12.4: The Qing Dynasty
Orthodox Confucian Painting under the Qing Dynasty
The early Qing Dynasty developed in two main strands, one of which was the Orthodox school of Confucian paintings.
Differentiate the work of the Six Orthodox Masters of the Qing Dynasty from that of their individualist contemporaries
Key Points
- Under the Qing Dynasty , traditional forms of art flourished and innovations were made at many levels and in many types. High levels of literacy, prosperous cities, a successful publishing industry, and the Confucian emphasis on cultivation all fed a lively and creative set of cultural fields.
- The early Qing dynasty developed in two main strands: the Orthodox School and the Individualist painters. Both approaches followed the theories of Dong Qichang but stressed different aspects.
- The Six Masters of the early Qing period were a group of major Orthodox artists whose art was generally conservative, cautious, subtle, and complex, in contrast to the vigorous and vivid painting of their individualist contemporaries.The Four Wangs—Wang Jian, Wang Shimin, Wang Yuanqi, and Wang Hui—were particularly renowned in the Orthodox School and sought inspiration in recreating the past styles , especially the technical skills in brushstrokes and calligraphy of ancient masters.
Key Terms
- “Four Wangs” : A group of Chinese painters of the Qing Dynasty, particularly renowned in the ç, who sought inspiration in recreating the past styles, especially the technical skills in brushstrokes and calligraphy of ancient masters.
Overview: Qing Dynasty Painting
The Qing Dynasty was the last imperial dynasty of China, ruling from 1644 to 1912 with a brief, abortive restoration in 1917. It was preceded by the Ming Dynasty and succeeded by the Republic of China. The Qing multi-cultural empire lasted almost three centuries and formed the territorial base for the modern Chinese state.
Under the Qing Dynasty, traditional forms of art flourished and many types of innovations were made at many levels. High levels of literacy, prosperous cities, a successful publishing industry, and the Confucian emphasis on cultivation all fed a lively and creative set of cultural fields. The early Qing dynasty developed in two main strands of painting: the Orthodox School and the Individualist painters. Both schools followed the theories of Dong Qichang, though emphasizing very different aspects.
Orthodox Painting
The Qing emperors were often skilled in painting and offered their patronage to Confucian culture . The Kangxi and Qianlong Emperors, for instance, embraced Chinese traditions both to control them and to proclaim their own legitimacy. Under the Orthodox School, court painters made new versions of the Song masterpiece, Zhang Zeduan ‘s Along the River During the Qingming Festival, whose depiction of a prosperous and happy realm demonstrated the beneficence of the emperor. The most impressive aesthetic works during this period were done among the scholars and urban elite. Calligraphy and painting remained a central interest to both court painters and scholar-gentry who considered the Four Arts (music, strategy games, calligraphy, and painting) part of their cultural identity and social standing.
The painting of the early years of the dynasty included such painters as the orthodox Six Masters, including the Four Wangs. The 19th century saw such innovations as the Shanghai School and the Lingnan School, which used the technical skills of tradition to set the stage for modern painting.
The Six Masters
The Six Masters of the early Qing period were a group of major Chinese artists who worked in the 17th and early 18th centuries. Also known as Orthodox masters, they continued the tradition of the scholar-painter, following the injunctions of the artist-critic Dong Qichang late in the Ming Dynasty. The works of the Six Masters are generally conservative, cautious, subtle, and complex in contrast to the vigorous and vivid painting of their individualist contemporaries.
The Six Masters include the flower painter Yun Shouping, the landscape painter Wu Li, and the Four Wangs: Wang Shimin, Wang Jian, Wang Yuanqi, and Wang Hui. The Four Wangs were particularly renowned in the Orthodox School and sought inspiration in recreating the past styles, especially the technical skills in brushstrokes and calligraphy of ancient masters. The younger Wang Yuanqi (1642–1715) ritualized the approach of engaging with, and drawing inspiration from, the work of an ancient master. His own works were often annotated with his theories of how his paintings relate to the master’s model.
Individualist Painting under the Qing Dynasty
During the Qing Dynasty, painters known as Individualists rebelled against many of the traditional rules of painting through free brushwork.
Explain how the work of Individualists of the Qing Dynasty, such as Shitao, deviated from the traditional rules of painting.
Key Points
- During the early Qing Dynasty (1644–1911), two main strands of painting developed: the Orthodox School and the Individualist painters.
- While Orthodox painters such as the Six Masters focused on a style that was conservative, cautious, subtle, and complex, Individualist painters tended to produce more vigorous and vivid works of art.
- The Individualist painters included Bada Shanren and Shitao , who drew more from the revolutionary ideas of transcending the tradition to achieve an original, individualistic style.
- The art created by Shitao was revolutionary in its transgressions of the rigidly codified techniques and styles that dictated what was considered beautiful.
Key Terms
- Qing Dynasty : The last dynasty of China, lasting from 1644 to 1912.
- Bada Shanren : (1626-1705) A Chinese painter of shuimohua and a calligrapher.
- Shitao : (1641-1707) A Chinese landscape painter and poet during the early Qing Dynasty.
Breaking From Orthodox Traditions
During the early Qing Dynasty (1644–1911), painters known as Individualists rebelled against many of the traditional rules of painting and found ways to express themselves more directly through free brushwork. While Orthodox painters such as the Six Masters focused on a style that was conservative, cautious, subtle, and complex, Individualist painters tended to produce more vigorous and vivid works of art.
The Individualist painters included Bada Shanren (1626–1705) and Shitao (1641–1707), who both drew from the revolutionary ideas of transcending tradition to achieve an original style. In this way, they were more faithfully following the way of Dong Qichang than the Orthodox School, who were considered his official direct followers.
Painting Styles
The paintings of Bada Shanren feature sharp brush strokes, which are attributed to the sideways manner by which he held his brush. The art created by Shitao was revolutionary in its transgressions of the rigidly codified techniques and styles that dictated what was considered beautiful. In his time, imitation was valued over innovation, and although Shitao was clearly influenced by his predecessors (namely Ni Zan and Li Yong), his art breaks with theirs in several new and fascinating ways.
Shitao’s formal innovations in depiction include drawing attention to the act of painting itself through his use of washes and bold, impressionistic brushstrokes, as well as an interest in subjective perspective and the use of negative or white space to suggest distance. The poetry and calligraphy that accompany his landscapes are just as vivid and irreverent as the paintings they complement. His paintings exemplify the internal contradictions and tensions of the literati or scholar-amateur artist, and they have been interpreted as an invective against art-historical canonization.
Reminiscences of Qin-Huai is one of Shitao’s unique paintings. Like many paintings from the late Ming and early Qing Dynasties, it deals with man’s place in nature. Upon first viewing, the craggy peak in this painting seems somewhat distorted. What makes this painting so unique is that, upon closer inspection, it appears to depict the mountain bowing. A monk stands placidly on a boat that floats along the Qin-Huai river, staring up in admiration at the stone giant. The economy of respect that circulates between man and nature is explored here in a sophisticated style reminiscent of surrealism or magical realism and bordering on the absurd. Shitao himself had visited the river and the surrounding region in the 1680s, but it is unknown whether the album that contains this painting depicts specific places.
- Curation and Revision. Provided by : Boundless.com. License : CC BY-SA: Attribution-ShareAlike
- Peonies by Yun Shouping. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/File:Peonies_by_Yun_Shouping.jpg. License : Public Domain: No Known Copyright
- Wang Hui10. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/File:Wang_Hui10.jpg. License : Public Domain: No Known Copyright
- Chinese art. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Chinese_art%23Early_Qing_painting. License : CC BY-SA: Attribution-ShareAlike
- Qing Dynasty. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Qing_Dynasty%23Arts_and_Culture. License : CC BY-SA: Attribution-ShareAlike
- Six Masters of the early Qing period. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Six_Masters_of_the_early_Qing_period. License : CC BY-SA: Attribution-ShareAlike
- Boundless. Provided by : Boundless Learning. Located at : www.boundless.com//art-history/definition/four-wangs. License : CC BY-SA: Attribution-ShareAlike
- Chu Ta 003. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/File:Chu_Ta_003.jpg. License : Public Domain: No Known Copyright
- ShiTao-Pine Pavilion Near A Spring. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/File:ShiTao-Pine_Pavilion_Near_A_Spring.jpg. License : Public Domain: No Known Copyright
- Shitao-Qinhuai. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/File:Shitao-Qinhuai.jpg. License : Public Domain: No Known Copyright
- Shitao. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Shitao. License : CC BY-SA: Attribution-ShareAlike
- Chinese painting. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Chinese_painting%23Late_imperial_China_.281368.E2.80.931895.29. License : CC BY-SA: Attribution-ShareAlike
- Chinese art. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Chinese_art%23Early_Qing_painting. License : CC BY-SA: Attribution-ShareAlike
- Bada Shanren. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Bada%20Shanren. License : CC BY-SA: Attribution-ShareAlike
- Shitao. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Shitao. License : CC BY-SA: Attribution-ShareAlike
- Qing Dynasty. Provided by : Wiktionary. Located at : en.wiktionary.org/wiki/Qing+Dynasty. License : CC BY-SA: Attribution-ShareAlike


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11: Microbial Pathogenicity and Epidemiology
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11.1: Characteristics and Steps of Infectious Diseases
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In an infection, a microorganism enters a host and begins to multiply. Symptoms of a disease are subjective and are reported by the patient. Diseases can either be noninfectious (due to genetics and environment) or infectious (due to pathogens). Virulence, the degree to which a pathogen can cause disease, can be quantified by calculating either the ID50 or LD50 of a pathogen on a given population. Primary pathogens are capable of causing pathological changes associated with disease in a healthy
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11.2: Virulence Factors in Infection
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Virulence factors contribute to a pathogen’s ability to cause disease. Exoenzymes and toxins allow pathogens to invade host tissue and cause tissue damage. Exoenzymes are classified according to the macromolecule they target and exotoxins are classified based on their mechanism of action. Bacterial toxins include endotoxin and exotoxins. Endotoxin is the lipid A component of the LPS of the gram-negative cell envelope. Exotoxins are proteins secreted mainly by gram-positive bacteria.
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11.3: How Diseases Spread
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Pathogens often have elaborate adaptations to exploit host biology, behavior, and ecology to live in and move between hosts. Hosts have evolved defenses against pathogens, but because their rates of evolution are typically slower than their pathogens (because their generation times are longer), hosts are usually at an evolutionary disadvantage. This section will explore where pathogens survive—both inside and outside hosts—and some of the many ways they move from one host to another.
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11.4: The Language of Epidemiologists
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The field of epidemiology concerns the geographical distribution and timing of infectious disease occurrences and how they are transmitted and maintained in nature, with the goal of recognizing and controlling outbreaks. The science of epidemiology includes etiology (the study of the causes of disease) and investigation of disease transmission (mechanisms by which a disease is spread).
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11.5: Tracking Infectious Diseases
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Some important researchers, such as Florence Nightingale, subscribed to the miasma hypothesis. The transition to acceptance of the germ theory during the 19th century provided a solid mechanistic grounding to the study of disease patterns. The studies of 19th century physicians and researchers such as John Snow, Florence Nightingale, Ignaz Semmelweis, Joseph Lister, Robert Koch, Louis Pasteur, and others sowed the seeds of modern epidemiology.
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11.6: Exercises
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18.8A: Capillary Dynamics
Hydrostatic and osmotic pressure are opposing factors that drive capillary dynamics.
- Describe hydrostatic pressure and osmotic pressure, the factors of capillary dynamics
Key Points
- Capillary exchange refers to the exchange of material from the blood into the tissues in the capillary.
- There are three mechanisms that facilitate capillary exchange: diffusion, transcytosis and bulk flow.
- Capillary dynamics are controlled by the four Starling forces.
- Oncotic pressure is a form of osmotic pressure exerted by proteins either in the blood plasma or interstitial fluid.
- Hydrostatic pressure is a force generated by the pressure of fluid on the capillary walls either by the blood plasma or interstitial fluid.
- The net filtration pressure is the balance of the four Starling forces and determines the net flow of fluid across the capillary membrane.
Key Terms
- proteinuria : Excessive protein in the urine, a condition which can alter the net filtration pressure altering flow of fluid across the capillary wall.
- hydrostatic pressure : A pressure generated by fluid on the walls of the capillary, usually forcing water out of the circulatory system.
- net filtration pressure : The balance of the four Starling forces that determines the net flow of fluid across the capillary membrane.
- oncotic pressure : A form of osmotic pressure exerted by proteins in a fluid that usually tends to pull water into the circulatory system.
Capillary exchange refers to the exchange of material between the blood and tissues in the capillaries. There are three mechanisms that facilitate capillary exchange: diffusion, transcytosis, and bulk flow.
Capillary Exchange Mechanisms
Diffusion, the most widely-used mechanism, allows the flow of small molecules across capillaries such as glucose and oxygen from the blood into the tissues and carbon dioxide from the tissue into the blood. The process depends on the difference of gradients between the interstitium and blood, with molecules moving to low-concentrated spaces from high-concentrated ones.
Transcytosis is the mechanism whereby large, lipid-insoluble substances cross the capillary membranes. The substance to be transported is endocytosed by the endothelial cell into a lipid vesicle which moves through the cell and is then exocytosed to the other side.
Bulk flow is used by small, lipid-insoluble solutes in water to cross the the capillary wall. The movement of materials across the wall is dependent on pressure and is bi-directional depending on the net filtration pressure derived from the four Starling forces that modulate capillary dynamics.
Capillary Dynamics
The four Starling forces modulate capillary dynamics.
- Oncotic or colloid osmotic pressure is a form of osmotic pressure exerted by proteins in the blood plasma or interstitial fluid.
- Hydrostatic pressure is the force generated by the pressure of fluid within or outside of capillary on the capillary wall.
The net filtration pressure derived from the sum of the four forces described above determines the fluid flow into or out of the capillary. Movement from the bloodstream into the interstitium is favored by blood hydrostatic pressure and interstitial fluid oncotic pressure. Alternatively, movement from the interstitium into the bloodstream is favored by blood oncotic pressure and interstitial fluid hydrostatic pressure.
Capillary Dynamics : Oncotic pressure exerted by proteins in blood plasma tends to pull water into the circulatory system.
Due to the pressure of the blood in the capillaries, blood hydrostatic pressure is greater than interstitial fluid hydrostatic pressure, promoting a net flow of fluid from the blood vessels into the interstitium. However, because large plasma proteins, especially albumin, cannot easily cross through the capillary walls, their effect on the osmotic pressure of the capillary interiors will to some extent balance the tendency for fluid to leak from the capillaries.In conditions where plasma proteins are reduced (e.g. from being lost in the urine or from malnutrition), or blood pressure is significantly increased, a change in net filtration pressure and an increase in fluid movement across the capillary result in excess fluid build-up in the tissues (edema).


1.2.8: How Not to Do Statistics
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Many studies are conducted and conclusions are made. However, there are occasions where the study is not conducted in the correct manner or the conclusion is not correctly made based on the data. There are many things that you should question when you read a study. There are many reasons for the study to have bias in it. Bias is where a study may have a certain slant or preference for a certain result. The following are a list of some of the questions or issues you should consider to help decide if there is bias in a study.
One of the first issues you should ask is who funded the study. If the entity that sponsored the study stands to gain either profits or notoriety from the results, then you should question the results. It doesn’t mean that the results are wrong, but you should scrutinize them on your own to make sure they are sound. As an example if a study says that genetically modified foods are safe, and the study was funded by a company that sells genetically modified food, then one may question the validity of the study. Since the company funds the study and their profits rely on people buying their food, there may be bias.
An experiment could have lurking or confounding variables when you cannot rule out the possibility that the observed effect is due to some other variable rather than the factor being studied. An example of this is when you give fertilizer to some plants and no fertilizer to others, but the no fertilizer plants also are placed in a location that doesn’t receive direct sunlight. You won’t know if the plants that received the fertilizer grew taller because of the fertilizer or the sunlight. Make sure you design experiments to eliminate the effects of confounding variables by controlling all the factors that you can.
Overgeneralization
Overgeneralization is where you do a study on one group and then try to say that it will happen on all groups. An example is doing cancer treatments on rats. Just because the treatment works on rats does not mean it will work on humans. Another example is that until recently most FDA medication testing had been done on white males of a particular age. There is no way to know how the medication affects other genders, ethnic groups, age groups, and races. The new FDA guidelines stresses using individuals from different groups.
Cause and Effect
Cause and effect is where people decide that one variable causes the other just because the variables are related or correlated. Unless the study was done as an experiment where a variable was controlled, you cannot say that one variable caused the other. Most likely there is another variable that caused both. As an example, there is a relationship between number of drownings at the beach and ice cream sales. This does not mean that ice cream sales increasing causes people to drown. Most likely the cause for both increasing is the heat.
Sampling Error
This is the difference between the sample results and the true population results. This is unavoidable, and results in the fact that samples are different from each other. As an example, if you take a sample of 5 people’s height in your class, you will get 5 numbers. If you take another sample of 5 people’s heights in your class, you will likely get 5 different numbers.
Nonsampling Error
This is where the sample is collected poorly either through a biased sample or through error in measurements. Care should be taken to avoid this error.
Lastly, there should be care taken in considering the difference between statistical significance versus practical significance . This is a major issue in statistics. Something could be statistically significance, which means that a statistical test shows there is evidence to show what you are trying to prove. However, in practice it doesn’t mean much or there are other issues to consider. As an example, suppose you find that a new drug for high blood pressure does reduce the blood pressure of patients. When you look at the improvement it actually doesn’t amount to a large difference. Even though statistically there is a change, it may not be worth marketing the product because it really isn’t that big of a change. Another consideration is that you find the blood pressure medication does improve a person’s blood pressure, but it has serious side effects or it costs a great deal for a prescription. In this case, it wouldn't be practical to use it. In both cases, the study is shown to be statistically significant, but practically you don’t want to use the medication. The main thing to remember in a statistical study is that the statistics is only part of the process. You also want to make sure that there is practical significance too.
Surveys
Surveys have their own areas of bias that can occur. A few of the issues with surveys are in the wording of the questions, the ordering of the questions, the manner the survey is conducted, and the response rate of the survey.
The wording of the questions can cause hidden bias , which is where the questions are asked in a way that makes a person respond a certain way. An example is that a poll was done where people were asked if they believe that there should be an amendment to the constitution protecting a woman’s right to choose. About 60% of all people questioned said yes. Another poll was done where people were asked if they believe that there should be an amendment to the constitution protecting the life of an unborn child. About 60% of all people questioned said yes. These two questions deal with the same issue, though giving opposite results, but how the question was asked affected the outcome.
The ordering of the question can also cause hidden bias. An example of this is if you were asked if there should be a fine for texting while driving, but proceeding that question is the question asking if you text while drive. By asking a person if they actually partake in the activity, that person now personalizes the question and that might affect how they answer the next question of creating the fine.
Non-response
Non-response is where you send out a survey but not everyone returns the survey. You can calculate the response rate by dividing the number of returns by the number of surveys sent. Most response rates are around 30-50%. A response rate less than 30% is very poor and the results of the survey are not valid. To reduce non-response, it is better to conduct the surveys in person, though these are very expensive. Phones are the next best way to conduct surveys, emails can be effective, and physical mailings are the least desirable way to conduct surveys.
Voluntary response
Voluntary response is where people are asked to respond via phone, email or online. The problem with these is that only people who really care about the topic are likely to call or email. These surveys are not scientific and the results from these surveys are not valid. Note: all studies involve volunteers. The difference between a voluntary response survey and a scientific study is that in a scientific study the researchers ask the individuals to be involved, while in a voluntary response survey the individuals become involved on their own choosing.
Example \(\PageIndex{1}\): Bias in a Study
Suppose a mathematics department at a community college would like to assess whether computer-based homework improves students’ test scores. They use computer-based homework in one classroom with one teacher and use traditional paper and pencil homework in a different classroom with a different teacher. The students using the computer-based homework had higher test scores. What is wrong with this experiment?
Solution
Since there were different teachers, you do not know if the better test scores are because of the teacher or the computer-based homework. A better design would be have the same teacher teach both classes. The control group would utilize traditional paper and pencil homework and the treatment group would utilize the computer-based homework. Both classes would have the same teacher, and the students would be split between the two classes randomly. The only difference between the two groups should be the homework method. Of course, there is still variability between the students, but utilizing the same teacher will reduce any other confounding variables.
Example \(\PageIndex{2}\): Cause and Effect
Determine if the one variable did cause the change in the other variable.
- Cinnamon was giving to a group of people who have diabetes, and then their blood glucose levels were measured a time period later. All other factors for each person were kept the same. Their glucose levels went down. Did the cinnamon cause the reduction?
- There is a link between spray on tanning products and lung cancer. Does that mean that spray on tanning products cause lung cancer?
Solution
- Since this was a study where the use of cinnamon was controlled, and all other factors were kept constant from person to person, then any changes in glucose levels can be attributed to the use of cinnamon
- Since there is only a link, and not a study controlling the use of the tanning spray, then you cannot say that increased use causes lung cancer. You can say that there is a link, and that there could be a cause, but you cannot say for sure that the spray causes the cancer.
Example \(\PageIndex{3}\): Generalization
- A researcher conducts a study on the use of ibuprofen on humans and finds that it is safe. Does that mean that all species can use ibuprofen?
- Aspirin has been used for years to bring down fevers in humans. Originally it was tested on white males between the ages of 25 and 40 and found to be safe. Is it safe to give to everyone?
Solution
- No. Just because a drug is safe to use on one species doesn’t mean it is safe to use for all species. In fact, ibuprofen is toxic to cats.
- No. Just because one age group can use it doesn’t mean it is safe to use for all age groups. In fact, there has been a link between giving a child under the age of 19 aspirin when they have a fever and Reye’s syndrome.
Homework
Exercise \(\PageIndex{1}\)
- Suppose there is a study where a researcher conducts an experiment to show that deep breathing exercises helps to lower blood pressure. The researcher takes two groups of people and has one group to perform deep breathing exercises and a series of aerobic exercises every day and the other group was asked to refrain from any exercises. The researcher found that the group performing the deep breathing exercises and the aerobic exercises had lower blood pressure. Discuss any issue with this study.
- Suppose a car dealership offers a low interest rate and a longer payoff period to customers or a high interest rate and a shorter payoff period to customers, and most customers choose the low interest rate and longer payoff period, does that mean that most customers want a lower interest rate? Explain.
- Over the years it has been said that coffee is bad for you. When looking at the studies that have shown that coffee is linked to poor health, you will see that people who tend to drink coffee don’t sleep much, tend to smoke, don’t eat healthy, and tend to not exercise. Can you say that the coffee is the reason for the poor health or is there a lurking variable that is the actual cause? Explain.
- When researchers were trying to figure out what caused polio, they saw a connection between ice cream sales and polio. As ice cream sales increased so did the incident of polio. Does that mean that eating ice cream causes polio? Explain your answer.
- There is a positive correlation between having a discussion of gun control, which usually occur after a mass shooting, and the sale of guns. Does that mean that the discussion of gun control increases the likelihood that people will buy more guns? Explain.
- There is a study that shows that people who are obese have a vitamin D deficiency. Does that mean that obesity causes a deficiency in vitamin D? Explain.
- A study was conducted that shows that polytetrafluoroethylene (PFOA) (Teflon is made from this chemical) has an increase risk of tumors in lab mice. Does that mean that PFOA’s have an increased risk of tumors in humans? Explain.
- Suppose a telephone poll is conducted by contacting U.S. citizens via landlines about their view of gay marriage.  Does that mean that you can say over 50% of all people in the U.S. do not support gay marriage? Explain.
- Suppose that it can be shown to be statistically significant that a smaller percentage of the people are satisfied with your business. The percentage before was 87% and is now 85%. Do you change how you conduct business? Explain?
- You are testing a new drug for weight loss. You find that the drug does in fact statistically show a weight loss. Do you market the new drug? Why or why not?
- There was an online poll conducted about whether the mayor of Auckland, New Zealand, should resign due to an affair. The majority of people participating said he should. Should the mayor resign due to the results of this poll? Explain.
- An online poll showed that the majority of Americans believe that the government covered up events of 9/11. Does that really mean that most Americans believe this? Explain.
- A survey was conducted at a college asking all employees if they were satisfied with the level of security provided by the security department. Discuss how the results of this question could be biased.
- An employee survey says, “Employees at this institution are very satisfied with working here. Please rate your satisfaction with the institution.” Discuss how this question could create bias.
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A survey has a question that says, “Most people are afraid that they will lose their house due to economic collapse. Choose what you think is the biggest issue facing the nation today.
- Economic collapse
- Foreign policy issues
- Environmental concerns.” Discuss how this question could create bias.
- A survey says, “Please rate the career of Roberto Clemente, one of the best right field baseball players in the world.” Discuss how this question could create bias.
- Answer
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See solutions


1.48: Uncrossed wires- working with non-English speaking patient populations
At the end of this activity, students will be able to:
- Identify health-related barriers for non-English speaking patient populations
- Discuss challenges that pharmacists may encounter when working with non-English speaking patient populations
- Propose strategies that pharmacists may use to overcome barriers when assisting non-English speaking patient populations seeking healthcare
- Identify resources that may be relevant for pharmacists when working with non-English speaking patient populations
Introduction
Language barriers have been identified as a determinant of health and a risk factor for adverse events. In the United States, non-English speaking patient populations encounter several health-related barriers in managing the dynamics of transcultural or cross-cultural care. Patients may be uncomfortable or distrustful of healthcare professionals, whether from previous negative experiences, cultural differences in expectations, or lack of trust in the healthcare professionals or the system itself. Issues related to transitions of care, medication adherence, patient counseling, health literacy, health disparities, and healthcare access issues also exist. Examples may include misunderstanding of directions for taking medication, instructions or need for follow-up appointments, or disease state education. To address these language-related issues to advance health equity, improve healthcare quality, and eliminate healthcare disparities, the United States Department of Health and Human Services Office of Minority Health (OMH) developed national standards for ensuring the provision of Culturally and Linguistically Appropriate Services (CLAS). 1
A systematic review of 14 studies within eight countries, which included 300,918 cross-cultural participants, studied the impacts of language barrier in healthcare. The researchers found that a language barrier between patients and healthcare professionals resulted in miscommunication, thereby resulting in dissatisfaction of both parties, decreased quality of healthcare delivery and patient safety, and increased the cost and time of care delivery. 2 The authors concluded that the use of online translation tools (e.g., Google Translate and MediBabble) may improve not only patient and healthcare professional satisfaction but also the quality of healthcare, although it comes with an increase in indirect cost of care due to the additional interpreter services. 2 On the other hand, practical experience has shown that these online translation tools are not always accurate and should be used with caution.
Pharmacists encounter variable challenges when working with non-English speaking patient populations, and these depend on the knowledge and self-efficacy of the pharmacist. Some pharmacists may feel uncomfortable or insecure with using medical translators to provide pharmaceutical care due to inexperience with the third-party communication. Pharmacists can become better equipped to overcome these challenges by gaining the skills and tools necessary for cultural humility when dealing with the non-English-speaking patient populations.
 The GI physician contacts you because she would like for you to schedule a telephonic visit with a patient who has been scheduled for a repeat colonoscopy after a recent inconclusive colorectal screening. The patient visited the GI physician specialist for both his hepatitis B virus (HBV) infection follow-up ultrasound and colonoscopy results today.
CC: “I’m here for my colonoscopy results”
HPI: XZ is a 50-year-old Chinese male (70 in, 87.5 kg) visits the GI clinic for a follow-up. A Chinese language interpreter assists with his encounter. The physician notes that during his last visit three months ago, XZ received a colorectal cancer screening, which was limited by poor colon preparation. Five polyps were found throughout his rectum. However, he was recommended for a repeat procedure in 6-12 months with better preparation. He currently has no concerning symptoms such as rectal bleeding or pain.
PMH: HBV infection with cirrhosis; AUD; overweight
FH:
- Father: HBV (chronic)
SH:
- Alcohol use (1-2 beers daily)
- Caffeine use (mostly green or black tea)
- Denies illicit drug use
- Smokes cigarettes (unable to ascertain quantity or frequency of use)
Surgical/procedural/imaging history:
- Abdominal ultrasound three months ago: Suspected small polyp on gallbladder similar to exam one year prior; the liver was unremarkable in appearance
- Colonoscopy three months ago
ROS: XZ reports no changes since his last visit and no current complaints. He recently started a new job and has lost a few pounds.
V itals:
- BP 136/93 mmHg
- HR 93 bpm
- RR 18/min
- Temp 97.8°F
Labs:
- BMP normal
- CBC normal except platelets 115 thou/L (reference: 177-406)
| Type | Lab | Result (five months ago) | Normal range |
|---|---|---|---|
| Liver panel | Serum creatinine | 1.05 mg/dL | 0.6-1.2 mg/dL |
| GFR | 74 mL/min/1.73 m 2 | ≥60 mL/min/1.73 m 2 | |
| Albumin | 4.85 g/dL | 3.2-5.5 g/dL | |
| Total bilirubin | 0.8 mg/dL | 0.2-1.2 mg/dL | |
| ALT | 33 IU/L | 0-55 IU/L | |
| AST | 25 IU/L | 0-50 IU/L | |
| Alk phos | 52 IU/L | 30-130 IU/L | |
| INR | 0.99 | <1 | |
| HBV panel | HBV surface antigen | positive | negative |
| HBV viral DNA | Not detected | <10 IU/mL | |
| Tumor marker | Alpha fetoprotein | 3 ng/mL | 0-8.3 ng/mL |
Medications:
- Entecavir 0.5 mg tablet once daily
- PEG-3350/Electrolytes 236 gm as directed for colonoscopy
Additional context: XZ previously demonstrated very limited English proficiency and has notes in his chart requesting a Chinese interpreter at his visits. He occasionally had an English-speaking family member accompany him to clinic visits, but they were not always able to attend appointments. The patient often appeared more anxious during visits without his family member present, even though a medical interpreter was provided.
Also of note, the patient’s sister had a challenging and extended hospital stay approximately two years ago due to severe pneumonia and heart failure exacerbation. During her hospitalization, the family was concerned that she was not receiving appropriate treatment. They had difficulty obtaining information about her progress due to lack of consistent language interpretation services at the facility. The experience was frustrating for XZ and likely contributed to his development of a level of distrust of healthcare providers.
Case Questions
- How might language create a barrier for XZ in achieving optimal adherence to his HBV regimen? To the colon preparation instructions?
- What are potential outcomes if XZ is not able to fully understand instructions for medications and procedural instructions?
- How should the pharmacist approach contacting XZ utilizing CLAS standards?
- What role can a pharmacist play in addressing XZ’s poor adherence?
- What are some best practices for communication via medical interpreter to ensure optimal patient care during the patient’s visit? What questions or preferences could the pharmacist discuss with a trained medical interpreter prior to meeting with a non-English speaking patient to better prepare for a patient visit?
Author Commentary
Non-English speaking patients suffer the burden of language barriers including miscommunication and high cost of care due to additional services. Pharmacists must make conscious efforts to ensure healthcare equity for non-English speaking patient populations by seeking and implementing evidence-based strategies to minimize the negative medication-related impacts of language barriers for the non-English speaking patient populations.
Some pharmacists may lack the time to provide highly needed extended patient appointments or may be unaware of other available resources to improve quality of care for this population. Patients’ lack of health insurance, inadequate health insurance coverage, or access to other healthcare resources may affect the pharmacist reimbursement and discourage the provision of the additional services, including interpretation services to the non-English speaking patient population. Pharmacists can overcome these barriers by advocating for hiring staff from diverse language backgrounds, especially if the pharmacy serves patients from specific language communities.
Patient Approaches and Opportunities
Counseling non-English speaking patients effectively through a medical interpreter requires some adjustments. When possible, plan extra time for the interaction. Speak slowly and clearly but avoid yelling. Use short sentences to provide a manageable amount of information for translation and avoid use of complicated medical terms, slang, or abbreviations. Be aware of nonverbal communication and use a caring tone of voice and facial expression. Even if you do not understand the patient’s words, actively listen to the patient while he or she is talking. Similarly, speak to the patient and not the interpreter (e.g., “How can I help you today?” instead of asking the interpreter “How can I help her today?”). This is often difficult as our tendency is to look toward the interpreter, but addressing the patient directly helps reinforce the relationship with the patient and perception of care. As with all patients, use open-ended questions to ensure understanding, and when possible, use pictures or gestures to aid understanding. 3
Along with the CLAS standards, Joint Commission standards require accredited hospitals to provide information in a way that patients understand, which includes providing information in their preferred language. 4 Availability of in-person versus telephone or video interpretation varies, but healthcare providers should be aware of the resources available at their practice sites to ensure they can provide equitable care to patients regardless of their preferred language. Use of online or smartphone app-based translation may be helpful in emergency situations if no other service is available, but otherwise is discouraged, unless it has been designed and tested for reliable translation of medical information.
Pharmacists can play a key role in overcoming barriers encountered by non-English speaking patient populations seeking healthcare services. Commitment to ongoing cultural competence and awareness of these challenges are vital for providing high-quality care for non-English speaking patient populations.
Related chapters of interest:
- Saying what you mean doesn’t always mean what you say: cross-cultural communication
- Communicating health information: hidden barriers and practical approaches
- Ethical decision-making in global health: when cultures clash
- Equity for all: providing accessible healthcare for patients living with disabilities
- The Sustainable Development Goals and pharmacy practice: a blueprint for health
- You say medication, I say meditation: effectively caring for diverse populations
- Experiences of a Caribbean immigrant: going beyond clinical care
- The great undoing: a multigenerational journey from systemic racism to social determinants of health
External resources:
-
Websites:
- International Medical Interpreters Association. IMIA guide on working with medical interpreters. https://www.imiaweb.org/uploads/pages/380_5.pdf
- Games:
-
Videos:
- Fanlight Productions: Worlds Apart. http://fanlight.com/catalog/films/912_wa.php
-
Other:
- Ratzan SC, Parker RM. 2000. Introduction. In: National Library of Medicine Current Bibliographies in Medicine: Health Literacy . NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services. https://www.nlm.nih.gov/archive/20061214/pubs/cbm/hliteracy.html
References
- United States Department of Health and Human Services, Office of Minority Health. Culturally and linguistically appropriate services standards. https://thinkculturalhealth.hhs.gov/clas/standards . Accessed December 16, 2020.
- Shamsi HA, Almutairi AG, Mashrafi SA, Kalbani TA. Implications of language barriers for healthcare: a systematic review. Oman Med J 2020;35(2):e122. https://doi.org/10.5001/omj.2020.40 .
- International Medical Interpreters Association. IMIA guidelines for working with medical interpreters. https://www.imiaweb.org/uploads/pages/380_5.pdf . Accessed December 7, 2020.
- The Joint Commission. Advancing effective communication, cultural competence, and patient- and family-centered care: a roadmap for hospitals. 2010. https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/health-equity/aroadmapforhospitalsfinalversion727pdf . Accessed December 7, 2020.


16.4: Assumption Checking
As with one-way ANOVA, the key assumptions of factorial ANOVA are homogeneity of variance (all groups have the same standard deviation), normality of the residuals, and independence of the observations. The first two are things we can test for. The third is something that you need to assess yourself by asking if there are any special relationships between different observations. Additionally, if you aren’t using a saturated model (e.g., if you’ve omitted the interaction terms) then you’re also assuming that the omitted terms aren’t important. Of course, you can check this last one by running an ANOVA with the omitted terms included and see if they’re significant, so that’s pretty easy. What about homogeneity of variance and normality of the residuals? As it turns out, these are pretty easy to check: it’s no different to the checks we did for a one-way ANOVA.
Levene test for homogeneity of variance
To test whether the groups have the same variance, we can use the Levene test. The theory behind the Levene test was discussed in Section 14.7, so I won’t discuss it again. Once again, you can use the
leveneTest()
function in the
car
package to do this. This function expects that you have a saturated model (i.e., included all of the relevant terms), because the test is primarily concerned with the within-group variance, and it doesn’t really make a lot of sense to calculate this any way other than with respect to the full model. So we try either of the following commands:
leveneTest( model.2 )
leveneTest( mood.gain ~ drug + therapy, clin.trial )
R will spit out the following error:
Error in leveneTest.formula(formula(y), data = model.frame(y), ...) :
Model must be completely crossed formula only.
Instead, if you want to run the Levene test, you need to specify a saturated model. Either of the following two commands would work: 237
library(car)
leveneTest( model.3 )
## Levene's Test for Homogeneity of Variance (center = median)
## Df F value Pr(>F)
## group 5 0.0955 0.9912
## 12
leveneTest( mood.gain ~ drug * therapy, clin.trial )
## Levene's Test for Homogeneity of Variance (center = median)
## Df F value Pr(>F)
## group 5 0.0955 0.9912
## 12
The fact that the Levene test is non-significant means that we can safely assume that the homogeneity of variance assumption is not violated.
Normality of residuals
As with one-way ANOVA, we can test for the normality of residuals in a straightforward fashion (see Section 14.9). First, we use the
residuals()
function to extract the residuals from the model itself, and then we can examine those residuals in a few different ways. It’s generally a good idea to examine them graphically, by drawing histograms (i.e.,
hist()
function) and QQ plots (i.e.,
qqnorm()
function. If you want a formal test for the normality of the residuals, then we can run the Shapiro-Wilk test (i.e.,
shapiro.test()
). If we wanted to check the residuals with respect to
model.2
(i.e., the model with both main effects but no interactions) then we could do the following:
resid <- residuals( model.2 ) # pull the residuals
hist( resid ) # draw a histogram
qqnorm( resid ) # draw a normal QQ plot
shapiro.test( resid ) # run the Shapiro-Wilk test
##
## Shapiro-Wilk normality test
##
## data: resid
## W = 0.95635, p-value = 0.5329
I haven’t included the plots (you can draw them yourself if you want to see them), but you can see from the non-significance of the Shapiro-Wilk test that normality isn’t violated here.


6.3: Inside the Earth
Before you can learn about plate tectonics, you need to know something about the layers that are found inside Earth. These layers are divided by composition into core, mantle, and crust or by mechanical properties into lithosphere and asthenosphere. Scientists use information from earthquakes and computer modeling to learn about Earth’s interior.
EXPLORING EARTH’S INTERIOR
How do scientists know what is inside the Earth? We don’t have direct evidence! Rocks yield some clues, but they only reveal information about the outer crust. In rare instances, a mineral, such as a diamond, comes to the surface from deeper down in the crust or the mantle. To learn about Earth’s interior, scientists use energy to “see” the different layers of the Earth, just like doctors can use an MRI, CT scan, or x-ray to see inside our bodies.
SEISMIC WAVES
One ingenious way scientists learn about Earth’s interior is by looking at how energy travels from the point of an earthquake. These are seismic waves (figure 1). Seismic waves travel outward in all directions from where the ground breaks at an earthquake.  Two types of seismic waves are most useful for learning about Earth’s interior.
-
P-waves (primary waves) are fastest, traveling at about 6 to 7 kilometers (about 4 miles) per second, so they arrive first at the seismometer. P-waves move in a compression/expansion type motion, squeezing and unsqueezing earth materials as they travel. This produces a change in volume for the material. P-waves bend slightly when they travel from one layer into another. Seismic waves move faster through denser or more rigid material. As P-waves encounter the liquid outer core, which is less rigid than the mantle, they slow down. This makes the P-waves arrive later and further away than would be expected. The result is a P-wave shadow zone. No P-waves are picked up at seismographs 104° to 140° from the earthquakes focus.
Figure 1. How P-waves travel through Earth’s interior. - S-waves (secondary waves) are about half as fast as P-waves, traveling at about 3.5 km (2 miles) per second, and arrive second at seismographs. S-waves move in an up and down motion perpendicular to the direction of wave travel. This produces a change in shape for the earth materials they move through. Only solids resist a change in shape, so S-waves are only able to propagate through solids. S-waves cannot travel through liquid.
By tracking seismic waves, scientists have learned what makes up the planet’s interior (figure 2).
- P-waves slow down at the mantle core boundary, so we know the outer core is less rigid than the mantle.
- S-waves disappear at the mantle core boundary, so the outer core is liquid.
Figure 2. Letters describe the path of an individual P-wave or S-wave. Waves traveling through the core take on the letter K.
This animation shows a seismic wave shadow zone.
Other Clues About Earth's Interior
- Earth’s overall density is higher than the density of crustal rocks, so the core must be made of something dense, like metal.
- Since Earth has a magnetic field, there must be metal within the planet. Iron and nickel are both magnetic.
- Meteorites are the remains of the material that formed the early solar system and are thought to be similar to material in Earth’s interior (figure 3).
Figure 3. This meteorite contains silica minerals and iron-nickel. The material is like the boundary between Earth’s core and mantle.
THE EARTH’S LAYERS
The layers scientists recognize are pictured in figure 4.
Figure 4. A cross section of Earth showing the following layers: (1) crust (2) mantle (3a) outer core (3b) inner core (4) lithosphere (5) asthenosphere (6) outer core (7) inner core.
Core, mantle, and crust are divisions based on composition:
- The crust is less than 1% of Earth by mass. The oceanic crust is mafic, while continental crust is often more felsic rock.
- The mantle is hot, ultramafic rock. It represents about 68% of Earth’s mass.
- The core is mostly iron metal. The core makes up about 31% of the Earth.
Lithosphere and asthenosphere are divisions based on mechanical properties:
- The lithosphere is composed of both the crust and the portion of the upper mantle that behaves as a brittle, rigid solid.
- The asthenosphere is partially molten upper mantle material that behaves plastically and can flow.
This animation shows the layers by composition and by mechanical properties.
Crust and Lithosphere
Earth’s outer surface is its crust; a cold, thin, brittle outer shell made of rock. The crust is very thin, relative to the radius of the planet. There are two very different types of crust, each with its own distinctive physical and chemical properties, which are summarized in table 1.
| Crust | Thickness | Density | Composition | Rock types |
|---|---|---|---|---|
| Oceanic | 5-12 km (3-8 mi) | 3.0 g/cm 3 | Mafic | Basalt and gabbro |
| Continental | Avg. 35 km (22 mi) | 2.7 g/cm 3 | Felsic | All types |
Oceanic crust is composed of mafic magma that erupts on the seafloor to create basalt lava flows or cools deeper down to create the intrusive igneous rock gabbro (figure 5).
Figure 5. Gabbro
Sediments, primarily muds and the shells of tiny sea creatures, coat the seafloor. Sediment is thickest near the shore where it comes off the continents in rivers and on wind currents.
Continental crust is made up of many different types of igneous, metamorphic, and sedimentary rocks. The average composition is granite, which is much less dense than the mafic rocks of the oceanic crust (figure 6). Because it is thick and has relatively low density, continental crust rises higher on the mantle than oceanic crust, which sinks into the mantle to form basins. When filled with water, these basins form the planet’s oceans.
Figure 6. This granite from Missouri is more than 1 billion years old.
The lithosphere is the outermost mechanical layer, which behaves as a brittle, rigid solid. The lithosphere is about 100 kilometers thick. Look at figure 4. Can you find where the crust and the lithosphere are located? How are they different from each other?
The definition of the lithosphere is based on how earth materials behave, so it includes the crust and the uppermost mantle, which are both brittle. Since it is rigid and brittle, when stresses act on the lithosphere, it breaks. This is what we experience as an earthquake.
Mantle
The two most important things about the mantle are: (1) it is made of solid rock, and (2) it is hot. Scientists know that the mantle is made of rock based on evidence from seismic waves, heat flow, and meteorites.
The properties fit the ultramafic rock peridotite, which is made of the iron- and magnesium-rich silicate minerals (figure 7). Peridotite is rarely found at Earth’s surface.
Figure 7. Peridotite is formed of crystals of olivine (green) and pyroxene (black).
Scientists know that the mantle is extremely hot because of the heat flowing outward from it and because of its physical properties.
Heat flows in two different ways within the Earth:
- Conduction: Heat is transferred through rapid collisions of atoms, which can only happen if the material is solid. Heat flows from warmer to cooler places until all are the same temperature. The mantle is hot mostly because of heat conducted from the core.
- Convection: If a material is able to move, even if it moves very slowly, convection currents can form.
Convection in the mantle is the same as convection in a pot of water on a stove. Convection currents within Earth’s mantle form as material near the core heats up. As the core heats the bottom layer of mantle material, particles move more rapidly, decreasing its density and causing it to rise. The rising material begins the convection current. When the warm material reaches the surface, it spreads horizontally. The material cools because it is no longer near the core. It eventually becomes cool and dense enough to sink back down into the mantle. At the bottom of the mantle, the material travels horizontally and is heated by the core. It reaches the location where warm mantle material rises, and the mantle convection cell is complete (figure 8).
Figure 8. Convections
Core
At the planet’s center lies a dense metallic core. Scientists know that the core is metal because:
- The density of Earth’s surface layers is much less than the overall density of the planet, as calculated from the planet’s rotation. If the surface layers are less dense than average, then the interior must be denser than average. Calculations indicate that the core is about 85% iron metal with nickel metal making up much of the remaining 15%.
- Metallic meteorites are thought to be representative of the core. The 85% iron/15% nickel calculation above is also seen in metallic meteorites (figure 9).
Figure 9. An iron meteorite is the closest thing to the Earth’s core that we can hold in our hands.
If Earth’s core were not metal, the planet would not have a magnetic field. Metals such as iron are magnetic, but rock, which makes up the mantle and crust, is not.
Scientists know that the outer core is liquid and the inner core is solid because:
- S-waves stop at the inner core.
- The strong magnetic field is caused by convection in the liquid outer core. Convection currents in the outer core are due to heat from the even hotter inner core.
The heat that keeps the outer core from solidifying is produced by the breakdown of radioactive elements in the inner core.
LESSON SUMMARY
- Earth is made of three layers: the crust, mantle, and core.
- The brittle crust and uppermost mantle are together called the lithosphere.
- Beneath the lithosphere, the mantle is solid rock that can flow, or behave plastically.
- The hot core warms the base of the mantle, which causes mantle convection.
REFLECTION QUESTIONS
- What skill does this content help you develop?
- What are the key topics covered in this content?
- How can the content in this section help you demonstrate mastery of a specific skill?
- What questions do you have about this content?
Contributors and Attributions
-
Original content from Kimberly Schulte (Columbia Basin College) and supplemented by Lumen Learning . The content on this page is copyrighted under a Creative Commons Attribution 4.0 International license.


5.4: Interpreting Point-of-Sale Information
Point-of-sale information is information that is gathered from your daily (or even hourly) receipts. Before computerized equipment was available, a supervisor would analyze the sales at the end of each day using the handwritten guest cheques. The total number of customers, the average cheque size, and the amounts of each entrée sold were tallied and recorded. The supervisor would also compute total sales, check cash against cash register totals, and complete other financial records. The information from the sales analysis was used by the chef or restaurant manager to manage inventory, predict volume of sales, and judge the popularity of items.
Types of Point-of-Sale Equipment
Today, most point-of-sales reports are generated automatically by point-of-sales (POS) hardware and software. A simple POS system may be a single cash register connected to a computer terminal that stores data, or it may be more complex with multiple terminals, handheld devices or tablets, and even smartphones connected to the system by supported applications, and also connected to printers at various points in the system that will print orders directly in the kitchen or bar area.
POS systems consist of a number of terminals connected to a central processing unit (Figure 38). For a terminal to process transactions, it must be connected to the central unit which houses the software and memory to process the information. Several types of terminals may be available. A pre-check terminal is used to enter orders; it has no cash drawer. Many pre-check terminals are now available in hand-held cordless models, or tablets or smartphones can be used for this purpose.
In some systems, a pre-check terminal is used to enter and print the orders for a table. The printed copy is then given to the kitchen to relay the order. In other systems, the order is sent directly from the pre-check machine to a printer in the kitchen or bar. The server does not have to carry the order over to the pickup counter.
A separate cashier terminal is used to settle guests’ cheques. The information may also be sent automatically to a journal printer and a manager workstation. The journal printer is usually located in a secure area and provides management with a detailed systems audit.
POS systems produce very detailed receipts (Figure 39). The wealth of information recorded by the machine allows much more detailed analysis of sales than was possible when guest cheques were handwritten.
POS information is a powerful tool that permits you to analyze menu performance and revise menus, forecast labour requirements, forecast inventory requirements, and analyze staff performance and sales. POS systems have the ability to generate
- Sales analysis reports
- Labour reports such as employee hours, wages, credits for meals, numbers of guests served per server, gross sales per server, average cheque size per server, and so forth
- Inventory files that can be used by inventory management software to automatically deduct items from inventory based on the standard recipe for a menu item
- Other management reports such as a daily revenue report
Sales Analysis Report
A sales analysis report analyzes sales by menu item. It can be computed for any period of time including an hour, a meal period (e.g., breakfast, lunch), a day, a week, or a month. The detailed reporting permits you to identify peak periods precisely. Fast-food restaurants will often want to analyze sales hourly to maximize the utilization of labour. The report includes:
- Number of items sold in each period
- Individual and total food cost for each menu item during the period (based on standard recipes and standard costs)
- Total food cost for the period (also called expected cost or ideal cost)
- Ideal food cost percentage
Ideal Food Cost
The ideal food cost is based on actual items sold. It is calculated by multiplying the actual number of items sold by the standard food cost per item, then summing the costs for all menu items. The ideal food cost is then compared to actual food costs. The standard recipe and standard cost must be regularly updated and recalculated for the comparison to be valid. The two costs should be fairly close. Minor variations can be the result of special purchases of bulk items or the use of small quantities of some items that are not restocked on a weekly basis. Larger discrepancies may indicate waste due to spills and spoilage, pilferage, poor portion control, changes in quality and yield of stock (e.g., due to overcooking). Customer complaints can result in an item being discarded without being charged or a second item being cooked.
Example
Menu Analysis and Engineering
Sales analysis reports provide detailed information that can be very helpful in menu planning. The reports can analyze the profitability and popularity of each item. You can then use the results to review the menu and make changes. Refer to the section of this book on menu engineering for more detail on how to use this information.
Forecasting Inventory Requirements
POS information can also be used to forecast inventory and staff requirements. If you have sales records that indicate that in a typical week you sell 84 portions of salmon and 97 portions of sirloin steak, you can look at your current inventory and decide how much you need to order for the coming week. Figure 40 illustrates this scenario.
| Menu Item | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday | Total | % Mix |
|---|---|---|---|---|---|---|---|---|---|
| Italian pizza | 7 | 9 | 10 | 10 | 25 | 22 | 17 | 100 | 11.90% |
| Cajun chicken | 8 | 9 | 9 | 12 | 10 | 13 | 12 | 73 | 8.69% |
| Sirloin steak | 5 | 8 | 6 | 8 | 27 | 25 | 18 | 97 | 11.55% |
| Chicken stir fry | 10 | 7 | 9 | 6 | 10 | 15 | 11 | 68 | 8.10% |
| Prawn stir fry | 5 | 5 | 6 | 11 | 8 | 8 | 6 | 49 | 5.83% |
| Linguine | 9 | 9 | 9 | 16 | 8 | 11 | 12 | 74 | 8.81% |
| Linguine chicken | 12 | 19 | 13 | 8 | 15 | 10 | 17 | 93 | 11.07% |
| Fettuccine alfredo | 11 | 13 | 12 | 18 | 16 | 19 | 22 | 111 | 13.21% |
| Salmon | 4 | 16 | 13 | 5 | 18 | 11 | 17 | 84 | 10.00% |
| BBQ chicken | 15 | 11 | 10 | 11 | 9 | 19 | 16 | 91 | 10.83% |
| Total | 81 | 106 | 97 | 106 | 146 | 153 | 147 | 840 | 100% |
If you have detailed reports that indicate the sales mix over the week, you can predict the required quantities of stock more precisely. In this example (Figure 40), the sales shown for the entire week are broken down into daily totals. If you look at the sales for sirloin steak, you will notice that they are not evenly spread throughout the week. If you have a delivery on Friday that must last you until Monday, you must have at least 70 steaks on hand to last you through the weekend.
Forecasting Staffing Requirements
If you have detailed reports that indicate levels of sales by hour, meal period, and day, you will be able to identify peak days and times more easily. Figure 41 shows an example.
| Meal Period | Mon | Tues | Wed | Thu | Fri | Sat | Sun |
|---|---|---|---|---|---|---|---|
| 5:00-6:00 | 56 | 72 | 48 | 54 | 53 | 119 | 123 |
| 6:00-7:00 | 94 | 156 | 117 | 119 | 94 | 121 | 131 |
| 7:00-8:00 | 145 | 183 | 156 | 173 | 156 | 163 | 165 |
| 8 :00-9:00 | 89 | 87 | 101 | 115 | 203 | 207 | 177 |
| 9:00-10:00 | 73 | 66 | 54 | 78 | 177 | 177 | 96 |
| 10:00-11:00 | 45 | 42 | 47 | 37 | 72 | 74 | 45 |
| Total | 502 | 606 | 523 | 576 | 755 | 861 | 737 |
You need to schedule staff for the restaurant. You need to know what times are busiest and how much staffing you will need for each period. In Figure 41, you can see that Monday and Wednesday are your slowest days, while Friday and Saturday are the busiest. There is also a different pattern for the peak times on weekdays versus the weekend. On Saturday and Sunday nights, volume peaks later in the evening and the peak period is much longer. For example, on Wednesday the peak of 156 guests comes between 7:00 p.m. and 8:00 p.m., while on Saturday, the peak is between 8:00 p.m. and 9:00 p.m.
Historical data collected from month to month and year to year is useful for projecting trends and seasonal variations in sales and, therefore, staffing needs. It may also be used to determine whether the sales figures you had for last Tuesday show an unexplained blip, or whether indeed Tuesday is usually a better day for your restaurant than Monday or Wednesday.
Another use for historical data is to project sales for holidays and special occasions. For example, last year, you had 250 guests for brunch on Mother’s Day. If this year, your average sales are up 10%, you might conclude that you need to have sufficient staff to handle 275 guests.
Manage Staff
POS information can also be used to manage staff. The software will allow you to prepare reports that track the sales of each server. You might be able to determine the average cheque size of guests served by each server. You could also track the amount of alcohol, appetizer, and dessert sales to see whether your servers are suggestively selling these items. If you have an incentive program to sell specific menu items or specials, you could track the staff member’s performance. These reports may be used to give feedback to staff on their performance and suggest methods of improving their sales.
Summary
Overall, the POS system has become a very effective tool for the industry to collect and manage a wide array of information. The advantages that the technology has brought are in the rapid calculation and analysis of a large amount of data, but all of these systems still require those who operate them and interpret the data to have a solid understanding of the principles of effective kitchen management and cost controls.


Skip to main content
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15.1: Motivation
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Driving routes on a graph. Looking at a map of Alberta, you might decide that there are three reasonable driving routes from Camrose to Red Deer and three reasonable driving routes from Red Deer to Drumheller.
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15.2: Walks, trails, and paths
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Suppose G=(V,E) is a graph.
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15.3: Connected Vertices, Graphs, and Components
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Connected Vertices: a pair of vertices v,v′ such that there exists a walk beginning at v and ending at v′
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15.4: Articulation vertices, bridges, and edge connectivity
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Articulation Vertex: a vertex of a graph such that, if it were to be removed (along with any edges incident to it), the resulting subgraph would have more connected components than the original
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15.5: Activities
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15.6: Exercises
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The sequential steps derived in the goal analysis are often too large to be taught in one step. The learner might need more information prior to learning a step. This can be seen in step 7 in Figure 10.3.1, where the learner needs some information about zooming in or out. Consequently, you need to break the steps into smaller components, using a subordinate skills analysis. When identifying subordinate skills, ensure the components are not too numerous, which can bore learners and interfere with learning, or too few, which can make the instruction ineffective. For each learning domain classification, you need to conduct a different type of subordinate skills analysis.
Verbal Information
With verbal information, you should derive the subordinate skills through a cluster analysis. In conducting a cluster analysis, identify all of the information that is needed to achieve the goal. After you gather the information, organize the information into logical groupings. Logical groupings should have up to five pieces of information for weaker or younger learners, or up to seven pieces of information for brighter or older learners. A few people can handle nine pieces of information but it is risky to assume that all learners in the target audience can do this. Humans can only process a limited amount of information at a time. These limitations must be factored into the design. To be safe, whenever there is doubt, choose smaller groupings.
Although some people think that verbal information is trivial, it provides the knowledge base for higher-level skills.
Note
Organize the information into small enough chunks for the learners to successfully learn.
Given the learning outcome “learners will be able to name body parts,” the verbal knowledge can be organized as illustrated in Table \(\PageIndex{1}\)
Table \(\PageIndex{1}\):Organization of verbal knowledge for teaching body parts
Body area
Major parts
Smaller parts
Head
Eyes
Ears
Nose
Mouth
Lips, teeth, tongue
Torso
Shoulder
Chest
Abdomen
Belly button
Arm
Upper arm
Elbow
Forearm
Wrist
Hand
Palm, thumb, fingers
Leg
Thigh
Knee
Shin
Ankle
Foot
Heel, toes
Intellectual Skills
With respect to intellectual skills, you need to conduct a hierarchical analysis to determine the subordinate skills. An example of the skills needed to multiply three digit numbers is shown in Figure \(\PageIndex{1}\).
For a hierarchical analysis, follow these steps:
For each goal analysis ask, “What must the learner know before learning this skill?” This creates the first hierarchical level.
For each first level component, ask the same question. This creates a second hierarchical level.
Continue this process as needed.
Assuming a problem-solving goal, the first level might be composed of rules, the second level might be rules or concepts, the third level might be concepts or verbal information, etc. Each level can have a simpler or equally difficult skill underneath it. (See Fenrich (2005) for more information on rules and concepts.)
Psychomotor Skills
You can derive subordinate psychomotor skills through a procedural analysis. An example of the subordinate skills needed for charging a battery for a camcorder is shown in Figure \(\PageIndex{2}\).
When conducting a procedural analysis:
Specify each activity that must be done for each goal analysis step.
Ask, “What must the student do or know before this step can be done?”
Continue this process as needed.
The resulting chart can include several layers.
Attitudes
To determine the subordinate attitude skills, you usually need to conduct at least one of the preceding instructional analysis techniques:
For each goal analysis step, ask “What must the student do when showing this attitude?” The answer is usually a cognitive, intellectual, or psychomotor skill. With this information, you can do the appropriate analysis.
Ask, “Why should learners show this attitude?” The answer is usually verbal information. You should then do a cluster analysis.


4.2: WAI-ARIA Landmarks
WAI-ARIA landmarks are used to define regions on a web page. They provide a means for assistive technology users to effectively navigate the various areas of a page. WAI-ARIA landmarks should be used with other means of within-page navigation, such as bypass links and page headings. These two latter means of navigating have been around for much longer, and many will continue to use these elements as their primary method of moving around within a web page.
There are eight landmark roles.
Follow the links below to read about each type of landmark:
In the following short video, you will see how ChromeVox interacts with landmarked regions for the next activity coming up in this unit. Use it as a model for implementing your own landmarks. Aim to have your activity submission operate the same as it does in the video.
Video: WAI-ARIA Landmarks Demo (1:07)
To help visualize landmarked regions, the figure below presents well-defined areas on the page, each of which serves a different purpose. Banner areas, the element that contains the content of each banner region, would be assigned
role="banner"
. The menu on the left would have its container assigned
role="navigation"
, as would other navigation bars or menus if they were present. The main content area, assigned
role="main"
, is where the primary content of the page appears. There should only be
one
main region. The region on the right containing secondary information, assigned
role="complementary"
, is where you might find advertising or related resources. And, finally, the container around the footer area would be assigned
role="contentinfo"
. This is where details such as copyright, a privacy statement, contact information, etc., would be located.
Websites may be laid out in a multitude of ways; this particular layout is just an example. The landmarks assigned to any given region should reflect the function of that particular region, regardless of where it might appear on the page. If advertising were spread across a region at the bottom of the page, for example, then that region would be assigned
role="complementary"
.
Example of landmarked regions of a web page:
Custom Regions
While most of the landmarks are relatively self-explanatory in terms of what they should contain,
role="region"
needs some explanation. This landmark role can be used to contain specific information that is not effectively described by one of the other landmark roles and is important enough that a user might want to navigate directly to that area of the page. When it is used, it must be accompanied by
aria-label
or
aria-labelledby
if there is an existing element on the page that describes the region (such as a heading).
For example, you may want to define a specific area on each page where contact information or a contact form is located. The following markup might be used to define a “contact region.”
Other Considerations When Using Landmarks
- The whole page defined in regions : When landmarks are used, it is considered best practice to contain all information presented on a page within a region, so no information is orphaned outside the defined regions.
-
Duplicate roles
: For landmarks that may be used for multiple regions, such as
role="navigation"
, these regions should be distinguished from one another. For instance, usearia-label
oraria-labelledby
to describe a “main navigation” bar and a “content menu.” Both are considered navigation features, even though they serve different purposes.


3.1.1: Maximization Applications (Exercises)
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For the following maximization problems, choose your variables, write the objective function and the constraints, graph the constraints, shade the feasibility region, label all critical points, and determine the solution that optimizes the objective function.
1) A farmer has 100 acres of land on which she plans to grow wheat and corn. Each acre of wheat requires 4 hours of labor and $20 of capital, and each acre of corn requires 16 hours of labor and $40 of capital. The farmer has at most 800 hours of labor and $2400 of capital available. If the profit from an acre of wheat is $80 and from an acre of corn is $100, how many acres of each crop should she plant to maximize her profit?
2) Mr. Tran has $24,000 to invest, some in bonds and the rest in stocks. He has decided that the money invested in bonds must be at least twice as much as that in stocks. But the money invested in bonds must not be greater than $18,000. If the bonds earn 6%, and the stocks earn 8%, how much money should he invest in each to maximize profit?
3) A factory manufactures chairs and tables, each requiring the use of three operations: Cutting, Assembly, and Finishing. The first operation can be used at most 40 hours; the second at most 42 hours; and the third at most 25 hours. A chair requires 1 hour of cutting, 2 hours of assembly, and 1 hour of finishing; a table needs 2 hours of cutting, 1 hour of assembly, and 1 hour of finishing. If the profit is $20 per unit for a chair and $30 for a table, how many units of each should be manufactured to maximize revenue?
4)
The Silly Nut Company makes two mixtures of nuts: Mixture A and Mixture B. A pound of Mixture A contains 12 oz of peanuts, 3 oz of almonds and 1 oz of cashews and sells for $4. A pound of Mixture B contains 12 oz of peanuts, 2 oz of almonds and 2 oz of cashews and sells for $5. The company has 1080 lb. of peanuts, 240 lb. of almonds, 160 lb. of cashews. How many pounds of each of mixtures A and B should the company make to maximize profit?
(Hint: Use consistent units. Work the entire problem in pounds by converting all values given in ounces into fractions of pounds).
5) \[\begin{array}{lc}
\text { Maximize: } &Z=4 x+10 y \\
\text { Subject to: } & x+y \leq 5 \\
& 2 x+y \leq 8 \\
& x+2 y \leq 8 \\
& x \geq 0, y \geq 0
\end{array}\nonumber \]
6) This maximization linear programming problem is not in “standard” form. It has mixed constraints, some involving ≤ inequalities and some involving ≥ inequalities. However with careful graphing, we can solve this using the techniques we have learned in this section.
\[\begin{array}{ll}
\text { Maximize: } &Z=5 x+7 y \\
\text { Subject to: } & x+y \leq 30 \\
& 2 x+y \leq 50 \\
& 4 x+3 y \geq 60 \\
& 2 x \geq y \\
& x \geq 0, y \geq 0
\end{array} \nonumber \]


20.11: Checklist for Staple Removal
Staples are made of stainless steel wire and provide strength for wound closure. Staples are strong, quick to insert, and simple to remove, but may cause more scarring than sutures.
Removal of staples is similar to the removal of sutures, but requires a sterile staple extractor instead of forceps and suture scissors. Typically every second staple is initially removed, and then the remaining staples are removed at a later time. In general, staples are removed within 7 to 14 days. See Figure \(\PageIndex{1}\) [1] for an example of staple removal.
Checklist for Staple Removal
Please follow the checklist below to review the steps for completion of “Staple Removal.”
Steps
Disclaimer: Always review and follow agency policy regarding this specific skill.
- Gather supplies: sterile staple extractors, sterile dressing tray, nonsterile gloves, normal saline, Steri-Strips, and sterile outer dressing.
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Perform safety steps:
- Perform hand hygiene.
- Check room for transmission-based precautions.
- Introduce yourself, your role, the purpose of your visit, and an estimate of the time it will take.
- Confirm patient ID using two patient identifiers (e.g., name and date of birth).
- Be organized and systematic.
- Use appropriate listening and questioning skills.
- Listen and attend to patient cues.
- Ensure the patient’s privacy and dignity.
- Assess ABCs.
- Confirm the provider order and explain the procedure to patient. Explanation helps prevent anxiety and increases compliance with the procedure. Inform the patient the procedure is not painful but they may feel some pulling or pinching of the skin during staple removal.
- Prepare the environment, position the patient, adjust the height of the bed, and turn on the lights. Ensuring proper lighting allows for good visibility to assess the wound. Ensure proper body mechanics for yourself and create a comfortable position for the patient.
- Place a clean, dry barrier on the bedside tables and add necessary supplies.
- Perform hand hygiene and apply nonsterile gloves.
- Remove the dressing and inspect the wound. Visually assess the wound for uniform closure of the wound edges, absence of drainage, redness, and swelling. After assessing the wound, decide if the wound is sufficiently healed to have the staples removed. If there are concerns, discuss the status of the wound before proceeding with the health care provider. For safety purposes, count the number of staples before beginning the procedure.
- Irrigate the wound with sterile normal saline solution to remove surface debris or exudate to reduce risk of infection from microorganisms on the wound site or surrounding skin and to help loosen and remove any dried blood or crusted exudate from the sutures and wound bed.
- Remove gloves, perform hand hygiene, and apply nonsterile gloves.
- Place a sterile 2″ x 2″ next to the wound to collect the staples.
- Remove the staples (start with every second staple).
- Place the lower tip of the staple extractor beneath the staple. Do not pull up while depressing the handle on the staple remover or change the angle of your wrist or hand. Close the handle, and then gently move the staple side to side to remove. The closed handle depresses the middle of the staple causing the two ends to bend outward and out of the top layer of skin.
- When both ends of the staple are visible, move the staple extractor away from the skin and place the staple on a sterile piece of gauze by releasing the handles on the staple extractor. This avoids pulling the staple out prematurely and avoids putting pressure on the wound. It also prevents scratching the skin with the sharp staple.
- Using the principles of no-touch technique, place Steri-Strips on the location of every removed staple along the incision line. Steri-Strips are supplied in pre-cut lengths. Cut the Steri-Strips to allow them to extend 1.5 to 2 cm on each side of the incision. Steri-Strips support wound tension across wounds and eliminate scarring. This allows wounds to heal by primary intention.
- Remove the remaining staples as indicated, followed by applying Steri-Strips along the incision line. Count the number of removed staples and compare to the pre-count to ensure safety.
- Apply a dry, sterile dressing on the incision site or leave it exposed to the air according to provider orders.
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Discard the supplies according to agency policies for sharps disposal and biohazard waste:
- The staple extractor may be disposed of or sent for sterilization according to agency policy.
- Perform hand hygiene.
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Complete patient teaching regarding Steri-Strips, bathing, and inspecting wound for separation. Instruct the patient to:
- Take showers rather than bathe in a tub.
- Avoid pulling off Steri-Strips but allow them to fall off naturally and gradually (usually takes one to three weeks).
- Receive adequate rest, fluids, nutrition, and ambulation for optional wound healing
- Assist the patient to a comfortable position, ask if they have any questions, and thank them for their time.
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Ensure safety measures when leaving the room:
- CALL LIGHT: Within reach
- BED: Low and locked (in lowest position and brakes on)
- SIDE RAILS: Secured
- TABLE: Within reach
- ROOM: Risk-free for falls (scan room and clear any obstacles)
- Document the procedure and assessment findings regarding the appearance of the incision. Report any concerns according to agency policy.
- "DSC_02191.jpg" by British Columbia Institute of Technology is licensed under CC BY 4.0. Access for free at https://opentextbc.ca/clinicalskills/chapter/4-4-suture-care-and-removal/ ↵


10.4: Our Star, the Sun
The sun, our central star in the solar system, plays a major role in life on Earth. The sun is about 300,000 times closer than the next closest star, Proxima Centauri. It takes light about 8. 3 minutes to travel from the sun to Earth; whereas light from Proxima Centauri takes over four years. Size and temperature-wise, the sun is an “average” star, at best. The sun goes through constant changes: energy output, brightness, size; all of which affect Earth.
Studying the sun and how it works allows astronomers to understand other stars. This study of how stars work is called Astrophysics . We specifically study the sun’s fusion process.
The sun’s photosphere vibrates like ripples on a pond. This is due to the sun producing sound waves through the gases. Sound waves and ripples emanate from within the Sun at very low frequencies deep within the Sun and higher frequencies close to the Sun’s surface. Studying these ripples and sound waves allows astronomers to examine the sun’s interior.