Why doesn't Lady Capulet want her husband to get involved in the fight in Act I, Scene 1?

In Act I, Scene 1 of Shakespeare's Romeo and Juliet a brawl breaks out in the streets of Verona between the Capulets and Montagues. The fight is initially instigated by the servants of Capulet and further provoked by Capulet's cousin Tybalt. Hearing the disturbance in the street, Lord Capulet emerges in his gown and calls for his "long sword," presumably to engage the Montagues in a fight. Lady Capulet is right behind him and remarks,

A crutch, a crutch! Why call you for a sword?

She is suggesting her husband is too old for sword play. Capulet is not to be dissuaded and counters that Montague "flourishes" his blade in defiance. Lady Montague offers basically the same suggestion to her husband. She says, 

Thou shalt not stir one foot to seek a foe.

Immediately after the Prince breaks up the fight and declares that the death penalty will be enforced if any more fighting occurs. Of course, this edict foreshadows the fight in Act III. 

The idea that both Lord Capulet and Lord Montague are too old to fight is reinforced in the next scene while Capulet talks to Count Paris. Capulet says,

But Montague is bound as well as I,
In penalty alike, and ’tis not hard, I think,
For men so old as we to keep the peace.

What are the hard questions that Calvin asks about Meg’s father in A Wrinkle in Time?

Calvin asks Meg hard questions about her father's disappearance, a touchy subject in the Murry family. He first repeats the rumor going around town that her father ran off with another woman. He says he knows that isn't true, but then probes Meg more deeply about her father's disappearance. Meg responds that all she knows is that her father had a top secret clearance with the government. Calvin asks if her father might be dead. Meg replies no, or they would have gotten a telegram. However, he has stopped writing letters. Calvin then asks if she thinks that the government doesn't know what happened to her father. Meg admits that's what she fears. 

It takes courage for Calvin to ask these questions, because Mr. Murray's disappearance is such a sensitive subject. Meg is hurt, misses her father and is deeply worried about what has happened to him. Calvin shows his maturity in being able to question her on such a sore subject in a way that Meg can accept. 

What is the moral of the story "The Country of the Blind"?

I can think of three possible morals to the story “The Country of the Blind.”

Don’t judge a book by its cover. Or: don’t presuppose that you know everything about a person, just because you know recognize one important feature. Nunez is a sighted man, and he lands in a village where everyone is blind. He immediately believes he’s got an advantage over them. He thinks he can tell them about the outside world and what it looks like. But they’ve developed their own culture and system of beliefs. He learns the hard way that in the Country of the Blind, the one-eyed man can never be King.

It was marvelous with what confidence and precision they went about their ordered world. Everything, you see, had been made to fit their needs.

This advice works both ways. The villagers should not assume that Nunez is a totally different kind of being, with the raw intelligence of a mere child, just because he uses words like “see” and “blind.”

Embrace diversity and tolerance. This advice follows on the first, and again, it works both ways. Nunez could be more tolerant of the villagers at first. They, in turn, could allow him to be different and to keep his eyes.

Slowly Nunez realized this; that his expectation of wonder and reverence at his origin and his gifts was not to be borne out; and after his poor attempt to explain sight to them had been set aside as the confused version of a new-made being describing the marvels of his incoherent sensations, he subsided, a little dashed, into listening to their instruction.

Be true to yourself. Sight is important to Nunez. More important than love, as it turns out. The young woman he’s fallen in love with, Medina-sarote, expects him to have the surgery to remove his eyes, so that he can be cured of his idiocy.

“They will hurt you but little,” she said; “and you are going through this pain – you are going through it, dear lover, for me. … Dear, if a woman’s heart and life can do it, I will repay you. My dearest one, my dearest with the tender voice, I will repay.”

But just because a loved one asks, and just because each individual gives up a little something in order to become part of a couple, doesn’t mean you must ever abandon who you are at your core. Nunez realizes this in the end.

In Of Mice and Men, discuss the relationship between Lennie and George as it relates to the way they speak.

Steinbeck uses the way that George and Lennie speak to one another to show a deep friendship between the two men.

Throughout the novella, the way in which George and Lennie speak to each other reflects a shared connection. They never speak with any stilted formality between them or anything that would constitute a sense of awkwardness. Their language reflects intimacy. This can be seen in the first conversation between them:

“Lennie!" he said sharply. "Lennie, for God’ sakes don’t drink so much.” Lennie continued to snort into the pool. The small man leaned over and shook him by the shoulder. "Lennie. You gonna be sick like you was last night.”

In both verbal and nonverbal modes of communication, there is a shared relationship between both men. George speaks with a sharp tone towards Lennie, something that could only happen if Lennie trusted George. Additionally, George physically touches Lennie. Given Lennie's imposing and intimidating size, it is highly unlikely that he would let anyone grab him unless they were a trusted friend. Lennie's response to George also reflects a caring friendship: “'You drink some, George. You take a good big drink.' He smiled happily." Lennie does not mind the embarrassment that might be associated with submerging his entire head in the water in front of George. He even encourages his friend to do so the same as he smiles "happily." He wants George to experience the same thing he experienced, something that indicates friendship. The conversational tone that exists between both men shows a relationship that has been cultivated over time.

While there is much that changes in George's and Lennie's world, the language they use towards one another shows that their friendship never dissipates. The repeated way in which George has to recite the story of how both men will live "off the fatta the land" is one such example. In Chapter 2, when Slim talks about his puppies and then leaves the room, George says to Lennie, "Yeah!... I heard him, Lennie. I’ll ask him.” This shows he knows the way Lennie's mind works and conversationally preempts it. This pattern continues until the end of the novella. The way in which both men speak to one another affirms their friendship, even in their darkest hour. Steinbeck is able to underscore a deep friendship through the conversational patterns both men share and the manner in which they speak to one another.

What is the brief pain inventory (BPI)?

Cancers diagnosed or treated: All cancers that cause chronic or severe sporadic pain

Why performed: The BPI is administered to determine cancer patients’ level of pain. Once the level of pain is determined, oncologists work to manage the painful symptoms of cancer and to make patients more comfortable. Pain management is especially important for terminal patients.

Cancer pain appears when a tumor presses against organs, nerves, or bone. Treatments for cancer such as chemotherapy, radiation therapy, and especially surgery also can cause pain.

The Veterans Administration and the Joint Commission on Accreditation of Health Care Organizations consider pain the fifth vital sign and require physicians to ask patients about their pain.

Patient preparation: Taking the BPI requires no patient preparation.

Steps of the procedure: The questionnaire for the BPI is usually filled out by the patient. In some cases, a doctor, nurse, or social worker helps by interviewing the patient and recording the answers. Filling out the short version of the BPI takes about five minutes, while the long version takes about ten minutes.

After the procedure: After the patient completes the BPI, it is scored on a scale of 0–10 for both the severity and the impact dimensions of the pain.

Risks: There are no inherent risks involved with the BPI. Its validity has been tested many times, and it has been translated into twenty-five languages. The only possible problem involved with the BPI is a patient’s inability or reluctance to report pain accurately.

Results: The results of an individual patient’s BPI can be tabulated in a few minutes. The results help oncologists, nurses, and other caregivers develop a pain management plan for the cancer patient.

Bibliography

Atkinson, Thomas M., et al. "Measurement of Affective and Activity Pain Interference Using the Brief Pain Inventory (BPI): Cancer and Leukemia Group B 70903." Pain Medicine 13.11 (2012): 1417–24. Print.

Atkinson, Thomas M., et al. "Using Confirmatory Factor Analysis to Evaluate Construct Validity of the Brief Pain Inventory (BPI)." Journal of Pain and Symptom Management 41.3 (2011): 558–65. Print.

Nguyen, J. "Palliative Response and Functional Interference Outcomes Using the Brief Pain Inventory for Spinal Bony Metastases Treated with Conventional Radiotherapy." Clinical Oncology 23.7 (2011): 485–91. Print.

Pelayo-Alvarez, Marta, Santiago Perez-Hoyos, and Yolanda Agra-Varela. "Reliability and Concurrent Validity of the Palliative Outcome Scale, the Rotterdam Symptom Checklist, and the Brief Pain Inventory." Journal of Palliative Medicine 16.8 (2013): 867–74. Print.

Wong, Karrie, et al. "Minimal Clinically Important Differences in the Brief Pain Inventory in Patients with Bone Metastases." Supportive Care in Cancer 21.7 (2013): 1893–99. Print.

Write a summary of Shakespeare's Sonnet 55.

Through the indestructibility of verse, the poet seeks to lend his beloved immortality. This is main idea of Shakespeare’s Sonnet 55.

Its first quatrain begins with the poet’s bold declaration that this piece of verse “shall outlive” “marble” or “the gilded monuments of princes.” During the Elizabethan period, the portraits of the members of the royal family were often carved on the stone cover of a coffin after their death. These memorials were gilded monuments made out of durable stone.

The poet, however, claims that the durability of these monuments would surrender to the effect of time, unlike this verse written on a piece of paper.

Not marble, nor the gilded monuments 
Of princes, shall outlive this powerful rhyme;

Calling time “sluttish,” the poet may be suggesting that time is faithful to none, kings or queens. It continues with its consistent and steady pace, indifferent to anything that happens on the earth. With time, these well-carved portraits, though belonging to royals or aristocrats, would get smeared and worn out. They would lose their sheen and splendor.

However, the contents of this sonnet are beyond the destructive effects of time. And, therefore, in this poem, his beloved “shall shine more bright” than the precious statues.  

In the second quatrain, the poet says that during “wasteful wars,” the monuments are demolished. The magnificent structures displaying the artistic skills of sculptors are turned to dust.

So, the poet has decided to keep his beloved safe till eternity in his verse. It’s because his verse couldn't be harmed even by the spear of Mars, the Greek God of war. As his words are indestructible even in fire, the poet calls this poem “the living record of your memory.”

In the final quatrain, the poet claims that even death wouldn't be able to harm his beloved. It’s because her essence is contained in this verse, and poetry is not a subject to death. Generation after generation would remember her until “the ending doom.” 

The final couplet sums up the main theme of the sonnet:

So, till the judgment that yourself arise, 
You live in this, and dwell in lovers' eyes.

It says that the poet’s beloved would “live in this” sonnet “till the judgment” Day. The confident poet assures his beloved that through his “powerful rhyme” he has made her immortal. Immortality is something that no king could buy himself with any quantity of precious stones or wealth. This is the strength of great poetry - that with its indestructibility, it can make its subject immortal.

What flaw causes Hamlet and Laertes to end up dead, while Fortinbras succeeds?

This is a very broad question and could be answered in a multitude of different and lengthy ways; not for nothing is Hamlet the most analyzed and interpreted character in Western literature! But since Hamlet is, in the critic Harold Bloom's words, "an experimental thinker rather more than he is Shakespeare's thought experiment," I propose that we try to respond to the question in the spirit of the prince himself, which is to say experimentally, to try to see and think outside the question rather than to accept as legitimate the premises we are given.

For me, part of the experimentalism of Hamlet lies in its dissolution of the traditional definition of "tragedy," which mandates that the great and mighty must be undone by their own flaws. Shakespeare's other tragedies can be said to fit that general definition in a variety of complex manifestations, but I don't really think it adequately explains Hamlet. Does the prince have "flaws?" Absolutely. Perhaps his most objectionable qualities, to my way of thinking, are the toxic misogyny created in him by his disgust at his mother's swift remarriage (which causes him to so cruelly mistreat Ophelia), and his inability to fully free himself from the system of martial values exemplified by his father, the warrior-king, to whose standard he painfully, fruitlessly compares himself--values which hold his mind partly captive even though Hamlet himself is plainly an artist in spirit and temperament, rather than a soldier (despite the cluelessly bitter irony of Fortinbras's concluding lines).

These flaws, which can be said to be the cursed inheritance of Hamlet's mother and father respectively (or even of the male and female principles in general), torment the prince throughout the play and drive many of his fatal errors of morality and judgment. But they are not Hamlet's most salient characteristics, and even they don't seem sufficient to explain, in the most profound and total sense, "why" Hamlet dies. Even less adequate is Hamlet's own brutal self-assessment, in which he ascribes to himself the faults he would like to have: "I am very proud, revengeful, ambitious, with more offences at my beck than I have thoughts to put them in, imagination to give them shape, or time to act them in." This description is exactly, utterly, even comically antithetical to the truth. Hamlet attributes to himself all the flaws that traditionally destroy "tragic heroes" (pride, vengeance, ambition). And indeed, each of these descriptions can be applied to the hot-headed Laertes, Hamlet's mirror image, who fulfills the arc of the tragic hero to a tee: his completely straightforward and identifiable desire to avenge the deaths of his father and sister cause him to rashly make a deal with the devil, one which leads to his destruction. But these recognizably "tragic" traits are lacking in Hamlet; in fact, the prince has nothing but "thoughts, imagination, and time." Time, that commodity and lie which is his great burden, and everyone's, keeps him from his appointed task by giving too much free play to his thought and imagination. It is only when he suddenly finds himself without time, that brief interval in which he knows with certainty that he is minutes from death, that he is able to act decisively and kill his uncle.

People will try to tell you that Hamlet's "tragic flaw" is his indecisiveness, or his desire for revenge, or his passivity, or any number of things. But the experimental genius of Hamlet is that it proposes a new, existential definition of tragedy: this new tragic hero is not a man ruined by his flaws, but one who suffers in tragic awareness of humanity's flaw, of Creation's flaw. Hamlet's "flaw" is simply that he is too sensitive to the tragic nature of reality. His "flaw" is his genius, which renders him incapable of enacting the prescribed roles of soldier, lover, prince, dutiful son, all of which he perceives deep down to be hollow and ephemeral. Shakespeare radically reinvents the nature of tragedy by imbuing his hero with tragic consciousness. Fortinbras, the consummate soldier, has no such consciousness. He is a much truer heir to King Hamlet than is the prince himself, and so he is able to prevail, at least within the little scope of time encompassed by the play, and to the extent that successfully occupying a castle full of dead nobles can be considered "prevailing." In a tragic universe, all victories are provisional, whether the victor realizes it or not. As in Faulkner's Hamlet-infused The Sound and the Fury, "No battle is ever won... they are not even fought. The field only reveals to man his own folly and despair, and victory is an illusion of philosophers and fools."

To which country does the speaker allude in "A Modest Proposal"?

In discussing his ironic proposal--that people should solve their social and economic woes by eating the children of the poor--the speaker alludes to several countries:

First, he addresses the proposal specifically to his fellow citizens of Ireland, saying that his solution will ease Ireland's longstanding and pervasive struggles:

"For preventing the children of poor people in Ireland, from being a burden on their parents or country, and for making them beneficial to the publick."

Second, he often alludes to the tensions between Ireland and England, which is important because we need to understand that this entire satirical essay is a critique of how England isn't helping Ireland with their social and financial issues (and how Ireland isn't helping itself, either).

The speaker mentions "the Pretender" twice, meaning King James Francis Edward Stuart, so called because he made a pretty weak claim to the British crown. The speaker talks about what happens to poor babies born to poor mothers: they "either turn thieves for want of work, or leave their dear native country, to fight for the Pretender in Spain." He mentions this "Pretender" again in reference to the poor members of society who keep on having babies, "who stay at home on purpose with a design to deliver the kingdom to the Pretender." In both cases, the speaker is criticizing not just the British king but also Irish society's relationship with him.

The Irish-British tensions are conveyed even more strongly toward the end of the essay, when the speaker claims that the proposal should be totally acceptable to England:

"I fortunately fell upon this proposal, which, as it is wholly new, so it hath something solid and real, of no expence and little trouble, full in our own power, and whereby we can incur no danger in disobliging England."

Third, in developing his authoritative, cold voice and tone, the speaker mentions authorities living in other countries who would support the cannibalism the speaker is proposing. Three examples are below:

A. An American authority who lives in London, England:

"I have been assured by a very knowing American of my acquaintance in London, that a young healthy child well nursed, is, at a year old, a most delicious nourishing and wholesome food, whether stewed, roasted, baked, or boiled; and I make no doubt that it will equally serve in a fricasie, or a ragoust."

This American is mentioned again: "...for as to the males, my American acquaintance assured me from frequent experience, that their flesh was generally tough and lean, like that of our school-boys..."

B. A French authority:

"...for we are told by a grave author, an eminent French physician, that fish being a prolifick dyet, there are more children born in Roman Catholick countries about nine months after Lent, the markets will be more glutted than usual..."

C. A Taiwanese authority (Taiwan used to be called "Formosa"):

"...this expedient was put into his head by the famous Salmanaazor, a native of the island Formosa, who came from thence to London, above twenty years ago, and in conversation told my friend, that in his country, when any young person happened to be put to death, the executioner sold the carcass to persons of quality, as a prime dainty..."

Fourth, the speaker makes some ugly allusions to other nations as well as to Jews. Let's have a look:

"Of learning to love our country, wherein we differ even from Laplanders, and the inhabitants of Topinamboo: Of quitting our animosities and factions, nor acting any longer like the Jews, who were murdering one another at the very moment their city was taken..."

Though Lapland is a real region, "Topinamboo" seems to be a term that the speaker is using to refer to a native tribe residing in Brazil.

By understanding how all these references to different countries come together, we can better place "A Modest Proposal" in a historical and geographical context.

What are 3 symbols from The Great Gatsby and how are they each significant? What do they teach us about society and the characters in the novel?

There are many symbols in The Great Gatsby. I will write about three: the green light, the valley of ashes, and Gatsby's clothes. 

The green light. Gatsby, from his house in West Egg, can look across the Sound and see Daisy's house. He is often seen standing on his lawn at night, looking wistfully toward a green light that burns on Tom and Daisy's dock. Clearly, this provides a focus for his longing for Daisy, who seems so remote from him, yet so sublime, like a star. In Chapter Five, when Gatsby finally gets to meet Daisy again, he tells her, 

"If it wasn't for the mist we could see your home across the bay ... You have always have a green light that burns all night at the end of your dock."

Daisy put her arm through his abruptly, but he seemed absorbed in what he had just said. Possibly it had occurred to him that the colossal significance of that light had now vanished forever.

The significance has vanished forever because now that he has the presence of Daisy herself, his enchanted dream of her is gone. The light, then, could be said to symbolize not just Gatsby's longing for Daisy and her way of life (which Nick calls Gatsby's "incorruptible dream"), but also the transience of that dream, the impossibility that things could actually be as Gatsby imagines.

The valley of ashes. The valley of ashes is Nick's term for an industrial area between West Egg and New York City.   

In one of the links below is an article where the author shows the actual historical location of the valley of ashes, "the vast trash-burning operation in north-central Queens in the exact spot that is now Flushing Meadows-Corona Park." So, this was a historical place that Fitzgerald no doubt passed through. In the second link, the same author points out the similarities between the valley of ashes and the circles of hell in Dante's Inferno. Indeed, Nick's description of the valley sounds hellish.

The valley of ashes is as different as could be from the large, gracious houses of East and West Egg. However, the residents of the Eggs have to pass through this valley every time they go to the city. They cannot ignore it. So, among other things, it symbolizes the vast difference between their lives and those of working-class people.

The inescapability of the valley of ashes hints that it symbolizes something deeper as well. Though the Buchanans would never consider living there, and Gatsby has spent his whole life trying to escape from places like this, nevertheless some of the novel's most important events happen there. This is the home of Tom's mistress, Myrtle Wilson, and her husband George, who runs a garage. It is in the valley of ashes, right in front of the Wilsons' garage, that Daisy runs over Myrtle Wilson while driving drunk. It is from the valley of ashes that George Wilson emerges to confront Tom and kill Gatsby.

In other words, though Tom, Daisy, and Gatsby have tried to insulate themselves from the valley of ashes, they end up having to deal with it, and it even in a sense comes after them. You could say it symbolizes Death, Fate, or perhaps Real Life.

Gatsby's clothes. Gatsby creates the impression of fabulous wealth and decadence with his huge house and massive parties. This extends to his clothes. There is the scene in Chapter Five where Gatsby, manic with joy at finally meeting Daisy again, opens his closet and starts throwing his shirts out onto the bed for her to admire. They are in glowing colors, "shirts with stripes and scrolls and plaids in coral and apple-green and lavender and faint orange."

Daisy cries at this point, saying, "It makes me sad because I've never seen such—such beautiful shirts before." Obviously this is not why she is really crying, but it may be true that Daisy has never seen such gaudily colored shirts. Gatsby is newly rich and probably has wilder taste in shirts than Tom, whose taste is likely to be more restrained. This is also a picture of Gatsby's character. His imagination is full of impossibly beautiful hopes and longings, and he is willing to do anything to make them happen, just as he is the sort of person who buys dozens of shirts every season.

This theme of Gatsby's clothing revealing his class and character is continued in Chapter Seven, the scene of the horrible showdown between Gatsby, Daisy and Tom. Early in the chapter, when Tom has just figured out that Daisy loves Gatsby, someone mentions to Tom that Gatsby is "an Oxford man." Tom sneers, "An Oxford man! Like hell he is. He wears a pink suit." Tom will use this same contempt, within the hour, to separate Daisy from Gatsby.

Gatsby is still wearing the pink suit at the end of that awful evening, when Nick remarks that "I must have felt pretty weird by that time, because I could think of nothing except the luminosity of his pink suit under the moon." At this point, Nick is angry and disgusted with Gatsby. The cheerfulness of the pink suit seems glaringly inappropriate after what has just happened.  t makes Gatsby, with his dream of the ideal, wealthy life with Daisy, seem out of touch and uncaring, though in fact he is neither of these things. It is true in contemporary society, too, that people can feel judged and alienated if someone shows up looking much better dressed, or much more fashionable, than everyone else.

In "And of Clay We Are Created," what are the strong diction choices that help to clearly create a tone?

Isabel Allende’s word choice, or diction, in the first paragraph of “And of Clay We Are Created” immediately sets the tone of despair and destruction for the short story.

In that vast cemetery where the odor of death was already attracting vultures from far away, and where the weeping of orphans and wails of the injured filled the air, the little girl obstinately clinging to life became the symbol of the tragedy.

Words that contribute to the tone of despair and tragedy create imagery by appealing to the reader’s senses. Allende describes the setting of the story as a “vast cemetery,” alluding to sadness, death, and a final resting place. The reader can smell death, hear the crying children, and see the little girl, partially buried alive, but clinging to life.

Later Allende writes, “First a subterranean sob rocked he cotton fields.” Again, using the word “sob,” she personifies the inner workings of the volcano until, with its eruption, “a prolonged roar announced the end of the world.” This diction supports the tone of misery, death, and destruction. In her final description of the aftermath of the volcanic eruption, she uses the word “cataclysm” to once again emphasize the destruction associated with the natural disaster. This tone is pervasive throughout the story. Just when the reader feels there may be hope, disaster strikes again in a different form.

What do other characters say or think about the narrator in "The Bass, the River, and Sheila Mant"?

In W. D. Wetherell's short story “The Bass, the River, and Sheila Mant” the narrator is a nameless fourteen-year-old boy who is smitten with a seventeen-year-old beauty named Sheila Mant. The story is told by an older version of the main character, who has the benefit of hindsight. In fact, he tells us at the end of the story that “I never made the same mistake again” regarding his choice of Sheila over his true loves: fishing and nature.

Although other characters are referenced in the story, it is only Sheila and the narrator that have any meaningful interaction. If we want to look at what other characters think of the narrator, we can really only consider Sheila.

Look at how she reacts to the narrator's choice of transportation:

It was her face that bothered me. It had on its delightful fullness a very dubious expression. 

“Look,” she said. “I can get Dad’s car.” 

“It’s faster this way,” I lied. “Parking’s tense up there. Hey, it’s safe. I won’t tip it or anything.” 

She let herself down reluctantly into the bow.

Sheila isn't crazy about the canoe. That was an early sign that she didn't share the narrator's interests.

Then, at the fair, Sheila decides to leave with the older guy, Eric Caswell, who just happens to have a Corvette. As she parts with the narrator, she says,

“You're a funny kid, you know that?”

What this really means is that there is something different about him, something she doesn't understand. This doesn't seem to bother the older version of the narrator, who follows with a bit of self assessment:

"...funny, different, dreamy, odd, how many times was I to hear that in the years to come..."

Sheila and the narrator don't connect because they are too different. But the narrator's admitted individualism remains intact throughout his life. Sheila wasn't wrong, but she doesn't know why.  He's “funny” because he is himself, his true self, unlike Sheila, who is a reflection of the expectations of others.

Give your views about the language of "An Essay on Man" by Alexander Pope.

"An Essay on Man" by Alexander Pope is an outstanding example of Augustan poetic style. It is written entirely in relatively regular end-stopped heroic couplets and yet, despite this, maintains a fairly natural and fluid rhythmical patterning. 

The very regularity of the poem's rhythm and rhyme scheme suggest to the reader the ideal of calm rationality that Pope espouses. The rhythmical shape of the lines enhances the periodic style and balanced clauses to present the reader with a sort of ordered linguistic universe that recapitulates Pope's sense of cosmos. 

Pope's poem exemplifies what the poet and critic Donald Davie advocated in his Purity of Diction in English Verse, a use of ordinary language that was direct and clearly readable, showing restraint in its use of poetic effects and figures and avoiding the recondite and obscure. Pope's language is distinguished by its clarity and precision and the way he approaches abstract concepts directly rather than through the abstruse metaphors of the Metaphysicals.

Compare and contrast Jack and Ralph in Lord of the Flies by providing comparative quotes from the novel.

Ralph and Jack are two contrasting characters. They symbolize the two extremes of humankind. When we are introduced to them, the text provides clear descriptors which distinguish the two.

In chapter one, Ralph is described as follows:

The boy with fair hair...

The fair boy stopped...

Throughout the chapter, the word 'fair' is repeated to emphasize not only what Ralph looks like, but also to suggest his inner nature. The word tells us that, in character, Ralph is not rash or prejudiced and that he judges others equally. One expects that he would provide a reasonable assessment of things and that his perspective would be balanced and that he would seek equitable solutions to problems or situations.

Ralph is further described as follows:

He was old enough, twelve years and a few months, to have lost the prominent tummy of childhood and not yet old enough for adolescence to have made him awkward. You could see now that he might make a boxer, as far as width and heaviness of shoulders went, but there was a mildness about his mouth and eyes that proclaimed no devil. 

Clearly, Ralph does not seem to possess any element of evil although he has the physique to exercise power.

In contrast, the reference to Jack, as part of a group of approaching boys, reads:

Here, the eye was first attracted to a black, bat-like creature that danced on the sand, and only later perceived the body above it. The bat was the child’s shadow, shrunk by the vertical sun to a patch between the hurrying feet.

The focus on darkness and creatures associated with the dark is pertinent. The contrast between the 'fair' and 'black, bat-like creature' cannot be more obvious. The reference to darkness suggests something malevolent and the disparity to 'proclaimed no devil' is clear. The distinction between the two boys is emphasized.

Jack was wearing a black cloak, which further brings up the image of someone veiled in and surrounded by, darkness. The image forebodes the occurrence of something wicked, just like the cloak of a magician or witch would signify an indulgence with dark forces.

Physically, Jack is also different to Ralph:

Inside the floating cloak he was tall, thin, and bony; and his hair was red beneath the black cap. His face was crumpled and freckled, and ugly without silliness. Out of this face stared two light blue eyes, frustrated now, and turning, or ready to turn, to anger.

Ralph had been painted as wholesome and athletic whilst Jack seems almost skeletal and, with his cloak, could be a representation of some creature of the dark, hungry and lean. Furthermore, Jack's features are much more pronounced - red hair and eyes which could easily turn to anger, suggests someone aggressive and short-tempered.

As the novel progresses, we discover that these descriptions are accurate indicators as to the nature of the two boys and how dissimilar they were. Since the two are the most distinguishable of all the boys, it stands to reason that they would vie for leadership. In the end, it is Ralph who is chosen. This, however, does no deter Jack from later forming a splinter group, the hunters, who he dominates completely.

This act by Jack also indicates his selfish nature for he wants to hunt and have fun whilst Ralph is more concerned about keeping a signal fire burning and building shelters. It becomes important for Ralph to maintain rules and create order, whilst Jack wants to do as he pleases.

These two contrasting approaches lead to conflict between the two boys.

“You wouldn’t care to help with the shelters, I suppose?”
“We want meat—”
“And we don’t get it.”
Now the antagonism was audible.
“But I shall! Next time! I’ve got to get a barb on this spear! We wounded a pig and the spear fell out. If we could only make barbs— ” “We need shelters.”
Suddenly Jack shouted in rage.
“Are you accusing—?”
“All I’m saying is we’ve worked dashed hard. That’s all.”
They were both red in the face and found looking at each other diffi- cult.

Jack becomes immersed in hunting and neglects doing his duty. he takes a number of boys with him and when they return with a slain pig, the fire had gone out at a time when a ship passed by the island. The antagonism between the boys increase as a result. Ralph is bitter for he feels that they could have been rescued. Jack apologizes for his irresponsible actions later, but the battle lines have clearly been drawn.

Jack's obsession with shedding blood grows and he and his hunters later isolate themselves from the other boys. They paint their faces and become savages. The island is divided in to two distinct camps - one which seeks rescue and wants to maintain order, led by Ralph, and the other that is brutal and does not care, led by Jack.

Eventually, Jack uses force and intimidation to isolate Ralph. He sees him as a threat and decides that he should be done away with. Ralph, in his vulnerable state, is saved by the arrival of a naval officer which also ends the conflict. The boys are rescued and taken back to civilization.

Why does Iago want Cassio's perception to be impaired?

Iago believes himself to have been cheated out of the promotion given to Cassio by Othello. Because of this, Iago is determined to ruin Cassio and discredit Othello in his plan to rise to power. On the night of the celebration of Cyprus's deliverance from the Turkish fleet, Iago encourages Cassio's inebriation and then sends his friend Roderigo to pick a fight. It is essential for Cassio to be drunk because the alcohol will remove the inhibition to fight. Once Cassio is demoted, Iago continues to cloud Cassio's perception by advising him to seek out Desdemona's help. By using her as a mediator, Iago convinces Cassio that he will be able to return to Othello's good graces. By manipulating the situations to his advantage, Iago ensures that Cassio will not catch on to his plot. 

What is chikungunya?

Definition

Chikungunya is a relatively rare form of viral infection caused by an alphavirus spread by mosquito bites. It is debilitating but generally nonfatal, with an estimated mortality rate of about one death per one thousand cases.

Causes

Chikungunya is transmitted primarily through two species of mosquito, Aedes aegypti and Aedes albopictus. The mosquitoes become infected when they feed on an infected person during the viraemic period (within five days of the onset of the mosquito bites and symptoms), then transmit the virus to other humans.

Risk Factors

The only known risk factor for chikungunya is an initial exposure to the virus through bites from infected mosquitoes. Before 2013, known outbreaks had occurred primarily in the Eastern Hemisphere, specifically in France, Italy, southern and southeastern Asia, the Arabian Peninsula, central and southern Africa, and various islands in the Indian and Pacific Oceans. In 2013, however, an outbreak of chikungunya in several Caribbean countries marked the first occurrence of the disease in the Americas. Since then, cases have been identified in the United States, Mexico, the Caribbean, Central America, and northern and central South America.

Symptoms

The clinical symptoms of the disease appear within two to twelve days after the initial infection. Symptoms include fever, debilitating joint pains, swelling and stiffness of joints, muscular pain, headache, fatigue, nausea, vomiting, and rash. Many of the clinical symptoms are short in duration, but joint pain can continue for as much as two years after initial infection, in some cases leading to chronic arthritis. Other nonspecific symptoms include conjunctivitis and slight photophobia. Infection with the virus, whether clinically symptomatic or silent, confers lifelong immunity.

Screening and Diagnosis

The common screening and diagnostic confirmation tests for chikungunya include detection of antigens or antibodies in the blood. The common laboratory tests are virus isolation, specific reverse transcription polymerase chain reaction (RT-PCR), and serological tests. The virus isolation test provides the most definitive diagnosis. This technique involves exposing specific cell lines to whole blood samples and identifying chikungunya-specific responses. The RT-PCR uses nested primer pairs to intensify several chikungunya-specific genes from whole blood, while the serological diagnosis uses an enzyme-linked immunoabsorbent assay to measure anti-chikungunya antibody levels of immunoglobulin M and immunoglobulin G.

Treatment and Therapy

There are no specific vaccines or antiviral treatments for chikungunya. Treatments include rest, fluids, and drugs to relieve the symptoms of fever and aching. Commonly used medications include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. In cases of long-term joint pain, ribavirin or chloroquine may be used. The use of aspirin or corticosteroids is generally discouraged.

Prevention and Outcomes

The best way to prevent chikungunya is through effective control of the host-agent-environment (HAE) epidemiological triad factors to inhibit the spread of disease vectors—in this case, mosquitoes. HAE control consists of ridding the environment of mosquito breeding sites (such as stagnant water), avoiding mosquito bites, and using screens on windows and doors to keep mosquitoes out of the house. Other preventive measures include using insect repellants on exposed skin and wearing bite-proof long sleeves and trousers.

Bibliography

“Chikungunya Virus.” Centers for Disease Control and Prevention. Dept. of Health and Human Services, 16 Nov. 2015. Web. 29 Dec. 2015.

Peters, Clarence J. “Infections Caused by Arthropod- and Rodent-Borne Viruses.” Harrison’s Principles of Internal Medicine. Ed. Dan L. Longo et al. 18th ed. Vol. 1. New York: McGraw, 2012. 1617–32. Print.

Simon, Fabrice, Elodie Vivier, and Philippe Parola. “Chikungunya: An Emerging Disease in Travelers.” Tropical Diseases in Travelers. Ed. Eli Schwartz. Hoboken: Wiley, 2009. 92–100. Print.

Tolle, Michael A. “Mosquito-Borne Diseases.” Current Problems in Pediatric and Adolescent Health Care 39.4 (2009): 97–140. Print.

How are efficiency and effectiveness related?

Ideally, we accomplish tasks efficiently and effectively, and they work hand in hand to achieve the very best results. However, it is possible to be efficient and ineffective, or, conversely, to be effective and inefficient. A Venn diagram would show two overlapping circles, with efficiency and effectiveness in the overlap and with each also occupying its own space as well.  Let's look at how this works.

Being efficient means using one's resources, labor, materials, information, and capital in such a way that the maximum results are achieved with the least amount in resources.  So, for example, if I am building a house, I will schedule my contractors and deliveries in such a way that I do not spend any money on materials until I need them and no contractors are scheduled until certain stages have been achieved. I will not have bricks and bricklayers sitting around doing nothing while the foundation is being dug. I will use information about the weather to not schedule driveway paving on a rainy day. This is efficiency, since I have taken care to not squander any of my resources.  However, I can do all of this and still have a house that no one wants to buy because the floors slant, the walls are out of square, and the basement floods.  Thus, I will have acted efficiently but ineffectively.

I can act effectively by building a house of good quality, one that meets our expectations of good housing, by focusing on the quality of my materials and the skills of my contractors.  To be effective means to accomplish what one intended to accomplish, and assuming one wants to accomplish the building of a marketable house, I can do so effectively.  However, I might very well take twice as long to build the house, for example, if I pay my contractors by the hour, as opposed to paying them by the job, or if I do not arrange deliveries efficiently, so that workers are tripping over materials they do not yet need, and I have spent money I did not need to spend yet.

Thus, it is possible to be efficient and not effective or effective and not efficient.  A good manager will try to the best of his or her ability to achieve both, although often we see a bit of a sacrifice in one or the other.  They should work hand in hand, but sometimes, they do not. 

What is Soma?

History of Use

Since the mid-1950s, the North American market for tranquilizing medications has been enormous. Most tranquilizers developed at this time were designed to overcome specific problems that had become apparent in earlier medications. For example, carisoprodol (brand name Soma) was developed because of problems with meprobamate, an older anxiolytic medication that had both high potential for dependence and difficult withdrawals.

The brand name “Soma” refers both to the drink of the gods in Hindu religious literature and to a fictional medication in the dystopic novel
Brave New World
(1932) by Aldous Huxley. Since the late 1950s, the medical and scientific communities have come to recognize that although Soma is an effective skeletal-muscle relaxant, it also has a high potential for abuse, dependence, and illegal purchase.

Effects and Potential Risks

How Soma works in the brain is not well understood, although studies have suggested that it stimulates the receptors for gamma-aminobutyric acid, which in turn prompts overall relaxation of skeletal muscles and then sedation. Because of these two effects, Soma has been frequently prescribed along with anti-inflammatory medications as an aid for muscle sprains.

However effective in the short-term, Soma has significant potential risks. Some users have experienced anterograde amnesia after taking large doses, during which they have driven vehicles or engaged in other dangerous behaviors. Like other tranquilizing medications, Soma can cause dependence; predictably, those who become dependent tend to take larger doses to achieve desired effects, which in turn substantially increases the subsequent risk of cardiac problems, coma, and death. Withdrawal from Soma also is difficult, as its symptoms include increased sensitivity to pain and anxiety, jitteriness, hallucinations, and bizarre behavior.

Bibliography

Bramness, Jørgen G., Svetlana Skurtveit, and Jørg Mørland. “Impairment Due to Intake of Carisoprodol.” Drug and Alcohol Dependence 74.3 (2004): 311–18. Print.

Gonzalez, Lorie A., et al. “Carisoprodol-Mediated Modulation of GABAA Receptors: In Vitro and In Vivo Studies.” Journal of Pharmacology and Experimental Therapeutics 329.2 (2009): 827–37. Print.

Reeves, Roy, et al. “Carisoprodol (Soma): Abuse Potential and Physician Unawareness.” Journal of Addictive Diseases 18.2 (1999): 51–56. Print.

Rossow, Ingeborg, and Jorgen G. Bramness. "The Total Sale of Prescription Drugs with an Abuse Potential Predicts the Number of Excessive Users: A National Prescription Database Study." BMC Public Health 15 (2015): 288. PDF file.

Tone, Andrea. The Age of Anxiety: A History of America’s Turbulent Love Affair with Tranquilizers. New York: Basic, 2008. Print.

What are some examples of when Maniac Magee is compassionate?

Maniac shows compassion when he saves Arnold from Finsterwald's, teaches Grayson to read, and shares his pizza with the little runaways.

Maniac may be weird, but he has a good heart. One example of when he baffled the town’s youth and showed kindness at the same time was when he rescued a boy who some big kids were harassing.

Finsterwald was one of those neighborhood boogeymen. No kid would go into his yard to retrieve a ball or hang out in front of his house. The older kids were teasing Arnold by sticking him in Finsterwald’s backyard. Maniac helped him dispassionately and without question.

The phantom Samaritan stuck the book between his teeth, crouched down, hoisted Arnold Jones's limp carcass over his shoulder, and hauled him out of there like a sack of flour. Unfortunately, he chose to put Arnold down at the one spot in town as bad as Finsterwald's backyard—namely, Finsterwald's front steps. (Ch. 5)

This is part of how Maniac developed his legend status, with crazy stunts like this. All he knew was that the kid was in distress, and it never occurred to him to not help. He then sat on Finsterwald’s porch and read his book.

Another example of Maniac’s compassionate personality is when he teaches Grayson to read. Grayson is an old man who takes Maniac in when he finds him sleeping in the buffalo pen. Maniac never questions Grayson’s somewhat odd lifestyle. When he realizes that Grayson can’t read, he teaches him.

Then they went to the library book-sale racks and bought about twenty old picture books, such as The Story of Babar and Mike Mulligani Steam Shovel and The Little Engine That Could. 

Then they went to Woolworth's for a small portable blackboard and a piece of chalk. (Ch. 27)

Through Jeffrey’s patience, Grayson learns to read rather quickly. When Grayson dies, he is devastated. He has to go on the run once again and go back to being Maniac Magee.

Finally, there are the two kids with the pizza. Maniac finds two kids, Russel and Piper, who have run away. He gives them his pizza and makes sure that they get home. Maniac later finds out why they ran away from home. He does his best to create order in the chaos.

In Macbeth, how do Banquo and Macbeth describe the witches appearances when they first encounter them?

Banquo describes the witches when he first encounters them as withered and dressed wildly: "wither'd and wild in their attire." He says they don't look like earthly creatures: "they look not like th' inhabitants o th' earth." He asks if they are alive, which indicates that he thinks they may be ghosts or spirits. He then describes how they put a "choppy finger" on a "skinny" lip, as if saying sshhh to him. He says he thinks they are women, but that they have beards, so their gender is confusing. 

Macbeth describes how the witches disappear, saying they "melted/As breath into the wind." 

These descriptions indicate that the witches are not real people but supernatural forces from the spirit world. 

Later, in pondering their words, the implications of what they say "unfix" Macbeth's hair and they make his heart beat wildly. This is not a description of the witches but suggests their supernatural, unholy and frightening quality as they plant unspeakable thoughts into his mind.

What is pneumocystis?

Definition

Pneumocystis is a fungus that lives in the lungs of mammals,
including humans, in a parasitic relationship. It causes no disease and does no
harm unless the mammal’s immune system becomes suppressed by
medications, age (very young and very old), disease (such as acquired immunodeficiency
syndrome), pregnancy, malnutrition, chemotherapy,
leukemia, or organ transplant.

Natural Habitat and Features

Pneumocystis species are either oval or cup-shaped, and they have a thick cell wall. These larger cells usually contain eight spores. The trophozoite cells are smaller and look like ameba. They have a thin cell wall. Pneumocystis cells blend in with the alveolar cells unless a stain is applied to the specimen. There is limited information about the appearance of Pneumocystis species cells.

Pneumocystis species require a host to live
and reproduce. They cannot be grown in a culture medium. They do not appear to be
present in the environment. Although hundreds of species of
Pneumocystis are thought to exist, only five have been named:
jirovecii, which lives in humans; murina,
which lives in mice; wakefieldiae and carinii,
which both can live in rats; and oryctolagi, which lives in
rabbits. These species are found only in their related mammal and do not
cross-contaminate other types of mammals.

Pneumocystis species find their way into the lungs of their
respective mammal early in life. In humans, jirovecii inhabits
the lungs of a child during his or her first year of life. In other mammals, such
as the rat, carinii is found in the lungs of newborns within
hours of delivery. Humans and other mammals do produce antibodies to
their respective Pneumocystis species.

The life cycle of Pneumocystis species is not completely known. Most of the available information about Pneumocystis species has come from studying carinii in lab rats. It is thought that Pneumocystis reproduces by two means: mitosis and sexual reproduction. Trophic forms of the fungus reproduce by replicating their genetic material and then splitting into two. Trophic cells provide nutrition for other cells. In sexual reproduction, two haploid cells merge to produce a zygote or sporocyte. Haploid cells are cells that contain one-half of the necessary genetic material. The zygote produces four haploid nuclei by splitting its genetic material, and then, by mitosis, the zygote produces eight haploid nuclei. The zygote cell then packages the eight nuclei into eight double-walled spores. The spores are released from the zygote cell and are capable of both asexual and sexual reproduction. It is not known how the spores are released from the lung.

Pathogenicity and Clinical Significance

In the healthy, immune-competent mammal, Pneumocystis appears to be a benign parasite. There appears to be a delicate balance of normal host function and normal fungus replication as long as the host’s immune system remains strong. The mammal’s immune system does not attack the Pneumocystis because of its surface antigens, and the Pneumocystis does not invade its host. Airborne transmission of Pneumocystis does not generally cause disease. Disease arises from the Pneumocystis that already resides within the mammal.

When a Pneumocystis infection occurs, it almost always
develops in the lungs. When the host’s immune system becomes weakened, the
Pneumocystis cells increase in number and are said to colonize
the lung. Within the alveoli of the lung, the Pneumocystis
trophic cells cling to the epithelial cells in the alveoli. The immune system of
the host attempts to fight the emerging infection by instituting the inflammatory response, a mechanism for responding to cellular damage.
In the inflammatory response, the area is flooded with white blood cells,
particularly the neutrophils and lymphocytes, and the white blood cells
called macrophages; tumor necrosis factor, which regulates immune cells, also
plays a major role. The inflammatory response causes more damage to the alveoli
than does the Pneumocystis. The inflammatory response damages the
alveolar tissue and interferes with oxygen and carbon dioxide exchange in the
lungs.

In the immune compromised person, the T cells may be absent or decreased, but
still, the alveoli fill with thick, white fluid. Pneumocystis
pneumonia is a serious condition with a mortality rate of
between 30 and 50 percent. Sometimes, persons using immune suppressing drugs will
be given a medication to prevent pneumocystis pneumonia.

Drug Susceptibility

The treatment of choice for pneumocystis pneumonia is
trimethoprim-sulfamethoxazole, which can be administered orally or intravenously.
Other antibiotics or medications against protozoa,
including Pneumocystis, include pentamidine, dapsone, primaquine
plus clindamycin, and atovaquone. There have been some reports of
Pneumocystis resistance to trimethoprim-sulfamethoxazole.
Corticosteroids may be administered during the first
seventy-two hours of pneumocystis pneumonia treatment to depress lung
inflammation.

Bibliography

AIDS InfoNet. “Pneumocystis Pneumonia (PCP).” Available at http://www.aidsinfonet.org.

Cushion, Melanie T. “Are Members of the Fungal Genus Pneumocystis (a) Commensals; (b) Opportunists; (c) Pathogens; or (d) All of the Above?” PLoS Pathogens 6 (September 23, 2010). Available at http://www.plospathogens.org.

Van Oosterhout, Joep J. G., et al. “Pneumocystis Pneumonia in HIV-Positive Adults, Malawi.” Emerging Infectious Diseases 13 (2007): 325-328.

West, John B. Pulmonary Pathophysiology: The Essentials. 7th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2008.

Wilkin, Aimee, and Judith Feinberg. “ Pneumocystis carinii Pneumonia: A Clinical Review.” American Family Physician 60 (October 15, 1999): 1699-1714. Also available at http://www.aafp.org/afp/991015ap/ 1699.html.

What do Jordan's carelessness as well as her lack of honesty and moral fortitude in Chapters Three and Four of F. Scott Fitzgerald's The Great...

A very early clue as to the nature of Jordan Baker in F. Scott Fitzgerald’s novel The Great Gatsby actually comes in the book’s opening chapter, when Nick Carraway is visiting the expansive estate of his cousin Daisy and her husband Tom. Nick is a Midwesterner newly arrived in New York and unaccustomed to the pretentiousness prevalent in the “old money” environment of East Egg, Long Island. He is smart and perceptive, but will struggle with his attraction to a woman through whom he can see quite clearly. The scene in Chapter One when Nick is at the Buchanans' palatial home provides Fitzgerald’s young, ambitious narrator the opportunity to engage with a category of humanity to which he might aspire but by which he will ultimately be repelled. During his initial visit to the Buchanan home, Nick meets Jordan Baker, a beautiful young woman who, it turns out, is a professional golfer familiar to Nick, prompting the following exchange and observation:

‘Jordan’s going to play in the tournament tomorrow,’ explained Daisy, ‘over at Westchester.’

‘Oh,—you’re Jordan Baker.’ I knew now why her face was familiar—its pleasing contemptuous expression had looked out at me from many rotogravure pictures of the sporting life at Asheville and Hot Springs and Palm Beach. I had heard some story of her too, a critical, unpleasant story, but what it was I had forgotten long ago.

So, we know from early on that Jordan is beautiful, but not necessarily kind, and certainly not above the pretentiousness that will prove a major turn-off for Nick. Nick’s next interaction with Jordan occurs at a party at Gatsby’s enormous house, described in Chapter Three, during which the narrator’s sense of discomfort with his surroundings becomes clear. Having failed to ascertain from other guests the whereabouts of his host, Nick feels immediately defeated, as though he knows he is out of his element: “. . . I slunk off in the direction of the cocktail table—the only place in the garden where a single man could linger without looking purposeless and alone.” It is while seeking solace in the garden, however, and with the intention of becoming inebriated, that Nick is reacquainted with Jordan, who, in contrast to Nick, is very much in her element, and, “looking with contemptuous interest down into the garden” in which he stood. Jordan’s contemptuous interest, however, does not extend to Nick, whose hand she takes with the intent of keeping him company, if only in a platonic sense.

During dinner at the party, Jordan is bored with the conversation and leads Nick and a “young undergraduate” man serving as her escort away from the table towards the library. While Nick will learn to abhor pretty much everything Jordan represents, she is his savior at this point in the story, navigating the young outsider through the rocky shoals of upper-class society. In fact, Jordan is friendly and inviting to Nick, suggesting he contact her in the near future.

It is midsummer when the two reconnect and Nick is able to observe for the first time the true nature of this beautiful woman. In Chapter Three, Nick describes the revelation that this woman he finds so physically attractive and a little intriguing is also more than a little lagging in the integrity department. The “bored haughty face that she turned to the world concealed something . . . and one day I found what it was.” "What it was" was Jordan’s refusal to accept responsibility for the damage inflicted on a borrowed car when she failed to put the roof of the convertible down and rain flooded the vehicle. Not only did Jordan fail to accept responsibility, Nick notes, “then she lied about it,” which sparks in his memory an episode from Jordan’s career as a professional golfer:

At her first big golf tournament there was a row that nearly reached the newspapers—a suggestion that she had moved her ball from a bad lie in the semi-final round. The thing approached the proportions of a scandal—then died away. A caddy retracted his statement and the only other witness admitted that he might have been mistaken. The incident and the name had remained together in my mind. Jordan Baker instinctively avoided clever shrewd men and now I saw that this was because she felt safer on a plane where any divergence from a code would be thought impossible. She was incurably dishonest. She wasn’t able to endure being at a disadvantage, and given this unwillingness I suppose she had begun dealing in subterfuges when she was very young in order to keep that cool, insolent smile turned to the world and yet satisfy the demands of her hard jaunty body.

This passage is revealing. Jordan is revealed as a fundamentally dishonest person whose selection of men involves those too dim or too dishonest themselves to care about her duplicitousness, and this revelation begins Nick’s reappraisal of this woman he would otherwise like to pursue sexually if not romantically. In Nick, she has a male friend who she can count on to watch out for her carelessness and disregard for conventional notions of civility and common sense, as in the following exchange pertaining to Jordan’s ineptitude behind the wheel of a car:

‘You’re a rotten driver,’ I protested. ‘Either you ought to be more careful or you oughtn’t to drive at all.’

‘I am careful.’

‘No, you’re not.’

‘Well, other people are,’ she said lightly.

‘What’s that got to do with it?’

‘They’ll keep out of my way,’ she insisted. ‘It takes two to make an accident.’

‘Suppose you met somebody just as careless as yourself.’

‘I hope I never will,’ she answered. ‘I hate careless people. That’s why I like you.’

Chapter Three ends, of course, with one of the seminal sentences from Fitzgerald’s classic—one that captures the essence of this haughty society in which Nick has found himself and the fundamental reason he is not long for that particular world: “I am one of the few honest people that I have ever known.”

In Chapter Four, Nick is alone with Gatsby as they drive across Long Island when Gatsby asks Nick for his opinion of him, explaining that he hopes to dispel any misconceptions the relative newcomer may have regarding this mysterious figure’s past. Jordan had, in Chapter Three, while at the party at Gatsby’s estate, suggested to Nick that she felt their host was not who he suggested he was, an old-money transplant from the Midwest educated at Oxford University in England. As Gatsby informs Nick of his autobiography, Nick sees it is filled with the details that Jordan had called into question, and provides Nick a curious comparison between these two deceptive characters who have come to play such major roles in his life. In the following passage from Chapter Four, Nick describes the sensation of discovering that his new friend is a fraud:

‘I’ll tell you God’s truth.’ His right hand suddenly ordered divine retribution to stand by. ‘I am the son of some wealthy people in the middle-west—all dead now. I was brought up in America but educated at Oxford because all my ancestors have been educated there for many years. It is a family tradition.’

He looked at me sideways—and I knew why Jordan Baker had believed he was lying. He hurried the phrase ‘educated at Oxford,’ or swallowed it or choked on it as though it had bothered him before. And with this doubt his whole statement fell to pieces and I wondered if there wasn’t something a little sinister about him after all.

It is also during this scene that Nick is exposed to the depth of both Jordan and Gatsby’s duplicitousness and how those two are somehow metaphysically connected by their shared lack of integrity. Mentioning that he is aware that Nick and Jordan are to get together for tea, Gatsby assumes that the purpose of the meeting will be to share notes about him, Gatsby, and that Jordan and Gatsby have colluded to perpetuate a myth:

'You see, I usually find myself among strangers because I drift here and there trying to forget the sad thing that happened to me.’ He hesitated. ‘You’ll hear about it this afternoon.’

‘At lunch?’

‘No, this afternoon. I happened to find out that you’re taking Miss Baker to tea.’

‘Do you mean you’re in love with Miss Baker?’

‘No, old sport, I’m not. But Miss Baker has kindly consented to speak to you about this matter.’

I hadn’t the faintest idea what ‘this matter’ was, but I was more annoyed than interested. I hadn’t asked Jordan to tea in order to discuss Mr. Jay Gatsby. I was sure the request would be something utterly fantastic and for a moment I was sorry I’d ever set foot upon his overpopulated lawn.

Much of Chapter Four involves Jordan’s relating to Nick Daisy and Gatsby’s previous history, during the war years when Gatsby was a young lieutenant and the two were presumably very much in love, although it would turn out that Daisy already had her sights on a much different future for herself. It is Jordan, also, who enlightens Nick as to Gatsby’s agenda to continue his pursuit of Daisy Buchanan—an obsession that has brought both Gatsby and Nick to their current situations. Jordan and Nick, Jordan reveals, are but tools Gatsby is exploiting to win back his lost love, Daisy Buchanan. It is now that Jordan makes a comment that reveals the extent to which she and Daisy have both lived emotionally empty lives: “‘And Daisy ought to have something in her life,’ murmured Jordan to me,” suggesting that Daisy’s marriage to Tom was empty and served as little more than a formality (and we know that Tom is a chronic adulterer, by the way).

So, after all that, we know that Jordan and Gatsby are kindred spirits even while Jordan nuzzles up to Nick, who is highly receptive to intimate overtures (“It was dark now, and as we dipped under a little bridge I put my arm around Jordan’s golden shoulder and drew her toward me and asked her to dinner. Suddenly I wasn’t thinking of Daisy and Gatsby any more but of this clean, hard, limited person who dealt in universal skepticism and who leaned back jauntily just within the circle of my arm”) and that Nick’s cynicism towards the Long Island upper-class has firmly taken root. Jordan’s carelessness is evident in the story about the damaged car, and in her willingness to participate in a scheme that will get Daisy back together with Gatsby. And we know from the automobile and golf anecdotes about Jordan’s dishonesty. Her physical beauty, that "jaunty body," however, continues, at this point in the story, to sway Nick in her direction, at least for a time.

What is light therapy?

Indications and Procedures

Light therapy, or phototherapy, treats a variety of disorders. By exposing individuals to different kinds of light (for example, monochromatic, polychromatic, ultraviolet), symptoms can often be delayed, reduced, and eradicated. Immunological, neurotransmitter, and neuroendocrine systems play key roles in response to this type of treatment.

Best known in psychiatry, light therapy serves as a treatment for seasonal affective disorder
(SAD), or winter depression; bulimia nervosa; sleep disorders; and “sundowner’s syndrome,” the late afternoon confusion and agitation sometimes accompanying Alzheimer’s disease. Shift workers can also experience difficulties related to light exposure, and light therapies may provide some relief. Reduced environmental light is a factor in the etiology, onset, or maintenance of these problems. Thus, treatment involves exposing individuals to bright, full-spectrum light for specific time periods. Duration of exposure and light intensity vary by the disorder and the individual treated.

In dermatology and oncology, light therapy treats psoriasis, skin
ulcers, tumors, and esophageal cancers. The type of light and the intensities used, however, vary considerably from those applied for the treatment of psychiatric disorders.

Uses and Complications

The side effects of light therapy are best documented in psychiatry: insomnia, mania, and (less frequently) morning hot flashes have been noted. Persons with other sensitivity to light, such as those prone to migraines, may also need to exercise caution with light therapy in order to avoid undesirable effects. Careful monitoring by medical providers of the patient’s response to treatment is necessary. Additionally, professionals advise morning administrations of light therapy.

Users of light therapy must also be cautioned to adhere closely to recommended doses and intensity of exposure to light. Use of light outside prescribed parameters may be damaging to the eyes.

Light therapy is not effective universally; some patients may experience no improvement. For seasonal affective disorder, evidence suggests that younger individuals whose depression involves weight gain and increased sleep may be most likely to respond to treatment. For psoriasis, complementary treatments, such as psychotherapy, may facilitate a response to treatment.

Perspective and Prospects

Light and dark cycles are a biological reality; thus, it is no surprise that light affects physical, emotional, and mental well-being. As the interest in noninvasive interventions increases, the attention given to environmental treatments such as light therapy is likely to increase as well. Recent developments in the use of light therapy for sleep and behavioral disorders are fueling clinical, research, consumer, and other business interests in this procedure. Experimentation with different frequencies or colors of light, doses, intensities, and sites on the body for the application of light are ongoing and likely to increase the diversity of uses for this type of treatment. Additionally, applications of light-based interventions in the workplace and elsewhere may prove useful in preventing disorders related to light deprivation and in helping to affect productivity, directly and indirectly.

Bibliography

Gold, Michael H. Photodynamic Therapy in Dermatology. New York: Springer Science, 2011.

Goldberg, Burton, John Anderson, and Larry Trivieri, eds. Alternative Medicine: The Definitive Guide. 2d ed. Berkeley, Calif.: Celestial Arts, 2002.

Hyman, Jane Wegscheider. Light Book: How Natural and Artificial Light Affects Our Health, Mood, and Behavior. Los Angeles: J. P. Tarcher, 1990.

"Is Phototherapy Right for Your Psoriasis?" PsoriasisNet. American Academy of Dermatology, Jan. 2010.

Jacobs, Jennifer, ed. The Encyclopedia of Alternative Medicine: A Complete Family Guide to Complementary Therapies. Rev. ed. Boston: Journey Editions, 1997.

Kastner, Mark, and Hugh Burroughs. Alternative Healing: The Complete A-Z Guide to over 160 Different Alternative Therapies. New York: Henry Holt, 1996.

Marshall, Fiona, and Peter Cheevers. Positive Options for Seasonal Affective Disorder. New York: Hunter House, 2003.

Palmer, John D. The Living Clock: The Orchestrator of Biological Rhythms. New York: Oxford University Press, 2002.

Rosenthal, Norman E. Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder. 4th ed. New York: Guilfod Press, 2013.

Safer, Diane A., and Michael Woods. "Phototherapy." Health Library, Nov. 26, 2012.

Why did Shakespeare use foreshadowing in this line? "In one respect I’ll thy assistant be, / For this alliance may so happy prove / To turn your...

Shakespeare uses foreshadowing throughout Romeo and Juliet. The play repeatedly hints that it will end in death. Juliet repeatedly talks about death after having met Romeo.

The reason Shakespeare, or any author for that matter, uses foreshadowing is to build suspense and tension. It alerts the reader to what is coming and heightens our anticipation of that event. The line in question is an interesting bit of foreshadowing, because it doesn't focus on all of the misery that comes later in the play. The line actually displays a very positive outlook on the future. It hints that the marriage will happen and will end the feud between the two families. The line gives the reader hope that the play will end on a happy note.

In fact, all of it comes true. Romeo and Juliet do get married. The Capulets and Montagues do agree to end the feud.  

"A glooming peace this morning with it brings."

Unfortunately, Romeo and Juliet had to die to make the friar's quote come true—a tragedy hinted at by the description of the peace as "glooming."

How does Juliet's brief conversation with Paris reveal her attitude towards him?

Juliet's parents feel that now she is thirteen, she is more than old enough to be married. In Act I, Scene III, Juliet's mother tells her that she wants to set her up to be married to Paris. Juliet admits that she hasn't really thought about marriage, but will at least meet him before deciding one way or another. Of course, at the fateful party where Juliet is supposed to be getting to know Paris, she meets and falls in love with Romeo. 

The love and marriage between Juliet and Romeo is private, but she is very committed. Even after learning that Romeo has killed her beloved cousin, she feels allegiance to him and despises the presence of the man her parents still plan for her to marry. She resents Paris, and when they speak in Act IV, Scene I, she knocks down all of his compliments and attempts to be affectionate or personal with her. Paris is delighted that they will be married on the coming Thursday, but Juliet dreads it. She does not want a life where she must pretend to have a happy marriage, stifle her sadness for her husband, or live with a man she does not love! Perhaps Juliet hopes that by being rude to Paris, she can get him to change his mind and call the marraige off. If nothing else, their exchange in Act IV, Scene I shows how Juliet is using Paris as a tangible focal point for her sorrow over Tybalt and her anger towards her parents. 

The pause created by the dash in line 2 emphasizes what?

Dickinson's prolific use of the dash always raises questions for the reader. What do we make of them? Aside from giving her poems a major mark of distinction, and aside from expressing sudden pauses and jamming phrases together, we know these dashes often add intense emotional tension to the ideas being expressed.

To examine that particular dash at the end of the second line, let's look at it in the context of the whole stanza:

"A Bird came down the Walk—
He did not know I saw—
He bit an Angleworm in halves
And ate the fellow, raw,"

Here, that dash seems to force us to pause right at a critical moment. The speaker is watching the bird, waiting to see what happens--enter the dash, where we hold our breath, too, waiting to see-- and in the next instant, the bird eats the worm.

So, forcing us to pause and consider gives more weight and drama to the action that occurs directly after the dash, namely, the bird devouring the worm. It makes us consider that action a bit more than we might without the dash. That tension calls attention to the viciousness of the bird's actions: he's not just eating the worm but is biting him in half and then eating him raw. And, the dash also calls attention to what came immediately before it, so we're particularly aware that the speaker is watching this feral scene like a spy, unknown to the bird.

In short, the dash adds tension to that moment and accentuates the tenuous relationship between the person observing the action (the speaker) and the one performing the action (the bird).

In what ways can Daoism be seen as a response to the political turmoil of the period in which it emerged?

Daoism, sometimes also spelled Taoism, is a Chinese religious philosophy that many scholars believe originated in the Warring States Period of 475-221 BCE. (Though others believe it really formed into a religion later. ) During this period, China was divided into eight states that were often at war with each other. Other religious traditions, including Legalism and Confucianism, also existed in China at the time.

Daoism is thought to have started with the philosopher Laozi (who some scholars think may not have existed), and its name comes from a word meaning "the way." His work, the Daodejing, emphasizes the role of the leader as someone who follows "the way." The leader lives a life of almost non-existence, referred to as wu-wei, and, in this manner, encourages his subjects to be peaceful and righteous. The work also advises leaders only to use war as a last resort. Wu-wei, the principle of inaction, is hard to define, but it can be compared to the work of a maker of fine jewelry who, in carving, seems to do nothing but leaves the gem perfect. In other words, wu-wei involves non-acting but living in accordance with the cosmic way of the universe.

Daoism was a response to the turmoil of the War States Period because it encouraged leaders and their people to live in accordance with nature and to strive to achieve non-action rather than pressuring people to follow their rules. It was a philosophy that contradicted the philosophies of the leaders who had caused China to live in a state of constant warfare. 

Who is Ted Cruz and where does he stand on important political issues?

Ted Cruz is a candidate for the Republican nomination for President of the United States. Currently he serves in the United States Senate as a Senator from Texas. As the Republican primary season has progressed, he finds himself one of only three of the original seventeen candidates for the Republican presidential nomination. Cruz runs on a conservative platform and often speaks against "the Washington cartel," by which he means entrenched politicians and lobbyists in the federal government who pursue an agenda that benefits themselves rather than the voters, everyday working men and women, around the country. Cruz has distinguished himself on the Senate floor by calling for a hard stance against the Affordable Care Act, preferring to hold off on passing a federal budget if it included funding for Obamacare. 

Some of his positions on issues, available on his website, are:

1. Restoring the Constitution: He would appoint originalist judges to the Supreme Court, and he would rescind executive orders signed by President Obama that overreach presidential authority.

2. Second Amendment: He is for the rights of gun owners and opposes gun control legislation.

3. Immigration: He feels strongly that the southern border needs to be secured to prevent illegal immigration and that current laws regarding immigration should be enforced.

4. National Defense: Cruz has said he would "rip up the Iran nuclear deal" his first day in office; he wants to rebuild the military; he takes a strong stand against ISIS; he embraces America's role as a leader in world affairs.

5. Israel: Cruz has declared that, unlike the Republican front runner, he will not be neutral in the conflict between Palestinians and Israel but would firmly stand with Israel as the foremost U.S. ally in the Middle East. 

6. Religious Liberty: As a lawyer, Cruz defended before the Supreme Court a monument in Texas that displayed the 10 Commandments. In matters where laws come into conflict with religious expression, such as companies or associations being required to pay for health plans that include abortions or bakers refusing to make wedding cakes for same-sex weddings, Cruz argues for religious liberty.

7. Life, Marriage and Family: Cruz is pro-life and has advocated legal restrictions on abortion; he would like to see the issue of same-sex marriage left to the states to decide. 

8. Taxes and Economy: Cruz has said he would like to abolish the IRS, which could be accomplished by adopting his proposed flat tax, which he believes will stimulate the economy, bringing back jobs and employers that are now doing business overseas. He favors reducing burgeoning regulations that have made it harder for small businesses to start and operate in the last two decades.

9. Rein in Government: Cruz favors smaller federal government and would eliminate five federal agencies: the IRS, the Department of Education, the Department of Energy, the Department of Commerce, and the Department of Housing and Urban Development. He believes this will not only reduce the money spent by the federal government but also provide more local control to states and citizens. 

How does O’Connor use foreshadowing to help us understand the actions of Mr. Shiftlet at the end of "The Life You Save May Be Your Own"?

Mr. Shiftlet is a drifter and his actions at the end, abandoning Lucynell and taking off on his own, are foreshadowed in the story. First, in his initial meeting with Mrs. Crater, he describes his past, noting that he had traveled extensively and "visited every foreign land." He had held many jobs in his life including "gospel singer," an undertaker's assistant, a railroad foreman and a soldier. This is a good hint that he will not be happy permanently staying on Mrs. Crater's property.

Second, his immediate interest in the Ford automobile signals to the reader that the car will take on an important role later in the story. At the end, after fixing up the car, he steals it and heads off to Mobile. He leaves Lucynell asleep at a roadside diner, an action he had presumably planned ahead of time. Third, as he bargains with Mrs. Crater over what it will take for him to marry Lucynell, he compares his spirit to the automobile:

"Lady, a man is divided into two parts, body and spirit...The body, lady, is like a house: it don't go anywhere; but the spirit, lady, is like a fine automobile: always on the move, always..."

While he suggests throughout the novel that he would really like to settle down "where I could see me a sun do that every evening" he's also likely to shift his sentiments, as his name suggests. The drifter part of him is always moving, even as it seems he has found what he was looking for, land and a girl who is described as an "angel of gawd." He readily dumps Lucynell to satisfy his wanderlust. 

What is plastic surgery?

Indications and Procedures

The intent of plastic, reconstructive, and cosmetic surgery is to restore a body part to normal appearance or to enhance or cosmetically alter a body part. The techniques and procedures of all three surgical applications are similar: extremely careful skin preparation, the use of delicate instrumentation and handling techniques, and precise suturing with extremely fine materials to minimize scarring.

Reconstructive surgery . Notable examples of reconstructive surgery involve the reattachment of limbs or extremities that have been traumatically severed. As soon as a part is separated from the body, it loses its blood supply; this leads to ischemia (lack of oxygen) to tissues, which in turn leads to cell death. When an individual cell dies, it cannot be resuscitated and will soon start to decompose. This process can be greatly slowed by lowering the temperature of the severed body part. Packing the part in ice for transport to a hospital is a prudent initial step.

An important consideration in any reconstructive procedure is site preparation. The edges, or margins, of the final wound must be clean and free of contamination. Torn skin is removed through a process called debridement. A sharp scalpel is used gently to cut away tissue that has been crushed or torn. All bacterial contamination must be removed from the site prior to closure to prevent postoperative contamination. Foreign material such as dirt, glass, gunpowder, metals, or chemicals must be completely removed. The margins of the wound must also be sharply defined. Superficially, this is done for aesthetic reasons. Internally, sharply defined margins will reduce the chances for adhesions to form. Adhesions are bands of scar tissue which bind adjacent structures together and restrict normal movement and function. Therefore, both the body site and the margins of the severed part must be debrided and defined. Reconstruction consists of the painstaking reattachment of nerves, tendons, muscles, and skin, which are held in place primarily by sutures although staples, wires, and other materials are occasionally used. Precise alignment of the skin to be closed is accomplished by joining opposing margins. Postoperative procedures include careful handling of the wound site, adequate nutrition, and rest in order to maximize healing. Abnormalities in the healing process can lead to undesirable scarring from the sites of sutures. Such marks can be avoided with careful attention to correct techniques.

Bones are reconstructed in cases of severe fractures. The pieces are set in their proper positions, and the area is immobilized. Where immobilization is not possible, a surface is provided onto which new bone can grow. These temporary surfaces are made of polymeric materials that will dissolve over time.

Congenital anomalies such as a deformed external ear or missing digit can be corrected using reconstructive techniques. In the case of a missing thumb, a finger can be removed, rotated, and attached on the site where the thumb should have been. This allows an affected individual to write, hold objects such as eating utensils, and generally have a more nearly normal life. Similar procedures can be applied to replace a missing or amputated great or big toe. The presence of the great toe contributes significantly to balance and coordination when walking.

Prosthetic materials are implanted in a growing variety of applications. There are two basic types of materials used in
prostheses, which are classified according to their surface characteristics. One is totally smooth and inert; an example is Teflon or silicone. The body usually encloses these materials in a membrane, which has the effect of creating a wall or barrier to the surface of the prosthesis. From the body’s perspective, the prosthesis has thus been removed. With any prosthesis, the problem most likely to be encountered is infection, which is usually caused by contamination of the operative site or the prosthesis. Infection can also occur at a later, postoperative date because of the migration of bacteria into the cavity formed by the membrane. This is a potentially serious complication. A smooth prosthesis can also be used to create channels into which tissue can later be inserted. In such an application, the prosthesis may be surgically removed at some time in the future. A second type of prosthesis does not have a smooth surface; rather, it has microscopic fibers similar to those found on a towel. This type of surface prevents
membranes from forming, contributing to a longer life for the prosthesis by reducing postoperative infections.

An important procedure in reconstructive surgery is skin grafting. A graft consists of skin that is completely removed from a donor site and transferred to another site on the body. The graft is usually taken from the patient’s own body because skin taken from another individual will be rejected by the recipient’s immune system. (Nevertheless, fetal pig skin is sometimes used successfully.) Skin grafting is useful for covering open wounds, and it is widely used in serious burn cases. When only a portion of the uppermost layer of the skin is removed, the process is called a split thickness graft. When all the upper layers of the skin are removed, the result is a full thickness graft. Whenever possible, the donor site is selected to match the color and texture characteristics of the recipient site.

A skin flap is sometimes created. This differs from a graft in that the skin of a flap is not completely severed from its original site but simply moved to an adjacent location. Some blood vessels remain to support the flap. This procedure is nearly always successful, but it is limited to immediately adjacent skin.

A wide variety of flaps has been developed. A flap may be stretched and sutured to cover both a wound and the donor site. Flaps may be created from skin that is distant to the site where it is needed and then sutured in place over the donor site. Only after the flap has become established at the new site is it cut free from the donor site. Thus, skin from the abdomen or upper chest may be used to cover the back of a burned hand, or skin from one finger may be used to cover a finger on the other hand. This two-stage flap process requires more time than a skin graft, but it also has a greater probability of success.

Plastic surgery . Plastic surgery consists of a variety of techniques and applications, often dealing with skin. Some common procedures that primarily involve skin are undertaken to remove unwanted wrinkles or folds. Folds in skin are caused by a loss of skin turgor and excessive stretching of the skin beyond which it cannot recover. Common contributors to loss of skin turgor in the abdomen are pregnancy or significant weight loss after years of obesity. Both women and men may undergo a procedure known as abdominoplasty (commonly called a “tummy tuck”). The skin that lies over the abdominal muscles is carefully separated from underlying tissue. Portions of the skin are removed; frequently, some underlying adipose (fat) tissue is also removed or relocated. The remaining skin is sutured to the underlying muscle as well as to adjacent, undisturbed skin. A major problem with this procedure, however, is scar formation because large portions of skin must be removed or relocated. The plastic surgeon must plan the placement of incisions carefully in order to avoid undesirable scars.

Plastic surgery is also used to reduce the prominence of ears, a procedure called otoplasty. In some children, the posterior (back) portion of the external ear develops more than the rest of the ear, pushing the ears outward and making them prominent. By reducing the bulk of cartilage in the posterior ear and suturing the remaining external portion to the base of the ear, the plastic surgeon can create a more normal ear contour. The optimal time to perform this procedure on children is just prior to the time that they enter school, or at about five years of age.

Cosmetic surgery. One of the most common sites for cosmetic surgical procedures is the face. The highest number of facial rejuvenation procedures in the form of botulinum toxin type A injections, to date, were performed in 2013, according to data from the American Society of Plastic Surgeons. Correction may be desired because of a congenital anomaly that causes unwelcome disfigurement or because of a desire to alter an unwanted aspect of one’s body. The cosmetic procedures that have been developed to correct abnormalities of the face include closure of a cleft lip or palate. The correction of a cleft lip is usually done early, ideally in the first three months of life. Closure of a cleft palate (the bone that forms the roof of the mouth) is delayed slightly, until the patient is twelve to eighteen months old. These procedures allow affected individuals to acquire normal patterns of speech and language.

Among older individuals, common procedures include blepharoplasty and rhinoplasty. The former refers to the removal of excess skin around the eyelids, while the latter refers to a change, usually a reduction, in the shape of the nose. Both procedures may be included in the more general term of face lift. The effects of aging, excessive solar radiation, and gravity combine to produce fine lines in the face as individuals get older. These fine lines gradually develop into the wrinkles characteristic of older persons. For some, these wrinkles are objectionable. To reduce them—or more correctly to stretch them out—a plastic surgeon removes a section of skin containing the wrinkles or lines and stretches the edges of the remaining epidermis until they are touching. These incisions are placed to coincide with the curved lines that exist in normal skin. Thus, when the edges are sutured together, the resultant scar is minimized. Rhinoplasty often involves the removal of a portion of the bone or cartilage that forms the nose. The bulk of the remaining tissue is also reduced to maintain the desired proportions of the patient’s nose. As with any plastic surgical procedure, small sutures are carefully placed to minimize scarring.

Another body area that is commonly subjected to cosmetic procedures is the breast. A woman who is unhappy with the appearance of her breasts may seek to either reduce or augment existing tissue. Breast reduction is accomplished by careful incision and the judicious removal of both skin and underlying breast tissue. Often the nipples must be repositioned to maintain their proper locations. A flap that includes the nipple is created from each breast. After the desired amount of underlying tissue is removed, the nipples are repositioned, and the skin is recontoured around the remaining breast masses.

Uses and Complications

Reconstructive, plastic, and cosmetic surgeries all have their complications, ranging from severe—such as the rejection of transplanted tissue—to minor but unpleasant—such as noticeable scars. In addition, there is an inherent risk in any procedure that requires the patient to undergo general anesthesia. With reconstruction, which involves the repair of damaged tissues and structures, the initial injuries sustained by the patient present further obstacles and dangers. The following examples from each type of surgery illustrate the risks involved.

For example, a surgeon who must perform a skin graft can choose between a split or a full thickness graft. A split thickness graft site will heal with relatively normal skin, thus providing opportunities for additional grafting at a later date. It also produces less pronounced scarring. A limitation of this technique, however, is an increased likelihood for the graft to fail. Full thickness grafts are stronger and more likely to be successful, but they lead to more extensive scarring, which is aesthetically undesirable and renders the site unsuitable for later grafts. The surgeon’s decision is based on the needs of the patient and the severity of the injury.

The minimization of scarring is a major concern for many patients undergoing plastic surgery. The prevention of noticeable scars involves an understanding of the natural lines of the skin. All areas of the body have lines of significant skin tension and lines of relatively little skin tension. It is along the lines of minimal tension that wrinkles and folds develop over time. These lines are curved and follow body contours. As a rule of thumb, they are generally perpendicular to the fibers of underlying muscle. The plastic surgeon seeks to place incisions along the lines of minimal tension. When scars form after healing, they will blend into the line of minimal tension and become less noticeable. Furthermore, the scar tissue is not likely to become apparent when the underlying muscles or body part is moved. Undesirable scarring is a greater problem in large procedures, such as abdominoplasty, than in procedures confined to a small area, such as rhytidectomy (face lift), because of the difficulty in following lines of minimum tension when making incisions.

One of the most popular cosmetic procedures is breast enlargement. According to the American Society of Plastic Surgeons, 290,000 breast augmentation surgeries were performed in the United States in 2013, and the total number of women with implants in the United States is in the millions. Initially, the most commonly used prosthesis, or implant, was made of silicone. In some patients, silicone leaked out, causing the formation of granulomatous tissue. Such complications led to a voluntary suspension of the production of silicone prostheses by manufacturers and of their usage by surgeons. Different materials, such as polyethylene bags filled with saline solution or solid polyurethane implants, were soon substituted. Saline will not cause tissue damage if it leaks, and few adverse reactions to polyurethane have been reported. Silicone implants made a comeback in 2006, when the US Food and Drug Administration began approving them for use in women aged twenty-two years or older. Of the more the nearly three hundred thousand breast augmentations performed in 2013, the American Society of Plastic Surgeons reported that 72 percent used silicone.

Perspective and Prospects

The origins of plastic, reconstructive, and cosmetic surgery are fundamental to the earliest surgical procedures, which were developed to correct superficial deformities. Without any viable methods of anesthesia, surgical interventions and corrections were limited to the skin. For example, present-day nose reconstructions (rhinoplasty) are essentially similar to procedures developed four thousand years ago. Hindu surgeons developed the technique of moving a piece of skin from the adjacent cheek onto the nose to cover a wound. Similar procedures were developed by Italians using skin that was transferred from the arm or forehead to repair lips and ears as well as noses. Ironically, wars have provided opportunities to advance reconstructive techniques. As field hospitals and surgical facilities became more widely available and wounded soldiers could be stabilized during transport, techniques to repair serious wounds evolved.

Skin grafts have been used since Roman times. Celsus described the possibility of skin grafts in conjunction with eye surgery. References were made to skin grafts in the Middle Ages. The evolution of modern techniques can be traced to the early nineteenth century, when Cesare Baronio conducted systematic grafting experiments with animals. The modern guidelines for grafting were formulated in 1870. Instruments for creating split thickness grafts were developed in the 1930s, and applications of this procedure evolved during World War II.

Plastic, reconstructive, and cosmetic procedures have all become important in contemporary surgical practice. Reconstructive surgery allows the repair of serious injuries and contributes greatly to the rehabilitation of affected individuals. Cosmetic surgery can help individuals feel better about themselves and their bodies. Both use techniques developed in the broader field of plastic surgery.

There are both positive and negative aspects of plastic surgery. Positively, many individuals who sustain serious and potentially devastating injuries are able to return to relatively normal lives. Burn victims and those having accidents are more likely to return to normal activities and resume their occupations than at any time in the past. Miniaturization and new materials have extended the range of a plastic surgeon’s skills. Negatively, there is growing criticism concerning the number of elective procedures undertaken for the repair of cosmetic defects. The American Society of Plastic Surgeons reported a total of 15.1 million cosmetic procedures and 5.7 million reconstructive procedures performed in 2013 alone.

The quest for perfection and physical beauty has prompted some critics to question the correctness of some unnecessary procedures. Although such procedures are not usually covered by insurance policies, their utilization has increased. The continuation of such activities invokes both ethical and personal considerations; there is no clearly defined, logical endpoint. Clearly, while plastic surgical techniques have benefited millions, there are opportunities for abuse. Society must decide if any limitations are to be placed on plastic surgical procedures and what they should be.

Further debate over the abundance of elective cosmetic procedures and their possibly dangerous ties to self-expression has only increased as the kinds of modifications have managed to grow. As of 2014, some more unique but rather popular trends have included hand lifts, forked tongues, "Cinderella surgery" (reshaping of the foot or toes), and iris implants. Specialists have also been emphasizing the importance of researching prospective surgeons carefully when considering any plastic surgery procedures. Because most insurance plans do not cover plastic surgery, many doctors have branched out beyond their specialties to attempt to take part in this consistently lucrative field, leading to several cases where patients are forced to have more surgeries to remedy mistakes or are left with serious scars or injuries.

In the meantime, advances in materials, instruments, and techniques will benefit plastic, reconstructive, and cosmetic surgery. For example, the advent of magnification and miniaturization and the development of tiny instruments and new suture materials have allowed the reconstruction of many injury sites. Blood vessels and nerves are now routinely reattached and a mere nine individual sutures are required to join the severed portions of a blood vessel one millimeter in diameter. Additionally, in the area of facial cosmetic surgery, new tools such as ultrasound to apply heat and a wide range of quality fillers have reduced the need for cutting. Similar less invasive methods are advancing in other areas as well.

Bibliography

American Society of Plastic Surgeons. 2013 Plastic Surgery Statistics Report. Arlington Heights: Amer. Soc. of Plastic Surgeons, 2013. Web. 13 Jan. 2015. PDF file.

Grazer, Frederick M., and Jerome R. Klingbeil. Body Image: A Surgical Perspective. St. Louis: Mosby Year Book, 1980. Print.

Loftus, Jean M. The Smart Woman’s Guide to Plastic Surgery. 2d ed. Dubuque, Iowa: McGraw, 2008. Print.

MedlinePlus. "Plastic and Cosmetic Surgery." MedlinePlus Natl. Lib. of Medicine, 2 May 2013. Web. 13 Jan. 2015.

Narins, Rhoda, and Paul Jarrod Frank. Turn Back the Clock Without Losing Time: Everything You Need to Know About Simple Cosmetic Procedures. New York: Three Rivers, 2002. Print.

Rutkow, Ira M. American Surgery: An Illustrated History. Philadelphia: Lippincott, 1998. Print.

Townsend, Courtney M., Jr., et al., eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia: Saunders-Elsevier, 2012. Print.

Weatherford, M. Lisa, ed. Reconstructive and Cosmetic Surgery Sourcebook. Detroit: Omnigraphics, 2001. Print.