It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.

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This dissertation explores how architecture is valorized by the cultural artifacts, both visual and text-based, which present and describe it. It examines aspects of the Gothic Revival in early Victorian Britain, to consider the assimilation of models of evolving architectural discourse by one organization with specialized interest in its promotion, and adaptations of that discourse in the realm of popular culture. The dissertation focuses on the ideology of the Cambridge Camden Society, from its inception in 1839 through to 1850. The Society advocated an appreciation of Gothic churches both for aesthetic, and for religious and moral reasons. A key dimension of its mandate, captured in the rhetoric of ecclesiology, was to prioritize an empirical investigation of extant medieval churches. Findings were to be recorded on specially-devised questionnaires, called "church schemes," using a text-based, specially-encoded taxonomy. Given the availability both of extensive documentation by the Society concerning these schemes, and of almost seven hundred completed forms, areas of conformity and divergence between the prescriptive, instructional material, and the descriptive material which indicates the actual reception of the architecture, may be discerned. "Church visiting" hence became the primary means of personal engagement with the architecture, enacted through the elaborate ritual of scripted tourism spelled out by the church schemes and attendant pedagogical documents. The importance, and the implications, of tourism to members of the Cambridge Camden Society are addressed through an evaluation of travel theories and methodologies, developed, especially, since the 1990s. An understanding of ecclesiology in terms of travel theory enables it to be evaluated in a wider context, namely as part of an emerging tourist ethos based on expanding opportunities and incentives to travel through Britain. From this perspective, the Cambridge Camden Society is to be perceived as part of a larger consortium of advocates of tourism to sights of medieval architecture, who employed similar inducements and terminology, and who created such markers of architectural authenticity as travel guides to mediate the traveller's reception of a given sight. As a result, the possibilities of the widespread dissemination of at least the architectural components of ecclesiological ideals, as part of the groundswell of promotional material devoted to all things Gothic, were enhanced.

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No description available.

This thesis questions a series of assumptions concerning the nineteenth- and early-twentieth-century modernization of European spaces. Current scholarship tends to concur with essayistic texts and images by contemporary intellectuals that technological and organizational developments increased the freedom of movement of those living in western-European societies, while at the same time alienating them from each other and from their environment. I assess this claim with the help of Dutch travel egodocuments such as travel diaries and letters. After a prosopographical investigation of all available northern-Netherlandish travel egodocuments created between 1500 and 1915, a selection of these documents is examined in greater detail. In these documents, travellers regarded the possession of identity documents, a correct appearance, and a fitting social identity along with their personal contacts, physical capabilities, and the weather as the most important factors influencing whether they managed to gain access to places. A discussion of these factors demonstrates that no linear increase, nor a decrease, occurred in the spatial power felt by travellers. The exclusion many travellers continued to experience was often overdetermined. The largest groups affected by this were women and less educated families. Yet travellers could also play out different access factors against each other. By paying attention to how practices matched hopes and expectations, it is possible to discover how gravely social inequities were really felt by travellers. Perhaps surprisingly, all social groups desired to visit the same types of places. Their main difference concerned the atmosphere of the places where the different groups felt at home. To a large degree this matched travellers' unequal opportunities. Therefore, although opportunities remained strongly unequal throughout the period, this was not always experienced as a problem. Also, in cases where it was, many travellers knew strategies to work around the obstacles created for them.