I am wedded to a ritual of reading the paper with my morning coffee. The reality is, however, that print editions of all media (including scientific journals) have far less appeal to the majority of the upcoming generations. The result is an ongoing trend toward printed information becoming accessed more and more in a digital format and less and less in the traditional paper format. As we move into the digital media, many newspapers have followed a policy of free digital distribution of all or much of their digital versions with a continued policy of charging for the paper editions. This was essentially the policy adopted by The Angle Orthodontist about ten years ago. Our local paper, The Star Tribune, recently announced a modification of their policy of how they will deal with distribution of their information on digital devices to now include your mobile devices with an iPad app and iPhone and Android apps. Like most other papers they had a policy of free access with digital devices. This change follows the model adopted by others such as The New York Times, Boston Globe, and Dallas Morning News, who also began with free digital access and have moved or are moving to pay programs for access on digital devices. This new model fundamentally deals with the problem of declining paper income and increased digital use by instituting a charge for digital access. This model gives free digital access to printed paper subscribers. Non-subscribers, however, will be able to access 20 articles per month free, but after that they must purchase digital access for $1.99 per week. The issue here is, of course, an economic question. How does a print media journal put out their material in digital format while deriving enough income to cover the expenses? The loss of the paper edition and its distribution costs surprisingly are relatively lesser matters. The material still has to be put into digital format, edited, and converted to a platform acceptable format etc. Now there are also more people involved in the creation and maintenance of the web site. In the scientific journal world, the cost of publishing articles averages close to $3000 per article in digital or paper versions. The Angle Orthodontist puts out over 175 articles per year and these fixed costs must be met. As a subscription base shrinks, the revenue also shrinks and there is today’s challenge. The www.angle. org/ web site pop up requesting you to consider donating to the Angle Heritage fund is a part of our effort to establish an endowment fund where the interest will contribute to the costs of keeping our site free and open access. Our site provides complete access to all 82 years of our journal’s content. We wanted to give our many readers world-wide the opportunity to participate and give back to orthodontics. Rick McLaughlin has done a fantastic job leading the Heritage Drive and is already working well into the second million dollars of donations to this fund. The vast majority of these contributions have come from the members of the Angle Society that sponsors the Angle Foundation, our publisher. The Angle Society is not well known, but consists of about 500 dedicated international members who recognize that they have received so much from those who went before them and thus derive a great satisfaction from doing their part to move the discipline’s information forward during their watch. There is no app yet for raising revenue, but we will be offering an app for your mobile device, iPad and iPhone or Android mobile device early in 2012. This will allow you to refer to or read the Angle Orthodontist no matter where you are and will be a nice complement to our pace-setting web site. Continue to enjoy the Angle Orthodontist whether on your computer or mobile device. But remember what past generations did for you and consider what your responsibility is to future generations.

Edward Hartley Angle died in 1930. In that same year 22 members of the former Edward H. Angle Society of Orthodontia met in Chicago and created The Angle Orthodontist with Mrs Angle as Editor-inChief. The purpose of the journal was to publish and preserve the papers delivered by the members of this small group. Until relatively recently the belief persisted that publishing in The Angle Orthodontist was restricted to members of the Angle Society. The full early history of the journal is beautifully documented at www.angle.org. Just click on SOCIETY and History. The data here was carefully collected and assembled by Dr Sheldon Peck. The journal went many years with only minimal or cosmetic changes, but a most significant change was made when Editor David Turpin instituted peer review in the 1990s. Previously the journal often contained much opinion and essay type papers, but with peer review modern science emerged. This development fortuitously occurred during the digital revolution and the form of today’s Angle Orthodontist began to take shape. Beginning in 2000 all our past issues were placed online and the journal is open access—freely available to everyone everywhere. We adopted digital submission and review of manuscripts in 2003 with 2004 as the first complete calendar year. One amazing feature of the digital age is the capacity of the system to store and recall data. A comparison of the 2004 data and 2010 shows a consistent growth of The Angle Orthodontist (Figure 1, Table 1). In 2004 we were able to accept 56% of the manuscripts submitted. In 2010 this number decreased to 22%. This does not mean that the manuscripts we did not accept were bad—only that we were able to accept the ones that we considered best and of most interest to our readers. In recognition of the fact that space limitations cause us to not accept some good manuscripts, we increased the size of our journal to over 1000 pages per year. Its current size is over twice what it was in recent years and several fold larger that it was when I first became a subscriber. The limitations are in productions costs. Currently it costs the journal well over $2000 to publish an article and this cost increases every year. Still, our costs are very much below the industry average. You might normally expect that going to an all-electronic journal would be much less costly. However, in today’s publishing world the review and preparation that an article must undergo is much the same process for either paper or digital transmission. The only significant economy is in the cost of paper, printing, and mailing. Science uses what is basically a free market system. The authors determine where they want to publish their work based on their concept of where it will best be seen and what the best journal is for their purposes. Journals accept articles based on their concept of its value for the purposes of their journal. If the journal opts to not accept an article, the author will send the article to their second choice in journals, but this must be done sequentially. The same article should not be sent to two journals at the same time. That could only lead to legal issues. From this system evolves an ever changing priority list of preferred journals in the minds of authors and a priority list of the parameters that rank an article in the minds of reviewers and journal editors. Where are all of these manuscripts coming from? Submissions came from a total of 42 countries in 2004 and 58 countries in 2010. Here is the number submitted by the top 5 contributors in these years:

The ever present and constantly growing ground swell of the digital revolution continues and opens concepts that many of us have never even considered. The newest step that we are presenting in The Angle Orthodontist is the three-dimensional figure. Without any Madison Avenue pizzazz, I want to share what this means for you, the reader. It was just a decade ago that we got caught up in the transition from analogue paper to online digital. First it was putting the current issue on line. Then we added some back issues. This was followed by putting everything the journal had ever published up on line. The kicker was that in the process The Angle Orthodontist simultaneously became an electronically open access journal. Anyone anywhere could make use of our information whenever they choose, free of charge. This was, of course, in the spirit of openly and freely communicating orthodontic science. Few people saw all of the potentials that these changes created. The digital revolution has opened new and exciting possibilities. Last year one of our authors at the University of Alberta in Edmonton, Canada wrote me to ask what we could do in terms of 3-D figures. Locked in a paper publishing mentality, I had never even considered this option. After slapping myself on the head for not thinking of this before, we set about to what we could do in this functionality. You all have probably already worked with digital models and experienced the ability to pick up, and visualize a set of orthodontic models from any perspective you desire. It adds a great deal to see the occlusion from any desired perspective; far superior to a two dimensional picture of one view of the models. Well, after some discussions with our printer and our Canadian colleagues, we worked our way thru several glitches and produced a prototype that works. All that remains before fully implanting this technique was developing instructions and the capacity for the author to submit their work with 3-D figures. It takes little imagination to see the day ahead where all case reports will be published in this way enhancing the ability of the reader to better view the figure and understand the treatment issues. This is, of course, not limited to figures of models. Any object that can be digitized in three dimensions can become a 3-D publication the same way. It’s a poorly kept secret that the print media has a problem. Harvey Mackey, author of ‘‘Swimming with Sharks’’, recently stated that 35% of Amazon’s book sales are for the Kindle. This is expected to grow to 50% in the next five years. The fundamental issue here is rate of change and this is partially governed by us and the rate of our conversion to the electronic media. Certainly younger people have been raised on electronics and are relatively comfortable reading on a screen. The implications of this for professional journals are obvious. The most recent advent in this evolution is the social media. Time magazine’s 2010 man of the year was Mark Zuckerberg, the creator of Facebook. In the US, in less than one year, one person in every three has joined Facebook. I heard recently that, by many parameters, Facebook is now bigger than Google. Whatever the format, personal communications will irrevocably change our life and how we get information. Mackey stated that there are 200 million bloggers with a third of them offering comments about commercial products. Where are orthodontists getting good information about orthodontic commercial products? Certainly The Angle Orthodontist has long held a position of avoiding product testing per se with the conviction that this aspect is the responsibility of the manufacturers. But it could be argued that this is akin to leaving the fox to guard the henhouse. We need to find a substantive way to use the media revolution to serve orthodontists as a valuable and unbiased source of professional product information. Anyway you view it, communication and information transfer is evolving. A tip of the hat and an accolade to our Canadian colleagues who gave us a boost and helped us reach this next level.

Why do you read professional journals? The obvious answer is to keep up, but doesn’t it seem hard to efficiently sort the wheat from the chaff and find the things that will really help you in your practice? We have all faced the problem of research that apparently is good work, but it seems hard to relate it to the practice of orthodontics. On the other side of the coin, there is the article that seems to offer the panacea for a clinical problem and it is followed next month by another article taking issue with those outcomes and offering a different solution. This is closely coupled with the idea that fundamental research is often not as useful as more clinical research. First, we need a definition of terms. I regard basic or fundamental research as research undertaken without an immediate application in mind. Applied research is research undertaken with an application in mind. Clinical research simply means that patients are involved. There is basic clinical research and there is applied clinical research There are journals that feature purely applied issues and these are often clinical. The fundamental difficulty these journals face is the inherent difficulty in doing applied research that is scientifically valid. Applied clinical issues are rife with variables that usually cannot be all standardized. Hence we needed more studies with concurrent outcomes before we can have reasonable agreement. Case in point—look at the volumes of work published on cigarette smoking before the preponderance of evidence established concurrence on the negative effects. For us, the consumers, it is often very difficult to sort out the ideas we should adopt from those that should not. Other journals are directed at very fundamental issues and they should usually supply state-of the-art science and credibility. However, very often you cannot see an application for the data produced. Their contribution is to develop ideas and building blocks for tomorrow’s application. They supply the solid basis for new developments and future applied information. Let’s look at the objectives of this journal. The Angle Orthodontist attempts to straddle a difficult position and bridge the gap between basic and applied research. Our first priority is to bring you articles that bridge this difficult area and supply good science that may ultimately lead to applied information. We recognize that all our articles do not have immediate clinical application, but we try to select those that seem to have some realistic possibility of leading to useful applications. There is little question that the quality of orthodontic literature is rapidly improving. Not that long ago orthodontic journals were not peer reviewed and most journals published material that had been presented at meetings. Today the measure is, ‘‘Does this article present a useful and scientifically valid contribution?’’ The peer review system isn’t perfect, but it is the best approach found thus far and far superior to the biases of a single editor. Journal content is now much better organized. An article needs to have a measurable specific objective. Why was this project undertaken? What is the goal? It is no longer indicated to simply investigate, to study or other such vague general objectives. The Conclusions need to address these specific goals and not be a simple summary of the Results. The Materials and Methods need to supply sufficient details that another worker could replicate the study if desired. The Results should be objective findings without any attempt at interpretations of the meaning or applications of the data. That last big step forward in this area was the call for statistical support for data. This is common today, but also misused. A well used example—A P-value does not prove a point in question; a P value only expresses the probability that it is true. Another example—a study may have good correlation coefficients, but correlations do not prove a cause and effect; only that two things often occur together. It is important to remember that science can only prove something false. To prove something false only requires finding one instance where the idea fails. This is the strength of the null hypothesis. To prove something true requires establishing its truth under any and all conceivable situations—a situation that is virtually impossible to create. What will an article contain to meet these goals? Clear measurable Objectives, a solid methodology, clean Results, a Discussion that related the Results to

Abstract No Abstract Available. This study was supported by the Minnesota Dental Foundation and the Graduate School of the University of Minnesota (Grant No. 417-0303-4909-2). From the Division of ...

What is truthiness? Do we need more truthiness in orthodontics? The word is attributed to Comedy Central's Steven Colbert, and he defined it as “truth that comes from the gut, not books.” Indeed, truthiness was selected as the Merriam-Webster choice for the word that best summed up 2006.Now truth itself is an elusive word, and not all that comes from textbooks or from the gut is truth, at least as defined by evidence-based guidelines. Truthiness in orthodontics is a natural step in the evolution of a field. Lacking hard evidence, the conscientious practitioner will use past experience as the best information available to treat patients. Orthodontics is far from a perfect science, and experience (the origin of gut feelings) is the best teacher when there is no better information available. This step logically leads to the preceptorship style of training in which the experiences of one generation are passed on to the next. Automating this process leads to the proprietary school.The important point is that, lacking better information, gut feelings will and should prevail since it usually will be somewhat better than chance alone. The problem is that as evidence-based information accumulates, we all have trouble abandoning ideas that have guided us. This difficulty is compounded by the fact that science rarely presents itself as a finished clinical application. Scientific truth usually comes in pieces that accumulate over time to become clinical applications.The bigger problem in dealing with truth is that truth is rarely absolute. A case report is a truth for that specific set of circumstances, but it is weak evidence for making future decisions. It probably is exceeded only by an editorial in terms of the absence of real substantive information.The encouraging feature of this is that true professionals continue to seek the best truth available. True professionals do not see the imperfection of a science as an obstacle or regard it as a frustration. Rather, they see it as an opportunity to grow, to improve constantly, to make the best decision possible with today's state-of-the-art information knowing that this information can and probably will change tomorrow.The more difficult problem for a discipline is our human desire to do the best and our inability to tolerate ambiguity. If someone has no threshold for ambiguity, he or she may well be attracted by an idea that promises absolute information and satisfies his or her comfort level for unambiguous clinical decisions. This may take the form of a named group that has stopped questioning and simply fills in information, presented as fact, wherever there is ambiguity. Here is truthiness in action. Such a group will derive comfort from confining their association to those of similar beliefs and often perceive the outside world as unwilling to listen to them. A common method of identifying such a group is to refer to them as a philosophy and identify them with a named technique or an eponym.Now, philosophy is a noble field and is defined as the search for a general understanding of values and reality by speculative means rather than observational means. Science, on the other hand, is focused on observational means obtained through the scientific method with hypothesis formulation and testing.A wonderful explanation of how we develop truthiness is in the field of cognitive dissonance. Cognitive dissonance is a well-established psychological theory first advanced 50 years ago by Leon Festinger, a social psychologist at Stanford. In essence, the theory says that when the human cannot tolerate incongruity between that which is felt (gut truth) and scientific fact, we resolve the conflict by rationalization. We cognate or rationalize to reduce the dissonance. Classic examples are habits we all have that we know are not good for our health, but we find a reason to continue them.We have many practices in orthodontics that we know are in conflict with the evidence, but our feelings tell us to continue them. These practices are often the hot button areas that are controversial. When you cite one, someone will rise with emotion in its defense. Conclusions based on truthiness or gut feelings are emotional issues. Fact-based science is accepted and even welcomed by the true professional. Truthiness is a wonderful word to describe feelings from the gut, not from science. It will always be with us. Our responsibility is to recognize it for what it is and, even when we apply it, to constantly seek better scientific information on the subject.Truthiness will always be with us. Our goal must be to decrease the amount and application of it by constantly developing better orthodontic science.