Advantages of a RSS feed over a Website¹²

·            Users can be notified of new content without having to actively check for it.

·            Content updates can be sourced from many modalities (news, journals, portals and PubMed) can be tracked and easily managed in one central location.

·            No time wasted navigating complex sites.

 There are many excellent text-based and Pod cast feeds available on Orthopaedic topics. Orthopaedic Web Links¹³ maintains a list of feeds of Orthopaedic interest.  

Video pod casts or Vodcasts have an important role in the education of a practical profession such as ours. Many excellent videos of operative technique on the internet, including the video library maintained by the Journal of Bone and Joint Surgery¹⁴ exist. Video files tend to be large, and a broadband connection is recommended for shortened download times.

Reference Linking

Once you have found useful information, it is useful to keep a link to it on your computer. Commonly this is done by adding a “bookmark” in your favorite web browser or other program linking descriptive text to the web address.

URLs (Uniform Resource Locator – the “link’ in a hypertext document), as a method of accessing to articles suffer from a number of disadvantages.

Problems with URL's

They are often not persistent i.e. the target document can be deleted or moved to another site¹⁵.

·         The linked copy may be in another format for example the user may be looking for a print or PDF format while the linked version is HTML (Hypertext Markup Language).

The International DOI Foundation (IDF) has developed a form of reference linking that aims to overcome some of these difficulties. The Digital Object Identifier (DOI) identifies a digital object. It is a number or series of symbols that uniquely identifies this particular publication and will link the user to the document’s current location on the Web. The DOI website¹⁶ maintains links to the document and the International DOI Foundation (the supervisors of the DOI system) strive to keep valid links to the numbered document, wherever it may be moved to. The aim is to prevent link obsolescence (“link rot”), which tends to occur over time whenever links are deleted or moved. 

Using DOI names as identifiers makes managing intellectual property in a networked environment much easier and more convenient.

These days many electronic journals and even web “reprints”, downloadable from the publishers include the document’s DOI number. This array of letters and digits can be entered into the search box at www.doi.org and it will link to the source document at the publisher’s site.

The user thus does not have to know the address of the institution which hosts this document. This may not be much of a problem with a well known journal publishing house but (the DOI System) is a major advantage when looking for a thesis or other paper without a known publisher. Over time even previously financially sound publishers may disappear, or cease to have a web address by, either selling copyright to a rival publisher or other party. This third party will now host the electronic archives of the defunct journal.  An identifier persistently refers to a content item regardless of its physical location or ownership, even if either is transferred to another publisher.¹⁷

The DOI is becoming ubiquitous. In recent years many popular magazines such as the “New Scientist” have begun to quote the DOI number in parenthesis as a reference rather than classical formal listing of title, author and journal as a footnote to the article. An interested reader can thus easily consult the relevant online source with minimal effort.

Another use for DOI numbers is in hypertext web documents. A link can be made using the DOI rather than (directly) to a website. The link is more likely to survive changes and deletions to the site or address you intend to quote if it links via doi.org whose professionals are dedicated to maintaining valid links. To make a link, use the format http://dx.doi.org/[doi-number] once a user clicks on this hyperlink he will be directed to the correct document, usually at the journal publisher’s site.

Archive sites

A reliable way to find scholarly articles is to visit an archive site. These respected sites such as PubMed and Medline ¹⁸ do not publish themselves, but invite other publishers to deposit either hard copy or digital versions of their publications with them. They do not own copyright over the articles they store. PubMed Central¹⁹ serves such a function. Besides peer reviewed journal articles they also store unpublished articles and data, considered of value in the opinion of   publishers, to researchers they trust.  .

 PubMed is an archive of biomedical and life sciences journal literature at the U.S. National Institutes of Health.  PubMed is well supported by all major publishers.  A search from PubMed web site will link the user to most of the Orthopaedic (and other biomedical) literature  ever published.  Currently most journals, have an online presence, and will be referenced by PubMed. In many cases only the abstract of an article and not the full text will be available.  PubMed maintains links  to the actual publisher’s site where, the full version of the article can be read, albeit often - only after paying a fee.

Cost Considerations

Many publishers now have digitalized their entire paper archives and these can be accessed online. The Journal of Bone and Joint Surgery, for example has PDF (Portable Document Format file) copies available from the date of first publication in 1948.²⁰

These articles need to be paid for; publishers are often for profit commercial organizations and will expect to extract a fee for these. After searching for and finding the article, the user typically will be allowed to read the abstract for free, but is then required to pay $30 or more to download the PDF or full text version of the article.

There are more cost effective ways of legitimately obtaining these articles. Journals you personally subscribe to will allow you to login on their website and download whatever is available, after signing up using your subscription number.    If you are a member of an academic library they probably already have subscriptions to many popular Orthopaedic journals. This right of access to the full text versions is also transferred to you as a member. It is not necessary visit the library in order to exercise this right; all that is necessary is access to the internet from a University computer. Many publisher’s sites take note of the referrer’s unique IP (internet Protocol) address, and if this packet comes from a subscribing academic institution, the remote host computer will sign the user in automatically and honor him with the privileges of a paid subscriber.

 Many universities also allow a students and staff to log on to their library site from outside the university. After verifying the user via login passwords, he is then allowed to log into publishers’ sites to which the University has subscription rights. License agreements pay a role here: some publishers do not allow away from campus access, but most do.

A University also has finite means and, most likely, does not have subscriptions to all Orthopaedic journals. If you still cannot get the full text of your reference free online, consider asking the librarian for an inter library loan. In many cases all that will have to be paid for is the cost of photostating the article. Ironically, because of license agreements, the paper version may be more freely available for inter-lending than a digital copy. This is because libraries are bound by treaties on interlibrary loans. The conference on fair use (CONFU)²¹ agreement determines fair use, its main aim is to allow fair academic use, and also to prevent the borrowing library from being able to redistribute it again as if they had a subscription. This agreement was more biased towards Photostat (paper) copies, but recently digital copies are becoming regarded as an equivalent.

If you need the copy for teaching purposes, for example to distribute to a class your University may already own a blanket copyright agreement. For example the University of Stellenbosch pays a levy to the Dynamic Artistic and Literary Rights Organisation (DALRO²²) to allow unlimited copies (with certain provisos, such as only one article per journal) to your class. The university requires to be notified retrospectively of your use of the article.

Privatly funded electronic libraries

Medical and paramedical practitioners, who are often not affiliated with a medical school and it's library have to take out individual subscriptions to each journal and join many pay sites. MELISA (Medical electronic library of South Africa) was set up to allow communal access to it's members to these existing subscriptions and online resources. It asked the pharmaceutical companies to sponsor costs. Melisa recently closed its services due to lack of funding. The feeling in the industry was that "doctors did not read", and that Melisa did not warrant sponsorship because industry would not get a return on its investment.

Such nobile initiatives must be encouraged, as a way to promote reading and study, especially in the South African context, where underpaid junior doctors are sent to do community service in rural areas. Libraries and other physical access to books and periodicals are virtually non existent at these places.

Free Journal Sites

Many are concerned by the fact that commercial publishers make their profit from selling articles generated from research funded by public money. To counter this commercialization, many Open Access (OA) electronic resources have been established. There is an advantage to the author too in using OA  journals.  Alma Swan²³  has shown that a publication is more likely to be cited from an OA journal than from a subscription equivalent. The reason is that the OA journal is easier to find and retrieve on the internet. 

Below is a selection of the better known OA sites.

·    BioMed Central.²⁴ is an independent online publishing house committed to providing free access to the peer-reviewed biological and medical research it publishes.

·         Directory of Open Access Journals ²⁵ Here the reader can find 8 journals in the field of Orthopaedic Surgery. These journals include Acta Orthopaedica and Orthopaedic Research and Reviews.

·        Free Medical Journals.com ²⁶ Links to many OA medical journals. The site allows the user to download (full text) copies of articles from 18 Orthopaedic Journals.

Reference manager software

The personal computer will generate many useful links and downloads from your academic quest for knowledge. Reference managers allow the user to create order with this data.

These handy programmes allow the user to compile a reference of articles read, even if the user does not wish to become an author. The software allows a user to download a citation, with a few clicks of the mouse, and keep a database of the downloaded reference. Links to a copy of the PDF (or any other file) you download to your own PC (Personal Computer) can be added including a field for a graphic. There is a field allowing the user to add his notes and annotations. Many citation managers interface with popular word processors such as MS Word, and can automatically add and maintain a list of references as a footnote to the article. The program will correctly order the articles and keep the style of the references uniform and in accordance with that wanted from a selection of well known journals. Alternatively the writers own style can be formatted.  

There are many commercial reference manager programmes such as EndNote²⁷ and Procite²⁸. In addition there are public domain (free ware) alternatives such as JabRef ²⁹distributed under the GNU³⁰ (General public license). Most of these public domain managers make use of  the BibTex notation. This is a simple text based format that can easily be hand written.

Example: Reference 15 in BibTex format:-

@article{

   author = {Priscilla Caplan, William Arms},

   title = {Reference linking for journal articles},

   journal = {D-Lib Magazine},

   volume = {5},

   number = {7/8},

   year = {1999}

}

 This formatted paragraph of text needs to be copied from the host site and merely pasted into your BibTex compatible browser.

The commercial reference mangers are even more automatic. The host site’s software will allow the user to “download to citation manager.” Once the manager type is selected the reference is downloaded in a format such as RIS³¹ (a standardized tag format developed by Research Information Systems ). This file can either be saved to disk on the user’s machine or will activate your citation manager automatically to include the reference in its library - as ‘RIS’ will be a file type associated by your operating system with your favorite citation manager.  The whole process is thus semi automatic and the user can with minimal effort, build up a large and ordered, library of the articles he has read. Most reference managers also allow the user to link to a local, on disk, copy the user may have saved from his web search.

Search Engines

Popular search engines such as Google³²,  Bing³³ and Yahoo³⁴ give too many non academic references to be of much use if an academic peer reviewed citation is sought.

Wootton³⁵ has pointed out that Boolean searches using (AND, NOT and OR) are easy to do and one does not need to be a skilled librarian to yield very accurate and specific search results.  

Another distraction is spam and illegal advertising from pharmaceutical vendors³⁶. Specialized services such as Google Scholar³⁷, a version of Google optimized for scholarly articles and patients, are an improvement for literature searches.

What distinguishes a good from a bad search engine? Simpson³⁸ considers a good search engine to have the capacity to search the whole internet and regularly update itself as new or altered pages appear. He considers that there should also be an ability to filter out poor quality material. At present the user gets all results yielded. This selection must be done by the user, as leaving anything out of the search results would amount to censorship. The way around this is search engines dedicated to academic publications.

In addition there are many specialized medical search sites such as

·        Intute⁶  Is a collection of gateways from the site which is  maintained by a consortium of respected British Universities. The site links to quality resources in the health and life sciences.

·         Scirius³⁹  Is a dedicated scientific research site which claims to have 370 million scientific articles indexed.

·         Google Scholar

This selective search engine dedicated to academic articles.

With this service, the full text is weighed, as well as author and the publication in which the article appears. It is ranked according to how often the article has been cited. Although the list is often old, the article is more likely to be peer reviewed. It may also come from libraries, theses and other academic sources such as conference proceedings.  Scholar often leads the user to sites requiring “paid for” subscriptions. Although there is a feature linking the user to his local library site for a full test version, Google Scholar does not know whether a user’s library is subscribed or not.

Conclusion

The internet has changed the way we deal with and acquire knowledge. Not only is more information available, it can be effectively stored and referenced on one’s own personal computer. Search engines that can index the entire internet and produce a search results in microseconds are both a boon and a curse as they have difficulty in distinguishing pearls of wisdom from pornography. The advent of search engines dedicated to scholarly work and archival sites such as Pub Med has helped to improve the quality of their results for the academic.

 It is still up to the individual to verify the quality of the information returned from such searches. All these sophisticated searches do is filter out some of the dirt. The spam producers and unscrupulous businessmen will always be able to keep ahead of these efforts.

A practical knowledge of how to obtain copies of references not available directly through your web connection to your internet provider is necessary. Use your local medical libraries’ online service and if this fails ask for an old fashioned interlibrary loan on paper!

Online information is growing in quantity but is much shorter lived than the paper documents it replaces. The life span of information on a hard disk is unknown³⁰, but probably only slightly longer than flash disks and non gold plated CD ROM disks. Joe Iraci ⁴⁰ has demonstrated in accelerated ageing tests, reliably store information for less than 10 years.  In addition to the concern about degradation of the data itself  there are other concerns online as a result of the basic building blocks of web pages- the HTML (Hypertext Markup Language); the  hyper links themselves. Online references are liable to ‘link rot’, and vendor obsolescence. Services such as PubMed and other archival sites are helping keep references pointing towards viable sites. The DOI initiative promises to grow and provide a system of valid links to much more scholarly output than just formal journal articles. 

The internet will continue to evolve. Orthopaedic websites will proliferate and search engines will become more attuned to the needs of the academic searcher. On the other hand spam producers, and con artists will continue to keep abreast of these developments. While the future of publishing will undoubtedly be more web-based, the Orthopaedic surgeon will always have to exercise judgment before accepting all online information as gospel truth.