Tuesday, August 25, 2020

Siaffing for a telecommunting job Essay Example | Topics and Well Written Essays - 500 words

Siaffing for a telecommunting work - Essay Example The primary explanation behind suggesting this technique is that leading meetings with the previous occupant, and their prompt manager, will help catch the significant subtleties identified with the sets of expectations and particulars. Furthermore, interviews with pros in the advertising division will be vital to help catch any subtleties that the active office holder and the managers may neglect to show. Besides, interviews with pros in working from home will likewise be vital to help give data that the organization will use to realign this new job. It is critical to take note of that, this technique would even now be appropriate in breaking down a vocation in the customary office condition since similar subtleties are vital separated from those identified with working from home. As a result, a similar investigation technique will be appropriate separated from directing meetings with a working from home authority. The best strategy to use in enlisting and employing a remote worker for the organization will be through recruiting of a remote worker from inside the organization. In such manner, this strategy is the most proper since the organization will stay away from the issues identified with lacking socialization. What's more, guarantee that the remote worker recruited is dependable, of which it will be a test to demonstrate reliable once employing was from outside the organization. Past the worth coinciding and proper abilities for the activity, and dependability, it is imperative to explore other significant attributes significant for working from home. In such manner, these attributes consolidate the ability to work free of express oversight, self-inspiration, certainty, and a person with significant administrative aptitudes (Schilling, 1999). In is just through recruiting inside the organization this is attainable. Then again, if the activity was not of a working from home nature, this me thodology of employing and enlistment could be material since similar highlights are required in a

Saturday, August 22, 2020

Differences Between Spice And CMMI Information Technology Essay

Contrasts Between Spice And CMMI Information Technology Essay Programming quality is progressively turning into a need with developing number of firms reliant on IT foundation and crucial virtual products for their business forms. The capacity development model and SPICE have been the two most far reaching models for programming process improvement that have brought about a vigorous framework for improving advancement process (Marshall, Mitchell 2004). A ton of uses have been created with the utilization of such models. Be that as it may, despite a great deal of contrasts between the two models, there has been little spotlight on the key contrasts between the two models. While the capacity development model is the most popular programming process improvement, the ISO/IEC 15004 is a set-up of gauges that are relied upon to influence the persistent evolvement of Software CMM (Paulk 1999). In this paper, the fundamental point is consequently to set out the essential and auxiliary contrasts between the two development models in SPICE and CMMI. Furt her, through diagrammatic portrayals, the paper attempts to rattle off the key contrasts between the models. CMMI: The ability development model (all the more famously known as CMM) had its starting points from a book distributed in 1989 by Watts Humphrey in his book Managing the Software Process. The fundamental topic behind the ability development model coordinated (CMMI) is process improvement (Glazer et al 2008). It must be comprehended that CMMI is a procedure model and not a procedure standard. CMMI comprises of procedure arranged exercises that can be utilized all things considered to achieve the procedure region and business objectives of an association. CMMI rehearses are additionally intended to urge associations to utilize different procedure models dependent on the associations need and practices. Essential Attributes of CMMI: The capacity development model has certain essential traits related with it. It has been seen by Hoggerl M and Sehorz (2006) that procedure region, objectives and practices are the three key ideas of CMMI. As expressed before, the CMMi is a rundown of pre-characterized forms that are expressed under CMMI. As indicated by the creators (Hoggerl Serhorz), the CMMI comprises of 25 explicit procedure territories inside the improvement forms. Essential ascribes of CMMI as per these scientists are in this way procedure the executives, venture the board and building and backing (Hoggerl Sehorz 2006). There are five fundamental development levels characterized in the CMMI model. These are definite in the table underneath Programming CMM Maturity Model Depiction 1. Introductory Programming forms described at this level are specially appointed and at times tumultuous. At this stage, not many procedures are characterized and the accomplishment of the procedures relies upon the individual endeavors and heroics 2. Repeatable The procedure the board forms are characterized at this stage. They are fundamental in nature and are commonly gotten from before triumphs 3. Characterized The product procedure for both the administration and execution are characterized and are very much reported during this stage 4. Overseen Point by point measures for the assessment of the product forms 5. Upgrading Nonstop improvement forms are completed utilizing quantitative input from the procedure and from steering of imaginative thoughts Table 1. CMMI Maturity Stages Optional Attributes of CMMI: Inside the essential characteristic of venture the board, the creators Hoggerl Sehorz (2006) recommend that there are a few procedures which are explicit in nature. These are alluded to as the optional traits of CMMI. A portion of the regular optional characteristics incorporate arranging, observing, provider the board and group the executives. Inside procedure the board as well, there are sure auxiliary characteristics. Hierarchical center, definition, preparing and advancement are a portion of the regular auxiliary characteristics that can be set under the procedure the board rule. The building segment of the CMMI model has a great deal of degree for upgrades. Hence, the optional qualities under this area are imperative to the procedure improvement. A portion of the auxiliary properties under the building area incorporate prerequisite administration, coordination, check and approval (Hoggerl Sehorz 2006). Inside the help area (essential quality of CMMI), there are some auxiliary tr aits as well. These incorporate arrangement the executives, quality confirmation, choice examination and hierarchical condition (Hoggerl Sehorz 2006). The whole arrangement of characteristics is better introduced in the composite highlights graph demonstrated as follows. For understanding a composite component graph, it must be noticed that the development of a product procedure is best comprehended in five unique levels. In spite of the fact that these levels shift from association to association, they can even now be summed up as starting, repeatable, characterized, oversaw and advanced (M, Paulk. M, Konrad. S, Garcia.1995;M, Paulk.1999). During the underlying level, the procedures are not requested. During this stage the procedures are confused and for the most part rely on the individual endeavors. According to its name, the repeatable procedures rehashes itself; the accomplishment of prior procedures. In this way, Paulk et al (1999) states that the characterized development lev els in the entire procedure experience the guidelines strategies to satisfy the procedure. An appropriate recorded strategy is one of the most significant perspectives in the culmination of a characterized development model. Be that as it may, the oversaw development models are tried quantitatively for the procedures and item quality (M, Paulk. M, Konrad. S, Garcia.1995; M, Paulk.1999). The enhanced development models are focused on advancement and ceaseless upgrades through input components. A glance at the focal points and detriments of CMMI model would be in accordance with the above conversations. Points of interest of CMMI: CMMI has various advantages. As per Konrad, Shrum and Chrisis (2003), the CMMI model gives a decent inclusion to the normal item life cycle than some other procedure improvement items when they are utilized alone. In addition, CMMI can be incorporated with any of the other programming improvement models and can be actualized to give powerful functionalities. In spite of the fact that the principle focal point of CMMI was on item and administration designing, it was likewise worked to give undertaking wide procedure improvement (Chrissis, Konrad, and Shrum 2003). Hindrances of CMMI: Despite the fact that CMMI gives a great deal of functionalities for powerful working, it is as yet difficult to actualize inside associations. CMMI isn't a procedure; it is fairly the qualities characterized that ought to be available inside a perfect procedure. In this way, the issue with process improvement isn't that of a missing norm yet to execute the standard in the point of view of the association (M, Niazi. D, Wilson, D, Zowghi.2003). Since CMMI doesn't give the real usage steps, it isn't fitting to use in specific situations. Outline 1. CFD For CMMI With such a concise depiction of CMMI, the ideas about the model are clarified. The following area of the paper talks about the SPICE or the ISO/IEC 15504 procedure development model. Zest: (ISO/IEC 15504): The SPICE model otherwise called the ISO/IEC 15504 is a rising global standard on programming process appraisal that characterizes the quantity of programming designing procedures and scales them to quantify their capacity (Emam, Birk 1999). The fundamental contrast between the CMMI and SPICE is that while CMMI is a model comprising of steps that may be required in a perfect programming process; SPICE is a standard for programming process usage that should be followed. The developing ISO/IEC 15504 global standard is an endeavor made to orchestrate the current appraisal of models that are in the basic use. It is an European model that depends on the quantitative score of evaluation related with the exhibition of the association or the task (Emam Birk 1999). A product procedure evaluation (SPA) gives a quantitative score that mirrors the associations or ventures execution of the accepted procedures as characterized in the appraisal model. Consequently, the more number of best practices that are embraced the more higher the quantitative score is relied upon to be. This score got from the pattern current execution gives an ideal system to settling on process improvement choices and furthermore fills in as a methods for following improvement endeavors. Traits of SPICE: Flavor model depends on five unique procedures. These procedures were made in various nationalities and became acknowledged universally. The five procedures are client provider, designing, supporting, the executives and association. Every one of these procedures has a capacity level on which it is checked quantitatively. These levels start from 0 to 5 running from inadequate procedure (0) to an improved procedure (5). These procedures are additionally stamped utilizing what is called as procedure characteristics. It is the base reason of the product procedure appraisal that the resultant quantitative scores are the indicators of the presentation of the undertaking or the association that is evaluated. Taking all things together, there are nine qualities in SPICE. As with CMMI, the nine procedure qualities are connected with the five procedures. The nine traits are Procedure Performance Execution Management Work Product Management Procedure Definition Procedure Deployment Procedure Measurement Procedure Control Procedure Innovation Process Optimization. Like CMMI, the ISO/IEC 15004 has five procedure zones. These are known as levels. Each key procedure territory is depicted regarding its key practices that add to fulfilling its objectives and are apportioned to deliver regular highlights. These key exercises portray the particular capacity of the foundation and exercises that add to create the best usage and regulation of the key procedure region (Paulk 1999). These five procedure territories are depicted in the table underneath Level Core interest Key Process territories 5 Streamlining Co

Sunday, July 26, 2020

Clark, George Rogers

Clark, George Rogers Clark, George Rogers, 1752â€"1818, American Revolutionary general, conqueror of the Old Northwest, b. near Charlottesville, Va.; brother of William Clark . A surveyor, he was interested in Western lands, served (1774) in Lord Dunmore's War (see Dunmore, John Murray, 4th earl of ), and later went to what is now Kentucky for the Ohio Company . In 1776 he secured the Virginia legislature's assertion of sovereignty over the Kentucky region, thereby obtaining military and financial support. He returned in time to repel British and Native American attacks on Harrodsburg, Ky., and other posts. In 1778, Clark made plans for aggressive action against the British in the Old Northwest and, going to Virginia, persuaded Gov. Patrick Henry and his council to send an expedition. At its head, he swept into the Illinois country and took the British-held settlements of Kaskaskia , Cahokia , and Vincennes . The British under Gen. Henry Hamilton advanced from Detroit and retook Vincennes after Clark had left. Winter and Ohio floods halted Hamilton there, but Clark and his men, defying cruel conditions of cold and hardship, braved the flooded bottom lands to return to Vincennes. With the heroic aid of Francis Vigo , François Bosseron, and Father Gibault , he struck at the British fort and surprised and captured Hamilton and the garrison in Feb., 1779. After this, the greatest of his exploits, Clark hoped to capture Detroit, but adequate supplies never came from Virginia to the fort he had built (Fort Nelson, where Louisville now stands), and he remained inactive. In 1782 the British and Native Americans disastrously defeated the Kentuckians in the battle of Blue Licks. The ensuing unrest led Clark, who had not taken part in the battle, to lead another expedition northward against the Native Americans and again establish control of the region. His services had been rewarded by the rank of brigadier general in the Virginia militia, and he was made an Indian commissione r. In 1786 he led another expedition against the Native Americans in Ohio. His own narrative of the capture of Vincennes is in Milo M. Quaife, ed., The Capture of Old Vincennes (1927). See biographies by J. A. James (1928, repr. 1970) and J. Bakeless (1957); A. W. Derleth, Vincennes: Portal to the West (1968). The Columbia Electronic Encyclopedia, 6th ed. Copyright © 2012, Columbia University Press. All rights reserved. See more Encyclopedia articles on: U.S. History: Biographies

Friday, May 22, 2020

Building Construction Essay - 1698 Words

In building construction and in fire prevention there are organizations that have created a useful system on how to determine what type of building falls under which category. The ICC (International Code Council) and the NFPA (National Fire Protection Association) create these building codes for the safety of firefighters. The two most commonly known standards for building classifications are the NFPA 5000 and also the International Building Code (IBC). The two are very similar, however, they different on sub-categorizing. The International Building Code uses Roman numerals behind the type of construction. In addition to subcategories with letters for each five classes and the amount of fire resistance provided for each building. NFPA†¦show more content†¦The interior walls are usually wooden boards with a lacquer finish or a gypsum board finish. Due the types of interior finishing, it can help a going or started fire indoors spread within seconds. The lacquer finishing pro poses an extreme fire hazard for both firefighters and the occupants. Post and Frame construction types of structures came to America from Europe. This type of construction was fitted together using a wooden frame and timber. They connected at joints called mortise and tenon. To ensure that load transfer was properly distributed they used wooden pins to hold the connected piece together called trunnels. Like log cabins, the interior wall finishing’s we often made of wood. This poses a danger to firefighters as well because it just adds more fuel to a structure fire. Balloon Frame construction derived from Post and Frame types of construction. The two types of construction are very similar in many ways. The differences between the two are that Balloon Frames didn’t require a skilled laborer to cut the notches in the timber and studs. Instead, by using nails it would hold the frame together. The studs wo uld be nailed on to horizontal boardShow MoreRelatedBuilding Construction11374 Words   |  46 Pages(4) Building construction is a complex, significant, and rewarding process. It begins with an idea and culminates in a structure that may serve its occupants for several decades, even centuries. Like the manufacturing of products, building construction requires an ordered and planned assembly of materials. It is, however, far more complicated than product manufacturing. Buildings are assembled outdoors on all types of sites and are subject to all kinds of weather. Additionally, even a modest-sizedRead MoreBuilding Construction1694 Words   |  7 PagesIn building construction and in fire prevention there are organizations that have created a useful system on how to determine what type of building falls under which category. The ICC (International Code Council) and the NFPA (National Fire Protection Association) create these building codes for the safety of firefighters. The two most commonly known standards for building classifications are the NFPA 5000 and also the International Building Code (IBC). The two are very similar, however, they differentRead MoreBuildings And Construction Of Asbestos Construction1806 Words   |  8 Pagesbuildings with asbestos construction. There is a risk of respiratory diseases from inhaling dust and fumes, this can lead to fatal disease for employees, quite often these types of claims are latent where the health issue is not discovered under some time after the contact. .Moving Machinery - Construction sites can become hectic with moving vehicles, machinery and lifting equipment often manoeuvring around a usually uneven ground. With large amounts of moving plant on site employees are at riskRead MoreThe Building And Construction Industry6387 Words   |  26 Pages Industry professionals The building and construction industry is a wide industry that encompasses many professionals. No one person does all the work from start to finish, many people are involved in teams that contribute to each stage of the works until completion. Material taken from: https://en.wikipedia.org/wiki/Geotechnical_engineering Geotechnical engineers: Geotechnical engineering uses principles of soil mechanics and rock mechanics to investigate subsurface conditions and materials;Read MoreBuilding Construction And Its Effect On The Environment1444 Words   |  6 Pagesforest standard. Throughout the building cycle, it’s a useful thing to produce a lot with very little waste. Buildings around the world are subject to a wide variety of natural important events such as floods, earthquake, windstorm, and other dangers. Comprehensible development is one of the major parts that increase the value of natural disaster. These events cannot be exactly described a possible future events, their effect is well understood. Building construction can have a long direct and indirectRead MoreFire and Lightweight Building Construction773 Words   |  3 Pagesand Lightweight Building Construction Lightweight construction has been used in building construction for more than thirty-five years. Fire fighters have been dealing with the dangers of this type of construction since it was developed. Lightweight construction is generally considered to be either wood frame or steel building materials, where the roof and/or floor supporting systems are constructed of lightweight prefabricated materials. The main problem with lightweight construction is the decreasedRead MoreDesigning A Building Construction Project1281 Words   |  6 PagesControl in a Building Construction Project Introduction Fundamentally, construction projects can be viewed as grouped collections of information and data that require convenient and appropriate storage, organization and distribution to those needing them. Configuration control comes across as a means of signifying changes between the updated and previous version of prints and drawings. In the current paper, I will reflect on the importance of configu ration control in a construction project. ConfigurationRead MoreThe Building And Construction Industry Improvement894 Words   |  4 Pages20 March 2012, the Building and Construction Industry Improvement (BCII) Act of the Australian Government was replaced by the Fair Work Bill (FWBI) 2012 which was implemented on 1 June 2012 (FWBC, 2012a). It was regarded as bill for ‘Transition to Fair Work Australia for the Building and Construction Industry’. The bill is intended towards: †¢ offering education, aid and suggestions to building industry participants; †¢ checking observance towards the Building Code and building regulations; †¢ undertakingRead MoreConstruction of the Empire State Building3610 Words   |  15 PagesProject Part II Construction of the Empire State Building | PM 595 | [Type the author name] | 10/9/2011 | | Table of Contents Introduction†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...3 Sources of Construction Project Risks†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.3 Timeline Risk†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦ 3 Cost Risk†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦4 Design Issues†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..†¦.5 Force majeure†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.....5 Systems to address construction project risk†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...6 Read MoreProblems Associated With The Building And Construction Commission892 Words   |  4 PagesDespite various construction acts, regulations, standards, codes, licensing regimes, other management approaches such as quality management, risk management, defect management building are still handed with defects. It is evident from Queensland Building and Construction Commission (2015a) annual report that in 2014/15 alone received 4,793 complaints about defective work. There are many other defects that are seen to occur during the construction process, which gets rectified before the practical

Friday, May 8, 2020

Organizational Culture And Ethical Values - 1604 Words

In every organization, there is a culture practiced in that organization. Different organizations have different cultures. A culture of an organization defines how that particular organization manages itself as well as treats its customers if it is a business. An organizational culture is basically developed within an organization and all the staffs or workers of an organization are usually conversant with the culture of the organization they work for. Ethical values are also part of organizational culture. Ethics are very crucial in an organization since they determine how individuals relate with one another within an organization. Ethical values are the ones which guide individuals in upholding good morals within an organization. The purpose of this study is to understand what an organizational culture is as well as the ethical values required in an organization. In addition, this study aims at showing how ethical values can be used in an organization in fostering good relationship s within and outside an organization. The question of research in this paper is the organizational culture and ethical values. The question is simply presented as a topic which requires some research about organizational culture and ethical values. The significance of studying this topic about organizational structure and ethical values is that we will be able to understand what organizational culture is and its importance in an organization. In addition, we will also understand the importance ofShow MoreRelatedThe Importance Of Culture And Organizational Culture1647 Words   |  7 PagesThe importance of culture in the organization The organization culture as a leadership concept has been identified as one of the many components that leaders can use to grow a dynamic organization. Leadership in organizations starts the culture formation process by imposing their assumptions and expectations on their followers. Once culture is established and accepted, they become a strong leadership tool to communicate the leader s beliefs and values to organizational members, and especially newRead MoreCultural Values and Personal Ethics Paper1583 Words   |  7 PagesCULTURAL VALUES AND PERSONAL ETHICS PAPER Cultural Values and Personal Ethics Paper MBA/500 Foundations of Problem-Based Learning R. Garth Ferrell April 23, 2006 University of Phoenix Cultural Values and Personal Ethics Paper Every day people make decisions that may have profound effect on their personal and/or professional lives as well as the lives of others. The decision people make have a foundation on their personal, cultural, and perhaps organizational values. When these values areRead MoreEssay on Cultural Values And Personal Ethics in Business1497 Words   |  6 Pagespersonal, cultural, and perhaps organizational values. When these values are in disagreement, an ethical dilemma occurs. This article attempts to explain how personal, cultural, and organizational values play significant parts in decision-making. In addition, the foundation of ethical dilemmas can often be traced to conflicting values. This paper will also briefly discuss how ethical dilemmas can be mitigated. A practical approach for understanding how ethical dilemmas occur, how dilemmas canRead MoreEnrons Ethical Dilemma1118 Words   |  4 Pagesï » ¿Enrons Ethical Dilemma: Ethical and moral issues have received substantial focus in the modern society because of the recent cases in which huge corporations with big profits and earnings have faced bankruptcy. Enron is an example of corporations that have faced bankruptcy in the recent past because of the numerous problems it had with federal and state governments for manipulation of financial statements. While these problems are not only attributed to organizational issues, accounting firmsRead MoreCultural Values and Personal Ethics1000 Words   |  4 PagesPersonal Values In today’s society, we live our lives and make our future depending â€Å"on what we believe has value.† What we do with our time, our money and our lives are all directly influenced by our capacity to make clear, balanced and valued decisions. Each individual brings a set of personal values into the workplace. These values and the moral reasoning associated with them translate into behavior that are considered important aspects of ethical decision making in organizations. For exampleRead MoreEthical Ethics And Ethical Issues1180 Words   |  5 PagesEthical issues in organizations are inevitable and are always on the horizon. These ethical concerns can directly impact the overall health of an organization in both positive and negative aspects. In order to be prepared for the ethical issues that will arise and to create an organizational competitive advantage, an intentional focus and effective communication of the code of ethics must be incorporated as a part of strategic planning. Sherwin (1983) indicates the that the term ethics, â€Å"refers toRead MoreOrganizational Culture And Its Impact On Employees Performance And Innovative Work Behavior949 Words   |  4 Pagesemployees’ perception of being ethical leaders. Some conducts, which might be considered right in one organizational culture might be considered wrong in another. Normative appropriate conduct varies with societal and organizational culture (Yidong Xinxin, 2013). Perception of leaders being ethical affects employees’ performance and innovative work behavior (Yidong Xinxin, 2013). Global leaders should possess traits such as honesty, altruism, high moral values, transparency, integrity, and fairnessRead MoreEthical Values And Behaviors Of An Organization941 Words   |  4 PagesDr. M and class, How do ethical values shape behavior in organizations? According to Saleem (2014), ethical values and behaviors of an organization are made up of organizations institutionalized philosophies along with the moral ideologies of its members. In addition, the codes of ethics help to enhance the moral reasoning of employees while shaping their behaviors towards morally questioning unethical situations. Organizational leaders are encouraged to build cultures of trust with leadershipRead MoreBenefits Of Ethical Leadership : A Positive Corporate Reputation, Ethically Empowered Employees, Increased Quality, And Higher1734 Words   |  7 Pagespurpose of this paper is to discuss four benefits of ethical leadership; having a positive corporate reputation, ethically empowered employees, increased quality, and higher customer satisfaction. Ethical leadership will benefit an organization, because it creates a healthy ethical environment, and culture which produces a positive corporate reputati on. This will foster employees that; appreciate that ethics is important, recognizes and discusses ethical concerns, works to resolve ethics issues at theRead MoreCulture Shaping Leadership : The Business World987 Words   |  4 PagesCulture-Shaping Leadership The business world has expanded globally in the 21st century. With the development of the Internet, companies can expand into new markets in a fraction of the time previously necessary. With this new global frontier, organizations have found new challenges. Culture barriers present real obstacles for building cohesive organizational structure. In order to overcome this hurdle and take advantage of the cultural diversity, the leadership must find an effective model to accommodate

Wednesday, May 6, 2020

Mecca Silk Conditioner a Research Paper Free Essays

Abstract Generally, the study wanted to make a homemade conditioner from eggyolk, flour, malunggay oil extract, cucumber juice and calamansi juice and Shall be called â€Å" MECCA Silk Conditioner. † Specifically, it tries to find out if oregano leaves eggyolk, flour, malunggay oil extract, cucumber juice and calamansi juice be made into a conditioner. Among the treatments, which one are the best proportion for the homemade conditioner and if there is a difference between the newly produced MECCA Silk Conditioner and the commercial one in terms of smell, appearance and shining effect. We will write a custom essay sample on Mecca Silk Conditioner a Research Paper or any similar topic only for you Order Now The materials were gathered and prepared. Cucumber was peeled, cut and pounded to get its 20 ml. juice. Calamansi fruit was also cut and squeezed to extract the 20 ml. juice. Twenty ml. detergents were measured. Three grams of Malunggay Leaves was boiled in 50 ml. vegetable oil. The beaker was covered and removed only when boiling starts. It was boiled for 3 minutes. It was then cooled for 5 minutes and strained in clean containers. Thirty ml. water was poured in a 100 ml. flour and stirred until well- blended. Two medium-sized egg yolk were beaten until sticky. Measured Malunggay oil, detergents, cucumber and calamansi juice were added little by little and stirred continuously. The mixture was added to the flour and mixed thoroughly until it looks whipped. Poured in a clean container, label its name, use and expiry date. The contents of the chosen ingredients which are carefully studied by the researchers and the positive effects to the respondents made the newly produced product to be an alternative conditioner for the commercial one. Aside from the availability of materials in the environment, it is also easy to prepare. Treatment B, came out to the best proportion for the produced deodorant as a result of the series of experimentation and through the application and evaluation of the five respondents. MECCA Silk Conditioner appeared to have shining effect, smooth and manageable in appearance . It last for a day therefore it is acceptable and comparable to the commercial one. IV. Research Plan a) Materials and Methods How to cite Mecca Silk Conditioner a Research Paper, Essays

Tuesday, April 28, 2020

Saved and The Wasp Factory Essay Example

Saved and The Wasp Factory Paper In The Wasp Factory and Saved one obviously apparent theme is the lack of community spirit in the societies. In The Wasp Factory there is no mention of a character who wonders why Frank isnt in school or doing things that other young men do. In Saved there is no mention of anybody making any sort of judgement when Pam goes to meet Fred, somebody who has been jailed for the murder of her baby. Therefore it is important to look into the issue of cultural poverty, as it will make clearer why the characters are who they are and behave as they do. Obviously, Saved is a play and The Wasp Factory is a novel. As Saved is a play the audience physically see characters actions and emotions whereas Iain Banks has to use imagery. The effect of this is that the disturbing images in Saved are there for the audience to see, initially making Saved even more sickening. The setting for Saved is on a bare stage so the plot seems extreme as the setting doesnt dilute the harsh actions and language used in the play but reinforces them. Although harsh actions and emotions are in The Wasp Factory the setting of empty beaches softens these actions, contrasting them with the natural splendour in which they take place. We will write a custom essay sample on Saved and The Wasp Factory specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Saved and The Wasp Factory specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Saved and The Wasp Factory specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Perhaps Bond is suggesting that his characters have been formed by the environment and uses the setting to illustrate this whereas Banks makes it clear that ugly actions are not dependant on ugly surroundings. The Wasp Factory is written in the first person narrative therefore the reader sees things from Franks viewpoint. The whole book is based on Franks thoughts and actions so the readers perceptions are based on those of Frank. When Frank says that he has killed people he says it casually; the reader isnt as shocked as they should be. Frank says on page 42, Thats my score to date and It was just a stage I was going through when talking about his murders which gives the impression he has no remorse. Saved, as a play on the other hand, actually shows the audience the murder of the baby. Stage directions such as He starts to throw burning matches in the pram and He takes a stone from the pram and throws it at point blank range are actually shown to the audience. Unlike The Wasp Factory there is no escape from, nor sympathy with, the murder of the baby. In both texts the reader feels very close to the main characters and this is due to the language. The Wasp Factory is written in a Scottish dialect e. g. the girl who Jamie meets in the pub says to Jamie Dud he say sumhin er? referring to Frank who is drunk at the time, which makes the novel seem more realistic. This language seems strange to the reader but by using this dialect the language links the book with the time and the setting and this realism involves the reader in the book. In Saved the cockney accent makes the reader feel more involved in the story. In a conversation between Len and Pam on page 82 Pam says None a that ld a appened if yer ain bin ere. Without this accent it would be harder to picture the London setting and characters. Violence pervades in both texts. The extreme details of violence in the texts are sickening to any audience. Even the description of the battle between Frank and a rabbit contains violent images as Frank says how he feared the rabbit tearing the flesh off his finger and how he feared the rabbit biting his nose off. The instances of violence on living things are quite sickening but they pale in comparison to the murder of the baby in Saved and the murders in The Wasp Factory. In Saved when the men are trying to get the baby to sleep Pete says, give it a punch and also that cloutins good for em. These images alone show signs of abnormal behaviour and attitudes. The men then begin throwing stones at the baby with Mike asking Oos got the matches? showing that the characters intend burning the baby, another sickening thought. These disturbing images can also be linked to The Wasp Factory where Frank kills three children. Franks explanation for killing his young brother Paul is on page 67 where he says that Paul was not long for this world. Frank made Paul blow himself up by hitting a bomb with a stick at the age of five. When Franks father asks him about killing living things Frank tells the reader how of course I was out killing things and there just arent enough natural deaths. The innocence of the victims in the texts increases the horror of the audience. The use of innocent victims in The Wasp Factory again highlights Franks mental instability as he almost sees himself as a God like figure. Characters from Saved thought that it was a giggle to hurt the baby and Frank thought that it was his duty to kill the characters in The Wasp Factory for no real reason, all protagonists are seemingly amoral which poses the question whether society is actually amoral. Another point to consider is the portrayal of women in both texts. Frank sees women as weak and stupid in The Wasp Factory and feels that they live in the shadows of men perhaps because Franks mother left at a very early age giving him no real female guidance. Iain Banks wrote The Wasp Factory at the time Thatcher was Prime Minister. Thatcher wasnt a popular figure in Scotland; they saw her as more of a dictator than somebody who was willing to help them. Thatcher had set ideas and didnt really adapt to certain situations. This could be why Banks has chosen to hardly include women in the book at all as he saw Thatcher as somebody who ignored women in his perception. Therefore because of Thatchers influence on Banks life he chose to represent women as a non-existent gender whose only role in the book was to leave their child to live in a one-parent family. However this is ironic as the audience learns at the end of the book that Frank is female, so the destructive character who was anti-female and violent is really a female. When Frank finds this out he says he shivers at the thought of the idea of intercourse and giving birth on page 82; the main female character in The Wasp Factory behaves and thinks as a male. Saved also has a negative image of women. Pam is portrayed as an easygoing woman who would go to bed with anyone. Pam takes Len home without even finding out his name so therefore from the start of the play Pam is portrayed as easy. Pam is reflected negatively, as the audience doesnt have much sympathy for her when her baby dies especially as Pam goes to meet Fred. Fred helped to torture the baby yet Pam still insists he moves in with her, goes to meet him from prison and hopes that they will have a relationship. Pam puts her feelings for Fred above the fact that he helped to kill her baby, which therefore shows how motherhood is represented in Saved. As in The Wasp Factory the representation of motherhood is negative. Similarly Mary is also portrayed negatively by her husband Harry. Harry says to Len that the reason he came back was so Mary could do his washin an cookin', he says that if he left Mary would soon ave someone in my bed so the man to whom she is married dislikes her. It is fair to say that neither Iain Banks nor Edward Bond have any positive images of women in their texts; as they dont include women in any real positive role in their texts as their writing excludes the caring half of society. The majority of the characters in Saved seem unpleasant. Len however contrasts with these characters as he is portrayed as respectable; this highlights the behaviour of the other characters. Len seems a flawless character who acts in the best interest of others. Len explains in scene eight how I lost me job stayin out a elp you when yer was sick! The audience feels sympathetic towards Len, as Pam acts terribly towards him throughout the play. Pam says in scene eleven Es pullin me t pieces. Nothin but trouble referring to Len who was somebody who supported Pam throughout. Therefore in Saved Len is the only real good character, which emphasises the faults in the other characters. There are some very strange relationships in the two texts and it is important to look at these relationships in order to find out why certain characters are shaped as they are. The person who Frank has most contact with in The Wasp Factory is his father, his closest relation. Yet his father tells Frank that he is a man and feeds him male hormones. When Frank does finally find out, through forcing the truth out of his father, he says that his fathers truth had murdered what he was. The man on whom Frank relies is responsible for ruining his life. Therefore it could be said that there are no real relationships in The Wasp Factory and that it is a book made up of individuals. Most characters have their own secrets e. g. Franks the only one who knows about his murders, Eric doesnt tell anybody where he is and Franks father is the only one who knows the real truth about Frank. Frank doesnt really have anybody to talk to apart from Jamie so therefore he spends a lot of time on his own, contributing to his psychopathy. The relationships in Saved are also quite strange. Len moves in with Pam after they had only met once. Pam makes it obvious that she wants Len to leave as she says Why dont e go? and that Lens pullin me t pieces in one of the final scenes in the play. It is Len who stands by Pam throughout the play and looks out for her yet, she would rather have Fred back, somebody who helped to kill her baby. The longest standing relationship in Saved is between Mary and Harry yet Harry says that if he was to leave Mary shed soon ave someone in my bed which shows the lack of faith he has in his wife. Although the characters talk more in Saved than in The Wasp Factory the relationships are still dysfunctional. It could be fair to say that there are more normal characters in Saved (Len, Harry and Mary) than in The Wasp Factory where one of the only normal characters is a dwarf. However for all the talking that is done little of value is exchanged which again highlights the cultural poverty in the text. Linking with relationships is isolation, which is very apparent in both of these texts. Frank is isolated from society as he was never registered as he tells on page 13. This would make him isolated; as he was unable to attend school for example, as officially he didnt exist. However Frank doesnt even want to bother trying to get to know other people, he says in chapter 1 that I dont bother people and they best not bother me and that hes learned to live without people. This could be the reason Frank kills living things. It could be argued to explain his murders, as he was unable to learn societys norms and therefore set his own boundaries. Franks life is based on what Frank experienced. When Blyth killed Frank and Erics rabbits Frank felt the hiding he got from his father was not enough and that Frank wanted to kill Blyth there and then. It is fair to say that as Frank was so isolated he was shaped differently to other people in society. There is a different type of isolation in Saved as the family seem isolated as a group rather than as individuals. The baby is isolated as, apart from Len everybody neglects it. Len says in scene four that he wishes to god that he could take that kid out a this and he listen out for the kid. They ain bothered. The family seem isolated because of the strange events that occur. Stoning to death of a baby and the mother wanting to get back in a relationship with one of the perpetrators seems to go unremarked. As in The Wasp Factory the lack of friendship and communication with other characters from society could have shaped Pam. The only real people she did communicate with that werent family were the people who stoned her baby to death. In both texts the only person to be diagnosed with a mental illness was Eric who was certified insane. Although Franks father says to Frank sometimes I think youre the one who should be in hospital its only Eric who is contained. However Frank obviously has mental problems and perhaps the only reason he hasnt been assessed is down to the fact that he hasnt been registered and therefore he cant see a doctor. Pam suffers from depression in Saved but this is more down to Fred going to jail rather than the murder of her baby. Pam does suffer postnatal depression but this seems to be completely ignored because it poses no threat to anybody but herself. It could be said that based on these texts society only reacts to what threatens society. There is optimism in the two texts, showing perhaps the only way out of the effects of cultural poverty. There are brief scenes of optimism; Frank finding the study door open results in his true identity and Len is optimistic in Saved. He stays with Pam even though she treats him badly. The real optimism however is found right at the end of both books where Frank says, Now the door closes and my journey begins and there are no arguments at the end of Saved, which represents a new peaceful beginning. Lack of education, lack of hope and lack of access to societys norms are all parts of both texts so therefore it is true that cultural poverty is a major theme. Even though shocking images have been discussed I think the ending shows the characters can escape. Frank can start his new journey and the final scene of Saved shows that Pam and Len can fold the radio times without arguing. These two texts are initially very depressing yet we do end in hope. Therefore it could be argued that by the end of both texts the writers offer hope for society and a way forward. They show us that society is our safety net as humanity; if we can be shocked by the murder of a few how can we ignore the needs of many?

Thursday, March 19, 2020

Free Essays on The Symbolism In “To His Coy Mistress“

The Symbolism in â€Å"To His Coy Mistress† We all have the choice either to take advantage of time or allow time to take advantage of us. This choice has been a struggle for everyone in some point in their lifetime. It has also been a topic in many literary pieces, for example this idea is presented in â€Å"To His Coy Mistress†, a poem by Andrew Marvell. In this poem, the opportunity of living life to the fullest or choosing to waste your time is supplied through symbolism. According to Webster’s Dictionary and Thesaurus symbolism is, â€Å"conveying impressions by suggestion rather than by direct statements†(â€Å"symbolism†). Using symbolism to express ideas makes it possible to visualize things that are not usually perceived, and in this case it makes time seem almost visible. Time is symbolized through a lover attempting to seduce a mistress, â€Å"a lady to whom courtesy and courtly convention and erotic longing attribute a superordinate status, a power to command†(Atlantic), into having a sexual relationship with him. The idea that time is running out is expressed throughout the poem, as the lover uses this excuse for wanting that sort of relationship so urgently. The very first line, â€Å"Had we but world enough, and time†(1) brings out the focus of time directly. It is then reinforced through hyperbole in the following phrases such as â€Å"A hundred years should go to praise / Thine eyes, and on thy forehead gaze; / Two hundred to adore each breast, / But thirty thousand to the rest; / An age at least to every part†(13-17). These lines symbolize the lack of time the lover has to show his mistress the love she is worthy of, â€Å"For, Lady, you deserve this state†(19). He tries to make her feel exceptional, so that he can seduce her into making love with him. Marvell then continues on to symbolize the lack of time using other literary devices. Running out of time is shown in several descriptive ways. For example, the pe... Free Essays on The Symbolism In â€Å"To His Coy Mistressâ€Å" Free Essays on The Symbolism In â€Å"To His Coy Mistressâ€Å" The Symbolism in â€Å"To His Coy Mistress† We all have the choice either to take advantage of time or allow time to take advantage of us. This choice has been a struggle for everyone in some point in their lifetime. It has also been a topic in many literary pieces, for example this idea is presented in â€Å"To His Coy Mistress†, a poem by Andrew Marvell. In this poem, the opportunity of living life to the fullest or choosing to waste your time is supplied through symbolism. According to Webster’s Dictionary and Thesaurus symbolism is, â€Å"conveying impressions by suggestion rather than by direct statements†(â€Å"symbolism†). Using symbolism to express ideas makes it possible to visualize things that are not usually perceived, and in this case it makes time seem almost visible. Time is symbolized through a lover attempting to seduce a mistress, â€Å"a lady to whom courtesy and courtly convention and erotic longing attribute a superordinate status, a power to command†(Atlantic), into having a sexual relationship with him. The idea that time is running out is expressed throughout the poem, as the lover uses this excuse for wanting that sort of relationship so urgently. The very first line, â€Å"Had we but world enough, and time†(1) brings out the focus of time directly. It is then reinforced through hyperbole in the following phrases such as â€Å"A hundred years should go to praise / Thine eyes, and on thy forehead gaze; / Two hundred to adore each breast, / But thirty thousand to the rest; / An age at least to every part†(13-17). These lines symbolize the lack of time the lover has to show his mistress the love she is worthy of, â€Å"For, Lady, you deserve this state†(19). He tries to make her feel exceptional, so that he can seduce her into making love with him. Marvell then continues on to symbolize the lack of time using other literary devices. Running out of time is shown in several descriptive ways. For example, the pe...

Tuesday, March 3, 2020

10 Ways to Promote Self-Directed Classroom

10 Ways to Promote Self-Directed Classroom Effective elementary teachers promote a self-directed classroom so that their students know if they cannot solve a problem or figure out an answer then they will have the tools to do it themselves. Here are 10 tips to help you promote a classroom where your students are self-reliant, as well as self-confident and feel that they can do anything on their own. Promote an â€Å"I Can† Attitude Teaching your students how to overcome disappointment is one of the best lessons that you can ever teach them in their life. When students face disappointment, teach them to analyze it and look at the big picture. Teach them to talk about how it feels so that they can move past it. Instilling an â€Å"I can† attitude will help them know and understand that they can do anything. Allow Student to Fail Failing is usually never an option in school. However, in today’s society, it just may be the answer to getting our children to be independent. When a student is practicing balancing on a beam or they are in a yoga position and they fall down, don’t they usually get back up and try one more time, or until they get it? When a child is playing a video game and their character dies, don’t they keep playing until they get to the end? Failure can be the pathway to something much bigger. As teachers, we can give students room to fail, and allow them to learn to pick themselves up and give it another try. Give your students a chance to make a mistake, allow them to struggle and let them know that it is okay to fail just as long as they get back up and try again. Study Leaders and Role Models Take time out of your busy curriculum to study leaders and role models who persevered. Study people like Bethany Hamilton who got her arm bitten off in a shark attack, but continued to compete in surfing competitions. Find a real-world example of perseverance that will help your students understand that people fail and go through hard times, but if they pick themselves up and try again, they can do anything. Get Students to Believe in Themselves Give students positive affirmations that they can do anything they put their mind to. Let’s say that one of your students is failing one of their subjects. Instead of telling them that there’s a chance that they will fail, build them up and tell them that you know that they can do it. If the student sees that you believe in their abilities, then they will soon believe in themselves too. Teach Students to Pull Themselves Out of a Negative Mindset If you want a classroom where your students are self-directed learners then you must get rid of the negative thoughts and beliefs that are in their head. Teach students to see that their negative thoughts are only holding them back from where they need to be or want to go. So then, the next time your students find themselves in a negative mindset, they will be able to pull themselves out of it all by themselves and be mindful of their actions and thoughts. Give Current and Frequent Feedback Try giving students feedback as soon as possible, this way your words will resonate with them, and they will be more willing to make changes if needed. By giving immediate feedback then your students will have the opportunity to implement your suggestions right away and make the changes they need in order to be a self-directed learner. Bolster Students Confidence Bolster your students’ confidence by discussing their strengths and their abilities with them. Find something about each and every student that you can celebrate, this will help boost their confidence. Confidence building is a known way to increase students’ self-assurance and make them feel more independent. Isn’t that what a self-directed learner is? Teach Students How to Manage their Goals In order to promote a self-directed classroom where students are self-reliant then you must teach them how to manage their own goals. You can begin by helping students set small, achievable goals that can be achieved fairly quickly. This will help them understand the process of setting and achieving a goal. Once students grasp this concept, then you can have them set more long term goals. Learn Something New Together To help cultivate a classroom where students learn independence then try learning something new together as a class. Students will learn by observing the way you learn. They will watch you learn through your techniques, which will help them get ideas on how they can do it on their own. Give Your Students a Voice Your classroom should set the stage for students to feel comfortable enough to have a voice. Make your classroom environment a place where students are free to speak their minds. This will not only make them feel more empowered, but also help them feel like they are part of a classroom community, which will help bolster their self-confidence, and in turn, help them become more independent learners.

Sunday, February 16, 2020

Politcal Science Essay Example | Topics and Well Written Essays - 500 words - 4

Politcal Science - Essay Example The global political economy is mostly concerned with the political forces shaping up the systems where economic interactions are detailed. The global political economy centers itself specifically on the debate regarding the globalization regimes, the international trade mechanisms, the global markets, the financial discussions, the socio-economic climates within the world, and so on. The concept is a new one as it was brought to light in the 1970s. Its origin was due to a heterodox approach towards the global studies during this era. It occurred somewhere between the 1973 world oil crisis and the Bretton Woods system breakdown which put a red alert on the face of academics within the United States of America in terms of economic foundations, contingencies and importance elements. The global political economy bases its origin upon a few scholars, most noteworthy of which is Eugene Low who described that earliest studies of international relations had emphasized a great deal on the excessive discussion of law, diplomatic history and politics (Viotti & Kauppi 2006). It was at the same time when neoclassical economics was being seen with a skeptical eye as it was accused of being ahistorical as well as abstraction. The origin drew heavily on the historical sociology as well as the economic history where the global political economy proposed a merger of economic and political discussions and the related analyses. Both the Marxist scholars as well as the global political economy ones protested against the dependence of Western social science towards the territorial state as being the unit of analysis and more than that focused on the adoption of a global system in place. The current political economy is such that there is immense room for growth and advancements within the different nations of the world. What is needed now is a concerted effort on the part of each and every player so that the international domains become quick

Sunday, February 2, 2020

Short and long term returns on overseas market Essay

Short and long term returns on overseas market - Essay Example Many firms, like large oil or chemical companies, operate in industries with large economies of scale and their operations spill across national boundaries simply to be competitive. Cost considerations (e.g. transport) are important in choosing whether to increase exports or invest overseas. Equally tariff barriers to trade can encourage direct investment, but non-tariff barriers are also important. Many services are not exportable in any direct sense and have to be delivered in the overseas market through direct investment. They need to respond to the changing demand considerations of overseas markets - especially where product specifications are different from the home market. This may make it sensible to locate closer to the main centres of demand, to enable easier adaptation without disruption to production in the domestic market. Other disincentives to direct trade could be that competition takes place on grounds other than price and quality of output. For example, competition in some product markets may be mainly in terms of after sales service. Most direct investment, as with trade, occurs between similar industrial countries. direct investments will take place without displacing trade. They may even encourage greater trade flows, because intermediate inputs of production will need to be exported to support the overseas plants. In this instance, as in some others, direct investment is complementary to trade. On other occasions, it may substitute for it. Another explanation for overseas investment with parallels in trade theory is a version of the "product cycle" theory. Here production initially begins in the domestic country where the product was developed, with good access to the skilled designers and technicians responsible for "inventing" the product. As the product matures, these inputs become less important and production shifts to a country with a cost advantage in the production of the now standard good. Production overseas is cheaper and goods are exported back into the domestic economy. A further explanation for firms' investment in a foreign market rather than exporting goods to it is that there are external benefits (or spillovers) from overseas investment. These are most likely to stem from location in markets which set trends in demand, or are the "centers of excellence" in terms of production techniques, design, marketing or organization. Why overseas investment The prime motivation for investment in the international market must be that the stream of earnings is expected to exceed that which could be earned in the domestic markets. This could often be attributed to lower production costs in other countries. This investment will ultimately benefit the economy as a whole. The stream of income from overseas investments changes the composition of the current account of the balance of payments. Most directly, it does so by increasing the economy's earnings from abroad. But it may also indirectly promote a net trade improvement. Portfolio Investment In portfolio investment, there is no attempt by portfolio investors to actively control the management of a firm, rather it aims to seek out

Saturday, January 25, 2020

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