Curriculum-Aware Interpolate-then-Refine: Learned Physiological Time-Series Imputation under Realistic Missingness

Imputing physiological time series (arterial blood pressure, blood glucose, etc.) is essential for addressing the missingness that pervades clinical data. Yet modern imputation methods perform poorly in this domain: a recent benchmark found that simple linear interpolation outperformed every learned imputer on real-world clinical signals with realistic gaps. We show that this reflects two properties of physiological missingness that generic imputers ignore: gaps may occur when the signal is clinically extreme rather than typical, and gap lengths can easily span orders of magnitude. To this end, we introduce Curriculum-Aware Interpolate-then-Refine (CAIR), a two-stage framework for physiological time-series imputation. Our key motivation is to learn a coarse base curve and then repeatedly correct it toward physiological realism, rather than predict a gap in a single pass. Consequently, CAIR couples a bidirectional-GRU interpolator with a Transformer refiner that corrects its own estimate over three successive passes, trained jointly under a broad, signal-agnostic random-gap curriculum. We evaluate imputers stratified by gap length and missingness mechanism (MCAR, MAR, NMAR) rather than by a single average, and CAIR is the most accurate under every mechanism on continuous glucose monitoring (AI-READI) and arterial pressure in intensive care (MIMIC-III). Its margin over the strongest baseline grows with difficulty, from 9% under MCAR to 19% under value-dependent dropout, where generic learned imputers are weakest. We further show low reconstruction error alone does not recover the burden metrics clinicians act on: interpolants matching CAIR's error fail to preserve those metrics, imputers that recover them are far less accurate, and CAIR alone ranks among the best on both axes.

When Clean Signals Are Not Enough: Detecting Structural Ambiguity for Safe Wearable Stress Classification

Wearable stress classifiers can achieve strong average performance while failing completely for a particular individual. On WESAD, a Random Forest reaches 93.0% mean accuracy yet yields F1 = 0 for Subject 14, whose cross-signal coupling weakens near stress onset. We call this structural ambiguity: individually plausible physiological channels form an inter-signal pattern that is poorly supported by the person's non-stress reference. We introduce the Individual Conformal Coupling Monitor (ICCM), a lightweight and transparent pre-inference monitor that quantifies subject-specific coupling divergence and routes each window to classify, defer, or abstain without retraining the downstream classifier. Across WESAD (N = 15) and Stress-Predict (N = 35), full-cohort Pearson associations between ambiguity and accuracy are negative (r = -0.607, p = 0.016; r = -0.412, p = 0.014). Robustness analyses temper this finding: rank correlations are not significant, and the WESAD association disappears when Subject 14 is removed. ICCM changes false-positive counts from 29 to 27 and 94 to 92, although neither paired change is significant. It withholds 3 of Subject 14's 21 stress windows but does not repair the missed-stress failure. These results position ICCM as an interpretable signal of unsupported physiology and individual failure, rather than a stand-alone safety guarantee.

BioKD: Selective Physiology-to-Video Knowledge Distillation via Reliability Gate for Emotion Recognition

To address the limitations of video-based emotion recognition under ambiguous or socially masked behavioral cues, as well as the poor deployability of physiological signals, this paper proposes a reliability-aware physiology-to-video knowledge distillation framework, termed BioKD. The proposed framework leverages physiological signals as privileged information during training to guide a video-based student model in learning deep affective representations, while relying solely on non-intrusive video inputs at inference time. To cope with the high noise and instability of physiological teacher supervision caused by inter-subject variability, signal artifacts, and temporal inconsistency, BioKD incorporates a sample-wise reliability-aware gating mechanism together with a progressive distillation strategy. By adaptively regulating the strength of knowledge transfer, the framework suppresses negative transfer induced by unreliable physiological supervision and enables more stable cross-modal distillation. Experiments on DEAP and AMIGOS show that BioKD consistently outperforms representative baselines under both trial-wise and subject-wise evaluation protocols for valence and arousal recognition. For example, BioKD achieves 68.01\% on DEAP (trial-wise arousal) and 65.29\% under the more challenging subject-wise setting, demonstrating improved performance under a subject-independent evaluation setting. Further analyses show that BioKD effectively mitigates overconfident teacher errors and outperforms an entropy-only weighting strategy, confirming the importance of explicitly modeling supervision reliability. In addition, BioKD introduces no additional inference-time overhead relative to the same video student architecture and removes the need for physiological sensing and multimodal synchronization.

Blood Pressure Estimation from PPG: A Comparative Study of Direct and ECG-Mediated Deep Learning Pipelines

Continuous cuffless blood pressure (BP) monitoring is essential for connected health systems and wearable devices, enabling early detection, longitudinal tracking, and personalized management of cardiovascular disease. Many prior approaches attempt to estimate BP indirectly by reconstructing electrocardiography (ECG) from photoplethysmography (PPG), assuming ECG provides a stronger physiological link to BP. However, ECG sensing is less accessible in wearable settings and may introduce unnecessary complexity. In this work, we first perform a large-scale physiological correlation analysis on the MIMIC-III waveform database, revealing that PPG exhibits substantially stronger coupling with arterial blood pressure (ABP) ($|r|=0.247$, $p<0.001$) than ECG does ($r=0.018$, $p=0.187$), challenging the assumption that ECG provides a superior intermediate representation. Motivated by this insight, we conduct a systematic comparison between direct PPG-to-BP prediction and ECG-mediated pipelines using multiple state-of-the-art deep learning models. Across 1.74M segments from 3,127 patients, direct PPG-to-BP prediction achieves British Hypertension Society Grade A performance ($\mathrm{MAE}_{\mathrm{SBP}} = 4.82 mmHg$, $\mathrm{MAE}_{\mathrm{DBP}} = 4.31 mmHg$), outperforming all ECG-mediated approaches, which achieve only Grade B accuracy. Our findings suggest that accurate continuous BP monitoring can be achieved directly from wearable PPG signals, enabling simpler, more efficient pipelines for real-world connected health systems.

An Exploratory Analysis of Pain Localization via Explainable Computational Modeling

Automatic pain localization, which involves identifying the anatomical origin of pain from peripheral physiological signals without patient self-report, is a clinically critical but largely unaddressed problem, particularly for non-verbal patients. This paper presents a systematic comparison of classical feature engineering and deep sequence learning for subject-independent three-class pain localization using the AI4Pain 2026 Challenge dataset, which comprises four synchronously recorded wearable modalities: electrodermal activity, blood volume pulse, respiration, and peripheral oxygen saturation recorded from 65 participants under controlled TENS-induced pain. A 115-dimensional hand-crafted feature set spanning time-domain, frequency-domain, modality-specific, and cross-modal descriptors is benchmarked against end-to-end deep architectures. Extremely Randomized Trees achieves the highest macro-F1 of 0.539, outperforming the best deep model by 7.4 percentage points, with EDA spectral features emerging as the dominant discriminators. A consistent 26-point gap between pain detection (F1\,=\,0.815) and localization (F1\,=\,0.552) across all models points to a fundamental ceiling imposed by the anatomical diffuseness of peripheral autonomic pathways at 10-second resolution.

Unit-Independent Low-Rate Wrist GSR Processing for Stress Detection Using Phasic nSCR Features

Galvanic skin response (GSR) is widely used for stress detection, but wrist-based GSR remains challenging because its absolute amplitude can differ substantially from laboratory-grade palmar measurements. In this paper, we propose a unit-independent low-rate wrist GSR processing pipeline to extract the number of skin conductance responses per minute (nSCR/min) as a stress-related feature. We collect paired wrist and palmar GSR recordings from 31 participants during sitting baseline, standing baseline, neutral speaking, and the Trier Social Stress Test (TSST), a laboratory social stressor task. The proposed pipeline cleans the raw GSR signal, decomposes it into tonic skin conductance level (SCL) and phasic skin conductance response (SCR), applies robust z-score normalization, and detects phasic SCR peaks to compute nSCR/min. Using random forest on 25Hz We-Be GSR, nSCR/min achieved balanced accuracies of 0.823 and 0.871 for binary classification between TSST and the sitting and standing baselines, respectively. Moreover, the 25Hz We-Be GSR features achieved comparable balanced accuracy to the original 100Hz features across the evaluated tasks. These results suggest the feasibility of low-rate, unit-independent wrist GSR processing for wearable stress detection.

A Multi-Analyst LLM Pipeline for Auditable Rule Discovery Across 68 Public Physiological Corpora

Open physiological corpora are heterogeneous: they use different sensors, labels, sampling rates, recording settings, and clinical endpoints. They can support detector design, but they do not directly specify which detector rules should be built for a new contactless monitoring platform. We report a controlled four-analyst large-language-model (LLM) workflow for converting 68 public physiological corpora, screened for commercial-use compatibility, into an auditable library of candidate rule shapes for prospective validation. Four independent commercial LLM families read the corpus documentation under a controlled prompt and produced 695 candidate rule markers (top-markers). Deduplication retained 649 rule records; a threshold-bounds audit then flagged 51 sanity violations for clamping or curator review. Cross-corpus consolidation produced 436 unique rule shapes. Gate-tagging against two hard invariants, native target-hardware channel availability and no multi-night per-patient personalization, identified 94 build-now detector components across four detector-family buckets. The pipeline does not produce a validated clinical detector. It produces an auditable engineering cascade in which analyst disagreement, threshold checks, curator review, and automated continuous-integration (CI) checks route literature-derived rules toward prospective hardware validation.

Timesynth: A Temporal Fidelity Framework for Health Signal Digital Twins

Forecasting models for health-signal digital twins must preserve the oscillatory, frequency, phase, and state-transition dynamics of physiological signals, yet the pointwise metrics used to benchmark them cannot detect when these fundamental properties are lost. We show that this blind spot misranks models: across 11 architectures, models with comparable pointwise error diverge by up to 53° in phase accuracy, equivalent to roughly 123 ms for a 1.2 Hz cardiac rhythm and invisible to standard metrics. To enable development of models that escape such failures, we introduce TimeSynth, a controlled benchmarking framework with two reusable components: a physiologically grounded generator producing signals with analytically known ground-truth dynamics from parametric models fitted to real electroencephalography, electrocardiography and photoplethysmogram signals, along with diagnostics quantifying amplitude, frequency, phase, and state-transition fidelity. Linear and full-sequence attention models systematically lose frequency and phase information despite acceptable amplitude error, whereas architectures with localized temporal structure better preserve dynamical fidelity and adapt to observable state transitions; none, however, reliably preserves stochastic switching. Because the dominant determinant of fidelity is architectural, model choice becomes a principled, use-case-driven decision rather than a search for a single winner. TimeSynth thus supplies the controlled preclinical stress test missing before models are coupled to patient data, with a reusable generator and diagnostics for fidelity-aware development.

State-Specific Respiratory Signatures for Affective and Stress Recognition: Interpretable Respiratory Markers, Autocorrelation Lags, and Compact CNN Models

Respiratory activity is a direct and interpretable physiological channel for wearable stress and affective-state recognition, yet many studies emphasize classification accuracy without identifying which respiratory properties separate different states. This work reframes RESP-based recognition as a joint predictive and explanatory problem. Using the chest respiratory channel of the WESAD dataset, we analyze 60 s windows under leave-one-subject-out validation and combine two complementary branches: compact raw-signal one-dimensional convolutional neural networks (1D-CNNs) and physically grouped handcrafted respiratory signatures. The primary application task is binary stress versus non-stress detection, while baseline, stress, amusement, and meditation are additionally analyzed in a one-vs-rest setting to reveal state-specific respiratory markers. The feature space is organized into respiratory timing, breath-to-breath variability, waveform statistics, spectral/time-frequency descriptors, and autocorrelation/nonlinear predictability descriptors, with the raw 60 s signal treated as a sixth representation for the CNN branch. We introduce autocorrelation transition lags (Zpm/Zmp) as interpretable markers of respiratory correlation scale and separately evaluate exploratory FEG-Pro/Lyapunov-like descriptors. In the final CNN refit setting, the raw-signal model achieved the strongest stress-vs-rest performance, with accuracy 96.72 percent, macro-F1 95.30 percent, and MCC 90.61 percent. In contrast, compact feature models were stronger for baseline, with MCC 65.34 percent, amusement, with MCC 35.69 percent, and especially meditation, with MCC 88.65 percent. These results show that CNNs are most useful for the practical stress detector, whereas interpretable respiratory signatures provide stronger and more physiologically transparent state-specific markers for several non-stress conditions.

Patient-Aware Contrastive Learning Preserves Per-Patient Structure in RR-Interval Representations

Contrastive representation learning struggles on physiological signals when each subject contributes a distinct baseline pattern. If class differences overlap with subject differences,class-level objectives such as supervised contrastive learning tend to merge per-subject structure into a single per-class cluster,removing the individual variation that a model needs to generalize to unseen patients. We study this problem in the setting of Paroxysmal Atrial Fibrillation(PAF) detection from RR-interval(RRI) sequences and propose a patient-aware contrastive objective that forms positive pairs only from same-patient, same-class segments, preserving each patient's own sinus rhythm(SR) baseline while still pushing the two classes apart. Examining the learned embeddings directly, our objective achieves the most consistent per-patient SR structure (cohesion $0.850$ vs. $0.800$ for supervised contrastive loss (SupCon) and $0.772$ for binary cross-entropy (BCE)). We also identify that BCE produces the cleanest global class separation yet the most disordered per-patient structure. This is precisely why a linear probe trained on its features breaks down on unseen patients. On the IRIDIA-AF dataset, the resulting representation reaches a patient-independent Area Under the Receiver Operating Characteristic Curve (AUROC) of $0.989 \pm 0.003$ with $2.6\times$ lower seed variance than supervised contrastive baselines.These results highlight that per-subject geometric consistency, rather than global class separability, is key to robust cross-patient generalization.

Deep learning-based detection of cessation of breathing in pre-term infants

Apnoea of prematurity is characterised by recurrent episodes of cessation of breathing and remains difficult to detect reliably using routinely monitored physiological signals in the Neonatal Intensive Care Unit (NICU). Existing bedside monitors rely primarily on respiratory rate and oxygen saturation thresholds, often generating high false-positive alarm rates and missing short or irregular events. Improving automated detection using routinely acquired clinical signals could enhance identification of clinically meaningful events without additional sensing hardware. We evaluated deep learning-based detection of apnoea-related Cessation Of BrEathing (COBE) events using impedance pneumography (IP), electrocardiography (ECG), and photoplethysmography (PPG) signals from approximately 430 hours of NICU recordings collected from 24 pre-term infants. Three independent reviewers annotated COBE events, producing a dataset of 346 COBE and 608 non-COBE events. We compared a shallow convolutional neural network (CNN), residual networks (ResNets), and a ConvNeXt architecture using an independent held-out test set. Across all architectures, detection performance was influenced more strongly by signal modality than by architectural complexity. Unimodal IP-based models achieved balanced accuracies of 86.8-88.0%, outperforming ECG-derived (62.6-69.7%) and PPG-derived (65.1-66.4%) respiratory surrogates. Multimodal fusion yielded modest improvements over IP alone. The best-performing model, a ConvNeXt architecture combining IP and PPG inputs, achieved 88.7% balanced accuracy and an F1 score of 0.75 on the independent test set. These findings demonstrate that deep learning models applied to routinely monitored NICU signals can reliably detect COBE events and highlight the importance of signal modality in data-constrained neonatal monitoring settings.

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.

Deep Temporal Modeling and Ensemble Fusion for Multimodal Emotion Recognition from Physiological Signals

Physiological stress and emotion recognition are important for health monitoring and affective computing. In this work, we present a comprehensive evaluation of deep learning models such as Long Short-Term Memory (LSTM), Temporal Convolutional Networks (TCN), and Transformer on the WESAD dataset for multimodal affect recognition using wrist and chest sensor signals. We perform ablation studies to assess the individual contributions of each modality by training models on wrist-only and chest-only inputs. In addition, we implement a late-fusion ensemble strategy that combines predictions from all three architectures trained on multimodal input. We also employ early fusion at the sensor level by concatenating wrist and chest signals before feeding them into each model. Our results show that Transformer models consistently achieve the highest accuracy in multimodal settings, while TCN models perform best in the wrist-only configuration. The ensemble method yields the highest overall accuracy (98.91 +/- 0.13%) and macro-F1 score (98.56 +/- 0.17%). These findings demonstrate the effectiveness of sensor fusion and ensemble-based fusion in developing robust systems for physiological emotion recognition.

Leveraging Physiological Signals to Predict Exam Outcomes with Machine Learning

This study investigates the application of machine learning models to predict exam outcomes using physiological data collected during examination sessions. Physiological stress indicators, including electrodermal activity, heart rate, and skin temperature, were analyzed to uncover their association with academic performance. A variety of machine learning approaches were employed, ranging from standard models like logistic regression, random forest, and support vector machines to more advanced architectures, including transformers, long short-term memory (LSTM), and gated recurrent unit (GRU) models. This diversity aimed to capture the complex interactions within the data effectively. A key focus was assessing the adaptability of transformers in processing numerical data and evaluating their performance in this novel context. Standard performance metrics, such as accuracy, precision, recall, and F1-score, were used to compare model efficacy. The experimental results demonstrate that while deep learning models generally excel at capturing complex relationships in physiological data, simpler models like random forests can sometimes achieve superior performance while offering computational efficiency and interpretability. Furthermore, transformers demonstrated notable versatility, showcasing performances comparable to those of the LSTM and GRU models. This research underscores the importance of experimenting with a broad class of models that align with the objectives of the problem at hand, balancing precision, efficiency, and interpretability. By elucidating the relationships between physiological signals and academic performance, this study contributes to understanding stressors affecting students' mental health. It further promotes leveraging physiological data to enhance student well-being and academic outcomes.

Event-Aligned Analysis of Multi-Rater Pain Assessments Using Continuous Wearable Physiology

Pain is assessed differently by patients, nurses, and clinicians, yet most computational approaches assume a single ground-truth label - effectively ignoring who is doing the rating. We introduce a rater-aware, event-aligned framework that converts sparse, rater-specific pain ratings into discrete pain-change events and aligns continuous wearable physiological signals to these events, preserving rater identity throughout. Applied to multimodal wearable data collected during spine-related pain procedures, the framework identifies substantial disagreement across rater groups and provides preliminary, exploratory evidence of rater-dependent physiological differences preceding reported pain increases. These findings suggest that pain-physiology relationships may not be rater-invariant, and that aggregating assessments across raters may mask meaningful physiological patterns. A rater-aware, event-aligned perspective is therefore a promising direction for interpreting wearable data in real-world clinical pain assessment.

A robust PPG foundation model using multimodal physiological supervision

Photoplethysmography (PPG), a non-invasive measure of changes in blood volume, is widely used in both wearable devices and clinical settings. Recent PPG foundation models either use open-source ICU datasets with pretraining paradigms that require curated data and thus complicate generalization to field-like data, or use closed-source field-like PPG data. In contrast, we propose a PPG foundation model that does not require high-quality or field-like pretraining data, and instead leverages accompanying electrocardiogram and respiratory signals in ICU datasets to select contrastive samples during pretraining. Our approach allows the model to retain and learn from noisy PPG segments, improving robustness at inference. Our model, pretrained on 3x fewer subjects than existing state-of-the-art approaches, achieves performance improvements on 14 out of 15 diverse downstream tasks, including field-like daily activity and heart rate prediction. Our results demonstrate that multimodal supervision can integrate complementary physiological information to improve the robustness of PPG foundation models and enhance their generalization to consumer-grade data.

Physiologically Grounded Driver Behavior Classification: SHAP-Driven Elite Feature Selection and Hybrid Gradient Boosting for Multimodal Physiological Signals

An interpretable and scalable framework for decoding driving behaviors from multimodal physiological signals is proposed in this study. We utilize multimodal physiological driving behavior large-scale dataset comprising synchronized electroencephalogram (EEG), electromyography (EMG), and galvanic skin response (GSR) signals. Our approach involves rigorous preprocessing followed by a domain-specific feature extraction pipeline targeting time-domain, frequency-domain, and derived physiological indices. To address high dimensionality, we employ SHAP-based elite feature selection, retaining the top 250 features to reduce computational overhead while preserving predictive power. Hyperparameter optimization for extreme gradient boosting (XGBoost) and light gradient boosting machine (LightGBM) models is conducted using Bayesian optimization via Optuna. Finally, a weighted soft-voting ensemble is constructed to leverage the complementary strengths of both gradient boosting frameworks. The results demonstrate that the proposed ensemble achieves a test accuracy of 80.91% and a macro-F1 score of 0.79, significantly outperforming single-modality baselines and traditional machine learning models. Ablation studies confirm an 8% performance gain over the best single modality (EEG), validating the necessity of multimodal fusion. SHAP analysis further validates the physiological plausibility of the model, revealing that the EEG contributes the majority of predictive weight, GSR and EMG features provide critical discriminatory signals for high-arousal and motor-intensive maneuvers.