arXiv subjects

Maxwell A. Xu

Publications and source records attributed to Maxwell A. Xu.

At least 19 recordsLinked to original sources

arXiv2026

TimeRLM: Recursive Language Models Enable Precise Anomaly Localization in Long-Context Time-Series

Precise anomaly localization over long-context time series is a crucial task in monitoring applications across clinical care, industrial operations, financial services, and logistics, where brief evidence may hide inside long spans of high-frequency data. Time-Series Language Models (TSLMs) are able to ingest time series data and verbalize findings on anomalies in natural language; however, recent benchmarks report a decrease in retrieval performance at long contexts, mirroring failure modes in text, vision, and audio. In the text domain, Recursive Language Models (RLMs) can recover much of this lost performance by keeping context external to the large language model (LLM), allowing the model to query it through code. We present TimeRLM, an RLM formulation for time-series that sequentially manipulates the signal using code and vision capabilities. We further introduce AnomalyXL, a synthetic long-context anomaly localization benchmark with programmatically injected anomalies that require precise retrieval. We implement five different task categories and two variants: AnomalyXL-MCQ and AnomalyXL-Localize. TimeRLM outperforms every evaluated TSLM and single-pass baseline on four of the five AnomalyXL-Localize tasks, reaching 0.682 IoU on localization and 0.745 on classify-with-evidence, versus at most 0.329 and 0.072 across all baselines. We post-train TimeRLM using reinforcement learning. The resulting model further improves performance and requires approximately one-third as many agent interaction turns as its untrained base model to produce a final answer. On unseen real-world ECG, sleep and software observability recordings, the post-trained TimeRLM retains or improves performance, surpassing TSLMs despite being trained exclusively on synthetic data. Our findings suggest recursive interaction with time-series is an effective approach for long-horizon retrieval.

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arXiv2026

GlucoFM: A Dual-Stream Foundation Model for Continuous Glucose Monitoring

Continuous glucose monitoring (CGM) provides a dense view of daily metabolic physiology, yet existing generic time-series and CGM-specific foundation models often encode glucose traces as entangled single-stream sequences, leaving their multiscale temporal structure only implicitly modeled. We present GlucoFM, a lightweight CGM foundation model that aligns irregular recordings to a 24-hour chronological grid, preserves observation masks, and decomposes glucose dynamics into slow-varying glycemic trend and short-term deviation streams. GlucoFM is pretrained on 109,066 hours of unlabeled CGM recordings from 477 subjects with masked contextual latent prediction over fused daily representations and temporal dynamics prediction over the two streams. Frozen pre-fusion probes confirm distinct temporal emphasis: state tokens preferentially preserve hourly glucose level, whereas event tokens better retain short-term change. Across four diverse cohorts and seven phenotype-classification tasks, GlucoFM achieves the strongest subject-disjoint linear-probing performance among evaluated baselines, improving average PR-AUC by 4.1 points over the best CGM-specific foundation model, while also supporting strong cross-dataset transfer and few-shot adaptation. Its gains are most pronounced on core metabolic outcomes, leading PR-AUC on all diabetes-risk and $β$-cell dysfunction tasks and on 3 of 4 insulin-resistance tasks. Beyond phenotyping, when combined with recent CGM, meal nutrition, and subject context, the same frozen encoder achieves the lowest two-hour postprandial glycemic response errors among evaluated methods for trajectory, incremental area under the curve, peak rise, and peak timing. Together, these results demonstrate that GlucoFM learns reusable frozen CGM representations spanning metabolic phenotyping and context-conditioned glucose-response prediction.

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arXiv2026

Towards a General Intelligence and Interface for Wearable Health Data

While ubiquitous wearable sensors capture a wealth of behavioral and physiological information, effectively transforming these signals into personalized health insights is challenging. Specifically, converting low-level sensor data into representations capable of characterizing higher-level states is difficult due to high phenotypic diversity and variation in individual baseline health, physiology, and lifestyle factors. Moreover, collecting wearable data paired with health outcome annotations is laborious and expensive, and retrospective annotation remains practically unfeasible, contributing to a scarcity of data with high-quality labels. To overcome these limitations, we propose a foundation model for wearable health that is pretrained on more than one trillion minutes of unlabeled sensor signals drawn from a large cohort of five million participants. We demonstrate that the joint scaling of model capacity and pretraining data volume leads to systematic improvements in performance, as evaluated on a diverse set of 35 health prediction tasks, spanning cardiovascular, metabolic, sleep, and mental health, as well as lifestyle choices and demographic factors. We find that this population scale representation unlocks label-efficient few-shot learning and generative capabilities for robust daily metric estimation. To further leverage this learned representation, we deploy a classroom of LLM agents to autonomously search the space of downstream predictive heads built on the model embeddings, showing broad performance improvements that increase with LLM model capacity. Finally, we show how integrating these downstream predictors into a Personal Health Agent can support model responses that are more relevant, contextually aware, and safe, and we validate this via 1,860 ratings from a cohort of clinicians.

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arXiv2026

TS-Haystack: A Multi-Task Retrieval Benchmark for Long-Context Time-Series Reasoning

Time Series Language Models (TSLMs) promise reasoning over real-world temporal data, but their ability to retrieve and reason over long time-series remains largely untested. We introduce TS-Haystack, a multi-domain retrieval benchmark with ten event-grounded question-answering tasks over contexts from 100 seconds to 24 hours, spanning direct retrieval, temporal reasoning, multi-step reasoning, and contextual anomaly detection. Existing TSLMs exhibit severe long-context degradation: accuracy declines with context length, direct-tokenization models run out of memory beyond 100 seconds on high-rate signals, and time-interval-grounded tasks collapse toward near-zero accuracy when increasing the time-series lengths, aligning with existing literature on text and multi-modal long context retrieval. An agentic retrieval framework using specialized time-series classifier tools matches or outperforms SoTA TSLMs on 9 of 10 tasks, highlighting agentic retrieval as a promising approach for long-context TSLMs.

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arXiv2026

An AI Co-Data-Scientist for Prioritizing Candidate Biomarkers from Wearable Sensor Data

Wearable devices generate continuous physiological and behavioral data, but converting these signals into clinically reviewable biomarker hypotheses remains labor-intensive. We introduce CoDaS, an AI co-data-scientist that integrates multi-agent hypothesis generation, deterministic statistical analysis, adversarial validation and literature-grounded interpretation under human oversight. Across three wearable cohorts comprising 9,279 participant-observations, CoDaS prioritized candidate associations for mental-health and metabolic endpoints after internal checks for replication, stability, robustness and leakage. The system identified related circadian-instability signals associated with depression, including sleep-duration variability in DWB ($ρ$ = 0.252, $p$ < 0.001) and sleep-onset variability in GLOBEM ($ρ$ = 0.126, $p$ < 0.001), and derived a wearable cardiovascular-fitness index associated with insulin resistance (steps/resting heart rate; $ρ$ = -0.374, $p$ < 0.001). Adding these features to demographic models produced modest gains ($ΔR^2$ = 0.040 for depression, 0.021 for insulin resistance). In a 12-clinician review totaling approximately 25 active hours, clinician validity judgments aligned with CoDaS confidence tiers ($ρ$ = 0.67, $p$ = 0.005), whereas added clinical value and confidence to act were rated lower. CoDaS supports traceable, hypothesis-generating prioritization of wearable candidate biomarkers.

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arXiv2026

Self-Supervised Dynamical System Representations for Physiological Time-Series

The effectiveness of self-supervised learning (SSL) for physiological time series depends on the ability of a pretraining objective to preserve information about the underlying physiological state while filtering out unrelated noise. However, existing strategies are limited due to reliance on heuristic principles or poorly constrained generative tasks. To address this limitation, we propose a pretraining framework that exploits the information structure of a dynamical systems generative model across multiple time-series. This framework reveals our key insight that class identity can be efficiently captured by extracting information about the generative variables related to the system parameters shared across similar time series samples, while noise unique to individual samples should be discarded. Building on this insight, we propose PULSE, a cross-reconstruction-based pretraining objective for physiological time series datasets that explicitly extracts system information while discarding non-transferrable sample-specific ones. We establish theory that provides sufficient conditions for the system information to be recovered, and empirically validate it using a synthetic dynamical systems experiment. Furthermore, we apply our method to diverse real-world datasets, demonstrating that PULSE learns representations that can broadly distinguish semantic classes, increase label efficiency, and improve transfer learning.

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arXiv2026

Bio-Inspired Self-Supervised Learning for Wrist-worn Accelerometer Data

Wearable accelerometers enable large-scale health monitoring, yet learning robust human-activity representations has been constrained by scarce labeled data. While self-supervised learning offers a remedy, existing methods treat sensor streams as unstructured time series, overlooking the underlying biological structure of human movement, a factor we argue is critical for effective Human Activity Recognition (HAR). We introduce a novel tokenization strategy grounded in the submovement theory of motor control, which posits that continuous wrist motion is composed of elementary basis functions called submovements. We define our token as the movement segment, a computationally tractable unit of motion composed of a finite sequence of submovements. By pretraining a Transformer encoder via masked reconstruction of these tokens, we shift the learning focus from local waveform morphology to high-level structural and temporal organization. Pretrained on the NHANES corpus (approximately 28k hours; 11k participants), our representations outperform strong wearable SSL baselines across six subject-disjoint HAR benchmarks. Code and pretrained weights are available at https://prithvitarale.github.io/biopm-site/.

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arXiv2026

SymptomAI: Toward a Conversational AI Agent for Everyday Symptom Assessment

Language models excel at diagnostic assessments on curated medical case-studies and vignettes, performing on par with, or better than, clinical professionals. However, existing studies focus on complex scenarios with rich context making it difficult to draw conclusions about how these systems perform for patients reporting symptoms in everyday life. We deployed SymptomAI, a set of conversational AI agents for end-to-end patient interviewing and differential diagnosis (DDx), via the Fitbit app in a study that randomized participants (N=13,917) to interact with five AI agents. This corpus captures diverse communication and a realistic distribution of illnesses from a real world population. A subset of 1,228 participants reported a clinician-provided diagnosis, and 517 of these were further evaluated by a panel of clinicians during over 250 hours of annotation. SymptomAI DDx were significantly more accurate (OR = 2.56, p < 0.001) than those from independent clinicians given the same dialogue in a blinded randomized comparison. Moreover, agentic strategies which conduct a dedicated symptom interview that elicit additional symptom information before providing a diagnosis, perform substantially better than baseline, user-guided conversations (p < 0.001). An auxiliary analysis on 1,509 conversations from a general US population panel validated that these results generalize beyond wearable device users. We used SymptomAI diagnoses as labels for all 13,917 participants to analyze over 500,000 days of wearable metrics across nearly 400 unique conditions. We identified strong associations between acute infections and physiological shifts (e.g., OR > 7 for influenza). While limited by self-reported ground truth, these results demonstrate the benefits of a dedicated and complete symptom interview compared to a user-guided symptom discussion, which is the default of most consumer LLMs.

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arXiv2026

How Well Do Multimodal Models Reason on ECG Signals?

While multimodal large language models offer a promising solution to the "black box" nature of health AI by generating interpretable reasoning traces, verifying the validity of these traces remains a critical challenge. Existing evaluation methods are either unscalable, relying on manual clinician review, or superficial, utilizing proxy metrics (e.g. QA) that fail to capture the semantic correctness of clinical logic. In this work, we introduce a reproducible framework for evaluating reasoning in ECG signals. We propose decomposing reasoning into two distinct, components: (i) Perception, the accurate identification of patterns within the raw signal, and (ii) Deduction, the logical application of domain knowledge to those patterns. To evaluate Perception, we employ an agentic framework that generates code to empirically verify the temporal structures described in the reasoning trace. To evaluate Deduction, we measure the alignment of the model's logic against a structured database of established clinical criteria in a retrieval-based approach. This dual-verification method enables the scalable assessment of "true" reasoning capabilities.

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arXiv2026

OpenTSLM: Time-Series Language Models for Reasoning over Multivariate Medical Text- and Time-Series Data

LLMs have emerged as powerful tools for interpreting multimodal data. In medicine, they hold particular promise for synthesizing large volumes of clinical information into actionable insights and digital health applications. Yet, a major limitation remains their inability to handle time series. To overcome this gap, we present OpenTSLM, a family of Time Series Language Models (TSLMs) created by integrating time series as a native modality to pretrained LLMs, enabling reasoning over multiple time series of any length. We investigate two architectures for OpenTSLM. The first, OpenTSLM-SoftPrompt, models time series implicitly by concatenating learnable time series tokens with text tokens via soft prompting. Although parameter-efficient, we hypothesize that explicit time series modeling scales better and outperforms implicit approaches. We thus introduce OpenTSLM-Flamingo, which integrates time series with text via cross-attention. We benchmark both variants against baselines that treat time series as text tokens or plots, across a suite of text-time-series Chain-of-Thought (CoT) reasoning tasks. We introduce three datasets: HAR-CoT, Sleep-CoT, and ECG-QA-CoT. Across all, OpenTSLM models outperform baselines, reaching 69.9 F1 in sleep staging and 65.4 in HAR, compared to 9.05 and 52.2 for finetuned text-only models. Notably, even 1B-parameter OpenTSLM models surpass GPT-4o (15.47 and 2.95). OpenTSLM-Flamingo matches OpenTSLM-SoftPrompt in performance and outperforms on longer sequences, while maintaining stable memory requirements. By contrast, SoftPrompt grows exponentially in memory with sequence length, requiring around 110 GB compared to 40 GB VRAM when training on ECG-QA with LLaMA-3B. Expert reviews by clinicians find strong reasoning capabilities exhibited by OpenTSLMs on ECG-QA. To facilitate further research, we provide all code, datasets, and models open-source.

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arXiv2025

RADAR: Benchmarking Language Models on Imperfect Tabular Data

Language models (LMs) are increasingly being deployed to perform autonomous data analyses. However, their data awareness -- the ability to recognize, reason over, and appropriately handle data artifacts such as missing values, outliers, and logical inconsistencies -- remains underexplored. These artifacts are especially common in real-world tabular data and, if mishandled, can significantly compromise the validity of analytical conclusions. To address this gap, we present RADAR, a benchmark for systematically evaluating data-aware reasoning on tabular data. We develop a framework to simulate data artifacts via programmatic perturbations to enable targeted evaluation of model behavior. RADAR comprises 2980 table query pairs, grounded in real-world data spanning 9 domains and 5 data artifact types. In addition to evaluating artifact handling, RADAR systematically varies table size to study how reasoning performance holds when increasing table size. Our evaluation reveals that, despite decent performance on tables without data artifacts, frontier models degrade significantly when data artifacts are introduced, exposing critical gaps in their capacity for robust, data-aware analysis. Designed to be flexible and extensible, RADAR supports diverse perturbation types and controllable table sizes, offering a valuable resource for advancing tabular reasoning.

cs.DB↗

arXiv2025

The Anatomy of a Personal Health Agent

Health is a fundamental pillar of human wellness, and the rapid advancements in large language models (LLMs) have driven the development of a new generation of health agents. However, the application of health agents to fulfill the diverse needs of individuals in daily non-clinical settings is underexplored. In this work, we aim to build a comprehensive personal health agent that is able to reason about multimodal data from everyday consumer wellness devices and common personal health records, and provide personalized health recommendations. To understand end-users' needs when interacting with such an assistant, we conducted an in-depth analysis of web search and health forum queries, alongside qualitative insights from users and health experts gathered through a user-centered design process. Based on these findings, we identified three major categories of consumer health needs, each of which is supported by a specialist sub-agent: (1) a data science agent that analyzes personal time-series wearable and health record data, (2) a health domain expert agent that integrates users' health and contextual data to generate accurate, personalized insights, and (3) a health coach agent that synthesizes data insights, guiding users using a specified psychological strategy and tracking users' progress. Furthermore, we propose and develop the Personal Health Agent (PHA), a multi-agent framework that enables dynamic, personalized interactions to address individual health needs. To evaluate each sub-agent and the multi-agent system, we conducted automated and human evaluations across 10 benchmark tasks, involving more than 7,000 annotations and 1,100 hours of effort from health experts and end-users. Our work represents the most comprehensive evaluation of a health agent to date and establishes a strong foundation towards the futuristic vision of a personal health agent accessible to everyone.

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arXiv2025

Pulse-PPG: An Open-Source Field-Trained PPG Foundation Model for Wearable Applications Across Lab and Field Settings

Photoplethysmography (PPG)-based foundation models are gaining traction due to the widespread use of PPG in biosignal monitoring and their potential to generalize across diverse health applications. In this paper, we introduce Pulse-PPG, the first open-source PPG foundation model trained exclusively on raw PPG data collected over a 100-day field study with 120 participants. Existing PPG foundation models are either open-source but trained on clinical data or closed-source, limiting their applicability in real-world settings. We evaluate Pulse-PPG across multiple datasets and downstream tasks, comparing its performance against a state-of-the-art foundation model trained on clinical data. Our results demonstrate that Pulse-PPG, trained on uncurated field data, exhibits superior generalization across clinical and mobile health applications in both lab and field settings. This suggests that exposure to real-world variability enables the model to learn fine-grained representations, making it more adaptable across tasks. Furthermore, pre-training on field data surprisingly outperforms its pre-training on clinical data in many tasks, reinforcing the importance of training on real-world, diverse datasets. To encourage further advancements in robust foundation models leveraging field data, we plan to release Pulse-PPG, providing researchers with a powerful resource for developing more generalizable PPG-based models.

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arXiv2025

SensorLM: Learning the Language of Wearable Sensors

We present SensorLM, a family of sensor-language foundation models that enable wearable sensor data understanding with natural language. Despite its pervasive nature, aligning and interpreting sensor data with language remains challenging due to the lack of paired, richly annotated sensor-text descriptions in uncurated, real-world wearable data. We introduce a hierarchical caption generation pipeline designed to capture statistical, structural, and semantic information from sensor data. This approach enabled the curation of the largest sensor-language dataset to date, comprising over 59.7 million hours of data from more than 103,000 people. Furthermore, SensorLM extends prominent multimodal pretraining architectures (e.g., CLIP, CoCa) and recovers them as specific variants within a generic architecture. Extensive experiments on real-world tasks in human activity analysis and healthcare verify the superior performance of SensorLM over state-of-the-art in zero-shot recognition, few-shot learning, and cross-modal retrieval. SensorLM also demonstrates intriguing capabilities including scaling behaviors, label efficiency, sensor captioning, and zero-shot generalization to unseen tasks.

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arXiv2025

LSM-2: Learning from Incomplete Wearable Sensor Data

Foundation models, a cornerstone of recent advancements in machine learning, have predominantly thrived on complete and well-structured data. Wearable sensor data frequently suffers from significant missingness, posing a substantial challenge for self-supervised learning (SSL) models that typically assume complete data inputs. This paper introduces the second generation of Large Sensor Model (LSM-2) with Adaptive and Inherited Masking (AIM), a novel SSL approach that learns robust representations directly from incomplete data without requiring explicit imputation. AIM's core novelty lies in its use of learnable mask tokens to model both existing ("inherited") and artificially introduced missingness, enabling it to robustly handle fragmented real-world data during inference. Pre-trained on an extensive dataset of 40M hours of day-long multimodal sensor data, our LSM-2 with AIM achieves the best performance across a diverse range of tasks, including classification, regression and generative modeling. Furthermore, LSM-2 with AIM exhibits superior scaling performance, and critically, maintains high performance even under targeted missingness scenarios, reflecting clinically coherent patterns, such as the diagnostic value of nighttime biosignals for hypertension prediction. This makes AIM a more reliable choice for real-world wearable data applications.

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arXiv2025

RelCon: Relative Contrastive Learning for a Motion Foundation Model for Wearable Data

We present RelCon, a novel self-supervised Relative Contrastive learning approach for training a motion foundation model from wearable accelerometry sensors. First, a learnable distance measure is trained to capture motif similarity and domain-specific semantic information such as rotation invariance. Then, the learned distance provides a measurement of semantic similarity between a pair of accelerometry time-series, which we use to train our foundation model to model relative relationships across time and across subjects. The foundation model is trained on 1 billion segments from 87,376 participants, and achieves state-of-the-art performance across multiple downstream tasks, including human activity recognition and gait metric regression. To our knowledge, we are the first to show the generalizability of a foundation model with motion data from wearables across distinct evaluation tasks.

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arXiv2024

PyPulse: A Python Library for Biosignal Imputation

We introduce PyPulse, a Python package for imputation of biosignals in both clinical and wearable sensor settings. Missingness is commonplace in these settings and can arise from multiple causes, such as insecure sensor attachment or data transmission loss. PyPulse's framework provides a modular and extendable framework with high ease-of-use for a broad userbase, including non-machine-learning bioresearchers. Specifically, its new capabilities include using pre-trained imputation methods out-of-the-box on custom datasets, running the full workflow of training or testing a baseline method with a single line of code, and comparing baseline methods in an interactive visualization tool. We released PyPulse under the MIT License on Github and PyPI. The source code can be found at: https://github.com/rehg-lab/pulseimpute.

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arXiv2024

Towards Time Series Reasoning with LLMs

Multi-modal large language models (MLLMs) have enabled numerous advances in understanding and reasoning in domains like vision, but we have not yet seen this broad success for time-series. Although prior works on time-series MLLMs have shown promising performance in time-series forecasting, very few works show how an LLM could be used for time-series reasoning in natural language. We propose a novel multi-modal time-series LLM approach that learns generalizable information across various domains with powerful zero-shot performance. First, we train a lightweight time-series encoder on top of an LLM to directly extract time-series information. Then, we fine-tune our model with chain-of-thought augmented time-series tasks to encourage the model to generate reasoning paths. We show that our model learns a latent representation that reflects specific time-series features (e.g. slope, frequency), as well as outperforming GPT-4o on a set of zero-shot reasoning tasks on a variety of domains.

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