Lifestyle-related type 2 diabetes and associated obesity (diabesity) affect >2.5 billion people worldwide and impose nearly $3 trillion in annual health care costs. We developed an implantable, wirelessly powered electrocatalytic closed-loop health optimization (ECHO) device containing platinum-decorated gold nanoclusters embedded in graphite felt that enabled selective, electrically tunable oxidation of blood glucose to renally cleared gluconate. In type 2 diabetic mice, wireless, low-power activation (0.75 volts, 10 milliamperes) restored glucose homeostasis within 1 hour, shifted metabolism from glucose to lipid utilization, reduced body weight and triglycerides, and increased circulating free fatty acids and ketone bodies without detectable hypoglycemia or adverse physiological, inflammatory, or behavioral effects during 6 weeks of treatment. Coupling this ECHO device to a commercial continuous glucose monitoring system enabled autonomous, smartphone-controlled, drug-free closed-loop management of experimental diabesity.
Reforms could shift fiscal discipline and resilience investment into reinforcing forces rather than competing ones
We explored the capabilities of frontier language models in sequential diagnosis, a diagnostic paradigm that captures the iterative nature of clinical reasoning. Given a brief clinical presentation, clinicians selectively acquired information to reach a diagnosis, enabling assessment of diagnostic accuracy and workup cost. We developed an interactive benchmark and an artificial intelligence (AI) system that simulates a panel of physicians, continually revising the differential diagnosis and selecting cost-effective tests. Using this benchmark, the system achieved 83.2% accuracy on New England Journal of Medicine clinicopathological conference cases and 80.3% on MIMIC-IV-ED emergency department admissions, outperforming generalist physicians (36.1 and 46.8%, respectively). Although these findings were obtained in a controlled benchmark setting, they highlight the promise of language models for supporting more accurate, lower-cost diagnoses.
Two proteins that permeabilize mitochondria promote cell death through distinct mechanisms
