"Those with access to these resources -- students, librarians, scientists --

you have been given a privilege. You get to feed at this banquet of knowledge

while the rest of the world is locked out. But you need not -- indeed, morally,

you cannot -- keep this privilege for yourselves. You have a duty to share it

with the world."

Aaron Swartz1 (who killed himself at the age of 26,

facing a felony conviction and prison sentence

for downloading millions of academic journal articles)

 

The Philippine Journal of Otolaryngology Head and Neck Surgery was accepted into the Directory of Open Access Journals (DOAJ) on October 9, 2019. The DOAJ is "a community-curated online directory that indexes and provides access to high quality, open access, peer-reviewed journals"2 and is often cited as a source of quality open access journals in research and scholarly publishing circles that has been considered a sort of "whitelist" as opposed to the now-defunct Beall's (black) Lists.3

As of this writing, the DOAJ includes 13,912 journals with 10,983 searchable at article level, from 130 countries with a total of 4,410,788 articles.2 Our article metadata is automatically supplied to, and all our articles are searchable on DOAJ. Because it is OpenURL compliant, once an article is on DOAJ, it is automatically harvestable. This is important for increasing the visibility of our journal, as there are more than 900,000 page views and 300,000 unique visitors a month to DOAJ from all over the world.2 Moreover, many aggregators, databases, libraries, publishers and search portals (e.g. Scopus, Serial Solutions and EBSCO) collect DOAJ free metadata and include it in their products. The DOAJ is also Open Archives Initiative (OAI) compliant, and once an article is in DOAJ, it is automatically linkable.4

Being indexed in DOAJ affirms that we are a legitimate open access journal, and enhances our compliance with Plan S.5 The Plan S initiative for Open Access publishing launched in September 2018 requires that from 2021, "all scholarly publications on the results from research funded by public or private grants provided by national, regional, and international research councils and funding bodies, must be published in Open Access Journals, on Open Access Platforms, or made immediately available through Open Access Repositories without embargo."5 Such open access journals must be listed in DOAJ and identified as Plan S compliant.

There are mixed reactions to Plan S. A recent editorial observes that subscription and hybrid journals (including such major highly-reputable journals as the New England Journal of Medicine, JAMA, Science and Nature) will be excluded,6 quoting the COAlition S argument that "there is no valid reason to maintain any kind of subscription-based business model for scientific publishing in the digital world."5 As Gee and Talley put it, "will the rise of open access journals spell the end of the subscription model?"6

If full open access will be unsustainable for such a leading hybrid medical journal as the Medical Journal of Australia,6 what will happen to the many smaller, low- and middle-income country (southern) journals that cannot sustain a fully open-access model? For instance, challenges facing Philippine journals have been previously described.7

According to Tecson-Mendoza, "these challenges relate to (1) the proliferation of journals and related problems, such as competition for papers and sub-par journals; (2) journal funding and operation; (3) getting listed or accredited in major citation databases; (4) competition for papers; (5) reaching a wider and bigger readership and paper contribution from outside the country; and (6) meeting international standards for academic journal publications."7  Her 2015 study listed 777 Philippine scholarly journals, of which eight were listed in both the (then) Thomson Reuters (TR) and Scopus master lists, while an additional eight were listed in TR alone and a further twelve were listed in Scopus alone.7 To date, there are 11,207 confirmed Philippine periodicals listed on the International Standard Serial Number (ISSN) Portal,8 but these include non-scientific and non-scholarly publications like magazines, newsletters, song hits, and annual reports. What does the future have in store for small scientific publications from the global south?

I previously shared my insights from the Asia Pacific Association of Medical Journal Editors (APAME) 2019 Convention (http://apame2019.whocc.org.cn) on the World Association of Medical Editors (WAME) Newsletter, a private Listserve for WAME members only.9 These reflections on transformation pressures journals are experiencing were the subject of long and meaningful conversations with the editor of the Philippine Journal of Pathology, Dr. Amado Tandoc III during the APAME 2019 Convention in Xi'an China from September 3-5, 2019. Here are three main points:

the real need for and possibility of joining forces- for instance, the Journal of the ASEAN Federation of Endocrinology Societies (JAFES) currently based in the Philippines has fully absorbed previous national endocrinology journals of Malaysia and the Philippines, which have ceased to exist.  While this merger has resulted in a much stronger regional journal, it would be worthwhile to consider featuring the logos and linking the archives of the discontinued journals on the JAFES website. Should the Philippine Journal of Otolaryngology Head and Neck Surgery consider exploring a similar model for the ASEAN Otorhinolaryngological - Head and Neck Federation? Or should individual specialty journals in the Philippines merge under a unified Philippine Medical Association Journal or the National Health Science Journal Acta Medica Philippina? Such mergers would dramatically increase the pool of authors, reviewers and editors and provide a sufficient number of higher-quality articles to publish monthly (or even fortnightly) and ensure indexing in MEDLINE (PubMed).the migration from cover-to-cover traditional journals (contents, editorial, sections, etc.) to publishing platforms (e.g. should learned Philippine societies and institutions consider establishing a single platform instead of trying to sustain their individual journals)? Although many scholarly Philippine journals have a long and respectable history, a majority were established after 2000,7 possibly reflecting compliance with requirements of the Commission on Higher Education (CHED) for increased research publications. Many universities, constituent colleges, hospitals, and even academic and clinical departments strove to start their own journals. The resulting journal population explosion could hardly be sustained by the same pool of contributors and reviewers.

In our field for example, faculty members of departments of otorhinolaryngology who submitted papers to their departmental journals were unaware that simultaneously submitting these manuscripts to their hospital and/or university journals was a form of misconduct. Moreover, they were not happy when our specialty journal refused to publish their papers as this would constitute duplicate publication. The problem stemmed from their being required to submit papers for publication in department, hospital and/or university journals instead of crediting their submissions to our pre-existing specialty journal. This escalated the tension on all sides, to the detriment of the new journals (some department journals ceased publication after one or two issues) and authors (whose articles in these defunct journals are effectively lost).

The older specialty journals are also suffering from the increased number of players with many failing to publish their usual number of issues or to publish them on time. But how many (if any at all) of these journals (especially specialty journals) would agree to yield to a merger with others (necessitating the end of their individual journal)? Would a common platform (rather than a common journal) provide a solution?

more radically, the individual journal as we know it today (including the big northern journals) will cease to exist- as individual OA articles (including preprints) and open (including post-publication) review become freely available and accessible to all. However proud editors may be of the journals they design and develop from cover to cover, with all the special sections and touches that make their "babies" unique, readers access and download individual articles rather than entire journals. A similar fate befell the music industry a decade ago. From the heyday of vinyl (33 and 78 rpm long-playing albums and 45 rpm singles) and 8-tracks, to cassettes, then compact disks (CD's) and videos, the US recorded music industry was down 63% in 2009 from its peak in the late 70's, and down 45% from where it was in 1973.10 In 2011, DeGusta observed that "somewhat unsurprisingly, the recording industry makes almost all their money from full-length albums" but "equally unsurprising, no one is buying full albums anymore," concluding that "digital really does appear to have brought about the era of the single.10 As McDowell opines, "In the end, the digital transforms not only the ability to disrupt standard publishing practices but instead it has already disrupted and continues to break these practices open for consideration and transformation."11

Where to then, scientific journals? Without endorsing either, will Sci-Hub (https://sci-hub.se) be to scholarly publishing what Spotify (https://www.spotify.com) is to the music industry? A sobering thought that behooves action.

Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Perso ; Open Access Publishing ; Open Access Publishing ; Journalism

BACKGROUND: Adrenal  nodules  can  either  be  non  functioning or hormone secreting. Once proven functional,
adrenalectomy is warranted. Laparoscopic adrenalectomy has been the popular intervention for these nodules. There is no local literature citing the clinical outcomes, particularly on  symptom  and  medication  reduction.  Considering  that  these tumors present with hypertension, such condition may be  under  diagnosed  in  a  population  with  a  hypertension  prevalence  of  22.3%.  This  study  reviewed  the  outcomes 
of the procedure particularly on the improvement of signs and  symptoms  and  medication  use.

METHODOLOGY: This  is  a  retrospective  review  describing  the  post-operative  outcomes  of  patients  who  underwent  laparoscopic  adrenalectomy  conducted  in  a  tertiary 
medical  center  from  2010  -  2015. 

RESULTS: Twenty-three  (23)  patients  were  categorized  according  to  pathology  -  primary  hyperaldosteronism 
-(17),   pheochromocytoma   -   four  (4)  and  Cushing's  syndrome - two (2). Post-operatively, there was a reduction in  the  systolic  blood  pressure  of  patients  with  primary  hyperaldosteronism  (p  =  0.156).  A  mean  reduction  of  20-30  mmHg  in  the  blood  pressure  was  documented  in patients  who  had  pheochromocytoma  (p  =  0.625).  There  was  a  reduction  in  the  number  and  dosages  of  anti-hypertensive  medications  (primary  hyperaldosteronism  p=
Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Perso ; Adrenalectomy ; Antihypertensive Agents ; Pheochromocytoma ; Hydrocortisone ; Hyperaldosteronism ; Hypertension ; Cushing Syndrome ; Blood Pressure Determination

BACKGROUND: Ischemic events commonly occur in the morning hours. This is retrospective study of association between morning blood pressure surge and ischemic events in hypertensive patients.

METHOD: A descriptive analysis of patients diagnosed with cerebrovascular disease who presented in the Emergency Department of Pasig City General Hospital with elevated blood pressure of 140/90 and above (either known hypertensive or newly diagnosed), between 12 midnight and 12 noon from January to June 2009.

CONCLUSION: Incidence of stroke is higher among males and it increases advancing age. It is highest in women 65 years old and above. Analysis showed that higher blood pressure in the morning implicated with higher incidence of stroke with peak occurrence between 8 and 11 in the morning. There is lack of association between circadian rhythm and the timing and type of stroke.

Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Perso ; Blood Pressure ; Stroke

BACKGROUND: Stroke is an emergency. In order to provide proper acute stroke treatment, there must be prompt activation of a stroke response system designed to deliver timely and optimum care. In our institution, the Brain Attack Team (BAT) was initiated upon the inception of the neurology residency training program.

OBJECTIVES:to ascertain the number and nature of BAT referral cases; to determine the time frames of the acute stroke response system observed in our institution. The time frames were compared to target times recommended by the National Institute of Neurological Disorders and Stroke (NINDS).

METHOD: We reviewed records of 399 BAT referral cases - both emergency room (ER) and floor referrals -over a ten-month period from January to October 2007. Frequency and percentage distributions were computed for the number of BAT referrals. Median time intervals in minutes were computed.

RESULTS: January had the most number of BAT calls at 17% (68 of 399). Fifty-five percent (220 of 399) of BAT calls were made during the night duty shift. Ischemic strokes had the highest incidence at 49.6% (198 of 399). Fifty-three percent (211 of 399) of patients were able to arrive at the ER within 3 hours; 47% (99 of 211) of these patients were ischemic stroke cases, and therefore eligible for possible thrombolysis. Of the 99 eligible patients, 8 passed our hospital criteria for thrombolysis. Intravenous recombinant tissue-plasminogen activator (rTPA) was administered in 6 out of 8 patients. Median time values were as follows: Ictus-to-Door time was 180 minutes, Door/Ictus at the floors-to-BAT referral was 30 minutes, BAT referral-to-BAT response was 5 minutes, Door/Order-to CT scan was 43 minutes. Door/Ictus at the floors-to-Drug median time among thrombolysed patients was 102.5 minutes.

CONCLUSION: Median time of BAT referral-to-BAT response was immediate. This was true even during night shift. Among those cases of patients who were given thrombolytic therapy, Door/Order-to-CT scan was within the NINDS target.

Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Perso ; Stroke ; Brain ; Neurology ; Neurosciences

INTRODUCTION: Stroke research in western countries has recently begun to focus on gender differences. There is evidence that the burden of stroke seems to be greater among women. They were found to have different stroke risk factor profiles from men; and found to be managed differently from men. To date, there are no local studies documenting gender disparities in stroke.

OBJECTIVES: To determine whether there are differences in stroke risk profiles -hypertension, diabetes mellitus, congestive heart failure, atrial fibrillation, previous strokes or transient ischemic attacks, smoking, BMI, low-density lipoprotein (LPL) levels, medication intake; stroke types; and initial stroke assessment  - NHSS scores and blood pressure levels on admission - among male and female stroke patients in our institution.

METHOD: Chart review of 181 stroke patients (98 males, 83 females) admitted in our institution over an eight-month period.

CONCLUSION: Our findings suggest that gender disparities among Filipino stroke patients may exist and should not be overlooked. Defining these disparities would then pave the way to optimal stroke risk management in our setting.

Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Perso ; Gender Identity ; Stroke ; Risk Factors ; Male ; Female ; Philippines ; Patients