Iman Azimi

Mahyar Abbasian, Iman Azimi, Amir M. Rahmani et al.

Conversational Health Agents (CHAs) are interactive systems that provide healthcare services, such as assistance and diagnosis. Current CHAs, especially those utilizing Large Language Models (LLMs), primarily focus on conversation aspects. However, they offer limited agent capabilities, specifically lacking multi-step problem-solving, personalized conversations, and multimodal data analysis. Our aim is to overcome these limitations. We propose openCHA, an open-source LLM-powered framework, to empower conversational agents to generate a personalized response for users' healthcare queries. This framework enables developers to integrate external sources including data sources, knowledge bases, and analysis models, into their LLM-based solutions. openCHA includes an orchestrator to plan and execute actions for gathering information from external sources, essential for formulating responses to user inquiries. It facilitates knowledge acquisition, problem-solving capabilities, multilingual and multimodal conversations, and fosters interaction with various AI platforms. We illustrate the framework's proficiency in handling complex healthcare tasks via two demonstrations and four use cases. Moreover, we release openCHA as open source available to the community via GitHub.

Mahyar Abbasian, Elahe Khatibi, Iman Azimi et al.

Generative Artificial Intelligence is set to revolutionize healthcare delivery by transforming traditional patient care into a more personalized, efficient, and proactive process. Chatbots, serving as interactive conversational models, will probably drive this patient-centered transformation in healthcare. Through the provision of various services, including diagnosis, personalized lifestyle recommendations, and mental health support, the objective is to substantially augment patient health outcomes, all the while mitigating the workload burden on healthcare providers. The life-critical nature of healthcare applications necessitates establishing a unified and comprehensive set of evaluation metrics for conversational models. Existing evaluation metrics proposed for various generic large language models (LLMs) demonstrate a lack of comprehension regarding medical and health concepts and their significance in promoting patients' well-being. Moreover, these metrics neglect pivotal user-centered aspects, including trust-building, ethics, personalization, empathy, user comprehension, and emotional support. The purpose of this paper is to explore state-of-the-art LLM-based evaluation metrics that are specifically applicable to the assessment of interactive conversational models in healthcare. Subsequently, we present an comprehensive set of evaluation metrics designed to thoroughly assess the performance of healthcare chatbots from an end-user perspective. These metrics encompass an evaluation of language processing abilities, impact on real-world clinical tasks, and effectiveness in user-interactive conversations. Finally, we engage in a discussion concerning the challenges associated with defining and implementing these metrics, with particular emphasis on confounding factors such as the target audience, evaluation methods, and prompt techniques involved in the evaluation process.

Zhongqi Yang, Iman Azimi, Salar Jafarlou et al.

The adverse effects of loneliness on both physical and mental well-being are profound. Although previous research has utilized mobile sensing techniques to detect mental health issues, few studies have utilized state-of-the-art wearable devices to forecast loneliness and estimate the physiological manifestations of loneliness and its predictive nature. The primary objective of this study is to examine the feasibility of forecasting loneliness by employing wearable devices, such as smart rings and watches, to monitor early physiological indicators of loneliness. Furthermore, smartphones are employed to capture initial behavioral signs of loneliness. To accomplish this, we employed personalized machine learning techniques, leveraging a comprehensive dataset comprising physiological and behavioral information obtained during our study involving the monitoring of college students. Through the development of personalized models, we achieved a notable accuracy of 0.82 and an F-1 score of 0.82 in forecasting loneliness levels seven days in advance. Additionally, the application of Shapley values facilitated model explainability. The wealth of data provided by this study, coupled with the forecasting methodology employed, possesses the potential to augment interventions and facilitate the early identification of loneliness within populations at risk.

Jung In Park, Mahyar Abbasian, Iman Azimi et al.

Objective: This study aims to develop and validate an evaluation framework to ensure the safety and reliability of mental health chatbots, which are increasingly popular due to their accessibility, human-like interactions, and context-aware support. Materials and Methods: We created an evaluation framework with 100 benchmark questions and ideal responses, and five guideline questions for chatbot responses. This framework, validated by mental health experts, was tested on a GPT-3.5-turbo-based chatbot. Automated evaluation methods explored included large language model (LLM)-based scoring, an agentic approach using real-time data, and embedding models to compare chatbot responses against ground truth standards. Results: The results highlight the importance of guidelines and ground truth for improving LLM evaluation accuracy. The agentic method, dynamically accessing reliable information, demonstrated the best alignment with human assessments. Adherence to a standardized, expert-validated framework significantly enhanced chatbot response safety and reliability. Discussion: Our findings emphasize the need for comprehensive, expert-tailored safety evaluation metrics for mental health chatbots. While LLMs have significant potential, careful implementation is necessary to mitigate risks. The superior performance of the agentic approach underscores the importance of real-time data access in enhancing chatbot reliability. Conclusion: The study validated an evaluation framework for mental health chatbots, proving its effectiveness in improving safety and reliability. Future work should extend evaluations to accuracy, bias, empathy, and privacy to ensure holistic assessment and responsible integration into healthcare. Standardized evaluations will build trust among users and professionals, facilitating broader adoption and improved mental health support through technology.

Iman Azimi, Mohan Qi, Li Wang et al.

Large language models (LLMs) are fundamentally transforming human-facing applications in the health and well-being domains: boosting patient engagement, accelerating clinical decision-making, and facilitating medical education. Although state-of-the-art LLMs have shown superior performance in several conversational applications, evaluations within nutrition and diet applications are still insufficient. In this paper, we propose to employ the Registered Dietitian (RD) exam to conduct a standard and comprehensive evaluation of state-of-the-art LLMs, GPT-4o, Claude 3.5 Sonnet, and Gemini 1.5 Pro, assessing both accuracy and consistency in nutrition queries. Our evaluation includes 1050 RD exam questions encompassing several nutrition topics and proficiency levels. In addition, for the first time, we examine the impact of Zero-Shot (ZS), Chain of Thought (CoT), Chain of Thought with Self Consistency (CoT-SC), and Retrieval Augmented Prompting (RAP) on both accuracy and consistency of the responses. Our findings revealed that while these LLMs obtained acceptable overall performance, their results varied considerably with different prompts and question domains. GPT-4o with CoT-SC prompting outperformed the other approaches, whereas Gemini 1.5 Pro with ZS recorded the highest consistency. For GPT-4o and Claude 3.5, CoT improved the accuracy, and CoT-SC improved both accuracy and consistency. RAP was particularly effective for GPT-4o to answer Expert level questions. Consequently, choosing the appropriate LLM and prompting technique, tailored to the proficiency level and specific domain, can mitigate errors and potential risks in diet and nutrition chatbots.

Mahyar Abbasian, Zhongqi Yang, Elahe Khatibi et al.

Effective diabetes management is crucial for maintaining health in diabetic patients. Large Language Models (LLMs) have opened new avenues for diabetes management, facilitating their efficacy. However, current LLM-based approaches are limited by their dependence on general sources and lack of integration with domain-specific knowledge, leading to inaccurate responses. In this paper, we propose a knowledge-infused LLM-powered conversational health agent (CHA) for diabetic patients. We customize and leverage the open-source openCHA framework, enhancing our CHA with external knowledge and analytical capabilities. This integration involves two key components: 1) incorporating the American Diabetes Association dietary guidelines and the Nutritionix information and 2) deploying analytical tools that enable nutritional intake calculation and comparison with the guidelines. We compare the proposed CHA with GPT4. Our evaluation includes 100 diabetes-related questions on daily meal choices and assessing the potential risks associated with the suggested diet. Our findings show that the proposed agent demonstrates superior performance in generating responses to manage essential nutrients.

Mohammad Feli, Iman Azimi, Pasi Liljeberg et al.

Large language models (LLMs) are revolutionizing healthcare by improving diagnosis, patient care, and decision support through interactive communication. More recently, they have been applied to analyzing physiological time-series like wearable data for health insight extraction. Existing methods embed raw numerical sequences directly into prompts, which exceeds token limits and increases computational costs. Additionally, some studies integrated features extracted from time-series in textual prompts or applied multimodal approaches. However, these methods often produce generic and unreliable outputs due to LLMs' limited analytical rigor and inefficiency in interpreting continuous waveforms. In this paper, we develop an LLM-powered agent for physiological time-series analysis aimed to bridge the gap in integrating LLMs with well-established analytical tools. Built on the OpenCHA, an open-source LLM-powered framework, our agent powered by OpenAI's GPT-3.5-turbo model features an orchestrator that integrates user interaction, data sources, and analytical tools to generate accurate health insights. To evaluate its effectiveness, we implement a case study on heart rate (HR) estimation from Photoplethysmogram (PPG) signals using a dataset of PPG and Electrocardiogram (ECG) recordings in a remote health monitoring study. The agent's performance is benchmarked against OpenAI GPT-4o-mini and GPT-4o, with ECG serving as the gold standard for HR estimation. Results demonstrate that our agent significantly outperforms benchmark models by achieving lower error rates and more reliable HR estimations. The agent implementation is publicly available on GitHub.

Zhongqi Yang, Elahe Khatibi, Nitish Nagesh et al.

The profound impact of food on health necessitates advanced nutrition-oriented food recommendation services. Conventional methods often lack the crucial elements of personalization, explainability, and interactivity. While Large Language Models (LLMs) bring interpretability and explainability, their standalone use falls short of achieving true personalization. In this paper, we introduce ChatDiet, a novel LLM-powered framework designed specifically for personalized nutrition-oriented food recommendation chatbots. ChatDiet integrates personal and population models, complemented by an orchestrator, to seamlessly retrieve and process pertinent information. The personal model leverages causal discovery and inference techniques to assess personalized nutritional effects for a specific user, whereas the population model provides generalized information on food nutritional content. The orchestrator retrieves, synergizes and delivers the output of both models to the LLM, providing tailored food recommendations designed to support targeted health outcomes. The result is a dynamic delivery of personalized and explainable food recommendations, tailored to individual user preferences. Our evaluation of ChatDiet includes a compelling case study, where we establish a causal personal model to estimate individual nutrition effects. Our assessments, including a food recommendation test showcasing a 92\% effectiveness rate, coupled with illustrative dialogue examples, underscore ChatDiet's strengths in explainability, personalization, and interactivity.

Zhongqi Yang, Mahkameh Rasouli, Neda Mohseni et al.

Personalized models are essential in digital health because individuals exhibit substantial physiological and behavioral heterogeneity. Yet personalization is limited by scarce and noisy user-specific data. Most existing methods rely on population pretraining or data from similar users only, which can lead to biased transfer and weak generalization. We propose a unified personalization framework that trains a personal model using adaptively weighted support users, including both similar and dissimilar individuals. The objective integrates personal loss, similarity-weighted transfer from similar users, and contrastive regularization from dissimilar users to suppress misleading correlations. An iterative optimization algorithm jointly updates model parameters and user similarity weights. Experiments on six tasks across four real-world digital health datasets show consistent improvements over population and personalized baselines. The method achieves up to 10% lower RMSE on large-scale datasets and approximately 25% lower RMSE in low-data settings. The learned adaptive weights improve data efficiency and provide interpretable guidance for targeted data selection.

Ziyu Wang, Zhongqi Yang, Iman Azimi et al.

Mental health conditions, prevalent across various demographics, necessitate efficient monitoring to mitigate their adverse impacts on life quality. The surge in data-driven methodologies for mental health monitoring has underscored the importance of privacy-preserving techniques in handling sensitive health data. Despite strides in federated learning for mental health monitoring, existing approaches struggle with vulnerabilities to certain cyber-attacks and data insufficiency in real-world applications. In this paper, we introduce a differential private federated transfer learning framework for mental health monitoring to enhance data privacy and enrich data sufficiency. To accomplish this, we integrate federated learning with two pivotal elements: (1) differential privacy, achieved by introducing noise into the updates, and (2) transfer learning, employing a pre-trained universal model to adeptly address issues of data imbalance and insufficiency. We evaluate the framework by a case study on stress detection, employing a dataset of physiological and contextual data from a longitudinal study. Our finding show that the proposed approach can attain a 10% boost in accuracy and a 21% enhancement in recall, while ensuring privacy protection.

Elahe Khatibi, Mahyar Abbasian, Zhongqi Yang et al.

To perform effective causal inference in high-dimensional datasets, initiating the process with causal discovery is imperative, wherein a causal graph is generated based on observational data. However, obtaining a complete and accurate causal graph poses a formidable challenge, recognized as an NP- hard problem. Recently, the advent of Large Language Models (LLMs) has ushered in a new era, indicating their emergent capabilities and widespread applicability in facilitating causal reasoning across diverse domains, such as medicine, finance, and science. The expansive knowledge base of LLMs holds the potential to elevate the field of causal reasoning by offering interpretability, making inferences, generalizability, and uncovering novel causal structures. In this paper, we introduce a new framework, named Autonomous LLM-Augmented Causal Discovery Framework (ALCM), to synergize data-driven causal discovery algorithms and LLMs, automating the generation of a more resilient, accurate, and explicable causal graph. The ALCM consists of three integral components: causal structure learning, causal wrapper, and LLM-driven causal refiner. These components autonomously collaborate within a dynamic environment to address causal discovery questions and deliver plausible causal graphs. We evaluate the ALCM framework by implementing two demonstrations on seven well-known datasets. Experimental results demonstrate that ALCM outperforms existing LLM methods and conventional data-driven causal reasoning mechanisms. This study not only shows the effectiveness of the ALCM but also underscores new research directions in leveraging the causal reasoning capabilities of LLMs.

Zhongqi Yang, Yuning Wang, Ken S. Yamashita et al.

Emotional states, as indicators of affect, are pivotal to overall health, making their accurate prediction before onset crucial. Current studies are primarily centered on immediate short-term affect detection using data from wearable and mobile devices. These studies typically focus on objective sensory measures, often neglecting other forms of self-reported information like diaries and notes. In this paper, we propose a multimodal deep learning model for affect status forecasting. This model combines a transformer encoder with a pre-trained language model, facilitating the integrated analysis of objective metrics and self-reported diaries. To validate our model, we conduct a longitudinal study, enrolling college students and monitoring them over a year, to collect an extensive dataset including physiological, environmental, sleep, metabolic, and physical activity parameters, alongside open-ended textual diaries provided by the participants. Our results demonstrate that the proposed model achieves predictive accuracy of 82.50% for positive affect and 82.76% for negative affect, a full week in advance. The effectiveness of our model is further elevated by its explainability.

Mahyar Abbasian, Iman Azimi, Mohammad Feli et al.

Agents represent one of the most emerging applications of Large Language Models (LLMs) and Generative AI, with their effectiveness hinging on multimodal capabilities to navigate complex user environments. Conversational Health Agents (CHAs), a prime example of this, are redefining healthcare by offering nuanced support that transcends textual analysis to incorporate emotional intelligence. This paper introduces an LLM-based CHA engineered for rich, multimodal dialogue-especially in the realm of mental health support. It adeptly interprets and responds to users' emotional states by analyzing multimodal cues, thus delivering contextually aware and empathetically resonant verbal responses. Our implementation leverages the versatile openCHA framework, and our comprehensive evaluation involves neutral prompts expressed in diverse emotional tones: sadness, anger, and joy. We evaluate the consistency and repeatability of the planning capability of the proposed CHA. Furthermore, human evaluators critique the CHA's empathic delivery, with findings revealing a striking concordance between the CHA's outputs and evaluators' assessments. These results affirm the indispensable role of vocal (soon multimodal) emotion recognition in strengthening the empathetic connection built by CHAs, cementing their place at the forefront of interactive, compassionate digital health solutions.

Kianoosh Kazemi, Iman Azimi, Pasi Liljeberg et al.

Respiratory rate (RR) serves as an indicator of various medical conditions, such as cardiovascular diseases and sleep disorders. These RR estimation methods were mostly designed for finger-based PPG collected from subjects in stationary situations (e.g., in hospitals). In contrast to finger-based PPG signals, wrist-based PPG are more susceptible to noise, particularly in their low frequency range, which includes respiratory information. Therefore, the existing methods struggle to accurately extract RR when PPG data are collected from wrist area under free-living conditions. The increasing popularity of smartwatches, equipped with various sensors including PPG, has prompted the need for a robust RR estimation method. In this paper, we propose a convolutional neural network-based approach to extract RR from PPG, accelerometer, and gyroscope signals captured via smartwatches. Our method, including a dilated residual inception module and 1D convolutions, extract the temporal information from the signals, enabling RR estimation. Our method is trained and tested using data collected from 36 subjects under free-living conditions for one day using Samsung Gear Sport watches. For evaluation, we compare the proposed method with four state-of-the-art RR estimation methods. The RR estimates are compared with RR references obtained from a chest-band device. The results show that our method outperforms the existing methods with the Mean-Absolute-Error and Root-Mean-Square-Error of 1.85 and 2.34, while the best results obtained by the other methods are 2.41 and 3.29, respectively. Moreover, compared to the other methods, the absolute error distribution of our method was narrow (with the lowest median), indicating a higher level of agreement between the estimated and reference RR values.

Ziyu Wang, Elahe Khatibi, Kianoosh Kazemi et al.

Electrocardiogram (ECG) signals are widely shared across multiple clinical applications for diagnosis, health monitoring, and biometric authentication. While valuable for healthcare, they also carry unique biometric identifiers that pose privacy risks, especially when ECG data shared across multiple entities. These risks are amplified in shared environments, where re-identification threats can compromise patient privacy. Existing deep learning re-identification models prioritize accuracy but lack explainability, making it challenging to understand how the unique biometric characteristics encoded within ECG signals are recognized and utilized for identification. Without these insights, despite high accuracy, developing secure and trustable ECG data-sharing frameworks remains difficult, especially in diverse, multi-source environments. In this work, we introduce TransECG, a Vision Transformer (ViT)-based method that uses attention mechanisms to pinpoint critical ECG segments associated with re-identification tasks like gender, age, and participant ID. Our approach demonstrates high accuracy (89.9% for gender, 89.9% for age, and 88.6% for ID re-identification) across four real-world datasets with 87 participants. Importantly, we provide key insights into ECG components such as the R-wave, QRS complex, and P-Q interval in re-identification. For example, in the gender classification, the R wave contributed 58.29% to the model's attention, while in the age classification, the P-R interval contributed 46.29%. By combining high predictive performance with enhanced explainability, TransECG provides a robust solution for privacy-conscious ECG data sharing, supporting the development of secure and trusted healthcare data environment.

Kianoosh Kazemi, Iman Azimi, Michelle Khine et al.

Sleep is an essential component of human physiology, contributing significantly to overall health and quality of life. Accurate sleep staging and disorder detection are crucial for assessing sleep quality. Studies in the literature have proposed PSG-based approaches and machine-learning methods utilizing single-modality signals. However, existing methods often lack multimodal, multilabel frameworks and address sleep stages and disorders classification separately. In this paper, we propose a 1D-Vision Transformer for simultaneous classification of sleep stages and sleep disorders. Our method exploits the sleep disorders' correlation with specific sleep stage patterns and performs a simultaneous identification of a sleep stage and sleep disorder. The model is trained and tested using multimodal-multilabel sensory data (including photoplethysmogram, respiratory flow, and respiratory effort signals). The proposed method shows an overall accuracy (cohen's Kappa) of 78% (0.66) for five-stage sleep classification and 74% (0.58) for sleep apnea classification. Moreover, we analyzed the encoder attention weights to clarify our models' predictions and investigate the influence different features have on the models' outputs. The result shows that identified patterns, such as respiratory troughs and peaks, make a higher contribution to the final classification process.

Kianoosh Kazemi, Iina Ryhtä, Iman Azimi et al.

The concept of Quality of Life (QoL) refers to a holistic measurement of an individual's well-being, incorporating psychological and social aspects. Pregnant women, especially those with obesity and stress, often experience lower QoL. Physical activity (PA) has shown the potential to enhance the QoL. However, pregnant women who are overweight and obese rarely meet the recommended level of PA. Studies have investigated the relationship between PA and QoL during pregnancy using correlation-based approaches. These methods aim to discover spurious correlations between variables rather than causal relationships. Besides, the existing methods mainly rely on physical activity parameters and neglect the use of different factors such as maternal (medical) history and context data, leading to biased estimates. Furthermore, the estimations lack an understanding of mediators and counterfactual scenarios that might affect them. In this paper, we investigate the causal relationship between being physically active (treatment variable) and the QoL (outcome) during pregnancy and postpartum. To estimate the causal effect, we develop a Causal Machine Learning method, integrating causal discovery and causal inference components. The data for our investigation is derived from a long-term wearable-based health monitoring study focusing on overweight and obese pregnant women. The machine learning (meta-learner) estimation technique is used to estimate the causal effect. Our result shows that performing adequate physical activity during pregnancy and postpartum improves the QoL by units of 7.3 and 3.4 on average in physical health and psychological domains, respectively. In the final step, four refutation analysis techniques are employed to validate our estimation.

Ajan Subramanian, Zhongqi Yang, Iman Azimi et al.

Health monitoring systems have revolutionized modern healthcare by enabling the continuous capture of physiological and behavioral data, essential for preventive measures and early health intervention. While integrating this data with Large Language Models (LLMs) has shown promise in delivering interactive health advice, traditional methods like Retrieval-Augmented Generation (RAG) and fine-tuning often fail to fully utilize the complex, multi-dimensional, and temporally relevant data from wearable devices. These conventional approaches typically provide limited actionable and personalized health insights due to their inadequate capacity to dynamically integrate and interpret diverse health data streams. In response, this paper introduces a graph-augmented LLM framework designed to significantly enhance the personalization and clarity of health insights. Utilizing a hierarchical graph structure, the framework captures inter and intra-patient relationships, enriching LLM prompts with dynamic feature importance scores derived from a Random Forest Model. The effectiveness of this approach is demonstrated through a sleep analysis case study involving 20 college students during the COVID-19 lockdown, highlighting the potential of our model to generate actionable and personalized health insights efficiently. We leverage another LLM to evaluate the insights for relevance, comprehensiveness, actionability, and personalization, addressing the critical need for models that process and interpret complex health data effectively. Our findings show that augmenting prompts with our framework yields significant improvements in all 4 criteria. Through our framework, we can elicit well-crafted, more thoughtful responses tailored to a specific patient.

Milad Asgari Mehrabadi, Seyed Amir Hossein Aqajari, Iman Azimi et al.

The world has been affected by COVID-19 coronavirus. At the time of this study, the number of infected people in the United States is the highest globally (7.9 million infections). Within the infected population, patients diagnosed with acute respiratory distress syndrome (ARDS) are in more life-threatening circumstances, resulting in severe respiratory system failure. Various studies have investigated the infections to COVID-19 and ARDS by monitoring laboratory metrics and symptoms. Unfortunately, these methods are merely limited to clinical settings, and symptom-based methods are shown to be ineffective. In contrast, vital signs (e.g., heart rate) have been utilized to early-detect different respiratory diseases in ubiquitous health monitoring. We posit that such biomarkers are informative in identifying ARDS patients infected with COVID-19. In this study, we investigate the behavior of COVID-19 on ARDS patients by utilizing simple vital signs. We analyze the long-term daily logs of blood pressure and heart rate associated with 70 ARDS patients admitted to five University of California academic health centers (containing 42506 samples for each vital sign) to distinguish subjects with COVID-19 positive and negative test results. In addition to the statistical analysis, we develop a deep neural network model to extract features from the longitudinal data. Using only the first eight days of the data, our deep learning model is able to achieve 78.79% accuracy to classify the vital signs of ARDS patients infected with COVID-19 versus other ARDS diagnosed patients.

Delaram Amiri, Arman Anzanpour, Iman Azimi et al.

Recent advances in the Internet of Things (IoT) technologies have enabled the use of wearables for remote patient monitoring. Wearable sensors capture the patient's vital signs, and provide alerts or diagnosis based on the collected data. Unfortunately, wearables typically have limited energy and computational capacity, making their use challenging for healthcare applications where monitoring must continue uninterrupted long time, without the need to charge or change the battery. Fog computing can alleviate this problem by offloading computationally intensive tasks from the sensor layer to higher layers, thereby not only meeting the sensors' limited computational capacity but also enabling the use of local closed-loop energy optimization algorithms to increase the battery life.