T U T E S O F H E A L T H

N A T I O N A L L I B R A R YO F M E D I C I N E

P R O G R A M S & S E R V I C E SF I S C A L Y E A R 1 99 1

Further information about the programs described in thisadministrative report is available from:

Office of Public InformationNational Library of Medicine

8600 Rockville PikeBethesda, MD 20894

(301)496-6308

Cover: In Fiscal Year 1991 the Regional Medical Library Network was expandedfrom seven to eight regions. It also underwent a name change and is nowdesignated the National Network of Libraries of Medicine (abbreviated NN/LM).The network is described on page 10 of this report.

N A T I O N A L I N S T I T U T E S O F H E A L T H

N A T I O N A L L I B R A R YO F M E D I C I N E

P R O G R A M S & S E R V I C E SF I S C A L Y E A R 1 9 9 1

U.S. D E P A R T M E N T O F H E A L T H A N D H U M A N S E R V I C E S • P u b l i c H e a l t h S e r v i c e

National Library of Medicine Catalog in Publication

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

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

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

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

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

Ill

PREFACEThe reader of this year's report will note a number of important events. New 5-

year contracts were signed with the eight Regional Medical Libraries that, togetherwith 130 Resource Libraries (primarily at medical schools) and 3600 Local Libraries(primarily at hospitals), make up the National Network of Libraries of Medicine. Inaddition to supporting the basic structure and programs of the National Network,the new contracts emphasize Grateful Med® and Loansome Doc training, demon-strations, exhibits, and other activities related to outreach.

The online information retrieval network continues to grow, both in number ofusers and breadth of services. Statistics contained in the chapter on Library Opera-tions reveal that the number of users and searches both hit an all-time high this year.

Two new network capabilities were introduced in 1991. In January, the Libraryintroduced the "clinical alert" service (described in the "Special Initiatives" chapter)designed to accelerate the speed with which potentially life-saving medical informa-tion from the NIH is disseminated to the practicing community. Anotherenhancement to the network was the introduction of "Loansome Doc." LoansomeDoc (see Library Operations chapter) allows the Grateful Med user to place an onlineorder to a network library for a copy of any article referenced in MEDLINE®.

Among other notable events in 1991, all of which are described in this report:• A Long Range Planning Panel on Toxicology and the Environment began its

work to advise the NLM about its services in that area.• The first year of operation of the new NLM Office of Health Services Re-

search.• The release of a second version of the UMLS Knowledge Sources, including

a prototype of the Information Sources Map.• The award of a first contract to create, in complete anatomical detail, three-

dimensional representations of the male and female human body.• The introduction of a new retrieval tool called Entrez, which searches nucle-

otide and protein sequence databases and MEDLINE citations in which thesequences were published.

• Progress in the Library's campaign to encourage medical publishers to issuetheir works on acid-free ("permanent") paper is described in the Special Ini-tiatives chapter.

On behalf of the staff of the National Library of Medicine, I would like to thankour many partners throughout the nation and around the world for their help. Thecreation and dissemination of medical knowledge is a truly international undertak-ing; working together we continue to improve our information systems for thebenefit of all. A

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

IV

CONTENTS

Page

Preface iiiCalendar of Events viSpecial Initiatives 1

Unified Medical Language System 1Paper Preservation 2NLM Outreach Activities 2High Performance Computing and Communications 4

Library Operations 5Planning and Management 5Collection Development 5Bibliographic Control 6Network Services 8Special Onsite Programs 10Health Services Research 11

Specialized Information Services 17Databases under ELHILL 17AIDS 18TOXNET and Its Files 19Other Programs 20

Lister Hill Center 22Computer Science Branch 22Information Technology Branch 25Communications Engineering Branch 26Educational Technology Branch 29Audiovisual Program Development Branch 31

National Center for Biotechnology Information 33Database Building and Enhancement 33Basic Research 34Communication 35Extramural Programs 35Biotechnology Information in the Future 36

Extramural Programs 37Research Grants 37Training 39Resource Grants 40IAIMS 40Publication Grants 41Bioethics 41Committee Activities 41Plans for FY1992 42

Office of Computer and Communications Systems 43Development Branch 43Applications Services Branch 44Systems Support Branch 44Computer Services Branch 45

International Programs 46Collaboration with Individual Countries 46International MEDLARS Agreements 46Collaboration with the W.H.0 47Special Foreign Currency Program 47International Meetings and Visitors 47

Administration 49Financial Resources 49Personnel 49Awards 49Equal Employment Opportunity 50

Appendixes 521. Acronyms, Abbreviations, and Initialisms 522. Staff Bibliography 563. Extramural Programs-Supported Publications 604. Board of Regents 685. Board of Sdentific Counselors/LHC 696. Board of Scientific Counselors/NCBI 707. Biomedical Library Review Committee 718. Literature Selection Technical Review Committee 73

TABLES

Table 1. Growth of Collections 12Table 2. Acquisitions Statistics 12Table 3. Cataloging Statistics 13Table 4. Bibliographic Statistics 13Table 5. Circulation Statistics 13Table 6. Online Searches 14Table 7. Offline Searches 15Table 8. Reference Services 15Table 9. History of Medicine Activities 16Table 10. Extramural Grants and Contracts Program 42Table 11. International MEDLARS Centers 47Table 12. Financial Resources and Allocations 49Table 13. Staff 50

VI

CALENDAR OF EVENTS—FISCAL YEAR 1991

1990Sept-Dec: "Public Health in New York City in the Late Nineteenth Century" (exhibit)Oct 1: Network awards contracts to 30 "unaffiliated" health professionalsOct: NCBI initiates Technical Reports SeriesOct: Friends publish NLM calendarOct 2: Lecture: DNA Regulatory Sequences & Local DNA Structure—D. Ghosh, R. NussinovOct 3: Florence Mahoney Lecture by A. SabinOct 12:President signs PL 101-423 establishing a national policy on permanent paperOct 31: IMPAG (International MEDLARS Policy Advisory Group) meets at NLMNov: NLM bookmark wins "Blue Pencil" AwardNov 16: Conference on improving NLM's information services for hospitalsNov 19:Secretary Sullivan names R. Anderson, L. DeNardis and R. Kahn to Board of RegentsNov 20:NLM Honor Awards CeremonyDec 3: Lecture: "Molecular Scene Analysis,"—}. Glasgow and S. FortierDec 5: Lecture: "Seeing Diseases: Visual Sources and the Meaning of History—S. Gilman

1991Jan-Apr: "Dentistry in Paris, 1830-1860: Georges Fattet and His Contemporaries" (exhibit)Jan 18:Transmission of first Clinical Alert over MEDLARSFeb 14: Literature Selection Technical Review Committee MeetingFeb 19:Lecture: African American Perception of the Constitution—Rep. Major OwensFeb 28: Board of RegentsMar 5: LHC seminar: Mass Storage Systems and Technology—Sanjay RanadeMar 6: Biomedical Library Review Committee MeetingMar 13:Lecture: Another Kind of Glory: Black Doctors in the Civil War—R. DavisMar 15:Lecture: Some Famous Persons with Visual Problems—F. BlodiMar 28:Lecture: Nurturing Tradition, Fostering Change—Rep. Constance A. MorellaApr: Grateful Med Mac 1.5 version releasedApr 5: Board of Scientific Counselors Meeting, NCBIApr 25:Training Directors MeetingMay-Sept: "A Decade of Historical Acquisitions at the NLM, 1981-1990" (exhibit)May: Phase I of Loansome Doc releasedMay 1: RML Network renamed National Network of Libraries of MedicineMay 1: Eighth region established for New EnglandMay 2: Board of Scientific Counselors Meeting, LHCMay 6: Lecture: NIH: The Crucible Years (1930-1948)—D. FredricksonJun 10:Lecture: High Performance Computing and Communications—A. BaratzJun 13: Literature Selection Technical Review Committee MeetingJun 20:New NIH director, Bernadine Healy, M.D., addresses NLM staffJun 20: Board meeting of Friends of the National Library of MedicineJun 20: Board of Regents MeetingJun 26:Biomedical Library Review Committee MeetingJul 3: Lecture: BiologicalQueries Using a Transcription Factors Database—D. GhoshAug 7: LHC lecture: Fuzzy Logic—Lotfi ZadehAug 15:First meeting of Toxicology Information Outreach Panel held at NLM

SPECIAL INITIATIVES

Unified Medical Language System

The goal of the Unified Medical Language System(UMLS®) project is to give practitioners and researcherseasy access to machine-readable information from di-verse sources, including the scientific literature, patientrecords, factual databanks, and knowledge-based ex-perts systems. The barriers to integrated access to infor-mation in these sources include: the variety of ways thesame concepts are expressed in the different machine-readable sources (and by users themselves) and the diffi-culty of identifying which of many existing databaseshave information relevant to particular questions.

The UMLS approach to overcoming these barriers isto develop "Knowledge Sources" that can be used by awide variety of application programs. These programscan compensate for differences in the way concepts areexpressed, identify the information sources most rel-evant to a user inquiry, and negotiate the telecommuni-cations and search procedures necessary to retrieveinformation from these information sources.

The three UMLS Knowledge Sources are: aMetathesaurus* of concepts and terms from several bio-medical vocabularies and classifications, a Semantic Net-work of the sensible relationships among the broadsemantic types or categories to which all concepts in theMetathesaurus are assigned, and an Information SourcesMap that describes the content and access conditions forthe available biomedical databases in both human-read-able and machine-readable form.

In the fall of 1990, NLM issued the first experimentaledition of the UMLS Knowledge Sources which con-tained initial versions of the Metathesaurus and the Se-mantic Network. During FY 1991, NLM distributed 160copies of this edition to medical libraries, university re-search groups, and commercial companies in the U.S.and abroad under the terms of an experimental agree-ment. The agreement requires the recipients to informNLM about their use of the Knowledge Sources and toprovide feedback on how they can be enhanced. Recipi-

ents are informed that future editions of the KnowledgeSources may differ substantially in content and format.

Information received to date indicates that theKnowledge Sources are being applied to a wide varietyof projects including linking patient records to relevantMEDLINE citations, analysis of medical and dentalschool curricula, user query interpretation, and naturallanguage processing. NLM itself has applied the UMLScomponents in the Coach expert search system and to re-search in natural language processing (see the Lister HillCenter chapter in this report).

In late FY 1991, NLM issued the second experimen-tal edition of the UMLS Knowledge Sources containingthe second versions of the Metathesaurus and SemanticNetwork and the first version of the Information SourcesMap. This last includes descriptions of all of NLM's pub-licly available databases and a small number of data-bases produced by other sources. The secondexperimental edition of the Knowledge Sources was sentto all those who had received the first edition and isavailable to new requestors under the same agreement.

The UMLS project continues to involve an interdisci-plinary team of NLM staff and a number of research anddevelopment contractors as well as a widening circle ofexperimental UMLS users. In July 1991, NLM issued anew set of competitively awarded UMLS research anddevelopment support contracts to Brigham andWomen's Hospital, Columbia University, MassachusettsGeneral Hospital, the University of Pittsburgh (with theUniversity of Utah as subcontractor), and Yale School ofMedicine. Lexical Technology, Inc. continues to be theprincipal contractor for development and maintenanceofthe Metathesaurus.

The key objectives for the next three years of theUMLS project are to develop and implement importantapplications that rely on the UMLS Knowledge Sources,to establish production systems for ongoing expansionand maintenance of the Knowledge Sources, and to ex-pand the content of the Knowledge Sources to supportthe applications being developed.

B. Humphreys

Programs and Services, FY1991

Paper Preservation

A fundamental responsibility of the NLM is to pre-serve permanently the content of periodicals, books, andother library materials pertinent to the biomedical sci-ences. Significant resources have been provided by theCongress for preservation of the Library's collection bymicrofilming of deteriorating documents, conservationin the original form of those that are rare and valuable,and research in the electronic storage of images.

A major threat to the survival of books and journalspublished since the mid-nineteenth century is the dete-rioration of paper caused by residual acids it contains.Without expensive efforts at preservation, the majority ofprinted matter now on library shelves across the nationis destined to become brittle and to crumble over the pe-riod of a lifetime. NLM has not been immune to theproblem. A Preservation Planning Team surveyed thephysical state of the holdings in 1985 and identified some158,000 volumes, over 12 percent of the collection, ashaving become so brittle that they would not be able towithstand one more library use, and estimated that an-other 5,000 volumes would be entering that endangeredcategory annually.

More recently, papermaking processes that employalkaline rather than acid-based chemistry have begun tocome into use. Paper so produced is acid-free and avail-able in commercial quantities and at competitive pricesin most paper grades. Acid-free, permanent paper willlast for centuries rather than decades in ordinary libraryuse. The preservation policy the Library's Board of Re-gents adopted in February 1986 notes that much of thepreservation problem can be stopped at its source bypublishing on permanent, archival media that are notpredisposed to rapid deterioration, such as acid-free pa-per. It recommends that NLM encourage the publishingindustry to use more permanent paper in the productionof biomedical literature.

To that end, the Board sponsored a hearing at the Li-brary in January 1987 on the use of permanent paper forbiomedical literature. As a result of the hearing, an NLMPermanent Paper Task Force of academic, commercial,and professional society publishers, editors, authors, pa-per manufacturers and distributors, printers, librarians,preservationists, and concerned citizens was established.It was charged with exploring the problem of paper dete-rioration, the economics, esthetics, and the manufactur-ing technologies of acid-free paper, and fosteringpositive action in its use, particularly in journals, themost important repository of contemporary biomedicalknowledge.

Initially, there were many stubborn myths for the 33-member Task Force to dispel and much skepticism toovercome that acid-free paper would ever amount to

more than an archival curiosity. Task Force membersjoined NLM staff in communicating with publishers,urging them to use acid-free paper and to identify its usein their publications. They developed educational mate-rials; wrote articles for professional and popular journalsand provided information to the press and broadcastmedia in order to increase awareness about acid-free pa-per use; appeared on the public radio network; con-ducted and participated in seminars and panels, madeindividual presentations, and arranged displays at pro-fessional society meetings; served on standards develop-ment and public agency and industry advisorycommittees; organized and chaired a major paper indus-try symposium on paper permanence; testified at Con-gressional hearings; and worked at convertingpublications with which they may have been themselvesinvolved to use acid-free paper.

The Library's campaign has made encouragingprogress, hi 1987, merely 4 percent of the 3,000 journalsindexed by NLM were acknowledged by their publish-ers to be using acid-free paper. In 1991, one half are onpermanent paper. Of the U.S. journals indexed, fourfifths are now acid-free. Beginning in 1990, journals in-dexed in MEDLINE and Index Medicus that are printedon acid-free paper and that also carry a notice to that ef-fect are marked as such in the List of Journals Indexed inIndex Medicus, the List of Serials Indexed for Online Users,and in SERLINE®, the Library's online file of serials infor-mation.

The campaign to encourage domestic publishers inpermanent paper use continues, with intensified effortsto bring the message of paper permanence to non-U.S.publications. Together with increasing expressed de-mand by users, the advantages of the economics andtechnology of alkaline papermaking are also becomingreflected in the paper market. The alkaline papermakingprocess reduces water consumption, facilitates wastetreatment, saves energy and materials costs, and iscleaner and less corrosive to machinery than acid-basedpaper making.

The use of acid-free paper is the preventive medicinefor reducing the problem of deterioration of publicationsand the threat of their being lost to the record of civiliza-tion forever.

C. Kalina

Outreach

The recent report of the NLM Board of Regents, Im-proving Health Professionals' Access to Information, pub-lished as an update to the NLM Long Range Plan, andbased on the work of a distinguished panel chaired byDr. Michael DeBakey, recommends: (1) major enhance-ments to NLM's national network as a way of improving

Special Initiatives

NLM's outreach to health professionals; (2) expansion ofResource Access Grants as well as access to national net-works and the Integrated Academic Information Man-agement Systems (IAIMS) program; (3) substantialincreases in the number of Medical Informatics trainingcenters, individual awards for research and career devel-opment and demonstration grants; and (4)research to as-certain the information requirements of U.S. healthprofessionals, the suitability of current means for acquir-ing health-related information, and impediments to suchacquisition, with an emphasis on the needs of minorityhealth professionals and other underserved groups.

Outreach continues to be NLM's highest priority.NLM is investing its fiscal and intellectual resources notonly in acquiring scientific information but in devisingnew and more efficient and effective methods for mak-ing it readily available to the health and scientific com-munity. Large numbers of health professionals in ournation do not have easy access to biomedical informationbecause of geographic isolation, nonaffiliation with ahospital or medical school library, or lack of informationabout available services. With the increased fundingavailable for outreach, we have identified institutionsand individuals to help us reach out to theseunderserved health professionals.

An important role in this effort is being played bythe libraries in the National Network of Libraries ofMedicine (NN/LM). The network was reconfigured inFY 1991, from seven regions to eight. The new 5-yearcontracts, signed with the Regional Medical Libraries thisyear, mandate important outreach responsibilities. Thechapter on Library Operations has more informationabout the NN/LM.

Results of these network outreach initiatives includeextensive efforts to train physicians and other health pro-fessionals in the use of Grateful Med in almost 50 com-munities. This is being accomplished through specialprojects at the Regional Medical Libraries, and awards toindividual small-to-medium sized libraries in the net-work, with an emphasis on those in rural and inner cityareas.

It is clear that within the population of health profes-sionals in underserved areas, there is a subgroup ofhealth professionals serving minority populations whohave a special set of problems in accessing information.NLM has geared a variety of new outreach initiatives tothese communities in the belief that direct access toNLM's databases—especially MEDLINE via GratefulMed—can help compensate for the absence of otherhealth resources. More than 20 outreach projects have aminority focus. Major examples:

NLM is collaborating with Meharry Medical College(Nashville, TN) to develop and put in place an innova-tive outreach demonstration project for health care prac-titioners, including family practice residents and their

preceptors, who are located in remote and professionallyisolated settings. The plan focuses on identifying impedi-ments to information access and incorporates a wide va-riety of technological and behavioral interventionsgeared to their removal.

In South Texas, the effectiveness of the circuit librar-ian concept as a means of improving information accessamong health professionals has been evaluated in a jointproject with the University of Texas at San Antonio.Communities in this region are geographically remote,largely rural, with large Hispanic populations, and dis-tant from the nearest health sciences library. The circuitlibrarian makes weekly visits to the nine participatinghospitals in the region and performs MEDLINE searchesfor the staff. She also provides for the delivery of neededdocuments by return trip or FAXand trains health pro-fessionals to perform their own MEDLINE searches us-ing Grateful Med.

Through the NN/LM, 45 purchase orders have beenawarded to a number of Area Health Education Centers,academic health centers, academies, associations, andhospitals, to identify "unaffiliated" health professionalsin underserved areas and to encourage them to gain ac-cess to information through electronic sources such asGrateful Med.

NLM has initiated an Undergraduate ResearchStudy Program to stimulate undergraduate medicalinformatics research programs in Historically Black Col-leges and Universities (HBCUs) for electrical engineeringand computer science students. Four electrical engineer-ing students from three institutions—Morgan State Uni-versity, Southern University at Baton Rouge, and NorthCarolina A & T State University—make up the first class.These students will complete two school year R&D as-signments and two summer internships at the Lister HillCenter.

A new initiative in NLM's Toxicology InformationProgram (TIP)is aimed at establishing a mechanism thatwould strengthen the capacity of historically black col-leges and universities to train medical and other healthprofessionals in the use of toxicological, environmental,and occupational information resources developed atNLM. This audience represents a group that would oth-erwise not get exposure to these valuable informationsources and also is considered one of the high prioritygroups within NLM's outreach efforts.

The Library's outreach activities this year includedtwo new MEDLARS® online network capabilities. First,in January, the Library introduced the "clinical alert" ser-vice. This was a move designed to accelerate the speedwith which potentially life-saving medical informationfrom NTHis disseminated to the practicing community.The need for such a service was repeatedly stressed at aJanuary 15, 1991, meeting at the National Institutes ofHealth, at which prominent health communicators,

Programs and Services, FY1991

medical editors, and government medical research ad-ministrators met to discuss ways to improve the speedwith which highlights of important clinical trial find-ings can be disseminated before publication in medicaljournals.

Three days later, on January 18, the NLM trans-mitted its first clinical alert over the online network.The alert, which remained on the network for 30 days,was a 74-line statement issued by the National Insti-tute of Child Health and Human Development regard-ing the efficacy of a drug used to treat HIV-infectedchildren. Before the fiscal year ended, six more clinicalalerts had been put up.

The second major enhancement to the network in1991 was the introduction, in May, of "LoansomeDoc." Loansome Doc allows the individual user toplace an online order for a copy of the full article forany reference retrieved from MEDLINE. This new ser-vice is described in the chapter on Library Operations.

E. R. Siegel

High Performance ComputingandCommunications

The President's Office of Science and TechnologyPolicy has initiated a multiagency High PerformanceComputing and Communications (HPCC) Program tostrengthen research and education nationwide. TheHPCC program has four components: Advanced Com-puter hardware design, with a goal of a "teraops" (1 tril-lion operations per second) supercomputer by the end ofthe decade; Advanced Software Technology and Algo-rithms to run on such supercomputers; the National Re-search and Education Network, a billion bits-per-second

computer network; and Basic Research and Human Re-sources, focusing on training in the design and use ofhigh performance computing systems.

NLM is the lead medical organization in this pro-gram, along with several other NTHcomponents. The en-hanced NLM program includes intramural andextramural research and development in several areas:molecular biology computing, creation and transmissionof electronic images, the linking of academic health cen-ters via computer networks, the creation of "intelligentgateways" to retrieve information from multiple life sci-ences databases, and expanded training in biomedicalcomputer science. The HPCC program as planned willsupport advanced technology aspects of the IAIMS pro-gram, the Visible Human digital image library project,biotechnology databases and research grants, and medi-cal informatics training grants.

NLM's initiatives in high performance computingand networking go hand in hand with its outreach pro-grams. High-speed computer networks will be the av-enue of choice for the dissemination of much biomedicalinformation in coming years. It is not enough to publi-cize NLM's products and services without assisting insti-tutions in connecting to national information resources,nor is it enough to provide high-technology innovationswithout reaching out to ensure that everyone has accessto the new technology. A number of steps are being un-dertaken to assure the participation of HBCUs andhealth professionals in under- and un-served areas.Through the HPCC initiative, funds will be available toacademic health science libraries, and to smaller hospitallibraries, to provide connections to the national highspeed network. The purpose of these efforts is to facili-tate access to and delivery of health sciences informationvia pathways employing the most up-to-date and effectivecomputer and telecommunications technology available.

D. Masys

LIBRARY OPERATIONS

Lois Ann ColaianniAssociate Director

NLM's Library Operations Division (LO) is respon-sible for: acquiring and preserving the world's biomedi-cal literature; organizing this literature through indexingand cataloging; disseminating NLM's authoritative bib-liographic records in online files, machine-readable for-mats and publications; lending or copying documents inthe NLM collection as a backup to the document deliv-ery service provided by other U.S. health sciences librar-ies; providing reference and research assistance to healthprofessionals; and coordinating the National Network ofLibraries of Medicine (NN/LM) which includes morethan 3,500 U.S.health sciences libraries. LO also conductsresearch and evaluation related to these basic responsi-bilities and maintains an active research program in thehistory of medicine.

A staff of more than 250 librarians, library techni-cians, technical information specialists, subject matter ex-perts, health professionals, and administrative supportpersonnel carry out LO's programs and services. LO hasfour main divisions: Bibliographic Services, Public Ser-vices, Technical Services, and History of Medicine; twosmaller units: the Medical Subject Headings (MeSH®)Section and the National Network Office; and a small ad-ministrative staff in the Office of the Associate Director.

Planning andManagement

LO carries out its strategic and operational planningwithin the framework of the NLM Long Range Plan, asextended by the reports of the special Panels convenedby NLM's Board of Regents to examine particular facetsof the Library's programs and services. In FY 1991, LOdeveloped a strategic plan for FY 1992-FY 1996. The ma-jor objectives of the plan are: (1) to eliminate redundantdata creation and maintenance and provide easy inte-grated access to acquisitions, bibliographic, preservation,circulation, and other inventory control data for mono-graphs and serials in the NLM collection; (2) to developand implement an integrated vocabulary control systemfor MeSH and the Unified Medical Language System(UMLS) Metathesaurus to ensure consistent descriptionof and access to material in NLM databases; (3) to de-velop and implement a National Collection Plan for theBiomedical Literature which ensures the availability andpreservation of published and unpublished literaturethat is not part of the NLM collection; (4) to developmechanisms to ensure that health professionals have

easy and rapid access to the text of published informa-tion held in the National Network of Libraries of Medi-cine (NN/LM); (5) to define the MEDLARS retrievalcapabilities needed to provide more effective service tothe rapidly growing population of NLM online users(this is a shorter term objective than the other five); and(6) to increase health professionals' knowledge and useof NLM products and services through developmentand implementation of an expanded LO component ofNLM's outreach program. Activities related to the NLMLong Range, its supplementary Outreach Plan, and LO'sStrategic Plan are described throughout this chapter.

Collection Development

Collection development activities include: establish-ing and revising literature selection policy, identifyingand acquiring biomedical literature in all formats andlanguages, processing materials as they are received, as-sessing whether the selection and acquisition process ismeeting the goals established by the selection policy; andmaintaining and preserving the collection. NLM cur-rently holds 2,000,511 printed books, journal volumes,theses, and pamphlets, and 2,820,295 non-print items, in-cluding audiovisuals, computer software, microforms,prints, photographs, and manuscripts (table 1).

Selection and collection assessment

The NLM staff selects items for the Library's collec-tion in accordance with guidelines in the Collection Devel-opment Manual of the National Library of Medicine. NLMconducts a complete review and revision of its selectionguidelines every 5 to 8 years and modifies specific sec-tions of the Manual each year as developments in bio-medicine or problems in applying the guidelineswarrant. During FY 1991, substantial progress was madein preparing a major revision of the Manual to be com-pleted in 1992.

As part of a continuing program to determine howsuccessful NLM has been in implementing its collectiondevelopment policy, the Library staff reviewed NLM'scollection of recent dental monographs, AIDS-relatedmaterials, and publications issued by associations. A re-view of the general physics journals in NLM's collectionled to the cancellation of a number of titles with minimalbiomedical content. The Library also initiated a compre-hensive assessment of its neurology collection.

Programs and Services, FY1991

Acquisitions

The Library acquired 43,105 volumes and 92,175other items (e.g., audiovisuals, microforms, software, pic-tures, manuscripts) for its collection in FY 1991 (table 1).The NLM staff processed 182,283 modern books, serialissues, audiovisuals, and software packages (table 2).Two important gaps in NLM's historical collection werefilled by the acquisition of Johannes Gerson's DePollutione Nocturna (Cologne 1466), considered to be thefirst medically related book printed with moveable type,and Dr. William T. G. Morton's broadside, To Surgeonsand Physicians, (Boston, 1846), thought to be the firstprinted document on anesthesia. The Library also ac-quired two large collections of Italian and Germanbroadsides and pamphlets dealing with public healthmatters from 1611 to 1830. NLM's manuscript collectionswere enriched by a number of important documents re-lated to the history of the National Institutes of Health(NIH) including a collection of materials concerning Dr.Joseph Kinyoun, the first director of the Hygienic Labo-ratory (forerunner of NIH), the personal files of the lateDr. DeWitt Stetten, Jr., former NIH Deputy Director forScience, and the chart prepared by NIH Nobel LaureateDr. Marshall Nirenberg during his work on breaking thegenetic code. Former NIH Director Dr. DonaldFredrickson donated to the library a 1968 film showingan NIH celebration in honor of Nirenberg's receipt of theNobel Prize for Physiology and Medicine.

Responding to deficiencies identified in previouscollection assessment studies, NLM implemented a moreactive acquisitions strategy for association publicationsand other biomedical literature not available throughcommercial sources. The staff continued its efforts to ac-quire issues missing from NLM's serials collection andbegan a more systematic program to fill lacunae in thebook collection. Several key improvements were made tothe automated systems that support serials processingand monograph acquisitions, including more efficienttransfer of data between modules of the serials systemand automatic generation of data elements previouslyentered manually.

Collection preservation and maintenance

NLM's preservation program includes: preservationand maintenance of the Library's collection; promotionof the use of acid-free paper in new biomedical publica-tions; and exploration of new technologies for preserva-tion of library materials. As funding permits, the Libraryalso provides support for preservation of important bio-medical literature not held by NLM.

In FY 1991, NLM microfilmed 2.08 million brittlepages and preserved 254 items from the special collec-tions. New competitive contracts were awarded for mi-crofilming and for preservation and conservation ofartifactually valuable materials from NLM's historical

collection. In FY 1991, NLM improved access to informa-tion about what it has microfilmed by updatingCATLINE® to indicate which books have been pre-served. Information about serials that NLM has micro-filmed is already available in SERLINE. Microfilmservice copies of items the Library has preserved cannow be ordered from an NLM contractor.

NLM's campaign to increase the use of acid-free pa-per in new biomedical publications continues to havepositive results (see "Paper Preservation" in Special Ini-tiatives section). NLM staff continue to be heavily in-volved in the effort to revise the American NationalStandard for Permanence of Paper (Z39.48-1984) and toextend its coverage to coated paper.

Bibliographic Control

NLM fulfills its mission to organize the biomedicalliterature by maintaining and enhancing the MedicalSubject Headings (MeSH) and the NLM classificationscheme for the shelf arrangement of biomedical librarymaterials; by cataloging biomedical publications in alllanguages and formats; and by indexing articles from se-lected biomedical journals.

Thesaurus

MeSH, the hierarchical thesaurus used to catalog, in-dex, and search NLM's online databases, now has 16,681subject headings. MeSH's supplementary chemical filecontains about 62,000 additional names of substances.MeSH is updated annually to keep pace with develop-ments in biomedicine and changes in the usage of bio-medical terms. In FY 1991, 554 new main headings and2,203 new entry terms were added to the vocabulary. Ajoint NLM/Agency for Health Care Policy and Research(AHCPR) Task Force is advising the Library on how toimprove MeSH terminology in the field of health ser-vices research: the first phase of these improvements wascompleted in FY 1991. MeSH's bacteria terminology wasrevised and expanded to conform to the Sergey's Manualof Systematic Bacteriology. The Library also continued toupdate terminology related to AIDS and molecular biol-ogy. An expert consultant reviewed MeSH's chemicaland drug classification and nomenclature and recom-mended a number of changes that will implementedover the next several years.

In FY 1991, the structure of the MeSH file was en-hanced to accommodate 9 levels of hierarchy in place ofthe current 7 levels. This permits more accurate hierar-chical organization of chemicals, neuroanatomy, andgene terminology. A number of other changes weremade to the MeSH file to facilitate the integration ofMeSH and the UMLS Metathesaurus. MeSH section staffmembers continued to be heavily involved in reviewingand editing the UMLS Knowledge Sources.

Library Operations

Cataloging

NLM's cataloging responsibilities include: catalog-ing new works added to the NLM collection, creatingand maintaining the Library's automated files of catalog-ing and name authority records, contributing NLM'scataloging data to national cooperative bibliographic da-tabases, and maintaining the NLM classification scheme,which is used by NLM and other health science librariesto assign shelving locations to materials based on theirsubject content.

In FY 1991, the Library cataloged 19,187 modernbooks, serials, nonprint items, and Cataloging-in-Publi-cation galleys, using in-house staff, contractors, aninteragency agreement with Library of Congress, and as-sistance from the MEDLARS Center in China. In the pastyear, NLM expanded the amount of serials cataloging re-ceived from outside sources. The year's cataloging pro-duction was roughly equal to last year's excellentperformance, but because of a sharp increase in receiptsof new titles the inventory of uncataloged modern worksincreased by 4359. In FY 1991, some of NLM's contractcatalogers began to use the new NLM online catalogingsystem from remote locations, and one of NLM's owncatalogers began to work from home for part of the workweek. NLM also continues to explore ways to simplifynational cataloging practices. Library staff members par-ticipated in a national conference on approaches to sim-plifying subject cataloging and actively supported areview by the three U.S. national libraries of potentialmechanisms for simplifying descriptive cataloging.

More than 14,000 abbreviated machine-readablerecords for items in NLM's picture collection were up-graded to fully cataloged status in FY 1991. An opera-tional system for integrated retrieval of the catalogrecords and the videodisc images of the picture collec-tion created under the direction of the Lister Hill Centeris being developed; a prototype system is currently avail-able in the History of Medicine Division.

Dr. Emilie Savage-Smith, an authority on the historyof Arabic medicine, made substantial progress on theproject to review NLM's Arabic manuscript collectionand to provide the information necessary for NLM staffto prepare complete cataloging records for the collection.The History of Medicine Division completed the process-ing of several important manuscripts collections with theaid of volunteers and student interns. Detailed findingsguides were prepared for the papers of John Adriani, anationally known expert on anesthesiologist and drugevaluation, and Mike Gorman, a significant figure inAmerican health policy in the twentieth century.

In early FY 1991, NLM disposed of its post-1800 cardcatalog (which had been removed from the public ser-vice area in late 1985). The massive catalog card caseswere donated to the Library of Congress. The Louise

Darling Biomedical Library at the University of Califor-nia, Los Angeles kindly provided some smaller surpluscard catalog cases to house the sections of the NLM seri-als shelf-list that are still needed by Library staff.

Indexing

NLM's indexing operation includes: selecting thejournals to be indexed, keyboarding descriptive informa-tion and abstracts from the articles to be indexed, index-ing the content of the articles, providing special indexingof the gene sequences that appear in indexed articles, re-viewing the accuracy of the keyboarding and indexing,and maintaining the citation databases to correct any in-dexing errors and to annotate citations to articles thathave been retracted, corrected, or challenged in subse-quent commentaries.

The Literature Selection Technical Review Commit-tee (LSTRC) (Appendix 8) provides advice to NLM onthe journals that should be indexed for MEDLINE andIndex Medicus®. In FY 1991, the LSTRC reviewed 370jour-nals and ranked 93 sufficiently high for NLM to begin in-dexing them. Professional societies in the field ofophthalmology and rheumatology prepared reports onjournals in their specialties considered useful for practice,research and education to assist the LSTRC in its reviewof indexing coverage for these subject areas. Guidelinesfor selection of journals for indexing were approved andpublished in an NLM Fact Sheet.

MEDLARS indexing is done by NLM staff, commer-cial contractors, some international MEDLARS centers,and cooperating agencies such as the American HospitalAssociation, the American Journal of Nursing Co., andthe American Dental Association. The NLM staff per-forms quality review of all indexing. In FY 1991 the Li-brary added 363,344 citations to MEDLINE (table 4) andentered English-language abstracts for the 72 percent ofthe articles that included them. Previously indexed cita-tions in MEDLARS databases were updated to reflect in-formation about 16 retracted publications, 2,722published error notices, and 18,885 substantive commen-taries.

The Library continued the phased acquisition of newPC workstations for its indexers. The project to modifyNLM's online indexing system to accommodate thenonjournal citations in BIOETFflCSLINE® and otherMEDLARS files was essentially completed; the new soft-ware will be implemented for BIOETHICSLINE in FY1992. NLM also began to investigate optical scanning asan alternative to keyboarding citations and abstracts. Toensure rapid indexing of gene sequences for the NationalCenter for Biotechnology Information's backbone data-base, Library Operations hired additional gene sequenceindexers. In FY 1991, four NLM indexers began workingfrom home several days a week.

Programs and Services, FY1991

Network Services

NLM's services to onsite and remote users include:distribution of authoritative bibliographic data in publi-cations, machine-readable formats, and an online re-trieval service; reference assistance provided in responseto onsite, telephone, and written requests; delivery ofdocuments from the NLM collection to onsite users andto remote requesters as needed to supplement the re-sources of other U.S. libraries; and overall direction of theNational Network of Libraries of Medicine. These ser-vices provide the essential foundation for NLM's out-reach initiatives.

Publications

NLM's publications continue to be "best-sellers" forthe Government Printing Office and the National Techni-cal Information Service despite the wide availability ofNLM data in machine-readable formats and online ser-vices. In FY 1991, NLM produced more than 100 indi-vidual issues of some 23 recurring indexes and catalogs,including Index Medicus, the National Library of MedicineCurrent Catalog, and more specialized publications suchas the Bibliography of the History of Medicine. In FY 1991,the Library issued a new publication, NLM RecommendedFormats for Bibliographic Citations, prepared by KarenPatrias. The MeSH publications were enhanced in sev-eral ways, including the permutation of word roots (e.g.,hepato-) in the Permuted MeSH.

Machine-readable databases

To promote access to its authoritative data, NLMleases complete databases and subsets of selected data-bases in machine-readable form. Commercial databasevendors, other segments of the information industry, in-ternational MEDLARS centers, universities, and other or-ganizations obtain machine-readable data from theLibrary and make them available online or in CD-ROMproducts.

In FY 1991, NLM distributed more than 6,000 tapesof various databases to licensees worldwide. The Libraryadded MARC records for its computer software and his-torical film collections to the array of available NLMdata. Nine new license agreements were established,bringing the number of licensees up to 100. At the end ofthe year, nine licensees were producing CD-ROM prod-ucts containing data from six different MEDLARS data-bases. After considering comments and suggestions frommany constituents, NLM proposed changes in revisedcharges for MEDLARS data in light of changes in CD-ROM and network technology and to facilitate NN/LMoutreach efforts.

Online services

NLM makes 43 databases available online. In FY1991, NLM's online users conducted 5.8 million searchesand were connected to the NLM systems for a total of324,000 hours (tables 6 and 7). These figures excludeonline searching performed on the computer systems oforganizations that lease data from NLM.

As a result of special outreach efforts by NLM andhealth sciences libraries throughout the NN/LM, thenumber of users of NLM's online system continues to in-crease rapidly. At the end of FY 1991, there were 48,772active codes for use of NLM's online system, an increaseof 23 percent from the previous year. Most of the newcodes were assigned to individuals rather than to institu-tions. Individuals now represent 53 percent of all U.S.code holders. The growth in the number of individualusers has led to increases in the number and complexityof the calls received at the MEDLARS Management Ser-vice Desk.

Ninety percent of the individuals who receivedcodes in FY 1991 indicated an intention to use the Grate-ful Med microcomputing front-end package to search theNLM databases. A total of 37,899 copies of Grateful Med(32,586 IBMPC versions; 5,313 Macintosh) have been dis-tributed by the National Technical Information Servicesince the package first appeared in 1986. Purchasers re-ceive new versions at no additional cost, hi FY 1991,NLM issued version 1.5 of the Macintosh Grateful Med.

hi addition to the new "Clinical Alerts" service (seethe Special Initiatives section of this report), the Librarymade a number of other enhancements to its online data-bases, retrieval capabilities, and user support mecha-nisms. AIDSLINE®, NLM's database of citations toliterature about acquired immunodeficiency syndromewas expanded to include AIDS-related records fromCATLINE and AVLINE®, NLM's databases of catalogrecords for print and nonprint materials respectively,and additional abstracts from AIDS-related meetings.The individual words in multiword MeSH terms arenow searchable in many NLM databases, and text wordsearching can be restricted to words in titles. Subheading"pre-explosions" facilitate searching by logical groups ofsubheadings, e.g., all subheadings that deal with someaspect of therapy. The new MEDLINE "publicationtype" field allows users to restrict searches to specifictypes of articles, e.g., guidelines and clinical trials. Thenew "gene symbol" field contains the gene name abbre-viation used by researchers. The special characters (e.g.,Greek letters, superscripts) that appear in gene symbolsare tagged according to the conventions of the StandardGeneralized Mark-up Language. The MEDLINE addressfield is now searchable.

Library Operations

In FY 1991, NLM concluded flat-rate per code pric-ing experiments with several institutions and is now ana-lyzing the data gathered. The charges for onlinesearching on NLM's system were revised to ensure fullrecovery of access costs. NLM now uses contract assis-tance to key data for new online code holders.

Exhibiting Grateful Med and NLM's online servicesat professional meetings continues to be an importantpart of the Library's outreach initiative. In FY 1991, theRegional Medical Libraries became even more heavilyinvolved in exhibiting NLM products and servicesthroughout the country, as NLM staff concentrated onexhibits in the Washington D.C. area. With the award ofnew 5-year contracts, RMLs in Regions 1, 4, and 7 arealso continuing to provide online training to librariansand information professionals. In FY 1991 a total of 1,079librarians and other search intermediaries receivedonline search training from NLM or RML staff. Thesearch training courses were modified to include a 3-day"Fundamentals of MEDLARS Searching" and special-ized training modules for various databases. TheMEDTUTOR® computer-assisted instruction package forcommand language searching was modified and up-dated.

Reference Services

NLM provides reference service and research assis-tance to onsite users and to remote requestors as a back-up to the service available from U.S. health sciencelibraries. In FY 1991, NLM's Reference Section received66,516 requests for reference assistance, 69 percent fromonsite requestors, 31 percent in telephone calls, and lessthan 1 percent in letters (table 8). In addition, a largenumber of routine requests for hours of service, direc-tions to the Library, etc., are handled by an automatictelephone answering system. In FY 1991, NLM installedNEK (NLM Information Kiosk), an automated guide toNLM for onsite users. NIK, which is implemented inSupercard and installed on a Macintosh computer, pro-vides information on NLM's programs and services andexplains how to locate and obtain materials and refer-ence assistance.

NLM continues to upgrade and expand its internalCD-ROM network that provides access to a variety ofCD-ROM tools and to the MEDSTATS expert system forlocating sources of answers to statistical questions. In FY1991, the content of MEDSTATS was revised and ex-panded to include sections on health care staffing, healthfacilities and services, costs, and general and vital statis-tics.

The NLM Reference staff provides a special litera-ture search service to other NIH components in supportof the NTH Consensus Development Conference. Thesearches prepared for attendees are published as part ofNLM's Current Bibliographies in Medicine series as are

other bibliographies on topics of special current interest.Topics covered in the series in FY1991 included: acousticneuroma, therapy-related second cancers, nutrition andAIDS, medical waste disposal, dental restorative materi-als, and adverse effects of fluoxetine (prozac).

Document Delivery

NLM provides document delivery service to remoterequesters as a back-up to other member libraries in theNN/LM and to onsite users who wish to consult itemsfrom NLM's closed stacks (table 5). The total number ofdocument requests submitted to NLM was 494,515, anincrease of 8 percent from FY 1990. NLM received281,606 interlibrary loan requests and filled 74 percent ofthem, an improvement of 3 percentage points from FY1990. If requests for which the requestor was unwillingto pay are excluded, NLM's fill rate was 81 percent. Thespeed with which requests are filled improved substan-tially; 54 percent of all filled requests were processedwithin a single day of receipt. NLM received 84 percentof its interlibrary loan request via DOCLINE, NLM's au-tomated request and routing system. Three percent or7,470 requests were received via telefacsimile transfer;ofthese 3,728 were needed for clinical emergencies andwere processed within two hours.

During FY 1991, NLM began a pilot test of the Sys-tem for Automated Interlibrary Loan (SAIL) which usesscanned bit-mapped page images of selected journaltitles to which NLM subscribes to fill requests referred toNLM via DOCLINE. Requested articles are printed outfor mailing or converted to faxable form and sent directlywithout human intervention. The pilot involves journalsrecently selected for MEDLINE for which NN/LM hold-ings data may not be available yet. Thus far, 2,593 re-quests have been referred to SAIL.

The number of libraries using DOCLINE increasedto 2,195 in FY 1991. These libraries entered 2.1 milliondocument requests and filled 86 percent of them. NLMfilled another 8 percent for an overall fill rate of 94 per-cent. DOCLINE routes requests to appropriate librariesbased or approximately 1.26 million SERHOLD records,which represent the holdings of more than 3,000 NN/LM member libraries. Recent DOCLINE enhancementsinclude a fax-only delivery option and allowance forseparate bill-to and ship-to addresses.

At the end of FY 1991, Loansome Doc, a new featureof Grateful Med that allows individual health profession-als to submit automated document requests to a specificNN/LM library, was made available to Grateful Med us-ers nationwide. Loansome Doc allows users to requestthe full text of articles identified in a Grateful Med/MEDLINE search. If a user's designated library cannotfill the request, the request can then be routed viaDOCLINE. In FY 1991, Loansome Doc users requested6,290 documents.

10 Programs and Services, FY1991

Onsite users requested 212,909 documents fromNLM's closed stacks, an increase of 7 percent from FY1990. Eighty-five percent of the requests were filled, and96 percent of filled requests were delivered to userswithin 30 minutes. This represents a substantial im-provement in service from last year. In FY 1991, NLMmodified its onsite service policies to raise the daily limiton free stack requests from 10 to 12 and to impose an an-nual limit of 150 requests per individuals. The use pat-terns of 98 percent of onsite users fall within these limits.The remaining high-volume users were operating com-mercial document delivery services. High-volume re-questors may use either NLM's regular fee-basedovernight photocopy service or an experimental infor-mation vendor service that was established after thechange in the onsite service policy. Exceptions to the lim-its are made for visiting scholars on a case-by-case basis.As expected and desired, the new policy shifted some ofthe onsite request traffic to the overnight photocopy ser-vice.

National Network Program

The goal of the NN/LM is to improve and equalizeaccess to biomedical information by linking U.S. healthprofessionals and researchers to the information re-sources they need, irrespective of geographic location.There are over 3,600 Network members including healthsciences libraries of every size and type located in allparts of the country. NLM's Network Office overseesand coordinates activities throughout the Network. TheNN/LM program is a critical component of NLM's out-reach initiative. In FY 1991, the network wasreconfigured from 7 to 8 regions and the responsibilitiesof the 8 Regional Medical Libraries were modified tosupport increased outreach to individual health profes-sionals. Many individuals network members wereawarded purchase orders for specific outreach projects.(See Special Initiatives Section). To assist the RML staffsin carrying out their expanded responsibilities for exhib-its, training sessions, and development of specific out-reach projects, the NLM Network Office developedtraining materials, special facts sheets, an exhibit man-agement packet, and exhibit backdrops for use in all Re-gions, and conducted a special 2-day workshop forRMLemployees who will exhibit NLM's products and ser-vices.

The Network Office also tested the use of a softwarepackage that can map data by U.S. zip code as a meansfor representing baseline demographic, online user, andNetwork member data for outreach projects. In FY 1991,NLM began to update DOCUSER®, an online file of in-formation on network libraries that are DOCLINE usersdirectly from the PC-based NN/LM network member-ship files maintained in each Region. This procedure al-lows for efficient maintenance of such information as

availability of telefacsimile service, FAX and telephonenumbers, names of contact people, etc.

Special Onsite Programs

In addition to the reference and document deliveryservices provided to onsite users, NLM offers a varietyofspecial programs and services to those who visit the Li-brary in Bethesda, including guided tours, briefings onNLM's operations and services, and historical exhibitsand symposia. NLM also has a visiting Historical ScholarProgram and a one-year post-master's training programfor librarians with potential for substantial contributionsto health sciences information services.

Public tours and briefing

NLM continues to be a popular attraction for domes-tic and international visitors with an interest in any andall facets of biomedical communication, medicallibrarianship, and information technology, hi FY 1991,LO staff members conducted 145regular daily tours for atotal of 425 visitors. The Office of Public Information (Of-fice of the Director) arranged 138special tours and orien-tation programs for groups (1,271 visitors). NLM staffmembers also arranged special briefings on library pro-grams and services for many individual visitors.

Historical Programs

In FY 1991, NLM prepared several special historicalexhibits, including: "Dentistry in Paris, 1830-1860:George Fattet and his Contemporaries," in collaborationwith the National Institute of Dental Research, "A De-cade of Historical Acquisitions at the National LibraryofMedicine," and "Midwife Means With Woman: An His-torical Perspective" in cooperation with the AmericanCollege of Nurse-Midwives.

The Library sponsored a lecture by Dr. DonaldFredrickson, former NIH Director, on "NIH: the CrucibleYears, 1930-1948," co-sponsored the Annual Meeting ofthe American Ophthalmic History Society with the Na-tional Eye Institute, and co-sponsored an oral historyconference on clinical research with the Acadia Institute.LO's History of Medicine Division and the NLM EqualEmployment Opportunity Office presented a lecture byProfessor Robert Davis entitled "Another Kind of Glory:Black Doctors in the Civil War." The FY 1991 VisitingHistorical Scholar was Sander Gilman, Ph.D. Each year arecognized historical scholar is selected competitively tospend 6 to 12 months at NLM to engage in research thatwill use the Library's collections, to give one or morepublic presentations, to assess segments of NLM's his-torical collections, and to consult with staff. Dr. Gilmancarried out research for his projected work "Freud, Race,and Gender" and served as a consultant on NLM's printsand photographs collection. He presented a public lee-

Library Operations 11

ture on "Seeing Diseases: Visual Sources and the Mean-ing of History" and an HMD staff seminar on "Nine-teenth Century Racial Biology and the Origins ofPsychoanalysis." Members of NLM's History of Medi-cine Division also continued their research using NLM'scollections. Staff research appeared in several publica-tions and was presented at professional meetings and in-vited lectures throughout the year.

NLM Associate Program

The NLM Associate Program is a one-year competi-tive program that allows library school graduates to be-come familiar with NLM's operations, to gain anunderstanding of key issues facing health sciences librar-ies, to use new information technologies, and to developtheir skills by conducting special projects. Projects car-ried out by Associates in FY1991 included an assessmentof NLM's collection of publications produced by profes-sional associations, the development of an exhibit man-agement manual, and work on developing theknowledge sources and algorithms to be used by theCoach expert search assistant program. Associates alsohave an opportunity to visit the other national librariesand various types of health sciences libraries and infor-mation centers and to attend professional meetings.

Four Associates completed the 1990/1991 programand moved on to jobs in academic health science centers,a university library, and a professional library associa-tion. Four new Associates began the program in Septem-ber 1991.

Health Services Research

In 1989, NLM received a legislative mandate to workwith the newly created Agency for Health Care Policyand Research (AHCPR) to improve information servicesin the field of health services research. With funds pro-vided by AHCPR under an interagency agreement, theLibrary established an Office of Health Services ResearchInformation (OHSRI) and initiated a number of activitiesto improve access to health services research informationand to support the development of AHCPR-sponsoredclinical practice guidelines.

hi FY 1991, NLM reviewed and revised its selectionpolicy for health services research literature in conjunc-tion with the general effort to revise the Collection Devel-opment Manual of the National Library of Medicine.Expansion of the NLM collection of health services re-search materials is already under way. With the help of a

joint NLM/AHCPR Task Force, the Library has begun torevise and expand MeSH terminology in the field ofhealth services research. A substantial number of newconcepts and cross-references were added to MeSH for1992 as a result of this effort. A more specific publicationtype, "Practice Guideline," was created to allow moreprecise retrieval of these important documents. It will beapplied retrospectively to selected guidelines that havealready been indexed or cataloged by NLM as well as tonewly received guidelines.

The NLM/AHCPR Task Force has identified theneed for a major reorganization of the MeSH hierarchiesrelated to health services research. This restructuring willappear in the 1993 MeSH. NLM recently awarded a con-tract to ECRI (formerly the Emergency Care Research In-stitute) to expand its database coverage of health servicesresearch information. ECRI will index additional healthservices research literature, with an emphasis on technol-ogy assessment, will update and add information toDIRLINE (Directory of Information Resources Online)about organizations involved in all facets of health ser-vices research, and will also help the Library to add con-cepts and terms from ECRI's Universal Medical DevicesNomenclature System to the UMLS Metathesaurus.

To date, the NLM staff has provided extensive litera-ture search support and backup document delivery ser-vice for nine panels convened by AHCPR to developclinical practice guidelines. Other Network libraries haveprovided primary document delivery service to some ofthe panels. NLM is establishing several mechanisms tofacilitate access to AHCPR-sponsored guidelines oncethey are approved. Electronic copies of some versions ofthe guidelines will be available for automatic documentdelivery. The Lister Hill Center is also developing anonline system that will provide access to the full-text ofAHCPR approved clinical practice guidelines. (SeeListerHill Center Chapter.)

At the end of FY 1991, NLM received from the Insti-tute of Medicine a report titled "Improving InformationServices for Health Services Researchers: A Report to theNational Library of Medicine." The report, the result of ayear-long IOM study funded by AHCPR, recommendsexpanding NLM's existing services, developing new ser-vices (e.g., a database of available datasets that are usefulin health services research), and training for medical li-brarians to assist them in responding to the complex in-formation needs of producers and users of healthservices research. In the coming year, the Library will de-velop plans and resource estimates for carrying out rec-ommended activities that are not already under way.

Programs and Services, FY1991

Table 1Growth ofCollections

CollectionPrevious

Total(9/30/90)

FY1991 New Total

Book MaterialsMonographs:

Before 1500 5711501-1600 5,7481601-1700 10,0571701-1800 24^621801-1870 39,921Americana 2,3411870-Present 537,967

Theses (historical) 281,794Pamphlets 172,021Bound serial volumes 917,641Volumes withdrawn* (35,017)

Total volumes* 1,957,406

Nonbook MaterialsMicroforms:

Reels of microfilm 54,115Number of microfiche 238,756Total microforms 292,871

Audiovisuals 50,176Computer software 244Pictures* 56,600Manuscripts 2,328,229

024150

13,86000

29,365(132)

43,105

2,21814,55616,7741,941

720

73,388

5715,750

10,06124,36339,9262,341

551,827281,794172,021947,006(35,149)

2,000,511

56,333253,312309,64552,117

31656,600

2,401,617

"Revised figure

Table 2Acquisition Statistics

Acquisitions FY1989 FY1990 FY1991

Serial titles receivedPublications processed:

Serial piecesOtherTotal

Obligationsfor:PublicationsIncluded for rare books

21,781

137,84918,382

156,231

$3,526,901($182,584)

21,557

144,35621,068

165,424

$3,632,746($203,559)

21,181

158,93923,344

182,283

$3,943,338($184,742)

Library Operations 13

Table 3Cataloging Statistics

Item FY1989 FY1990 FY1991

Completed CatalogingFullLimitedTotal

11,9856,748

18,733

12,0607,309

19,369

12,7076,480

19,187

Table 4Bibliographic Services

Services

Citations published in MEDLINEFor Index Medicus . . .

Recurring bibliographiesJournals indexed for Index MedicusAbstracts entered

FY1989

372,806352,206

262,888

233,707

FY1990

391,172363,890

282,973

275,000

FY1991

363344341874

233020

281,644

Table 5Circulation Statistics

Activity

Requests Received:Interlibrary LoanReaders . . . . .

Requests Filled:Interlibrary Loan

PhotocopyOriginalAudiovisual

Readers

Requests Unfilled:Interlibrary Loan

ReferredReturned

Reader ServiceReturned as unavailable

FY1989

414,354227,841186,513

310^63158,840146,67910,7531,408

151,523

101,00969,0012,850

66,151

32,008

FY1990

456,904258,421198,483

349,999183,950170,60512,0541,291

166,049

106,90574,4713,431

71,040

32,434

FY1991

494,515281,606212,909

385,405207,670193,85512,6061,209

177,735

109,09073,9362,050

71,886

35,154

14 Programs and Services, FY1991

Table 6Online Searches

DATABASES FY 1989 FY1990 FY1991

AIDSDRUGS 48AIDSLINE 18,940AIDSTRIALS 95AVLESJE 11,989BIOETHICS 8,196CANCERLIT® 61,070CATLINE 157,783CCRIS 3,060CHEMID*CHEMLME® 24,674CLINPROT® 2,763DARTDBIR® 657DENTALPROJ 121DIRLINE® 7,271DOCUSER 2,646EMICBACK 331ETICBACK 1,316GENETOXHEALTH 128,658HISTLINE* 4,341HSDB® 32,641INFORM 115INTROMED® 692IRISLOAN STATUSMEDLINE 1,782,750

MED86 567,991MED83 492,092MED80 254,539MED77 144,562MED72 99,358MED66 70,202

MESH VOCABULARY 20,542NAME AUTHORITY 3,580PDQ* 69,158POPLINE® 22,534REFLDME 38,799RTECS® 17^46SDILINE® 39,812SERLINE 53,532STORED SEARCH 130TOXLINE® 71,101

TOXLINE65 5,202TOXLIT® 20,877

TOXLIT65 7,087TRI 12,158YEAR86 2

Total 4,260,761

24724,525

76812,8798,505

63,898158,293

2,9833,497

22,6832,4321,2441,942

2627,1203^091,5171,627

136,6164,643

34,939127

4,959211

2,058^01602394402341225340132,97691,6016837320,4483,179

69,68419,14041,90216,30341,18555,038

10768,9119,962

15,5165,116

30,625655

31036,904

64615,76011,22179,511

213,3764,8627,939

26,8781,1174,6322,241

2799,4829,4752,1071,776

919175,285

5,91842,479

306

12,133737

2,731,557700,010402,914247,919151,620106,88284,58627,0793,507

44,19417,2605139317,68455,07775309

15480,19110,41117,6535,634

35,67418

4,478,323 5,533,019

Library Operations 15

Table 7Offline Searches

DATABASES FY1989 FY1990 FY1991

AIDSLINE 191AVUNE 126BIOETHICS 38CANCERLIT 3,842CATLINE 558CHEMLINECLINPRDT 2DIRLDMEDOCUSER 1HEALTH 11,516HISTLINE 6MEDLINE 6,115

MED86 7,380MED83 8,823MED80 5,971MED77 3,830MED72 2,440MED66 1,510

MESH VOCABULARY 1POPLINE 5,378SDILINE 247,812SERLME 6TOXLINE 12,731

TOXLINE65 35TOXLIT 145

TOXLIT65 119

Total 318,576

1,294103'

253,654

5361040

10,9839

4,6305,9935,2113,5572,0731,452

8381

5,107229,625

106,608

765,497

103

1,80712930

3,586555

1000

10,6542

5^644,7513,4152,5131,401

993610

13,778

2263978

5,42124

4,44122

287,390 275,903

Table 8Reference Services

Activity FY1989 FY1990 FY1991

Reference Section:Requests by telephone.Requests by mailIn-person requestsTotal

21,481985

39,37461,840

19,222585

40,82360,630

19,889487

46,14066,516

16 Programs and Services, FY1991

Table 9History of Medicine Activities

Activity FY1989 FY1990 FY1991

Acquisitions:Books 127 360 66Modern manuscripts 946,750 128,088 73,388Prints and photographs 3,420 642 0

Processing:Books cataloged 346 232 330Modern manuscripts processed* 48,001 112,541 129,000Pictures cataloged 0 0 0Citations indexed 5,479 5,136 5,888Pages microfilmed 48,774 66,581 88,524

Public Services:Reference questions answered 10,244 13,982 12,184ILL and pay orders filled 2,406 3,506 3,477Reader requests filled 8,309 9,358 5,992Pictures supplied 6,045 5,872 4,683

* Revised category.

17

SPECIALIZEDINFORMATION SERVICES

Henry Kissman, Ph.D.Associate Director

The widely quoted results of a recent Louis Harrispoll in which respondents rated a clean environmentmore important than a satisfactory sex life, are clearly astronger indicator of the urgency of environmental issuesthan they are of the demise of romance. Society is recog-nizing that its environmental future cannot be deferred.Chemicals must be used safely and wisely today, so thattheir benefits can be reaped without deleterious conse-quences tomorrow. NLM's Specialized Information Ser-vices Division (SIS), through its Toxicology InformationProgram and other activities, is making available infor-mation now, to meet current and long-term environmen-tal and toxicological needs. The past year has witnessedseveral significant milestones within the Division.

The much-used TOXNET (Toxicology Data Net-work) system now encompasses 12 files. Most recentlyadded were GENE-TOX, a scientifically reviewed Envi-ronmental Protection Agency (EPA)file of mutagenicitydata, and the 1989 edition of the Toxic Chemical ReleaseInventory (TRI89). The TRI series of files responds toFederal right-to-know legislation and anticipates con-tinuing demands by the public to be apprised of routineor accidental releases of toxic chemicals to the environ-ment. The TRI series, along with HSDB (Hazardous Sub-stances Data Bank), RTECS (Registry of Toxic Effects ofChemical Substances) and IRIS (Integrated Risk Informa-tion System) account for the bulk of the usage onTOXNET. These and TOXNET's other files give research-ers, physicians, emergency responders, and citizens in-formation on hazardous chemicals to help them manageexisting needs and plan for future ones.

TOXNET has also undergone an internal evolutionto a new software system. This has been accompanied bya hardware switch from minicomputers to a PC-basedcluster consisting of ten 386 microprocessor machines.This new approach results in improved processing time,greater flexibility and the ability to respond quickly to fu-ture technological changes, by expanding the number ofPCs or stepping up to 486 or even 586 machines as maybe warranted. It also resulted in considerable savings. SIShas continued investigating the feasibility of redesigningTOXNET in a Relational Database Management System(RDBMS) environment as another means of facilitatingfile building and maintenance capabilities.

Another major SIS initiative has been the develop-ment of a Toxicology Information Outreach Program for

Historically Black Colleges and Universities. This initia-tive will attempt to facilitate the training of students andhealth professionals in the use of environmental andtoxicological information resources.

SIS's AIDSTRIALS and AIDSDRUGS continue toprovide extensive up-to-date information on AIDS clini-cal trials and the agents tested in such trials. While theAIDS toll has not subsided, research goes on, and thesefiles offer much needed data on treating patients.

A Long Range Planning Panel for Toxicology andthe Environment has been formed. During the comingyear, it will explore the deep waters of toxicological andenvironmental information and help NLM chart a courseto navigate them for the remainder of this decade. Envi-ronmental issues are clearly "hot." Addressing these is-sues head-on is fashionable but also imperative if we areto survive and thrive on this planet. SIS has been at theforefront of making data publicly accessible since the1960's, when society first became aware of how suscep-tible the environment was to widespread damage. SISislooking ahead, further into the 1990's and beyond, andassessing new information approaches to help in keep-ing man and the environment safe and healthy.

Databases under ELHILL

ChemID (Chemical Identification File) is an onlinechemical dictionary and directory, which covers prima-rily chemicals of biomedical and regulatory importance.ChemID allows users to search by a variety of chemicaland biological identifiers, and to locate other files on theELHILL® and TOXNET systems, or external data, whichcontain more information about the chemical in ques-tion. In August 1991 ChemID contained over 183,000records, and was expected to contain over 200,000records by the end of the fiscal year.

ChemID includes an important set of regulatory andscientific data, collectively known as SUPERLIST. Morethan 6,000 records are augmented with the name and anindication of source for chemicals mentioned in one ormore of 16 lists of regulatory or biomedical importance.These data allow users to determine if a certain chemicalis mentioned on a given list and under what name; tosearch for chemical classes on these lists; and to showcoverage overlap between lists. In 1991, an additionalseven lists were prepared for inclusion in SUPERLIST.

18 Programs and Services, FY 2991

These include the Priority Based Assessment of FoodAdditives (PAFA) list, and the Generally Recognized asSafe (GRAS) list, both from FDA, as well as the Hazard-ous Air Pollutants (HAP) list, established under theClean Air Act. Thus, SUPERLIST establishes a means tolink a wide array of information sources and helps estab-lish an overview of Federal regulation of a chemical sub-stance.

CHEMLINE (Chemical Dictionary Online) is anonline chemical dictionary and directory file that allowsusers to identify chemical substances via nomenclatureand other identifiers, and to formulate optimum searchstrategies for other NLM files. Each chemical record haspointers to other files on the ELHILL and TOXNET sys-tems which contain information about that chemical sub-stance. CHEMLINE is updated every two months andregenerated annually. Most of CHEMLINE's data aresupplied by the Chemical Abstracts Service (CAS) fromits Registry System; users must pay CAS royalty fees touse CHEMLINE. The file now contains more than1,000,000 records of chemical substances.

During FY 1991, the scope of coverage of theCHEMLINE file continued to increase. CHEMLINE nowcovers substances in the TRI87 and TRI88 files onELHILL, as well as both the EMICBACK, ETICBACKand GENETOX files on TOXNET. For seekers of regula-tory information, the data from the EPA's Toxic Sub-stances Control Act (TSCA) Inventory was updated, aswell as that for EINECS, the European Inventory of Ex-isting Commercial Chemical Substances. Data from allsources contributing to CHEMLINE were updated andenhanced during the file regeneration of 1991.

CHEMLINE was also changed in 1991 to take ad-vantage of features pioneered the previous year inChemlD. A new Name of Substance (NM) field wasadded to separate the more useful and important chemi-cal names such as United States Adopted Names(USAN) for printing, and then for selection as searchterms in files such as TOXLINE. Also, a MeSH Heading(MH) field was added to point out pertinent indexing,and a Name of Mixture (MX) field was added to identifynames of drug mixtures which contain the drug recordretrieved by a user.

TOXLINE (Toxicology Information Online) is anonline bibliographic retrieval service, produced by merg-ing "toxicology" subsets from some seventeen secondarysources. TOXLINE and its backfile, TOXLINE65, containdata from sources that do not require royalty chargesbased on usage.

Information from Chemical Abstracts Service (CAS),which requires usage royalties, is used for two otheronline bibliographic files, TOXLIT and TOXLIT65. Thefour databases in the TOXLINE family of services nowcontain more than three million records.

The TOXLINE indexing vocabulary mapping projectwhich resulted in the addition of MeSH vocabulary toBiological Abstracts records added to TOXLINE sinceAugust 1985, is continuing. SIS staff developed a pro-gram that maps Biological Abstracts' Concept Codes andBiosystematic Codes to the MeSH vocabulary, and arecurrently working on the mapping of indexing terms forother TOXLINE components to MeSH.

During FY 1991, the TOXLINE files were regener-ated to add current MeSH indexing vocabulary to theportion derived from MEDLINE, and to update severalother components as well. The new DART (Develop-mental and Reproductive Toxicology) subfile, availableon NLM's TOXNET system, was developed and is ex-pected to be added to TOXLINE shortly.

DIRLINE (Directory of Information ResourcesOnline), is an online directory of organizations with in-formation resources and subject expertise who are will-ing to provide information and assistance in response toinquiries. This database assists MEDLARS users by pro-viding an alternative resource for information needs notmet by the usual bibliographic or factual databases.Medical Subject Headings (MeSH) indexing for all therecords in DIRLINE has been provided. Grateful Med 5.0was programmed to include the ability to use MeSH inorder to search DIRLINE.

Health Hotlines is a booklet listing organizations inDIRLINE with toll-free telephone numbers. This hasbeen a very popular publication; over 90,000 copies havenow been distributed to all sectors of the public, includ-ing libraries, health departments, newspapers, maga-zines, and private citizens.

AIDS

NLM has continued to develop AIDS informationresources including those mandated by the Health Om-nibus Programs Extension Act. NLM is one of four Pub-lic Health Service agencies cooperating in the AIDSClinical Trials Information Service.

The AIDSTRIALS and AIDSDRUGS databases, botha part of this cooperative project, have continued togrow. AIDSTRIALS, which includes both trials activelyadding new patients and those which have completedthis accrual, is an effective mechanism for health profes-sionals to identify suitable clinical trials and locations towhich they may refer patients.

AIDSDRUGS contains information about the agentsbeing tested in the clinical trials listed in AIDSTRIALS.The information, extracted from handbooks, compendia,databases, and trial protocols, includes pharmacology,interactions, adverse effects, and chemical/physicalproperties. Under NLM's guidance, the contractor hasadded bibliographic references for those who seek addi-tional information about these agents.

Specialized Information Services 19

The AIDS component of DIRLINE was expanded toinclude more than 1,800 organizations.

TOXNET and Its FILES

The TOXNET computer system continues to provideone of the most comprehensive sources of informationon toxicology and hazardous substances. Over the pastyear, the TOXNET system has undergone a completesoftware conversion and an entirely new hardwareimplementation. Transparent to the user, a networkedPC-based system in a client/server architecture wasbuilt, and after extensive testing, became publicly avail-able on May 6. This new system architecture consists of acluster of 386 microprocessors with over 15 gigabytes ofonline disk storage and 224 user ports on three terminalservers. TOXNET's new mirrored configuration resultsin a twelve-fold increase in processing power over theformer system which operated on a pair of minicomput-ers. The new hardware platform offers flexibility andgrowth together with the ability to accommodate rapidchanges in technology without requiring a complete sys-tem conversion.

During FY 1991 two new files were added to theTOXNET system, bringing the total to 12. They were:TRI89 (the Toxic Chemical Release Inventory's 1989 re-porting year data) and GENE-TOX, a scientifically re-viewed file of mutagenicity data prepared directly onTOXNET by the EPA.TOXNET's online usage continuedto increase throughout the year despite the system con-version. Usage of the TOXNET-to-ELHILL gateway, atransparent switching mechanism providing user accessto other NLM files, has maintained its high usage in1991.

Some of the major system-wide enhancement toTOXNET include online and offline sorting features forall TOXNET databases, and advanced TRI search menus.The sorting capability, combined with numerical calcula-tion commands in the TRI databases, provide users withvery sophisticated and powerful data manipulation ca-pabilities. The advanced TRI menus (see below) havebeen extremely well received, doubling usage over thelast six months of the year.

The Hazardous Substances Data Bank (HSDB) con-tinues to be the most highly used file on the TOXNETsystem, averaging 645 hours of online access eachmonth. The file building activities for HSDB continue tobe supported by the Agency for Toxic Substances andDisease Registry (ATSDR). During this period, 369chemical records were peer reviewed by the ScientificReview Panel, and 514 records went through Public Sys-tem Updates. Hazard summaries were prepared for 67peer-reviewed records and 150 toxicity summaries werewritten by staff.

The Toxic Chemical Release Inventory (TRI) files,including TRI87, TRI88, and TRI89, remain as importantinformation resources with continued high usage onTOXNET. Mandated by the Emergency Planning andCommunity Right-to-Know Act (Title in of theSuperfund Amendments and Reauthorization Act of1986), these EPA-sponsored databases contain environ-mental release data to air, water, and soil for 325EPA-specified chemicals. During FY 1991, TRI advancedmenus were introduced to permit searching against anyor all of the TRI files.

The Chemical Carcinogenesis Research Informa-tion System (CCRIS) continues to be maintained onTOXNET by the National Cancer Institute. The databank contains test results from carcinogenicity, mutage-nicity, tumor promotion and tumor inhibition studies.CCRIS now contains more than 2,800 records.

The Developmental and Reproductive Toxicology(DART) database continues to be accessible throughTOXNET. DART contains approximately 9,000 citationsfrom literature published since 1989 on agents that maycause birth defects. Records in DART contain biblio-graphic citations, abstracts (when available), MedicalSubject Headings (MeSH), and the names and ChemicalAbstracts Services (CAS) Registry Numbers (RN) for allchemicals mentioned in the publications. Over half of therecords are derived from MEDLINE and supplementedwith additional chemical index terms. Records not foundin MEDLINE, such as citations to meeting abstracts, ar-ticles from journals not indexed for MEDLINE, books,and technical reports, make up the remainder of the da-tabase.

DART is a continuation of the Environmental Tera-tology Information Center Backfile (ETICBACK) data-base on TOXNET. ETICBACK, produced by theDepartment of Energy's Oak Ridge NationalLaboratory(ORNL), contains approximately 50,000 citations to lit-erature published from 1950-1989.

The Environmental Mutagen Information Center(EMIC) database is produced by ORNL and is managedby NLM. Plans are under way to create a new EMIC da-tabase, with citations to literature published since 1991,that will be built and maintained on the TOXNET sys-tem. ORNL will also locate and add citations to publica-tions not found in MEDLINE.

A backfile for EMIC (EMICBACK) has been publiclyavailable through NLM's TOXNET system since June1989. EMICBACK contains 70,000 citations to literaturepublished since 1950 on agents that have been tested forgenotoxic activity. Records in EMICBACK contain biblio-graphic citations, EMIC special keywords, and the namesand CASRegistry Numbers for all chemicals tested.

These four bibliographic databases on TOXNET arefunded by the EPA and the National Institute of Envi-ronmental Health Sciences and are operated by NLM.

20 Programs and Services,FY1991

The Integrated Risk Information System (IRIS),EPA's health risk assessment file, has grown consider-ably in its first year on TOXNET. Nearly 200 recordswere added to the file to make a total approaching 600chemicals. Meanwhile, hundreds of these chemicals wereedited with new or revised information. Though rela-tively small and new, IRIS is now TOXNET's fourthmost heavily used file.

The Registry of Toxic Effects of Chemical Sub-stances (RTECS) is a data bank based upon a NationalInstitute for Occupational Safety and Health (NIOSH)file by the same name which NLM has restructured andmade available for online searching on TOXNET. SIScontinues to add new data to this file as NIOSH makesthem available. In addition, SIS continues to enrichRTECS records that lack CAS Registry Numbers withthese important identifiers. So far about 35,000 recordshave been so enhanced. RTECS now contains approxi-mately 110,000 records.

GENE-TOX, a new online data bank created byEPA, contains genetic toxicology (mutagenicity) data on3,000 chemicals. GENE-TOX is a multiphase effort topeer review the existing scientific literature and assaysystems available in the field of genetic toxicology.

Other Programs

Microcomputer Workstation for Chemical Emergency Response

SIS, with the ATSDR, has built a portable, microcom-puter-based workstation that provides information assis-tance to emergency response teams working onaccidents involving hazardous chemicals. The prototype,known as ANSWER (an acronym for ATSDR/NLM'sWorkstation for Emergency Response), consists of soft-ware modules designed to facilitate easy access to infor-mation useful to response teams during emergencies.

The core modules of the Workstation are: a CD/ROM-based database containing information on bothhazard management and medical management; a spe-cialized database containing information gleaned fromprevious chemical emergencies; a modified version ofsoftware that facilitates searching of diverse remoteonline databases; a fax capability to transmit informationto and from an emergency site; access to weather infor-mation from the National Weather Service; and a wordprocessing capability for editing, sorting, merging, andtransforming retrieved data fields.

The Workstation was made available for beta test-ing at 13 sites, including selected state health depart-ments and several poison control centers. The resultsof the test show that ANSWER is fully functional in acommand center environment in both emergency andnonemergency situations. Further, the test shows that

additional chemical databases on CD-ROM would bevery helpful in the field.

Relational Toxicology (RelTox) Project

In RelTox, a new initiative, SIS is investigating theuse of relational database management system (RDBMS)technology for building and operating its chemical andtoxicology files. The first phase of the project was to de-velop a relational model of the data elements of the rel-evant files from TOXNET and ELHILL. SIS thenconvened a panel to review the resulting report. Thepanel recommended that SIS proceed with developingan RDBMS-based file-building module for HSDB andsome of the files now being built on TOXNET.

Outreach

A new outreach project was initiated by NLM tostrengthen the capacity of Historically Black Collegesand Universities to train medical and other health profes-sionals in the use of NLM's toxicological, environmental,and occupational information resources. This audiencerepresents a group that might otherwise not get expo-sure to these valuable information sources. Also, thisgroup is considered one of the high priority populationsfor NLM's outreach efforts. Further, it is intended to tiethis initiative to NLM's High Performance Computingand Communications Program to allow access to a vari-ety of textual and image computer resources.

A Toxicology Information Outreach Panel was es-tablished and held its first meeting at the Library in Au-gust 1991. Representatives from each institutionpresented their preliminary plans for implementing atraining model. PC-based workstations which includeuser-friendly access software (Grateful Med), microcom-puter-based tutorials, and multimedia demonstrationsare to be provided by NLM and will be installed at eachuniversity.

User Support Services

User support for its online files is an ongoing SISfunction. User Guides for the CHEMLINE, TOXLINE,RTECS, HSDB, CCRIS, and DIRLINE files are madeavailable as part of NLM's Online Services ReferenceManual. Guides for newer SIS files that are not yet cov-ered in the manual are provided directly to system userson request or in training classes. In addition, a special ref-erence manual and other training materials are preparedin conjunction with the Oak Ridge Associated Universi-ties. Updated fact sheets for all databases and other re-lated activities are prepared routinely. SIS staff continuedto provide training for the SISonline files both as a partof the MEDLARS training program and, for other users,at special training sessions and at professional meetings.

Special training in the use of the toxicology files alsowas provided in collaboration with the ATSDR to envi-

Specialized Information Services 21

roranental health specialists from that agency and fromstate agencies. This program is conducted under SIS di-rection by ORAU in Oak Ridge, Tennessee. In FY 1990,the project was expanded, with an additional programdesigned to "train trainers"—state health departmentrepresentatives—who teach the use of the NLM toxicol-ogy files back in their home states. To date, representa-tives from health agencies in 40 states and two U.S.territories have been trained. Also, individuals from 11occupational health clinics and the 7 organizationalmembers of the American Minority Professional HealthSchools have taken this training.

During FY 1991, SIS completed development ofELHILL LEARN, a microcomputer-based tutorial for theELHILL search and retrieval software that supports themajority of the MEDLARS databases. It is intended to beused as a precursor to the CHEMLEARN®,TOXLEARN®, and MEDTUTOR® microcomputer-basedtutorials. While it is designed primarily for new usersunfamiliar with the ELHILL software, it can be used as aquick reference tool to reinforce or recall previouslylearned search procedures.

The MEDTUTOR and TOXLEARN tutorials wereupdated. Perhaps the most important design feature ofthese tutorials is their systematic practice and diagnosticfeedback. These programs provide an alternative or aug-mentation to formal classroom training.

The Toxicology Information Program Files DemoDisk, originally written for use in a DOS environment,was made available for Windows. It takes full advantageof Windows' multimedia capability by incorporatingcolor graphics, photography, animation, and audio.

Alternatives to Animal Testing

SIS staff has undertaken a number of projects relatedto the use of alternatives to using live vertebrates in bio-medical research and testing. Quarterly annotated bibli-ographies were prepared by the Oak Ridge NationalLaboratory under the direction of SIS staff and are dis-tributed to those requesting them. ILAR NEWS, a publi-cation of the National Research Council, announces theiravailability. Under an agreement with NLM,ILAR (Insti-tute of Laboratory Animal Research) also publishes an-

nually concatenated versions of the NLM/ORNL quar-terly bibliographies.

Directory of Biotechnology Information Resources

CDBIR has been available online since January 1989,both as a separate file in TOXNET, and as a subset ofDIRLINE in ELHILL. It currently contains more than1,700 records describing databases and other informationservices, organizations, collections and repositories, pub-lications, and sanctioned nomenclature committees, allrelated to biotechnology and molecular biology.

Long Range Planning Panel on Toxicology and the Envi-ronment

The Division has been cooperating with the NLMOffice of Planning and Evaluation in developing chargesto the Panel and in proposing candidates. The Panel willfirst convene in late October 1991, with subsequent meet-ings scheduled for January and March 1992.

Information Services to Other Agencies

As described, SIS provided support for building,maintaining, and deploying computer-based informa-tion resources for ATSDR, NIOSH, NCI, EPA, andNIEHS. SIS also provided leadership for the Subcom-mittee on Information Coordination of the DHHSCommittee to Coordinate Environmental Health andRelated Programs. Activities of Subcommittee includedeveloping a Directory of DHHS Risk AssessmentProjects and determining the need for information re-sources to support epidemiology projects. SISalso rep-resents the Library on the Committee's subcommitteeson Environmental Health Risk Assessment, Testingand Test Method Validation and Research Needs.

SIS continued to represent NLM on the congression-ally mandated Interagency Task Force on EnvironmentalCancer, Heart and Lung Diseases as well as on the work-ing group established to develop a Directory of ExposureData and Information Resources. Staff also participatedin deliberations of the NIEHS Working Group respon-sible for the Annual Report on Carcinogens. The Library,through SIS, helps to develop the National ToxicologyProgram Annual Plan and its review of current DHHS,DOE, and EPA research relevant totoxicology.

22

LISTER HILL NATIONALCENTER FOR BIOMEDICALCOMMUNICATIONS

Daniel R. Masys, M.D.Director

The Lister Hill National Center for Biomedical Com-munications (LHNCBC) was established by a joint reso-lution of Congress in 1968. The Center serves as anintramural research and development division of theNLM. LHNCBC research programs apply state-of-the-art computer and communications technologies to themanagement of biomedical knowledge. Such knowledgecan take the form of procedural rules found in expertsystems, information in bibliographic and factual data-bases, as well as images, electronic signals, and sounds.LHNCBC programs create innovative methods for ac-quiring, storing, retrieving, analyzing, communicating,and presenting information to biomedical researchersand health care professionals.

A Board of Scientific Counselors meets to review thequality and contents of the intramural research programswithin the Lister Hill Center. The Board is composed ofscientific and technical experts (see Appendix 5 for a listof members) who are prominent leaders in the fields ofmedicine, computer science, engineering, and health pro-fessions education.

The Center is organized in five component branches:• Computer Science Branch• Information Technology Branch• Communications Engineering Branch• Educational Technology Branch• Audiovisual Program Development BranchThe research and development programs of the

LHNCBC fall into three categories:• Computer and information science as applied to

the problems of the Library, of biomedical re-search, and health care delivery;

• Biomedical image engineering, including imageacquisition, processing, storage, retrieval, andcommunications; and

• Use of computer and image technologies forhealth professions education.In 1991 the LHNCBC successfully initiated an

Undergraduate Research Study Program to provide two-year scholarships and research assignments in imageprocessing and computer visualization as they pertain tomedical informatics for sophomore students majoring inelectrical engineering, computer science, computer engi-neering, or physics at participating historically black col-

leges and universities. The program selected threeschools, Morgan State University (Maryland), SouthernUniversity (Louisiana), and North Carolina Central Uni-versity to begin a 5-year collaboration. Participating stu-dents began the first of two summer internsips at theLister Hill Center and have now begun the first of twoacademic year assignments under the guidance of theirpreceptors.

Computer Science Branch

Research projects of the Computer Science Branch(CSB) concentrate on the application of artificial intelli-gence techniques to problems in the representation, re-trieval and manipulation of biomedical knowledge. CSBprojects involve both basic and applied research in suchareas as expert systems, natural language systems, ma-chine learning, and machine-assisted indexing for infor-mation classification and retrieval. The researchaddresses issues in knowledge representation, knowl-edge base structure, knowledge acquisition, the valida-tion of automated consultant systems, and thehuman-machine interface for complex systems. Impor-tant components of the research include multimediaknowledge-based systems with interactive video capabil-ity, and embedded intelligence systems which combinelocal reasoning with access to large-scale mainframedatabanks.

Branch staff members participate in individual andteam research projects within the branch, in various as-pects of such projects as NLM's Unified Medical Lan-guage System initiative, and in the medical informaticsand information science research communities. Currentefforts of the Computer Science Branch include the Ex-pert Systems Program, the Natural Language SystemsProgram, the MedlndEx Project, and the Machine Learn-ing Project (described in the FY1990 report).

Expert Systems Program

Expert systems are computer programs that combineknowledge of a particular subject with inferencingmechanisms enabling them to use this knowledge inproblem-solving situations. An artificial intelligence re-search program concentrating in expert systems was es-

Lister Hill National Center for Biomedical Communications 23

tablished at LHNCBC in 1984. The objective of the pro-gram is to facilitate computer-assisted access to knowl-edge. This knowledge may reside in different forms, indifferent places, on different media, with different struc-tures and naming conventions.

The primary research projects of the Expert SystemsProgram in FY 1991 were the AI/RHEUM consultantsystem in rheumatology, the Rheumatology Image Li-brary videodisc, the CTX "criteria engine" shell and itsfamily of automated testing and validation tools, themedical expert systems evaluation project, the AI/COAG hemostasis consultant system, and the COACHexpert searcher system.

The flagship project of the program is the AI/RHEUM expert consultant system in rheumatology. TheAI/RHEUM knowledge base has been updated andnearly doubled in scope in FY 1991. The system now of-fers online access to 468 text definitions, to more than6,800 still images and 23 minutes of brief motion se-quences on the Rheumatology Image Library videodisc,to 136automated MEDLJNE searches using the GratefulMed Search Engine, and to the 44 disease criteria tableswhich are the heart of its knowledge base. The system'sdata entry process has been significantly streamlined anda new Case Data Editor module added to facilitate its usein clinical settings.

AI/RHEUM is the best known of a series of knowl-edge-based medical consultant systems using the criteriatable form of knowledge representation pioneered byNLM researchers. An expert system shell, called "CTX"for its use in criteria table expert systems, is designed tobe widely applicable and is now in beta-test phase inseveral subject domains. It has the potential to be a usefulbuilding block for integration into complex projectswhich need decision-support components. The new shellallows direct coupling of video image libraries to expertsystems. Voice-over narration for the video motion se-quences, a major expansion of the number of motion se-quences, and nearly 500 new still frames were added tothe Rheumatology Image Library videodisc in FY1991.

Several software tools written as adjuncts to the CTXshell provide utilities assisting the developer in manipu-lating multi-thousand-frame videodisc image banks andin automating the performance evaluation of CTX-basedconsultant systems against benchmark sets of test cases.The shell, with its explicit and very unusual multimedialinks to knowledge sources in different forms and in dif-ferent places, even on different machines, is one focus ofthe overall Expert Systems Program goal of providingusers with access to knowledge. Its unique combinationof capabilities can help developers build consultant sys-tems in any domain which lends itself to the criteria formof knowledge representation.

The AI/COAG hemostasis consultant system, re-ported in prior years, is the basis of a hemostasis advis-

ing system now in daily use on the Yale Laboratory Net-work. Expert Systems Program staff in FY 1991 exploredthe Unking of the AI/COAG consultant system runningon a Macintosh workstation to the hospital informationsystem at the NIH Clinical Center. In another instance,demonstrating the utility of intelligent local systemswhich reach out to huge mainframe databanks, the sys-tem successfully downloaded, parsed and interpretedappropriate hematology laboratory results.

The most recent project is the Coach expert searchersystem. Coach brings to bear the UMLS Metathesaurusand other knowledge sources to assist Grateful Med us-ers seeking help in improving retrieval from ELHILL onNLM's mainframe. Initial work has concentrated onMEDLINE and its backfiles, and in particular on theproblem of null retrieval. Coach offers true ELHILLmultifile searches, ELHILL sorting of output citations be-fore download, and considerable flexibility in the printformat of downloaded results. It works interactivelywith the user, with Grateful Med, and with ELHILL.

Coach emulates a number of the actions of an experthuman searcher in diagnosing user search problems anddetermining which of a series of functions to invoke fortheir solution. It has access to multiple knowledgesources built to help augment or replace the user's queryterms or to map to new terms in accordance with theuser-stated goal of getting more or getting better focusedretrieval. Coach's primary knowledge source, the UMLSMetathesaurus, is an extremely rich source of potentiallyuseful related terms, lexical variants, relationships, defi-nitions, co-occurrences and other information. MeSHand special Coach knowledge sources allow mapping foroccupational specialty headings; subheading synonyms,subheadings, and conceptual clusters of subheadings; ex-plodes and pre-explodes; "consider also" terms; and"forward see related" cross reference terms.

Dr. Kingsland of the Expert Systems Program servedagain in FY 1991 as coordinator for the 8-week NIH"Medical Informatics" elective for third-year and fourth-year medical students. Nine students from medicalschools across the U.S. completed the elective. Thecourse included a seminar series of more than 45 90-minute lectures, independent research projects under thedirection of NIH preceptors, and oral and written pre-sentations of research results. Some of these extremelybright, highly motivated students have themselves madeimportant contributions to Expert Systems Programprojects.

Natural Language Systems Program

The Natural Language Systems Program carries outresearch in automated language understanding with thegoal of providing health professionals with natural andflexible access to biomedical information stored in com-puterized form. NLM's long range report has noted that

24 Programs and Services, FY1991

a desirable goal for information systems would be to"...allow humans and computers to function in their pre-ferred states and attempt to develop technology that willpermit them to communicate with each other, translatingbetween their respective representation systems." Thisprogram's objective is to develop and test methods forbiomedical language processing that will result in moreeffective interaction between users and the computerizedinformation sources they attempt to access.

Efforts have concentrated on the development ofSPECIALIST, a prototype system for parsing and access-ing biomedical text. The system includes both linguisticand biomedical knowledge. Linguistic knowledge in-volves rules and facts about the grammar of the lan-guage. Biomedical knowledge involves rules and factsabout the domain of biomedicine. The UMLSMetathesaurus and Semantic Network, as well as theUMLS test collection, have recently contributed to thefurther development of the SPECIALIST system.

The linguistic knowledge used by the SPECIALISTparser includes lexical information and rules of morphol-ogy, syntax, and semantics. The lexicon, which forms acentral part of the system, contains both general Englishlexical items and items specific to biomedicine. DuringFY 1991 the program concentrated on increasing the sizeand scope of the SPECIALIST lexicon. Five consultantswere brought on for this work. The one-year lexicon de-velopment project has increased the lexicon's size from5,000 entries to over 40,000. When expanded to the fullset of inflectional variants, this is actually over 75,000lexical forms. Each lexical entry encodes graphemic,morphologic, syntactic, and semantic information. Thisinformation is used by the grammar rules as they at-tempt to produce structured representations of phrasesand sentences in biomedical texts. Each lexical record in-cludes entries for one or more parts of speech, inflec-tional information, information on complementation,logical interpretation, potential for transformation, andother information relevant to a specific lexical item. Ac-ronyms and abbreviations are cross-referenced to theirfull forms; nominalizations of verbs are cross-referencedto their verbs. The syntactic/semantic component ofSPECIALIST is an extended Definite Clause Grammar.The grammar includes context-free BNF (phrase struc-ture) rules together with context-sensitive restrictionswhich constrain the structures actually built.

The biomedical knowledge needed by SPECIALISTincludes knowledge of the important concepts in the do-main of biomedicine, the relations among these concepts,and rules to process these concepts and relations. TheMetathesaurus and the Semantic Network provide thesort of biomedical knowledge SPECIALIST requires.The program's head, Dr. Alexa McCray, and other staffhave been involved in the UMLS project since its incep-tion. The SPECIALIST lexicon was augmented with a

large number of items from Meta-1 during this past yearand a menu-based browser for the Metathesaurusknowledge source was developed. This application al-lows users (or programs) to search for Metathesaurusterminology, reporting the term and its source vocabu-lary; its definition, lexical tags and variants; and its syn-onyms, semantic types, related terms, other associatedterms, or contexts as specified by the user. The globalsearch capability allows the user to find all concepts inthe Metathesaurus with a particular characteristic; e.g.,all concepts that have a particular semantic type, or allconcepts that are labelled as acronyms. The browser iswritten in C and runs under Unix on Sun workstations.

The first version of the UMLS Semantic Networkcontains 131 semantic types and 35 links, or relation-ships, that hold between them. During FY 1991 programstaff have carried out initial tests of the feasibility of us-ing the UMLS semantic types for expressing selectionalrestrictions. Selectional restrictions establish what maysensibly co-occur with an item. For example, a verb suchas "administer" takes an agent as a subject and may takea therapeutic substance as one object and a body regionas a second object. The use of such selectional restrictionscan both help reduce the number of spurious parses gen-erated by a parser that has only grammatical informa-tion, and give an indication of the meaning of the majorconcepts in a sentence. The investigations have used twoapproaches. The first has involved an analysis of highlyfrequent verbs and their nominalizations as they occur inbiomedical texts. Sentences containing these verbs havebeen analyzed and their complements studied to see if amatch to an existing semantic type can be made. The sec-ond approach has involved identifying the semantictypes of all the nouns that are in the current SPECIALISTlexicon and also in the Metathesaurus. At last count therewere over 10,000 such terms.

An additional lookup step has been added to theparser, so that if a semantic type exists for any of the lexi-cal items in the sentence, it is reported as part of the finalparse. This means that the semantic types are seen incontext as part of normal development on the parser.Staff is working on an application that will allow theparser to reason in a variety of ways with the knowledgeencoded in the Metathesaurus and the Semantic Net-work.

In order to test the extent to which natural languageprocessing techniques may improve access to informa-tion, staff have developed an experimental databasemodule. The module processes files such as MEDLINEcitation records, creates an index for the items in all rel-evant fields, and provides for Boolean retrieval of theseitems. One of the major sources of textual material for thesystem is the UMLS test collection of queries and citationrecords. The collection, which was developed for use asan evaluation tool in the UMLS project, includes more

Lister Hill National Center for Biomedical Communications 25

than 150 queries and some 3,000 citation records, withrelevancy judgments. The queries were selected prima-rily from search request forms submitted to the NIH andNLM libraries. This test collection provides a large yet fi-nite set of biomedical texts for experimentation andevaluation.

MedlndEx Project

The MedlndEx Project develops and tests interactiveknowledge-based systems for computer-assisted index-ing of medical literature currently indexed in theMEDLINE database using terms from the Medical Sub-ject Headings (MeSH) thesaurus. The main objective ofMedlndEx is to facilitate expert indexing that goes intothe MEDLINE product. Another focus of this researchhas been to develop intelligent retrieval systems utilizingthe same representations and environment of the index-ing system. Background information about howMedlndEx is being developed was included in the FY1990 NLM Programs and Services.

The prototype MedlndEx is written in Sun CommonLisp 3.0 and runs on Sun SPARCstation workstations un-der the SunOS operating system. Domain-independentproject software includes a Lisp-based experimentalframe language. MedlndEx is designed to run similar in-dexing and knowledge base manager applications inother domains. As of late FY 1991, the knowledge basecontained nearly 3500 frames (MeSH concepts).

In FY 1991, an XWindow System interface using XI1Release 4 and other public-domain software (CLOS,CLX, CLUE) was developed and installed, replacing ahardware-dependent interface. Use of X Windowsshould provide much flexibility in choice of computerson which to install the system. The system can now berun in a client-server architecture with two ethernettedSPARCstations and can be accessed from a PC with Xserver software. The new interface permits enhanced hi-erarchical displays of the knowledge base. In addition,direct manipulation of code as objects, which is a specialinterface for the knowledge base manager, has been ex-tended.

Adapting the indexing system for new uses such asretrieval would integrate different applications of thesame knowledge base into a single system and may al-low re-use of the same interface design. This has beendemonstrated during FY 1991 by extending theMedlndEx prototype for use by searchers who would in-dex their queries, producing a set of query frames. In oneapproach, the system generates conventional indexingterms from these query frames (in effect, indexing thequery with MeSH terms, similar to what MedlndEx doesnow to index documents). In this search application, in-dexing terms would serve as suggested terms for search-ing MEDLINE.

In the other approach, as in the first, query frameswould be generated from MedlndEx. Instead of the con-ventional MEDLINE database, the database used is theindexing frame database in a relational form. Since it cor-responds to indexing frames, this database provides amore precise representation of documents thanMEDLINE. In this approach, rather than using conven-tional indexing terms generated from query frames, thesearch interface decomposes query frames into indi-vidual relationships. The user (searcher) clicks on selec-tions and on Boolean operators with a mouse pointingdevice, combining them into more complex search state-ments to achieve a final statement which represents thequery. The system then translates this statement intoSQL queries used for searching the relational database.

Work planned for FY 1992 includes designing anevaluation of the indexing system, extending the systemto include a module for indexers to tag conventional in-dexing terms as central concepts, and further automatingthe knowledge base manager in representing contextualhierarchies (similar to MeSH trees).

Information Technology Branch

The Information Technology Branch pursues ap-plied research and development in computer and infor-mation science with an emphasis on electronicinformation generation, storage, and retrieval. Areas ofactivity within the current programs include develop-ment of generalized windowing interfaces across mul-tiple platforms, object-oriented retrieval systemsencompassing fielded data, full text, and graphics ob-jects, editing workstations for manuscript preparation,computer-based publication, and CD-ROM technology.Within these programs many areas of applied computerscience must be addressed including portability, object-oriented programming, multiprocessing, client/serverdistributed processing models, and advanced memorymanagement.

Current efforts of the Branch are the Online Refer-ence Works project, including the work on the OnlineMendelian Inheritance in Man (reported in FY 1990 NLMPrograms and Services), a CD-ROM program, and full-textand information retrievalprojects.

CD-ROM Program

NLM has a growing need to effectively disseminatelarge full-text databases and/or digitized images and/ordigitized audio in a number of program areas and acrossmultiple platforms such as MSDOS, Macintosh, andSun/Unix. CD-ROM represents a unique storage me-dium for the dissemination of such information. In 1990,the Branch established a laboratory for CD-ROM devel-

26 Programs and Services, FY1991

opments and acquired technical expertise in CD-ROMdesign and pre-mastering. The primary laboratory tool isa CD-ROM Pre-mastering and Simulation Workstationwhich will allow the formatting of tapes for masteringand the simulation of CD-ROM applications even priorto mastering.

During FY 1991, CD-ROMs were mastered in thelaboratory for the NCBI and the UMLS. Procurementswere also initiated for the acquiring a CD-ROM write-once mastering unit and an upgraded pre-masteringworkstation. The Branch has extended the original ob-ject-oriented systems design for IRx2 to include fieldedas well as full text data (see Information Retrieval, be-low).

Full Text Program

As reported last year, the Agency for Health CarePolicy and Research (AHCPR) has a requirement for anonline, full-text retrieval system. Based on previous full-text retrieval developments (e.g., IRx), the Branch com-pleted in 1991 a full-text information retrieval capabilitydesigned to support medical guidelines. This extendedthe capability developed for IRxl by including consider-ation of the structure inherent in the planned AHCPRguidelines. In addition to the available AHCPR draftguidelines, two other related databases were obtainedand implemented: the monographic report, "Guidelinesfor Preventive Medical Services," and a database of 83NTH Consensus Development Conference Reports. All ofthese databases have been mounted on the Lister HillFull Text Server and will be accessed over dial-up tele-phone lines.

Information Retrieval

During 1991, the Information Technology Branchmade operational several retrieval systems, each ofwhich is made up of a search engine and modules tosupport windowing interfaces across different userworkstations (MS-DOS, Macintosh, Unix) and/or char-acter-mode terminals. Major developments have pro-ceeded in full-text retrieval (noted above) andfielded-data retrieval.

Many databases targeted for CD-ROM are of thefielded-data type rather than full-text. Examples of suchdatabases being addressed by the Branch are theSERLINE database of journal titles, the NLM ChemIDand TOXLINE databases, and the EPA Toxic ChemicalRelease Inventory (TRI) database. An object-orientedsearch engine capability has been developed in FY 1991incorporating incremental searching of terms and userdefined data types. The latter allow the database fields tobe of arbitrary hierarchy or complexity. The incrementalsearch capability enables the user to select long or com-

pound terms with the entry of a small number ofcharac-ters. The search engines for the fielded-data databaseshave been designed to run on local personal computers.

Communications Engineering Branch

The research and development activities in this pro-gram focus on the capture, storage, processing, online re-trieval, transmission and display of biomedicaldocuments and medical imagery. Areas of active investi-gation center on image compression, image enhance-ment, image understanding, pseudo-grayscale rendition,image transmission and networks, omnifont text recogni-tion, and man-machine interface design. This appliedR&D is directed toward NLM's mission-critical taskssuch as document delivery and preservation. In addition,research into imaging techniques that support medicaleducational packages employing digitized radiographic,dermatological, and other imagery is also being pursued.

System for Automated Interlibrary Loan (SAIL)

Following the successful outcome of an earlier imag-ing program for document preservation, a new programwas initiated primarily motivated by the need for auto-mated document delivery to support the NLM'sinterlibrary loan (ILL) service. Preservation remains asecondary objective in the program. This multiphase ef-fort involves: 1. The creation of an electronic documentimage store on WORM-type optical disks; the images areof selected journals in the NLM collection for which thereis significant demand. 2. The development of an inter-connected complex of workstations that store, retrieve,and transmit the documents. 3. The linkup of this work-station complex to NLM's DOCLINE system to retrieveILL requests. 4. Employing this prototype system to fill aportion of the ILL requests arriving at NLM. 5. Evaluat-ing the system to determine performance, cost, and howit meets ILL objectives.

Following a review of SAIL by the Board of ScientificCounselors, a subset of the collection was selected forscanning and storage on optical disk. Capture of thesedocuments began by using a Document Capture Work-station (DCW-1) already developed. Meanwhile, abaseline SAIL system for image tagging, indexing, qual-ity control, image retrieval and transmission was devel-oped. In April 1991, the system was placed in operation.To date, the SAIL prototype has received over 2500 re-quests, and has handled over 75percent of them.

Recognizing the delays posed by the slow capture, afast scanner was developed and placed in operation inMarch 1991. This system, Document Capture Worksta-tion-2 (DCW-2), has tripled the rate of document capture.A number of engineering studies were done in supportof SAIL development and the library's ILL activity.

Lister Hill National Center for Biomedical Communications 27

Simulation: Studies were begun to predict a migra-tion path for a scaled-up SAIL system. A discrete eventsimulation language, GPSS/H, is being used to modelthe image retrieval subsystem. This model consists ofvarying numbers of fax servers, optical disk drives, mag-netic disk drives, and jukeboxes. Independent variablesare the rate of ILL requests, the fraction of requests thatare for fax service, and the distribution of requests overthe optical platter set. The model will enable the testingof strategies on how the articles should be distributedover magnetic and optical media; for example, older ar-ticles could be on optical disks and more recent ones onmagnetic disks. The results of the simulation will estab-lish theoretical bounds on the number of system compo-nents and the overall system architecture for differentlevels of service.

Document Identification Strategies: An individual ar-ticle in a journal issue may be identified either by itsMEDLINE Unique Identifier (UI) or by a combinationofthe issue identifier (a number called the MRI) and thestarting page number of the article. Though the SAIL in-put system accommodates both types of data, studies areunder way to determine the need to do both. The work-ing hypothesis is that the MRI-starting page numbercombination is adequate to identify the requested articleand that the MEDLINE UI is superfluous. Eliminatingthe entry of the latter would have significant advantagesin reducing the operator labor and also in eliminatingdata-intensive index files.

Factors Affecting WORM File Server Performance: Com-mercial software was selected to support archiving andretrieving document image files to and from WORM me-dia over a LAN. Research was conducted to evaluate theperformance of this software and ARCHTV, the inhouse-developed software for archiving and retrieving docu-ment image files. The study focused on the effect ofseveral factors, such as network interface hardware,LAN organization, CPU clock speeds, remaining opticaldisk capacity, and the use of RAM by the WORM serverfor maintaining index files and for caching image files onperformance. Performance issues included speed, stor-age overhead, compatibility, system flexibility, data secu-rity, and system reliability. The study concluded that theinhouse ARCHIV software would store and retrieve filesfrom WORM disks at a rate about twice as fast as thecommercial software, and, because of the way it storesfile access data, would store about 5 percent more imagefiles. However, these advantages are offset by the greaterlevel of compatibility, flexibility, data security and easeof use afforded by the commercial software. The studyalso showed that throughput would be improved mainlyby WORM server CPU speed and the use of RAM for in-dex files and caching, whereas LAN organization andnetwork interface hardware would have little effect. We

are integrating the commercial software into our currentsystem development efforts and are performing morecomplete tests of its performance. A paper describingthis effort appears in the proceedings of an IEEE MassStorage Conference.

Document Image Server Study

As a contribution to the technical literature of sys-tems combining WORMdrives and LANs for image filedistribution, the laboratory's prototype system for docu-ment image distribution was used to simulate a systemwith several users. The objectives of the study were topredict the performance of a practical multi-user systemand to evaluate the performance of an inhouse devel-oped image transmission protocol. A database of docu-ment images, whose file size is representative of a crosssection of NLM documents, was stored on WORM plat-ters at the Image Server Workstation (ISW). An ImageRetrieval Workstation (IRW), capable of expanding anddisplaying document images, retrieved images from theserver over an Ethernet LAN using an inhouse devel-oped protocol. Retrieval times and reliability were mea-sured at the IRW and at the ISW while auxiliaryworkstations simulated larger scale conditions by pro-viding varying loads to the Ethernet and to theISW.

The document image server was found to approxi-mate patterns similar to a standard and mathematicallydescribed model in queueing theory. Thus, this modelcan be used to extrapolate from the measured data toother cases. Also, if components of the image retrievalsystem are modified to improve performance, two basicmeasurements will suffice to predict server performanceunder most conditions. The study concluded that thecurrent system would be able to support from five toeight workstations simultaneously with acceptable re-sponse times. It also determined that an image retrievalapplication could share an Ethernet LAN with other ap-plications with little impact on the performance of either.Finally, it concluded that the speed of file retrieval fromoptical disks is significantly improved when the sub-system interface includes a large data buffer. Papers de-scribing this work appear in the proceedings of IEEEconferences.

Facsimile Machines for Interlibrary Loans

In FY1990 we investigated the impact of introducingfax in the library's ILL service to replace conventionalmail as the method of document delivery. In FY 1991 thisstudy was followed up with the acquisition of two ad-vanced fax machines to aid the ILL service. Performancedata were collected in the lab for both advanced fax ma-chines and conventional machines, the former equippedwith internal hard disks enabling store and forward ca-pability. Mathematical models were developed to relatevarious decision measures, such as the number of ma-

28 Programs and Services, FY1991

chines required and costs to the fraction of the ILL loadto be served via fax. The models yielded families ofcurves that served as decision tools leading to the acqui-sition of specific machines and the operational strategy tobe followed. The final report is available from the Na-tional TechnicalInformationService.

Electronic Document Delivery System Program

An approach to document delivery different fromthat in the SAIL Program was undertaken. The motiva-tion for this approach is the hypothesis that there exists aclass of users who need direct access to an electronicarchive of document images rather than the indirectroute employing the interlibrary loan system. Three gen-erations of a prototype system were built and tested,each succeeding generation possessing greater function-ality than the previous one.

The EDDS program demonstrated in prototype forma system for direct document access and delivery, i.e., asystem that allows a remote user equipped with a Docu-ment Request Workstation (DRW) to perform a search ofMEDLINE via Grateful Med, and then directly access anelectronic store of document images and receive thedocument images through fax, mail, or local pickup. Theremote user's DRW consists of affordable, off-the-shelfcomponents such as an IBM-AT compatible clone and astandard fax machine. It also requires special inhouse-developed software. At present, we have demonstratedthe third-generation EDDS system and will plan to use itas a testbed to evaluate the role of such a system for localarea document delivery. The results of work in this areaappear in the Proceedings of the 53rd Annual Meeting ofthe American Society for Information Science.

Machine-Readable Archives in Biomedicine

The long-term goal is to build a prototype system fora machine-readable archive. Current activities in MRABinclude evaluations of commercial OCR devices and in-vestigation of techniques for image enhancement andimage segmentation.

Image Enhancement: Rendering grayscale imagerywith high fidelity is an important goal of this research.The current inhouse image capture systems employ or-dered dithering to render grayscale images in a one bit/pixel matrix taking as input thresholded one bit/pixeldata from the scanning engine. To investigate other op-tions leading to better image quality, a project was un-dertaken to employ 8 bits/pixel data in a technique, theFloyd-Steinberg filter, that falls within the class of error-diffusion dithering techniques. A software implementa-tion of this technique has been completed and applied tograyscale images from an old atlas of microscopic photo-graphs (K. Birnbaum, printed in 1886 in Stuttgart, Ger-many). Early results indicate this technique has promiseand a scanning engine with the capability of 8 bits/pixel

output will be used to continue this research.OCR Evaluation: An investigation was conducted in

employing OCR to eliminate the keyboarding activitycurrently done to enter fields such as author, article titleand abstract, into NLM's indexing database. Softwarewas written to convert bitmapped images from a desk-top scanner to machine-coded form, and to allow an op-erator to select regions representing the desired fieldsand to convert them to dBase files. Current work is in de-veloping a database structure to incorporate selectedportions of the scanned material with minimal operatorintervention, and a prototype database management sys-tem.

Image Segmentation: Image segmentation, or the de-composition of a bitmapped image into its constituentparts, is of importance in a variety of El functions, im-age compression and border (page edge effects) re-moval among them. A project was initiated to developsoftware to automatically remove unwanted borders.The techniques employed include: first order statistics,second order statistics and image morphology. Thefirst method calculates the black pixel statistics and at-tempts to differentiate different regions on this basis.The second method uses an autocorrelation computa-tion to get a measure of the inter-pixel relationshipswithin each row and column of the image. The thirdmethod uses the morphologic dilation operator to cre-ate "blobs" of different sizes and shapes and differen-tiates regions on this basis.

Digital Xray Prototype Network (DXPNET)

This is a collaborative program in which the Com-munications Engineering Branch on behalf of NLMserves as Technical Manager. The other participants arethe National Center for Health Statistics (NCHS) and theNational Institute of Arthritis, Musculoskeletal and SkinDiseases (NIAMS). The general goal of the program is tosupport the National Health and Nutrition ExaminationSurveys (NHANES) which periodically produce statis-tics on the health status of the U.S. population. One ele-ment of the collected data consists of radiographs, 17,000from a survey already completed and an expected addi-tional 10,000 from a current survey. The Branch is partici-pating in this program by integrating and testing aprototype low cost workstation that enables techniciansfrom NCHS to perform quality control on the imagesproduced by scanning the xrays. Hardware componentswere integrated and a complete image retrieval and dis-play software system was developed. The workstation iscurrently being used for quality checking the images.

The next steps are to develop an archive of the digi-tized xrays implemented via an optical disk jukebox tobe located at NLM, to develop a pair of more advanced"radiologist" workstations that will allow NCHS radiolo-gists to create standardized readings, to develop the ca-

Lister Hill National Center for Biomedical Communications 29

pability of linking the workstations over Internet, and todeploy one of the two workstations at NCHS to allowimage retrieval from the archive located at NLM.

The software component of this project is both themost challenging and the most potentially useful. Thekey to success will be identifying and satisfying userneeds. The software will make the image database acces-sible and will allow the retrieval of classes of imagesbased upon user-supplied search terms. The NHANESdatabase contains all of the information on each partici-pant; the x-ray images are just one element of a unitrecord. The ideal system will have the entire NHANESdatabase searchable online so that all possible search cri-teria are available. Local retrieval of images and otherhealth statistics could be achieved through remotesearching of the database.

Educational Technology Branch

Computer-based Curriculum Delivery Systems (CCDS)

The goal of CCDS is to produce and test experimen-tal technology-deliverable curricula for the health profes-sions. The first CCDS prototype curriculum for basicmedical pathology was offered to U.S. medical schools inJune 1983. Since that time the field-testing network hasgrown from 12 to 102 schools that have tested a varietyof prototype curricula in mental health (teenage depres-sion and suicide risk assessment) and in orthopedics.

The number of student work stations has grown toat least 800 (an accurate count is difficult to obtain sincestations are added almost daily). There are now 78 healthprofessions schools in the U.S. (including Puerto Rico), 5in Canada, 3 in Europe, and 1in Southeast Asia involvedin the pathology project.

The basic medical pathology is the largest and mostextensive of the CCDS projects. By the end of FY 1991CCDS had furnished to the test sites over 1100 video-discs and diskettes containing revised code (Version 3.6)for the pathology engine and associated files. The impactof the pathology project can, in part, be judged on the ba-sis not only of its rapid adoption of its but on itsevalution. Over 5,600 student evaluations of the pro-grams have been received. On a scale of 1 to 5, the stu-dents rated the programs 4+ as a learning experience.Comparison of pre- and post-test scores of students notpassing (a 70 percent score) the pre-test show that stu-dents master the material in about one-third the time de-voted to it by the traditional curriculum. At least threeschools have canceled all lectures on topics covered byCCDS lessons and others have reduced lecture time andmade the CCDS lessons a required part of the course.During FY 1991 CCDS started field testing a new enginefor the pathology programs which is programmed inCLIPPER with data (content and student performance

information) stored in relational database (dBASE) files.This new engine was made necessary by the size and in-creased complexity of the content and performancetracking routines.

CCDS staff, working with a guest investigator, com-pleted two new orthopedic prototype programs for useat the 1990 annual meeting of the American Academy ofOrthopaedic Surgeons and revised them for the 1991 an-nual meeting. The new programs represent a"repurposing" of the 1984 Level I videodisc on anatomyof the knee. The new programs correlate magnetic reso-nance and anatomic images of normal and abnormal hu-man knees.

The adolescent depression and suicide risk assess-ment videodisc program continues to be used in severalschools both as required curriculum and as an enrich-ment tool. The program is now distributed by a commer-cial vendor and also the National Audiovisual Center.

Dermatology Visual Database Project

The Dermatology Visual Database Project empha-sizes the integration of electronic imaging into currentlyavailable educational technology while continuing pur-suit of standards for "diagnostic quality" imaging.

NTSC videodisc recording was further explored us-ing a standardized test set of photographic images pro-vided by the Sulzberger Institute of DermatologicEducation. These slides were captured by commerciallyavailable techniques. All tapes were edited together inLHNCBC facilities and premastered to videodisc. Der-matologists of the Institute's subcommittee on imagearchiving and standards ranked the image quality fairlyconsistently across a variety of images.

Evaluation of diagnostic performance as well asmorphology recognition was included in FY 1991 physi-cian studies; dermatologists' performance was not sig-nificantly impaired using either silver halide prints orsuper-VGA computer graphics (640x480 pixel/best 256colors), but even aerial image transferred slides in NTSCvideo still failed to provide reliable recognition of pap-ules from pustules. Sony Corporation recorded some ofthe test slides on HDTV videodisc, but lack of portabilityof this technology has precluded extensive evaluation todate.

The melanoma interactive video tutorial has beenreauthored in LS/1 to evaluate student performance.Thetutorial was evaluated at the Medical College of Virginiausing a new instrument which emphasized students per-ception of their own educational outcomes; second-yearstudents graded the tutorial as well-organized, challeng-ing, and useful in developing clinicalproblem-solving skills.Trials of the LS/1 version of the tutorial with individual per-formance data have begun at University of Arkansas andUniversity of South Alabama in collaboration with derma-tology and family medicine faculty at thoseinstitutions.

30 Programs and Services, FY1991

Library Growth Project

The principal accomplishments for the year are: 1)the completion of a 15-year trend study, 1975-1989, basedon data from 67 ARL-associated medical school libraries;2) the near-completion of a collaborative project with theCommission on Preservation and Access staff on expen-ditures for preserving access to vulnerable materials; and3) major progress toward explaining the serious prob-lems that research libraries have experienced during theyears since 1971. In addition, the databases developedand analyzed in the 1987 ResearchLibrary Trends... report,in the 1990 sequel, and in the 1991 study of medicalschool libraries have been maintained in a near-currentstate as each new year's data have become available.

A medical library study showed these libraries to bein relatively good health, with funding increases that av-erage 9 percent, recent staff increases of 30 percent, andrelatively rapid collection growth. In comparison withARL libraries studied earlier, the medical libraries are ex-pensive, personnel-intensive institutions, although theyalso allocate funds to staff and acquisitions essentially asARL libraries do, both now and in the earlier years. A pe-ripheral finding is that the medical libraries seem to haveexperienced a lower level of recent per-volume price in-flation than either of the two known groups of ARL li-braries. This was unexpected because of medicallibraries' greater dependence on serials and the pur-ported rapid inflation of serials prices.

The Learning Center For Interactive Technology

The Learning Center for Interactive Technology(TLC) is a "hands on" laboratory for medical educators,researchers, and scientists. Visitors to the TLC can ex-plore the applications and various uses of interactiveeducational technology in the health sciences. The Centerconsists of two components: 1) a central location wherevarious microcomputer and interactive video informa-tion and educational technologies are demonstrated, re-viewed, and evaluated; and 2) an interactive trainingfacility used for health professional faculty developmentworkshops and training for NLM staff.

A total of 34 interactive health science programs aredisplayed at 22 demonstration carrels. Large group dem-onstrations are presented from a carrel configured forvideo/data projection and are also conducted in thetraining facility. Programs include applications repre-senting patient management problems, tutorials,evaluation, visual databases, expert systems, and in-formation retrieval.

In FY 1991, TLC staff provided more than 330 dem-onstrations and "hands on" experiences for 1,316 visi-tors. This brings the total number of visitors to 4,779since the Center opened in March 1985.

In FY1991,60 health professionals attended 5 facultyworkshops on videodisc repurposing conducted in the

training facility. In addition, there were 52 training ses-sions for NLM staff members.

Among the year's highlights were the publication ofa monograph on Authoring Systems, creation of a data-base of authoring system software (AuthorBase), andcompletion of The Interactive Technology Sampler vid-eodisc. The sampler provides brief overviews of 20 inter-active programs and serves both as a generalintroduction to interactive technology and The LearningCenter itself.

The E.T.Net (Educational Technology Network), anonline computer conferencing system begun in February1989, has been described in previous reports. E.T.Net isopen to professionals engaged in either the developmentor use of interactive technology in health science educa-tion. It is available at no cost, 24 hours a day, 7 days aweek, 365days a year.

Access via the Internet began in November 1990. Asof September 1991, there were 578 health professionalsregistered as active users. Because SprintNet and theInternet have international connections, E.T.Net regis-trants include colleagues in Canada, Europe, South Af-rica, and Australia. Help and a User's Guide areavailable online. A new user-friendly menu system wasinstalled in October 1990. Use of E.T.Net was demon-strated at several professional association meetings. InApril 1991, NUCARE (NUrsing CAre REsearch) wasadded as a conference carried on E.T.Net. In addition toNUCARE, E.T.Net carries AVLINE, CAI, hardware,shareware, digital imaging, hypermedia, and "general"as conferences.

Visible Human Project

Images are an important part of biomedical knowl-edge. Pictures facilitate the understanding of biologicalstructure and function, and are an essential componentof education, research, and health care delivery. Newcomputer-based technologies are providing an unprec-edented opportunity to supplement the traditional twodimensional images of medicine, such as pictures in text-books and plain radiographs, with dynamic three di-mensional images. These images can be viewed,rotated, and reversibly dissected in a manner analo-gous to the physical objects they represent, providingvaluable instruction to the student, insight to the re-searcher, and critical treatment planning informationto the practitioner.

The NLM has long been a leader in archiving anddistributing the print-based images of biology and medi-cine. NLM has also been a pioneer in the use of computersystems to encode and distribute the textual knowledgeof the life sciences. The NLM's Long Range Planning ef-fort of 1985-86 foresaw a coming era where NLM's bib-liographic and factual database services would becomplemented by libraries of digital images, distributed

Lister Hill National Center for Biomedical Communications 31

over high-speed computer networks and by high capac-ity physical media.

Early in 1989, under the direction of the Board of Re-gents, a Long Range Planning Panel on Electronic Imag-ing was convened to explore the role of the NLM in thisrapidly changing field. The panel found that the tech-nologies underlying computer-based representation anddisplay of complex three-dimensional biological struc-ture are sufficiently mature that the NLM can proceedwith building prototype digital image libraries. How-ever, there remain fundamental research problems in thedomain of computerized representation of biomedicalstructural data, and its linkage to related text and nu-meric data. The Panel made the following recommenda-tion as an initial step:

The NLM should undertake a first project, building adigital image library of volumetric data representing acomplete normal adult human male and female. This"Visible Human Project" would include digitized photo-graphic images from cryosectioning, digital images de-rived from computerized tomography, and digitalmagnetic resonance images of cadavers.

With the recommendations of the advisory panels inmind, a four-phase plan, "The Visible Human Project,"was initiated. Phase 1, a development phase, entails ac-quiring enhanced computed tomography images, mag-netic resonance images, and cryosection images ofrepresentative, carefully selected and prepared male andfemale cadavers, at an average of 1 millimeter intervals.

The pixel library thus constructed will be madeavailable by the Library in an electronic format (such asCD-ROM discs) and the derived image library as a pho-tographic image set. Phase 2, an applied research phaseto be carried on in parallel with Phase 1, will be neces-sary to determine the electronic format.

Phase 3 will entail the development of contour mapsby anatomy experts, to define organs, tissues, and otherstructural entities in the CT, MRI and cryosection im-ages. These contours will then be coded into the pixel li-brary.

During the last phase, Phase 4, a series of evaluationstudies will determine the most effective applications forthis resource from the wide range of educational, diag-nostic, treatment planning, and commercial uses envi-sioned for this pixel library.

The recommendation of the NLM Planning Panel onElectronic Imaging to complete Phase 1 and 2 of theproject was adopted by the Board of Regents. Phase 1was divided into two parts: Phase 1A includes the acqui-sition of the digital CT and MRI data and thecryosectional photographic data. Phase IB includes thedigitization of the cryosectional photographs obtainedduring Phase 1A.

A Request for Proposals (RFP) covering Phase 1Awas circulated throughout the medical community. A

competitive contract was awarded to the University ofColorado at Denver with a completion date of August15,1993. An RFP covering Phase IB will be circulated inthe future.

Under Phase 2, preliminary meetings were held withrepresentatives of the National ElectricalManufacturersAssociation to explore the possibility of this standardsorganization establishing the canonical form underwhich the pixel library will be made available by the Li-brary in an electronic format.

Audiovisual Program Development Branch

The APDB applies current and emerging video com-munications technologies and audiovisual techniques toLister Hill Center research, development, and demon-stration projects and to the information needs of thehealth sciences community. The Branch operates a video-disc premastering facility employing state-of-the-artvideo and audio systems to produce high quality andcreative materials for the LHNCBC's research and dem-onstration projects, as well as the NLM's educational andinformational programs.

With identified technical issues such as image qual-ity, resolution, color fidelity, and transportability, theBranch continued to upgrade and improve its electronicand audiovisual systems and capabilities. As part of theCenter's efforts to improve the quality of electronic medi-cal images, the Branch purchased a High Definition TV(HDTV) system—a newly available laser disc player anda special HDTV monitor. These have been configured ina test facility with a standard laser videodisc player anda monitor and a 35mm slide projection system so that di-rect comparisons of the several modes can be made andthe image preservation capabilities of various electroniccapturing, transferring, and display techniques can beevaluated.

In collaboration with the University of Arkansas forMedical Sciences, specially selected and photographedslides were recorded in laser videodisc format, after go-ing through a number of differing film and electronic im-age transfer systems. Results are being evaluated bysubject matter (dermatology) experts, and further col-laborative experiments in medical image transfer andquality retention techniques are planned.

In collaboration with health sciences experts at theUniversities of Missouri and Arizona, approximately7,000 rheumatology images, in 35mm slide format, andmotion video physical examination sequences, accompa-nied by special narration, were edited onto premastervideotape and then transferred to laser discs. This projectis known as "Rheumatology Image Library—Phase II".

APDB continues to provide consultation, and techni-cal advice to the History of Medicine Prints and Photo-graphs Collection Videodisc project. Most of the fiscal

32 Programs and Services, FY1991

year was spent in crosschecking DRAW disc imagesagainst HMD cataloging, re-photographing and transfer-ring to videotape missing images (from among morethan 55,000 total images), and transferring certain imageswithin the premaster videotape so that items will appearin proper sequence and on the correct side of the final la-ser videodiscs.

Much time and effort was expended in FY 1991 on abiological visualization project, in which 3-dimensionalcomputerized representations of the embryonic develop-ment of the human heart are being created. With theguidance of Dr. Carl Jaffe, who is spending his sabbaticalyear from Yale University in APDB, the Branch's graph-ics staff is transferring images from the Carnegie Embry-ology Collection, as computerized planar sections andassembling them in 3-dimensional wire frame forms onMacintosh computers. Techniques of solid rendering,transformation, animation, and levels of transparency ofthe developing organ are being constructed in a commonfile format for display on microcomputer and, as motionsequences, on laser videodisc. Johns Hopkins and YaleUniversities, as well as other health sciences organiza-tions, are providing subject matter, design, and artisticcooperation.

In collaboration with the National Cancer Instituteand the American College of Obstetricians and Gyne-cologists, the Branch used a large number of audiovi-sual, electronic, and computer technologies to createan interactive laser disc program on Cervical CancerScreening. Stressing the importance of following rec-ommended guidelines in early cancer screening, labo-ratory work, reporting and follow-up, these programmaterials will be shown at a meeting of the Academyof Family Physicians.

APDB also continued to support the Library's edu-cational and informational activities:

• More than 20 interviews were videotaped fea-turing health sciences practitioners, educators,and administrators who participated in the Re-gional Medical Programs initiative, 1966-1974.This previously poorly documented programwas the subject of a day-long conference held inthe Lister Hill Center Auditorium in December1991. Presentations will make use of four docu-mentary videotapes prepared by APDB.

• To illustrate the activities of several federalagencies in carrying out the White House HighPerformance Computing and CommunicationsProgram (HPCC), the Branch produced a 10-minute videotape program which featured se-lected examples of HPCC Case Studies.

• Samples of more than 20 NLM/LHC programswere edited on premaster videotape for the pro-duction of Level II interactive videodiscs, called"NLM Videodisc Sampler HI." These have beenmounted in information kiosks at the NIH andin the NLM Visitor's Center.

• A short videotape program was produced high-lighting historical medical films acquired by theLibrary's History of Medicine Division duringthe 1980's. The resulting tape was converted tovideodisc format for use with an HMD exhibit.

• APDB cooperated with a Library AssociateProject by producing a 14-minute videotape tohelp NLM Reading Room patrons use GratefulMed in retrieving references from the in-housedatabase, REFLINE.

• To assist the Library's National Center for Bio-technology Information (NCBI), the Branch pro-duced a videotape program explaining threesoftware packages being used by the NCBI:"Medline Browser," "Vibrant Portable Inter-face," and "Network Services." The tape is usedto educate collaborating educational institutionson this important phase of genetic research.

The Branch continues to provide audiovisual sup-port to meetings in the Lister Hill Center Auditoriumand the NLM Board of Regents Room. A number ofmodifications were undertaken this year to improve theprojection quality and the efficiency of operator inter-faces in both locations. A number of lectures and presen-tations were videotaped (see "Calendar of Events").

APDB's Graphic and Still Photography Laboratoriescontinue to provide visual information materials for theLibrary and to support the Lister Hill Center's audiovi-sual research and demonstration projects. A number ofcomputer graphics hardware and software improve-ments were added to the Branch's capabilities during FY1991, including those to permit the transfer of video im-ages to Macintosh computer systems and Macintosh-generated graphics to video formats.

33

NATIONAL CENTER FORBIOTECHNOLOGYINFORMATION

David Lipman, MDDirector

The National Center for Biotechnology Information(NCBI) was established by Public Law 100-607 in No-vember 1988 as a division of the Library. The establish-ment of the NCBI reflects the importance of informationscience and computer technology in the understandingof the molecular processes that control health and dis-ease. The Center has been given the responsibility to:

• Create automated systems for storing and ana-lyzing knowledge about molecular biology, bio-chemistry, and genetics;

• Perform research into advanced methods ofcomputer-based information processing for ana-lyzing the structure and function of biologicallyimportant molecules and compounds;

• Facilitate the use of databases and software bybiotechnology researchers and medical care per-sonnel; and

• Coordinate efforts to gather biotechnology infor-mation worldwide.

There are presently 34 senior scientists, postdoctoralfellows, and support staff working at the NCBI. Thesescientists have backgrounds in medicine, molecular biol-ogy, biochemistry, genetics, biophysics, structural biol-ogy, computer science, and mathematics.

NCBI programs are divided into three areas: (1)building of new databases and enhancing existing oneswhich involve genomic information; this includes NLM-developed databases and extramural support for otherresearch information resources; (2)basic research in com-putational molecular biology; and (3) dissemination andsupport of molecular biology databases and services.Within each of these areas, NCBI closely coordinates itsactivities with other NLM divisions and integrates infor-mation from key NLM databases such as MEDLINE intospecialized data resources.

Database Building and Enhancement

Beginning in September 1992, the NCBI will assumethe responsibility of GenBank, the NIH DNA sequencedatabase, and will be providing users with not onlyDNA sequence information but protein sequences andjournal abstracts as well. NCBI, working with LibraryOperations, is now building the literature component of

the database. These records will be supplemented withauthor-supplied direct sequence submissions which areprocessed and reviewed by Los Alamos National Labo-ratory, and the complete set of records will be distributedas the GenBank Sequence database in September 1992.

Comprehensive coverage of all sequence data, pro-tein as well as DNA,will be provided along with the cor-responding MEDLINE bibliographic information,including abstracts. At the NLM, more than 3200 jour-nals are scanned for sequence data and the NLM has ex-panded its journal coverage to include all journals whichregularly contain sequence data even if they are innonmedical domains, e.g., plant science. An integralcomponent of the database is the inclusion of abstractsand indexing terms from the MEDLINE records of se-quence-containing articles. The concept of an "index" se-quence has been introduced to capture sequences orportions of sequences that do not qualify for full data-base records (e.g., probes, consensus or previously pub-lished sequences) but which would be useful as"indexes" back to the journal articles in which they ap-peared.

NCBI is using a relational database system for devel-oping a sophisticated data entry system for building thedatabase from the scientific literature. Specialized se-quence indexers, members of the Library Operationsstaff with advanced training in biological disciplines, areresponsible for identifying and annotating sequence datafrom the MEDLINE literature. The work flow involves:

• Indexers identify articles containing sequencedata as part of normal MEDLINE processing;

• Corresponding MEDLINE records are loadedinto NCBI's relational database;

• Journal issues with sequences are scanned by se-quence indexers and selected sequences are en-tered into database with the addition ofbiological annotation; keyboarding of sequencesis performed by contractor;

• Accuracy of biological information is reviewedby NCBI biologists.

The GenBank data will be a key component in an in-tegrated sequence database system known as Genlnfowhich will be a comprehensive source of DNA and pro-tein sequence information. By using a well-defined datastructure, the ASN.l syntax described below, specialized

34 Programs and Services,FY1991

databases such as databases of sequence alignments or ofspecific organisms can readily be linked together in theGenlnfo system to provide users with seamless search-ing across a wide range of molecular data.

Cooperative arrangements are being used to aug-ment the in-house data capture operation. Aninteragency agreement with the National AgriculturalLibrary as part of the Plant Genome Project will furnishcoverage of the plant sequence literature. Similarly, anagreement with the U.S. Patent and Trademark Officehas been established to capture sequence informationfrom issued patents.

NCBI staff also are active in creating small-scale, spe-cial-purpose databases. These databases have includedmetabolic pathways, transcription factors, and integra-tion of E. coli genetic map and sequence data. Collabora-tive work with the Drosophila research community hasresulted in a prototype database that will be developedand maintained by an international consortium of labo-ratories. The NLM, in conjunction with other NIH insti-tutes and NSF, also provides funding for databanks thatare major resources for biological research, includingGenBank, the Protein Identification Resource, and theProtein DataBank at Brookhaven National Laboratory.The NLM, through an interagency agreement, is work-ing with NSF on a database initiative to help support thedesign and the development of biological databases andto foster interdisciplinary projects in biology and com-puter science.

Software Toolkit

Equally important as capturing molecular sequencedata is the ability to access and retrieve the informationusing automated systems. The software toolkit conceptaddresses this need by focusing on the creation of soft-ware modules that will provide a set of high-level func-tions to assist developers in building applicationsoftware. Among these tools are a Portable Core Libraryof functions in the C language that facilitates writingsoftware for different hardware platforms and operatingsystems, an AsnTool Utility, and an ASN.l function li-brary. The ASN.l (Abstract Syntax Notation) tools use anInternational Standards Organization data descriptionlanguage that provides a mechanism for defining andstructuring data as well as a set of program definitionsthat can interact with databases structured in ASN.l.

NCBI's adoption of ASN.l for database output hasseveral advantages for users as well as developers. Thedata definitions in ASN.l for biological objects enable therepresentation and structuring of complex biologicaldata in data files without the need for a specific databasemanagement system. Manipulation of the complex ob-jects is performed through the ASN.l software toolswhich are being freely distributed to the biology commu-nity. Thus, complex analysis programs can be readily

constructed from existing sets of modular tools, savingconsiderable time and effort for developing new, por-table applications.

A major reason for adopting a standardized repre-sentation is to facilitate the exchange of data; currentlyASN.l versions have been developed for the major se-quence databases (GenBank, PIR, and Swiss-Prot), theprotein structure database at Brookhaven, the ProteinData Bank, and the OMDVI database of Dr. VictorMcKusick. ASN.l is being used as a distribution formatfor the Genlnfo databases to provide a hardware- andsoftware-independent version of the data in the rela-tional database.

User Retrieval Tools

A major application based upon the toolkit approachis a retrieval tool called Entrez which searches nucleotideand protein sequence databases and MEDLINE citationsin which the sequences were published. With Entrez anda database on a CD-ROM or a local network, a user canrapidly search several hundred megabytes of sequenceand literature data using techniques that are fast and in-tuitive. A key feature of the system is the concept of"neighboring" which permits a user to locate related ref-erences or sequences by asking for all papers or se-quences that resemble a given paper or sequence.Neighbors are precomputed using statistical algorithmsdeveloped at the NCBI. The ability to traverse the litera-ture and molecular sequences via neighbors and linksprovides a very powerful yet intuitive way of accessingthe data. Moreover, the underlying software lends itselfto a server-client model, whereby the user interface por-tion of the application can be on a local machine whichthen uses a network connection to query a retrieval en-gine.

NCBI is also using this highly modular approach inbuilding systems for online retrieval. The BLAST se-quence searching server has been implemented as a net-work-based retrieval system. Over 20 genome researchgroups around the country have been provided withversions of this software which enables them to transmita query sequence from their local computer over theInternet network to a BLAST server running on a com-puter at the NCBI. In a few seconds, the BLAST serverexecutes the user's query and returns the results to theclient program for viewing by the user. The BLAST net-work server has been recognized by the research groupsas an essential laboratory tool not only to analyze databut to aid in setting directions for wet bench research.

Basic Research

Basic research lies at the core of NCBI's mission. Itsgroup of multidisciplinary scientists work on fundamen-tal biomedical problems at the molecular level using

National Center for Biotechnology Information 35

mathematical and computational methods. The basic re-search and database/software development have beenfound to be mutually reinforcing: the drive to make andsubstantiate new discoveries in biomedical science givesa rich stimulus, urgency, and direction to the develop-ment of new methods.

In the last year, NCBI scientists Mark Boguski,Stephen Altschul and Jean-Michel Claverie have collabo-rated on sequence analysis with major laboratories inves-tigating disease genes. Boguski's work last year in thecomputer identification of the neurofibromatosis-1 (NF1)gene as a homolog of a yeast gene and implications forhuman tumor formation was followed up by experimen-tal work at Cold Spring Harbor Laboratory which corre-lated the NF1 locus to mammalian GTPase activatingproteins. Boguski and Altschul also participated in theanalysis of the newly discovered genes for familial coloncancer. Structural analogies to proteins with coiled-coilregions give evidence of how the gene products could in-teract with other proteins. Claverie performed work onthe analysis of a gene implicated in KaUmann syndrome,a genetic disease mapped to the X chromosome andcharacterized by anosmia, hypogonadism, and ab-sence of puberty. The gene appears to be involved inregulating early neural development. NCBI databasesand software tools played key roles in the discoveryand analysis process.

Other basic research carried out at NCBI includes thedevelopment of models for molecular evolution,Bayesian classification of protein structure, detection oflow entropy regions of protein sequences, methods forassessing the statistical significance of molecular se-quence features, and enhanced methods for vector-basedtext retrieval. Continuing research on the BLAST simi-larity search algorithms has been incorporated into asuite of rapid sequence query programs for comparingnew nucleotide or protein sequences against data-bases. The speed of the algorithm and implementationhave been crucial to their success as a tool for databaseexploration and for discovery of new functional asso-ciations among genes.

Communication

As part of its mandate to support the developmentof new information technologies of relevance to biologyand genetics, the NCBI has exercised a leadership role insponsoring forums for the exchange of informationamong leading scientists from the fields the computerscience and biology. NCBI has also extended its outreachto the library science community by invited presenta-tions and workshops on biotechnology information top-ics. Staff from NCBI presented a series of 15 lectures onthe theory and practice of sequence analysis for NIH in-

tramural scientists in the fall. Over 350 NIH scientists arealso supported through online access to 20 databases un-der the IRX system.

Workshops are being organized for software devel-opers to have an opportunity to work with the NCBIsoftware tools and the ASN.l specifications for databaseobjects. The first of the workshops will be held in the fallof 1991 and will facilitate the creation of software by aca-demic and commercial groups which can directly makeuse of NCBI databases distributed on CD-ROMs. Aninteragency agreement has been set up with the NationalTechnical Information Service to produce and distributethe CD-ROM versions of NCBI databases. Several hun-dred evaluation copies of CD-ROMs have been releasedthat include the Entrez retrieval software and sequencedatabases; full-scale distribution will begin in the springon a bimonthly basis.

The Visitors Program was established this year andhas been successful in bringing members of the scientificcommunity to the NCBI to engage in collaborative re-search in the bioinformatics area as well as joint activitiesin database design and implementation. Selection of can-didates is coordinated through the NLM's ExtramuralProgram and involves a peer review of candidates' expe-rience and proposed program.

In addition to meetings, information disseminationis being provided by the Genlnfo Data Repository, a net-work-based service for distributing software and data-bases produced by the NCBI as well as by outsidegroups. NCBI coordinated the production of the fifth edi-tion of a classic compendium of immunological se-quences edited by Dr. Elvin Kabat, Sequences of Proteins ofImmunological Interest, and is continuing to work with Dr.Kabat in collecting the primary sequence data fromNCBI and NLM databases. The NCBI also participates inan advisory role with other government agencies such asthe Patent and Trademark Office and the Department ofAgriculture on programs involving biotechnology infor-mation. Special workshops on sequence analysis havebeen organized for the patent examiners at the U.S.Patent and Trademark Office who evaluate sequencedata. Within the NIH, the NCBI coordinates with the Na-tional Institute for General Medical Sciences and the Na-tional Center for Human Genome Research on databasesand informatics programs which impact information ex-change on a national level.

Extramural Programs

NLM's extramural division has a program of grantsfor computer analysis of molecular biology data. Itsscope is quite broad and includes research into methodsand algorithms for improving the efficiency of informa-tion retrieval and improving the efficiency of analyticaloperations which are computationally intensive. Re-

36 Programs and Services, FY1991

search applications to develop expert systems for anno-tating and linking databases are encouraged, as are pro-posals for work on algorithms for structure and functionprediction. Software development for newer machine ar-chitectures is within the scope of the program as well, in-cluding molecular analysis by neural net techniques, andmultiprocessor programming. Postdoctoral training inthe cross-disciplinary areas of biology, medicine, andcomputer science is also supported through the NLM'sinformatics fellowship program.

Biotechnology Information in the Future

The design of molecular biology databanks andtheir resulting utility will, of necessity, need to followscientific trends in research. The stimulus to maintain

state-of-the-art systems will come from an intramuraland extramural program supporting scientific discov-ery.

The NCBI will continue to develop software toolsto facilitate gaming access to the growing volume ofsequence and gene data and will encourage the wide-spread distribution of software and databases as essen-tial components in the research process.

In the area of information resources, the NCBI willuse contract and cooperative agreements to support mo-lecular biology data banks located around the countryand to encourage the development of specialized data-bases.

With the rapid advances of molecular biology re-search, NCBI will be engaged in developing and em-ploying new methods for disseminating this newknowledge to the biomedical community.

EXTRAMURAL PROGRAMS

Milton Corn, M.D.Acting Associate Director

37

The Extramural Programs Division provides supportto the health science community in the biomedical areasfor which the National Library of Medicine takes particu-lar responsibility. NLM support for extramural programsstems from two sources: from the Medical Library Assis-tance Act of 1965 and its extensions, and from Section301 of the Public Health Service Act as amended.

The dual basis of the funding sources as well as thehistoric mission of the Library explain the eclectic varietyof the funded projects for which the Division takes re-sponsibility, and for which an overview may be helpfulin explaining Division activities.

The Research Grants Section of this report summa-rizes some recent activities in the area of basic and ap-plied information science. The application of computersto biomedical information storage and retrieval has revo-lutionized the operations of biomedical libraries and hasengendered the useful term, medical informatics, to de-scribe the theory and practice of providing informationand decision support accurately and usefully to healthworkers. Such research is vital now when the volume ofbiomedical information is growing at a rate that threat-ens our ability to keep track of what we know, and to usewhat we do know most efficiently.

Training efforts also merit specific description. Train-ing of competent professionals in medical informaticsmust remain an important goal of the Division. This newfield needs scientists who can exploit the enormous po-tential for improvement in health delivery which medi-cal informatics is capable of providing. Merginginformation science with the peculiar complexities ofmodern health care and research poses complex prob-lems whose solution will depend on well-trained special-ists. NLM supports both institutional training programsand a fellowship program.

The NLM's Integrated Academic Information Man-agement Systems (IAIMS) program addresses the insuffi-ciently appreciated but vital issue of integrating usefullythe myriad information systems which have sprung upat most of our medical centers. These systems are useful,to be sure, but all too often are unrelated, isolated, andvery far from taking advantage of the synergism that canbe realized by Unking the various academic informationsystems present in our health centers, including the li-brary, research material, academic administration infor-mation, medical education, and hospital informationsystems (particularly patient records.)

Medical Library Resource Grants have been an es-sential element of the Division's activities for years. It isclearly an NLM mission to make biomedical informationeasily available to health professionals. This emphasiswas heightened when the NLM adopted outreach as amajor new initiative. As recommended by the Board ofRegents' Outreach Planning Panel, the outreach programinvolves a number of extramural responsibilities, includ-ing professional training, IAIMS, and improving accessto national biomedical information by hospital librariesand physicians.

Improvement of access by physicians to medical in-formation was specifically addressed by an amendmentof the Resource Grant Program designed to expand theability of hospital libraries, particularly in rural orunderserved areas, to establish facile contact with the na-tional biomedical library system.

Grants in support of publications have little to dowith medical informatics but are a time-honored, impor-tant commitment by the Division to the scholarly activi-ties which lie at the heart of libraries everywhere.

The support provided for the bioethics center is self-explanatory, as is the section on the Division's committeeactivities.

Support for the National Network of Libraries ofMedicine, as authorized by the Medical Library Assis-tance Act, is described in the chapter on Library Opera-tions. The Special Foreign Currency Program,administered by the Extramural Programs' InternationalPrograms Branch, is described elsewhere in the annualreport under International Programs.

Budget information is summarized in table10.

Research Grants

The Library continues to support innovative research inlibrary information sciences, medical informatics, and bio-technology informatics. Library science represents the moretraditional discipline dealing with issues of medical litera-ture and bibliography. Medical informatics, an interdiscipli-nary field combines the medical sciences with informationand computer sciences, computational linguistics, decisionanalysis, and related disciplines in addressing healthknowl-edge issues. Biotechnology information deals with the vastamounts of data which are accumulating about the molecu-lar control of life processes, and with techniques to be uti-lized in analyzingand comparing such data.

38 Programs and Services, FY1991

Librarianship and Information Science

In this program area, NLM supports a variety of ac-tivities and projects that have to do with the organizationand utilization of the literature, i.e., medical bibliogra-phy. Projects of interest range from analyses of formal-ized retrieval mechanisms, through innovativearrangements of medical subject matter (so long as thereis some analogy or compatibility with published work),to studies of medical information in its social context.

At Massachusetts General Hospital, a project is un-der way to develop and evaluate hypertext-based deci-sion-support systems for pulmonary cathetermanagement, skin breakdown, and ventilator manage-ment. The evaluation of the resulting systems will try tolearn whether, or in what ways the health care team hasbenefited from computerized decision-support.

At Harvard University School of Public Health, asmall grant assists development of a monograph onmeta-analysis with supplemental computer software.Meta-analysis is a statistical methodology dealing withcollection and analysis of data from independent butrelated studies. It is useful for the planning and analy-sis of clinical trials. The project goal is to help clini-cians who lack advanced statistical skills understandand use this methodology. The accompanying com-puter disk will supplement the text with interactiveproblems, examples, and guides.

An ongoing project at the University of West Vir-ginia is exploring the potential role of community andhospital pharmacists as information providers fordrug therapy. A number of pharmacists are providedwith desktop computer facilities for accessing biblio-graphic databases. How and in what ways their newcapabilities are drawn upon by the professional com-munity is being assessed. It is hoped that this form ofinformation support will be especially helpful in iso-lated rural communities.

Medical Informatics

Although much of the informatics research NLMsupports is basic, there are some opportunities for sci-entifically rigorous studies in applied informatics.NLM's medical informatics activity is quite small andfree from the constraint of categorical disease applica-tions. This allows investigators to consider complexproblems of knowledge representation and retrieval.In this small but growing field, NLM's grant-sup-ported investigators have achieved significant recogni-tion. Twenty-eight medical informatics awards weremade in FY 1991. Nineteen of these were to continuethe support of projects begun in earlier years. In addi-tion, nine new or competing awards were made, fol-lowing the usual selective peer group review.

An example of research in this area is an award tothe University of Washington, Seattle, on behalf of Dr.Cornelius Rosse, Professor and Chairman, Departmentof Biological Structure. This project concerns research is-sues in representing spatial and symbolic knowledge ofhuman anatomy in advanced computer systems. The re-search is relevant to teaching, research, and clinical prac-tice. Knowledge representation, graphic images asknowledge bases, and computer applications for medicaleducation are the main areas of interest.

Another example, also from the University of Wash-ington, involves Dr. Ira Kalet, Assistant Professor, De-partment of Radiation Oncology, as PrincipalInvestigator. This project continues work on an artificialintelligence-based expert system for planning the radia-tion therapy of head and neck tumors. The goal is to pro-duce a more effective program for interactive treatmentmodeling and to contribute to the general field of expertsystems by developing a generic theory for design.

A final example is a FIRST (First Independent Re-search Support and Transition) Award to Georgia Insti-tute of Technology and Dr. Norberto Ezquerra, AssociateProfessor, College of Computing. Dr. Ezquerra plans todevelop a clinically useful, computer-based methodol-ogy to assist in decision-making tasks in cardiac imaging.

Biotechnology Informatics

The appearance of new experimental methods in thepast several years has greatly increased the rate at whichdata are accumulating about the molecular control of lifeprocesses. Restriction enzymes, synthetic molecularprobes, efficient microchemical methods for DNA andprotein sequence determination, and recombinant DNAtechnology have developed to the point that it is nowfeasible to consider large-scale projects, such as the sys-tematic analysis of entire eukaryote genomes. Becauseoftheir size and complexity, the data that are generated bysuch undertakings must be analyzed and compared us-ing computerized techniques for storage, searching, andanalysis. The computer databases that hold this informa-tion, currently numbered in millions of nucleotide basepairs and thousands of amino acids, are expected togrow by three orders of magnitude to encompass se-quences totaling billions of nucleotides. Current methodsfor structuring, searching, and analyzing such databasesneed to be enhanced correspondingly.

An example of NLM support for this area is a re-search project from the University of Pittsburgh and Dr.Bruce Buchanan, Professor of Computer Science, Phi-losophy, and Medicine. He and his colleagues are pro-viding other investigators with a program that providesa uniform retrieval interface to multiple databases scat-tered throughout the world. The program user need notremember where the database resides or its unique pro-

Extramural Programs 39

tocols. The Pittsburgh groups are also developingcommunications software to assist in the database uti-lization problem.

Another example of biotechnology informaticscomes from Pennsylvania State University and Dr. WebbMiller, Professor of Computer Science. His project hasproduced 12published papers in the past year concernedwith such topics as searching and analyzing restrictionmaps, space efficient methods for comparison of twolong sequences, and graphical user interfaces for utiliz-ing sequence comparison algorithms.

Yet another example of a biotechnology informaticsresearch project comes from the Cold Spring HarborLaboratory and Dr. Richard Roberts, who is developinga database of protein sequence motifs which are predic-tive of protein function. The short motifs of interest rep-resent the basic building blocks from which proteinshave evolved.

Training

The NLM supports predoctoral and postdoctoral re-search training in medical informatics. Such training willhelp meet a growing need for qualified, talented investi-gators, well prepared to address information problems inhealth care, health professions education, and biomedicalresearch. These investigators will contribute to thegrowth of information science by their studies of knowl-edge management, and by advancing the frontiers of thecomputer sciences for acquiring, organizing, retrieving,and utilizing health knowledge. The expectation is thattrainees will become able, multidisciplinary informaticsspecialists.

Medical informatics goes beyond the use of the com-puter as a computational tool and extends into the pro-cess of knowledge representation, acquisition, storage,retrieval, and manipulation largely to support reasoningand decision-making.

To prepare trainees for research careers in a de-manding research environment, the sponsorship of a re-search-oriented academic health sciences institution iscritical. The core of training emphasizes the synthesis, or-ganization, retrieval, and effective management ofknowledge. The curricula are interdisciplinary, involvingmedicine and the biological sciences, the cognitive sci-ences, information science, and computer science. Thetraining sites offer an excellent setting for instruction,and opportunities for meaningful trainee involvement inhealth-related computer science research.

In addition to its general goal of assisting in the edu-cation of persons who can take academic positions toconduct research and teach medical informatics, NLMalso envisions several more specialized enhancements tothe training programs, including such areas as high per-

formance computing and communication, biotechnol-ogy, cancer, and information systems. Dental informaticsis another area for which additional training slots maybecome available in the future.

Seven institutional training grants supported 51postdoctoral and 21 predoctoral trainees in 1991. Inaddition to the institutional training grants, NLM sup-ported 7 individual fellows. The current fellows are re-ceiving their research training at the University ofUtah, Columbia University-Presbyterian Hospital,University of Washington, Yale University, ColdSpring Harbor Laboratories, University of Pittsburgh,and Ohio State University.

Institutional training grantees:

1. Harvard Medical SchoolBrigham and Women's HospitalMassachusetts General HospitalRobert A. Greenes, M.D., Ph.D., Director

Major research emphases are computer-based deci-sion support systems, modeling of physician decisionmaking, representation and structure of medical knowl-edge, application of information technology to medicaleducation, database and data analysis systems, computergraphics, and the development and evaluation of digitalimaging systems.

2. University of MinnesotaLael Gatewood, Ph.D., Director

The focus of this interdisciplinary program is to pro-vide training in cognitive, information, and computersciences. Current research includes physician decisionmaking, diagnostic classification, nurse decision making,electronic communications for health professionals, phy-sician training, and health information systems.

3. New England Medical CenterDartmouth College of MedicineStephen G. Pauker, M.D., Director

This research training program emphasizes clinicaldecision making, artificial intelligence approaches to thestructure and use of medical knowledge, and clinicalcognition. The program focuses on research experiencerather than on preparing for an additional graduate de-gree, although that option is available.

4. University of PittsburghRandolph A. Miller, M.D., Director

Operating under the Intelligent Systems Program atthe University of Pittsburgh, this program uses the facultyand services of the School of Medicine, the GraduateSchoolof Business, the Department of Computer Science, and theInterdisciplinary Department of Information Science.

40 Programs and Services, FY1991

5. Stanford UniversityEdward H. Shortliffe, M.D., Ph.D., Director

This formal program in medical informatics offersMasters and Ph.D. degrees. The specialized curriculumfocuses on developing a new generation of researchersinterested in developing practical, computer-based solu-tions to problems in the optimal management of bio-medical knowledge.

6. Washington University (St. Louis)Charles E. Molnar, Sc.D., Director

The development of skills in basic techniques ofinformatics, and experience in applying these techniquesin a biomedical setting are inseparable goals of this pro-gram. Research opportunities for trainees are availablefrom a wide range of options represented by the researchof the core faculty and of a much larger group of partici-pating faculty.

7. Yale UniversityPerry L. Miller, M.D., Ph.D., Director

This training program will prepare individuals forcareers in medical informatics research. The programwill include both postdoctoral and predoctoral training.In addition to multidisciplinary research opportunities,the program will also offer didactic experiences.

Resource Grants

FY 1991 continued the implementation of the Re-source Grant Program (as redefined in 1989) with theaward of 14 Information Access Grants and 2 Informa-tion Systems Grants—all designed to improve access toinformation resources utilizing computer and communi-cations technologies.

For example, an Information Systems Grant to theAlaska Health Sciences Library will assist in establishinga statewide computer network linking the outlying hos-pitals to the state's largest medical library in Anchorage.Similarly, the Information Systems Grant to the Univer-sity of New Mexico Medical Center Library is helping toform the foundation of a statewide electronic networkaccessible to all health professionals engaged in research,education, and patient care.

The Information Access Grants encompass fourtypes of project: 1) Grateful Med, 2) automated technicalservices, 3) document delivery, and 4) specialized auto-mated reference services. Grateful Med grants wereawarded to the Fayetteville, North Carolina, Area HealthEducation Center, the University of Nevada for a state-wide network, Kootenai Medical Center for two addi-tional members of the North Idaho Health InformationNetwork which had received an NLM Information Ac-

cess Grant in FY 1990, DuBois Regional Medical Center(DuBois, Pa.), J.C. Blair Memorial Hospital (Huntington,Pa.), and Navapache Hospital (Show Low, Arizona). In-formation Access Grants to automate library technicalservice functions were awarded to the MassachusettsEye and Ear Infirmary in Boston, the Sacred Heart Hos-pital in Norristown, Pa., Richmond Memorial Hospital(Virginia), Mercer University (Macon, Georgia) for theGeorgia Information Network, and Suburban Hospital(Bethesda, Md.). Access Grants to enhance document de-livery and establish communications links were given tothe Northeast Indiana Health Sciences Libraries Consor-tium in Fort Wayne, and to Marquette General Hospital(Marquette, Michigan). An Access Grant was awarded toClara Maass Medical Center (Belleville, NJ) to establish abusiness information center for the 50-member adminis-trative staff of this 475-bed hospital.

In FY 1991, NLM, for the first time, gave resourcegrantees an opportunity to apply for supplemental fund-ing to provide minority undergraduate and graduatestudents a practical experience in health scienceslibrarianship to encourage them to pursue this profes-sion. Two Information Access Grantees received suchadministrative minority supplements: Columbia Hospi-tal Medical Library in Milwaukee and Kootenai MedicalCenter in Coeur d'Alene, Idaho.

IAIMS

Integrated Academic Information ManagementSystems (IAIMS) are institution-wide computer net-works that link and relate library systems with a vari-ety of individual and institutional databases andinformation files for patient care, research, education,and administration. Resource grants have been madeto assist medical centers and health science institutionsin planning and development projects that will lead tothe implementation of IAIMS. The goal is to create or-ganizational mechanisms within health institutions tomanage more effectively the knowledge of medicine,and to provide for a system of comprehensive infor-mation access.

NLM has provided grant support for (1) institu-tion-wide IAIMS planning and policy analysis, (2)model development and testing, and (3) implementa-tion of full-scale IAIMSprojects.

Some of the functions undertaken by grantees dur-ing planning include preparing a 10-year strategicplan for the institution, developing an institutional in-formation policy, assessing the technological capabili-ties of the institution, and defining informationmanagement needs and requirements. From these ac-tivities an IAIMS plan is created to serve as the guidefor the second phase of activity, model development.

Extramural Programs 41

Publication Grants

The Publication Grant Program provides selectiveshort-term financial support for not-for-profit, biomedi-cal scientific publications. Studies prepared and/or pub-lished under this NLM program include critical reviewsor monographs on special areas of medical research andpractice; secondary literature tools (such as atlases andcatalogs); research monographs in the history of medi-cine; publications on medical informatics, health infor-mation science and biotechnology; pilot or temporarysupport for secondary periodicals; and the proceedingsof scientifically significant symposia related to U.S.health needs. Because funds for publication support havedwindled, available resources in recent years have beenused principally for history of medicine projects.

The Publication Grant Program is supplemented byNLM's Special Foreign Currency Program, authorizedunder Public Law 480. (The Special Foreign CurrencyProgram is described in the chapter on International Pro-grams.) Both publication support programs aid in thedissemination of biomedical information important to anunderstanding of progress in medicine and the healthsciences.

During FY 1991 NLM awarded 13 PublicationGrants totaling $365,000. Of these, 7 were new awards.This small grant program has a current self-imposed an-nual ceiling on direct costs per grant of $25,000.The aver-age grant awarded in FY 1990, including both direct andindirect costs, was under $23,000.

Among the books published in FY 1990 fundedthrough the Publication Grant Program was Dr. KennethZysk's Asceticism and Healing in Ancient India; Medicine inthe Buddhist Monastery (New York, Oxford UniversityPress, 1991). This book was one result of the grant-sup-ported task of translating from the Sanskrit and prepar-ing a critical edition of Vagbhara the Elder's AstangaSamgraha, "The Summary of the Octopartite (Science)."This medical history has not been available in a Westernlanguage, and it represents the earliest compilation of an-cient Indian medical and surgical knowledge. This workled Dr. Zysk back to earlier contributions to medicine byascetic Buddhists which resulted in the published mono-graph.

Another notable work published in FY 1991 withsupport from NLM was Dangerous Passage: The SocialControl of Sexuality in Women's Adolescence by Dr.Constance Nathanson (Philadelphia, Temple Univer-sity Press, 1991). Professor Nathanson's book exam-ines the normative, structural, and political context inwhich pregnancy-related services for adolescents weredeveloped, implemented, and put to use. The volumeanalyzes the social history of policy decisions towardadolescent childbearing, utilizing both historical and

contemporary data. It provides an important contribu-tion to the study of adolescent pregnancy and to theunderstanding of public health policy development.(A list of supported publications received in FY 1991 isin Appendix 3.)

Bioethics

With a specialized center grant, NLM continued itssupport for a National Reference Center for Bioethics atGeorgetown University. The Center, which has beensupported by NLM for many years, has grown as a ma-jor resource for bioethics information of every kind. Itscollection, while selective, is also comprehensive in itsrange, because bioethical issues are frequently addressedin literatures other than medical ones. This collection isindexed, in part by a separate contract, and is madeavailable to the world through BIOETFflCSLINE®, one ofNLM's online databases.

The Reference Center is available to visitors in a re-stored part of the original late nineteenth century Uni-versity library. A toll-free telephone line offers distantinquirers convenient access; article photocopies aremailed for a small fee. Bibliographic overviews on ethicaltopics of broad concern, called Scope Notes, appear inpamphlet form as well as in a scholarly journal. OtherCenter activities include a clearinghouse for bioethicscourse syllabi and an archive for major unpublisheddocuments. This resource and the related contract for theBIOETHICSLINE indexing constitute the major Feder-ally supported activities that directly assist the nationalbiomedical community in addressing the often thornyquestions of ethics, law, and morality posed by currenthealth care modalities.

Highlights of Committee Activities

NLM's scientific merit grant peer review group—the Biomedical Library Review Committee (BLRC)—met three times in FY 1991 and reviewed 130applications, approving 97. The Committee operates asa "flexible" review group; i.e., it is composed of threestanding subcommittees, consisting of seven memberseach: Medical Library Resource Subcommittee, Medi-cal Informatics Subcommittee, and Biotechnology In-formation Subcommittee.

A final peer review of applications is performed bythe Board of Regents, which meets three times a year.One of the Board's subcommittees, the Extramural Pro-grams Subcommittee, meets the day before the fullBoard meeting for the review of "special" grant applica-tions. Examples of "specials" include applications forwhich the recommended amount of financial support is

42 Programs and Services, FY1991

larger than some predetermined amount, when atleast two members of the scientific merit review groupdissented from the majority, when a policy issue isidentified, and when an application is from a foreigninstitution. The Extramural Programs Subcommitteemakes recommendations to the full board which voteson the applications.

Plans for FY 1992

Detailed grant-funding plans depend on the actualamounts made available by Congress. In general, all ofthe existing grant programs will be continued al-though some possible modifications are under discus-sion:

High Performance Computing and Communica-tion (HPCC) funds, if allocated to EP, will be distrib-uted among research, training, and IAIMS programsto help develop the various elements needed for usefulapplication of HPCC to biomedical needs.

The very popular IAIMS program, now 10 years old,is being reevaluated, and may be modified so as to pro-vide additional guidelines for the applicants, and to re-duce the total duration and amount of support.

The current institutional informatics training grantsexpire in June 1992. The peer review system will be usedto identify 6-10 universities to which new 5-year traininggrants will be awarded.

An NLM fellowship in applied informatics tocomplement the research training fellowship is underconsideration as a means of training physicians, nurses,librarians, and others to use the new technology in bio-medical organizations, research, and patient care.

The library resource awards may be redefined to re-flect more faithfully the NLM long-range plan directivethat emphasis should be given to facilitating access byhealth libraries to national databases.

The library information science awards programmay be expanded to include research in questions aboutinformation-seeking behavior, a poorly understood fieldof enormous importance to informatics and to theNLM.

Table 10Extramural Grant and Contract Program(dollars in thousands)

Category

ResearchResource projectsResource access/improvementTrainingFellowshipsRegional Medical LibrariesPublications*

(IAIMS projects")(Med. info, research)(Biotech research)

FY1989No. $

45149737

13(9)

(26)(14)

$7,6663,487

1292,537

992,569

346(2,962)(4,008)(2,747)

FY1990No. $

471515757

17(8)

(24)(17)

$11,3434,492

5192,886

1893,772

390(3,821)(6,030)(4,179)

FY1991No. $

491717798

13(9)

(26)(16)

$11,2314,721

6842,714

3065,500

365(3,693)(6,066)(4,192)

Totals:. 98 $16,833 113 $23,591 120 $25,521

* Includes one Special Scientific Project"Includes both IAIMS resource and research projects

OFFICE OF COMPUTER ANDCOMMUNICATIONSSYSTEMS

Aaron B. Navarro, Ph.D.Acting Director

The Office of Computer and Communications Sys-tems (OCCS) provides information processing capabili-ties to meet NLM needs and, in so doing, determines andmeets the data processing and data communications re-quirements for: (1) disseminating biomedical informa-tion to thousands of institutional and individual healthprofessionals around the nation and the world; (2) oper-ating the world's largest library in a single technicalarea—biomedicine, and (3) providing Management In-formation System (MIS) services, including office auto-mation.

OCCS: (1) implements computer and communica-tions systems using state-of-the-art technology and tech-niques; (2) analyzes, plans, and provides real-time,online, around-the-clock information services for increas-ingly sophisticated users; (3) schedules and controlsmaintenance and publication of dozens of databases,each measured in billions of bytes (characters); (4) oper-ates a modern computer center; (5) conducts perfor-mance measurement and capacity planning forcomputer hardware, operating systems, database man-agement systems, transaction processors; and (6) pro-duces and distributes data and software products tothousands of institutions and health professionals.

The organization of OCCS is a direct reflection ofthese responsibilities. Computer and communicationssystems are:

• developed and implemented by the Develop-ment Branch

• enhanced and maintained by the ApplicationServices Branch

• executed on computers under operating systemcontrol by the Systems Support Branch

• provided as an around-the-clock service by theComputer Services Branch

Development Branch

The Development Branch is responsible for analyz-ing, designing, and implementing computer-based sys-tems to support NLM's requirements. Developmentactivities during the past year included the implementa-tion of an additional subsystem capability for the Techni-cal Services System (TESS), expansion of Grateful Med

support, enhancements to DOCLINE, implementation ofLoansome Doc, extensions to the local area network ser-vices, and the establishment of the Information SystemsLaboratory (ISL).

The Technical Services System (TESS) is being devel-oped to perform functions for the Technical Services Di-vision. TESS is a distributed processing system thatintegrates mainframe computer, personal computer(workstation), database, and local area network (LAN)technologies. The basic approach has been to develop acommon set of system functions that drive the main-frame, database, LAN, and workstation, and then to usethem to construct the specific application functions. TheCataloging Front-End (CAFE) subsystem is one such setof application functions that has been successfully imple-mented.

During 1991 the principal effort on TESS has been di-rected toward the integration of authority control intothe cataloging function. When this effort is completed inOctober 1991, all creation and maintenance of the NameAuthority File will be performed within the TESS sys-tem, and authority control of name and subject fields ofthe cataloging record will be tightly integrated with thecurrent cataloging creation and maintenance activities.

The scope and coverage of Grateful Med continue togrow. New versions for both the PC (version 5.0) and theApple Macintosh (version 1.5) were released in 1991. PCversion 6.0 reached the beta test stage in 1991, and aUnix-based version was initiated. More than 2 millionsearches were performed via Grateful Med this year byover 35,000 registered owners of the software.

The functionality and utilization of DOCLINE alsocontinue to grow. Approximately 2.1 million interlibraryloan requests were processed by nearly 2,200 libraries inFY 1991. DOCLINE volume hit a new daily record onOctober 26,1990, when 11,224 interlibrary loan requestswere entered. In March 1991, the average number ofinterlibrary loan requests entered and processed viaDOCLINE was more than 9,600 per day. This was thehighest sustained volume since system inception.

DOCLINE enhancements include support for for-eign libraries, expansion of message capability, im-proved performance, and increased capacity. The Systemfor Automated Interlibrary Loan (SAIL), a pilot project

44 Programs and Services, FY1991

linking DOCLINE with the Lister Hill Center's electronicdocument delivery system, was implemented and is be-ing evaluated.

Loansome Doc provided an interface between Grate-ful Med and DOCLINE, enabling the user to order jour-nal articles electronically from a DOCLINE libraryduring a Grateful Med session. Loansome Doc was dis-tributed to more than 10,500 users during FY 1991. Theinitial reports have been very positive from participatingDOCLINE libraries and from health professionals whohave ordered documents using LoansomeDoc.

NLM Local Area Networks (LANs) continue to beenhanced in order to keep pace with demands to shareand transfer information among diverse systems. As theprocessing power of NLM staff and patron workstationscontinues to increase, greater requirements are placed oninternal communications in terms of throughput andvolume of data traffic. Currently a broadband cable sys-tem is used throughout NLM for both video applicationsand data communication rinks between workstations,servers and other processing resources, using the NovellNetware operating system. Workstations can access in-ternal hosts through gateways or direct links. These com-munications facilities form a network that supports officeautomation, electronic mail, distributed applications, anddata processing activities. Plans are being developed toreplace the digital communications portions of thebroadband system with Ethernet-based systems, whichwill ultimately include higher speed networking.

The Information Systems Laboratory (ISL) was es-tablished in 1991. It will be the focal point for definingand evaluating future OCCS computer systems conceptsand operational enhancements. Thus, it will help supportan orderly evolution of NLM capabilities and services, aswell as allow OCCS to take advantage of advances instate-of-the-art technologies.

Applications Services Branch

The Applications Services Branch (ASB) supportsthe various NLM programs and serves as the nucleusof all automated programming support services. Therewere a number of advances in in FY 1991.

New generations of software for subsystems of theAutomated Indexing Management System (AIMS) be-came operational. AIMS is an IBM mainframe com-puter application that runs under the CustomerInformation Control System (CICS). It provides accessto the Inquire Database Management System (DBMS)for storage/retrieval of new records or old records tobe maintained. The data entered, verified and vali-dated is NLM bibliographic data that becomes part ofthe MEDLARSdatabases and associated publications.Subsystems affected were: (1) journal control; (2) in-

dexing; (3) check-in; (4) bibliographic processing; (5)binding; and (6) gapping.

Many software enhancements were made to theModel 204 DBMS-based MeSH system. This system pro-vides for data entry/verification and validation of theNLM controlled thesaurus, MeSH. Data are extracteddaily from the Model 204 MeSH database and updatedto the MEDLARS information retrieval MeSH database.These controlled thesaurus data are used to formulatesearches of the MEDLARS online databases.

The Bioethic Citation Maintenance System (BCMS)became operational. This system is PC-based and pro-vides for individual citation maintenance and newrecord creation of bioethics-related data.

More than 10 percent of over 7 million records of theNLM bibliographic data are class maintained each year.Class maintenance is the adding of new terms, deletingold terms, and replacing terms with preferred ones in theMEDLARS database records. Moreover, new data fieldsare introduced to the records as required. Major softwareenhancements to support the class maintenance effort in-cluded:

• Creation of "Publication Type" data• Mapping of MeSH to chemical names• Identification of inconsistent data between

MeSH Chemical records and data carried in theMEDLINE family of files

A new database, USERS, became operational. US-ERS was developed to facilitate the Medlars ServiceDesk. USERS is used internally and eliminates the neces-sity to access two different systems while callers arewaiting for information.

There are currently more than 52,000 users of NLMonline services. Over 500 new codes are assigned eachmonth. Computer software was developed to assign thenew codes and passwords.

The In Process (INPROC) data entry/verificationand validation system was implemented. This system isan IBM mainframe CICS-based application which uti-lizes the Inquire DBMS. It provides for creation andmaintenance of records that identify monographs.

Systems Support Branch

The Systems Support Branch is responsible for hard-ware analysis, system software, and data communica-tions. The current NLM production configuration is anIBM 3084-Q with MVS/XA (multiple virtual systems/extended architecture) and VTAM. An IBM 3081-K isused for system testing and development. A third sys-tem, IBM 9370 with VM (virtual machine) is used forPROFS (Professional Office System).

During FY 1991, online access was expanded andimproved. Higher speed lines were installed, additional

Office of Computer and Communications Systems 45

online access capability was installed, and Internet con-nectivity was enabled. In addition, all online access wasplaced under control of VTAM (Virtual Telecommunica-tion Access Method) and the use of TCAM (Telecommu-nication AccessMethod) was discontinued.

The IBM 3084-Q and 3081-K systems will be re-placed during the winter of 1991/1992 with an IBM3090-300J system, obtained from NIH in August 1991.Acquisition of this new system will: (a) permit NLM toupgrade its 3084 system to a system capable of effec-tively using new technology; (b) provide a base systemfor further MEDLARS development; (c) permit paralleltesting and development of the NLM applications withthe current production system; and (d) permit continuedinstallation of new and/or enhanced capabilities wellinto the mid-1990s:

Accomplishments for the year include:• Installation of two IBM 3725 communications

controllers for increased capacity and speed.• Installation of three Packet Assembler

Disassemblers (PADS) for ASCII connectivityto VTAM.

• Installation of IBM 3172 interconnect controllerfor Internet connectivity to NLM applications.

• Increased line speeds of 56KBS for Telenet and19.2KBS for Tymnet.

• Upgrade of 300/1200 to 1200/2400 for local di-rect dial users.

• Implementation of RACF (Resource AccessCon-trol Facility) to improve security for TSO users.

• Support of more than 100 software productsused by programmers, users and System Sup-port staff.

• Operating systems support and communica-tions connectivity for new terminals and work-stations throughout the NLM.

• Development and distributions of proceduresand status information for the mainframesystems.

• Program changes to system software as requiredby ELHILL and other applications softwaredevelopment.

• Office automation support for personal comput-ers and PROFS.

• Acquisition of an IBM 3090-300J.

Computer Services Branch

The Computer Services Branch provides data pro-cessing services and support for subscribers and users ofthe MEDLARS, DOCLINE, and other databases throughthe use of two mainframe computer systems installed atthe NLM.

These systems are an IBM 3084Q with performancecharacteristics of 24.4 million instructions per second(MIPS) and an IBM 3081K with performance of charac-teristics of 13.5 MIPS. In addition, the Branch maintainsthe IBM 9370 in support of the Library's PROFScalendaring and messaging system. Operational supportis provided on a 24-hour day, 7-day a week basis withcomputer operator coverage for all weekends and gov-ernmental holidays, as most subscribers, both domesticand foreign, continue to use the online system.

The peripheral equipment attached to the IBM3084Q mainframe consists of 220 direct access storagedevices (DASD) with a total online storage capacityofapproximately 260 billion bytes. In addition, sub-scriber support of requested database files is per-formed through the use of 14 magnetic tape andcartridge drives. Also installed are many telecommu-nication units to provide easy and quick access intothe main MEDLARS and DOCLINE databases forworld-wide use.

During the past fiscal year, the Computer Ser-vices Branch created and mailed over 5,500 magnetictapes of MEDLARS and TOXNET database informa-tion and files to both domestic and foreign subscribers.

Annual printed output exceeded 22 millionpages or 989 million lines of local printing on the high-speed, fanfold and cut-sheet laser printers and high-speed impact printers attached to the IBM 3084mainframe system. Another 550,000 pages or 38 millionlines were printed through the use of remote printers.

46

INTERNATIONALPROGRAMS

Richard K. C. Hsieh, Dr. P.H.Director, International Programs

During the past year, NLM continued its interna-tional cooperation with individual countries, interna-tional government organizations such as the WorldHealth Organization (WHO) and the Pan AmericanHealth Organization (PAHO), and international nongov-ernmental organizations such as the International Coun-cil for Scientific and Technical Information (ICSTI). TheSpecial Foreign Currency Program was active in the sup-port of critical reviews and history of medicine projects.Other NLM international activities included training forcolleagues from abroad, the NLM publication exchangeprogram (with 169 institutions in 51 countries, includingthe U.S.), as well as receiving numerous professionalvisitors from abroad.

Collaboration with Individual Countries

A collaborative project was discussed with theAcademy of Scientific Research and Technology, Egypt,to initiate planning for a National Library of Medicine inEgypt. Egypt has an established International MEDLARSCenter, but the library would be an important step to-ward improved health information services in the coun-try. This project will improve the collections in threemajor health libraries.

International MEDLARS Agreements

NLM has MEDLARS agreements with partners in 15foreign countries and with two international organiza-tions (Table 11).

The National Informatics Center (NIC) in NewDelhi, India, has begun to provide online search services,in addition to setting up a tape leasing center, for provid-ing MEDLARS services to health professionals in India.NLM will conduct a test with NIC to determine whether

the search software to be used by NIC can accurately re-trieve citations from MEDLARS databases with searchresults in agreement with those of the NLM.

The National Science and Technology Infor-mation Center (STIC) in Taipei, Taiwan, is the newestInternational MEDLARS Center to provide MEDLARSservices. STIC has successfully demonstrated the useof Grateful Med for access from Taipei. Australia,China, the U.K. and Sweden have also begun to dis-tribute Grateful Med to their MEDLINE users.

NLM has a MEDLARS agreement with the PanAmerican Health Organization (PAHO), anintergovernmental health organization, In 1989, PAHOamended its leasing agreement with NLM to provideonline access to MEDLARS databases from Argentina,Chile, Jamaica, and Costa Rica, hi 1990, NLM continueda collaborative project with PAHO and the University ofChile to improve a gateway system named BLTNIS. Thisnew system demonstrated the capability for health pro-fessionals to conduct MEDLINE searches from Argen-tina, Chile, Costa Rica, Mexico, and Venezuela. A Betatest was conducted from February to August 1991 byseveral participating institutions in these countries. Touse BLTNIS, a MEDLINE search is initiated using Grate-ful Med; the search commands are transmitted to NLMthrough the BLTNET network. The search results ob-tained from the NLM computer are transmitted back tothe originator through BLTNET; and Grateful Med isused again to edit and present search results. The objec-tive of the BITNIS project is to provide NLM MEDLINEto health professionals in all Latin American countrieswhere the high cost of international communication ser-vices now inhibits access.

Unfortunately, since August 2, 1990, NLM hasbeen unable to make contact with the Kuwait Interna-tional MEDLARS Center, but the Center is expected tobecome active in the very near future.

International Programs 47

Table 11International MEDLARS Centers

Tapes Tapes/Software Online NLM

FranceGermanyJapanPAHO (BIREME)*Switzerland*

Australia*ChinaSweden

PAHO*CanadaEgyptFrance*India (Provisional)ItalyKuwaitMexicoSouth AfricaSwitzerland*TaiwanUnited Kingdom

*Combined online/tapes

Collaboration with the World HealthOrganization

NLM and the World Health Organization continuedto cooperate in the publication of the Quarterly Bibliogra-phy of Major Tropical Diseases and the Bibliography of AcuteDiarrhoeal Diseases. NLM prepares camera-ready copyfrom the MEDLINE system, and WHO prints and dis-tributes these to thousands of institutions in the develop-ing countries.

NLM and WHO also continued a collaborativeinterlibrary loan arrangement in which photocopies ofjournal articles are provided to WHO-referred requestorsat a reduced rate. Library resources in developing coun-tries are usually insufficient and the need for biomedicaland health information can be met only by drawing onthe collections of the developed world. Even thoughNLM and WHO continue to provide some photocopiesof journal articles to developing countries, this arrange-ment can only partially meet the demand. Unless otherresources in developed countries can be found, the needfor interlibrary loans to developing countries will con-tinue to grow.

Special Foreign Currency Program

Authorized under Public Law 83-480, as amended,the Library's Special Foreign Currency Program utilizesU.S.-owned local foreign currencies to prepare and pub-lish biomedical scientific publications for the health-sci-ence community. This program, active since 1962, is theoldest of NLM's extramural support activities. Althoughover the years NLM has sponsored collaborative PL-480

projects in seven countries, support is presently availableonly in India.

During FY 1991, 20 projects totaling $345,500(equivalent in foreign currency) were active in India.About 15 percent supported the translation and publica-tion of biomedical monographs and bibliographies bynoted foreign scientists. The remainder funded the trans-lation and publication of major historical monographs.These classics in the history of medicine are selected incollaboration with the American Association for the His-tory of Medicine.

Among the publications received in FY 1991 was atranslation from the German of a classic text in the his-tory of psychiatry: Emil Kraepelin's Psychiatry, A Text-book for Students and Physicians, in two volumes. Editedand with a new introduction by Jacques Quen, M.D., thistranslation of Kraepelin's is based on the sixth (1889) edi-tion, which was the first to contain and compare his con-ceptions of dementia praecox and manic-depressivepsychosis. Kraepelin successfully used the late 19th cen-tury model of scientific study and classification in devel-oping a comprehensive nosologic system incorporatingthe etiology, course, prognosis and outcome in the clini-cal definition of disease entities. The translation will be ofbroad interest to psychiatrists, psychologists, medicalhistorians and all those with an interest in understandingclinical psychiatry.

Also published in FY 1991 was an English transla-tion of the research reports of L.V. Krushinsky (1911-1984) on reasoning capability and other complicatedforms of behavior in animals in the natural habitat. Ed-ited by Edith Tobach and Inge Poletaeva, the mono-graph is entitled, Experimental Studies of ElementaryReasoning: Evolutionary, Physiological and Genetic As-pects of Behavior, and records 50 years' experience withlong-term research in the USSR on brain activity andbehavior. This work is of interest to U.S. scientistsstudying the physiological and genetic aspects of ani-mal behavior. (A list of supported publications re-ceived in FY 1991 is in Appendix 3.)

International Meetings andVisitors

The Library is a member of the International Councilfor Scientific and Technical Information (ICSTI). This or-ganization serves as a meeting ground for informationand abstracting agencies, commercial and governmental,from a number of countries. Common interests includeeconomics of primary and secondary publications,transborder flow of information, electronic publication,standardization and the information needs of developingcountries. At the 1991 general meeting of ICSTI held in Or-leans, France,NLM was represented by the DeputyDirectorand the Assistant Directorfor Planning and Evaluation.

48 Programs and Services, FY1991

The Library continues to attract many foreign visi-tors each year, including medical librarians, health pro-fessionals, and government officials. Many of thesevisitors have responsibility for medical, scientific or tech-nical information in their own countries. Their interest inNLM is more than cursory, and they are officially re-ceived and briefed on relevant aspects of NLM opera-tions and research. In 1990 visitors came from thefollowing countries:

Argentina, Bangladesh, Brazil, Burma, Chile,China, Colombia, Cyprus, Czechoslovakia, Ecuador,Egypt, England, Finland, France, Germany, Guyana,Hungary, Iceland, India, Italy, Ivory Coast, Jamaica,Japan, Latvia, Malaysia, Mauritania, Mexico,Mongolia, New Zealand, Nicaragua, Nigeria, Pakistan,Poland, Romania, Saudi Arabia, South Africa, Spain,Swaziland, Taiwan, Thailand, Tunisia, Turkey, USSR,Venezuela, Yemen, and Yugoslavia.

ADMINISTRATION

Kenneth G. CarneyExecutive Officer

49

Financial Resources

In FY 1991, the Library had a total appropriation of$91,408,000. Table 12 displays the FY 1991 budget au-thority plus reimbursements from other agencies, andthe allocation of these resources by program activity.

Table 12Financial Resourcesand Allocations, FY 1991(In Thousands of Dollars)

Budget Authority:Appropriation, NLM.

Plus: ReimbursementsTotal

Budget Allocation:Extramural ProgramsIntramural Programs

Library OperationsLister Hill National Center forBiomedical Communications

National Center for BiotechnologyInformation

Toxicology InformationResearch Management and Support

$91,40813,638

105,046

25,49172,111

(47,208)

(11,851)

(6,130)(6,922)

7,444

Total $105,046

Personnel

The Library's efforts to recruit and retain the most ef-fective personnel were productive in 1991. The NLM ex-pects to close the fiscal year with 587 full timeequivalents (FTEs), a significant increase over the 550FTEs originally allocated.

Three senior positions in the Office of Computer andCommunications Systems (OCCS) were filled during1991. Aaron Navarro, Ph.D., was selected as Deputy Di-rector for Development. Dr. Navarro also served as Act-ing Director, OCCS, replacing Mr. John Anderson wholeft the NLM to accept a position as Vice President,BIOSIS. Prior to his position at the Library, Dr. Navarrowas a Senior Systems Scientist with the Mitre Corpora-tion. Robert Kicklighter was selected as the Chief of theApplications Services Branch, and George Buckland,Ph.D., was selected as the Chief of the Development Branch.

Three special expert appointments were made atNLM during 1991. Mr. Victor Cid was appointed toserve as Project Leader within OCCS for the implementa-tion and rehosting/migration of the Unix version of theBrrNET-NLM Intercommunciation System gateway andits conversion to INTERNET; Ms. Marjorie Cahn was ap-pointed to spearhead the establishment of the Office ofHealth Services Research Information in the Public Ser-vices Division, Library Operations; and Charles Walker,Ph.D., was appointed to the newly established Office ofHealth Information Programs Development, Office ofthe Director, NLM. Dr. Walker will assist the NLM in co-ordinating and evaluating new program opportunities insupport of NLM's outreach activities.

To ensure NLM's continuing competitive stance inrecruitment, the Director approved the concept of Alter-native Work Schedules (AWS) for NLM employees. TheAWS provides employees with a great deal of flexibilityin determining work schedules, including compressedwork weeks, flexitime, and the use of credit hours. Vari-ous components of the NLM are now implementingsome form of AWS in their organizations.

Awards

NLM Director, Donald A.B.Lindberg, M.D. was therecipient of the highest award that can be bestowed onNTH managers by the President: the Meritorious Presi-dential Rank Award. Dr. Lindberg was cited for "insti-tuting at the National Library of Medicine sophisticatedand successful information programs and services re-sponsive to the needs of the Nation's health professionalsin dealing with biotechnology, AIDS, and other contem-porary issues in medicine."

Charles Goldstein, Information Technology Branch,Lister Hill National Center for Biomedical Communica-tions, received the Medical Library Association's FrankB. Rogers Information Advancement Award. Mr.Goldstein received the award in recognition of his pio-neering effort on the Online Mendelian Inheritance inMan project.

In 1991, the NLM Director's Award was presentedto two employees of Library Operations: Peri L.Schuyler, in recognition of outstanding work to in-crease the utility of NLM's Medical Subject Headings,and to support the development of the Unified Medi-cal Language Systems; and Nelson C. Johnson, in rec-

50 Programs and Services, FY1991

ognition of his exceptional skill in supervising theinterlibrary loan service at the NLM.

Two other NLM employees received the NIHDirector's Award in 1991: Sheldon Kotzin, Library Op-erations, for outstanding contributions to the rapid andeffective dissemination of the results of biomedical re-search; and Dr. Jeanne L. Brand, Extramural Programs,for outstanding leadership in promoting scholarship inthe history of medicine through the grant programs ofthe NLM.

The Public Health Service's Commissioned Corps'Outstanding Service Award was presented to David J.

Lipman, M.D., National Center for Biotechnology Infor-mation (NCBI), for creative leadership as NCBI Directorand for establishing the organization as a national focalpoint in the field of biomolecular computing.

The NLM's Frank B. Rogers Award recognizes anemployee who has made a significant contribution to theLibrary's fundamental operational programs and ser-vices. In 1991, Carolyn Tilley, Library Operations, re-ceived the award in recognition of her work to improveNLM's MEDLARS products and services, and for her ef-forts to extend their availability to librarians and healthprofessionals throughout the Nation.

Table 13Staff, FY1991Full-TimeEquivalents

Program

Office of the Director . .Office of Public Information . .Office of Administration . . .Office of Computer and CommunicationsSystems

Extramural Programs . . . .Lister Hill National Center

for Biomedical CommunicationsNational Center for Biotechnology

InformationSpecialized Information ServicesLibrary OperationsTotal

Full-TimePermanent

195

45

6114

66

1035

224479

Other

124

33

11

124

3171

Total FTEs 550

Equal Employment Opportunity

The most difficult resource to manage is "people."By the year 2000 it is projected that minorities andwomen will constitute the majority of the workforce.Does NLM have the vision to prepare for the future bydeveloping the strategies needed to manage a culturallydiverse workforce? Will NLM take the necessary actionsto create an environment that fully taps the potential ofall individuals?

There will be great benefits if NLM successfullymanages its diverse workforce. Empowered people willaccomplish the Library's objectives in a harmonious,nonadversarial environment. NLM managers will hire,train, and promote individuals exclusively because oftheir qualifications, skills, and abilities. There will be lessconfrontation over affirmative action and fewer time-consuming, costly discrimination complaints.

NLM's EEO Office has brought attention to theLibrary's diverse workforce through a series of specialemphasis programs that have increased our awarenessof the contributions that minorities and women havemade to society. Among the programs in FY1991:

In observance of Martin Luther King's Birthday,NLM presented a photo exhibit on Dr. King's quest forequality in America. The exhibit was borrowed from theSchomburg Center for Research in Black Culture. Mr.Arthur A. Schomburg was a foremost curator of AfricanAmerican culture. The exhibit also included materials incelebration of African American History Month. Thatpart of the exhibit was entitled "Blacks and the UnitedStates Constitution." The Honorable Major Owens, U.S.House of Representatives, was the keynote speaker at aspecial NLM observance of African American History

Administration 51

Month. The EEO Officer extended an invitation to allpublic schools with the greater Washington, D.C. area toview the Schomburg exhibit.

In observance of Women's History Month (March1991), the EEO Officer extended an invitation to the Hon-orable Connie Morella (Republican representative fromMaryland in the U.S. House of Representatives) to be aguest speaker. Congresswomen Morella's remarks wereon the theme, "Nurturing Tradition, Fostering Change."

Another event focusing on cultural diversity,sponsored by the History of Medicine Division, was alecture by Robert C. Davis, Ph.D, Professor of Sociol-ogy at Case Western Reserve University in Cleveland.His lecture was titled "Another Kind of Glory: BlackDoctors in the Civil War."

There have been a number of significant EEO-re-lated actions in FY 1991: (1) the Library's Equal Em-ployment Opportunity Advisory Committeedistributed a pamphlet explaining its functions; (2) ba-sic EEO training is being planned for supervisors to in-sure that NLM is in compliance with the latest EEOlaws; (3) the EEO Officer has taken the first steps forNLM to participate in NIH's adopt-a-school program;(4) a series of talks by the NLM EEO Officer have been

delivered at public schools regarding career planning("The year 2000, Will You be Ready?"); (5) as part ofthe adopt-a-school program NLM is advising the D.C.public schools that are being converted into healthacademies about computerized access to health infor-mation; and (6) the NLM EEO Office has exhibited atthe National Association for Equal Opportunity inHigher Education and the Congressional Black CaucusFoundation's 21st Annual Legislative Weekend.

NLM is also reaching out to the Hispanic and Na-tive American communities in an effort to inform themof employment opportunities at NLM. Organizationssuch as the National Congress of American Indians arecritical in the Library's efforts to expand training andcareer opportunities. In addition, the NLM EEO Officehas addressed the concerns of NLM staff memberswith disabilities.

Over the last several decades, the Library hasmade progress in its commitment to Equal Employ-ment Opportunity. This momentum must not be lostas we move toward Workforce 2000. The Library mustadapt to the changing composition of the workforce toensure that hiring, advancement, and training oppor-tunities are afforded equitably to all.

David NashEEO Officer

52

APPENDIX 1:ACRONYMS, ABBREVIATIONS, ANDINITIALISMS

AAOS

AATADAAHAAHCPR

AI/COAG

AI/RHEUM

AIDSDRUGSAIDSLINEAIDSTRIALSAKATANNANSWER

APDB

ARCARLASBASNATSDR

AVLINE

BCMSBDIPProgramBIBICC

BIOETHICSLINEBffiEME

BITNETBITNIS

BLASTBOSC

CAFECANCERLTTCASCASE

American Academy of OrthopaedicSurgeonsArt and Architecture ThesaurusAmericans with Disabilities ActAmerican Hospital AssociationAgency for Health Care Policy and Re-searchArtificial intelligence hemostasis con-sultant systemArtificial intelligence rheumatologyconsultant systemAIDS drugsAIDS information onLINEAIDS Clinical TRIALSAudio Knowledge Acquisition ToolArtificial neural networkATSDR/NLM's Workstation for Emer-gency ResponseAudiovisual Program DevelopmentBranchAnnual Review of CarcinogensAssociation of Research LibrariesApplications Services BranchAbstract Syntax NotationAgency for Toxic Substances and Dis-ease RegistryAudioVisuals onLINE

Bioethic Citation Maintenance SystemBiomedical Digital Image ProcessingBiotechnology InformaticsBiomedical Information Communica-tions CenterBIOETHICSonLINEBiblioteca Regional de MedicinaNLM's International MEDLARSCenter in Brazil

Because It's Time NetworkBITNET NLM Intercommunication Sys-temBasic Local Alignment Search ToolBoard of Scientific Counselors

Cataloging Front-EndCANCER LITeratureChemical Abstracts ServiceComputer Assisted SoftwareEngineering

CATLINE CATalogonLINECBM Current Bibliographies in MedicineCC Chemline's Classification CodeCCDS Computer-based Curriculum Delivery

SystemsCCEHRP Committee to Coordinate Environmen-

tal Health and Related ProgramsCCRIS Chemical Carcinogenesis Research In-

formation SystemCD-ROM Compact Disk-Read Only MemoryCENDI Commerce, Energy, NASA, NLM and

Defense InformationCHEMID Chemical Identification FileCHEMLEARN Microcomputer-based training for

CHEMLINECHEMLINE CHEMical Dictionary OnLINECLINPROT CLINical cancer PROTocolsCOACH Expert searcher system prototype. To

help improve retrieval fromMEDLINE with Grateful Med

CODATA Committee on Data for Science andTechnology

CPT The AMA's Current Procedural Termi-nology

CRISP Computer Retrieval of Information onScientific Projects

CROSSFILE Permits users of TOXNET to search forand/or display) data frommultiple files simultaneouslyCSB

(Computer Science Branch)CTX Criteria Table Expert Systems

DART Developmental and ReproductiveToxi-cology

DASD Direct access storage devicesDBIR Directory of Biotechnology Information

ResourcesDBMS Database Management SystemDENTALPROJ Dental Projects databaseDHHS Department of Health and Human Ser-

vicesDIRLINE Directory of Information Resources

OnlineDOCLINE DOCumentsonLINEDOCUSER DOCument delivery USERDOE Department of EnergyDRAW Direct Read After Write

Acronyms, Abbreviations, and Initialisms 53

DRW Document Request WorkstationDSM-HIR American Psychiatric Association's Di-

agnostic and StatisticalManual of Mental Disorders

DSRT Document Storage, Retrieval, andTransmission

DXP Digital X-ray Prototype

E.T. Net Educational Technology NetworkECRI Emergency Care Research InstituteEDDS Electronic Document Delivery SystemEDSR Electronic Document Storage and Re-

trievalEEO Equal Employment OpportunityEINECS European Inventory of Commercial

Chemical SubstancesELHTLL MEDLARS software named after Sena-

tor Lister HillEMICBACK Environmental Mutagen Information

Center BackfileEPA Environmental Protection AgencyER Entity RelationshipETICBACK Environmental Teratology Information

Center Backfile

FASEB Federation of American Socities for Ex-perimental Biology

FCCSET Federal Coordinating Committee forScience, Engineering andTechnology

FEDRIP Federal Research-In-ProgressFIRST First Independent Research Support

and TransitionFLICC Federal Library and Information Center

CommitteeFTE Full-time equivalents

GenBank National, NIH-supported DNA se-quence database

Genlnfo Databank providing a core of biologicalinformation about sequences,including the sequence itself, that accu-

rately reflects the journalliterature

GM Grateful MedGRAS list Generally Recognized as Safe List

HAP Hazardous Air Pollutants ListHBCU's Historically Black Colleges and Univer-

sitiesHCTA Health Care Technology AssessmentHEALTH HEALTHplanning & administration

databaseHISTLINE HISTory of medicine onLINE

HOPE

HPCC

HSDB

IAIMS

lARClist

ICD-9-CM

ICSTI

IEEE

ILARILLDVIPAG

INFORM

INTELSAT

INTROMEDINTROTOX

INVESTIGATOR

IOMIRISIRWIRxISWITB

JHU

KB

LANLCLCSHLEXTOOL

LHNCBC

LISLOLSTRC

Health Omnibus Programs ExtensionActHigh Performance Computing andCommunicationsHazardous Substances Data Bank

Integrated Academic Information Man-agement SystemInternational Agency for Research onCancer ListInternational Classification of Diseases,9th Edition, ClinicalModification

International Council for Scientific andTechnical InformationInstitute for Electrical and ElectronicsEngineersInstitute of Laboratory Animal ResearchInterlibrary LoanInternational MEDLARS Policy Advi-sory GroupUsed to obtain online NEWSand sys-tems informationInternational Telecommunications Sat-ellite OrganizationA training/practice databaseA practice subset of HSDB for users tobecome accustomed to TOXNETsearching

A research program for knowledge ac-quisition planningInstitute of MedicineIntegrated Risk InformationSystemImage Retrieval WorkstationInformation Retrieval ExperimentImage Server WorkstationInformation Technology Branch

Johns Hopkins University

Knowledge Base

Local Area NetworkLibrary of CongressLibrary of Congress Subject HeadingsAn interactive lexicon building tool foradding entries to theSPECIALIST lexicon)

Lister Hill National Center for Biomedi-cal CommunicationsLibrary Information SciencesLibrary OperationsLiterature Selection Technical ReviewCommittee

54 Programs and Services, FY1991

MACAW Multiple Alignment Construction and NTISAnalysis Workbench NUCARE

MARC Machine-Readable CatalogMedlndEx Medical Indexing Expert OCCSMEDLARS MEDical Literature Analysis and Re-

trieval System OCRMEDLINE MEDlars onLINE OHSUMEDSTATS Medical Statistics Expert System OMIMMEDTUTOR Microcomputer-based tutorial for

MEDLINE ORAUMeSH Medical Subject Headings ORNLMH MeSH Heading ORWMI MedicalInformaticsMicro-CSIN Chemical Substances Information Net- PA

workMIIS Modified Interpretative Information PADS

System PAFA listMDVI Mendelian Inheritance in ManMisHTN Mississippi Health Sciences Information PAHO

Network PAMMRAB Machine-Readable Archives in Bio- PDQ

medicine PIRMRI Magnetic resonance imaging POPLINEMUMPS Massachusetts Utility Multi-Program-

ming System RACEMX CHEMLINE's Name of Mixture field RDBMS

NAC National Audiovisual Center REFLEMENARIC National Rehabilitation Information RelTox

Center RMLNCBI National Center for Biotechnology In- RQList

formationNCHS National Center for Health Statistics RTECSNEMA National Electrical Manufacturers Asso-

ciation SAASNHANES National Health and Nutrition Exami- SAIL

nation SurveysNIAMS National Institute of Arthritis, Musculo- SDILEME

skeletal and Skin DiseasesNIC National Informatics Center SERHOLDNICHD National Institute of Child Health and SIC

Human DevelopmentNIEHS National Institute of Environmental SIDE

Health SciencesMH National Institutes of Health SISNIK NLM InformationKiosk SNOMEDNIOSH National Institute for Occupational

Safety and HealthNISO National Information Standards Orga- SPECIALIST

nizationNLQ Natural Language Query SPIENLS Natural Language SystemsNM CHEMLINE's Name of Substance field STICNN/LM National Network of Librariesof

Medicine SUPERLIST

National Technical Information ServiceNUrsing CAre REsearch

Office of Computer and Communica-tions SystemsOptical character recognitionOregon Health Sciences UniversityOnline version, Mendelian Inheritancein ManOak Ridge Associated UniversitiesOak Ridge National LaboratoryOnline Reference Works

CHEMLINE's MeSH PharmacologicalAction FieldPacket Assembler-DisassemblersPriority Based Assessment of Food Ad-ditives ListPan American Health OrganizationPrincipals of Ambulatory MedicinePhysician Data QueryProtein IdentificationResourcePOPulation information onLINE

Resource Access Control FacilityRelational Database Management Sys-temSubset of MEDLINE for NLM patronsRelational Toxicology ProjectRegional Medical LibraryHazardous Substances ReportableQuantities ListRegistry of Toxic Effects of ChemicalSubstancesSelection and Acquisition SubsystemSystem for Automated InterlibraryLoanSelective Dissemination of InformationonLINESerial HoldingsSubcommittee on Information Coordi-nationSulzberger Institute of DermatologicEducationSpecialized Information ServicesThe College of American Pathologists'Systematized NomenclatureofMedicine

Experimental system for parsing, ana-lyzing, and accessing biomedicaltextSociety of Photo-optical Instrumenta-tion EngineersScience and Technology InformationCenterChemicals having regulatory or health

Acronyms, Abbreviations, and Initialisms 55

importance found on one or more TRIof 16 Federal and State government lists TSCA

TESS Technical Services System UMLSTIP Toxicology Information Program URSPTLC The Learning Center for Interactive

Technology USANTOXLEARN Microcomputer-based training for

TOXLINE WHOTOXLINE TOXicology Information OnLINE WORMTOXLIT TOXicology LITerature from special

sources

Toxic Chemical Release InventoryToxic Substances Control Act

Unified Medical Language SystemUndergraduate Research Study Pro-gramUnited States Adopted Names

World Health OrganizationWrite Once Read Many—Disc

56 Programs and Services, FY1991

APPENDIX 2: STAFF BIBLIOGRAPHY

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Major F, Lapalme G, Cedergren R. Domain generat-

58 Programs and Services, FY1991

ing functions for solving constraint satisfaction prob-lems. J Func Programming 1991;l:213-27.

Major F, Turcotte M, Gautheret D, Lapalme G,Pillion E, Cedergren R. The combination of symbolic andnumerical computation for three dimensional modelingof RNA. Science 1991;253:1255-60.

Marchuk DA, Saulino AM, Tavakkol R,Swaroop M, Wallace MR, Andersen LB, Mitchell AL,Gutmann DH, Boguski MS, Collins FS. cDNA cloning ofthe type 1 neurofibromatosis gene: complete sequence ofthe NF1 gene product. Genomics 11:931-40.

Masys DR. Of codes and keywords: standardsfor biomedical nomenclature. Acad Med 1990;65:627-9.

Masys DR. The National Research and Educa-tion Network. Acad Med 1991;66:397-8.

McCray AT, Hole WT. The scope and structureof the first version of the UMLS semantic network. In:Miller RA, ed. Proceedings of the 14th annual sympo-sium on computer applications in medical care. LosAlamitos CA: IEEE Computer Society, 1990; 126-30.

Mehnert RB. National Library of Medicine.Bowker Annual 1991;36:139-41.

Miller N, Backus JEB. Menu systems for CD-ROMs at the National Library of Medicine — Using di-rect net and direct access. CD-ROM Professional1990;4(5):48-51.

Miller W, Barr J, Rudd KE. Improved algorithmsfor searching restriction maps. CABIOS 1991;7:447-56.

Moens HJB, vanderKorst JK, Kingsland LC HI.Evaluatie van AI/RHEUM: de gegevens die deartsgebruiker nodig heeft. Proc Medisch InformaticaCongres 1990. Noordwykerhout, The Netherlands, 1990.

Parascandola J. The development of the Draizetest for eye toxicity. Pharm Hist 1991;33;lll-7.

Parascandola J. The introduction of antibiotics intherapeutics. In: Kawakita Y, Sakai S, Otsuka, Y, eds.History of therapy: proceedings of the 10thinternationalsymposium on the comparative history of medicine -East and West. Tokyo: Ishiyaku EuroAmerica, 1990;261-81.

Peitsch MC, Boguski MS. The first lipocalin withenzymatic activity. Trends Blochem Sci 1991;16:363.

Prochnicka-Chalfour A, Casanova J-L,Avrameas S, Claverie J-M, Kourilsky P. Biased aminoacid distributions in regions of the T cell receptors andMHC molecules potentially involved in their association.Int Immunol 1991̂ :853-64.

Ram A, Hunter L. A goal-based approach to in-telligent information retrieval. In: Proceedings of the 8thinternational workshop on machine learning. Chicago IL:Morgan Kaufmann, 1991;265-9.

Richards DT. By your selection criteria are yeknown. Libr Acquis Theory Pract 1991;15(2):279-85.

Richards DT. Monograph collection in scientific

libraries. J Libr Adm 1991;15(2):279-85.Rudd K, Miller W, Werner C, Ostell J,

Tolstoshev C, Satterfield SG. Mapping sequenced E. coligenes by computer: software, strategies and examples.Nucl Acids Res 1991;19:637-47.

Schule GD, Altschul SF, Lipman DJ. A work-bench for multiple alignment construction and analysis.Proteins Struct Func Genet 1991;9:180-90.

Sette A, Vitiello A, Farness P, Furze J, Sidney J,Claverie J-M, Grey HM, Chestnut R. Random associationbetween the peptide repertoire of A2.1 Class 1 and sev-eral different DR Class II molecules. J Immunol1991;148:1234-5.

Sharer LR, Michaels J, Murphey-Corb M, Hu FS,Kuebler DJ, Martin LN, Baskin GB. Serial pathogenesisstudy of SIV brain infection. J Med Primatol1991;20(4):211-17.

Siegel E. Evaluating the impact of GRATEFULMED using the Critical Incident Technique. In: AndersonJE, ed. ICSTI symposium proceedings. Paris: Interna-tional Council for Scientific and Technical Information,1991;62-71.

Simopoulos AP, Kifer RR, Wykes AA. w3 fattyacids: research advances and support in the field sinceJune 1985(worldwide). World Rev Nutr Diet 1991;66:51-77.

Smith K. New needs, new tools, new products.In: Anderson JE, ed. ICSTI symposium proceedings.Paris: International Council for Scientific and TechnicalInformation, 1991;89-92.

Sperzel D, Erlbaum M, Fuller L, Sherertz D,Olson N, Schuyler P, Hole W, Savage A, Passarelli P,Turtle M. Editing the UMLS Metathesaurus: review andenhancement of a computed knowledge source. In:Miller RA, ed. Proceedings of the fourteenth annualsymposium on computer applications in medical care.Los Alamitos CA: IEEE Computer Society, 1990;136-40.

Sperzel D, Erlbaum M, Fuller L, Sherertz D,Olson N, Schuyler P, Hole W, Savage A, Passarelli P,Turtle M. Editing the UMLS Metathesaurus: review andenhancement of a computer knowledge source. In: MillerRA, ed. Proceedings of the 14th annual symposium oncomputer applications in medical care. Los Alamitos CA:IEEE Computer Society, 1990;136-40.

States DJ, Botstein D. Molecular sequence dataaccuracy and the analysis of protein coding regions. ProcNatl Acad Sci USA 1991;88:5518-22.

States DJ, Boguski MS. Similarity and homology.In: Gribskov M, Devereaux J, eds. Sequence analysisprimer. Salt Lake City: W H Freeman, 1991;89-157.

Tang JL, Liu YN, Barber CE, Dow JM, WoottonJC, Daniels MJ. Genetic and molecular analysis of a clus-ter of rpf genes involved in positive regulation of synthe-sis of extracellular enzymes and polysaccharide in

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Thoma GR. Electronic imaging for documentpreservation: system performance. In: Roth JP, ed. Casestudies of optical storage applications. Westport CT:Meckler, 1990;65-72.

Thoma GR. Technical challenges in the produc-tion of electronic image databases. In: Roth JP, ed. OB[Optical Information Systems] '90 conference proceed-ings. Westport CT:Meckler, 1990;91-104.

Thoma GR, Cass SI, Kendrick C. Interlibraryloans via facsimile: performance and cost analysis.Bethesda, MD: National Library of Medicine, 1990;ListerHill Center Technical Report;102.

Thoma GR, Walker FL Hauser SE. Documentpreservation by electronic imaging. In: Roth JP, ed. Con-verting information for WORM optical storage, a casestudy approach. Westport CT:Meckler, 1990;92-131.

Thoma GR, Walker FL. A prototype electronicdocument delivery system. Proc ASIS 1990;27:29-35.

Tilley CB. At your service: MEDLARS Q & A.Databases 1990;13(5):103-4.

Toone WM, Rudd KE, Friesen SJ. deaD, a newEscherichia coli gene encoding a presumed ATP-depen-dent RNA helicase, can suppress a mutation in rpsB, thegene encoding ribosomal protein S2. J Bacteriol1991;173:3291-3302.

Walker FL, Thoma GR. Access techniques fordocument image databases. Library Trends: Intellectual

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Wigler M. Sari, a gene from Schizosaccharomycespombe encodes a GAP-Iike protein that regulates rasl.CeU Regulation 19912:453-65.

Weiss PJ. Analysis of cataloging copy: LibraryofCongress vs. selected RLG members. Libr Resour TechServ 1991;35(l):65-75.

Weiss PJ. MARC notes. LITA [Library & Infor-mation Technology Association] News 1991;12(l):15-7.

Weiss PJ. MARC notes. LITA [Library & Infor-mation Technology Association] News 1991;12(3):12-3.

Whittaker BL, ed. Collection development atNLM. Developments 1991;3(2):3-6.

Woodsmall RM, Siegel ER. Reconciling designphilosophy and user expectations. In: Siegel MA, ed. De-sign and evaluation of computer/human interfaces: is-sues for librarians and information scientists.Urbana-Champaign: University of Illinois, 1991;163-82.

Wootton JC, Nicolson RE, Cock JM, Walters DE,Burke J, Doyle W, Bray RC. Enzymes depending on thepterin molybdenum cofactor; sequence families, spectro-scopic properties of molybdenum and possible cofactor-binding domains. Biochim Biophys Acta1991;1057:157-85.

Yamamoto WS, Dixon WJ, Ledley RS, WaxmanBD, Schoohnan HM, Stead EA Jr. Planting the seeds—apanel. In Blum BI, Duncan K, eds. A history of medicalinformatics. New York: ACM press, 1990;48-73.

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APPENDIX 3: FY1991 EXTRAMURAL PROGRAMS-SUPPORTED PUBLICATIONS

Abendroth TW, Greenes RA. Computer presentationof clinical algorithms. MD Comput; 1989; 6(5): 295-9.(R01LM 04572).

Aghassi DS. Evaluating case-based reasoning forheart failure diagnosis. Cambridge, MA: MassachusettsInstitute of Technology; 1990; MIT/LCS/TR-478; 144p.(R01LM 04493).

Altschul SF, Gish W, Miller W, Myers EW, LipmanDJ. Basic local alignment search tool. J Mol Biol; 1990;215:403-10 (R01 LM 04960 and R01 LM 05110).

Aronow DB, Payne TH, Pincetl SP. Postdoctoraltraining in medical informatics: a survey of National Li-brary of Medicine-supported fellows. Med Decis Mak-ing; 1991 Jan-Mar; 11(1): 29-32. (T15 LM 07037).

Bankowitz RA, McNeil MA, Challinor SM, ParkerRC, Kapoor WN, Miller RA. A computer-assisted medi-cal diagnostic consultation service; implementation andprospective evaluation of a prototype. Ann Intern Med;1989 May 15; 110(10): 824-32. (K04 LM 00084).

Bergeron BP, Rouse RL. Cognitive aspects in themodeling and simulation of complex biological systems.In: lyengar SS, ed. Computer Modeling of Complex Bio-logical Systems, Vol H;Forthcoming. (R29 LM 04715).

Bergeron BP, Morse AN, Greenes RA. A genericneural network-based tutorial supervisor for computeraided instruction. In: Miller RA, ed. SCAMC Proceed-ings. 14th Annual Symposium on Computer Applica-tions in Medical Care: Standards in Medical Informatics;1990 Nov 4-7; Washington, DC. Los Alamitos (CA): IEEEComputer Society Press; [1990]: 435-9. (R29 LM04715).

Bergeron BP, McClure RC, Dichter MS, Rouse RL.Repurposing: a fundamental factor in the developmentof multimedia applications. Collegiate Microcomputer;Forthcoming. (R29 LM04715).

Bergeron BP.Using a spreadsheet metaphor to visu-alize neural network behavior. Collegiate Microcom-puter; 1990 May; 8(2):81-92. (R29 LM04715).

Bergeron BP, Fallen JT, Morse AN, Rouse RL. Usinga gaming approach to maximize student participation incomputer-based education. Collegiate Microcomputer;1990 Nov; 8(4): 293-300. (R29 LM 04715).

Berman L, Miller RA. Problem area formation as anelement of computer aided diagnosis: a comparison oftwo strategies within Quick Medical Reference (QMR).Methods Info Med; 1991; 30(90-5. (K04 LM 00084)).

Blumenfeld B. A Connecticut approach to the recog-nition of trends in time ordered medical parameters. In:

Kingsland LC, ed. Proceedings of the Thirteenth AnnualSymposium on Computer Applications in Medical Care;Nov 5-8,1989; Wash., DC: IEEE Computer Society Press;1989:288-94. (T15 LM 07059).

Bouhaddou O, Warner HR, Yu H, Lincoln MJ. Theknowledge capabilities of the vocabulary component of amedical expert system. In: Miller RA, ed. SCAMC pro-ceedings. 14th Annual Symposium on Computer Appli-cations in Medical Care: Standards in Medical Care; 1990Nov 4-7; Washington, DC. Los Alamitos (CA): IEEEComputer Society Press; [1990]: 660-5. (R29 LM 5260).

Broering NC, Hylton JS, Guttmann R, Pagan D.BioSYNTHESIS: access to a knowledge network of healthsciences databases. J Med Syst; 1991; 15(2): 139-53. (G08LM 04392).

Broering, NC, Bagdoyan H, Hylton JS, Rosansky J. Ademonstration of BioSYNTHESIS, a system integrationtool for multiple databases. In: Miller, RA, ed. SCAMCproceedings. 14th Annual Symposium on Computer Ap-plications in Medical Care: Standards in MedicalInformatics; 1990 Nov 4-7; Washington, DC. LosAlamitos (CA): IEEE Computer Society Press; [1990]:961-4. (G08LM 04392).

Broering NC. LIS: an electronic library for the future.In: Genaway DC, comp. IOLS (Integrated Online LibrarySystems) '91 proceedings.; 1991 May 8-9; New York.Medford, NJ: Learned Information: 1-9. (G08LM 04392).

Broering NC. The MAClinical workstation project atGeorgetown University. Bull Med Libr Assoc; Jul 1991;79(3): 276-87. (G08LM 04392).

Broering NC. The many phases of IAIMS: a biotech-nology and biomedical knowledge network atGeorgetown University. In: Health information: new di-rections. Joint Conference of the Health Libraries Sec-tions of the Australian Library and InformationAssociation and New Zealand Library Association. Pro-ceedings; 1989 Nov 12-6; Auckman, New Zealand: 16-29.(G08LM 04392).

Bylander T, Johnson TR. Structured matching: atask-specific technique for making decisions. KnowledgeAcquisition; 1991; 3:1-20. (R01 LM 04298).

Chambers LW, Haynes RB, Pickering R, McKibbonA, Walker-Dilks CJ, Panton L, Goldblatt E. New ap-proaches to addressing information needs in local publichealth agencies. Can J Public Health; Mar/Apr 1991; 82:109-14. (R01 LM 04696).

Christensen C, Heckerling PS, Mackesy ME,

FY1991 Extramural Programs-Supported Publications 61

Bernstein LM, Elstein AS. Framing bias among expertand novice physicians. Acad Med; 1991 Sep (Suppl);66(9): S76-8. (R01 LM 04583).

Cimino C, Bamett GO, Lowe H, Blewett DR,Hassan LJ,Piggins JL. The interactive query workstation:an environment for helping students formulate queriesand for testing methods of query processing. In: Proceed-ings of First Annual Educational and Research Confer-ence of American Medical Informatics Association; 1990Jun; Snowbird, UT: 47. (T15LM 07037).

Cimino C, Barnett GO. Standardizing access tocomputer-based medical resources. In: Miller RA, ed.SCAMC proceedings. 14th Annual Symposium on Com-puter Applications in Medical Care; 1990 Nov 4-7;Wash-ington, DC. Los Alamitos (CA): IEEE Computer SocietyPress; [1990]: 33-7. (T15LM 07037).

Cimino JJ, Barnett GO. Automated translationbetween medical terminologies using semantic defini-tions. MD Comput; 1990; 7(2):104-9. (T15LM 07037).

Cimino JJ, Elkin PL, Barnett GO. The medicalconcept space as a model for hypertext. In: Proceedingsof First Annual Educational and Research Conference ofAmerican Medical Informatics Association; 1990 Jun;Snowbird, UT: 41. (T15 LM 07037).

Clyman JI, Miller PL. An environment for build-ing and testing advice-giving systems in medicine. In:Miller RA, ed. SCAMC proceedings. 14th Annual Sym-posium on Computer Applications in Medical Care:Standards in Medical Informatics; 1990 Nov 4-7; Wash-ington, DC. Los Alamitos (CA): IEEE Computer SocietyPress; [1990]: 584-8. (T15 LM07056).

Conn AI, Rosenbaum S, Factor M, Miller PL.DYNASCENE: an approach to computer-based intelli-gent cardiovascular monitoring using sequential clinical"scenes." Methods Inf Med; 1990; 29: 122-131. (T15 LM07056).

Cohn AI, Miller PL, Fisher PR, Mutalik PG,Swett HA. Knowledge-based radiologic image retrievalusing axes of clinical relevance. Comp Biomed Res; 1990;23:199-221. (T15 LM 07056).

Cohn AI. Summary of: The Tenth Annual Con-ference on Computers in Anesthesia; New Orleans, LA,U.S.A. October 18-21, 1989. Int J Clin Monit Comput;1990; 7:41-4. (T15 LM07056).

Daniels N. Book review: AIDS: the burdens ofhistory. Ed. by E. Fee and DM Fox (Berkeley, Univ. ofCalif. Press, 1988). J of Interdisciplinary History; 1990Spring; 20(4): 706-8. (R01 LM 05005).

Daniels N. Duty to treat or right to refuse?Hastings Cent Rep; 1991 Mar-Apr; 21(2): 36-46. (R01 LM05005).

Daniels N. Insurability and the HIV epidemic:ethical issues in underwriting. Milbank Q; 1990; 68(4):497-525. (R01 LM 05005).

Daniels N. Is the Oregon rationing plan fair?JAMA; 1991 May 1; 265(17):2232-5. (R01LM05005).

Davis DT, Hwang JN, Lee JSJ. Improved net-work inversion technique for query learning applicationto automated cytology screening. In: Bankman IN and JETsitiik. Computer-based medical systems; proceedings ofthe Fourth Annual IEEE Symposium; May 12-14, 1991;Baltimore, MD. Los Alamitos, CA: IEEE Computer Soci-ety Press; 1991:313-20. (F37 LM 00006).

Deibel SRA, Greenes RA, Snydr-Michal JT.DeSyGNER: a building block architecture fostering inde-pendent cooperative development of multimedia knowl-edge management applications. In: Miller RA, ed.SCAMC proceedings. 14th Annual Symposium on Com-puter Applications in Medical Care: Standards in Medi-cal Informatics; 1990 Nov 4-7; Washington, DC. LosAlamitos (CA): IEEE Computer Society Press; [1990]:445-9. (T15 LM 07037and R01 LM 04572).

Dichter MS, Greenes RA, Bergeron BP. The clini-cal problem-solving exercise: an orthogonal approach toorganizing medical knowledge. In: Miller RA, ed.SCAMC proceedings. 14th Annual Symposium on Com-puter Applications in Medical Care: Standards in Medi-cal Informatics; 1990 Nov 4-7; Washington, DC. LosAlamitos (CA): IEEE Computer Society Press; [1990]:473-7. (R29LM 04715).

Dichter MS, Greenes RA, Bergeron BP. Use ofmultimedia clinical problem-solving exercises to access amedical knowledge base. In: Miller RA, ed. SCAMC pro-ceedings. 14th Annual Symposium on Computer Appli-cations in Medical Care; Standards in MedicalInformatics; 1990 Nov 4-7; Washington, DC. LosAlamitos (CA): IEEE Computer Society Press; [1990]:1026-7. (R29 LM 04715 and T15 LM07037).

Doyle J, Wellman MP. Impediments to universalpreference-based default theories. Cambridge, MA: Mas-sachusetts Institute of Technology; 1989; MIT/LCS/TM-416; 29p. (R01LM 04493).

Doyle J, Wellman MP. Impediments to universalpreference-based default theories. Artif Intell; 1991; 49:97-128. (R01LM04493).

Doyle J, Sacks EP. Markov analysis of qualitativedynamics. Comput Intell; 1991; 7:1-10. (R01 LM 04493).

Doyle J. Rational control of reasoning in artificialintelligence. In: Fuhrmann A, Morreau M, eds. The logicof theory change. Berlin: Springer-Verlag; 1990: 19-48.(R01 LM 04493). (LectureNotes in Artificial Intelligence).

Doyle J. Rational belief revision (preliminary re-port). In: Fikes RE, Sandewall E, eds. Proceedings of theSecond Conference on Principles of Knowledge Repre-sentation and Reasoning; 1991; San Mateo, CA: MorganKaufmann; 1991:163-74. (R01 LM 04493).

Doyle J. Rationality and its role in reasoning (ex-tended abstract). In: Proceedings of the Eighth National

62 Programs and Services, FY1991

Conference on Artificial Intelligence; Menlo Park, CA;1990:1093-1100. (R01 LM 04493).

Doyle J. Reasoning, representation, and rationalself-government. In: Ras, ZW, ed. Methodologies for in-telligent systems, 4. Amsterdam, North-Holland:Elsevier; 1989:367-80. (R01 LM 04493).

Doyle J, Sacks EP. Stochastic analysis of qualita-tive dynamics. Cambridge, MA: Massachusetts Instituteof Technology; 1989; MTT/LCS/TM-418; 24p. (R01LM04493).

Doyle T, Patil RS. Two theses of knowledge rep-resentation: language restrictions, taxonomic classifica-tion, and the utility of representation services. Artif Intell;1991; 48:261-97. (R01 LM 04493).

Elkin PL, Barnett GO, Famiglietti KT, Kim RJ.Closing the loop on diagnostic decision support systems.In: Miller RA, ed. SCAMC proceedings. 14th AnnualSymposium on Computer Applications in Medical Care:Standards in Medical Informatics; 1990 Nov 4-7; Wash-ington, DC. Los Alamitos (CA): IEEE Computer SocietyPress; [1990]: 589-93. (T15LM07037).

Elkin PL, Cimino JJ, Barnett GO. The hypertextmedical workstation. In: Proceedings of First AnnualEducational and Research Conference of AmericanMedical Informatics Association; 1990 Tun; Snowbird,UT: 33. 015 LM 07037).

Estey G, Oliver DE, Chueh HC, Levinson JR,Zielstorff RD, Barnett GO. Problem-based knowledge ac-cess: useful design principles for clinical hypertexts. In:Miller RA, ed. SCAMC proceedings. 14th Annual Sym-posium on Computer Applications in Medical Care:Standards in Medical Informatics; 1990 Nov 4-7; Wash-ington, DC. Los Alamitos, CA: IEEE Computer SocietyPress; 1990:430-4. (R01 LM 04572).

Factor M, Sittig DF, Cohn AL Gelernter D, MillerPL, Rosenbaum SH. A parallel software architecture forbuilding intelligent medical monitors. Int J Clin MonitComput; 1990; 7:117-28. (T15 LM 07056).

Factor M. The process trellis architecture forreal-time monitors. In: Proceedings of the Second ACMSIGPLAN Symposium on Principles & Practice of Paral-lel Programming; 1990 Mar 14-16; Seattle, WA: 147-55.(T15LM 07056).

Feldman MJ, Barnett GO. An approach to evalu-ating the accuracy of DXplain. In: Miller RA, ed. SCAMCproceedings. 14th Annual Symposium on Computer Ap-plications in Medical Care: Standards in MedicalInformatics; 1990 Nov 4-7; Washington, DC. LosAlamitos (CA): IEEE Computer Society Press; [1990]: 38-43. (T15LM 07037).

Feldman MJ, Cimino C, Hoffer EP, Packer MS,Elkin PL, Forman BH, Oliver DE, Bhave SY, Barnett GO.A strategy to assess the performance of DXplain. In: Pro-ceedings of First Annual Educational and Reserach Con-

ference of American Medical Informatics Association;1990 Tun; Snowbird, UT: 71. (T15 LM 07037).

Forman BH, Eccles R, Piggins J, Raila W, EsteyG, Barnett GO. Using cross-sectional imaging to conveyorgan relationships: an integrated learning environmentfor students of gross anatomy. In: Miller RA, ed. SCAMCproceedings. 14th Annual Symposium on Computer Ap-plications in Medical Care: Standards in MedicalInformatics; 1990 Nov 4-7; Washington, DC. LosAlamitos (CA): IEEE Computer Society Press; [1990]:450-3. (T15LM07037).

Foulser DE, Core NG. Parallel computation ofmultiple biological sequence comparisons. CompBiomed Res; 1990; 23: 310-31. (T15 LM 07056 and R01 LM05044).

Georgeson S, Meyer KB, Pauker SG. Decisionanalysis in clinical cardiology: when is coronaryangiography required in aortic stenosis? J Am CollCardiol; 1990 Mar 15; 15(4): 751-62. (R01 LM 04493 andT15 LM 07044).

Georgeson S, Sonnenberg FA, Feingold M,Pauker SG. Twisted sisters: when is the optimal time fordelivery? Med Decis Making; Oct-Dec 1990; 10(4): 295-302. (R01 LM 05266).

Giuse DA, Giuse NB, Bankowitz RA, Miller RA.Heuristic determination of quantitative data for knowl-edge acquisition in medicine. Comput Biomed Res; 1991;24:261-72. (R01 LM 04622).

Giuse DA, Giuse NB, Miller RA. QMR-KAT: aninteractive knowledge acquisition tool for the QMRmedical knowledge base. In: Miller RA, ed. SCAMCpro-ceedings. 14th Annual Symposium on Computer Appli-cations in Medical Care: Standards in MedicalInformatics; 1990 Nov 4-7; Washington, DC. LosAlamitos (CA): IEEE Computer Society Press; [1990]:1057-8. (R01 LM 04622 and K04 LM 00084).

Giuse DA, Giuse NB, Miller RA. Towards com-puter-assisted maintenance of medical knowledge bases.Artificial Intelligence in Medicine; 1990; 2: 21-33. (K04LM00084).

Giuse NB, BankowitzRA, Giuse DA, Parker RC,Miller RA. Medical knowledge base acquisition: the roleof the expert review process in disease profile construc-tion. In: Kingsland LC, ed. Proceedings of the ThirteenthAnnual Symposium on Computer Applications in Medi-cal Care; Nov 5-8,1989; Wash., DC: IEEE Computer Soci-ety Press; 1989:105-9. (R01 LM 04622).

Greenes RA, Bergeron BP, Dichter MS, FaUon JT.Computer-aided clinical problem solving as an educa-tional paradigm for teaching preclinical cardiac patho-physiology. In: Meester GT, Pinciroli F, eds. Databasesfor cardiology. Dordrecht, The Netherlands: Kluwer;1991:113-40. (R29 LM 04715 and R01 LM 4572).

Greenes RA, Deibel SRA. The DeSyGNER

FY 3991Extramural Programs-Supported Publications 63

knowledge management architecture: a building blockapproach based on an extensible kernel. Artificial Intelli-gence in Medicine; 1991; 3: 95-111. (R01 LM 04572 andT15LM 07037).

Greenes RA, Tarabar DB, Cope L, Slosser E, HershW, Pattison-Gordon E, Abendroth T, Rathe R, Snydr-Michal J. Explorer-2: an object-oriented framework forknowledge management. In: Proceedings MEDINFO 89;1989 Dec; Singapore. Amsterdam: Elsevier; 1989: 29-33.(R01 LM 04572 and T15 LM07037).

Greenes RA. Promoting productivity by propagatingthe practice of "plug-compatible" programming. In:Miller RA, ed. SCAMC proceedings. 14th Annual Sym-posium on Computer Applications in Medical Care:Standards in Medical Informatics; 1990 Nov 4-7; Wash-ington, DC. Los Alamitos (CA): IEEE Computer SocietyPress; [1990]: 22-6. (T15 LM 07037).

Greenes RA. The radiologist as clinical activist: atime to focus outward. In: Mun SKet al, eds. ProceedingsFirst International Conference on Image Managementand Communication in Patient Care: Implementationand Impact; 1989 Jun; Washington, DC. Los Alamitos,CA: IEEE Computer Society Press; 1989:136-40. (R01 LM04572 and T15 LM 07037).

Hagen MD, Eckman MH, Pauker SG. Aortic aneu-rysm in a 74-year-old man with coronary disease and ob-structive lung disease: is double jeopardy enough? MedDecis Making; 1989 Oc-Dec; 9(4): 285-99. (R01LM 04493,T15 LM 07044 and R01 LM 04022).

Haimowitz If. Generating empathetic responses withindividual user models. Cambridge, MA: MassachusettsInstitute of Technology; 1989; MTT/LCS/TR-461; 105p.(R01 LM 04493).

Haimowitz IJ. Modeling all dialogue system partici-pants to generate empathetic responses. In: Miller RA,ed. SCAMC proceedings. 14th Annual Symposium onComputer Applications in Medical Care: Standards inMedical Informatics; 1990 Nov 4-7; Washington, DC. LosAlamitos (CA): IEEE Computer Society Press; [1990]: 51-7. (R01LM 04493).

Hammond JE, Hammond WE, Stead WW. Informa-tion management through integration of distributed re-sources: the TMR-NLM connection a prototype. In:Miller RA, ed. SCAMC proceedings. 14th Annual Sym-posium on Computer Applications in Medical Care:Standards in Medical Informatics; 1990 Nov 4-7; Wash-ington, DC. Los Alamitos (CA): IEEE Computer SocietyPress; [1990]: 719-23. (G08 LM04613).

Hammond WE, Straube MJ, Stead WW. The syn-chronization of distributed databases. In: Miller RA, ed.SCAMC proceedings. 14th Annual Symposium on Com-puter Applications in Medical Care: Standards in Medi-cal Informatics; 1990 Nov 4-7; Washington, DC. LosAlamitos (CA): IEEE Computer Society Press; [1990]:345-9. (G08 LM 04613).

Harris NL. Probabilistic reasoning in the domain ofgenetic counseling. Cambridge, MA: Massachusetts In-stitute of Technology; 1989; MTT/LCS/TR-460; 70p.(R01LM 04493).

Haskill S, Peace A, Morris J, Sporn SA, Anisowicz A,Lee SW, Smith T, Martin G, Ralph P, Sager R. Identifica-tion of three related human GRO genes encodingcytokine functions. Proc Natl Acad Sci USA; 1990 Oct; 87:7732-6. (P41LM 05205).

Haynes RB, McKibbon KA, Walker CJ, RamsdenMF. Rapid evolution of microcomputer use in a facultyof health sciences. Can Med Assoc J; 1991; 144(1): 24-8.(R01 LM 04696).

Hersh WR, Pattison-Gordon E, Greenes RA, EvansDA. Adaptation of Meta-1 for SAPHIRE, a general pur-pose information retrieval system. In: Miller RA, ed.SCAMC proceedings. 14th Annual Symposium on Com-puter Applications in Medical Care: Standards in Medi-cal Informatics; 1990 Nov 4-7; Washington, DC. LosAlamitos (CA): IEEE Computer Society Press; [1990]:156-60. (T15 LM 07037).

Hersh WR, Greenes RA. SAPHIRE—an informationretrieval system featuring concept matching, automaticindexing, probabilistic retrieval, and hierarchical rela-tionships. Comp Biomed Res; 1990; 23: 410-25. (T15 LM07037 and R01LM 04572).

Horres MM, Starr SS, Renford BL. MELVYLMEDLINE: a library services perspective. Bull Med LibrAssoc; Jul 1991; 79(3): 309-20. (G08LM 04466).

Huang X. A space-efficient parallel sequence com-parison algorithm for a message-passing multiprocessor.Int J Parallel Programming; 1989 June; 18(3): 223-9. (R01LM 05110).

Huang X, Hardison RC, Miller W. A space-efficientalgorithm for local similarities. Comput Appl Biosci;1990; 6(4): 373-81. (R01LM 05110).

Jang Y, Patil R. KOLA: a knowledge organizationlanguage. In: Kingsland LC, ed. Proceedings of the Thir-teenth Annual Symposium on Computer Applications inMedical Care; 1989 Nov 5-8; Washington, DC: IEEEComputer Society Press; 1989: 71-5. (R01 LM 04493).

Johnson TR, Smith JW. A flexible technique for ab-duction. In: Working notes; AAAI spring symposium se-ries. Symposium: AI in Medicine; 1990 Mar 27-9;Stanford University. [Palo Alto, CA]; [1990]: 105-7. (R01LM 04298).

Kalet IJ. Artificial intelligence. In: Benedetto AR,Huang HK, Ragan DP, eds. Computer in medical phys-ics. Woodbury, NY: Am. Institute of Physics; [1990]: 355-74. (R01LM 04174).

Kalet IJ, Paluszynski W. Knowledge-based computersystems for radiotherapy planning. Am J Clin Oncol;1990; 13(4): 344-51. (R01LM4174).

Kalet IJ. Operating systems. In: Benedetto AR,Huang HK, Ragan DP, eds. Computers in medical phys-

64 Programs and Services, FY1991

ics. Woodbury, NY: Am. Institute of Physics; [1990]: 72-91.(R01LM4174).

Kalet IJ, Sweeney C, Jacky J. Software design for in-teractive graphic radiation treatment simulation systems.In: Miller RA, ed. SCAMC proceedings. 14th AnnualSymposium on Computer Applications in Medical Care:Standards in Medical Informatics; 1990 Nov 4-7; Wash-ington, DC. Los Alamitos (CA): IEEE Computer SocietyPress; [1990]: 594-8. (R01 LM 04174).

Kassirer JP, Kopelman RI. Diagnosis and the struc-ture of memory: 1. disease polymorphism and mentalmodels. Hosp Pract; Oct 15,1990; 25(10): 17-24. (R01 LM04493).

Kassirer JP, Kopelman RL. Lest we become smug.Hosp Pract;July 15,1990; 25(7): 33-47. (R01 LM 04493).

Kraepelin E. Psychiatry; a textbook for students andphysicians. Quen JM, ed. Canton, MA: Science HistoryPublications/USA; [1990]; 2: Clinical psychiatry: 450p.(Resources in Medical History).

Krushinsky LV. Experimental studies of elementaryreasoning; evolutionary physiological and genetic as-pects of behavior. Tobach E, Poletaeva I, eds. New Delhi,India: Amerind; 1990.

Lee JS, Hwang JN, Davis DT, Nelson AC. Integrationof neural networks and decision tree classifiers for auto-mated cytology screening. In: Proceedings of the Interna-tional Joint Conference on Neural Networks; July 8-12,1991; Seattle, WA: IEEE; 1991; 1:257-62. (F37 LM00006).

Leong T-Y. Knowledge representation for support-ing decision model formulation in medicine. CambridgeMA: Massachusetts Institute of Technology; 1991; MIT/LCS/TR-504; 106p. (R01 LM 04493).

Lincoln MJ, Turner CW, Williamson JW, et al. Iliadtraining enhances medical students' diagnostic skills. JMed Syst; 1991; 15(1): 93-109. (R29 LM 05260).

Long WJ. Flexible reasoning about patient manage-ment using muiltiple models. Artif Intell Med; 1991; 3: 3-20. (R01 LM 04493).

Masarie FE, Miller RA, Bouhaddou O, Giuse NB,Warner HR. An interlingua for electronic interchange ofmedical information: using frames to map between clini-cal vocabularies. Comput Biomed Res; 1991; 24: 379-400.(R29 LM 03589 and K04 LM 00084).

McCarthy BD, Wong JB, Sonnenberg FA. Cost-effec-tiveness in screening for asymptomatic HTV infection.Med Deris Making; Oct-Dec 1990; 10(4): 329(abstract).(R01 LM 05266).

McClure RC, Greenes RA, Bergeron BP. MEDBase: atool for managing multimedia content. In: Miller RA, ed.SCAMC proceedings. 14th Annual Symposium on Com-puter Applications in Medical Care: Standards in Medi-cal Informatics; 1990 Nov 4-7; Washington, DC. LosAlamitos (CA): IEEE Computer Society Press; [1990]:420-4. (T15 LM07037 and R29 LM04715).

McClure RC, Dichter MS, Fallen JT, Greenes RA,Bergeron BP. Multimedia knowledge management ap-plications for cardiovascular education. J Am CollCardio; 1991; 17(2): 10A. (R29 LM04715).

McKibbon KA, Haynes RB, Dilks CJ, Ramsden MF,Ryan NC, Baker L, Hemming T, Fitzgerald D. How goodare clinical MEDLINE searches? A comparative study ofclinical end-user and librarian searches. Comput BiomedRes; 1990; 23:583-93. (R01 LM 04696).

McKinin EJ, Sievert ME, Collins BR. Currency of full-text medical journals: CCML and MEDIS vs. MEDLINE.Bull Med Libr Assoc; Jul 1991; 79(3): 282-7. (R01 LM4605).

Mengeritsky G, Smith TF. New analytical tool foranalysis of splice site sequence determinants. CABIOS;1989; 5(2):97-100. (P41LM05205).

Miller PL, Gelernter D. Machine-independentmodel-based tools for parallel computation in biomedi-cine. In: Miller RA, ed. SCAMC proceedings. 14th An-nual Symposium on Computer Applications in MedicalCare: Standards in Medical Informatics; 1990 Nov 4-7;Washington, DC. Los Alamitos (CA): IEEE Computer So-ciety Press; [1990]: 262-5. (R01 LM 05044, R01 LM 04336and T15LM 07056).

Miller PL, Nadkarni PM, Carriero NM. Parallel com-putation and FASTA: confronting the problem of paralleldatabase search for a fast sequence comparison algo-rithm. Comput Appl Biosci; 1991; 7(1): 71-8. (R01 LM05044).

Miller RA. Legal issues related to medical decisionsupport systems. Int J Clin Monit Comput; 1989; 6: 75-80.(K04 LM 00084).

Miller RA, Giuse NB. Medical knowledge bases.Acad Med; 1991 Jan; 66(1): 15-7. (K04 LM 00084).

Miller RA, Masarie FE. Quick medical reference(QMR): an evolving microcomputer-based diagnostic de-cision-support program for general internal medicine. In:Kingsland LC. Proceedings of the Thirteenth AnnualSymposium on Computer Applications in Medical Care;Nov. 5-8,1989; Wash., DC: IEEE Computer Society Press;1989:947-8. (K04 LM 00084).

Miller RA. Why the standard view is standard:people, not machines, understand patients' problems. JMed Philos; 1990; 15:581-91. (K04 LM 00084).

Miller W, Ostell J, Rudd KE. An algorithm forsearching restriction maps. Comput Appl Biosci; 1990;6(3): 247-52. (R01 LM 05110).

Nadkarni P, Gelernter JE, Carriero N, Pakstis AJ,Kidd KK, Miller PL. Parallelizing genetic linkage analy-sis: a case study for applying parallel computation in mo-lecular biology. In: Miller, RA, ed. SCAMC proceedings.14th Annual Symposium on Computer Applications inMedical Care: Standards in Medical Informatics; 1990Nov 4-7; Washington, DC. Los Alamitos (CA): IEEE

FY1991 Extramural Programs-Supported Publications 65

Computer Society Press; [1990]: 104-8. (R01 LM 05044).Nathanson CA. Dangerous passage; the social con-

trol of sexuality in women's adolescence. Philadelphia:Temple Univ. Press; [1991]. 286p. (R01 LM 4655).

Ng }, Orav EJ. A generalized chain binomial modelwith application to HTV infection. Mathematical Bio-sciences; 1990; 101:99-119. (T15 LM 07037).

O'Connor GT, Sox HC. Bayesian reasoning in medi-cine: the contributions of Lee B. Lusted, MD. Med DecisMaking; 1991 Apr-Jun; 11(2): 107-11. (R29 LM 04667).

O'Connor GT, Plume SK, et al. A regional prospec-tive study of in-hospital mortality associated with coro-nary artery bypass grafting. JAMA; 1991 Aug 14; 266(6):803-9. (R29LM 04667).

Oliver D, Piggins J, Hassan L, Blewett DR, Eccles R,Schoelles C, Raila W, Link, Barnett GO. CASEBOOK: asystem for tracking cases seen by medical students. In:Proceedings of First Annual Educational and ResearchConference of American Medical Informatics Associa-tion; 1990 Jun; Snowbird, UT: 10. (T15 LM 07037).

Oliver DE, Estey G, Ford P, Burke SM, TeplickRS, Zielstorff RD, Barnett GO. Computer-based access topatient care guidelines. In: Miller RA, ed. SCAMC pro-ceedings. 14th Annual Symposium on Computer Appli-cations in Medical Care: Standards in MedicalInformatics; 1990 Nov 4-7; Washington, DC. LosAlamitos (CA): IEEE Computer Society Press; [1990]:398-402. (T15 LM 7037).

Osheroff JA, Forsyth DE, Buchanan BG, BankowitzRA, Blumenfeld BH, Miller RA. Physicians' informationneeds: analysis of questions posed during clinical teach-ing. Ann Intern Med; 1991 Apr 1; 114(7): 576-81. (K04 LM00084).

Pao, ML. On the relationship of funding and re-search publications. Scientometrics; 1991; 20(1): 257-81.(R01 LM 04680).

Pao ML, A prototype clustering program. In: Pro-ceedings of the 9th National Online Meeting; 1988: 301-6.(R01LM 04677).

Pao ML. Term and citation searching: a preliminaryreport. In: Proceedings of the American Society for Infor-mation Science; 1988; 24:261-4. (R01 LM 04677).

Paton JA, Clyman JI, Lynch P, Miller PL, Sittig DF,Berson BZ. Strategic planning for LAIMS: prototyping asa catalyst for change. In: Miller RA, ed. SCAMC proceed-ings. 14th Annual Symposium on Computer Applica-tions in Medical Care: Standards in Medical Informatics;1990 Nov 4-7; Washington, DC. Los Alamitos (CA): IEEEComputer Society Press; [1990]: 709-13. (T15 LM 07056).

Payne TH, GoroU AH, Morgan M, Barnett GO. Con-ducting a matched-pairs historical cohort study with acomputer-based ambulatory medical record system.Comp Biomed Res; 1990; 23:455-72. (T15 LM 07037).

Peitzman SJ. From dropsy to Blight's Disease to end-stage renal disease. Milbank Q; 1989; 67, Suppl 1: 16-32.

(R01 LM 04906).Peitzman SJ. Thomas Addis (1881-1949): mixing pa-

tients, rats, and politics. Kidney Int; 1990; 37: 833-40.(R01LM 04906).

Perlin M. Production rules and systems: a top-downconstruction of bottom-up inference. In: Bourbakis NG,ed. Architectures, languages and algorithms for artificialintelligence. New York: Wiley; Forthcoming. (R29 LM04707).

Perlin M. Topologically traversing the RETE net-work. Appl Artif Intell; 1990; 4:155-77. (R29 LM 04707).

Rabold JS, Baysden GS, Blunden PS, Califf RM, FangW-C, Hammond WE, Pryor DB, Stead WW. The practicemanagement workstation: providing incentive acrosssubgroups of users. In: Miller RA, ed. SCAMC proceed-ings. 14th Annual Symposium on Computer Applica-tions in Medical Care: Standards in Medical Informatics;1990 Nov 4-7; Washington DC. Los Alamitos (CA): IEEEComputer Society Press; [1990]: 760-3. (G08LM04613).

Rudd KE, Miller W, Werner C, Ostell J, TolstoshevC, Satterfield SG. Mapping sequenced E. coli genes bycomputer: software, strategies and examples. NucleicAcids Res; 1991; 19(3): 637-47. (R01 LM 05110).

Russ TA. Using hindsight in medical decision mak-ing. In: Kingsland LC, ed. Proceedings of the ThirteenthAnnual Symposium on Computer Applications in Medi-cal Care; 1989 Nov 5-8; Washington, DC: IEEE ComputerSociety Press; 1989:38-44. (R01 LM 04493).

Russ TA. Using hindsight in medical decision mak-ing. Comput Methods Programs Biomed; 1990; 32: 81-90.(R01 LM 04493).

Shvyrkov VB. Neurophysiological study of systemicmechanisms of behavior. Weinberger NM, ed. NewDelhi, India: Amerind: 253p.

Sielaff BH, Scott EP, Connelly DP. Design and pre-liminary evaluation of an expert system for platelet re-quest evaluation. Transfusion; 1991; 31(7): 600-6. (T15 LM07041).

Sittig DF, Foulser D, Carriero N, McCorkle G, MillerPL. A parallel computing approach to genetic sequencecomparison: the master-worker paradigm. In: Miller RA,ed. SCAMC proceedings. 14th Annual Symposium onComputer Applications in Medical Care: Standards inMedical Informatics; 1990 Nov 4-7; Washington, DC. LosAlamitos (CA): IEEE Computer Society Press; [1990]:109-13. (R01LM 05044).

Sittig DF, Foulser D, Carriero N, McCorkle G, MillerP. A parallel computing approach to genetic sequencecomparison: the master-worker paradigm withinterworker communication. Comput Biomed Res; 1991;24:152-69. (R01LM 05044).

Sittig DF, Factor M. Physiologic trend detection andartifact rejection: a parallel implementation of a multi-state Kalman filtering algorithm. Comput Method Pro-grams Biomed; 1990; 31:1-10. (T15 LM 07056).

66 Programs and Services, FY1991

Sittig DF, Factor M, Gelemter DH, Miller PL.Real-time clinical decision-support systems: challengesfor the AI community. In: Proceedings of the Am. Assoc.for Artificial Intelligence Spring Symposium; 1990 Mar27-9; Stanford Univ., Stanford, CA: 166-70. (T15 LM07056).

Sittig DF, Clyman JI, Cheung KH, Miller PL. Re-ceiver operating characteristic (ROC) curve helps opti-mize blood pressure detection algorithms.Anesthesiology; 1990 Sep; 73(3A): A456. (T15 LM 07056).

Smith RF, Smith TF. Automatic generation ofprimary sequence patterns from sets of related proteinsequences. Proc Natl Acad Sci USA; 1990 Jan; 87:118-22.(P41LM 05205).

Smith RF, Smith TF. Identification of new pro-tein kinase-related genes in three herpesviruses, herpessimplex virus, varicella-zoster virus, and Epstein-Barr vi-rus. J Virol; 1989 Jan; 63(1): 450-5. (P41 LM 05205).

Smith TF. Genetic sequence semantic and syn-tactic patterns. In: Bell G, Marr T, eds. Computers andDNA; SFI studies in the sciences of complexity. NewYork: Addison-Wesley; 1989; 7:259-70. (P41 LM 05205).

Smith TF. The history of the genetic sequencedatabases. Genomics; 1990; 6: 701-7. (P41 LM 05205).

Spackman KA, Beck JR. A knowledge-basedsystem for transfusion advice. Am J Clin Pathol; 1990Oct; 94(4) (Suppl): S25-9. (K04 LM00086).

Stead WW, Bird WP, Califf RM, Elchlepp,Hammond WE, Kinney TR. LAfMS at Duke UniversityMedical Center; from model to implementation: a blue-print for 1990-1995. Durham, NC: Duke UniversityMedical Center; Dec 1990; 29pp.+ Appendices A-E.

Stead WW, Roderer N, Zimmerman JL. Success-ful principles for collaboration: formation of the lADVISconsortium. Acad Med; 1991 Apr; 66(4): 196-201. (G08LM 04613).

Stead WW. Systems for the year 2000: the casefor an integrated database. MD Comput; 1991; 8(2): 103-10. (G08LM 04613).

Stein LD, Snydr-Michal J, Greenes, RA. Realisticviewing and manipulation of radiographic images on apersonal computer—a user interface for educational ap-plications. Journal of Digital Imaging; 1991; 4(3): 169-76.(R01 LM 04572).

Szolovits P. Knowledge-based systems. In:Meyer AR, Guttag JV, Rivest RL, Szolovits P, eds. Re-search Directions in Computer Science: an MTT Perspec-tive. Cambridge, MA: MIT Press; 1991: 317-70. (R01LM04493).

Wagner MM, Bankowitz RA, McNeil M,Challinor SM, Janosky JE, Miller RA. The diagnostic im-portance of the history and physical examination as de-termined by the use of a medical decision supportsystem. In: Kingsland LC, ed. Proceedings of the Thir-

teenth Annual Symposium on Computer Applications inMedical Care; Nov 5-8,1989; Wash. DC: IEEE ComputerSociety Press; 1989:139-44. (T15 LM 07059).

Walker CJ, McKibbon KA, Haynes RB, RamsdenMF. Problems encountered by clinical end users ofMEDLINE and GRATEFUL MED. Bull Med Libr Assoc;Jan 1991; 79(1): 67-9. (R01LM 04696).

Webster C, Banks G. Modeling manic-depres-sion with symbolic logic, In: Kingsland LC, ed. Proceed-ings of the Thirteenth Annual Symposium on ComputerApplications in Medical Care; Nov. 5-8,1989; Wash. DC:IEEE Computer Society Press; 1989: 325-9. (T15 LM07059).

Webster TA, Patarca R, Lathrop RH, Smith TF.Potential structural motifs for reverse transcriptases. MolBiol Evol; 1989; 6(3): 317-20. (P41 LM 05205).

Wellman MP, Eckman MH, Fleming C, MarshallSL, Sonnenberg FA, Pauker, SG. Automated critiquing ofmedical decision trees. Med Decis Making; 1989 Oct-Dec;9(4): 272-84. (R01LM 04493and T15 LM 07044).

Wellman MP. Fundamental concepts of qualita-tive probabilistic networks. Artif Intell; 1990; 44: 257-303.(R01LM 04493).

Weyer J. Witches, devils, and doctors in theRenaissance. Mora G, Kohl B, eds.; Shea J, trans.Binghamton, NY: Medieval & Renaissance Texts &Studies; 1991: 790p. Translation of De praestigiisdaemonum (R01LM 04648).

Wildemuth BM, Jacob EK, Fullington A, de BliekR, Friedman CP. A detailed analysis of end-user searchbehaviors. Proceedings of the American Society for Infor-mation Science; 1991; 28(302-12. (R01LM 0 4843)).

Wong JB, Kaplan MM, Meyer KB, Pauker SG.Ablative radioactive iodine therapy for apparently local-ized thyroid carcinoma. Endocrinol Metab Clin NorthAm; 1990 Sep; 19(3): 741-60, (R01LM 04493 and T15 LM07044).

Wong JB, Sonnenberg FA, Salem DN, Pauker,SG. Myocardial revascularization for chronic stable an-gina. Ann Intern Med; 1990 Dec; 113(11): 852-71. (R01LM 04493and T15 LM 07044).

Wong JB, Sonnenberg FA, Salem DN, PaukerSG. Myocardial revascularization for chronic stable an-gina. Ann Intern Med; 1 Dec 1990; 113(11): 852-71. (R01LM 04493 and T15 LM 7044).

Wu S, Manber U, Myers G, Miller W. An O(NP)sequence comparison algorithm. Information ProcessingLetters; 1990; 35: 317-23. (R01 LM 04960 and R01 LM05110).

Wu TD. A problem decomposition method forefficient diagnosis and interpretation of multiple disor-ders. In: Miller RA, ed. SCAMC proceedings. 14th An-nual Symposium on Computer Applications in MedicalCare: Standards in Medical Informatics; 1990 Nov 4-7;

FY1991 Extramural Programs-Supported Publications 67

Washington, DC. Los Alamitos (CA): IEEE Computer So-ciety Press; [1990]: 86-92. (R01 LM 04493).

Wu TD. Symptom clustering and syndromic knowl-edge in diagnostic problem solving. In: Kingland LC, ed.Proceedings of the Thirteenth Annual Symposium onComputer Applications in Medical Care; 1989 Nov 5-8;Washington, DC: IEEE Computer Society Press; 1989:45-9.CR01LM04493).

Yeh A. Automatically finding the average output ofa steadily beating ventricle. In: Miller RA, ed. SCAMCproceedings. 14th Annual Symposium on Computer Ap-

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Zhu Q, Smith TF, Lathrop RH, Figge J. Acid helix-turn activator motif. Proteins; 1990; 8: 156-63. (P41 LM05205).

Zysk KG. Ascetism and healing in Ancient India;medicine in the Buddhist monastery. New York: OxfordUniv. Press; 1991.

Note: (R01 LM04514).

68

APPENDIX 4: BOARD OF REGENTS

The NLM Board of Regents meets three times a year to consider Library issues and make recommendations to theSecretary of Health and Human Services on matters affecting the Library.

Appointed Members:

DAVIS, Ruth M, Ph.D. (Chair)President, The Pymatuning Group, Inc.Arlington,VA

ALLEN, Beverly E.Director, Multi-Media CenterMorehouse School of MedicineAtlanta, GA

ANDERSON, Rachael K.Director, Health Sciences Center LibraryUniversity of ArizonaTucson, AZ

CAPE, Ronald E.,Ph.D.Chairman, Cetus CorporationEmeryville, CA

COHN, Lawrence H., M.D.Chief of Cardiac SurgeryBrigham and Women's HospitalBoston, MA

DeNARDIS, Lawrence J., Ph.D.President, University of New HavenWest Haven, CT

KAHN, Robert E., Ph.D.President, Corporation for National Research InitiativesReston, VA

SMITH, Alvy Ray, Ph.D.President, Altamira Software Co.Mill Valley, CA

SPURLOCK, Jeanne,M.D.Deputy Medical Director, andDirector, Department of Minority National AffairsAmerican Psychiatric AssociationWashington, DC

WALKER, H. Kenneth, M.D.Professor of MedicineEmory University School of MedicineAtlanta, GA

Ex Officio Members:

Librarian of Congress

Surgeon GeneralPublic Health Service

Surgeon GeneralDepartment of the Air Force

Surgeon GeneralDepartment of the Navy

Surgeon GeneralDepartment of the Army

Chief Medical DirectorDepartment of Veterans Affairs

Assistant Director for Biological SciencesNational Science Foundation

DirectorNational Agricultural Library

DeanUniformed Services University of the Health Sciences

69

APPENDIX 5: BOARD OF SCIENTIFIC COUNSELORS/LISTER HILLCENTER

The Board of Scientific Counselors meets periodically to review and make recommendations on the Library's in-tramural research and development programs.

Members:

YU, Victor L., M.D. (Chairman)Professor of MedicineUniversity of PittsburghPittsburgh, PA

BRUTLAG, Douglas L., Ph.D.Associate Professor of BiochemistryStanford University School of MedicineStanford, CA

CIMINO, James J., MDAssistant Professor of MedicineCollege of Physicians and SurgeonsColumbia UniversityNew York, NY

ERNST, Ruann R, Ph.D.Director of MarketingInformation SystemsHewlett-Packard CompanyCupertino, CA

FOSTER, John, Ph.D.Dean, College of Engineering and ArchitecturePrairie View A & M UniversityPrairie View, TX

FRISSE,MarkE.,M.D.Assistant Professor of MedicineWashington University School of MedicineSt. Louis, MO

FRYBACK, Dennis G., Ph.D.Professor, of Preventive Medicine and Industrial

EngineeringUniversity of Wisconsin-MadisonMadison, WI

LEHNERT, Wendy G., Ph.D.Professor of Computer and Information ScienceDepartment of Computer and Information ScienceUniversity of MassachusettsAmherst, MA

70

APPENDIX 6. BOARDOF SCIENTIFIC COUNSELORS/NATIONAL CENTER FOR BIOTECHNOLOGYINFORMATION

The National Center for Biotechnology Information Board of Scientific Counselors meets periodically to revie\and make recommendations on the Library's biotechnology-related programs.

Members:

SAUER, Robert T., Ph.D. (Chairman)Professor, Department of BiologyMassachusetts Institute of TechnologyCambridge, MA

ALONSO, Rafael, Ph.D.Assistant ProfessorDepartment of Computer SciencePrinceton UniversityPrinceton, NJ

BERMAN, Helen M., Ph.D.Professor of ChemistryDepartment of ChemistryRutgers UniversityPiscataway, NJ

CANTOR, Charles R., Ph.D.Principal Scientist of the Department of EnergyHuman Genome ProjectLawrence Berkeley LaboratoryBerkeley, CA

DEVEREUX, John R., Ph.D.President, Genetics Computer Group, Inc.Madison, WI

KELLY, Thomas J., M.D., Ph.D.Professor and DirectorDepartment of Molecular Biologyand GeneticsThe Johns Hopkins University School of MedicineBaltimore, MD

71

APPENDIX 7. BIOMEDICAL LIBRARY REVIEW COMMITTEE

The Biomedical Library Review Committee meets three times a year to review applications for grants under the Medi-cal Library Assistance Act.

Members:

BUCHANAN, Bruce G., Ph.D. (Chairman)Professor of Computer Science, Philosophy and

MedicineUniversity of PittsburghPittsburgh, PA

ABARBANEL, R.M., M.D., Ph.D.Manager, Engineering Computing and AnalysisBoeing Computer ServicesSeattle, WA

ABOLA, Enrique E., Ph.D.ChemistDepartment of ChemistryBrookhaven National LaboratoryUpton, NY

BECK, J. Robert,M.D.Director, Biomedical Information Communication

CenterThe Oregon Health Sciences UniversityPortland, OR

CHANDRASEKARAN, B., Ph.D.Professor, Department of Computer and Information

ScienceOhio State UniversityColumbus, OH

FENICHEL, Carol H., Ph.D.Director of the Library and Professor of Information

ScienceHahnemann UniversityPhiladelphia, PA

FIELDS, Christopher A., Ph.D.Special ExpertNational Institute of Neurological Disorders and StrokeBethesda, MD

FULLER, Sherrilynne, Ph.D.Director, Health Sciences Library and Information

Center

University of WashingtonSeattle, WA

HAMBERG, Cheryl J.Director of the LibraryMeharry Medical College LibraryNashville, TN

HAYNES, R. Brian,M.D.Chief, Health Information Research UnitMcMaster UniversityHamilton, Ontario

JAFFE, Conrade C,M.D.Professor of Diagnostic Radiology and Internal MedicineYale University School of MedicineNew Haven, CT

LOVE, ErikaDirector, Medical Center LibraryUniversity of New MexicoAlbuquerque, NM

MESSERLE, JudithLibrarianThe Francis A. Countway Library of MedicineHarvard Medical SchoolBoston, MA

MYERS, Eugene W., Ph.D.Associate ProfessorDepartment of Computer ScienceUniversity of ArizonaTucson, AZ

PEARSON, William R., Ph.D.Associate ProfessorUniversity of Virginia School of MedicineCharlottesviUe, VA

SIEVERT, MaryEUen C., Ph.D.Associate ProfessorSchool of Library and Information ScienceUniversity of Missouri-ColumbiaColumbia, MO

72 Programs and Services, FY1991

STORMO,GaryD.,Ph.D.Assistant ProfessorDepartment of Molecular, Cellular and Developmental

BiologyUniversity of ColoradoBoulder, CO

VANNIER, Michael W., M.D.Professor of RadiologyWashington UniversitySt. Louis, MO

WILLIAMS, Arthur L., Ph.D.Professor, Department of Botany and MicrobiologyHoward UniversityWashington, D.C.

WRIGHT, Barbara A.Director, Library and Information ServicesFayetteville Area Health Education CenterFayetteville, NC

73

APPENDIX 8. LITERATURE SELECTION TECHNICALREVIEW COMMITTEE

The Literature Selection Technical Review Committee meets three times a year to select journals for indexing in IndexMedicus and MEDLINE.

Members:

ANDERSON, Philip C, M.D. (Chairman)Professor and ChairmanDepartment of DermatologyUniversity of Missouri School of MedicineColumbia, MO

BERG, Alfred O., M.D., M.P.H.Associate Professor/Director of ResearchDepartment of Family MedicineUniversity of WashingtonSeattle, WA

BLODI, Frederick C, M.D.Professor EmeritusDepartment of OphthalmologyThe University of Iowa HospitalIowa City, IA

BONAPARTE, Beverly H, Ph.D.Chief Nursing AdministratorUniversity of Medicine and Dentistry of New JerseyNewark, NJ

CASHEL, C. Michael, M.D., Ph.D.Chief, Section on Molecular RegulationsNational Institute of Child Health and Human

DevelopmentBethesda, MD

DeBAKEY, Lois E., Ph.D.Professor of Scientific CommunicationBaylor College of MedicineHouston, TX

GOLDBERG, Herbert S., Ph.D.Associate Dean for Research and Academic AffairsUniversity of MissouriColumbia, MO

PARKER, Curtis L., Ph.D.Professor and Chairman of AnatomyMorehouse School of MedicineAtlanta, GA

RABSON, Alan S.,M.D.Director, Division of Cancer Biology and DiagnosisNational Cancer InstituteBethesda, MD

UTIGER, Robert D.,M.D.Deputy EditorNew England Journal of MedicineBoston, MA

WALTER, Pat L.Acting Biomedical LibrarianLouise Darling BiomedicalLibrary, UCLALos Angeles, CA

WEAVER, William Lynn, M.D.,F.A.C.S.Nashville, TN

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