Recent advances in wearable technology have enabled the continuous monitoring of vital physiological signals, essential for predictive modeling and early detection of extreme physiological events. Among these physiological signals, heart rate (HR) plays a central role, as it is widely used in monitoring and managing cardiovascular conditions and detecting extreme physiological events such as hypoglycemia. However, data from wearable devices often suffer from missing values. To address this issue, recent studies have employed various imputation techniques. Traditionally, the effectiveness of these methods has been evaluated using predictive accuracy metrics such as RMSE, MAPE, and MAE, which assess numerical proximity to the original data. While informative, these metrics fail to capture the complex statistical structure inherent in physiological signals. This study bridges this gap by presenting a comprehensive evaluation of four statistical imputation methods, linear interpolation, K Nearest Neighbors (KNN), Piecewise Cubic Hermite Interpolating Polynomial (PCHIP), and B splines, for short term HR data gaps. We assess their performance using both predictive accuracy metrics and statistical distance measures, including the Cohen Distance Test (CDT) and Jensen Shannon Distance (JS Distance), applied to HR data from the D1NAMO dataset and the BIG IDEAs Lab Glycemic Variability and Wearable Device dataset. The analysis reveals limitations in existing imputation approaches and the absence of a robust framework for evaluating imputation quality in physiological signals. Finally, this study proposes a foundational framework to develop a composite evaluation metric to assess imputation performance.

The dead-in-bed syndrome describes the sudden and unexplained death of young individuals with Type 1 Diabetes (T1D) without prior long-term complications. One leading hypothesis attributes this phenomenon to nocturnal hypoglycemia (NH), a dangerous drop in blood glucose during sleep. This study aims to improve NH prediction in children with T1D by leveraging physiological data and machine learning (ML) techniques. We analyze an in-house dataset collected from 16 children with T1D, integrating physiological metrics from wearable sensors. We explore predictive performance through feature engineering, model selection, architectures, and oversampling. To address data limitations, we apply transfer learning from a publicly available adult dataset. Our results achieve an AUROC of 0.75 +- 0.21 on the in-house dataset, further improving to 0.78 +- 0.05 with transfer learning. This research moves beyond glucose-only predictions by incorporating physiological parameters, showcasing the potential of ML to enhance NH detection and improve clinical decision-making for pediatric diabetes management.

We introduce MedXpertQA, a highly challenging and comprehensive benchmark to evaluate expert-level medical knowledge and advanced reasoning. MedXpertQA includes 4,460 questions spanning 17 specialties and 11 body systems. It includes two subsets, Text for text evaluation and MM for multimodal evaluation. Notably, MM introduces expert-level exam questions with diverse images and rich clinical information, including patient records and examination results, setting it apart from traditional medical multimodal benchmarks with simple QA pairs generated from image captions. MedXpertQA applies rigorous filtering and augmentation to address the insufficient difficulty of existing benchmarks like MedQA, and incorporates specialty board questions to improve clinical relevance and comprehensiveness. We perform data synthesis to mitigate data leakage risk and conduct multiple rounds of expert reviews to ensure accuracy and reliability. We evaluate 16 leading models on MedXpertQA. Moreover, medicine is deeply connected to real-world decision-making, providing a rich and representative setting for assessing reasoning abilities beyond mathematics and code. To this end, we develop a reasoning-oriented subset to facilitate the assessment of o1-like models.

Given their ability for advanced reasoning, extensive contextual understanding, and robust question-answering abilities, large language models have become prominent in healthcare management research. Despite adeptly handling a broad spectrum of healthcare inquiries, these models face significant challenges in delivering accurate and practical advice for chronic conditions such as diabetes. We evaluate the responses of ChatGPT versions 3.5 and 4 to diabetes patient queries, assessing their depth of medical knowledge and their capacity to deliver personalized, context-specific advice for diabetes self-management. Our findings reveal discrepancies in accuracy and embedded biases, emphasizing the models' limitations in providing tailored advice unless activated by sophisticated prompting techniques. Additionally, we observe that both models often provide advice without seeking necessary clarification, a practice that can result in potentially dangerous advice. This underscores the limited practical effectiveness of these models without human oversight in clinical settings. To address these issues, we propose a commonsense evaluation layer for prompt evaluation and incorporating disease-specific external memory using an advanced Retrieval Augmented Generation technique. This approach aims to improve information quality and reduce misinformation risks, contributing to more reliable AI applications in healthcare settings. Our findings seek to influence the future direction of AI in healthcare, enhancing both the scope and quality of its integration.

Accurately predicting blood glucose (BG) levels of ICU patients is critical, as both hypoglycemia (BG < 70 mg/dL) and hyperglycemia (BG > 180 mg/dL) are associated with increased morbidity and mortality. We develop the Multi-source Irregular Time-Series Transformer (MITST), a novel machine learning-based model to forecast the next BG level, classifying it into hypoglycemia, hyperglycemia, or euglycemia (70-180 mg/dL). The irregularity and complexity of Electronic Health Record (EHR) data, spanning multiple heterogeneous clinical sources like lab results, medications, and vital signs, pose significant challenges for prediction tasks. MITST addresses these using hierarchical Transformer architectures, which include a feature-level, a timestamp-level, and a source-level Transformer. This design captures fine-grained temporal dynamics and allows learning-based data integration instead of traditional predefined aggregation. In a large-scale evaluation using the eICU database (200,859 ICU stays across 208 hospitals), MITST achieves an average improvement of 1.7% (p < 0.001) in AUROC and 1.8% (p < 0.001) in AUPRC over a state-of-the-art baseline. For hypoglycemia, MITST achieves an AUROC of 0.915 and an AUPRC of 0.247, both significantly higher than the baseline's AUROC of 0.862 and AUPRC of 0.208 (p < 0.001). The flexible architecture of MITST allows seamless integration of new data sources without retraining the entire model, enhancing its adaptability in clinical decision support. Although this study focuses on predicting BG levels, MITST can easily be extended to other critical event prediction tasks in ICU settings, offering a robust solution for analyzing complex, multi-source, irregular time-series data.

The study aims to investigate the similarities and differences in the brain damage caused by Hypoxia-Ischemia (HI), Hypoglycemia, and Epilepsy. Hypoglycemia poses a significant challenge in improving glycemic regulation for insulin-treated patients, while HI brain disease in neonates is associated with low oxygen levels. The study examines the possibility of using a combination of medical data and Electroencephalography (EEG) measurements to predict outcomes over a two-year period. The study employs a multilevel fusion of data features to enhance the accuracy of the predictions. Therefore this paper suggests a hybridized classification model for Hypoxia-Ischemia and Hypoglycemia, Epilepsy brain injury (HCM-BI). A Support Vector Machine is applied with clinical details to define the Hypoxia-Ischemia outcomes of each infant. The newborn babies are assessed every two years again to know the neural development results. A selection of four attributes is derived from the Electroencephalography records, and SVM does not get conclusions regarding the classification of diseases. The final feature extraction of the EEG signal is optimized by the Bayesian Neural Network (BNN) to get the clear health condition of Hypoglycemia and Epilepsy patients. Through monitoring and assessing physical effects resulting from Electroencephalography, The Bayesian Neural Network (BNN) is used to extract the test samples with the most log data and to report hypoglycemia and epilepsy Keywords- Hypoxia-Ischemia , Hypoglycemia , Epilepsy , Multilevel Fusion of Data Features , Bayesian Neural Network (BNN) , Support Vector Machine (SVM)

We explore the usage of large language models (LLM) in human-in-the-loop human-in-the-plant cyber-physical systems (CPS) to translate a high-level prompt into a personalized plan of actions, and subsequently convert that plan into a grounded inference of sequential decision-making automated by a real-world CPS controller to achieve a control goal. We show that it is relatively straightforward to contextualize an LLM so it can generate domain-specific plans. However, these plans may be infeasible for the physical system to execute or the plan may be unsafe for human users. To address this, we propose CPS-LLM, an LLM retrained using an instruction tuning framework, which ensures that generated plans not only align with the physical system dynamics of the CPS but are also safe for human users. The CPS-LLM consists of two innovative components: a) a liquid time constant neural network-based physical dynamics coefficient estimator that can derive coefficients of dynamical models with some unmeasured state variables; b) the model coefficients are then used to train an LLM with prompts embodied with traces from the dynamical system and the corresponding model coefficients. We show that when the CPS-LLM is integrated with a contextualized chatbot such as BARD it can generate feasible and safe plans to manage external events such as meals for automated insulin delivery systems used by Type 1 Diabetes subjects.

Large language models (LLMs) have broad medical knowledge and can reason about medical information across many domains, holding promising potential for diverse medical applications in the near future. In this study, we demonstrate a concerning vulnerability of LLMs in medicine. Through targeted manipulation of just 1.1% of the model's weights, we can deliberately inject an incorrect biomedical fact. The erroneous information is then propagated in the model's output, whilst its performance on other biomedical tasks remains intact. We validate our findings in a set of 1,038 incorrect biomedical facts. This peculiar susceptibility raises serious security and trustworthiness concerns for the application of LLMs in healthcare settings. It accentuates the need for robust protective measures, thorough verification mechanisms, and stringent management of access to these models, ensuring their reliable and safe use in medical practice.

Objective: The artificial pancreas (AP) has shown promising potential in achieving closed-loop glucose control for individuals with type 1 diabetes mellitus (T1DM). However, designing an effective control policy for the AP remains challenging due to the complex physiological processes, delayed insulin response, and inaccurate glucose measurements. While model predictive control (MPC) offers safety and stability through the dynamic model and safety constraints, it lacks individualization and is adversely affected by unannounced meals. Conversely, deep reinforcement learning (DRL) provides personalized and adaptive strategies but faces challenges with distribution shifts and substantial data requirements. Methods: We propose a hybrid control policy for the artificial pancreas (HyCPAP) to address the above challenges. HyCPAP combines an MPC policy with an ensemble DRL policy, leveraging the strengths of both policies while compensating for their respective limitations. To facilitate faster deployment of AP systems in real-world settings, we further incorporate meta-learning techniques into HyCPAP, leveraging previous experience and patient-shared knowledge to enable fast adaptation to new patients with limited available data. Results: We conduct extensive experiments using the FDA-accepted UVA/Padova T1DM simulator across three scenarios. Our approaches achieve the highest percentage of time spent in the desired euglycemic range and the lowest occurrences of hypoglycemia. Conclusion: The results clearly demonstrate the superiority of our methods for closed-loop glucose management in individuals with T1DM. Significance: The study presents novel control policies for AP systems, affirming the great potential of proposed methods for efficient closed-loop glucose control.

People with diabetes have to manage their blood glucose level to keep it within an appropriate range. Predicting whether future glucose values will be outside the healthy threshold is of vital importance in order to take corrective actions to avoid potential health damage. In this paper we describe our research with the aim of predicting the future behavior of blood glucose levels, so that hypoglycemic events may be anticipated. The approach of this work is the application of transformation functions on glucose time series, and their use in convolutional neural networks. We have tested our proposed method using real data from 4 different diabetes patients with promising results.