NLM Annual Report of Programs and Services, 1977

NATIONALLIBRARY

ofMEDICINE

PROGRAMSand

SERVICESFISCAL YEAR 1977

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health ServiceNational Institutes of Health

Bethesda, MarylandDHEW Publication No. (NIH) 78-256

Z National Library of Medicine.675.M4 Program* and services.U56an -- 1971/72-

-- Bethesda, Md.v. illus., port!. —(DHEW publication no. (NIH) 73-256,

•tc.)Continue tht Library's Annual report.

Report for 1974/75 called Coonunlcatlon In the service ofAmerican health; a bicentennial report from the NationalLibrary of Medicine.

I. National Library of Medicine. Communication In theservice of American health. II. Title III. Title:Communication In the aervlce of American health; abicentennial report from the National Library of MedicineIV. Series

PrefaceThe past year has been characterized by continued increases in requests for library and

information service. We are fulfilling these demands by a steady improvement in our per-formance aided by new technological applications.

MEDLARS On-Line (MEDLINE) service was introduced to the health community by NLMlate in 1971. MEDLINE was followed rapidly by computerized on-line data bases for toxicologyinformation, cataloging, serials, audiovisuals, cancer information, and others. The acceptanceof this mode of search and retrieval as a tool for researchers, practitioners, and educators isreflected in the remarkable growth in usage of the system. In Fiscal Year 1977, almost 900,000on-line and off-line searches were done at the 800 institutions in the U.S. that belong to theNLM network. This represents an increase of about 50 percent over last year.

Impressive gains in productivity were achieved in several areas of reference services.Reference inquiries were up 33 percent in FY 1977 and 13 percent more users were registeredin our Reading Room. These patrons requested more material from the stacks than everbefore and it is remarkable that the fulfillment rate actually increased. Similarly, the fulfillmentrate for interlibrary loans edged upward despite an increase of six percent in the number ofrequests received. It is a tribute to the people performing these tasks that the gains havebeen accomplished with no increase in number of staff.

Another area of success described in this report is in the automation of technical services.New computerized procedures have eliminated backlogs in acquisitions processing, speededup binding, and improved our ability to identify and quickly fill gaps in the serial collection.

Health practitioners will be interested in the description of the Lister Hill Center projectto improve the dissemination of research information (Chapter 6). The prototype of a com-prehensive bank of authoritative and up-to-date information for the practicing health pro-fessional is now being successfully demonstrated. Although unconventional in terms of NLM'straditional involvement with biomedical literature, it holds intriguing promise for future healthinformation systems.

It gives me great pleasure to end this message by reporting that the construction of theLister Hill Center building is well under way. When the dust settles, early in 1980, we willhave a remarkable new communications facility dedicated to applying the benefits of moderntechnology to the problems of health information transfer.

Martin M. Cummings, M.D.Director

Contents1. POLICY AND DIRECTION 1

Board of Regents 1Lister Hill Center building 1Copyright 2Financial resources 2Personnel 2

Staffing activities 4Awards and honors 5

Equal employment opportunity 6Exhibits 7

2. LIBRARY SERVICES AND OPERATIONS 8Medical Subject Headings 9Mid-Atlantic Regional Medical Library 10Bibliographic Services Division 10

Indexing 11Network services 11Training 12Publications 12

History of Medicine Division 13Acquisitions 13Public service 14

Reference Services Division 14Technical Services Division 15

3. COMPUTER AND COMMUNICATIONS SYSTEMS 22

4. SPECIALIZED INFORMATION SERVICES 24Query response 24Publications 24On-line retrieval services 25Collaborative activities 26

5. AUDIOVISUAL PROGRAMS 28Education research and evaluation 28Media development 29Distribution 29Workshops and conferences 30Advisory services 31

6. LISTER HILL CENTER 32Dissemination of research information 32Broadband biomedical communications 34Broadband telecommunications research 36Computer-based education materials 36Library automation 38

7. GRANTS FOR LIBRARY ASSISTANCE 39Regional Medical Libraries 39Resource project grants 40Resource improvement grants 41Research, development, and demonstration grants 42Training programs 42Special scientific projects 42Biomedical scientific publications 43

8. INTERNATIONAL ACTIVITIES 45International MEDLARS agreements 45International exchanges and services 46Special Foreign Currency Program 46Regional resources- and biomedical information 47Visitors and specialized training 47

APPENDIX 1. Staff bibliography 50

APPENDIX 2. Grant-supported publications 52

APPENDIX 3. P.L.-480 supported publications 55

APPENDIX 4. NMAC audiovisual materials produced 56

List of TablesTABLE 1. Financial resources and allocations 2

TABLE 2. Personnel ceilings 3

TABLE 3. RML IV statistics 10

TABLE 4. Bibliographic services 17

TABLE 5. On-line searches 17

TABLE 6. Off-line searches 18

TABLE 7. History of medicine activities 18

TABLE 8. Growth of collections 19

TABLE 9. Acquisitions statistics 19

TABLE 10. Cataloging statistics 20

TABLE 11. Circulation statistics 20

TABLE 12. Binding statistics 21

TABLE 13. Reference services 21

TABLE 14. Selected statistics, NMAC 31

TABLE 15. Extramural grant and contract programs 44

TABLE 16. International access to MEDLARS 49

TABLE.17. Data bases searched by non-U.S. centers 49

Chapter 1: Policy and DirectionKent A. Smith, Assistant Director for

Administration

Board ofRegentsThe NLM Board of Regents met in January

and May, 1977 and reviewed a wide varietyof topics and issues including the revisionof the NLM Scope and Coverage Manual,computerization of technical processing,procurement of the present IBM 370/158MEDLARS computers, Toxic Substances Con-trol Act, transfer of research results intopractice, Communications Technology Satel-lite, and the quality of NLM's research grantprogram.

Special presentations before the Boardwere made by William J. Welsh, DeputyLibrarian of Congress, who gave an illus-trated report on Library of Congress activi-ties, and by H. Calvin Meadows of the Na-tional Health Planning Information Center,who spoke on the development of thatorganization's programs.

On the subject of the Toxic SubstancesControl Act, the Regents passed a resolu-tion recommending to the Director of theNational Institutes of Health that the Librarynot handle proprietary toxicological infor-mation for regulatory agencies.

Another resolution concerning appoint-ments to the Board of Regents was sent tothe HEW Secretary on January 27, 1977,requesting that the Secretary do all in hispower to "expedite the Presidential nomi-nation of ten new members to the Board asrequired by law." By the end of the fiscalyear, the Regents had not been appointed

and the scheduled October 1977 Boardmeeting was cancelled. Review of grant ap-plications scheduled for October will bedeferred until a new Board is appointed.

Lister Hill Center BuildingA $13.6 million construction contract for

the Lister Hill Center building was awardedto the George Hyman Construction Com-pany on June 17,1977. The Center, which isexpected to be completed by the spring of1980, was designed by the architectural firmof J. Roy Carroll, Jr. and Partners.

The new building will house the commu-nications technology and network engineer-ing programs of the Lister Hill National Cen-ter for Biomedical Communications and theclosely related functions of the NationalMedical Audiovisual Center. Extramural Pro-grams, the Office of Computer and Com-munications Systems, the Toxicology Infor-mation Program and selected activities ofLibrary Operations will also move to thenew building.

In conjunction with this construction proj-ect, renovations to the existing building arealso planned. The purpose of the renova-tions is to return much of the present officespace and special purpose areas, such asthe computer room, to their originally in-tended library use. Extensive modificationsare also planned to bring the existing build-ing into compliance with the GSA fire code.

NLM Programs and Services

CopyrightCopyright legislation was passed by the

Congress on September 30, 1976. It wassigned into law (P.L. 94-76) on October 19,1976 by President Ford. This legislation up-dates the copyright law which had beenrelatively unchanged since its passage in1909. The revisions were urgently neededto deal with current copyright issues result-ing from photocopying, motion pictures,radio, television, and phonographic record-ings.

The law will have an impact on the inter-library loan activities of libraries since itregulates the reproduction of copyrightedmaterials. Guidelines and regulations forimplementing the Copyright Law will beestablished by the Register of Copyrights.Most provisions of the law will becomeeffective on January 1, 1978.

Financial ResourcesThe National Library of Medicine's FY

1978 appropriation request is for $36,746,-000. This appropriation, when enacted, willprovide for an increase of approximately$1,512,000 over the amount available to the

Library in FY 1977. The increase is to be usedprimarily to sustain and improve the effec-tiveness of NLM's traditional and on-lineservices through extension of these servicesto health care practitioners.

PersonnelThe Department of HEW conducted a

position management and classification re-view of the Library in May 1977. The reviewinvolved interviews with top managementofficials, supervisors, union officials, per-sonnel staff, and a group of employeeswhose positions had been selected forclassification review. A review was made ofthe Library's conformance to principles ofgood position management and to regula-tory requirements affecting position classi-fication. The results reported by the DHEWAudit Team were very satisfactory. The NLMPersonnel Office in FY 1977 was also deeplyinvolved in the DHEW Three Year Classifi-cation Review Program in which every posi-tion is reviewed through a comprehensivedesk audit.

The NLM program to hire the handicappedcontinued to expand in FY 1977. There were

Table 1. Financial Resources andAllocations(dollars inthousands)

Amounts Available for ObligationAppropriation, NLM

Earned ReimbursementsTotal

Amounts Obligated by Extramural ProgramsAmounts Obligated for Direct Operations

Lister Hill National Center for Biomedical CommunicationsNational Medical Audiovisual CenterOffice of Computer and Communications SystemsLibrary OperationsToxicology Information ProgramReview and Approval of GrantsProgram Direction

Subtotal, Direct Operations

FY 7977

$35,2342,530

37,764$ 8,354

$ 3,5314,4325,1317,7222,115

8374,936

$28,704

Total Obligations, NLM $37,058

Policy and Direction

Table 2. Personnel Ceilings

13

634

5834

Office of the DirectorOffice of Inquiries and Publications

ManagementOffice of AdministrationOffice of Computer and Communi-

cations SystemsExtramural ProgramsLister Hill National Center for Bio-

medical CommunicationsSpecialized Information Services . . .National Medical Audiovisual CenterLibrary Operations 188

TOTAL 467

12 handicapped persons employed at theLibrary during the year, an increase of fourover last year. The Personnel Office andprogram managers worked together to ex-pedite the integration of these employees

FY71 FY72 FY 73 FY 74 FY 75 FY 76 FY 7712

537

5531

12

636

5430

11

536

5127

534

5222

10

535

5424

12

535

5227

1317104188

1517105192

1716103192

2017100199

2217101196

2418101201

241788212

469 466 466 458 472 472

into the Library work force. During the year,a sign language course was conducted forsupervisors and coworkers of deaf em-ployees. The course was well received andadditional courses are planned.

Instructor Cynthia Saltzman (right) conducts a sign language class for NLM staff to prepare them to communicatewith deaf employees. Among the students are Linda Kudnck and Phillip Coleman Ms. Saltzman broadcasts the morn-ing news for the deaf on a Washington TV station.


Staffing ActivitiesKenneth M. Endicott, M.D. was appointed

Acting Director of the Lister Hill NationalCenter for Biomedical Communications. Hesucceeded Robert M. Bird, M.D., who diedon December 31, 1976. Dr. Endicott servedas Acting Director until June 30, 1977,whenhe retired from Federal service. During hislong and distinguished career as a scientistand medical administrator within the PublicHealth Service, Dr. Endicott served as theAdministrator of the Health Resources Ad-ministration.

Harold M. Schoolman, M.D. was ap-pointed Deputy Director for Research andEducation. In this capacity, Dr. Schoolmanis responsible for two major NLM compo-nents, the Lister Hill National Center forBiomedical Communications and the Na-tional Medical Audiovisual Center. Thesetwo divisions will be merged in Fiscal Year1980, after completion of the Lister HillCenter building. Dr. Schoolman was alsonamed Acting Director of the Lister HillCenter -pending the selection of a newDirector.

Lionel M. Bernstein, M.D., Ph.D., was ap-pointed Special Assistant to the Director ofthe Lister Hill Center and Acting Directorof the Center's new Health Professions Ap-plications Branch. Dr. Bernstein also servesas the Assistant Deputy Director for Researchand Education. Before accepting his positionwith the Library, Dr. Bernstein was SpecialAssistant to the Assistant Secretary forHealth, DHEW.

Davis B. McCarn was appointed to heada new office to direct planning activities ofthe Library. This office will establish andmaintain liaison with NIH and other Federalagencies, with scientific organizations, pro-fessional groups, and others in the privatesector, as well as with the senior staff of theLibrary. The purpose will be to promote theexchange of information and ideas whichwill benefit the NLM planning activity. Mr.McCarn was previously Deputy Director of

the Lister Hill Center, and since 1972 haddirected the Office of Computer andCom-munications Systems.

Myron J. Adams, Jr., M.D., was appointedDeputy Director of the Library's NationalMedical Audiovisual Center (NMAC) inAtlanta. Dr. Adams has been associated withNMAC since 1971and has served as a Medi-cal Advisor and most recently as Chief ofthe Materials Development Branch. On theretirement of George E. Mitchell, D.M.D.,as Director of NMAC on September 30,1977,Dr. Adams assumed the position of ActingDirector.

Erika B. Love, Deputy Associate Directorfor Library Operations, accepted a positionas Director of the Health Sciences Library,University of New Mexico (Albuquerque).Mrs. Love had served as Deputy AssociateDirector since 1972 as well as RegionalMedical Library Director for Region IV.Appointed to fill the position of DeputyAssociate Director for Library Operationswas James W. Barry. Immediately prior tocoming to NLM, Mr. Barry was Director ofthe Learning Resource Center/Library of thenew Uniformed Services University of theHealth Sciences. Mr. Barry has also servedas head librarian at the Medical Center ofthe University of Arizona, and previously atRutgers University. In 1968, Mr. Barry servedas a visiting librarian and consultant at theMahidol University in Bangkok, Thailand.

Stewart H, Rowberry, D.D.S., Ph.D. wasappointed Chief, Materials DevelopmentBranch, NMAC. Dr. Rowberry was formerlyAssistant Chief of the NMAC EducationalResearch and Evaluation Branch.

James J. Hartman, formerly with the Fed-eral Aviation Administration, was appointedthe Library's new Personnel Officer, suc-ceeding R. Brian Makoff, who accepted aposition with the Social Security Adminis-tration.

Bruno M. Vasta, formerly Chief of theToxicology Information Services Branch, Spe-


cialized Information Services, has been ap-pointed Chief, Bibliographic Services Divi-sion, Library Operations.

Awards and HonorsNLM Director Martin M. Cummings, M.D.,

was honored by the Medical Academy ofLodz, Poland, where he was awarded thetitle of doctor honoris causa. In presentingthe award, Professor Antoni Kotelko, rectorof the Academy, cited Dr. Cummings' contri-butions in organizing and applying moderntechnology for biomedical communications.

Dr. Cummings was elected President ofthe American Osier Society at a meeting ofthe Society held at the Mayo Clinic inRochester, Minnesota. The Society was or-ganized in 1970 for the purpose of bringingtogether members of the medical and alliedprofessions who are convinced of the im-portance of humanism in medicine as ex-emplified by the career of William Osier(1849-1919).

Dr. Cummings was also elected to theboard of directors of the American Associa-tion for the Advancement of Science. TheAAAS, founded in 1848, has nearly 300 affili-ated societies and more than 112,000 indi-vidual members. Dr. Cummings' term is forfour years beginning January 1, 1977.

Melvin S. Day, NLM's Deputy Director,was elected President of ICSU AB—theInternational Council of Scientific UnionsAbstracting Board—at a meeting of theBoard in York, England. The term of office isthree years. ICSU AB was established in1952 as an outgrowth of a joint UNESCOand International Council of ScientificUnions commission organized to study theproblem of abstracting the literature ofscience and technology.

Mary E. Corning, NLM Assistant Directorfor International Programs, was appointed aFederal Executive Fellow by the BrookingsInstitution. The six-month fellowship beganin January 1977 and enabled Miss Corning

to undertake a research study of inter-national cooperation in biomedicine. TheBrookings Institution, located in Washing-ton, D.C., is a private, nonprofit organiza-tion devoted to research, education, andpublication in matters of government, for-eign policy, and economics.

Eighth Annual Regents Award

Emilie V. Wiggins, Head of the CatalogingSection, received the 1977 Regents Awardin recognition of her efforts to make theNLM catalog file conform fully to the cur-rent Anglo-American rules, and for her mas-sive restructuring and modernization of theNLM Classification.

Emilie V Wiggins receives the 1977 Regents Award fromBoard of Regents Chairman Dr Joseph F Volker

NLM Director's Award

On May 6 and 7, 1976, the Library andthe Josiah Macy, Jr. Foundation sponsoreda "Colloquium on the Bicentennial of Medi-cine in the United States" at the NationalInstitutes of Health. Several hundred dis-tinguished physicians, scientists, and edu-cators gathered to discuss a series of topicsrelated to U.S. medicine. The Director'sAward honored three NLM employees fortheir participation in the Colloquium: MaryE. Corning, Dr. John B. Blake and Dr. PeterD. Olch. The three staff members each madea presentation at the Colloquium; in addi-tion, Miss Corning was colloquium coordi-nator, and Drs. Blake and Olch developed aspecial Bicentennial exhibit.


NMAC Film Wins Award

Right Heart Catheterization, an instruc-tional motion picture developed by theNational Medical Audiovisual Center, hasreceived the National Society for Perform-ance and Instruction's 1976-1977 Outstand-ing Research Effort award. The motion pic-ture, designed for students of basic cardio-vascular physiology, was developed by ateam of NMAC specialists: Morton J. Oppen-heimer, M.D., Margaret L. Brooke, andRichard W. Bell. The film was the outcomeof a research project designed to study theuse of a motion medium to teach higherlevel processes (in this case, determiningcatheter location from blood pressure read-ings shown on an oscilloscope).

NIH Director's AwardsErnest M. Allen, Sc.D., (Associate Director

for Extramural Programs): "for pioneeringefforts in biomedical research grant admin-istration and dedicated service in fosteringprograms of the NLM, NIH, and PHS."

Charles M. Goldstein (Chief, ComputerTechnology Branch, Lister Hill Center): "forleadership of a nationally recognized pro-gram to explore and develop innovativecomputer applications for libraries and com-puter-based education."

Lillian R. Kozuma (Assistant Head, Cata-loging Section, Technical Services Division):"for leadership provided in the develop-ment and implementation of an on-line database (CATLINE), which serves the Nation'smedical librarians."

NIH Merit AwardsKenneth C. Carney (Program Analysis

Officer, Office of Program Analysis andLegislation): "in recognition of significantcontributions to the administrativemanage-ment of NLM and innovative developmentof a program analysis and legislation func-tion at NLM."

Laura Eisenberg (On-line Training Coordi-nator, Bibliographic Services Division): "forwork in developing and implementing com-puterized instructional training programsused to train librarians in the use of NLMdata bases."

Thomas D. Tonkery (Deputy Chief, Tech-nical Services Division): "for the design andimplementation of an automated system forcomputer management of bibliographicordering, invoicing, and production controlin the procurement and processing of sci-entific book literature."

Forty-Year Service Award

Joseph Leiter, Ph.D., NLM Associate Di-rector for Library Operations, received aForty-Year Length-of-ServiceAward.

Equal EmploymentOpportunity

The Library is placing special emphasis onattracting minority students into the LibraryAssociate Program. This effort will includevisits and interviews at more than 15 libraryschools throughout the Nation, as well asletters to library school deans requestingtheir assistance in encouraging top minoritystudents to apply for the Library AssociateProgram.

The Administrative Trainee program inthe Office of Administration, created throughthe Affirmative Action Plan of 1971, wasexpanded to provide two training positionsthis year. Patricia Ruben and George Franklinwere selected for these positions and arebeing trained in the Office of Administra-tive Management Services.

During FY 1977, the Equal EmploymentOpportunity Committee received excellentleadership from its chairman, Alvin Barnes.Elections for FY 1978 were held on Septem-ber 26, 1977. The new Committee consists


of Phillip Coleman, Gail Yates, Joan Cepko,John Olive and the newly elected members,Peggy Beavers, Lois Terry, Kathleen Nichols,James Snowden, and Valerie Settles. TheCommittee will be chaired this year byMelvin Spann of the Library's SpecializedInformation Services.

ExhibitsNLM presented four exhibits in the lobby

during FY 1977. The Library's special year-long Bicentennial exhibit (described in NLMPrograms and Services, 1976) was featuredthroughout 1976. This exhibit was followedby a display of 32 microscopes from theBillings Collection of the Armed ForcesInstitute of Pathology. The display illustratedthe development of the microscope fromthe 17th through the 20th centuries.

In May, an exhibit entitled "Medicine andMusic" was installed. In addition to booksand prints dealing with the relationshipbetween medicine and music through theages, the exhibit featured a musical record-ing "describing" a lithotomy.

In September, an exhibit entitled "HealthSciences Communication Technology" was

Health Sciences Communication Technology exhibit NLMpatron examines case containing models used in healthsciences teaching

presented. The exhibit described how theinnovative use of computer and audiovisualtechnology can improve the efficiency ofprofessional health education. The exhibitwas prepared by the National Medical Audio-visual Center.

Chapter 2: Library Services andOperations

Joseph Leiter, Ph.D., Associate Director,Library Operations

FY 1977 was a year of significant accom-plishment in almost all areas of Library activi-ties. First and foremost has been the Library'ssuccess in coping with growing demands formaterials in its collection. Not only has theLibrary met most of these demands, whichhave increased at the rate of approximately11 percent over last year, but the quality ofthe service has also improved, despite noincrease in staff for this function. Ninetypercent or more of the requests for publica-tions from the serial literature and approxi-mately seventy percent of requests for loansof original material are currently beingsatisfied.

Although there are some signs of levelingoff of requests for interlibrary loans therewas still a six percent increase in requestsover FY 1976. Unless additional manpowerresources can be found to support this activ-ity the ability to provide the necessary serv-ices will soon deteriorate. Even at this time,minor personnel problems have had amagnified impact on service.

Concommitant with the increase in tradi-tional library services has been the con-tinued expansion of on-line services. Thenumber of searches increased by about 50percent during the past year. Much of thisresulted from the implementation of amonthly SDI (Selective Dissemination ofInformation) service providing monthly bib-liographies to health care practitionersbasedon an individualized search profile storedin the NLM computer.

During FY 1977, a major consolidation ofon-line services was accomplished with theMEDLARS Management Section assumingthe role of coordinating all on-line services.The training program for search analystswas restructured and an integrated on-linetraining program developed for all databases. Chang'es were made to allow accessto all data bases by all domestic users, andextensive orientations were held to familiar-ize the users with data bases. Finally, anintegrated NLM Technical Bulletin was de-veloped and published.

The Library has established a RegionalMedical Library Task Group to extend on-line access to more hospitals and directhealth care delivery institutions. In addition,a cooperative program with the AmericanHospital Association is underway to developan on-line hospital and health care deliverydata base. It is scheduled to be available incalendar year 1978. The file will also be usedto produce the AHA's Hospital LiteratureIndex. A substantial augmentation of thecontrolled vocabulary was made to capturemany of the concepts related to these areas.In addition, the Library's Scope and Cover-age policy was completely rewritten to re-flect the expanded mission of the Library.

An outstanding accomplishment duringFY 1977 was the successful reorganizationand implementation of an up-to-date on-linefile of non-print materials called AVLINE(Audiovisuals On-line). This now provideseducators in many fields of health sciencewith a unique data base of peer-reviewed

Library Services and Operations

audiovisual material that has been criticallyassessed for quality of content and educa-tional objectives. AVLINE contains sufficientdescriptive material to enable the educatorto make an intelligent selection for his teach-ing needs.

The ability to meet service demands whichrequire large manpower resources has beenimproved by implementing automated pro-cedures in technical services and by exten-sive and aggressive maintenance and clean-up activities in the Library's collection.

The automation of technical services, be-gun three years ago, has been paying offhandsomely. Backlogs and bottlenecks inacquisitions have been eliminated and, withno increase in staff, it has been possible tomount exhaustive search and acquisitionprocedures to approach the goal of acquir-ing all of the significant published literature.

Many new programs in serial and catalog-ing automation have also been imple-mented, including automated binding data,gapping files, invoicing, and other technicalprocessing activities. A successful experi-ment to use check-in and claiming data pro-vided by dealers has been completed andthis activity will expand over the next year.In addition, NLM's on-line Name AuthorityFile has been extended to provide on-linemaintenance. It remains the only on-line,updatable authority file in the library worldand it is accessible to all users of NLM'son-line system.

Rigorous housekeeping practices havebeen implemented. A complete inventoryand gapping of our current periodical collec-tion was begun and is scheduled to becompleted in 1978. Gaps will be processedin the automated gap files and filling of gapsgreatly expanded.

As a result of an inventory of our mono-graphs last year, an overhaul of the collec-tion was completed and, where possible,the deficiencies corrected. A similar surveyof older serials on C-level has led to theoverhaul of this part of the collection. Morethan 2,000 older serials, never before cata-

loged, have been cataloged and are nowmore readily available to users. The docu-ment collection was completely overhauledand improved bibliographic control nowprovides ready access to this important partof the collection.

Despite the accomplishments reported,and the heroic efforts to support Libraryservices, there are imminent problems if theLibrary's attempts to obtain additional staffauthorizations are unsuccessful. Staff havebeen stretched to the limit. Any further de-mands for services will surely exceed theselimits. There is ample evidence of fatigue,with highly productive and imaginative li-brarians who are no longer able to dedicate10-12 hours daily to maintain production sothat automation may also proceed. Otherstaff can no longer be readily persuadedwith the attractions of overtime pay to main-tain longer work hours to cope with de-mands. There have also been significantlosses of important staff members to farless demanding and frequently better payingpositions.

The Library at this time has an outstand-ing group of vigorous and imaginative librar-ians. Unless some assistance can be obtainedit is unlikely that the Library will be able tosustain its excellent record of service.

Medical Subject Headings(MeSH)

All phases of the annual cycle of MeSHreview, modification, and production pro-ceeded on schedule; the faster-than-usualservice provided by the printer enabled usto make the 1978 MeSH available to eventhe overseas indexing centers comfortablyin advance of their scheduled need.

The terminology contained in 1978 MeSHhas been strengthened in a number of sub-ject areas. The effort in the field of healthcare, begun in the previous year, was con-tinued, resulting in the introduction of manynew terms dealing with concepts relating tohealth care financing, health care organiza-


tion, and health care manpower. Manyterms related to hospital administrationwere added in anticipation of the develop-ment of a new bibliography requiringbroader coverage of hospital administrationliterature. Added MeSH terminology hasfacilitated the development and searchingof an experimental MEDLARS data base con-cerned with bioethics. With a consultantprovided by the National Institute of Neuro-logical and Communicative Disorders andStroke, a thorough review of terminology inthe field of neurology has begun: In spiteof the special attention given to these sub-jects, every part of MeSH received consider-ation in FY 1977. New terms were introducedinto each of the 15 categories and into 81of the 107subcategories.

While about 600 terms were added, eitheras new concepts, or as replacements for lessdesirable terminology, 172 were deletedThe deleted terms that were not replacedrepresent concepts that are now rarelywritten about, these were made cross refer-ences to other MeSH terms. Innumerableadditional cross references were suppliedin 1978. There was a three percent net in-crease in the number of MeSH descriptors.Seven new subheadings were added tofacilitate the linkage of concepts that werepreviously handled by coordinate indexing.

MeSHup, a new computer program forthe on-line maintenance of the MeSH file,became available for use in FY 1977. Theprogram has somewhat simplified the taskof modifying MeSH, and reduces the oppor-tunities to introduce errors.

Mid-Atlantic Regional Medi-cal Library (RMLIV)

The RML IV Program experienced a yearof growth and change, with increased pro-gram participation and responsibility beingassumed by libraries within the Region.RML IV serves over 500 libraries in health-related institutions in the District of Colum-

bia, Maryland, North Carolina, Virginia, andWest Virginia.

A new set of bylaws was prepared andadopted which will result in organizationalchanges to reflect the Region's goals fordeveloping a cooperative library service net-work. Beginning in October 1977, the Re-gional Advisory Council and the ExecutiveBoard will provide most of the planningand decision-making for the RML IV Pro-gram.

Many of the program achievementsof thepast year can be credited to the work of thestanding committees in four areas: audio-visual, education, interhbrary loan, and on-line services.

Major activities for FY 1977 includedcontinuation of the Regional Core JournalClearinghouse; initiation of a basic unitdevelopment contract, development workon educational packages for medical andlibrary terminology, and on a core referencecollection; preparations for workshops onthe bibliographic citation, and revision ofthe Region IV Core Journal Lists.

Table 3 RML IV Statistics

Interlibrary loansOn-line centers . . .

FY 197779,799

108

Bibliographic ServicesDivision

The Bibliographic Services Division is re-sponsible for indexing the journal literaturefor Index Medicus and for coordinating theon-line network that makes the indexedreferences available via MEDLINE and otherdata bases. Training for users of the networkhas become an increasingly important func-tion of the Division and several changes intraining procedures are reported m FY 1977The Division is also the publisher of manyof the bibliographic tools issued by theLibrary.

10


Six Library Associates selected for training for 1977-78 (standing from leftKelly, Daza Craig, James Cain. Seated: Martha Benzer, Patricia Healy.

to right): Julia Sollenberger, Marguerite

Indexing

The number of articles indexed for IndexMedicus reached 248,346 in FY 1977 includ-ing 242,800 journal articles and 5,546 articlesfrom the monographic literature. In addi-tion, 11,634 articles were indexed fromjournals for special indexes such as theIndex to Dental Literature and the Inter-national Nursing Index. Thus, a total of 259,-980 articles were entered into the MEDLARSdata base, as shown in Table 4.

The number of journals regularly indexedwas increased by over 100 to 2,525. Theincrease in the number of journals wasrecommended by the Journal Selection Com-mittee, a group of non-NLM advisors whoreview candidate journals to be added toor dropped from the system. Much of theincrease resulted from a special emphasison the literature of health care delivery, andthis category will be expanded even morein the future. All indexed citations, whetherprepared by NLM staff, contract indexers, or

foreign MEDLARS centers are reviewed care-fully by NLM indexers before being enteredinto the system.

Network ServicesThe MEDLARS Management Section is the

contact point for the day-to-day operationof the on-line network. The network grewto about 800 centers in FY 1977, with almost900,000 on-line and off-line searches beingperformed by users. In its role as the contactpoint for on-line users, the MEDLARS Man-agement Section answers questions, solvesproblems, maintains billing records, andproduces manuals and other descriptivematerials on the use and characteristics ofthe various NLM data bases.

One of the most important new activitiesin the past year was an Automatic SDI (Selec-tive Dissemination of Information) service.Specific searches which are stored in a com-puter file by the individual users are proc-essed automatically each month against

11


either SDIL1NE or TOXLINE, as appropriate.Approximately 150 institutions receivedabout 34,700 printouts in FY 1977 in thismanner.

Another major change in FY 1977 is thatall new on-line centers automatically haveaccess to all publicly available NLM files.TOXLINE, for example, had previously beenavailable only under a separate arrangement.Existing centers were also given the oppor-tunity to have access to TOXLINE and relatedfiles.

In August 1977 the 100th issue of theNLM Technical Bulletin was produced. InApril 1977 the name of this publication waschanged and the formerly separate LibraryNetwork/MEDLARS Technical Bulletin andthe TOXLINE Technical Bulletin weremerged. Users of NLM's on-line system re-ceive one copy of the NLM Technical Bulle-tin each month so that they may be keptcurrent on system and policy changes,searching strategy hints, new data bases, etc.

TrainingImportant changes occurred in training

during FY 1977 as a result of the merger ofMEDLINE and TOXLINE courses into a singleOn-Line Services Training program. The newcourses for initial and advanced trainingcover all the various data bases which con-stitute the NLM system. The traditional three-week course, held three times in FY 1977,was dropped from the training program.

Decentralization of training activities,which began in FY 1976, was continued withseven one-week classes being held in Re-gions IV, VI, VIII and XI. In all, 17 courseswere conducted at both NLM and in thefield for a total of 254 participants (100more than last year).

As part of the development of on-lineservices training, the Library began to plana continuing education program for usersof the system. In cooperation with the Re-gional Medical Libraries, the Standing Com-

mittee for On-Line Retrieval Education(SCORE) was created. As an advisory com-mittee to the NLM Associate Director forLibrary Operations, SCORE will assess thecontinuing education needs of search ana-lysts and devise an instructional program tomeet those needs. This assessment has be-gun, and a prototype continuing educationcourse is now being developed.

Staff member Jacqueline van de Kamp (left) assists agraduate student to retrieve references from MEDLINE.

PublicationsThe Bibliographic Services Division is the

publisher of Index Medicus and other NLMbibliographic publications including Cumu-lated Index Medicus, Abridged Index Medi-cus, Recurring Bibliographies in various bio-medical disciplines, and Literature Searches.In addition to these, FY 1977 saw the pub-lication of a series of important user guides:MEDLARS Indexing Manual (Part II), Anno-tated MeSH: Its Content and Use (for traineeindexers and searchers), and a revised TreeAnnotations for Medical Subject Headings.

A series of meetings with representativesof the American Hospital Association hasresulted in an agreement to have NLM pre-pare from the MEDLARS data base the pub-lication Index to Hospital Literature Arrange-ments are now being made to implementthis decision. In addition, NLM and AHAstaff plan to develop an on-line data basefor the literature related to hospitals andhealth care delivery.

12


History of Medicine Division

During the past year the cumulated Bibli-ography of the History of Medicine for1970-74 was published from the now com-puterized data base. The increased speedof production which this provides also madeit possible to publish promptly the annualissue for 1975. At the end of the fiscal yearthe next edition, 1976, was ready for theprinter. Progress continued on other plannedpublications as well, so that the manuscriptof a short-title catalog of the 18th centurycollection was also completed by the end ofthe year; the catalog is expected to appearin 1978.

AcquisitionsDuring the year some 500 books and

theses were added to the historical collec-tions, as well as over 77,000 items in themanuscript collection and approximately

600 prints and photographs. Book acquisi-tions ranged from great classic works, suchas the second printing of William Harvey'sDe motu cordis, in Emilio Pansario'sNobilium exercitationum libn duodecim desubtilitate (4 vol., Venice, 1623-43), to illu-minating ephemera, such as a San Franciscofee bill of 1850. Probably the rarest acquisi-tion was a 51-page pamphlet bv the Fnghshsurgeon, Dale Ingram (1710-1793), An Essayon the nature, cause, and seat of dysentery's,printed in Barbados in 1744. Ingram laterreturned to England, where he publishedseveral other works and was elected surgeonto Christ's Hospital. Another rare and intrin-sically more important addition was a collec-tion of 51 issues of the official Swedishalmanac from 1753 to 1771 which togethercontain the first printing of Nils Rosenvon Rosenstein's Underrattelser om barn-sjukdomar, one of the most widely trans-lated and published pediatric works of the18th century.

The History of Medicine Division provides access to pre-1871 material in a separate reading room staffed with refer-ence librarians trained in the history of medicine

13


Additions to the manuscript collection in-cluded gifts or bequests of papers from A.Baird Hastings, James A. Shannon, Fred L.Soper, Emile F. Holman and others. TheLibrary is pleased to acknowledge thesecontributions, which will provide valuablesource material for future historians explor-ing the complex developments of medicinetoday.

Public ServiceWhile building collections for the future,

the History of Medicine Division has asalways continued to provide services toreaders and to patrons at a distance. Duringthe year over 5,000 volumes were servedto readers in the building and nearly 2,500books and journal articles were provided toothers by interlibrary loan—chiefly photo-copy—or special paid photographic services.In addition more than 1,800 photographicprints and slides were provided from theprints and photographs collection.

Members of the staff have also partici-pated actively in advancing knowledge ofthe history of medicine through their par-ticipation in the affairs and programs ofprofessional societies and through publica-tion of the results of their research."Medicine and Music," one of the exhibitsprepared by the Division, proved to be aparticularly popular one.

Reference Services DivisionIt is apparent from the demand for on-

site and interlibrary loan services that thesteady increase in volume which beganshortly after regionalization in 1967 has yetto level off. Requests for material from thecollection topped the 400,000 mark in FY1977 and reference inquiries were up 33percent over the last fiscal year. A new rec-ord was set in October, when over 2,000requests for interlibrary loans were receivedin one day.

Maintenance and security of the collectioncontinued high on the list of priorities: the

older journal collection was shifted in orderto open up areas which were tightly packed;systematic "gapping" was initiated to recordmissing items in the recent journal collec-tion so that recovery attempts could beundertaken; a new module was added tothe automated serials file which would per-mit production of machine generated bind-ing records; the Government DocumentsUnit staff completed a review and reorgani-zation of the entire Documents collection;the Library's Publication Archive was trans-ferred from the Documents Unit to the His-tory of Medicine Division; and the Divisionfilmed the Library's annual reports, goingback to the first one (1868) that mentionsthe Library as separate from the Army Medi-cal Museum. This 1H68 report included amention of the Library of the Surgeon Gen-eral's Office as a budget item (lumped to-gether with many others) under "Miscella-neous Expenses of the Medical Department."A collection of histories of health legisla-tion was also filmed for the Archives andprinted copies produced and bound for theDocuments Collection.

In the Reading Room, a continuing dis-play of new books was installed which hasattracted a great deal of attention and favor-able comment from the Library's patrons.A modest charge for on-line bibliographicsearch service was initiated in April. An in-creasing number of audiovisual packageswere received in the Audiovisual LearningResource Center, so that imprints of 1974and earlier were moved for shelving to theGeneral Collection to make room for newermaterials. Access to audiovisual in the Gen-eral Collection is available in the same man-ner as books and journals.

Interlibrary loan service continued to bethe single largest program administered bythe Division, and in spite of the increasedvolume of requests, acceptable throughputtime for loans was maintained. Increasingdemand for the loan of monographs in theoriginal form resulted in shortening the loanperiod from four to three weeks and the

14


installation of a reserve system for mono-graphs currently on loan. Requests for itemson loan are held pending return of the book,rather than returning the request noting "notavailable." Librarians have enthusiasticallyendorsed the new procedure.

Although micropreservation of the de-teriorating portions of the collection hascontinued under contract, lack of staff bythe end of the year eliminated the Division'sability to convert badly worn and brittlematerial to film format in-house. Micropres-ervation is a necessary program to fulfill theLibrary's archival responsibility and if addi-tional staff becomes available, the Libraryhopes to be able to re-start it if only on alimited basis during the next year.

The second publication resulting from Dr.Jaroslav Nemec's research into medicolegalserials was published during the year, High-lights in Medicolegal Relations. Dr. Nemec,now retired from the Reference Section staff,compiled the material which describes "theimportant events and publications in themedicolegal calendar extending chronologi-cally from ancient times to the present day."It consists of 549 entries from 4000 B.C. to1973, with name and subject indexes and abibliography. This is a revised and muchexpanded edition of an earlier Highlights,and is available from the Government Print-ing Office.

Nursing students from the Washington area scan a com-puter printout of journal titles in the NLM collection.

Technical Services Division

The Technical Services Division (TSD) ac-quires and catalogs biomedical monographs,serials, and audiovisual materials for theLibrary's collections. The Division providessupport for such activities as acquisition,authoritative cataloging, reference services,and interlibrary lending both at NLM andin field libraries through its publicationsand on-line computerized services.

In FY 1977 there was an increase in thenumber of books processed and sent tocataloging, orders placed, and serial piecesprocessed. However, the number of titlescataloged has declined due to the loss ofspecialists with certain language skills, par-ticularly in the Japanese, Russian, and Scan-dinavian areas. Cataloging backlogs aretracked and controlled by TSD's machinereadable on-line Inprocess File (INPROC).All titles for which complete catalogingcan-not be provided are brief-listed in INPROC,thus allowing access to the material.

The Division, through contract support,was able to improve collection control bycataloging a backlog of 2,000 serial titlespublished between 1861 and 1962, and in-corporating serial congresses into the MasterSerial System. These older serial titles hadnot previously been accessible because ofthe lack of bibliographic control.

Division staff, working closely with a sub-committee of the Board of Regents andconsultants, produced a new Scope andCoverage Manual in FY 1977. The manualdefines the subjects pertinent to medicine(scope) and the extent to which materialshould be collected (coverage), and providesa guide for TSD staff in selecting literaturefor the Library's collections. The last majorrevision of the NLM Scope and CoverageManual was completed in 1972. The mostsignificant impact of the new manual is onthe literature of health care delivery, anarea that is difficult to control because ofits diverse pattern of publication.

15


In FY 1977, the Division became heavilyinvolved in the technical processing of non-print media. The Division's audiovisual proc-essing staff have produced over 40 percentof the total AVLINE data base since fulloperation began in January 1977.

The first publications from AVLINE wereproduced in 1977 with an AVLINE sectionappearing in the quarterly NLM CurrentCatalog In addition, the NLM AVLINE Cata-log, a subject catalog of all AVLINE titlesfor 1975-1976, was published. The AVLINEdata base was also the source for the newNational Medical Audiovisual Center Cata-log, which lists titles available from NMAC.

During the past two years the Division hasconverted most of its manual processingsystems to computerized operation. Thevolume of on-line computer utilization hasgrown to over 2,500 connect hours permonth, in addition to the nearly 1,000 jobsexecuted off-line in non-prime time.

TSD's dependence on automation touchesevery aspect of technical processing. Over30 full-time staff members spend at least50 percent of the working day at a terminal.With this volume of activity TSD is cur-rently engaged in shifting the load from theIBM 370 to a dedicated minicomputer, partof TSD's Distributed Processing System.

In addition to the implementation ofPhase I of the Distributed Processing System(the acquisitions module for both print andnonprmt media), the Division, workingclosely with the Office of Computer andCommunications Systems, has designed andimplemented an improved on-line real-timeName Authority File. In the past, the systemwas a batch operation with often a notice-able delay in adding new cataloging recordsto the CATLINE file. With the new MEDNAMfile, names are added to the system on-lineand are available for validating catalogingdata the same day.

With the conversion of NLM catalogingdata into the Library of Congress's MARCformat, NLM is providing CATLINE tapes toTrmco, Inc., under a lease agreement. Asimilar arrangement is being negotiated withthe Ohio College Library Center (OCLC).Health science libraries now can obtain cata-log cards or book catalog service fromTrmco. In addition, the OCLC user commu-nity will be able to utilize NLM data andproduce catalog cards

A new SERLINE file, containing biblio-graphic information for approximately26,000 serial titles, can also be used forverification by network libraries. For ex-ample, the resource libraries in Region XIare using the data base to test the usefulnessof manipulable holdings data in developinga cooperative serials acquisitions policy atthe Regional level. This project, calledCOSAP, is supported by an NLM grant to theUCLA Biomedical Library.

Improved control of NLM serial recordsthrough automation has allowed TSD staffto expand the dealer check-in and claimprogram. Six major subsc ription dealers nowprovide NLM with off-site check-in service.By FY 1978 over 9,000 serial titles will bechecked in and claimed by dealers underthis program As a by-product, magnetictapes of machine-readable data producedby the dealers will be sent to update NLM'sserial data base on an experimental programbeginning in January 1978.

The Division continues to remain an activeparticipant in several cooperative programs,including Catalogmg-m-Publication (CIP)and CONSER (Conversion of Serials). Effortsto reduce TSD manpower involved withCONSER are underway Once an agreementis reached, NLM will send magnetic tapes toOCLC to create and maintain NLM serialrecords in the CONSER data base.

16


Table 4. Bibliographic Services

)u\y 7975-FY 7975 lune 7976

Articles IndexedNLM

Other U.SForeign

TotalRecurring bibliographies . . . .Journals indexedMonographs indexed*Abstracts entered

49,50098,70072,600

220,80028

2,353

10.000**

38,400100,000116,600255,000

282,408

186103.200

Transi-tional

Quarter '

8,60024,50032,60065,700

282,410

15929.100

FY 7977

39,66384785

135,532259,980

262,525

225111.467

' Indexing of selected monographs began in May 19761 Estimated

1 July-Sept. 1976

Table 5. On-Line Searches*

Data base

July 7975-June 7976

TransitionalQuarter' FY 7977

AVLINECANCERLINECANCERPROJCATLINECHEMLINECLINPROTEPILEPSYLINEJOURNAL AUTHORITYMEDLINEMESH VOCABULARYNAME AUTHORITYRTECSSDILINESTORED SEARCHTOXICOLOGY DATA BANK (TDB)TOXLINE

Total

2,1394,777

891103,307

9,34720

339486

286,2501,1895,598

39,3530

18,356472,052

8681,469

36822,079

2,7737

280132

77,963314832

6,4000

5,454118,939

9,10015,841

3,863125,455

25,482596

1,630898

405,6532,302

10,464471

19,67745

1,28639,432

662,1951 July-Sept 1976

• The method of computing the number of searches for Tables 5 and 6 was changed for this report Figures given heremay not be s t r i c t l y comparable to those of past years Descriptions of the data bases are included in (he variouschapters of this report

17


Data base

Tables. Off-LineSearches*

luly 7975-/une 7976

AVLINE 6BACK66 15,591BACK69 33,686BACK72 37,749CANCERLINE 330CANCERPROJ 56CATLINE 78CHEMLINE 3CLINPROT 0EPILEPSYLINE 18JOURNAL AUTHORITY 0MEDLINE 14,169MESH VOCABULARY 5NAME AUTHORITY 0RTECS —SDILINE 8,795TOXICOLOGY DATA BANK (TDB) —TOXBACK 2,149TOXLINE 1,354

Total 113,989• See footnote, page 17.

TransitionalQuarter1

27,546

10,08912,098

269271500

160

5,34800

5,245

1,2391,009

42,903

FY 7977

934,60045,18559,388

1,25728687

56

310

26,92410

1239,454

125,6285,663

218,5481 July-Sept. 1976

Table 7. History of Medicine Activities

AcquisitionsBooksModern Manuscripts ..Prints and photographs

FY7975

86389,563

762

ProcessingTitles catalogedModern manuscripts cataloged ...Pictures indexedArticles indexed

2,86659,355

4044,236

Pages microfilmed 151,130

Public serviceReference questions answeredILL and pay orders filledReader requests filledPictures supplied

1,8802,2148,9621,797

July 7975-lune 7976

90482,452

815

3,72144,201

5773,950

160,583

1,7822,1625,7601,995

Transi-tional

Quarter1

18213,544

119

69516

136519

59,423

408578

1,322430

FY 7977

50477,177

606

3,22561,290

4956,074

152,994

1,8032,4565,3861,848

1 July-Sept. 1976

18


Table 8. Growth of Collections

Previous Total Added Withdrawn(Sept. 1976) FY1977 FY 1977

A. Book MaterialsMonographs:

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

Theses HMDPamphletsBound serial volumes ..Total Volumes

B. Nonbook MaterialsMicroformsAudiovisualsPicturesManuscripts

5625,4489,545

22,70239,0962,272

344,60010,220'

281,295172,021*510,785

1,398,546

30,1583,291

71,629743,131

23549

21115411

9,8643,764

160

34,81848,924

1,4782,103

60679,177

1 Corrected Figure* In collection before July 1, 1975. Additions now included with monographs.

Table 9. Acquisitions Statistics1

Serial RecordsNew titles addedDiscontinued titles ...Current titles received

Publications ProcessedSerial piecesOther

Total

FY 7975

990404

25,228

137,18021,553

158,733

Obligations forPublications $723,571Included for rare books $ 82,136

July 1975-lune1976

722289

18,086

169,72619,582

189,308

$859,572$ 76,008

83

401484

Transi-tional

Quarter*

28848

18,326

41,6565,225

46,881

$275,997$ 26,061

NewTotal

5645,4839,594

22,91339,2502,283

354,38113,984

281,311172,021545,202

1,446,986

31,6365,394

72,235822,308

FY 1977

990812

25,831'

182,80425,000

207,804

$1,350,683'$ 79,246

1 Does not include history of medicine acquisitions1 July-Sept 19761 Includes addition of Serial Congresses to Serial Record"; represents open entries for serials included In Nl.M's machinereadable data bases—Master Serials System.4 Includes $110,000 in quid pro quo arrangements for services abroad.

19


Table 10 C

Completed Cataloging

Catalog Cards Filed

Volumes Shelf-Listed

' Does not include history of medicine cataloging'July-Sept 1976

Table 1 1

Number of requests receivedFor interlibrary loanFor readers

Number of requests filledFor interlibrary loan

PhotocopyOriginal

For readers

Number of requests unfilledInterhbrary loan

RejectedReferredReturned as unavailable

Reader service returned asunavailable

)atalogmg Statistics1

luly 7975-FY 7975 June 7976

12,844 15,044

118,463 118,628

11,843 13,326

Circulation Statistics

)uly 7975-fV7975 June 7976

320,079 380,475228,755 263,07291,324 117,403

247,614 301,965173,642 205,695158,493 184,70415,149 20,99173,972 96,270

72,465 78,51055,113 57,37715,446 18,1276,645 8,684

33,022 30,566

17,352 21,133

Transi-tional

Quarter1

3,051

24,992

3,310

Transi-tional

Quarter1

90,90064,71626,184

74,78551,74347,1534,590

23,042

16,11512,9734,5852,0996,289

3,142

FY 7977

13,507

126,591

12,182

FY 7977

423,801280,512143,289

343,313221,517198,760

22,757121,796

80,48858,99523,083

7,94627,966

21,493

1 July-Sept 1976

20


Table 12. Bindings

FY 7975

Number of volumes sent to binder . . . 38,178Obligations for binding $136,409

Table 13. Refereno

FY7975

Requests by telephone 11.509Government . . .Nongovernment

Requests by mail .GovernmentNongovernment

Readers assistedGovernmentNongovernment

TotalGovernmentNongovernment

Reading room users registered . . .

4,0287,481

1,488385

1,103

16,4094718

11691

29,4069,131

20,275

22,426

itatistics

Transi-luly 7975- t/ona//une 7976 Quarter1

24,997 6,274$95,508 $25,000

B Services

Trans/-)uly 1975- t/ona//une 7976 Quarter1

13,275 4,0153,562 1,2019,713 2,814

1,446 342189 43

1,257 299

17,613 5,8193,793 1,098

13,820 4,721

32,334 10,1767,544 2,342

24,790 7,834

28,384 5,725

FY 7977

33,045$113,104

' July-Scpl. TJ76

FY 7977

15,0434,119

10,924

1,140106

1,034

26,7724,726

22,046

42,9558,951

34,004

32,060

1 July-Sept 1976

21

Chapter 3: Computer and Commu-nications Systems

Harry D. Bennett,DirectorOffice of Computer and Communications

Systems

The Office of Computer and Communica-tions Systems is responsible for providingdata processing and data communicationssupport to all elements of thp Library Assuch, it has a critically important supportingrole for Library Opcrntions as well as in Spe-cialized Information Services The presentIBM 370/158 multi-process computer systemis the equipment workhorse providing thissupport During FY 1977 the major compo-nents of this system—the central processingunits, the magnetic tape units, and sixteendisk drivrs— were purchased As a result,during the three-year period ending in De-cember 1979, the Library will have savedover $1,500,000 m equipment costs as com-pared with continued lease of these compo-nents In addition, for each month of use in1980 and after, the Library will save theequivalent of $120,000 in lease costs

NLM is working with the General ServicesAdmin1 stration on a competitive purchase toreplace the IBM 170 system in late 1979 toprovide the capacity necessary to meet thegrowing requirements for data processingservices This replacement, which has beenin the planning stages for over two years,will handle the estimated annual 20-25 per-cent growth rate until 1985 Installation ofthe replacement system is scheduled to co-incide with the completion of the DataProcessing Facility which will be located inthe new Lister Hill Center building presently

under construction This facility has been de-signed to house the data processing equip-ment necessary to support NLM throughthe 1980s

Considerable emphasis has been placedon improving the performance of the pres-ent 370 system so that NLM's data processingrequirements can continue to be met on theexisting equipment prior to acquisition ofthe replacement system

Fine tuning of systems performance isbeing accomplished through the use ofsophisticated computer programs which ana-lyze the utilization of all systems compo-nents and assist in determining present andpotential system bottlenecks

Early in FY 1977 NLM began to work withthe Government Printing Office in a projectto transfer the typesetting of Index Mcdicusand a number of recurring bibliographiesfrom NLM's Photon 901 photocomposer tothe GPO VideoComp 500 Over a six-monthperiod all of NLM's computer-generatedpublications were converted to the Video-Comp and the Photon 901, which had beenused for photocomposition since 1969, hasbeen removed

Another major activity in FY 1977 was acomplete change in preparing input toMEDLARS II and other NLM data basesThe citation processing portion of MEDLARS

22

Computer and Communications Systems

Computer operator Linda Ford puts a roll of paper intothe new IBM high-speed printer

II was replaced by a new citation inputmodule (MEDCIM). MEDC1M permits initialinput and correction of citation records tobe performed on-line with cathode ray tube(CRT) terminals. With this program it be-came possible for the citation proofreadersto enter corrections immediately. This capa-bility has been extended to the other por-tions of the MEDLARS input and correctionprocess. As a result it is now possible tohave initial input and correction performedas a by-product of the intellectual effortassociated with citation validation, MeSHchanges, and other in-house functions. Thisdevelopment has reduced both errors and

the time required to process the data. Italso has permitted the Library to dispensewith the outdated Keymatic Encoders whichhad served their useful life and were be-coming difficult to maintain.

Early in FY 1977 NLM significantly im-proved its computer printing capabilitywhen it installed an IBM 3800 laser printer.This printer is capable of printing 10,000pages per hour and it has reduced theamount of time needed to print MEDLARSoff-line prints by over 50 percent. This print-er, with its laser beam print capability, pro-duces very high quality print and has beenused not only to increase the speed ofprinting but also its quality.

An improved version of ELHILL—the on-line retrieval portion of MEDLARS—was in-stalled in July. This new version, designed tosupport the experimental Toxicology DataBank maintained by Specialized InformationServices, provides the capability to handlelarger records than the previous version.In addition, continued tuning of the retrievalsystem and the IBM model 370 operatingsystem has provided the capability to handlea 15 percent increase in workload with nodegradation of service and terminal responsetime.

23

Chapter 4: Specialized InformationServices

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

The Toxicology Information Program (TIP)is the major activity of the Library's Special-ized Information Services component. InFY 1977, the Program began to gear up tomeet the demand projected for its servicesas a result of the passage of the ToxicSubstances Control Act (TSCA). Through theToxicology Information Subcommittee ofthe DHEW Committee to Coordinate Toxi-cology and Related Programs, the Programhas played an important role in the coordi-nation of toxicology information activitiesbetween the Department and the Environ-mental Protection Agency and has identifiedsome of the information services and databanks that should be developed as a con-sequence of TSCA.

Query ResponseThe Toxicology Information Response

Center (TIRC), supported by TIP at the OakRidge National Laboratory, continues to pro-vide query response and literature searchservices on request. During FY 1977 theCenter completed more than 700 full bib-liographic searches for industrial, academic,and Government organizations (the last ac-counting for about 68 percent of TIRC'sservices). In addition, TIRC processed morethan 900 comprehensive information re-quests. Charges for these search services arebilled through the National Technical Infor-mation Service, Department of Commerce,or in the case of Government agencies, are

recovered through mteragency agreements.The charge rate was increased from $20 to$25 per hour to bring the search serviceclose to a full cost recovery level. TIP sup-ports the purchase of basic library andliterature sources for TIRC, in addition tothe collection already available at the OakRidge National Laboratory.The Program alsosupports the major portion of the admin-istrative overhead required to provide thequery response services. During this year,the above-mentioned interagency agree-ments for literature search services involvedthe Chemical Systems Laboratory of theDepartment of Army, Environmental Protec-tion Agency, National Center for Toxicologi-cal Research, and the Food and Drug Ad-ministration's Bureau of Foods.

PublicationsReviews and annotated bibliographies

were prepared by staff of the ToxicologyInformation Response Center and publishedin toxicology journals or as monographs bythe National Technical Information Service.These publications covered toxic agents ofcurrent broad interest such as mercury, lead,mirex, methoxyfluranc, trichloroethylene,and kepone. Two indexes for the thousandliterature searches completed by TIRC be-tween July 1975 and May 1977, were pre-pared and sent to the National TechnicalInformation Service for sale and distribution.

24

Specialized Information Services

On-Line Retrieval ServicesTOXLINE: This file of bibliographic ref-

erences on toxicology now provides sub-scribers with on-line access to more than470,000 records covering the most recentfive years. The records deal primarily withthe toxicology/pharmacology of drugs, pesti-cides, industrial chemicals, environmentalpollutants, and hazardous household chemi-cals. The TOXLINE data base is now updatedmonthly. The backfile of TOXLINE (TOX-BACK) was enlarged to 189,000 recordsdated before 1971. All records in TOXLINEand TOXBACK are enriched with indexterms and/or full abstracts. TOXLINE/TOX-BACK now contain the following componentfiles: Toxicity Bibliography, Chemical-Bio-logical Activities, Abstracts on Health Effectsof Environmental Pollutants, Pesticides Ab-stracts, International Pharmaceutical Ab-stracts, Hayes File (a precursor to PesticidesAbstracts), Environmental Mutagen Informa-tion Center data, Toxic Materials Informa-

tion Center data, Environmental TeratologyInformation Center data, and a second spe-cial file of references in teratology.

During the past year much of the TOX-LINE user support was transferred from Spe-cialized Information Services to Library Op-erations. This was done to improve manage-ment of user support by consolidating thesefunctions in one group. In August, all TOX-LINE users were permitted access to MED-LINE and other NLM on-line services. Newsubscribers to these services are now trainedto use the MEDLINE, TOXLINE, CANCER-LINE, and CHEMLINE files. TOXLINE reacheda usage level of over 700 hours per month.During the year more than 36,700 searcheswere conducted by TOXLINE users, who alsorequested more than 460,000 pages ot off-line prints.

CHEMLINE: This file was regenerated andsubstantially enlarged, bringing its size to

Nongovernment experts and staff of the Toxicology Information Program review records extracted from source materials before the records are entered into the Toxicology Data Bank.

25


more than 243,000 chemical records (includ-ing the 33,000 records on the EPAToxic Sub-stances Control Act Inventory Candidate List)known by some 550,000 different names. Inaddition, CHEMLINE now contains ChemicalAbstracts Service (CAS) Registry Numbers,molecular formulas, chemical names, syno-nyms and corresponding name fragments,ring information, some MeSH terms, and a"locator" data element to aid in identifyingother files with information about a specificsubstance Arrangements were made to fa-cilitate the use of CHEMLINE by industry,EPA, and other interested parties in connec-tion with the chemical product inventorymandated by the TSCA. EPA's TSCA Inven-tory Candidate List—now a component ofCHEMLINE—is a key element of this newcapability. On-line usage for CHEMLINEreached 300 hours per month for a total ofmore than 3,000 hours during the year.

Registry of Toxic Effects of Chemical Sub-stances: A new on-line service is based onthe contents of the National Institute of Oc-cupational Safety and Health publication(1976) entitled Registry of Toxic Effects ofChemical Substances (RTECS). The file con-tains acute toxicity data for approximately21,000 substances known by some 60,000synonyms. The file also provides somethreshold limit values, recommended stand-ards in air, and aquatic toxicity. Referencesto data sources are cited. RTECS will be up-dated annually.

Toxicology Data Bank. Work continuedon the development of the Toxicology DataBank (TDB) which contains evaluated dataon selected chemicals extracted from suchsources as textbooks, handbooks, reviews,and criteria documents. The data bank willultimately contain information on more than5,000 chemicals, and potential or knownbiological hazards to which major popula-tion groups are exposed. An initial file con-taining some 600 records was used for sys-tems testing. A regenerated and augmentedfile with more than 1,000 records is readyfor expanded testing of format, content, anddata accessibility.

Collaborative Activities withOther Agencies

TIP continued to manage the ToxicologyInformation Subcommittee of the DHEWCommittee to Coordinate Toxicology andRelated Programs This group hab taken ona more important role with the passage ofthe Toxic Substances Control Act (TSCA)Resources were provided by the Committeeto support certain continuing Subcommitteeprojects and to initiate projects that will bedeveloped as a consequence of the enact-ment of TSCA. The projects being carr iedout with interagency funds and managed byNLM are:

1. The Toxicology Re-search Pro/eelsDirectory, Volume II, was published infour issues plus a fifth cumulative indexissue in calendar year 1977; it includessome 10,000 project descriptions. TheDirectory is a subset of "toxicology"project descriptions extracted from thecomputerized files of the SmithsonianScience Information Exchange Based ontwo years' experience with this publica-tion, the decision was made to improveits usefulness by converting it in 1978to a monthly publication with an annualindex. Other changes m format and typestyle are planned to improve the publi-cation's utility.

2. Toxicology Tesr/ng-/n-Progress (1 OX-TIPS) is a monthly publication intendedto serve as a forum for exchanging in-formation on the long-term toxicologytesting of chemicals Since such testingis very expensive and because testingfacilities are in short supply, it is im-portant for Government and industryto avoid inadvertant replication of tests.The importance of disseminating infor-mation about testing will increase as thegrowing requirements of the Toxic Sub-stances Control Act have an impact onthe scarce facilities and scientific re-

26

Specialized Information Services

sources available for long-term toxicol-ogy testing.

Afiei <i period of experimentation, thefoim.it of I OX TIPS has been stabilized.Issues contain from 20 to 30 testing re-ports; these a ic - indexed by compoundtested (and within this category by spe-c ies, route, and duration of the test) andby organization and investigator. Thecompound index is cumulated quar-terly, while the organization index iscumulated in each issue. A recent suc-cessful innovation was - to include shortbibliographies (from MEDLINE, TOX-LINE, and CANCERLINE) on the biologi-cal effects of the compounds beingtested.

3. The Lj/)or.ifory Animal Data Bank isbeing developed as an on-line, interac-tive data retrieval service that providesbase-line values and characteristics forselected strains of laboratory controlanimals. The data for LAJ3B come fromindustrial, academic, and Governmentlaboratories. The file currently containshusbandry and base-line data on 70colonies of various species/strains (ro-dent, dog, and monkey) and about12,000 animals. Phase I (sponsor) testingof this file was completed on August31, and Phase II testing, which includesabout 30 data donors, has been started.Decisions regarding public access to thisfile will be made after the results of thetwo tests have been evaluated.

27

Chapter 5: Audiovisual Programs

George E. Mitchell, D.M.D.*

The National Medical Audiovisual Center(NMAC), a part of the National Library ofMedicine since 1967, is responsible for plan-ning and administering a national programto improve the quality and utilization oflearning materials in the health professionsThe Center is located in Atlanta, Georgia Incooperation with the Library's Lister HillCenter and the Learning Resources Branchof the Bureau of Health Manpower, NMACemphasizes projects to assist educators inthe health professional community in deter-mining instructional needs, implementingeffective teaching methods, and developingevaluation techniques

The Center has concentrated on projectswith health professional schools and nationalspecialty groups that can continue to func-tion independently after the Center's initialsupport is withdrawn

Education Research andEvaluation

A wide range of research and evaluationprojects was completed or carried forwardin FY 1977 These included initiatives in ana-lyzing instructional development and audio-visual design procedures, improving tech-niques in medical photography, and up-grading existing audiovisual materials The

• Dr Mitchell Director of the Center since 1173 retiredon September JO 1')77 Dr Myron ) Adams )r hasbeen appointed Acting Director

completion of the first phase of a planningdocument for NMAC training was a majormilestone during the year The next step isto begin developing lesson plans for specificinstructional materials for NMAC's trainingprograms A test of medical students to de-termine their different learning stylos wasalso completed This information will pro-vide the basis for experimental studies tosee if these styles can be matched withdifferent kinds of instructional modalities toimprove effectiveness Work continued onthe development of prototype learning ma-terials and problem-based learning packages

A survey on the state of the art of instruc-tional technology in schools of the healthprofessions, based on data obtained fromquestionnaires sent to 1,479 schools, wascompleted in FY 1977 A final report on thesurvey is now being prepared that will con-tain a description of the purpose, signifi-cance, and methodology of the project, adetailed analysis and interpretation of thedata, and conclusions and recommendationsThis report will be sent to the schools thatparticipated in the survey and made avail-able to other interested organizations and in-dividuals

A survey on the status of biomcdical com-munications programs in the United Statesand Canada is also near completion Prelim-inary data have been partially analyzed andwere presented at a meeting of the Associa-tion of Biomedical Communications Direc-tors All responses to the five-page question-naire have now been coded and enteredinto the computer As soon as analyses and

28

Audiovisual Programs

interpretation of the data are completed, afinal report will be sent to all who partici-pated in the survey.

Significant findings and products from allresearch and evaluation efforts are beingmade available through training, consulta-tion, and a variety of publications.

Media DevelopmentDuring FY 1977, 91 instructional units

were completed through a combination ofcontractual agreements, collaborative activi-ties, and in-house productions. These in-cluded 6 motion pictures, 27 videotapes, 49slide-tape sets, 6 filmstrips, and 3 print units.(See Appendix 4.)

Students of medicine, nursing, and dentis-try continue to be the primary intendedviewers of most NMAC sponsored audiovis-ual materials, although increased emphasisis now being placed on the cont'nuing edu-cation needs of health professionals. A num-ber of projects intended primarily for resi-dents and practicing health professionals arein progress. Notable among these are a

Audiovisuals play an important role in health scienceeducation Students studying to be X-ray technicians areshown here from Woodruff Medical Center of Atlanta'sEmory University.

videotape program on "Acromegaly" and amulti-media course on "Amniocentesis."

Twelve new videotape recordings weremade for the series, "Leaders in AmericanMedicine." Two videotapes were recordedin a companion series, "Distinguished Lead-ers in Nursing," and will be released in earlyFY1978.

A new series of videotape recordings en-visioned as a long-range, continuing projectwas begun. Entitled "NMAC Technical Re-ports," the series offers an audiovisual alter-native to print documentation of innovativetechniques and procedures developed atNMAC. Two programs in the series, "MakingColor Composite Slides with a Rear-Projec-tion System" and "Variable Area Light Con-trol in X-ray Duplication," were completedand placed into distribution.

In the coming year, besides placing addi-tional emphasis on the Center's intramuralactivities, it is anticipated that a larger por-tion of the Center's media developmenteffort will be devoted to continuing educa-tion for practicing health professionals.

DistributionIn FY 1977 the functions of NMAC's Selec-

tion and Reference Section were transferredto Library Operations (in Bethesda). This ledto a reorganization of NMAC's MaterialsUtilization Branch and resulted in two newSections—the Distribution Section and theAcquisitions and Sales Section.

During the fiscal year, 48,690 loan requestswere received and 42,356 motion picturesand videotapes shipped. Some 5,000 NMAC-sponsored teaching packages were soldthrough the Sales Program of the NationalAudiovisual Center, General Services Admin-istration (GSA).

The Center acquired 164 new titles in FY1977 and made them available through thedistribution program. Seventy-seven new

29


titles were placed with the National Audio-visual Center (GSA) Sales Program. An-nouncements for each of these were distrib-uted by selected mailing keys.

The NMAC videotape distribution pro-gram begun last year continued to gain inuser demand. In FY 1977, 50 new titles wereadded bringing the number of videotapesnow available on loan to 192.

Three NMAC-sponsored self-study publi-cations were completed and offered for salethrough the National Technical InformationService, U.S. Department of Commerce. Atotal of 2,110 monographs, case studies, andtechnical reports were distributed by theCenter to requesters in the United States andforeign countries.

An inventory of materials in the archivalcollection was completed, 700 titles werelisted and are now being abstracted. Archi-val films are being transferred to videotapeand made available to requesters. Approxi-mately 75 titles have been transferred so farand will be advertised through a promo-tional flyer.

A new NMAC Gifa/og containing 818peer-reviewed titles was published duringthe second quarter of FY 1977. This editionwas computer-produced from ti t les in AV-LINE. A special listing of 573 NMAC titlesavailable for purchase from GSA Sales wasdistributed on mailing keys.

Workshops and ConferencesThe NMAC workshop/seminar program is

designed to teach health educators how toapply educational technology and systemsapproaches to instruction. There was an in-crease in the number of health educatorstrained in NMAC's six regional training cen-ters and a concomitant decrease in the num-ber trained at NMAC. This reflects progressmade in a three-phase plan to discontinuegiving certain workshops and seminars at

NMAC by placing packager) versions of thesesame workshops in the regional training cen-ters. A major objective of the plan is to con-centrate NMAC resources and staf f time indeveloping and testing new workshops andseminars. Faculty trained at both NMAC andin regional centers increased from 500 inFY 1976 to f>59 in this f i sca l year. Among the2f> workshops and seminars the followingtopics were included development andevaluation of audiovisual instructional mate-rials, designing and utili/mg simulation andgaming activities in health science educa-tion, content analysis, management of learn-ing resources, test construction, learningspaces, television production techniques,enhancement of instruct ional materials, anda workshop for Regional Medical Libraryaudiovisual consultants.

The NMAC regional training renter pro-gram begun last year made substantial prog-ress during the period. All six centers—Uni-versity of North Carolina, Delia College,University of Nebraska, Ohio State Univer-sity, Loma Linda University, and the StateUniversity of New York at Buffalo—havecompleted Phase II of the program and areconducting workshops with the assistance ofone NMAC coordinator The State Univer-sity of New York at Buffalo (SUNY) enteredPhase III of the program and conducted aworkshop in August independent of directsupport from NMAC staff . The workshopwas attended by 14 fa tu i ty members fromstates across the Nation SUNY has reportedreceiving over 100 inquiries from the fieldregarding dates and times for future work-shops. Centers at the University of NorthCarolina and Loma Linda University alsohave scheduled Phase III independent work-shops for the near future.

NMAC conducted the third training work-shop for Regional Medical Library audiovis-ual consultants at the South Central RegionalMedical Library (Dallas) in February 1977.This workshop, a spmoff from the advanced

30

Audiovisual Programs

seminar conducted during FY 1976, was de-signed to train a new group of audiovisualconsultants as backups to those previouslytrained. Fifteen participants representingnine of the eleven regions attended.

Dr. Myron J. Adams, Jr., Acting Director of NMAC, dis-cusses a storyboard with Dr Stewart H Rowberry, newChief of the Center's Materials Development Branch.

Advisory ServicesA number of on-site surveys and consulta-

tions were conducted in FY 1977. One ofthese was at the two Medical Centers of the

Louisiana State University—in New Orleansand Shreveport. The major objective was toidentify areas of the learning resources andaudiovisual departments that are useful andefficient and atso those that are deficient, in-efficient, or redundant. Other on-site surveyswere conducted at Oral Roberts University,Boston University Medical Center, Universityof Texas Medical Branch at Galveston, theAmerican College of Chest Physicians, Beth-Israel Medical Center, Vocational EducationMedia Center in Atlanta, MLA Program atLSU Medical Center, and the 112th Mid-Winter Meeting of the Chicago Dental So-ciety.

At NMAC, a total of 167 consultationswere provided to administrators, faculty, andstaff from schools of the -health sciences,universities, and hospitals. Coming from allparts of the United States and 11 foreigncountries, the visitors discussed educationaltechnology, instructional materials develop-ment, learning spaces, equipment and com-munications systems with NMAC staff.

Table 14. Selected Statistics, NMAC

Audiovisuals RequestedAudiovisuals ShippedTitles Added (Film & Videotape)Audiotape DuplicationTitles to NAC for SaleTeaching Packages Sold Through NACOn-site SurveysOn-site ConsultationsIn-house ConsultationsGrants ReviewedMonographs DistributedIn-house Workshops (314 attendees) .Regional Workshops (345 attendees) .

FY197748,69042,356

1642,404

775,048

111

16711

2,1101214

31

Chapter 6: Lister Hill National Cen-ter For Biomedical Communications

Harold M. Schoolman, M.D., Acting Director

During the period of this report the ListerHill National Center for Biomedical Com-munications saw construction start on thenew Lister Hill Center building The PublicHealth Service/Communication!) TechnologySatellite Network installed six stations, andbecame an operating reality A major newproject to help meet the information needsof health care professionals was successfullydemonstrated The applications of minicom-puters and microprocessors to both libraryautomation and medical education contin-ued to expand.

Dissemination of ResearchInformation

The translation of new research findingsinto forms useful for health care practi-tioners is addressed by many different ap-proaches within the biomedical and infor-mation science communities A new pro-gram area within the Lister Hill Center isaimed at the development, demonstration,and evaluation of innovative mechanisms forinformation transfer and exchange, with em-phasis on the organization and utilizationof information.

The health care practitioner is faced witha profusion of words on almost any bio-medical topic The practitioner's problem isnot so much in being unable to find thesources of information as it is in having thetime and access to a source of informationappropriate for his needs In principle, thereservoirs of information m medical libraries

can be drawn upon to provide answers tothe practitioner's questions However, formany busy health care providers, the factsof life are often otherwise The user is con-fronted with dif f icult dilemmas m choosingsources of information from which to seekanswers In a medical library, for instance,.1 query may e l ic i t c i t a t i ons to many relevantpublications, but no guidance as to whichspecific art ic le contains the informationwanted The requester must obtain the ar-ticles (sometimes a di f f icul t process) andread them In those he reads, he may or maynot find what he wants Answers might befound in several ar t ic les, but disagreeingwith one another Obtaining some approxi-mation of a consensus in a controversial areamay require investing a considerable num-ber of hours In an area in which the readeris not himself an expert, it is not always easyto know if a view expressed by an author isgenerally accepted, or is unique and aber-rant Information, although relevant, mayhave quietly and unknowingly become obso-lete Added to the user's burdens is a dis-turbing amount of redundancy m the litera-ture Clearly, the individual practitionerneeds help m dealing with the massiveamount of available biomedical information

A prototype sysk'm to meet the healthpractit ioner's needs, being developed by thelister Hill (enter, aims at providing a com-prehensive bank of information which 1)will contain substantive answers to questionsposed by prnrlitioners, 1) will provideanswers that .ire cuncnt and are the con-sensus of a group of experts, J) will be

32

Lister Hill Center

immediately responsiveto inquiries (reliable,ready of access); and 4) will provide datasupporting the answers as well as citationsto primary publications for more detailedstudy if desired.

The diseases "viral hepatitis" have beenselected to serve as a test model for suchan information transfer system. Knowledgepertaining to aspects of the diseases impor-tant to the practitioner and/or academicianhas been synthesized using the informationcontained in several outstanding syntheseson the subject previously published by hepa-titis experts. Relevant information has beenselected, placed in a highly organized hier-archical arrangement to permit easy re-trieval, and encoded into a minicomputer.The data base, still in draft form, is arrangedby topics (headings). For each heading thereis an accompanying heading-statementwhich synthesizes the state of knowledge

about the subject Each heading and head-ing-statement is supported by "data ele-ments"—paragraphs taken from previouslypublished source documents. Citations in-cluded within the data element paragraphsare to the primary publications cited by theexperts in their source document articlesto back up their conclusions or generalstatements. This draft hepatitis data basecan now be explored via terminals at NLM.A printed copy of the data base Table ofContents serves as a convenient index andallows easy access to whatever informationis sought in varying degrees of detail (tomatch the user's needs).

In the next several months, the Centerwill work with a group of experts to: (1)validate the content of the initial baselineviral hepatitis information bank; (2) updatethe content with selected materials pub-lished in the last two-and-a-half years; and

Lister Hill Center staff members Dr Lionel M Bernstein (left) and Dr Elliot R Siegel experiment with the on-linehepatitis data base.

33


(3) maintain currency of the informationbank by continuous monitoring of newlypublished material and modifying the database monthly.

Once the prototype computerized infor-mation bank is established, validated, andbrought up to date in the selected diseasearea, methods of user access to the informa-tion will be studied. Access may be directvia a computer terminal or through a trainedintermediary using a toll-free dial-accesstelephone number, users also may receivecomputer-generated printed material, eitherin response to specific queries'or as a com-plete document on a given disease. The in-formation bank also will be made availableto professional societies and to other pro-ducers of health-related information prod-ucts and services, ranging from scholarlymonographs to multimedia instructionalpackages.

Broadband BiomedicalCommunications

In its role as technical coordinator forthe Public Health Service (PHS), the NationalLibrary of Medicine has developed a nationalexperimental biomedical communicationsnetwork consisting of six earth terminalslinked via the Communications TechnologySatellite (CTS) The network provides full-duplex (simultaneous two-way) color videoand audio communications of high qualityand reliability This network is used to con-duct experiments in resource sharing, con-tinuing health education, and teleconfer-encing, in order to explore interactive videoas a tool for future health systems. In addi-tion, technical experiments are being de-signed to identify and evaluate parameterswhich must be taken into consideration forfuture operational networks

The earth terminals in this network use10-foot parabolic dish antennas and operatein the relatively uncrowded K-band (12-14GHz) of the radio frequency spectrum.

This ground network of small terminalsinterconnects facilities in six cities distrib-uted over a broad, genuinely "national"geographical area to form the nucleus ofthe first interactive experimental broadbandbiomedical communications network. Theseterminals are located at Bethesda, Lexington,Denver, Seattle, Bozeman (Montana), andFairbanks.

Although the terminals installed and oper-ated by the Public Health Service form thenucleus of the network, other United StatesCTS experimenters have shared their facili-ties with the health community in theirlocalities With the extension made possibleby such cooperation on the part of otherCTS users, the experimental network canspan over 50 communications facilitieswithin the continental United States.

Bethesda is the Network CoordinatingCenter (NCC). From this location, each ofthe PHS facilities receives the operationaland maintenance coordination required toperform the experiments. Each terminal,however, is equipped to operate as an inde-pendent transmission center. The main roleof the NCC is to provide a centralized con-trol point for the network and a contactpoint for the NASA Experiment ControlCenter.

The Bethesda earth terminal at NLM, inaddition to housing the K-band satellitecommunications equipment, also includes afacility for interactive telecasting that con-sists of a mini-studio and the Billings Audi-torium. Although the facility borrows con-cepts from the world of standard televisionbroadcasting studios, it is different in func-tion and layout The basic functional differ-ence is in the emphasis on interactive, ratherthan one-way, communications. This com-munication mode gives rise to certain prob-lems, such as the "echo problem" that isfrequently experienced by interactive com-munication facilities

34

Lister Hill Center

Production crew oversees program being telecast by sateftite transmission from NLM's new CTS control room

The Lister Hill Center is coordinating userprograms with three of the six Public HealthService agencies. The Health Resources Ad-ministration, presently the largest of theexperimental groups, is sponsoring programsin four health disciplines:

1. Under the project management ofHRA's Division of Nursing, a pro-gram with the University of Wash-ington has been designed and per-formed to disseminate researchresults in the field of predictivenursing involving infants and par-ents.

2. The American Dietetic Associationhas developed a continuing educa-tion program for professional dieti-tians in long term care.

3. The Division of Dentistry will pre-sent a series of programs in con-

tinuing dental education and dentalfaculty development.

4. The University of Washington'sWAMI program (Washington—Alas-ka—Montana—Idaho) is expandingits program under the Division ofMedicine to include faculty sharing,independent student learning, ad-missions, minority recruitment, stu-dent consultation, and legislativeprocess.

The second experimental group, the Na-tional Institutes of Health, is planning toproduce and distribute a series of continuingeducation programs for health professionals.

The third group, the National Institute onDrug Abuse under the Alcohol, Drug Abuse,and Mental Health Administration, is explor-ing the use of teleconferencing to exchangeinformation between drug program centers.

35


Broadband Telecommuni-cations Research

The Public Health Service/Communica-tions Technology Satellite (PHS/CTS) net-work is also being used as a communicationsresearch laboratory to correct shortcomingsrevealed by the actual operation of the PHS/CTS system, and to optimize usage of thesystem. Experimenting with and introducinginnovative techniques, such as channel-sharing, will point toward more cost-effec-tive biomedical communications.

The use of the network for simultaneoustwo-way audio/video communications hasuncovered certain problems that limit itseffectiveness. The audio channel, for ex-ample, suffers both from intermittent fadingand from echoes, an undesirable feature ofinteractive communications. The studiocontroller copes with these problems atpresent by manually controlling the channelto maintain constant signal levels, but thisis a stopgap solution. Incorporating a voiceactivated switch and an echo suppressor inthe audio channel has only partially solvedthese problems. An investigation now under-way should lead to either an adjustment tothe present hardware or to the design anddevelopment of an improved version thatwill rectify the audio impairment.

To increase the interaction between thestations in the network, two video signalswere allowed to share one of the two broad-band CTS channels by a frequency-divisionmultiple-access technique. The other chan-nel meanwhile was occupied by anothervideo signal, as normally done. This processtherefore has allowed three video signalsto be "on the air" simultaneously as op-posed to the two for which the system wasoriginally planned. Now three stations canbe in a full-duplex video communicationsmode with a fourth conducting full-duplexaudio. This increased technical capabilityhas brought about the opportunity to insti-tute and evaluate programs that can effec-

tively utilize, or actually need, more inter-action than before.

Telephone transmissions of physiologicalsignals such as EKG's and EEC's are becom-ing increasingly important m biotelemetryas applied to the areas of remote consulta-tion and computer-aided diagnosis, and po-tentially for remote medical education. Aninvestigation was conducted into the spec-trum requirements to transmit EKC's andEEC's, currently used methods of transmis-sion, and various shortcomings in their im-plementation. The study also points outpossible solutions to these shortcomings,such as digital modulation and coding tech-niques

Computer-Based EducationMaterials (CBEM)

The Lister Hill Center has continued tosupport the health science educationcom-munity through its program in computer-based education. The Learning ResourceLaboratory, completed last year, has con-tinued to serve as a "window" to the worldof computer-based educational materials forthe many visitors from the health sciencecommunity Additional projects this yearhave included the development of a mini-computer/microprocessor CAI system thatpromises to have great impact on the cost-effective delivery of CBEM A major goal ofthese endeavors is to demonstrate the trans-fer of CBEM from centralized large-scalecomputers or minicomputers to microproc-essor-based stand-alone intelligent terminalsystems This would merge the advantagesof centralized management with the econo-mies of stand-alone delivery

Another major project has been the de-velopment of a Plasma Terminal System(PTS). The PTS, when completed, willanswer many needs of the health scienceeducation community There are presentlyfour CAI languages (systems) of major im-portance to the health science community

36

Lister Hill Center

PLATO/TUTOR (University of Illinois, Ur-bana-Champaign), MUMPS (MassachusettsGeneral Hospital, Boston), Coursewriter(IBM), and PILOT (University of California,San Francisco). Of these four, PLATO/TUTOR is unique in its use of computer-generated graphics; it also requires, at pres-ent, a special computer terminal. Since agrowing number of medical, dental, andnursing institutions also use the other threelanguages, they are required to support twodifferent types of computer terminals. ThePlasma Terminal System will allow users toaccess all four CA1 languages with oneterminal. It will, furthermore, provide theMUMPS, Coursewriter, and PILOT languageswith a capability for computer-generatedgraphics comparable to that available onlyfrom PLATO today. Such graphics capabilityhas already been demonstrated with MUMPSin the Learning Resource Laboratory. Last,but not least, the PTSwill also allow CBEMmaterial written in the PILOT CAI language

to be used by the student in a stand-alonemode with graphics; that is, not connectedto a remote host computer. The design ofthe PTS has been completed, and the pro-totype unit is presently under development.A working system will be demonstrated inthe first quarter of FY 1978.

A national workshop was held at theNational Library of Medicine, in collabora-tion with the Association of AmericanMedical Colleges (AAMC), to establish"Guidelines for the Appraisal of Computer-Based Educational Materials in the HealthSciences." This workshop resulted in a setof initial guidelines from which were devel-oped appraisal forms. The AAMC has fieldtested the guidelines and appraisal formsand is now drafting recommendations fortheir implementation.

An experimental Lister Hill Center News-letter on Computer-Based Education for theHealth Sciences was published and sent to

On April 20, 1977 a CIS satellite transmission allowed students in Bethesda and California to discuss DNA researchguidelines with NIH Director Donald S Frednckson On Dr Frednckson's right is Allan Ladwig, president of theForum for the Advancement of Students in Science and Technology.

37


approximately 1500 members of the healthscience education community. In addition,a slide-tape presentation of the Center'sCBEM programs was produced and shownat the 1976 AAMC annual meeting in SanFrancisco.

Library AutomationThe Lister Hill Center has begun a pro-

gram to exploit the potential of mini-computer/microprocessor-based systems forcost-savings in libraries. These efforts haveas their aim the evolution of a minicom-puter-based, integrated library system. Spe-cial concern is for effective access, by theminicomputer-based system, to the nationallibrary networks.

As a first effort, the Center's ComputerTechnology Branch implemented, early inFY 1977, a distributed, minicomputer-basedinput processing system for NLM's LibraryOperations Division. This system is nowoperational and supports "selection and ac-quisition" processing. Now being extendedto other NLM applications, the system hasalready resulted in a great saving in proc-essing costs.

As the only federal library with an in-house R&D program on library automation,NLM was asked to consult on this topic bythe Federal Library Committee. As a conse-quence, the Lister Hill Center staff has pro-vided consultation to numerous federalagencies on minicomputer and microproc-essor based library applications.

Efforts of the Lister Hill Center in this areahave also been recognized by the GeneralServices Administration and the Army Li-brary, in the Pentagon. The General ServicesAdministration has entered into an inter-agency agreement with the NLM to obtaintechnical direction from the Lister Hill Cen-

ter for a minicomputer-based library systemin the Army Library. The first function to beimplemented will be capable of integrationwith the previously described "selection andacquisition" system already operational atNLM.

Other federal agencies are considering thefunding of complementary library functionsconsistent with the Lister Hill Center effort.This potential for cooperative, nonduplica-tive funding and development nmong fed-eral agencies is of .major interest to theGeneral Services Administration. The federalcommunity, in return, ran obtain maximumbenefit from parallel research and develop-ment efforts underway at the National Li-brary of Medicine.

The Division Directors of the Ohio Col-lege Library Center (OCLC) have voted toapprove a joint Lister Hill Center/OCLC re-search and development project to developa specialized interface to the OCLC na-tionally shared cataloging network. Thisinterface experiment will use the micro-processor-based "Intelligent Input/OutputBuffer (MOB)" developed by the Lister HillCenter in FY 1977. The HOB allows com-munication between different computersystems.

In concert with earlier plans to improvethe interface between the user and the tech-nology, a "user-cordial interface" was devel-oped to provide access to the Library's on-line catalog, CATLINC, without requiring theuser to learn a sophisticated retrieval lan-guage. The user-cordial interface also for-matted the CATLINE record into a cardimage format familiar to all users of theNLM public catalog. The concepts demon-strated have opened up new alternatives forutilization of general retrieval systems bylibrary patrons.

38

Chapter 7: Grants for LibraryAssistance

Ernest M. Allen, Sc.D., Associate Director,Extramural Programs

The Extr.imural Programs of the NationalLibrary of Medicine .ire helping to improvethe dissemination of health knowledge byfunding a variety of information programsat institutions around the United States. Bymeans of grants and contracts, these institu-tions can augment their information activi-ties and share in ,1 coordinated nationaleffort to expedite the exchange of informa-tion among health researchers, practitioners,and educators.

The Extramural Programs operate underthe authori/ation of the Medical LibraryAssistance Act of 19(>r>, as amended. Title IIof Public Law 95-fU, "Biomcdical ResearchExtension Act of 1977," the most recentamendment, provides extended authority forthe currently supported programs.

Regional Medical LibrariesA highly visible example of cooperative

effort is the Regional Medical Library Net-work. When Congress first considered theauthorities thai established the ExtramuralPrograms in 1%S, it appeared that the in-creasing amount of health information gen-erated by research, on the one hand, and theincreased need to h.ive access to this in-formation, on the other, represented a long-term trend. Furthermore, even with moderncommunications, dispersal of the healthcommunity posed difficulties for rapid accessto knowledge. It seemed clear that some

form of regional organi/afion could bestassure adequate health information servicesfor the entire country.

The Francis A. Countway Library of Medi-cine, at Harvard Medical Center, received agrant for regional services in 1967. Within18 months, nine other regions of the coun-try had also established Regional Librarieswith support from the National Library ofMedicine. (The NLM ads as the eleventhregional medical library.) In FY 1977, Re-gional Medical Library obligations amountedto $.5,08(>,000.

In the regions, the librarian of a contract-ing institution acts as Regional Medical Li-brary Director. For day-to-day regionalservices there is usually a separate staff.Frequently, certain activities are subcon-tracted to other libraries. Each region alsohas at least one advisory group, represent-ing health information users and providers.The combined RML staffs include 42 pro-fessional librarians.

The eleven Regional Medical Library Di-rectors meet twice a year. In FY 1977 theymet in Bethesda in December, and at theannual meeting of the Medical Library Asso-ciation in Seattle in June. In cooperationwith NLM staff, the Directors have sponsoredtraining for regional audiovisual library con-sultants. In February, 1977, for example, 30librarians met in Dallas for a week of inten-sive training and orientation in this field.

39


Planning is very important in developingcoordinated services in the regions In Re-gion VII (Indiana, Illinois, Iowa, North Da-kota, Wisconsin, Minnesota) a planningorganization has evolved to solicit the viewsof librarians from city and country, medicalcenter and isolated community hospital, andto integrate these views into mutually agreed-on priorities In Region II there are areagroups corresponding to Health SystemsAgencies (HSAs) which meet regularly toconvey their needs and plans to the RMLOther regions have developed other mech-anisms

An essential function of the RegionalMedical Library Network is the exchange ofdocuments among participating membersThese mterhbrary loans flow in a hierarchicalpattern Material not available in a basicunit, such as a community hospital, is re-quested from a larger library, such as anacademic medical center If this library isunable to fill the request, it is forwarded tothe Regional Medical Library If the RML isunsuccessful, it may send the request on tothe National Library of Medicine Healthprofessionals, no matter where they are lo-cated, now can draw upon the Nation's col-lected health knowledge conveniently andquickly In 1977 the network provided morethan a million mterhbrary loans within theregions In the past year, Extramural Pro-grams staff and the RML Directors havebeen working on a plan to establish fiscalstability within the network by an appro-priate allocation of responsibilities amongthe various public and private organi/ationsand institutions involved

Resource Project GrantsResource Project Grants to support in-

formation activities are awarded to institu-tions on behalf of their health libraries Theinstitution must show how it will maintaina successful project after the period of grantsupport

In FY 1977 the Extramural Programsfunded 37 new projects and continued nine

into an additional grant year Of the newprojects, 15 involve arrangements for mter-institutional cooperation or resource sharing,12 are for alteration and renovation of space,5 are for new information services, primarilyfor educational programs 1 will enableacademic medical center libraries to adoptadvanced computer systems The final twoprojects are for preserving signif icant sourcedocuments in the history of medicine

The comparatively large number of proj-ects for resource-sharing arrangements con-tinues a program direction begun severalyears ago by NLM The new projects, reflect-ing careful local planning, seek to raiseprofessional standards, to improve commu-nication, and to develop arrangements forperpetuating shared activities after the grantruns out

A particularly ambitious resource-sharingproject is the development of a network inIdaho—IDA-HEAL-NET Because Idaho doesnot have a medical school, the state libraryhas assumed responsibility for coordinatinga health information network The 52 hos-pitals* in the state arc small, only 12 havemore than 100 beds Tew have identifiablelibraries or information functions A full-time health sciences librarian will serve ascoordinator, working with three area healtheducation consortia located in each of thestate's natural geographic regions Networkprojects include a list of serials, coordinatedon-line services, better stat ist ics, and work-shops for the staff providing informationservices

In addition to statewide cooperativeefforts like IDA-HEAl-NET, project grantssupport local and regional associations ofhealth institutions The Northwest IndianaHealth Science Consortium, for example,sponsored by the Indiana University Schoolof Medicine, will enable a group of six hos-pitals to coordinate programs and activitiesin a densely populated but medically under-served area

In the New York-New lersey region, theRegional Medical Library s ta f f and academic

40

Grants for Library Assistance

First year medical students at the Albany Medical College view audiovisual instructional materials in the SchafferLibrary of the Health Sciences. The library's multimedia services were developed with the assistance of a two-yeargrant from NLM.

medical librarians have organized to developaudiovisual services. Their model is a sophis-ticated audiovisual (AV) resource center atthe College of Medicine and Dentistry ofNew Jersey. An advisory task force used thisexperience as a guide in planning region-wide shared audiovisual services. The taskforce members designated certain institu-tions to serve as AV resource libraries withingeographically defined areas. Following themaster plan, grant supported AV projectshave been started at SUNY-Buffalo, SUNY-Upstate Medical Center at Syracuse, and theAlbany Medical College. Project activitiesinclude developing collections of audio-visuals, shared reference and technical serv-ices, and union audiovisual lists.

Resource ImprovementGrants

While Resource Improvement Grants willcontinue to help small or isolated institu-tions start health libraries, the primary in-

terest and priority changed in FY 1977 toone of fostering local health informationconsortia. The grants make start-up fundingavailable to groups of institutions to plancooperative programs. A second award thenhelps provide basic print materials. Theselocal cooperative arrangements, where someinstitutional matching funds are required,seem the best way to help smaller institu-tions participate more effectively in the Re-gional Medical Library Network.

An Improvement Grant for first year plan-ning was awarded to the Laurel HighlandsHealth Sciences Library Consortium, a groupof 12 members headquartered at ConemaughValley Memorial Hospital in Johnstown,Pennsylvania. Membership includes hos-pitals, community health agencies, and sev-eral educational institutions with healthmanpower programs.

A Resource Improvement Grant has beenawarded to the Health Sciences Libraries of

41


Central Georgia for the second budget in-crement period. The eight-member HSLCGconsortium was organized in October 1975.Considerable planning and organization hadtaken place so that a first-year award forplanning was not needed. The grant fundswill help the smaller members of the con-sortium strengthen their collections of booksand journals.

Research, Development, andDemonstration Grants

The discovery of new knowledge and thetesting of new technologies are necessary toadvance the state of medical hbrarianshipand to meet health information needs. OnJuly 22, 1977, a special task force met atNLM to examine the Research Grants Pro-gram and to make recommendations forimproving the quality of NLM researchgrants. Dr. John F. Sherman, Vi<e Presidentof the Association of American Medical Col-leges, presided Task force members weredrawn from a variety of disciplines and orga-nizations including library schools, medicalschools, private industry, and other Federalagencies.

The task force disc ussed the need to defineNLM goals in this area so that the limitedresearch funds are used for areas of highprogrammatic interest, the need for a properbalance between basic and applied researchso that both immediate information prob-lems and future issues are addressed, grantsupport for salaries of promising young re-searchers; a small research grant program(under $10,000) with a more rapid reviewcycle to support modest, short-term projects,assumption of responsibility by NLM forbasic research in computer medicine; cross-fertilization between intramural and extra-mural R £ D efforts at NLM; developmentof synergistic relationships with other Fed-eral agencies; and a greater emphasis ondisseminating the results of communicationsresearch and applying them to medical li-brary practice.

A small working group of task force mem-bers and NLM staff is scheduled to meetearly in FY 1978 to consider the discussionsand to prepare a report with spc( ific recom-mendations. It is anticipated that the qualityof NLM research grants will be enhancedas result of these activities.

Training ProgramsSince 1971 the Training Grant Program

has concentrated on preparing health pro-fessionals for our increasingly computerizedworld. The ultimate goal is to promote thecomplete and effective integration of com-puter technology into all phases of medicine—teaching, research, and prac t ice .

The approach selected is to provide inter-disciplinary training in the computer andhealth sciences for teachers and potentialfaculty members, especially those with careergoals in biomedical research. Graduates ofthe programs can be expe< led to instil l intheir own students and colleagues an aware-ness of the potential of computer appl ica-tions of medicine, in short, to a c t as trans-lators between the computer s c i e n c e s andthe health field.

One new program leading to a master'sdegree in computer science after two yearsof intensive training was funded in FY 77 atthe University of Illinois at ( hampaign-Urbana. The first class of four trainees wasenrolled in September I977 The studentsare physicians who have completed all ormost of their residencies. The School ofHasic Medical Science and the Departmentof Computer Science are collaborating inoffering coursework and supervising researchprojects for the trainees With this award,Fxtramural Programs now sponsors ten suchtraining programs. Seventy-eight individualtrainees received stipends during the 1()7(>/77academic year.

Special Scientific ProjectsThese awards enable outstanding scholars

to analyze, evaluate, and synthesize what isknown—although frequently published very

42

Grants /or Library Assistance

diffusely—into single treatises on broadhealth topics These treatises provide theserious inquirer with complete and docu-mented interpretation of a major subjectOnly a few projects are supported eachyear, although the range of program interestcovers all of health and medicine

One piojed begun this year is a study ofnational policies and priorities for healthresearch and development Professor RobertF Rushmer of the University of WashingtonCenter for Bioengmeermg will explore theorigins and current trends of policies andpriorities adopted by Federal agencies intheir support of health-related research Hewill assess the relationship of future researchand development to pressures for budgetaryreform, to changing public attitudes towardscience and technology, and to the public'srole in research and development decisions

Dr Ernst Jokl, Professor Emeritus of theUniversity of Kentucky School of Medicine,has received a grant for a book on the socialand medical implications of the growingfield of sports medicine He will describe thesports movement as it has developed in thiscentury, in several countries, with specialreference to i ts medical implications Thevaried studies and experiments he will de-scribe i l lustrate the potential contributionof sports to national fitness and health

Four persons who received Special Scien-tific Project awards in earlier years havesent their manusc npls to publishers The nev\works are expected to appear on publisherslists in early 1978

Biomedical Scientific Public-ations

Publication Grants facilitate the dissemi-nation and sharing of scientific informationimportant to medical progress and publichealth Both domestic and international re-sources are utilized in this effort Interna-tional support is through Special Foreign

'W

Currency Agreements and collaborative, bi-lateral programs in certain countries Theinternational biomedical publication pro-gram, authorized under Public Law 480, isdescribed in the chapter on InternationalActivities

The domestic Publication Grant Programsupports biomedical publications of a non-profit nature The Program includes thepreparation and publication of critical re-views and monographs in health fields,publications in library and information sci-ence and in biomedical communication,pilot or temporary support for periodicalpublications, studies in the history of medi-cine, translations of current foreign bio-medical monographs, publication of sym-posia proceedings and secondary literaturetools in the health sciences, such as atlases,catalogs, and bibliographies

In authorizing NLM funds for biomedicalpublication grants, the Congress recognizedthe continuing growth in quantity and spe-cialization of biomedical knowledge Theneed persists for tools to analyze, synthesize,repackage, and disseminate information forU S health professionals Expanding knowl-edge and new concepts of health carerequire evaluation in both current and his-torical perspective In developing the pub-lication support program NLM staff hascalled on U S professional societies, univer-sity presses, research investigators, healthpractit ioners, and public and private healthsupport agencies to examine their informa-tion needs and resources

During FY 1977, 42 Publication Grants,totaling $7WMr>, were funded Of these,26 were new awards, including a compre-hensive monograph on endemic goiter andcretinism, the proceedings of a conferenceon the early diagnosis of compressed airillness, and a history of radiation protectionstandards Some1 priority is given to theaward of small grants for p ro jec ts whichare i/nderway and scheduled for early pub-lication This priority is reflected in the

43


average amount of all Publication Grantsawarded in FY 1977—under $18,000.

Among the studies published in FY 1977was the multi-authored Review of AlliedHealth Education:2 (Lexington, Kentucky:The University Press of Kentucky, 1977), thesecond in a series of current appraisals ofdevelopments in allied health education andresearch, ranging from the general topic ofeducation in the health sciences, to specifichealth care disciplines such as mentalhealth.The Library's continuing interest in the inter-relationships between medicine and society

was also reflected in an article publishedwith NLM support by a leading U.S. his-torian, Dr. Gerald N. Grob, entitled, "TheSocial History of Medicine and Disease inAmerica: Problems and Possibilities." Writ-ing in the journal of Social History (June,1977), the author points to the serious needfor systematic, historical studies of morbidityand mortality patterns and their influencein various societies. (For a complete listingof books, periodicals, and journal articlesresulting from NLM Publication Grants, re-ceived in FY 1977, see Appendix 2.)

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

ResearchResource ProjectsResource ImprovementTraining (including

Fellowships)Special Scientific

ProjectsRegional Medical

Libraries*"Publications**OtherTotal

" Includes contract funding.

FY 7975luly 7975-/une 7976

Transi-tional

Quarter FY 7977

(20)*(47)(28)

(9)

(4)

$1,2921,387

82

891

153

(14)(27)(10)

(11)

(2)

$1,14766326

1,056

59

(3)(2)(4)

(2)

(1)

$ 2062611

333

13

(15)(46)(20)

(10)

(3)

$1,1651,696

77

1,207

109

(9)(36)

(153)

number

2,194614

$6,613

of projects.

(8)(40)

'112)

2,721606

$6,278

(2)(4)

(18)

63062

$1,281

(9)(42)

(4)(149)

3,0867.38276

$8,354

1 Mv-Si'pt. 1976

44

Chapter 8: International Activities

Mary E. Corning, Assistant Director forInternational Programs

The NLM continues as a national resourcewith international impact. Its internationalactivities include: bilateral quid-pro-quoMEDLARS agreements; exchange of bio-medical literature; information services tothe developing countries through an NLM/Agency for International Development (AID)agreement; special foreign currency pro-gram for the support of publications; par-ticipation in international organizations;providing technical consultation; and receiv-ing non-U.S. colleagues for specializedtraining.

International MEDLARSAgreements

Today, NLM has eleven internationalMEDLARS partners: Australia, Canada,France, Germany, Iran, Japan, Mexico, SouthAfrica, Sweden, United Kingdom, and thePan American Health Organization (PAHO).The most recent—Iran, Mexico, South Africa,and PAHO—achieved operational statusduring the past year.

The quid-pro-quo bilateral agreementwhich is the basis for this collaboration,continues as an effective mechanism forcooperation. Together, these bilateral ar-rangements constitute essentially an inter-national network in which the value of bio-medical information is recognized as vitalto the advancement of medical research,education, and the improvement of health.

Table 16 summarizes the modes of accessto the NLM data base. In April 1977 theBritish Library, which had been accessingthe NLM computer on-line, mounted thedata base in the U.K. for the direct opera-tion of a computerized biomedical infor-mation activity. It continues, however, toaccess the NLM on-line for supplementaluse of data bases on the NLM computer.In the same manner, Sweden, in additionto operating the MEDLARS system in Stock-holm, is supplementing its usage with on-line access to NLM.

With the advent of on-line operations onthe European scene, Sweden, Germany,France, and the United Kingdom are pro-viding extensive on-line services outside of

Frieda Vaghar searches MEDLINE from the terminal inthe Pahlavi Library of Medicine, Tehran, Iran

45


their national boundaries. Table 17 showsthe data bases now being searched on anoperational basis by our partners. Somewho are not currently using the TOXLINEand CHEMLINE data bases intend to usethem within the next year.

The World Health Organization, whichhad been providing MEDLARS services to itsstaff and to the developing countries, hasdecided to terminate its MEDLARS activitiesas of December 1977. This raises a seriousissue of availability of resources to provideservices to the developing countries.

Preparations are underway for the nextmeeting of the NLM International MEDLARSPolicy Advisory group This body consistsof policy officials from NLM and the par-ticipating countries Topics to be studiedand reviewed will be networking, regionalservices with special attention to the devel-oping countries, document delivery systems,and data base building.

International Exchanges andServices

The NLM, after reviewing its internationalpublications exchange program, is continu-ing this activity with institutions in othercountries when an equitable exchange bal-ance can be achieved. This program is inaddition to NLM's regular acquisitions pro-gram and often provides both NLM and theparticipating country with material not easilyobtained otherwise.

The NLM provides interhbrary loans ofpublished and audiovisual materials inter-nationally for a fee. Exceptions are madefor countries with which the United StatesAgency for International Development hasa health program. Under an agreement be-tween AID and NLM, the Library has pro-vided during the past year approximately30,000 interlibrary loans, 22 reference re-plies, 273 MEDLARS searches, 52 sub-

scriptions to Index Med/cus and 48 sub-scriptions to /Abridged /ndex Med/rus Ap-proximately 20 percent of these were fortechnical support to PAIIO's Regional Li-brary of Medicine in Sao Paulo, Brazil, 39percent to Turkey, 12 percent to Indonesiaand 8 percent to Korea

Special Foreign CurrencyProgram

The types of projects funded in the PL480 program are similar to those sponsoredin the domestic Publication Grant Program—critical reviews and monographs analyzingbiomedical research and practice, transla-tions of foreign monographs in the healthsciences, studies in the history of medicine,the publication of major international sym-posia and conference proceedings, and thepreparation and publication of authoritativebibliographies, guides, and other literaturetools in the biomedical sciences.

During FY 1977, 96 scientific projectswere active in seven participating countries.Of these, 18 were new awards Critical re-views and biomedical monographs con-tinued to be the most frequent type of over-seas NLM project, constituting 55 percentof the FY 1977 program. Sixty percent of allthe projects were undertaken in two coun-tries—Poland and Israel The remaining 40percent of the studies were carried out inIndia, Egypt, Tunisia, Yugoslavia, and Paki-stan.

Among the new projects activated in FY1977 were a critical review of lipoproteinmetabolism in man, publication of the pro-ceedings of the Fourth International Con-gress on Tnchmellosis, and a clinical, bio-chemical and genetic review of cystmosis—a congenital, metabolic disturbance.

Several of the Polish studies publishedunder the NLM program in FY 1977 havearoused considerable interest in the U S.scientific community A substantial book oncurrent trends m Burn Therapy and Research

46

International Activities

by Witold Rudowski, ct a/, has been authori-tatively described as nn outstanding report,which will be the principal source materialon burns for many years to come. S. Baran-ski and P. Czerski's Biological Effects ofMicrowaves also provides a useful summaryand reference for safe exposure levels ineffect in various countries, as well as an ex-tensive view of Soviet and Eastern Europeanresearch in this important field. (For a com-plete listing of books and journal articlesresulting from the NLM P.L. 480 programreceived in FY 1977, see Appendix 3).

Among some of the more important de-velopments in the Library's internationalpublication program in FY 1977 were theconclusion of special NLM arrangements forthe publication of biomedical monographsin Egypt, under the National Science Founda-tion contract with the AI-Ahram PublishingCompany, the largest publisher in the Arabworld; a three-year extension, throughfunding awarded by the U.S.-lsrael BinationalScience Foundation in Jerusalem, of NLM'scollaborative program with the Israel lour-nal of Medical Sciences; and a three-yearaward to continue the cooperative NLM"Health Research Communications Program"with the Ministry of Health and Social Wel-fare in Poland.

Regional Resources and Bio-medical Information

Dr. Abraam Sonis, formerly medical offi-cer, Pan American Health Organization(PAHO) Latin American Center for HealthCare in Argentina, was appointed directorof the PAHO Regional Library of Medicine(BIREME) succeeding Dr. Amador Neghmeon October 1, 1976. BIREME continues to bea unique model of a regional resource forproviding biomedical information services.Increased emphasis is being placed on ex-tending these services effectively throughoutSouth America.

The staff of BIREME has been traininglibrarians from South America and develop-

ing a library network within Brazil. BIREMEperforms approximately 45,000 servicesevery year, including exchange of materials,reference services, interlibrary loans, andmore recently computer based informationservices from the MEDLARS data base.PAHO/BIREME now has an operationalMEDLARS activity, using a specialized por-tion of the total data base to respond to theinformation needs of its user community.

Dr. Cummings, Director of NLM andChairman of the Scientific Advisory Com-mittee for BIREME, attended the Ninth Meet-ing of this Committee in Sao Paulo, Brazil,May 5-7, 1977. The Committee reviewedboth policy considerations and the opera-tional status of BIREME.

The Pahlavi Library of Medicine, estab-lished in Tehran, Iran, in 1975, has maderapid progress in'recruiting a specialized staffand in developing a broad collection of bio-medical literature. The World Health Orga-nization (WHO) has designated the PahlaviLibrary of Medicine as a WHO RegionalCenter for providing biomedical informationservices to the WHO Eastern Mediterraneanregion beginning in 1978.

Visitors andSpecializedTraining

World-wide interest in NLM's programsis evidenced by the many international visi-tors from the health, library, and information-science communities. Over 1000 foreign visi-tors are received annually. During FY 1977these individuals represented 49 countriesand many specialized interests—medicalresearch and education, health care, gov-ernment organization and administration ofbiomedical information, information andlibrary science.

Formal delegations included a medicaldelegation from Poland, a delegation ofengineers, information specialists, and librar-ians from Japan, scientific and technicalinformation specialists from Bulgaria, healthofficials from Egypt, representatives from

47


twelve Latin American countries participat-ing in the development of information sys-tems and services, the World Health Organi-zation Regional Advisors on Cancer, Sovietgroups under the US/USSR program forcooperation in health, and specialists fromthe International Atomic Energy Agency andthe Food and Agriculture Organization.

Dr. Julian Knox of London was appointedas a Scholar-in-Residence at NLM on July 1,1977. He will be in residence until May 1978working on a study in "development ofconsumer functions in programs and policymaking of health systems agencies," whichis a joint project of DHEW's National Centerfor Health Research and the NLM.

Dr. Knox is a member of the Royal Soci-ety's Council for Science and Commissionon Health Technology Assessment. Untilrecently he was the ranking staff memberof the Community Health Council, Islington,London, and he has published a collectionof consumer oriented guides to health serv-ices planning and management. In 1972 and1973 he was in the U.S., with visiting fel-lowships at Yale School of Medicine andGeorgetown University School of BusinessStudies. He undertook studies of consumerparticipation in various types of health orga-nizations.

The NLM does not have nor does it funda formal program for trainees from abroad.It does, however, try to respond to specialrequests from other governments or insti-tutions where a person's experience qualifieshim for specialized training which can beapplied upon his return home.

In FY 1977 NLM received for specializedtraining a number of individuals associatedwith NLM collaborative programs: MissRahadoust and Mrs. Vaghar from the Pahlavi

Miss Corning (center) is shown with four foreign traineeswho have been working at NLM From left, they areShree Nath Agarwal (India), Maria Helena Piegas (Brazil),Amir M Nikbakht (Iran), and Andre Roussel (France)

Library of Medicine in Iran; Mike Hymanfrormthe British Library; Michael J. Phillipsfrom the Institute for Medical Literature,South African Research Council; Mrs. MariaHelena Piegas from the PAHO RegionalLibrary of Medicine in Brazil; and Dr. CesarMacias from the Centro Nacional de Infor-macion y Documentacion en Salud inMexico. In addition, Mr. V. P. Choudhry,Medical Librarian at the National MedicalLibrary in India received specialized trainingin indexing, Mr. Andre Roussel of theBibliotheque Interuniversitaire de Rennesstudied interlibrary loan processing, Mr.Shree Nath Agarwal of the Industrial Toxi-cology Research Centre in Lucknow, India,examined the development and productionof information services in toxicology, Mr.A. M. Nikbakht, Director of the Library,School of Dentistry, University of Tehran,Iran, studied library operations with par-ticular emphasis in the field of dentistry, andMrs. Mawiya Shour, Executive Assistant tothe Minister of Health in Syria concentratedon library design and planning.

48

International Activities

Tapes

Table 16 International Access to MEDLARS

Tapes/Software On-Line NLM

GermanyJapan

AustraliaCanadaFranceGermanyIranJapanMexicoSouth AfricaSwedenU.K.PAHO

Sweden [Sweden]United Kingdom [United Kingdom]Australia FrancePAHO Canada

IranMexicoSouth Africa

Table 17 Data Bases Searched by Non-U S Centers

Medlars Joxline Chemline Catline Cancerlme

•••

49

Appendix 1. Staff bibliographyThe following works were published by National Library of Medicine staff in FY 1977:

Blake, J. B.: The bicentennial of medicine in the United States: a commentary. In Epilogue:Essays at the Bicentennial of Medicine in the United States. U.S. DHEW, PHS, NIH, NLM.DREW Publ. No. (NIH) 77-1194. Bethesda, Md., National Library of Medicine, 1976,PP, 1-8.

: Early American medical literature. Clio Medica. 11: 147-160, 1976.

: From Buchan to Fishbein: the literature of domestic medicine. In Risse, G. B. et al(Eds.): Medicine without Doctors. New York, Science History Publications, 1977, pp. 11-30.

Brand, J. L.: The medical professional and the public health, 1929-1940. In Proceedings of the24th International Congress for the History of Medicine, Budapest, August 7974, Vol. II.Budapest, Semmelweis Museum, 1976, pp. 1571-1577.'

Cassedy,). H.: Why self-help? Americans alone with their diseases. In Risse, G. B. et al. (Eds.):Medicine without Doctors. New York, Science History Publications, 1977, pp. 31-48.

Clausen, C: Medicine and music. The DO. 17(12): 48-51, 1977.

Erdman, B.: The role of communications for providers and consumers of health services, edu-cation, and research information. In Proceedings of the Aspen Biosciences Communica-tions Seminar. Given Institute, Aspen, Colo., 1976.

Goldstein, C. M.: Trends in technology for bibliographic health sciences information. InShires, D. F. and Wolf, H.: MEDINFO 77: Proceedings of the Second World Conferenceon Medical Informatics. Toronto, August 8-12, 7977. New York, North-Holland Pub-lishing Company, 1977, pp. 335-339.

Henderson, B. E.: Elements of a broadband biomedical commuiiications network. In Pro-ceedings of the International Telemetry Conference. Los Angeles, September 1976. Wash-ington, D.C., McGregor and Werner, 1976, pp. 102-107.

: Telecommunications and health science. In Reprints of 7976 Annual Scientific Meet-ing. Los Angeles, Aerospace Medical Association, May 1976, pp. 40-41.

Howard, F.H. see West, R.T.

Leiter, ).: On-line systems of the National Library of Medicine. In Shires, D.F. and Wolf, H.:MEDINFO 77: Proceedings of the Second World Conference on Medical Informatics.Toronto, August 8-12, 1977. New York, North-Holland Publishing Company, 1977, pp.349-353.

Mehnert, R.B.: The National Library of Medicine: access to health-science literature. Occu-pational Therapy Newsletter. September 1977, p. 3.

50

: National Library of Medicine. The Bowker Annual of Library and Book Trade Infor-mation. New York, R.R. Bowker Co., 1977, pp. 41-44.

Nemec, J. (Comp.): Highlights in Medicolegal Relations. Rev. and enl. ed. U.S. DHEW, PH5,NIH, NLM. DHEW Publ. No. (NIH) 76-1109. Wash., D.C., U.S. Covt. Print. Office., 1976,168 pp.

Pothier, P.E.: Substructive searching in CHEMLINE. On//ne. 1(2): 23-25, 1977

Schoolman, H.M.: Information transfer in medicine and maintenance of professional compe-tence, journal of the Oklahoma State Medical Association. 70(10): 445-450, 1977.

: The role of the physician as a patient advocate. The New England lournal of Medi-cine. 296(2): 104-105,1977.

Thoma, C.R.: CTS: an experimental tool for biomedical communications. In HEW Telecom-munications Information Exchange, Special Edition: Communications Technology Satel-lite (CTS) Launching. U.S. DHEW, Office of Telecommunications Policy. Wash., D.C.Jan./Feb. 1976, pp. 6-8.

: Earth terminal design considerations for biomedical communications via CTS. InProceedings of the International Telemetering Conference. Los Angeles, 1976. Wash.,D.C., McGregor and Werner, 1976, pp. 108-119.-

: The selection of earth terminal parameters for the CTS biomedical communicationsexperiments. Proceedings of the Conference on Engineering in Medicine and Biology. 18:265, 1976.

White, K.S.: The lecture does it have to be boring? American Society for Microbiology News.43(6): 317-320, 1977.

West, R.T. and Howard, F.H.: Area health education centers and health sciences library serv-ices. Bulletin of the Medical Library Association. 65: 368-376, 1977.

Wooster, H.: An experiment in networking: the LHNCBC experimental CAI network, 1971-1975. lournal of the American Society for Information Science. 27: 329-338, 1976.

: Confessions of a CAI ignoramus. In Seidel, R.J. and Rubin, M. (Eds.): Computers andCommunications: Implications for Education. New York, Academic Press, 1977, pp. 403-405.

51

Appendix 2. Grant-supported publications

Benzmger, T.H. Role of thermoreceptors in thermoregulation. In: Sensory Functions of theSkin (Wenner-Cren Vol. 27). Ed. by Y Zotterman, New York- Pergamon Press 1976,pp. 379-397.

Brown, A W.A, Haworth, j , and Zahar, A.R.- Malaria eradication and control from a globalstandpoint, journal ol Medical Entomology, Vol. 13, No 1, 1976, pp. 1-25

Browne, William F , and Palmer, Howard R Role of the Oklahoma County Medical Societyin territorial medicine, 1904-1905. The journal of the Oklahoma State Medical Asso-ciation, Vol. 7, No. 3, March 1977, pp. 92-98.

Burnham, )ohn C The growth of scientific medicine. In Issues and Ideas in America Ed. byBenjamin ). Taylor and Thurman j. White, Norman, Oklahoma University of OklahomaPress, 1976, pp. 301-307.

: The mind-body problem in the early twentieth century. Perspectives in Biology andMedicine, Winter 1977, pp. 271-284.

Carlson, Eric T , and Wollock, Jeffrey L. Benjamin Rush and his insane son. Bulletin of theNew York Academy ol Medicine, 2nd Series, Vol. 51, No. 11, pp. 1312-1330, December1975.

Benjamin Rush on politics and human nature. IAMA, Vol. 236, No. 1, July 5, 1976,pp. 73-77.

• Benjamin Rush and mental health. Anna/s of the New York Academy of Sciences, Vol291, April 18, 1977 pp. 94-103.

Dols, Michael W The Black Death in the Middle East Princeton, New Jersey Princeton Uni-versity Press, 1977. 390 pp.

Doss, Mildred A , and Anastos, George Index-Catalogue of Medical Veterinary Zoology, Ticksand Jickbourne Diseases, III. Checklist of Families, Genera, Species, and Subspecies ofTicks Special Publication No. 3, Washington, D.C., U.S. Government Printing Office,May 1977, 97 pp.

Forbes, Thomas R: Death of a chairman: a new William Hunter manuscript. The Yale jour-nal ol Biology and Medicine, Vol. 49, 1976, pp. 169-173.

By what disease or casualty: the changing face of death in London, journal of theHistory of Medicine and Allied Sciences, Vol. 31, No. 4, October 1976, pp. 395-420.

: Why is it called "beautiful lady"? a note on belladonna. Bulletin of the New YorkAcademy of Medicine, 2nd series, Vol. 53, No. 4, 1977, pp. 403-406.

Inquests into London and Middlesex homicides, 1673-1782. The Yale journal ofBiology and Medicine, 50, 1977, pp. 207-220.

52

Forbes, Thomas R. The- barber surgeons help the sick poor, lournal of History of Medicine andAllied 5c/ences, Vol. 31, No. 4, October 1976, pp. 461-462.

Greenbaum, louis S "The commercial treatyof humanity", la tournee des hopitaux anglaispar Jacques Tenon en 1787. Revue d'Histoire des 5c/encei, Vol. 24, 1971, pp. 317-350.

: The humanitarianism of Antoine Laurent Lavoisier. Studies on Voltaire and the Eight-eenth Century, T. Besterman, ed, Vol. 88. 1972, pp. 651-672.

: Health-care and hospital-building in eighteenth-century France: reform proposals ofDu font de Nemours and Condorcet. In: Studies on Voltaire and the Eighteenth Cen-tury, ed. by T. Mesierman, Vol. 152. Oxford, England: The Voltaire Foundation at theTaylor Institution. l<)76, pp. 895-930.

Grob, Gerald N: Edwaicl Jarvis and the federal census: a chapter in the history of nineteenthcentury American medicine. Bulletin of the History of Medicine, Vol. 50, 1976, pp. 4-27.

—• : The political system and social policy in the nineteenth century: legacy of the revolu-tion. Mid-Amerua, Vol. 58, No. 1, January 1976, pp. 5-19.

• The social history of medicine and disease in America: problems and possibilities.journal of Social History, Vol. 10., No. 4, June 1977, pp. 392-409.

: Rediscovering asylums: the unhistorical history of the mental hospital. HastingsCenter Report, Vol 7, No. 4, August 1977, pp. 33-41.

Hamburg, Joseph (ed.) Review of Allied Health Education: 2. Lexington, Kentucky: The Uni-versity Press of Kentucky. 1977. 190 pp.

Hand, Wayland I"), (ed ) : American Folk Medicine. Berkeley, California: University of Cali-fornia Press. 1976. (47 pp.

Hanson, Ann El l is: Signs, lournal of Women in Culture and Society, Vol. 1, No. 2, Winter1975, pp. r>67-584.

Harbach, R E., and Knight, K. L.: A mosquito taxonomic glossary. Mosquito Systematics, Vol.9, No. 1, 1977, pp. 25-57.

: A mosquito taxonomic glossary. Ibid., Vol. 9, No. 2, 1977.

Howard, R P. From O U. Medical School . . . to Health Sciences Center: 1900-76. Bulletin ofthe Oklahoma County Medical Society, Vol. 48, April 1976, pp. 22-23.

• Medicine in Oklahoma County and the twin territories in 1906. Bulletin of the Okla-homa County Medical Society, Vol. 48, September 1976, pp. 22-23.

: Medicine in Oklahoma during 1907. Bulletin of the Oklahoma County MedicalSociety, Vol. 49, January 1977, p. 13.

Howard, R. P., and Allen, V. R.: Stress and death in the settlement of Indian territory. TheChronicles of Oklahoma, Vol. 54, Fall, 1976, pp. 352-359.

53

Jarcho, Saul: Carrell and Tuffier (1914) on Experimental surgery of the cardiac orifices. Ameri-can journal of Cardiology, Vol. 36, 1975, pp. 954-956.

: DelVecchio (1895) on suture of the heart. American lournal oi Cardiology, Vol. 37,1976, pp. 309-310, 807-808.

: An early retrospect of research on endocarditis (Saltykow, 1912). American lournalof Cardiology, Vol. 37, 1976, pp. 1086-1088.

lohnson, Robert E: Sir lohn Richardson. N.Y.: Crnne, Russak and Co, Inc. 1976. 209 pp.

Langley, P. A.: Initiation and regulation of ingestion by hematophagous arthropods, lournalof Medical Entomology, Vol. 13, No. 2, September 10, 1976, pp. 121-130.

Nelson, W. A., Keirans, ). E., Bell, ]. F., and Clifford, C.M.: Host-ectoparasite relationships.lournal of Medical Entomology, Vol. 12, No. 2, June 30, 1975, pp 143-166.

Rather, L.J.: Systematic medical treatises from the ninth to the nineteenth century: the un-changing scope and structure of academic medicine in the West C//o Med/ra, Vol. 11,No. 4, 1976, pp. 289-305.

Schaller, O., Habel, R. E., and Frewein, ]. (eds.): Changes in the nominn anatomica veterinaria.Zentralblatt fur Vet. Med. Series C. Anal. Hist. Embryo/., Vol. 5, 1975, pp. 83-90.

Sheridan, Richard B.: "Sweet malefactor": the social costs of slavery and sugar in Jamaicaand Cuba, 1807-54. The Economic History Review, 2nd ed., Vol 29, No. 2, May 1976,pp. 236-237.

: The Jamaican slave insurrection scare of 1776 and the American Revolution, lournal ofNegro History, Vol. 61, No. 3, July 1976, pp. 290-308.

: The crisis of slave subsistence in the British West Indies during and after the AmericanRevolution. The William and Mary Quarterly, 3rd Series, Vol. J3, October 1976, pp.615-641.

Siegel, Rudolph E.: Principles and contradictions in the evolution of Hippocrates: Aristotle'sand Galen's doctrine of respiration and blood flow, fpisteme. Vol. 3-4, 1975, pp. 169-194.

Sollers-Riedel, Helen: Literature references to mosquitoesand mosquito-borne diseases. 1977,Part II. Mosqu/lo Newi; journal of the American Mosquito Control Association. Vol. 37,No. 2, June 1977.

-: The challenge of coping with mosquito literature. Mosquito News, Vol. 36, No. 4,December 1976, pp. 540-543.

Washino, Robert K: The physiological ecology of gonotrophic dissociation and related phe-nomena in mosquitoes, lournal of Medical Entomology, Vol. 1 i, No. 4-5, January 31,1977, pp. 381-388.

Whorton, James C: Christian physiology: William Alcott's prescription for the millenium. Bul-letin of the History of Medicine, Vol. 49, 1975, pp. 466-481.

54

Appendix 3. PL-480 supported publications

Baranski, Stanislaw, and Czerski, Przemyslaw. Biological Effects of Microwaves Stroudsburg,Pa. Dowdcn, Hulchmson & Ross, Inc., 1976. 234 pp.

Cabalska, M D (ed) Proceedings ol the International Symposium on Laboratory ScreeningTechniques lor Inborn Errors of Metabolism in Newborn and Selected High-Risk Infants.Warsaw, Poland Foreign Scientific Publications Department of the National Center forScientific, Technic.il and Economic Information, 1976. 285 pp.

Ginsburg, Isaac, and Sola, Michael N- The role of leukocytes and their hydrolases in thepersistence, degradation and transport of bacterial constituents in tissues relation tochronic inflammatory processes in staphylococcal, streptococcal, and mycobactenalinfections, and in chronic penodontal diseases. In. Critical Reviews in Microbiology, Vol.4, Cleveland, Ohio Chemical Rubber Co., 1976, pp. 249-332.

Izak, Gabriel (ed ) International symposium on malignant neoplastic diseases. I. Israel loornalol Medital Sc/ernes, Vol. 13, No 7, July 1977 pp 651-752.

Izak, Gabriel (ed ) International symposium on malignant neoplastic diseases. II. Israel journalof Medical Sciences, Vol 1 J, No 8, August 1977. pp. 753-869.

Lesky, Erna. The Vienna Medical School of the 79(h Century Trans from German by L.Williams and I. S. Levij, Jerusalem, Israel Program for Scientific Translations. Baltimore,Md The Johns Hopkins University Press, 1976, 604 pp.

Mechoulam, Raphael, McCallum, Neil K , and Burstem, Sumner: Recent advances in the chem-istry and biochemistry of cannabis. In Chemical Reviews, Vol. 76, Eason, Pa. AmericanChemical Society, 1976, pp. 75-112.

Rudowski, Witold J (ed ) Disorders ol Hemostasis in Surgery Hanover, New Hampshire: TheUniversity Press of New England, 1977. 465 pp.

, Nasilowski, Wieslaw, Zietiewicz, Witold, and Zienkiewicz, Konrad Burn Therapyand Research Baltimore, Maryland The Johns Hopkins University Press, 1976. 332 pp.

Samueloff, Shlomo, and Endholm, O G (eds.): Jerusalem satellite symposium on environ-mental physiology Israel loumal of Medical Sciences, Vol. 12, No. 8, August 1976, pp.719-903.

55

Appendix 4. NMAC audiovisual materials produced

Motion Pictures

"Right Heart Catheterization"

Preschool Screening Series"Preschool Articulation Screening""Preschool Vision Screening""Preschool Hearing Screening"

"Introduction to the Denver Development Screening Test (DDST)"

"The DDST—Demonstration and Review"

Videotapes

Head and Neck Anatomy Series"The Larynx—Part I""The Larynx—Part II""The Larynx—Part III"

"Making Color Composite Slides with a Rear-Projectio*n System"

"Variable Area Light Control m X-ray Duplication"

"Acute Myocardial Infarction" Series (5)

"The Ionic Basis of the Action Potential"

"Introduction to the Denver Developmental Screening Test (DDST))"

"The DDST—Demonstration and Review"

Leaders in American Medicine SeriesGeorge W. Thorn, M.D.Henry C. Schwart/, M.D.David Secgal, M.D.Russel V. Lee, M.D.Franz J. Ingelfmger, M.D.Dwight L. Wilbur, M.D.Maxwell Fmdland, M.D.lonathan E. Rhoads, M.D.John P. Hubbard, M.D.Robert H. Williams, M.D.A. McGehee Harvey, M.D.

56

Making of a Clinician Part 1 and Part 2

"World Within a World—Maximum Containment Lab"

"Demonstration of Isolation Chamber Setup and Use"

Slide Series

"Gross Anatomy" series (13)

"Recognition and Management of the Neonate with Heart Disease" series (4)

"Anesthesia Gas Systems and Machines" series (6)

"Intestinal Function and Diarrhea" series (5)

"An Introduction to Plastic Embedding"

Preschool Screening Series"Preschool Articulation Screening""Preschool Vision Screening""Preschool Hearing Screening"

"Three-Stage Developmental Screening"

Human Physiology Series"The Heart as a Pump Mechanical Correlates""Mechanical Properties of Muscle""Microurculation I""Microcirculation II""Introduction to Cardiovascular Physiology"

Health Sciences Consortium"Calculating Ambient Gas Tension""Anatomy of Major Arteries to the Lower Extremities"

Dental Consortium—Curriculum Forum II"Clinical Signs of Dentmogenesis Imperfecta""Lesions of Epithelial Tissue Origin""Evaluation of the Gmgiva in the Penodontal Examination""Clinical Characteristics of the Gmgiva and Alveolar Mucosa"

Head and Neck Anatomy Series"The Larynx—Part I""The Larynx—Part II""The Larynx—Part III"

"On-Lme MEDLARS Searching"

57

Pediatric Ambulatory Series"The Nephrotic Syndrome in Children"

Filmstnps

"El Parto Normal Atondido Por La Parteia Empirica"

"La Lactancia Materna"

"Captura Y Preparacion De Artropodos Para El Aislamiento de Virus"

"Auga Potable1 Para La Comunidad Rural"

"Captura Y Preparacion De Espccimenes Vertebrados Para Estudios De Arbovirus'

"Filing Medical Records"

Print

Health Sciences Consortium"Structure of the U S. Health Care System""Human Population Genetics"

Dental Consortium—Curriculum Forum II"The NUVA System for Restoring Fractured Permanent Anterior Teeth"

58

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