AGENDA

Thirty-Eiphth Meeting of theBOARD OF REGENTS

National Library of Medicine

9:00 a.m., March 22-23, 1971Board Room

Bethcsda, Maryland

I. CALL TO ORDER AND INTRODUCTORY REMARKS Dr. Robert Ebert

II. CONSIDERATION OF MINUTES OF LAST MEETING

III. DATES OF FUTURE MEETINGS1971 and 197?. Calendars in all booksNext Meeting -•June 14-15, 1971 (M-T)Subsc-qucnt MeetingNovember 18-19, 1971 (T-F)

Selection of Meeting Date - March 197220-21M-T

23-24T-F

27-28M-T

TAU I Dr. Robert Ebert(Orange book)

TAB II Dr. Robert Ebert

IV. REMARKS P-YTHE SPECIAL ASSISTANT, OFFICEOF THE ASSISTANT SECRETARY FOR HEALTH ANDSCIENTIFIC AI'FALRS

V. REMARKS HY THE DIRECTOR, NIH

Dr. Raymond Moore

Dr., Robert Marston

VI. REPORT OF THE DIRECTOR, NIJ-1 TAT! Ill Dr. M a r t i n Cummuigs

V I T . LIBRARY OPERATIONS REVIEW TAB IV Dr. Joseph Loiter

Photograph of Members of Luc Hoard of Regentsin Board Room of the National Library of Medicine

LUNCH (Open Choice)

(Cafeteria in NLM on A Level, O'Donnoll's Restaurant:, 8301 Wisconsin Avenue,Bethesda, Md. , Governor's House Restaurant, 8400 Wisconsin Avenue, Betlicsua,Maryland (both within a ft-.w blocks walking distance))

VIII. MEDLARS II DEVELOPMENT

IX. EXPERIENCES WITH MEDLARS I ANDPLANS FOR MEDLARS II

TAB V Mr. Ralph SimmonsMr. Alfred ZipfMr. Bruno Augpnsteln

Dr. RimeKarol in ska In sti.t ut o tStockholm, Sweden

Agenda - Page 2

X. REMOTE BIBLIOGRAPHIC ACCESS TAB VI Mr. Davis McCarn

XI,

XII,

100TH ANNIVERSARY OF MEDICAL DEPARTMENT,U.S. NAVY (Exhibit;)

Admiral George Davis

ADJOURNMENT

DINNER (DITCH TREAT) - Evans Farm Inn, Route 123, McLean, Virginia

Cocktails: 6:45 p.m. (cash bar) Dinner: 7:45 p.m.

RECENT SPEAKER - Dr. Jack M. Layton

SUBJECT: "Dr. Walter Reed in Arizona Territory"

RECONVENE - 9:00 a.m. - March 23, 1971

RETORT OJ-1 THE ASSOCIATE DIRECTORFOR ilXTlUWTdRAL PROGRAMS

a. Review of Publications Program(1) Consideration of Policy for

Publications Pro;',r".m(2) Information on Fiocodurc to

Normalize Priorities

b. Legal Opinion with regard toFAST Ta^k Force Recommendation"It is recommended that routineBoard of Regents Review oC al ]New, Renewal and Supp]cuucinLa]Applications be Elivnin.it.cd."

c. Revised Regulations for EPGranti; Necessitated by theMcdic.nl Library AssistanceExtension Act of 1970

d. Resource Program Policy Questions(1) Support of Audiovisual Activities

(a) Production(b) Distribution(c) Teaching Aids

(2) Support of Automation Projects(3) Priorities for the Use. of Resource

Grant Funds.(a) The library as a teaching

program(b) Strengthening of traditional

services vs new roles(4) Staff Review of Resource Improvement

Grants

TAB I(Gray book)

Dr. Lee Langley

Dr. Ann Kaufman

TAB II Dr. Lee Lanyley

TAB III Mr. Robert Ualkingtor

TAB IV Dr., Lee Langley

Agenda - Page 3

c. The Ad Hoc Committee Mooting on TAB VHistorical Trans Lat ions(1) Report; of the: meeting(2) Policy recommendation-;

Dr. Lee I,nnj»ley

i ' . Hionirdic. i l Communicat ions S tudy Sect ionE v a l u a t i o n of. the Nl.M Research (Irant

£. Training G r a n t s Program(1) Program Directors; M e e t i n g to be

Held May 9-10-11, 1971(2) I n t e r i m Act ions - Roducnd pcTiods

of support

h. DRG A c l n i j n j . s t r a f . i v c - Report TAB VIII

XIII . CONS'LDKl-'ATION OF P h i N D T N C APPT.KJATl.ONS

A. UK'SIiAUCM Ai,;D PUBUCATJ ON C HANTS TA13 IX

H. TRAIN INC C RANTS TA1J X

C. R U S O U R C K GRANTS TAT.XT

1). INT1CK1M ACTIONS TAD X1T.

C r i t e r i a fo r K v . i l u a t l v i j ; Rc.sourcc G r a n t s

X T V . TOXICOLOGY INFORMATION PROGRAM

LUNCH - Catered in Hoard Room

XV. F.XKCUTTV]:] SKSSJ .ON

A D J O U R N M l i N T

TA11 VI Dr. Ann Kdufiiu-in

TAP. VII Dr. Ann Kaufman

Dr. Lc;e Langley

TAP. VII Dr. Henry Kiscman(Oran};c: book)

EMBERS PRESENT:

EMBERS ABSENT;

.TERNATES:

FESTS:

:AFF:

THE BOARD OF REGENTSof the

NATIONAL LIBRARY OF MEDICINE

MINUTKS OF Till', 38th MTETINC

M;irch 22-23, 197J , Bethcsda, Maryland

Dr. William G. Anlyan, Mr. Bruno W. Augunstein, Dr. William 0. Baker,Dr. Harvc J. Carlson, Vice; Admiral George M. Davis, Dr. Robert H. Ebert,Lt. General Hal B. Jennings, Dr. Jack M. Layton, Dr. Max Michael, Jr.,Dr. Marc J. Musscr, Dr. George W. Tcuscher, Dr. Frederick H. Wagman

Dr. James C. Fletcher (resigned effective 3/12/71 to become theDirector, National Aeronautics and Space Administration)Dr. John P. McGovern, Dr. L. Quincy Mumford

General Gerrit L. Hekhuis, M.C., USAF represented Lt. General Townerboth daysDr. Raymond T. Moore represented Dr. Steinfeld the first dayAdmiral Charles L. Waite, M.C., USN and his replacement as alternateto Admiral Davis (to become effective 4/9/71) Captain Edward J. Rupnik,M.C., USN, represented Admiral Davis both daysGeneral Thomas J. Whelan accompanied General Jennings to the first dayof the meeting.

Dr. Robert Q. Marston, Director, National Institutes of HealthDr. Sune Bergstrom, Karolinska Institutet, Stockholm, SwedenDr. Fred Cole, President, Council of Library Resources, Inc.Mr. John Sherrod, Director, National Agricultural LibraryMr. Alfred Zipf, Consultant to the NLM and Executive Vice Presidentof the Bank of AmericaDr. Ruth Davis, Director, Center for Computer Sciences and Technology,National Bureau of StandardsMrs. Ileen Stewart, Executive Secretary, History of Life SciencesStudy Section and the Biomedical Communications Study SectionMiss Marjorie L. Morrill, Continuing Education and Training Branch,Division of Professional and Technical Development, Regional MedicalPrograms, DHEWMr. Albert Feiner, Magnavox Research Laboratories, Torrance, California

Dr. Clifford Bachrach, Dr. Robert Benford, Dr. John Blake, Mrs. RuthBortz, Dr. Charles Bridgman, Mr. Arthur Broering, Mr. Raymond Brown,Dr. Ralph Christenson, Mr. Peter Clepper, Mr. Lawrence Coffin,Miss Mary Corning, Mr. John Cox, Mr. Donald Dennis, Mrs. Doris Doran,Mr. Joseph Foley, Mrs. Louise Gamage, Mrs. Frances Howard, Mr. DonaldHummel, Mrs. Frances Johnson, Dr. Ann Kaufman, Dr. Leonard Karel,Dr. Henry Kissman, Dr. Lee Langley, Dr. Joseph Leiter, Mr. Davis McCarn,Mr. Peter Monk, Dr. Paulo Pamplona, Mrs. Rita Pusey, Mrs. Ann Sabin,Dr. Harold Schoolman, Mr. Ralph Simmons, Mr. Kent Smith, Mr. Stan Smith,Mrs. Barbara Sternick, Mr. Daniel Tonkery, Dr. Sharon Valley, Mr. BrunoVasta, Mr. John Waldcn, Mr. Robert Walkington, Mr. Richard West,Mrs. Mary White, Dr. Harold Wooster

NOVEMBER 1970 MINUTES APPROVED. FORTHCOMING MEETINGS SCHEDULED

The minutes of the November 19-20, 1970 meeting were approved. The datesof June 14-15, 1971 were- reaffirmed. The Board reconsidered its meetingdate for the November 1971 meeting and selected Monday and Tuesday,November 22-23, 1971. The dates of March 27-28, 1972 were tentativelyselected for the second meeting in FY 1972.

OPENING REMRKS OF THE CHAIRMAN OF THE BOARD

Dr. Robert Ebert, the Chairman, opened the meeting with a welcome to Lt.General Jennings, the Surgeon General, Department of the Army; Admiral Waite,Office of the Surgeon General, Department of the Navy; General Hekhuis, Officeof the Surgeon General, Department of the Air Force; General Whelan, Officeof the Surgeon General, U.S. Army; Dr. Moore, representing Dr. Jesse L.Steinfeld, the Surgeon General, U.S. P.H.S.; and Dr. Marston, Director, NIH.The Chairman also welcomed Dr. Cole, President of the Council on LibraryResources; Mr. John Shcrrod, Director of the National Agricultural Library;Dr. Ruth M. Davis, now with the National Bureau of Standards as Director,Center for Computer Sciences and Technology; and Professor Sune Bergstromof the Karolinska Institutet, Stockholm, Sweden.

The Chairman announced that Dr. McGovern would not attend because of illnessand that Dr. Fletcher had resigned because of his appointment as Administratorof NASA.

PRESENTATION OF PLAQUE TO DR. RUTH M. DAVIS

In token of their esteem for Dr. Ruth M. Davis, the first Director, ListerHill National Center for Biomedical Communications, the Board of Regentsawarded her a plaque for exceptional management and technical contribution.The Board stated that her leadership had been preeminent; her imagination,drive, and sound reasoning, impressive; and the progress of the Center,greater than could reasonably have been anticipated.

Dr. Cummings introduced new members of the Senior Staff of the Library:

Mr. Kent Smith, Executive Officer, Dr. Harold Wooster, Chief, Research andDevelopment Branch, Lister Hill National Center for Biomedical Communicationsand Mr. Albert Feiner, Director Designate, Lister Hill Center.

REMARKS BY DR. ROBERT Q. MARSTON. DIRECTOR. NIH

Dr. Marston's remarks to the Board concerned three areas: people, money, andlegislation. He said that great importance attaches to the health manpowerlegislation submitted by the Administration for extension of legislation ex-piring the end of June 1971. Of the many similarities between the Administra-tion bill and bills introduced by others, perhaps the most important is the

Federal Government's direct interest in participating financially, with nostrings attached, in the educational support of every student involved inschools of medicine, dentistry, osteopathy, and others. All previous billsrequired an increase in enrollment to qualify for funds under the formulaportion of the bills. Current bills assert that the Federal Government hasa direct and an entitlement interest in every graduate of these institutionsthrough some form of capitation payment. The Administration bill ties thecapitation payment to the number of graduates; the Staggers and the Rogersbills, the capitation to the number of students enrolled. These bills setthe tone for a major examination of the needs for change in support of healthmanpower educational institutions and their students.

Pending in the Congress is a bill first introduced by Senator Yarborough toestablish a separate cancer authority. Reintroduced by Senator Kennedy, thisbill calls for removing the National Cancer Institute from the NIH; having itreport directly to the President; and engaging in a "moonshot" attempt toconquer cancer. The Administration, on the other hand, has spoken stronglyfor the President's program, which calls for a cancer conquest program to beinitiated within the NIH; managerial changes at the NIH; addition of $100million to the NIH cancer program for fiscal year 1972; and the furtheraddition of as much additonal money as may be needed. The Kennedy bill hasgenerated concern within the Administration, Congress, and the scientificcommunity.

Dr. Marston said that the juxtaposition of the 1972 budget processes and the1971 budget decisions on the appropriation processes have led to a narrowingof the differences between the two budgets. The NIH budget for 1972 showsessentially no increase over the 1971 budget except for the $100 million incancer.

The NLM budget for 1972, like the NIH budget, shows essentially no increase.An increase in 1971 occurred above what had been anticipated, but did notoffset the need for an increase in 1972. Dr. Marston said that Dr. Gummings,with a covering note from him, has brought this particular point to theattention of the Secretary's office.

Dr. David P. Rail will succeed Dr. Paul Kotin as Director, EnvironmentalHealth Sciences Institute, North Carolina.

Responding to a question about funding of NLM, Dr. Marston replied that atthe very highest levels, the NLM is grouped conceptually with libraries ingeneral. His office has reviewed the special problems of the NLM and hastried to outline these in terms of needs. He has endorsed an expression ofconcern about fiscal needs of NLM. Another element relating to NLM fundingis the Administration proposal for extension of the manpower legislationhaving to do with health educational institutions - an outgrowth of thesuggestion in the Carnegie Commission Report. The impact that it will haveon the NLM's programs raises again the whole question of the role of theLibrary's programs and the resources needed to carry out those programs,as the biomedical communications problems continue to grow in magnitude.

REMARKS BY DR. RAYMOND MOORE. SPECIAL ASSISTANT. OFFICE OF THE ASSISTANTSECRETARY FOR HEALTH AND SCIENTIFIC AFFAIRS.

Dr. Moore emphasized two matters of programmatic import: creation of theNational Institute for Occupational Safety and Health and the Presidentiallyauthorized study on the nature and gravity of the hazards to human health andsafety created by common environmental pollutants.

The new Institute grew out of a requirement of the Occupational Safety andHealth Legislation. By April 28, the Institute will be legally in being;however, organizational and many other questions have yet to be resolved.

The hazards and human health study followed from passage of the Public HealthService Amendments Act last October. The Act directed a survey of the medicaland other assistance available to persons affected by pollution, especiallywhen such pollution reaches emergency levels. The Act directed also a surveyof the measures, other than those relating solely to abatement of the pollution,that may be taken to avoid or to reduce the effects of such pollution on thehealth of individuals. This Presidential study marks the first that HEW hashad in this field.

REPORT OF THE DIRECTOR. NLM

Dr. Cummings reminded the Board that 1971 marks two significant anniversariesin the history of the Library: the 135th year since the establishment of theLibrary, which grew out of the Library of the Office of the Surgeon General,U.S. Army; and the tenth anniversary of the dedication of the Library'spresent quarters. Also, 1971 is either the 99th or the 100th anniversaryof the Index Catalog - 99th by virtue of its publication date and 100th byvirtue of its completion.

Today the NLM contains over 1.3 million items in its collection, uniquelyorganized to meet needs of health professionals and students in the healthprofessions. In the coming year, the Library expects to make 115,000 inter-library loans; will likely respond to some 80,000 reader requests fromreaders who come to work in the facility; will provide about 11,000 referenceservices and about 28,000 special computer searches through the MEDLARS pro-gram; will index 230,000 medical articles from the Journal literature; andwill catalog 17,500 books and monographs. Indexing and cataloging will beperformed with the assistance of domestic and foreign participating organiza-tions which share these tasks with NLM. MEDLARS I, operational sinceJanuary 1964, contains \k. million citations to literature since that date.In 1964 MEDLARS entered 144,000 articles into the computers; last year 225,000.In this enormous input task, the Library has collaboration from seven foreigncountries. Through MEDLARS, the Library produces Index Medicus, Cumulated IndexMedicus. the Current Catalog and its cumulations, and some 23 special recurringbibliographies.

Dr. Gummings said that lie has boon delighted with the response of the medicalcommunity to Abridged Index Mcdicus (AIM). produced by the Library during thepresent fiscal year. AIM contains references derived from 100 English-languageclinically-oriented journals primarily directed to serving the practitioner.The subscription response from physicians and from small medical librarieshas been enthusiastic.

Regarding MEDLARS II, the Library is still deeply disappointed in the per-formance of the contractor in development of this system; serious slippagehas occurred. Furthermore, cost estimates exceed those of the originalcontract; however, the Library is still within its budgetary capability tocomplete the system if, in the Board's judgment, the system - with thepresent contractor, should be completed.

Dr. Cummings said that the Board would see later this morning a highly success-ful demonstration of the Library's first on-line bibliographic service, theADi-TWX system developed by the Lister Hill Center.

The Library instituted a fee for service about a year ago for interlibraryloans to foreign countries. As the Board predicted, the number of requestsfrom abroad has declined. A careful examination reveals that there has beenno lessening of need for the service. The decline in requests stems fromadministrative difficulty in obtaining dollar exchange.

The Library has stopped providing MEDLARS service abroad. The foreignMEDLARS network which stretches from Australia to Sweden now providesthese services.

For the second year, the Library has sold its MEDLARS tapes to the JapaneseInformation Center for Science and Technology even though the Japanese stillare not using these tapes operationally for services in Japan.

The Library has completed all of its arrangements for selling MEDLARS tapesto profit-making institutions domestically. Sales will be handled by theDepartment of Commerce. A full year's tapes will cost $30,000.

Under the Medical Library Assistance Act, the Extramural Programs haveprovided almost 600 awards to medical, hospital, and allied healthlibraries in all states except Alaska for strengthening collections, pro-fessional staffs, and readers' .services. The Library, furthermore, supportsten Regional Medical Libraries. It is negotiating with these institutionsto convert from grant supported to contract supported service activities.

Since the last Board meeting, the Assistant Secretary for Health andScientific Affairs has designated the Director of the Library to serve ashis Deputy for Biomedical Communications. In chip capacity the Directoris heavily engaged in being responsive to the Office of Science and Tech-nology, which has asked every Department of the Government to report onits expenditures for scientific information and communication.. TheDirector has also been asked to respond to questions addressed to theDepartment by the Office of Budget and Management. These questions dealwith basic aspects relating to publications, information systems management,and related matters.

Dr. Cummings remarked that he has boon delighted with the leadership broughtby Dr. Charles Bridgman to the National Medical Audiovisual Center.Dr. Bridgman has been exquisitely sensitive to the policies and guidelinesdeveloped last year by the Board, particularly with regard to innovativemedia development and distribution of audiovisual materials for healtheducation.

The Library is working very closely with Dr. Kenneth M. Endicott, Directorof the Bureau of Health Manpower EducaLion, to develop a common set ofprograms through whicli to use resources of the NMAC in behalf of professionaleducation and manpower training and has reached the following general under-standing:

For those productions which the Bureau wishes to develop, it will providefunds on a cost reimbursable basis and professional manpower to join theLibrary's highly skilled technical capabilities in script writing and pro-fessional production. It appears that units involved in dental educationand nursing education are prepared to utilize the resources at NMAC.

Dr. Cummings commented on how pleased he has been with the leadership andtechnical competence brought to the Toxicology Information Program byDr. Henry Kissman. Dr. Kissman has demonstrated the capability of theLibrary and the Toxicology Information Program to be responsive to theoriginal PSAC report and plans. The Toxicology Information Program hascompleted plans for creation of a MEDLARS-based abstract journal to becalled The Health Effect of Environmental Pollutants, an important sequelto the highly successful index generated by the Library, Selected Referenceson Environmental Quality As It Relates to Health. The Library has receiveda number of compliments for this index not only from subscribers to thisnew service but also from agencies such as the Environmental ProtectionAgency and the Food and Drug Administration.

The relations between the Lister Hill Center and NASA remain excellent.Also, the NLM maintains good relations with the National Science Foundation,Food and Drug Administration and the other two national libraries.

The Library has, in essence, had no budget increase from 1968 to 1972. Ithas had to absorb the usual, incessant, inflated uncontrollable costs duringthis five-year period. A memorandum to Dr. Egeberg, which was endorsed byDr. Marston, clearly points out that the NLM cannot be expected to maintainthe level of service that will be satisfactory to the user community witha continued static budget. During this 5-year period, the Library has hada reduction of some sixty-nine positions. Despite mechanization and theintroduction of other short-cuts in technical processing, the Library canno longer guarantee to provide efficient services with the present levelof manpower.

There are essentially little more than cost-of-living increases in one or twoprograms and no cost-of-living increase in most programs. The brightest notein the FY 1972 budget is an authorization for seven additional positions inthe Lister Hill Center.

The budget for the Extramural Programs shows no significant change.

In response to questions from the Board, the Director estimated that a5% increase ($1 million) would be required Just to offset inflation,and a $15 million increase over the next five-year period would be requiredfor any significant progress. For 1972, the Lister Hill Center requiresan increase of $1 million, and the Extramural Program, $2 million. Withreference to the Toxicology Information Program and the President'sScience Advisory Committee (PSAC) request and recommendation for develop-ment of a comprehensive computer-based information resource, at least a$10 million commitment must be obtained. Dr. Cummings indicated thatfor 1972, the Library's budget should be increased by $3.5 million--$1 million for cost-of-living increases and $2.5 million for programdevelopment.

REPORT OF LIBRARY OPERATIONS

Dr. Joseph Letter, Associate Director, Library Operations, discussed thefollowing:

1. New products -- Abridged Index Medicus, Cumulated Abridged IndexMedicus, Semi-weekly Catalog Proof Sheets, Tissue CultureBibliography, Selected References on Environmental Quality as itRelates to Health, New Literature Searches, Library Network/MEDLARSTechnical Bulletin, and Audiovisual MEDLARS Orientation Packages;

2. Expansion of existing services and development of new services --Integration of document delivery and of MEDLARS services with theRegional Library Network, establishment of new MEDLARS centers inJapan and Canada and negotiations with Belgium, field testing ofAIM-TWX at NLM and at MEDLARS centers, integration of audiovisualcataloging with the NLM catalog file (in cooperation with NMAC),development of prototype book catalogs for the Naval MedicalResearch Library, and commercial production of NLM catalog cardsets;

3. Improvement in the quality of products and services -- Airliftingof foreign Index Medicus serials, timeliness of Index Medicus andof MEDLARS products; throughput time for interlibrary loans,MEDLARS search services, reader services, quality control proce-dures for indexing and for MEDLARS searches, evaluation of theLibrary's acquisition policies and practices, and review andassessment of the Index Medicus and the MEDLARS data base; and

4. Cost of Library procurement -- The results of a brief study thatanalyzed the effect of inflation on the cost of periodicals andmonographs during the period of 1960-1970, and the impact of in-creased costs on the acquisition of rare books for the History ofMedicine Division.

Dr. Leiter concluded his presentation with a successful, livedemonstration of AIM-TWX.

MEDLARS II DEVELOPMENT

Mr. Ralph A. Simmons, Associate Director for the Library's Computer andEngineering Services, reported on a staff review of the MEDLARS II pro-ject, which is under contract to Computer Sciences Corporation. Theprincipal occurrences since the November Board meeting are these:

Report of a CSC technical audit, Board of Regents consultants' review,preparation of hardware recommendations, detailed procedural design, pro-ject control document, detailed schedule of sub-events, and IBM systemssupport.

In their technical audit, CSC summarized the status of the project asfollows:

a. design -- nearing completion but requires extensive documentationand NLM approval;

b. software -- the major portion has been completed and furtherprogress can only be made after acceptance of design;

c. project problems -- analysis of causes concluded and correctiveactions undertaken. (The report did not attempt to discuss thedetails concerning delays but to report status and plans forthe completion of the project.)

The technical audit led CSC to the following conclusions and recommendations;

a. that the system does meet each of the functional, contractualand design requirements;

b. that a separate task force be set up within the projectdedicated toward the development of proper system testing;

c. that a complete rescheduling of the project is necessary(This schedule was included in the report); and

d. that a separate task force within the project organization beestablished to plan and conduct the acceptance testing requiredby the contract.

The audit report concluded that the design and implementation of theMEDLARS II system are basically sound and that the problems of atechnical nature deal with the process by which the system was developed.

Based on its detailed review of the audit report, the Library's principalcriticism is not with what is presented but with what is missing. Thereport lacks evidence that tho system will perform adequately.

A Board of Regents consultants' review,independently conducted inmid-December by two computer and systems experts from the Bank of Americaand two from RAND, confirmed the conclusions of the Library review andwere reported to the Board by Mr. Zipf and Mr. Augenstein. The con-sultants' findings suggest that the contractor has not performed welland that NLM must examine alternatives in seeking to complete the system.

The Library has requested departmental approval to upgrade the IBM 360/50to an IBM 370/155. Although the MEDLARS system objectives have notchanged since the original justification of the project, the softwaresystem developed by CSC has exceeded the capability of the hardwareproposed originally. This is attributable to the development of a verygeneralized data management system rather than a specialized softwarepackage with limited capabilities. In addition, the computer facilitiesare intended to support all program elements of the Library; some of theother applications to be accommodated are the Audiovisual DistributionSystem for NMAC, a chemical name-matching system for the toxicology program,and the AIM-TWX on-line project developed under the Lister Hill NationalCenter.

On the basis of an analysis made by staff and IBM, the Library hasrecommended lease instead of purchase for the upgrading of equipment.The present intent of the Library calls for installation of the centralprocessor and transmission control unit in July or August, with peripheralsto be added over a period of about six months.

From its evaluation of the detailed procedural design, the NLM staffagreed that major sections are, in general, acceptable. The acceptablesections deal with objectives, description of data flows, single iteminput processing and file descriptions, analysis of MEDLARS II publications,and conversion capability. The principal objections to the detailedprocedural design were poor organization and presentation; detailedprocedures for obtaining objectives were not included; the productionsystem design was Inadequately covered; the relationship of ADP withfunctional modules was inadequate; and file maintenance procedures wereunclear. In addition, the design document contained a significant numberof inconsistencies, and cataloging details were inadequate.

10

The NLM felt that the project control document is generally acceptable,but CSC was attempting to shift responsibilities of the contract andhad failed to provide adequate scheduling detail. Documentationidentification was incomplete; conversion roles of NLM and CSC were notclearly defined; the acceptance test plan timing appeared inadequate;and the operational test plan was too general.

Software progress was difficult for NLM to evaluate, although the testoutput on the Linotron and the high speed printer were successful. CSCis now involving their own software personnel more closely with theirown design personnel. In some critical areas of design, a number oftheir own software personnel are telling their own management personnelthat they, the former, do not know how to fulfill design events.

Mr. Simmons, in discussing NLM schedule and cost estimates, said thatit is his view that it would cost the Library $270,000 to go throughthe testing necessary to make the system dependable for production.Therefore, Mr. Simmons arrived at a total cost of $3,970,000, andavailability of the system not earlier than June, 1972. The most recentCSC cost estimates now are $3,648,000, with a system available for testingby mid-November, 1971.

In view of all circumstances, Dr. Gummings had addressed a letter toDr. Nashman, East Coast Vice-President of CSC, with these specificinstructions:

Hold cost to $17,500 a week; provide plans for software documentationby May 1; provide COSMIS and LPS (software pieces) design specificationsby May 1; provide documentation by August 31 for software developed byJuly 31; limit system development to the basic MEDLARS I capabilities,including augmented vocabulary capability; provide, by May 1, demonstrationsof conversion of vocabulary and citation files, the creation and maintenanceof the index citation file, the creation and maintenance of the vocabularyfile, conversion of MEDLARS I to MEDLARS II, and a complex demand searchwith output on the line printer; and provide estimates of the totalpro-duction environment.

The CSC response to this letter in effect reiterated their previousposition while stressing their problems in handling personnel.

Mr. Simmons now recommended to the Board and the Director that the Libraryallow delivery of selected demonstrations as late as May and insist on aplan and schedule for documentation; and that the Library evaluate demon-strations and the CSC projection of the production environment. Then, ifthese demonstrations are acceptable to NLM, the Library should renegotiatethe contract and plan to proceed to completion of the initial system. Inevent the demonstrations are unacceptable, the Library should terminate thecontract with CSC; develop, review, and select from alternatives; and planactions accordingly.

11

The alternatives for the development of the capabilities originally intendedfor the EXTENDED phase of the MEDLARS II system have been examined by theLibrary staff. Mr. Zipf and Mr. Augenstein pointed out that the success ofthe AIM-TWX experiment conducted by the Lister Hill National Center in con-Junction with Library Operations has led to consideration of AIM-TWX as amajor replacement for the on-line search and retrieval capabilities ofMEDLARS II. Although technical problems remain to be solved, this substitu-tion is believed to be the best solution for the Library.

The other functional activities intended to be supported by on-line capabili-ties will be reviewed and priorities established. Alternatives will be soughtfor the development of these capabilities as appropriate. The EXTENDED phaseof MEDLARS II will not be developed by CSC.

In the Board discussion which followed, Mr. Augenstein said that a number ofBoard members are pessimistic about the ability of the contractor to performon schedule. The architecture of the system is quite faulty in many respects.Mr. Zipf expressed the thought that the Government process is at fault alsobecause the contract was awarded to the lowest bidder rather than to themoat capable bidder. Mr. Zipf said that there is an outside possibility thatthe project can be salvaged, but only in the kind of environment in which theLibrary and the contractor perform the contract as a united team. In responseto a question from Mr. Zipf, Dr. Baker replied that we are not beyond the•tate-of-the-art in hardware or in systems potential. Mr. Augenstein agreedwith Dr. Baker but added that although every operation proposed in the systemcan be programmed, the problem lies in the time element - seconds, or tnilli-•aconds, or even less. To make the system useful in the Library's senseraquires very short times.

Dr. Cummings remarked that although the Library is by no means pleased withwhat has happened, it does have options not yet presented to the Board.Further discussion was left for the Executive Session.

EXPERIENCE WITH MEDLARS I AND PLANS FOR MEDLARS II

Dr. Bergstrom introduced his report with the following background history:

In January 1964, the Swedish Medical Research Council approached NLM andauggested cooperation in the development of MEDLARS I. The British did thesame at a later date, but started at once to reprogram for their KBS-9. Ayear later, Sweden did likewise.

When the State Department decided to offer MEDLARS to the Organization forEconomic Cooperation and Development (OECD) at the beginning of 1966, allOECD members were invited to participate if they would agree to index 60,000articles. The NLM was prepared to start a third center in Europe. Despitesix meetings over the next eighteen months, OECD could not agree; eachcountry wanted a center of its own. Finally, after eighteen months, it wasproposed that any country with Interest in having people trained to useMEDLARS and with an actual volume of 500 searches a year would be qualifiedto be given training and the tapes to establish a center on a quid pro quobasis.

12

The NLM negotiated bilateral agreements with Sweden and with England, andboth countries agreed to do a certain amount of indexing. Subsequently,France qualified for a center and Germany obtained training both inStockholm and the United States. Initially, Sweden processed German searches;now Germany processes its own.

Sweden offers extensive training for its Scandinavian neighbors. The trainingperiod has been reduced to four weeks. Since 1968, Sweden has given twocourses yearly for trainees from Sweden, Norway, Denmark, Finland, and Belgium.Germany this year has sent eleven trainees, and Sweden's first trainee fromPoland is enrolled in this spring's course. Eastern European countries havea large interest in the program. Under its contract, Sweden is permitted tosupply searches to Eastern Europe.

Since the beginning of MEDLARS services in Sweden, all costs have been carriedby the Swedish Medical Research Council. For two years, the Swedish centerhad a special grant from the Scandinavian Culture Corporation so that thecenter would be able to supply 100 searches for each country free of charge.

Stockholm processes retrospective searches quarterly and now charges for them.Since the charge was initiated, demand has decreased by about 507,.

Sweden concentrates mainly on monthly recurring searches, because most activeresearch workers have need for a continuing service. Approximately 400 monthlysearches in Scandinavia are paid for at a rate of $60.00 a year for the twelvemonthly searches. Sweden was supplying Germany with 1200-1300 searches permonth, but since February, Germany is processing its own.

The Swedish delivery schedule is four weeks - a serious drawback for retro-spective searches. Faced with the MEDLARS II program and the likelihood thatthe 7090 program would be phased out, the Swedish center decided to reprogram.By January, the center had a complete system running on a 360/50 and is nowrunning it on a new Government computer unit, a 360/55. By next month turn-around time should be one week to ten days.

The Australians received the 360/50 version in January and now have it inoperation.

The Swedish center expects to stay with MEDLARS I for several years for retro-spective and for monthly profiles and then use the ELHILL II and III programs.

Although NLM offered MEDLARS to the World Health Organization (WHO) in 1966or 1967, and a WHO survey indicated a need of 12,000 searches a year fordeveloping countries and for WHO's own experts, WHO has taken no action toestablish a center.

Dr. Bergstrom referred to a critical review of WHO's information system byhim and Dr. Leiter. He is interested in starting a WHO research and develop-ment effort in the field of human reproduction to improve documentation andliterature service in that field. Dr. Bergstrom would like to have NLMcooperate in this effort.

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A very crude estimate of the number of papers related to human reproductionis 20,000 annually, of which (50-) 60% are indexed in MEDLARS. A considerablepart of the remainder is indexed by Chemical Abstracts (CAC) and BiologicalAbstracts (BA). It is proposed to establish a "subfile" or specialized IMfile for human reproduction at the Biomedical Documentation Center atKarolinska Institutet in Stockholm (BMDC), since part of the KarolinskaInstitutet has been assigned as a WHO research and training center in humanreproduction. This Specialized Index Medicus "file would contain the presentINDEX MEDICUS (MEDLARS) coverage of the literature. To this would be added -by a special indexing effort at BMDC - articles, reports and reviews, includingreports and information collected by other WHO centers 'and units of variouskinds, to yield one consolidated special IM file in Stockholm. It would beformatted and organized to the new ELHILL II AND III, including addresses ofthe authors, and, when wanted, abstracts. The whole subfile would be directlyaccessible.

The ELHILL System with direct access to the AIM-TWX file by terminals will beInstalled at Karolinska Institutet during the summer of 1971.

The advantage of utilizing and expanding an existing system is obvious froman economic point of view. The system could be in full operation fromJanuary 1, 1972. It is also especially valuable as WHO-Geneva is planning toInstall a MEDLARS operation on the same hardware as that of the center inStockholm. All systems and programming efforts at BMDC could therefore bedirectly utilized at WHO and other centers.

The present MeSH-vocabulary is insufficiently developed for the needs of thewhole field of human reproduction; it is, therefore, proposed that an immediateeffort be made to develop such a vocabulary in cooperation with NLM. Specialnotice must be taken of hormones, drugs, and other chemicals of interest,teratogenlcity, toxicity, etc. An international group of specialists shouldassist in this effort.

It is proposed to produce and send monthly profile or retrospective searchesto countries that do not have MEDLARS services or do not have any foreigncurrency. Dr. Bergstrom said that he had made site visits to Poland, Hungary,and Russia and had sent some searches to these countries. It is pathetic tosee what tremendous impact this has on them, how isolated they are, and howslowly they get access to literature.

A special effort is planned for recording clinical trial data, side effects,etc. in the systems and formats evolved in other WHO projects. Contacts andefforts to cooperate with existing documentation and abstracting servicesof different kinds should be undertaken.

From the site visits it has already been found that a great need exists forimmediate services of the type BMDC is already performing (%d500 monthlyprofiles were distributed in January 1971). Funds are listed for coveringthe cost of 500 human reproduction profiles to be sent to scientists inmember countries where this type of service Is not available and is needed.A similar retrospective service should also be available.

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The data base and the data system should contain a complete cross-indexedfile to authors and workers in the field, and their addresses, interest,and competence profiles compiled and updated continually and automaticallyfrom the published literature and from within the WHO network of cooperatingcenters and other units. The file would also be available by direct accessfrom WHO Headquarters in Geneva.

Xerox service of copies is envisioned only on a very selective basis. Thisservice would be provided to laboratories in countries where such servicesdo not exist.

Dr. Bergstrom closed his presentation by the question: "Where in the worldwould we be without the work and the initiative of NLM?" He complimentedNLM for its development of AIM-TWX and indicated a desire by the SwedishGovernment to use this system.

REMOTE BIBLIOGRAPHIC ACCESS

The following presentation was made by Mr. Davis McCarti, Acting Director ofthe Lister Hill National Center for Biomedical Communications.

Since June 1970 the Lister Hill National Center for Biomedical Communicationshas been providing an experimental on-line, remote-access bibliographicservice called AIM-TWX. The AIM stands for the Abridged Index Medicus, the100 most important English-language serials in clinical medicine, the lastfive years of which comprise the data base for the service (now about 130,000citations). Access is also available through the teletypes and IBM 2741'son the Standard Telephone Network. Over 40 medical schools, hospitals,libraries, and biomedical research institutions have used this service whichallows rapid, interactive bibliographic searches.

At the request of the Director, NLM, the Lister Hill National Center forBiomedical Communications, in collaboration with other elements of the Library,has undertaken & review of the extent to which the programs, ELHILL II, underdevelopment by the System Development Corporation could meet on-line biblio-graphic service objectives of MEDLARS II. The preliminary conclusion of thisreview is that ELHILL II, with modifications, can meet the goals of theMEDLARS II (Extended) system in the provision of remote-access bibliographicservices. If operated on the planned IBM 370/155 computer, the system wouldprovide responsive access to 40 or more simultaneous users. On the basis ofthis conclusion, the problems of actually implementing the on-line systemhave been studied.

Planning for the on-line, remote-access bibliographic service has been based,in part, on experience gained from the AIM-TWX experimental service and, inpart, on projections of the service goals of the NLM. Six major decisionareas have been investigated; these include (1) the probable total demand forthe service and the numbers of communication lines required to meet thesedemands; (2) the improvements required in the presently planned ELHILL II inorder to meet service goals of MEDLARS II (Extended); (3) hardware requirements,schedules, and costs to implement the service; (4) data base alternatives;(5) communication network alternatives; and (6) decentralized computer servicealternatives. Progress in each of these areas is described below.

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Senior staff members of the NLM provided the Lister Hill Center with a minimumlist of users of the planned service. This list included all the medicalschools and the major biomedical research institutions. Based on presentAIM-TWX request rates, the preliminary estimate of demand is approximately70,000 requests per year. Servicing this request rate would require 22telephone lines into the computer. If the service were extended to halfthe hospital and academic libraries with serial holdings of over 150 titles,the request rate might rise to over 180,000 per year and would require 57telephone lines. (Present MEDLARS demand searches number less than 20,000per year in the United States). Either of these request rates could probablybe handled by the IBM 370/155.

The capabilities in the present ELHILL program were reviewed in comparisonwith MEDLARS I and II to determine those which needed to be added to theELHILL program. A joint review defined a group of 15 required improvementscosting about $100,000. The present program will be available to run on theNLM computer in July 1971; the improvements could be added by November orDecember 1971.

The Office of Computer and Engineering Services (OCES) reexamined the planningfor the IBM 370/155 and determined that the equipment on order would allow theprovision of the remote-access bibliographic service. In addition, that officecomputed the additional cost to the NLM of providing the service over and abovethe costs of the planned applications; that additional cost amounted to about$12,000 per month for 8 hours of service per day. If the system averaged 30simultaneous users, a single search would cost about one dollar for computerservices.

The Library Operations staff has conducted a study of data base alternatives.Detailed data on Priority I and Priority II Journals have been developed formaterial published in 1969, and alternative data base configurations have beeninvestigated. It now appears feasible to provide a data base of great generalutility with 400,000 to 500,000 citations. The Lister Hill Center staffconducted an operations analysis of data base alternatives and concluded thattrade-offs between depth (in years) and breadth (in serial titles) were suchthat there were no clear optima and any reasonable decision between thesewould meet essentially the same portion of the needs.

The Lister Hill Center has been investigating communication alternatives.The use of the regular dial telephone network would be expensive and communica-tion costs would exceed computer costs by a factor of ten. Alternatives beinginvestigated include use of the Federal Telephone System (FTS), Inward WideArea Telephone Service (INWATS), development of a multiplexor network, andconnection to the multi-computer network of the Advanced Research ProjectsAgency (ARPA). Preliminary calculations have been completed on a multiplexornetwork through Boston, New York, and Philadelphia to NLM. Such a networkwould cut communication costs for an average search by a factor of five.Preliminary discussions have been held with ARPA and planning is underway totest that network from the SDC computer. A contract has been signed with theNational Bureau of Standards to assist in communications planning.

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The use of multiplexors is cheaper than duplicating the system on othercomputers; however, to provide backup and alternative facilities for testof the system, consideration is being given to operating the system atSystem Development Corporation, and another smaller configuration.

In summary, it appears both feasible and desirable to provide an improvedremote-access bibliographic service from the NLM in 1971. Such a servicecould provide inexpensive access to a large data base. Its availabilitycould reduce the substantial annual expense of the MEDLARS Search Centers.Planning is well under way to develop this service. The Library is now inthe process of obtaining the software programs, which will run on any 360or 370 computer system with adequate core memory.

Dr. Baker expressed the view that the Library was working at exactly theright scale and that the system would likely be a pattern for others.

100th ANNIVERSARY OF MEDICAL DEPARTMENT. U. S. NAVY (EXHIBIT)

Vice-Admiral George M. Davis, the Surgeon General, U. S. Navy, brieflycommented on the 100th anniversary of the Navy Medical Department anddirected the Board's attention to the exhibit presently in the lobby ofthe Library.

EXTRAMURAL PROGRAMS I/ 21 3/REPORT OF THE ASSOCIATE DIRECTOR FOR "EXTRAMURAL PROGRAMS

After reviewing the 1971 Budget of $6 million, the 1972 Budget, which carriesno significant change, and a "need" budget of $8 million, Dr. Langley andhis staff presented the following policy and information items:

Policy for Support of Publication Projects -- Because the applications recom-mended for approval in a given year may exceed available funds, the Board wasasked whether program priorities should be assigned in addition to prioritiesbased on merit review. The Board's subcommittee, when considering the question,said that since there is presently no discrepancy between the money requestedand the money available, the problem does not exist. The Subcommittee agreedthat until the Library is completely overvhelmed with applications, they wouldrather not have a firm policy decision on which programmatic requests will befunded. Instead, they would like to look at all applications at each round of

\_l Proceedings of meetings are restricted unless cleared by the Office of theDirector, National Institutes of Health. The restriction relates to allmaterial submitted for discussion at the meetings, the agenda for themeetings, and supplemental material, and all other official documents.

2/ For the record, it is noted that members absent themselves from the~" meeting room when the Board has under individual discussion applications

(a) from their respective institutions, (b) in which a conflict of interestmight occur.

2/ The Board of Regents, when considering the Extramural Programs of the NLM,also consists of the National Medical Libraries Assistance Advisory Board,and concurrently discharges the responsibilities of both bodies.

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meetings and make decisions at that time. The Subcommittee urged the Staffto program actively to stimulate publications in the fields of librarian-ship and biomedical communications. Should the Library reach a pointwhere decisions along policy lines must be made, priority should be givento publications in these two fields. The Board concurred in the recommenda-tions of its Subcommittee.

Normalizing or Standardizing Priority Scores on Grant Applications -- Theproblems of relating priority scores from different study sections and fromthe same study section over a period of time are now being evaluated by anNIH-wide committee. This committee is now developing a procedure to normalizeall priority scores to a common mean. The two methods now in use at NIH tonormalize priority scores are the decile method and the "Z score," or normali-zation, method. The decile method is a procedure by which the "raw" priorityscores are taken in priority order from each Study Section and then dividedinto a distribution of tenths. The "Z score" method is a procedure of con-verting raw scores to distributions with a common mean. The common meanused by the Heart Institute (240) is based on a four-year study of thepriorities given by their Study Sections. The formula for converting a rawscore to a standard score with a common mean and a common standard deviation,called standardization, is

Standard Score - Raw Score - Mean x New Standard Deviation + New MeanStandard Deviation

The Subcommittee decided that since the Library deals with very small num-bers of grants in the three primary review committees, to engage in thesuggested procedures would not be mathematically feasible. The Subcommitteerequested, however, that Staff manipulate the scores by the suggested pro-cedures, and see if the manipulations significantly alter the priority list.

Board of Regents Review of Grant Applications Under the Medical LibraryAssistance Extension Act of 1970 — The FAST group which reviewed the NLM'sprograms recommended that the Board of Regents not routinely review allgrant applications submitted under the Medical Library Assistance ExtensionAct of 1970. The Board of Regents, at its meeting in November of 1970,raised the question as to whether it is legal for grants to be awardedwithout Board review.

The General Counsel's Office, DREW, has informally stated that althoughthe Board must review every application for construction funds, it neednot review individual applications for support of resources, training, re-search, publications, or special scientific projects. At present, thereis a regulatory requirement for Board review of individual grant requestsin the Regional Medical Library Program.

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Regulations (42 CFR Part 59 a, Subpart D) -- grants for special scientificprojects, and for research and development (including demonstrations) inmedical library science — Draft proposed Regulations under P.L. 91-212 --The draft regulations prepared by the Office of the General Counsel with theassistance of NLM staff generally follow the language and format of Part52 which governs the general research grant regulations for the researchinstitutes of NIH. The decision to develop a new and complimentary setof regulations for the Library's research and special scientific projectsprograms was necessitated by specific changes in the language of theExtension Act.

A new provision has been added permitting the transfer of an existing grantfrom a grantee to any other eligible person or institution upon applicationby such persons in accordance with the regulations; the grantee would berequired upon request by the Secretary to transfer such equipment purchasedwith grant funds. A proviso is included for the protection of granteesto the effect that no transfer of a grant may be made where the originalgrantee remains ready and able to continue the project in accordance withthe original terms and conditions of the award. Such provision will proveuseful where, for example, a university is the named grantee and theprincipal investigator accepts a position at another Institution. In effect,such provision will enable him to "take" the grant with him, includingequipment, and continue to conduct the project at his new location.

Also, a section has been drafted to conform with the recent NIH policy onthe disposition of grant related income set forth in the NIH Manual, Ch. 5601(7/1/70). Briefly, such policy provides that where grant related income isanticipated, NIH may prescribe at the time of award, the time and the methodof reporting, and the disposition of the NIH share of such income. In allother cases, the grantee may elect the manner of disposition of such incomewithin certain specified options.

The Staff sought the Board's opinion as to whether this policy may be lenientto the point of allowing grantees to profit from windfall gains if unantici-pated income derives from a grant. Furthermore, the Staff expressed the viewthat the language in this section needs revision.

Because the matter of income is such an important one, the Board felt thatNLM should maintain some measure of control. The Board concurred in approvalof the regulations in general with the understanding that wording changesto improve the language in the section will be acceptable to the Board.

Resource Improvement Grant Applications — Medical Library Resource GrantProgram -- The FAST group recommended that in the Resource Program thecurrent procedure of having Committee review of all new, renewal, and supple-mental applications be modified to permit staff review, approval and awardingof certain types of applications. The Committee and staff were advised todevelop criteria to determine which applications require outside review andwhich do not. The NLM concurred in this recommendation and on February 3, 1971,a plan for staff review of certain Resource Grants was presented to the Committeefor their consideration. The Committee unanimously approved the staff reviewprocedure which is based on seven criteria for evaluation of applications.

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The Committee also endorsed a staff proposal that a one-year $3,000 non-renewable "Resource Improvement Grant" be made to institutions for thepurpose of establishing a library, or for the purpose of expanding orimproving present libraries having inadequate resources relative to theirneeds and user population.

The Subcommittee of the Board concurred in both actions of the BiomedicalLibrary Review Committee and yet another to the effect that no applicationfor a $3,000 resource improvement grant be recommended for disapproval. Allsuch applications would be funded in accordance with an assigned priority.(See "Consideration of Pending Applications")

Resource Project Grant Proposals for Library Automation -- Medical LibraryResource Grants are intended to aid in the establishment, improvement, andexpansion of the Nation's health science libraries. Under the provisions ofthe amended Resources Program it is to be expected that many applicationsfor these Project Grants will be concerned with the automation of libraryprocedures. Rapidly changing technology, and the consequent changes inthe library environment make it increasingly difficult to keep abreast ofthe latest developments in library automation.

The Committee believes that if they are to evaluate Resource Project Grantproposals for library automation effectively and equitably, they needconcise, factual information concerning the present "state of the art."They, therefore, recommended that an "ad hoc" committee consisting ofexperts in the field of library automation be established. This committeewould: (1) review the characteristics of the Grant Program and of thegrant review mechanism; (2) consider the subject of automation as it relatesto some of the specialized problems in health science libraries; (3) preparea report which would describe, in less technical terms than are usuallyfound in the literature, the current status of library automation. In theinterim, the Biomedical Library Review Committee deferred action on all pend-ing applications until their next meeting, by which time they will have thebenefit of the "ad hoc" committee's report.

The Subcommittee of the Board viewed this as a sensible approach to a difficultproblem, and the Board concurred in the Biomedical Library Review Committee'srecommendations.

Resource Grant Support of Audiovisual Activities -- The Library is now receivingResource Project Grant applications in which the "project" is the establishmentof a complete audiovisual library. Slide, tape, and film production facilitiesare being requested, and many of the "Learning Resource Centers" in academicinstitutions are considering grant requests to create individual learning labswith an array of systems including closed circuit television and dial accessretrieval.

The Biomedical Library Review Committee believes that some policy guidelinesshould be established to assure proper and effective use of grant funds inthis library service area. The Committee thinks that the production of audio-visual material is not an appropriate library activity. Also, while the

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Committee acknowledges that the library should be an important component ofthe total educational effort of the institution, it believes that the libraryshould not be the source and the center of an institution's educational pro-gram.

The Subcommittee of the Board agreed with the Biomedical Library ReviewCommittee, and the Board concurred in the feelings of both the review com-mittee and the Subcommittee.

Recommendations of the NLM "Ad Hoc" Committee on Historical Translations --An Ad Hoc Committee on Historical Translations, convened by the Library, metto evaluate current NLM P.L. 480 historical translating activities, and toassist in the development of criteria for funding new historical translations.

The Committee affirmed the need for NLM's assuming an expanded role in spon-soring the English-language translation and publication of significant worksin the history of medicine, in the history of biomedical sciences and studiesrelating to medicine and culture, for use not only by scholars in the field,but for a wider audience in the U.S. community of physicians, health scientists,and medical students.

The Committee made specific recommendations on translation of primary sources,translation of secondary sources, reprinting of out-of-print classics, foreignlanguage facsimile reproductions, and identification and preservation ofprimary source materials in medical history. The ad hoc committee, furthermore,made procedural recommendations on funding, establishing translation priorities,publication and distribution of translations, scientific review of completedmanuscripts, and U.S. scholarly collaboration with foreign scholars. Finally,the committee provided review and recommendation of specific historical studiesfor translation and publication.

Training Grant Program Directors Meeting -- Dr. Kaufman announced that theResearch, Training, and Publications Division of the Library's ExtramuralPrograms is organizing a two-day conference of NLM-sponsored Training GrantProgram Directors. The conference will take place on May 9-10-11, 1971, atBelmont House. Participants will include the program directors, one represen-tative each from the Board of Regents, the Biomedical Library Review Committee,and the Biomedical Communications Study Section, a consultant expert on trainingin the health sciences, and appropriate NLM staff; the total not to exceed30 individuals.

Biomedical Communications Study Section Evaluation of NLM Research Grants —Dr. Kaufman announced that at the request of the Extramural Programs, andwith concurrence of the Director, NLM, the principal investigators of tworesearch grants presented reports of their research at the January 27 meetingof the Biomedical Communications Study Section. Following the presentationsand a quest ion-and-answer session, the study section discussed the projectsin private. This seminar session was an experiment in NLM-study section com-munication and program evaluation. The study section is planning a workshopon four topics in biomedical communications.

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Commendation by the Subcommittee to the Associate Director for ExtramuralPrograms and His Staff -- At the close of the presentations by Dr. Langleyand his staff, the Board Subcommittee for Extramural Programs commendedDr. Langley for his exceptional presentation of complex and difficult material,particularly with respect to policy.

Consideration of Pending Applications

The Board of Regents, acting concurrently as the National Medical LibrariesAssistance Advisory Board, reviewed the following grant applications:

Research and Reviewed 14 $443,252Publication Grants Approved 4 30,996

Disapproved 9 349,756Deferred 1 62,500

Training Grants Reviewed 3 295,098Approved 1 101,742Disapproved 2 193,356

Resource Project Grants Reviewed 87 $2,579,504Approved 10 111,066Disapproved 64 1,769,178Deferred 13 699,260

Resource Improvement Grants 135*

* Board concurrence for Staff review only

Summaries of Board actions on all Extramural Grant Programs are appended tothese minutes.

APPOINTMENT OF A NOMINATING COMMITTEE TO NOMINATE THE NEXTCHAIRMAN AND VICE-CHAIRMAN OF THE BOARD OF REGENTS

The Chairman, Dr. Ebert, appointed Dr. Layton, Dr. Hekhuis and Mr. Augensteinto nominate the next Chairman and Vice-chairman of the Board and to presenttheir nominations to the Board in June. Dr. Ebert asked Dr. Layton to serveas Chairman of this nominating committee.

The Board reconsidered its meeting date for the November 1971 meeting andselected Monday and Tuesday, November 22-23, 1971.

TOXICOLOGY INFORMATION PROGRAM REVIEW

Dr. Henry M. Kissman, Associate Director, Specialized Information Services,provided a background description of factors leading to establishment of theprogram and discussed its mandate, its resources, its fiscal constraints, itsservices, its plans for the future, and basic principles which have to beapplied to information activities of this nature.

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The basic mission of the Toxicology Information Program is the implementationof the 1966 President's Science Advisory Committee (PSAC) Report on theHandling of Toxicologi>..il lnfonu.it ion. Specifically, that PSAC Panel recom-mended "that Llie establishment of a computer-based system for handling toxi-coloyical inform.it.iori. .. .be given high priority within (the Department of)Health, Education and WeJfare and be established with a speed commensuratewith the urgency of the need."

When the program was located in the National Library of Medicine in 1967, theLibrary estimated that it would take approximately $10 million over a 5-yearperiod, plus even-leveled support thereafter, to bring this program to fruitionwithin the parameters outlined by PSAC. The resources which actually becameavailable to this program during the period 1967-1971 are only about 407= ofwhat had been expected during the planning and initiation period. This refersboth to funding and to personnel resources.

Since its beginning, the program has enjoyed the valuable advice of a specialCommittee of the Division of Medicine of the National Academy of Sciences --the Toxicology Information Program Committee, or TIPCOM. It was on the adviceof this Committee that the program, in 1969, restricted its aims severely andconcentrated on pesticide toxicology as a first step and as a model for othersections of the general toxicology field.

The over-all objectives of TIP are to create automated or computerized toxi-cological information and data banks from the literature, from the files ofcollaborating government agencies, and from such other data files as can beobtained. The program has the further objective of establishing informationand data services for the scientific community.

The scientific literature, including primary and secondary journals, reports,and monographs, is an obvious source of such information and data. However,as the 1966 PSAC Panel found, a great deal of toxicology data not appearing inthe published literature are contained in the files of Government agencies andof industries.

Using the literature to build an abstract or article file costs about $200-$250per compound. The cost of data extraction from an existing file is approximately$150-$200.

Last June, the Director of the Library took an important step by declaring thatthe personnel and financial resources of TIP would be made fully available to"mobilize" relevant toxicology data in the files of cooperating Governmentagencies. The principle of using one's own funds to support the creation ofdata systems for other agencies has some significant consequences. The primarybeneficiary of such a policy is the agency whose systems are being transformedinto modern computer-based systems at no cost to its management. It becomesvery hard for such an agency to say "no" to such a proposition. The ultimatebeneficiary is, of course, the scientific community.

In its files, the FDA had 400 primary pesticide petitions and 600 secondary,or derivative, petitions. These files have now been moved with the pesticidepetition evaluation function to the Office of Pesticides of the Environmental

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Protection Agency. An existing data extraction contract of TIP with theUniversity of Pennsylvania was restructured in part so that the contractornow extracts designated data from these files. The contractor personnel areextracting dat;i for input into the selected computer system (Mark IV datamanagement system ol Informatics, Inc.).

In another example of collaboration with a Government Agency, TIP is involvedin building a central data management system and data bank for pesticidecommunity studies in the Division of Community Studies, EPA (formerly FDA).The Pesticide Community Studies program has for the last five years operatedan epidemiological study of persons occupationally exposed to higher dosesof pesticides.

In a cooperative effort involving TIP, FDA, and Division personnel, the follow-ing activities were accomplished:

(1) design of a computerized central data bank for the entire project;(2) creation of an edit and translation program which will convert all

of the incoming data (Some of the contractors have data processingsystems of their own and can deliver their data in machined form) ina uniform manner to the central system (over 50% complete); and

(3) design of a set or procedures -- still to be implemented -- whichwill salvage a portion of the 5-year, 100,000 form backlog fileinto the central system.

Last week, at a general conference of Division of Community Studies personnel,contractors, and TIP and FDA personnel, the system was formally turned over tothe Division of Community Studies for operation.

Under an existing contract, the literature from 1967-1970 is being searchedfor publications containing information about drug-drug and drug-chemicalinteractions. At present, this project represents the major activity of TIPin the drug toxicology field. It is planned to publish a Drug InteractionBibliography With Selected Excerpts to direct attention of physicians andothers in the health professions to the problem of drug interactions.

The Library is also discussing with several Journal editors the possibilityof publishing selected excerpts in their journals -- on a continuing basis --before the complete Bibliography is published sometime next year.

TIP is building several channels through which its information and servicescan reach the user population. In order to establish TIP as an informationand data center of value to the scientific community, it seemed of paramountimportance to create a distinct service unit for this Program. This unitwould have to perform in-depth literature searches, have the competence ofanalyzing and evaluating information, and have the capability of transmittingand returning this material in usable format to the original requester.Following a recommendation from the Director, NLM, the TIP negotiated withthe Oak Ridge National Laboratory (ORNL) of the Atomic Energy Commission forthe establishment of a Toxicology Query Response Center (TIQRC) as part ofthe ORNL1s Environmental Information System. The Oak Ridge National Laboratorywas selected for the site of the query response and service center because the

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Laboratory already operates some fourteen information analysis centers whichwork on the principle of using laboratory scientists for information work onan £d hoc, part-time basis. The capabilities of ORNL for this type of activityare impressive. TIQRC will be an arm of the TIP, and will be funded initiallywith some $100,000 of FY '71 TIP funds.

Using existing facilities at ORNL, TIQRC will also have access to most of thecommercial literature tape services which are now available (e.g. CA Condensates,CBAC, BIOSIS tapes, Nuclear Science Abstracts, Engineering Index). It is ex-pected that requests for services will come to TIQRC either directly throughTIP or via TIP from the Reference Section of NLM.

TIP has also established several on-line interactive computer systems for itsown operations and is now looking into the possibility of opening these systemsto the public. One of these systems consists of a file which was created byplacing the entire text of the abstract journal Health Aspects of PesticidesAbstract Bulletin QlAPAB) into an on-line, whole-text searching computer system(Mead Data Central). HAPAB is prepared on contract for the Division of CommunityStudies and has produced some 5,300 abstracts in the years 1966-1970. TIP alsoplaced into the same computer system the entire text of the Report of theSecretary's Commission on Pesticides and Their Relationship to EnvironmentalHealth — also known as the Mrak Report, after the chairman of the Commission.This report represents probably the most authoritative set of statements onthe entire pesticide problem and is a treasure trove of information.

It is quite feasible, through additional terminals, to open up the use of thesebanks to other Governmental, academic, and industrial organizations. Such aterminal will go into the Division of Community Studies at Atlanta, Georgia,within the next few days.

The originating agency pays only for machining and loading of Information.After that, the agency pays only for its own terminal, for the computer timewhich it uses in searching, and for line charges. The computer costs includecharges for storage of the data. All these costs are relatively low; itcosts TIP $95 for a two-hour weekly query session on the Data Central system.

The Federal Water Quality Administration is now actively working to place itswater quality abstracts into the Mead Data Central system. If this is done,TIP could search these abstracts for pesticide information, and FWQA couldsearch TIP data and information files for any water pollution references.

In another on-line search system which was built for TIP by the SystemDevelopment Corporation, some 3,200 authorities In various sub-topics oftoxicology were identified and registered by questionnaire. These question-naires were then machined and loaded into an SDC computer. The system is nowoperational and its capabilities are being tested. Several other Governmentagencies have expressed an interest in the on-line interactive features of thisroster, because it presents the possibility of assembling a panel of expertsquickly or of consulting an expert on an emergency basis.

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At Dr. Cummings1 suggestion, TIP has selected about fifteen journals from thearea of clinical toxicology for augmentation of AIM-TWX.

TIP has also been involved in the production of a number of printed products.Thus, the program collaborated with the National Referral Center of the Libraryof Congress on the production of a Directory of Information Resources in theUnited States - General Toxicology. Also, the Program worked with otherLibrary units on the production of the MEDLARS-derived product, ToxicityBibliography. Following u direct recommendation of the 1966 PSAC Panel, theProgram has been working on the production of a Toxicology Vocabulary and isnow in the process of letting a contract for the production of such a vocabu-lary in thesaurus format. The Toxicology Vocabulary will be compatible withMedical Subject Headings (MeSH), the vocabulary for MEDLARS.

TIP is also investigating the possibility of the issuance of a new journal tobe called Health Effects of Environmental Pollutants (KEEP).

TIP has been working with BIOSIS. a product related to Biological Abstracts (BA),on the idea of producing a journal which would amalgamate selected informationfrom _BA and MEDLARS. As now envisioned, HEEP would offer subscribers a monthlyJournal containing some 1,000 JBA-like abstracts (selected from JJA and MEDLARSarticles); there would also be a MEDLARS-like tape service which would containthe citations to these abstracts and MeSH indexing terminology.

Preliminary work on a two-phased contract with the publishers of BA is underway, and TIP hopes that a prototype issue of the Journal will be availablefor review by the end of this fiscal year.

Dr. Kissman's presentation was followed by a successful live demonstration ofthe Mead Data Central whole text searching system, for searching abstracts inthe pesticide literature and the entire Mrak Commission Report.

On behalf of the Board, the Chairman thanked Dr. Kissman for a very stimulatingdiscussion and invited him to report to the Board again in the near future.

Speaking for the Board, Dr. Ebert requested that the Director and the staff ofNLM cooperate in gaining information about the human reproduction project whichDr. Bergstrom described. Dr. Ebert suggested that the Director report back tothe Board how the Library may be able to cooperate in this enterprise.

Respectfully submitted,

Martin M. Cummings, M.D.Executive Secretary to the

Board of RegentsNational Library of Medicine

Attachments

ACTIONS TAKEN BY THE BOARD OF REGENTS IN GENERAL SESSIONMarch 22-23, 1971

1. After a review of current policies governing the Publications GrantProgram, the Board recommended that:

a. Publication grants continue to be reviewed on an individual basis;b. NLM staff encourage the submission of publications in the areas

of biomedical librarianship and biomedical communications;c. If the amount of funds requested significantly exceeds the funding

capability of the program, priority be given to publication grantsdealing with medical librarianship and biomedical communications.

2. After Dr. Langley's review of NIH concerns about the normalization andstandardization of priority scores, the Board recommended no standardiza-tion factor be applied to priority scores. The Board did, however,request that Dr. Langley provide information on the differences between"raw" priority scores and standardized scores at the next Board meeting.

3. The Board concurred with the plan to have Resource Improvement Grantsreviewed by the staff, based on criteria approved by the Board andthe review committee. The Board concurred in the recommendation of thereview committee that the staff not disapprove any applications but,ifthere were applications which they felt were not approvable, that theseshould be sent to the committee and the Board for final action.

4. The Board approved policies which would preclude the funding, underResource Grants, of projects to produce AV materials, or to have thelibraries plan and direct continuing education activities for healthprofessionals. The Board noted, however, that this latter action inno way diminished the role of the library in supporting continuing educa-tion activities in the health fields.

5. The Board approved, in principle, the revised Regulations (42 CFR Part59 a, Subpart D) -- grants for special scientific projects, and forresearch and development (including demonstrations) in medical libraryscience. Necessary wording changes are to be negotiated between NLMstaff and the Office of General Counsel.

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BOARD OF REGENTSNATIONAL LIBRARY OF MEDICINE

MINUTES OF EXECUTIVE SESSION

The Board of Regents of the National Library of Medicine convened inexecutive session at the Library in Bethesda, Maryland, at 1:20 p.m., March 23,1971.

The Chairir.an asked for cormiiGnt on a resolution introduced by three membersof the Board, circulated to the members at the opening of the session, identi-fying in general terms the effect of constraints during the fiscal years1968-1972, inclusive, on the ability oL the Library to meet the demands of thebiomedical community and to support the health priority objectives identifiedby the President in his recent message to the Congress. Minor modificationsin order and grammar were incorporated. Tnereupon the resolution was adoptedunanimously, with the recommendation that the Chairman of the Board transmitthe resolution (attached) personally to the Secretary of Health, Education,and Welfare.

Mr. Augenstein reported that Dr. Baker, unable to attend the executivesession, had recommended that the Library complete- the develop;,.cmt of MEDLARS IIwith its own personnel. While Mr. Augcnstein favored such a course of action,he recognized that the requirement of about 25 additional }',oo_d people skilledin computer technology exceeded the resources available or likely to becomesavailable to the NLM in the foreseeable future. Tnc possibility of involvingsome Federal Contract Researcli Center such as Rand or Mitre was examined, butit would place the problem of further development of MEDLARS II under thecontrol of an organization other than the Library where the responsibilityproperly belongs; some improvement in the situation could be anticipated forthe short haul, but not for the long run. Mr. Zipf agreed with the desirabilityof in-house development of MEDLARS II but felt it impractical when faced withthe realities of fiscal and manpower constraints.

The debate turned to the next immediate move required by the NLM infurthering MEDLARS II development, A draft letter to the President, ComputerSciences Corporation (CSC) from Director, NLM, was considered (attached). Inessence, this accepts the propos.il m..iic last week by CSC to provide demonstrationof four system components for I MOLARS II by May 1 in lieu of reduced systemdevelopment to emphasize documentation at a lowor level of expenditure. Mr. Zipfhad reviewed the NLM correspondence with CSC and found it "generally good," but"holes" could be identified in ;;.ems that dealt with greater complexities. '\ hodraft, letter under consideration by ti.e Board will in Mr. Zipf's opinion permitcontinuing evaluation of the Library's posture vis-.a-vis M^DLAXS II until May 1.Definition of the essential elements to reproduce' MEDLARS I capabilities inMEDLARS II' should continue and include production of a docunent by the NLM staffdetailing the capabilities of MEDLARS I in the projected system now beingdeveloped by GSC.

Director, NLM, then said that he had asked Systems Development Corporation(SDC) to examine the proposed input for MEDLARS II to see how it could inter-face with the ELHILL programs for AIM-TWX development. Subsequently he hadalso asked SDC to examine the technical procedural design proposed by CSC forMCDLARS II. Mr. Zipf then suggested that SDC be asked to provide their bestestimate by May 1 based on their examination of CSC's description of the com-position and structure of the data base file.

Mr. Augenstein summarized his view of the proposed letter to CSC as forcinga response from the organization which, if favorable, would involve its seniormanagement in the program. The May 1 demonstration will provide a good indexof progress or lack thereof by the CSC. Moreover, the reply provided by SDCwill furnish additional useful information prior to renegotiation of thecontract. It should then be possible to determine the advisability of con-tinuing the CSC contract or relax the objectives to the extent tluit NLM intr.-i-mural capability can complete the tnsk, a]beit in an extended time frame whichwould enable the Library to define its objectives better nt a slower pace.For the time being, consideration should be given to joining MEDLARS I andAIM-TWX.

Library Operations has already identified all non-essential elements ofMEDLARS II which might be stripped out. However, CSC has said that eliminationof the requirement for activities on such library functions as acquisition,serial records, cataloging, and the like would reduce the efforts minimally -about 14 man months. Per conj-ra CSC had said in the past that such require-ments were among the most complicated in the entire program. Dr. Wagman toldof long term efforts at Chicago and at Stanford to build sucli a system with"very good people" which is not yet completed.

The Chairman agreed that the draft letter should be sent to CSC but askedwhat would happen if a decision to cancel the contract resulted from the demon-strations on May 1. Dr. Cummings outlined the legalisrns and technical detailsand assumed complete responsibility for the decision and its consequences.

Dr. Michael questioned the state of the art in relation to MEDLARS IIobjectives. The consensus regarded the objectives as feasible of attainment.The Director, NLM, agreed, lie identified these errors from retrospectiveanalysis:

1. The NLM engaged a contractor to write the specificationsfor the MEDLARS II system, which became the Request forProposal. It was written almost entirely on functionalgrounds, a departure at that time from more conventionaldescriptions.

2. The NLM should have known that the lowest bid was too low.Additional questions elicited the information that the lowest

bidder, CSC, was not the Library's first choice on the basisof cost alone. CSC and IBM were extremely close in tech-nical evaluation.

3. The NLM was unaware that CSC had employed a "second team"staff on the MEDLARS II program and did not insist onupgrading their capabilities for many months when slippagesand over-runs appeared.

A major error by both parties was to allow the design concept to include manyfunctions. "Any good software company should be able to build the MEDLARS IIsystem," said Dr. Cumr.ungs.

The Chairman expressed the opinion that Dr. Baker's point was that thesystem now being developed could not be patched up to do the job; a newstart would be required. Tiic group assented.

Discussion centered on a fall-back position for the Library shouldthe CSC demonstration fail on May 1. Mr. Augenstoin espoused a combinationof upgraded MEDLARS 1 (presumably on honeywe11 800), AIM-TWX (again, presum-ably an expanded version) and the on-line capabilities demonstrated earlierin the day by the Library's Specialized information Services. The last isloaded on a computer owned by Mead Data Central which leases iLs servicesonly, costs are not necessarily stable, and the system has no productioncapability of the type required to produce the NLM bibliographic compilations.The Director, NLM, considered reliance on Mead Data Central too risky imctorthe circumstances. He felt the cheapest fall-back position to be a modifiedMZDLARS I with input via Kcyinatics directly to magnetic type, an imperativein view of the deteriorating flexowriters which were specially designed tomeet the Library requirements, and possible replacement of the; Honeywell 800with a new one at a cost of §600,000. The disadvantage of that approach isthe limited and already saturated vocabulary capability of thu Honeywell 800.

Dr. Mider suggested that the Swedish MEDLARS I tapes written for IBM 360equipment could be available to run on the IBM 370/155 due for delivery atthe NLM in July 1971. Those tapes do not include the instructions essentialto photocomposition, but perhaps that piece could be added.* Mr. Zipf thought

Earlier in the open meeting Mr. Simeons had reported successful demon-stration of progruUi written by CSC foj photocomposition on LINOTRO^and for output on .! line: printer. However, the programs do not yo.twork for PliOVON 901. The distinct poj.-ibility exists that photocompo-sition programs so usse.iti^l to the publication function ;.uiy be availablesoon to link with the Swedish MEDLARS uapes because the CSC programs arcnow being tested on IliX 360/50 at the 2\LX. This point was not brou^uLout at the meeting, although it was established that programs writtenfor IBM 360 series would also run wi Lh little difficulty on IBM 370equipment.

this possibility should be explored. Though some of the desirable capabilitiesof the more powerful computer might have to be sacrificed, the IBM 370/155would permit expanded vocabulary. He indicated that the 370/155 run in anemulator mode would be better than the H800.

The Board then agreed without dissent to the draft letter addressed to thePresident, CSC. Director, NLM, said he would mail it before the day was out,after first reading its content to the Eastern Representative of the company.He then reaffirmed his intent Co restrict expenditures by CSC to a total of$3.8 million, saying that any additional funds required to complete MEDLARS IIwould be used to finish the system in-house.

The Chairman felt it essential to build broader computer capability in-houseas a long range objective. All agreed. The Chairman complimented the Director,NLM, on his detailed reports of.developments with CSC over the years, to whichDr. Cummings responded by thanking the Board, however "inadequately," for theirefforts on behalf of the Library both at its stated meetings and during theintervals between meetings.

The Board expressed regret for the resignation of Dr. James Fletcher necessi-tated by his appointment as Administrator of the National Aeronautics and Sp.-.ccAdministration. This led to a brief explanation by the Director, NLM, of themechanisms by which Board members are appointed.

The Director, NLM, also reported the recruitment of Dr. Barry Beattie torepresent NLM interests in the Alaska Communications project.

Adjournment came at 2:37 p.m.

Respectfully Submitted,

tortln H. Ci:Mila~3t ; I . T

Mart in M. Cummings, M.D.Executive Secretary, Board of RegentsNational Library of Medicine

Bcthcsda, Maryland

RESOLUTION OF THE BOARD OF REGENTS, NATIONAL LIBRARY OF MEDICINE,ADOPTED UNANIMOUSLY IN EXECUTIVE SESSION,

MARCH 23, 1971.

The'Board of Regents of the National Library of Medicine hasreviewed the budgetary history of the Library for fiscal years 1968through 1972. The Board is concerned wich the inadequacy of chat supportin the face of rapidly rising, uncontrollable costs, and more importantlyin the light of the current administration's avowed purpose of makingexcellent health resources more readily available to the American public.

The Board notes that the budget for the National Institutes ofHealth increased about 50 percent between 1968 and 1972. It is recog-nized that the addition of the Bureau of Health Manpower Education mayhave been the major contributing factor to that increase. In our viewthe failure to provide commensurabiy adequate resources to the Libraryduring that same period reflects failure of the Department of Health,Education, and Welfare to comprehend the implications of the healthpriorities established in the President's recent message to the Congress.

The creation of new knowledge and manpower to improve the ca.Jc.bili-ties of health professionals for preventing disease or treating it moreeffectively must be communicated to those who need that information,through the organized systems developed by libraries in general and theNational Library of Medicine in particular. Moreover, students of thehealth professions need exactly the same information, although therapidly evolving changes in curricula indicate a serious need for v.vnc-vative formats, audio-visual in the main, to supplement more convontiona*texts. The National Library of Medicine is the world's preeminentorganizer and purveyor of biomedicai information., the essential ingrediento£ professional practice and education emanating from a vigorous researcheffort.

The Board of Regents entreats the Secretary of Health, Education,and Welfare to concern himself with the impact of an array of Federalhealth programs on the activities of the National Library of Medicine.It is convinced that more effective delivery of health services andeconomies of scale in health professional education can be realized bygreater familiarity with the Library's activities and capabilities.

Particularly, we believe that solutions to the socially compallir.;;problems of degenerative and malignant disease, and of environmental health,involve ingenious access and utilization of knowledge. This combinationdepends on the scope and depth of accessible literature. The organizedrecord is indeed the basis for use of what has been learned. It SCG.-..S to-us that resources put into research, development and education must be

accompanied by suitably enhanced budgets for information services bythe National Library of Xedicine. Although better coordination ofconveyance of information by operating health agencies is anotherurgent mission suitable for the Library, we doubt that there is nowan adequate transfer of knowledge into useful action in any portion ofour Federal health programs. Further, we are convinced that a vigorous,innovative, technically strong information handling capability in theNational Library of Medicine and its Lister Hill National Center forBiomedical Communications will inspire our national health care insti-tutions to use the world store of biomedical knowledge.

Without additional support the resources of the National Libraryof Medicine are unable to cope with the increased demands for informationservices generated by programs for health care delivery, health education,and health research.

Respectfully submitted,

Chairman, Board of RegentsNational Library of Medicine

DEPARTMENT OF HEALTH. EDUCATION. AND WELFAREPUBLIC HEALTH SERVICE

NATIONAL INSTITUTES OF HEALTHBETHESDA. MARYLAND 20014

March 23, 1971NATIONAL LIBRARY OF MEDICINE

Mr. William R. HooverPresidentComputer Sciences Corporation1901 Building - Century CityLos Angeles, California 90067

Dear Mr. Hoover:

On March 21 representatives of the Library met with your project managersto define the four demonstrations (set forth in Schedule A attached)to take place on May 1, 1971. Your Mr. Xazok telephoned Mr. Zipf at theLibrary on March 22 to inform him than you agree that if you can not satis-factorily perform'these demonstrations by May 1 you will absorb whatevercosts are pertinent thereto until such time as they can be performed inaccordance with Schedule A.

We are prepared to accept this commitment as an indication of your personalappraisal and interest in the successful pursuit of the MEDLARS II program.While these demonstrations represent a very small segment of the overallsystem, your personal confidence in their accomplishment will in largemeasure help restore the Board of Regents' confidence in the ability ofthe CSC to forecast completion dates and budgets with some reliability.The demonstrations will also provide the Board firmer benchmarks on whichto base their recommendations on the program.

On March 16 your associates presented to me the attached schedule showingvarious levels of expenditure during 1971. It is within the frameworkof the expenditures shown in this schedule that we now authorize you toproceed with the demonstration scheduled for May 1, 1971. This authoriza-tion is also predicated upon the aforementioned schedule which shows asystem available for acceptance-operational testing by mid-November 1971at a cost not to exceed $3,648,284.

It is upon the basis of the foregoing that we are now prepared to rescindour order to "stand down."

On the basis of your conversations with Mr. Zipf, he indicates that youvolunteered to spend as much time as is necessary to review the currentstatus of the project with the library staff and its advisers and your

own staff. We believe that such a tr.eeting is imperative and should bescheduled before Hay 1; the dates of April 14 and 15 appear possiblefrom our standpoint.

It will be appreciated if you will sign a copy of this letter1 and returnit as an indication of your agreement with its contents.

Sincerely yours,

Martin M. Cummings, M.D,Director

Enclosure

cc: Dr. Nashman

AGENDA

Thirty-Ninth Meeting of theBOARD OF REGENTS

National Library of Medicine

9:00 a.m., June 14-15, 1971Board Room

Bethesda, Maryland

I. CALL TO ORDER AND INTRODUCTORY REMARKS Dr. Robert Ebert

II.

III.

CONSIDERATION OK MINUTES OF LAST MEETING TAB I(Orange book)

DATES OF FUTURE MEETINGS1971 and ]972 Calendars in all booksNext Meeting - November 22-23, 1971 (M-T)Subsequent MeetingMarch 27-28, 1972 (M-T)

Selection of M O P I i n g p.it e - Juru. 197215-16 19-20 22-2'3(T-F) (M-T) (T-F)

TAB II

Dr. Robert Ebert

Dr. Robert Ebert

IV. RFMAKKS BY THE ASSISTANT SECRETARY FORHEALTH AND SCIENTIFIC AFJ'ATRS AND Tl FDIRECTOR, NATIONAL INSTITUTES OF HEALTH

Dr. Merlin DuVal

Dr. Robert liarston

V. REPORT OF THE DIRECTOR, NLM TAB III Dr. M a r t i n Curamings

VI.

VII.

NATIONAL MEDICAL AUDIOVISUAL CENTER

LUNCH (Opc:n Choice)

TAB IV Dr. C h a r l e s Bridgman

(Cafe te r ia in NLM on A Level, O ' D o n n o l l ' s R e s t a u r a n t , 8301 Wisconr . in Avenue,Bcthcr ida , M d . , Governor ' s House Rest .inr.-mt, 8400 Wisconsin Avenue, Bc lhesda ,M a r y l a n d (both w i t h i n n few blocks walking d i s t a n c e ) )

REPORT OK Till1: ASSOCIATE DIRECTOR (p,ray hook)FOR KXTRAMUKAL PROGRAMS

a. Cr i t ica l Keviow and Eva lua t ion of TAB 1the NLM Grant Supported ResfiarchProgram

b. Report of the T i a i n l n f i D i r ec to i s 1 TAB IIMectinr, H e l d M.'iy 9-10-11, 1971 f i tt h e Bclmont House--

Dr. Lee Langley

Dr. Lee I.nngley

Dr. Lee Lrnj',leyDr. Ann K n u f r r i j n

Agenda - Page 2

c. Results of the Meeting on LibraryAutomation

d. Policy Issues

TAB III Dr. Lee LangleyMr. Arthur Broering

TAB IV Dr. Lee Langley

e. DRG Administrative Report TAB V

VIII. CONSIDERATION OF PENDING APPLICATIONS

Confidentiality of Proceedings andConflict of Interest

A. RESEARCH AND PUBLICATION GRANTS

B. TRAINING GRANT

C. RESOURCE GRANTS

Dr. Lee Langlcy

TAB VI.

TAB VII

TAB VI11

IX. REGIONAL MEDICAL LIBRARIES

ADJOURNMENT

TAB V Dr. Harold Schoolman(Orangr book)

DINNER (DUTCH TREAT) - HOLIDAY INN OF BETHESDA - MONTGOMERY ROOM8120 Wisconsin AVPIIUC, Bc;the.sda, Maryland

Cocktails: 6:30 p.m.

AWARD CEREMONY

(1) Board members completing their terms of office.(2) Hoard award to NLM Staff mrnibc>r for Scholarship

and Technical Achievement.

RECONVENE - 9:00 a.m. - June 15,1971

X. REPORT OF THE ASSOCIATION OF AMERICANMEDICAL COLLEGES;, ROLES FOR THE LIS'JERHILL CENTER

Dinner: 7:30 p.m.

XI. LISTER H I L L NATIONAL CENTER FORBIOMEIHCAL COMMUIJI CATWNS REPORT

TAB VT

Dr. Eugene Stc-ndDuke University

Dr. William Anly.in

Mr. Albert Fciner

XII. MEDLARS Tl DEVELOPMENT TAB V1J Mr. Ralph Simmon:;Mr. Alfred Xipf

XIII. REVIEW OF FOREIGN MEDLARS CENTERS TAB VIIJ Mr. Bruno Auf;cnst<'in

Agenda - Page 3

LUNCH - Catered in Board Room

XIV. EXECUTIVE SESSION

ADJOURNMENT

THE BOARD OF REGENTSof Che

NATIONAL LIBRARY OF MEDICINE

MINUTES OF THE 39th MEETING

June 14-15, 1971, Bechesda, Maryland

Dr. William G. Anlyan, Mr. Bruno W. Augenstein, Dr. William 0. BakerDr. Harve J. Carlson attended the first day of the meeting,Dr. Robert H. Ebert, Dr. Jack M. Layton, Dr. John P. McGovern,Dr. Max Michael, Jr., Dr. George W. Teuscher

EMBERS ABSENT: Dr. L. Qulncy Mumford, Dr. Frederick H. Wagman

EMBERS PRESENT:

LTERNATES:

JESTS:

TAFF:

Brig. Can. Gerrit L. Hekhuis represented Lt. Gen.Towner both days,Dr. Raymond T. Moore represented Dr. Steinfeld the firstday,Mrs. Martha Phillips represented Dr. Musser both days,Capt. Edward J. Rupnik represented Vice Admiral Davis both days,Brig. Gen.Thomas J. Whelan represented Lt. Gen.Jennings both days

Dr. John F. Sherman, Deputy Director, National Institutes of Health,Dr. Kenneth M. Endicott, Director, Bureau of Health Manpower Education,Dr. John A.D. Cooper, President, Assoc. of American Medical Colleges,Dr. Eugene A. Stead, Jr.,Professor of Medicine, Duke University,Mr. Alfred Zipf, Exec. Vice President of the Bank of America, Consultant,Dr. Fred Cole, President, Council on Library Resources, Inc.,Mr. John Sherrod, Director, National Agricultural Library,Dr. Rob S. McCutcheon, Executive Secretary, Toxicology Study Section,Mrs. lieen Stewart, Executive Secretary, History of Life SciencesStudy Section and the Biomedical Communications Study Section

Dr. Martin M. Cummlngs, Dr. G. Burroughs Mider, Dr. Jeanne Brand,Dr. Robert J. Benford, National Library of Medicine, Consultant,Dr. Charles Brldgman, Mr. Arthur Broering, Mr. Raymond Brown (OCES),Mrs. Dawn Carlisle, Dr. Ralph Christenson, Mr. Peter Clepper,Mr. Lawrence Coffin, Miss Mary Corning, Mrs.Doris Doran, Mr. AlbertFelner, Mr. Joseph Foley, Mrs. Louise Carnage, Mrs. Frances Howard,Dr. Ann Kaufman, Dr. Leonard Karel, Dr. Henry Kissman, Dr. Lee Langley,Dr. Joseph Leiter, Mr. Davis McCarn, Mr. Peter Monk, Miss Irene Moore,Dr. Paulo Pamplona, Mrs. Frances Rigau, Dr. Harold Schoolman,Mr. Ralph Simmons, Mr. Kent Smith, Mrs. Janet Welsh, Mr. Richard West

MARCH 1971 MINUTES APPROVED. FORTHCOMING MEETINGS SCHEDULED

Minutes of the March 22-23, 1971 meeting were approved, and meeting dates ofNovember 22-23, 1971 and March 27-28, 1972 were reaffirmed. June 15-16was tentatively selected as the date of the second meeting in 1972.

OPENING REMARKS OF THE CHAIRMAN OF THE BOARD

Dr. Ebert opened the meeting with a welcome to Captain Edward J. Rupnik,M.C., USN, representing Vice Admiral Davis; Mrs. Martha Phillips, DeputyDirector for Education Service, Veterans Administration, representingDr. Marc J. Musser; and Dr. Fred Cole, President, Council on LibraryResources, Inc.

Dr. Cunnings introduced new members of the Library Staf f :

Mr. Raymond Brown, Deputy Associate Director, Office of Computer andEngineering Services; Dr. Fred W. Clayton, Chief, Toxicology InformationServices, SIS; and Mrs. Frances Rigau, Committee Management Assistant whosucceeds Mrs. Ann Sabin.

The Chairman welcomed Dr. Raymond Moore, representing the AssistantSecretary for Health and Scientific Affairs, who announced the appointmentof Dr. Merlin DuVal to succeed Dr. Roger Egeberg on July 1, 1971.Dr. DuVal plans to be present at the November meeting of the Board.

Dr. Ebert welcomed Dr. John F. Sherman, Deputy Director,NIH.

REMARKS BY DR. JOHN F. SHERMAN. DEPUTY DIRECTOR. NIH

Dr. Sherman commented that Dr. Marston is attending hearings on a bill toestablish a National Institute of Gerontology within the NIH. Gastroentero-logists, kidney specialists, marine medicine people, and sickle cell anemiaproponents are also urging establishment of new institutes within the NIH.

Mr. Steven Kurzman, formerly a member of Senator Javlts* staff, hasjoined the Department as Assistant Secretary for Legislation. Mr. RobertBeatty of Boise-Cascade is the Department's first Assistant Secretaryfor Public Affairs.

Dr. Sherman briefly discussed pending legislation: 1) Welfare reformand revenue sharing; 2) Higher education and education generally;3) Health - a. major effort by the administration to do something aboutincreasing effectiveness of delivery of health care through a healthmaintenance organization; b. manpower - renewal, of authorities and theHealth Professions Education Assistance Act and the Nursing Assistance Act.The current authorities will be modified rather extensively both qualitativelyand quantitatively; c. cancer - a considerable, far-reaching legislativemovement; d. comprehensive or national health insurance; e. reorganizationto bring the Executive Branch under more reasonable coordination and control.

The proposal would enlarge DHEW despite Che Department's already largeresponsibilities; £. management - now under Dr. Roderick Brady, newAssistant Secretary for Administration.

The Health Professional Education Assistance Act expires on June 30,1971.New proposals will require some compromise on 1) Student assistance;2) Construction; 3) Institutional support. The Senate recently heldhearings on the Yarborough-Kennedy proposal to establish creation of aseparate Cancer Authority and on an Administration bill which would retainthe Cancer Authority in the NIH. A third bill - essentially a modificationof the first, by Senators Cranston, Nelson and Schwelker, proposes removingall of NIH from DHEW.

The NIHis concerned about creation of a separate authority whose activitieswould not be coordinated with other substantive programs in blomedicalresearch generally and has expressed its misgivings. The American HeartAssociation which has nowmodified its original position, suggests keepingblomedical research components together but elevating the Heart and LungInstitute to a different status within the NIH and broadening the scopeof its programs.

NIH budget hearings have been completed in the House and are awaited inthe Senate.

Dr. Anlyan said that in the context of Dr. Sherman's presentation, theBoard of Regents recognizes only minimal visibility of the need for Libraryservices for the new programs. Planning for discussion of cancer informationservices has been negligible. Little support Is available for free-standinghealth sciences libraries not part of an educational complex. Dr. Anlyanexpressed the view that the Regents should emphasize their views to NIHand DHEW.

Dr. Ebert reiterated that one cannot separate communications and retrieval ofinformation from research activities; unless the two go together money willinevitably be wasted. Dr. Baker then commented that there is still a greatdeal of uneasiness with respect to the role of the NLM and of information andcommunications in the cancer mission. DHEW has not identified the majoroperational needs of a cancer mission of this kind which include communications.

REPORT OF THE DIRECTOR. NLM

The Director offered his congratulations to Dr. Baker and Mr. Zipf on theirrecent appointment to the President's Commission on Libraries and InformationScience and to Dr. Layton on his appointment as Dean of the University ofArizona School of Medicine.

On May 10, 1971 Dr. Marston convened a meeting of an Intercouncil AdvisoryGroup to which a representative of each Institute's Council and a representativeof the Board of Regents was invited. Major concerns of the NIH were discussed.The Board has been asked to report back to NIHwhether this kind of meetingis desirable.

Dr. Anlyan, the Board's representative, considered the meeting worthwhileas a medium for information exchange among the Advisory Councils andsuggested that it might be useful to have one more meeting.

Dr. Cummings announced that on April 19 he had decided with full supportof the Board's consultants and the NLM s taff , to allow the ComputerSciences Corporation contract to terminate. To deal more efficientlywith the completion of MEDLARS II, the Library has established a DirectorateManagement System organized to handle the contract with the Systems DevelopmentCorporation. Mr. Davis McCarn will have the prime management responsibility forcompletion of AIM-TWX and MEDLARS II. The Library has also identified tasksthat it can fulfill in-house in the construction of MEDLARS II. Two arealready in progress: Programming for input with keymatic devices andprogramming for use of the Linotron system of the Government PrintingOffice. Both efforts are meeting with success. Deadlines for the completionof these two tests are June 30, 1971, for the first program and September 1,1971, for the second.

The National Technical Information Service of the Department of Commercehas agreed to act as the NLM's agent In the replication, sale, and distributionof MEDLARS tapes at $30,000 per year. The formal agreement specifies thatNLM will approve the use of each set of tapes. Income la to be shared equallywith the Department of Commerce; the NLM share will revert to the Treasury.No sales have been made thus far. The sale of MEDLARS tapes has raised theproblem of compatibility of policies among various Federal Agencies sellingtapes. Mr. William Knox, Department of Commerce has suggested that the variousAgencies generating information tapes standardize their pricing and marketingpolicies.

Sales of interllbrary loan services abroad have led to a decrease of some66 percent in the number of foreign loans made.

The National Science Foundation has announced the appointment of Mr. MelvinDay, formerly of NASA, to succeed Dr. Burt Adklnson as Chief of its Officeof Science Information Services.

The COSATI apparatus, a component of the Federal Council on Science andTechnology, will be transferred to the National Science Foundation. Mr. MelvinDay will replace Col. Andrew Alnes as Chairman of COSATI.

The Director proposed that distinguished visiting scholars in residenceat NLM be formally designated as NLM Scholars In Residence or as VisitingScholars. The Board approved this suggestion and recommended that theLibrary develop specific guidelines for implementation of the program.

The Director called the Board's attention to an important report nowbeingcircularized through the Federal Agencies entitled "A Study of the EnvironmentalQuality Information Programs in the Federal Government." Dr. Henry Kissman waschairman of the panel which wrote the report. It contains a fine analysis ofinformation analysis systems in a highly specialized field which may beextended more broadly to associated specialized information programs.

The Director concluded hi* remark* with mention of lengthy visits with andInquiries from several distinguished members of the Executive and LegislativeBranches and Secretary Richardson's knowledgeable reference to the NLH at aNational Press Club luncheon.

Dr. Mider reported the gist of the NLM hearings before the Subcommitteefor Labor-Health, Education and Welfare of the House of RepresentativesCosnlttee on Appropriations on Hay 12, 1971.

Dr. Mider then presented a report entitled "National Library of Medicine -National Cancer Institute Relationships." which appears as Appendix I.Dr. William Baker complimented Dr. Mider on his analysis of the literaturein this field.

Dr. Ebert welcomed Dr. Luther Terry, former Surgeon General, US Public HealthService. Dr. Terry commented that his attachment to the Library is very longand very deep. The present NLM building was dedicated while he was SurgeonGeneral. The Medical Library Assistance Act had been passed just before heleft in May 1965. Also, as Dr. Cummlngs had earlier indicated, Dr. Terry hadserved for four years on the Resources Facilities Committee of the Library.Hie interest in libraries continues; during the time he has been at theUniversity of Pennsylvania the letter's library budget has quadrupled.

COOPERATIVE MEDIA DEVELOPMENT PROGRAMS—EVALUATION AND TEACHING PACKAGES

Pursuant to recommendations of the Board of Regents and directives of theNLM, during the past year the NMAC has Initiated an active program of cooperationwith national professional medical organizations, to make useful Instructionalmadia available to the medical community. This program has two components:Location and peer evaluation of existing Instructional media, and the developmentand production of pilot instructional units. These unite are based uponinstructional objectives identified by cooperating groups and are designedin modules to permit economical modification as indicated by student tryoutsor as material becomes obsolete. Upon completion of the pilot phase, it ishoped that the appropriate professional organization will assume responsibilityfor production and utilization.

This activity appears to be of such Importance to several medical organizationsthat they have hired full-time professional instructional media progremdirectors. For example, The American Physiological Society has recentlyhired e physiologist as Head, Education Office, who Is presently workingwith NMAC to Identify existing audiovisual materials In physiology, end isactively soliciting support for e six-month planning phase prior tobeginning instructional media design and production.

Typical of the projects are those under development by the Association ofDeans of Southern Medical Schools, a consortium of 28 medical schools.Several planning sessions have been held and a position paper entitled"A Program for Sharing Independent Learning Resources in the SouthernRegion" defines the group's commitment. A full-time program directorhaa been appointed whowill work with a trio of deans with broad executiveauthority, and a steering committee of seven coordinators. Individual

instructional packages in modular format will be produced in "trial"form by various members of the consortium. There are perhaps 100experimental teaching packages identified as in-house productions withinthe various schools of the consortium which may be finished at NMAC fordistribution. A self-study multi-media unit on "The NeurovascularExamination" has been developed at NMAC. This unit Is now undergoingstudent use with revisions to be made based on test results.

Basic materials in ophthalmology for medical students are being developedby two ophthalmologists at the University of Iowa Medical School withlimited financial support from the Association of University Professorsin Ophthalmology.

For Dental Health Manpower Training (DHMT), Division of Dental Heelth (DDH),Bureau of Health Manpower Education (BHME), a slide/sound production wasdeveloped on the TEAM approach to dentistry. Completed May 1971, DHMT staffhave previewed it and are enthusiastic.

The American College of Orthopaedic Surgeons with the aid of partialfinancing by the Veterans Administration, and input from the Office ofResearch in Medical Education at the University of Illinois MedicalCenter, is developing 60 sound/slide units for use in undergraduateteaching. Five units in the ssrles are now at NMAC for productionfinishing; approximately 23 or more are expected by end of June afterpeer review by a committee from the American College of OrthopaedicSurgeons. These units will initially be made available to approximately160 VAHospitals.

The Association of Anatomy Chairmen Committee on Audiovisual Development,and the Committee, on Educational Affairs and Learning Resources of theAmerican Association of Anatomists will meet at the NMAC in June to sharpenthe focus on future anatomy projects. An effort to relate the development.of anatomy teaching packages to the objectives of the National Board ofMedical Examiners is a hopeful outcome. Under the "Unlverelty-on-Loan"program, a faculty member of the Department of Anatomy, University ofKansas, is now committed to spend his sabbatical leave at the NMAC startingin January 1972. He will work primarily in the area of evaluation ofanatomical teaching materials but will be prepared to function in otherareae of need as relating to the teaching of anatomy.

Other approved projects Include those with the Association of Schoolsand Colleges of Optometry (pilot units on ocular pharmacology are inproduction), Universities Associated for Research and Education in Pathology,Inc. (three teaching units), Alpha Omega Alpha Honor Medical Society(three television programs on "Great Men in Medicine"), and the Associationof Professors of Gynecology and Obstetrics (provision of multi-mediainstructional units to 100 medical schools), the latter project In cooper-ation with the Lister Hill National Center for Blomedlcal Communications.

Additional projects under development which heve not yet reached finalproposal stage are with the American College of Surgeons, Harvard Medical

School, Department of Pathology, the University of Pennsylvania, Departmentof Neurology, the University of Alabama Medical Center, School of Community andAllied Health Resources, and the University of Florida, School of Health Sciences.

A major evaluation activity secures peer group assistance in bringing qualitycontrol to the cataloging, acquisition, and distribution programs and to providea mechanism to inventory and review audiovisual media in conjunction with theCooperative Media Development Program. The NMAC has been working with surgeonsfrom the Veterans Administration for the evaluation of over 400 surgical filmtitles, with the American College of Radiology which periodically submits filmtitled to the NMAC for acquisition, with the Association of American CollegesMedical School Pediatric Department Chairman, Inc., The American Associationfor Cancer Education, the American College of Cardiology, the American Academyof Dermatology, and the American Physiological Society.

Dr. Brldgman concluded his report with a demonstration and discussion ofseveral kinds of instructional films, video tapes and 3-dlmensional functionalmodels which could comprise a teaching package to cost about $100,000 each.The Board expressed the view that this kind of program would be an inexpensiveway to enhance teaching and learning if used by all medical schools.

EXTRAMURAL PROGRAMS I/ 2J 3J

REPORT OF THE ASSOCIATE DIRECTOR FOR EXTRAMURAL PROGRAMS

Dr. Langley announced that Senator Humphrey introduced a joint resolutioninto the Senate on May24, requesting the President to proclaim June 1, 1971,SB National Medical Library Day. The joint resolution passed the Congressunanimously and President Nixon signed it. The date of June 1 was pickedto coincide with the national meeting of the Medical Library Association.Dr. Langley discussed the following subjects:

Critical Review of the Research Grant Program — At present, the research grantsprogram allocation is $590,000. The Library has supported 72 projects sincethe progrem began; 27 are still In progress. Projects include three broadsubject areaa: library research, biomedical communications, and history ofmedicine. The history of msdicine program has been active and of good quality.The two other programs, however, have not been as satisfactory.

I/ Proceedings of meetings are restricted unless cleared by the Office of theDirector, National Institutes of Health. The restriction relates to allmaterial submitted for discussion at the meetings, the agenda for themeetings, and supplemental materiel, and all other official documents.

2J For the record, it Is noted that msmbers absent themselves from themeeting room when the Board has under individual discussion applications(a) from their respective institutions, (b) in which a conflict of interestmight occur.

3/ The Board of Regents, when considering the Extramural Programs of the NLM,also consists of the National Medical Libraries Assistance Advisory Board,and concurrently discharges the responsibilities of both bodies.

8

The Board's Subcommittee for Extramural Programs expressed the view that theLibrary should Involve itself in basic processes of information and activelysupport projects in linguistics. The Subcommittee recommended that the Libraryorganize a conference bringing together knowledgeable persons in linguisticsand related fields to discuss their relationship to the general mission of theLibrary. The cost of the conference was estimated at $15,000 - $20,000. TheBoard concurred.

Conference of the Training Grant Program Directors May9-11. 1971 —The Conference provided an opportunity for familiarization with the varioustraining grant programs; an opportunity for defining manpower needs andsuggesting programs to meet those needs; and an opportunity for productiveInterchange of views.

Dr. Teuscher, who represented the Board at the Conference, commendedDr. Langley for stimulating attendees to enter into a thorough discussionof the problem and thought that the conference was a great success.

Dr. Langley presented the Board with two proposals for their consideration:

1. To support only internships In medical llbrarianship, or

2. To convert the active masters degree programs either to internshipsor to internships plus Ph.D. programs which would Incorporatespecial training in one or more of the biomedical sciences.

Dr. Cummlngs said that whether librarians should be trained on a broadbase sad then specialized, or whether they should be given specializedtraining from the start, represents a critical point both in terms ofphilosophy and budget. He suggested that Dr. Langley provide the Boardwith data shoving what has happened to the people who have already receivedsupport for training and that the matter be scheduled for Board review attheir next meeting.

Results of the Meeting on Library Automation — The following criteriato be applied to resource grant applications proposing library automationprojects were adopted by the Biomedical Library Review Committee onHay 4, 1971:

1. Feasibility analysis - literature review and cost benefits

2. System types - conventional or Innovative

3. System resource - own computer, some other computer, or computersused In a cooperative enterprise

4. Systems integration - multipurpose use of an automated system

5. Phase-over timing of change from manual to automated system

6. Back-up capabilities in event of machine down time

7. Selective dissemination of information - not advisable forapplicant to request funds to engineer such a system

8. Check points - interim progress reports to NLH in addition to thegrant-year reports

Policy Issues — The Board has recommended that applications for resourcegrants be divided into two groups:

1. Those from health-related libraries, and

2. Those from libraries not primarily health-related

The Subcommittee of the Board was asked to consider a change from existingpolicy that all applications continue to be reviewed, but awards will begoverned by policy assigning top priority to group 1 applicants. Thus,the Library must process and review each application. So many are beingreceived that the Blomedlcal Review Committee had to meet for more than twodays to complete their review. The Library has never funded any applicationsin group 2.

The Subcommittee agreed with staff. Therefore, whenever possible, the staffwould continue to discourage resource grant applications from Institutionswhich are not primarily health-related. If such applications are submittedthe applicant is to be informed that' his application will not be processedor reviewed until such time as all approved requests from libraries relatedto health are funded. Those libraries which are not primarily related tohealth but serve programs which in the judgment of staff, have major healthsignificance would continue to be submitted to the Biomsdical Review Committeeand to the Boerd of Regents.

The Board accepted this statement.

Dr. Langlay addressed the Board on the use of resource grants in thehistory of medicine to purchase rare books, to catalog such books, torepair rare books, to microfilm rare books, and to renovate reading roomsfor rare book collections.

The Subcommittee recommended the use of resource grant funds for maintenanceof collections but not for purchase of rsre books, historical items, norfor renovation of facilities. The Board concurred.

The Subcommittee also recommended that, although worthwhile, security systemsfor protection of collections should not be funded through grants. TheBoard concurred.

Dr. Langlay referred to an application from the John Crerar Library, aRegional Medical Library which applied for a grant to compile e regional

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union list of serials. The Subcommittee discussed the request but becauseof insufficient information came to no decision. Despite the desirabilityof locator tools, Dr. Cummings informed the Board that philosophically theLibrary has supported only those union lists which would ultimately leadto the building of a compatible national list. Most of the regional medicallibraries that have union lists have developed them under their own sponsorship.The Greater NewYork Library Center has a union list which NLM supported. Itcan serve as a national model for union list development. Dr. Cummingsexpressed the hope that the Board would discourage the Library from usingfunds for autonomous serial record building. After discussion the Boardsupported this view.

Consideration of Pending Applications

The Board of Regents, acting concurrently as the National Medical LibrariesAssistance Advisory Board, reviewed the following grant applications:

Research and Reviewed 27 $667.047Publication Grants Approved 7 122,070

Disapproved 18 437,958Deferred 2 107,019

Training Grants Reviewed 1 59,085Approved 1 56,005Disapproved 0

Resource Project Grants Reviewed 88 $2,986,988Approved 27 554,635Disapproved 55 1,954,216Deferred 6 309,613

Resume of Board actions on all Extramural Programs are appended tothese minutes.

REGIONAL MEDICAL LIBRARIES (RML)

Dr. Schoolman briefly reviewed the Board's recommendations and guidelinesfor converting RMLsupport from grants to contracts to achieve greatermanagement control and a more uniform coordination in the planning ofgrowth and development.

The Library has now completed contract negotiations with seven librarieswith two fundamental objectives: to provide greater management controland better coordination of planning and to partition the funding of RMLin what might be called a service component to be funded by contractand research and development components to be funded by grants. Contractfunds for the seven contracts came to $1,333,347 whereas grant funds totaled$1,360,144. The RML's will fill 275,000 interlibrary loans in FY 1972 comparedto 239,000 under the grants in FY 1971.

11The Library will develop a definitive statement of program objectives,a description of program structure, and a classification of the obligationsand responsibilities of program elements. Such a document should eliminateambiguity and provide uniform understanding of the nature of the program,especially as it relates to development of an interactive cooperatingnetwork as a model for study, growth and development of a nationwideBiomedical Communications Network. The network should have the followingcharacterlatics:

1. Rapid and efficient delivery of documents

2. Optimal cost effectiveness

3. Access to all of the nation's relevant Information resources

4. National coordination

5. Ability to deal with that group of requests which cannot ordinarilybe fulfilled by institutions of prime responsibility

6. Responsiveness to the broad variation In resources and usersacross the country.

The system design is hierarchial in nature, each higher level facility actingas a backup resource to the echelon below.

On the assumption that every community hospital in this country may bethought of as having an obligation to continuing education, the basic unitis best considered as a relatively independent, free-standing educationalorganization. This would include, but not be limited to the following:

1. Community hospitals

2. Colleges and Junior Colleges with meaningful health scienceeducation and training programs

3. Other health related schools, research organizations orgovernmental agencies.

A second level would be made up of selected institutions designatedas resource libraries, in most instances, libraries of the nation'smedical schools.

The third level would comprise the RML's, and the fourth level, the NLM,responsible for network management and control, a backup resource forthe regional medical libraries, and RML for the odd-Atlantic states.

Basic policies will be determined by the Board of Regents. The Board wouldbe kept informed by an annual report and review by NLM of the RML Program

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(RMLP), and through a permanent subcommittee of the Board to review thepractieea and operations of the RMLP management.

Network management and control by NLM would be Implemented by a seniormanagement group consisting of the Special Assistant for Program Planningand Evaluation, Chairman; Associate Director, Library Operations (LO), andAssociate Director, Extramural Programs (EM). The Associate Director, LOwould be responsible, through his designee as Project Officer, for theservice contracts with RMLs.

The Associate Director, EM, would assign an Associate Project Officerfor fiscal control for service contracts. The Associate Director, EM,would supervise and direct the grants aspect of the RMLP according toguidelines established by the Director, NLM. The RMLP grant programwould be open to all institutions on the basis of a national competitionfor funds to support research and development aspects of the network.The Associate Director, EM, would assure coordination of the ResourceGrant Program with the Implementation of the Regional Medical LibraryProgram.

Dr. CuBBings has accepted the offer of the Resources Review Committee tohelp in reviewing current and potential RML problems. Among problems to beconsidered are the geographic and Institutional appropriateness of existingRMLs, the future of the free-standing medical libraries and institutionalcooperation.

After an extended discussion the Board unanimously agreed to the principlesstated and the issuance of formal guidelines.

Dr. Cunnings said that Dr. Schoolman has done an outstanding job of coordinatingthe two voices of NLM, Intramural and extramural. Before Dr. Schoolman assumedresponsibility for this program, the Library had a serious problem arisingfrom a dichotomy of management: one set of guidelines was being annunciatedfrom the EM with a grant philosophy, and another set was coming from directoperations, which is oriented to production and technology.

AAMC REPORT ON LISTER HILL CENTER FUNCTIONS

As the first item of business on the second day of the meeting, theChairman welcomed Dr. Eugene Stead of Duke University, Dr. John A.D. Cooperof the Association of American Medical Colleges (AAMC), and Dr. Kenneth M.Endicott, Director, BHME. Dr. Stead presented an overview and summarizationof "Educational Technology for Medicine - Roles for the Lister Hill Center -Recommendations for a National Blomedical Communications Network", a reportof the Steering Committee, Council of Academic Societies, Association ofAmerican Medical Colleges, published In March 1971. Dr. Stead said that,in the opinion of the Steering Committee, the Schools of Medicine workingin concert with the Lister Hill Center could produce results greater thancould be produced by either acting alone.

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Discussion from the beginning centered around creation of a biomedicalcommunications network consisting of a series of peripheral nodes through-out the nation. Conmunications among these nodes would be coordinatedby the Lister Hill Center, which would stimulate and catalyze the develop-ment of materials by these centers and put.them in a form and frameworkwhich would allow them to be used and distributed to the efferent portionsof the network. The Committee had difficulty in finding a group of schoolswhich were creating and sharing materials together to show on a smallscale what could be accomplished.

Few, if any, schools have ever had a budget which would permit the productionof materials other than printed materials for use in teaching programs.Unfortunately, preparation of better teaching materials brings neitherrecognition nor promotion in academe.

One function of the Lister Hill Center would be to obtain agreement throughoutthe educational world for production of materials for widespread use afterpeer review. The Center might sponsor production of standardized curriculain the form of modular blocks which could be adapted and manipulated byindividual professionals. The various Associations of Professors couldbe the avenue through which one might begin to put together cooperativeprograms, to look for common funding, to have material prepared undersupervision of an appropriate committee. One essential in the audiovisualfield is an annotated catalog and a record of peer review to show thecompetencies Involved in the preparation and review of material.

The Committee was also faced from the beginning with the problem of how toimplement a network that did not exist even in the simplest of terms.Throughout the report the Committee has emphasized the need for educationalfunds, training funds, facilities present in places where materials areproduced, and advice equivalent to the training programs of the NIH inother fields - to train a rather wide variety of people to handle theseprograms at a career or professional level.

The Committee was unable to find any reason why the network could notbe effective with peripheral production, central coordination, centraldistribution, and effective peripheral utilization. Most of the problemsare cultural rather than technological.

Dr. Anlyan agreed with Dr. Stead's point that we must await a newgeneration of consumers. One probably cannot rely on existing consumersto use the system effectively. Dr. Anlyan emphasized the following partsof the report:

Coordination of all biomedical communications in the health field in theFederal establishment. The Lister Hill Center should train or stimulateothers to train manpower equipped to apply new knowledge and techniquesin communications technology in the medical schools and other healtheducational settings. Its programs should also promote application oflearning research in the design and evaluation of learning materials.

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That the Board of Regents continue to urge the DHEW to provide moresupport for the educational programs sponsored by NLM. The ListerHill Center should exercise unceasing concern for the acceptability ofits programs. Program development should be concentrated in subjects,schools, and/or disciplines where the benefits of technology are alreadyperceived and where support is actively sought.

Where the medical community has defined core curricula to meet educationalobjectives, the Lister Hill Center should be responsive to requests forassistance in preparing evaluating, and distributing audiovisual andcomputer materials to meet their needs.

Within each disciplinary area, It Is the clear responsibility of contentadvisory groups to the Lister Hill Center to suggest priorities onprograms and materials to be developed based on demonstrated needs andself-perceived wants. Dr. Anlyan recommends consideration of an alternativemechanism - for the Study Sections of the NIH to consider spending a partof their time addressing themselves to this issue which then might becalled to the attention of Associations of Department Chairmen.

Dr. Anlyan believed that the Lister Hill Center should fund Initiallyapproximately ten regional medical divisions of computer science programsin medical centers with strong university programs which will developneeded manpower. These programs should also be encouraged to clarifythe role of the computer in education and clinical decision-making andto standardize data collection and storage techniques as well as hardwareaad software so that material could flow between the programs and eventuallybe concentrated for distribution in the Lister Hill Center.

The Lister Hill Center should also increase its role in manpower trainingdirected primarily to the development of three programs; central staff,educational technologists, and communications technologists.

Appointment by the Board of Regents of NLM of an advisory committee tothe Lister Hill Center, whose overall objective should be the developmentof the educational program of the Lister Hill Center was also proposed.

The NLM ought to develop the Interface on the university and academichealth center side to get the program moving, funding should be obtainedfor several models - several mini-networks that can be tested and evaluated,using the discipline-oriented material which could be available to the nonmini-network.

Dr. Endicott offered to work with the Regents in such a manner that theBureau program and that of the NLM will reinforce and strengthen theexcellent programs being developed by the Library. Cooperation betweenthe NLM and the BHME was stressed by Dr. Endicott, who referred to fundingfor the BHME-NMAC program in FY 1972.

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Dr. Cooper expreesed his appreciation to Dr. Stead for his contributionsto the report and said that the blending together of the various partsof the continuum of medical education that la developing, and the Increasingintereet of the academic medical centers in long-term education planningwill facilitate development of the kinds of proposals already discussed.The AAMC regards the study and report as most timely. It will be publishedin July of this year In the Journal of Medical Education.

Dr. Ebert said that this kind of program will certainly revolutionizepresent concepts about educetlon. It will require an enormous amount ofwork at the software level. His one word of caution was against developmentof too large networks too early.

Dr. Cunnings remarked that Dr. Stead's preeentation served as a bettervehicle to convey what the program and problems are all about than didthe report itself. For thet reason, Dr. Cunnings suggested that perhapsDr. Stead's convents might be published as an editorial to accompany the report.The publication of the report will serve as a very useful means to generateneeded public discussion end debate.

Dr. Cunnings fully agreed with those who said that a companion piece tothe report is needed to Identify clearly the role of the health professionalschools. NLM with support of the Board will be prepared to sponsor it.

The need for coordination within DHEW must be emphasized until the point getsrecognition. Accordingly, Dr. Baker suggested formallzatlon of efforts suchas that between the BHME and the Library to demonstrate that such cooperativeefforts benefit both participants and the Department.

Dr. Cunnings had asked the senior staff of the Lister Hill Center, the NMAC,and the Library broadly to review the recommendations in the AAMC report toIdentify those which NLM can implement. The staff identified ebout one-thirdachievable by NLM within Its present mandate, interest, talents and resources.Those that deal with the functions of NMAC are recommendations that theLibrary must accept and implement. Some of those are already under way.Those elements of the report that deal with today's communications technologyand ite applicability to health affairs can be implemented. Those that dealwith the creative production and such matters as the input into the networkere the recommendations which NLM would find difficulty in implementing.Therefore the Library sought the essistance of the BHME.

The Director concluded his comments with the following etatement:

"The NLM may from time to time expand its visions and aspirations beyondthe reality of its resources. Having done so, the NLM is not onlywilling but eager to share the opportunities that come out of studieslike this with organizations and Institutions In a better position toimplement the ideas and recommendations."

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In discussions which followed, Mr. Augenstein suggested that the reportidentify costs for its many excellent recomnendatlons and that prioritiesbe established for progressive steps within fiscal limits. Mr. Augensteinalso suggested exploration of cooperative ventures with other organizationssuch as the BHME. Dr. Baker endorsed Mr. Augenstein's remarks and pointedout that the action content of the report Is sufficiently demanding, expensive,and exhausting of talent to warrant a developmental phase.

Dr. Gumming* expressed concern about dependence on some other Agency'sbudget for substantive parts of Library programs. He is interested in thephilosophy of cooperation and the Integration of program planning and offeredthe Lister Hill Center staff to provide staff support for such a study.

The Chairman, after more discussion, proposed appointment of a subcommitteeof the Board to work with NLM staff to develop priorities for recommendationswhich could be priced and, further, to explore alternatives such as relation-ships that might be established with other Federal Agencies through researchand development contracts.

LISTER HILL NATIONAL CENTER FOR BIOMEDICAL COMMUNICATIONS

Mr. Feiner briefly reviewed the background and current status of the majorprojects of the Center, emphasizing the communications satellite experimentwith Alaska.

A conference in Seattle, Washington, March 15-16, brought together theAlaskans and personnel from Stanford University, the University ofWashington, the University of Wisconsin, NASA, and DHEW. The overalloutline of the experiment was coordinated with all Interested parties.The approach to a two level voice network will be developed from theAlaskan Native Medical Center to the 5 Field Service Units of theAlaskan Native Medical Service and then from these service units to 20selected locations.

The development of new capabilities, beyond voice, are now to be testedfirst by the universities and the Lister Hill Center in the "lower 48."Such tests will Investigate the use of physiologic data, facsimile, slow-scan TV, and computer data. Engineering feasibility will be demonstratedfollowed by controlled medical evaluation. After these tests have beencompleted, the new capabilities will be tried in Alaska. Technical/medicaltests of new capabilities will be done In a priority order established bythe Alaskans.

The Library has recruited a young physician, Dr. Brian Beattie, who willbe assigned to the Lister Hill Center and stationed in Alaska. He will beresponsible for managing the medical side of the experiment, providingliaison with the various public and private medical groups Involved, andoverseeing the evaluation of the project. Installation of satellite terminalswill begin in July and should be completed before October1971.

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The Biomedical Project has been expanded at the request of the Secretary,DHEW, to include a limited experiment in education under the auspices ofthe Office of Education. Remote equipments, speaker/microphone, will beadded to schools in 21 locations so that the terminal can be used fromthe home of the village medical aide to the village school. These remotescan then be used to allow teacher - teacher conferences and provide broad-casts in general education subjects and community health instruction tothe students.

MEDLARS II DEVELOPMENTS

Mr. Simmons summarized developments leading to termination of the Library'scontract with Computer Sciences Corporation:

The MEDLARS II development project was reviewed at the March meetingof the Board of Regents. At that time, it was estimated that the INITIALphase of the system probably would not be operational until June 1972,and that it would require between $800,000 and $1 million beyond the$3,197,000 committed under the existing contract with the Computer SciencesCorporation. In addition to the schedule delays and increasing costs forthe project, serious doubts were raised as to the acceptability of thesystem design at any cost or delivery date. The following questions wereproposed as those requiring resolution.

Will the system, as designed, ever operate effectively for NLM? If so,when and for what cost? If not, what are the alternatives? The workduring the latter part of March and April was directed toward the resolutionof these questions. The consultants serving the Board, in conjunctionwith members of the Library staff, engaged In a detailed analysis of theMEDLARS II system. A review was also conducted of the on-line, interactiveaystern known as AIM-TWX which was developed concurrently with the MEDLARS IIproject by the System Development Corporation. These reviews resulted inthe following recommendations to the Director by Mr. Zipf and Mr. Augenstein:

1. The AIM-TWX interactive system should be expanded through anextension of the contract with the System Development Corporation.

2. The contract for the MEDLARS II development by the ComputerSciences Corporation should be allowed to expire and not berenewed or renegotiated.

3. A new fixed price contract should be negotiated with SDC todevelop a computer based system (in a batch processing mode)for MEDLARS II to complement and be interactive with AIM-TWX.

The Director, NLM, as a result of the reviews and recommendations,notified CSC by letter and telegram on April 19 that he had decided notto extend the CSC contract for MEDLARS II. He requested that CSC utilizeremaining funds in the contract to complete as much documentation aspossible and Identify that which was of most importance to the Library.CSC has since removed all of its personnel from the Library, and phasedthe staff of 49 down to 10.

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A review is underway of tha CSC documentation to determine those partsof the MEDLARS II work that maybe of some use in the redirected effort,and plans are being developed to Implement AIM-TWX on the NLM computer.

The Library has received from CSC (1) overall functional system specification,(2) detailed procedural design, (3) project control document, (4) detailedschedule of sub-events, (5) training plan, (6) data conversion capabilityspecifications, and (7) miscellaneous working papers. CSC is to deliverthe following by June 18, 1971:

1. Matrix of program status

2. Purpose and operation of each program

3. Summary overview for COSMIS, LPS and APS

4. Description for each module

5. Program specificatlona for 269 programs, and

6. Test cases that were used for unit and integrated testing.

The Library will shortly obtain software programs from Sweden to Implementdemand searches on the Library's IBM 360-50.

Mr. McCarn briefed the Board on the role of the Syatem Development Corporationwith respect to currant AIM-TWX activities and their extension. In May SDCsubmitted a proposal on how the Library could build a reduced MEDLARS II.After a comprehensive review of this proposal, the Library auggestad anumber of alterations. These were made by SDC and agreement wo reachedon a letter contract. Tha letter contract does not have the status ofa definitive contract but commits tha Library to funding part of thedevelopment effort through a detailed system design but not to fullImplementation; it does obligate funds to complete the project shouldthat appear doirabla to NLM. The proposal covered (1) an extension ofthe present AIM-TWX service, (2) development of ELHILL II to make ELHILL III,and (3) creation of maintenance publication capabilities necessary forreplacement of MEDLARS I.

Through e well defined procedure and management mechanism the Librarywill maintain control over hardware and software development throughoutthe course of the contract with SDC. A configuration control boardwill review all proposed changes.

The Chairman called on Mr. Zipf, who said that he wo impressed with theknowledge, capability, and understanding of the SDC team and that extensionof AIM-TWX is the wisest and the most efficient course of action. Mr. Zipfpraised the Director for his courage in cancelling the CSCcontract.Dr. Baker agreed and hoped that tha competency of NLM'a internal expertisewill be enhanced. He said that the Library deserves appreciation of tha

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Board and others for ita raaponaa Co the unfortunate experience with CSC.He concluded that by maintaining a constant commitment to quality of itsown staff, the Library will build an internal competency and skill whichwill carry forward to other programs.

REVIEW OF FOREIGN MEDLARS CENTERS

Between April 29 and May 12, Mr. Augenstein and Dr. Leiter visited thefive European MEDLARS centers to brief them on the most recent developmentsrelating to MEDLARS II and AIM-TWX. Mr. Augenstein and Dr. Leiter visitedin London, Nottingham, Stockholm, Paris, Cologne and Geneva.

Without exception, representatives of the European centers expressed admirationfor Dr. Comings' courage and judgment when they learned the circumstancesof the terminated CSC contract. All of the centers are interested in theSDC effort and should be involved at a very early stage. Such Involvementwill be beneficial to all concerned. Perhaps the NLM could sponsor a work-shop reviewing this effort this fall. Mr. Augenstein 's overall impressionwaa that the people in European centers are enthusiastic, ingenious andinnovative and are doing a vary creditable job. The spirit and talent ofNLM waa reflected in the centers and is a credit to Dr. Cummin gs and his staff.

ANNUAL REGENTS ' AWARD FOR SCHOLARSHIP AND TECHNICAL ACHIEVEMENT

Dr. Ebert announced that the second annual Regents ' award for scholarshipand technical achievement is being presented to Mr. Stanley Jablonski forhis published work "Illustrated Dictionary of Eponymic Syndromes and Diseasesand Their Synonyms." This is the work of an outstanding lexicographer. Thevolume represents both scholarship and a massive amount of hard work. TheBritish Medical Journal said: "This dictionary Is an astonishing work ofscholarship for one man to have undertaken".

In his concluding remarks as Chairman of the Board, Dr. Ebert said howmuch he had enjoyed working with the Board and the staff. He said, too,that the morale of the Library seems unusually high.

At this point the Board of Regents acknowledged with signal gratitudethe contributions made to the Board and to the National Library ofMedicine by Dr. Robert Ebert, Mr. Bruno Augenstein and Dr. FrederickWagman, and extended the thanks of the Board to them for their servicesduring their tenure.

Respectfully submitted,

(L -—

Martin M. Cunnings, M.D.Executive Secretary to the

Board of RegentsNational Library of Medicine

Attachments

ACTIONS TAKEN BY THE BOARD OF REGENTS IN GENERAL SESSIONJune 14-15, 1971

1. Formal designation of Visiting Scholars was agreed to in the ExecutiveSession. The program Is described in Appendix II.

2. The Board passed a resolution defining the relationship of theNational Library of Medicine to the new Cancer Conquest Program.(See Appendix III)

3. The Board concurred with present Library practice of restricteddistribution of audiovisual materials primarily but not exclusivelyto the support of health professionals.

4. The Board expressed the view that the Library should Involve itselfin basic processes of information such as linguistics, activelysupport projects in this area, and organize a conference for discussionof the relationship of linguistics to the Library's general mission.

5. The Board agreed, where possible, that the staff continue to discourageresource grant applications from institutions not primarily health-related. If such applications are submitted, the applicant is to beinformed that his application will not be processed or reviewed untilsuch time as all approved requests from libraries related to healthare funded. Those libraries which are not primarily related to healthbut serve programs which, in the judgment of staff, have major healthsignificance would continue to be submitted to the Biomedical ReviewCommittee and to the Board of Regents.

6. The Board recommended the use of resource grant funds for maintenanceof collections but not for purchase of rare books or historical itemsand not for renovation of facilities.

7. The Board accepted the recommendation that, although worthwhile,security systems for protecting collections should not be fundedthrough grants.

8. The Board passed a resolution discouraging the Library from usingfunds for autonomous serial-record building. (See resolution Appendix IV)

9. The Board authorized implementation of the principles enunciated bythe Library for construction of an Interactive cooperating networkas a model for study, growth, and development of a nationwideBiomedical Communications Network and endorsed issuance of guidelines.

10. The Regents award for Scholarship and Technical Achievement waspresented to Mr. Stanley Jablonski for his published workIllustrated Dictionary of Eponymic Syndromes and Diseases andTheir Synonyms.

11. The Board of Regents acknowledged with signal gratitude thecontributions made to the Board and to the National Library ofMedicine by Dr. Robert Ebert, Mr. Bruno Augenstein, and Dr. FrederickWagman and extended the thanks of the Board to them for theirservices during their tenure on the Board.

APPENDIX I

NATIONAL LIBRARY OF MEDICINE - NATIONAL CANCER INSTITUTERELATIONSHIPS

The National Library of Medicine has offered its services to the NationalCancer Institute on several occasions antedating the current debate on theInstitute's future. Several members of the Library staff are former membersof the NCI; two of us held major management positions. Therefore communicationsbetween the Library and the Institute are easy, perhaps too easy, because weknow each other so well.

The Institute as an organization has never availed itself of MEDLARS capa-bilities despite Dr. Leiter's attempts to introduce them to this modern system.Individual members of the NCI have used MEDLARS effectively and recognize thatthe quality of a demand search is greatly improved by discussion of the topicwith a trained MEDLARS analyst. One group in the Institute has been exposedto AIM-TWX, but we would not expect its comparatively small data base to satisfythe needs of this largest of the NIH research institutes.

The National Cancer Institute has published since 1940 its own monthlyJournal containing original articles largely on laboratory research but includinga substantial amount of demography and epidemiology. Contributions are refereedby a sophisticated editorial board of NCI staff. The Journal's coverage isglobal, accurately reflecting the swings of the popularity pendulum in cancerresearch, currently virology and immunology. Supplements to the Journal appearat irregular intervals dealing with some newly emerging facet of cancer research,or reporting a meeting to resolve controversial topics important to the field.The most recent of the supplement series deal with Cell Cultures for VirusVaccine Production and Human Tumor Cell Kinetics.

The Institute has also published Cancer Chemotherapy Reports since 1959.Originally this irregular periodical, controlled by its own Editorial Committee,carried a notation that publication of material in its pages did not fulfillthe need for publication of definitive expositions. That stipulation has beendropped. CCR was and still is Intended to facilitate communication in the fieldof cancer chemotherapy. Thus it accepts screening data, preliminary reports,interim reports and the like, including abstracts of papers presented at meetings.It too publishes supplements, usually records of meetings important to thechemotherapy of cancer. The scientific content of Cancer Chemotherapy Reportsmay appear to be somewhat less precise than that of the Journal of the NationalCancer Institute, but both are included in Index Medlcus.

The Institute also publishes two abstract periodicals, Cancer ChemotherapyAbstracts and Carcinogenesis Abstracts. Each is produced by contract, andneither Is highly regarded by the staff of the Institute though both are popularwith cancer interests outside of Bethesda. Cancer Chemotherapy Abstracts iswoefully behind. The November-December 1968 issues appeared this spring. Theycontained 1,862items of which 14} (7.5%) were from 69 periodicals not coveredby Index Medicus. The yield from those journals was less than five, and morefrequently one article, except for the Journal of the Japanese Society for Cancer

Therapy which yielded 38, and Annales Case Salud Valdecilla that contributedsix articles. In other words, MEDLARS could have identified 92.5% of thearticles to be abstracted by a monthly printout of the relevant titles. Ofthe articles from journals not included in Index Medicus I was able to findseveral authors who had written essentially the same paper for publication inan Index Medicus periodical, but did not quantify this factor.

Mr. Mills, of Specialized Information Services (SIS), performed a similaranalysis of Carcinogenesis Abstracts for November-December 1970. It contained558 abstracts. Thirteen publications accounted for about 40% of the abstracts;the balance came from 190 serials. Of the 13 high-yield sources, four werefrom publications not included in Index Medicus;

Chemical-Biological Interaction 10Recent Results in Cancer Research 19Thyroid Neoplasia 8Annual Reports. Argonne National Laboratories 6

The first two of these are periodicals, but Recent Advances is a secondarypublication. Thyroid Neoplasta is a book, and presumably the Annual Reportsof the Argonne National Laboratories summarizes findings published Jji extensoin conventional Journals, most of which would probably be included in IndexMedicus.

Failure of the National Cancer Institute to avail themselves of MEDLARScapabilities may reflect in part the attitude of a former member of theNational Advisory Cancer Council who testified before a Senate Committee onS-34 that MEDLARS was too slow in retrieving citations and insufficientlycomprehensive in its coverage, particularly of clinical articles. This samegentleman is a compiler and editor of the Year Book of Cancer. The 1970edition contains 313 footnotes that are bibliographic references. Actuallythe number of articles cited is larger because a single designation may citemore than one reference. Of the 313, only 13 (4%) cite articles not includedin Index Medicus. and of those, two cite European doctoral dissertations, andonly three cite serials published in the United States. The editors commenton the majority of the articles that are abstracted in the Year Book of Cancer.but commented on only five of the 13 articles obtained from non-Index Medicusperiodicals.

The Director^ NCI, wants better Information services and told theInter-Institute Council at its meeting on May 10 that some fraction of the$100 million expected to swell its budget in fy 72 would be diverted to thatpurpose with the help of the National Library of Medicine. Conversationswere initiated between the NLM and NCI on May 24, the new capabilities developedby SIS were described, and the NLM offered to provide existing services to theInstitute on the same basis as to others and to develop such new services asthe NCI might require.

Dr. Kissman had already offered to provide a special type of SDI service byscreening citations emanating from monthly printouts from MEDLARS, Chemical

Abstracts. Biological Abstracts. Engineering Index, etc., based on profilesof interest by NCI staff and sending forward only the most relevant citations.The interests of NCI scientists span the entire spectrum of the biomedicalsciences as well as clinical medicine. Therefore it would seem preferableto merge data bases and search them routinely for the proposed SDI service.Software for the use of such pooled data bases has been created by the Univer-sity of Georgia among others. While MEDLARS has not been officially includedin these "pools," experiments at the University of Georgia with a pilot MEDLARStape have indicated, in Dr. Kissman's opinion, that such an inclusion wouldpresent no special problems. The Georgia software has already been acquiredby Oak Ridge National Laboratories, and SIS could presumably utilize thiscapability through its contractor-operated Toxicology Information Query ResponseCenter at ORNL. SIS personnel would assist NCI scientists in developing "interestprofiles" and assure their currency through frequent interaction with the partici-pants. I regard this experiment as highly desirable and one that the NLM shouldundertake in any case, providing adequate resources can be obtained.

We also offered the services of ORNL in preparing state of the art reviewson subjects of their choice at no cost to the NCI, at least for the time being.

Dr. Carl G. Baker told of the desire of a prominent senator that NCI set upa computerized data bank that would serve global interests in cancer research.He believes, and I agree, that the scientific base on which the study of cancerdepends is too small and too soft to merit such a costly venture at this time.However, Dr. Baker did express an interest in two efforts:

1. Acquiring information more rapidly and more readilythan conventional publication permits, and

2. A management information system.

The NIH has had experience in circulating unpublished documents and abandonedthe effort when some proportion of the abstracts, summaries, preliminary reportsor what have you proved to be the end of the road. Moreover, some scientificentrepreneurs used this device as a means of establishing a rather tenuouspriority. The system was never intended to supplant conventional publication.It was started and stopped at the request of the scientific community. Anylarge scientific research organization is aware of the enthusiasm engenderedby an unanticipated result which can lead one down a series of primrose pathsif published prematurely. The idea of a "Journal of Irreproducible Results"has made most administrators wary of information that has not passed theseveral screens by which the scientific community assays the validity of itsworks. Nevertheless, it would be entirely possible to link up the major cancerresearch centers in the United States, and perhaps abroad, in some network tofacilitate communications, but the NCI was told explicitly that the NLM cannotevaluate the validity of scientific documents, nor should it attempt to do so.

The concept of a management information system was not explored other thanto express the Library's desire to be helpful in assisting the Institute infurthering its goals.

The NCI was invited to visit the Library to talk with the people in itsvarious branches about their current capabilities and to learn in more detailwhat the Institute wants and needs. The first of a series of meetings isscheduled for June 18 and will be devoted to a demonstration of AIM-TWX anddiscussion of its projected expanded data base.

It seems reasonable to me that the on-line system that now contains 6,000abstracts from the Health Aspects of Pesticides Abstract Bulletin will attractthe interest of the cancer people. It has an appealing versatility. For example,the abstracts already being produced by the NCI could be entered into the systemat modest cost and retrieved on-line or printed off-line on many different axesthrough free text searching. Also, the excellent data generated by the New YorkState (exclusive of New York City) and Connecticut Cancer Registries could becomputerized to monitor the changing scene in clinical oncology. A paper inthe New England Journal of Medicine for April 22 describes a series of youngwomen in Boston suffering from adenocarcinoma of the vagina. The mothers ofall but one had received diethylstilbestrol therapy during pregnancy. Would itnot be highly desirable to compare the experience of women in New York andConnecticut with the same lesion?

I would not have you believe that the Information activities of the NationalCancer Institute are hopelessly or uniformly bogged down in a horse and buggytechnology. A large part of the data required for their effective cancerchemotherapy program Is computerized to the extent that, in one sense, the com-puter actually selects the candidate chemical compounds to be developed as newdrugs. The Institute has conducted surveys of the total experience with malig-nant neoplasms at intervals of ten years in several large American cities.The approach was retrospective, the cost enormous, but the information important.Conversion to a prospective automated approach has reduced the time needed tocomplete the study by 50 percent without materially Increasing the cost. NCIpersonnel are already acquainted with TIP's computerized Roster of Toxicologists.which they used with considerable success earlier this year. They identifiedpersons previously unknown to them who possessed skills and information Importantto cancer research. Undoubtedly NCI will want to help In keeping the file current.It now contains data on some 3,200 experts.

In any case, the Library will help the NCI to develop modern informationservices. We would hope to have something more definitive to report at thefall meeting of the Board.

G. Burroughs Mider, M.D.Deputy Director, NLM

June 1971

APPENDIX II

SCHOLARS IN RESIDENCE (VISITING SCHOLARS) PROGRAM

The National Library of Medicine will establish a Scholars in Residence(Visiting Scholars) Program to encourage and to recognize scholarly researchrequiring use of the Library's collection. Candidates for appointment shouldmake a major commitment to their chosen projects to the extent that theresearch constitutes essentially a full-time activity for a period of atleast six months during which a substantial proportion of their time will bespent within the Library. They should hold no other current active positionunless on sabbatical or other extended leave.

Candidates should submit a brief application to the Director, NLM, inthe form of a letter outlining their proposed program or project, which wouldbe expected to have an historical component or to treat a subject in broad,long-range perspective. A curriculum vitae should accompany the letter todemonstrate a record of accomplishment evidenced by academic or other appoint-ments and publications.

The NLM will provide appropriate office space as available, occasionalassistance in typing manuscripts (although not regular secretarial services),photocopying, and the usual reference and reader assistance such as a facultymember might expect from his own university library.

The Scholar would be expected to use the above title on publishedpapers and other appropriate occasions during his appointment and to provideacknowledgment to NLM for the use of its facilities.

Appointment of Scholars in Residence would be made by the Board ofRegents upon recommendation of the Director.

APPENDIX III

The Board affirms the assessment of the Deputy Director concerning

the role of information technology and bibliography in the national

conquest of cancer. Particularly, the present fragmented and uncoordinated

effort in dealing with the literature on cancer research is felt to be

a marked defect in our fight against neoplasia.

The Board of Regents asserts its conviction that the program for

the^control of cancer will depend on unprecedented generation and

correlation of information in the biomedical, and also physical, sciences

and technologies.

In the forthcoming Implementation of the Act to conquer cancer,

the Board recommends that the NLM be designated by the President

specifically as the agent for assembly of knowledge, its organization

and dissemination, on behalf of all components of the National Cancer

Program.

APPENDIX IV

The Board favors, as part of a national network for

document delivery, simple locator tools based on a principle

of vertical referral compatible with a national serials data

base which will provide easy access to the holdings of major

resource libraries and NIM. The Board does not favor for

this purpose the funding of multiple incompatible union lists

containing detailed information on the serial holdings for

limited geographic areas.

June 15, 1971

BOARD OF REGENTSNATIONAL LIBRARY OF MEDICINE

MINUTES OF EXECUTIVE SESSION

The Board of Regents of the National Library of Medicine met inexecutive session at 1:45 p.m.,June 15, 1971.

REPORT OF NOMINATING COMMITTEE

Dr. Layton reported for the Nominating Committee, which recommendedDr. William G. Anlyan to succeed Dr. Robert H. Ebert as Chairman of theBoard. The recommendation was affirmed unanimously, and Dr. Anlyan assumedthe chair.

RESOLUTIONS

A program to encourage scholars to use the Library's collection and torecognize their contributions by naming them as Scholars in Residence, orperhaps Visiting Scholars, was discussed in the context of a discussiondraft circulated to the group. Need for such a program has been voicedby several distinguished physicians and scientists who have made extensiveuse of the Library in widening the experience of the blomedical communityand society in general by their scholarly studies which cast importantevents in broad perspective. The recommendation, adopted unanimously bythe Board, appears as Attachment A.

Dr. Baker introduced a resolution defining the relationship of theNational Library of Medicine to the emerging "National Cancer Program,"which was also adopted by unanimous vote of the Board:

"The Board affirms the assessment of the Deputy Directorconcerning the role of Information technology and bibliography inthe national conquest of cancer. Particularly, the present frag-mented and uncoordinated effort in dealing with the literature oncancer research is felt to be a marked defect in our fight againstneoplasia.

"The Board of Regents asserts Its conviction that the programfor the control of cancer will depend on unprecedented generation andcorrelation of information in the biomedlcal, and also physical, sciencesand technologies.

"In the forthcoming implementation of the Act to conquer cancer,the Board recommends that the NLM be designated by the Presidentspecifically as the agent for assembly of information, its organizationand dissemination, on behalf of all components of the National CancerProgram."

The Board then adopted, without dissent, the following policy statementfor guidance of the Director, NLM:

"The Board favors, as part of a national network for documentdelivery, simple locator tools based on a principle of verticalreferral compatible with a national serials data base which willprovide easy access to the holdings of major resource libraries andNLM. The Board does not favor for this purpose the funding ofmultiple incompatible union lists containing detailed informationon the serial holdings for limited geographic areas."

WHO HUMAN REPRODUCTION DOCUMENTATION CENTER

The Deputy Director, NLM, summarized for the Board the "Report of aFeasibility Study" for an "Expanded Programme of Research, Development andResearch Training in Human Reproduction" submitted to the World HealthOrganization in May 1971. Professor Sune Bergstrom had provided a copyto the Library and had solicited evaluation of the cost estimate by theBoard. This refers particularly to Appendix E, "WHO International Docu-mentation Centre on the Blomedical Aspects of Human Reproduction," whichProfessor Bergstrom had described to the Board of Regents in some detail onMarch 22. Dr. Mlder pointed out that Appendix E contained little moresubstantive information than that already available to the Board, otherthan the cost estimates.

The initial year of operation is projected at $300,000, the second yearat $360,000, with ultimate cost of $388,000 during the fourth and fifthyears of operation. All costs for personnel services (Including systemsand program consultants) constitute about 55 percent of the budget throughoutthe five-year period. No costs are Included for acquisition of documents,probably because the philosophy of shared resources that dominates the planpermits one to assume that those required are already in the possession ofparticipating organizations. The first-year projection is based on the costof 5,000 retrospective searches annually and distribution of 1,500 monthlysearches to be produced at the Karolinska Institutet which has extensiveexperience in this type of activity. Dr. Mider believed that such & docu-mentation program would cost somewhat more in the United States, whereuponMr. Augenstein stated that his recent trip to examine foreign MEDLARS centershad indicated that the costs to Sweden were about one-half of the cost forthe same operation in this country.

The Board then agreed that the costs seemed realistic and asked theDirector, NLM, to transmit to Professor Bergstrom a letter encouraging himto proceed with the documentation plan.

MEETING WITH SECRETARY. PHEW

Dr. Ebert reported on his meeting with the Secretary, DHEW, on April 30,1971, which was also attended by the Assistant Secretary, Comptroller, DHEW.The Secretary was well informed on the affairs of the NLM and sympathetic to

its need for more adequate resources in keeping with the resolution passedby the Board in March. Dr. Ebert felt the meeting, which lasted for anhour and a half, quite useful and probably productive. The question ofholding a similar meeting with the Director, NIH, was considered andabandoned after the Director, NLM, had detailed tangible evidence of supportfor the Library's programs by Dr. Marston.

AAMC REPORT

Mr. Augenstein returned to the morning's discussion of EducationalTechnology for Medicine; Roles for the Lister Hill Center, the report pro-duced by the Steering Committee, Council of Academic Societies, Associationof American Medical Colleges. He proposed that those recommendations inthe report that were clearly within the scope of the Library's programs andpresent or projected capabilities should be priced, and priorities assignedfor their implementation. His thoughts coincided with report recommenda-tion 8.3. Discussion led to the conclusion that a committee includingmembers of the Board of Regents and other external advisers should be formedspecifically for those purposes receiving staff support from the Lister HillNational Center for Biomedical Communications. It was specifically suggestedthat Drs.Robert H. Ebert and Eugene A. Stead, Jr. serve in the group, whichshould hold its first meeting in September.

The next phase of the examination of educational technology for medicinewas agreed to require a report Identifying the responsibilities and role ofacademic Institutions in developing the program. However, no attempt wasmade to assign this function (it is not included under terms of the existingcontract with AAMC).

NLM RELATIONS WITH BHME

Director, NLM,addressed the proposal made by Dr. Baker that the NLMor perhaps the Lister Hill group be formally designated as the research anddevelopment arm of the Bureau of Health Manpower Education, asking that heconsider the matter further before responding. The Board assented.

OTHER BUSINESS

Before, ceding the chair to his successor, Dr. Ebert expressed hisappreciation for the support afforded him by his colleagues during his tenureas Chairman and regarded his experience as a Regent as most gratifying.His sentiments were echoed by Mr. Augenstein. Both gentlemen expressedinterest in continuing their association with the NLM.

Details of the Board membership were not discussed, but twoexisting committees of the Board are concerned with NMAC andLHNCBC respectively. It might be desirable to select membersof those committees to serve on the group referred to here.

It was agreed that the March 1972 meeting of the Board of Regentsshould be held at the National Medical Audiovisual Center in Atlanta,Georgia.

The meeting adjourned at 2:45 p.m.

Respectfully submitted,

9*3

Martin M. Cummings, M.D.Executive Secretary, Board of RegentsNational Library of Medicine

Bethesda, Maryland

ATTACHMENT A

SCHOLARS IN RESIDENCE (VISITING SCHOLARS) PROGRAM

The National Library of Medicine will establish a Scholars in Residence(Visiting Scholars) Program to encourage and to recognize scholarly researchrequiring use of the Library's collection. Candidates for appointment shouldmake a major commitment to their chosen projects to the extent that theresearch constitutes essentially a full-time activity for a period of atleast six months during which a substantial proportion of their time will bespent within the Library. They should hold no other current active positionunless on sabbatical or other extended leave.

Candidates should submit a brief application to the Director, NLM, inthe form of a letter outlining their proposed progrnm or project, which wouldbe expected to have an historical component or to treat a subject in broad,long-range perspective. A curriculum vltae should accompany the letter todemonstrate a record of accomplishment evidenced by academic or other appoint-ments and publications.

The NLM will provide appropriate office space as available, occasionalassistance in typing manuscripts (although not regular secretarial services),photocopying, and the usual reference and reader assistance such as a facultymember might expect from his own university library.

The Scholar would be expected to use the above title on publishedpapers and other appropriate occasions during his appointment and to provideacknowledgment to NLM for the use of its facilities.

Appointment of Scholars In Residence would be made by the Board ofRegents upon recommendation of the Director.

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AGENDA

Fortieth i-Ieotlng of thoBOARD OF REGENTS

National Library of Medicine

9:00 a.m.J'.'overnber 2?-?3, 1971'fioarcl Room

Bc'thorjdn, Maryland

I. CALL TO ORDER AIID INTRODUCTORY REMARKS Dr. William G. Anlyan

II. CONSIDERATION OF MINUTES OF LAST MEETING TAB I(Orange book)

TAB II

Dr. William G. Anlyan

Dr. William G. AnlyaaII. DATES OF FUTURE MEETINGS1971 and 1972 Calendars in all booksNext Meeting - March 27-23, 197? (M-T) in Atlanta, Ga.Subsequent MeetingJune 15-1.0, 1972 (T-F)

Seloctiori qTJ.fectins Date - November 197?10-17 20 -21 2'(-2$(T-F) (M-T) (M-T) Thanksgiving - November 23, 1973

American College of Preventive Medicine, November 15-16, Atlantic CityAmerican Medical Association (Clinical), November 26-29; Cincinnati

EV. raMAKKS lift TUT! ASSISTANT SECRETARY FORJftlALTH AND SCIilMTIFIC AFFAIhS

Dr. Merlin K. DuVo..L

V. REMARKS BY TilE DIRECTOR, Nil! Dr. Robert Q. Marston

RETORT OP' THE DIRECTOR, NLM TAB III Dr. Martin M. Gumming

13r,ril AI'INIVERSARY OF TK12 NATIONALLIBFL\RY OF MEDICINE

Dr. G.B. M.Lder

il. REPORT ON THE SAT'ELLITE COMMUNICATIONS TAB IVPROJECT IN ALASKA

Mr. Alfred Zipf

X. REPORT ON HEALTH ASPECTS OF THE STUDYPERFORMED BY DHEW FOR TIE PRESIDENT'SDOMESTIC COUNCIL(DEMONSTRATION OF MODEL SATELLITE)

TAB V Mr. Albert Feiner

\gcnda - Page 2

LUNCH (OPEN CHOICE)

Cafeteria in Nil! on A Level, O'Donncll's Restaurant, 8301 WisconsinAvenue, Bc'thesda, Md. , Governor's House Restaurant, 8400 WisconsinAvenue, Bethesda, Md. , Holiday Inn, 8120 Wisconsin Avenue, lic'thesda,Md. All within a few blocks walking distance from NLM.

{. DISCUSSION OF PRIORITY REVIEW COMMITTEE TAB VI Dr. Harold SchoolmanMEETING, SEPTEMBER 8-9, ]971 TO CONSIDER Ur. William G. AnlyanAAMC REPORT Mr. Bruno Augcnstein

Mr. Alfred Zipf

[. COMPARATIVE ASPECTS OF MEDICAL EDUCATION Dr. Moshc Prywes

ADJOURNMENT

DINNER (DUTCH TREAT) - NORMANDY FARM - FALLS ROAD, ROCKVILLE, MARYLAND

Cocktails: 6:30 p.m. Dinner: 7:30 p.m.

Speaker: Dr. George W. leuschcr Title: "A Profession Evolves"

Board Award to NLM Staff Memher for Scholarship and Technical Achievement

RECONVENE - 9:00 a.m. - November 23, 1971

REPORT OF THE ASSOCIATE DIRECTOR FOR Dr. Lee LangleyEXTRAMURAL PROGRAMS

a. Analysis of EMP Training Programs TAB I Dr. Lee LangleyVOLUME I(Gray Book)

b. Review of Council Procedures TAB II Dr. Lee Langley"Guidelines for Adjustments by Staffin Time or Amount of Grant Award

c. Information requested by the BOR at TAB IIIJune 14-15, 1971 Meeting

d. DRC Report TAB IV

CONSIDERATION OF PENDING APPLICATIONS Dr. Lee Langley

Confidentiality of Proceedings and Conflict of Interest

genda - Page 3

A. P.L. 480 Application 06-502-1National Audiovisual Program forMedical Education in Israel

B. RESEARCH GRANTS

C. SPECIAL SCIENTIFIC GRANT

D. TRAINING GRANTS

E. RESOURCE GRANTS

1. Policy Issues

2. Pending Applications

3. Status of Resource ImprovementApplications

TAB V

TAB VI

TAB VII

TAB VIII

TAB IXVOLUME II(Gray Book)

TAB X

TAB X

REVIEW OF PT, 480 PROGRAMS IN ISRAEL,POLAND AND YUGOSIAVIA

TAB VII(Orange Rook)

Dr. Lee LangleyDr. Robert II. EbertDr. Max Michael

SOURCES FOR THE HISTORY OF MICROSCOPY Dr. John B. Blake

LUNCH - Catarod in Board Room

EXECUTIVE SESSION

ADJOURNMENT

THE BOARD OF REGENTSof the

NATIONAL LIBRARY OF MKDICI.NE

MINUTES OF Tim /40th MEETING

November 22-23, 1971, Bcthesda, Maryland

SHEERS PRESENT;

'MBERS ABSENT;

.TERNATES:

RSTS;

Dr. William G. Anlyan, Dr. William 0. Baker, Dr. Harve J. Carlson,Dr. Susan Y. Crawford, Vice Admiral George M. Davis, Mrs.Brrnice U.Hctzner, Dr. Jack Layton, Dr. Stanley Marshall, Dr. AngeloMay,Dr. John P. McGovern, Dr. Max Michael, Jr.,Dr. Marc J. Musser,Dr. George Teuscher

Dr. Quincy Muniford, Dr. J. L. Steinfeld

Brig. Gen.Gerrit L, Hekhuis represented Lt. Gen.Townor both days.Capt. Edward J. Rupnik represented Vice Admiral Davis the second day,Brig. Gen. Thomas J. Whelan represented Lt. Gen. Jennings both days.

Dr. Merlin K. DuVal, Asst. Sec'y. for Health and Scientific Affairs, DHCU'Dr. John Sherman, Deputy Director, National Institutes of HealthMr. Bruno Augenstein, Vice President for Research, Rand Corp.,ConsultantDr. 'Robert II. Ebert, Dean, Harvard Medical School, ConsultantMr. Alfred Zipf, Executive Vice President of the Bank of Aneri.cn,Cor.sultanDr. Kenneth M. Endicott, Director, Bureau of Health Manpower EducationMME. J. Zeraffa, Chef du Centre de Documentation dc I1 INSEIIM, France

(National Institute of Health and Medical Research)Dr. Rolf Fritz, President, D1MDI MEDLARS Center, Germany (German

Institute for Medical Documentation and Information)Mr. John Sherrod, DirecLor, National Agricultural LibraryDr. Fred Cole, President, Council on Library Resources,Inc.Mrs. Ileen Stewart, Division of Research Grants, National Institutes

of HealthMr. Robert Mehnert, National Institute of Mental Health

Dr. Martin M. Cummings, Dr. G. Burroughs Mider, Dr. Robert J. Benford,Dr. Jeanne Brand, Dr. Charles Bridgnun, Mr. Arthur Broering,Mr. William Caldwcll, Mrs. Davrn Carlisle, Dr. Ralph Christenson,Mr. Peter Cleppcr, Mr. Lawrence Coffin, Miss Mary Coming, Dr. RogerDahlcn, Mrs. Doris Daran, Mr. Albert Feincr, Mr. Joseph Foley,Mrs. Louise Carnage, Dr. Raquel Halc-gu.-i, Mrs.Frances Howard,Dr. Henry Kissman, Dr. Lee Langley, Dr. Joseph Lc.itcr, Mrs. En'ka Love,Mr. Davis McCarn, Miss Irene Moore, Dr. Paulo Pamplona, Mrs.FrancesKigan, Dr. Harold Schoolman, Mr. Ralph Simmons, Mr. Kent Smith,Mrs. Janet Welsh, Mr. Richard West

Minutes oi' Meat.ingBoard of Rej^nto

November 22-23,

rNTRODUCTION OF NEW HQWU MEMBERS

Dr. Anlyan opened the meeting by introducing and welcoming four newlyappointed Regenty. Mrs. Bernlca Hetzner, Dr. Susan Crawford, andDr. Angelo May replace Dr. Ebcsrt:, Dr. Wagmaa, and Mr. Aug<?nstfrin,respectively. Dr. J. Stanley Marshall will complete the unexpired termof Dr. Fletcher.

Dr. Cumming'3 Introduced two now members of die Library Staff: Mrs. ErikaLove, Deputy Associate Director for Library Operations, and Dr. Roger W.Dahlen, Chief, Research, Training and Publications Division, l;!xtr;iuiuralPrograms. Dr. Cummings also introduced Mr. Robert Melm:j.rt, currentlywith the JIation-il Institute of Mental Health, who will soon join the1ILM staff as Special Assistant l:o the.Director for Communications Media.

JUNK 1971 MINUTES AMENDED AND APPROVED, FORTHCOMING MEETINGS SCHEDULED

Dr. Cummlngs brought to the Board's attention an error in the minutes of theJune meeting. Under Tab 1, page 7, paragraph 3, line 3, the figure citedshould read $10,000, not $100,000. With this correction the minutes of theJune 14-15 meeting were approved.

March 27-28, 1972, were reaffirmed as the dates of the next meeting, to beheld in Atlanta, Georgia; June 26-27 and November 20-21 were selected forthe other two meetings in 1972.

REMARKS BY THE ASSISTANT SECRETARY FOR HEALTH AND SCIENTIFIC AFFAIRS

Dr. DuVal stated his keen interest in the Library's mission and its programs.He expressed appreciation for the Board's recommendation that a more focalizedhealth 'communications effort be established, possibly as a Bureau. Thatsuggestion is under advisement at the N1H and in theDepartment.

In response to .1question poaed by Dr. Anlyan regarding the renewal of theMedical Library Assistance Act, Dr. DuVal stated that he felt renewalshould be for a three-to-five yea:: period, and he sees no need for a one-year extension simply to put the effective date in phase with health man-power education legislation.

-2-

Dr. Anlyan questioned the impact of the intenaified cancer effort upon the.amount and type of informa til. on required, and NLM'a ability to provide it.The Assistant Secretary suggested that the; Board make tha Administrationaware of the Library's concern; Dr. Cj:n:nings stated t:hat the National Cancer'Institute (NCI) has been invited to expreas its anticipated needs. Dr. Midcradded that. NCI has stated its interest in the possibility of an internationaldata bank, and haa already beguu to explore existing information sources.Dr. Mider stated further that NCt understands that they are.welcome to aharein any of NLM's current Information services, but that tluiy must support anyadditional ones they want.

Dr. DuVal endorsed the expansion and growth of the Lister Ilil.l Center, butcautioned that this must be approached in such a manner as not to duplicateor usurp the resourced and functions of NLM.

Dr. Michael asked for a clarification of the term "area he:ilth educationcenter," and aaked whether a hospital is such a center. Dr. DuVal citedthe Carnegie Commission Report and various legislative reports as using thephrase, and said it is presently unclear whether the centers are manpower-or service-oriented. Dr. Endicott stated that the goals of the area healtheducation center concept ware to improve the quality and scope of servicesoffered in areas remote from medical schools, and to provide increasededucational opportunities in those areas. To this end, a network ofInstitutions is generally involved - - one or more educational institutions,and onu or more community, military, or Veterans Administration hospitals.

REMARKS BY DR. JOHN SHERMAN. DEPUTY DIRECTOR. NIH

The 1973 NIH budget is completed, and will be presented in Congress inJanuary.

The Health Professional Education Assistance Act, which expired on June 30,1971, has been renewed. Budgetary aspects of the new Act are yet to beresolved'by the Congress; this, coupled with some differences between thenew and old legislation, has delayed NIH's drafting of new regulations forpublication.

The new legislation clearly enunciates, for the first time, the government'srole in supporting medical education. "First dollar," base support will beprovided by capitation grants, instead of the present "last dollar" supple-mentation through programs primarily funded for other purposes. With respectto funding medical school construction, however, loan provisions in the newlegislation are in conflict with the "matching grants" program launched bythe Federal government several years ago. This situation must be resolved,although a combined loan and "matching grant" mechanism is being used thisfiscal year.

- 3 -

The House and Senate have parsed different: versions ot a cancer attackprogram. The principal insue to bs resolved Lr, whether the dimeter of thisprogram will report directly r.othe President, or through regular-NIH/HEWchannels. In the maaiittme, National Caucar Institute planning for imple-mentation of the program is continuing with good progress.

Dr. Sherman briefly reviewed a number of issues of particular concern toNIH: 1) Allocation of national resources, especially in relation to thepressures for applied as opposed to basic medicil reaearch, the disparity ofemphasis on and resources devoted to various efforts, and the restrictionsthat may be placed upon the duration and amount of support to be given tonew programs ouch a3 the conquest of cancer. 2) The threat to the peerreview system of biomedical research evaluation, especially motivated bypolitical considerations. 3) The dilemma arising from a need to reduce boththe number and average grade of employees, and at the aame time attemptingto correct deficiencies in employment and promotion opportunities forminorities and women. 4) Recent allegations in the public press chargingthe Divicion of Biologies Standards with dereliction of responsibility byfailing to assure safety ond efficacy of vaccines. Subsequent investigationinto the charges showed thai; consumer protection had not been jeopardized.The Allegations were unsubstantiated. Dr. Sherman expressed concern at thistype of public challenge to the scientific integrity of the NIH. 5) Thechallenge to NIH's basic concept of attempting to create, to the extentpossible within the Federal framework, an atmosphere conducive to attractingand keeping highly qualified scientists. The sensational, publicized aspectsof a recent case of alleged abuse to this tenat by an institute directorobscures the more basic issue of the need for top program officials toremain at the forefront of their scientific disciplines.

REPORT OF THE DIRECTOR. HIM

The Director presented the Library's FY 1971 Annual Report to the Board,and pointed out that its more elegant appearance was in tribute to the 135thanniversary of NLM and its 10th year of occupancy in the present building.Dr. Cummings credited Dr. Robert Benford, the Library's consulting editor,for his excellent work in upgrading this report as well as other NLMpublications.

The FY 1972 budget authorization reflects a two million-dollar increase inappropriation over last year, but the Department has reserved the increasesfor the present.

The authorized personnel ceiling for 1972 set at 469 reflects a favoredposition for NLM, under the current personnel cut-back program, despiteearlier authorization for new positions in the budget. The Director reiter-ated Dr. Sherman's concern over the difficulty in reducing total staff andaverage grade while affording greater opportunities for minority membersand women. This dilemma is made more pronounced by a position of passiveresistance on the part of some lower grade, employees, resulting in a loss of

-4-

productiv.ity. The NLM supports th« goals of the Upward Mobi.li.ty College,but the lottery mechanism for selecting participa-uts complicates th« per-sonnel situation. Dr. Cummings felt that supervisors should have someinvolvement in thti scheduling, if not the selection, of participants inthe program.

The Director cited two specific examples of the wayw in which the Bureauof Health Manpower Education (BHME), and NLM, are seeking ways to reinforceeach other's misslona. .1) Tha Library's National Medical Audiovisual Center,through formal agreement, is supplying content materials to health professionalschools supported by BHME. 2) The Lister Hill National Center for BiomedicalCommunications, and the Extramural Program have responded to a CHME requestfor assistance in developing training programs and demonstration materialsfor computer science utilization in academic settings.

The Library has received approval for upgrading its computer configuration;an IBM 370/155 is scheduled for delivery in December 1971.

The Director expressed his surprise to find that many individual educationalinstitutions were slow to realize the implications of the impending outcomeof the copyright infringement case levied against the Federal governmentby Williams and Wilkins. Whereas medical libraries have long perceivedthose implications, the institutions themselves have only recently come torealize the impact the decision will have on their own educational processes.The panel of judges is expected to act in the near future, possibly by theend of this calendar year. Regardless of the outcome, the case will probablybe appealed to the Supreme Court.

NLM senior staff has been working with officials of the Medical LibraryAssociation (MLA) to establish new mechanisms for communication betweenNLM and the individual medical libraries around the country. Arising fromthese efforts were the following constructive recommendations: 1) The NLMNews should be sent to each member of the MLA. 2) NLM is invited to writeperiodic guest editorials for the Bulletin of the Medical Library Association.3) Semi-annual program reports should be submitted, by both NLM and MLA, toa liaison committee established between the two groups. In addition, theDirector of NLM will submit an annual program report to the Board ofDirectors of the MLA.

The Medical Library Assistance Act (MLAA), though non-controversial andgenerally held t.o be helpful, may be in for some problems when it comes upfor renewal next July. NIH has requested a five-year renewal, rather thanan annual one, but there may be a move under way to put the MLAA in phasewith BHME legislation by renewing it for only one year. In addition, evena one-year renewal will most likely be preceded by the traditional yet costlyrequest for detaLled Justification of the MLAA.

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Tlie Director presented status reports on these foreign developments:1) The Regional Medical Library for South America, which is co-sponsoredby the Library and the Pan American Health OrganiKat:!on, is making goodprogress. 2) With the exception of the .slov.ly-dovcvLopinj; MKDLAKS Center inJapan, all foreign MEDLARS Centers are performing vi^ry well. 3) There hasrecently been a flurry of Interest in Chinese ir.edic.iiu;. In response to anopportunity to offer suggestions for the President's consideration inpreparation for his forthcoming trip to China, the Library has recommendedthe exchange of information and of library personnel, and the restorationof exchange of publications. 4) In October, at a UNESCO-sponsored meetingin Paris on UNISIST (a world science information sy.stom), Dr. Cummingsparticipated in the review of a report which outlined the proposed system.Consideration of the many issues and proposals contained in the report,which was the result of a five-year joint study effort by UNESCO arid theInternational Council of Scientific Unions, was made more difficult by anapparent lack of understanding of information systems on the part of a large1

bloc of lesser-developed nations. The final recommendations of the con-ference called for the establishment of a UNTSIST secretariat in UNESCO tomanage the development of the system, the creation of a large steeringcommittee to develop the overall plan, formation of n technical advisorycommittee, and the scheduling of an intergovernmental conference in 1972at which the final plan will be presented. The future of this effort isuncertain, due largely to limited funds and the extremely complex politicalrelationships Involved.

Dr. Cummings concluded his report with a re-statement of one of the Library'sprimary functions — the provision of information to the practicing healthprofessional. The Director cited th« development of KEDLINE as being themost recent effort in this regard.

MEDLARS II/MEDLINE STATUS REPORT

Mr. McCarn briefly reviewed the progress of the MEDLAJIS II effort, from theinitiation of a Letter Contract with System Development Corporation onJune 9, 1971, to the present. The contractor is currently working on aSystem Design Overview document which is expected to define in some detailthe characteristics of the system to be delivered; this document will besubmitted on February 3, 1972. As for the prospects for scheduling andimplementation of the effort through July 1973, Mr. McCarn expressed"cautious optimism" due, in part, to the success of the contractor in theimplementation of MEDLINE, which began operation on NLM's computer onOctober 18, 1971. Before MEDLINE becomes fully operational over the nextfew months, activities will center around the generation of the complete database to run on the new computer, and linkages with the Western Union andTYMSHARE communication networks. MEDLINE training courses, of which two havebeen completed, will continue. One of the primary considerations in theoperation of MEDLINE is the number of users which may use the system simul-taneously. As this number increases to its anticipated optimal maximum of40 to 45, the average cost per search is between $5 and $10. These figuresare quite impresalve when compared to approximately $85 per search forMEDLARS searches. And yet, MEDLINH can reasonably be expected to performover 200,000 searches per year, ten times the number now processed by MEDLARS,

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board members were invttc'.'d to a MEDLINE demonstration.

135th ANNIVERSARY OF THE NATIONAL LIBRARY OF MEDICINE

On the occasion of the Library's 135th anniversary, Dr. Mider presented aseries of slides tracing some of the history of the Library at itsIndependence Avenue location, circa 1890, to the late 1950's when the acuteneed for new quarters became so evident. Dr. Mider concluded his delightfulhistory with a photograph of "the smallest book in the Library," which bookhe wryly pointed out cannot now be identified or found.*

REPORT ON THE SATELLITE COMMUNICATIONS PROJECT IN ALASKA

Mr. Zipf reported that the Alaska trip taken by the Director and himsulfduring August removed all doubts as to the value of this project. He wasparticularly impressed with the utter lack of reliable communications mediain the remote portions of Alaska, and with the tremendous efforts of healthprofessionals there to cope with the situation. Those with whom he andDr. Cummings came in contact were extremely enthusiastic over the Library'scommunications project and its potential for improving the health care ofAlaska's citizens. Dr. Whelan cited his own first-hand experience with thedeficiency of training, communications, and transportation facilities inAlaska and other remote areas. Dr. Cummings suggested that Alaska may bean appropriate testing ground for male members of the physician-assistantstraining programs, especially in view of the hardships to which nurses areexposed there. Dr. Ebert endorsed this possibility, but expressed concernover leaving semi-qualified people in remote areas without adequate technicaland professional support.

REPORT ON HEALTH ASPECTS OF THE STUDY PERFORMED BY PHEW FOR THE PRESIDENT'SDOMESTIC COUNCIL

Mr. Feiner cited the Administration's interest in the application of com-munications technology to the problem of health education. Arising froma NASA-sponsored study at the request of the President were the followingcommunications Initiatives, as proposed by the DHEW participants whorepresented the health communities: 1) Easily accessible information shouldbe available to all individuals, telling what health services are availablein the local area. 2) Health messages, via closed-circuit cable television,might be transmitted to waiting rooms and out-patient clinics. 3) Real-timeaccess to computer-stored medical records — an application of HSMHA's

* Dr. Mider's post-script: Eureka.' The book in questions is: Meibom,Johann Heinrich, De flagrorum usu in re veneria. Londini, 1665 (i.e.Parisiis, 1757). The misprinted date on the title page caused the dif-ficulty.

-7-

Regionul Medical Information System and an extension of MEDLINE — should beconsidered as a means of coping with the shortage of manpower. A) Thefeasibility of "neighborhood health care stations" should be explored, inwhich communications technology could be utilized :Lu the. creation of centralizedcoordinating centers for total, one-stop health services. 5) The further useof satellite communications should be exploited for the sharing of resourcesand information among health professionals in rural or remote areas. As anexample of the potential of this type of communication, Mr. Feiner played aportion of a recorded conversation between a physician in Anchorage and ahealth aide in Artie Village who was ceeking advice for the treatment of apuncture-^wound victim.

Mr. Feiner concluded his remarks with a description of the next generationof satellites (ATS-F) which will replace the type currently used in the Alaskaexperiment, and outlined a possible future study-project in the Southwest inwhich such a new satellite might be used.

DISCUSSION OF PRIORITY REVIEW COMMITTEE MEETING TO CONSIDER AAMC REPORT

Dr. Schoolman reported the results of a meeting held on September 8-9, 1971,by a committee to review the AAMC report and identify those elements whichshould be recommended to the Board for immediate Implementation. TheCommittee identified both long-range and short-range goals, and endorsedDr. John Cooper's request for a companion report outlining the role ofacademic health centers in the implementation of the Report. (NLM has metwith AAMC, and a companion report is forthcoming.)

Four specific recommendations were made by the Review Committee:

1. The Board of Regents should initiate and maintain a continuinginterest in the development of manpower for computer applications inmedicine. The Regents are urged to assert a leadership role in thisarea, and to seek support both in and outside government.

2. The Committee advocates the organization of a blomedical communi-cations network fundamentally conceived as providing the mechanism bymeans of which inter-institution cooperation and sharing of resourceswill be used to meet some of the needs of medical education and medicalpractice.

3. The Committee advocates the development of multi-media free-standinginformation,modules designed to permit manipulation by individual facultymembers in their presentation of a floor curriculum for the health sciences.

A. The National Library of Medicine should accept the national respon-sibility for indexing and cataloging appropriate health science learning

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rcsourcu information-material not published in journals and toonographs.This indexing and cataloging should be limited f..o selected mnttsrialssuch as audiovisuals, multimedia presentations, and computer-aidedinstructions which inetc published criteria.

Dr. Schoolman said these four were amalgamations which embodied the sub-stance of 39 of the Report's total of 52 recommendations, and that tlusywere intended to be responsive, respectively, to the jjoals of: the pro-duction of appropriate manpower; the development of a distribution systemwhich would make the sharing of resources economically and technicallyfeasible; the development of educational aids; and the development ofcatalogs and indices to provide ready access to non-journal, non-monographicinformation. Dr. Cummings added that he considered some of the AAMC's 52recommendations to be inappropriate for NLM action, and to belong rightlywithin the purview of the academic health centers.

The first of these recommendations is responsive to the long-range goal ofovercoming two stumbling blocks — a shortage of personnel trained in bothmedicine and computer technology, and the absence of dedicated educationfunding for this purpose. The Committee suggested two general programs forNLM and BHME support: a joint M.D.-Ph.D. program (with the Ph.D. incomputer science and communications technology), and a one or two year post-doctoral computer/communications fellowship for academic health scientists.During discussion, Dr. Ebert expressed concern over the proposed M.D.-Ph.D.program being built around a technology, and questioned the specific goal ofsuch a program. Dr. May stated that pursuit of the M.D. degree was a full-time effort, and asked if the double-degree program was intended to shortenthe amount of time ordinarily required for the two degrees. Dr. Schoolmanresponded to Dr. Ebert's and Dr. May's questions by pointing out that one ofthe goals of this long-range program would be to prepare the physician,via a concurrent and possibly shorter period of education in the twodisciplines, for a markedly different role in the future. Dr. Aulyan echoedthis view, and envisions the M.D.-Ph.D. as being an innovator who woulddevelop and test new techniques for subsequent use by practitioners.Dr. Cummings remarked that one clear intent of the program would be toteach teachers of new technology.

The second recommendation calls for the development of a clearinghouse forinformation on all aspects of technology in medicine, and for a center forthe coordination of Federal programs involving application of biomcdlcalcommunications and educational technology in the health sciences. TheReview Committee suggested that NLM should assume the role of coordinatorin these efforts and thereby establish "authority by doing."

The Review Committee's third recommendation identifies the need for thecreation and dissemination of responsive, multi-media information modules.In addition, it was recognized that mechanisms would have to be establishedto assure technical and content quality, to decide on the mix of productions

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creaUed and supported, and to determine priorities for immediate implementation.To achieve these goals, the Review Commit.t«>e advocated the participation ofdisciplinary societies in the creation of individual program elements, theappointment of discipline-oriented committees to review proposals aad assignpriorities, and tlie development of an extensive stepwiae procedure for thereview and evaluation of materials prior to and following their integrationinto modules. Although Dr. McGovern agreed with the modularconcept for teaching well-defined areas of singular knowledge and "how to"skills, he did not believe this approach would lend itself to instructionin complex, multi-faceted clinical entitles in which outdated facts; ordiverse points of view and interpretation come into play. Dr. Cummingsresponded that it was precisely in such multi-faceted areas that the flex-ibility of modular packages might be used to good advantage, in thatindividual pieces may be easily replaced. Dr. Schoolman made it clear thatthe Review Committee's recommendation was for the creation of a single pilotof this nature so that the relative merits and shortcomings might beassessed.

The fourth recommendation of the Review Committee addresses the need forbibliographies of "non-print" materials, i.e., those not included incatalogs and Indices of journal and monographic items. Identification andscreening of existing and new material, and definition of output requirements,were recommended as requiring action. The criteria for initial and subsequentselection of materials to be cited in bibliographies should assure currency,technical and subject excellence, and availability at reasonable cost.Dr. Cummings stated that the range of "non-print" materials encompassed bythis recommendation was a broad one, and would include such things ascomputer programs and software packages.

Responsibility for each aspect of the proposed programs has been assignedto the appropriate components of NLM. Functional groups will simply enlargetheir areas of responsibility in order to accommodate the four recommenda-tions, and no new organizations need be created. Funding for part of thecomputer effort will be supported by BHME, and although funds are notavailable yet, both Dr. Endlcott and the Director have advised the Officeof Management and Budget of their interest in this cooperative effort.NLM staff is proceeding with program planning on the assumption thatbudgetary approval is forthcoming.

The Board then moved to accept the four recommendations of the ReviewCommittee.

DISSEMINATION OF MEDICAL INFORMATION AND THE ROLE OF THE NLM IN ISRAEL

Dr. Prywes paid homage to the NLM staff for their efforts during the pastfive years in helping the Israel Journal of Medical Sciences to become anagency for a national health research communications program. He reviewedthe many difficulties encountered in fusing two existing publications ofquestionable value into one responsive journal of international interest.With the emergence of the Journal, however, Dr. Prywes felt that Israelhad something to offer in the way of helping to further NLM's programs for

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the dissemination of medical information. In a collaborative effort,Dr. Prywes and the Journal began to promote, screen, and produce medicalinformation, and provided personnel to index material for Index Medicus.Subsequently, the Department of Medical Education of the Hadassah MedicalSchool, and NLM's National Medical Audiovisual Contcr, jointly embarkedupon a three-year health sciences cowmunlcations and audiovisual domon-atration project.

Dr. Prywea cited the many projects, publications, and other mutual benefitsarising from this cooperative effort as being demonstrative of the truelack of International boundaries in the pursuit of improved techniques ofinformation handling.

REVIEW OF P. L. 480 PROGRAMS IN ISRAEL. POLAND AND YUGOSLAVIA

Dr.. Langley referred the Board to the reports of Drs. Ebert and Michael,under Tab VII, for the details of their visit to these countries InAugust .1971. Dr. Langley noted that it was now recognized that thisis a viable and worthwhile program not requiring further evaluation Lrithe near future. However, tha additional benefit of sending Board memberson such trips Is to indicate to participating foreign scientists theesteem in which the program is held, to facilitate scientific interchangewith potential applicants, and to stimulate interest in the program.

Dr. Langley described the concept of the bloc grant, whereby NLM has, inessence, a representative abroad who assists by providing advice to grantapplicants, submits proposals to peer groups and to NLM for review, andthen re-allocates funds to grant recipients within the country.

Dr. Max Michael, reporting on his visits, observed that in each of thethree participating countries he had spoken with a considerable numberof scientists—in general persons of distinction and scientific ability.Dr. Michael enumerated his impressions of the P.L. 480 programs:1) They contribute financial support to a significant number of scientists,making pos'sible the preparation of valuable publications. 2) They haveaided the economies of the participating countries. 3) They have stimulatedscientific thought. 4) They have made possible the publication ofexcellent Journals, such as the Israel Journal of Medical Sciences.5) They have had a catalytic effect in bringing scientists together fora common purpose. 6) They have Improved the American image abroad.Dr. Michael emphasized that, frequent foreign staff travel is essential tothe operation of such a program.

Dr. Robert Ebert said he concluded after his trip that the program hasa very important role in providing for an interchange of ideas andknowledge in the biomedical sciences. He believes the program is to thegreat credit of the Library, both scientifically and for our relationshipswith the nations concerned. The NLM P. L. 480 program also has played

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au important role for the participating countrias. Because scientistsparticipating in the program respect U. S. science and medicine, theyspare no efforts to produce the beat kind of product Lhey are capableof. The bloc grant mechanism has provided a means of expediting andcoordinating the program, and is especially effective in getting scientiststogether around a project. Israel, where the bloc grant had already provento be highly successful, was the prototype of the program developing nowin Poland and Yugoslavia.

Dr. Ebert expressed some concern over the impact of terminating P. L. 480programs in participant countries when funds expire. Over the severalyears during which funds are available the scientific pattern is affectedto a significant degree, and the NLM should carefully consider how toterminate these viable programs. Dr. Ebcrt considers them to be extremelyimportant for cementing international relations, and for the interchange ofknowledge.

It waa noted that the U. S. and Israeli governments are currently negotiatingarrangements (the Harmon plan) to continue support for Public Law 480programs in Israel. Regardless of the outcome of this proposal, the major NLMP. L. 480 project in Israel (I.J.M.S.) is financed through the end of FY 1974.

Dr. Langley urged that NLM repeat previous attempts to establish P. L. 480programs in India, and advocated a mission to that country by some of theRegents. Dr. Cummings described earlier efforts by NLM, and by theRockefeller and Ford Foundations, which proved unsuccessful and frustrating;even though the scientific community in India is receptive, the Indiangovernment has made it clear in the past that they wish to use the P. L. 480funds for other programs with higher priority.

In response to several questions about P. L. 480 programs in general,Dr. Cummings' traced their history, the methods of allocating funds to thevarious U. S. agencies, and the criteria for selecting countries to partici-pate. Dr. Cummings noted that substantial support for staff negotiationshad been given by the U. S. embassies in Poland and Israel.

The Director reminded the Board that P. L. 480 is not an AID program, andthat a quid pro quo return is expected. The Director also stated his beliefthat the level of funding should be commensurate with a country's scientificcapability. He cited India, Pakistan, Tunisia, as cases in point.

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RKPORT OF THE ASSOCIATE DIRECTOR FOR EXTRAMURAL PKOCJUMS iy 2_/ 3/

Dr. Langley reviewed Che Board's earlier discussion and actions relating to theExtramural Programs Training Grant Program?*. He suvamarized the results of'ananalysis by Kronick and flees of the manpower: needs in medical libraries, whoconcluded that the field of medical librarianship is experiencing a crisis ofquality and recommended strong programs for continuing education. The NLMsponsored Belmont Conference, in May 1971, supported this recommendation andfurther recommended that medical librarians need a better understanding of thevocabulary of medicine, that there should be more training in information science,and that Ph.D. Programs be supported for the training of health scientists inlibrary science.

Dr. Langley presented an analysis of the known outcomes of the traditionalmaster's degree program in medical library science and the internship programsupported by the NLM. Some 55 to 65% of the Individuals trained under themaster's program have remained in the field of biomedical Hbrarianship, whereas80% of the individuals trained under the internship program are associated withbiomedical libraric-.s. The master's program supported by the MLM does not differsignificantly from that offered in some 50 or 60 schools of library sciencethroughout the country; in only two of the programs is there strong emphasis onbiomedical content.

The recommendations endorsed by the Subcommittee of the Board, based on theconsideration of these data, are that the NLM should (1) emphasize some type ofPh.D. program with a strong managerial component; (2) develop programs forcontinuing education; (3) continue to expand the intern or similar programsand (4) phase out the current master's degree programs. The Board concurredunanimously in the recommendations.

Dr. Langley requested renewal of staff authority to make adjustments in timeor amounts of grant awards. The guidelines originally adopted in 1964 wereamended in 1968 and have been reaffirmed annually. The Board again reaffirmedthe guidelines.

I/ Proceedings of meetings are restricted unless cleared by the Office of theDirector, National Institutes of Health. The restriction relates to allmaterial submitted for discussion at the meetings, the agenda for themeetings, and supplemental material, and all other official documents.

2J For the record, it is noted that members absent themselves from the meetingroom when the Board has under individual discussion applications (a) fromtheir respective institutions, (b) in which a conflict of interest mightoccur.

3_i The Board of Regents, when considering the Extramural Programs of the NLM,sits as the National Medical Libraries Assistance Advisory Board, andconcurrently discharges the responsibilities of both bodies.

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Information concerning recurring bibliographies published wiLh EP .support war.submitted. The Administrative Report of the Dlvisi.on of Research Grants includeda study, "Normalization of Study Section Priority Scores". The question ofnormalizing priority scores had come up at two previous Board meetings.Dr. Langley felt that it would be interesting to convert the raw priority scoresfor NLM awards to the.normalized priority scores tor current applications. Thevariation in range was so alight that normalization produced no significantinformation and will not be used. The Board accepted this, statement.

CONSIDERATION OF PENDING APPLICATIONS

The Board considered a proposal in the NLM Special Foreign Currency Programsubmitted by Dr. Moshe Prywes of the Hebrew University, Hadassah Medical School,Application Number 06-502-1 Amendment #3 for 3 years support in a total amountof IL 1,500,000 ($350,143 equivalent) to continue and expand a health sciencesaudiovisual demonstration program initiated with NLM support in July 1968. Thisapplication had been recommended for approval by an Ad Hoc Review Committee. Atleast two aspects of the program were noted us offering advantages to the UnitedStates—unique audiovisual productions which could be utilized in the countryand the role the project could play in serving as a microcosm for development ofa national audiovisual system which could assist in the development of a muchlarger system in the United States. The Board unanimously recommended approvalof the project subject to the deletion of $53,500 (Equivalent) in productioncosts which they believed should be provided locally. The Board also agreed thatthe project should not be funded unless funds were available to continue it forat least 2 of the 3 years requested as recommended by the Subcommittee.

In accordance with the procedxires recommended by the FAST Task Force the Boardreviewed only the grant applications which carried a split vote action, requireda policy decision, or requested a yearly amount of over $50,000. The Boardconsidered five applications which had received split votes from the StudySections. The Board concurred with the majority for disapproval of three appli-cations. It reversed the actions of the Study Sections on two applications.

The Board concurred with the Subcommittee's recommendation to approve the firstSpecial Scientific Project application received for Board review in sometime.It further moved to change the priority score to a funding level.

The Board then considered the training grant applications. The Board concurredwith the Subcommittee's recommendations. In view of the earlier action to phase-out the Master's degree training program supported by the Extramural Programs,the Board voted disapproval of the approved application from Drexel University,School of Library Science, which proposed a Master of Science BiomedicalInformation Specialist training program. The Board concurred with all otherSubcommittee recommendations on applications which are shown in Appendix I.

The Board also concurred with the interim actions taken by staff with regard toresearch, publications and training programs which in each case negotiated adecreased amount for payment.

14

Policy Issues — The Board considered the medical library resource grant policyon support document delivery. Two r^comme.nd.itLous were approved:

1. Resource Grant funds shall not be u«td to dc?.t'ray any o.£ thuexpenses involved in free document delivery ^services.

2. This policy shall be effective December 1, 197.1 but shallnot be retroactively applied to projects already funded.

Tha Board discussed policy guidelines for support to iiew health science schoollibraries. The Chairman, Dr. Anlyan, absented himself from the room during thisdiscussion and that which followed on the question of support to East CarolinaUniversity. The Board concurred with the Subcommittee recommendation that staffprepare guidelines £or the use of the applicants which define the relevantfactors that would Justify the level of support requested. The Board requestedthat these guidelines be brought to the next meeting.

The Board considered a request for policy on the support of certain non-recurringequipm«nt costs. The Board approved the ro>commendatlon that rasource grantfunds shall not be used for the purchase, lease or rental of terminal equipmentrelated to Medline or other on-line bibliographic searching projects.

The Board considered five Resource Grant Applications. The Board concurredwith the majority of the Committee and Subcommittee in its recommendations forthree of the five; the Board disapproved two applications which had been approvedby the majority of the Committee.

Dr. Langlcy observed that the present low approval rate for the resource grantprogram is due to three factors: 1) This is a new program, 2) There is a lackof sophistication on the part of the applicants, and 3) The Committee has hadto work out its guidelines for review of these applications. He anticipatethat the program will be receiving better, fewer, and more fundable applicationsin the future.

Dr. Langley-was commended for the excellence of his presentation and for thework his staff had contributed to the presentation.

Respectfully submitted,

7^0. ~

Martin M. Cummings, M.D.Executive Secretary to the

Board of RegentsNational Library of Medicine

ACTIONS TAKEN »Y TtlE I jQARP OF KHU::\TS IN C.EIW'.RAl,, SESSION

Nov.-:r.ib.>.r :•'.; -.'.H , ! ' ) / ' ;

1. The Board accepted the four rccornrncnclnt ions of the AAMC Koporl:RcwLew Committee. The. rec.orvnendat'.ions were1.:

a. The Board of Regents should Initiate ami maintain a continuinginterest in the development: of manpower for computer applicationsin medicine. The Regents are urj;ed to nssert a leadership role inthis area, and to seek support both in and outside government.

b. The Committee advocates Che organisation of a. bxoinedic.".1 com-munications network fundamentally conceived as providing themechanism by means of which inter-institution cooperation andsharing of resources will be used to meat some of the needs ofmedical education and medical practice.

c. The Committee advocates the development of multi-media free-standing information modules designed to permit manipulation byindividual faculty members in their presentation of a floor cur-riculum for the health sciences.

d. The National Library of Medicine, should accept the nationalresponsibility for indexing and cataloging appropriate health sciencelearning resource Information material not published in journalsand monographs. This indexing and cataloging should be limited toselected materials such as audlovisuals, multimedia presentations,and computer-aided instructions which meet published criteria.

2. The Board concurred with its Subcommittee's recommendations relatingto the Training Grant Programs. The recommendations were that the NLMshould:

a. emphasize some type of Ph.D. program with a strong managerialcomponent;

b. develop programs for continuing education;

c. continue to expand the intern or similar programs; and

d. phase out the current master's degree programs.

3. The guidelines for staff authority to make adjustments in time oramounts of grant awards were again reaffirmed by the Board.

A. The Board accepted the finding that normalization of priority scoresproduced no significant information, since the variation in range be-tween raw and normalized priority scores was so slight.

!>. 'I'li-i Hoard rocoiiin.'_Mided approval ot" a proposal from thc> HebrewUnivr> i1 a J. ty , Maflassah Mndica'i School, to continue and expand n health.'•jc Lenc.c'3 audiovisual demons t ration program '.nj t-iated with WT,M supportin l%b. Rcoomm.'nriaU.on for approval was made subject to the deletionoi.' $!.O,50Q in production costs. The Board also agreed that. the-, projectshould nut be funded unless funds were available to continue it for atlo.ast two of the three years requested.

6. The Board considered the medical library resource grant policy onsupport document delivery. Two recommendations were approved:

a. Resource Grant funds shall not be uued to delray p.ny of theexpenses involved in free document delivery services.

b. This policy shall be effective December 1, 1971 but shall notbe retroactively applied to projects already funded.

7. The Board approved the recommendation that resource grant fundsshall not be used for the purchase, lease or rental of terminal equip-ment relatud to MEDLINE or other on-line bibliographic searching projects.

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OJ W LP>aJ ON

BOARD OF REGENTSNATIONAL LIBRARY OF MF.DICINF,

MINUTES OF EXECUTIVE SESSION

The Board of Regents of the National Library of Medicine mot inexecutive session at the Library in Bcthesda, Maryland, at 1:05 p.m.,November 23, 1971.

The Chairm-in described the interim action by the executive committeedelineated in his letter to Dr. Merlin K. DuVal, Assistant Secretaryfor Health and Scientific Affairu, DHEW, of September 21, 1971 (Appendix A).Briefly stated, the objective was to seek increased support for develop-ment of the Library's programs by reorganizing the NLM into a broaderbureau structure and renaming it the Bureau of Health Communications,with such divisions as NfJ-1, NMAC, LIINCBC, and Extramural Programs.This movement was impelled by two considerations:

1. Confusion in the biomedical community over therelative relationships of the NLM, NMAC, and LHNCBC,and

2. The current constrictivc effect of the term "medicine"as opposed to the more generic designation, "health."

Although he had received no reply from Dr. DuVal, Dr. Anlyan under-stood that the Director, NIH, had made a strong case for preservationof the status quo at this time while recognizing the merit of thepro-posal which had been raised by members of the Congress at appropriationhearings. The Chairman of the Board sought no action from the members.

The Director, NLM, agreed with the position of the Director, NTH,and added that the concept originated with the Report of the SpecialSubcommittee of the Committee on Interstate and Foreign Commerce,House of Representatives, chaired by Mr. Rogers (Florida) which investi-gated DHEW in 1966.*

The Chairman appointed the following new members to subcommitteesof the Board:

Mrs. Hetzner to Extramural Programs,

Dr. Crawford and Dr. May to the Lister Hill NationalCenter for Biomedical Communications, and

Dr. Marshall to National Medical Audiovisual Center

(The complete list of subcommittee membership for fy 72 appears inAppendix B.)

*Special Subcommittee on Investigation of the DHEW, House Report No. 2266,89th Congress. 2nd Session, Washington, D.C., Government Printing Office,1966. pp. lDb-157

The Director, NLM, then presented to the Board th« curriculavitarum and bibliographies of the following candidates for appointmentHS Visiting Scholars at the National Library of Medicine:

Harry Filmore Dowling, A.B., M.D., D.Sc.

Fred Lowe Soper, A.B., M.S., M.P.H., Dr. P.H.

The Board of Resents agreed unanimously to the appointment of thesedistinguished, scholarly physicians.

Dr. Michael proposed that the Director, NLM, be encouraged to con-tinue to consult with members of the Board of Regents whose terms ofoffice had expired as thair broad experience and manifestly sincere andintense interest in the future of the Library provide an unusually richsource of expertise. He recalled the significant contributions ofDr. Ebert and Messrs. Augenstein and Zipf to deliberations during thecurrent meeting. The suggestion was enthusiastically endorsed by theentire membership, whereupon Dr. Layton moved that the Director, NLM,be encouraged to consult with members of the Board of Regents whoseterms of office had expired. The motion, being duly seconded, was passedunanimously.

General Whelan expressed concern for the impact of expanding Federalhealth activities on the services required from the Library. In hisview, the informational needs of these programs, and particularly thecancer conquest effort, should capitalize on the capabilities of the NLMrather than to duplicate functions under other auspices. Members of theBoard recapitulated the recommendation made to the Secretary of Health,Education, and Welfare - in broad general terms during March 1971, andthe more specific recommendation relating to the National Cancer Programthe following June - to which no response had been received. The follow-ing resolution was adopted unanimously:

WHEREAS, the Board of Regents of the National Library ofMedicine on March 23, 1971, expressed its concern to the Secretaryof Health, Education, and Welfare "for the impact of an arrayof Federal health programs on the activities of the NationalLibrary of Medicine," and

WHEREAS, the Board on June 15, 1971, adopted unanimouslyan additional resolution which recommended a specific relationshipof the National Library of Medicine to the emerging "NationalCancer Program" in view of the "present fragmented and uncoordinatedeffort in dealing with the literature on cancer research," andconcluded:

"In tho. forthcoming implementation of. the Act.to conquer cancer, tlio Board recommands that theNLM be designated by the President specifically asthe agent for assembly of information, its organi-zation and dissemination, on behalf of all componentsof the. National Cancer Program," and

WHEREAS, these prior actions of the Board have evoked noresponse, therefore

BE IT RESOLVED that the Board of Regents reaffirm to theSecretary of Health, Education, and Welfare its deep concern forthe impact on the National Library of Medicine of the anticipatedincrease in the breadth and scope of its mission occasioned bythe increase in informational material needed in support of theAdministration's conquest of cancer effort, which will requireappropriate authorization for increased personnel and fiscalresources.

Members of the Board inquired about the current relationships ofthe NLM to other elements of the DHEW. Dr. Cummings described thenature of the weekly meetings with Director, NI1I, and his staff in whichhe participated, and the meetings of the Buroau-Institute-DivisionDirectors when the Deputy Director represented the NLM. lie viewed therelations ns cordial and increasingly supportive. He recounted ingeneral terms the substance of the hearings on the budget for fy 73before Lhe Office of Management and Budget at which both the Director,NIll, and the Assistant Secretary (Comptroller), DREW, strongly endorsedthe NLM budget request.

Dr. Cummings also spoke of Improved relations with Regional MedicalPrograms and described as rather ineffective the intradepartmentalcornmittue in parallel with the Committee on Scientific and TechnicalCommunications, Federal Council for Science and Technology. Herecounted the visit of Representative. Michel, ranking minority member.of the Library's Appropriations Subcommittee, to the NLM on November 18.Mr. Michel was obviously interested in and impressed with the variousactivities that were demonstrated.

Dr. Baker and Mr. Zipf expressed satisfaction with the quality ofvoice communications transmitted between Bethesda and Alaska via theATS-1 satellite. These gentlemen, both members of Lhe President's Com-mission on Libraries and Information Science, informed the Board of theearly activities of that body and expressed the hope that the techno-logical innovations introduced by the NLM would serve ns prototypes forbroader involvement of other parties.

Dr. May, on behalf of the new Regents, expressed interest in theactivities depicted at this meeting and gratitude for the cordial recep-tion they had received from their colleagues and the NLM staff.

The dates of June 26 and 27, 1972, were Agreed upon to resolve theconflict x^ith the meeting of the Medical Library Association scheduledfor June 11-15.

The meeting adjourned at 1:55 p.m.

Respectfully submitted,

Martin M. Cummlngs, M.U.Executive Secretary, Board of RegentsNational Library of Medicine

Bethe.sda, Maryland

APPENDIX A

DUKE UNIVERSITY MEDICAL CENTER

Durham, North Carolina 27710

Vice' President for Health AffairsSeptember 21, 1971

Dr. Merlin K. DuValAssistant Secretary for Healthand Scientific AffairsRoom 5077, HEWNWashington, D. C. 20201

Dear Monte:

As the Chairman of the Board of Regents of the National Library ofMedicine, I am writing about a problem of particular concern to the Board;namely the coordination of effective biomedical communications activitiessupported by DIIEW. This Issue has been called to the attention of yourpredecessors but no effective action has been taken to improve the situation.

Congressman Paul Rogers' Special Subcommittee on Investigation of DHEWwas keenly aware of the problems in biomodical communications when it issuedPart E of its October 1966 report on the Investigation of HEW (see attacliment#1).

This report was issued upon the heels of landmark legislation passed bythe Congress in 1965, the Medical Library Assistance Act. This legislationexpanded the horizons? of the traditional Library through support for,amongother things, a national system of regional and branch medical libraries;development and expansion of madical library resources and technology;construction of medical libraries and training of medical librarians.

As a direct result of a recommendation in the Rogers' Committee Reportin January 1967, the Medical Audiovisual Branch of the Communicable DiseaseCenter in Atlanta was renamed the National Medical Audiovisual Center andtranaferred to the National Library of Medicine. This Center novadministersa national program to improve the quality and the use of biomedical audio-visual materials in schools of the health professions and throughout thebiomedical community. However, the remaining recommendations of the RogersSubcommittee have yet to be implemented.

COPY

Dr. Merlin K. DuValI'agc TwoSeptember 21, 1971

On August 3, 1968, the President signed Joint Resolution 193establishing the Lister Hill National Center for Biomedical Communications.The following month the Secretary of DREW established the Center withinthe NLM and directed the new organization to:

1. Design, develop, implement and technically manage aBiomedical Communications Network;

2. Develop networks and information systems to improvehealth education, medical research and the deliveryof health services;

3. Apply technology to the improvement of biomedicalcommunications; and

4. Serve as the focal point in the Department fordevelopment and coordination of biomedical communi-cations, systems and network projects.

The Board of Regents of the National Library of Medicine has onnumerous occasions reviewed thoroughly the objectives of the various pro-grams of the NLM and believes that they remain vitally important toAmerican medicine. On the other hand, the Board is concerned that despitevarious resolutions passed by the Board and appeals to the OS, D11EW,the LllNCBC has neither the authority nor the resources to perform theirfunctions that are so vital to improving health education, medical research,and the delivery of health services.

In November of 1960 the Assistant Secretary for Health and ScientificAffairs directed that the Center collect information on DHEW sponsoredprojects involving communication and information science technologies.This Biomedical Communications Inventory issued in July 1969 (see attach-ment #2) revealed that there were some 29 different health organizationsin DHEW spending at that time approximately 75 million dollars on some711 different identifiable biomadical communications projects. Only1.6 million dollars was administered by the LHNCBC.

It is still the Board's strong conviction that the Lister HillCenter for Biomedical Communications could best fulfill its mission, andthat the ultimate delivery of health services and the improvement ofhealth education can best be enhanced by assigning the appropriate DHEWfunctions and resources to NLM so that it can truly be the focal point inthe Department for development of a biomedical communications network.

Dr. Mer l in K. DuValPt'iyo Threes

21, 1971

I am sure you arc aware Chat this direction has been reinforced withthe issuance recently of a study conducted by the Association of AmericanMedical Colleges entitled, "Educational Technology for Medicine: Roles forthe Lister Hill Center" (see attachment #3). The recommendations emanatingfrom this report would certainly, if adopted, broaden the functions of theCenter.

We arc well aware that any action to shift functions within the Depart-ment would imply some restructuring or organizational adjustments. It hasoccurred to me that perhaps the name "National Library of Medicine" should bechanged to more, appropriately reflect the expanded role the Library has inbiomadical communications.

Another means of implementing the Board of Regents' recommendations thatthere be better coordination of biomedical communications is to adopt areorganization plan similar to alternative #2 contained in the previouslymentioned report of Congressman Paul Rogers' Special Subcommittee on Investi-gation of DREW. The creation of a Bureau of Health Communications like theBureau of Health Manpower Education would achieve this purpose. This wouldnot require a change in name for NLM nor would it require. Congressional approval.T. believe that this kind of reorganization can be implemented by the Secretary,DHEW.

I would suggest that the Bureau could operate equally well within Nil!or within some other organizational locus.

The Bureau of Health Communications might well be organized as follows:

eneo

•rlM-t 4JU-l On c4J 3to *w

wGo

(U -He <j•H nhJ 1-1

01P.o

BUREAU OF HEALTHCOMMUNICATIONS

BOARD OF REGENTS

f I

1 NMAC NLM | LHC | ! EMP '

Educational technologyand content development

library andspecializedinformationservices

communicationstechnologyr&d

programs underthe MedicalLibrary AssistanceAct plus otherDHEW grant programs

Dir. Merlin K. IXtVnlP;i;;e FourSeptember 21, 1971

The Executive Committee of the Board of Regents is in agreement thatthe NLM should develop in concert with your office a plan for reorganizationto accomplish these vital coordinating functions.

We strongly urge your favorable consideration of such action and lookforward to receiving your suggestions and advice. We hope you will concurthat the time has come to seriously examine the organizational structure ofan important health service activity and agree thnt a coordinated and coherentprogram for biomcdical communications is necessary. I will be happy todiscuss this matter with you in greater detail at your convenience.

Sincerely yours,

William G. Anlyan, M.D.Chairman, Board of Regents

WGA.-jp

Attachments

cc: Dr. Martin M. CummingsDr. George Tcusche.rDr. Max MichaelDr. Robert Q. Marston

William G. AnIvan, H.D.Vice President for Health F-rxairs

Univarnity Medical C nt<;rNorth Carolina 2770$

D'.:ar Dill:

j\s I promised in ray lottcr of Octo'cor 4, 1971, your proposalconcerning tha possibility of establishing a Bureau of liaalthCc.a-cmnicationa has been reviewed and discussed at some length.3ob Marston's recommendation is that now is not the tir.ie forsuch a chango, and I concur. Cvor the past several months,during tho development of th-3 FY 1973 budget, v;a hava i-;-;enincreased. interest in the Library'n pronrrana by officials-within the Dnpartnent as wall a.i tho.ua on tha Proaidont'astaff and in the o.tfice of • lanacjonen!: and Budcjat. TheLibrary's rcquaat for an increase of $4 million has beenoastainod through all levels oi review. Dob auggasta, andI agroe h*ara too, thnfc a Euroau such a:s you propose or somasimilar organi-.iation v/ill evolvo ovc-r tine asi tho innovativepro<3ra.T j o£ tho Library and of th« Liatcr HL11 center takeconcrete/ universally accepted form and 39 thoJG progranacontinue to contribute significantly to th:> iraprcvcniantof health car*> in the Unit-ad Stat-.i3. in the moantimo, youhavo r.iy aaouranc-? that v;o v/ill continna to oupport theLibrary's efJTorta; I think we can point to none uucceas

'ik in the roccnt paat.a3 I c'.on't bolieva you have seen it so I am enclosing a copy« of Bob's mer.o on this nubjoct for your information. T an!:o you for sharir.q thaae ideas with na. Ar> you know, I findo th?1 fiolcl of health communication a challenging opportunity.on• Sincoroly yours/

;i .rlin •.<. DuVol, M.D.i\aai-jtant iifcro.tary for ?i:'alth

an(i •" icntific JM'fair:;

APPENDIX B(1)

Board o £ RegentsSub commit: too for Exf.ramural Programs

Dr. George W. Teucchcr - ChairmanDean, Dental SchoolNorthwestern University311 East Chicago AvenueChicago, Illinois 60611

Dr. Max Michael, Jr.Executive DirectorJacksonville Hospitals Educational

ProgramDuvall Medical Center2000 Jefferson StreetJacksonville, Florida 32206

Dr. Jack M. LaytonProfessor and HeadDepartment of PathologyUniversity of ArizonaCollege of MedicineTucson. Arizona 85721

Dr. John P. "[oGovernProfessor an.l ChairmanDepartment of the History of MedicineUniversity of TexasGraduate School of Biomedical Sciences6655 Travis StreetHouston, Texas 77025

Mrs. Bernicc M. HetznerLibrarianUniversity of NebraskaOmaha, Nebraska 6810.'5

Surgeon General, United States Army

Telephone

(72) 312-649-8333

(72) 904-356-5533

(73) 602-884-3341

(74) 713-528-5591

(75) 402-541-4006

11/15/71

ATl'ENDIX B(2)

Boai'd of RegentsSubcommittee for

Lister Hill National Center for Biomedical Communications

Established: 3/27/70 at the Executive Session of the Board of Regents

TelephoneDr. Ma:: Michael, Jr. - Chairman (72) 904-356-5533Executive DirectorJacksonville Hospitals

Educational ProgramDuvall Medical Center2000 Jefferson StreetJacksonville, Florida 32206

Dr. William C. Anlynn (72) 919-684-3438Vice President for Health AffairsDuke UniversityDurham, North Carolina 27706

Dr. William 0. Baker (73) 201-582-3423Vice President in Charge of ResearchBell Telephone LaboratoriesMurray Hill, New Jersey 07971

Dr. Angelo M. May (75) 415-781-3151450 Sutter StreetSan Francisco, California 94108

Dr. Susan N. Crawford (75) 312-527-1500 x 763DirectorArchives-Library DepartmentManagement Services DivisionAmerican Medical AssociationChicago, Illinois 60610

Surgeon General, United States Air Force

11/10/71

APPENDIX B

(3)

Board of RegentsSubcommittee for

National Medical Audiovisual Centtr

Ur. William G. Anlyan - Chairman (72) 919-684-3438Vir.e President for Health AffairsDuke UniversityDurham, North Carolina 27706

Dr. Jack M. Layton (73) 602-884-3341Professor and HeadDepartment of PathologyUniversity of ArizonaCollege of MedicineTucson, Arizona 85721

Dr. George W. Teuscher (72) 312-649-8333Dean, Dental SchoolNorthwestern University311 East Chicago AvenueChicago, Illinois 60611

Dr. J. Stanley Marshall (74) 904-599-2525PresidentFlorida State UniversityTallahassee, Florida 32306

Surgeon General, United States Navy