Cardiovascular diseases (CVDs) are the leading cause of death worldwide, accounting for approximately 17.9 million deaths each year. Early detection is critical, creating a demand for accurate and inexpensive pre-screening methods. Deep learning has recently been applied to classify abnormal heart sounds indicative of CVDs using synchronised phonocardiogram (PCG) and electrocardiogram (ECG) signals, as well as multichannel PCG (mPCG). However, state-of-the-art architectures remain underutilised due to the limited availability of synchronised and multichannel datasets. Augmented datasets and pre-trained models provide a pathway to overcome these limitations, enabling transformer-based architectures to be trained effectively. This work combines traditional signal processing with denoising diffusion models, WaveGrad and DiffWave, to create an augmented dataset to fine-tune a Wav2Vec 2.0-based classifier on multimodal and multichannel heart sound datasets. The approach achieves state-of-the-art performance. On the Computing in Cardiology (CinC) 2016 dataset of single channel PCG, accuracy, unweighted average recall (UAR), sensitivity, specificity and Matthew's correlation coefficient (MCC) reach 92.48%, 93.05%, 93.63%, 92.48%, 94.93% and 0.8283, respectively. Using the synchronised PCG and ECG signals of the training-a dataset from CinC, 93.14%, 92.21%, 94.35%, 90.10%, 95.12% and 0.8380 are achieved for accuracy, UAR, sensitivity, specificity and MCC, respectively. Using a wearable vest dataset consisting of mPCG data, the model achieves 77.13% accuracy, 74.25% UAR, 86.47% sensitivity, 62.04% specificity, and 0.5082 MCC. These results demonstrate the effectiveness of transformer-based models for CVD detection when supported by augmented datasets, highlighting their potential to advance multimodal and multichannel heart sound classification.

The coupling signal refers to a latent physiological signal that characterizes the transformation from cardiac electrical excitation, captured by the electrocardiogram (ECG), to mechanical contraction, recorded by the phonocardiogram (PCG). By encoding the temporal and functional interplay between electrophysiological and hemodynamic events, it serves as an intrinsic link between modalities and offers a unified representation of cardiac function, with strong potential to enhance multi-modal cardiovascular disease (CVD) detection. However, existing coupling signal estimation methods remain highly vulnerable to noise, particularly in real-world clinical and physiological settings, which undermines their robustness and limits practical value. In this study, we propose Noise-Robust Multi-Modal Coupling Signal Estimation (NMCSE), which reformulates coupling signal estimation as a distribution matching problem solved via optimal transport. By jointly aligning amplitude and timing, NMCSE avoids noise amplification and enables stable signal estimation. When integrated into a Temporal-Spatial Feature Extraction (TSFE) network, the estimated coupling signal effectively enhances multi-modal fusion for more accurate CVD detection. To evaluate robustness under real-world conditions, we design two complementary experiments targeting distinct sources of noise. The first uses the PhysioNet 2016 dataset with simulated hospital noise to assess the resilience of NMCSE to clinical interference. The second leverages the EPHNOGRAM dataset with motion-induced physiological noise to evaluate intra-state estimation stability across activity levels. Experimental results show that NMCSE consistently outperforms existing methods under both clinical and physiological noise, highlighting it as a noise-robust estimation approach that enables reliable multi-modal cardiac detection in real-world conditions.

We investigate the recovery dynamics of healthy cardiac activity after physical exertion using multimodal biosignals recorded with a polycardiograph. Multifractal features derived from the singularity spectrum capture the scale-invariant properties of cardiovascular regulation. Five supervised classification algorithms - Logistic Regression (LogReg), Suport Vector Machine with RBF kernel (SVM-RBF), k-Nearest Neighbors (kNN), Decision Tree (DT), and Random Forest (RF) - were evaluated to distinguish recovery states in a small, imbalanced dataset. Our results show that multifractal analysis, combined with multimodal sensing, yields reliable features for characterizing recovery and points toward nonlinear diagnostic methods for heart conditions.

Serious Games (SGs) are nowadays shifting focus to include procedural content generation (PCG) in the development process as a means of offering personalized and enhanced player experience. However, the development of a framework to assess the impact of PCG techniques when integrated into SGs remains particularly challenging. This study proposes a methodology for automated evaluation of PCG integration in SGs, incorporating deep reinforcement learning (DRL) game testing agents. To validate the proposed framework, a previously introduced SG featuring card game mechanics and incorporating three different versions of PCG for nonplayer character (NPC) creation has been deployed. Version 1 features random NPC creation, while versions 2 and 3 utilize a genetic algorithm approach. These versions are used to test the impact of different dynamic SG environments on the proposed framework's agents. The obtained results highlight the superiority of the DRL game testing agents trained on Versions 2 and 3 over those trained on Version 1 in terms of win rate (i.e. number of wins per played games) and training time. More specifically, within the execution of a test emulating regular gameplay, both Versions 2 and 3 peaked at a 97% win rate and achieved statistically significant higher (p=0009) win rates compared to those achieved in Version 1 that peaked at 94%. Overall, results advocate towards the proposed framework's capability to produce meaningful data for the evaluation of procedurally generated content in SGs.

Simultaneous electrocardiography (ECG) and phonocardiogram (PCG) provide a comprehensive, multimodal perspective on cardiac function by capturing the heart's electrical and mechanical activities, respectively. However, the distinct and overlapping information content of these signals, as well as their potential for mutual reconstruction and biomarker extraction, remains incompletely understood, especially under varying physiological conditions and across individuals. In this study, we systematically investigate the common and exclusive characteristics of ECG and PCG using the EPHNOGRAM dataset of simultaneous ECG-PCG recordings during rest and exercise. We employ a suite of linear and nonlinear machine learning models, including non-causal LSTM networks, to reconstruct each modality from the other and analyze the influence of causality, physiological state, and cross-subject variability. Our results demonstrate that nonlinear models, particularly non-causal LSTM, provide superior reconstruction performance, with reconstructing ECG from PCG proving more tractable than the reverse. Exercise and cross-subject scenarios present significant challenges, but envelope-based modeling that utilizes instantaneous amplitude features substantially improves cross-subject generalizability for cross-modal learning. Furthermore, we demonstrate that clinically relevant ECG biomarkers, such as fiducial points and QT intervals, can be estimated from PCG in cross-subject settings. These findings advance our understanding of the relationship between electromechanical cardiac modalities, in terms of both waveform characteristics and the timing of cardiac events, with potential applications in novel multimodal cardiac monitoring technologies.

Cardiovascular diseases are best diagnosed using multiple modalities that assess both the heart's electrical and mechanical functions. While effective, imaging techniques like echocardiography and nuclear imaging are costly and not widely accessible. More affordable technologies, such as simultaneous electrocardiography (ECG) and phonocardiography (PCG), may provide valuable insights into electromechanical coupling and could be useful for prescreening in low-resource settings. Using physical stress test data from the EPHNOGRAM ECG-PCG dataset, collected from 23 healthy male subjects (age: 25.4+/-1.9 yrs), we investigated electromechanical intervals (RR, QT, systolic, and diastolic) and their interactions during exercise, along with hysteresis between cardiac electrical activity and mechanical responses. Time delay analysis revealed distinct temporal relationships between QT, systolic, and diastolic intervals, with RR as the primary driver. The diastolic interval showed near-synchrony with RR, while QT responded to RR interval changes with an average delay of 10.5s, and the systolic interval responded more slowly, with an average delay of 28.3s. We examined QT-RR, systolic-RR, and diastolic-RR hysteresis, finding narrower loops for diastolic RR and wider loops for systolic RR. Significant correlations (average:0.75) were found between heart rate changes and hysteresis loop areas, suggesting the equivalent circular area diameter as a promising biomarker for cardiac function under exercise stress. Deep learning models, including Long Short-Term Memory and Convolutional Neural Networks, estimated the QT, systolic, and diastolic intervals from RR data, confirming the nonlinear relationship between RR and other intervals. Findings highlight a significant cardiac memory effect, linking ECG and PCG morphology and timing to heart rate history.

Procedural Content Generation (PCG) is defined as the automatic creation of game content using algorithms. PCG has a long history in both the game industry and the academic world. It can increase player engagement and ease the work of game designers. While recent advances in deep learning approaches in PCG have enabled researchers and practitioners to create more sophisticated content, it is the arrival of Large Language Models (LLMs) that truly disrupted the trajectory of PCG advancement. This survey explores the differences between various algorithms used for PCG, including search-based methods, machine learning-based methods, other frequently used methods (e.g., noise functions), and the newcomer, LLMs. We also provide a detailed discussion on combined methods. Furthermore, we compare these methods based on the type of content they generate and the publication dates of their respective papers. Finally, we identify gaps in the existing academic work and suggest possible directions for future research.

These authors contributed equally to this work. Abstract This paper explores the efficacy of Mel Frequency Cepstral Coefficients (MFCCs) in detecting abnormal heart sounds using two classification strategies: a single classifier and an ensemble classifier approach. Heart sounds were first pre-processed to remove noise and then segmented into S1, systole, S2, and diastole intervals, with thirteen MFCCs estimated from each segment, yielding 52 MFCCs per beat. Finally, MFCCs were used for heart sound classification. For that purpose, in the single classifier strategy, the MFCCs from nine consecutive beats were averaged to classify heart sounds by a single classifier (either a support vector machine (SVM), the k nearest neighbors (kNN), or a decision tree (DT)). Conversely, the ensemble classifier strategy employed nine classifiers (either nine SVMs, nine kNN classifiers, or nine DTs) to individually assess beats as normal or abnormal, with the overall classification based on the majority vote. Both methods were tested on a publicly available phonocardiogram database. The heart sound classification accuracy was 91.95% for the SVM, 91.9% for the kNN, and 87.33% for the DT in the single classifier strategy. Also, the accuracy was 93.59% for the SVM, 91.84% for the kNN, and 92.22% for the DT in the ensemble classifier strategy. Overall, the results demonstrated that the ensemble classifier strategy improved the accuracies of the DT and the SVM by 4.89% and 1.64%, establishing MFCCs as more effective than other features, including time, time-frequency, and statistical features, evaluated in similar studies.

Procedural content generation uses algorithmic techniques to create large amounts of new content for games at much lower production costs. In newer approaches, procedural content generation utilizes machine learning. However, these methods usually require expensive collection of large amounts of data, as well as the development and training of fairly complex learning models, which can be both extremely time-consuming and expensive. The core of our research is to explore whether we can lower the barrier to the use of personalized procedural content generation through a more practical and generalizable approach with large language models. Matching game content with player preferences benefits both players, who enjoy the game more, and developers, who increasingly depend on players enjoying the game before being able to monetize it. Therefore, this paper presents a novel approach to achieving personalization by using large language models to propose levels based on the gameplay data continuously collected from individual players. We compared the levels generated using our approach with levels generated with more traditional procedural generation techniques. Our easily reproducible method has proven viable in a production setting and outperformed levels generated by traditional methods in the probability that a player will not quit the game mid-level.

In this work, we consider the problem of procedural content generation for video game levels. Prior approaches have relied on evolutionary search (ES) methods capable of generating diverse levels, but this generation procedure is slow, which is problematic in real-time settings. Reinforcement learning (RL) has also been proposed to tackle the same problem, and while level generation is fast, training time can be prohibitively expensive. We propose a framework to tackle the procedural content generation problem that combines the best of ES and RL. In particular, our approach first uses ES to generate a sequence of levels evolved over time, and then uses behaviour cloning to distil these levels into a policy, which can then be queried to produce new levels quickly. We apply our approach to a maze game and Super Mario Bros, with our results indicating that our approach does in fact decrease the time required for level generation, especially when an increasing number of valid levels are required.