Robust Nasality Representation Learning for Cleft Palate-Related Velopharyngeal Dysfunction Screening in Real-World Settings

Velopharyngeal dysfunction (VPD) is characterized by inadequate velopharyngeal closure during speech and often causes hypernasality and reduced intelligibility. Although speech-based machine learning models can perform well under standardized clinical recording conditions, their performance often drops in real-world settings because of domain shift caused by differences in devices, channels, noise, and room acoustics. To improve robustness, we propose a two-stage framework for VPD screening. First, a nasality-focused speech representation is learned by supervised contrastive pre-training on an auxiliary corpus with phoneme alignments, using oral-context versus nasal-context supervision. Second, the encoder is frozen and used with lightweight classifiers on 0.5-second speech chunks, whose probabilities are aggregated to produce recording-level decisions with a fixed threshold. On an in-domain clinical cohort of 82 subjects, the proposed method achieved perfect recording-level screening performance (macro-F1 = 1.000, accuracy = 1.000). On a separate out-of-domain set of 131 heterogeneous public Internet recordings, large pretrained speech representations degraded substantially, while MFCC was the strongest baseline (macro-F1 = 0.612, accuracy = 0.641). The proposed method achieved the best out-of-domain performance (macro-F1 = 0.679, accuracy = 0.695), improving on the strongest baseline under the same evaluation protocol. These results suggest that learning a nasality-focused representation before clinical classification can reduce sensitivity to recording artifacts and improve robustness for deployable speech-based VPD screening.

Stop Listening to Me! How Multi-turn Conversations Can Degrade Diagnostic Reasoning

Patients and clinicians are increasingly using chatbots powered by large language models (LLMs) for healthcare inquiries. While state-of-the-art LLMs exhibit high performance on static diagnostic reasoning benchmarks, their efficacy across multi-turn conversations, which better reflect real-world usage, has been understudied. In this paper, we evaluate 17 LLMs across three clinical datasets to investigate how partitioning the decision-space into multiple simpler turns of conversation influences their diagnostic reasoning. Specifically, we develop a "stick-or-switch" evaluation framework to measure model conviction (i.e., defending a correct diagnosis or safe abstention against incorrect suggestions) and flexibility (i.e., recognizing a correct suggestion when it is introduced) across conversations. Our experiments reveal the conversation tax, where multi-turn interactions consistently degrade performance when compared to single-shot baselines. Notably, models frequently abandon initial correct diagnoses and safe abstentions to align with incorrect user suggestions. Additionally, several models exhibit blind switching, failing to distinguish between signal and incorrect suggestions.

VERI-DPO: Evidence-Aware Alignment for Clinical Summarization via Claim Verification and Direct Preference Optimization

Brief Hospital Course (BHC) narratives must be clinically useful yet faithful to fragmented EHR evidence. LLM-based clinical summarizers still introduce unsupported statements, and alignment can encourage omissions ("say-less" degeneration). We introduce VERI-DPO, which uses claim verification to mine preferences and distill them into the summarizer with Direct Preference Optimization (DPO). On MIMIC-III-Ext-VeriFact-BHC (100 ICU patients; patient-level splits), we train a retrieval-augmented verifier to label claim-evidence pairs as Supported, Not Supported, or Not Addressed via a single-token format. The verifier scores sentence-level claims from sampled BHC candidates and aggregates margins into a coverage-aware utility to mine length-controlled, contradiction-anchored preference pairs. On held-out patients, verifier-mined preferences separate candidates by contradiction density, and VERI-DPO reduces Not Supported claim rates from 10.7% to 1.9% (local verifier judge) and from 11.6% to 6.4% (GPT-4o judge), while improving validity from 76.7% to 82.5% and maintaining informative length.

Learning When to Sample: Confidence-Aware Self-Consistency for Efficient LLM Chain-of-Thought Reasoning

Large language models (LLMs) achieve strong reasoning performance through chain-of-thought (CoT) reasoning, yet often generate unnecessarily long reasoning paths that incur high inference cost. Recent self-consistency-based approaches further improve accuracy but require sampling and aggregating multiple reasoning trajectories, leading to substantial additional computational overhead. This paper introduces a confidence-aware decision framework that analyzes a single completed reasoning trajectory to adaptively select between single-path and multi-path reasoning. The framework is trained using sentence-level numeric and linguistic features extracted from intermediate reasoning states in the MedQA dataset and generalizes effectively to MathQA, MedMCQA, and MMLU without additional fine-tuning. Experimental results show that the proposed method maintains accuracy comparable to multi-path baselines while using up to 80\% fewer tokens. These findings demonstrate that reasoning trajectories contain rich signals for uncertainty estimation, enabling a simple, transferable mechanism to balance accuracy and efficiency in LLM reasoning.

Optimizing Domain-Adaptive Self-Supervised Learning for Clinical Voice-Based Disease Classification

The human voice is a promising non-invasive digital biomarker, yet deep learning for voice-based health analysis is hindered by data scarcity and domain mismatch, where models pre-trained on general audio fail to capture the subtle pathological features characteristic of clinical voice data. To address these challenges, we investigate domain-adaptive self-supervised learning (SSL) with Masked Autoencoders (MAE) and demonstrate that standard configurations are suboptimal for health-related audio. Using the Bridge2AI-Voice dataset, a multi-institutional collection of pathological voices, we systematically examine three performance-critical factors: reconstruction loss (Mean Absolute Error vs. Mean Squared Error), normalization (patch-wise vs. global), and masking (random vs. content-aware). Our optimized design, which combines Mean Absolute Error (MA-Error) loss, patch-wise normalization, and content-aware masking, achieves a Macro F1 of $0.688 \pm 0.009$ (over 10 fine-tuning runs), outperforming a strong out-of-domain SSL baseline pre-trained on large-scale general audio, which has a Macro F1 of $0.663 \pm 0.011$. The results show that MA-Error loss improves robustness and content-aware masking boosts performance by emphasizing information-rich regions. These findings highlight the importance of component-level optimization in data-constrained medical applications that rely on audio data.

Role and Use of Race in AI/ML Models Related to Health

The role and use of race within health-related artificial intelligence and machine learning (AI/ML) models has sparked increasing attention and controversy. Despite the complexity and breadth of related issues, a robust and holistic framework to guide stakeholders in their examination and resolution remains lacking. This perspective provides a broad-based, systematic, and cross-cutting landscape analysis of race-related challenges, structured around the AI/ML lifecycle and framed through "points to consider" to support inquiry and decision-making.

Catalysts of Conversation: Examining Interaction Dynamics Between Topic Initiators and Commentors in Alzheimer's Disease Online Communities

Informal caregivers (e.g.,family members or friends) of people living with Alzheimers Disease and Related Dementias (ADRD) face substantial challenges and often seek informational or emotional support through online communities. Understanding the factors that drive engagement within these platforms is crucial, as it can enhance their long-term value for caregivers by ensuring that these communities effectively meet their needs. This study investigated the user interaction dynamics within two large, popular ADRD communities, TalkingPoint and ALZConnected, focusing on topic initiator engagement, initial post content, and the linguistic patterns of comments at the thread level. Using analytical methods such as propensity score matching, topic modeling, and predictive modeling, we found that active topic initiator engagement drives higher comment volumes, and reciprocal replies from topic initiators encourage further commentor engagement at the community level. Practical caregiving topics prompt more re-engagement of topic initiators, while emotional support topics attract more comments from other commentors. Additionally, the linguistic complexity and emotional tone of a comment influence its likelihood of receiving replies from topic initiators. These findings highlight the importance of fostering active and reciprocal engagement and providing effective strategies to enhance sustainability in ADRD caregiving and broader health-related online communities.

Split Learning for Distributed Collaborative Training of Deep Learning Models in Health Informatics

Deep learning continues to rapidly evolve and is now demonstrating remarkable potential for numerous medical prediction tasks. However, realizing deep learning models that generalize across healthcare organizations is challenging. This is due, in part, to the inherent siloed nature of these organizations and patient privacy requirements. To address this problem, we illustrate how split learning can enable collaborative training of deep learning models across disparate and privately maintained health datasets, while keeping the original records and model parameters private. We introduce a new privacy-preserving distributed learning framework that offers a higher level of privacy compared to conventional federated learning. We use several biomedical imaging and electronic health record (EHR) datasets to show that deep learning models trained via split learning can achieve highly similar performance to their centralized and federated counterparts while greatly improving computational efficiency and reducing privacy risks.

High speed free-space optical communication using standard fiber communication component without optical amplification

Free-space optical communication (FSO) can achieve fast, secure and license-free communication without need for physical cables, making it a cost-effective, energy-efficient and flexible solution when the fiber connection is absent. To establish FSO connection on-demand, it is essential to build portable FSO devices with compact structure and light weight. Here, we develop a miniaturized FSO system and realize 9.16 Gbps FSO between two nodes that is 1 km apart, using a commercial fiber-coupled optical transceiver module with no optical amplification. Basing on the home-made compact 90 mm-diameter acquisition, pointing and tracking (APT) system with four-stage close-loop feedback, the link tracking error is controlled at 3 {\mu}rad and results an average coupling loss of 13.7 dB. Such loss is within the tolerance of the commercial optical communication modules, and without the need of optical amplifiers, which contributes to the low system weight and power consumption. As a result, a single FSO device weighs only about 12 kg, making it compact and portable for potential application in high-speed wireless communication. Our FSO link has been tested up to 4 km, with link loss of 18 dB in the foggy weather in Nanjing, that shows longer distances can be covered with optical amplification.