What is the physical objects a society produces things people create and use?

2.3 Women's Roles

Understandably, the material culture of domestic life has figured in the work of historians of women. A special interest among some such scholars in the decorative arts and in the history of technology has focused on kitchen tools and appliances and their roles in defining, confining, or undermining a ‘woman's place.’ While various researchers have contributed to this scholarly enterprise, the work of Ruth Schwatz Cowan, Dolores Hayden, and Susan Strasser aptly represent their general concerns.

Cowan's research has moved from the study of a single artifact genre (A Case of Technology and Social Change: The Washing Machine and the Working Wife 1974) to kitchen appliances in general (‘The “Industrial Revolution” in the Home,’ Technology and Culture, 1973) to women's interaction with technological material culture throughout American history (More Work for Mother: The Ironies of Household Technology From Open Hearth to Microwave, 1983). In an essay titled ‘Virginia Dare to Virginia Slims: Women and Technology in American Life,’ Technology and Culture (1979), Cowan points out that none of the standard histories or bibliographies of America technology contain adequate reference to such culturally significant artifacts as the baby bottle. Here is a simple implement that, along with its attendant delivery system, revolutionized a basic biological process, transformed a fundamental human experience for vast numbers of infants and mothers, and served as one of the more controversial exports of Western technology to underdeveloped countries.

According to Cowan, there is a host of questions that scholars might reasonably ask about the baby bottle. For how long has it been part of Western culture? When a mother's milk could not be provided, which classes of people used the bottle and which the wet nurse, and for what reasons. Which was a more crucial determinant for widespread use of the bottle, changes in milk technology or changes in bottle technology? Who marketed the bottles, at what prices, to whom? How did mothers or different social classes and ethnic groups react to them? Can the phenomenon of ‘not enough milk,’ which was widely reported by pediatricians and obstetricians in the 1920s and 1930s be connected with the advent of the ‘safe’ baby bottle? Which was cause and which effect?

Hayden's interests have been more spatial and environmental than technological. Her Seven American Utopias: The Architecture of Communitarian Socialism, 1790–1975 (1976) details the social and cultural history of several countercultural societies through their extant structures and sites, as well as through their furniture and household technology. Hayden's The Grand Domestic Revolution: A History of Feminist Designs for American Homes, Neighborhoods, and Cities (1981), provides the social historian with a useful review of the interaction of domestic feminism, cooperative housekeeping, the community kitchen movement, and projects for social reform.

Susan Strasser's Never Done: A History of American Housework (1982) has set the agenda for future research into basic topics such as food preparation, housekeeping and housecleaning, and domestic consumerism. On the last topic, Strausser has followed up on her own work and written books on the material culture of advertising, particularly its orientation toward women consumers and on the history of trash.

How might the nexus of domestic life and material culture appear in the near future? One prediction is that the three subfields outlined above will continue to thrive. In each research area there are scholars experimenting with new methodologies as well as widening the boundaries of traditional evidential data.

For example, a few individuals in organizations such as the Vernacular Architecture Society (Great Britain) and the Vernacular Architecture Forum (United States) now study prefabricated and manufactured housing, condominiums, and assisted-care residences for the elderly. Some decorative arts historians are venturing beyond museum period-room settings as well as the old prescript maintained by dealers, collectors, and the US Customs office that ‘one hundred years doth an antique make,’ and are examining post-World War II kitchen remodelings, family rooms, the changing functions of the garage, plus patios and decks. Within the interdisciplinary gender studies movement, investigators have turned their attention to the social and material culture of Tupperware parties, to the current popularity of replica/reproduction nineteenth-century household goods, and the artifacts (computers, fax machines, telemarketing devices) of an increasing number of home offices serving as career centers for a variety of occupations.

Two, relatively recent, scholarly perspectives should influence future work on domestic life research and material culture studies. First, the re-emergence of anthropology, a parent-field for material culture, will strength both areas, particularly in paradigm building and in social science rigor. Material culture sessions at the International Congresses of Ethnological and Anthropological Sciences suggest this trend. It has also been argued that consumerism studies may become the most noticeable cynosure of contemporary material culture research. Perhaps. The twentieth-century data appears omnipresent and continually proliferating. While some basic research has been done over the past several decades, the full impact of door-to-door sales, general/specialty merchandising, department, chain, and franchise stores, shopping centers, mail-order cataloging (perhaps reaching more homes now than in the nineteenth century), suburban and megamalls on domestic life awaits at least a generation of researchers.

Whatever the future configurations of those who explore the intersections between domestic life and material culture, they will most probably share common cause in the vernacular, the populist, the typical; and in the desire to make human experience, as the novelist William Makepeace Thackeray once hoped ‘more familiar than heroic.’

Comparative Value Orientations

In contrast to material culture, or the more easily observed and understood parts of culture (clothing, food, music, forms of greeting, ceremonial rites of passage), nonmaterial culture is more difficult to assess. Sometimes similarities in the material culture obscure profound differences in the nonmaterial culture that are relevant to the therapist-patient interaction. These value orientations are as important, or even more important, for the PT to pay attention to.

Many observers have identified recurrent themes and patterns in cultures (Table 3-1). These cultural elements may be the core of one's worldview, or values people live by. Typically, cultures that have been most heavily influenced by Euro-American values will match those cultural characteristics listed in the left column of Table 3-1, whereas those influenced by a Latin or Hispanic, Asian, Middle Eastern or African culture, for example, will fit the characteristics listed on the right. However, worldview can be heavily influenced by personality traits and socioeconomic and acculturation status. Also, people do not necessarily fit into a rigid category; some may fall at the far end of one dichotomous scale, in the middle for a second, or at the other end for a third.

If forced to choose one contrasting element for these two columns, it would arguably be an individualist society versus a collectivist society. These adjectives symbolize general social organization and relationships and can be linked to many of the other values listed. There are innumerable ways in which these characteristics can influence the therapeutic encounter. For example, Euro-American values emphasize the importance of the individual and the ability of each person to affect his or her future through hard work. In this type of cultural orientation, both time and nature are commodities to be used profitably and the success—or lack of success—of each person is credited to that individual. Professionals with this type of cultural value system would emphasize the autonomy and personal responsibility of their patients and expect them to work hard while in therapy. Desires and expectations would be clearly stated in a direct manner.

In contrast, patients may have a cultural value system that emphasizes the importance of the group over the individual. In the Hispanic culture, possibly the most significant value is that of familismo. Consistent with a collectivist society, the emphasis is on family commitment and responsibility. The welfare and honor of the family are preeminent concerns. The father is typically the final arbiter of decision making. The mother is central within the household and is responsible for child rearing and cultural and social stability.40 Kinship bonds across generations are common. Thus a patient may arrive at the clinic with several family members and feel there is little point to working too hard because they will be cared for by the family, and much of what happens to people—including disability—is predetermined by fate. For both of you to save face they might act politely and be accommodating when, in fact, they may not understand your instructions or know that your goals and theirs are not in sync. Other cultural values associated with the Hispanic culture include personalismo (friendliness), simpatia (kindness, avoid conflict; sympathy), and fatalismo (fatalism).

Core cultural values associated with African Americans include community and connection to ancestors and history, religion and spiritualism, oral expressiveness, commitment to family, and intuition and experience.5 Core cultural values of Asian people are associated with the teachings of Buddhism, Taoism, and Confucianism. Harmony between and among human beings and nature is critical.44

Perhaps the most difficult cultural differences to overcome in an outpatient orthopedic clinic, especially for North Americans, relates to pace of life and notion of time.20 The different views on the importance of an appointment time can have profound psychologic and business impact. Monochronism is the view that events happen in chronologic order, work tasks and socialization are separate, and adherence to schedules is important. Euro-Americans are monochronic: they are action oriented and are often unforgiving about such things as missed appointments and a casual approach to punctuality, “red tape,” bureaucratic delays, and the sense that time is an unimportant concept.

Polychronism, on the other hand, is the view that events can happen concurrently and that fixed schedules are insignificant. The focus is on a more personal interaction, with less concern toward completion of the task at hand. With the Hispanic patient as an example, there is the value for personalismo, or a more humanistic approach. The attention to a work orientation and the acquisition of material goods may not be present among individuals who more highly value a relaxed, human relationship–oriented lifestyle. Imagine the potential for misunderstanding if a Cuban patient, for example, arrives late for an appointment and expects the therapist to chat for a few minutes about nontherapeutic issues, such as the well-being of his family, and the therapist, already annoyed about her schedule being interrupted, immediately launches into a discussion about how to do exercises. In a rehabilitation setting, even the development of group exercise programs may be influenced by comparative value systems. For example, does the patient value competition or cooperation?

The role and status of medical personnel may be different depending on cultural orientation. A patient from a Middle Eastern culture would more naturally defer to the health professional, who is considered an authority figure worthy of high esteem. An interactive conversation about health options is less likely to occur.

Comparative value systems may affect behaviors around a particular age group of patients. For instance, there may be particular expectations of Asian American adolescents that are different from those of a typical Euro-American adolescent. In contrast to how young children are obliged and indulged, older children are expected to be well disciplined and to take on some adult roles. An older, adolescent sibling may be expected to accept personal sacrifice and assume child care for young children in the extended family, while at the same time maintaining a strong academic record. A sense of duty or obligation to the family may be pronounced, and this is learned through proper role modeling. If there is misbehavior by a younger sibling, an older sibling might be rebuked for not setting a good example. High expectations may be a source of stress. Adolescents are likely to be recipients of a parenting style that is somewhat controlling, restrictive, and protective. This may lead to distancing behaviors or distrust of outsiders. Discussions about sensitive topics such as sexuality may be avoided, and the willingness to discuss personal issues related to treatment can be minimal.32

Similarly, special considerations may be necessary when working with elder or terminal patients that reflect a particular worldview. Widespread respect for elders is prevalent among many ethnic groups. Signs of respect may include use of the terms “Ma'am” or “Sir” or asking for tales of wisdom. Although the orthopedic primary care PT is not typically faced with discussions regarding end-of-life decisions, this is still a possible topic of conversation, especially with family members. Of note, in Asian and Hispanic cultures disclosure of a terminal disease may take away any hope that the patient may have. Family members have a strong obligation to protect loved ones from emotional distress.

Furthermore, elder adults are likely to have variations in attitudes toward advance directives. For example, Chinese elders may be less likely to write something down because they honor the spoken word. In actuality, Chinese elders commonly do not discuss the likelihood of death at all because it is believed to be a bad omen. The Navajo feel similarly. Negative thoughts would be in conflict with the concept of “hozho,” which involves goodness, harmony, and positive attitude. Japanese elders place great faith in family and professional relationships, and it is less likely that individual decision-making would be a norm. Children, particularly the oldest son, feel the duty to maintain a parent's life. For the Navajo as well, major decisions are collaborative, and family and tribespeople would have input into any advance health directives.4

African Americans who have been socioeconomically marginalized tend to be more likely to desire life-sustaining treatment and are less likely to desire or receive hospice care. In contrast, white people are more likely to feel empowered and in control, which may account for their greater willingness to forgo life-sustaining treatment.4 Finally, considering a person's value system may influence whether accepting a gift from a patient or their family is ethically appropriate. In many cultures it would be a great insult to refuse a gift; a person's pride may be at stake.

3.1.4 Animal Models

Apart from human intestinal material, cultures of the immature intestine of rat or chick fetus have been used to demonstrate the cytotoxic activity of gliadin fractions [58,59]. CD-active compounds inhibit development and morphogenesis of the very immature small intestine, showing that gliadin peptides may have a direct damaging activity against the small intestinal mucosa during the early phase of its morphogenesis. Another approach has been to study the disruption of rat liver lysosomes caused by active gliadin peptides [60].

To better understand the immunologic pathways and mechanisms of CD, a number of attempts have been made to create an animal model for various purposes. Currently, there are three models that spontaneously generate gluten-dependent diarrhea: (1) the dog, (2) the rhesus macaque, and (3) the horse model [32,61]. In the dog model, Irish setters develop partial villous atrophy and IEL infiltration in response to the consumption of gluten [62]. Gluten-dependent, small intestinal mucosal damage has been described in rhesus macaques [63], and gluten-dependent increased levels of antibodies have been observed in horses with inflammatory small bowel disease [64]. Common to all three of these spontaneous models is the lack of association with HLA-DQ2/8 alleles. Other models (e.g., with mice, rats, or rabbits) are not spontaneous and need gluten sensitization, chemical and/or drug treatment, and genetic alterations to develop features of CD. The mouse model has a big advantage over the other models because transgenes can be introduced to evaluate the contribution of specific genes to the development of CD. For example, transgenic mice were generated expressing human HLA-DQ2 or -DQ8, but none of the animals used developed full-blown villous atrophy [65,66]. De Paolo and coworkers reported that gliadin-fed humanized HLA-DQ8 mice overexpress IL-15 in the lamina propria, a condition resembling early developing CD; however, the mucosal architecture remains normal [67]. Numerous studies used transgenic mice to investigate different elements of CD pathogenesis (e.g., the role of CD4+ T cells, TG2, IL-15, and intestinal microbiota) [32,61]. Specific mouse models also were used to test novel therapies for CD [32,61] (see Chapter 3, Section 2). Examples targeting pathogenic steps are modification of gluten peptides, suppression of the innate response, the blocking of Zonulin-1, suppression of inflammatory T-cell response, and the blocking of IL-15 or receptors of IL-15. Regardless of all these attempts, the animal model for CD that reproduces all the aspects of this disorder still awaits development.

Artifact Review

Artifact review, most recently referred to as material culture methods,8 comprises a set of techniques primarily used to ascertain the meaning of objects in research contexts. For example, archaeologists examine ruins to learn about ancient cultures. Material culture theorists examine objects for emotive meanings, to identify conferral and response. Artifact review in health and human service research may include the examination of personal objects in a patient's hospital room or client's home to determine interests and preferred ways of arranging the environment as a basis for intervention planning.

Sobchack13 contrasted the meaning of lower extremity prostheses in an object reading methodology. In contrast to Mullins, a model and athlete known for running on bilateral “cheetah legs” who sees prosthetics as wearable sculpture, Sobchack's prostheses meant rejoining typical functioning and ambulation.

2 Archaeological Approaches to Ceramics

Ceramics have played a central role in archaeological method and theory, for several reasons: (a) pottery has a long history, and is virtually ubiquitous in most sedentary societies; (b) pottery is nonperishable, and is often recovered in very large quantities from archaeological excavations; (c) pottery functioned both as utilitarian cooking, storage, and serving vessels for all strata of a society, as well as special purpose functions for elite ceremonial or funerary use; and, (d) as a highly plastic material, pottery displays seemingly infinite variation in composition, manufacturing method, shape, and decoration. These variations, moreover, were culturally conditioned, resulting in particular ceramic styles or traditions, which can be traced through time and space.

Early in the development of modern archaeology, scholars such as Flinders Petrie in Egypt, and somewhat later James Ford, Irving Rouse, and James Griffin in North America, recognized the value of ceramic studies in developing relative chronologies based on changes in ceramic style over time. Prior to the development of such absolute chronometric dating methods as radiocarbon or dendrochronology (see Chronology, Stratigraphy, and Dating Methods in Archaeology), the construction of ceramic chronologies were essential to developing local and regional time frames for prehistoric cultures.

With the rise of absolute dating methods in the second half of the twentieth century, archaeological studies of ceramics have shifted somewhat, with less emphasis on classification, seriation, and chronology construction, in favor of new approaches. These include detailed physical and chemical studies of ceramic composition and of production techniques and sequences, which inform archaeologists about the technology of ceramic production and use, and about the distribution and movement of ceramic vessels during their life spans. Such information in turn is useful to archaeologists who are attempting to understand prehistoric economic and sociopolitical organization.

Flexible Bronchoscopy

Flexible bronchoscopy is safe in experienced hands and provides excellent culture material in the immunocompromised child with pneumonia.101–108 Indications in children with pneumonia include (1) failure of the pneumonia or fever to clear with appropriate antibiotic therapy; (2) suspicion of endobronchial obstruction by an infection or a tumor; (3) recurrent pneumonia in a lobe or segment; and (4) suspicion of unusual organisms such as P. jiroveci, fungi, and the pathogen that causes tuberculosis. Although the yield of gastric aspiration is probably superior to that of bronchoscopy for tuberculosis, bronchoscopy can also be useful to evaluate for endobronchial disease or bronchial compression.

The bronchoscope suction channel is contaminated by organisms of the upper airway, and simple washings obtained through the bronchoscope channel are generally useless for culture. Several techniques, including the use of a double-sheath, wax-protected sterile brush and quantitative cultures of bronchoalveolar lavage fluid, have been developed to avoid this problem. Bronchoalveolar lavage is the most useful technique for diagnosing infection in the immunocompromised host, and a variety of infectious and noninfectious diagnoses, including hemorrhage and pulmonary involvement with leukemia (Fig. 36-11), can be made using it. Bronchoalveolar lavage is generally safe even in patients with reduced numbers of platelets. Brushings obtained through the bronchoscope can be used for cytologic examination and viral cultures, but the yield is usually low.

Although the safety and usefulness of bronchoscopy are well documented in this population, it is important for the clinician to recognize the limitations of bronchoscopy. In patients on empirical broad-spectrum antibiotic therapy, the yield of bacterial pathogens is likely to be low. In oncology patients and other non-AIDS immunocompromised patients, the number of P. jiroveci organisms is usually low compared to the number obtained from patients with AIDS, so the results may be falsely negative. In populations receiving prophylaxis for this infection, the yield for PCP is likely to be low, reducing the overall yield of bronchoscopy for treatable infections. CMV can also be diagnosed rapidly by bronchoscopy, but patients may have other complicating infections, such as those caused by fungi and CMV, that are more easily missed by bronchoscopy. Infections caused by Aspergillus and other fungi are often difficult to diagnose by bronchoscopy, particularly early in the infection when therapy is most likely to be effective.

What are physical objects that people create and use?

What is physical things produced by a society?

What is an object produced by human culture?

What is the term for the built objects in a society?