An introduction to the Internet

ORTHO BYTES The use of computers, computer programs, and other computerized equipment to assist in the orthodontic practice will be reported under this section of the AMERICAN JOURNAL OF ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS.

Manuscripts, comments, and reprint requests may be submitted to Dr. Martin N. Abelson, 14720 North Shotgun Pl., Tucson, A Z 85737.

An introduction to the Internet Frederick J. Regennitter, DDS, a and John E. Volz, DDS, MPA b

Fort Knox, Ky

(This is part two of the article in the February issue.) ON RAMPS TO THE SUPERHIGHWAY

An Internet user first needs a computer or access to one. It does not have to be top of the line or even new. An old IBM X T or ancient Macintosh Plus will work for text based services. However, putting imagery, pictures, sound, or other multicasted information on a user's screen will require a higher-powered Macintosh or PC that uses Windows (Microsoft Corp., Redmond, Wash.). Computers on the Internet are divided into two basic types: host computers and client computers. Host computers are usually more powerful with higher speed connections and more disk space. Client computers tend to be like the smaller computers potential users of the Internet would have. The next piece of hardware needed is a modem. The modem establishes a connection from a personal computer through the telephone lines to another computer. Modems are rated by how many bits per second (bps) they can move down a phone line. Current prices for 14,400 bps modems are around $100 to $150. The faster the modem the better until the cost of additional speed outpaces a user's finances. The personal computer will need communications software to effectively use a modem. These programs should offer, at a minimum, the ability to set communications parameters that include the bps rate, parity, data, and stop bits. In addition, they should allow keyboard automation permitting

The views expressed in this article are exclusively those of the authors and do not reflect those of the Department of Army, the United States Army Dental Corps, the Department of Defense or other Departments of the United States Government. ~Colonel, U.S. Army Dental Corps; Former Director, Advanced Education in Orthodontics. bColonel, U.S. Army Dental Corps; Former Assistant Director, Advanced Education in Orthodontics. 8/1/63227

a user to run a login script from a single keystroke. Communications software permits a user's computer to connect another computer, either through a modem or by a direct connection. The user's computer can then mimic the remote computer; a function called terminal emulation. Commonly used standards are VT100 and ANSI-BBS emulation. When terminal emulation software is used the personal computer acts like a video display terminal, revealing incoming information on the screen and sending characters typed by a user to the other computer. Most terminal emulators support file transfers, so a user can send or receive files from another computer. Wood's book contains detailed information. = There are several avenues to the Internet (Fig. 1). The connection for a typical person is called a dial-up account. A dial-up connection needs a computer, modem, and communications software. A user obtains an account number or name and a password from an organization, agency, public access provider, or other commercial online service. This allows a personal computer to be linked with the provider's computer who has access to a network. Physically, however, the personal computer remains one step away from the actual Internet. Most of the previously mentioned services will require a subscriber fee although academic and government institutions have local area networks that may be "wired" into the Internet providing free access to educators, researchers, or government workers. Alternatively, a user may live in an area that has access to the Internet through a Free-net or community network. These may charge a nominal fee. For $10 to $30 a month public access Internet hosts will provide a user with dial-up service to their systems, which are then connected to the Internet. If a user needs guardrails as he eases onto the information highway, several commercial online

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services have opened gateways that will allow a moderated level of network access. America Online, CompuServe, GEnie, and Prodigy are examples. These commercial services also offer a full range of electronic periodicals, educational references, sports, weather, live discussions, hundreds of bulletin boards, and access to Internet mail. Fees are based on the extent and frequency of usage. They differ according to the time of day the service is accessed, the speed of a user's modem, and how many of the specialized services offered are used. To get closer to a true network connection, a dial-up IP (Internet Protocol) type of account can be set up with a provider. Essentially these are subscription services that sell access specifically to the Internet. 23 The modem on the user's computer connects to the Internet provider's host computer, which is connected directly to the Internet. A1-

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though the subscription service and the user maybe separated geographically, to a user's computer the connection looks just like that of a LAN. Two ways to do this are by either a SLIP (Serial Link Internet Protocol) or PPP (Point to Point Protocol) connection. Both require TCP/IP software installed on the user's computer. Full featured software may cost several hundred dollars and be bought from subscription service providers for use on their systems. Alternatively, the technically inclined may find applications in the shareware and public domain arena to custom configure their communications. They must still use a provider who charges a flat rate connection fee. A dial-up IP service provider gives the user greater access to Internet resources particularly those with graphic interfaces like Mosaic or Cello. It also allows simultaneous reading of electronic mail, downloading a file from the Library

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Table Ih Accessible government Internet hosts Name

Login

Internet address

FEDWORLD (Telnet)

fedworld.gov or 192.239.92.205

your name

FEDWORLD (FTP)

flp.fedworld.gov or 192.239.92.205

your name

FEDWORLD (WWW)

www.fedworld.gov

your name

LC MARVEL (Telnet) Gopher-based, Library of Congress information system that presents information about many electronic resources accessible through the Internet.

marvel.loc,gov or 140.147.2.69

gopher

Network Information Center

rs.internic.net or 198.41.0.5

gopher

Library of Congress (FTP)

seql.loc.gov or 140.147.3.12

anonymous send your email address at the password prompt

Library of Congress (Telnet)

locis.loc,gov or 140.147.254.3

gopher

National Institute of Dental Research NIH EDNET BBS 301-402-2221 or access from fedworld.gov databases

of Congress or viewing a satellite image depending on the power of the user's computer. On the high cost end, a user could become an Internet host with a dedicated connection consisting of a leased, high speed telephone line between two points. This is the Internet linkage universities and many corporations have. It is the most direct route. With the right software, and user could always have a high quality Internet connection. The user's computer becomes a part of the Internet complete with an IP address assigned by the Internet Address Naming Authority (IANA). The approximate cost of setting this up, not including the computers, high speed modems, and significant professional help is $2000 to $3000 plus a monthly fee of at least $200. TYPES OF INTERNET SERVICES

The information on the Internet is not readily identifiable or available. A user almost has to know what information exists and where it exists before they try to access it. This has led to the practice known as "surfing the Net." This is a "recreational" activity of looking for things that may be of benefit on the Internet. The diversity of information on the Internet can be categorized into three main services; reaching distant computer resources, information retrieval, and computer expedited communication. On the Internet this services are called remote login (Telnet), file transfer (FTP) and electronic mail (e-mail). Each has unique characteristics and require special navigational aids for optimal use. Gopher, Archie, Veronica, Jughead, and WAIS (Wide Area Information Servers) are

tools for searching and retrieving information from the libraries of information stored on the Internet through Telnet and FTP services. TELNET

Telnet is a program that allows a user to operate a remote computer from their own desktop computer by a dial up connection. It is the Internet standard protocol that allows a user at one site to interact with a remote, timesharing system at another site. Remotes include computers located outside a school, office, or home. They are generally available 24 hours a day. By being able to access a remote from their desktop computer, researchers can conveniently find new material on a topic in a collection that is possibly better than the local one. Globally separated, specialized references in electronic form provide flexibility of use and permit searching capabilities based on keyword or subject content. Some academic institutions and many government agencies have established Online Public Access Catalogs (OPACs) and databases which may be accessed via the Internet. Many of these can be searched at no cost (Table II). T E L N E T operates in a client/server environment in which the user's computer becomes a client, with T E L N E T negotiating the opening of a session on a remote computer (server). Both the client and the server must be able to accept T E L N E T ' s standard protocol (TCP/IP) before a user can transfer commands and data between the two computers. To open a T E L N E T session, the basic commands are simple. To login, T E L N E T < host > or T E L N E T < cr > is typed followed by O P E N < host > at the

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prompt. At the TO < host > prompt the computer name (for example, marvel.loc.gov) or its Internet address (such as 140.147.2.69) is typed. To find help, a user can try typing help or ? at the prompt. A list of commands available should then be displayed. Once a remote session is established all commands a user types are sent to the server (remote host) for execution. The resulting data requests or computations are then sent and displayed on the client's computer simultaneously. This allows a user to search, then "cut-and-paste" information from multiple sources into a log that is available for later use. Once a search has been conducted, a user may want to save or electronically mail the results back to their own computer. Gopher is one of the more popular Telnet tools for rapidly moving from one place on the Internet to another. It does this by standardizing the menu format on thousands of Internet hosts. Veronica is a service that lists the files available through gophers if the user is looking for a specific file but does not know which gopher to use. WAIS is a tool that lets a user search multiple databases at the same time. The World-Wide Web (WWW) is a more sophisticated navigational system that organizes contents by subject matter using hypertext links. A search will show screens of information with certain words highlighted. When a highlighted word is selected WWW automatically links to another document that could be more text, sound, or video. Sound and video require a special interface like Mosaic. Mosaic is a "front end application" that enables a user to get through the Internet by using a mouse to point and click. This hypermedia tool accesses mixed media documents containing graphics, text and sound, which can be all linked and cross referenced with other such documents and programs on the Internet. FILE TRANSFER PROTOCOL

File Transfer Protocol (FTP) is the Internet standard protocol for transferring files from one computer to another. Thousands of sites provide FTP service, allowing a user to download online books, reference documents, accessible databases, and public-domain software. Unless a user's computer is directly connected to the Internet getting this information is a two-step process. First, the information is FTPed to the local host and then the user downloads it to his personal computer. If the information a user is looking for is in the public domain, they FTP to the site and login as "anonymous" giving their user ID or e-mail address at the

American Journal of Orthodontics and Dento)acial Orthopedics March 1995

password prompt. As a result of this methodology, these sites are known as anonymous FTPs. Anonymous sites are usually accessed free of charge and do not require a user to establish an account or to be assigned a login identification. Nonanonymous sites require that a user contact the FTP system administrator to request an account. Other sites have criteria that a user must meet to be assigned an account, such as belonging to a certain client group (faculty, for instance) and may charge for logging in and length of connection. FTP sites are set up only to move information, so a user cannot actually view file contents. To view or manipulate files, a user will have to transfer them to their system (using the get < filename > command) and open them with a word processing program. FTP files can also be found through a gopher list by a navigator such as an Archie server. Archie servers can be used to tell a person where to look more easily than having to use the unfamiliar UNIX commands that are needed on some host computers that store large FTP files. Tennant, Ober and Lipow have written a concise handbook which discusses Telnet and FTP usage. 24 E-MAIL

Electronic mail (e-mail) provides the ability to compose, send and receive messages through the computer, and demonstrate how valuable networked information can be. Although addresses are needed, a user does not need an envelope, a stamp, or someone to deliver the mail. Depending on net traffic, it can arrive at its destination almost instantly. To use e-mail, a user needs an e-mail account or ID on a host computer and the Internet address of the person with whom they want to communicate; user [email protected]. After drafting an electronic package (whether it contains text, sound, and/or images) on a their computer, a user sends it to the receiver over the network. At the other end, the recipient of the package may check their "mailbox" at anytime. Freedom from time restrictions is one of the most useful aspects of e-mail, allowing correspondents from different regions to consult regardless of time zones or office hours. Exchanging information with colleagues around the world, sending and receiving manuscripts for collaboration, editing or review are just a few of the uses of e-mail. E-mail messages and files can be sent to users on the same network or through and to a different network. They are generally "stored" on a computer until the time appointed for that computer to

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contact the next one on the network to the final destination, at which time it is "forwarded" along its way. It is also possible to send e-mail to more than one person at a time. Large mailing lists, called listservers, function as electronic conferences, allowing a working group of colleagues from all over the world to easily converse. These mailing lists are typically unmoderated. Moderated mailing lists provide another category of e-mail service. The content of these lists can be controlled by an editor. One advantage of moderated lists is that they permit the user to collect and assemble messages into topic-specific or discipline-specific groupings such as dentistry or possibly orthodontics. Moderated lists can even function in a manner similar to that of refereed professional journals. A specialized application of e-mail is the electronic newsgroup that is the equivalent of an electronic bulletin board. Newsgroups, also called Usenet, provide an electronic bulletin board for opinions, queries, conference announcements, job offerings, and interdisciplinary dialogue. Although there are several different forms of newsgroups, they all work in basically the same way. Once a user has subscribed to the list any message they send to that list will be posted for other subscribers to view. Similarly, a user will receive a copy of postings sent to the list by other subscribers. Newsgroups exist on every conceivable subject. Sci.med.dentistry is an example of a newsgroup that offers both professional discussion and public service. Although there are only a small number of dentists participating, it is an excellent forum for lay people with questions about dental care. ~NTERNET POTENTIAL

The electronic record, video imaging, and filmless radiography can all be transmitted electronically. As a result there are professional and educational reasons that connectivity in the information age will be a prerequisite for orthodontists. In 1992 the AAO and Council on Orthodontic Education focused on computer usage at an educator's forum just before the annual meeting in St. Louis. This group set as future goals establishing digital access to orthodontic literature and providing storage for diagnostic and research quality information. For a growing number of clinicians, cracking a textbook or wading through piles of journals is often impractical because of time constraints or lack of access to well stocked libraries. Online orthodontic consultation services could help clinicians if dental specific networks crisscrossed the nation prudently

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sharing computerized patient records and images. Specialists could be queried thousands of miles away, and the clinician could continually upgrade his education and skills. The framework for such a network has already been proposedY Telemedicine is a method of remote therapeutic intervention through healthcare provider networks and distributed computing. This idea could also be applied to a future dental network. In addition to the potential educational benefits, electronic commerce is another incentive for the orthodontist to participate in the world of telecommunications.26 One of the administration's goals for the NII is to establish standards that could be used to facilitate implementation of unified electronic claims. This could dramatically reduce administrative costs of health care. Online parts catalogues for electronic vendors, electronic payment, and brokering services are further examples. These same technologies will also permit the service sectors of the US economy to grow, to increase their scale and ability to respond to consumer demands. The thoughtful management of existing resources and coordinated construction of new ones by government, educational, and commercial interests are likely to insure continued benefits for all. Access to Internet resources can shrink time, distance, and the cost of information transfer while promoting idea sharing among professional colleagues. However, for a new technology to find its way into the mainstream it must become a natural part of the user's normal business routine. It should be no more complicated than using the telephone, fax machine, or desktop computer. The functions must be easily understood and helpful to the user. This remains a challenge to the architects of the Internet. Telecommunications is an enabling technology for rapid retrieval and dissemination of information. While it may be only a prototype for the lofty goals of the National Information Infrastructure, the Internet will likely influence the way people interact with the world around them in the future. REFERENCES 1. Burstone CJ. Uses of the computer in the orthodontic practice, part I. J Clin Orthod 1979;13:442-53. 2. Watson W. Computer evolution or revolution. AM J ORTHOD 1980;78:674-6. 3. Kantrowitz B. Live wires. Newsweek 1993;122(10):42-9. 4. Econoimides J. The microcomputer in the orthodontic ofrice. J Clin Orthod 1979;13:767-72.

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5. Harley H, Stout R. The Internet: complete reference. New York: McGraw-Hill, 1994. 6. Dern D. Internet guide for new users. New York: McGraw-Hill, 1994. 7. Gibbs M, Smith R. Navigating the Internet. Carmel, Indiana: Sams Publishing, 1993. 8. LaQuey T. The Internet companion: a beginner's guide to global networking. Reading, Massachusetts: Addison-Wesley, 1992. 9. Marine A, Kirkpatrick S, Neou V, Ward C. Internet: getting started. Englewood Cliffs, New Jersey: Prentice-Hall, 1993. 10. Engst A. Internet starter kit. Indianapolis, Indiana: Hayden Books, 1993. 11. Kehoe BO. Zen and the art of the Internet: a beginner's guide. 2nd ed. Englewood Cliffs, New Jersey: PTR PrenticeHall, 1993. 12. Mille M. Networks: from a defense laboratory to a worldwide web of users. Congressional Quarterly Weekly Report 1993 Apr 3: 830-5. 13. Philip EW. Cyberpunk. Time 1993 Feb. 8;141:59-65. 14. Lane ES, Summerhill C. A Internet primer for information professionals: a basic guide to Internet networking technology. Westport, Connecticut: Meckter, 1993. 15. Philip EW. Technology: first nation in cyberspace. Time 1993 Dec. 6;142:62-4.

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16. US Congress. High-performance computing Act of 1991. Washington: US Government Printing Office; 1991: Public Law 102-94. 17. Philip EW. Technology: electronic superhighway. Time 12 Apt 1993;141:50-58. 18. Gibbs W. Software's chronic crisis. Sci Am 1994;271:86-95. 19. Lewis PH. First-time tourist guide to the Internet. Bottom Line 1994;15(16):13-14. 20. Nicotl LH. An introduction to the Internet part I: history, structure, and access. J Nurs Adm 1994;24(3):9-11. 21. Krol E. The whole Internet user's guide and catalog. Sebastopol, California: O'Reilly & Assoc., 1993. 22. Wood L. Get online! The communications software companion. New York: Wiley and Sons, 1993:68-69. 23. Estrada S. Connecting to the Internet: an O'Reilly buyer's guide. Sebastopol, California: O'Reilly & Associates, 1993. 24. Tennant R, Ober J, Lipow A. Crossing the Internet threshold: an instructional handbook. San Carlos, California: Library Solutions Press, 1993. 25. Zimmerman JL, Lang WP, Williams JN, Spohn EE. DENTIN (dental information network) a communications and information resource for dental education and practice. J Dent Educ 1994;58(3):241-5. 26. Chop WM Jr. Information when you want it. Dent Econ 1993;83(8):93-4, 96-8.