Severe Sepsis and Septic Shock - Understanding a Serious Killer
Edited by Ricardo Fernandez, ISBN 978-953-307-950-9, Hard cover, 436 pages, Publisher: InTech, Chapters published February 10, 2012 under CC BY 3.0 license DOI: 10.5772/1311
Despite recent advances in the management of severe sepsis and
septic shock, this condition continues to be the leading cause of death
worldwide. Some experts usually consider sepsis as one of the most
challenging syndromes because of its multiple presentations and the
variety of its complications.
Various investigators from all over the world got their chance in this
book to provide important information regarding this deadly disease .
We hope that the efforts of these investigators will result in a useful
way to continue with intense work and interest for the care of our
patients.
English: Open Access logo, converted into svg, designed by PLoS. This version with white background. (Photo credit: Wikipedia)
El acceso abierto (en inglés, open access) es el acceso
inmediato, sin requerimientos de registro, suscripción o pago -es decir
sin restricciones- a material digital educativo, académico, científico o
de cualquer otro tipo, principalmente artículos de investigación
científica de revistas especializadas con peer review ('revisión por pares').
Source: Nature Michael
Eisen doesn't hold back when invited to vent. “It's still ludicrous how
much it costs to publish research — let alone what we pay,” he
declares. The biggest travesty, he says, is that the scientific
community carries out peer review — a major part of scholarly publishing
— for free, yet subscription-journal publishers charge billions of
dollars per year, all told, for scientists to read the final product.
“It's a ridiculous transaction,” he says. Eisen, a molecular biologist at the University of
California, Berkeley, argues that scientists can get much better value
by publishing in open-access journals, which make articles free for
everyone to read and which recoup their costs by charging authors or
funders. Among the best-known examples are journals published by the
Public Library of Science (PLoS), which Eisen co-founded in 2000. “The
costs of research publishing can be much lower than people think,”
agrees Peter Binfield, co-founder of one of the newest open-access
journals, PeerJ, and formerly a publisher at PLoS.
But publishers of subscription journals insist that such
views are misguided — born of a failure to appreciate the value they add
to the papers they publish, and to the research community as a whole.
They say that their commercial operations are in fact quite efficient,
so that if a switch to open-access publishing led scientists to drive
down fees by choosing cheaper journals, it would undermine important
values such as editorial quality. These charges and counter-charges have been volleyed back
and forth since the open-access idea emerged in the 1990s, but because
the industry's finances are largely mysterious, evidence to back up
either side has been lacking. Although journal list prices have been
rising faster than inflation, the prices that campus libraries actually
pay to buy journals are generally hidden by the non-disclosure
agreements that they sign. And the true costs that publishers incur to
produce their journals are not widely known. The past few years have seen a change, however. The number
of open-access journals has risen steadily, in part because of funders'
views that papers based on publicly funded research should be free for
anyone to read. By 2011, 11% of the world's articles were being
published in fully open-access journals1 (see 'The rise of open access').
Suddenly, scientists can compare between different publishing prices. A
paper that costs US$5,000 for an author to publish in Cell Reports, for example, might cost just $1,350 to publish in PLoS ONE — whereas PeerJ
offers to publish an unlimited number of papers per author for a
one-time fee of $299. “For the first time, the author can evaluate the
service that they're getting for the fee they're paying,” says Heather
Joseph, executive director of the Scholarly Publishing and Academic
Resources Coalition in Washington DC.
The variance in prices is leading everyone involved to
question the academic publishing establishment as never before. For
researchers and funders, the issue is how much of their scant resources
need to be spent on publishing, and what form that publishing will take.
For publishers, it is whether their current business models are
sustainable — and whether highly selective, expensive journals can
survive and prosper in an open-access world.
The cost of publishing
Data from the consulting firm Outsell in Burlingame,
California, suggest that the science-publishing industry generated $9.4
billion in revenue in 2011 and published around 1.8 million
English-language articles — an average revenue per article of roughly
$5,000. Analysts estimate profit margins at 20–30% for the industry, so
the average cost to the publisher of producing an article is likely to
be around $3,500–4,000. Most open-access publishers charge fees that are much
lower than the industry's average revenue, although there is a wide
scatter between journals. The largest open-access publishers — BioMed
Central and PLoS — charge $1,350–2,250 to publish peer-reviewed articles
in many of their journals, although their most selective offerings
charge $2,700–2,900. In a survey published last year2,
economist Bo-Christer Björk of the Hanken School of Economics in
Helsinki and psychologist David Solomon of Michigan State University in
East Lansing looked at 100,697 articles published in 1,370 fee-charging
open-access journals active in 2010 (about 40% of the fully open-access
articles in that year), and found that charges ranged from $8 to $3,900.
Higher charges tend to be found in 'hybrid' journals, in which
publishers offer to make individual articles free in a publication that
is otherwise paywalled (see 'Price of prestige'). Outsell estimates that the average per-article charge for open-access publishers in 2011 was $660.
J. WEST, C.BERGSTROM, T. BERGSTROM, T. ANDREW/JOURNAL CITATION REPORTS, THOMSON REUTERS
Although these fees seem refreshingly transparent, they
are not the only way that open-access publishers can make money. As
Outsell notes, the $660 average, for example, does not represent the
real revenue collected per paper: it includes papers published at
discounted or waived fees, and does not count cash from the membership
schemes that some open-access publishers run in addition to charging for
articles. Frequently, small open-access publishers are also subsidized,
with universities or societies covering the costs of server hosting,
computers and building space. That explains why many journals say that
they can offer open access for nothing. One example is Acta Palaeontologica Polonica,
a respected open-access palaeontology journal, the costs of which are
mostly covered by government subsidies to the Institute of Paleobiology
of the Polish Academy of Sciences in Warsaw; it charges nothing for
papers under 10 pages. Another is eLife, which is covered by
grants from the Wellcome Trust in London; the Max Planck Society in
Munich, Germany; and the Howard Hughes Medical Institute in Chevy Chase,
Maryland. And some publishers use sets of journals to cross-subsidize
each other: for example, PLoS Biology and PLoS Medicine receive subsidy from PLoS ONE, says Damian Pattinson, editorial director at PLoS ONE. Neither PLoS nor BioMed Central would discuss actual costs
(although both organizations are profitable as a whole), but some
emerging players who did reveal them for this article say that their
real internal costs are extremely low. Paul Peters, president of the
Open Access Scholarly Publishing Association and chief strategy officer
at the open-access publisher Hindawi in Cairo, says that last year, his
group published 22,000 articles at a cost of $290 per article. Brian
Hole, founder and director of the researcher-led Ubiquity Press in
London, says that average costs are £200 (US$300). And Binfield says
that PeerJ's costs are in the “low hundreds of dollars” per article. The picture is also mixed for subscription publishers,
many of which generate revenue from a variety of sources — libraries,
advertisers, commercial subscribers, author charges, reprint orders and
cross-subsidies from more profitable journals. But they are even less
transparent about their costs than their open-access counterparts. Most
declined to reveal prices or costs when interviewed for this article. The few numbers that are available show that costs vary
widely in this sector, too. For example, Diane Sullenberger, executive
editor for Proceedings of the National Academy of Sciences in
Washington DC, says that the journal would need to charge about $3,700
per paper to cover costs if it went open-access. But Philip Campbell,
editor-in-chief of Nature, estimates his journal's internal costs
at £20,000–30,000 ($30,000–40,000) per paper. Many publishers say they
cannot estimate what their per-paper costs are because article
publishing is entangled with other activities. (Science, for
example, says that it cannot break down its per-paper costs; and that
subscriptions also pay for activities of the journal's society, the
American Association for the Advancement of Science in Washington DC.)
Scientists
pondering why some publishers run more expensive outfits than others
often point to profit margins. Reliable numbers are hard to come by:
Wiley, for example, used to report 40% in profits from its scientific,
technical and medical (STM) publishing division before tax, but its 2013
accounts noted that allocating to science publishing a proportion of
'shared services' — costs of distribution, technology, building rents
and electricity rates — would halve the reported profits. Elsevier's
reported margins are 37%, but financial analysts estimate them at 40–50%
for the STM publishing division before tax. (Nature says that it
will not disclose information on margins.) Profits can be made on the
open-access side too: Hindawi made 50% profit on the articles it
published last year, says Peters. Commercial publishers are widely acknowledged to make
larger profits than organizations run by academic institutions. A 2008
study by London-based Cambridge Economic Policy Associates estimated
margins at 20% for society publishers, 25% for university publishers and
35% for commercial publishers3.
This is an irritant for many researchers, says Deborah Shorley,
scholarly communications adviser at Imperial College London — not so
much because commercial profits are larger, but because the money goes
to shareholders rather than being ploughed back into science or
education. But the difference in profit margins explains only a small
part of the variance in per-paper prices. One reason that open-access
publishers have lower costs is simply that they are newer, and publish
entirely online, so they don't have to do print runs or set up
subscription paywalls (see 'How costs break down').
Whereas small start-ups can come up with fresh workflows using the
latest electronic tools, some established publishers are still dealing
with antiquated workflows for arranging peer review, typesetting,
file-format conversion and other chores. Still, most older publishers
are investing heavily in technology, and should catch up eventually.
Costly functions
The publishers of expensive journals give two other
explanations for their high costs, although both have come under heavy
fire from advocates of cheaper business models: they do more and they
tend to be more selective. The more effort a publisher invests in each
paper, and the more articles a journal rejects after peer review, the
more costly is each accepted article to publish. Publishers may administer the peer-review process, which
includes activities such as finding peer reviewers, evaluating the
assessments and checking manuscripts for plagiarism. They may edit the
articles, which includes proofreading, typesetting, adding graphics,
turning the file into standard formats such as XML and adding metadata
to agreed industry standards. And they may distribute print copies and
host journals online. Some subscription journals have a large staff of
full-time editors, designers and computer specialists. But not every
publisher ticks all the boxes on this list, puts in the same effort or
hires costly professional staff for all these activities. For example,
most of PLoS ONE's editors are working scientists, and the journal does not perform functions such as copy-editing. Some journals, including Nature,
also generate additional content for readers, such as editorials,
commentary articles and journalism (including the article you are
reading). “We get positive feedback about our editorial process, so in
our experience, many scientists do understand and appreciate the value
that this adds to their paper,” says David Hoole, marketing director at
Nature Publishing Group.
“The costs of research publishing can be much lower than people think.”
The key question is whether the extra effort adds useful
value, says Timothy Gowers, a mathematician at the University of
Cambridge, UK, who last year led a revolt against Elsevier (see Naturehttp://doi.org/kwd;
2012). Would scientists' appreciation for subscription journals hold up
if costs were paid for by the authors, rather than spread among
subscribers? “If you see it from the perspective of the publisher, you
may feel quite hurt,” says Gowers. “You may feel that a lot of work you
put in is not really appreciated by scientists. The real question is
whether that work is needed, and that's much less obvious.” Many researchers in fields such as mathematics,
high-energy physics and computer science do not think it is. They post
pre- and post-reviewed versions of their work on servers such as arXiv —
an operation that costs some $800,000 a year to keep going, or about
$10 per article. Under a scheme of free open-access 'Episciences'
journals proposed by some mathematicians this January, researchers would
organize their own system of community peer review and host research on
arXiv, making it open for all at minimal cost (see Naturehttp://doi.org/kwg; 2013). These approaches suit communities that have a culture of
sharing preprints, and that either produce theoretical work or see high
scrutiny of their experimental work — so it is effectively peer reviewed
before it even gets submitted to a publisher. But they find less
support elsewhere — in the highly competitive biomedical fields, for
instance, researchers tend not to publish preprints for fear of being
scooped and they place more value on formal (journal-based) peer review.
“If we have learned anything in the open-access movement, it's that not
all scientific communities are created the same: one size doesn't fit
all,” says Joseph.
The value of rejection
Tied into the varying costs of journals is the number of articles that they reject. PLoS ONE (which charges authors $1,350) publishes 70% of submitted articles, whereas Physical Review Letters (a hybrid journal that has an optional open-access charge of $2,700) publishes fewer than 35%; Nature published just 8% in 2011. The connection between price and selectivity reflects the
fact that journals have functions that go beyond just publishing
articles, points out John Houghton, an economist at Victoria University
in Melbourne, Australia. By rejecting papers at the peer-review stage on
grounds other than scientific validity, and so guiding the papers into
the most appropriate journals, publishers filter the literature and
provide signals of prestige to guide readers' attention. Such guidance
is essential for researchers struggling to identify which of the
millions of articles published each year are worth looking at,
publishers argue — and the cost includes this service. A more-expensive, more-selective journal should, in
principle, generate greater prestige and impact. Yet in the open-access
world, the higher-charging journals don't reliably command the greatest
citation-based influence, argues Jevin West, a biologist at the
University of Washington in Seattle. Earlier this year, West released a
free tool that researchers can use to evaluate the cost-effectiveness of
open-access journals (see Naturehttp://doi.org/kwh; 2013). And to Eisen, the idea that research is filtered into
branded journals before it is published is not a feature but a bug: a
wasteful hangover from the days of print. Rather than guiding articles
into journal 'buckets', he suggests, they could be filtered after
publication using metrics such as downloads and citations, which focus
not on the antiquated journal, but on the article itself (see page 437). Alicia Wise, from Elsevier, doubts that this could replace
the current system: “I don't think it's appropriate to say that
filtering and selection should only be done by the research community
after publication,” she says. She argues that the brands, and
accompanying filters, that publishers create by selective peer review
add real value, and would be missed if removed entirely. PLoS ONE supporters have a ready answer: start by
making any core text that passes peer review for scientific validity
alone open to everyone; if scientists do miss the guidance of selective
peer review, then they can use recommendation tools and filters (perhaps
even commercial ones) to organize the literature — but at least the
costs will not be baked into pre-publication charges. These arguments, Houghton says, are a reminder that
publishers, researchers, libraries and funders exist in a complex,
interdependent system. His analyses, and those by Cambridge Economic
Policy Associates, suggest that converting the entire publishing system
to open access would be worthwhile even if per-article-costs remained
the same — simply because of the time that researchers would save when
trying to access or read papers that were no longer lodged behind
paywalls.
The path to open access
But a total conversion will be slow in coming, because
scientists still have every economic incentive to submit their papers to
high-prestige subscription journals. The subscriptions tend to be paid
for by campus libraries, and few individual scientists see the costs
directly. From their perspective, publication is effectively free. Of course, many researchers have been swayed by the
ethical argument, made so forcefully by open-access advocates, that
publicly funded research should be freely available to everyone. Another
important reason that open-access journals have made headway is that
libraries are maxed out on their budgets, says Mark McCabe, an economist
at the University of Michigan in Ann Arbor. With no more library cash
available to spend on subscriptions, adopting an open-access model was
the only way for fresh journals to break into the market. New
funding-agency mandates for immediate open access could speed the
progress of open-access journals. But even then the economics of the
industry remain unclear. Low article charges are likely to rise if
more-selective journals choose to go open access. And some publishers
warn that shifting the entire system to open access would also increase
prices because journals would need to claim all their revenue from
upfront payments, rather than from a variety of sources, such as
secondary rights. “I've worked with medical journals where the revenue
stream from secondary rights varies from less than 1% to as much as
one-third of total revenue,” says David Crotty of Oxford University
Press, UK. Some publishers may manage to lock in higher prices for
their premium products, or, following the successful example of PLoS,
large open-access publishers may try to cross-subsidize high-prestige,
selective, costly journals with cheaper, high-throughput journals.
Publishers who put out a small number of articles in a few mid-range
journals may be in trouble under the open-access model if they cannot
quickly reduce costs. “In the end,” says Wim van der Stelt, executive
vice president at Springer in Doetinchem, the Netherlands, “the price is
set by what the market wants to pay for it.” In theory, an open-access market could drive down costs by
encouraging authors to weigh the value of what they get against what
they pay. But that might not happen: instead, funders and libraries may
end up paying the costs of open-access publication in place of
scientists — to simplify the accounting and maintain freedom of choice
for academics. Joseph says that some institutional libraries are already
joining publisher membership schemes in which they buy a number of free
or discounted articles for their researchers. She worries that such
behaviour might reduce the author's awareness of the price being paid to
publish — and thus the incentive to bring costs down. And although many see a switch to open access as
inevitable, the transition will be gradual. In the United Kingdom,
portions of grant money are being spent on open access, but libraries
still need to pay for research published in subscription journals. In
the meantime, some scientists are urging their colleagues to deposit any
manuscripts they publish in subscription journals in free online
repositories. More than 60% of journals already allow authors to
self-archive content that has been peer-reviewed and accepted for
publication, says Stevan Harnad, a veteran open-access campaigner and
cognitive scientist at the University of Quebec in Montreal, Canada.
Most of the others ask authors to wait for a time (say, a year), before
they archive their papers. However, the vast majority of authors don't
self-archive their manuscripts unless prompted by university or funder
mandates. As that lack of enthusiasm demonstrates, the fundamental
force driving the speed of the move towards full open access is what
researchers — and research funders — want. Eisen says that although PLoS
has become a success story — publishing 26,000 papers last year — it
didn't catalyse the industry to change in the way that he had hoped. “I
didn't expect publishers to give up their profits, but my frustration
lies primarily with leaders of the science community for not recognizing
that open access is a perfectly viable way to do publishing,” he says.
This article originally described David Solomon as an
economist; he is a psychologist. It also wrongly defined STM as
‘science, technology and mathematics’ instead of ‘scientific, technical
and medical’. These errors have been corrected.
Cambridge Economic Policy AssociatesActivities, costs and funding flows in the scholarly communications system in the UK (Research Information Network, 2008). Show context
a link to Clipboard will be added to the homepage, if applicable
a new Limits page with additional limits for dates and search field tags
PubMed Limits
The Limits page is available from a link above the search box on all PubMed pages, including the PubMed homepage. The homepage will also include a link to the Clipboard if citations have been added (see Figure 1).
The Limits page includes limit selections previously available on the Advanced search page as well as additional limits for dates and search field tags. The functionality of Limits will not change; subsequent searches will include Limits until they are removed. Limits are not activated for Related Article results; however, Limits will be retained for searches that are run after displaying Related Article results. The search box on the Limits page retains the search from other PubMed pages (see Figure 2).
The "Limits Activated" message has moved from the discovery area on the right to display above the results summary line on search results, and under the search box on the homepage and Advanced search page. Users may click either the Change link or the Limits link to return to the Limits page. The Remove link will deactivate selections for the current and subsequent searches (see Figure 3).
On the Advanced search page, a Search Builder replaces the Search by Author, Journal, Publication Date, and more and Index of Fields and Field Values sections. The Limit by Topics, Languages, and Journal Groups section was removed — replaced by the new Limits page. The Search History section will not change (see Figure 4).
The Advanced search box does not retain previously run searches, i.e., the search box always defaults to "Clear." Previous searches are available from the Search History section and can be entered into the Search box using the Options menu on each Search number (#).
The Search Builder allows users to create a search using Boolean operators. Retain the All Fields selection to run your search through the Automatic Term Mapping process, or select a specific field to apply to your search term. An Index button is available to display the specified search field index and number of citations for each term within the search field. You may select multiple terms (ORed together) from the Index display.
A link to the Search Builder instructions is provided under the Boolean operator buttons (see Figure 5).
The Author, First Author, Full Author Name, Last Author, and Journal fields include an autocomplete feature. Date fields include two search boxes to accommodate date range searching (see Figure 6).
