Laptops are evolving fast, with some new models harnessing AI-powered features that adapt to your usage and improve performance in real time. These AI PCs can optimize battery life, manage power across tasks and even enhance webcam quality during video calls. While AI integration is still relatively new in laptops, it’s a feature to watch if you’re considering future-proofing your setup. Plus, it’s exciting to see how these AI-powered PCs might handle everything from productivity to entertainment, offering smart adjustments and enhancements that could make our digital lives a bit easier.

Out of the 11 notebooks we've tested and reviewed in the first half of 2024, we consider Apple's 13-inch MacBook Air M3 to be the best laptop for most people, and this is still the case in our November top picks. It's powerful enough to handle most tasks (even light video editing); it has a great screen and built-in speakers; and its battery could last around 20 hours (depending on what you're doing, of course). The MacBook Air M3 is also one of the lightest and thinnest systems we've reviewed, and it's dead silent, thanks to a fanless design. While Apple has debuted its new M4 chip in the recent iPad Pro, we may not see it in the MacBook Air until next year. For now, the MacBook Air M3 is still an excellent laptop to buy, particularly if you need a machine with good battery life.

Of course, not everyone wants a MacBook, and there are excellent Windows laptops and Chromebooks out there, too. Windows systems offer a range of configurations, from budget to high-end UHD screens with stunning IPS panels that boast high nits for vivid brightness. Chromebooks, on the other hand, tend to be more affordable and are great for users who mostly work online. Whether you need a powerhouse for creative work, a compact system for note-taking, or a laptop that can handle family movie night, there’s something for everyone in today’s laptop market.

Table of contents

• Best laptops of 2024

• How we test and pick laptops

• Factors to consider when choosing a laptop

• Best laptops specs comparison chart

• Other laptops we’ve tested

• Laptop FAQs

• Recent updates

Best laptops of 2024

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How we test laptops

Engadget has been reviewing laptops for two decades, and while the definition of what a portable PC is has changed considerably since, our obsession with testing their limits and serving up informative buying advice remains the same. Be it a hybrid tablet like Microsoft's Surface machines, a rotating 2-in-1 convertible like HP's Spectre x360s or a plain old clamshell notebook, our review process follows similar beats. How does it look and feel? How fast is it? Whether it’s a Windows device powered by an Intel Core i5 or higher, a MacBook or a Chromebook, we aim to answer the most important question: Is it actually worth your hard-earned cash? We also pay close attention to webcam quality and display features, including IPS panels and nits of brightness, as they can make a big difference in daily use.

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Factors to consider when choosing a laptop

Price

You can expect to spend between $1,000 and $1,800 for a new laptop these days, depending on the configuration. If you're looking for more of a workhorse, that could cost you well over $2,000 for additional RAM, storage, as well as a beefier graphics card and CPU. But you can also find some affordable laptops under $1,000 if you're willing to overlook build quality (or buy a refurbished or previous generation machine, which we highly recommend). Systems with AMD chips tend to come in cheaper than their Intel counterparts, but the bulk of their cost will come down to other components like RAM and storage.

I’ve included our favorite affordable model in this best laptop buying guide, but we have a list of the best budget laptops that you can check out as well.

Operating system: Apple, Windows or Chrome OS

There's a good chance you've already committed to an operating system, but my advice is to be as flexible as possible. These days, most major software is compatible with both Macs and PCs. (Of course, it's another story if you've become dependent on an Apple-only app like Final Cut Pro.) Web-based apps, naturally, will work on any platform with an internet browser.

If you're an Apple-loyalist, there aren't many reasons to consider Windows laptops (unless you want a secondary gaming machine). But for Windows users, macOS is becoming more tempting every year. Apple's MacBooks, powered by its M-series Silicon chips, are among the fastest and most efficient laptops we've ever seen. They're incredibly well-built and have tremendous battery life to boot. MacOS itself is also an easy platform to learn, especially if you're used to iOS and iPadOS.

That brings up another point: iPhone users may want to consider Macs because of the seamless integration with Apple's other platforms. You can't respond to iMessage conversations easily or hop into FaceTime chats on Windows PCs, but doing so is simple on Macs. (Microsoft's Phone Link app lets you send iOS users individual texts, but not media or group chats.) Android users, meanwhile, may be better off with Windows, as Phone Link can make calls, synchronize all your texts and also access your phone's photos.

As for whether you’ll want a PC with a dedicated Copilot AI button on the keyboard, that depends on how often you see yourself using Microsoft’s generative tools. Given we’re only just seeing the first slate of AI PCs, it would be wiser to wait out the hype and see what improvements might come over time.

And what about ChromeOS? Chromebooks are a smart and (typically) inexpensive way to browse the web and hop on a few video chats, but they're not the best choice as your primary computer. There aren't many apps or games that work offline, and they also don't work with powerful software suites like Adobe's (you can use the stripped-down Adobe Express and Photoshop online tools, though).

Chromebooks are great secondary machines to use alongside a more powerful Mac or PC, and they're popular in schools because they're cheap and easy for IT workers to manage. And if all you need is web access, or a notebook for a kid, a Chromebook might be enough.

If, for some reason, you’re looking for a powerful ChromeOS system, there are also Chromebook Plus models to consider. These machines sport faster processors and more RAM than typical Google notebooks, and they can also tap into a few of the company’s online AI features, like AI image generation and photo processing.

Ports and connectivity

These days, most laptops ship with a few USB-C ports, which can handle both charging and speedy data transfers. Apple's MacBooks also include a separate connection for MagSafe power, and you'll find custom power connections on some PCs like Microsoft's Surface. Older USB Type-A connections are less common now, but they still pop up in systems like HP's Spectre x360 14, as well as many models from ASUS.

If you're a fan of wired headphones, it's worth keeping a close eye on headphone jack availability. Many lightweight laptops, like Dell's XPS 13, don’t have the 3.5mm socket entirely. They usually include a USB-C to 3.5mm adapter, but that's a clunky solution, and it also takes up a USB port. Sure, most people use wireless earbuds and cans today, but it's still helpful to have a wired one around for when those devices run out of juice.

Most laptops in 2024 offer Wi-Fi 6 or 6E and Bluetooth 5.0 or later, which should mean faster and more stable connections if you have compatible routers and devices. While Wi-Fi 7 routers have started appearing, that spec hasn't made its way into laptops yet. As for cellular coverage, there are notebooks like the Surface Pro 9 and Samsung Galaxy Book models that offer integrated 5G. But from our testing, that feature may not be worth the cost of a separate data plan. Instead, you could tether to your smartphone or invest in a wireless hotspot that can keep multiple devices online.

Laptop size and weight

So how portable do you want your laptop to be? That's the ultimate question you need to ask when choosing between various screen sizes. 13-inch machines have become a solid starting point for most shoppers — it's enough real estate for the majority of tasks like emailing and writing, and it also helps keep machines relatively light (typically between two to three pounds). Thanks to manufacturing advancements, these dainty machines sometimes even come with larger screens (the smaller MacBook Air actually has a 13.6-inch display).

If you have trouble seeing fine text, we’d recommend going for a display larger than 13 inches. ASUS’s Zephyrus G14 is a solid 14-inch option for gamers, and we’re also seeing more productivity-focused machines aim for that size, like the XPS 14 and MacBook Pro. While 14-inch notebooks are a bit heavier than 13-inch models, coming in between three to four pounds, their screens are noticeably roomier.

For artists, or anyone else who needs a large canvas, a 15-inch laptop may make the most sense. They typically weigh between 3.5 and 4.5 pounds, but that extra heft may be worth it to fit wider video editing timelines or Photoshop windows. And, as you'd expect, you'll also pay a bit more for a 15-inch notebook compared to smaller ones (the 15-inch MacBook Air starts at $1,299, while the smaller model goes for $999). PC makers are also replacing 15-inch systems with 16-inch versions, which will give you even more space to work.

You can still find laptops with 17-inch or 18-inch screens, but those are typically gaming systems or souped-up workstations. They're not meant for mere computing mortals.

Battery life

A laptop's battery life depends on several factors: The power draw from the screen and other hardware, the optimizations used to avoid unnecessary power drain, and, of course, the size of the actual battery. One of our favorite systems, the Dell XPS 13, lasted 13 hours and 15 minutes in the PCMark 10 battery benchmark. In real-world testing, I was able to use it for a day and a half without needing a recharge. The MacBook Air 13-inch, meanwhile, lasted 20 hours in our benchmark and kept running for more than two work days of my typical workflow. In general, you should expect a modern laptop to last at least eight hours.

If battery life is your absolute priority, I'd strongly suggest looking at Macs over Windows PCs. Apple's M-series chips are essentially mobile hardware, with all of the power efficiency you'd expect from something originally designed for phones. Qualcomm’s upcoming Snapdragon chips could help Windows PCs compete with Apple’s astonishing battery life, but we’ve yet to see those in action. Chromebooks also typically get decent battery life (as long as you don’t overstuff them with power-draining tabs).

Refresh rate

A laptop's refresh rate refers to the amount of times its screen is cycled every second. Modern displays like IPS LCDs and OLEDs support 60Hz refresh rates at a minimum, but we're seeing more devices offering 120Hz, 240Hz and beyond. The higher the number, the faster the screen is refreshed, which ultimately leads to a smoother experience while mousing around or scrolling through web pages. (If you want to get a sense of what a slow refresh rate looks like, just grab an e-reader like the Kindle and try to flip between book pages.)

While high refresh rates used to be reserved for gaming laptops, nowadays we're seeing more mainstream machines like the XPS 13 offer 120Hz (or variable rates that move between 60Hz and 120Hz). If there's one knock against the MacBook Air, it's that it's still stuck at 60Hz.

CPU

If you’re buying a new laptop, you’ll want to make sure it’s powered by the latest CPUs. For Windows PCs, that includes Intel’s Core Ultra chips for thin-and-light machines or the 14th-gen HX chips for beefier systems. The Core Ultra series have NPUs for handling AI tasks, while the HX hardware does not – they’re based on Intel’s previous chip architecture, and they’re more focused on delivering raw horsepower. Intel's older 13th-gen and 12th-gen laptop chips also don't have NPUs, so keep that in mind if you're looking at used systems.

You'll also see AMD's Ryzen 8000 and 9000 chips in plenty of new systems like the ASUS Zephyrus G14 and Razer Blade 14. Those CPUs mainly target gaming laptops and high performance systems, while you'll still find AMD’s older Ryzen 7000 chips in ultraportables. AMD's main advantage is that its chips also include Radeon graphics, which are far more capable than Intel's Arc hardware (though those are getting better).

Qualcomm’s new Snapdragon X Elite and X Plus are also an option in Copilot+ PCs (more on those below). Since they’re based on mobile chip designs, they’re likely also more power efficient than AMD and Intel’s hardware. In the past, we’ve avoided recommending Snapdragon chips because they led to a slow and frustrating Windows experience. But Microsoft claims it’s rebuilt Windows 11 around Snapdragon’s Arm-based architecture, which should lead to far faster performance and better app compatibility.

As for Apple's laptops, you'll be choosing between the M3, M3 Pro and M3 Ultra, each of which is progressively more powerful. Apple is also keeping its older M2 chip around for the $999 MacBook Air, which is still a solid performer for the price. Apple’s M4 chip made its debut in the recent iPad Pro, but it’s not in any laptops yet (and it likely won’t be until the end of 2024).

GPU

A GPU, or graphics processing unit, is the component that communicates directly with a laptop's display. Laptop CPUs all have some form of integrated GPU: Intel has either its standard graphics or beefier Arc hardware, while AMD's chips include fast Radeon mobile graphics. If you want to play demanding games at high speeds (measured in frames per second, or fps), or if you need some extra power for rendering video or 3D models, you can configure a laptop with a dedicated GPU like NVIDIA's RTX 40-series hardware or AMD's Radeon RX 7000. Just be sure to leave room in your budget if you want a powerful GPU, as they typically add $300 or more to the cost of a laptop.

Apple's M-series chips, meanwhile, have GPU cores that can perform as well as NVIDIA’s and AMD's lower-end dedicated GPUs. That's quite the accomplishment for systems like this (especially the MacBook Air and 14-inch MacBook Pro), and it's another reason we highly recommend Apple's notebooks.

AI PCs, NPUs and Copilot+

Simply put, an AI PC is a computer equipped with a neural processing unit (NPU), which is designed to handle AI-related tasks. Much like how GPUs tackle heavy-duty gaming and rendering workloads, NPUs are designed to handle the complex math necessary for AI workloads. They’re also far more power efficient than CPUs or GPUs, which could lead to better battery performance in laptops. While many factors go into NPU performance, for the most part we measure their potential speed by TOPS (tera operations per second).

We were primed for AI PCs in 2024 based on the chips Intel and AMD announced late last year. Intel unveiled its "Core Ultra" CPUs in December, its first to include an NPU for AI work. AMD also announced its Ryzen 8040 AI mobile chips that month (and it couldn't help but say they were faster than Intel's new hardware). But in May, Microsoft announced its Copilot+ initiative, which is pushing major PC makers to deliver premium AI PCs with specifications including 16GB of RAM, 256GB SSDs and NPUs with at least 40 TOPS of AI performance.

Copilot+ is more than just a marketing term: Microsoft is also launching AI-powered features in Windows 11 that take advantage of powerful NPUs. That includes Recall, which can help you locate anything you’ve done on your PC (whenever it finally launches), as well as Cocreator in Paint, which can generate AI images based on text prompts and doodles.

If you buy an AI PC that isn’t Copilot+ certified, you’ll still be able to use some features like Windows Studio Effects, which can blur your background in video calls or keep you in frame. Developers like Adobe and Audacity are also building features into their apps that can take advantage of NPUs.

At the time of this post, Chromebook Plus notebooks can also access a few of Google’s online AI features, like image generation and photo processing.

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Other laptops we tested that didn't make the cut

Apple 15-inch MacBook Air M3

This Apple laptop is just a larger version of the 13-inch M3 MacBook Air. It's still quite portable at 3.3 pounds, and some will appreciating having just a tad more screen real estate all the time. Configuration options are the same as well; you can spec out the 15-inch Air with up to 24GB of RAM and 2TB of storage. But considering it starts off $200 more than the smaller model, it's primarily best for those who absolutely need a larger screen and are willing to pay for it.

ASUS Zenbook 14 OLED

Aside from its lovely OLED screen, the ASUS Zenbook 14 OLED doesn't stand out from the crowded laptop field in any way. It just looks dull and boring, especially compared to the strikingly beautiful ASUS Zephyrus G14, which also came out this year. While you can probably find the Zenbook 14 for a decent price, I'd recommend holding out for something with a bit more personality (and with a less wobbly screen hinge).

Razer Blade 14

The Razer Blade has almost everything you'd want in a 14-inch gaming notebook, but it's far pricier than the Zephyrus G14 on this list, and it doesn’t even have an SD card reader. It would be a solid competitor once its price falls a bit, and it's certainly a great option if you just have to have a jet-black laptop.

Framework Laptop 16

Framework gave its modularity magic to the Laptop 16, delivering a gaming notebook where almost every single component is user replaceable. But you'll have to pay a pretty penny to snag it with upgraded hardware, and its optional Radeon 7700S GPU was surprisingly slow.

Alienware m16 R2

The Alienware m16 r2 has been revamped with a slimmer case, but it’s otherwise a fairly typical gaming laptop. It’s a solid option for Alienware fans, but you’ll find better hardware and deals elsewhere.

ASUS Zenbook Duo (2024)

The Zenbook Duo is a fascinating dual-screened notebook, and according to my colleague Sam Rutherford it’s the first of its kind that’s worth buying. But its unique hardware isn’t really meant for mainstream consumers, and Windows 11 still doesn’t support multi-screen setups well enough to make full use of the Zenbook Duo’s ample canvas.

Dell XPS 16

Dell’s XPS 16 is big and beautiful, but it’s far too expensive compared to the competition. Plus, it uses a capacitive row of function keys that you basically can’t see under bright light and has too few ports for a machine of this size.

See Also:

• Best Gaming Laptops for 2024

• Best Cheap Windows Laptops

• Best 2-in-1 Laptops for 2024

• Best Chromebooks

• Best Laptops for College Students

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Laptop FAQs

What is the average battery life of a laptop per charge?

It’s hard to come up with an average battery life for laptops, since that will ultimately depend on what you’re doing with them. An ultraportable like the MacBook Air that sips power can last around 20 hours in our battery benchmark, and around two full work days of real-world usage. But a gaming laptop may last only a few hours if you’re actively playing something while on battery. At this point, Macs are delivering far better battery life than PCs, thanks to Apple’s Silicon chips, but Microsoft claims Copilot+ systems with Qualcomm chips will also get over 20 hours of batter life.

How much RAM do I really need?

The more RAM you have, the more things your computer can do simultaneously. For that reason, we recommend buying PCs and Macs with at least 16GB of RAM. That gives you enough memory to have several applications open at once, as well as web browsers filled with RAM-hogging tabs. Many PC games also require at least 16GB of RAM. While you could use a system with 8GB of RAM for basic tasks, you’ll quickly run into slowdowns and error messages as your apps stack up. Many laptops, especially ultraportables, don’t let you upgrade RAM, too – so you’ll have to buy an entirely new computer if you didn’t equip enough memory at the start.

If you’re a hardcore gamer, programmer or planning to render videos or 3D models, then you may want to go for 32GB of RAM or more. And if you just need a secondary laptop for lighter work – perhaps a no-frills system for writing – then you can probably get by with 8GB. Just be sure to keep those browser tabs in check.

What is the best storage capacity for a laptop?

There is no one-size-fits-all solution when it comes to laptop storage. You’ll typically find configurations between 256GB and 1TB SSDs (solid state drives) on most laptops, and I’d recommend most people get at least 512GB. That’ll be enough space for large apps, music and video files without stressing your system too much. If you’re a media hoarder, or want to play a ton of games, then it’s definitely worth getting a 1TB SSD.

If you’ll mainly be streaming your shows and music, and would rather invest in RAM or other hardware, then 256GB of storage would be serviceable. I’d recommend staying away from any machine with 128GB of storage though. Most of that will be taken up by the operating system, and you’ll likely run into issues cramming in large apps after a few months.

We recommend springing for extra built-in storage or investing in a portable SSD for backing up your most important files. It's also worth noting that Chromebooks tend to come with less built-in storage — 32GB, 64GB or 128GB — since ChromeOS encourages users to save their files in the cloud rather than on the device. In that case, 128GB is plenty.

What's a good price range for a decent laptop in 2024?

You can expect to spend between $1,000 and $1,800 for a typical 13-inch laptop today. As I explained above, you'll pay more if you want to stuff in more RAM or better GPU hardware. But you can also find deals below $1,000 if you look for refurbished or older-generation models.

What’s the difference between macOS and Windows? Which is better?

Simply put, macOS is the operating system in all of Apple's notebooks and desktops, while Windows powers the vast majority of PCs. You'll also find Chromebooks running Google's ChromeOS, but those are basically just web browsers running on top of Linux.

Debating the differences between Windows and Macs is something PC nerds have been doing since the '80s, so we won't be declaring a winner here. There are some small, negligible distinctions, like using a Command versus a Control key, how file explorers work and concerns about viruses and security. For the most part, those are minor issues or have become moot thanks to better built-in security.

But if you care more about playing the newest games, you'll want to have a Windows system. If you're more focused on creative apps, like Photoshop, Premiere and Final Cut Pro, then macOS may be a better fit (especially if you're running an iPhone).

What are the best laptop brands?

There is no single "best" laptop brand, but judging from this guide alone, we're generally impressed by notebooks from Apple, Dell and ASUS. They all offer fast, reliable and sturdy machines. HP also makes some eye-catching devices if you want an option that’s the most aesthetic. Those four brands, along with Lenovo and Acer, dominate laptop sales worldwide. We'd avoid systems from any retail store brands, or companies that don't have a major presence in the US.

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Best laptops specs comparison chart

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Recent updates

November 2024: Updated to include the M4-powered MacBook Pros.

August 2024: Updated to include the Lenovo ThinkPad X1 Carbon Gen 12.

June 2024: Updated with more information about current AI PCs, Microsoft’s Copilot+ initiative and the latest CPUs from Intel, AMD and Qualcomm. We’ve also added a FAQ query around RAM and updated the “Other laptops we’ve tested” section to include the Alienware m16 r2, Dell XPS 16 and ASUS Zenbook Duo.

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After briefly offering a transparent Steam Deck OLED last year, Valve has announced its next limited edition variant featuring a bold new color: "white." It'll cost you $679 when it's available on November 18, and it features the exact same hardware as the 1TB Steam Deck OLED. (Most importantly, it sports that gorgeous 7.4-inch display with HDR and a 90Hz refresh rate). There's also a white carrying case, naturally. While the perils of white console hardware are hard to ignore (especially for a hefty portable that'll surely trap plenty of hand grease), this new variant may convince early Steam Deck owners to make the jump. 

As we covered in our review, the Steam Deck OLED's display looks significantly bolder than the original LCD models, especially with the addition of HDR support. This time around, Valve says it's also shipping the limited edition white model worldwide where Steam Decks are already available (including Australia).

"We're curious to see what the response is, and will use what we learn to inform future decisions about any potential new color variants down the line," Valve said in an e-mail. "We've always said our intent is to continually work on improving Steam Deck, and that's true from both a software perspective (continuing to ship improvements) and a hardware one (Steam Deck OLED, as well as ongoing work toward the future of Steam Deck and other hardware plans)."

If you use Chrome on your iPhone, you’re about to see some features sliding over from the Android version. Google Lens will let you add text to your image searches, and you can save files and pictures directly to Google Drive and Photos. You can get “Shopping Insights” for products you’re browsing.

Chrome for iOS now lets you add words to your Google Lens visual searches, allowing you to add nuance to your query or “perform more complex and specific searches,” as Chrome Product Manager Katia Muradyan wrote in a blog post. After activating Lens by tapping the camera icon in the Chrome search bar, you can ask questions about the object you’re snapping a pic of, and it will produce corresponding results. Google says AI Overviews will also appear for some of these search results.

The feature shares some common ground with an Apple Intelligence feature for iPhone 16 owners in iOS 18.2, which is currently in beta. Visual Intelligence lets you point your camera at something and get info about it, including asking ChatGPT questions about it or searching for it on Google.

Chrome for iPhone now has a feature that lets you save a file directly to Google Drive or Google Photos, sparing you from using your phone’s internal storage. When saving files from Chrome, you’ll see a new option to save the file to Drive. Similarly, when browsing a photo you want to save, long-press on it, and you’ll see a new “Save in Google Photos” option in the context menu. Of course, the feature requires you to be signed into a Google account.

Chrome for iOS also adds a feature that pops up a mini-map when you click on an address. Look for an underlined link to specific addresses; clicking on it will take you to the mini-map without leaving the browser.

Finally, Google is adding Shopping Insights for US users. The company frames it as a way to help you find great prices on items you’re shopping for, but it’s hard to imagine this feature exists strictly from the kindness of Google's heart. Regardless, you’ll soon see a “Good Deal Now” alert in Chrome’s address bar when browsing for products for which it’s available. You’ll see details like price history / tracking and buying options if you tap it.

Apple has a history of eye-popping price tags, but the company is reaching new heights with a product that isn't even a gadget. After Apple Music unveiled a list of the 100 best albums of all time earlier this year, the streaming service is releasing a companion coffee table book. You can grab one of the 1,500 copies for a cool $450.

I find these endeavors to rank and quantify art hilarious, because music is subjective and personal by nature. But people do love to debate their own artistic opinions, so if that's your jam there's plenty to dig into with Apple Music's assessment. (And before you ask, the top spot was claimed by The Miseducation of Lauryn Hill.) This particular countdown was assembled by "Apple Music’s team of experts alongside an exclusive group of artists including Maren Morris, Pharrell Williams, J Balvin, Charli XCX, Mark Hoppus, Honey Dijon and Nia Archives, as well as songwriters, producers and industry professionals," according to the book listing.

I'm sure this limited-run hardcover will be very beautiful, and maybe the liner notes analyzing each entry are deeply insightful. But I also wonder who would bother to buy it. If you are one of those 1,500 people who wants one, the book is due to start shipping in January.

The federal government ordered an end to TikTok's Canadian operations on Wednesday, citing national security concerns. But its decision to keep the app itself available has privacy experts puzzled.

While public transit in many Canadian cities is struggling with rising fares and falling ridership, one Ontario community has more than doubled its transit use in the past two years. Orangeville has made its buses free, joining a list of much larger communities that have gone fare-free.

“Magic mirror in the hand, who has the most wrinkles in the land?” has transcended from Snow White to 21st century camera technology.

THOUSANDS of fans stay up late to watch the English Premier League. But the UK leaving the EU could change all that.

Scientific American staff and sleep experts share advice on how to get better sleep in the stressful days leading up to the U.S. presidential election—and those that come after

No, but the direction of our hair whorls could teach us about human development

Put your own spin on a zoetrope with homemade drawings—or carve one into a pumpkin

People are really stressed about the U.S. presidential election. A psychiatrist offers several self-help methods to reduce feelings of despair

The latest information about the novel coronavirus identified in Wuhan, China, and advice on how pharmacists can help concerned patients and the public.

Researchers around the world are working at record speed to find the best ways to treat and prevent COVID-19, from investigating the possibility of repurposing existing drugs to searching for novel therapies against the virus.

The good folks down at eyeforpharma have asked me to write a few blog posts in the run-up to their Patient Centered Clinical Trials conference in Boston this September. In my second article -Buzzword Innovation: The Patient Centricity “Fad” and the Token Patient - I went over some concerns I have regarding the sudden burst of enthusiasm for patient centricity in the clinical trial world.

Apparently, that hit a nerve – in an email, Ulrich Neumann tells me that “your last post elicited quite a few responses in my inbox (varied, some denouncing it as a fad, others strongly protesting the notion, hailing it as the future).”

In preparing my follow up post, I’ve spoken to a couple people on the leading edge of patient engagement:

• Abbe Steel, CEO of HealthiVibe, which is focused on bringing greater patient input into the earliest stages of trial design through focus groups and patient surveys
• Casey Quinlan, co-founder of Patients for Clinical Research, which aims to be a force in patient education and engagement for clinical trials

To get a better idea of what other folks think of the idea, I am sending out a little ad hoc survey. Only 4 questions (so people hopefully do it). Added benefit: There is a massive 50% one-time discount for completed surveys until Friday connected to it as an incentive).

1. Complete the survey and share your thoughts
2. Come to the conference and tell us all exactly what you think

Your daily light exposure impacts your health. A new study finds that too much light at night and not enough natural light during the day can be harmful. This story first aired on Morning Edition on Nov. 4, 2024.

More people are getting cancer in their 20s, 30s, and 40s, and surviving, thanks to rapid advancement in care. Many will have decades of life ahead of them, which means they face greater and more complex challenges in survivorship. Lourdes Monje is navigating these waters at age 29.

Nearly every day since she was a child, Alex Leow, a psychiatrist and computer scientist at the University of Illinois Chicago, has played the piano. Some days she plays well, and other days her tempo lags and her fingers hit the wrong keys. Over the years, she noticed a pattern: How well she plays depends on her mood. A bad mood or lack of sleep almost always leads to sluggish, mistake-prone music.

In 2015, Leow realized that a similar pattern might be true for typing. She wondered if she could help people with psychiatric conditions track their moods by collecting data about their typing style from their phones. She decided to turn her idea into an app.

After conducting a pilot study, in 2018 Leow launched BiAffect, a research app that aims to understand mood-related symptoms of bipolar disorder through keyboard dynamics and sensor data from users’ smartphones. Now in use by more than 2,700 people who have volunteered their data to the project, the app tracks typing speed and accuracy by swapping the phone’s onscreen keyboard with its own nearly identical one.

The software then generates feedback for users, such as a graph displaying hourly keyboard activity. Researchers get access to the donated data from users’ phones, which they use to develop and test machine learning algorithms that interpret data for clinical use. One of the things Leow’s team has observed: When people are manic—a state of being overly excited that accompanies bipolar disorder—they type “ferociously fast,” says Leow.

Compared to a healthy user [top], a person experiencing symptoms of bipolar disorder [middle] or depression [bottom] may use their phone more than usual and late at night. BiAffect measures phone usage and orientation to help track those symptoms. BiAffect

BiAffect is one of the few mental-health apps that take a passive approach to collecting data from a phone to make inferences about users’ mental states. (Leow suspects that fewer than a dozen are currently available to consumers.) These apps run in the background on smartphones, collecting different sets of data not only on typing but also on the user’s movements, screen time, call and text frequency, and GPS location to monitor social activity and sleep patterns. If an app detects an abrupt change in behavior, indicating a potentially hazardous shift in mental state, it could be set up to alert the user, a caretaker, or a physician.

Such apps can’t legally claim to treat or diagnose disease, at least in the United States. Nevertheless, many researchers and people with mental illness have been using them as tools to track signs of depression, schizophrenia, anxiety, and bipolar disorder. “There’s tremendous, immediate clinical value in helping people feel better today by integrating these signals into mental-health care,” says John Torous, director of digital psychiatry at Beth Israel Deaconess Medical Center, in Boston. Globally, one in 8 people live with a mental illness, including 40 million with bipolar disorder.

These apps differ from most of the more than 10,000 mental-health and mood apps available, which typically ask users to actively log how they’re feeling, help users connect to providers, or encourage mindfulness. The popular apps Daylio and Moodnotes, for example, require journaling or rating symptoms. This approach requires more of the user’s time and may make these apps less appealing for long-term use. A 2019 study found that among 22 mood-tracking apps, the median user-retention rate was just 6.1 percent at 30 days of use.

App developers are trying to avoid the pitfalls of previous smartphone-psychiatry startups, some of which oversold their capabilities before validating their technologies.

But despite years of research on passive mental-health apps, their success is far from guaranteed. App developers are trying to avoid the pitfalls of previous smartphone psychiatry startups, some of which oversold their capabilities before validating their technologies. For example, Mindstrong was an early startup with an app that tracked taps, swipes, and keystrokes to identify digital biomarkers of cognitive function. The company raised US $160 million in funding from investors, including $100 million in 2020 alone, and went bankrupt in February 2023.

Mindstrong may have folded because the company was operating on a different timeline from the research, according to an analysis by the health-care news website Stat. The slow, methodical pace of science did not match the startup’s need to return profits to its investors quickly, the report found. Mindstrong also struggled to figure out the marketplace and find enough customers willing to pay for the service. “We were first out of the blocks trying to figure this out,” says Thomas Insel, a psychiatrist who cofounded Mindstrong.

Now that the field has completed a “hype cycle,” Torous says, app developers are focused on conducting the research needed to prove their apps can actually help people. “We’re beginning to put the burden of proof more on those developers and startups, as well as academic teams,” he says. Passive mental-health apps need to prove they can reliably parse the data they’re collecting, while also addressing serious privacy concerns.

Passive sensing catches mood swings early

A crucial component of managing psychiatric illness is tracking changes in mental states that can lead to more severe episodes of the disease. Bipolar disorder, for example, causes intense swings in mood, from extreme highs during periods of mania to extreme lows during periods of depression. Between 30 and 50 percent of people with bipolar disorder will attempt suicide at least once in their lives. Catching early signs of a mood swing can enable people to take countermeasures or seek help before things get bad.

But detecting those changes early is hard, especially for people with mental illness. Observations by other people, such as family members, can be subjective, and doctor and counselor sessions are too infrequent.

That’s where apps come in. Algorithms can be trained to spot subtle deviations from a person’s normal routine that might indicate a change in mood—an objective measure based on data, like a diabetic tracking blood sugar. “The ability to think objectively about my own thinking is really key,” says retired U.S. major general Gregg Martin, who has bipolar disorder and is an advisor for BiAffect.

The data from passive sensing apps could also be useful to doctors who want to see objective data on their patients in between office visits, or for people transitioning from inpatient to outpatient settings. These apps are “providing a service that doesn’t exist,” says Colin Depp, a clinical psychologist and professor at the University of California, San Diego. Providers can’t observe their patients around the clock, he says, but smartphone data can help close the gap.

Depp and his team have developed an app that uses GPS data and microphone-based sensing to determine the frequency of conversations and make inferences about a person’s social interactions and isolation. The app also tracks “location entropy,” a metric of how much a user moves around outside of routine locations. When someone is depressed and mostly stays home, location entropy decreases.

Depp’s team initially developed the app, called CBT2go, as a way to test the effectiveness of cognitive behavioral therapy in between therapy sessions. The app can now intervene in real time with people experiencing depressive or psychotic symptoms. This feature helps people identify when they feel lonely or agitated so they can apply coping skills they’ve learned in therapy. “When people walk out of the therapist’s office or log off, then they kind of forget all that,” Depp says.

Another passive mental-health-app developer, Ellipsis Health in San Francisco, uses software that takes voice samples collected during telehealth calls to gauge a person’s level of depression, anxiety, and stress symptoms. For each set of symptoms, deep-learning models analyze the person’s words, rhythms, and inflections to generate a score. The scores indicate the severity of the person’s mental distress, and are based on the same scales used in standard clinical evaluations, says Michael Aratow, cofounder and chief medical officer at Ellipsis.

Aratow says the software works for people of all demographics, without needing to first capture baseline measures of an individual’s voice and speech patterns. “We’ve trained the models in the most difficult use cases,” he says. The company offers its platform, including an app for collecting the voice data, through health-care providers, health systems, and employers; it’s not directly available to consumers.

In the case of BiAffect, the app can be downloaded for free by the public. Leow and her team are using the app as a research tool in clinical trials sponsored by the U.S. National Institutes of Health. These studies aim to validate whether the app can reliably monitor mood disorders, and determine whether it could also track suicide risk in menstruating women and cognition in people with multiple sclerosis.

BiAffect’s software tracks behaviors like hitting the backspace key frequently, which suggests more errors, and an increase in typing “@” symbols and hashtags, which suggest more social media use. The app combines this typing data with information from the phone’s accelerometer to determine how the user is oriented and moving—for example, whether the user is likely lying down in bed—which yields more clues about mood.

Ellipsis Health analyzes audio captured during telehealth visits to assign scores for depression, anxiety, and stress.Ellipsis Health

The makers of BiAffect and Ellipsis Health don’t claim their apps can treat or diagnose disease. If app developers want to make those claims and sell their product in the United States, they would first have to get regulatory approval from the U.S. Food and Drug Administration. Getting that approval requires rigorous and large-scale clinical trials that most app makers don’t have the resources to conduct.

Digital-health software depends on quality clinical data

The sensing techniques upon which passive apps rely—measuring typing dynamics, movement, voice acoustics, and the like—are well established. But the algorithms used to analyze the data collected by the sensors are still being honed and validated. That process will require considerably more high-quality research among real patient populations.

Greg Mably

For example, clinical studies that include control or placebo groups are crucial and have been lacking in the past. Without control groups, companies can say their technology is effective “compared to nothing,” says Torous at Beth Israel.

Torous and his team aim to build software that is backed by this kind of quality evidence. With participants’ consent, their app, called mindLAMP, passively collects data from their screen time and their phone’s GPS and accelerometer for research use. It’s also customizable for different diseases, including schizophrenia and bipolar disorder. “It’s a great starting point. But to bring it into the medical context, there’s a lot of important steps that we’re now in the middle of,” says Torous. Those steps include conducting clinical trials with control groups and testing the technology in different patient populations, he says.

How the data is collected can make a big difference in the quality of the research. For example, the rate of sampling—how often a data point is collected—matters and must be calibrated for the behavior being studied. What’s more, data pulled from real-world environments tends to be “dirty,” with inaccuracies collected by faulty sensors or inconsistencies in how phone sensors initially process data. It takes more work to make sense of this data, says Casey Bennett, an assistant professor and chair of health informatics at DePaul University, in Chicago, who uses BiAffect data in his research.

One approach to addressing errors is to integrate multiple sources of data to fill in the gaps—like combining accelerometer and typing data. In another approach, the BiAffect team is working to correlate real-world information with cleaner lab data collected in a controlled environment where researchers can more easily tell when errors are introduced.

Who participates in the studies matters too. If participants are limited to a particular geographic area or demographic, it’s unclear whether the results can be applied to the broader population. For example, a night-shift worker will have different activity patterns from those with nine-to-five jobs, and a city dweller may have a different lifestyle from residents of rural areas.

After the research is done, app developers must figure out a way to integrate their products into real-world medical contexts. One looming question is when and how to intervene when a change in mood is detected. These apps should always be used in concert with a professional and not as a replacement for one, says Torous. Otherwise, the app’s assessments could be dangerous and distressing to users, he says.

When mood tracking feels like surveillance

No matter how well these passive mood-tracking apps work, gaining trust from potential users may be the biggest stumbling block. Mood tracking could easily feel like surveillance. That’s particularly true for people with bipolar or psychotic disorders, where paranoia is part of the illness.

Keris Myrick, a mental-health advocate, says she finds passive mental-health apps “both cool and creepy.” Myrick, who is vice president of partnerships and innovation at the mental-health-advocacy organization Inseparable, has used a range of apps to support her mental health as a person with schizophrenia. But when she tested one passive sensing app, she opted to use a dummy phone. “I didn’t feel safe with an app company having access to all of that information on my personal phone,” Myrick says. While she was curious to see if her subjective experience matched the app’s objective measurements, the creepiness factor prevented her from using the app enough to find out.

Keris Myrick, a mental-health advocate, says she finds passive mental-health apps “both cool and creepy.”

Beyond users’ perception, maintaining true digital privacy is crucial. “Digital footprints are pretty sticky these days,” says Katie Shilton, an associate professor at the University of Maryland focused on social-data science. It’s important to be transparent about who has access to personal information and what they can do with it, she says.

“Once a diagnosis is established, once you are labeled as something, that can affect algorithms in other places in your life,” Shilton says. She cites the misuse of personal data in the Cambridge Analytica scandal, in which the consulting firm collected information from Facebook to target political advertising. Without strong privacy policies, companies producing mental-health apps could similarly sell user data—and they may be particularly motivated to do so if an app is free to use.

Conversations about regulating mental-health apps have been ongoing for over a decade, but a Wild West–style lack of regulation persists in the United States, says Bennett of DePaul University. For example, there aren’t yet protections in place to keep insurance companies or employers from penalizing users based on data collected. “If there aren’t legal protections, somebody is going to take this technology and use it for nefarious purposes,” he says.

Some of these concerns may be mediated by confining all the analysis to a user’s phone, rather than collecting data in a central repository. But decisions about privacy policies and data structures are still up to individual app developers.

Leow and the BiAffect team are currently working on a new internal version of their app that incorporates natural-language processing and generative AI extensions to analyze users’ speech. The team is considering commercializing this new version in the future, but only following extensive work with industry partners to ensure strict privacy safeguards are in place. “I really see this as something that people could eventually use,” Leow says. But she acknowledges that researchers’ goals don’t always align with the desires of the people who might use these tools. “It is so important to think about what the users actually want.”

This article appears in the July 2024 print issue as “The Shrink in Your Pocket.”

Elemind, a 5-year-old startup based in Cambridge, Mass., today unveiled a US $349 wearable for neuromodulation, the company’s first product. According to cofounder and CEO Meredith Perry, the technology tracks the oscillation of brain waves using electroencephalography (EEG) sensors that detect the electrical activity of the brain and then influence those oscillations using bursts of sound delivered via bone conduction.

Elemind’s first application for this wearable aims to suppress alpha waves to help induce sleep. There are other wearables on the market that monitor brain waves and, through biofeedback, encourage users to actively modify their alpha patterns. Elemind’s headband appears to be the first device to use sound to directly influence the brain waves of a passive user.

In a clinical trial, says Perry [no relation to author], 76 percent of subjects fell asleep more quickly. Those who did see a difference averaged 48 percent less time to progress from awake to asleep. The results were similar to those of comparable trials of pharmaceutical sleep aids, Perry indicated.

“For me,” Perry said, “it cuts through my rumination, quiets my thinking. It’s like noise cancellation for the brain.”

I briefly tested Elemind’s headband in May. I found it comfortable, with a thick cushioned band that sits across the forehead connected to a stretchy elastic loop to keep it in place. In the band are multiple EEG electrodes, a processor, a three-axis accelerometer, a rechargeable lithium-polymer battery, and custom electronics that gather the brain’s electrical signals, estimate their phase, and generate pink noise through a bone-conduction speaker. The whole thing weighs about 60 grams—about as much as a small kiwi fruit.

My test conditions were far from optimal for sleep: early afternoon, a fairly bright conference room, a beanbag chair as bed, and a vent blowing. And my test lasted just 4 minutes. I can say that I didn’t find the little bursts of pink noise (white noise without the higher frequencies) unpleasant. And since I often wear an eye mask, feeling fabric on my face wasn’t disturbing. It wasn’t the time or place to try for sound sleep, but I—and the others in the room—noted that after 2 minutes I was yawning like crazy.

How Elemind tweaks brain waves

What was going on in my brain? Briefly, different brain states are associated with different frequencies of waves. Someone who is relaxed with eyes closed but not asleep produces alpha waves at around 10 hertz. As they drift off to sleep, the alpha waves are supplanted by theta waves, at around 5 Hz. Eventually, the delta waves of deep sleep show up at around 1 Hz.

Ryan Neely, Elemind’s vice president of science and research, explains: “As soon as you put the headband on,” he says, “the EEG system starts running. It uses straightforward signal processing with bandpass filtering to isolate the activity in the 8- to 12-Hz frequency range—the alpha band.”

“Then,” Neely continues, “our algorithm looks at the filtered signal to identify the phase of each oscillation and determines when to generate bursts of pink noise.”

To help a user fall asleep more quickly [top], bursts of pink noise are timed to generate a brain response that is out of phase with alpha waves and so suppresses them. To enhance deep sleep [bottom], the pink noise is timed to generate a brain response that is in phase with delta waves.Source: Elemind

These auditory stimuli, he explains, create ripples in the waves coming from the brain. Elemind’s system tries to align these ripples with a particular phase in the wave. Because there is a gap between the stimulus and the evoked response, Elemind tested its system on 21 people and calculated the average delay, taking that into account when determining when to trigger a sound.

To induce sleep, Elemind’s headband targets the trough in the alpha wave, the point at which the brain is most excitable, Neely says.

“You can think of the alpha rhythm as a gate for communication between different areas of the brain,” he says. “By interfering with that communication, that coordination between different brain areas, you can disrupt patterns, like the ruminations that keep you awake.”

With these alpha waves suppressed, Neely says, the slower oscillations, like the theta waves of light sleep, take over.

Elemind doesn’t plan to stop there. The company plans to add an algorithm that addresses delta waves, the low-frequency 0.5- to 2-Hz waves characteristic of deep sleep. Here, Elemind’s technology will attempt to amplify this pattern with the intent of improving sleep quality.

Is this safe? Yes, Neely says, because auditory stimulation is self-limiting. “Your brain waves have a natural space they can occupy,” he explains, “and this stimulation just moved it within that natural space, unlike deep-brain stimulation, which can move the brain activity outside natural parameters.”

Going beyond sleep to sedation, memory, and mental health

Applications may eventually go beyond inducing and enhancing sleep. Researchers at the University of Washington and McGill University have completed a clinical study to determine if Elemind’s technology can be used to increase the pain threshold of subjects undergoing sedation. The results are being prepared for peer review.

Elemind is also working with a team involving researchers at McGill and the Leuven Brain Institute to determine if the technology can enhance memory consolidation in deep sleep and perhaps have some usefulness for people with mild cognitive impairment and other memory disorders.

Neely would love to see more applications investigated in the future.

“Inverse alpha stimulation [enhancing instead of suppressing the signal] could increase arousal,” he says. “That’s something I’d love to look into. And looking into mental-health treatment would be interesting, because phase coupling between the different brain regions appears to be an important factor in depression and anxiety disorders.”

Perry, who previously founded the wireless power startup UBeam, cofounded Elemind with four university professors with expertise in neuroscience, optogenetics, biomedical engineering, and artificial intelligence. The company has $12 million in funding to date and currently has 13 employees.

Preorders at $349 start today for beta units, and Elemind expects to start general sales later this year. The company will offer customers an optional membership at $7 to $13 monthly that will allow cloud storage of sleep data and access to new apps as they are released.

Many companies are entering the digital youth mental health space, but it’s important to know which ones are effective, according to a panel of investors at the Behavioral Health Tech conference.

The post Measuring Impact in Digital Youth Mental Health: What Investors Look For appeared first on MedCity News.

Watch the video and learn basic principles of modeling panel data using SAS/ETS.

Singapore's food culture is legendary, with staples such as chicken rice, bak chor mee, laksa, and roti prata feeding generations of locals and visitors alike. But there's one thing they all have in common — carbs! In carb-crazy Singapore, sticking to a keto diet might seem like a gone case and borderline sacrilegious, but trust me, it's doable. I've been through it, and I'm here to share my tips on how you can enjoy our local food scene while staying keto. What is keto? In case you blur about what a ketogenic (keto) diet is, it's all about cutting carbs and eating more fat. Yup, you read that right — more fat. Sounds shiok, right? The goal is to push your body into ketosis, where instead of burning carbs for energy, it burns fat. Hello, weight loss! Beyond that, keto helps you avoid those pesky post-meal sugar crashes — you know, the ones that make want to toh after a heavy meal. My keto experience I first tried keto as a teen, thinking it was just about cutting out rice, bread, and noodles. Wrong! Keto is stricter than that. To stay in ketosis, you've got to limit your carbs to just 20-50g a day.

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