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Energy and resource management is an important and growing research area at the intersection of conservation, sustainable design, alternative energy production, and social behavior. Energy consumption can be significantly reduced by simply changing how occupants inhabit and use buildings, with little or no additional costs. Reflecting this fact, an emerging measure of grid energy capacity is the negawatt: a unit of power saved by increasing efficiency or reducing consumption.Visualization clearly has an important role in enabling residents to understand and manage their energy use. This role is tied to providing real-time feedback of energy use, which encourages people to conserve energy.The challenge is to understand not only what kinds of visualizations are most effective but also where and how they fit into a larger information system to help residents make informed decisions. In this article, we also examine the effective display of home energy-use data using a net-zero solar-powered home (North House) and the Adaptive Living Interface System (ALIS), North House's information backbone.

A rare case of double-outlet right ventricle with intact ventricular septum diagnosed by foetal echocardiography at 21 weeks of gestation is described. Amniocentesis revealed trisomy-18. The cardiac diagnosis was confirmed at autopsy.

Objective: To correlate fetal morphometrics with studies of fetal lung maturity., Study Design: One hundred six patients undergoing amniocentesis for fetal lung maturity studies were examined prospectively. Eighty-four patients were normal (79%), and 22 were diabetic (21%). Fetal morphometrics were obtained prior to amniocentesis. The fetal colon and placenta were graded. Discriminant analysis was used to identify variables that were predictive of a mature lecithin/sphingomyelin ratio and the presence of phosphatidylglycerol (PG). All patients delivered within 48 hours of amniocentesis., Results: In the normal group, 28 (33%) fetuses had a grade 3 colon, which was 68% sensitive and 98% specific for a mature amniocentesis. A grade 3 colon was the single best predictor of a mature amniocentesis (P < .001). Twenty-five (29%) fetuses had a grade 3 placenta, which was 64% sensitive and 96% specific for a mature amniocentesis (P < .005). Diabetes did not influence colonic grading since a grade 3 colon was present in seven (32%) patients (47% sensitivity and 100% specificity for PG) (P < .02). Interexaminer and intraexaminer variability for the study was excellent, kappa = 1.0 (P < .001)., Conclusion: Colonic and placental stage 3 grading are reliable and reproducible ultrasonographic scales that can help predict the findings of fetal lung maturity studies.

Here we report on an infant of a diabetic mother (IDM) with midline interhemispheric "fusion" (MIF), or syntelencephaly. This is a rare anomaly characterized by segmental failure of cleavage of the cerebral hemispheres and other brain structures in the posterior frontal and parietal regions, with a normal interhemispheric fissure anterior and posterior to the "fused" region. While there is obvious overlap with holoprosencephaly (HPE), this condition differs from HPE in that the midline "fusion" in MIF is complete but segmental, while the structural brain anomalies seen in the HPE spectrum progress smoothly in severity in a posterior to anterior "fusion." However, while it is apparent that there are key distinctions between MIF and HPE, in all likelihood they arise from a similar pathogenetic mechanisms. We therefore suggest that MIF is a distinct variant of the HPE spectrum of midline brain anomalies. Given the known increased incidence of HPE in IDMs, MIF is likely a maternal diabetes-associated malformation.

Objectives: The authors analyzed the impact of home health education by studying the impact of a computer service called Community Health Rap. When patients call this service, the computer records their questions and alerts an expert who records a response. Subsequently, the computer alerts the patient that the question has been addressed., Methods: Subjects included a group of 82 pregnant women who had used cocaine during or 1 month before pregnancy (as reported by the woman) and a group of residents of zip code areas with the lowest income in Cleveland. From the drug-using pregnant women, we collected data regarding satisfaction with Community Health Rap, usage of Community Health Rap per month, self-reported health status (using the General Health Survey), and the extent of drug use (using the Addiction Severity Index). Trained coders also classified the nature of questions posed to the Community Health Rap by either the pregnant women who abuse drugs or the members of target households. Among the pregnant women who abuse drugs, we compared the differences between those who used the service and those who did not. To control for baseline differences between the two groups, analysis of co-variance was used with exit values as the dependent variables, the baseline values as the co-variates, and participation in the Community Health Rap as the independent variable., Results: Almost half (45%) of poor, undereducated subjects who lived in inner urban areas used the computer service. Content analysis of Community Health Rap messages revealed that subjects had many questions that were of a social nature (regarding sex, relationships, etc), in addition to medical questions. Analysis showed that poor health status, more frequent drug use, lower education, and age did not affect regular use of Community Health Rap service. No health outcomes or utilization of treatment were associated with regular use of Community Health Rap. One exception, however, was that regular users of Community Health Rap reported slower improvement of their pain than those who did not use Community Health Rap., Conclusions: These data suggest that expansion of information services to households will not leave the poor and the undereducated population groups "behind." They will use computer services, though such services may not have an impact on their health status or cost of care.

Myocardial infarction is rare in the newborn period. We describe a case in which myocardial infarction was suspected at 25 weeks of gestation by fetal echocardiography. There was an aneurysm of the left ventricular apex with paradoxical motion and bulging of the left ventricular free wall during systole. The diagnosis was confirmed by postnatal electrocardiogram, vectorcardiogram, and thallium myocardial perfusion imaging.

Objective: To characterize the performance of vacuum equipment used in operative vaginal deliveries., Study Method: We measured wall suction in eight Cleveland area labor-and-delivery units. Additionally, we tested samples of hand-operated and electric vacuum pumps. For each apparatus we recorded vacuum in millimeters of mercury using a calibrated, diaphragm-type gauge. We calculated mean maximal vacuum. Work required to produce 500 mm Hg of vacuum was determined for the hand-operated pumps. At increments of vacuum, we compared the vacuum displayed by the gauge head included with the device to our standard., Results: Mean wall suction was 494 mm Hg (range, 248-655). As compared to the Mity-vac, the CMI hand-operated pump needed significantly more work to generate 500 mm Hg of vacuum. Electric pumps produced a reliable and consistent vacuum. Gauges included with the pump had an average error of 4% over 400-600 mm Hg., Conclusion: Wall suction was an unreliable source of vacuum. The two hand-operated pumps tested required significantly different amounts of work to achieve an adequate vacuum. Addition of a fluid trap does not affect the vacuum, and head gauges supplied with vacuum pumps are accurate.

Objective: To isolate and describe the effect of chignon formation (vacuum-induced caput) on the performance of six vacuum extractors., Methods: Six vacuum extractors were examined in the laboratory: the 6-cm Malmstrom, Mityvac, M-Type, Silc, Silastic, and Tender-Touch. The devices were tested in two model systems that duplicated the fetal scalp with and without chignon. A fetal cephalic model mimicked the head without chignon. The second model used the hind quarters of anesthetized dogs. Chignon was formed by slowly increasing vacuum until the target vacuum was reached. At increments of vacuum, traction was applied in the axis of the cup and maximal tractive force (pop-off) was measured., Results: A statistically unique regression line described each device. There was no significant difference in the regression lines for the Malmstrom and M-Type cups with or without chignon. At equal vacuum, there was a significant decrease (P < .05) in maximal tractive force with chignon formation in the bell-shaped cups., Conclusions: There is a demonstrable deterioration in the performance of bell-shaped cups with the formation of chignon. These data suggest that when using a bell-shaped extractor, efforts should be directed toward minimizing chignon formation by applying vacuum only with traction.

Objective: Our objective was to describe the effect of off-axis traction on the performance of modern vacuum extractors., Study Design: Eight vacuum extractors were examined in the laboratory with a force indicator and fetal cephalic model. Devices evaluated included the 6 cm Malmstrom, Mity-Vac, M-Type, O'Neil, Posterior, Silc, Tender-Touch, and silicone elastomer. Maximal tractive force (pop-off) was measured for each device at 10-degrees increments from the vertical., Results: Multivariate regression analysis described the best model as follows: Maximal tractive force = Constant + Angle + Vacuum (p < 0.05). The partial regression coefficients for angle were negative in all devices except the Posterior cup. At increasing angles of off-axis traction, maximal tractive force decreased in the following order: Silc, silicone elastomer, Tender-Touch, M-Type, Mity-Vac, O'Neill, Malmstrom, and Posterior., Conclusions: Application of oblique traction resulted in a linear decline in maximal tractive force. An understanding of in vitro performance may allow tailoring of cup selection to the clinical situation.

We compared oral magnesium oxide with oral terbutaline sulfate in a prospective, randomized manner to determine efficacy and side effects. Preterm labor patients whose labor was arrested with parenteral tocolysis were randomized to oral tocolysis with either magnesium oxide, 200 mg every 3 to 4 hours (n = 23), or terbutaline, 2.5 to 5 mg every 3 to 4 hours (n = 27). The number of patients who were delivered of infants before 36 weeks' gestation was similar between groups (18.5% receiving terbutaline versus 17.4% receiving magnesium). At least one side effect occurred in 81.5% of patients in the terbutaline group and 47.8% in the magnesium group (p less than 0.01). Finally, the cost for 1 day of magnesium (20 cents) is approximately one third the cost of terbutaline (56 cents). These data suggest that oral magnesium oxide is as effective as terbutaline for the maintenance of tocolysis, with fewer side effects and at a lower cost.