Scale-to-Dialogue: Low-Burden Elicitation of Daily Premenstrual Symptom Ratings with Small Language Models

Prospective daily symptom tracking is central to premenstrual health assessment, but repeated ordinal forms impose substantial response burden. We formulate conversational administration as an ordinal label-recovery problem: the system actively elicits a small set of symptom clusters and maps each response to the original severity labels. We used 3,320 complete participant-days from the mcPHASES dataset, covering cramps, mood swing, fatigue, sleep issues, stress, and bloating on a six-level scale. Six participants were reserved for development and 36 for a frozen evaluation comprising 360 participant-days and 2,160 item labels. A ModernBERT evidence gate detected whether a symptom was expressed, and Qwen2.5-1.5B-Instruct produced deterministic structured severity scores. Fixed six-item questioning achieved a quadratic weighted kappa of 0.976, whereas three joint symptom-cluster questions achieved 0.913, 97.45% agreement within one severity level, and 80.94% recall for moderate-or-higher symptoms while reducing questions by 50%. Open-first adaptive policies required 3.92-5.98 questions and produced lower agreement than the corresponding fixed policies. Participant-cluster bootstrap analysis estimated a kappa difference of -0.062 (95% CI -0.076 to -0.048) between the three-cluster and six-item strategies. Active cluster-level elicitation provides a direct, local-model route from natural conversation to reusable daily symptom labels.

Exploring Post-Training Alignment of Small Language Models for Biomedical Data-to-Text Generation: A Case Study of Medication Leaflet

Translating complex biomedical data into patient-friendly narratives is central to modern biomedical informatics. This study presents a comparative analysis of training small language models (SLMs) in specialized biomedical datato-text generation tasks. We explore widely adopted post-training methods including supervised fine-tuning (SFT), direct preference optimization (DPO), odds ratio preference optimization (ORPO), and group relative policy optimization (GRPO) with Qwen-based SLMs on a medicine package leaflets dataset. To assess cross-dataset generalizability, we also curated drug label data from openFDA. We evaluate models using both standard lexical overlap metrics like ROUGE as well as semantic similarity measures. Across our experiments, the results show that (1) the aligned SLMs outperform proprietary models like GPT-5; (2) ORPO outperforms the SFTbaselines; (3) GRPO yields the most robust cross-dataset performance among the alignment methods tested as well as GPT-5.

Measuring the practice of shared-decision making (OPTION12): An Investigation into Open-sourced Smaller LLMs (OS-sLLMs) for Better Privacy and Sustainability

We present LLM4SDM, the first study of open-source smaller language models (OS-sLLMs) for automated assessment of shared decision making (SDM) using the Observer OPTION12 framework. Unlike previous work that relies on large commercial models and the shorter OPTION5 instrument, our study focuses on privacy-preserving locally deployable models and Dutch melanoma consultation transcripts. Using expert-annotated clinical consultations, we evaluate three general-domain and two medical-domain OS-sLLMs during a development-phase pilot study. Results show that general-domain models outperform medical-domain models, which exhibit substantial hallucination and instruction-following failures. Gemma3:12b achieves the strongest agreement with human annotations (Pearson r=0.51, Spearman \r{ho}=0.59). Item-level and qualitative analyses reveal systematic challenges related to temporal discourse reasoning, conversational role attribution, and evidence grounding. We further introduce a Judge-LLM consensus framework designed to support disagreement resolution among multiple models. Our findings suggest that while current OS-sLLMs cannot replace human annotators, they offer a promising foundation for privacy-preserving human-in-the-loop SDM assessment.

Clinical Term Extraction using Open-Source Small Language Models

Clinical information for amyotrophic lateral sclerosis (ALS) care documented in unstructured clinical notes limits downstream analysis without extraction into structured formats. Open-source small language models with few-shot prompting for detecting the presence of ALS-relevant clinical terms in patient documentation were evaluated without task-specific training data. The detection task targeted 17 categories spanning functional scores, respiratory measures, medications, and related clinical and non-clinical attributes. Clinical note content was normalized from JSON-encoded discharge summaries and processed with a prompt template having structured JSON outputs. We compared 26 open-source models using aggregate, label-level, and manual-validation multilabel classification metrics. Manual validation showed that a regex rule baseline had higher overall micro-F1 and lower Hamming loss than any single SLM or TF-IDF baseline, while Qwen3-4B-Instruct-2507 was the highest-performing SLM by micro-F1. Model rankings varied by metric and label category, with the TF-IDF baseline showing high recall but low precision, some SLMs showing higher precision but lower recall, and Hammer2.1-7b showing strong performance for ALSFRS-R subscore detection. These findings support targeted hybrid extraction workflows rather than replacement of existing rule-based methods.

Domain-Adapted Small Language Models for Reliable Clinical Triage

Accurate and consistent Emergency Severity Index (ESI) assignment remains a persistent challenge in emergency departments, where highly variable free-text triage documentation contributes to mistriage and workflow inefficiencies. This study evaluates whether open-source small language models (SLMs) can serve as reliable, privacy-preserving decision-support tools for clinical triage. We systematically compared multiple SLMs across diverse prompting pipelines and found that clinical vignettes, concise summaries of triage narratives, yielded the most accurate predictions. The SLM, Qwen2.5-7B, demonstrated the strongest balance of accuracy, stability, and computational efficiency. Through large-scale domain adaptation using expert-curated and silver-standard pediatric triage data, fine-tuned Qwen2.5-7B models substantially reduced discordance and clinically significant errors, outperforming all baseline SLMs and advanced proprietary large language models (LLMs, e.g., GPT-4o). These findings highlight the feasibility of institution-specific SLMs for reliable, privacy-preserving ESI decision support and underscore the importance of targeted fine-tuning over more complex inference strategies.