E-Readers For Neurologists

December 11, 2008

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By Saty Satya-Murti, MD

Introduction

For several years, we physicians have been bombarded with information aimed at moving to a paperless office. What about moving to a paperless library? Recently introduced technology is making this a viable option.

Books and journals have been available in various electronic formats since the late 1980s, some for free and some for a fee. Because copyrights have expired, many literary classics are freely accessible in electronic form. For example, Project Gutenberg is the Internet’s oldest library of free electronic books (e-books).

Technologies to Read E-Books

Today, there are two main technologies that enable mobile devices to display e-book text and graphics: liquid crystal displays (LCDs) and e-paper. LCDs are used by laptops and PDAs (Personal Digital, or Data, Assistants). Electronic paper1, also called e-paper, is a display technology designed to mimic the appearance of ordinary ink on paper. It is used by e-book readers (e-readers). E Ink2, a type of electronic paper, is a proprietary material that is processed into film for integration into electronic displays that are used in e-readers such as the Sony Reader and the Amazon Kindle.

LCD-based devices are currently more popular than devices that use e-paper. E-readers, however, are slowly gaining in popularity and market share due to certain advantages.

E-Readers: Advantages

  • Unlike a conventional LCD display, which uses a backlight to illuminate its pixels, electronic paper reflects light like ordinary paper and is capable of holding text and images indefinitely without drawing electricity, while allowing the image to be changed later.
  • Since constant refreshing of pixels/displays is not necessary, power consumption is reduced. E-readers have much longer battery life than laptops, but larger displays than most PDAs or smartphones.
  • Additionally, with contrast ratios similar to paper newsprint, e-paper is generally more comfortable for reading than LCDs. Text clarity simulates a "reading experience almost comparable to that of reading a traditional book."3
  • E-readers can hold huge amounts of text; contents are searchable by keywords.
  • The environmental benefits from eliminating paper, ink, and shipping/handling of hard-copy materials.

E-Readers: Disadvantages

  • Although e-readers simulate text exquisitely, unlike LCDs they cannot display color at the present time.
  • LCDs can change their displays instantly, whereas e-readers take one to two seconds to "turn" their pages.
  • Long-term, downstream consequences of battery manufacture, disposal, and discarded hardware are undetermined.

Table Comparing Features of LCD and E-Paper Based Electronic Books

Feature

LCD based

E-Paper Based

Display

Back lit LCD
Examples: PDAs, Laptops

No back lighting
Example: Dedicated readers from Sony or Amazon

Readability

Possible with ambient low light

Poor in bright light.

Readable even in bright sun light

Low light requires external illumination.

Power consumption

Higher

Sustained display draws power

Low to nil even when display stays on

Long life on single battery charge

New page refresh rate

Fast

Slower, up to 1.5 to 2 secs

Sync with PC

Necessary for PDAs

Possible but not needed

Data transfers with PC

Available

Available

Resemblance to paper and print

Not close

Crisp, very similar to paper and print

Color

Readily available

Not yet

Adjustable Font sizes

Available

Available

Other features

General purpose computing, web access, music play

One model allows web access, limited browsing without value-added charges. Music play=yes.

Library size

Memory dependent; not as large as dedicated readers

Large, expandable to 8+GB. One model allows repeated download of purchased books

E-readers Available Today

Tables comparing features of several e-readers are available at two websites. 4, 5 The Kindle™ by Amazon and the PRS series from Sony® are popular in the US.

The Amazon Kindle

In late 2007, Amazon introduced its Kindle e-reader. It serves not only as a reader but also as limited-capacity web browser and music player.

    Display: The display screen is 12cm x 9cm X 15.5cm (6”) diagonal, weighing 10.3 oz (289g). It has a keyboard, thumbwheel cursor and page-turn side bars (next, previous pages). The full dimension is about 33 percent larger than its display.
  • Reading experience: The feel and readability are akin to holding and reading a medium paperback book. There are six font sizes. Text and images are black and white with crystal clear definition. It takes about 1 to 1.5 seconds for a new display page to appear.
  • Battery: Displays do not drain batteries. Sleep mode time is about 10 minutes. Battery life is about seven days for reading, without web browsing. Recharge time is about two hours. Bright light will not interfere, it only enhances readability. Low light may require a reading light.
  • Books/periodicals available: Approximately 202,000 books of general, scientific and technical interests are now available ranging from $1–$150 and upwards. Most general interest books, newspapers (e.g., New York Times, LA Times) and magazines (e.g., Technology Review Magazine, Newsweek, Time) cost $1.50–$20. At least two well-respected clinical neurology texts and several health science books are available. Reasonably priced ($25–$50) volumes on statistics, evidence-based medicine, and epidemiology are accessible.
  • Downloading: Books are downloaded within minutes of their online purchase. The process utilizes a 3G cell phone network, independent of computer connectivity, to deliver content to Kindle. Downloads do not require a hardwired PC/laptop. Internet connectivity is via Amazon's EVDO (Evolution-Data Optimized—Sprint's national high-speed data network) connection called "Whispernet." Whispernet uses a 3G network delivering content to Kindle, but without service charges or commitments.
  • Web browsing: An additional benefit, labeled “experimental” so far, is Kindle’s ability to access the web using its proprietary Whispernet. Browsing is available at most US locations thus enabling email, news services (e.g., CNN, NYT, MSNBC, BBC, etc.) and blogs. The page layouts differ from PC and paper-based formats. Valuable sites such as GeneReviews and OMIM (On-line Mendelian Inheritance in Man) can be browsed without hunting for Wi-Fi hotspots or paying for Internet services.
  • Personal library: Purchased contents are available online for reloads from your user-specific account indefinitely, even if you erase your reader’s memory. This is akin to owning a portable user library without the bulk and hulk. Text may be bookmarked, clipped, user-annotated, and exported.
  • Requesting Kindle versions of hardcopy Amazon books, not yet on Kindle, is possible.

Examples of Kindle E-Books Relevant to Neurology include:6

  • A Dictionary of Epidemiology, by John M. Last
  • Adams and Victor’s Principles of Neurology, by Allan H. Ropper and Robert H. Brown
  • Clinical Neurology, by Michael J. Aminoff, David A. Greenberg, and Roger P. Simon
  • Clinician’s Pocket Drug Reference 2007, by Leonard G. Gomella, Steven A. Haist, Aimee Gelhot Adams, and Kelly M. Smith
  • Deep Pocket Series Neurology, by Harvey Castro and Jeffrey D. Gould
  • How Doctors Think, by Jerome Groopman
  • Statistics Explained, by Perry R. Hinton
  • The Goodman and Gilman Manual of Pharmacology and Therapeutics, by Laurence Brunton, Donald Blumenthal, Iain Buxton, and Keith Parker
  • The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. The JAMA series, by David Simel

The Sony PRS Series

Sony introduced its PRS series in 2006. Six PRS models are available. Sony's PRS-700BC is the top of the line model. Its specs are reviewed here:

  • With a 6" diagonal display, the PRS-700BC is comparable in its dimensions, weight, and readability to the Kindle.
  • Instead of keys, the PRS-700BC has a touch-screen for input.
  • The PRS-700BC has a built-in LED reading-light.
  • More than 7,000 page turns are possible with one battery charge.
  • Unlike Kindle, the PRS-700BC does not access the Internet without an Internet connection and a PC.
  • Sony carries fewer titles of clinical scientific interest than Amazon.

Examples of Sony E-Books Relevant to Neurology include:7

  • Clinical Neurology, by Michael J. Aminoff and David Greenberg
  • Neurology for Lawyers, by Ken Cummings
  • Neurology in General Practice, by G David Perkin
  • Statistics Explained: A Guide for Social Science Students, by Perry R. Hinton
  • The Rational Clinical Examination: Evidence-Based Clinical Diagnosis, by Robert Hayward

Conclusions

E-readers have crisp displays that mimic traditional paper and offer the advantage of reduced power consumption. Of the available e-readers, Amazon’s Kindle and Sony’s PRS series provide several useful features for avid readers:

  • Ability to build a portable personal library
  • Large selection of popular, general interest, and scientific books
  • Fewer, but a growing number of clinical medicine and neurology books
  • On the Kindle, self-contained Internet connectivity to useful databases and access to web and web-based news resources

References

  1. Electronic Paper. (Wikipedia article)
  2. E Ink. (Wikipedia article)
  3. Bits, Bands and Books. Paul Krugman. The New York Times, Op-Ed Column. June 6, 2008.
  4. E-book Reader Matrix from Mobile Read.
  5. Top 5 E-Book Readers Compared.
  6. Searchable on-line catalog of Amazon Kindle E-Books.
  7. Searchable on-line catalog of Sony E-Books.

Author Disclosure

Within the past 24 months, Dr. Satya-Murti received compensation as an advisor for the following companies or agencies: Genentech, Glaxo Smith Kline, Amgen, Avalere Health LLC, Covance, Argenta Reimbursement Advisors, NeurogesX, AMAG Pharmaceuticals, and Allergan.