nlm annual report of programs and services, 1986

• <NationalLibrary ofMedicinePrograms

Services

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FiscalYear1986

T . . - AU.S. DEPARTMENT OF HEALTHAND HUMAN SERVICES

Public Health ServiceNational Institutes of HealthBethesda, Maryland

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NationalLibrary ofMedicineProgramsanaServices

FiscalYear1986

IS DEPARTMENT OF HEALTHAND H U M A N SERVICES

Hublk Health ScrviicNational Institutes or HealthBeihcsda, Maryland

National Library of Medicine Cataloging in Publication

Z National Library of Medicine (U S )675 M4 National Library of Medicine programs and services —U56an 1977- - Bethesda, Md The Library, [1978-

v i l l , portsReport covers fiscal yearContinues National Library of Medicine (U S ) Programs and services Vols for1977-78 issued as DHEW publication , no (NIH)

78-256, etc, for 1979-80 as NIH publication , no 80-256, etcVols for 1981- available from the National Technical Information Service,

Springfield, VaISSN 0163-4569 = National Library of Medicine programs and services

1 Information Services - United States - periodicals 2 Libraries, Medical •United States • periodicals I Title I I Series DHEW publication , no 80-256, etc

Contents

Preface 5

A Historic Year 6

1986 Special Initiatives 10

Program Reports

Library Operations 16

Specialized Information Services 34

Lister Hill National Center for BiomedicalCommunications 39

Extramural Grants and Contracts 54

International Programs 64

Administration 68

Appendices

Appendix 1. Staff Bibliography 71

Appendix 2. Extramural Programs SupportedPublications 74

Appendix 3. Board of Regents 80

Appendix 4. Board of ScientificCounselors 81

Appendix 5. Biomedical Library ReviewCommittee 83

Appendix 6. Agendas of Major SesquicentennialEvents 84

Figures

1. Extramural Awards, 1966-1975 56

2. Extramural Awards, 1976-1986 57

Tables

1. Growth of Collections 18

2. Acquisition Statistics 19

3. Cataloging Statistics 22

4. Bibliographic Services 22

5. Online Searches 23

6. Offline Searches 26

7. Circulation Statistics 30

8. Reference Services 32

9. History of Medicine Activities 33

10. Extramural Grant and Contract Program 62

11. International MEDLARS* Centers 65

12. Financial Resources/Allocations 68

13. Staff 70

•Reg US Pai Off

Preface

administrative report, although it containsstatistics and descriptions of programs for fiscalyear 1986 (October 1, 1985, through September30, 1986), also reports on the Sesquicentennialactivities conducted by the Library for the entirecalendar year of 1986.

The Library's 150th year was a special one. Avariety of events —from the staff picnic to theformal banquet sponsored by the Friends of theNational Library of Medicine—was enjoyed byemployees, families, Regents, and friends. As abyproduct, the institution gained anunprecedented opportunity to educate manyhealth professionals and the general public aboutour important information services and productsMy personal thanks to all those who helped planand carry out our ambitious SesquicentennialYear observance, and especially to Dr. LoisDeBakey, past Regent and good friend of theLibrary, for her extraordinary efforts on ourbehalf.

1 believe that the program descriptionscontained in this report will show that, withinthe budget and staffing constraints imposed onFederal agencies, we continue to make steady

progress. The Library's Long Range Plan,completed this year and approved by the Boardof Regents, is a remarkable document that willhelp guide us in the coming years. The sectionof this report titled "1986 Special Initiatives"describes the Long Range Plan, including twoissues of great importance— biotechnologyinformation and the Unified Medical LanguageSystem.

The National Library of Medicine exists toserve all who seek health information. If it werenot for the exceptional cooperation we receivefrom Regents, consultants, MEDLARS partnersaround the globe, health professionals andmedical librarians everywhere, this would not bepossible. On behalf of the Library's staff, I wouldlike to express my appreciation to all thoseindividuals and institutions who work closelywith us to make the system function.

Donald A.B. Lindberg, M.D.Director

A Historic Year

Programs andServices. FY1986

L torn Bethesda to Bogota to Beijing, fromCanberra to Cairo, from Toronto to Tokyo, fromRegion 1 to Region 7, from the depths of NLM'sB-3 stacks to outer space, from 1836 to 2006,from the newest clerk-typist on the NLM staff tothe President of the United States: All wereinvolved in some way with the 150th anniversarycelebration of the National Library of Medicinein 1986.

Thousands visited the Library during the yearand, quite literally, millions more were reachedthrough various media. What follows is a briefdescription of some of the events and productsattendant on the celebration.

January• President Reagan signed the Proclamation

declaring 1986 the Sesquicentennial Year ofthe National Library of Medicine.

• A new, colorful Sesquicentennial brochure andposter were delivered from the printer, as wasa Literature Search on the National Library ofMedicine (LS 87-1).

• Articles about the Library appeared in IBMandTYMNET publications.

February• Early in the month there was a special

ceremony in the U.S. Capitol highlighting theJoint Resolution of the Congress honoring theNLM, passed late the previous year. Participat-ing were Rep. Claude Pepper, Senator StromThurmond, Board members of the Friends ofthe National Library of Medicine, and NLMstaff.

• A special all-day seminar for sciencejournalists, "Online for Medicine and theMedia," was attended by more than 100science writers and journalists. A highlight ofthe program was the first public demonstra-tion Of GRATEFULMED.

March• "Extramural Programs Week" was the occasion

of a number of events connected with theNLM grants activities, including an IAIMSSymposium,

• Among the special visitors this month werethe new HHS Under Secretary, Mr. Donald M.Newman, the National Library Week Partners(sponsored by the American Library Associa-tion), the Consortium of Universities (D.C.area), and a research group of the AmericanAssociation of Dental Schools.

• The Library's Toxicology Information Programreceived a special commendation for sustainedhigh quality services from the Society of Tox-icology on the occasion of theSesquicentennial.

April• A major exhibit in honor of the Sesquicenten-

nial was mounted in the Library's catalog area.Another NLM exhibit was put up in Ford'sTheatre, where the Library was located for 20years in the last century.

• An Open House, attended by 1,000 friends,neighbors in the community, and colleaguesfrom NIH was held.

• "Medicine and the Arts," an all-day collo-quium, was held in the Lister Hill Auditorium.The agenda is reproduced in Appendix 6.

May

• Lecture by Dr. Albert Sabin in the Lister HillCenter auditorium.

• Tribute to NLM at the World Health Assemblyin Geneva, Switzerland, by HHS Secretary OtisBowen.

• The CBSseries 'An American Portrait,"featured John Shaw Billings.

• Major NLM exhibits at the Medical LibraryAssociation and the American IndustrialHygiene Association.

June• Dinner/ceremony at Ford's Theatre sponsored

by the Friends of the NLM.• Group photograph of entire Library staff.• Visits to NLM by the Drug Information

Association, Society of Biological Chemists,and Association of Biomedical Communica-tions Directors.

• NLMexhibits at the annual meetings of thePublic Health Service Association and theAmerican Nurses Association.

• Region 7 hosts a special program in honor ofthe NLM's 150th.

July• Ceremony to open the Library's new Visitors

Center.• NLM staff picnic held at the Naval Medical

Research Institute.• Visits by the American Association of Law

Librarians and the Institute of Federal LibraryResources.

August• The new HHS Assistant Secretary for Health,

Dr. Robert E. Windom, toured NLM with hisstaff.

• Item about the Library on Paul HarveyNews—radio and television.

• A week of free interlibrary loans from NLM inhonor of the 150th.

• NLM exhibited at the American HospitalAssociation annual meeting.

September• "National Library of Medicine: Past, Present,

Future" held in conjunction with the Board ofRegents meeting (see agenda, Appendix 6).

• Barbecue on the Library grounds for staff andvisitors—sponsored by the Friends of theNLM.

• Public service announcements by Dr. MichaelDeBakey on behalf of the Library sent to radioand television stations around the nation.

• NLMexhibit sponsored jointly with the WorldCongress on Cardiology.

A Historic Year

Program andServices, FY1986 October

• MEDINFO 86-exhibit and tours of theLibrary.

• Foreign MEDLARS partners meet at NLM andobserve the Sesquicentennial.

• Day of free MEDLINE searching for NLM'sonline users.

• Exhibit about NLMat the Karolinska Institutein Stockholm.

• Region 2 features NLM at a special"Technology Fair."

• Special section on the Library in the Bulletinof the Medical Library Association.

November• One-day symposium on space medicine spon-

sored jointly by NLM and NASA (see agenda,Appendix 6).

• Exhibit at the American Heart Associationmeeting in collaboration with Region 5.

• Regions 1, 3, 4, 6 hold symposia and specialobservances on the Library's Sesquicentennial.

December• Week-long medical film festival held at NLMin

observance of the Sesquicentennial.• An exhibit honoring both NLMon its 150th

anniversary and NIH on its centennial wasinstalled outside HHS Secretary Bowen's office.

Selected BibliographyOver the year, there were a number of articlesabout the Library in the professional and publicpress. A selection of these articles, listedchronologically, follows:

Austrian, Geoffrey D. Nothing abstract abouttheir abstracts. Think. No. 1, 1986, 14-18.

National Library of Medicine. THUGSQuarterly. January 1986. 8-12.

Swick, Thomas. The National Library ofMedicine after 150 years. American College ofPhysicians Observer. February 1986. pp. 12-13.

The National Library of Medicine celebratesits Sesquicentennial. Library News. Dolph. B.Briscoe Library—University of Texas HealthScience Center at San Antonio. February 1986.p.l.

Rooney, Andy. Good news about govern-ment. The Frederick Post. February 15, 1986.[Syndicated column in 400 newspapers]

Mitric, Joan McQueeney. Spreading themedical word. The Washington Post, HealthSection. April 9, 1986. 10-11.

Colburn, Don. Medicine and its muses. TheWashington Post, Health Section. May 7, 1986.10-11.

Medical theater party. The New York Times.June 15, 1986. p. 40.

Lawrence, Susan V. Medicine and the arts:An ancient and persisting relationship. AmericanCollege of Physicians Observer. July/August,1986. p. 28.

Watson, Linda. National Library of Medicinecelebrates its sesquicentennial year. HoustonAcademy of Medicine—Texas Medical CenterLibrary. New Titles & News, Number 158. July/August 1986. pp. 4-5.

Schoolman, Harold M. The physician andthe medical librarian. Archives of Dermatology.Vol. 122, No. 8. August 1986. pp. 875-6.

Harvey, Paul. How your doctor keeps intouch. [Syndicated newspaper, radio, and tele-vision presentation about NLM] August 16, 1986.

National Library of Medicine celebratessesquicentennial. Journal of the AmericanVeterinary Medical Association. Vol. 189, No. 5.September 1, 1986. p. 503.

Cuniberti, Betty. Electronic library puts aworld of information at doctors' fingertips. TheLos Angeles Times. Part V. October 14, 1986.[Syndicated: L.A. Times/Washington Post NewsService],

150th birthday gala for NLM. AmericanLibraries. October 1986. p. 659.

Spotlight on the National Library ofMedicine. Levy Library News. The Mount SinaiMedical Center. October 1986. pp. 1-3.

Sesquicentennial of the National Library ofMedicine. Bulletin of the Medical LibraryAssociation. Vol. 74, No. 4. October 1986. pp.316-352. [Series of 5 articles with introduction).

Gamarekian, Barbara. A library of medicineturns 150. The New York Times. November 14,1986.

Baker, Peter. National medical librarycelebrates 150th anniversary. The WashingtonTimes. November 19, 1986. p. 6B.

National library of medicine marks 150 yearsof service. American Medical News. November14, 1986. p. 46.

Mehnert, Robert B. A world of knowledgefor the nation's health: The U.S. National Libraryof Medicine. American Journal of HospitalPharmacy. Vol. 43. December 1986. pp. 2991-97.

Culliton, Barbara J. "Friends" dance forlibrary of medicine. Science. 19 December 1986.p. 1493.

Jones, Jenkin Lloyd. Elimination of error:Guesses being replaced by instant recall. TheTulsa Tribune. December 27, 1986.

Lindberg, Donald A. B. National Library ofMedicine: The view at 150 years. Journal of theAmerican Society for Information Science.Vol. 38, No. 1. January 1987. pp. 34-39.

Cassedy, James H. National Library ofMedicine aids historians. The Federalist. Vol.8,No. 1. Spring 1987. p. 3.

A Historic Year

1986 Special Initiatives

Programs andServices, FY1986

Llast year's report described three "specialinitiatives": planning, Unified Medical LanguageSystem, and preservation. This section updatesthe Library's activities in planning and the UMLSand adds a section on biotechnology. Thechapter on Library Operations contains a sectionon the Library's continuing preservationactivities.

PlanningThe Board of Regents is charged with advisingthe Secretary of Health and Human Services onimportant matters of policy affecting the Library.Mindful of this duty, the Board two years agobegan to consider the Library's future in light ofthe increasingly important role of information inAmerican medicine and science The Regentstook note of the accelerated growth of themedical literature, the special challenges andopportunities presented by the scientific revolu-tion in molecular biology, and the remarkableadvances in electronic systems technology forstoring and communicating information. Suchtrends, they concluded, present NLM with anopportunity to play an even greater role inimproving the Nation's health by improvingbiomedical communications. Accordingly, theRegents requested that a long range strategy forthe Library's future be devised, and they soughtout the assistance of experts to develop it.

Physicians, nurses, dentists, veterinarians,librarians, editors, publishers, educators, and par-ticipants from industry, biomedical professionalassociations, information services, and healthinsurance companies enthusiastically respondedto the call. This broad diversity of occupationsand expertise reflects the constituencies of theLibrary and the variety of needs and interests it

serves. More than one hundred outstandingindividuals willingly gave their attention to theprocess by participating in or providing expertadvice to one of five planning panels.

Each panel addressed the future in one of thefive domains that encompass NLM's current pro-grams and activities. The domains, which pro-vided the panels a framework for thinking aboutthe future, are:

I Building and organizing the Library'scollection

II Locating and gaining access to medical andscientific literature

III Obtaining factual information from data basesIV Medical informaticsV Assisting health professions education

through information technologyThe panels worked from September 1985

through May 1986. At the end of the planningprocess, each panel formulated recommendationsand priorities for future NLM programs andactivities in the domain under its purview. Thefive panel reports were reviewed by the Board ofRegents in June 1986. They prepared a syn-thesized Plan reflecting their high priority initia-tives and an Executive Summary which together,represents the official Long-Range Plan of theBoard of Regents of the National Library ofMedicine. The Plan will be published in sevenvolumes in FY 1987 and made available to awide audience including Congress and theExecutive Branch, relevant professional com-munities, and the lay public.

The vision of the planners is both dazzling andsimple. They posit nothing less than a nation-wide system that will provide immediate,authoritative answers to questions posed byhealth professionals. Often these answers may

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come from systems based on the medicalliterature—either bibliographic or full text—butthey may also come from knowledge bases,expert systems, or other computer-based andnetwork-accessible collections of information.

The Board of Regents acknowledges that,although the Library's mandate clearly coverssuch a system, it would be wise for NLM toinvolve others in building it. The Library canprovide the vision and leadership, but it willrequire broad collaboration among academicinstitutions, national and international organiza-tions, professional societies, libraries, publishers,and computer hardware and software developersif such a goal is to be achieved.

The Plan embodies a central challenge to theNational Library of Medicine to strive to be cer-tain that health care in America and the advance-ment of biomedical research toward this end willbenefit from the technological discoveries thatare available to us now from computer and infor-mation science, telecommunicau'ons engineering,physics and chemistry. In the past, the Libraryhas established a distinguished record ofscholarly leadership in medicine. This Planemphasizes the present urgent need for improvedaccess by health-care professionals and scientiststo the fast growing scientific literature of newlydiscovered biomedical concepts, treatments, andpreventives—across a wide range of practicaland theoretical problems. The most encouragingaspect of the Plan is the recommendation thatthe Library move as quickly as possible totranslate the existing "raw" technology of com-puters, information, and engineering science intoproducts and services that through its insightand understanding of the special biomedicalpractices and needs can improve health care inAmerica.

The Plan clearly recognizes certain outstandingconsiderations. NLM's fundamental priority cer-tainly is to sustain the collections of the Libraryand to provide better access; or, stated anotherway, to provide high quality library and informa-tion services to the biomedical community.Actions toward this goal include continuedrefinement of collections and preservation pro-grams, improvements to the electronic system forend-user access, and modernization of our infor-mation support services.

The top priority for NLM's discretionary effortsis to prepare the Library and the Nation's healthprofessionals for the optimal utilization of theburgeoning electronic technologies forknowledge management. Of the numerous initia-tives the Plan proposes as components of thispreparation, one in particular stands out. This Isthe "window of opportunity" presented to theLibrary in the field of molecular biology andbiotechnology. Attention to this opportunity-through the provision of advanced informationhandling services—will permit NLM to contributesignificantly to discovery of new principles andtreatments by health-care professionals andscientists.

Unified Medical Language SystemThe substantial and growing body of medically-related information available in machine-readableform can be divided into at least four broadcategories: (1) the published literature; (2) clinicalrecords; (3) medically relevant databanks, such asNLM's Hazardous Substances Databank; and (4)knowledge bases, such as those in medicalexpert systems. The availabilityof these machine-readable data provides the potential for rapidautomated retrieval and integration of a variety of

Special Initiatives, 1986

Services. FY1986information pertinent to a particular clinical orresearch question.

The NLM-sponsored IAIMS program is aneffort to foster integration of the various sourcesof information critical to the operations ofacademic medical centers. The potential thatexists for such integrated medical informationsystems is unlikely to be realized, however,without the development of a mechanism forintelligent switching and linking among the manydisparate vocabularies and classifications cur-rently employed in automated systems. Today thepractitioner who wishes to examine literaturerelated to clinical findings retrieved from amedical record system or to a diagnosis sug-gested by an expert system has no alternative butto turn to a different automated system, rephrasethe question in one or more ways, and startagain.

Although the variety of hardware and softwarein use presents real problems, the inability tocross back and forth among the types of infor-mation is not due primarily to technological bar-riers. The principal impediment is the lack ofany precise intellectual links among related infor-mation of the four different types. There is noautomated way to translate information retrievedin one area into a query that can be interpretedintelligently by existing systems in another area.There is no automated way to take the user'soriginal question and frame it in the variety ofdifferent codes needed to access all the differenttypes of relevant information.

To solve these fundamental medical informa-tion problems, NLM has begun the developmentof a Unified Medical Language System or UMLS,in the form of an integrated series of automatedtools that can be invoked by a variety of applica-tions to interpret questions, classify new medical

information, and provide the intelligent linksnecessary to retrieve or process the whole rangeof information relevant to a particular inquiry.The goal is not to impose a single vocabulary onall systems and users, but to make the myriad ofclassifications of medical knowledge invisible tothe user and to provide one logical path to thewhole range of automated biomedicalinformation.

Moving from the current fragmented situationwill require research, development, and creativeimplementation strategies in many different areas.While the achievement of the ultimate goal is farin the future, the early steps in the process canhave immediate payoffs in better informationservice to health care practitioners, administra-tors, researchers, and educators.

In FY 1986 a multi-disciplinary team of NLMstaff and a wide variety of experts and con-sultants worked to identify the generalparameters of the problem; assemble basic infor-mation about some of the key sources of medicalinformation and some of the medical classifica-tions currently in use; define the objectives forthe initial years of the project; and develop amechanism for involving qualified researchersfrom throughout the country in the UMLSdevelopment.

The second phase of the project began withthe award of UMLS support contracts in August1986. In this two-year phase, the intent is to(1) develop tools that will assist in the long-termresearch effort; (2) perform background studiesto obtain key information needed in the designof a functioning UMLS; and (3) as a by-productof these activities, create interim products whichwill have an immediate beneficial effect on theability of health professionals and researchers toretrieve relevant information. The following

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institutions have received two-year UMLS supportcontracts:• Massachusetts General Hospital

(with Brigham & Women's Hospital as asubcontractor)

Principal Investigator: G. Octo Barnett, M.D.Principal Investigator for subcontractor:

Robert Greenes, M.D.,Ph.D.• MPC Corporation (for Universityof Pittsburgh

and Carnegie-Mellon University)Principal Investigators: David Evans, Ph.D.,

and Randolph Miller, M.D.Consultant: Homer Warner, M.D., University

of Utah• University of California, San Francisco

Principal Investigator: Marsden S. Blois,M.D., Ph.D.

Associated Senior Investigator: JohnStarkweather, Ph.D.

• Yale University School of MedicinePrincipal Investigator: Perry Miller, M.D.,

Ph.D.The principal investigators and other key con-

tract personnel met with NLM staff at the Libraryon September 11-12, 1986 to discuss previousrelated work and the research approaches pro-posed by each of the contractors and by NLMitself. Initial tasks were identified for eachresearch group and work is now underway on avariety of projects.

Massachusetts General Hospital will expandMicroMeSH, its current microcomputer basedgraphical tool for searching, traversing, anddisplaying the MeSH vocabulary. New features tobe added will include the means to accom-modate mapping between MeSH81 and othervocabularies. In a related project, Brigham andWomen's Hospital will use a semantic network

approach and expert software to explore theoptimum structure for storing mapped thesauriand for displaying them graphically to users.

Massachusetts General Hospital will also examineterminology used for procedures, signs, and symp-toms in existing medical thesauri and classificationsand develop a prototype nomenclature to recordthe results of a defined section of the physical ex-amination. This prototype nomenclature will bebuilt using the MicroMeSH system.

The University of Pittsburgh, Carnegie-MellonUniversity, and the Universityof Utah will col-laborate on a task to develop and refine a frame-based "standardized representation scheme" forthe clinical manifestations of disease and will usethis scheme to map the terminology for signsand symptoms of diseases found in theINTERNIST-1 knowledge base, the HELP hospitalinformation system, and MeSH. The initial focuswill be on pulmonary diseases.

The University of California at San Franciscowill create a structured file of disease descriptionsusing standard terms derived from MeSH as muchas possible. These descriptions will include:disease names and synonyms; ICD and other ap-plicable disease codes; names of related diseases;predominant sex, age, and race of those affected;etiology, symptoms, signs; laboratory procedures;tests; complications; treatment, prevention, etcThe goal is not to create an expert knowledgebase about the diseases, but to provide a matrixor structure with consistent terminology that auser can easily understand and which also willbe machine processable. UCSF will begin withselected diseases in the INTERNIST-1 knowledgebase. UCSF will also compare the terminologyfrom questions in standard test instruments usedin medical education with the terminology inMeSH and the medical literature.


•Reg U S Pat Off 13

Program andServices, FY1986

The Yale University School of Medicine willuse a specific subject area, liver cancers, toexplore how words and phrases in a thesauruslike MeSH can be augmented with "semanticfeatures" indicating certain of their propertiesand how a set of attributes and relationshipsamong terms can be defined using thesesemantic features. If a limited set of attributesand relationships is identified as useful in focus-ing bibliographic retrieval, these features couldbe incorporated in NLM's vocabulary system andpossibly in the indexing process.

NLM staff will work on mapping MeSH to thePDQ® (Physician's Data Query) Thesaurus and tothe keywords in GenBank. Developed by theNational Cancer Institute, PDQ provides access toinformation about types of cancer, cancer treat-ment protocols, and individuals involved inrelated clinical research or practice. GenBank is adatabank of information about gene sequences.Mapping MeSH to the vocabularies used in thesefiles will serve as a test-bed for exploring prob-lems associated with keeping evolving thesaurisynchronized and in mapping extensive subject-specific thesauri to a general medical thesaurus.These mapping projects will eventually make iteasier for PDQ and GenBank users to retrieverelated MEDLINE® citations and for MEDLINEusers to access pertinent information in PDQ andGenBank. NLM staff will also continue to experi-ment with automated or semi-automatedmethods for mapping and merging thesauri, willdevelop a group of sample search questions tobe used in testing and evaluation of researchresults, and will apply knowledge gained in theUMLS development effort to the improvement ofthe Library's retrieval interfaces, such asGRATEFUL MED™.

BiotechnologyAs mentioned in the previous section, theplanners described biotechnology as a "windowof opportunity" for the Library. It appears thatthis subject will be of great importance to thehealth science community for some time tocome, and that the Library should be prepared toassume a leadership role in the crucial area ofbiotechnology information handling.

Late in the 99th Congress, RepresentativeClaude Pepper introduced a bill—H.R. 5271—thatcalled for the creation of a center onbiotechnology information at the NationalLibrary of Medicine. The center would storebiotechnology information,build links amongexisting data banks, and create new computerizedsystems that would allow scientists around theUnited States to share the molecular genetic in-formation coming from the nation's laboratories.

Biotechnology is the research and develop-ment involving the all important molecules thatcontrol life processes—how our bodies grow,how we age, whether we suffer a host of mentaland physical diseases. Its central focus is DNA,the long, twisted threads in the nucleus of eachof our ten trillion cells. Genes are essentiallypieces, or chemical subunits, of DNA carryingthe messages of heredity in the strands of thefamous double helix. If researchers can read andunderstand the language of heredity—if they canlearn the sequence of nucleic acid bases in agene and amino acid sequences in the geneproducts—they can clone these genetic elementsoutside the body. Or find out why certain genesare switched on, or off during a lifetime. Orwhich ones are defective or even missing.

It is the complexity and amount ofbiotechnology information that give rise to the

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• Reg, U.S. Put, Off.™A trademark of the National Library of Medicine

need for a center devoted to handling it. TheLibrary, with its experience in building com-puterized databases and communication net-works, is being looked to as a locus for such anactivity. The center would work with researchlaboratories where the data originate to coor-dinate its handling—to store, process, and makeit available to the research community nation-wide. New information systems would allow dataretrieved from one source to be linked to otherrelated findings and to other research databases.So an investigator might ask one computer aquestion and that computer wouldautomaticallysearch for the answer not only in its ownknowledge base but in other research bases aswell.

Such a center would not only help fit togetherthe pieces of the genetic puzzle, it could helpprevent unnecessary duplication of research. Thenumber and variety of genetic diseases that willbenefit from improved biotechnology informa-tion services range from diseases which weknow are inherited, like sickle cell anemia, tosuch common and serious diseases as cancer andarthritis, which may well be influenced in com-plicated ways by the working of the human gene.

The chapter in this report on the Lister HillCenter has a brief report on the BiotechnologyInformation Program already under way withinthe Center.


15

Library OperationsLois Ann ColaianniAssociate Director, Library Operations


he Library Operations Division of NLM:• Acquires and preserves the world's biomedical

literature;• Organizes this literature by cataloging and

indexing;• Disseminates indexing and cataloging data in

publications, online files, and other machinereadable forms;

• Lends or copies documents in the NLM collec-tion as a backup to document delivery serviceprovided by other U.S. biomedical libraries;and

• Provides reference and research assistance tohealth professionals.A staff of more than 250 librarians, technical

information specialists, subject matter experts,health sciences professionals, library technicians,and administrative support personnel carries outLibrary Operations' programs and services. Thesepeople are organized into four main divisions:Bibliographic Services, Public Services, TechnicalServices, and History of Medicine; two specialunits: the Medical Subject Headings Section andthe Regional Medical Library Program Office; anda small administrative group in the Office of theAssociate Director.

Planning and ManagementDuring FY 1986, Library Operations (LO) con-tinued to make progress toward the broad objec-tives in its strategic plan for FY 1984-1988. Thefour objectives are: (1) to improve internaltechnical and bibliographic processing; (2) todevelop and implement programs that make iteasier to identify, locate, obtain and usebiomedical information and literature; (3) to

develop and implement a program for the preser-vation of the biomedical literature; and (4) toascertain the information needs and information-seeking behavior of health science professionalsand the history of medicine community, as a steptoward improving Library Operations' productsand services. Accomplishments related to theplan are described throughout the Library Opera-tions report. In FY 1987, LO will reorient its acti-vities as needed to respond to the recommenda-tions of the new NLM Long Range Plan.

Several LO components were reorganized inFY 1986 to reflect current program emphasesand to handle workloads more effectively. TheReference Services Division became the PublicServices Division. Public Services now containsthree sections: Reference, Collection Access(formerly Circulation and Control), and Preserva-tion. Most collection maintenance functions,previously handled in Circulation and Control,were transferred to the new Preservation Section.The Audiovisual Resources Section was dis-banded and its functions divided among theReference, Collection Access, and PreservationSections. This action was taken to provide amore integrated approach to service from allparts of the NLM collection and represents animprovement on NLM's existing commitment toexcellent audiovisual services.

LO substantially completed the first three in aseries of seven management studies of LO func-tions mandated by the governmentwide produc-tivity improvement program, which is governedby the Office of Management and Budget's A76Circular. As a result of the study of the docu-ment delivery function, LO has increased thenumber of first-line supervisors in the CollectionAccess Section, plans to create a new unit tohandle referral of requests NLM cannot fill, and

16

will contract out the reshelving of books andjournals in FY 1987. Recommendations from theA76 studies of the serials control and indexingoperations will be reviewed by LO managementin early FY 1987.

The Cataloging Section has been reorganizedto reduce the number of staff members reportingdirectly to the Head of the Section and to inte-grate all catalog maintenance functions. DorothyGregor, University Librarian, University ofCalifornia at San Diego, served as a consultant onthe reorganization which is designed to improvethe Section's ability to catalog incoming materialsexpedltiously and reduce the cataloging backlog.

Collection DevelopmentCollection development includes maintainingliterature selection policies, identifying andacquiring biomedical literature in all formats andlanguages, and processing materials as they arereceived. NLM's collection currently containsmore than 1,791,000 printed books, journalvolumes, theses, and pamphlets and 1,918,000other items, including audiovisual, computersoftware, microforms, prints, photographs, andmanuscripts.

Selection. Materials are selected for the NLM col-lection according to the guidelines described inthe Collection Development Manual of theNational Library of Medicine, published in1985. This year, NLM's profile as a selectivedepository of Government Printing Officepublications was revised based on the provisionsof the new manual. NLM provided a test floppydisc version of the Collection DevelopmentManual to a few selected health scienceslibraries to assess the value of a

machine-readable version of NLM's manual in thedevelopment of selection guidelines for theirown collections.

The Library continued to coordinate its selec-tion policies with those of other U.S. nationallibraries and to support and participate incooperative collection development effortsamong other research libraries. NLM and the Na-tional Agricultural Library (NAL) developed ajoint statement clarifying their collectiondevelopment policies in the field of human nutri-tion. A similar statement covering veterinaryscience was published by the two nationallibraries last year. NLM contributed additionaldata about its existing collection strengths andcurrent collecting policies to the automated com-pilation of data on U.S.research library collec-tions maintained by the Research Libraries Group(RLG). The Library also produced listings of ran-dom samples of its cataloging records formonographs in the fields of neurology and nurs-ing to be used by RLG institutions in verifyingstaff estimates of their collection strengths Inthose subjects.

As part of NLM's program of collection evalua-tion and indexing coverage studies in specificsubject areas, staff completed a report on NLM'scoverage of the literature in medical informatics,defined as the application of computer and infor-mation science to medicine and health services.In general, NLM's coverage of the field appearsto be good. The results of the inhouse study willbe compared with opinions solicited from abroad cross-section of experts in the field ofmedical informatics in FY 1987. A group of con-sultants was convened to discuss informationneeds in the field of health services research andadvise on a planned study of NLM's coverage ofliterature in that field. Also in FY 1986, NLM

Library Operations

17


Table 1Growth of Collections

Collection

Book MaterialsMonographs:

Before 15001501-16001601-17001701-18001801-1870Americana1871-Present

Theses HMDPamphletsBound serial volumesVolumes withdrawn

Total volumes

Nonbook MaterialsMicroforms:

Reels of microfilmNumber of microfiche

Total microformsAudiovisualsPicturesManuscripts

PreviousTotal

(Sept. 1985)

5685,6809,949

. . . 24,04239,664

2,331468,980281,780172,021'772,889'(30,066)

1,747,838'

35,179169,104204,283

. . 43 00175,422

1,433,384

FY 1986

02241

12874

111,482

80

31,547(12)

43,291

11016,31216,422

1 294190

144 105

New Total

5685,7029,990

24,17039,738

2,332480,462281,788172,021804,436(30,078)

1,791,129

35,289185,416220,705

4429575,612

1,577489

'Adjusted figure

identified the need to improve its collection ofearly works in psychology and began systematicefforts to acquire additional historical items inthis field.

Acquisitions. The NLM collection grew by43,291 volumes and 162,011 other items, includ-

ing microforms, pictures, audiovisual programs,manuscripts, and a limited number of computersoftware programs. The staff received and pro-cessed about 153,000 modern books, individualserial issues, and audiovisual programs. TheLibrary's historical collections were enriched bymany significant acquisitions including: Bin new

18

Table 2Acquisition Statistics

Library Operations

Acquisitions

Cuucnt serial titles receivedPublications processed:

Serial piecesOther

TotalObligations for:

PublicationsIncluded for Rare Books

FY 1984

22,294

126,16727,456

153,623

12,390,426($88,088)

FY 1985

23087

125,24327,212

152,455

12,128,787(5116,154)

FY 1986

22621

125 58427,264

152,848

12, 318,192(J90.000)

Wund-Artzney by Johannes von Beris, Strassburg,ca. 1540, an early and rare book on woundsurgery; Martin Pansa's Consiliumperipneumoniacum, 1614, which describes thelung diseases of miners and smelters; JacquesGohory's Instruction sur I'herbe petum ditte enFrance I'herbe de la royne ou medicee, Paris,1572, thought to be the earliest published workon tobacco; the Luminare Maius of JoannesJacobus de Manlius in a 1522 edition publishedin Venice, an influential pharmaceutical workduring most of the sixteenth century; a large col-lection of material documenting in detail theoperation of a Civil War hospital, Sloan Generalin Montpelier, Vermont; the early records of theAmerican Society for Clinical Investigation,founded in 1907; and materials from the filmarchive of the American Dental Association.

Collection Preservation and Maintenance. Thisincludes ensuring appropriate storage conditionsfor the NLM collection, promoting safe handlingof materials, providing physical or chemical pro-tection to items, and making copies of items inarchival formats. The development of a more

comprehensive preservation program for thebiomedical literature is one of LO's strategicobjectives for FY 1984-1988. In FY 1985, NLMcompleted a preservation plan based on athorough study of the condition of the NLM col-lection and available preservation options. InFY 1986, LO implemented several key recommen-dations of the plan.

The NLM Board of Regents approved a revisedPreservation Policy which links NLM's preserva-tion program to its collection developmentguidelines, clarifies the Library's responsibility forthe preservation of the content as opposed to theformat of the literature, defines NLM's role inassisting to preserve significant biomedicalliterature held by other U.S. libraries, and assignsNLM a responsibility to work with publishers toencourage the publication of the biomedicalliterature on more permanent media. A newPreservation Section was established and apreservation librarian recruited to head it. At theend of the fiscal year, the Library awarded afour-year contract for preservation microfilmingof up to 37,000,000 pages of brittle books andserial volumes. Staff in the Technical Services and

19


Public Services Division developed a plan forobtaining or borrowing missing issues to com-plete back volumes of serials being preserved onmicrofilm.

NLM also began a campaign to persuadeblomedical publishers to use more permanentpaper in printed publications. The campaign isdirected by Charles Kallna, Special ProjectsOfficer, Office of the Director, with support fromother NLM components. The NLM Board ofRegents will sponsor a hearing on permanentpaper in early FY 1987. An LO staff member ischairing the National Information StandardsOrganization (NISO) Committee charged withrevising the American National Standard forInformation Science: Permanence of Paper forLibrary Materials to cover coated as well as un-coated papers. Coated papers are heavily used inbiomedlcal publishing because they are essentialfor high quality illustrations. NLM also continuedits research on the preservation characteristics ofoptical-digital disks. This activity is discussed inthe section of this report describing the pro-grams of the Lister Hill National Center forBiomedlcal Communications.

Staff from the Conservation Center for Art andHistorical Artifacts in Philadelphia surveyedNLM's collection of fine art prints. The Center'sreport indicated that the Library's fine art printsare generally in good condition, but recom-mended several ways to improve storage condi-tions and treat specific items. During FY 1986,final plans were completed for the insulation ofNLM's film vault and improved humidification ofsections of the Library building used to storehistorical collections. The actual buildingmodifications will take place in 1987. To providebetter control over the use of fragile older itemsand more integrated service for materials of

historical interest, LO transferred the responsibil-ity for materials published between 1871 and1913 from the Public Services Division to theHistory of Medicine Division. Some of thesematerials are being moved as a result of thisrealignment.

Regular preservation and maintenance activitiesalso continued during FY 1986. A total of 27,533modern volumes were bound; the bindings for345 rare books were oiled and 2,714 pages weremended; 245 rare books were restored and/orrebound; and 286 bound manuscript volumeswere repaired and rebound. Five hundred sixtyhistorical films were copied on new film stock;and 317 were produced by Research Publications,Inc. as part of NLM's agreement with the firmallowing them to film nineteenth-centuryAmerican medical periodicals in NLM's collectionin exchange for archival and service copies ofthe microfilm.

Bibliographic ControlBibliographic control includes the developmentof intellectual schemes for organizing thebiomedical literature by subject; the cataloging ofall types of library materials in the field ofmedicine and health; and indexing journal ar-ticles on biomedical subjects. Providing intellec-tual access to the content of the world'sbiomedical literature is one of NLM's primaryservices.

Thesaurus. The Medical Subject Headings(MeSH), NLM's hierarchical thesaurus used inboth cataloging and indexing, now contains14,647 subject headings and 42,816 chemicalterms. Since its first use by NLM in I960, MeSHhas provided the foundation for the Library's

20

efforts to create uniform subject access to thebiomedical literature. Each year staff reviewdevelopments in medicine and health andmodify MeSH in an effort to keep current withchanges in biomedical terminology. In FY 1986,311 individual suggestions for MeSH changeswere reviewed. These led to the introduction of334 new MeSH headings, 1,000 new entry termsor cross-references to MeSH headings, and 164other changes, such as modified hierarchical rela-tionships among existing terms. Of thesechanges, 139 were the result of a special projectto review and improve MeSH terminology in thefield of medical informatics and to develop aspecial-purpose thesaurus for use in creatingstandard subject indices to the proceedings ofthe MEDINFO and SCAMC conference onmedical informatics.

MeSH inevitably plays an important role in theLibrary's long-term effort to develop the UnifiedMedical Language System or LJMLS (described inthe earlier section on Special Initiatives) to allowintegrated access to different kinds of biomedicalinformation classified according to a variety ofsubject schemes. As the UMLS develops, MeSHterms will be mapped to a variety of othervocabularies; more "user friendly" access toexisting MeSH terminology will be provided; andthe "intelligence" of MeSH will be exploitedmore fully in online retrieval systems.

In FY 1986, the bulk of the intellectual workof mapping MeSH terms to biomedical ter-minology in the Library of Congress SubjectHeadings (LCSH) was completed. The mappingwill make it possible to improve subject search-ing capabilities in catalog files containing somerecords with MeSH and some records with LCSHterms. NLM staff are now deciding on an appro-priate approach to machine storage and distribu-tion of the mapping.

Additional entry terms were added to the MeSHfile to improve retrieval by users unfamiliar withthe MeSH vocabulary. Singular forms of termsnow map directly to plural forms and vice versa.Direct order versions of multiple word terms(e.g., infectious arthritis) are now available ascross-references to all inverted headings (e.g., arth-ritis, infectious). Only some Inverted headingspreviously had such direct entry terms. Betteraccess to MeSH terminology will also be incorpor-ated into Version 2 of GRATEFUL MED,NLM'smicrocomputer-based search package for access toMEDLINE and other selected MEDLARS files.

Cataloging, At NLM, cataloging includes: (1) thecreation of a standard bibliographic descriptionof each new work added to the NLM collection,containing author's name, title, publisher, date ofpublication, etc., (2) the assignment of MeSHheadings to describe its subject content; (3) theassignment of a classification code or shelvingnumber which identifies the item's principal sub-ject focus; and (4) the maintenance of automatedfiles of cataloging records and of theauthoritative forms of names used in thoserecords.

The Library cataloged 20,285 books, serials,audiovisual programs, and Cataloging in Publica-tion (CIP) galleys in FY 1986, a 20.5 percentincrease over FY 1985 cataloging output. Theincrease was due to a combination of improvedinhouse production and expanded contracts andinteragency agreements for cataloging. NLM con-tinues to obtain assistance from the Library ofCongress for limited cataloging of books in cer-tain languages for which NLM does not havesufficient expertise. In FY 1986, NLM begancataloging computer software on an experimentalbasis. Based on data obtained in this experiment,the Library will establish a policy for acquiring

Library Operations

Reg U.S Pal Off21


Table 3Cataloging Statistics

Item FY 1984 FY 1985 FY 1986

Completed CatalogingFullLimited

Total

11,243 11,174' 11,7166,267 5,676* 8,569

17,510 16,850* 20,285

'Adjusted figure

Table 4Bibliographic Services

Services FY 1984 FY 1985 FY 1986

Total citations published*For Index Medicus

Recurring bibliographiesJournals indexed for Index MedicusAbstracts entered

306,263278,905

242,695

172,153

307,333280,379

232,730

177,000

•Includes special list articles, audlotapes, and Health Administration citations.

316,585297,772

272,740

187,662

and cataloging this material in 1987. The firstcataloging records for items in NLM's historicalfilm collection were produced under contractand added to the AVLINE® file this year.

To provide better access to lower priorityserials awaiting cataloging, the Library began toassign call numbers to these titles and shelve theissues in the NLMgeneral collection pendingavailable staff time for cataloging them. In themeantime, these serials are more easilyretrievable for use by onsite patrons andphotocopying in response to interlibrary loanrequests.

In preparing a five-year plan for the reductionof NLM's monograph cataloging backlog of12,935 items to a working inventory of about6,000 books, LO identified the need to modifyany time-consuming cataloging processes whichdo not assist catalog users and to provide betterautomated assistance to catalogers. The entirecataloging workflow will be reviewed to see if itcan be further streamlined and to achieve anoptimum balance in the use of inhouse staff andoutside cataloging resources. In FY 1986, NLMinitiated a combined project with the other twonational libraries to investigate the development

22

of an expert cataloger system. After attendingtwo NLM-sponsored seminars on artificial intelli-gence techniques and their possible applicationto cataloging, representatives from LC, NAL, andNLM examined the amount of time required forvarious cataloging activities and identified aspectsof the cataloging process most likely to benefitfrom improved automated assistance Each of thethree national libraries will mount projects toprovide more sophisticated automated support tocataloging LO and the Lister Hill Center will col-laborate on the development of NLM's prototypeexpert cataloger system

Indexing. At NLM, indexing is the creation ofrecords describing the contents of specificarticles in the journals the Library has selectedfor indexing. An indexing record includesdescriptive information (authors' names, articletitle, pagination, journal title, date, etc.) essen-tially as it appears in the journal and a numberof MeSH terms assigned to describe in detail thesubject content of the article

In FY 1986, the consultants who advise NLMon the selection of literature to be indexed inIndex Medicus™ reviewed and rated 273 newjournals Of these, 65 were accepted forinclusion in Index Medtcus. In addition, the con-sultants reviewed currently indexed journals inthe fields of orthopedics, artificial organs, humanengineering, medical technology, biomedicalengineering, geriatrics, zoology, veterinarymedicine, primates, laboratory animals, and com-parative physiology. At the end of the year, therewere 2,774 titles being indexed for IndexMedicus and a total of 3,759 titles represented inMEDLINE. During FY 1986, staff began a reviewof the policies related to selection of titles for in-clusion in MEDLINE and tested some modifica-

TablesOnline Searches

Databases

AVLINEBIOETHICSCANCERLIT*CANCERPROJ*CATLINECCDBCCRISCHEMLINE*CLINPROT*DIRECTORYD1RLINEEXPRESSHEALTHHISTLINE*HSDB»INFORMINTOXINTROMED*MEDLINE

MED83MED80MED77MED75MED71MED66

MESH VOCABULARYNAME AUTHORITYPDQ-ELHILLPDQ-UFSPOPLINEREFRTECS*SDILINE*SERLINE*STORED SEARCHTDB«-ELHILL»TBDTOXNETTOXLINE*

TOXBACK76TOXBACK74TOXBACK65

FY 1984

11,3394,580

48,6641,797

156,914

32,6142,405

8402,4461,761

90,1404,173

47

7191,199,482

247,046189,07790,64462,79945,50012,1415,3224,7241,949

19,486

8,51225,97929,887

897,470

75,1902,889

11,5188,246

2,406,389

FY 1985

11,1555,392

51,5821,875

138,818

28,4593,378

502,7581,173

99,6663,7664,999

117292

4,9061,282,755

353,978153,88686,75857,98545,59810,0834,4991,426

19,74225,588

10,53528,85630,307

888,849

37271,95920,216

14,158

2,586,024

FY 1986

13,2775,997

54,8762,337

135,5464

14,58227,056

3,394

3,534

108,7194,842

32,375176282

10,0871,442,598

269,614313,112133,06083,16856,84546,22313,1863,473

25,99420,058

1310,65833,01036,982

95

5,32568,86918,681

13,395

3,011,443

Library Operations

'Reg US Pit Off

™A trademark of the National Library of Medicine23


tions to existing procedures. NLM will institute arevised approach to journal selection in 1987.

The number of indexed citations to articlesadded to MEDLINE in FY 1986 was 316,585,about 6 percent higher than each of the twoprevious years. The increase was due primarily toan effort to reduce the number of articles In theworking backlog. Abstracts were added toMEDLINE for 187,662 or 59 percent of the cita-tions added to that database. Of the articlesindexed for Index Medicus, 22 percent wereindexed by NLM staff; 9 percent directly byforeign centers or through arrangements made bythem with U.S. commercial firms; and 69 percentby NLM contractors. Indexing throughput, or theelapsed time between receipt of journals issues atNLM and the completion of the indexing ofthose issues, continued to improve; 60 percentof all articles processed were indexed within 30days.

The Library developed a policy and pro-cedures for entering information about errata inarticles indexed by NLM into the appropriateMEDLINE citations. When a published erratumnotice appears in the literature, staff will modifythe citation to the original article to indicatewhere the erratum has been published. For cer-tain types of errors (e.g., in the title, author'sname, or dosage levels in the abstract), correctedinformation will be inserted in the citationfollowing the incorrect portion. NLM will alsoannotate citations to articles with substantiveerrors before a published erratum appears, if theeditor or publisher intends to publish such anotice.

Network ServicesNLM's services to remote users throughout thecountry include: (1) disseminating its

authoritative cataloging and indexing data inpublications, machine-readable formats, and anonline retrieval service; (2) providing referenceassistance in response to telephone and writtenrequests; (3) sending documents or copies ofdocuments not available in other U.S. healthsciences library collections to health profes-sionals and researchers who need them; and (4)directing the Regional Medical Library Network,which links U.S. biomedical libraries in an effortto make quality information service available toall health professionals irrespective of theirgeographic location.

Publications. Publications, NLM's originalmethod for distributing its cataloging and index-ing data, remain an important vehicle forworldwide dissemination of the Library'sauthoritative information about the biomedicalliterature. In FY 1986, NLM produced issues ofover 30 recurring indexes and catalogs on paperor microfiche. These included Index Medicus,the National Library of Medicine CurrentCatalog, Health Sciences Serials, Health SciencesAudiovisuals, and the NLM Catalog, amongmany other publications. The 1981-85 cumulationof the Bibliography of the History of Medicinewas published. Four new publications, ONCHOUpdate, Schisto Update, Selected Medical Libraryon Microfiche, and Bibliography on MultipleSclerosis, joined the list of recurringbibliographies which NLM produces in collabora-tion with other organizations.

In addition to its catalogs and indexes, NLMalso published several literature searches onspecific topics of current interest, such as theintegrated approach to the management of pain,use of computer models in biomedical research,and diet and exercise in the treatment of non-insulin dependent diabetes mellitus. The Library

24

produces and distributes a quarterly literaturesearch on acquired immunodeficiency syndrome(AIDS) to make the latest research results readilyavailable to investigators in this field. Approx-imately 56,000 copies of various LiteratureSearches were distributed by NLMduringFY 1986. Health professionals may requestLiterature Searches through AMANET andWORLDLINK, as well as by mail and telephone.

Machine Readable Databases. In order to pro-vide the broadest possible access to itsauthoritative data, NLM leases complete databasesand subsets to other organizations in machine-readable form. These organizations include com-mercial database vendors, international MEDLARScenters, medical schools, and a variety of othernonprofit and commercial organizations. In 1986,NLM distributed more than 2,000 tapes ofvarious databases to 70 foreign and domesticlicensees. The Chinese Academy of MedicalSciences (Beijing) and the Academy of ScientificResearch and Technology (Cairo, Egypt) becameinternational MEDLARS Centers and tapelicensees in FY 1986. Mead Data Central becamethe fifth U.S. database vendor to offer MEDLINEto its users. By the end of the fiscal year, therewere 25 licensees providing access to subsets ofMEDLINE on their local systems. Data from someof the institutions indicate that the subset pro-gram has achieved its goal of making MEDLINEavailable to a broader spectrum of health profes-sionals, including students. In another effort tobroaden the availability of MEDLINE data, NLMhas made agreements with 10 commercial firmsto allow them to produce compact disk copies ofMEDLINE data on an experimental basis. NLMwill participate in the evaluation of the productsresulting from these experiments.

FY 1986 also saw a great Increase In the onlineavailability of NLM's catalog records. TheResearch Libraries Information Network (RLIN)and the Online Computer Library Center (OCLC)decided to mount NLM's retrospective catalogingrecords, joining the University of Toronto LibraryAutomation System (UTLAS) and MARCIVE, acommercial service which produces catalog cardsand machine-readable catalogs for individuallibraries and consortia, which made the recordsavailable in FY 1985. UTLAS and MARCIVE alsoobtained NLM's audiovisual cataloging records inMARC format.

As the number of organizations providingaccess to MEDLARS data increases and the waysin which the data are made available proliferate,assuring the quality of the data on these manysystems becomes more important and increas-ingly difficult. This year, the Library worked todevelop acceptable methods to exert reasonablecontrol over how licensees of MEDLARS dataupdate and provide access to NLM records andhow they represent the source, content, and usesof these records. NLM has drafted a revision ofits License Agreement to require that qualityassurance issues be addressed by all institutionsleasing the databases.

Online Services. NLMprovides online access to28 MEDLARS databases. During FY 1986, thenumber of online domestic and foreign users ofNLM's system increased 64 percent to a total of6,975. Most of the new recipients of codes areindividual health professionals and researchers,who now make up about one third of alldomestic online users. To keep pace with the in-crease in applications for online codes, theLibrary streamlined its procedures and reducedthe time required to assign new codes to lessthan 7 days.

Library Operations

25

Programs andSirvlces, FY1986

Table 6Offline Searches

Databases

AVLINEBIOETHICSCANCERL1TCANCERPROJCATLINECCDBCCR1SCHEMLINECLINPROTDIRL1NEEXPRESSHEALTHHISTLINEHSDBMEDLINE

MED83MED80MED77MED75MED71MED66

MESH VOCABULARYPOPLINERTECSSDILINESEKLINETDB-ELHILLTOXL1NE

TOXBACK76TOXBACK74TOXBACK65

f Y 1984

32065

5,76610

333

2058

659,997

9

26,628

25,80329,61021,81715,43210,462

89,688

124218,110

15103

17,097111

2,2631,996

395,865

FY 1985

27819

5,98918

357

8163

3511,664

5

19,949

26,65321,08016,37910,3097,631

1712,804

248228,039

2243

17,2301,370

1,164

381,573

F Y 1986

19430

5,6761

329

31

1

12,76523

14,09817,38021,73914,07311,1376,6504,481

211,694

37244,165

1

17,1891,418

1,280

384,394

The dramatic increase in the number of indi-viduals searching NLM's databases directly isattributable not only to the many special trainingclasses in online searching conducted bylibrarians for health professionals using materialsdeveloped by NLM, but also to the introductionin March 1986 of GRATEFUL MED, an NLMmicrocomputer-based software package whichassists users to search MEDLINE and selectedother MEDLARS databases. GRATEFUL MEDallows people without knowledge of search com-mands or the MeSH vocabulary to conduct theirown searches and suggests appropriate MeSHterms for use in subsequent searches. More than3,000 copies of GRATEFUL MED have been soldby the National Technical Information Service.

The total annual usage of the MEDLARS systemat NLM was 257,351 connect hours, an increaseof 9.3 percent above the FY 1985 total. The indi-viduals who make up the bulk of the new onlineusers tend to access the system less than theexisting institutional users who perform searchesfor many different individuals. To gain a betterunderstanding of the particular informationneeds and searching behavior of individual usersthe Library is planning to survey this group inFY 1987.

NLM's usage figures cover searching by usersof the 9 international MEDLARS centers whichprovide direct online access to the NLM system.Use of MEDLARS data on the computer systemsof foreign and domestic tape licensees is notreflected in NLM's online usage statistics.

In FY 1986, NLM took several steps to makeinformation about NLM's online services morewidely available. A new MEDLINE pocket cardproviding basic instructions on searching the filewas published, as was a new brochure describingthe MEDLARS files and a revised edition of the

26

Online Services Reference Manual. MEDLEARN®,the computer-assisted instruction program forMEDLINE, became available 24 hours a day. Inconjunction with the NLM Sesquicentennialcelebration, LO staff demonstrated the MEDLARSdatabases and GRATEFUL MED at a variety ofprofessional meetings, symposia, and informationfairs.

With the availability of GRATEFUL MED andother "user friendly" means of access to NLM'ssystem, the Library eliminated the requirementthat all new users have some level of training inonline searching prior to obtaining an accesscode. Many new users, particularly library and in-formation professionals who will provide searchservices to others, continue to attend NLM-sponsored online training classes. Approximately1,000 people attended classes in searchingNLMdatabases in FY 1986. LO staff conducted 17classes at NLM and 6 in other locations in theUnited States. Three Regional MedicalLibrariesalso provide MEDLARS online training. Togetherthe New York Academy ofMedicine, the University of California at LosAngeles, and the University of Nebraska con-ducted 30 classes at several different sites. Healthsciences librarians around the United States alsotaught many special online searching classes forthousands of health professionals.

Reference Assistance. In FY 1986, NLMresponded to 25,397 telephone requests forreference assistance and 686 reference requestsreceived in the mail. An analysis of the telephonerequest traffic conducted by an NLM Associaterevealed that about 20 percent of the calls comefrom outside the Washington, DC. metropolitanarea. Requestors called from every region of theUnited States and several foreign countries. Many

people who write to NLM are unaware ofbiomedical information resources availablelocally or of the various federal informationclearinghouses for health information for the laypublic. In addition to providing some informa-tion to answer the requestor's immediate ques-tion, the NLM staff also directs people to otheragencies that can help. The staff also providesrapid responses, usually on the same day, to avariety of special Information requests frommembers of Congress, the Supreme Court, theOffice of the President, the Office of theSecretary of the Department of Health andHuman Services, and other federal agencies.

Document Delivery. In FY 1986, NLM filled119,591 requests for interllbrary loans orphotocopies of books, journals, and audiovisualprograms; 85 percent were filled within fourdays of receipt. The number of interlibrary loanrequests received by NLM increased 11 percent inFY 1986, the first significant increase in eightyears.

Four hundred seventy-three libraries beganusing DOCLINE,® NLM's automated documentrequest system, during the year, bringing thetotal number of DOCLINE users to 588 as ofSeptember 30, 1986. Thirty-five percent of allinterlibrary loan requests received by NLM dur-ing the year came through DOCLINE. An addi-tional 700-800 libraries are expected to becomeDOCLINE users in FY 1987. The RegionalMedical Libraries are assisting NLM in implement-ing the system throughout the U.S. DOCLINE islinked to MEDLINE, CATLINE,® and AVLINE tofacilitate the generation of requests and uses datain SERHOLD,• NLM's computerized serialsholdings database, to route requests automaticallyto libraries which report holding the requested

Library Operations

• Reg. U S, Pat. Off. 27


titles. SERHOLD now contains over 960,000holdings statements for 2,276 U.S. biomedicallibraries. SERHOLD is updated by merging datafrom a variety of machine-readable databases towhich health sciences libraries contribute. InFY 1986, NLM successfully tested the incorpora-tion in SERHOLD of a tape of holdings dataoriginally entered in OCLC. In 1987, anySERHOLD participant which is also an OCLCmember institution will have the option of con-tributing holdings data in this fashion.

NLM conducted a test of telefacsimile deliveryof documents by eight health sciences librariesin FY 1986 to determine the costs of providingsuch a service and the procedures and policiesnecessary to support it. A total of 751 documentswere delivered by telefacsimile during the year;50 were needed for patient care emergencies.Based on the experience gained in this test, LOstaff members are preparing a plan for regulartelefacsimile service, probably in 1987.

Regional Medical Library Program. From itsinception twenty-one years ago, a major goal ofthe Regional Medical Library Program has beento improve document delivery service by makingoptimum use of local library collections and thenreferring requests for items not availablelocallyto more distant libraries. This year LO staff com-pleted a study comparing interlibrary loan re-quests received by NLM in 1984 with thosereceived in 1959. This comparison showed atremendous change in the materials requestedfrom NLMand the number of institutionsrequesting these materials. In 1959, the journaltitles most heavily requested from NLM wereEnglish language titles now commonly held bymany U.S. health sciences libraries; twenty-fiveyears later the most heavily requested journal

titles were primarily foreign publications notreadily available elsewhere in the United States.The number of different libraries requestingmaterials from NLM doubled between 1959 and1984. These results indicate the RegionalMedicalLibrary Network is handling the bulk of docu-ment requests for readily available materials andis serving as an effective conduit for transferringunfilled requests from all over the country to thebackup collection at NLM. An estimated2,000,000 requests for journal articles, books,and audiovisual programs are filled for healthprofessionals each year by libraries in theRegional Medical Library Network. In FY 1986,the Regional Medical Libraries themselves filled123,527 requests; NLM, as national backup, filled119,591 requests.

In FY 1986, the Library awarded new five-yearcontracts to the seven Regional Medical Libraries.

Regional Medical Libraries1. Greater NortheasternRegional

Medical Library ProgramThe New York Academy of Medicine2 East 103rd StreetNew York, New York 10029States served: CT, DE, MA, ME, NH, NJ, NY,PA, RI, VT, and Puerto Rico

2. Southeastern/Atlantic RegionalMedical Library ServicesUniversity of MarylandHealth Sciences Library111 South Greene StreetBaltimore, Maryland 21201States served: AL, FL, GA, MD, MS, NC, SC,TN, VA, WV, the District of Columbia and theVirgin Islands

28

3. Greater Midwest Regional MedicalLibrary NetworkUniversity of Illinois at ChicagoLibrary of the Health SciencesP.O. Box 7509Chicago, Illinois 60680States served: IA, IL, IN, KY, MI, MN, ND, OH,SD, WI

4. Midcontinental Regional MedicalLibrary ProgramUniversity of NebraskaMedical Center Library42nd and Dewey AvenueOmaha, Nebraska 68105-1065States served: CO, KS, MO, NE, UT, WYONLINE CENTER for Regions 3, 4, and 5

5. South Central Regional MedicalLibrary ProgramUniversity of TexasHealth Science Center at Dallas5323 Harry Hines Blvd.Dallas, Texas 75235States served: AR, LA, NM, OK, TX

6. Pacific Northwest Regional HealthSciences Library ServiceHealth Sciences Library andInformation CenterUniversity of WashingtonSeattle, Washington 98195States served: AK, ID, MT, OR, WA

7. Pacific Southwest Regional MedicalLibrary ServiceUCLA Biomedical LibraryCenter for the Health SciencesLos Angeles, California 90024States served: AZ, CA, HI, NV, and U.S.Territories in the Pacific Basin

The new RML contracts continue to stressdocument delivery and information access pro-grams, but also place greater emphasis oncooperative collection development, preservationactivities, and cooperation with NLM in thetesting of new products and services, such asGRATEFUL MED.A new feature of the currentcontracts is the series of enhancement projectswhich will be awarded at intervals throughoutthe life of the contracts. These projects willInclude investigations of the information needsand information-seeking behavior of health pro-fessionals, pilot development of new informationservices, tests of new technologies or proceduresto improve health information processing, andother similar activities. In FY 1986, threeenhancement projects were awarded: theUniversity of California at Los Angeles is studyingwhat use health professionals make of thedocuments delivered to them via the RMLNet-work; the New York Academy of Medicine isenhancing NLM's serials database by adding titlesheld in the Regions but not at NLM; and theUniversity of Washington is developing a regionalmicrocomputer directory of informationresources based on DIRL1NE*, but enhancedwith additional information of specific regionalinterest.

During the past year, NLM, the RMLNetworkand the Land Grant College Network sponsoredby the National Agricultural Library developedand publicized a cooperative agreement designedto provide better Information service in the fieldof veterinary science. Users requiring veterinaryscience documents or information may contacteither a local health sciences library in the RMLnetwork or a land grant college library. Requestswill be referred to NLM or NAL as appropriate

Library Operations

» Reg. U.S. Pat. Off.29


Table 7Circulation Statistics

Activity

Requests Received:Interlibrary LoanReaders

Requests Filled:Interlibrary Loan

PhotocopyOriginalAudiovisual

Readers

Requests Unfilled:Interlibrary LoanReferredReturned

Reader ServiceReturned as unavailable

FY 1984

358,654147,017211,637

299,681113,440102,723

6,5344,183*

186,241

54,73733,577

1,97531,602

25,160

FY 1985

390,058144,346245,712

327,125110,849102,698

6,6061,545

216,276

57,34727,911

1,50426,407

29,436

FY 1986

438,678153,797284,881

364,661119,591110,379

7,5951,617

245,070

74,01734,206

1,16933,037

39,811

'Includes vldeocassettes loaned by the Audiovisual Resources Section and motion pictures circulated from an off-site contractfacility directly to Individuals for educational use. Beginning In FY 1985, all audiovisual programs in the NLM collection becameavailable for loan; and the contract for motion picture distribution was discontinued

regardless of which network was originallyentered by the user. The RML Network alsodeveloped an interim directory of health scienceslibraries with telefacsimile equipment to facilitatetelefacsimile transfer of documents in response toemergency requests and gathered data for a moreextensive directory of services available fromresource libraries for users not affiliated withinstitutions with libraries. Plans were made forregular teleconferences among the staffs of the

seven Regional Medical Libraries and NLM tofacilitate exchange of information and thedevelopment of network policies and programs.

To ensure a permanent record of the develop-ment and accomplishments of the RML Network,NLM has issued a contract to the Medical LibraryAssociation to prepare a written history of theRML Program. Alison Bunting, Director, PacificSouthwest Regional Medical Library System(Region 7), is the principal investigator on this

30

project, which also includes the preparation of abrochure about the current RML program.

Onsite ServicesNLM offers a variety of services for people whocome to the Library in Bethesda. These servicesinclude reference and research assistance, accessto materials in the collection, guided tours andbriefings on NLM's services and operations, andspecial programs in the history of medicine. TheLibrary also conducts a one-year onsite trainingprogram for library school graduates with poten-tial for useful careers in health sciencesinformation.

Reference and Research Assistance. An increasingnumber of people come to NLM to use its tworeading rooms and Learning Resource Centereach year. In FY 1986, these visitors requested248,881 modern books, journals, and audiovisualprograms from NLM's closed stacks, 16 percentmore than in FY 1985. Since FY 1983 onsitedocument request traffic has increased 59percent. Onsite users also asked 44,444 referencequestions and received the results of 1014 onlinesearches. Use of NLM's audiovisual and historicalcollections continued to grow.

In an effort to gain a better understanding ofonsite use of the NLM collection, in FY 1986Library Operations used sampling techniques toidentify the different user groups and thematerials they were requesting. The percentagesof different types of onsite users are as follows:19 percent health care practitioners; 17 percentresearchers; 7 percent librarians and commercialinformation professionals; 37 percent students;and 20 percent various other categories. Eighty-

five percent come from the Washingtonmetropolitan area; 13 percent from elsewhere inthe United States; and 2 percent from foreigncountries. Eighty-five percent of the materialsrequested by onsite users were serials. The mostheavily used titles were English language journalsthat are readily available at many other healthsciences libraries. NLM staff will consider thesedata when reassessing the Library's onsite servicepolicies in FY 1987.

The facilities available to onsite users under-went dramatic changes. The main card catalogwas removed from the public service area; allaccess to catalog records for modern materials isnow through the online catalog or the backupmicrofiche catalog. The main Reading Room andand the area vacated by the card catalog werethen redesigned, recarpeted, and refurnished. ASesquicentennial exhibit highlighting NLM'shistory and its current activities was installed inpart of the space formerly occupied by the maincard catalog. Although users of the historical col-lections continue to rely on card and early bookcatalogs for access to some items, they can nowalso use the online catalog in the History ofMedicine Reading Room. A new system of signsand directories was installed In the LibraryBuilding and the Lister Hill Center Building tohelp onsite visitors navigate through the NLMfacilities.

Public Tburs. The Sesquicentennial celebrationdrew large numbers of visitors to both theregularly scheduled daily tours of NLM and tothe special tours held in conjunction with themany Sesquicentennial events. In FY 1986, LOstaff conducted 135 regular tours for a total of469 visitors. More than 1,200 people (140 groups)

Library Operations

31

Services, FY1986TablesReference Services

Activity FY 1984' FY 1985' FY 1986

Reference Section:Requests by telephoneRequests by mailReaders assisted

Total

22,5422,106

39,63864,286

24,2182,100

42,56168,879

25,7441,104

44,44471,292

'All figures revised

received special orientation programs and toursarranged by the Office of Inquiries and Publica-tions Management (Office of the Director). Thisdoes not include the estimated 1,000 visitors dur-ing the April 11 Open House. NLM staff alsoarranged special briefings on library programsand services for many individual visitors.

Special Historical Programs. The FY 1986Visiting Historical Scholar was James HarveyYoung, Charles Howard Candler Professor ofAmerican Social History Emeritus at EmoryUniversity. Under the Visiting Scholar program,each year a recognized scholar is competitivelyselected to spend 6 to 12 months at the Libraryto engage in research that will use NLM's collec-tions, to give one or more public presentations,to assess segments of NLM's historical collection,and to consult with staff in his or her areas ofexpertise. Dr. Young used NLM's collection in hiswork on a history of food and drug regulation inAmerica and delivered a public lecture at NLMon 'American Health Quackery: Past andPresent" on June 4. Dr. Thomas Bonner,Distinguished Professor of History, Wayne State

University, has been selected as the 1987 visitingHistorical Scholar. He will come to NLM inJanuary 1987 to pursue his research on 19th and20th century medical education in England,Germany, and the United States.

Another distinguished historian, Dr. AlbertCowdry, was detailed to NLM from the U.S. ArmyCenter for Military History to carry out researchin the Library's Collection of Stanhope Bayne-Jones papers in preparation for a biography ofDr. Bayne-Jones. In FY 1986, NLM's History ofMedicine Division staff members assisted in thepreparation of many special exhibits, presenta-tions, brochures, and other materials associatedwith the NLM Sesquicentennial. A major lobbyexhibit on "Historical Treasures of the NationalLibrary of Medicine" displayed a selection ofunique and significant printed works, manu-scripts, and fine art prints in the historical collec-tions. A symposium on "History of ChemistryResources at the National Library of Medicine"was conducted at the American Chemical SocietyMeeting in New York on April 14.

Individual staff members continued theirresearch using NLM's historical collections. Staff

32

Table 9History of Medicine Activities

Library Operations

Activity FY 1984 FY 1985 FY 1986

Acquisitions:BooksModem Manuscripts . . .Prints and Photographs

Processing:Book catalogedModern manuscripts catalogedPictures catalogedCitations indexedPages microfilmed

27133,024

459

34936,209

1,4366,000

80,817

438193,101

298

32691,304

1634,954

94,594

296146,105

190

31362,650

9955,880

134,546

Public Service:Reference questions answeredILL and pay orders filledReader requests filledPictures supplied

2,6592,1185,0612,627

3,0932,0424,9813,252

4,5601,9366,2285,262

research was published in several publicationsand presented at invited lectures throughout theyear (see Appendix 1, Staff Bibliography).

NLM Associate Program. The NLM AssociateProgram is a one-year competitive programwhich provides three to six library schoolgraduates an opportunity to learn about NLM'soperations and those of other health scienceslibraries, to use new information technologies,and to develop their skills through the conductof special projects. Associates have an opportun-ity to visit the other national libraries andvarious types of health sciences libraries or infor-mation centers and to attend professionalmeetings. NLM offers an international traineeshipfor one librarian from outside the United States

to participate in the NLM Associate Program. Inthis arrangement, NLM provides the training, butdoes not assume the cost for the trainee's travelor stay in the United States.

Three Associates completed the program inAugust 1986; four new Associates began the pro-gram in September 1986. Beginning in FY 1986,NLM staff members may apply to attend selectedportions of the Associates' formal curriculum. InSeptember 1986, faculty from three southernlibrary schools were invited to attend the initialorientation for the new Associates. The purposewas to increase their understanding of the pro-gram so they could promote interest in it amongqualified library school students, particularlyminority students.

33

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

Pmpams andServices, FY1986

\Jtuiristmas Week 1986: Shoppers onManhattan's Fifth Avenue search for last minutegifts while, several miles north, a threateningpackage is about to be unwrapped. A warehousewith massive quantities of hazardous chemicals isdiscovered in a densely populated section of theBronx. Over 100 chemicals are identified, manyof which are explosive, flammable, corrosive,poisonous, and highly reactive. They arecon-tained in drums and boxes, most in poor condi-tion. The building is roped off and guarded by apolice sentry. One falling container or one leak-ing drum of the wrong chemical could result ina fire or explosion. The health and safety of theneighborhood is at risk. Officials need guidanceon the safe handling and disposal of thesechemicals, but where can they get it?

Quick-thinking federal emergency responseofficials contact the National Library of Medicine.The Toxicology Information Program in theLibrary's Division of Specialized InformationServices (SIS)is widely recognized as a resourcewhich maintains data that can assist in chemicalemergency situations. The chemical names aretransmitted by facsimile to SIS. One of its manycomputer files, the Hazardous Substances DataBank, is searched. This data bank can answerquestions about the safety and handling, healtheffects, and environmental fate of thesechemicals. Multiple printouts with detailed infor-mation are promptly generated and sent both tothe federal emergency response teams handlingthis case and,as a further precautionary measure,to six local hospitals. The chemicals are ultimate-ly removed without incident and theneighborhood around the warehouse is sparedan unwelcome Christmas surprise.

The above real-life situation is just one exam-ple of a critical SIS activity not traditionally

associated with library services. AlthoughSISdoes issue publications and answer inquiries, itsprimary function is to build and make availableonline, computer files related to toxicology andhazardous chemicals. From TOXLINE, the earliestonline service covering toxicology literature, toTOXNET®, an advanced integrated system of tox-icologically oriented data banks, SIS has been atthe forefront of utilizing sophisticated computertechnologies to answer pressing scientific ques-tions. Very recently, SIS has also begun investigat-ing the adequacy of information handling in theburgeoning field of biotechnology.

Online ServicesThe Toxicology Information Program of NLM,established in 1967in SpecializedInformationServices (SIS), is a direct outgrowth of therecommendations made by a panel of the Presi-dent's Science Advisory Committee in 1966which found that "there exists an urgent needfor a much more coordinated and more com-plete computer-based file of toxicology informa-tion than any currently available and further, thataccess to this file be more generally available toall those legitimatelyneeding such information."SIS is responsible for several of NLM's onlineservices that relate to the provision of chemicaland toxicological information. These servicesinclude the CHEMLINE, TOXLINE, RTECS andDIRLINE files on the ELHILL system and theCCRIS and HSDB files on the TOXNET system.

Databases under ELHILLCHEMLINE (Chemical Dictionary Online) is anonline chemical dictionary and directory filewhich allows users to verify chemical

34• Reg L'S Pat Off

nomenclature and structure and to formulateoptimum search strategies for other NLM files.Each chemical record also has pointers to theseother files which contain information about thatchemical substance. CHEML1NE is built andmaintained in collaboration with ChemicalAbstracts Service (CAS). It is updated bimonthlyand regenerated annually, and now contains over700,000 records.

During FY 1986, several changes were made toincrease CHEMLINE's effectiveness in retrievingrecords. The content of the Synonym field wasenhanced with the identifier (NLM) which indi-cates the synonym was provided by NLM. Cita-tions in TOXLINE appearing during a 12-monthperiod in 1985-86 were checked for newchemical names not appearing in CHEMLINE,and many such names were added to CHEMLINEafter a quality review. Work is scheduled toobtain Hazardous Waste/Regulatory identifiers(synonyms), and to investigate the availability ofcommercial mixture names and the names offoreign drugs.

A new Classification Code (CC) field wasadded to CHEMLINE. The first data put into thisfield was Pharmacologic and/or TherapeuticCategory data obtained from the publicationUSAN and the USP Dictionary of Drug NamesFor example, major "antiviral" drugs are labelledas such, and are now searchable as a class. Thesedata were added to over 2,700 drug records. Toenhance the ability to use the directory functionof CHEMLINE, certain filenames were added forthe first time to the Locator field; these wereMED83, CANCERLIT, and CANCERPROJ on theELHILL system, and HSDB and CCRIS on theTOXNET system. This allows users to bridge thegap between the two systems for chemicalretrieval questioas. Ring structure data for over

21,000 records were coded for addition toCHEMLINE

TOXLINE (Toxicology Information Online) is anonline bibliographic retrieval service, producedby merging "toxicology" subsets from some thir-teen secondary sources, including BiologicalAbstracts, Chemical Abstracts, GovernmentReports Announcement and Index (reportliterature), International PharmaceuticalAbstracts, and Index Medicus. TOXLINE and itstwo backfiles TOXBACK76 and TOXBACK65 nowcontain some 2,018,000 records.

A new subfile from the Environmental MutagenInformation Center, the Aneuploidy File, wasadded to TOXLINE in 1986. It provides citationsto literature about various aspects ofchromosomal abnormalities. In another change,the contribution of Biological Abstracts toTOXLINE has tripled to 37,000 references peryear. Increased coverage is being provided in theareas of occupational exposure to chemicals,disposal methods, and environmental effects ofchemical waste dumps.

An evaluation of TOXLINE's coverage, and howwell this coverage adapts to changes in tox-icology and related sciences, is being conductedin FY 1987. A contract has been awarded to theInstitute for Scientific Information to undertakethis evaluation using bibliometric analyses.

RTECS (Registry of Toxic Effects of ChemicalSubstances), another online data retrieval service,is based upon a National Institute for Occupa-tional Safety and Health file which NLM restruc-tures for online searching. In 1986, the file wasenriched by adding Chemical Abstracts Service(CAS) Registry Numbers to RTECS records lackingthem. These identification numbers are crucial

Specialwd InformationServices

35

Services, FY1986for unequivocal data retrieval and for matchingRTECS records with those in other files. Some12,000 records were enhanced in this way; a fewthousand more remain to be processed. Thework was done by CAS under contract. Fundingsupport came from Superfund (see below).RTECS now contains over 80,000 records. Plansare underway to move this database to theTOXNET system.

D1RL1NE (Directory of Information ResourcesOnline), is an online directory which assistsMEDLARS users by providing an alternativeresource for information needs not met bybibliographic or factual databases, by locatingservice facilities and educational materials, byidentifying organizations capable of providingsupport services, and by serving as a generalinformation tool in locating "helping" organiza-tions. DIRLINE has been available as one ofNLM's online services since August 1984. At pre-sent, this directory uses data from (1) the Libraryof Congress's National Referral Center (NRC)database (14,405 multi-disciplinary records);(2) DHHS's Office of Disease Prevention andHealth Promotion Health Information Centerdatabase (984 records on health-related organiza-tions); (3) poison control center directories (PCC)compiled and maintained by the publication,Emergency Medicine, and the .American Associa-tion of Poison Control Centers (119 recordsindicating certified and/or state-designatedcenters); and (4) the DHHS Alcohol, Drug Abuseand Mental Health Administration'sDrug AbuseCommunications Network (DRAGON) (49 recordswhich link the users to over 10,000 local drugabuse and alcoholism resources).

TOXNET and Its FilesSIS's major file building and enrichment effortsthis year continue to be partially funded bySuperfund. The Superfund Amendments andReauthorization Act of 1986 (SARA), whichamends the Comprehensive EnvironmentalResponse, Compensation, and Liability Act of1980, charges the Department of Health andHuman Services with certain health-relatedresponsibilities associated with the cleanup ofchemical dump sites and responses to accidentsinvolving hazardous chemicals. The lead agencyin the Department for Superfund-relatedactivitiesis the Agency for Toxic Substances and DiseaseRegistry (ATSDR). Relevant informationactivitiessuch as file building and creation of improvedaccess methods to information resources in theareas of hazardous wastes and emergencyresponses are carried out by NLM under anagreement with ATSDR. The predominant SISactivities supported by Superfund have beenenhancement of its online, factual data bank,HSDB, and the development of TOXNET, an inte-grated, file building and online search system.

TOXNET became available to the NLM onlinecommunity for searching and retrieval on July 1,1985. TOXNET is an umbrella system that cur-rently contains two data banks, the HazardousSubstances Data Bank (HSDB) and the ChemicalCarcinogenesis Research Information System(CCRIS). The addition of other files is plannedfor FY 1987. One will be the RTECS file presentlyavailable on NLM's ELHILL system and scheduledfor transfer to TOXNET in early 1987.

TOXNET's major online data bank is HSDB, adirect outgrowth of the former TDB (ToxicologyData Bank). TDB® service was discontinued onSeptember 30, 1986, since its file content had

36 Reg. U.S. Pat. Off.

been subsumed by the larger, more comprehen-sive HSDB. HSDB contains records for 4200chemical substances described in 144 data fieldsorganized into 11 subject categories. The scopeof HSDB includes and expands upon that of itspredecessor, the TDB, by providing more com-prehensive information primarily in the areas ofenvironmental fate and exposure, standards andregulations, and safety and handling. Data areextracted from monographic sources, govern-ment reports and from the primary scientificliterature. Data statements in the file arereferenced.

A major accomplishment of the past year wasthe chartering of the new Scientific ReviewPanel, appointed by NLM but operated by a con-tractor, to peer review the information containedin the HSDB file. The panel is co-funded by theDefense Logistics Agency (DLA) and reviewsHSDB content as well as materials for the DLA-supported Hazardous Materials Technical Center.Refinements to the HSDB file include the crea-tion of five new data fields and the ability todisplay complete source bibliographic citations.

Also mounted on TOXNET is CCRIS, a file ofthe National Cancer Institute (NCI), whichbecame publicly available on February 25, 1986.CCRIS is a scientifically evaluated and fullyreferenced data bank, developed and maintainedby NCI, containing carcinogenicity, mutagenicityand tumor promotion test results. Data arederived from the scanning of primaryjournals,current awareness tools, and a special core set ofsources, including a wide range of NCI reports.CCRIS is organized by chemical substance andnow contains 1200 chemical records

User Support for all online files is an onging SISfunction. User Guides for the CHEMLINE,

TOXLINE, RTECS and DIRLINE files wereupdated. A TOXNET User Guide and a briefguide for searching TOXNET were developed. Aself-instructional guide for searching DIRLINEbecame available. Fact Sheets for the TOXNETsystem and each of the files on TOXNET wereupdated. SIS continued to provide training for itsonline files both as a part of the MEDLARS Train-ing Program and for end-users at professionalmeetings and elsewhere.

Information Services to Other AgenciesThe SIS continues to provide data and informa-tion to Federal and State agencies, as well as tousers in the private sector. SIS has also beeninvolved in joint ventures with several Federalorganizations in developing new or enhancingexisting data and information services. The Divi-sion continues to be involved with the restruc-tured Committee to Coordinate EnvironmentalHealth and Related Programs (CCEHRP), andchairs the Subcommittee on InformationCoordination.

Collaboration has continued with the Agencyfor Toxic Substances and Disease Registry, whichis the organization coordinating Superfund-supported activities across DHHS. Theseactivities include the HSDB and TOXNETProjects described above and the development ofa microcomputer workstation for chemicalemergency response.

Enhancement of the microcomputer worksta-tion continued as new features were imple-mented. The workstation uses softwaredeveloped by NLM in conjunction with theEnvironmental Protection Agency (EPA) and theCouncil on Environmental Quality (CEQ) toretrieve and manipulate data and information

Specialized InformationServices

37


needed in responding to emergencies involvinghazardous materials. Primary emphasis during theperiod has been the development of a general-ized bibliographic "script." This script, known asBIBLIO, can search over 250 separate databases,located in eight vendor systems, for 18 subjectareas. The bibliographic script uses storedstrategies to search on authors' names, keywords,languages, publication dates, and chemicalnames. In addition to the bibliographic databases,access to six new factual/numeric databases wasalso completed. These are: EPA's AQUIRE,DERMAL, ENVIROFATE, and GENETOX databasesand NLM's HSDB and CCRIS on the TOXNETSystem. The microcomputer workstation wasfield-tested by NLM and ATSDR at the end ofFY 1985 and the first quarter of FY 1986. Later inFY 1986 a formal beta-test was conducted at 20organizations in government, privateindustry,and academia. Results of these tests were com-piled and a report was prepared.

NLM and ATSDR plan to enhance the work-station further for emergency response use byadding relevant subsets of chemical/toxicologicalfiles. This will allow response staff to searcheither the resident subsets or to go outside theworkstation by accessing remote onlinedatabases. Workstations of this type wouldfacilitate access to important sources of data andinformation for workers at chemical waste dumpsor emergency response teams at chemical acci-dent sites. Other enhancements include addingfactual/numeric databases and increasing accessspeed to them through another "script," calledTOXCHEM. A related activity is the start-up ofthe development of a prototype expert system,capable of running in a microcomputer, whichsupports information gathering for personnelresponding to chemical emergencies.

SIS continues to produce TOX-TIPSni

(Toxicology Testing-in Progress) as a monthlypublication identifying toxicology testing that isongoing or planned in public or private sectorlaboratories, It also identifies from the scientificliterature new lexicological test methods as wellas articles dealing with "alternatives to animaltesting."

On the horizon is increased SIS involvement inbiotechnology, An NLM-sponsored NationalAcademy of Sciences Workshop, convened inMay 1986, explored the organization ofbiotechnology nomenclature and information.The workshop found great need for a standard-ized biotechnology vocabulary, linkages amongdata banks, and improved methods of tracking,capturing and making accessible, the literatureofthe field.

As information continues to be a highly valuedcommodity, libraries will be increasingly calledupon to provide the answers to complex ques-tions. SIS's staff uses advanced computertechnologies mixed with human know-how toanswer the questions. The Division anticipatesthe needs of a diverse scientific community andcontinues to seek better ways to fulfill theseneeds through technology and personalunderstanding.

38A trademark of the National Library of Medicine

Lister Hill National Center forBiomedical CommunicationsDaniel Masys, M.D.Director

Lister Hill National Center for BiomedicalCommunications (LHNCBC) was established in1968 by a joint resolution of Congress. TheCenter serves as the intramural research anddevelopment arm of the National Library ofMedicine. LHNCBC research programs explorethe use of state-of-the-art computer and com-munications technologies to disseminatebiomedical knowledge. This knowledge takes theform of electronic representations of text, imagesand sound, as well as the procedural knowledgeencoded in rule-based expert systems. LHNCBCprograms develop innovative methods for acquir-ing, storing, retrieving, analyzing, and presentinginformation to biomedical researchers and healthcare professionals.

During its first decade, the Center devised pro-totype systems for computer-assisted instructionalnetworks, two-way audio and video communica-tions via satellite, and system designs for onlineinformation retrieval which were later incor-porated into the NLM's precedent-settingMEDLINE system. The Center has graduallyturned to research projects with long-term poten-tial for improving patterns of information proc-essing, analysis and retrieval on a national scale.Document image processing, videodisc-basedcomputer assisted instruction and simulation,artificial intelligence for medical decisionassistance, and natural language processingresearch are among important areas currentlyunder investigation by Lister Hill Center staff.

The Long Range Planning exercise undertakenby the NLM in FY 1985-86 portrayed a future ofbiomedical communications rich with opportun-ity for national leadership in advanced informa-tion systems development. It was an appropriatelegacy of the planning effort that Dr. DanielMasys, a member of the panel on "Obtaining

Information from Factual Databases," wasappointed as Director of the Lister Hill Center inJune 1986. Dr. Masys had previously served asthe Chief of the National Cancer Institute's Inter-national Cancer Research Data Bank Branch,where he had managed the development of bothpublication and computer-based technical infor-mation services, including components of NCI's"Physician Data Query" (PDQ) cancer informa-tion system.

Organizational StructureLeadership for the Lister Hill Center programs isprovided by a Director and Deputy Director,overseeing the activities of six branches:• Computer Science Branch• Information Technology Branch• Communications Engineering Branch• Audiovisual Program Development Branch• Health Professions Applications Branch*• Training and Consultation Branch*

A Board of Scientific Counselors (BoSC) meetsto review the quality and content of the intra-mural research programs within NLM, with par-ticular attention directed to the Lister Hill Center.It is composed of scientific and technical expertswho are prominent leaders in the fields ofmedicine, computer science, and health profes-sions education. The BoSC meets twice yearly toreview and make recommendations on theLHNCBC programs to the NLM Director and theLister Hill Center Director.

Lister Hill Center

'Effective February 1987, the Health Professions Applicationsand Training and Consultation Branches were merged into anew Educational Technology Branch responsible fordevelopment and testing of educational applications for thehealth professions.

39

Programs andServices, FY /986 Research Program Overview

The research and development programs of theLHNCBC fall into three major categories:1. Computer and Information Science as applied

to the problems of the Library, of biomedicalresearch, and health care delivery.

2. Biomedical image engineering, includingimage acquisition, processing, storage,retrieval, and communications.

3. Use of new technologies for health profes-sions education.

Within each of these major program areas,there are a number of diverse projects.

Computer and Information Science

Biotechnology Information Program. The longrange planning panels identified molecularbiology and biotechnology information as anarea of special importance for future develop-ment by NLM. In response to this, LHNCBC andNLM staff have been analyzing the impact of theaccumulation of massive amounts of informationon human gene sequences and othermacromolecules which is resulting from therapidly accelerating pace of biological research.In FY 1986, LHNCBC began the process of iden-tifying needs for organizing, and accessing theenormous amounts of data expected to resultfrom molecular biology research over the nextseveral years. Collaborating with efforts by otherNIH Institutes, other government agencies andprivate organizations such as the Howard HughesMedical Institute, the Center initiated a programto develop advanced, multi-database informationretrieval and analysis prototypes for biologists.

This Biotechnology Information Programencompasses a series of short and long rangegoals in which existing systems, such as theInformation Retrieval Experiment (describedwithin the Online Reference Works Projectbelow), could be applied for enhancing informa-tion retrieval and analysis from molecularbiology databases. By the close of the fiscal year,GenBank (nucleic acid sequences), ProteinSequence Database, and a subset of MEDL1NE onmolecular genetics had been mounted asdatabases under LHNCBC prototype retrievalsystems as the first step to developing anadvanced multi-database retrieval system formolecular biologists. The requirements for thissystem are being developed through interviewswith molecular biologists on the NIH campuswho will also serve as test users of the experi-mental system. Key issues will be providing easeof access to the sequence databases,downloading of sequence information to analyticprograms, and linked retrieval from MEDLINE(which already extensively covers the field ofmolecular biology). Longer-range issues nowbeing addressed include data management forlarge-scale sequence databases, common ter-minology, networked databases, and expertsystems for retrieval and analysis.

Artificial Intelligence/Expert Systems Program.A research program in artificial intelligence con-centrating on expert systems was established atLHNCBC in FY 1985. Expert systems are com-puter programs which combine knowledge of aparticular subject area with inferencingmechanisms enabling them to use this knowl-edge in problem-solving situations. Such systemscan amplify the accessibility of specialist-level

40

expertise by making it available when the humanexperts are not. The Expert Systems Programexplores research topics in artificial intelligenceappropriate to the development of knowledge-based expert consultant systems in biomedicine.

Of particular interest to the Expert SystemsProgram investigators are problems in knowledgerepresentation and knowledge base structure, inhuman factors design for expert systems, in theuses of high-resolution graphics to illustratesystem reasoning, in interactive videodisccapability to extend system utility and educa-tional potential, in the linking of expert systemsto visual databanks, in the linking of expertsystems to large-scale mainframe databanks, andin high-performance microcomputers andworkstations as delivery vehicles for thesecomplex programs.

The efforts of the researchers are directed bothto the extension of an in-house artificial intelli-gence systems development capability and to theextramural aspects of technology transfer,research community-building, and informationdissemination appropriate to the mission of theNational Library of Medicine. The in-housecapability has been enhanced by the develop-ment of an Artificial Intelligence Laboratory areato provide hardware and software environmentswhich facilitate this research and the demonstra-tion of its results.

During FY 1986 Expert Systems Program staffaddressed software environment and technologytransfer issues by significantly augmenting thecapabilities of EXPERT, a major expert systemssoftware development tool, and porting it to theIBM PC-AT microcomputer. The mainframe ver-sion of the EXPERT was produced by theDepartment of Computer Science at RutgersUniversity. The capabilities added to the IBM

PC-AT version included a new user interface witha mouse pointing device, color and context-sensitive help frames, a videodisc interface andvideo image bank utilities, a dial-out interface foraccess to mainframe databanks, and a criteriatable translator to assist in knowledge acquisi-tion. The resulting software system offers anexcellent test-bed for the development of expertconsultant systems in widely varied subject areas.

One focus of the Expert Systems Program isthe continuing development of the AI/RHEUMconsultant system in rheumatology, one of theworld's largest medical artificial intelligencesystems. AI/RHEUM was built at the University ofMissouri in Columbia by a project team whichincluded Dr. Lindberg and Dr. Kingsland. Withtheir move to NLM, AI/RHEUM became a ListerHill Center project in FY 1985. AI/RHEUM runsunder EXPERT and takes full advantage of thenew NLM-developed user interface and newfunctional capabilities. AI/RHEUM is unusualamong expert systems in offering the user directaccess to information from four knowledgesources: text definitions, videodisc images, thedisease criteria tables which are the foundationof its medical knowledge base, and direct dial-out to NLM's MEDLARS family of databases fromwithin the running consultant system.

At the close of FY 1986, the AI/RHEUMdiagnostic system contained in its knowledgebase information on 26 rheumatologic diseases.It was able to reason from 877 patient findings(basic information such as signs, symptoms,laboratory tests and radiographic observations)through 547 intermediate hypotheses to these 26disease conclusions. It had 181 text definitionsavailable online for those patient findings whichmight not be familiar to its intended users, physi-cians not having specialty training in

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rheumatology. In addition, the system offereddirect access to an "image bank" of 1,500videodisc images illustrating specificrheumatologic findings. The scope and complex-ity of the program continue to grow.

AI/RHEUM has been tested with more than500 clinical cases. Its overall level of agreementwith the consensus diagnosis of Board-certifiedrheumatologist clinicians is above 90%. A total of500 additional test cases are currently beingacquired from five widely separated institutionsin a futher validation of the system's knowledgebase. The knowledge base itself has beenextended with draft criteria for six new diseases,bringing the total to 32 diseases when the valida-tion is complete.

The evaluation of medical expert systems suchas AI/RHEUM is a difficult problem which hasnot yet been well addressed. One of the ExpertSystems Program initiatives in FY 1986 was aproposal for the development of a generalmethodology for the evaluation of medicalexpert systems. An NLM-sponsored process forthe development of this methodology began inFY 1986. From FY 1987 through 1989,AI/RHEUM will be used as the specific vehiclefor the testing of this methodology at multipleclinical sites in an NIH-funded evaluation trial.

In addition to the diagnostic componentdetailed above, AI/RHEUM has a patient manage-ment component. The AI/RHEUM patientmanagement system provides therapy recommen-dations for patients having rheumatoid arthritis,one of the more complex rheumatologicdiseases. It assesses patient condition on thebasis of specific information requested andmakes treatment suggestions at several levels,from basic measures through cytotoxic drugtherapies. This system has "Tell Me More"

information available in many categories for userswho would like detailed explanations of itsrecommendations.

The Expert Systems Program also works withknowledge-based consultant systems in otherareas of medicine. An example is AI/COAG,which like AI/RHEUM was originally developedat Missouri and brought to NLM by Dr. Lindbergand Dr. Kingsland. AI/COAG offers diagnosticassistance for problems in human hemostasis.This system also is designed in several modules.The first module performs a differential inter-pretation of six coagulation laboratory screeningtests, and offers "Tell Me More" and "Tell MeReference" information to support its conclu-sions. The second module acquires and stores adetailed hemostasis history It prints a summaryrecord for the user and analyzes the history tohelp the user decide whether a full workup isdesirable. During FY 1986 a clinician expert inhemostasis and blood banking joined the ExpertSystems Program team to assist in the building ofa third module, for advising emergency roomphysicians on blood component replacementtherapy in cases of major trauma.

Expert Systems Program staff are currentlyinvolved in the start-up phases of a system toadvise emergency response teams duringhazardous substances emergencies and of a"cataloger's assistant" system to assist in the NLMcataloging process for new acquisitions. In addi-tion, staff members are actively involved in theartificial intelligence initiatives of NLM's UnifiedMedical Language System project.

The extramural aspects appropriate to artificialintelligence research at the National Library ofMedicine have been addressed in several ways.The issues of technology transfer have beenexplored by focusing on methods of delivering

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these large-scale artificial intelligence programson powerful microcomputers which are morewidely available than the mainframe systemspreviously used. The porting of the developmentsystem called EXPERT to the IBM PC AT is anexample of such an effort.

The dissemination of information on artificialintelligence in medicine has been addressed byworking with LHNCBC's Audiovisual ProgramDevelopment Branch in the production of aseries of brief (10-15 minutes) videotape segmentson medical expert systems. These taped produc-tions help to explain artificial intelligence pro-grams in presentations by the system developersthemselves. When appropriate, they use elec-tronic graphics to illustrate the reasoning processof the system being presented. The tapes areavailable through the standard library loanprocess for audiovisual materials.

In FY 1986, Dr. Kingsland of the ExpertSystems Program worked with members ofLHNCBC's Audiovisual Program DevelopmentBranch to develop an NLM-sponsored museumexhibit on "Artificial Intelligence in Medicine."This exhibit is a portion of a larger exhibitioncalled "Robots and Beyond: The Age of Intelli-gent Machines" which opens at the Museum ofScience in Boston in January of 1987. It will bein Boston for three months, then will appear in atotal of eight major museums of science nation-wide over the course of three years. The NLM-sponsored exhibit on artificial intelligence inmedicine is a fully interactive computer-controlled videodisc system with touch-screencommand input by the museum visitor, theoverlaying of videodisc sequences withcomputer-generated graphics frames, and syn-thetic voice response to user choices. TheMuseum of Science estimates that three million

visitors will have seen this exhibit by the end of1989.

Manuscripts describing research results of theExpert Systems Program Staff have appeared injournals and conference proceedings during theyear. The AI/RHEUM system was presented to astanding-room-only group of attendees in aformal theater-style demonstration at MEDINFO86, a triennial international conference inmedical information. During 1986, AI/RHEUMwas also the subject of a cover article in MDComputing magazine.

Online Reference Works. The Online ReferenceWorks program, directed by Charles Goldstein,addresses the issues of how to use most effec-tively the extensive, published body of medicalreference works in an online, interactive mannerand how to aid in the scholarly process of textcreation and maintenance. One objective of theprogram is to define and build a prototype of a"scholar's workstation" that would serve as anintegrated information resource for both thecreation and the retrieval of reference works.

Current work in the ORW program hasevolved from earlier projects within the Informa-tion Technology Branch which addressed issuesrelated to the effective management anddissemination of information from factualdatabases, i.e., collections of data and informa-tion other than bibliographic records. One of theearlier projects was the design of a system foronline management and delivery of full-text datafrom the Toxicology Data Bank Tile, a collectionof information on over 4000 toxic substances. Asecond project, and one in which there is con-tinuing development, is the Network AccessWorkstation which aims at providing a

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user-friendly, personal computer front-end to dif-ferent online information systems. With the col-laboration of the NLM's Specialized InformationServices, the project has resulted in the Micro-CSIN™ (Chemical Substances InformationNet-work) workstation, a PC-based system that canautomatically logon to online databases, create asearch that can be sent to over 200 differentdatabases, and transform the retrieved data into astandard format. Work is under way to combinefeatures of the NLM's GRATEFUL MED front-endprogram to MEDLINE with the multi-databasefacilities of Micro-CSIN.

Since retrieval from factual or full-textdatabases has been a common element in ITB'sprojects, a testbed system for evaluating retrievalstrategies was developed in 1985 and has servednot only as a test system but also as the founda-tion for an interactive retrieval system for endusers. Designated IRX (Information RetrievalExperiment), the system has been used to con-duct experiments in document ranking, wordstemming algorithms, and the use of thesauruses.The testbed has been constructed as a series ofextensible modules that permits independentevaluation of the different components of docu-ment retrieval such as query processing, docu-ment access methods, and the user interface.Since AI principles or rule-based systems couldbe used in modules of IRX, IRX can be con-sidered a bridge between traditional accessmethods and fully developed AI systems. Imple-mented on a DEC VAX-11/780 in the C language,IRX has been transported to IBM PCs and, mostrecently, to Sun workstations in order to evaluatea high-resolution display device and a windowenvironment.

These earlier projects have formed a founda-tion for ongoing work in collaboration with The

Johns Hopkins School of Medicine whereby con-cepts and prototypes developed at Lister Hill arebeing tested and evaluated in the operationalenvironment of Johns Hopkins and the WelchMedical Library. The authoring and retrieval con-cepts have been implemented in a system basedon the text, Mendelian Inheritance in Man(M1M), Dr. Victor A. McKusick. The text, cur-rently in its seventh published edition, is over 12million characters in length and is considered theauthoritative work in cataloging human inheriteddisorders. All text creation and revision is per-formed online and versions of the text areimmediately available for retrieval. The efficiencyof the text management system was demon-strated in preparing the seventh edition forpublication: less than three weeks lapsedbetween the final updates to the text and thedelivery of the phototypesetting tape to theprinter. Users access the text online with IRX byentering a natural language query and obtaining alist of documents ranked in order of expectedrelevance. Other related data, such as a humanchromosome map and a list of fundamentalenzyme defects, have been linked to the MIMdatabase and appear to the user as a single vir-tual database. Another linkage is being developedfor a visual database of several thousandphotographs and radiographs that will be storedon a videodisc and accessed simultaneously withthe text description of a particular disorder.Besides being in daily operation at JohnsHopkins for the past year, the system has alsobeen demonstrated at several medical geneticsmeetings.

Automated Classification & Retrieval ProgramThe objectives of this program are to conductbasic and applied research which will lead to the

44MA trademark of ihe National Library of Medicine

development of automated systems for identify-ing, representing, and retrieving relevant informa-tion from biomedical documents, Current workincludes the development of an interactive index-ing aid arid the development of a naturallanguage understanding system.

The specific objectives of the indexing aid pro-ject are to develop and test interactiveknowledge based systems for computer assistedindexing. A pilot system has been developed.The system represents medical concepts and rela-tionships as frames in a knowledge base. Thisrepresentation forms the basis for the interactivecreation of document-specific indexing frames,and the generation of indexing terms from NLM'sMedical Subject Headings (MeSH). Work con-tinues both in expanding the knowledge baseand in enhancing the interface to the system.

The specific objective of the natural languageunderstanding project is to develop a system thatwill intelligently process biomedical text, withthe result that access to biomedical informationis improved. Current work is concerned with thedevelopment of a syntactic parser. A lexicon ofbiomedical terms and general English terms isbeing constructed, using data provided by text inNLM's MEDLINE system, by MeSH, and bymedical dictionaries. Work continues in theenhancement of the parsing engine and in thedevelopment of morphological, lexical, andsyntactic rules.

Work to construct a medical thesaurus is underway through a contract with Carnegie MellonUniversity. The purpose of the contract is to con-struct a thesaurus which will contain entries inthe domains of the management and treatmentof rheumatoid arthritis, diseases and findings ingeneral medicine and in neurology, and links tothe MeSH vocabulary.

Biomedical Image Engineering. The focus ofthis research area is electronic imagingtechnology in the capture, storage, processing,online retrieval, transmission and display ofbiomedical documents and medical imagery.Research areas include image compression, imageenhancement, image understanding, pseudo-grayscale rendition, image transmission and net-works, omnifont text recognition, and man-machine interface design. Research into imagingtechniques that support medical educationalpackages employing digitized radiographic andother imagery are also included.

Electronic Document Storage and Retrieval Pro-gram. The NLM mandate to serve as an archivefor preserving biomedical information ischallenged by the deterioration occurring in aportion of its collection. In large part thisdeterioration is due to the use of acid-containingpaper as a print medium, which may result inspontaneous destruction of printed works in aslittle as thirty years. The standard means forarchiving such endangered materials isphotographic. LHNCBC is investigating new elec-tronic technologies as an alternative means ofpreservation which promises improved accessand communications possibilities. Additionally,the principles governing the acquisition, storage,and retrieval of document page images are poten-tially applicable to a wide range of biomedicalimages.

A laboratory facility has been developed forinvestigating the role of electronic documentstorage and retrieval information processingactivities. The facility is implemented as anintegrated prototype system that includes docu-ment capture devices for both loose-leaf pages as

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well as bound volumes, magnetic buffer storage,digital optical disk drives, high resolution softcopydisplays rendering a legible bit-mapped image of afull page of a book or journal, modules fordynamic thresholding and pseudo-halftoning, highspeed digital image transmission subsystems, andmodules for image enhancement and manipula-tion. A system controller has been designed andimplemented to control the basic functions ofcapturing the document images, transferring themto magnetic and optical disk storage, retrievingthem in conjunction with bibliographic databasessuch as MEDLINE and CATLINE, and displayingthem at remote workstations,

In the process of implementing archivalstorage capability in the prototype system bymeans of digital optical disk technology, researchwas conducted on hardware and software inter-face design techniques, image data transfer errorperformance, design factors limiting transfer rate,and modification of optical disk drives to inter-changeably handle optical media having differentcharacteristics. These studies have been reportedin the technical journal literature.

To implement access to and retrieval of docu-ment images at a remote workstation, researchwas conducted in image transmission techniques.Three high speed (10 Mbps) digital transmissioninterfaces were developed using various signalmodulation techniques, design factors affectingspeed and reliability were identified, applicationprotocols and software modules to support highspeed image transmission were developed, andremote distance transmission was demonstrated.The demonstrations took the form of onlinedocument delivery of journal articles on normalpressure hydrocephalus in the Lister Hill Centerauditorium (for the February 1986 ScienceWriters' seminar), in the Center lobby (as a part

of NLM's Sesquicentennial observance), and inthe NLM Board Room (to a meeting of the Boardof Scientific Counselors).

Document capture by means of the bookscanner (for bound volumes and brittle materialthat would be damaged by rapid transportthrough the loose leaf scanner) results in pageimages that have borders and that are off-center.Software and hardware interfaces were developedto remove the borders electronically and tocenter the images. Apart from the aesthetic valueof this processing, studies showed that itsubstantially improved image compression per-formance. Custom interface hardware was alsodeveloped to allow pseudo- gray (halftone) rendi-tion of multiple gray level imagery.

In March 1986 an Experiment Plan for investi-gating document preservation by electronic imag-ing was presented for review by the NLM Boardof Scientific Counselors. This followed a recom-mendation by NLM's Preservation Committeethat while the Library should begin the preserva-tion of its store of biomedical literature bymicrofilming and the mass deacidification ofpaper, research should proceed in the use ofelectronic imaging techniques and digital opticaldisk media for document preservation. The Planidentified several preservation objectives and thecorresponding research questions. It also de-scribed experiments designed to address thesequestions by using the laboratory prototypesystem as a testbed. The issues of interest in-cluded throughput and conversion costs, docu-ment classification strategies, errors encounteredin the conversion process, quality controlstrategies, and image enhancement techniques,among others.

To summarize this experiment in the periodsince April 1986: the NLM collection has been

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randomly sampled, the items in the assembledsample have undergone conversion (from boundvolumes to bitmapped images on optical media),tools to support data collection, reduction andanalysis were developed, data on documentcharacteristics and system performance were col-lected, and data analysis is currently proceeding.The Experiment Plan divided the overall effortinto five parts:1. Throughput and Conversion Costs2. Document Classification3. Error Evaluation and Quality Control Strategy4. Optimal Scheduling5. Man-Machine Interface Evaluation

By the close of FY 1986, progress included thefollowing: In conducting the experiment investi-gating document throughput, a random sampleof about 6000 pages from nearly 400 volumeswas assembled in line with established statisticalprocedures and underwent conversion using thebaseline system and procedures. Detailed timingdata (mean time distributions)was collected foreach stage of conversion. Preliminary analysis ofthis data led to a deeper understanding of theprocess and helped in the development ofdetailed workflow diagrams for the differentstages. The data has also helped clarify the roleof the system design factors (both hardware andsoftware) that introduce delays in image dataflow and thereby reduce throughput. The col-lected data therefore is a sound basis for furtheranalysis leading to design specifications for anoperational system.

A cost model was developed on the basis ofcertain assumptions. The conversion process isdominated by the two most time-consumingstages, document scanning and quality check

(QC). The model is undergoing further refine-ment (e.g., to include the remaining stages andintroduce cost dependencies in systemsparameters) to allow its use as a tool for tradeoffanalyses.

For document classification, over a dozenoptical and mechanical characteristics of theapproximately 400 volumes were recorded.Cluster analysis resulted in creating six documentclasses and a formula that allows a documentpicked arbitrarily from the NLM collection to beplaced in one of the six classes. The identifica-tion of these classes is a basis for estimatingimprovements in throughput and cost over thebaseline system and procedures by batchingdocument by class.

In the experiment investigating errorperformance and a quality control strategy, thebaseline procedure developed for quality controlinvolved: a quick check of the image after initialscan, a check of the quality and retrievability ofthe image on magnetic disk followed by arescanning if necessary, and a final check of theimage on optical disk. The contribution ofquality control to throughput was determined.The types and frequency of errors were alsodetermined. As a result of error rate tests it wasfound that the magnetic disk to optical disktransfer was error-free. Consequently the qualitycontrol procedure was modified to eliminate thefinal check on the optical disk.

This research into the applicability of elec-tronic imaging to the problem of preserving thebiomedical literature is continuing. An interimreport on this work was presented to the Boardof Scientific Counselors in November 1986.

Digital Biomedical Image Processing. This R&Darea involves the development and evaluation of

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Propams andServices, FY I9t

improved techniques to capture, store anddisplay medical images for computer-basededucation systems. Techniques presently beingimplemented and evaluated include digital cap-ture and encoding of radiographs to improve thesignal-to-noise ratio, and window techniques toprovide high resolution images in video formaton standard television video (also called NTSC)systems. Compared to analog systems, thesetechniques provide improved image quality onlow cost personal computer workstations.

Image processing techniques are also beingexplored to isolate and display localized regionsof interest on digitized radlographic images. Aspart of this research, a prototype x-ray imagingsystem (XRIS) has been developed using an IBMAT controlling a "frame grabber" subsystem anda CD-ROM storage unit capable of online accessto half a gigabyte of image data and displaying a512x512 pixel image.

The Center for Devices and RadiologicalHealth supported the project with images fromits library of digital x-ray images. Fifty-eightcases, a total of 121 images, were selected fromthe library for the XRIS visual database. Casesselected included examples of different bodyareas, with images for both male and female, andpatient case impressions for different age groups.

Each image in the database is provided with apatient history text file and two bit map files,one consisting of a low resolution image and theother a high resolution image. The low resolu-tion image files are structured as eight bit binaryfiles with a spatial resolution of 512 x 512 pixelswith gray levels. High resolution files use thesame data structure and contain 2048 x 2048pixels of spatial resolution. A menu driven userinterface to a relational database was developedto retrieve and display image files. The database

is structured using a record management systemallowing relational access to the files by casenumber, medical impression, and body area. Thisretrieval schema was developed to support theprototype system; any future retrieval system willbe integrated into the host computer-basededucational system it supports.

Because the bandwidth and spatial resolutionof NTSC (TV-like video) systems limit the displaycapability of the monitor to the size of lowresolution images, a windowing technique isused to display segments of the high resolutionimage. Each low resolution image contains one-sixteenth the area of a high resolution image;this is equivalent to an image one-fourth theheight and width of the full high resolutionimage. Therefore a moveable fixed size windowis superimposed onto the low resolution imagewhich correlates to a mapped segment of thehigh resolution image file. By locating thiswindow over a selected area using a "mouse"pointing device, the system can effectivelyincrease the resolution of that area by a factor ofsixteen, that is, equivalent to the resolution yield-ed by a 2048 x 2048 pixel display.

In addition to the XRIS prototype a laboratorysystem involving a high resolution (2048 x 2048pixel, 8 bit/pixel) gray scale image capturesystem, and a Gould IP8500 Image ProcessingSystem hosted by a DEC PDF 11/44 has beendeveloped for the capture and processing of highresolution digitized biomedical imagery. Softwaredeveloped inhouse allows zoom, scroll and roamthrough a 2048 x 2048 pixel bit image with a1024 x 1024 pixel display.

Audiovisual Program Support. The AudiovisualProgram Development Branch (APDB) appliescurrent and emerging video communications

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technologies and audiovisual techniques to ListerHill Center research, development, anddemonstration projects and to the informationneeds of the health sciences community.

In order to achieve its program goals, APDBmaintains a major videodisc premastering facility,improving and enlarging its capabilities through aconstant upgrading effort. A sophisticated elec-tronic videographics system, activated in 1986,and the installation of improved one-inchvideotape recording equipment have allowed thefacility to incorporate state-of-the-art visualtechniques in the development of projectmaterials. A flexible, computer-controlled stillvideo transfer system ("The Rig"), to be installedin December, 1986, will enable the Branch tointegrate slides, transparencies and hard-copyvisuals into videotaped project materials withhigher quality and with greater effectiveness thanwas possible in the past.

In support of the NLM Sesquicentennial Yearactivities, the Branch videotaped the U.S. Con-gress Joint Resolution AnnouncementCeremonies at the Capitol on February 5. Alsoon that date, a Library-sponsored Science WritersSeminar was videotaped in the Lister Hill CenterAuditorium, as were program demonstrationsduring an April 11 NLM Open House, a Medicineand the Arts Colloquium on April 22, a lectureby Dr. Albert Sabin on May 28, a symposium onthe NLM:Past, Present and Future on September16 and a Space Medicine Colloquium onNovember 13. Numerous additional Sesquicen-tennial-related events, including the productionand installation in Ford's Theatre of a specialInteractive Videodisc Sampler, highlighting anumber of NLM and Lister Hill Center programsand projects, were completed.

APDB continued working with the TIME pro-ject during 1986 (described in the EducationalTechnology section, following). Materials fromthe first TIME project, "The Case of Frank Hall,"were re-edited as a pre-master videotape for theproduction of a standalone Level II (pro-grammed) videodisc, which was installed in theNLM Visitor's Center in June. This and mostother interactive videodisc projects, continue tomake use of DRAW (Direct Read After Write)videodiscs as programming and editing tools,prior to the manufacture of final opticalvideodiscs—an approach developed duringFY 1985. A wide variety of location videotapingand considerable computerized editing went intothe pre-mastering of three videodisc "sides" of asecond TIME project on the subject of obesity,"The Case of Patricia Fletcher."

A collaborative effort with the National Insti-tute of Mental Health was completed this year,with the production of an interactive videodiscon "Adolescent Depression and Suicide." Anothercollaborative project—this one with the NIHOffice for Protection from Research Risks-resulted in the production of three videotapeprograms explaining the history, problems andprocedures necessary to assure protection ofhuman rights and health in the conduct ofmedical research.

To expand its usefulness to foreign visitors andhealth sciences personnel abroad, Japanese andChinese versions of the NLM program "Com-municating for Health" were produced. Sixty-three radiographs and fourteen photographicprints were video recorded, using both physicaland electronically produced masking fortechnical quality comparison, and an eight-inchvideodisc of "Mendellan Inheritance In Man/

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Prototype Visuals" was prc-mastered, in coopera-tion with an Information Technology Branchhuman genetics Information project. An opticalvideodisc was pre-mastered on the subject oforthopedics, with "Arthroscopy: the ChronicUnstable Knee" on one side and with "SegmentalMicro-Cryoanatomy" slides and"CT and MRImaging" sequences on the other side.

Project work, including the integration ofBOSCH-gcnerated electronic videographicsequences, continued on five videomicroscopyprograms; "Necrosis," "Acute Inflammation,""Chronic Inflammation," and "CirculatoryDisturbances- Part I and II." A German version ofthe "Necrosis" program was also produced forevaluation.

The Branch continued development of NLMeducation program materials with the productionof three videotape programs on the Library'sinformation storage and retrieval systems:"MEDLARS/An Overview," "MEDLARS/Indexing"and "MEDLARS/DOCLINE."

In collaboration with Dr. Gordon Sharpe andthe AI/RHEUM project at the University ofMissouri, 1,700 stills and additional graphics werepre-mastered for conversion to an "AI/LEARN"optical videodisc.

Working with Dr. Frank Allan, GWU School ofMedicine, the Branch finished video recordingsome 3,000 histology slides which, enhancedwith graphic descriptors and other visual aids,will be indexed and pre-mastered for Interactivevideodisc conversion for use In microanatomyteaching units.

APDB's Graphics and Still Photography Labscontinue to provide visual materials to Lister HillCenter research and demonstration projects andto other elements of the Library. The GraphicsLab contributes to the upgrading of the Branch's

premastering facility through the generation ofnumerous and creative electronic videographicanimation sequences. The Still Photo Lab willhave similar responsibility for the effective opera-tion of a new computer-controlled still videotransfer system to be installed in early FY 1987.The Branch also provides projection, audiorecording and other audiovisual support tomeetings scheduled in the Lister Hill CenterAuditorium and the NLM Board of RegentsConference Room.

The Branch provided extensive coordination,consultation and technical support to a numberof specialized programs making use of the LHCAuditorium. Among these were two TexasInstruments-sponsored teleconferences on Arti-ficial Intelligence (November 13, 1985 and June25, 1986); a USlA/Worldnet MEDCOM '85 two-way satellite teleconference, linking Americancardiovascular experts in the Auditorium withRussian counterparts in Moscow (December 16,1985); and the live origination of a four-site, twohour teleconference, aired on national television,of a Public Broadcasting Service "Frontline" pro-gram on Acquired Immune Deficiency Syndrome(AIDS). This complex event entailed severalweeks of detailed planning with PBS and its sub-contractors. APDB's coordinating role includedworking with the microwave transmit unit, twosatellite receive units, telephone communicationsgroup, audio and lighting contractors, stagingcontractors, security personnel and programproducers.

Educational Technology

TIME PROJECT. The TIME project has createdan innovative form of patient simulation whichembodies the powerful capabilities of interactive

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videodisc, voice recognition and microprocessortechnology. This educational model shows prom-ise of providing faculty with the ability to con-duct patient-centered, problem-orientedclassroom sessions for medical students at vir-tually any level of their training.

Specifically, the TIME Project is asking thefollowing research questions: 1)Can the newtechnology support the systematic inclusion ofpatient-centered, problem-oriented, experimentallearning strategies in the existing medical schoolcurriculum? 2) Is the model useful and effectiveas a resource to aid faculty teaching of medicalfacts concepts and clinical decision-making? 3) Isthe model a useful and effective strategy forteaching medical students the non-cognitivecharacteristics (e.g., attitudes, values andpsychosocial concerns) which are essential to themedical practitioner? 4) Does the model providean effective educational strategy for medicalstudents to learn medical concepts and their rela-tionship to illness and the patient condition?6) What is the actual cost of creating and imple-menting these interactive case studies?

A prototype demonstration videodisc of theTIME interactive case study model was producedin 1985. The videodisc-based simulated patient,"Frank Hall," is an alcoholic with a bleedingduodenal ulcer and a variety of life problems.The purpose of the demonstration disc was toshow educators what is possible in terms ofinnovative teaching approaches using thecapability of the new technology. In October1985, the TIME Project received, on behalf ofthe National Library of Medicine, the Best Educa-tional Achievement Award for the Case of FrankHall. The award was presented by the NebraskaVideodisc Design/Production Group at theannual symposium in Lincoln, Nebraska.

Fourteen major presentations were made duringthe remainder of 1986 to a variety of profes-sional groups. In addition, five papers concern-ing the work of the project were written, submit-ted and accepted for publication during FY 1986.

During the first six months of 1986, thedemonstration disc was expanded into a fullyoperational program. In May, the Case of FrankHall was presented to second-year medicalstudents at Georgetown University in apreliminary field trial. The case was Included inthe Introduction to Clinical Medicinegastroenterology seminar by a Georgetowninstructor with the assistance of Dr. Harless,Project Director.

Analysis of the data gathered from pre- andpost-tests and a questionnaire showed thatstudents mastered the content objective of thecurriculum with this approach while feelingpositive about the interactive case study methodcompared to the paper case study methodemployed by the school. In July, the TIMEProject was awarded NIH set-aside evaluationfunds to conduct an expanded field test of theTIME model at selected medical schools in 1987.

The TIME project staff designed the Case ofPatricia Fletcher during 1986 and, with thecooperation of Dr. William Avers, UndergraduateDean of Georgetown Medical School, and staffmembers from Georgetown University accom-plished the video production of that case. ThePatricia Fletcher case involves a 48-year-oldfemale college professor with a history of obesityfrom childhood. The case study was developedaround contemporary patient managementoptions including the Garren-Gastric Bubble,gastroplasty and outpatient monitoring. Thedesign also includes multiple crisis probabilitiesand performance feedback. This case was

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developed with the intention of including it inthe expanded field test.

Plans for 1987 revolve around extensive fieldtesting, evaluating and documenting theclassroom use of the interactive case studiesdeveloped by the TIME Project staff. To this end,an educational committee of senior medicaleducators (Dr. George M. Miller, Dr. Donald W.King, Dr. Edward N. Brandt and Dr. EdmundPellegrino) was convened at the Lister Hill Centerto advise the Center. Dr. Robert Duncan of theUniversity of Miami Medical School was engagedto consult with the project staff concerning theexperimental design for the field tests.

Dermatology. Activities of the Dermatology pro-ject included continuation of the consulting rela-tionship with Dr. Antoniette Hood, JohnsHopkins University, which contributed todevelopment of a dermatologic image videodisc;presentation/demonstration of the disc at theAmerican Association of Dermatologists' annualmeeting; and two investigations of videodisc-based dermatologic images, both conducted atThe Johns Hopkins Universitywith local staffcooperation. In other collaborations, the projectobtained 800 photographs of febrile eruptionsfrom Dr. W.V. Stoecher of Rolla, MO, and par-ticipated in the experimental recording of der-matologic images, using flying spot scannerfacilities of the U.S. Video Corp., Vienna, VA.

Computer Based Curriculum Delivery System.The Computer-based Curriculum Delivery System(CCDS) project expanded its field testing net-work from 38 to 50 schools of the health profes-sions and recruited five new authors for thepathology series, thus assuring completion ofthat project in FY 1987. Four of the networkschools have produced their own videodiscs, anindication that CCDS is achieving some success

in its goal of facilitating adoption of newtechnologies by medical educators. Two CCDSprojects, Teenage Suicide and OrthopaedicSurgery, were completed during the year. To-gether, they represented the planning and devel-opment of five videodisc sides and three relatedcomputer programs. Dr. Woods presented pro-gram plans and demonstrated by invitation at theannual meetings of the American Academy ofOrthopaedic Surgeons, American PsychiatricAssociation, American Psychological Association,and American Suicidology Association. Dr. Woodsalso assisted European colleagues in organizingan international meeting (DOCMED EUROPE87)to be held in May 1987, in Amsterdam.

National Learning Demonstration Center TheNational Learning Demonstration Center (NLDC)opened in March 1985 as a central locationwhere various computer-video information andeducational technologies are demonstrated,reviewed, and evaluated. The NLDC also servesas a laboratory where visiting scholars can spendextended periods of time exploring comparativeapplications and developing evaluation methodsfor assessing the impact of specific technologies.

The NLDC staff assist visitors in a variety ofways. Individual or small group tutorials are pro-vided depending on the interests, needs and timecommitment of visitors. Tutorials range from ageneral overview of computer-based and videoeducation/information systems in the health pro-fessions to self-tutorials and hands-on experiencewith individual systems. Demonstrations are alsoprovided to illustrate the diversity among systemattributes and the alternatives available forcourseware design and delivery.

Exhibits available in the NLDC representexamples of education and informationtechnologies developed by staff of the LHNCBC,by individualsat other institutions,and by

52

private companies. Exhibits are organized in fivecategories:• Health Science Education and Information

Networks• Stand-alone Microcomputer Courseware• Interactive Videodiscs• Courseware Authoring Tools• Knowledge-based Information Systems

More than seven hundred health professionalsvisited the NLDC in FY 1986. In response totheir needs and interests the NLDC staff con-ducted three hundred demonstrations. In addi-tion, two national medical organizations includedvisits to the NLDC as part of their formalmeeting agenda: the American College of Car-diology Conference on Cardiovascular TeachingTechniques and the 63rd annual session of theAmerican Congress of Rehabilitation Medicine.

NLDC staff, in collaboration with theAudiovisual Program Development Branch,designed and developed a National LearningDemonstration Center exhibit to celebrate theNational Library of Medicine's Sesquicentennial.The exhibit highlighted information and educa-tion technology programs of the Lister HillNational Center for Biomedical Communicationsand was presented at the Library's "Open House"and at the Biomedical Information TechnologyFair held at the University of Maryland, HealthSciences Library.

Research in Support of NLM Operational Goals

PH Testing of NLM Holdings. The NLM's com-mitment to preservation of the world'sbiomedical literature is complicated by the factthat many biomedical publishers do not know if

the paper which they use to publish their jour-nals is acid free. The large number of paper pro-ducers makes it difficult to find readily availabledata about the acid/alkaline nature of the papersin use by biomedical publishers. In order toassist the Library Operations Division survey thechemical characteristics of the paper in serialsacquired by the Library, the LHNCBC began apilot project to test selected samples of book andperiodical papers for pH (and alkaline reserve, ifapplicable) over a period of seven months begin-ning in the early fall of 1986.

Library Growth. The Library Growth projectcompleted the data analyses for a majorstudy/report on recent research library trendsand prepared major portions of the report,which is scheduled for completion early inFY 87. (Evidence indicates that, for 35 years,research library expenditures have increased atan annual compounding rate of 9%; if con-tinued, this rate will result in growth from a1985 level of 110.8 million expenditures perresearch library to 116 million in 1990 and J20.7million in 1993). Project staff also collected andorganized data required for related studies ofother research and medical libraries, includingNLM. Status reports on the work were presentedto Council on Library Resources staff, ARLStatistics Committee, ARL membership, and theNLM Library Operations staff. The project con-tinued its collaborations with Dr. Paul Games,Penn State U.; Maxine Sitts, ARL headquartersstaff; and Kendon Stubbs, Alderman Library ofthe University of Virginia, and it sponsored aninformal "first annual" meeting that includedthese collaborators, plus five additional col-leagues with interest in library statistical studies.

Lister Hill Center

53

Extramural Grants and ContractsArthur J. BroeringActing Associate Director, Extramural Programs

Propam andServices, FX1986

National Library of Medicine's ExtramuralPrograms provide assistance opportunities in avariety of areas consistent with the NLM mission,using a number of competitive awardmechanisms which best facilitate specific pro-gram objectives. Authorities for NLM grants andcontracts come from two Public Laws, theMedical Library Assistance Act (MLAA) of 1965and extensions, and Section 301 of the PublicHealth Service Act as amended. Together thesecomprehensive laws provide the basis and condi-tions for financial support for any appropriatearea of NLM interest or concern and to anyqualified Institution or organization which hasthe capability of carrying out the purpose ofmeritorious projects. Scientific merit of Indi-vidual applications is determined using a systemof peer review which is identical to other grantfunding units of the National Institutes of Health.The current set of priority grant programs, fund-ing mechanisms and examples of recent awardsare described later in this chapter. RegionalMedical Library contract activities, as authorizedby the MLAA, are described in the section onLibrary Operations.

In the 150-year-old family of the NationalLibrary of Medicine, the Extramural ProgramsDivision is a relatively young member. However,NLM's sesquicentennial year of 1986 also marksthe twentieth anniversary of an annual grantsappropriation for extramural assistance activities.The NLMgrants program, an innovative experi-ment in the mid-1960's, has matured in tandemwith the relevant, rapidly advancing technology.Architects of the 1965 MLAA, while recognizingthe potential change in the management of infor-mation and knowledge, could not have foreseenthe direction or the extent of this change. Thecharts (Figures 1 and 2) provide some indication

of the shifting emphasis in areas of grant supportbetween the first and second decades of NLM'sassistance programs.

If the NLM 1966 grant authorities have come ofage in the opportunities they provide, they con-tinue to lag fiscally when measured against thesuccess of other health-related assistance. Twentyyears before the MLAA, the "golden age" of NIHextramural activities began. In the succeedingtwenty years, NIH extramural support increasedmore than 100 fold and, with every advancingyear and virtually every recorded grant, widenedthe gap between the body of health knowledgeand the effective means to make that knowledgeavailable. If the tenets of the NLM 1986 planningeffort are given their due, the next twenty yearscould eliminate that gap.

In the dual celebration of the NLM sesqui-centennial and the Extramural Programs vicen-nial, it seemed appropriate to set aside an "Extra-mural Programs Week." The week of March 10-14was so designated. On March 10-11, 1986, theProgram Directors and the trainees from each ofthe five training sites convened at NLM. On themorning of the first day NLM staff from theLister Hill Center, Specialized InformationServices, and Library Operations presented anddemonstrated some of their ongoing research. Inthe afternoon, while the Directors were meetingwith senior NLM staff, three traineesdemonstrated models and simulations whichformed part of their research. The following day25 of the trainees gave presentations of theirresearch results or their research plans. Thepapers fell into four broad categories: KnowledgeManagement, Medical Decision Making,Knowledge Representation, and Expert Systems.

The next event of the special week of Extra-mural Programs activities for the Sesquicentennial

54

Year, held on March 12, was a second IAIMSSymposium. IAIMS—Integrated Academic Infor-mation Management Systems—is a relatively newNLM Initiative. The Program's primary objectivesare to support the planning and development ofcomprehensive, integrated information networksof computer-based systems and services inacademic institutions, and to apply such systemsto advancing health sciences education, research,patient care, and management. The theme for thesecond symposium was the support of healthsciences education by IAIMS. More than 200academic health center senior officials, deans,librarians and hospital directors, representingsome 85 institutions, heard reports from institu-tions that are involved in IAIMS planning anddevelopment, and from individuals engaged ininnovative educational programs. Proceedings forthe symposium have been published.

Although a number of participants in thosetwo special week events were also members ofNLM's principal grants review group, it was morethan logistical convenience that the third event,on March 13-14 of Extramural Programs (EP)Week, was a meeting of the Biomedical LibraryReview Committee (BLRC). To the contrary, it isthis committee and the peer review system that Itrepresents and executes, which are the founda-tion of all NLM and NIH grant programs.Members of the 1986 BLRC are found in Appen-dix 5.

In addition to the EP Week events, the Publica-tion Grant Program and the Special Foreign Cur-rency Program were the subject of a special ses-quicentennial exhibit (prepared in collaborationwith the History of Medicine Division) at theAnnual Meeting of the American Association forthe History of Medicine, held in Rochester, NewYork, April 29-May 3, 1986.

Research Grants

As in past years, the library continued to offerassistance to research investigators concernedwith health knowledge issues. Following theusual highly selective review of grant applica-tions, five new awards were issued. Althoughsmall in number, they cover the full range oftheoretical through applied research endeavors inmedical informatics. NLM also continued supportfor awards committed in earlier years. NLM'sawardees are highly regarded members of severalhealth information professional societies. Theywere also highly visible through presentationsand other activities at MEDINFO 86, an inter-national meeting of workers In health informa-tion disciplines which met in Washington inOctober.

Medical informatics is an interdisciplinary fieldwhich combines the medical sciences with othersciences in the information, computer, linguistic,and behavioral domains. The field thereforerepresents a coalescence of more traditionaldisciplines, due in large part to the emergence ofadvanced computing and telecommunicationscapabilities. Attempting to harness thesetechnologies to the constantly enlarging body ofblomedical knowledge has by itself given rise tomany fundamental problems about knowledgerepresentation, human cognitive processes, andadaptation of new information behaviors to prac-titioners' dally routines. NLM's research grantprogram is the only Federal program specificallyconcerned with knowledge issues and health. Assuch, it is not constrained by specific categoricaldisease.

Among the new work supported, Dr. MarsdenBlois at the University of California, San Fran-cisco, will probe the origin of structure in

Extramural Programs

55

Programs andServices. FY1986

Figure 1

Mrilii'dlInlonnimci

Region.! I

Medicall.ibniry

Conir.icts

Extramural AwardsFY 1966-1975 ($75 million)

56

Figure 2 Extramural Programs

Mi'illc.ill.ihr.in.mshi|i

RegionalMedicalLibrary

Cnniraci.s

Ri'Miurcc

Extramural AwardsFY 1976-1986 ($100 million)

Emphasis to New and Expanded Program Priorities

57


medical databases. Dr. Blois is the author of thedefinitive text, Information and Medicine, TheNature of Medical Descriptions, which was writ-ten in part with NLM support.

At the Universityof Southern California Schoolof Medicine, Dr. Bharat Nathwani is investigatinga system for computer-aided diagnosis of lymphnode pathology. In doing so, he will draw upona team of nationally known pathologists togetherwith younger workers studying artificial in-telligence methodologies in medicine.

Professor Arthur Elsteln at the University ofIllinois is investigating the similarities and dif-ferences of decision-making by experts andnovices in intensive care situations.

At Cornell University,Dr. Roy Pollock isextending his concept of computer-basedknowledge nets for medical information. Theproject Involves knowledge in both human andveterinary medicine.

Dr. J. Robert Beck at Dartmouth CollegeMedical School received a Research CareerDevelopment Award for his ongoing studies Intheories of medical decision-making.

As one of its final awards for the year, NLMwas able to renew support for Professor HarryPople at the Universityof Pittsburgh. His highlyadvanced concepts of inferencing mechanismsfor medical knowledge bases take the form ofCADUCEUS, a computer-based diagnostic consul-tant for internal medicine,

Training and Career DevelopmentThe National Library of Medicine continues itssupport of postdoctoral research training in thefield of medical Informatics. It is clear that thisdiscipline goes beyond the use of the computer

as a computational tool and extends into theprocess of knowledge representation, storage,retrieval, and manipulation largely to supportinferential reasoning and to rationalize decision-making in the health sciences. There remains aneed for qualified talented investigators, wellequipped to address fundamental issues in theuse of computers and automated informationsystems in health care, health professions educa-tion, and biomedical research. These Investi-gators will contribute to the growth of scienceby their studies of knowledge management andby advancing the frontiers of the computersciences for organizing, retrieving, and utilizinghealth knowledge. It is also intended to fostermedical informatics as a growing discipline withan appropriate place in academic medicine. It isexpected that the trainees will become able,cross-disciplinary translators, taking the computersciences to all of medicine.

Twenty-nine individualsare currently beingsupported at the five training sites:• University of California, San Francisco. This

postdoctoral training program is broadly basedin the field of medical information science.Research areas include clinical database pro-jects, decision support programs, and usersoftware engineering.

• University of Minnesota. The focus of thisinterdisciplinary program is to provide trainingin cognitive, information, and computersciences for academic researchers who willaddress fundamental issues in the managementand clinical application of health knowledge.

• Harvard Medical School. Major emphases arecomputer-based decision support systems,modeling of physician decision-making,representation and structuring of medical

58

knowledge, applications of informationtechnology to medical education, database anddata analysis systems, computer graphics, anddevelopment and evaluation of digital imagingsystems.

• New England Medical Center. This researchtraining program emphasizes clinical decision-making, the use of microcomputers, artificialintelligence tools for structuring and usingmedical knowledge, clinical cognitions, andthe use of medical informatics in medicaleducation.

• Stanford University. All students, includingpostdoctoral trainees, are enrolled in a formalMaster's or Ph.D. program and specialize ineither medical computer science or medicaldecision science.The National Library of Medicine also offers

research grant programs in the fields of medicalinformatics and in health information sciencedesigned for individuals who have completedpostdoctoral training and are now embarking onan independent research career. The First Inde-pendent Research Support and Transition (FIRST)Award is such a mechanism. It replaces the NewInvestigator Research Award and provides fiveyears of support and a maximum total direct costof $300,000 for the five-year period.

To be eligible for this award the principalinvestigator must be a beginning investigatorwho is not in training status and who has notbeen designated previously as principal investi-gator on any peer-reviewed project supported bythe PHS. Because the FIRST Award was initiatedand announced this year, NLM was not able tomake any awards. We continued to support thefour New Investigator Research Awards already inexistence.

The next career supporting mechanism utilizedby NLM is the Research Career DevelopmentAward. These awards are given to institutions onbehalf of candidates with promising researchpotential. The grants provide five years of salarysupport so that the individual can develop andadvance as an independent investigator. Theaward is intended to make a significant differenceto the individual's career growth. Researchresources and support are not provided as a partof this award but must be available for use of theawardee.

Resource GrantsResource Grants are directed towards the nation'shealth science libraries and provide "seedmoney" to improve information resources and toenhance information services to the ultimateusers whether they be faculty, students,researchers, or practitioners. Resource Grants areof two types—the Resource Improvement Grantand the Resource Project Grant—and offerassistance over a broad spectrum ranging frombook and journal purchases in rural hospitals toinstalling computers in medical school libraries toautomating internal technical operations. Thesegrants require substantial cost sharing from theinstitutions to assure that the resources andservices Initiated with NLM funds will becontinued.

The Medical Library Resource ImprovementGrant is intended to develop book and journalresources in institutions which have notpreviously supported a library. These grants areavailable to single health science institutions,usually hospitals, as well as consortia of organiza-tions which are involved in some aspect of thehealth sciences. The intent is to foster a

Extramural Program

59


collaboration of a variety of organizations inorder to maximize the information resourcesavailable to all. Such partnerships have joinedhospital libraries with public libraries, commun-ity college libraries, county health agencies, toname a few. In 1986, Resource ImprovementGrants were awarded to eight hospital librariesand to one consortium encompassing health-related institutions in the five northern countiesof Idaho.

Medical Library Resource Project Grants aredirected toward libraries which are alreadyestablished and providing services. The purposeof the grant assistance is to initiate an Informa-tion service or to expand an existing one. Sup-port is available for up to three years dependingupon the nature of the project, some requiringmore or less time to become operational and toobtain alternative funding, since the NLM grantassists only in the large initial start-up costs. In1986, three Medical Library Resource ProjectGrants were awarded. At the University ofCalifornia the five medical school libraries arecooperating to add the MEDLINE periodicaldatabase to the previously computerized bookcatalog called MELVYL. Eventually the automatedjournal and book catalog will be extended to allUniversity of California campuses. At the Univer-sity of Texas at San Antonio the health scienceslibrary, which is already equipped with a com-puterized system, is adding a drug informationcomponent in order to have drug data availablewithin patient care areas. In the state of NewJersey a computerized library system is beingestablished to connect the four campus sites ofthe University of Medicine and Dentistry of NewJersey.

IAIMS ProgramGrants are awarded to assist medical centers andhealth science institutions in planning anddevelopment projects leading to the implementa-tion of Integrated Academic Information Manage-ment Systems (IAIMS). IAIMS are institution-widecomputer networks that link and relate librarysystems with individual and institutionaldatabases and information files, within andexternal to the institution, for patient care,research, education, and administration. The goalis to create an organizational mechanism tomanage more effectively the knowledge ofmedicine, and to provide for a system of com-prehensive information access.

The IAIMS concept was originally described ina study sponsored by the NLM and developed bythe Association of American Medical Colleges:"Academic Information in the Academic HealthSciences Center: Roles for the Library in Infor-mation Management." The report strongly recom-mended that the scholarly record and medicaldatabases be brought together in an integratednetwork of computer-based systems and services.The primary objectives of the IAIMS Program areto assist in the development of such comprehen-sive networks, and to encourage the rapid inte-gration of information technologies in healthsciences education and practice.

NLM provides grant support for: 1) institution-wide IAIMS planning and policy analysis;2) model development and testing of some seg-ment or cross-section of the IAIMS plan; and3) implementation of detailed, tested plans for afull-scale IAIMS. These phases of IAIMS activityare considered sequential, and successful com-pletion of one stage is required before beginning

60

the next. Grant support is also provided forresearch projects related to IAIMS activities.IAIMS sites provide an expedient opportunity toexploit advances resulting from medical informa-tion science research, as well as a locus for amultitude of studies to improve informationaccess and use in the health sciences.

During FY 1986, ten IAIMS planning anddevelopment projects were active; three werecontinuing, based on support received inFY 1985. IAIMS Phase I Planning was under wayor nearlng completion at the Baylor College ofMedicine, Harvard University, Johns HopkinsUniversity, and the University of Cincinnati. Hav-ing successfully completed institutional IAIMSplanning, IAIMS Phase II Model Developmentand Testing was under way at Columbia Univer-sity, Georgetown University, the University ofMaryland, and the University of Utah. Reports ofactivities at each of these institutions were givenat the second IAIMS Symposium cited previouslyin this Extramural Programs section.

Two new grants to begin strategic planning forIAIMS made during FY 1986 represented the firstto a hospital and the first to a national medicalspecialty society. In approving the grant applica-tion from Rhode Island Hospital (Providence),the NLM reviewers stated that this institution pro-vided an excellent example for demonstrating therelevance and effectiveness of IAIMS in a hospitalsetting. In their grant application, the AmericanCollege of Obstetricians and Gynecologists(AGOG), Washington, DC., cited numerousreferences to professional associations in theAAMC report that gave rise to the IAIMS pro-gram, and carefully delineated a series of ac-tivities and programs to develop and extend theIAIMS concept for a national community.

Two IAIMS research projects were active withcontinuation grant awards made during FY 1986.Investigators at the Baylor College of Medicineare studying the problem of integrating severallocal area networks (LANs), designing an advancedwork station, and exploiting a specialized datamanagement computer to advance IAIMSdevelopment, user interaction with IAIMS, andcommon access. At Georgetown University, theassessment of the information needs of healthprofessionals in a Comprehensive Cancer Centerwill lead to the design and provision of anexperimental library module. Evaluation of themodule will give rise to guidelines for creatingspecialized information services, and therebyserve as a model for implementing the IAIMSconcept broadly in an academic medical center.

Publication Grant ProgramBiomedical scientific publication grants expeditethe availability of health information important tomedical progress. The Publication Grant Programprovides selective, short-term support for a varietyof not-for-profit publications, including criticalreviews and monographs in health fields;publications in library and information scienceand in biomedlcal communication; temporarysupport for periodical publications; studies in thehistory of medicine; translations of currentforeign biomedical monographs; proceedings ofsymposia related to U.S. health needs; and secon-dary literature tools in the health sciences (suchas annotated bibliographies, catalogs, and atlases).Together with its complementary activity, theSpecial Foreign Currency Program (described inthe chapter on International Programs), thePublication Grant Program is administered by the

Extramural Programs

61


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

FY 1984 FY 1985 FY 1986Category

Number Amount ($) Number Amount ($) Number Amount (J)

ResearchResource ProjectsResource Improvement . . .TrainingRegional Med. Libraries . . .Publications

(IAIMS Projects)* . . . .(Med. Info. Research) .

129162297

20

(2)

12,3991,114

614786

2,000587

(134)

39251757

15

(11)(3D

$5,4312,507

52810912054

403

(1,717)(4,489)

35191557

16

(9)(27)

15,6092,604

19010952325

426(2,205)(4,029)

Total 103 $7,500 108 512,014

'Includes both IAIMS Resource & Research Projects

97 112,249

International Programs Branch of NLM'sExtramural Programs Division.

During FY 1986, NLM awarded 16 PublicationGrants, totaling 1426,609. Of these, 10 were newawards, including one for the development of ahandbook on clinical and legal issues for mentalhealth practitioners, so that psychiatrists andothers caring for mental patients may have theknowledge necessary to make clinical decisionsconfidently, while cognizant of legal require-ments. The average amount of a PublicationGrant in FY 1986—approximately $27,000 inboth direct and indirect costs—reflects the con-tinuing emphasis in this program upon highquality, but low-cost, projects that are scheduledfor early publication.

Among the studies published in FY 1986*which the Publication Grant Program fundedwas a monograph on Steroid-Protein Interac-tions II, by Ulrich Westphal (New York: Springer-Verlag, 1985), which is a critical review ofresearch carried out in many countries duringthe last fifteen years on interactions betweensteroids and proteins. The author is a world-recognized authority in this field and his reviewis expected to be a major source book forresearchers for years to come. Anothersignificantvolume published this year is the first part of anew listing and description of all genetic andcytologic variations known in Drosophila: TheGenome of Drosophila melanogaster, Part 1:Genes A-K, by Dan Lindsley and Georgiana

62

'See Appendix 2 for a complete listing of publicationsreceived in FY 1986 resulting from NLM Extramural Programsupport

Zlmm (Drosophila Information Service, No, 62, Biomedical Research Policy, 1887-1937, by Extramural Programs1985). Since publication of the original volume Victoria A. Harden (Baltimore, Maryland: Thein 1968, prolific research has led to an explosion Johns Hopkins University Press, 1986). Emphasisof information, thus making updating of the is placed upon the activities of the Public Healthcatalog of this material crucial to continued rapid Service in the late 1920s and a critical analysis ofprogress in Drosophila genetics. Also completed the subsequent development of a national con-thls year with grant support was a book on sensus on the need for broad Federal support forthe origin and early years of the National Insti- U.S. blomedical research.tutes of Health: Inventing the NIH: Federal

63

International ProgramsRichard K. C. Hsieh, Dr. P.M.Director, International Programs


international programs of the NationalLibrary of Medicine (NLM) are integral to NLM'sresponsibilities in biomedical information. TheU.S. health professional benefits from the inter-national character of the NLM collection andfrom the powerful biomedical informationretrieval service. The world health communityshares benefits from NLM's advanced informationsystems.

During the past year NLM has continued itsbilateral cooperative MEDLARS agreements withindividual countries; its cooperation with inter-national governmental organizations such as theWorld Health Organization (WHO) and the PanAmerican Health Organization (PAHO); and inter-national nongovernmental organizations such asthe International Council of Scientific andTechnical Information (ICSTI). The SpecialForeign Currency Program was active in the pro-duction of critical reviews and history ofmedicine projects. Other NLM internationalactivities have included a jointly sponsoredworkshop entitled "International Collaborationon the Application of Medical Infor-matics,"specialized training for colleagues fromabroad, the NLM publications exchange program,as well as numerous professional visitors fromabroad.

International MEDLARS AgreementsThe National Library of Medicine currently hasMEDLARS agreements with partners in 15 foreigncountries and with the Pan American HealthOrganization. An International MEDLARS PolicyAdvisory Group (IMPAG) meeting was held onOctober 31, to November 1, 1986 at the Library.Major topics discussed were progress in CD-ROMdevelopment, MEDLARS III (the enhanced

automated system being developed by theLibrary), TOXNETand Hazardous Substance DataBank (HSDB), NLM Long Range Plan, CurrentIssues in Library Operations, and Research andDevelopment Projects of the Lister Hill NationalCenter for Biomedical Communications. EachInternational Center also reported highlights ofrecent developments and plans for future years.

The Honorary Director of the Institute ofMedical Information of the Chinese Academy ofMedical Sciences (Beijing) represented China atthe International MEDLARS Policy AdvisoryGroup meeting. Technical assistance from NLMstaff to Install the ELHILL software and the train-ing of system operators took place in Beijing inJuly and August of 1986. The MEDLINE systemin China is operational on a limited service base,and the completion of testing is anticipated insix months.

The Director of the Center for EducationalTechnology and the Director of the Egyptian SDINetwork represented Egypt at the InternationalMEDLARS Policy Advisory Group meeting for thefirst time. The Director and two other staff fromthe Center completed their MEDLARS search andmanagement training from NLM in July andAugust. Currently, the NLM provides SelectiveDissemination of Information (SDI) tapes to thisnew Egyptian MEDLARS Center as well as accesscodes for their online search service on MEDLINE.

The following table lists the existing non-US.MEDLARS Center countries and how they accessthe MEDLARS system. Following the meeting ofthe International MEDLARS Policy Group, theInternational MEDLARS Centers continued tofulfill their mandate and functions to serve asnational resources for the provision ofbiomedical research, education, and healthinformation.

64

Table 11Non-US. MEDLARS Centers

Tapes Tapes/Software Online NLM

EgyptGermanyJapanSwitzerland

AustraliaChinaBIREME (PAHO)FranceSweden

CanadaColombiaItalyKuwaitMexicoSouth AfricaUnited Kingdom

India has shown an interest in sharingadvances in science and technology with NLM.At the meeting with a delegation from India forScience and Technology as well as the visit ofthe Minister of Health, their desire to set up aMEDLARS Center in New Delhi was discussed.The Indian government has made progress ondeciding the appropriate organizational entity toserve as a MEDLARS center and how the centershould be administered.

Collaboration with the World HealthOrganizationThe National Library of Medicine has enjoyedcollaborative activities with the World HealthOrganization (WHO) and its affiliated PanAmerican Health Organization (PAHO).

With WHO, the Library collaborates on theQuarterly Bibliography of Acute DiarrboealDiseases. NLM is responsible for carrying out theliterature searches, classifies the articles retrievedand prepares camera-ready copy, which WHOprints and distributes to thousands of institutionsin developing countries. The Library also

supports the Quarterly Bibliography of MajorTropical Diseases, printed in India and col-laboratively distributed internationally by WHO.

NLM provides bibliographies from the contentsof the MEDLINE system to PAHO in camera-ready copy, and PAHO prints and distributesthese in the Bibliography of Respiratory Infec-tions in Children publication.

NLM and WHO also continue a collaborativearrangement to provide photocopies of journalarticles for the use of health professionals indeveloping countries in Africa, the EasternMediterranean and South East Asia. Libraryresources in developing countries are usuallyinsufficient and their need for biomedical andhealth information can be met only by drawingon the collections of the developed world. Eventhough NLM provides more than 5,000 photo-copies a year to developing countries (more than80 are eligible for interlibrary loans), this numbercan only partially meet their demand. Unlessnew resources or contributions from otherdeveloped countries can be found, the gap forfree interlibrary loans to developing countrieswill be widened continuously.

NLM Special Foreign Currency ProgramAuthorized under Public Law 83-480, theLibrary's Special Foreign Currency Programutilizes appropriations of U.S.-owned, localforeign currencies to fund biomedical scientificpublication and translation projects incooperating countries. The NLM PL. 480Program, administered in the Extramural ProgramDivision's International Programs Branch, is theoldest of the Library's extramural support activi-ties and constitutes an important supplement tothe domestic Publication Grant Program.

International Activities

65


During FY 1986, the PL. 480 Program spon-sored 73 projects totaling 1945,288 in U.S.equivalent dollars. Approximately 70 percent ofthe program is carried out in India, 20 percent inPoland, and the remaining projects are active inEgypt, Israel and Pakistan.

About half of NLM's current PL. 480 fundingsupports the preparation of scholarly researchmonographs and translations of classics in thehistory of medicine, Another fourth of the pro-gram funds the preparation and publication ofstate-of-the-art critical reviews and monographswhich analyze research and practice Inblomedicine. Approximately 20 percent of theprogram supports secondary literature tools(bibliographies, handbooks, biomedical guides,etc.). Among these is the Quarterly Bibliographyof Major Tropical Diseases, printed in India andcollaboratlvely distributed Internationally by theWorld Health Organization.

Among the studies resulting this year fromsupport in the PL. 480 program was a com-prehensive review of the natural history of aunique zoonotic viral infection, Omskhemorrhagic fever (OHF):

Kharitonova, and Leonov, Yu. A.Omsk Hemorrhagic Fever: Ecologyof the Agent and Epizootiology.New Delhi, India: AmerindPublishing Co. Pvt. Ltd, 1985, 230pp. Distributed through the NationalTechnical Information Service

Originally published in Russian, this Englishtranslation was edited by the late Dr. HarryHoogstraal, the well-known international author-ity on ticks, tickborne infections, and hemor-rhagic fevers. The monograph raises importantnew Issues of practical public health significanceto international medicine.

The Library has sponsored a critical reviewprogram in Poland for the past 20 years whichhas produced a distinguished series ofmonographs written by Polish biomedical scien-tists. Despite the political tension in U.S.-Polishrelationships since 1981, NLM PL. 480-fundedbooks continue to reach publication. In FY 1986Dr. Franciszek Kokot's review of EndocrineAbnormalities Associated with Acute RenalFailure, published in collaboration with thePolish Academy of Sciences, was received. Theauthor is an eminent clinical research scientistand Professor of Medicine at the Sileslan Schoolof Medicine in Katowice. The study exploreswhy endocrine abnormalities may be expected inacute renal failure (ARF) and studies a range ofabnormal hormone levels in blood plasma frompatients with ARF

A significant share of NLM's overall supportprogram for research and publication in thehistory of medicine is carried out through theSpecial Foreign Currency Program. This year PI.480 support in Egypt resulted in the publicationof a critical edition and translation of Averroes'commentaries on works of Galen, prepared col-laboratively by the Director of the DominicanInstitute of Oriental Studies of Cairo, Father G. C.Anawati, and the Professor Emeritus of Medicineat Aln Shams University, Dr. Paul Ghalloungui.These 12th century commentaries, originallywritten in Arabic, have never been previouslypublished in Arabic or available in English.

Two additional studies in a new series entitled"Resources in Medical History," selected In col-laboration with the American Association for theHistory of Medicine, were also published inFY 1986. Charles Turner Thackrah's The Effectsof Arts, Trades and Professions on Health andLongevity, initially published in 1831, was the

66

first systematic publication in Great Britain onindustrial disease and its prevention. Alsoreprinted, with a new historical introduction byCharles G. Roland, M.D., of McMaster University,was a rare volume by Dr. John Douglas on theMedical Topography of Upper Canada—the firstmedical book ever to be published (1812) inOntario, Canada.

International Conferences, Seminars,and MeetingsThe National Library of Medicine is a member ofthe International Council for Scientific andTechnical Information (ICSTI). This organizationserves as a meeting ground for information andabstracting agencies, commercial and govern-mental, in a number of countries around theworld including Canada, Federal Republic ofGermany, France, Japan, the Netherlands, SouthAfrica, United Kingdom, and U.S.S.R. Commoninterests include economics of primary andsecondary publications, trans-border flow ofinformation, electronic publication, standardiza-tion and the information needs of developingcountries. At the general meeting of ICSTI heldMay 17-21, 1986 in York, United Kingdom, NLMwas represented by the Assistant Director forInternational Programs.

On October 23 and 24 of 1986, NLM held aninvitational workshop which was sponsoredjointly with the Fogarty International Center, theDivision of Computer Research and Technology,and the Division of Research Resources. Forty-five participants from 22 developing countriesmet for two days to exchange their viewpointsand experiences in international collaboration onthe application of medical informatics. One con-sensus reported by participants of this workshop

is that as the advent of microcomputers reachesmost households in the United States and otherdeveloped countries, the rate of utilization ofcomputers in medicine in developing countries isnot progressing at a same pace. Unless Inter-national collaboration and national resources formedical informatics are developed rapidly, thegap between the developed and developingcountries will not be narrowed.

International VisitorsThe National Library of Medicine continues toattract hundreds of foreign visitors each year,including doctors, medical librarians, publichealth specialists, and government officials. Manyof these visitors have responsibilities for medical,scientific or technical information in their owncountries. Their interest in NLM is more thancursory, and they are officially received andbriefed on relevant aspects of NLM operationsand research. The visitors came from the follow-ing countries:

Australia, Bulgaria, Canada, China,Colombia, Egypt, Federal Republic ofGermany, Fiji Islands, France, India,Israel, Italy, Jamaica, Japan, Korea,Liberia, New Guinea, New Zealand,Poland, Singapore, South Africa, SriLanka, Sweden, Switzerland, Taiwan,Thailand, and Venezuela.

Many official delegations came to scrutinizeone or more facets of NLM and to pursuetechnical issues in information and libraryscience, usually with a view to identifyingappli-cations that might prove useful. In addition toforeign visitors, NLM received many trainees,students, and professionals in observer roles forshort periods.

International Activities

67

AdministrationKenneth G. CarneyExecutive Officer

Programs andServices, FY1986 Financial Resources

In FY 1986, the National Library of Medicine hada total budget authority of 557,397,000. Table 12displays the FY 1986 budget authority plus reim-bursements from other agencies and the alloca-tion of these resources by program activity.

Table 12Financial Resources and Allocations FY 1986(in thousands of dollars)

Budget authority:Appropriation, NLM $57,808Sequestration pursuant to P.L.

99-177 -2,486Funds withheld pursuant to PL.

99-190 -49

Subtotal 55,273

Plus: Reimbursements 2,124

Total 157,397

Budget allocation:Extramural Programs 112,254Intramural Programs and Services . . 39,737

Library Operations (26,858)Lister Hill National Center for

Biomedical Communications... (8,915)Toxicology Information (3,964)

Research Management and Support. 5,406

Total 157,397

Personnel

Richard K.C. Hsieh, Dr.P.M., was nominated forthe position of Associate Director for Inter-national Programs in March 1986. Dr. Hsiehpreviously served as a Health ScientistAdministrator in the extramural program of theNational Cancer Institute.

Carol Spencer, formerly Deputy, ReferenceServices Division (RSD), and more recentlySpecial Assistant in the Office of the AssociateDirector, LO, retired in April after almost 14 yearsof service at NLM.

Charles R. Kalina was appointed Special Expertin the Office of the Director, NLM in May 1986.Mr. Kalina was formerly Associate Director,Health Planning Council, Inc., of Providence,Rhode Island.

Cassandra Allen was appointed Head, Collec-tion Access Section, Public Services Division(PSD) in May 1986. Ms. Allen had previouslyserved as Assistant Head, Circulation Section, atthe Library of Congress.

Daniel R. Masys, M.D., was appointed Directorof the Lister Hill National Center for BiomedicalCommunications in June 1986. Dr. Masys hadpreviously served as the Chief, InternationalCancer Research Data Bank Branch, NationalCancer Institute.

Sally K. Sinn was appointed Deputy Chief,Technical Services Division (TSD), in July 1986.Ms. Sinn had previously served as Assistant Head,Cataloging Section in TSD.

Joseph Ganter, formerly Chief, TechnicalServices Division (TDS), and more recentlyCollection Development Officer, died in June1986.

Margaret Byrnes was appointed Chief, Preserva-tion Section, Public Services Division (PSD) in

68

August 1986, Ms. Byrnes was formerly the Preser-vation Officer at the University of Michigan.

Lloyd L. Wommack retired from his position asHead of the Index Section, BibliographicServices Division (BSD) in August 1986. Mr.Wommack had devoted 25 of his 34 years ofFederal service to the Index Section.

Bella L. Ceja was appointed Assistant to theDirector, NLM, in August 1986. Mrs. Cejapreviously served as Special Assistant to theDirector of NIH.

Mamie 0. Toler retired from her position inthe Selection Acquisition Section of the TechnicalServices Division (TSD), after over 35 years ofgovernment service.

Arthur S. Pollltt, M.D., was appointed as aSpecial Expert in the Lister Hill National Centerfor Biomedical Communications in December1986. Dr. Pollitt was formerly a senior lecturer inComputing and Information Systems in theDepartment of Computer Studies andMathematics at the Polytechnic in Huddersfield,Great Britain.

Thomas N. Bonner, Ph.D., was appointed as aSpecial Expert in the History of Medicine Divi-sion, LO in January 1987. Dr. Bonner previouslyserved as a Distinguished Professor of Historyand Higher Education at Wayne State University,Detroit, Michigan; and as Visiting Professor at theInstitute of the History of Medicine, University ofFreiburg, Germany.

Charlotte Kenton retired from her position inthe Reference Section of the Public ServicesDivision (PSD) in January 1987 after concludingover 37 years of government service.

AwardsNIH Merit Awards were presented to:Becky Lyon-Hartman, Division of Library Opera-tions, "for her outstanding leadership in admin-istering the Regional Medical Library Program,which provides access to biomedical informationresources to health professionals."

Frances E. Spina, Division of Library Opera-tions, "for her initiative and industry in pro-viding bibliographic input of the highest qualityin the NLM MEDLARS databases."

Bruno M. Vista, Division of Specialized Infor-mation Services, "for his initiative,resourcefulness, and leadership in providing acomprehensive, publicly accessible inventory ofliterature, research, and studies of health effectsof toxic substances."

James W. Woods, Ph.D., Division of Lister HillNational Center for Biomedical Communications,"by anticipating trends and collaborating withprominent biomedical educators, his NLM pro-jects advance the adoption of new instructionaltechnologies."

Rose Marie Woodsmall, Office of Planning andEvaluation, "for her efforts in the developmentof specifications for GRATEFUL MED, whichallows access to the most widely usedbiomedical database in the world, enhancinghealth practitioners' access to new and importantknowledge."

The NLM Director's Award was presented toMark J. Rotariu, Budget Officer, Office of Finan-cial Management, "for his outstanding service tothe library in the formulation and execution ofthe budget and for his conscientious preparationof the senior NLM management staff for congres-sional testimony."

Administration

69

Services, FY1986The NLM Board of Regents Award was

presented to William G. Harless, Ph.D., SpecialAssistant to the Director, Lister Hill NationalCenter for Biomedical Communications, "for hiscreativity and leadership in the TechnologicalInnovations in Medical Education (TIME)Project."

Table 13Staff, FY 1986 Full-Time Equivalents (FTEs)

Program Full-TimePermanent

Total.

Total FTE Usage

457

501

Other

Office of the Director 17 1Office of Inquiries and

Publications Management. 5 1Office of Administration . . . 42 4Office of Computer and

Communications Systems. 60 5Extramural Programs 19 2Lister Hill National Center

for BiomedicalCommunications 66 7

Specialized Information

Library Operations 220 20

44

Equal Employment OpportunityThe focus of the 1986-87 NLM Equal Employ-ment Opportunity Program was to revise the1982 Affirmative Action Plan. One subcommitteeof the EEO Advisory Committee evaluated the1982 plan and recommended revisions; anothersubcommittee incorporated those recommenda-tions into a revised plan.

During the year, several EEO Open Meetingswere held by the operating Divisions to improveworking conditions by management andemployees informally addressing EEO issues. InApril, Mike Causey, Washington Post journalist,addressed NLM employees discussing the EEOimpact of the Gramm-Rudmann-Hollings Bill.

Also in April, a meeting was held at which 16issues and problems concerning handicappedemployees were identified and later discussedwith management. Essie Lawrence, Chairman ofthe N1H Handicapped Employees Committee,received the Outstanding Handicapped EmployeeAward of the year from the Department ofHealth and Human Services.

Dr. Donald Buckner, NLM EEO Chairman,received the NLM EEO Special AchievementAward for providing outstanding leadership inencouraging discussion in open employee meet-ings and providing leadership in the develop-ment of the revised Affirmative Action Plan.

Another accomplishment was the establish-ment by the NLM EEO Officer of a quarterlyminority statistics report. The most recent figuresshow that the NLM workforce comprises 30percent members of minority groups, 65 percentfemales, and 6 percent handicapped employees.

70

Appendix 1: Staff Bibliography

following works were published byNational Library of Medicine staff in FY 1986:

Avram, H.R., Colaianni, L.A., and Howard,J.H. National libraries' vision of the nationwidenetwork and their role in that network. In: Net-work planning paper #13—toward a commonvision in the library networking: proceedings ofthe Library of Congress network advisory com-mittee meeting, December 9-11, 1985.Washington, D.C.: Library of Congress, 1986:35-9.

Benson, D.A., Goldstein, CM.,Fitzpatrick,L, Williamson, D., Huntzinger, R. Developingtools for online medical reference works. In:Salamon, R., Blum, B., Jorgensen, M., eds. Pro-ceedings of the 5th World Congress on MedicalInformatics (MEDINFO 86). Amsterdam: ElsevierScience Publishers, 1986:55-8-9.

Cassedy J.H., [Highlights in the developmentof medical history in the United States]. Japanesetranslation, with comments by Chuhei Yamagushiand Yosio Kawakita. Kagatu-Igaku ShiryoKenkyu (Tokyo) 1986;l43:l-4; 144:8-12;145:8-12;146:8-12.

Cookson J.P., Thoma, G.R. The effect of pre-processing on image compression. In: Casasent,D.P., Techer, A., eds. Proceedings of SPIE—theInternational Society for Optical Engineering.Bellingham, WA: Society of Photo-Optical Instru-mentation Engineers, 1986;638:139-47.

Cosmides, G.J. National Library of Medicineaccords recognition to non-animal testing. TheAnimal Welfare Institute Quarterly1985/6;4(4):2.

Darden, L., Rada, R.: Hypothesis formationvia interrelations [Universityof Marylandtechnical report no. 1628]. College Park, MD:University of Maryland, 1986:18.

Doszkocs, T.E. IR, NLP, AI, and UFOS: or IR-relevance, natural language problems, artfulintelligence and user-friendly online systems. In:Rabitti, E, ed. 1986 ACM Conference on Researchand Development in Information Retrieval. Pisa,Italy: Association for ComputingMachinery,1986:49-57

Harless, W.G. An interactive videodisc drama:the case of Frank Hall. Journal of Computer-Basect Instruction 1986;13(4):113-6.

Harless, W.G. Technology in medicaleducation—a case study approach. Computers inLife Sciences Education 1985;2(23):92-4.

Harless, W.G., Zier, M.A., Toothman, J.P.Technological Innovations in MedicalEducation—the TIME project. In: Proceedings ofthe ninth annual symposium on computer appli-cations in medical care. Washington DC: IEEEComputer Society, 1985:596-7.

Harris, T.R. Electronic eye-position monitor-ing interface. In: Kuklinski, W.S., Ohley, W.J., eds.Proceedings of the eleventh annual northeastbioengineering conference. Worcester, MA.;Worcester Polytechnic Institute 1985:267-70.

Hauser, S.E., Crocker, M.A., Harris, T.R. Aninvestigation of broadband ethernet for imagetransmission. In: Proceedings of the eleventhconference on local computer networks.Washington, DC.: IEEE Computer Society Press,1986:56-62.

Humphrey, S.M., Miller, N.E. The NLM index-ing aid research project. In: Hurd, J.M., ed. ASIS'86: Proceedings of the 49th ASIS annualmeeting. Medford, N.J.: Learned Information,Inc., 1986:106-12.

71

Humphreys, B. Acid-free paper: stopping thepreservation problem at its source, CBE Views[Council of Biology Editors) 1986;9;45-7.

Kingsland, L.C. Artificial intelligence: pro-mise and reality. In: Levy, A.H., Williams, B.T.,eds. Proceedings of the American Association forMedical Systems and Informatics (AAMS1)Congress 1986. Washington, D.C.: AAMSI,1986:87-91.

Kingsland, L.C. The evaluation of medicalexpert systems: experience with the AI/Rheumknowledge-based consultant system inrheumatology. In Ackerman, M.J., ed. Pro-ceedings of the Ninth Annual Symposium onComputer Applications in Medical Care (SCAMC).Washington, D.C.: IEEE Computer Society Press,1985:292-5.

Kingsland, L.C., Lindberg, D.A.B. The criteriaform of knowledge representation in medical ar-tificial intelligence. In: Salamon R., Blum, B.,Jorgensen, M., eds. Proceedings of the FifthWorld Congress on Medical Informatics (MEDIN-FO 86). Amsterdam: Elsevier Science Publishers,1986:12-6,

Kingsland, L.C., Lindberg, DAB, Sharp, G.C.Anatomy of a knowledge-based consultantsystem: AI/RHEUM. MD Comput 1986;2(5):18-26.

Kissman, H.M.,ed. State/Federal Workshopon the Joint Development of Environmental andToxicological Information Resources (workshopreport). Springfield, VA: National Technical Infor-mation Service, 1985:129pp.

Lindberg, D.A.B. Evolution of medical infor-matics. In; Medical Education in the InformationAge: Proceedings of the symposium on medicalinformatics. Washington, D.C.: Association ofAmerican Medical Colleges, 1986:86-95.

Lindberg, D.A.B., Schoolman, H.M, The Na-tional Library of Medicine and medical infor-matics. WestJMed 1986;145;789-90.

Locatis, C. Foreword to the health sciencetheme. Journal of Instructional Development

Locatis, C., Carr, V. Authoring systems andassumptions about them. JBC 1986;13(2):4-9.

McHale, C.G, Hawk, S.A., Wagstaff, D.J.TOXLINE— an information resource. Vet HumToxicol 1986:28:237-9,

Mehnert, R.B., The National Library ofMedicine. In. Kent, A., ed. Encyclopedia ofLibrary and Information Science. New York,Marcel Dekker, Inc., 1986;231-47.

Mehnert, R.B. National Library of Medicine.In: Simora, F., ed. The Bowker Annual ofLibrary & Trade Book Information. New York,R.R. Bowker, 1986:143-8.

Mili, H, Rada, R. A statistically builtknowledge base. In: Proceedings of ExpertSystems in Government Conference. IEEE Com-puter Society Press, 1985:457-63.

Parascandola, J. The development of recep-tor theory. In: Parham M.J., Buivels, J., eds.Discoveries in Pharmacology. Vol 3. Phar-macological Methods, Receptors andChemotherapy. Amsterdam: Elsevier SciencePublishers, 1986:129-56.

Rada, R. Gradualness eases refinement ofmedical knowledge. Med Inf 1986;ll-.59-73.

Rada, R, Gradualness facilitates knowledgerefinement. IEEE Transactions on Pattern Analysisand Machine Intelligence 1985;7:523-30,

72

Rada, R. On evolving systems. [Letter to theEditor). Communications of the Association ofComputing Machinery 1986;20:173-21.

Rada, R. Review of Elaine Rich's artificialIntelligence. Artificial Intelligence and Inter-national Journal 1986;28:119-21.

Rada, R., Humphrey, S., Coccia, C. Aknowledge-base for retrieval evaluation. In:Annual Proceedings of the Association ofComputing Machinery 1985:360-67.

Rada R., Darden, L, Eng, J. Relating twoknowledge bases: the role of identity and part-whole [University of Maryland technical reportno. 1627]. College Park, MD: University ofMaryland, 1986:27.

Rada, R., Brown, E., Humphrey, S., Suh, A.,Coccia, C.: Relevance on a biomedical classifica-tion structure. In: Proceedings of Expert Systemsin Government Conference. Los Angeles: IEEEComputer Society Press, 1985; 532-7.

Schoolman, H.M. The physician and themedical literature. Arch Dermatol 1986;122:875.

Smith, K.A.: National Library of Medicine.ALA Yearbook 1986;ll:217-8.

Smith, K.A.:Medical information systems.ASIS Bull 1986;12(4):17-18.

Sneiderman, C.A. Computer-assisted medicaldiagnosis and therapeutics: a literature review.Physicians 6 Computers 1986;5:31-5.

Sparks, S.M. The U.S. National Library ofMedicine: a worldwide nursing resource. IntrNurs Rev 1986;33(2):47-9.

Suthasinekul, S., Walker, F.L.,Cookson, J.P.,Rashidian, M., Thoma, G. Prototype system forelectronic document image storage and retrieval.

Teigen, P.M. William Osier's historiography: arhetorical analysis. Can Bull Hist Med1986;3:31-49.

Thoma, G.R., Cookson, J.P., Walker, F.L.,Hauser, S.E. Interfacing optical disks to a docu-ment image storage and retrieval system. / ImageTech 1986;12(5):288-92.

Ullmer, E.J. Work design in organizations:comparing the organizational elements modeland the ideal system approach. EducationalTechnology 1986;26(4):12-8.

Williamson, D. An experimental study offactors important in document ranking. In: Rabit-ti, F, ed. 1986 ACM Conference on Research andDevelopment in Information Retrieval. Pisa,Italy: Association of ComputingMachinery,1986:186-91.

Woods, J.W.,Jones, R.R. Using opticalvideodiscs in biomedical education: a primer. In:Proceedings of the Symposium on ComputerApplications in Health Science. Montgomery, AL:Pioneer Press, 1986:35-47.

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Appendix 2: FY 1986 ExtramuralPrograms-Supported Publications

Adams, J.A. and Coutts, M.C.: Breaking roleand spatial barriers: the syllabus exchange inbioethics fosters collaboration between aresearch library, interdisciplinary scholars andclinical practitioners. In Proceedings of TheFourth National Conference of the Associationof College and Research Libraries. Baltimore,MD, 1986, pp. 63-66.

Anawati, G.C. and Ghalloungui, P.: MedicalManuscripts of Averroes at El-Escorial. Cairo,A.R.E.: Al-Ahram Center for Scientific Trans-lations, 1986, 499 pp.

Baer, K.E. von: Autobiography of Dr. KarlErnst von Baer. With a Preface by Jane M.Oppenheimer. New Delhi, India, AmerindPublishing Co. Pvt. Ltd., 1986, 389 pp.Distributed by Science History Publications

Benson, C.B., Doubilet, P.M.,Saltzman, D.H.,Greene, M.F., and Jones, T.B.: Femur length/abdominal circumference ratio: poor predictor ofmacrosomic fetuses in diabetic mothers. Journalof Ultrasound Medicine 5: 141-144, 1986.

Benson, C.B., Doubilet, P.M., Saltzman, D.H.,and Jones, T.B.: FL/AC ratio: poor predictor ofintrauterine growth retardation. InvestigativeRadiology 20: 727-730, 1985.

Blum, R.L.: Computer-assisted design ofstudies using routine clinical data: analyzing theassociation of prednisone and cholesterol.Annals of Internal Medicine 104: 858-868, 1986.

Broering, N.C.: Beyond the library: IAIMS atGeorgetown University. Bulletin of the MedicalLibrary Association 74: 249-256, 1986.

: Strategic Planning: An Inte-grated Academic Information ManagementSystem (IAIMS) at Georgetown UniversityMedical Center. Washington, DC., GeorgetownUniversity Medical Center, 1986, 224 pp.

Broering, N.C. and Hendrickson, G.F.: Sym-posium on integrated academic informationmanagement systems: introduction. Bulletin ofthe Medical Library Association 74: 235-237,1986.

Chandrasekaran, B. and Smith, J.W.: Tenthannual workshop on artificial intelligence inmedicine: an overview. AI Magazine: 84-90,1985.

Covell, D.G., Uman, G.C., and Manning, PR.:Information needs in office practice: are theybeing met? Annals of Internal Medicine 103:596-599, 1985.

Doubilet, P. and McNeil, B.J.: Clinical deci-sionmaking. Medical Care 23: 648-662, 1985.

Doubilet, P., Weinstein, M.C., and McNeil,B.J.: Occasional notes: use and misuse of theterm "cost effective" in medicine. New EnglandJournal of Medicine 314: 253-256, 1986.

Doubilet, P., Begg, C.B., Weinstein, M.C.,Braun, P., and McNeil, B.J.: Probabilistic sensitiv-ity analysis using monte carlo simulation: a prac-tical approach. Medical Decision Making 5:157-178, 1985.

Douglas, John: Medical Topography ofUpper Canada. With an Introduction by CharlesG. Roland. New Delhi, India, Amerind PublishingCo. Pvt. Ltd., 1985, 45 pp. Distributed byScience History Publications.

74

Elstcin, A.S,, et aL Comparison of physi-cians' decisions regarding estrogen replacementtherapy for menopausal women and decisionsderived from a decision analytic model. TheAmerican Journal of Medicine 80 246-258,1986.

Emch-Deriaz, Antoinette: "L'inoculationjustifiee.. .vraiment?" Canadian Bulletin ofMedical History. 2:236-264, 1985.

Eyler, John M.: "The epidemiology of milk-borne scarlet fever: the case of EdwardianBrighton," American Journal of Public Health.76:573-584, 1986.

Pagan, L: New directions for expert systems:examples from the ONCOCIN project. In Levy, A.and Williams, B. (Eds.): Proceedings of AAMSICongress-85. San Francisco, 1985, pp. 183-186.

Pagan, L., et al.: Knowledge acquisition andstrategic therapy planning for cancer clinicaltrials. Artificial Intelligence in Medicine 75-81,1985.

Pagan, L., Differding, J., Langlotz, C, and TU,S.: Knowledge acquisition and strategic therapyplanning for cancer clinical trials. In Proceedingsof the International Conference on ArtificialIntelligence in Medicine. Pavia, Italy, 1985,pp. 1-7.

First, M.B., Soffer, L.J., and Miller, R.A :QUICK (quick index to caduceus knowledge):using the internist-1/caduceus knowledge base asan electronic textbook of medicine. Computersand Biomedical Research 18: 137-165, 1985.

Florence, V: Government publications andhealth sciences libraries. Government Publica-tions Review 11: 313-318, 1984.

: Published proceedings of con-ferences in health and medical sciences: aselected bibliography of 1984 issuances. Govern-ment Publications Review 12: 253-258, 1985.

Forbes, Thomas, R.: Surgeons at the Bailey:English Forensic Medicine to 1878. New Haven,Yale University Press, 1985, 255 pp.

Funds for hospital library equipment. In:Merced Sun-Star. Merced, CA, August 2, 1985, p.3.

Greenes, R.A.: Computer aids to selection ofdiagnostic strategy. In Proceedings of theAmerican Association for Medical Systems andInformatics Congress 85. San Francisco, CA1985, pp. 159-163.

Greenes, R.A.and Begg, C.B.: Assessment ofdiagnostic technologies: methodology for un-biased estimation from samples of selectivelyverified patients. Investigative Radiology 20:751-756, 1985.

Greppin, John A.C. (Ed.): Bark Galianosi:The Greek-Armenian Dictionary to Galen.Delmar, New York, Caravan Books, 1985, 191 pp.

Harden, Victoria A.: Inventing the NIH:Federal Biomedical Research Policy, 1887-1937.Baltimore, Maryland, The Johns Hopkins Univer-sity Press, 1986, 274 pp.

IAIMS project receives 2 grants. InGeorgetown University Medical Center Report.Washington, D.C., Winter 1986.

Josephson, J., Chandrasekaran, B., and Smith,J.: Abduction by classification and assembly.Laboratory for Artificial Intelligence TechnicalReport. Columbus, OH, July 8, 1985, 11 pp.

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Kahn, M.G., Ferguson, J.C., Shortliffe, E.H.,and Pagan, L.M.: Representation and use of tem-poral information in ONCOCIN. In Proceedingsof the Ninth Symposium Computer Applicationsin Medical Care. Baltimore, MD, IEEE ComputerSociety Press, 1985, pp. 172-176.

Kane, D.N.: Environmental Hazards toYoung Children. Phoenix, Arizona, The OryxPress, 1985, 246 pp.

Kent, D.L., Shortliffe, E.H., Carlson, R.W.,Bischoff, M.B., and Jacobs, CD.: Improvementsin data collection through physician use of acomputer-based chemotherapy treatment consul-tant. Journal of Clinical Oncology 3; 1409-1417,1985.

Kharitonova, N.N.and Leonov, Yu.A.: OmskHemorrhagic Fever; Ecology of the Agent andEpizootiology. New Delhi, India, AmerindPublishing Co. Pvt. Ltd., 1985, 230 pp.

Kokot, Franciszek: Endocrine AbnormalitiesAssociated with Acute Renal Failure. PolishAcademy of Sciences Section VI of MedicalSciences. Wroclaw, The Polish Academy ofSciences Press, 1985, 51 pp.

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

Langlotz, C, Pagan, L, Tu, S., Williams, J.and Sikic, B.: ONYX: an architecture for planningin uncertain environments. Presented at theNinth International Joint Conference on Arti-ficial Intelligence. Los Angeles, CA, 1985.

Lindsley, Dan and Zimm, Georgianna: "Thegenome of drosophila melanogaster, Part 1:Genes A-K." Drosophila Information Service.62:1-227, 1985.

Lounibos, L. Philip, Rey,Jorge, R., andFrank, J. Howard (Eds.): Ecology of Mosquitoes:Proceedings of a Workshop. Vero Beach, Florida,Florida Medical Entomology Laboratory, 1985,579 pp.

Manning, PR., et aL Changing prescribingpractices through individual continuing educa-tion. Journal of the American Medical Associa-tion 256: 230-232, 1986.

Marcus, R.S.:Development and testing ofexpert systems for retrieval assistance. InProceedings of the 48th American Society forInformation Science (ASIS) Annual Meeting. LasVegas, NV, 22: 289-292, 1985.

: Intermediary systems forinformation retrieval. First Conference on Com-puter Interfaces and Intermediaries for Infor-mation Retrieval: Selected Papers. Williamsburg,VA, 45-54, 1984.

Masarie, Jr., F.E.,Miller, R.A., and Myers, J.D.:1NTERNIST-1 properties: representing commonsense and good medical practice in a computer-ized medical knowledge base. Computers andBiomedical Research 18: 458-479, 1985.

Masarie, F.E., Miller, R.A., First, M.B., andMyers, J.D.: An electronic textbook of medicine.In Proceedings of the Ninth Annual Symposiumon Computer Applications in Medical Care.Baltimore, MD, IEEE Computer Society Press,1985, p. 335.

Miller, PL. A Critiquing Approach to ExpertComputer Advise: ATTENDING. Boston, MA,Pitman Advance Publishing Program, 1984, 112pp.

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.: ATTENDING: critiquing aphysician's management plan. IEEE Transactionson Pattern Analysis and Machine Intelligence 5:449-461, 1983.

: Critiquing anesthetic manage-ment: the ATTENDING' computer systems.Anesthesiology 58: 362-369, 1983.

: Critiquing:a differentapproach to expert computer advice in medicine.Medical Informatics 11: 29-38, 1986.

: Medical plan-analysisby com-puter. Computer Programs in Biomedicine, 18:15-20, 1984.

: Critiquing as a modality forexplanation: three systems. In Proceedings of theAmerican Association for Medical Systems andInformatics Congress-S4. San Francisco, 1984,pp. 105-109.

: Goal-directed critiquing bycomputer: ventilator management. Computersand Biomedical Research 18: 422-438, 1985.

: Essential-attending: a domain-independent tool for building critiquing systems.In Proceedings of the American Association forMedical Systems and Informatics Congress-86.Anaheim, CA, 1986, pp. 9-13.

The evaluation of artificialintelligence systems in medicine. ComputerMethods and Programs in Biomedicine 22: 5-11,1986.

.: Exploring the critiquingapproach: sophisticated practice-based feedbackby computer. In Proceedings of MEDINFO 86.Washington, D.C. 1986, pp. 2-6.

Miller, P.L.and Black, H.R.:HT-ATTENDING:critiquing the pharmacologic management ofessential hypertension. Journal ofMedicialSystems 8: 181-187, 1984.

Miller, P.L., Blumenfrucht, S.J. and BlackH.R.: An expert system which critiques patientworkup: modeling conflicting expertise. Com-puters and Biomedical Research 17: 554-569,1984.

Miller, P.L., et al.: Critiquing the process ofradiologic differential diagnosis. ComputerMethods and Programs in Biomedicine 22:21-25, 1986.

Miller, R.A., et al.: Ethical and legal issuesrelated to the use of computer programs inclinical medicine. Annals of Internal Medicine102: 529-536, 1985.

Musen, M.A., Pagan, L.M.,and Shortliffe,E.H.: Graphical specification of proceduralknowledge for an expert system. Second IEEEComputer Society Workshop on VisualLanguages. Dallas, TX, 1986, 20 pp.

Musen, M.A.,Langlotz, C, Pagan, L.M.,andShortliffe, E.H.: Rationale for knowledge baseredesign in a medical advice system. In Pro-ceedings of the American Association forMedical Systems and Informatics Congress 85.San Francisco, CA, 1985, pp. 197-201.

New Titles in Bioethics: Annual Cumula-tion, Volume 11. Washington, D.C., NationalReference Center for Bioethics Literature, TheJoseph and Rose Kennedy Institute of Ethics,Georgetown University, 1985, 68 pp.

Pao, M.L.: An empirical examination ofLotka's Law. Journal of the American Society forInformation Science 37: 26-33, 1986.

77

'Passion for excellence' premieres at MCMCApril 15. In; Merced Sun-Star. Merced, CA, April11, 1986.

Patil, R.S.; Coordinating clinical &pathophysiologic knowledge for medicaldiagnosis. In Proceedings of the AmericanAssociation for Medical Systems and Infor-matics Congress 86. Anaheim, CA, 1986, pp. 3-8

Peay, W.J., Florance, V., Epstein, W.C. andThelin, A.M.: Documents librarianship: 11.MEDOC: an index for the health sciences.Government Information Quarterly 2: 193-205,1985.

Peterson, J.R., Miller, R.A., and Kapoor, W.N.:An alternative to microcomputers: the relationaldatabase system on mainframe computers.Patient Management 3: 15-21, 1985.

Quarterly Bibliography of Major TropicalDiseases. 8:1985 and following.

Rennels, G.D., Shortliffe, E.H., Stockdale,F.E., and Miller, PL.: Reasoning from the clinicalliterature: a "distance" metric. In Proceedings ofthe American Association for Medical Systemsand Information Congress-86. Anaheim, CA,1986, pp. 19-23.

Schlein, R.S. and Edgerton, N.M.: Training:how to get it out of the classroom. Training andDevelopment Journal 84-85, 1985.

Sewell, W. and Teitelbaum, S.: Observationsof end-user online searching behavior overeleven years. Journal of the American Societyfor Information Science 37: 234-245, 1986.

: Micromanual for CasualUsers of National Library of MedicineDatabases. Bethesda, MD, Drug IntelligencePublications, 1986, 69 pp.

Sheridan, Richard B.: "The doctor and thebuccaneer: Sir Hans Sloane's case history of SirHenry Morgan, Jamaica, 1688," Journal of theHistory of Medicine and Allied Sciences.41:76-87, 1986.

Sievert, M.C. and Boyce, B.R.: EvaluatingDAPPOR as a learning tool. In Proceedings ofEighth International Online InformationMeeting. London, England, Learning InformationLtd., 1984, pp. 519-524.

Smith, J.W., Svirbely, J.R., Evans,C.A.,Strohm, P.. Josephson, J.R., and Tanner, M.: RED:a red-cell antibody identification expert module.Journal of Medical Systems 9: 121-138, 1985.

Sneath, Peter H.A. (Ed.): Sergey's Manual ofSystematic Bacteriology, Volume 2. Baltimore:Williams & Wilkins, 1986, 635 pp.

Starkweather, J.A. and Bishop, D.: Informa-tion file support for collaborating medicalresearch investigators. In Proceedings of Inter-national Congress of Medical Librarianship 5:681-686, 1985.

Sticklen, J., Chandrasekaran, B., andJosephson, J.R.: Control issues in classificatorydiagnosis. In Proceedings of the Ninth Inter-national Joint Conference on Artificial Intelli-gence. Los Angeles, CA, 1985, pp. 300-306.

Swett, H.A., Shaw, C, Rose, J.R., and Miller,PL.: ICON: An expert system for critiquingradiologic differential diagnosis. In Proceedingsof the American Association for MedicalSystems and Informatics Congress-85, San Fran-cisco, CA, 1985, pp. 202-206.

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Swett, H.A., Rothschild, M., Weltin, G., andMiller, P.: Expert system knowledge validation:essential-attending's knowledge exerciser pro-gram. In Proceedings of American Associationfor Medical Systems and InformaticsCongress-86. Anaheim, CA, 1986, pp. 14-18.

Thackrah, Charles Tlirner: The Effects ofArts, Trades and Professions on Health andLongevity. With a Preface by Saul Benison, NewDelhi, India, Amerind Publishing Co. Pvt. Ltd.,1985, 217 pp. Distributed by Science HistoryPublications.

The hospital ACE. In: The Scan.- MercedCommunity Medical Center 3: December, 1985,pp. 1,3.

Walters, L. and Kahn, T.J.: Bibliography ofBioethics Volume 11. Washington, D.C., KennedyInstitute of Ethics, Georgetown University, 1985,444 pp.

Warner, John Harley: "Science in Medicine",Osiris. 2nd Series, 1:37-58, 1985.

.: "The selective transport ofmedical knowledge: antebellum American physi-cians and Parisian medical therapeutics", Bulletinof the History of Medicine. 59:213-231, 1985.

: "The idea of southern medicaldistinctiveness: medical knowledge and practicein the Old South". In Leavitt, Judith Walzer andNumbers, Ronald L. (Eds.): Sickness and Healthin America: Readings in the History of Medicineand Public Health, second edition, revised.Madison, Wisconsin, The University of Wiscon-sin Press, 1985, pp. 53-70.

: The Therapeutic Perspective:Medical Practice, Knowledge, and Identity inAmerica, 1820-1885. Cambridge, Massachusetts,Harvard University Press, 1986, 367 pp.

Wender, R.W.: The World of Information atYour Fingertips: Obtaining Materials ByTelephone and Interlibrary Loan. OklahomaCity, OK, University of Oklahoma HealthSciences Center Library, 1986, 27 pp.

Westphal, Ulrich: Steroid-Protein Inter-actions II. (Monographs on Endocrinology.Volume 27), Berlin, Germany: Springer-Verlag,1985, 603 pp.

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Appendix 3= Board of Regents

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

Appointed Members:Albert E. Gunn, M.D.(Chairman)Medical DirectorM.D. Anderson Hospital and TUmor InstituteEdward N. Brandt, Jr., M.D, Ph.D.ChancellorUniversity of Maryland at BaltimoreH. Robert CathcartPresidentPennsylvania HospitalEdward A, Feigenbaum, Ph.D.Professor of Computer ScienceStanford UniversityRussell L. FenwickSenior Vice PresidentBank of AmericaJohn K. LopezExecutive Vice PresidentMedicalelectrographic SciencesNina W. MathesonDirector, Welch Medical LibraryThe Johns Hopkins UniversityAnn K. Randall, D.L.S.Chief LibrarianCity College of CUNYGrant V. Rodkey, M.D.Associate Clinical Professor of SurgeryHarvard Medical SchoolEugene A. Stead, Jr., M.D.Professor Emeritus of MedicineDuke University

Ex Officio Members:Librarian of CongressSurgeon GeneralPublic Health ServiceSurgeon GeneralDepartment of the Air ForceSurgeon GeneralDepartment of the ArmySurgeon GeneralDepartment of the NavyChief Medical DirectorVeterans AdministrationAssistant Director for Biological, Behavioral, and

Social SciencesNational Science FoundationDirectorNational Agricultural LibraryDeanUniformed Services University of the

Health Sciences

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Appendix 4: Board of Scientific Counselors

Board of Scientific Counselors meets periodically to review and make recommendations onthe Library's intramural research and development programs.

Members:Morris F. Collen, M.D. (Chairman)ConsultantPermanente Medical GroupArthur S. Elsteln, Ph.D.Professor of Health Professions EducationUniversity of Illinois at ChicagoSusan J. Grobe, Ph.D.Associate Professor of NursingUniversity of Texas at AustinJerome P. Kassirer, M.D.Associate Chairman, Dept. of MedicineTufts University School of Medicine

Casimir A. Kulikowski, Ph.D.Professor of Computer ScienceRutgers UniversityGwllym S. Lodwick, M.D.Department of RadiologyMassachusetts General HospitalM. Lucius Walker, Jr. Ph.D.Dean, School of EngineeringHoward UniversityBonnie L. Webber, Ph.D.Associate Professor of Computer

and Information ScienceUniversity of Pennsylvania

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Appendix 5: Biomedical LibraryReview Committee

Biomedical Library Review Committee meets three times a year to review applications forgrants under the Medical Library Assistance Act.

Members:Anthony R. AguirreDirector of LibraryCollege of PhysiciansPhiladelphia College of PhysiciansRachael K. AndersonHealth Sciences LibrarianColumbia UniversityVirginia M. BowdenLibrary Director, Briscoe LibraryThe Universityof Texas HealthScience Center at San AntonioMarsden S. Bloisjr, M.D.Ph.D.Professor and ChairmanSection on Medical Info. ScienceUniversity of CaliforniaSan FranciscoC. Michael Brooks, Ed.D.Director, Office of Educational Dev.School of MedicineUniversity of Alabama in BirminghamG. Anthony Gorry, Ph.D.Vice President for Information Tech.Baylor College of MedicineRobert A. Greenes, M.D, Ph.D.Radiologist and DirectorDepartment of RadiologyBrigham & Women's HospitalBoston, Mass.Lillian Haddock, M.D.Professor of MedicineDiv. of Endocrinology & MetabolismDepartment of MedicineUniversity of Puerto Rico

Donna P. JohnsonDirector, Resource CenterAbbott Northwestern HospitalMinneapolis, MinnesotaRandolph A. Miller, M.D.Associate Professor of MedicineDepartment of MedicineUniversity of PittsburghJoyce A. Mitchell, Ph.D.DirectorInformation Science GroupUniv. of Missouri-ColumbiaRamesh S. Patil, Ph.D.Asst. ProfessorComputer ScienceMass. Institute of TechnologyThomas E. Piemme, M.D.Asst. Dean for Continuing Ed.George Washington UniversitySchool of MedicineLinda C. Smith, Ph.D.Associate ProfessorGraduate School of Libraryand Information ScienceUniversity of IllinoisD. Dax Taylor, M.D.Evaluation ProgramNational Board of MedicalExaminersPhiladelphia, Pennsylvania

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Appendix 6[Reproductions of the agendas from "Medicineand the Arts," "NLM: Past Present and Future";and "Space Medicine Colloquium."

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