An LLM-Powered Agent for Physiological Data Analysis: A Case Study on PPG-based Heart Rate Estimation

Large language models (LLMs) are revolutionizing healthcare by improving diagnosis, patient care, and decision support through interactive communication. More recently, they have been applied to analyzing physiological time-series like wearable data for health insight extraction. Existing methods embed raw numerical sequences directly into prompts, which exceeds token limits and increases computational costs. Additionally, some studies integrated features extracted from time-series in textual prompts or applied multimodal approaches. However, these methods often produce generic and unreliable outputs due to LLMs' limited analytical rigor and inefficiency in interpreting continuous waveforms. In this paper, we develop an LLM-powered agent for physiological time-series analysis aimed to bridge the gap in integrating LLMs with well-established analytical tools. Built on the OpenCHA, an open-source LLM-powered framework, our agent features an orchestrator that integrates user interaction, data sources, and analytical tools to generate accurate health insights. To evaluate its effectiveness, we implement a case study on heart rate (HR) estimation from Photoplethysmogram (PPG) signals using a dataset of PPG and Electrocardiogram (ECG) recordings in a remote health monitoring study. The agent's performance is benchmarked against OpenAI GPT-4o-mini and GPT-4o, with ECG serving as the gold standard for HR estimation. Results demonstrate that our agent significantly outperforms benchmark models by achieving lower error rates and more reliable HR estimations. The agent implementation is publicly available on GitHub.

Multimodal Sleep Stage and Sleep Apnea Classification Using Vision Transformer: A Multitask Explainable Learning Approach

Sleep is an essential component of human physiology, contributing significantly to overall health and quality of life. Accurate sleep staging and disorder detection are crucial for assessing sleep quality. Studies in the literature have proposed PSG-based approaches and machine-learning methods utilizing single-modality signals. However, existing methods often lack multimodal, multilabel frameworks and address sleep stages and disorders classification separately. In this paper, we propose a 1D-Vision Transformer for simultaneous classification of sleep stages and sleep disorders. Our method exploits the sleep disorders' correlation with specific sleep stage patterns and performs a simultaneous identification of a sleep stage and sleep disorder. The model is trained and tested using multimodal-multilabel sensory data (including photoplethysmogram, respiratory flow, and respiratory effort signals). The proposed method shows an overall accuracy (cohen's Kappa) of 78% (0.66) for five-stage sleep classification and 74% (0.58) for sleep apnea classification. Moreover, we analyzed the encoder attention weights to clarify our models' predictions and investigate the influence different features have on the models' outputs. The result shows that identified patterns, such as respiratory troughs and peaks, make a higher contribution to the final classification process.

Skewed Memorization in Large Language Models: Quantification and Decomposition

Memorization in Large Language Models (LLMs) poses privacy and security risks, as models may unintentionally reproduce sensitive or copyrighted data. Existing analyses focus on average-case scenarios, often neglecting the highly skewed distribution of memorization. This paper examines memorization in LLM supervised fine-tuning (SFT), exploring its relationships with training duration, dataset size, and inter-sample similarity. By analyzing memorization probabilities over sequence lengths, we link this skewness to the token generation process, offering insights for estimating memorization and comparing it to established metrics. Through theoretical analysis and empirical evaluation, we provide a comprehensive understanding of memorization behaviors and propose strategies to detect and mitigate risks, contributing to more privacy-preserving LLMs.

HealthQ: Unveiling Questioning Capabilities of LLM Chains in Healthcare Conversations

In digital healthcare, large language models (LLMs) have primarily been utilized to enhance question-answering capabilities and improve patient interactions. However, effective patient care necessitates LLM chains that can actively gather information by posing relevant questions. This paper presents HealthQ, a novel framework designed to evaluate the questioning capabilities of LLM healthcare chains. We implemented several LLM chains, including Retrieval-Augmented Generation (RAG), Chain of Thought (CoT), and reflective chains, and introduced an LLM judge to assess the relevance and informativeness of the generated questions. To validate HealthQ, we employed traditional Natural Language Processing (NLP) metrics such as Recall-Oriented Understudy for Gisting Evaluation (ROUGE) and Named Entity Recognition (NER)-based set comparison, and constructed two custom datasets from public medical note datasets, ChatDoctor and MTS-Dialog. Our contributions are threefold: we provide the first comprehensive study on the questioning capabilities of LLMs in healthcare conversations, develop a novel dataset generation pipeline, and propose a detailed evaluation methodology.

Accuracy and Consistency of LLMs in the Registered Dietitian Exam: The Impact of Prompt Engineering and Knowledge Retrieval

Large language models (LLMs) are fundamentally transforming human-facing applications in the health and well-being domains: boosting patient engagement, accelerating clinical decision-making, and facilitating medical education. Although state-of-the-art LLMs have shown superior performance in several conversational applications, evaluations within nutrition and diet applications are still insufficient. In this paper, we propose to employ the Registered Dietitian (RD) exam to conduct a standard and comprehensive evaluation of state-of-the-art LLMs, GPT-4o, Claude 3.5 Sonnet, and Gemini 1.5 Pro, assessing both accuracy and consistency in nutrition queries. Our evaluation includes 1050 RD exam questions encompassing several nutrition topics and proficiency levels. In addition, for the first time, we examine the impact of Zero-Shot (ZS), Chain of Thought (CoT), Chain of Thought with Self Consistency (CoT-SC), and Retrieval Augmented Prompting (RAP) on both accuracy and consistency of the responses. Our findings revealed that while these LLMs obtained acceptable overall performance, their results varied considerably with different prompts and question domains. GPT-4o with CoT-SC prompting outperformed the other approaches, whereas Gemini 1.5 Pro with ZS recorded the highest consistency. For GPT-4o and Claude 3.5, CoT improved the accuracy, and CoT-SC improved both accuracy and consistency. RAP was particularly effective for GPT-4o to answer Expert level questions. Consequently, choosing the appropriate LLM and prompting technique, tailored to the proficiency level and specific domain, can mitigate errors and potential risks in diet and nutrition chatbots.

ECG Unveiled: Analysis of Client Re-identification Risks in Real-World ECG Datasets

While ECG data is crucial for diagnosing and monitoring heart conditions, it also contains unique biometric information that poses significant privacy risks. Existing ECG re-identification studies rely on exhaustive analysis of numerous deep learning features, confining to ad-hoc explainability towards clinicians decision making. In this work, we delve into explainability of ECG re-identification risks using transparent machine learning models. We use SHapley Additive exPlanations (SHAP) analysis to identify and explain the key features contributing to re-identification risks. We conduct an empirical analysis of identity re-identification risks using ECG data from five diverse real-world datasets, encompassing 223 participants. By employing transparent machine learning models, we reveal the diversity among different ECG features in contributing towards re-identification of individuals with an accuracy of 0.76 for gender, 0.67 for age group, and 0.82 for participant ID re-identification. Our approach provides valuable insights for clinical experts and guides the development of effective privacy-preserving mechanisms. Further, our findings emphasize the necessity for robust privacy measures in real-world health applications and offer detailed, actionable insights for enhancing data anonymization techniques.

Enhancing Performance and User Engagement in Everyday Stress Monitoring: A Context-Aware Active Reinforcement Learning Approach

In today's fast-paced world, accurately monitoring stress levels is crucial. Sensor-based stress monitoring systems often need large datasets for training effective models. However, individual-specific models are necessary for personalized and interactive scenarios. Traditional methods like Ecological Momentary Assessments (EMAs) assess stress but struggle with efficient data collection without burdening users. The challenge is to timely send EMAs, especially during stress, balancing monitoring efficiency and user convenience. This paper introduces a novel context-aware active reinforcement learning (RL) algorithm for enhanced stress detection using Photoplethysmography (PPG) data from smartwatches and contextual data from smartphones. Our approach dynamically selects optimal times for deploying EMAs, utilizing the user's immediate context to maximize label accuracy and minimize intrusiveness. Initially, the study was executed in an offline environment to refine the label collection process, aiming to increase accuracy while reducing user burden. Later, we integrated a real-time label collection mechanism, transitioning to an online methodology. This shift resulted in an 11% improvement in stress detection efficiency. Incorporating contextual data improved model accuracy by 4%. Personalization studies indicated a 10% enhancement in AUC-ROC scores, demonstrating better stress level differentiation. This research marks a significant move towards personalized, context-driven real-time stress monitoring methods.

Graph-Augmented LLMs for Personalized Health Insights: A Case Study in Sleep Analysis

Health monitoring systems have revolutionized modern healthcare by enabling the continuous capture of physiological and behavioral data, essential for preventive measures and early health intervention. While integrating this data with Large Language Models (LLMs) has shown promise in delivering interactive health advice, traditional methods like Retrieval-Augmented Generation (RAG) and fine-tuning often fail to fully utilize the complex, multi-dimensional, and temporally relevant data from wearable devices. These conventional approaches typically provide limited actionable and personalized health insights due to their inadequate capacity to dynamically integrate and interpret diverse health data streams. In response, this paper introduces a graph-augmented LLM framework designed to significantly enhance the personalization and clarity of health insights. Utilizing a hierarchical graph structure, the framework captures inter and intra-patient relationships, enriching LLM prompts with dynamic feature importance scores derived from a Random Forest Model. The effectiveness of this approach is demonstrated through a sleep analysis case study involving 20 college students during the COVID-19 lockdown, highlighting the potential of our model to generate actionable and personalized health insights efficiently. We leverage another LLM to evaluate the insights for relevance, comprehensiveness, actionability, and personalization, addressing the critical need for models that process and interpret complex health data effectively. Our findings show that augmenting prompts with our framework yields significant improvements in all 4 criteria. Through our framework, we can elicit well-crafted, more thoughtful responses tailored to a specific patient.

Empathy Through Multimodality in Conversational Interfaces

Agents represent one of the most emerging applications of Large Language Models (LLMs) and Generative AI, with their effectiveness hinging on multimodal capabilities to navigate complex user environments. Conversational Health Agents (CHAs), a prime example of this, are redefining healthcare by offering nuanced support that transcends textual analysis to incorporate emotional intelligence. This paper introduces an LLM-based CHA engineered for rich, multimodal dialogue-especially in the realm of mental health support. It adeptly interprets and responds to users' emotional states by analyzing multimodal cues, thus delivering contextually aware and empathetically resonant verbal responses. Our implementation leverages the versatile openCHA framework, and our comprehensive evaluation involves neutral prompts expressed in diverse emotional tones: sadness, anger, and joy. We evaluate the consistency and repeatability of the planning capability of the proposed CHA. Furthermore, human evaluators critique the CHA's empathic delivery, with findings revealing a striking concordance between the CHA's outputs and evaluators' assessments. These results affirm the indispensable role of vocal (soon multimodal) emotion recognition in strengthening the empathetic connection built by CHAs, cementing their place at the forefront of interactive, compassionate digital health solutions.

ALCM: Autonomous LLM-Augmented Causal Discovery Framework

To perform effective causal inference in high-dimensional datasets, initiating the process with causal discovery is imperative, wherein a causal graph is generated based on observational data. However, obtaining a complete and accurate causal graph poses a formidable challenge, recognized as an NP-hard problem. Recently, the advent of Large Language Models (LLMs) has ushered in a new era, indicating their emergent capabilities and widespread applicability in facilitating causal reasoning across diverse domains, such as medicine, finance, and science. The expansive knowledge base of LLMs holds the potential to elevate the field of causal reasoning by offering interpretability, making inferences, generalizability, and uncovering novel causal structures. In this paper, we introduce a new framework, named Autonomous LLM-Augmented Causal Discovery Framework (ALCM), to synergize data-driven causal discovery algorithms and LLMs, automating the generation of a more resilient, accurate, and explicable causal graph. The ALCM consists of three integral components: causal structure learning, causal wrapper, and LLM-driven causal refiner. These components autonomously collaborate within a dynamic environment to address causal discovery questions and deliver plausible causal graphs. We evaluate the ALCM framework by implementing two demonstrations on seven well-known datasets. Experimental results demonstrate that ALCM outperforms existing LLM methods and conventional data-driven causal reasoning mechanisms. This study not only shows the effectiveness of the ALCM but also underscores new research directions in leveraging the causal reasoning capabilities of LLMs.