Remote Photoplethysmography

Continuous and cuffless blood pressure (BP) monitoring using photoplethysmography (PPG) is of great interest for low-cost and personalized cardiovascular health management. However, significant population heterogeneity and the "one-to-many mapping" problem, where similar waveforms across individuals correspond to different BP levels, limit the accuracy of conventional population-based models. To address this challenge, we propose a dual-path architecture termed SIFPBPNet, which separately represents steady-state and instantaneous features, through a Steady-state Feature Path (SFP) and an Instantaneous Feature Path (IFP). The SFP employs a Graph Attention Network (GAT) to extract individual-specific and long-term characteristics from multi-day historical PPG trajectories. In parallel, the IFP captures short-term dynamics from current PPG segments and incorporates the steady-state prior via a cross-attention mechanism. Experiments on a large-scale wearable dataset demonstrate that SIFPBPNet achieves a Mean Absolute Error (MAE) of 8.57 and 5.97 mmHg for systolic and diastolic BP, respectively, outperforming state-of-the-art models. Furthermore, the SFP module consistently improves performance when integrated into various backbone architectures, yielding 2.8-13.1% relative MAE reductions for systolic BP. These results highlight the strong generalizability and plug-and-play transferability of the SFP module, underscoring its great potential for accurate cuffless BP monitoring.

As the population ages, the number of patients with cardiovascular diseases continues to increase, highlighting the need for early detection before progression to severe and irreversible functional decline. Consequently, estimating cardiovascular biomarkers from non-invasive biosignals, such as photoplethysmography (PPG) and arterial pressure wave (APW) signals, has attracted increasing attention. These signals can be measured using wearable and cuff-type devices. Previous studies have used PPG and APW signals to estimate cardiovascular biomarkers. However, these signals exhibit strong similarities in both the temporal and frequency domains and primarily reflect peripheral and arterial pulse waveforms. Therefore, they may provide limited information about cardiac mechanical function. In contrast, the quantitative impact of additional biosignals, such as ballistocardiography (BCG), which reflect the body's minute mechanical responses to cardiac ejection, remains unclear. In this study, we generated synthetic PPG, APW, and BCG signals from a unified whole-body cardiovascular circulation model and evaluated the complementary contribution of BCG to probabilistic cardiovascular biomarker estimation. We estimated posterior distributions of cardiovascular biomarkers using neural posterior estimation and simulation-based inference. The results showed that adding BCG signals significantly improved estimation performance. Furthermore, even in ill-posed cases where PPG and APW alone produced multimodal posterior distributions, adding BCG yielded unimodal posterior distributions. These findings provide fundamental insights into signal selection for estimating cardiovascular dynamics.

Recent deepfake detection studies increasingly suggest remote photoplethysmography (rPPG) signals as an authenticity cue. However, existing benchmarks lack physiological ground truth, and current detectors underexplore the cross-level relationship between facial features and physiological dynamics, often relying on late fusion or rPPG features alone. In this paper, we construct high-fidelity deepfake manipulations on established real rPPG datasets (COHFACE and UBFC-rPPG) to investigate how forgeries disrupt natural physiological signals and facial behavior at the same time. Building on this analysis, we propose a bidirectional co-attention fusion detector that jointly models rPPG and facial behavior tokens. This mechanism explicitly captures the cross-level dependencies between pulse dynamics and facial motion to learn a robust, joint authenticity representation. Extensive experiments using a subject-disjoint 5-fold evaluation demonstrate the superiority of our approach. Achieving a 92.80% AUC on constructed datasets using face swapping and 96.78% AUC on motion transfer, our model outperforms both the rPPG-only single modality baseline and the best feature-level fusion methods. Furthermore, transfer-learning result of the fusion detector on Celeb-DF-v2 while keeping both feature extractors fixed achieves 91.20% accuracy and 86.08% AUC, which suggests applicability under target-domain adaptation.

Heart rate is a critical biomarker of health, and remote photoplethysmography (rPPG) enables its contactless estimation from video data for telemedicine applications. Recent advancements in deep learning based rPPG methods achieve state-of-the-art results, outperforming classical signal-processing methods in complex scenarios. However, deep learning methods depend on datasets with precise synchronization between videos and ground truth signals collected via contact sensors, whereas signal-processing-based methods do not. To address this dependence on labeled datasets, which are labor-intensive to collect, we investigate under which circumstances pseudo-labels extracted using unsupervised signal-processing methods can replace contact sensors labels for training deep learning methods. Our systematic evaluations found that for datasets with imperfect synchronization, the pseudo-label approach outperforms supervised training on contact sensors. For datasets with good synchronization, results are mixed: within-dataset evaluation shows no significant difference between training methods, while cross-dataset evaluation favors supervised training. However, removing a single outlier participant significantly improves the pseudo-label approach's cross-dataset performance, highlighting the importance of label quality. These results demonstrate that signal-processing methods can generate valid training signals for deep learning models, reducing dependency on labor-intensive dataset collection while maintaining competitive performance.

Background. Remote photoplethysmography estimates the cardiovascular pulse from facial video, and its explanations have rested on inspecting heatmaps rather than on quantitative evidence about where a model reads it. We quantified the explanations and asked whether such explanations transfer between datasets and track model performance. Method. We trained eight condition-specific RhythmFormer models on NCKU-rPPG, recorded under three illumination levels, speaking, rotation, and cycling, estimated one heart rate per 5.12-second clip, and set them beside a UBFC-rPPG reproduction. Raw attention, rollout, attention flow, and Beyond Intuition were assessed by skin coverage and the Salience-guided Faithfulness Coefficient (SaCo). Results. Beyond Intuition ranked highest on both datasets, at median coverage 0.789 and SaCo 0.837 on Static level 3 against 0.826 and 0.917 on UBFC-rPPG; lower ranks differed. Within one participant of one condition, neither measure was related to a clip's heart-rate error, waveform correlation, or signal-to-noise ratio on either dataset: 186 of the 252 coefficients fell below $|ρ|=0.10$ and 28 reached $p<0.05$ against the 13 expected by chance. Across the eight scenarios only Beyond Intuition's coverage followed the three performance measures, at $ρ=-0.43$, $+0.57$, and $+0.43$, while the attention-only methods' SaCo ran opposite to each. It failed at 40 lux alone, its median coverage falling to 0.180 and its median SaCo to $-0.178$, whereas motion degraded the estimates far more without such a drop. Conclusions. Skin coverage and SaCo carry information complementary to the performance measures rather than a proxy for them: attributing to the skin does not guarantee an accurate estimate. What an attribution reveals about a condition is where the model looks rather than how faithfully its map is ordered.

Remote photoplethysmography (rPPG) enables contactless physiological measurement from facial videos, yet its subtle pulse-related variations are easily affected by illumination variation, head motion, facial blur, and region-of-interest instability. Existing methods mainly suppress interference during feature learning, while whether the learned temporal features remain affected by interference and how to further suppress such interference before rPPG estimation are rarely examined. To address this limitation, we propose PhysVR, a vision-language model guided interference-aware temporal feature refinement framework for rPPG estimation. Specifically, a physiological backbone produces global temporal features and a coarse rPPG prediction, from which signal-derived physiological reliability evidence is constructed from local temporal characteristics. In parallel, a frozen vision-language model processes sampled facial frames under an interference-oriented prompt, and an evidence head extracts visual interference evidence from the VLM output. Temporal cross-attention integrates the physiological and visual evidence with the global temporal features to construct interference-aware temporal context. Guided by this context, a shared temporal correction unit performs general refinement, while four interference-specific experts selectively suppress different interference through adaptive routing. The refined temporal features are then used for final rPPG estimation. Extensive experiments on five public benchmarks demonstrate that PhysVR consistently outperforms representative methods under both intra-dataset and cross-dataset evaluation protocols.

Arterial pulse waveform morphology evolves with age, reflecting structural and functional changes in the cardiovascular system. Thus, vascular age is a valuable surrogate marker of cardiovascular health, and premature vascular ageing can indicate increased disease risk. Pulse wave analysis could support risk stratification in otherwise asymptomatic adults. We transformed pulse wave time-series data from photoplethysmography (PPG) and arterial tonometry into images, using the Symmetric Projection Attractor Reconstruction (SPAR) method. These SPAR images were used to train a convolutional neural network to classify healthy subjects into two closely spaced age groups (35-40 and 50-55 years). The model demonstrated consistent classification performance across internal and external test sets, achieving F1 scores above 70% for both PPG and tonometry signals. These results suggest that SPAR-derived pulse wave images contain discriminative morphological features even among healthy adults close in age. This proof-of-concept lays the groundwork for future research into the use of SPAR for early risk detection using smart wearables.

Cardiovascular AI models can classify clean elec- trocardiogram (ECG) signals, but real wearable signals change because of motion, breathing, posture, sensor contact, and true clinical deterioration. This paper asks when a model should keep its prediction, change it, or flag uncertainty. We propose a physiologic stability framework, called PECS, that compares changes inside the model with measurable changes in the signal. ECG is treated as the main cardiac signal, photoplethysmography (PPG) adds pulse and vascular information, and respiration is used only when ECG and PPG disagree. We test the framework on PTB-XL at pilot and full scales and on synchronized BIDMC and MIMIC waveform cohorts. The PTB-XL pilot and full- scale analyses selected different domain pairs, and the strongest cross-modal pair also changed across BIDMC and MIMIC, showing that adding every available signal is not always the best choice. PECS outperformed the evaluated drift-detection baseline implementations, reaching drift classification accuracy (DCA) of 0.8786 on expanded BIDMC and 0.9560 on MIMIC. The MIMIC results also showed that respiration can help during disagreement cases, but it should be used selectively rather than as an automatic override. Overall, the results support PECS as a candidate monitoring framework for wearable cardiovascular AI while highlighting the need for scale-aware domain selection and interpretable trust routing

Ubiquitous companion robots offer a promising avenue for immediate anxiety relief in children, yet their effectiveness relies on the ability to monitor physiological states continuously and unobtrusively. Current solutions often depend on external wearables, which impose usability barriers and limit the robot's autonomy. This paper investigates the integration of an embedded photoplethysmography (PPG) sensor directly into a pocket-sized companion robot, AffectaPocket, to enable self-contained heart rate monitoring during tactile interaction. We address the significant challenge of motion artifacts inherent in handheld usage by implementing a two-stage filtering pipeline that utilizes an onboard Inertial Measurement Unit (IMU) to reject high-variance segments and a confidence-based smoothing algorithm for recovery periods. We evaluated the system against a commonly used wrist worn sensor in a Within-Subjects Study with 26 participants. Our results demonstrate that the filtering strategy significantly reduced the Mean Absolute Percentage Error and achieved statistical equivalence to the ground truth measurements (p<0.05). Analysis of short-duration interactions shows that the sensor requires stability over longer periods to converge.

Non-invasive blood glucose level (BGL) estimation from photoplethysmography (PPG) holds great promise for wearable health monitoring, but results across studies are hard to compare due to inconsistent datasets, data leakage, and non-standardized evaluation metrics. We present the first reproducible, extensible evaluation pipeline and use it to reassess five representative PPG-based BGL methods on published datasets under three increasingly strict data-split protocols: random window-level, participant-aware, and leave-some-participants-out (LSPO). Models appeared competitive under random splitting but collapsed under participant-aware and LSPO evaluation, with nearly all yielding near-zero or negative R$^2$ values comparable to a mean-prediction baseline. Critically, across every model and split, over 90% of predictions fell within clinically acceptable zones (Clarke Error Grid A+B), including the baseline. This reveals a fundamental disconnect: clinical zone metrics systematically conceal model failure in this domain. Our findings demonstrate that random train-test splits substantially overestimate the generalization of PPG-based BGL models due to sample-level data leakage, and that robust ML evaluation must precede clinical validation to meaningfully assess real-world utility.

Automated sleep staging assigns discrete stage labels to successive time epochs throughout an overnight recording; conventionally each window spans at least 30 seconds, reflecting the minimum temporal resolution of the clinical scoring standard. Wearable photoplethysmography (PPG) has attracted sustained interest as an ambulatory alternative to laboratory-based polysomnography, which relies on electroencephalography (EEG) and other recording modalities that are impractical outside clinical environments. Yet PPG-based staging trails EEG-based methods by a substantial margin, and we argue this gap largely reflects a mismatch between signal and task. Within a stable stage, PPG's inter-stage feature differences are more subtle than those in EEG; yet at stage boundaries, PPG's principal cardiovascular features, heart rate variability and pulse morphology, shift sharply within seconds. The conventional practice of assigning one label to each 30-second epoch therefore suppresses feature that is concentrated near boundaries. We address this gap in two steps. First, we develop a label expansion pipeline based on Hidden Semi-Markov Models that converts coarse epoch labels into sec-level annotations. To assess whether these expanded labels are reliable enough for downstream supervision, we validate them on a separate expert-reviewed dataset and through an auxiliary sleep-wake task whose labels are independent of the expansion pipeline. Second, we use the resulting sec-level supervision on MESA to improve conventional four-class epoch-level staging across four architecturally diverse baselines by 3.7--5.7,pp in accuracy against the original epoch labels, with supplementary zero-shot evaluation on CFS showing that the transfer benefit persists under cohort and annotation-protocol shift.

Derived measurements increasingly enter large language model (LLM) pipelines as direct facts despite their instance-dependent validity. We define derived-feature over-trust (DFOT) as the failure in which a downstream LLM assigns such a measurement the epistemic status of a direct fact or uses it outside its valid scope. Using physiological sensing as a case study, D1 tests acceptance of a PPG-derived rhythm contradicted by offline ECG, whereas D2 tests rejection of an offline-confirmed reliable PPG rhythm under misleading severe history. ECG supplies training supervision and offline reference construction but is never shown to the LLM. Five estimands quantify this chain: conflict over-trust rate (COTR) and context-induced error rate (CIR) characterize D1/D2; correct repair rate (CRR) measures frozen-error repair; evidence-specific repair margin (ESRM) contrasts matched and patient-disjoint shuffled evidence; and utility harm rate (UHR) measures unnecessary verification among HIGH-reliability cases used without verification at baseline. The framework does not depend on a particular reliability generator. We demonstrate it on 50,000 paired PPG-ECG records using ECG-to-PPG privileged distillation as an illustrative baseline and PPG-only inference. On a protocol-locked 187-patient test, the baseline improves four repair and specificity endpoints by 1.82-6.69 percentage points, with all paired confidence intervals excluding zero; UHR increases by 0.67 percentage points (95% CI: -0.4 to +1.7). DFOT provides a common evaluation target for stronger mitigation methods. The code is available at https://github.com/Zongheng-Guo/When-Derived-Measurements-Mislead.

Continuous cuffless blood pressure (BP) monitoring remains challenging due to motion artifacts, physiological variability, and the limited robustness of conventional pulse transit time (PTT) models under dynamic conditions. Many prior approaches rely on multi-second windows to stabilize estimation, an assumption that is frequently violated during real-world monitoring with intermittent signal corruption. Here, we show that discriminative BP-related information is preserved at the single-beat level and present a lightweight multi-modal wearable framework for continuous BP estimation. The system integrates synchronized chest electrocardiography (ECG) and ear-clip reflectance photoplethysmography, each co-located with a 6-axis inertial measurement unit to provide motion context. We introduce a hybrid learning architecture in which a one-dimensional convolutional neural network extracts a 64-dimensional embedding from individual PPG beats and fuses it with 30 physiology-grounded features, including PTT statistics and heart rate variability, followed by LightGBM regression. The method was evaluated using a multi-phase stress protocol ($n=10$) and the PulseDB public dataset with subject-disjoint validation. Across 30 independent runs, the model achieved mean absolute errors of $4.02 \pm 0.21$~mmHg for systolic BP and $1.79 \pm 0.05$~mmHg for diastolic BP, corresponding to a 28.2% reduction in combined MAE relative to baseline models. By enabling beat-wise estimation without long temporal context, this framework supports computationally efficient cuffless BP monitoring suitable for wearable deployment under practical resource constraints. The source code for this work is available at https://github.com/SYMBIOX-Lab/BP-wireless.

Remote photoplethysmography (rPPG) enables non-contact heart-rate estimation from facial videos, but its weak physiological signal is easily corrupted by motion, illumination changes, occlusion, skin-appearance variation, and device noise. Existing rPPG methods typically rely on a single model to directly predict heart rate or recover pulse waveforms, while different strong estimators may produce conflicting yet individually plausible candidates for the same video. To resolve these conflicts, we propose PhysAgent, an inference-time multi-agent candidate-verification framework. Unlike direct prediction approaches, PhysAgent neither trains a new base rPPG model nor asks Multimodal Large Language Models (MLLMs) to output heart rate directly. In contrast, it treats outputs from multiple base estimators as physiological hypotheses to be verified and uses a lightweight 4B MLLM, Qwen3-VL-4B, to drive multi-agent reasoning over video conditions, signal reliability, and candidate disagreement. A deterministic physiological verifier checks the fusion proposal, and a reproducible numerical fusion process produces the final heart rate. Experimental results on multiple public rPPG benchmarks show that PhysAgent improves fusion stability and reliability across different datasets and source-domain settings, while avoiding the irreproducibility and physiological inconsistency of direct MLLM prediction or unconstrained ensemble fusion. The code will be released soon.

Continuous cuffless blood pressure (BP) monitoring is essential for connected health systems and wearable devices, enabling early detection, longitudinal tracking, and personalized management of cardiovascular disease. Many prior approaches attempt to estimate BP indirectly by reconstructing electrocardiography (ECG) from photoplethysmography (PPG), assuming ECG provides a stronger physiological link to BP. However, ECG sensing is less accessible in wearable settings and may introduce unnecessary complexity. In this work, we first perform a large-scale physiological correlation analysis on the MIMIC-III waveform database, revealing that PPG exhibits substantially stronger coupling with arterial blood pressure (ABP) ($|r|=0.247$, $p<0.001$) than ECG does ($r=0.018$, $p=0.187$), challenging the assumption that ECG provides a superior intermediate representation. Motivated by this insight, we conduct a systematic comparison between direct PPG-to-BP prediction and ECG-mediated pipelines using multiple state-of-the-art deep learning models. Across 1.74M segments from 3,127 patients, direct PPG-to-BP prediction achieves British Hypertension Society Grade A performance ($\mathrm{MAE}_{\mathrm{SBP}} = 4.82 mmHg$, $\mathrm{MAE}_{\mathrm{DBP}} = 4.31 mmHg$), outperforming all ECG-mediated approaches, which achieve only Grade B accuracy. Our findings suggest that accurate continuous BP monitoring can be achieved directly from wearable PPG signals, enabling simpler, more efficient pipelines for real-world connected health systems.

Talking-face (TF) deepfake generation synthesizes photore- alistic facial video from a static source image and an au- dio signal, producing forgeries that current image-based detectors consistently fail to identify. Unlike face-swap ma- nipulation, TF synthesis has no underlying real video from which to inherit physiological characteristics, making re- mote photoplethysmography (rPPG) a uniquely motivated detection modality for this forgery category. We propose a detection framework that extracts per-video rPPG wave- forms via RhythmFormer and trains a suite of lightweight classifiers to distinguish real from synthesized physiologi- cal signals. Evaluated on the TF subset of Celeb-DF++ un- der a strict subject-independent protocol, where test identi- ties are completely separated from training identities, our 1D ResNet achieves an AUC of 0.806 and EER of 27.8%, placing it within 2.4 points of the best published general- purpose detector (Effort, ICML 2025) while operating ex- clusively on the physiological channel. We document a con- trolled reproduction study of DeepFakesON-Phys, the rep- resentative prior rPPG detector, demonstrating degrada- tion from AUC 0.999 on legacy face-swap data to 0.622 on the TF subset of Celeb-DF++. We further show that detec- tion difficulty is strongly method-dependent: AUC ranges from 0.985 (Real3DPortrait) to 0.690 (IP-LAP) across the seven TF generators, with the ranking remaining perfectly stable across all evaluation protocols. This spread reflects an interpretable physiological property of each generator rather than evaluation noise, and constitutes the primary theoretical contribution of the work.

This Good Practice Guide presents work done in the QUMPHY project (Uncertainty quantification for machine learning models applied to photoplethysmography signals) that considered both machine learning and uncertainty quantification for problems which used photoplethysmography (PPG) signals from wearable devices as input. It provides high-level guidance on what types of machine learning model might be used and how different models compare when applied to both regression and classification tasks. It provides guidance on the implementation of different methods for uncertainty quantification, covering both model-dependent and model-independent techniques, and on the validation of the results provided by those methods. It also describes six benchmark problems together with pointers to different benchmark datasets for each problem. Software is described that can assist practitioners in implementing the methods described herein and there is a brief consideration of ethical issues. It concludes with a summary and recommendations.

Deep remote photoplethysmography (rPPG) attains sub-bpm heart-rate error on frontal, stationary faces yet degrades sharply under head pose: on MMPD, the state-of-the-art FactorizePhys backbone's MAE grows $1.60\times$ from frontal ($|\text{yaw}|{<}15^\circ$) to large-yaw ($|\text{yaw}|{\geq}45^\circ$) frames. We argue that pose is a \emph{coordinate-structural} nuisance rather than a data-augmentation problem: in image coordinates the same pixel maps to different anatomy at different poses, blocking three priors otherwise natural for rPPG, namely the dichromatic reflection model, pulse-phase invariance across skin regions, and the POS/CHROM chromaticity projection, each of which presumes a stable anatomy-to-pixel mapping. We introduce \textbf{CanonicalPhys}, which prepends a differentiable four-point homography that fixes four facial anchors at canonical positions; in this canonical frame the three priors become expressible as a per-pixel Lambertian weight, a cross-ROI temporal consistency loss, and knowledge distillation from windowed POS, none of which adds trainable parameters over the backbone. At an identical parameter count, CanonicalPhys reduces MMPD's frontal-to-large-yaw MAE degradation from $1.60\times$ to $1.33\times$ and flattens the mild-yaw bin from $1.32\times$ to $1.07\times$ (across CanonicalPhys variants), with matched cross-dataset MAE reductions of up to $32\%$ on pose-rich targets. Code: https://github.com/infraface/CanonicalPhys

Continuous oxygen saturation (SpO$_2$) estimation from wearable photoplethysmography (PPG) is important for long-term health monitoring, but low-quality red and infrared PPG segments can distort waveform morphology and degrade SpO$_2$ prediction accuracy. Existing PPG denoising and reconstruction methods usually optimize waveform fidelity or heart rate characteristics, while time-domain waveform loss on PPG signals alone insufficiently preserves frequency structure and SpO$_2$-relevant information. This paper proposes a SpO$_2$ predictor-guided stage-wise time-frequency reconstruction framework for low-quality dual-wavelength PPG signals. The proposed method first selects high-quality PPG segments to pretrain a SpO$_2$ predictor. A masked reconstruction model is then trained to recover randomly masked PPG regions using a joint reconstruction objective that combines time-domain waveform loss with frequency-domain loss computed from the short-time Fourier transform (STFT). To make the reconstruction task physiologically relevant, the pretrained SpO$_2$ predictor is incorporated as an additional constraint, encouraging the reconstructed PPG to preserve SpO$_2$ information rather than only minimizing waveform reconstruction error. The SpO$_2$ predictor and PPG reconstructor model are optimized through four training stages. Experiments on the public OpenOximetry Repository and a private wearable PPG dataset show that the proposed approach achieves the lowest subject-level MAE, with 2.882% on the public dataset and 2.359% on the private dataset.

Remote photoplethysmography (rPPG) estimates physiological signals from facial videos by analyzing subtle pulse induced skin color variations. Despite recent progress, existing self-supervised rPPG methods mainly reconstruct masked pixels or low-level visual representations, which can bias the model toward facial appearance rather than latent physiological dy namics. Moreover, most recent Mamba-based approaches scan facial video tokens only in chronological order, limiting their ability to exploit the cyclic structure of pulse signals. To ad dress these limitations, we propose RhythmJEPA, a rhythm structured joint-embedding predictive learning framework for rPPG. Instead of reconstructing RGB frames, RhythmJEPA predicts latent teacher representations from masked facial videos, thereby encouraging physiology-aware representation learning in the embedding space. To explicitly model pulse-related tem poral structure, we introduce a Cyclic Rhythm-State Plan ner (CRSP), which estimates frame-wise latent physiological states and decodes the most plausible cyclic state path via dynamic programming with a constrained transition grammar. Guided by the decoded states, we further design a Dual Order Mamba Encoder (DOM), which combines conventional chronological scanning with state-ordered scanning to capture both local temporal continuity and long-range rhythm-consistent dependencies. Finally, a lightweight Spatial Pulse Mixer (SPM) extracts compact pulse-sensitive facial tokens with a favorable balance between complexity and performance. Experiments on PURE, UBFC-rPPG, and MMPD show competitive performance over representative rPPG methods. The codes are available at https://github.com/deconasser/RhythmJEPA.

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.

Remote Photoplethysmography (rPPG) enables contactless pulse estimation from facial videos, serving as a vital tool for health monitoring. However, current deep learning methods often struggle under complex disturbances, particularly varying illumination, facial expressions, and unconstrained head movements. In such scenarios, subtle physiological signals are easily dominated by external interference, making the recovered rPPG waveform unstable and unreliable. One important reason is that most existing methods directly model the rPPG signal in a unified manner, where different signal components are coupled during reconstruction. This makes it difficult to preserve weak pulse-related variations when strong disturbance-induced changes are present. To address this challenge, we propose PhysFlow, a frequency-decoupled dual-field rectified flow framework tailored for robust rPPG estimation. Specifically, the ground-truth rPPG signal is decomposed into trend and amplitude components, which are used as separate supervisory targets. Based on the extracted facial features, PhysFlow learns two component-specific conditional velocity fields to model the two components separately. This design reduces mutual interference between different components and improves the robustness of rPPG reconstruction under complex disturbances. Moreover, the rectified flow formulation enables efficient waveform reconstruction with only a few ordinary differential equation (ODE) integration steps. Extensive experiments on multiple benchmark datasets demonstrate that PhysFlow outperforms state-of-the-art methods in both heart-rate estimation and rPPG waveform reconstruction across diverse challenging scenarios.

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.

Remote photoplethysmography (rPPG) estimates the blood volume pulse (BVP) signal from facial videos, enabling contact-free health monitoring. Conventional clip-wise approaches, which use video clips as input, require capturing over one hundred frames before inference, thus introducing several seconds of delay and hindering real-time use. Meanwhile, frame-wise approaches struggle to capture long-range temporal and periodic features of physiological rhythms, and therefore lead to reduced estimation accuracy. To overcome these issues, we propose StreamPPG, a unified architecture that enables low-latency frame-wise physiological signal estimation while achieving competitive accuracy compared with clip-wise approaches. StreamPPG is trained under a consistent privileged learning (CPL) strategy, which leverages ground-truth rPPG signals as privileged information to enhance the model's representation capability. Extensive experiments demonstrate that StreamPPG achieves state-of-the-art accuracy across multiple datasets while maintaining real-time throughput on edge devices.

The cardiovascular system evolves along a bounded trajectory in physiological state space that converges to a compact geometric object: the cardiac attractor. A wearable photoplethysmograph (PPG) or electrocardiograph (ECG) observes a one-dimensional projection of this attractor; by Takens' embedding theorem, delay coordinates reconstruct its full geometry. Three decades of nonlinear cardiac dynamics have extracted Lyapunov exponents, recurrence statistics, and sample entropy from reconstructed attractors, yet no principled account exists of which attractor properties capture which cardiovascular quantities, or why, leaving feature selection as a search problem and negative results uninterpretable. We introduce Attractor Domain Theory (ADT), which proves that the reconstructed attractor's information partitions into three mutually non-redundant domains: the Geometry Domain G (delay embedding; native capability: artifact rejection), the Ergodic Domain S (asymptotic statistical invariants; native capability: stability estimation), and the Variational Domain V (finite-time Lyapunov exponent field; native capability: hemodynamic inference). We prove a Domain Sufficiency Theorem (the Parseval analog for attractor information) and establish that three domains are necessary and sufficient. Geometry Domain validation via the SCSI framework across 176,742 PPG segments from four datasets yields AUC = 0.757 [0.686-0.828] and NPV = 0.966 after correcting three systematic evaluation artifacts (+0.179 net inflation). Ablation confirms C_NL as the dominant Geometry Domain component (Delta AUC = -0.413) and intra-domain redundancy across five components.

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.

Remote photoplethysmography (rPPG) is a camera-based technique for measuring physiological signals, particularly cardiac activity. From the remotely measured signals, heart rate can be estimated, which is crucial for health monitoring. In this study, we investigate a driver health monitoring system based on remote heart rate estimation. However, driving environments represent uncontrolled settings where videos are subject to varying illumination conditions and frequent head movements. We introduce MS-rPPG, a multi-spectral framework that combines RGB with near-infrared (NIR) face video to alleviate rPPG estimation under challenging driving conditions. To combine the complementary features from two spectral videos, we propose a cross-spectral linear modulation (CSLM) strategy based on frequency-domain analysis. Moreover, we introduce MS-Mamba, a novel state space model designed to effectively model long-range temporal dependencies while jointly capturing cross-channel interactions between multi-spectral features. We collected a real-world dataset called MS-Drive, which was recorded from 50 participants while driving the vehicle. The proposed method was evaluated on the MR-NIRP Car dataset and MS-Drive datasets. The experimental results indicate that MS-rPPG shows better robustness and heart rate estimation accuracy than previous methods, highlighting its promise for driver health monitoring. The codes are available at github.com/ziiho08/MS-rPPG.

Diabetes and extreme blood sugar levels are some of the major health problems faced by humans today across the world. While Continuous Glucose Monitoring (CGM) has emerged as an effective technology for management of diabetes as well as for monitoring blood sugar levels, this technology has traditionally been invasive (that is, requiring the piercing of the skin) and carries the risk of irritation, induration, etc. This highlights the need for accurate and non-invasive CGM methods that can be deployed at scale. With the emergence of various sensing technologies and their integration in wearables like the smart-watch, we now have the capability to continuously monitor body signals like the Photoplethysmogram (PPG) in a non-invasive manner. Having the ability to continuously monitor blood glucose through CGMs and continuously monitor PPG signals through a smart-watch offers an opportunity to get dense data on these two, opening the possibility of building machine learning and deep learning based models to estimate blood glucose level from PPG signals. In this work, we first present a paired dataset comprising continuous PPG signals from a smartwatch along with glucose values recorded using a CGM device. We also present the results of some preliminary experimental explorations performed on our dataset. These preliminary results suggest that some predictive signals may exist, though more exploration is needed with more data from a larger number of individuals. The dataset can be accessed at https://zenodo.org/records/20577959

Non-contact pulse wave reconstruction hinges on the precise recovery of waveform morphology, including the dicrotic notch. Conventional Red-Green-Blue (RGB)-based methods, which extract physiological signals from recorded facial videos, are constrained by the integral imaging mechanism of standard cameras, where the exposure process induces a smoothing effect that attenuates subtle vascular pulsation details. Conversely, neuromorphic event cameras, while offering exceptional sensitivity to intensity fluctuations, are inherently susceptible to noise and artifacts induced by minor motion. To exploit the synergy between frame-based integration and event-based differential sensing, we propose a novel multimodal network named Fusion-E2Pulse. This framework utilizes filtered RGB signals as structural priors to suppress motion artifacts, while leveraging the high-sensitivity of event streams to recover fine-grained morphological details. Experimental results demonstrate that Fusion-E2Pulse achieves state-of-the-art performance, effectively balancing noise suppression and morphological fidelity, achieving a mean absolute error of 0.78 bpm for heart rate estimation, a waveform correlation of 0.89, and a systolic phase duration error of 16.74 ms, validating its efficacy in reconstructing fine-grained pathological features.

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 .

Remote photoplethysmography (rPPG) transformers achieve low heart-rate error on benchmarks, yet their decisions remain opaque--a growing concern as rPPG moves toward clinical heart rate estimation. Existing rPPG XAI is dominated by qualitative heatmap inspection without quantitative faithfulness metrics or physiology-grounded validation, leaving a gap between visual plausibility and auditable evidence. We address this gap. First, we adapt four attribution methods (raw attention, rollout, flow, Beyond Intuition) to RhythmFormer's bi-level routing attention with top-$k$ selection. Second, we introduce a skin coverage metric quantifying how much attribution mass falls on skin regions. Third, we adapt the SaCo faithfulness coefficient from its original classification setting to rPPG regression by using the MAE between original and perturbed predicted rPPG waveforms as the perturbation impact. Applying these tools, we quantify a multi-hop leakage effect under sparse top-$k$ routing: attention rollout and flow almost completely restores the connections that individual refined-attention layers explicitly set to zero. Beyond Intuition mitigates this via its value-projection-weighted rollout and gradient-supported mask, attaining the highest median refined skin coverage ($0.83$ vs. $0.57$ for vanilla rollout) and faithfulness ($F=0.92$) among the evaluated methods on UBFC-rPPG. Validation across diverse datasets and model variants is needed. A case study on a low-SaCo outlier further shows all four methods recovering consistently once an artefactual region is replaced, suggesting consistent SaCo behavior across attribution families in this illustrative case. Together, these metrics move XAI for rPPG toward auditable numerical evidence about spatial alignment and perturbation faithfulness, i.e. trustworthy rPPG XAI.

Physiological awareness is important for service, social, and assistive robots that interact with humans in everyday environments. Remote photoplethysmography (rPPG) enables non-contact heart-rate (HR) estimation from an RGB camera, making it a promising sensing modality for robot-mounted vision systems. However, illumination variation remains a major barrier to robust deployment. This paper presents an end-to-end spatial-temporal transformer framework for remote HR estimation on a new dataset with varied illumination. Our estimator integrates PRNet-based 3D face alignment, clip-level illumination augmentation, the Residual Temporal Standardization Module, and controlled hybrid temporal-frequency supervision. The training objective combines a Soft-Shifted Pearson waveform loss with a spectral Kullback-Leibler divergence loss, where a tuned weight ($\mathbfβ$) controls the contribution of frequency-domain heart-rate guidance. Experiments on a static all-level mix protocol covering three illumination levels show that $\mathbfβ=5$ provides the strongest result among the tested beta settings, achieving a best-run HR mean absolute error (MAE) of 0.79 bpm and an HR correlation of 0.982. Compared with the PhysFormer baseline evaluated on our dataset, our estimator reduces HR MAE by 93.6 %, while increasing HR correlation from 0.088 to 0.982, making it usable when illumination varies.

Blood pressure (BP) is a key marker for cardiovascular risk assessment and therapeutic decision-making, and Photoplethysmography (PPG) enables low-cost, wearable-friendly cuffless BP estimation. However, even with recent progress, many PPG-based models are trained with BP regression alone and may rely on amplitude-dominated shortcuts. In addition, demographic covariates that systematically modulate vascular compliance are often incorporated only via late fusion, limiting subject-specific representation learning. We propose a Transformer-based network for cuffless BP estimation from PPG signal, leveraging self-attention to capture long-range dependencies across multiple cardiac cycles. To account for subject-specific vascular differences, the model is conditioned on demographics via FiLM-style feature modulation applied through the attention and feed-forward sublayers of Transformer blocks. In addition, we add an auxiliary morphology head to guide the model to attend to BP-relevant waveform morphology associated with arterial stiffness and wave reflection. Under calibration-based evaluation protocols on the large-scale PulseDB dataset, the proposed method achieves MAE of 4.56 mmHg for systolic BP and 2.62 mmHg for diastolic BP, reducing errors by 47% and 50% compared with prior demographic-enhanced PPG baselines. The resulting lightweight, single-sensor model supports scalable and clinically grounded cuffless BP estimation in calibration-enabled deployment settings.

Photoplethysmography (PPG), a non-invasive measure of changes in blood volume, is widely used in both wearable devices and clinical settings. Recent PPG foundation models either use open-source ICU datasets with pretraining paradigms that require curated data and thus complicate generalization to field-like data, or use closed-source field-like PPG data. In contrast, we propose a PPG foundation model that does not require high-quality or field-like pretraining data, and instead leverages accompanying electrocardiogram and respiratory signals in ICU datasets to select contrastive samples during pretraining. Our approach allows the model to retain and learn from noisy PPG segments, improving robustness at inference. Our model, pretrained on 3x fewer subjects than existing state-of-the-art approaches, achieves performance improvements on 14 out of 15 diverse downstream tasks, including field-like daily activity and heart rate prediction. Our results demonstrate that multimodal supervision can integrate complementary physiological information to improve the robustness of PPG foundation models and enhance their generalization to consumer-grade data.

Remote photoplethysmography (rPPG) achieves low heart-rate error on uncompressed benchmarks yet is deployed over compressed video channels in telehealth, neonatal ICU, and driver fatigue applications. No prior work identifies the physical quantity determining when spatial decomposition outperforms global-projection methods under codec compression. We propose Spatial Artifact Coherence (SAC), defined as the ratio of off-diagonal to diagonal energy in the 4x4 inter-patch Green-channel covariance matrix (bandpass 0.75-2.5 Hz), and the PatchPCA algorithm family (four codec-aware rPPG algorithms). We evaluate 280 subjects across three public datasets, 11 codec degradation variants (MPEG-4, H.265, H.264, JPEG, chroma subsampling), and 13 algorithms via Wilcoxon tests (BH-FDR, q < 0.05, 904 tests). SAC explains 93.8% of between-variant variance in PCA advantage (r = +0.969), with zero overlap between codec families: non-MPEG-4 variants cluster at SAC 0.10-0.18 with 84-90% PCA win rates, while MPEG-4 variants cluster at SAC 0.48-0.59 with 61% win rate and a 5.8x reduction in mean improvement. Within subjects, 78% confirm the expected pattern (p < 10^-22, dz = 0.73). Within-variant subject-level SAC correlation is r = +0.099, confirming SAC classifies codec families rather than predicting individual outcomes. MPEG-4's effect is structural (macroblock DCT geometry, not noise amplitude), governed by source codec state, not resolution. P-Hybrid is identified as the most deployment-robust algorithm. Two necessary operating conditions for PatchPCA advantage are established: SAC < 0.30 and low-to-moderate motion, directly ruling out raw-to-MPEG-4 transcoding pipelines. SAC provides a physically grounded metric for codec-aware rPPG algorithm selection in clinical remote monitoring systems.

Objective: Consumer face camera remote photoplethysmography (rPPG) enables passive cardiovascular monitoring, but whether single-cycle waveform morphology encoding arterial stiffness biomarkers is recoverable from this measurement has not been characterised. Methods: We evaluated 16 architectures spanning six families on 153 subjects across three datasets, introducing cross-subject Pearson r to distinguish subject-specific recovery from template collapse. Results: No architecture recovered subject-specific morphology (cross-subject r range 0.773--0.9999; ground-truth ceiling 0.601). Supervised Contrastive (SupCon) converged to log N = 4.844, constituting the strongest available empirical evidence that no discriminative morphological structure is extractable from single-cycle rPPG by the encoder families tested. The VAE decoder restores population-level harmonic content absent from the rPPG input (H2/H1: 0.310 output vs. 0.275 input), generalising zero-shot to UBFC (r = +0.708); a directional hallucination gap (p = 0.150) suggests partial signal reading. Anti-collapse objectives fail when input carries no discriminative structure. Significance: Consumer cameras cannot encode individual arterial morphology; cross-subject r is a necessary collapse diagnostic for waveform reconstruction benchmarks.

Remote photoplethysmography (rPPG) enables non-contact extraction of blood volume pulse (BVP) signals using consumer-grade cameras. Recent unsupervised rPPG methods learn BVP representations without requiring ground-truth physiological annotations, yet their optimization is often hindered by noisy and unstable gradients, resulting in slow convergence and limited cross-domain generalization. In this paper, we propose FCUS-rPPG, a fast-converging unsupervised rPPG framework with strong generalization capability. Motivated by the observation that BVP representations exhibit both multi-spectral covariation and low-dimensional manifold structure, we design a spectrally shared backbone that facilitates BVP feature disentanglement while improving optimization efficiency. To jointly enhance convergence stability and generalization performance, we further develop a unified optimization framework operating at the gradient, loss-landscape, and feature-representation levels. Specifically, a post-verification masking mechanism filters out misleading gradients according to the weak-amplitude physiological prior of BVP signals; a perturbation-based loss landscape smoothing strategy steers optimization toward more generalizable flat minima; and a noise-aware null-space regularization constrains feature updates to the orthogonal complement of the noise subspace, thereby mitigating noise-induced representation drift. Extensive experiments on five datasets demonstrate that FCUS-rPPG requires only one training epoch, whereas existing methods typically require tens to hundreds of epochs. Notably, FCUS-rPPG consistently achieves state-of-the-art (SOTA) performance in cross-dataset evaluations. This study provides an efficient and robust solution to the real-world deployment of unsupervised rPPG. The source code will be publicly available at https://github.com/JiaJieLee/FCUS-rPPG.

Autonomous Sensory Meridian Response (ASMR) is a somatosensory phenomenon characterized by pleasant tingling sensations and cardiovascular slowing. However, ASMR research has been hindered by a dearth of standardized, open-access multimodal datasets. To address this limitation, we present REST-ASMR (Response to Environmental & Sensory Triggers), a synchronized multimodal dataset designed to capture behavioral reports and physiological dynamics during ASMR, with nature-relaxation videos as control stimuli. The dataset includes high-resolution photoplethysmography (PPG), time-aligned audiovisual stimuli, and continuous subjective annotations from 34 participants. Technical validation showed high stimulus efficacy (97% responder rate), significant stimulus-specific inter-subject agreement (p < 0.05), and a robust PPG-derived ASMR-specific cardiovascular deceleration. Additionally, a Bidirectional Long-Short Term Memory model successfully predicted subjective ASMR tingle states, achieving video-level ASMR vs. Nature classification with perfect accuracy and a frame-level global mean accuracy of 75.51%, macro F1-score of 71.86%, and 100% Nature-baseline specificity, under a strict, leakage-free subject-video double-independent 4-fold cross-validation. REST-ASMR constitutes a dense temporal foundation for affective computing, multimodal research, and the development of personalized models of relaxation-related responses.

Remote photoplethysmography (rPPG) enables non-contact measurement of physiological signals from facial videos, offering strong potential for remote healthcare and daily health monitoring. Driven by this potential, various deep learning-based rPPG methods have been proposed to improve rPPG estimation. However, previous deep learning-based rPPG methods have paid little attention to the quality of training labels and their impact on model learning. Contact-based PPG signals used as training labels often contain noise and variability caused by motion artifacts, inconsistent sensor contact, and morphological distortions. Such label inconsistency can lead models to overfit to the label noise and variability and consequently degrade generalization performance. To address this issue, we propose LQ-rPPG, a label-quantized coarse-to-fine learning framework for robust rPPG estimation. LQ-rPPG consists of a label quantization module and a coarse-to-fine rPPG estimation model. The label quantization module transforms continuous PPG signals into multi-bit quantized pseudo labels with reduced noise and variability. The coarse-to-fine estimation model progressively refines rPPG signals under hierarchical supervision guided by the multi-bit pseudo labels. This design alleviates overfitting to label-specific variations and enables the model to learn structured and consistent representations. As a result, LQ-rPPG achieves robust and generalizable rPPG estimation even under challenging conditions. Experiments on multiple benchmark datasets demonstrate that LQ-rPPG achieves strong performance in both intra- and cross-dataset evaluations, while reducing parameters and multiply-accumulate operations by 88% and 29%, respectively, and increasing throughput by 191%. The code is available at https://github.com/Anonymous-repo-code/LQ-rPPG.

Remote photoplethysmography (rPPG) enables non-contact measurement of cardiac pulse signals by analyzing subtle color changes in facial videos. Nevertheless, extracting rPPG signals remains challenging because of their extremely weak signal strength and susceptibility to illumination noise. In this paper, we propose an rPPG signal extraction method that exploits the quasi-periodic characteristics of rPPG signals. Our approach models quasi-periodicity of the rPPG signal, which arises from the stable cardiac cycle, as a block-sparse structure in the time-frequency domain. To incorporate a block-sparse model and enable adaptive signal separation under illumination fluctuations, we construct a time-varying signal separation framework. Experiments using a public dataset demonstrate the effectiveness of our method.

Accurate estimation of the Angle of Progression (AoP) from intrapartum transperineal ultrasound is critical for objective assessment of labor progression, yet remains highly sensitive to imaging noise, boundary ambiguities, and the geometric amplification of local segmentation errors. We propose R2AoP, a reliable and robust AoP estimation framework that integrates structurally informed segmentation and confidence-guided geometric modeling to achieve stable and reproducible measurements. A three-branch local-structure-enhanced backbone improves the delineation of the pubic symphysis (PS) and fetal head (FH), while confidence-weighted contour fitting explicitly suppresses the influence of unreliable boundary points in AoP computation. To further improve performance under heterogeneous acquisition conditions, we introduce a lightweight geometry-reliable test-time adaptation strategy as an auxiliary component, enabling stable inference without target annotations. Extensive evaluations on multi-center benchmarks demonstrate consistent reductions in AoP error and boundary metrics compared with state-of-the-art AoP methods. Our source code is available at https://github.com/baiyou1234/R2AoP.

Accurate cardiac output (CO) estimation from photoplethysmography (PPG) is promising for unobtrusive hemodynamic monitoring, but remains difficult since CO is jointly determined by cardiac function and vascular tone. Conventional feature-based models use physiologically meaningful PPG descriptors, yet depend on accurate pulse detection and may miss latent temporal relationships. In contrast, fully end-to-end deep learning models learn directly from raw PPG but often underuse established PPG-derived prior information. Here, we introduce the Cross-View Attention Fusion Network (CVAF-Net), a prior-guided dual-view deep learning model for CO estimation from short, fixed-length PPG segments. CVAF-Net processes raw PPG as a temporal view and a feature sequence map (FSM) as a structured prior-guided view, and fuses the two representations through cross-view attention. The model was independently evaluated using 5-, 15-, and 30-s segments from three datasets: simulated pulse waves (3323 subjects), vasoconstriction provocation (79 subjects), and resting/cycling activities (10 subjects), and was compared with multiple machine learning and deep learning benchmarks. CVAF-Net outperformed most benchmark methods and achieved performance comparable to a state-of-the-art Transformer-based model, with a mean absolute error (MAE) of 0.19 L/min (MAPE: 3.95%) on simulated data and high accuracy in real-world settings (minimum MAE: 1.20 L/min). Importantly, CVAF-Net reduced FLOPs by twelvefold compared with the leading Transformer-based model. Plausibility analysis showed physiologically consistent CO estimates, with expected correlations with age ($ρ= -0.274$), heart rate ($ρ= 0.894$), and systemic vascular resistance ($ρ= -0.740$). These findings indicate that CVAF-Net provides an accurate, computationally efficient, and generalizable approach for continuous wearable-based CO monitoring.

Uncertainty quantification (UQ) is critical for safety-critical domains like healthcare, yet it is rarely evaluated under realistic out-of-distribution (OOD) conditions. Here, we assessed predictive performance and uncertainty reliability for deep learning-based blood pressure (BP) estimation from photoplethysmography (PPG) signals under both in-distribution (ID) and OOD settings. Using an XResNet1D-50 trained on PulseDB and tested on four external datasets, we compared deep ensembles (DE) and Monte Carlo dropout (MCD) with Gaussian negative log-likelihood (GNLL) and mean squared error (MSE) losses, optionally followed by post-hoc recalibration via conformal prediction (CP), temperature scaling (TS), and isotonic regression (IR). The key findings of our study are as follows: (1) DE provides stronger predictive robustness under domain shift than MCD, an advantage that becomes clear primarily under external shift. (2) Recalibrated GNLL-based methods yield the best uncertainty calibration (e.g., GNLL+DE+CP for systolic blood pressure (SBP), GNLL+DE+TS for diastolic blood pressure (DBP)), while MSE-based uncertainty requires recalibration to become practically useful. (3) Across settings, CP and TS offer the most consistent gains, with IR remaining competitive in several cases. Overall, our results identify DE-based methods as most robust for predictive performance under domain shift, GNLL as strongest for native UQ, and recalibration as essential for making MSE-based uncertainty practical. These findings highlight the need to jointly assess predictive accuracy and calibration on external data for trustworthy cuffless BP estimation

Wearables are widely used for mobile health monitoring, and photoplethysmography (PPG) is a key sensing modality for heart rate and related physiological measurements. However, public in-the-wild PPG datasets remain largely wrist-centric or limited to short, controlled studies, constraining research on emerging wearable form factors. We present Multi-site PPG, an in-the-wild physiological dataset collected from four custom-developed unobtrusive wearables: a smart earring, ring, watch, and necklace. Each device records green and infrared reflective PPG, 3-axis acceleration, and temperature with timestamps for cross-device alignment, while a Polar H10 chest strap provides reference electrocardiogram (ECG). Participants wore the devices for multiple days during daytime activities while continuing their normal routines. The dataset contains over 350 hours of raw data and 230-290 hours of modeling-ready 8-second windows per wearable. We benchmark heuristic, supervised, and self-supervised heart-rate estimation methods, showing substantial body-site differences: the best methods achieve mean absolute errors (MAEs) of 2.30 bpm on the earring, 5.13 bpm on the ring, 8.37 bpm on the watch, and 8.68 bpm on the necklace. We further analyze motion effects and evaluate multi-site and PPG-accelerometer fusion, demonstrating the dataset's value for robust physiological sensing across emerging wearable form factors.

Photoplethysmography (PPG) has become a ubiquitous physiological signal; however, current generative models still struggle to preserve realistic waveform morphology and learn a latent structure that captures cardiac and respiratory physiology. PPG generators trained with adversarial losses can produce plausible waveforms, but provide no inference path from a real signal to a latent representation. Variational autoencoders, on the other hand, map the PPG data to latent codes, although their decoders often blur systolic upstrokes and dampen amplitude and spectral details. Diffusion models improve waveform fidelity, but typically lack an inference path for reconstruction and physiological analysis. We propose VampPrior Latent Diffusion (VAMP-Diff), a jointly trained variational diffusion model that combines a temporal PPG encoder, a conditional one-dimensional diffusion decoder, and VampPrior regularization on a compact pooled latent. The model uses full temporal latent during diffusion reconstruction, giving the decoder access to beat timing and morphology while generating samples from learned VampPrior components instead of a fixed Gaussian prior. We demonstrate on the CapnoBase dataset that VAMP-Diff produces realistic PPG signals, reconstructs sharper physiological waveforms than Gaussian-prior baselines, preserves heart-rate information, maintains respiratory-rate consistency, and is sensitive to waveform corruptions through reconstruction error.

This work proposes Attractor-Vascular Coupling Theory (AVCT), a mathematical framework showing that cardiac attractor geometry encodes blood pressure (BP) information sufficient for AAMI-standard estimation, and validates the theory through a calibrated cuffless BP model using photoplethysmography (PPG). AVCT is grounded in Cardiac Stability Theory and operationalized using Takens delay embedding and attractor morphology extraction. Two theorems, one proposition, and one corollary formally justify the use of PPG attractor features for BP estimation and predict the feature-importance hierarchy. A LightGBM model trained on pulse transit time (PTT) and Cardiac Stability Index (CSI) attractor features under single-point calibration was evaluated using strict leave-one-subject-out cross-validation (LOSO-CV) on 46 subjects from BIDMC ICU (n = 9) and VitalDB surgical data (n = 37), comprising 29,684 windows. The model achieved systolic BP (SBP) mean absolute error (MAE) of 2.05 mmHg and diastolic BP (DBP) MAE of 1.67 mmHg, with correlations r = 0.990 and r = 0.991, satisfying the AAMI/IEEE SP10 requirement of MAE below 5 mmHg. Median per-subject MAE was 1.87/1.54 mmHg, and 70%/76% of subjects individually satisfied AAMI criteria. A PPG-only ablation using nine smartphone attractor features matched the ECG+PPG model within 0.05 mmHg, demonstrating that clinical-grade BP tracking is achievable using only a smartphone camera while surpassing prior generalized LOSO-CV results using fewer sensors. All four AVCT predictions were quantitatively confirmed, with 91.5% error reduction from uncalibrated to calibrated estimation (epsilon_cal = 0.915). Unlike post-hoc explainable AI methods, AVCT predicts features satisfying the architectural faithfulness criterion of the Explainable-AI Trustworthiness (EAT) framework and grounding BP estimation in nonlinear dynamical systems theory.

Cardiovascular stability estimation from wearable photoplethysmography (PPG) requires a principled nonlinear framework, yet major gaps persist in heuristic parameter selection and evaluation protocols that inflate reported performance. We introduce a Stability-Constrained Cardiovascular Stability Index (SCSI) grounded in Cardiac Stability Theory and validate it across 176,742 segments from four heterogeneous PPG datasets at three temporal scales. Cross-dataset analysis demonstrates a large Kruskal-Wallis effect size (eta2 = 0.351, p < 0.001), strong cross-scale consistency (kappa > 0.97), and significant correlation with respiratory rate across 53 ICU records (Spearman r = 0.346, p = 0.011). We identify three evaluation artifacts that inflate heuristic AUC from a true baseline of 0.573 to 0.752: segment-level cross-validation leakage, test-set normalization leakage, and pooled-AUC overweighting that conceals per-patient failure. Correcting these artifacts and applying Bayesian optimization over 15 joint parameters yields SCSI with cross-validation AUC of 0.720. On 18 held-out records, SCSI achieves pooled AUC of 0.757 (95% CI: 0.686-0.828) and negative predictive value of 0.966 for tachypnea screening, while per-record AUC of 0.497 +/- 0.207 is disclosed for transparency. External validation on 42 elective-surgery records yields AUC of 0.621, confirming cross-population generalization. Ablation analysis identifies the nonlinear complexity module as the dominant component. A sparse three-component architecture is proposed as the minimal deployable configuration. The corrected protocol provides a reproducible benchmark for future wearable cardiovascular stability indices.

Emotion recognition from facial videos enables non-contact inference of human emotional states. Although facial expressions are widely used cues, they cannot fully reflect intrinsic affective states. Remote photoplethysmography (rPPG) provides complementary physiological information, but it is highly susceptible to noise and inter-subject variability, limiting generalization to unseen individuals. Existing multimodal methods combine facial and rPPG features, yet their fusion strategies often disrupt pretrained facial representations and lack explicit mechanisms to suppress subject-specific variations. To address these issues, we propose a subject-invariant cross-modal prompt-tuning framework for video-based emotion recognition. Specifically, rPPG waveforms are transformed into noise-robust time-frequency representations (TFRs), from which modality-complementary prompts are generated to modulate facial tokens within a frozen Vision Transformer (ViT). This design enables effective cross-modal interaction while preserving the generalizable facial representations learned by the pretrained backbone. In addition, we introduce a decoupled shared-specific adapter (DSSA) into each ViT layer to explicitly separate subject-shared and subject-specific components, thereby improving cross-subject generalization. Experiments on the MAHNOB-HCI and DEAP benchmarks demonstrate that the proposed method consistently outperforms strong baselines in both recognition accuracy and generalization ability, highlighting its effectiveness for video-based emotion recognition.

Remote photoplethysmography (rPPG) holds great promise for continuous heart-rate monitoring of drivers in intelligent vehicles. However, its performance is severely degraded by the highly dynamic illumination changes. A critical yet overlooked factor is the lack of exposure controlling during video acquisition -- most existing systems rely on either fixed exposure settings or camera build-in auto-exposure, both of which fail to maintain stable facial brightness under rapidly changing lighting conditions during driving. To address this gap, we propose a highly-adaptive exposure controlling framework that proactively adjusts exposure parameters based on predictive modeling of historical skin reflections. Unlike standard auto-exposure, our method is specifically optimized for rPPG measurement, ensuring the skin region of interest (ROI) remains within the optimal dynamic range for rPPG signal extraction. As an important contribution of this study, we introduce ExpDrive, a public in-vehicle physiological monitoring dataset comprising synchronized facial video and reference ECG from 48 subjects captured under real driving conditions. Extensive experiments demonstrate that our method consistently outperforms fixed exposure and standard auto-exposure strategies. Specifically, it reduces the Mean Absolute Error (MAE) by 6.31 bpm (from 14.1 to 7.79 bpm) and significantly increases the success rate by 32.3 percentage points (p < 0.001) (from 24.9% to 57.2%) across challenging driving scenarios. Notably, it clearly improved the performance of non-contact heart-rate monitoring in both low-light (rainy) and high-glare (sunny) conditions, validating the efficacy of exposure-aware acquisition design.

Photoplethysmography (PPG) is increasingly used in wearable affective computing due to its low cost and ease of integration into consumer devices. Recent advances in deep learning have introduced long-range sequence models, such as Transformers, and state-space models, like Mamba, which have demonstrated strong performance on natural language and general time-series tasks. However, it remains unclear whether these architectures offer tangible benefits over widely used Convolutional Neural Networks (CNNs) and Long Short-Term Memory (LSTMs) for PPG-based affect recognition, given that datasets are typically small and noisy. This work presents a measurement-driven comparison of four deep learning architectures, CNN, CNN-LSTM hybrid, Transformers, and Mamba, for classifying arousal, valence, and relaxation states from wrist-based PPG signals. All models are evaluated under a subject-independent 5-fold cross-validation protocol using identical preprocessing, segmentation, and training pipelines. Our results show that the Transformer and Mamba models achieve performance comparable to that of a CNN baseline, but do not consistently outperform it across all tasks. CNNs remain the most effective overall, providing the highest accuracy with the smallest model size, whereas Transformers have a better balance of F1 scores for Arousal and Relaxation. The study provides the first evaluation of Transformer and Mamba models for PPG-based affect recognition, offering practical guidance on model selection for wearable affective monitoring systems.

Unaddressed pain in neonates can lead to adverse effects, including delayed development and slower weight gain, emphasising the need for more objective and reliable pain assessment methods. Hence, automated methods using behavioural and physiological pain indicators have been developed to aid healthcare professionals in the Neonatal ICU. Traditional contact-based methods for physiological parameter estimation are unsuitable for long-term monitoring and increase the risk of spreading diseases like COVID-19. We introduce a novel approach using remote photoplethysmography (rPPG) to estimate pulse signals in a non-contact manner and employ them for neonatal pain detection. The temporal signals acquired from regions-of-interest (ROIs) affected by skin deformations may exhibit lower quality and provide erroneous rPPG signals. Therefore, we incorporated a quality parameter to select the temporal signals obtained from ROIs that are least affected by skin deformations. Further, we employed signal-to-noise ratio as a fitness parameter to extract the rPPG signal corresponding to the clip that is least affected by noise. Experimental findings demonstrate that the rPPG signals provide useful information for neonatal pain detection, and signals extracted from the blue colour channel outperform those extracted from other colour channels. We also show that combining rPPG and audio features provides better results than individual modalities.

We present Cardiac Stability Theory (CST), an axiomatically grounded framework formally defining cardiovascular health as a stability margin around a cardiac dynamical attractor. From four axioms we derive the Cardiac Stability Index (CSI), a composite scalar in [0,1] integrating the largest Lyapunov exponent, recurrence determinism, and signal entropy via time-delay embedding. The ECG-based model (CSISurrogateV2, CNN-Transformer) achieves $R^2=0.8788$, MAE$=0.0234$ on PTB-XL (21,799 recordings). We extend CSI to smartphone PPG via Complementary Domain Transfer (CDT): CSISurrogateV2 generates pseudo-labels for the BUT PPG dataset (48 recordings, 12 subjects), training TinyCSINet (122,849 parameters), achieving MAE$=0.0557$, $ρ=0.660$ on the held-out test set ($n=1065$ windows) at ${<}30$ ms mobile latency. CDT is validated on BIDMC, Welltory, and RWS-PPG. Paired validation on 5,035 BIDMC windows yields $r=0.454$ ($ρ=0.485$, $p<10^{-295}$), confirming correlated cardiac stability across modalities. CSI is negatively correlated with age (slope $= -0.000225$ CSI/year, PTB-XL), discriminates atrial fibrillation from normal sinus rhythm (AUROC$=0.89$), and is robust under Perturbation Invariance Training (max AUC drop 1.65%). We derive HeartSpan, a longitudinal stability metric relative to population age norms, enabling continuous non-invasive cardiac monitoring from commodity smartphones for longevity tracking and cardiac risk stratification.

Remote Photoplethysmography (rPPG) enables convenient non-contact physiological measurement. Existing Self-Supervised Learning (SSL) methods commonly fall into a correlation trap: they tend to learn the most dominant periodic signals in the data, such as high-energy motion or illumination noise, rather than the faint, true rPPG signal, leading to poor model generalization. To address this, we propose a new SSL paradigm, Physiological Causal Probing (PCP), which treats the latent rPPG signal as the underlying physical source and the resulting pixel chrominance variations as its visual manifestation. Its core idea is to shift from passive correlation learning to active, precise intervention: it intervenes on the video based on a proposed rPPG hypothesis, and verifies whether the post-intervention changes match physical expectations. We propose the Interv-rPPG framework to implement PCP: an rPPG extractor named PhysMambaFormer hypothesizes the rPPG signal, while a Controllable Physiological Signal Editor conducts precise chrominance-domain interventions on videos based on this hypothesis. Interv-rPPG validates the physical realism of the hypothesis through Falsifiability via Nulling' and Axiomatic Equivariance'. Our editor achieves precise editing of the rPPG signal by intervening in the low-frequency chrominance components of the video. Our method improves both in-domain and cross-domain performance on challenging datasets such as VIPL-HR and MMPD. Furthermore, it surpasses the supervised baseline in complex cross-dataset settings, while remaining competitive on clean datasets where the intervention mechanism may introduce slight residual chrominance noise. Extensive experiments, including diagnostic analysis of nuisance sensitivity, demonstrate that the PCP paradigm effectively resists motion and illumination artifacts.

In principle, deep generative models can be used to perform domain adaptation; i.e. align the input feature representations of test data with that of a separate discriminative model's training data. This can help improve the discriminative model's performance on the test data. However, generative models are prone to producing hallucinations and artefacts that may degrade the quality of generated data, and therefore, predictive performance when processed by the discriminative model. While uncertainty quantification can provide a means to assess the quality of adapted data, the standard framework for evaluating the quality of predicted uncertainties may not easily extend to generative models due to the common lack of ground truths (among other reasons). Even with ground truths, this evaluation is agnostic to how the generated outputs are used on the downstream task, limiting the extent to which the uncertainty reliability analysis provides insights about the utility of the uncertainties with respect to the intended use case of the adapted examples. Here, we describe how decision-theoretic uncertainty quantification can address these concerns and provide a convenient framework for evaluating the trustworthiness of generated outputs, in particular, for domain adaptation. We consider a case study in photoplethysmography time series denoising for Atrial Fibrillation classification. This formalises a well-known heuristic method of using a downstream classifier to assess the quality of generated outputs.

Photoplethysmography (PPG) is widely used in wearable health monitoring, but its reliability is often degraded by noise and motion artifacts, limiting downstream applications such as heart rate (HR) estimation. This paper presents a deep learning framework for PPG denoising with an emphasis on preserving physiological information. In this framework, we propose DPNet, a Mamba-based denoising backbone designed for effective temporal modeling. To further enhance denoising performance, the framework also incorporates a scale-invariant signal-to-distortion ratio (SI-SDR) loss to promote waveform fidelity and an auxiliary HR predictor (HRP) that provides physiological consistency through HR-based supervision. Experiments on the BIDMC dataset show that our method achieves strong robustness against both synthetic noise and real-world motion artifacts, outperforming conventional filtering and existing neural models. Our method can effectively restore PPG signals while maintaining HR accuracy, highlighting the complementary roles of SI-SDR loss and HR-guided supervision. These results demonstrate the potential of our approach for practical deployment in wearable healthcare systems.

Mental health problems such as stress, anxiety, and depression affect millions of people worldwide. These conditions are usually assessed using questionnaires, which rely on how people describe their own feelings. In this study, we explore whether a wearable device can help measure mental health using physical signals from the body. The device records small changes in blood flow and tissue activity from the fingertip. We collected data from 132 adults across 19 countries and compared these signals with mental health questionnaire results. We found that patterns in blood flow and tissue activity are linked to stress-related symptoms. This approach may help develop new tools for simple, non-invasive mental health monitoring in everyday life. Code and datasets are publicly available: https://github.com/leduckhai/Wearable_LDF-FS

The scarcity of temporally aligned pre-event physiological data limits the study of stroke risk states before documented clinical recognition. We focus on patients who experienced stroke during hospitalization while undergoing continuous monitoring, enabling retrospective analysis of pre-anchor photoplethysmography (PPG). Using MIMIC-III and MC-MED, an LLM-assisted pipeline generated candidate stroke anchors from unstructured notes. All retained anchors underwent physician adjudication, and a stratified 100-case double-review audit showed 95.0% candidate-to-adjudicated agreement within +/-15 min. We identified 176 MIMIC-III patients and 154 MC-MED patients with eligible synchronized pre-anchor PPG. A fixed 17-channel hemodynamic representation and ResNet-1D classifier were evaluated using patient-level five-fold internal validation and frozen external testing. At validation-selected operating points, F1-scores were 0.7956, 0.8759, and 0.9406 for 4-, 5-, and 6-hour horizons in MIMIC-III and 0.9256, 0.9595, and 0.9888 in MC-MED; the corresponding threshold-free AUCs ranged from 0.6124 to 0.7079. The PPG model achieved higher F1 than four non-waveform clinical and structured-EHR comparators in all six cohort-horizon settings. On high-risk non-stroke controls, window-level false-positive rates ranged from 0.1371 to 0.2938 and decreased to 0.0183-0.1739 after persistence aggregation. These retrospective findings support measurable pre-anchor PPG structure, but do not establish biological stroke onset, a calibrated bedside alarm, or a clinically validated prediction lead time.