19.5: Sputum Specimen Collection
Sputum specimens collected by expectoration are commonly used for cytology, culture and sensitivity, and acid-fast bacilli (AFB) testing. Cytologic examination identifies abnormal cells such as cancer. Culture and sensitivity testing identifies specific infectious microorganisms and their sensitivity to antibiotics. Optimally, sputum samples used for culture and sensitivity testing should be collected before initiating antibiotic therapy because antibiotics affect the results. AFB testing, along with culture and sensitivity testing, is used to diagnose tuberculosis (TB). When testing for TB, at least three consecutive samples are collected, with at least one being an early morning sample.
Prior to implementing the procedure, it is helpful to ensure the patient is well-hydrated. Hydration helps thin and loosen sputum and increases the likelihood of obtaining an adequate sample. If the patient is prescribed nebulizer treatments, it is helpful to administer this treatment prior to the procedure to help mobilize secretions. It is also important to assess if the patient is experiencing pain related to coughing. For example, pain following chest or abdominal surgery can inhibit the patient from taking deep breaths and expectorating. In this case, pain medication should be provided prior to performing the procedure. Patients can also be encouraged to support surgical wounds with a pillow while coughing to provide additional support and comfort.
It is best to obtain sputum samples in the early morning because secretions accumulate overnight. The patient can rinse their mouth with water prior to the procedure, but avoid mouthwash or toothpaste because these products can affect the microorganisms in the sample. Remove dentures if they are present.
Be aware that droplets and aerosols may be generated when collecting sputum specimens, so use appropriate personal protective equipment when entering the room and during the procedure based on the patient’s condition. Explain the procedure to the patient, the type of specimen required, and the difference between oral secretions and sputum. Position the patient in a seated position in a chair or at the side of the bed, or place them in high Fowler’s position.
Instruct the patient to take three slow, deep breaths and then cough deeply. Repeat this process until the patient has produced sputum, with rest periods between each maneuver.
When the patient has mobilized sputum, instruct them to expectorate directly into a sterile specimen container without touching the inside or rim of the container. The specimen should be at least 5 mL (one teaspoon); ask the patient to continue producing and expectorating sputum until this amount is achieved. Assess the sputum specimen to ensure it is sputum and not saliva. Sputum appears thick and opaque, whereas saliva appears thin, clear, and watery.
Cap the specimen container tightly and ensure it is labeled with the patient’s name. Place the specimen in a transport bag and send it to the laboratory for analysis. Document the time and date the sputum specimen was collected and the characteristics of the sputum, including amount and color.
If a patient is unable to expectorate a sputum sample, other interventions may be required to mobilize secretions. It is often helpful to collaborate with a respiratory therapist for assistance in this situation. Interventions may include nebulizers, hydration, deep-breathing exercises, chest percussion, and postural drainage. If these interventions are not successful, a sputum sample may be obtained via oropharyngeal or endotracheal suctioning; these methods are used to obtain sputum samples for patients who are intubated. [1] , [2] , [3]
Read South Dakota Department of Health’s PDF with instructions for collecting a sputum sample:
Sputum Collection Instructions
- Shepherd, E. (2017). Specimen collection 4: Procedure for obtaining a sputum specimen. Nursing Times, 113 (10), 49-51. https://www.nursingtimes.net/clinical-archive/assessment-skills/specimen-collection-4-procedure-for-obtaining-a-sputum-specimen-11-09-2017/ ↵
- Sputum collection by expectoration. (2020). Lippincott procedures. http://procedures.lww.com ↵
- South Dakota Department of Health (2018, February). Sputum collection instructions . https://doh.sd.gov/documents/diseases/infectious/SputumCollection.pdf ↵


17: Family Strengths and the Future
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The good news for fans of family relationships is that the family is here to stay. The family is by far the most enduring and central institution in society and has been throughout all human history. The family, in all its varieties and forms, is extremely salient to the United States as political, economic, religious, educational, and societal institutions that demands consideration by all members of society in the larger social and personal levels of family experience. Family homogeneity is a thing of the past. Family diversity is the theme of the future. The formation, maintenance, and perpetuation of the family will, I predict, continue as it has for thousands of years. It will adapt itself to changing technologies and economies. It will adapt itself to religious and political influences. And it will adapt itself to scientific discovery. Most importantly, and I repeat myself, it will persist as long as humans persist.
World surveys of human values continue to document the selection of family issues as the most important value to people worldwide (see http://www.worldvaluessurvey.org/library/index.html ). Billions continue on with traditions of tribal, monogamous, polygamous, matriarchal, and patriarchal family forms.
Lesbian and gay couples continue to carve their niche into the mainstream of the various societies in which they live. Poor families, average families, and wealthy families continue to perform the core family functions and create another generation of adult children who will likely do the same by socially reproducing the next generation of fathers and mothers, husbands and wives.
The General Social Surveys are a national survey of US persons have been conducted from 1972 to present (see www.norc.org, General Social Surveys). When asked if a girl's or boy's chances for a happy family life were better than yours, about the same, or worse than yours, thousands of respondents reported that 19 percent for girls and 17 percent for boys said better, 45 percent and 48 percent said about the same, and 36 and 35 percent said worse (retrieved 13 may, 2010 from www.norc.org/GSS+Website/Brow...Subject+Index/). Most see continuity and hope for the family of the future. In this complex society, over 1/3 responding with worry is understandable, especially for those who feel their preferred family form is threatened.
In the US families are a source of satisfaction. When asked another question about how much satisfaction they get from their family life, 43 percent said a very great deal, 34 percent said a great deal, and 11 percent said quite a bit (retrieved 13 May, 2010 from www.norc.org/GSS+Website/Brow...Subject+Index/). That was with 24,070 respondents combine in the summary. When asked in general how satisfied they were with their family 90 percent indicated satisfaction at some level (24% Completely Sat., 42% Very Sat., and 24% Fairly Sat., retrieved 13 May, 2010 from www.norc.org/GSS+Website/Brow...Subject+Index/). In the US, most are hopeful and most find family to be a satisfying aspect of their lives.
You, like many others will chose a lifestyle that includes a family in one form or another.
If so, what can be done to strengthen the family in your own home? Figure 1 lists research-based efforts you and your family members can put forth to strengthen your family in coming years. Let's discuss these points in detail. Ever wonder why grandma or Mom keeps asking you to attend the family picnic or reunion? What might they know that you don't know?  Perhaps your Mom and Grandma know that family rituals, traditions, and holidays are the way to build a connection between generations, to create new memories, and to keep family traditions alive.
Figure 1. Strategies and Efforts That Strengthen a FamilyTheorem \(\PageIndex{1}\)
- Fostering rituals, traditions, and holidays together
- Spirituality (formal and informal)
- Keeping Family History
- Quality Family Time (lots of it)
- Staying connected (resist family entropy)
- Strengthen the couple bond (resist marital entropy "The Escalator")
Nuclear and extended families have in the past, and should in the future celebrate together. Scientists have found that reunions and celebrations tend to promote cohesion and adaptability in family systems while offering mutual support between nuclear and extended family members. Rituals are very important to the family. These can be as simple as eating three meals a day together, holding weekly movie parties, buying fresh doughnuts on Saturday morning or reading to small children at bedtime. Rituals when practiced come to be expected. The ritual of taking Driver's education and obtaining a driver's license is a common experience. For many family members it marks a rite of passage or an event that signifies the transition of a person from one stage in life to another (e.g., non-driver to driver).
Religion and Spirituality
When a new driver emerges among the teen children, a new taxi driver emerges as well.
Siblings can transport family members around town and provide the entire family with much needed support. A first date, high school or college graduation, and even marriage are also rituals that serve as rites of passage. There are rituals that take place outside of the family institution which are also important. Religious rituals are found among the world's major religions. Religion is a unified system of beliefs, rituals, and practices that typically involve a broader community of believers who share common definitions of the sacred and the profane. Religions provide meaning to us about what is sacred and what is profane. Sacred is the supernatural, divine, awe inspiring, and spiritually significant aspects of our existence. Profane is that which is part of the regular everyday life experience. These definitions originated from Durkheim's studies of religion (see 1947 The Elementary Forms of Religious Life, Glencoe Press reprint of 1912). For you religion might be a personal definition of how you feel about your place in the universe.
It may also reflect how you understand categories of people who share a common system of beliefs that differ from your own (Jews, Muslims, Christians, etc.).
For sociologists religion is studied in two typical approaches first, a cultural approach that evaluates the religious aspects of the culture shared by followers of a certain religion, and second, the theoretical approach to religion including its symbols, functions, exchange-based interactions, and power issues. Religion has always been an important issue at both levels of society personal and larger social. Figure 2 shows a pie chart of the CIA's 2007 estimate of the world's composition of religious followers. By far, Muslims collectively comprise the largest single religious belief system in the world in 2007. Over the last century birthrates among Muslims have remained high. By sheer numbers alone, a high birthrate among an estimated 1,300,000,000 people makes birth become a significant factor in the Muslim world growth rate. A less common factor is that in many Muslim nations polygamy continues to be the norm with 1-4 wives being acceptable. Next is the Roman Catholic Church which has strong membership in Western Europe, Latin America, the United States and other Countries and regions. Hindus which are primarily located in India come in a close third. Jews which are daily discussed in the news because of international issues pertaining to Israel are ranked 12th most common in the world.
Figure 3 shows the CIA estimated US religions for 2007. The collective category of US Protestants is the largest collection of religious belief systems. These include Baptists, Lutherans, Anglicans, and various non-Catholic and non-Orthodox Christian denominations. Second in percentage is the Roman Catholic Church. In contrast to the Protestant classification which is comprised of many diverse denominations, the Roman Catholic Christian Church is comprised of only one denomination headquartered in Rome, Italy.
The Roman Catholic population in the US has grown for two primary reasons, first, Roman Catholics continue to have higher birthrates than others (yet about the same for Mormons and Catholics), and second, many of our US immigrants since the 1980s come from Mexico and bring their Catholicism with them to the US. Also from the CIA data is the fact that about 12 percent were unaffiliated, 4 percent reported none, and 3 percent chose not to specify their religion. After that Mormons were next with nearly 2 percent.
Mormons have a very high birthrate and a strong force of proselytizing missionaries throughout the US and the World.
In fact, religion does shape the attitudes and values of individuals. Gallup polling corporation collected US religiosity data during 2008. Religiosity is the measurable importance of religion to a person's life. Religiosity can be measured by considering how active someone feels in their religion, how often someone attends formal services, how much money they donate, how often they privately worship in their home, and other factors.
Gallup in January 28, 2009 reported that after interviewing 350,000 US individuals, there were some collective religiosity patterns which emerged. The top 10 most religious states were all in the South Eastern US. The bottom 10 least religious states were North Eastern (7), North Western (2), and Nevada in the West. They also reported that 65 percent of people in the US said “Yes religion is an important part of their daily life” (taken form Internet 26 March 2009 from http://www.gallup.com/poll/114022/St...-Religion.aspx ).
The history of religions in the world and the US cannot be overstated in terms of the influence that formal religions exert of family systems. There are numerous religious rituals that include circumcision, blessing a newborn, baptism, rites of passage into womanhood or manhood, ancestral ceremonies, religious holiday observances, marriage, a solo quest of self-discovery, new years, festivals and commemorations of religious founders and gods, public reading of scripture or other forms of worship, and many other practices. Statistically, the most celebrated world holiday is Christmas then Ramadan.
Christmas is the celebration of Jesus Christ's birth (About 2+ billion). Ramadan is the holy month of fasting and worship adhered to my Muslims worldwide (About 1.4 billion). Jews celebrate Pesach or the Feast of the Passover (About 100+ million). Hindus celebrate Hana Matsuri or the birth of Gautama the Buddha (About 700+ million).
There are many more religious holidays, but suffice it to say that religiously-based family rituals are often a source of strength to families which use them for tradition and family cohesion. Many families also have spiritual rituals independent of formal religion. There are family fasts, family prayers in behalf of others, family offerings made in hopes of receiving blessings, and family outings designed to get family members in touch with nature and the forces of peace and creation.
Family History
One tradition utilized by many families is that of oral histories. My family, when together for a reunion, will tell stories as a form of entertainment and bonding (Jeff Foxworthy started out in his family doing the same thing). I have many stories about my parents when they were children and about my own childhood and young adult experiences. What surprised me was how interested my own children were in them. As a young father, I was certain my children would roll their eyes if ever I shared one. One day, my wife asked me a question about growing up in Georgia. I shared a few humorous stories. She enjoyed them (one of the reasons I married her is that she thinks I'm funny as a comedian). I never dreamed my children would, but I have been a hit with my own children who repeat my stories to their friends at times. I want to share one story with you to illustrate this point.
Just before cancer took my grandfather, Frank, I found myself in his backyard helping him with his chores. He was showing me his hybrid corn that had 16 rows of kernels on extremely large cobs. We shucked the corn as the sun set behind us and the cool evening breeze blew in. Grandpa knew I loved to fish so he asked me if I'd ever heard about the world record catfish he caught when he was a young man. When I told him I hadn't heard about that one, he sent my Granny into the house to get the photo album while he began to tell me his story.
“When I was 17 I heard tell of the monster catfish that swam the bayous of Louisiana. My two buddies and me went down there to see if there was any truth to the tales. We drove for nearly a day, with three hours of it being on the dirt roads between swamps, with snakes and alligators in every ditch. When we got to the bait and tackle store it was the end of the road, we rented a flat bottom wooden boat with deep sea fishing rigs mounted to it. At about midnight, we started out into the bayou. The store owner had told us the way back into the deep waters of the swamp. We spent most of that night swattin' mosquito's and shewin' bats. Not one bite all night long. Just as dawn broke a thud vibrated through the entire boat that woke up my buddies. My pole bent over so far I thought it'd break for sure. We pulled up anchor and reeled in the other two lines. We'd caught a fish! That monster drug our boat all over the swamp, scratchin' us into thorn bushes and trying to break the line around tree stumps. Five hours passed before we got that catfish alongside the boat. I wore him out, but he made me pay for it. I still got scars in my hands from the blisters. I could never have done it alone. It was the three of us working together like a team that beat him. Well, anyway, he was too big to pull into the boat so we shot him in the head until he quit flippin' around so much. We took the anchor chain from the boat and run it through his gills, makkin' sure he didn't somehow fall off our boat and disappear into the swamp. We wanted to show everybody what we'd caught. At six that night we rowed back up to that bait and tackle shop and they'd been waitin' for us to see if they needed to go call the Sherriff for a rescue. They all pitched in and we finally got that catfish up on a tow line and hoisted him up on a deep sea fish scale. He was a new world record fish.”
Of course at this point I asked, “How much did it weigh, Grandpa?” He grinned and said,
“I ain't sure anymore with my memory bein' bad and all. But, he was so big that the picture they took of him came in at a weight of 32 pounds.” I do hope you enjoyed that tale. “'Twasn't true" my Grandpa would say after everyone stopped laughing. My Granny was in on this too. She would go into the house to pretend to get a picture of it to help with building the suspense. Two weeks after we shucked, boiled, and ate that corn on the cob, Grandpa passed. This story was my last experience with him and it seemed to be just what he and I needed to say our goodbyes to one another. As of this writing my Granny is still alive. She was 96 in 2010, legally blind and mostly deaf, but clear in her mind and thinking as anyone my age.
She has challenged me to outlive her someday and I'm planning on doing it. My Granny was a factory mill, working with her hands, laborer who toiled for decades in a mill that no longer exists. She was a World War I widow. One of my favorite stories she ever told was about how her grandfather hid a family of “Black folk” who were former slaves in his own wagon and drove a team of horse clear up into Tennessee where sympathetic people would help them escape the KKK. My Granny was the matriarch of the family and the glue that held three generations of family together during wars, divorces, premature deaths, and lost jobs, and many other challenges. She has lived long enough to experience what in her words is “the hardest thing life has to offer,” the death of all but one of her children. Her stories are the stories I tell.
Telling stories has become a lost art in some families. Professionals tell stories and there are even story telling festivals around the US if you'd like to go. But, for your family, you would be the best story teller because your children and grandchildren would feel connected to the characters since they were part of their own ancestral heritage. By the way, if you are one of the last survivors of the generation the story is told about, who will know if you embellished a bit for entertainment purposes? I get away with that all the time.
All of us have an ancestral heritage. Family history is the process of documenting and cataloging one's own ancestral heritage. Millions of family members worldwide have begun personal family histories to pass down to their children and grandchildren. It is easy to start. You simply write down your birth date and place and your parents' names, birthdates, and places. Then, right down your mother's parent's birthdates and death dates if they apply. Ask your parents to provide you with names, dates, and places of your grandparents. Got any photographs or newspaper clippings? It tells a better story and means a bit more if you can visualize your ancestors and what they looked like.
Years ago, I read that Spike Lee and Oprah Winfrey had a DNA test performed to discover their genealogical heritage at the biological level. I saved my money and went to the same Website and ordered a DNA test of my own (See www.ancestrybydna.com/). All it took was a cheek swap (no needles) that I mailed back into the company. Within six weeks I discovered the geographic origin of my particular ancestral line. Most of my genes came from the people who lived in the British Isles (British, Scottish, and Irish). About 20 percent came from the Middle East and about 12 percent came from South East Asia. I was very surprised to know about the Middle East and the Asia connection (this test is 95 percent accurate and can be submitted as legal evidence if needed).
I had heard from my parents that I was one-thirty-second Cherokee Indian which was a source of great pride for me. But, my results indicated that in fact there were no Native American genetic markers in my DNA. My son was 7 at the time of my test. He nearly cried when he discovered he was not even a part American Indian. The next day, he came back from school excited because when he told his teacher he was part Asian, she informed him that China was part of Asia. He loved China and knowing that he might be related to the Chinese helped him to feel cool again. Parents who share stories with their children help them to form their developing identities.
On the Internet, genealogy and family history searches account for the second most common Internet search topics today (retrieved 18 May 2010 from http://www.google.com/trends ). Family history buffs can trace their ancestors back to the 1500s before records become sparse. After the 1500s, only European royalty have such records. There are a number of family history Websites to help you get started if you decided to do so ( http://www.ancestry.com/ for one of the largest and most comprehensive sites). Many who study and write down their family history share it with their children and grandchildren, creating bonds of unity that span the generations. If you have absolutely no family records or photos, start a shoe box for your own family with newspaper clippings, photos, and dates and places. Who knows, someday this might bond your own descendants to you?
Quality Family Time
Another key strategy is spending quality time together as a family. Work, school, friends, recreation, and entertainment exact a tremendous toll on family cohesion and adaptability because it distracts them from taking time to simply be together. Family members need time together, not just doing electronic stuff, but being bored, doing chores, cleaning, or even cooking together. When we get bored we get talkative and start opening up to one another. We then get an idea of what's going on in each other's life and become aware of the details that make us who we are. We know each other's hopes and fears, concerns, and aspirations. Watching TV together is time spent together.
Sometimes, that works perfectly for certain family members. Other times, conversation and interaction is needed to reinforce loyalties and affirmations of one another.
As mentioned before, doing mundane household task is a practical way to create a socially interactive moment. During the 1980s and 90s, as more and more women entered college and the labor force, a great deal of literature focused on which was best, quality or quantity time in the family. In other words, was it better to have truly meaningful and briefer time or was it better to have average meaning and more time? The answer was simple, yes to both. Husbands and wives, partners, parents and children all need time together and in today's busy lifestyles in will not happen unless you are purposeful about it. It simply takes time to experience family relationships.
All of the rituals, traditions, holidays, and spiritual approaches mentioned above are valuable because of the intimate bond that persists between family members. Work diligently to nurture and reestablish that bond throughout your life. The concept of marital entropy was presented in an earlier chapter wherein couples have to work diligently against the forces of decay and chaos that wear down their marital bond. Here, I want to mention that family system entropy is the process of decay within a nuclear family system that is facilitated by the diverse roles and demands placed on family members as they travel their life courses together. Children are very close to their parents before their teen years. It is essential to connect with children and establish a strong bond before they hit age 13.
Around the time of puberty, rational thinking processes mature, self-consciousness increases, and the importance of peer-acceptance increases. All this happens while teens prefer their friends over their family, especially over their parents. That is not to say that teens hate their parents, typically the opposite is true, they need their parents, but crave peer-acceptance and interaction. After your children hit this point in their maturation, it is crucial to become friends with their friends, to know their friends' names, feed them (I know), and host them in your home. Accepting your teen's friends increases your bond to your teens.
Of course you wouldn't accept a destructive friend who might influence your child in self-destructive ways. Most teens are not like that anyway. Here's a suggestion that my wife and I did that may help you. Just before your children turn 12, take them on a special parent-child trip. It doesn't matter where, but it works great if it's a place they'd really like to visit. Get sitters for the other children and make this a special getaway, where your child gets a special time where they bond and make memories with their parents. In our family, it became a big deal with each child looking forward to their turn.
We went to Alaska to pan gold, San Diego to Sea World, Washington DC to the National Mall, San Jose to watch whales out in the bay, Seattle to see the city and drive to Mount St. Helens, and Jacksonville to attend sporting events and spend time on the beach. Yes, we have six children (5 boys and 1 girl). As a parent I truly enjoyed this quality time and it established patterns of being close to each child that pay great dividends now that the youngest three are all teenagers. Throughout the life course it requires efforts on every family member's part to renew and nurture the bond of connectedness.
Make sure and control your technology and don't let it control you. Remember that technology demands attention. While you use it, your attention is distracted from people.
Experts have even found that driving while talking on the cell phone impairs your judgment because you are distracted mentally from the details of driving. The same is true for being distracted by TV, video games, texting, GPS, Blue Tooth, MP3 & IPod, and the computer. It is safe to assume that all our electronic gadgets are a distraction to us and they have the potential to undermine our relationships if not managed. Some families declare a techno-free day where all the electronic gadgets are turned off for 24 hours and family together time is shared.
Resist Family Entropy
By far and with few exceptions, the marital bond is the core of a nuclear family system.
Married couples are decidedly better off than singles in a number of key quality of life areas. Table 1 shows the benefits to marrieds (same as in Chapter 9). Couples may not be aware of how much their quality of life is enhanced by being married. Awareness in this case hopefully will bring a strong commitment to resist marital entropy (couples have to work diligently against the forces of decay and chaos that wear down their marital bond). Family system functions much better when the married heads of the family have strength and unity in their marriage.
| 1. Better physical and emotional health |
| 2. More wealth and income |
| 3. Positive social status |
| 4.  Life-long continuity of intimate relationships |
| 6. Safer circumstances for children |
| 7. Longer life expectancy |
| 8. Lower odds of being crime victims |
| 9. Enhanced legal and insurance rights and benefits (tax, medical, and inheritance) |
| 10. Higher self-reported happiness |
Figure 4 shows the metaphor of “the escalator” as it relates to marriage. I will discuss the remainder of the efforts that strengthen the family as I focus specifically on how to strengthen the marriage. The forces that work against marriage in our complicated daily lives are like an escalator that is always descending. As a couple we walk upward, united against these forces. At the top of the escalator is marital strength. At the bottom is marital chaos and decay. If we don't purposefully work to improve our marriage and to resist the downward and decaying forces that work against it being resilient, adaptable, strong, and pleasurable, then we may find ourselves sadly disappointed at our marriage's final destination. When couples decide to end a marriage, they could if so desired, chose to get back on the escalator and try to rescue their relationship (search Divorce Busters on Internet). But, it is the small daily supportive and preventative efforts that work better, long before things have fallen apart for the couple. A marriage is never truly lost if each spouse is sincerely making a go at staying together and improving things. The best literature on marital permanence and quality indicates that it must be intentional, concerted, and purposeful.
Look to the right side of Figure 4 and notice the stressors that come with being parents, employed, and related to extended family. Couples in their 40-50s face tremendous burdens from these areas. They have teens and young adults, expenses and startup cost for their children, and their own middle lives. The burdens are very heavy during this stage of parenting, even though things may lighten in a matter of months once children start leaving home and forming their own families. If couples were prudent with their finances and refused to spend the equity in their homes and cars, they could easily find themselves relatively free to do many things they'd like to do.
But many couples spend a bit more than they make and sometimes pin themselves down with debts that came with a more luxurious lifestyle than the couple could afford. We work hard for our money, but work has become more and more stressful. During recent recession-based efforts to reduce expenses, many companies fired or laid of employees and never replaced them. They simply shifted the fired person's duties to others who were still working. Thus, more work is expected with the same or less pay.
If a couple does not strategize diligently against it, the numerous demands on their time and energies can land them in a long-term fatigued state. Once exhausted, they find it very difficult to nurture their marriage, because they are running on an individual deficit.
Add to this the fact that in the middle years, health declines settle in on the husband and wife. These declines could be met in a united effort and adjusted to the same way, so that they strengthen rather than undermine the relationship.
Extended family may be a blessing or a curse. Or, most of the extended family may be a blessing while a relatively small portion of the family may be the curse. I know an elderly couple with a daughter in prison. They are in their 80s and are raising their grandchild, more like the grandchild's parents than her grandparents. I also know of a friend my age whose father is disabled and mother suffers dementia. He and his wife are moving closer to his parent's home to assume the role as caregivers, even though they still have children at home. Some of these extended family matters can be ignored or refused as far as an added burden. Others make the couple seriously consider their values and eventually lead to more responsibility for one or both spouses (typically the wife).
| Efforts that Help Couples Resist the Decay of Their Marriage | Factors Contributing to Decay & Chaos of the Marriage | |
|---|---|---|
|
•Weekly Dating
|
•Parenting Stress
•Work Stress & Demands for more Productivity with less or the Same Pay •Financial Burdens •Health Declines •Long-Term Fatigue •Extended Family Issues •Electronic Distractions •In-law and/or Extended Family Problems •Parallel lives •Over-complicated Schedules •Other Distractions •Llife's Crisis •Grudge Holding •Extraneous Activities •3'* Party Distractions •Entitlement Values |
Electronic distractions can be avoided if that is the couple's desire. If family members are not careful these can interfere with resolving critical issues or renewing bonds. Some couples who have issues about their sexual relationship may use TV or other electronic distractions as a tool in the effort to avoid dealing with those issues. I remember when Johnny Carson did the Late Show, a psychologist studied how couples who stayed up late to watch him felt too tired for sex by the end of the show. The article claimed that Johnny was interfering with married couple's sex lives. Outside the bedroom, video games, online entertainment, movies, Texting, and other electronic distractions can keep us apart by demanding our undivided attention.
For husbands and wives, the concept of parallel lives may be a crucial factor to understand. You see, when newlyweds marry and go through college they set a goal to get a good job, have children and raise them, buy a house, and get a retirement going.
For many couples this takes place as planned. But for some, they get lost once the plans are in motion. He is the main breadwinner and is absorbed in his work. She works for pay as well and is the mother, focusing her energies in those two arenas of life. Yeah, they sleep in the same bed, but begin to live lives that are heading in the same direction, but are on different tracks-his work versus her work and home life. They travel parallel lives in the same direction and for the same long-term goals. If not careful, they begin to grow apart and feel like strangers-like they were driving on the West and East frontage roads that parallel the freeway. Strange as it may appear, some couple set out on a life long journey to reach a destination, yet fail to remain a team and sometimes deciding not to continue on together or even to the original destination.
Marriages and families can be neglected and we don't even realize it. Have you ever walked into your garage and found that years of careless storage and unfinished projects had piled up to create an unmanageable mess? I have. Our modern family lives are often like a cluttered garage. Sometimes when we get into the motion of daily life activities and goals we fail to realize that we as a family are overscheduled and are putting money, time, and effort into things that may not be worth it. Sometimes, it is wise to sit down and assess what all the family is doing and if it really is in sync with the goals and aspirations of individuals and the family as a whole. One of the criticisms of the generation of children born after 1984 is that they have to many diverse experience and opportunities (e.g., karate, soccer, Glee Club, Little League Coaching, etc.).
This has yielded an entire generation of young adults who are fairly talented at most things while being the master of few or no things. Some of our family member's activities are pursued with little thought to the family down-time needs and the marital renewal needs. Much of this clutter could be cancelled, allowing those valuable family resources to be allocated to a slower-paced yet more connected nuclear family. It is easier than one might think to reduce the complexity of our family schedules to a more reasonable level. Distractions that may or may not contribute to the long-term goals of individuals and the family as a whole can be eliminated, or reduced with thoughtful planning. I know of a family that bought a new truck, boat and trailer because sometimes the family ended up camping and boating together. Eventually the father and mother decided that with the maintenance, licensing, payments, and storage, that it was easier in the long-term to rent the boat for a day or two than to own it. They decluttered their yard and their lives and saved money.
Family life is prone to crises because we deeply care about our family and what hurts one family m ember may be felt by all family members. Each of us has faced crises and will again. A crisis can unite a family if they have the capacity to adapt and remain cohesive.
So many families struggle to do that because their lives are weighed down by superfluous activities. As mentioned in previous chapters, the family has to rally resources and garner support when a crisis happens. For some, the crisis will force them to simplify their family demands in order to make it. For others, the crisis may render the family system fragile and easily damaged by other life stressors.
Grudge holding can be very destructive to relationships. Truly forgiving another family member or friend relieves the victim who was wronged from the burden of being a victim. I heard a man talk about his younger brother who fell asleep at the wheel and the car rolling off the road and killing his father. It took nearly a decade for all the family to forgive and forget when truly this was a case of misjudgment and carelessness rather than a criminal act. The impact the grudge holding had on the brother is still haunting him to this day. Sometimes, even when mean intention was part of the offense, growth will only come after the grudge is let go. When a grudge is held, the perpetrator is still the perpetrator and the victim is in the victim role. Many survivors find freedom in releasing the offender from the role of being the offender by forgiving him or her and by choosing to move on with life.
Ultimately the family that sits down together and annually creates a goal that is written and posted for everyone to see on a regular basis has the direction needed to eliminate unnecessary burdens on the family. For example, the family that sets a goal to spend every other weekend in an activity that will allow them to spend time together, building bonds that endure, may decide to forgo the season tickets to a professional team in exchange for more quality down-time together. Conversely, the family who anticipates the departure of a high school senior to college may purchase the season tickets if it meets the family goal of experiencing the joy of supporting the team one last season together. Extraneous activities can be kept or dismissed. Careful planning can keep them from continuing without notice or consideration for their impact on the family system.
Third party distractions occur when unexpected intruders crash the family routines. It could be as simple as a telemarketer or survey taker calling during meal time. It can be a friend of one of the family members who regularly drops by to “hang out.” It can be family, coworkers, other associates who might do just as well at your house or somewhere else. It is acceptable to set boundaries for limiting interrupters so that they don't undermine the efforts at meeting family member's needs of the family. There are those who interrupt who feel entitled to do so and could care less of the impact their presence may have on the family. Again, it is acceptable to set clear boundaries, even if it takes a stronger effort to do so.
In the US and other societies, there are persons who feel that if they want something they have the right to get it regardless of the impact it may have on family members. At the extreme, abusers are this way. For most, the issue of entitlement is less sinister than abuse. A family member may want to make purchases he or she cannot afford and thereby strap the family with debt. A person may want to portray a status that is pretended more than real and may sacrifice family stability to do so. For example, the country club member who can't pay the bills because he or she is living on the salary of a doctor when they have only the income of a school teacher. Family members as individual consumers are nurtured in their entitlement by eager marketers who lure them into financially unsustainable circumstances. Entitlement values continuously land family members into trouble, because accountability eventually catches up in one form or another.
Now let's look at the positive efforts a couple can do to resist the decay of their marriage (Left side of Figure 4). Couples should date regularly. Plan dates together and sacrifice less important activities so that there is ample time to go out and enjoy each other as friends. Some suggest a weekly date while for others a bi-weekly or monthly date is more meaningful. I urge any of my students with children to at least get an overnighter date in once every 3-4 months. Getting away to be a couple can be extremely rejuvenating. Courtship does not have to end after the wedding. True when you were single you courted with the eventual goal to “catch someone” and settle down. Courting for marrieds is more of a “keeping someone” and enjoy life effort that makes the journey together more meaningful. A self-help book such as the 5 Love Languages (Gary Chapman) can be valuable tools in helping you know how best to speak the language of love as you try to most efficiently continue a courtship with your spouse.
Daily couple time is crucial. It is acceptable to go to bed even while others are awake in the house. Once there, pillow talk, next-day planning, and do-nothing time can be very supportive of the relationship.  With all the forces of entropy and stress bearing down on the couple, it is easy to put sex and the renewal that accompanies it to the side. Many have documented the value of protecting that time and expression together, even as though it is sacred time.
Whatever distracts fatigues, annoys, or interferes with needed sexual expression should be evaluated and managed so that needs and wants can be met and bonds can be reestablished. Part of this is the ongoing romance of one another. Couples who are committed to sex and romance find ways to show and speak their love far away from the marriage bed and beyond the sexual interactions they enjoy.
One might do the tasks of the other during the week in order to express love and support.
Another might bring home a flower or treat. Still another might cancel plans to just spend time together when needed. Romance burns as bright and hot as we want it to burn. It can be kindled and renewed and for some couples can lead to healing from deep issues and wounds. Sexual intimacy is simultaneously healing and bonding spiritually, socially, emotionally, and physically. Family and work stressor can minimize or eliminate this marital benefit if left unchecked.
It may perhaps be the best advice one could ever give to newlyweds-learn how to forgive and forget This ties directly back to refusing to continue as a victim and move on with life). Every spouse has their mortal flaws. Every spouse will suffer to one degree or another because of the inconsideration and/or misbehavior of the other. Forgiveness makes it possible to work through these issues together, learn from them, and move on with renewed cohesion. Forgiveness is an act of grace wherein the offender is held harmless by the offended spouse in matters of the offense. Forgiveness is not pretending that an offense never occurred. Forgiveness works best after the offense is considered and resolved to the satisfaction of both spouses.
Tracking is not forgiveness. There are some who claim to forgive, yet keep a mental record of current and past offenses. Tracking the offenses of a spouse means that you document and remember the offensive behavior and others like it and regularly bring past “forgiven” issues back up as though they just occurred and were never dealt with.
Tracking can build an entire “case” against a spouse so that he or she feels overwhelmed and hopeless about working through the problem. To hold the grudge or refuse to let the memory of an offense fade is to interfere with recovery efforts in the marriage.
One who is offended may chose to remain a victim and by so doing create a long-term perpetrator out of the other spouse. Victims can assume some of the blame or none of it at all. In other words he can say, like one of my students said in a class, “My wife cheated on me with my brother. I had nothing to do with it.” When confronted by another student about some of the comments he made about women being untrustworthy, he also confessed that he and his wife and brother were using Heroine at the time and were addicts. “But, my wife left me and is now married to my brother.” He argued.
“You can't grow if you can't learn from your own mistakes,” added a single mother of three. She explained, “My ex-husband beat me down every day in one form or another. I finally got up the courage to leave him and the police had to keep him from killing me. After I was finally divorced and safe, I learned in therapy that I'm not responsible for his violence. But I had to acknowledge the fact that I chose him as my spouse and I chose to stay with him for a long time after his violence became known to me. Once I owned up to that much, I could change how and who I chose for an intimate relationship.”
“Wow!” I sat listening to her as she instructed him. I felt amazed for her wisdom at such an early age in life. She told him to quit being a victim, forgive, and move on. She is correct in saying that he has to decide what if anything he can do to avoid repeating such a scenario in the future.
As I've mentioned in other chapters, I am a huge fan of written goals, of taking good ideas and turning them into tangible expectations. “A goal unwritten is just a good idea.”
One of my very successful college buddies told me when I asked him how he came to make so many millions of dollars in his twenties. When he and his wife sat a goal they put it on the fridge and in the bathrooms and the entire family worked together to attain them.
Seeking consensus and finding common goals is a unity-building activity that yields direction to the family as a whole and to the individual family members. For example, a family may consult together and set a goal to save their money by cutting back on the extras. Once enough money is saved they would then take a high canopy rainforest tour in Costa Rica. To remind everyone of the goal and to inform them of the progress, they might put a sheet of paper on the fridge that keeps an ongoing record of their money saved and the remaining funds needed. Such a goal and effort would create a wonderful and uniting family outing even as the family escaped some of the stresses of everyday life.
Stress is very common in US families today. Stress has a deadly physiological influence on individuals and families. The economic standards we set for our lifestyles require tremendous sacrifice and effort to attain. Parents and spouses have to exert leadership in minimizing unnecessary stressors and in coping with unavoidable ones. Stress can render the flexibility and adaptability of a family into dysfunctional levels. Many families eliminate the nonessentials. Others ensure that the family gets renewal time at the individual and family systems levels. Like a goal, a family can discuss stress, family values, and stress management strategies. These too, can be written and displayed to remind family members about strategies.
 This often leads to hurt feelings and heartache. John Gottman (2004) wrote of accepting bids. To Gottman a bid is an effort and repair or reinforcing the spousal relationship that is extended in good will from one spouse to another. Accepting a spouse's bid is highly associated with strong marriages (See John Gottman http://www.gottman.com/ and “The Seven Principles for Making Marriage Work,” Three Rivers Press, NY).
Judith Wallerstein also wrote about the ability strong married couple has to support and nurture one another and to manage the daily wear and tear on the marriage and family (“Thee Good Marriage” 1995, Warner Books, with Sandra Blakeslee). Rescuing one another is one of the duties and benefits that come with marriage. Today the husband may help her get through difficult times. In a few years she may reciprocate and support him. The key is to take the time, sacrifice the needed resources, and be your spouse's number one support, especially when the chips are down. This, when done consistently is part of the explanation about the 10 marital benefits mentioned above in Table 1.
Wallerstein (1995) also talked about using humor and having fun with and without your children. When a couple discovers one another, they establish a relationship filled with fun, romance, and togetherness. Once married and pursuing their goals, married life bears down so heavily at times that it becomes easy to forget those early attractions that made courting and marrying so much fun. Fun can be free or it can cost millions. Make sure and enjoy the bounty that is available to all of us in this country, our states, and the community in which we reside. When fun gets pushed out of our lives adapt your family to cope with the demands and eliminate the disposable demands.
There are persons who are alone, bored, and intrusive who would intrude into your marital time. Work at keeping them at bay and managing the intrusive influence they have. My wife and I once took a Thanksgiving Holiday 5 minutes down the road, where we stayed in a hotel with the children. We ate out, swam in the pool, stayed up to the late hours watching cartoons, and toured fun places in town. Our children remember this as one of their favorite holidays ever. We came home to 63 phone messages and over 100 emails from people who just wanted to touch base. Interestingly, some of them were angry because they didn't know where we were. Once we told them their anger subsided.
My wife and I also have pattern of escaping together. She and I attend professional conferences together. We escape to another county or state. We even get away if we really need to disagree and want to be uninterrupted.
When couples disagree they should remove distractions such as electronics and newspapers, isolate themselves so that they can finish a thought or a sentence and think more clearly. It may take concerted efforts, but persist even if it takes one or more consultations together to get the issue resolved.  We had tried to talk in our bedroom, but the interruptions were incessant form children and telephones. We talked for nearly an hour until we felt good about our strategy. The issue was one of the most important we ever discussed together. The children were so happy when we returned into the home. For parents with preschool and elementary aged children an early bedtime is advisable so that the couple can have a daily time to talk and relax together.
Why not seek help when you need it? Studies have shown that some people will never go see a dentist, doctor, or therapist. They are treatment-avoidant and refuse to seek these professional services. Couples often seek professional help after things have gotten to a critical point in the relationship. Although many couples can work out most of their issues together, it is advisable to learn to recognize early those issues that might be a deep threat to the stability of the relationship. If the issue is persistent and keeps coming up, if the issue deals with one or both spouse's commitment to the relationship, if the issue has to do with the core role of husband or wife or the core agreements on what each should be or do in those roles, and/or if the issue is very important to one spouse and feels that professional help may be needed then professional assistance should be considered. It is not a failure to seek professional medical, dental, therapeutic, accounting, mechanical, or other services. A student of mine was in a divorce and was ordered to go through pre-divorce mediation because of the children. He told me that during mediation with his ex they learned valuable communication skills and decided to postpone the divorce. He told me that the state should order mediation or counseling when things can be fixed not once the divorce starts. Of course states would not order such a thing, but spouses can voluntarily seek the help.
I have taught in higher education for over 20 years now. I can name 5 colleagues who worked until their retirement and once retired died within 3-18 months. It became a joke among us here at UVU that somebody needed to change that pattern-to retire and live another 30 years. We work so long to secure our later years with the necessities we desire.  In marriages, similar things happen, but in a slightly different way. The young couple sets valiant long-term goals so that they can raise children, establish assets, and eventually retire together. But, many couples forget that marriage requires constant attention and upkeep. In the pursuit of these goals they grow apart, lose intimacy, and get lost in child-rearing. After the last child launches into their own adult roles, some couples find themselves waking up to a person they barely know or get along with.
I also know of 4 elderly couples who divorced after retirement. In each case, one of the spouses told me that they just grew apart over the years. To them it was as though they started a journey, progressed well together, and lost interests in one another along the way. The husband and wife relationship are the engine that drives the married family system forward. Nurturing, protecting, and enhancing the maintenance of the marriage benefits the couple and the family.
Finally, families can be the most fun, most meaningful, and most rewarding social groups we belong to in our lives. Many elderly rate their family relationships as being among the most satisfying aspects of their golden years. The family experience can be valued or endured, cherished or loathed, essential or distracting. Regardless of the circumstances we face in life, our efforts to build and enjoy the family as individuals, couples, and other family members will most likely be rewarding to us throughout our entire lives. If neglected, just the opposite could prove to be true. As a final thought, I wrote this book as a service to my UVU students at UVU and other students everywhere. It has decades of teaching experience and mountains of research built into each chapter. My goal is to inform, not modify values. I hope that if this text was too liberal for your taste or too conservative that it was still of use to you. I find joy in being a life-long student of families and how to make them work better. I hope you found a bit of that joy for yourself.


23.0: Introduction
The respiratory system allows the body to breathe, talk, and smell. The respiratory system is primarily responsible for bringing oxygen into the body and is a major pathway to remove carbon dioxide and other waste gases. Adequate functioning of the respiratory system depends on having the nervous, cardiovascular, and musculoskeletal systems working properly as well. This will be discussed later in the chapter.
This chapter is separated into three sections: the upper respiratory system, the lower respiratory system (see Figure 23.2), and the system of oxygenation and gas exchange. This chapter will review both the upper and lower respiratory systems and will briefly discuss common conditions that affect the respiratory tract, oxygenation, and gas exchange (Cleveland Clinic, 2023).


4.6: China from Neolithic Village Settlements to the Shang Kingdom
Chapters Two and Three covered the development of the first major civilizations of Mesopotamia, Egypt, and India. In each case, rivers were particularly important to that process because they offered a stable supply of water for agriculture. Similarly, in China, the first major states emerged along China’s second longest river–the Yellow River . These states are the Xia [shee-ah] Dynasty (c. 1900 – 1600 BCE), Shang [shawng] Dynasty (1600 – 1046 BCE), and Zhou [joe] Dynasty (1045 – 256 BCE). Each of these kingdoms was ruled by a line of hereditary monarchs hailing from one lineage, which is why they are also referred to as dynasties.
Because written sources don’t become available until the Shang Dynasty, historians have relied heavily on the archaeological record to reconstruct the process by which these states arose. Looking back at the end of the Paleolithic era (c. 10,000 BCE), East Asia was sparsely populated by bands of foragers living in temporary settlements. During the eighth millennium BCE, in China, some of these hunter-gatherers turned to domesticated cereals for a stable food supply and settled into villages so they could cultivate them. Thus, the Neolithic Age (8000 – 2000 BCE) commenced.
Over the course of those six millennia leading up to the Xia Dynasty, Neolithic communities became more diverse and complex. For instance, for the period 5000 – 3000 BCE, archaeologists have identified at least eight major regional Neolithic cultures located along rivers and coasts (see Map \(\PageIndex{1}\)). They did so by examining pottery styles and village settlement patterns. One example is Yangshao culture , which was concentrated along the middle reaches of the Yellow River. Over one thousand sites left behind by millet-farming village communities have been discovered. Jiangzhai (c. 4000 BCE), for instance, was a moated village settlement that occupied roughly thirteen acres (see Figure \(\PageIndex{1}\)). It was composed of related lineages and tribal in organization.
During the third millennium BCE, Yangshao culture was gradually supplanted by Longshan culture (c. 3000 – 1900 BCE), which emerged further to the east, along the middle and lower reaches of the Yellow River. In 1928, when archaeologists excavated a site near the town after which Longshan was named, they found evidence for a culture that had laid the foundations for the kingdoms that emerged in the second millennium BCE, including the ruins of numerous walled towns with cemeteries outside (see Map \(\PageIndex{2}\)). Their rammed-earth walls protected urban areas with public buildings, roads, and drainage systems. The cemetery’s arrangement suggests that people living in the towns were buried alongside clan members, but also that some members were wealthier and more powerful: while most graves had nothing but a skeleton, others contained numerous artifacts, such as pottery and jade.
Based on this evidence, archaeologists have concluded that, during the third millennium BCE, population grew and some of it shifted from villages to walled towns. These walled towns developed into political and economic centers exercising control over and serving as protection for surrounding communities. Individuals with more elaborate graves were likely political and religious leaders, and served as chieftains. Hence, numerous competing chiefdoms emerged, providing the foundation for more powerful kingdoms to follow.
Ancient Chinese histories identify the first major kingdom as the Xia Dynasty (c. 1900 – 1600 BCE). However, these were written many centuries after the kingdom about which they speak and, lacking written evidence from the dynasty itself, specialists have been unable to definitively establish its location. Nevertheless, most agree that the Xia capital was located along the Yellow River at Erlitou [are-lee-toe] (see Map \(\PageIndex{2}\)). At its peak of activity from 1900 – 1600 BCE, this town looks like something more complex than a chiefdom. Erlitou included a central, walled palace complex (see Figure \(\PageIndex{2}\)), workshops for the production of bronze and pottery, and elite burials containing bronze weapons and jade, suggesting a socially stratified, Bronze Age civilization and kingdom. That is why many historians identify it as the capital of the Xia Dynasty.
With the Shang Dynasty (1600 – 1046 BCE), we formally step into China’s historical period. In 1899, in an apothecary, a Chinese scholar came across mysterious bones that were being ground up for use as medicine. He immediately recognized that the Chinese characters inscribed on them were very ancient. Subsequently, the origin of these bones was traced to fields in Anyang [anneyawng], China where, beginning in 1928, excavations were carried out. Similar to the discovery of the Indus Valley Civilization, a lost civilization was revealed on the North China Plain, the one difference being that traditional histories of a later time had documented this one (see Map \(\PageIndex{3}\)).
The findings were substantial. A diverse array of settlements with a royal capital at the center covered nearly thirty square kilometers (see Map \(\PageIndex{4}\)). Archaeologists have identified 53 pounded earth foundations as the floors of royal palace-temples and the ruins in their vicinity as residential areas for elites and commoners; sacrificial pits; and workshops for the production of bronze, pottery, and stone. Also, a royal cemetery with eight large tombs and dozens of smaller ones lies to the northwest. The larger graves were roughly half the size of a football field, each accessible through four ramps whose orientation to the cardinal directions gives them the appearance of crosses. Deep down at the bottom of each tomb’s central shaft, wooden chambers were built to house the dead bodies of Shang kings. Shockingly to us, dozens of human skeletons were placed above and below these, presumably as servants to accompany rulers in the afterlife (view reconstruction of a Xia Dynasty palace at Erlitou at the following link: http:// www.waa.ox.ac.uk/XDB/images/ world/tours/china-erlitou2.jpg).
Anyang , we now know, served as the last capital of the Shang Dynasty, from 1200 to 1046 BCE. It was at the center of a loosely governed territorial state located on the North China Plain. Shang kings directly governed the capital and its vicinity, but likely controlled areas farther out by building confederations with locally powerful lineage chieftains, and regularly hunting, warring, and carrying out rituals with them. Some of those leaders were directly related to the Shang kings, and some were allies by marriage.
The bones are the most important source for understanding this kingdom. Most of the two hundred thousand fragments found so far are either turtle plastrons or scapula from cows. Interestingly, these were used for divination, which is why they are called oracle bones (see Figure \(\PageIndex{4}\)). When Shang kings or his diviners sought to know the future, they would proceed to a temple erected in honor of a Shang deity or the spirits of deceased ancestors in the royal line. Before a stone tablet, they would make a statement about what might happen (for example, “It will rain,” or “If we attack the Mafang [high god], Di will confer assistance on us”), and then apply heat to a hole bored into a bone until it cracked. The crack was viewed as the response from the god or spirit. The king would then determine whether or not it was auspicious, and a record would be inscribed on the bone, sometimes including the actual outcome (see Figure \(\PageIndex{5}\)). From these, we know that Shang elites believed that a high god Di, nature gods, and the spirits of deceased kings controlled the future. That is why Shang kings had massive bronzes cast and carried out sacrifices for them. The bronzes were filled with food and placed at the temples, literally to feed the spirits. Likewise, the sacrificial pits show that a substantial shedding of blood for these higher powers was a regular occurrence. Shang elites worshipped their ancestors and frequently divined to determine their will.


15.10F: Amoebic Dysentery (Amoebiasis)
- Outline the life cycle of Entamoeba histolytica
Amoebic dysentery, also referred to as amoebiasis, is caused by the ameoba Entamoeba histolytica. Dysentery is characterized as an inflammatory disorder of the intestine that results in severe diarrhea containing both mucus and blood in the feces, often accompanied with fever and abdominal pain.
The route of transmission for ameobic dysentery is the fecal-oral route. Transmission and infection occur upon exposure or ingestion of contaminated food and water. The infective cysts are passed via infected stool. The ameoba also demonstrates the ability to spread as free amoebae or trophozoites, meaning the cysts are not absolutely necessary; however, these states do not survive long outside of the host.
Ameobic dysentery is seen in both developing and industrialized countries, although it is most common in tropical areas. Ameobic cysts are often found in areas of the world where the use of human feces for fertilizer is common, often referred to as ‘night soil’. Upon ingestion of contaminated foods or water, the cysts will move into the intestinal area. These cysts are protected from stomach acids and are able to evade destruction. Once in the intestine, the cyst breaks open and releases the amoebas which then burrow into and damage the intestinal walls.
The amoebae or trophozoites are able to divide via binary fission and and produce cysts. If they are passed in the feces as is, instead of developing into cysts, their survival rate decreases as they are unable to survive in harsh environments. Interestingly, individuals can be asymptomatic if infected with trophozoites and can function as carriers by passing cysts in their stool.

Key Points
- Amoebiasis is transmitted via food or water contaminated with fecal matter from an infected individual.
- The pathogen, Entamoeba histolytica, is mainly found in tropical areas and is protected from degradation and destruction by its protective shell, formed during its cyst stage.
- The cyst stage is typically passed in the feces and then ingested to cause infection.
- The amoebas are able to burrow into the walls of the intestines, causing damage.
Key Terms
- trophozoites : A protozoan in the feeding stage of its life cycle.


8.1: Getting Ready for Chapter 8
Chapters 4 through 7 dealt with elements of weather and climate and set the stage for chapter 8 "Weather Systems". In chapter 8 we'll focus on how these weather elements explain the daily changes in our daily weather. We'll also examine the processes that create, and geographical patterns of, powerful storm systems like tornadoes and hurricanes.
Weather and climate are elements of physical geography that impact all of our lives. That's why an understanding of the potential effects of climate change is important to all of us. If we stay on our present course, geoscientists predict storm systems in some parts of the world will become more severe. The patterns of both weather systems, and climates could radically shift, causing significant changes in natural habitats, agricultural systems, population distribution, and the economic stability. Geographers will be at the forefront of understanding how these changes will take place, where they will happen, and how we might address them.
What you should already know ...
Weather systems, like any other natural system, are composed of many interacting components. Temperature, moisture, pressure and air circulation combine to create systems that affect our day-to-day weather. We'll focus mostly on the impact of cyclonic systems that form in the mid- to high latitudes in association with jet streams. We'll also look at severe weather systems, thunderstorms, tornadoes, and hurricanes.
The elements of these systems were presented in Chapter 5, Chapter 6, and Chapter 7. In particular, you should have a handle on the basic concepts of humidity, precipitation formation, cloud types, air pressure, and wind.
Use the quiz below to assess your understanding of a few key topics from these chapters.
-
Which of the following is considered a cold, dry airmass?
- mT
- mP
- cP
- cT
-
Wind direction is described as
- where the wind comes from.
- where the wind is blowing to.
-
Low pressure systems in the Northern Hemisphere exhibit
- surface convergence and subsidence
- suface convergence and uplift
- surface divergence and subsidence
- surface divergence and uplift
-
The approximate wind direction and speed (assume north at top of page)
- SW, 20 knots
- NE, 15 knots
- SW,15 knots
- NE, 20 knots
-
Circulation in a cyclone in the Northern Hemisphere is
- clockwise and outward from the center
- clockwise and inward toward the center.
- counterclockwise and inward toward the center.
- counterclockwise and outward from the center
-
____ uplift occurs when two unlike air masses collide.
- Orographic
- Convective
- Convergent
- Frontal
-
A steep pressure gradient would exhibit ___ isobars on a weather map.
- closely spaced
- widely separated
- What type of cloud is shown here?
- Cirrus
- Stratus
- Cumulonimbus
- Altostratus
-
If the surface air pressure is 1010 mb it would be considered ______ pressure.
- high
- low
-
_____ flow occurs when the polar front jet stream and equatorward edge of the circumpolar vortex takes on a curving flow.
- zonal
- meridonal
- Answer
-
- C
- A
- B
- B
- C
- D
- A
- A
- B
- B
About your score ....
If you scored 80% or above, Great! ... start reading the chapter.
If you scored 70% to 80% you should consider reviewing the previous material.
If you scored less than 70% you should consider reviewing the previous material and seeking help from your instructor.


13.2: Guiding Principles of Supporting Children’s Physical Development
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Teachers play a critical role in supporting children’s physical development because physical skills need to be explicitly and deliberately taught. Physical play, both indoors and outdoors, is not merely “free time”; it requires thoughtful planning and intentional interactions. The following guidelines will help teachers support children’s physical development.
Developmentally appropriate movement programs accommodate a variety of individual differences among children.
Children often learn best through maximum active participation. There should be a daily quest to minimize sitting, waiting, and watching so children enjoy meaningful participation in physical activities. Maximum purposeful participation at some level is a challenging but attainable goal.
The physical safety of children’s play environments should be of paramount importance at all times (children should be able to take reasonable risks).
Family members working as partners with teachers are key to enriching the physical development of children.
Inclusion of children with special needs is beneficial to all and promotes greater understanding of and respect for diversity.
Children are multisensory learners with unique learning styles.
To maximize teaching effectiveness, movement skill learning should first focus on improving body coordination and increasing awareness of body movements. The product, or quantitative aspect of movements (e.g., how far they jumped, or how fast they ran), should not be the initial focus of learning.
Children generally learn new movement skills more easily when they can focus on one specific aspect of the skill at a time.
Children benefit from ample opportunities to practice new physical skills.
Children benefit from integrated learning activities across the curriculum.
Frequency, intensity, type, and duration are the four key parameters to designing active physical play to enhance children’s fitness and health. The four parameters may be thought of as the FITT principles (Frequency, Intensity, Type, Time [duration]).
o “Frequency” refers to the regularity of engaging in physical activity; frequent short periods of physical activity each day are preferred (children should not be sedentary for more than 60 minutes at a time except when sleeping).
o “Intensity” refers to whether activities are sedentary, mild, moderate, or vigorous; moderate to vigorous activities are preferred.
o “Type” deals with the specific kind of physical activity engaged in; for young children, the types of activities usually take the form of active games, child-initiated play, as well as rhythms and dance.
o “Time” (duration) refers to the amount of time in which the child is engaged in physical activity; accumulating at least 60 minutes, and up to several hours, of moderate to vigorous physical activity per day is recommended.
Physical skills are more easily learned when clear instructions and appropriate feedback are provided in children’s home language using familiar communication methods.
Allow children to take risks. Risk taking allows children to challenge themselves, and to assess their own skills and abilities. [1]
[1] The California Preschool Curriculum Framework, Volume 2 by the California Department of Education is used with permission;
Content by Clint Springer is licensed under CC BY 4.0