Abstract-- Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide, and sustained hypertension is an often silent risk factor, making cuffless continuous blood pressure (BP) monitoring with wearable devices important for early screening and long-term management. Most existing cuffless BP estimation methods use only photoplethysmography (PPG) and electrocardiography (ECG) signals, alone or in combination. These models are typically developed under resting or quasi-static conditions and struggle to maintain robust accuracy in multi-motion-state scenarios. In this study, we propose a six-modal BP estimation framework that jointly leverages ECG, multi-channel PPG, attachment pressure, sensor temperature, and triaxial acceleration and angular velocity. Each modality is processed by a lightweight branch encoder, contrastive learning enforces cross-modal semantic alignment, and a mixture-of-experts (MoE) regression head adaptively maps the fused features to BP across motion states. Comprehensive experiments on the public Pulse Transit Time PPG Dataset, which includes running, walking, and sitting data from 22 subjects, show that the proposed method achieves mean absolute errors (MAE) of 3.60 mmHg for systolic BP (SBP) and 3.01 mmHg for diastolic BP (DBP). From a clinical perspective, it attains Grade A for SBP, DBP, and mean arterial pressure (MAP) according to the British Hypertension Society (BHS) protocol and meets the numerical criteria of the Association for the Advancement of Medical Instrumentation (AAMI) standard for mean error (ME) and standard deviation of error (SDE). Hypertension is one of the most prevalent and important risk factors for cardiovascular disease (CVD) [1].

Hypotension in critically ill ICU patients is common and life-threatening. Escalation to catecholamine therapy marks a key management step, with both undertreatment and overtreatment posing risks. Most machine learning (ML) models predict hypotension using fixed MAP thresholds or MAP forecasting, overlooking the clinical decision behind treatment escalation. Predicting catecholamine initiation, the start of vasoactive or inotropic agent administration offers a more clinically actionable target reflecting real decision-making. Using the MIMIC-III database, we modeled catecholamine initiation as a binary event within a 15-minute prediction window. Input features included statistical descriptors from a two-hour sliding MAP context window, along with demographics, biometrics, comorbidities, and ongoing treatments. An Extreme Gradient Boosting (XGBoost) model was trained and interpreted via SHapley Additive exPlanations (SHAP). The model achieved an AUROC of 0.822 (0.813-0.830), outperforming the hypotension baseline (MAP < 65, AUROC 0.686 [0.675-0.699]). SHAP analysis highlighted recent MAP values, MAP trends, and ongoing treatments (e.g., sedatives, electrolytes) as dominant predictors. Subgroup analysis showed higher performance in males, younger patients (<53 years), those with higher BMI (>32), and patients without comorbidities or concurrent medications. Predicting catecholamine initiation based on MAP dynamics, treatment context, and patient characteristics supports the critical decision of when to escalate therapy, shifting focus from threshold-based alarms to actionable decision support. This approach is feasible across a broad ICU cohort under natural event imbalance. Future work should enrich temporal and physiological context, extend label definitions to include therapy escalation, and benchmark against existing hypotension prediction systems.

We focus on scenarios where identifying a patient's digital twin from noninvasive

In clinical settings, monitoring hemodynamics is crucial for managing patient prognosis, necessitating the integrated analysis of multiple physiological signals. While recent research has analyzed single signals such as electrocardiography (ECG) or photoplethysmography (PPG), there has yet to be a proposal for an approach that encompasses the complex signal analysis required in actual clinical scenarios. In this study, we introduce the SNUPHY-M (Seoul National University hospital PHYsiological signal Masked representation learning) model extracts physiological features reflecting the electrical, pressure, and fluid characteristics of the cardiac cycle in the process of restoring three masked physiological signals based on self-supervised learning (SSL): ECG, PPG, and arterial blood pressure (ABP) signals. By employing multiple physical characteristics, the model can extract more enriched features only using non-invasive signals. We evaluated the model's performance in clinical downstream tasks such as hypotension, stroke volume, systolic blood pressure, diastolic blood pressure, and age prediction. Our results showed that the SNUPHY-M significantly outperformed supervised or SSL models, especially in prediction tasks using non-invasive signals. To the best of our knowledge, SNUPHY-M is the first model to apply multi-modal SSL to cardiovascular analysis involving ECG, PPG, and ABP signals. This approach effectively supports clinical decision-making and enables precise diagnostics, contributing significantly to the early diagnosis and management of hemodynamics without invasiveness.

Blood pressure (BP) monitoring is critical in in tensive care units (ICUs) where hemodynamic instability can rapidly progress to cardiovascular collapse. Current machine learning (ML) approaches suffer from three limitations: lack of external validation, absence of uncertainty quantification, and inadequate data leakage prevention. This study presents the first comprehensive framework with novel algorithmic leakage prevention, uncertainty quantification, and cross-institutional validation for electronic health records (EHRs) based BP pre dictions. Our methodology implemented systematic data leakage prevention, uncertainty quantification through quantile regres sion, and external validation between the MIMIC-III and eICU databases. An ensemble framework combines Gradient Boosting, Random Forest, and XGBoost with 74 features across five physiological domains. Internal validation achieved a clinically acceptable performance (for SBP: R^2 = 0.86, RMSE = 6.03 mmHg; DBP: R^2 = 0.49, RMSE = 7.13 mmHg), meeting AAMI standards. External validation showed 30% degradation with critical limitations in patients with hypotensive. Uncertainty quantification generated valid prediction intervals (80.3% SBP and 79.9% DBP coverage), enabling risk-stratified protocols with narrow intervals (< 15 mmHg) for standard monitoring and wide intervals (> 30 mmHg) for manual verification. This framework provides realistic deployment expectations for cross institutional AI-assisted BP monitoring in critical care settings. The source code is publicly available at https://github.com/ mdbasit897/clinical-bp-prediction-ehr.

Rapid and reliable vascular access is critical in trauma and critical care. Central vascular catheterization enables high-volume resuscitation, hemodynamic monitoring, and advanced interventions like ECMO and REBOA. While peripheral access is common, central access is often necessary but requires specialized ultrasound-guided skills, posing challenges in prehospital settings. The complexity arises from deep target vessels and the precision needed for needle placement. Traditional techniques, like the Seldinger method, demand expertise to avoid complications. Despite its importance, ultrasound-guided central access is underutilized due to limited field expertise. While autonomous needle insertion has been explored for peripheral vessels, only semi-autonomous methods exist for femoral access. This work advances toward full automation, integrating robotic ultrasound for minimally invasive emergency procedures. Our key contribution is the successful femoral vein and artery cannulation in a porcine hemorrhagic shock model.

Although large language models (LLMs) have demonstrated impressive reasoning capabilities across general domains, their effectiveness in real-world clinical practice remains limited. This is likely due to their insufficient exposure to real-world clinical data during training, as such data is typically not included due to privacy concerns. To address this, we propose enhancing the clinical reasoning capabilities of LLMs by leveraging real-world clinical data. We constructed reasoning-intensive questions from a nationwide sepsis registry and fine-tuned Phi-4 on these questions using reinforcement learning, resulting in C-Reason. C-Reason exhibited strong clinical reasoning capabilities on the in-domain test set, as evidenced by both quantitative metrics and expert evaluations. Furthermore, its enhanced reasoning capabilities generalized to a sepsis dataset involving different tasks and patient cohorts, an open-ended consultations on antibiotics use task, and other diseases. Future research should focus on training LLMs with large-scale, multi-disease clinical datasets to develop more powerful, general-purpose clinical reasoning models.

Clinical measurements such as blood pressures and respiration rates are critical in diagnosing and monitoring patient outcomes. It is an important component of biomedical data, which can be used to train transformer-based language models (LMs) for improving healthcare delivery. It is, however, unclear whether LMs can effectively interpret and use clinical measurements. We investigate two questions: First, can LMs effectively leverage clinical measurements to answer related medical questions? Second, how to enhance an LM's performance on medical question-answering (QA) tasks that involve measurements? We performed a case study on blood pressure readings (BPs), a vital sign routinely monitored by medical professionals. We evaluated the performance of four LMs: BERT, BioBERT, MedAlpaca, and GPT-3.5, on our newly developed dataset, BPQA (Blood Pressure Question Answering). BPQA contains $100$ medical QA pairs that were verified by medical students and designed to rely on BPs . We found that GPT-3.5 and MedAlpaca (larger and medium sized LMs) benefit more from the inclusion of BPs than BERT and BioBERT (small sized LMs). Further, augmenting measurements with labels improves the performance of BioBERT and Medalpaca (domain specific LMs), suggesting that retrieval may be useful for improving domain-specific LMs.

Photoplethysmography (PPG)-based blood pressure (BP) estimation represents a promising alternative to cuff-based BP measurements. Recently, an increasing number of deep learning models have been proposed to infer BP from the raw PPG waveform. However, these models have been predominantly evaluated on in-distribution test sets, which immediately raises the question of the generalizability of these models to external datasets. To investigate this question, we trained five deep learning models on the recently released PulseDB dataset, provided in-distribution benchmarking results on this dataset, and then assessed out-of-distribution performance on several external datasets. The best model (XResNet1d101) achieved in-distribution MAEs of 9.4 and 6.0 mmHg for systolic and diastolic BP respectively on PulseDB (with subject-specific calibration), and 14.0 and 8.5 mmHg respectively without calibration. Equivalent MAEs on external test datasets without calibration ranged from 15.0 to 25.1 mmHg (SBP) and 7.0 to 10.4 mmHg (DBP). Our results indicate that the performance is strongly influenced by the differences in BP distributions between datasets. We investigated a simple way of improving performance through sample-based domain adaptation and put forward recommendations for training models with good generalization properties. With this work, we hope to educate more researchers for the importance and challenges of out-of-distribution generalization.

Blood pressure (BP) is a key indicator of cardiovascular health. As hypertension remains a global cause of morbidity and mortality, accurate, continuous, and non-invasive BP monitoring is therefore of paramount importance. Photoplethysmography (PPG) and electrocardiography (ECG) can potentially enable continuous BP monitoring, yet training accurate and robust machine learning (ML) models remains challenging due to variability in data quality and patient-specific factors. Recently, multiple research groups explored Electroencephalographic (EEG)--based foundation models and demonstrated their exceptional ability to learn rich temporal resolution. Considering the morphological similarities between different biosignals, the question arises of whether a model pre-trained on one modality can effectively be exploited to improve the accuracy of a different signal type. In this work, we take an initial step towards generalized biosignal foundation models by investigating whether model representations learned from abundant EEG data can effectively be transferred to ECG/PPG data solely with fine-tuning, without the need for large-scale additional pre-training, for the BP estimation task. Evaluations on the MIMIC-III and VitalDB datasets demonstrate that our approach achieves near state-of-the-art accuracy for diastolic BP (mean absolute error of 1.57 mmHg) and surpasses by 1.5x the accuracy of prior works for systolic BP (mean absolute error 2.72 mmHg). Additionally, we perform dynamic INT8 quantization, reducing the smallest model size by over 3.5x (from 13.73 MB down to 3.83 MB) while preserving performance, thereby enabling unobtrusive, real-time BP monitoring on resource-constrained wearable devices.