Frequency Selective Neural Networks as a Foundation Architecture for Time Series Learning

Time-series data across physical and biological domains are fundamentally driven by complex, non-stationary oscillatory modes. While deep learning models, such as Convolutional Neural Networks (CNNs), Recurrent Neural Networks, and Transformers, have dominated sequential analysis, they remain fundamentally "spectral-blind". By mapping continuous physical waves into unconstrained spatial or discrete token spaces, these architectures suffer from severe spectral entanglement, acting as opaque black boxes that decouple predictive accuracy from physical reality. In this paper, we introduce the Frequency Selective Neural Network (FSNN), pioneering a foundation architecture guaranteeing physical interpretability without sacrificing expressive power of deep learning. FSNN addresses spectral entanglement by explicitly embedding the rigorous mathematics of advanced signal processing into its neural topology. Through a fully differentiable Wiener-like filter bank optimized via complex-domain backpropagation, FSNN autonomously discovers and isolates the precise physical modes of a given task. Extensive evaluations demonstrate that FSNN establishes state-of-the-art predictive performance, achieving $77.0\%$ average accuracy on the standard 10 multivariate UEA datasets and leading across all major metrics on the highly imbalanced PTB-XL clinical ECG benchmark. Crucially, in contrast to yielding abstract feature maps, FSNN converges directly on physically meaningful frequency bands, such as isolating the cardiac QRS complex, providing a highly scalable, interpretable paradigm for robust pattern recognition in complex temporal domains. Our code is available at: https://github.com/ad6174hhhh/FSNN.

CardioFusion-AI: Robust ECG--PPG Fusion for Multimodal Physiological Monitoring Under Signal Degradation

Wearable electrocardiogram (ECG) and photoplethysmogram (PPG) sensors are complementary but individually fragile: motion artifact, poor contact, and sensor dropout can degrade one or both signals. Fusion strategies that assume both modalities are equally trustworthy can become less reliable than a single clean modality under degradation. We present CardioFusion-AI, a framework whose signal-processing front end, including R-peak and systolic-peak detection, an Orphanidou-type signal-quality index, and beat-by-beat pulse transit time estimation, is validated on 53 real intensive-care recordings (848 windows; heart-rate mean absolute error 1.61 bpm for ECG and 2.78 bpm for PPG) and a real annotated fetal ECG database (R-peak F1 0.89-0.98). We then conduct a controlled synthetic degradation study comparing eight ECG-PPG fusion strategies across six degradation regimes spanning graded corruption and complete modality loss, using five independent training seeds. Attention fusion achieved the lowest descriptive overall error (1.66+/-0.43 bpm). Both adaptive gates reallocated weight toward the healthy modality under complete modality loss, but showed near-zero correlation between gate weight and signal quality under graded degradation (r = 0.10-0.24). Signal-quality conditioning produced a specific improvement under missing-PPG conditions (1.56+/-0.59 bpm), approaching the 1.48 bpm unimodal ceiling. With only five training seeds, no pairwise comparison survives Holm-corrected significance testing; effect sizes and confidence intervals are therefore reported. These results indicate that modality availability and modality quality are functionally distinct problems for adaptive fusion.

Capturing Cardiac Cyclicity through Phase-Equivariant Self-Supervised Learning

The cyclic structure of physiological processes offers a natural prior for self-supervised representation learning, and the cardiac cycle provides a particularly well-defined setting in which to exploit it. We derive a phase-equivariant self-supervised objective and introduce Winder, a joint-embedding architecture that organises representations into phase-invariant coordinates and phase-rotating harmonic subspaces. Its transport operator is fixed and closed-form, derived from the cycle's geometry rather than learned, and adds no parameters. Evaluated on PTB-XL under a frozen linear-probe protocol, Winder attains diagnostic accuracy within the range reported by state-of-the-art self-supervised methods at a ~1 M parameter footprint, while exhibiting phase-equivariant latent geometry. These findings demonstrate that explicitly encoding cardiac-phase symmetry can preserve diagnostically useful information while yielding a latent geometry that is legible, parameter-efficient, and directly tied to a measurable physiological quantity.

Guaranteed Adaptive Modality Acquisition: When the Policy Chooses Its Own Calibration Group

A multimodal system may begin inference holding only some of its inputs and may acquire the rest at a cost. With adaptive acquisition, the policy determines which inputs are ultimately observed, so we state the guarantee conditional on that terminal input pattern. Conditional calibration normally assumes the grouping map is fixed independently of the calibration sample, which policy-induced grouping does not satisfy. We characterize when pattern-conditional guarantees remain valid and give two finite-sample constructions: threshold-free routing with calibration applied at the terminal pattern, and simultaneous certification of complete policy-pattern pairs, which lets calibration data select the deployed policy. A counterexample shows that a guarantee proved for a calibration-independent grouping map need not transfer once the policy makes the terminal group calibration-dependent. We call the resulting method RouteCert. On a clinical electrocardiogram task with a staged, cost-ordered lead protocol, the certified policy answers 71.2% of held-out patients at an observed 7.4% disagreement with the cardiologist's diagnosis at 48.8% of the prespecified ordinal cost of acquiring every stage, and all three acquisition stages carry their own certificate. On masked multimodal benchmarks, certifying pointwise at each terminal pattern holds observed worst-pattern selective risk, measured against the full-information reference decision rather than the true label, at 0.034 where a pooled design reaches 0.145 against a 0.10 cap, at a comparable answered fraction (0.350 vs 0.342); under the budget-matched simultaneous comparison the answered fraction falls to 0.305.

CardioState-JEPA: Delay-Aware Cross-Modal Learning of a Shared Cardiac Representation

Electrocardiography (ECG), photoplethysmography (PPG), and phonocardiography (PCG) provide complementary views of the same cardiac cycle, yet existing cardiac foundation models are trained for a single sensing modality, leaving the shared physiology across sensors unexploited. We introduce CardioState-JEPA, a cardiac foundation model to learn a single shared representation jointly across ECG, PPG, and PCG, built on a physiology-aware joint-embedding predictive architecture. The model maps heterogeneous waveforms into a common token space, processes them with a single shared Transformer encoder, and learns by predicting masked latent cardiac states, placing the pretraining target on shared physiology rather than sensor-specific waveform appearance. To handle the temporal offsets between electrical, mechanical, and hemodynamic events, cross-modal prediction uses a learned delay aligner that matches signals at the corresponding cardiac time. Because synchronized multi-sensor recordings are scarce, CardioState-JEPA first learns within-modality structure from abundant unimodal data and then uses paired data to align modalities in latent cardiac time. Evaluated as a frozen encoder across 25 downstream tasks spanning ECG, PPG, and PCG, our encoder improves average PPG classification by 8.2 AUROC points, PCG murmur detection by 18.8 AUROC points, and ECG classification by 15.5 AUROC points over the best self-supervised signal baseline and matches or exceeds cardiac models trained with privileged clinical text or supervised labels on several ECG benchmarks. These results establish that heterogeneous cardiac signals can mutually supervise a single foundation model of cardiac physiology.

CFD-Guided Detection of Concept Drift in Multimodal Physiologic Signals

Cardiovascular AI models can classify clean elec- trocardiogram (ECG) signals, but real wearable signals change because of motion, breathing, posture, sensor contact, and true clinical deterioration. This paper asks when a model should keep its prediction, change it, or flag uncertainty. We propose a physiologic stability framework, called PECS, that compares changes inside the model with measurable changes in the signal. ECG is treated as the main cardiac signal, photoplethysmography (PPG) adds pulse and vascular information, and respiration is used only when ECG and PPG disagree. We test the framework on PTB-XL at pilot and full scales and on synchronized BIDMC and MIMIC waveform cohorts. The PTB-XL pilot and full- scale analyses selected different domain pairs, and the strongest cross-modal pair also changed across BIDMC and MIMIC, showing that adding every available signal is not always the best choice. PECS outperformed the evaluated drift-detection baseline implementations, reaching drift classification accuracy (DCA) of 0.8786 on expanded BIDMC and 0.9560 on MIMIC. The MIMIC results also showed that respiration can help during disagreement cases, but it should be used selectively rather than as an automatic override. Overall, the results support PECS as a candidate monitoring framework for wearable cardiovascular AI while highlighting the need for scale-aware domain selection and interpretable trust routing

FOUND-AF: Benchmarking ECG Foundation Models for Atrial Fibrillation Detection

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with increased risks of stroke, heart failure, and mortality. Recent ECG foundation models offer transferable representations for automated AF detection. However, their relative effectiveness remains unclear because existing studies use different datasets, preprocessing procedures, classifiers, and validation protocols. This study presents FOUND-AF, a unified, leakage-controlled, and deployment-oriented benchmarking framework that evaluates the quality of pretrained ECG representations under identical experimental conditions. Nine publicly available foundation models from five families, including HuBERT-ECG, CLEF, ST-MEM, ECG-JEPA, and ECGFounder, were evaluated across four heterogeneous ECG datasets, namely AFDB, CinC2017, CPSC2021, and LTAFDB. All models were used as frozen feature extractors with standardized preprocessing, model-native resampling, a fixed XGBoost classifier, and recording-level grouped cross-validation. The evaluation included classification metrics, receiver operating characteristic analysis, paired recording-level bootstrap comparisons with Holm correction, embedding-space visualization, and computational efficiency profiling. The ECGFounder model consistently achieved the strongest overall performance across datasets while offering a favorable trade-off between accuracy, model size, inference time, and memory usage. FOUND-AF therefore provides a reproducible framework for selecting ECG foundation models and demonstrates that compact, clinically pretrained encoders can support robust and computationally efficient AF detection across heterogeneous acquisition settings.

Loud or Silent? A Reusable Framework for Per-Modality Failure Analysis in Multimodal Clinical AI

Multimodal clinical models are usually judged on accuracy with every modality present, but deployment removes modalities; an echocardiogram is often unavailable where an ECG is routine. Two questions then matter beyond the size of the accuracy loss: which modality was responsible, and whether the model fails loudly or silently once that modality is dropped. The distinction is per-example and modality-level, and is separate from post-hoc feature attribution (e.g. SHAP). Models are replaced often; the evaluation that answers these questions is reused. We present a model-agnostic modality-failure framework: given N modality embeddings, any mask-aware probe, and labels, it returns a per-example failure taxonomy, a per-modality complementarity matrix that attributes error to modalities, and a loud-vs-silent dropout profile separating monitorable failures from those that pass unflagged far from the decision boundary, using only deployment-observable signals. We release it as a small, unit-tested harness and validate it against planted ground truth. Across seeds it recovers that planted modality dominance and complementary subset, reports per-modality loud-vs-silent rates, and scales to a three-modality complementarity matrix; because the planted structure is known by construction, this validates recovery of per-example attribution rather than clinical performance. We then instantiate the framework on frozen EchoJEPA and HuBERT-ECG embeddings for LVEF and the EF <= 40% HFrEF gate over a paired MIMIC-IV cohort, where on the held-out test split (n = 245) dropping echo nearly doubles error. The narrow echo-to-ECG overlap that bounds cohort size is itself a deployment finding for cardiac foundation models. All of our work can be found at https://github.com/criticaldata/PRIMED-AI.

Does the Heart Show Your Pain? Tackling the X-ITE Pain Challenge with Self-Supervised ECG Representation Learning

Accurate recognition of pain using physiological signals remains a challenging problem due to pain's subjective nature and high inter-individual variability. In this study, we investigate self-supervised representation learning (SSL) methods applied to unimodal electrocardiogram (ECG), complemented by multimodal pretraining, including accelerometer (ACC) signals from the chest. We focus on classifying low versus medium pain levels on the X-ITE Pain dataset. Our results reveal that while ECG-based models show limited classification performance, multimodal pretraining improves learned representations by capturing cross-modal dependencies. Notably, we observe substantial inter-subject variability in model performance, suggesting that pain-related ECG patterns may be subject-specific. Visualizations indicate distinct subject-specific clustering but no clear separation by pain levels, highlighting the complexity of pain detection from ECG alone. We discuss limitations of unimodal input, label noise, and generalization across subjects and propose future directions. This work advances the understanding of physiological signal representation learning for pain recognition and sets the stage for more robust, clinically relevant wearable pain monitoring solutions.

P2E-VQ: ECG-linked representation augmentation for PPG via discrete patch retrieval

Photoplethysmography (PPG) is widely used in consumer wearables because of its low cost and ease of acquisition. However, unlike electrocardiography (ECG), PPG measures peripheral pulse dynamics rather than cardiac electrical activity, limiting its ability to predict cardiac conditions that rely on ECG-specific morphological cues. Existing methods attempt to bridge this gap by reconstructing ECG signals from PPG signals. However, this inverse mapping is inherently ill-posed, and faithful waveform reconstruction does not necessarily translate into improved downstream performance. To address this challenge, we propose P2E-VQ, a retrieval-augmented framework that replaces ECG waveform reconstruction with ECG-linked representation retrieval. Specifically, P2E-VQ converts PPG patches into discrete tokens and retrieves ECG-linked information from a memory bank constructed exclusively from the training data. This process augments PPG representations while requiring only PPG signals during inference. Extensive experiments on five public datasets covering six downstream tasks, including clinical endpoint prediction and affective state recognition, demonstrate that P2E-VQ consistently outperforms pretrained baselines under a unified frozen-feature linear-probing protocol.

Single-Beat Cuffless Blood Pressure Estimation Using Ear-PPG and ECG with a Lightweight Hybrid Learning Framework

Continuous cuffless blood pressure (BP) monitoring remains challenging due to motion artifacts, physiological variability, and the limited robustness of conventional pulse transit time (PTT) models under dynamic conditions. Many prior approaches rely on multi-second windows to stabilize estimation, an assumption that is frequently violated during real-world monitoring with intermittent signal corruption. Here, we show that discriminative BP-related information is preserved at the single-beat level and present a lightweight multi-modal wearable framework for continuous BP estimation. The system integrates synchronized chest electrocardiography (ECG) and ear-clip reflectance photoplethysmography, each co-located with a 6-axis inertial measurement unit to provide motion context. We introduce a hybrid learning architecture in which a one-dimensional convolutional neural network extracts a 64-dimensional embedding from individual PPG beats and fuses it with 30 physiology-grounded features, including PTT statistics and heart rate variability, followed by LightGBM regression. The method was evaluated using a multi-phase stress protocol ($n=10$) and the PulseDB public dataset with subject-disjoint validation. Across 30 independent runs, the model achieved mean absolute errors of $4.02 \pm 0.21$~mmHg for systolic BP and $1.79 \pm 0.05$~mmHg for diastolic BP, corresponding to a 28.2\% reduction in combined MAE relative to baseline models. By enabling beat-wise estimation without long temporal context, this framework supports computationally efficient cuffless BP monitoring suitable for wearable deployment under practical resource constraints. The source code for this work is available at https://github.com/SYMBIOX-Lab/BP-wireless.

Cardiologent: Multi-Agent Clinical Decision Support for Patient-Level Arrhythmia Assessment, Urgency, and Management

The same episode of atrial fibrillation is a minor finding in a healthy adult and grounds for anticoagulation in an elderly patient with hypertension: identical signal, opposite decision. Naming the rhythm is only the start; what determines a patient's outcome is the judgement that follows -- what the arrhythmia is across the whole record, what it means for this patient, and what should be done about it. Recent work pairing large language models with the ECG stops short of this, reading one recording without assembling a patient-level finding; and agentic systems built around it either receive the arrhythmia a device has already detected or target a different diagnostic task, stopping before the decision this task requires. We formulate patient-level arrhythmia decision support as a task and present Cardiologent, a multi-agent system that spans it from detection to decision. An agent for each signal -- a single ECG lead and the photoplethysmogram a wearable acquires -- grounds its window reading in measured features rather than a bare label; the readings are assembled into the patient's rhythm profile and, with the patient's own data, reasoned against clinical guidelines retrieved for the case, with a critic checking each conclusion against the guideline it cites. We evaluate the clinical decision rather than the report, across integrated diagnosis, clinical significance, and urgency and management. Cardiologent scores highest on every axis, first on every patient-level task under both cardiologists and an at-scale LLM judge -- whose agreement with the cardiologists (ICC 0.74, 0.66) matches theirs with each other (0.67). Because each conclusion traces to a cited guideline and is validated against expert cardiologists, it yields decisions a clinician can audit rather than act on blindly -- a step toward use in continuous monitoring.

Multimodal Wearable-Based Olfactory-Induced Emotion Recognition in Arousal-Valence Dimensions

Olfaction is important for emotion regulation because it acts as a non-intrusive and cognitively lightweight pathway that directly engages the brain s affective circuitry and achieves unobtrusive emotional modulation. This trait is essential for advancing practical affective computing in daily and attention-critical scenarios. However, current olfactory emotion research has two key limitations. First, it overemphasises the valence dimension while neglecting arousal. Second, it lacks multimodal datasets that synchronously capture central and peripheral physiological responses to olfactory stimuli. To address these issues, we construct a large-scale multimodal olfactory emotion dataset based on 111 subjects, in which odors are labeled in the 2D arousal-valence space and electroencephalogram (EEG), electrocardiogram (ECG), and photoplethysmography (PPG) signals synchronously recorded. Nevertheless, multimodal signals present challenges such as non-stationarity, differences in latency, and cross-modal heterogeneity. Thus, we propose a spatiotemporal-frequency hybrid fusion network (STF-HFNet), which integrates three core modules. Frequency aggregation processing learns adaptive frequency aggregation in order to model non-stationary dynamics. Reciprocal guided attention enables reciprocal bidirectional calibration for cross-modal temporal alignment without synchronisation priors. Hybrid collaborative fusion combines spatial and channel attention mechanisms to enhance cross-modal complementarity while suppressing redundant information. Extensive experiments show that STF-HFNet achieves state-of-the-art (SOTA) recognition accuracies of 88.34% on the AMIGOS dataset and 92.40% on our self-constructed dataset, and outperform the SOTA methods by 8.27% and 5.07%, respectively.

FedDP-PALD: A Privacy-Preserving Federated Latent Diffusion Framework with Prototype Aggregation for Medical Data Synthesis

Medical images and physiological signals provide valuable information for accurate diagnosis. Developing diagnostic models often requires patient data from multiple institutions, although strict privacy regulations limit the sharing of sensitive clinical records. Federated learning enables multiple hospitals to train a shared model without exchanging raw data. However, existing methods face two problems: the information exchanged during training can reveal whether a patient's data were used, and synthetic data meant to replace real records often fail to preserve their predictive structure, which limits clinical use. To address this issue, we propose FedDP-PALD, a privacy-preserving federated latent diffusion framework for multimodal medical data synthesis under formal privacy guarantees. It jointly processes chest X-ray images and electrocardiogram (ECG) signals through gated multi-head attention with modality-availability masks, remaining effective even when a modality is missing. We also introduce Differentially Private Prototype Mixture Aggregation (DP-PMA), which clips class-level latent prototypes and adds calibrated Gaussian noise before combining them on the server to maintain $(ε, δ)$ differential privacy. We evaluate FedDP-PALD on PneumoniaMNIST, ChestMNIST, and MIT-BIH datasets, where differential privacy reduced summary-level attack AUROC from 0.6229 $\pm$ 0.0026 to between 0.5016 and 0.5093 for privacy budgets from $ε= 1$ to $ε= 8$. On the test data, synthetic-latent training achieved an F1 score of 0.8993 $\pm$ 0.0006 and an AUROC of 0.9057 $\pm$ 0.0503, close to the 0.9747 $\pm$ 0.0132 real-latent training. These results show that FedDP-PALD generates private synthetic representations that preserve useful decision performance while strongly resisting membership inference.

Cross-Modal Generative Framework for Signal Translation from Fetal-Maternal Electrocardiograms to Fetal Doppler Waveforms

Fetal electrocardiogram (fECG) and Doppler ultrasound provide complementary views of fetal cardiovascular function: fECG captures electrical activity while Doppler reflects mechanical hemodynamics shaped by factors such as placental resistance and vascular compliance. Understanding the recoverable and unrecoverable Doppler components through reconstruction from fECG offers insight into the relative contributions of electrical versus mechanical factors in fetal circulation, thereby informing clinical decisions. In addition, clinical evidence of maternal-fetal cardiac coupling suggests that maternal cardiovascular dynamics may also inform fetal hemodynamics. To computationally model these relationships, we propose a cross-modal generative framework combining dilated convolutions with cross-modal attention to selectively incorporate maternal ECG and self-attention to capture long-range temporal dependencies. Trained on 885 synchronized fetal/maternal ECG and Doppler envelope segments from 39 pregnancies, our model synthesizes Doppler envelopes with power spectral density mean squared error (PSD MSE) of 49.9 +/- 15.8 dB^2 (51% lower than two-channel baseline) and heart-rate error of 4.71 +/- 0.77 bpm (1.5% better than baseline; negligible relative to the 110-160 bpm physiological range). Cross-modal attention yields a 39% PSD MSE reduction over naive dual-channel concatenation, quantifying the contribution of maternal-fetal coupling. Our proposed framework advances computational modeling of the maternal-fetal cardiovascular system by enabling the synthesis of Doppler envelopes from dual-lead ECG. By analysis of both recoverable and residual Doppler components, this approach enables quantification of the purely mechanical contributions to Doppler waveforms -- those not recoverable from electrical recordings -- ultimately facilitating a more comprehensive fetal assessment.

MorphologyFM: A Foundation Model for Morphology-Aware Representation Learning from ECG and Pulse Oximetry Waveforms

Foundation models have recently emerged as a powerful paradigm for learning transferable representations from large scale biomedical data, yet existing approaches for physiological waveforms primarily optimize reconstruction or forecasting objectives that do not explicitly preserve clinically meaningful waveform morphology. Electrocardiograms (ECGs) and pulse oximetry (SpO2) waveforms encode rich cardiovascular and hemodynamic information through their morphological structure. In this work, we introduce MorphologyFM, a multimodal foundation model pretrained on paired ECG and SpO2 waveforms from the MIMIC critical care database using a morphology aware self supervised learning objective. MorphologyFM combines morphology guided masking, cross modal representation learning, and contrastive latent alignment to learn representations that capture clinically relevant physiological structure without requiring manual annotations. We evaluate MorphologyFM across multiple downstream prediction tasks, including arrhythmia classification, hypoxemia prediction, mortality prediction, and length of stay estimation, demonstrating consistent improvements over representative self supervised learning methods, including Masked Autoencoders (MAE), contrastive learning, Barlow Twins, and Joint Embedding Predictive Architectures (JEPA). Furthermore, we show that jointly modeling ECG and SpO2 waveforms produces more transferable representations than single modality pretraining. Our results establish waveform morphology as a powerful inductive bias for self supervised physiological representation learning and introduce MorphologyFM as a general purpose foundation model for continuous physiological monitoring.

Do ECG Foundation Models Transfer to Rare Cardiac Diseases? Evidence from Brugada Syndrome Detection

Background: Foundation models (FMs) trained on large-scale unlabeled physiological data have emerged as a promising paradigm for medical artificial intelligence. Their ability to capture clinically meaningful, transferable representations for rare diseases remains largely unproven. This study investigates whether FM pre-training provides genuine clinical generalization benefits beyond improved optimization for rare electrocardiographic (ECG) phenotypes. Methods: We systematically evaluated nine publicly available ECG FMs for Brugada syndrome detection on the BrSwiss cohort (294 patients, 87 cases) and the independent external HUCA cohort (363 patients, 76 cases), under three strategies (from-scratch training, linear probing, full fine-tuning) across several configurations, including a 3% data ablation and zero-shot cross-site transfers. Results: Pre-training was necessary for high-capacity architectures unable to converge from scratch (AUC gain up to 0.411, p < 0.05), but gave no significant gain for compact architectures already converged on labeled data alone. On full BrSwiss, the best fine-tuned FM (ECG-CPC, AUC = 0.962) only marginally exceeded the strongest supervised baseline (ECG-CPC from scratch, AUC = 0.932; p = 0.091). At matched training-set size, the data-efficiency advantage on BrSwiss-3% (AUC gain = 0.055, p < 0.01) did not replicate on HUCA. Under zero-shot cross-site transfer, FM-based pipelines did not generalize better than supervised baselines, all approaching chance-level performance. Conclusion: For Brugada syndrome detection, FM pre-training is mechanical rather than semantic, providing optimization stability rather than transferable clinical knowledge. These findings challenge the assumption that large-scale pre-training inherently encodes clinically meaningful representations, highlighting the central role of model architecture and data-domain alignment.

Quantifying Explainable AI-introduced signal noise on ECG data with Spectral Entropy

Explainability techniques are used to assess the output of various deep learning models. This is especially true in healthcare, where models need to be trusted and decisions justified. Explainability (XAI) tools use heuristics which often add signal noise to the explanation "core". It is not always obvious what is signal from the model and what is noise from the XAI. We propose the use of spectral entropy as a measure of noise in XAI output. We demonstrate its usefulness in the context of classifying arrhythmias in an ECG dataset with different post hoc explainability techniques.

SPOTR: Spatio-temporal Pooling One-Token Reconstruction for Universal Physiological Signal Self-supervised Learning

Physiological signals such as EEG, ECG, and PPG are widely used in clinical monitoring. Recent self-supervised learning (SSL) methods offer an attractive way to leverage unlabeled recordings, yet they still fall short in practice. In particular, current SSL methods struggle across heterogeneous datasets, often distorting clinically meaningful structures or learning shortcuts from temporal and cross-channel redundancy. Consequently, existing SSL methods often deliver limited performance under linear probing, a lightweight adaptation setting that better matches real-world medical scenarios. Moreover, most Transformer-based SSL models encode a flattened spatiotemporal token sequence, incurring high computation and memory cost, and are typically developed within a single modality. To address these limitations, we present SPOTR (Spatio-temporal Pooling One-Token Reconstruction), a compress-reconstruct pretraining framework that introduces a single-token global bottleneck for physiological signals. SPOTR compresses each waveform into a single-token representation and reconstructs the signal conditioned only on this representation. Meanwhile, SPOTR introduces an efficient spatio-temporal compaction module to reduce computation and memory cost. Pretrained on 20 datasets spanning EEG, iEEG, ECG, and PPG, SPOTR consistently outperforms the strongest baseline under linear probing, improving average AUC by 18.49%, 21.71%, 17.86%, and 4.64%, respectively. Compared with a representative general-purpose time-series foundation model, SPOTR achieves around 78% lower latency and 52% lower peak GPU memory on average. The code can be found at https://github.com/5GYYYYY/SPOTR.

MedTS-TTT: Test-Time Training for Medical Time Series Classification

Medical time series (MedTS) signals such as electroencephalography (EEG) and electrocardiography (ECG) support many clinical applications. However, substantial subject-level heterogeneity often induces subject-level distribution shift, causing a fixed parameter set to generalize poorly to unseen individuals. Compared with domain adaptation methods that often depend on extra adaptation components or target-batch statistics, Test-Time Training (TTT) provides a more practical solution for sequential clinical data by enabling online adaptation from unlabeled test samples. However, many representative TTT methods require iterative inner-loop optimization, increasing test-time overhead. In this paper, we propose MedTS-TTT, a test-time training framework for medical time series modeling. MedTS-TTT is built upon Closed-Loop Self-Alignment Test-Time Training (CLSA-TTT) and a Gated Convolutional Backbone (GCB). CLSA-TTT constructs a token-level self-supervised target and performs a single-step fast-weight update for intra-layer closed-loop alignment, enabling rapid sample-wise adaptation without iterative inner-loop optimization. GCB combines CLSA-TTT-based fast adaptation and token-level fusion with a gated convolutional branch to balance local dynamic modeling and information-flow control. On 4 public datasets (2 EEG and 2 ECG) with subject-independent splits, MedTS-TTT achieves 11 top-1 rankings out of 12 evaluations across 9 baselines and 3 metrics. The code is publicly available at https://github.com/mingzhi-c/MedTS-TTT.

SL-S4Wave: Self-Supervised Learning of Physiological Waveforms with Structured State Space Models

Modeling long-sequence medical time series data, such as electrocardiograms (ECG), poses significant challenges due to high sampling rates, multichannel signal complexity, inherent noise, and limited labeled data. While recent self-supervised learning (SSL) methods, based on various encoder architectures such as convolutional neural networks, have been proposed to learn representations from unlabeled data, they often fall short in capturing long-range dependencies and noise-invariant features. Structured state space models (S4) excel at long-sequence modeling, but existing S4 architectures fail to capture the unique characteristics of multichannel physiological waveforms. In this work, we propose SL-S4Wave, a self-supervised learning framework that combines contrastive learning with a tailored encoder built on structured state space models. The encoder incorporates multi-layer global convolution using multiscale subkernels, enabling the capture of both fine-grained local patterns and long-range temporal dependencies in noisy, high-resolution multichannel waveforms. Extensive experiments on real-world datasets demonstrate that SL-S4Wave (1) consistently outperforms state-of-the-art supervised and self-supervised baselines in a challenging arrhythmia detection task, (2) achieves high performance with significantly fewer labeled examples, showcasing strong label efficiency, and (3) maintains robust performance on long waveform segments, highlighting its capacity to model complex temporal dynamics in long sequences that most existing approaches fail to efficiently model, and (4) transfers effectively to unseen arrhythmia types, underscoring its robust cross-domain generalization. We additionally evaluate SL-S4Wave on multiple EEG tasks, achieving superior performance over strong baselines, demonstrating generalizability of our approach beyond cardiac waveforms.

A spectral audit framework reveals task-dependent aperiodic reliance across EEG and ECG deep learning

Deep learning on physiological time series is interpreted through domain-specific features -- oscillatory rhythms in EEG, morphological complexes in ECG -- yet these signals sit atop a broadband aperiodic 1/f-like envelope that covaries with arousal, age, and pathology. We introduce a spectral audit framework combining aperiodic/periodic decomposition, phase-preserving Fourier interventions, sham controls, and simulation validation. Aperiodic reliance was task-dependent and architecture-general: across six neural architectures, flattening drops exceeded 0.42 balanced-accuracy points for sleep-wake classification, reached 0.07-0.13 for clinical abnormality detection, and remained minimal for motor imagery. Six of seven EEG foundation models showed FDR-significant aperiodic reliance on clinical EEG; age/sex and recording-era controls reduced but did not eliminate the effect. Applying the audit to PTB-XL ECG revealed neural drops of 0.32--0.36 persisting after demographic matching, confirming this confound class extends beyond EEG. Aperiodic controls should become standard for interpretable physiological time-series deep learning.

PAMF: Prior-Aware Multimodal Fusion for Incomplete Time Series Data

In healthcare, multimodal time series tasks often operate on incomplete observations in practice, for example when ECG segments are lost because electrodes detach or an entire respiratory channel is unavailable during overnight monitoring. Such missingness typically appears in two structurally distinct patterns: within-modality missing, where values are absent within an otherwise observed modality, and modality-level missing, where an entire modality is unavailable. Existing methods typically represent unobserved data implicitly through masks or missing embeddings, without learning instance-specific missing information, and most are designed for only one missingness pattern. A natural approach is to explicitly estimate the missing data; however, existing imputation methods treat missingness uniformly despite their different structural priors, and the imputation process is often isolated from downstream tasks, preventing downstream tasks from guiding imputation toward more informative representations. To address these limitations, we present PAMF, a multimodal time-series framework that explicitly handles different missingness patterns while coupling imputation with downstream prediction through prior-aware flow matching and weight sharing. Specifically, the method initializes the flow-matching source state with type-specific priors to distinguish two missing types. It further connects imputation and classification through architecturally matched encoders with weight sharing, transferring task-relevant representations into the imputation process. Experiments on multiple multimodal healthcare time-series benchmarks show that the proposed method achieves the strongest overall downstream performance across diverse datasets and missing settings compared with existing baselines.

ADAPTOOD: Uncertainty-Aware Fine-Tuning for Out-of-Distribution ECG Time Series Models

Data samples used for training often differ from those encountered during fine-tuning and deployment, and while ML models show promise, their performance remains limited when only small annotated datasets are available. Performance often degrades under distribution shifts caused by diverse sensors, populations, and application settings. Although pre-training helps, models frequently encounter out-of-distribution (OOD) data in real-world settings, leading to reduced robustness. Existing adaptation methods usually assume fixed distribution shifts and struggle when multiple types or severities occur. In particular, they overlook shift severity, for example treating adaptation to a large familiar dataset the same as adaptation to a small dataset with a new task, which limits generalisation. To address this, we propose ADAPTOOD, a novel framework that leverages data uncertainty to quantify distribution shift severity and guide fine-tuning for time series. This uncertainty measures how strongly samples from the target deployment distribution deviate from the pre-training distribution, providing a direct signal of OOD severity. Our framework combines this uncertainty with low-rank model updates and adaptive hyperparameter optimisation to improve adaptation. We show that ADAPTOOD achieves up to 7% higher accuracy and 12.9% higher precision than existing methods in OOD tasks, maintaining strong performance as distribution shift severity increases.

CogAdapt: Transferring Clinical ECG Foundation Models to Wearable Cognitive Load Assessment via Lead Adaptation

Real-time cognitive load assessment is essential for adaptive human-computer interaction but remains challenging due to limited labeled data and poor cross-subject generalization. Recent ECG foundation models pre-trained on millions of clinical recordings offer rich representations, but cannot be directly applied to wearable devices due to sensor configuration mismatch and task differences. In this paper, we propose CogAdapt, a framework that adapts clinical ECG foundation models to wearable cognitive load assessment. CogAdapt introduces LeadBridge, a learnable adapter that transforms 3-lead wearable signals into anatomically consistent 12-lead representations, and ProFine, a progressive fine-tuning strategy that gradually unfreezes encoder layers while preventing catastrophic forgetting. Evaluations on two public datasets (CLARE and CL-Drive) under leave-one-subject-out cross-validation show that CogAdapt substantially outperforms baselines trained from scratch, achieving macro-F1 scores of 0.626 and 0.768. These results demonstrate the promise of foundation model adaptation for subject-independent cognitive load assessment from wearable sensors.

Physiology and Anatomy Aware Inverse Inference of Myocardial Infarction for Cardiac Digital Twin

Accurate localization of myocardial infarction is essential for risk stratification. While LGE-MRI remains the gold standard, it is resource-intensive. Integrating cine MRI with ECG enables a more detailed representation of infarct properties. Existing inverse MI inference methods overlook realistic scar morphology and cardiac repolarization, reducing sensitivity to subtle ECG variations and interpretability of infarct-induced electrophysiological changes. In this paper, we propose a novel framework for noninvasive MI localization using cardiac digital twins. To bridge the domain gap between simulation and reality, we introduce an anatomy-aware stochastic infarct synthesis strategy to synthesize realistic, irregular scars with border zones, mimicking ischemic transmural progression. We then construct a virtual cohort to simulate QRS-T waveforms, capturing both depolarization and repolarization dynamics. Furthermore, we design a Physiology and Anatomy Aware Network (PAA-Net) that jointly encodes 3D myocardial geometry and multi-lead ECGs to infer infarct areas with varying localizations, sizes, spatial extents, and transmuralities. Experimental results demonstrate that our framework significantly outperforms existing methods in inverse inference, achieving Dice scores of 0.7391 and 0.5503 for scar and border zone segmentation, respectively, while further enhancing the interpretability of the ECG-infarct relationship. Our code will be released upon acceptance.

Pretraining on Sleep Data Improves non-Sleep Biosignal Tasks

Sleep foundation models have recently demonstrated strong performance on in-domain polysomnography tasks, including sleep staging, apnea detection, and disease risk prediction. In this work, we investigate whether sleep biosignals can serve as an effective pretraining distribution for learning representations that transfer beyond sleep to adjacent domains. Following sleep foundation models, we perform sleep-only multimodal contrastive pretraining (with a leave-one-out objective) and evaluate transfer to non-sleep EEG and ECG, two well-benchmarked biosignal modalities with heterogeneous datasets and clinically meaningful downstream tasks. Across eight downstream tasks spanning multiple EEG and ECG datasets, sleep pretraining consistently improves performance relative to training from scratch. Moreover, on several tasks, we achieve performance competitive with or surpassing prior specialized state-of-the-art and foundation models.