NationalLibrary ofMedicine

ProgramsandServices

Fiscal Year 1985

NationalLibrary ofMedicine

ProgramsandServices

Fiscal Year 1985

U S DEPARTMENT OF HhAIIHAND HUMAN SERVICES

Public Health ServiceNational Institutes of HealthBethesda Man land

NIH Publication No 87 256

OFFICE OFDIRFCTOR1

DR DONALD A B LINDBCHG

OFriCE OFADMINISTRATION

KENNFTM Q CARNEY

BOARD OF REGFNIiFNI1.

OFFICE OF INQUIRIES& PUBLICATIONS

MANAGEMENT

ROBERT B MEHNERT

DIVISION OFSPECIALIZED

INFORMATION SERVICES

DR HENRY KISSMAN

LISTER HIL1NAIIONAL CENTEM FOR

BIOMEDICAICOMMUNICATIONS

DH DANIEL R MASYS

BIOMEDICAIINFORMATION

StRVICES BRANCHDFI MELVIN SPANN

BIOMEOICAL FILESIMPLEMENTATION

BRANCHBRUNO VAS'A

OFFICE OFHA7ARDOUSSUBSTANCESINFORMATION

DH SIDNEY SII'QI I

'Deputy Director Konl SmithDeputy Director lor Research and Educalion Dr Harold M SchoolmanAssociate Direclor lor Planning arKl Evalualioh Dr Henry W RiecKenAssislflnl Direclor (or International Programs Dr Richard KC HsiehDirector ol Information Syslems John Anderson

"Incudes Rejionnl Medical Lirary Program and Medical Subject Headings Section

COMMUNICATIONSENGINEERING

BRANCHDR GFORGF THOMA

COMPUTERSCIENCEBRANCH

JULTS ARONSON(ACTG)

i(FAITH PROI ESSIONSAPPLICATIONS

BRANCHDR WARREN SEIBERT

(ACTG)

Contents

Preface 5 Appendices

A Note on the History of NLM 6

Officers of the Library 8

Directors of the Library 9

1985 Special Initiatives:Looking Toward the Future 10

Snapshot of the Library on the Eve of ItsSesquicentennial 13

The Medical Library Assistance Act:A Vicennial Vignette 19

Program Reports

Library Operations 22

Specialized Information Services 44

Lister Hill National Center for BiomedicalCommunications 50

Extramural Grants and Contracts 59

International Programs 67

Administration 71

Appendix 1. Staff Bibliography 74

Appendix 2. Extramural Programs SupportedPublications 78

Appendix 3- Board of Regents 84

Appendix 4. Board of Scientific Counselors 85

Appendix 5. Biomedical Library ReviewCommittee 86

Tables

1. Growth of Collections 24

2. Acquisition Statistics 25

3. Cataloging Statistics 26

4. Bibliographic Services 27

5. Online Searches 31

6. Offline Searches 32

7. Circulation Statistics 34

8. Reference Services 38

9. History of Medicine Activities 39

10. Extramural Grant and Contract Program 66

11. International MEDLARS Centers 70

12. Financial Resources and Allocations 71

13. Staff 73

"Portrait of ProfessorGross," also called "TheGross Clinic," by ThomasEakins (1875). Thispainting, perhaps the mostfamous in American meat-cine, was selectedfor thebrochure and poster plan-ned to commemorate theNational Library ofMedicine's sesquicenten-nialyear in 1986. Eakinshad attended lectures atthe Jefferson MedicalCollege (in Philadelphia,where thepaintingremains) and he hadundoubtedly seen SamuelDavid Gross, Chairman ofSurgery, both as lecturerand in the clinic. Eakins'students andfriends posedas the spectators of theoperation; Eakins includeda portrait of himself sketch-ing theprocedure at thecenter left of the painting.The woman in the pictureis a relative of the patientand herpresence indicatesthat this is a charity case.The law at that timerequired that a relativebepresentfor surgeryon a chanty patient.

Samuel David Gross wasan early and ardent sup-porter of the NationalLibrary of Medicine (thenknown as the Library ofthe Army Surgeon-General'sOffice). As head of severalphysicians' organizations,Dr. Gross argued eloquentlyfor federal funding for theIndex-Catalogue then beingproposed by the Library'sdirector,John Shaw Billings.

Preface

e National Library <>l Medicine is on thethreshold of its Sesquicentennul One hundredand fifty years ago, an army scrgeam or perhaps itwas a lieutenant, was ordered to spend SI 50 for"medical books for officers " That unremarkableroutine, bureaucratic transaction w.is the beginningof what is now called the National Library ofMedicine

The two decades ol ferment thai began with theintroduction of MKDLARS in 1964, was continuedin Fiscal Year 1985 An ambitious long-rangeplanning effort was begun, preservation was givennew emphasis, work began on a 1'niliecl MedicalLanguage System, and DOCLINH, a nationwidemterlibrary loan request and referral system wasintroduced, as were TOXNL'T and a NationalLearning Demonstration Center

These efforts, described in this report, were allmade possible by a close collaboration betweenthe Library and its constituents I would like toexpress my sincere thanks— to those who work atthe Library, to its advisors on the Ho.nd ofRegents and other bodies, and to the healthscience community at large— lor then support inthe past year

Donald A H Lmclberg, M I)Director

A Note on the History of theNational Library of Medicine

T±h£. he National Library of Medicine began as asmall collection of books in the office of theSurgeon General of the United States Army Theyear 1836has been generally accepted for thebirth of the Library, for that appears to have beenthe first year that funds were specifically ear-marked in the budget for the purchase of medicalbooks. The amount budgeted for this purpose,$150, seems trifling when compared to today'sbook prices and acquisitions budgets. The earliestknown catalog of the Library, an 1840hand-written document preserved in the History ofMedicine Division, includes 134 book and journaltitles.

Although the formal beginning of the Library ofthe United States Army Surgeon General's Officedates back to 1836, it was only after John ShawBillings took charge of the collection in 1865 thatit began to develop into a national library. Usingthis as a starting point, what follows are a fewhighlights* from the Library's history

1866

Collection moved to Ford's Theatre, theauthorities feeling the assassination of Lincolnthere made it unsuitable for continued use as atheater.

Ford's Theatre, the library'shome from 1866 to 1886.This photograph dates fromthe 1870s.

1879

The first issue of Index Medicus issued by Billings.It continues to be published today, 107 years later

•'* frtr,

1880

In a curious footnote in history, Billings suggeststo Herman Hollerith, a friend, that statistical datamight be recorded by holes on cards and amachine invented for sorting and tabulating themBillings' idea bears fruit as Hollerith successfullyimplements the resulting machine in the 1890Census; Billings' business acumen fails him as hedeclines Hollerith's offer of partnership to exploitthe invention commercially. Hollerith sells hispatents to a firm that becomes IBM.

The Library was housedin this building on theWashington Mall from 1887to 1962. It was torn down

in the late 1960s to makeroomfor the HirshhornMuseum of Art.

1887

Library moves to newly constructed brick buildingon the Washington Mall "OldRed,"as it wascalled, continued as the Library's home until 1962Old Red has since given way to the HirschhornMuseum

1922

The Library of the Surgeon General s Officebecomes the Army Medical Library

1940

Microfilming begins at the Library and is suppliedon loan

1952

The Armv Medical Library becomes the ArmedForces Medical Library That same year wasorganized the "Friends of the Army MedicalLibrary," forerunner of today's 'Friends of theNational Library ot Medicine"

1956

Senators Lister Hill and John F Kennedy sponsorthe National Library of Medicine Act, passed bythe Congress and signed by President F.isenhoweron August 3 The Library is now a u\ ilian agencywithin the Department of Health, Education, andWelfare

1962

The Library begins operation in its new buildingon the grounds of the National Institutes ofHealth

1964

MEDLARS, the Library s computers! mlormationretrieval system becomes operational A pioneeringphototypesetter called GRACE (Graphic ArtsComposing Equipment) sets the standard forcomputer-driven typesetting

1965

Medical Library Assistance Act becomes law Itcreates a program of grant assistance to medicallibraries and for research in healthcommunications

1967

The Toxicology Information Program is establishedat NLM

1968

The Lister Hill National Center for BiomedicalCommunications established by Act of CongressThe Center applies the latest in computer,communications, and audiovisual technology toimprove biomedical information transfer

1971

MEDLINE (MEDLARS Online) is inauguratedToday this world tamous network serves healthprofessionals worldwide with some three millionsearches each year

1980

The Lister Hill Center Building is dedicated

1985

The Library begins work on a 20-year plan andprepares to celebrate its 150th anniversary in1986

"A comprehensive, illustrated histon ol the M M is .n.iil.ihk inA lli\ton o/ Ihc \aliiiiial librar) o/ \Mniiiv llv \ation *Inibun <>l Mediitil Knoulvdft.' W\ndham I) MiksWashington IK I S Government Priming (Mine IW2

Senator Lister Hill ofAlabama, co-sponsortilthJohn Kennedy ofthe National Library orMedicine Act oj'1956. Thisbust, done by sculptorRobert Berks, Is displayedprominently In the lobbyof the Library's Lister HillCenter.

Officers of the Library

Director

Deputy Director

Deputy Director, Research and Hclucation

Executive Officer

Special Assistant, International Programs

Associate Director tor Planning and Evaluation

Director, Information Systems

Chief, Office of Inquiries and Publications Management

Director, Office of Computer and Communications Systems

Associate Director, Library Operations

Associate Director, Specialized Information Services

Associate Director, Extramural Programs

Director, Lister Mill National Center lor Hiomediul Communications

Donald A B Lmdberg, M D

Kent A Smith

Harold M Schoolman, M D

Kenneth G Carney

Richard K C Hsieh, D P H

Henry W Riecken, P h D

John A Anderson

Robert H Mehnert

John A Anderson

Lois Ann Colaianni

Henry M Kissman, Ph D

Arthur IJrocrmg (Acting)

Daniel R Masys, M D

Directors of the Library

1865-1895 Col John S Billings

1896-1897 Col David S Huntmgton

1898-1902 Ma] James C Merrill

1902 Ma) Walter Reed

190VI904 Brig Gen Cjlvm DeWitt

1904-1913 Brig Gen Walter McCiw

1913-1918 Col ChampeC McCullough

1919 Col Paul F Straub

1919-1924 Maj Gen Robert E Noble

1924-1927 Col James M Phalen

1927-1932 Col Percy M Ashburn

1932-1936 Ma] Edgar E Hume

W6-1944 Col Harold W Jones

1945-1946 Col L L Gardner

1946-1949 Col Joseph H McNmch

1949-1963 Col Frank B Rogers

1963-1983 Martin M Cummings, M D

1984- Donald A B Lmdberg, M D

1985 Special Initiatives: LookingToward the Future

Planning

At their January, 1985 meeting, the Board ofRegents asked the Director to work with them toprepare a long-range plan to guide the Library'sfuture development The Regents' request wasmotivated by the need for guidance in dealingwith an era in which the technology of medicalinformation management is changing rapidly andin which there are many competing opportunitiesfor the allocation of limited resources The Boardbelieves that wise choices can be made only ifthere is a long-term vision of what the Library canand must become in order to discharge its missionin the 21st century Further, the Regents reasoned,preparation of a long-range plan could inform andbe informed by the Library's users who couldplan more effectively the use of their ownresources if they knew how the Library expectedto serve their needs

The Director responded to the Regents requestby choosing a planning process that distributes thework of planning over five domains whichencompass current programs and activities of NLMand also constitute a framework for thinking aboutthe future These five domains are

I Building and organizing the Library scollection

II Locating and gaming access to medical andscientific literature

III Obtaining factual information from databases

IV Medical informatics

V Assisting health professions education throughinformation technology

Planning Panels are developing recommenda-tions and priorities for future NLM activities andprograms for each domain

The Libran has chosen a planning model thathas three components First, it incorporates adistant, somewhat indistinct vision of the 20-year-off future in medicine, library and informationscience, and computer/communicationstechnology That environment cannot be forecastprecisely, so it is appropriate to speak of thedistant goal as 'fu/./y ' This goal is seen as asocietal objettive whose attainment involves manyorganizations and agencies NLM has a role to playin achieving the goal and it is necessary for NLMto plan its p.irt

Second, while the 20 vear goals are indistinu,there are opportunities leading toward the goals,and also impediments to achieving them Third,the specific steps that should be taken in order toremove the impediments and take advantage ofthe opportunities should be programmed for ^ to5 years henic In effect the Planning Panels arc-in vited to consider the vision of the 20-year futureand recommend what role NLM should play inapproaching this souetal objective

The Board of Regents has asked that a draft ofthe long-range plan be ready for their review inJune 1986 The Board will want to have anopportunitv to consider the several recommenda-tions that are anticipated to be the major productol the planning process and to examine theirimplications

10

Unified Medical Language System

The remarkable developments in computer andcommunications technology in the last decade orso have formed the foundation on which havebeen built equally remarkable information systemsThe speed and magnitude of these technologicaldevelopments are illustrated by the comment offormer Secretary of the Treasury, W MichaelBlumenthal, that if a comparable growth hadoccurred in the automobile industry, we wouldnow be driving cars that cost J4 SO, weighed apound and a half, and got a million miles to thegallon This spectacular growth of technology hasled to applications m everv aspect of medicine,unfortunately these applications have resulted inan enormous amount of inconsistent terminologyin health science systems of all types

The Library, of course, has us ownvocabulary—Medical Subject Headings (MeSH) It ,at least, has some of the attributes required of amsystematic vocabulary used for machine retrievalunambiguous definitions, organi/ation by a set ofrules, and standardixed data entry and verificationprocedures Although there are other suchvocabularies in use, the definitions, rules oforgani/ation, and procedures are quite diverse, sothat the systems represented by these vocabulariescannot communicate with each other It is impossi-ble to integrate information found in varioussystems, and even switching from system to systemis extremely difficult because the user is faced withthe formidable task of learning the language andorganization of disparate systems Clearly, theindispensable need is for a universal medicallanguage system

To create such a system and to ensure that it isadopted throughout the health professions wouldseem to be an impossible task Local and

discipline-specific jargon, abbreviations, multiplemeanings, terms that are inherently ambiguous,and centuries of usage, all argue that such aneffort would be doomed to failure An alternativemethod, however, might be to translate existingmedical language, wherever and however used, toa single, unambiguous form This "unified medicallanguage" could then act as a bridge from and tothe many actual vocabularies being used in avariety of medical settings

For example, a clinician taking a medical historycould describe the patient's condition directly intothe system, his words being translated into theunified medical language The terms might then berestructured in accordance with MeSH and anautomatic search done on MEDLINE or otherbibliographic database related to the patient'scondition The translation could also be made toother databases which might then suggestappropriate laboratory tests, their relative costs,probable diagnostic considerations, indications andcontra-mdications of various therapies, and eveninto databases that keep track of the prevalenceand incidence of specific diseases

In 1985, the Library took a lead role inbeginning to develop such a unified medicallanguage system The effort, in cooperation withthe American Medical Association, universityinvestigators, and other Federal agencies is seen asa long-term project

The NLM Board of Regents,which consists of 10appointed and 9 ex officiomembers, meets threetimes ayear at the Library.In this picturefrom theSeptember 1985 meetingare (left to right) Albert E.Gunn, M.D., David 0.Moline, D.D.S., andjohnK. Lopez.

Preservation

The physical state of the collection, always amatter of concern, came under intense scrutiny in1984 and 1985. A senior NLM PreservationPlanning Team surveyed the collection and theenvironmental conditions under which it is stored(temperature, humidity, light, and pollutants). Theteam found that although the environment isrelatively good, nevertheless some 8.8 percent or113,000 volume equivalents of paper-basedmaterials are brittle. This compares favorably tothe condition of other research libraries, forexample, Yale and the Library of Congress reportsome 25 percent of their collections are brittle.

The Preservation Planning Team recommendedthat the Library:

• Modify existing Board of Regents policy onpreservation to link the NLM preservationprogram more explicitly to its collectiondevelopment guidelines; to clarify the Library'sresponsibility for preserving the printed contentas opposed to the artifact; and to define NLM'srole in assisting to preserve significantbiomedical literature held by other U.S.libraries.

• Establish a Preservation Section in the ReferenceServices Division.

• Expand preservation efforts, emphasizing massdeacidification and microfilming, and also b\improving the conditions under which thecollection is stored.

• Use the Electronic Document Storage andRetrieval system being developed by the ListerHill Center as a laboratory testbed for researchin preservation on optical disk. This effortshould be coordinated with the Library ofCongress, the National Archives, and otherinterested institutions.

• Encourage publication in archival formats, forexample, permanent durable paper.

• Work through the Regional Medical Libraries toidentify other biomedical collections that shouldbe preserved and to assist in their preservation

These recommendations were presented to theBoard of Regents at its September 1985meeting.The Board voted unanimously to accept them inprinciple, and the recommendations are now beingimplemented by the Library's staff.

12

Snapshot of the Library on the Eve ofits Sesquicentennial

Scene:

The Atlanta physician had nei>er before treated aboy complaining of "numb chin." He sent the ladto the examining room to undress and quicklyturned to his personal computer. He typed in theterm "numb chin" and read from the screen alengthy description of an article on just thatsubject. This information provided the vital cluethe physician needed to diagnose a form oflymphoma.

Similar scenes are reenacted thousands of timesevery day in physicians' offices, researchlaboratories, hospital nurses' stations, medicalschools—in short, wherever health professionalsrequire information.

The system this physician tapped into isMEDLINE, one of the National Library ofMedicine's online databases containing medicalreferences, abstracts, and other information.MEDLINE is a computerized counterpart to IndexMedicus, the monthly bibliography of journalarticle references which made its first appearancein 1879 and is still published by the Library today.

NLM's online files contain descriptions of some6 million articles, books, journals, and audiovisualprograms in subjects related to medicine andhealth. By creating standard machine-readablerecords for these items, storing abstracts of manyof them, and describing their content using aspecial vocabulary (known as Medical SubjectHeadings, or MeSH), the Library's staff makes itpossible for searchers to identify in minutes thespecific documents most likely to contain theinformation that is needed.

Some health professionals, such as the physicianin the scenario above, search NLM's online filesdirectly, either on the NLM computer system or

through commercial online database vendors thatlease NLM files. Other users rely on medicallibrarians and information specialists to researchthe databases for them. To help health profes-sionals and medical librarians search MEDLINE andother NLM online files effectively, NLM provides arange of online training classes and materials. Lastyear, more than 1,000 people took NLM-sponsoredonline training sessions. In addition, medicallibrarians throughout the country conduct specialonline training sessions for health professionalsusing The Basics of Searching MEDLINE: A Guidefor Health Professionals, a new manual publishedby the Library.

The Library also looks for ways to make itsonline system easier to use. Some improvementsnow being developed are a microcomputer pro-gram called GRATEFUL MED that helps userssearch MEDLINE, aids that lead users to the mostappropriate subject terms to search, and asimplified way of entering search requests on theNLM system.

Scene:

A veterinarian in Florida notices an increasingdeath rale in exotic birds and suspects that itmight be linked to a recent ban on a pesticideused in bird feed, lie calls the state's ToxicSubstances Information Center which in turnquickly uncovers relevant information in NLM'sonline toxicology databases.

The field of toxicology, barely recognized as adistinct science 25 years ago, has grown at anunprecedented rate and has generated largequantities of data and information. The publicinterest in toxicology as a social concern and theresultant laws and regulation have fueled—and

13

been fueled by—extensive testing and researchTechnological innovation!) in computers andcommunication, advancing at a rate no less thantoxicology information, have resulted insophisticated systems for collecting, organizing,and distributing this information From the earlvdays of toxicology to the present, the NationalLibrary of Medicine, through its Toxicology Infor-mation Program operated by the Division ofSpecialized Information Services, has been a leaderin providing the toxicology community withreadily accessible quality information Detailedinformation about the Library's toxicology infor-mation services begins on page 00

Poison Control Centers throughout the countryare deluged with calls relaying poisoning incidentsAmong the arsenal of tools used by many of thecenters are computer files such as the ToxicologyData Bank, which contains specific information ontreatment of drug overdoses and other accidentalpoisonings The Toxicology Data Bank and theHj/ardous Substances Data Bank, both developedb\ the Toxicology Information Program, containfully referenced facts on potentially ha/ardouschemicals, their properties, safety and handling,toxicity, pharmacology, environmental fate, etc

Throughout the country, citi/ens concernedabout the effects of environmental chemicals arcable to call their local or regional medical libraries,where the staff is trained to search the appropriatecomputer files TIP's file, for instance, has beenused to retrieve references to journal articles forindividuals with the following questions "What isthe danger of spraying lawns with 2, 4-D'' "Myson has been sniffing butane lighters What are theeffects of butane'' "Is it possible for lipstick tocause lip irritation'"

Scientific researchers, physicians, emergencyresponse teams, the media, legal professionals and

the general public all profit from the Library'sextensive computer storehouses of toxicologicalinformation By providing information to meetresearch needs and to prevent or remedyhazardous situations, the Library strives to helpsafeguard the health of the American public andinsure a clean environment

Scene

The surgeon at the Betbesda hospital inspectedwith some puzzlement the congenital anomalypresented by the resseh in the chest of the man hewas operating on He recalled seeing drawings ina journal that might shed some light on theproblem The article, brought from nearby N1.M,was propped up on a stand in front of theBurgeon u ho proceeded to complete the operationsuccessfully

This true incident, which occurred in themid-1960s, impressed on the NLM staff as nothingelse could the crucial importance of the medicalliterature to qualit\ medical practice Of course, inthis case, the surgeon remembered a specificarticle As the number of published medicalarticles continues to increase dramatically, thechance of .1 phvsician recalling precisely whicharticle is required becomes increasingly remoteHowever, as long as the physician can useMEDLARS to quickly cull through millions ofreferences 10 |ournal articles, such reliance onmemory is unnecessary

Once a health professional or researcher hasused an NLM database to identify a useful journalarticle, the next step is to obtain a copy of thearticle For a limited number of journals, the usercan view an online version of the full-text of thearticle on a database vendor's system Morefrequently the user can obtain a copy of the article

14

immediately from the health sciences library wherethe search was performed But in some cases, theuser must ask a medical librarian to obtain a copyfrom another health sciences library collectionThe chances are excellent that the user s requestwill be filled rapidly—thanks to a variety of serv-ices NLM provides to help health sciences librariesserve health professionals and researchers moreeffectively

NLM'j) assistance to other libraries begins whenthey receive new biomedical books for theircollections Because NLM s authoritative catalogingrecords are readily available online and in printedcatalogs, medical librarians can use the catalogingdata NLM has prepared rather than spending timeand energy preparing their own records Often theNLM cataloging record is actually printed insideI' S biomedical books, as part of the (atalogmg-m-Publication program directed by the Library ofCongress The NLM classification, a scheme forarranging biomedical materials on library shelvesaccording to their subject content, helps healthsciences libraries organi/e collections m a way thatmakes sense to health professionals

I'se of NLM cataloging records saves other U Sbiomedical libraries over three million dollarsannually in staff time required to catalog incomingjournals, books, and audiovisuals NLM catalogingrecords help librarians and librarv users to findmaterials m health science library collectionsthroughout the United States and m manycountries of the world

Faced with requests that cannot be filled fromtheir own collections, health science librarians gethelp through NLM s Regional Medical 1 ibrary Net-work In each of seven Regions m the network, .1distinguished medical librarv serves under contractto NLM as the Regional Medical Librarv (RML) forthat area The RML is responsible for coordinating

the activities of health sciences libraries to improvebiomedical information service to all health profes-sionals in the Region, whether in cities, suburbs,or remote rural locations

The Regional Medical Library plays a critical rolein implementing national policies and standards forreferring document requests among health sciencelibraries and in developing effective ways ofhandling requests within its Region The goal is tofill each request quickly and as close to home aspossible Requests are referred to larger, moreremote library collections if the materials are notavailable locally, with NLM serving as the backupfor the entire network

NLM has recently introduced DOCLINE, anautomated document request and routing systemthat cuts the time required to create a request andget it to a library that has the needed materialLibrarians using DOCLINE transfer informationfrom MEDLINE or other NLM online files into thedocument request and avoid typing the author'sname, title, etc , of the item being requestedDOCLINE automatically routes requests for journalarticles to libraries that own the journals Therouting system relies on an automated file of thejournal holdings for over 1,700 health scienceslibraries throughout the country NLM developedand maintains this file with assistance from theRegional Medical Libraries The DOCLINE systemwill eventually route most of the estimated twomillion mterlibrary requests for documentscurrently handled in the RML network each year

Libraries in the network can fill over ninetypercent of the mterlibrary loan requests made forU S health care practitioners and researchers Theremaining requests come to NLM, which has byfar the world's largest collection of biomedicalliterature NLM contains 1 75 million volumes ofprinted materials and 1 76 million items m other

15

formats—prints, photographs, historical films,audiovisual programs, microforms, computer soft-ware, and manuscripts. The figures on the overallgrowth of the NLM collection are in Table 1.

Some 229,000 books, journals, audiovisual,pictures, pamphlets, and manuscripts wereacquired for the NLM collection in 1985, at a costof about 12,250,000. NLM fills over 1200 requestsfor materials from its vast collection every day. For-ty percent of these requests are forwarded fromother libraries; sixty percent come from visitors tothe Library in Bethesda. Lending activities aredescribed in the section on Document Delivery inthe chapter on Library Operations. Statistics are inTable 7.

Scene:

A Virginia novelist working with the diary of anineteenth century plantation owner asks NLM'shistorians to identify the modem day terms andthe uses for some 20 drugs mentioned in the diaryonly by obsolete names. By using early sources thehistorians are able to identify them all, thus givingverisimilitude to the novelist's descriptions.

Most of the requests to NLM are for currentmaterials and information needed to assist patientcare and biomedical research. But the Librarycontains not only the latest published medicalinformation, but also the earliest. NLM's historicalfilms and still pictures are heavily used by peoplein the newspaper, book publishing, television, andmotion picture industries. Footage from NLM'shistorical picture collection appeared in theWoody Allen movie Zelig. ABC recently requestedpictures of quarantine measures taken in the U.S.in past epidemics for use in a "Nightline" showabout the controversy over isolation of AIDS

victims. Medical and social historians draw uponthe Library's magnificent holdings in rare books,pamphlets, theses, and manuscripts to further theirresearch.

In addition to providing materials from its com-prehensive collection, NLM also gives referenceassistance to health professionals and researcherswho don't know where to look for the informa-tion they need. The Library staff responded toalmost 100,000 requests for information in 1985.Inquiries may be for specific facts on topics ofcurrent interest, for recommendations ofaudiovisual programs suitable for a specific educa-tional purpose, or for information about theservices provided by other organizations, such aslocal biomedical libraries or information clearing-houses operated by other federal agencies.Requesters include members of Congress, theSupreme Court, and the Office of the Presidentwho need information to make informed decisionsregarding health policy and health care legislation.

While responding to current demands for itsservices, NLM also looks for better ways toorganize biomedical information and make itavailable in the future. The Library faces thedouble challenge of preserving the paper recordsof the past for use by future generations anddeveloping new services that take advantage ofelectronic forms of information and emerginginformation handling techniques.

16

TLX 033 FAIRBANKS AK MAY 18 J15M

MOJAVE TRACKING STATION (RELAY THRUGODDARD)

"AT APPROXIMATELY 10:15 AM ALASKADAYLIGHT TIME ON THURSDAY MAY 18, 1972,ST. PAUL ISLAND DECLARED A MEDICALEMERGENCY AND REQUESTED ASSISTANCEOVER THE SATELLITE FOR A 3() YEAR OLDMALE PATIENT WHO HAD SUFFERED A HEADINJURY AND WHOSE CONDITION HADDETERIORATED TO INCLUDE PARALYSIS ANDUNCONSCIOUSNESS. A COAST GUARD AIRCRAFTHAS BEEN DISPATCHED. MEDICAL FACILITIESIN ANCHORAGE ARE ALERTED AND ANEUROSURGEON IS STANDING BY. "

TLX 038 FAIRBANKS AK MAY /9 400P

"PATIENT EVACUATED FROM ST. PAUL ISLANDTO ANCHORAGE PHS HOSPITAL BY COASTGUARD AIRCRAFT. PATIENT WAS IN POORCONDITION UPON ARRIVAL. ANEUROSURGICAL PROCEDURE WAS PUR-FORMED AND THE SUBDURAL HEMATOMA WASREDUCED. PHYSICIAN REPORTS THAT PATIENTPROBABLY WOULD NOT HAVE SURVIVEDMUCH LONGER WITHOUT SURGERY. "

These two telegrams were received by the ListerHill Center about an emergency in 1972 in whichcommunication via NASA's ATS-1 satellite wascredited with saving a life. The use of a satellitenetwork to bring medical consultation to remoteAlaskan villages was sponsored by the Library'sLister Hill National Center for Biomedical Com-munications in cooperation with the state ofAlaska and NASA.

The Lister Hill Center is the NLM's research anddevelopment component, established in 1968 by ajoint resolution of the Congress. The Center'soffices and laboratories are located in the 10-storyLister Hill Center Building, dedicated in 1980.

The Alaska voice network was the first of aseries of satellite-based communications experi-ments sponsored by the Lister Hill Center. Laterexperiments, using NASA's ATS-6 and CTSsatellites, added video to the voice link andextended their use to medical education in Alaskaand the Pacific Northwest and nationwideteleconferencing for the U.S. Public Health Service.

These experiments typified the Lister HillCenter's philosophy of

• identifying a communications need in the healthsciences,

• applying the most modern technology to asolution, and

• developing a prototype system to demonstrateits feasibility to the medical community.

This is what was done with the Alaska satelliteproject, where the state, with private help, nowoperates the network. Another outstanding successfollowing the same formula was the Lister HillCenter's experimental Computer Assisted Instruc-

17

tion (CAI) Network This system linked threeuniversity-based computer centers to a nationwidetelecommunications network to allow students inalmost 100 schools to have online access todo/.ens of computerised teaching modules Afterdeveloping and operating the system for severalyears, the Lister Hill Center turned it over to anorgani/^tion composed of users who continued torun it

The Lister Hill Center's communicationsspecialists and engineers have been concentratingin recent years on videodisc, voice recognition,and microcomputer technologies There areexciting experiments under way to create teachingmaterials in basic medical pathology, radiology,and even realistic patient simulations for training

health practitioners Other Lister Hill Centerresearch efforts are concerned with providing theLibrary with improved methods for acquiring, pro-cessing, and making available the biomedicalliterature The LHC has also created a prototypeNational Learning Demonstration Center thatmakes available for display and testing a widerange of computer-based teaching materials in thehealth sciences These programs are all describedin the chapter on the Lister Hill Center

18

The Medical Library Assistance Act:A Vicennial Vignette

e Library observes another anniversary in1986 Twenty years ago, in 1966, Nl.M receivedits first appropriation under the Medical LibraryAssistance Act Since that time, mam havebenefited from grant awards made under the Actauthors and scholars, researchers and academi-cians, librarians and media experts, computerscientists and linguists, as well as aspiring graduateand post-graduate students ot librarunship,biomedical communications, and medicalinformatics

Although the Library's grant programs aremodest in comparison with those ot other com-ponents of the National Institutes ot Health, it canbe fairly said that they have had an impact on thenation's health out ot all proportion to their si/eThe following composite vignette is intended toillustrate the effects of Nl.M grant assistance

Scene

On a late Sunday afternoon in Jill] an elderlyfarmer has fallen from his tractor and is pinnedbeneath the front wheels The retain1 unit arrivesand bos little difficult}' in freeing the Jarmer, whoappears only to have superficial in/unes However,an alert emergency medical technician notices anunsteady gait in the fanner's stride After thetechnician asks the farmer what he recalls aboutthe Jail, the farmer admits that he may have hada "dizzy s/>eH" just prior to the acudent Finally,after persistent questioning, the farmer admitshaving had three or four episodes of brief periodsof dizziness and double vision during the past «.Ymonths Some weeks previously, the paramedichad seen a training film about recognizing

neurological "events " He is persuaded to call theemergency room at the county general hospitalThe attending physician listens to the paramedic'sreport and requests that the farmer be brought tothe hospital

In the meantime, the emergency room physiciandecides to do a quick medical records check She"calls up" the medical records department on theemergency room microcomputer She does this withease and no hesitancy, for her first year atmedical school included a learning laboratory classin computer competency, and before she enteredher clinical science years she had purchased asecond-hand personal computer

Entering the farmer's name and her ownauthorization number and password she verifiesthat the farmer had two prior hospital admissionssince 1980 l"he farmer's medical records are apart of the hospital's [wrmanent, common,computer registry fits last admission was recentand the physician can retrieve preliminary infor-mation online from the active file Laboratory'results, radiology and surgical pathology and out-patient pharmacy prescriptions are rapidly printedout There is no clue from past admissions andtreatment protocol which she can immediatelyassociate with the paramedic's observations

She decides to do a literature search to see if shecan locate a case history article on brain tumorsthat she remembers reading in which the subject'ssymptoms were similarly undramattc and initiallymisleading until a nuclear magnetic resonancescan of the brain was conducted (me of herorientation sessions to the hospital was a presenta-tion by the librarian which included a demonstra-tion of I'aperChase, "an easy-to-use bibliographicretrieval system" The local system can locate allthe MEDLINL-based holdings in the ten-hospitallibrary consortium in the sourthern part of the

19

state She was familiar with NLM's MEDLINE, butonly through searches done by the referencelibrarian at her medical school She establishescontact with the PaperChase files and, after just afew search commands, she finds the reference tothe case history and notes that the journal is heldby the private hospital across town (Theconsortium includes a very cost-effective arrange-ment for cooperative acquisitions) She sends an"electronic-mail" message to the library of the otherhospital requesting that a copy of the article byforwarded on Monday

The scenario will be extended but events evento this point exemplify the operational results of anumber of NLM funded awards Their representa-tion is simplified but, in the context of theirindividual situations, their value and effectivenessare vividly displayed Included are awards for

• a cooperative program for sharing library-controlled audiovisual training aids among anumber of rescue squad units,

• a highly reputed computer-based operationwhich electronically combines individualhospital department records (such as clinicallaboratories, admissions, medical records, phar-macy and radiology) into a permanent, commonregistry accessible by a microprocessor,

• a successful program that demonstrated the valueof a learning laboratory for improving computerliteracy in a medical school setting,

• the well-known PaperChase bibliographicretrieval system, now commercially available andwidely used,

• an experiment in using "electronic mail" soft-ware to facilitate various medical library servicesand, finally,

• consortia of libraries for the sharing of informa-tion resources

To bring the vignette to a conclusion will revealthe opening chapter of one of NLM's priorities forthe future—Medical Informatics research anddevelopment

By Tuesday afternoon the outpatient has seenhis physician, hiid a neurologic examination,including a brain scan, and numerous laboratorytests All data and information, including the resi-dent's work-up and the prior admissions, are nowincluded in the database The farmer's physicianhas the foundation for a dialogue, not at thispoint with a department head of the hospital, orwith a colleague at the large upstate medicalcenter, but with an in-house artificial-mtelligence-based system to assist in the diagnosis and drugtherapy of almost KXX) diseases The systemcodifies the knowledge of experts in many fieldsand is supplemented by program! in probabilitytheory It is interactive with the user, asking andanswering questions, providing explanations foradvice given, and suggesting additional tests Theuser can accept advice, ignore it (the reason mustbe documented) or suggest additions to thedatabase

Responding la the command for a "combinedanalysis" of symptoms (possible conditions rankedaccording to the number of symptoms present) thesystem displays a list of eight possibilities, five ofwhich have at least three of the symptoms incommon Further narrowing begins when, throughthe keyboard the physician examines each of thefive as its features compare to logged clinical dataFinally, conclusions of the diagnostic phase aresummarized for the Physician-User Category =Cerebral Thmmbotic, Territory = Carotid systems,

20

Location = Ipstlateral with ocular disturbance(right eye) Following the summary is anexplanation of how the conclusions were reached,and which of the symptoms and data led to thespecific conclusions and which did not Alsoincluded are relevant citations to the literature

In the therapy phase, the system discusses"options with the physician Specifically, the use ofanticoagulants or antiplatelet agent* and surgicalendarterectomy are weighed The physician informsthe system of his choice—the anticoagulantCOUMADIN The computer program is once againautomatically directed to the medical record A"wait" instruction flashes on the screen but isshortly replaced by "caution" and the explanation

'Anticoagulant is contraindicati'd—patient's last hospital admission andtreatment suggest that the hazard ofhemorrhage might be greater thanpotential clinical benefits—considerinstead , because "

The clinical problem described is not a medically complex one and the complexities andtechnical aspects of the illustrated ' system" areabsent In addition, the ' system" is not identifiedwith a single operational entity, bui is rather acomposite of a number of such systems supportedwith NLM grant funds However, the scenario isonly simulated and is not farfetched conjecture

Medical Informatics work in this jrea is still inthe early stages and much more needs to be done-See page 60 for a description of Medical Infor-matics research and development currently beingsupported by grant, work within NI.M's Lister HillCenter is described beginning on p.ige ^ Relatedalso is another NLM program of high priority-Integrated Academic InformationManagement

Systems—which i.s described on page 60Responding to the generally sad state of medical

libraries in the early 1960's, those who framed theMedical Library Assistance Act built perhaps betterthan they knew Twenty years later it is apparentthat the Act has been immensely valuable to theprogress of American medicine Today's successfulRegional Medical Library Network, the training ofa generation of medical librarians and informationspecialists, the emergence of the field of MedicalInformatics as a vigorous discipline, all owe muchto this legislation The challenges facing the healthprofessions today require continued extramuralsupport for research, training, and the develop-ment of new communications modalitiesappropriate for the 198()'s and beyond

21

Library OperationsLois Ann ColaianniAssociate Director, Library Operations

TJ.he Library Operations Division of NLM

• acquires and preserves the world's biomedicalliterature,

• organi/cs this literature by cataloging andindexing,

• disseminates indexing and cataloging data inpublications, online files, and other machine-readable forms,

• lends copies of documents in the NLMcollection, and

• provides reference and research assistance tohealth professionals

More than 250 librarians, technical informationspecialists, subject matter experts, health sciencesprofessionals, library technicians, and admini-strative support personnel carry out LibraryOperations' programs and services The staff isorgani/ed into four divisions BibliographicServices, Reference Services Technical Services,and History of Medicine, two special units theMedical Subject Headings Section and the RegionalMedical Library Program Office, and a smalladministrative group in the Office ol the Associate-Director

Planning and Management

In FY 1985, Library Operations (LO) continued towork toward the four objectives in its strategic-plan for FY 1984-19H8 These objectives are

• to improve internal technical and bibliographic-processing,

• to develop and implement programs that makeit easier to identify, locate, obtain, and usebiomedical information and literature,

• to develop and implement a program for thepreservation of the biomedical literature, and

• to ascertain the information needs andinformation-seeking behavior of health scienceprofessionals and the history of medicinecommunity, .is a step toward improving LibraryOperations' products and services

Progress in these areas is described throughoutthis section

Automation of administrative management func-tions throughout IX) continued, with a specialemphasis on assisting secretarial and clerical staffto function moie efficiently In FY 1985, elec-tronic mail became a prevalent means ofcommunication and the use of microcomputers inLO for controlling production, personnel, andbudget data increased substantially

Staff working groups examined currentemployee training and development programs andrecommended improvements in program contentand format and in the distribution of training anddevelopment opportunities These recommenda-tions are expected to lead to several changes incurrent practices Steps have already been taken toconduct microcomputer training classes at theLibrary

22

Collection Development

Collection development encompasses literatureselection policies, identifying and acquiringbiomedical literature in all formats and languages,and processing materials as they are received. TheNLM collection currently contains more than1,786,000 printed volumes and 1,756,000 otheritems, including audiovisual, microforms, prints,photographs, and modern manuscripts. TheLibrary's distinguished collection of rare books,pictures, and historical pamphlets was begun dur-ing John Shaw Billings' tenure as director of theLibrary from 1865 to 1895, and the Library hascontinued to acquire important historical itemssince that time. The rate of acquisition of currentmaterials has increased to keep pace with thetremendous growth in biomedical research andpublication following World War II.

Selection. As many of the Library's services aredependent on the materials in its collection, thepolicies governing which materials are to beacquired affect the scope of information servicesthe Library can provide. In FY 1985, NLMpublished the Collection Development Manual ofthe National Library of Medicine. This publication,which supersedes the Scope and Coverage Manualof the National Library of Medicine published in1977, is the most recent in a series of manualsdeveloped to guide staff in selecting literature forthe NLM collection. The first such manual wasproduced in 1951; new editions have appearedevery five to eight years since that time.

Like its predecessors, the Collection DevelopmentManual attempts to define "scope," or the rangeof subjects to be acquired, and "coverage," or theextent to which each subject is acquired for theNLM collection. It also attempts to clarify and

improve selection guidelines in several areas,including the behavioral sciences and chemistry.The new manual puts more emphasis on areas ofgrowing interest to health professionals, such asdiagnostic imaging techniques, medical informatics,and laboratory animal ethics. In addition toexpanded and restructured scope and coverageguidelines, the Collection Development Manualincludes an overview and history of the NLMcollection; a description of the Library's policiesfor acquisitions, preservation, and collectionweeding; and a statement of the relationshipsamong the collections of NLM, the Library ofCongress, and the National Agricultural Library(NAL). The publication of the new manualrepresents the culmination of a two-year effortinvolving more than 50 NLM staff members, agroup of distinguished outside consultants, and DrFaye Abdellah, Deputy Surgeon General, as Boardof Regents liaison.

The Library's LearningResource Center makesavailable some 15,000audiovisual productionsdealing with variousaspects of health scienceeducation. These materialsmay be used at the NLM orborrowed on interlibraryloan.

Table 1Growth of Collections

Prei'iousCollection Total FY1985 New Total

(Sept. 1984)

Book MaterialsMonographs:

Before 1500 568 0 5681501-1600 5,658 22 5,6801601-1700 9,918 31 9,9491701-1800 23,940 102 24,0421801-1870 39,586 78 39,664Americana 2,327 4 2,3311871-Present 457,379 11,601 468,980

Theses HMD 281,593 187 281,780Pamphlets 172,021 26,891 198,912Bound serial volumes 745,998 39,006 785,004Volumes withdrawn (27,448) (2,618) (30,066)

Total volumes 1,711,540 75,304 1,786,844

Nonbook MaterialsMicroforms:

Reels of microfilm 34,622 557 35,179Number of microfiche 138,578 30,526 169,104

Total microforms 173,200 31,083 204,283Audiovisuals 41,822 1,179 43,001Pictures 75,124 298 75,422Manuscripts 1,240,283 193,101 1,433,384

In FY 1985, NLM made information about the current collecting policies to the automatedscope of the collection available in other ways as compilation of data on U.S. research librarywell. A joint statement was published by NLM and collections maintained by the Research LibrariesNAL clarifying the collection development policies Group.of the two national libraries in the field of Following the publication of the new Collectionveterinary science. The Library also contributed Development Manual, staff began the first of adata about its existing collection strengths and series of collection evaluation and indexing

24

Table 2Acquisition Statistics

Acquisitions

Current serial titles receivedPublications processed

Serial piecesOther

TotalObligations ($) for

PublicationsIncluded for Rare Books

•Revised ligurc

FY 7983

23,470

FY 1984

22,294

FY1985

23,087

127,92725,479

153,406

1,861,48957,610

126,16727,456*

153,623*

2,390,42688,088

125,24327,212

152,455

2,128,787116,154

coverage studies in specific subject areas Theinitial study covers the field of medical infor-matics, defined as the application of computer andinformation science to medicine and healthservices Similar studies are planned for FY 1986in health services research and various aspects ofveterinary medicine

Acquisition, In FY 1985, 36,388 volumes wereadded to the NLM collection and more than152,000 books, serial issues, and audiovisualprograms were received and processed For thefirst time, NLM acquired a limited number ofcomputer software packages on biomcdicalsubjects for the collection, as part of a pilot pro-ject to determine the resources needed to acquireand catalog these items Expenditures for thehistorical collections increased by 25 percentSignificant additions to these collections includedthe archives of the Medical Library Association,additional papers of Julius Richmond, formerSurgeon General of the U S Public Health Service,the Albert and Mary Lasker Foundation Research

Award archives for 1968-80, a manuscript copy ofa 1565 letter from the French diplomat HubertLanguet to the physician Caspar Peucer, relatingthe circumstances of the death of Vesahus, amanuscript letter by Florence Nightingale in whichshe writes of hospital sanitation and administra-tion, a contemporary pencil drawing of the youngFlorence Nightingale by Sir William Boxall, ConradGesner's Historia plantarum et vires ex Disconde,Paulo Aegmeta, Theophrasto, Plimo, et recen-tioribus, Basel, 1541, which enhances the Library'sfine collection of the works of Gesner, and over200 seventeenth century theses

Twenty-seven of the theses were a gift from theDenison Memorial Library of the University ofColorado Health Sciences Center Included in thisgroup was Herman Boerhaave's Doctor ofPhilosophy thesis (1690) on the distinctionbetween the mind and the body There were alsoseveral important additions to the historical filmcollection, and plans were developed forexpanding NLM's collection of medical and health-related posters

25

Table 3Cataloging Statistics

Item FY

Completed catalogingFullLimited

Total

11,3227,126

18,448

FY 1984

11,2436,267

17,510

FY 1985

11,5295,647

17,176

Collection Preservation and Maintenance.Collection preservation and maintenanceencompass such diverse activities as maintaining anappropriate storage environment, promoting safehandling of materials, providing physical orchemical protection to items, and making copiesof items in archival formats. The development of amore comprehensive preservation program for thebiomedical literature is one of four majorobjectives in the Library Operations' strategic planfor FY 1984-88. The earlier chapter in this reporton special initiatives describes a preservation studyand its recommendations.

Regular preservation and maintenance activitiescontinued and expanded during FY 1985: 26,500modern volumes were bound and 470 items werepreserved on microfilm. The bindings for 1,363rare books were oiled and 1,403 pages weremended; 202 rare books were restored and/orrebound. Fifty films in the historical film collectionwere transferred to new film stock. Arrangementswere made to rebind and repair bound manuscriptvolumes. Work continued on transferring NLM'sprints and photographs collection to acid-freefolders.

Another section of compact shelving was

procured according to NLM's plan for providingspace for projected collection growth through theyear 2004, Work was begun on obtainingimproved humidification capacity for some areaswhere library materials are stored. NLM also signedagreements with two commercial firms allowingthem to microfilm certain materials in thehistorical collections for subsequent sale inexchange for a free preservation master of thematerials involved,

Bibliographic Control

Bibliographic control includes the development ofintellectual schemes for organizing the biomedicalliterature by subject, cataloging all types of librarymaterials in the field of medicine and health, andindexing journal articles on biomedical subjects.For over 100 years, NLM has produced catalogingand indexing data for use not only at the Libraryitself, but also by health professionals, researchers,and health science librarians around the world.The creation of intellectual access to the contentof the biomedical literature is one of the Library'smost significant services.

26

Table 4Bibliographic Services

Sendees

Total citations published* . . .For Index Medicus .

Recurring bibliographies .Journals indexed for Index MedicusAbstracts entered . . .

' Includes special list articles, audiotapes, and Health Adminisiranon citations

FY 1983 FY 1984 FY 1985

310,445284,856

242,709

149,851

306,263278,905

242,695

172,153

307,333280,379

232,730

177,000

Thesaurus and Classification. NLM's MedicalSubject Headings (MeSH) is a hierarchicalthesaurus, developed in the late 195()'s and firstused in cataloging and indexing literature receivedby the Library in I960. From an initial list ofabout 4,250 terms, it has grown to its current sizeof 14,411 subject headings and 39,697 chemicalnames. Since its inception, staff have endeavoredto keep MeSH current with developments inmedicine and health and with trends m biomedicalterminology. A total of 183 headings were addedto the vocabulary in FY 1985 Of these, 147 wereentirely new and 36 replaced deleted terms Anadditional 177 headings were deleted Most ofthese represented rarely mentioned chemicals andplants. The chemicals were transferred from theregular MeSH to the chemical subfile Beginningwith the 1986 publication, topical subheadings areinterfiled with main headings in the AnnotatedAlphabetic MeSH in order to make these importantqualifiers more noticeable to online searchers andother users of the thesaurus.

Work proceeded on the project to create amachine-readable "table" to relate MeSH termsused in cataloging to equivalent Library ofCongress Subject Headings (LCSH) and vice versa.

Such a table will make it possible to improve sub-ject searching capabilities in catalog files containingsome records with MeSH and some records withLCSH terms. A machine match of terms in LCSHand MeSH was performed. A total of 4,419 or32% of MeSH terms matched exactly; another 780or 5% were near matches (e.g., singular vs. plural).Staff are now reviewing and matching terms thatcould not be handled by machine. The intellectualwork associated with this project should becompleted in 1986, but it is unlikely that themachine-readable version will be available fordistribution before FY 1987 or 1988.

In addition to maintaining the MeSH vocabularyfor use in subject cataloging and indexing, NLMalso has developed the National Library ofMedicine Classification, a scheme for the shelfarrangement of books by general subject, which isused by biomedical libraries around the world.The first edition of the NLM Classification wasproduced in 1951. It has undergone periodicrevisions since that time, the most recentoccurring in 1981. Any modifications madebetween editions are reported in the Notes forMedical Catalogers, which is published in thequarterly National Library of Medicine Current

27

Catalog and cumulated annually as a separatepublication. The next full scale review of the NLMClassification is scheduled to begin in FY 1987.

Cataloging Cataloging at NLM includes: (1) thecreation of a standard description of each newwork added to the NLM collection—author'sname, title, publisher, date of publication, editionstatement, etc ; (2) the assignment of MeSHheadings to describe its subject content; (3) theassignment of a classification code or shelvingnumber that identifies its principal subject focus;and (4) the maintenance of automated files of theauthoritative forms of names used in catalogingrecords and the cataloging records themselves.

In FY 1985, the Library cataloged 17,176 books,serials, audiovisual programs, and Cataloging inPublication (CIP) galleys. In all, 11,529 receivedfull cataloging, 5,647 items received limitedcataloging. After reviewing acquisitions and staffingpatterns, NLM decided to increase gradually theamount of cataloging and cataloging support doneunder contract, purchase order, and interagencyagreement as part of a long-term strategy toimprove the Library's ability to catalog newlyacquired materials quickly, while reducingbacklogs of uncataloged items. The amount oflimited cataloging for monographs acquired fromoutside sources increased; the first contract foraudiovisuals cataloging was awarded; contractassistance was also obtained for editing records tobe contributed to the CONSER (consolidation ofserials) database NLM also began an experimentalprogram to incorporate cataloging records forindividual programs in the videocassette series,

Network for Continuing Medical Education,supplied by its publisher into AVLINE (audiovisualscataloging on-line file). The majority of the work

to upgrade names in NLM's name authority andcatalog files to the form required by the currentedition of the Anglo-American Cataloging Ruleswas completed under contract. The period ofperformance of this contract has been extended toallow upgrading of additional names used incataloging the historical collections.

NLM continued to make substantial progresstoward the goal of making descriptive catalogingrecords produced by the Library completely com-patible with records produced by the Library ofCongress (LC) and other U.S. research libraries.This will make it easier for health sciences librariesto merge records produced by NLM with recordsproduced by other cataloging agencies. After asuccessful pilot project in FY 1984, NLM becamesolely responsible for the production of descriptivecataloging data for biomedical books covered bythe Cataloging in Publication (CIP) programdirected by LC LC now uses NLM's descriptivecataloging for these items, thus avoiding duplicatework. NLM also expanded its contributions to thenational Name Authority Cooperation (NACO) pro-ject in January 1985 to cover all names used infull cataloging records

The amount of time needed to train newcatalogers and to produce high-quality originalcataloging records is a serious concern for NLMand other major research libraries. The applicationof artificial intelligence techniques to catalogingmay eventually help to solve this problem. In FY1986, NLM,LC, and NAL will examine the pros-pects for joint research on an expert catalogingsystem.

Indexing. Indexing at NLM is the creation of arecord for each article in an indexed journal. Therecord includes a description of the article (itsauthor's name, title, pagination), issue information

28

for the journal in which it appeared, and anumber of MeSH terms assigned to describe indetail the subject content of the article

During FY 1985, the consultants who adviseNLM on the selection of literature for IndexMedicus reviewed and rated 297 journals Ofthese, 57 were accepted for inclusion in IndexMedicus The consultants also reviewed currentlyindexed journals in the French language and on .the topics of orthopedics and substance abuseNine of these journals were dropped eitherbecause they had ceased publication or were con-sidered to have limited value for Index Medicususers At the end of the year, there were 2,730titles being indexed for Index Mednus and a totalof 3,690 titles represented in MEDL1NE, the HealthPlanning and AdministrationFile, and POPL1NE

A total of 307,333 citations for indexed articleswere added to MEDL1NE in FY 1985 Of these,280,379 citations were published in IndexMedicus Abstracts were added to the MEDLINEfile for 177,000 or 59% of the citations added tothat database Of the articles indexed for IndexMedicus this year, 24% were indexed by NLMstaff, 9% directly by foreign MEDLARS centers orthrough arrangements made by them with U Scommercial firms, and 67% by NLM contractorsThe Chinese Academy of Medical Sciences beganindexing all Chinese Index Mediae |ournals inJanuary 1985

The online indexing system continued tofunction well for mhouse mdexers, and use of thesystem was extended to contract mdexers workingin the local area If communications problems canbe resolved successfully, the online indexingsystem will also be made available to contractmdexers at more distant sites

Network Services

NLM's services to remote users throughout theU S include (1) distributing its authoritativecataloging and indexing data in publications,machine-readable formats and an online searchservice, (2) answenng telephone referencequestions and reference correspondence,(3) sending documents or copies of documentsneeded by U S health professionals andresearchers, and (4) directing the Regional MedicalLibrary Network, which links U S biomedicallibraries in an effort to make quality biomedicalinformation services available to all health profes-sionals irrespective of their geographic location

Publications The Library first began publishing itscataloging and indexing data in a systematic wayin the 1870's The Catalogue of the Library of theSurgeon General's Office appeared in 1872 Thefirst issue of Index Medicus appeared in 1879, tobe followed in 1880 by the first volume of theIndex-Catalogue of the Library of the SurgeonGeneral's, Office In 1964, the Library introducedMEDLARS (Medical Literature Analysis andRetrieval System) which included the firstpublication-quality computerised phototypesettmgcapability and greatly improved NLM's ability topublish its indexing and cataloging data in a timelyfashion Today NLM produces some 85 individualissues of various bibliographic tools on eitherpaper or microfiche, including Index Medicus,National Library of Medicine Current Catalog theNational Library of Medicine AudiovisualsCatalog, the Bibliography of the History ofMedicine, the 1984 Index of NLM Serial Titles theMedical Subject Headings, and several specialisedrecurring bibliographies NLM collaborates withother organisations such as the AmericanHospital

29

The Library's catalog isavailable topatrons onlinethrough a user-friendlyprogram developed at MM.

Association, the American Dental Association, andthe American Journal of Nursing Company to pro-duce some of these specialized indexes Probablythe best seller is Index Medicus, NLM's majorindex to 2,730 biomedical journals, which hadmore than 5,200 subscribers in FY 1985.

An important new publication which willbecome available in October 1985is themicrofiche NLM Catalog, including records forapproximately 575,000 books, serials, and modernmanuscripts cataloged by NLM before 1985. Aquarterly microfiche NLM Catalog—Supplement,covering cataloging records produced from 1985to the present also will begin publication in FY1986.

In addition to its catalogs and indexes, NLM alsopublished several Literature Searches on specifictopics of current interest, such as child abuse,

financing health care for the elderly, and acquiredimmunodeficiency syndrome (AIDS). The LiteratureSearch on AIDS is updated quarterly to make thelatest research results more readily available toinvestigators in this field. More than 72,000 copiesof various Literature Searches were distributed byNLM in FY 1985. Health professionals may nowrequest Literature Searches directly through GTEMEDMAIL.

In FY 1985,the 1984 Cumulated Index Medicusand the annual 1984National Library of MedicineCurrent Catalog were printed on more permanent"add-free" paper This is part of NLM's effort toreduce the future cost of preservation of thebiomedical literature by encouraging publication inmore durable media

From time to time, new editions of uniqueitems in the NLM collection are published by

30

other organizations. In 1985, an edition of an1839 William Budd manuscript from the NLM'smodern manuscripts collection was published byJohns Hopkins University Press. The work, entitled"On the Causes of Fevers," was edited by Dr.Dale C. Smith.

Machine Readable Databases. Almost as soon asNLM's indexing and cataloging data wereautomated, the Library began to make these dataavailable to other organizations in machine-readable form. Beginning in 1964, tapes ofMEDLARS indexing records were made available toseveral U.S. institutions to support the decentraliza-tion of the MEDLARS demand search program. In1966, the British Library became the first foreigninstitution to mount the MEDLARS tapes andprovide search service to the internationalcommunity. From these beginnings, NLM's tapedistribution service has grown to include thedispatch of 2,000 tapes of various databases to 31domestic and foreign licensees each year.

NLM is continuing efforts to ensure the broadestpossible availability of its databases. In FY 1985,the Library began to distribute subsets of theMEDLINE database to U.S individuals and institu-tions; by the end of the year there were eightsubscribers to this service The Library alsodeveloped a new policy to permit domesticlicensees to redistribute portions of the file subjectto certain conditions and restrictions NLMhasentered into agreements with several commercialfirms to allow them to produce compact diskcopies of MEDLINE data on an experimental basis.

In order to make its cataloging records easilyusable by the library community, NLM distributesthem in standard MARC (Machine ReadableCataloging) format. In FY 1985, NLM's audiovisualcataloging records became available in this formatfor the first time. All NLM cataloging records are

Table 5Online Searches

Online Databases

AVLINKBIOETHICSCANCERLITCANCERPROJCATLINECHEMLINECLINPROTDIRECTORYDIRLINEEPILEPSYLINEEXPRESSHEALTHHISTLINEHSDBINFORMINTOXINTROMEDMEDLINE

MEDHOMED79MED77

MEl)71>MED71MED66

MESH VOCABULARYNAME AUTHORITYPDQ-ElhillPDQ-User Friendly SystemPOPLINERTECSSDILINESERLINESTORED SEARCHTDB-ELHILLTDB-ToxnetTOXLINE

TOXBACK76TOXBACK74TOXBACK65

TOTAL

FY 198}

19,0504,047

45,7393,099

250,72940,880

3,166420

1,389326

1,08781,289

4,460

951,582

28,482193,79667,47846,211.30,14520,46916,528

7,124

18,65217,57818,61948,941

4919,737

67,381

11,651411

2,020,515

/T 1984

11,3.394,580

48,6641,797

156,91432,614

2,405840

2,446

1,76190,140

4,17.3

47

7191,199,482

247,046

I89,()7790,64462,79945,50012,1415,3224,7241,949

19,4868,512

25,97929,887

897,470

75.1902,889

11,5188,246

2,406,389

FY 1985

11,1555,392

51,5821,875

138,81828,459

3,37850

2,758

1,17399,666

3,7664,999

I I 7

2924,906

1,282,755.353,978

153,88686,75857,98545,59810,0834,4991,426

19,74225,58810,5.3528,85630,307

888,849

37271,95920,216

14,158

2,586,024

31

Table 6Offline Searches

Online Databases

AVLINEBIOETHICSCANCERLITCANCERPROJCATLINECHEMLINECLINPROTDIRLINEEPILEPSYLINEEXPRESSHEALTHHISTLINEHSDBMEDLINE

MEDHOMED79MED77MED75MED72MED7IMED69MED66

MESH VOCABULARYPOPLINERTECSSDILINFSERLINETDB-ElhillTOXLINE

TOXBACK7()TOXBACK74TOXBACK6S

FY I98J

1041H

5,09531

H714713

207,147

3

26,771

8,97235,90631,212

8,41315,5015,966

14,1666

6,342124

197,76210

11718,591

4,4104,984

TOTAL 391,833

r !<)84

32065

5,76610

3332058

659,997

9

26,62825,803

29,61021,817

15,432

10,4628

9,6H8124

218,11015

10317,097

1 1 12,2631 ,996

395,865

FY /<W5

27819

5,98918

3578163

3511,664

50

19,94926,653

21,OHO16,379

10,309

7,631r

12,804248

228,0392

24317,2301,370

1,164

381,573

now available in MARC. NLM also intends todistribute MeSH in MARC format after theMEDLARS III subject authority module isimplemented m FY 1987 or 1988.

Online Services. The precursor to NLM's onlinesearch services, the MEDLARS batch searchservice, was implemented in 1965. General onlineaccess to MEDLARS data began in 1971 with theadvent of MEDLINE, the first public online fileaccessible through a national telecommunicationsnetwork. The original MEDLINE file containedcitations to recent articles in a subset of thejournals in Index Medicus. From that beginninghas evolved NLM's current online services whichinclude 27 different databases and 4.75 millionMEDLINE citations from 1966 to the present.

Currently, there are 3,621 domestic institutionsand 630 individuals with access codes to theNLM's MEDLARS system The number ofindividual health professionals and researchersusing the system increased 326% during FY 1985,due in large part to the many special trainingclasses in online searching for health professionalsconducted by librarians throughout the countryusing materials prepared by NLM. NLM's TheBasics of Searching MEDLINE. A Guide for HealthProfessionals was published in 1985 and isavailable through the National Technical Informa-tion Service (NTIS).

The average monthly connect hour usage ofMEDLARS files was 19,613 hours, 2.5% higherthan the average monthly usage in FY 1984. Thetotal annual usage of NLM's MEDLARS system was235,360 connect hours. The MEDLARS databasesare also heavily used on the systems of other U.S.database vendors and foreign MEDLARS centers,which lease copies of certain NLMfiles.

In FY 1985, NLM extended the hours of

32

availability for the online system to around-the-clock service, seven clays a week The monthlyminimum charge for each online access code wasdiscontinued, users are now charged only foractual system usage The new user-friendlyTOXNET system, which provides access tochemical, toxicological, and ha/ardous waste data,became available to all users of NI.M s MEDLARSsystem

Approximately 1,080 people received training insearching NLM databases in the 46 regular classesand 4 special classes held to prepare searchers toteach MEDLINE to health professionals in FY1985 LO staff conducted 19 classes at NLM and 5in other locations in the United States UCLA andthe University of Nebraska, two RegionalMedicalLibraries which provide online search training forMEDLARS databases under contract to NLM,conducted 22 classes Health sciences librariansthroughout the country also taught many specialonline searching classes for health professionals

Reference Assistance In FY 1985, NLM respondedto 26,318 reference inquiries received viatelephone or mail Requests may be tor specificfacts or information on a health related topic ofcurrent interest, for recommendations ofaudiovisuals or other materials appropriate for aspecific educational purpose, or for .1 fullerdescription of certain films, pictures, manuscriptsor books in NLM's extensive historical collectionsMany requesters are unaware of the biomedicalinformation resources available locally or of thevarious information clearinghouses operated byother federal agencies In addition to providingsome information to answer the immediatequestion, NLM staff also direct people to otheragencies that can be of assistance NLM alsoresponds rapidly, usually the same dav, to a

variety of special information requests frommembers of Congress, the Supreme Court, theOffice of the President, the Secretary of theDepartment of Health and Human Services, andother federal agencies

Document Delivery The Library began lendingitems m its collections to distant libraries andphysicians on a regular basis in the 1870's By1885, the number of borrowers outnumberedactual visitors to the Library In 1940, the docu-ment delivery service was enhanced when theLibrary began to offer microfilm copies of someitems in its collection The first paper copies orphotoprints of library materials became available in1946 As demand for copies of journal articles mthe NLM collection increased, the Library installedmoveable cameras in the journal stack areas in1962 so that articles could be filmed quicklywithout transporting materials away from theshelves The film was then developed in theLibrary and paper copies printed from it fordelivery to requesters The mobile camerasremained in operation until 1980, whenphotocopiers that could be easily moved onwheeled carts became available to the Library

The introduction of MEDLINE In 1971 made itmuch easier for physicians and researchers to iden-tify articles of interest and caused the number ofrequests for biomedical documents to increasedramatically nationwide Fortunately, the RegionalMedical Library program provides support tohealth sciences libraries for responding to theincreased demand and helps distribute the requestload efficiently among these libraries and NLM

In FY 1985, NLM filled 109,304 requests formterlibrary loans or photocopies of books andjournal articles, 89% were filled within four daysof receipt NLM's loan service was expanded to

33

Table?Circulation Statistics

Activity FY

Requests Received: 395,957For Interlibrary Loan 216,536For Readers 179,421

Requests Filled: 332,478For Interlibrary Loan 169,501

Photocopy 159,583Original 9,918

For Audiovisual Loan 5,087'For Readers 157,890

Requests Unfilled: 63,552Interlibrary Loan 41,941

Rejected 14,167Referred 3,718Returned as Unavailable 24,056

Reader ServiceReturned as Unavailable 21,611

FY 1984

358,654147,017211,637

299,681109,257102,7236,5344,183'

186,241

54,73733,57712,5721,97519,030

25,160

FY 1985

390,058144,346245,712

327,125109,304102,6986,6061,545

216,276

57,34727,91110,3661,504

16,041

29,436

'Includes videocasscttcs loaned by the Audiovisual Rcv)urces Secnon and motion pictures circulated from an off-site contract facilitydirectly to individuals for educational use Beginning in FY 1985, all audiovisual programs in the NI.M collection are available forloan, and the contract for motion picture distribution has been discontinued

cover all audiovisual programs in the NLM collec-tion; over 1,500 audiovisuals were loaned duringthe year. When requests are received for documentsnot available in the NLM collection, the Library mayrefer these requests to other institutions that ownthe requested items. Since 1973, NLM has beenreferring requests it cannot fill to the British LibraryLending Division. During FY 1985, NLM also madearrangements to refer unfilled requests in particularsubject areas to the Asa S. Bacon Memorial Libraryof the American Hospital Association, the AmericanJournal of Nursing Company, and the National

Agricultural Library (NAL).NLM's automated support to document delivery

activities was improved substantially during FY1985. The new DOCLINE system, NLM'sautomated document request and referral system,became available for use by health scienceslibraries throughout the country. One hundredthirteen network libraries were using the system atthe end of FY 1985; during FY 1986, the RegionalMedical Libraries will assist NLM in extending theuse of DOCLINE to many more U.S. healthscience libraries. DOCLINE is linked to MEDLINE,

34

CATLINE, and AVLINE to facilitate generatingrequests It uses data in SERHOLD, NLM's com-puterized serials holdings database, to identifywhich libraries own requested journal articles andto route the requests to those libraries automati-cally SERHOLD now contains more than 700,000holdings statements for some 1,750 t1 Sbiomedical libraries It is also used to generateRegional Union Lists Other efforts to enhanceautomated support for document delivery serviceincluded expansion of the number of electronicmail systems from which NLM accepts documentrequests and a test project to receive documentrequests via OCLC In FY 1985, NLM used tele-facsimile equipment to fill three emergencyrequests from hospitals to provide articles relatedto critical patient care problems NLM intends totest broader use of telefacsimile for documentdelivery in FY 1986

Regional Medical Library Program The MedicalLibrary Assistance Act of 1965 was a response to agrowing concern that the nation's medical librariesdid not have the organization, resources, andfacilities needed to ensure that the results ofmedical research were communicated to healthprofessionals in every area of the country The Actauthorized NLM to use grant funds to assist U Smedical libraries in a variety of ways, including theestablishment of Regional Medical Libraries tocoordinate a network of biomedical libraries andto act as back-up service centers for other healthsciences libraries m particular regions In 1967, theFrancis A Countway Library at HarvardUniversitywas awarded the first Regional Medical Librarygrant From 1968 to 1970, grants were awarded tonine other institutions to serve as Regional MedicalLibraries There were 11 Regions in all, NLM itself

served as the Regional Medical Library for RegionIV In 1971/72, the Regional Medical Libraryawards were converted from grants to contracts toallow for greater national coordination of thenetwork

Initially, the Regional Medical Library programserved as a vehicle for partially subsidizing thecosts incurred by one library in filling an inter-library loan request for another This encouragedthe development of more efficient hierarchicalpatterns for referring loan requests throughout thecountry and of national standards for handlingrequests Once the mterlibrary loan program wasoperating effectively, the amount of the subsidywas gradually reduced until it was eliminated in1976 In 1982, regional boundaries were recon-figured to reduce the number of Regions from 11to 7 This change was made to reduce the amountof administrative overhead for the program andmake a larger proportion of funds available fornetwork services New three-year Regional MedicalLibrary contracts were awarded to seven institu-tions in 1982/83 At that time, NLM ceased toserve as a Regional Medical Library in order toconcentrate its resources on serving as a nationalbackup for the system

Today, approximately 2,000,000 requests forjournal articles, books, and audiovisual programsare filled for health professionals by libraries in theRegional Medical Library Network each year TheRMLs themselves fill 112,000 requests annually,NLM, as national backup, filled almost 111,000requests in 1985 The Regional Medical Librariesalso develop outreach services to health profes-sionals in areas without adequate library services,promote resource sharing among health scienceslibraries, encourage and support use of onlineservices within their regions, and provide trainingand consultation to hospital librarians to improve

35

Region •>University of Illinois atChicago Library of theHealth Sciences

Region •)University of TexasHealth Science Centerat Dallas

Region 7

UCLA Biomedical Library,Center for theHealth Sciences

36

Region 2University of MarylandHealth Sciences Libran

Region -tUniversity of NebraskaMedical Center Library

Table 8Reference Services

1-7

Reference SectionRequests by telephone.Requests by mail . . .Readers assisted . . . .

Total

Audiovisual Resources SectionRequests by telephone. .Requests by mail . .Readers assisted

Total

Total reference service

Reading Room users registered

'Adjusted HHIIFC

information services to health professionalsIn FY 1985, the rccompctition of the RML

contracts for the period 1986-90 began. Initialtechnical and budget reviews were completed forall proposals received. The contracts will beawarded between October 1985 and January 1986The new RML services contracts will place greateremphasis on cooperative collection developmentand preservation activities, while continuing docu-ment delivery and information access programs.

15,157386

42,318

2,300220

i,643

62,5(H

23,0%

FY 1984

20,069527

39,255'

59,851'

2,4731,579

383

4,435

64,286'

26,273

FY 7985

21,746512

42,176

64,434

2,4721,588

385

4,445

68,879

27,579

Onsite Services

NLM provides a variety of services for people whocome to the Library in Bethcsda These servicesinclude reference and research assistance, access tomaterials in the collection, guided tours andbriefings on NLM's services and operations, andspecial programs related to the history ofmedicine. NLM also directs a special one-yearonsite training program for library schoolgraduates with high potential in the health scienceslibrary/information field

38

Table 9History of Medicine Activities

AcquisitionsB o o k s . . .Modern manuscripts .Prints and photographs

ProcessingTitles cataloged . .Modern manuscripts catalogedPictures cataloged .Citations indexed .Pages microfilmed .

Public ServiceReference questions answeredILL and pay orders filledReader requests filledPictures supplied

FY 1983

25346,313

346

2,3782,5755,2362,209

FY 1984

27133,024

459

FY 1985

438193,101

298

86251,353

1886,178

103,930

34936,2091,4366,00080,817

32691,304

1634,95494,594

2,6592,1185,0612,627

3,9032,0424,9813,252

Reference and Research Assistance Since the187()'s the Library has been available to anyresearcher who wished to make direct use of itscomprehensive collection and services. In FY1985, a record number of people came to NLM touse its two Reading Rooms and Learning ResourceCenter. These visitors requested thai 245,712books, journals, and audiovisual programs beretrieved from NLM's closed stacks, 16% morethan the number of items requested last year.Onsite users also asked 68,589 reference questionsand received the results of 3,670 online searches.Use of NLM's collection of modern audiovisuals,historical films, and picture collections continuedto grow.

During FY 1985, an improved version ofCITE/CATLINE, NLM's prototype online catalog,became available to the public, and plans toremove the card catalog from the main publicservice area were developed and approved. Thespace vacated by the removal of the card catalogwill be used for a combination of reference serv-ice and exhibits In a complementary project, staffprepared plans to redesign, recarpet, and refurnishthe main Reading Room. The two areas will berenovated in early FY 1986.

Public Tours During FY 1985, LO staff conducted158 regularly scheduled tours for a total of 591visitors. Of these, 24% were students, interns, or

39

Aspan of its History ofMedicine Division, theLibrary has a collection ofsome 70,000prints, photo-graphs, and other graphicrepresentations related tothe history of the healthprofessions.

residents; 24% were librarians or others associatedwith the information science field; 13% werehealth professionals; 8% were NLM or NIH staff;18% were foreign visitors; and 13% belonged toother categories. Another 1,100 (104 groups)received special programs and tours arranged bythe Office of Inquiries and Publications Manage-ment (Office of the Director). Many individualvisitors also received special briefings on libraryprograms and services.

Special Historical Programs NLM's new VisitingScholar Program was initiated during FY 1985.Under this program, each year a recognizedhistorical scholar is invited to spend from 6 to 12months at the Library. Scholars are expected toengage in research that will use the NLMhistorical

collections extensively. They are also available torstaff consultation, for one or more public presenta-tions, and for assessing segments of the collection

Dr. Thomas Hall participated in the prototype ofthe Visiting Scholar Program in 1985. Dr. Hallused the NLM's collections for his research on theinfluence of Descartes on medicine and delivered apublic lecture at NLM on "Physiology and theKuhnian Hypothesis — Evolution or Revolution"on June 3. Dr. James Harvey Young is the firstcompetitively selected Visiting Scholar. He willcome to the Library in FY 1986 to pursue hisresearch on the history of the Food and DrugAdministration. NLM has also contracted with Dr.Morris Collen to write a history of medicalcomputing using materials available at NLM andelsewhere and to advise the Library on importantdocuments to acquire in this field

The responsibilities of some staff in NLM'sHistory of Medicine Division include researchusing NLM's historical collections. Staff researchwas published in several publications and alsopresented at invited lectures during the year. Theseries of internal seminars given for History ofMedicine staff by staff and other scholars using theNLM historical collections continued in 1985.

Services to NIH and NLM Staff. NLM providesspecial support to some National Institutes ofHealth (NIH)programs, although the NIH Libranhas the primary responsibility for library and infor-mation services to NIH employees. LibraryOperations' staff prepare Literature Searches fordistribution to the participants in many of the NIHConsensus Development Conferences and providePublic Health Service officials with up-to-dateinformation on publications dealing with acquiredimmunodeficiency syndrome (AIDS) throughspecial monthly supplements to the quarterly

40

Literature Searches on AIDS. The NIH Libraryrelies on NLM's Learning Resource Center to pro-vide audiovisual services to NIH employees.Library Operations' staff members also serve onadvisory committees to the NIH Library, asadvisors to public information clearinghousesoperated by various institutes, and on specialcommittees formed to address high priority healthissues

A Staff Library is maintained to a.ssist NLMemployees in obtaining the information needed tomeet their various job responsibilities. In FY 1985,a microcomputer support center was added to theStaff Library facilities, online search and inter-library services were expanded, and a newbrochure describing Staff Library policies andservices was issued.

NLM Associate Program The Library's first post-graduate training program for health scienceslibrarians ran from 1957 to 1964. After a briefhiatus, the program was restructured andreinstituted in 1966 as the NLM Associate Program,which has continued to the present The one-yearcompetitive program provides three to six libraryschool graduates an opportunity to learn about thefull range of activities performed by NLM andother health sciences libraries, to use the latestinformation technology, and to develop their skillsthrough the conduct of special projects Associatesalso visit various types of health scienceslibraries/information centers and other nationallibraries and attend professional meetings.

Since 1966, a total of 88 people haveparticipated in the Associate Program Of these, 81percent are still in the library and informationfield. Thirty-two percent are currently employedby NLM, including several who have left theLibrary to work in other health sciences libraries

and later returned. Thirty-three percent are nowworking in other health sciences libraries; 8% inother types of libraries; and 8% in other aspectsof the information field. Five Associates completedthe program in August 1985; three new Associatesbegan their year at NLM in September 1985. In FY1986, NLM will offer an international traineeshipfor one librarian from outside the United States toparticipate in the NLM Associate Program. In thisarrangement, NLM will provide the training, butwill not assume the cost for the trainee's travel orstay in the U.S.

41

NLM inthe headlines . . .

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42

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43

Specialized Information ServicesHenry M. Kissman, Ph.D.Associate Director, Specialized Information Services

IntroductionThe field of toxicology, barely recognized as adistinct science 25 years ago, has grown at anunprecedented rate and has generated large quan-tities of data and information. The public interestin toxicology as a social concern and the resultantlaws and regulation have fueled—and have beenfueled by—extensive testing and research.Technological innovations in computers andcommunication, advancing at a rate no less thantoxicology information, have resulted insophisticated systems for collecting, organizing,and distributing this information. From the earlydays of toxicology to the present, the NationalLibrary of Medicine through its Toxicology Infor-mation Program operated by the Division ofSpecialized Information Services, has been a leaderin providing the toxicology community withreadily accessible qualityinformation.

Established in 1967, the Toxicology InformationProgram (TIP) is a direct outgrowth of the recom-mendations made by the President's ScienceAdvisory Committee in 1966 which found that"there exists an urgent need for a much morecoordinated and more complete computer-basedfile of lexicological information than any currentlyavailable and further, that access to this file mustbe more generally available to all those legitimatelyneeding such information." The TIP was createdto meet these needs. It continues to search forinnovative ways to provide toxicology informationservices to its growing user community.

Over time, TIP has concentrated on providingthree types of services: publications, queryresponse services, and online retrieval. TIP's earlyefforts were directed to publications and queryresponse while it investigated the rapidly changingcomputer and telecommunication technologies as

means of designing automated toxicology informa-tion systems. Ultimately, interactive online retrievalservices were to play—as they still do—the majorrole in TIP's activities. Following NLM's pioneeringlead in developing MEDLINE, the earliest signifi-cant online bibliographic retrieval system, the TIPin 1972 unveiled TOXLINE, the first onlineretrieval service for the toxicology literature. Thesame year saw the development of CHEMLINE, anonline chemical dictionary that facilitated thesearching of TOXLINE and other informationsources

In the late 1970's, TIP made publiclyavailabletwo toxicology data retrieval systems, the TDB(Toxicology Data Bank) and RTECS (Registry ofToxic Effects of Chemical Substances). TDB isbuilt and maintained by the TIP. RTECS isproduced by the National Institute for Occupa-tional Safety and Health as a publication and ismaintained as an online service on the NLMMEDLARS network. The most recent of TIP'sonline services are DIRLINE (Directory of Informa-tion Resources Online) and HSDB (HazardousSubstances Data Bank) Other major TIPdevelopments have been the creation of TOXNET(Toxicology Data Network), a new integrated soft-ware system which facilitates the building andsearching of factual databases, and micro-CSIN,which permits and assists the rapid retrieval ofinformation from a variety of disparate onlinesystems.

Throughout its history, the TIP has maintained alinkage to the toxicology community throughTIPCOM (Toxicology Information ProgramCommittee), an advisory committee, which hasbeen operated for the Library by the NationalAcademy of Sciences (NAS). Through the years,TIPCOM has been staffed by some of the leadinglexicologists in the United Stales. Many of these

44

scientists have also been active in the Society ofToxicology and other professional groups, and,thus, have been able to keep close track of theinformation needs of toxicology and related fields.

This year, as part of its long-range planningeffort, TIPCOM has recommended that NLMinvestigate the adequacy of information handlingin the burgeoning field of biotechnology. Areasthat might require attention are nomenclature,linkage among sequence data banks, and currentstrategies for capturing information and data fromthe biotechnology literature for subsequent searchand retrieval. In response to these recommenda-tions, NLM will support a National Academy ofSciences Workshop on BiotechnologyNomenclature and Information Organization inMay 1986.

Online Services

As mentioned, TIP is responsible for several ofNLM's online services such as CHEMLINE,TOXLINE, RTECS, DIRLINE, TDB and HSDB.Prior to this year all the TIP-managed onlinedatabases operated under the NLM ELHILL soft-ware. With the advent of TOXNET, some of thesefiles are now accessible through it, while othersremain in the ELHILL system,

I. Databases under ELHILL

CHEMLINE (Chemical Dictionary Online) is anonline chemical dictionary and directory file whichallows users to verify chemical nomenclature andstructure, and to formulate optimum searchstrategies for other NLM files, Each chemicalrecord also has pointers to these other files which

may contain information about that substance.CHEMLINE is built and maintained in collaborationwith Chemical Abstracts Services (CAS). It isupdated bimonthly and regenerated annually, andnow contains over 650,000 records.

During FY 1985, efforts continued to improveCHEMLINE to meet the changing needs of itsusers. An important tool to accomplish this was aquestionnaire-based survey of 1,390 users ofonline chemical databases, including CHEMLINE.Respondents indicated general satisfaction withCHEMLINE, but also identified changes that mightfurther assist users. A final report on the surveyand its results is being prepared for publication.

A major augmentation to the nomenclaturecoverage of CHEMLINE was the addition of some14,800 drug names, taken from the publicationUSAN and the USP Dictionary of Drug Names, toover 5,500 CHEMLINE records. These data wereobtained through an agreement with the UnitedStates Pharmacopeia! Convention. The project ofadding ring structure information to records forcyclic compounds in CHEMLINE was continuedwith the enhancement of 9000 records.

TOXLINE (Toxicology Information Online) is anonline bibliographic retrieval service, produced bymerging "toxicology subsets" from some elevenother secondary sources, including BiologicalAbstracts, Chemical Abstracts, Government ReportsAnnouncement and Index (report literature),International Pharmaceutical Abstracts and IndexMedicus. TOXLINE and its two backfilesTOXBACK76 and TOXBACK65 now contain some1,770,000 records.

Three new subfiles were added to TOXLINEthis year. These were subsets from the HazardousMaterial Technical Center Abstract Bulletin (aDefense Department-sponsored project), CIS

45

Abstracts (from the U N 's International LabourOrganization), and from CRISP (Computer Retrievalof Information on Scientific Projects), the NIHgrants information database Another major enrich-ment of TOXLINE was initiated by a change inthe contract with BIOSIS through which NLMobtains material from Btologtcal Abstracts Inputfrom this source will triple to about 37,000records per year with increased coverage in theareas of occupational exposure to chemicals,disposal methods, and environmental effects ofchemical waste dumps

RTECS (Registry of Toxic Effects of ChemicalSubstances) This online data retrieval service isbased upon a database which NLMobtains fromthe National Institute for Occupational Safety andHealth This year, NLM enriched this file byadding Chemical Abstracts Service (CAS) RegistryNumbers to RTECS records which did not havethem These identification numbers are crucial forunequivocal data retrieval and for matching RTECSrecords with those in other fields Some 4,700records were enhanced in this way, another14,000 remain to be processed RTECS now con-tains some 76,000 records.

DIRLINE (Directory of Information ResourcesOnline), an onbne directory which refersMEDLARS users to organizations and other sourcesthat can provide information in specific subjectareas, has been available as one of the NLM onlineservices since August 1984 At present, DIRLINEreceives records from the Library of Congress'National Referral Center (NRC) database and fromDHHS' National Health Information Clearinghouse(NHIC) database The NRC component containssome 14,000 records while the NHIC file hasapproximately 950 records

II TOXNET and its FilesTIP1!) major file building and enrichment effortsthis year continued to be supported partially withSuperfund resource,s Superfund—or CERCLA(Comprehensive Environmental Response,Compensation, and Liability Act of 1980)—charged the Depjrtment of Health and HumanServices with certain responsibilities for thecleanup of abandoned chemical dump sites andresponses to accidents involving hazardouschemicals The lead agency in the Department forSuperfund-related activities is the Agency for ToxicSubstances and Disease Registry (ATSDR) Relevantinformation activities, such as file building andcreation of improved access methods to informa-tion resources, are carried out by NLM under anagreement with ATSDR The predominant TIPactivity supported by Superfund has been anenhancement of its data retrieval service, TDB,which involved among others, the development ofTOXNET, a new file building and online searchsystem

It is best to describe these efforts by startingwith TOXNET This system, developed jointlywith the Lister Hill Center, became fully opera-tional and publicly available to domestic MEDLARSusers on July I , 1985 TOXNET, operating on aData General minicomputer in a contractor facility,consists of modules tor online file building, reviewand editing, electronic mail/messaging, in-processcontrol/tracking and online search and retrievalSeveral contractors build TOXNET files online,while reviewers at a variety of sites inspect thefiles and recommend changes online The NLMMEDLARS user can search TOXNET in a querylanguage that appears very similar to ELHILL whileoffering enhanced capabilities An even more userfriendly access system, using menus, is being

46

designed for the novice or occasional userIn addition to the NLM TOXNET file described

below, the CCRIS (Chemical CarcmogenesisResearch Information System) file of the NationalCancer Institute, is expected to be mounted inTOXNET early in FY 1986 Later in the year,RTECS will be moved from ELHILL to join theother TOXNET data files TOXNET will eventuallycontain a cluster of toxicology data banks and willaccommodate cross-file searching

TDK (Toxicology Data Hank) is an online inter-active data retrieval service focusing on the toxico-logical properties of selected chemical substancesTDB now contains over 4,100 records, eachconsisting of 96 data elements This file is anexpanded version of the discontinued ELHILL/TDBand has, itself, been used as a starting point todevelop the even more extensive HSDB (seebelow) As stated, both TDB and HSDB filebuilding and enrichment have been partiallysupported by Superfund

In line with the changes in scope and coverageof the TDB, it became necessary to restructure the10-year old review mechanism for the TDB At thesame time, the NIH Division of Research Grants,which operated the TDB Peer Review Committee(PRC) for NLM, recommended that the Libraryreplace this committee with a new mechanism forreviewing file content Accordingly, the PRC wasdissolved in June, 1985 A new scientific reviewpanel appointed by NLM and operated by acontractor, will be in place in October 1985 Itwill be cofunded by the Department of Defense(DOD) and will review TDB and HSDB content aswell as some material from the DOD-sponsoredHa/ardous Material Technical Center

HSDB (Hazardous Substances Data Bank) isanother online data retrieval system At this time itdescribes the same 4,100 records that are con-tained in TDB Each record has 144 data elementsThe scope of HSDB includes and expands uponthat of the TDB by providing fuller informationprimarily in the areas of environmental fate andexposure, standards and regulations, monitoringand analysis, and safety and handling Data areextracted from TDB source materials as well asfrom various other sources, such as Governmentdocuments and material safety data sheets HSDBis edited and then scientifically reviewed by thenew scientific review panel

INTROTOX, a small subset of the HSDB file,was created as a practice file to allow users toexperiment with searching the TOXNET system ata reduced rate

User Support for the online files is an ongoing TIPfunction The manual and pocket cards for theTOXLINE and CHEMLINE services were revisedand a videocassette describing the entire Toxic-ology Information Program was produced Aspecialized training program was initiated at profes-sional meetings of technical societies such as theAmerican Chemical Society and the Society ofToxicology This training is provided in conjunc-tion with the meeting exhibit program, to acquaintpotential users with the toxicology informationservices of NLM A microcomputer demonstrationdiskette to introduce prospective users to theonline services was developed

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Information Services to Other Agencies

The Toxicology Information Program continues toprovide information services to several otherFederal agencies and to chair two mteragencycommittees

Collaboration with the Agency for Toxic Substancesand Disease Registry (ATSDR) ATSDR—a unit ofthe Centers for Disease Control—is the leadagency for Superfund activities in DHHS, allSuperfund-related NLM activities proceed under anmteragency agreement with this agency Some ofthe major file enrichment activities carried outwith partial Superfund support already have beendescribed and so has the development of the filebuilding and online access capabilities representedby TOXNET Another project in this cluster is thedevelopment of a microcomputer workstation forchemical emergency response information

Since 1983, TIP, in collaboration with the ListerHill Center and ATSDR, has worked on amicrocomputer workstation designed to permitrapid retrieval of information located in a varietyof different online databases in different vendorsystems It will be used in chemical emergenciessuch as spills or fires This workstation, based ona software system called micro-CSIN (i e , themicrocomputer version of the Chemical SubstancesInformation Network), was first implemented andtested last year in a CODATA microcomputer Thisyear, the system was rewritten in the C languagefor the much more widely available IBM PC XTand AT microcomputers

The workstation will assist individual searchers,from beginners to experts, to use most onlineinformation sources effectively Extensive helpmessages underlie all of the micro-CSIN menusand options Pre-programmed searches—called

scripts—make certain types of searches such asthose for the toxic effects of a chemical, runalmost automatically Three such scripts, CHEMID(chemical identity), TOXCHEM (toxic effects) andBIBLIO (general bibliographic) have now beenimplemented and can be used in accessing andsearching a variety of services including those ofNLM, System Development Corp, BRS,CASONLINE and the Chemical Information System(CIS) The workstation is now being field-tested byATSDR and by several other Government andindustrial organizations

As another Superfund-supported function, theProgram furnishes information support in the formof on-demand literature searches to the inter-agency Hazardous Waste Information EvaluationSubcommittee

Interagency Subcommittees NLM through the TIPcontinued to chair the Toxicology InformationSubcommittee (recently renamed Subcommittee onInformation Coordination) of the DHHSCommittee to Coordinate Environmental Healthand Related Programs and the CSIN Subcommitteeof the Interagency Toxic Substances DataCommittee—a body governed jointly by theEnvironmental Protection Agency and by theCouncil on Environmental Quality The continuingwork on the micro-CSIN workstation, anoutgrowth of the original mteragency CSINproject, has been described

The Toxicology Information Subcommitteesponsors and monitors the following three projectswhich the TIP operates

TOX-TIPS (Toxicology Testing-m-Progress) is amonthly publication that describes ongoing orplanned toxicity testing in Governmental, industrialor academic laboratories As a current awareness.

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service, the publication also carries reports on newtesting methodologies published in the literatureThis year, TOX-TIPS added a new alerting serviceto articles on "alteratives to animal testing "Hmphasis is placed on references to articles report-ing new in vitro methods, use of isolated organsystems, or computer-based modeling systems forbiological activities Coverage of DHIIS activities inthe animal alternative area is also provided

Two other Subcommittee-supported projectsfeed directly into the TOXLINE database One ofthese is Research Proiects (RPROJ), u carries infor-mation about ongoing research in toxicology Theother—called Toxicology Document and DataDepository (TD3)—contains information about thetoxicology report literature This year, theResearch Projects file was augmented with a"toxicology" subset from the NIH ( RISP(Computer Retrieval on Scientific Projects)database Through the TIM project, toxicology-related reports from the Government RefwrtsAnnouncement and Index database of NTIScontinue to be added to TOXI.INF

In May 1985, TIP co-sponsored a Mate/FederalWorkshop on the Joint Development o/Environmental and Toxicolo%ical In/ormattonResources with the National Governors' Association(NGA), the Association of State and territorialHealth Officials, the Centers for Disease Controland the Environmental Protection Agency Theobjective of the Workshop was to explorecollaborative means of building databases andimproving access methodologies for State agenciesfaced with problems of remedial or acuteresponses to chemical emergencies stemming fromchemical dump sites or accidental spills ofhaxardous substances Most States have difficult in

amassing or getting ready access to current,accurate and complete information aboutchemicals and their biological and environmentalproperties By bringing together representativesfrom key States and Federal agencies, the sponsorshoped to create a framework for future collabora-tion in these areas Some 15 States and severalFederal agencies were represented at theWorkshop A report is being prepared and will bedistributed b\ the NGA to the participants,Governors and health officials in all the States andTerritories, and to all others who request copies

SIS/IMA Collaboration SIS supplied a subset ofdata on selected chemicals from the Ha/ardousSubstances Data Bank for inclusion in the DrugEnforcement Administration's ControlledSubstances Information System (CSIS) The set ofchemicals for which NLM provided informationconsisted of materials known to be used in theproduction or refinement of controlled substances,and included starting chemicals,intermediates,solvents and waste products CSIS is a lawenforcement-oriented, encyclopedic database ofinformation on approximately 1,500 controlledsubstances, and provides online information toauthorized DKA personnel on substance ha/ards,toxicity, use and physical properties

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Lister Hill National Center forBiomedical CommunicationsEarl Henderson*Acting Director

. he research programs of the Center focus onthe information needs of the biomedicalcommunity and on matching those needs withpotential solutions offered by evolving communi-cations and information technologies Early effortsincluded collaborative projects with federalagencies, consortiums of health organizations,educational groups, and medical disciplinaryorganizations Computer assisted instruction net-works, CIS satellite communications, and earlvonline searching prototypes for MEDLINE areexamples of projects in the Center s first ten years

A longstanding goal was achieved in the springof 1980 with the dedication of the Lister HillCenter building adjacent to the mam librarybuilding In 19M the breadth of LHNCBC researchinterests was expanded through an organizationalmerger with the National Medical AudiovisualCenter, NLM's division charged with the enhance-ment and use of audiovisual and educationaltechnology

The Center has gradually turned to research-oriented projects with long-term potential forimproving patterns of information processing,analysis and retrieval Document image processing,videodisc-based computer assisted instruction andsimulation, and artificial intelligence in both expertsystems and natural language processing researchare among important areas currently underinvestigation by Lister Hill Center staff Because ofthese efforts, future users of information servicesmay be able to receive better and more completeinformation in the form it is best understood andapplied

The LHNCBC is managed by a Director and aDeputy Director who provide leadership to theCenter's six branches and four laboratories

• Communications Engineering Branch

• Computer Science Branch

• Information Technology Branch

• Audiovisual Program Development Branch

• Health Professions Applications Branch

• Training and Consultation Branch

• Document Image Processing Laboratory

• Microcomputer Technology Laboratory

• Computer Science Resource Laboratory

• Multimedia Development Laboratory

The Board of Scientific Counselors (BoSC) meetsto assess the quality of the intramural researchprograms within the NLM with particular attentiondirected toward LHNCBC- It is composed ofscientific and technical experts who reviewongoing and proposed intramural research anddevelopment programs as well as advise on theperformance of staff scientists The BoSC meetstwo to three times a year to review and makerecommendations on the Center programs to theDirector, NLM and Director, LHNCBC

Information Technology Programs

These are programs that provide access to large-scale information sources and utili/e state-of the-arttechnology to solve problems in health education,medical research, and information sciencesCurrent programs within the Center are

'IXimcl R \Us\s M I)(emir in I Y 19H<>

s appointed diixuor ol thi I isiir Hill

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Distributed Information Systems (I)IS) In 1982 theDistributed Information Systems Program wasestablished to investigate the effective managementand dissemination of information trom "informa-tional" databases, l e , full-text, non bibliographicsystems Whereas traditional retriev.il systems haveconcentrated on bibliographic databases within atime-shared, mam-frame environment, the IMSprogram has concentrated on having the varioustasks associated with information retrievaldistributed to mini- and microcomputers in orderto increase the cfficiencv ol a central computerand provide intelligent, convenient interfaces forthe user

The efforts ot the Information TechnologyBranch have benefited trom a collaborativeprogram with NI.M's Speciali/ed InlormationServices in which the results have been applied tooperational systems The Interactive InformationManagement System project is designed to pro-duce a working model tor testing anddemonstrating advanced information managementand retrieval techniques which can be applied toful l- text databases The project h.is been builtupon concepts and code developed tor previousLister Hill Center projects On July 1, 198S severalot these concepts became operational in the NLMTOXNET .system which ofters to the public online-access to the full- text ol toxicologv databases

A second project in the IMS program is theNetwork Access Information Workstation Thepurpose is to develop a user-fnendh micro-computer workstation that can facil i tate access todifferent online information sources The work-station provides automatic logon to onlinedatabases, automated search sequences (scripts) foraccessing up to 200 different online databases,transformation ot retrieved data to standardformats, and transfer ot data to a user's personal

filing system The prototype has been based upona design for the Chemical Substances InformationNetwork which was originally implemented on aDEC VAX 11/780 The workstation has broughtthe functionality of the VAX implementation to aninexpensive personal computer and in the processhas provided greater flexibility and ease of use Incollaboration with Speciali/ed Information Servicesand the Council on Environmental Quality, aversion of the workstation that has been tailoredfor access to hazardous waste information will befield-evaluated by several government agenciesincluding the EPA and the Centers for DiseaseControl (CDC) in Atlanta

The third DIS project is the implementation ofan extended MUMPS programming language-environment under the UNIX operating systemMUMPS is one of the ANSI-standard languages andhas been extensively used in biomedicalcomputing applications Two of the strong pointsot the language are its interpretive nature and anembedded database management system, whichare two features missing in UNIX Since a signifi-cant amount of software, including the InteractiveInformation Management System, has beendeveloped tor NLM in a version of MUMPS, thetranslation to a language that operates under aportable operating system such as UNIX wouldincrease the availability of this software and savethe effort or recodmg these applications in anotherlanguage The Information Technology Branch hasbegun testing commercial implementations ofMUMPS that exist under UNIX with the purposeot defining the functions necessary to provide atranslation ot NLM software and an optimalMUMPS environment in UNIX

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The Information Retrieval Testbed System (IRX)This program evolved from earlier work in thearea of natural-language queries and statisticalretrieval techniques As part of the effort, a systemcalled ANNOD (A Navigator of Natural LanguageOrgam/ed Data) was developed as a query systemfor the Hepatitis Knowledge Base The objective ofthe present effort is to create a testbed system thatwill permit evaluation of the performance ofdifferent information retrieval strategies The basicset of component programs, including wordstemming, thesaurus building, ranking and displayof retrieved output, has been developed under theI 'NIX operating system and will permit systematictesting of different retrieval strategies and theirdependency on the types of databases searched

Allied with the study of full-text retrievalstrategies is the investigation of providing onlineaccess to medical reference works such as thetextbook on medical genetics, MendelianInheritance in Man by Dr Victor A McKusick ofJohns Hopkins University Online access toreference works holds great promise for enhancedaccess to information, more timely updating, andspeciali/ed capabilities for authors of both singleand multi-authored texts The initial restructuringfor online access to Mendelian Inheritance in Man,has been completed and implemented in an initialversion of IRX for evaluation in a clinical settingas part of a collaborative project with JohnsHopkins I'niversitv Efforts are also being directedto the problem of linking disparate data sourcesinto a virtual single database in order to provide auniform interface not only to textual, but totabular and visual information as well

klectronic Document Morale and Retrieval (ED\R)Program The 1ister Hill Center's interest invarious electronic and optical technologies arisesto a great extent from their applicability inmeeting the mission objectives of the NationalLibrary of Medicine These include the preserva-tion and archiv.il storage of biomedical literatureand the processing of this information for use bvresearchers and practitioners Since most of thecollection is in the form of printed matter, theLister Hill Center is pursuing a research anddevelopment program involving optical, electronicand computer based technologies for the capture,storage, processing, retrieval, transfer and displayof biomedical documents

The first ph.ise of this program, now completed,was to design and develop a modular laboratoryfacility in the form of an experimental prototypesystem capable ot the electro-optical capture ofpaper documents m both loose-page as well asbound volume lorms, the storage of the digiti/edimage data on suitable media, and the retrieval anddisplay of the exact images on high resolutionsoftcopv as well .is hardcop\ devices Morerecently, a rapid linking up of document imageswith bibliographic citations from NLM's medicaldatabases with document images was accomplish-ed Also, the recent incorporation of digital opticaldisk storage units has expanded the store of online-images available tor experiments In addition, itallows investigation ot storage density, responsetime, image access and retrieval, and other issuespertinent to the use ot optical disk technology forimage archiving

This laboratory facility also offers the opportunitv to do research in the areas of imageenhancement, image data compression andomnifont text recognition in addition to theabove-mentioned experiments designed to answer

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kcv questions regarding the role of electronicdocument storage and retrieval technology inmedical library information processing

Medical Information Programs

These are programs that use advanced technologysvstems, including artificial intelligencetechniques,to improve the transfer of medical information forhealth care providers Current programs arc

System A research program in artificialintelligence concentrating on expert systems hasbeen established at LHNCBC during KY 1985Expert systems are computer programs whichcombine knowledge of a particular subject areawith mferencmg mechanisms enabling the pro-grams to use this knowledge in problem-solvingsituations The Expert Systems Program addressesresearch issues in the application of these artificialintelligence techniques to the development ofknowledge-based consultant systems in medicineand medical education

Efforts in this area in FY 1 985 have beendirected to both the intramural aspects of buildingan in-house artificial intelligence s\ stems develop-ment capability and the extramural aspects oftechnology transfer, research community-building,and information dissemination appropriate to theLibrary s mission

The creation of an in-house capability wasaccomplished in several steps As part of a long-standing collaboration between I)r DonaldLmdberg and Or Casimir Kulikovvski of theDepartment of Computer Science at RutgersI mversitv, the Rutgers artificial intelligence software framework called EXPFRT was successfullytransferred from the Rutgers DECsystem-20 main-frame computer to the Lister Hill (.enter

VAX-11/780 computer Two existing expertsystems of many years' development, AI/RHEUM(for diagnosis and therapy recommendations inrheumatology) and AI/COAG (for consultation inproblems of hemostasis), were brought from theUniversity of Missouri by Dr Donald Lmdberg andDr Lawrence Kmgsland Finally, a project teamconsisting of an experienced expert systemsresearcher, two computer specialists, and ahemostasis/blood banking subject matter expertwas assembled

During FY 1985 efforts were directed to 1)refining the AI/RHEUM diagnostic system inpreparation for its validation and evaluation as anexample from which to generali/.e a paradigm forthe evaluation of other medical expert systems, 2)improving the AI/RHEUM therapy recommendationsystem and testing it with additional clinical cases,and ^) extending the AI/COAG system to providerecommendations on blood component transfusiontherapy for cases of major trauma

In its current state, the AI /RHEUM diagnosticsystem contains in its knowledge base informationon 26 rheumatologic diseases It reasons from 877patient findings (basic information such as signs,symptoms, laboratory tests and radiographic obser-vations) through 547 intermediate hypotheses tothese 26 disease conclusions It has 181 definitionsavailable on line for those patient findings whichmight not be familiar to its intended users, physi-cians who are not themselves rheumatologistsThis system has been tested with more than 500clinical cases Its overall level of agreement with aconsensus diagnosis of Board-certifiedrheumatologist clinicians is above 90%

The AI/RHF.UM patient management system pro-vides therapy recommendations for patients havingone complex disease, rheumatoid arthritis Itassesses patient condition on the basis of specific

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information requested and makes treatmentsuggestions on several levels, from basic measuresthrough more complex drug therapies This systemhas "Tell Me More" statements available in manycategories for users who would like detailed infor-mation supporting its recommendations

The AI/COAG consultant system for problems inhuman hemostasis is designed in several modulesThe first module performs a differential interpreta-tion of six coagulation laboratory screening tests,and offers "Tell Me More" and "Tell MeReference" information to support us conclusionsThe second module acquires and stores a detailedhemostasis history It prints a summary record forthe user, and analyzes the history to determinewhether a hemostatic defect is present whichwould make a further workup desirable The thirdmodule, still under development, makesrecommendations for blood component trans-fusion therapy in cases of major trauma

Proposals for additional expert systems projectsaddressing different research questions are beingconsidered for the coming year These proposalsinvolve the addition of an interactive videodisccapability to an expert system, the interfacing ofsuch a system to existing large databases forreference information, and the creation of a hybridexpert system having an image analysis front end

The extramural aspects appropriate to artificialintelligence research at the National Library ofMedicine have been addressed m three ways 1)exploring issues of technology transfer by focusingon methods of delivering these large-scale artificialintelligence programs on powerful microcomputersmore widely available than the mainframe systemson which many such programs have beendeveloped, 2) hosting a 2'/! day ArtificialIntelligence in Medicine workshop for 140

attendees, and S) developing a series of three15-mmute videotapes on medical expert systems

Dermatologic Diagnosis Videodisc Propel Thisproject involves developing an experimentalvideodisc and associated computer software toassist practitioners to identity and classify dermato-logic lesions The videodisc will include imagesselected to represent common dermatoses, and thesoftware will guide practitioners in retrievingindividual images or classes of images that canassist practitioners in the diagnostic process

The dermatology project completed the prepara-tion of its pilot videodisc, which includes almost700 images of clermatologic lesions representing Wcommon dcrnutoscs Project staff also developed aclassification scheme for the physical descriptionof lesions, began the expert review and revision ofthis scheme, developed a (Manguagc program tocontrol access to disc images, began developmentof .1 unified demuiologic lexicon, and began acollaborative relationship with the AmericanAcademy of Dermatologists This collaborationserves to improve the processes ol expert reviewof content and siratcgv, acquisition of additionalimages/dermatologic cases, and field testing

Automated Oasstf nation and Retrieval Thepurpose of this program is to develop computersystems that w i l l improve and automate theclassification ol published literature and aid theretrieval of uselul information The ultimateobjectives of the project .ire to ( I ) automaticallyclassify articles and (2) permit content addressable,natural language computerised searches Theclassification swcm should permit efficient andprecise searches by subjects and the relationshipsbetween the various subjects in the text The pro-gram includes jirojects in the area of natural

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language understanding, knowledge representation,and information retrieval Currently the Center hisa contract with Carnegie-Mellon University toconduct research in knowledge representation andnatural understanding and to develop tools tosupport research in those areas The research hasfocused, in general, on the problem of classifyingliterature in the domain of rheumatoid disordersand, in particular, in the development of aconceptual hierarchy, knowledge bases, and funda-mental concepts for the semantic representation oftitles and abstracts in the domain The tooldevelopment effort has involved ( I ) a NaturalLanguage Interpreter, (2) a Frame-based KnowledgeRepresentation System, 0) a I'ser Interface

1wo intramural research projects were initiatedOne is Knowledge Refinement with the objectiveof discovering methods to incrementally refine andmerge hierarchical structures such as MeSH andSNOMED

The second project, Indexers Aid, is to developa system for classifying concepts and relationshipsin medical articles as frame representations andproviding knowledge-based assistance in theassignment of MeSH indexing terms

Computer-Based Education Technology Programs

These health education programs use interactivevideodisc technology to improve the transfer ofhealth information and enhance student learningCurrent programs are

TVA/f (Technological Innoi aliotb in \k'dicalEducation) This project explores the use ofmicroprocessor, videodisc, and speech recognitiontechnologies to enhance the education of medicalstudents Using these combined technologies, the

project is developing patient simulations toprovide a contextual framework for acquiringmedical knowledge and learning clinical decisionmaking

The TIME simulation prototype, described inlast year's report, is "The Case of Frank Hall " Thedelivery system consists of an IBM PC/XTmicroprocessor, a Votan voice system (VPC-2000),three LDV-6000 Pioneer videodisc players and aSony color monitor The capabilities of the newtechnology for random access of high qualityvideo and multiple audio tracks, coupled with theintelligence capacity of the computer, makepossible the creation of an effective interactivesimulation which encompasses sophisticated educa-tional strategies while supporting engagingdramatic situations

The Frank Hall prototype embodies fivecharacteristics which distinguish the TIME modelas a unique resource in medical education

1 Uncued interaction allows the learner to usehis/her natural spoken language while dealingwith the patient

2 Multiple health problems require multiplediagnoses for appropriate management

•} A full range of medical, social and clinicalinformation available to the learner in dynamicvisual and audio form portrays the drama ofthe patient's condition and life situation

4 Probability-based occurrences and outcomesreflect the real clinical environment

5 A dynamic, time-related management processresponds to the learner's independent, uncuedinterventions

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The prototype provides formative feedback byimmediately portraying the impact of the learner'sclinical interventions, and summative feedbackwhich conveys his/her overall diagnostic andmanagement performance as a physician with thesituation at hand Also, included in the summativefeedback are the medical expenses incurred by thepatient as a result of the clinical course chosen bvthe student

Two more TIME simulations will be createdusing the knowledge and experience gained fromthe prototype The plan for FY 1986 involves thecompletion of the simulation concerning a geriatricpatient with a hip fracture and a variety of relatedmedical and sociological problems Following this,one other patient simulation will be created Thesethree will be used in four or five medical schoolsas a part of the Introduction to Clinical Medicinecurriculum Appropriate interviewing, question-naires and performance evaluation instruments willbe developed to assess the effectiveness andeducational value of the TIME model in thissetting

Computer-based Curriculum Delivery Systems(CCI)S) This project seeks to develop prototypeinstructional systems and to evaluate theirdissemination and use by health professionsstudents and practitioners

During the year, CCDS continued with fieldtesting of the first of four microscopy-pathologyvideodiscs and collected over 1000 faculty andstudent evaluations of the disc from 36 parti-cipating I' S and Canadian medical schools Basedon these, the program's software was modifiedand distributed as Version 2 0 to participatingschools The CCDS project is also working withthree other specialist groups to develop prototypeeducational videodiscs in juvenile suicide riskassessment, radiology, and m orthopaedic surgery

Bibliometrics

Broadly defined, bibliometnc studies examinestatistical frequencies and relationships found in adefined body or collection of professionalliterature These studies may describe certainstatistical features of j literature or may relate thesefeatures to the nature and extent ot the literature'suse Current studies within l.HNCBC

Library Growth The Library Growth projectcompleted a successful search to locate the largestatistical database created at Purdue Universityduring the ltXH-"T2 period, obtained the similarbut more recent statistic.il data from the Associa-tion of Research Libraries, acquired other similardata from Mr Richard Lvders at the Houstonmedical campus, and collected supplementarystatistics from the National Center for EducationalStatistics in Canada These collected statistics nowinclude the several customary or traditionalindexes of library size or library capability andthey cover a time span which ranges betweenseven years (l977-83) and 34 years (1951-84)Libraries represented in the data include 58 oldermembers of ARL, about 50 newer members ofARL, including NLM,and about 125 medicalschool libraries in the I' S and CanadaPreliminary data analvses were begun during theyear and, earl\ in FY 1986, these will be extendedto include "validation" studies ot previous growthforecasts, new forecasts of research library andmedical libran growth, and preliminary studies of"personality1 differences among libraries

Online Trend1* The Online Trends" study begunthis year will analyze and report trends in thedevelopment of online biomedical files in the I' S ,1974-1984 The data to be analy/ed are beingdrawn from published literature which describes

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new, developing, or continuing online files thatincorporate biomeclical content

Iowa Study The Iowa study of health professionsfaculty was completed during FY 19H5 Althoughit experienced some early delays, this contractstudy now represents a thoroughdescription/analysis of the process h\ which healthprofessions educators seek, find, and evaluate orjudge audiovisual teaching materials I he study isbased on responses of a national sample of 1000educators Prior to conducting the survey ofeducators, the project also prepared .1 literaturereview that examines the question How dofaculty select print or nonprmt teaching materials'Briefly, the review concludes that the literaturepresents little credible, generali/able evidence thatdescribes the selection procedures used by faculty

Multimedia Development Programs

These programs use the rapidlv changingtechnology of video communications to inform,educate, or motivate health professionals andstudents in the health sciences Current projectsinclude

Leaders in American Medicine I his is a series olvideotaped interviews recording the memoirs ofeminent American medical scientists and teachersThe tapes have been produced through the collab-orative efforts of Alpha Omega Alpha (NationalHonor Medical Society), American College ofPhysicians, and NI.M The tapes constitute aunique resource for men and women embarkingon medical careers, as well as a permanent recordof some of the physicians and basic scientists whohelped shape medicine in the United States Thedistinguished list includes such luminaries as Dr

John h Enders, University Professor Emeritus,Harvard University, Dr Helen B Taussig, Professorof Pediatrics Emeritus,Johns Hopkins University,Dr William B Bean, Osier Professor of Medicine,University of Iowa, and Dr J Willis Hurst, Chair-man and Professor, Department of Medicine,Emory University It is expected that theseaudiovisual memoirs will be a valuable resource-tor future generations of physicians and forhistorians concerned with medical education andbiomcdical science

History of Medicine An experimental videodisc ofmore than 1000 selected visuals from the NLMhistorical collection was produced to test thefeasibility of using this technology as a means ofselecting prints or photographs for research oreducational purposes by authors, teachers, studentsand other library patrons

Artificial Intelltnence in Medicine (AIM) A series ofvideotapes and videodiscs on major expert systemsin medicine The initial set was produced for theartificial intelligence in medicine workshop in July1985 This scries is intended for professionalsknowledgeable in computer science and artificialintelligence techniques as well as for other personsinterested in expert consultant systems inmedicine

National Learning Demonstration Center

The National Learning Demonstration Center(NLDC) opened in March 1985 as a facility wherevarious computer-video information and educa-tional technologies can be demonstrated, reviewed,and evaluated The establishment of the NLDCresulted from interdisciplinary efforts within theLister Hill Center and guidance provided by an

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advisory group of outside consultantsThe recent GPEP (General Professional Educa-

tion of the Physician) report of the Association ofAmerican Medical Schools emphasized the need toexploit new technology in the service of medicaleducation The NLDC will assist this effort by pro-viding visibility to effective applications of thesetechnologies In addition, the NLDC may alsoserve as a laboratory for comparative studies andevaluation of such technologies Exhibits presentlyavailable in the NLDC represent health sciencescomputer-based and video-based educationalmaterials, relevant information systems, anddemonstrations of LHNCBC computer-basedresearch projects

NLDC staff assist visitors in a variety of waysIndividual or small group tutorials are provideddepending on the interests, needs and time com-mitment of visitors Tutorials range from a general

overview of computer-based and video educa-tional/information systems in the health professionsto self-tutorials and hands-on experience withindividual systems Demonstrations are also pro-vided to illustrate the diversity among systemattributes and the alternatives available forcourseware design and delivery

The NLDC occupies a room on the Bl-level ofthe Lister Hill Center It comprises 12 carrels, areception center, and a small conference area Thecarrels are modular and can be easily reconfiguredor augmented as requirements change

NLDC staff have hosted over 3000 visitors sincethe Center opened in March 1985 Present effortsare directed towards developing a series of audio-visuals and self-directed learning aids for visitoruse The NLDC will also be expanded into asecond demonstration area in the near future

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Extramural Grants and ContractsWilliam G Cooper, Ph D •Associate Director, Extramural Programs

"Vicennial Vignette ' earlier in this reportgives a fictional introduction to the subject of theLibrary's grant and contract programs WyndhamD Miles, in his book, A //»s/orv of tbc NationalLibrary of Medicine—The Nation's Treasury ofMedical Knowledge, states "It was inevitable thatthe Library would become involved with grantsafter it became a part of the Public Health Serviceand closely associated with the Nation.il Institutesof Health " It is probably fair to assume that itwas to some degree a consequence ol orgam/a-tional association and even geographical proximitythat NLM became involved with a type of grantactivity

However, it was not by chance that some formof aid, at some point in time, and administered bysome public entity, would finally be established tocorrect the disparity which in the early 1960sexisted between the Federal investments in thecreation of health science information andknowledge and the neglect of programs tor theefficient orgam/ation, rapid transmission, and effec-tive utih/ation of this cxj^anding corpus This wasinevitable, just as today it is inevitable that,independent of any NLM involvement (but, wehope sustained by it), the next decades of con-tinued effort by health knowledge brokers to keeppace with the health knowledge creators will focusmore and more on technological tools which seemalmost daily to offer new opportunities andchallenges

The following are brief summaries of FY 1985activities in the various categories of grant andcontract assistance Training, Research IA1MS,Resource Grants, Publication Grants, and theSpecial Foreign Currency Program In addition,there is a brief section on grant expenditures andlegislative activity

Training Program

Computer speed, reliability, and storage capacityprobably will continue to increase for the nextfew decades, and component size and cost perstorage unit will continue to decrease Althoughthere will be a need for more and more trainedpersonnel, most medical schools have yet toinclude Medical Informatics in their curricula

The academic discipline of Medical Informaticsrepresents the convergence of computer and infor-mation science with the delivery of health careThe new discipline emphasix.es the role ofknowledge in professional life and seeks todevelop better ways to orgam/e, retrieve, andutili/e health knowledge To expand this emergingfield, NLM continued to support five awards,initiated the previous year, in the Health ComputerScience Research Training Program Twenty-onepostdoctoral trainees were supported in FY 1985Of these, 18 were physicians, 2 had a Ph Ddegree, and one had both the M D and Ph D

*l)r (oopir resigned trom 11ilu.il SUMU in (Xtolxr 1WSMr A r t h u r llnnTing is Auinn ASM nun Piruioi

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The five training sites and directors are

Marsden S Blois, M DProfessor and ChairmanMedical Information ScienceUniversity of California, San FranciscoLael Gatewood, Ph DAssociate Professor and DirectorHealth Computer SciencesUniversity of Minnesota

Robert A Greenes, M D , Ph DAssociate Professor and DirectorComputer Science DivisionDepartment of RadiologyHarvard Medical SchoolBrigham and Women s Hospital

Stephen G Pauker, M DChief, Division of Clinical Decision MakingNew England Medical Center (Boston)

Edward H Shorthffe, M D , Ph DAssistant Professor of MedicineStanford University

Research GrantsUsing various grant mechanisms, the Librarysupports research into fundamental questions ofattributes, organization, and utilization of medicalknowledge I his program initiative—MedicalInformatics—has been responsible for significantadvances in how health knowledge is organizedand utili/x'd tor medical problem solving In FY1985 an increase in NLM's appropriation empha-si/cd the importance ot informatics research andmade it possible to expand research activities

At major research institutions, such as MIT,Stanford, Yale, and the University of Pittsburgh,NLM awardees are using artificial intelligencemethodologies to develop expert reasoningsystems where the computer functions inter-actively with the human user At Stanford Univer-sity, a protocol management system for oncologyis well advanced and is being disseminated toother sites At Yale University, the development ofan expert system which provides a critique of thephysician s chosen course of action has attractedmuch attention from computer scientists andclinicians

The evolution of computen/ed expert systemsdepends in large part on understanding the humanreasoning processes in the exercise of judgment—clinical judgment in this case At several institu-tions, NLM-supported investigators are studyingvarious aspects of clinical judgment and the natureof clinical decision making These range from amajor theoretical investigation at the University of1exas-Austm through more applied system studiesin specific medical domains at Latter Day SaintsHospital in Salt Lake Citv, among others

Related work in Medical Informatics includeswork at the Massachusetts Institute of Technologyon a computcTi/ed searching intermediary which

60

allows the user to search several medicalbibliographic databases simultaneously The systemalso takes account of such constraints as time andcost Mount Sinai School of Medicine in New Yorkis the site of a scholarly investigation of thevalidity of clinical trials reports The objective is toderive standards and guidelines for assuring scien-tific validity of the clinical trial design and itsultimate journal report

Access to recorded knowledge is essential notonly to those who investigate biologicalphenomena and deliver health care, but to allthose who are concerned with the ethical andhumane dimensions of human health With theavailability of especially appropriated funds, NLMhas jointly sponsored a major bibliography of theentire bioethics literature The literature acquisitionand indexing is performed at Georgetown Univer-sity's Center for Bioethics The indexed material ismade available for computen/ed bibliographicsearching by NLM through its online database,BIOETHICSLINE In a related effort, the Libraryalso supports a national clearinghouse jndreference center for bioethns, also based atGeorgetown University

IAIMS Program

NLM provides grant support to assist in theplanning and development of Integrated AcademicInformation Management Systems (IAIMS) and inthe conduct of research related to IAIMS activitiesThe IAIMS concept is to use computer andcommunications technologies to bring togetheroperational and academic information in supportof health research, education, patient care, andmanagement The goal is to integrate the librarysvstems with the multitude of mdividu.il and

institutional working information files at healthscience centers In FY 1985, nine institutionsreceived support for IAIMS planning and develop-ment, and three of these also received IAIMSresearch grants

Grant support is available for 1) institution-wideIAIMS strategic planning and policy analysis, 2)IAIMS model development and testing, involvingsome segment or cross-section of the completedIAIMS strategic plan, and 3) implementation of thedetailed and tested plan for full-scale, institution-wide IAIMS development The three phases ofIAIMS activity are considered sequential, and thesuccessful completion of each phase is the pre-requisite for further support

Grant awards were made for the second year ofIAIMS Phase I planning to the Baylor College ofMedicine and the University of Cincinnati tocontinue activities begun in FY 1984 The OregonHealth Sciences University also continued IAIMSPlanning under contract support Two new IAIMSPhase I grants were made to begin planning atHarvard University and Johns Hopkins University

Four IAIMS Phase II model development andtesting awards were made in FY 1985 to ColumbiaUniversity, Georgetown University, the Universityof Maryland, and the University of Utah Thesefour institutions,previously supported by NLMcontracts, had completed IAIMS Phase 1 planning,and had published IAIMS Plans for their institu-tions Based on their plans, they successfullycompeted for grant awards to begin model testingof IAIMS concepts on a small scale in theirinstitutions

In January 1985, NLM invited investigator-initiated Research Grant applications for innovativeresearch to support the planning, development,and implementationof IAIMS The first IAIMS

61

Research Grants were awarded to the BaylorCollege of Medicine to study the problem ofintegrating several local area networks (LANs) anddesigning an advanced workstation, toGeorgetown University to identify informationneeded in an interdisciplinary cancer centerenvironment and how specialized library databasesrespond to those needs, and to the University ofUtah to demonstrate how an IA1MS environmentcan support the research and development ofmicrocomputer databases of significant value toclinical medicine

During the past two years, the Nl.M had beenurged to further promote the 1AIMS concept,especially to those who may be involved in futureIAIMS development or may be affected by workassociated with IAIMS planning and implementa-tion Accordingly, NLM hosted a symposium onIAIMS planning on October 17, 1984, attended bymore than 150 individuals representing some 75institutions in 32 states In addition to learningabout how the IAIMS concept was developed,they heard reports of approaches and issuesregarding strategic planning for informationmanagement in academic medical centers by DrThomas Q Morris, Columbia University,Ms Naomi C Broermg, Georgetown University,Dr Marjone P Wilson, University of Maryland,and Dr Homer R Warner, University of UtahThese four individualsshared their frank percep-tions of the complex issues raised bv the IAIMSeffort and commented on the costs and lessonslearned More than 1,000 copies of the publishedsymposium proceedings have been distributed

Medical Library Resource Grant Program

The purpose of this program is to improvemedical library collections and enhance servicesResource Grants are of two types Improvementand Project Resource Improvement Grants, whichare available to consorna as well as single institu-tions, assist m collection development In the pastyear, such grants were awarded to nine consortia,which included 99 institutions, and to 8 singleinstitutions

Resource Project Grants are directed towardsestablished health science libraries and enablethem to undertake a new service or expand anexisting one Of the five new Resource ProjectGrants awarded during the year, four involvedextending library and information services to usersin remote areas

• The University of Nebraska Medical CenterLibrary wil l establish libraries at three familypractice sues to demonstrate <i new role forhealth science librarians and to promoteindependent information-seeking behavior of theresidents

• The University ot Utah, Eccles Health SciencesLibrary u i l l test the use of microcomputers bymedical students, while engaged in preceptor-ships at rural family practice sites, m communi-cating with their peers, faculty and library staff

• At the University of Oklahoma Health SciencesCenter Library, a library-clinical consultationprogram will be developed to address the infor-mation needs of health professionals practicingm rural, underserved areas of the state

• In central California at the Merced CommunityMedical (enter two previously funded libraryconsortia have combined to undertake an

62

audiovisual cooperative project to support theeducation and training of health professionals infive rural counties

The fifth Resource Project Grant was awardedto Meharry Medical College Library to process,preserve and publicize a black medical historycollection

Publication GrantsThe Publication Grant Program provides selective,short-term support for a variety of not-for-profitbiomedical scientific publications, expediting accessand availability of health information for U Spractitioners, research scientists, planners andeducators

Projects prepared and/or published in the U Sunder this NLM program include critical reviewsand monographs on special areas ot medicalresearch and practice, publications on biomedicalcommunications and in library and informationsciences, secondary literature tcxils (such asannotated bibliographies, atlases and catalogs),temporary support for periodical publications,studies in the history of medicine, translations ofcurrent foreign biomedical monographs, andproceedings of symposia related to I' S healthneeds

Together with its complementary activity, theSpecial Foreign Currency Program, the PublicationGrant Program assists the advancement of themedical sciences and aids in the dissemination andexchange of scientific and other informationimportant to the progress of medicine and health

During FY 1985, NLM awarded 16 PublicationGrants, totaling $403,000 Of these, 9 were newawards, including one for a study which willsynthesi/e the last two decades ot research on

hospital organizations and produce a book thatemphasizes practical recommendations forimproving hospital performance The averageamount of a Publication Grant in FY1985—approximately 825,000 in both direct andindirect costs—reflects the continuing emphasis inthis program upon high quality, but low-costprojects that are scheduled for early publication

Among the studies published in FY 1985*which the Publication Grant Program funded wasa critical review on Human Underwater VisionPhysiology and Physics, by Jo Ann Kmney(Bethesda, Maryland Undersea Medical Society,Inc , 1985), which presents current knowledgeabout vision, visual perception, and the visualsystem under water The summarized informationcomes from international diving research andincludes that conducted by the author and hercolleagues at the Vision Department of the NavalSubmarine Medical Research Laboratory over 20years Another significant volume published thisyear is a reference source for physicians and otherhealth care professionals AMA Handbook ofPoisonous and Injurious Plants, by Kenneth FLampe and Mary Ann McCann (Chicago, IllinoisAmerican Medical Association, 1985)

Representative of some of the significant studieswhich have been supported under the PublicationGrant Program is Viral Infections of HumansEpidemiology and Control, 2nd ed , edited by DrAlfred Evans The American Journal of TropicalMedicine and Hygiene finding the quality of thebook to be "excellent" and the information in it"authoritative," concluded "The book providesan excellent source of reference forepidemiologists, virologists and public healthworkers '

"Sn Appendix 2 for a lumplcic. lisun|j of hooks periodicalsand |ourrul artitks rucivcd in hY 19H1) risulnriH from NI Mhxiramural Program support

63

The Special Foreign Currency Program

The oldest of the Library's extramural supportactivities, the Special Foreign Currency Program,continues today to be a very valuable supplementto the Publication Grant Program Authorizedunder Public Law 83-480, as amended, the SpecialForeign Currency Program utilizes appropriationsof U S -owned local foreign currencies to fundbiomedical writing and publication projects incooperating countries

During FY 1985 the P L 480 Program .spon-sored 77 projects, totaling 5956,069 U Sequivalent dollars More than 60 percent of thecurrent program is in India, 20 percent in Polandand the remaining projects in Egypt, Israel,Pakistan, and Yugoslavia

About half of the awards in the Special ForeignCurrency Program support the preparation ofscholarly research monographs and translations ofclassics in the history of medicine Another fourthof the program supports the preparation andpublication of state-of-the-art, analytical reviewsand monographs, which explore the status ofresearch and practice in health care andbiomedical research The program also funds afew secondary literature tools, such as theQuarterly Bibliography of Major Tropical Diseases,printed in India through the Public Law 480 Pro-gram and distributed in cooperation with theWorld Health Organization

The first of a new series of Resources in MedicalHistory, selected in collaboration with theAmerican Association for the History of Medicineand published under the Public Law 480 Program,appeared in 1985 Rudolf Virchow's CollectedEssays on Public Health and Epidemiology (NewDelhi Amerind Publishing Company Distributedfrom Canton, MA by Watson Publishing Inter-national, 1985) Edited by the distinguished

American pathologist and medical historian, DrLJ Rather, this two-volume collection, originallyassembled by Virchow in 1879, has never beenpreviously available in English Virchow's uniquestature as an internationally recognized physician-scientist-statesman, coupled with his deep involve-ment in public health reform, make these papersof particular importance

Although political complexities between theUnited States and Poland in the last few yearshave impacted upon P L 480-funded collaborativescience activities in that country, NLM-supportcdstudies written by Polish scientists continue to bereceived This year saw the publication of a signifi-cant monograph by Professor WaldemarOlszewski, M D of the Medical Academy ofWarsaw, entitled Peripheral Lymph Formationand Immune Function (Boca Raton, FL CRCPress, Inc , 1985) This study makes much Polishand Russian literature on the subject, hithertoinaccessible to the international biomedical com-munity because of language barriers, available torthe first time The audience addressed by thepublication includes oncologists, transplantologists,physiologists and surgeons interested in lymphaticpathology

The Program also sponsored the publication in1985 of an overview of problems connected withresearch on the processing of information understress, based on classic experimental studiesinitiated bv Russian authors in the 1970's NLM'sP L 480 Program commissioned the translation inYugoslavia and the printing in India of V PZinchenko et al The Psychometric* of Fatigue(Distributed from London and Philadelphia byTaylor & Francis, 1985)

64

NLM Extramural ProgramsTVventy Year History of Obligations

il Dollars

$12

FlNralVcar M 70

Exclude* Appropriations for ConNtrucllon I96M

I75

I80

I85

Grant Expenditures and Legislative ActivityA Continuing Resolution (P.L 98-47^) provided anadditional $3.5 million in FY 1985 tor NLM'sextramural programs in Medical Informaticsresearch and the development of IntegratedAcademic Information Management Systems(IAIMS). These additional funds increased theextramural programs budget to $12 2 million in FY1985, contrasted with a $7 5 million spendinglevel for each of the three previous years Thus,1985 represents the highest NLM grant appropria-tion, except for 1968 when NLM received its onlyallocation for the since-repealed Construction

Grant Authority. The grant spending level for FY1985, modest in relative terms, neverthelessrepresents more than a 60 percent increase overFY 1984. Table 10 represents grant expendituresby program for FY 1985 and the two previousfiscal years. Figure 1 illustrates in current andconstant dollars the 20-year history of NLM'sextramural programs funding In constant dollarterms, the FY 1985 budget is very close to the1969 level. However, considering overall 1985budget constraints and the amount and specifica-tions of the increase in NLM's extramural programsspending authority, the budget is surely evidencethat computerization has come of age vis-a-vis

65

Table 10Extramural Grant and Contract Program(Dollars in Thousands)

Catef>or\'

ResearchResource ProjectsResource ImprovementTrainingSpecial Scientific ProjectsRegional Medical LibrariesPublications

Total

h'Y

Number

29I I29917

19

105

h'Y 1W4

Amount (S) Number Amount (S)

$2,782575646744

442,400

440

291622907

20

104

$2,4991 , 1 1 4 '

614786

02,000

587

$7,500

'Includes IAIMS Resource Projects (2)"Includes I A I M S Research Projects (-\) JTI .incl Research in Mcdiul Inlornuiics ( M ) $ i )H9

•"Includes I A I M S Resource Projects (H) SI U6

h'Y 1985

mber

V)2517507

15

Amount (S)

$ 5,441"2,507'"

5281,091

02,054

404

108 112,01*

health science knowledge managementFor the first time since September 40, 1982,

funding levels arc stipulated by the authon/mglegislation for the programs administered by NLMunder the Medical Library Assistance Act TheHealth Research Extension Act of 1985, acomprehensive bill authon/mg funds for majorNational Institutes of Health activities, includingMLAA programs, was enacted into law onNovember 20, 1985 when Congress elected tooverride the President's earlier veto ot themeasure

'Ihc new law ( P I . 99-158) extends thejuthon/ation of appropriations for the MedicalLibrary Assistance Acl programs for three years, atfunding levels of $12, $ 1 4 , and $14 million for FY86, FY 87, and FY 88 respectively, and raises thedollar limitation on individual MLAA resource-grants to medical libraries to 8500,000 (instead of$200,000) in am fiscal year

66

International ProgramsHenry W Riecken, Ph D 'Acting Special Asistant for Inicrnationjl Programs

;/ the entire medical literature of the worldwith the exception oj that which is collected in theUnited States were to be now destroyed nearly allof it that is valuable could be reproduced withoutdifficulty "

John Shaw Hilling

Our Medical LiteratureTransactions oj the InternationalMedical Congress fth london, 1881)

For more than a century, the National Library ofMedicine has collected foreign medical literatureand cultivated relationships with medical librariesand information centers abroad The init ial motivefor this policy wa,s certainly to keep the I' Shealth establishment a.s well-informed as possibleabout developments in the laboratories and clinicsof other nations, and the verv first number ofIndex Medicus in 1879 leflects thai concern Aboutthree-quarters of the journals indexed in that"Classified Record of the Current MedicalLiterature of the World," were published abroadAlthough that proportion had diminished to about65 percent in the 1985 List of journals Indexed mIndex Medicus, Billings' claim that the I'nitedStates was a repository of the world's medicalliterature can be sustained as well toda\ as it wasa century ago, and Billings' ambition tor theNational Library of Medicine to take a major partin maintaining the storehouse continues to be abasic tenet of the Library's program

International MEDLARS Centers

During the hundred vears of Index Medicm thestature and significance of I ' S medical researchand practice has grown enormously and it has

accordingly become essential for physicianseverywhere to be informed about it

Furthermore, the indexing .scheme that Billingsbegan has assumed a worldwide importance thatits initiator may not have anticipated The classic-printed Index Medicus now occupies the shelvesof all the world's medical libraries Its counterpart,in modern dress, is the online Medical Literature-Analyses and Retrieval System (MEDLARS) that iscurrently accessed worldwide through 14 centersin as many foreign countries (Table 11)

This network of foreign partners is more than aset of agreements to distribute services Thevarious MEDLARS centers contribute intellectuallyas well by helping to identify significant literature,by indexing and cataloging in unfamiliar languagesand alphabets, and by collaborating in a variety oftechnical tasks including training, documentation,system performance assessment and other ways ofsharing time, talent and resources with no transferof funds, i e , quid-pro-quo arrangements

International MEDLARS centers are establishedby agreement between the Library and anappropriate instrumentality of the respectivenational government, usually the Ministry ofHealth or the Ministry of Information which isasked to designate the host institution for thecenter Accordingly, the MEDLARS center maylodge in a library, a medical research institution, agovernmental scientific research council or anindependent center for scientific and technicalinformation Although the matter of regionalcoverage is just as complex and delicate as theissues of trans-border data flow, the NationalLibrary of Medicine imposes no restrictions onhow and where individual MEDLARS centers mayoffer their services, and it does keep itself inform-ed on such decisions and actively encouragesmutual communication among centers New

•Ri t lurd K ( l lMth I) I' II was .ippoimul Spuul Assisum lorIniunjiiorul I'rogrjms in I Y IWft

67

requests to the Library for MEDLARS services orproposals to establish additional centers arebrought to the attention of the partners.

Such developments inter alia occupy theattention of the partners at the biennial meetingsof the International MEDLARS Policy AdvisoryGroup (IMPAG) The next meeting of this group inOctober 1986 will be concerned with operationalexperience, networking, regional coverage andcollaborative efforts, as well as with preparationsfor the installation of MEDLARS I I I , the latestrevision of the system.

International Cooperation

In addition to these specific national partners, NLMhas enjoyed collaborative activities with the WorldHealth Organization, and its affiliated Pan AmericanHealth Organization. With WHO, the Librarycompiles and distributes the QuarterlyBibliography of Major Tropical Diseases andBibliography of Acute Diarrhoeal Diseases and,with PAHO the Bibliography of RespiratoryInfections in Children. NLM is responsible forcarrying out the literature searches, classifies thearticles retrieved and prepares camera-ready copy,which WHO prints and distributes to thousands ofinstitutions in developing countries.

NLM and WHO have also continued a collabor-ative arrangement to provide photocopies ofjournal articles for the use of health professionalsin developing countries in Africa, the EasternMediterranean and South East Asia. Libraryresources in the developing countries are usuallyinsufficient and their need for biomedical andhealth information can be met only by drawing onthe collections of the developed world. Eventhough NLM provides more than 5,000

photocopies a year to developing countries (morethan 80 arc eligible for interlibrary loans), thisnumber can only partially meet the need andother developed country resources mustcontribute too

Recent and Forthcoming Developments

Further progress m establishing a MEDLARS centerin the People's Republic of China occurred in July1985. Dr. Richard Frcy, Vice-Director of theInstitute of Medical Information of the ChineseAcademy of Medical Sciences (Beijing) visited NLMto discuss the configuration of computer hardware,the technical demands of ELHILL software and thetraining of system operators. The determination ofthe Chinese to establish a center is quite evidentand preliminary plans have been made for furthertechnical discussions and assistance from NLM staffto take placx- in Beijing next year. The timetablefor installation of the system and its shakedownenvisions operation by the end of 1986. Mean-while NLM continues to provide SelectiveDissemination of Information (SDI) searches to theChinese Academy, with the active involvement ofone of its librarians who has completed a periodof study and practicum at NLM.

FY 1985 also saw further progress in discussionswith India regarding the development of aMEDLARS center in new Delhi. Mrs. Sarala Grewal,Secretary for Health in the Ministry of Health andWelfare, called at NLM to acquaint herself betterwith the institution and to report that the PrimeMinister had taken an interest in MEDLARS andencouraged the Ministry of Health and Welfare toproceed. A proposal has been approved by theMinistry and forwarded to the Ministry ofEconomics for review

68

Visitors

NLM continues to attract the attention of hundredsof foreign visitors each year, including doctors,medical librarians, public health specialists, andgovernment officers Many of these visitors haveresponsibilities for medical, scientific or technicalinformation in their own countries Their interestin NLM is more than cursory, and thev are offi-cially received and briefed on relevant aspects ofNLM operations and research The visitors camefrom the following 29 countries Australia, Bahrain,Bangladesh, Cameroon, Canada, Cuba, Denmark,Egypt, Finland, France, India, Israel, I taK, Japan,Kenya, New Zealand, People s Republic of China,Philippines, Poland, Singapore South Africa Spam,Swit?erland, Taiwan, Tunisia, United Kingdom,Venc/uela, Yugoslavia, Zimbabwe

Eight official delegations came to scrutmi/e oneor more facets of NLM and to pursue technicalissues in information and library science usuallywith a view to identifying applications that mightprove useful In addition to foreign visitors,NLMenjoyed the companv of more than a do/entrainees, students, and professionals m observerroles for short periods

The interests of foreign visitors arc diverse AJapanese bioengmeer would like to know NLM'sexperience with satellite networks for the transmission of information He believes thatestablishing such a network would be a prudentstrategy for a country at considerable risk of earthquake destruction of its telecommunications Twophysicians from Colombia call to explain therelocation of its MEDLARS center and their plansfor extending services to medical schools inCentral America and the Caribbean A represen-tative of the Egyptian Academv of ScientificResearch and Technologv drops bv to inquire into

some of the technical details of the MEDLARStapes and some further information about thecomputer hardware needed to mount them Twomembers of the professional staff of the CentreNational de la Recherche Scientifique seek an houror two of consultation about NLM's automatedprocedure for handling serials and to inquire intohow MEDLARS 111 will change that procedure Adelegation of information specialists from theInstitute for Scientific and Technical Informationof China have been taken on a tour of theLibrary Now they want to pursue some questionsin greater depth, particularly the operational detailsof NLM's journal article indexing who choosesarticles to be indexed' if not all indexing is doneat NLM by in-house staff, how is quality controlexercised' how much does indexing cost' howlong does it take to index an issue of a journal'and so on They leave, as most visitors do, withsome answers and some further questions,stimulated by what they have seen and heard1hey will bring both back to their home institu-tions Many will write for more information, come-back for another visit They have become part ofNLM s circle of acquaintances

69

Table 11International MEDLARS Centers

Country

Australia

Canada

Colombia

France

Germany (KM!)

lialy

Japan

Kuwait

Title o]

South Africa

Sweden

Swit/.crland

Initcd Kingdom

Intergovernmental

Nanorul Library of Australia

(NLA)

Canada Institute lorScientific1 and Technical

Information (CISTI)

I'anamcncan Federation olAssociations ol MedicalSchcxils (PAFAMS)

Institut National de la

Same et dc la Recherche

Mcdicale (INSERM)

Dcutsches Insiitut fur

Medi/amschc I )okumcnianon

Istituto Superior; di Sanita(ISTI.SAN)

Japan Information Ccnicr ol

Science and Technology

(JICST)

Arab Centre for Medical

Literature

Ccfitro Nacional de Informationy Documentation en Salud(CK.NIDS)

Institute tor Medical Literature

K.irohnsk.i Insiitulei

DokunieiilationsdieiiM derSchwci/'crischcn Akademie der

Mcdmnisi hen Vi'isseiischalien(DOKDIl

The British l.ibrarv

(.entro Linno Americano deInlorm.u.io em (.lentus d.iSaude (HIRBI1')

Sponsoring Organization

National Library of Australia

National Research Council

COI.CIF.NC1AS, ColombiaICI'I'S, Colombia

Mmistcrc de la Same Publique

ct dc la Sccurne Socialc

Der Itundeniinister fur Jugend

Famihe und Gcsundlieit

Ministero Delia Sanita

Science and Teclinolo|<y AHCIIC\

of I'uhlii Health

Ministr\ ol Health and Wellare

South Alriun Medic.il Research

(.ouni.il

Swedish Medical Research( oiimil

Schwei/erisc'hc- Akademie derMedi/inisehen ^'isscnschalicn

I he llnnsh l.ihi.ir\

I'.in American Health

International Organi/ations

NI.M is linked to opposite numbers abroadthrough membership in the International Council

for Scientific and Technical Information (ICSTI).This organi/ation serves as a meeting ground forinformation and abstracting agencies, commercial

and governmental in a number of countries

around the world including the United Kingdom,France, Germany, South Africa, Netherlands,Canada, Japan and the USSR. Common interests

include economics of primary and secondary

publications, trans-border flow of information,

electronic publication, standardixation and the

information needs of developing countries

70

AdministrationKenneth G. CarneyExecutive Officer

Financial Resources

In FY 1985, the National Library of Medicine hada total budget authority of 555,848,000 Table 12displays the FY 1985 budget authority plus reim-bursements from other agencies, and the allocationof these resources by program activity

Table 12Financial Resources and Allocations FY 1985(in thousands of dollars)

Budget authorityAppropriation, NI.M . $55,910Funds withheld pursuant to P I.

98-473 . . . -62

Subtotal 55,848

Plus Reimbursements . 1,912

Total 357,760

Budget allocationKxtramural Programs $12,240Intramural Programs and Services 39,384

Library Operations . (26,429)Lister Hill National Center

for Biomcdical Communications (8,451)Toxicology Information (4,504)

Research Management and Support 6,136

Total. $57,760

Personnel

John E. Anderson was appointed Director, Infor-mation Systems in November 1984. He hadpreviously served as a Special Expert in the Officeof the Director, NLM with responsibility forproviding advice and technical direction for thecomputeri/ation of library activities.

Duane W. Arenales was appointed Chief of theLibrary's Technical Services Division (TSD) inFebruary 1985 Ms. Arenales has been at NLMsince 1971. In 1978, she was named head of theLoan and Stack Section of the Reference ServicesDivision, and in 1981 she was appointed DeputyChief, TSD.

Eve-Marie Lacroix was appointed Chief,Reference Services Division, LO, in March 1985Ms Lacroix was former Head, Information Services,Canada Institute for Scientific and Technical Infor-mation (CISTI), where she was responsible fordeveloping and maintaining ClSTI's nationalcomputerized information systems and services.

Roy F Rada, M.D., was appointed Head,Medical Subject Headings (MeSH) Section/Editor ofIndex Medicus in September 1985. Dr Rada hadpreviously served as a Research Medical Officer inthe Computer Science Branch, Lister Hill NationalCenter for Biomedical Communications.

Henry W. Riecken, Ph.D., was appointed as aSpecial Expert in December 1984, and has beenActing Associate Director for Planning and Evalua-tion Dr. Riecken is a former Professor ofBehavioral Sciences at the I'niversity ofPennsylvania School of Medicine.

Philip M Teigen, Ph.D , was appointed DeputyChief, History of Medicine Division, LO, inOctober 1984 Dr Teigen was formerly anAssistant Professor in the Department ofHumanities and Social Studies in Medicine at

71

McGill University, Montreal, CanadaWilliam G Cooper, Ph D , resigned from his

position of Associate Director for ExtramuralPrograms effective October 1985 Dr Cooperjoined the staff of NLM in 1979 In December1980, he was appointed Associate Director forPlanning In addition to this responsibility, he-served as Acting Deputy Director for Research andEducation, from October 1981 to June 1982, withresponsibility for administering the programs ofthe Lister Hill National Center for BiomedicalCommunications In October, 1982, Dr Cooperassumed responsibilities as Acting AssociateDirector for Extramural Programs and was namedpermanent Associate Director in March 1984

Calvin H Plimpton, M D , resigned from hisposition of Special Assistant for InternationalPrograms in November 1984 He held this positionsince October 1983 Dr Plimpton resigned tobecome the President of the American Universityof Beirut, Lebanon

Jacque-Lvnne Schulman resigned from herposition of Head, Circulation and Control Section,Reference Services Division (RSD), in October1985 Ms Schulman had been with NLM sinceSeptember 1983 and had previously served as theAssistant Section Head of the Reference Section,RSD

Linda A Watson resigned from her position ofHead, Audiovisual Resources Section, ReferenceServices Division, in October 1985 Ms Watsoncame to NLM in August 1975 In May 1980 shewas appointed Chief, Materials Utili/ation Branch,National Medical Audiovisual Center (NMAC) Withthe reorganization of NMAC in October 1982, theBranch was transferred to the Division of LibraryOperations and retitled Audiovisual ResourcesSection Ms Watson has been appointed Director

of Information Services, Houston Academy ofMedicine

Awards

Henry M Kissman, Ph I ) , Associate Director forSpecialized Information Services, received the N1HDirector's Award 'for his foresight and leadershipin developing and improving the availability ofcritical lexicological information for the biomedicalcommunity

NIH Merit Awards were presented to

John E Anderson, Director, Information Systems,"tor his skillful management of the MEDLARS 111development and exceptional direction of NLM'scomputer and communications systems "

Frances M Howard, Fxtramural Programs, 'forher dedication and meritorious contributions tothe National I ibrary of Medicine and the NationalInstitutes of Health

Mamie 0 Toler, Division of Library Operations,' exceptional contributions to maintaining theresponsiveness ol the NLM collection to the needsot the biomedical communit\ "

Jacqueline Van de Kamp, Division of LibranOperations' tor outstanding instruction on MeSHand indexing procedures and assistance to healthprofessionals and librarians in training classes "

The NLM Directors Award was presented toKarm K Colton, Committee Management Assistant,Division ot hxtramural Programs, "in recognitionot her outstanding performance of the manyfaceted duties involved in the management of theexternal advisory committees and Boards of theNational Libr,ir\ of Medicine

72

Equal Employment Opportunity

The purpose of the NLM EEO program is toprovide equal employment opportunity for allemployees regardless of race, religion, sex, nationalorigin, color, age, or handicap. Our institutionalresponsibility for accomplishing these objectives isspecified within our Affirmative Action Plan.

The NLM EEO Open Meeting was one of thehighlights of this year's activities. The meeting,attended by more than 150 NLM employees, washosted by a panel composed of the NLM AssociateDirectors, the Executive Officer, Personnel Officer,EEO Officer, and the Chairperson of the EEOCommittee. In addition to hearing presentations onmaternity and paternity leave guidelines andorgani/ational statistics related to EEO, thoseattending had the opportunity to participate in anactive question and answer session wiih panelmembers on EEO issues.

Two employees received the NLM KEO SpecialAchievement Award this year: Ms. Jackie Mikail,Librarian and coordinator of the NLM LibraryAssociates Program, Library Operations, and Ms.Louella Thomas, Technical Information Specialist,Library Operations.

Table 13Staff, FY 1985 Full-Time Equivalents (FTEs)

Program fuMim OtherPermanent

Office of the Director 16 1

Office of Inquiries andPublications Management 5 1

Office of Administration 45 6

Office of Computer andCommunications Systems 61 5

Extramural Programs 20 2

Lister Hill National Centerfor BiomedicalCommunications 76 9

Specialized InformationServices 28 5

Library Operations 232 20

Total 483 49

Total FTE Usage 532

73

Appendix 1: Staff Bibliography

e following works were published byNational Library of Medicine staff in FY 1985

Black, I) E Effectiveness of the women-owned business set-aside contracting goals aregression analysis Policy Studies Reinew 5(1)21-32, 1985

Black, D E Effectiveness of the mandatoryminority business set-aside contracting goals aregression analysis In Proceedings of the 1985Federal Acquisition Research Symposium FortBelvoir, VA, Defense Systems Management College,1985, 447-454

Cosmides, GJ I ' S catalogs library materialson animal testing alternatives The Johns HopkinsCenter for Alternatives to Animal Testing News-letter 3(2) 2-3, Winter 1985

Doszkocs, T E Natural language processing inintelligent information retrieval In ftoceedings ofthe Association for Computer Machinery (Denver,Col, October 14-16, 1985) New York] NY,Association for Computing Machinery, 1985,356-359

Graitson, M M SNOMED as a knowledgebase for a natural language understanding programIn Cote', R A , Frotti, D J and Sherrer, J R (Eds)Kole of Informatics in Health Data Coding andClassification Systems New York, North Holland,1985, pp 179-189

Harless, W G Technological Innovations inMedical Education—the TIME project Proceedingof the American Association for Medical Systemsand Informatics 3 391-394,1985

Henderson, E and Thoma, G Opticaltechnology impact on information transfer MooreJ (Ed) The Bowker Annual of Library & BookIrade Information New York, R R BowkerCompany, 1985, pp 190-194

Humphrey, S M We need to bridge the gapbetween computer and information science ASISIMetm 11(2) 25-27, 1984

Kaldor, G and Rada, R A hierarchiclaboratory interpretiveexpert system on amicrocomputer Government Laboratory 3(1)18-27, March 1985

Kissman, H M and Wexler, P Toxicologyinformation systems a historical perspectiveJournal of Chemical Information and ComputerSciences 25(3) 212-21", 1985

Knvats\ , P Review of Johannes von Muralt(1645-1733) Art/ t , Chriung, Anatom, Naturforsch,Philosoph (Horsihung, I ' , eel) Journal of theHistory of Medicine, 4(> 96-97, 1985

Locatis, ( and I.unm, M DesigningMicrocomputer Patient Management SimulationsSpringfield, Va , National Technical InformationService, 19H-i, 9-4 pages

Loc.uis ( and C.irr, V Selecting authoringsystems Journal <>/ ( omputer-Based Instruction12(2) 28-31 1985

Locatis ( and C.irr, V Factors to considerwhen choosing an authoring svstem Computers inLife Science' 1-dncatioii 2 (1) 5-", 1985

Locatis (, and C.irr, V Systems lor AuthoringComputer-bdsi'd Instruction Springfield, V a ,National 1 ethnical Information Service, 1985,62 pp

74

Locatis, C , Weisberg, M , jnd 'loothman, JPConversation and discourse in iiistruuionaldevelopment Journal of Instructional Development7(2) 20-23, 1984

Matheson, N and Lmdbcrg, I) A 15 Subgroupreport on medical information science skillsJournal of Medical Education 59(1 I , pt 2)155-159, 1984

Mehnert, R B National Librar\ of MedicineIn Moore, J (Ed ) The Hou'ker Annual of library£ Hook Trade Injormation New York, R RBowker, 1985, pp 159-163

Mehnert, R B The I'nited States NationalLibrary of Medicine Az Orrost Konyvlaros 25(4)32^-354, 1985

Mitchell, J A , Davenport, S 1. M , Hefner, M A ,Chang, M , and Kmgsland, I. (, I I I The approachto an expert consultant svstem in deal-blindsyndromes In Cohen, G S (Hd ) Proceedings ofthe Eighth Annual Symposium on ComputerApplications in Medical Care (Washington, D C ,November 4-7, 1984) Los Angeles, I I ' M E ComputerSociety, 1985, pp 50-53

Page, N I ' , Hudson, V , and Arthur , JIdentilication and Evaluation o/ Sources for theToxicology Data Hank Springfield, VA, NationalTechnical Information Service, 1985, 175 pp

Page, N P and Kissman, II M On-line sourcestor toxicology and safety data In Bennett, G andBernard, H (Eds) Proceeding <>/ the NationalConjerence and Inhibition on Hazardous Wastesand Environmental Emergencies (Toxicology andHealth) Silver Spring, MI), Hazardous MaterialsControl Research Insti tute, 1984, pp (09-412

Parascandola, J Industrial research comes ofage the American pharmaceutical industry,1920-1940 Pharmacy in History 11 12-21, 1985

Parascandola, J Patent medicines innineteenth-century America Caduceus 1 1-39,1985

Rada, R AI languages should expressgradualness In Jernigan, R , Hamill, B , Wemtraub,I) (Eds) Role o/ language in Problem SolvingNew York, North-Holland, 1985, pp 61-82

Rada, R Classification and publication Sigbio(Special Interest Group on Biomedical Computing]Newsletter 1(\) 21-24, 1985

Rada, R Do VDT's cause fetal damage' Oh-Gyn World 1(5) "MO, December 1984

Rada, R Gradualness facilitates knowledgerefinement IKEE Transactions on Pattern Analysisand Machine Intelligence Vol PAMI-7(5) 523-530,1985

Rada, R Preview of the session "Issues mknowledge-base development " In Cohen, G S( E d ) Proceedings of the Eighth Annual Symposiumon Computer Applications in Medical Care(Washington, D C , November 4-7, 1984) LosAngeles, IEEE Computer Society, 1985, p 49

Rada, R Probabilities and predicates inknowledge refinement. In Proceedings of the IEEEWorkshop on Principles of Knowledge-Hosed Systems(Denver, Col , December 3-4, 1984) Los Angeles,IEEE Computer Society, 1985, pp 123-128

Rada, R and Kaldor, G Computerisedevaluation of acid-base disorders based on a nine-cell decision matrix Journal of Medical andbiological Engineering and Computing 23(3)269-273, 1985

75

Rada, R and Mill H A statistically builtknowledge base Proceedings of Expert Systems inGovernment Los Angeles, IEEE Computer SocietyPress, 1985, pp 457-463

Rada, R , Blum B Riche, E , Jean, S andSneiderman, B Application of computer languagesto practical problems In Jcrnigan, R , Hamill, B ,Wemtraub, D (Eds) Role of Language in ProblemSolving New York, North Holland, 1985, pp309-337

Rada, R , Brown, E , Coccia, C , Humphrey,S , and Suh, M Improved retrieval throughtraversal of a knowledge-base In Proceedings ofExpert Systems in Government Los Angeles, IEEEComputer Society Press, 1985, pp 532-537

Rada, R , Humphrey, S , and Coccia, C Aknowledge-base for retrieval evaluation InProceedings of the Association for ComputerMachinery (Denver, Col, October 14-16, 1985)New York, Association for Computing Machinery,1985, pp 360-367

Rada, R , Rhine, Y , and Smallwood, J Rulerefinement In Cohen, G S (Ed) Proceeding* ofthe Eighth Annual Symposium on ComputerApplications in Medical Care (Washington, D C ,November 4-7, 1984) Los Angeles, IEEE ComputerSociety, 1985, pp 62-65

Schoolman, H M The impact of electroniccomputers and other technologies on informationresources for the physician Bulletin of the NYAcademy of Medicine 6l(3) 284-290, 1985

Seibert, W F How libraries grow a brief lookbackward (and forward) Journal of AcademicLibrananship 11(3) 19-23, 1985

Smith, K A National Library of Medicine, AlAYearbook 10 202, 1985

Sparks, S M Taking off a nurse's guide tostudying abroad Nursing Success Today 2(7) 1-8,July 1985

Teigen, P Review of A Directory of MedicalArchives in Ontario by Dunn, M Bulletin of theHistory of Medicine 58 614-615, 1984

Thoma, (1 R Electronic document storageand retrieval program status report In Provision ofFederal Government Publications in ElectronicFormat to Depository Libraries Washington, D C ,Joint Committee on Printing, 1984, pp 29-30

Thoma, G R Electronic storage and retrievalof medical document images In MedicalLibraries—One World Resources Cooperation,Services Proceedings o/ the Fifth InternationalCongress on Medical Librananship (Sept 30-Oct4, 1985, Tokvo) Tokyo, Keio I'niversity, 1985,pp 750-756

Thoma, G R Facsimile technology a reviewIn Reedijk ( , , et al (Eds) Large Libraries andNew Technological Developments New York, K GSaur, 1984, pp 71-92

Thoma, G R Linking bibliographic citationretrieval to an electronic document imagedatabase Proceedings oj the American Society forInformation Science 2\ 190-194, 1984

Thoma, G R , Cookson, J P , and Walker, F LIntegration of .in optical disk subsystem into anelectronic document storage and retrieval systemIn Proceeding of the /9#5 Videodisc, Optical Disk,and CD-ROM Conference (Philadelphia, Pa ,December 9-12, 1985) Westport, CT, MecklerPublishing Co , 1985, pp 180-185

76

Thoma, G.R., Suthasinckul, S., Walker, F.,Cookson, J., and Rashidian, M A prototypesystem for the electronic storage and retrieval ofdocument images. Association Jor ComputingMachinery- Transactions on OJJice InjurinationSystems 3(3): 279-291, 1985

Tilley, C. and Kenton, I ) . The MEDLARSpricing algorithm. In Wood, M S. (Ed.) CostAnalysis, Cost Recovery, Marketing, and Fee-BasedServices New York, The Haworth Press, Inc.,1985, pp 83-94.

Vasta, B.M.: TOXNET debuts on MEDLARS.Information Today 2(1). 12, July/August 1985.

Willmering, W Check-in for indexing NLMserial control system. In Stine, D (Ed ) Projectsand Procedures for Serials Administration. AnnArbor, Ml, Pierian Press, 1985 pp 277-286.

Willmering, W . Developing performancestandards for library staff responses. In Melin, N.(Ed.): Proceedings of the Third Annual SerialsConference. Westport, CT, Meckler Publishing Co.,1984, pp 49-53.

Woods, J.W.Jones, RR, Kuenz, MA, Seihert,W b', and Moore, RL. The optical videodisc incomputer based education In Cohen, (i S (Ed.):Proceedings of the Eighth Annual Symposium onComputer Applications in Medical Cure(Washington, D.C., November 4-7, 1981). LosAngeles, IEEE Computer Society Press, 1985, pp.937-940

77

Appendix 2: Extramural ProgramsSupported Publications

Ancona-Bcrk, A Overview of cost studies ofhospitali/ation In Taintor Z , Widem, P , CareetS A (Eds) Cost Considerations in Mental HealthTreatment Settings, Modalities and ProvidersWashington, DC , I ' S Government PrintingOffice, 19-24, 1984

Beck, J R and Meier, F A Bayesian strategiesin spontaneous bacterial peritonitis integration oftest selection into clinical decision analysesScandinavian Journal oj Clinical and Laboratory'Investigation 44 97-112, 1984

Beck, J R , Pyle, K I and Lusted L B Acitation analysis of the field of medical decisionmaking, 1959-1982 Medical Decision Making, 4449-469, 1984

Blois, M S Injormation and Medicine, TheNature of Medical Descriptions Berkeley and LosAngeles, California, I 'niversity of California Press,1984, 298 pp

Bloomquist, Harold J Interview by KstelleBrodman 18-19 April 1978 Oral history interview,Medical Libran Association, Chicago

Boyce, B R , et al The DAPPOR answerevaluation program Information 'technology andLibraries 3 300-309, 1984

Bra/icr, Mary A B A History <>/Neurophysiology in the nth and 18th Centuriesfrom Concept to Experiment N Y , Raven Press,1984, 2W pp

Buchanan, B (i and Shortliffe, F. H Rule-liased Ex[>ert Systems The MYCIN Experiments ofthe Stanford Heuristic Programming ProjectReading, Massachusetts, Addision-Wesley PublishingCo, 1984, 748 pp

(lam, Kevin, C , Greenes, Robert A and Begg,Colin B Patient-Oriented Performance Measures otDiagnostic Tests Medical Decision Making 433-46, 1984

Califf, R M , et al Outcome in one-vesselcoronary ariery disease Circulation 67 283-290,1983

Prognostic value of ventriculararrhythmias associated with treadmill exercisetesting ischcmic heart disease Journal of theAmerican College of (.ardiolog}' 2 1060-1067,1983

Left mam equivalent coronaryartery disease its clinical prognostic significancewith nonsurgical therapy The American Journal ofCardiology S3 1489-1495, 1984

Chalmers, Thomas ( , , et ,il Bias in treatmentassignment in controlled clinical trials The NewEngland Journal of Medicine 309 1358-1361, 1983

Chalmers, Thomas C Triage Fromgovernment to institutions Mt Sinai Journal ofMedicine 51 101-103 1984

Keynote Address The need forrandomi/.ecl control trials Journal of ClinicalApheresis 1984

Glances, WJ and Shortliffe, E H Readings inMedical Artificial Intelligence The First DecadeReading, Massachusetts, Addison-Weslcy PublishingCompany, 1984, 512 pp

D'Agostmo, I I J ) r , et al Effect of verapamilon left ventricular function at rest and duringexercise in normal men Journal of CardiovascularPharmacology 5 812-8P, 1983

Gibbons, R |, et al The use of radionuclideangiograph\ in the diagnosis of coronary arterydisease, a logistic regression analysis Circulation68 74(P4d, 1984

Assessment of regional leltventriculai function using gated radionuclideangiographv The American /ournal of Cardiology54 294-300, 1984

78

Goffman, W and Pao, M L Informatics inschools of medicine In World Con/entice ofMedical Informatics (MI'DINf-'O) New York, NorthHolland Publishing Co , 198V pp 103^-1039

Grant, A 0 , Starmer, C K and Str.iuss, H CI'nitary sodium channels in isolated cardiacmyocytes of rabbit Circulation Research 53823-829, 1983

Grccnbcrg, E R and Beck, | R The effects ofsample si/.e on reticuloycte counting and stoolexamination Archives of Pathology andLaboratory Medicine 108 396-398, 1984

Greenes, Robert A InteractiveMicrocomputer-Based Graphical Tools torPhysician Decision Support Medical DecisionMaking 3 15-21, 1983

Toward more effectiveradiologic consultation design of a desktopworkstation to aid in the selection and interpre-tation of diagnostic procedures Eighth Conferenceon Computer Applications in Radtolog) 1-9, May1984

Greenes, Robert A , Begg, Colin B , Cam,Kevin C , Swet.s, John A , Feehrer, Carl K andMcNeil, Barbara J Patient-OrientedPerformanceMeasures of Diagnostic Test Medical DecisionMaking 4 18-31, 1984

Grob, Gerald N The Inner World ofAmerican Psychiatry, 18W-W40 New Brunswick,New Jersey, Rutgers l 'nivcrsit\ Press, 1985, 310PP

Mallam, Bertha B Interview by Nancy W/inn, 12 May 1978 Oral history interview,Medical Library Association, Chicago

Harrell, F F Jr and Lee, K I. Regressionmodelling strategies for improved prognosticprediction Statistics in Medicine 3 h3 152, 1984

Herskowit?,, I H (Ed) "Bibliography onDrosophila " In Drosopbila Information Service,No 58, 1982, pp 227-270 and No 59, 1983,pp 162-257

Hewitt, P and Chalmers, T C UsingMEDLINE to peruse the literature ControlledClinical Trials 6 75-83, 1985

Hlatky, M A , et al Diagnostic test use indifferent practice settings A controlledcomparison Archives of Internal Medicine 1431886-1889, 1983

Natural history of patients withsingle-vessel disease suitable for percutaneoustranslummal coronary angioplasty The Americanjournal of Cardiology 52 225-229, 1983

Factors affecting sensitivity andspecificity of exercise electrocardiographymultivanable analysis The American Jounial ojMedicine 77 64-71, 1984

Jarcho, Saul "Some Early ItalianEpidemiological Maps," Imago Mundi, The Jounialoj the International Society for the History' o/Cartography, 1983, pp 9-19

Jokl, Ernst Introduction Medicine and Sport1 1 1-28, 1978

Sudden Death of AthletesSpringfield, Illinois, Charles C Thomas Publishing,1985 pp 124

Jones, M Irene Interview by EstelleBrodman, 9 October 1978 Oral history interview,Medical Library Association, Chicago

Kahn, TJ and Orr, C Biocthicslme anoverview for searchers Medical Reference ServicesQuarterly 3 1-21, 1984

79

Kahn, Tamar Joy: "New Search Element inBIOETHICSLINE", NLM Technical Bulletin,No. 177, January 1984, pp. 10-14.

Kahn, Tamar Joy, and Orr, Cecily: "BioethicsDatabase Restructured", NLM Technical Bulletin,No. 163, November 1982, pp. 6-10.

Kinney, Jo Ann: Human Underwater VisionPhysiology and Physics. Bethesda, Maryland,Undersea Medical Society, Inc., 1985, 179 pp.

Kuipers, B. and Kassirer, J.P.: Causal reasoningin medicine: analysis of a protocol. CognitiveScience 8: 363-385, 1984.

How to discover a knowledgerepresentation for causal reasoning by studying anexpert physician. International Joint Conference onArtificial Intelligence 49-56, 1983

Kuipers, B. Programs that understand howthe body works. Institute of Electrical andElectronic Engineering—Computer Society • StockerSymposium and Workshop 1-8, 1983.

: Commonsense reasoning aboutcausality: deriving behavior from structure.Artificial Intelligence 24: 169-203, 1984

: Expert causal reasoning andexplanation. American Education ResearchAssociation, 1985 Annual Meeting, Chicago,Illinois. 1-26, March 1985.

: The limits of qualitativesimulation. Paper to be presented at the. NinthInternational Joint Conference on ArtificialIntelligence. Los Angeles, CA. August 18-23, 1985.

Kwoh, C Kent, Beck J.R., and Pauker, S.G :Repeated syncope with negative diagnosticevaluation To pace or not to pace? MedicalDecision Making. 4: 351-378, 1984.

La Berge, Ann F "The Early Nineteenth-Century French Public Health Movement TheDisciplinary Development and Institutionali/ationof Hygiene Publique," Bulletin of the History ofMedicine, 58, 1984, pp. 363-379.

Lampe, Kenneth F. and McCann, Mary Ann:AMA Handbook oj Poisonous and InjuriousPlants, Chicago, Illinois, American MedicalAssociation, 1985, 432 pp

Lee, K L., et al Secondary prevention trials inpost-myocardial infarction patients: methodologicissues. In Kulbertus, Wellens (Eds.). The First YearAfter a Myocardtal Infarction. New York, FuturaPublishing Co., 1983, pp. 407-419.

A comparison of test statisticsfor assessing the effects of concommitant variablesin survival analysis. Biometrics 39: 341-350, 1983.

Sefer Hanisyonot, The Book of MedicalExperiences Attributed to Abraham Ibn EzraTranslated and edited with a commentary by J.D.Leibowitx and S. Marcus Jerusalem, The MagnesPress Hebrew University, 1984, 345 pp

Long, William J Reasoning about state fromcausation and time in a medical domain. AmericanAssociation of Artificial Intelligence. 1-4, 1983.

Long, William J., and Russ, Thomas A.. Acontrol structure for time dependent reasoning.International Joint Conference on ArtificialIntelligence 1-3, August 1983.

McCarthy, Jane C.: RESCUE: An audiovisualrescue squad consortium Bulletin of the MedicalLibrary Association. 73' 61-63, 1985.

Magoun, H.W and Fisher, Charles: "Walter R.Ingram at Ranson's Institute of Neurology,1930-1936," Persi)ectwes in Biology and Medicine,Autumn 1980, pp 31-56.

"John 15 Watson and the Semantic relevance vsStudy of Human Sexual Behavior," The Journal ojSex Kesearch 174, November 1981, pp 368-378

Mark, D B , et al Clinical characteristics andlong-term survival of patients with variant anginaCirculation (V 880-888, 1984

Marshall, Louise H "The l-ecundn\ ofAggregates The Axonologists at WashingtonI'mversity, 1922-1942, Perspectires in Miolofy andMedium 264, Summer 198^, pp 613-636

Masson, Jeffrey Moussaieff (Trans ,md Ed)The Complete Letters <>/ Sigmund l-'reud to Wilhelmh'liess IM7-I<)04 Cambridge, Massachusetts, TheBelknap Press of Harvard I'mversity Press, 1985,SOS pp

Mohtch, M E , Beck, J R , Dreisman, M ,Gottlieb, J E and Pauker, S G 77v (.old ThroulNodule An Analyst* oj Diagnostic and TherapeuticOptions Endocrine Reviews, 5 185-199 1984

Morrison, Alan S , Kirshner, Julius, and Molho,Anthony "Epidemics in Renaissance Florence",American Journal <>/ Public Health 75 S, May1985, pp 528-535

Nomma Histologica, Second Edition Preparedby the International Anatomical NomenclatureCommittee In Nomma Anaiomica, Hrth EditionBaltimore, Williams & Wilkms, 1983, 31 pp + ix

()ls/.ewski, Waldemar 1. Peripheral l.vmph/•'ormation and Immune Function Bota Raton,Florida, CRC Press, I no , 1985, Kr pp

Pao, M L Semantic and pragmatic retrieval Inl'roceedinf>s o/ the American Society forIn/ormalion Science Annual Meeting Philadelphia,American Society tor Information Science,134-136, 1984

pragmatic relevance In Proceedings of the 6thInternational Conference of Cybernetics andSystems Paris, 1984

Paul, Ramesh S , Szolovit/, Peter andSchwartz, William B Causal understanding ofpatient illness in medical diagnosis InternationalJoint Conference on Artificial Intelligence, 893-899,1981

Pople, H E , J r , CADl'CEl'S An experimentalexpert system for medical diagnosis In Winston,P 11 and Prendergast, K A (Eds) The Al Husiness.The Commercial Uses of Artificial Intelligent.!.' MA,The MIT Press, 67-80, 1984

Pritchett, E I. , et al Life-table methods torevaluating anti-arrhythmic drug efficacy m patientswith paroxysmal atrial tachycardia The Americanloumal of Cardiology 52 1007-1012, 1983

The spontaneous occurrence ofparoxysmal supraventricular tachycardiaCirculation 70 1-6, 1984

Pryor, I) B , et al An improving prognosisover time in medically treated patients withcoronary artery disease 777f American Journal ofCardiology 52 444-448, 1983

Estimating the likelihood ofsignificant coronary artery disease The AmericanJournal of Medicine ~t<> 771-780, 1983

Prognostic indicators fromradionuclide angiography in medically treatedpatients with coronary artery disease TheAmerican Journal of Cardiology 53 18-22, 1984

The effects of crossovers onestimates of survival m medically treated patientswith coronary artery disease Journal of ChronicDiseases 37 521-529, 1984

81

Quarterly Bibliography of Major TropicalDiseases Vol 8, No 1, First Quarter, 1985

Reitcr, M J , et al Efficacy, safety, andpharmacokmctics of a concentration-maintainingregimen of intravenous pirmenol The AmericanJournal of Cardiology 52 83-87, 1983

Reiter, M J and Pntchett, E L Clinicalpharmacology of calcium channel hlockersverapamil, diltia/em, nifedipme Recent Advancesin Clinical Pharmacology 107-127, 1984

Investigation! antiarrhythmicagents pirmenol Clinical Cardiology 7 330-334,1984

Roark, S F and Pntchett, E L New therapyupdate Cardiovascular Revteu's £ Reports 5599-60, 1984

Roberts, K B , et al The prognosis forpatients with new-onset angina who haveundergone cardiac catheten/ation Circulation 68970978, 1983

Rothert, M L , et al Differences in medicalreferral decisions for obesity among familypractitioners, general internists, and gynecologistsMedical Care 22 42-55, 1984

Sacks, H S , Rose, D N , Chalmers, T CShould the Risk of Acquired ImmunodeficiencySyndrome Deter Hepatitis B Vaccination' ADecision Analysis The Journal of the AmericanMedical Association 252 3375-3377, 1984

Sacks, H S , Chalmers, T C , Berk, A , Reitman,D Should mild hypertension be treated' Anattempted meta-analysis of the clinical trials MtSinai Journal oj Medicine 52 265-270, 1985

Savitt, Todd L "Lincoln University MedicalDepartment • A Forgotten 19th Century BlackMedical School," Journal of the History ofMedicine and Allied Sciences, 40, 1, January 1985,pp 42-65

Shand, D G and Pntchett E L The role ofpharmacokmetic studies in establishingantiarrhythmic drug efficacy In Lucchesi, B R ,Dmgell, | V and Schwar/, RP Jr (Eds) ClinicalPharmacology of Antiarrhythmic Therapy NY,Raven Press 1984, pp 167 174

Sheridan, Richard B Doctors and Slaves AMedical and Demographic History of Slaver}' inthe Hrttish West Indies 1680-1814 Cambridge,Cambridge University Press, 1985, 420 pp

Sievert, MaryEllen C , and Boyce, Bert BEvaluating DAPPOR as a learning tool 8tb Inter-national Online Information Meeting Oxford,Learned Information L t d , 519-523, 1984

Smith, Dale C (hd ) On the Causes of l-evers(I8W) by William Kudd Baltimore, The JohnsHopkins University Press, 1984, 164 pp

Smith, H J r , Chan, S S , Chalmers, T C ,Reitman D , Sacks, H S , Peer review using apaired-comparison technique Medical Care 22412-417 1984

Smith, M S and Pntchett, E L Electro-cardiographic monitoring in ambulatory patientswith cardiac arrhythmias Cardiology Climes 1293-304 1983

Starkweather, |ohn A A User's Guide to I'llotNewjerse\ Prentice-Hall, Inc , 1985 246 pp

Starmer, C F Feedback stabili/ation of controlpolicy selection in data/knowledge based systems//•'/:/' l<)84 Proceedings of the InternationalConference on Data higineenng Silver Spring,Maryland, 1EFE Computer Society Press, 586-591,1984

Starmer, C F , Grant, A L , and Strauss, II CMechanism^ of use-dependent block of sodiumchannels in excitable membranes bv localanesthetics Biophysical Journal 46 15-2"", 1984

82

Stevens, Rosemary "Sweet Charity Sute Aidto Hospitals in Pennsylvania, 1870-1910,' Hulletmof the History of Medicine 58, 3, Fall, 1984

Trask, N , et al Accuracy and mterohservervariability of coronary cmeangiography acomparison with postmortem evaluation Journalof the American College of Cardiology i 1145-54,1984

Virchow, Rudolf Collected /•s.say.s on PublicHealth and Epidemiology Edited and % ith aforeword by LJ Rather, M D , New Delhi,Amerind Publishing Co Pvt Ltd Distributed fromCanton, Massachusetts by Watson Publishing Inter-national, 1985 Vol 1, 619 pp , Vol 2, 614 pp

Viseltear, Ar thu r ] "Milton C Wmternitx andthe Yale Institute of Human Relations A BriefChapter in the History of Social Medicine," TheYale Journal of Hiology and Medicine, 5"?, 1984,pp 869-889

Walters, LeRoy, and Kahn, Tamarjoy (Eds)Dihliographv of Htoethic* Volume 10 Washington,D C , Kennedy Institute of Ethics, GeorgetownUniversity, 1984, 387 pp

Wiesel J , Rose, D N , SiKer, A 1., Sacks, H S ,Bernstein, R H Lumbar puncture in asymptomaticlate syphilis, an analysis of the benefits and risksArchtm of Internal Medicine 145 465-^68, 1985

Woodward, William R Introduction In TheWorks oj William James /fjwwp '" Psychology,Edited by Frederick Burkhardt Cambridge,Massachusetts, Harvard I'niversity Press, 1983, ppxi-xxxix

"Die Entdeckung' des

Yamamoto, W S Modelling and the controlof breathing modelling perspective In Whipp, BJand Wiberg, D M (Eds) Modelling and Control ofBreathing New York-Amsterdam-Oxford, ElsevierScience Publishing Co , 1983, pp 369-375

Analogies betweenmathematical models of physiological systems andrelational data bases Proceedings of the SixthAnnual Symposium on Computer Application*, inMedical Care Silver Spring, Maryland, IEEEComputer Society Press, 879-881, 1982

Computer simulation ofexperiments in responses to intravenous andinhaled CO, The Journal of Applied Physiology50 835-843, 1981

Zmchenko, V P , Leonova, A B , and Strelkov,Yu K The Psychometncs of Fatigue Translated inYugoslavia Printed in India London andPhiladelphia, Taylor & Francis, 1985, 83 pp

So/.ialbehavionsmus und der Theorie des so/,ialenLernen, 1890-1980," Perwnale I\vcholoye,Supplement, 1983, pp 59-71

83

Appendix 3: Board of Regents

TJLhc.he NLM Board of Regents meets three times a year to consider Library issues and policies and makerecommendations to the Secretary of Health and Human Services on matters affecting the Library

Appointed Members.

L Thompson Bowles, M D , Ph D (Chairman)Dean for Academic AffairsGeorge Washington University

Kdward N Brandt, J r , M D , Ph I)ChancellorUniversity of Maryland at Baltimore

Lois F. DeBakey, Ph DProfessor of Scientific CommunicationsBaylor College of Medicine

Russell L FenwickSenior Vice PresidentBank of America

Albert F Gunn, M I)Medical DirectorM 1) Anderson Hospital and Tumor Institute

John K Lope/.Fxecutive Vice PresidentMedicalelectrographic Sciences

David () Molme, I) D SAsst Professor of DentistryUniversity of Iowa

Ann K Randall, D L SChief LibrarianCitv College of CUNY

Grant V Rodkey, M DAssociate Clinical Professor of SurgeryHarvard Medical School

Eugene A Stead, J r , M DProfessor Emeritus of MedicineDuke University

Ex Officio Members

Librarian of Congress

Surgeon GeneralPublic Health Service

Surgeon GeneralDepartment of the Air Force

Surgeon GeneralDepartment of the Army

Surgeon GeneralDepartment of the N.ivv

Chief Medical DirectorVeterans Administration

Assistant Director for Biological, Behavioral, andSocial Sciences

National Suence Foundation

DirectorNational Agricul tural Librar\

DeanUniformed Services I n ivers i tv ot the

Health Sciences

84

Appendix 4: Board of ScientificCounselors

e Board ot Scientific Counselors meets periodically to review and make recommendations on theLibrary's intramural research and development programs

Members

Morris F Collen, M I) (Chairman)ConsultantPermanente Medical Group

Arthur S Elstcm, Ph 1)Professor of Health Professions EducationI'mversity of Illinois at Chicago

Leonard I) Fennmger, M 1)Vice PresidentAmerican Medical Association

Susan J drone, Ph I)Associate Professor of NursingI'nivcrsiu of Texas at Austin

Casimir A Kulikowski, Ph DProfessor of Computer ScienceRutgers University

Gwilym S Lodwick, M DDepartment of RadiologyMassachusetts General HospitalMitchell W Spellman, M DDean for Medical ServicesHarvard I'mversity Medical School

M Lucius Walker, Ph DDean, School of EngineeringHoward I'mversitv

85

Appendix 5: Biomedical LibraryReview Committee

Biomedical Library Review Committee meets three times a year to review applications for grantsunder the Medical Library Assistance Act

Memben

Anthony R AguirreDirector of LibraryPhiladelphia College of Physicians

Rachael K AndersonHealth Sciences LibrarianColumbia University

Marsden S Blots, J r , M D , Ph I)Professor of Medical Information ScienceUniversity of California, San FranciscoC Michael Brooks, Ed 0Director, Dept of PsychiatryI 'niv of Alabama School Medicine

G Anthony Gorry, Ph DVice President for Institutional DevelopmentBaylor College of MedicineRobert A Greenes, M D , Ph DDepartment of RadiologyBrigham & Women's HospitalBoston, Mass

Lillian Haddock, M DDean for Academic AffairsSchool of MedicineUniversity of Puerto Rico

Mary M llorresBiomedical LibrarianUniv ot C a l , San Diego

Donna P JohnsonDirector, Resource CenterAbbott Northwestern HospitalMinneapolis, Minn

Randolph A Miller, M DAssociate Professor of MedicineUniversity of Pittsburgh

Joyce A Mitchell, Ph DDirector Information Science GroupUniversity of Missouri-Columbia

Miranda I. Pao, Ph DAsso Prot ot Library ScienceCase Western Reserve UniversityD Dax Liylor, M l )Vice PresidentNational Board of Medical KxammersPhiladelphia

Homer K Warner, M D , Ph D (Chairman)Dept ot Medical Biophysics and ComputingUniv ot Utah School ol Medicine

86