From Biometrics to Environmental Control: AI-Enhanced Digital Twins for Personalized Health Interventions in Healing Landscapes

The dynamic nature of human health and comfort calls for adaptive systems that respond to individual physiological needs in real time. This paper presents an AI-enhanced digital twin framework that integrates biometric signals, specifically electrocardiogram (ECG) data, with environmental parameters such as temperature, humidity, and ventilation. Leveraging IoT-enabled sensors and biometric monitoring devices, the system continuously acquires, synchronises, and preprocesses multimodal data streams to construct a responsive virtual replica of the physical environment. To validate this framework, a detailed case study is conducted using the MIT-BIH noise stress test dataset. ECG signals are filtered and segmented using dynamic sliding windows, followed by extracting heart rate variability (HRV) features such as SDNN, BPM, QTc, and LF/HF ratio. Relative deviation metrics are computed against clean baselines to quantify stress responses. A random forest classifier is trained to predict stress levels across five categories, and Shapley Additive exPlanations (SHAP) is used to interpret model behaviour and identify key contributing features. These predictions are mapped to a structured set of environmental interventions using a Five Level Stress Intervention Mapping, which activates multi-scale responses across personal, room, building, and landscape levels. This integration of physiological insight, explainable AI, and adaptive control establishes a new paradigm for health-responsive built environments. It lays the foundation for the future development of intelligent, personalised healing spaces.

Real-Time, Single-Ear, Wearable ECG Reconstruction, R-Peak Detection, and HR/HRV Monitoring

Biosignal monitoring, in particular heart activity through heart rate (HR) and heart rate variability (HRV) tracking, is vital in enabling continuous, non-invasive tracking of physiological and cognitive states. Recent studies have explored compact, head-worn devices for HR and HRV monitoring to improve usability and reduce stigma. However, this approach is challenged by the current reliance on wet electrodes, which limits usability, the weakness of ear-derived signals, making HR/HRV extraction more complex, and the incompatibility of current algorithms for embedded deployment. This work introduces a single-ear wearable system for real-time ECG (Electrocardiogram) parameter estimation, which directly runs on BioGAP, an energy-efficient device for biosignal acquisition and processing. By combining SoA in-ear electrode technology, an optimized DeepMF algorithm, and BioGAP, our proposed subject-independent approach allows for robust extraction of HR/HRV parameters directly on the device with just 36.7 uJ/inference at comparable performance with respect to the current state-of-the-art architecture, achieving 0.49 bpm and 25.82 ms for HR/HRV mean errors, respectively and an estimated battery life of 36h with a total system power consumption of 7.6 mW. Clinical relevance: The ability to reconstruct ECG signals and extract HR and HRV paves the way for continuous, unobtrusive cardiovascular monitoring with head-worn devices. In particular, the integration of cardiovascular measurements in everyday-use devices (such as earbuds) has potential in continuous at-home monitoring to enable early detection of cardiovascular irregularities.

PainFormer: a Vision Foundation Model for Automatic Pain Assessment

Pain is a manifold condition that impacts a significant percentage of the population. Accurate and reliable pain evaluation for the people suffering is crucial to developing effective and advanced pain management protocols. Automatic pain assessment systems provide continuous monitoring and support decision-making processes, ultimately aiming to alleviate distress and prevent functionality decline. This study introduces PainFormer, a vision foundation model based on multi-task learning principles trained simultaneously on 14 tasks/datasets with a total of 10.9 million samples. Functioning as an embedding extractor for various input modalities, the foundation model provides feature representations to the Embedding-Mixer, a transformer-based module that performs the final pain assessment. Extensive experiments employing behavioral modalities-including RGB, synthetic thermal, and estimated depth videos-and physiological modalities such as ECG, EMG, GSR, and fNIRS revealed that PainFormer effectively extracts high-quality embeddings from diverse input modalities. The proposed framework is evaluated on two pain datasets, BioVid and AI4Pain, and directly compared to 73 different methodologies documented in the literature. Experiments conducted in unimodal and multimodal settings demonstrate state-of-the-art performances across modalities and pave the way toward general-purpose models for automatic pain assessment.

Deep Learning Assisted Outer Volume Removal for Highly-Accelerated Real-Time Dynamic MRI

Real-time (RT) dynamic MRI plays a vital role in capturing rapid physiological processes, offering unique insights into organ motion and function. Among these applications, RT cine MRI is particularly important for functional assessment of the heart with high temporal resolution. RT imaging enables free-breathing, ungated imaging of cardiac motion, making it a crucial alternative for patients who cannot tolerate conventional breath-hold, ECG-gated acquisitions. However, achieving high acceleration rates in RT cine MRI is challenging due to aliasing artifacts from extra-cardiac tissues, particularly at high undersampling factors. In this study, we propose a novel outer volume removal (OVR) method to address this challenge by eliminating aliasing contributions from non-cardiac regions in a post-processing framework. Our approach estimates the outer volume signal for each timeframe using composite temporal images from time-interleaved undersampling patterns, which inherently contain pseudo-periodic ghosting artifacts. A deep learning (DL) model is trained to identify and remove these artifacts, producing a clean outer volume estimate that is subsequently subtracted from the corresponding k-space data. The final reconstruction is performed with a physics-driven DL (PD-DL) method trained using an OVR-specific loss function to restore high spatio-temporal resolution images. Experimental results show that the proposed method at high accelerations achieves image quality that is visually comparable to clinical baseline images, while outperforming conventional reconstruction techniques, both qualitatively and quantitatively. The proposed approach provides a practical and effective solution for artifact reduction in RT cine MRI without requiring acquisition modifications, offering a pathway to higher acceleration rates while preserving diagnostic quality.

ArrhythmiaVision: Resource-Conscious Deep Learning Models with Visual Explanations for ECG Arrhythmia Classification

Cardiac arrhythmias are a leading cause of life-threatening cardiac events, highlighting the urgent need for accurate and timely detection. Electrocardiography (ECG) remains the clinical gold standard for arrhythmia diagnosis; however, manual interpretation is time-consuming, dependent on clinical expertise, and prone to human error. Although deep learning has advanced automated ECG analysis, many existing models abstract away the signal's intrinsic temporal and morphological features, lack interpretability, and are computationally intensive-hindering their deployment on resource-constrained platforms. In this work, we propose two novel lightweight 1D convolutional neural networks, ArrhythmiNet V1 and V2, optimized for efficient, real-time arrhythmia classification on edge devices. Inspired by MobileNet's depthwise separable convolutional design, these models maintain memory footprints of just 302.18 KB and 157.76 KB, respectively, while achieving classification accuracies of 0.99 (V1) and 0.98 (V2) on the MIT-BIH Arrhythmia Dataset across five classes: Normal Sinus Rhythm, Left Bundle Branch Block, Right Bundle Branch Block, Atrial Premature Contraction, and Premature Ventricular Contraction. In order to ensure clinical transparency and relevance, we integrate Shapley Additive Explanations and Gradient-weighted Class Activation Mapping, enabling both local and global interpretability. These techniques highlight physiologically meaningful patterns such as the QRS complex and T-wave that contribute to the model's predictions. We also discuss performance-efficiency trade-offs and address current limitations related to dataset diversity and generalizability. Overall, our findings demonstrate the feasibility of combining interpretability, predictive accuracy, and computational efficiency in practical, wearable, and embedded ECG monitoring systems.

ALFRED: Ask a Large-language model For Reliable ECG Diagnosis

Leveraging Large Language Models (LLMs) with Retrieval-Augmented Generation (RAG) for analyzing medical data, particularly Electrocardiogram (ECG), offers high accuracy and convenience. However, generating reliable, evidence-based results in specialized fields like healthcare remains a challenge, as RAG alone may not suffice. We propose a Zero-shot ECG diagnosis framework based on RAG for ECG analysis that incorporates expert-curated knowledge to enhance diagnostic accuracy and explainability. Evaluation on the PTB-XL dataset demonstrates the framework's effectiveness, highlighting the value of structured domain expertise in automated ECG interpretation. Our framework is designed to support comprehensive ECG analysis, addressing diverse diagnostic needs with potential applications beyond the tested dataset.

Towards Robust Multimodal Physiological Foundation Models: Handling Arbitrary Missing Modalities

Multimodal physiological signals, such as EEG, ECG, EOG, and EMG, are crucial for healthcare and brain-computer interfaces. While existing methods rely on specialized architectures and dataset-specific fusion strategies, they struggle to learn universal representations that generalize across datasets and handle missing modalities at inference time. To address these issues, we propose PhysioOmni, a foundation model for multimodal physiological signal analysis that models both homogeneous and heterogeneous features to decouple multimodal signals and extract generic representations while maintaining compatibility with arbitrary missing modalities. PhysioOmni trains a decoupled multimodal tokenizer, enabling masked signal pre-training via modality-invariant and modality-specific objectives. To ensure adaptability to diverse and incomplete modality combinations, the pre-trained encoders undergo resilient fine-tuning with prototype alignment on downstream datasets. Extensive experiments on four downstream tasks, emotion recognition, sleep stage classification, motor prediction, and mental workload detection, demonstrate that PhysioOmni achieves state-of-the-art performance while maintaining strong robustness to missing modalities. Our code and model weights will be released.

Time-Series Analysis on Edge-AI Hardware for Healthcare Monitoring

This project addresses the need for efficient, real-time analysis of biomedical signals such as electrocardiograms (ECG) and electroencephalograms (EEG) for continuous health monitoring. Traditional methods rely on long-duration data recording followed by offline analysis, which is power-intensive and delays responses to critical symptoms such as arrhythmia. To overcome these limitations, a time-domain ECG analysis model based on a novel dynamically-biased Long Short-Term Memory (DB-LSTM) neural network is proposed. This model supports simultaneous ECG forecasting and classification with high performance-achieving over 98% accuracy and a normalized mean square error below 1e-3 for forecasting, and over 97% accuracy with faster convergence and fewer training parameters for classification. To enable edge deployment, the model is hardware-optimized by quantizing weights to INT4 or INT3 formats, resulting in only a 2% and 6% drop in classification accuracy during training and inference, respectively, while maintaining full accuracy for forecasting. Extensive simulations using multiple ECG datasets confirm the model's robustness. Future work includes implementing the algorithm on FPGA and CMOS circuits for practical cardiac monitoring, as well as developing a digital hardware platform that supports flexible neural network configurations and on-chip online training for personalized healthcare applications.

ProtoECGNet: Case-Based Interpretable Deep Learning for Multi-Label ECG Classification with Contrastive Learning

Deep learning-based electrocardiogram (ECG) classification has shown impressive performance but clinical adoption has been slowed by the lack of transparent and faithful explanations. Post hoc methods such as saliency maps may fail to reflect a model's true decision process. Prototype-based reasoning offers a more transparent alternative by grounding decisions in similarity to learned representations of real ECG segments, enabling faithful, case-based explanations. We introduce ProtoECGNet, a prototype-based deep learning model for interpretable, multi-label ECG classification. ProtoECGNet employs a structured, multi-branch architecture that reflects clinical interpretation workflows: it integrates a 1D CNN with global prototypes for rhythm classification, a 2D CNN with time-localized prototypes for morphology-based reasoning, and a 2D CNN with global prototypes for diffuse abnormalities. Each branch is trained with a prototype loss designed for multi-label learning, combining clustering, separation, diversity, and a novel contrastive loss that encourages appropriate separation between prototypes of unrelated classes while allowing clustering for frequently co-occurring diagnoses. We evaluate ProtoECGNet on all 71 diagnostic labels from the PTB-XL dataset, demonstrating competitive performance relative to state-of-the-art black-box models while providing structured, case-based explanations. To assess prototype quality, we conduct a structured clinician review of the final model's projected prototypes, finding that they are rated as representative and clear. ProtoECGNet shows that prototype learning can be effectively scaled to complex, multi-label time-series classification, offering a practical path toward transparent and trustworthy deep learning models for clinical decision support.

xLSTM-ECG: Multi-label ECG Classification via Feature Fusion with xLSTM

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, highlighting the critical need for efficient and accurate diagnostic tools. Electrocardiograms (ECGs) are indispensable in diagnosing various heart conditions; however, their manual interpretation is time-consuming and error-prone. In this paper, we propose xLSTM-ECG, a novel approach that leverages an extended Long Short-Term Memory (xLSTM) network for multi-label classification of ECG signals, using the PTB-XL dataset. To the best of our knowledge, this work represents the first design and application of xLSTM modules specifically adapted for multi-label ECG classification. Our method employs a Short-Time Fourier Transform (STFT) to convert time-series ECG waveforms into the frequency domain, thereby enhancing feature extraction. The xLSTM architecture is specifically tailored to address the complexities of 12-lead ECG recordings by capturing both local and global signal features. Comprehensive experiments on the PTB-XL dataset reveal that our model achieves strong multi-label classification performance, while additional tests on the Georgia 12-Lead dataset underscore its robustness and efficiency. This approach significantly improves ECG classification accuracy, thereby advancing clinical diagnostics and patient care. The code will be publicly available upon acceptance.