Hassan Ghasemzadeh

Parker Seegmiller, Joseph Gatto, Madhusudan Basak et al.

Medications often impose temporal constraints on everyday patient activity. Violations of such medical temporal constraints (MTCs) lead to a lack of treatment adherence, in addition to poor health outcomes and increased healthcare expenses. These MTCs are found in drug usage guidelines (DUGs) in both patient education materials and clinical texts. Computationally representing MTCs in DUGs will advance patient-centric healthcare applications by helping to define safe patient activity patterns. We define a novel taxonomy of MTCs found in DUGs and develop a novel context-free grammar (CFG) based model to computationally represent MTCs from unstructured DUGs. Additionally, we release three new datasets with a combined total of N = 836 DUGs labeled with normalized MTCs. We develop an in-context learning (ICL) solution for automatically extracting and normalizing MTCs found in DUGs, achieving an average F1 score of 0.62 across all datasets. Finally, we rigorously investigate ICL model performance against a baseline model, across datasets and MTC types, and through in-depth error analysis.

Ebrahim Farahmand, Mohammad Javad Askarizadeh, Ali Mahani et al.

In this paper, we propose a scalable approximate multiplier design, scaleTRIM, that approximates the multiplication operation using fitted linear functions, also referred to as linearization. We show that multiplication operations can be completely replaced by low-cost addition and bit-wise shift operations by exploiting linearization. Moreover, our proposed design utilizes a lookup table (LUT)-based compensation unit as a novel error-reduction method. In essence, input operands are truncated to a reduced bit-width representation (i.e., h bits) based on their leading-one positions. Then, a curve-fitting method is employed to map the product term to a linear function. Additionally, a piecewise constant error-correction term is used to reduce the approximation error. To compute the piecewise constant, we divide the function space into M segments and average the errors within each segment. In particular, our multiplier supports various degrees of truncation and error compensation to offer a range of accuracy-efficiency trade-offs. The proposed multiplier improves the Mean Relative Error Distance (MRED) by about 15.2% while satisfying the efficiency constraint and improves the Power Delay Product (PDP) by about 22.8% while satisfying the accuracy and efficiency constraints compared to different state-of-the-art approximate multipliers. From a usability perspective, our evaluation of the proposed design for image classification using Deep Neural Networks (DNNs) demonstrates that scaleTRIM offers a better accuracy-efficiency trade-off than state-of-the-art approximate multiplier designs.

Shovito Barua Soumma, Asiful Arefeen, Stephanie M. Carpenter et al.

Counterfactual explanations (CFEs) provide human-centric interpretability by identifying the minimal, actionable changes required to alter a machine learning model's prediction. Therefore, CFs can be used as (i) interventions for abnormality prevention and (ii) augmented data for training robust models. We conduct a comprehensive evaluation of CF generation using large language models (LLMs), including GPT-4 (zero-shot and few-shot) and two open-source models-BioMistral-7B and LLaMA-3.1-8B, in both pretrained and fine-tuned configurations. Using the multimodal AI-READI clinical dataset, we assess CFs across three dimensions: intervention quality, feature diversity, and augmentation effectiveness. Fine-tuned LLMs, particularly LLaMA-3.1-8B, produce CFs with high plausibility (up to 99%), strong validity (up to 0.99), and realistic, behaviorally modifiable feature adjustments. When used for data augmentation under controlled label-scarcity settings, LLM-generated CFs substantially restore classifier performance, yielding an average 20% F1 recovery across three scarcity scenarios. Compared with optimization-based baselines such as DiCE, CFNOW, and NICE, LLMs offer a flexible, model-agnostic approach that generates more clinically actionable and semantically coherent counterfactuals. Overall, this work demonstrates the promise of LLM-driven counterfactuals for both interpretable intervention design and data-efficient model training in sensor-based digital health. Impact: SenseCF fine-tunes an LLM to generate valid, representative counterfactual explanations and supplement minority class in an imbalanced dataset for improving model training and boosting model robustness and predictive performance

Parker Seegmiller, Joseph Gatto, Abdullah Mamun et al.

Prescription medications often impose temporal constraints on regular health behaviors (RHBs) of patients, e.g., eating before taking medication. Violations of such medical temporal constraints (MTCs) can result in adverse effects. Detecting and predicting such violations before they occur can help alert the patient. We formulate the problem of modeling MTCs and develop a proof-of-concept solution, ActSafe, to predict violations of MTCs well ahead of time. ActSafe utilizes a context-free grammar based approach for extracting and mapping MTCs from patient education materials. It also addresses the challenges of accurately predicting RHBs central to MTCs (e.g., medication intake). Our novel behavior prediction model, HERBERT , utilizes a basis vectorization of time series that is generalizable across temporal scale and duration of behaviors, explicitly capturing the dependency between temporally collocated behaviors. Based on evaluation using a real-world RHB dataset collected from 28 patients in uncontrolled environments, HERBERT outperforms baseline models with an average of 51% reduction in root mean square error. Based on an evaluation involving patients with chronic conditions, ActSafe can predict MTC violations a day ahead of time with an average F1 score of 0.86.

Saman Khamesian, Sri Harini Balaji, Di Yang Shi et al.

Type 1 Diabetes (T1D) management requires continuous adjustment of insulin and lifestyle behaviors to maintain blood glucose within a safe target range. Although automated insulin delivery (AID) systems have improved glycemic outcomes, many patients still fail to achieve recommended clinical targets, warranting new approaches to improve glucose control in patients with T1D. While reinforcement learning (RL) has been utilized as a promising approach, current RL-based methods focus primarily on insulin-only treatment and do not provide behavioral recommendations for glucose control. To address this gap, we propose GUIDE, an RL-based decision-support framework designed to complement AID technologies by providing behavioral recommendations to prevent abnormal glucose events. GUIDE generates structured actions defined by intervention type, magnitude, and timing, including bolus insulin administration and carbohydrate intake events. GUIDE integrates a patient-specific glucose level predictor trained on real-world continuous glucose monitoring data and supports both offline and online RL algorithms within a unified environment. We evaluate both off-policy and on-policy methods across 25 individuals with T1D using standardized glycemic metrics. Among the evaluated approaches, the CQL-BC algorithm demonstrates the highest average time-in-range, reaching 85.49% while maintaining low hypoglycemia exposures. Behavioral similarity analysis further indicates that the learned CQL-BC policy preserves key structural characteristics of patient action patterns, achieving a mean cosine similarity of 0.87 $\pm$ 0.09 across subjects. These findings suggest that conservative offline RL with a structured behavioral action space can provide clinically meaningful and behaviorally plausible decision support for personalized diabetes management.

Asiful Arefeen, Hassan Ghasemzadeh

Monitoring unexpected health events and taking actionable measures to avert them beforehand is central to maintaining health and preventing disease. Therefore, a tool capable of predicting adverse health events and offering users actionable feedback about how to make changes in their diet, exercise, and medication to prevent abnormal health events could have significant societal impacts. Counterfactual explanations can provide insights into why a model made a particular prediction by generating hypothetical instances that are similar to the original input but lead to a different prediction outcome. Therefore, counterfactuals can be viewed as a means to design AI-driven health interventions to not only predict but also prevent adverse health outcomes such as blood glucose spikes, diabetes, and heart disease. In this paper, we design \textit{\textbf{ExAct}}, a novel model-agnostic framework for generating counterfactual explanations for chronic disease prevention and management. Leveraging insights from adversarial learning, ExAct characterizes the decision boundary for high-dimensional data and performs a grid search to generate actionable interventions. ExAct is unique in integrating prior knowledge about user preferences of feasible explanations into the process of counterfactual generation. ExAct is evaluated extensively using four real-world datasets and external simulators. With $82.8\%$ average validity in the simulation-aided validation, ExAct surpasses the state-of-the-art techniques for generating counterfactual explanations by at least $10\%$. Besides, counterfactuals from ExAct exhibit at least $6.6\%$ improved proximity compared to previous research.

Abdullah Mamun, Lawrence D. Devoe, Mark I. Evans et al.

Early detection of intrapartum risk enables interventions to potentially prevent or mitigate adverse labor outcomes such as cerebral palsy. Currently, there is no accurate automated system to predict such events to assist with clinical decision-making. To fill this gap, we propose "Artificial Intelligence (AI) for Modeling and Explaining Neonatal Health" (AIMEN), a deep learning framework that not only predicts adverse labor outcomes from maternal, fetal, obstetrical, and intrapartum risk factors but also provides the model's reasoning behind the predictions made. The latter can provide insights into what modifications in the input variables of the model could have changed the predicted outcome. We address the challenges of imbalance and small datasets by synthesizing additional training data using Adaptive Synthetic Sampling (ADASYN) and Conditional Tabular Generative Adversarial Networks (CTGAN). AIMEN uses an ensemble of fully-connected neural networks as the backbone for its classification with the data augmentation supported by either ADASYN or CTGAN. AIMEN, supported by CTGAN, outperforms AIMEN supported by ADASYN in classification. AIMEN can predict a high risk for adverse labor outcomes with an average F1 score of 0.784. It also provides counterfactual explanations that can be achieved by changing 2 to 3 attributes on average. Resources available: https://github.com/ab9mamun/AIMEN.

Abdullah Mamun, Asiful Arefeen, Susan B. Racette et al.

Postprandial hyperglycemia, marked by the blood glucose level exceeding the normal range after consuming a meal, is a critical indicator of progression toward type 2 diabetes in people with prediabetes and in healthy individuals. A key metric for understanding blood glucose dynamics after eating is the postprandial area under the curve (AUC). Predicting postprandial AUC in advance based on a person's lifestyle factors, such as diet and physical activity level, and explaining the factors that affect postprandial blood glucose could allow an individual to adjust their lifestyle accordingly to maintain normal glucose levels. In this study, we developed an explainable machine learning solution, GlucoLens, that takes sensor-driven inputs and uses advanced data processing, large language models, and trainable machine learning models to predict postprandial AUC and hyperglycemia from diet, physical activity, and recent glucose patterns. We used data obtained from wearables in a five-week clinical trial of 10 adults who worked full-time to develop and evaluate the proposed computational model that integrates wearable sensing, multimodal data, and machine learning. Our machine learning model takes multimodal data from wearable activity and glucose monitoring sensors, along with food and work logs, and provides an interpretable prediction of the postprandial glucose pattern. Our GlucoLens system achieves a normalized root mean squared error (NRMSE) of 0.123 in its best configuration. On average, the proposed technology provides a 16% better performance level compared to the comparison models. Additionally, our technique predicts hyperglycemia with an accuracy of 73.3% and an F1 score of 0.716 and recommends different treatment options to help avoid hyperglycemia through diverse counterfactual explanations. Code available: https://github.com/ab9mamun/GlucoLens.

Abdullah Mamun, Diane J. Cook, Hassan Ghasemzadeh

Adherence to prescribed treatments is crucial for individuals with chronic conditions to avoid costly or adverse health outcomes. For certain patient groups, intensive lifestyle interventions are vital for enhancing medication adherence. Accurate forecasting of treatment adherence can open pathways to developing an on-demand intervention tool, enabling timely and personalized support. With the increasing popularity of smartphones and wearables, it is now easier than ever to develop and deploy smart activity monitoring systems. However, effective forecasting systems for treatment adherence based on wearable sensors are still not widely available. We close this gap by proposing Adherence Forecasting and Intervention with Machine Intelligence (AIMI). AIMI is a knowledge-guided adherence forecasting system that leverages smartphone sensors and previous medication history to estimate the likelihood of forgetting to take a prescribed medication. A user study was conducted with 27 participants who took daily medications to manage their cardiovascular diseases. We designed and developed CNN and LSTM-based forecasting models with various combinations of input features and found that LSTM models can forecast medication adherence with an accuracy of 0.932 and an F-1 score of 0.936. Moreover, through a series of ablation studies involving convolutional and recurrent neural network architectures, we demonstrate that leveraging known knowledge about future and personalized training enhances the accuracy of medication adherence forecasting. Code available: https://github.com/ab9mamun/AIMI.

Shovito Barua Soumma, Asiful Arefeen, Stephanie M. Carpenter et al.

Counterfactual explanations (CFs) offer human-centric insights into machine learning predictions by highlighting minimal changes required to alter an outcome. Therefore, CFs can be used as (i) interventions for abnormality prevention and (ii) augmented data for training robust models. In this work, we explore large language models (LLMs), specifically GPT-4o-mini, for generating CFs in a zero-shot and three-shot setting. We evaluate our approach on two datasets: the AI-Readi flagship dataset for stress prediction and a public dataset for heart disease detection. Compared to traditional methods such as DiCE, CFNOW, and NICE, our few-shot LLM-based approach achieves high plausibility (up to 99%), strong validity (up to 0.99), and competitive sparsity. Moreover, using LLM-generated CFs as augmented samples improves downstream classifier performance (an average accuracy gain of 5%), especially in low-data regimes. This demonstrates the potential of prompt-based generative techniques to enhance explainability and robustness in clinical and physiological prediction tasks. Code base: github.com/shovito66/SenseCF.

Shovito Barua Soumma, Hassan Ghasemzadeh

Accurate forecasting of blood glucose from CGM is essential for preventing dysglycemic events, thus enabling proactive diabetes management. However, current forecasting models treat blood glucose readings captured using CGMs as a numerical sequence, either ignoring context or relying on additional sensors/modalities that are difficult to collect and deploy at scale. Recently, LLMs have shown promise for time-series forecasting tasks, yet their role as agentic context extractors in diabetes care remains largely unexplored. To address these limitations, we propose GlyRAG, a context-aware, retrieval-augmented forecasting framework that derives semantic understanding of blood glucose dynamics directly from CGM traces without requiring additional sensor modalities. GlyRAG employs an LLM as a contextualization agent to generate clinical summaries. These summaries are embedded by a language model and fused with patch-based glucose representations in a multimodal transformer architecture with a cross translation loss aligining textual and physiological embeddings. A retrieval module then identifies similar historical episodes in the learned embedding space and uses cross-attention to integrate these case-based analogues prior to making a forecasting inference. Extensive evaluations on two T1D cohorts show that GlyRAG consistently outperforms state-of-the art methods, achieving up to 39% lower RMSE and a further 1.7% reduction in RMSE over the baseline. Clinical evaluation shows that GlyRAG places 85% predictions in safe zones and achieves 51% improvement in predicting dysglycemic events across both cohorts. These results indicate that LLM-based contextualization and retrieval over CGM traces can enhance the accuracy and clinical reliability of long-horizon glucose forecasting without the need for extra sensors, thus supporting future agentic decision-support tools for diabetes management.

Ebrahim Farahmand, Reza Rahimi Azghan, Nooshin Taheri Chatrudi et al.

Diabetes is a chronic metabolic disorder characterized by persistently high blood glucose levels (BGLs), leading to severe complications such as cardiovascular disease, neuropathy, and retinopathy. Predicting BGLs enables patients to maintain glucose levels within a safe range and allows caregivers to take proactive measures through lifestyle modifications. Continuous Glucose Monitoring (CGM) systems provide real-time tracking, offering a valuable tool for monitoring BGLs. However, accurately forecasting BGLs remains challenging due to fluctuations due to physical activity, diet, and other factors. Recent deep learning models show promise in improving BGL prediction. Nonetheless, forecasting BGLs accurately from multimodal, irregularly sampled data over long prediction horizons remains a challenging research problem. In this paper, we propose AttenGluco, a multimodal Transformer-based framework for long-term blood glucose prediction. AttenGluco employs cross-attention to effectively integrate CGM and activity data, addressing challenges in fusing data with different sampling rates. Moreover, it employs multi-scale attention to capture long-term dependencies in temporal data, enhancing forecasting accuracy. To evaluate the performance of AttenGluco, we conduct forecasting experiments on the recently released AIREADI dataset, analyzing its predictive accuracy across different subject cohorts including healthy individuals, people with prediabetes, and those with type 2 diabetes. Furthermore, we investigate its performance improvements and forgetting behavior as new cohorts are introduced. Our evaluations show that AttenGluco improves all error metrics, such as root mean square error (RMSE), mean absolute error (MAE), and correlation, compared to the multimodal LSTM model. AttenGluco outperforms this baseline model by about 10% and 15% in terms of RMSE and MAE, respectively.

Ebrahim Farahmand, Shovito Barua Soumma, Nooshin Taheri Chatrudi et al.

The availability of continuous glucose monitors as over-the-counter commodities have created a unique opportunity to monitor a person's blood glucose levels, forecast blood glucose trajectories and provide automated interventions to prevent devastating chronic complications that arise from poor glucose control. However, forecasting blood glucose levels is challenging because blood glucose changes consistently in response to food intake, medication intake, physical activity, sleep, and stress. It is particularly difficult to accurately predict BGL from multimodal and irregularly sampled data and over long prediction horizons. Furthermore, these forecasting models must operate in real-time on edge devices to provide in-the-moment interventions. To address these challenges, we propose GlucoNet, an AI-powered sensor system for continuously monitoring behavioral and physiological health and robust forecasting of blood glucose patterns. GlucoNet devises a feature decomposition-based transformer model that incorporates patients' behavioral and physiological data and transforms sparse and irregular patient data (e.g., diet and medication intake data) into continuous features using a mathematical model, facilitating better integration with the BGL data. Given the non-linear and non-stationary nature of BG signals, we propose a decomposition method to extract both low and high-frequency components from the BGL signals, thus providing accurate forecasting. To reduce the computational complexity, we also propose to employ knowledge distillation to compress the transformer model. GlucoNet achieves a 60% improvement in RMSE and a 21% reduction in the number of parameters, improving RMSE and MAE by 51% and 57%, using data obtained involving 12 participants with T1-Diabetes. These results underscore GlucoNet's potential as a compact and reliable tool for real-world diabetes prevention and management.

Saman Khamesian, Asiful Arefeen, Stephanie M. Carpenter et al.

Maintaining a balanced diet is essential for overall health, yet many individuals struggle with meal planning due to nutritional complexity, time constraints, and lack of dietary knowledge. Personalized food recommendations can help address these challenges by tailoring meal plans to individual preferences, habits, and dietary restrictions. However, existing dietary recommendation systems often lack adaptability, fail to consider real-world constraints such as food ingredient availability, and require extensive user input, making them impractical for sustainable and scalable daily use. To address these limitations, we introduce NutriGen, a framework based on large language models (LLM) designed to generate personalized meal plans that align with user-defined dietary preferences and constraints. By building a personalized nutrition database and leveraging prompt engineering, our approach enables LLMs to incorporate reliable nutritional references like the USDA nutrition database while maintaining flexibility and ease-of-use. We demonstrate that LLMs have strong potential in generating accurate and user-friendly food recommendations, addressing key limitations in existing dietary recommendation systems by providing structured, practical, and scalable meal plans. Our evaluation shows that Llama 3.1 8B and GPT-3.5 Turbo achieve the lowest percentage errors of 1.55\% and 3.68\%, respectively, producing meal plans that closely align with user-defined caloric targets while minimizing deviation and improving precision. Additionally, we compared the performance of DeepSeek V3 against several established models to evaluate its potential in personalized nutrition planning.

Shovito Barua Soumma, Kartik Mangipudi, Daniel Peterson et al.

Parkinson's disease (PD) is a progressive neurological disorder that impacts the quality of life significantly, making in-home monitoring of motor symptoms such as Freezing of Gait (FoG) critical. However, existing symptom monitoring technologies are power-hungry, rely on extensive amounts of labeled data, and operate in controlled settings. These shortcomings limit real-world deployment of the technology. This work presents LIFT-PD, a computationally-efficient self-supervised learning framework for real-time FoG detection. Our method combines self-supervised pre-training on unlabeled data with a novel differential hopping windowing technique to learn from limited labeled instances. An opportunistic model activation module further minimizes power consumption by selectively activating the deep learning module only during active periods. Extensive experimental results show that LIFT-PD achieves a 7.25% increase in precision and 4.4% improvement in accuracy compared to supervised models while using as low as 40% of the labeled training data used for supervised learning. Additionally, the model activation module reduces inference time by up to 67% compared to continuous inference. LIFT-PD paves the way for practical, energy-efficient, and unobtrusive in-home monitoring of PD patients with minimal labeling requirements.

Saman Khamesian, Asiful Arefeen, Maria Adela Grando et al.

Managing Type 1 Diabetes (T1D) demands constant vigilance as individuals strive to regulate their blood glucose levels to avoid the harmful effects of dysglycemia, including both hyperglycemia and hypoglycemia. Despite the development of advanced technologies such as automated insulin delivery (AID) systems, achieving optimal glycemic control remains challenging. AID systems combine continuous subcutaneous insulin infusion with data from continuous glucose monitors (CGMs), offering potential benefits in reducing glucose variability and increasing time-in-range. However, these systems still frequently fail to prevent dysglycemia, partly due to limitations in their prediction algorithms, which lack the accuracy needed to avert abnormal glucose events. This shortcoming highlights the need for more advanced glucose forecasting methods. To address this need, we introduce GLIMMER, Glucose Level Indicator Model with Modified Error Rate, a machine learning-based model for predicting blood glucose levels. GLIMMER classifies glucose values into normal and abnormal ranges and employs a novel custom loss function that prioritizes accuracy in dysglycemic regions, where patient safety is most critical. To evaluate GLIMMER's effectiveness for T1D management, we used both a publicly available dataset and a newly collected dataset involving 25 individuals with T1D. In forecasting glucose levels for the next hour, GLIMMER achieved a root mean square error (RMSE) of 23.97 (+/-3.77) and a mean absolute error (MAE) of 15.83 (+/-2.09) mg/dL. These results represent a 23% improvement in RMSE and a 31% improvement in MAE compared to the best previously reported models.

Shovito Barua Soumma, S M Raihanul Alam, Rudmila Rahman et al.

Freezing of gait (FOG) is a debilitating symptom of Parkinson's disease that impairs mobility and safety by increasing the risk of falls. An effective FOG detection system must be accurate, real-time, and deployable in free-living environments to enable timely interventions. However, existing detection methods face challenges due to (1) intra- and inter-patient variability, (2) subject-specific training, (3) using multiple sensors in FOG dominant locations (e.g., ankles) leading to high failure points, (4) centralized, non-adaptive learning frameworks that sacrifice patient privacy and prevent collaborative model refinement across populations and disease progression, and (5) most systems are tested in controlled settings, limiting their real-world applicability for continuous in-home monitoring. Addressing these gaps, we present FOGSense, a real-world deployable FOG detection system designed for uncontrolled, free-living conditions using only a single sensor. FOGSense uses Gramian Angular Field (GAF) transformations and privacy-preserving federated deep learning to capture temporal and spatial gait patterns missed by traditional methods with a low false positive rate. We evaluated our system using a public Parkinson's dataset collected in a free-living environment. FOGSense improves accuracy by 10.4% over a single-axis accelerometer, reduces failure points compared to multi-sensor systems, and demonstrates robustness to missing values. The federated architecture allows personalized model adaptation and efficient smartphone synchronization during off-peak hours, making it effective for long-term monitoring as symptoms evolve. Overall, FOGSense achieved a 22.2% improvement in F1-score and a 74.53% reduction in false positive rate compared to state-of-the-art methods, along with enhanced sensitivity for FOG episode detection.

Saman Khamesian, Asiful Arefeen, Bithika M. Thompson et al.

High quality real world datasets are essential for advancing data driven approaches in type 1 diabetes (T1D) management, including personalized therapy design, digital twin systems, and glucose prediction models. However, progress in this area has been limited by the scarcity of publicly available datasets that offer detailed and comprehensive patient data. To address this gap, we present AZT1D, a dataset containing data collected from 25 individuals with T1D on automated insulin delivery (AID) systems. AZT1D includes continuous glucose monitoring (CGM) data, insulin pump and insulin administration data, carbohydrate intake, and device mode (regular, sleep, and exercise) obtained over 6 to 8 weeks for each patient. Notably, the dataset provides granular details on bolus insulin delivery (i.e., total dose, bolus type, correction specific amounts) features that are rarely found in existing datasets. By offering rich, naturalistic data, AZT1D supports a wide range of artificial intelligence and machine learning applications aimed at improving clinical decision making and individualized care in T1D.

Asiful Arefeen, Saman Khamesian, Maria Adela Grando et al.

Frequent and long-term exposure to hyperglycemia (i.e., high blood glucose) increases the risk of chronic complications such as neuropathy, nephropathy, and cardiovascular disease. Current technologies like continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) primarily model specific aspects of glycemic control-like hypoglycemia prediction or insulin delivery. Similarly, most digital twin approaches in diabetes management simulate only physiological processes. These systems lack the ability to offer alternative treatment scenarios that support proactive behavioral interventions. To address this, we propose GlyTwin, a novel digital twin framework that uses counterfactual explanations to simulate optimal treatments for glucose regulation. Our approach helps patients and caregivers modify behaviors like carbohydrate intake and insulin dosing to avoid abnormal glucose events. GlyTwin generates behavioral treatment suggestions that proactively prevent hyperglycemia by recommending small adjustments to daily choices, reducing both frequency and duration of these events. Additionally, it incorporates stakeholder preferences into the intervention design, making recommendations patient-centric and tailored. We evaluate GlyTwin on AZT1D, a newly constructed dataset with longitudinal data from 21 type 1 diabetes (T1D) patients on automated insulin delivery systems over 26 days. Results show GlyTwin outperforms state-of-the-art counterfactual methods, generating 76.6% valid and 86% effective interventions. These findings demonstrate the promise of counterfactual-driven digital twins in delivering personalized healthcare.

Abdullah Mamun, Krista S. Leonard, Megan E. Petrov et al.

Objective: This research aims to develop a lifestyle intervention system, called MoveSense, that forecasts a patient's activity behavior to allow for early and personalized interventions in real-world clinical environments. Methods: We conducted two clinical studies involving 58 prediabetic veterans and 60 patients with obstructive sleep apnea to gather multimodal behavioral data using wearable devices. We develop multimodal long short-term memory (LSTM) network models, which are capable of forecasting the number of step counts of a patient up to 24 hours in advance by examining data from activity and engagement modalities. Furthermore, we design goal-based forecasting models to predict whether a person's next-day steps will be over a certain threshold. Results: Multimodal LSTM with early fusion achieves 33% and 37% lower mean absolute errors than linear regression and ARIMA respectively on the prediabetes dataset. LSTM also outperforms linear regression and ARIMA with a margin of 13% and 32% on the sleep dataset. Multimodal forecasting models also perform with 72% and 79% accuracy on the prediabetes dataset and sleep dataset respectively on goal-based forecasting. Conclusion: Our experiments conclude that multimodal LSTM models with early fusion are better than multimodal LSTM with late fusion and unimodal LSTM models and also than ARIMA and linear regression models. Significance: We address an important and challenging task of time-series forecasting in uncontrolled environments. Effective forecasting of a person's physical activity can aid in designing adaptive behavioral interventions to keep the user engaged and adherent to a prescribed routine.

Reza Rahimi Azghan, Gautham Krishna Gudur, Mohit Malu et al.

The rise of deep learning has greatly advanced human behavior monitoring using wearable sensors, particularly human activity recognition (HAR). While deep models have been widely studied, most assume stationary data distributions - an assumption often violated in real-world scenarios. For example, sensor data from one subject may differ significantly from another, leading to distribution shifts. In continual learning, this shift is framed as a sequence of tasks, each corresponding to a new subject. Such settings suffer from catastrophic forgetting, where prior knowledge deteriorates as new tasks are learned. This challenge is compounded by the scarcity and inconsistency of labeled data in human studies. To address these issues, we propose CLAD-Net (Continual Learning with Attention and Distillation), a framework enabling wearable-sensor models to be updated continuously without sacrificing performance on past tasks. CLAD-Net integrates a self-supervised transformer, acting as long-term memory, with a supervised Convolutional Neural Network (CNN) trained via knowledge distillation for activity classification. The transformer captures global activity patterns through cross-attention across body-mounted sensors, learning generalizable representations without labels. Meanwhile, the CNN leverages knowledge distillation to retain prior knowledge during subject-wise fine-tuning. On PAMAP2, CLAD-Net achieves 91.36 percent final accuracy with only 8.78 percent forgetting, surpassing memory-based and regularization-based baselines such as Experience Replay and Elastic Weight Consolidation. In semi-supervised settings with only 10-20 percent labeled data, CLAD-Net still delivers strong performance, demonstrating robustness to label scarcity. Ablation studies further validate each module's contribution.

Ebrahim Farahmand, Reza Rahimi Azghan, Nooshin Taheri Chatrudi et al.

This paper proposes GluMind, a transformer-based multimodal framework designed for continual and long-term blood glucose forecasting. GluMind devises two attention mechanisms, including cross-attention and multi-scale attention, which operate in parallel and deliver accurate predictive performance. Cross-attention effectively integrates blood glucose data with other physiological and behavioral signals such as activity, stress, and heart rate, addressing challenges associated with varying sampling rates and their adverse impacts on robust prediction. Moreover, the multi-scale attention mechanism captures long-range temporal dependencies. To mitigate catastrophic forgetting, GluMind incorporates a knowledge retention technique into the transformer-based forecasting model. The knowledge retention module not only enhances the model's ability to retain prior knowledge but also boosts its overall forecasting performance. We evaluate GluMind on the recently released AIREADI dataset, which contains behavioral and physiological data collected from healthy people, individuals with prediabetes, and those with type 2 diabetes. We examine the performance stability and adaptability of GluMind in learning continuously as new patient cohorts are introduced. Experimental results show that GluMind consistently outperforms other state-of-the-art forecasting models, achieving approximately 15% and 9% improvements in root mean squared error (RMSE) and mean absolute error (MAE), respectively.

Asiful Arefeen, Shovito Barua Soumma, Hassan Ghasemzadeh

Counterfactual explanations provide human-understandable reasoning for AI-made decisions by describing minimal changes to input features that would alter a model's prediction. To be truly useful in practice, such explanations must be realistic and feasible -- they should respect both the underlying data distribution and user-defined feasibility constraints. Existing approaches often enforce inter-feature dependencies through rigid, hand-crafted constraints or domain-specific knowledge, which limits their generalizability and ability to capture complex, nonlinear relations inherent in data. Moreover, they rarely accommodate user-specified preferences and suggest explanations that are causally implausible or infeasible to act upon. We introduce RealAC, a domain-agnostic framework for generating realistic and actionable counterfactuals. RealAC automatically preserves complex inter-feature dependencies without relying on explicit domain knowledge -- by aligning the joint distributions of feature pairs between factual and counterfactual instances. The framework also allows end-users to ``freeze'' attributes they cannot or do not wish to change by suppressing change in frozen features during optimization. Evaluations on three synthetic and two real datasets demonstrate that RealAC balances realism with actionability. Our method outperforms state-of-the-art baselines and Large Language Model-based counterfactual generation techniques in causal edge score, dependency preservation score, and IM1 realism metric and offers a solution for causality-aware and user-centric counterfactual generation.

Sangmin Jung, Utkarsh Nath, Yezhou Yang et al.

Text-to-image generation models have achieved remarkable capabilities in synthesizing images, but often struggle to provide fine-grained control over the output. Existing guidance approaches, such as segmentation maps and depth maps, introduce spatial rigidity that restricts the inherent diversity of diffusion models. In this work, we introduce Deep Geometric Moments (DGM) as a novel form of guidance that encapsulates the subject's visual features and nuances through a learned geometric prior. DGMs focus specifically on the subject itself compared to DINO or CLIP features, which suffer from overemphasis on global image features or semantics. Unlike ResNets, which are sensitive to pixel-wise perturbations, DGMs rely on robust geometric moments. Our experiments demonstrate that DGM effectively balance control and diversity in diffusion-based image generation, allowing a flexible control mechanism for steering the diffusion process.

Sanyam Paresh Shah, Abdullah Mamun, Shovito Barua Soumma et al.

Metabolic Syndrome (MetS) is a cluster of interrelated risk factors that significantly increases the risk of cardiovascular diseases and type 2 diabetes. Despite its global prevalence, accurate prediction of MetS remains challenging due to issues such as class imbalance, data scarcity, and methodological inconsistencies in existing studies. In this paper, we address these challenges by systematically evaluating and optimizing machine learning (ML) models for MetS prediction, leveraging advanced data balancing techniques and counterfactual analysis. Multiple ML models, including XGBoost, Random Forest, TabNet, etc., were trained and compared under various data balancing techniques such as random oversampling (ROS), SMOTE, ADASYN, and CTGAN. Additionally, we introduce MetaBoost, a novel hybrid framework that integrates SMOTE, ADASYN, and CTGAN, optimizing synthetic data generation through weighted averaging and iterative weight tuning to enhance the model's performance (achieving up to a 1.87% accuracy improvement over individual balancing techniques). A comprehensive counterfactual analysis is conducted to quantify the feature-level changes required to shift individuals from high-risk to low-risk categories. The results indicate that blood glucose (50.3%) and triglycerides (46.7%) were the most frequently modified features, highlighting their clinical significance in MetS risk reduction. Additionally, probabilistic analysis shows elevated blood glucose (85.5% likelihood) and triglycerides (74.9% posterior probability) as the strongest predictors. This study not only advances the methodological rigor of MetS prediction but also provides actionable insights for clinicians and researchers, highlighting the potential of ML in mitigating the public health burden of metabolic syndrome.

Ramesh Kumar Sah, Hassan Ghasemzadeh

Stress detection and monitoring is an active area of research with important implications for the personal, professional, and social health of an individual. Current approaches for affective state classification use traditional machine learning algorithms with features computed from multiple sensor modalities. These methods are data-intensive and rely on hand-crafted features which impede the practical applicability of these sensor systems in daily lives. To overcome these shortcomings, we propose a novel Convolutional Neural Network (CNN) based stress detection and classification framework without any feature computation using data from only one sensor modality. Our method is competitive and outperforms current state-of-the-art techniques and achieves a classification accuracy of $92.85\%$ and an $f1$ score of $0.89$. Through our leave-one-subject-out analysis, we also show the importance of personalizing stress models.

Asiful Arefeen, Ali Akbari, Seyed Iman Mirzadeh et al.

Inter-beat interval (IBI) measurement enables estimation of heart-rate variability (HRV) which, in turns, can provide early indication of potential cardiovascular diseases. However, extracting IBIs from noisy signals is challenging since the morphology of the signal is distorted in the presence of the noise. Electrocardiogram (ECG) of a person in heavy motion is highly corrupted with noise, known as motion-artifact, and IBI extracted from it is inaccurate. As a part of remote health monitoring and wearable system development, denoising ECG signals and estimating IBIs correctly from them have become an emerging topic among signal-processing researchers. Apart from conventional methods, deep-learning techniques have been successfully used in signal denoising recently, and diagnosis process has become easier, leading to accuracy levels that were previously unachievable. We propose a deep-learning approach leveraging tiramisu autoencoder model to suppress motion-artifact noise and make the R-peaks of the ECG signal prominent even in the presence of high-intensity motion. After denoising, IBIs are estimated more accurately expediting diagnosis tasks. Results illustrate that our method enables IBI estimation from noisy ECG signals with SNR up to -30dB with average root mean square error (RMSE) of 13 milliseconds for estimated IBIs. At this noise level, our error percentage remains below 8% and outperforms other state of the art techniques.

Anbumalar Saravanan, Justin Sanchez, Hassan Ghasemzadeh et al.

This paper takes initial strides at designing and evaluating a vision-based system for privacy ensured activity monitoring. The proposed technology utilizing Artificial Intelligence (AI)-empowered proactive systems offering continuous monitoring, behavioral analysis, and modeling of human activities. To this end, this paper presents Single Run Action Detector (S-RAD) which is a real-time privacy-preserving action detector that performs end-to-end action localization and classification. It is based on Faster-RCNN combined with temporal shift modeling and segment based sampling to capture the human actions. Results on UCF-Sports and UR Fall dataset present comparable accuracy to State-of-the-Art approaches with significantly lower model size and computation demand and the ability for real-time execution on edge embedded device (e.g. Nvidia Jetson Xavier).

Seyed Iman Mirzadeh, Mehrdad Farajtabar, Dilan Gorur et al.

Continual (sequential) training and multitask (simultaneous) training are often attempting to solve the same overall objective: to find a solution that performs well on all considered tasks. The main difference is in the training regimes, where continual learning can only have access to one task at a time, which for neural networks typically leads to catastrophic forgetting. That is, the solution found for a subsequent task does not perform well on the previous ones anymore. However, the relationship between the different minima that the two training regimes arrive at is not well understood. What sets them apart? Is there a local structure that could explain the difference in performance achieved by the two different schemes? Motivated by recent work showing that different minima of the same task are typically connected by very simple curves of low error, we investigate whether multitask and continual solutions are similarly connected. We empirically find that indeed such connectivity can be reliably achieved and, more interestingly, it can be done by a linear path, conditioned on having the same initialization for both. We thoroughly analyze this observation and discuss its significance for the continual learning process. Furthermore, we exploit this finding to propose an effective algorithm that constrains the sequentially learned minima to behave as the multitask solution. We show that our method outperforms several state of the art continual learning algorithms on various vision benchmarks.

Yuchao Ma, Andrew T. Campbell, Diane J. Cook et al.

While activity recognition from inertial sensors holds potential for mobile health, differences in sensing platforms and user movement patterns cause performance degradation. Aiming to address these challenges, we propose a transfer learning framework, TransFall, for sensor-based activity recognition. TransFall's design contains a two-tier data transformation, a label estimation layer, and a model generation layer to recognize activities for the new scenario. We validate TransFall analytically and empirically.

Paratoo Alinia, Ali Samadani, Mladen Milosevic et al.

There exist significant gaps in research about how to design efficient in-bed lying posture tracking systems. These gaps can be articulated through several research questions as follows. First, can we design a single-sensor, pervasive, and inexpensive system that can accurately detect lying postures? Second, what computational models are most effective in the accurate detection of lying postures? Finally, what physical configuration of the sensor system is most effective for lying posture tracking? To answer these important research questions, in this article, we propose a comprehensive approach to design a sensor system that uses a single accelerometer along with machine learning algorithms for in-bed lying posture classification. We design two categories of machine learning algorithms based on deep learning and traditional classification with handcrafted features to detect lying postures. We also investigate what wearing sites are most effective in accurate detection of lying postures. We extensively evaluate the performance of the proposed algorithms on nine different body locations and four human lying postures using two datasets. Our results show that a system with a single accelerometer can be used with either deep learning or traditional classifiers to accurately detect lying postures. The best models in our approach achieve an F-Score that ranges from 95.2% to 97.8% with 0.03 to 0.05 coefficient of variation. The results also identify the thighs and chest as the most salient body sites for lying posture tracking. Our findings in this article suggest that because accelerometers are ubiquitous and inexpensive sensors, they can be a viable source of information for pervasive monitoring of in-bed postures.

Seyed Iman Mirzadeh, Mehrdad Farajtabar, Razvan Pascanu et al.

Catastrophic forgetting affects the training of neural networks, limiting their ability to learn multiple tasks sequentially. From the perspective of the well established plasticity-stability dilemma, neural networks tend to be overly plastic, lacking the stability necessary to prevent the forgetting of previous knowledge, which means that as learning progresses, networks tend to forget previously seen tasks. This phenomenon coined in the continual learning literature, has attracted much attention lately, and several families of approaches have been proposed with different degrees of success. However, there has been limited prior work extensively analyzing the impact that different training regimes -- learning rate, batch size, regularization method-- can have on forgetting. In this work, we depart from the typical approach of altering the learning algorithm to improve stability. Instead, we hypothesize that the geometrical properties of the local minima found for each task play an important role in the overall degree of forgetting. In particular, we study the effect of dropout, learning rate decay, and batch size, on forming training regimes that widen the tasks' local minima and consequently, on helping it not to forget catastrophically. Our study provides practical insights to improve stability via simple yet effective techniques that outperform alternative baselines.

Seyed-Iman Mirzadeh, Mehrdad Farajtabar, Hassan Ghasemzadeh

In recent years, neural networks have demonstrated an outstanding ability to achieve complex learning tasks across various domains. However, they suffer from the "catastrophic forgetting" problem when they face a sequence of learning tasks, where they forget the old ones as they learn new tasks. This problem is also highly related to the "stability-plasticity dilemma". The more plastic the network, the easier it can learn new tasks, but the faster it also forgets previous ones. Conversely, a stable network cannot learn new tasks as fast as a very plastic network. However, it is more reliable to preserve the knowledge it has learned from the previous tasks. Several solutions have been proposed to overcome the forgetting problem by making the neural network parameters more stable, and some of them have mentioned the significance of dropout in continual learning. However, their relationship has not been sufficiently studied yet. In this paper, we investigate this relationship and show that a stable network with dropout learns a gating mechanism such that for different tasks, different paths of the network are active. Our experiments show that the stability achieved by this implicit gating plays a very critical role in leading to performance comparable to or better than other involved continual learning algorithms to overcome catastrophic forgetting.

Niloofar Hezarjaribi, Zhila Esna Ashari, James F. Frenzel et al.

This article presents PerSense, a framework to estimate human personality traits based on expressed texts and to use them for commonsense reasoning analysis. The personality assessment approaches include an aggregated Probability Density Functions (PDF), and Machine Learning (ML) models. Our goal is to demonstrate the feasibility of using machine learning algorithms on personality trait data to predict humans' responses to open-ended commonsense questions. We assess the performance of the PerSense algorithms for personality assessment by conducting an experiment focused on Neuroticism, an important personality trait crucial in mental health analysis and suicide prevention by collecting data from a diverse population with different Neuroticism scores. Our analysis shows that the algorithms achieve comparable results to the ground truth data. Specifically, the PDF approach achieves 97% accuracy when the confidence factor, the logarithmic ratio of the first to the second guess probability, is greater than 3. Additionally, ML approach obtains its highest accuracy, 82.2%, with a multilayer Perceptron classifier. To assess the feasibility of commonsense reasoning analysis, we train ML algorithms to predict responses to commonsense questions. Our analysis of data collected with 300 participants demonstrate that PerSense predicts answers to commonsense questions with 82.3% accuracy using a Random Forest classifier.

Marjan Nourollahi, Seyed Ali Rokni, Hassan Ghasemzadeh

Detecting when eating occurs is an essential step toward automatic dietary monitoring, medication adherence assessment, and diet-related health interventions. Wearable technologies play a central role in designing unubtrusive diet monitoring solutions by leveraging machine learning algorithms that work on time-series sensor data to detect eating moments. While much research has been done on developing activity recognition and eating moment detection algorithms, the performance of the detection algorithms drops substantially when the model trained with one user is utilized by a new user. To facilitate development of personalized models, we propose PALS, Proximity-based Active Learning on Streaming data, a novel proximity-based model for recognizing eating gestures with the goal of significantly decreasing the need for labeled data with new users. Particularly, we propose an optimization problem to perform active learning under limited query budget by leveraging unlabeled data. Our extensive analysis on data collected in both controlled and uncontrolled settings indicates that the F-score of PLAS ranges from 22% to 39% for a budget that varies from 10 to 60 query. Furthermore, compared to the state-of-the-art approaches, off-line PALS, on average, achieves to 40% higher recall and 12\% higher f-score in detecting eating gestures.

Ramesh Kumar Sah, Hassan Ghasemzadeh

Machine learning is used for inference and decision making in wearable sensor systems. However, recent studies have found that machine learning algorithms are easily fooled by the addition of adversarial perturbations to their inputs. What is more interesting is that adversarial examples generated for one machine learning system is also effective against other systems. This property of adversarial examples is called transferability. In this work, we take the first stride in studying adversarial transferability in wearable sensor systems from the following perspectives: 1) transferability between machine learning systems, 2) transferability across subjects, 3) transferability across sensor body locations, and 4) transferability across datasets. We found strong untargeted transferability in most cases. Targeted attacks were less successful with success scores from $0\%$ to $80\%$. The transferability of adversarial examples depends on many factors such as the inclusion of data from all subjects, sensor body position, number of samples in the dataset, type of learning algorithm, and the distribution of source and target system dataset. The transferability of adversarial examples decreases sharply when the data distribution of the source and target system becomes more distinct. We also provide guidelines for the community for designing robust sensor systems.

Parastoo Alinia, Iman Mirzadeh, Hassan Ghasemzadeh

Sensor-based human activity recognition has become a critical component of many emerging applications ranging from behavioral medicine to gaming. However, an unprecedented increase in the diversity of sensor devices in the Internet-of-Things era has limited the adoption of activity recognition models for use across different domains. We propose ActiLabel a combinatorial framework that learns structural similarities among the events in an arbitrary domain and those of a different domain. The structural similarities are captured through a graph model, referred to as the it dependency graph, which abstracts details of activity patterns in low-level signal and feature space. The activity labels are then autonomously learned by finding an optimal tiered mapping between the dependency graphs. Extensive experiments based on three public datasets demonstrate the superiority of ActiLabel over state-of-the-art transfer learning and deep learning methods.

Zhila Esna Ashari, Hassan Ghasemzadeh

We propose a novel active learning framework for activity recognition using wearable sensors. Our work is unique in that it takes physical and cognitive limitations of the oracle into account when selecting sensor data to be annotated by the oracle. Our approach is inspired by human-beings' limited capacity to respond to external stimulus such as responding to a prompt on their mobile devices. This capacity constraint is manifested not only in the number of queries that a person can respond to in a given time-frame but also in the lag between the time that a query is made and when it is responded to. We introduce the notion of mindful active learning and propose a computational framework, called EMMA, to maximize the active learning performance taking informativeness of sensor data, query budget, and human memory into account. We formulate this optimization problem, propose an approach to model memory retention, discuss complexity of the problem, and propose a greedy heuristic to solve the problem. We demonstrate the effectiveness of our approach on three publicly available datasets and by simulating oracles with various memory strengths. We show that the activity recognition accuracy ranges from 21% to 97% depending on memory strength, query budget, and difficulty of the machine learning task. Our results also indicate that EMMA achieves an accuracy level that is, on average, 13.5% higher than the case when only informativeness of the sensor data is considered for active learning. Additionally, we show that the performance of our approach is at most 20% less than experimental upper-bound and up to 80% higher than experimental lower-bound. We observe that mindful active learning is most beneficial when query budget is small and/or oracle's memory is weak, thus emphasizing contributions of our work in human-centered mobile health settings and for elderly with cognitive impairments.

Mahdi Pedram, Seyed Ali Rokni, Marjan Nourollahi et al.

Advances in embedded systems have enabled integration of many lightweight sensory devices within our daily life. In particular, this trend has given rise to continuous expansion of wearable sensors in a broad range of applications from health and fitness monitoring to social networking and military surveillance. Wearables leverage machine learning techniques to profile behavioral routine of their end-users through activity recognition algorithms. Current research assumes that such machine learning algorithms are trained offline. In reality, however, wearables demand continuous reconfiguration of their computational algorithms due to their highly dynamic operation. Developing a personalized and adaptive machine learning model requires real-time reconfiguration of the model. Due to stringent computation and memory constraints of these embedded sensors, the training/re-training of the computational algorithms need to be memory- and computation-efficient. In this paper, we propose a framework, based on the notion of online learning, for real-time and on-device machine learning training. We propose to transform the activity recognition problem from a multi-class classification problem to a hierarchical model of binary decisions using cascading online binary classifiers. Our results, based on Pegasos online learning, demonstrate that the proposed approach achieves 97% accuracy in detecting activities of varying intensities using a limited memory while power usages of the system is reduced by more than 40%.

Mahdi Pedram, Mahsan Rofouei, Francesco Fraternali et al.

We propose two optimization techniques to minimize memory usage and computation while meeting system timing constraints for real-time classification in wearable systems. Our method derives a hierarchical classifier structure for Support Vector Machine (SVM) in order to reduce the amount of computations, based on the probability distribution of output classes occurrences. Also, we propose a memory optimization technique based on SVM parameters, which results in storing fewer support vectors and as a result requiring less memory. To demonstrate the efficiency of our proposed techniques, we performed an activity recognition experiment and were able to save up to 35% and 56% in memory storage when classifying 14 and 6 different activities, respectively. In addition, we demonstrated that there is a trade-off between accuracy of classification and memory savings, which can be controlled based on application requirements.

Seyed-Iman Mirzadeh, Mehrdad Farajtabar, Ang Li et al.

Despite the fact that deep neural networks are powerful models and achieve appealing results on many tasks, they are too large to be deployed on edge devices like smartphones or embedded sensor nodes. There have been efforts to compress these networks, and a popular method is knowledge distillation, where a large (teacher) pre-trained network is used to train a smaller (student) network. However, in this paper, we show that the student network performance degrades when the gap between student and teacher is large. Given a fixed student network, one cannot employ an arbitrarily large teacher, or in other words, a teacher can effectively transfer its knowledge to students up to a certain size, not smaller. To alleviate this shortcoming, we introduce multi-step knowledge distillation, which employs an intermediate-sized network (teacher assistant) to bridge the gap between the student and the teacher. Moreover, we study the effect of teacher assistant size and extend the framework to multi-step distillation. Theoretical analysis and extensive experiments on CIFAR-10,100 and ImageNet datasets and on CNN and ResNet architectures substantiate the effectiveness of our proposed approach.

Seyed Ali Rokni, Marjan Nourollahi, Hassan Ghasemzadeh

A major barrier to the personalized Human Activity Recognition using wearable sensors is that the performance of the recognition model drops significantly upon adoption of the system by new users or changes in physical/ behavioral status of users. Therefore, the model needs to be retrained by collecting new labeled data in the new context. In this study, we develop a transfer learning framework using convolutional neural networks to build a personalized activity recognition model with minimal user supervision.