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Shwetak Patel

Publications and source records attributed to Shwetak Patel.

At least 19 recordsLinked to original sources

Pixel Watch: Robust Heart Rate Sensing from Multipath PPG and On-Device Deep Learning Trained on 10,000 hours of Free-Living and Fitness Data

The Pixel Watch 2 (PW2) is the first Google smartwatch to combine multipath photoplethysmography (PPG) with deep learning-based heart rate inference, designed to significantly improve sensing accuracy during motion-heavy activities. The device processes 10 optical channels using an on-device, 15-layer temporally dilated convolutional neural network (~300K parameters) to yield a 1 Hz heart rate output. Crucial to this model's performance was its training on a massive dataset comprising 10,000 hours of data from 962 participants, curated from a broader corpus of controlled and free-living activities. We evaluated the PW2's sensing performance across two independent validation sets: an in-house fitness dataset (229 participants, 250 hours) and an external free-living dataset (27 participants, 1000+ hours). The system achieved 95% Limits of Agreement of -10.34 to 8.66 BPM during exercise and -6.57 to 7.48 BPM during free-living activities, demonstrating substantially tighter error margins than previous Google devices. Finally, we discuss key design lessons, emphasizing that large-scale deep learning was instrumental in fully leveraging multipath PPG hardware over traditional signal processing approaches.

cs.HC

RubricsTree: Scalable and Evolving Open-Ended Evaluation of Personal Health Agents across Health Memory and Medical Skills

The LLM-empowered personal health agents with user health (sensor) metrics have offered a promising pathway to alleviate global disparities in healthcare access. However, large-scale clinical deployment remains constrained by an open-ended evaluation bottleneck: physician annotation is reliable but costly and unscalable, while LLM-as-a-judge evaluators are scalable but subjective, inconsistent, and sometimes clinically misaligned. We introduce RubricsTree, a scalable evaluation framework with an expert-aligned hierarchical taxonomy of over 100 atomic, clinically-verifiable Boolean rubrics, evolving from the insights of 4,000 real user queries through an iterative human-in-the-loop curation protocol with an expertise panel led by an experienced physician. A context-aware adaptive router activates only the relevant auto-weighted rubric subset per query, providing the throughput needed for scalable evaluation with expert-aligned quality. Through a systematic meta-evaluation, we show that RubricsTree (i) substantially exceeds a strong large-scale evaluation baseline in expert alignment on challenging open-ended queries; (ii) reliably penalizes contextually degraded responses; and (iii) when used as structured instructions, text feedback, or training rewards for performance optimization, yields up to ~66% relative gains on HealthBench for Gemini, GPT, and Qwen model families. RubricsTree thus provides a scalable, auditable, and evolving evaluation infrastructure required for the continuous optimization of product-level personal healthcare AI.

cs.CL

Embedded Arena: Iterative Optimization via Hardware Feedback

Embedded devices from wildlife monitoring stations to clinical wearables require local AI inference due to latency, communication, or privacy constraints. Optimizing models for heterogeneous microcontrollers (MCUs) requires simultaneously satisfying hard physical constraints on memory, power, and temperature while preserving accuracy, a multidimensional optimization that is today performed manually by experts. We ask whether an LLM agent can autonomously navigate this complex, multi-turn pipeline guided by real hardware feedback, and introduce a hardware-in-the-loop agent arena in which the agent iteratively refines both model and firmware -- compiling, flashing, and measuring on real hardware -- to enable closed-loop optimization. Frontier models, including Claude Opus 4.7 and Gemini 3.1 Pro, fail entirely without hardware feedback (0% deployment success), whereas our hardware-in-the-loop formulation achieves the first successful deployment within three iterations and can surpass human expert results within seven. This agentic co-optimization achieves 250x compression for vision models with <3.3% accuracy loss and 400x for audio with <6% Feature Error Rate loss, enabling battery-free operation on a commercial MCU via solar harvesting. We demonstrate practical impact in two real-world systems: an elk-detection camera trap (96.7% accuracy) and a phonetic-transcription wearable (8.44% FER) for child development research.

cs.AR

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 $\beta$-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.

cs.LG

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.

cs.AI

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.

cs.AI

WavesFM: Hierarchical Representation Learning for Longitudinal Wearable Sensor Waveforms

Wearable sensors enable the continuous acquisition of high-resolution physiological waveforms, such as photoplethysmography and accelerometry, under free-living conditions. However, inferring health-related phenotypes from these signals presents significant challenges due to high sampling frequencies, multimodal dependencies, and extreme sequence lengths (e.g., weeks of recordings), compounded by a scarcity of ground-truth labels. To address these challenges, existing self-supervised learning (SSL) methodologies typically follow two paradigms: (1) learning rich morphological representations from short waveform segments while collapsing longitudinal dynamics through simple aggregation, or (2) modeling behavioral patterns from coarse, hand-crafted features (e.g. heart rate, step counts) spanning longer horizons but foregoing subtle, predictive signatures in raw waveforms. To bridge this gap, we propose WavesFM, a foundation model utilizing a two-stage SSL framework for longitudinal physiological data. Specifically, we decompose the learning problem into two stages: first, a segment-level encoder is pretrained to extract local embeddings from short waveforms; subsequently, a temporal encoder is trained to model the sequence of these embeddings across a multi-day horizon. This hierarchical approach overcomes the computational complexity of high-resolution, long-sequence data, allowing the overall model to capture both local signal semantics and the complex circadian and inter-day variations governing physiological dynamics. Pretrained on over 6.8M hours (N=324k individuals) of recordings for the first stage and 5.3M hours (N=10k) for the second stage, WavesFM demonstrates superior performance across 58 diverse tasks spanning demographics, lifestyle, health conditions, and medications.

cs.LG

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 ($\rho$ = 0.252, $p$ < 0.001) and sleep-onset variability in GLOBEM ($\rho$ = 0.126, $p$ < 0.001), and derived a wearable cardiovascular-fitness index associated with insulin resistance (steps/resting heart rate; $\rho$ = -0.374, $p$ < 0.001). Adding these features to demographic models produced modest gains ($\Delta R^2$ = 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 ($\rho$ = 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.

cs.AI

Towards a Science of Scaling Agent Systems

Agents, language model-based systems capable of reasoning, planning, and acting are widely adopted in real-world tasks, yet how their performance changes as these systems scale across key dimensions remains underexplored. We introduce quantitative scaling principles for agent systems as a predictive model, capturing how performance varies with coordination, model capability, and measurable system and task factors. Across 260 configurations spanning six agentic benchmarks, five canonical architectures (Single-Agent and four Multi-Agent: Independent, Centralized, Decentralized, Hybrid), and three LLM families, we perform controlled evaluations, standardizing tools, prompts, and compute to isolate architectural effects. The resulting model achieves a cross-validated R^2=0.373 across all six benchmarks (R^2=0.413 with a task-grounded capability metric). We identify a robust capability-saturation effect and additional patterns: (1) a coordination yields diminishing returns once single-agent baselines exceed certain performance; (2) tool-heavy tasks appear to incur multi-agent overhead; and (3) architectures without centralized verification tend to propagate errors more than those with centralized coordination. Relative performance change compared to single-agent baseline ranges from +80.8% on decomposable financial reasoning to -70.0% on sequential planning, demonstrating that architecture-task alignment determines collaborative success. The framework identifies the best-performing architecture for 87% of held-out configurations and shows consistent relative architecture preferences on unseen frontier models. Agent effectiveness depends on alignment between coordination and task structure, and that mismatched coordination degrades the performance.

cs.AI

Beyond BMI: Smartphone Body Composition Phenotyping for Cardiometabolic Risk Assessment

Body Mass Index (BMI) is a widely accessible but imprecise proxy of cardiometabolic health. While assessing true body composition is superior, gold-standard methods like Dual-Energy X-ray Absorptiometry (DXA) are not scalable. We address this gap by developing and validating "PhotoScan," a method to estimate body composition from smartphone imagery. We pretrained a deep learning model on UK Biobank participants (N=35,323) and fine-tuned on a newly recruited clinical cohort (PhotoBIA cohort, N=677) with diverse ethnicity, age, and body fat distribution, achieving high accuracy against DXA for total body fat percentage (BF%, MAE = 2.15%), Android-to-Gynoid fat ratio (A/G, MAE = 0.11), and visceral-to-subcutaneous fat area ratio (V/S, MAE = 0.09). Generalizability of the model was demonstrated on an independent metabolic health study cohort (MetabolicMosaic cohort, N=132 participants), achieving MAEs of 2.13% for BF%, 0.09 for A/G, and 0.09 for V/S. We then evaluated the clinical utility of these metrics in the MetabolicMosaic cohort by predicting insulin resistance (IR). Adding PhotoScan-derived body composition metrics to baseline demographics model (Age, Sex, BMI) significantly improved insulin resistance classification (Area Under the Receiver Operating Characteristic Curve "AUROC" 76.0% vs 69.2%, DeLong test p=0.002, Net Reclassification Index "NRI" 0.593). Crucially, this accessible smartphone method achieved performance nearly equivalent to adding clinical-grade DXA data to baseline demographics model (AUROC 77.3% vs 69.2%, DeLong test p=0.004, NRI 0.748). These findings demonstrate that smartphone-based phenotyping captures clinically meaningful risk signals missed by BMI and anthropometrics, offering a scalable alternative to DXA for cardiometabolic risk stratification.

q-bio.QM

EgoReasoner: Learning Egocentric 4D Reasoning via Task-Adaptive Structured Thinking

Egocentric video understanding is inherently complex due to the dynamic 4D nature of the environment, where camera motion and object displacements necessitate a continuous re-evaluation of spatial relations. In this work, we target a suite of under-explored egocentric 4D reasoning tasks, including fixture interaction counting, viewpoint-relative fixture location, object movement itinerary tracking, and stationary object localization, that require fundamentally different cognitive operations: spatial anchoring, temporal tracking, and duration reasoning. We observe that these structural differences make task-agnostic approaches insufficient: generic Chain-of-Thought methods lack task-appropriate reasoning primitives, and uniform reinforcement learning actively destabilizes performance on spatial tasks. To address this, we propose EgoReasoner, a two-stage framework that aligns both the reasoning scaffold and the reward signal to each task's cognitive structure. In the first stage, Task-Adaptive Thinking Templates guide the synthesis of structured CoT traces that teach the model to reason adaptively across task types via supervised fine-tuning. In the second stage, task-aware reward functions verify entity grounding, temporal alignment, and task-adaptive logical consistency, selectively strengthening each reasoning pathway via reinforcement fine-tuning with GRPO. Our 3B-parameter model, trained on only 16K samples, achieves 37.5% average accuracy on the challenging HD-EPIC benchmark, surpassing Qwen2.5-VL-7B (25.7%) by over 10 points.

cs.CV

Quantifying Cardiovascular-Kidney-Metabolic(CKM) Health Age Using Wearables and lab Biomarkers

Cardiovascular-Kidney-Metabolic (CKM) syndrome represents a growing public health crisis, yet its subclinical heterogeneity remains underexplored. Early detection of physiological deviation is critical for preventing irreversible organ damage. Here, we characterize the prevalence and interplay of CKM impairment in a US cohort (N=819) by integrating continuous wearable data with clinical biomarkers. We assessed cardiovascular, kidney via clinical biomarkers, namely Chol/HDL, eGFR, as well as metabolic health risk through Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). We show that while metabolic and cardiovascular disruptions are significantly associated (r=0.26, $p<0.001$), early-stage kidney impairment manifests independently. Utilizing a normalized deviance score, we identified significant health impairments in 29.0% of the cohort. Cardiovascular deviation was the most prevalent singular phenotype (13.3%), followed by metabolic (9.1%) and renal (6.25%) deviations, with dual metabolic-cardiovascular impairment occurring in only 2.2% of participants. These findings suggest that high system-specific deviance may serve as an indicator for accelerated physiological aging within the respective organ system. Furthermore, Step count, Active Zone Minutes, and resting heart rate were identified as the key wearable predictors of cardiovascular and metabolic decline. Leveraging these and CKM metrics, we developed a Health Age model that tracks physiological health, aligning with established clinical standards (Metabolic syndrome severity and modified AHA Life's Essential 8) and user-reported overall health. These findings underscore the necessity of a multi-system subtyping approach, demonstrating that wearable-derived phenotypes can facilitate the early, targeted interventions required to manage the complex landscape of CKM syndrome.

q-bio.QM

A Scalable Framework for Evaluating Health Language Models

Large language models (LLMs) have emerged as powerful tools for analyzing complex datasets. Recent studies demonstrate their potential to generate useful, personalized responses when provided with patient-specific health information that encompasses lifestyle, biomarkers, and context. As LLM-driven health applications are increasingly adopted, rigorous and efficient one-sided evaluation methodologies are crucial to ensure response quality across multiple dimensions, including accuracy, personalization and safety. Current evaluation practices for open-ended text responses heavily rely on human experts. This approach introduces human factors and is often cost-prohibitive, labor-intensive, and hinders scalability, especially in complex domains like healthcare where response assessment necessitates domain expertise and considers multifaceted patient data. In this work, we introduce Adaptive Precise Boolean rubrics: an evaluation framework that streamlines human and automated evaluation of open-ended questions by identifying gaps in model responses using a minimal set of targeted rubrics questions. Our approach is based on recent work in more general evaluation settings that contrasts a smaller set of complex evaluation targets with a larger set of more precise, granular targets answerable with simple boolean responses. We validate this approach in metabolic health, a domain encompassing diabetes, cardiovascular disease, and obesity. Our results demonstrate that Adaptive Precise Boolean rubrics yield higher inter-rater agreement among expert and non-expert human evaluators, and in automated assessments, compared to traditional Likert scales, while requiring approximately half the evaluation time of Likert-based methods. This enhanced efficiency, particularly in automated evaluation and non-expert contributions, paves the way for more extensive and cost-effective evaluation of LLMs in health.

cs.AI

GazeSummary: Exploring Gaze as an Implicit Prompt for Personalization in Text-based LLM Tasks

Smart glasses are accelerating progress toward more seamless and personalized LLM-based assistance by integrating multimodal inputs. Yet, these inputs rely on obtrusive explicit prompts. The advent of gaze tracking on smart devices offers a unique opportunity to extract implicit user intent for personalization. This paper investigates whether LLMs can interpret user gaze for text-based tasks. We evaluate different gaze representations for personalization and validate their effectiveness in realistic reading tasks. Results show that LLMs can leverage gaze to generate high-quality personalized summaries and support users in downstream tasks, highlighting the feasibility and value of gaze-driven personalization for future mobile and wearable LLM applications.

cs.HC

Smartphone monitoring of smiling as a behavioral proxy of well-being in everyday life

Subjective well-being is a cornerstone of individual and societal health, yet its scientific measurement has traditionally relied on self-report methods prone to recall bias and high participant burden. This has left a gap in our understanding of well-being as it is expressed in everyday life. We hypothesized that candid smiles captured during natural smartphone interactions could serve as a scalable, objective behavioral correlate of positive affect. To test this, we analyzed 405,448 video clips passively recorded from 233 consented participants over one week. Using a deep learning model to quantify smile intensity, we identified distinct diurnal and daily patterns. Daily patterns of smile intensity across the week showed strong correlation with national survey data on happiness (r=0.92), and diurnal rhythms documented close correspondence with established results from the day reconstruction method (r=0.80). Higher daily mean smile intensity was significantly associated with more physical activity (Beta coefficient = 0.043, 95% CI [0.001, 0.085]) and greater light exposure (Beta coefficient = 0.038, [0.013, 0.063]), whereas no significant effects were found for smartphone use. These findings suggest that passive smartphone sensing could serve as a powerful, ecologically valid methodology for studying the dynamics of affective behavior and open the door to understanding this behavior at a population scale.

cs.CV

Towards Characterizing Knowledge Distillation of PPG Heart Rate Estimation Models

Heart rate estimation from photoplethysmography (PPG) signals generated by wearable devices such as smartwatches and fitness trackers has significant implications for the health and well-being of individuals. Although prior work has demonstrated deep learning models with strong performance in the heart rate estimation task, in order to deploy these models on wearable devices, these models must also adhere to strict memory and latency constraints. In this work, we explore and characterize how large pre-trained PPG models may be distilled to smaller models appropriate for real-time inference on the edge. We evaluate four distillation strategies through comprehensive sweeps of teacher and student model capacities: (1) hard distillation, (2) soft distillation, (3) decoupled knowledge distillation (DKD), and (4) feature distillation. We present a characterization of the resulting scaling laws describing the relationship between model size and performance. This early investigation lays the groundwork for practical and predictable methods for building edge-deployable models for physiological sensing.

cs.LG

Thinking While Speaking: Inference-Time Knowledge Transfer for Responsive and Intelligent Conversational Voice Agents

Voice agents face a fundamental tension: the reasoning, retrieval, and tool use that make foundation models capable are iterative and slow, while conversational interaction demands responses on a millisecond timescale. Smaller, real-time models meet the latency bar but cannot match foundation models on complex tasks, leaving current voice agents to trade away either responsiveness or capability. We introduce conversational infill, where a small talker model both immediately generates contextually grounded responses to hide the latency of an external reasoner model and fluently integrates streamed reasoner knowledge into its responses during inference. We curate a 290,571-example synthetic dataset spanning six domains and demonstrate that this task is learnable across seven widely used small language models ranging from 135M to 1.7B parameters. Our system implementation, ConvFill, sustains millisecond-level time-to-first-response while closing the accuracy gap to within 6.3% of the corresponding frontier reasoner performance. In a live user study (n=18) with talker deployments running on an Apple M2 SoC, participants rank ConvFill on par with frontier models overall, prefer it for retrieval-heavy tasks, and rate it significantly more responsive. These results show that conversational infill unlocks a new point on the latency-capability Pareto frontier, offering a practical path toward voice agents that are both responsive and highly capable. Code, models, and datasets are available at https://github.com/vysri/conversational-infill.

cs.CL

SnappyMeal: Design and Longitudinal Evaluation of a Multimodal AI Food Logging Application

Food logging, both self-directed and prescribed, plays a critical role in uncovering correlations between diet, medical, fitness, and health outcomes. Through conversations with nutritional experts and individuals who practice dietary tracking, we find current logging methods, such as handwritten and app-based journaling, are inflexible and result in low adherence and potentially inaccurate nutritional summaries. These findings, corroborated by prior literature, emphasize the urgent need for improved food logging methods. In response, we propose SnappyMeal, an AI-powered dietary tracking system that leverages multimodal inputs to enable users to more flexibly log their food intake. SnappyMeal introduces goal-dependent follow-up questions to intelligently seek missing context from the user and information retrieval from user grocery receipts and nutritional databases to improve accuracy. We evaluate SnappyMeal through publicly available nutrition benchmarks and a multi-user, 3-week, in-the-wild deployment capturing over 500 logged food instances. Users strongly praised the multiple available input methods and reported a strong perceived accuracy. These insights suggest that multimodal AI systems can be leveraged to significantly improve dietary tracking flexibility and context-awareness, laying the groundwork for a new class of intelligent self-tracking applications.

cs.HC