Want to get a data center online quickly? Give it some flex.

At the end of a tense and scoreless first half of a soccer match between the English men’s team and rival Germany, millions of Brits let out a collective sigh and did what they so often do in moments of stress: They made tea. That wave of electric kettles clicking on, however, caused a different kind of stress: a huge and sudden increase in demand for electricity. But National Grid, which operates the local transmission network, was ready.

Just as those kettles started heating up, an AI program sent instructions to a data center in London to slow down some of the facility’s power-hungry chips. This reduction helped make sure there was enough supply to match demand, staving off potential blackouts or damage to electrical hardware. For data centers, which normally guzzle power without consideration for anyone or anything else’s needs, it was a radical departure.

It was also a simulation. In December 2025, engineers sought to test a new breed of data center built to be flexible about its electricity needs, so they re-created the energy demand facing the UK’s grid during a match from the 2020 Euro tournament. They wanted to see how their software, called Conductor, would have responded had it been online at the time.

Conductor is the signature product of Emerald AI, a firm based in Washington, DC, that’s part of a wave of companies trying to figure out whether data centers can work within the confines of the existing electric grid.

This year, Emerald is set to deploy Conductor in a new facility in the part of Virginia known as Data Center Alley, this time connected to the live grid. When overall demand spikes, Conductor will turn down the power used by the data center, while making sure its servers still carry out their timeliest and most important jobs. Emerald’s partners on the project—which include Nvidia and the giant data-center operator Digital Realty—bill it as one of the world’s first “power-flexible AI factories.”

Demonstrating that data centers can participate in this kind of give-and-take could ease what many tech leaders identify as the bottleneck in getting facilities online: It takes far longer to get approval for, construct, and connect new power plants than to build data centers. PJM, the grid operator in Virginia and the largest one in the US, for instance, needs eight years to bring new generation online, according to RMI, an energy research and advocacy group. “We need to solve the energy equation,” says Josh Parker, head of sustainability at Nvidia. “AI factory flexibility is the bridge between the incredible demand for AI and the immediate limitations of our energy grid.”

Speed, though, is only one of the issues. Once facilities do plug in, neighbors often criticize them for drawing too much electricity and contributing to rising prices. They say the data centers generate more noise than they do long-term jobs, contribute to pollution, and threaten to put people out of work. Organizers stalled over $150 billion worth of projects in 2025, according to Data Center Watch, and policymakers alert to the public mood are starting to impose limitations on development.

More than a dozen states are considering bans, and local moratoriums are in effect in places like Minneapolis and DeKalb County in Georgia. At the federal level, the GRID Act, a bipartisan bill in the US Senate, proposes to sever new data centers from public grids entirely. Some operators are already moving that way by trying to develop their own power generation.

Rather than rushing to build new power plants, companies could find part of the solution to the crunch right under our noses—or, more precisely, in the transmission lines under our feet and above our heads. The existing system operates near its full capacity during only a small number of high-demand hours throughout the year. This means, some grid experts argue, that if data centers can limit the power they draw during those stretches, they won’t need to wait for big infrastructure upgrades or build their own off-grid generation. 

Indeed, a growing number of studies have shown there could be plenty of power available for data centers that can flex. A widely discussed 2025 report from researchers at Duke University found that the US grid could offer an additional 76 gigawatts—about 5% of its entire capacity, and about enough to accommodate projected data-center growth in the US through 2030—to facilities that are willing to reduce their usage just 0.25% of the time. That’s about 22 hours a year. And when researchers from Princeton University and two grid-modernization companies looked at locations for new data centers in the PJM region, their report, which was funded by Google, found that a 500-megawatt facility capable of flexing for less than 1% of the year could reach full operation three to five years faster than one that’s inflexible. 

Flexible power connections could also help data centers address some of their PR problems. By decreasing their draw at times of grid stress, for instance, they could avoid diverting power from where it’s most needed, thus boosting stability. By using existing capacity, they might be able to reduce the need for new fossil-fuel power plants and spread fixed costs over more electricity users, pushing prices down. 

The AI power pinch is attracting resources and research into strategies for grid flexibility overall, which could help negotiate a tricky period: Taken together with electric vehicles, air-conditioning, and other sectors, data centers are helping drive what analysts predict will be a 25% increase in US electricity demand by 2030 compared with 2023 levels.

Ideally, flexibility gives grid operators more control over the flow of electrons, making them leaders of a harmonious ensemble rather than hostages to inflexible electricity requirements. That will help them manage demand spikes across the entire system and deal more effectively with the intermittent nature of renewables like wind and solar. “Demand flexibility is incredibly useful for power grids,” says Johanna Mathieu, a grid expert at the University of Michigan. “It helps reduce electricity costs and improve grid reliability.”

But while advocates see plenty of benefits, the concept brings complexity. For data centers, compromising on energy needs can be a hard sell. Flexibility requires utilities and grid operators, which tend to be operationally conservative, to change long-held practices. And some skeptics also say that flexibility distracts from the very real need to build more grid infrastructure faster, and could even pose risks to our electricity supply. 

Still, some technologists, grid operators, and utilities are hoping to show that flexibility works—not only in white papers or simulations but in real life. 


The poster children for data-center growth default toward inflexibility. Hyperscalers like Microsoft and Oracle have proposed enormous new centers, many of which would rely on off-grid, natural-­gas-burning power plants. When xAI wanted to speed up the buildout of the Colossus site outside Memphis, Tennessee, it rolled up with gas turbines on flatbed trucks. The facility, now in operation, is facing blowback from regulators and residents about the spike it’s causing in emissions and other pollution. In any case, there aren’t enough gas turbines worldwide to meet the demand from data-center operators. 

One big obstacle for anyone demanding a lot of power is that our grids are mostly rigid. They’re designed to supply enough power to meet total demand when it’s highest, even if that’s for only a relatively small number of hours a year. That conservative approach is a simple route to reliability, but it means that the grid has quite a bit of headroom. “The grid is already overbuilt by a lot. If you were an airline running at 30% utilization, you would not buy more planes,” says Amit Narayan, the cofounder and CEO of GridCare, a company developing flexibility technologies, referring to a 2025 Stanford study of transmission lines in western North America. “If you are running a grid at 30% utilization, there’s no scientific reason you can’t go to 60.” 

“If you were an airline running at 30% utilization, you would not buy more planes. If you are running a grid at 30% utilization, there’s no scientific reason you can’t go to 60.”

To be fair, the idea of flexibility isn’t entirely foreign to grid operators. For decades, they’ve practiced a technique called demand response: When it looks as if demand will get too close to supply, as it might during a heat wave when many people turn on the AC at the same time, they call large commercial or industrial facilities and ask them to shut down parts of their operations. This method can help avoid the need to fire up so-called peaker plants, which run on fossil fuels, but it’s slow, imprecise, and hard to scale.

In the 2000s, as the adoption of technologies like electric cars and solar panels presented new challenges, more internet-­connected grids also provided new means of flexibility. Virtual power plants, or VPPs, offered a smarter, faster, more granular alternative. Electricity customers ranging from factories to homeowners with smart thermostats, solar panels, or big batteries would allow the utility to adjust their draw to help meet demand—often getting paid for their (frequently unnoticed) trouble. 

After the generative AI boom began with the release of ChatGPT in 2022, some companies began to see flexibility as a way to get data centers set up more easily, efficiently, and affordably. If they bring AI money into existing grids and reduce or defer the need for expensive upgrades, data centers could actually help spread out fixed costs so as to lower rates for other users. A study from Duke University published this past February, for instance, found that flexibility could reduce rates by 0.5% to 2.8%. 

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The trick is figuring out how data centers, notorious power hogs, can keep operating when their flexible connections are throttled. Flexibility specialists envision three possible ways. The simplest is for the new data center to install on-site backup power storage or generation to tap when the grid is maxed out—at their own expense, of course.

A facility could also fill the gap by drawing on a VPP. The utility would turn down the electricity going to users who signed up for the VPP, and the data center would pay them for their flexibility. This method wouldn’t require any major infrastructure, but it would require the utility to have a big VPP program and to coordinate the exchange at a time when the grid was under stress. While VPPs exist to some extent in nearly 40 states, the rules governing them vary widely, and they are empowered to do more in some areas than in others. 

Finally, a data center could simply use less power at peak times. The conventional wisdom is that they won’t go for such limits, particularly when every number-­crunching server can feel like a goose potentially laying little golden eggs. But some experts are betting that the value of getting up and running quickly is enough to change their minds. “There is a clear and growing trend,” says Ayse Coskun, chief scientist at Emerald AI. “Operators are increasingly willing to trade some level of flexibility for faster grid interconnection.” 


GridCare, a startup based in Silicon Valley, was one of the first companies to use flexibility to get data centers online quickly. Instead of looking at grids only in worst-case scenarios when electricity demand is highest, the company analyzes the system under all conditions, explains CEO Narayan, who studied smart grids at Stanford. It feeds every part of the grid—including power plants, lines, substations, and homes—into a generative AI model that creates a “digital twin” for different grid configurations. It then picks out results that could unlock capacity while maintaining reliability, and it feeds those into another model trained on the physics of electrical components like resistors and capacitors to make sure they’re realistic.

GridCare found its first customer in the Silicon Forest, an area in the Pacific Northwest named for the trees that dominate the landscape and the IT industry that has more recently sprouted up there. The local grid needed more capacity to support more data centers. “Data centers wanted ‘speed to power,’” says Isaac Barrow, a manager of data-center relations at Portland General Electric, or PGE, the local power generator and distributor, “but transmission buildout is a long process that’s very costly.”

In 2024, Aligned Data Centers came to PGE wanting to expand its operation in Hillsboro, Oregon, and PGE followed a recommendation from GridCare. Aligned will install a 31-megawatt battery, set to be in service in May 2027, and decrease its draw by up to that amount when the grid becomes congested. Bundled with other flexibility measures, that battery has allowed PGE to increase the capacity it can offer Aligned and other nearby operators by 80 megawatts without any new power plants. Though the buildout of data centers in Hillsboro has faced plenty of pushback from locals, Barrow points out that it could have the knock-on effect of lowering costs for ratepayers, because it spreads out the tab.

Other companies are promoting different flavors of flexibility. Google has been moving processing loads from facilities in areas experiencing demand spikes to those in less stressed spots since 2023. It’s signed agreements with five utilities, including the Tennessee Valley Authority and Indiana Michigan Power, that add as much as a gigawatt of flexibility. 

Voltus, a major VPP provider across the US and Canada, markets a “bring your own capacity” program in which a data-­center company can fund a VPP nearby. The grid operator can use the VPP to decrease demand at busy times, and participants get a financial thank-you. “We can spin up new VPPs on the order of months,” says Emily Orvis, Voltus’s vice president of energy markets. In June, the company signed their first such data-center deal: a three-year plan in which Google will bankroll a VPP in the PJM interconnection.

Of all the approaches to flexibility, Emerald AI’s may be the most ambitious: asking data centers to dial into the grid’s needs. The company’s Conductor software, which can run on premises or in the cloud, builds on the research of chief scientist Coskun. Her group at Boston University showed in a pair of 2013 papers that a data center could watch the grid and help balance big power fluctuations, such as the intermittent effects of solar and wind power. By 2022, she and her colleagues had tested their methods on a cluster of 36 research servers and shown that the system could respect power limits without breaking the processes it was running. 

One of the most important questions for Conductor is deciding which AI processes can be slowed down to save energy without kneecapping performance. A lot of companies label their jobs by priority—a real-time chatbot query, for instance, might outrank something like a web search that’s part of a deep research project. When they don’t, Emerald AI tries to infer priority from the nature of the job. Conductor then analyzes the AI workload to determine how tweaking the power to a given processor will affect the performance and help meet the usage limits set by the grid operator.

“The performance curve changes for different kinds of workloads,” says Coskun. “Each AI job is going to have a different location on that curve. Our intelligence is figuring out where you are on that curve.” 

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Last year, Emerald AI began assessing the technology’s readiness for real-world use in a series of tests, raising the difficulty each time. The trials were carried out in partnership with the Data Center Flexible Load Initiative—a collaboration among tech companies like Google and Nvidia, utilities like Duke Energy, and grid operators like PJM that aims to help establish a repeatable framework for power-­flexible data centers.

The first challenge was in Phoenix, a fast-growing computing hub. For the test, Conductor took control of a group of server racks laden with 256 Nvidia A100 GPUs—hardware that can use about as much power as around 170 US homes. When presented with a simulation of a busy grid, Conductor reduced the power to the chips by 25% for three hours, while maintaining acceptable computing performance. Emerald AI and its partners reported the results in a paper in Nature Energy in December 2025.

The next trial forced the system to juggle surprise grid fluctuations without advance warning and redirect AI jobs from a data center in Virginia to a less busy one in Chicago. Then, in London, Conductor took the reins of equipment beyond the main GPU processors and faced a more complicated mix of fluctuations, including very short and long bouts of congestion—plus the notorious teakettle effect.

The progress so far shows that flexibility can work, at least in some situations, but only a small fraction of operators have pursued it as yet. “We’re just in the beginning innings of the game,” says Jesse Jenkins, one of the authors of the 2025 Princeton study and cofounder of Firma, a startup that works on data-center flexibility. “People are recognizing that this is a potential solution. The motivation is there; there are some bespoke examples. But there’s no uniform solution set that’s the default option, which is where we need to get.”


While data centers are going up across the US, no place on Earth comes close to the accumulated computing muscle in Northern Virginia’s Data Center Alley. The region is home to around 500 compute-crunching facilities, which represent 13% of the entire world’s capacity; the next two hot spots, Beijing and Oregon, contain 6% each.

There are proposals to build hundreds more facilities in Virginia, but a government study found that the state’s electricity demand will increase 183% (around 26 gigawatts) by 2040 if they all go forward, and supporting even half would be difficult. The power-flexible data center that Emerald AI, Nvidia, Digital Realty, and their partners are building in the suburb of Manassas could demonstrate how data centers can squeeze the power they need out of existing capacity. The facility, slated to come online later this year, is intended to give Conductor the chance to manage power at the largest scale yet and to respond to conditions on a live grid for the first time. In the UK demonstration, Conductor managed a 130-kilowatt AI cluster; in Manassas, it will pull the strings of a 96-megawatt hyperscale AI factory. 

Some degree of flex will play a key role as we transition away from fossil fuels and toward a future that has to juggle technologies like solar and wind power, batteries, and electric cars.

For PJM, the Manassas facility points to a potential path through the current power crunch. “We think data-center flexibility, in different forms, will be essential for the reliable integration of data-center load over the short to mid term,” says Scott Baker, who manages demand-side markets at PJM. 

But not all grid experts are so sanguine. PJM’s market monitor, which oversees the grid operator, says there are no workarounds when it comes to adding capacity. “The notion that large amounts of data-center load can be added without adding new generation is magical thinking,” says Joseph Bowring, an economist and the head of PJM’s market monitor since 1999.

One problem, he says, is that there’s no way to guarantee that a data center will actually take less power when demand is high. That is, absent any legal or regulatory push for flexibility or compliance, the utility won’t be able to step in to help prevent, say, a blackout. Utilities can rely on resources like power plants, but they can’t control or rely on data centers. “They do not want to be fully interruptible,” Bowring says of the facilities.

Stephen Empedocles, an advisor for technology companies, views flexibility as more of a tool than a silver bullet. “These approaches are excellent for improving grid reliability and getting more out of the infrastructure we already have,” he says, “but they are optimization tools.” They’re not substitutes for the “generation, transmission, and distribution expansion that will still be required,” he continues.

Flexibility advocates agree that over the long term, whether or not AI continues to boom, electrification will drive a need for more generation and transmission. Some degree of flex will play a key role in using grid infrastructure better as we transition away from fossil fuels and toward a future that has to juggle technologies like solar and wind power, batteries, and electric cars. A report published by the International Renewable Energy Agency in January 2026 found that grids around the world will need three times as much flexibility in 2030 as they had in 2019—and 10 times as much by 2050—to balance increasing demand with fluctuating supplies of renewable energy. 

The challenge of powering AI could provide just the spark we need to do the work of designing and building smarter, more flexible grids, says Coskun. “I think with a crisis like this, there’s no quick solution,” she says. “Sometimes a crisis like this creates an opportunity to do something differently.” 

Amos Zeeberg is a freelance science and technology journalist based in Bucharest. He’s developing a book about technology networks, including electric grids.

Silica Nanoparticles Induce Ferroptosis, Reprogram Immunity in Prostate Cancer Models

Ultrasmall fluorescent core‑shell silica nanoparticles—best known for their roles in medical imaging applications—are now showing surprising therapeutic muscle. Originally engineered as inert carriers for imaging agents, these particles, called Cornell Prime dots (C’ dots), have steadily expanded their résumé. In a new preclinical study, researchers at Weill Cornell Medicine report that these engineered silica nanoparticles can directly kill prostate tumor cells while reawakening antitumor immunity, offering a potential new edge in a disease where immunotherapy has historically struggled.

Prostate cancer remains one of the most immunologically “cold” solid tumors, with myeloid‑driven immune suppression, metabolic bottlenecks, and stromal remodeling that blunt the effects of checkpoint blockade. The new work suggests that C’ dots—when targeted to prostate‑specific membrane antigen (PSMA)—can break through these layers of resistance by triggering ferroptosis, remodeling the tumor microenvironment, and priming tumors for combination immunotherapy.

“We’re very encouraged by these results; a treatment that directly induces tumor‑cell death while transforming the immune microenvironment, as this does, would represent a new clinical paradigm,” said senior author Michelle Bradbury, MD, PhD, the endowed professor of imaging research in radiology and director of the Molecular Imaging Innovations Institute at Weill Cornell Medicine and a neuroradiologist at NewYork-Presbyterian/Weill Cornell Medical Center.

The study, published in Cancer Research and titled “Reprogramming of TLR–Ferroptosis Signaling and Immunometabolic Pathways Overcomes Myeloid Suppression to Improve Checkpoint Blockade in Prostate Cancer,” shows that the silica particles accumulate in prostate tumors and push cancer cells toward ferroptosis, a form of iron‑dependent cell death driven by runaway lipid peroxidation. Although the particles were originally designed for imaging, the team found that they often pick up positively charged iron ions in the bloodstream and shuttle them into tumor cells—effectively turning the particles into catalytic seeds for oxidative collapse.

At the same time, the nanoparticles reshape the immune landscape. T cells, macrophages, and other immune populations shift from inert or suppressive states into robust antitumor activity, converting cold tumors into hot ones. “One of the most intriguing aspects of this work is the convergence of direct tumor cell killing with broad immune remodeling,” said co‑author Jedd Wolchok, MD, PhD, the Meyer director of the Sandra and Edward Meyer Cancer Center, professor of medicine at Weill Cornell Medicine, director of the Parker Institute for Cancer Immunotherapy at Weill Cornell Medicine Meyer Cancer Center, and an oncologist at NewYork-Presbyterian/Weill Cornell Medical Center.

prostate cancer
Multiplex immunofluorescence image of a prostate tumor 10 days after treatment with prostate-targeted C’ dots and immunotherapy, showing extensive infiltration of immune cells throughout the tumor. Different colors represent distinct immune cell populations, including anti-tumor T cells, helper T cells, regulatory T cells, and macrophages. The image illustrates the coordinated immune response triggered within the tumor following treatment. [Bradbury Lab]

The therapeutic impact was most striking in survival experiments. C’ dots alone modestly extended survival in aggressive mouse models, as did checkpoint blockade alone. But the combination produced complete or near‑complete remissions in 40% of mice. Adding CSF‑1R blockade increased complete remissions to 50%.

The researchers’ next steps include continuing to explore these ultrasmall core-shell silica particles, setting the stage for the platform’s translational potential.

“By creating conditions that support a more effective antitumor immune response, these particles may help unlock the full potential of immunotherapy in prostate cancer, where durable responses have historically been difficult to achieve,” added Wolchok.

The post Silica Nanoparticles Induce Ferroptosis, Reprogram Immunity in Prostate Cancer Models appeared first on GEN – Genetic Engineering and Biotechnology News.

Characterizing Social Determinants of Health in Patients With Type 2 Diabetes and Liver Disease: Cross-Sectional Survey Study

Background: The mortality rate from liver disease among people with type 2 diabetes mellitus (T2DM) increased by 20% between 2001 and 2018. There are marked racial and ethnic differences among people with T2DM at risk of metabolic dysfunction–associated steatotic liver disease (MASLD) and related complications. Objective: We aimed to investigate the distribution of individual-level social determinants of health (SDOH) in people living with both T2DM and MASLD. Methods: In this small cross-sectional study, patients (N=50) were recruited from a tertiary care general hepatology clinic to complete a survey that assessed potential determinants of health. We sought to oversample Black and Hispanic patients to better understand the prevalence of SDOH. Electronic health records were reviewed to determine stage of liver disease, and these data were linked to survey results to identify the distribution of individual-level determinants of health in patients with cirrhosis. Results: Black and Hispanic respondents were more likely to report more experiences of racial discrimination, worries about being discriminated against, and group-based medical mistrust, especially regarding unsupportive health care providers. Cirrhosis groups tended to have lower incomes and less coverage from private health insurance. However, no substantial trends were observed in the distribution of health literacy, discrimination, and diabetes stigma among patients with and without cirrhosis. Conclusions: These findings will inform a future study aimed at assessing and developing interventions to address the combined impact of individual- and neighborhood-level SDOH on health-related outcomes in patients with T2DM and MASLD.
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Standardized Patient vs Video Demonstration for Teaching Psychomotor Skills in Spinal Injury Management to Undergraduate Medical Students: Prospective Interventional Comparative Study

<strong>Background:</strong> Emergency trauma care in the “golden hour” can reduce the fatality rates by 20%-50%. Imparting trauma care training in the undergraduate Indian medical graduate curriculum can prepare graduates as first responders for both prehospital and hospital setup management. However, teaching these skills for managing acute traumas in a competency-based medical education curriculum is challenging. These skills can be taught on a standardized patient (SP), allowing the learner to achieve higher clinical competency and better communication skills. However, since SP availability is limited, a video demonstration (VD) of such skills is an easy and reliable teaching-learning method. <strong>Objective:</strong> This study aims to evaluate the effectiveness of using an SP vs VD for teaching psychomotor skills to undergraduate students in the management of spinal injury. <strong>Methods:</strong> A prospective interventional comparative study was performed in the orthopedics department of a teaching hospital from September 2024 to February 2025, with institutional ethics committee approval. Thirty undergraduate students posted in the orthopedics department were divided into 2 groups (15 each) based on their even and odd roll numbers (systematic sampling). One group was shown a VD of the skills like application of an improvised cervical collar and log rolling maneuver for the management of a patient with spinal injury in a primary setting, while the other group was taught on an SP. The students were assessed by an objective structured clinical examination (OSCE), and maneuvers were performed on mannequins. Pretest and posttest evaluations with peer-validated questionnaires along with students’ feedbacks were obtained. The data were analyzed using unpaired 2-sided <i>t</i> test for OSCE scores and paired 2-sided <i>t</i> test for pretest and posttest scores with statistical significance set at <i>P</i>&lt;.05 (95% CI). Student feedback questionnaires based on a 5-point Likert scale were evaluated. <strong>Results:</strong> The mean OSCE scores obtained by the VD group (15.47) were significantly different from those obtained by the SP group (18.27) (<i>P</i>=.004). However, the mean OSCE scores obtained in individual skill demonstration stations for log rolling maneuver and cervical spine immobilization of the VD group were 2.27 and 3.20 and those of the SP group were 2.33 and 3.27, respectively. This difference was not significant (<i>P</i>=.74 and .79, respectively). The student feedback showed that teaching with an SP was marginally more interesting and effective, giving them more confidence to apply these skills in a primary setting. <strong>Conclusions:</strong> Both VD and SP methods are equally effective for teaching lifesaving psychomotor skills for the management of spinal injury. However, SP group students had better student engagement. Hence, a blended approach, where VD is used to teach large groups or can be given to students prior to the sessions, followed by teaching or assessing on SPs for application of these skills will lead to optimum results and save time.

Health Care Providers’ Perspectives on a Hybrid Outpatient Stroke Telerehabilitation Program: Qualitative Implementation Study

Background: Although patient outcomes are improved by stroke rehabilitation, the suggested amount of therapy is rarely maintained. The COVID-19 pandemic aggravated this situation further due to disruptions in health care. One solution was the rapid and extensive transition to virtual care. A hybrid outpatient stroke telerehabilitation program (HOSTP) was introduced by St John’s Rehab—a tertiary rehabilitation hospital in Toronto, Ontario. The HOSTP integrated in-person and virtual care in an effort to alleviate long-standing obstacles that challenge stroke rehabilitation. Objective: This study explored health care providers’ (HCPs) experiences with the HOSTP and their perspectives on its implementation, quality, and impact to determine the modifications needed to optimize its delivery and sustainability. Methods: A qualitative implementation study was conducted, with semistructured interviews conducted among HCPs involved in the HOSTP. The interview guide was informed by the CFIR (Consolidated Framework for Implementation Research). In total, 14 HCPs were recruited and interviewed from St John’s Rehab outpatient program. Interview transcripts were analyzed using a 2-stage analytic approach involving inductive thematic analysis, followed by deductive categorization using CFIR. Results: Four main themes were identified across CFIR domains: (1) adaptability and flexibility of the hybrid care model (intervention characteristics), (2) alignment with patient needs and resources (outer setting), (3) the impact of organizational resources and infrastructure (inner setting), and (4) variability in provider confidence and perceptions of virtual care (characteristics of individuals). Key determinants were identified as adaptability, patient-related factors, resource availability, and provider beliefs about virtual care. Conclusions: Our findings suggest that, from HCPs’ viewpoints, optimizing virtual care processes and resources may support access and care quality within hybrid outpatient stroke rehabilitation. HCPs viewed maintaining virtual care as important for supporting ongoing access and patient-centered care. Lastly, optimizing the benefits and mitigating the drawbacks of hybrid care can ensure future integration of virtual care into standard outpatient stroke rehabilitation.
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Examining the Efficacy of a Telehealth-Based Virtual Reality Clinic in Treating Adults With Specific Phobia: Feasibility Randomized Controlled Trial

Background: Virtual reality (VR) has the potential to enhance telemental health care (TMH) by enabling accessible, engaging, and personalized treatment from home. Although VR is well-supported for in-person treatment, evidence for telehealth-based VR is limited. Moreover, no prior research has demonstrated the feasibility of therapists and clients conducting therapy sessions remotely within a shared (ie, multiuser) VR experience. Objective: The primary objective of this study was to evaluate the feasibility of conducting a randomized controlled efficacy trial (RCT) comparing exposure therapy delivered via Doxy.me VR (Doxy.me Inc)—a multiuser, telehealth-based VR app—to standard TMH in adults with clinically elevated fear of dogs, snakes, or spiders. A secondary objective was to preliminarily examine clinical (ie, specific phobia symptom severity) and treatment-related outcomes (ie, therapeutic alliance, client satisfaction, system usability, presence, cybersickness, and treatment fidelity). Methods: This study used a single-site, fully remote, parallel, feasibility RCT design. Participants were randomly assigned using a 1:1 ratio to receive 12 weekly exposure therapy sessions over 3 months, delivered via either standard TMH or Doxy.me VR. Assessments were conducted at baseline, each session, midtreatment, and posttreatment. All therapy sessions were audio recorded, 20% of which were randomly selected and rated for treatment fidelity. Feasibility benchmarks during the 12-month trial included: (1) enrolling 30 participants during Months 1‐9 of the trial; (2) collecting 70% of midtreatment self-report data; (3) collecting 70% of posttreatment self-report data; (4) collecting 70% of weekly self-report data; and (5) achieving treatment fidelity ≥80%. Between-group differences in clinical treatment-related outcomes also were examined preliminarily. Results: A total of 54 participants were enrolled between October 25, 2023 and July 26, 2024, and randomly assigned to the Doxy.me VR (n=29) and TMH (n=25) conditions, exceeding our recruitment target by 180%. Among the 30 participants targeted for completion, data were obtained from 29 (96.7%) at midtreatment and 28 (93.3%) at posttreatment. Participants completed 86.5% (180/208) of weekly self-report assessments. Treatment fidelity was 90% based on ratings of 41 session recordings. There were no significant between-group differences in clinical outcomes (all >.05) or most treatment-related outcomes. However, client satisfaction improved significantly more for the Doxy.me VR condition compared to TMH (=.04). Power analyses indicated that a sample of 160 participants would ensure adequate power for a fully powered trial. Conclusions: Telehealth-based, multiuser, synchronous VRET is feasible and shows preliminary evidence of efficacy. These findings are promising, and opportunities to improve procedures identified in this feasibility trial will directly inform the protocol for a fully powered RCT evaluating telehealth-based VR and its potential to improve treatment of mental health disorders. Trial Registration: ClinicalTrials.gov NCT06302868; https://clinicaltrials.gov/study/NCT06302868 International Registered Report Identifier (IRRID): RR2-10.2196/65770

mRNA Flu Vaccine Shows Stronger, Longer-Lasting Immune Response

Flu shots reduce hospitalizations and deaths for the roughly one billion people worldwide that get the flu each year. But they are less effective when the vaccine strains don’t closely match the viruses circulating in the community. Today’s vaccines are made months in advance of the flu season due to a long manufacturing process. When projections are off, strain mismatch can reduce the efficacy of the flu vaccines from about 60% (in a good year) down to 19%. A broader immune response could translate to a more effective vaccine even when the virus is changing faster than vaccine makers can update their shots.

Now, an investigational mRNA influenza vaccine, developed by Moderna, helps the immune system recognize a wider range of influenza viruses than today’s standard flu shot, offering stronger and potentially longer-lasting protection. The vaccine is currently under review by the U.S. Food and Drug Administration and, if approved, would be the first mRNA vaccine against influenza.

The findings are published in Nature Immunology in the paper, “mRNA-based influenza vaccine expands the breadth of the B cell response in humans.”

“We are seeing that the mRNA flu vaccine doesn’t just boost the immune system’s response to what it has already seen, it can help expand and diversify the antibody response, covering a broader range of flu strains,” said Ali Ellebedy, PhD, professor in the department of pathology and immunology at WashU Medicine. “If we can make flu immunity broader and more durable, that could mean fewer hospitalizations and deaths, which translates into a major impact on public health.”

In a separate Phase III clinical trial, Moderna found that its mRNA-based flu vaccine reduced the risk of illness by 26.6% more than the standard flu vaccine in older adults. Seeking to understand possible causes of this improved protection, the new study examined how immune responses to the mRNA-based flu vaccine differ from those of the standard vaccine.

The researchers followed 75 adults ages 20 to 50 over either the 2022-2023 flu season or the 2023-2024 flu season. About half received the investigational mRNA vaccine (mRNA-1010). The other half got Fluarix, an approved flu shot containing inactivated influenza viruses. Both vaccine platforms targeted the same strains recommended by the World Health Organization for the two flu seasons.

Analyzing blood samples, the researchers found a stronger immune response in participants who received the mRNA vaccine compared with participants who received the standard flu shot. Specifically, those given the mRNA vaccine produced more flu-specific antibodies and more flu-specific memory B cells.

“Influenza is constantly evolving to evade our immune system,” said Hanover Matz, PhD, a postdoctoral research associate working in Ellebedy’s laboratory. “But if we can develop vaccines that activate diverse B cells that target a broad portfolio of flu viruses, we have a better chance of avoiding strain mismatches and potentially even reducing the frequency with which the vaccine is needed.”

To investigate the vaccine’s ability to diversify B cells, the researchers studied germinal centers—where B cells improve their ability to recognize the virus and generate slightly different versions of themselves—in a subset of participants. It had not been previously understood if mRNA-based influenza virus vaccines can induce a superior germinal center (GC) response.

Among 13 people receiving the mRNA flu vaccine, five developed flu-specific germinal center responses in the lymph nodes that persisted for the 26 weeks of the study. In contrast, persistent immune responses were not seen in the 15 participants who received the traditional flu shot.

In addition, from four weeks after vaccination until the six-month mark, antibodies from mRNA vaccine recipients recognized and bound to many diverse flu strains across many decades of viral evolution, especially those known to cause the most widespread illness. Antibodies from standard vaccine recipients bound to fewer divergent virus strains.

These findings, the authors note, reveal a key role for persistent GC responses in broadening the repertoire of vaccine-induced antibodies. “We are seeing that the mRNA flu vaccine is driving strong, persistent germinal center responses,” said Ellebedy. “This can broaden the antibody response and better arm the immune system against an ever-changing virus.”

The post mRNA Flu Vaccine Shows Stronger, Longer-Lasting Immune Response appeared first on GEN – Genetic Engineering and Biotechnology News.

Genetics of How Steroids Are Metabolized Impacts Adverse Events

Research led by the University of Exeter on a large group of people from the UK Biobank shows that carriers of certain genetic mutations are more likely to have an adverse reaction to oral corticosteroid medications.

The researchers found that a variant in the CYP3A4 gene raised osteoporosis risk and a variant in the CTLA4 gene increased the risk for multiple adverse outcomes including stroke and cataracts.

People with these variants were also more likely to have a higher cumulative exposure to corticosteroids over time, suggesting that genetic differences may blunt the clinical benefit of standard steroid doses, so they end up needing more treatment over time and therefore being at even higher risk of adverse events.

“We were also able to show a clear relationship between the dose of steroid and side effects,” said Deniz Turkmen, PhD, a postdoctoral researcher at the University of Exeter, who presented the work at the European Society of Human Genetics conference in Gothenberg this week. “This precise analysis shows the increased risk associated with long-term treatment.”

Oral corticosteroids are an effective and very common medication used to target excessive inflammation. They are widely used to treat conditions such as asthma, rheumatoid arthritis, lupus, and other autoimmune diseases, as well as severe allergies and some acute respiratory infections.

In the U.S., millions of people take oral steroid tablets each year, and roughly one in 100 adults is on them at any given time. However, even short courses can increase the risk of health problems like infections, fractures and blood clots, and long‑term use is linked to osteoporosis, diabetes, weight gain and cataracts, among other adverse effects.

Around one in 10 people are estimated to have side effects to these medications, but it has been difficult to predict who will respond poorly, which triggered Turkmen and colleagues to look into the genetics of how these drugs are metabolized.

In this study, the team evaluated information from almost 38,000 participants from the UK Biobank. These individuals had primary‑care prescriptions for oral corticosteroids for inflammatory and autoimmune conditions.

For each person, Turkmen and colleagues calculated cumulative steroid dose up to the point they had an adverse event or a follow‑up appointment. They also modelled dose–response relationships with outcomes such as osteoporosis, stroke and cataracts. In total, 21 candidate pharmacogenetic variants were assessed.

Median cumulative exposure to corticosteroid in the study was around 1.5 g. Increasing this dose from 1.5 g to 4.0 g was associated with an approximate 50% higher risk of osteoporosis. Variants in the genes CYP3A4 and CTLA4 were associated with higher cumulative dose and increased risk of adverse outcomes, but only in steroid‑treated individuals, consistent with pharmacogenetic effects on steroid metabolism and immune regulation.

Adding polygenic scores to the evaluation including multiple variants for osteoporosis‑related traits significantly improved prediction of steroid‑related osteoporosis beyond age and sex, with particular improvements seen in individuals under the age of 40 at first prescription.

A genome wide association study identified an area on the genome (HLA‑DQA1) where the allele linked to lower cumulative oral corticosteroid dose was not associated with adverse outcomes, hinting at biology that reduces steroid need without obvious toxicity signals.

“It was reassuring that the genetic findings involving CYP3A4 and CTLA4 aligned with their roles in steroid metabolism and immune regulation, but the improvement in prediction of osteoporosis when we incorporated polygenic risk scores data was remarkable, especially in younger patients,” said Turkmen.

“We hope that, in time, greater availability of genetic data at population level will mean that it will be possible to integrate genomics into everyday healthcare and hence into prescribing decisions. That will be a major step on the road to the provision of personalized medicine for all.”

The post Genetics of How Steroids Are Metabolized Impacts Adverse Events appeared first on Inside Precision Medicine.

Cellular Biological Age Test Can Predict Disease Risk and Survival

A research team at the Stanford Medicine-based Wu Tsai Neurosciences Institute has developed a blood-based method that can determine the biological age of more than 40 different cell types throughout the body, providing a new way to assess disease risk and longevity years before symptoms emerge. The method, published in Nature Medicine, combines plasma proteomics with machine learning to develop estimates of the biological age of cell types including neuronal, immune, glial, endocrine, epithelial and musculoskeletal systems.

“With this indicator, we can assess the age of an organ today and predict the odds of your getting a disease associated with that organ 10 years later,” said senior author Tony Wyss-Coray, PhD, professor of neurology and neurological sciences and director of the Knight Initiative for Brain Resilience at the Wu Tsai Neurosciences Institute.

Developing this new cellular aging estimate was driven by the understanding that aging is the largest driver of a range of chronic diseases.

“Over 50% of the global disease burden can be attributed to aging,” the researchers wrote noting that while aging increases the risk of neurodegenerative disease, cancer and other chronic illnesses, “aging itself remains poorly understood, and quantifying its biology is therefore an important priority for improving prevention and treatment.”

This new model builds on the lab’s previous work in which the team developed a blood test capable of estimating the biological age of 11 organs and organ systems: the brain, muscle, heart, lung, arteries, liver, kidneys, pancreas, immune system, intestine and fat. In that study, published last July, the investigators analyzed blood samples from 44,498 participants in the UK Biobank and measured nearly 3,000 proteins circulating in the bloodstream. By identifying proteins associated with specific organs and comparing individual protein signatures with age-adjusted population averages, the researchers created algorithms that assigned biological ages to each organ.

Those organ-specific aging profiles revealed that organs age at different rates within the same person. Approximately one-third of participants had at least one organ classified as “extremely aged” or “extremely youthful,” while one in four had multiple organs falling into those categories. The biological age of a person’s organs was strongly associated with future disease risk. For instance, people with an aged heart were more likely to develop atrial fibrillation or heart failure, while aged lungs predicted a greater risk of chronic obstructive pulmonary disease. An aged brain was linked to a substantially higher risk of Alzheimer’s disease.

“The brain is the gatekeeper of longevity,” said Wyss-Coray. “If you’ve got an old brain, you have an increased likelihood of mortality. If you’ve got a young brain, you’re probably going to live longer.”

Participants with extremely aged brains experienced a 182% increase in mortality risk over roughly 15 years of follow-up in the study, while those with extremely youthful brains had a 40% reduction in mortality risk.

This new research goes beyond organ-level measurements to evaluate aging at a cellular level. For this research, the team analyzed more than 7,000 plasma proteins from 60,542 people across three independent cohorts. Using protein signatures mapped to their likely cellular origins, they constructed machine-learning models capable of estimating the biological age of more than 40 cell types.

The findings showed substantial variation in cellular aging patterns. Between 20% and 25% of people showed accelerated aging in a single cell type, while 1% to 3% showed accelerated aging in 10 or more cell types. These cellular aging signatures were associated with disease status and predicted disease development and mortality over a 15-year follow-up period.

One important finding centered on the risk of developing Alzheimer’s disease. The data showed that people carrying two copies of the APOE4 genetic variant, a major risk factor for Alzheimer’s disease, tended to have older astrocytes in the brain. Extreme astrocyte aging tripled the risk of developing Alzheimer’s disease among APOE4 homozygotes, whereas youthful astrocytes appeared to reduce that risk. “Youthful astrocytes seem to powerfully attenuate the detrimental effects of APOE4,” the researchers wrote.

The researchers also found strong links between cellular aging and amyotrophic lateral sclerosis (ALS). Individuals with extremely aged skeletal muscle cells had a 12.7-fold higher risk of developing ALS than those with youthful muscle-cell profiles. According to the researchers, this elevated risk could be detected more than three years before a clinical diagnosis.

Other findings suggest potential applications in cancer prevention and metabolic disease monitoring. The researchers reported that extreme aging of respiratory epithelial cells identified smokers at higher risk of lung cancer, while aging of myeloid immune cells was associated with elevated risk of developing type 2 diabetes.

“Our findings suggest that specific cellular vulnerabilities and cumulative aging burden influence survival,” the researchers wrote. Skeletal muscle-cell aging showed the strongest association with mortality, followed by neurons, fibroblasts, alveolar type 2 lung cells and myeloid lineage immune cells.

The investigators believe these new findings could begin to shift medicine toward earlier intervention. “This is, ideally, the future of medicine,” Wyss-Coray said. “Today, you go to the doctor because something aches, and they take a look to see what’s broken. We’re trying to shift from sick care to health care and intervene before people get organ-specific disease.”

The post Cellular Biological Age Test Can Predict Disease Risk and Survival appeared first on Inside Precision Medicine.

Why do South Koreans love AI so much?

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When I landed in Seoul after a grueling 12-hour flight from San Francisco, I walked through an unmanned immigration checkpoint, where a machine scanned my face and passport. On the subway home, people were glued to their phones (powered by flawless 5G even underground), as we raced past platforms lined with LED screens of ads celebrating K-pop idols’ birthdays. When I got off the station in Gangnam, a cartoon-eyed robot on wheels was waiting patiently at a crosswalk to deliver someone’s dinner. Internet cafés dotted the sidewalks, crammed with teenagers playing computer games, maybe hoping to become the next legendary pro gamer.

I stood at a bus stop with interactive touch screens showing real-time bus schedule updates. It will soon become an “AI bus stop,” the Gangnam district announced in June, with a kiosk that answers riders’ questions in multiple languages. The news didn’t surprise me. Having grown up in the city, I’ve watched Seoul transform from a scrappy boomtown into the gleaming tech capital it is today.

South Korea loves AI.

While a public backlash against AI is brewing across the US, South Koreans are optimistic. Only 16% say they are more concerned than excited about AI—the lowest of any of the 25 countries surveyed by the Pew Research Center—while 50% of Americans were more worried than excited. A majority of Koreans use AI every day, either as a sort of personal assistant or to do tasks at work, according to surveys by the Ministry of Culture, Sports, and Tourism and Korea Chamber of Commerce and Industry.

One of the most wired countries in the world, South Korea loves to street-test every new technology on the block—AI webcomics, virtual K-pop idols, and humanoid monks. And the appetite for experimentation doesn’t stop with ordinary citizens. Government agencies are early adopters too, deploying AI textbooks in schools and AI eldercare robots in welfare centers. South Koreans share a deep conviction that embracing technology is integral to modernizing the country and cementing its place in the global order. Their fascination with AI is just the latest incarnation of that ethos—and it’s making them anxious to stay ahead.

Engineered enthusiasm

All this techno-optimism has largely been engineered by South Korea’s national agenda to make AI a motor of economic growth. “The South Korean government has designated an AI-powered Fourth Industrial Revolution as the country’s path forward and aggressively promoted and invested in it,” says Chihyung Jeon, a professor of science and technology policy at the Korea Advanced Institute of Science and Technology. “South Koreans have consistently and relentlessly been told by the government about AI’s potential to create a better future.”

As South Korea rose from the ashes of the Korean War, technology lifted the nation from poverty into an economic powerhouse. In the 1970s, South Korea manufactured steel and ships, then semiconductors in the 1980s, broadband in the 1990s, and smartphones in the 2000s. Today, Samsung and SK Hynix supply most of the world’s high-bandwidth memory chips, which power the cutting-edge Nvidia hardware used to train AI models. South Korea’s economy now orbits these two semiconductor giants: The country’s main equity index, Kospi, surged to record highs in 2026, powered by the soaring share prices of both companies, each valued above $1 trillion.

Lee Jae-myung, president of South Korea, has pledged to vault the country into the ranks of the “top three AI powers” alongside the US and China. After taking office in 2025, he launched the Presidential Council on National AI Strategy to help buy massive amounts of computing power and a sovereign AI foundation model project that funds Korean companies to develop homegrown AI models. The government has also supported semiconductor titans, including Samsung and SK Hynix, through generous tax credits and low-interest financing. 

South Korea’s policy posture also prioritizes accelerating AI development over safety considerations. In 2024, South Korea’s legislature passed the AI Basic Act, one of the world’s first comprehensive AI laws, to promote AI development and establish light-touch regulatory guardrails. Seventy percent of South Koreans say advancing science and medicine through AI innovation is a bigger priority than protecting industries through regulation, according to the 2026 Stanford AI Index.

All of that effort might be paying off. The same index ranked South Korea as having the third largest number of notable AI models in the world, based on criteria such as state-of-the-art advancements or high citation rates. For many small countries like South Korea, AI is a chance to punch above their weight.

The blind spots

But that single-mindedness can crowd out critical reflection on AI’s broader societal impacts. “Because the national agenda on AI prioritizes economic development,” says Jeon, the professor of science and technology policy, “there isn’t much reflection on the social, political, ethical dimensions of the technology.” In 2025, the South Korean government faced a fierce backlash for rolling out AI textbooks riddled with factual inaccuracies and data privacy risks without testing them first in a pilot program to evaluate how they affect student learning.

And despite their optimism, South Koreans are still worried that AI could displace them from their jobs. After Hyundai announced in January that it will deploy Atlas humanoid robots across its car factories, the Hyundai Motor Group union protested vehemently. “Without labor-management agreement, not a single robot using new technology will be allowed to enter the workplace,” the union said. Sixty-four percent of South Koreans fear AI could displace human labor and exacerbate inequality, although 52% believe it could also increase productivity. 

On a recent Friday night in the Seoul Central Market, I went out with my cousins to a pocha, a late-night restaurant that serves fish cakes stacked in neat pyramids. As we clinked our cups of soju cut with beer—the scrappy staple cocktail of every Korean night out—one cousin asked me if I’d asked ChatGPT about my saju, a traditional Korean fortune-telling practice. A 29-year-old insurance agent in Seoul praying for a new job and a boyfriend, she said asking ChatGPT about work and dating was her favorite pastime. She pulled up her phone and punched my birth date into the chatbot. 

Addicted to their screens, trapped between unemployment and dead-end jobs, and priced out of marriage and homeownership, 46% of South Koreans in their 20s have used a chatbot to read their fortunes, according to a survey by Korea Gallup. 

My cousin said she also asks ChatGPT for tips on trading stocks, dreaming big about making bank on her investment accounts into which she’s been pouring her salary. ChatGPT, she believes, is her portal out of reality into a better future.

Despite how fond she is of the chatbot as her shaman and financial advisor, she fears losing her job to AI. She still uses ChatGPT feverishly at work, as all her coworkers do, afraid of falling behind. 

“I sometimes fear AI, but for now, it’s just so useful,” she said.