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MeSH, LCSH, and Lupus Foundation of America: Subject Headings and Usability Jayme Johnson LI804XA

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MeSH, LCSH, and Lupus Foundation of America: Subject Headings and Usability Lupus is an autoimmune disease with references in history dating back to the classical era. Known for its variations in symptoms, including skin, joint, and organ involvement, it has recently been separated into 4 main groups used for diagnosing individuals; cutaneous (or discoid), systemic, neonatal, and drug-induced. For this paper, I will be focusing on the LCSH, MeSH and online references to Systemic Lupus Erythematosus or SLE. The identification of a type of Lupus that affects the entire body, or systemic Lupus, was first categorized in the Neoclassical era around the early 1870s by Moriz Kaposi who realized that there could be two different variations, cutaneous and systemic (Hochberg, 2003). By the mid-1900s there was a surge of research on the topic and many new discoveries, including treatment and testing procedures. So far there is no known cure for Systemic Lupus Erythematosus. The goal of this paper will be to analyze the subject heading systems of both the National Library of Medicine and the Library of Congress. The MeSH system is a comprehensive controlled vocabulary for the purpose of indexing journal articles and books in the life sciences; it can also serve as a thesaurus that facilitates searching (Medical Subject Headings). Created in 1960, I will examine the history of MeSH and look at how this system manages the category of Lupus. LCSH is much broader subject heading system and created in the late 19 th/ early 20th century, from here I will try to map the introduction of Lupus into the LCSH system and look at its evolution. In

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addition to the subject heading systems, the Lupus Foundation of American runs a site to help educate patients and their families. The site,, has an extensive collection of research and information on the disorders known as Lupus. By looking at the website I will introduce the idea of folksonomies or user-created tags and data and examine the possibility of such data to make subject heading easier to navigate and more useful. Created in 1898, Library of Congress Subject Headings are one of the most widely used subject heading systems used in the United States. Although popular today in all sizes of libraries, whether they are public, special, or academic, the LCSH was originally thought to be the most useful for the university and only the largest of public libraries with small public libraries using ALA List and Sears List of Subject Headings to sort their collections (Stone, 3). This all changed in the 1930s, many libraries began the conversion from their own subject headings lists and converted to LCSH, for several factors, all of which remain selling points for LCSH today. The Library of Congress maintains their list of subject headings and is continually revised to include new subjects and topics and it would be economically improbable for small libraries to constantly be updating their subject catalogs at the same rate as the Library of Congress (Stone, 4). But with the ease of convenience of the LCSH system came disadvantages. Although it became easier and easier for smaller libraries to update their catalogs with the most up-to-date subject headings, many eventually complained that the

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wording of some terms was biased or used language that was discriminatory. As the times changed and accepted terminology did as well, by the 60s and 70s, there was the first of many attempts to remove some of this biased language (Stone, 5). Another obvious disadvantage is lack of control from the librarians and the subsequent reliance of the Library of Congress to create the proper subject headings for the materials being cataloged. But overall the ease of use and the ability to standardize the searching of headings throughout the majority of the United States has been a huge selling point in the adoption of the Library of Congress subject headings. Another very important subject heading system is MeSH, created in 1960 by the National Library of Medicine. Originally based off of a 1954 Armed Forces Medical Library Subject Heading Authority list, the NLM created a list of 3,800 descriptors and 67 topical subheadings to be used in indexing and cataloging. Unlike the LCSH system, MeSH focuses on only medical or health related sciences. The MeSH system is one of the most popular subject heading systems in use today in medical or health related libraries. Early in its history, the MeSH system underwent a major change (eventually recognized to be a misstep), in the 1963-65 editions of MeSH the subheadings were completely removed in an effort to streamline the system. After an uproar about their disappearance, the subheadings returned and are still available to this day (Schulman, 2010).

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Similar to the Library of Congress subject heading system, the MeSH system has had its share of detractions and setbacks. As mentioned above, in an attempt to streamline the cataloging process by limiting subheadings to 10 major areas they were removed. But they were quickly returned and today there are over 80 difference subheadings available. Another additional problem can be the specific subject matter of the system. The majority of medical and health related libraries currently use MeSH as their system of subject headings approximately 76% of libraries in responded to a study in 1975 that they use MeSH with only 22% using LCSH. More recent studies have concluded there is a mix of difference strategies for types of subject headings systems and cataloging systems used in special subject libraries, such as health sciences libraries (Womack, 105). The basic problem in limiting a library to one subject heading system is simple, patrons of a health sciences library may need information outside of the health sciences field. In an attempt to remedy this problem some medical libraries are currently supplementing MeSH with LCSH (Womack, 108). Now that weve examined the history of both MeSH and the LCSH systems, we need to look at how the term Lupus and more specifically Systemic Lupus Erythematosus is cataloged within each system and explore if there are any differences between the two. While MeSH is a system for organizing subject headings for medical and health related libraries there are several difference ways to access their system. One of the easiest ways is through the National Library of

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Medicines website. Another popular access point is MEDLINEs searchable thesaurus. The results for a basic search of Lupus in the National Library of Medicines online subject heading search system yields many different terms that would be applicable (see Figure 1). To further narrow the search down to the specific Systemic Lupus Erythematosus, a search of Systemic Lupus yields the result. Systemic Lupus Erythematosus is references in MeSH as Erythematosus, Systemic Lupus and by examining the expanded concept view of the subject any researcher can conclude that there is several other variations that are acceptable including, Systemic Lupus Erythematosus and Lupus Erythematosus Disseminatus. Also noted is several concepts that are related to the systemic lupus, which include Antiphospholipid Syndrome and Libman-Sacks Disease (see Figure 2). MEDLINE is an online database that accesses several difference medical journals and articles, including Index Medicus and International Nursing Index. As a way of examining this database, the articles can be searched by the Library of Congress Subject Headings. While some areas are not as detailed, one benefit is the ability to see a list of qualifiers spelled out instead of just a list of abbreviations (see Figure 3). As expected the Library of Congress Subject Headings also has several locations were one can look up the needed information on their topic. And although many libraries may own the official publication set of the Library of Congress Subject

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Headings (also commonly known as the Red Books), one of the easiest ways to find the correct subject headings is to search on-line. Two of the most common search sites are the Library of Congress Authorities Listing and FirstSearch OCLC also known as WorldCat (see Figure 4). While WorldCat provides the basic information, understandably it is the Library of Congress Authorities listing that is the most complete (see Figure 5). As mentioned in the beginning of this paper, the lupus disorder has been recognized for hundreds of years. As a subset Systemic Lupus was first described in the late 1800s most likely making it a recognized disorder by the time the Library of Congress publish its first list of Subject Headings. In an attempt to map the permutations in the Subject Headings of this disorder, I examined the Library of Congresss authority on Systemic Lupus. After speaking with a gentleman from the Library of Congress, we were able to possibly determine this records date by looking at the LC Control Number (b85078942) which would make the records creation date 1985), sometime after the discovery of the disorder (personal communication, April 28, 2012). Even more interesting was the information that the Library of Congress does not regularly track that information, meaning even though 1985 seems to be an incorrect establishment date for this record the only way to confirm any changes would be to go through past Library of Congress Subject Heading books individually to record any changes.

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The MeSH system is similar in its overall layout, similar keywords are used and the alternate names by which it is known is also the same. The differences between MeSH and the LCSH come from the amount of information that is given in the expanded version of the record. The MeSH system indicates the creation date and the dates of when additional information or terms were added. For example in Figure 2, the original subject heading, Lupus Erythematosus, Systemic is marked that it was created in 1999. After speaking with Stuart Nelson, the head of the MeSH department at the National Library of Medicine, he responded that the 1999 date is a default for the system to indicate that the record has been in the system since the creation of MeSH in 1960 (personal communication, April 3, 2012). More information comes from the list of secondary terms and concepts; here you are able to see the evolution of the disorder and the research on it. On March 30 th, 1974 Libman-Sacks Disorder (an inflammatory process of the heart) was linked to the System Lupus record and on December 31st, 1986, Systemic Lupus Erythematosus was recognized as an alternate term. This mapping gives MeSH users a nice view of the progression of the disorder via Subject Heading records. But library searches and subject heading lists are not the only places people can gather information about medical disorders, as the world becomes more and more internet dependent, people are also becoming more likely to search for information (medical or not) via the web. One of the most reliable sources for Lupus information via the web is the Lupus Foundation of America ( and one

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of the most common ways to research is via keyword search on an internet search engine like But are you able to get enough information from these searches and is it all correct? How does organize their information area and could MeSH and LCSH learn from its accessibility? Lupus Foundation of America is the premier institution for Lupus advocacy and research information. Unlike Library of Congress and the National Library of Medicine, the Lupus Foundation of America is not a library based organization and they do not categorize their information with subject headings. Instead, the site is more user-oriented and contains only a search bar that allows for keywords searches. If the user is unsure of what they may be looking for the website also has a section dedicated solely to education. Here, the information is separated into topics including; Understanding Lupus, Diagnosing Lupus, Treating Lupus. But what does this have to do with the LCSH and MeSH? Although is not a library system, users may find its style of searching and organization much more familiar and may be more likely to use a system that relies one keywords searches versus subject headings. Recent evidence shows that keyword searching alone does not gather all the data that could be useful or brings back results that do not quite fit. For example, searching for Systemic Lupus keyword in the Emporia University Library catalog brings back a total of 12 hits but several of the results seem unrelated to the Lupus disorder. On the other hand if I search the Subject Headings for it limits the results to just 8, all of which seem highly relevant.

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So how do we bridge this gap between the decades old traditions of subject heading searches and the more modern art of keyword searching? Subject headings are efficient but clunky and keywords are easy and quick but unreliable. The answer may be an emerging in the form of a new technique originating from blogs and types of websites that have users creating large amounts of data or photos. Folksonomies are user-generated categorization and labeling primarily found on websites such as, blogs, and bookmarking services like (West, 58). Users have access to content on the website and are allowed to tag the information with keywords and phrases that describe that work and help categorize it (West, 58). As a user reads or creates content on these types of websites, they are allowed to post descriptors about it. These tags are not limited only to content but could express ideas or themes that are relatable only to that specific user, such as the terms read or to read indicating to that person details about that article. User created tags are also links, so if one user tags an item with a specific title it links to all items tagged the same way. Although currently headings and subject assigning are done exclusively by professional catalogers, the popularity of tagging system on the internet have had professionals questioning the usefulness of these types of tagging systems. Current research is being done to look at how these user-generated tags could be useful in a library setting. One website,, currently uses the system to tag books added to personal libraries. The tags are used by members of

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the site to organize their collections and to aide in finding new books tagged with the same information. Some researchers believe that user-generated tags in library catalogs would create a sense of ownership and pride in the local libraries and because of the ease of use, help patrons navigate the cataloging system without having to learn complicated subject headings (Rolla, 175). On the other hand, drawbacks to the system are complicated as well. Since the system is user-generated there are some areas of weakness that could undermine its usefulness. Since the terms are generated by a large group of untrained people, tags and labels created for the content would be uncontrolled. For example, one individual may tag an article about Systemic Lupus with Systemic Lupus Erythematosus while another may only put Systemic Lupus. Also, since tags are un-moderated there is the possibility of user-abuse and purposeful mis-tagging of articles. But even with these drawbacks, many librarians and catalogers are beginning to see possibilities in introducing Folksonomies into the cataloging process. Indeed, user-generated tags would by no means replace the current subject headings system but instead it would be added to the system in an attempt to make searching easier for the patrons while engaging users to create tags. Users are becoming more and more accustomed to keyword searching and less familiar with subject headings. As shown from the two different types of subject headings systems, finding the correct wording for a topic can be confusing and if the incorrect heading is used your results could be significantly less or off topic. The

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References Field, H. G. (1942). Subject Headings and the Growing Library. Bulletin of the Medical Library Association, 30(4), 361367. Fikar, C. (n.d.). Making Sense of of Autoimmune and Rheumatic Disorders at the Reference Desk. Medical Reference Services Quarterly, 22(4), 1319. Gault, L., Shultz, M., & Davies, K. (2002). Variation in Medical Subject Headings (MeSH) mapping: from the natural language of patron terms to the controlled vocabulary of mapped lists. Journal of the Medical Library Association, 90(2), 173180. Hochberg, M. C. (2003). The History of Lupus Erythematosus. The Lupus Foundation of America. ction.aspx?articleid=1520&zoneid=9 Jensen, J. B. (2010). Folksonomies for Digital Resources. PNLA Quarterly, 74(3), 2338. Lupus Foundation of America. (n.d.). McElfresh, L. K. (2008). Folksonomies and the Future of Subject Cataloging. Technicalities, 28(2), 36. McGregor, B. (2005). Constructing a consise medical taxonmy. Journal of the Medical Library Association, 93(1).

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Medical Subject Headings. (n.d.). %20domains/medical_subject_headings.htm Medical Subject Headings (MeSH) - Pallipedia. (n.d.). id=541 Medical Subject Headings: Main headings, Subheadings, and Cross references used in the Index Medicus and the National Library of Medicine Catalog. (1960). Digital Library Collections. National Library of Medicine - Medical Subject Headings. (n.d.). National Library of Medicine - Medical Subject Headings: Lupus. Nelson, S. (personal communication, April 3, 2012). Olson, T. (n.d.). LCSH to MeSH, MeSH to LCSH. Cataloging & Classification Quarterly, 46(4), 431446. Rolla, P. J. (2009). User Tags versus Subject Headings: Can User-Supplied Data Improve Subject Access to Library Collections? Library Resources & Technical Services, 53(3), 174184. Ruffner, M., & Glenn, E. (2009). Highly Subjective: The Librarianship of Winfred Sewell. Libraries & the Cultural Record, 44(2), 256275. Schreier Hallett, K. (1998). Separate but equal? a system comparison study of MEDLINEs controlled vocabulary MeSH. Bulletin of the Medical Library

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Association, 86(4), 491495. Schulman, Jacque-Lynne. History of MeSH. (2010). Stone, Alva T. (2009). The LCSH Century: A Brief History of the Library of Congress Subject Headings, and introduction to the Centennial Essays. Cataloging & Classification Quarterly. 29(1-2), 1-15. Suster, M. (2006). Folksonomy. AIIM E-DOC, 20(6), 2021. Thirion, B., & Darmoni, S. (1999). Simplified access to MeSH tree structures on CISMeF. Bulletin of the Medical Library Association, 87(4), 481481. West, J. (2007). Subject Headings 2.0: Folksonomies and Tags. Library Media Connection, 25(7), 5859. Williamson, D. (personal communication, April 28, 2012). Womack, K. (2006). Conformity for Conformities Sake? The Choice of a Classification System and a Subject Heading System in Academic Health Sciences Libraries. Cataloging & Classification Quarterly, 42(1), 93115.

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Figure 1. Search of the term Lupus using the National Library of Medicine MeSH. Available at

Figure 2. National Library of Medicine Expanded Concept View for Erythematosus, Systemic Lupus. Available at mode=&index=7831&view=expanded

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Figure 3. MEDLINEs Medical Subject Heading Listing for Systemic Lupus.

Figure 4. OCLC or WorldCat subject headings.

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Figure 5. Library of Congress Subject Heading for Systemic Lupus Erythematosus. Available at AuthRecID=4729565&v2=1&HC=2&SEQ=20120503102632&PID=MxylOrJcIO4AgW7Bn2W_7FkHI5-A