Toward World Modeling of Physiological Signals with Chaos-Theoretic Balancing and Latent Dynamics
Authors: Yunfei Luo, Xi Chen, Yuliang Chen, Lanshuang Zhang, Md Mofijul Islam, Siwei Zhao, Peter Kotanko, Subhasis Dasgupta, +3 more
Organizations: University of California San Diego · Dartmouth College · Amazon Web Services · Sanderling Renal Services · Renal Research Institute · Icahn School of Medicine at Mount Sinai
Abstract
Physiological time series signals reflect complex, multi-scale dynamical processes of the human body. Existing modeling studies focus on static tasks such as classification, event forecasting, or short-horizon next step prediction, while long-horizon signal-level forecasting and predictive nature of physiological signals remain underexplored. We introduce NormWear-2, a world model that encodes both multivariate physiological signals and clinical intervention variables into a shared latent space and models their joint temporal evolution as a dynamical system. Our approach combines inference from prior pre-trained knowledge (intuition) with instant non-parametric latent state transition adaptation (insight), enabling coherent forecasting across multiple temporal scales, conditioned on heterogeneous clinical interventions. During the pretraining phase, we find that chaos-theoretic balancing of dynamical regime diversity yields more robust representations, with a smaller balanced corpus outperforming one twice its size and capturing bifurcation regimes. We evaluate the world model performance across diverse real-world physiological datasets spanning heterogeneous temporal resolutions and intervention regimes, covering daily life, point-of-care, and clinical settings, including fitness planning, hemodialysis, diabetes management, and surgical monitoring. These evaluation datasets comprise records from 8,026 subjects, spanning study durations from 3.2 hours for high-resolution signal data to 2.3 years for longitudinal clinical biomarker tracking. NormWear-2 achieves the best overall forecasting performance across time, frequency, and latent representation domains, with significant improvements over state-of-the-art time series foundation models, while maintaining competitive downstream representation quality, providing a step toward general-purpose world models for physiological signals.
Time-series foundation models have demonstrated strong cross-domain transfer, yet their common architectural assumptions remain poorly aligned with wearable physiological signals, which are multichannel, irregularly sampled, noisy, and governed by coupled continuous-time dynamics spanning distinct spectral scales. We present SOTER, a generative foundation model for wearable physiological time series that unifies cross-channel coupling, spectrum-guided expert specialization, and continuous-time latent evolution within a single pre-training framework. SOTER combines a spatial feature-aware backbone that models inter-signal dependencies, a power spectral density (PSD)-guided mixture-of-experts layer that routes representations to experts associated with fixed spectral bands through an inspectable, non-learned rule, and a neural controlled differential equation decoder that supports prediction and imputation at arbitrary timestamps. We pre-train SOTER on 226 billion time points from five public physiological datasets and evaluate the same pre-trained model across out-of-distribution zero-shot forecasting, frozen-encoder linear-probe classification, and continuous-time imputation on wearable benchmarks. SOTER achieves the best RMSE on 4 of 6 datasets and the best MAE on 5 of 6 in zero-shot forecasting, the highest average Macro-AUROC in classification, and the lowest imputation error on all six datasets at 75% missingness. It further remains robust to additive acquisition noise, matching or surpassing baselines evaluated on clean inputs even under the strongest corruption. These results indicate that domain-specialized foundation models for wearable physiology benefit from jointly modeling channel structure, spectral scale, and continuous-time dynamics.
Multivariate forecasting in physical systems requires models that predict coupled temporal variables while preserving meaningful state evolution. Deep forecasters can fit temporal correlations, and physics-informed models can regularize predictions with scientific constraints, but these directions are often connected only at the decoded-output level. As a result, the hidden predictive state that generates future trajectories may remain statistically useful but physically unstructured. We introduce Phys-JEPA, a physics-informed joint-embedding predictive architecture for multivariate time-series forecasting. Phys-JEPA learns a latent world model in which predictive states are decomposed into physical and residual components, and physical consistency is imposed directly on latent states and latent transitions rather than only on decoded forecasts. This formulation uses known physical variables to organize the representation space while retaining residual capacity for unresolved dynamics. On Jena Climate 2009--2016, Phys-JEPA reduces aggregate MSE from 0.12482 to 0.12273 and temperature MSE from 0.01892 to 0.01831 at H=24. On Traffic, full Phys-JEPA improves aggregate MSE over the supervised baseline across all tested horizons, reducing H=192 MSE from 0.800784 to 0.773873. On Electricity, the best variant depends on horizon: static latent consistency is strongest at H=24 and H=48, while full Phys-JEPA gives the best aggregate and target-variable MSE at H=192. These initial results suggest that moving physics-informed learning from output space to latent predictive state space is a promising direction for interpretable temporal world models.
Long-horizon clinical simulation -- predicting how a patient's physiology evolves over years under specified interventions -- is central to chronic-disease care, yet existing electronic health record (EHR) models are predominantly discriminative, and general-purpose large language models drift under repeated interventions. We propose the \textbf{ChronoMedicalWorld Model (CMWM)}, an action-conditioned latent world-model framework for learning patient trajectories from longitudinal care data. CMWM couples a joint-embedding state encoder with a wide action encoder that admits both structured intervention indicators and free-text communication embeddings, and trains a recurrent latent transition module under a six-term objective: next-observation supervision, next-latent prediction, SIGReg latent regularisation, and three physiology-aware shape priors (slope, continuity, large-jump penalty). A closed-loop rollout-prefix protocol matches training to deployment, so the model is optimised against the same multi-step error it exhibits at inference. As a concrete case study, we instantiate CMWM for annual estimated glomerular filtration rate (eGFR) trajectory forecasting in chronic kidney disease (CKD). On a 2{,}232-patient nephrology cohort, the CKD instantiation achieves a dynamic-50% history rollout test mean absolute error (MAE) of 7.384 and root-mean-square error (RMSE) of 10.256, against 7.964 and 11.069 for a tuned GPT-5.5 structured-prompting baseline (−7.28% MAE, −7.35% RMSE), with the gain dominated by the dialogue portion of patient--health-coach communication. The framework is not CKD-specific: its architecture, loss design, and training protocol apply to any chronic condition that can be cast as periodic clinical state interleaved with structured and conversational interventions.