Andrea Magnorsky presented on Byte-Sized Architecture at Cloud Native Summit 2025, as a format for building shared understanding through small, recurrent workshops. Ahilan Ponnusamy and Andreas Grabner discussed the Technology Operating Model for AI adoption. Both approaches drew on the Open Practice Library for human-centred collaboration and driving architectural evolution.

By Rafiq Gemmail

Background: Among the alternative solutions being tested to improve access to genetic services, chatbots (or conversational agents) are being increasingly used for service delivery. Despite the growing number of studies on the accessibility and feasibility of chatbot genetic service delivery, limited attention has been paid to user interactions with chatbots in a real-world health care context. Objective: We examined users’ interaction patterns with a pretest cancer genetics education chatbot as well as the associations between users’ clinical and sociodemographic characteristics, chatbot interaction patterns, and genetic testing decisions. Methods: We analyzed data from the experimental arm of Broadening the Reach, Impact, and Delivery of Genetic Services, a multisite genetic services pragmatic trial in which participants eligible for hereditary cancer genetic testing based on family history were randomized to receive a chatbot intervention or standard care. In the experimental chatbot arm, participants were offered access to core educational content delivered by the chatbot with the option to select up to 9 supplementary informational prompts and ask open-ended questions. We computed descriptive statistics for the following interaction patterns: prompt selections, open-ended questions, completion status, dropout points, and postchat decisions regarding genetic testing. Logistic regression models were used to examine the relationships between clinical and sociodemographic factors and chatbot interaction variables, examining how these factors affected genetic testing decisions. Results: Of the 468 participants who initiated a chat, 391 (83.5%) completed it, with 315 (80.6%) of the completers expressing a willingness to pursue genetic testing. Of the 391 completers, 336 (85.9%) selected at least one informational prompt, 41 (10.5%) asked open-ended questions, and 3 (0.8%) opted for extra examples of risk information. Of the 77 noncompleters, 57 (74%) dropped out before accessing any informational content. Interaction patterns were not associated with clinical and sociodemographic factors except for prompt selection (varied by study site) and completion status (varied by family cancer history type). Participants who selected ≥3 prompts (odds ratio 0.33, 95% CI 0.12-0.91; P=.03) or asked open-ended questions (odds ratio 0.46, 95% CI 0.22-0.96; P=.04) were less likely to opt for genetic testing. Conclusions: Findings highlight the chatbot’s effectiveness in engaging users and its high acceptability, with most participants completing the chat, opting for additional information, and showing a high willingness to pursue genetic testing. Sociodemographic factors were not associated with interaction patterns, potentially indicating the chatbot’s scalability across diverse populations provided they have internet access. Future efforts should address the concerns of users with high information needs and integrate them into chatbot design to better support informed genetic decision-making.

Artificial intelligence can draw cat pictures and write emails. Now the same technology can compose a working genome.

A research team in California says it used AI to propose new genetic codes for viruses—and managed to get several of these viruses to replicate and kill bacteria.

The scientists, based at Stanford University and the nonprofit Arc Institute, both in Palo Alto, say the germs with AI-written DNA represent the “the first generative design of complete genomes.”

The work, described in a preprint paper, has the potential to create new treatments and accelerate research into artificially engineered cells. It is also an “impressive first step” toward AI-designed life forms, says Jef Boeke, a biologist at NYU Langone Health, who was provided an advance copy of the paper by MIT Technology Review.  

Boeke says the AI’s performance was surprisingly good and that its ideas were unexpected. “They saw viruses with new genes, with truncated genes, and even different gene orders and arrangements,” he says.

This is not yet AI-designed life, however. That’s because viruses are not alive. They’re more like renegade bits of genetic code with relatively puny, simple genomes. 

In the new work, researchers at the Arc Institute sought to develop variants of a bacteriophage—a virus that infects bacteria—called phiX174, which has only 11 genes and about 5,000 DNA letters.

To do so, they used two versions of an AI called Evo, which works on the same principles as large language models like ChatGPT. Instead of feeding them textbooks and blog posts to learn from, the scientists trained the models on the genomes of about 2 million other bacteriophage viruses.

But would the genomes proposed by the AI make any sense? To find out, the California researchers chemically printed 302 of the genome designs as DNA strands and then mixed those with E. coli bacteria.

That led to a profound “AI is here” moment when, one night, the scientists saw plaques of dead bacteria in their petri dishes. They later took microscope pictures of the tiny viral particles, which look like fuzzy dots.

“That was pretty striking, just actually seeing, like, this AI-generated sphere,” says Brian Hie, who leads the lab at the Arc Institute where the work was carried out.

Overall, 16 of the 302 designs ended up working—that is, the computer-designed phage started to replicate, eventually bursting through the bacteria and killing them.

J. Craig Venter, who created some of the first organisms with lab-made DNA nearly two decades ago, says the AI methods look to him like “just a faster version of trial-and-error experiments.”

For instance, when a team he led managed to create a bacterium with a lab-printed genome in 2008, it was after a long hit-or-miss process of testing out different genes. “We did the manual AI version—combing through the literature, taking what was known,” he says. 

But speed is exactly why people are betting AI will transform biology. The new methods already claimed a Nobel Prize in 2024 for predicting protein shapes. And investors are staking billions that AI can find new drugs. This week a Boston company, Lila, raised $235 million to build automated labs run by artificial intelligence.

Computer-designed viruses could also find commercial uses. For instance, doctors have sometimes tried “phage therapy” to treat patients with serious bacterial infections. Similar tests are underway to cure cabbage of black rot, also caused by bacteria.

“There is definitely a lot of potential for this technology,” says Samuel King, the student who spearheaded the project in Hei’s lab. He notes that most gene therapy uses viruses to shuttle genes into patients’ bodies, and AI might develop more effective ones.

The Stanford researchers say they purposely haven’t taught their AI about viruses that can infect people. But this type of technology does create the risk that other scientists—out of curiosity, good intentions, or malice—could turn the methods on human pathogens, exploring new dimensions of lethality.

“One area where I urge extreme caution is any viral enhancement research, especially when it’s random so you don’t know what you are getting,” says Venter. “If someone did this with smallpox or anthrax, I would have grave concerns.”

Whether an AI can generate a bona fide genome for a larger organism remains an open question. For instance, E. coli has about a thousand times more DNA code than phiX174 does. “The complexity would rocket from staggering to … way way more than the number of subatomic particles in the universe,” says Boeke.

Also, there’s still no easy way to test AI designs for larger genomes. While some viruses can “boot up” from just a DNA strand, that’s not the case with a bacterium, a mammoth, or a human. Scientists would instead have to gradually change an existing cell with genetic engineering—a still laborious process.

Despite that, Jason Kelly, the CEO of Ginkgo Bioworks, a cell-engineering company in Boston, says exactly such an effort is needed. He believes it could be carried out in “automated” laboratories where genomes get proposed and tested and the results are fed back to AI for further improvement.

 “This would be a nation-scale scientific milestone, as cells are the building blocks of all life,” says Kelly. “The US should make sure we get to it first.”

Nature, Published online: 17 September 2025; doi:10.1038/s41586-025-09505-x

People cheat more when they delegate tasks to artificial intelligence, and large language models are more likely than humans to comply with unethical instructions—a risk that can be minimized by introducing prohibitive, task-specific guardrails.

Meta launches Hyperscape into beta, allowing users to turn real world spaces into digital spaces for VR.

Nature, Published online: 17 September 2025; doi:10.1038/d41586-025-02993-x

A modified large language model called Delphi-2M analyses a person’s medical records and lifestyle to provide risk estimates for more than 1,000 diseases.

Nature, Published online: 17 September 2025; doi:10.1038/d41586-025-02931-x

The Science Foundation seeks donations to fund ten $10,000 ‘what if’ seed grants.

Background: Artificial intelligence (AI) is increasingly used in digital health, particularly through large language models (LLMs), to support patient engagement and behavior change. One novel application is the delivery of motivational interviewing (MI), an evidence-based, patient-centered counseling technique designed to enhance motivation and resolve ambivalence around health behaviors. AI tools, including chatbots, mobile apps, and web-based agents, are being developed to simulate MI techniques at scale. While these innovations are promising, important questions remain about how faithfully AI systems can replicate MI principles or achieve meaningful behavioral impact. Objective: This scoping review aimed to summarize existing empirical studies evaluating AI-driven systems that apply MI techniques to support health behavior change. Specifically, we examined the feasibility of these systems; their fidelity to MI principles; and their reported behavioral, psychological, or engagement outcomes. Methods: We systematically searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library for empirical studies published between January 1, 2018, and February 25, 2025. Eligible studies involved AI-driven systems using natural language generation, understanding, or computational logic to deliver MI techniques to users targeting a specific health behavior. We excluded studies using AI solely for training clinicians in MI. Three independent reviewers screened and extracted data on study design, AI modality and type, MI components, health behavior focus, MI fidelity assessment, and outcome domains. Results: Of the 1001 records identified, 15 (1.5%) met the inclusion criteria. Of these 15 studies, 6 (40%) were exploratory feasibility or pilot studies, and 3 (20%) were randomized controlled trials. AI modalities included rule-based chatbots (9/15, 60%), LLM-based systems (4/15, 27%), and virtual or mobile agents (2/15, 13%). Targeted behaviors included smoking cessation (6/15, 40%), substance use (3/15, 20%), COVID-19 vaccine hesitancy, type 2 diabetes self-management, stress, mental health service use, and opioid use during pregnancy. Of the 15 studies, 13 (87%) reported positive findings on feasibility or user acceptability, while 6 (40%) assessed MI fidelity using expert review or structured coding, with moderate to high alignment reported. Several studies found that users perceived the AI systems as judgment free, supportive, and easier to engage with than human counselors, particularly in stigmatized contexts. However, limitations in empathy, safety transparency, and emotional nuance were commonly noted. Only 3 (20%) of the 15 studies reported substantially significant behavioral changes. Conclusions: AI systems delivering MI show promise for enhancing patient engagement and scaling behavior change interventions. Early evidence supports their usability and partial fidelity to MI principles, especially in sensitive domains. However, most systems remain in early development, and few have been rigorously tested. Future research should prioritize randomized evaluations; standardized fidelity measures; and safeguards for LLM safety, empathy, and accuracy in health-related dialogue. Trial Registration: OSF Registries 10.17605/OSF.IO/G9N7E; https://osf.io/g9n7e

Background: Determining effective nurse staffing levels is crucial for ensuring quality patient care and operational efficiency within hospitals. Traditional workload prediction methods often rely on professional judgment or simple volume-based approaches, which can be inaccurate. Machine learning offers a promising avenue for more data-driven and precise predictions, by using historical nursing workload data to forecast future patient care requirements, which could help with staff planning while also improving patient outcomes and nurse well-being. Objective: This methodological study aims to use nursing activity data, specifically LEP (Leistungserfassung in der Pflege; “documentation of nursing activities”), to predict future workload requirements using machine learning techniques. Methods: We conducted a retrospective observational study at the University Hospital of Zürich, using nursing workload data for inpatients across eight wards, collected between 2017 and 2021. Data were transformed to represent nursing workload per ward and shift, with three shifts per day. Variables used in modeling included historical workload trends, patient characteristics, and upcoming operations. Machine learning models, including linear regression variants and tree-based methods (Random Forest and XGBoost), were trained and tested on this dataset to predict workload 72 hours in advance, on a shift-by-shift basis. Model performance was assessed using mean absolute error (MAE) and mean absolute percentage error (MAPE), and results were compared against a baseline of assuming no change in workload from the time of prediction. Prediction accuracy was further evaluated by categorizing future workload changes into decreased, similar, or increased workload relative to current shift levels. Results: Our findings demonstrate that machine learning models consistently outperform the baseline across all wards. The best-performing model was the Lasso Regression model, which achieved an average improvement in accuracy of 25.0% compared to the baseline. When used to predict upcoming changes in workload levels, the model achieved strong classification performance, giving an average AUROC of 0.79 and precision values between 66.2% and 75.3%. Crucially, the model severely misclassified—predicting an upcoming increase as a decrease, and vice versa—in just 0.17% of cases, highlighting potential reliability for using the model in practice. Key variables identified as important for predictions include historical shift workload averages and overall ward workload trends. Conclusions: This study suggests the potential of machine learning to enhance nurse workload prediction, while highlighting the need for refinement. Limitations due to potential discrepancies between recorded nursing activities and the actual workload highlight the need for further investigation into data quality. To maximize impact, future research should focus on: 1) utilizing more diverse data, 2) more advanced machine learning architecture that perform time-series modelling, 3) addressing data quality concerns, and 4) conducting controlled trials for real-world evaluation.

Background: Adolescent idiopathic scoliosis is a common spinal deformity typically treated with exercise therapy. Despite the increasing use of digital technologies in interventions, there remains a gap in understanding how to effectively integrate behavior change techniques (BCTs) and behavior theories within these digital solutions. Objective: This review aims to identify the digital characteristics of interventions and the BCTs used, and to analyze potential theoretical mechanisms with the Theoretical Domains Framework and the capability, opportunity, motivation, and behavior model. Methods: We conducted a scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A total of 5 databases, including PubMed, Web of Science, Embase, Cochrane Library, and CINAHL, were selected for screening eligible studies up to April 4, 2024. We included studies of any design type that involved patients with adolescent idiopathic scoliosis using digital interventions for exercise rehabilitation, including qualitative, quantitative, or mixed methods studies, and study protocols with detailed descriptions of digital interventions. Two researchers independently screened studies and extracted data into tables for descriptive analysis. The Mixed Methods Appraisal Tool was used to assess the quality of studies. Results: Out of the 3267 identified papers, 21 (0.64%) studies were included. The most frequently used technologies were videoconferencing (n=7) and instructional videos (n=5). The three most common BCT clusters were “Shaping Knowledge” (n=19), “Social Support” (n=16), and “Antecedents” (n=16). “Knowledge” was the most used mechanism of action (n=21), followed by “Skills” (n=16), “Environmental Context and Resources” (n=16), and “Social Influences” (n=16). The studies primarily addressed “Capability” and “Opportunity,” with less emphasis on “Motivation,” particularly “Automatic Motivation.” Conclusions: This review identified common digital technologies and their characteristics, analyzed potential mechanisms of behavior change in interventions, and provided recommendations for technology utilization. Future research should further evaluate the effectiveness of digital technologies while enhancing patient motivation and user experience. Trial Registration: PROSPERO CRD42024530851; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024530851

Nature Biotechnology, Published online: 15 September 2025; doi:10.1038/s41587-025-02822-6

AI designs de novo antibiotics

Called the Agent Payments Protocol (AP2), the system is meant to be interoperable between AI platforms, payment systems and vendors.

Researchers and health care institutions have increasingly applied structured futures methods—such as the futures wheel, scenario analysis, forecasting, and horizon scanning—to systematically explore, generate, and prepare for multiple possible futures. However, discussions around the future of medicine, specialties, or therapeutic areas have often relied on the subjective opinions or perspectives of key opinion leaders rather than on future strategies, policies, visions, and scenarios that are grounded in rigorous and established methods. This underscores the need for futures methods to be widely adopted and effectively incorporated into both medical practice and health care policymaking. Integrating structured foresight techniques into strategic planning enables clinicians and policymakers to transition from reactive decision-making to proactive, plausible approaches that shape a more resilient and adaptive health care system. Our goal with this paper is to provide a methodological guide that is supported by case studies, demonstrating how futures methods can be systematically applied in health care. By offering practical examples, we intend to empower medical professionals, health care leaders, researchers, patients, and policymakers with the tools to anticipate and navigate future challenges and opportunities more effectively.

Nature, Published online: 15 September 2025; doi:10.1038/d41586-025-02940-w

Developers of griefbots say that they help people by allowing them to commune with recreations of the dead, but others say that the technology is fraught with danger.

Background: Even though Digital Health Technology (DHT) is widely utilized in the United States (U.S.) at both hospital provider and individual levels, it is beset with several challenges that have contributed to inequities in the health service delivery. Previous studies have shown that health inequities observed may be amplified many by DHT requirements. Objective: The objectives of this scoping review are aimed at synthesizing information on DHT inequities by exploring evidence that describes DHT infrastructure needs focused on promoting health equity in the U.S. and identifying key challenges at both the individual/patient level and at the health service provider's level. Methods: We adapted Arksey and O'Malley's scoping review guidelines in our review. We searched PubMed, Web of Science, CINAHL, and PsycINFO were searched. We also conducted supplementary searches on Google Scholar. The inclusion criteria were peer-reviewed publications that broadly conceptualize or analyze DHT infrastructure from a health equity perspective and the challenges of DHT requirements between 2020 and 2024. Following a full-text screening using eligibility criteria such as studies were included if they examined DHT infrastructure in the U.S. from a health equity perspective, discussed health disparities resulting from DHT interventions, or investigated the variables influencing health inequities connected to DHT. Two researchers evaluated each citation’s individually at the title and abstract levels. Thematic approach and qualitative analysis determined this scoping review’s outcome. Results: Of the 628 research articles from the search, 27 were included in the analysis based on the inclusion criteria. In this review, we discussed factors such as elderly population, education, race, ethnicity, and socioeconomic status leading to health inequities in DHT. Patients and Service providers challenges that exist in health inequities related to DHT. The most common challenges for service providers were infrastructure and technical issues such as inadequate integration with existing workflows, user-unfriendly health information exchange (HIE) interfaces, and lack of skilled staff, while for individuals or patients, this included limited broadband internet access, cultural or linguistic appropriateness, and access to digital tools. Conclusions: The study identified that in the U.S., DHT is an essential part of the delivery of health services, yet it is saddled with key challenges leading to health inequities. Finding pragmatic solutions to these challenges can improve health equity in DHT.

Large language models (LLMs), such as OpenAI’s GPT series and Google’s PaLM, are transforming healthcare by improving clinical decision-making, enhancing patient communication, and simplifying administrative tasks. However, their performance relies heavily on prompt design, where small changes in wording or structure can greatly impact output quality. This poses a challenge for clinicians who are not experts in natural language processing (NLP). This tutorial combines prompt engineering techniques tailored for clinical use, covering methods like zero-shot, few-shot, chain-of-thought, and meta-prompting. We examine four critical dimensions (accuracy, bias mitigation, privacy protection, and workflow integration) through clinical case studies grounded in real-world practice. We provide actionable guidance on defining objectives, applying core principles, iteratively refining prompts, and integrating them into interoperable electronic health record (EHR) systems. This framework helps clinicians leverage LLMs to improve decision-making, streamline documentation, and enhance patient communication while maintaining ethical standards and ensuring patient safety.

Hugging Face has unveiled FinePDFs, the largest publicly available corpus built entirely from PDFs. The dataset spans 475 million documents in 1,733 languages, totaling roughly 3 trillion tokens. At 3.65 terabytes in size, FinePDFs introduces a new dimension to open training datasets by tapping into a resource long considered too complex and expensive to process.

By Robert Krzaczyński

Nature Medicine, Published online: 15 September 2025; doi:10.1038/s41591-025-03965-4

A brief, self-administered digital cognitive test, in combination with a blood test, accurately detects clinical Alzheimer’s disease in primary care.

Nature Medicine, Published online: 11 September 2025; doi:10.1038/s41591-025-03936-9

In an irrevocably changed landscape, reform of the global health system needs to answer key questions on functions, what should be delivered in different contexts and at different levels, and how the system should operate.