 The ongoing evolution of the computer has changed forever the way information is made available. This is a medical librarian, one of the team of circuit riders that served the medical community in four rural upstate New York counties. They use portable computers and telephone modems to tap into the latest research data. A local internist had a patient with unusual symptoms. A 36 year old male presented with symptoms I'd never seen before. One half of his face turned red and sweated. The other half remained white. This extended down the upper half of his body. I called a pediatrician friend of mine who felt these symptoms were consistent with Harlequin syndrome. Harlequin syndrome, could this be the same condition? Dr. Kellogg turned to the Mercy Center for Health Services and one of its circuit riders. Using the keywords Harlequin and the modifier adult, he discovered that yes, the conditions occurred in adults very rarely. The information from Jeff's search told me we were dealing with a nervous system disorder. This led to subsequent testing and appropriate neurosurgical referral. Medline, the database where the reference to Harlequin syndrome was found, comes from the collection of the National Library of Medicine in Bethesda, Maryland. Its holdings of over 5 million items make it the world's largest collection of biomedical information. Its collection of historical medical publications goes back to the 11th century. Today, Internet Grateful Med allows healthcare professionals around the world instant access to the library's databases. For caregivers everywhere, NLM provides a free electronic service that provides access to the full text of clinical practice guidelines and other documents useful in healthcare decisions. The service is called HSTAT. These guidelines are published by the Public Health Service. They are recommendations designed to help health professionals and patients make decisions about appropriate care. Through member libraries in the National Network of Libraries of Medicine, services are distributed nationally. NLM is proud of the way its databases touch the day-to-day lives of people in this country and around the world. This is the AIDS Information Network Office in Philadelphia. Here, information specialists use several NLM databases to give the latest information to HIV-positive people and their families. While some NLM services have nominal service charges, the AIDS databases are free to anyone with a computer and modem. The Internet is essential to modern librarianship. An emerging role for librarians is helping researchers locate and use databases. This is Jim Olds. As a researcher at the National Institutes of Health, he has local access to the 40-plus databases at NLM. Yet his research methodology was radically changed by another database he used via the Internet. Any time when it's using a marine model system, one has to consider technical issues. And this is especially true when considering something as complicated as human learning and memory, which is the issue our laboratory principally addresses. The marine animal Dr. Olds was using had limitations. He needed a better specimen to advance his research. We used the NBL database to explore different model systems. We came up with using the sea urchin egg, which has the advantage that it doesn't have any out of fluorescence. Once we used the sea urchin egg system to study the activation of the enzyme, we actually got fantastic results. The significance of Dr. Olds' experience is this. A database needs to be in only one place. A researcher anywhere can view images in the Woods Hole Library. Hazardous chemicals are all around us in our everyday lives. For the most part, we are protected from them, but accidents happen. We're blackened at 1490. They had a fire in the, uh, what appeared to be the blanks. Chemical spills, large or small, can be life-threatening. Howard University Medical School. The broken bottle has no legible label. Pharmacology professor Dr. Robert Copeland evacuates the immediate area and calls the university safety officer. Earlier, Dr. Copeland had taken part in an NLM outreach program for historically black colleges and universities. Through Grateful Med, he entered ToxNet, then the Hazardous Substances Data Bank. This database holds identifying information on over 4,300 chemicals. Dr. Copeland had little to go on. The word methyl from the label and the properties of being a clear liquid that smelled sweet and pleasant. The information Dr. Copeland pulled up told him that total evacuation was unnecessary. Ventilation would take care of the problem. The National Library of Medicine is an active participant in research, applying advanced computer technology to medicine and biology. NLM maintains and distributes GenBank, an international database of gene sequences. Researchers need to compare newly identified sequences with all other known sequences. Without a computer's help, it's like looking for a needle in a haystack. To help these researchers, NLM's National Center for Biotechnology Information provides GenBank. The sequences of the base pairs identified, 500 million of them so far, are loaded into these computers. Large-scale worldwide sequencing efforts like the Human Genome Project contribute to GenBank's doubling in size every 12 months. To give you some idea of how widely GenBank is utilized, NCBI services approximately 15 to 20,000 queries of the database per day. Recently, GenBank helped Dr. Richard Collodner of the Harvard Medical School identify the gene that causes hereditary colon cancer. I think the power of GenBank to people who do molecular biology is that in the early days of molecular biology, it was hard to clone genes, hard to sequence genes. As a consequence, there was very little data so one could search through it manually. We couldn't necessarily do very much with it, but there wasn't much of it. Then, as time has gone on, it's become much easier, much faster to clone and sequence genes. While Dr. Collodner and his colleagues around the world exchange data, others share images. Some use the internet to tap into NLM's 59,000 historical images. One project at the National Library of Medicine has created a huge database that contains a fully three-dimensional representation of the human body. For this visible human project, the library has commissioned photographs of one-millimeter sections of frozen cadavers, one male and one female. From these photographs and from electronic imaging such as CT scans and MRI, scientists can convert the billions of data points into fully retrievable 3D images of the body. With this database, users can travel anywhere in the body, penetrate layers, see through bones, all on a computer screen. Specialists in, say, sports medicine can explore new surgical techniques or devices to protect us from injury. Doctors may use the visible human database for something as simple and essential as explaining upcoming surgery. The database will be available to all. The National Library of Medicine and its research and development arm, the Lister Hill National Center for Biomedical Communications, are bringing the telemedicine revolution to medicine. These new technologies are most beneficial in isolated, underserved regions. An NLM research grant to rural West Virginia is funding a program to bring high-quality healthcare to everyone. Applying computer and communications technologies to telemedicine, patients in the most remote areas can have the benefit of consultation from specialists. Joe, are you listening? Yes, I'm listening. Okay, I was hoping you might be able to help me with my patient, Barbara Jones. She's a 61-year-old patient that I'm following down here at Wayne Health Services, and she's an asthmatic who is also hypertensive and has some osteoarthritis, has had some medication-related dyspepsia as well. Well, looking at her medications on board, I think it would be reasonable to start her on every other day steroid dosage at this point. Now, can I check the X-ray with you? Absolutely. This film was taken during her last hospitalization, as a matter of fact. There were some areas in the X-ray that were a little bit of concern to me. It might be a good idea to check this out. NLM's computer specialists are becoming international leaders in breaking down the barriers of computer formats, languages, and professional terminology. The National Library of Medicine is dedicated to making its resources available worldwide.