – across 18 different procedures on the airway. The game is designed for anesthesiologists, otolaryngologists, critical care specialists, emergency room physicians and pulmonologists. Along the way, they can earn Continuing Medical Education credit by playing the game.
 
The idea came to CEO Sam Glassenberg after realizing there was a dearth of surgical simulation centers around the country, and that the simulators lacked the sophisticated graphics and video he saw in the video game industry. Glassenberg, a game developer who comes from a family of doctors and has many friends in medicine, had also been asked several times to help build surgical training programs.

“There is a big gap between surgery training simulations and the video game industry. It’s like the old business video game distribution model where the equipment was expensive, so you'd grab your roll of quarters and go across town to an arcade,” Glassenberg told MobiHealthNews. “Of course, now you don’t do that, because what you have in game consoles and computers is way better, but the surgical training simulators of today are still like the Pac-Man arcade games. It's that level."

Through realistic simulations of human tissue dynamics, endoscopic device optics and moving fluids to recreate life-life surgeries, doctors who need to practice surgical techniques can do so in a way that doesn’t run the risk of harming anyone, even though mistakes in the game can end up a bit shocking.

“It bleeds, it coughs, it reacts and it’s running on a device you already own,” Glassenberg said. “It’s a totally reactive patient.”

Additionally, the availability of the app means surgeons can really explore in ways they otherwise couldn’t with traditional training modes.

“Right now, if you want to try out a new device, they reserve a cadaver lab, or you a mannequin in a room,” Glassenberg said. “But the beauty of this is you have it on a tablet or phone and it reacts, but it’s not a live patient. It’s perfectly safe. You can try things you never would.”
 
2. Pain Management
 
Probably the virtual reality use case we’ve covered the most at MobiHealthNews is pain management, specifically Cedars Sinai’s virtual reality program, headed up by Dr. Brennan Spiegel. As Cedars Sinai, patients use virtual reality to escape the “bio-psycho-social jail cell”, as Spiegel calls it, of the hospital bed. Using apps made by Applied VR, they have deployed VR headsets to a number of patients to help them manage pain.
 
“We’ve now done this with well over 300 of our patients and we have been learning a lot about when it works and when it doesn’t work,” Spiegel said. “How effective is this for managing conditions like pain, managing depression, managing anxiety, even managing hypertension?”
 
In a small controlled study, the VR technology was able to drop patients’ average self-reported pain scores from a 5.4 to a 4.1. A 2D distraction experience in the control group only dropped that score to 4.8. And there’s some evidence that, by noting whether the headset helps or not, the technology could be used to help determine when pain is a result of something in the body or purely mental.
 
You can read more about Spiegel’s efforts at Cedars Sinai here and here.
 
3. Patient Education
 
Pain management is just one area where Cedars Sinai is exploring virtual reality. The hospital is also partnering with Holman United Methodist Church in south LA on a community health education initiative aimed at reducing hypertension in a vulnerable population.
 
The education initiative is much bigger than VR. But the VR aspect is interesting. Members of the Holman congregation used a VR program that takes users into a virtual kitchen where foods are labelled with their sodium content. It then takes them inside the body for a visualization of what hypertension does to the heart. Finally, Cedars-Sinai and Holman UMC created a relaxation app to help congregants deal with stress, which also contributes to hypertension. Holman Pastor Rev. Kevin Sauls narrates the guided meditation in the app.
 
Another virtual reality company, BioLucid, also uses VR for patient education, designing virtual tours of the human body. BioLucid was recently acquired by digital health M&A juggernaut Sharecare.
 
“Visual storytelling technologies – particularly virtual reality blended with 360-degree video – have boundless potential in healthcare and patient engagement, yet consumer-facing innovation in VR has been limited mostly to entertainment and gaming,” Jeff Arnold, chairman and CEO of Sharecare, said in a statement at the time. “By differentiating our platform with BioLucid’s immersive simulation of the human body, we can turn data into actionable, visual intelligence, and make a transformative impact on patient engagement, health literacy, medical education and therapy adherence.”
 
4. Clinician Education
 
Gone are the days where text books and two dimensional anatomical images are the only way for physicians to learn about common afflictions. Salix Pharmaceuticals, a New Jersey-based drug development company that focuses on gastrointestinal conditions,developed an interactive virtual reality platform to guide clinicians through an open-minded approach to treatment, which can be difficult to pin down due to the mysterious etiology of IBS.
 
In an educational voyage up close and personal with the GI tract, Salix will guide healthcare providers through the numerous theories floating around on the potential causes of IBS, including changes in the gut-brain axis, an imbalance in the gut microbiome, hypersensitivity to pain signals in the intestinal wall, or a chronic imbalance set off by a temporary gastrointestinal bug.

“As a gastroenterologist who treats conditions like IBS on a daily basis, I believe this virtual reality experience will move GI treatment forward by helping healthcare professionals better understand this complex condition," Dr. Brooks Cash, one of Salix's gastroenterology advisors, chief of gastroenterology and director of the Gastroenterology Physiology Lab at the University of South Alabama Digestive Health Center, said in a statement.
 
5. Physical Therapy and Rehabilitation
 
A few years ago, the Microsoft Kinect and similar 3D motion tracking cameras were set to revolutionize physical therapy. By tracking and gamifying movement, the Kinect could be used to send patients home with exercises, motivate them to do those exercises, and collect hard data on things like range of motion.
 
VIrtual reality enhances that capability even further. VRPhysio is a Boston-based company that offers immersive, interactive virtual reality environments that trick patients into doing physical therapy exercises without even knowing it. For instance, one game puts virtual swords in the patients’ hands and asks them to slice through a line of targets that appear on the screen. To accomplish that goal, the patient will necessarily test out the range of motion in their shoulders. Another gives patients an always-on water cannon that shoots in the direction their head is pointed, then instructs them to fill a moving barrel -- all the while taking their neck through a full range of movement.
 
On the backend, a physical therapist can see data collected through the device and can change the parameters of the game on the fly in order to guide the patient to the most beneficial exercise.
 
Another company, MindMaze, is using VR for stroke recovery. For stroke victims who have lost the use of the left hand but retain the use of the right, for instance, the computer will project a virtual reality depiction of the nonfunctional left hand, which is controlled by the patient's movement of the working right hand. This can trick the brain into kickstarting the functionality of the other hand.
 
That functionality doesn’t use the mask, but another MindMaze product, called Mask, does. Mask is a thin sensor that can be worn with a VR headset. It can detect the user's facial expressions and map them onto an in-game avatar.
 
"If you go into, say, the autism spectrum or other aspects of social interactions, you can imagine a scenario where a patient is controlling something and you’re able to emote," CEO Tej Tadi told MobiHealthNews. "It’s helpful in a therapeutic context, but also as a true clinical monitor for other kinds of deficits, not necessarily stroke. The Mask is designed to capture emotions either for therapeutic effect or just for consumer gameplay. It just works on both metrics.

 
6. Post-traumatic Stress Disorder
 
Post-traumatic stress disorder, or PTSD, is one of the most pervasive mental health conditions in the United States, as well as among the most challenging to treat. Today, many experts are beginning to agree that exposure therapy can help, and virtual reality can provide that exposure in a physically safe, controlled environment.

It’s a big issue to tackle: Experts say one in three people who experience an extremely traumatic event will develop the condition, and 2013 statistics report 69,000 brand new cases of PTSD diagnosed in veterans from wars in Afghanistan and Iraq, What’s more, accordingto an NBC interview with USC Davis School of Gerontology professor Albert “Skip” Rizzo, the condition can lie dormant for years, meaning those who may have developed PTSD decades ago can begin to experience the worst symptoms much later in life.
 
Anything could trigger an episode in which the person with PTSD is transported back to the moment the traumatic event or events happened. It seems counterintuitive to purposely put a PTSD sufferer back in that place, but experts say using virtual reality creates a world where people with the condition can exert control over the situation, therefore experiencing a sense of resolution.

“Exposure therapy is an ideal match with VR,” Rizzo told NBC. “You can place people in provocative environments and systematically control the stimulus presentation. In some sense it’s the perfect application because we can take evidence-based treatments and use it as a tool to amplify the effect of the treatment.”
 
7. Conversion Disorder Treatment
 
The Stanford University School of Medicine and the Stanford Virtual Human Interaction Lab started working last year on a small clinical trial investigating the possibilities for virtual reality in treating conversion disorder. Participants will use special software developed by the VHIL, combined with the Oculus Rift, to inhabit a virtual avatar body.
 
Conversion disorder, also known as functional neurological symptom disorder, is a condition wherein mental or emotional stresses are converted into physical symptoms.
 
"It’s kind of the roots of psychiatry," Dr. Kim Bullock, a clinical associate professor of pyschiatry and behavioral sciences at Stanford and the lead researcher on the study, told MobiHealthNews. "Everyone’s very curious about this subject because it’s the intersection between mind, body, culture, environment. It kind of embodies everything that we’re trying to figure out. But very little research has been done on this subject. There’s no big pharmaceutical money behind it and there’s really a lack of awareness among providers about how ubiquitous this disorder is, because it kind of infiltrates every medical specialty."
 
Bullock said that neuro-imaging studies have shown that in people with conversion disorder, a part of the prefrontal cortex that normally inhibits the amygdala from taking control of the motor-sensory cortex doesn't function like it should. Most existent treatments focus on calming down the amygdala so it doesn't become overactive and "hijack" motor functions or senses, and VR could serve a similar function.
 
8. Smoking Cessation

Redwood City, California-based MindCotine is using virtual reality to address one of the oldest and most difficult health hazardous habits on the planet: smoking.

Since smoking is more than a physiological need, the Argentina-born cofounders Cristian Waitman, Nicolas Rosencovich and Emilo Goldenhersch say, so their VR program – which launched on Kickstarter in early June – brings together mindfulness, biofeedback and other elements of psychological techniques like immersion to help prospective non-smokers change their behavior to change their habit.

Technically speaking, it means an app, a cardboard headset and a growing community of users to act as a support system and research opportunity. Users download the app, which features guided meditation and calming imagery to encourage introspection before going on to an animated smoking experience, complete with sitting down with a cigarette in hand. It’s meant to be used 20 minutes per day along with tools and resources in the app to help deal with nicotine withdrawal systems.

9. Dealing with Fear
 
Death is an inevitable part of life, yet many struggle to accept that reality. While some may prefer to not think about it at all, others believe facing this fact of life head-on is the only way to truly reduce fear. Of course, thanks to virtual reality, people need not put themselves purposely in harm’s way in order to experience a near-death experience.

Researchers at the University of Barcelona used an Oculus Rift headset to create a virtual reality simulation called “the full body ownership illusion,” which uses the image of a human body the wearer assimilates to until they feel the body is their own. After they get used to that view, the VR headset shifts to a third-person viewpoint, which is mimics the experience some describe as “out-of-body incidents.” Thesmall study, which was published in PLOS One, showed a lower anxiety about death.
 
VR can also help with children’s fear of needles. Pediatricians administering vaccines may try direct their young patients’ attention to colorful posters or don a puppet to get them focused on something – anything – other than the shot they were being given. But, this being 2017,a recent pilot study suggests doctor’s office child diversions may start going virtual.

In a study of 244 children at Sansum Clinic locations in Santa Barbara and Lompoc, California, roughly half of the children were given virtual reality goggles to view ocean scenes while getting their seasonal flu shot. Parents and clinicians for both groups were surveyed after, and reported the VR group felt less pain and fear than those braving it without.

As innovative as the idea sounds, it didn’t come from an industry insider keenly aware of the way such technology has been taking off. Dr. Mark Silverberg, the clinic’s pediatrician, got the idea from his 15-year-old daughter.
 
10. Concussion Assessment
 
Virtual reality companies in the entertainment space are interested in eye tracking because it offers another hands-free way to interact with a virtual environment. But in the healthcare space, eye tracking has potentially lifesaving applications.
 
SyncThink, a Boston-based company that just last week won the grand prize at the Pulse@MassChallenge startup contest, is applying VR and eye-tracking to assess ability to focus as an indicator of concussion damage. This can be used to assess the extent of the damage immediately after an injury, or to track recovery practice with an objective measure.
 
The  company has been working on eye tracking or concussions for about 10 years and has a partnership with the US Army. But VR allowed them to create a much more accessible version of the product.
 
“Eye tracking’s not new, it’s been around for about 30 years in all kinds of configurations,” CTO Daniel Beeler told MobiHealthNews. “We thought about two and a half years ago that VR is the perfect way to commercialize this in a cost-effective way and bring it to market. Eye-tracking has traditionally been the domain of large instruments in laboratory settings. The thing about VR is it’s a cost-effective way to introduce a mobile platform with eye-tracking.”
 
Right now, the platform is being used by professional sports teams and at Walter Reed Army Medical Center. They’re currently focused on making the assessment even more useful.
 
“We can use this technology to help pinpoint the exact type of injury,” Beeler said. “Head injury is complicated. A force to the head could involve brain damage, it could involve inner ear issues like balance, it could be other issues that produce similar symptoms. We want to provide objective technology to identify the specific issue at hand and improve outcomes.”

 
11. Aging in Place
 
Senior citizens are often firmly outside of the target market for consumer electronics, but digital health innovators have found the demographic refreshingly receptive to many forms of technology. As people may find themselves less mobile as they age, virtual reality could be a particularly big hit as a means of experiencing a world outside, and one MIT startup is jumping on that opportunity.

Rendever offers Oculus-based VR headsets to people living in nursing homes, allowing them to “take a stroll down memory lane” by immersing themselves in imagery of their childhood home or favorite outdoor setting. Moreover, the VR serves to spark conversation among residents, and users can also go on a “tour” of a certain place together, like the Grand Canyon or Machuu Pichuu, or use a virtual paint brush to recreate famous works of art. The company reports facilities using their product have seen a 40 percent increase in their residents’ happiness

“We started to notice once they were done with the demo they would go back to their friends at their table and talk about what they experienced. It was social, it lit a spark,” Reed Hayes, one of Rendevor’s founders,told the Boston Globe. “Can you imagine coming up with a new conversation after being there 10 years and you haven’t been out?”
 
12. Stress Relief
 
A general wellness use case is to create immersive, relaxing environments to promote meditation and reduce stress. Those apps are easy enough to find in the app store, but some companies are going further.
 
San Jose-based Happinss is offering virtual relaxation apps in the context of corporate wellness programs. The company launched a dedicated corporate VR wellness room at the Amdocs Development and Operations Center in Guadalajara, Mexico.
 
Another company, Fisher Wallace Labs, partnered with virtual reality headset company Zeiss to combine neurostimulation and VR into a new product called Kortex, which recently raised $123,000 on Indiegogo.
 
“I think one story of Kortex is kind of this transition from medical device to consumer device. Fisher Wallace Labs, we’ve been a medical device company for 10 years and we’ve manufactured one prescription neurostimulator for the last 10 years called the Fisher Wallace stimulator,” Fisher-Wallace cofounder Kelly Roman told MobiHealthNews. “And that is a handheld device that has two wires that come up to electrodes that connect to a headband. And we have FDA clearance for that device to treat depression, anxiety, and insomnia. … When I saw the mobile headsets coming to market, I recognized that the headband was in the same place and there was room for our electrodes without disrupting the headset. So from a design perspective it could work. So what we did was basically for Kortex we altered the intended use so it’s not to treat depression, anxiety, insomnia -- it’s to manage stress and sleep, and that’s a general wellness claim.”
 
Fisher Wallace and Zeiss have plans to build special apps and curate content for VR-enhanced neurostimulation.
 
13. Fitness
 
Physical fitness is one of the most high-profile areas of digital health innovation, with countless wearables and apps on the market designed to help people get the most out of their bodies. On the other end, virtual reality typically only requires the ability to see. But technology marrying the two has proliferated nonetheless.
 
Connected stationary bike maker Peloton combines the exercise machinery with tablets to create virtual cycling classes. The $2,000 exercise bike integrated with a tablet-like screen allows sers can hop on the bike and join in live or pre-recorded classes with cycling instructors. During live sessions, real-time social features like leaderboards or video chats with friends keep users immersed in the process. The setup also allows users to track their rides and view combined metrics over time. It’s been a popular – and profitable – venture for Peloton,which just pulled n $325 million in late stage funding in May. In January, Peloton partnered with Fitbit to allow users to sync ride metrics directly to the Fitbit app, helping them see how cycling fits into their overall fitness goals. Each ride on Peloton is logged as an exercise in the Fitbit app, so all Peloton workouts and Fitbit data will be in one centralized location.
 
Peloton isn’t the only one. Three years ago, London-based Zwift launched a stationary bike MMO, or massive multiplayer online game. The game is displayed on a computer screen, but riders can adjust camera angles and other features from their phones, and a tablet version of the whole system is coming in the future. The system can also take in and use data from a chest-strap heart monitor, and can upload activity data to Strava, Garmin Connect, and Training Peaks.
 
In February 2013, Aetna launched Passage, which uses the Apple device’s built-in accelerometers as a pedometer to track the users’ steps whenever the app is open and running. It translates those steps to a virtual display of another location, shown on the screen in a 360 degree view. The app starts out with a course through Paris, which the user must complete in order to unlock subsequent locations.
And in December 2013.  Santa Clara, California-based Blue Goji, co-founded by Guitar Hero inventors Charles Huang and Kai Huang, launched an exergame called Goji Play which is meant to be played at the gym on exercise machines such as treadmills, elliptical machines and stationary bikes. Blue Goji has three components: the app, available only on iOS devices, a set of wireless controllers that can be attached to any fitness machine, and an activity tracker to wear while exercising.
 
In September 2014,Rock Health graduate BitGym, which makes mobile software for smartphones and tablets that display virtual runs or tools while the user works out on a treadmill, exercise bike, or elliptical, launched a new product. BitGym doesn’t connect to the exercise machine but instead gauges the user’s speed using the tablet’s front-facing camera, so it can be used on any workout machine. And a very similar crowdfunded offering, FitTrip, tracks heart rate in addition to speed and cadence.
 
14. Training Midwives
 
All of the advantages of using VR to train surgeons -- a safe, controlled, inexpensive environment for building up clinical skills -- can also apply to midwives.
 
The University of Newcastle in Australia announced in May that it’s using VR to prepare midwives for complications that could arise during a birth.
 
“With 15 per cent of births in Australia and New Zealand requiring some form of resuscitation – a number even higher in premature babies – it is imperative our students feel comfortable and confident applying their experience in a time-critical, emergency environment,” project leader Jessica Williams said in a statement. “New graduates may find transitioning from performing a neonatal resuscitation in an educational setting to a real-world emergency room an overwhelming shift, which is exactly why we designed the program to bridge that gap.”
 
The University uses Samsung GearVR, HTC Vive, and Microsoft HoloLens headsets for this and other educational initiatives. It is conducting a small randomized trial to see if this training is effective.
 
15. Dentist Visits
 
Most people don’t like going to the dentist, and some people find the experience extremely stressful. These days, dentists’ attempts to address the situation are along the lines of soothing music and beach scenes painted on the ceiling tiles. But VR could be game-changer.
 
The evidence so far is pretty scant -- a single n=80 study published recently in the journal Environment and Behavior. Patients in the intervention group explored a virtual environment -- using a Sony personal 3D viewer headset and a Zeemote JS1 Thumbstick Controller -- while having a tooth pulled or a cavity filled. Interestingly, the group tested a coastal and urban VR environment and found that one reduced reported pain, but the other did not.
 
“Engaging with the coast VR was associated with significantly less experienced pain than standard care,” researchers wrote. “This effect remained significant after controlling for age, gender, dental anxiety, type and duration of treatment. By contrast, there was no difference in experienced pain between the urban VR and standard care, either before or after controls were added. None of the control variables were significantly associated with experienced pain in their own right.”

While it may or may not be working on a secret glucose wearable, Apple has definitely upgraded its HealthKit app framework to provide more tracking options for people with diabetes. In addition, the company made some other upgrades to both the HealthKit and ResearchKit frameworks. Apple engineers shared these updates at WWDC earlier this month.

“Our users love using Apple products to help manage their condition,” software engineer Michael Ozeryansky said in a presentation. “Today in HealthKit we have support for tracking blood glucose samples, keeping track of carbohydrates and tracking all kinds of activity data, which is all useful in managing diabetes. We've heard there's some missing pieces to the story and I'm pleased to announce that we've added some new additional features to help out. First, we added the ability to track the relative mealtime to a blood glucose sample. Next, we added the ability to track insulin delivery.”

The first update is fairly minor, but it allows developers to include preprandial and postprandial glucose as different fields. Insulin delivery, however, is a big addition and one that shows that Apple is interested in being involved in “closed loop” diabetes interventions that include both glucose tracking and insulin dosing. HealthKit will track both basal and bolus insulin in units.

On the main stage on WWDC, it was also announced that Dexcom will take advantage of the Apple Watch’s native Bluetooth to allow users of Dexcom’s CGM to access their blood glucose data directly from the Watch, even if they’ve left their phone at home.

In addition, Apple has added workout route, waist circumference, and VO2 Max to HealthKit, and can also track different types of workouts including tai chi and mixed cardio. Workout routes allow users to track not just vitals from their run, but also where they went.

Another update makes it easier for Apple to detect duplicate data when users are tracking with multiple devices, for instance a Watch and a phone. The feature, called Sync Identifiers, allows developers to tag certain data sets so that the Health app doesn’t count them twice.

Apple ResearchKit has also added a number of new tests into the framework, many of them created or suggested by users.

The company upgraded its tone audiometry test so it can test hearing in each ear and added the Stroop Test, which tests mental processing; the Trail Making Test, which looks at visual attention and task-switching; and new range of motion tests for the shoulder and knee that use the phone’s accelerometer and gyroscope. The company is also making it easier to add instructional videos into ResearchKit apps.

At least three digital health companies are poised to take advantage of native Bluetooth on the Apple Watch, announced at the company’s WWDC keynote last month. In addition to Dexcom (which was announced on stage), Apple Watch apps are also either deployed or in the works from both respiratory health company Propeller Health and ReSound, a connected hearing aid company.

“New for this year, we're supporting [core Bluetooth for] watchOS,” Apple Bluetooth Engineer Craig Dooley said in a WWDC side session. “We think this opens a lot of cool opportunities, especially in the health and fitness space, for places where it was impractical to bring your phone previously.”

Dexcom users can leave their phone at home

Dexcom has long had an Apple Watch app for its CGM, but previously it required both a transmitter device and the user’s smartphone to function. In March 2016, they were able to cut out the receiver box with a software update. Now, with Bluetooth built into the Watch, users won’t need to have anything on them but the CGM itself and their Apple Watch.

“If you’re wearing an Apple Watch, there are times you’re going to get up at work and leave your phone in your office,” Dexcom CEO Kevin Sayer told MobiHealthNews. “If you’re going to go on a run, how nice would it be to not have to carry your phone on your arm and [to instead] get your glucose values on your Watch? I think the exercise case is a real good one. And I’ll tell you another one that may be under-emphasized. I think at nighttime when patients are sleeping, if they’re wearing the Apple Watch and they can get the alerts and alarms silently without having to get the phone or receiver or get out of bed, I think that’s a great use case as well.”

Sayer said that the Watch doesn’t completely replace the phones. If users want to manually enter data, they’ll need to do it on the phone.

“But the fact is probably 95 of a patient’s interaction [with their CGM] they’re not logging anything, they’re just looking at values,” he said. “And so 90-plus percent of the time the Watch will really be exactly what the patient needs, and I think it will be a great convenience feature for our patients.”

Eventually, Sayer hopes to add similar functionality for AndroidWear and other smartwatches, but the difficulty is finding a device with wide enough market penetration that its worth the company’s while. Dexcom’s Watch app is not yet available, because it will have to go through some regulatory steps.

“The way it works with medical devices is the OS will go out first and then we have to go through a validation and verification process of our software app to make sure it performs in the manner in which it’s labeled, then we have to file with the FDA, the FDA will review and approve that filing and then we can go with our revised app,” Sayer said. “So I really don’t have a timeline for that.”

Propeller’s first Apple Watch venture

While Dexcom is upgrading an existing Apple Watch app, Propeller is adding Apple Watch support for the first time in light of the new upgrade.

“The Apple Watch hasn't been a priority for us until now, due to many competing feature requests,” Chase Acton, an iOS engineer at Propeller, told MobiHealthNews in an email. “We try to prioritize features that will have the greatest impact on the largest number of users. Lately, we've had a few users ask for watch support and now 20 percent of our users have a Watch, so we decided to launch an initial, simple version of a Watch app to test the waters. If all goes well and user response is positive, we'll continue to devote resources to it and add more features. The first version won't use the new native Bluetooth support, as that won't be officially released until this fall.”

Propeller’s products work to help patients and their physicians better manage and understand asthma and COPD with sensor-enabled inhalers and connected apps. The company’s digitally-guided therapy platform pulls information from various sources, like connected medications, then leverages machine intelligence to personalize recommendations for individuals.

The Apple Watch app will start to bring some of that data directly to the Watch, like the Daily Asthma Forecast, which delivers predictions about environmental factors and potential triggers, medication reminders, and an implementation of the asthma control test (ACT) that users can take directly from the Watch screen. Once the native Bluetooth functionality goes online, users will be able to gather data directly from their inhaler sensors and display it on the Watch, without the need for the phone. Propeller is also hoping to create a Propeller complication, displaying relevant data right on the user’s watch face, Acton said.

“I think native Bluetooth on Apple Watch will open up a whole new way to use the watch, especially for health and fitness applications where you might not have your phone with you,” Acton said. “Imagine running on a treadmill and having the Watch automatically get rich workout details like incline, speed and distance added to Apple Health, directly from the machine without needing to use your phone as a proxy. We envision Propeller users being able to sync their sensors directly with the watch. Overall, this is a huge step forward for Apple Watch because it reduces its dependency on a paired iPhone.”

Hearing aids and more

One more healthcare use case was shared by Apple during one of the WWDC side sessions: Ian Parks, an engineering product manager at Apple, mentioned that the ReSound Smart 3D app, which currently connects ReSond hearing aids to iOS devices, will pair with the Watch so users can adjust their settings with the tap of the Watch.

“ReSound Smart 3D is an app that lets you connect to Bluetooth enabled hearing aids so you can change the listening environment depending on where you are,” Parks said. “So I can change from an outdoor listening environment to a restaurant, which has a pretty different audio profile, just with a tap on my wrist. And with watchOS 4, they can connect directly to the hearing aids so that they can make faster updates and they can continue using the device when the phone is no longer present.”

This is just the beginning, of course. Expect to see more health and fitness devices taking advantage of native Bluetooth on the Watch when the feature launches with the WatchOS update in September. Dexcom CEO Sayer shared some thoughts about where he thinks things might go from here.

“Where this becomes interesting — where we have an opportunity — is we don’t know what happens when you take all the data from an Apple Watch, like all the activity data, and your diabetes data and your heart rate data, what happens when you merge it all together?” he said. “Who can develop that app, and can we learn even more about a patient? Can we learn things that will really improve care now that we have more data that we can gather? I think there will be a whole new kind of science that evolves from this. Taking all these markers and putting them all together to provide better combined outcomes for patients rather than one specific thing.”

Pact, the startup that incentivized users to healthy behaviors by getting them to essentially bet money on their own adherence, has shut down, according to an email the company sent out to its users on Friday.  The company will pay out its final rewards to users on July 11th and will continue supporting users until the end of August.

“Thanks for choosing Pact - we hope it has helped you live a healthier lifestyle, and been that kick you need to get off the couch on rainy days,” the company wrote in its email. “Sadly, after much discussion, we have decided to shut Pact down.”

Founded by Geoff Oberhofer and Yifan Zhang towards the end of 2011, Pact, originally known as GymPact, aimed to help keep users accountable to their fitness goals. Initially, the app tracked one behavior — going to the gym — using GPS for accountability.

When users signed up for GymPact, they gave the company their credit card information and chose an amount of money that they would have to pay if they missed their workout goal for the week. If the user achieved their goal instead, GymPact would pay them -- divvying up the money made off of the slackers. The company tracked whether the user really went by requiring them to check in with their phone's GPS.

In 2014, the company took on its new name and raised $1.5 million in a round led by Khosla Ventures and PayPal alum Max Levchin, bringing the company’s total funding to $2.5 million. At that point, Pact added two other pact options, one for eating more vegetables and one for tracking meals with MyFitnessPal. Pact also eventually added GPS tracking for workouts outside the gym as well.

It’s not clear exactly what led the company to shut down, or if any of the company's assets are being sold. We’ve reached out to the team for comment and will update if we hear back.

“While we are sad that we will no longer be able to help our users get healthy, we are also thankful to have had such a passionate, supportive community throughout the years. Ultimately, while we hope that our incentives motivated you, it was each of you that snapped veggie photos, typed food logs, and went on runs. It’s amazing that together, you completed over 40 million healthy activities during our 5 years of existence. We are proud of what you have accomplished, and you should be too,” the team wrote.

According to LinkedIn, Zhang has already moved on, starting a new startup called Loftium in January. Loftium is a complete departure from the fitness space. It’s a real estate startup that helps users pay the down payment on a new home in exchange for them listing a spare room on AirBNB for the first few years of home ownership.

It looks like Jawbone, the activity tracker company that has been teetering on the brink of collapse for a few years now, is finally shutting down. Citing sources close to the company, The Information is reporting that the company has begun liquidation procedures. 

However, the company's long-rumored health device – which was supposed to save the company – could be coming to market via a new spinoff company, also led by CEO Hossain Rahman, called Jawbone Health Hub. That company has already absorbed some departed Jawbone employees and will apparently service Jawbone devices going forward. 

Jawbone has been in trouble since at least May 2015, when the company accepted a $300 million loan from Blackrock Capital. According to leaked emails, Blackrock was pressuring Rahman to sell the company last fall, but Rahman was instead seeking additional funding to stay afloat. 

But even before that there was no shortage of signs of disfunction, with the company losing key executives, dumping its speaker business, reportedly selling out of its inventory, and not announcing any new products for several years. That's not to mention the seemingly never-ending multi-front legal battle with competitor Fitbit.

Last we heard, the company's planned Hail Mary was a more clinically-focused wearable, likely building on the company's 2015 acquisition of Spectros. Now it looks like those plans will be realized at the new company, Jawbone Health Hub.

The question going forward is whether a new company -- with the same leadership and name as the old one -- will be able to shake Jawbone's old woes, and whether investors will have enough confidence to invest in such a business.

A team of NIH-funded researchers at Stanford University have published some results in Nature from a large global study of activity data, as collected by Azumio's Argus smartphone app. The data has yielded a handful of interesting findings that could have implications for public health programs targeting obesity.

"The study is 1,000 times larger than any previous study on human movement,” Scott L. Delp, head researcher and the director of the Mobilize Center at Stanford University, said in a statement. “There have been wonderful health surveys done, but our new study provides data from more countries, many more subjects, and tracks people’s activity on an ongoing basis in their free-living environments versus a survey in which you rely on people to self-report their activity. This opens the door to new ways of doing science at a much larger scale than we have been able to do before.” 

Specifically, the dataset, which began to be collected in 2015, included a total of 68 million days of minute-by-minute step recordings from 717,527 anonymized Argus users. Residents of 111 countries participated, but researchers looked most closely at the 46 countries that had at least 1,000 users. Unsurprisingly, participation skewed heavily toward higher income countries, though about 10 percent of participants heailed from middle income countries. 

The main takeaway from the study was that it wasn't the average activity of a country that correlated with its obesity rates, but the range of activity levels contained in that average. Countries where everyone reported similar levels of activity had much lower obesity rates than countries like the United States, which has a mix of very active and very sedentary users. In fact, the study group form the five countries with the greatest activity inequality were almost 200 percent more likely to be obese than those from the five countries with the lowest activity inequality.

Another finding about countries with high activity inequality was that it also broke down on gender lines, with women being generally less active than men. Zeroing in on the city level in the United States, there was a correlation between the walkability of a city and its activity equality -- and that correlation was more pronounced among women.

When the Stanford-Azumio partnership launched back in late 2015, Azumio CEO Bojan Bostjancic told MobiHealthNews that activity data was just one small part of the data that was being collected.

"The team that is working with Stanford on the data is coming from a different group," he said at the time. "There are people interested in mobility, how people walk, gait, that sort of thing. There are people interested in diet and obesity. There are people who study social networks. It’s kind of heterogenous and everyone has their own agenda. There’s a lot of scientific curiosity, looking thorugh these datasets for the first time and trying to see the patterns in them."

Data from one of the other arms that we highlighted at the time – a look at social networks' effect on health behavior led by Pinterest Chief Scientist Jure Leskovec –  was presented at a conference earlier this year. The paper showed that social forces accounted for 55 percent of observed behavior change among app users.

Fitbit is once again facing a patent lawsuit, this time over the haptic feedback technology present in its last two generations of trackers. San Jose-based Immersion filed suit in the U.S. District Court for the Northern District of California over three patents, and is also pursuing legal action in China to get Fitbit's Chinese distributor Runtong to stop making and selling Fitbit devices as well.

“Since 1993, Immersion has been a leading innovator in the field of haptic technology, leveraging our culture of innovation and market-leading haptic know-how,” Victor Viegas, Immersion’s CEO, said in a statement. “Our valuable patents in the US. and China help us protect our longstanding investment in research and development in this exciting field. We are disappointed that Fitbit rejected our numerous attempts to negotiate a reasonable license for Fitbit’s products, but it is imperative that we protect our intellectual property both within the US and through the distribution chain in China.”

The three patents at issue are patent number 8,351,299, “Apparatus and Method for Providing Condition-Based Vibrotactile Feedback”;  patent number 8,059,105, “Haptic Feedback for Touchpads and Other Touch Controls”; and patent number 8,638,301, “Systems and Methods for Transmitting Haptic Messages”.

Immersion is seeking a court order requiring Fitbit "to immediately and permanently stop manufacturing, using, selling, offering for sale, or importing infringing Fitbit devices in both the US and China; as well as damages to compensate Immersion for the harm the infringement has inflicted" according to a statement from the company.

"Fitbit believes the suit brought by Immersion has no merit. Since its inception, Fitbit has amassed more than 450 issued patents and patent applications," a spokesperson for Fitbit said in an email. "As the pioneer and leading global wearables brand, Fitbit has developed and delivered innovative product offerings to empower its more than 50 million registered users to lead healthier, more active lives."

Fitbit has faced a good deal of litigation since the company went public and became a leader in the wearable space, much of it revolving around patents. We've covered Fitbit's patent dispute with Jawbone at length; it was already winding down, with several of both company's patents essentially invalidated by the courts, even before news of Jawbone's liquidation broke last week. Fitbit was also sued by Valencell over patents related to heart rate tracking. That case is still ongoing. In addition to patent litigation, Fitbit has faced class action suits alleging dangerous inaccuracy of both its heart rate and sleep tracking capabilities. 

Lately we've seen a trend in cases like these of the patents being ultimately struck down by the court for being unenforceably broad, but that may not be the case here, where the patents at issue are more concrete and hardware-related.

It's been a rough year for wrist-worn wearable activity trackers. As we noted in a column last December, what was once a vibrant and competitive field is now a graveyard of failed devices like the Pebble, the Basis Band, the Nike FuelBand, and many more. Just this month news broke about Jawbone's liquidation after a long, slow decline.

You can place the blame for these failures in a number of places, but one that holds a lot of weight is that behavior change is hard. Getting people to use a device and keep using it, and, through the device, getting them to change their exercise habits, is a taller order than most companies thought it would be when they started. An oft-quoted survey by Endeavor Partners showed that a third of wearables users stopped using their device after six months.

Meanwhile, in Cupertino, there's Apple. Athough the Apple Watch is a multifacted smartwatch, its fitness features continue to be a major draw and a major focus for the company, to the extent that Apple has built a fitness lab at its headquarters with 20 full-time nurses and 13 full-time exercise specialists. 

So what makes Apple so bullish on a technology that seems doomed to failure? Jay Blahnik, Apple's director of fitness and health, spoke about the company's design philosophy at a breifing with reporters last week attended by MobiHealthNews. He said the Apple Watch takes a distinct approach from other wearables, and that Apple hasn't seen the sort of attrition suggested by the Endeavor study.

"One of the big notions of the activity app is that it automatically keeps track of something you’re already doing and makes it really easy to achieve it," Blahnik said. "Those are the things that lead to rituals. People don’t get tired of brushing their teeth; they do it for most of their life. So there are things that don’t create fatigue -- if it’s really simple to do and it starts to become a ritual. And that was the design philosophy behind this. Let’s not try to make this about the most you can do, let’s save that for the workout app. This is not about the most you can do, but the least you should do every day."

Without naming names, Blahnik compared the three-ring structure of the activity app, which encourages users to meet self-entered goals for moving, exercising, and standing, to the 10,000-step paradigm that might be familiar to Fitbit users.

"What a lot of people don’t realize is the average American does 25 to 35 hundred steps per day," he said. "So 10,000 is four times the amount the average person does. Which is why it’s really hard. And when it’s really hard for you to do, there is going to be burnout. Because it’s not a ritual; it’s actually a challenge every day. We let you set that goal and we nudge you to keep increasing it until you get to a level that you want to do, or a level that you can do. And we back off once it appears that you’ve leveled out. Because our philosophy is ‘great if you can do more, but let’s try and help you do as much as you want to do and then try to get you to repeat that.’ So everything about the way it’s designed is really designed to prevent the fatigue."

The rings are simple by design, but they're meant to motivate users on an almost subconscious level.

"Typical activity trackers also measure metrics but they tend to do them in numbers," Blahnik said. "We’ve built our entire design around a visual. Well, what’s interesting about a visual is numbers continue to get bigger. No matter how big they are, they can always be bigger. But a ring is either closed or not closed. So we’ve found there’s a real addictive behavior in making sure that final ring gets closed."

There are a few other differences between the Apple Watch and other trackers. For one thing, because the Apple Watch is more than just a fitness device, falling off the Activity app wagon doesn't mean leaving the whole device at home, as it might for a dedicated fitness tracker. This makes it easier to reel back lapsed users. For another, Apple's "Activity Sharing" also has a different philosophy than other trackers.

"Most any activity tracker does sharing, but they tend to focus on leaderboards and competition and we really wanted ours to be much more about support," Blahnik said. "... So we might be talking about work on a messaging app but also on my Watch and phone I get a message that you closed your activity ring. So right in the middle of the meeting I can give you a high five just by responding from my Watch and phone.  And that seemed to be really powerful for people who want to share activity, that it’s much more about me giving you a high five or giving you a little smack talk than it is about using the leaderboard or being number one."

Blahnik said the company initially envisioned having completely different experiences for enfranchised athletes and people who just want to get exercise, but they found that the rings were resonant among all users.

"Athletes find that they still want to close those activity rings and they find that, even though they might get up in the morning and run a 10K, they’re still interested in the fact that they don’t want to sit too much during the day. So while it might be easy for them to close their move and exercise ring, they still have to focus on their stand ring," he said. "And then beginners who don’t work out have found it really interesting that they can see the difference between just moving and what counts as exercise and whether they’re sedentary or not."

Now, as the company gets ready to launch the next generation of its WatchOS, Blahnik and his team are exploring new ways to motivate users. Recently, they've added new limited-availability badges timed with holidays and other occasions. They're also aiming to increase the personalization of the activity nudges the Watch gives.

"We previously have given you nudges, but those were all time-based," he said. "We wanted to make the Watch even smarter. So now in the fall, the Watch is going to get to know you based on your activity and provide notifications that are personal. So we would all start our day with inspiration, but the inspiration I would get from the Watch for me would be different from what you would get. So let’s say I’m five days away from a streak, it might point that out to me to keep me on track Or say I don’t have any good news coming up, it might remind me what yesterday’s good news was. Which rings did I close? Did I double up my exercise goal? It’s constantly looking for ways every morning to nudge you and keep you on track for what you might be doing."

The app will also create a personal monthly goal for each user based on their past performance.

"Every month you will get a challenge that’s based on you," Blahnik said. "It will try to get you to beat or repeat something you’ve already done. What we’ve found is when you make it really close to something you’ve already done but just a little bit farther than that goal you did before, it tends to be really addictive. So we’re excited to see how users interact with those challenges but in our early testing it’s been really compelling."

Finally, like most other wearable makers, Apple is eyeing the employee wellness space in addition to personal fitness. The company has opened up the ring infrastructure to be usable by third parties, and Apple itself recently instituted a corporate wellness challenge using an app built by Lose It!

Opaque as Apple is wont to be about things like sales figures, it's hard to say definitively if the Apple Watch is doing well as a product -- that is, whether it is avoiding the fate of so many standalone fitness trackers over the last few years. But its certainly clear that the company has a vision for how to do fitness tracking differently.

K4Connect, a technology company focused on seniors and those with disabilities, has partnered up with Garmin International on wearable devices geared toward residents of senior living communities, as well as staff and operators.
 
The devices will be part of K4Community, K4Connect’s “connected-life” platform. The idea is to give senior living residents a means of tracking their wellness and fitness information through use of a simple app; concurrently, the staff will have access to that information, in theory giving them the means to help the residents achieve personal fitness goals.
 
“K4Connect reached out to Garmin and asked if we’d be open to exploring a deeper collaboration than your traditional API integration,” said Sean McNamara, head of Health Partnerships at Garmin International. “From there, conversations progressed and we aligned on a strategy to leverage the Garmin Health mobile SDK and vivofit 3 devices to provide a frictionless experience for the older adults who are using K4Connect offering.”
 
If the idea of seniors using tech-equipped wearables seems incongruous, the evidence shows otherwise: a recent AARP report, “Building a Better Tracker: Older Consumers Weigh In on Activity and Sleep Monitoring Devices,” older adults are actually pretty interested in using technology to track and improve their health. More than 75 percent of those studied, in fact, said it was helpful.
 
“We believe K4Connect is a market leader in the senior technology and IoT space,” said McNamara. “We expect this partnership to help dramatically expanded the solutions connected wellness capabilities and drive considerable gains in this market.”
 
The Garmin wearables are slated to monitor heart rate and track sleep, in addition to other fitness-related bells and whistles, such as the requisite steps and activity levels. The interface with K4Community is seamless, and gives senior-living community staff a peek into real-time analytics showing activity and wellness trends.
 
Garmin’s activity tracker is called the vivofit 3, and when the product was announced in April it was touted for tracking VO2 max, fitness age, and stress. VO2 Max and fitness age are related metrics that show users whether their fitness level overall is poor or superior, and what age correlates to their fitness. These are levels that users can change through exercise.
 
Garmin Health Lead Product Manager Travis Johnson said early results from the pilots have been encouraging, due largely to a high rate of use among the seniors testing the device.
 
K4Connect has raised $10 million to date across two rounds of capital (Seed Round and Series A).  Investors include Intel Capital, Sierra Ventures, Stonehenge Growth Equity, Lowe's Venture, Traverse Ventures Partners, and RGAx, a subsidiary of Reinsurance Group of America.
 

Weight loss app Lose It!, which boasts 30 million users and more than 50 million pounds lost, has launched embodyDNA, a DNA-based weight loss plan that personalizes results using an interactive app-based interface.

Lose It! developed embodyDNA, which offers customized recommendations on food and beverage consumption and physical activities, in collaboration with Helix, a personal genomics company, that has just launched what it touts as the first online marketplace for DNA-powered products.

For $188.99, interested users can go to embodydna.com and order a kit, which involves a saliva sample. When they mail in the sample, Helix reads their DNA and Lose It! translates the data into insights, delivering them to the user directly in the Lose It! app along with personalized weight loss, nutrition, fitness and food sensitivity recommendations.

embodyDNA also identifies patterns in users’ Lose It! history and provides feedback on their recorded behaviors, using the data to concoct ways in which people can tweak their daily habits to reach their weight loss goals.

Lose It! CEO and cofounder Charles Teague said nearly two-thirds of Americans are overweight or obese, which represents the potential for prominent market share for the company’s new offering.

This isn’t the company’s first foray into personalized apps geared toward nutrition and weight maintenance. Last year, Lose It! launched Snap It, a tool that uses machine learning to identify food and corresponding nutritional information from a photo.

“The Helix marketplace thrives on offering a robust and diverse selection of products like embodyDNA, which have tremendous personal utility to consumers, and in turn increase the overall utility of personal genomics in everyday life,” said Justin Kao, co-founder and senior vice president of Helix.

In addition to embodyDNA, the Helix marketplace will host a range of DNA-powered products focused on health, fitness, nutrition, family, ancestry and entertainment. The Helix marketplace can be accessed at www.helix.com.

In October 2017, Helix announced several partnerships: The Icahn School of Medicine at Mount Sinai, National Geographic and ExploraGen will collaborate to deploy Helix’s genetic-testing service, which is powered by DNA sequencing giant Illumina. Additionally, the company secured an investment from Kleiner Perkins Caufield and Byers, and the company also recently announced a partnership with genetic information company Invitae.

More than 500,000 births occur each year in the state of California, but deciding where to get care can often be a difficult process for consumers. That’s where a new partnership between Yelp and the California Health Care Foundation comes in.
 
Thanks to the partnership, maternity care measures are now being displayed for the roughly 250 hospitals that deliver babies in the state. These measures have the potential to be seen by millions of people who turn to Yelp in their daily life to help them make these types of decisions.
 
The data for the measures comes from www.CalHospitalCompare.org, a hospital quality website founded by CHCF and operated by Cal Hospital Compare, a multistakeholder nonprofit organization.
 
Among the measures that are displayed on Yelp pages are the percentage of cesarean section deliveries in low-risk pregnancies to mothers having their first baby. Consumers can also check on a facility’s percentage of newborns fed only breast milk before discharge; how often episiotomies are performed; the availability of vaginal births after c-sections; and how often vaginal births among women with a prior c-section occur at a given hospital, or if it routinely provides them at all.
 
For its part, CHCF has operated a couple of data-centric websites for some time now. But it lacked the accessibility and reach of a site like Yelp.
 
“Consumers don’t always flock to these kind of wonky websites that have lots of data on there,” said Stephanie Teleki, director of evaluation and impact at CHCF. “Consumers are already going to Yelp. We can marry the comments with the more empirical-based measures.”
 
In that way, the partnership represents a multi-pronged approach, which Teleki said is necessary to address such a complex issue.
 
“Poor maternity care is a multifaceted problem, and addressing it requires a multifaceted solution,” she said. “It involves having better data. … Bring about change, you have to have multiple pressure points. You have to align payments with better outcomes, and you need to help providers improve care. You need to have public policies that are supportive, you need to have a workforce -- in this case, midwives focusing less on intervention and more on vaginal birth. And of course, focusing on the patients."
 
“Yelp is really a megaphone for for the clinical quality measures,” she said. “Those are the more wonky kind of clinical things that a lot of patients can’t understand, so putting them side-by-side with the comments, hopefully we can acclimate consumers with looking at that kind of data -- really socialize the idea that they should be using this data.”
 
The project is part of a larger statewide effort to reduce the rate of unnecessary low-risk, first-birth C-sections at every hospital in the state to the national goal of 23.9 percent. CHCF is working with several organizations, including the California Maternal Quality Care Collaborative, Smart Care California, Pacific Business Group on Health, and the Hospital Quality Institute.
 
There are plans to launch a mobile module by the end of the year. The maternity care data presented on Yelp will be refreshed semiannually.

Cardiogram, a startup working on algorithms to make the Apple Watch’s heart rate data clinically actionable, is launching two new features for the Apple Watch that aim to help people stay more active this summer: Leaderboards and Workout Zones.

Leaderboards is geared toward those who want to inject some friendly competition into their active lifestyles. Friends can compete with one another and track each others’ progress throughout the day, in turn challenging the other to be more active -- helping to increase exercise levels, and potentially lead to healthier lives.

The feature also lets users compare their exercise levels to other people in their age range. This effectively creates a goal for the user -- to match or surpass the average exercise level of their age group, or at the very least make some progress toward it.

Workout Zones, meanwhile, allow users to track the intensity of their workouts. For each workout, a person can now see how long they spent in each of their target heart rate zones. The American Heart Association recommends at least 30 minutes of moderate-intensity aerobic activity, which translates into roughly 50-70 percent of max heart rate at least five days per week for a total of 150 minutes -- or at least 25 minutes of vigorous aerobic activity, at 70-85 percent of max heart rate, at least three days a week for a total of 75 minutes.

Alone, Apple Watch is projected to create more than 2 trillion heart rate measurements this year. But that’s just raw data. Cardiogram interprets what the heart rate means: Whether a spike in heart rate corresponds to what a person is eating, for example, or whether it’s due to stress of an abnormal heart condition.

To take things a step further, Cardiogram is also running an N=14,011 study with UCSF Cardiology, using the Apple Watch to predict and prevent heart disease. In May, the company presented a clinical study showing that its deep neural network, DeepHeart, can detect atrial fibrillation with 97 percent accuracy compared to an in-hospital gold standard, using Apple Watch’s heart rate sensor alone. Similar to how Siri or Google speech recognition transforms a raw audio signal into a sequence of phonemes, DeepHeart transforms raw heart rate signal into a sequence of health risk scores.

Cardiogram plans to invest in more medical research, and expand to other conditions associated with heart rate variability.