Dynamic Prediction of Alternating Recurrent Events via Neural Network

Current-status data arise when an event time is observed only through an indicator of whether it occurred before an examination time. This paper studies a nonparametric neural-network sieve maximum likelihood estimator of the conditional cumulative distribution function of the event time. Under Hölder smoothness assumptions, we establish an explicit convergence rate by combining approximation theory for rectified linear unit neural networks with empirical-process arguments. This result provides theoretical support for neural-network estimation and subsequent inference under current-status observation.

Many clinical prediction models treat post-intervention outcomes as a one-step mapping from baseline measurements to a future endpoint. However, recovery after a procedure often unfolds as an irregular trajectory: clinical observations, medication changes, repeat interventions, and physiological measurements are recorded asynchronously and can change risk assessment over time. We propose an intervention-aware clinical world model that represents each patient with a structured latent state and evolves it through time-ordered post-intervention events. The model first encodes baseline imaging into a 3D spatial latent state. It then updates this state using procedural context, static covariates, elapsed time, and peri-event physiological embeddings. Follow-up imaging provides training-only supervision through a latent forecasting objective. We apply the framework to atrial fibrillation ablation. During the 90-day recovery window, irregular post-procedure records provide clinically meaningful evidence for long-term recurrence risk. In repeated internal cross-validation on DECAAF-II, our model achieves AUROC 0.756 and AUPRC 0.777 for recurrence prediction. It also achieves a scar-extent MAE of 2.971 percentage points without requiring follow-up MRI intensities at inference. The learned state supports recurrence-risk queries at different horizons and retrospective input editing of blanking-period records.

Prediction tasks over individual futures, which are inherently noisy, often admit multiple similarly accurate models. When these models produce different predictions for the same individual, they raise concerns of arbitrariness in decision-making. How severe can this arbitrariness be, in theory and in practice? How can it be resolved to support high-stakes risk assessment? We address these questions through a study of a machine learning-based decision support system for recidivism risk assessment that has been in use for over 15 years. By translating complex legal rules into an algorithm for labeling post release outcomes (recidivist or non-recidivist), we first construct a dataset of thousands of inmate releases. Using this dataset, we learn interpretable models that improve predictive performance, reduce error-rate disparities between groups, and ensure that rehabilitative progress lowers risk scores. Next, we study predictive multiplicity, by first deriving a tight lower bound on the expected predictive agreement of any finite set of models over a dataset, and then by evaluating the extent to which structural diversity (e.g., different model coefficients) within this set translates to predictive multiplicity (i.e., different predictions for the same individual). Our experiments indicate that the existence of many similarly accurate models with comparable error-rate disparities does not necessarily translate into severe predictive multiplicity. Empirically, similarly performant models can exhibit substantially higher predictive agreement than worst-case theoretical guarantees suggest. We find that a simple policy that assigns each inmate the lowest risk among these models is effective for addressing predictive arbitrariness.