Indian Parliament

PARLIAMENT IN INDIA AND SHORT NOTES ON OTHER PARLIAMENTS By, T. Vishnu, IX A. The  Parliament of India  is the supreme  legislative body  in  India. The parliament house originally known as ‘Council House ‘, founded in 1919, the Parliament alone possesses  legislative supremacy  and thereby ultimate power over all political bodies in India. The Parliament of India comprises thePresident of India  and the two Houses,  Lok Sabha  (House of the People) and  Rajya Sabha  (Council of States). The President has the power to summon and prorogue either House of Parliament or to dissolve Lok Sabha.The parliament is  bicameral, with an  upper house  called as Council of States or  Rajya Sabha, and a  lower house  called as House of People or  Lok Sabha. The two Houses meet in separate  chambers  , in New Delhi. The Members of either house are commonly referred to as Members of Parliament or MP. The MPs of Lok Sabha are elected by  direct election  and the MPs of Rajya Sabha are elected by the members of the State Legislative Assemblies and Union territories of Delhi and Pondicherry only in accordance with  proportional voting.The Parliament is composed of 790 MPs, who serve the largest  democratic  electorate  in the world The Estimates Committee, constituted for the first time in  1950, is a Parliamentary Committee consisting of 30  Members, elected every year by the Lok Sabha from amongst its Members. The Chairman of the Committee is  appointed by the Speaker from amongst its members. A Minister cannot be elected as a member of the Committee and if a member after his election to the Committee, is appointed a Minister, he   ceases to be a member of the  Committee from the date of such appointmentTerm of Office The term of office of the Committee is one year. Functions The functions of the Estimates Committee are: (a) to report what economies, improvements in  organisation, efficiency or admini strative reform, consistent with the policy underlying the estimates  may be effected; (b) to suggest alternative policies in order to bring about efficiency and economy in administration; (c) to examine whether the money is well laid out within the limits of the policy implied in the estimates; and d) to suggest the form in which the estimates shall be presented to Parliament. The Committee does not exercise its functions in relation to such Public Undertakings as are allotted to the Committee on Public Undertakings by the Rules of Procedure of Lok Sabha or by the Speaker. Working The  Parliament of Great Britain  was formed in 1707  Soon after it is constituted, the Committee selects such of the estimates pertaining to a Ministry/Department of the  Central Government or such of the statutory and other bodies of the Central Government as may seem fit to the Committee.The Committee also examines matters of special interest which may arise or come to light in the course of its work or which are specifically referred to it by the House or the Speaker. The Committee calls for preliminary material from the Ministry/Department, statutory and other Government bodies in regard to the subjects selected for examination and also memoranda from non-officials connected with the subjects for the use of the Members of the Committee. The Committee, from time to time, appoints one or more Sub-Committees/Study Groups for carrying out detailed examination of various subjects.If it appears to the Committee that it is necessary for the purpose of its examination that an on-the-spot study should be made, the Committee may, with the approval of the Speaker decide to undertake tours to make a study of any  particular matter, project or establishment, either as a whole Committee or by dividing itself into Study Groups. Notes relating to the institutions/offices etc. to be visited are called for in advance from the concerned Ministries/Departments etc. and circulated to th e Members of the Committee/Sub- Committee/Study Group.The Members while on tour may also meet the representatives of chambers of commerce and other nonofficial trade organisations and bodies which are concerned with the subjects under examination of the Committee, for an informal discussion. When the Committee/Sub-Committee/Study Group is on study tour only informal sittings are held at the place of visit. At such sitting neither evidence is recorded nor any decisions are taken. All discussions held by the Committee with the representatives of the   Ministries/ Departments, nonofficial organisations, etc. re treated as confidential and  no one having access to the discussions directly or  indirectly, should communicate to the Press or anyunauthorised person any information about matters taken  up during the discussions. Later in the light of informal discussions during Study Tours,  memoranda received from non-officials and information  collected from the Ministry/Depart ment concerned and other sources, non-official and official witnesses are invited to give evidence at formal sittings of theEstimates Committee held in Parliament House/Parliament House Annexe, New Delhi. The observations/recommendations of the Committee are embodied in its Reports which are presented to Lok Sabha. After a Report has been presented to the House the Ministry or Department concerned is required to take action on the recommendations and conclusions contained in the Report within a period of six months. The replies of the Government are examined by the Committee and an Action Taken Report is presented to the House.The replies to the recommendations contained in the Action Taken Reports are laid on the Table of Lok Sabha in the form of Statements. While U. S. A’s parliament is called as UNITED STATES CONGRESS The  United States Congress  is the  bicameral  legislature  of the  federal government  of the  United States, consisting of the  Senate, its upper house, and the  House of Representatives, its lower house. Congress meets in the  Capitol  in  Washington, D. C.Both representatives and senators are chosen through  direct election. There are 535 voting Members of Congress; the House of Representatives has a membership of 435 and the Senate has a membership 100. Members of the House of Representatives serve two-year terms representing the people of a district. Congressional districts are  apportioned  to states by  population  using the United States Census results, each state in the union having at least one representative in the Congress.Regardless of population, each of the 50 states has two senators; the 100 senators each serve a six-year term. The terms are staggered so every two years approximately one-third of the Senate is up for election. Most incumbents seek re-election, and their historical likelihood of winning subsequent elections exceeds 90 percent. The  Parliament of the United Kingdom o f Great Britain  is the supreme  legislative body in the United kingdom, British  Crown dependencies  and  British overseas territories.The  parliament  is  bicameral, with an  upper house, the  House of Lords, and a  lower house, the  House of Commons. ]The Queen is the third component of the legislature. The House of Lords includes two different types of members: the  Lords Spiritual  (the senior  bishops  of the  Church of England) and the  Lords Temporal  (members of the  Peerage) whose members are not elected by the population at large, but are appointed by the Sovereign on advice of the Prime Minister . The  Parliament of Great Britain  was formed in 1707. Read also: My Ambition Is To Become a Collector

Wives as Deputy Husbands

â€Å"Wives as Deputy Husbands† by Laurel Thatcher Ulrich Article Review â€Å"Wives as Deputy Husbands† by Laurel Thatcher Ulrich was written to give the author’s opinion on the roles of women in the 17th and 18th century. Some historians thought women were merely there to do housework and take care of the children. They thought they were helpless. On the contrary other’s thought they were very involved in various affairs such as: blacksmiths, silversmiths, tinworkers, shoeworkers, tanners, etc. They thought they may have been very independent.However, this article is used to understand how households were run and how women fit into both female and male roles. The author’s thesis of this article is to inform the reader that women had more roles in colonial times than people rarely consider. Ulrich’s contention is that â€Å"the husband was in control of the external affairs and of the family, a husband’s decision would incorporate hi s wife’s opinion, and should fate or circumstance prevent the husband from fulfilling his role the wife could stand in his place† (Paragraph 4. ).Women didn’t only depend on their husband. She was not helpless. Her commitment to her husband did allow him to be able to trust her with difficult tasks that a servant couldn’t be trusted with. A wife specialized in housekeeping skills but it also included the responsibilities of being a deputy husband. Ulrich says â€Å"Economic opportunities were limited for women; however, female responsibility was a very broad topic† (Paragraph 8. ). A woman could do any task as long as it furthered the good of her family and her husband deemed it acceptable.Wives could double as their husbands and became respected companions and shared the spouse’s authority. There was no sharp division between home and work in the colonial time period. Many people worked on a farm which also doubled as their home. This was al so true for male and females, their spaces overlapped. While the husband was around her responsibility was limited. When he was absent her responsibility was more weighted. If a woman became a widow, and she had no sons, and chose not to remarry she could inherit the deceased spouse’s estate.Many of the male’s responsibilities were less desirable to a woman than doing housework was. This work may prepare her to function competently in a male’s world, though. This article is specific to female roles. The textbook and class discussions/lectures mainly taught about the people of colonial America as a whole. We learned a lot more about men’s roles and female responsibility wasn’t mentioned very often. The article taught me that women were very important to not only the household but the entire family.In her husband’s absence she would take on his responsibilities as well as the household one’s and not only be able to survive but thrive. I think it was important to read this article because both women and men were present in this time period. Without women there would be no men (literally), so why would we study the important of one? To understand he time period I think all genders and races need to be studied to a certain extent. The strengths of this article were that Ulrich added many examples to help understand how not all women were shrew and servile but rather very independent.A weakness was that she also presented arguments from the opposing sides which in some cases were slightly confusing. Yes, it does fit into the prevailing interpretation because men weren’t present in every situation and when they weren’t women were to maintain the household and affairs. This information is indeed different that what I previously learned about gender roles; women stayed at home to cook, clean, and take care of children while men worked. Overall, this article was very informative and helped me understand how families worked together to be successful in the colonial time period.

A local conflict Essay

Q) With reference to a local conflict over the use of a resource that you have studied, discuss the extent to which all interest groups involved can be satisfied with its outcome. (40) The local conflict I have studied was the expansion of Heathrow airport, although the conflict itself ended in 2010 when it was legally resolved. However there are still effects that were created from the plans to expand Heathrow that have upset many different groups. In this essay I will discuss how the groups involved were either satisfied or dissatisfied with the outcome. There was a debate to whether or not the expansion at Heathrow was necessary. Here BAA (the airports directing company) pointed out that Heathrow was currently operating at 99.2% capacity utilisation meaning that even small incidents would create major delays, such as the ability of Heathrow to cope in extreme winter conditions such as snow. But the Greater London Authority and Hillingdon council argued saying there were alternativ es such as expanding Gatwick airport. Labour parliament also intervened stating the huge increase in passengers should be met by London’s most efficient and largest airport should be developed into the UK’s air hub. However the conservative party suggested more alternatives such as improving rail infrastructure to allow extra capacity to spread to other airports such as Manchester. This would benefit the north of England especially with the struggling economy. Arguments then arose over the impacts that would come from the expansion of Heathrow and there were many mixed attitudes towards this. A positive outcome economically would be that 140,000 new jobs would be created meaning that more people would be earning a decent wage paying taxes that would contribute to the government in funding public services such as hospitals. And if the expansion didn’t go ahead then it was estimated the UK would lose potentially  £4.5 billion GDP growth and  £1.6 billion of its existing GDP to other nations around the world. But the protest groups ‘Plane Stupid’ said that jobs would only benefit the south east as this is where Heathrow is located, it was also pointed out that the GDP figures are miniscule when compared to the UKs total GDP of  £2.435 trillion. In terms of the environment, the labour government at the time presented schemes whereby extra greenhouse emissions would be offset. This included involvement in the EUs new Carbon Permit Trading Scheme. However many environmental groups and  charities argued against this. Greenpeace produced information showing that Heathrow’s post-expansion carbon footprint would be a similar size to that of Kenya’s. The National Trust pointed out that regardless of whether CO2 was being offset around the UK, London air quality would fall. Also, the impacts on local communities came into question. A village on the expansion site known as Sipson would be destroyed if the expansion of Heathrow was granted. This would involve 700 homes being demolished as well as several a listed buildings. BAA claimed it would relocate and reimburse the whole community displaced. They also said they would not destroy but in fact repair and maintain the listed buildings on the site. However Sipson village council, the Greater London Authority and the conservative party argued against this. They stated that significant proportions of Greenbelt land would be destroyed and the sound levels in the area wou ld expand by several km2. In January 2009 Heathrow’s proposal for expansion was granted by the Labour Government. But this was put to a standstill as the demonstration groups opposing the plans for Heathrow appealed the decision to the Higher Court. It took a whole year of a legal battle but it was decided eventually in March 2010 that the Labour government’s decision was invalid and it was placed under review. That year in the general election the Conservatives and Lib Dems came to power and cancelled all the plans and proposals of extending Heathrow. With this outcome many groups were satisfied such as the Royal Society for the protection of Birds as the habitat of many birds around the airport shall not undergo any more destruction. However it is notable that the expansion won’t occur in the medium term. This is due to the whole process shall have to be reran if the plans are to risen again. Therefore it could be argued that in the short term the opposition groups will be satisfied. But in the long term the decision may be overturned and these groups left dissatisfied. For example Sipson Village Council are now being brought into another conflict as an alternative to the expansion of Heathrow the government have begun developing the HS2 as an infrastructure project. Supposedly it will link up with Heathrow, meaning the land will be built upon again destroying thousands of homes in the process. So now local communities are having to campaign in another conflict leaving them still dissatisfied. In conclusion, protest groups have been awarded for their hard work and efforts in avoiding the plans for Heathrow expansion going  ahead which has been very satisfying. But in the long term more problems have arisen as the HS2 is said to be in motion which would just cause the same problems to local communities. It seems that no matter what the decision some groups will always have different feelings towards them of satisfaction and dissatisfaction.

Business Law Essay Example | Topics and Well Written Essays - 1250 words - 10

Business Law - Essay Example Stevenson1 in which it was stated that a person must take reasonable care to avoid acts or omissions which if seen with reasonable foreseeability are likely to cause an injury to that person’s neighbour. The definition of neighbour was stated to be a person who would be so closely and directly affected by the act that he should be contemplated of when doing the act or omission. This is what is known as the neighbour principle. The test was reformed in Anns v Merton2 where Lord Wilberforce suggested a twos tagged test. The current position is that of House of Lords in Caparo v. Dickman3 whereby a three stage test was laid down. First, it must be reasonably foreseeable that the conduct of defendant would cause damage to the claimant. Secondly, there must be sufficient proximity between the parties and finally ‘the situation must be one in which the court considers it fair, just and reasonable the law should impose a duty of care of a given scope on the one party for the be nefir of the other’. (Wild et al 2010) The courts in Caparo stated that the defendant, who had undertaken the statutory audit of the public company was under a duty by way of contract to the shareholders as a collectivity and went on to say that individual purchasers of the shares of the company were not owed any duty even if they were existing shareholders nor did any liability arise in respect of the creditors of the company. It is more than evident that the accounts of the company are relied upon and the auditors’ manuals and other material may clearly point out to the fact that there has been reliance. However, the courts have due to policy reasons that the possibility of multiplicity of claims (floodgates argument) and business factors have disallowed such claims. Therefore the main reason of the courts has been that the auditors do not owe a duty to investors where reliance is placed on such audit reports because of lack of proximity; the other reason would be an

Air pollution in Al Ain Essay Example | Topics and Well Written Essays - 1250 words

Air pollution in Al Ain - Essay Example The most recent secondary data indicates that air pollution in Al Ain is the leading at 66.67% followed by drinking water pollution at 25%. This has to be established and a way to reduce such extraneous impacts be suggested. Air is an important resources God given free and human beings would only do well by protecting it and its use for the future generation (Book, 2009). This forms my basis of the research I intend to conduct in Al Ain. Al Ain is a city within the United Arab Emirates and this is the region that I intend to conduct my research. My respondents in this research will be the general population within Al Ain. I intend to sample a considerable number across all the gender and ages within the region (Lomborg, 2001). I believe that this region and the selected participants will help in establishing the exact impact of air pollution in this area (Book, 2009). In addition, it is highly anticipated that from the analysis of the data provided by these participants a clear way f orward will be established on how to handle the menace. This will be within Al Ain as well as the other regions of the UAE affected by pollution due to industrialization and human activity (Currie & Neidell, 2004). Through secondary research, I have found the following information to be of much importance in formulating my research. First, Air pollution is a big part of pollution affecting major cities in the world apart from just Al Ain. Such a form of pollution is composed of a mixture of solid particles and gases in the air. We also have car emissions, chemicals from factories and pollen as other causative agents of air pollution (Apling, 2000). Secondly, air pollution is irrespective of whether it is indoors or outdoors exposes individuals in millions throughout the world to huge health risks (Sastry, 2000). As a result, such individuals have recorded acute conditions of asthma, emphysema, lethal heart diseases, and other numerous conditions (Lomborg, 2001). In Al Ain alone, mil lions get infected everyday due to the bad air condition in which they are exposed. Next, humanity is not protected well by the laws formulated to handle air pollution menace. For example, the Environmental Protection Agency set in 1979 has done little and this necessitates for major changes and restructuring to be done to enable the rules and guidance on air pollution to be effective (Sales & Folkman, 2000). Research has it that the most polluted countries are the developed due to industrialization. This leaves the developing countries, which are at times even more industrialized and hence air pollutants unmonitored. Consequently, such countries proceed with the evil act leading to the deterioration of the atmospheres and the air that we breathe (Apling, 2000). Al Ain id not quite a big city in terms of geographical size while it is quite intense in terms of industrial activity most so in the construction sector. As a result, the city has high impacts on air pollution from the chem icals produced by such industries to the immense dust due to the nature of production rampant within the region (Miller, 2007). Governments have tried and taken initiatives to limit emissions into the air such as carbon dioxide and any other greenhouse gases (Simioni, 2004). For example, through the Kyoto protocol and putting of taxes on carbon emissions and other causative agents like gas. On the contrary, this is not enough hence the need for a collective activity to curb the menace (Browning, 2010). In conclusion, all parties and

CREEP Literature Review 3 Essay Example | Topics and Well Written Essays - 1000 words

CREEP Literature Review 3 - Essay Example In addition, this protocol applies to all special procedure units where aspirations, biopsies, or visualization through scopes may be performed. In 1997, the writer personally experienced an incident that took place in an operating theatre at a local hospital. Fortunately, a wrong site surgery on the patient was avoided on the last minute, hence leaving the patient unharmed and safe. According to this experience and to the writer, responsibility is an important part of being a member of the operating theatre management team; the writer in this literature review will essentially try to cover the most important elements and researches for wrong site surgery to answer the research question â€Å"What are the potential solutions to prevent wrong site surgery?† The search strategy used the following sources – MEDLINE, CINAHL, EMBASE, BNET, PubMed, OVID and ScienceDirect; additionally, primary sources such as AORN, Journal of PeriAnesthesia Nursing and Journal of American College of Surgeons were also used throughout research. Search terms used were ‘Surgical errors’, ‘Site Surgery’, ‘Surgical site’, ‘Wrong site surgery’, ‘Wrong procedure’, ‘Wrong person surgery’, ‘Communication failures in the Operating Room’. There was no location restriction in this literature review. All entries were in the English language or with abstracts in English that were viewed because of the paucity of ‘clinical trials’ or ‘systematic reviews’. These searches were made between 2000 and 2008. Due to the depth of this important topic a total of (the number will be add later) articles were only identified using the above sources and eight articles were chosen from those that were reviewed. The majority of the research conducted was done in the United States. Five major themes were identified in the literature review: definitions of wrong site surgery, the

Litriture Essay Example | Topics and Well Written Essays - 750 words

Litriture - Essay Example He was persistent in his belief that they should not surrender to Xerxes and that the Spartan army will endure the faith that awaits them for the glory of Greece. He believed enough in his strategy that though he was defeated in the end it marked an awakening among the Grecians to fight the Persians and eventually yield to the same belief that Leonidas figured early on. The same courage was also apparent to Achilles who remained unfazed even to his death. Achilles holds a diverse type of courage which is almost borderline arrogance but it is not without precedence as he is close to an immortal and he is aware of it. Though he knew of the prophecy of his death in the Trojan War he still joined the war that brought him to his end. Charisma is also important. It is almost impossible to concretely define what charisma is but it is a characteristic that is common among heroes. They are able to influence and move their followers into action not because of fear but because of the charisma that they have over people. Looking upon it, why would 300 men join Leonidas even though they are aware that it will cause their families mourning? It is because of charisma. Not because they are afraid but because they believed in his abilities and they are inclined to his persona. The mere fact that one can be associated with Achilles is a sign of his own charisma. These heroes exude something that transcends confidence and draws in followers. Love, that all encompassing emotion manifests itself despite and because of heroic films. It holds many variations and it is not limited to the romantic type or the ideal that we so often see. It endears us to the characters of the stories and it humanizes the heroes that even as they come to their tragic ends, we are instilled with the grief that we feel due to the love that they have revealed through the course of their stories. The movie 300

Nike Case Study Research Paper Example | Topics and Well Written Essays - 750 words

Nike Case Study - Research Paper Example Ballinger was passionate that a company should have a responsibility for its workers even if they are the lowest paid workforce of the company (Spar, 2002). Ballinger was assigned to monitor labor conditions in an Indonesian plant by overseas American companies because he considered that the reason for international companies to prepare a setup in poor countries is to exploit the low-wage labors. This has been true over years that big multinational companies have been shifting their operations to lower wage countries in order to reduce their production cost and collect more profits. The cost of production in America is double the cost of a product which is being manufactured in other countries (Locke, 2002). He claims that Nike has a policy that in order to produce cost effective products, they mistreat their workers and make them work longer hours than required. He believed that even though there were laws for protecting the labor rights, Nike continuously fed the Indonesian governm ent with bribe to overlook their part of misdeed. Ballinger accused Nike that they knew people were dependent on the company and would rarely leave the company, so they mistreated them to get more production with fewer necessities and food provided to the people. Ballinger had strength in his arguments because workers were in a bad situation and when they were interviewed by Ballinger, they agreed with the same (Connor, 2001). Nike’s Response to Ballinger’s Allegations The first response from Nike was clear that their manager said Nike’s not responsible for the actions of their independent contractors. Nike considered that they are not involved in any kind of activity in Indonesia and most likely they would not be responsible for their act. However, Nike asked its public relation officer to draft a code of conduct for its independent contractors (Stoner, 2006). This code of conduct would then be sent to their new contractors in which all aspects of working condi tions of labors, environment regulation and insurance of their workers were addressed. Nike wanted all of their suppliers and independent contractors to agree with all terms that were specified before making any further deal. It was made mandatory that these suppliers would have to give their written consent of their honesty and non-discrimination (Spar, 2002). Nike hired an accounting firm Ernst & Young to conduct an audit of its overseas factories. Auditing would inform Nike with activities of their overseas factories and would identify their problems. But the problem started to mount and criticism had started to rise again with a greater force. Nike denied any act of direct involvement in child labor activity and of worker exploitation. In Washington, Nike was the first company to join Apparel Industry Partnership (AIP) which was aimed to develop reformed labor standards in foreign factories. Nike also included a new department in its company which was known as Labor Practices De partment which role was to monitor labor practices in premises of the factory (Spar, 2002). Recommendations Firstly, Nike should focus on improving its processes in their overseas factories by making strict guidelines and norms for their factories to follow. The company shall motivate their independent

Brand Strategy and Analysis Essay Example | Topics and Well Written Essays - 1000 words

Brand Strategy and Analysis - Essay Example This helps to establish whether the brand meets the customers’ expectation and hence establish the need to modify or maintain the brand. Moreover, the managers can carry out an analysis on the customers’ data with a view of developing a marketing strategy that will communicate the brand messages to the target customers and help in predicting future market demands for the brand. For instance, the management can derive a strategic plan for the marketing department with an aim of helping them understand the customers’ needs and henceforth design a brand that meets those needs and reaches the customers in an effective way. Additionally, customers’ analysis helps in brand positioning through the analysis and understanding of different customer segments which defines their usage, needs, and experiences (Alameda County SBDC, 2013). Indeed, such an understanding clearly helps in creating brand strategy as the brand design seeks to satisfy each customer segment. Ho w a Competitor Analysis Helps In Creating a Brand Strategy A strong brand strategy is the one which positions the company’s strengths above its competitors’ weaknesses or the one which expose no threat to the competitors (Czepiel and Kerin, 2009). To achieve this, the company’s strategists must have adequate knowledge about competitors' strengths and weaknesses which comes through competitor analysis (Brown, 2010). As such, competitor analysis helps in creating a brand strategy. For instance, the strategists may seek to establish what the competitors does best and what they perform poorly with an aim of designing a brand strategy that will capitalize on the competitors’ weaknesses and dilute the competitors’ strengths with an aim of gaining competitive advantage. Indeed, brand strategy uses competitors’ analysis to establish a profile of opportunities and threats for the company against its competitors. In addition, competitor analysis has a goal of knowing all aspects of the competitor with a view of relating to them and designing a brand strategy that will address the competitors' probable actions and responses (Czepiel and Kerin, 2009). For example, the strategists can analyze the competitors’ mission statement and future policies with a view of using that information to develop a brand strategy that will position the company in a strategic position. Indeed, brand image and brand strengths are components of competitor analysis which significantly define brand strategy. Knowledge about the competitor’s current and possible future position is fundamental in the overall strategy of a company. More so, competitor’s analysis entails the competitors marketing strategy which helps in designing brand strategy. For example, the strategists may seek to know how, where, what, and who their competitors’’ advertisement target. Such information would be necessary for the company in devising a br and strategy for the future. Example of a Customer Analysis This is a customer analysis for a car manufacturing company. The customer analysis will address the market research, customer needs, and current or targeted customers (Jersey Business, n.y). Customer Needs Most car buyers seek for high quality, low maintenance, comfortable, and durable cars.

A Summary of a Chapter Writing the Winning Thesis or Dissertation Essay

A Summary of a Chapter Writing the Winning Thesis or Dissertation - Essay Example The researcher should present all datasets in tables and figures. Joyner, Rouse, and Glatthorn, 2005, emphasize on proper development of tables and figures to show study results.Writing the Introductory Paragraph. The introduction of chapter four should remind readers of the research problem and restate it in the first sentence. Similarly, an introductory paragraph should feature a sentence that gives a succinct overview of the whole chapter. The researcher should summarize study results by referring to tables. The researcher should state the evidence. However, when the writer states the narrative, part it only highlights the significant results. Using headings to attain proper chapter organization forms an imperative aspect of a thesis or dissertation.Revise the chapter before submission to the dissertation chair for review. Revising research is important to identify any errors in grammar and format in the chapter. A good thesis or dissertation should be free of grammar errors. It s hould be clear to the readers and easily understandable. Should the dissertation require tables or figures, the researcher must ensure he fully understands the programs applied such as word and spreadsheet. The writer then considers creating rows and columns of a table and makes a hard copy draft to ensure of size. Mention the table title and table number. The book outlines how a researcher can make a table on word and spreadsheet. Based on the information, the researcher can use whatever is suitable for him or her.

Campaign review 2 Essay Example | Topics and Well Written Essays - 2250 words

Campaign review 2 - Essay Example Worth noting about the topic of advertisement is that various studies have been conducted to determine the influence humor has in terms of persuasion. In the past, it has been established that customers or prospects seldom responds to mere information meant to advertise. Conversely, when an advertisement has humor included, it inevitably catches the attraction of many people. Consequently, many tend to seek more information regarding the product or service being advertised. In the end, there is a high possibility of the client purchasing the service (Cialdini, 2001). Having presented a campaign review on Old Spice’s â€Å"Your man can smell like me† advertisement, this paper will analyze how one theory of communication process was appropriately applied. One theory that was evidently applied in the campaign is Richard Petty’s and John Cacioppo’s Elaboration Likelihood Model (ELM). ELM theory is one that Richard Petty and John Cacioppo developed in the 70s that sought to explain how prospects respond to advertisements. The theory explains the path taken in the shaping, formation and reinforcement of attitudes through persuasive arguments. In essence, the theory claims that once information is availed to a person, there is some inevitable elaboration level that tends to occur. It explains that persuasion takes one of the two paths: Central or Peripheral paths. Each of these is dependent on a couple of things exhibited by the prospects. Four principles are used to analyze which path a buyer or a prospect has taken (Payne, 2008). These include elaboration, attitude, information processing and the strength of the attitude that has been reinforced, and this section will highlight how the theory is analyzed. In the case of Central path, a client has to understand the message behind an advert in order to take this side. In contrast, when the elaboration is limited the most likely

A Spatial Median Filter for Noise Removal in Digital Images Essay Example for Free

A Spatial Median Filter for Noise Removal in Digital Images Essay With each snap of a digital photograph, a signal is transmitted from photon sensor to a memory chip embedded inside a camera. Transmission technology is prone to a degree of error, and noise is added to each photograph. Signi? cant work has been done in both hardware and software to improve the signal-to-noise ratio in digital photography. In software, a smoothing ? lter is used to remove noise from an image. Each pixel is represented by three scalar values representing the red, green, and blue chromatic intensities. At each pixel studied, a smoothing ? lter takes into account the surrounding pixels to derive a more accurate version of this pixel. By taking neighboring pixels into consideration, extreme â€Å"noisy† pixels can be replaced. However, outlier pixels may represent uncorrupted ? ne details, which may be lost due to the smoothing process. This paper examines four common smoothing algorithms and introduces a new smoothing algorithm. These algorithms can be applied to one-dimensional as well as two-dimensional signals. Figure 1. Examples of common ? ltering approaches. (a) Original Image (b) Mean Filtering (c) Median Filtering (d) Root Signal of Median Filtering (e) Component wise Median Filtering (f) Vector Median Filtering. The simplest of these algorithms is the Mean Filter as de? ned in (1). The Mean Filter is a linear ? lter which uses a mask over each pixel in the signal. Each of the components of the pixels which fall under the mask are averaged together to form a single pixel. This new pixel is then used to replace the pixel in the signal studied. The Mean Filter is poor at maintaining edges within the image. 1 N ? xi N i=1 MEANFILT ER(x1 , , xN ) = (1) The use of the median in signal processing was ? rst introduced by J. W. Tukey [1]. When ? ltering using the Simple Median Filter, an original pixel and the resulting ? ltered pixel of the sample studied are sometimes the same pixel. A pixel that does not change due to ? ltering is known as the root of the mask. It can be shown that after suf? cient iterations of median ? ltering, every signal converges to a root signal [2]. The Component Median Filter, de? ned in (3), also relies on the statistical median concept. In the Simple Median Filter, each point in the signal is converted to a single magnitude. In the Component Median Filter each scalar component is treated independently. A ? lter mask is placed over a point in the signal. For each component of each point under the mask, a single median component is determined. These components are then combined to form a new point, which is then used to represent the point in the signal studied. When working with color images, however, this ? lter regularly outperforms the Simple Median Filter. When noise affects a point in a grayscale image, the result is called â€Å"salt and pepper† noise. In color images, this property of â€Å"salt and pepper† noise is typical of noise models where only one scalar value of a point is affected.

Management Information System In Jet Airlines

Management Information System In Jet Airlines Data analysis plays vital role in determining which resources to use in order to achieve the mission of an organization. The world is developing an increasingly global market and economy. The basic management information system measures inputs and/or outputs, allowing managers to analyse the relationship between them and make decisions based on the outcomes they desire.Day to day example can be a speedometer, a speed-measuring system Types of Management Information Systems The different types of MIS can be classified into the following: Transaction-Processing Systems: With the advent of mainframe computers, Transaction-processing systems were introduced in the 1960s. They are designed for the banks to handle a huge volume of routine, recurring transactions. They record deposits and payments into the accounts, record sales and track inventory.. Operations Information Systems After transaction-processing systems, operations Information Systems came into existence. It gathers information, organises and summarises it in a useful form. It access data from TPS and moulds it into suitable form. One can obtain sales report or inventory etc from this. Decision Support Systems (DSS) DSS is an interactive computer system. It hasthree fundamental components: database management system (DBMS), model-based management system (MBMS) and dialog generation and management system (DGMS) which can be used for decision making. Expert Systems and Artificial Intelligence ESAI use human knowledge encapsulated in a computer to solve various problems that usually requires human expertise. Computer recognizes, formulates and then solves a problem. It also explains the solution and learns from its experience as well. Introduction to Jet Airways Jet Airways is a leading Indian airline with its headquarter in Mumbai, Maharashtra. It is the second largest airline in India and the market leader in the domestic sector. It offers over 400 flights daily to 67 destinations worldwide. Main domestic hubs: Mumbai and Delhi. International hubs: Brussels Airport, Belgium. It is owned by the London-based businessman, Mr. Naresh Goyal. BACKGROUND Jet Airways emerged with its first flight in 1993. It is one of the fastest expanding airlines in the world, and in future will become the most preferred airline making your journey enjoyable. Jet Airways offers flights to 24 international destinations and 43 destinations in India. OVERVIEW Jet Airways was incorporated as an air service operator on 1 April 1992. It commenced Indian commercial airline operations on 5 May 1993. On 4th January 1995, Jet Airways was granted a scheduled airline status.The company is registered on the Bombay Stock Exchange. Although,a major portion (80% of its stock) is controlled by Naresh Goyal. It has over 10,017 employees (March 2007).Jet Airways has fleet of 90 aircraft. CORPORATE VISION Jet Airways will become the most preferred domestic airline in India. Jet Airways will achieve this outstanding position by offering a high quality of service and reliable, comfortable and efficient operations.Jet Airways will uplift the concept of domestic airline travel -to be a world class airline. It will achieve this objective even while ensuring consistent profitability, achieving long-term returns for its investors and providing its employees with an environment for excellence and growth. Information Systems in Airlines Airlines exist to connect people to distant locations very efficiently and safely while making profit for the shareholders. . There has to be a trade-off between the three aspects. Thus, the designing of information system is very essential and its management helps them reach the organizations purpose. Key indicators in management are required to guide the working of the process and making changes in resource allocation. A management information system regularly provides information about the efficient working and function of the organization. The ultimate aim of the airline industry is to make the passengers journey comfortable and convenient. The different procedures in the airport and airplane should be simplified and highest degree of customers satisfaction have to maintained in order to succeed in todays competitive world. The Current Scenario The airline industry is constantly evolving and incorporating the latest innovations and technologies all with a common aim to make the journey of the passengers more and more comfortable and convenient. All the different procedures that the passenger goes through in the airport and airplane have to be simplified and highest quality of satisfaction for customers have to maintained by airlines in order to succeed in todays competitive scenario. Flying is nowadays one of the fastest and easiest way to cover large distances. It saves a lot of travelling time compared to other means of transport. For employees, this is a huge bonus as the business can be carried out at a faster speed as they can reach their destinations in a matter of hours. The 4 basic factors that the airline industry has to carefully tackle are as follows: Efficiency Speed Safety Comfort Every year more and more people are resorting to airlines as a mode of transportation and hence constant innovation and establishing a unique relationship with the passengers is the need of the hour. Hence, the importance of the technology of integrated systems has become clearer and unavoidable in the airlines for the future as well. Improving Air Transport Information Systems It has been seen that many vendor companies are doing constant research and development in the technologies which have a prime aim to improve customer satisfaction and provide better services to the customer. Huge investments are also being made in this area which has a lot of scope of improvement. Example of such service can be self- checking kiosks, in-flight entertainment and connectivity, check-in via mobile phones, airport and baggage management services. Currently what can be seen as the prime objective of the airlines is: Optimizing revenues while maximizing customer relationships. Management Information system in Jet Airlines VENDOR: IBM Jet Airways and IBM have announced that the companies have signed a business transformation for 10 years and information technology (IT) services agreement. Valued at 62 million US dollars, the agreement is a major step towards Jet Airways journey of technology led business transformation, which will help the airline to achieve significant growth by implementing the companys IT with business strategies. Jet Airways aims to use IBMs domain knowledge of the global airline industry and its leadership in technology to meet the groups business transformation objectives. As part of the deal, IBM will provide with the latest technological solutions to transform the airlines various business areas such as airport operations, direct distribution and frequent flier programs. IBM has provided Jet Airways with cutting edge IT Infrastructure and application to support services including employee transition, data centre operations, help desk support and storage operations, internet security services, network management, SAP and various other operating systems. Customer Relationship Management CRM stands for Customer Relationship Management. It is methodology used to learn more about customers needs in order to develop stronger relationships with them. CRM has always been a matter of great concern for airlines aspiring to improve relationships with the customers. Airlines that can effectively target, attract, serve and hold the best customers will definitely experience significant benefits. The better the bonding the airline holds with these customers, the more opportunities will be open for selling additional products and services. However, as the e-business is evolving, the hurdles of establishing customer relationships have become even greater. Airlines must be completely responsible for a customers satisfaction whilst the want it, buy it and use it experience. Advantage of CRM In Sales and Marketing CRM defines marketing processes and satisfy customer requirements using functionality to improve management of resources, segments and lists, campaigns, trade promotions, and marketing analytics. It also enables management of accounts, product configuration, opportunities, quotations, orders, contacts, activities pricing, billing, and contracts. Make smart business decisions with improved customer relations. Speedy access to databases so faster marketing. Improve visibility of your entire marketing process Increase returns on investments. Grow profitable relationships Maintain focus on productive activity Eliminate barriers to productivity Improve sales efficiency Service Transform service into a profitable line of business Increase customer loyalty Reduce costs of customer service and field service CRM in Jet Airways The figure 5 shows a few special offering from Jet Airlines The special offerings from it are as follows: It offers free tickets Special rates for Students Special Fares for corporate deals Jetlite Surprises The other Customer Relationship Management activities also include: Rapid Rewards program for all passengers that make all their reservations online. Incentives include lower rates, express boarding passes, and in-flight bonuses like free snacks drinks. Business Rapid Rewards for Business travelers. Special Benefits and services for Senior Citizens Vendor For Jet Airways CRM: EPSILON The emerging digital marketing company Epsilons email solution will now provide customer and trade communication services to Jet Airways in order to improve their relationship with customers. Jet Airways known for its in-flight services is striving hard to enhance its customer relationship management and loyalty management. Various surveys were conducted and was found that customers prefer email as the channel for communication. Thus, in order to be forward it selected Epsilons email marketing services. Epsilon is a pioneer in email sevices and provides exact view of all the customers. Such an overview allows the airways to design solutions for targeted customers which also increase its brand equity and nurtures great profits with loyalty. Epsilons email platform speeds up the email delivery. Ithas an intense tracking and report forming features as well as optimisation tools that enable Jet Airways to enjoy the benefits of relevancy in communicating with the customers. It also allows Jet Airways to monitor and track the position and status of specific email communication all the way from booking to enquiry transaction. This allows the airline to improve its profile and transaction behaviour data to ultimately achieve one-to-one relationship with its customers. Jet Airways currently publishes a monthly email newsletter to Jet Privilege members, all the travel agency partners and corporate clients. The company is planning to introduce transactional e-mailing through the Epsilon platform, such as registration confirmation, welcome messages and purchase confirmations. Conclusion In general, the airlines have to ensure that they strike a proper balance between the customer services and operating costs. In the aviation industry, the competition is ever increasing as more players enter each year. Effective management of information systems can definitely help in attaining these goals and also assist to incorporate the innovative solutions as well. In order to meet to meet these challenges, lot of companies and firm are working on different software and solutions with a common objective in mind to make travel both easy and convenient It is important to choose the suitable information that will help managers observe their situation clearly. When airlines observed management information systems that included loss in the revenue due to not selling empty seats or rooms, they managed ways to get some value from latecomers at deep discounts. A good information system in practice can ensure that the operation is able to run efficiently with clear focus on customers. By incorporating better and better technology systems, we can reach out to demands of more customers and also strengthen vital features like security, avoiding delays, reducing the cost of travel. The scope of improvement is virtually endless and the companies will have to keep on evolving in order to survive in the future as well.

Causes of Stillbirth

Causes of Stillbirth Abstract: Feto-infant mortality is increasing worldwide. Stillbirth is defined as uterofetal death at 20 weeks of gestation or greater. Stillbirths contribute as a primary factor to the growing magnitude of feto-infant mortality. The reasons for stillbirth are usually not reported. In many cases, the specific cause of fetal death remains unknown. The key risk factors include smoking, increased maternal age, being overweight, fetal-maternal hemorrhage. Even though there has been remarkable development in prenatal and intranatal care, stillbirths have been consistently increasing and remain an important problem in obstetrics and gynecology. Current research studies focus mainly on the epidemiology of stillbirths. I review the known and suspected causes of stillbirth. It also describes the recommended diagnostic tests to evaluate definite cause of stillbirth. In this paper, I also review analysis of stillbirths in the United States (US). The National Center of Health Statistics recorded 26,359 stillbirths in 2001. The number of stillbirths can be greatly reduced if the specific reasons for stillbirth are understood. Introduction: A pregnancy ending in stillbirth can be mentally devastating to a patient and her family. The most widely accepted definition of stillbirth is death of the fetus inside the uterus at 20 weeks of gestation or greater (Cartlidge et al., 1995). Much information is available on protocols for evaluating other types of postmortem examination but little work has been done on the evaluation of the causes of stillbirths (Mirlene et al., 2004). No universally followed protocol is available to guide the evaluation of stillbirths. In part because a wide variety of causes can be involved in stillbirths and it can be difficult to designate a specific cause of death. A stillbirth might result from various diseases, infections, trauma or genetic defects in the mother or fetus (Gardosi et al., 2005). In many cases, a specific reason is not known. Even though stillbirths are a serious problem, few resources have been focused on them and most obstetricians lack a sound method of evaluating of stillbirths (Petersson, 2002). In this document, I will review the accepted causes of still birth and the suggested diagnostic tests for evaluating the reason behind stillborn infants. In the year 2001 in the US, the National Center of Health Statistics recorded 26,359 stillbirths (Ananth et al., 2005). When compared to 27,568 infant deaths were reported in the same year. More than half of the stillbirths are before 28 weeks of gestation and almost 20% are close to the term. If a history of stillbirth exists then there is a 5-fold increase for subsequent stillbirth to occur. Prominent racial discrimination occurs in the rates of stillbirths. Stillbirths are almost three times more prevalent in African Americans when compared to whites (Puza et al., 2006). In 2001, the rate of stillbirths among white mothers was 5.5 per 1000 live births and 12.1 per 1000 among the black mothers. According to an analysis of U.S. vital statistics between 1995 and 1998, the increased risk of black, compared with white, stillbirths is greatest among singleton stillbirths (Puza et al., 2006). Reduction of proportion of fetal deaths at gestation of 20weeks or longer to 4.1 per 1000 live births and also reduction of fetal deaths for all racial and ethnic groups are the objectives of U.S. National Health for 2010. Categorization of Stillbirths: Different attempts were made in order to classify causes of stillbirth. Baird and his colleagues were among the first to classify the causes of perinatal death from the available clinical information. Depending on the British perinatal mortality survey, in 1958 Butler and Bonham designed a classification scheme that included the results of postmortem examinations. The most widely used is the 9 category classification system formulated by Wigglesworth and his coworkers (Wigglesworth, 1980). A new classification scheme which does not include neonatal deaths was proposed by Gardosi and his colleagues known as the ReCoDe Classification which focuses on the relevant conditions at the time of death in the uterus. It includes factors which affect the fetus followed by the factors which affect the mother (Gardosi et al., 2005). When compared with the Wigglesworth classification, a remarkable decrease in the number of unclassified stillbirth was achieved using this classification. One of the most vital aspects is to develop a proper definition of the factors that lead to death of the fetus. The basic definition for the â€Å"cause of death† is injury or disease responsible for a death. Froendefined cause of death in stillbirth as â€Å"an event or condition of sufficient severity, magnitude, and duration for death to be expected in a majority of such cases in a continued pregnancy in the clinical setting where it was observed† (Froen, 2002). When the definition of â€Å"cause of death† is reviewed, it is observed that only a few disorders are directly responsible for fetal death while many others are not. Causes of Stillbirth: Infection: Infections such as viral, protozoal and bacterial are linked with stillbirth. Almost 10-25% of stillbirths result from feto-maternal infections in the developed countries where as bacterial infections are common in developing countries (Goldenberg et al., 2003). Stillbirths that result from infection might be due to various factors which include direct infection, placental damage, and severe maternal illness. Usually the stillbirths in the initial weeks of gestation are linked with infection. Bacterial infections caused by Escherichia coli, group B streptococci, and Ureaplasma urealyticum are a cause of stillbirth in developed countries (Goldenberg et al., 2003). If syphilis epidemic occurs in an area then it might be the cause of a considerable proportion of stillbirths. If women come in contact with a parasite like malaria for the first time then stillbirth might be attributed to it. Toxoplasma gondii, leptospirosis, Listeria monocytogenes, Q fever, and Lyme disease are associated with the occurrence of stillbirth (Goldenberg et al., 2003). The magnitude of stillbirths due to viral infections is not known mainly due to the absence of a well defined systematic evaluation of infections in stillborn infants. The problem lies behind the fact that these viruses are difficult to culture and moreover, a positive viral serological diagnostic test identifying the DNA or RNA of the virus in the fetal tissue or placental tissue does not definitely determine that infection was the reason behind death. In most of the cases, infection is linked with stillbirth in early gestational weeks around twenty weeks. If molecular diagnostic technology (DNA and RNA polymerase chain reaction [PCR]) is utilized, it will help in diagnosis of viral infections without any error. Parvovirus B-19 appears to have the strongest association with stillbirth. According to a Swedish survey, in 8%of stillbirths B-19 PCR positive tissues were observed (Enders et al., 2004). In the United States, less than 1% of all stillbirths are reported to be due to parvovirus infection Parvovirus B19 moves across the placenta spreading the infection to fetal erythropoetic tissue resulting in fetal anemia leading to fetal death (Wapner et al., 2002). Myocardial damage may also occur due to Parvovirus B19. Here the virus directly attacks the fetal cardiac tissue. Parvovirus infection that leads to stillbirth usually occurs before 20 weeks of gestation (Wapner et al., 2002). Enteroviruses which include Coxsackie A and B, echoviruses and other enteroviruses are associated with stillbirth. Coxsackie viruses can cross the placenta and lead to villous necrosis, inflammatory cell infiltration, calcific pancarditis, and hydrops. Echovirus infection begins with severe maternal illness and finally ends with stillbirth. Cytomegalovirus (CMV) belongs to herpesvirus family and it is a congenital viral infection. Initially, the mother is infected and then it is transmitted to the fetus. CMV causes placental damage leading to intrauterine fetal growth restriction, but an association with stillbirth remains controversial (Goldenberg et al., 2003). Viral infections in the mother like rubella, mumps and measles are linked with stillbirth. If the vaccinations are administered on time then the proportion of stillbirths occurring due to infections can be reduced greatly. Genetics: Genetic causes are responsible for a considerable magnitude of stillbirths. 6- 12% of stillbirths attributed to genetic etiologies are due to karyotyping abnormalities. Due to the fact that in some of the cases cells cannot be cultured, karyotyping is not possible. Such factors alter the exact estimate of stillbirths resulting from chromosomal abnormalities. In stillborn fetuses which show apparent structural defects the probability of chromosomal abnormality is much higher when compared to normal stillborn fetuses. The usually focused abnormalities include monosomy X (23%), trisomy 21 (23%), trisomy 18 (21%), and trisomy 13 (8%). There are many instances where the karyotype of the stillborn is normal yet the cause of death is a genetic abnormality. Indeed, 25-35% of stillborn infants undergoing autopsy have intrinsic abnormalities (Wapner et al., 2002) .These include single malformations (40%), multiple malformations (40%), and deformations or dysplasia (20%) (Wapner et al., 2002). Almost 25% ofstillborns due to intrinsic defects show an abnormal karyotype whereas the rest of the 75% may have genetic defects which are not identifiable by the regular cytogenetic tests. This holds good for fetuses with multiple abnormalities. Single gene mutations may be responsible for death of the fetus in early weeks of development. Stillbirths in the midgestational weeks might be due to abnormal placental growth, development, or angiogenesis. Some autosomal recessive disorders including glycogen storage diseases and hemoglobinopathies have been reported as the cause of stillbirth (Wapner et al., 2002). In male fetuses, X-linked disorders may prove to be fatal. Many other genetic defects that are not recognized by the conventional cytogenetic diagnostics may lead to stillbirth. For example, conventional karyotype cannot identify chromosomal microdeletions that are linked with unexplained mental retardation. Confined placental mosaicism has also been associated with fetal growth impairment and stillbirth (Kalousek et al., 1994). Heritable Thrombophilia is another probable etiology of stillbirth.It is thought that placental infarction occurs due to thrombosis in the uteroplacental circulation leading to death. This poses concern over other thrombophilic defects and their effects on stillbirth. It is noteworthy that many heritable thrombophilias are common in normal individuals without a history of thrombosis or pregnancy loss (Rey et al., 2003). Even though many studies relate thrombophilias to fetal loss, most of the women with thrombophilias have healthy pregnancies with no lethal complications. It can be said that in the absence of any previous obstetric problems, thrombophilia will not result in stillbirth. Feto-maternal Hemorrhage: Feto-maternal hemorrhage has been linked to almost 3- 14% of all stillbirths which implies that it is responsible for a considerable number of stillbirths. Obstetric procedures such as external cephalic version and cesarean section lead to fetal maternal hemorrhage. Hemorrhage can also result due to placental abruption and/or abdominal trauma during pregnancy. Fetal maternal hemorrhage must be identified and quantitated using a proper dependable diagnostic test to attribute this reason behind the death of fetus. Hypoxia and anemia are indicators of death due to fetal hemorrhage. So, they should be confirmed by autopsy as in some normal cases too, few fetal cells can be seen in maternal blood. Maternal Features: Delayed child bearing or increased maternal age, prepregnancy obesity and stress are found to have their effects on the occurrence of stillbirth. The underlying mechanisms of action are unknown; however, with both obesity and delayed child-bearing on the rise, their importance as potential causes of stillbirth deserves greater attention (Cnattingius et al., 2002). Women whose only risk factor is being overweight have about a 2-fold increased risk of stillbirth (Nohr et al., 2005). Likewise, compared with women younger than 35 years of age, the stillbirth rate is increased 2- fold for women 35-39 years of age, and 3- to 4-fold for women aged 40 years old or olderwhereas some age-associated risk is due to higher rates of maternal complications, in uncomplicated pregnancies there may be a 50% increased risk associated only with maternal age 35 years or older (Nohr et al., 2005). Stress is a suspected cause of stillbirth which might occur as a result of a major life event (such as loss or poverty) (Huang et al., 2000) or through unexplained health changes related to adverse childhood experiences (Hillis et al., 2004). Different exposures are attributed to stillbirth. One of the most prevalent and preventable cause of stillbirth is cigarette smoking (Hillis et al., 2004). Smoking negatively affects fetal growth and oxygen supply to the tissues as it produces high levels of carboxyhemoglobin and decreases blood supply to the placenta. Smoking is also associated with increased risks of placenta previa and placental abruption and women who stop smoking in the first trimester have stillbirth rates equivalent to women who never smoked which indicates that quitting smoking in early pregnancy may significantly reduce the chances of occurrence of stillbirth (Hillis et al., 2004). A variety of complications result due to continuous exposure of different recreational drugs. Consumption of cocaine during pregnancy is also linked with stillbirth because it causes fetal growth restriction and/or abruption. The use of meth amphetamines leads to premature deliveries and stunted growth but its association with stillbirth remains unknown. In some cases, alcohol consumption during pregnancy has been associated with an increased risk of stillbirth (Mary et al., 2006). According to a study in Scandinavia, for women who consume less than 1 drink per week, the rate of stillbirth is 1.37 per 1000 births while the rate increases to 8.83 per 1000 births in women who consume 5 drinks or more per week. If smoking habits, caffeine intake, prepregnancy body mass index, marital status, occupational status, education, parity, and fetal gender are considered, the risk of stillbirth for women consuming 5 drinks or more per week was 2.96 (95% confidence interval 1.37 to 6.41) (Mary et al., 2006). Some studies show a protective effect on both stillbirth and fetal growth restriction rates if small amounts of alcohol are consumed during pregnancy (Mary et al., 2006). A link between pesticide exposure and stillbirth was observed by Pastore and his colleagues in 1997. Occupational exposures prove to be deleterious compared to residential exposure because the occupational exposures cause congenital abnormalities in addition to risk of stillbirth. A noteworthy fact is that the use of fertility drugs is also associated with stillbirths. This finding is problematic due to the fact that many women make use of fertility treatments to conceive. However, data on stillbirths due to exposures is obtained from retrospective studies which are prone to bias. The link between exposures and stillbirth should therefore be dealt with great attention and care. Maternal Diseases: Diabetes: There is always an increased danger of stillbirths in second and third trimester for mothers who are affected with type I or type II diabetes mellitus (DM) pregestationally. Even with modern obstetric care and diabetes management, stillbirth rates in women with type 2 DM have been reported to be 2.5-fold higher than nondiabetic women (Mary et al., 2006). The rate of stillbirth is the same between women with gestational diabetes (GDM) as well as normal women when the whole population is taken into account. The magnitude of danger involved with fetal death in women with type II DM is identical to women with GDM who in fact entered the pregnancy with undiagnosed type II DM. Therefore, women with GDM who have an undiagnosed type II DM are usually at a greater danger of encountering stillbirth. Examples of women with undiagnosed type II DM include history of GDM in previous pregnancies, high fasting glucose values;random glucose values greater than 200mg/dL or diagnosis of GDM early in pregnancy. The reason behind fetal death in late gestation in diabetic women is not known precisely. In addition to an increased risk of fetal death in diabetic women, there also exists a higher magnitude of danger associated with fetal abnormalities in these women compared to healthy women. Stress, hypertension and obesity complement each other in DM patients. In women with DM, there is a higher risk of stillbirth as it may lead to fetal abnormalities which may be either abnormally increased growth rate or retarded growth. To maintain the physiological range of the plasma glucose level, tremendous amounts of insulin is produced by the fetus resulting in fetal hyperglycemia. This fetal hyperglycemia is acquired from maternal hyperglycemia which finally results in fetal death due to excessive growth. The precise limit of plasma glucose level which poses a threat to the fetal life is not well defined. The most that could be done is to detect and deal with it using needed medications to lower the incidents of stillbirths.Many other maternal diseases have been linked to stillbirth, including thyroid disease, cardiovascular disease, asthma, kidney disease, and systemic lupus erythematosus (Simpson, 2002). These are subclinical diseases which in many cases has not been proven to be direct causes of stillbirth and women had normal pregnancies giving birth to healthy babies. Multiple Gestation and Stillbirth: Nearly 3% of all births and 10% of all stillbirths result from multiple pregnancies. According to national vital statistics, 1.8% of twin, 2.4% of triplet, 3.7% of quadruplet, and 5.6% of quintuplet fetuses suffered intrauterine fetal deaths (Salihu et al., 2003). The stillbirth rate among singleton pregnancies is approximately 0.5%. The reason behind fetal death in multiple pregnancies is difficult to be resolved when compared to singleton pregnancies. The broad causes of fetal death in multiple pregnancies include fetal growth retardation, preclamsia, abruption and cord accidents. It is vital to determine the chorionicity of multiple gestations as the rate of stillbirth is higher in monochorionic multiple gestations (Salihu et al., 2003) (Lynch et al., 2007). Assisted Reproductive Technology (ART) is an essential aspect in the occurrence of multiple pregnancies and stillbirth (Helmerhorst et al., 2004). Complications in Fetus: Fetal Growth Restriction: Some stillbirths result from fetuses which are smaller for a particular gestational age (SGA) compared to normal fetuses. Birth weight and risk of stillbirth are inversely proportional. If one increases, the other decreases. The main fact behind stillbirths in this condition is retardation of fetal growth and not the small size of fetus. An obstacle that occurs in determining the precise time of death of fetus due to SGA is the fact that the death might have occurred a long time before but the gestational age at the time of delivery is considered to be the time of death. This gives a false implication of the magnitude of stillbirths resulting from SGA. This problem can be solved by analysis of early and mid pregnancy placental hormones which are very specific for gestational periods (Smith et al., 2004). An evaluation of the amounts of these hormones relates directly to the time of death. Umbilical Cord Accidents: An increased number of stillbirths are due to â€Å"accidents† of umbilical cord like cord occlusion or blockage due to true knots, nuchal cords and compression of the cord. In almost 30% of normal healthy infant deliveries, nuchal cord and true knots in umbilical cords are observed. According to a study in Sweden, 9% of stillbirths were due to cord accidents (Petersson, 2002). Determination of cord accidents leading to fetal death by autopsy is smaller in proportion (up to 2.5%) (Horn et al., 2004). This difference indicates that in the absence of a proper cause, many times fetal death is attributed to cord entanglement. Due to the increased load of complications with live infants, little concern is expressed towards dead fetuses. In order to precisely relate a fetal death to cord accident, a clear indication of either hypoxic tissue injury or cord occlusion must be observed in autopsy. As nuchal cords are observed in normal deliveries also, the exact proportion of stillbirths due to cord accidents is biased. Obstetric Complications: Some of the obstetric complications are preclampsia, preterm premature rupture of membranes, preterm labor, cervical insufficiency, abruption, placenta previa, and vasa previa. These may either be direct or primary causes or may be indirect or secondary causes of stillbirth. Almost 10-19% of stillbirths occur due to abruption. Since cervical insufficiency or preterm labor lead to neonatal death, their role in causing stillbirth is not well defined. Evaluation of Stillbirth Stillbirth in itself may be emotionally devastating to many patients and their families. There the likelihood of carrying out genetic testing or autopsy on the fetus may not be readily agreeable from the family and culture. Lastly the procedures for evaluation must be cost effective and within reach. The two important facts that should be kept in mind while deciding which tests would prove as the most useful ones are primarily the consideration of cost of that test. It should not be beyond limits. Secondarily, if this test would be helpful in prevention of recurrent or sporadic stillbirths. In recurrent stillbirths, medical interference may prove helpful by preventing them in future. Analyzing the etiology of sporadic stillbirths might lead to reassurance and avoid irrelevant diagnostic tests in future pregnancies. The single most useful diagnostic test is a fetal autopsy (Peterson et al., 1999). Not only does the visible genetic and structural abnormalities but also an autopsy would be of great help in relating specific etiologies to stillbirth. The frequency of fetal autopsy is very less due to the fact that it is costly, not many trained pathologists are available and also it may be of great discomfort to the family and clinicians to deal with such a case. If autopsy is refused, partial autopsy or postmortem magnetic resonance imaging (MRI) scans may provide the necessary data. Embryonic membranes, placenta and umbilical cord must be physically and histologically examined while evaluating stillbirth etiology. This would give a precise cause of fetal death and might also provide clues for death due to secondary causes like infections, thrombophilia, and anemia. In most cases, families do not object on placental evaluation. In the cases where autopsy is not performed karyotyping the fetus would prove helpful. Cells and tissues from placenta (especially chorionic plate), fascia lata, skin from the nape of the neck, and tendons can be isolated and cultured and used for diagnostic tests like karyotyping. Comparative genomic hybridization shows tremendous promise for the identification of chromosomal abnormalities in stillbirths wherein fetal cells cannot be successfully cultured (Silver et al., 2006). An autopsy followed by a careful histological examination might help in relating stillbirths that result due to infections from the bacteria or virus. Parvovirus serology may be useful because this virus has been implicated in a meaningful proportion of cases (Erik et al., 2002). Diagnostic tests are performed for the detection of syphilis also since it contributes to the list of accepted causes of stillbirth. For various viral and protozoal agents like toxoplasmosis, rubella, cytomegalovirus (CMV) and herpes simplex virus (HSV) {TORCH}, serological screening is carried out. For bacterial and viral infections in the fetus, nucleic acid based tests are more helpful when compared to tissue cultures. Feto-maternal hemorrhage can be detected using Kleihauer – Betke test (KBT). Most laboratories use manual KBT which is prone to error. It has been found that flow cytometry is a better tool in detecting fetal erythrocytes in maternal blood. In order to eliminate red cell alloimmunization as an etiology of stillbirth, an indirect Coomb’s test is performed. Autopsy and examination of placenta are helpful in this situation. During the initial prenatal visits, if the antibody screen comes out to be negative then there is a need for recurrent testing. Diagnostic tests for conditions like diabetes and heritable thrombophilias must be carried out on a regular basis to prevent any complications which may lead to stillbirth. The treatment of such conditions at the appropriate time may prevent similar complications in subsequent pregnancies. Heritable thrombophilia might be of concern in the cases where there is recurrent fetal loss or there is a history of thrombosis or with complications involving placental insufficiency like placental infarction and intrauterine growth restriction. Administration of illicit drugs through various modes may be a cause of stillbirth in many cases. Toxicological examination may reveal the results for women who are subjected to such exposures. A simple urinary examination may prove helpful. The advanced and cost effective technology like ELISA (Enzyme Linked Immuno Sorbent Assay) can be used to detect a variety of metabolites like steroids in various tissues like blood, hair, and homogenized umbilical cord. Conclusion: Many medical and nonmedical agents govern the best approach to evaluate a stillbirth. The obstacles faced by obstetricians in solving these issues include the fact that in most of the cases the reason behind fetal death is unknown. Also the magnitude of stillbirths resulting from a single cause is not known precisely. Here there arises a need for population based studies to attribute stillbirths to their specific etiologies. There is a clear cut need of experts in the field of perinatal pathology and the required funding should be provided at the national level to promote it. Moreover, the clinician should be aware of the history of pregnant women in better evaluation. In cases where the local clinicians cannot reach a conclusion, the tissue samples must be sent to senior pathologists who have a thorough command on the subject and can help in reaching decisive conclusions. A universally accepted protocol is required for a systematic evaluation of stillbirths. Due to its absence a difference of opinion occurs among the obstetricians and gynecologists. The institutions like Stillbirth Collaborative Research Network should formulate guidelines for the proper judgement of stillbirth etiologies. The responsibility lies in the hands of the clinicians to do the best they can to reach a definite conclusion from the available data. It is noteworthy that the proportion of stillbirths that are â€Å"explained† is much higher in centers using systematic evaluations for recognized causes and potential causes of stillbirth (Petersson, 2002) (Horn et al., 2004). In conclusion, autopsy, placental evaluation, karyotype, Kleihauer-Betke, antibody screen, and serologic test for syphilis are useful in evaluating the etiologies of stillbirth. Depending on the case, other relative tests should be performed. The approach towards the testing of potential causes of stillbirth is not clear if it should be very specific and sequential or should it be comprehensive which means that it is targeted towards a broad spectrum of causes. Each of these has its own advantage. Sequential testing avoids false positive results and is directed to a specific cause and more over, it is cost effective. Comprehensive testing may prove helpful in cases where more than one factor is responsible for stillbirth. The problem with autopsy, placental evaluation, karyotype, screen for fetal-maternal hemorrhage, and toxicology screen is that they are dependant on time, that is, these tests should be performed immediately after the delivery. Autopsy cannot be delayed because death of the fetus already occurred and this would lead to physiological changes in the whole body and decay begins. The necessary evidence for stillbirth is easily available from fresh samples of placenta and also for toxicology screen. As the time since death increases, the physiology of fetus also changes leading to false positive or false negative results. If the time of fetal examination is delayed, fetal hemorrhage may be mistaken for postmortem lividity. Therefore a serious call for action is expected from institutions like Stillbirth Collaborative Research Network (SCRN) which would help in creating the most applicable diagnostic setting for evaluation of stillbirth (Silver et al., 2006). SCRN was developed by the National Institute of Child Health and Human Development to target the range of etiologies of stillbirth in the U.S. The aim of SCRN is to focus on the following objectives. The use of standardized surveillance in a geographic catchment area will show that the stillbirth rates are greater than those reported in the vital statistics catchment. The use of a prospectively implemented, standardized, postmortem, and placental examination protocols will improve diagnosis of fetal or placental conditions that cause or contribute to stillbirth. Maternal biologic and environmental risk factors in combination with genetic predisposition increase the risk for stillbirth. This is a population based study which is carried out in different counties of different states in the U.S. This study would take into account all the stillbirths and live births occurring in rural as well as urban areas in different racial groups. Even though occurrence of stillbirths cannot be stopped completely, yet attempts of such sort can be made atleast to prevent them to a maximum extent. Glossary Abruptio placenta totalis A placental abruption is a serious condition in which the placenta partially or completely separates from the uterus before the baby is born. Achondrogenesis Dwarfism characterized by various bone aplasias and hypoplasias of the extremities and a short trunk with delayed ossification of the lower spine. Alloimmunization Development of antibodies in response to alloantigens; antigens derived from a genetically dissimilar animal of the same species. Angiogenesis The formation of new blood vessels. Anomaly abnormality Autosome a chromosome other than the X and Y sex-determining chromosomes. Camptomelia bending of the limbs that produce a permanent curving or bowing. Cholestasis a condition caused by rapidly developing or long-term interruption in the excretion of bile (a digestive fluid that helps the body process fat). Chondrodysplasia Congenital dwarfism similar to but milder than achondroplasia, not familial and not evident until mid-childhood, in which the skull and facial features remain normal. Chorioamnionitis Inflammation of the fetal membranes. Dystocia Difficult delivery or parturition. Erythema infectiosum mild infectious disease occurring mainly in early childhood, marked by a rosy-red maculopapular rash on the cheeks, often spreading to the tr Causes of Stillbirth Causes of Stillbirth Abstract: Feto-infant mortality is increasing worldwide. Stillbirth is defined as uterofetal death at 20 weeks of gestation or greater. Stillbirths contribute as a primary factor to the growing magnitude of feto-infant mortality. The reasons for stillbirth are usually not reported. In many cases, the specific cause of fetal death remains unknown. The key risk factors include smoking, increased maternal age, being overweight, fetal-maternal hemorrhage. Even though there has been remarkable development in prenatal and intranatal care, stillbirths have been consistently increasing and remain an important problem in obstetrics and gynecology. Current research studies focus mainly on the epidemiology of stillbirths. I review the known and suspected causes of stillbirth. It also describes the recommended diagnostic tests to evaluate definite cause of stillbirth. In this paper, I also review analysis of stillbirths in the United States (US). The National Center of Health Statistics recorded 26,359 stillbirths in 2001. The number of stillbirths can be greatly reduced if the specific reasons for stillbirth are understood. Introduction: A pregnancy ending in stillbirth can be mentally devastating to a patient and her family. The most widely accepted definition of stillbirth is death of the fetus inside the uterus at 20 weeks of gestation or greater (Cartlidge et al., 1995). Much information is available on protocols for evaluating other types of postmortem examination but little work has been done on the evaluation of the causes of stillbirths (Mirlene et al., 2004). No universally followed protocol is available to guide the evaluation of stillbirths. In part because a wide variety of causes can be involved in stillbirths and it can be difficult to designate a specific cause of death. A stillbirth might result from various diseases, infections, trauma or genetic defects in the mother or fetus (Gardosi et al., 2005). In many cases, a specific reason is not known. Even though stillbirths are a serious problem, few resources have been focused on them and most obstetricians lack a sound method of evaluating of stillbirths (Petersson, 2002). In this document, I will review the accepted causes of still birth and the suggested diagnostic tests for evaluating the reason behind stillborn infants. In the year 2001 in the US, the National Center of Health Statistics recorded 26,359 stillbirths (Ananth et al., 2005). When compared to 27,568 infant deaths were reported in the same year. More than half of the stillbirths are before 28 weeks of gestation and almost 20% are close to the term. If a history of stillbirth exists then there is a 5-fold increase for subsequent stillbirth to occur. Prominent racial discrimination occurs in the rates of stillbirths. Stillbirths are almost three times more prevalent in African Americans when compared to whites (Puza et al., 2006). In 2001, the rate of stillbirths among white mothers was 5.5 per 1000 live births and 12.1 per 1000 among the black mothers. According to an analysis of U.S. vital statistics between 1995 and 1998, the increased risk of black, compared with white, stillbirths is greatest among singleton stillbirths (Puza et al., 2006). Reduction of proportion of fetal deaths at gestation of 20weeks or longer to 4.1 per 1000 live births and also reduction of fetal deaths for all racial and ethnic groups are the objectives of U.S. National Health for 2010. Categorization of Stillbirths: Different attempts were made in order to classify causes of stillbirth. Baird and his colleagues were among the first to classify the causes of perinatal death from the available clinical information. Depending on the British perinatal mortality survey, in 1958 Butler and Bonham designed a classification scheme that included the results of postmortem examinations. The most widely used is the 9 category classification system formulated by Wigglesworth and his coworkers (Wigglesworth, 1980). A new classification scheme which does not include neonatal deaths was proposed by Gardosi and his colleagues known as the ReCoDe Classification which focuses on the relevant conditions at the time of death in the uterus. It includes factors which affect the fetus followed by the factors which affect the mother (Gardosi et al., 2005). When compared with the Wigglesworth classification, a remarkable decrease in the number of unclassified stillbirth was achieved using this classification. One of the most vital aspects is to develop a proper definition of the factors that lead to death of the fetus. The basic definition for the â€Å"cause of death† is injury or disease responsible for a death. Froendefined cause of death in stillbirth as â€Å"an event or condition of sufficient severity, magnitude, and duration for death to be expected in a majority of such cases in a continued pregnancy in the clinical setting where it was observed† (Froen, 2002). When the definition of â€Å"cause of death† is reviewed, it is observed that only a few disorders are directly responsible for fetal death while many others are not. Causes of Stillbirth: Infection: Infections such as viral, protozoal and bacterial are linked with stillbirth. Almost 10-25% of stillbirths result from feto-maternal infections in the developed countries where as bacterial infections are common in developing countries (Goldenberg et al., 2003). Stillbirths that result from infection might be due to various factors which include direct infection, placental damage, and severe maternal illness. Usually the stillbirths in the initial weeks of gestation are linked with infection. Bacterial infections caused by Escherichia coli, group B streptococci, and Ureaplasma urealyticum are a cause of stillbirth in developed countries (Goldenberg et al., 2003). If syphilis epidemic occurs in an area then it might be the cause of a considerable proportion of stillbirths. If women come in contact with a parasite like malaria for the first time then stillbirth might be attributed to it. Toxoplasma gondii, leptospirosis, Listeria monocytogenes, Q fever, and Lyme disease are associated with the occurrence of stillbirth (Goldenberg et al., 2003). The magnitude of stillbirths due to viral infections is not known mainly due to the absence of a well defined systematic evaluation of infections in stillborn infants. The problem lies behind the fact that these viruses are difficult to culture and moreover, a positive viral serological diagnostic test identifying the DNA or RNA of the virus in the fetal tissue or placental tissue does not definitely determine that infection was the reason behind death. In most of the cases, infection is linked with stillbirth in early gestational weeks around twenty weeks. If molecular diagnostic technology (DNA and RNA polymerase chain reaction [PCR]) is utilized, it will help in diagnosis of viral infections without any error. Parvovirus B-19 appears to have the strongest association with stillbirth. According to a Swedish survey, in 8%of stillbirths B-19 PCR positive tissues were observed (Enders et al., 2004). In the United States, less than 1% of all stillbirths are reported to be due to parvovirus infection Parvovirus B19 moves across the placenta spreading the infection to fetal erythropoetic tissue resulting in fetal anemia leading to fetal death (Wapner et al., 2002). Myocardial damage may also occur due to Parvovirus B19. Here the virus directly attacks the fetal cardiac tissue. Parvovirus infection that leads to stillbirth usually occurs before 20 weeks of gestation (Wapner et al., 2002). Enteroviruses which include Coxsackie A and B, echoviruses and other enteroviruses are associated with stillbirth. Coxsackie viruses can cross the placenta and lead to villous necrosis, inflammatory cell infiltration, calcific pancarditis, and hydrops. Echovirus infection begins with severe maternal illness and finally ends with stillbirth. Cytomegalovirus (CMV) belongs to herpesvirus family and it is a congenital viral infection. Initially, the mother is infected and then it is transmitted to the fetus. CMV causes placental damage leading to intrauterine fetal growth restriction, but an association with stillbirth remains controversial (Goldenberg et al., 2003). Viral infections in the mother like rubella, mumps and measles are linked with stillbirth. If the vaccinations are administered on time then the proportion of stillbirths occurring due to infections can be reduced greatly. Genetics: Genetic causes are responsible for a considerable magnitude of stillbirths. 6- 12% of stillbirths attributed to genetic etiologies are due to karyotyping abnormalities. Due to the fact that in some of the cases cells cannot be cultured, karyotyping is not possible. Such factors alter the exact estimate of stillbirths resulting from chromosomal abnormalities. In stillborn fetuses which show apparent structural defects the probability of chromosomal abnormality is much higher when compared to normal stillborn fetuses. The usually focused abnormalities include monosomy X (23%), trisomy 21 (23%), trisomy 18 (21%), and trisomy 13 (8%). There are many instances where the karyotype of the stillborn is normal yet the cause of death is a genetic abnormality. Indeed, 25-35% of stillborn infants undergoing autopsy have intrinsic abnormalities (Wapner et al., 2002) .These include single malformations (40%), multiple malformations (40%), and deformations or dysplasia (20%) (Wapner et al., 2002). Almost 25% ofstillborns due to intrinsic defects show an abnormal karyotype whereas the rest of the 75% may have genetic defects which are not identifiable by the regular cytogenetic tests. This holds good for fetuses with multiple abnormalities. Single gene mutations may be responsible for death of the fetus in early weeks of development. Stillbirths in the midgestational weeks might be due to abnormal placental growth, development, or angiogenesis. Some autosomal recessive disorders including glycogen storage diseases and hemoglobinopathies have been reported as the cause of stillbirth (Wapner et al., 2002). In male fetuses, X-linked disorders may prove to be fatal. Many other genetic defects that are not recognized by the conventional cytogenetic diagnostics may lead to stillbirth. For example, conventional karyotype cannot identify chromosomal microdeletions that are linked with unexplained mental retardation. Confined placental mosaicism has also been associated with fetal growth impairment and stillbirth (Kalousek et al., 1994). Heritable Thrombophilia is another probable etiology of stillbirth.It is thought that placental infarction occurs due to thrombosis in the uteroplacental circulation leading to death. This poses concern over other thrombophilic defects and their effects on stillbirth. It is noteworthy that many heritable thrombophilias are common in normal individuals without a history of thrombosis or pregnancy loss (Rey et al., 2003). Even though many studies relate thrombophilias to fetal loss, most of the women with thrombophilias have healthy pregnancies with no lethal complications. It can be said that in the absence of any previous obstetric problems, thrombophilia will not result in stillbirth. Feto-maternal Hemorrhage: Feto-maternal hemorrhage has been linked to almost 3- 14% of all stillbirths which implies that it is responsible for a considerable number of stillbirths. Obstetric procedures such as external cephalic version and cesarean section lead to fetal maternal hemorrhage. Hemorrhage can also result due to placental abruption and/or abdominal trauma during pregnancy. Fetal maternal hemorrhage must be identified and quantitated using a proper dependable diagnostic test to attribute this reason behind the death of fetus. Hypoxia and anemia are indicators of death due to fetal hemorrhage. So, they should be confirmed by autopsy as in some normal cases too, few fetal cells can be seen in maternal blood. Maternal Features: Delayed child bearing or increased maternal age, prepregnancy obesity and stress are found to have their effects on the occurrence of stillbirth. The underlying mechanisms of action are unknown; however, with both obesity and delayed child-bearing on the rise, their importance as potential causes of stillbirth deserves greater attention (Cnattingius et al., 2002). Women whose only risk factor is being overweight have about a 2-fold increased risk of stillbirth (Nohr et al., 2005). Likewise, compared with women younger than 35 years of age, the stillbirth rate is increased 2- fold for women 35-39 years of age, and 3- to 4-fold for women aged 40 years old or olderwhereas some age-associated risk is due to higher rates of maternal complications, in uncomplicated pregnancies there may be a 50% increased risk associated only with maternal age 35 years or older (Nohr et al., 2005). Stress is a suspected cause of stillbirth which might occur as a result of a major life event (such as loss or poverty) (Huang et al., 2000) or through unexplained health changes related to adverse childhood experiences (Hillis et al., 2004). Different exposures are attributed to stillbirth. One of the most prevalent and preventable cause of stillbirth is cigarette smoking (Hillis et al., 2004). Smoking negatively affects fetal growth and oxygen supply to the tissues as it produces high levels of carboxyhemoglobin and decreases blood supply to the placenta. Smoking is also associated with increased risks of placenta previa and placental abruption and women who stop smoking in the first trimester have stillbirth rates equivalent to women who never smoked which indicates that quitting smoking in early pregnancy may significantly reduce the chances of occurrence of stillbirth (Hillis et al., 2004). A variety of complications result due to continuous exposure of different recreational drugs. Consumption of cocaine during pregnancy is also linked with stillbirth because it causes fetal growth restriction and/or abruption. The use of meth amphetamines leads to premature deliveries and stunted growth but its association with stillbirth remains unknown. In some cases, alcohol consumption during pregnancy has been associated with an increased risk of stillbirth (Mary et al., 2006). According to a study in Scandinavia, for women who consume less than 1 drink per week, the rate of stillbirth is 1.37 per 1000 births while the rate increases to 8.83 per 1000 births in women who consume 5 drinks or more per week. If smoking habits, caffeine intake, prepregnancy body mass index, marital status, occupational status, education, parity, and fetal gender are considered, the risk of stillbirth for women consuming 5 drinks or more per week was 2.96 (95% confidence interval 1.37 to 6.41) (Mary et al., 2006). Some studies show a protective effect on both stillbirth and fetal growth restriction rates if small amounts of alcohol are consumed during pregnancy (Mary et al., 2006). A link between pesticide exposure and stillbirth was observed by Pastore and his colleagues in 1997. Occupational exposures prove to be deleterious compared to residential exposure because the occupational exposures cause congenital abnormalities in addition to risk of stillbirth. A noteworthy fact is that the use of fertility drugs is also associated with stillbirths. This finding is problematic due to the fact that many women make use of fertility treatments to conceive. However, data on stillbirths due to exposures is obtained from retrospective studies which are prone to bias. The link between exposures and stillbirth should therefore be dealt with great attention and care. Maternal Diseases: Diabetes: There is always an increased danger of stillbirths in second and third trimester for mothers who are affected with type I or type II diabetes mellitus (DM) pregestationally. Even with modern obstetric care and diabetes management, stillbirth rates in women with type 2 DM have been reported to be 2.5-fold higher than nondiabetic women (Mary et al., 2006). The rate of stillbirth is the same between women with gestational diabetes (GDM) as well as normal women when the whole population is taken into account. The magnitude of danger involved with fetal death in women with type II DM is identical to women with GDM who in fact entered the pregnancy with undiagnosed type II DM. Therefore, women with GDM who have an undiagnosed type II DM are usually at a greater danger of encountering stillbirth. Examples of women with undiagnosed type II DM include history of GDM in previous pregnancies, high fasting glucose values;random glucose values greater than 200mg/dL or diagnosis of GDM early in pregnancy. The reason behind fetal death in late gestation in diabetic women is not known precisely. In addition to an increased risk of fetal death in diabetic women, there also exists a higher magnitude of danger associated with fetal abnormalities in these women compared to healthy women. Stress, hypertension and obesity complement each other in DM patients. In women with DM, there is a higher risk of stillbirth as it may lead to fetal abnormalities which may be either abnormally increased growth rate or retarded growth. To maintain the physiological range of the plasma glucose level, tremendous amounts of insulin is produced by the fetus resulting in fetal hyperglycemia. This fetal hyperglycemia is acquired from maternal hyperglycemia which finally results in fetal death due to excessive growth. The precise limit of plasma glucose level which poses a threat to the fetal life is not well defined. The most that could be done is to detect and deal with it using needed medications to lower the incidents of stillbirths.Many other maternal diseases have been linked to stillbirth, including thyroid disease, cardiovascular disease, asthma, kidney disease, and systemic lupus erythematosus (Simpson, 2002). These are subclinical diseases which in many cases has not been proven to be direct causes of stillbirth and women had normal pregnancies giving birth to healthy babies. Multiple Gestation and Stillbirth: Nearly 3% of all births and 10% of all stillbirths result from multiple pregnancies. According to national vital statistics, 1.8% of twin, 2.4% of triplet, 3.7% of quadruplet, and 5.6% of quintuplet fetuses suffered intrauterine fetal deaths (Salihu et al., 2003). The stillbirth rate among singleton pregnancies is approximately 0.5%. The reason behind fetal death in multiple pregnancies is difficult to be resolved when compared to singleton pregnancies. The broad causes of fetal death in multiple pregnancies include fetal growth retardation, preclamsia, abruption and cord accidents. It is vital to determine the chorionicity of multiple gestations as the rate of stillbirth is higher in monochorionic multiple gestations (Salihu et al., 2003) (Lynch et al., 2007). Assisted Reproductive Technology (ART) is an essential aspect in the occurrence of multiple pregnancies and stillbirth (Helmerhorst et al., 2004). Complications in Fetus: Fetal Growth Restriction: Some stillbirths result from fetuses which are smaller for a particular gestational age (SGA) compared to normal fetuses. Birth weight and risk of stillbirth are inversely proportional. If one increases, the other decreases. The main fact behind stillbirths in this condition is retardation of fetal growth and not the small size of fetus. An obstacle that occurs in determining the precise time of death of fetus due to SGA is the fact that the death might have occurred a long time before but the gestational age at the time of delivery is considered to be the time of death. This gives a false implication of the magnitude of stillbirths resulting from SGA. This problem can be solved by analysis of early and mid pregnancy placental hormones which are very specific for gestational periods (Smith et al., 2004). An evaluation of the amounts of these hormones relates directly to the time of death. Umbilical Cord Accidents: An increased number of stillbirths are due to â€Å"accidents† of umbilical cord like cord occlusion or blockage due to true knots, nuchal cords and compression of the cord. In almost 30% of normal healthy infant deliveries, nuchal cord and true knots in umbilical cords are observed. According to a study in Sweden, 9% of stillbirths were due to cord accidents (Petersson, 2002). Determination of cord accidents leading to fetal death by autopsy is smaller in proportion (up to 2.5%) (Horn et al., 2004). This difference indicates that in the absence of a proper cause, many times fetal death is attributed to cord entanglement. Due to the increased load of complications with live infants, little concern is expressed towards dead fetuses. In order to precisely relate a fetal death to cord accident, a clear indication of either hypoxic tissue injury or cord occlusion must be observed in autopsy. As nuchal cords are observed in normal deliveries also, the exact proportion of stillbirths due to cord accidents is biased. Obstetric Complications: Some of the obstetric complications are preclampsia, preterm premature rupture of membranes, preterm labor, cervical insufficiency, abruption, placenta previa, and vasa previa. These may either be direct or primary causes or may be indirect or secondary causes of stillbirth. Almost 10-19% of stillbirths occur due to abruption. Since cervical insufficiency or preterm labor lead to neonatal death, their role in causing stillbirth is not well defined. Evaluation of Stillbirth Stillbirth in itself may be emotionally devastating to many patients and their families. There the likelihood of carrying out genetic testing or autopsy on the fetus may not be readily agreeable from the family and culture. Lastly the procedures for evaluation must be cost effective and within reach. The two important facts that should be kept in mind while deciding which tests would prove as the most useful ones are primarily the consideration of cost of that test. It should not be beyond limits. Secondarily, if this test would be helpful in prevention of recurrent or sporadic stillbirths. In recurrent stillbirths, medical interference may prove helpful by preventing them in future. Analyzing the etiology of sporadic stillbirths might lead to reassurance and avoid irrelevant diagnostic tests in future pregnancies. The single most useful diagnostic test is a fetal autopsy (Peterson et al., 1999). Not only does the visible genetic and structural abnormalities but also an autopsy would be of great help in relating specific etiologies to stillbirth. The frequency of fetal autopsy is very less due to the fact that it is costly, not many trained pathologists are available and also it may be of great discomfort to the family and clinicians to deal with such a case. If autopsy is refused, partial autopsy or postmortem magnetic resonance imaging (MRI) scans may provide the necessary data. Embryonic membranes, placenta and umbilical cord must be physically and histologically examined while evaluating stillbirth etiology. This would give a precise cause of fetal death and might also provide clues for death due to secondary causes like infections, thrombophilia, and anemia. In most cases, families do not object on placental evaluation. In the cases where autopsy is not performed karyotyping the fetus would prove helpful. Cells and tissues from placenta (especially chorionic plate), fascia lata, skin from the nape of the neck, and tendons can be isolated and cultured and used for diagnostic tests like karyotyping. Comparative genomic hybridization shows tremendous promise for the identification of chromosomal abnormalities in stillbirths wherein fetal cells cannot be successfully cultured (Silver et al., 2006). An autopsy followed by a careful histological examination might help in relating stillbirths that result due to infections from the bacteria or virus. Parvovirus serology may be useful because this virus has been implicated in a meaningful proportion of cases (Erik et al., 2002). Diagnostic tests are performed for the detection of syphilis also since it contributes to the list of accepted causes of stillbirth. For various viral and protozoal agents like toxoplasmosis, rubella, cytomegalovirus (CMV) and herpes simplex virus (HSV) {TORCH}, serological screening is carried out. For bacterial and viral infections in the fetus, nucleic acid based tests are more helpful when compared to tissue cultures. Feto-maternal hemorrhage can be detected using Kleihauer – Betke test (KBT). Most laboratories use manual KBT which is prone to error. It has been found that flow cytometry is a better tool in detecting fetal erythrocytes in maternal blood. In order to eliminate red cell alloimmunization as an etiology of stillbirth, an indirect Coomb’s test is performed. Autopsy and examination of placenta are helpful in this situation. During the initial prenatal visits, if the antibody screen comes out to be negative then there is a need for recurrent testing. Diagnostic tests for conditions like diabetes and heritable thrombophilias must be carried out on a regular basis to prevent any complications which may lead to stillbirth. The treatment of such conditions at the appropriate time may prevent similar complications in subsequent pregnancies. Heritable thrombophilia might be of concern in the cases where there is recurrent fetal loss or there is a history of thrombosis or with complications involving placental insufficiency like placental infarction and intrauterine growth restriction. Administration of illicit drugs through various modes may be a cause of stillbirth in many cases. Toxicological examination may reveal the results for women who are subjected to such exposures. A simple urinary examination may prove helpful. The advanced and cost effective technology like ELISA (Enzyme Linked Immuno Sorbent Assay) can be used to detect a variety of metabolites like steroids in various tissues like blood, hair, and homogenized umbilical cord. Conclusion: Many medical and nonmedical agents govern the best approach to evaluate a stillbirth. The obstacles faced by obstetricians in solving these issues include the fact that in most of the cases the reason behind fetal death is unknown. Also the magnitude of stillbirths resulting from a single cause is not known precisely. Here there arises a need for population based studies to attribute stillbirths to their specific etiologies. There is a clear cut need of experts in the field of perinatal pathology and the required funding should be provided at the national level to promote it. Moreover, the clinician should be aware of the history of pregnant women in better evaluation. In cases where the local clinicians cannot reach a conclusion, the tissue samples must be sent to senior pathologists who have a thorough command on the subject and can help in reaching decisive conclusions. A universally accepted protocol is required for a systematic evaluation of stillbirths. Due to its absence a difference of opinion occurs among the obstetricians and gynecologists. The institutions like Stillbirth Collaborative Research Network should formulate guidelines for the proper judgement of stillbirth etiologies. The responsibility lies in the hands of the clinicians to do the best they can to reach a definite conclusion from the available data. It is noteworthy that the proportion of stillbirths that are â€Å"explained† is much higher in centers using systematic evaluations for recognized causes and potential causes of stillbirth (Petersson, 2002) (Horn et al., 2004). In conclusion, autopsy, placental evaluation, karyotype, Kleihauer-Betke, antibody screen, and serologic test for syphilis are useful in evaluating the etiologies of stillbirth. Depending on the case, other relative tests should be performed. The approach towards the testing of potential causes of stillbirth is not clear if it should be very specific and sequential or should it be comprehensive which means that it is targeted towards a broad spectrum of causes. Each of these has its own advantage. Sequential testing avoids false positive results and is directed to a specific cause and more over, it is cost effective. Comprehensive testing may prove helpful in cases where more than one factor is responsible for stillbirth. The problem with autopsy, placental evaluation, karyotype, screen for fetal-maternal hemorrhage, and toxicology screen is that they are dependant on time, that is, these tests should be performed immediately after the delivery. Autopsy cannot be delayed because death of the fetus already occurred and this would lead to physiological changes in the whole body and decay begins. The necessary evidence for stillbirth is easily available from fresh samples of placenta and also for toxicology screen. As the time since death increases, the physiology of fetus also changes leading to false positive or false negative results. If the time of fetal examination is delayed, fetal hemorrhage may be mistaken for postmortem lividity. Therefore a serious call for action is expected from institutions like Stillbirth Collaborative Research Network (SCRN) which would help in creating the most applicable diagnostic setting for evaluation of stillbirth (Silver et al., 2006). SCRN was developed by the National Institute of Child Health and Human Development to target the range of etiologies of stillbirth in the U.S. The aim of SCRN is to focus on the following objectives. The use of standardized surveillance in a geographic catchment area will show that the stillbirth rates are greater than those reported in the vital statistics catchment. The use of a prospectively implemented, standardized, postmortem, and placental examination protocols will improve diagnosis of fetal or placental conditions that cause or contribute to stillbirth. Maternal biologic and environmental risk factors in combination with genetic predisposition increase the risk for stillbirth. This is a population based study which is carried out in different counties of different states in the U.S. This study would take into account all the stillbirths and live births occurring in rural as well as urban areas in different racial groups. Even though occurrence of stillbirths cannot be stopped completely, yet attempts of such sort can be made atleast to prevent them to a maximum extent. Glossary Abruptio placenta totalis A placental abruption is a serious condition in which the placenta partially or completely separates from the uterus before the baby is born. Achondrogenesis Dwarfism characterized by various bone aplasias and hypoplasias of the extremities and a short trunk with delayed ossification of the lower spine. Alloimmunization Development of antibodies in response to alloantigens; antigens derived from a genetically dissimilar animal of the same species. Angiogenesis The formation of new blood vessels. Anomaly abnormality Autosome a chromosome other than the X and Y sex-determining chromosomes. Camptomelia bending of the limbs that produce a permanent curving or bowing. Cholestasis a condition caused by rapidly developing or long-term interruption in the excretion of bile (a digestive fluid that helps the body process fat). Chondrodysplasia Congenital dwarfism similar to but milder than achondroplasia, not familial and not evident until mid-childhood, in which the skull and facial features remain normal. Chorioamnionitis Inflammation of the fetal membranes. Dystocia Difficult delivery or parturition. Erythema infectiosum mild infectious disease occurring mainly in early childhood, marked by a rosy-red maculopapular rash on the cheeks, often spreading to the tr