33
Anna Mary Cooper and Alex Clarke-Cornwell, University of Salford, UK
The link between the built environment and the impact on people’s health is well known, and the interest in this area is continuing to grow at pace (Jackson, Dannenberg, & Frumkin, 2013). In developed countries, we are seeing illness and disease related to lifestyle risk factors becoming the biggest risk to mortality and hospital admissions. Lopez (2012), in the book ‘The Built Environment and Public Health’ writes:
“The built environment provides the framework for how daily lives are conducted, influences health across life spans, and represents important pathways through which individuals come into contact with many health risks” (p. 4)
To start with we want to give you an example from the University of Salford (UK) of how buildings can impact our movement. For many, the workplace has a large impact on our physical activity and sedentary behaviour, through both building design and workplace culture (Finch, Wilson, & Dugdill, 2012). The images below show examples of two buildings on the University of Salford campus. The first is a new building (2011) where the stairs are clearly visible as you enter through the main doors, and the lift (elevator) is at the back of the building (by the red carpet). The second is an older building (1966) – our building – where the lifts are visible and the stairs are through the small door on the left hand side; the stairs are not in view of those travelling around the building.
Through these two images, you can see how design can impact our public health in terms of activity. In the first one, would you (if you didn’t need to) go looking for the lift? Then in the second one, would you know where to find the stairs, or would you use the lifts as they dominate the eye line?
Stair location is one example of something that influences our decisions to be active or sedentary in our everyday lives. There are an increasing number of examples of how places are trying to encourage people to change their behaviour and choose the stairs rather than the lift, including: the #pianostairs that became a functioning keyboard when walked on; displaying calories used per step; and motivational messages to keep you climbing.
What other ways can a building’s design and setting influence us to be more active at work?
With the development of technology, activity levels at work have declined over the last century; the introduction of desk dependent computer based jobs has seen an increase in the number of sedentary occupations. Over recent years leisure-time activity has remained relatively stable, whilst workplace activity has decreased, which in turn has led to an increase in time spent in sedentary behaviours (Bassett, Pucher, Buehler, Thompson, & Crouter, 2008). For those who are economically active, sedentary behaviour at work may represent the majority of their sedentary time; therefore, the workplace is an ideal setting to influence active behaviour and replace part of our sedentary time with light physical activity.
Sedentary behaviour is known to be independently associated with a number of health-related outcomes (e.g. cardiovascular disease, metabolic syndrome, obesity, type 2 diabetes, some cancers and premature mortality) (Dalkilinc, 2015; Wilmot et al., 2012). Musculoskeletal disease and mental ill-health are responsible for the majority of work-related ill-health and days absent from work in the UK (Health and Safety Executive, 2012); however, physical activity is known to reduce symptoms of anxiety and depression (Landers & Arent, 2012), and the use of sit-stand desks has been found to relieve some musculoskeletal complaints (Husemann, Von Mach, Borsotto, Zepf, & Scharnbacher, 2009). Sedentary behaviour is associated with reduced productivity at work through presenteeism (Brown, Ryde, Gilson, Burton, & Brown, 2013); therefore, it is conceivable that increasing activity in the workplace has the potential to increase productivity and decrease absenteeism.
The workplace environment and built environment should ideally enhance both health and productivity (Sallis & Owen, 1999). New buildings can be designed to encourage movement through: location, which impacts on transportation options; structural design, to include activity friendly features; and services, such as gym facilities and bicycle storage. The built environment in which we work should ideally support healthy, rather than unhealthy behaviours; for many though, buildings in urban spaces are in established locations and can have limited natural design features. Changes to building design are dependent on available resources – but, we can make small modifications to our office settings and our individual behaviours, which can consequently increase physical activity and productivity in the workplace (Active Design Guidelines, 2010):
- alternating between sitting and standing – sit-stand desks can create a significant increase in energy expenditure and can be easy to introduce into office buildings (Levine & Miller, 2007)
- encouraging more workplace intercommunication; for example, walking to speak to co-workers rather than sending emails or having more welcoming spaces for people to meet
- having standing meetings or walk and talk meetings (Merchant, 2013) – with buildings designed to help facilitate this (e.g. The RBS building in Scotland with internal courtyards and walkways)
- supplying painting/artwork/motivational quotes in stairwells and walking routes to make them more appealing to users and reduce the use of lifts (which also impacts upon carbon footprints)
- displaying prompts to use the stairs – informational (i.e. calorie expenditure, health benefits) and motivational signage (for example StepJockey)
- providing centralised areas that encourage people to get up from their desk and engage in brief bouts of walking.
- locating facilities (such as bathrooms, lunch areas, mail room), a walking distance from offices to promote walking and also considering the design of these to ensure they are welcoming and used
- and using computer applications to encourage short breaks from sitting every hour (Beddhu, Wei, Marcus, Chonchol, & Greene, 2015)
We want to leave you with a question – What more can those who work in areas relating to sustainable urbanisation and public health do to encourage people to sit less and move more whilst at work in urban places?
Finally, we want to acknowledge the late Professor Lindsey Dugdill and the influence of her work and interests in shaping the idea for this blog.
References
Bassett, D. R., Pucher, J., Buehler, R., Thompson, D. L., & Crouter, S. E. (2008). Walking, cycling, and obesity rates in Europe, North America, and Australia. Journal of Physical Activity & Health, 5(6), 795–814.
Beddhu, S., Wei, G., Marcus, R. L., Chonchol, M., & Greene, T. (2015). Light-Intensity Physical Activities and Mortality in the United States General Population and CKD Subpopulation. Clinical Journal of the American Society of Nephrology, 10(7), 1145–53. doi:10.2215/CJN.08410814
Brown, H. E., Ryde, G. C., Gilson, N. D., Burton, N. W., & Brown, W. J. (2013). Objectively measured sedentary behavior and physical activity in office employees: relationships with presenteeism. Journal of Occupational and Environmental Medicine, 55(8), 945–53. doi:10.1097/JOM.0b013e31829178bf
Dalkilinc, M. (2015). Why sitting is bad for you. TEDEducation. YouTube. Retrieved from https://youtu.be/wUEl8KrMz14
Department of Design and Construction, Deparment of Health and Mental Hygiene, Department of Transportation, & Department of City Planning. (2010). Active Design Guidelines: Promoting Physical Activity and Health in Design. New York.
Finch, E., Wilson, P., & Dugdill, L. (2012). Stimulating Physically Active Behavior Through Good Building Design. In S. Mallory-Hill, W. F. E. Preiser, & C. G. Watson (Eds.), Enhancing Building Performance (1st ed., pp. 203–212). Chichester: Wiley-Blackwell.
Health and Safety Executive. (2012). Health and Safety Executive Annual Statistics Report for Great Britain.
Husemann, B., Von Mach, C. Y., Borsotto, D., Zepf, K. I., & Scharnbacher, J. (2009). Comparisons of musculoskeletal complaints and data entry between a sitting and a sit-stand workstation paradigm. Human Factors, 51(3), 310–20.
Jackson, R. J., Dannenberg, A. L., & Frumkin, H. (2013). Health and the built environment: 10 years after. American Journal of Public Health, 103(9), 1542–4. doi:10.2105/AJPH.2013.301482
Landers, D. M., & Arent, S. M. (2012). Physical Activity and Mental Health. In G. Tenenbaum & R. C. Eklund (Eds.), Handbook of Sport Psychology (3rd ed., pp. 467–491). Hoboken, New Jersey: John Wiley & Sons.
Levine, J. A., & Miller, J. M. (2007). The energy expenditure of using a “walk-and-work” desk for office workers with obesity. British Journal of Sports Medicine, 41(9), 558–561. doi:10.1136/bjsm.2006.032755
Lopez, R. (2012). The Built Environment and Public Health. San Francisco, California: Jossey-Bass.
Merchant, N. (2013). Got a meeting? Take a walk. TEDTalks. YouTube. Retrieved from https://youtu.be/iE9HMudybyc
Sallis, J. F., & Owen, N. (1999). Physical Activity and Behavioral Medicine. Thousand Oaks, California: Sage Publications.
Wilmot, E. G., Edwardson, C. L., Achana, F. A., Davies, M. J., Gorely, T., Gray, L. J., … Biddle, S. J. H. (2012). Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia, 55(11), 2895–2905.
Author Biographies
Dr. Anna Cooper is a Lecturer in Public Health at the University of Salford, with a background in Psychology and working therapeutically with children. The ongoing goal of her teaching and research is focused around global public health, accelerometers, childhood, behaviour change, transport, interventions and oral health. Anna also has research interests around the use of mHealth/applications within interventions, evaluating interventions, and the design of apps to collect children’s research data. Anna is also involved in research around cardiovascular health checks in North West England. Anna’s PhD evaluated a school based oral health programme with primary school children.
Contact Details:
Email<EMAIL_ADDRESS>Twitter: @amc_83
Alex Clarke-Cornwell is a final year PhD student and researcher at the University of Salford. She has a BSc in Mathematics and an MSc in Statistics. Alex has been involved in a range of research projects that have used her experience of epidemiology and statistics. These include for example, studies relating to the burden of musculoskeletal disease in the UK, coding in general practice research databases, and evaluations of uptake of cardiovascular health checks in North West England. More specifically, her PhD focuses on the associations between sedentary behaviour and health-related outcomes in the workplace.
Contact Details:
Email<EMAIL_ADDRESS>Twitter: @barmyalex


27 Blockquotes and Pullquotes
Blockquotes
Blockquotes are used for long quotations that must be placed in a stand-alone block of text without using quotation marks. The blockquote feature in Pressbooks is useful because it automatically formats the text according to blockquote requirements. For guidelines on when blockquotes should be used, check your chosen style guide.
The blockquotes feature is identified in the WYSIWYG toolbar by the double quotation mark icon. To use this feature:
- Highlight the text you want included in the quotation (this may include the in-text citation, depending on your style guide) and click on the blockquote icon.
- In the visual editor, the text that marked as a blockquote is indented and have a smaller font than the main-body text.
In the webbook, the blockquote is indented and highlighted in gray.
Pullquotes
A pullquote is a quotation that has been pulled from the body of a book or other piece of writing that highlights a key piece of information in a way that adds visual interest to that same book.
| For more information, see Adding Pullquotes in the Pressbooks User Guide. |


Heating
11 Baseboard Heat
Click play on the following audio player to listen along as you read this section.
The simplest form of fixed electric heat is the baseboard heater. These small, modular units with their long horizontal profile are installed underneath windows and other areas of high ambient heat loss.
Energized at 240V in households to maximize heat production, baseboard heaters are commonly controlled by line-voltage thermostats installed in each room or heated area though some can also be controlled by built-in thermostats installed directly into the unit housing.
Because line-voltage thermostats directly control the flow of current to the heater element they must be rated for whatever value of current flows through them.
Baseboard heaters are rated for their power output, in watts, and are generally available in 250W increments, thus allowing installers to select the appropriate size of heater for the area being heated. To find the current requirements of a device, divide the rated power by rated voltage.
For example, a thermostat rated 3kW at 240V would be able to handle 12.5 amps of current.
[latex]12.5\text{ A}=\dfrac{3000\text{ W}}{240\text{ V}}[/latex]
When installing any kind of baseboard heaters, care must be taken not to install any other electrical equipment above them. No receptacles may be installed above a baseboard heater because of the risk of a cord resting on the heater and getting damaged by the heat. If a receptacle is required in a section of wall that also has baseboard heat, some manufactures will provide spacing inside the heater for installation of a receptacle.
Small modular fixed electric heating loads. Rely on passive convection to heat a room, controlled by local thermostats.
A common way to refer to a 240V thermostat.
Meaning the component is designed to be safely operated within certain tolerances. EG: A 240V Rated switch could safely switch a 120V load, but not a 480V load.


From Library Babel Fish, October 26, 2010
At the risk of e-mail overload, I still find it useful to belong to some old-fashioned email lists that engage different communities in discussion. Sometimes they set up intriguing resonances.
On one of my lists, one populated by writing instructors, discussion recently focused on whether teaching argument was all it was cracked up to be. Shouldn’t we concentrate more on helping students master inquiry? Though being able to understand the academic meaning of the word “argument” and to gain skill in marshaling evidence effectively in writing is important, too often students early in their career as apprentice writers have a hard time escaping the popular notion that argument means persuasion by any means. But then, inquiry is also often misconstrued as a matter of finding sources that will act as a ventriloquist for their preconceived prejudices rather than expecting evidence to lead them to conclusions. (Perhaps I’m overly sensitive to this winner-take-all attitude during a cantankerous election season.)
On another list, one for librarians involved in instruction programs, a parallel issue bubbled up when one member wondered whether librarians found it troubling that a popular database that provides a selection of sources on topics neatly arranged in “pro” and “con” binaries contains articles about global warming that she finds spurious and patently false.
This kind of question usually produces a few predictable responses among librarians.
- The principled stance: Students need to learn how to make up their own minds, so we need to provide sources that represent a variety of opinion. (This is a fairly fundamental library value: providing multiple perspectives, including unpopular ones, is an important way to support intellectual freedom. This has become less expensive with the Internet providing more perspectives than you can shake a stick at.)
- The appeasement strategy: Who are we to say what’s true? Librarians must be neutral in all things. Are you suggesting we become censors? (This is, to my mind, a garbled version of the principled stance. Often librarians are urged to avoid suggesting any opinion or belief is false or unsupportable. I find that attitude completely irresponsible in a higher education setting. That said, I will happily provide access to texts that I feel are demonstrably false if they have played a significant role in shaping social issues and public opinion; I happen to think The Bell Curve draws false conclusions based on shoddy evidence, but people should be able to examine it as an influential primary source.)
- The practical approach: Students have to write argument papers, particularly in their first year composition course. They don’t have time to conduct extensive research, and most of what they might turn up in other databases is way over their heads. This database is exactly what they need.
I’m not sure what the answer to these dilemmas is. I don’t think it’s possible to teach students how to conduct responsible and nuanced inquiry about unfamiliar topics in their first year of college. We can get them started, but it takes a few years to gain enough contextual knowledge and enough familiarity with the ways in which evidence is gathered and presented in various formats to get on handle on it. It’s not that undergraduates can’t do it; they just can’t learn how in one course or one semester.
I like to think these skills and inclination are a major accomplishment of a college education and the library is an important lab or workshop or studio where they can be developed. Yet however we work the arts of inquiry and argument into our courses, I suspect there are more responsible ways to give students practice in understanding and using evidence than resorting to spending our money on canned collections that make life easier for undergraduates but unfortunately end up reinforcing the all-too-popular notion that for every issue there are equal and opposite truths.


3.4. Sources of Criminal Law: Statutes, Ordinances, and Other Legislative Enactments
Lore Rutz-Burri and Kate McLean
Statutes, Ordinances, and Other Legislative Enactments
Most substantive criminal law is legislative law. State legislatures and Congress enact laws which take the form of statutes or congressional acts. Statutes are written statements, enacted into law by an affirmative vote of both chambers of the legislature and accepted (or not vetoed) by the governor of the state or the president of the United States. State legislatures may also create legislative law by participating in interstate compacts, or multi-state legal agreements. An example of this includes the Uniform Extradition Act, or the Uniform Fresh Pursuit Act. Congress makes federal law by passing acts and approving treaties between the United States and other nation states. Local legislators, city and town councilors, and county commissioners also make laws through the enactment of local ordinances.
Controversial Issue: Ballot Measures, Initiatives, and Referendums–Direct Democracy and Law Making
In several states, citizens have the power to enact laws through direct democracy by putting “ballot measures” or “propositions” up for a vote. This type of lawmaking by the people started primarily in the Western states around the turn of the 20th century. Initiatives, referendums, and referrals have some slight differences, but generally, these ballot measures ultimately find their way into either statutes or the constitution, and so they are included in this section on legislative law. For example, Oregon Ballot Measure 11, establishing minimum mandatory sentences for 17 person felonies, was voted on in November 1994 and took effect April 1, 1995. It is now found in the Oregon Revised Statutes as ORS 137.700. Proposition 36, approved by Californians in 2012, significantly amended the “three strikes” sentencing laws approved in 1994. Initiatives, referendums, and referrals can be effective in quickly changing the criminal law, and is a way to circumvent what can be a contentious legislative process. Most notably, this form of “direct democracy” has led to the decriminalization of marijuana in Washington, Oregon, Colorado, and Alaska (among other states)!
States’ Authority to Pass Criminal Laws
States are sovereign and autonomous, and unless the Constitution takes away state power, the states have broad authority to regulate activity within the state. Most criminal laws at the state level are derived from the states’ general police powers, or authority, to make and enforce criminal law within their geographic boundaries. Police power is the power to control any harmful act that may affect the general well-being of citizens within the geographical jurisdiction of the state. A state code, or state statutes, may regulate any harmful activity done in the state or whose harm occurs within the state.
Congress’s Authority to Pass Laws
Federal lawmakers do not possess police power. Instead, Congress must draw its authority to enact criminal statutes from particular legislative powers and responsibilities assigned to it in the Constitution. Congress’s legislative authority may be either enumerated in the Constitution or implied from its provisions, but if Congress cannot tie its exercise of authority to one of those powers, the legislation may be declared invalid.
Enumerated powers (for example, the power to regulate interstate commerce) are those that are specifically mentioned in Article I Section 8 of the Constitution. Over the years, however, courts have broadly interpreted the term “interstate commerce” to mean more than just goods and services traveling between and among the states. Instead, interstate commerce includes any activity—including purely local or intrastate activity—that affects interstate commerce. The affectation doctrine maintains that congressional authority includes the right to regulate all matters having a close and substantial relation to interstate commerce. Although the Court has found limits on what affects interstate commerce, Congress has used its broad power to regulate interstate commerce to criminalize a wide range of offenses including carjacking, kidnapping, wire fraud, and a variety of environmental crimes.
The implied powers of Congress are those that are deemed to be necessary and proper for carrying out all the enumerated powers. Article I Section 8 of the Constitution states, “Congress shall have Power . . . to make laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution.” The implied powers doctrine expands the legislative power of Congress, and for that reason, the Necessary and Proper Clause has often been called the “expansion clause.” Due to the implied powers found in the Necessary and Proper Clause, Congress has authority to pass legislation and regulate a wide variety of activity to the extent that it is able to show that the law furthers one of the enumerated powers. Nevertheless, the Court will overturn acts of Congress when it believes Congress has overstepped its constitutional authority. So, despite the broad expanse of implied powers, Congress’s authority is still limited and by no means is as vast as the states’ police powers.
Conflicting State and Federal Statutes
Sometimes substantive federal law conflicts with state laws or policies, and sometimes the federal government’s interest in prosecuting cases in federal court conflicts with the interests of states. One recent conflict between federal interests and state interests involves Oregon’s physician-assisted suicide law, the “Death with Dignity Act.” (See Gonzales v. Oregon, 646 U.S. 243 (2006), upholding Oregon’s law by deciding that the United States Attorney General could not enforce the national controlled substance act against Oregon physicians). Another debate surrounds the conflicting federal and state laws governing marijuana use. Between 1996 and 2022, 42 U.S. states and territories passed laws legalizing the possession of small quantities of marijuana for medicinal purposes for state residents. Since 2012, 19 states (and several territories) have passed laws through the initiative process legalizing recreational use and possession of small amounts of marijuana by adults. (See a full map, updated October 2022, below). These popular initiatives conflict directly with the federal Controlled Substance Act, 21 U.S.C. 13, § 841, (CSA) which holds that any use or possession of marijuana is a federal crime. In January 2018, the Trump administration rescinded the Obama-era restraint policies on marijuana prosecutions, and indicated their intentions to fully enforce the CSA. However, in April 2018, President Trump announced he was backing down on the crackdown on recreational use of marijuana that had been announced in January 2018, a policy continued by the Biden Administration.
Marijuana Laws by State, October 2022
Blue = Legal for recreational use, Green = Legal for medical use, Gray = Illegal, D = Decriminalized
Movement Towards Codification: The American Institute and the Model Penal Code
By the 1960s and 1970s, all states had begun codifying their criminal laws. These codifications would likely not have taken place if not for the American Law Institute (ALI) and the publication of its Model Penal Code (MPC). Established in 1923, the ALI is an organization of judges, lawyers, and academics that draft model codes and laws. Its most important work in the criminal justice realm is the Model Penal Code. The ALI began working on the MPC in 1951, and it proposed several tentative drafts over the next decade. In 1962, the Model Penal Code was finally published. It consists of general provisions concerning: criminal liability, definitions of specific crimes, defenses, and sentences. The MPC has had a significant impact on the legislative drafting of criminal statutes. Every state has adopted at least some provisions, or at least the approach of the MPC, and some code states have adopted many or most of the provisions in the MPC. No state has adopted the MPC in its entirety.


8.2. Intermediate Sanctions
David Carter and Kate McLean
Community corrections as a whole has changed dramatically over the last half-century. Due to a rapid and overwhelming increase of the offender population – largely due to policy changes – we have witnessed an immense increase in the use of community sanctions at the community level, including probation and parole. It has only been within the last 10 years that community correctional populations have begun to decrease.
While much attention has been paid to the crisis of mass incarceration in the United States, a majority of individuals under correctional control are supervised in the community. As of 2022, roughly 1.9 million individuals are incarcerated in the United States – while over 3.7 million are under some form of community-level control. [1] The sheer volume of individuals under community correction is rarely noted, but has important resonance for offender recidivism, reincarceration, and life chances more generally. The public may view probation or parole as concessions to offenders, but in fact, these methods of supervision have the power to dramatically improve offenders’ success – or to send them to jail or prison.
As we have discussed, in the late 1970s and early 1980s, there was a fundamental shift in corrections. This is largely due to the “Nothing Works” dogma in the area of rehabilitation. In turn, there was a nationwide turn toward the use of “institutional corrections,” or prison and jail sentences. Yet, when parole is available, the use of institutional corrections has dramatic implications for community corrections, as incarcerated offenders are ultimately released to the supervision of a parole officer. Moreover, as the U.S. prison population has bulged, many policymakers have started to realize the value and necessity of community sanctions for relieving an overcrowded, and ineffective, system.
At the same time, community corrections has also evolved in line with the “punitive turn” in criminal justice. The last 40 years has seen the rise of what are often termed “intermediate sanctions,” or punishments in between traditional probation (offender supervision in community, with behavioral restrictions) and traditional incarceration (continuous offender detention in prison or jail). Examples include house arrest, electronic monitoring, shock incarceration (incarceration for a very short period), and intensive supervision probation (with more regular PO check-ins or daily drug-testing.)
What Would You Do?
As stated before, there are three primary goals for corrections: to punish the offender, to rehabilitate the offender, and to protect society. Often the first and third goals take precedent, displacing and even opposing the goal of rehabilitation. Here is an example of how this might happen.
Imagine a man, who is married, has a couple of kids, a stable blue-collar job, a house/mortgage, and is living just a little bit better than a paycheck to paycheck. We can call him Joe Citizen. Joe likes to hang out with his friends after a adult soccer league game, have a beer and catch up on life. For all intents and purposes, Joe is a decent guy. He does not have a significant criminal record. Perhaps one misdemeanor when he was a juvenile, and a couple of speeding tickets, like tens of millions of other adults.
However, one time after practice, Joe is driving home when his wife texts him to pick up some eggs at the store. He looks down at his phone at the exact same time that someone pulls out in front of him. An accident occurs. No one is seriously injured, but the damage to both vehicles is enough to warrant a write-up of the accident. This leads to police presence. At the scene, the officer smells alcohol on Joe. The officer is obligated to go through standard procedures, which results in Joe being arrested. The question is this – what should Joe’s punishment be?
This question forces us to reckon with both the rule of law, and unintended consequences of punishment. Arguably, Joe should be punished, as he chose to drive after drinking alcohol. But would Joe’s incarceration lead to other events that may have lasting, negative effects for both Joe, his family, and the larger community?
This brings up the question of “collateral consequences,” or the long-term, informal consequences of criminal sanctions. If Joe receives a lengthy jail sentence, will he lose his job? Will he lose his family? Will this put him a greater risk of recidivating in the future? At what point has the immediate action caused punishment beyond what the law stipulates is punishment?
- Sawyer, W., and Wagner, P. (2022). Mass Incarceration: The Whole Pie, 2022. https://www.prisonpolicy.org/reports/pie2022.html#community ↵


101 Reading: Criminal Activity
Although deviance is a violation of social norms, it’s not always punishable, and it’s not necessarily bad. Crime, on the other hand, is a behavior that violates official law and is punishable through formal sanctions. Walking to class backward is a deviant behavior. Driving with a blood alcohol percentage over the state’s limit is a crime. Like other forms of deviance, however, ambiguity exists concerning what constitutes a crime and whether all crimes are, in fact, “bad” and deserve punishment. For example, during the 1960s, civil rights activists often violated laws intentionally as part of their effort to bring about racial equality. In hindsight, we recognize that the laws that deemed many of their actions crimes—for instance, Rosa Parks taking a seat in the “whites only” section of the bus—were inconsistent with social equality.
As you have learned, all societies have informal and formal ways of maintaining social control. Within these systems of norms, societies have legal codes that maintain formal social control through laws, which are rules adopted and enforced by a political authority. Those who violate these rules incur negative formal sanctions. Normally, punishments are relative to the degree of the crime and the importance to society of the value underlying the law. As we will see, however, there are other factors that influence criminal sentencing.
Types of Crimes
Not all crimes are given equal weight. Society generally socializes its members to view certain crimes as more severe than others. For example, most people would consider murdering someone to be far worse than stealing a wallet and would expect a murderer to be punished more severely than a thief. In modern U.S. society, crimes are classified as one of two types based on their severity. Violent crimes (also known as “crimes against a person”) are based on the use of force or the threat of force. Rape, murder, and armed robbery fall under this category. Nonviolent crimes involve the destruction or theft of property but do not use force or the threat of force. Because of this, they are also sometimes called “property crimes.” Larceny, car theft, and vandalism are all types of nonviolent crimes. If you use a crowbar to break into a car, you are committing a nonviolent crime; if you mug someone with the crowbar, you are committing a violent crime.
When we think of crime, we often picture street crime, or offenses committed by ordinary people against other people or organizations, usually in public spaces. An often-overlooked category is corporate crime, or crime committed by white-collar workers in a business environment. Embezzlement, insider trading, and identity theft are all types of corporate crime. Although these types of offenses rarely receive the same amount of media coverage as street crimes, they can be far more damaging.
An often-debated third type of crime is victimless crime. Crimes are called victimless when the perpetrator is not explicitly harming another person. As opposed to battery or theft, which clearly have a victim, a crime like drinking a beer when someone is twenty years old or selling a sexual act do not result in injury to anyone other than the individual who engages in them, although they are illegal. While some claim acts like these are victimless, others argue that they actually do harm society. Prostitution may foster abuse toward women by clients or pimps. Drug use may increase the likelihood of employee absences. Such debates highlight how the deviant and criminal nature of actions develops through ongoing public discussion.
Hate Crimes
On the evening of October 3, 2010, a seventeen-year-old boy from the Bronx was abducted by a group of young men from his neighborhood and taken to an abandoned row house. After being beaten, the boy admitted he was gay. His attackers seized his partner and beat him as well. Both victims were drugged, sodomized, and forced to burn one another with cigarettes. When questioned by police, the ringleader of the crime explained that the victims were gay and “looked like [they] liked it” (Wilson and Baker 2010).
Attacks based on a person’s race, religion, or other characteristics are known as hate crimes. Hate crimes in the United States evolved from the time of early European settlers and their violence toward Native Americans. Such crimes weren’t investigated until the early 1900s, when the Ku Klux Klan began to draw national attention for its activities against blacks and other groups. The term “hate crime,” however, didn’t become official until the1980s (Federal Bureau of Investigations 2011).
An average of 195,000 Americans fall victim to hate crimes each year, but fewer than five percent ever report the crime (FBI 2010). The majority of hate crimes are racially motivated, but many are based on religious (especially anti-Semitic) prejudice (FBI 2010). After incidents like the murder of Matthew Shepard in Wyoming in 1998 and the tragic suicide of Rutgers University student Tyler Clementi in 2010, there has been a growing awareness of hate crimes based on sexual orientation.
Crime Statistics
The FBI gathers data from approximately 17,000 law enforcement agencies, and the Uniform Crime Reports (UCR) is the annual publication of this data (FBI 2011). The UCR has comprehensive information from police reports but fails to account for the many crimes that go unreported, often due to victims’ fear, shame, or distrust of the police. The quality of this data is also inconsistent because of differences in approaches to gathering victim data; important details are not always asked for or reported (Cantor and Lynch 2000).
Due to these issues, the U.S. Bureau of Justice Statistics publishes a separate self-report study known as the National Crime Victimization Report (NCVR). A self-report study is a collection of data gathered using voluntary response methods, such as questionnaires or telephone interviews. Self-report data are gathered each year, asking approximately 160,000 people in the United States about the frequency and types of crime they’ve experienced in their daily lives (BJS 2013). The NCVR reports a higher rate of crime than the UCR, likely picking up information on crimes that were experienced but never reported to the police. Age, race, gender, location, and income-level demographics are also analyzed (National Archive of Criminal Justice Data 2010).
The NCVR survey format allows people to more openly discuss their experiences and also provides a more-detailed examination of crimes, which may include information about consequences, relationship between victim and criminal, and substance abuse involved. One disadvantage is that the NCVR misses some groups of people, such as those who don’t have telephones and those who move frequently. The quality of information may also be reduced by inaccurate victim recall of the crime (Cantor and Lynch 2000).
Public Perception of Crime
Neither the NCVR nor the UCS accounts for all crime in the United States, but general trends can be determined. Crime rates, particularly for violent and gun-related crimes, have been on the decline since peaking in the early 1990s (Cohn, Taylor, Lopez, Gallagher, Parker, and Maass 2013). However, the public believes crime rates are still high, or even worsening. Recent surveys (Saad 2011; Pew Research Center 2013, cited in Overburg and Hoyer 2013) have found U.S. adults believe crime is worse now than it was twenty years ago.
Inaccurate public perception of crime may be heightened by popular crime shows such as CSI, Criminal Minds and Law & Order (Warr 2008) and by extensive and repeated media coverage of crime. Many researchers have found that people who closely follow media reports of crime are likely to estimate the crime rate as inaccurately high and more likely to feel fearful about the chances of experiencing crime (Chiricos, Padgett, and Gertz 2000). Recent research has also found that people who reported watching news coverage of 9/11 or the Boston Marathon Bombing for more than an hour daily became more fearful of future terrorism (Holman, Garfin, and Silver 2014).
Further Research
How is crime data collected in the United States? Read about the methods of data collection and take the National Crime Victimization Survey here.
Think It Over
Recall the crime statistics presented in this section. Do they surprise you? Are these statistics represented accurately in the media? Why, or why not?
Practice
1. Which of the following is an example of corporate crime?
- Embezzlement
- Larceny
- Assault
- Burglary
Show Answer
a
2. Spousal abuse is an example of a ________.
- street crime
- corporate crime
- violent crime
- nonviolent crime
Show Answer
c
- Rates of violent and nonviolent crimes are decreasing.
- Rates of violent crimes are decreasing, but there are more nonviolent crimes now than ever before.
- Crime rates have skyrocketed since the 1970s due to lax corrections laws.
- Rates of street crime have gone up, but corporate crime has gone down.
Show Answer
a
- The NCVS doesn’t include demographic data, such as age or gender.
- The NCVS may be unable to reach important groups, such as those without phones.
- The NCVS doesn’t address the relationship between the criminal and the victim.
- The NCVS only includes information collected by police officers.
Show Answer
b
Show Glossary
- corporate crime:
- crime committed by white-collar workers in a business environment
- corrections system:
- the system tasked with supervising individuals who have been arrested for, convicted of, or sentenced for criminal offenses
- crime:
- a behavior that violates official law and is punishable through formal sanctions
- hate crimes:
- attacks based on a person’s race, religion, or other characteristics
- legal codes:
- codes that maintain formal social control through laws
- nonviolent crimes:
- crimes that involve the destruction or theft of property, but do not use force or the threat of force
- self-report study:
- a collection of data acquired using voluntary response methods, such as questionnaires or telephone interviews
- street crime:
- crime committed by average people against other people or organizations, usually in public spaces
- victimless crime:
- activities against the law, but that do not result in injury to any individual other than the person who engages in them
- violent crimes:
- crimes based on the use of force or the threat of force
Self-Check: Crime and the Law
You’ll have more success on the Self-Check, if you’ve completed both Readings in this section.


7.4 Antidiarrheal Medications and Laxatives
This section will review the anatomy and pathophysiology of defecation and the condition of diarrhea and then apply the nursing process to administering antidiarrheals. From there, we will discuss the condition of constipation, apply the nursing process to treating constipation, and discuss classes of laxatives.
Review of Anatomy and Physiology of Defecation
The digestive system is continually at work, but unless something goes amiss, you don’t notice your digestive system working. This section will focus on bowel disorders that occur in the lower intestine during the final step of digestion called defecation, when undigested materials are removed from the body as feces. During this final step, the large intestine absorbs water and changes the waste from liquid into stool; then peristalsis helps move the stool into the rectum. Diarrhea and constipation occur when conditions occur that affect this final step of defection.
The process of defecation begins when mass movements force feces from the colon into the rectum, stretching the rectal wall and provoking the defecation reflex, which eliminates feces from the rectum. This parasympathetic reflex is mediated by the spinal cord.  Figure 7.9[1] reviews the anatomy of the rectum and its external and internal sphincters. The presence of feces in the anal canal sends a signal to the brain, which gives the person the choice of voluntarily opening the external anal sphincter (defecating) or keeping it temporarily closed. If defecation is delayed until a more convenient time, it takes a few seconds for the reflex contractions to stop and the rectal walls to relax. The next mass movement will trigger additional defecation reflexes until defecation occurs.[2]
If defecation is delayed for an extended time, additional water is absorbed, making the feces firmer and potentially leading to constipation. Alternatively, if the waste matter moves too quickly through the intestines, not enough water is absorbed, and diarrhea can result. Figure 7.10[3] demonstrates the Bristol Stool Chart that is used to assess stool characteristics, ranging from very constipated to diarrhea.
Additional information about how the digestive system works can be reviewed using the information below:
“Digestive System Processes and Regulation” in Open Stax Anatomy and Physiology.
Diarrhea
Diarrhea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Frequent passing of formed stools is not considered diarrhea. Diarrhea has multiple causes such as bacteria from contaminated food or water; viruses such as influenza, norovirus, or rotavirus; parasites found in contaminated food or water; medicines such as antibiotics, cancer drugs, and antacids that contain magnesium; food intolerances and sensitivities; and diseases that affect the colon, such as Crohn’s disease or irritable bowel syndrome.[6] The most severe threat posed by diarrhea is dehydration caused by the loss of water and electrolytes. Diarrheal disease is a leading cause of child mortality and morbidity throughout the world due to dehydration; frail elderly are also at risk. When severe diarrhea occurs, assessment for dehydration and electrolyte imbalances receive top priority, and rehydration with oral rehydration solutions or IV fluids may be required.[7] Common medications used to manage the symptoms of diarrhea are discussed below.
Applying the Nursing Process to Administering Antidiarrheals
Assessment
When administering antidiarrheals, the nurse should document an abdominal assessment, frequency of bowel movements and stool characteristics, and if there is skin breakdown in the anal area. Dehydration is a serious risk in clients with severe diarrhea, so priority assessments and documentation relate to monitoring for dehydration, especially in vulnerable populations of infants, children, and elderly. If signs of dehydration occur, the provider should be immediately notified, and treatment initiated for dehydration.
Implementation
Teach the client to not exceed dosages of OTC medications because life-threatening adverse effects may occur. Probiotics have been found to be likely safe in all populations, and the nurse can advocate for the use of probiotics in clients with diarrhea or those at risk for diarrhea because of other medications prescribed. In addition to teaching about medication therapy, nurses can also teach clients with diarrhea other nonpharmacological interventions, such as replacing fluid and electrolytes by drinking water, sports drinks, or sodas without caffeine; and eating soft, bland food like bananas, rice, and toast. Children with severe diarrhea may also require oral rehydration solutions to replace lost fluids and electrolytes. The nurse should also keep in mind that antidiarrheals should be used very cautiously with children because some categories are contraindicated.
Evaluation
Because antidiarrheals treat the symptoms of diarrhea but do not eliminate the cause of it, if symptoms do not resolve within 48 hours, the provider should be notified, and other potential causes of diarrhea investigated. Monitor for serious adverse effects such as increased bleeding in clients taking salicylates and for abnormal heart rhythms in clients taking loperamide and notify the provider immediately. Evaluation for dehydration should continuously occur until the condition resolves.
Antidiarrheal Medication Classes
There are three common mechanisms of action of antidiarrheal medications: adsorbents, which help eliminate the toxin or bacteria from the GI tract; antimotility agents, which slow peristalsis; and probiotics, which help to restore the normal bacteria found in the lower intestine. Oral rehydration agents may also be used in clients with diarrhea to replace fluid and electrolyte loss, but they do not treat the diarrhea. Antibacterial agents may also be used to treat diarrhea caused by specific infections, such as campylobacter or giardia, but they are not routinely needed.[8]
Adsorbents
Adsorption is the adhesion of molecules to a surface. This process differs from absorption, where a substance is dissolved or penetrates into a surface. Bismuth subsalicylate (brand name Pepto Bismol) is an example of an adsorbent (see Figure 7.11[9]).
Mechanism of Action: Adsorbent medications work by coating the walls of the GI tract and binding the causative bacteria or toxin for elimination from the GI tract through the stool.[10] Bismuth subsalicylate also decreases the flow of fluids and electrolytes into the bowel, reducing inflammation within the intestine.[11]
Indications: Adsorbent medications are used to treat conditions that involve excess gas or toxins in the digestive system.
Nursing Considerations: Bismuth subsalicylate contains salicylate. It should be avoided if the client has an allergy to salicylates (including aspirin) or if the client is taking other salicylate products such as aspirin. It should not be used if the client has an ulcer, a bleeding problem, or bloody or black stool. Children and teenagers who have or are recovering from chicken pox or flu-like symptoms should not use this product. When using this product, if changes in behavior with nausea and vomiting occur, consult a provider because these symptoms could be an early sign of Reye’s syndrome, a rare but serious illness. Liquid products should be shaken well before use. Tablets should be swallowed whole and not chewed unless they are a chewable tablet. Medication can cause a black or darkened tongue. If symptoms worsen, a fever, or ringing in the ears occurs, or if diarrhea lasts longer than 48 hours, contact the provider.[12],[13]
Side Effects/Adverse Effects: Side effects of adsorbent medications include black or darkened tongue. Individuals should contract their provider if symptoms worsen or if they experience a fever or ringing in the ears.
Health Teaching & Health Promotion: Clients should be advised to take medication as directed. They should be aware of potential color changes to stool that may occur and that the medication contains aspirin. They should discontinue the medication if tinnitus occurs.[14]
Antimotility
Antimotility medications help to treat diarrhea by slowing peristalsis. There are two categories of antimotility medication: anticholinergics and opiate-like medications.
Anticholinergics
Mechanism of Action: Hyoscyamine is an anticholinergic that works on the smooth muscle of the GI tract to inhibit propulsive motility and decreases gastric acid secretion.
Indications: Anticholinergic medications are a class of drugs that block the action of the neurotransmitter acetylcholine in the nervous system.
Nursing Considerations: Read drug label information for all contraindications, including but not limited to, glaucoma, myasthenia gravis, and paralytic ileus. Diarrhea may be an early symptom of incomplete intestinal obstruction, and the use of this drug would be inappropriate and possibly harmful. CNS symptoms and other adverse effects may occur that are common with anticholinergic medications.[15],[16]
Side Effects/Adverse Effects: Common side effects of anticholinergic medications include dry mouth, constipation, blurred vision, and confusion, especially in older adults.
Health Teaching & Health Promotion: Clients should receive instruction that these medications may cause dizziness and drowsiness. If clients experience dry mouth, frequent oral hygiene may alleviate discomfort.[17]
Opioid-like Medication
Mechanism of Action: Loperamide has an opioid-like chemical structure but causes fewer CNS effects. It works by decreasing the flow of fluids and electrolytes into the bowel and by slowing down the movement of the bowel to decrease the number of bowel movements (see Figure 7.12[18]).
Indications: Opioid-like medications such as loperamide work by slowing down the movement of the intestines, which reduces the frequency and volume of bowel movements.
Nursing Considerations: Loperamide should not be given to a child younger than two years of age because of the risk of serious breathing and heart problems. Taking more than the prescribed dose can cause a serious abnormal heart rhythm that can lead to death. Read the drug label carefully for information about interaction with other medications, especially antidysrhythmics and antipsychotics.[19],[20]
Side Effects/Adverse Effects: Common side effects of loperamide may include constipation, abdominal discomfort, nausea, vomiting, dizziness, drowsiness, or allergic skin reactions such as hives.
Health Teaching & Health Promotion: Clients should take medications as directed. They should also avoid alcohol and other CNS depressants. The medications may cause drowsiness.[21]
Probiotics
Probiotics are used for the prevention and treatment of diarrhea. They are often used concomitantly with antibiotics to prevent the common associated side effects of diarrhea (see Figure 7.13[22]). An example of a probiotic is lactobacillus.
Mechanism of Action: Probiotics help replenish normal bacterial flora in the gastrointestinal tract.
Indications: Probiotics are live microorganisms that are beneficial for digestive health.
Nursing Considerations: Probiotic usage should be tailored to the individual’s specific health needs because not all strains of probiotics have the same health benefits.
Side Effects/Adverse Effects: Probiotics may have some side effects such as gas, bloating, and diarrhea.
Health Teaching & Health Promotion: Side effects of probiotics are mild such as gas and bloating. Probiotics are safe for use in children.[23],[24]
Now let’s take a closer look at medication grids comparing medications used to treat diarrhea. (See Table 7.4a.[25],[26])
Medication grids are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. Basic information related to each class of medication is outlined below. Detailed information on a specific medication can be found for free at DailyMed. On the home page, enter the drug name in the search bar to read more about the medication. Prototype/generic medications listed in the grids below are also linked directly to a DailyMed page.
Table 7.4a Diarrhea Medication Grids
Class/Subclass |
Prototype/Generic |
Nursing Considerations |
Therapeutic Effects |
Side/Adverse Effects |
|---|---|---|---|---|
| Adsorbents | bismuth subsalicylate (Pepto Bismol) | Avoid if taking other salicylates
Do not use in children or teenagers recovering from chicken pox or flu-like symptoms as it may cause Reye’s syndrome Do not use if client has an ulcer, bleeding problem, or bloody or black stool |
Decreased diarrhea symptoms | May cause black or darkened tongue
Contact provider if symptoms worsen, a fever, or ringing in the ears occurs, or if diarrhea lasts longer than 48 hours |
| Anticholinergic | hyoscyamine | Contraindicated in glaucoma, myasthenia gravis, or paralytic ileus | Decreased diarrhea symptoms | May cause CNS and other adverse effects associated with anticholinergic medication |
| Opiate-like Medication | loperamide (lmodium) | Contraindicated in children younger than two and with several other medications; read drug label information before administering | Decreased diarrhea symptoms | Constipation, abdominal discomfort, nausea, vomiting, dizziness, drowsiness, or allergic skin reactions such as hives
Boxed Warning: May cause abnormal heart rhythm |
| Probiotic | lactobacillus | Pediatric dosing is age based and varies by product | Prevention of diarrhea or decreased symptoms of diarrhea | Mild such as gas and bloating |
Critical Thinking Activity 7.4
- A client has been prescribed loperamide for diarrhea associated with gastroenteritis. The client begins to complain of “heart palpitations.” What is the nurse’s next best response?
- A child, aged 6, has diarrhea. The mother asks the nurse what OTC medications she can provide to her child to help resolve the diarrhea. What is the nurse’s best response?
Note: Answers to the Critical Thinking activities can be found in the “Answer Key” section at the end of the book.
Constipation
Constipation is defined as “three or fewer bowel movements in a week; stools that are hard, dry or lumpy; stools that are difficult or painful to pass; or the feeling that not all stool has passed.”[27] If defecation is delayed for an extended time, additional water is absorbed, thus making the feces firmer and potentially leading to constipation.
There are several causes of constipation, such as lack of proper fluids or fiber in the diet, lack of ambulation, various disease processes, recovery from surgical anesthesia and opiates, and side effects of many medications. A list of these potential causes can be found in Table 7.4b.[28]
Because there are several potential causes of constipation, treatment should always be individualized to the client. Many times, constipation can be treated with simple changes in diet, exercise, or routine. However, when medications are also needed to resolve constipation, there are several categories of laxative medications that work in different ways. Classes of laxative medications are described below.
Table 7.4b Common Causes of Constipation
| Medications | Antacids that contain aluminum and calcium
Anticholinergics and antispasmodics Anticonvulsants—used to prevent seizures Calcium channel blockers Diuretics Iron supplements Medicines used to treat Parkinson’s disease Narcotic pain medicines Some medicines used to treat depression |
|---|---|
| Health and Nutrition Problems | Not eating enough fiber
Not drinking enough liquids or dehydration Not getting enough physical activity Celiac disease Disorders that affect the brain and spine, such as Parkinson’s disease Spinal cord or brain injuries Diabetes Hypothyroidism Inflammation linked to diverticular disease or proctitis Intestinal obstructions, including anorectal blockage and tumors |
| Daily Routine Changes | Pregnancy
Aging Traveling Ignoring the urge to have a bowel movement Medication changes Change in diet |
Applying the Nursing Process to Administering Laxatives
Assessment
The nurse should assess for the potential cause of the client’s constipation and appropriately individualize the treatment and health teaching. The nurse should document an abdominal assessment that includes discomfort, distention, and decreased bowel sounds. The date of the last bowel movement should also be documented. The client may be asked additional history questions such as the appearance of the stool to determine if it is hard and dry, if passing the stool is difficult or painful, or if there is a feeling of incomplete emptying.
Implementation
Many facilities have a bowel medication protocol with progressive treatment of constipation, ranging from stool softeners to stimulants to enemas, depending on the length of time since the last bowel movement. Medications should be administered according to label instructions, and the client should be instructed when to expect a bowel movement will occur. Measures to prevent constipation should also be discussed with the client.
Patient teaching for all classes of laxative medications should be individualized based on the cause of constipation. These measures to prevent constipation should be reviewed with the client:
- Getting enough fiber in the diet
- Drinking plenty of water and other liquids
- Getting regular physical activity
- Trying to have a bowel movement at the same time every day[29]
Evaluation
If a bowel movement does not occur within the expected time frame, the provider should be notified, and other causes investigated for individualized treatment. It is imperative that good documentation of bowel movements and communication among staff occur when constipation is being treated with various medications. If there is a complete absence of bowel sounds, worsening distension or abdominal pain, a smearing of stool, or other findings indicating that a paralytic ileus or blockage may be occurring, the provider should be immediately notified.
Laxative Medication Classes
There are five categories of laxative medications commonly used to treat constipation: fiber supplements, stool softeners, osmotic agents, lubricants, and stimulants. Fiber supplements and stool softeners are often used daily to prevent constipation, whereas the other laxative categories are used to treat constipation. Table 7.4c compares the mechanism of action for each laxative category and includes common prototype and OTC brand names.[30],[31],[32]
Table 7.4c Categories of Laxatives Used to Treat Constipation
Category |
Prototypes |
Mechanism of Action |
|---|---|---|
| Fiber supplements | psyllium (Metamucil) | Bulk forming to facilitate passage of stool through rectum |
| Stool softeners | Docusate (Colace) | Facilitates movement of water and fats into stool |
| Osmotic agents | Milk of Magnesia; polyethylene glycol (PEG) 3350 (Miralax) | Causes water to be retained with the stool, increasing the number of bowel movements and softening the stool so it is easier to pass |
| Lubricants | mineral oil enema (Fleet) | Coats the stool to help seal in water |
| Stimulants | Bisacodyl (Dulcolax) | Causes the intestines to contract, inducing stool to move through the colon |
Fiber Supplements
Psyllium (brand name Metamucil) is an example of a common OTC fiber supplement (see Figure 7.14[33]).
Mechanism of Action: Psyllium adds bulk to the stool to facilitate passage through the rectum.
Indications: A type of soluble fiber that is commonly used as a dietary supplement and as an ingredient in some medications to help treat constipation.
Nursing Considerations: When administering, put one dose into an empty glass and mix with at least 8 ounces of water or other fluid. Taking this product without enough liquid may cause choking. Stir briskly and drink promptly. If mixture thickens, add more liquid and stir. Administer at least 2 hours before or 2 hours after other medications as it can affect absorption. Psyllium usually produces a bowel movement within 12 to 72 hours. It may cause bloating and cramping.
Side Effects/Adverse Effects: Psyllium is generally well-tolerated; however, some individuals may experience abdominal discomfort, ongoing constipation, diarrhea, or obstruction. It may also interfere with medication absorption.
Health Teaching & Health Promotion: When teaching clients how to take psyllium at home, in addition to the above considerations, advise them to start with one dose per day but may gradually increase to three doses per day as necessary to maintain soft stools.
Stool Softeners
Docusate is a common OTC stool softener that is also used frequently in health care settings.
Mechanism of Action: Docusate facilitates movement of water and fats into stool to make it soft and improve regularity of bowel movements.
Indications: Stool softeners are medications that help to moisten and soften the stool, making it easier to pass.
Nursing Considerations: Docusate usually produces a bowel movement in 12 to 72 hours. It may cause stomach cramping.
Side Effects/Adverse Effects: Stool softeners can cause diarrhea, nausea, vomiting, abdominal cramping, and electrolyte imbalances in some clients.
Health Teaching & Health Promotion: Stool softeners may interact with other medications, such as blood thinners or antibiotics. They should not be used in individuals with intestinal blockages.
Osmotic Agents
Milk of Magnesia and polyethylene glycol 3350 (brand name Miralax) are examples of common osmotic agents used to promote a bowel movement (see Figure 7.15).[34]
Mechanism of Action: Osmotic agents cause water to be retained with the stool, increasing the number of bowel movements and softening the stool so it is easier to pass.
Indications: They are often used to treat constipation or to prepare for certain medical procedures, such as colonoscopies.
Nursing Considerations: Polyethylene glycol 3350 has a bottle top that can be used as a measuring cap to contain 17 grams of powder when filled to the indicated line. Fill to the top of clear section in cap, which is marked to indicate the correct dose (17 g); stir and dissolve in any 4 to 8 ounces of beverage (cold, hot, or room temperature) and then administer.
Side Effects/Adverse Effects: Side effects of osmotic agents include diarrhea, abdominal cramping, electrolyte imbalance, dehydration, or allergic reactions.
Health Teaching & Health Promotion: In addition to the administration considerations above, teach clients that polyethylene glycol usually produces a bowel movement in 1-3 days. It may cause loose, watery stools.
Lubricants
A mineral oil enema (brand name Fleet enema) is an example of a lubricant laxative (see Figure 7.16[35]).
Mechanism of Action: Mineral oil coats the stool to help seal in water.
Indications: Mineral oil may be used to relieve constipation by lubricating and softening the stool.
Nursing Considerations: Read drug label for children as some brands can be used in children aged 2 or older, whereas others are not intended for children.
Side Effects/Adverse Effects: Side effects of mineral oil enemas may include irritations and inflammation of anal area, electrolyte imbalances, dehydration, or interference with medication absorption.
Health Teaching & Health Promotion: A mineral oil enema generally produces a bowel movement in 2 to 15 minutes. It may cause stomach cramps, bloating, upset stomach, or diarrhea.
Stimulants
Bisacodyl is an example of a stimulant laxative.
Mechanism of Action: Bisacodyl causes the intestines to contract, inducing the stool to move through the colon.
Indications: Stimulant laxatives such as bisacodyl are used to treat constipation and prepare the bowel for medical procedures.
Nursing Considerations: Oral dosage or rectal suppositories are available. See instructions for how to insert a rectal suppository. Instruct the client to retain suppository for about 15 to 20 minutes (see Figure 7.17[36]).
Side Effects/Adverse Effects: Common side effects of bisacodyl include abdominal cramps, nausea, and vomiting, diarrhea, rectal irritation, dehydration, or electrolyte imbalances. Adverse effects may include severe abdominal pain, rectal bleeding, severe dehydration, fainting, and hypokalemia.
Health Teaching & Health Promotion: A bowel movement is generally produced in 15 minutes. Bisacodyl may cause stomach cramps, dizziness, or rectal burning.
Herbals
Many herbal substances may be useful in facilitating natural bowel function. Substances such as senna can have a significant benefit in relieving constipation due to its laxative properties. Senna is a plant that belongs to the legume family.
Mechanism of Action: Senna leaves contain compounds known as anthraquinones, which act as stimulant laxatives by increasing motility of the intestines.
Indications: Senna is given to increase motility of the intestines and promote bowel movements.
Nursing Considerations: Overuse of senna can result in diarrhea and dehydration. Clients should take adequate fluids to prevent dehydration. Short-term use is recommended to diminish risk of dependence.
Side Effects/Adverse Effects: Senna can cause cramps, bloating, and abdominal discomfort. Overuse can lead to diarrhea and dehydration, as well an electrolyte imbalance.
Health Teaching & Health Promotion: Senna can cause discoloration of the urine, turning it into a reddish-brown color. It is important that clients take senna at the lowest possible dose for the shortest duration of time.
Now let’s take a closer look at the medication grids comparing medications used to treat constipation. (See Table 7.4d).[37],[38]
Medication grids are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. Basic information related to each class of medication is outlined below. Detailed information on a specific medication can be found for free at DailyMed. On the home page, enter the drug name in the search bar to read more about the medication. Prototype/generic medications listed in the grids below are also linked directly to a DailyMed page.
Table 7.4d Medication Grid Comparing Laxatives Used to Treat Constipation
| Class/Subclass | Prototype/Generic | Nursing Considerations | Therapeutic Effects | Side/Adverse Effects |
|---|---|---|---|---|
| Laxative/Bulk-Forming | psyllium (Metamucil) | Put one dose into an empty glass and mix with at least 8 ounces of water or other fluid. Taking this product without enough liquid may cause choking. Stir briskly and drink promptly. If mixture thickens, add more liquid and stir
Usually produces a bowel movement within 12 to 72 hours Administer at least 2 hours before or 2 hours after other medications as it can affect absorption Start with 1 dose per day; may gradually increase to 3 doses per day as necessary |
Improves regularity of bowel movements | May cause bloating and cramping |
| Laxative/Stool Softener | docusate | Usually produces bowel movement in 12 to 72 hours | Softens stool and improves regularity of bowel movements | May cause abdominal cramping |
| Laxative/Osmotic Agent | polyethylene glycol 3350 (Miralax) | Usually produces a bowel movement in 1-3 days
The bottle top is a measuring cap marked to contain 17 grams of powder when filled to the indicated line For adults and children 17 years of age and older: ○ fill to top of clear section in cap, which is marked to indicate the correct dose (17 g) ○ stir and dissolve in any 4 to 8 ounces of beverage (cold, hot, or room temperature) and then drink ○ use once a day ○ use no more than 7 days |
Softens stool and improves regularity of bowel movements | May cause loose, watery stools |
| Laxative/Lubricant Laxative | Mineral oil enema | Read drug label for children as some brands can be used in children aged 2 or older, whereas others are not intended for children
Generally, produces bowel movement in 2 to 15 minutes |
Bowel movement within 15 minutes | Stomach cramps, bloating, upset stomach, or diarrhea |
| Laxative/Simulant Laxative | bisacodyl | Oral dosage or rectal suppositories are available
To administer a rectal suppository, position the client on their left side with the right knee up towards the chest. In the presence of anal fissures or hemorrhoids, suppositories should be coated at the tip with petroleum jelly. Remove foil and insert suppository well into rectum touching the bowel wall. Instruct the client to retain suppository for about 15 to 20 minutes. A bowel movement is generally produced in 15 minutes to one hour. For children, read drug label for dosage |
Bowel movement within one hour | Stomach cramps, dizziness, or rectal burning |
| Laxative/Herbal | Senna | Overuse of senna can result in diarrhea and dehydration. Clients should take adequate fluids to prevent dehydration. Short-term use is recommended to diminish risk of dependence | Improved bowel movements | Cramps, bloating, and abdominal discomfort.
Overuse can lead to diarrhea and dehydration, as well an electrolyte imbalances |
Critical Thinking Activity 7.4b
A client who underwent hip surgery two days ago has not had a bowel movement since before admission. The client is receiving oxycontin ER 10 mg every 12 hours and oxycodone 5 mg every 4 hours for pain. The client describes abdominal discomfort, and the nurse finds decreased bowel sounds in all quadrants. The nurse notifies the provider, follows the bowel protocol, and administers docusate sodium to the client.
- What are the potential causes of constipation that should be addressed for this client?
- What is the mechanism of action for docusate?
- The client asks how quickly the medication will work. What is the nurse’s best response?
- What other preventative measures for constipation should the nurse teach the client?
- If docusate is not effective within 24 hours, what other medications can the nurse anticipate being ordered?
Note: Answers to the Critical Thinking activities can be found in the “Answer Key” section at the end of the book.
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- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
- A.D.A.M. Medical Encyclopedia [Internet]. A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; ©2019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https://medlineplus.gov/ency/anatomyvideos/000068.htm ↵
- uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
- A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; ©2019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https://medlineplus.gov/ency/anatomyvideos/000068.htm ↵
- uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral ↵
- “Loperamide2mg.JPG” by Kristoferb is licensed under CC BY-SA 3.0 ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
- A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; ©2019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https://medlineplus.gov/ency/anatomyvideos/000068.htm ↵
- uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral ↵
- “WildWood Probiotic Soyogurt” by Veganbaking.net is licensed under CC BY-SA 2.0 ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
- A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; ©2019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https://medlineplus.gov/ency/anatomyvideos/000068.htm ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
- A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; ©2019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27] https://medlineplus.gov/ency/anatomyvideos/000068.htm ↵
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. (2018). Symptoms and causes of constipation. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/symptoms-causes ↵
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. (2018). Symptoms and causes of constipation. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/symptoms-causes ↵
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. (2018). Treatment for constipation. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/treatment ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. (2018). Treatment for constipation. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/treatment ↵
- Drugs.com [Internet]. Fleet mineral oil enema (rectal); © 1996-2018 [updated 1 October 2019; cited 27 October 2019]. https://www.drugs.com/mtm/fleet-mineral-oil-enema-rectal.html ↵
- “Metamucil ad (cropped).jpg” by unknown is licensed under CC0 ↵
- “MiraLax Mix-In Pax, Unflavored, 20 Little Packets” by Ava Williams is licensed under CC0 and “Phillips' Milk of Magnesia, 1910's” by Roadsidepictures is licensed under CC BY-NC 2.0 ↵
- “fleet_enema” by Logesh79 is licensed under CC BY-NC 2.0 ↵
- “Administering-med-rectally-2.png” by British Columbia Institute of Technology (BCIT) is licensed under CC BY 4.0 ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
- Drugs.com [Internet]. Metamucil; © 2000-2019 [reviewed 20 November 2017; updated 1 October 2019; cited 27 October 2019]. https://www.drugs.com/mtm/metamucil.html ↵
The digestive process where undigested materials are removed from the body as feces.
The passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual).
Relieve the symptoms of diarrhea, such as an increased frequency and urgency when passing stools, but do not eliminate the cause of it.
Medications that help to treat diarrhea by slowing peristalsis.
The adhesion of molecules to a surface. For example, bismuth salicylate coats the walls of the GI tract and binds the causative bacteria or toxin for elimination from the GI tract through the stool.
Laxatives that facilitate movement of water and fats into stool to make it soft and improve regularity of bowel movements.
Cause water to be retained with the stool, increasing the number of bowel movements and softening the stool so it is easier to pass.
Laxatives that cause the intestines to contract, inducing stool to move through the colon.


Chapter 5: Newton’s Laws of Motion (Volume 1)
William Moebs; Samuel J. Ling; and Jeff Sanny
Chapter Outline
When you drive across a bridge, you expect it to remain stable. You also expect to speed up or slow your car in response to traffic changes. In both cases, you deal with forces. The forces on the bridge are in equilibrium, so it stays in place. In contrast, the force produced by your car engine causes a change in motion. Isaac Newton discovered the laws of motion that describe these situations.
Forces affect every moment of your life. Your body is held to Earth by force and held together by the forces of charged particles. When you open a door, walk down a street, lift your fork, or touch a baby’s face, you are applying forces. Zooming in deeper, your body’s atoms are held together by electrical forces, and the core of the atom, called the nucleus, is held together by the strongest force we know—strong nuclear force.


Origins of UDL
This chapter was adapted from Universal Design for Learning (UDL) for Inclusion, Diversity, Equity, and Accessibility (IDEA) Copyright © 2022 by Darla Benton Kearney, which is licensed under a Creative Commons Attribution 4.0 International License
Concept of Universal Design
In the 1980s, architect Ronald Mace introduced the term Universal Design (UD). In its original application, UD refers to “the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design” (Connell et al., 1997). For example, consider the barriers presented by entering a building that has steps up to a door with handles. Who would have difficulty accessing such a building?
Now, consider a building entrance that is at ground-level entry with doors that open automatically. Who would have difficulty navigating this building?
Just as stairs pose barriers in the built environment, there are barriers to learning in education. The concept of removing barriers and increasing access has been applied to the field of education with the development of various UD frameworks, including Universal Instructional Design (UID), Universal Design for Instruction (UDI), and Universal Design for Learning (UDL).
Despite their differences, inclusive instruction is the common goal of all three of these frameworks. The ultimate goal of inclusive instruction is to remove unnecessary barriers and improve access for all learners.
Universal Design for Learning
In the 1900s, David Rose, Anne Meyer, and their colleagues at the Center for Applied Special Technology (CAST) developed the UDL framework, which is the only UD framework that is based on research on cognitive neuroscience (Meyer, et al. 2002; Rose, Rouhani, et al., 2013; Rose, 2016). CAST is an organization whose mission is to eliminate barriers to learning and support the development of expert learners while addressing aspects of inclusion, diversity, equity and accessibility.
A key aspect of UDL is understanding that all learners are variable and that the “average student” simply does not exist. We cannot plan for every learner variable, but we can design, develop, and deliver our curriculum knowing our learners will have diverse needs and providing them options to ensure everyone’s needs are met.
View this short video (run time: 6 minutes and 7 seconds) that provides a good overview of designing for ‘everyone.’
Text Attributions
This was adapted from Universal Design for Learning (UDL) for Inclusion, Diversity, Equity, and Accessibility (IDEA) Copyright © 2022 by Darla Benton Kearney, which is licensed under a Creative Commons Attribution 4.0 International License


References
References
References
Plea. (n.d.). Deaths and estates, a death in the family, paperwork. https://www.plea.org/death-estates/a-death-in-the-family/paperwork#:~:text=A%20Medical%20Certificate%20of%20Death%20will%20include%20particulars,completed%20in%20order%20to%20obtain%20a%20burial%20permit.
eHealth Saskatchewan. (n.d.) Guidelines for completing the medical certificate of death and the medical certificate of stillbirth.
https://www.ehealthsask.ca/residents/deaths/Documents/HowToCmpltMCD%20v7.pdf
College of Physicians and Surgeons Saskatchewan. (2019) Physician obligations regarding medical certification of death. https://www.cps.sk.ca/imis/Documents/Legislation/Policies/POLICY%20-%20Physician%20Obligations%20Regarding%20Medical%20Certification%20of%20Death.pdf
The Vital Statistics Regulations. (2008). https://www.canlii.org/en/sk/laws/regu/rrs-c-v-7.1-reg-1/latest/rrs-c-v-7.1-reg-1.html
Saskatchewan Coroners Service. (n.d.). Training manual: The role of the coroner.
Hanzlick, R., Hunsaker, J., Davis, G. (2002). A guide for manner of death classification. https://name.memberclicks.net/assets/docs/MANNEROFDEATH.pdf
The Coroners Act. (1999). https://www.canlii.org/en/sk/laws/stat/rss-1978-c-c-38/latest/rss-1978-c-c-38.html
Hanzlick, R. (2006). Cause of death and the death certificate. Important information for physicians, coroners, medical examiners, and the public. https://www.health.state.mn.us/people/vitalrecords/physician-me/docs/capcodbook.pdf
Office of the Registrar General. (2010). Handbook on medical certification of death. https://www.publications.gov.on.ca/store/20170501121/Free_Download_Files/016600.pdf
The Vital Statistics Act. (2009). https://publications.saskatchewan.ca/#/products/28725
Centers for Disease Control and Prevention. (2003). Physicians handbook on medical certification of death. https://stacks.cdc.gov/view/cdc/6533


Miles Gloriosus, or The Braggart Captain
Act One, Scene One
Enter PYRGOPOLINICES[1] ARTOTROGUS, and Soldiers.
PYRGOPOLINICES
Take ye care that the lustre of my shield is more bright than the rays of the sun are wont to be at the time when the sky is clear; that when occasion comes, the battle being joined, ‘mid the fierce ranks right opposite it may dazzle the eyesight of the enemy. But, I wish to console this sabre of mine, that it may not lament nor be downcast in spirits, because I have thus long been wearing it keeping holiday, which so longs right dreadfully to make havoc of the enemy. But where is Artotrogus?
ARTOTROGUS
Here he is; he stands close by the hero, valiant and successful, and of princely form. Mars could not dare to style himself a warrior so great, nor compare his prowess with yours.
PYRGOPOLINICES
Him you mean whom I spared on the Gorgonidonian[2] plains, where Bumbomachides Clytomestoridysarchides, the grandson of Neptune, was the chief commander?

PYRGOPOLINICES
That, on my troth, was really nothing at all.
ARTOTROGUS
Faith, that really was nothing at all in comparison with other things I could mention–(aside) which you never did. If any person ever beheld a more perjured fellow than this, or one more full of vain boasting, faith let him have me for himself, I’ll resign myself for his slave; if ’tis not the fact that[3] my one mess of olive pottage[4] is eaten up by me right ravenously.
PYRGOPOLINICES
Where are you?
ARTOTROGUS
Lo! here am I. I’ troth in what a fashion it was you broke the fore-leg[5] of even an elephant, in India, with your fist.
PYRGOPOLINICES
How?–the fore-leg?
ARTOTROGUS
I meant to say this–the thigh.
PYRGOPOLINICES
I struck the blow without an effort.
ARTOTROGUS
Troth, if, indeed, you had put forth your strength, your arm would have passed right through the hide, the entrails, and the frontispiece of the elephant.
PYRGOPOLINICES
I don’t care for these things just now.
ARTOTROGUS
I’ faith, ’tis really not worth the while for you to tell me of it, who know right well your prowess. (Aside) ‘Tis my appetite creates[6] all these plagues. I must hear him right out with my ears, that my teeth mayn’t have time[7] to grow, and whatever lie he shall tell, to it I must agree.
PYRGOPOLINICES
What was it I was saying?
ARTOTROGUS
O, I know what you were going to say just now. I’ faith ’twas bravely done; I remember its being done.
PYRGOPOLINICES
What was that?
ARTOTROGUS
Whatever it was you were going to say.
PYRGOPOLINICES
Have you got your tablets[8]?
ARTOTROGUS
Are you intending to enlist[9]? I have them, and a pen as well.
PYRGOPOLINICES
How cleverly you do suit your mind to my own mind.
ARTOTROGUS
‘Tis fit that I should know your inclinations studiously, so that whatever you wish should first occur[10] to me.
PYRGOPOLINICES
What do you remember?
ARTOTROGUS
I do remember this. In Cilicia there were a hundred and fifty men, a hundred in Cryphiolathronia[11], thirty at Sardis, sixty men of Macedon, whom you slaughtered altogether in one day.
PYRGOPOLINICES
What is the sum total of those men?
ARTOTROGUS
Seven thousand.
PYRGOPOLINICES
It must be as much: you keep the reckoning well.
ARTOTROGUS
Yet I have none of them written down; still, so I remember it was.
PYRGOPOLINICES
By my troth, you have a right good memory.
ARTOTROGUS
aside . ‘Tis the flesh-pots [12] give it a fillip.
PYRGOPOLINICES
So long as you shall do such as you have done hitherto, you shall always have something to eat: I will always make you a partaker at my table.
ARTOTROGUS
Besides, in Cappadocia, you would have killed five hundred men altogether at one blow, had not your sabre been blunt.

ARTOTROGUS
Why should I tell you what all mortals know, that you, Pyrgopolinices, live alone upon the earth, with valour, beauty, and achievements most unsurpassed? All the women are in love with you, and that not without reason, since you are so handsome. Witness those girls that pulled me by my mantle yesterday.
PYRGOPOLINICES
What was it they said to you?
ARTOTROGUS
They questioned me about you. “Is Achilles here?” says one to me. “No,” says I, “his brother is.” Then says the other to me: “By my troth, but he is a handsome and a noble man. See how his long hair becomes him Certainly the women are lucky who share his favours.”
PYRGOPOLINICES
And pray, did they really say so?
ARTOTROGUS
They both entreated me to bring you past to-day by way of a sight [13]to them.
PYRGOPOLINICES
‘Tis really a very great plague to be too handsome a man.
ARTOTROGUS
They are quite a nuisance to me; they are praying, entreating, beseeching me, to let them see you; bidding me be fetched to them; so that I can’t give my attention to your business.
PYRGOPOLINICES
It seems that it is time for us to go to the Forum, that I may count out their pay to those soldiers whom I have enlisted of late. For King Seleucus [14] entreated me with most earnest suit that I would raise and enlist recruits for him. To that business have I resolved to devote my attention this day.
ARTOTROGUS
Come, let’s be going then.
PYRGOPOLINICES
Guards, follow me. (Exeunt.)
- Pyrgopolinices: The literal meaning of the name of the swaggering Captain is "the much-conquering tower," or something similar. "Artotrogus" means "bread-eater." The word "Parasite" properly denotes "one person who dines with another." The name was originally given to persons who were assistants to the priests and high magistrates, and, consequently, had a respectable signification. The hangers-on, who are called "Parasites" by the Comic writers of Greece and Rome, first received that name from Alexis, the Greek Comedian. It has been well remarked, that their chief characteristics were "importunity, love of sensual pleasures," and "the desire of getting a good dinner without paying for it." They may be subdivided into the jesting, the officious, and the flattering Parasite (assentator), of which latter kind Artotrogus is an admirable specimen. From ancient writers we find that it was their method to frequent the Courts of justice, market-places, baths, places for exercise, and other objects of public resort, with the view of obtaining a dinner, at the price of being the butt of their entertainer, and cheerfully submitting to the greatest humiliations. ↵
- Gorgonidonian: These three crackjaw names are coined by Plautus much in the style of the names of the characters in Bombastes Furioso. They are mere gibberish, though the two latter are derived from Greek or Latin words; the first of which signifies "a son of a fighter at the sound of the trumpet." ↵
- 'Tis not the fact that: This line is read in many different ways, and is evidently in a most corrupt state. Ritschel suggests, "Unum epityrum apud illum estur insane bene," which we follow as nearly as is consistent with the English idiom. ↵
- Mess of olive pottage: -- "Epityrum" was the name of a dish much used by the people of Sicily, who ate it together with cheese. We learn from Cato (on Rural Matters), that it was made of various kinds of olives minced up, and mixed with oil, vinegar coriander, cummin, fennel, rue, and mint, and then preserved in jars. ↵
- The fore-leg: Brachium is supposed by some to mean "the trunk" of the elephant; but it seems more probable that it here means "the fore-leg." ↵
- My appetite creates: He now addresses the Spectators, and honestly confesses why he is a Parasite. ↵
- Mayn't have time: Dentes dentire is that which we call "teething." He says that he acts the flatterer that his teeth may not have time to grow through want of employment. ↵
- Got your tablets: The "tabulae," or "tabellae," used by the ancients for the purpose of writing, were pieces of wood, mostly of an oblong shape, covered with wax, on which an impression was made with the "stylus," or iron pen. They were sometimes made of ivory, but more frequently of citron-wood, beech, or fir The inside only of the tablet was covered with wax, the outer consisting of wood. The leaves were fastened at the back with wires, and opened and shut like the books of the present day. There was a raised margin to each leaf of the tablet, for the purpose of preventing the wax of the one from rubbing against the other. From two to five, six, or even more of these leaves were joined together, which were accordingly called "diptycha," "triptycha," and so on. Those tablets which contained legal documents were pierced through the outer edges with holes, through which a triple thread or string was passed, on which a seal was placed, in order to prevent forgery and to show that the deed was duly executed. ↵
- Intending to enlist: Rogare. Soldiers, when enlisted, were asked (regabantur) whether they would take the oath. Hence the word "rogare" means something tantamount to our word "enlist," or "recruit." The Parasite asks him if he is going to enlist, as the tablets would be wanted in the "Forum," or "Court of justice," for the purpose of taking down the oaths, and entering the names as the parties were sworn. ↵
- Should first occur: "Praevolat mihi." Literally, "should fly to me beforehand." ↵
- Cryphiolathronia: This word is mere gibberish: it is compounded of Greek words, which would make it to mean "the place of hidden secrecy." The part of the flatterer seems to be a little overdone here. ↵
- Tis the flesh-pots: "Offae monent." "Offa" properly means "a lump of flesh," from which it came to signify "victuals" in general. ↵
- By way of a sight: "Pompam." Strictly speaking, this word means the escort of a procession, whence it came to signify the procession itself. ↵
- Seleucus: The King of that part of Asia Minor where Ephesus was situated. ↵