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One of March's best Pixel features is finally reaching more users
Transit mode and commute notifications are finally rolling out widely.
Apple's Warnings About Spyware Are Real, Don't Ignore Them
"Mercenary spyware" isn't targeted at everybody, but don't skip the notification if you see it.
McLean County launches alert system for sharing weather, traffic and public health information
The system is similar to notifications set up in Bloomington and Normal, with some overlap, used to share pertinent information county-wide or by quadrant. The county can now send push notifications to automatically alert cell phones in a targeted area of weather and public safety emergencies.
iOS 26.4.2: Apple Emergency iPhone Update Fixes Deleted Notification Bug
Apple has released a new iPhone update — that has taken many by surprise — to address a vulnerability that was recently exploited by the FBI.
Legacy, Regence Health split over rates; Oregon families scramble for healthcare
Melanie Bobbett was already facing mounting medical expenses when her partner received a notification that his insurance plan was ending on April 1.
California Assembly Health Committee passes 'Next of Kin Notification' bill
Assembly Bill 2598 was introduced in response to KCRA’s “Dignity Delayed.” The investigation revealed a backlog of human remains after patient deaths at Dignity Health hospitals.
First Ward residents talk business, office vacancies, new city website
First Ward residents received an update on economic development and a crash course on how to navigate the city’s new website at the ward’s Thursday night meeting. The meeting included a notification of retail and office vacancy rates and a list of new business openings by Economic Development Manager Paul Zalmezak. Zalmezak shared that the...
GSA Issues Notice of “Glitch” and Recommends Contractors Validate Small Business Status Representations on SAM.gov
The General Services Administration (GSA) has begun sending out email notifications of a “known glitch” affecting certain System for Award Management
Apple Now Sending Critical Security Alerts to iPhones Running iOS 17 and Earlier
Apple has begun pushing Lock Screen notifications to iPhones and iPads running older versions of iOS and iPadOS, warning users of active web-based attacks. The alerts, which appear as a "Critical Software" notification from the Settings app, warn that Apple "is aware of attacks targeting out-of-date iOS software, including the version on your iPhone," and urge users to install a critical update to protect their device.
I stopped playing music on my Android phone and went back to my iPod
In 2026, my favorite music player has no Wi-Fi, no notifications, and no subscription. Here's why I'm using an iPod instead of an Android.
Erie County Department of Health reports potential diphtheria exposure in West Seneca schools
BUFFALO, N.Y. (WIVB) — The Erie County Department of Health has confirmed a travel-related case of bacterial illness diphtheria, with schools in the West Seneca Central School District being identified as potential exposure sites. According to the district, notifications have been sent to families at Clinton Primary, Northwood Elementary, Winchester-Potters Elementary & East Middle School. […]
Division I Cabinet approves new transfer windows in several sports
The Division I Cabinet on Wednesday approved changes to the notification of transfer windows for multiple sports, as proposed by each respective sport’s oversight committee.
Android 17 QPR2 brings system blur to the Pixel lockscreen
The interface changes in Android 17 QPR2 Beta 3 continue with more blur for the Pixel lockscreen. Notifications...
Trump's Iran notice aims to reset war powers clock amid growing political risks
The Trump administration's notification to restart the war with Iran aims to reset a 60-day clock for military action, but questions are mounting about public support as midterms approach.
The Trump administration is trying to divert $2 billion in global health funding to pay for USAID shutdown
The Trump administration plans to redirect $2 billion in funding intended for global health programs to cover the cost of closing the US Agency for International Development (USAID), according to a copy of the notification obtained by CNN.
FBI Extracts Suspect’s Deleted Signal Messages Saved in iPhone Notification Database
The case was the first time authorities charged people for alleged “Antifa” activities after President Trump designated the umbrella term a terrorist organization.
Apple sends fresh wave of mercenary spyware warnings worldwide
Apple has notified users in 110 countries who it suspects may have been targeted by spyware attacks. Here are the details.
Apple fixes bug that cops used to extract deleted chat messages from iPhones
The iPhone and iPad bug allowed law enforcement using forensic tools to read messages that had long been deleted by the Signal app.
Android 17 brings a bit of Pixel Watch whimsy to your notification shade
Google is porting over a tidbit from its Pixel Watch to the notification shade on Pixel phones with its Android...
iOS 26.4.2 Patches Flaw That Let FBI Extract Deleted Signal Messages
The iOS 26.4.2, iPadOS 26.4.2, iOS 18.7.8, and iPadOS 18.7.8 updates that Apple released today address a security vulnerability that the FBI recently used to extract Signal message previews from an iPhone even after the app was deleted. A flaw with notification services allowed notifications that were supposed to be deleted to be retained on an iPhone or iPad. Apple says it fixed the logging issue with improved data redaction.
Upgrading to Apple Watch Series 12 Could Cost You Hypertension Notifications
Some Apple Watch users who upgrade to the Series 12 or the Ultra 4 might temporarily lose access to hypertension notifications. On the watchOS feature availability page, Apple says notifications might not be available on the Series 12 or Ultra 4 at launch because regulatory clearances are in process. Hypertension Notifications may not be available on Apple Watch Series 12 or Ultra 4 in your region, as additional regulatory clearances for these devices are in process.
Android 17 Beta 3 starts adding more blur to system UI [Gallery]
Android 16 introduced translucency to the notification shade and Quick Settings. As rumored, Android 17 Beta 3 continues that blur trend...
Casio's Tiny Ring Watch Is Now a Full-Blown Oura Alternative
The CRW-H001 can track heart rate, blood oxygen, and sleep and vibrate when you receive a notification.
Galaxy S25 could get two more AI features from Galaxy S26
The One UI 8.5 update for the Galaxy S25 didn't bring all the AI features from the Galaxy S25, but a new update could bring two new features.
Here's how Pixel 11 Pro HiLight will work with Google Contacts
Pixel 11 Pro phones are getting a new "HiLight" notification system, and Google's Contacts app reveals how it will work.
Cunion Frames Its Wearable Health Ecosystem Around Five Health Benefits
San Diego, California--(Newsfile Corp. - August 29, 2026) - Most health technology can overwhelm users with constant notifications and dashboards, eventually causing them to disengage. In response to this challenge, Cunion is building an ecosystem around the premise that the healthiest device is the one that stays quiet until it has something worth saying. From this approach, Cunion identifies five practical health benefits across its wearable ecosystem.To view an enhanced version of this...
New York finalizes social media restrictions for kids
The regulations, which take effect in January, limit the use of algorithmic feeds and nighttime notifications.
Why the Hottest New Wearables Want to Be Ignored
Burnt out on wrist buzzes and notification overload? A new crop of minimalist wearables promises to collect your health data without demanding your attention.
Australia Says Rogue OpenAI Agent Hacked Health Service Website
Australia said an OpenAI agent hacked a data portal for its public health insurance system, in what’s thought to be the first known instance of an AI agent infiltrating a government website. Australian prime minister Anthony Albanese said the agent had accessed public and non-public information relating to health care spending, but personal information is not believed to have been part of the breach. Albanese, speaking on Wednesday at a media briefing in New York where he is attending the United Nations General Assembly, said that the incident took place in June. OpenAI learned of the hack in August, but only emailed a general inbox of an Australian government agency on September 10, and it wasn’t until this week that OpenAI and the Australian government spoke directly about the issue. “It took the company way too long to inform the government what had occurred,” Albanese said, “and the nature of the way that that notification occurred as well was unacceptable.”
US proposes AI incident notification mechanism before Trump-Xi summit
Treasury Secretary Scott Bessent proposed an AI notification mechanism for national security ahead of Trump-Xi talks.
Apple introduces privacy rules for third-party access to notifications
Apple has updated its Developer Program License Agreement with new rules on how third-party accessories must handle forwarded notifications.
Apple Warns Users in 110 Countries They May Be Targets of Mercenary Spyware
Apple alerts suspected mercenary spyware targets in 110 countries, expanding threat notifications that have reached users in over 150 countries.
Anavex Life Sciences Receives Expected Nasdaq Delinquency Notification
Anavex Life Sciences Corp. (“Anavex” or the “Company”)(Nasdaq: AVXL), a clinical-stage biopharmaceutical company focused on developing innovative treatments for central nervous system (CNS) disorders, today announced it received anexpected delinquency notification letter (the “Notice”) from the Listing QualificationsDepartment of The Nasdaq Stock Market LLC (“Nasdaq”) on May 20, 2026.
iOS 26.6 Will Warn You About Malicious iMessages
Apple is adding a new warning about malicious iMessages in iOS 26.6, according to X user @limpless_skelly, who shared a mockup of the notification. The pop-up will warn users that a message could be trying to harm their iPhone or compromise their privacy. Apple asks users to share the message so it can guard against future attacks, and there are "Not Now," "Share With Apple," and "Don't Report" options to tap.
Ford supplier cuts jobs in Sterling Heights as some work sent to India
Kern J.G. Enterprise Inc. filed the Worker Adjustment and Retraining Notification, citing "unforeseeable business circumstances."
Gen Z Is Wearing the Same Watch as Your Grandmother and It's Become the Most Coveted Accessory of Summer 2026
You glance down at your wrist and see a notification about your sleep score, a reminder to stand up, and three unread texts – all before you have even finished your morning coffee. At some point, the thing on your wrist stopped being an accessory and became a tiny taskmaster. But what if the most...
Samsung Electronics America to reduce workforce by 739 in New Jersey, US WARN notice says
Samsung Electronics America is reducing its workforce by 739 in Englewood Cliffs, New Jersey, according to a Worker Adjustment and Retraining Notification (WARN) reviewed by Reuters.
Google’s upcoming Pixel phones are for the fans, even if its launch event isn’t
Notification lights are back back back.
Apple Watch Ultra 4 Could Get Redesign and Blood Pressure Monitoring
The Apple Watch Ultra 4 could feature a complete redesign and blood pressure monitoring, according to DigiTimes. Apple will apparently add a new high blood pressure notification feature to the Apple Watch that uses the optical heart-rate sensor on the back of the device to analyze how blood vessels respond to each heartbeat, sending alerts when an abnormal pattern is detected. The feature is said to be under FDA review.
Google Chrome Is Silently Downloading a 4GB Gemini Nano AI Model to User Devices Without Consent
Google Chrome has been automatically downloading a 4GB folder of Gemini Nano AI weights to user devices without notification, and redownloads it if deleted.
FTC Rescinds 2021 Policy Statement on Health App Data Breaches
In September 2021, the U.S. Federal Trade Commission (FTC) issued a policy statement extending the FTC Health Breach Notification Rule to cover health In 2021, the FTC issued a policy statement extending its Health Breach Notification Rule to cover health apps and other connected devices not covered by HIPAA. The policy statement was withdrawn in September 2026, as it was considered obsolete.
Android 17 QPR2 enables Pixel 11 Pro HiLight for messages
With Android 17 QPR2 Beta 6.1, HiLight on the Pixel 11 Pro series now supports message notifications. This should have...
Allied Gaming & Entertainment, Inc. Receives Nasdaq Deficiency Letter for Late 10-K Filing
Allied Gaming & Entertainment, Inc. received a Nasdaq deficiency letter due to delayed filing of its annual report.Quiver AI SummaryAllied Gaming & Entertainment, Inc. (AGAE) announced on April 21, 2026, that it received a deficiency letter from Nasdaq due to its failure to file the Annual Report on Form 10-K for the fiscal year ending December 31, 2025, by the March 31, 2026 deadline. Despite this notification, there is currently no immediate im
Apple Sends Out Warnings To Targets Of Mercenary Spyware Attacks
Apple has recently sent out notifications, warning users that they’d been targeted by mercenary spyware attack.
SteamOS 0.3.0 for Steam Frame released
Valve are now beginning to announce SteamOS updates for the Steam Frame, with the first public notification being SteamOS 0.3.0 for Steam Frame.
Fulton County health officials notify Johns Creek High School community of possible tuberculosis exposure
Students and staff who may have had close contact with the individual will receive separate notifications and be offered free tuberculosis testing.
Parlance Brings Verified Push Notification Security to Health System IT Help Desks on ServiceNow Store
/PRNewswire/ -- Parlance, a healthcare voice AI company, today announced the availability of its help desk intelligent virtual assistant (IVA) on the...
Birding is more than a hobby. It’s a public health tool
Notifications, deadlines, and a steady stream of information compete for our attention all day long., Birding offers a simple interruption to that pattern.
Google Is Teasing Some Kind of Notification Light on the Pixel 11’s Camera Bar
Google really does beat to the rhythm of its own drum.
September Monthly Review: Health MCP Guy?
For all the time I spend talking about APIs and data exchange, this newsletter has had embarrassingly little interoperability of its own. It’s old-school SaaS, baby - UI or bust. Not all of that is my fault! Substack, for all its popularity, is (as mentioned before) really frustrating as my system of record. The primary user it optimizes towards is the reader, whose attention feeds the app, the Notes feed, and the recommendation network that Substack is actually selling. Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe They’re falling into the same trap that Medium once sprinted into, albeit at a much more glacial speed. Younger generations may not remember (or never knew) it, but Medium once lured publications like The Ringer and Signal v. Noise onto its platform, only to lose them as it rebuilt itself around a paywall and an algorithmic feed. Substack’s original pitch circa 2020 was the antidote (you own your list), but every new feed feature chips away at it. I get it: writers are generic supply in the eyes of the Substack product team. Generic supply follows demand, so the consistent pressure on the PMs is to generate demand, which leads to every product cycle going toward discovery (Notes, recommendations, the app, live video). The end result lackluster author tools (laggy and broken analytics are truly crippling) all despite the premium price point. The archive is where it crosses from authorial gripes to actual reader impact, though. Across Substack and LinkedIn, I’ve published 1,218 posts and nearly 900,000 words since 2018. Substack’s native search can see only the 464 posts that live on Substack, and even there it’s woefully inadequate at surfacing relevant content (even for the guy who wrote it)! Readers have the same problem, writ large. Ask the Archive Fixing search (for both my readers and my own use) turned out to be extremely non-trivial, unfortunately: There’s no public API for readers to access content RSS exists for new content notification, but it only carries the 20 most recent posts and cuts paid ones off at the preview The only Substack MCP is an admin tool for analytics The export exists for authors, but it’s painfully awkward and slow. So I built something to work around that: the Health API Guy MCP. It’s a private MCP server holding the full text of everything I’ve written across Substack and LinkedIn. Add it to Claude or ChatGPT as a connector and you can ask things like: It pairs keyword search (for acronyms and case names, of which we have many) with semantic search. Every post is also labeled by topic, form, and court case, so you can pull a lawsuit’s (or multiple cases’) entire docket across Substack and LinkedIn in one query: Hail, Healthapiguyhydra This is also a bit of me eating my own cooking. I’ve spent the year arguing that headless healthcare is arriving and that developers want primitives over abstractions. Last week in Hail, Benihydra, I watched Salesforce plug its platform into Claude and bet that the records underneath outlive whatever interface sits on top: Salesforce must believe that the Hydra’s immortal head is the records, permissions, and business logic (in that they will survive whatever happens to the interface). It felt a bit hypocritical to keep my own archive behind a Substack search bar. The archive is the body. Substack is one head, and now whatever tool you might use is another. Will the EHRs follow my lead? Probably not imminently, but one can hope! Why Founding Members Only The MCP is available to Founding Member subscribers. A few reasons: It costs money and time to run. Hosting, the database, Clerk usage and AI compute for search and labeling are significant operational costs (that increase with usage). Substack gives me no way to automate access. There’s no API to check whether someone is a paid subscriber, so every user is manual operations for now. It’s a beta. We’ll need to improve things and parts will break. I’d rather they break for a small group of dedicated readers who will tell me about it. The Founding tier deserved a real benefit. Until now it was mostly a generous tip. Now it comes with something. If you’re already a Founding Member, reply to this email with the address you’d like provisioned. If you’re not and want in, upgrade here. Larger teams (such as companies) can get access too: group subscriptions at the Founding tier come with the group discount. The admin for the subscription can reply with the list of addresses to provision. Get 20% off a group subscription Pricing Founding membership is now a flat $200 a year, replacing the old suggested $150 that readers could adjust. Existing Founding Members will have access grandfathered in at their previous rate. Month in Review Articles Published Make Networks Dumb Again (Sep 11): AI is making old analog networks cheaper to use and flooding them with machine traffic in the process. A plea for agent-native rails with the intelligence at the endpoints, and for Washington to drag them to ubiquity. Interoperability, Unbuttoned (Sep 29): Interoperability is a series of workflows in a trenchcoat, and this post finally takes the trenchcoat off. A color-coded map shows which provider workflows went digital, which are fragmented, and which still run on fax. Video Content Antitrust’s System of Record Problem (Sep 3): The FTC’s investigation into Epic prompted a ninety-minute webinar, now posted with chapters and a smoothed transcript. We get into why market definition, missing B2B share data, and the SSNIP test leave antitrust poorly suited to systems of record, plus why information blocking may be doing more than any pending lawsuit. The Information Exchange: Cerner Milking Edition (Sep 18): This was so fucking fun. Ryan Tucker, Ryan Brickner, Brad Thorson, and I try an Around the Horn format, complete with points, penalties, and a mute button. We debate whether Oracle Health is dead, who would actually buy Cerner (IBM enters the chat), p(Doom), and why the front desk still hands you a clipboard. Regulatory Ask Not What Your Network Can Do (Sep 23): CDC’s RFI on public health data intermediaries lists use cases already served, unevenly, by eCR, lab reporting, IZ Gateway, and syndromic surveillance. The real opportunity sits in one question about AI: a network that can handle the next emergency without another interface project. Court cases Particle v. Epic: The Naughty Schoolteacher (Sep 4): After a summer-long vigil, the answer on Epic’s early summary judgment bid is two paragraphs and a remedial assignment. Particle advances to the next grade, and market definition gets another year of discovery. The Epic Discovery Files (Sep 8): Texas’s motions to compel arrive with a 251-page appendix of requests, objections, and meet-and-confer letters with Cravath. Inside: Epic using generative AI for document review, denied interoperability requests in scope, and Noerr-Pennington raised against lobbying discovery. Epic v. Health Gorilla: “Working as Designed” (Sep 9): Epic wants nothing to do with the data breach MDL, and explaining why puts fresh discovery on the public docket. The spiciest allegation: Health Gorilla told GuardDog to scrub its law firm business from its website instead of cutting off access. Veeva v. Epic: Legal Bypass Surgery (Sep 15): Veeva asks the Wisconsin Supreme Court to skip the Court of Appeals, while law professors and three policy groups line up as amici. Meanwhile, Epic’s lawyers apologize for another round of citation errors, including a quote that never existed. Texas v. Epic: Behind the Black Bars (Sep 17): The court portal served up Epic’s unredacted filings, revealing a $5 million document review budget and the AI workflow behind it. Also inside: the 200-plus company names Texas wants searched, and one very expensive Zoom invitation. OpenEvidence v. Doximity: Consequences Will Follow (Sep 25): OpenEvidence tells the court it will not comply with a discovery order, and its own lawyers at Quinn Emanuel say they won’t defend the choice. Add years of Slack reported unrecoverable, and Rule 37 sanctions come into view. Health Tech Keeps Choosing Violence (Sep 28): Doximity moves to end OpenEvidence’s case, Epic asks Texas to show its work, and a sleepy Audacious Inquiry patent fight sprouts antitrust and information blocking counterclaims. The main event is a long-sealed Cognizant v. Infosys ruling that hints where system of record antitrust claims can survive. EHRs One Verb for Oracle Health (Sep 14): Oracle’s earnings call quantifies every data center to the decimal point, while Oracle Health gets a single verb: “accelerate.” Panning the few healthcare mentions turns up an agentic care management system, a research-to-care ledger play, and the question of whether healthcare gets Larry’s patience. Epic’s Forretress Under Siege (Sep 30): Judy Faulkner tells a panel Epic paused hundreds of projects to harden its software and calls it a “shame,” while a spokesperson insists the roadmap hasn’t changed. Project Glasswing, a Pokémon-branded QAN sprint, and a trove of Jodel grievances reconcile the two Epics and preview the Jevons paradox coming for all software. Industry Analysis Scanning for a Network (Sep 1): Scan.com raises $220M to build the imaging network labs never got, speedrunning Zocdoc’s consumer-to-B2B pivot. Its wedge to network density may be the most American one available: personal injury litigation. The Front Desk Wants the Damn Whole Building (Sep 16): Hello Patient buys Converse Health, pushing its AI front desk into referrals, chart work, and prior auth. The copilot categories keep blurring, and your distribution partner is still your final boss. Cross-industry Comparisons A Different Patchwork Quilt (Sep 10): Healthcare loves to envy open banking, but the US version has no mandate, a toll booth at Chase, and data quality problems of its own. The grass isn’t greener; it’s another American patchwork quilt, and perhaps a worse one. Hail, Benihydra (Sep 21): Salesforce brings its platform into Claude, Slack, and its own agent, inviting the interfaces that might replace it. Cut off one head and more grow back, so long as the records underneath stay put. Living on A Trade Secret Prayer (Sep 22): Six credit unions are suing Fiserv, the Epic of core banking, by claiming their own member records as trade secrets. Banking has no Cures Act, so its lawyers reach for legal alchemy that healthcare has already tried. Other News None this month External Media Nabla Accelerate NYC: I kicked off fall conference season at Nabla’s Accelerate event in New York, where Delphine Groll opened by asking the room to picture the company it wants to become and the one it doesn’t. I liked her framework of bureaucracy, fear, and ego as the blockers. I also love vendor conferences/events in general - different vibe than industry biggies. Healthcare 101 with Nikhil Krishnan: I briefly guest lectured Out-Of-Pocket’s Healthcare 101 class. Appreciated Nikhil’s takeaways cover whether AI doctors can query HIEs, why healthcare’s data-liberation rules beat most industries’, and the hi-res graphic is in the comments. HCN: Epic Probed by the FTC: I joined the HCN guys to talk through the FTC’s investigation into Epic. Cedric’s new hairdo was an unexpected plot twist. The episode also covers MFN drug pricing, healthcare M&A and Eli Lilly’s acquisition streak. Fall Conferences: At eHealth Exchange’s Annual Meeting in Austin on Oct 27, I’ll moderate a panel on the tensions between AI, HIEs, and timely patient access with Jean Ross (Primary Record), Therasa Bell (Kno2), Byron Crowe (Doctronic), and Michael Marchant (Freenome). Here’s the rest of my schedule if you want to meet up: CommonWell (Redwood Shores, CA): Oct 13-14 Will be participating in a fun Jeopardy event Open@Epic (Madison, WI): Oct 20-23 Will be enjoying Verona, Willy Street, and other local adventures eHealth Exchange and Sequoia Project (Austin, TX): Oct 27-29 Yeehaw HLTH (Vegas): Nov 15-18 Groundhog Day, Venetian Edition RSNA (Chicago): Nov 30-Dec 2 See me at “Governing AI in Breast Imaging: What Health Systems Are Actually Doing” Digital Health Counsel 2026 AI Summit (Seattle): December 2-3 Will likely be speaking to a bunch of lawyers about information blocking Posts I Liked ChatGPT’s Epic integration: game changer or nothing burger?: Joshua Liu, MD offers five thoughts on OpenAI’s Epic launch, starting from the point that it rides the same open APIs available to anyone. He argues read-only access leaves ordering to Art and the ambient startups, and asks why HCA is piloting it alongside Commure. He’s sorta a must-follow at this point - consistently excellent, thought-provoking takes. Epic, Lilly, and the Discovery pass: Seth Chaney reads Epic’s first major Discovery deal (with Eli Lilly), as well as its revised developer terms on commercial displays, as the pipe finally opening between EHRs and pharma. Life sciences and health continue to collide. Scott Rossignol on EHR payer platforms and ePA fees: Scott argues the top ambulatory EHR vendors are turning the prior auth mandate into a per-member-per-year toll on payers, for an API whose operating cost has nothing to do with covered lives. His fix is two lines of regulatory text: put the CRD/DTR/PAS certification criteria in the Base EHR definition, and bring payer-facing ePA connectivity under § 170.404’s cost-based fee rules. It’s a good solution. Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe
This Android feature could put your notifications on autopilot
Create rules to filter alerts
US says foreign financial institutions doing business with Iran may be sanctioned without notice
WASHINGTON, Oct 5 (Reuters) - The US Treasury Department said on Monday it was alerting foreign financial institutions that continue to do business with Iran or its financial sector that they may be sanctioned by Washington without advance notice. DETAILS: • "Foreign financial institutions continuing to transact with sanctioned Iranian financial institutions could be targeted at any time without advance notification and should take immediate action to terminate such activity and relationship
FBI used iPhone notification data to retrieve deleted Signal messages
The FBI was able to recover deleted Signal messages from an iPhone by extracting data stored in the device’s notification database.
iOS 27 just broke 15 years of muscle memory on iPhone and iPad
Since iOS 5 in 2011, the iPhone and iPad have included Notification Center, a central place to find alerts from...
The Big Holes in Wearable Heart Rate Variability And Readiness Scores
On September 9th, Apple announced it was revamping its Apple Watch Health Sensing System, rolling out a Readiness score (0 to 10), and increasing the frequency of heart rate variability (HRV) outputs 24-fold. This can be viewed as upping its competition with various other consumer wearable sensors. These “readiness scores” as a composite of multiple metrics, with heart rate variability (HRV) being front and center for most. The majority of Americans are now using wearable sensors, which equates to well over 100 million adults. HRV and Readiness scores are increasingly being marketed as a measurement of autonomic nervous system health, a digital marker for future disease, a clock for biological age, and a holistic metric to promote healthspan and even longevity. (Apple also introduced a new longevity tab and “Health Age”.) None of this has been proven. In this edition of Ground Truths I am going to review what we know about heart rate variability and readiness scores. Heart Rate Variability HRV is the variation in normal heart cycle timing. The variability of the heart rate, the barely perceptible millisecond changes in time between consecutive heart beats (see R-R intervals in the Figure below, left panel), is due to interplay between the sympathetic and parasympathetic (vagal nerve) inputs. Distinct from heart rate, individuals with the same heart rate can have very different HRVs. It is a rough reflection of the autonomic nervous system (ANS) activity, inadequate to say whether a person’s ANS function is abnormal. For more than three decades, heart rate variability (HRV) has been measured and several studies have found an association of low HRV and clinical outcomes, particularly a link with higher all-cause and cardiovascular mortality. There have also been less well established links of low HRV to risk of early cognitive impairment, dementia, mental illness, Type 2 diabetes and substance abuse. An important reminder is that HRV is a surrogate marker without any established cause-and-effect relationship. If you increase your HRV, that doesn’t mean it will improve health outcomes. In fact, there is no hard evidence for that. All that work linking to health outcomes was done with electrocardiogram (ECG) derived HRV. Now, in the era of consumer wearables, this is getting assessed differently, by optical pulse (yes, the lights you see) plethysmography (PPG) or what is called pulse rate variability (PRV). They are not the same, as shown below (right panel) and only concordant when the delay between the ECG and pulse is kept constant, which basically means at rest. I should mention there’s also what I will call MPV, a mattress mechanical movement sensor, a derived heart rate variability, that companies like Eight Sleep use, even further away from directly measuring HRV. HRV has not one uniform measurement but many different types of quantification, such as RMSSD, the magnitude of difference between successive R-R intervals of normal sinus beats (N-N) or SDNN, the standard deviation of NN intervals, both in milliseconds. SDNN is one of the so-called frequency domain HRVs (others are LF, HF, LF/HF). Different wearable sensors use different metics; Apple has relied on SDNN and nearly all of the others use RMSSD, which is generally considered the more accurate metric. There’s also the different length of time measured, such as for a matter of minutes, all day, or an overnight’s sleep. Short measurements are especially problematic since they don’t capture enough of respiratory modulation and other factors that influence HRV. Share Ground Truths How well does HRV correlate with PRV? There are very limited studies, especially independently done. One that is commonly cited was conducted by Air Force researchers in only 13 healthy adults assessing Oura ring 3 and 4, Whoop 4.0, and Garmin Fenix 6 and showed a correlation coefficient of 0.88 to 0.97 and a mean absolute percentage error from 6 to 10%. The correlation is not a perfect 1.0, but there’s at least a fairly high level of correlation. HRV is supposed to increase during the night due to takeover of the parasympathetic nervous system, and higher during deep sleep. A recent example of my 1 week, all day “HRV,” and one during sleep is shown below. As you can see, the N of 1 data are inconsistent for the same days from different sensors (Oura, AppleWatch, Fitbit Air, and Eight Sleep) by patterns, absolute numbers, and comparison with prior days and weeks. The largest study in over 8 million Fitbit users (the old version, not Google Fitbit Air, introduced in May 2026) gives you a sense of the effect of age, sex, and the 2 different main HRV (here PRV) metrics, with RMSSD on the left and SDRR (=SDNN) on the right below. That study, from data collected in 2018, is a major outlier, since all the more recent ones are tiny with respect to sample size. Many of the companies have not had independent evaluation of their HRV, such as Eight Sleep, but have published a low standard error on their website. There are some other published studies on the correlation between HRV and PRV, but they are all small and only in healthy adults. A scoping review emphasized the lack of study in underrepresented individuals, including the aged, people of color (which affects the PPG signal), and individuals who are underweight or obese. Add the typical adult age 60 plus with one or more chronic diseases. For example, one study in over 900 adults found poor correlation of HRV and PRV, non-uniformly underestimated across many chronic diseases (cardiovascular, endocrine, neurological, respiratory, and others), concluding PRV is “an invalid surrogate for HRV.” A recent systematic review of 43 studies comparing HRV and PRV found reasonable pooled absolute standardized error (HRV as gold standard) but only 10 of the studies provided quantitative synthesis in ideal conditions. Their main conclusion was similarly cautious: “PPG-derived HRV [PRV] should not be regarded as universally interchangeable with ECG-derived HRV across all devices, populations, and recording contexts.” Factors Affecting HRV and PRV That gets me to the long list of factors that affect HRV (and PRV) besides the device, the type of measurement (RMSSD, SDNN or others), the person’s signal, the sensor site, the duration of data capture, if weighting by sleep stage is used, how artifact is processed and corrected. And this list is not complete!: Oura puts out data from their community of users (who input data) on what affects their overnight HRV. The factors currently provided are: no alcohol (increase 8%), melatonin (increase 2%, float tank (increase 2%), wine (decrease 4%), and party (decrease 14%) in overnight HRV. Must be some big parties! Subscribe What is a PRV measurement good for? It has been falsely characterized as an index of “autonomic balance” and a specific indicator of stress. A 2018 review of the studies available for HRV and its relationship to stress, not using any of the current wearables, found that stress can lower HRV. But so can many other factors. The non-specificity of the signal, indexed to the table above, is striking. Evidence from a UK Biobank study of over 46,000 participants with actual HRV looked at genetically predicted HRV, a genetic risk score, that failed to show the expected HRV-mortality link, indicating that _HRV is likely not causa_l, but rather a reflection of person’s physiologic state. A review of consumer wearable HRV data from 5 longitudinal studies showed that nighttime PRV was not associated with perceived stress, and surprisingly higher HRV, in the largest cohort (N=717 participants), was correlated with higher stress. An Oura ring cohort of 525 first-year college students found a link between overnight PRV and perceived stress, but that was also seen with resting heart rate, sleep, and respiratory rate. Several very small studies have examined the relationship of HRV and athletic injuries or guiding training with mixed, and predominantly negative results. HRV biofeedback training with paced breathing had no significant effect on reducing stress or raising HRV, as demonstrated with sham controlled trials. When HRV for multiple days showed a decline in conjunction with body temperature, the Oura ring published data for prediction of Covid. The WHOOP company sponsored an observational study, published in 2026, of 30,000 users for 72 weeks, without a control group, that reported reduced alcohol intake (5.8 % points) by self-report. That doesn’t tell us much, and particularly about the merits of HRV for behavioral change. If you use the same device and conditions as longitudinal trends for multiple (at least 2-3) weeks that may be the one way to get something useful from the measurements. Data for overnight sleep with minimal motion and using RMSSD is the best proxy for real HRV. The reason to look at trends rather than any given night is that it more likely represents something, even though you won’t know with certainty what the “it” is. Keep in mind there are no data, no peer-reviewed evidence, to show that HRV fluctuation in-person has any correlation with health outcomes. Share Readiness Scores These are proprietary scores that integrate different metrics for each of the wearables: no algorithms have been disclosed. They are unvalidated against health outcomes. In a review of 14 composite health scores of readiness and recovery, HRV contributed 86% to the scores, followed by reading heart rate (79%), physical activity and sleep duration (both at 71%). That review noted the substantial variability in measurement protools and lack of standardization. Sleep staging is notoriously inconsistent and inaccurate by these sensors, which adds further to the HRV uncertainties for what the scores, which use sleep stage data, mean. Only resting heart rate has been shown consistently across devices to be extremely accurate. I’ve made a Table to summarize what we know about which metrics are included, the scores, any peer-reviewed studies that compared the readiness score with health outcomes, and the corresponding (if any, NA-not available) citation. You will note that some companies do not use the term “readiness," such as WHOOP for recovery, and Garmin, which has 2 different scores, one of which is Body Battery. Eight Sleep uses the term “Fitness Score.” They all include HRV; Apple includes a new metric they call “Recovery HRV” which among other components uses 7-days of sleep, but it is unclear what this means or how it is differentiated from other scores (there are clearly no data for outcomes). We have no knowledge of how the different components are weighted or whether any of these scores are better than resting heart rate, HRV alone, physical activity, or any other single metric. Since none of these are standardized, they are not interchangeable, so if you get a 90 for Oura that has no relationship to a 90 on a Google Fitbit Air. Notably, the company can update its algorithm for readiness score at any point without notification to device users. Without any useful evidence of actionability for these scores or established relationship with health outcomes, it is hard to make a case for their value. At the Apple recent announcement they showed their Readiness score (0-10) on the watch (Figure below) but there are no published data on this score, not even on their website. It’s available only on their new Watch Series 12 or Ultra 4 [of course, ;-)]. That exemplifies the problems with these scores, lack of data and evidence for being meaningful to promote health. Perhaps the best study (which isn’t saying much) is the WHOOP Recovery for golfer performance, because it did correlate with an objective outcome, even though there was no control group and the authors were all from the company. Among the 389 pro golfers, an absolute 10-per cent point increase in Recovery score was associated with about 0.5 fewer strokes per round. But that’s hardly a health outcome! WHOOP is also conducting a study in over 2,700 runners to see if their recovery score will be linked to less injuries and improved performance, but that is not yet published and has no control group or randomization. Putting This in Context For two decades I’ve been enthusiastic about the potential for digital health and particularly wearable biosensors. Over the years, we’ve seen some great progress for their ability to promote physical activity and accurately detect atrial fibrillation (the first FDA cleared deep learning AI for consumers). That work was the subject of rigorous research. But there are holes in the data and evidence for other metrics. One notable one is the “VO2 max” story that I wrote about earlier this year. At that time many subscribers asked me to cover heart rate variability, which I finally got to here. When I dived into the research and publication for HRV and readiness scores, I expected to find at least some that were of high quality and demonstrated their utility by linkage to health outcomes. To my surprise, I found none. The wearable sensor measurements for HRV (PRV) are, for the most part, accurate, but that validation work has only been done in small studies of healthy adults and does not take into account the long list of factors, from the device, software side, and the user side, that affect HRV measurements. Moreover, this metric chiefly relies on optical sensing and, as we have learned for heart rate PPG sensing, may be less accurate in people of color. Keep in mind that all of the health outcome association evidence comes from ECG-derived HRV; none are from wearable sensor data. I will repeat the key point: there's no peer-reviewed evidence to show that in-person HRV fluctuation—or efforts to raise your HRV— has any correlation with health outcomes. For those of you who look at your HRV on awakening, or even 2+ week trends of it being low, I hope this context helps to relieve any anxiety. Yes, low HRV (not PRV) has been shown to increase risk of some diseases as summarized above. But efforts to raise your HRV—a surrogate metric— has not been established for improving any health outcomes. HRV does not have any evidence of causality (the genetic evidence actually goes against this possibility). In this summary, I have not included data for other wearable sensors such as Polar, Samsung, Withings, Suunto, Amazfit, Coros, Ultrahuman, or additional mattress sensors. These are beyond my first-hand experience, and as far as I know from my in-depth review none have any peer-reviewed published data that differ from the 6 sensors I’ve reviewed here. From the points I’ve gone over above, we’re not ready for readiness scores. Besides being proprietary, they are predominantly based on metrics that have their own issues. It’s compounding the problem, like building a house without a solid foundation that has never undergone a rigorous inspection, and then selling it. Like I mentioned for PRV, you can look at trends over weeks rather than any single day, to get a handle, but even that may not be helpful. There’s simply no evidence that these scores meaningfully relate to health outcomes. I’d emphasize they might, but that requires doing prospective or randomized studies to prove it. None exist. There’s great promise for HRV/PRV utility_. For example**,**_ Prof Maiken Nedergaard, who discovered the brain glymphatics that are essential in eliminating metabolic waste products from the brain during sleep, has posited that HRV could be a non-invasive marker for neuromodulator oscillations, brain-body regulatory circuits, and brain clearance. That would be extremely useful, but like everything else on HRV and readiness scores it requires solid research and validation. The lay media isn’t helping much to get the story straight. Earlier this year The Economist published a piece entitled “The most useful indicator of your overall health” which ordained HRV as an “accumulated stress score.” That’s akin to the false assertion about VO2max: “V02 max is the singular most powerful marker for longevity.” As I’ve summarized here, that is not established. The fact is that so many things can lower HRV, including physical exercise (especially an intense workout), reduced sleep quality, stress, the list above, no less the device, signal, and software. Whatever fluctuations observed have not been correlated with any health outcome. Sadly, “datamaxxers” are widely using HRV and readiness scores that have never been validated to mean anything. We already know that for some people using the sensors for sleep metrics, it can induce “orthosomnia,” an obsession to get high sleep quality, with associated high levels of anxiety. In an experiment done by a company to promote sleep quality for its employees, “For those employees who did use the trackers, many reported feeling perfectly rested until their tracker told them they had had a terrible night. Others were told that they had slept like a baby when they had actually been lying awake worrying about the quality of their sleep. “ The same problem can result from preoccupation with HRV or readiness scores, with anxiety that would lead to further reduction in both. It you are using a wearable like >100 million American adults, it’s OK to look at these data, but contextualized with the major caveats reviewed here. If you are one to require evidence that HRV or readiness scores are linked to health outcomes, you may not even want to look. The companies make it hard to turn them off! Let me end with the companies that make and sell wearables. Apple’s doubling down on HRV (24-fold more reporting and heart rate very 5 seconds) and introduction of a Readiness score tells us that consumers have bought into these metrics and they are joining the club. However, all of this is occurring with a backdrop of tens millions of users, claims about the data that are not backed up by adequate evidence, marketing way out in front of whatever limited data exists, and not being transparent about their readiness score algorithms. The companies can well afford to do the research that is needed to connect these metrics with health outcomes show, once and for all, that increasing HRV or using readiness scores promotes our health. If they believed and invested in the products they are selling, we’d not be in this position of not knowing. That’s essentially where we are with HRV and readiness scores. Perhaps someday this will change and we’ll have good reason to embrace them. NB: I wrote this post. No AI. I have no conflicts of interest with any of its content. Loading... Ground Truths has 215,000 subscribers from every US state and 214 countries. There are over 300,000 followers of Ground Truths so more than 90,000 folks who can easily convert to be free subscribers. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. If you’re not a subscriber, please join! If you found this interesting PLEASE share it! Share Ground Truths The proceeds from all voluntary paid subscriptions go to support our summer internship program. It enabled us to accept and support a record number of 62 summer interns that joined us in 2026! These are high school, college and medical students selected from thousands of applicants. We couldn’t do this expanded program without the funds coming in through Ground Truths. Thank you!
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