Community Case Management of Fever Due to Malaria and Pneumonia in Children Under Five in Zambia: A Cluster Randomized Controlled Trial
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{"title"=>"Community case management of fever due to malaria and pneumonia in children under five in zambia: A cluster randomized controlled trial", "type"=>"journal", "authors"=>[{"first_name"=>"Kojo", "last_name"=>"Yeboah-Antwi", "scopus_author_id"=>"6505943384"}, {"first_name"=>"Portipher", "last_name"=>"Pilingana", "scopus_author_id"=>"36551640800"}, {"first_name"=>"William B.", "last_name"=>"Macleod", "scopus_author_id"=>"35916357100"}, {"first_name"=>"Katherine", "last_name"=>"Semrau", "scopus_author_id"=>"6603281616"}, {"first_name"=>"Kazungu", "last_name"=>"Siazeele", "scopus_author_id"=>"36551555500"}, {"first_name"=>"Penelope", "last_name"=>"Kalesha", "scopus_author_id"=>"36551311100"}, {"first_name"=>"Busiku", "last_name"=>"Hamainza", "scopus_author_id"=>"26429327000"}, {"first_name"=>"Phil", "last_name"=>"Seidenberg", "scopus_author_id"=>"36616542200"}, {"first_name"=>"Arthur", "last_name"=>"Mazimba", "scopus_author_id"=>"6507772332"}, {"first_name"=>"Lora", "last_name"=>"Sabin", "scopus_author_id"=>"6603506911"}, {"first_name"=>"Karen", "last_name"=>"Kamholz", "scopus_author_id"=>"12795845900"}, {"first_name"=>"Donald M.", "last_name"=>"Thea", "scopus_author_id"=>"7004245833"}, {"first_name"=>"Davidson H.", "last_name"=>"Hamer", "scopus_author_id"=>"35433232300"}], "year"=>2010, "source"=>"PLoS Medicine", "identifiers"=>{"pui"=>"359754400", "sgr"=>"77957885216", "pmid"=>"20877714", "scopus"=>"2-s2.0-77957885216", "isbn"=>"1549-1676 (Electronic)\\n1549-1277 (Linking)", "doi"=>"10.1371/journal.pmed.1000340", "issn"=>"15491277"}, "id"=>"f1d9ba64-4f55-3c85-aab9-95a057778b32", "abstract"=>"BACKGROUND: Pneumonia and malaria, two of the leading causes of morbidity and mortality among children under five in Zambia, often have overlapping clinical manifestations. Zambia is piloting the use of artemether-lumefantrine (AL) by community health workers (CHWs) to treat uncomplicated malaria. Valid concerns about potential overuse of AL could be addressed by the use of malaria rapid diagnostics employed at the community level. Currently, CHWs in Zambia evaluate and treat children with suspected malaria in rural areas, but they refer children with suspected pneumonia to the nearest health facility. This study was designed to assess the effectiveness and feasibility of using CHWs to manage nonsevere pneumonia and uncomplicated malaria with the aid of rapid diagnostic tests (RDTs).\\n\\nMETHODS AND FINDINGS: Community health posts staffed by CHWs were matched and randomly allocated to intervention and control arms. Children between the ages of 6 months and 5 years were managed according to the study protocol, as follows. Intervention CHWs performed RDTs, treated test-positive children with AL, and treated those with nonsevere pneumonia (increased respiratory rate) with amoxicillin. Control CHWs did not perform RDTs, treated all febrile children with AL, and referred those with signs of pneumonia to the health facility, as per Ministry of Health policy. The primary outcomes were the use of AL in children with fever and early and appropriate treatment with antibiotics for nonsevere pneumonia. A total of 3,125 children with fever and/or difficult/fast breathing were managed over a 12-month period. In the intervention arm, 27.5% (265/963) of children with fever received AL compared to 99.1% (2066/2084) of control children (risk ratio 0.23, 95% confidence interval 0.14-0.38). For children classified with nonsevere pneumonia, 68.2% (247/362) in the intervention arm and 13.3% (22/203) in the control arm received early and appropriate treatment (risk ratio 5.32, 95% confidence interval 2.19-8.94). There were two deaths in the intervention and one in the control arm.\\n\\nCONCLUSIONS: The potential for CHWs to use RDTs, AL, and amoxicillin to manage both malaria and pneumonia at the community level is promising and might reduce overuse of AL, as well as provide early and appropriate treatment to children with nonsevere pneumonia.\\n\\nTRIAL REGISTRATION: ClinicalTrials.govNCT00513500", "link"=>"http://www.mendeley.com/research/community-case-management-fever-due-malaria-pneumonia-children-under-five-zambia-cluster-randomized-1", "reader_count"=>131, "reader_count_by_academic_status"=>{"Unspecified"=>4, "Professor > Associate Professor"=>8, "Librarian"=>3, "Researcher"=>23, "Student > Doctoral Student"=>8, "Student > Ph. D. Student"=>23, "Student > Postgraduate"=>14, "Student > Master"=>28, "Other"=>7, "Student > Bachelor"=>3, "Lecturer"=>3, "Lecturer > Senior Lecturer"=>3, "Professor"=>4}, "reader_count_by_user_role"=>{"Unspecified"=>4, "Professor > Associate Professor"=>8, "Librarian"=>3, "Researcher"=>23, "Student > Doctoral Student"=>8, "Student > Ph. D. Student"=>23, "Student > Postgraduate"=>14, "Student > Master"=>28, "Other"=>7, "Student > Bachelor"=>3, "Lecturer"=>3, "Lecturer > Senior Lecturer"=>3, "Professor"=>4}, "reader_count_by_subject_area"=>{"Unspecified"=>6, "Agricultural and Biological Sciences"=>11, "Arts and Humanities"=>1, "Business, Management and Accounting"=>5, "Computer Science"=>1, "Economics, Econometrics and Finance"=>4, "Engineering"=>1, "Environmental Science"=>2, "Nursing and Health Professions"=>6, "Mathematics"=>2, "Medicine and Dentistry"=>68, "Physics and Astronomy"=>1, "Psychology"=>1, "Social Sciences"=>21, "Immunology and Microbiology"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>68}, "Social Sciences"=>{"Social Sciences"=>21}, "Physics and Astronomy"=>{"Physics and Astronomy"=>1}, "Psychology"=>{"Psychology"=>1}, "Mathematics"=>{"Mathematics"=>2}, "Unspecified"=>{"Unspecified"=>6}, "Environmental Science"=>{"Environmental Science"=>2}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Engineering"=>{"Engineering"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>4}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>11}, "Computer Science"=>{"Computer Science"=>1}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>5}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>6}}, "reader_count_by_country"=>{"Canada"=>1, "Bangladesh"=>1, "United States"=>3, "Tanzania"=>1, "Brazil"=>1, "South Africa"=>1, "Uganda"=>1, "Nigeria"=>1}, "group_count"=>6}

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Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/829088"], "description"=>"a<p>Up-to-date immunization, received all immunizations for age as per national guidelines.</p><p>SD, standard deviation; WAZ, weight for age Z-score.</p>", "links"=>[], "tags"=>["characteristics", "children", "managed"], "article_id"=>499437, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Kojo Yeboah-Antwi", "Portipher Pilingana", "William B. Macleod", "Katherine Semrau", "Kazungu Siazeele", "Penelope Kalesha", "Busiku Hamainza", "Phil Seidenberg", "Arthur Mazimba", "Lora Sabin", "Karen Kamholz", "Donald M. Thea", "Davidson H. Hamer"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000340.t002", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Baseline_characteristics_of_children_managed_by_community_health_workers_/499437", "title"=>"Baseline characteristics of children managed by community health workers.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-09-21 02:37:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/412810", "https://ndownloader.figshare.com/files/412906", "https://ndownloader.figshare.com/files/412938", "https://ndownloader.figshare.com/files/413010"], "description"=>"<div><h3>Background</h3><p>Pneumonia and malaria, two of the leading causes of morbidity and mortality among children under five in Zambia, often have overlapping clinical manifestations. Zambia is piloting the use of artemether-lumefantrine (AL) by community health workers (CHWs) to treat uncomplicated malaria. Valid concerns about potential overuse of AL could be addressed by the use of malaria rapid diagnostics employed at the community level. Currently, CHWs in Zambia evaluate and treat children with suspected malaria in rural areas, but they refer children with suspected pneumonia to the nearest health facility. This study was designed to assess the effectiveness and feasibility of using CHWs to manage nonsevere pneumonia and uncomplicated malaria with the aid of rapid diagnostic tests (RDTs).</p><h3>Methods and Findings</h3><p>Community health posts staffed by CHWs were matched and randomly allocated to intervention and control arms. Children between the ages of 6 months and 5 years were managed according to the study protocol, as follows. Intervention CHWs performed RDTs, treated test-positive children with AL, and treated those with nonsevere pneumonia (increased respiratory rate) with amoxicillin. Control CHWs did not perform RDTs, treated all febrile children with AL, and referred those with signs of pneumonia to the health facility, as per Ministry of Health policy. The primary outcomes were the use of AL in children with fever and early and appropriate treatment with antibiotics for nonsevere pneumonia. A total of 3,125 children with fever and/or difficult/fast breathing were managed over a 12-month period. In the intervention arm, 27.5% (265/963) of children with fever received AL compared to 99.1% (2066/2084) of control children (risk ratio 0.23, 95% confidence interval 0.14–0.38). For children classified with nonsevere pneumonia, 68.2% (247/362) in the intervention arm and 13.3% (22/203) in the control arm received early and appropriate treatment (risk ratio 5.32, 95% confidence interval 2.19–8.94). There were two deaths in the intervention and one in the control arm.</p><h3>Conclusions</h3><p>The potential for CHWs to use RDTs, AL, and amoxicillin to manage both malaria and pneumonia at the community level is promising and might reduce overuse of AL, as well as provide early and appropriate treatment to children with nonsevere pneumonia.</p><h3>Trial registration</h3><p><a href=\"http://ClinicalTrials.gov\">ClinicalTrials.gov</a><a href=\"http://clinicaltrials.gov/ct2/show/NCT00513500?term=NCT00513500&rank=1\">NCT00513500</a></p><h3></h3><p><em>Please see later in the article for the Editors' Summary</em></p></div>", "links"=>[], "tags"=>["malaria", "pneumonia", "children", "randomized", "controlled"], "article_id"=>141548, "categories"=>["Medicine", "Cancer", "Information And Computing Sciences"], "users"=>["Kojo Yeboah-Antwi", "Portipher Pilingana", "William B. Macleod", "Katherine Semrau", "Kazungu Siazeele", "Penelope Kalesha", "Busiku Hamainza", "Phil Seidenberg", "Arthur Mazimba", "Lora Sabin", "Karen Kamholz", "Donald M. Thea", "Davidson H. Hamer"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000340.s001", "https://dx.doi.org/10.1371/journal.pmed.1000340.s002", "https://dx.doi.org/10.1371/journal.pmed.1000340.s003", "https://dx.doi.org/10.1371/journal.pmed.1000340.s004"], "stats"=>{"downloads"=>50, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Community_Case_Management_of_Fever_Due_to_Malaria_and_Pneumonia_in_Children_Under_Five_in_Zambia_A_Cluster_Randomized_Controlled_Trial/141548", "title"=>"Community Case Management of Fever Due to Malaria and Pneumonia in Children Under Five in Zambia: A Cluster Randomized Controlled Trial", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2010-09-21 00:25:48"}
  • {"files"=>["https://ndownloader.figshare.com/files/829037"], "description"=>"<p>Characteristics of community health workers and community health posts.</p>", "links"=>[], "tags"=>["workers"], "article_id"=>499400, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Kojo Yeboah-Antwi", "Portipher Pilingana", "William B. Macleod", "Katherine Semrau", "Kazungu Siazeele", "Penelope Kalesha", "Busiku Hamainza", "Phil Seidenberg", "Arthur Mazimba", "Lora Sabin", "Karen Kamholz", "Donald M. Thea", "Davidson H. Hamer"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000340.t001", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_community_health_workers_and_community_health_posts_/499400", "title"=>"Characteristics of community health workers and community health posts.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-09-21 02:36:40"}
  • {"files"=>["https://ndownloader.figshare.com/files/828901"], "description"=>"a<p>Adjusted for baseline fast breathing and fever.</p>", "links"=>[], "tags"=>["evidence-based healthcare", "infectious diseases/respiratory infections", "pediatrics and child health", "public health and epidemiology/health policy"], "article_id"=>499253, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Kojo Yeboah-Antwi", "Portipher Pilingana", "William B. Macleod", "Katherine Semrau", "Kazungu Siazeele", "Penelope Kalesha", "Busiku Hamainza", "Phil Seidenberg", "Arthur Mazimba", "Lora Sabin", "Karen Kamholz", "Donald M. Thea", "Davidson H. Hamer"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000340.t005", "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Treatment_failure_for_all_patients_/499253", "title"=>"Treatment failure for all patients.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-09-21 02:34:13"}
  • {"files"=>["https://ndownloader.figshare.com/files/829131"], "description"=>"<p>Presenting complaints and signs.</p>", "links"=>[], "tags"=>["complaints"], "article_id"=>499491, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Kojo Yeboah-Antwi", "Portipher Pilingana", "William B. Macleod", "Katherine Semrau", "Kazungu Siazeele", "Penelope Kalesha", "Busiku Hamainza", "Phil Seidenberg", "Arthur Mazimba", "Lora Sabin", "Karen Kamholz", "Donald M. Thea", "Davidson H. Hamer"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000340.t003", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Presenting_complaints_and_signs_/499491", "title"=>"Presenting complaints and signs.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-09-21 02:38:11"}
  • {"files"=>["https://ndownloader.figshare.com/files/828949"], "description"=>"a<p>Adjusted for baseline fever.</p>", "links"=>[], "tags"=>["patients", "classified"], "article_id"=>499307, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Kojo Yeboah-Antwi", "Portipher Pilingana", "William B. Macleod", "Katherine Semrau", "Kazungu Siazeele", "Penelope Kalesha", "Busiku Hamainza", "Phil Seidenberg", "Arthur Mazimba", "Lora Sabin", "Karen Kamholz", "Donald M. Thea", "Davidson H. Hamer"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000340.t006", "stats"=>{"downloads"=>1, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Treatment_failure_for_patients_classified_as_malaria_/499307", "title"=>"Treatment failure for patients classified as malaria.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-09-21 02:35:07"}
  • {"files"=>["https://ndownloader.figshare.com/files/828581"], "description"=>"<p>Treatment algorithm for Intervention Community Health Workers.</p>", "links"=>[], "tags"=>["algorithm"], "article_id"=>498935, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Kojo Yeboah-Antwi", "Portipher Pilingana", "William B. Macleod", "Katherine Semrau", "Kazungu Siazeele", "Penelope Kalesha", "Busiku Hamainza", "Phil Seidenberg", "Arthur Mazimba", "Lora Sabin", "Karen Kamholz", "Donald M. Thea", "Davidson H. Hamer"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000340.g002", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Treatment_algorithm_for_Intervention_Community_Health_Workers_/498935", "title"=>"Treatment algorithm for Intervention Community Health Workers.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-09-21 02:28:55"}
  • {"files"=>["https://ndownloader.figshare.com/files/828484"], "description"=>"<p>Study profile.</p>", "links"=>[], "tags"=>["evidence-based healthcare", "infectious diseases/respiratory infections", "pediatrics and child health", "public health and epidemiology/health policy"], "article_id"=>498837, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Kojo Yeboah-Antwi", "Portipher Pilingana", "William B. Macleod", "Katherine Semrau", "Kazungu Siazeele", "Penelope Kalesha", "Busiku Hamainza", "Phil Seidenberg", "Arthur Mazimba", "Lora Sabin", "Karen Kamholz", "Donald M. Thea", "Davidson H. Hamer"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000340.g001", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Study_profile_/498837", "title"=>"Study profile.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-09-21 02:27:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/828992"], "description"=>"a<p>Adjusted for baseline fast breathing.</p>", "links"=>[], "tags"=>["patients", "classified"], "article_id"=>499347, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Kojo Yeboah-Antwi", "Portipher Pilingana", "William B. Macleod", "Katherine Semrau", "Kazungu Siazeele", "Penelope Kalesha", "Busiku Hamainza", "Phil Seidenberg", "Arthur Mazimba", "Lora Sabin", "Karen Kamholz", "Donald M. Thea", "Davidson H. Hamer"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000340.t007", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Treatment_failure_for_patients_classified_as_pneumonia_/499347", "title"=>"Treatment failure for patients classified as pneumonia.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-09-21 02:35:47"}
  • {"files"=>["https://ndownloader.figshare.com/files/828848"], "description"=>"<p>Proportion of children with positive rapid diagnostic tests.</p>", "links"=>[], "tags"=>["children", "diagnostic"], "article_id"=>499201, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Kojo Yeboah-Antwi", "Portipher Pilingana", "William B. Macleod", "Katherine Semrau", "Kazungu Siazeele", "Penelope Kalesha", "Busiku Hamainza", "Phil Seidenberg", "Arthur Mazimba", "Lora Sabin", "Karen Kamholz", "Donald M. Thea", "Davidson H. Hamer"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000340.t004", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Proportion_of_children_with_positive_rapid_diagnostic_tests_/499201", "title"=>"Proportion of children with positive rapid diagnostic tests.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-09-21 02:33:21"}
  • {"files"=>["https://ndownloader.figshare.com/files/828799"], "description"=>"<p>CMH, Chikankata Mission Hospital; RHC, rural heath center.</p>", "links"=>[], "tags"=>["children", "seeking", "illnesses", "baseline", "poststudy"], "article_id"=>499154, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Kojo Yeboah-Antwi", "Portipher Pilingana", "William B. Macleod", "Katherine Semrau", "Kazungu Siazeele", "Penelope Kalesha", "Busiku Hamainza", "Phil Seidenberg", "Arthur Mazimba", "Lora Sabin", "Karen Kamholz", "Donald M. Thea", "Davidson H. Hamer"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000340.t008", "stats"=>{"downloads"=>2, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Proportion_of_children_seeking_care_for_all_illnesses_and_fast_breathing_during_the_baseline_and_poststudy_household_surveys_/499154", "title"=>"Proportion of children seeking care for all illnesses and fast breathing during the baseline and poststudy household surveys.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-09-21 02:32:34"}
  • {"files"=>["https://ndownloader.figshare.com/files/828718"], "description"=>"<p>Treatment algorithm for Control Community Health Workers.</p>", "links"=>[], "tags"=>["algorithm"], "article_id"=>499071, "categories"=>["Medicine", "Infectious Diseases", "Information And Computing Sciences"], "users"=>["Kojo Yeboah-Antwi", "Portipher Pilingana", "William B. Macleod", "Katherine Semrau", "Kazungu Siazeele", "Penelope Kalesha", "Busiku Hamainza", "Phil Seidenberg", "Arthur Mazimba", "Lora Sabin", "Karen Kamholz", "Donald M. Thea", "Davidson H. Hamer"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000340.g003", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Treatment_algorithm_for_Control_Community_Health_Workers_/499071", "title"=>"Treatment algorithm for Control Community Health Workers.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-09-21 02:31:11"}

PMC Usage Stats | Further Information

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  • {"unique-ip"=>"15", "full-text"=>"14", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"3", "year"=>"2015", "month"=>"11"}
  • {"unique-ip"=>"16", "full-text"=>"13", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"3", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"12"}
  • {"unique-ip"=>"10", "full-text"=>"10", "pdf"=>"7", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"1"}
  • {"unique-ip"=>"15", "full-text"=>"19", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"2"}
  • {"unique-ip"=>"17", "full-text"=>"17", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"1", "cited-by"=>"0", "year"=>"2016", "month"=>"3"}
  • {"unique-ip"=>"10", "full-text"=>"9", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"4"}
  • {"unique-ip"=>"10", "full-text"=>"10", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"5"}
  • {"unique-ip"=>"21", "full-text"=>"24", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"6"}
  • {"unique-ip"=>"14", "full-text"=>"13", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"1", "cited-by"=>"0", "year"=>"2016", "month"=>"7"}
  • {"unique-ip"=>"15", "full-text"=>"19", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"8"}
  • {"unique-ip"=>"17", "full-text"=>"13", "pdf"=>"10", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"9"}
  • {"unique-ip"=>"18", "full-text"=>"18", "pdf"=>"8", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"10"}
  • {"unique-ip"=>"7", "full-text"=>"5", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"11"}
  • {"unique-ip"=>"13", "full-text"=>"12", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"12"}
  • {"unique-ip"=>"12", "full-text"=>"15", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"1"}
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  • {"unique-ip"=>"8", "full-text"=>"11", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"6"}
  • {"unique-ip"=>"6", "full-text"=>"6", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"7"}
  • {"unique-ip"=>"8", "full-text"=>"11", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"8"}
  • {"unique-ip"=>"5", "full-text"=>"4", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"9"}
  • {"unique-ip"=>"13", "full-text"=>"12", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"10"}
  • {"unique-ip"=>"16", "full-text"=>"14", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"11"}
  • {"unique-ip"=>"13", "full-text"=>"7", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"12"}
  • {"unique-ip"=>"12", "full-text"=>"14", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"1", "cited-by"=>"0", "year"=>"2018", "month"=>"1"}
  • {"unique-ip"=>"1", "full-text"=>"1", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"2"}
  • {"unique-ip"=>"9", "full-text"=>"8", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"3"}
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  • {"unique-ip"=>"9", "full-text"=>"8", "pdf"=>"3", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"4"}
  • {"unique-ip"=>"15", "full-text"=>"18", "pdf"=>"5", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"5"}
  • {"unique-ip"=>"3", "full-text"=>"8", "pdf"=>"3", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"2", "year"=>"2018", "month"=>"6"}
  • {"unique-ip"=>"11", "full-text"=>"10", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"2", "cited-by"=>"0", "year"=>"2018", "month"=>"7"}
  • {"unique-ip"=>"6", "full-text"=>"5", "pdf"=>"3", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"8"}
  • {"unique-ip"=>"6", "full-text"=>"5", "pdf"=>"4", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"9"}
  • {"unique-ip"=>"6", "full-text"=>"7", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"10"}
  • {"unique-ip"=>"20", "full-text"=>"22", "pdf"=>"5", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"4", "cited-by"=>"0", "year"=>"2018", "month"=>"11"}
  • {"unique-ip"=>"9", "full-text"=>"9", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"12"}
  • {"unique-ip"=>"11", "full-text"=>"12", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"2"}
  • {"unique-ip"=>"8", "full-text"=>"10", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"3"}
  • {"unique-ip"=>"15", "full-text"=>"13", "pdf"=>"6", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"3", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"4"}
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Relative Metric

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