Cyprus Medical Libraries Project: International Collaboration for Electronic Document Delivery and Full-Text Database Development

Abstract

Through funding from the Middle East Cancer Consortium, ({MECC}) and a partnership with the {Spencer S. Eccles Health Sciences Library} at the University of Utah, Cyprus medical libraries now have access to an electronic document delivery system and a full-text database of Cypriot cancer and health literature. This paper will describe the process of establishing these services. Because access to current health literature is essential for quality health care, the authors believe that international cooperation and collaboration of this type should be encouraged and expanded. The benefit to the smaller library with limited funding is dramatic and the impact on the larger library providing the service is minimal.

Cyprus Background

Cyprus history reads like a Who's Who of invaders and conquerors: Myceneaens, Phoenicians, Egyptians, Romans, Byzantines, French Lusignans, English Crusaders, Greeks, and Turks have all laid claim to its soil. The roots of the modern conflict can be traced to the 19th century. In 1878 the Ottoman Empire ceded Cyprus to Great Britain, which added the island to its long list of colonies. Antagonisms between Greek Cypriots and the Turkish Cypriot minority were muted under British rule, but tensions flared after Cyprus gained independence in 1960. A Greek nationalistic movement (Enosis) sought a union with Greece, while the Turkish Cypriots naturally demurred. Atrocities occurred on both sides, and in 1974, fearing a Greek coup against the Cypriot government of Archbishop Makarios, Turkey sent an invasion force and captured 38% of north Cyprus, effectively dividing the island. Greek Cypriots fled their villages in the north, Turkish Cypriots fled from the south, and the United Nations brokered a cease-fire by drawing a buffer zone (Green Line) between north and south, which is still in effect. The Republic of Cyprus in the south is officially recognized throughout the world, while only Turkey recognizes the Turkish Republic of Northern Cyprus.

The effect of this division on Cypriots cannot be underestimated. It is a constant force, economically, culturally, and psychologically. The Green Line is a daily reminder of the precarious peace under which they live, and expressions of hope, regret, and resignation are common on faces and in conversations. Cypriots cannot normally cross the line, and tourists are allowed day passes only from south to north (i.e., a visitor who flies into an airport in the north will be denied a border crossing into the south by Greek Cypriot officials).

In this political climate, libraries naturally suffer with small budgets. In the case of government medical libraries, small budgets translate to potentially life-threatening shortages of current information sought by physicians and other researchers.

State of Medical Libraries in Cyprus

The Health Sciences Library at Nicosia General Hospital, directed by Andreas Savva, Medical Librarian, serves as the main library for four national hospitals on the island:

• Nicosia General Hospital
• Larnaca General Hospital
• Limassol General Hospital
• Paphos General Hospital

The library maintains 120 journal subscriptions, has 5,000 books, 2,000 World Health Organization (WHO) materials, and approximately 2,000 government documents. Three of the Cypriot hospitals have no librarian on site, requiring Mr. Savva to perform literature searching for health professionals in all four national hospitals.

Prior to the implementation of this project, a WHO gift subscription to SilverPlatter MEDLINE, CINAHL, PsychLit and HealthStar on CD-ROM had provided primary access to the literature. The library housed only one computer workstation. Internet access was limited to one workstation in the library office and the account was shared with another department in the hospital. As a result, patron access to the Internet was not available in the library. These factors limited access to current health literature and required time intensive searching by the Medical Librarian.

"Lack of staff is our main problem. I am the only qualified librarian (with two assistants) on the whole island to do the library administration, take care of the user services, technical services and activities of the library aimed at serving the information needs of the 2,000 physicians, 3,000 nurses, more than 500 student nurses, and physicians taking their specialization or pre-registration practice, etc. I am under constant stress."

Andreas Savva, Medical Librarian
Nicosia General Hospital Library, Cyprus
September 29, 1999

The Cyprus Medical Association (CMA) has produced a journal continuously since 1982, the Cyprus Medical Journal (CMJ), which has never been indexed. While the Health Sciences Library at Nicosia General Hospital owns a nearly complete collection of CMJ, the only access to its information is through manual searching of individual issues. Cyprus hosts a number of conferences relating to cancer, but papers from these conferences have not been systematically collected or indexed. This prevents health professionals from searching or retrieving the information disseminated through these conferences. Additionally, health-related government documents are housed in the Health Sciences Library at Nicosia General Hospital, but they have not been indexed, leaving them essentially inaccessible to the patrons.

There has not been a great deal of organized cooperation or collaboration between the health sciences libraries and the CMA. Until recently, communication and cooperative projects were not frequent among libraries on the island. Communication between government agencies is not well organized. This situation requires individual librarians to be resourceful and take their own initiative in designing and offering new services.

MECC Funding Opportunity

In the autumn of 1997, Kenning Arlitsch, Head of the Digitization Center at the J. Willard Marriott Library, University of Utah, was living in Nicosia, Cyprus as an international library fellow of the American Library Association and U.S. Information Agency. During Mr. Arlitsch's stay in Nicosia, Mr. Savva heard of a funding opportunity from the Middle East Cancer Consortium (MECC) and the two librarians quickly collected some data and sent a proposal. Shortly after returning to the U.S. in April of 1998 Mr. Arlitsch learned that the grant had been awarded. The initial grant from MECC was to have been for $30,000, but since Mr. Arlitsch does not reside in the Middle East, he was disqualified as a recipient and the amount was reduced to $15,000.

Identified Problems -- Two Major Needs

The grant proposal identified two major needs:

1. Electronic document delivery of health science literature. While document delivery was available through the British Lending Library, processing time was painfully slow and costs exceeded the budget of the Cypriot medical libraries.
2. Digitization and indexing of health related materials originating in Cyprus. Health related literature produced in Cyprus via journals, conference proceedings and government documents was inaccessible due to lack of systematic collection and indexing.

The $15,000 grant funds were transferred to the Ministry of Health in Cyprus by MECC in June 1998. The funds were released to Mr. Savva for use in the project in May 1999, nearly one year after the funds were awarded and three months after implementation of the project.

After notification of the funding award, Mr. Arlitsch enlisted the help of Nancy Lombardo, Head of Systems at the Eccles Health Sciences Library. Her experience with health science resources and practices proved useful in finding solutions and meeting the needs of the Cyprus medical libraries.

University of Utah

The University of Utah, located in Salt Lake City, has three libraries serving a student population of approximately 26,000. The J. Willard Marriott Library is a member of the Association of Research Libraries, and the Center for Research Libraries. It houses over 2 million books and has more than 14,000 periodical subscriptions. The Spencer S. Eccles Health Sciences Library is a Resource Library in the National Network of Libraries of Medicine and houses over 56,000 books and more than 1,600 journal subscriptions.

The libraries of the University of Utah have a tradition of cooperation. Efforts are made to collaborate on projects and share information and resources. Experience has proven that many of the libraries' goals are similar and that creative synergy can result from librarians with different backgrounds working together. The library directors encourage communication, collaboration and cooperative projects. Having the support of the Eccles and Marriott Library directors has been essential to the success of this project.

Finding Solutions

Solutions for the two major components of the grant proposal, the document delivery service and the indexing of Cypriot health materials, were developed taking advantage of existing tools and practices at the Eccles Health Sciences Library. In the electronic environment, adding services for a library in another country is nearly as simple as adding services for an individual patron. Physical boundaries are truly irrelevant and designing these solutions required a mere extension of services. Extending existing services allowed the team to build the project infrastructure and test all procedures at the University of Utah.

Document Delivery through the National Library of Medicine's Loansome Doc Program

The solution to the document delivery issue was found through PubMed, Loansome Doc and traditional Interlibrary Loan (ILL) services using electronic delivery. With PubMed, the National Library of Medicine's free Web access to MEDLINE, PREMEDLINE and molecular biology databases, biomedical literature searching is available to the worldwide Internet community. While only citations and abstracts are available in the MEDLINE database, PubMed includes the Loansome Doc service, which allows users to order complete articles directly from their online search results. The user must establish an account with a participating health sciences library, and requests are automatically routed to the participating library.

A Loansome Doc account was established for the Medical Librarian, Andreas Savva, to serve the four government hospital libraries in Cyprus. The account allows online ordering of articles and document delivery through the Eccles Health Sciences Library at the University of Utah. A free trial period was established allowing up to 50 free documents per month from March through May of 1999. The trial period helped the borrowing and lending institutions establish effective procedures and communication.

Using this service, Mr. Savva is able to search the free PubMed service on the Internet and place orders directly from the online literature search results. Physicians and health professionals submit their own PubMed searches to the Librarian who places requests for the articles selected. For materials not found in PubMed, Mr. Savva is able to place requests using the Eccles Library electronic ILL request forms on the library's web site. While it is technically possible for the individual health professionals to place their orders directly, a centralized ordering procedure has been established to allow Mr. Savva to track usage and costs and to ensure accurate accounting.

Documents are delivered electronically from the Eccles Library to the Nicosia General Hospital Library via e-mail. Print articles are scanned using the Research Libraries Group's {Ariel software}, a flatbed scanner and networked computer at the Eccles Library. The Ariel software is easily configured to send the scanned material through e-mail, and the process is fast and efficient. The articles arrive as attachments in graphic TIF format and are opened using the {Kodak Imaging for Windows software}, a standard accessory with Windows 95, 98 and NT operating systems. Imaging is a multi-page TIF viewer, allowing articles of multiple pages to be displayed as a single document. Mr. Savva's PC was configured to use the Imaging software as the default program for all files with the TIF extension, allowing a simple double click on the attachment link in the e-mail message to open the file. Once displayed, the article is printed on a laser printer and distributed. Mr. Savva is responsible for tracking the orders and delivering the articles as they arrive. After the trial period, a per article charge was established at $5 for documents owned by Eccles Library and $10 for documents not owned by Eccles Library.

Indexing Cypriot Health Materials

The solution to the indexing of Cypriot health materials was found through the use of the Eccles Health Sciences Library's existing integrated library system, {epixtech} Horizon. Library catalogs are not traditionally used to index beyond the title of a journal. Indexing individual articles is stretching the limits of the catalog.

The Horizon system allows the creation of "locations" and "collections" which allow users to limit a search to a specific group of materials. A new "location" and seven new "collections" were established to allow Cypriot users to search their own collection if desired. Template work forms were developed for articles, pamphlets, and proceedings, which simplified the indexing process. The work forms allow novice indexers to more easily identify the required indexing information.

The Cypriot materials offer additional challenges because many of the articles are written in Greek. Transliterations and translations of titles and translations of abstracts were thought necessary. Horizon technical representatives indicated the system would have Greek character capabilities in the near future.

The Horizon system includes a Web interface, {WebPAC}. The WebPAC interface can be customized to provide searching limited to the Cyprus medical libraries' materials. This web interface can also be designed to present a unique look for the Cypriot user. Combined with the limiting features, this will allow the Cyprus libraries to have a distinct catalog, or index, to local materials.

The types of materials to be included were articles from the Cyprus Medical Journal, proceedings from Cypriot medical conferences and medical pamphlets published by the Cypriot government. An estimated 10,000 individual pieces were expected for the database. Materials were to be scanned and loaded onto the Eccles web server in portable document format (PDF). Records would be entered directly into Horizon based on templates, or work forms, and 856 field hyperlinks would provide direct access to the full text of the literature. Samples of each type of material were used as prototypes for scanning and indexing.

The articles were scanned on a flatbed scanner at 300 pixels per inch (ppi) with document feeder and were saved as PDF files. Experimentation determined that scanning at less than 300 ppi produced PDF files in which the edges of the text were not crisp. Scanned file sizes for articles ranged from 100 KB to 1.5MB, and pamphlets, some of which exceeded 30 pages in length, were even bigger. The pamphlets were slow to transfer over the Internet, even across T1 connections at the University of Utah, so Optical Character Recognition (OCR) software options were explored as an attempt to reduce files sizes by creating text files.

Universal OCR from {Language Force}, which claimed to translate numerous languages, including Greek, worked beautifully on English at the University of Utah; however, it never worked with Greek text. Undaunted, and thinking this was simply because Greek fonts were not installed on the local system, the team took the software to Nicosia.

Mr. Arlitsch and Ms. Lombardo were trained to index using the Horizon library system by Joan Gregory, Head of Technical Services at the Eccles Health Sciences Library. Procedures were established for indexing monographs, journal articles, conference proceedings, government documents and pamphlets. Work forms were prepared to simplify the procedure and allow for remote indexing to be submitted via the Internet. Procedures for Horizon client installation were documented, and a manual was prepared to use while training Mr. Savva. Additional resources were organized and linked on a {Cyprus Medical Library Project} web page.

Travel

A site visit to Cyprus was necessary in order to purchase and install the equipment and to train Mr. Savva in using the new services. Because the original grant had been halved, the entire project was left with $15,000 for equipment, training, travel, and labor. Recognizing the deficiency, Dr. Michael Silbermann, chief executive officer of MECC, generously agreed to fund Mr. Arlitsch's travel to Cyprus.

Coincidentally, the University of Utah Middle East Center was seeking applications for research travel grants. An application was prepared and the team was awarded $1,200, which covered the cost for Ms. Lombardo. The directors of the Eccles Health Sciences and Marriott Libraries were very supportive of the project and offered to assist with any travel expenses not covered by the two funding sources.

On February 23, 1999, Ms. Lombardo and Mr. Arlitsch went to Nicosia, Cyprus to work with Mr. Savva in implementing the proposal. They stayed in Nicosia at the Cyprus American Archaeological Research Institute (CAARI), a hostel for visiting scholars and the place where Mr. Arlitsch had lived for the six months of his 1997-98 fellowship.

Equipment and Internet Access

Procuring equipment took place immediately upon arrival. Mr. Savva had arranged for the purchase of the necessary hardware from a local computer vendor, and Mr. Arlitsch was taken directly from the airport to the vendor after traveling for more than 24 hours. Because the grant funds had not been released, it was necessary to work with a vendor willing to extend credit on nothing more than good faith. Always, the implication was that the funds were due for imminent release. The equipment purchase included:

Computer	Scanner	Printer
IBM Pentium II 450 MHz	HP 5200 C flatbed	HP Laserjet 4000
17-inch monitor	Automatic Document Feeder	17ppm
8.4 GB HDD	600 x 1200 ppi	1200 ppi
128 MB RAM	36-bit color processing
Windows NT 4.0	8.5 x 14 inch scan area
32X CD-ROM	HP PrecisionScan 2.0 software Caere PageKeeper Standard Ed.
56.6 Kb modem

While Windows NT 4.0 was a requirement of the Horizon client, it caused problems with Internet connections and with the scanner, and more delays resulted. Technicians from the vendor came to the library to reinstall the operating system. There were problems with the local dial-up Internet connection which the same technicians were able to resolve.

There were also problems with the laser printer. Printing seemed to require a mysterious sequence of button pushing that defied logic. The manuals were not particularly helpful; they were bilingual, but the two languages were French and Turkish and no one on the team spoke either.

When the scanner arrived, there were problems connecting it to the NT machine. The scanner was supplied with a USB cable, but there was an NT incompatibility issue and additional delays resulted while the team waited for a SCSI card to be delivered. In the meantime, the scanner was connected to Mr. Savva's original library computer. This caused the computer to crash and be removed to the shop for major reformatting, leaving the team with only one computer for several days. The scanner came with two software possibilities, in addition to the Universal OCR purchased by the team. Of these three, only one worked correctly. Problems with the other two included inverted colors (white text, blue background) and different character sets. The idea of creating text files with OCR was abandoned when it became clear that recognition of Greek characters was not working, and the focus turned to PDF.

Once it was determined that PDF would be the format of choice, Adobe Acrobat 4.0 was used as the scanning software. Acrobat has an Import Scan feature which works with the scanner software to allow multiple pages to be scanned into one file and opened directly as a PDF. With a document feeder on the scanner an entire article or pamphlet can be scanned at a rate of approximately five pages per minute. Once pages have run through the scanner they are processed into one file and displayed by Acrobat, at which point they can be cropped if necessary.

Cropping was sometimes necessary because of stray marks left by the copy machine; these marks can increase the sizes of files. This issue is the result of a trade off. On high-volume jobs like this a document feeder is a necessity, but using it requires either that the articles be photocopied or the binding be chopped off each journal issue so that the pages can be fed through the feeder in a stack. Photocopying wastes paper and can produce stray marks that must be cleaned up in the software, but chopping off a binding destroys the journal issue. Since many of the Cyprus Medical Journal issues in the Nicosia General Hospital were single copies, they could not be destroyed, and were thus photocopied. In an age when virtually every journal becomes electronic at some point in the publishing process the obvious best solution is to generate PDF and HTML files directly from the publishing software. Not only are the PDFs cleaner but the file sizes are much smaller than those digitized with a scanner. It is hoped that future submissions to the database, whether they are journal articles, pamphlets, or conference proceedings, will be in some electronic format.

Internet access was very limited compared to the ubiquitous access enjoyed at the University of Utah. Mr. Savva's existing modem was a 28.8Kbps and his dial-up Internet account was shared between the library and another hospital department. This led to some confusion when a physician accidentally downloaded some of the documents e-mailed to the library. Not only did the physician discard the documents, not knowing what they were, but he was also annoyed at having waited for 20 minutes for the attachments to download. Obviously, a shared account is not ideal for this kind of project. Mr. Savva has since been able to secure a separate library account.

Another Internet issue had to do with the amount of server space allotted by the local Internet Service Provider (ISP), {Cytanet}. The default for individual accounts was 2 megabytes. When those 2 MB were filled, a warning message was automatically sent out to the subscriber via e-mail. With the first document delivery, Mr. Savva received numerous messages indicating that he had filled his allotted space. A call to Cytanet and explanation of the project was met with a generous boost of the account space to 10 MB, with the understanding that going over the limit was not a problem as long as the documents were not stored on the server.

Training -- Searching, Ordering, Indexing and Transferring Files

Each problem caused some frustration due to the limited time allotted for the onsite visit and the desire to accomplish as much as possible during the visit. Occasionally, Mr. Savva would lighten the mood by explaining, with a smile on his face, "This is Cyprus!" The time was not wasted. Ms. Lombardo was able to train Mr. Savva to use PubMed and Docline using the single remaining library workstation and Mr. Arlitsch was able to evaluate the library collection for appropriate materials to be indexed.

PubMed Training

The actual PubMed training went very well. Mr. Savva had an excellent understanding of MEDLINE and was an experienced searcher of the SilverPlatter databases on CD-ROM. He quickly learned the variations involved with searching PubMed. The library was very busy with physicians and other health professionals constantly stopping in to browse the collection, read the available literature, or to drop off literature search requests. Typically, a physician would drop by to discuss a literature search with Mr. Savva. The search would be run and refined, then printed and given to the physician. The physician would read through the citations and mark those he/she wished to order. Mr. Savva would then call up the individual articles in PubMed using the Unique Identifier number (UID). Orders would be placed directly from the citation, using the Docline account established with the Eccles Health Sciences Library. Using actual physician requests, document orders were placed the first day of the visit and the electronic documents were delivered within 24 hours. Because of the eight-hour time difference, the Eccles Library generally receives the requests before the service hours of the Interlibrary Loan department, meaning the requests are actually filled the same day they are received. All agreed this was not a bad start for the project!

It was evident immediately that the document delivery service would become very popular among the health professionals at the Nicosia General Hospital. Those who placed orders during the first week were astounded when the full text of the articles were delivered to them in less than 48 hours. Managing the new document delivery service will have its challenges for Mr. Savva. While the service has the potential to allow each individual health professional to place document requests, there is also potential for confusion and difficulty matching documents with the requesting individual. Billing issues also present a challenge. As long as the library is responsible for payment for all orders requested through its Docline account, Mr. Savva prefers to centralize the ordering in the library so that he can maintain records and track the usage.

Ms. Lombardo and Mr. Arlitsch observed the workload of Mr. Savva during their visit. The library is very busy and Mr. Savva has very little support. What assistance he does receive is from inconsistent and unqualified staff. Managing this new service will require a substantial amount of time each day and will add to his already busy work day. However, Mr. Savva showed tremendous enthusiasm for the project and has continued to allow the service to grow during the past year. This is a demonstration of his strong personal commitment to providing the best possible service to his patrons.

Indexing Cypriot Materials Training

In order to index Cypriot materials in the Eccles Library Horizon catalog, it was necessary for the team to install the Horizon 5.1 client on the new NT workstation. The installation went smoothly and the test of remote access proved fast response times and successful data entry.

Mr. Savva was trained to enter the indexing information into the prepared work forms for the three types of materials: articles, proceedings, and pamphlets. The training went slowly, as Ms. Lombardo was an inexperienced indexer and Mr. Savva had many procedural questions. For example, each MARC tag had to be explained. The existing standards for use of the MARC tags were not as flexible as Mr. Savva would have liked. Indexing is a complex process. Preliminary searching of the database for matching titles, using the authority files, and entering the correct information in the correct field turned out to be quite time consuming.

After the initial training was completed, Mr. Savva indexed one sample from each of the three categories. During the training, a variety of issues arose, including transliteration, abstracting and selection of MeSH headings. Transliteration of titles is not useful to the Cypriots. Because Cypriot health professionals are bilingual, there is no need for an intermediate interpretation. Most of the materials do not have prepared abstracts, which means the indexer must write the abstract. Writing a succinct and accurate abstract requires careful reading of each article and thoughtful selection of all appropriate keywords. Finally, MeSH headings have to be selected. There were frequent discussions about the difficulty of finding just the right MeSH headings for the material being indexed.

Because the library is extremely busy, there were constant interruptions during the indexing process. One item could take up to four hours to index completely. Occasionally, records were saved when only partially completed. It became clear that Mr. Savva would require personnel assistance with the indexing component of the project.

FTP Training

The final training element involved File Transfer Protocol (FTP). Mr. Savva was provided with an account on the Eccles Library server. His account allowed for FTP to a specific directory on the server. This directory would house the scanned digital images of all the Cypriot materials. Using the educational version of WS_FTP software, Mr. Savva was able to easily move files created in Cyprus onto the Utah-based server.

Most of the visit was spent training and practicing the new skills and testing the new services. Two potential assistants were identified and given a brief overview of the indexing process on the final day of Ms. Lombardo's visit. At that time, the funds had still not been released by the Cypriot government for Mr. Savva's use in paying for the computer equipment or in hiring assistants. The funds were finally released in the end of May, 1999. By that time, the two potential assistants were no longer available and much of the training in the indexing process had gone unused. Additional training will be necessary if the materials are to be digitized and indexed in Cyprus.

Publicity

In order to make Cypriot health professionals aware of the new services, a presentation was delivered by the team. Attendees included local health professionals, members of the CMA, representatives from the Genetic and Neurological Center, and librarians from various local institutions. The presentation outlined the services and showed the {Cyprus Medical Library Project} web page. Many of the attendees expressed interest in the project and the possibility of expanding the services to additional organizations was discussed. No progress has been made in including these organizations in the project.

Update

In the year since the site visit to Cyprus both aspects of the project have advanced. The Document Delivery service has remained popular among health care professionals in Cyprus. The full-text database, while developing more slowly, has benefited from additional funding in the form of a Faculty Grant awarded to Ms. Gregory from the University of Utah for digitization and indexing of Cypriot materials.

Document Delivery Update

With an average monthly order of 98 articles, it is clear that health care professionals in Cyprus are taking advantage of the new service. The following table indicates the number of articles ordered per month since the inception of the project.

Date	Number of Documents Delivered
May 2000	44
April 2000	68
March 2000	92
February 2000	95
January 2000	161
December 1999	100
November 1999	100
October 1999	106
September 1999	189
August 1999	172
July 1999	76
June 1999	124
May 1999	57
April 1999	78
March 1999	81
February 1999	27

The document delivery model has been extended to two other countries. Eccles Health Sciences Library is now serving health sciences libraries in Macedonia and Bulgaria. This method of document delivery is easy to employ and fills a critical need for libraries in underserved countries.

The only drawback stems from the additional traffic generated by the project's success. Mr. Savva recently reported that he now returns to his office for an additional 2-3 hours each evening, without additional pay, to maintain control over the workload. It has made more work for him and he remains short-staffed.

Full-Text Database Update

The full text database has taken longer to bring to fruition, but once its content reaches a critical mass it will prove to be a valuable resource. While in Cyprus, Mr. Arlitsch collected nearly all issues of the Cyprus Medical Journal from 1982 to the present and brought them back to the U.S. That scanning project was completed in March 2000; the PDF files have all been moved to the Eccles Health Sciences Library web server and await indexing to make them accessible to the world. To achieve this goal, Ms. Gregory applied for and was awarded a Faculty Grant by the University of Utah in the amount of $5,613. The grant, supplemented with support from the Marriott and Eccles libraries, will fund the indexing of approximately 5,000 digitized articles into the Horizon system with links to the PDF files on the web server.

The long-term goal is for all indexing to be done in Nicosia by an indexer who will be hired from the remainder of the MECC grant. The entire database will also eventually be moved to an ISP in Cyprus, giving the Cypriots greater control over their own resources. As the database grows it will take its place among the country's information resources, not only for its value as a medical resource, but also for its preservation of locally-produced literature.

Summary

The project's continued progress and development can be attributed to the involvement of committed library professionals who have established lasting international relationships. The success of this project can be a model for international cooperation among libraries. It is evident that international sharing and cooperation can be of great benefit to underserved or under funded libraries around the world. With minimal effort by the sponsoring library, the health care provided to the people of less developed countries can be vastly improved. Were every major health sciences library to sponsor a single underdeveloped nation following this model, the resulting access to health information could significantly impact the provision of quality health care worldwide.

Acknowledgements

Certain elements of this collaboration deserve note. Foremost, the hospitality of the Cypriot hosts was unmatched; the U.S. librarians were frequently invited to dinner, taken to lunch and taken on trips around the island. Mr. Savva and members of the larger Cypriot library community offered unfailing kindness and generosity. The team was particularly grateful for all the technical assistance from the computer vendor, WPC Ltd., considering that the equipment had been purchased on good faith credit. The fact that English fluency in nearly ubiquitous on Cyprus meant communication was never a problem. The support of the {American Embassy} was also crucial to the success of the project. Special thanks go to Judy Baroody, Public Affairs Officer, and Dorothy Akkides, Librarian, at the American Documentation Center for all their help during the site visit. Thanks also to Camille Salmond and Amy Birks of the Eccles Library InterLibrary Loans Department for their enthusiasm and excellent service, and to Wayne Peay and Sarah Michalak, directors of the Eccles Library and the Marriott Library, for their support throughout this project.

Relevant Web Addresses

Adobe Acrobat - http://www.adobe.com/products/acrobat/

American Embassy in Cyprus - {http://cyprus.usembassy.gov/}

Cyprus Medical Libraries Project Web page - {http://library.med.utah.edu/cyprus/}

Cytanet - {http://www.cytanet.net/}

epixtech Horizon library system - {http://www.epixtech.com/product/Horizon.htm}

J. Willard Marriott Library, University of Utah - http://www.lib.utah.edu/

Kodak Imaging - {http://www.eastmansoftware.com/}

Language Force Universal OCR - {http://www.diskovery.com/products/desc.asp?ProductDesc=1107}

Middle East Cancer Consortium - {http://www.cancer.gov/aboutnci/organization/global-health/research-programs-initiatives/mecc}

National Library of Medicine's PubMed - http://www.ncbi.nlm.nih.gov/PubMed/

Research Libraries Group's Ariel software - {http://www.rlg.org/ariel/}

Spencer S. Eccles Health Sciences Library, University of Utah - {http://library.med.utah.edu/}

WebPAC (Eccles Library) - {http://155.100.78.49/ipac20/ipac.jsp?&profile=ec#focus}

WS_FTP - http://www.ipswitch.com/

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