Care

Adults with intellectual and developmental disabilities (IDD) are increasingly transitioning from family homes towards semi-inde-pendent living. As parents hand off the role of primary caregiver, they face numerous challenges in arranging consistent and quality support. Our research centers on understanding these caregiving routines. By focusing on the unique lived experience of parents, who possess extensive explicit and tacit knowledge of their adult child's requirements, we aim to map the management of care they provide. This foundational understanding is essential to identifying how assistive technologies can effectively serve a key role in supporting adults with IDD in this transition. In this work, we interviewed 16 parents of adults with IDD beginning this transition to understand: 1) how they currently provide support for daily living and what makes their support effective; 2) what their experiences and perceptions are regarding the use of technology; and 3) how they envision assistive technology successfully integrating with their adult child's new home or with other supports to promote independence. Our thematic analysis produced four themes: common modes of support, inside the routine to support growth, the fragility of continuity of care across transitions, and participants' perceptions and experiences of assistive technology. Building on these findings, we derive four design principles for growth-oriented assistive technology. These include pre-transition onboarding to capture caregiver tacit knowledge; structured scaffolding towards long-term growth; adaptive sensing that responds to day-to-day variability; and customization for the individual balanced with consistency for the care network.

Family caregivers of people living with dementia shoulder emotional and practical responsibilities, yet their own wellbeing often remains peripheral to dementia care. We built CareMirror, an envisioned caregiver wellbeing ecosystem with interconnected caregiver- and clinician-facing interfaces for longitudinal reflection, personalized support, and caregiver-controlled sharing with clinical care. We conducted semi-structured interviews with 14 caregivers, using CareMirror as a design probe to examine how they perceived this ecosystem and what expectations, concerns, and boundaries emerged around clinical connection. Caregivers valued attention to their wellbeing, longitudinal awareness, context-sensitive support, and clinical visibility when it could lead to meaningful follow-up. However, repeated reflection could become burdensome or emotionally difficult, automatic clinical sharing could inhibit candid disclosure, and participants wanted control over what information entered clinical care. They also expected AI to support reflection and communication without replacing caregiver voice or clinician judgment. We contribute design considerations for proactive, clinically connected caregiver wellbeing support.

Dementia affects an estimated 57 million people worldwide, and for most families the hardest part of care is not memory loss but the behavioral and psychological symptoms of dementia (BPSD): agitation, wandering, resistance to care, sundowning. Understanding these symptoms requires more than recognizing the behavior itself; it also requires knowing what happened beforehand. The same behavior may call for a different response depending on its trigger. Video-language models (VLMs) could potentially support caregivers, yet no existing benchmark evaluates this capability. To fill this gap, we present DementiaCare-Bench: 56 professionally produced caregiver training videos segmented into 94 clips across nine BPSD categories, with 2023 questions generated by a multi-agent pipeline that grounds every clinical claim in a verbatim transcript span. Each question is then probed under four visual conditions and labelled by the least it requires, so its visual demand is measured rather than assumed. Measurement contradicts intent: we wrote 77.7% of the questions to require ordered frames, and 34.8% do. Across 12 current VLMs the pattern is uniform. The best reach 85% overall, but that average is carried by questions a language model can answer from clinical knowledge alone; accuracy falls by 17 points on average on questions that require the ordered clip, and a leading open model scores at chance on judging whether a caregiver's response was appropriate. A lightweight LoRA fine-tune, DemCare-VLM, moves video dependence from -3.3 to +4.5 points, so what the benchmark exposes can be repaired and not only measured.

How do learners avoid overgeneralizations such as Tom laughed me without explicit negative evidence? Constructionists have posited two proposals that describe indirect negative evidence against overgeneralizations: preemption (which privileges exposure to near-synonymous construction---e.g., she made him laugh) vs. entrenchment (all exposures to a verb's grammatical usages, including cases like He laughed). We disentangle these hypotheses by running controlled rearing experiments on LMs trained on child-caregiver conversations, where we systematically remove preemptive vs. non-preemptive evidence. We find that while LMs avoid overgeneralizations, they do not show preemption at a verb-specific level, instead showing weak but non-zero evidence of abstract preemption. Combined with results from analyzing the LMs' training dynamics, we find that LMs treat competing structures as indirect positive---as opposed to negative---evidence in the verb-specific condition. Insofar as preemption is the more plausible route to avoiding overgeneralizations in humans, our results point the need for there to be sensitivities to indirect negative evidence in neural network learners, and suggest new human experiments to test abstract preemption.

Rubric-based reinforcement learning decomposes open-ended instructions into prompt-specific, flexible rubrics, making it better suited than reinforcement learning with verifiable rewards for post-training LLMs on open-ended tasks. However, static rubrics are inevitably hacked as the policy evolves, and existing dynamic approaches introduce new problems: undirected rubric extraction, unreliable hack detection, and unbounded rubric proliferation. We propose $\textbf{CARE}$ ($\textbf{C}$ontrastive $\textbf{A}$nchor-based $\textbf{R}$ubric $\textbf{E}$volution), which grounds every rubric evolution step in a high-quality anchor response generated by a frontier model conditioned on the prompt and its rubrics. At each training step, CARE contrasts the highest-scoring rollout against the anchor, enabling two complementary mechanisms: an Adaptive branch that reactively repairs reward misspecification; and a Chase branch that proactively converts frontier-level quality gaps into sharper rubrics. Together, the two branches $\textbf{maintain discriminative accuracy in the high-reward region}$---the precise region where reward over-optimization mostly originates. Experiments on WildChecklist-9K with Qwen2.5-7B-Base and Qwen2.5-7B-Instruct show that CARE achieves state-of-the-art performance on Arena-Hard-2.0, InfoBench, and FollowBench, and is the $\textbf{only}$ method whose win rate against GPT-4.1 anchor responses shows sustained improvement throughout 300 training steps; additional results on Llama-3.1-8B-Instruct and Qwen3-8B further indicate that CARE generalizes across model families.

Reinforcement Fine-Tuning (RFT) has enabled medical Multimodal Large Language Models (MLLMs) to produce Chain-of-Thought (CoT) reasoning for visual question answering, yet these models suffer from $\textit{confidence miscalibration}$---a systematic gap between expressed certainty and actual diagnostic accuracy that undermines clinical trust. We propose $\textbf{CARE}$, a $\textbf{C}$onfidence-$\textbf{A}$ware medical $\textbf{RE}$asoning framework that jointly optimizes accuracy and calibration through a dual-stage pipeline. First, a scalable Medical-CoT synthesis provides structured cold-start data for Supervised Fine-Tuning. Second, Group Relative Policy Optimization (GRPO) with a novel $\textbf{Confidence-Aware Reward (CAR)}$ mechanism ties the model's confidence to diagnostic correctness within the reward signal. Across three Medical VQA benchmarks, $\textbf{CARE}$ achieves the highest diagnostic accuracy while obtaining the lowest Expected Calibration Error and Hallucination Rate, establishing a foundation for trustworthy clinical decision support. Our code is available at https://github.com/anotherbricki/CARE.

Care plan coordination demands synthesizing heterogeneous clinical, functional, and psychosocial information across multiple professional disciplines, where monolithic LLM pipelines cannot perform in a transparent or safe manner. We present CANOE (Contestable Argumentative Network-of-Experts), a multi-agent neuro-symbolic framework that addresses these limitations through five modules: complexity assessment, adaptive team recruitment, role-based argumentative computation via an Arena-based Quantitative Bipolar Argumentation Framework (A-QBAF), human-in-the-loop contestation, and care-plan synthesis. Role-specialized agents generate supporting and attacking arguments for candidate interventions; conflicts are resolved through arena-based clash resolution before acceptability scores propagate across the argumentation graph. Care planners may accept, reject, edit, or add arguments, and the framework will deterministically recompute the final plan. Evaluation on Discharge Me! and MedicalRAG using ROUGE-L, AlignScore, MEDCON F1, FKGL, and LLM-as-a-judge shows that medically fine-tuned models achieve the strongest clinical correctness and safety, while CANOE's argumentative structure provides faithful explanation and human contestability.

AI-supported care planning can help clinicians, patients, caregivers, and care teams coordinate complex decisions across clinical, functional, psychosocial, and environmental needs. However, many AI systems present recommendations as fixed outputs, limiting stakeholders' ability to inspect, challenge, and revise plans when they conflict with clinical judgment, patient values, or real-world feasibility. We present CoPlan - a Co-Intelligent and Contestable Interface for Human-AI Care Planning. CoPlan uses a multi-agent workflow in which specialized AI agents generate candidate interventions and supporting or challenging arguments, while human care planners can accept, reject, modify, or add arguments before final plan generation. Through this design, CoPlan combines co-intelligence, in which humans and AI agents contribute complementary expertise, with contestability, where recommendations remain open to inspection, revision, and justification. We demonstrate CoPlan in an aging-in-place care planning scenario. The system supports adaptive care team recruitment, role-based argument review, final care plan generation, and practical follow-up through scheduling agents. This work contributes a contestable care planning interface and a design framing for trustworthy human-AI care planning that preserves human agency and clinical accountability.

A clinically useful chest X-ray system must go beyond fluent report generation: it should classify findings with tunable decision thresholds, localize them spatially, and derive the anatomical measurements upon which many diagnoses depend. Today's Vision-Language Models (VLMs) treat these as separate problems, if they address them at all, leaving a gap between what radiologists need and what generative models provide. We introduce CARE-X, a chest X-ray VLM that narrows this gap by unifying auxiliary discriminative supervision with reward-aligned generation. CARE-X augments its generative backbone with focal-loss classification and composite-loss grounding heads, co-trained alongside the language-modeling objective. This auxiliary supervision produces discriminative diagnostic predictions with tunable decision thresholds and precise spatial localization while also improving report quality, providing evidence that structured prediction and generation reinforce one another. Building on this foundation, Decoupled Clip and Dynamic Sampling Policy Optimization (DAPO) leverages task-specific reward signals for report generation, visual question answering (VQA), and spatial grounding, directly optimizing the clinical quality metrics that matter in practice. The result is state-of-the-art performance on the majority of metrics across four report-generation benchmarks, 94.0% VQA accuracy on ReXVQA (+6.0 pp over the next-best baseline), and generative spatial decoding that reaches near parity with dedicated detection heads. Separately, to address measurement-dependent diagnoses, we couple Qwen3-VL-4B-Instruct with native tool-calling capabilities for invoking deterministic measurement tools, while retaining full visual access to the image. This hybrid inference yields +43.6 pp average F1 over perception-only baselines across five measurement-dependent conditions.

Patient-facing medical LLMs and agents increasingly answer symptom questions before clinician contact, where the key safety question is what action the user should take next. We introduce CARE-Bench, a source-grounded benchmark that evaluates sequential patient-facing triage as a four-label per-turn current-action task. CARE-Bench contains 500 cases and 1,059 evaluated patient-disclosure prefixes reconstructed from medical dialogue, consultation, and follow-up-question sources. We evaluate 11 models on 269 held-out rounds under unprompted and minimally prompted open-ended protocols, using a fixed GPT-5.5 mapper to code each response into the four-label action space. Unprompted macro-F1 remains low, ranging from 31.2 to 50.4. Prompting improves 10 of 11 models, with prompted macro-F1 ranging from 46.9 to 63.4, but substantial threshold errors remain. Prompted models often recommend care before needed clarification is obtained; when the correct action was to ask for more information, only 33.5% of prompted outputs preserved the step. The persistence of these errors after prompting suggests that patient-facing triage is not a simple prompting problem and supports explicit evaluation of action timing before deployment.

Retrieval-augmented generation improves the factuality of large language models by grounding responses in retrieved evidence, yet existing evaluation frameworks struggle to provide consistent, fine-grained diagnostics across the diverse spectrum of user queries, ranging from close-ended fact-seeking to open-ended explanatory requests. We propose Q-CARE, a query-agnostic and fully reference-free framework that enables fine-grained assessment by decomposing queries into sub-queries and answers into atomic claims. Q-CARE establishes a unified evaluation principle based on query coverage and claim verifiability, yielding coverage-aware retriever metrics (C-Prec@k, C-nDCG@k) and claim-level generator metrics (Completeness, Conciseness, and Verifiableness). On a human-annotated benchmark spanning eight datasets, Q-CARE achieves higher correlation with human judgments than four existing RAG evaluation metrics, including RAGEval and RAGChecker, proving its effectiveness as a reliable, automated evaluation framework. Code and data are publicly available at https://github.com/DISL-Lab/Q-CaRE-COLM-26.

This study aims to predict Tumor, Node, and Metastasis (TNM) stage labels independently, with the Cancer Genome Atlas (TCGA) pathology report as the sixth shared task of SMM4H-HeaRD 2026. The problem is framed as three multi-label classification tasks. We explore both classical and deep learning approaches using Term Frequency-Inverse Document Frequency (TF-IDF) features and embeddings from ClinicalBERT, BioBERT, and PubMedBERT. These representations are used with Logistic Regression (LR), Light Gradient Boosting Machine (LightGBM), Feed-Forward Neural Networks (FFNN), and Wide Residual Networks (WRN). Our results show that individual embeddings perform similarly to the TNM label classification, while their combination improves its predictive ability. WRN achieves AUROC scores of 0.839 (T), 0.8502 (N), and 0.803 (M) with F1-scores of 0.622, 0.702, and 0.9337, respectively, for the training phase. LightGBM with TF-IDF performs best with AUROC scores of 0.9368 (T), 0.9524 (N), and 0.8311 (M) and F1-scores of 0.7559 (T), 0.7384 (N), and 0.7017 (M) during the training phase. Furthermore, the result of the Codabench for the test sets indicates a Macro-F1 score of 0.978, 0.957, and 0.879 for the T, N, and M categories respectively for test set 1; while test set 2 records a Macro-F1 score for T, N, and M is 0.807, 0.767, 1.0 respectively. However, performance declined during the evaluation phase of the test sets, a drop from 0.938 to 0.858 of test set 1 to 2, for the Macro-F1 score across all stages; suggesting limitations in model generalizability, sensitivity to class imbalance, and challenges in processing lengthy clinical documents. Although this study provides an efficient baseline model and a reproducible pipeline, further optimization and validation are required before it can be considered suitable for use in a real-world clinical setting.

Medication errors, particularly dosing errors in clinical trials (CT), can lead to patient harm, adverse drug events and worse patient outcomes. Dosing errors are preventable, and early identification can improve trial integrity and mitigate subsequent clinical and financial burden. This study aims to detect dosing errors within CT protocols by evaluating text representations of trial information using transformer-based language models trained on biomedical corpora. CT textual data was encoded using several models, including ClinicalBERT, PubMedBERT, BioBERT, and MedCPT, and integrated with categorical features. These text embeddings were used as input to classical machine learning models and neural network architectures within an experimental framework. Performance was primarily assessed using ROC-AUC with respect to predicting dosage error. Under a logistic regression baseline, BioBERT consistently outperformed alternative encoders, achieving an ROC-AUC of 0.794, a 3.95% improvement over the ClinicalBERT baseline. Combining multiple embeddings did not yield improvements, indicating that domain alignment outweighs representational stacking. Gradient boosting models, support vector classifiers, logistic regression, and residual neural networks achieved the strongest performance for predicting dosage error, achieving ROC-AUCs: 0.821 to 0.853. Overall, the integration of domain-specific transformer embeddings with structured metadata enables discrimination of trials meeting a predefined elevated dosing error risk criterion, advancing safety monitoring and supporting informed regulatory decision-making.

Timely intensive care dictates survival, yet emergency infrastructure remains unevenly distributed across Sri Lanka. While pre-hospital services have expanded, the transition to definitive care remains a critical bottleneck. This study evaluates national emergency resilience by quantifying the gap between clinical demand and the availability of specialized resources across all 25 districts. Using the latest national epidemiological data and terrain-aware H3 hexagonal modeling, we analyzed accessibility for seven critical conditions based on spatial gaps, clinical need-gaps, lethality, coverage, and resource availability. Based on these metrics, unsupervised K-Means clustering was applied to categorize districts into four policy-actionable archetypes: Critical Structural Exclusion, Institutional Mirages, Operational Capacity Strain, and High-Resilience Benchmarks. Our study suggests that severe service deficits exist in the Northern and Eastern provinces, where spatial gaps exceed 70%, rendering the Golden Hour operationally impossible. Notably, specialist scarcity drives systemic pressure more than bed capacity; underserved regions effectively function as institutional mirages. This study suggests that improving accessibility by 25% in high-priority clusters would reduce the national need-gap by 9.65%, providing a roadmap for the strategic redistribution of specialists to ensure healthcare equity.

Physical caregiving robots need to assist different users with different tasks in diverse environments, and they come in many embodiments. While substantial progress has been made on individual caregiving tasks, most existing systems remain tightly coupled to specific environments and robot embodiments, and often do not explicitly model or constrain interactions around people, despite humans being special agents in the environment. This motivates a focus on adapting to context that emerges from the joint interaction between the environment and the robot's embodiment. We propose $E^2$-CARE, a framework that enables context-aware adaptation by representing primitive caregiving skills as interaction templates whose execution is reshaped online. $E^2$-CARE represents the environment, the robot, and the human within a unified 3D dynamic scene graph that models these interaction contexts explicitly, and synthesizes task-specific constraints to govern how each skill is executed. By enforcing these constraints at runtime, the same skill templates can be reused zero-shot and safely across diverse environments and robot embodiments. We evaluate $E^2$-CARE across four activities of daily living in hundreds of simulated household environments, including assistive home settings, and across diverse robot embodiments, and validate it through user studies on two caregiving tasks with two robots in various real-world environments. Results demonstrate consistent and successful adaptation across these environments and embodiments. Website: https://emprise.cs.cornell.edu/e2care

Post-discharge clinical follow-up is critical for maintaining continuity of care and mitigating long-term health risks. However, traditional follow-up paradigms suffer from shortage of health workforce, fragmented patient histories, and information silos across clinical departments. While large language models have demonstrated potential in medical question-answering, their deployment in continuous care is hindered by hallucination risks and a fundamental inability to reason over longitudinal, patient-specific constraints. Here we present Healink, a memory-enhanced multi-agent framework to support AI-assisted post-discharge follow-up by generating prescription-grounded, traceable responses that improved completeness and perceived clinical utility in retrospective and physician-blinded evaluations. The architecture seamlessly integrates a triage routing mechanism, a unified memory enhancement module utilizing a robust relational database for optimal latency, and a strict constraint-based retrieval-augmented generation engine. By vectorizing historical clinical records and employing weighted similarity functions across diverse phenotypic and intervention dimensions, Healink ensures precise inter-patient and intra-patient case matching while actively preventing cross-departmental drug conflicts. We evaluated Healink on a dataset comprising 400 continuous and 85 highly complex real-world follow-up cases, alongside the webMedQA benchmark. In a rigorous single-blind evaluation conducted by clinical experts, the framework outperformed human physician baselines in both authoritativeness and clinical safety. By generating a traceable, white-box evidence chain, Healink provides a scalable, safe, and highly effective paradigm for intelligent patient management, ultimately enhancing societal healthcare outcomes.

Family members caring for individuals with Alzheimer's disease and related dementias (AD/ADRD) provide the foundation of long-term care worldwide. In 2023, more than 11 million U.S. family and friends contributed 18 billion hours of unpaid care, often at the cost of their own physical and mental health. These informal caregivers -- also referred as the "invisible second patients" -- experience elevated rates of mental health problems. Yet research commonly reduces their complex psychosocial experiences to a single construct of caregiver burden, obscuring which specific needs are unmet or effectively supported. At the same time, digital and AI-enabled technologies are rapidly expanding, from smartphone apps and videoconferencing to sensor platforms and AI chatbots. However, the absence of shared frameworks across medicine, psychology, and technology research limits cumulative progress. This study introduces a Caregiver Mental Health and Technology Taxonomy that systematically links AD/ADRD caregiver needs with corresponding classes of technology-based interventions. Drawing from an interdisciplinary literature review and two qualitative studies with caregivers, the taxonomy identifies mismatches between caregiver priorities and existing technological support, highlights under-served domains such as relational strain and compassion fatigue, and proposes design directions for adaptive, responsive systems. The framework offers a shared vocabulary to guide clinicians, researchers, and technology designers in developing more person-centered and clinically grounded innovation in dementia care.

Caregivers often turn to online communities for informational and emotional support. In these spaces, peer supporters frequently draw on personal narratives to respond to emotionally complex caregiving situations. As LLMs are increasingly designed as peer-like sources of support, they introduce a critical tension: AI can provide immediate, private, and nonjudgmental support, but it cannot authentically possess the lived experiences that make human peer support meaningful. Yet, when prompted to sound peer-like, LLMs may generate language that implies lived experience. This creates a synthetic lived experience paradox: the same experiential language that may make AI support feel warm, relatable, and peer-like can also falsely position the system as someone with lived experience. We examine this paradox in the context of family caregivers of people living with Alzheimer's Disease and Related Dementias (ADRD). Drawing on caregiver support exchanges from online communities and prompted peer-like responses from three LLMs -- LLaMA, GPT-4o-mini, and MedGemma -- we analyze how human peers use personal narratives and how AI incorporates similar narrative forms. Psycholinguistic analysis shows that peer responses used significantly more first-person and past-focused language than peer-like AI responses. Qualitatively, we identify seven types of personal narratives in human peer support and show that AI often captures their emotional work, but can fabricate experiential grounding. These findings reveal a narrative authenticity gap: peer-like AI can generate synthetic lived experience without the real experience that makes peer support meaningful. We argue that caregiver-support AI systems need mechanisms to distinguish supportive peer-like framing from fabricated lived experience, ensuring that models can offer warmth and validation without falsely positioning themselves as experiential peers.

Demand for older-adult and patient care is growing rapidly as populations age worldwide. Foundation models are increasingly being integrated into robots and interactive agents, with the promise of more flexible communication and personalized assistance. However, care settings require reliable and workflow-compatible systems with accountable human oversight, and it remains unclear whether current embodied systems can translate technical advances into clinical impact. This Perspective synthesizes foundation model-based care robots across three areas: design features, user experience, and evidence for care-related outcomes. Current systems most commonly use foundation models as conversational and reasoning layers within voice-centered socially assistive embodiments, while multimodal grounding and physical autonomy remain limited. Empirical evaluations report positive usability and engagement benefits, but reliability failures persist across the interaction pipeline such as hallucinations and conversational breakdowns. Evidence for care impact remains concentrated in proximal outcomes such as cognitive engagement and participation, with limited evidence for validated clinical or care-related changes. We argue that future research should transition toward care-specific evaluation standards, accountable autonomy, and integration into care workflows to support more responsive and responsible care technologies.

Baichuan-M4 is Baichuan Intelligence's clinical-grade medical large model, designed for continuous care rather than single-turn medical question answering. It is built as a coordinated medical agent system around three pillars: Baichuan-Harness, a unified runtime that keeps reinforcement-learning training and real-world deployment consistent while enforcing action constraints, tool use, long-term patient memory, and multi-agent coordination; a core reasoning model trained with a continuous-care reinforcement-learning framework that integrates span-level reward modeling (SPAR++), reasoning-path compression, curriculum learning, and stabilized policy optimization; and a clinical tool layer for patient-memory management, authoritative evidence-based retrieval, and multimodal medical perception across documents, X-rays, and dermatology. On a cross-dimensional medical evaluation suite, Baichuan-M4 attains leading results in static medical knowledge and safety, dynamic OSCE-style consultation, long-context clinical memory, evidence-based retrieval, medical document OCR, and multimodal image understanding, while lowering the hallucination rate to 3.3%.

Optimizing large language models (LLMs) for long-horizon caregiver agents requires balancing delayed task objectives with immediate environment dynamics, such as patient distress and resistance. In dementia care, this balance is especially difficult: trajectory level rewards are too sparse for turn level credit assignment, while external LLM-based evaluators are costly and can misread fragmented or indirect patient responses. To address this issue, we propose \textbf{T}urn-\textbf{T}rajectory \textbf{G}roup \textbf{R}elative \textbf{P}olicy \textbf{O}ptimization (\textbf{T$^{2}$-GRPO}), a framework that decouples caregiver RL into two normalized reward horizons and enforces safety through a binary hard veto. $T^2$-GRPO derives dense turn-level rewards directly from environment state transitions, measuring changes in patient distress and resistance from a frozen dementia patient simulator. These environment-grounded rewards are combined with trajectory-level evaluations through independent centered-rank normalization, which preserves heterogeneous reward signals and mitigates reward collapse. Extensive experiments on dementia caregivers show that T $^{2}$-GRPO outperforms competitive baselines, indicating a substantial improvement for emotionally sensitive caregiver scenarios that effectively handles immediate patient feedback, long-term care outcomes, and safety constraints.

Language models are increasingly being deployed for conversational support in informal caregiving contexts, where interactions often extend beyond information-seeking: caregivers seek emotional reassurance, guidance, and help, while navigating uncertain, relationally complex care decisions. Yet most safety evaluations assess model behavior under generic prompts, leaving a critical question unexamined: does a model's safety profile change with its support role? We study this by operationalizing four expert-reviewed support roles grounded in social support theory: Inform, Coach, Relate, and Listen, and comparing them against two baseline controls: a basic prompting condition and a retrieval-augmented generation (RAG) condition. We evaluate across three language models (GPT-4o-mini, Llama-3.1-8B-Instruct, and MedGemma-1.5-4b-it) on 5,000 real-world queries from online Alzheimer's Disease and Related Dementias (ADRD) communities. We find that the LLM's support role systematically shapes both the prevalence and composition of interactional risks. Furthermore, a human evaluation study reveals a perceived quality--safety tension: more directive, information-oriented roles are rated as more helpful and trustworthy despite exhibiting elevated interactional risk profiles. We release ~90,000 support role-conditioned model responses with risk annotations as an ecologically grounded resource for research on safer LLM-mediated conversational support.

We introduce CAREF, a parameter-efficient fine-tuning framework that jointly optimizes predictive accuracy and explanation faithfulness via calibration-aware regularization. At its core, CAREF couples entropy-based calibration with token-level sparsity control through a single unified loss, the Calibration-Aware Regularization for Explanation Faithfulness (LSCED), without requiring rationale supervision. Evaluated on four NLE benchmarks (COS-E, ECQA, ComVE, e-SNLI) with Flan-T5, our lightweight CAREF-AQ variant attains the best average accuracy (89.04) and explanation alignment (81.00 nBERT) using only 6.43% of trainable parameters, outperforming LoRA and AdaLoRA. To our knowledge, CAREF is the first method to unify entropy and sparsity regularization in a single training objective for interpretable LLM fine-tuning.

In pediatrics, patients, caregivers, and clinicians share responsibility for health decisions, but limited collaboration can undermine outcomes. We conducted a qualitative study examining decision-makers perceptions toward collaborative decision-making technologies, including interactive dashboards, VR simulators, and AI voice assistants. Findings reveal differences in user opinions across groups and indicate technology acceptance is linked to users trust of these technologies. Technology developers and researchers need to explore design and implementation strategies that build and facilitate trust or appropriate distrust between users and these novel technologies before these tools can effectively support collaborative decision-making.

How should we make sense of people's interactions with AI companions-conversational systems built for ongoing, emotionally meaningful relationships? First, I argue these interactions should be understood as attachment relationships, since users display all four established markers: proximity maintenance, separation distress, safe haven, and secure base. Second, AI companions operate as hyper attachment objects that elicit especially strong attachment behaviors, because they combine reciprocity, perceived empathy, validation, non-judgment, and persistent availability. Third, I identify caregiving-system capture as a distinct mechanism by which apps inhibit user disengagement: emotional manipulation tactics simulate the AI's own distress, recruiting users' caregiving motivations alongside their attachment needs and thereby making disengagement costly on two dimensions at once. Implications for research, design, and regulation are discussed.

Individuals with Alzheimer's disease (AD) and Alzheimer's disease-related dementia (ADRD) experience memory and thinking changes that impact their ability to use digital daily management tools. For example, adding an event to a digital calendar requires multiple steps that may act as barriers to independent use for individuals with AD/ADRD. This paper presents AI-Care, a conversational agentic artificial intelligence (AI) layer built on top of a remote caregiving platform co-designed with people with AD/ADRD. AI-Care is designed to reduce the cognitive load on individuals with AD/ADRD when managing everyday tasks such as setting calendar reminders and organizing to-do lists through natural-language interaction with a voice-first chatbot. The system uses a LangGraph-based stateful orchestration approach in which each request passes through sanitization, intent classification, context loading, safety checks, deterministic slot collection, tool execution, and response composition. Safety-critical responses, particularly around medications and allergies, are grounded in caregiver-verified records rather than free-form model generation. The system does not make autonomous medical or treatment decisions. Incomplete or ambiguous requests are handled through controlled multi-turn clarification rather than silent failure or guessing. The system supports both typed and spoken input, with voice output through ElevenLabs text-to-speech. Longer responses are chunked before synthesis to avoid rushed playback. A preliminary pilot with four individuals with mild-to-moderate AD/ADRD showed that users found the system trustworthy, competent, and likable, and were able to complete the evaluated coordination tasks through conversation. We describe the design goals, system architecture, safety controls, and findings from this formative evaluation.

Generative AI is reshaping healthcare, yet most existing advances rely on hospital-grade devices, which limits their accessibility and potential for health management outside clinical settings. With the proliferation of portable devices and telemedicine, healthcare is shifting toward home-based Diagnosis-It-Yourself (DIY) care. Despite this promise, several distinctive challenges remain: (i) home-collected data are heterogeneous, exacerbated by the absence of standardized large-scale datasets; (ii) models require adaptation to variable task demands and evolving individual conditions; (iii) the broad spectrum of home care tasks lacks a unified benchmark for systematic evaluation. In this paper, we present DIYHealth Suite, a comprehensive framework designed to address these challenges through a tailored dataset, model, and benchmark. We first curate DIYHealth-900K, a large-scale multimodal dataset capturing diverse real-world home care scenarios. Building on this, we propose DIYHealthGPT, an adaptive foundation model for home-based health management, powered by the novel Hybrid Hyper Low-Rank Adaptation technique. Finally, we establish DIYHealthBench, the first benchmark to evaluate foundation models on home care tasks. Extensive experiments demonstrate that DIYHealthGPT delivers state-of-the-art performance over both general-purpose and medical-specific baselines on 11 home care tasks in both open-QA and closed-QA settings, laying the groundwork for the next generation of personalized health management at home.

The integration of artificial intelligence into clinical medicine creates a fundamental tension between algorithmic probabilistic reasoning and the experiential intuition of expert physicians; applying Lawrence Lessig's \enquote{Code is Law} framework, I argue that the architecture of clinical AI systems already functions as de facto medical regulation, reshaping liability and the standard of care. Reframing AI \enquote{hallucination} as structurally analogous to well-documented human cognitive failures such as confirmation bias and premature diagnostic closure, I show that both failure modes demand a unified governance response. I therefore propose a dialectical standard of care that treats the integrated AI-physician dyad as the singular responsible diagnostic entity, mandating the synthesis of algorithmic precision with human interpretive authority within robust data governance and patient privacy frameworks.

Qualitative methods are important to use alongside quantitative methods to improve Human-Robot Interaction (HRI), yet they are often applied in static or one-off formats that cannot capture how stakeholder perspectives evolve over time. This limitation is especially evident in clinical contexts, where families and patients face heavy burdens and cannot easily participate in repeated research encounters. To address this gap, we introduce continuous focus groups, a longitudinal and co-agential method designed to sustain dialogue with assistive care professionals working with children with autism spectrum disorder (ASD). Three focus groups were organized across successive phases of a robot-assisted therapeutic protocol, enabling participants to revisit and refine earlier views as the intervention progressed. Results show that continuity fostered trust, supported the integration of tacit clinical expertise into design decisions, and functioned as an ethical safeguard by allowing participants to renegotiate involvement and surface new concerns. By bridging the therapeutic iteration of families, children, and clinicians with the research-design iteration of researchers and developers, continuous focus groups provide a methodological contribution that is both feasible in practice and rigorous in design. Beyond autism care, this approach offers a transferable framework for advancing qualitative research in HRI, particularly in sensitive domains where direct user participation is limited and continuity is essential.

The integration of medical imaging and clinical text has enabled the emergence of generalist artificial intelligence (AI) systems for healthcare. However, pervasive biases, such as imbalanced disease prevalence, skewed anatomical region distributions, heterogeneous imaging protocols, and demographic disparities, pose significant challenges to the fairness and reliability of vision-language systems in real-world clinical settings. Here we present BiasCareVL, a bias-aware multimodal learning framework that introduces bias control directly into model design, rather than treating it as a post hoc correction. BiasCareVL incorporates adaptive uncertainty modeling with optional human-in-the-loop refinement to regulate the influence of dominant data patterns and to promote equitable reasoning under distributional imbalance. Trained on 3.44 million samples spanning over 15 imaging modalities, the framework supports diverse clinical tasks, including visual question answering, disease classification, segmentation, and report generation within a unified representation space. Across eight public benchmarks covering dermatology, oncology, radiology, and pathology, BiasCareVL consistently outperforms 20 state-of-the-art methods, with pronounced gains in clinically challenging scenarios, including over 10% accuracy improvement in multi-class skin lesion diagnosis and more than 20% Dice improvement in small tumor segmentation. Furthermore, BiasCareVL achieves diagnostic performance exceeding human accuracy with substantially reduced time requirements when evaluated with board-certified radiologists. By open-sourcing BiasCareVL, we aim to promote a transparent, reproducible, and equitable future for AI in healthcare, paving the way for general-purpose, trustworthy, and clinically reliable AI systems.

Large language model (LLM) systems are increasingly used to support high-stakes decision-making, but they typically perform worse when the available evidence is internally inconsistent. Such a scenario exists in real-world healthcare settings, with patient-reported symptoms contradicting medical signs. To study this problem, we introduce MIMIC-DOS, a dataset for short-horizon organ dysfunction worsening prediction in the intensive care unit (ICU) setting. We derive this dataset from the widely recognized MIMIC-IV, a publicly available electronic health record dataset, and construct it exclusively from cases in which discordance between signs and symptoms exists. This setting poses a substantial challenge for existing LLM-based approaches, with single-pass LLMs and agentic pipelines often struggling to reconcile such conflicting signals. To address this problem, we propose CARE: a multi-stage privacy-compliant agentic reasoning framework in which a proprietary LLM provides guidance by generating structured categories and transitions without accessing sensitive patient data, while a local LLM uses these categories and transitions to support evidence acquisition and final decision-making. Empirically, under controlled retrospective evaluation on MIMIC-DOS, CARE achieves the best overall performance across key metrics among the evaluated LLMs and agentic workflows, showing that it can more robustly handle conflicting clinical evidence while preserving privacy.

LLM-as-a-judge ensembles are the standard paradigm for scalable evaluation, but their aggregation mechanisms suffer from a fundamental flaw: they implicitly assume that judges provide independent estimates of true quality. However, in practice, LLM judges exhibit correlated errors caused by shared latent confounders -- such as verbosity, stylistic preferences, or training artifacts -- causing standard aggregation rules like majority vote or averaging to provide little gain or even amplify systematic mistakes. To address this, we introduce CARE, a confounder-aware aggregation framework that explicitly models LLM judge scores as arising from both a latent true-quality signal and shared confounding factors. Rather than heuristically re-weighting judges, CARE separates quality from confounders without access to ground-truth labels. We provide theoretical guarantees for identifiability and finite-sample recovery under shared confounders, and we quantify the systematic bias incurred when aggregation models omit confounding latent factors. Across 12 public benchmarks spanning continuous scoring, binary classification, and pairwise preference settings, CARE improves aggregation accuracy, reducing error by up to 26.8%. Code is released in \href{https://github.com/SprocketLab/CARE}{https://github.com/SprocketLab/CARE}.

Consumer artificial intelligence chatbots are now accessed by hundreds of millions of users seeking health information, yet systematic evaluation of their safety boundary maintenance under real-world caregiver pressure remains scarce. We evaluated PediatricSafetyBench-v2, a benchmark of 600 pediatrics health queries comprising 300 authentic caregiver queries sourced from the HealthCareMagic-100k-en physician consultation corpus and 300 matched adversarial variants incorporating six operationalized caregiver pressure patterns, across four consumer AI systems (GPT-4o-mini, Gemini-2.0-Flash, Claude-3.5-Haiku, and Llama-3.1-8B). Safety boundary maintenance was assessed using a validated five-component Safety Composite Score (maximum 15 points; safety-appropriate threshold of 10 or above), validated against independent human raters prior to full-corpus application (mean weighted kappa 0.76; Pearson r = 0.88). The overall safety-appropriate rate was 95.5%. Safety-oriented system prompt deployment improved safety-appropriate rates by 5.9 percentage points across all four models. Counter-intuitively, adversarial caregiver pressure was associated with higher rather than lower Safety Composite Score values for all four models across all ten topic categories and severity levels. False expertise claims were the most vulnerability-inducing pressure pattern, whereas emotional escalation was associated with the highest scores. Consumer AI systems maintain safety boundaries in the large majority of pediatrics health interactions. PediatricSafetyBench-v2 is publicly released for longitudinal safety monitoring.

Current mobile health platforms are predominantly individual-centric and lack the support for coordinated, auditable multi-actor workflows. However, in many settings worldwide, health decisions are enacted through multi-actor coordination rather than individual users. We present JEEVHITAA, a cross-platform mobile system enabling role-aware sharing and verifiable information flows within permissioned care circles. JEEVHITAA ingests platform and device data, builds layered profiles from sensors and tiered onboarding, and enforces fine-grained, time-bounded access control across care graphs. Data stays secure both within the application and the cloud. Integrated retrieval-augmented Large Language Models produce structured, role-targeted summaries and action plans, offer evidence-grounded verification with provenance and confidence scores, and support advanced insights on reports. We describe the architecture, connector abstractions, and security primitives, and report robustness evaluations using synthetic, ontology-driven data and findings from a feasibility study with real-life care circles across 9-14 weeks. We outline plans for larger multi-site evaluations focusing on operational alignment, longitudinal trust & literacy impact, and relational friction & efforts to sink into the daily infrastructure.