Louisiana Historical Sites Article Example | Topics and Well Written Essays - 1250 words

Louisiana Historical Sites - Article Example Added to the National Register of Historic Places in 1979, the Centenary State Historic Site holds some of the buildings of the College of Louisiana, which opened in 1826 at Jackson. Though it was not a successful college, with only 24 men graduating from it, however, during the Civil War the buildings of the college were used by both factions. The Union soldiers used it as their area headquarters, whereas the Confederate troops used it as a hospital. This site is historically significant because it gives a glimpse into education in the 19th century, as well as the early history of Jackson and its foundation, and, finally, into the medicine practiced during the Civil War. Established as a military outpost, Fort Jesup, or Cantonment Jesup as it was originally called, operated from 1822 to 1846. The Fort was placed at the Neutral Strip, which was created because of a dispute between Spain and the United States arising out of the Louisiana Purchase – the land in contention was proclaimed a Neutral Strip with no interference or presence of the armed forces of either country. However, Texas was won over by the United States, the fort was rendered unnecessary. Even though only a kitchen remains of the original structure, however, the reconstructed site renders insight into what life was like at the outposts. As the soldiers there were involved with the American settlers, the visitors can also learn much about how the lands were surveyed, roads built and treaties negotiated during those days. The Locust Grove State Historic Site consists of a cemetery which was owned by the sister of Jefferson Davis, Anna E. Davis Smith, and her family. Some semi-famous people from history are buried here. The daughter of General Zachary Taylor, who was the first commander of Fort Jesup, is also buried here, as is General Eleazer Wheelock Ripley who served in the war of 1812. The visitors to the site can learn about the cemeteries of 19th

The Man Who Walked Between the Towers Essay Example for Free

The Man Who Walked Between the Towers Essay Mordicai Gerstein was born November 24, 1935 in Los Angeles. He attended the Chouinard Institute of Art before moving to New York City where he lived and worked for twenty-five years making animated films for television. He tells on his official website, that he never thought to be something else but a painter, when he grows up (http://www. mordicaigerstein. com). To support his family, he designed and directed animated television commercials. In the mid 1960s he made some films of his own until 1970, when he met Elizabeth Levy, who asked him to illustrate for a children’s book she has written. Encouraged by her and other editors, he started to write his own books in 1980s. In 2004, he received the Caldecott medal for his book â€Å"The Man Who Walked Between the Towers. † Besides the Caldecott medal, he received numerous awards such as AJLA SidneyTaylor Award in 2005, Hornbook Award in 2004 and was chosen as the gold award winner of parents’ choice in 2002. His works include among others Sholom’s Treasure, What Charlie Heard, The Wild Boy, The Mountains of Tibet and many more. Mordicai Gerstein is also a painter, sculptor, and prize-winning designer and director of animated films. Mordicai Gerstein lives in western Massachusetts with his wife, Susan Yard Harris, who is also an illustrator, and their daughter, Risa (http://www. mordicaigerstein. com). The Man Who Walked Between the Towers Narrative Consideration In 2003, Roaring Brook Press published Gerstein’s children’s book â€Å"The Man Who Walked Between the Towers. this story opens, French aerialist Philippe Petit is dancing across a tightrope tied between two trees to the delight of the passersby in Lower Manhattan. Gerstein places him in the middle of a balancing act, framed by the two unfinished World Trade Center towers when the idea hits: He looked not at the towers, but at the space between them and thought, what a wonderful place to stretch a rope† (Gerstein, 2004, p. 4). The rising action takes place when Petit knew that the police and the owners of the towers would never allow him walk across the two towers. So he and his friends disguised as construction workers, carried a 440 pound reel of cable and other equipment on an August evening, causing the conflict in this story. After carrying everything up to the roof, Petit and his friends tied the line to an arrow and shot it from one tower to the other and tightened it. After the dawn he started to walk on the wire and the story has reached its climax. He was arrested and was sentenced to â€Å"perform in the park for the children of the city† (Gerstein, 2004, p. 25). This story ends with the picture of the World Trade Center which is long gone now. Based on the narratives, this book contains characteristics of a good plot since it includes â€Å"a beginning, a middle, and an end. The beginning should quickly engage the reader’s interest (†¦) established by using characters and a conflict that the reader can relate to and care about. The conflict should grab the attention of the reader and create a desire to find out what happens† (Sawyer, 2012, p. 84). Gerstein’s story definitely encompasses this concept. The main character, Philip Petit is captivating and fascinating. His courage and stubbornness can be detected throughout the story. Sawyer (2012) mentions in his textbook that â€Å"a good author will let the reader know the personality and motivation of the character through the character’s thoughts, words, actions, language, and expressions (†¦) the character may change and grow, but the basic portrayal must remain intact† (p. 78-79). Petit’s character certainly remains consistent throughout the story and provides the reader with the feeling of intensity and even personal closeness to Petit himself, while following his actions closely. Interestingly, this mesmerizing story has a real hidden theme which is the 9/11. Using Petit’s character as the medium, Gerstein addresses the effect of the tragedy happened ten years ago. This enables the story to evoke different emotions in readers and offers the opportunities to tackle different topics depending on the level of understanding and maturity of a child. Art Consideration â€Å"In picture books, the illustrations play a key role in conveying the message of the story† (Sawyer, 2012, p. 93). This can be seen in this book. The story is masterfully illustrated using pen and oil colors. Gerstein’s drawing is dramatic and even reckless. This is especially suitable for this story as the plot itself is full of suspense. As the conflict arises and is reaching its climax, the pacing of sentences decreases and eventually becomes a single sentence in order to draw the attention from the readers to the illustration and to increase the expectancy. In its climax, the text completely disappears and a small, framed close-up of Petits foot on the wire yields to two three-page foldouts of the walk. One captures his progress from above, the other from the perspective of a pedestrian. Even though the text is not placed consistently on the same line, they are simple and short enough to follow and are always synchronized with the pictures. The illustration is mesmerizing in its color which matches to the different mood as the events take place chronologically. â€Å"The final scene depicts transparent, cloud-filled skyscrapers, a man in their midst. With its graceful majesty and mythic overtones, this unique and uplifting book is at once a portrait of a larger-than-life individual and a memorial to the towers and the lives associated with them† (www. amazon. com). Overall analysis After reading this book, I had mixed feelings. First of all, I strongly feel that this targets readers at the age seven and above. The reason is first of all the theme which addresses the 9/11. It is a tricky and difficult topic for children to understand as any tragedy can be. Second reason is the moral of the story. Even though the Caldecott award does not necessarily focuses on the moral or any educational intentions, I did not agree with Petit’s actions. After reading the book, I automatically assumed that the story encouraged the reader to follow any goal they have whether it is ethical or not. The main character even gets away with his rule-breaking action without any punitive consequences. It is clear that his action is an admiration for his profound commitment to his own â€Å"mission† and his willingness not to limit his life according to the constraints set up by society. However, this book not only depicts but even seemingly glorifies deceits and it can be alarming for authoritative figures such as us future teachers. One can argue that it is inspiring to observe someone having such tremendous control of their body and mind with determination. Nonetheless, the way this book comes across can be defiant of authority especially of the police, given that there were many policemen who came to serve alongside the firemen during/after 9/11. Perhaps this book will be a good tool to discuss these issues. In conclusion, despite my disagreement with the moral of the story, I have to give props to the author/illustrator for his skilled and entrancing story and drawings. It is, without doubt, a very interesting story and something that can be conferred in depth. In this regard, I think this book does deserve the Caldecott medal. Although I did not think this book was suitable to read to my children, if used wisely by knowing their level of maturity and understanding, this book can be utilized effectively to help them think for themselves. In his acceptance speech in 2004, Gerstein emphasized this by saying â€Å"children do need adults; I think it’s children that make us become the adults they need. We must give them love and nourishment and books, which, as we know, are part of a healthy diet. My intention in all my books is to give children just what I want to give everyone: something beautiful, magical, funny, and soulful: something that provokes good questions: questions about what an incomprehensible, beautiful and seemingly impossible thing it is to be a human being in this incomprehensible, beautiful and seemingly impossible world. What could be more difficult and more wonderful? † (http://www. mordicaigerstein. com) I hope that he follows through with this philosophy and continues to create children’s book based on this regard.

Comparing Joseph Conrads Heart of Darkness and Francis Ford Coppolas

Parallels Between Conrad's Heart of Darkness and Coppola's Apocalypse Now      Ã‚   Apocalypse Now is a very vivid and sometimes disturbing film centered on the Vietnam War. Because it was based on Joseph Conrad's novella Heart of Darkness, it is possible to draw some parallels between the two. Both can be interpreted as metaphors for a journey through the inner self, and each has its own singular message to convey. Apocalypse Now very perspicuously depicts the fact that men have hearts of darkness, and it explores the evils of war. At the same time, however, it seemingly glorifies some aspects. The anti-war sequences were often brutal and portrayed destruction as a result of the human condition. The film Apocalypse Now, directed by Francis Ford Coppola, can be interpreted both as pro-war and anti-war in its intent, although the latter is a more valid interpretation.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Apocalypse Now, graphic and disturbing, vividly depicts the true image of war. Coppola and his cinematographer, Vittorio Storaro, presented a series of visually stunning images throughout the film that made it impossible for the viewer not to contemplate the Vietnam War, its purposes, and its shortcomings. These images also lead the audience to an anti-war sentiment. One of the first images that depicts the anti-war disposition was the series of visuals presented during the film's opening sequence, as Captain Willard, the protagonist, is shown in his hotel room in Saigon. A song titled "The End," by The Who, is played as images of helicopters flying overhead and exploding bombs flash across the screen. Willard is first shown lying on the bed and staring at the ceiling fan, which frequently merges with the helicopter blades. Later he is shown, wea... ...ess, 1981. Conrad, Joseph. Heart of Darkness & The Secret Sharer. New York: Penguin Books, 1978. Fortmeyer, Russell. 'Apocalypse' cast filled with rage http://collegian.ksu.edu/issues/v099B/fa/n022/a-e-apocalypse-fortmeyer.html created 1994 (accessed 23 Jan. 2000). Heart of Darkness. Dir. Nicolas Roeg. Turner Network Television (TNT) Pictures, 1994. Heart of Darkness: Theme/Symbol/Allusion/Foreshadow http://164.116.90.3/public/jarvinen/hod.html (accessed 21 Jan. 2000). Nash, Jay Robert, and Stanley Ralph Ross. "Apocalypse Now" The Motion Picture Guide. Chicago: Cinebooks, 1985. Urch, Martin. Apocalypse Now: A film review by Martin Urch http://us.imdb.com/Reviews/30/3030 created 1994 (accessed 29 Jan. 2000). Virtanen, Panu S. Plot summary of 'Apocalypse Now' http://www.geocities.com/Hollywood/9067/plot.html (accessed 16 Jan. 2000).

Islamic Art and Architecture; Influence and Effects Essay

Introduction During the reign of the Ottomans, Safavids, and Mughal rulers, architecture and art took on more meaning than it had in the past. The types of architecture and manuscript writing have had both symbolic significance and influence on the people of these empires. The architecture can be said to have had the greatest impact on the presence of power and devotion to Islamic arts of all of the empires, while manuscripts were held privately until trends influenced their spread over greater distances and people. The Ottomans, in their quest to expand their lands and influence, conquered Constantinople in 1453, which sparked a major period of construction in the new capital of the Ottoman Empire. This large building initiative took place in order to encourage a repopulating of Istanbul, as well as the revitalization of the economy in this declining city. The buildings and complexes the Ottomans built shed an interesting light on their concerns and ideals. For example, while the complexes were mainly built as places of worship, they took on other roles, such as, centers for education, commerce, and hospital care. One complex is clear in its intentions to the public, as can be seen by the endowment deed, which read â€Å" to elevate matters of religion and religious sciences in order to strengthen the mechanisms of worldly sovereignty and to reach happiness in the afterworld†, (Bloom & Blair, 298). This combination of buildings in a complex format drew people from the old capital and cities of the empire, and generated revenue that amassed into fortunes for the rulers of the Ottoman Empire. The Ottomans, however, were not the only empire to enjoy great wealth and displays of that wealth. The Mughals, who descended from the same Turkish conquerors as the Ottomans, also enjoyed prosperity from great building projects. The architecture of the Mughals was able to change with great regularity during its time, due to the constant movement of the central government. The Mughals also benefited from a blend of styles and influences to create their palaces. The most famous example of Mughal architecture was the Taj Mahal, which was built in the memory of a deceased favorite wife. In the building of temples and tombs in Mughal history, it is quite common to find them built as reminders to the community of saints, heroes, or loved ones. It was  also common to find that they lacked as muc h fine detail as their neighbors to the west, but brought new styles to the architecture derived from the rich traditions of the people of India. Unlike the Ottomans and The Mughal, the Safavids were derived from the family lineage of Mohammed the prophet. Despite this difference, the Safavids built great temples and complexes for similar reasons. The Safavids built great complexes, and like the Ottomans, they moved their capital to a centralized location in order to centralize power, and increase commerce. The Safavids also shared another trait in building with the Ottomans. They both had a strong emphasis on education, and liked to keep a watchful eye over it. For this reason, religious complexes often included the highest forms of education for both the government and the religion of Islam. Though in competition for much of their histories, the Ottomans and Safavids adhered to many of the same architectural styles, with one major difference. Due to their difference in branches of Islam, the Safavids, unlike their Sunni neighbors the Ottomans, had little problem with diverging from traditional customs of avoiding the use of depictions of animals and people in their design. This proved to enhance the appearance of the buildings, but also give them a unique place in the history of Islamic buildings. Manuscripts, on the other hand, have a very different history than do the magnificent buildings of the Islamic world. In the Ottoman Empire, as was true of most of the Muslim world, the Koran was the most copied manuscript. Copies of the Koran were reproduced with astonishing art, but were usually given as gifts to other rulers. In this system, the common person was excluded from viewing the finest manuscripts. Common manuscripts were produced by artisans, but lacked the high quality of that of the royal courts. The Ottomans also used their talents to reproduce manuscripts that depicted great rulers and events in history, as well as topography paintings that displayed the prominence of conquest in the Ottomans daily life. Ottoman manuscripts were not as popular or unique as the ones created by the Safavids or Mughals, but they did posses superiority in the ar t of calligraphy. Manuscripts from the Safavid and Mughal empires possessed greater detail in art, but most of the calligraphers were not as skilled as those of the Ottoman Empire. Despite this lack of good calligraphy, the Safavids and Mughals were more skilled in art and design. Like the Ottomans, the Mughals and Safavid empires copied  the Koran at a high rate, but only the best works of art were given away as gifts. This lack of quality reproductions, which included not only writing, but also painting, led to the decline of the bound book. This decline led to the development of an industry of artisans creating single manuscripts. These manuscripts allowed for both artistic differences that were hard to avoid in large manuscripts, and it allowed more people to posses art. They were collected into books, but they had a greater impact on both the people of the Muslim world and the Europeans, who were exploring the area heavily in search of people to colonize. The arrival of the Europeans also led to a decline in the production of small manuscripts, due to the fact that the printing press and mass production of books were arriving in Europe. Conclusion Islamic art and architecture both had more than one use in Islamic life. The architecture reminded the people of saints, great rulers, martyrs, or beloved figures, as well as serving as a center for religion, education, commerce, and medicine. The art of the Islamic world was originally used to tell of battles, heroes, and most popularly recreate the Koran. Art also allowed for the growth of writing, painting, and the distribution of ideas over greater distances than the spoken word. Both Islamic art and architecture still hold as reminders to Muslims and the world that great rulers, conquerors, and artists have made a lasting impact on the region and its culture.

Mitchell’s Gone With the Wind

Margaret Mitchell’s celebrated novel Gone With the Wind weaves a wonderful love story that happened in the eve of the American Civil War. Almost everyone has known the two lovebirds named Scarlett O’Hara and Rhett Butler, whose tempestuous love affair and memorable lines popularized in the film version of the novel. The Civil War background, the pathos of the South’s defeat, the poverty and suffering (with its clear parallels to the 1930s depression) and eventual economic triumph of Scarlett, so cheering to readers with little to feel cheerful about, and then the â€Å"realistic† ending with its bitter-sweet parting of Rhett and Scarlett, contained more excitement than a dozen lesser novels. All readers are enthralled about the details of how the Southern life runs, the humor, the dozens of colorful minor characters all presented in competent and flowery prose. Definitely, it is a must-read novel for love story fanatics who don’t mind to get a strong dose of American history to go along with the love affair of the main characters. Actually, Gone with the Wind is not solely a love story because it is considered as a coming-of-age story of Scarlett O’Hara. At the novel’s opening in 1861, Scarlett O’Hara is a sixteen-year-old Southern belle, when it concludes in 1873 she is a twenty eight year-old woman. Millichap (1994) recounted that in the twelve year span of the novel, Scarlett â€Å"experiences Secession, Civil War, and Reconstruction, as well as romance, love, marriage, and motherhood. Scarlett lives through the adolescent trauma of American culture, which is matched by a traumatic personal history as much or more tumultuous†. She was fuelled by her own life and that’s why â€Å"Mitchell created one of the most arresting tales of troubled adolescence in American literature and in so doing created a novel which will continue to captivate teenagers and fascinate their teachers well into the next century†. The relevance of this novel in American history is that Scarlett is caught up in the historic period like the Secession, Civil War, and Reconstruction that we all studied in our history class. When the Southwest was defeated during the Civil War, the huge plantations were destroyed and the slaves were freed. This prompted plantation owners to suffer greatly from their downfall. The American Civil War also interrupted cotton supplies that had disastrous effects in the United States. The Great Hunger of the 1840s was a time of agrarian crisis and industrial slump. We can all experience these parts of American history as readers go through the life of Scarlett O’Hara. By reading the novel, we can see the events that transpired during these periods through the eyes of a woman struggling to redeem herself from all the difficulties brought about by the events that happened. In this way, readers can learn about American history when reading the novel as these were intertwined with the life of the heroine in the Mitchell’s novel. For younger readers, Scarlett O’Hara’s development from teenaged girl to mature woman proves as fascinating now as it did when the book was first published in 1936 or when the movie first appeared in 1939. The particular, indeed peculiar energy of the story proceeds from Mitchell’s own girlhood, adolescence, and young adult life. During these years she heard the family legends of the Civil War era into which she projected her own development toward womanhood. The novel combines Mitchell’s family and personal romances with historical facts to create powerful and popular fiction. Also, it was a great hit during the time of its publication because many people can relate it to the Great Depression that happened in the 1920s. As Beye (1993) writes: Gone With the Wind was published in the depths of the Great Depression. The years of the Depression were followed by the Second World War. It is not hard to see how it spoke to an American audience of that period. The economic and social disaster that the Civil War brought to the white aristocracy of the old South is a good metaphor for the economic and social dislocation that millions of ordinary Americans experienced between 1936 and 1946. Suddenly vast numbers of people were devastated by hunger, homelessness, and joblessness. Often, however, they were also freed from middle class gentility; women especially were freed from propriety; classes were mixed up; immigrant groups became richer and freer in the experience of America; war made women independent of men as never before. Reading the book was an awe-inspiring experience, although there are parts that can be dragging. All in all, the love story was quite enthralling indeed and readers can both enjoy the plot of the story and take a slice of American history without a sweat. Works Cited Beye, Charles Rowan. â€Å"Gone with the Wind, and Good Riddance, Southwest Review 78.3 (Summer 1993): 366-80. Millichap, Joseph R. â€Å"Margaret Mitchell: Overview†, in Berger, Laura Standley (Ed.), Twentieth-Century Young Adult Writers, 1st ed. Detroit: St. James Press, 1994. Mitchell, Margaret. Gone With the Wind.

Greek Art and Architecture essays

Greek Art and Architecture essays The ancient Greeks created what has become known as classical art. Many of Americas govermental buildings have been designed with classical Greek structures. Greeks are seen by many as the corner stone to the Western traditions of art and ideas. The Ancient Greeks are known for three main items; their sculptures, their temples and their vase paintings. The art work embodies much of what made the Greek civilization great. The Ancient Greeks organized into independent city-states. In these states the ideas of courage, valor and independence where strongly held values. These themes can be seen very clearly in their human depictions. The Greeks idealized humans showing the strong and youthful depiction of men and women. The topics shown in there vases reflect the importance of strength athletic competition and battles. Their temples reflected their Greek life was dominated by religon and so it is not surprising that the temples of ancient Greece were the biggest and most beautiful. They also had a political purpose as they were often built to celebrate civic power and pride, or offer thanksgiving to the patron Question: What changes have been made since early and modern Greece? The importance of Greek art and architecture for the history of Western civilization hardly be overstated, for the Greeks established many of the most enduring themes, attitudes, and forms of western culture. The stories told in Greek art and literature of gods and heroes have been retold ever since and continue to form common ground for the art, literature, and even popular culture of the western world. The Greeks developed three architectual systems, called orders, each with their own distinctive proportions and defailing. The Doric style is rather sturdy and its top (the capital) is plain. This style was used in ma ...

Medical curriculum conclusion Essays

Medical curriculum conclusion Essays Medical curriculum conclusion Paper Medical curriculum conclusion Paper The curriculum developed for the health care institution will focus on three core areas of medical practices – Providing an interactive learning environment, exposing the internee’s to both the academic and practical aspect of medical practice, and enabling the transition of senior students nurses from academic environment to real time hospital services. Interactive learning environment will be provided to through providing exercises to the students where they not only required to work alone but with team under the mentor to understand the nuances of the job, priorities under certain situation and reaching out to patients. Learning environment will be created not only by putting the students into real time situation but making them understand the whole picture. The whole picture will be presented through them making under work under a mentor, evaluating performance, providing presentations and various other dossiers regarding how performance can be improved. Doing medical procedure under the watchful eye of a mentor and finally reviewing the performance both academically and practically with the mentor. The new curriculum will not only foster creative thinking and new solution but also groom the senior nurses’ student to make the transition. It will enable this transition by not putting them straight into the hot water but by making them to go through trenches in a step wise process.

How to Use the Italian Verbs Sapere and Conoscere

How to Use the Italian Verbs Sapere and Conoscere â€Å"I know how to play the piano† and â€Å"I know him.† While the main verb â€Å"to know† in those two phrases doesn’t differ in English, it does in Italian. In fact, the two verbs you would use would be either â€Å"sapere† or â€Å"conoscere.† Both mean to know, but have different implications. Sapere means to know† in the sense of to be able to, or to know how to. It can also be understood as knowing about a situation or a fact, like â€Å"Non sapevo che tu fossi qui. - I didn’t know that you were here.† Conoscere, on the other hand, means â€Å"to know† in the sense of â€Å"to know someone† or â€Å"to know an area, town, restaurant, etc. Examples With Sapere  in the Present Tense Non so sciare. - I don’t know how to ski.So cantare. - I know how to sing. / I am able to sing.Non lo so. - I don’t know.Non so la risposta giusta. - I don’t know the right answer.Lei sa quando il treno arriva? - Do you know when the train arrives? (formal)So la lezione. - I know the lesson. TIP: The last example could also be used with the verb conoscere: â€Å"Conosco la lezione. -  I prepared for today’s lesson.† Using Sapere in Other Tenses (Il condizionale) Credo di sà ¬, ma...non saprei. - I believe so, but...I wouldn’t know.(L’imperfetto) Sapevi che Marco frequenta qualcuno? - Did you know that Marco is dating someone?(L’imperfetto) Non sapevo che tu volessi imparare l’italiano! - I didn’t know that you wanted to learn Italian! TIP: If you want to say something like â€Å"I’m able to speak Italian,† you would use the verb â€Å"riuscire† instead. For example, â€Å"Riesco a parlare bene Italiano. - I’m able to speak Italian well.† Examples of the Verb Conoscere in the Present Tense Non conosciamo Bologna molto bene. - We dont know Bologna very well. / We aren’t very familiar with Bologna.Il ristorante si chiama L’archetto? Mhh, non lo conosco. - The restaurant is called L’archetto? Hmm, I don’t know it.Quel film con Hugh Grant? Quello in cui conosce un’attrice e si innamorano? - Do you know that Hugh Grant movie? The one where he meets that actress and they fall in love? Conoscere in Other Tenses (Il passato prossimo) Ho conosciuto Francesca a casa di Giuseppe. - I met Francesca at Giuseppes house.(Il passato prossimo) Li Abbiamo conosciuti tre anni fa. - We met them three years ago.(Limperfetto) Da bambino conoscevo bene New York, ma tutto era cambiato da quel periodo. - When I was a kid, I knew New York well, but everything has changed since that time. TIP: Unlike the verb â€Å"conoscere,† which means the same thing when conjugated in the present, past, or imperfect tenses, the meaning of â€Å"sapere† changes when in the passato prossimo form. For example, when you say â€Å"Ieri sera ho saputo che lei viene qua. - Last night I found out that she’s coming here.† So, you could define â€Å"sapere† in the past tense as â€Å"to find out.†

Social Marketing Essay Example | Topics and Well Written Essays - 750 words

Social Marketing - Essay Example The selling of social issues has become a business that is in the same league as selling soap or automobiles. The concept got its beginnings when Phillip Kotler and Gerald Zaltman pursued the application of marketing technologies to the realm of social issues and coined the term 'social marketing' (Andreasen 2006, p.89). Social marketing is used by organizations to promote a cause, advocate on a political issue, or change the behavior of the public. Because the technique is designed to change peoples' minds and behavior through the use of advertising, it is met with several obstacles. Social marketing faces the task of fulfilling their objective without the transgression of an ethical approach. Social marketing can be used to modify behavior such as the antismoking campaigns that have been launched on behalf of various health organizations. The National Cancer Institute, a government agency, publishes numerous fact sheets on the methods and benefits of smoking cessation (Fact sheets: Tobacco/Smoking cessation). This information is designed to de-market a product by modifying behavior with the goal of decreasing consumption. Social marketing may also be used to change a corporate image by associating the brand with a social issue or cause. This may be seen when a company donates a share of their profits to a social or philanthropic endeavor. In 1999 Mattel partnered with Girls Inc. through an agreement to promote the girls' organization by including brochures in the Barbie packaging. Though the goals of Girls Inc., which promoted feminist empowerment, were contrary to the long standing image of the Barbie doll, Girls Inc. was anxious to reach millions of potential new members. For their part, Mattel wanted to "...create an enhanced, more relevant Barbie brand through an association with a progressive, girl-focused organization" (Marconi 2002, p.187). As more and more products are sold through socially or culturally based advertising, social marketing has moved beyond the traditional arenas of politics and social activism and into commercialism. Trying to change a person's mind or behavior can be difficult at anytime. Trying to sway public opinion or motivate them to action can be extremely challenging. The organization must be open and willing to undergo intense public scrutiny. The public can be a very sophisticated audience and may tire of a message that is overstated or exaggerated. The Department of Homeland Security's terror threat level system was initially designed to maintain awareness among the public of an impending threat. However, its overuse and the public's suspicion about its validity soon rendered it to an irrelevant position. Nancy Reagan's anti-drug campaign that insisted 'Just Say No' was a failure due to oversimplification. Rose (2005, p.169) calls the Reagan marketing scheme an, "example of a strategic communications failure - not just with the wrong messenger for the intended audience, but with a naive, presumably unresearched, if memorable, message". These unrealistic expectations are the result of at tempting to reach a widely diverse audience with a single concise message. Trying to deal with the challenges facing a social marketing campaign requires that ethical issues be thoroughly addressed. The issue of full disclosure can be difficult to define or to measure what information needs to be revealed. Various stakeholders may have different objectives and standards. American Express has been criticized for their participation in the 'Charge for Hunger' campaign and the campaign to raise money for the restoration of the statue of liberty. Critics contended that American Express spent far more money on their own self-promotion about the campaigns than they spent on the actual issue (Andreasen & Drumwright 2000). Though it can also be said that American Express would have spent the money on advertising anyway, the perceived conflict of interest and motivation are ethical issues that must be addressed when social marketing.

Fair trade for the developing countries Research Paper

Fair trade for the developing countries - Research Paper Example Fair trade mainly exists in developing countries and it targets specific areas, for instance, the Handicrafts, Coffee Industry, Tea Industry etc, it does so in order to make sure that the workers and the producers are benefitted and their economic stature improves by participating in Fair trade. To understand the concept better, its principles should be well understood and they are as follows:â€Å"Creating opportunities for economically disadvantaged producers, Fair trade is a strategy for poverty alleviation and sustainable development. Its purpose is to create opportunities for producers who have been economically disadvantaged or marginalized by the conventional trading system.† The most important principle of Fair trade is to ensure that there are ample opportunities provided to the producer, the sole aim of Fair trade is to ensure the well being of the workers and the producers and in this process the first is to provide opportunities to the producer because only when th e producer has opportunities, it can be passed on to the workers.â€Å"Transparency and accountability, Fair trade involves transparent management and commercial relations to deal fairly and respectfully with trading partners.† Another important principle of Fair trade is to make sure transparency exists in every activity initiated by it, in the sense that every activity initiated by Fair trade should be without any fusses and problems, fair rules and policies are followed hence ensuring the economic and financial safety of the producer.

Scientific Advancement in the 20th Century Essay

Scientific Advancement in the 20th Century - Essay Example Instead of analyzing the problem on scientific basis, they have adhered to their timeworn ideologies with a practical surrender to the materialistic values in vogue. Even the torchbearers, the so-called intellectuals and modern scholars of any religion pretend to be abreast with the modern scientific thought have given in to the onslaught of modern sciences and in secret depths of their hearts feel nervous how to defend their position. They are doing more harms than good by defending their post with archaic weapons. Like the case of William James in his "Varieties of Religious Experience: A Study in Human Nature" wrote: Failure, then, failure! So the world stamps us at every turn. We strew it with our blunders, our misdeeds, our lost opportunities, with all the memorials of our inadequacy to our vocation. And with what a damning emphasis does it then blot us out! No easy fine, no mere apology or formal expiation, will satisfy the world's demands, but every pound of flesh exacted is soaked with all its blood. The subtlest forms of suffering known to man are connected with the poisonous humiliations incidental to these results. And they are pivotal human experiences. A process so ubiquitous and everlasting is evidently an integral part of life. 'There is indeed one element in human destiny,' Robert Louis Stevenson writes, 'that not blindness itself can controvert. Whatever else we are intended to do, we are not intended to succeed; failure is the fate allotted.' And our nature being thus rooted in failure, is it any wonder that theologians should have held it to be essential, and thought that only th rough the personal experience of humiliation which it engenders the deeper sense of life's significance is reached (Varieties, p. 138) The main reason of this fall to dishonor and disdain, is the writer's indifference towards scientific disciplines. It has put among the tail-enders in the world. An in-depth inquiry of human history reveals that our forefathers disseminated thought and philosophy to the whole world and founded numerous scientific disciplines. Had our forefathers not accomplished their pioneer work in the field of empirical sciences, the contemporary scientific disciplines could never have developed into their present status. They dawned in the words of William James and others1 with wisdom on the Western thoughts and drowned in murk and darkness of ignorance. This philosophy amply fled on our illuminating heredity. And we spared everything witlessly. The science is advancing by leaps and bounds. As shown in the William work, he was rightly proud of his superior evolutionary status among the comity of nations. As he keep the poor and the deprived dependent and subdued, he also intended to see the other religions under their subjugating authority. His philosophical thought and civilization is eating up geographical distances and the world spread over millions of miles has been reduced to Global village. Owing to scientific progress, deserts are being transformed into meadows and fertile fields. The mineral wealth is drawn to one feet. Scientific knowledge has enabled to bring all the natural sources under human control and consumption. This is, however, tragic to note that his scientific approaches are adamantly bent upon keeping the backward nations dependent and subdued. In this regards, the minorities are well-defined target. Like

Wind Power generation station in England Essay Example | Topics and Well Written Essays - 3000 words

Wind Power generation station in England - Essay Example Project Management refers to the various types of activities that involved in Planning, Categorizing, Securing and organizing various resources to accomplish a specific aim. The primary challenge of project management is to accomplish all of these aims and goals of the project, taking into consideration of known and unexpected contingencies. So that it is the duty of the project manager to study about the environmental aspects of area before launching a project. Here our company is planning to build a new Wind Power generation station in England. The United Kingdom is the 8th biggest manufacturer of wind power in the world. The current installed capability is over 5.9 gigawatts. And also after biogas UK is the 2nd highest source of renewable energy. As of 2012, there are in excess of 300 wind farms working in the UK, with installed capability of 5953 MW and 3956 turbines. In a sustainable atmosphere, the rate of use of natural sources of energy by person activity is below the capabil ity of natural world to replace them. Environmental sustainability plays most significant role in the overall accomplishment of the project. It facilitates companies to be able to accomplish energy effectiveness and obey with environmental policy governing carbon emissions. Environmental sustainability helps to reduce the production cost so that it will help to increased financial gains. The ability to recognize the key sustainability associated knowledge plays a significant position in leading change in the directions of sustainability. â€Å"In today’s fast-paced economy, an organization’s knowledge base is quickly becoming its only sustainable competitive advantage. As such, this resource must be protected, cultivated, and shared among organizational members .Knowledge is required for more effective and efficient management decision-making regarding sustainability issues† (Egbu & Renukappa n.d., p. 290). To develop organizational sustainability- associated pe rformance, project manager have to make out and better comprehend the key sustainability- associated knowledge assets obtainable in and across companies. It is significant for companies to recognize the key drivers previous to executing sustainability- associated knowledge management programs. If companies do not completely understand what drives the requirement for organizing sustainability- associated knowledge, they may fall into the trap of generating an incompetent knowledge management policy and operational plans. The study includes aim, objective, methodology, discussion and various key issues and challenges faced to start the wind power station. Managing change associated with environmental sustainability initiatives, leading and managing change in sustainability, and also some challenges -impact of initiatives on competitiveness also incorporated in this study. Background of the Study: A growing stream of study demonstrates that the adoption of environmental and communally sustainable skills and practices are, at a smallest amount, cost neutral and frequently put aside public agencies and private organizations substantial sums of cash at the same time as rising market share, decreasing risk, increasing worker productivity and stakeholder dedication. It is no surprise then that a rising number of companies have embraced the thought of sustainability in the last decade. Environmental sustainability must be a key consideration in the organization of every government buildings. And also agencies have a key position to supporting this plan for the period of the planning, operation, manufacture, preservation and removal of government buildings by decreasing negative environmental impacts and guaranteeing services to the society are resistant to environment change. â€Å"Using environmentally sustainable practices for the management of government bui

Business Environment Assignment Example | Topics and Well Written Essays - 2000 words

Business Environment - Assignment Example In addition, the current economic, political, social and environmental factors significantly determine the organizational structure as well as financial performance of businesses. In order to address the needs of all the supply chain partners including the producers, manufacturers, wholesalers, retailers, employees and customers among others, companies have embarked on creating an environment that enables the participation of all the stakeholders. This paper keenly analyzes how the current economic situations have shaped the operations of Coca-Cola and Body Shop Companies in the local and international markets. Coca-Cola Company Coca-Cola Company is an American based firm that is headquartered in Atlanta. Being the market leader in the soft drinks industry, Coca-Cola specializes in the production of wide range of non-alcoholic beverages. The company operates in more than 200 countries. In order to meet the demands of all its customers, Coca-Cola has wide range of products that include Coke, Nestea, Fanta, C2 Cola, Dasani water and Sprite among others. The purpose of Coca Cola is outlined in its mission that include creating customers value and making a difference, refreshing the world as well as generating moments of happiness and optimism in the contemporary world. In the same way, the company aims at involving its partners including the bottling companies in its global operations. Ownership of Coca-Cola Company Coca-Cola is a public limited company. This means that for an individual to own a share of the company he or she should buy the company’s stock. In its effort to strengthen its capital base, Coca-Cola shares are quoted in various stock exchanges that include New York Stock Exchange, Chicago, Philadelphia, Boston as well as Pacific (George 9). Responsibilities The responsibility of Coca-Cola is to instigate healthy living among its consumers and members of the public in general. In order to achieve its objectives, the company has undertaken various corporate social responsibilities including sponsoring of Olympic Games in Canada and Vancouver among other places. In addition, the company is focused at improving the environment through adoption of various initiatives such as the use of recyclable bottles and reduction of footprints within its premises and surrounding environment. Organizational structure In order to effectively serve its large number of customers, Coca-Cola has established various market segments which include Latin America Group, Far East and Middle Groups, North America Groups, Europe Groups, Minute Maid Company and the African Group (Aaker 26). The well experienced human resources under the leadership of Muhtar Kent, the company CEO has led to high sales and increased profitability in the international market. The corporate human resource is responsible for designing of procedures and policies that are followed by the company. On the other hand, the duty of local human resources department is to implement the various human resources systems that are put in place by the company. Shareholders and Shareholders objectives Being a limited company, Coca-Cola does not restrict members of the public from being its shareholder. As mentioned earlier, the company stocks are sold in various exchange ma rkets thus allowing high number of investors to be part of the company ownership. The main objective of the Coca-Cola shareholders is to attain high returns on their investments. Similarly, the shareholders aim at increasing their quarterly dividend. In order to meet the objectives of the shareholders, Coca-Cola uses the services of

Search and Rescue in Residential Fire Structures Research Paper

Search and Rescue in Residential Fire Structures - Research Paper Example It is vital to the safety of our society that researchers continue to enhance the technologies that allow fire fighters to do their jobs in the safest and most effective fashion possible, especially those working in residential structure fires and residential search and rescue. Residential structure fires are responsible for approximately two to three thousand civilian deaths per year since 1997, but these numbers have been dropping due to improved fire prevention education, early fire detection, and fire suppression technologies being used, and also the improved technologies and equipment available for search and rescue efforts (USFA, 2008). These search and rescue technologies fall into two major categories: those devices that make it easier for fire fighters to find and save those victims trapped within a burning building and those technologies that protect the fire fighters' own lives, which indirectly will save even more lives than the direct equipment. Technologies that allow f ire fighters to rescue those victims who have been trapped within a burning building mainly include those which allow the rescue workers to find those individuals more quickly. The primary and most impressive piece of equipment in this category is the thermal imaging camera. A thermal imaging camera helps the fire fighters to see people more easily through dense smoke or haze, by analyzing the image of a trapped figure and â€Å"convert[ing] the 'thermal signature' to a visible image† (Marlow Industries Inc, 2008). These cameras are able to convert the most minute differences in the temperature of objects into a visible light image for the fire fighter using the camera to view, and they work even in complete darkness as they do not require any ambient visible light to resolve the images (FLIR Commercial Vision Systems, n.d.). This combination of processes means that a thermal imaging camera can be used by a fire fighter to look into a dark or smoke-filled room and determine i mmediately if there are any people within the room who need to be evacuated from the building. The image will also show the fire fighter if there are any flames or ignition sources within that room (FLIR Commercial Vision Systems, n.d.) Such cameras work by visualizing an image using infrared radiation instead of visible light sources. They are able to produce images at high resolution through heavy smoke due to the fact that the infrared radiation used has a longer wavelength, reducing scattering off of particulate matter in the air. (FLIR Commercial Visions Systems, n.d.). Some cameras are even able to transmit these images to a commander outside the building, allowing him or her to better control the situation within the building based on the real-time data being received (Santa Clara County Fire Department, â€Å"High-Tech and Specialized Equipment, n.d.). These cameras are also sometimes of adjustable sensitivity, to allow for varying temperature ranges in the space being view ed. They can be more sensitive for narrow temperature ranges, such as looking into a hot room, and less sensitive cameras for situations where temperatures vary more widely, such as trying to locate an individual in a smoky but relatively cool room (Amon, Bryner, & Hamins, 2005).

Business Environment Assignment Example | Topics and Well Written Essays - 2000 words

Business Environment - Assignment Example In addition, the current economic, political, social and environmental factors significantly determine the organizational structure as well as financial performance of businesses. In order to address the needs of all the supply chain partners including the producers, manufacturers, wholesalers, retailers, employees and customers among others, companies have embarked on creating an environment that enables the participation of all the stakeholders. This paper keenly analyzes how the current economic situations have shaped the operations of Coca-Cola and Body Shop Companies in the local and international markets. Coca-Cola Company Coca-Cola Company is an American based firm that is headquartered in Atlanta. Being the market leader in the soft drinks industry, Coca-Cola specializes in the production of wide range of non-alcoholic beverages. The company operates in more than 200 countries. In order to meet the demands of all its customers, Coca-Cola has wide range of products that include Coke, Nestea, Fanta, C2 Cola, Dasani water and Sprite among others. The purpose of Coca Cola is outlined in its mission that include creating customers value and making a difference, refreshing the world as well as generating moments of happiness and optimism in the contemporary world. In the same way, the company aims at involving its partners including the bottling companies in its global operations. Ownership of Coca-Cola Company Coca-Cola is a public limited company. This means that for an individual to own a share of the company he or she should buy the company’s stock. In its effort to strengthen its capital base, Coca-Cola shares are quoted in various stock exchanges that include New York Stock Exchange, Chicago, Philadelphia, Boston as well as Pacific (George 9). Responsibilities The responsibility of Coca-Cola is to instigate healthy living among its consumers and members of the public in general. In order to achieve its objectives, the company has undertaken various corporate social responsibilities including sponsoring of Olympic Games in Canada and Vancouver among other places. In addition, the company is focused at improving the environment through adoption of various initiatives such as the use of recyclable bottles and reduction of footprints within its premises and surrounding environment. Organizational structure In order to effectively serve its large number of customers, Coca-Cola has established various market segments which include Latin America Group, Far East and Middle Groups, North America Groups, Europe Groups, Minute Maid Company and the African Group (Aaker 26). The well experienced human resources under the leadership of Muhtar Kent, the company CEO has led to high sales and increased profitability in the international market. The corporate human resource is responsible for designing of procedures and policies that are followed by the company. On the other hand, the duty of local human resources department is to implement the various human resources systems that are put in place by the company. Shareholders and Shareholders objectives Being a limited company, Coca-Cola does not restrict members of the public from being its shareholder. As mentioned earlier, the company stocks are sold in various exchange ma rkets thus allowing high number of investors to be part of the company ownership. The main objective of the Coca-Cola shareholders is to attain high returns on their investments. Similarly, the shareholders aim at increasing their quarterly dividend. In order to meet the objectives of the shareholders, Coca-Cola uses the services of

Protecting and Improving Quality Assignment Example | Topics and Well Written Essays - 250 words

Protecting and Improving Quality - Assignment Example s, equity in the provision of health services, efficient utilization of resources, effectiveness, timeliness, and focusing on patients needs (Institute of Medicine, 2001). Joint effort may be required to help organization achieve its goals. As a leader, measures that will be taken to improve the quality include implementing IT because it will revolutionize service delivery in the health sector. It is also important to bring all stakeholders on board for them to be involved in the search for quality services. Sensitive issues about the sector should be resolved amicably to avoid deadlocks which may hamper the delivery of improved service delivery (Institute of Medicine, 2001). Medication errors arise because of negligence from health practitioners. Controlling risks and putting safety measures in place needs a serious focus on the systems will aid in making errors severe. Medication safety refers to preventing accidents to patients who have come to seek medication. Lack of safety measures can make health institutions to be sued because of failure to comply with the set safety standards. Legal suits may interfere with operations of the facilities (Lewin, Altman, & Institute of Medicine, 2000). In order to improve quality service in the health sector, performance of professionals in this sector needs to be evaluated frequently. Such evaluation may help to ensure health practitioner improves their performance (Institute of Medicine of the national academics,

Public Library Essay Example for Free

Public Library Essay Library is something which has a lot of importance in everyone’s life. And specially in the life of school going children’s. It is responsible for teaching those children the moral values which are required a lot in further run of their life. Library is something whose importance cannot be neglected at any point of life. I consider myself to be very lucky as I was being provided with one of the best library by my school. My school had a big and efficient library. Almost all sorts of books required by student’s could be found in that library. And also there were many different types of magazines and newspapers in our library. We had a different room known as Reading Room adjacent to our library. It was the place where we used to take our books for reading them or making notes. No one was allowed to read books in library instead of teachers. Students till class 10th had two library period in a week. They had permission to issue books during those two periods only. Also they had to return the issued book within 15 days. No student till class 10th was allowed to keep books for more than 15 days. Keeping books with themselves for more than 15 days would require the student to pay a fine of Rs5 a day for each extra day. But this was not the case with senior students or students of class 11th-12th they were allowed to issue books whenever they wanted. There was no specific Library period for senior students. Also they had the permission to keep books with themselves till they want. They had to return books only during the time of examination. There were different sections in our library which were divided according to classes. The section for senior students mostly consisted of reference books. But they too had an option of issuing novels and other story books. Although due to study pressure there was hardly any student who issued novels or story books. Everyone issued references.

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