Pulmonary function tests in emergency department pediatric patients with acute wheezing/asthma exacerbation.

Background. Pulmonary function tests (PFT) have been developed to analyze tidal breathing in patients who are minimally cooperative due to age and respiratory status. This study used tidal breathing tests in the ED to measure asthma severity. Design/Method. A prospective pilot study in pediatric patients (3 to 18 yrs) with asthma/wheezing was conducted in an ED setting using respiratory inductance plethysmography and pneumotachography. The main outcome measures were testing feasibility, compliance, and predictive value for admission versus discharge. Results. Forty patients were studied, of which, 14 (35%) were admitted. Fifty-five percent of the patients were classified as a mild-intermittent asthmatic, 30% were mild-persistent asthmatics, 12.5% were moderate-persistent asthmatics, and 2.5% were severe-persistent. Heart rate was higher in admitted patients as was labored breathing index, phase angle, and asthma score. Conclusions. Tidal breathing tests provide feasible, objective assessment of patient status in the enrolled age group and may assist in the evaluation of acute asthma exacerbation in the ED. Our results demonstrate that PFT measurements, in addition to asthma scores, may be useful in indicating the severity of wheezing/asthma and the need for admission.

"This compendious language": mathematics in the world of Augustus De Morgan.

Mathematics is the most chameleon of subjects, whose meaning is differently defined in different circumstances. This essay considers the mathematics of Augustus De Morgan as an illustration of the ways that the essence of the subject, the very objects that are included within it, has been adjusted in response to cultural factors. Since these cultural factors are the same ones that shape scientific development, the argument is that the history of mathematics and the history of science are always inextricably bound to one another.

Historical mathematics in the French eighteenth century.

At least since the seventeenth century, the strange combination of epistemological certainty and ontological power that characterizes mathematics has made it a major focus of philosophical, social, and cultural negotiation. In the eighteenth century, all of these factors were at play as mathematical thinkers struggled to assimilate and extend the analysis they had inherited from the seventeenth century. A combination of educational convictions and historical assumptions supported a humanistic mathematics essentially defined by its flexibility and breadth. This mathematics was an expression of l'esprit humain, which was unfolding in a progressive historical narrative. The French Revolution dramatically altered the historical and educational landscapes that had supported this eighteenth-century approach, and within thirty years Augustin Louis Cauchy had radically reconceptualized and restructured mathematics to be rigorous rather than narrative.

A model structure for an EBM program in a multihospital system.

Evidence-based medicine (EBM) offers a great opportunity to translate advances in medical science into advances in clinical practice. We describe the structure of a comprehensive EBM program in a multihospital community teaching system. This EBM model is distinct and separate from the peer review process and has achieved substantial physician involvement. The program emanates from the Board of Directors Quality of Care Committee and has strong administrative support. The approach relies extensively on physician involvement and expert physician panels to enhance existing EBM practice guidelines, with an explicit strategy of performance reports and feedback.