Surveillance of Antidepressant Safety (SADS): Active Signal Detection of Serious Medical Events Following SSRI and SNRI Initiation Using Big Healthcare Data.

INTRODUCTION: The current process for generating evidence in pharmacovigilance has several limitations, which often lead to delays in the evaluation of drug-associated risks. OBJECTIVES: In this study, we proposed and tested a near real-time epidemiological surveillance system using sequential, cumulative analyses focusing on the detection and preliminary risk quantification of potential safety signals following initiation of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). METHODS: We emulated an active surveillance system in an historical setting by conducting repeated annual cohort studies using nationwide Danish healthcare data (1996-2016). Outcomes were selected from the European Medicines Agency's Designated Medical Event list, summaries of product characteristics, and the literature. We followed patients for a maximum of 6 months from treatment initiation to the event of interest or censoring. We performed Cox regression analyses adjusted for standard sets of covariates. Potential safety signals were visualized using heat maps and cumulative hazard ratio (HR) plots over time. RESULTS: In the total study population, 969,667 new users were included and followed for 461,506 person-years. We detected potential safety signals with incidence rates as low as 0.9 per 10,000 person-years. Having eight different exposure drugs and 51 medical events, we identified 31 unique combinations of potential safety signals with a positive association to the event of interest in the exposed group. We proposed that these signals were designated for further evaluation once they appeared in a prospective setting. In total, 21 (67.7%) of these were not present in the current summaries of product characteristics. CONCLUSION: The study demonstrated the feasibility of performing epidemiological surveillance using sequential, cumulative analyses. Larger populations are needed to evaluate rare events and infrequently used antidepressants.

Artificial Intelligence in Pharmacoepidemiology: A Systematic Review. Part 1-Overview of Knowledge Discovery Techniques in Artificial Intelligence.

AIM: To perform a systematic review on the application of artificial intelligence (AI) based knowledge discovery techniques in pharmacoepidemiology. STUDY ELIGIBILITY CRITERIA: Clinical trials, meta-analyses, narrative/systematic review, and observational studies using (or mentioning articles using) artificial intelligence techniques were eligible. Articles without a full text available in the English language were excluded. DATA SOURCES: Articles recorded from 1950/01/01 to 2019/05/06 in Ovid MEDLINE were screened. PARTICIPANTS: Studies including humans (real or simulated) exposed to a drug. RESULTS: In total, 72 original articles and 5 reviews were identified via Ovid MEDLINE. Twenty different knowledge discovery methods were identified, mainly from the area of machine learning (66/72; 91.7%). Classification/regression (44/72; 61.1%), classification/regression + model optimization (13/72; 18.0%), and classification/regression + features selection (12/72; 16.7%) were the three most frequent tasks in reviewed literature that machine learning methods has been applied to solve. The top three used techniques were artificial neural networks, random forest, and support vector machines models. CONCLUSIONS: The use of knowledge discovery techniques of artificial intelligence techniques has increased exponentially over the years covering numerous sub-topics of pharmacoepidemiology. SYSTEMATIC REVIEW REGISTRATION: Systematic review registration number in PROSPERO: CRD42019136552.

Quantifying the sources of uncertainty when calculating the limiting flux in secondary settling tanks using iCFD.

Solids-flux theory (SFT) and state-point analysis (SPA) are used for the design, operation and control of secondary settling tanks (SSTs). The objectives of this study were to assess uncertainties, propagating from flow and solids loading boundary conditions as well as compression settling behaviour to the calculation of the limiting flux (JL) and the limiting solids concentration (XL). The interpreted computational fluid dynamics (iCFD) simulation model was used to predict one-dimensional local concentrations and limiting solids fluxes as a function of loading and design boundary conditions. A two-level fractional factorial design of experiments was used to infer the relative significance of factors unaccounted for in conventional SPA. To move away from using semi-arbitrary safety factors, a systematic approach was proposed to calculate the maximum SST capacity by employing a factor of 23% and a regression meta-model to correct values of JL and XL, respectively - critical for abating hydraulic effects under wet-weather flow conditions.

Artificial Intelligence in Pharmacoepidemiology: A Systematic Review. Part 2-Comparison of the Performance of Artificial Intelligence and Traditional Pharmacoepidemiological Techniques.

Aim: To summarize the evidence on the performance of artificial intelligence vs. traditional pharmacoepidemiological techniques. Methods: Ovid MEDLINE (01/1950 to 05/2019) was searched to identify observational studies, meta-analyses, and clinical trials using artificial intelligence techniques having a drug as the exposure or the outcome of the study. Only studies with an available full text in the English language were evaluated. Results: In all, 72 original articles and five reviews were identified via Ovid MEDLINE of which 19 (26.4%) compared the performance of artificial intelligence techniques with traditional pharmacoepidemiological methods. In total, 44 comparisons have been performed in articles that aimed at 1) predicting the needed dosage given the patient's characteristics (31.8%), 2) predicting the clinical response following a pharmacological treatment (29.5%), 3) predicting the occurrence/severity of adverse drug reactions (20.5%), 4) predicting the propensity score (9.1%), 5) identifying subpopulation more at risk of drug inefficacy (4.5%), 6) predicting drug consumption (2.3%), and 7) predicting drug-induced lengths of stay in hospital (2.3%). In 22 out of 44 (50.0%) comparisons, artificial intelligence performed better than traditional pharmacoepidemiological techniques. Random forest (seven out of 11 comparisons; 63.6%) and artificial neural network (six out of 10 comparisons; 60.0%) were the techniques that in most of the comparisons outperformed traditional pharmacoepidemiological methods. Conclusion: Only a small fraction of articles compared the performance of artificial intelligence techniques with traditional pharmacoepidemiological methods and not all artificial intelligence techniques have been compared in a Pharmacoepidemiological setting. However, in 50% of comparisons, artificial intelligence performed better than pharmacoepidemiological techniques.

iCFD: Interpreted Computational Fluid Dynamics - Degeneration of CFD to one-dimensional advection-dispersion models using statistical experimental design - The secondary clarifier.

The present study aims at using statistically designed computational fluid dynamics (CFD) simulations as numerical experiments for the identification of one-dimensional (1-D) advection-dispersion models - computationally light tools, used e.g., as sub-models in systems analysis. The objective is to develop a new 1-D framework, referred to as interpreted CFD (iCFD) models, in which statistical meta-models are used to calculate the pseudo-dispersion coefficient (D) as a function of design and flow boundary conditions. The method - presented in a straightforward and transparent way - is illustrated using the example of a circular secondary settling tank (SST). First, the significant design and flow factors are screened out by applying the statistical method of two-level fractional factorial design of experiments. Second, based on the number of significant factors identified through the factor screening study and system understanding, 50 different sets of design and flow conditions are selected using Latin Hypercube Sampling (LHS). The boundary condition sets are imposed on a 2-D axi-symmetrical CFD simulation model of the SST. In the framework, to degenerate the 2-D model structure, CFD model outputs are approximated by the 1-D model through the calibration of three different model structures for D. Correlation equations for the D parameter then are identified as a function of the selected design and flow boundary conditions (meta-models), and their accuracy is evaluated against D values estimated in each numerical experiment. The evaluation and validation of the iCFD model structure is carried out using scenario simulation results obtained with parameters sampled from the corners of the LHS experimental region. For the studied SST, additional iCFD model development was carried out in terms of (i) assessing different density current sub-models; (ii) implementation of a combined flocculation, hindered, transient and compression settling velocity function; and (iii) assessment of modelling the onset of transient and compression settling. Furthermore, the optimal level of model discretization both in 2-D and 1-D was undertaken. Results suggest that the iCFD model developed for the SST through the proposed methodology is able to predict solid distribution with high accuracy - taking a reasonable computational effort - when compared to multi-dimensional numerical experiments, under a wide range of flow and design conditions. iCFD tools could play a crucial role in reliably predicting systems' performance under normal and shock events.

In vivo Comet assay--statistical analysis and power calculations of mice testicular cells.

The in vivo Comet assay is a sensitive method for evaluating DNA damage. A recurrent concern is how to analyze the data appropriately and efficiently. A popular approach is to summarize the raw data into a summary statistic prior to the statistical analysis. However, consensus on which summary statistic to use has yet to be reached. Another important consideration concerns the assessment of proper sample sizes in the design of Comet assay studies. This study aims to identify a statistic suitably summarizing the % tail DNA of mice testicular samples in Comet assay studies. A second aim is to provide curves for this statistic outlining the number of animals and gels to use. The current study was based on 11 compounds administered via oral gavage in three doses to male mice: CAS no. 110-26-9, CAS no. 512-56-1, CAS no. 111873-33-7, CAS no. 79-94-7, CAS no. 115-96-8, CAS no. 598-55-0, CAS no. 636-97-5, CAS no. 85-28-9, CAS no. 13674-87-8, CAS no. 43100-38-5 and CAS no. 60965-26-6. Testicular cells were examined using the alkaline version of the Comet assay and the DNA damage was quantified as % tail DNA using a fully automatic scoring system. From the raw data 23 summary statistics were examined. A linear mixed-effects model was fitted to the summarized data and the estimated variance components were used to generate power curves as a function of sample size. The statistic that most appropriately summarized the within-sample distributions was the median of the log-transformed data, as it most consistently conformed to the assumptions of the statistical model. Power curves for 1.5-, 2-, and 2.5-fold changes of the highest dose group compared to the control group when 50 and 100 cells were scored per gel are provided to aid in the design of future Comet assay studies on testicular cells.