Good Morning from Germany, where the heatwave is already hitting the country’s economic arteries. Rhine water levels at Kaub – a key bottleneck on Europe’s industrial waterway – have fallen 0.20m in just 3 days to around 0.83m, the lowest since April 2025. That matters: the Rhine is a crucial transport route for Germany’s chemical industry, including BASF, Covestro and Evonik. Low water can restrict barge loads, raise logistics risks and disrupt supply chains. For now, barge rates to Basel are still flat – but the heat is on.

Check out the IVUS runs pre- and post-#ShockwaveIVL# ⚡ Dr. Ash Patel used #ShockwaveE8# to treat a 55M patient with CLTI to restore blood flow to his heavily calcified distal PT and lateral plantar arteries. Learn more about Shockwave E8 for below the knee and beyond the ankle: US Rx only. Safety Info: availability may vary by country.

New Science research in mice challenges a long-standing view of how the heart builds backup blood vessels after a coronary artery blockage, showing that new collateral arteries arise primarily from capillaries rather than existing arteries. The findings offer insight into a molecular pathway that could be leveraged to promote cardiac repair. Learn more:

This is great news. As you age, sugar binding to your proteins creates stiff, sticky chemical scars that affect skin, arteries, eyes and more. It was considered irreversible and now may be reversible, restoring to a healthy state. Researches did this by using AlphaFold to search 45,000 oxidases, then screened more than 500 million engineered variants through directed evolution. The work is still ex vivo in a lab setting. Delivering a large bacterial enzyme safely into living tissues, with sufficient penetration and bioavailability, remains a major challenge.

Thrilled to announce the first SKYWARD IDE enrollment! Huge congratulations to Dr @NickMouawadMD & team at McLaren Bay Region Hospital in Bay City, MI on enrolling the first patient in the clinical program to evaluate the novel Shockwave SkyRunner Carotid IVL System for the treatment of calcified carotid arteries prior to stenting.  Read the Press Release:   CAUTION - Investigational device. Limited by US law to investigational use.

SKYWARD is off and running! Johnson & Johnson announced today the initiation of its SKYWARD IDE clinical program evaluating the novel Shockwave SkyRunner Carotid IVL System for the treatment of calcified carotid arteries prior to stenting. This clinical program is part of Johnson & Johnson’s plan to enhance treatment options for patients with calcified carotid artery disease, which accounts for up to one-third of all strokes. Read the Press Release: @JNJNews @JNJMedTech @NickMouawadMD CAUTION - Investigational device. Limited by US law to investigational use.

Terafab is insane. Terafab might fail. Terafab is just an announcement for now. But it’s a signal that the United States is going to try to become a critical hub for hardware manufacturing again. We’re going to embark on the journey. This is a huge deal. It is inspiring as fuck. Please look at how big this project is, and what the implications are if successful. Terafab would be a beating heart that would spawn many new arteries and veins. It would give suppliers a reason to exist and build. It’ll expand many industries around Terafab and throughout the USA. Everything is connected. Slap a massive machine of physical productivity into the heart of Texas, and many smaller machines spawn to help feed the beast. More people making money inside of the USA vs piping money back in from outside the USA. The USA desperately needs a manufacturing base again. For economic reasons but also for national security. It’s insane, it’s just an announcement, it might fail. But it’s a sign that the United States is going to attempt to re-ignite something we’ve lost. Anyone who says you shouldn’t be excited by it is a fuckin moron

THINGS MY PATIENTS TAUGHT ME — No. 6 HIS HEART HAD TO STOP BEFORE HE'D LISTEN TO IT He was fifty-two, and he'd been calling it indigestion for three days. He finally gave in when the pain climbed into his jaw in the middle of a board meeting. Minutes later he was on my table, and his heart stopped keeping time — it dissolved into that useless quivering we call V-fib, which is not a heartbeat at all. It's a muscle panicking. We shocked him. Nothing. We shocked him again. Through the glass I could see his wife holding her handbag against her chest like it was armor. Then a blip. Then another. He came back to us. Two stents propped open arteries he'd spent twenty years quietly closing, sixteen hours a day. Do you know what he asked for when he woke up in the ICU? Not am I okay. Not where's my wife. "My phone." I told him he had nearly died the day before. He told me I didn't understand — there was a deal that couldn't move without him. And for five days he ran his company from a hospital bed. Calls. Emails at three in the morning. His wife pulled me into the hallway and said, "I can't make him believe it happened." Then, the day before discharge, I walked in and found him staring out the window. Something had finally cracked. His assistant had sent flowers. The card said the office wasn't the same without him. But she'd also let slip, on the phone, that they'd already handed his biggest client to someone else. "Twenty years," he said. "Sixty-hour weeks. Anniversaries. My kid's games. I was the indispensable one." He looked at me. "They figured it out in five days." I've repeated that sentence to patients a hundred times since. They figured it out in five days. I sat down and told him the truth as I saw it: his heart didn't just have a blockage. It had staged a revolt against the way he was living. Six months later I barely recognized him walking in. Thirty pounds down. The permanent clench gone out of his shoulders. His wife told me he'd bought a kayak and was on the water at sunrise three mornings a week, and that his blood pressure was the lowest it had been in two decades. "I'd have died successful," he said. "But unfinished." Here's what he taught me, and I say it now to nearly every man who sits in my chair convinced he can't be spared: Your body is keeping a ledger. Every skipped meal, every stolen hour of sleep, every year you told yourself you'd rest after this next thing. It says nothing for a long time. And then one ordinary afternoon, without warning, it presents the bill. The heart speaks in a lot of languages. Pressure. Pain. Rhythm. And when nothing else gets through — silence. Our job isn't only to restart it. It's to help a man finally hear what it had been telling him for twenty years. So let me ask you what I asked him. What is the thing you keep promising yourself you'll do after — and who exactly are you counting on to still be there when after arrives? Blessings. P.S. He came back a year later with a photo on his phone he wanted me to see. Him in the kayak, sun barely up, water like glass. "Best conference room I've ever had," he said. I've thought about that more than the stents.

I just launched an AI model based on sleep data… and it accurately predicts your age. I teamed up with @m_franceschetti, and it's now available on their platforms. It turns out you have a sleep fingerprint. This research can identify you out of thousands of users from one night's signal with 92.5% accuracy. It also detects… + biological age within 3.3 years + diabetes better than Apple’s model + speed of aging + heart failure at 0.822 This Eight Sleep model is possibly the most accurate contactless bioage estimate ever reported. What we did: #1# What data was it built on? This model was built on the largest raw biosignal dataset ever used to train an AI, from any device, including every wearable on the market. > 2.04 million hours > 136,575 participants > 498k sessions > 122 million segments #2# What can it predict? It can predict your biological age (the age your body acts like) within 3.3 years. It also predicts heart-related and metabolic conditions. Here are the detection scores (AUROC): > diabetes (0.852) > heart failure (0.82) > hypertension (0.810) > sleep apnea (0.792) > snoring (0.751) > general heart conditions (0.734) > cancer (0.678) > hot flashes (0.671) > migraines (0.673) #3# How was it built? Interestingly, the pretraining task was not “predict someone’s age”. The model was tasked with comparing two 60 second windows across different nights to figure out if the nights belonged to the same person. To do that, it had to find someone’s ‘sleep fingerprint’. These are biological signals that the data is coming from the same person. Things like how forcefully your heart contracts, your breathing depth and rhythm, and the timing of the recoil wave each heartbeat sends through your body. Those signals are age-predictive. It learned to estimate age, detect diabetes, and flag heart failure as a downstream readout. The whole pretraining run was ~four days. #4# Why is it good at age? The reason aging prediction is accurate is mechanical. Aging stiffens arteries, reduces cardiac compliance, changes autonomic tone, HRV declines. Aging also alters sleep architecture. Deep sleep shrinks and fragmentation rises. Every one of those changes the recoil waveform and its overnight dynamics. Said differently, the heart of a 65 year old mechanically pushes the body differently than a 25 year old's. #5# Why a bed vs wearables? A bed is an elegant solution. It makes a high fidelity uninterrupted 5 to 10 hour recording every single night possible. And session-level sequence modeling becomes viable. Whereas wearables get fragmented data: battery limits, sparse snippets, people taking the watch off, adherence dropping over weeks. #6# More data, better prediction The bigger the training batches (the more people the model compares at once) the better it got, log-linearly (R²=0.982). That means the recipe is predictable: you can forecast improvement with more compute, the same way scaling laws work for language models. The current model only ever compares two nights at a time, and the average training user contributed under 4 nights. The team's stated next step is modeling 30+ consecutive nights per person. You can imagine how this will improve with the constant stream of data Eight Sleep gets every night. — It’s worth noting some limitations. Internal labels are self-reported and external cohorts are small, and that this is a research milestone, not a diagnostic device. What makes this exciting: a passive, daily activity like sleep can now provide meaningful insight into your well-being. I speak often of Autonomous Health, a world where the things around us take care of us without our knowing or asking. Eight Sleep is a great example of this in practice and a major reason I maintain so much optimism for the future of health.