Roger A. Brumback

Worshiping False Idols: The Impact Factor Dilemma

It always begins innocently enough! In the middle of the 19th century, mining and earthmoving were increasingly important enterprises of the industrial revolution. To remove rock and to open mine shafts, an explosive was needed, but nitroglycerine was too unstable for practical use. The Swedish scientist/inventor Alfred Nobel discovered that mixing nitroglycerine with the diatomaceous earth kieselguhr produced a stable explosive product he patented as dynamite, which was quickly adopted by the mining and construction industries. In the early 20th century, the Italian physicist Enrico Fermi, while attempting to understand the structure of atomic nuclei, discovered that nuclei bombarded by neutrons would split and release large amounts of energy. As others have employed these discoveries, both dynamite and nuclear fission have had destructive effects on society that were initially unimaginable by their discoverers. It was only a quarter century after the first nuclear fission bombs that Eugene Garfield, a library scientist and structural linguist from the University of Pennsylvania, discovered a metric that could be used to select journals for inclusion in his new publication Genetics Citation Index (the forerunner of Science Citation Index, which was subsequently commercialized by Garfield’s company Institute for Scientific Information). This metric for journals was named “impact factor” and was to be calculated “based on 2 elements: the numerator, which is the number of citations in the current year to any items published in a journal in the previous 2 years, and the denominator, which is the number of substantive articles (source items) published in the same 2 years.” 1,2 Thus, although the journal impact factor was born innocently enough, just like the examples involving Nobel and Fermi, Garfield’s impact factor is now being used by others in ways that threaten to destroy scientific inquiry as we know it. 3,4 For much of human history (about 200,000 generations), scientists were few in number, often worked in relative isolation, and only communicated findings to close

An Emerald Event The Journal of Child Neurology Reaches 20

An estimated 5 to 10% of the pediatric population has a developmental disability. The current strategy to identify these children is through developmental surveillance, a continuous procedure in which the health professional observes the infant, takes a developmental history, and elicits any concerns that the caregiver might have. However, identification of delayed children is ineffective when based solely on routine surveillance. A necessary adjunct is developmental screening: the process of systematically identifying children with suspected delay who need further assessment. Screening tests S. Lane Rutledge Jan 2001–Dec 2004 Stephen G. Ryan Feb 1999–Dec 2004 Norio Sakuragawa Jan 1986–Dec 2004 Frederick J. Samaha Jan 1986–Nov 1996 Pirkko Santavuori Jan 1996–Jan 2004 Harvey B. Sarnat Jan 1996–Dec 2004 Ronald C. Savage Jul 2003–Dec 2004 G. Bradley Schaefer Jan 1995–Dec 2004 Mark S. Scher Jan 2001–Dec 2004 Sydney S. Schochet Jr Feb 1998–Dec 2000 Nina Felice Schor Feb 1999–Dec 2004 Hervey D. Segall Jan 1986–Oct 1993 Stefano Seri Jan 2001–Dec 2004 Raj D. Sheth Mar 1998–Dec 2004 Michael Shevell Jan 1997–Dec 2004 Lloyd K. Shield Jan 1996–Dec 2002 Jack P. Shonkoff Jan 1986–Oct 1990 Robert M. Shuman Jul 1986–Oct 1989 O. Carter Snead Jan 1988–Nov 1996 Russel D. Snyder Apr 1988–Nov 1995 Giovanna M. Spinella Jan 2002–Dec 2004 John Stephenson Feb 1999–Jan 2001 Herbert M. Swick Jan 1988–Oct 1990 Marc Tardieu Jan 1994–Dec 2004 John A. R. Tibbles Jan 1993–Dec 2000 Ann H. Tilton Jan 1995–Dec 2004 Kytja K. S. Voeller Jan 1996–Dec 2004 Warren A. Weinberg Jan 1986–Oct 1993; Jan 1995–May 2002 James W. Wheless Feb 1998–Jan 2004 Paul Winner Sep 2001–Dec 2004 Max Wiznitzer Jan 2004–Dec 2004 Virginia Wong Feb 2000–Dec 2004 Francis S. Wright Jan 1988–Jan 2002 Wu Xi-Ru Feb 1999–Dec 2004 Richard S. K. Young Jan 1991–Oct 1994 Sotiris G. Youroukos Jan 2001–Dec 2004 Name Term Name Term Table 2. (continued) Journal of Child Neurology Editorial Board Members editor-in-chief and publisher sincerely thank everyone for their past contributions to the journal’s success, we also invite suggestions and comments for future improvement of JCN and hope for the continued support of the worldwide child neurology community. References 1. Raposo J: Joe Raposo Songbook. Milwaukee, WI, Hal Leonard Corporation, 2001. 2. Matlins A, Bonanno AC: Jewelry & Gems, The Buying Guide, 5th ed. Woodstock, VT, Gemstone Press, 2003. 3. Brumback RA: A new journal of a medical specialty that has come of age. J Child Neurol 1986;1:2. 4. Brumback RA: Citation and impact of the Journal of Child Neurology. J Child Neurol 1998;13:560–569. 5. Brumback RA: Impact of the Journal of Child Neurology: 2002 data. J Child Neurol 2003;18:795–797. 6. Brumback RA: Further analysis of the impact factors and submission information for the Journal of Child Neurology. J Child Neurol 2004;19:290–293. Figure 2. Number of members of the Child Neurology Society from 1972 to 2004.

Medullomyoblastoma: case report.

This 7-year-old boy presented with a 2-week history of headache, nausea, vomiting, anorexia, lethargy, and unsteadiness of gait. Brain magnetic resonance imaging (MRI) revealed a cystic mass within the vermis of the cerebellum. A suboccipital craniectomy was performed to remove a tumor that contained primitive neuroectodermal cells with florid skeletal muscle differentiation. Immunohistochemical studies and electron microscopy confirmed the presence of both a primitive neuroectodermal component and rhabdomyoblastic differentiation, consistent with the diagnosis of medullomyoblastoma. This exceedingly rare tumor of the cerebellar vermis of children is characterized by two components: primitive neuroectodermal tumor cells and skeletal muscle. Although the histogenesis remains uncertain, advances in immunohistochemistry and electron microscopy suggest the origin of this tumor from a multipotential stem cell precursor. (J Child Neurol 2001 ; 16 :598-599).

Journal Combat Initiating a Publication, Competing for Visibility, and Assuring Ethical Behavior

‘‘Publish or perish’’ is the time-honored ‘‘principle’’ that is drummed into all young academicians at the start of their careers and haunts their lives as they race to accumulate lines under the section ‘‘publications’’ on a curriculum vitae. Originally, the publication of scholarly activity was meant to inform others of findings and thereby further the knowledge of scientists generally. Unfortunately, that goal, which began in 1665 with the first scientific journal (Philosophical Transactions of the Royal Society of London), has been corrupted over the past half century. Many factors have contributed to this perversion, but major among them are (1) the exponential growth of journals and the journal industry, (2) the adoption of journal metrics as the measure of quality rather than the written content of the article, and (3) the intrusion of the Internet into all aspects of academic life. Until the second half of the 20th century, most of the important journals in what is now categorized as ‘‘science, technology, and medicine’’ (STM is the abbreviation used by the publishing industry) were the organs of major societies or associations and sometimes were even published by those organizations. To be an editor of such a publication was an honor (and generally unpaid or with only a minimal stipend to cover expenses) and manuscript submissions were reviewed by peers who gladly donated their time and expertise to assure the integrity of the publication. However, with the acceleration of technological innovation and scientific and medical discovery that marked the second half of the 20th century, journals through their advertising and subscription revenues became major sources of funding for many organizations. Smaller or developing organizations viewed journals as a means for sustaining financial viability, while at the same time, journals unaffiliated with any society or association proliferated exponentially. To maintain the original purpose of journals (to disseminate useful information for other scientists, engineers, or physicians) indexing was necessary for the growing volume of journal articles published annually. This resulted in 2 classes of journals: those that were indexed by major indexing services and those that were not indexed (more like ‘‘vanity’’ publishing, often with a ‘‘pay for publication’’ stratagem). For biomedical journals, indexing in the National Library of Medicine Index Medicus (or the digital version Medline, which is now PubMed) became the distinguishing characteristic of the important peer-reviewed journal. To be indexed by the National Library of Medicine, a publication undergoes evaluation by a panel of expert reviewers, who assess the quality of articles and the peer review process used by the journal, scientific stature of the editor and editorial board members, and timeliness of publication. With the increased revenues and competition accompanying journal proliferation, journal management became so complex that most journals were taken over by the large consolidated publishing companies, which could use consortium deals to assure circulation numbers and to capture the full capabilities of the Internet to disseminate materials. Libraries (and individual subscribers) have been overwhelmed with the sheer volume of material to be perused for useful content. With library budgets unable to sustain the costs of increasing numbers of journals and increasing journal subscription prices, librarians have looked for ways to limit the number of journal subscriptions. In 1955, Eugene Garfield, a library scientist and structural linguist from the University of Pennsylvania, had developed a metric that he termed impact factor to select journals for inclusion in his initial publication (Genetics Citation Index, which was the forerunner of his later Science Citation Index). This impact factor number calculated ‘‘based on 2 elements: the numerator, which is the number of citations in the current year to any items published in a journal in the previous 2 years, and the denominator, which is the number of substantive articles (source items) published in the same 2 years’’ seemed to be a reasonable measure for librarians navigating through budget crises to use in prioritizing their journal subscription lists. This led publishing companies to put greater emphasis on boosting journal impact factors in order to ensure continuing subscriptions. The resultant changes in editorial practices at many journals and the maneuvering by publishers to adjust article designations (to alter the numbers in the ratio used to calculate the impact factor) produced considerable

In Memoriam: Daniel Carleton Gajdusek (1923-2008)

T he final act closed on what could be considered a modern major Shakespearean tragedy. On December 12, 2008, the 85-year-old flawed Nobel Laureate D. Carleton Gajdusek was found dead in his room in Tromsø, Norway. Born on September 9, 1923, in Yonkers, New York, Gajdusek was a product of the intellectually and scientifically vigorous mid-20th century America. His father, Karl Gajdusek (born about 1887), had immigrated just before World War I from a village near Senica in the Trnava Region of western Slovakia and worked as a butcher. His mother Ottilia Dobroczki, born in Yonkers in June 1893, was the oldest child of Hungarian immigrants (Debrecen, Hungary) who had first met and married in New York. Carleton also had a brother who was 2 years younger than him, Robert E. (Robin) Gajdusek (born April 18, 1925, Robin Gajdusek became a noted poet, writer, and leading Ernest Hemingway scholar and was professor emeritus of English at the San Francisco State University at the time of his death in June 26, 2003). As a child, Carleton spent considerable time with his maternal aunt Irene, who was an entomologist at the Boyce Thompson Institute for Plant Research (then an independent research facility located in Yonkers, New York, but since the late 1970s located in Ithaca, New York, in affiliation with Cornell University). His fascination with science led him to summer jobs at the Boyce Thompson Institute to work in synthesis of halogenated hydrocarbons as potential insecticides. After graduating from high school at the age of 16 years, Gajdusek enrolled at the University of Rochester, obtaining a BS degree in 1943, and then attended the Harvard Medical School, obtaining an MD degree in 1946. He trained in pediatrics at the Boston Children’s Hospital and became certified by the American Board of Pediatrics in October 1951. Following his studies with the Nobel Laureates Linus Pauling at the California Institute of Technology and John F. Enders at Harvard Medical School, he was stationed by the US Army at the Walter Reed Army Institute of Research in Washington, DC. Subsequent work at the Institut Pasteur of Iran in Tehran greatly stimulated his interest in infectious diseases of isolated populations and prompted further study under another subsequent Nobel Laureate Sir Frank Macfarlane Burnet at the Walter and Eliza Hall Institute in Melbourne, Australia. While there, he learned of a strange ‘‘new’’ disease afflicting natives of the remote Papua New Guinea highlands. Teaming with Vincent Zigas (a German immigrant physician), he painstakingly documented this illness termed kuru, along with the social, religious, and healing customs of the Fore people. Thus, began the first Received February 25, 2009. Accepted for publication February 26, 2009.

In Memoriam: Lowell Winship Lapham (1922-2006)

Following medical school, he was an intern (1948-1949) and assistant resident (1949-1950) at the Harvard Internal Medicine service at Boston City Hospital. He spent 1 year as an assistant resident (1950-1951) in neurology at the Neurological Institute of New York (Columbia Presbyterian Hospital), which was then under the directorship of the renowned neurologist H. Houston Merritt. This training was interrupted by service as a neurologist at the Brooke Lowell Winship Lapham was born March 20, 1922, in Hampton, Iowa, and grew up in nearby Charles City, Iowa (both of which are close to Mason City, Iowa, the hometown of Meredith Willson, who wrote the musical comedy Music Man). Lowell attended Charles City High School; his father, Percy Lapham, was the superintendent of schools in Charles City, and his mother, Altha Dygert Lapham, was a homemaker raising Lowell and his 2 siblings, Lewis and Margaret (Peggy). Growing up, Lowell had several dogs, and during high school, he received an award for his photograph of the most cherished dog, Buster, looking at his reflection in a pond. In 1938, Lowell was the Iowa State winner of the Ninth Annual Gorgas Essay Contest (this national contest for high school students was meant to encourage interest in public health in memory of William Crawford Gorgas, the US Army Medical Officer who helped conquer yellow fever, which allowed the Panama Canal to be built; Lowell received a prize of

William Henry Olson (1936-2003)

10 from the Gorgas Memorial Institute). The following year (1939), Lowell was the salutatorian of his high school class (Figure 1). Upon entering Oberlin College in Oberlin, Ohio, Lowell received one of the highest honors given to an entering freshman: an Amos Miller Scholarship. In 1943, he obtained an AB degree in psychology and was elected to Phi Beta Kappa. In 1945, Lowell married an artist, Miriam Sellers, who also attended Oberlin College. He then enrolled in Harvard Medical School, graduating cum laude 1948 and was elected to membership in the Alpha Omega Alpha honor medical society. While a Harvard medical student, he won second prize in the Boylston Medical Society essay contest (with an essay titled “Functions of the Hypothalamus”). It was apparent that Lowell had discovered his true calling when he exclaimed to Miriam that a neurology textbook was “more interesting than any novel” he had ever read (Figure 2). Obituary

Warren A. Weinberg (1934—2002)

William Henry Olson (Figure 1) was bom September 2, 1936, in the small town of Haxtun in the extreme northeast comer of Colorado. This area is dry, rolling prairie, which had been virtually treeless before the arrival of white settlers. Bill’s father, William H. Olson Sr, was bom on a farm 1 mile east and 3 miles north of Haxtun, close to the land that his grandfather (Bill’s great grandfather) had claimed as a sodbuster in 1890. Bill’s mother, Burdene O. (Anderson) Olson, was the daughter of a lumberman and sometime preacher who ran the lumberyard in Haxtun. The Great Depression and the dustbowl brought hard years to that county and taught those who survived frugality and gritty perseverance (lessons Bill learned well). The family was slightly more fortunate than most because Bill’s father had a relatively secure job as a land appraiser for the

Quality Improvement Specific for Child Neurology

On May 30, 2002, the field of child neurology lost a pioneer: Warren Abraham Weinberg, MD (Figure 1) died after a valiant 2-year battle with lung cancer. The great historian Henry Adams said, “A teacher affects eternity; he can never tell where his influence stops.”1 This was very true for Warren, who had a profound influence on pediatricians and pediatric specialists by teaching them the proper way to evaluate and treat the countless children experiencing learning and behavioral problems. Warren was born January 12, 1934, in the then sleepy southern town of Memphis, Tennessee, most famous for its blues singers. His early childhood spent on the opposite side of the Mississippi River in Osceola, Arkansas, could not have portended his revolutionary ideas about the brain and behavior in children. Like most boys of that era, his interests revolved mainly around sports, at which he had a passion to excel. He set track records and played basketball and baseball, but he was particularly talented at football (Figure 2). Warren was an All-State Arkansas football star during his junior and senior years in high school and was one of the standout players in the 1952 National High School All-American All Star Football Game, along with the legendary Bart Starr. Warren was heavily recruited in football and baseball by many colleges, but he, fortunately, chose a path of academics and science In Memoriam

INITIATING REFERRAL IN MILD COGNITIVE IMPAIRMENT: WHO RINGS THE BELL?

Physicians traditionally have always tried to do what is right for their patients. However, in the current healthcare environment, such efforts are not good enough and physicians must constantly strive for better and better quality. The 2001 Institute of Medicine report empowered a movement among physician organizations to improve healthcare quality. One such organization, the Accreditation Council for Graduate Medical Education (ACGME) now requires residents in all specialties to be able to demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant selfevaluation and life-long learning. Residents are expected to develop skills and habits to be able to meet the following goals: