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.

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.

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.

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

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

Does Silicon Valley still give founders an edge? At TechCrunch Disrupt 2025, Anh-Tho Chuong (Lago), David Hall (Revolution), and Tawni Nazario-Cranz (SignalFire) debate whether location still drives startup success.

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.

Background: In modern, high-speed work settings, the significance of mental health disorders is increasingly acknowledged as a pressing health issue, with potential adverse consequences for organizations, including reduced productivity and increased absenteeism. Over the past few years, various mental health management solutions, such as biofeedback applications, have surfaced as promising avenues to improve employees’ mental well-being. However, most studies on these interventions have been conducted in controlled laboratory settings. Objective: This review aimed to systematically identify and analyze studies that implemented biofeedback-based interventions in real-world occupational settings, focusing on their effectiveness in improving psychological well-being and mental health. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed and EBSCO databases for studies published between 2012 and 2024. Inclusion criteria were original peer-reviewed studies that focused on employees and used biofeedback interventions to improve mental health or prevent mental illness. Exclusion criteria included nonemployee samples, lack of a description of the intervention, and low methodological quality (assessed using the Physiotherapy Evidence Database [PEDro] checklist). Data were extracted on study characteristics, intervention type, physiological and self-reported outcomes, and follow-up measures. Risk of bias was assessed, and VOSviewer was used to visualize the distribution of research topics. Results: A total of 9 studies met the inclusion criteria. The interventions used a range of delivery methods, including traditional biofeedback, mobile apps, mindfulness techniques, virtual reality, and cerebral blood flow monitoring. Most studies focused on breathing techniques to regulate physiological responses (eg, heart rate variability and respiratory sinus arrhythmia) and showed reductions in stress, anxiety, and depressive symptoms. Mobile and app-directed interventions appeared particularly promising for improving resilience and facilitating recovery after stress. Of the 9 studies, 8 (89%) reported positive outcomes, with 1 (11%) study showing initial increases in stress due to logistical limitations in biofeedback access. Sample sizes were generally small, and long-term follow-up data were limited. Conclusions: Biofeedback interventions in workplace settings show promising short-term results in reducing stress and improving mental health, particularly when incorporating breathing techniques and user-friendly delivery methods such as mobile apps. However, the field remains underexplored in occupational contexts. Future research should address adherence challenges, scalability, cost-effectiveness, and long-term outcomes to support broader implementation of biofeedback as a sustainable workplace mental health strategy.

The $300B deal is a reminder that despite Oracle’s legacy status, it shouldn’t be overlooked when it comes to AI infrastructure. But key questions around power and how OpenAI will pay for this remain.

Nature, Published online: 10 September 2025; doi:10.1038/s41586-025-09374-4

Cancer evolutionary dynamics are quantitatively inferred using a method, EVOFLUx, applied to fluctuating DNA methylation.

Nature, Published online: 10 September 2025; doi:10.1038/d41586-025-02911-1

Representatives of four medical research centres have told Nature they have waived normal ethical review because ‘synthetic’ data do not contain real or traceable patient information.

Google DeepMind has introduced EmbeddingGemma, a 308M parameter open embedding model designed to run efficiently on-device. The model aims to make applications like retrieval-augmented generation (RAG), semantic search, and text classification accessible without the need for a server or internet connection.

By Robert Krzaczyński

Nature, Published online: 09 September 2025; doi:10.1038/d41586-025-02810-5

The academic community has looked at how artificial-intelligence tools help researchers to write papers, but not how they distort the literature scientists choose to cite.