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ISSN: 0163-4569

NATDNALLIBRARY ofMEDICINEPROGRAMSandSERVICESFISCAL YEAR 1979

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFAREPublic Health SnviivNational Institutes of Hralth

NATIONAL LIBRARY OF MEDICINE8600 Rockville PikeBethesda, Maryland 20209

NIH Publication No. 80-256

Z National Library of Medicine675.M4 National Library of Medicine programs and services.U56an 1976/77-

Betheada, Md., U. S. Dept. of Health. Education, andWelfare, Public Health Service, National Inatltutea ofHealth, National Library of Medicine,

v. 111., ports.Issued 1976/77-1977/78 as DKEW publication ; no. (NIH)

78-256, etc.; 1978/79- as NIH publication ; no. 80-256, etc.Continues Programs and servicesKey title: National Library of Medicine programs and services,

ISSN 0163-4569.

1. Information Services - U. S. - periodicals 2. Libraries,Medical - U. S. - periodicals I. Title II. Series: DHEWpublication ; no. (NIH) 78-256, etc. III. Series: NIHpublication ; no. 80-256, etc.

PrefaceThis year marked the centenary of the first publication of Index Medicus. The event,

widely noted throughout the medical community, is a tribute both to Dr. John Shaw Bill-ings and to the many organizations and individuals who sustained its publication over thecentury. On May 25, 1979, there was a special gathering of members of the NLM Board ofRegents, physicians, historians, librarians, and Library staff to mark this occasion. Thestimulating essays delivered at this meeting will be published in 1980 and made available tothose interested in the history of medical bibliography.

In this, the hundredth year of its publication, the Library has revived the prestigious titleof Editor, Index Medicus. Clifford A. Bachrach, M.D., who has been named Editor, willstrive to continue the accuracy of content and quality of format that has marked IndexMedicus since its inception.

As reflected in the statistics of this report, the online services network continues to ex-pand both in number of searches and variety of data bases available. Over 1.4 milliononline and offline searches were performed in FY1979, a remarkable increase of almost 30percent over last year. Two important new online data bases became available this year: theToxicology Data Bank and the Health Planning and Administration file.

The new Lister Hill Center Building is now almost completed. Its specialized communica-tions laboratories, conference facilities, audiovisual capabilities, and computer area willafford NLM the opportunity to develop new communications services for the benefit ofbiomedical practitioners, researchers, educators, and students. We look forward to movingselected NLM programs into this modern and handsome facility in 1980.

One disturbing note in 1979 was a reduction of 35 positions in the Library's personnelceiling—from the 503 authorized by Congress to 468. Although this was part of an NIH-wide reduction, this reduction in staff will make it difficult for the Library to continue pro-viding the quantity and quality of services the health-science community has come to ex-pect from us. It will also make it difficult for us to take full advantage of the potential offeredby the new Lister Hill Center.

I wish to express my appreciation to the staff of the Library for their diligent efforts—it isthey who are responsible for the accomplishments described in this report. The Board ofRegents provided sound advice with regard to NLM policies and programs while maintain-ing a careful overview of our operations. My thanks go also to those in the biomedical andlibrary community who continue to support our efforts, and I invite their suggestions astohow we may serve them better in the future.

Martin M. Cummings, M.D.DirectorNational Library of Medicine

Contents1. POLICY AND DIRECTION 1

Board of Regents 1Lister Hill Center building 2MEDLARS III 2Financial resources 3Personnel 3

Staffing activities 4Honors and awards 5

Equal employment opportunity 5Exhibits 7Centenary of Index Medicus 8

2. LIBRARY SERVICES AND OPERATIONS 10Highlights 10

National library cooperation 10Bibliographic Services Division 11

Indexing. 11MEDLARS management 11

History of Medicine Division 13Reference Services Division 14Technical Services Division 15

Retrospective conversion 15Limited cataloging 15OCLC 16Exchange 16Serials 16

Medical Subject Headings 17Mid-Atlantic Regional Medical Library 17

3. COMPUTER AND COMMUNICATIONS SYSTEMS 23System improvements 23Data communications 24

4. SPECIALIZED INFORMATION SERVICES 26Online services 26Query response and publication services 28Collaborative projects 29

5. AUDIOVISUAL PROGRAMS 31Educational research and evaluation 31Workshops and seminars 32Advisory services 32Media development 33Distribution 34

6. LISTER HILL CENTER 35Health professionsapplications 35

Knowledge base program 35Biomedical communication costs 37

Information technology 37Integrated Library System 37Knowledge base program 38Advanced Terminal System 38Videodisc program 38Retrospective Data Entry System 39

PHS/CTS program 39System evaluation 39Technical evaluation 40

7. EXTRAMURAL GRANTS AND CONTRACTS 41Regional Medical Library Program 42Resource project grants 43Resource improvement grants 44Biomedical scientific publications grants 44Special scientific project grants 45Research grants 46Training grants 47

8. INTERNATIONAL ACTIVITIES 49International MEDLARS agreements 49US/USSR cooperation in biomedical information 50US/People's Republic of China cooperation 52Collaboration with WHO/PAHO 53Special Foreign Currency Program 54Visitors and specialized training 55

APPENDIX 1. Staff bibliography 56APPENDIX 2. Grant-supported publications 58APPENDIX 3. P.L-480 supported publications 61APPENDIX 4. NMAC audiovisual materials produced 62

TablesTable 1. Financial resources and allocations 8

Table 2. Personnel ceilings 9

Table 3. Online institutions in RML IV 18

Table 4. Bibliographic services 18

Table 5. Online searches 18

Table 6. Offline searches 19

Table 7. History of medicine activities 20

Table 8. Acquisitions statistics 20

Table 9. Growth of collections 21

Table 10. Cataloging statistics 21

Table 11. Circulation statistics 22

Table 12. Reference services 22

Table 13. Binding statistics 22

Table 14. Selected statistics, NMAC 34

Table 15. Extramural grant and contract programs 48

Chapter 1: Policy and Direction

Philip D. Amoruso, Executive Officer

Board of RegentsThe NLM Board of Regents met in October

1978, and in January and May 1979 to review awide range of NLM program policies and grantapplications. Among the policy items whichthey considered were the future roles of theLister Hill Center and the National MedicalAudiovisual Center, procurement of a newcomputer system, closing the NLM card catalog,evaluation and performance standards of theRegional Medical Libraries, and audiovisualprograms and plans.

The National Library of Medicine Act wasamended by Public Law 95-622 in November1978 to provide that Regents be appointed bythe HEW Secretary rather than the President.Three existing vacancies on the Board werefilled within three weeks of the effective date ofthis amendment, giving the Board a full comple-ment of members. Those appointed were:

Ismael Almod6var, Ph.D.PresidentUniversity of Puerto RicoSan Juan, Puerto Rico

Emmet F. Ferguson, Jr., M.D.Jacksonville, Florida

Martha E. WilliamsResearch ProfessorCoordinated Science LaboratoryCollege of EngineeringUniversity of IllinoisUrbana, Illinois

The terms of Dr. ThomasC. Chalmers and Dr.Kelly M. West were completed in August 1979.The following new Regents were appointed tofour year terms on the Board commencingAugust 3, 1979:

John L. Townsend, M.D.Chairman, Department of MedicineHoward University College of MedicineWashington, D.C

Edward J. Huth, M.D.Editor, Annals of Internal MedicineAmerican College of PhysiciansPhiladelphia, Pennsylvania

The Board of Regents unanimously electedDr. S. Richardson Hill, Jr., Chairman of theBoard for 1979-1980, replacing retiring Chair-man Dr. Kelly M. West.

The forthcoming fiscal year will seethe Boardconsidering program opportunities afforded bythe new research and development facilities to

NLM Programs and Services

the Lister Hill National Center for BiomedicalCommunications and the National MedicalAudiovisual Center.

Lister HillCenterBuilding

As completion of the new facility nears, N LMstaff have been busy with activities related tooccupancy of the Lister Hill Center. Amongthese activities are the preparation of laborato-ries and other special purpose facilities; designand installation of a data communicationssystem; development of specifications for abuilding security system; planning the reloca-tion of staff from Atlanta (National MedicalAudiovisual Center), rental space (ExtramuralPrograms), and the present Library building;commissioning of sculpture and fine art; andplanning the dedication of the new building.

Construction has proceeded ahead ofschedule since the project was begun, butslowdowns in the final stages may delay occu-pancy until December 1979, the originallyscheduled completion date. As blocks of spaceare completed they will be released by thebuilders for acceptance by NIH and occupancyby the following NIH divisions:

Lister Hill CenterNational Medical Audiovisual CenterSpecialized Information ServicesExtramural ProgramsOffice of Computer and Communications

SystemsBibliographic Services DivisionPhotoduplication Section, RSDOffice of Administrative Management Serv-

icesOffice of Contracts Management

The relocation of these programs is expectedto be completed by March 1980 when the Na-tional Medical Audiovisual Center will betransferred, and the building will be formallydedicated on May 22,1980.

Renovation

Shortly after the beginning of construct ion forthe new Lister Hill Center Building, NLM staffbegan planning for the renovation of the pre-sent building. Thearchitecturaland engineeringfirm of McLeod, Ferrara and Ensign has beenselected to prepare detailed constructionplansand specifications for modifying the building.The firm is committed to revise existingspace tomeet NLM's present and projected needs, with-in the existing unique interior architecturalstyleand spirit. The design work is expected to becompleted by March 1,1980 with constructiontaking an additional 18 months.

MEDLARSA MEDLARS ill Task Force was established in FY

1979 to develop a coherent library automationprogram which would satisfy NLM's operationaland service requirements for the 1980s. Thenew system is intended to improve, extend, andintegrate NLM's internal operations and net-work services in the areas of technical process-ing, online bibliographic retrieval, automatedpublication, and document delivery.

The internal integration will encompassbibliographic and other library functions whichare being developed in several parts of the Li-brary. These include activities of the TechnicalServices Division, Bibliographic Services Divi-sion, References Services Division, SpecializedInformation Services, and the Lister Hill Center.The expanded and integrated network serviceswill provide new and improved capabilities toassist health sciences libraries in the creation ofbibliographic records, retrieval of bibliographicand text information, access to national hold-ings and location information, and ordering anddelivery of documents.

The set of functional requirements for MED-LARS in to be developed by the Task Force willbe incorporated in the workscope of a requestfor contract proposal for an overall system

Policy and Direction

The MEDLARS III Task Force (left to right) Ben Erdman, Betsy Humphreys, Duane Arenales, Richard Dick,Grace McCarn, John Cox, Laura Kassebaum, Lillian Kozuma, and Dr Joseph Leiter (Not pictured, RobertSchultheisz.)

design. Although major portions of the designand implementation will require contractorsupport, there will be extensive participation byLibrary staff in implementing parts of the system.

In addition to the goal of providing improvedservices, MEDLARS in planning will also pro-vide an opportunity to examine basic issues andchallenges facing library and informationsystems and to address the policy decisions fac-ing NLM with regard to its role in emerging na-tional networks.

Financial ResourcesThe National Library of Medicine's FY 1980

appropriation will provide $44,000,000. Thislevel represents an increase of $2,569,000 overthe previous year and a reduction of eight posi-tions from the levels authorized for FY 1979.

The budget increase will permit NLM to ex-pand the new Computers in Medicine Program(see Chapter 7) and also provide funding for the

Chemical Structure and Nomenclature System(Chapter 4). This system is the cornerstone ofthe Chemical Substance Information Networkcurrently being developed in cooperation withthe Environmental Protection Agency. A por-tion of the FY 1980 increase will be used tokeep up with the rapidly increasing cost ofbiomedical literature, especially for NLM's ex-panding collection of materials concerninghealth planning and health care delivery.

PersonnelIn FY 1979 the NLM Personnel Office com-

pleted the final year of the HEW three-yearclassification review program, having audited atotal of 643 positions during the three-yearperiod.

The U.S. Office of Personnel Management(formerly the U.S. Civil Service Commission)conducted an occupational study in August,focusing on the Librarian, Library Technician,


and Technical Information Specialist occupa-tions. The data they derive from this study willbe used to revise classification and qualifica-tions standards.

The Ubrary received eight new positions inthe FY 1979 Congressional appropriations,bringing the total number of NLM full-time per-manent positions to 503. This level was short-lived, and never attained, because of subse-quent ceiling reductions by HEW whichestablished a reduced level of 468, 35 positionsbelow the appropriated level. As a result of this,and the imposition of an absolute freeze on hir-ing in July, the Library's on-board strength at theclose of FY 1979 was 458, ten positions belowceiling.

The National Medical Audiovisual Center(NMAC) entered the final phase of transition.As preparations for the March 1, 1980 reloca-tion proceeded, we experienced increasinglosses in personnel by the election of individualstaff members not to move to Bethesda.

Staffing Activities

Kent A. Smith was appointed to the positionof Deputy Director, NLM. Mr. Smith, formerlyAssistant Director for Administration, replacedMelvin S. Day, who left to accept the position ofDirector, National Technical Information Serv-ice, Department of Commerce.

Charles N. Farmer, Jr.,was appointed Direc-tor, National Medical Audiovisual Center,replacing Myron J. Adams, Jr., M.D., who ac-cepted a position with the Center for DiseaseControl. Mr. Farmer formerly servedasaSpecialAssistant to the Director at NMAC.

Willian G. Cooper, Ph.D., formerly Vice Chan-cellor for Programs and Educational Resourcesat the University of Colorado Health SciencesCenter, has been appointed as an Expert Con-sultant to assist in NLM's planning activities re-lated to determining the effectiveness of existing

biomedical communications programs as wellas planning new NLM programs to addressfuture needs.

Tamas Doszkocs, Ph.D., was appointedChief, Technical Services Division (TSD), Libra-ry Operations. Dr. Doszkocs formerly servedwith the Specialized Information Servicesprogram, and he replaces T.D. Tonkery as TSDChief. Mr. Tonkery accepted a position with theUCLA University Research Library.

Grace McCarn was selected to replace BrunoVasta as Chief, Bibliographic Services Division(BSD), Library Operations. Ms. McCarn wasfor-merly Head, MEDLARS Management Section,BSD.

A.D. Merritt, M.D., was appointed to theposition of Chief, Health Professions Applica-tions Branch, Lister Hill National Center forBiomedical Communications. Dr. Merritt hadserved on an Intergovernmental Personnel ActAssignment from his position as Chairman andProfessor of Medical Genetics, Indiana Univer-sity School of Medicine.

Philip D. Amoruso was appointed ExecutiveOfficer, NLM, replacing Kent A. Smith. Mr.Amoruso was formerly an AdministrativeOfficer with the National Cancer Institute, NIH.

John Cox was appointed Deputy Director,Office of Computer and CommunicationsSystems (OCCS). Mr. Cox was formerly theChief, MEDLARS Support Branch, OCCS.

Joseph Hutchins was selected to replace Mr.Cox asChief, MEDLARS Support Branch, OCCS.

Mr. Hutchins has been a Computer SystemsAnalyst with OCCS since 1970.

Duane Arenales was appointed Head of theCirculation and Control Section, BibliographicServices Division, Library Operations. Ms.Arenales had been Assistant Head of the Sec-tion prior to her appointment.


Phyllis Mirsky, formerly with the BiomedicalLibrary, University of California at Los Angeles,accepted the position as Head, ReferenceSec-tion, Reference Services Division, LibraryOperations. Ms. Mirsky replaces Edith Blair,who retired last year.

Yvonne Scott was appointed to the positionof Head, MEDLARS Management Section,Bibliographic Services Division. Ms. Scott hasbeen a member of the Section since August1968.

Brenda Swanson was selected to serve asHead, Selectionand Acquisitions Section, Tech-nical Services Division, Library Operations. Ms.Swanson has been a member of the Sectionsince 1973.

Honors and Awards

The Association for Hospital Medical Educa-tion presented the John C Leonard Award toNLM Director, Martin M. Cummings, M.D. TheAward, which recognizes important contribu-tions to graduate education and to communityhospital education programs,was presented onMay 11 at the annual business meeting of theAssociation, held in conjunction with the AMACongress on Medical Education in Washington,D.C

Jeanne L. Brand, Ph.D., Chief, InternationalPrograms Division, Extramural Programs,received an honorary degree from St. LawrenceUniversity at the Spring CommencementCeremony when the University honored alum-nae prominent in the field of medicine andpublic health.

lames I. Hartman, Personnel Officer, NLM,was presented with the NLM Director's HonorAward at the May meeting of the Board ofRegents. In making the award, Dr. Cummingscited Mr. Hartman's outstanding performancein providing a sound personnel managementprogram for the National Library of Medicine.

/oseph W. Hutchins, Chief, MEDLARS Sup-port Branch, OCCS, was presented with theNIH Director's Award for his development ofsophisticated online data management sub-systems for MEDLARS which has substantiallyimproved NLM's processing of technicalliterature.

Dean W. Darby, D.D.S., Chief, EducationalTraining and Consultation Branch, NMAC,received a PHS Commendation Medal in recog-nition of his development of training materialson information transfer and of innovativesystems to integratethese materials in the healthprofessional community.

Marguerite L. Pusey, Grants ManagementOfficer, Extramural Programs, received the NIHMerit Award for meritorious contributions tothe development of grants administrationpolicies.

Charles N. Farmer, Jr., Director, NMAC,received the NIH Merit Award for his contribu-tions to the development of audiovisual educa-tional technology in schools of the healthprofessions and other health sciences institu-tions.

C/tfford A. Bachrach, M.D., Chief, MedicalSubject Headings Section, Library Operations,received the NIH Merit Award for developingand maintaining an effective review system toassure the selection of the most useful periodi-cal literature for citation in NLM publicationsand data bases.

Equal EmploymentOpportunity

The NLM EEOCommittee, under the Chair-manship of Ms. Peggy Beavers, is continuing towork on the areas identified by the EEOCom-mittee as requiring priority attention. One ofthese is to develop career ladder opportunitiesin all areas of the NLM. Each program area is


now establishing career ladders with entry andtarget level positions identified. These positions,for the most part in grade levels GS-4 throughGS-7, will provide competitive upward mobilityopportunities for employees who might other-wise find themselves in the dead-end jobs.

A statistical profile of N LM's minorities showsthat the total number of minorities as of June30, 1978 was 125 or 26.3 percent of 478 full-time permanent staff; on June 30, 1979, 124minorities represented 25.4 percent of 488 full-time employees. A corresponding profile ofwomen shows that the total as of )une 30,1978was 258, or 55 percent of the work-force; on)une 30, 1979 that number increased to 267 or54.7 percent.

The Selective Placement Program for han-dicapped employees has developed a suc-cessful training program. Over a two-year

period 30 employees, including a significantnumber of supervisors, have received trainingin sign language in a course given at NLM tohelp facilitate communication with deafemployees. Of this initial group, 13 employeescontinued in an advanced sign languagecourse.

Three recommendations to assist the NIHSelective Placement Program were submitted byNLM to the NIH EEO Council forconsideration.They were:

1. To provide a sign language course at NIHfor employees and supervisors;

2. To provide manual communicationdevices for the hearing-impaired invarious buildings of NIH; and

3. To provide an interpreter for hearing-im-paired NIH staff at meetings theseemployees are likely to attend.

Balloon ascent from the front of the library in conjunction with the Aerospace Medical Association's 50th An-niversary Almost-completed Lister Hill Center building is visible on left


These recommendations were accepted by NIHand are now being implemented.

In March 1979 the EEO Committee con-ducted an open meeting with NLM employees.The purpose of the meeting was to keepemployees abreast of current developments inthe EEOprogram; inform employees about thecomplaint process; and give employees an op-portunity to bring issues and concerns to theCommittee for action. Questions were preparedin writing by employees prior to the meetingwhich allowed for a more complete response tomany of their concerns. A record of the con-cerns discussed and the questions and answerswas published in the NLM EEO Update.

ExhibitsThe first lobby exhibit in the fiscal year

(described in last year's report) celebrated the400th anniversary of William Harvey's birth in1578 and the 350th anniversary of the publica-tion of his discovery of the circulation of theblood. The exhibit featured a number ofportraits and first editions and translations ofHarvey's publications.

The Harvey exhibit was followed in Februaryby "Aviation Medicine . . . From the Aeronautsto the Eve of the Astronauts." The exhibit, dis-played until mid-May, explored the growth ofaviation medicine from its beginnings in highaltitude physiology (of concern to balloonistsand mountain climbers) to the specialized fieldrequired by the development of ever faster andhigher-flying aircraft. The exhibit primarilyfeatured aviation medicine literature from theLibrary's historical collections, although a num-ber of interesting prints, photographs, and ar-tifacts were also included.

The exhibit was assembled by Peter D. Olch,M.D., Deputy Chief of the History of MedicineDivision, in cooperation with the AerospaceMedical Association. In conjunction with theexhibit, the Association sponsored a balloon as-

cent from the NLM grounds on May 12 Theas-cent was made by three members of theAssociation, who with other members hadgathered at the Library to view the exhibit andto celebrate the Association's 50th anniversary.

A third exhibit "The Centenary of IndexMedicus" opened in connection with a specialcelebration held at the Library on May 15 (seebelow). The exhibit, which traced the develop-ment of Index Medicus from its first issuance in1879 to the present time, was prepared byManfred ). Waserman of the History ofMedicine Division.

The Index Medicus exhibit, displayedthrough 1979, explored the roles of the Library,American Medical Association, and CarnegieFoundation of Washington in sustaining andpublishing Index Medicus, and the challengeposed by the ever-increasing quantity ofperiodical medical literature. Among the itemson display were unpublished letters of JohnShaw Billings, William S. Halsted, and FieldingH. Garrison; photographs and printed materials,including a number of issues of Index Medicusconsidered important in its evolution; andseveral significant medical bibliographies whichpreceded Index Medicus.

The Index Medicus celebration brought togetherthree directors of the National Library ol MedicineFrom the left, Frank B Rogers, M D (1949-63), Mar-tin M Cummmgs, M D (1964- ), and |oseph HMcNmch, M D (1946-49)

NLM Programsand Services

Centenary of IndexMedicus: 1879-1979

On May 25, at the National Library ofMedicine, a gathering of members of the Boardof Regents, physicians, historians, librarians,andNLM staff paid tribute to Index Medicus and toits creator and first editor, Dr. John Shaw Bill-ings.

The reading room of the History of MedicineDivision was the scene of the program. A seriesof distinguished speakers, using Billings and theIndex Medicus as a point of departure, dis-cussed various aspects of physicians, books,and medical bibliography.

In his welcoming remarks NLM Director Mar-tin M. Cummings, M.D., said that IndexMedicus has proved so socially and scien-tifically useful that it has been able to overcome

many adversities in its hundred years. He notedthat 1979 is also the hundredth anniversary ofthe invention of the punched card and the con-struction of the first electric tabulating machineby Herman Hollerith, assisted by Dr. Billings.When Billings and his co-editor Dr. RobertFletcher issued the first volumes, IndexMedicus contained references to about 20,000articles taken from 570 medical journals; todayIndex Medicus lists each year some 250,000references from 2,500 journals. Dr. Cummingspraised the work of those who, over the years,have indexed the literature on which IndexMedicus is based.

At the morning session, entitled "Medicineand Bibliography," guests and staff heard thefollowing presentations: "Between Two Worlds:American Medicine in 1879," by CharlesRosenberg, Ph.D., Professor of History at theUniversity of Pennsylvania; "The NineteenthCentury Medical Press," by Cenevieve Miller,

Table 1Financial Resourcesand Allocations, FY1979

(dollars inthousands)

Amounts available for obligationAppropriation, NLM $41,431Earned reimbursements 1,000Total 42,431

Amounts obligated by Extramural ProgramsAmounts obligated for directed operations

Lister Hill National Center for Biomedical Communications.National Medical Audiovisual CenterOffice of Computer and Communications SystemsLibrary OperationsToxicology Information ProgramReview and approval of grantsProgram direction

Subtotal, direct operations

8,987

6,0623,8115,5168,9032,6731,0305,44933,444

Total $42,431


Ph.D., Director of the Howard Dittrick Museumof Historical Medicine, Cleveland; "Billings andBefore: Nineteenth Century Medical Bibliogra-phy," by John B. Blake, Ph.D., Chief of NLM'sHistory of Medicine Division; and "IndexMedicus in the Twentieth Century," by Frank B.Rogers, M.D., former NLM Director. Themoderator for the morning session was Kelly M.West, M.D., outgoing Chairman of the Board ofRegents.

After lunch, William B. Bean, M.D., KempnerProfessor and Director of the Institute for theMedical Humanities at the University of TexasMedical Branch at Galveston, presided over asession entitled "The Physician and His Books."Presentations in this session were on "ThePhysician as Bibliographer and Bibliophile," byK. Garth Huston, M.D., of Los Angeles, and"The Physician as Scholar," by Saul Jarcho,M.D., of New York City.

Table 2. Personnel Ceilings

FY73 FY74 FY 75 FY 76 FY 77 FY 78 FY 79

Office of the Director 12 11 9 10 12 14 12Office of Inquiries and Publications Manage-

ment 6 5 5 5 5 5 5Office of Administration 36 36 34 35 35 38 38Office of Computer and Communications

Systems 54 51 52 54 52 51 51Extramural Programs 30 27 22 24 27 25 25Lister Hill National Center for Biomedical

Communications 17 20 22 24 24 35 30Specialized Information Services 16 17 17 18 17 18 19National Medical Audiovisual Center 103 100 101 101 88 88 76Library Operations 192 199 196 201 212 221 212Total 466 466 458 472 472 495 468

Chapter 2: Library Services andOperations

Joseph Leiter, Ph.D., AssociateDirector

Library Operations

HighlightsQuality of bibliographic data and timeliness

in making records and materialsavailable to thepublic continue as the primary concerns ofLibrary Operations. With the appointment ofOr. Clifford A. Bachrach as Editor of IndexMedicus, there is closer quality review and con-trol over citations entering MEDLINE. Long-stand-ing quality control measures in the production-related functions of index scheduling andkeyboarding have been improved to insurepublication at the earliest possible time.

Throughput time for photocopied interlibraryloans has improved to the extent that 83 per-cent are filled within four days of receipt and upto 90 percent within ten days. Planning towardcooperative technical processing among thethree national libraries holds real promise forthe future, particularly when the new Anglo-American Cataloging Rules (AACR-2) are imple-mented in January 1981. Meanwhile, NLM has

begun a retrospective conversion project for itspre-1965 catalog to put its entire catalog online.

National Library Cooperation

The National Library of Medicine, Library ofCongress, and National Agricultural Library(N AL) opened a promising series of meetings inApril 1979. The first of these meetings, initiatedby the Medical Library Association, attemptedto identify long-standing differences andproblem areas between LC and NLM that wereamenable to a solution and developed an agen-da for future meetings. It became apparent thata rational approach to the larger issue of varyingpractices of the national libraries meant thatNALalso should participate. The three U.S na-tional libraries have committed themselves toresolving differences, promoting beneficialcooperation, and working toward better com-munication in the area of technical processing.

The principal topics of discussion at subse-quent meetings have been cooperation in

10

Library Services and Operations

building an online name authorities data base,cooperative acquisitions, and cataloging.Cooperative effort in name authority work isfundamental to all other considerations sincestandardization of bibliographic description de-pends upon a common authority file. The mostnoteworthy accomplishment to date is that thethree libraries agreed to participate in long-range plans to develop a national onlineauthorities data base. Comparison studies incollection development are expected to iden-tify subject areas of primary responsibility andestablish a framework for cooperative catalog-ing. Consistent practices in establishing nameheadings and common use of the new AACR-2rules, effective January 1981, will permit com-mon use of the cataloging copy as produced inany one of the three libraries. Cooperation is ex-pected to extend also to shared use of foreignlanguage capacities between the three institu-tions.

Bibliographic ServicesDivision

The Bibliographic ServicesDivision is respon-sible for indexing journal and monographicliterature for Index Medic us, for entering thereferences into the data base,and for coordinat-ing the online network that makes these index-ed references available via online data basesSUChaSMEDLINE.

Indexing

The total number of journal articles andmonographic chapters indexed in FY 1979 was254,210. An analysis of this figure shows that230,427 articles were published in IndexMedicus (including 1,990 monographic cita-tions), and 13,167 entries were indexed forspecial indexes such as the Index to DentalLiterature, International Nursing Index, andPopulation Sciences—Index of BiomedicalResearch. One thousand three hundred andeighty-two "articles" were indexed to appear in

the Index to Audiovisual Serials in the HealthSciences, 8,138 articles were indexed for theHealth Literature Index, and an additional1,0% articles were indexed but not publishedin FY 1979 for a total of 254,210 indexed cita-tions.

Seminars on indexing consistency, begun inFY 1978, were continued in 1979. These semi-nars were conducted for members of the index-ing staff who are responsible for revising articlesindexed for Index Medicus and the variousdata bases. Continued effort is made to ensurethat the intellectual content of Index Medicusremains high, and that the indexing policies areconsistently followed.

During the year additional quality controlmeasures were implemented in order to in-crease the timeliness and accuracy of data beinginput monthly into MEDLINE. These included:the implementation of precise methods foralerting NLM staff to possible gaps in the receiptof journal issues as well as the monitoring ofjournal throughput time; the identification ofjournal issues which contained no indexable ar-ticles; the addition of a final editing step ofkeyboarded data by NLM indexersand revisers;the refinement and enlargement of the scope ofthe computer edit program for data in process;and a final online verification of data beforetheir releaseinto MEDLINE.

MEDLARS Management

The MEDLARS Management Section serves asthe public contact point for the day-to-dayoperation of the NLM Online User Network.This Section provides answers to telephone andwritten inquiries about the use and charac-teristics of the various data bases, maintains bill-ing records, processes applications for access tothe data bases, handles the mailing of offlineprints and offsearches, and produces manualsand other descriptive materials. In October1978, the Online Services Training Unit wascreated within the MEDLARS Management Sec-

11


tion. It is responsible for all training in the use ofthe online system.

Two new data bases wereadded to MEDLARS:

• TOXICOLOGY DATA BANK, added Octo-ber 30, 1978, contains chemical, phar-macological, and toxicological informationand data on more than 1000 substances.This data base was developed by theSpecialized Information Services at NLM(see Chapter 4).

• HEALTH PLANNING AND ADMINISTRA-TION, added November 1,1978, containscitations to literature on health planning,organization, financing, management, andrelated subjects. This data base serves asthe source for the Hospital Literature In-dex and is prepared in cooperation withthe American Hospital Association.

The 14-volume 1978 Cumulated IndexMedicus contained 227,684 citations printedon 11,269 pages. Twenty-eight recurringbibliographies continued to be published, anda new Quarterly Bibliography on Major Tropi-cal Diseases was begun on an experimentalbasis (seeChapter 8).

A number of enhancements to ELHILL wereadded during FY 1979:

• A new capability called "pre-explosion"was added to facilitate searching. Nine ofthe frequently needed explosions wereac-complished in advance and stored in thecomputer.

• Two new online print formats becameavailable in April. One is a compressed for-mat which permits all items in a field to beprinted across the page rather than ver-

ALASKA

ONLINE CENTERS IN THE UNITED STATESSeptember 1979

DISTRICT OFCOLUMBIA

HAWAII

AUSTRALIACANADAENGLANDPRANCErTALYJAPAN

MEXICOPARC.

KXJTH AFRICA

WE»T GERMANY

12


tically, thus saving space. The other is acatalog card format, available from CATLINEand AVLINE.

• Two new print formats for SDILINE and TOX-LINE were made available.

The growth of online training continued. Sixhundred and forty-four persons were trained ina total of 32 initial and advanced classes. In ad-dition to classes at N LM, classes were also heldin Dallas, Chicago, Seattle, New Hampshire,Denver, Atlanta, New York, and Los Angeles. Anew advanced training curriculum was used forthe first time in January.

History of MedicineDivision

During the past year the Library published AShort Title Catalogue of Eighteenth CenturyPrinted Books In the National Library ofMedicine, listing some 25,000 titles of booksand journals in the historical collections. Be-tween 30 and 40 percent will not be found inany of the Library's previously publishedcatalogs or in the National Union Catalogpre-1956 Imprints. It thus reveals as neverbefore the wealth of source material in this greatnational collection and available for historicalstudy of medicine and related sciences in theeighteenth century. Based on the work of manypast and present members of the catalogingstaff, it was compiled for publication by Dr.John B. Blake.

A significant proportion of the time of HMDstaff is devoted to what might be called publicevents. Notable among them this year was thecelebration of the Centenary of Index Medicus,for which a day-long program of historical-bibliographical papers was arranged describingthe origin and development of Index Medicusand some activities of physicians as book col-lectors, bibliographers, and scholars. Dr. Blakearranged the program and presented a paper onnineteenth century medical bibliography. A

special exhibit tracing the history of IndexMedicus was also prepared by Manfred J.Waserman. Other exhibits prepared by Historyof Medicine Division staff and displayed in thelobby during the year commemorated the400th anniversary of the birth of William Harveyand recognized achievements in aviationmedicine beginning with Dr. John Jeffries'pioneer aerial voyage in a balloon across theEnglish Channel in 1785.

The historical collections were enriched bythe addition of some 417 books and theses andan estimated 46,000 manuscript items. Book ac-quisitions ranged in publication date from thefifteenth to the nineteenth centuries. One in-cunabulum was added this year, Petrus deArgellata's Chirurgia (Venice, 1497/98; CoffA-953). Other significant acquisitions rangedfrom the works of Galen edited and translatedby Leonhart Fuchs (4 volumes, Paris, 1550-54)and the rare first German translation ofDioscorides' De mater/a medica, the KreutterBuch published in Frankfurt in 1546, to the firstedition of Robert Boyle's Certain PhysiologicalEssays (London, 1661). The last is one of theauthor's important early works in chemistry andincludes a discussion of the process of diges-tion. The Library also enhanced its already out-standing collection of the works of WilliamHarvey by the acquisition of his Exercitatioanatomica de circulatione sanguinis (Paris,1650), which contains the two essays addressedto Jean Riolan answering, for the first time inprint, the objections of Riolan and others to thedoctrine of the circulation. The essays were firstpublished in Cambridge in 1649 (an edition theLibrary still lacks); subsequent editions were ap-pended to Harvey's De motu cordis. At theother end of the scale of significance in thedevelopment of medical science but of muchinterest to Americanists was the acquisition ofPeter Smith's The Indian Doctor's Dispensato-ry (Cincinnati, 1813), the first medical bookpublished in Ohio.

Additions to the manuscript collection in-cluded archives from the early years of the In-

13


ter-Urban Clinical Club and personal papers ofIrvine Page, George H. Burch, and W. HenrySebrell. To them and to other donors the Libraryexpresses its thanks not only for their gifts butespecially for making these valuable materialsavailable for the benefit of future historicalscholars.

Current historical scholars, meanwhile, havecontinued to use the existing collection in sub-stantial numbers, in the reading room andthrough interlibrary loan and special photo-graphic services, as the statistics in Table 7show. A number of staff members have alsocontinued their historical investigations andhave participated actively in the affairs andprograms of professional societies. During theyear D>\ Peter D. Olch served as Vice-Presidentof the Halsted Society and Lucinda Keister waselected Secretary of the Picture Division,Special Libraries Association.

brary loan, micropreservation,nance of the collection.

and mainte-

As can be seen from Tables 11, 12, and 13,there were no dramatic changes in the level ofservices performed by the Division. However,there were two special activities in FY 1979; anexperiment in facsimile transmission and thedevelopment of a Disaster Recovery Plan (thatwe hope never to have to use).

The Division participated in the first facsimiletransmission test of interlibrary loans using thenew International Electronic Post system (IN-TELPOST). Two articles requested by NLM fromthe British Lending Library in Yorkshire, Eng-land, were scanned by a facsimile reader in Lon-don, transmitted via satellite, and received atthe Washington Post Office. Copy quality wasexcellent and further tests are planned.

Reference ServicesDivision

The Division functions as the Library's prin-cipal public service arm in the areas of reader,reference, and bibliographic services, interli-

Reference librarian Howard Drew stands beneaththe new annunciator board.

The Disaster Recovery Plan was developedagainst the event of water damage to any part ofthe Library's collections. The plan includesreporting procedures, naming of a RecoveryTeam, location of necessary supplies and equip-ment, and procedures for handling wetmaterials. It also calls for the installation offreezers in the building to accommodate dampor wet volumes for rapid freezing and stabiliza-tion in the event of a water accident. Arrange-ments were made with outside freezer com-panies to accommodate a larger number ofbooks should the damage exceed NLM's freezercapacity.

Interlibrary loan requests dropped by some12,000 (from 262,000 to 250,000), most ofwhich was accounted for by a reduction inforeign requests, mainly attributable to the dis-continuation of the agreement between theLibrary and the Agency for InternationalDevelopment in October 1978. Under thatagreement, in force for many years, the standardloan charge of $2 for foreign libraries was en-tirely subsidized for loans to libraries in AIDcountries.

14


The fulfillment rate and timeliness ofresponse to demand continued at satisfactorylevels. The leveling off of service demands onthe collection and for reference assistance,which began last year, continued. It is still tooearly to know whether this is a short-termphenomenon or represents the success of at-tempts to control a demand that was strainingthe Library's and the network's ability to satisfyit.

Bound journal volumes representing about20,000 titles for 1963-69 were shifted from theA level to C level during the year. The shift, toalleviate crowded conditions in the currentjournal collection, necessitated every volumeon both floors to be relocated.

The Collection Maintenance Unit completedsystematic "gapping" of the entire current jour-nal collection to determine which issues weremissing from the collection. Records of the gapswere entered in the computer-based MasterSerials File that is used to determine theavailability of material for document deliveryand for requesting replacement by the SerialRecord Section.

Motorized COM (Computer-Output-Microfilm) readers were installed in the readingroom and work areas of the Division. Each filmreader contains Master Serial File data on 16mmfilm, including descriptive cataloging with issu-ing bodies, call numbers, places of publication,and gaps in the run.

Work continued on developing and updatingthe Library's government documents collectionwith the hope of making it a model of legislativereference materials relating to the healthsciences. During this first year of operation as aSelective Depository, NLM received some 2,000publications from the Government PrintingOffice. Also, a collection of Federal laws, Con-gressional Committee Reports, hearings, andstatistics relating to public health is beingassembled in microform.

Technical ServicesDivision

Retrospective Conversion

The year's most momentous decision was toprepare for closing the card catalog by convert-ing the shelflist to machine-readable form. InNovember, the Director invited a panel of ex-perts to meet and review alternatives.The panelreported that retrospective conversion was themost reasonable and appropriate approach toclosing the card catalog. Major benefits will in-clude improved in-house processing and provi-sion of a wealth of bibliographic data to the na-tional network.

A data entry system for converting NLM'sbibliographic records from 1801 to 1965 wasdeveloped by a team composed of representa-tives from the Technical Services Division(TSD), the Office of Computer and Com-munications Systems, and the Lister Hill Center.The team defined the system configuration anddeveloped software which will meet the projectrequirements. A Request for Proposal for theretrospective conversion was prepared by TSDand the contract was awarded in September.

Limited Cataloging

TSD has begun a special project to applylimited cataloging to certain arrearage items—items previously uncataloged but under NLMcontrol in the Inprocess file. Much of the ar-rearage material was uncataloged because of in-sufficient resources in the Cataloging Section tohandle the volume of acquisitions and thevariety of languages represented.

The standard for bibliographic description oflimited cataloging is enriched beyond theminimal record defined in the draft version ofthe National Level Bibliographic Record-Books. This draft standard has been reviewed

15


by research libraries in the U.S. and has beengenerally accepted as a minimum level recordnecessary for distribution of cataloging in anynational bibliographic system. Subject headinganalysis will be applied according to NLM'sMedical Subject Headings (MeSH), but sub-ject analysis will be limited to only one or twomain headings. Classification is not being ap-plied and the shelf arrangement is by an internalshelving number. It is anticipated that limitedcataloging data will be prepared at two to fourtimes the rate of full cataloging.

OCLC

CATLINE monograph data, available to OCLCsince FY 1978, were loaded into their onlinesystem in August 1979. At this time only currentmonograph records from August 1979 forwardare being added to the OCLC system; the fullretrospective CATLINE file is expected to be ad-ded in the future. NLM cataloging for new serialtitles has been input into the OCLC systemsince June 1974 as part of NLM's participationin the CONSER Project.

Exchange

The NLM exchange program was updatedand automated. NLM hasapproximately 388 ex-change partners in 72 countries. The titles sentto each partner are recorded in an ExchangeFile. Receiptsfrom these countries are coded inthe INPROC record if the title is a monograph.Serial title receipts from these countries have asubscription record created.

Serials

During the past year several new NLM pro-ducts became available which increase accessto bibliographic and location information forbiomedical serials. The second edition of the

Index of NLM Serial Titles appeared in Febru-ary 1979. This keyword-out-of-context indexwill be generated annually from the SERLINE file.The first issue of Health Sciences Serials, aquarterly microfiche publication, was dis-tributed in January 1979. It includes locationsymbols for resource libraries in the RML net-work, as well as complete bibliographic infor-mation for each title. Health Sciences Serials isNLM's first microfiche publication. Two newmonthly roll microfilm products, one for useinthe reading room and one for staff use, werealso produced from the Master Serials System in1979.

During FY1979, attention has focused on theneed to establish an efficient method for updat-ing regional serials location information inSERLINE. A special RML Task Force on SERLINEwas established to provide assistance to NLM inthis and other matters related to serials holdingsinformation. NLM is now committed to thestorage of actual summary holdings statementsin the SERLINE file, using an American NationalStandards Institute standard which was ap-proved in the summer of 1979. NLM believesthat SERLINE should be updated by machinetransfer of automated data from existing localand regional files whenever possible in order toavoid duplicate effort. To accomplish this, a oneto one correspondence must be established be-tween like titles in SERLINE and external files.During the past year, NLM sponsored a suc-cessful experiment to match SERLINE with an ex-ternal file in order to add NLM control numbersto the external file. A contract will be proposedfor FY1980 to apply this technique to approx-imately 40 external files.

The dealer check-in program continued toexpand. A file to hold dealer-supplied auto-mated check-in data was created and pro-cedures were established to processand mergedata from three participating dealers. Data fromthree other dealers will be added to the file inFY 1980 and the merged data will then appearin in-house microfilm products.

16


Medical SubjectHeadings

In preparing 7980 MeSH, 366 new headingswere added, representing concepts with nodirectly corresponding headings in 7979 MeSH.An additional 99 new headings replaced exist-ing terms. One new subheading was in-troduced and seven others were made availablefor use with additional MeSH categories.

All terminology concerned with family plan-ning and fertility control was extensivelyreviewed, and terms used by the creators of thePOPINFORM data base were mapped to MeSH tomake possible the conversion of POPINFORM asthe nucleus of an online POPLINE data base.Continuing cooperation with the NationalHealth Planning Information Center resulted infurther development of health care deliveryterms. A systematic review of the terminology ofthe digestive diseases and digestive system wasbegun with the cooperation of the National In-stitute for Arthritis, Metabolic, and DigestiveDiseases.

A limited number of "pre-explosions" wereintroduced when 1979 MEDLINE was generated.These make possible the searching of somecomplete categories and subcategories of sub-

Clifford A Bachrach, M D , newly appointed editorof Index Medicus

ject headings that are frequently wanted butthat have previously been impossible to searchas a whole because of limitations of onlineprograms. The popularity of this featureprompted many user requests to expand thiscapability in 1980.

Mid-Atlantic RegionalMedical Library Program(RMLIV)

The RML IV Program has developed aregional plan for cooperative activities amongthe Regional Medical Library (NLM), 14Resource Libraries, and approximately 500community institutions in the Mid-Atlanticstates. This plan serves as a framework for thetwo major RML program areas: resource sharingand education. Within this framework, detailedoperational plans are being developed forspecific activities such as document delivery,cooperative bibliographic activities, training,and consultation.

An important accomplishment this year wasthe approval by the Regional Advisory Counciland NLM of a document delivery plan. Thisplan, to be implemented at the beginning of1980, establishes an interactive regional in-terlibrary loan network within and among theMid-Atlantic states. At the community level,hospitals and other health-related institutionsare responsible for limited cooperative services,with more extensive services from the ResourceLibraries, and backup support from theRegional Medical Library (NLM). In FY 1979NLM provided 73,955 interlibrary loans to theMid-Atlantic Region.

The regional education program concen-trated on basic level training for library person-nel in hospitals and other health-related institu-tions. Workshops were presented by RML-trained instructors to 700 trainees on basichospital library practices, basic reference serv-

17


ices, basic cataloging procedures, and manage-ment of audiovisuals.

The NLM Online Services Network con-tinued to expand in the Mid-Atlantic Region,with most of the growth attributable to the in-creasing number of hospitals and commercialorganizations joining the network.

Continuing education is provided for theonline centers though annual online updatesprepared by NLM for presentation by a techni-cal resource person from the Region. In addi-tion, online workshops emphasizing searchstrategy were presented on the following topics:basic online searching and health care delivery.

Table 3. Online Institutions in the Mid-Atlantic Region

Type of Center Number

Government agenciesCommercial organizationsAcademic institutionsHospitalsAssociations

Total

773834329

190

Table 4. Bibliographic Services

F Y 1977

Total Items Indexed*For Index Medic us

Recurring Bibliographiesjournals Indexed for Index MedicosMonographs IndexedAbstracts Entered

259,980248,346

262,525

225111,467

FY 1978

259,807232,563

282,543

8794,174

FY 1979

254,210230,427

282,595

5598,501

* Includct tptcul ll« iniclcv iudlotipn, ind monofriph chtpuri.

Data Base

AVLINEBIOETHICSCANCERLITCANCERPRO) .CATLINECHEMLINE . . . .

Table 5. Online Searches

FY 1977

9,100

15,8413,863

125,45525,482

FY 1978

10,4251,582

23,0864,208

147,13833,009

FY 1979

14,3872,403

36,7065,713

184,66746,149

18


CLINPROTEPILEPSYLINEHEALTHHISTLINEJOURNAL AUTHORITYMEDLINEMESH VOCABULARYNAME AUTHORITYRTECSSDILINESERLINESTORED SEARCHTDB (TOXICOLOGY DATA BANK)TOXLINE

Total

5961,630——

898405,653

2,30210,464

47119,677

—45

1,28639,432

662,195

1,0172,327—

183511

460,2092,3034,9365,983

19,58111,914

531,572

47,323

777,360

1,5712,028

23,3873,263—

548,4692,8705,3279,788

19,39423,577

6010,95364,667

1,005,379

Table 6. Offline Searches

Data Base

AVLINEBACK66BACK 69BACK 72BACK 75BIOETHICSCANCERLITCANCER,PROJCATLINECHEMLINECLINPROTEPILEPSYLINEHEALTHHISTLINEJOURNAL AUTHORITYMEDLINEMESH VOCABULARYNAME AUTHORITYRTECSSDILINESERLINETDB (TOXICOLOGY DATA BANK)TOXBACKTOXLINE

FY 7977 FY 1978 FY 1979

Total.

934,60045,18559,388

——1,257286875631

—— 0

26,9241012

39,454

—125,6285,663

218,548

2038,02849,65868,42358,625

11,472356101171138

— 00

28,8460036

53,85623

6,7167,953

314,162

1742,33756,86776,81891,956

61,3942711775423203258

—36,9970082

71,173874

7,69311,976

398,276

19


Table 7. History of Medicine Activities

FY 1977 FY 1978 FY 7979

AcquisitionsBooks 504 489 417Modern manuscripts 77,177 15,805 46,006Prints and photographs 606 293 297

ProcessingTitles cataloged 3,225 2,782 2,789Modern manuscripts cataloged 61,290 37,527 61,666Pictures indexed 495 526 320Articles indexed 6,074 4,887 4,787Pages microfilmed 152,994 124,158 118,151

Public ServiceReference questions answered 1,803 2,160 2,187ILL and pay orders filled 2,456 2,362 2,107Reader requests filled 5,386 7,560 3,923Pictures supplied 1,848 1,840 2,474

Table 8. Acquisitions Statistics

FY 7977 FY 1978 FY 1979

Serial RecordsNew titles added 990 1,272 1,974Discontinued titles 812 830 828Current titles received 25,831 23,711 22,172

Publications ProcessedSerial pieces 172,804 173,566 174,318Other 25,000 21,793 26,503Total 197,804 195,359 200,821

Obligations for:Publications $1,350,683 $1,571,836 $1,655,000Included for rare books 79,246 81,185 80,000

20


Table 9. Growth of Collections

Previous Total(Sept 1978)

A. Book materialsMonographs:

Before 15001501-16001601-17001701-18001801-1870Americana1871-PresentBrief listed-INPROC

Theses HMDPamphletsBound serial volumes.Volumes withdrawn..Total volumes

B. Nonbook MaterialsMicroformsAudiovisual*PicturesManuscripts

5645,5249,658

23,05839,3102,285

363,64716,812

281,452172,021576,679

1,491,010

78,7618,149

72,498837,913

AddedFY 1979

12341

1688710

10,9723,795

56

25,591(4,081)36,663

9401,903

29746,006

NewTotal

5655,5479,699

23,22639,3972,295

374,61920,607

281,508172,021602,270(4,081)

1,527,673

79,70110,05272,795

883,919

Completed cataloging.Catalog cards filedVolumes shelf-listed...

Table 10. Cataloging Statistics

FY 1977

13,507126,59112,182

FY 1978

14,186166,30014,166

FY 1979

13,530285,72619,641

21


Table 11.

Number of requests receivedFor interlibrary loanFor readers

Number of requests filledFor interlibrary loan

PhotocopyOriginal

For readers

Number of requests unfilledInterlibrary loan

RejectedReferredReturned as unavailable

Reader service returned as unavailable

Circulation Statistics

FY 1977

423,801280,512143,289

343,313221,517198,760

22,757121,796

80,48858,99523,0837,946

27,96621.493

FT 1978

425,000261 ,969163,031

329,119193,804176,158

17,646135,315

95,88168,16528,164

7,44532,55627.716

FY 1979

417,613249,820167,793

327,118186,172168,787

17,385140,946

90,49563,64821,072

7,61634,96026.847

Table 12. Reference Services

FY 1977

Requests by telephoneRequests by mailReaders assistedTotalReading room users registered.

15,0431,140

26,77242,95532,060

FY 1978

16,317753

30,76347,83333,504

FY 1979

13,494729

32,24146,46429,758

Table 13. Binding Statistics

FY 1977

Number of volumes sent to binderObligations for binding

33,045$113,104

FY 1978

33,881$157,426

FY 1979

31,911$149,520

22

Chapter 3: Computer andCommunicationsSystems

Harry D. Bennett, DirectorOffice of Computer and

Communications Systems

The Office of Computer and Communica-tions Systems (OCCS) provides data processingand data communications support to all ele-ments of the Library. As such, it has a criticallyimportant supporting role for Library Opera-tions (Chapter 2) aswell as Specialized Informa-tion Services (Chapter 4). The present IBM370/158 multi-process computer system is theequipment workhorse providing this support.NLM purchased the major portion of thisequipment in 1977 when it became clear thatthere would be significant cost savings to thegovernment for each year the present system isused until the planned replacement system isinstalled in 1960.

NLM is working with the General ServicesAdministration on a competitive purchase toreplace the IBM 370 system in early 1980 inorder to provide the capacity necessary to meetthe Library's growing requirements for data pro-cessing services. This replacement, which hasbeen in the planning stages for well over twoyears, will handle the estimated 20-25 percent

annual growth until 1985. The system will be in-stalled in the Data Processing Facility in the newLister Hill Center building which is under con-struction. This facility has been designed tohouse the data processing equipment necessaryto support NLM through the 1980s.

System ImprovementsConsiderable emphasis has been placed on

improving the performance of the present 370system so that NLM's data processing require-ments can continue to be met on the existingequipment until the replacement system is in-stalled. This emphasis will insure that the pre-sent system will continue to meet NLM's needsuntil the new system becomes operational in1980.

During FY 1978 OCCS began implementingseveral new online input systems, includingMEDNAM (MEDLARS name authority processing).MEDNAM provides for the online input and

23

NLM Programsand Services

maintenance of authority names in support ofcataloging. During FY 1979 OCCS continued toenhance the MEDLARS u software system. A newsystem, MEDIEM (MEDLARS Input-Edit Module),was introduced this year and it has greatly im-proved the processing of cataloging informa-tion. Taken together with ME ONAM, MEDCIM, andMEDVOC, which were previously implemented,these modules constitute a complete conver-sion of MEDLARS input processing to more effi-cient online methods.

Enhancements to the ELHILL retrieval systemthis year included more efficient printing tech-niques, catalog card format online, and acapability to explode terms with very large post-ings. Another change now being developed willallow network users to input and editpasswords, saved searches, user codes andother items which previously were availableonly under NLM control.

During 1979 OCCS was given responsibilityfor the Data General Eclipse 200 minicomputerand OCCS subsequently made operationalvarious developmental data entry software pro-jects. One project in particular, the Retrospec-tive Data Entry System (RDES) for the closing ofthe NLM Card Catalog, is being developed by aproject team of OCCS and Lister Hill Centeranalysts. The growth in minicomputer applica-tions and users made it necessary to upgradethis computing power. The Data GeneralSystem 350 is being acquired to meet this re-quirement and will be installed in the computerfacility of the new Lister Hill Center building.

Another important activitycentered on Com-puter Output Microform (COM) applications,commencing with the quarterly microfichepublication of the Health Sciences Serials inJanuary 1979. Other products being developedfor internal NLM usewill be on 16mm film. Thegrowth of these applications, responding to theneed of easy access to voluminous data, led tothe acquisition of COM equipment which willalso be installed and made operational in thenew computer facility.

In FY 1979 OCCS also upgraded INQUIRE, thedata base management system that providesmanagement and software support to all theNLM components. This upgrading provides forgreater data integrity and allows processing ofpartial and full text databases.

Data CommunicationsDuring this year OCCS personnel have

reviewed the varied and complex requirementsfor data communications of the Libraryand thenew building. In addition to the ongoing serv-ices requiring terminals and processors in every-day use (such as MEDLINE), these requirementsinclude research and development of com-puter-based educational material and researchprojects such as developing stand-alone ter-minals and examining the potential of minicom-puters/microprocessor-based systems for costsavings in information transfer. A project wasbegun to develop a total data communicationssystem.

The first step in the project was to documentthe data communications requirements for allNLM components. Analysis of these require-ments highlighted the need for a single and flex-ible local network that could serve the needs ofboth buildings. Such a local network should: (a)permit heterogeneous devices to communicatewith one another in a "transparent" mode; (b)permit users access to multiple devices (e.g.,multiple computer systems); (c) permit thesharing of resources; (d) provide a gateway fromthe local network to the public packet networks(Telenet and Tymnet); and (e) allow for growthin number of users and types of devices.

The next step was to analyze alternative net-work architectures that showed promise ofmeeting the objectives of such a local network.After investigating three possibilities, it wasdetermined that a high speed "coaxial bus"system best met the requirements. The advan-tages of the coaxial system are good signal

24

Computer and CommurWcat/ons Systems

quality, ease of implementation, highly even though a component fails. The newdeveloped components, adaptability to a system will service the inter- and intra-buildingchanging communication system, accommoda- data and video distribution requirements oftion of different traffic types, potential for NLM. Final design of this system was started thisbroadcasting, simplicity, potential for high year; the system will be installed and tested inutilization, and the ability to continue operating the third quarter of 1980.

25

Chapter 4: SpecializedInformationServices

Henry M. Kissman, Ph.D.,AssociateDirector

The Division of Specialized Information Serv-ices is responsible primarily for the operation ofthe Library's Toxicology Information Program(TIP). The objectives of the Program are (1) tocreate computer-based toxicology data banksfrom the scientific literature and from the files ofcollaborating industrial, academic, and govern-mental organizations, and (2) to establish andoperate toxicology information services for thescientific community.

During the period covered by this report, theHEW Secretary established the National Tox-icology Program (NTP) to strengthen theDepartment's activities in the testing of chemi-cals of public health concern and to developand validate new and better test methods. Toaccomplish these goals NTP has established aDepartment-wide effort to provide needed in-formation to regulatory and research agenciesand to strengthen the science base.

The NLM has agreed to provide, through theToxicology Information Program,basic informa-tion support required by the NTP.This includesbuilding and maintaining information files for

compounds selected by NTP for testing, infor-mation support for new areas of NTP research,technical direction for the NTP-sponsored En-vironmental Mutagen and EnvironmentalTeratology Information Centers at the OakRidge National Laboratory, and assistance toNTP in building a data base on human exposureto carcinogens.

Collaborative projects with other agenciescontinue to be active and with the advent ofNTP are indeed increasing. There is continuingincrease in the use of online services such asTOXLINE, CHEMLINE, and RTECS, in hours of usageand number of printouts. The size of all thepublicly available files has increased during FY1979.

OnlineServicesTOXLINE: This bibliographic retrieval service

comprises an extensive collection of about630,000 journal citations and abstracts derivedfrom published human and animal toxicitystudies and information about the biological

26

Specialized Information Services

effects of drugs, pesticides, food additives, in-dustrial and household chemicals and hazards,radioactive materials, toxic pollutants andchemicals in the environment, and analyticalchemical and bioassay methodology for toxicsubstances. TOXLINE is updated monthly andnow includes citations and abstracts from themost recent five years of the biomedical andchemical literature. Information older than1974 is now in the backfile, TOXBACK, whichcontains about 400,000 records.

TOXLINETOXBACK information is gleaned fromsix major secondary sources and six special col-lections of referenced biomedical and chemicalinformation. The component subfiles now in-clude selected MEDLARS references from 1968;Chemical-Biological Activities from 1965(Chemical Abstracts,Sections 1-5, and Sections8, 59, and 60); Abstracts on Health Effects ofEnvironmental Pollutants from 1972 (Bio-Sciences Information Services); InternationalPharmaceutical Abstracts from 1970(American Society of Hospital Pharmacists);Pesticide Abstracts from 1966 (EnvironmentalProtection Agency); Toxicology/EpidemiologyResearch Projects (RPROI) from 1977 (Smithso-nian Science Information Exchange); the HayesFile (a precursor to the Pesticide Abstracts)1940-1966; the Environmental Mutagen Infor-mation Center File from 1960 (OakRidge Na-tional Laboratory); the EnvironmentalTeratology Information Center file from1950(Oak Ridge National Laboratory); the ToxicMaterials Information Center File, 1971-1975(Oak Ridge National Laboratory); and theSpecial Teratology File, 1960-1974.

In FY 1979, almost 65,000 online searcheswere conducted by TOXLINE users involvingover 10,000 hours of computer connect time.In the process, more than 3.5 million citationswere requested to be printed offline from TOX-LINE/TOXBACK, an increase of about 1.5 millionover FY 1978.

In April 1979, the newest subfile, identified asRPROI (Research Projects), was added to TOX-

LINE. The RPROI subfile contains abstracts thatdescribe planned and ongoing research in tox-icology, and epidemiology studies, coveringmorbidity and mortality resulting from popula-tion exposures to hazardous chemicals, drugs,biological agents, and disease organisms. RPROIis generated from the Smithsonian Science In-formation Exchange data base by employing anappropriate setof subject profiles related to tox-icology and epidemiology. In content, it isequivalent to the monthly publicationTox-icology Research Projects Directory (TRPD)and the annual Epidemiology Research Pro-jects Directory (ERPD). This data base consistsof initial and updated reports of planned orongoing research projects supported withgrants, contracts, or inhouse research fundsfrom a variety of sponsors, mostly Federal.Thereare now 9,561 research projects in RPROI. Thisfirst version of the subfile represents researchprojects which were funded from fiscal year1977 forward. Monthly additions are made aspart of the normal TOXLINE updating pro-cedures. RPROI will grow at a rate of about1,000projects per month.

CHEMLINE: This file, which was completelyregenerated in April 1979,has almost doubledand now contains 425,112 chemical records forchemical substances known by some 800,000different names. It includes 43,000 records onthe Toxic Substances Control Act (TSCA)Chemical Substances Inventory of the Environ-mental Protection Agency. CHEMLINE recordscontain Chemical Abstracts Service (CAS)Registry Numbers, molecular formulas, chemi-cal names, synonyms, ring structure informa-tion, some MeSH terms, and a locator data ele-ment to aid in identifying other files with infor-mation about a specific substance.Total onlineusage for CHEMLINE, which is made availablefrom both the NLM and the SUNY computers,reached a peak of 520 hours/month for a totalof 4,454 hours during the year.

RTECS (Registry of Toxic Effects of ChemicalSubstances): This file is an online searchableversion of the National Institute of Occupa-

27


tional Safety and Health (NIOSH) publicationRegistry of Toxic Effects of Chemical Sub-stances. By September 1979, RTECS providedonline users with acute toxicity data for 36,851substances. For many of these, the file also con-tains information on threshold limit values,recommended standards in air,aquatic toxicitydata, eye and skin irritation data, and car-cinogenicity data. All information in RTECS isreferenced back to the source literature. NIOSHcontinues to maintain responsibility for thecontent of the file which it updates quarterlyand republishes annually.

Toxicology Data Bank (TDB): This data bankhas been made available during FY 1979 as anonline, interactive data retrieval service. TheTOB contains evaluated data describing thechemical and biological properties, as well asthe usage, environmental, and occupationalcharacteristics of selected chemical substancesthat may be hazardous and/or whose exposurepotential is significant. Data extracted fromsources such as textbooks and handbooks arefurther evaluated by a peer review committeeconstituted from the NIH Toxicology Study Sec-tion which is comprised of pharmacologists,toxicologists, and analytical chemists. Data ex-traction and input tasks are performed at theOak Ridge National Laboratory for NLM. At theend of calendar year 1979 the online file shouldcontain over 1,500 complete and reviewed sub-stance records and another 1,000 references torecords in various stages of development.

Laboratory Animal Data Bank (LADB): Thisdata base provides comparative data onlaboratory animals used as experiment controlsin research and testing institutions. It is anonline computer system designed for retrievaland statistical analysis by scientists. Formal train-ing in computer retrieval methodology is notnecessary. Eventually, the system will be availa-ble through a nationwide telecommunicationsnetwork.

Using LADB, a scientist may: (1) select and ex-amine base-line data for various physiologicand pathologic values; (2) determine the en-

vironmental and husbandry conditions for eachanimal group selected; (3) statistically analyzethe retrieved data; and (4) print out the dataasdistributions (such as histograms or datatables)and as complete reports. Control data are con-tributed to the LADB project voluntarily by in-dustrial, academic, and government laborato-ries. At present the file contains data from 185animal groups, 26,203 animals of 28 strains, 9species on which 371,198 observations(hematology, clinical chemistry, growth, orpathology) were recorded. Formal testing ofLADB has been completed and it is expectedthat the file will be ready for public service inearly 1980.

The LADB project is sponsored by the DHEWCommittee to Coordinate Environmental andRelated Programs,the National Cancer Institute,the National Library of Medicine, the NationalCenter for Toxicological Research, the Environ-mental Protection Agency, and the InteragencyRegulatory Liaison Group.

Query Response andPublication Services

The Toxicology Information Response Center(TIRC) at the Oak Ridge National Laboratory issponsored by TIP to provide query responseservices in the form of literature searches. Dur-ing the past year there has been a 41 percent in-crease in TIRC services. While this Center res-ponds to search requests from the generalbiomedical community as well as from govern-ment agencies, the services provided to thelat-ter have continued to increase during recentyears. Thus, in FY 1979,93 percent of TIRC serv-ices went to Federal agencies as against 79 per-cent in the previous fiscal year.

The current charge for services is $30/hour,billed through the National Technical Informa-tion Service (NTIS), Department of Commerce.Charges for services to the Federal agencies arerecovered through interagency agreements.During FY 1979 such interagency agreements

28

Specialized Information Services

were negotiated with the Food and Drug Ad-ministration, National Center for ToxicologicalResearch, National Institute of EnvironmentalHealth Sciences, the National Institute for Oc-cupational Safety and Health, the ChemicalSystems Laboratory of the Department of theArmy, and the National Toxicology Program.

Recently TIRC has agreed to provideliterature searches for the Information Responseto Chemical Crises (IRCC) project which issponsored by the DHEW Committee to Coordi-nate Environmental and Related Programs, theDepartment of Agriculture, the EnvironmentalProtection Agency, the National Institute of En-vironmental Health Sciences, and the NationalOceanic and Atmospheric Administration.Federal organizations concerned with toxicsubstances are occasionally confronted withunexpected events, caused by or related to achemical substance, which threaten humanhealth and/or the environment; these eventsaredesignated as "chemical crises." The primaryobjective of the IRCC project is to provide thesponsoring organizations with the results of aliterature search on an identified chemical sub-stance or topic within 48 hours. A secondaryobjective is to prepare bibliographies on sub-stances or topics which, although noncrisis innature, areof interest to the organizations spon-soring this project.

Publications: TIRC publishes reviewsand an-notated bibliographies in toxicology journals orthrough the NTIS. During 1979, these bibliogra-phies covered the following topics: Health andEnvironmental Effects of Toxaphene andVinyl Chloride. Two IRCC noncrisis searcheswere completed: Asbestos in Air and Healthand Environmental Effects of Acid Rain.

TOX-TIPS (Toxicology Testing-in-Progress):TIP continues to produce, for the ToxicologyInformation Subcommittee of the DHEW Com-mittee to Coordinate Environmental and Re-lated Programs, two publications that describeresearch-in-progress. The first of these, TOX-TIPS, reports new projects in toxicology testingof chemicals by governmental, industrial, and

academic laboratories. Descriptions ofepidemiology studies to determine toxic agentsand their effects are also included. The rapidpublication of this information is designed toprevent the unknowing duplication of these ex-pensive studies. TOX-TIPS is published monthlythrough the National Technical InformationService at an annual subscription rate of $25.

The scope and contents of the secondpublication, Toxicology Research ProjectsDirectory (TRPD), are much larger. Included aredescriptions of about 12,000 government-sup-ported research projects in toxicology and re-lated fields. These descriptions, together withextensive indexes, offer laboratory scientists andadministrators the opportunity to learn whichorganizations support what studies at which in-stitutions. The information is prepared inpublication form by the Smithsonian ScienceInformation Exchange from its extensive database and is published by NTIS at the sub-scription rate of $lOO/year. As stated above, thecontent of the TRPD is also included, as theRPRO) segment, in TOXLINE.

Collaborative ProjectsThe involvement of the Library's Toxicology

Information Program with interagency projectshas continued throughout the fiscal year andhas been mentioned previously in this chapter:planning activities related to the National Tox-icology Program, the Laboratory Animal DataBank project, the publications TOX-TIPS andToxicology Research Projects Directory, andthe Information Response to Chemical CrisesProject.

Work continued during the past year on theChemical Data Bases Directory, previouslyidentified as an integral part of the ChemicalSubstances Information Network (CSiN), whichunderwent substantivechanges in function anddata format during FY1979. A prototype file ofrecords was created describing relevant datasources and a suitable indexing methodology

29


was developed for experimental online access Committee, the group primarily responsible forusing modified ELHILL ii capabilities. overview of the CSIN project. In the coming

year, the TIP will work on another key compo-In the summer of 1979, the TIP accepted nent of CSIN, the Chemical Structure and No-

responsibility for managing the CSIN Subcom- menclature System, for which CHEMLINE can bemittee of the Interagency Toxic Substances Data considered a forerunner.

30

Chapter 5: Audiovisual Programs

Charles N. Farmer,Jr., DirectorNational Medical Audiovisual Center

The National Medical Audiovisual Center(NMAC) is the component of the National Li-brary of Medicine with primary responsibilityfor planning and administering a nationalprogram to improve the quality and use ofaudiovisual learning materials in health profes-sional education.

In March 1980, NMAC will move from Atlan-ta to the new Lister Hill Center in Bethesda.Although extensive preparations for the im-pending changes in location have been made,NMAC's major programs— EducationalResearch and Evaluation, Training and Con-sultation, Media Development, and Distribu-tion—will be continued.

EducationalResearchand Evaluation

A wide range of research and evaluation pro-jects were completed or carried forward in FY1979. Included were studies concerned withanalyzing and validating instructional designand audiovisual development models, develop-ing cost effective techniques in medical photo-graphy, and developing experimental visual ex-cerpts for existing audiovisual materials.

The completion of a planning document forNMAC training in FY 1978 has resulted in thedevelopment of 50 lesson plans for facultytraining material. Nine of the lessons are cur-rently being developed for integration into theCenter's training program. A test of medical stu-dents' learning styles was completed and vali-dated. A workshop was held at NMAC to tramhealth education researchers in the administra-tion and interpretation of the test. Many atten-dees expressed their interest in utilizing the testin their local setting.

Materials Development Branch start plan tor thelocation of production equipment in the newLister Hill Center building. Left to right, ClementFowler, l a c k Ki rk land, Ldward Burns, andGeorge Maloney

31


Prototype learning materials in immunologyand problem-based learning have also beendeveloped. In addition, a project to developand validate a system for field testing instruc-tional programs in medical schools was com-pleted. The system includes specifications fortest development, procedures for conductingstudent tryouts, and techniques for reportingresults.

Three literature reviews were initiated in FY1979—in psychomotor skill training, inserviceeducation programs in schools of the healthsciences, and clinical evaluation. In addition, aproject was begun with the Association ofBiomedical Communication Directors todevelop a model for conducting programevaluation, A workshop on program evaluationis being developed for presentation at theABCD annual meeting in June 1980.

During FY 1979 a reevaluation of NMAC'sloan and sales distribution program was com-pleted. Results of the evaluation, based on asurvey of over 3,500 clients, are available fromthe Center.

Workshops andSeminars

The NMAC workshop/seminar programdevelops and conducts faculty developmentworkshops to demonstrate a variety of research-oriented training methodologies for healthprofessional trainers. Workshops are initiallyconducted, evaluated, and improved at NMAC,and are then shared with NMAC's Field TrainingCenters across the nation.

Thirty-five workshops were conducted byNMAC and the nine regional training centersthis fiscal year. The 766 participants who at-tended represented medicine, nursing, dentis-try, allied health, and audiovisual support per-sonnel. Workshop/seminar topics included:Development and Evaluation of InstructionalMaterials, Slide Art Techniques, Basic Television

Production Techniques, Learning Spaces, BasicPhotography for Health Science Faculty, TestConstruction, Interpersonal Skills, Develop-ment and Evaluation of Instructional Materials,and Design of Simulation Activities.

Two contracts supporting the NMACworkshop/seminar program were completed inFY 1979. The first, entitled "Analysis of ClinicalTeaching Skills," provided a representative na-tional sampling of teaching skills in medicine,dentistry, and nursing. The second contractwasentitled "Use of Videotechnology to Teach In-terpersonal Skills." Three new workshops, twovolumes of resource documents, threevideotape programs, and seven trainingmanuals resulted from this contract.

Advisory ServicesOne hundred and forty consultations were

provided to domestic and foreign visitors dur-ing the reporting period. Subject areas dis-cussed include: teaching/learning methodsusing audiovisual, updating audiovisual pro-ducing methods, the NMAC training program,mediated instructional materials, facilitiesdesign and hardware selection, audiovisualequipment needs, classroom design, applica-tions of audiovisual educational technology,and various aspects of initiating and operatingan audiovisual department.

Foreign countries represented by visitors in-clude Australia, Canada, japan, India, Switzer-land, China, Scotland, and the Soviet Union.The four U.S.S.R. delegates who visited NMACwere accompanied by Miss Mary Corning, N LMAssistant Director for International Programs,and an interpreter. Their interests includedmedical information, indexing approaches, andlibrary resources.

At the request of the National Naval DentalCenter in Bethesda, a two-day site survey wasconducted to evaluate the present LearningResources Center and to make recommenda-tions for the design of a future LRC and

32

Audiovisual Programs

classrooms in a proposed remodeling project Asite visit wa^also made to the School of Nursmgof the William Gary College in New Orleans toprovide analysis and recommendations on thedevelopment and management of a learningresources program at the school

Media DevelopmentMoving to the new Lister Hill Center next

March will require the dismantling, shipping,and remstallation of many items and systems es-sential to NMAC's media developmentprogram Consequently, audiovisual produc-tion will be disrupted for several months Aconcerted effort is being made to complete asmany ongoing projects as possible while nor-mal production capability exists, new projectsare being initiated only if they can be completed quickly One major exception will be

joint LHC/NMAC efforts, including audiovisualsupport for NLM data bases

During the fiscal year, 101 productions in-tended fo r genera l d i s t r i b u t i o n (58slide/audiotape units, 30 videotape programs,and 13 motion pictures) were completedSeveral topic series, notably "Leaders inAmerican Medicine," "Distinguished Leaders inNursing," "Rural Health," "Cell Biology,""Gross Anatomy,' and "Human Physiology" ac-counted for a large share of the total productioneffort

Five additional sound/slide and videotapeunits were developed for use in NMAC-spon-sored workshops Three videotapes—"MeSHC a t e g o r y D, ' ' I m m u n o l o g y , ' and"Neoplasm"—were developed and deliveredto NLM's Bibliographic Services Division, andthree filmstnps were produced for the Pan-

NMACs TV production crew record a Distinguished Leaders in Nursing videotape Lucille Retry Leoneformer Assistant Surgeon General and Chief Nurse Officer USPHS (left) was featured and interviewed by RuthHepler R N Ph D (right)

33


American Health Organization. A complete listof productions completed in FY 1979 is in Ap-pendix 4.

DistributionNMAC maintains and distributes a largecol-

lection of medical motion pictures andvideotapes, available to requesters on a free-loan basis. The Center also places selected films,videotapes, and slide/audiotape programs withthe Sales Program of the National AudiovisualCenter, General Services Administration.

During the current fiscal year, 45,508 motionpictures and videotapes were shipped :-in

response to requests for loans. Fifteen new filmsand fifty-four videotape programs were addedto the list of titles available. Combined sales ofmotion picture prints, videotape cassettes, andslide/audiotape packages totaled 3,114 units forthe year, and 124 new titles were placed withthe Sales Program.

Abstracting of selected films in NMAC'sarchival collection was continued, along with astudy to determine the historical value of in-dividual motion pictures in the collection.

Distribution of 1,827 copies of NMAC-spon-sored monographs was made during the fiscalyear.

Table 14. Selected StatisticsNMAC

Audiovisuals requestedAudiovisual shippedTitles added (film and videotape)Audiotape duplicationTitles to NAC for saleTeaching packages sold through NAC . . .On-site surveys and consultationsNMAC-based consultationsMonographs distributedNMAC-based workshops (215 attendees)Regional workshops (766attendees)Audiovisual units completed

FY 197944,40445,508

692,976

1243,114

6140

1,8279

26107

34

Chapter 6: Lister Hill NationalCenter for Biomedical

Communications

Lionel M. Bernstein, M.D., Ph.D.,Director

During the year of this report the Lister HillCenter phased out one program and greatly ex-panded the scope of another.

June 27,1979, was the date of the last broad-cast over the Public Health Serv-ice/Communications Technology Satellite net-work. During its 816 days of operation thenet-work had logged 2082.7 broadcast hours. Over16,000 people had appeared before thecameras, logging a total of 46,372 participanthours. A summaryevaluation of this experimentappears later in this chapter.

During the past year the Health ProfessionsApplications Branch has undergone significantenlargement. A Branch Chief was selected inMay and by year's end seven professionals wererecruited. This nucleus should allow the furtherdevelopment of the Knowledge Base Programand associated studies during the coming year.

Health ProfessionsApplications

Knowledge Base Program

A Knowledge Base Program has beenestablished in the Health Professions Applica-tions Branch, with collaborative support fromthe other Lister Hill Center branches and Na-tional Medical Audiovisual Center. A"Knowledge Base" is one in which informationis selected, reviewed, corripacted, and syn-thesized to form a total package of"knowledge" in a subject for use by a specifiedaudience, such as medical practitioners.

The busy practitioner does not usually gainaccess to the formal literature via referenceretrieval and interlibrary loan, nor should the

35


physician be expected to be expert in thenecessary online access techniques. Further-more, the physician does not have the time toprocess the mass of information likely to beavailable on any given problems relating to hispractice. The Knowledge Base Systems beingdeveloped by the Lister Hill Center have the po-tential of extending the practitioner's ability toacquire, analyze, synthesize, and translateavailable biomedical information in solving theday-to-day problems of diagnosis, prognosis,and treatment of illness.

Knowledge Base Systems have the followingcharacteristics: 1) computer-based, condensedrepresentations of published information; 2)organized with varying levels of specificity; 3)citations selected to provide authority; 4) il-lustrations available to complement textualmaterial; 5) current data amenable to con-tinuous updating; 6) based on expert consen-sus; and 7) convenient for users—simplified in-teractive information access through text and il-lustrations.

A prototype Knowledge Base in the field ofviral hepatitis was established in 1977 and hasbeen subsequently refined. The HepatitisKnowledge Base has been made available on anexperimental basis for field testing at nine majormedical centers and biomedical libraries. Itsutility for assisting in medical decision makingand in medical education is now beingassessed.

The Hepatitis Knowledge Base experiencehas demonstrated the feasibility of the concept.Medical subject areas especially appropriate forthis approach are those characterized by rapidincreases in knowledge stemming from newresearch findings. The availability of such onlineinformation should have the potential to impacta major health area that has a significant propor-tion of clinical illness associated with its pre-sence. Clinical areas characterized by a com-plex, rapidly expanding, and already extensiveliterature are especially appropriate. Thus, theKnowledge Base Program is now being ex-

tended to two additional areas—peptic ulcerand human genetics.

These areas, in particular human genetics,involve the application of new technology toaugment the capabilities of computers to storeand retrieve digital information. Opticalvideodisc technology permits the storage oflarge numbers of illustrations, either in the formof still pictures or motion pictures supple-mented with audio. Contemporary systems cansupport the random access of over 50,000 in-dividual frames of video information. Thiscapability allows an almost endless variety of il-lustrative information as well as composites, ta-bles, and drawings to be stored and displayed.Microprocessors allow terminal control and in-tegration of these illustrative materials. Such in-formation must, of course, be appropriatelystructured and indexed for random access andcorrelated with the textual content of theKnowledge Base.

The Knowledge Base system is presentlybeing supported by a Data General EclipseC-330 minicomputer using the MUMPS/MI is data

Dr Merritt and Dr Siegel of the Health ProfessionsApplications Branch demonstrate the HepatitisKnowledge Base to Dr Raymond Koff (left), amember of the hepatitis panel of experts

36

Lister Hill Center

base management system and a Hewlett-Packard 2648A display terminal. The HepatitisKnowledge Base was demonstrated to morethan 200 visitors during the past year.

Another technology developed to facilitateaccess to the Knowledge Bases was an auto-mated telephone access system. This experi-mental system is based on the use of the touchtone telephone to have access to an array ofaudio messages that provide immediate answersto questions pertaining to hepatitis. The systemwas required to have unattended operation 24hours a day with rapid response to user ques-tions. The messages vary in length from 30 sec-onds to 10 minutes. Voice grade quality audiowas required along with the ability to modifyand update an individual answer without takingthe total system out of service. Expansion of theanswer bank to 100 messages per subject areaand the augmenting of one message with infor-mation contained on another were also con-sidered requirements. The cartridges can beselected instantly and in random order, and thebasic system has been modified to allow thesimultaneous selection of one tape by multipleusers.

By dialing a single telephone number, aphysician has access to any of the answers inthe data bank. Selection of the desired tape ismade through the appropriate number enteredfrom the touch tone panel. Brief answers areprovided, and more detailed answers are availa-ble asare referencesto other related tapes. Theanswers are updated as the Knowledge Base isupdated. The Telephone Access System hasbeen tested in the Lister Hill Center and demon-strated to a large number of individuals. Thesystem is now being prepared for testing byselected physicians in a health care setting.

Biomedlcal Communication Costs

A study was conducted by the Health Profes-sions Applications Branchon total expendituresassociated with the formal biomedical com-munication activities in the United States. Data

are reported for the period of 1960-1977 andprojections are made to 1985. The study covers:1) the amount of time devoted by scientists asauthors, reviewers, and editors of the biomedi-cal literature; 2) publishers as reproducers anddistributors of literature; 3) libraries and secon-dary services as literature managers; and 4)biomedical personnel as users of the literature.Overall biomedical communication expen-ditures are estimated at $0.9 billion for 1960,$4.7 billion for 1977, and $8.4 billion for 1985,reflecting costs for researchers, educators, andphysician-practitioners. These expendituresrepresent approximately 25 percent of all scien-tific and technical communication costs in theUnited States.

Information TechnologyThe research and development activities of

the Center's Computer Technology Branch forFY 1979 have included the Integrated LibrarySystem (ILS), Knowledge Base Program,Videodisc, and the Advanced Terminal System(ATS) developments. Among the systemdevelopment activities were the design and im-plementation of a Retrospective Data EntrySystem (RDES) for Library Operations.

Integrated Library System(ILS)

The goal of the Center's research anddevelopment program addressing problems oflibrary automation is to develop a modular In-tegrated Library System. Other objectives of thisprogram are to: (1) overcome problems associ-ated with the transportability of such systems;(2) provide for multilevel online user interfaces;(3) allow system access to network resources(shared cataloging, interlibrary loan, etc.); and(4) achieve processing efficiencies that willallow various minicomputer, microcomputer,and large-scale computer implementations.

Initial efforts have concentrated on an integr-ated online catalog and circulation controlsystem. During FY 1979 prototypes of all sub-

37


system components have been developed andmany have been tested These initial moduleswill be in operational test during the first quarterof the next fiscal year. The Army Library, Pen-tagon, has collaborated in and provided partialfunding for this initial subsystem While not abiomedical library, this installation will providean invaluable test site for these developmentsasthey relate to small and medium size libraries.

Knowledge Base Program

The minicomputer system previouslydeveloped by the Computer TechnologyBranch for the Hepatitis Knowledge Base wasexpanded and extended in FY 1979 to allowonline access by nine academic institutionsthroughout the United States. Studies were alsoundertaken to allow for greater flexibility andtransportability of the stand-alone microcom-puter version of the delivery system. Efforts areunderway to generalize the system capabilitiesto allow easy addition of other KnowledgeBases.

Advanced Terminal System(ATS)

The Advanced Terminal System (ATS) repre-sents a new level of sophistication and cost-effectiveness for the delivery of computer-based educational materials in the healthsciences. The ATS affords, from a singleterminalsystem, the following capabilities, access to allnetwork CAI systems, including PLATO; the in-corporation of PLATO-commensurate graphics(including animation) in all other non-PLATOCAI systems; and creating and delivering com-puter-based educational materials with fullgraphics in a local stand-alone system. The lat-ter, stand-alone capability, merges the ad-vanced terminal technology of ATSwith the ex-tended LHC-PILOT CAI language developed bythe Computer Technology Branch. This stand-alone terminal, costing about $10,000, offers alevel of sophistication surpassed only by PLATO.The latter has start-up costs of over one milliondollars (a PLATO terminal, alone, costs approx-imately $5,000).

During FY 1979, delivery was taken on asec-ond pre-production ATS prototype which in-cluded two floppy diskettes.This prototype ver-sion will be used for field testing at up to sevenhealth sciences educational institutions in thecoming fiscal year.

Videodisc Program

The optical videodisc technology has beendeveloped by, and for, the entertainment indus-try. Consumer model videodisc players arebeing marketed by Magnavox-Phillips for thehome TV market for approximately $700. Theseunits will play disks with up to one hour ofvideo programming per side. An "industrially"formatted optical videodisc will have only one-half hour of video programming per side butwill format this material into 54,000 randomlyaccessible frames. An "industrial" videodiscplayer will cost, in production, about $2,500. Itwill allow computer-controlled, random accessto any one of the 54,000 frames, or to any videosequence

The potential applications of this technologyfor the delivery of health sciences graphics aremany, including computer-based education,online medical encyclopedias, etc. Even moreexciting is the potential for encoding textual in-formation and storing up to five billion charac-ters per side on a videodisc. It would thus bepossible to store all of MEDLINE (about threemillion citations)on one side of one disk In ad-dition, the cost of replicating these disks is esti-mated at less than $10 each in quantities of athousand.

The Lister Hill Center has two prototype in-dustrial videodisc players. The Computer Tech-nology Branch has built and programmed an"intelligent videodisc interface controller"(VIC) that is presently being used to control thevideodisc players for testing. The Branch is alsodeveloping circuitry and computer protocols toallow the storage and retrieval of text ratherthan video information.

38

Lister Hill Center

Retrospective Data Entry System

The Retrospective Data Entry System (RDES), aproject undertaken in FY1979 by the ComputerTechnology Branch in cooperation with LibraryOperations and the Office of Computer andCommunications Systems, is an onlinecapability to support the contract to convertretrospective records from the NLM cardcatalog. The RDES represents a mini-catalogingcapability with special consideration given tooptimizing the entry of bibliographic data fromcatalog cards which may contain a great deal ofredundancy. Design of the RDES borrowedheavily from studies conducted for the Integr-ated Library System and many of the innovativefeatures of the RDES will be used in the creationof the bibliographic edit module for ILS. RDES it-self represents an important system capabilityand is of interest to libraries considering closingtheir card catalogs.

PHS/CTS ProgramSince 1977 the Lister Hill Center has provided

technical coordination and installation supportfor 20 experiments conducted by the PublicHealth Service using the CommunicationsTechnology Satellite (CTS). As the world's mostpowerful communications satellite,CTS is capa-ble of transmitting simultaneous two-way colortelevision programs between widely separatedsites. Its high transmitting power and the use ofa high frequency band (12-14 GHz) permittedthe employment of small, relativelyinexpensiveground terminals which have enabled variousgroups to engage in satellite-based videoteleconferencing experiments. For the past twoyears the Public Health Service has sponsoredtwo-way video teleconferencing among groundstations located in Bethesda, Maryland; Boze-man, Montana; Denver, Colorado; Fairbanks,Alaska; Lexington, Kentucky; and Seattle,Washington. Network experiments were con-cluded this past June. (A list of the 20 experi-ments is available from the CommunicationsEngineering Branch, Lister Hill Center) Several

evaluation efforts were undertaken to deter-mine whether the original goals were met

System Evaluation

In order to evaluate broadband communica-tion as a tool for transmitting informationamong health science groups, each of the 20CTS projects conducted over the past two yearswas reviewed by the Mitre Corporation Theprimary elements of this system evaluationwere: the potential for effectively disseminatinginformation, potential for curriculum andresource sharing, potential for continuingeducation, and the use of broadband satellitecommunication as a substitute for travel

As a medium for wide dissemination ofhealth science information, broadband satellite

First broadcast via the CTS satell ite

39


communication was found to have unlimitedpotential. Broadcasts using existing networksand terrestrial retransmission can greatly in-crease audience participation via the CTSsatellite, which is capable of transmitting be-tween three sites as widely separated as six timezones. Less than four percent of the total num-ber of program hours experienced satellite-re-lated difficulties.

Curriculum and resource sharing via theCTSresulted in reduced travel by the faculty, whichmeant more time could be devoted to classes.Direct interaction with experts in the healthsciences community was promoted throughCTS experiments. These benefits were broughtabout with a minimal investment by the par-ticipating groups.

Learning was found to be about the samewhen the lecture was presented interactively(two-way transmission) as in a classroom situa-tion. Lecturers who had difficulties usuallylacked familiarity with the mechanics of TV pro-duction, such as not looking at the proper TVcamera and nervousness while on camera. Arecurring problem was the use of graphic/visualaids which could have been more effective ifproperly adapted to television specifications.While CTS teleconference projects demon-strated that the broadband two-way mode is anacceptable substitute for face-to-face com-munication, users who assessed the programsgenerally preferred the latter.

The Mitre Corporation report is availablefrom the National Technical Information Serv-ice: Biomedical Communications Experi-ment;, Using the CTS: System Evaluation,PB-295-549, $5.25.

Technical Evaluation

This evaluation assessed the technical perfor-mance of the network in terms of channel

quality, system availability, and equipmentmaintainability; its capability for broadgeographical coverage, channel sharing, anddigital transmission were also looked at.Another objective was to identify causes fordeficiencies observed in performance, and toinvestigate corrective measures.

Among the highlights of the technical evalua-tion:

• The PHS/CTS network demonstrated highquality reception of color video and audiosignals under both simplex and full duplexmodes of operation.

• The ground terminal equipment demon-strated a high overall reliability. In fact, therigid specifications on important groundterminal elements may be relaxed with nosignificant degradation in performance,thereby opening up the possibility oflower cost substitutions.

• Where deficiencies in performance wereobserved, such as the unwanted presenceof echo, satisfactory corrective action wastaken.

• "Outages," or loss of scheduled terminaltime were rare, but when they did occur,they were caused by malfunctioning ofearth terminal or studio elements.

• Programs were successfully conductedamong stations geographically separated inlarger coverage areas than had beenoriginally assumed to be possible.

• It wasof importance to find that with someperceptible, but not annoying degradation,it was possible to share the higher poweredband between two video signals. Severalprograms were successfully conductedusing this feature for which the system wasnot originally designed.

The technical evaluation, conducted by ListerHill staff members, is available as a report fromthe Center's Communications EngineeringBranch.

40

Chapter 7: Extramural Grants andContracts

Ernest M. Allen, Sc.D., AssociateDirector

for Extramural Programs

The National Library of Medicine administersa program of grants and contracts to improveinformation access for health professionals, andto assist health institutions in developing im-proved library services During FY 1979, 152grants and 9 Regional Medical library contractswere awarded for $8,962,000 These awards areauthorized by the Medical Library AssistanceAct of 1965 and extensions, the most recent,P.L 95-622, covering the period through FY1981

The NLM Office of Extramural Programs con-tinues to emphasize the development of a na-tional biomedical communications network bysupporting activities of the Regional MedicalLibraries and assisting other health sciences libr-aries. The newly appointed Regional MedicalLibrary Coordinator assumed an active role inthe management and direction of the RMLprograms and activities. In April 1979 a jointNLM/RML planning meeting was held to assessRML progress and to consider future develop-ments and goals

This year NLM funded improvements in con-sortia of libraries in 150 local health institutions,primarily hospitals, through the Medical LibraryResource Improvement Grant Program Thisconsortia support, begun in 1977, is aimed athelping cooperating groups of health institu-tions, rather than individual institutions, so thatcoordinated information services may be plan-ned and implemented for health professionalsin a large geographic area These 150 institu-tions supported through 19 consortium grantsin FY 1979, when added to institutions sup-ported in FY 1977 and 1978, mean that NLMhas achieved the 1977 five-year goal of support-ing 250 new institutions in only three years. Thisresult proves the efficacy of consortia supportin extending cooperative library developmentand national networking

Recommendations of a 1978 task force to im-prove the quality of NLM-sponsored researchwere implemented by creating three newprograms. New Investigator Awards providefunding for researchers who are, for the first

41


time, seeking support for research projects oftheir own design. Research Career Develop-ment Awards provide support for moreestablished researchers who have shown out-standing potential for contributions to health-related information science. The support ofstudies of computer applications in health-science communication was initiated with theawarding of Program Project Grants.

There is a continuing interest on the part ofinstitutions and individual scientists in both thepublications program of the Library and theSpecial Scientific Project Grant Program. Theforeign component of the publicationsprogram, which uses Special Foreign CurrencyFunds (P.L. 480), is reported in Chapter 8, "In-ternational Activities."

Regional MedicalLibrary Program

The Regional Medical Library (RML) Programis a national network of eleven Regional libr-aries and more than 100 Resource Librariescoordinated by the National Library ofMedicine. The network provides access to in-formation in support of health services delivery,education, and research. Supported by ten con-tracts (NLM functions asthe eleventh RML) theRegional and Resource Libraries share theirresources through the following services: docu-ment delivery, bibliographic access to journaland monograph information, and cooperativetechnical processing. Also, RMLs promote net-work participation, especially by hospital libr-aries, through programs of consultation, train-ing, workshops, and continuing education. TheRML staffs administer, coordinate, publicize,and evaluate regional activities and provideNLM with advice and information to improvethe network. In FY 1979 the RMLs placed in-creased emphasison extension activities involv-ing the hospital-library community. During FY1979 nearly $3 million was awarded to theRegional and Resource Libraries to fund RML

programs. Approximatelyhalf was used to sup-port document delivery activities.

This year the Regional Medical Libraries im-plemented regional document delivery plansbased on network-wide principles of cost shar-ing, increased local responsibility, and usercharges. Performance standards for documentdelivery and analyses designed to determineoptimal levels of fulfillment by network partici-pants were issues examined in detail by NLMand RML Directors. Two decisions made duringthe year will have significant impact on the RMLprogram now and for years to come.

First, NLM has decided to request competi-tive proposals from qualified institutions in theregions for future RML contracts. In eight of theten regions supported by NLM contracts, thischange will mean the first occasion of opencompetition since the RMLs were established in1967-70. Proposals to perform RML serviceswere solicited in June from institutions inRegions I, VII, and X. Libraries in Regions II, III,VIM, IX, and XI will compete in FY 1980 whentheir present contracts terminate. Regions V andVI will compete in FY 1981. Standards for fulfill-ing interlibrary loans were included in the con-tract statement of work for the first time. Newawards will be made for three years, with an-nual incremental funding.

The second major decision was to hold a na-tional planning meeting of RML Directors andAssociate Directors, and key NLM staff. Atten-

Regional Medical Library Directors at their Novem-ber 1 978 meeting at NLM.

42

Grants for Library Assistance

dees met on April 18-21 to assess the progressof the RML Program and to suggest ways to im-prove the effectiveness and efficiency of the na-tional network. The intent was to lay thegroundwork to plan for allocating resources,evaluating progress, and continuing network-wide planning Discussions emphasized the im-portance of cooperation and snaring within thenetwork and the need to develop a philosophi-cal framework within which regions could par-ticipate in a coherent national system Seventask groups were formed at the meeting to workon the following issues

1) Measurement of regional performance2) Network configuration3) Content and format of RML Directors'

meetings4) Basic network services5) Communication6) Funding sources7) Roles and responsibilities of network

components

In addition to the national planning meeting,the RML Directors met twice during the yearDiscussions at the fall meeting concentrated onthe document delivery cost sharing plan. Intheir summer meeting, the Directors agreed toserve on committees to continue the workbegun by the task groups listed above. TheDirectors also agreed to a revised structure andorganization of future RML meetings and toalternate the location of the fall meeting be-tween RML sites and the NLM.

Advances were made in other areas as well.The RML Directors held a series of meetingswith the Association of State and CooperativeLibrary Agencies of the American LibraryAssociation to improve network interactionwith state and public libraries; approval wasgiven on a statement of the responsibilities ofthe Medical Library Association, the RMLs, andthe NLM for continuing education; a networkposition on the joint Commission on Accredita-tion of Hospitals consultation standards wasdeveloped, and a SERLINE task force was

established to provide regional input on unionlist activities.

This year might be viewed as a transition yearfor the RML Program Though the network hasbeen a model for the library community andoften acclaimed the most successful nationalactivity of its kind, its participants realize thatevaluating services and establishing futurepriorities are essential to continued effective-ness. The phase-in of cost sharing plans signaleda change to increased local responsibility. Thisyear the network began to concentrate more onevaluative efforts. Issues relating to the optimalnetwork configuration for efficiently deliveringservices, appropriate standards for perfor-mance, improvement of the capability of libr-aries to make information available more exten-sively and rapidly, and the impact of tech-nological advances, will require cooperationfrom libraries at all levels of the network. Thecommitment was clear in 1979; the results willbe measured and defended in the future.

Resource Project GrantsThe Medical Library Resource Project grant

provides assistance to the established healthscience library to stimulate new health informa-tion services or to add a new dimension to ex-isting services Emphasis is placed on projectsthat support resource sharing and on institu-tions that are involved in outreach services.These activities reinforce and strengthen theRegional Medical Library network.

The National Library of Medicine made 44awards for resource projects in FY1979. Twen-ty-two of these were specifically for the supportof consortium or network development. Such agrant, for example, was made to the AlabamaHospital Association to establish a health infor-mation network in sixteen rural counties acrosscentral Alabama. The network would linktogether a number of health-related institutions:The Alaha headquarters in Montgomery, theTuskegee VA Hospital, a state junior college,and numerous small health-care facilities.

43


An addit ional 11 awards supportedaudiovisual activities that had an outreach serv-ice component. For example, a Resource Pro-ject Grant awarded to Springdale MemorialHospital, Springdale, Arkansas, established anaudiovisual center to serve 11 cooperatingcommunity hospitals in Northwest Arkansas.The primary holdings of audiovisuals will beused for shared in-service hospital trainingprograms.

The remaining 11 awards were for a variety ofactivities to facilitate resource sharing. For ex-ample, an award was made to the University ofFlorida, Gainesville, for a study of the problemsinvolved in converting slide-tape programs tomicrofiche format. The results obtained by thislibrary, an active participant in the RML Net-work, should prove useful to other libraries.

Resource ImprovementGrants

The Medical Library Resource ImprovementGrant is available to assist small libraries todevelop basic collections of books and jour-nals. Support is offered to single institutions andto consortia of libraries. For consortia, two-yearsupport is available. In the first year, funds maybe used to employ a coordinator to organizethe consortium and conduct a collection needsassessment. In the second year, member institu-tions are eligible to receive up to $4,000 topurchase books and journals if they can con-tribute matching funds up to $1,000. Single in-stitutions may receive up to $4,000 for one yearto develop a basic library collection. Conditionsof the award include a half-time library managerand matching funds based on a ratio of 4 to 1.

In FY1979 NLM made awards to 15 single in-stitutions for $57,881. Start-up awards totaling$97,669 were made to 13 consortia to allowthem to plan, organize, and conduct a collec-tion needs assessment. Six established consortiareceived a total of $113,593 which enabled 23institutions to purchase books and journals.

BiomedicalScientificPublicationsGrants

NLM's support for biomedical publicationsfacilitates the dissemination of scientific infor-mation important to the U.S. health com-munity. Administered in the InternationalPrograms Division, these programs utilize bothdomestic and international resources. The inter-national publications program, authorizedunder Public Law 480 and funded with specialforeign currencies, is described in Chapter 8,"International Activities."

The domestic Publication Grant Program pro-vides selective support for nonprofit biomedi-cal publications, including critical reviews andmonographs in health fields; secondaryliterature tools (such as bibliographies, atlases,and catalogs); publications in library science,biomedical communication, and informationscience; temporary support for periodicalpublications; studies in the history of medicine;translations of current foreign biomedical

TlrRistofS

Three recent publications resulting from thePublications Grant Program.

44


monographs; and the publication of symposiaand conference proceedings related to U.S.health needs.

During FY 1979, 35 Publication Grants wereawarded in a total amount of $745,798. Ofthese, 12 were new awards, including areference volume on human bacterial infec-t ions, an author i tat ive handbook inophthalmology on the physiology andpathology of the pupil for use by clinicians andresearchers, and a review on the developmentof British forensic medicine. The continuingemphasis in this program upon high-quality, butlow-cost, projects that are scheduled for earlypublication was reflected in a drop in theaverage amount of a Publication Grant in FY1979—slightly over $21,000, including bothdirect and indirect costs. About 30 percent ofthe total funding supported analytic criticalreviews and monographs in the health sciences.

Among the studies published in FY 1979,which had received earlier support in thePublication Grant Program, was L.J. Rather's,The Genesis of Cancer (Baltimore: JohnsHopkins University Press, 1978), a history ofWestern medical thought on the genesis oftumors. The first issue of a newsletter dealingwith human experimentation, IRB:A Review ofHuman Subjects Research, was published bythe Institute of Society and Ethics and the LifeSciences, from Hastings-on-Hudson, New York.This NLM-supported periodical is expected tocontribute to the protection of people who par-ticipate in experiments as volunteers. A majorstudy by a distinguished American surgeon andhis wife also reached publication: O.K. and S.D.Wangensteen's The Rise of Surgery (Min-neapolis: University of Minnesota Press, 1976).The result of many years of research, for whichNLM provided only partial support, the bookexplores surgery's progress from an empiric craftto a scientific discipline. (See Appendix 2 for acomplete listingof books, periodicals, and jour-nal articles received in FY 1979 resulting fromNLM Publication Grants.)

Special ScientificProject Grants

These awards support the preparation ofauthoritative treatises on major health topics. Ina time of rapidly growing literature, whereproblem areas attract the attention of many dis-ciplines, there is a need for an authoritativetreatment of a major issue in a way that bringsthe relevant literature together and sets it forthin a cogent, reliable interpretation. Suchtreatises are written for a broad professional ormulti-professional audience.

These works make heavy demands uponscholarship and call for the ability to organizegreat amounts of material. They require acogent, graceful prose style, with the perspec-tive of mature scientific experience. Their docu-mentation must be impeccable. Grants can helpqualified scholars or scientists find the time andthe supporting resources necessary to ac-complish these demanding tasks in a relativelybrief time.

Applications for Special Scientific ProjectGrants are reviewed competitively as are otherNLM grants. Reviewers seek evidence that theproposed work is likely to fill an identified need,that pertinent materials and documents areavailable or will become available, that the pro-posed organization of the treatise is appropri-ate, and that a reputable publisher is interestedin publishing it. The project period may coverone or several years. Earlier grant-supportedauthors have found that writing the manuscripttakes at least one year, and that additional timeis required after delivery of a manuscript to apublisher. While the book is in press, indexing,final verification of sources, and work witheditorial staffs require close attention.

This year NLM initiated four new SpecialScientific Projects:

Tom H. Christoffel, J.D.University of Illinois"Health and the Law"

45


Leon Gordis, M.DThe Johns Hopkins University"Epidemiology of Cancer in Children"

Tom L. Beauchamp, Ph.D.Georgetown University"Informed Consent"

Dorothy Noyes Kane, Ph D.Early Childhood Education, Inc"Environmental Hazards of SmallChildren"

A grant-supported treatise appeared inDecember, 1978 Wesley W Spmk, M D., In-fectious Diseases, Prevention, and Treatmentin the Nineteenth and Twentieth Centuries,University of Minnesota Press, 1978.

Research GrantsUsing a number of grant mechanisms to sup-

port a variety of research activities it has beenpossible to implement the principal recommen-dations of the Task Force which had evaluatedNLM's Research Grant program in 1977 and1978. The Task Force had recommended thesupport of major studies in the area of "com-puters in medicine" and had also encouragedNLM to help develop talented younger personsas research scientists in biomedical com-munications. In collaboration with the ListerHill National Center for Biomedical Com-munications, several major studies were in-augurated in the form of Program ProjectGrants. Additionally, two new kinds of grantswere implemented to support the developmentof seven potentially promising researchers

Research, Development,Demonstration

These awards are investigator-initiated pro-jects that address problems ot health informa-tion access, retrieval, and utilization The pro-jects may investigate fundamental research

problems, they may undertake to developtheoretical findings into practical applications,or they may demonstrate the value of new tech-nologies in operating situations Two examplesillustrate the range of NLM interest in providingsupport

• At North Texas State University newmethods of document indexing, usingcer-tain techniques of bibliographic analysis,are being explored. The possibility ofautomating the indexing process couldhave many advantages for computerizedbibliographic information systems

• At the University of Southern California,library reference services and continuingmedical education assessment are beingcombined to develop individualized libr-ary services for medical office practice Thisspecialized information service brings tothe physician's attention current publishedinformation relating to his patients'problems

New Investigator ResearchGrants

These are small project awards to help youngscientists advance to maturity as independentresearch investigators in the general area ofbiomedical communications Eligibility islimited to those who have received the doctor-ate within five years but not yet served as prin-cipal investigators on a research grant or con-tract. The amount of support is limited to$90,000 over a three-year period. Four New In-vestigator Research Grants were awarded thisyear.

Research Career DevelopmentAwards

These awards enable institutions to furtherthe career development of young scientists withthree or more years of relevant post-doctoralexperience by making it possible for them todevote substantially full time to research inbiomedical communications. Support may con-

46


tinue for five years and provide up to $30,000 ayear for salary. Applicants are evaluated on theirpotential for further growth in research, thesuitability of their environment for the work,and their research plans. Three Research CareerDevelopment Awards were made in FY 1979.

Computers in Medicine

The Task Force found that advances in com-puter sciences with potential application to im-proved biomedical communication will requirethe support of large scale studies. Althoughcomputers are clearly a part of modernmedicine, achieving their full potential as aidsto decision-making, information handling, andhealth education requires the coordinatedefforts of many disciplines. For this reason,Program Project Grant applications were soughtin November 1978.The Program Project is agroup of discrete but related research effortswith a central leadership and common focus.This form of support is widely used throughoutthe National Institutes of Health.

Although the announcement of this programcame late in the year, 23 proposals werereceived and reviewed, of which seven wererecommended for approval. It was possible toaward five program project grants totalingnearly $1,150,000. These funds were notawarded under the Medical Library AssistanceAct but were provided by the Lister Hill Center.However, general program developmentstrategies, the application review process, andgrant administration are carried out exclusivelyby the Extramural Programs.

The five program project awards are:

Edward A. Feigenbaum, Ph.D.Stanford University"Biomedical Knowledge Representation"

Robert A. Greenes, M.D., Ph.D.Peter Bent Brigham Hospital"Investigations in Clinical Decision Mak-ing"

C. Frank Starmer, Ph.D.Duke Medical Center"Medical Databases and Clinical Investiga-tion"

Peter Szolovits, Ph.D.Massachusetts Institute of Technology"Artificial Intelligence and Clinical ProblemSolving"

Arthur S. Elstein, Ph.D.Michigan State University"Studies in Clinical Reasoning and Infor-mation Theory"

The large response to the first announcementof the program was a gratifying indication ofwidespread interest in this field, and the Boardof Regents has recommended continuation ofthe program. Because the requirements for aprogram project application can impose undueconstraints on some individuals and institu-tions, the research community has been ad-vised that applications may take the form ofeither major single research projectsor programprojects.

Training GrantsThe National Library of Medicine's Training

Grants Program in Health Sciences and Com-puter Technology was begun in 1972. One of itsobjectives is to promote a more effective in-tegration of computer technology into allphases of clinical medicine—teaching, practice,and research.

In FY1979, $1,472,000 was expended in sup-port of this program. Approximatelyone-half ofthe training funds covered direct training ex-penses (stipends, tuition, etc.)the,other halfreimbursed the grantee institutions for some ofthe added expenses generatedas a result of thetraining grant. In FY 1979, 84 individualsreceived training: 44 were predoctoral students,40 were postdoctoral. These grants supportedtraining activities in 10 institutions locatedthroughout the United States.

47


Seven of the training program directors haveshared information about the current activitiesof individuals having completed their trainingprograms. Sixty-five individuals were so iden-tified, 36 of whom had been postdoctoraltrainees. Twenty-nine of the postdoctoral* werephysicians. Of the predoctoral trainees, eighthad obtained the Ph.D. degree while under theauspices of the training grant. As to the currentpositions held by former trainees: 22 are facultymembers at a variety of academic institutions,others are in private practice or are actingas pri-vate consultants. Ten individuals are pursuingpostdoctoral experience which is not grant sup-ported, others are working in industry or withthe government. Of the 65 trainees, only twoare not utilizing the experience which they hadobtained from NLM training grants.

The results of this initial survey indicate thatthe NLM training grant program has both ac-

celerated and lent coherency to what otherwisewould be a diffuse set of academic activities. Ithas supported the training of a substantial num-ber of individuals who have gone on to careersin medical computing, some of whom will befuture leaders in this area. The momentumgenerated by the NLM supported trainingprograms has been taken advantage of and ad-ded to by the academic and professional com-munities.

In addition to the grants for training, NLM hasa contract with the Council on LibraryResources to support management interns atselected health science libraries. The objectiveof this program is to provide an experiencewhich will qualify librarians for director-levelpositions. In this fiscal year, three interns havecompleted their internship: William E. Maina,Carol C. Jenkins, and Faith A. Meakin.

Table 15. Extramural Grant and Contract Programs(In thousands)

ResearchResource ProjectsResource ImprovementTraining*Special Scientific ProjectsRegional Medical Libraries*Publications*OtherTotal

Flgum in pircntneMi refer lo numbv of projectt• Include* conirtcl funding

FY 7977 FY 1978 FY1979

( 15) $1,165( 46) 1,696( 20) 77( 10) 1,207( 3) 109( 9) 3,086( 42) 738( 4) 276(149) $8,354

( 13) $1,111( 39) 1,848( 13) 165( 11) 1,459( 7) 248( 9) 3,020( 47) 1,071

(139) $8,922

( 22) $1,658( 44) 1,735( 34) 284( 10) 1,472( 7) 215( 9) 2,848( 35) 750

(161) $8,962

48

Chapters: International Activities

Mary E. Corning,AssistantDirector forInternational Programs

The NLM has continued its internationalcooperative undertakings designed to improvelibrary and health information services with theultimate objective of enhancing biomedicalresearch, education, and health care. Theprograms relate to the developed and thedeveloping world.

International MEDLARSAgreements

The current NLM MEDLARS partners areAustralia, Canada, France, Germany, Italy,Japan, Mexico, South Africa, Sweden, UnitedKingdom, and the Pan American HealthOrganization. Italy became a new collaboratorduring this past year; and Iran ceased its MED-LARS operations.

An International MEDLARS Technical Meetingwas held at NLM on March 21-23,1979 with 25representatives of the non-U.S. MEDLARS Cen-

ters in attendance. These individuals met withNLM staff to share technical information andoperational experience. There were sessions onnetwork developments, user services, training,new data bases, computer hardware and soft-ware limitations, and systems evaluations.

A European MEDLINE Workshop was held inParis in June 1979 which was attended by MissMary E.Corning, Assistant Director for Interna-tional Programs; Dr. Joseph Leiter, AssociateDirector for Library Operations; and Mrs. PeriSchuyler, Head of Unit A, Index Section. Dr.Leiter gave a review of technical developmentsand Mrs. Schuyler participated in the technicalworkshops and conducted an indexing course.Miss Corning, attending at the invitation of theDirector, Institut National de la Sante et de laRecherche Medicate (INSERM), describedNLM's international activities within thecontextof U.S. domestic mandates and responsibilities,and she represented NLM on policy matters.

The Workshop provided an excellent oppor-tunity for formal and informal discussion among

49


members of the European Centers and for themembers to meet with the NLM representatives.The Directors of the MEDLINE Centers hadspecial discussions, and there were workinggroups on training and user information needs,multifile searching, relationship between mainand associate centers, and searching problems.Special presentations described the status of,and planned developments in, networkdevelopment and telecommunications.

US/USSR Cooperationin BiomedicalInformation

Background

In 1976 during the course of a visit to theUSSR by an NLM Delegation consisting of theDirector, Martin M. Cummings, M.D., W.N.Hubbard, Jr., M.D., Mary E. Corning, and Dr.Vladimir Slamecka, a memorandum for futurecollaborative efforts was signed by Dr. Cum-mings and Dr. Hubbard for NLM, and by Dr.Lisitsyn for the USSR's All-Union ScientificResearch Institute for Medical and Medico-Technical Information (VNIIMI). Th ismemorandum recommended the establish-ment of a )oint Working Group to implementspecific projects and to consider futureprospects.

On March 5, 1979 NLM received a USSRDelegation on Biomedical Information led byAcademician A.S. Pavlov, Chairman of theMinistry of Health's Scientific Council and VicePresident of the Academy of Sciences, to dis-cuss implementation of the memorandum.

Joint Working Group Established

A Joint US/USSR Working Croup wasestablished in March 1979. The US/NLM sideconsists of Miss Corning, Chairman; Dr. Henry

M. Kissman, Associate Director, Specialized In-formation Services; Dr. Joseph Leiter, AssociateDirector, Library Operations; James W. Barry,Deputy Associate Director, Library Operations;and Dr. Clifford A. Bachrach, Head, MedicalSubject Headings Section, Library Operations.The Soviet side consists of Dr Yuri Lisitsyn,Director, VNIIMI, Chairman; Dr. N.A. Yakunin,Director, State Central Scientific Medical Library(SCSML); and Dr. Elena I. Dubinina, Chief,MEDINFORM Department, VNIIMI.

Participating in the discussions of the JointWorking Croup were Professor A.S.Pavlov; Dr.Cummings; and NLM Consultants W.N. Hub-bard, Jr., M.D., former Chairman of the NLMBoard of Regents; G. Burroughs Mider, M.D.,former NLM Deputy Director; and S. PaulEhrlich, Jr., M.D., former Assistant SurgeonGeneral of the U.S. Public Health Service.

Addendum Signed

As a result of a detailed examination of the1976 memorandum, the Joint Working Groupprepared an addendum to that document. Thisaddendum, signed by Dr. Cummings and Dr.Lisitsyn, represents a program for implementingthe original 1976 memorandum. The proposedcooperation includes projects for immediateimplementation in the exchange of biomedical

Dr Pavlov, Miss Corning, and Dr Hubbard at theMarch 1979 meeting on US/USSR cooperation inbiomedical communication

50

International Activities

literature, interlibrary loans, and exchange of ex-perts. Programs requiring better definition inorder to determine the feasibility of pilot pro-jects are: vocabulary development in publichealth and social hygiene, and information ex-change in toxicology and pharmacology.

Exchange of Biomedical Literature

Exchange of biomedical literature will be ex-ecuted on an equivalent basis and will take intoaccount differences in the subject scope ofNLM, VNIIMI, and SCSML and in materialswhich each has available for exchange pur-poses. Materials for exchange were identifiedand agreement was reached on procedures.James Barry is responsible for NLM aspects ofthe exchange of biomedical literature; theSoviet counterparts are N. D. Ponomareva,Branch Chief, SCSML, and C. A. Serova, Head ofa group of the MEDINFORM Branch, VNIIMI.

Interlibrary Loan Cooperation

The NLM and the SCSML agreed to transmitto each other requests for photocopies of arti-cles contained in journals in the collections ofthe counterpart institution. The transmission ofthese requests may be either by telex linkage be-tween the USSR Ministry of Health and the U.S.Department of Health, Education, and Welfareor by air mail. Agreement was reached on pro-cedures, forms, and copyright requirements.

Exchange of Personnel In HealthInformation

Under the leadership of NLM and VNIIMI,the exchange of U.S. and Soviet experts maytake any of three forms: (1) exchanges withinthe context of agreed-upon joint cooperativeprojects, (2) exper ts to engage inwork/study/training programs, and (3) in-dividual exchanges which will be decided on acase-by-case basis.

To move rapidly from these agreed-uponconcepts of exchanges to a specific cooperative

project, NLM proposed a work/study/trainingprogram of mutual benefit. Illustrative exampleswere discussed, such as a Soviet expertknowledgeable in the content of the medicalliterature and in Soviet medical terminologywho will work with NLM specialists in indexingand subject classification of Soviet literature. Inreturn, NLM will provide specialized training tothe Soviet individual in the management andadministration of modern medical library tech-nology. Such a project at NLM may be followedby a second similar project to be proposed byVNIIMI, in which a U.S. expert will engage in awork/study/training project in the USSR.

Vocabulary Development

The joint Working Group discussed a pilotproject in the vocabulary and nomenclature ofpublic health and social medicine. The con-cepts of "public health and social medicine"are different in the U.S. and the USSR. TheMedical Subject Headings and vocabulary usedby NLM have been reviewed by VNIIMI, butNLM experts have not had the benefit of know-ing VNIIMI's vocabulary and classifications ofpublic health and social medicine literature.VNIIMI will provide copies of their vocabularyand classification to NLM.

Each side will have an expert staff memberstudy the materials to determine whether, with-in the general area of public health and socialmedicine, a carefully circumscribed area can beselected for comparison of both concepts andterminology. A report and recommendation willbe submitted to the joint Working Group. Theappointed experts are Dr. Clifford A. Bachrach,Head, Medical Subject Headings, and E. I.Dubinina, Head of the MEDINFORM Branch,VNIIMI.

Pharmacology/ToxicologyInformation

The Joint Working Group examined the areaof pharmacology and toxicology. It recognizedthe scientific and social significance of these

51


fields but, after extensivediscussion, the Croupacknowledged that the specific development ofa pilot project needs further study, examination,and definition

As a beginning, each side will identify one ex-pert to exchange views and correspondence tolearn the responsibilities of each institution inthe area of pharmacology and toxicology infor-mation Based on this informal exchange ofviews, the two experts will submit a specificstatement to the joint Working Group forfurther examination in order to determine anyfuture course of action The designated expertsare Dr Henry Kissman, Associate Director,Specialized Information Services and A MNevzorova, Senior Researcher, VNIIMI

This Addendum to the 1976 Memorandumwill be presented to the next meeting of theJoint US/USSR Committee on Cooperation inPublic Health and Medical Sciences

The Soviets reviewed in detail the functionsand programs of the National Library ofMedicine, including its National MedicalAudiovisual Center in Atlanta In addition, theUSSR Delegation met with Dr Julius Richmond,HEW Assistant Secretary for Health, and DrDonald Frednckson, Director of the NationalInstitutes of Health The Delegation visited andwas briefed by the staff of several NIH institutes,the American College of Cardiology, the EmoryUnivers i ty School of Medicine, theSoutheastern Regional Medical Library Program,the National Technical Information Service, andthe Library of Congress

United States/People'sRepublic of ChinaCooperation

During FY1979 there has been an increase incooperative efforts between NLM and the Peo-

ple's Republic of China A few weeks before theannouncement by President Carter of theestablishment of diplomatic relations betweenthe United States and the People's Republic ofChina, NLM Director Dr Martin M Cummmgstraveled to China as part of a delegation of theAmerican Association for the Advancement ofScience The trip consisted of a three-week tourof scientific and medical institutions in Peking,Shanghai, Canton, and other parts of ChinaNLM Board of Regents member Dr Eloise Clarkwas also a member of the delegation The AAASarranged a return visit from the Scientific andTechnical Associationof the People's Republicof China (STAPRC) to the United States Adelegation led by Pei Lisheng, Vice Chairman,STAPRC, was received by NLM in May 1979

With the resumption of a number of Chinesepublications, there has been an increase in theexchange of publications between NLM andthe Chinese Medical Association and ChineseAcademy of Medical Sciences NLM nowreceives 17 Chinese journals regularly in returnfor which the Library sends NLM publications

As a result of Dr Cummmgs' visit, a quid-pro-quo arrangement was agreed upon withProfessor Huang Chia-ssu, President of theChinese Academy of Medical Sciences NLMhas agreed to receive three individuals who willperform specialized cataloging of Chinesematerial in the NLM collection in return forwhich they will receive NLM training in modernmedical technology On June 22,1979 a formalUnited States-People's Republic of China Pro-tocol on Cooperation in the Science andTechnology of Medicine and Public Health wassigned by Secretary of Health, Education, andWelfare Cahfano and Minister of Public HealthQian of the People's Republic of China Underthis agreement, medical information sciencewas identified as one of the areas for collabora-tion Dr Cummmgs was named the Coordina-tor for the United States and Professor Li Sigiao,Associate Professor, Institute of Information,Chinese Academy of Medical Sciences, for thePRC

52


Collaboration withWHO/PAHO

Recognizing that biomedical and health in-formation is essential in the fostering of researchand training, Dr Sune Bergstrom, Chairman ofthe WHO Global Advisory Committee on Medi-cal Research suggested that the National Libraryof Medicine might produce a specializedbibliography on tropical diseases from its com-puterized storage and retrieval system,MEDLINE As a result, the NLM and WHO arenow collaborating on such a quarterlybibliography

The Quarterly Bibliography of Ma/or Tropi-cal Diseases is a cooperative undertaking ofNLM and the Special Program for Research andTraining in Tropical Diseases sponsored by theUnited Nations Development Program, theWorld Bank, and the World Health Organiza-tion The Special Program for Research andTraining in Tropical Diseases is a concertedeffort to control six major tropical diseasesfilanasis, leishmaniasis, leprosy, malaria,schistosomiasis, and trypanosomiasis ThisSpecial Program includes research and develop-ment for preventive, diagnostic, therapeutic,and vector control methods as well as thestrengthening of research capability within thedeveloping countries

The new quarterly bibliography preparedthrough NLM's MEDLINE system covers thesesix major tropical diseases, it is distributed byWHO to scientists and institutions in tropicalcountries The first pilot issue (Vol 1,No 1,4thquarter 1978) was produced by NLM, printedwith funds from the Medical InformationCenter (MIC) of the Karolmska Institute!, anddistributed by the WHO Tropical DiseaseProgram Issues for 1979 (beginning with Vol 2,No 1, January-March 1979) are being pro-duced and printed by NLM for distribution byWHO in Geneva, Switzerland This is an experi-mental arrangement which will be continuedduring 1980 while WHO assesses the usefulness

of the bibliography in order to determine afuture course of action

The WHO Advisory Committee on MedicalResearch Subcommittee on Information, whichis chaired by Professor Bergstrom, met inWashington, DC September 11-13, 1979Members of the Committee are Dr Cummmgs,Professor B O Osuntokun, Dean, Faculty ofMedicine, University of Ibadan, Nigeria, Dr A SPavlov, Vice-President, Academy of MedicalSciences of the USSR, Mr M A P Sendahira,University of Sri Lanka, Dr Abraam Sonis,Director, PAHO Regional Library of Medicine,Sao Paulo, Brazil, and Mrs Tsu Ping Woodhull,University of Malaysia The NLM hosted thegroup for one day during its meetings

In September 1979 a Memorandum of Un-derstanding was signed between NLM andWHO for the provision of MEDLARS computersearches and mterlibrary loans (photocopies ofjournal articles) for the 84 developing countriesin the WHO Regions of Africa, Southeast Asia,Eastern Mediterranean, and the Western PacificThis is an experimental one-year arrangement inan effort to develop a mechanism to respond tothe needs of the developing countries Underthis arrangement, WHO will pay the equivalentof one and one half people who will be in resi-dence at NLM to provide 1,400 MEDLINEsearches and 2,500 mterlibrary loans for oneyear beginning October 1, 1979 This is amodest number of services compared to thetotal needs of the developing countries Thisyear of experience will provide useful data todetermine future activities

The NLM has continued to provide technicalexpertise and service support to PAHO'sRegional Library of Medicine (BIREME) as wellas receive BIREME staff for specialized trainingAs a member of the Scientific Advisory Commit-tee for BIREME, Miss Corning attended the ele-venth meeting of this group in Sao Paulo in May1979 This Committee provides policy guidanceto the Director of PAHO on the organizationand functions of BIREME and its role as a


regional health information resource for SouthAmerica. The Committee studied BIREME's func-tions and activities in 1978, including interlibraryloans, bibliographic searches and publications;reviewed BIREME's budget and problems; andexamined the relationship of resources to needs.

Special ForeignCurrency Prog ram

The oldest of the Library's extramural ac-tivities, the Special Foreign Currency Program,supports the preparation and publication ofbiomedical studies in seven cooperating coun-tries: Poland, Yugoslavia, Israel, Egypt, Tunisia,India, and Pakistan. Initial authorization for theprogram derives from Public Law 83-480, asamended. The program is also currently fundedthrough collaborative, bilateral agreements inIsrael and Poland.

Ancillary to NLM's domestic PublicationGrant Program (see Chapter 7), the Public Law480 Program enables the Library to draw uponforeign scientific personnel and resources inobtaining and disseminating information impor-tant to U.S. health educators, practitioners, andresearchers. Among the P.L. 480 projects cur-rently funded are critical reviews andmonographs analyzing medical practice andresearch; the translation of foreign monographsin the health sciences;the publication of majorinternational symposia and conference pro-ceedings; the preparation of bibliographies,atlases and other secondary literature tools; andstudies in the history of medicine.

The projects are multiyear, and during FY1979 there were 108 active projects, totaling$1,648,439 equivalent in foreign currencies.Almost 60 percent of the program is currentlycarried out in Poland and Israel, about 20 per-cent in Yugoslavia, and some 15 percent inEgypt. New critical reviews and monographs inhealth fields constitute almost 65 percent of theprojects, with English translations of foreign-

language books representing another 20 per-cent

Among the new P.L. 480 projects activated inFY 1979 were a critical review of internationalmedical experience with prostaglandins andmyocardial infarction, carried out by two dis-tinguished Polish scientists at the MedicalAcademy of Krakow, Poland; a critical reviewby an Israeli investigator at Hadassah MedicalSchool in Jerusalem,on "Suppressor Cells: Per-mitters and Promoters of Malignancy"; and ahistorical study, by a senior Egyptian scholar, ofthe structure of the medical profession in an-cient Egypt.

Among the studies published under thisprogram in FY 1979 was a major review on the"Pathophysiology of Blood Disorders: Red CellDisorders I," written by Drs. Chaim Hershkoand Gabriel Izak and published in the IsraelJournal of Medical Sciences, Vol. 14 (Novem-ber, 1978), pp. 1101-1201. A summary of Rus-sian research on lung cancer, translated inPakistan and published in Yugoslavia under theLibrary's P.L 480 program, also appeared in FY1979: B.D. Peterson, ed., Cancer of the Lung(published by the NOLIT Publishing Co.,Belgrade, and distributed by the P.S.G. Publish-ing Company, Littleton, Massachusetts, 1979).From Poland, a monumental three-volumestudy by Drs. T. Korzybski, Z. Kowszyk-Gin-difer, and W. Kurylowicz on Antibiotics:Origin, Nature and Properties reachedpublication this year (Washington, D.C.,American Society for Microbiology, 1978). (For

Three recent publications resulting from the NLMSpecial Foreign Currency Program (P L 480)

54


a complete listing of books and journal articlesresulting from the NLM P.L 480 Programreceived in FY 1979, see Appendix 3.)

Visitors and SpecializedTraining

NLM receives about 1,000 international visi-tors annually. During FY 1979 these individualsrepresented 68 countries and many interestssuch as medical research and education, healthcare, information and library science, ad-ministration and development of biomedicaland health information programs, and con-struction of new library buildings. Meetingshave been held with visitors representing theMinistry of Health from 17 different countries.

Formal delegations from the PRC includedgroups from the Scientific and TechnicalAssociation of the People's Republic of China,the Chinese Academyof Sciences, the ChineseMedical Association, a delegation in connec-tion with a medical center project in Peking,and a study mission in quarantine and sur-veillance of communicable diseases. Japanesedelegations included study groups on medi-cal/health information systems in the UnitedStates, on the practical use and management ofdata bases, and from the Japanese GovernmentMinistry of Health and Welfare. Other delega-tions were from Brazil, Italy, and Poland.Partici-pants from around the world attending a Pan

American Health Organization seminar on con-tinuing education visited NLM, as did a groupof reference librarians sponsored by the Inter-national Communications Agency and severalinformation systems workshops sponsored bythe National Technical Information Service.

In connection with NLM's bilateral MED-LARS agreement, NLM has received AnthonyCheung of the Canada Institute for Scientificand Technical Information and Steve Rossouwof the Institute for Medical Literature, SouthAfrican Medical Research Council for advancedMEDLINE training. Based on requests from theWHO, training in management and specialoperations was provided to George Guirguis,Regional Office Librarian, World HealthOrganization, Alexandria, Egypt; Mrs. S.L. Chin-nappa, Documentation Office, Institute forResearch in Reproduction, Indian Council ofMedical Research, Bombay, India; Dr. Cecile W.Istasi, Director, National DocumentationCenter, Khartoum, Sudan; Dr. Aron Nowinski,Coordinator, and Kenneth Collins, staff mem-ber from the PAHO Regional Library ofMedicine, Sao Paulo, Brazil; Dr. H.M.K. Saxena,Deputy Director, Indian Registry of Pathology,New Delhi, India; and Dr. Carlos Sanguinetti,National Medical Library of Uruguay.

These arrangements are made when an in-dividual has national or international sponsor-ship. The training at NLM is usually part of abroader study/training program undertaken bythe individual.

55

Appendix 1: Staff BibliographyThe following works were published by National Library of Medicine staff in FY 1979:

Bernstein, L.M., Siegel, E.R., and Ford, W.H.: The hepatitis knowledge base prototype. InProceedingsof the Second Annual Symposium on Computer Application in Medicine. New York, In-stitute of Electrical and Electronics Engineers, 1978, pp. 366-367.

Blake, J.B.:History of Medicine Division, National Library of Medicine. The Watermark 2 (4): 1-2,April 1979.

: A Short Title Catalogueof Eighteenth Century Printed Books in the National Library ofMedicine. Washington, D.C., U.S. Government Printing Office, 1979, 501 pp.

Brand, J.L.: The historian and the psychiatrist:shared understandings. In Riese, H. (Ed.): Historical Ex-plorations in Medicine and Psychiatry. New York, Springer Publishing Co., 1978, pp. 4-13.

Bridgman, C.F. and Suter, E.F.:Searching AVLINE for curriculum related audiovisual instructionalmaterials, lournal of Medical Education 54 (3): 236-7,1979.

Cassedy, J.H.: Medical world of madness, morality, and number. Reviews in American History 7:219-223, June 1979.

Corning, M.E. and Cummings, MM: International aspects of U.S. biomedical communications. InChacko, O.K. (Ed.): Health Handbook. New York, North-Holland Publishing Company, 1979,pp. 643-653.

Cummings, MM: Control of Federal publications. Science 205: 285, July 20,1979.: Information transfer: the biomedical model. Science 202: 1247, December 22,1978.: The National Library of Medicine and quality information filters. In Coping With the

Biomedical Literature Explosion: A Qualitative Approach. New York, The Rockefeller Founda-tion, 1978, pp. 61-67.

Doszkocs, T.E.: AID, an associative interactive dictionary for online searching. Online Review2:163-73, 1978.

: Natural language searching in large retrieval systems. In Piternick, A.B. (Comp.): Col-lected Papers, American Society for Information Science,8th Mid-Year Meeting, May 76-79,7979: North American Networking. Banff, Alberta, Canada, 1979.

Dougherty, W.S.: Making it move. Audio-visual Communications, pp. 36-38, May 1979.Flint, C: The Six Basic Needs of Education vs. Public Law 94-553 (Copyright Act of 1976). Atlanta,

Georgia: National Medical Audiovisual Center, 1979, 37 p.Ford, W.H. and Johnson, K.N.: Microprocessor implementation for full text data basewith graphics. In

Zimmerman, P.J. (Ed.): Proceedings of the 1978 MUMPS Users Croup Meeting, September1978. Bedford, Mass., MUMPS Users Group, 1978, pp. 42-58.

Goldstein, CM. and Ford, W.H.: Computer-based educational technology program at the Lister HillNational Center for Biomedical Communications. In Computer-Based Education: Mission ofthe Future. Proceedings of the Association for the Development of Computer-Based Cduca-tional Systems, Vol. 1,1979, pp. 291-309.

Hand, J.D.: Educational Cognitive Style for Health Science Students. Atlanta, Georgia: NationalMedical Audiovisual Center, 1978, 236 p.

Hanke, M.K. and Benzer, M.J. Training at the postgraduate level for medical librarians: a review.Bu//et/n of the Medical Library Association 67 (1): 42-46,1979.

Hoag, W.G., Gluckstein, F.P., Doszkocs, T. Development of an Online Computerized LaboratoryAnimal Data Bank. (Abstract No. 16) 29th Annual Session, September 24-29,1978. New York,American Association of Laboratory Animal Science, 1978.

Humphreys, B.L: National Periodicals System. Medical Library Association News 112: 6-7, March1979.

Kerpelman, LC: Evaluation of the National Medical Audiovisual Center Distribution Program.Atlanta, Georgia: National Medical Audiovisual Center, 1978,178 p.

Kissman, H.M.: Operation of adata bank in biomedical science and correlation problems, 6th Interna-tional CODATA Conference, CODATA Bulletin 29: 34-40,1978.

56

Mehnert, R.B.: National Library of Medicine. The Bowker Annual of Library and Book Trade Infor-mation. New York, R.R. Bowker Co., 1979, pp. 72-76.

Prophet, D.M.: Echo suppression in video teleconferencing via the Communications TechnologySatellite. In Proceedings of the 31st Annual Conference on Engineering in Medicine andBiology. Atlanta, Georgia, Alliance for Engineering in Medicine and Biology, 1978, p. 283.

Rowberry, S.H., Sparks, S.M., and Kudrick, L.W.: AVLINE: a search resource for audiovisual instruc-tional materials, journal of Dental Education 43 (7): 323-326,1979.

Schoolman, H.M.: Audiovisual: some problems revisited. The Journal of Biocommunication 6 (2):2-4, July 1979.

: Retrieving information on clinical trial methodology. Clinical Pharmacology andTherapeutics 25 (5, pt.2): 758-760,1979.

Siegel, E.R.: Information transfer for health practitioners: an innovative approach. In Proceedings ofthe American Society for Information Science, 41st Annual Meeting, Vol. 15. New York,Knowledge Industry Publications, Inc., 1978, pp. 306-307.

Smith, K.: National Library of Medicine. In The ALA Yearbook. Chicago, American Library Associa-tion, 1979, pp. 184-185.

Spann, M.L, Hummel, D.J., Schultheisz, R.J., Valley, S.L, and Walker, D.F.: CHEMLINE:a chemicalstructure search key to biological information. In Howe, W.J. et al. (Eds.): Retrieval of MedicinalChemical Information, ACS Symposium Series No. 84. Washington, D.C., American ChemicalSociety, 1978, pp. 58-72.

McPheeters, V.W.: Viewpoint: videotape or film? Journal of Audiovisual Media in Medicine 1:174-175,1978.

Small, P.A., Johnson, S.M., and Ullmer, E.J.: The Patient-Oriented Problem-Solving System in Im-munology. Atlanta, Georgia: National Medical Audiovisual Center, 1978,14 p.

Sparks, S.M., and Hayman, J.L.: Word Games for Health Professionals. Vol. 2. New York, Americanjournal of Nursing Co., 1979, 75 p.

Sparks, S.M and Kudrick, L.W.: An audiovisual Information retrieval System: AVLINE./ourna/o/Nurs-ing Education 18 (7): 47-55, September 1979.

Yep, S., Thoma, G.R., and Suthasinekul, S.: Digital transmission over an FM-FDM/FM satellite audiochannel. National Telecommunications Conference Record 3: 48.3.1-48.3.5,1978.

57

Appendix 2: Grant-Supported PublicationsAlexander, John T. "Medical Developments in Petrine Russia," Canadian-American Slavic Studies,

Vol. 8, No. 2, Summer 1974, pp. 198-221."Communicable Disease, Anti-epidemic Policies and the Role of Medical Professionals in

Russia, 1725-62," Canadian-American Slavic Studies, Vol. 12, No. 1, Spring 1978, pp. 154-69."Medical Professionals and Public Health in 'Doldrums' Russia (1725-62)," Canadian-

American Slavic Studies, Vol. 12, No. 1, Spring 1978, pp. 116-35.Benford, Robert J. The Heritage of Aviation Medicine. Washington, D.C. Aerospace Medical

Association, 1979,122 pp.Blair, Margaret Berry and Howard, R. Palmer. "Scalpel in a Saddlebag: The Story of a Physician in In-

dian Territory," Virgil Berry,M.D. journal of the Oklahoma State Medical Association, Vol. 71,October 1978, pp. 387-398; November 1978, pp. 427-433; December 1978, pp. 460-467; Vol.72, January 1979, pp. 15-20.

Breeden, James O. "In the Beginning(s)? A Chapter in Antebellum American Ethnology," Translations& Studies of the College of Physicians of Philadelphia, Vol. XL, April 1978.

Debus, Allen C. "Chemistry, Pharmacy and Cosmology A Renaissance Union," Pharmacy in History,Vol. 20, No. 4, 1978, pp. 127-137.

Science vs. Pseudo-Science: The Persistent Debate. Chicago, Illinois: Morris FishbeinCenter for the Study of the History of Science and Medicine, Publication No. 1,1979,18 pp.

Doetsch, Raymond N. "Benjamin Marten and His 'New Theory of Consumptions/" MicrobiologicalReviews, September 1978, p. 521-528.

Forbes, Thomas R. "Coroners' Inquisitions on the Deaths of Prisoners in the Hulks at Portsmouth,England, in 1817-27," journal of the History of Medicine and Allied Sciences, Vol.XXXIII,Number 3, July 1978, pp. 356-366.

"An Early Record of a Freemartin," journal of the History of Medicine and Allied Sciences,Vol. XXXIV, No. 3, July 1979, pp. 355-356.

Forbes, Thomas R. and Venes, John L. "The Case of the Quarrelsome Watchmen," Transactions &Studies of the College of Physicians of Philadelphia, Vol. 1, No. 1, March 1979, pp. 58-61.

Frank, Robert C., and Coetzl, Judith H. "The J.H.B. Archive Report The Alexander Forbes Papers,"lournal of the History of Biology, Vol. 11, No. 2, Fall 1978, pp. 387-393.

Celfand, Toby. "A Clinical Ideal: Paris 1789," Bulletin of the History of Medicine, Vol. 51,1977, pp.397-411.

"Medical Professionals and Charlatans. The Comite de Salubrite enquete of 1790-91,"Histoire soc/a/e—Social History, Vol. XI, No. 21, March-May 1978, pp. 62-97.

Hamburg, Joseph, (ed.). Review of Allied Health Education: 3. Lexington, Kentucky: The UniversityPress of Kentucky, 1979. 161 pp.

Hannaway, Caroline C. "Veterinary Medicine and Rural Health Care in Pre-Revolutionary France,"flu//et/n of the History of Medicine, Vol. 51,1977, pp. 431-447.

Hannaway, Owen and Hannaway, Caroline. "La Fermeture Du Cimetiere Des Innocents," Dix-huitieme siecle, Vol. 9,1977, pp. 181-191.

Harbach, Ralph E. and Knight, Kenneth L. "A Mosquito Taxonomic Glossary XVI. Vestitute," Mos-quito Systematics,Vol. 10, No. 4,1979, pp. 540-564.

Hoogstraal, Harry. "The Epidemiology of Tick-Borne Crimean-Congo Hemorrhagic Fever in Asia,Europe, and Africa," lournal of Medical Entomology, Vol. 15-, No. 4, May 22, 1979, pp.307-417.

Jarcho, Saul. "The 'Epidemia Rheumatica' Described by Lancisi (1711)," In: Healing and History:Essays for George Rosen; Edited by C.E. Rosenberg. New York: Science History Publications,1979, pp. 51-58.

Jones, Russell M. The Parisian Education of an American Surgeon: Letters of Jonathan Mason

58

Warren (1832-1835) With Notes and Introduction by Russell M. Jones Philadelphia, Pa.: TheAmerican Philosophical Society, 1978. 266 pp.

Kohler, Robert E. "The Management of Science. The Experience of Warren Weaver and theRockefeller Foundation Programme in Molecular Biology," MINERVA, Vol XIV, No. 3, Autumn1976, pp. 279-306.

"Walter Fletcher, F.G. Hopkins, and the Dunn Institute of Biochemistry A Case Study in thePatronage of Science," ISIS, Vol 69, No 248, 1978, pp 331-335

La Berge, Ann F."A Restoration Prefect and Public Health Alban De Villeneuve-Bargemont at Nantesand Lille, 1824-1830," Proceedings of the Western Society for French History, Vol V, 1977,pp 128-137

"A.J.B Parent-Duchatelet Hygiemst of Paris, 1921-1936," Clio Medica, Vol. 12, No. 4,1977,pp. 279-301

Morantz, Regina M. "Making Women Modern. Middle Class Women and Health Reform in 19th Cen-tury America," journal of Social History, Vol. 10, No. 4, June 1977 pp. 103-120

"Nineteenth Century Health Reform and Women A Program of Self-Help" in MedicineWithout Doctors, Edited by Guenter B. Risse, Ronald L. Numbers, Judith W Leavitt, New York.Science History Publications, 1977, pp. 73-93.. "The 'Connecting Link' The Case for the Woman Doctor in Nineteenth Century America," in

Sickness and Health in America, Edited by Judith W. Leavitt and Ronald L Numbers Madison,Wisconsin. The University of Wisconsin Press, 1978, pp 117-128

O'Neill, Ynez Viole, and Chan, Gerald L "An Anatomical Mystery with Global Dimensions," Proceed-ings of the 25th International Congress for the History of Medicine, Quebec, 1976, pp1031-1044.

Patterson, K David "River Blindness in Northern Ghana, 1900-50," In Disease in African History AnIntroductory Survey and Case Studies, edited by Gerald W Hartwig and K David Patterson.Durham, N.C. Duke University Press, 1978, pp. 88-117.

Quen, Jacques M. "Isaac Ray 'The Greatest Amount of Good with the Smallest Amount of Harm ' "in: Healing and History: Essays for George Rosen, Edited by C.E Rosenberg, New York ScienceHistory Publications, 1979, pp 149-159

Rather, L.J The Genesis of Cancer, A Study in the History of Ideas Baltimore, Md The JohnsHopkins University Press, 1978 262 pp

Rosenberg, Charles E "The Origins of the American Hospital System," Bulletin of the New YorkAcademy of Medicine, Vol 55, No 1, January 1979, pp 10-21

Ryckman, Raymond E and Casdin, Margaret A "The Triatommae of Western North America, AChecklist and Bibliography," California Vector News, Vol 23, Nos 9/10, September/October,1976, pp 35-52

"The Polyctenidae of the World, A Checklist with Bibliography," California Vector News,Vol 24, Nos 7/8, Jul//August 1977, pp 25-31

Savitt, Todd L Medicine and Slavery. The Diseases and Health Care of Blacks in AntebellumVirginia. Urbana, Illinois University of Illinois Press, 1978, 332 pp

Sheridan, Richard B "The Role of the Scots in the Economy and Society of the West Indies In Com-parative Perspectives on Slavery in New World Plantation Societies," edited by Vera Rubin andArthur Tuden Annals of the New York Academy of Sciences, Vol 292, N Y The New YorkAcademy of Sciences, 1977, pp. 94-106.

"The West Indian Antecedents of Josiah Martin, Last Royal Governor of North Carolina, TheNorth Carolina Historical Review, Vol. LIV, No. 3, July 1977, pp 253-270

Wangensteen, Owen H , and Wangensteen, Sarah D. The Rise of Surgery. From Empiric Craft toScientific Discipline Minneapolis' University of Minnesota Press, 1978 785 pp

59

Temporary Support Provided to Periodical Publications

IRB: A Review of Human Subjects Research. Hastings-on-Hudson, N.Y.: The Hastings Center, In-stitute of Society, Ethics and the Life Sciences (10 times a year). Vol. 1, No. 1, March 1979 andfollowing.

"Literature References to Mosquitoes and Mosquito-borne Diseases," Comp. Helen Sollers-Reidel.Selma, California: Mosquito News, Vol. 38, No. 3, September 1978, pp. 429-448.

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Appendix 3: P.L-480 Supported PublicationsBecker, Yechiel. "The Chlamydia: Molecular Biology of Procaryotic Obligate Parasites of Eucaryoctes,"

Microbiological Reviews, June 1978, p. 274-306.Hausmanowa-Petrusewicz, Irena. Spinal Muscular Atrophy: Infantile and luvenile Type.

Springfield, Virginia: U.S. Dept. of Commerce, National Technical Information Service,1978,180PP-

Hershko, Chainp and Izak, Gabriel. "Pathophysiology of Blood Disorders; RedCell Disorders I," Israellournal of Medical Sciences, Vol. 14, No. 11, November 1978, pp. 1101-1201.

Johnston, Donald E.(comp.) Acarologlsts of the World. A Directory. Columbus, Ohio: The OhioState University, 1979,153 pp.

Kethley, John (ed.). An Index to the Acarina Collections of the World (To the Family Level). Cairo,Egypt: U.S. Naval Medical Research Unit Number Three, January 1979, 87 pp.

Kim, Charles W. and Pawlowski, Zbigniew S. (eds.). Trichinellosis: Proceedings of the Fourth Inter-national Conference on Trichinellosis: August 26-28, 1976 Poznan, Poland. Hanover, NewHampshire: University Press of New England, 1978. 571 pp.

Korzybski, Tadeusz, Kowszyk-Gindifer, Zuzanna, and Kurylowicz, Wlodzimierz. Antibiotics: Origin,Nature, and Properties. Vols. I, II, III. Washington, D.C.: American Society for Microbiology,1978,2270pp.

Kosowicz, Jerzy. Atlas of Endocrine Diseases. Bowie, Maryland: The Charles Press Publishers, Inc.1978, 364 pp.

Modan, Baruch. "Population Distribution of Histological Types of Lung Cancer," Israel lournal ofMedical Sciences, Vol. 14, No. 7, July 1978, pp. 771-784.

Peterson, B.E. Cancer of the Lung. Littleton, Mass.: PSC Publishing Co., Inc. 1979, 259 pp.Razin, Shmuel, "The Mycoplasmas," Microbiological Reviews, Vol. 42, No. 2, June 1978, pp.

414-470.Schaefer, Ernst J., Eisenberg, Shlomo, and Levy, Robert I. "Lipoprotein Apoprotein Metabolism," The

lournal of Lipid Research, Vol. 19, No. 6, August 1978, pp. 667-687.Sherf, Libi, and Neufeld, Henry N. The Pre-Excitation Syndrome: Facts and Theories. N.Y.: Yorke

Medical Books, 1978, 269 pp.

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Appendix 4: NMAC Audiovisual MaterialsProduced

Motion PicturesRecognition of Signs and Symptoms in Life-Threatening Emergencies series

Hemorrhage—Professional VersionHemorrhage—Non-Professional VersionCardiovascular Signs—Professional VersionCardiovascular Signs—Non-Professional Version

Family Oriented Maternity Care by the Nurse Clinician seriesPost Partum

Beyond Compliance—A Film on Patient Education for the Primary Care ResidentMedical Legal Aspects of Amniocentesis for Prenatal DiagnosisAmniocentesisZiehl-Neelsen Staining ProcedureFluorescent Acid-Fast StainingPrimary Isolation of Mycobacteria Using the N-Acetyl-L-Cysteine-NaOH MethodUse of the Pneumatic OtoscopeTrichrome Stain for Fecal Specimens

TV ProductionsLeaders in American Medicine series

James V. Warren, M.D.H. W. Magoun, Ph.D.William P. Longmire, Jr., M.D.Irving H. Page, M.D.Abraham White, Ph.D., D.Sc.Dorothy M. Horstmann, M.D.Alexander D. Langmuir, M.D., M.P.H.Dorothy Smith, R.N.

Distinguished Leaders in Nursing seriesColloquium Highlights—The Nature of Nursing, Is It Changing?Ruth Freeman, R.N., Ph.D.Virginia Henderson, R.N.

Animated Images from Still Projectors (NMAC Technical Report No. 3)Flame PhotometryTechnique for Making a Slide CultureBlood Gas Analysis: TonometrySingle Beam Spectrophotometer—Wavelength CalibrationNutrition and Total HealthFood Nutrition MisinformationCholesterol and Other Lipids in the DietNutrition and Preventive MedicineTechnique for Making a Lactophenol Cotton Blue PreparationWorkers in Tropical Medicine (3)Auxanographic Methods in Yeast IdentificationMajor Medical Syndromes series (5)

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Slide/Tape SetsIntestinal Function and Diarrhea series

Classification and Abnormal Physiology of DiarrheaMalabsorption and DiarrheaIntestinal Fluid Secretion—Secretory DiarrheaOsmotic Diarrhea and Carbohydrate IntoleranceNonspecific DiarrheaSpecial Features of Infectious Diarrhea in InfantsDiagnostic Approach to Chronic Diarrhea (The Initial Encounter)Diagnostic Approach to Chronic Diarrhea (Further Diagnostic Steps)Pharmacology of the Symptomatic Treatment of Diarrhea

Rural Health seriesBeef CattleZoonosesSwine ZoonosesSheep ZoonosesPoultry ZoonosesZoonoses of Agricultural EnvironmentZoonotic Diseases: An OverviewIntroduction to Agricultural TraumasAgricultural Traumas: Traumas to the HeadAgricultural Traumas: Traumas to the Trunk and ExtremitiesAgricultural RespiratoryProblemsToxicology of Cholinesterase—Inhibiting InsecticidesToxicology of Commonly Used HerbicidesToxicology of Fungicides, Rodenticides, and FumigantsDairy ZoonosesPesticide Poisonings and Injuries: Where, When, and How

Cell Biology Study ProgramIntroduction to Cell MembranesIntroduction to Membrane ChemistryMembrane LipidsMembrane ProteinsMembrane CarbohydratesMembrane ReceptorsIntercellular Junctions

Cross Anatomy seriesBones of the Head and Neck—Part IBones of the Head and Neck—Part IISurvey of the Cranial NervesThe Meninges and Dural Sinuses

The Suboccipital RegionForamina of the SkullThe Thoracic Wall—Part 1The Thoracic Wall—Part 2

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The Thoracic Wall—Part 3The Thoracic Wall—Part 4The Breast

Human Physiology seriesAcid-Base ImbalanceTemperature ControlPulmonary Function: Mechanics and VentilationExchange of Respiratory CasesChemical Control of RespirationPhysiology of VisionRegulation of Body Water and ElectrolytesThe Physiological Properties of BloodEnergy Flow Within the CellCoronary Circulation and Cardiac Metabolism

Learning Resources Centers: Past, Present, and FuturePuerperium EvaluationRecognition of Signs and Symptoms in Life-Threatening Emergencies series

Surface Phenomena—Professional VersionSurface Phenomena—Non-Professional VersionHemorrhage—Professional VersionHemorrhage—Non-Professional Version

Development of a aide/Tape Instructional Presentation

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