Statistical learning for turboshaft helicopter accidents using logistic regression
Authors:
Rachmat Subagia aff001; Joseph Homer Saleh aff001; Jared S. Churchwell aff001; Katherine S. Zhang aff001
Authors place of work:
School of Aerospace Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
aff001
Published in the journal:
PLoS ONE 15(1)
Category:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0227334
Summary
The objective of this work is to advance the understanding of helicopter accidents by examining and quantifying the association between helicopter-specific configurations (number of main rotor blades, number of engines, rotor diameter, and takeoff weight) and the likelihood of accidents. We leverage a dataset of 8,338 turboshaft helicopters in the U.S. civil fleet and 825 accidents from 2005 to 2015. We use the dataset to develop a logistic regression model using the method of purposeful selection, which we exploit for inferential purposes and highlight the novel insights it reveals. For example, one important question for the design and acquisition of helicopters is whether twin-engine turboshaft helicopters exhibit a smaller likelihood of accidents than their single-engine counterparts, all else being equal. The evidence-based result we derive indicates that the answer is contingent on other covariates, and that a tipping point exists in terms of the rotor diameter beyond which the likelihood of accidents of twin-engines is higher (worse) than that of their single-engine counterparts. Another important result derived here is the association between the number of main rotor blades and likelihood of accidents. We found that for single-engine turboshaft helicopters, the four-bladed ones are associated with the lowest likelihood of accidents. We also identified a clear coupling between the number of engines and the rotor diameter in terms of likelihood of accidents. In summary, we establish important relationships between the different helicopter configurations here considered and the likelihood of accident, but these are associations, not causal in nature. The causal pathway, if it exists, may be confounded or mediated by other variables not accounted for here. The results provided here lend themselves to a rich set of interpretive possibilities, and because of their significant safety implications they deserve careful attention from the rotorcraft community.
Keywords:
Critical care and emergency medicine – Statistical data – Aerodynamics – Polynomials – Engines – Rotors – Twins – Aviation
1. Introduction
The work is part of a larger effort whose objective is to provide a better understanding of helicopter accidents, and to identify important areas for different stakeholders in the rotorcraft community to focus their attention and resources on for accident prevention. The end-objective is to contribute toward improving the safety track record of helicopters, and ultimately to reduce the burden of injuries, fatalities, and financial losses due to helicopter accidents.
Rotorcraft fulfill a wide range of functions, and they have become indispensable for many civilian and military applications, from medical evacuation, to delivery of humanitarian aid, law enforcement, and a whole slew of commercial and military applications. This mission flexibility is enabled by the fundamental design feature of these craft, a rotating wing, which, in turn, is responsible for a host of challenges and complexities in the design, operation, and maintenance of these systems. These complexities also likely have an imprint on the poor safety track record of helicopters. For context, the fatal accident rate of civilian helicopters in the U.S. has shown little or no progress over the last decade, and it is about 17 times higher than fatal accident rates of passenger cars. Over 120 helicopter accidents occur every year, with several hundred injuries and fatalities, and a few hundred million dollars in yearly losses (details in Churchwell et al. [1], and Saleh et al. [2]). These issues are cursorily noted to motivate the need for more research into helicopter accidents and for more vigorous safety intervention efforts by the regulators and other stakeholders in this industry.
Helicopter accidents have generally not received the same level of attention or thoroughness in the safety literature as accidents in other sectors such as chemical, oil and gas, or airline industries. Studies related to the helicopter safety have typically focused on a specific mission type or particular geographic area of operations. SINTEF, for example, examined trends and risk reduction factors for helicopters in the Norwegian oil and gas operations in the North Sea [3, 4]. These studies were the basis for a number of other investigations for similar helicopter missions and within the same geographic area [5–7]. Other studies have examined helicopter accidents in different areas of operations. Atkinson and Irving [8], for example, examined helicopter accidents in the UK. The authors found that light helicopters (weight less than 2,730 kg) had a significantly higher accident rate than their heavier counterparts; and that about 60% of all accidents were due to pilot errors. Another important study of helicopter safety was carried out by the European Helicopter Safety Team (EHEST) [9]. The organization, re-established as the European Safety Promotion Network Rotorcraft (ESPN-R) since 2017, examined helicopter accidents in Europe and provided recommendation of areas of improvement, including flight operations, and regulatory provisions. Accidents of helicopter medical emergency services (HEMS), another example of mission type, have received some attention in both the mainstream media and the technical literature. The National Transportation Safety Board (NTSB), for instance, HEMS accidents in 1988, and again in 2006 [10, 11]. The Board identified several deficiencies in EMS operations and made a number of recommendations to improve their safety track record, in particular better flight risk assessment and planning. Other researchers also examined medical helicopter accidents in the United States [12, 13] and found that there was a steady increase in the number of medical helicopter accidents during over time. Such findings, however, have to be interpreted cautiously because the lack of exposure data in these studies (the absence of denominator for calculating accident rates, such as total number of medical helicopters in operation or their total flight hours). A more extensive literature review can be found in the related articles by the authors [1, 2].
In this work, we seek to further advance the understanding of helicopter accidents and their association with a set of attributes or covariates. Our objectives are both methodological in nature and content-specific related to helicopter configurations. More precisely, our first objective is to demonstrate the application of logistic regression to modeling helicopter accidents. We detail in the next subsections our model-building process, the use of the developed model for inferential purposes, and the novel insights this statistical tool can provide. Our second objective is to identify and quantify the association, if any, between helicopter-specific configurations or attributes and their likelihood of accidents.
Once our logistic model is built and its goodness of fit is verified, we leverage it to investigate a set of research questions subsumed under this second objective. For example, one important question for the design and acquisition of helicopters is whether or not twin-engine helicopters exhibit a smaller likelihood of accidents than their single-engine counterparts, all else being equal. Intuition may suggest that this is likely the case. There are important consequences to this in terms of regulatory pressures, for example, in phasing out single-engine helicopters in favor of their twin counterparts. As a result, this question deserves careful attention beyond the common-sense expectation. The evidence-based answer, we will show, is more nuanced than the expected intuitive answer, that it is contingent on other covariates, and that a tipping point exists in terms of rotor blade diameter beyond which the likelihood of accidents of twin-engines is worse (higher) than that of their single-engine counterparts. We investigate two other inferential questions under this second objective: Do turboshaft helicopters with different number of main rotor blades have different likelihood of accidents, and if so, are these differences statistically significant? Is it better, worse, or irrelevant from a safety perspective to increase the main rotor diameter, all else being equal? The answer to the latter question can help inform design choices, for example, if wiggle room exists in the selection of rotor diameter beyond the performance, structural, and aerodynamic considerations.
We address these two objectives and provide the answers to these questions in this work. The answers lend themselves to a rich set of interpretive possibilities, and they deserve careful attention from the rotorcraft community. There remainder of this work is organized as follows. Section 2 discusses the data and methods used hereafter. Section 3 develops the logistic model and leverages it for inferential purposes. The limitations of this study are also discussed in Section 3. Section 4 concludes this work.
2. Data and methods
The present work utilizes publicly available data of civil helicopters from three sources: (1) the Federal Aviation Administration (FAA) for registration records; (2) the National Transportation Safety board (NTSB) for accident records; and (3) helicopter manufacturers for technical details available online in the public domain. The time frame for the data extends from January 2005 to December 2015. We excluded data related to gyrocopters, experimental and homebuilt helicopters since they are subject to different airworthiness specifications as well as different regulations regarding their maintenance and usage. We also excluded data recorded in territories and geographic regions within the domain of the FAA and NTSB but not classified as states, such as Virgin Islands and Puerto Rico. The reason for this was that the data from these regions were sparse and oftentimes inadequately recorded. We only include in our analysis adverse events formally classified as accidents. The NTSB defines accident as an occurrence: (1) associated with the operation of an aircraft that takes place between the time any person boards the aircraft with the intention of flight and all such persons have disembarked; (2) in which any person suffers death or serious injury; (3) in which the aircraft receives substantial damage. Incidents, minor adverse events that affect or could affect the safety of operations and which result in light or no damage, are not considered in this analysis. Their examination offers nonetheless useful learning opportunities and are left as fruitful venue for future work. The application of these exclusion filters resulted in a dataset with 13,055 helicopters and 1,572 accidents over the 11-year timespan of study.
For each helicopter, the dataset includes its identification (ID) number, whether it experienced an accident or not—this is the response variable in our analysis—and the following attributes or potential covariates: (1) the number of main rotor blades; (2) the number of engines; (3) the type of engines; (4) the diameter of main rotor blades (rotor diameter); and (5) the maximum takeoff weight (MTOW).
We treat MTOW as continuous variable instead of classifying it into discrete light/medium/heavy bins for two reasons. First, different agencies set different thresholds for helicopter weight category. The FAA, for example, does not categorize helicopters as light/medium/heavy, but as normal or transport helicopters based on MTOW: transport helicopters are those with MTOW greater than 7,000 pounds (3,175 kg). However, the National Interagency Fire Center (NIFC) does categorize helicopters into three bins: light helicopters with certified gross weight less than 6,000 pounds (2,722 kg), medium helicopters between 6,000 and 12,500 pounds (2,722 and 5,670 kg), and heavy helicopters with certified gross weight exceeding 12,500 pounds (5,670 kg). Second, from a statistical point of view, several studies [14, 15] have demonstrated that categorizing continuous variables leads to the loss of important information and increase in type I error. The categorization of continuous variable can also conceal possible nonlinearity in the relation between the variable and outcome, in addition to the fact that individual helicopters close to but on the opposite side of the thresholds are classified as being different rather than similar.
Table 1 provides a four-level frequency summary of our dataset. It shows, for example, that there is only one data point for a twin-engine helicopter with reciprocating engines. Furthermore, Table 1 shows that there are very few or no helicopters with a single reciprocating engine in the 5 - and 6-blade categories. This has an important implication: there is insufficient data to conduct statistical analysis using the entire dataset without encountering numerical problems (ill-conditioned or singular matrix). For this reason, we only focus in this work on turboshaft helicopters. Helicopters equipped with reciprocating engines, or only single engines, will be examined in future work. During the 11-year period of interest in this study, there were 8,338 turboshaft helicopters (64% of the original dataset) and 825 accidents.
To examine turboshaft helicopter accidents, we use logistic regression with this turboshaft dataset to construct a mathematical model for inferential purposes given a set of covariates (or configuration) x. This is the conditional probability that an accident occurs given a configuration captured in the vector x, Pr(accident = 1|x), which in general take the following form:
The unknowns in Eq (1) are the coefficients βi or the vector β whose components are these individual coefficients, and the form of the power in the exponent. The observations are assumed to be independent and identically distributed. To fit this model to the observed data, logistic regression uses maximum likelihood estimation to determine the best estimated coefficients:
A brief explanation of what the odds and odds ratio are warranted since these measures of association are central to logistic analysis, and they may not be as familiar to an engineering audience as other measures of association such as risk ratio. In our study, the odds of an accident is defined as the ratio of the probability that an accident occurs to the probability that the accident does not occur for a given configuration x:
By taking the log of the odds of accident and substituting Eq (1) to this expression, we obtain what is defined as the logit transformation g(x), which is linear in its parameters:
A particularly meaningful interpretation arises when we exponentiate the coefficient associated with a variable in Eq (4). Consider, for example, dichotomous variable x2 whose value is either 0 and 1, and suppose that this value represents single and twin engine respectively. Therefore, the ratio of the odds of accidents for twin engine (x2 = 1) to the odds of accidents for single engine (x2 = 0), all else being equal, is given by the odds ratio (OR):
Similar process also applies to other variables. A single coefficient is therefore a measure of the log of the odds ratio for different value of the associated variable in logistic regression (this is an adjusted odds ratio, which controls for all the other covariates xi≠2). This is a powerful result, and it accounts in part for the extensive adoption of logistic regression in many fields to model categorical variables. A more nuanced interpretation of the coefficients, however, is required when statistical interaction is present in the model. This will be carefully examined in the next section.
In the analysis that follows, we lumped the two-bladed and three-bladed turboshaft helicopters into one category. The reason for this was because we found that these two types of helicopters exhibited the same odds of accidents. Furthermore, we found that the models with 2-bladed and 3-bladed helicopters as separate groups on the one hand, and the model with the two as one group on the other hand generated identical results. Therefore, the categorization of the number of main rotor blades used in this study, and the associated design (dummy) variables are shown in Table 2.
To determine the best linear (in the parameters) form of the logistic regression model as well as the associated coefficients, we adopted the method of purposeful selection in logistic regression as our model-building strategy (developed by Hosmer et al. [16]). The method begins with a univariate analysis of each variable to assess the relevance, or lack thereof, of each candidate covariate for the response variable, here the likelihood of accident. It is then extended to multivariate logistic regression with all previously identified statistically significant covariates included, and further down-selection is applied (details in Fig 1 and next section). The method then diagnoses for possible confounders and assesses the scale (linearity) of the continuous variables. It then investigates the presence of statistical interactions to account for effect modifier(s), as this could significantly affect the odds ratio of accidents for the associated covariates and, hence, its model fitness. Once the final model is developed, we examine its goodness-of-fit, and we make extensive use of it for inference purposes in the next section. Throughout this study, the logistic regression analysis was performed using Stata version 15.1 software (Stata Corporation, College Station, TX).
3. Turboshaft helicopter accidents: Statistical learning, result, and discussion
We begin this section by executing on the model-building strategy discussed previously to develop the logistic model of turboshaft helicopter accidents. We then leverage this model for inferential purposes and determine the effect of varying each covariate (e.g., number of main rotor blades, number of engines) on the likelihood of accidents. Finally, we discuss the limitations of this analysis.
3.1 Logistic model building
The following discussion explains how we converged on the final logistic model for turboshaft helicopter accidents. The reader only interested in the end result can skip the developments in Section 3.1.1 and 3.1.2 and jump ahead to the final model expressed in Eq (7).
3.1.1 From univariate to multivariate models
The first step in the method of purposeful selection is to fit a univariate logistic regression model for each covariate (one at a time). The objective of this step is to examine the significance of the covariate to the model at the 25% level. The results of this analysis are shown in Table 3. Note that in this table, each row presents the results for the estimated regression coefficients from a model containing only that single covariate. The statistical significance of the estimated coefficient or crude odds ratio is examined using the Wald test and the associated p-value, that is, the likelihood that the null hypothesis H0 (the odds of accidents of two types of helicopters are equal) is true given the data. For example, when considering the number of main rotor blades (N_BLADES) as the only covariate, the penultimate column in Table 3 shows a crude odds ratio of 0.58, that is, the odds of accident of four-bladed turboshaft helicopters is 0.58 times the odds of accident of two - or three-bladed turboshaft helicopters. Similar interpretation applies to the univariate model with the number of engines (N_ENGINES) as the only covariate. The result in Table 3 shows a crude odds ratio of 0.49, that is, the odds of accidents of turboshaft helicopters with twin engines is nearly one-half the odds of accidents of turboshaft helicopters with a single engine.
The interpretation of the logistic model for continuous covariate is different from categorical ones. As an example, the estimated odds ratio in the univariate model containing only the rotor diameter (ROTORDIA) in Table 3 is interpreted to mean that for every increase of 1 ft (0.305 m) in rotor diameter, the odds of accidents changes by 0.94 times.
The results in Table 3 should not be used for inferential purposes as we have not yet considered all the covariates together nor have we accounted for the possibility that each model is confounded by other covariates. For our purposes given our model-building strategy (Fig 1), all the covariates, when examined independently (Table 3), are significant below the 25% level. Consequently, we include them all in our first multivariate model. This completes Step 1 in Fig 1.
The suite of building multivariate model is not straightforward, and several intermediate results are embedded in the process. To facilitate its understanding, we decompose the multivariate model development into three major steps shown in Fig 1: linear multivariate model (Step 2); main effect model (Step 3); and final model (Step 4). The results from Step 2 are discussed shortly, and the two remaining steps are addressed in the next subsections.
The linear multivariate model refers to the model from the output of Step 2 in Fig 1, where we evaluate for confounders, under the assumption that the continuous covariates are linear in the logit. In intermediate results not shown here, the presence of N_ENGINES in the model brings statistical adjustment to N_BLADES, and MTOW brings statistical adjustment to both N_BLADES and ROTORDIA. The implication of this fact is that, although the estimated coefficients for N_ENGINES and MTOW are not statistically significant in the multivariate model, their presence brings notable changes to the estimated coefficient for N_BLADES and ROTORDIA, and hence, should be included in the model. Therefore, the linear multivariate model contains all four covariates: N_BLADES, N_ENGINES, ROTORDIA and MTOW.
3.1.2 Assessment of linearity assumption for continuous covariates
The model development is far from over at the end of the previous step. The next step of the multivariate model development is referred to as the main effect model, and it is obtained after we investigate the linearity assumption of the continuous covariates involved in the previous step, i.e., rotor diameter (ROTORDIA) and MTOW. To do this, we present three different methods for comparison: smoothed scatter plot (lowess smooth), fractional polynomials, and linear spline functions. The lowess smoothing is a nonparametric approach that provides some indication about the relationship between the outcome (here, accidents) and the continuous covariate by computing the weighted average of the outcome from the subsets of bandwidth k × N observations. The default bandwidth k = 0.8 is used in this analysis. Note that the weighted average of the outcome is often expressed in the logit form using similar transformation as in Eq (4) for logistic regression. Therefore, if the lowess smoothing approach shows linear in the logit, then the continuous covariate is likely to be linear. Otherwise, if nonlinearity is detected, we would need to use an analytical approach to fit a parametric function that would satisfactorily capture the displayed nonlinearity; this is addressed by the two remaining methods discussed next.
The idea of fractional polynomials as developed by Royston and Altman [17] is to determine the number of terms and their corresponding powers for the continuous covariates in the logit that best fits the data. This is achieved first by an iterative process to search for the best powers for each number of terms (e.g., one-term, two-term continuous covariate model), then comparing them one another as well as with the model in which the continuous covariate is linear (details can be found in [16, 18]). The third method used here is spline function, which takes the idea of the draftsman’s spline to fit a series of smooth curves joined at specified points called knots. In this work, we only consider linear spline with one knot for which the location is determined based on the behavior depicted in the lowess smooth.
The application of these three methods for turboshaft helicopter accidents is shown in Fig 2, where the y-axis represents the log-odds of helicopter accidents, g(x). In Fig 2A, for example, we see a clear nonlinearity in the log-odds as a function of MTOW, and that the fractional polynomial fits better than the linear spline in capturing the lowess smooth behavior. In addition, in a side analysis not shown here, we calculated the deviance of the model (that is defined as D = -2×log-likelihood) with the two-term fractional polynomial and found it is smaller than that of the model with the linear spline, which further confirms that the fractional polynomial has the better fit to the model nonlinearity of MTOW in the logit.
The result of the scale of the continuous covariate ROTORDIA in Fig 2B raises an interesting dilemma. On the one hand, the one-term fractional polynomial fits the lowess smooth better than the linear spline when the rotor diameter is lower than 53 ft (16.15 m). On the other hand, the linear spline is able to capture the change in slope as the lowess smooth. However, by examining the source data, we found that the change in slope of the lowess smooth is due to only three accidents that occurred to helicopters with rotor diameter of 72 ft (21.95 m). Therefore, the exclusion of these helicopters and those with similar configurations, which is less than 0.1% of the dataset, leads to a linear behavior of ROTORDIA in the logit without measurably changing the estimated coefficient in the model. For this reason, we decided that the linearity assumption for ROTORDIA in the logit is valid. For added precaution and to remain on the conservative side, we propose that the results that follow not be extended beyond rotor diameters larger than 72 ft (21.95 m).
Hence, we conclude that the main effect model contains all four covariates (N_BLADES, N_ENGINES, ROTORDIA, and MTOW) whose logit g(x) is linear in ROTORDIA and nonlinear in MTOW with two-term fractional polynomial as described in Fig 2. This is the output of Step 3 in Fig 1. Therefore, the MTOW appears in two terms in the estimated logit of the main effect model as follows:
In an intermediate result not shown here, we found that the estimated coefficients of the main effect model are in general not statistically significant, except for the 4B versus the 2B-and-3B turboshaft helicopters. This situation indicates that the main effect model generates estimated probability of accidents with high standard errors, despite the fact that all of the important covariates are included. This is the main motivation for Step 4 in the model-building strategy: to explore the possibility of statistical interactions between covariates, and in the process to improve the performance of the fitted model. We examine this issue in the next subsection.
3.1.3 Statistical interactions and goodness of fit
The last step in the development of the multivariate model is completed after we examine whether or not statistical interactions between covariates exist and are statistically meaningful, and after checking the goodness-of-fit of the (candidate) final model with all the covariates and their possible interactions.
A statistical interaction describes a situation in which the effect of one covariate on the outcome depends on the state of the second covariate. The presence of the statistical interaction in a model implies that the odds ratio for the covariate that has the interaction must be specified at certain values. To better appreciate this, consider a hypothetical situation in epidemiology for example, where the presence or absence of Coronary Heart Disease (CHD) in a person is influenced by their age and gender. The absence of statistical interaction between these two covariates, age and gender, would indicate that the odds ratio of CHD between two individuals with different ages is independent of their gender (the two curves of the log-odds of CHD as a function of age for male and female are parallel). If there is statistical interaction between age and gender, it means that gender modifies the exposure to CHD as a function of age (and the two log-logit curves are not parallel). In which case, we cannot estimate the odds ratio of CHD between individuals of different ages without specifying their gender. In other words, gender is an effect modifier because it controls the effect of age on the CHD outcome.
In logistic regression, the statistical interaction between two variables is modeled by the inclusion of product terms of the two in the logit. For the method of purposeful selection, the search for relevant statistical interaction in the fitted model begins by the inclusion of each possible pair of interaction to the main effect model one at a time. The statistically significant and practically sensible interaction(s) are then included in the model for further assessment. We tested all possible interactions (not shown here for the sake of brevity) and found that only three interactions are important and statistically meaningful for further assessment. They are the interactions between: the number of main rotor blades with the number of engines; the number of engines with the rotor diameter; and the rotor diameter with the MTOW. Table 4 confirms this conclusion and demonstrates that these statistical interactions significantly improve the fitted model over the previous main effect model (seen here in the increase of the log-likelihood and the p-values of the corresponding partial likelihood-ratio test).
The inclusion of these three statistical interactions generates the model in Table 5. Note that an interaction is included in the model as long as at least one component is statistically significant [16]. In Table 5, we see this situation with the interaction between N_BLADES2×N_ENGINES which is statistically significant (p-value < 0.05). Thus, the interaction between the number of main rotor blades and the number of engines is included in the model despite the fact that the other two interaction components are not statistically significant. Next, we assess the model adequacy and its fitness before using it for inferential purposes.
To assess the model fitness, we conduct two different tests: the Hosmer-Lemeshow (H-L) test [16] and the Stukel’s test [19]. The H-L test is conducted by grouping the estimated probability based on percentiles and comparing with the observation data. The goodness-of-fit test using this method obtains that the p-value computed from the chi-square distribution with 6 degrees of freedom is 0.3317. Therefore, the null hypothesis H0 that the probability of accidents in each group between estimated and observation data is similar cannot be rejected. In other words, a comparison of the observed versus expected frequencies in each group shows close agreement, as shown in Table A in S1 Appendix. The Stukel’s test provides a similar conclusion. Hence, we conclude that the model shown in Table 5 is our final model for turboshaft helicopter accidents. The estimated probability of accident and its 95% confidence interval for a given configuration (number of main rotor blades, number of engines, rotor diameter, and MTOW) is written in mathematical form as follows:
3.2 Model inference: Adjusted odds ratio and implications
We now begin to unpack the implications contained in the final model developed in the previous subsection. We examine hereafter the odds ratio of accidents by changing one covariate at a time. First, we examine the odds ratio of accidents for turboshaft helicopters with different number of main rotor blades while controlling for all the other covariates (i.e., all else being equal), the reference group being the 2B-and-3B helicopters. Second, we examine the odds ratio of accidents for turboshaft helicopters with single versus twin engines. Third, we examine the odds ratio of accidents for turboshaft helicopters with different rotor diameters. Because of statistical interactions, the results cannot be displayed as single values, but will be presented in either a stratified manner, e.g., separately for single and twin engines for the first analysis, or as a function of one of the continuous covariates for the other two. The following discussion will further clarify these issues.
3.2.1 Adjusted odds ratio for different number of main rotor blades
One of the main motivations for this work was the simple question of whether turboshaft helicopters with different number of main rotor blades exhibited different likelihood of accidents. A more nuanced questions can now be formulated and addressed given our logistic model: do turboshaft helicopters with different number of main rotor blades have different odds of accidents, that is, controlling for all other covariates? And if so, are these differences statistically significant? To investigate these questions, we leverage the final model in Table 5 and Eq (7), and compute the estimated odds ratio of accidents for different number of main rotor blades, where the 2B-and-3B turboshaft helicopters are chosen as the reference group. As an example, the log-odds ratio of accidents for the 4B versus the 2B-and-3B turboshaft helicopters is computed as follows:
Note that the log-odds ratio in Eq (9) depends on another covariate, namely the number of engines due to the statistical interaction between these two. Therefore, to compute the estimated odds ratio of accidents for different number of main rotor blades, we have to specify the number of engines. The corresponding variance of the log-odds ratio can also be computed to provide the 95% confidence interval. For example, the log-odds ratio for the 4B turboshaft helicopters versus their 2B-and-3B counterparts among those with twin engines is ln[OR(4B,2B-and-3B)]=β^1,1+β^6,1. The associated estimated variance is computed as follows:
The covariance matrix is provided in Table B in S1 Appendix. This process is repeated for the single and twin engines, and for the other number of main rotor blades (5B and 6B versus 2B-and-3B). The results are shown in Fig 3.
How to interpret these results? Consider, for example, turboshaft helicopters with single engine (the left panel in Fig 3), the ones equipped with four main rotor blades are associated with approximately 0.677 times the odds of accidents of the reference group (2B-and-3B), all other covariates held constant. In addition, the 95% confidence interval of this odds ratio varies from 0.537 to 0.854, thus indicating that there is a statistically significant difference between the odds of accidents for the single-engine 4B turboshaft helicopters and the 2B-and-3B counterparts. For the single-engine 5B and 6B turboshaft helicopters, their odds ratios of accidents with respect to the reference group (2B-and-3B) are 2.2 and 2.4 respectively. And these differences are statistically significant. These are important findings, and they can help inform design and acquisition choices for helicopter manufacturers and operators. For example, if a single-engine turboshaft helicopter is under consideration for development or acquisition, all else being equal, the four-bladed choice is the best-in-class, and the five - or six-bladed choices are the worst-in-class in terms of their proneness to accidents.
The situation is different for the twin engines. As can be seen in the right panel of Fig 3, the odds of accidents of the 4B, 5B, and 6B turboshaft helicopters are lower than the odds of the reference group, namely the 2B-and-3B ones, and the odds ratios being 0.78, 0.62, and 0.65 respectively. But these differences are not statistically significant since the 95% confidence intervals contain the null value that the odds of the two are the same (OR = 1). The implication of these findings is that safety considerations have no bearing on, or do not help inform the selection of the number of main rotor blades for twin-engine turboshaft helicopters.
3.2.2 Adjusted odds ratio of twin - versus single-engine
Another main motivation for this work was the fundamental question of whether or not twin-engine turboshaft helicopters exhibited a smaller likelihood of accidents than their single-engine counterparts, all else being equal. Common sense and intuition may suggest that this is the case. There are important consequences to this intuition in terms of regulatory pressures, for example, in phasing out single-engine turboshaft helicopters in favor of the twins. As a result, this question deserves careful attention beyond the common-sense expectation. To investigate this question, we leverage again the final model in Table 5 and Eq (7) and compute the estimated odds ratio of accidents for different number of engines, where the single-engine turboshaft helicopters are chosen as the reference group.
The results are more nuanced and involved than what the common-sense answer would have been expected to be. To explain them, we begin by computing the log-odds ratio for twin - versus single-engine turboshaft helicopters as follows:
Note that the log-odds ratio in Eq (11) depends on two covariates, the number of main rotor blades and the rotor diameter, due to statistical interactions between these covariates with the number of engines (as seen in Table 5). In other words, the odds ratio of accidents for different number of engines is controlled by two effect modifiers. The first one, the number of main rotor blades, is a discrete variable, and we isolate its effect by stratifying the analysis and displaying the results separately in four different panels within the same figure. The second one, the rotor diameter, is a continuous variable and we will need to analyze and display the odds ratio as a function of this variable. It will be the x-axis in each of the panels in the figure of these results. Consider for example turboshaft helicopters with four main rotor blades. The log-odds ratio for twin - versus single-engine 4B turboshaft helicopters varies as a function of the rotor diameter:
The results are provided in Fig 4, and they require special attention and careful explanation. Consider for example the upper-right corner panel displaying the results for the 4B turboshaft helicopters. The panel displays three fundamental features to the results: (1) the odds ratio (twin - versus single-engine) of accidents increases (worsens) as the rotor diameter increases; (2) there exists a tipping point beyond which this odds ratio becomes greater than 1 (or the log-odds > 0), which indicates that the twin-engine turboshaft helicopters have a higher propensity to accidents than the single-engine ones, all else being equal; and (3) there are regions within the range of the rotor diameter below or above which the differences in the odds are statistically significant. We explain these in detail in the case of the 4B turboshaft helicopters.
We begin with the tipping point in the odds ratio or log-odds ratio since this delineates two distinctive regions: for a rotor diameter of 37 ft (11.27 m), the odds ratio between twin - versus single-engines is 1, which indicates that there is no advantage to having two engines over a single engine in a four-bladed turboshaft helicopter. Below this rotor diameter threshold, the twin-engine turboshaft helicopters have a lower propensity to accidents than the single-engine counterparts since they exhibit a smaller odds ratio. Above this rotor diameter threshold, the twin engines exhibit a higher propensity to accidents than their single-engine counterparts, all else being equal. To further clarify and emphasize this counter-intuitive result, it states that if the main rotor diameter is larger than 37 ft (11.27 m) on a four-bladed turboshaft helicopter, the twin engines are more prone to accidents than its single-engine counterpart.
Furthermore, the vertical dashed lines in the figure delineates the threshold(s) for which the differences in the odds of accidents for the twin - versus single-engine turboshaft helicopters are statistically significant. For example, in the upper-right corner panel (4B), we see that for rotor diameters below 31.75 ft (9.68 m), the upper bound of the 95% confidence interval is smaller than 1, which indicates there is a safety advantage of twin-engine turboshaft helicopters over their single-engine counterparts. We also see that for rotor diameters above 42 ft (12.80 m), the lower bound of the 95% confidence interval is larger than 1, which indicates a safety advantage of single-engine turboshaft helicopters over their twin-engine counterparts. For rotor diameters between these dashed lines boundaries, from 31.75 ft (9.68 m) to 42 ft (12.80 m), the differences are not statistically significant, and we cannot reject the null hypothesis that a twin-engine turboshaft helicopter offers no safety advantage over a single-engine counterpart, all else being equal. The interpretation of the results in the other panels is similar to the 4B ones. We simply note for instance the small range of rotor diameter below 35 ft (10.67 m), the twin-engine turboshaft helicopters offer a safety advantage over their single-engine counterparts for the 6B. Above that, there is no safety advantage to add another engine.
The causal basis for this intriguing result cannot be resolved with a statistical analysis such as this one, but the data and the modeling clearly demonstrate a coupling between the number of engines and the rotor diameter in terms of safety implications. While this deserves careful attention and further analysis from a structural perspective for example, there are some meaningful implications that can help inform the design of future helicopters.
3.2.3 Adjusted odds ratio for increasing rotor diameter
Given the previous results, we decided to further examine the effects of increasing rotor diameter in isolation of the other covariates. More specifically, we sought to analyze the odds ratio of turboshaft helicopter accidents when the rotor diameter is increased, all else held constant. The general question we seek to address is the following: all else being equal, are we better off increasing a helicopter’s rotor diameter to reduce its odds of accidents, or not? The answer can help inform design choices, for example, when wiggle room exists in the selection of rotor diameter beyond the purely structural and aerodynamic considerations. In other words, the answers can infuse safety considerations in addition to the traditional requirements in the down-selection process of the rotorcraft design.
Unlike the question in the previous subsection, there is no common-sense or intuitive (wrong) answer to this question. We leverage the final model in Table 5 and Eq (7) to address this question. We begin by computing the log-odds ratio for increasing rotor diameter, from a to b ft., all other covariates held constant:
The reference group in this case is the helicopter with the shorter rotor diameter a, and we examine the odds ratio of a similar helicopter in all other aspects except a larger rotor diameter b. Note that the log-odds ratio in Eq (14) depends on two covariates, the number of engines and the MTOW, and it is independent of the number of main rotor blades. In other words, the odds ratio for increasing rotor diameter is controlled by these two effect modifiers. The first one, the number of engines is a discrete variable, and we isolate its effect by stratifying the analysis and displaying the results separately in two different panels within the same figure. The second one, MTOW, is a continuous variable and we will need to analyze and display the adjusted odds ratio as a function of this variable. It will be the x-axis in each of the panels in the figure of these results.
Consider, for example, single-engine turboshaft helicopters, their log-odds ratio for an increase of 1 ft (0.305 m) in rotor diameter is expressed as follows:
Similar calculations are repeated for the twin-engine turboshaft helicopters. By exponentiating the log-odds ratio, we generate the estimated odds ratio for an increase of 1 ft (0.305 m) in rotor diameter as a function of the MTOW and its associated 95% confidence interval. The results are provided in Fig 5, and they require special attention and careful explanation.
Consider for example the right panel, which displays the odds ratio of accidents of twin-engine turboshaft helicopters for an increase in the main rotor diameter by 1 ft (0.305 m). We see again the tipping points and ranges of the MTOW where increasing the rotor diameter provides either a safety advantage or penalty in terms of decreasing or increasing the odds ratio of accidents. More specifically, we see that for the twin engines, the odds ratio of increasing the rotor diameter is always greater than 1, which indicates an increase in the propensity to accidents along with an increase in rotor diameter. Moreover, this increase is statistically significant below the MTOW threshold of 8,500 lbs (3,856 kg) and above 41,000 lbs (18,597 kg), as shown by the lower bound of the 95% confidence interval and the dashed line boundaries. A casual summary of this result can be stated as follows: for twin-engine turboshaft helicopters, it is better to keep the rotor diameter as short as required by other structural and aerodynamic considerations and not any longer.
The results for the single-engine turboshaft helicopters, however, are different. Notice for example in the left panel that for MTOW between 9,000 lbs (4,082 kg) and 19,500 lbs (8,845 kg), the odds ratio for increasing the rotor diameter is less than 1, including the upper bound of the 95% confidence interval. This result indicates that within this MTOW range, it is better from a safety perspective to increase the rotor diameter. No statistically significant results can be ascertained outside this range given that the 95% confidence interval include the null value OR = 1.
Again, the causal basis for this intriguing result cannot be resolved with a statistical analysis such as this one, but the data and the modeling clearly demonstrate an impact of varying the rotor diameter on the likelihood of helicopter accidents. The results are in some ways almost the opposite for single - and twin-engine turboshaft helicopters. While this deserves careful attention and further engineering analyses, there are some meaningful implications that can help inform the design of future helicopters.
3.3 Limitations
It is important to acknowledge the limitations of any statistical analysis, especially with observational studies such as the retrospective cohort study undertaken in this work. The most important limitation is that none of the results derived here should be taken as causal in nature. We established important relationships between the different covariates and the response variable, namely the likelihood of accidents, but these are merely associations, not causal in nature. The causal pathway, if it exists, may be mediated by several other things not accounted for here, and it cannot be ascertained in observational studies. The other limitation concerns the absence of two particular covariates in this study, namely the helicopter usage or mission type, and the intensity of usage or flight hours. Some of our results are possibly confounded by these missing variables.
Mission type, such as helicopters use for law enforcement, local news gathering, sight-seeing tours, or emergency medical services (HEMS), can modify the risk exposure of a rotorcraft to accidents beyond its particular configuration. For example, the 6B heavy twin-turboshaft helicopters with one of the highest (worst) probability of accidents are used for external-load operations, and this distinctive usage may account for its safety track-record. The difficulties in accounting for this usage variable are twofold: first, the FAA does not collect this data except for a small voluntary survey of operators, and when collected, the helicopters in question are not classified according to our covariates (no number of main rotor blades for example); second, it is likely that some helicopters are put to multiple use, or fractional use for different mission types. The absence of mission type data makes this variable unsuitable for inclusion in statistical analysis.
The absence of flight-hours should also be acknowledged as a limitation in this work. This requires some detailed explanation. It was addressed in a previous work by Churchwell et al. [1], and it is worth repeating here for ease of reading and to keep this work self-contained. Limited helicopter flight-hours data are collected in the US. Several authors, and the NTSB have lamented this state of affairs. For example, Fox [20] stated that “the lack of flight-hour exposure data [is a major] roadblock to the helicopter industry. If we cannot measure risk, we cannot tell whether our “improvement” is an actual one or whether it made the problem worse”. Knetch and Smith [21] recognized this limitation as well in their study of training school and examiner type on general aviation flight safety. The authors acknowledged that, “some readers will be disappointed and would prefer to see a study based on, say, accident per flight-hour, or per departure. Unfortunately, that kind of [exposure] data is not readily available.” The NTSB has also been cognizant of this limitation, in the case of helicopter medical emergency services for example. A snippet from the letter of a NTSB Board member is worth quoting: “I am concerned that the [voluntary survey] will not yield the information required to adequately monitor and evaluate the safety record of the EMS industry” [11]. What is the issue referred to here? The FAA estimates the flight hours of helicopters based on a voluntary annual survey known as the “General aviation and Part 135 Activity Survey”. The reluctance of the previously quoted authors to use this data is due to in part to the inherent voluntary response bias in this sampling exercise. We were not able to use these FAA flight-hour estimates in this work for some additional reasons:
The survey lumps different configurations of helicopters together (for example, all twin-engine turboshaft helicopters into a single category), and a single estimate of the flight hours for each category of helicopter is provided. This is not appropriate since the 2B-and-3B, the 4B, the 5B, and the 6B helicopters can be found with twin engines, and these helicopters can have different intensity of use. As a result, the estimate provided likely aggregates highly different (multi-modal) data points, and for which the mean is an otiose statistic. Furthermore, the bias in this estimate can be aggravated if for example the response rates are different for operators of the four-bladed helicopters than, say, the six-bladed ones. Since no such information is available, it is best to treat the survey results with guarded skepticism;
More importantly, since we were interested in examining, among other things, whether differences in number of main rotor blades are associated with different probability of accidents, the absence of this classification in the FAA estimates renders them unusable for our purposes.
The possibility that these missing variables confound our results can be mitigated to some extent by comparing only configurations that are likely to be used for similar mission types and with comparable intensity of usage. We conclude this subsection by noting that better data collection is warranted and recommend that the FAA collect measures of exposure for rotorcraft (e.g., flight-hours, usage) stratified appropriately in order to enable calculations of accident rates for different helicopter configurations. We reiterate what was noted earlier, that “the lack of flight-hour exposure data [is a major] roadblock to the helicopter industry. If we cannot measure risk [accident rates], we cannot tell whether our “improvement” is an actual one or whether it made the problem worse”.
4. Conclusions
In this work, we demonstrated the power of logistic regression to model turboshaft helicopter accidents. Our objective was to advance the understanding of these accidents, and to identify important issues for different stakeholders in the rotorcraft community to focus their attention on for accident prevention. This work, as noted in the Introduction, is part of a larger effort whose end-objective is to contribute toward improving the safety track record of helicopters, and ultimately to reduce the burden of injuries, fatalities, and financial losses due to helicopter accidents.
After a careful model-building process, we determined that four covariates, the number of main rotor blades, the number of engines, the rotor diameter, and the MTOW, are associated with the response variable of the model, namely the probability of accidents. Furthermore, we found that three interactions between these covariates are important and statistically meaningful. They are the interactions between the number of main rotor blades and the number of engines; the number of engines and the rotor diameter; and the rotor diameter and the MTOW. Then, having established and assessed the goodness-of-fit of the model, we leveraged it for inferential purposes. More specifically, we examined the adjusted odds ratio of accidents by changing one covariate at a time, and we teased out important implications in the process. Some of the important questions we addressed are the following
Q1. Do turboshaft helicopters with different number of main rotor blades have different odds of accidents, and if so, are these differences statistically significant? The answers to this are nuanced and required careful explanation. The answer to Q1 depends on the number of engines: for single-engine turboshaft helicopters, the four-bladed ones outperform (lowest odds of accidents) all the others in a statistically significant way. Whereas for twin-engines, no statistically significant difference is detected in the odds of accidents by varying the number of main rotor blades and holding all else constant.
Q2. Do twin-engine turboshaft helicopters exhibit a safety advantage over their single-engine counterparts (all else being equal), and, are these differences statistically significant? The results are more involved than what the common-sense answer would have been expected to be. We found that no one-size-fit all answer exists, and that the results are contingent on both the number of main rotor blades and the rotor diameter. More specifically, we found that (1) the adjusted odds ratio (twin - versus single-engine) of accidents increases (worsens) as the rotor diameter increases; (2) a tipping point exists beyond which twin-engine turboshaft helicopters have a higher propensity to accidents than the single-engine ones, all else being equal; (3) there are regions within the range of the rotor diameter below or above which the differences in the odds are statistically significant.
Q3. Is it better, worse, or irrelevant from a safety perspective to increase the main rotor diameter, all else being equal? What we found was that the answer is contingent on the number of engines and the MTOW. For example, for twin-engine turboshaft helicopters, there was an increase in the propensity to accidents along with an increase in rotor diameter, although there are regions of rotor diameter where the odds difference is not statistically significant. We causally summarized this finding by stating that for twin-engine turboshaft helicopters, it is better to keep the rotor diameter as short as required by other structural and aerodynamic considerations and not any longer. The results, however, were quite different for single-engine helicopters: we found that within a range of 9,000 lbs. (4,082 kg) < MTOW < 19,500 lbs. (8,845 kg), it is better from a safety perspective to increase the rotor diameter since doing so decreases the propensity to accidents.
The results provided here are relevant for different stakeholders in the rotorcraft community, and they lend themselves to a rich set of interpretive possibilities. The causal basis for these results cannot be resolved with a statistical analysis such as the one carried out here. Because of their significant safety implications, they deserve nonetheless careful attention from helicopter manufacturers, operators, and regulators.
Supporting information
S1 Appendix [pdf]
H-L goodness-of-fit table, estimated covariance matrix of fitted model, and the adjusted odds ratio of accidents for twin- versus single-engine.
Zdroje
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- Radiomics signature for prediction of lateral lymph node metastasis in conventional papillary thyroid carcinoma
- Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: A systematic review and meta-analysis
- Perceptions of risk and influences of choice in pregnant women with obesity. An evidence synthesis of qualitative research
- The role of refugee and migrant migration status on medication adherence: Mediation through illness perceptions
- Job stress and emotional exhaustion at work in Spanish workers: Does unhealthy work affect the decision to drive?
- Correction: Amphibians on the hotspot: Molecular biology and conservation in the South American Atlantic Rainforest
- Sexual risk classes among youth experiencing homelessness: Relation to childhood adversities, current mental symptoms, substance use, and HIV testing
- Time for change is now: Experiences of participants in a community-based approach for iron and folic acid supplementation in a rural county in Kenya, a qualitative study
- Non-invasive genetic monitoring for the threatened valley elderberry longhorn beetle
- Statistical learning for turboshaft helicopter accidents using logistic regression
- Vegetation change over seven years in the largest protected Pacific Northwest Bunchgrass Prairie remnant
- The effect of various metal-salts on the sedimentation of soil in a water-based suspension
- Using electronic health record system triggers to target delivery of a patient-centered intervention to improve venous thromboembolism prevention for hospitalized patients: Is there a differential effect by race?
- Effects of CK2β subunit down-regulation on Akt signalling in HK-2 renal cells
- Novel broad-spectrum activity-based probes to profile malarial cysteine proteases
- Health-related quality of life in cancer patients treated with immune checkpoint inhibitors: A systematic review on reporting of methods in randomized controlled trials
- Environmental tobacco smoke (ETS) and hyperlipidemia modified by perceived work stress
- Association between opioid analgesic therapy and initiation of buprenorphine management: An analysis of prescription drug monitoring program data
- Effect of a community-based approach of iron and folic acid supplementation on compliance by pregnant women in Kiambu County, Kenya: A quasi-experimental study
- Radiocarbon dating of two old African baobabs from India
- Improvement project in higher education institutions: A BPEP-based model
- An updated evaluation of serum sHER2, CA15.3, and CEA levels as biomarkers for the response of patients with metastatic breast cancer to trastuzumab-based therapies
- Genome-wide association study of metabolic syndrome in Korean populations
- The diagnostic accuracy of liver fibrosis in non-viral liver diseases using acoustic radiation force impulse elastography: A systematic review and meta-analysis
- Drug therapy problems and treatment satisfaction among ambulatory patients with epilepsy in a specialized hospital in Ethiopia
- Short- & long-term effects of monetary and non-monetary incentives to cooperate in public good games: An experiment
- Niche modeling reveals life history shifts in birds at La Brea over the last twenty millennia
- Morphological consequences of artificial cranial deformation: Modularity and integration
- Distributed flux balance analysis simulations of serial biomass fermentation by two organisms
- Plasma kynurenines and prognosis in patients with heart failure
- Occurrence and distribution of anthropogenic persistent organic pollutants in coastal sediments and mud shrimps from the wetland of central Taiwan
- Intensified visual clutter induces increased sympathetic signalling, poorer postural control, and faster torsional eye movements during visual rotation
- Restoration of cortical symmetry and binaural function: Cortical auditory evoked responses in adult cochlear implant users with single sided deafness
- A smartphone-enabled wireless and batteryless implantable blood flow sensor for remote monitoring of prosthetic heart valve function
- Gut microbiota composition alterations are associated with the onset of diabetes in kidney transplant recipients
- Shock index and TIMI risk index as valuable prognostic tools in patients with acute coronary syndrome complicated by cardiogenic shock
- Merit overrules theory of mind when young children share resources with others
- Economic burden of maternal morbidity – A systematic review of cost-of-illness studies
- Comparison of balance changes after inspiratory muscle or Otago exercise training
- Correction: Escherichia coli and Salmonella spp. isolated from Australian meat chickens remain susceptible to critically important antimicrobial agents
- Metabolic analysis of amino acids and vitamin B6 pathways in lymphoma survivors with cancer related chronic fatigue
- Cell-free DNA donor fraction analysis in pediatric and adult heart transplant patients by multiplexed allele-specific quantitative PCR: Validation of a rapid and highly sensitive clinical test for stratification of rejection probability
- Immunopathogenesis of canine chronic ulcerative stomatitis
- Correction: Quantification of speech and synchrony in the conversation of adults with autism spectrum disorder
- Efficacy and safety of ultrasonic circular cyclocoagulation with second-generation probe in glaucoma: A retrospective study
- Generalizing findings from a randomized controlled trial to a real-world study of the iLookOut, an online education program to improve early childhood care and education providers’ knowledge and attitudes about reporting child maltreatment
- Self-selection of food ingredients and agricultural by-products by the house cricket, Acheta domesticus (Orthoptera: Gryllidae): A holistic approach to develop optimized diets
- Machine learning detection of Atrial Fibrillation using wearable technology
- Comparative proteomic analysis of different stages of breast cancer tissues using ultra high performance liquid chromatography tandem mass spectrometer
- A cross-sectional study of psychopathy and khat abuse among prisoners in the correctional institution in Jimma, Ethiopia
- Head impulse compensatory saccades: Visual dependence is most evident in bilateral vestibular loss
- Complementarity of empirical and process-based approaches to modelling mosquito population dynamics with Aedes albopictus as an example—Application to the development of an operational mapping tool of vector populations
- Pepsin promotes laryngopharyngeal neoplasia by modulating signaling pathways to induce cell proliferation
- When and what to test for: A cost-effectiveness analysis of febrile illness test-and-treat strategies in the era of responsible antibiotic use
- Comparison of effects and safety in providing controlled hypotension during surgery between dexmedetomidine and magnesium sulphate: A meta-analysis of randomized controlled trials
- The gene encoding the ketogenic enzyme HMGCS2 displays a unique expression during gonad development in mice
- Seroepidemiological study of rubella in Vojvodina, Serbia: 24 years after the introduction of the MMR vaccine in the national immunization programme
- Efficacy of a mitochondrion-targeting agent for reducing the level of urinary protein in rats with puromycin aminonucleoside-induced minimal-change nephrotic syndrome
- Association of endothelial nitric oxide synthase (NOS3) gene polymorphisms with primary open-angle glaucoma in a Saudi cohort
- Antitrust analysis with upward pricing pressure and cost efficiencies
- Machine learning models for identifying preterm infants at risk of cerebral hemorrhage
- Natural selection contributes to food web stability
- Pyramiding QTLs controlling tolerance against drought, salinity, and submergence in rice through marker assisted breeding
- Diversity and plant growth-promoting functions of diazotrophic/N-scavenging bacteria isolated from the soils and rhizospheres of two species of Solanum
- Sustainability effects of motor control stabilisation exercises on pain and function in chronic nonspecific low back pain patients: A systematic review with meta-analysis and meta-regression
- Sofosbuvir-based regimen for genotype 2 HCV infected patients in Taiwan: A real world experience
- The virulence domain of Shigella IcsA contains a subregion with specific host cell adhesion function
- Sequencing artifacts derived from a library preparation method using enzymatic fragmentation
- Analysis of the Rdr1 gene family in different Rosaceae genomes reveals an origin of an R-gene cluster after the split of Rubeae within the Rosoideae subfamily
- Concomitant phytonutrient and transcriptome analysis of mature fruit and leaf tissues of tomato (Solanum lycopersicum L. cv. Oregon Spring) grown using organic and conventional fertilizer
- Quantitative analysis of adsorption and desorption of volatile organic compounds on reusable zeolite filters using gas chromatography
- Comparing bioinformatic pipelines for microbial 16S rRNA amplicon sequencing
- TMEM98 is a negative regulator of FRAT mediated Wnt/ß-catenin signalling
- Modeling migration patterns in the USA under sea level rise
- Quo vadis Pantanal? Expected precipitation extremes and drought dynamics from changing sea surface temperature
- Cloud-computing and machine learning in support of country-level land cover and ecosystem extent mapping in Liberia and Gabon
- An exploratory study on the quality of patient screening and counseling for hypertension management in Tanzania
- Relation of fibroblast growth factor receptor 2 expression to hepatocellular carcinoma recurrence after liver resection
- The Brief Measure of Emotional Preoperative Stress (B-MEPS) as a new predictive tool for postoperative pain: A prospective observational cohort study
- The impact of diabetes mellitus medication on the incidence of endogenous endophthalmitis
- Correction: Chl1 DNA helicase and Scc2 function in chromosome condensation through cohesin deposition
- Clinical and pathological features of thrombotic microangiopathy influencing long-term kidney transplant outcomes
- Multidisciplinary investigation of two Egyptian child mummies curated at the University of Tartu Art Museum, Estonia (Late/Graeco-Roman Periods)
- Occupational exposure to particulate matter from air pollution in the outdoor workplaces in Almaty during the cold season
- Morphological adjustment in free-living Steinernema feltiae infective juveniles to increasing concentration of Nemafric-BL phytonematicide
- Murine Surf4 is essential for early embryonic development
- Using mHealth to improve health care delivery in India: A qualitative examination of the perspectives of community health workers and beneficiaries
- Algorithmic handwriting analysis of the Samaria inscriptions illuminates bureaucratic apparatus in biblical Israel
- Key necroptotic proteins are required for Smac mimetic-mediated sensitization of cholangiocarcinoma cells to TNF-α and chemotherapeutic gemcitabine-induced necroptosis
- Concurrent lipidomics and proteomics on malignant plasma cells from multiple myeloma patients: Probing the lipid metabolome
- Short treatment with antalarmin alters adrenal gland receptors in the rat model of endometriosis
- Is it really always only the others who are to blame? GP’s view on medical overuse. A questionnaire study
- Serum visfatin and vaspin levels in hepatocellular carcinoma (HCC)
- Retraction: SDR9C7 Promotes Lymph Node Metastases in Patients with Esophageal Squamous Cell Carcinoma
- iTRAQ proteomics reveals the regulatory response to Magnaporthe oryzae in durable resistant vs. susceptible rice genotypes
- A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients
- Association between tuberculosis and depression on negative outcomes of tuberculosis treatment: A systematic review and meta-analysis
- Incidence and predictors of loss to follow up among adult HIV patients on antiretroviral therapy in University of Gondar Comprehensive Specialized Hospital: A competing risk regression modeling
- Point-of-care diagnostic (POCD) method for detecting Bursaphelenchus xylophilus in pinewood using recombinase polymerase amplification (RPA) with the portable optical isothermal device (POID)
- Bioluminescent imaging of Arabidopsis thaliana using an enhanced Nano-lantern luminescence reporter system
- Biosynthetic pathway of indole-3-acetic acid in ectomycorrhizal fungi collected from northern Thailand
- Clinical implications of elevated serum interleukin-6 in IgG4-related disease
- Downscaling NLDAS-2 daily maximum air temperatures using MODIS land surface temperatures
- Sex-specific and opposite modulatory aspects revealed by PPI network and pathway analysis of ischemic stroke in humans
- Plasma Trimethylamine-N-oxide and impaired glucose regulation: Results from The Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS)
- Self-esteem and other risk factors for depressive symptoms among adolescents in United Arab Emirates
- Control of the microsporidian parasite Nosema ceranae in honey bees (Apis mellifera) using nutraceutical and immuno-stimulatory compounds
- The effect of storage conditions on microbial communities in stool
- Role of donor genotype in RT-QuIC seeding activity of chronic wasting disease prions using human and bank vole substrates
- Influence of flow on phosphorus-dynamics and particle size in agricultural drainage ditch sediments
- A prospective, randomized, double-blind trial to compare body weight-adjusted and fixed doses of palonosetron for preventing postoperative nausea and vomiting in obese female patients
- Application of computerized 3D-CT texture analysis of pancreas for the assessment of patients with diabetes
- Predictive validation and forecasts of short-term changes in healthcare expenditure associated with changes in smoking behavior in the United States
- An information-based approach to handle various types of uncertainty in fuzzy bodies of evidence
- Oral magnesium supplementation for leg cramps in pregnancy—An observational controlled trial
- Health care professionals’ knowledge of commonly used sedative, analgesic and neuromuscular drugs: A single center (Rambam Health Care Campus), prospective, observational survey
- Campylobacter portucalensis sp. nov., a new species of Campylobacter isolated from the preputial mucosa of bulls
- OGG1 deficiency alters the intestinal microbiome and increases intestinal inflammation in a mouse model
- Transgenic interleukin 11 expression causes cross-tissue fibro-inflammation and an inflammatory bowel phenotype in mice
- Novel method to measure temporal windows based on eye movements during viewing of the Necker cube
- Whole blood transcriptomic analysis of beef cattle at arrival identifies potential predictive molecules and mechanisms that indicate animals that naturally resist bovine respiratory disease
- Effects of smoke flavoring using different wood chips and barbecuing on the formation of polycyclic aromatic hydrocarbons and heterocyclic aromatic amines in salmon fillets
- Sleep quality and sex modify the relationships between trait energy and fatigue on state energy and fatigue
- The role of peer, parental, and school norms in predicting adolescents’ attitudes and behaviours of majority and different minority ethnic groups in Croatia
- Filtered beauty in Oslo and Tokyo: A spatial frequency analysis of facial attractiveness
- The impact of rehabilitation frequency on the risk of stroke in patients with rheumatoid arthritis
- Availability, prices and affordability of selected antibiotics and medicines against non-communicable diseases in western Cameroon and northeast DR Congo
- The effect of mutations derived from mouse-adapted H3N2 seasonal influenza A virus to pathogenicity and host adaptation
- Detection of posttraumatic pneumothorax using electrical impedance tomography—An observer-blinded study in pigs with blunt chest trauma
- Educators’ perceptions of organisational readiness for implementation of a pre-adolescent transdisciplinary school health intervention for inter-generational outcomes
- Beyond the heterodimer model for mineralocorticoid and glucocorticoid receptor interactions in nuclei and at DNA
- The effects of sport expertise and shot results on basketball players’ action anticipation
- Framework and algorithms for identifying honest blocks in blockchain
- Efficacy and safety of anti-viral therapy for Hepatitis B virus-associated glomerulonephritis: A meta-analysis
- Selective transmission of some HIV-1 subtype C variants might depend on Envelope stimulating dendritic cells to secrete IL-10
- Noise reduction and quantification of fiber orientations in greyscale images
- Exploring the impact of terminology differences in blood and organ donor decision making
- Ontogenetic similarities between giraffe and sauropod neck osteological mobility
- Load transfer mechanism and critical length of anchorage zone for anchor bolt
- Income inequalities in stroke incidence and mortality: Trends in stroke-free and stroke-affected life years based on German health insurance data
- Community’s perception, experiences and health seeking behavior towards newborn illnesses in Debre Libanos District, North Shoa, Oromia, Ethiopia: Qualitative study
- Platelet indices significantly correlate with liver fibrosis in HCV-infected patients
- Reanalysis of the Bridge et al. study of suicide following release of 13 Reasons Why
- Validation of the easyscreen flavivirus dengue alphavirus detection kit based on 3base amplification technology and its application to the 2016/17 Vanuatu dengue outbreak
- The nitrate content of fresh and cooked vegetables and their health-related risks
- Bioreactor for mobilization of mesenchymal stem/stromal cells into scaffolds under mechanical stimulation: Preliminary results
- Serotonin transporter dependent modulation of food-seeking behavior
- Implicit task switching in Parkinson’s disease is preserved when on medication
- Root treatment with oxathiapiprolin, benthiavalicarb or their mixture provides prolonged systemic protection against oomycete foliar pathogens
- Real-world effectiveness and safety of ranibizumab for the treatment of myopic choroidal neovascularization: Results from the LUMINOUS study
- Non-gradient and genotype-dependent patterns of RSV gene expression
- Multiplex real-time PCR for the detection of Clavibacter michiganensis subsp. michiganensis, Pseudomonas syringae pv. tomato and pathogenic Xanthomonas species on tomato plants
- The 24-hour urinary cortisol in post-traumatic stress disorder: A meta-analysis
- Parasites modulate the gut-microbiome in insects: A proof-of-concept study
- The dynamics of shapes of vesicle membranes with time dependent spontaneous curvature
- Vascularization and biocompatibility of poly(ε-caprolactone) fiber mats for rotator cuff tear repair
- The shield of self-compassion: A buffer against disordered eating risk from physical appearance perfectionism
- Disease-specific out-of-pocket healthcare expenditure in urban Bangladesh: A Bayesian analysis
- Advanced biofilm analysis in streams receiving organic deicer runoff
- Upregulation of long non-coding RNA ROR1-AS1 promotes cell growth and migration in bladder cancer by regulation of miR-504
- Method development and validation for rapid identification of epigallocatechin gallate using ultra-high performance liquid chromatography
- Neonatal sepsis in Iran: A systematic review and meta-analysis on national prevalence and causative pathogens
- Drug-eluting versus bare-metal stents for first myocardial infarction in patients with atrial fibrillation: A nationwide population-based cohort study
- Same-day antiretroviral therapy initiation for HIV-infected adults in South Africa: Analysis of routine data
- Health-related quality of life among patients with type 2 diabetes mellitus in Eastern Province, Saudi Arabia: A cross-sectional study
- Photocatalytic biocidal effect of copper doped TiO2 nanotube coated surfaces under laminar flow, illuminated with UVA light on Legionella pneumophila
- The interoceptive hippocampus: Mouse brain endocrine receptor expression highlights a dentate gyrus (DG)–cornu ammonis (CA) challenge–sufficiency axis
- Educational attainment and HIV testing and counselling service utilisation during antenatal care in Ghana: Analysis of Demographic and Health Surveys
- Dissection of flag leaf metabolic shifts and their relationship with those occurring simultaneously in developing seed by application of non-targeted metabolomics
- Centromeres of Cucumis melo L. comprise Cmcent and two novel repeats, CmSat162 and CmSat189
- Acute high-intensity and moderate-intensity interval exercise do not change corticospinal excitability in low fit, young adults
- “I like the way I am, but I feel like I could get a little bit bigger”: Perceptions of body image among adolescents and youth living with HIV in Durban, South Africa
- Nanoparticle-based ‘turn-on’ scattering and post-sample fluorescence for ultrasensitive detection of water pollution in wider window
- The relationship of moral sensitivity and patient safety attitudes with nursing students’ perceptions of disclosure of patient safety incidents: A cross-sectional study
- Insights into the strategy of micro-environmental adaptation: Transcriptomic analysis of two alvinocaridid shrimps at a hydrothermal vent
- Thirty-day readmission after medical-surgical hospitalization for people who experience imprisonment in Ontario, Canada: A retrospective cohort study
- The effect of long-term brine discharge from desalination plants on benthic foraminifera
- Hyper-spectral response and estimation model of soil degradation in Kenli County, the Yellow River Delta
- Prescribing trends of glaucoma drugs in six major cities of China from 2013 to 2017
- Significant changes in synovial fluid microRNAs after high tibial osteotomy in medial compartmental knee osteoarthritis: Identification of potential prognostic biomarkers
- Reassortment and adaptive mutations of an emerging avian influenza virus H7N4 subtype in China
- Ischemia and reperfusion injury in superficial inferior epigastric artery-based vascularized lymph node flaps
- High failure rates of protease inhibitor-based antiretroviral treatment in rural Tanzania – A prospective cohort study
- Switchable resolution in soft x-ray tomography of single cells
- Mitochondrial DNA variations and mitochondrial dysfunction in Fanconi anemia
- Extended-spectrum beta-lactamase (ESBL)-producing and non-ESBL-producing Escherichia coli isolates causing bacteremia in the Netherlands (2014 – 2016) differ in clonal distribution, antimicrobial resistance gene and virulence gene content
- Molecular characterization of blaKHM-1 encoding plasmid in an Enterobacter hormaechei subsp. hoffmannii isolate from blood culture
- PR3 levels are impaired in plasma and PBMCs from Arabs with cardiovascular diseases
- Sex differences in self-regulation in early, middle and late adolescence: A large-scale cross-sectional study
- Interaction between elevated temperature and different types of Na-salicylate treatment in Brachypodium dystachion
- A highway crash risk assessment method based on traffic safety state division
- A brain connectivity characterization of children with different levels of mathematical achievement based on graph metrics
- Quantifying the level of difficulty to treat major depressive disorder with antidepressants: Treatment Resistance to Antidepressants Evaluation Scale
- Occupational gender segregation and economic growth in U.S. local labor markets, 1980 through 2010
- The association of telomere length and telomerase activity with adverse outcomes in older patients with non-ST-elevation acute coronary syndrome
- Construction of a high-density genetic map and fine mapping of a candidate gene locus for a novel branched-spike mutant in barley
- Alterations of aqueous humor Aβ levels in Aβ-infused and transgenic mouse models of Alzheimer disease
- Parameters impacting the live birth rate per transfer after frozen single euploid blastocyst transfer
- Deep2Full: Evaluating strategies for selecting the minimal mutational experiments for optimal computational predictions of deep mutational scan outcomes
- Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review and meta-analysis
- Distinctive effect of anesthetics on the effect of limb remote ischemic postconditioning following ischemic stroke
- Natural hybridization between Phyllagathis and Sporoxeia species produces a hybrid without reproductive organs
- Preliminary evaluation of a novel nine-biomarker profile for the prediction of autism spectrum disorder
- The impact of peer attachment on prosocial behavior, emotional difficulties and conduct problems in adolescence: The mediating role of empathy
- Spatial and climatic variables independently drive elevational gradients in ant species richness in the Eastern Himalaya
- What is the qualitative evidence concerning the risks, diagnosis, management and consequences of gastrointestinal infections in the community in the United Kingdom? A systematic review and meta-ethnography
- Naringenin protects AlCl3/D-galactose induced neurotoxicity in rat model of AD via attenuation of acetylcholinesterase levels and inhibition of oxidative stress
- Key barriers and enablers associated with uptake and continuation of oral pre-exposure prophylaxis (PrEP) in the public sector in Zimbabwe: Qualitative perspectives of general population clients at high risk for HIV
- Characterizing the University of California’s tenure-track teaching position from the faculty and administrator perspectives
- Restoration of Mal overcomes the defects of apoptosis in lung cancer cells
- Patient preferences for maintenance therapy in Crohn’s disease: A discrete-choice experiment
- Diagnostic performance of serum interferon gamma, matrix metalloproteinases, and periostin measurements for pulmonary tuberculosis in Japanese patients with pneumonia
- Hesperidin improves insulin resistance via down-regulation of inflammatory responses: Biochemical analysis and in silico validation
- Accuracy of intraocular lens power calculation formulas using a swept-source optical biometer
- Characterization of black patina from the Tiber River embankments using Next-Generation Sequencing
- Comparison of blood lactate and perceived exertion responses in two matched time-under-tension protocols
- Fibrin hydrogels are safe, degradable scaffolds for sub-retinal implantation
- Post-translational modifications of Drosophila melanogaster HOX protein, Sex combs reduced
- Problem gambling, associations with comorbid health conditions, substance use, and behavioural addictions: Opportunities for pathways to treatment
- Liganded T3 receptor β2 inhibits the positive feedback autoregulation of the gene for GATA2, a transcription factor critical for thyrotropin production
- Characterization of METTL16 as a cytoplasmic RNA binding protein
- Impact of long-term storage and freeze-thawing on eight circulating microRNAs in plasma samples
- Nanosheet wrapping-assisted coverslip-free imaging for looking deeper into a tissue at high resolution
- Assessment of dynamic cerebral autoregulation in humans: Is reproducibility dependent on blood pressure variability?
- Early diagnosis of sepsis in emergency departments, time to treatment, and association with mortality: An observational study
- Validity of cerebrovascular ICD-9-CM codes in healthcare administrative databases. The Umbria Data-Value Project
- Tuberculoid leprosy: An in vivo microvascular evaluation of cutaneous lesions
- Neuromuscular blockers in the acute respiratory distress syndrome: A meta-analysis
- Identification of putative Type-I sex pheromone biosynthesis-related genes expressed in the female pheromone gland of Streltzoviella insularis
- Redefining transcriptional regulation of the APOE gene and its association with Alzheimer’s disease
- Disease-relevant mutations alter amino acid co-evolution networks in the second nucleotide binding domain of CFTR
- A bushel of viruses: Identification of seventeen novel putative viruses by RNA-seq in six apple trees
- Torque teno virus viral load is related to age, CMV infection and HLA type but not to Alzheimer's disease
- The variability of bacterial communities in both the endosphere and ectosphere of different niches in Chinese chives (Allium tuberosum)
- Tripartite factors leading to molecular divergence between human and murine smooth muscle
- Characterization of dermal skin innervation in fibromyalgia syndrome
- A neonatal nonhuman primate model of gestational Zika virus infection with evidence of microencephaly, seizures and cardiomyopathy
- A scoping review of importation and predictive models related to vector-borne diseases, pathogens, reservoirs, or vectors (1999–2016)
- Assessment of climate change impact on the malaria vector Anopheles hyrcanus, West Nile disease, and incidence of melanoma in the Vojvodina Province (Serbia) using data from a regional climate model
- Associations of cigarette smoking and burden of thoracic aortic calcification in asymptomatic individuals: A dose-response relationship
- Healthcare utilization of Mexican-American Medicare beneficiaries with and without Alzheimer’s disease and related dementias
- Evaluation of questionnaire as an instrument to measure the level of nutritional and weight gain knowledge in pregnant women in Poland. A pilot study
- TranCEP: Predicting the substrate class of transmembrane transport proteins using compositional, evolutionary, and positional information
- Non-Invasive Functional-Brain-Imaging with an OPM-based Magnetoencephalography System
- Expression of acyl-CoA-binding protein 5 from Rhodnius prolixus and its inhibition by RNA interference
- Transforming assessment of speech in children with cleft palate via online crowdsourcing
- High prevalence of off-label and unlicensed paediatric prescribing in a hospital in Indonesia during the period Aug.—Oct. 2014
- General practice management of rotator cuff related shoulder pain: A reliance on ultrasound and injection guided care
- Estimating the population size of female sex workers and transgender women in Sri Lanka
- Can helmet decrease mortality of craniocerebral trauma patients in a motorcycle accident?: A propensity score matching
- Obesity, smoking habits, and serum phosphate levels predicts mortality after life-style intervention
- Treatment of children under 4 years of age with medulloblastoma and ependymoma in the HIT2000/HIT-REZ 2005 trials: Neuropsychological outcome 5 years after treatment
- Can a semi-quantitative method replace the current quantitative method for the annual screening of microalbuminuria in patients with diabetes? Diagnostic accuracy and cost-saving analysis considering the potential health burden
- A two-arm parallel double-blind randomised controlled pilot trial of the efficacy of Omega-3 polyunsaturated fatty acids for the treatment of women with endometriosis-associated pain (PurFECT1)
- Association of benzodiazepines, opioids and tricyclic antidepressants use and falls in trauma patients: Conditional effect of age
- Burden and risk factors of cutaneous leishmaniasis in a peri-urban settlement in Kenya, 2016
- Predicting strike susceptibility and collision patterns of the common buzzard at wind turbine structures in the federal state of Brandenburg, Germany
- Embryonic thermal manipulation has short and long-term effects on the development and the physiology of the Japanese quail
- High-order radiomics features based on T2 FLAIR MRI predict multiple glioma immunohistochemical features: A more precise and personalized gliomas management
- Human-raptor conflict in rural settlements of Colombia
- Regional adaptations and parallel mutations in Feline panleukopenia virus strains from China revealed by nearly-full length genome analysis
- Long-term ecological research in southern Brazil grasslands: Effects of grazing exclusion and deferred grazing on plant and arthropod communities
- Assessment of peritoneal microbial features and tumor marker levels as potential diagnostic tools for ovarian cancer
- Survival analysis of 230 patients with unresectable hepatocellular carcinoma treated with bland transarterial embolization
- Adverse drug reaction reporting practice and associated factors among medical doctors in government hospitals in Addis Ababa, Ethiopia
- TaWAK6 encoding wall-associated kinase is involved in wheat resistance to leaf rust similar to adult plant resistance
- Deficiency syndromes in top predators associated with large-scale changes in the Baltic Sea ecosystem
- The inhibitor of apoptosis proteins antagonist Debio 1143 promotes the PD-1 blockade-mediated HIV load reduction in blood and tissues of humanized mice
- Allele specific expression of Dof genes responding to hormones and abiotic stresses in sugarcane
- Perceived relative social status and cognitive load influence acceptance of unfair offers in the Ultimatum Game
- Quantitative evaluation of choriocapillaris using optical coherence tomography and optical coherence tomography angiography in patients with central serous chorioretinopathy after half-dose photodynamic therapy
- Structure-function analyses of candidate small molecule RPN13 inhibitors with antitumor properties
- Extracting lung function measurements to enhance phenotyping of chronic obstructive pulmonary disease (COPD) in an electronic health record using automated tools
- Multiple fragmented habitat-patch use in an urban breeding passerine, the Short-toed Treecreeper
- Histological and immunohistochemical characterization of the porcine ocular surface
- Household environmental tobacco smoke exposure in healthy young children in Hong Kong: Prevalence and risk factors
- Wind energy development and wildlife conservation in Lithuania: A mapping tool for conflict assessment
- Characteristics and prognosis of primary treatment-naïve oral cavity squamous cell carcinoma in Norway, a descriptive retrospective study
- Effect of epoch length on intensity classification and on accuracy of measurement under controlled conditions on treadmill: Towards a better understanding of accelerometer measurement
- Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda: A pilot study
- Error rates of human reviewers during abstract screening in systematic reviews
- Faecal analyses and alimentary tracers reveal the foraging ecology of two sympatric bats
- Urethral realignment with maximal urethral length and bladder neck preservation in robot-assisted radical prostatectomy: Urinary continence recovery
- Error metrics determination in functionally approximated circuits using SAT solvers
- Spatial movement pattern recognition in soccer based on relative player movements
- A novel visual ranking system based on arterial spin labeling perfusion imaging for evaluating perfusion disturbance in patients with ischemic stroke
- Prospective Validation of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score for Necrotizing Fasciitis of the Extremities
- The importance of transporters and cell polarization for the evaluation of human stem cell-derived hepatic cells
- Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study
- Morphological and functional characteristics of mitral annular calcification and their relationship to stroke
- And the nominees are: Using design-awards datasets to build computational aesthetic evaluation model
- Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review
- Multidimensional Scales of Perceived Self-Efficacy (MSPSE): Measurement invariance across Italian and Colombian adolescents
- Diversity of Mycobacteriaceae from aquatic environment at the São Paulo Zoological Park Foundation in Brazil
- A graph-based algorithm for RNA-seq data normalization
- Parents’ underestimation of their child’s weight status. Moderating factors and change over time: A cross-sectional study
- Pharmacokinetics, absolute bioavailability and tolerability of ketamine after intranasal administration to dexmedetomidine sedated dogs
- Spatial variation in fertilizer prices in Sub-Saharan Africa
- Knowledge, beliefs, and concerns about bone health from a systematic review and metasynthesis of qualitative studies
- Successful isolation of Treponema pallidum strains from patients’ cryopreserved ulcer exudate using the rabbit model
- Effects of size and elasticity on the relation between flow velocity and wall shear stress in side-wall aneurysms: A lattice Boltzmann-based computer simulation study
- Pupil response to noxious corneal stimulation
- Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients
- The impact of computed radiography and teleradiology on patients’ diagnosis and treatment in Mweso, the Democratic Republic of Congo
- Differential effects of synthetic psychoactive cathinones and amphetamine stimulants on the gut microbiome in mice
- Hepatitis B and C virus infection among HIV patients within the public and private healthcare systems in Chile: A cross-sectional serosurvey
- Increased episodes of aspiration on videofluoroscopic swallow study in children with nasogastric tube placement
- Obstructive sleep apnea and hypopnea syndrome in patients admitted in a tertiary hospital in Cameroon: Prevalence and associated factors
- Association of single nucleotide polymorphisms with dyslipidemia in antiretroviral exposed HIV patients in a Ghanaian population: A case-control study
- Sonic Hedgehog upregulation does not enhance the survival and engraftment of stem cell-derived cardiomyocytes in infarcted hearts
- The pharmacokinetic parameters and the effect of a single and repeated doses of memantine on gastric myoelectric activity in experimental pigs
- Blind method for discovering number of clusters in multidimensional datasets by regression on linkage hierarchies generated from random data
- Predictive factors of first dosage intravenous immunoglobulin-related adverse effects in children
- Description and characterization of the artisanal elasmobranch fishery on Guatemala’s Caribbean coast
- Individual and community level determinants of short birth interval in Ethiopia: A multilevel analysis
- Effects of rejection intensity and rejection sensitivity on social approach behavior in women
- The impact of IoT security labelling on consumer product choice and willingness to pay
- The development and validation of a measurement instrument to investigate determinants of health care utilisation for low back pain in Ethiopia
- Validity of the French version of the Autonomy Preference Index and its adaptation for patients with advanced cancer
- The epidemiological characteristics and spatio-temporal analysis of childhood hand, foot and mouth disease in Korea, 2011-2017
- Exponential random graph model parameter estimation for very large directed networks
- The implementation of community-based diabetes and hypertension management care program in Indonesia
- Effect of temperature variation on hospital admissions and outcomes in dogs with myxomatous mitral valve disease and new onset pulmonary edema
- The development of the Police Practices Scale: Understanding policing approaches towards street-based female sex workers in a U.S. City
- A capability approach to assess aquaculture sustainability standard compliance
- Pre-collecting lymphatic vessels form detours following obstruction of lymphatic flow and function as collecting lymphatic vessels
- Construct validity and reliability of the Talent Development Environment Questionnaire in Caribbean youth track and field athletes
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- Correction: Extraversion personality, perceived health and activity participation among community-dwelling aging adults in Hong Kong
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- The use of telephone communication between nurse navigators and their patients
- CNP mediated selective toxicity on melanoma cells is accompanied by mitochondrial dysfunction
- HIV RNA measurement in dried blood spots of HIV-infected patients in Thailand using Abbott m2000 system
- Retraction: Oncogenic Fibulin-5 Promotes Nasopharyngeal Carcinoma Cell Metastasis through the FLJ10540/AKT Pathway and Correlates with Poor Prognosis
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- Analysis on hydraulic characteristics of improved sandy soil with soft rock
- Development and use of a scale to assess gender differences in appraisal of mistreatment during childbirth among Ethiopian midwifery students
- Factors for starting biosimilar TNF inhibitors in patients with rheumatic diseases in the real world
- Correction: Force field generalization and the internal representation of motor learning
- Prevalence and foetomaternal effects of iron deficiency anaemia among pregnant women in Lagos, Nigeria
- Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC)
- Microbiome signatures in neonatal central line associated bloodstream infections
- Interventions for incarcerated adults with opioid use disorder in the United States: A systematic review with a focus on social determinants of health
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- The impact of lowbush blueberry (Vaccinium angustifolium Ait.) and cranberry (Vaccinium macrocarpon Ait.) pollination on honey bee (Apis mellifera L.) colony health status
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- Patterns of symptoms possibly indicative of cancer and associated help-seeking behaviour in a large sample of United Kingdom residents—The USEFUL study
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- Use of magnetic resonance imaging to determine laterality of meniscal size in healthy volunteers
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- Thermal biology of two tropical lizards from the Ecuadorian Andes and their vulnerability to climate change
- When weight is an encumbrance; avoidance of stairs by different demographic groups
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- From the host's point of view: Effects of variation in burying beetle brood care and brood size on the interaction with parasitic mites
- Kernel-based Gaussian process for anomaly detection in sparse gamma-ray data
- Unmet care needs of children with ADHD
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- The role of moral reasoning & personality in explaining lyrical preferences
- Would you like to participate in this trial? The practice of informed consent in intrapartum research in the last 30 years
- Correction: Mutation spectrums of TSC1 and TSC2 in Chinese women with lymphangioleiomyomatosis (LAM)
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- Challenges associated with homologous directed repair using CRISPR-Cas9 and TALEN to edit the DMD genetic mutation in canine Duchenne muscular dystrophy
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- A prospective case-control study on miRNA circulating levels in subjects born small for gestational age (SGA) evaluated from childhood into young adulthood
- Polymer-fiber-coupled field-effect sensors for label-free deep brain recordings
- Global depth perception alters local timing sensitivity
- How to detect a polytrauma patient at risk of complications: A validation and database analysis of four published scales
- Module for SWC neuron morphology file validation and correction enabled for high throughput batch processing
- Reduced gray matter volume and cortical thickness associated with traffic-related air pollution in a longitudinally studied pediatric cohort
- Recombinant human soluble thrombomodulin is associated with attenuation of sepsis-induced renal impairment by inhibition of extracellular histone release
- Human and climatic drivers affect spatial fishing patterns in a multiple-use marine protected area: The Galapagos Marine Reserve
- Correction: Leisure-time physical activity and sports in the Brazilian population: A social disparity analysis
- Application of the mixture item response theory model to the Self-Administered Food Security Survey Module for Children
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- Improved multi-parametric prediction of tissue outcome in acute ischemic stroke patients using spatial features
- Genome-wide association and epistatic interactions of flowering time in soybean cultivar
- Correction: Association between workplace bullying and burnout, professional quality of life, and turnover intention among clinical nurses
- Correction: Estimation of membrane bending modulus of stiffness tuned human red blood cells from micropore filtration studies
- Correction: Limited indirect effects of an infant pneumococcal vaccination program in an aging population
- Correction: Targeting of the Plzf Gene in the Rat by Transcription Activator-Like Effector Nuclease Results in Caudal Regression Syndrome in Spontaneously Hypertensive Rats
- Fieldwork-based determination of design priorities for point-of-use drinking water quality sensors for use in resource-limited environments
- Young women’s reproductive health conversations: Roles of maternal figures and clinical practices
- Correction: Differential recordings of local field potential: A genuine tool to quantify functional connectivity
- Survival of medial versus lateral unicompartmental knee arthroplasty: A meta-analysis
- Novel MscL agonists that allow multiple antibiotics cytoplasmic access activate the channel through a common binding site
- Is it time to stop sweeping data cleaning under the carpet? A novel algorithm for outlier management in growth data
- Changes in oak (Quercus robur) photosynthesis after winter moth (Operophtera brumata) herbivory are not explained by changes in chemical or structural leaf traits
- Mutual interaction between motor cortex activation and pain in fibromyalgia: EEG-fNIRS study
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- Analysis of cholesterol in mouse brain by HPLC with UV detection
- Sugar, amino acid and inorganic ion profiling of the honeydew from different hemipteran species feeding on Abies alba and Picea abies
- Exploring prior diseases associated with incident late-onset Alzheimer’s disease dementia
- Hypertension prevalence in patients attending tertiary pain management services, a registry-based Australian cohort study
- SRL pathogenicity island contributes to the metabolism of D-aspartate via an aspartate racemase in Shigella flexneri YSH6000
- Correction: Comprehensive genome-wide analysis of the pear (Pyrus bretschneideri) laccase gene (PbLAC) family and functional identification of PbLAC1 involved in lignin biosynthesis
- Epilepsy in a melanocyte-lineage mTOR hyperactivation mouse model: A novel epilepsy model
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- Mixed evidence for the relationship between periodontitis and Alzheimer’s disease: A bidirectional Mendelian randomization study
- Correction: Health conditions associated with overweight in climacteric women
- Correction: Determining Glomerular Filtration Rate in Homozygous Sickle Cell Disease: Utility of Serum Creatinine Based Estimating Equations
- Modelling the number of antenatal care visits in Bangladesh to determine the risk factors for reduced antenatal care attendance
- Correction: Cumulative viral load as a predictor of CD4+ T-cell response to antiretroviral therapy using Bayesian statistical models
- Dominant negative effects by inactive Spa47 mutants inhibit T3SS function and Shigella virulence
- ICOS-deficient and ICOS YF mutant mice fail to control Toxoplasma gondii infection of the brain
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- Life history of northern Gulf of Mexico Warsaw grouper Hyporthodus nigritus inferred from otolith radiocarbon analysis
- Physiology education for intensive care medicine residents: A 15-minute interactive peer-led flipped classroom session
- Strengthening capacity for natural sciences research: A qualitative assessment to identify good practices, capacity gaps and investment priorities in African research institutions
- Systematic scoping review of the concept of ‘genetic identity’ and its relevance for germline modification
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- Retraction: Outer Membrane Protein A (OmpA) of Shigella flexneri 2a Induces TLR2-Mediated Activation of B Cells: Involvement of Protein Tyrosine Kinase, ERK and NF-κB
- Retraction: Biofabrication of streptomycin-conjugated calcium phosphate nanoparticles using red ginseng extract and investigation of their antibacterial potential
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- Podocyte autophagy is associated with foot process effacement and proteinuria in patients with minimal change nephrotic syndrome
- Effect of Lactobacillus acidophilus D2/CSL (CECT 4529) supplementation in drinking water on chicken crop and caeca microbiome
- Retraction: MiR-30a-5p Antisense Oligonucleotide Suppresses Glioma Cell Growth by Targeting SEPT7
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- Correction: Tissue-Specific Expressed Antibody Variable Gene Repertoires
- Retraction: Immunoglobulin G Expression in Lung Cancer and Its Effects on Metastasis
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- Retraction: Use of Granulocyte Colony-Stimulating Factor for the Treatment of Thin Endometrium in Experimental Rats
- Correction: Dynamic mechanical and nanofibrous topological combinatory cues designed for periodontal ligament engineering
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- Core Scientific Dataset Model: A lightweight and portable model and file format for multi-dimensional scientific data
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- Correction: Strategies for achieving high sequencing accuracy for low diversity samples and avoiding sample bleeding using illumina platform
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