Analysis of NFL Injuries

Analysis of NFL Injuries INTRODUCTION Achilles tendon (AT) ruptures are increasing in incidence across all populations[1-9]. Recent large-scale analyses put the incidence as high as 7-40 ruptures per 100,000 person-years[3-5, 10]. A 33-year study from Finland discovered from 1979 to 2011 the injury rate increased from 2.1 to 21.5 ruptures per 100 person-years in all age groups and activities[6]. Even in the athlete population, the number of athletes suffering AT ruptures is increasing which poses a potentially career-altering and even ending injury[1, 6, 11-13]. Nearly a third (27.5-32%) of all National Football League (NFL) players who suffer an AT rupture are unable to return to competition[13, 14]. In the NFL from 1980-2001, around 4 AT ruptures that required surgical intervention occurred each year[11]. From 2009 to 2014 in the NFL, there was an average of 14.67 (Standard deviation: 4.13) AT ruptures each season[15]. These ruptures are seen most frequently in running, jumping and cutting movements[6, 12, 16]. Achilles tendon ruptures typically occur from a non-contact mechanism during explosive acceleration or a sudden change of direction with an eccentrically loaded foot[14]. The AT has elastic properties that are required for locomotion and is the strongest tendon in the human body[12, 17, 18]. This elastic nature and strength allows it to transmit high forces, up to 12 times ones body weight[17, 19, 20]. Durability requirements of the AT create a unique set of challenges in proper treatment decisions. Current reconstruction concepts differ behind the ideal treatment strategy[9, 21]. The recovery process from all surgical techniques is an arduous challenge involving significant physical therapy and medical treatment. Unfortunately a majority of patients, especially those in the general population are able to return to a pre-injury level, with the current exception being elite athletes[22]. Although several studies evaluate AT ruptures in multiple populations, including professional athletics, studies that assess trends in professional football are scarce. NFL athletes provide an interesting patient population due to the intricate details and variables reported for every game where data is archived and widely available. A recent NFL Injury Surveillance System (ISS) analysis by Mai HT et al., discovered only a 72.5% return to play rate for athletes who suffered an AT rupture. If the athlete was able to return, the average return was 375.1 days, similar to the recovery period for ACL reconstruction (378.1 days)[13]. Athletes fortunate enough to return to competitive action frequently experience a significant decline in performance, and their competitive athletic longevity may be shortened[13, 14, 23]. The potential devastating effect on high-level athletes has required the development of ideas to optimize treatment management and improve return to play rates[23]. Previously, anterior cruciate ligament (ACL) injuries have been scrutinized due to their high incidence, long rehabilitative process and potential career-threatening nature of the injury[24]. A recent review by Balazs et al. identified four studies that found an increased risk of ACL injury on artificial playing surfaces in football cohorts, although these findings are not consistent across all studies[24]. Current research evaluates multiple variables in efforts to find potential contributing risk factors, including playing surface, that may increase the risk and rate of these devastating injuries[24, 25]. Identifying and understanding risk factors from prior research has been used to develop and improve protocols and outcomes after ACL injuries[24]. With the growing incidence of AT injuries, research is necessary to improve management and prevention of AT ruptures, especially in football players where the current literature is limited. This study performed an extensive review of reported NFL injuries from public injury records and injury reports during the 2009-10 to 2016-17 seasons. This data was compiled to monitor the incidence and injury rates of AT injuries that occurred during the regular season to evaluate the influence of playing surface on rupture rate. Additionally, further analysis to identify potential effects of position and frequency of injury at different periods of the season on AT ruptures was performed to guide future studies. Our hypothesis is that playing surface has no impact on the incidence and injury rate of AT ruptures in professional football players despite a recent overall increase in AT ruptures. METHODS A thorough online review was conducted by three co-authors to document AT ruptures sustained in the NFL between the 2009-10 and 2016-17 seasons. Online search criteria consisted of information acquired from Rotoworld.com, NFL.com, ESPN.com, SBNation.com, SI.com and from each teams local sports reports and blogs covering the team. Open searches through Google.com utilized combinations of the words Achilles and tendon along with the player, team and year of injury. Published weekly injury reports and team injury reserve lists were utilized to identify players who suffered injuries to their lower extremity or leg. Their names were added to the open internet search key words in attempts to improve accuracy of documenting all AT ruptures of NFL athletes. Only injuries with corresponding reports that confirmed the injury were included. Additional information gathered through the online search and acquired reports included player-specific details including team, position, approximate date of injury, activity at time of injury and other injury specific details including mechanism and playing surface when available. Injury incidence was recorded for each season. A season was defined as the day after the prior Super Bowl until the day of the Super Bowl in each given season. Descriptive statistics characterizing the injuries by playing surface, time in the season (broken up in to four game segments specific to each team considering their bye week) and players participating on offense, defense or being a specialist (i.e. kicker, punter, long-snapper) were determined for analysis. As previously described by Lawrence et al., injury rates were calculated per 100 team-games (TG)[26]. A TG is defined as one team exposure to a game[26]. One regular season or post-season game is equal to two TG as there are two individual teams participating in each game[26]. Mid-P exact tests were calculated to evaluate differences in IRs with statistical significance established at p Team and schedule information was gathered through Pro Football Reference and official team websites. The yearly team schedules and location of games played was recorded to help determine the home team and playing surface for all injuries suffered in games. Adjustments were made when games did not take place at the stadium of the home team and corrected accordingly. An analysis of the number of AT injuries per game for each variable was calculated. An NFL game in this study included the participation of two teams. Injury rate ratios were used to compare the incidence of AT injuries on different playing surfaces (i.e. natural grass and artificial turf). RESULTS Between the 2009-10 and 2016-17 seasons, there were a total of 45 Achilles tendon ruptures reported in the NFL during games (Figure 1). There was a subtle increase in the number of ruptures suffered each year. The most Achilles tendon ruptures occurred during the 2013-14 and 2016-17 season (N = 9) and the incidence of ruptures on grass was 24 (IR: 1.00 per 100 TG) compared to 21 (IR: 1.13 per 100 TG) on artificial turf playing surfaces (Figure 2). The difference in rate was not statistically significant (p = .67). Of the 45 Achilles tendon ruptured over the eight years, 32 (71.1%) were suffered by defensive players.  Ãƒâ€šÃ‚   Offensive players only sustained 13 ruptures and specialists reported no ruptures over that time (Figure 3). Defensive players suffered the greatest number of Achilles tendon ruptures every season monitored except for 2015-16. Defensive players had a significantly increased IR (p = .005) compared to offensive players (Table 1). When factoring in the playing surface, offensive players suffered a higher percentage of their ruptures on turf (N = 8, 61.5%) compared to defensive players that sustained a great number of their ruptures on natural grass (N = 19, 59.4%). Achilles tendon ruptures were most likely to occur early in the season. The greatest incidence was reported in the 1st or 2nd 4 game segments of the regular season schedule (N = 17 and N = 14 respectively). These 31 ruptures in the first 8 games of the regular season made up 68.9% of all Achilles ruptures in games over eight seasons (Table 2). There was a significant rate difference between the first four games of the regular season with the last four games of the regular season (IRR: 3.40, p = .01). The second four games of the regular season also demonstrated a significant rate difference with the final four games of the regular season (IRR: 2.80, p = .04). DISCUSSION Previous studies have documented the increased incidence of acute Achilles tendon ruptures in the general population. After the NFL lockout, the increasing incidence of Achilles tendon ruptures in the NFL was noted and gained national attention[11]. The purpose of this study was to document the incidence and injury rates of Achilles tendon ruptures in games over eight NFL seasons. Using this data, we were able to evaluate the potential influence of playing surface on the rate of Achilles tendon ruptures between grass and artificial turf to improve our understanding of the growing injury. Game information provides playing surface details for each game for analysis. Since this injury compilation is from public records, the ability to accurately identify the playing surface for training and practice injuries is limited. Analysis of 4,272 regular season and playoff team-games reported 45 Achilles tendon ruptures. The overall game injury rate was 1.05 AT ruptures per 100 TG. As the current literature on AT rupture epidemiology in professional football is limited, this is one of the few studies in the past decade reporting IRs. The IR for artificial turf was 1.13 per 100 TG and 1.00 per 100 TG on natural grass. There was no demonstrated difference between rates on artificial turf and natural grass (p = .67). These early findings support that playing surface does not affect the rate of AT ruptures. Other studies evaluating injury patterns have confirmed that certain injuries are more likely during certain activities or periods of the season, like hamstring strains in the NFL preseason[27]. To further understand our findings, overall AT ruptures were broken down in to four game segments of the regular season and the post-season. The greatest IR was observed in the first and second four-game portions of the regular season (IR: 1.66 and 1.37 per 100 TG respectively). The only significant rate difference occurred between those two four-game segments with the final four games of the regular season (p = .01 and .04 respectively). These findings support the significantly increased rate of injury early in the season. A further analysis of all AT ruptures in practice and games is important to help understand the significance of these early findings. Previously between the 1997 and 2002 seasons, a total AT analysis reported that Achilles tendon ruptures sustained were evenly distributed[ 14]. Our game findings do not support this earlier analysis; however, the overall incidence has increased substantially since the previous study[14]. Further evaluation may confirm these findings and help identify risk factors that lead to an increased risk of AT rupture early in the season. Additionally, further evaluation should identify if this increase is only during the beginning of the regular season or is also distributed throughout pre-season training camps. Immediately following the NFL lockout in the 2011 season, there were 10 reported Achilles tendon ruptures in the first 12 days of training camp[11]. That off-season was unique for at least the last decade due to the elimination of rookie mini-camps and off-season training sessions (OTAs), but potentially highlighted the importance of adequate preparation for current physical demands of professional football players[11]. Ultrasound evaluation found that subjects who are less active have a thinner Achilles tendon compared to athletes[18, 28]. A recent meta-analysis of 27 studies identified that differences in the loading conditions affected the adaptive responses (tendon stiffness, Youngs modulus, and tendon cross-sectional area)[29]. Additionally, although shorter high intensity programs may induce adaptive tendon responses, intervention programs of longer duration appears to be more efficient and clearly demonstrated increased adaptive responses (greater than or equal to 12 weeks)[29 ].   The combination of findings after an NFL Lockout off-season preventing team-affiliated practice and the meta-analysis findings stress the significance of adequate player preparation[29]. An adequate player preparation programs involves sufficient high level intensity training of significant length that prepares the athlete and allows for tendon adaptations to prepare them for training camp exposures. Continued efforts to identify the best training protocols to prepare athletes for the demands of football training camp is crucial for optimal injury prevention. Additional analyses identify specific positions or position groups most likely to sustain specific injuries[14, 27]. We were interested if the reactive nature of defensive players increased their likelihood for injury. Of the 45 AT ruptures identified, a majority (N = 32, 71.1%) were sustained by defensive players that demonstrated a significantly increased rate in games compared to offensive players (p = .005). Eccentric movements increase the tendon length[29, 30]. The Achilles tendon functions as both a spring and a shock absorber[18]. Previously, athletes have been found to have a thicker Achilles tendon than subjects who are less active[18, 28]. Currently, ruptures are believed to be caused due to the overloading of the taut tendon, but other studies have also discovered degenerative changes within the ruptured tendon[8, 29, 30]. Although research demonstrates a genetic influence on the predisposition of a person towards an Achilles tendon injury[31], these findings clearly demonstrate an additional risk experienced by defensive players.   We suspect one factor that increased the incidence of AT injuries for defensive players is the reactive nature of the position and movements required of defensive players compared to the movements utilized by offensive and specialist players. A further analysis may be able to confirm this hypothesis and if practice injuries are included may be able to provide an adequate sample size to identify specific positions more susceptible to injuries. CONCLUSION Utilizing game data, there is no apparent correlation between playing surface and rate of AT ruptures. Our findings identify significant rate differences in AT ruptures in the first and second four game segments of the regular season compared to the final four games. Additionally, our findings are some of the most recent published game IRs for AT ruptures. Defensive players suffered a majority of ruptures compared to offensive or specialist players. Further analysis to identify an overall IR including practices and additional analysis of player position and time of the season of injury will improve our understanding of AT ruptures in professional football. LIMITATIONS This analysis of the NFL relies on publicly available data. We are aided in our analysis as the NFL requires all teams to report and publish injury reports each week of the season in addition to every game of the season televised. This allows the accuracy of game data to be of increased accuracy compared to practice information that is not as widely publicly available. Even with the precautions, there are possibilities for AT ruptures to not be documented. With the current attention to long-term injuries, there is potential bias from an increased attention and publication of athletes who sustained AT ruptures compared to the beginning of our study. REFERENCES [1] Fox G, Gabbe BJ, Richardson M, et al. Twelve-month outcomes following surgical repair of the Achilles tendon. Injury 2016; 47: 2370-2374. [2] Ganestam A, Kallemose T, Troelsen A, et al. Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients. Knee Surg Sports Traumatol Arthrosc 2016; 24: 3730-3737. [3] Huttunen TT, Kannus P, Rolf C, et al. Acute Achilles Tendon Ruptures: Incidence of Injury and Surgery in Sweden Between 2001 and 2012. Am J Sports Med 2014; 42: 2419-2423. [4] Mattila VM, Huttunen TT, Haapasalo H, et al. Declining incidence of surgery for Achilles tendon rupture follows publication of major RCTs: evidence-influenced change evident using the Finnish registry study. Br J Sports Med 2015; 49: 1084-1086. [5] Jacobsson J, Timpka T, Kowalski J, et al. Prevalence of Musculoskeletal Injuries in Swedish Elite Track and Field Athletes. Am J Sports Med 2012; 40: 163-169. [6] Lantto I, Heikkinen J, Flinkkilà ¤ T, et al. Epidemiology of Achilles tendon ruptures: Increasing incidence over a 33-year period: Clinical relevance level IV. Scand J Med Sci Sports 2015; 25: e133-e138. [7] Sheth U, Wasserstein D, Jenkinson R, et al. The epidemiology and trends in management of acute Achilles tendon ruptures in Ontario, Canada: a population-based study of 27 607 patients. Bone Jt J 2017; 99-B: 78-86. [8] Wertz J, Galli M, Borchers JR. Achilles Tendon Rupture: Risk Assessment for Aerial and Ground Athletes. Sports Health 2013; 5: 407-409. [9] Ververidis AN, kalifis KG, Touzopoulos P, et al. Percutaneous repair of the Achilles tendon rupture in athletic population. J Orthop 2016; 13: 57-61. [10] Raikin SM, Garras DN, Krapchev PV. Achilles Tendon Injuries in a United States Population. Foot Ankle Int 2013; 34: 475-480. [11] Myer GD, Faigenbaum AD, Cherny CE, et al. Did the NFL Lockout Expose the Achilles Heel of Competitive Sports? J Orthop Sports Phys Ther 2011; 41: 702-705. [12] Gajhede-Knudsen M, Ekstrand J, Magnusson H, et al. Recurrence of Achilles tendon injuries in elite male football players is more common after early return to play: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med 2013; 47: 763-768. [13] Mai HT, Alvarez AP, Freshman RD, et al. The NFL Orthopaedic Surgery Outcomes Database (NO-SOD): The Effect of Common Orthopaedic Procedures on Football Careers. Am J Sports Med 2016; 44: 2255-2262. [14] Parekh SG, Wray WH, Brimmo O, et al. Epidemiology and Outcomes of Achilles Tendon Ruptures in the National Football League. Foot Ankle Spec 2009; 2: 283-286. [15] Hoffman J, Krill M, Hewett T. Anterior Cruciate Ligament And Achilles Tendon Injuries In The Nfl From 2009-10 To 2014-15 Seasons: 3075 Board #140 June 3, 3:30 PM-5:00 PM. Med Sci Sports Exerc; 48: 873. [16] Hess GW. Achilles Tendon Rupture: A Review of Etiology, Population, Anatomy, Risk Factors, and Injury Prevention. Foot Ankle Spec 2010; 3: 29-32. [17] Joseph MF, Lillie KR, Bergeron DJ, et al. Achilles Tendon Biomechanics in Response to Acute Intense Exercise: J Strength Cond Res 2014; 28: 1181-1186. [18] Malvankar S, Khan WS. Evolution of the Achilles tendon: The athletes Achilles heel? Foot Edinb Scotl 2011; 21: 193-197. [19] Lorimer AV, Hume PA. Achilles Tendon Injury Risk Factors Associated with Running. Sports Med 2014; 44: 1459-1472. [20] Oda H, Sano K, Kunimasa Y, et al. Neuromechanical Modulation of the Achilles Tendon During Bilateral Hopping in Patients with Unilateral Achilles Tendon Rupture, Over 1 Year After Surgical Repair. Sports Med. Epub ahead of print 3 October 2016. DOI: 10.1007/s40279-016-0629-3. [21] Gulati V. Management of achilles tendon injury: A current concepts systematic review. World J Orthop 2015; 6: 380. [22] Egger AC, Berkowitz MJ. Achilles tendon injuries. Curr Rev Musculoskelet Med. Epub ahead of print 13 February 2017. DOI: 10.1007/s12178-017-9386-7. [23] McCullough KA, Shaw CM, Anderson RB. Mini-open repair of achilles rupture in the national football league. J Surg Orthop Adv 2014; 23: 179-183. [24] Balazs GC, Pavey GJ, Brelin AM, et al. Risk of Anterior Cruciate Ligament Injury in Athletes on Synthetic Playing Surfaces: A Systematic Review. Am J Sports Med 2015; 43: 1798-1804. [25] Hershman EB, Anderson R, Bergfeld JA, et al. An Analysis of Specific Lower Extremity Injury Rates on Grass and FieldTurf Playing Surfaces in National Football League Games: 2000-2009 Seasons. Am J Sports Med 2012; 40: 2200-2205. [26] Lawrence DW, Hutchison MG, Comper P. Descriptive Epidemiology of Musculoskeletal Injuries and Concussions in the National Football League, 2012-2014. Orthop J Sports Med 2015; 3: 232596711558365. [27] Elliott MCCW, Zarins B, Powell JW, et al. Hamstring Muscle Strains in Professional Football Players: A 10-Year Review. Am J Sports Med 2011; 39: 843-850. [28] Emerson C, Morrissey D, Perry M, et al. Ultrasonographically detected changes in Achilles tendons and self reported symptoms in elite gymnasts compared with controls An observational study. Man Ther 2010; 15: 37-42. [29] Bohm S, Mersmann F, Arampatzis A. Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults. Sports Med Open 2015; 1: 7. [30] Pedowitz D, Kirwan G. Achilles tendon ruptures. Curr Rev Musculoskelet Med 2013; 6: 285-293. [31] Maffulli N, Margiotti K, Longo UG, et al. The genetics of sports injuries and athletic performance. Muscles Ligaments Tendons J 2013; 3: 173-189. FIGURES Figure 1. Figure 2. Figure 3. Table 1. IncidenceIRaIRRbp-value Defense320.752.46 (1.31-4.85).005 Offense130.30 a Injury rate based on 4,272 TG (4,096 regular season and 176 post-season TG) bInjury rate ratios with 95% confidence limits Table 2. IncidenceIRaIRRbp-value 1st 4 games171.66 1.21 (0.59-2.51)c.60 2.13 (0.93-5.21)d.08 3.4 (1.30-10.31)e.01 2.92 (0.53-61.68)f.29 2nd 4 games141.37 1.75 (0.74-4.40)d.21 2.80 (1.04-8.67)e.04 2.41 (0.43-51.37)f.42 3rd 4 games80.78 1.6 (0.52-5.38)e.42 1.38 (0.22-30.76)f.85 4th 4 games50.49 0.86 (0.12-20.45)f.83 Post-season10.57 aInjury rate based on 4,096 regular season (1,024 each 4-game period) or 176 post-season TG bInjury rate ratios with 95% confidence limits Compared with c2nd 4 games of the regular season, d3rd 4 games of the regular season, e4th 4 games of the regular season, or fpost-season

Analysis “Hanging Fire” & “Barbie Doll”

Thesis Statement & Introduction An analysis of the literary elements imagery, symbolism, and tone/mood in â€Å"Barbie Doll†, by Marge Piercy and, â€Å"Hanging Fire† by Audre Lorde reveals each character and their struggle with their identity in society. Summary of â€Å"Barbie Doll† In the poem â€Å"Barbie Doll† by Marge Piercy, we read about a young girl who has self image problems. Due to the expectations of society, she is not happy with her physical appearance. She had many good qualities but is unable to see these for herself. Instead she only sees is a â€Å"a great big nose and fat legs†(Piercy,1936). In order to conform to society’s idea of beauty, the young girl was â€Å"advised to play coy, exhorted to come on hearty, exercise, diet, smile and wheedle. †(Piercy, 1936) The pressures became too much for her to handle. She could no longer live this way so she â€Å"cut off her nose and her legs/and offered them up. †(Piercy, 1936) The author states that finally, the girl has achieved acceptance, but not on the qualities of her character or her being; rather, through the unwilling compromise to culture. Summary of â€Å"Hanging Fire† The poem â€Å"Hanging Fire†, by Audre Lorde is about the hardships of a teenager who is possibly growing up during the tense civil rights movement era, and is afraid for her life. She is scared about growing up and has many insecurities. There are many things she wants to do such as, learn to dance & be on the math team. The young girl has self confidence problems due to her appearance. For example she states, â€Å"my skin has betrayed me,† ( Lorde, 1978) meaning there are many things she feels she cannot do because her skin is not white. She also asks, â€Å"how come my knees are always so ashy? (Lorde, 1978) She continues to refer to her mother throughout the poem as being in the bedroom with the door closed. Without her mothers’ guidance, she is struggling in society because she has no guidance. Lorde argues that anyone enduring these forces would feel the loneliness and loss of identity that the young girl had felt. Literary Element-Imagery in â€Å"Barbi e Doll† Imagery is used in â€Å"Barbie Doll† in several areas of the poem. Piercy uses lots of imagery to describe the struggles the girl experiences during her teenage years and the effects that can happen. In the first stanza, we see the beginning of an ideal image being stained in the girls mind. She was â€Å"presented dolls that did pee-pee and miniature GE ovens and irons and wee lipsticks the color of cherry candy†. (Piercy, 1936) By being presented these gifts the girls parents have already instilled a visualization of what the perfect woman is like and the girl is already learning her place in society. Their place was in the kitchen and taking care of the kids. Piercy has painted an image to the reader of a little girl playing with toy stoves and irons and wearing red lipstick to make herself pretty. Piercy writes, â€Å"In the casket displayed on satin she lay with the undertaker's cosmetics painted on, a turned-up putty nose, dressed in a pink and white nightie. †(Piercy, 1936) The next line reads, â€Å"Doesn’t she look pretty? † (Piercy, 1936) The derisive imagery criticizes gender discrimination of the modern society. The character has struggled to feel pretty until the pressure of society has became too much for her and in response to this has cut off her nose & legs. Literary Element- Imagery in â€Å"Hanging Fire† The imagery of the mother plays a big part in the poem â€Å"Hanging Fire† by Audre Lorde. This line is repeated all throughout the poem, â€Å"and momma's in the bedroom with the door closed. † (Lorde, 1978) I think it is representative of the fact that this speaker has to grow up alone without the guidance of her mother. Another way to look at the imagery of the locked up mother is that her mother just wasn't there in the first place. Her mother could have been an absent figure in her life and that is a scary thing (to grow up without the guidance of a motherly figure). Audre Lorde was a African American lady who went back and forth with her sexuality during times of struggles with civil rights. â€Å"Hanging Fire† may have been her way of expressing the guidance of her mother could have helped her through her confusion with her sexuality. I think this really impacted her, so she reminds herself and the reader of it at the end of every stanza. Compare/Contrast Authors Use of Literary Element Imagery Imagery is used to depict identity issues in â€Å"Barbie Doll† by Marge Piercy and in â€Å"Hanging Fire† by Audre Lorde. In both â€Å"Barbie Doll† and â€Å"Hanging Fire,† a young girl struggles with their appearance. In â€Å"Barbie Doll† the author Marge Piercy uses imagery to portray a young girl who is unhappy with the way she looks. For instance, in the following lines â€Å"She was healthy, tested intelligent, possessed strong arms and back, abundant sexual drive and manual dexterity. She went to and fro apologizing. Everyone saw a fat nose on thick legs,† (Piercy, 1936) although she possessed several good qualities, the only thing that stood out to her was her nose and legs. In â€Å"Hanging fire,† the author Audre Lorde uses imagery to show a young woman struggling with her identity as well, not only with the physical part of her identity but the emotional side as well. After repeated use of the line, â€Å"and momma's in the bedroom with the door closed,† (Lorde, 1978) it is apparent the young girl struggles without the guidance of her mother. Literary Element- Symbolism in â€Å"Barbie Doll† The title â€Å"Barbie Doll† itself symbolizes a thin, curvy body, with symmetrical, perfect facial features. The beginning of the poem starts out with, â€Å"This girlchild was born as usual and presented dolls that did pee-pee and miniature GE stoves and irons and wee lipsticks the color of cherry candy. † (Piercy, 1936) This line symbolizes society’s expectations for a girls role in life. For example, introducing the mothering instinct, as well as cooking and cleaning while encouraging her to look pretty while doing all of that. The poem makes a reference to a fan belt, similar to a person’s â€Å"good nature,† will wear out from being over used and abused. With line twenty’s mention of an â€Å"undertaker’s cosmetics painted on,† (Piercy, 1936) the author paints an image of disguise–suppressing hurt and anguish suffered when a girl was forced to absorb into a materialistic society that functions only according to the standards set by its members. In the beginning of the last stanza of â€Å"Barbie Doll,† the reader can achieve almost a sense of relinquishment as the subject symbolically â€Å"cut off her nose and her legs and offered them up. † (Piercy, 1936) The reader is led to believe hat the girl has come to realize that she must account for the loneliness and emptiness that she has felt as a result of imitating a false person. In line 21, the putty nose symbolizes the â€Å"perfect nose† for a girl, even though it is very unrealistic. The pink and white clothes that the girl is wearing, symbolize colors that represent purity and femininity. The conclusion is her death, an act of her surrendering herself to the pain. Literary Element- Symbolism in â€Å"Hanging Fire† The title â€Å"Hanging Fire† symbolizes wanting to do something or, waiting on something to happen that you are expecting. In this poem, the girl is ready to mature although her body has not done so yet. She has insecurities about her skin color and appearance. Audre Lorde grew up during the civil rights era and much of her poetry represents these types of feelings. In the line, â€Å"My skin has betrayed me† (Lorde, 1978), is symbolism for change. Not only what she is going through at that particular time, but how she is the black girl in the neighborhood, the outrage in this racist society. At this age, she is going through changes which affect every possible way of life. She is going through changes in her body which may be related to puberty. Her ashy knees symbolize all the â€Å"falls† she has taken, representative of all the scars of her life. At the end of every stanza, Lorde writes â€Å"and momma’s in the bedroom with the door closed. †(Lorde, 1978) This symbolizes the absence of her mother in her life. Without her mothers guidance the girl feels as though she must face the struggles of life alone. Compare/Contrast of Symbolism Symbolism in â€Å"Barbie Doll† is used by the author to represent the lack of self confidence of a girl who does not have society’s idea of the perfect body. For example, â€Å"You have a great big nose and fat legs† (Piercy, 1936) gives a very good indication that the young girl is not part of the norm as far as beauty goes. â€Å"Piercy uses symbolism to convey the false views society has toward women, while in â€Å"Hanging Fire,† symbolism is used to portray a young girl who is impatiently waiting to see changes within her body. Lorde uses symbolism to show insecurities the young girl in â€Å"Hanging Fire† has with her body. For instance, in the line â€Å"and my skin has betrayed me† (Lorde, 1978) Lorde uses symbolism to show the change that her body is going through. In both poems the characters are struggling with their appearance as well as other things. In difference, â€Å"Hanging Fire† was written in the civil rights era, leading me to believe Lorde used symbolism to show an African American girl struggling with race issues. While in Piercys’ â€Å"Barbie Doll,† symbolism is used to portray aspects of gender discrimination. Literary Element Tone in â€Å"Barbie Doll† The first four lines of â€Å"Barbie Doll† are written in simplistic tones which represent the normality and basic needs of infancy. The ironic tone of the poem criticizes gender discrimination of the modern society. In the beginning of the poem, the tone is silent and simplistic at first, describing the norm for a child and what is expected from society, â€Å"This girlchild was born as usual and presented dolls that did pee-pee and miniature GE stoves and irons and wee lipsticks the color of cherry candy† (Piercy, 1936) The tone of the introductory stanza changes quickly in line five when the author writes â€Å"Then, in the magic of puberty, a classmate said You have a great big nose and fat legs. † (Piercy, 1936) The last line of the second stanza again changes in tone from simple to straight-forward with the statement â€Å"Everyone saw a fat nose on thick legs. (Piercy, 1936) This line re-emphasizes the offensiveness of not measuring up to the standard of an ideal female, a standard set by society. Tone is used to show the severity of the pressures that society can produce. Literary Element Tone in â€Å"Hanging Fire† Audre Lorde[-;0] used her diction to indicate the s erious tone in â€Å"Hanging Fire. † Lorde used a serious tone to enforce that this poem was to be taken sincerely. â€Å"My skin has betrayed me† (Lorde, 1978) indicates not only that the skin appears displeasing, but that it is displeasing. This also reveals that the tone is confident. The use of â€Å"and† instead of â€Å"if† gives the speaker a sad tone. The teenager in the poem worries excessively about everything, which is not abnormal from what most teenagers do. There is a sense of worry throughout the whole poem. She is stressed and the tone really represents that. The diction sets this tone because the speaker makes generalizations such as, â€Å"nobody even stops to think about my side of it,† (Lorde, 1978) and how her skin has â€Å"betrayed,† her. She is very overdramatic which is characteristic of a teenager. The author also shows a sense of urgency such as in the lines â€Å"I have to learn how to dance in time for the next party. † (Lorde, 1978) There are things the girl wants to accomplish and coveys that she feels a sense of urgency to do so. The serious and stressed tone of the poem conveys to the reader how serious the effects of the civil rights era were on many people and in particular young people. Compare/Contrast of Literary Element Tone The tone in â€Å"Barbie Doll† evolves and changes throughout the poem from a simplistic tone to a negative tone. While in â€Å"Hanging Fire,† the tone stays on serious side indicating signs of stress and worry. In both poems the tone indicates stress, in â€Å"Barbie Doll,† it is due to the fact that others have pointed out the flaws they believe the girl has based on societies standards. While in â€Å"Hanging Fire† the tone indicates the girl never had confidence in the first place. Her mother was not there to encourage or support her which led to stress and worry over her cosmetic issues such as her ashy knees. The beginning of â€Å"Barbie Doll† starts out with a simplistic tone then changes to tone portraying low self esteem and cruelty. In particular in the line â€Å"You have a great big nose and fat legs† (Piercy, 1936) indicates cruelty the young girl endures. The girl is described as smart and strong yet is still viewed negatively by others because of her nose and legs. The author uses tone to showcase that society as a whole is too obsessed with physical appearance and not focused on the qualities that really matter. In â€Å"Hanging Fire,† Lorde used a serious tone to enforce that this poem was to be taken sincerely. Tone is used to stress that the girl has many worries and that she needs to express them. Audre Lorde[->1] used very little punctuation in this poem to emphasize the variation of the worries of teenagers. The use of â€Å"how come,† and â€Å"why do,† in the poem suggests frustration about her current situation as an African American girl struggling to find her way in life without the guidance of her mother. Author’s Engagement with Culture and Society Marge Piercy’s â€Å"Barbie Doll† â€Å"Barbie Doll† is a poem that follows the life of a young girl growing up with modern expectations that she struggles to conform to. The young girl begins to suffer and she develops anxiety and depression. She loses her self confidence and becomes inferior and weak. â€Å"Barbie Doll† uses different aspects of a woman’s life to express the different pressures on women today. Marge Piercy grew up in a family greatly affected by the Great Depression. Due to the environment Piercy was raised in during the Great Depression, many of her works tend to be highly personal and often address concerns with feminist and social issues. Piercy’s poetry is known for its highly personal, often angry, and very emotional character. Author’s Engagement with Culture and Society Audre Lorde â€Å"Hanging Fire† â€Å"Hanging Fire† reveals a young girl who is troubled by the changes her body is going through as well as self confidence issues. Her lack of guidance is continuously mentioned throughout the poem. Lorde expresses or explores racial and sexual oppression, urban neglect, and personal survival in many of her other writings as well as in â€Å"Hanging Fire. † Lorde grew up during the civil rights era where she experienced first hand racism and prejudice. She addressed subjects concerning the complexity surrounding her life as an African American and as a woman. Fixed in her resentment of the racism and sexism that marked the history of the United States, Lorde dedicated her work to her ancestors, to the love and support of women, and to African Americans. In conclusion, my analysis of the literary elements imagery, symbolism, and tone/mood in â€Å"Barbie Doll†, by Marge Piercy and, â€Å"Hanging Fire† by Audre Lorde reveals each character and their struggle with their identity in society. References http://www. americanpoems. com/poets/Marge-Piercy http://www. margepiercy. com/Piercy%20Website/sampling/Barbie_Doll. htm Poem http://www. poetryfoundation. org/bio/audre-lorde http://famouspoetsandpoems. com/poets/audre_lorde/poems/19831 Poem [->0] – .. /essay_search/Audre_Lorde. html [->1] – .. /essay_search/Audre_Lorde. html

How to Choose Fun Essay Topics

How to Choose Fun Essay Topics The Appeal of Fun Essay Topics Writing something which tickles someone's funny bone demands lots of prowess. Nicole Nicole is among Melinda's former buddies. You may want to include a concise history of plastic surgery and why it has gotten so common. Writing the college application essay is a difficult gig. There are a number of fun essay topics you may write on. Students ponder and talk about the courses three primary questions from. They want to learn the skills to become good writers but they also want to enjoy the assignment enough that they are driven to work hard through each stage. After you choose the subject or topic you want to compose about, do the research that's required to compose the essay. The way to the perfect essay is by way of WritePaperFor.Me. In this kind of situation, it's more convenient to locate ready-made essays and use them as an example. When you're writing such essay, the goal is to come out with the ideal college essays. The Downside Risk of Fun Essay Topics Journaling is one method to achieve that. Working on your college essay may be overwhelming, but nevertheless, it may also be among the most fun regions of the college application practice. Since it's such a huge subject, you are going to want to narrow your paper down to a particular angle. The primary aim of topic choice for a proposal essay is to demonstrate the idea can be put into place in practice. The proposal meeting ought to be regarded as a chance for you and your key professor to look for the recommendations of the committee. Do not be hesitant to request a form of paper that you do not see in our list. Remember your final grade significantly is contingent on the topic. Remember that you may make funny argumentative essays if you do a few things. If you don't know that fun is really among the costliest things on earth of today, then you really do not know anything. All you will need is the proper topic. If you're searching for an intriguing topic to compose your paper on, check whether any of these ideas inspires you don't hesitate to use our suggestions. All our writers pass a considerable procedure to look at their abilities. What's funny to you might not be funny to your readers. What you aspire to teach your reader will choose the kind of your essay. Don't neglect to bring a strong hook at the beginning (introduction paragraph) and wind up with an impressive conclusion to create the reader want to go over the interesting persuasive essay topics of your selection. Always think deeply about the way to create a superior essay structure it's a significant part academic writing. Now, if you prefer to understand how to compose a grant proposal with some funny twist to it, you need to stick with us too. There are a lot of special topics you could use in writing process essays. You might believe that interesting essay titles do all of the work, permitting you to add obvious examples and share ordinary ideas. The role of writing a satirical essay is only to entertain readers and therefore, topic selection is indeed critical. Our writers will guarantee that your essay is written from scratch to totally reflect the prompt you've been requested to write against. You always intuitively understand once an intriguing essay idea is in fact the ideal idea for you. Every author wants an amazing editor. What Has to be Done About Fun Essay Topics Creative Essay writing is currently recognized among the most helpful activity for kids for their general personality development. Your essay might incorporate the explanations for teen pregnancy and talk about the recent rates of teen pregnancy and potential solutions. The option of compare and contrast essay topics isn't a simple task because you should demonstrate your analytical skills. One of the most important hiccups in choosing funny argumentative essay topics is how comedy is a rather touchy field, and various individuals have various opinio ns of what comedy is about. Reflecting upon all your positive qualities will set you in a positive mindset and provide you with the confidence you have to tackle the remainder of the exercises and to compose that stellar college essay. Our tremendous experience on handling complicated papers enables us to guarantee in-time delivery together with excellent prompt each time students buy argumentative assignments with title. Some students utilize the very first idea that arrives in their head and work on it, but the outcome isn't successful. Someone gets essential wisdom and experience there.

Sex in Traditional Chinese Culture

The Chinese are more traditional than Western people. Talking about sex is controversial. Whenever sex is mentioned, Chinese people usually consider it as being in bad taste. This tradition causes a lack of education about sex issues. A couple married for many years went to see a doctor for infertility. Both were in good health, but to the doctors surprise, the couple had never made love. This is one of the extreme cases, but it shows that some people have no knowledge about sex. Chinese Women and Having Sex Some young, unmarried women in China have no idea about sex  before they become pregnant and have to undergo abortions, which could be avoided if they knew better. Moreover, the lack of knowledge about sex could also lead to the spread of venereal diseases and AIDS. Therefore, sex education is urgently needed in China. Young people need to learn what love is and how to protect themselves. Sex in China The Sex Education Program, introduced in 2017, is the main key to the problem. However, the courses set for all levels of schools are not optimized. Teachers and students are always finding themselves in a very embarrassing situation when they debate about sex in class. Sex has become forbidden fruit. Even so, most people think they can use some guidance about sex. Some think it works well to get informed by their peers. Some think they can be taught well from books on sex. Most people seem to find a way to educate themselves. But that is not enough to help the young from getting into bitter results. Impetuous love and sexual activities can be risky and sometimes even fatal, so it is better for them to get educated about sex before they fall in love. Not everyone is optimistic about this approach. A college student once said that he didnt want to marry a medical graduate. He thought knowing too much about the body and sex would bring an end to romance. Anyway, bringing sexual knowledge to people, especially to students, is an urgent but long-term task. China is working hard on it with entirely new approaches. More compatible courses have been introduced to junior and senior schools for teens and college students are beginning to debate sex in class. Furthermore, organizations have been established to lead the movement to a higher level to modernize the old views on sex in China.