Neonatal mortality risk prediction from bedside monitoring data remains challenging due to extreme class imbalance, heterogeneous clinical risk factors, multi-scale temporal dynamics, and substantial missingness. We propose NeoTriFuse, a reliability-aware multimodal fusion framework for missingness-heterogeneous neonatal monitoring data. Unlike conventional multimodal approaches that treat missingness primarily as a preprocessing issue, NeoTriFuse models missingness as an explicit reliability signal that dynamically modulates modality contributions during fusion. The framework integrates static perinatal variables, local-global temporal encoders, and patient-level statistical summaries through reliability-guided gating mechanisms, while jointly optimizing mortality prediction and an auxiliary length-of-stay objective. NeoTriFuse achieves competitive performance, with an F1 score of 0.6736 +/- 0.0216 and an AUROC of 0.9454 +/- 0.0056. Ablation studies indicate that the local-global temporal architecture and patient-level summary branch contribute most substantially to predictive performance, while reliability-aware gating provides additional improvements on threshold-dependent metrics under heterogeneous observation completeness. Sensitivity analyses further suggest stable performance across nearby hyperparameter settings. Overall, the findings support reliability-aware multimodal fusion as a practical approach for neonatal mortality prediction under realistic clinical missingness conditions.
Wearable device data enables continuous health monitoring, but suffers from structured missingness: features sharing a physical sensor drop out together. Deep imputation methods such as BRITS and SAITS have seen limited evaluation on multimodal physiological data under realistic missingness, and existing benchmarks use random-point holdout protocols that incorrectly assume missingness is independent across features and time. Using data from a person with epilepsy recorded on a Garmin smartwatch, we develop an evaluation protocol that mines contiguous missing-run templates from training data, stratifies them by per-feature gap-length quantiles, and injects them as block masks with preserved co-missingness structure. A matched training protocol exposing models to the same missingness distribution reduces BRITS's severe-gap MAE by 43%, demonstrating the potential benefit of the proposed evaluation and training protocol within this single-participant dataset. We further extend BRITS with time-of-day encoding and a circadian harmonic channel. No single model dominates: linear interpolation is optimal for slow-moving features over short gaps; extended BRITS achieves lower MAE on dynamic cardiac features in moderate and severe gaps; and SAITS better preserves the ground-truth distribution by Jensen-Shannon distance despite higher MAE. Ultimately, model rankings strongly depend on evaluation designs. By exposing how traditional evaluation methods obscure true model capabilities, our transferable protocol establishes critical steps towards developing better imputation strategies for future multi-sensor wearable datasets.
Yu-Chao Huang, Haochen Zhang, Nicholas Konz +1cs.LG cs.AI
Imputing physiological time series (arterial blood pressure, blood glucose, etc.) is essential for addressing the missingness that pervades clinical data. Yet modern imputation methods perform poorly in this domain: a recent benchmark found that simple linear interpolation outperformed every learned imputer on real-world clinical signals with realistic gaps. We show that this reflects two properties of physiological missingness that generic imputers ignore: gaps may occur when the signal is clinically extreme rather than typical, and gap lengths can easily span orders of magnitude. To this end, we introduce Curriculum-Aware Interpolate-then-Refine (CAIR), a two-stage framework for physiological time-series imputation. Our key motivation is to learn a coarse base curve and then repeatedly correct it toward physiological realism, rather than predict a gap in a single pass. Consequently, CAIR couples a bidirectional-GRU interpolator with a Transformer refiner that corrects its own estimate over three successive passes, trained jointly under a broad, signal-agnostic random-gap curriculum. We evaluate imputers stratified by gap length and missingness mechanism (MCAR, MAR, NMAR) rather than by a single average, and CAIR is the most accurate under every mechanism on continuous glucose monitoring (AI-READI) and arterial pressure in intensive care (MIMIC-III). Its margin over the strongest baseline grows with difficulty, from 9% under MCAR to 19% under value-dependent dropout, where generic learned imputers are weakest. We further show low reconstruction error alone does not recover the burden metrics clinicians act on: interpolants matching CAIR's error fail to preserve those metrics, imputers that recover them are far less accurate, and CAIR alone ranks among the best on both axes.
Continuous physiological time series underpin modern clinical monitoring, yet many of the most informative signals are invasive, expensive, or simply unavailable for a given patient. Conditional generation offers a remedy: an absent signal can be synthesized from co-recorded signals and routine clinical variables. Existing generators, however, are built around a single conditioning modality and degrade when forced to handle the heterogeneous, irregularly missing mix of time-variant signals and static covariates seen in practice. We propose ReCoGen (Represent Conditions, then Generate), a two-stage framework that decouples multimodal condition representation from target generation. Stage I trains one masked autoencoder per modality, distilling each time-variant condition into a compact and missingness-tolerant token sequence. Stage II trains a flow-matching generator that fuses these tokens with static conditions to synthesize the target signal. Across three physiological benchmarks, including continuous glucose monitoring on AI-READI and arterial blood pressure generation on MIMIC-III and MIMIC-IV, ReCoGen attains the best downstream utility on all sixteen (dataset, task, metric) settings, surpassing six representative conditional generators; on thirteen of them its utility also reaches or exceeds the utility measured on the real signal, a reference we read as an approximate anchor rather than a ceiling. Ablations trace the gains to the conditioning path: learnable cross-attention over the frozen per-modality encoders, and a dual token-plus-AdaLN route for the static conditions. ReCoGen thus turns routinely collected signals into informative surrogates for invasive or unavailable ones, a step toward less invasive, lower-cost continuous clinical monitoring.
Clinical irregular multivariate time series are shaped not only by physiological dynamics but also by the measurement process that determines when and what to observe. In event-centric models, however, co-timestamp structure can be flattened too early: measurements acquired at the same timestamp are embedded as isolated nodes, leaving local patient-state context unavailable until later message-passing layers. We study this pre-propagation representation bottleneck and address it by restoring co-timestamp context before message passing begins. We propose MissHyper, a missingness-guided hypergraph forecasting model with pre-propagation synchronicity restoration. MissHyper augments each event with a local support-density cue, aggregates co-timestamp records to recover patient-state context, and uses a missingness-guided gate to adaptively fuse node-specific evidence with the recovered context. Across PhysioNet 2012, MIMIC-III, and MIMIC-IV, MissHyper achieves consistent gains in multi-step forecasting and outperforms a strong hypergraph baseline. These results suggest that improving event initialization can benefit sparse clinical forecasting without requiring a redesigned downstream propagation architecture. Ablations indicate that snapshot restoration, adaptive fusion, and support-density encoding all contribute, pointing to event initialization as a critical design axis for sparse clinical forecasting.
Clinical time series prediction in intensive care units remains challenging due to heterogeneous physiological variables and informative missingness. The presence or absence of a measurement can reflect clinical decisions and patient severity, and thus missingness can serve as a predictive signal rather than a simple data artifact. This work presents CISM, a Channel-Independent Spectrogram framework with a Missingness stream for clinical multivariate time series prediction. CISM converts each clinical variable into a variable-wise time-frequency spectrogram, preserves variable identity through variable-aligned encoding, and aligns an explicit missingness stream with the spectrogram representation. Experiments on an in-hospital mortality task derived from MIMIC-IV show that CISM achieves the highest mean AUROC (0.7225), AUPRC (0.3308), and F1 (0.3808) among the compared time series, missingness-aware, vision, and time-frequency baselines. Ablation studies further show that observation patterns provide a meaningful informative signal. Pixel-level mask injection improves performance over plain spectrogram inputs and recovers much of this predictive value. The aligned missingness stream contributes a further, complementary gain in both AUROC and AUPRC. These results highlight the importance of modeling observation patterns as structured signals in clinical time series prediction.