This is a uniquely Californian problem. Robot taxis – Waymos – are hogging all the EV charging stations in downtown San Diego. Living as I do in two cities, I can be amazed and blasé’ at the same time. This is something that would never be on the radar in Louisville. But here in Socal, you drive in traffic and of the 8-10 cars you see around you, half of them are EVs, mostly Teslas. So EV charging stations are in big demand. My one ride in a Waymo convinced me that they’re a future, if not *the* future. But it’ll be a while before they take over a red state. The F250s in KY will just run over them.
Big day today at Keeneland – the Breeders’ Cup races. Several races with a purse in the $1-2M range, plus one race at $5M and one at $7M. there’s a lotta money being paid out today. Courtesy of my Twinspires betting app, I’ve bet every race today from the comfort of my chair in CA. We’ll see if my betting strategy pays off. I’ll be at Keeneland a week from today to watch our syndicate’s horses go to auction. One of our fine yearlings pictured above.
The NY Times just published their list of the ten best and worst cities to retire in. I can’t say I agree with much of their ratings – no way I would live in most of their “best” cities.
But to each his/her own, I suppose. I could imagine living in the Pittsburgh area, but everywhere else on those lists…nope.
Even though it’s Halloween tonight, we won’t see any trick or treaters here. That’s one of the downsides of living on a private hilltop. I miss the kids coming to the door. It’s also the end of daylight savings time, so we get an extra hour tonight. Woo hoo – more time for insomnia.
Recent family health problems have me reading a lot about cardiology. I found this in the Journal of the American College of Cardiology. The abstract tells the story succinctly, as it should. Interesting stuff; worth a read.
BACKGROUND Consumer wearables provide continual physiological data, including multiple cardiovascular metrics,
yet their use in detecting physiological changes that precede cardiac events remains limited.
CASE SUMMARY A 76-year-old man with structural heart disease experienced sudden cardiac death minutes after
high-intensity indoor cycling. Change-point analysis of wearable-captured physiology revealed a coordinated step-
change, with most changes clustering 4-6 months before the sudden cardiac death: heart rate variability halved, resting
and nocturnal heart rate rose, deep sleep and 6-minute walk distance fell. These coincided with a fatigue complaint and
a murmur prompting echocardiography, which revealed severe left ventricular dilation with preserved ejection fraction
(approximately 60%), severe mitral regurgitation, moderate aortic regurgitation, and trace tricuspid regurgitation,
consistent with advanced structural heart disease.
DISCUSSION The key signal was not any single abnormal value but a coordinated, sustained step-change from the
patient’s own baseline that preceded imaging. Data of this kind could complement the episodic measurements car-
diovascular care now relies on, informing both when to re-evaluate patients with known heart disease and how wearable
heart-rate kinetics might guide their exercise.
TAKE-HOME MESSAGE Embedding continuous digital physiology monitoring into traditional cardiology has the
potential to aid clinicians in timely evaluation and intervention. (JACC Case Rep. 2026;■:110397) © 2026
Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
ISSN 2666-0849 https://doi.org/10.1016/j.jaccas.2026.110397
From the aDepartment of Bioengineering, Schools of Engineering and Medicine, Stanford University, Stanford, California, USA;
bDepartment of Genetics, Stanford University School of Medicine, Stanford, California, USA; cDepartment of Clinical Science,
University of Bergen, Bergen, Norway; dDivision of Cardiology, Department of Medicine, University of California, Irvine, Cali-
fornia, USA; eDepartment of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California,
USA; fDivision of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA; gStanford Car-
diovascular Institute, Stanford University School of Medicine, Stanford, California, USA; and the hWu Tsai Human Performance
Alliance, Stanford University, Stanford, California, USA.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’
institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more
information, visit the Author Center.
Manuscript received July 23, 2026; accepted August 5, 2026.
J A C C : C A S E R E P O R T S V O L . ■ , N O . ■ , 2 0 2 6
ª 2 0 2 6 P U B L I S H E D B Y E L S E V I E R O N B E H A L F O F T H E A M E R I C A N C O L L E G E O F
C A R D I O L O G Y F O U N D A T I O N . T H I S I S A N O P E N A C C E S S A R T I C L E U N D E R T H E
C C B Y – N C – N D L I C E N S E ( h t t p : / / c r e a t i v e c o m m o n s . o r g / l i c e n s e s / b y – n c – n d / 4 . 0 / ) .
