NYU PressAmazon.comFind in a libraryAll sellers _OC_InitNavbar({"child_node":[{"title":"My library","url":" =114584440181414684107\u0026source=gbs_lp_bookshelf_list","id":"my_library","collapsed":true},{"title":"My History","url":"","id":"my_history","collapsed":true}],"highlighted_node_id":""});Independent Intellectuals in the United States, 1910-1945Steven BielNYU Press, 1995 - Biography & Autobiography - 310 pagesA new intellectual community came together in the United States in the 1910s and 1920s, a community outside the universities, the professions and, in general, the established centers of intellectual life. A generation of young intellectuals was increasingly challenging both the genteel tradition and the growing division of intellectual labor. Adversarial and anti-professional, they exhibited a hostility to boundaries and specialization that compelled them toward an ambitious and self-conscious generalism and made them a force in the American political, literary, and artistic landscape.
This book is a cultural history of this community of free-lance critics and an exploration of their collective effort to construct a viable public intellectual life in America. Steven Biel illustrates the diversity of the body of writings produced by these critics, whose subjects ranged from literature and fine arts to politics, economics, history, urban planning, and national character. Conceding that significant differences and conflicts did exist in the works of individual thinkers, Biel nonetheless maintains that a broader picture of this vibrant culture has been obscured by attempts to classify intellectuals according to political or ideological persuasions.
His book brings to life the ways in which this community sought out alternative ways of making a living, devised strategies for reaching and engaging the public, debated the involvement of women in the intellectual community and incorporated Marxism into its evolving search for a decisive intellectual presence in American life. Examined in this lively study are the role and contributions of such figures as Randolph Bourne, Max Eastman, Crystal Eastman, Walter Lippmann, Margaret Sanger, Van Wyck Brooks, Floyd Dell, Edmund Wilson, Mable Dodge, Paul Rosenfeld, H. L. Mencken, Lewis Mumford, Malcolm Cowley, Matthew Josephson, John Reed, Waldo Frank, Gilbert Seldes, and Harold Stearns.
Pertussis, or whooping cough, is an acute infectious disease caused by the bacterium Bordetella pertussis. Outbreaks of pertussis were first described in the 16th century by Guillaume de Baillou. The organism was first isolated by Jules Bordet and Octave Gengou in 1906.
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In the 20th century, pertussis was one of the most common childhood diseases and a major cause of childhood mortality in the United States. Before the availability of pertussis vaccine in the 1940s, more than 200,000 cases of pertussis were reported annually. Since widespread use of the vaccine began, incidence has decreased more than 75% compared with the prevaccine era.
Pertussis remains a major health problem among children worldwide. Data from a recent modeling study suggest that more than 24 million new pertussis cases occurred globally among children younger than age 5 years in 2014 and caused an estimated 160,700 deaths.
B. pertussis produces multiple antigenic and biologically active products, including pertussis toxin (PT), filamentous hemagglutinin (FHA), agglutinogens, adenylate cyclase, pertactin, and tracheal cytotoxin. These products are responsible for the clinical features of pertussis disease. An immune response to one or more of these products produces immunity following infection. Immunity following B. pertussis infection is not permanent.
Pertussis is primarily a toxin-mediated disease. The bacteria attach to the cilia of the respiratory epithelial cells, produce toxins that paralyze the cilia, and cause inflammation of the respiratory tract, which interferes with the clearing of pulmonary secretions. Pertussis antigens appear to allow the organism to evade host defenses in that lymphocytosis is promoted but chemotaxis is impaired.
The incubation period of pertussis is commonly 7 through 10 days, with a range of 4 through 21 days. The clinical course of the illness is divided into three stages: catarrhal, paroxysmal, and convalescent.
The first stage, the catarrhal stage, is characterized by the insidious onset of coryza (runny nose), sneezing, low-grade fever, and a mild, occasional cough similar to the common cold. The cough gradually becomes more severe and after 1 to 2 weeks, the second, or paroxysmal, stage, begins. Fever is generally minimal throughout the course of the illness.
It is during the paroxysmal stage that the diagnosis of pertussis is usually suspected. Characteristically, the patient might have bursts, or paroxysms, of numerous, rapid coughs, apparently due to difficulty expelling thick mucus from the tracheobronchial tree. At the end of the paroxysm, a long inspiratory effort is usually accompanied by a characteristic high-pitched whoop. During such an attack, the patient may become cyanotic. Children and young infants, especially, might appear very ill and distressed. Vomiting and exhaustion might follow the episode. The person does not appear to be ill between attacks.
Paroxysmal attacks generally occur more frequently at night, with an average of 15 attacks per 24 hours. During the first 1 or 2 weeks of this paroxysmal stage, the attacks might increase in frequency, remain at the same level for 2 to 3 weeks, and then gradually decrease. The paroxysmal stage usually lasts 1 to 6 weeks but may persist for up to 10 weeks. Infants younger than age 6 months may not have the strength to have a whoop, but they can have paroxysms of coughing. Additionally, the classic whoop might not be present in persons with milder disease.
In the convalescent stage, recovery is gradual. The cough becomes less paroxysmal and disappears in 2 to 3 weeks. However, paroxysms often recur with subsequent respiratory infections for many months after the onset of pertussis.
Adolescents, adults, and children who were previously vaccinated may become infected with B. pertussis but may have milder disease than infants and young children. Pertussis infection in these persons may be asymptomatic or present as illness ranging from a mild cough illness to classic pertussis with persistent cough (i.e., lasting more than 7 days). Inspiratory whoop is not common.
Even though the disease may be milder in older persons, those who are infected may still transmit the disease to other susceptible persons, including unimmunized or incompletely immunized infants. An adult, adolescent, or older school-age child is often found to be the first case in a household with multiple pertussis cases and is often the source of infection for young infants.
Neurologic complications such as seizures and encephalopathy may occur as a result of hypoxia from coughing, or possibly from pertussis toxin. Neurologic complications of pertussis are more common among infants.
Other less serious complications of pertussis include otitis media, anorexia, and dehydration. Complications resulting from pressure effects of severe paroxysms include pneumothorax, epistaxis, subdural hematomas, hernias, and rectal prolapse.
Culture is considered the gold standard laboratory test and is the most specific of the laboratory tests for pertussis. However, fastidious growth requirements make B. pertussis difficult to culture. The yield of culture can be affected by specimen collection, transportation, and isolation techniques. Specimens from the posterior nasopharynx, not the throat, should be obtained using polyester, rayon, nylon, or calcium alginate (not cotton) swabs. Isolation rates are highest during the first 2 weeks of illness (catarrhal and early paroxysmal stages). Cultures are less likely to be positive if performed later in the course of illness (more than 2 weeks after cough onset) or on specimens from persons who have received antibiotics or who have been vaccinated. Since adolescents and adults have often been coughing for several weeks before they seek medical attention, it is often too late for culture to be useful.
PCR is a rapid test and has excellent sensitivity. PCR tests vary in specificity, so obtaining culture confirmation of pertussis for at least one possible case is recommended any time there is suspicion of a pertussis outbreak. Results should be interpreted along with the clinical symptoms and epidemiological information. PCR should be performed on nasopharyngeal specimens taken at 0 to 3 weeks following cough onset but may provide accurate results for up to 4 weeks of cough in infants or unvaccinated persons. After the fourth week of cough, the amount of bacterial DNA rapidly diminishes, which increases the risk of obtaining false negative results. PCR assay protocols that include multiple targets allow for Bordetella speciation. False positive results may be obtained because of contamination in the laboratory or during specimen collection. Direct comparison with culture is necessary for validation, and the use of multiple targets is recommended to distinguish B. pertussis from other Bordetella species.
Serologic testing is generally more useful for diagnosing pertussis during the later phase of disease when both culture and PCR are likely to be negative. For the CDC/FDA single-point serologic assay, the optimal timing for specimen collection is 2 to 8 weeks following cough onset, when the antibody titers are at their highest. However, serology may be performed on specimens collected up to 12 weeks following cough onset. Many state public health labs have included this assay as part of their testing regimen for pertussis.
Commercially, there are many different serologic tests used in the United States with unproven or unknown clinical accuracy. CDC is actively engaged in better understanding the usefulness of these commercially available assays. 152ee80cbc
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