Measuring Morbidity Associated with Urinary Schistosomiasis: Assessing Levels of Excreted Urine Albumin and Urinary Tract Pathologies
Publication Date
October 06, 2009
Journal
PLOS Neglected Tropical Diseases
Authors
José C. Sousa Figueiredo, María Gloria Basáñez, I. Simba Khamis, Amadou Garba, et al
Volume
3
Issue
10
Pages
e526
DOI
https://dx.plos.org/10.1371/journal.pntd.0000526
Publisher URL
http://journals.plos.org/plosntds/article?id=10.1371%2Fjournal.pntd.0000526
PubMed
http://www.ncbi.nlm.nih.gov/pubmed/19806223
PubMed Central
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752803
Europe PMC
http://europepmc.org/abstract/MED/19806223
Web of Science
000272032800004
Scopus
70449501103
Mendeley
http://www.mendeley.com/research/measuring-morbidity-associated-urinary-schistosomiasis-assessing-levels-excreted-urine-albumin-urina
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Mendeley | Further Information

{"title"=>"Measuring morbidity associated with urinary schistosomiasis: Assessing levels of excreted urine albumin and urinary tract pathologies", "type"=>"journal", "authors"=>[{"first_name"=>"José C.", "last_name"=>"Sousa-Figueiredo", "scopus_author_id"=>"25621818700"}, {"first_name"=>"María Gloria", "last_name"=>"Basáñez", "scopus_author_id"=>"6701712698"}, {"first_name"=>"I. Simba", "last_name"=>"Khamis", "scopus_author_id"=>"8539025800"}, {"first_name"=>"Amadou", "last_name"=>"Garba", "scopus_author_id"=>"56256015800"}, {"first_name"=>"David", "last_name"=>"Rollinson", "scopus_author_id"=>"7006140704"}, {"first_name"=>"J. Russell", "last_name"=>"Stothard", "scopus_author_id"=>"35581378700"}], "year"=>2009, "source"=>"PLoS Neglected Tropical Diseases", "identifiers"=>{"pui"=>"355629336", "sgr"=>"70449501103", "issn"=>"1935-2735", "pmid"=>"19806223", "scopus"=>"2-s2.0-70449501103", "doi"=>"10.1371/journal.pntd.0000526", "isbn"=>"1935-2735 (Electronic)\\r1935-2727 (Linking)"}, "id"=>"f40f24d0-2287-3a54-8cf1-677ce5fa4547", "abstract"=>"BACKGROUND: Urinary schistosomiasis is responsible for a variety of debilitating conditions; foremost perhaps are urinary tract pathologies (UTPs). Although portable ultrasonography can be used to detect UTPs visually, there is still a need for rapid morbidity assessment (henceforth referred to as RaMA) tools that can be deployed in the field during implementation, monitoring and evaluation of control programmes. We therefore aimed to determine associations between excreted urine-albumin, as measured using a HemoCue photometer, and UTPs, as detected by ultrasonography, in children and adults from an urinary schistosomiasis endemic area in Zanzibar.\\n\\nMETHODOLOGY/PRINCIPAL FINDINGS: In a survey of 140 school-children of both sexes (aged 9 to 15 yr) and 47 adult males (> or =16 yr) on the island of Unguja, the prevalence of egg-patent urinary schistosomiasis was 36.4% (CI(95) 28.5-45.0%) and 46.8% (CI(95) 32.1-61.9%) (P = 0.14), and that of UTPs was 39.4% (CI(95) 31.0-48.3%) and 64.4% (CI(95) 48.8-78.1%) (P = 0.006), respectively. In school-children, raised urine-albumin concentrations (>40 mg/L) were associated, albeit non-significantly, with prevalence of infection (OR = 3.1, P = 0.070), but more specifically and significantly with the prevalence of micro-haematuria (OR = 76.7, P<0.0001). In adults, elevated urine-albumin excretion was associated with UTPs, particularly lesions of the bladder wall (OR = 8.4, P = 0.013). Albuminuria showed promising diagnostic performance, especially in school-aged children with sensitivity of 63.3% and specificity of 83.1% at detecting lower UTPs, i.e. bladder-wall lesions (ultrasonography as 'gold standard').\\n\\nCONCLUSION/SIGNIFICANCE: This study indicates that albuminuria assays could be used as a RaMA tool for monitoring UTP prevalence during control programmes, as well as a tool for selecting those with more chronic bladder-wall lesions without resorting to ultrasonography.", "link"=>"http://www.mendeley.com/research/measuring-morbidity-associated-urinary-schistosomiasis-assessing-levels-excreted-urine-albumin-urina", "reader_count"=>28, "reader_count_by_academic_status"=>{"Professor > Associate Professor"=>2, "Librarian"=>1, "Researcher"=>3, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>4, "Other"=>2, "Student > Master"=>8, "Student > Bachelor"=>3, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>1, "Professor"=>2}, "reader_count_by_user_role"=>{"Professor > Associate Professor"=>2, "Librarian"=>1, "Researcher"=>3, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>4, "Other"=>2, "Student > Master"=>8, "Student > Bachelor"=>3, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>1, "Professor"=>2}, "reader_count_by_subject_area"=>{"Unspecified"=>3, "Environmental Science"=>2, "Biochemistry, Genetics and Molecular Biology"=>1, "Mathematics"=>1, "Medicine and Dentistry"=>9, "Agricultural and Biological Sciences"=>7, "Social Sciences"=>1, "Computer Science"=>2, "Immunology and Microbiology"=>2}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>9}, "Social Sciences"=>{"Social Sciences"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>7}, "Computer Science"=>{"Computer Science"=>2}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>3}, "Environmental Science"=>{"Environmental Science"=>2}}, "reader_count_by_country"=>{"Spain"=>1}, "group_count"=>0}

Scopus | Further Information

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  • {"files"=>["https://ndownloader.figshare.com/files/880501"], "description"=>"<p>In all cases parasitological positivity by microscopy (eggs in urine) was the ‘gold standard’.</p><p>PPV = positive predictive value; NPV = negative predictive value; CI<sub>95</sub> = 95% confidence interval.</p>", "links"=>[], "tags"=>["diagnostic", "children", "boys", "enrolled", "mwera", "schools", "adults", "attending", "chaani", "centre", "urine", "opacity", "albumin", "excreted", "urine-albumin", "urine-reagent", "strips"], "article_id"=>550933, "categories"=>["Medicine"], "users"=>["José C. Sousa-Figueiredo", "María-Gloria Basáñez", "I. Simba Khamis", "Amadou Garba", "David Rollinson", "J. Russell Stothard"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000526.t003", "stats"=>{"downloads"=>5, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Comparison_between_rapid_S_haematobium_diagnostic_tests_for_children_9_15_yr_boys_and_girls_enrolled_in_Chaani_Kinyasini_and_Mwera_schools_N_140_and_adults_16_yr_males_attending_Chaani_Health_Centre_N_47_on_Unguja_Zanzibar_visual_blood_in_urine_macro_hae/550933", "title"=>"Comparison between rapid <i>S. haematobium</i> diagnostic tests for children (9–15 yr, boys and girls) enrolled in Chaani, Kinyasini, and Mwera schools (<i>N</i> = 140), and adults (≥16 yr, males) attending Chaani Health Centre (<i>N</i> = 47) on Unguja, Zanzibar: visual blood in urine (macro-haematuria); visual opacity (turbidity); albumin concentration (HemoCue, excreted urine-albumin levels); and urine-reagent strips (Hemastix, micro-haematuria).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-10-06 00:15:33"}
  • {"files"=>["https://ndownloader.figshare.com/files/880239"], "description"=>"<p>In school-children (left), worms are likely located in the vesical plexus. As egg production ensues, eggs pass from the lumen of blood vessels into adjacent tissues, and many penetrate the bladder mucosa being shed into the urine (blue arrows). This causes tissue damage and subsequent haemorrhage (red broken lines and arrow) identifiable using urine-reagent strips (micro-haematuria) and/or visually (macro-haematuria). The presence of blood will increase the levels of albumin in urine (albuminuria). In adults (right), chronic manifestations of past and present <i>S. haematobium</i> are common, particularly bladder wall lesions. Through these lesions, blood serum and white blood cells (leukocytes), as well as other components of the human immune system, infiltrate the bladder (orange broken lines and arrow) from the several capillary vessels, responding to scarring and attempting to reduce risk of subsequent urological infections through the already damaged epithelial barrier. Blood serum is rich in albumin, and its leaching into the urine will increase protein concentration; importantly, this will occur without the direct influence of <i>S. haematobium</i> egg excretion and in the absence of haematuria.</p>", "links"=>[], "tags"=>["aetiology", "raised", "urine-albumin", "levels", "school-children"], "article_id"=>550694, "categories"=>["Medicine"], "users"=>["José C. Sousa-Figueiredo", "María-Gloria Basáñez", "I. Simba Khamis", "Amadou Garba", "David Rollinson", "J. Russell Stothard"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000526.g001", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Proposed_aetiology_of_raised_urine_albumin_levels_in_school_children_and_adults_/550694", "title"=>"Proposed aetiology of raised urine-albumin levels in school-children and adults.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2009-10-06 00:11:34"}
  • {"files"=>["https://ndownloader.figshare.com/files/880449"], "description"=>"<p>Prevalence categories are classified according to the number of eggs per 10 ml urine.</p>", "links"=>[], "tags"=>["micro-haematuria", "macro-haematuria", "turbid", "urine", "raised", "urine-albumin", "urinary", "tract", "pathologies", "school-children", "enrolled", "mwera", "males", "attending", "chaani"], "article_id"=>550887, "categories"=>["Medicine"], "users"=>["José C. Sousa-Figueiredo", "María-Gloria Basáñez", "I. Simba Khamis", "Amadou Garba", "David Rollinson", "J. Russell Stothard"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000526.t001", "stats"=>{"downloads"=>3, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Prevalences_values_and_CI_95_of_S_haematobium_infection_microscopy_micro_haematuria_urine_reagent_strip_macro_haematuria_visual_blood_in_urine_turbid_urine_urine_visual_opacity_raised_urine_albumin_HemoCue_and_urinary_tract_pathologies_ultrasonography_in/550887", "title"=>"Prevalences values (and CI<sub>95</sub>) of <i>S. haematobium</i> infection (microscopy), micro-haematuria (urine-reagent strip), macro-haematuria (visual blood in urine), turbid urine (urine visual opacity), raised urine-albumin (HemoCue) and urinary tract pathologies (ultrasonography) in school-children enrolled in Chaani, Kinyasini, and Mwera schools, and adult males attending the Chaani Health Centre, Unguja, Zanzibar.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-10-06 00:14:47"}
  • {"files"=>["https://ndownloader.figshare.com/files/880402"], "description"=>"<p>Explanatory variables included urine's chemical/physical properties (pH, specific gravity, protein content, glucose, nitrite and ketone levels, as well as leukocyte presence), urinary tract pathology prevalence (general and specific – bladder, renal pelvis and ureteric pathologies) and urinary schistosomiasis prevalence. Shown are significant associations at univariate level (after accounting for possible intra-correlations in the data), and stepwise (AIC-driven) logistic regression results, enabling identification of the most parsimonius, yet adequate, model for explaining elevated concentration of albuminuria.</p>", "links"=>[], "tags"=>["associations", "raised", "urine-albumin", "levels", "school-children", "males"], "article_id"=>550856, "categories"=>["Medicine"], "users"=>["José C. Sousa-Figueiredo", "María-Gloria Basáñez", "I. Simba Khamis", "Amadou Garba", "David Rollinson", "J. Russell Stothard"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000526.t004", "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Statistical_associations_of_raised_urine_albumin_levels_gt_40_mg_L_measured_by_Albumin_HemoCue_in_school_children_9_8211_15_yr_both_sexes_and_adult_males_8805_16_yr_Chaani_Health_Centre_/550856", "title"=>"Statistical associations of raised urine-albumin levels (>40 mg/L) measured by Albumin-HemoCue, in school-children (9–15 yr, both sexes) and adult males (≥16 yr) (Chaani Health Centre).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-10-06 00:14:16"}
  • {"files"=>["https://ndownloader.figshare.com/files/880545"], "description"=>"<p>An overall, binomial score was attributed to the pathological state of individual tissues (positive score), as well as the urinary tract system as a whole (overall positive score), denoting the prevalence of any identifiable pathology according to WHO (1991) standardized methodology.</p>", "links"=>[], "tags"=>["prevalence", "pathologies", "school-children", "sexes", "attending", "kinyasini", "mwera", "males", "chaani", "ultrasonography", "tissues", "urinary", "tract", "renal"], "article_id"=>550987, "categories"=>["Medicine"], "users"=>["José C. Sousa-Figueiredo", "María-Gloria Basáñez", "I. Simba Khamis", "Amadou Garba", "David Rollinson", "J. Russell Stothard"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000526.t002", "stats"=>{"downloads"=>7, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Number_and_prevalence_of_pathologies_UTPs_recorded_in_school_children_of_both_sexes_9_8211_15_yr_attending_Chaani_Kinyasini_and_Mwera_schools_and_adult_males_8805_16_yr_attending_Chaani_Health_Centre_via_ultrasonography_in_the_different_tissues_of_the_hu/550987", "title"=>"Number (#) and prevalence (%) of pathologies (UTPs) recorded, in school-children of both sexes (9–15 yr) attending Chaani, Kinyasini and Mwera schools, and adult males (≥16 yr) attending Chaani Health Centre, via ultrasonography in the different tissues of the human urinary tract (bladder, ureters, and renal pelvis) associated with urinary schistosomiasis, Unguja, Zanzibar.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-10-06 00:16:27"}
  • {"files"=>["https://ndownloader.figshare.com/files/880360"], "description"=>"<p>Ultrasound identification of pathologies was the ‘gold standard’. Refer to <a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000526#pntd.0000526.s001\" target=\"_blank\">table S1</a> for further information on diagnostic performances at the school level.</p><p>PPV = positive predictive value; NPV = negative predictive value; CI<sub>95</sub> = 95% confidence interval.</p>", "links"=>[], "tags"=>["albuminuria", "mg", "albumin", "litre", "albumin-hemocue", "urinary", "tract", "pathologies", "bladder", "children", "boys", "enrolled", "mwera", "schools", "adults", "attending", "chaani", "centre"], "article_id"=>550797, "categories"=>["Medicine"], "users"=>["José C. Sousa-Figueiredo", "María-Gloria Basáñez", "I. Simba Khamis", "Amadou Garba", "David Rollinson", "J. Russell Stothard"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000526.t005", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Diagnostic_performance_of_albuminuria_40_mg_of_albumin_per_litre_of_urine_measured_by_Albumin_HemoCue_photometer_for_identifying_general_urinary_tract_pathologies_UTPs_or_more_particularly_bladder_pathologies_in_children_9_15_yr_boys_and_girls_enrolled_i/550797", "title"=>"Diagnostic performance of albuminuria (>40 mg of albumin per litre of urine), measured by Albumin-HemoCue photometer, for identifying general urinary tract pathologies (UTPs) or more particularly bladder pathologies in children (9–15 yr, boys and girls) enrolled in Chaani, Kinyasini, and Mwera schools (<i>N</i> = 132), and adults (≥16 yr, males) attending Chaani Health Centre (<i>N</i> = 47) on Unguja, Zanzibar.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-10-06 00:13:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/436827", "https://ndownloader.figshare.com/files/436877", "https://ndownloader.figshare.com/files/436933"], "description"=>"<div><h3>Background</h3><p>Urinary schistosomiasis is responsible for a variety of debilitating conditions; foremost perhaps are urinary tract pathologies (UTPs). Although portable ultrasonography can be used to detect UTPs visually, there is still a need for rapid morbidity assessment (henceforth referred to as RaMA) tools that can be deployed in the field during implementation, monitoring and evaluation of control programmes. We therefore aimed to determine associations between excreted urine-albumin, as measured using a HemoCue photometer, and UTPs, as detected by ultrasonography, in children and adults from an urinary schistosomiasis endemic area in Zanzibar.</p><h3>Methodology/Principal Findings</h3><p>In a survey of 140 school-children of both sexes (aged 9 to 15 yr) and 47 adult males (≥16 yr) on the island of Unguja, the prevalence of egg-patent urinary schistosomiasis was 36.4% (CI<sub>95</sub> 28.5–45.0%) and 46.8% (CI<sub>95</sub> 32.1–61.9%) (<em>P</em> = 0.14), and that of UTPs was 39.4% (CI<sub>95</sub> 31.0–48.3%) and 64.4% (CI<sub>95</sub> 48.8–78.1%) (<em>P</em> = 0.006), respectively. In school-children, raised urine-albumin concentrations (>40 mg/L) were associated, albeit non-significantly, with prevalence of infection (OR = 3.1, <em>P</em> = 0.070), but more specifically and significantly with the prevalence of micro-haematuria (OR = 76.7, <em>P</em><0.0001). In adults, elevated urine-albumin excretion was associated with UTPs, particularly lesions of the bladder wall (OR = 8.4, <em>P</em> = 0.013). Albuminuria showed promising diagnostic performance, especially in school-aged children with sensitivity of 63.3% and specificity of 83.1% at detecting lower UTPs, i.e. bladder-wall lesions (ultrasonography as ‘gold standard’).</p><h3>Conclusion/Significance</h3><p>This study indicates that albuminuria assays could be used as a RaMA tool for monitoring UTP prevalence during control programmes, as well as a tool for selecting those with more chronic bladder-wall lesions without resorting to ultrasonography.</p></div>", "links"=>[], "tags"=>["measuring", "morbidity", "urinary", "assessing", "levels", "excreted", "urine", "albumin", "tract", "pathologies"], "article_id"=>146142, "categories"=>["Medicine"], "users"=>["José C. Sousa-Figueiredo", "María-Gloria Basáñez", "I. Simba Khamis", "Amadou Garba", "David Rollinson", "J. Russell Stothard"], "doi"=>["https://dx.doi.org/10.1371/journal.pntd.0000526.s001", "https://dx.doi.org/10.1371/journal.pntd.0000526.s002", "https://dx.doi.org/10.1371/journal.pntd.0000526.s003"], "stats"=>{"downloads"=>10, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Measuring_Morbidity_Associated_with_Urinary_Schistosomiasis_Assessing_Levels_of_Excreted_Urine_Albumin_and_Urinary_Tract_Pathologies/146142", "title"=>"Measuring Morbidity Associated with Urinary Schistosomiasis: Assessing Levels of Excreted Urine Albumin and Urinary Tract Pathologies", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2009-10-06 01:42:22"}

PMC Usage Stats | Further Information

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  • {"unique-ip"=>"18", "full-text"=>"15", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"3", "cited-by"=>"0", "year"=>"2014", "month"=>"10"}
  • {"unique-ip"=>"9", "full-text"=>"11", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"11"}
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  • {"unique-ip"=>"12", "full-text"=>"14", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"6"}
  • {"unique-ip"=>"11", "full-text"=>"14", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"7"}
  • {"unique-ip"=>"14", "full-text"=>"13", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"8"}
  • {"unique-ip"=>"10", "full-text"=>"10", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"9"}
  • {"unique-ip"=>"4", "full-text"=>"6", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"10"}
  • {"unique-ip"=>"10", "full-text"=>"9", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"1", "year"=>"2015", "month"=>"11"}
  • {"unique-ip"=>"9", "full-text"=>"8", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"12"}
  • {"unique-ip"=>"3", "full-text"=>"4", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"1"}
  • {"unique-ip"=>"9", "full-text"=>"9", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"2"}
  • {"unique-ip"=>"7", "full-text"=>"11", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"3"}
  • {"unique-ip"=>"3", "full-text"=>"6", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"4"}
  • {"unique-ip"=>"4", "full-text"=>"3", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"5"}
  • {"unique-ip"=>"2", "full-text"=>"1", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"6"}
  • {"unique-ip"=>"6", "full-text"=>"5", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"1", "year"=>"2016", "month"=>"7"}
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  • {"unique-ip"=>"9", "full-text"=>"9", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"9"}
  • {"unique-ip"=>"10", "full-text"=>"8", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"10"}
  • {"unique-ip"=>"5", "full-text"=>"5", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"11"}
  • {"unique-ip"=>"7", "full-text"=>"7", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"12"}
  • {"unique-ip"=>"11", "full-text"=>"7", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"1"}
  • {"unique-ip"=>"2", "full-text"=>"2", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"2"}
  • {"unique-ip"=>"4", "full-text"=>"5", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"3"}
  • {"unique-ip"=>"5", "full-text"=>"6", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"4"}
  • {"unique-ip"=>"7", "full-text"=>"8", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"5"}
  • {"unique-ip"=>"5", "full-text"=>"5", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"6"}
  • {"unique-ip"=>"1", "full-text"=>"1", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"7"}
  • {"unique-ip"=>"4", "full-text"=>"4", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"8"}
  • {"unique-ip"=>"3", "full-text"=>"3", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"9"}
  • {"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"=>"10"}
  • {"unique-ip"=>"7", "full-text"=>"8", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"11"}
  • {"unique-ip"=>"7", "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"=>"7", "full-text"=>"7", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"1"}
  • {"unique-ip"=>"6", "full-text"=>"7", "pdf"=>"0", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"3"}
  • {"unique-ip"=>"10", "full-text"=>"10", "pdf"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"1"}
  • {"unique-ip"=>"12", "full-text"=>"11", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"4"}
  • {"unique-ip"=>"10", "full-text"=>"10", "pdf"=>"5", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"5"}
  • {"unique-ip"=>"6", "full-text"=>"4", "pdf"=>"3", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"6"}
  • {"unique-ip"=>"9", "full-text"=>"5", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"2", "cited-by"=>"0", "year"=>"2018", "month"=>"7"}
  • {"unique-ip"=>"8", "full-text"=>"10", "pdf"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"8"}
  • {"unique-ip"=>"7", "full-text"=>"8", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"10"}
  • {"unique-ip"=>"3", "full-text"=>"3", "pdf"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"9"}
  • {"unique-ip"=>"8", "full-text"=>"10", "pdf"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"12"}
  • {"unique-ip"=>"12", "full-text"=>"13", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"3", "cited-by"=>"0", "year"=>"2018", "month"=>"11"}
  • {"unique-ip"=>"14", "full-text"=>"15", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"2"}
  • {"unique-ip"=>"10", "full-text"=>"10", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"3"}
  • {"unique-ip"=>"9", "full-text"=>"9", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"4"}
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Relative Metric

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