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Before the first scientific journal appeared in 1665, scientists waited until they amassed enough material for a book to communicate new findings to fellow scientists. By enabling researchers to publish little units of information, the invention of journals may have been the decisive step in advancing the scientific method (1). But when a researcher starts to build on the work of other scientists, the scattering of papers in different issues of a journal and in different journals makes it difficult to find relevant preceding work. To help turn these centrifugal forces in a centripetal direction, AJRCCM is introducing a new series of articles, Year in Review.
Physician-scientists need to know everything about very little when working in a lab but a little about everything when
rounding
their narrow peak of expertise is set in a broad
plain of ignorance. In his recent biography, Michael Bliss tells
of an undercurrent of critical talk among colleagues that William Osler was no longer keeping up after his fiftieth birthday
(2). And that was before the advent of the first subspecialty
journal, and said of a man who covered all of internal medicine in a single-author text. The new series in AJRCCM is
aimed at helping readers keep up. The key findings of every
article published in the Journal in 2000 are communicated in
précis form and categorized by subject matter. The hypertext
link in each summary allows the reader to return to the original article within seconds. In writing these summaries, I tried
to select relevant conceptual material, unscramble the jargon,
and present the key findings in words that can be rapidly assimilated. I may have misunderstood many points, missed others, and misrepresented some. But the summaries are not ends in themselves, but rather a trailer to the main feature. I hope the summaries cause you to read articles you might otherwise
have missed, because the goal of good journalism is to fascinate people with topics they didn't think would interest them
till brought to their attention. And like news, you want to hear
about it as soon as it happens. New information has a short
shelf life, and unlike brandy, cheapens with age.
Arranging the articles for Year in Review into a taxonomy
is arbitrary because the categorical schemes are not fixed; I
glossed over nuances and complexities to make generalizations. Describing and classifying natural objects forms the
foundation of much scientific knowledge (3). Yet researchers
in the hard sciences view this taxonomic exercise condescendingly. Science is "either physics or stamp collecting" quipped
Ernest Rutherford. But he would never have split the atom
nor won his Nobel Prize if generations of scientists had not
classified the elements he tested. And the quantum leap of
Darwin arose directly from taxonomic research. Whereas the
Linnaean taxonomy classifies plants along a branching hierarchy, libraries catalogue books and journals along a single dimension. The tag on a spine works well for staff returning
books to a shelf, but is far from satisfactory when you are trying to retrieve books. Unlike the linearity of a library shelf, scientific disciplines speciate, interpenetrate, overlap, and merge
the boundaries are convoluted and fractal. Fortunately, the
Internet provides an unprecedented resource for cartographers faced with mapping this bibliographical terrain.
With the Internet, it is possible to take the variegated
threads of information published in AJRCCM and spin and
weave them into a sturdy cloth of knowledge. Employing the
taxonomy of categories, you can scan the spectrum of subjects
covered in AJRCCM and find an article relevant to your immediate need. The summaries in Year in Review would have
little value without the hypertext links to the original article.
The links and the taxonomy allow you to organize your reading material into a virtual filing cabinet. Researchers spend inordinate amounts of time trying to retrieve a needed reference
(4). Which folder did I put it in? Am I in the wrong drawer?
Or is it in the pile I have yet to sort? Stacks of articles are no
help to a researcher unless organized into a system that allows
easy retrieval. Year in Review replicates the old system of cutting out abstracts and sticking them on index cards. But there
was never a good method for linking those cards. Nor did the
cards give you immediate access to the original articleyou still had to root in a drawer. Year in Review not only organizes your reading material by subject category, but it also gives you immediate access to the original articles. And unlike papers
on paper, clicking on the hypertext of citations allows you to
explore and exploit other bibliographical sourcesthe worth
of the article you are reading increases dramatically. By interweaving journals and libraries into an interconnected archive
of information, the Internet gives new meaning to E.M. Forster's precept: "Only connect!". AJRCCM is fortunately part
of the HighWire Press stable of electronic journals, meaning
that our readers have instant access to the world's largest free
repository of biomedical publications: over 324,000 articles and
increasing daily.
A challenge for readers of AJRCCM is the diversity of the
subject matter, ranging from apoptosis caused by lung preservation solutions (5) to quality of life in sufferers of allergic
rhinitis (6), from molecular biology of the glucocorticoid receptor (7) to exhaled nitric oxide for predicting bronchiolitis
obliterans (8), from atelectasis caused by a heavy heart in the
acute respiratory distress syndrome (9) to the effects of German reunification on clean air and childhood wheeze (10),
from use of lipoarabinomannan for diagnosing tuberculosis
(11) to the influence of the N-methyl-D-aspartate glutamate
receptor on the hypoxic ventilatory response of the newborn
(12), and from genetic polymorphisms in sarcoidosis (13)
to a decrease in ventilator-associated pneumonia by rotating
antibiotics (16). This broad diversity carries a risk of fragmenting pulmonary and critical care medicine into a myriad of mutually incomprehensible and noncommunicating sects. The insularity of domains slows the percolation of new ideas through
a population, and too much indoctrination within a subfield
inhibits imaginative powers. Original ideas rarely arise out of
the blue, and usually consist of novel combinations of existing
ideas. Cross-fertilization between disciplines becomes a major
source of mental creativity, as illustrated by the collaboration between physicist Crick and zoologist Watson in arriving at
the structure of DNA. A journal acts as a unifying force for
members of a discipline, because it gives them interests in
common (17). The summaries in Year in Review are presented
in words that make it possible for sleep researchers to get
ideas from studies of airway inflammation in asthma (18),
for asthma investigators to get stimulated by recent advances
in the molecular biology of sepsis (25), and for critical care
researchers to catch hints in reports on the regulation of the
vasculature in sleep apnea (33). And so on. Unlike newspapers, journals have a more intimate relationship with their
readers, because readers are also the authors supplying the
published articles. At AJRCCM, we recognize that we exist to
serve authors and readersnot the other way around. And
our success depends on how well we meet your needs.
The cornerstone of editorial policy at AJRCCM is the
anonymous work carried out by our reviewers. At a time of
wanton commercialism, reviewers donate untold hours with
no monetary reward. The idealism is not surprising because
reviewers are one of the principal owners of a journal. Without authors participating in peer-review, self-regulationthe hallmark of a professiongoes out the window. Reviewers
are our primary instrument for ensuring quality control at
AJRCCM. And the constructive criticism of reviewers, which
transform manuscripts between the time of submission and
publication, is the hidden treasure of the Journal. The more
reputable a journal, the more it is regarded as authoritative,
the stronger are its refereeing procedures and editorial norms
(37). Like people, the reputation of an article is based on the
company it is seen with. The increase of almost 300 submissions to AJRCCM in 2000equal to the total annual submissions of many pulmonary journalshas necessarily resulted in
a tightening of standards. The editors have a duty to maintain
standards, but we also recognize that it is wounding for authors to get work rejected. Original papers are selected for
publication in AJRCCM on the basis of significance, validity, novelty, and comprehensibility. A large number of papers are
declined for publication, not out of problems with design or
methodology, but because they fare poorly when a reviewer
asks, "Does the manuscript contain information that is really
new?" Or "Is it just a slight advance over previously published
work?" Reviewers will have easy access to Year in Review to
judge the novelty of a manuscript. But authors will also be
able to contrast their manuscript with other recently published
work and emphasize its novelty at the time of submission.
Reviewers get upset when an author gives insufficient credit to the work of other investigators in an area. To paraphrase Congreve, hell hath no fury like the reviewer uncited. This view is hardly surprising because like Newton's reference to giants, every scientist owes a debt to fellow researchers, competitors and collaborators alike. Recognition of this truth gives the scientific community its distinctive character. Although the etiquette of citation is not precisely formalized, it is a trademark of scholarship. We cite authorities not only out of humble deference to past achievements, but to enlist support for our own claims and to buttress our case (3). A published paper is of little significance unless other scientists cite it and build on it. Subsequent citations are as much a part the life of a paper, as the germ of the idea from which it sprouted. Citations embed a publication in the pre-existing consensus, authenticating it by linking it back to an archival source. And with hypertext tagging, it is possible to link publications backwards and forwards in time, making it easier to identify a seminal paper and the succession of reports of incremental knowledge culminating in a substantial new discovery, and then the ripple effect of that discovery on subsequent research. By organizing articles by subject category, Year in Review will help authors find relevant previous work. Citations demonstrate not only the accreditation but also the accretion process of science, whereby every paper builds on the preceding work that it cites.
Of metaphors applied to science, the most evocative is the building of an edifice of knowledge with every paper serving as a brick (38). Each modest contribution remains a permanent part of the edifice long after the researcher is forgotten. The library is the quarry of the researcher's materials, where the documents can be mined, sifted, sorted, and reordered. The storage, searchability, and speed of the Internet make it an important addition on the building site. Every mason knows that the durability of a building depends on selecting the right brick and placing it on a sound foundation. And every so often, a researcher needs to stand back, take a look at the edifice as a whole and ask where the next brick can have greatest effect. I hope Year in Review will serve as a blueprint, helping researchers decide what part of the edifice needs another brick and to find a sturdy predecessor for the addition. I also hope that the distilled and digestible delivery will help time-constrained clinicians stay abreast of advances over a broad range, making AJRCCM the journal you quote on rounds.
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