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Minutes of the Board of Regents September 2000

DEPARTMENT OF HEALTH AND HUMAN SERVICES

NATIONAL INSTITUTES OF HEALTH

NATIONAL LIBRARY OF MEDICINE

MINUTES OF THE BOARD OF REGENTS

September 26-27, 2000

The 125th meeting of the Board of Regents was convened on September 26, 2000, at 9:00 a.m. in the NLM Board Room, Building 38, National Library of Medicine (NLM), National Institutes of Health (NIH), Bethesda, Maryland. The meeting was open to the public from 9:00 a.m. to 2:50 p.m., followed by the closed session for consideration of grant applications until 3:15 p.m. On September 27, the meeting was reopened to the public from 9:00 a.m. until adjournment at 12 Noon.

MEMBERS PRESENT

Dr. Jordan Baruch

Ms. Alison Bunting

Ms. Michele Klein Fedyshin

Dr. Henry Foster [Chair]

Dr. Joshua Lederberg

Dr. Ralph Linsker

Dr. Joseph Newhouse

Dr. Herbert Pardes

Ms. Eugenie Prime

Gov. Lowell Weicker

EX OFFICIO AND ALTERNATE MEMBERS PRESENT

Dr. W. Richards Adrion, representing Dr. Mary Clutter, National Science Foundation

Ms. Pamela Andre, U.S. Department of Agriculture

Rear Admiral Kenneth Moritsugu representing Dr. David Satcher, Public Health Service

Colonel Kristen Raines representing Lieutenant General James Peake, Dept of the Army

Dr. Richard Rowberg, Library of Congress

Brigadier General Klaus Schafer, representing Lieutenant General Paul Carlton, Dept of the Air Force

Captain David Wade representing Vice Admiral Richard Nelson, Dept of the Navy

Dr. James Zimble, Uniformed Services University of the Health Sciences

CONSULTANTS TO THE BOR PRESENT

Dr. Tenley Albright, Vital Sciences

Dr. Marion Ball, Johns Hopkins School of Nursing

Dr. Kenneth Walker, Emory University School of Medicine

MEMBERS OF THE PUBLIC PRESENT

Mrs. Mary Lindberg

Dr. James Wynne, IBM T.J. Watson Center

Mr. Steven Foote, Perry Dean Rogers & Partners

Dr. Bailus Walker, Howard University

FEDERAL EMPLOYEES PRESENT

Dr. Ruth Kirschstein, Principal Deputy Director, NIH

Dr. Donald A.B. Lindberg, Director, NLM

Mr. Kent A. Smith, Deputy Director, NLM

Dr. Steven Phillips, Assistant Director for Research and Education, NLM

Dr. Michael Ackerman, Assistant Director for High Performance Communications & Computing, NLM

Dr. Vivek Anantharaman, National Center for Biotechnology Information, NLM

Ms. Suzanne Aubuchon, Office of the Director, NLM

Dr. Simon Baatz, History of Medicine, Division of Library Operations, NLM

Ms. Joyce Backus, Division of Library Operations, NLM

Mr. John Butler, Office of Computer & Communications Systems, NLM

Ms. Marjorie Cahn, Library Operations, NLM

Mr. James Charuhas, Lister Hill National Center for Biomedical Communications, NLM

Dr. Donald Comeau, National Center for Biotechnology Information, NLM

Ms. Kathleen Cravedi, Office of Communication and Public Liaison, NLM

Ms. Vicky Siu Ngan Choi, National Center for Biotechnology Information, NLM

Ms. Kathleen Cravedi, Office of Communication and Public Liaison, NLM

Mr. Lou Duggan, NLM Associate Fellowship Program

Ms. Gale Dutcher, Division of Specialized Information Services, NLM

Ms. Ann Elderkin, Office of the Surgeon General, PHS

Dr. Elizabeth Fee, History of Medicine, NLM

Ms. Martha Fishel, Division of Library Operations, NLM

Ms. Nakita Harris, Division of Extramural Programs, NLM

Ms. Jennifer Heiland, NLM Associates Fellowship Program

Mr. Earl Henderson, Lister Hill National Center for Biomedical Communications, NLM

Mr. Joseph Hutchins, Office of Computer & Communications Systems, NLM

Ms. Betsy Humphreys, Associate Director for Library Operations, NLM

Ms. Bonnie Kaps, Division of Extramural Programs, NLM

Dr. Lawrence Kingsland III, Assistant Director for Applied Informatics, NLM

Ms. Eve-Marie Lacroix, Division of Library Operations, NLM

Dr. David Landsman, National Center for Biotechnology Information, NLM

Mr. William Leonard, Lister Hill National Center for Biomedical Communications, NLM

Dr. Simon Liu, Office of Computer & Communications Systems, NLM

Ms. Becky Lyon, Deputy Associate Director for Library Operations, NLM

Ms. Wei Ma, Office of Computer & Communications Systems, NLM

Mr. James Marcetich, Division of Library Operations, NLM

Dr. Alexa McCray, Director, Lister Hill National Center for Biomedical Communications, NLM

Ms. Jean McKay, Lister Hill National Center for Biomedical Communications, NLM

Mr. Robert Mehnert, Director, Office of Communication and Public Liaison, NLM

Ms. Janice McPeake, NLM Associates Fellowship Program

Dr. Mary Moore, NLM Associate Fellowship Program

Mr. Dwight Mowery, Division of Extramural Programs, NLM

Mr. David Nash, Equal Opportunity Officer, NLM

Ms. Tomeka Oubichon, NLM Associates Fellowship Program

Dr. Sharee Pepper, Division of Extramural Programs, NLM

Mr. Donald Poppke, Executive Officer, NLM

Dr. Angela B. Ruffin, Division of Library Operations, NLM

Ms. Alberta Sandel, Office of the Director, NLM

Ms. Catherine Selden, Library Operations, NLM

Dr. Benjamin Shoemaker, National Center for Biotechnology Information, NLM

Dr. Elliot Siegel, Associate Director for Health Information Program Development, NLM

Ms. Amy Seif, NLM Associates Fellowship Program

Mr. Ronald Stewart, Deputy Executive Officer, NLM

Liora Strichman Almashanu, National Center for Biotechnology Information, NLM

Ms. Martha Szczur, Division of Specialized Information Services, NLM

Ms. Maryann Tatman, Department of Veterans Affairs

Dr. George Thoma, Lister Hill National Center for Biomedical Communications, NLM

Mr. Anthony Tse, Lister Hill National Center for Biomedical Communications, NLM

I. OPENING REMARKS

Board Chair Dr. Henry Foster welcomed the Regents, alternates, consultants, and guests to the 125th meeting of the Board of Regents of the National Library of Medicine. He noted especially the presence of new members Dr. Ralph Linsker, Ms. Eugenie E. Prime, and Governor Lowell Weicker. He said that there have been recent appointments to Subcommittees: Dr. Pardes will chair the Extramural Programs Subcommittee and Capt. David Wade is a member of that Subcommittee; Dr. Linsker has been appointed to the Subcommittee on Research and Development; Dr. Foster will chair the Subcommittee on Outreach and Public Information, and Ms. Prime and Governor Weicker have been appointed members of that Subcommittee.

II. REMARKS BY THE NIH PRINCIPAL DEPUTY DIRECTOR

Dr. Ruth Kirschstein, NIH Principal Deputy Director, reported that the NIH has a new advisory group, the Council of Public Representatives. The group of 20 was formed a year and a half ago because of the belief that the NIH should be reaching out more to the public and disease advocacy groups, and in this could use the help of public advisors. Dr. Kirschstein described the nomination and selection process for the Council. She noted that the representatives were enthusiastic users of NLM's services, including PubMed and ClinicalTrials.gov. NLM's work in setting up the communications aspects of the Multilateral Initiative on Malaria is much appreciated, as are the many invaluable information services provided by NLM's National Center for Biotechnology Information. Dr. Kirschstein reported to the Regents about NIH's initiative in reducing health disparities in America's minority populations. She cited infant mortality, diabetes, and prostate cancer as examples of problems that affect minorities inordinately, especially African Americans. Dr. Yvonne Maddox, who has been detailed to be the NIH Acting Deputy Director, is cochairing a committee of Institute directors to prepare an NIH strategic plan on how to lessen health disparities in minority populations. The plan will soon be put up on the NIH Website. NLM's part of this plan is very good and reflects the fact that the Library has been working with Historically Black Colleges and Universities and others in this area for many years. On another matter, Dr. Kirschstein said there is great interest in clinical trials and how to ensure that they are performed with maximum safety for patients. HHS Secretary Shalala has an excellent article on the subject in the September 14 New England Journal of Medicine. Conflict of interest ("guidelines for maintaining objectivity in research") is another subject being looked at closely by NIH. This is becoming a serious issue as institutions obtain funds from pharmaceutical firms and other commercial entities, or themselves invest in these firms. She closed by saying that the NIH was seeking candidates for the position of Director of the Office of Equal Opportunity. NLM's Donald Poppke cochairs with Dr. Maddox the search committee for this position.

III. REPORT FROM THE OFFICE OF THE SURGEON GENERAL, PHS

Rear Admiral Kenneth P. Moritsugu, Deputy Surgeon General, updated the Regents on several items he had previously reported. The mental health report released by the Surgeon General in December 1999 has received much publicity and is having a favorable impact on the American people. We believe that the principles underlying the report "Healthy People 2010," which was distributed at the last Board meeting, are nonpartisan and will be embraced by whatever administration comes into office next year. Dr. Moritsugu, echoing a point brought up by Dr. Kirschstein, said that the Surgeon General's Office is very much involved in the administration's effort to reduce health disparities based on racial or ethnic biases. Since the last Board meeting, he said, the Surgeon General has released a report on oral health. One of its findings is that, while fluoridation is one of the most effective ways to prevent oral disease, only 62 percent of Americans have it available. Another new issuance is the Surgeon General's report, "Reducing Tobacco Use." Dr. Moritsugu said that these reports are available on the Surgeon General's Web site at SurgeonGeneral.gov. He noted with pleasure the NLM's major exhibit on asthma, "Breath of Life," and said that at a national meeting of physicians' assistants in May, a "virtual tour" of this exhibit was presented utilizing modern display technology. To be released this winter is a Surgeon General's report on mental health in racial, ethnic, and minority groups; a Surgeon General's conference on obesity and overweight is planned for December; the section on the elderly in the report on mental health is being reprinted for a midNovember conference; a report on youth violence is scheduled to be released before the end of 2000; and in January a report on women and tobacco will be released. Following Dr. Moritsugu's presentation, Dr. Lindberg suggested that the Surgeon General's reports need more consistent attention to bibliographical standards, including dating, titles, publication numbers, simultaneous publication in other formats, indexes, etc.

IV. FUTURE BOARD MEETINGS

The Board of Regents will meet next on February 27-28, 2001. The Board meeting next spring will be May 22-23, 2001. The dates of September 11-12, 2001 were adopted for the meeting next fall.

V. CONSIDERATION OF MINUTES OF PREVIOUS MEETING

The Regents approved without change the minutes from the May 16-17, 2000 meeting.

VI. REPORT OF THE NLM DIRECTOR

Dr. Lindberg reported that the FY 2001 appropriation for HHS has not yet been passed. Whether Senate, House, or Administration figures prevail, NLM is hopeful of a good increase in its budget. The Director noted that the report that accompanies the Senate budget encourages a number of NLM initiatives: genomic information, consumer health, outreach, PubMed Central, information services for the elderly, telemedicine, and the Next Generation Internet. There have been several appointments to key positions: Dr. Angela B. Ruffin has been named to head the National Network Office; Dwight H. Mowery has been appointed Grants Management Officer; Dr. Simon Y. Liu is the new head of the Office of Computer and Communications Systems; Martha R. Szczur is a Special Expert in the Division of Specialized Information Services; Dr. Mary Moore, Dean of Library and Information Resources at Arkansas State University, is serving under a special appointment as coordinator of NLM's Associate Fellowship program; and Dr. Simon Baatz, who has joined the History of Medicine Division staff as a Special Expert, will update the published history of the NLM. Dr. David Landsman of the NCBI introduced several new staff of the National Center for Biotechnology Information: Dr. Benjamin A. Shoemaker, Dr. Donald C. Comeau, Dr. John J. Anderson, and Dr. Liora Z. Strichman-Almashanu. Dr. Alexa McCray of the Lister Hill Center then introduced Dr. Tony Tse from the Howard Hughes Medical Institute who is working in the LHC. Dr. Mary Moore introduced the new Library Associate Fellows: Lou Duggan, Jennifer Heiland, Janice McPeak, Tomeka Oubichon, Amy Seif, Tao You, and Marlo Young. Dr. Lindberg noted two retirements: Peter Clepper of the Extramural Programs and Patricia S. Page of the Office of Acquisitions Management. In the area of legislation, the NLM Director reported briefly on medical records confidentiality and the proposal to establish a "Privacy Commission"; the welcome news that there has been no further action on the database protection bill; the Next Generation Internet Act of 2000, which authorizes funding at seven agencies, including NIH; and the Health Insurance Portability and Accountability Act (HIPAA), which has been discussed with the Board in the past. He called on Betsy Humphreys, who updated the Regents on HIPAA by saying that 17,000 comments were received about the proposed regulations and that the resulting HIPAA standards will be announced soon. Following this, Dr. Lederberg reported briefly on the two recent meetings of the PubMed Central Advisory Committee, which he chairs. One consensus reached by the advisors was to proceed slowly on extending the facilities of PubMed Central to non-peer-reviewed material, until technical and other issues pertaining to peer-reviewed materials have been straightened out. Dr. Lindberg announced that 220,000 citations from 1958-1959 have been added to OLDMEDLINE, which now contains nearly one million pre-1966 citations to supplement MEDLINE (1966 and later citations). He also noted that the contracts for the eight Regional Medical Libraries are in the fifth of five years. An RFP for new contracts was released on March 14 and proposals have been received from all eight regions. They are now being reviewed and NLM expects to announce the awards in April 2001. Dr. Lindberg reported on the annual meeting of the directors and staff of the NLM-supported Informatics Research Training Programs. The meeting this year, held at NLM, was attended by about 100, including 18 trainees who presented their work. In another matter, the NLM is providing $102,000 to the Medical Library Association to fund minority scholarships and to recruit minorities into medical librarianship. Related to this is the creation of the NIH plan to ameliorate health disparities in the U.S., which Dr. Kirschstein discussed earlier in the meeting. NLM's part of the NIH health disparities plan includes, for example, augmenting the collection in pertinent areas, increasing the amount of consumer health information that is sensitive to cultural diversity issues (e.g., educational level, language), and expanding outreach services to Hispanic and Native American populations. We welcome comments on our plan. The NLM Director drew the attention of the Regents to a modest exhibit in the Library's lobby on the career of Dr. Lederberg. Dr. Lindberg said that NLM has received the Vice President's "No Gobbledygook" award for the content of the new database, ClinicalTrials.gov. Another welcome plaudit was received from the 8th International Congress on Medical Librarianship which passed by acclamation a resolution expressing gratitude to the National Library of Medicine for the "enlightened generosity of your policy on access to MEDLINE and other electronic resources via the Internet."

VII. SYSTEM REINVENTION REVISITED

Mr. Kent Smith, NLM Deputy Director, briefly reviewed the Library's experience since 1994 as a "Reinvention Laboratory," so-designated as part of the Vice President's National Performance Review initiative. The heart of the effort was to convert our extensive legacy mainframe computer operation to a modern client/server system. As a Reinvention Laboratory NLM was given certain authorities to cut through red tape in procurement, staffing, and budgeting. Using Web-based technologies, the Library has made great strides in developing and introducing new information services. Mr. Smith said there were three aspects to the effort: internal support systems, the retrieval engines, and user access services. Among the highlights in the internal support systems: Relais (for electronic transmission of interlibrary loans), Voyager (an integrated library system for acquiring and processing the books and journals), and Medical Subject Headings 2000 (vocabulary compatible with the Unified Medical Language System Metathesaurus). In the area of retrieval engines, the major focus was a replacement for the ELHILL legacy system: the Entrez system, developed by NLM's National Center for Biotechnology Information, was selected. As to user access services, free MEDLINE searching via the PubMed and Internet Grateful Med was introduced in 1997, leading to a dramatic growth in usage. LocatorPlus was another user access advance, making Web-based access to NLM's catalogs available to all. What follows are demonstrations of three of the newest NLM information products to result from the National Performance Review initiative.

Martha Fishel, Deputy Director of the Public Services Division, demonstrated the new DOCLINE interlibrary loan request routing and referral system. It serves 3,000 participating libraries in the National Network of Libraries of Medicine. DOCLINE allows these libraries to easily make document requests that are routed automatically to libraries that hold the specific year or volume needed. It also helps libraries respond to requests from individuals via Loansome Doc by maintaining administrative information about Loansome Doc users. The system has about 1.4 million holdings held by network members; more than 3 million interlibrary loan requests were entered into DOCLINE last year of which 10-12 percent come to NLM for fulfillment. The new Web-based DOCLINE: is off the mainframe; takes advantage of the newest technology; makes use of PubMed and LocatorPlus; lowers costs (for example, savings in telecommunications charges and postage); and empowers network members who can maintain their records locally. Ms. Fishel logged on to the system and demonstrated its various features, showing how a librarian would enter an interlibrary loan request into the system and track it through fulfillment.

James Marcetich (Bibliographic Services Division) and John Butler (Office of Computer and Communications Systems) next described the creation of the new Data Creation and Maintenance System (DCMS). The old MEDLINE creation and maintenance systems, on the mainframe computer, have been replaced under the System Reinvention Initiative by a consolidated system that handles not only MEDLINE but its related databases. Indexed citations for than 425,000 references from some 4,000 journals are added each year to MEDLINE, the output of some 100 staff and contractors. Some of the data is keyed into the database, some scanned, and a rapidly growing percentage is received electronically from the publishers. The presenters did a live demonstration of how the indexers call up the citation records for each journal issue in the DCMS and add the descriptive data necessary to complete the indexing operation. The new system increases accuracy, timeliness, and output.

Dr. Lawrence Kingsland of the Lister Hill Center described a new system known as the NLM Gateway. The NLM offers information on more than a dozen major Web sites, each having its own interface. Thus a user who wants to search all NLM electronic information resources on a specific subject faces a daunting task. The solution that Dr. Kingsland and his group have devised is a system that initiates searches in multiple NLM retrieval systems from one search screen. The individual information resources still have their own interfaces for those who know where to look and who choose to focus their search. The goal of the NLM Gateway is to provide "one-stop shopping" that offers citations, full text, video, audio, and images. The results are provided by information category, across databases. The first version of the Gateway, which went live in October 2000 after usability testing over the summer, searches MEDLINE, OLDMEDLINE, LocatorPlus, AIDS meeting abstracts, MedlinePlus health topics and drug information, and HSRProj. It helps users find terms with the UMLS Metathesaurus and allows users to request documents through Loansome Doc. Over time, future releases will access DIRLINE, ClinicalTrials.gov, consumer information areas of HSTAT, several TOXNET files, Images from the History of Medicine, Profiles in Science, and other NLM resources. Dr. Kingsland conducted several online demonstrations for the Board illustrating the Gateway's many features.

Following these presentations, Ms. Prime commented that the Gateway will be particularly useful for those searchers who are not aware of the differences between the various NLM information resources; the ability to search many these databases with one search statement is a big advance. Ms. Bunting approved the way that NLM consulted with Network members extensively in developing and testing the new DOCLINE system. One remaining challenge is to increase the number of Network institutions who use desktop delivery of journal articles rather than paper for their interlibrary loans. She asked whether NLM was looking into how to speed up the journal review process in deciding which publications to index for MEDLINE, especially those journals that are exclusively online. Ms. Bunting suggested that this would be an appropriate topic for discussion at a future Board meeting.

VIII. NLM REGENTS' AWARD

Dr. Foster presented the NLM Regents' Award for Scholarship or Technical Achievement to Dr. Elizabeth Fee, Chief of the History of Medicine Division, for "her outstanding scholarship as an author and editor of highly regarded books, journals, and journal articles on the history of medicine and public health."

IX. ARCHITECT'S REPORT ON NEW NLM PHYSICAL FACILITIES

Mr. Steven Foote, of Perry Dean, Rogers and Partners, reported on the conclusion of the programming phase of facilities planning for a new NLM building. [He had reported at the May 1999 Board meeting on NLM's space utilization requirements; at the May 2000 meeting, Mr. Smith and Mr. Poppke reported about the Library's progress in dealing with both long term and current space issues.] Mr. Foote showed graphically how NLM could meet its space requirements through 2030 in three categories: collection storage, special biotechnology-related requirements, and public service space (including staff). He then showed an artist's rendering of the proposed new building and alterations to the existing buildings 38 and 38A. There are four principles that governed their planning: (1) Building 38 (the original library facility) should be reserved exclusively for Library Operations (the collection and services); (2) the Lister Hill Center (Building 38A) should be devoted to its pre-NCBI functions; (3) the National Center for Biotechnology Information would occupy a new building; and (4) there would be a new main entrance that would provide access to all three buildings. Using a series of graphics, Mr. Foote described various design features of the overall proposal. In answer to a question, he said that it would require about 18-22 months to construct the new building; the work on Building 38 would require about 12 months. These phases could be done either sequentially or concurrently. There was a general discussion about the funding required; NLM is hopeful that the Congress will provide additional resources in FY 2001 for completion of the architectural and engineering design.

X. REPORT OF ASSOCIATE DIRECTOR FOR EXTRAMURAL PROGRAMS

Dr. Milton Corn presented to the Board an update on BISTI (Biomedical Information Science and Technology Initiative), a pan-NIH program intended to optimize use of computer science and IT to address problems in biomedicine. These activities will be coordinated by the BISTI consortium, which includes representatives from the participating institutes, including NLM. NIH's BISTI activities can be inspected at http://grants.nih.gov/grants/bistic/bistic.cfm/ Dr. Corn said that three "research opportunities" programs were released on June 29, 2000, with awards to be made in FY 2001: (1) Planning Grants: National Programs of Excellence in Biomedical Computing (Pre-NPEBC); (2) Innovations in Biomedical Information Science and Technology: Phased Innovation Awards (R21/R33); and (3) Innovations in Biomedical Information Science and Technology: SBIR/STTR Initiative. The Institutes have not actually contributed funds to some central pool for BISTI purposes: after the applications have been received and reviewed each Institute will select for funding those most relevant to its mission. It is anticipated that considerable co-funding will also occur with two or more Institutes chipping in to support certain applications or broadly useful applications. Because BISTI awards will not be made until FY 2001, NLM allocated $2 million from its FY 2000 budget for administrative supplements made to our 12 training programs for research training in informatics. We believed such grants would help our programs to enhance or, in some cases, initiate training in biomedical computing. Such enhancements are desirable in themselves, and might well help our programs to compete successfully for the BISTI grants being offered by NIH. NLM believes that training of more specialists able to build the tools necessary for biomedical computing is an important imperative of the BISTI program. NLM has been providing support for informatics training for 25 years, and it may be that increased support of such training is the area in which NLM may be best equipped to foster BISTI success.

XI. REPORT OF THE SUBCOMMITTEE ON OUTREACH AND PUBLIC INFORMATION

Dr. Henry Foster reported on yesterday's discussions at the Board Subcommittee on Outreach and Public Information. The members heard reports on various outreach activities, including press releases (Bob Mehnert), MedlinePlus publicity (including a public service announcement) (Kathy Cravedi), a January 2001 conference in conjunction with the Public Library Association (Becky Lyon), the upcoming Friends of the National Library of Medicine conference and annual patron dinner in December (Dr. Thomas Bryant), and the NIH health disparities initiative and NLM evaluation plans (Dr. Elliot Siegel). Following Dr. Foster's report, Dr. Lindberg commented about NLM's plans to evaluate how useful its Web sites are for the public. Ms. Prime said that existing tools to measure Web use are very poor and it will be interesting to see how NLM succeeds in its efforts. This will be the subject of a future report to the Board.

Ms. Joyce Backus of the Public Services Division next updated the Board on the evolution of MedlinePlus, NLM's Web site for consumer health information. MedlinePlus debuted in October 1998 with 22 "health topics." She described how these topics were selected and how they have since been expanded to more than 400 on a variety of disease and wellness issues. Today there are also links to organizations, libraries, directories, dictionaries, an extensive drug information resource, and an illustrated medical encyclopedia. There were 116,000 page hits in its first full month of operation (November 1998); the latest monthly count is over 2 million page hits. Ms. Backus described how the authoritative information in MedlinePlus is selected, evaluated, and kept up to date by NLM staff and experts in the National Network of Libraries of Medicine. There is close collaboration with the NIH institutes. She got online and demonstrated for the Regents various MedlinePlus features, such as its links to custom-formulated PubMed/MEDLINE searches and ClinicalTrials.gov. There are many e-mail notes sent to the MedlinePlus staff by users, most of them complimentary, some of them recommending topics and sites to be added. Ms. Backus noted that the system will be enhanced in the near future with daily newswire service feeds for health information that will be linked to the appropriate health information topic page in MedlinePlus. Another improvement will be the addition of patient education modules that may help with requests we have received for low literacy information. NLM is working with the National Institute on Aging to create a MedlinePlus site that is especially friendly for seniors. Other improvements in the offing are an additional drug information resource and adding links to local and regional Web sites. Following Ms. Backus's presentation, there was a general discussion among the Regents about how to make MedlinePlus use more widespread among those who are not connected to the Internet and how to ensure that the contents of MedlinePlus are understandable to those with low health literacy. A health information Web site designed for younger people was also suggested as an add-on to MedlinePlus.

Ms. Kathleen Cravedi of the Office of Communications and Public Liaison said that MedlinePlus has received much favorable publicity in recent months. She showed the Regents a number of newspaper and magazine clippings and also played for them a video news clip from NBC. Since January 2000 MedlinePlus has been either the subject of or mentioned favorably in some 750 magazine and newspaper articles in all 50 states. A 60-second radio public service announcement (PSA) was produced in cooperation with NIH and distributed by their service to more than 1,000 stations; a version in Spanish was also distributed to 260 stations broadcasting to the Hispanic community. Ms. Cravedi said that the Library is planning a more coordinated public service information campaign for MedlinePlus that will involve radio, television and print PSAs. She distributed mock-ups of several PSAs intended for magazines and newspapers and played for the Regents a first version of a MedlinePlus television PSA.

XII. TOXICOLOGY INFORMATION OUTREACH PROGRAM

Dr. Bailus Walker of Howard University, Chair of the Toxicology Information Outreach Panel, praised the NLM for its long-term commitment to the Toxicology Information Outreach program. This effort was born 10 years ago when there was heightened awareness that disadvantaged communities were at increased risk for environmental toxicants and industrial pollutants. There was little data then about the environmental components of many diseases in the general population, and even less in disadvantaged communities. At that time, officials of the Department of Health and Human Services, in their health goals for the year 2000, said that we must emphasize preventive efforts on special populations, specifically the poor, minorities, and children. The NLM recognized the need of the Historically Black Colleges and Universities for improved tools to access the information and databases put up electronically by the NLM. Acting on this need, the Library has invested in HBCUs by providing workstations on a long-term basis and training in searching the databases. Nine HBCUs that had highly visible health sciences programs were included at the very beginning (1991); many more HBCUs joined the effort later. The objectives of the program were (1) to increase awareness of the toxicological resources available; (2) provide instruction in the use of these resources; and (3) to use the HBCUs as outreach agents to disseminate the benefits of using the databases. The technical assistance provided by NLM was crucial to the success of the program. Using Howard University as an example, Dr. Walker described how the school parlayed the NLM investment into the creation of a major new academic division, a new telemedicine initiative, and a partnership with the health sciences library. He noted specifically how several other of the HBCUs (Xavier, Meharry, and Florida A&M) have used NLM support to take different paths in improving their ability to provide information programs and services in toxicology and environmental health. Further, this support has stimulated the HBCUs to move into areas where they were not active before, for example, some are conducting research on toxicological mechanisms. NLM support has also helped the institutions to recruit students and encourage them to enter research careers. Finally, Dr. Walker said that by providing this support for HBCUs, the NLM has provided itself with a cadre of willing partners for future outreach efforts in minority, rural, and otherwise disadvantaged communities.

Following this presentation, Dr. Foster commented that he occasionally hears the question as to whether HBCUs are still needed. He said that the special needs and interests of the communities they serve make them an important part of the educational landscape and he believes that NLM should continue to support these institutions. Dr. Walker said that, taking the long view, one of the great services NLM can perform is to the environment. He and Dr. Zimble several years ago reviewed the toxicological databases; the interface to them has been much improved. The idea of connecting them to the HBCUs was a "stroke of genius," he said. They have been of enormous benefit to this community, but they are still underutilized by the public at large and the media. Dr. Zimble agreed that TOXLINE and the other databases were not being taken full advantage of for toxic clean-up and disaster response.

XIII. ANATLINE: AN ONLINE IMAGE DATABASE

Mr. Earl Henderson, Deputy Director of the Lister Hill National Center for Biomedical Communications, demonstrated to the Board AnatLine (anatomy online)--a new Web-based image delivery system based on NLM's Visible Human datasets developed and now being beta-tested by Mr. Henderson and his colleagues. AnatLine (http://anatline.nlm.nih.gov/) uses high performance computing and communications systems to demonstrate techniques for processing, storing, and distributing large volume human anatomy image files. Using the raw Visible Human datasets as a source, the purpose of AnatLine is to collect and segment anatomical structures so they can be stored and retrieved directly. The development team rescanned the 70mm film to obtain images that were higher in resolution than the Visible Human images existing on the Web. The segmentation and anatomical labeling were accomplished under contract, the remainder of the project was accomplished by staff. It took considerable effort to convert the raw dataset into processed structures, store them, and put them online. Four types of image formats emerged: rendered data format sets, voxel format data for developers who wished to do their own rendering, for extremely large datasets a compressed format, and the raw cross-section files with image labels mapped onto them. In total, these four image types comprise a collection of 590 files (30 gigabytes) for the thorax region of the Visible Human. LHC staff developed a high-resolution display system downloadable over the Web to aid users. In addition, they developed a low-resolution online browser to allow users to "walk through" the Visible Human body and extract rendered images. This was very popular with the beta testers. Mr. Henderson demonstrated examples of several AnatLine image formats to the Board.

Following Mr. Henderson's presentation, Dr. Linsker made some comments that might apply to future work in the area of systems that permit a query that involves access to more than one database without copying all the data into large file and without the user having to learn the formats associated with each of the different databases. This would be in contrast with the NLM Gateway project, which is one query mapped into each of many datafiles. Further, the tools for accessing non-text multimedia databases are still in the primitive stage and this is an area for more work. He asked whether the AnatLine developers had any plans to assess the usefulness of the different image formats and browser capabilities for the different intended target audiences. Dr. Michael Ackerman, the Visible Human project officer, noted that in fact there is an upcoming conference of Visible Human applications developers that will showcase what they are doing with the datasets and discuss where the project is going.

XIV. EXCERPTS FROM FILM ON HEALTH SERVICES RESEARCH

Ms. Marjorie Cahn, Head of NLM's National Information Center on Health Services Research and Health Care Technology, showed to the Regents an excerpted version of the video, Health Services Research: A Historical Perspective, produced by NLM in 2000. Copies are being distributed to members of the Board, the Regional Medical Libraries, members of the NNLM, and others on request.

XV. ADJOURNMENT

The Board adjourned at noon.

ACTIONS TAKEN BY THE BOARD OF REGENTS

The Board of Regents concurred with the recommendations of the Extramural Programs Subcommittee

Dr. Henry Foster presented the NLM Regents' Award to Dr. Elizabeth Fee

ATTACHMENTS

A Roster - NLM Board of Regents

B Roster - EP Subcommittee

C Roster - Subcommittee on Outreach and Public Information

I certify that, to the best of my knowledge, the foregoing minutes and attachments are accurate and complete.

Donald A.B. Lindberg, M.D.

Director, National Library of Medicine

Henry Foster, M.D.

Chair, NLM Board of Regents