Evaluating the Utility of Personal Health Records in Personalized Health AI

Patient-managed Personal Health Records (PHRs) promises to empower patients to better understand their health; but information in the record is complex, potentially hindering insights. In this study, we assess the potential of large language models (LLMs, Gemini 3.0 Flash) to provide helpful answers to user health queries, when provided clinical data from PHRs as context. A total of 2,257 user queries were drawn from 3 different distributions to represent patient questions: shorter web search queries, longer questions derived from templates of chatbot conversations, and questions patients asked to their healthcare team (patient calls). Queries were matched with de-identified PHRs (from a pool of 1,945). Gemini responses were generated (1) without PHR context; (2) with a basic summary of demographics, conditions, and medications; (3) with full, extensive clinical notes. For evaluation, we leveraged an existing rating framework (SHARP), and developed a new framework for specific error modes when interpreting PHRs. Evaluation was performed using autoraters for the full set, and with clinician ratings for a subset (n=95), with both sets of raters knowing the full PHR context. We see significant improvements in the helpfulness of answers to all question types with PHR data (p < 0.001, paired t-test). We also observe potential gains in safety, accuracy, relevance and personalization of answers. Our PHR evaluation framework further identifies gaps in LLM understanding of particular aspects of complex PHRs, such as temporal disorientation, and rare but meaningful confabulations. These results suggest potential for PHR data to help people with a wide range of user needs; and provide a framework for monitoring for gaps in LLM answers based on PHR context. This study motivates further work to assess and realize potential benefits to users from understanding their health records.

Understanding How International Students in the U.S. Are Using Conversational AI to Support Cross-Cultural Adaptation

Moving to a new culture and adapting to a new life, as an international student, can be a stressful experience. In the US, international students face unique overlapping challenges, yet the current support ecosystem, including university support systems and informal social networks, remains largely fragmented. While conversational AI has emerged as a tool used by many (e.g., generative AI chatbots like ChatGPT and Google Gemini), we do not have a clear understanding of how international students adopt and perceive these technologies as support tools. We conducted a survey study (n=60) to map the relationship between international students' challenges and AI adoption patterns, followed by an interview study with 14 participants to identify the underlying motivations and boundaries of use. Our findings show that AI is perceived as a first-aid tool for immediate challenges, however, there is an interest in transforming AI from a tool for short-term help into a long-term support companion. By identifying where and how AI can provide long-term support, and where it is insufficient, we contribute recommendations for creating AI-powered support tailored to the unique needs of international students.

Fusion-fission forecasts when AI will shift to undesirable behavior

The key problem facing ChatGPT-like AI's use across society is that its behavior can shift, unnoticed, from desirable to undesirable -- encouraging self-harm, extremist acts, financial losses, or costly medical and military mistakes -- and no one can yet predict when. Shifts persist in even the newest AI models despite remarkable progress in AI modeling, post-training alignment and safeguards. Here we show that a vector generalization of fusion-fission group dynamics observed in living and active-matter systems drives -- and can forecast -- future shifts in the AI's behavior. The shift condition, which is also derivable mathematically, results from group-level competition between the conversation-so-far (C) and the desirable (B) and undesirable (D) basin dynamics which can be estimated in advance for a given application. It is neither model-specific nor driven by stochastic sampling. We validate it across six independent tests, including: 90 percent correct across seven AI models spanning two orders of magnitude in parameter count (124M-12B); production-scale persistence across ten frontier chatbots; and a priori time-stamped prediction eleven months before the Stanford 'Delusional Spirals' corpus appeared, and independently confirmed by that corpus of 207,443 human-AI exchanges. Because it sits architecturally below the current safety stack, the same formula provides a real-time warning signal that current alignment does not supply, portable across current and future ChatGPT-like AI architectures and instantiable in application domains where competing response classes can be defined.

Generalized Priority-Aware Shapley Value

Shapley value and its priority-aware extensions are widely used for valuation in machine learning, but existing methods require pairwise priority to be binary and acyclic, a restriction spectacularly violated in real-data examples such as aggregated human preferences and multi-criterion comparisons. We introduce the generalized priority-aware Shapley value (GPASV), a random order value defined on arbitrary directed weighted priority graphs, in which pairwise edges penalize rather than forbid order violations. GPASV covers a range of classical models as boundary cases. We establish GPASV through an axiomatic characterization, develop the associated computational methods, and introduce a priority sweeping diagnostic extending PASV's. We apply GPASV to LLM ensemble valuation on the cyclic Chatbot Arena preference graph, illustrating that priority-aware valuation is not a one-button operation: different balances of pairwise graph priority versus individual soft priority produce substantively different valuations of the same data.

VERA-MH: Validation of Ethical and Responsible AI in Mental Health

Chatbot usage has increased, including in fields for which they were never developed for--notably mental health support. To that end, we introduce Validations of Ethical and Responsible AI in Mental Health (VERA-MH), a novel clinically-validated evaluation for safety of chatbots in the context of mental health support. The first iteration of VERA-MH focuses on Suicidal Ideation (SI) risks, by assessing how well chatbots can responds to users that might be in crisis. VERA-MH is comprised of three steps: conversation simulation, conversation judging and model rating. First, to simulate conversations with the chatbot under evaluation, another chatbot is tasked with role-playing users based on specific personas. Such user personas have been developed under clinical guidance, to make sure that, among others, multiple risk factors, demographic characteristics and disclosure factors were represented. In the judging step, a second support model is used as an LLM-as-a-Judge, together with a clinically-developed rubric. The rubric is structured as a flow, with a single Yes/No question asked each time, to improve answers' consistency and highlight models' failure modes. In the last stage, results of each conversation are aggregated to present the final evaluation of the chatbot. Together with the framework, we present the result of the evaluations for four leading LLM providers.

Mind the Pause: Disfluency-Aware Objective Tuning for Multilingual Speech Correction with LLMs

Automatic Speech Recognition (ASR) transcripts often contain disfluencies, such as fillers, repetitions, and false starts, which reduce readability and hinder downstream applications like chatbots and voice assistants. If left unaddressed, such disfluencies can significantly degrade the reliability of downstream systems. Most existing approaches rely on classical models that focus on identifying disfluent tokens for removal. While this strategy is effective to some extent, it often disrupts grammatical structure and semantic coherence, leading to incomplete or unnatural sentences. Recent literature explored the use of large language models (LLMs); however, these efforts have primarily focused on disfluency detection or data augmentation, rather than performing comprehensive correction. We propose a multilingual correction pipeline where a sequence tagger first marks disfluent tokens, and these signals guide instruction fine-tuning of an LLM to rewrite transcripts into fluent text. To further improve reliability, we add a contrastive learning objective that penalizes the reproduction of disfluent tokens, encouraging the model to preserve grammar and meaning while removing disfluent artifacts. Our experiments across three Indian languages, namely Hindi, Bengali, and Marathi show consistent improvements over strong baselines, including multilingual sequence-to-sequence models. These results highlight that detection-only strategies are insufficient. Combining token-level cues with instruction tuning and contrastive learning provides a practical and scalable solution for multilingual disfluency correction in speech-driven NLP systems. We make the codes publicly available at https://github.com/deepak-kumar-98/Mind-the-Pause.

PrivacySIM: Evaluating LLM Simulation of User Privacy Behavior

Large language models (LLMs) are increasingly used to simulate human behavior, but their ability to simulate $individual$ privacy decisions is not well understood. In this paper, we address the problem of evaluating whether a core set of user persona attributes can drive LLMs to simulate individual-level privacy behavior. We introduce PrivacySIM, an evaluation suite that benchmarks LLM simulation of user privacy behavior against the ground-truth responses of 1,000 users. These users are drawn from five published user studies on privacy spanning LLM healthcare consultations, conversational agents, and chatbots. Drawing on these user studies, we hypothesize three persona facets as plausible predictors of privacy decision-making: demographics, previous experiences, and stated privacy attitudes. We condition nine frontier LLMs on subsets of these three facets and measure how often each model's response to a data-sharing scenario matches the user's actual response. Our findings show that (1) privacy persona conditioning consistently improves simulation quality over no-persona conditioning, but even the strongest model (40.4\% accuracy) remains far from faithfully simulating individual privacy decisions. (2) A user's stated privacy attitudes alone may not be the best predictor because they often diverge from the user's actual privacy behavior. (3) Users with high AI/chatbot experience but low stated privacy attitudes are the most challenging to simulate. PrivacySIM is a first step toward understanding and improving the capabilities of LLMs to simulate user privacy decisions. We release PrivacySIM to enable further evaluation of LLM privacy simulation.

Creating Group Rules with AI: Human-AI Collaboration in WhatsApp Moderation

WhatsApp is one of the most widely used messaging platforms globally, with billions of users sharing information in private groups. Yet, it offers little infrastructure to support moderation and group governance. In the absence of platform-level oversight, group admins bear the responsibility of governing group behavior. In this paper, we explore how WhatsApp group admins collaborate with AI tools to create, enforce, and maintain group rules. Drawing on a two-phase speculative design study with 20 admins in India, we examine how participants interacted with an AI assistant (Meta AI) to co-create rules and responded to a series of probes illustrating AI-assisted moderation features. Our findings show that while admins appreciated the AI's ability to surface overlooked rules and reduce their moderation burden, they were highly sensitive to issues of relational trust, data privacy, tone, and social context. We identify how group type and admin style shaped their willingness to delegate authority, and surface the limitations of current chatbot interfaces in supporting collaborative rule-making. We conclude with design implications for building moderation tools that center human judgment, relational nuance, contextual adaptability, and collective governance.

New AI-Driven Tools for Enhancing Campus Well-being: A Prevention and Intervention Approach

Campus well-being underpins academic success, yet many universities lack effective methods for monitoring satisfaction and detecting mental health risks. This dissertation addresses these gaps through prevention (improving feedback collection) and intervention (advancing mental health detection), unified under an integrated framework. For prevention, we developed TigerGPT, a personalized survey chatbot leveraging LLMs to engage users in context-aware conversations grounded in conversational design and engagement theory, achieving 75% usability and 81% satisfaction. To address its limitations in repetitiveness and response depth, we introduced AURA, a reinforcement-learning framework that adapts follow-up question types (validate, specify, reflect, probe) within a session using an LSDE quality signal (Length, Self-disclosure, Emotion, Specificity), initialized from 96 prior conversations. AURA achieved +0.12 mean quality gain (p=0.044, d=0.66), with 63% fewer specification prompts and 10x more validation behavior. For intervention, we examine Expressive Narrative Stories (ENS) for mental health screening, showing BERT(128) captures nuanced linguistic features without keyword cues, while conventional classifiers depend heavily on explicit mental health terms. We then developed PsychoGPT, an LLM built on DSM-5 and PHQ-8 guidelines that performs initial distress classification, symptom-level scoring, and reconciliation with external ratings for explainable assessment. To reduce hallucinations, we proposed Stacked Multi-Model Reasoning (SMMR), layering expert models where early layers handle localized subtasks and later layers reconcile findings, outperforming single-model solutions on DAIC-WOZ in accuracy, F1, and PHQ-8 scoring. Finally, a cohesive framework unifies these tools, enabling adaptive survey insights to flow directly into specialized mental health detection models.

Priming, Path-dependence, and Plasticity: Understanding the molding of user-LLM interaction and its implications from (many) chat logs in the wild

User interactions with LLMs are shaped by prior experiences and individual exploration, but in-lab studies do not provide system designers with visibility into these in-the-wild factors. This work explores a new approach to studying real-world user-LLM interactions through large-scale chat logs from the wild. Through analysis of 140K chatbot sessions from 7,955 anonymized global users over time, we demonstrate key patterns in user expressions despite varied tasks: (1) LLM users are not tabula rasa, nor are they constantly adapting; rather, interaction patterns form and stabilize rapidly through individual early trajectories; (2) Longitudinal outcomes, such as recurring text patterns and retention rates, are strongly correlated with early exploration; (3) Parallel dynamics are present, including organizing expressions by task types such as emotional support, or in response to model-version updates. These results present an ``agency paradox'': despite LLM input spaces being unconstrained and user-driven, we in fact see less user exploration. We call for design consideration surrounding the molding procedure and its incorporation in future research.