Designing models that generalize effectively in low- to medium-data regimes remains a primary challenge in medical machine learning, particularly for physiological time-series classification. While tabular foundation models such as TabPFN offer an attractive alternative to conventional fine-tuning through in-context learning, they are not designed to capture the temporal dependencies inherent to physiological signals. ~In this paper, we introduce TSPFN, a foundation model that redesigns TabPFN's architecture for time series data. TSPFN integrates structured temporal representations and positional embeddings to capture intra-sample temporal and channel dependencies. To fully leverage its spatio-temporal design, the model is pretrained on 140,000 real-world physiological time series across multiple medical domains. This yields a unified, generalizable framework capable of learning the specificities of medical time series. Experiments across diverse physiological benchmarks demonstrate that TSPFN consistently outperforms standard tabular baselines and TabPFN, and achieves superior cross-domain generalization compared to specialized deep time-series models. All our experiments, ablation studies, and pre-processing scheme are publicly available at https://github.com/Jeremstym/TSPFN
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.