Dermatology and the World Wide Web

0195-5616/99 $8.00

DERMATOLOGY

+ .00

DERMATOLOGY AND THE WORLD WIDE WEB James 0. Noxon, DVM

THE INTERNET The World Wide Web (WWW), also known simply as the "web," is one component of a vast system of interconnected computers that has become known as the Internet (Table 1). 1 The web emerged in the late 1960s when the US Department of Defense funded a project (Advanced Research Projects Agency Network) to allow computers from various · locations to communicate with each other to share military and scientific information. In the mid 1980s, the National Science Foundation established a network that connected to parts of this original network to facilitate interinstitutional computer research projects. Since that time, millions of computers have connected to this network, or the Internet. Components of the Internet

Computers connected to the Internet may originate as a single computer or from a local network (often called a local area network [LAN]), which may consist of many computers. The individual accessing the Internet is called a client or user. Information transmitted from the user must go through special computers called routers that connect the user to another computer or LAN on the Internet. Information available to the Internet community is stored on a computer called a server or From the Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa

VETERINARY CLINICS OF NORTH AMERICA: SMALL ANIMAL PRACTICE VOLUME 29 • NUMBER 6 • NOVEMBER 1999

1461

1462

NOXON

Table 1. INTERNET SERVICES Service

Electronic mail (e-mail) Mailing lists (list servers) Newsgroups Chat rooms World Wide Web

Description

Communication clirectly with other users on the Internet. E-mail is often used for sending mass messages (i.e., mailing lists). E-mail communication system, where users send messages to one server and that message is relayed out to multiple members of the listserve. An electronic message board, where users post messages about specific topics. Electronic message boards, where users enter and communicate "live" with other users logged into the chat room. A graphics intense system for locating and receiving information about various topics.

host. The server contains information that its owners wish to share with the Internet community and runs special software programs that allow it to sense and respond to requests from WWW users. The host may provide several services (e.g., electronic mail [e-mail], web page storage, file transfer protocol [FTP]) to individuals connected to the server. When a request for information is sent to a server from a user (or client) elsewhere in the world, the request is directed to the server by routers, and the server then sends the requested information back to the original user. The owners of a server can set restrictions on who can access information and who may add or change information in a host computer. These restrictions protect the files on the server from being changed by anyone who does not have specific permission to change, add, or delete the files. The server often hosts many different clients or individual computer users, for example, when a university computer server has home pages for various faculty and organizations within the university all stored on one computer. The various computers on the Internet must be connected to allow communication. This process is generally done by universities and government agencies or through a private company, referred to as an Internet service provider (ISP), which provides this service for a fee. There are many options for selecting an ISP, including AT&T, MCI, America Online, CompuServe, Prodigy, and local service providers. It is critical to have a local access telephone number to access the Internet; if you do not, you incur the costs of both the Internet service and long-distance telephone rates. The actual communication is done through connecting cables (in the case of large corporations and universities), telephone lines, and cable television lines. Special digital telephone lines called ISDN lines (Integrated Services Digital Network) have been installed by the telephone companies in some areas to allow for faster transmission of signals. Computers use special pieces of hardware called modems to translate computer messages to signals that can be transmitted through

DERMATOLOGY AND THE WORLD WIDE WEB·

1463

these telephone lines or other transmission lines. Most computers purchased today have built-in modems; although they can be installed or attached separately. Information transfer is measured in bauds, or bits per second. A bit is one piece of information and is analogous to a letter in a word. Modems work at different speeds to allow faster transmission and reception of signals: faster modems operate at 56,000 (or 56 K) baud or faster. It is useful to have the fastest modem possible. The speed of information transfer through the Internet is an important issue. Most of the useful material in the area of dermatology includes images of some type. Images tend to be large files; the larger the file is, the more time is required to send the information through this system. As chemical reactions have "rate determining steps," so it is with the Internet. Information moves through computers, modems, telephone lines, and routers at different rates. The final rate of transfer is completely dependent on the slowest step in the process. For example, you may have a fast modem, but the speed of transfer may be restricted by slow telephone lines. When setting up your personal Internet connections, consider these limitations, and ask your telephone company and ISP about the speed you should expect for your system. Computers connected to the Internet must communicate with each other. To do this, they "speak" different languages known as protocols. A protocol can also be considered as a set of rules or guidelines describ. ing how to transmit data. Some of the protocols used on the Internet include: • FTP: This is an Internet service that transfers files from one computer to another. It requires a software program to identify and select files that the user wishes to transfer. Files may be sent to or copied from a server, if the user has permission (in the form of a password). Some FTP servers allow unlimited access, although others require the user to be registered (e.g., a subscription) to gain access. • Electronic-mail: E-mail allows users to send and receive electronic mail messages to and from others who have Internet access and an e-mail address. The "mailbox" is provided by the ISP or company with which you have an account to allow you access onto the Internet. • Gopher: This is an Internet browsing service organized in a series of menus allowing the user to navigate through the menus to locate various types of information.

THE WORLD WIDE WEB

The concept of sharing information with other investigative groups was initiated by the European Laboratory for Particle Physics. (http:/ I www.cern.ch/Public/ ACHIEVEMENTS /WEB /history.html) These early

1464

NOXON

efforts rapidly expanded into the system that we use today. The WWW is an Internet service that uses hypertext links to locate and retrieve documents (pages) from WWW servers. The WWW pages may contain text, images, sound, animation, and video components that are read by the users with a software program called a browser. The two most frequently used browsers are Netscape (Fig. 1) and Microsoft Explorer (Fig. 2). Both of these browsers are easy to use and have a similar appearance on the computer screen. The WWW is the fastest growing Internet service. It has literally transformed the use of the Internet into an educational and entertainment service. A user on the WWW is called a client, user, or browser (the same term used to describe the software used to travel through the web). As mentioned previously, the computer that stores information accessible to browsers is called the server or host. On the WWW, the user and the host communicate using a communication language (i.e., protocol) called hypertext markup transfer protocol (HTML). This language has evolved over the past several years to add more exciting functions such as animation and video. These additions are made possible by software running on the server and often downloaded onto the user's computer (plug-ins) from the host. How to Read and Understand an Internet Address

The uniform resource locator (URL) gives the Internet address, also known as the domain, of any file located on the Internet and the service

Figure 1. Appearance of Netscape Navigator, one of the common browsers used on the web.

DERMATOLOGY AND THE WQRLD WIDE WEB

1465

Figure 2. Appearance of Microsoft's Internet Explorer.

able to handle the file. All sections of the address (after the protocol) are separated by one forward slash(/). As an example, for the address: http:/ /www.vetmed.iastate.edu/ units/aavd/ maui.html/#rndtable: • http: gives the protocol (in this case, hypertext transfer protocol) used to move the file. • www.vetmed.iastate.edu tells the computer address or location of the server. • units/ aavd identifies the file in which the document is located. • maui.html gives the file name to be read (pulled up on the user's browser). • #rndtable is called a bookmark. This can be added to an address to take the user to one specific location in the document. A bookmark is used primarily in longer documents to help break up the size. A bookmark is not a required part of an address.

USES OF THE WORLD WIDE WEB IN DERMATOLOGY

A plethora of information about dermatology may be found on the WWW. Nevertheless, the usefulness of the information is limited by 1) the quantity of information related to veterinary dermatology, 2) the depth and quality of the information provided, and 3) the ability of the user to find that information.

1466

NOXON

Quantity of Information Provided

Let us first discuss the quantity of material in the field of dermatology. At the present time, there are hundreds of sites containing information on dermatology in the human medical field. Some sites provide lessons for medical students or residents in dermatology. Some sites are provided by specialists in private practice. Many sites are designed for commercial purposes, and a few are intended to entertain. Some of those sites may be found in Table 2. Of course, information on human dermatological topics is of great value to academicians, dermatology specialists, and dermatology residents but is less valuable to pracTable 2. HUMAN DERMATOLOGY SITES OF INTEREST Uniform Resource Locator*

http:/ /telemedicine.org/ids.htm http:www.derma.med. uni-erlangen.de I index_e.htm Ntimberg http:/ /tray.dermatology.uiowa.edu/ home.html http: I I www.medmatrix.org/ index.asp http:/ /www.medweb.emory.edu/MedWeb/ default.htm http: I I www.hslib. washington.edu/ clinical/ http:www.delasco.com http: I I www.gretmar.com/ webdoctor I Dermatology.html http:/ I ohsu.edu/ cliniweb /browse.html http:/ /www.cmh.edu/allergy gopher: I I gopher.dartmouth.edu/ 1 I Research/BioSci/CDRD http:/ /www.aad.org http:/ /www.aaaai.org/default.htm

Description

Internet Dermatology Society. Great links to lessons and the "Electronic Textbook of Dermatology" Dermatology Internet Service. FredrichAlexander University of Erlangen School of Medicine. Links, lectures, cases, and atlas. University of Iowa Department of Dermatology. Access to lessons, data banks of images, and tutorials. Medical Matrix home page. Great site for links to journals and other sites. Provides searches. Emory University Health Sciences Library page with great links to lessons. Access to many interesting sites, lessons, databases to search for cutaneous drug reactions, and more. Commercial site of Delasco Dermatological Supplies (Council Bluffs, IA). Excellent links section. Links to educational sites (lessons, atlases, tutorials) in dermatology. Clinweb International by Oregon Health Sciences providing links to lessons. Children's Mercy Hospital of Kansas City home page on allergies providing information about pollens. Cutaneous drug reaction database. Home page of the American Academy of Dermatology. Home page of the American Academy of Allergy and Immunology. Provides pollen counts and links.

*All uniform resource locators provided are active at the time of writing. Some sites may be discontinued or have addresses changed before the time of publication.

DERMATOLOGY AND THE WORLD WIDE WEB

1467

Table 3. WEB SITES OF INTEREST IN VETERINARY DERMATOLOGY Description

Uniform Resource Locator*

http:/ /www.altvetmed.com information http: I I www. vetmed.iastate.edu/ units I vth/ noxon/ saderm.html http:/ /www.pet-vet.com/pet-vet/ http:/ /www.DVMPharmaceuticals.com http:/ /www.hillspet.com http:/ /www.nofleas.com http:/ /www.dermapet.com http:www.programpet.com/ http:/ /www.heska.com http:/ /avma.org

Complementary and alternative veterinary medicine home page providing some information on dermatological conditions Companion animal dermatology site of Iowa State University providing lessons and links Pet Comer, a site written by Dr Lowell Ackerman containing a nice variety of information for pet owners Commercial site of DVM Pharmaceuticals (Miami, FL) Commercial site of Hills Pet Foods (Topeka, KS) Commercial site of Bayer Advantage (Shawnee Mission, KS) Commercial site of Dermapet (Potomac, MD) Novartis pages providing information on Program, Interceptor, and Sentinel (Greensboro, NC) Commercial site of HESKA Corporation (Fort Collins, CO) Home page of the American Veterinary Medical Association with access to NOAH

*All uniform resource locators provided are active at the time of writing. Some sites may be discontinued or have addresses changed before the time of publication.

titioners. There are significantly fewer sites devoted to veterinary dermatology (Table 3). Depth and Quality of Information

The first question one should ask when placing information on the web is "who is the end user?" In other words, "to whom is the material found at any given site directed?" Users must ask this question whenever they visit a site. Dermatology information provided to web users may be directed toward the veterinarian or animal owner. Hopefully, this is apparent to the user when the site is first accessed, although some sites may actually provide useful information to both consumer groups. Obviously, the depth and type of content vary depending on the end user. Material directed to the animal-owning public can facilitate pet care and animal health and can provide useful information about referral to specialists. At Iowa State University, we have a page (http:/ I www.vetmed.iastate.edu/units/vth/derm.html) that provides prospective clients with information on dermatology referrals and preparation of their pet for a visit to our hospital. When we consider the quality of the information, it is necessary to understand that there is no quality control or peer review of information placed in servers that are accessible on the web. The individual or groups placing material in a server for access by other users may or not

1468

NOXON

provide users with accurate or up-to-date information. When studying information on dermatological topics on the web, it is wise to look for references just as you would with a textbook or journal article. If material is not referenced, the quality and accuracy are suspect. Many sites are excellent, but the web has a lot of inaccurate or misleading information available to users. In addition, many sites are placed on the web by companies and corporations. These sites are often designed to provide some information while promoting a specific product or veterinary practice at the same time. Of course, these may (and often do) provide great information to the user (always consider the source). Finding Dermatology Information on the Web

There may be great information on a specific dermatological topic placed on a server, but a user must be able to find that information for it to be of any real value. Sites containing useful information may be found with any of the following methods. Browsing the Web

Interesting and useful web sites may be found by browsing web sites and following various links provided on each page. This is called "surfing" the web and can become addictive; however, it is an inefficient method to find information on a specific topic. Still, it can be fun if you are not looking for specific information. Browsing is considered by many to be part of the fun of the WWW. As more veterinary dermatology sites are placed on servers, it should be easier to "selectively browse" by following links provided on each site. The American Academy of Veterinary Dermatology (www.aavd.org) has a page of important links, and the American College of Veterinary Dermatology (www.acvd.org) also plans to provide some links for users. Some practitioners, both specialists in dermatology and general practitioners, have home pages with links that may be followed to sites useful to veterinarians and clients. In addition, lists of links that may have some application in the field of dermatology may be found in published lists such as those included in a recent article on therapeutical information available on the InterneU Searches

Browsers and Search Engines. Home pages providing information on any topic may be found by doing a topic or word search using one of the many web search engines (Table 4). These search engines can be accessed by clicking on the "search" button on your web browsing software (e.g., Netscape or Explorer), by typing in the URL of the search engine, or by clicking on the search engine from a page that lists the many providers of this service. Searches of this type are free of cost to

DERMATOLOGY AND THE WORLD WIDE WEB

1469

Table 4. GENERAL SEARCH ENGINES

Name

Uniform Resource Locator*

Netscape Yahoo Lycos Excite Hotbot Webcrawler search. com

www.netscape.com www.yahoo.com wwwc.lycos.com www.excite.com www.hotbot.com www.webcrawler.com www.search.cnet.com

•All uniform resource locators provided are active at the time of writing. Some sites may be discontinued or have addresses changed before the time of publication.

the user. The specificity of the response depends greatly on the word or words entered in the search process. For example, if you search for "skin," you are likely to get thousands of matches, although if you search for "systemic lupus erythematosus," you find fewer matches. You receive a list of sites containing the word or words that you entered for your search. Be prepared for the possibility of thousands of matches, which are also called "hits." The number of matches varies with the search engine used for your search. In addition, different search engines match with different sites, . so it is recommended to search for your topic using at least two different search engines. Literature Searches. Literature searches may also be performed through the web. These sites generally provide results of a search and abstracts for no charge but charge a small fee to provide the text of the complete article. Some of these sites are listed in Table 5. Journal Web Sites. You may also choose to browse the sites of some dermatology journals that have web pages (Table 6). At this time, these web pages are supplemental to the written journal. The author is not aware of any veterinary dermatology publications that provide the text of articles on the web. There are many journals with a web site that Table 5. SITES FOR LITERATURE SEARCHES

Uniform Resource Locator*

Description

http:/ /www.ncbi.nlm.nih.gov /PubMed/ National Library of Medicine search engine forMEDLINE National Network of Libraries of Medicine http:/ /www.nnlm.nlm.nih.gov /nnlm/ online databases providing information about searching and links to several search engines such as PubMed National Center of Biotechnology Information http:/ /www.ncbi.nlm.nih.gov I providing access to many search engines. *All uniform resource locators provided are active at the time of writing. Some sites may be discontinued or have addresses changed before the time of publication.

1470

NOXON

Table 6. JOURNAL SITES OR LINKS TO JOURNALS Journal

Uniform Resource Locator*

Dermatology Online Journal

matrix.ucdavis.eduiDOJdeskl desk.html www.ama-assn.orglpublicljournalsl derml dermhome.htm www.medvet. umontreal.calbiblio I veljr.html www.vetpathol.cum.uiuc.edul vetpathol www.blacksci.co.uklproductsl journals I vetderm.htm

Archives of Dermatology University of Montreal Bibliography Veterinary Pathology Veterinary Dermatology

Provides

Full text and articles Abstracts

Links Table of contents Table of contents Table of contents Information for authors

*All uniform resource locators provided are active at the time of writing. Some sites may be discontinued or have addresses changed before the time of publication.

provides a table of contents of each issue. They may also provide abstracts for review, giving the user the opportunity to order the entire paper or journal for a fee. This technique of periodical review of a journal is easy and fast and can be done from either the workplace or home. HOW TO MAKE A HOME PAGE

If you think that you have useful information to make accessible to the dermatology community, consider making a home page and placing your information on a server accessible to others. (You may find it easier to place your information on a site already established.) After your site is established, you should consider contacting the authors of similar sites and ask to have a link established to your new site. Similarly, it is useful to users to have a list of links to other sites with related information. You may also register your site with the search engines by accessing their sites and then finding the link for additions and following the instructions. If possible, you should ask permission to link to other sites. Before you proceed, be certain that you have something useful and unique to say. Then try to follow the rules of good web page design and the overall rules of etiquette. After that, have fun and make your page a place of beauty!

To make a home page: • Connect to the Internet through an ISP to surf the net or view the pages that you or others put onto a server. • Invest in and learn the software that allows you to write web pages. Examples are HotDog Pro (Sausage), FrontPage (Microsoft), and Dream Weaver (Macromedia).

DERMATOLOGY AND THE WORLD WIDE WEB

• • • •

1471

Many newer versions of word processing software (e.g., Microsoft Word) automatically convert text into HTML upon request. Learn more about HTML at: http:/ /www.ncsa.uiuc.edu/General/Internet/WWW /HTMLPrimer.html. Follow web page etiquette (see the site and links from the above bookmark). Rent storage space on a server (generally through your ISP) or buy a server to store your web page and other associated files. Your address may be arranged through the ISP, or you may file for and register a specific domain name through interNIC (http:/ I rs.internic.net/). After your domain has been approved, load your web pages onto the server using FTP or other transfer protocols (or provide them to the ISP on a disc).

SUMMARY

The WWW has an almost unlimited amount of information stored and available to users. There is already much information pertaining to the specialty of dermatology but relatively little information specific to veterinary dermatology. The amount of information placed on the web continues to increase, so familiarity with the web is a necessity in today's world and the future. We must develop our use of the web for teaching, client education, and increasing communication between colleagues. References 1. Boschert K, James H: Getting started on the internet. In NetVet. Mosby's Veterinary Guide to the Internet. St. Louis, Mosby-Year Book, 1998 2. Wilcke JR: Therapeutic information on the internet. Vet Clin North Am Small Anim Pract 28:449, 1998

Address reprint requests to

J. 0. Noxon, DVM Department of Veterinary Clinical Sciences College of Veterinary Medicine Iowa State University Ames, IA 50011

Terminology of the World Wide Web Bandwidth The size of the line that connects a computer to the Internet. It directly affects the rate (higher= faster) at which you can send or receive information through your connection (e.g., telephone line). Browser Software loaded on the user's (client's) computer that allows you to

1472

NOXON

request, receive, and send information to and from various servers located around the world. CGI Common gateway interface. Programs run on the server in response to a request by a user (e.g., registration form). Domain The unique name (address) that identifies a site on the Internet. The ending indicates the type of site (.edu = education/university, .org = organization, .com = commercial site, .net = network providers). The domain for Iowa State University College of Veterinary Medicine is: www.vetmed.iastate.edu/. The domain name is the first part of a web address. Download Transferring information (e.g., pictures, software, text files) to a browser's computer from a server on the Internet. E-mail Electronic mail. Messages sent between computers with an Internet address. FAQ Frequently asked questions. Many web pages have an FAQ section to provide clients with additional information. FTP File transfer protocol. A method of transferring files from one computer to another. It requires a software program (e.g., WinSock FTP) to manipulate the files. Gopher A menu-based system of searching for information on the Internet. Home page The first screen that comes up when you visit a web site. HTML Hypertext markup language. The rules of communication used to create documents that are found on the WWW. HTTP Hypertext transfer protocol. The rules or guidelines used to identify the location of and transfer of HTML files on the Internet. Hypertext Any text that contains links to other documents or resources. Words or phrases are generally colored differently from the text or underlined indicating that a link is present. The user jumps to the other site when the word or phrase is clicked. Links are placed in the document with the software programs used to write HTML. ISP Internet service provider. A company that maintains servers and browsers and provides connections from individual computers or LANs to the Internet (e.g., America Online). Java A program language written by Sun Microsystems for downloading onto user computers through the Internet without risk of virus contamination. Small Java programs (i.e., applets) run functions that include animation, perform calculations, and run games on web sites. LAN Local area network. The network created when computers at one site are linked, generally by cables. Links Links are documents or files that are accessible from one document by clicking on hypertext. Listserv A program that manages e-mail mailing lists by either responding automatically to requests or distributing messages to members of the listserv. Modem A device that connects your computer to the Internet or other computers via the telephone. MPEG Moving pictures experts group. A compression method for storing movie files. Netscape Navigator Also called Netscape or Navigator. A software program (i.e., browser) used to access the WWW. Page The basic document of the WWW. Each page contains text along with "tags," which build features such as tables, forms, and embedded images.

DERMATOLOGY AND 1HE WORLD WIDE WEB

1473

"Attributes" are descriptions that modify the tags (e.g., table width, layout of image. PPP Point-to-point protocol. A protocol that allows the user to connect to a computer or server using a modem and regular telephone line. Router A computer system that decides which path Internet traffic travels to reach its destination. Server A computer used to hold information accessible to the Internet or the software used to allow others to view home page information. Shareware The term used to indicate software found on the Internet that can be downloaded at no charge. Most shareware allows free use for a limited time, after which a small payment is expected. Surfing The slang used to indicate traveling on or moving through the WWW. Tip Transmission control Internet protocol. A communications protocol for connecting a computer (user) to the Internet. Telnet The command program used to access other servers on the Internet. URL Uniform resource locator. The Internet "address" of information, generally a web site. WAN Wide area network. A local network larger than a single building, generally connected by cables of some type. WWW World Wide Web. The hypertext-based system used to transfer information around the world.