A Comprehensive Inference-Time Augmentation Framework in Physiological Signals: Application to PPG-Based AF Detection

Objective: Accurate classification of physiological signals in real-world deployments is challenged by sensor noise, motion artifacts, and distribution shifts between training and deployment data. Inference-time augmentation (ITA), which applies augmentations during inference rather than retraining, offers a simple, model-agnostic mechanism to improve robustness. However, ITA application to physiological signals has remained narrow in scope, relying on limited augmentation methods with fixed, unoptimized parameters. This work proposes a unified ITA framework to address that gap. Approach: The framework incorporates 13 augmentation methods spanning time-domain, amplitude-domain, frequency-domain, and artifact-injection transformations, with hyperparameters optimized via Bayesian optimization. We evaluate on atrial fibrillation (AF) detection from 30-second PPG signals using GPT-PPG and ResNet across five datasets comprising more than 400 patients and ${\sim}$9,800 hours of recording. Main results: Standard ITA consistently improved AUROC (up to 8.5% for GPT-PPG and 0.7% for ResNet) and AUPRC (up to 10.6% for GPT-PPG and 0.8% for ResNet). Selective ITA further reduced average FPR by up to 4.4% (GPT-PPG) and 1.3% (ResNet) on non-AF datasets. Significance: These findings establish ITA as a practical, model-agnostic approach for improving PPG-based AF classification reliability in deployment settings where retraining is not feasible, with broader applicability to physiological signal analysis.

NutriMLLM: Multimodal Large Language Models for Dietary Micronutrient Analysis

Comprehensive estimation of dietary micronutrients from food images could improve clinical nutrition care, but training such models requires large multimodal datasets linking diverse foods to complete nutrient profiles. We first show that existing multimodal large language models (MLLMs), including leading proprietary models, are unreliable for this task. Across five model families and four independent evaluation benchmarks (ASA24, SNAPMe, FNDDS, and NutriBench), models frequently abstained or returned statistically implausible values. To address this gap without costly expert annotation, we repurposed a decade of population-scale 24-hour dietary recalls as structured prompts for text-to-image generation. This pipeline produced a synthetic corpus of about 1.1 million image-description-nutrient triplets, each pairing a generated food image with a complete 65-nutrient label. To our knowledge, this is the largest synthetic food-image corpus with comprehensive micronutrient annotation planned for public release upon publication. Fine-tuning Qwen3-VL (2B/4B/8B/30B) and GLM-4.6V-Flash on this corpus yielded NutriMLLM, the first family of vision-language models specialized for comprehensive dietary micronutrient estimation. We evaluate these models with a four-component framework that separately measures abstention, hallucination, overall usability, and per-nutrient numerical accuracy. On real food images, every NutriMLLM variant achieved near-complete coverage across all 65 nutrients, and the largest variant matched or exceeded proprietary baselines (GPT-5, Gemini 3, and Claude Sonnet 4.5) in accuracy on most nutrients. These results show that recall-driven synthetic supervision can make image-based comprehensive micronutrient estimation a tractable engineering problem and support dietary assessment, personalized nutrition guidance, and population-scale micronutrient surveillance.

MIRAGE: Knowledge Graph-Guided Cross-Cohort MRI Synthesis for Alzheimer's Disease Prediction

Reliable Alzheimer's disease (AD) diagnosis increasingly relies on multimodal assessments combining structural Magnetic Resonance Imaging (MRI) and Electronic Health Records (EHR). However, deploying these models is bottlenecked by modality missingness, as MRI scans are expensive and frequently unavailable in many patient cohorts. Furthermore, synthesizing de novo 3D anatomical scans from sparse, high-dimensional tabular records is technically challenging and poses severe clinical risks. To address this, we introduce MIRAGE, a novel framework that reframes the missing-MRI problem as an anatomy-guided cross-modal latent distillation task. First, MIRAGE leverages a Biomedical Knowledge Graph (KG) and Graph Attention Networks to map heterogeneous EHR variables into a unified embedding space that can be propagated from cohorts with real MRIs to cohorts without them. To bridge the semantic gap and enforce physical spatial awareness, we employ a frozen pre-trained 3D U-Net decoder strictly as an auxiliary regularization engine. Supported by a novel cohort-aggregated skip feature compensation strategy, this decoder acts as a rigorous structural penalty, forcing 1D latent representations to encode biologically plausible, macro-level pathological semantics. By exclusively utilizing this distilled "diagnostic-surrogate" representation during inference, MIRAGE completely bypasses computationally expensive 3D voxel reconstruction. Experiments demonstrate that our framework successfully bridges the missing-modality gap, improving the AD classification rate by 13% compared to unimodal baselines in cohorts without real MRIs.

Noninvasive Intracranial Pressure Estimation Using Subspace System Identification and Bespoke Machine Learning Algorithms: A Learning-to-Rank Approach

Objective: Accurate noninvasive estimation of intracranial pressure (ICP) remains a major challenge in critical care. We developed a bespoke machine learning algorithm that integrates system identification and ranking-constrained optimization to estimate mean ICP from noninvasive signals. Methods: A machine learning framework was proposed to obtain accurate mean ICP values using arbitrary noninvasive signals. The subspace system identification algorithm is employed to identify cerebral hemodynamics models for ICP simulation using arterial blood pressure (ABP), cerebral blood velocity (CBv), and R-wave to R-wave interval (R-R interval) signals in a comprehensive database. A mapping function to describe the relationship between the features of noninvasive signals and the estimation errors is learned using innovative ranking constraints through convex optimization. Patients across multiple clinical settings were randomly split into testing and training datasets for performance evaluation of the mapping function. Results: The results indicate that about 31.88% of testing entries achieved estimation errors within 2 mmHg and 34.07% of testing entries between 2 mmHg to 6 mmHg from the nonlinear mapping with constraints. Conclusion: Our results demonstrate the feasibility of the proposed noninvasive ICP estimation approach. Significance: Further validation and technical refinement are required before clinical deployment, but this work lays the foundation for safe and broadly accessible ICP monitoring in patients with acute brain injury and related conditions.

Generalist vs Specialist Time Series Foundation Models: Investigating Potential Emergent Behaviors in Assessing Human Health Using PPG Signals

Foundation models are large-scale machine learning models that are pre-trained on massive amounts of data and can be adapted for various downstream tasks. They have been extensively applied to tasks in Natural Language Processing and Computer Vision with models such as GPT, BERT, and CLIP. They are now also increasingly gaining attention in time-series analysis, particularly for physiological sensing. However, most time series foundation models are specialist models - with data in pre-training and testing of the same type, such as Electrocardiogram, Electroencephalogram, and Photoplethysmogram (PPG). Recent works, such as MOMENT, train a generalist time series foundation model with data from multiple domains, such as weather, traffic, and electricity. This paper aims to conduct a comprehensive benchmarking study to compare the performance of generalist and specialist models, with a focus on PPG signals. Through an extensive suite of total 51 tasks covering cardiac state assessment, laboratory value estimation, and cross-modal inference, we comprehensively evaluate both models across seven dimensions, including win score, average performance, feature quality, tuning gain, performance variance, transferability, and scalability. These metrics jointly capture not only the models' capability but also their adaptability, robustness, and efficiency under different fine-tuning strategies, providing a holistic understanding of their strengths and limitations for diverse downstream scenarios. In a full-tuning scenario, we demonstrate that the specialist model achieves a 27% higher win score. Finally, we provide further analysis on generalization, fairness, attention visualizations, and the importance of training data choice.

Learning ECG Representations via Poly-Window Contrastive Learning

Electrocardiogram (ECG) analysis is foundational for cardiovascular disease diagnosis, yet the performance of deep learning models is often constrained by limited access to annotated data. Self-supervised contrastive learning has emerged as a powerful approach for learning robust ECG representations from unlabeled signals. However, most existing methods generate only pairwise augmented views and fail to leverage the rich temporal structure of ECG recordings. In this work, we present a poly-window contrastive learning framework. We extract multiple temporal windows from each ECG instance to construct positive pairs and maximize their agreement via statistics. Inspired by the principle of slow feature analysis, our approach explicitly encourages the model to learn temporally invariant and physiologically meaningful features that persist across time. We validate our approach through extensive experiments and ablation studies on the PTB-XL dataset. Our results demonstrate that poly-window contrastive learning consistently outperforms conventional two-view methods in multi-label superclass classification, achieving higher AUROC (0.891 vs. 0.888) and F1 scores (0.680 vs. 0.679) while requiring up to four times fewer pre-training epochs (32 vs. 128) and 14.8% in total wall clock pre-training time reduction. Despite processing multiple windows per sample, we achieve a significant reduction in the number of training epochs and total computation time, making our method practical for training foundational models. Through extensive ablations, we identify optimal design choices and demonstrate robustness across various hyperparameters. These findings establish poly-window contrastive learning as a highly efficient and scalable paradigm for automated ECG analysis and provide a promising general framework for self-supervised representation learning in biomedical time-series data.

Offline Guarded Safe Reinforcement Learning for Medical Treatment Optimization Strategies

When applying offline reinforcement learning (RL) in healthcare scenarios, the out-of-distribution (OOD) issues pose significant risks, as inappropriate generalization beyond clinical expertise can result in potentially harmful recommendations. While existing methods like conservative Q-learning (CQL) attempt to address the OOD issue, their effectiveness is limited by only constraining action selection by suppressing uncertain actions. This action-only regularization imitates clinician actions that prioritize short-term rewards, but it fails to regulate downstream state trajectories, thereby limiting the discovery of improved long-term treatment strategies. To safely improve policy beyond clinician recommendations while ensuring that state-action trajectories remain in-distribution, we propose \textit{Offline Guarded Safe Reinforcement Learning} ($\mathsf{OGSRL}$), a theoretically grounded model-based offline RL framework. $\mathsf{OGSRL}$ introduces a novel dual constraint mechanism for improving policy with reliability and safety. First, the OOD guardian is established to specify clinically validated regions for safe policy exploration. By constraining optimization within these regions, it enables the reliable exploration of treatment strategies that outperform clinician behavior by leveraging the full patient state history, without drifting into unsupported state-action trajectories. Second, we introduce a safety cost constraint that encodes medical knowledge about physiological safety boundaries, providing domain-specific safeguards even in areas where training data might contain potentially unsafe interventions. Notably, we provide theoretical guarantees on safety and near-optimality: policies that satisfy these constraints remain in safe and reliable regions and achieve performance close to the best possible policy supported by the data.

GPT-PPG: A GPT-based Foundation Model for Photoplethysmography Signals

This study introduces a novel application of a Generative Pre-trained Transformer (GPT) model tailored for photoplethysmography (PPG) signals, serving as a foundation model for various downstream tasks. Adapting the standard GPT architecture to suit the continuous characteristics of PPG signals, our approach demonstrates promising results. Our models are pre-trained on our extensive dataset that contains more than 200 million 30s PPG samples. We explored different supervised fine-tuning techniques to adapt our model to downstream tasks, resulting in performance comparable to or surpassing current state-of-the-art (SOTA) methods in tasks like atrial fibrillation detection. A standout feature of our GPT model is its inherent capability to perform generative tasks such as signal denoising effectively, without the need for further fine-tuning. This success is attributed to the generative nature of the GPT framework.

Explore the Use of Time Series Foundation Model for Car-Following Behavior Analysis

Modeling car-following behavior is essential for traffic simulation, analyzing driving patterns, and understanding complex traffic flows with varying levels of autonomous vehicles. Traditional models like the Safe Distance Model and Intelligent Driver Model (IDM) require precise parameter calibration and often lack generality due to simplified assumptions about driver behavior. While machine learning and deep learning methods capture complex patterns, they require large labeled datasets. Foundation models provide a more efficient alternative. Pre-trained on vast, diverse time series datasets, they can be applied directly to various tasks without the need for extensive re-training. These models generalize well across domains, and with minimal fine-tuning, they can be adapted to specific tasks like car-following behavior prediction. In this paper, we apply Chronos, a state-of-the-art public time series foundation model, to analyze car-following behavior using the Open ACC dataset. Without fine-tuning, Chronos outperforms traditional models like IDM and Exponential smoothing with trend and seasonality (ETS), and achieves similar results to deep learning models such as DeepAR and TFT, with an RMSE of 0.60. After fine-tuning, Chronos reduces the error to an RMSE of 0.53, representing a 33.75% improvement over IDM and a 12-37% reduction compared to machine learning models like ETS and deep learning models including DeepAR, WaveNet, and TFT. This demonstrates the potential of foundation models to significantly advance transportation research, offering a scalable, adaptable, and highly accurate approach to predicting and simulating car-following behaviors.

Measuring Spiritual Values and Bias of Large Language Models

Large language models (LLMs) have become integral tool for users from various backgrounds. LLMs, trained on vast corpora, reflect the linguistic and cultural nuances embedded in their pre-training data. However, the values and perspectives inherent in this data can influence the behavior of LLMs, leading to potential biases. As a result, the use of LLMs in contexts involving spiritual or moral values necessitates careful consideration of these underlying biases. Our work starts with verification of our hypothesis by testing the spiritual values of popular LLMs. Experimental results show that LLMs' spiritual values are quite diverse, as opposed to the stereotype of atheists or secularists. We then investigate how different spiritual values affect LLMs in social-fairness scenarios e.g., hate speech identification). Our findings reveal that different spiritual values indeed lead to different sensitivity to different hate target groups. Furthermore, we propose to continue pre-training LLMs on spiritual texts, and empirical results demonstrate the effectiveness of this approach in mitigating spiritual bias.