Ratio of Trunk to Leg Volume as a New Body Shape Metric for Diabetes and Mortality
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{"title"=>"Ratio of Trunk to Leg Volume as a New Body Shape Metric for Diabetes and Mortality", "type"=>"journal", "authors"=>[{"first_name"=>"Joseph P.", "last_name"=>"Wilson", "scopus_author_id"=>"25954974600"}, {"first_name"=>"Alka M.", "last_name"=>"Kanaya", "scopus_author_id"=>"35421187100"}, {"first_name"=>"Bo", "last_name"=>"Fan", "scopus_author_id"=>"15739324900"}, {"first_name"=>"John A.", "last_name"=>"Shepherd", "scopus_author_id"=>"55236369100"}], "year"=>2013, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-84880017599", "pui"=>"369294501", "doi"=>"10.1371/journal.pone.0068716", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)", "sgr"=>"84880017599", "pmid"=>"23874736"}, "id"=>"cf347f96-1de5-320c-9899-1d56e75ddaca", "abstract"=>"BACKGROUND: Body shape is a known risk factor for diabetes and mortality, but the methods estimating body shape, BMI and waist circumference are crude. We determined whether a novel body shape measure, trunk to leg volume ratio, was independently associated with diabetes and mortality.\\n\\nMETHODS: Data from the National Health and Nutritional Examination Survey 1999-2004, a study representative of the US population, were used to generate dual-energy X-ray absorptiometry-derived trunk to leg volume ratio and determine its associations to diabetes, metabolic covariates, and mortality by BMI category, gender, and race/ethnicity group.\\n\\nRESULTS: The prevalence of pre-diabetes and diabetes increased with age, BMI, triglycerides, blood pressure, and decreased HDL level. After adjusting for covariates, the corresponding fourth to first quartile trunk to leg volume ratio odds ratios (OR) were 6.8 (95% confidence interval [CI], 4.9-9.6) for diabetes, 3.9 (95% CI, 3.0-5.2) for high triglycerides, 1.8 (95% CI, 1.6-2.1) for high blood pressure, 3.0 (95% CI, 2.4-3.8) for low HDL, 3.6 (95% CI, 2.8-4.7) for metabolic syndrome, and 1.76 (95% CI, 1.20-2.60) for mortality. Additionally, trunk to leg volume ratio was the strongest independent measure associated with diabetes (P<0.001), even after adjusting for BMI and waist circumference. Even among those with normal BMI, those in the highest quartile of trunk to leg volume ratio had a higher likelihood of death (5.5%) than those in the lowest quartile (0.2%). Overall, trunk to leg volume ratio is driven by competing mechanisms of changing adiposity and lean mass.\\n\\nCONCLUSIONS: A high ratio of trunk to leg volume showed a strong association to diabetes and mortality that was independent of total and regional fat distributions. This novel body shape measure provides additional information regarding central adiposity and appendicular wasting to better stratify individuals at risk for diabetes and mortality, even among those with normal BMI.", "link"=>"http://www.mendeley.com/research/ratio-trunk-leg-volume-new-body-shape-metric-diabetes-mortality", "reader_count"=>24, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>1, "Librarian"=>2, "Researcher"=>6, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>1, "Other"=>4, "Student > Master"=>3, "Student > Bachelor"=>3, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>1, "Librarian"=>2, "Researcher"=>6, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>1, "Other"=>4, "Student > Master"=>3, "Student > Bachelor"=>3, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>4, "Engineering"=>2, "Biochemistry, Genetics and Molecular Biology"=>2, "Nursing and Health Professions"=>1, "Medicine and Dentistry"=>5, "Agricultural and Biological Sciences"=>5, "Sports and Recreations"=>3, "Social Sciences"=>1, "Earth and Planetary Sciences"=>1}, "reader_count_by_subdiscipline"=>{"Engineering"=>{"Engineering"=>2}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>5}, "Social Sciences"=>{"Social Sciences"=>1}, "Sports and Recreations"=>{"Sports and Recreations"=>3}, "Earth and Planetary Sciences"=>{"Earth and Planetary Sciences"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>5}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>2}, "Unspecified"=>{"Unspecified"=>4}}, "reader_count_by_country"=>{"United Kingdom"=>1, "Australia"=>1, "Peru"=>1}, "group_count"=>0}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/1116258"], "description"=>"<p>Mortality versus trunk to leg volume ratio quartile is displayed below for (A) BMI category, (B) gender, (C) race/ethnicity, and (D) age group in NHANES 1999–2004. (A) All data displayed by BMI category had a significant trend (P-for-trend<0.001) in mortality versus trunk to leg volume ratio quartile; there was also a significant interaction (P-for-interaction<0.01) between trunk to leg volume ratio quartile and BMI category for mortality. (B) All data displayed by gender had a significant trend (P-for-trend <0.001) in mortality versus trunk to leg volume ratio quartile. (C) All data displayed by race/ethnicity had a significant trend (P-for-trend<0.001 for Mexican American, Non-Hispanic Black, and Non-Hispanic White; P-for-trend<0.05 for Other Race)) in mortality versus trunk to leg volume ratio quartile. (D) Only individuals >70 years displayed a significant trend (P-for-trend <0.01) in mortality versus trunk to leg volume ratio quartile.</p>", "links"=>[], "tags"=>["Anatomy and physiology", "cardiovascular", "hypertension", "Diagnostic medicine", "pathology", "anatomical pathology", "Clinical pathology", "Test evaluation", "Endocrinology", "Diabetic endocrinology", "Diabetes mellitus type 2", "epidemiology", "Non-clinical medicine", "Health care policy", "Health risk analysis", "Evidence-based medicine", "nutrition", "obesity", "Public health", "Health screening", "quartile"], "article_id"=>743488, "categories"=>["Medicine"], "users"=>["Joseph P. Wilson", "Alka M. Kanaya", "Bo Fan", "John A. Shepherd"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0068716.g004", "stats"=>{"downloads"=>1, "page_views"=>45, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Mortality_versus_trunk_to_leg_volume_ratio_quartile_by_BMI_gender_race_ethnicity_and_age_/743488", "title"=>"Mortality versus trunk to leg volume ratio quartile by BMI, gender, race/ethnicity, and age.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-07-10 02:34:46"}
  • {"files"=>["https://ndownloader.figshare.com/files/1116256"], "description"=>"<p>The prevalence of metabolic syndrome versus trunk to leg volume ratio quartile is displayed below for (A) BMI category, (B) gender, (C) race/ethnicity, and (D) age group in NHANES 1999–2004. (A) All data displayed by BMI category had a significant trend (P-for-trend<0.001) in metabolic syndrome versus trunk to leg volume ratio quartile; there was also a significant interaction (P-for-interaction<0.001) between trunk to leg volume ratio quartile and BMI category for metabolic syndrome. (B) All data displayed by gender had a significant trend (P-for-trend <0.001) in mortality versus trunk to leg volume ratio quartile; there was also a significant interaction (P-for-interaction<0.001) between trunk to leg volume ratio quartile and gender for metabolic syndrome. (C) All data displayed by race/ethnicity had a significant trend (P-for-trend<0.001) in metabolic syndrome versus trunk to leg volume ratio quartile; there was also a significant interaction (P-for-interaction<0.05) between trunk to leg volume ratio quartile and race/ethnicity for metabolic syndrome. (D) All data displayed by age group had a significant trend (P-for-trend<0.001) in metabolic syndrome versus trunk to leg volume ratio quartile; there was also a significant interaction (P-for-interaction<0.001) between trunk to leg volume ratio quartile and age group for metabolic syndrome.</p>", "links"=>[], "tags"=>["Anatomy and physiology", "cardiovascular", "hypertension", "Diagnostic medicine", "pathology", "anatomical pathology", "Clinical pathology", "Test evaluation", "Endocrinology", "Diabetic endocrinology", "Diabetes mellitus type 2", "epidemiology", "Non-clinical medicine", "Health care policy", "Health risk analysis", "Evidence-based medicine", "nutrition", "obesity", "Public health", "Health screening", "metabolic", "quartile"], "article_id"=>743486, "categories"=>["Medicine"], "users"=>["Joseph P. Wilson", "Alka M. Kanaya", "Bo Fan", "John A. Shepherd"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0068716.g003", "stats"=>{"downloads"=>0, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Prevalence_of_metabolic_syndrome_versus_trunk_to_leg_volume_ratio_quartile_by_BMI_gender_race_ethnicity_and_age_/743486", "title"=>"Prevalence of metabolic syndrome versus trunk to leg volume ratio quartile by BMI, gender, race/ethnicity, and age.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-07-10 02:34:46"}
  • {"files"=>["https://ndownloader.figshare.com/files/1116261"], "description"=>"<p>BMI categories were defined as follows: underweight BMI (<18.5 kg/m<sup>2</sup>), normal BMI (> = 18.5 kg/m<sup>2</sup> and <25 kg/m<sup>2</sup>), overweight BMI (> = 25 kg/m<sup>2</sup> and <30 kg/m<sup>2</sup>), and obese BMI (> = 30 kg/m<sup>2</sup>). All measures displayed were significantly different (P<0.05) for each BMI category (by Bonferroni-adjusted t-test) unless otherwise noted.</p>a<p>Differences between Overweight & Obese were not significantly significant.</p>b<p>Differences between Underweight & Normal were not significantly significant.</p>c<p>Differences between Underweight & Overweight were not significantly significant.</p>", "links"=>[], "tags"=>["Anatomy and physiology", "cardiovascular", "hypertension", "Diagnostic medicine", "pathology", "anatomical pathology", "Clinical pathology", "Test evaluation", "Endocrinology", "Diabetic endocrinology", "Diabetes mellitus type 2", "epidemiology", "Non-clinical medicine", "Health care policy", "Health risk analysis", "Evidence-based medicine", "nutrition", "obesity", "Public health", "Health screening", "individuals", "nhanes", "bmi", "displayed", "deviation"], "article_id"=>743491, "categories"=>["Medicine"], "users"=>["Joseph P. Wilson", "Alka M. Kanaya", "Bo Fan", "John A. Shepherd"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0068716.t001", "stats"=>{"downloads"=>0, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Demographics_of_individuals_analyzed_in_NHANES_1999_8211_2004_by_BMI_category_displayed_as_total_number_for_gender_and_race_ethnicity_and_mean_177_standard_deviation_for_all_other_measures_/743491", "title"=>"Demographics of individuals analyzed in NHANES 1999–2004 by BMI category displayed as total number (for gender and race/ethnicity) and mean ± standard deviation for all other measures.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-07-10 02:34:46"}
  • {"files"=>["https://ndownloader.figshare.com/files/1116260"], "description"=>"<p>(A) Mean height-normalized trunk fat mass index (kg/m<sup>2</sup>), trunk lean mass index (kg/m<sup>2</sup>), and trunk volume index (L/m<sup>2</sup>) values are stratified by quartile of trunk to leg volume ratio. The increase in trunk volume is attributed mainly to the increase in trunk fat. (B) Mean height-normalized leg fat mass index (kg/m<sup>2</sup>), leg lean mass index (kg/m<sup>2</sup>), and leg volume index (L/m<sup>2</sup>) values are stratified by quartile of trunk to leg volume ratio. There is an overall decrease in leg volume primarily driven by a decrease in leg fat mass. (C) Mean trunk to leg fat mass ratio, trunk to leg lean mass ratio, and trunk to leg volume ratio are stratified by quartile of trunk to leg volume ratio. Trunk to leg fat mass ratio increases more dramatically than trunk to leg lean mass ratio.</p>", "links"=>[], "tags"=>["Anatomy and physiology", "cardiovascular", "hypertension", "Diagnostic medicine", "pathology", "anatomical pathology", "Clinical pathology", "Test evaluation", "Endocrinology", "Diabetic endocrinology", "Diabetes mellitus type 2", "epidemiology", "Non-clinical medicine", "Health care policy", "Health risk analysis", "Evidence-based medicine", "nutrition", "obesity", "Public health", "Health screening"], "article_id"=>743490, "categories"=>["Medicine"], "users"=>["Joseph P. Wilson", "Alka M. Kanaya", "Bo Fan", "John A. Shepherd"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0068716.g006", "stats"=>{"downloads"=>0, "page_views"=>14, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Breakdown_of_trunk_to_leg_volume_ratio_by_its_major_components_/743490", "title"=>"Breakdown of trunk to leg volume ratio by its major components.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-07-10 02:34:46"}
  • {"files"=>["https://ndownloader.figshare.com/files/1116255"], "description"=>"<p>The prevalence of diabetes (A), high triglycerides (B), low HDL (C), and high blood pressure (D) versus trunk to leg volume ratio quartile for race/ethnicity in NHANES 1999–2004 are shown below. All data displayed had a significant trend (P-for-trend <0.001) in prevalence versus quartile of trunk to leg volume ratio. There was a significant (P<0.05) interaction term (trunk to leg volume ratio quartile & race/ethnicity) in the prevalence of diabetes and high blood pressure.</p>", "links"=>[], "tags"=>["Anatomy and physiology", "cardiovascular", "hypertension", "Diagnostic medicine", "pathology", "anatomical pathology", "Clinical pathology", "Test evaluation", "Endocrinology", "Diabetic endocrinology", "Diabetes mellitus type 2", "epidemiology", "Non-clinical medicine", "Health care policy", "Health risk analysis", "Evidence-based medicine", "nutrition", "obesity", "Public health", "Health screening", "metabolic", "covariates", "quartile"], "article_id"=>743485, "categories"=>["Medicine"], "users"=>["Joseph P. Wilson", "Alka M. Kanaya", "Bo Fan", "John A. Shepherd"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0068716.g002", "stats"=>{"downloads"=>0, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Prevalence_of_diabetes_and_metabolic_covariates_versus_trunk_to_leg_volume_ratio_quartile_by_race_ethnicity_/743485", "title"=>"Prevalence of diabetes and metabolic covariates versus trunk to leg volume ratio quartile by race/ethnicity.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-07-10 02:34:46"}
  • {"files"=>["https://ndownloader.figshare.com/files/1116254"], "description"=>"<p>The prevalence of diabetes (A), high triglycerides (B), low HDL (C), and high blood pressure (D) versus trunk to leg volume ratio quartile for normal BMI (> = 18.5 kg/m<sup>2</sup> and <25 kg/m<sup>2</sup>), overweight BMI (> = 25 kg/m<sup>2</sup> and <30 kg/m<sup>2</sup>), obese BMI (> = 30 kg/m<sup>2</sup>), and total population in NHANES 1999–2004 are shown below. All data displayed had a significant trend (P-for-trend <0.001) in prevalence versus quartile of trunk to leg volume ratio. There was a significant (P<0.001) interaction (trunk to leg volume ratio quartile & BMI category) in the prevalence of diabetes and high blood pressure.</p>", "links"=>[], "tags"=>["Anatomy and physiology", "cardiovascular", "hypertension", "Diagnostic medicine", "pathology", "anatomical pathology", "Clinical pathology", "Test evaluation", "Endocrinology", "Diabetic endocrinology", "Diabetes mellitus type 2", "epidemiology", "Non-clinical medicine", "Health care policy", "Health risk analysis", "Evidence-based medicine", "nutrition", "obesity", "Public health", "Health screening", "metabolic", "covariates", "bmi"], "article_id"=>743484, "categories"=>["Medicine"], "users"=>["Joseph P. Wilson", "Alka M. Kanaya", "Bo Fan", "John A. Shepherd"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0068716.g001", "stats"=>{"downloads"=>0, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Prevalence_of_diabetes_and_metabolic_covariates_versus_trunk_to_leg_volume_ratio_by_BMI_category_/743484", "title"=>"Prevalence of diabetes and metabolic covariates versus trunk to leg volume ratio by BMI category.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-07-10 02:34:46"}
  • {"files"=>["https://ndownloader.figshare.com/files/1116263"], "description"=>"<p>AUC is the area under the receiver-operator characteristic curve. Odds ratios are displayed as odds ratio (95% confidence interval). Quartile cut points (Q1-Q4) were based on individuals without diabetes.</p>a<p>Age model adjusts for age.</p>b<p>Covariate model adjusts for gender, race/ethnicity, age, BMI, waist circumference, self-reported activity level, and poverty index ratio.</p>c<p>Covariate 2 model adjusts for gender, race/ethnicity, age, BMI, waist circumference, self-reported activity level, poverty index ratio, and trunk to leg fat mass ratio.</p>d<p>Full model adjusts for all variables in <sup>b</sup> and insulin, triglycerides, HDL, systolic blood pressure, and diastolic blood pressure.</p>e<p>Full 2 model adjusts for all variables in <sup>d</sup> and trunk to leg fat mass ratio.</p>*<p>Odds ratio not significant.</p>†<p>Forward selection turned off because trunk to leg volume ratio quartile wasn’t significant enough to remain in the model otherwise.</p>", "links"=>[], "tags"=>["Anatomy and physiology", "cardiovascular", "hypertension", "Diagnostic medicine", "pathology", "anatomical pathology", "Clinical pathology", "Test evaluation", "Endocrinology", "Diabetic endocrinology", "Diabetes mellitus type 2", "epidemiology", "Non-clinical medicine", "Health care policy", "Health risk analysis", "Evidence-based medicine", "nutrition", "obesity", "Public health", "Health screening", "logistic", "regression", "individuals", "triglycerides", "metabolic", "nhanes"], "article_id"=>743493, "categories"=>["Medicine"], "users"=>["Joseph P. Wilson", "Alka M. Kanaya", "Bo Fan", "John A. Shepherd"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0068716.t003", "stats"=>{"downloads"=>0, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Results_of_logistic_regression_models_to_distinguish_those_individuals_with_diabetes_high_triglycerides_TG_low_HDL_high_blood_pressure_BP_metabolic_syndrome_MetS_and_mortality_in_NHANES_1999_8211_2004_by_trunk_to_leg_volume_ratio_/743493", "title"=>"Results of logistic regression models to distinguish those individuals with diabetes, high triglycerides (TG), low HDL, high blood pressure (BP), metabolic syndrome (MetS), and mortality in NHANES 1999–2004 by trunk to leg volume ratio.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-07-10 02:34:46"}
  • {"files"=>["https://ndownloader.figshare.com/files/1116262"], "description"=>"<p>Quartile cut points (Q1–Q4) were based on individuals without diabetes. For waist circumference and HDL levels, there were separate cutoffs by gender, so ‘M’ is male and ‘F’ is female. Systolic blood pressure is shown as ‘S’, and diastolic blood pressure is shown as ‘D’.</p>a<p>Pre-Diabetes P-for-trend <0.05.</p>b<p>Diabetes P-for-trend <0.05.</p>", "links"=>[], "tags"=>["Anatomy and physiology", "cardiovascular", "hypertension", "Diagnostic medicine", "pathology", "anatomical pathology", "Clinical pathology", "Test evaluation", "Endocrinology", "Diabetic endocrinology", "Diabetes mellitus type 2", "epidemiology", "Non-clinical medicine", "Health care policy", "Health risk analysis", "Evidence-based medicine", "nutrition", "obesity", "Public health", "Health screening", "pre-diabetes", "measures", "nhanes"], "article_id"=>743492, "categories"=>["Medicine"], "users"=>["Joseph P. Wilson", "Alka M. Kanaya", "Bo Fan", "John A. Shepherd"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0068716.t002", "stats"=>{"downloads"=>0, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Prevalence_of_pre_diabetes_and_diabetes_by_selected_measures_in_NHANES_1999_8211_2004_/743492", "title"=>"Prevalence of pre-diabetes and diabetes by selected measures in NHANES 1999–2004.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-07-10 02:34:46"}
  • {"files"=>["https://ndownloader.figshare.com/files/1116259"], "description"=>"<p>Each ROC curve displays the sensitivity versus one minus specificity for each logistic regression model that is used to distinguish those individuals with diabetes in NHANES 1999–2004. The trunk to leg volume ratio only model (AUC = 0.748) includes only the variable of trunk to leg volume ratio. The age model (AUC = 0.796) includes the variables of age and trunk to leg volume ratio. The covariate model (AUC = 0.839) includes the variables of gender, race/ethnicity, age, BMI, waist circumference, self-reported activity level, poverty index ratio, and trunk to leg volume ratio. The full model (AUC = 0.796) includes the variables of race/ethnicity, age, waist circumference, poverty index ratio, insulin, triglycerides, systolic blood pressure, diastolic blood pressure, and trunk to leg volume ratio; gender, BMI, self-reported activity level, and HDL level were dropped from the final model because the coefficients were not significant (P<0.05).</p>", "links"=>[], "tags"=>["Anatomy and physiology", "cardiovascular", "hypertension", "Diagnostic medicine", "pathology", "anatomical pathology", "Clinical pathology", "Test evaluation", "Endocrinology", "Diabetic endocrinology", "Diabetes mellitus type 2", "epidemiology", "Non-clinical medicine", "Health care policy", "Health risk analysis", "Evidence-based medicine", "nutrition", "obesity", "Public health", "Health screening", "logistic", "regression", "nhanes"], "article_id"=>743489, "categories"=>["Medicine"], "users"=>["Joseph P. Wilson", "Alka M. Kanaya", "Bo Fan", "John A. Shepherd"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0068716.g005", "stats"=>{"downloads"=>0, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Diabetes_Receiver_Operating_Characteristic_ROC_for_Logistic_Regression_Models_in_NHANES_1999_8211_2004_/743489", "title"=>"Diabetes Receiver Operating Characteristic (ROC) for Logistic Regression Models in NHANES 1999–2004.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-07-10 02:34:46"}

PMC Usage Stats | Further Information

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Relative Metric

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