Respiratory Sound Classification

Spontaneous speech offers a scalable, noninvasive signal for respiratory health assessment, yet interpretable models that generalize across languages remain challenging because disease-related acoustic changes are confounded by language-specific phonetic variation. We present CL-DAF, a Cross-Lingual Disease-Alignment Framework that identifies acoustic dimensions whose disease effects remain consistent across languages. Using 201 English and 75 newly collected Bangla speakers, we construct a common 272-dimensional acoustic representation and quantify disease alignment using signed rank-biserial effects and the Language Invariance Score. We first show that spontaneous Bangla speech separates COPD from controls (AUC 0.85); however, 133 features reverse their disease direction across languages and the full representation transfers poorly (AUC 0.49 from Bangla to English). CL-DAF isolates 26 disease-aligned features that raise AUCs to 0.825 and 0.722 from English to Bangla and Bangla to English, respectively. These findings provide a foundation for multilingual clinical speech models emphasizing pathology over language-dependent variation.

Chronic Obstructive Pulmonary Disease (COPD) remains a major global health challenge, emphasizing the need for accessible and non-invasive detection. Since speech production is fundamentally linked to respiratory physiology, its disruptions can serve as indirect indicators of pulmonary impairment. This study introduces SpiroPhonia, a machine learning framework that leverages spontaneous speech for respiratory health assessment. We evaluated SpiroPhonia on a new dataset of 201 speakers (102 with COPD, 99 healthy controls). By integrating statistical analysis with recursive feature selection, we identified a compact set of discriminative speech markers. Our best model achieved 78% accuracy, 80% F1-score, and 87% AUC. This performance on spontaneous speech is competitive with methods using controlled laboratory recordings. Findings demonstrate that everyday speech encodes robust respiratory biomarkers, paving the way for continuous health monitoring via voice-enabled technologies.

Airway stenosis can cause severe respiratory complications, yet its detection often relies on specialized examinations and medical imaging. This study explores the potential of acoustic AI for rapid and accessible airway stenosis detection using readily acquired patient voice recordings. We systematically investigate whether acoustic foundation models (AFMs) can extract acoustic representations associated with airway stenosis-related speech patterns. Experiments are conducted on a cohort of 748 participants from the Bridge2AI-Voice dataset, 134 with airway stenosis and 614 without. The best-performing model achieves an AUROC of 0.952 and an accuracy of 0.924 (means over five-fold cross-validation), highlighting the potential of AFMs to transfer beyond general-purpose speech applications to clinical diagnostic tasks. Further analysis reveals that the model primarily relies on connected-speech recordings rather than isolated acoustic tasks, such as sustained phonation and breathing. Overall, these results suggest that voice-based acoustic AI could complement existing diagnostic workflows by enabling rapid, low-burden, and widely accessible screening for airway stenosis.

The heightened prevalence of respiratory disorders, particularly exacerbated by a significant upswing in fatalities due to the novel coronavirus, underscores the critical need for early detection and timely intervention. This imperative is paramount, possessing the potential to profoundly impact and safeguard numerous lives. Medically, chest radiography stands out as an essential and economically viable medical imaging approach for diagnosing and assessing the severity of diverse Respiratory Disorders. However, their detection in Chest X-Rays is a cumbersome task even for well-trained radiologists owing to low contrast issues, overlapping of the tissue structures, subjective variability, and the presence of noise. To address these issues, a novel analytical model termed Exponential Pixelating Integral is introduced for the automatic detection of infections in Chest X-Rays in this work. Initially, the presented Exponential Pixelating Integral enhances the pixel intensities to overcome the low-contrast issues that are then polar-transformed followed by their representation using the locally invariant Mandelbrot and Julia fractal geometries for effective distinction of structural features. The collated features labeled Exponential Pixelating Integral with dually characterized fractal features are then classified by the non-parametric multivariate adaptive regression splines to establish an ensemble model between each pair of classes for effective diagnosis of diverse diseases. Rigorous analysis of the proposed classification framework on large medical benchmarked datasets showcases its superiority over its peers by registering a higher classification accuracy and F1 scores ranging from 98.46 to 99.45% and 96.53-98.10% respectively, making it a precise and interpretable automated system for diagnosing respiratory disorders.

Neonatal respiratory diseases are a major cause of neonatal morbidity and mortality, posing substantial challenges in clinical practice. Despite recent advances, existing Multimodal Large Language Models (MLLMs) face two key limitations in neonatal diagnosis: (1) domain gap arising from predominantly adult training data; (2) insufficient integration of multidimensional clinical context for accurate diagnosis. To address these challenges, we collect two real-world clinical datasets (NeoCXR and NeoCXR-EV) and propose NeoRed, to the best of our knowledge, the first MLLM tailored for neonatal respiratory disease, filling the gap in neonatal diagnostic reports generation. To enhance joint diagnosis from heterogeneous clinical context and chest X-rays, we design a novel Knowledge-Logic-Alignment (KLA) framework which constrains model behavior from three perspectives: 1) Knowledge Prior Injection (KPI) incorporates neonatologist-inspired diagnostic priors into multimodal representations, guiding disease-specific attention across modalities; 2) Diagnostic Logic Constraint (DLC) aligns the semantics of generated reports with multimodal diagnostic logic; and 3) Visual Semantic Alignment (VSA) establishes semantic correspondence between visual features and imaging conclusions. Extensive experiments demonstrate that NeoRed enables accurate neonatal diagnostic reports generation, achieving ROUGE-L of 53.29% and Clinical Efficacy F1 score of 65.19% on NeoCXR, outperforming existing MLLMs. NeoRed also preserves competitive report generation performance on adult benchmarks (MIMIC-CXR and IU-Xray). Datasets will be available upon application.

Respiration provides a continuously available window into physiological state and behavior. However, monitoring it outside controlled settings remains challenging because a wearable system must capture small body deformations while remaining comfortable, low power, and robust to changes in posture and motion. We present a compact non-invasive respiratory sensing system based on a force-sensitive resistor (FSR) embedded in an abdominal belt and integrated with a custom Bluetooth Low Energy acquisition board. The system combines a simple piezoresistive readout with a mechanical holder designed to transfer abdominal expansion to the sensor without analog amplification. We evaluate the complete sensing pipeline across multiple breathing patterns and body positions. In stationary settings, the recorded signals exhibit consistent amplitude changes and recurring peak-to-peak timing across breathing maneuvers; under light movement, these variations remain visible despite motion-induced baseline shifts. We further design a five-phase stress-induction protocol and collect respiratory recordings from 12 participants. Using interpretable time-domain features and standard classifiers, we examine whether the acquired signals distinguish relaxation from stress-induction phases. In this preliminary experiment, the best-performing model achieves 88.0% test accuracy, indicating that the extracted respiratory features distinguish stress-induced phases from relaxation phases in this dataset. Overall, our results show that the proposed platform enables real-time respiratory monitoring across diverse daily-life scenarios and captures respiratory changes that distinguish stress-induction from relaxation phases, supporting its potential for affective-computing applications.

Background: Respiratory specialty care requires multimodal interpretation, longitudinal risk assessment, guideline-concordant intervention, and whole-course management, which are poorly represented by examination-oriented medical benchmarks. Objective: To develop RESPClinBench, a real-world scenario-based benchmark for respiratory clinical decision-making, and evaluate seven contemporary large language models across AECOPD-PIM and PNBIM. Methods: RESPClinBench cases were adapted from de-identified respiratory clinical data. Three attending-level respiratory physicians revised cases, reference answers, and atomic clinical-action points, while one senior respiratory specialist performed cross-review and final adjudication. AECOPD-PIM comprised 427 open-ended COPD cases, and PNBIM comprised 196 multimodal pulmonary nodule cases combining chest CT with structured clinical information. Seven models generated 4,361 responses through standardized API inference with temperature 0 and a maximum output length of 8192 tokens. An automated framework calculated the final score as the arithmetic mean of atomic-action recall and rubric-based LLM-as-a-Judge assessment. Results: Across 623 cases, the mean final score was 68.58. Qwen3.6-27B ranked first overall at 71.22, Qwen3.5-397B-A17B led PNBIM at 72.48, and Qwen3.6-27B led AECOPD-PIM at 71.11. Imaging hallucination and serious medical risk occurred in 31.85% and 8.16% of PNBIM responses; medication-safety risk and serious medical risk occurred in 26.93% and 1.44% of AECOPD-PIM responses. Conclusions: RESPClinBench identifies task-specific limitations in multimodal pulmonary nodule assessment and longitudinal COPD management. Combining explicit clinical-action coverage, holistic evaluation, and independent safety flags provides a clinically grounded basis for model selection and prospective validation.

Recent Phonetic Foundation Models (PFMs) for Speech-to-IPA transcription rely on Grapheme-to-Phoneme (G2P) labels, but the phoneme labels are not necessarily phonetically faithful. To investigate this issue, we evaluate zero-shot phonetic classification on Chinese aspiration and Japanese moraic nasals. A PFM trained on G2P-labeled data excluding these two languages yields poor accuracy on both tasks, showing that multilingual coverage with discrete IPA tokens is not sufficient for unseen settings. To overcome this limitation, we propose a classification method based on continuous Articulatory Feature (AF) vectors extracted from each frame. This AF-based approach outperforms discrete token-based methods, particularly for rare phones. We further show that it is crucial to adopt the optimal temporal aggregation of AF vectors for the target distinction: single-frame classification is best for aspiration, while segmental classification substantially improves nasal classification.

Air pollution and climate-related stressors are increasingly important concerns for respiratory health, especially in settings with unequal environmental exposure and healthcare capacity. This study evaluates an interpretable machine learning framework for predicting respiratory disease rates and air-quality status using structured country-level weekly data. Two supervised learning tasks were considered: regression of respiratory disease rate per 100,000 population and binary classification of air-quality status. Nine regression models and nine classification models were compared using nested cross-validation. Model interpretation was conducted using SHAP values, and subgroup analysis was performed across income levels and geographic regions. The results showed that PM2.5 concentration was the dominant predictor of respiratory disease rate, with linear and regularized linear models achieving the strongest regression performance. For air-quality classification, models achieved high balanced accuracy when PM2.5 was included, but performance decreased substantially when PM2.5 was removed, indicating strong dependence on pollutant-related information. SHAP analysis showed that, without PM2.5, socioeconomic and meteorological variables such as GDP per capita, precipitation, and healthcare access became more influential. Subgroup analysis showed similar aggregate regression error across income groups, but PM2.5 contributed more strongly to predictions in lower-middle-income countries. These results show that model accuracy alone is not sufficient for climate-health prediction. Interpretable models can help identify dominant pollution-related signals, test whether results depend on key pollutant variables, and show whether prediction patterns differ across socioeconomic groups.

Self-driving laboratories increasingly rely on low-cost liquid handlers such as the Opentrons OT-2, which ship without the pressure-based aspiration monitoring of Hamilton or Tecan systems and are typically run open-loop. Two failure modes go undetected: protocols that are syntactically valid but violate assay-specific invariants (e.g., tip reuse between a PCR template and a no-template control), and physical execution failures (partial dispense, air bubbles, missing tips) at runtime. We present AEGIS, a two-layer guardian for both. Layer 1 pairs a curated machine-readable assay rule database with an LLM that reasons over OT-2 Python code, reaching an adjusted F1 of 0.97 on a 24-protocol benchmark across five assay families and beating rules-only and LLM-only ablations across five backends; a free open-weight model ties the best proprietary one, so no paid API is required. Layer 2 fits a PCA world model to YOLO-cropped four-frame pipette trajectories; under a leakage-free leave-one-plate-out evaluation it reaches average precision 0.89 and operating-point F1 0.71 (AUROC 0.80), a deployment-faithful number that matches the live demonstration, and we characterize the small-pipette (p20) resolution limit (F1 0.47). A live demonstration on a physical OT-2 (five replicates per condition) catches planted no-tip failures deterministically and partial dispense on coloured dyes, with an always-VLM self-vote gate lifting partial-dispense recall to 5/5; transparent water is a principled limit of any front-view-only monitor, which AEGIS surfaces as low-confidence VLM reasoning rather than a wrong verdict. Cascade triage holds VLM cost near $1.63 per plate versus$10.33 for an always-VLM baseline. AEGIS is open source and, to our knowledge, the first system to unify pre-flight assay-aware validation with runtime visual monitoring for an open-source liquid handler.

Distributed optical fiber sensing (DOFS) combines the advantages of fiber optic sensors, including flexibility, small size, immunity to electromagnetic interference, and high metrological performance, with the capability to transform a single optical fiber into a continuous sensing element for spatially resolved mechanical measurements. Optical frequency domain reflectometry (OFDR), based on Rayleigh backscattering, enables high spatial resolution DOFS measurements, broadening the range of potential sensing applications. However, OFDR based DOFS remains largely unexplored for biomedical applications, despite the need for sensitive, spatially resolved, and conformable sensing interfaces. This study presents a soft DOFS based mat as a large-area interface for physiological monitoring. A single-mode optical fiber was embedded in a flexible silicone matrix and arranged in a serpentine layout to distribute sensing over the mat surface. With a gage pitch of 2.6 mm, the system provided 2250 sensing sites across the active area at a sampling frequency of 50 Hz. The mat was assessed on six healthy volunteers in a seated nearable configuration on the backrest of a standard office chair. The distributed output enabled two dimensional mapping of the mat response, reflecting back mat mechanical coupling and cardiorespiratory induced perturbations. Respiratory rate and heart rate were therefore estimated and compared with a reference wearable system. The maps revealed physiologically coherent spatial and temporal patterns, while the estimated rates showed good agreement with the reference measurements. These results demonstrate the feasibility of combining large area distributed sensing, spatial mapping, and quantitative cardiorespiratory monitoring within a DOFS based soft nearable interface.

Pre-term infants are susceptible to potentially harmful apnoea-related cessations of breathing due to immature respiratory control. However, reliable respiratory monitoring in the neonatal intensive care unit (NICU) remains challenging because motion artefacts, sensor displacement, and skin fragility can compromise contact-based measurements. Non-contact video monitoring offers a complementary approach that does not depend on adhesive sensors while providing additional respiratory information. We investigated whether camera-based signals can detect apnoea-related cessation of breathing (COBE) and provide complementary information to routinely acquired physiological signals. Using video and clinical recordings from 30 pre-term infants, respiratory motion was extracted from dynamically tracked torso regions to generate camera-derived time-series signals. Camera-only models were trained using residual network (ResNet) architectures, while hybrid models combined video-derived signals with impedance pneumography (IP), ECG-derived respiration (EDR), and the PPG-derived respiratory envelope. Camera-only models achieved a balanced accuracy of 76.9%, demonstrating the feasibility of non-contact COBE detection. Combining video-derived features with IP improved balanced accuracy to 90.6%, outperforming either modality alone and indicating that video provides respiratory information beyond standard physiological signals. These findings show that video-derived signals contain clinically relevant respiratory features and enhance COBE detection when combined with conventional physiological signals. This supports non-contact video as a complementary modality for automated COBE detection and highlights its potential to improve the robustness of neonatal respiratory monitoring.

Sri Lanka has experienced a decade of progressive forest degradation and rising atmospheric pollution, yet district-level respiratory admissions have paradoxically declined, pointing to the confounding role of healthcare access. This study addresses that gap by constructing an 11-year (2014-2024) panel dataset across all 25 administrative districts, integrating satellite-derived vegetation indices, fire radiative power, pollutant concentrations (particulate matter (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2)), carbon flux metrics and population-normalized respiratory admission rates. Two temporally validated XGBoost models were created for annual district-level respiratory rate (R^2 = 0.937) and monthly PM2.5 concentration (R^2 = 0.976) with generalization validated in 21 out of 25 districts (Mean Absolute Percentage Error (MAPE) <= 20%). Shapley Additive Explanations (SHAP) analysis established that cumulative air quality burden is the overwhelming driver of respiratory rate variance (80.1%), ahead of forest degradation (15.6%) and fire activity (4.3%). The Forest-Air-Health (FAH) Risk Index used these SHAP-derived weights to find the districts with the highest risk: Colombo (FAH = 0.802), Gampaha (0.708), and Kalutara (0.682). These findings present the inaugural evidence-based, district-level framework correlating environmental degradation with respiratory health in Sri Lanka, establishing a quantitative basis for focused public health and environmental policy.

I propose a new methodology to attack the fascinating Gilbreath's conjecture about prime numbers, first posted in 1878 and unsolved to this day. The problem statement is rudimentary: kids can understand it. However, despite decades of research, almost no progress has been made. This paper changes the game by presenting a new approach based on sieving, a number of new results with proof, a precise path to the solution, and solid references. It also introduces the concept of reverse sieving, along with applications to testing randomness, pattern and fraud detection, cybersecurity, synthetic data, sequence categorization and normalization, or to detect and quantify a new type of chaos in time series including Brownian motions. Magic primes, forbidden prime number constellations, cellular automata, and reduction via classes of equivalent sequences, are some of the innovative and promising topics discussed in the paper.

Wrist-worn photoplethysmography (PPG) enables continuous monitoring of cardiopulmonary physiology, but reliable heart rate (HR) and respiratory rate (RR) estimation in free-living conditions remains challenging due to non-stationary motion artifacts that spectrally overlap with physiological dynamics. Existing signal-processing methods degrade under strong motion, while unconstrained deep learning approaches often lack physiological interpretability and identifiable structure. We propose a Physically-Constrained Harmonic Separation (PCHS) framework that formulates HR and RR estimation from wrist PPG as an analysis-by-synthesis problem, where accelerometer measurements condition artifact separation rather than directly regressing vital signs. A physics-guided harmonic generator decomposes the observed signal into quasi-periodic physiological components and a motion-related residual, enabling HR recovery from the fundamental frequency and RR prediction from respiratory-driven modulations of the harmonic parameters. Robust reconstruction objectives, separation constraints, and uncertainty-aware weighting stabilize the decomposition under motion. Experiments on the motion-intensive PPG-DaLiA dataset demonstrate that PCHS outperforms state-of-the-art methods while yielding interpretable signal decompositions that effectively disentangle physiological activity from motion artifacts.

This paper presents an automatic system for recognizing pulmonary diseases in chest X-rays using geometric normalization of the lung region. The method combines three modules: (1) a ResNet-18 landmark detector with coordinate attention that predicts 15 lung-contour landmarks, achieving a mean localization error of 3.61 pixels through an ensemble of four models with test-time augmentation; (2) a geometric normalizer based on Generalized Procrustes Analysis, Delaunay triangulation, and piecewise affine warping to map each lung region to a standardized shape; and (3) a ResNet-18 classifier with transfer learning and SAHS contrast enhancement to classify images as COVID-19, Viral Pneumonia, or Normal. On the COVID-19 Radiography Database, the normalized-image classifier achieved 98.60+/-0.26% accuracy and 98.00% F1-Macro using five-fold cross-validation. Although original images produced slightly higher raw accuracy, Grad-CAM and cropping experiments suggest that this advantage is partly influenced by acquisition artifacts. In contrast, geometrically normalized images outperformed artifact-masked/cropped unaligned images on both the COVID-19 Radiography Database (98.60% vs. 96.24%) and a balanced adult-pediatric mixed dataset including pediatric cases from the Kermany dataset (94.67% vs. 94.17%). These results suggest that anatomical alignment can provide a more controlled and artifact-resistant representation for pulmonary disease recognition.

Video-based remote physiological measurement (RPM) is highly accessible but remains fragile under varying illumination, skin tones, and motion. Radio frequency (RF) radar is largely invariant to illumination and appearance, providing complementary cardio-respiratory micro-motion cues; however, requiring radar at inference is often impractical due to its limited ubiquity and deployment overhead. We propose RPM-Distill, a physiology-guided cross-modal distillation framework that leverages synchronized radar only during training while retaining video-only inference. Our key observation is that although RGB and RF waveforms differ in sensing physics and time-domain morphology, they share similar latent periodic rhythm in the frequency domain. We thus distill physiology-structured spectral evidence to improve robustness, via losses that (i) anchor the fundamental peak, (ii) match the off-peak background distribution, and (iii) preserve spectral morphology and sharpness. To avoid negative transfer under sample-level teacher quality and alignment uncertainty, a spectral policy network predicts sample-level distillation gates and component weights from the student--teacher spectral relation map, learned with a meta bilevel objective on a small labeled validation split. Through extensive experiments in challenging conditions and cross-dataset settings, RPM-Distill brings 81% MAE and 21% correlation improvement over unimodal baselines. Code is at https://github.com/WJULYW/RPM-Distill.

Respiratory acoustic foundation models (FMs) are benchmarked exclusively on smartphone recordings, yet clinical deployment increasingly targets body-coupled (BC) wearables whose sensors attenuate high-frequency content through tissue and bone, leaving FM reliability uncharacterised. We introduce BCoughBench, evaluating five FMs (OPERA-CT/CE/GT, HeAR, M2D+Resp) on nine classification tasks (AUROC, sensitivity at 95% specificity, Expected Calibration Error) and three age regression tasks (MAE vs. a mean-predictor baseline) across five EBEN-simulated BC sensor conditions on five labeled cough datasets. Mean AUROC declines from 0.785 (smartphone) to 0.689-0.723, degrading most under temple vibration pickup ($Δ$ = -0.096) and least under the soft in-ear ($Δ$ = -0.062). No FM meets the clinical sensitivity threshold (Se@Sp95 $\geq$ 0.20) on most disease tasks under any BC sensor. Sex classification on the CIDRZ cohort collapses (AUROC 0.954 to 0.596-0.628, $Δ$ = -0.341) while COVID detection is nearly unaffected ($Δ$ = -0.004). Age regression is robust, improving under the forehead accelerometer on CoughVID (MAE 9.61 to 8.97 yr); HeAR leads on regression and demographic tasks, M2D+Resp on disease and characteristic tasks. BCoughBench provides a reproducible framework for FM evaluation under wearable conditions.

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.

Respiratory rate is a vital indicator of pulmonary and cardiovascular health, yet conventional methods for estimating respiratory rate are often intrusive due to their contact-based nature. Remote photoplethysmography offers a promising non-contact alternative and has been widely used for heart rate estimation; however, its potential for respiratory rate estimation remains underexplored. Existing methods typically adapt green and chrominance-based projections originally designed for heart rate estimation, which only partially capture respiratory dynamics. Most prior work focuses on the Eulerian representation with fixed or empirically selected RGB projections. To address these gaps, we propose a skin-tone-aware dynamic RGB signal projection that captures respiratory information. To mitigate the sensitivity of the Lagrangian representation to non-respiratory motion, we introduce a denoising network for motion-based remote photoplethysmography signals. We further design a phase-independent contrastive loss that enables Eulerian and Lagrangian representations to collaboratively learn respiratory rate information. We also introduce RR-rPPG, a respiratory-rate facial video dataset with Indian demographic representation. We evaluate the method on RR-rPPG and the publicly available COHFACE dataset, where it consistently outperforms comparison methods and achieves up to a 42.1% reduction in mean absolute error across the evaluated settings. The proposed framework demonstrates the effectiveness of jointly leveraging skin-tone-aware Eulerian and denoised Lagrangian representations for contactless respiratory rate estimation from facial videos. In addition, RR-rPPG contributes a diverse benchmark resource for future research in remote respiratory monitoring. The code and dataset will be made publicly available upon paper acceptance.

In this work, we introduce CoughPhase-CLR, a self-supervised learning framework designed to leverage the physiological phases of a cough for robust representation learning. Unlike generic contrastive frameworks, CoughPhase-CLR constructs positive pairs based on these specific acoustic phases. We pre-trained our model on approximately 40 hours of public cough audio and evaluated it across five downstream tasks, including COVID-19 detection, chronic obstructive pulmonary disease (COPD) state classification, and smoker status prediction. Our results demonstrate that cough-specific pre-training consistently outperforms standard random-cropping techniques when training on cough recordings. Additionally, we benchmarked a diverse set of state-of-the-art models on COPD state classification, highlighting the difficulty of this task. The best-performing models, pretrained on either general audio or respiratory sounds, achieved a UAR of 57%, failing to outperform the state-of-the-art performance of 84% UAR achieved using speech analysis.

Inference-time engineering can alter model behavior without fine-tuning. However, its utility for improving diagnostic performance in medical vision-language models (VLMs) remains unclear. We aim to evaluate whether Contrastive Activation Addition (CAA) can improve pneumonia classification in chest radiograph VLMs without updating model weights. Three frozen chest radiograph VLMs (MedGemma-4B-IT, NV-Reason-CXR-3B, and CheXOne-3B) were evaluated on the public Kermany pneumonia test set. Classification was based on the logits of the tokens Yes and No under a binary prompt. Steering vectors included a 30-pair answer-bias control, a 30-pair pneumonia text contrast, and an image-conditioned contrast derived from 30 pneumonia and 30 normal development images. A deterministic 200-image development set was used for layer and scale selection (100 images) and threshold calibration (100 images). Performance was assessed using ROC-AUC, PR-AUC, F1 score, threshold analyses, reverse-vector controls, random-vector controls, and conditional bootstrap confidence intervals. Fixed-threshold F1 improvements were frequently observed but did not consistently indicate improved diagnostic performance. For MedGemma-4B-IT. NV-Reason-CXR-3B showed the strongest benefit: calibrated F1 improved from 0.7692 in the zero-shot setting to 0.8619 with pneumonia-text steering and to 0.8727 with image-conditioned steering. For CheXOne-3B, pneumonia-text steering increased calibrated F1 from 0.8528 to 0.8666, although the confidence interval crossed zero. On this public pneumonia benchmark, CAA substantially altered prediction score distributions and operating characteristics without fine-tuning. Meaningful performance gains were observed in one of three evaluated VLMs, suggesting that activation steering may serve as a lightweight approach for adapting medical VLM behavior.

Objective sleep assessment relies on polysomnography (PSG), yet clinical impact is often better reflected in patient-reported outcomes (PROs) such as sleepiness and fatigue. Existing summary indices, including the Apnea-Hypopnea Index (AHI), provide limited insight into the multidomain physiology underlying functional recovery. We propose an interpretable, causal-discovery-guided framework for deriving a hierarchical Sleep Recovery Score (SRS) from multimodal PSG. Using two large population cohorts (MESA: $n=1{,}540$; MrOS: $n=825$), we apply directed acyclic graph (DAG) learning to identify candidate physiological drivers spanning respiratory burden, hypoxic burden, sleep fragmentation, sleep architecture, and autonomic regulation. Although derived from clinical PSG, these domains map naturally to sensing streams increasingly available in connected health technologies, including wearable ECG, oximetry, and sleep-stage estimation devices. To preserve mechanistic plausibility, we introduce a two-stage screening process that combines physiology-based constraints with constrained LLM-assisted auditing to identify and remove structural confounders and construct-overlapping variables. Across cohorts, these five domains emerge as recurrent physiological domains associated with recovery, and the resulting SRS shows up to $3.4\times$ stronger alignment with perceived recovery than AHI. By linking multimodal sleep physiology to patient-centered outcomes through an interpretable, bias-aware, and domain-structured framework, this work provides a practical foundation for recovery modeling across both clinical sleep studies and emerging smart and connected health settings.

Respiratory-rate (RR) monitoring is a critical component of remote triage and victim assessment in emergency response, disaster recovery, and infectious-disease scenarios, where minimizing physical contact can reduce responder risk and improve operational safety. However, field deployment of contactless RR monitoring remains challenging due to variable illumination, posture changes, platform heterogeneity, and the impracticality of wearable sensors in hazardous environments. In this paper, we present a modality-adaptive contactless RR monitoring framework for heterogeneous mobile robots with onboard edge computing. The proposed system combines brightness-adaptive sensor selection across RGB, thermal, near-infrared (NIR), and low-light cameras, keypoint-guided chest ROI extraction for posture-robust monitoring, and a signal-quality-index (SQI)-based filtering mechanism for reliable respiratory estimation. We implement and evaluate the framework on three robotic platforms spanning quadruped and wheeled locomotion and multiple edge-computing architectures. Experiments conducted across diverse lighting conditions, subject poses, and robot-to-subject distances demonstrate that the framework generalizes across platforms without per-platform algorithmic retuning, while revealing modality-specific operational boundaries. RGB provides the broadest coverage up to 8m, NIR remains effective up to 6m, thermal is reliable only at short range, and low-light sensing supports monitoring in complete darkness up to 8m. Overall, the results demonstrate the feasibility of multimodal contactless RR monitoring on mobile robots and support its use as a foundation for autonomous triage and victim assessment in hazardous search-and-rescue settings.

Respiratory acoustic foundation models (FMs) excel at cough classification, yet their ability to predict continuous health quantities from cough audio remains largely unexplored, despite the clinical value of passive age, BMI, and disease probability estimation in settings where physical measurements are unavailable. We introduce the multi-model, multi-target cough regression benchmark evaluating five FMs (OPERA-CT, OPERA-CE, OPERA-GT, HeAR, M2D+Resp) across six targets on three datasets under subject-disjoint protocols, comparing linear, MLP-small, and full MLP regression heads. MLP-small beats the mean-predictor baseline on all tasks and linear probing in 23 of 30 model x task cases, with full MLP overfitting on small clinical data but recovering on larger sets, revealing a dataset size x head-capacity trade-off. HeAR leads within-dataset age regression on Coswara (9.12 yr MAE); its CIDRZ result is excluded from headline claims owing to possible HeAR-CIDRZ pretraining overlap. OPERA-GT is favored over OPERA-CT on age in all three datasets, with the CIDRZ margin within seed variance, extending a generative-pretraining advantage from breath to cough. HeAR and M2D+Resp reach near-full performance at N = 50 samples while OPERA models require N = 400. Cross-dataset transfer is strongly asymmetric as large diverse data generalises to small clinical populations (CoughVID to CIDRZ: -0.17 yr) but not vice versa (CIDRZ to Coswara: +2.43 yr, +26.6%).

Photoplethysmography (PPG) plays a central role in wearable health monitoring and clinical decision support. Yet existing approaches to universal PPG representation learning largely focus on signal-level objectives and often overlook patient-level health context, which limits generalization to complex clinical tasks and heterogeneous cohorts. To address this gap, we construct a large-scale paired PPG-EHR multimodal dataset by distilling fragmented medical histories and clinical records into cohesive, patient-level electronic health records (EHR). Building on this resource, we propose Clinical Anchored Pretraining for PPG (CAP). During pretraining, CAP performs cross-modal contrastive alignment that anchors PPG representations to patient-level clinical semantics, guiding the encoder beyond waveform fitting toward modeling consistency in a patient's overall physiological state. During downstream adaptation, the pretrained PPG encoder provides clinically grounded representations that strengthen inductive bias and improve robustness and transferability. Experiments demonstrate that CAP consistently outperforms strong baselines on four diverse downstream tasks. CAP achieves a particularly large gain on respiratory rate prediction (up to +87.6% relative improvement over the state-of-the-art baseline) and delivers an average relative +26.7% across all tasks. We further enhance the interpretability of our approach through comprehensive analyses, including ablations and multiple complementary visualizations of the learned representations. The code for our experiments is available at: https://github.com/gody123gody/CAP .

Recent respiratory sound classification (RSC) studies largely rely on CLS-token driven self-attention architectures such as the Audio Spectrogram Transformer (AST). While effective at modeling global context, recent analyses suggest a low-pass filtering behavior that may reduce sensitivity to localized abnormal patterns. In this work, we investigate State Space Models (SSMs) as an alternative backbone for RSC. Using the Distilled Audio State Space model, we analyze intermediate representations through spectral response curves and observe stronger preservation of mid-to-high spatial-frequency components. Based on these observations, we introduce spectral-aware layer regularization using Gaussian convolution applied to selected layers. We further propose Dual-Axis Patch-Mix contrastive learning tailored to SSM-based audio models for robust representation learning. Experiments on the ICBHI benchmark show that our approach achieves 64.48% score, outperforming the AST baseline by 5%. Code is available at https://github.com/RSC-Toolkit/Lung-SRAD.

We present a quality-adaptive angular-margin learning framework that improves feature generalization by enforcing intra-class compactness and inter-class separability. Our framework, titled QLung, introduces a no-reference audio quality margin derived from spectral entropy and root-mean-square energy, which adaptively scales angular margins based on recording quality. To this end, we propose a log-scaled angular margin that stabilizes training under severe class imbalance. We also use an angular classifier that normalizes features and class weights, ensuring margin penalties are applied consistently on the unit hypersphere. Our approach improves in-distribution performance on the ICBHI dataset by 2.46% over the cross-entropy baseline, and most significantly, achieves the strongest out-of-distribution performance on the SPRSound dataset compared to prior state-of-the-art methods. Code is available at https://github.com/RSC-Toolkit/QLung.

This study aims to explore the performance of the VAR model in comparison with mel-frequency cepstral coefficient (MFCC) matrices and log-mel spectrograms using deep learning. In pulmonary sound classification, spectrogram-based representations suffer from inconsistent temporal dimensions due to varying respiratory cycle durations. Along with traditional trimming/zero-padding, adaptive-length windowing was presented to fix their temporal dimensions. Their spectral and temporal dimensions were optimized by testing a range of parameters. Different convolutional neural network (CNN) architectures were employed to extract features from the two-dimensional representations obtained over the sub-phases. The extracted sub-phase features were then fused using various strategies including direct concatenation, gated recurrent unit (GRU) network and GRU with attention mechanism. Model performances were assessed through respiratory cycle-based evaluation and subject-based evaluation comprising multiple respiratory cycles. Several data augmentation techniques were also studied to cope with limitations in data size. The best cycle-based F1-score (0.877) was obtained using the MFCC matrices with thirteen coefficients and 64-point time resolution per sub-phase representation followed by direct feature concatenation, and the best subject-based F1-score (0.855) was obtained using the MFCC matrices with thirteen coefficients and 256-point time resolution per full-cycle representation, both obtained by adaptive-length windowing. Augmentation degraded the performance of models overall, yet mixup augmentation was the best among the methods tested. MFCC outperformed log-mel spectrogram and VAR model in differentiation of asthma and COPD. Sophisticated fusion strategies did not improve the diagnosis. Augmentation did not contribute, demonstrating the significance of authentic data in pulmonary sound studies.

Respiratory diseases remain a leading cause of global mortality, where timely and accurate diagnosis is critical to improving patient outcomes and reducing healthcare burdens. While prior work has explored audio-based models for respiratory disease detection, such unimodal approaches often suffer from limited generalizability and diagnostic precision. In this paper, we propose RespiraMFM, a Multimodal Foundation Model that integrates respiratory sounds with patient medical history and symptoms to enhance diagnostic accuracy and disease detection capabilities. We introduce an effective contrastive alignment strategy for audio-text multimodal integration, allowing the model to learn better cross-modal representations between respiratory sounds and corresponding textual clinical information. We evaluate RespiraMFM across five major respiratory diseases using seven real-world datasets in both supervised fine-tuning and zero-shot settings, achieving a 9.15% improvement in AUROC on supervised tasks and a 20.98% gain on zero-shot tasks over existing baselines. These findings underscore the potential of our framework to advance early diagnosis and improve clinical decision-making in respiratory disease management.

Foundation models offer a promising route to compress multi-modal physiological signals into compact representations of human health, with broad applications across sleep medicine, cardiology, neurology and other healthcare domains. Existing models have typically been trained with masked-reconstruction or contrastive objectives. However, masked reconstruction may be poorly suited to the stochastic nature of these signals, while contrastive approaches rely on positive-pair definitions despite the semantic invariances of physiological signals being poorly understood. In this work, we show that next-token prediction is a simple and scalable alternative. We develop Hypnos, a multi-modal sleep foundation model trained using eight different sensing modalities (e.g. EEG, ECG, respiratory signals) drawn from over 20,000 overnight polysomnography recordings. We tokenize each modality into streams of discrete tokens using residual vector quantization, then train a large auto-regressive RQ-Transformer to jointly predict the next token across all modalities in parallel. After training, Hypnos can be applied to continuous streams of sensor data from any subset of supported modalities, generating embeddings for downstream tasks. Across a range of benchmarks, Hypnos significantly outperforms existing foundation models. In sleep stage classification, we match the performance of strong supervised baselines on held-out test sets whilst using $100\times$ less labelled data. Hypnos even generalises to daytime physiology, surpassing a dedicated ECG foundation model at detecting atrial fibrillation. Our results demonstrate that next-token prediction is a strong self-supervised objective for representation learning from multi-modal physiological signals.

Inferring the forces that drive a dynamical system from partial observations is a fundamental challenge across physics, particularly when distinct underlying mechanisms produce similar observable dynamics. Here we show that the effective muscular forcing underlying avian respiratory dynamics can be reconstructed from measurements of air-sac pressure alone. Using an interpretable learning framework based on Kolmogorov-Arnold networks, we infer the governing equations of the system directly from data and uncover a nontrivial structure in the underlying forcing that is not apparent from the pressure signal, which instead suggests a relaxation-like oscillation. The reconstructed dynamics predict a two-phase activation pattern within each respiratory cycle, which we independently validate through electromyographic recordings of expiratory muscles. These results demonstrate that data-driven reconstruction of dynamical laws can reveal hidden physical structure and provide access to unobserved driving variables, establishing a general route to infer latent forces in partially observed dynamical systems.

Acute asthma risk assessment requires rapid interpretation of respiratory sounds, oxygenation, airflow limitation, speech ability, work of breathing, mental status, and response to reliever therapy. Conventional audio-only classifiers can detect wheeze-like patterns but often lack transparent clinical reasoning and safe escalation logic. This paper presents AeroSpectra Sentinel, a client-side research prototype and decision-support workflow that combines short-time Fourier transform (STFT) respiratory sound analysis, lightweight machine-learning screening, clinical feature fusion, and a five-stage large language model (LLM) prompt-chaining process. The workflow separates signal acquisition, preprocessing, acoustic feature extraction, ML screening, clinical guardrails, and FHIR-ready reporting. We evaluated the audio screening component on a public respiratory sound dataset containing 1,211 WAV recordings from five labels. Using a stratified subset of 584 recordings, a random forest achieved 91.10% binary accuracy and 78.69% F1-score for asthma-vs-non-asthma screening, while a feature-based multilayer perceptron achieved 89.73% accuracy and 78.26% F1-score. A compact log-spectrogram CNN achieved 73.29% accuracy and 55.17% F1-score. Multiclass classification achieved 77.40% accuracy and 77.23% macro-F1. To evaluate the LLM workflow, we conducted a scenario-based audit on 40 simulated clinical vignettes comparing one-shot prompting, prompt chaining, prompt chaining with guardrails, and prompt chaining with guardrails plus FHIR schema validation. The guardrail-plus-schema variant achieved the strongest simulated safety and documentation consistency. AeroSpectra Sentinel is intended as a research prototype, not as a diagnostic medical device or clinically validated risk-assessment product.

Vision-Language-Action (VLA) models have shown strong potential for robotic manipulation, but real-time deployment on edge hardware remains challenging. In this work, we identify VLM visual and context tokens as a major source of deployment latency: for GEMM-dominated projection operators, computation grows linearly with the number of input tokens when model dimensions are fixed. Motivated by this observation, we propose RhinoVLA, a deployment-oriented VLA model co-designed with the Huixi R1 edge SoC. RhinoVLA adopts a token-efficient Qwen3-VL backbone and a continuous Action Expert, reducing the VLM-side token and computation burden while preserving pretrained multimodal capability. To support cross-robot learning, RhinoVLA further introduces a unified interface that combines View Registry, 72D physical state-action slot space, and robotinstance LoRA, allowing heterogeneous robot observations and action schemas to be aligned under a shared policy. On the deployment side, RhinoVLA is optimized through hardware-aware compilation, mixed-precision execution, and parallel visual encoding. Experiments show that RhinoVLA achieves downstream performance comparable to π0.5 at a similar parameter scale, while reaching 11.69 Hz end-to-end inference on Huixi R1, meeting the 10 Hz real-time closedloop control target. The project will be open-sourced at https://github.com/HuixiAI/RhinoVLA.

Childhood asthma is a common illness exacerbated by air pollution as well as meteorological and neighborhood-level socioeconomic factors. Modeling asthma exacerbation (AE) in large spatiotemporal datasets requires disentangling impacts from multiple contributors. In this case study, we compared three techniques that balance predictive power with interpretability to predict AE in Hampton Roads, a coastal Virginia region comprising 7 cities and over 1.5 million people. After collating ambient air pollution measurements, weather data, and measures of neighborhood opportunity, we modeled zip code-level acute AE visits to a regional children's hospital and affiliated providers from 2018-2023. Generalized linear models (GLM) provided a baseline while neural networks (NN) served as a maximally predictive target. To bridge between statistical models and deep learning, we developed a framework based on sparse dictionary learning to identify and interpret parsimonious nonlinear interacting equations. After comparing each model's predictive performance, we estimated relative risks for AE due to input exposure variables and found consensus across frameworks. Our work links statistical and interpretable machine learning models to highlight possible synergistic interactions influencing AE, and may enable future studies to guide public health interventions in coastal Virginia.

Mechanical ventilation for Acute Respiratory Distress Syndrome (ARDS) requires balancing competing physiological goals, including oxygenation, lung protection, and acid-base homeostasis. However, current data-driven methods, especially those imitating retrospective Electronic Health Records (EHR), often suffer from imitation bias. They may capture superficial correlations from inconsistent clinical demonstrations, such as associating passive ventilator settings with survival because such settings are common in stable patients, and thus fail to generalize to volatile or out-of-distribution phenotypes. Standard Reinforcement Learning (RL) methods also struggle with the adversarial trade-offs of critical care and often produce opaque policies with limited clinical interpretability. To address these limitations, we introduce VentAgent, a hierarchical framework in which Large Language Models (LLMs) act as transparent arbitrators for mechanical ventilation. We reformulate ventilation control as a dynamic Multi-Objective Arbitration process rather than single-objective optimization. VentAgent decomposes decision-making into three interpretable stages: Perception, Planning, and Orchestration. By leveraging the semantic reasoning capabilities of LLMs, it synthesizes strategies from heterogeneous experts and resolves conflicting clinical priorities through an explicit coordination mechanism. Evaluations on a high-fidelity physiological simulator show that VentAgent outperforms state-of-the-art RL and classical control baselines. Moreover, it converts control decisions into human-readable reasoning chains, offering a safer, more interpretable, and adaptable paradigm for critical care automation.

Automated cough analysis offers a path to low-cost respiratory screening, but most existing work stops at binary COVID-19 detection. A practical tool needs to tell apart several respiratory conditions from one cough recording on a consumer smartphone. We present CoughSense, a system that sorts cough recordings into five classes. These are healthy, COVID-19, asthma or respiratory condition, bronchitis, and pneumonia. We aggregated 18,301 recordings from four public datasets (Coswara, CoughVID, Virufy, and the West China Hospital Pediatric Cough Dataset) and used the OpenAI Whisper encoder as a pretrained backbone for cough disease classification. The main contribution is active-frame QKV attention pooling, which restricts attention to the first 200 of 1500 encoder tokens. This avoids the silence-dilution problem that arises because a 3-second cough fills only 150 tokens of Whisper's 30-second input window. Other training parts handle the 19 to 1 class imbalance and the four-dataset domain shift. These include WeightedRandomSampler, SpecAugment, Balanced Mixup with forced minority pairing, a supervised contrastive auxiliary loss, FiLM symptom conditioning, and gradient-reversal domain adaptation. A dual-encoder model fuses Whisper with the OPERA-CT respiratory foundation model through cross-attention. CoughSense (Whisper-tiny, 8.6M parameters) reached 82.3 percent balanced accuracy on five-fold cross-validation (macro-F1 of 0.817, AUC of 0.941). It beat an ImageNet-pretrained EfficientNet-B2 by 11.1 points and a ViT trained from scratch by 29.6 points. All five classes passed 74 percent recall and four of five passed 80 percent. The dual-encoder model reached 85.4 percent balanced accuracy. Active-frame pooling is the largest single contributor across all ablation components at 5.1 points, which should help any short-audio task using Whisper as a backbone.

Background: Respiratory sound classification plays a critical role in the clinical identification of pulmonary pathologies. However, its performance is often hindered by the limited size, severe noise, and class imbalance of real-world auscultation datasets. Although conventional audio augmentation techniques are easy to implement, they may inadvertently distort subtle pathological characteristics. Meanwhile, existing Variational Autoencoder (VAE)- or Generative Adversarial Network (GAN)-based generative approaches often suffer from limited sample fidelity and insufficient controllability over class semantics, particularly under conditions of scarce supervision. Methods: To overcome these limitations, we propose C2GA, a class-controllable generative augmentation framework. C2GA first constructs a semantically rich discrete latent space using a conditional Vector-Quantized Variational Autoencoder (VQ-VAE), in which local acoustic tokens are explicitly decoupled from global class prototypes. Subsequently, a Transformer-based autoregressive prior is trained to generate label-consistent token sequences. These generated tokens are then fused with the corresponding class prototypes and decoded into high-fidelity Mel-spectrograms for data augmentation. Conclusion: These results indicate that C2GA provides an effective and semantically reliable augmentation strategy for respiratory sound analysis. By enabling controllable and high-quality data generation, the proposed framework offers a promising solution for improving the robustness and generalization of respiratory sound classification in realistic clinical scenarios.

AI-driven respiratory sound classification (RSC) is promising for automated pulmonary disease detection, yet multi-site deployment is hindered by inter-stethoscope variability. We introduce a federated domain generalization (FedDG) formulation for RSC in which clients hold recordings from different stethoscopes and the model is evaluated on an unseen device. Our empirical analysis shows that stethoscope-induced style and disease-relevant content are partially entangled, making deterministic style removal unreliable. In response, we propose BTS-CAFE, a framework combining (i) causality-inspired device-style interventions with constraints designed to limit content distortion, (ii) counterfactual metadata augmentation to relieve device and demographic shortcuts, and (iii) gradient alignment to promote device-invariant decision boundaries across clients. Built on BTS with CLAP, a multimodal language-audio pretraining model, BTS-CAFE improves the out-of-distribution ICBHI Score by 3.69 points on average over five held-out devices relative to its backbone, and outperforms conventional data augmentation and federated learning baselines in simulated device leave-out evaluations on the ICBHI and SPRSound datasets.

Early prediction of respiratory failure is critical for timely clinical intervention in intensive care units. Existing electronic health record (EHR)-based models can continuously monitor physiologic deterioration, but they may not fully capture pulmonary pathophysiology reflected in chest radiographs (CXRs). In this study, we ask whether CXR information improves prospective prediction of invasive mechanical ventilation beyond EHR signals alone. We develop a gated multimodal framework that integrates structured EHR time-series data with CXR foundation-model representations. The gating module adaptively controls the contribution of imaging features based on patient-specific clinical context, allowing the model to selectively rely on imaging information when it is informative. We prospectively evaluate the framework for predicting invasive mechanical ventilation within 24 hours in ICU patients and compare it with an established EHR-only model (Ventio), physician predictions obtained at matched clinical time points, and alternative multimodal variants. The gated multimodal models achieved higher discrimination than the EHR-only baseline, with AUROC values of 0.860 and 0.858 using REMEDIS and MedInsight CXR representations, respectively, compared with 0.752 for Ventio. Relative to physician predictions, the multimodal framework substantially improved sensitivity while maintaining favorable specificity. Compared with the EHR-only model, multimodal integration increased specificity and positive predictive value, suggesting that CXR information can refine risk estimation in selected patients. These findings support adaptive multimodal fusion as a practical strategy for incorporating imaging into prospective respiratory failure prediction.

Effective pre-polysomnography screening for obstructive sleep apnea-hypopnea syndrome (OSAHS) requires combining clinical risk factors with visible craniofacial and neck cues. Directly prompting general-purpose multimodal foundation models for medical yes/no decisions can yield unstable, poorly calibrated outputs. We propose EviOSAHS, an evidence-grounded multimodal reasoning framework that separates image-only anatomical evidence acquisition from final clinical adjudication. Each frontal facial image is decomposed into seven fixed anatomical queries covering the neck, chin, mouth, face/neck fat, lower jaw, midface, and nose. Visual responses are converted into structured evidence cards recording target anatomy, visibility, risk direction, evidence strength, confidence, and a concise summary. These cards are combined with a cleaned clinical profile only in the final stage, where a large language model performs balanced binary screening adjudication. We evaluated EviOSAHS on a 642-subject cohort, mapping normal subjects to screening-negative and mild, moderate, or severe OSAHS subjects to screening-positive. EviOSAHS achieved 88.47% accuracy, 94.86% sensitivity, 93.74% F1-score, and a 5.14% false-negative rate, outperforming clinical-only prompting, direct multimodal prompting, and naive two-stage pipelines under a unified protocol. Ablations showed that seven-question visual decomposition and balanced final adjudication were critical to the high-sensitivity operating point. A question-level audit of 4,494 visual outputs showed a 100% structured parse rate and 93.88% high-visibility rate. EviOSAHS provides an auditable, high-sensitivity workflow for binary pre-polysomnography OSAHS screening, but should be viewed as a triage assistant rather than a diagnostic system. Prospective validation, external testing, and calibrated operating-point control are needed before clinical deployment.

Diabetes is a global health burden, and early detection is critical for timely intervention. This study explores a non-invasive, data-driven framework to identify individuals at risk of diabetes using Volatile Organic Compounds (VOCs) and lifestyle variables. We use causal inference techniques to estimate the impact of VOCs such as acetone, isopropanol, isoprene, and ethanol on blood glucose levels. Additionally, we designed a classifier to distinguish diabetics from non-diabetics using non-invasive markers. We created a risk-based ranking system for individuals in the "gray zone," and identified natural clusters in the population using Gaussian Mixture Model. Our results suggest that specific VOCs exhibit a strong causal influence on glucose levels and that machine learning models can reliably classify and stratify individuals at high risk. This integrated causal-explainable analysis can support the development of tool for non-invasive early screening of diabetes.

Deep learning models achieved high accuracy in pneumonia detection from chest X-rays. However, their generalization across clinical domains remains limited due to variations in imaging devices, acquisition protocols, and institutional conditions. This study introduces a replay-based domain-incremental continual learning designed to enable continual adaptation to cross-domain variations without catastrophic forgetting. The proposed method incorporates a class-aware balanced replay to maintain balanced class representation within a constrained memory and a class-aware loss to dynamically reweight class imbalance during training. Experiments conducted on a domain-shifted PneumoniaMNIST dataset consisting of five simulated domains demonstrate that the proposed method achieves an average accuracy of 88.66%, outperforming Experience Replay, Fine-Tuning, and Joint Training baselines. These findings highlight the efficacy of the proposed approach in achieving robust and consistent pneumonia detection across clinical environment variations.

Current clinical artificial intelligence (AI) systems are evaluated almost exclusively on clean, standardised, English-language inputs, conditions that do not reflect the realities of healthcare delivery in low-resource settings. This study presents the first systematic dual audit of two orthogonal safety vulnerabilities in clinical AI: adversarial image fragility and cross-lingual diagnostic drift. Using DenseNet121, the architecture underlying CheXNet, fine-tuned on the COVID-QU-Ex chest X-ray dataset (85,318 images; COVID-19, Non-COVID Pneumonia, Normal), we demonstrate that diagnostic accuracy collapses from 89.3% to 62.0% under a Fast Gradient Method (FGM) perturbation of epsilon=0.021, a magnitude imperceptible to the human eye. Standard defensive strategies including Gaussian smoothing and ensemble voting failed to restore clinical safety. In a parallel language fragility experiment, we tested Llama3.1:8b and NatLAS (N-ATLAS) on 20 COVID-19 clinical cases presented in Standard English, Nigerian Pidgin (Naija), and Yoruba-inflected English. Both models exhibited significant accuracy degradation: Llama3.1:8b dropped from 80.0% to 65.0% on Pidgin; NatLAS, an African-context model, collapsed from 85.0% to 55.0%, with diagnosis consistency falling to 50%. These findings establish a quantitative failure envelope for clinical AI under conditions representative of Primary Health Centre (PHC) deployment in Nigeria, and motivate urgent calls for adversarially hardened, linguistically inclusive clinical AI architectures.

Early detection of exacerbations in asthma and chronic obstructive pulmonary disease (COPD) is important for timely intervention. Speech has emerged as a promising tool for continuous, non-invasive respiratory disease monitoring. However, speech signals inherently carry speaker-identifiable attributes that may dominate model predictions, which may compromise both diagnosis performance and patient privacy. Furthermore, the acoustic features associated with respiratory disease and speaker identity remain unclear in respiratory disease monitoring. We propose an adversarial learning architecture that disentangles pathology-related acoustic patterns from speaker-identifiable attributes. The framework optimizes two clinically hierarchical tasks: (i) respiratory status classification (stable vs. exacerbated) and (ii) exacerbation type classification (asthma exacerbation vs. COPD exacerbation). Speaker identity is suppressed through gradient reversal-based adversarial training. To enhance clinical interpretability, we employ SHapley Additive exPlanations (SHAP) to quantify the contributions of acoustic features to pathology-related predictions versus speaker identity. On the TACTICAS dataset, our method outperforms the single-task baseline across both tasks. For the respiratory status task (stable vs. exacerbated), the AUC improves from 0.897 to 0.910. For the exacerbation type task (asthma exacerbation vs. COPD exacerbation), the AUC increases from 0.674 to 0.793. Concurrently, the J-ratio decreases, confirming effective suppression of speaker information. SHAP analysis reveals the contributions of the acoustic features to both tasks. External validation on the Bridge2AI-Voice dataset further demonstrates consistent performance improvement and reduced speaker dependency, confirming cross-dataset generalizability.

This work presents a physics-guided machine-learning framework for carbon monoxide concentration inference from experimentally measured resistance transients of a mixed-phase SnO-SnO$_2$ material gas sensor exhibiting temperature-dependent p-n switching behavior. Cycle-level transient responses are represented through physically interpretable descriptors and complemented by compact fast Fourier transform (FFT) and discrete wavelet transform (DWT)-based summaries. Using leakage-aware grouped cross-validation, we study both multi-class concentration classification and continuous concentration regression for the p-type and n-type sensing regimes separately. Across both regimes, fused features provide the strongest overall performance, while the physics-guided descriptor block remains highly competitive, indicating that the dominant concentration information is already encoded in physically meaningful transient dynamics. The p-type branch shows the best concentration-class discrimination, with the fused Random Forest classifier reaching approximately $96.5\%$ accuracy, whereas the n-type branch yields the best quantitative concentration estimation, with the fused Random Forest regressor achieving an MAE$\approx 1.48$ ppm and an R$^2$ $\approx 0.992$. These results reveal a clear dual-regime behavior: p-type sensing is particularly favorable for classification, whereas n-type sensing is more favorable for high-fidelity regression. More broadly, the study demonstrates that leakage-aware, cycle-level, physics-guided machine learning can extend conventional gas-sensing analysis beyond single-response metrics while preserving physical interpretability

Automated sleep stage classification typically employs a single population-agnostic model, disregarding established demographic variations in sleep architecture. Sleep patterns, however, differ substantially across gender, age, and obstructive sleep apnea (OSA) severity, indicating that a onesize-fits all approach may be suboptimal for diverse clinical populations. In this paper, we propose a two stage training strategy based on demographic stratification and transfer learning framework. We first pretrains a convolutional recurrent model on the full population and then fine tunes it independently for demographic subgroups defined by gender, age, and Apnea-Hypopnea Index (AHI) severity according to the AASM clinical standard. Using the DREAMT dataset comprising 100 clinical subjects and 7 PSG channels, we evaluate 37 fine-tuned configurations across single-axis and two-way demographic combinations. Results demonstrate that 35 of the 37 fine-tuned models outperform the baseline, with Cohen's kappa improvements ranging from 0.9 to 12.9%. These findings indicate that stratified fine tuning tailored to specific patient demographics yields substantially more accurate sleep staging than a single generalized model, offering a practical and clinically grounded paradigm for personalized sleep assessment.

Pneumonia remains a leading global cause of morbidity and mortality, particularly in low-resource settings where access to imaging, laboratory testing, and specialist care is limited. Clinical assessment relies on heterogeneous evidence, including symptoms, respiratory patterns, spoken descriptions, and chest imaging, making frontline screening inherently multimodal. However, many existing computational approaches remain unimodal and focus primarily on radiographs. In this work, we present MultiSense-Pneumo, a multimodal research prototype for pneumonia-oriented screening and triage support that integrates structured symptom descriptors, cough audio, spoken language, and chest radiographs. The system combines deterministic symptom triage, LightGBM-based acoustic classification, domain-adversarial radiograph analysis using ResNet-18, transformer-based speech recognition, and an interpretable late-fusion operator. Each modality is transformed into a normalized concern signal and aggregated into a unified screening estimate. The fusion weights are hand-specified and are treated as heuristic, interpretable parameters rather than learned or clinically optimized values. MultiSense-Pneumo is implemented with offline execution in mind on standard laptop-class hardware, but it is not presented as a deployment-validated or clinically validated diagnostic system. Experimental results demonstrate strong component-level performance of the radiograph pathway under synthetic domain shifts, while also highlighting important limitations, especially reduced abnormal-class recall for cough acoustics and the absence of paired end-to-end multimodal patient evaluation. MultiSense-Pneumo is therefore intended as a framework and component-level prototype for screening and triage research.

Bronchoscopic navigation relies on registering endoscopic video to a preoperative CT scan, but respiratory motion deforms the airway by 5-20 mm, creating CT-to-body divergence that limits localization accuracy. In practice, this is mitigated through breath-hold protocols, which attempt to match the intraoperative anatomy to a static CT, but are difficult to reproduce and disrupt clinical workflow. We propose to eliminate the need for breath-hold protocols by leveraging patient-specific respiratory modeling. Paired inhale-exhale CT scans, already acquired for planning, implicitly define the patient-specific deformation space of the breathing airway. By registering these scans, we reduce respiratory motion to a single scalar breathing phase per frame, constraining all reconstructions to anatomically observed configurations. We embed this representation within a mesh-anchored Gaussian splatting framework, where a lightweight estimator infers breathing phase directly from endoscopic RGB, enabling continuous, deformation-aware reconstruction throughout the respiratory cycle without breath-holds or external sensing. To enable quantitative evaluation, we introduce RESPIRE, a physically grounded bronchoscopy simulation pipeline with per-frame ground truth for geometry, pose, breathing phase, and deformation. Experiments on RESPIRE show that our approach achieves geometrically faithful reconstruction, over 20x faster training, and 1.22 mm target localization accuracy (within the 3mm clinically relevant tolerances) outperforming unconstrained single-CT baselines. Please check out our website for additional visuals: https://asdunnbe.github.io/RESPIRE/

Training reliable respiratory sound classification models remains challenging due to the limited size and subject diversity of datasets. Ensemble methods can improve robustness, but when base models are trained on identical data, models tend to overfit and produce highly correlated predictions, thereby reducing the effectiveness of ensembling. In this work, we investigate a meta-ensemble learning methodology that enhances prediction diversity by training base models on diverse data splits and combining their outputs through a trained meta-model. Specifically, we train base models on the ICBHI dataset using two data split settings: fixed 80-20% split and five-fold cross-validation split, under two data granularity settings: patient- and sample-level. The resulting diversity in base model predictions enables the meta-model to better generalize. Our approach achieves new state-of-the-art performance on the ICBHI benchmark, reaching a Score of 66.49% and showing improved generalization on two out-of-distribution datasets, indicating its potential applicability to real-world clinical data.

Respiratory airflow signals provide critical insight into breathing mechanics, yet conventional analysis methods remain limited in their ability to characterize the internal structure of individual breaths. Traditional approaches treat airflow as a quasi-periodic signal and rely on global descriptors such as tidal volume or peak flow, obscuring sub-breath events that reflect neuromuscular coordination and compensatory breathing strategies. This study introduces a parametric framework for decomposing inspiratory airflow into a small number of time-localized components with explicit amplitude, onset time, and duration parameters. Unlike spectral or data-adaptive methods, the proposed approach employs physiologically grounded basis functions, Half-Sine, Gaussian, and Beta, to represent intrabreath waveform morphology through constrained nonlinear optimization. Evaluation across 8,276 breaths demonstrates high reconstruction accuracy (mean squared error $<$ 0.001 for four-component models) and robust parameter precision under moderate noise. Component-derived features describing sub-breath timing and coordination improved classification of cognitive fatigue states arising from cognitive-respiratory competition by up to 30.7% in Matthews correlation coefficient compared with classical respiratory metrics. These results establish that modeling airflow as a sum of parameterized, time-localized primitives provides an interpretable and precise foundation for quantifying intrabreath organization, compensatory breathing dynamics, and respiratory motor control adaptation under cognitive-respiratory dual-task demands.

Chronic rhinosinusitis (CRS) is a common heterogeneous inflammatory disorder that causes substantial morbidity and healthcare costs. CRS is difficult to identify early from routine encounters, as symptom presentations overlap with common conditions such as allergic rhinitis, and heterogeneous phenotypes further obscure risk patterns. Prior predictive studies often rely on single-institutional cohorts , which reduce population-level generalizability. To overcome this, we leveraged nationwide longitudinal EHR data from the \textit{All of Us} Research Program to predict CRS diagnosis using two years of pre-diagnostic history. To address extreme feature sparsity and dimensionality in coded EHR data, we implemented a hybrid feature-selection pipeline that combines prevalence-based statistical screening with model-based importance ranking, compressing approximately 110,000 candidate codes into 100 interpretable features. To capture demographic heterogeneity, we trained demographic stratified models across six adult sex and life-stage subgroups with subgroup-specific hyperparameter tuning. Our framework achieved an overall AUC of 0.8461, improving discrimination by 0.0168 over the best baseline. These results demonstrate that routinely collected EHR data may support population-representative CRS risk stratification and inform earlier triage and referral prioritization in primary care.

Human-machine interfaces in industrial automation need sensing modules that monitor operator actions and physiological state. This is important in factories, vehicles, machinery cabins, and human-robot collaboration, where workload, stress, fatigue, or reduced attention can affect safety. RGB monitoring is limited by low light, shadows, and privacy concerns, while thermal infrared imaging captures skin temperature dynamics without visible illumination. This paper studies thermal video as a contactless computer vision modality for estimating electrodermal activity (EDA), heart rate (HR), and breathing rate (BR), with the goal of supporting adaptive human-machine interfaces and operator-state awareness. We propose a signal-processing pipeline that tracks facial regions, aggregates thermal signals, and separates slow sudomotor trends from faster cardiorespiratory components. HR is estimated using orthogonal matrix image transformation (OMIT) across multiple facial regions, while BR is estimated from nasal and cheek thermal signals using spectral peak detection. We characterize 288 ROI-method configurations against contact references with lag-tolerant metrics using 31 sessions from the public SIMULATOR STUDY 1 (SIM1) driver monitoring dataset. The best fixed EDA configuration reaches a mean absolute correlation of $0.40 \pm 0.23$ against palm EDA, with individual sessions reaching $0.89$. BR estimation achieves $3.1 \pm 1.1$ bpm mean absolute error, while HR estimation yields $13.8 \pm 7.5$ bpm MAE, limited by the $7.5$ Hz thermal camera frame rate. The results show that thermal video provides useful respiratory and sudomotor cues, while revealing limitations caused by ROI selection, polarity changes, latency, and subject variability. These findings provide baseline design guidance for thermal computer vision as an auxiliary sensing layer in adaptive industrial HMI systems.

As conversational multimodal AI tools are increasingly adopted to process patient data for health assessment, robust benchmarks are needed to measure progress and expose failure modes under realistic conditions. Despite the importance of respiratory audio for mobile health screening, respiratory audio question answering remains underexplored, with existing studies evaluated narrowly and lacking real-world heterogeneity across modalities, devices, and question types. We hence introduce the \textbf{Respiratory-Audio Question-Answering (RA-QA) benchmark}, including a standardized data generation pipeline, a comprehensive multimodal QA collection, and a unified evaluation protocol. RA-QA harmonizes public RA datasets into a collection of 9 million format-diverse QA pairs covering diagnostic and contextual attributes. We benchmark general audio-language models as well as domain-specific architectures, establishing reproducible reference points and showing how current approaches fail under heterogeneity.

Monitoring respiration parameters such as respiratory rate could be beneficial to understand the impact of training on equine health and performance and ultimately improve equine welfare. In this work, we compare deep learning-based methods to an adapted signal processing method to automatically detect cyclic respiratory events and extract the dynamic respiratory rate from microphone recordings during high intensity exercise in Standardbred trotters. Our deep learning models are able to detect exhalation sounds (median F1 score of 0.94) in noisy microphone signals and show promising results on unlabelled signals at lower exercising intensity, where the exhalation sounds are less recognisable. Temporal convolutional networks were better at detecting exhalation events and estimating dynamic respiratory rates (median F1: 0.94, Mean Absolute Error (MAE) $\pm$ Confidence Intervals (CI): 1.44$\pm$1.04 bpm, Limits Of Agreements (LOA): 0.63$\pm$7.06 bpm) than long short-term memory networks (median F1: 0.90, MAE$\pm$CI: 3.11$\pm$1.58 bpm) and signal processing methods (MAE$\pm$CI: 2.36$\pm$1.11 bpm). This work is the first to automatically detect equine respiratory sounds and automatically compute dynamic respiratory rates in exercising horses. In the future, our models will be validated on lower exercising intensity sounds and different microphone placements will be evaluated in order to find the best combination for regular monitoring.

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. 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 task is 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 forecast-error-growth/Lyapunov-like descriptors. In the final CNN refit setting, the raw-signal model achieved the strongest stress-vs-rest performance (accuracy 96.72%, macro-F1 95.30%, MCC 90.61%). In contrast, compact feature models were stronger for baseline (MCC 65.34%), amusement (MCC 35.69%), and especially meditation (MCC 88.65%). Strict nested reanalysis of the auxiliary Top-20 stress search yielded mean MCC=82.29% versus 85.45% originally, indicating modest selection optimism. 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.