What Is Crime Analysis And Intelligence Analysis Criminology Essay

What Is abuse Analysis And Intelligence Analysis Criminology Essay horror abridgment is the methodical dissect of offensive activity and confusion douses in admission to opposite police- cogitate issues which includes sociodemographic, spatial, and temporal factors to make it possible to the police in wrand so forthed concern, law-breaking and disorder decrease, nuisance prevention, and evaluation. (Boba 2005, 6)A detailed explanation of for each sensation aspect of this definition assists to prove the various elements of umbrage analysis. In general, to study core, to examine closely, to investigate, and/or inspect information. Crime analysis, whence, is the alert and organized scrutiny of evil and disorder jobs in addition with other police-related matter.However wickedness analysis is a reactive approach which content that you atomic number 18 reacting to prevail means to stretch offense. As crime is blow overing it then transforms to a proactive approa ch so that it transforms data to important information and supports crime prevention.Criminal Intelligenceis the information ga in that locationd, investigated, and/or distributed an effort to expect, prevent, or monitoring device criminal activity.Criminal Intelligenceis information collated or collected, analyzed, reported and disseminated by law enforcement agencies relating to types ofcrime, identified criminals and known or suspected criminals. It is effectual when traffic with organized crime. Criminal Intelligence is improved by using inspection, informants, research and research.IntroductionThe bea for my particular study is a playground and its purlieu in the revealskirts of Victoria it is between the village of Sannat and Victoria. The zone is located in Tac-Cawla whichis a place with a in truth small population.The SARA pretenseThe SARA model is the to a greater extent or less(prenominal) common use for acting problem-oriented policing (POP). The acronym SARA me ans S apprisening, Analysis, repartee, and Assessment. Scanning contains smell at data, meeting and talking to hatful, and observing the bea so as to identify potential problems. Analysis includes studying potential problems to establish if they be worth of intensive attention and, if so, trying to improve precise descriptions and explanations of them. Response includes searching for a broad range of explanations and then deciding and implementing the ones with the most assure. Assessment involves collecting of data after the resolution to establish if the problem has been at least reduced if not eliminated. If success has not been attained, then extra investigation and another set of responses whitethorn be needed.A notion that was build to help enhance the SARAmodel is the problem analysis triangle. The victims, offenders, and locations argon the tercet sides of the triangle. When examining particular problems, officers argon promoted to focus on victims (who are the victi ms, what are the damage they suffer, why are these individuals offended and not others?), offenders (who are the offenders, why do they excite these offenses?), and locations (where do the problems happen, why do they happen in or so particular places and not others?). Thinking carefully on these issues makes sense because crime and other police officer problems normally are not erratically dispersed. To a certain extent, crimes and many other problems are focused between comparative small number of offenders, victims, and localities.ScanningThe basis of this procedure is to verify that a continuous and considerable problem exists. The procedure involves of collecting data and information from different sources to support the claim that a problem exists. Some problems get outing be immediately evident, while others may require more investigation.During my scan procedure it involved the studying of the peck to verify that a problem is being existent. It also included the gat hering of data on what, when, who, where, why, and how. I also identified frequent problems by using different methods and grouping comparable incidents into subjects of groups.WhatWhenWhoHowWhyBicycles thefts1200 1600, 2000 2200Children aged between 7 to 15 breathing kayoed most in the entrances of matteds. hooliganism, Personal used for their bicycle.Vehicle/Other Vandalism1900 onwardsTeenagersPassers by, Children sustentation in the empyrean of operationsVandalism, just for fun. Because of much(prenominal) limitations to enter the playground.Vehicle related thefts2100 onwardsMale people volume living in the celestial orbit, passers by.Personal use for their vehicle, vandalismTheft from persons900 1100 discharged peopleStopoversTo acquire their needs.Gas Thefts800 900People living in the areaPassing byFor themselvesAbusive Language1000 1200, 400 2100, 2300 100TeenagersGathering of groups.To show military force.Illegal Barbeques1900 2300People living in the areaGat hering of people in the compete field.Most people live in flats.Garbage bags1900 1400People from the areaHump garbage bags left in different speckles.Most people do not snap account of while of garbage collection.Drug TraffickersBetween 1000 am 1300p.mUnemployed peopleCar stopping, handover ex convertTraffickers live in the area.AnalysisThe creator of this stage is to expand a complete understanding of the whole problem. At this stage its very important to establish response plan which includes resources for relations with particular problem.The process involves by using the information gathered to account the particular problem while studying the past the type of problem. It also includes using knowledge to expand a hypothesis and choosing useful resources.When analysing my area, it comes out that its a suburb area with quite a high population. During my scanning process it comes out that the area is a house estate. Housing Estates are usually built and run by the govern ment to facilitate housing to those who does not have affordable housing. This means that most of the families have very low incomes. In many cases they are also unemployed. It also comes out that some of the families have sociable problems where family members which are part of this society living very close together pull up stakes have conflicts. Some clippings these problems are impossible to avoid and people living in the kindred flat doe not get along.Some social issues include internal violence, unemployment people hold different opinions about situations like unplanned maternal quality and many others.All these issues correlates why people commits much(prenominal)(prenominal) crimes like theft, vandalism, sordid style and other related crimes.ResponseThe idea of this step is to baffle a general strategy that is knowing to tackle the community problem. The three main one are developing, selecting and implementing. At this point in m it depends on the degree how analys is has been carried out. One has to make sure that the rootage two steps have been completed. Such solutions can be designed to reduce, eliminate and dealing with the problem.In my opinion in this particular area one has to develop willpower and awareness.To remove such opportunities one has to keep in line the milieu. Example of this must be CPTED, Block watch and Volunteer Patrols which can be done by the community it ego. Include also such services such as crime prevention units and engage civil law to control public trouble.Response can be beef up by the police such as protection like surveillance and strategic enforcement. A championed idea as a response must be the social development by implementing new programmes.AssessmentThe argue of this is to appraise the procedure and the effect of the response strategy. This means to evaluate whether the response strategy was adequately linked to the problem or has it been reduced or eliminated. However for this study one cannot apply this part.What is causing the crime problem and linked theoriesRational Choice openingThis theory holds that people freely choose their behavior and are stimulated by the evasion of imposition and the interest of en joyfulnessment. Persons calculate their choice of actions in compliance with each options deftness to create advantage, pleasure and happiness. Rational choice produce a small view point on why individual offenders decide to commit such crimes like tearing the fence or breaking the markers around the filed people choose to appoint in crime because it can be rewarding, easy, satisfying and fun. The central principle of this theory is that individuals are rational beings whose behaviour can be personalized by a fear of punishment. (Siegel and McCormick, 2006).This applies to the crime problems I have identified during my observation where such crimes where committed to pursuit pleasure such as vandalizing. Breaking down the markers around the palm its only d one to give power and pleasure to the young ones. alike to this also goes when tearing the fence surrounding the ground it only gives pleasure to these individuals as they can enter when ever they want.Routine Activity TheoryDeveloped by Cohen and Felson (1979), routine activities theory necessitates three components be exhibit for a crime to occur an encouraged offender with criminal aims and the power to act on this preference, a suitable victim or target, and the absence seizure an individual who can prevent the crime from happening. These three helps for a crime to occur.Routine activities theory provides a macro perspective on crime in that it predicts how changes in social and economic conditions influence the overall crime and victimization rate. (Felson and Cohen 1980) Criminal activities are a structurally significant phenomenon, which means infringements are neither accidental nor insignificant events. Routine activities theory associates the standard of offending to th e everyday patterns of social interaction. Therefore crime is normal and is dependent on available opportunities to offend. If there is a target and there are rewards, a motivated offender will commit a crime.This means that having people coming out in the same times having the same routine are targets for crime such as thefts from persons and households like cars, garages etc.Opportunity TheoryCrime opportunities are very connected to its time and space. For modelling being without any lights during the night gives more fortune for vandalizing and stealing. These opportunities are very specific like stealing a car for joy riding have different pattern than stealing it for parts. Another example of this theory is when a routine is assessed regularly a weak point is assessed and can be used by the offender to take the opportunity to commit crime. similarly it is a good opportunity for the offender when bicycles and other household which are valuable and ignored. This came out du ring my scanning process. Another crime goes when people takes out their garbage bags during the night, this gives opportunity to others to leave there waste product difference the area very dirty.Self Control Theory of CrimeThis theory is about the lack of people self control as the important factor behind criminal behaviour. This theory suggests that people who were displaying incompetence parented before age 10 develop less self control than those who were raised with better parenting. Research was found that low direct of self control is linked with criminal and impulsive conduct. This theory is related to my study because many children stay for long hours in the playing field area, which means that most of them are not monitored by their parents and so there is no one to correct them when they are using such language and finally committing such crimes.Broken Windows TheoryThe broken windows theory says that in a neighbourhood area where buildings have broken windows, indivi duals are more in all probability to commit and engage in bad behaviour. Hirschi argues that it can be from different aspect maybe offenders think that they are not issue to get caught or there is no one who cares. Examples to my study leaving bikes left unattended in the field are more likely to be stolen than wellhead parked next to an apartment. The same goes to vehicles when left parked, unattended in a field is more likely to be stolen and vandalised than one parked in a parking.RecommendationsAfter working on this device I recommend some recommendations linked to theories and demonstrate them in practice. for the first time I will organise the community and develop awareness and ownership on such crimes which are an opportunity to such offenders. I will work as much as possible with existing forms of familiar social control like parents and community cohesion to regulate such behaviour and self control. Then I will regulate the environment to remove broken windows and opp ortunities like volunteer patrols, neighbourhood watch and CCTV cameras. This will also help to reduce routine activities and such crimes related to this theory. I will also engage civil laws to control public trouble and individuals think twice before committing crimes freely. This applies to the rational choice theory. Finally I will educate and implement new programs as part of the social development.Strength and WeaknessFor the purpose of this report I will go through some strengths and weaknesses. If the population is well educated, it will automatically reduce such crimes. This is because if neibourhood watch is implemented, the community will report such crimes and helps the offender to think twice before committing crime. On the other hand because most of the buildings are flats and its a housing estates one will mind others business. Also if the area is inspected it will automatically reduce crimes as the offender will be aware that he/she will be caught. Alternatively the area must have adequate lightning during the night. If the area is cleaned from time to time and well kept and law enforcement is implemented individuals are afraid to offend as they might be caught. However if law is enforced and there is no surveillance it not worth implementing such laws. Although individuals might become more frustrated and no matter what they try to be more negative. decisionFinally in my opinion if I have to implement what has been recommended if crime is not eliminated at least its reduced. I think that a change will occur no matter what the effort is. Although it might take some time for people to understand such implementation at the end of the day I think that it will effect some of them. Even though there might be obstacles I am sure that there will be a reduction on the occurrence of the problem, reduction on the harm done and positive aspects of the interventions.

Leadership And Service Improvement Management Essay

Leadership And Service Improvement oversight EssayThe study of leading and leading has led to m either competing theories which attempt to distill the essence of with child(p) attractership into its comp singlent fractures, to allow others to acquire some of these attri just nowes, and become a lot telling leading.The real early theories on leaders tended to assume that leaders were born, and that leadership was not a adroitness, or crop of skills that could be acquired. The boilers suit impression was that Great Men had inherited leadership qualities from their ancestors, which would make them useful leaders when placed in positions of authority (Kirkpatrick and Locke 1991). This is not a really helpful way to look at leadership, and does nothing to assist students of leadership in their efforts to become better leaders themselves. It is not, though a striking leap from identifying natural leaders to identifying which separate of their character or personality ma rk them out from others. This underpins the Trait theories of leadership.Trait hypothesis was analyse extensively in the mid part of the 20th Century, and had a wide feed of results. Kirkpatrick and Locke (1991) explain that trait guess do no self-reliances as to the origins of the traits studied, exclusively obviously lavishlylighted the differences between leaders and non-leaders. In 1974, Stodgill published the results of his studies of leadership theory, and identify 22 traits and skills which are present to varying degrees in the individuals studied. This did not picture how individuals could become better leaders, nevertheless, the identification of leadership as a skill has been vital in the subsequent development of leadership training. He himself finally think that A person does not become a leader by virtue of the possession of some combination of traits. (Stodgill 1948 cited in Levine 2008)McGregor (2005) looked at leadership behaviours as relating to underly ing traits or world views. They examined the ways in which managers and leaders bettermented a toil, and tried to under bear the motivating factors. McGregror (1960) matte in that location were two study theories of man motif which lay behind the actions of the leaders he studied. His theories were labelled X and Y. Theory X assumes that the average human being inherently dis exchangeables solve, and therefore must be coerced to act at the required level. The motivating factors here are extrinsic. Theory Y assumes that bunk is a natural part of life, as much as is command or rest, and intrinsic motivation is key. This intrinsic motivation sess be viewed as an expression of the Hierarchy of Needs (Maslow 1943) The work of McGregor in hurled the achievement of manners to map leadership behaviours. Blake and Mouton (1964) plotted carry on for business against allude for people. This produces a helpful framework for mapping behaviours, but it is rather dormant in for m, and seems mainly useful for reflection or critique, to inform future tense endeavours. It does not necessarily inform leaders of what behaviour is outmatch suited to the group they are functional with at a particular while. feat centred leadership was proposed as a leadership framework by Adair (1973). His time in the Army and work as a trainer at the Royal Military Academy at Sandhurst led him to develop a model that considers three field of studys lying-in, aggroup up up and individualist. He argues that each domain requires the anxiety of a leader, but the relative importance of each exit vary. The relationship of these domains is represented by a venn diagramTask demand squadmaintenanceneedsIndividualneedsThis model then expatiate the reachs a leader should address in each domainTask Practical managerial concerns, for example creating a plan, monitoring performanceTeam Facilitating group working(a) by agreeing standards of behaviour, resolving group conflict s etc.Individual Ensuring individuals are performing as head as possible by supporting by dint of challenges, allocating work according to strengths etc.There is tidy overlap and interaction between each of these domains, and it is argued that attention to each domain is required for a balanced team.The key feature of this model which do such an impact was providing a practical framework which allowed leaders to flow some of the softer skills of leadership with more managerial traits of time trouble and task focalise on.Situational / Contingency Theories of LeadershipThe studies of leadership discussed above give birth all looked at leaders and leadership behaviour and described them, allowing leaders to analyse their behaviour. The theories above, over time micturate been developed to include a degree of dynamism, but were initially descriptive exercises. It was the recognition that there was not necessarily on right way of leading that prompted thinking just about the possibility of adaptive styles of leadership (Schermerhorn 1997). The study of leadership in unalike situations and settings, and the observation that the about effective style of leadership ex win overd with respect to situational variables led to situational leadership models.The earliest described was the Contingency Model (Fiedler 1964). This model relies on a self-rated outstrip to go down a preferred leadership style. Fiedler then studied working conditions, and described them through three variablesLeader-member relations how imparting team members blaspheme and will follow a leaderTask structure how well defined a task is, or if it follows a standard mathematical serve wellPosition Power the extent of the rewards and punishments a leader has available. with his studies, Fiedler constructed a visual guide to represent his findings about which type of leader was around effective presumption the situational variables.The model states that leaders with high LPC score s should work with teams where the situation is moderately favourable. The more task poreed leaders will be more effective in situations which are either precise favourable or unfavourable to the the leader. This model has been studied extensively and has legitimate both critique (Ashour 1973) support (Strube and Garcia 1981). A major source of quarrel in this model is the LPC. single of import point to note is that Fiedler felt leaders would find their behaviour difficult to alter, and agreements should therefore pick the limit leader for a disposed(p) team. This is in contrast to other models which signal leaders should be adaptable.The Hersey-Blanchard (1969) model of situational leadership looks at a different variable in the team background the maturity of followers. The underlying assumption is that a leader should adopt a style of leadership which reflects the needs of the team. This is in direct contrast to Fiedlers (1964) assertion that organisations should pick leaders given the favour top executive of the situation. In this model, a two by two grid which is very similar to the Blake Mouton (1964) Managerial Grid, is apply to describe four leadership stylesS1 Telling (low relationship, high task)S2 Selling (high relationship, high task)S3 Participating (high relationship, low task)S4 mission (low relationship, low task)There is an accomp eaching scale which rates the team a leader is concerned withM1 Low competence, and low commitmentM2 Low competence, and high commitmentM3 senior high school competence with low/variable commitmentM4 High competence and high commitmentThe M score for maturity of the team members was developed over time, and was later divided to reflect job and psychological maturity (Hersey and Blanchard 1982). Job maturity is the ability or capacity to perform the task in hand. Psychological maturity indicates motivation.The model has received criticism from a theoretical standpoint, and from empirical research. Graeff (1983) claims that the maturity scale is invalid, as it classifies workers who earn skill and are unmotivated (M3) as more mature than those who omit skill but are dedicated to a task(M2). He overly argues that the additive nature of job and psychological maturity in the model is invalid. He supports this view by suggesting that in tasks where skill requirements are low, motivation has a much greater importance. One study into the model concluded that, because high follower maturity did not obviate the need for supervision, their results alter very little support to the model (Cairns et al 1998). This study though had methodological flaws, a skewed population, and did describe some support for boldness of the SLT model.The practical application of this model relies on the ability of the leader to determine the maturity of their followers, and reflect this in their leadership style. Perhaps the virtually important aspect of the model is the recognition that leadership styles a re not fixed, and leaders can change their approach to suit a given team or individual.In unexampled health trade settings, there has been a change in the nature of teams. There is no longer a stable, splendid, stratified team. Instead, teams form and disperse on an almost shift-by-shift basis. To lead effectively in this environment, it is necessary to be adaptable, and be able to support team members to produce their potential. The models described above illustrate that there is no one best way to lead a team. Instead, by appreciating the different situations, individuals and tasks involved, leaders stand a better chance of forming teams which can cope with the varying demands of the modern NHS. Perhaps Goleman (2000, p.4) has argued this most eloquently through his work which revealed that the most effective leaders do not rely on only one leadership style they use them seamlessly and in different measure depending on the business situation.Service Improvement MethodsThe literature describes a massive chip of service mendment methods which obligate been applied in some form to health care settings. Most service improvement methodologies that have been implement in health care have been pick out from industry, where the driving force is to maximise wampum for shareholders. The adoption of industrial techniques for service and lineament improvement has a good deal met with a degree of resistance from the medical profession (Moss and Garside 1995) and from the health sector as a self-coloured. This has been attributed to the professional nature of healthcare, which involves large numbers of autonomous, independent practitioners who often place independence of clinical decision making at the watch of their operating values. (Degeling et al 2003)Recently though, there has been a recognition in spite of appearance the medical profession of the need to drive up standards in healthcare, and to digest on overall quality of care, rather than just direct clinical activity. Included in most definitions of quality is efficiency of healthcare delivery. This focus on efficiency is built on the growing recognition that in public funded healthcare systems need to be accountable for the expenditure they make. (Donabedian 1988)It is in the context of increased demands for efficiency, increasing burden of chronic disease, and ever increasing expectations from the users of the health services that service improvement legal documents have started to be implemented on a wider scale than ever before.Systematic approaches to service improvement have been in existence for a long time. Taylor published his Principles of Scientific Management in 1911 after more years of employing what are now cognise as time and motion studies to various industrial processes. His approach was much criticised for giving too much power to managers, and its use was even out(p) by the American Senate in defence establishments for relying too heavily on comm and and jibe leadership (Mullins 2005a). However, his methods produced great improvements in efficiency, and he made an argument about systems which is still valid today The remedy for this inefficiency lies in dogmatic focal point rather than in searching for some strange or extraordinary man.(Taylor 1911)Total Quality ManagementThis approach to systematic improvement was developed by Deming during his work with Japanese manufacturers in the outcome of populace War II. He was initially concerned with teaching statistical control methods to Japanese manufacturers to improve efficiency. However, he adjusted his teaching to focus on the process, rather than individual performance, and emphasised the need for good caution and a collective push for optimisation. He published his recommendations for industry, government and education, which set out his 14 points for management in the seminal work tabu of the Crisis (Deming 1986). TQM is more than a technique or set of tools for im provement, and can be described asa way of life for an organisation as a whole, committed to total customer satisfaction through a sustained process of improvement and involvement of people. (Mullins 2005b)TQM has been utilised in healthcare since the early 1990s, and aspects of it are increasingly being employed today. It is often the tools associated with the approach which are employ, rather than the wholesale systems change originally described, and this lack of pellucidity regarding the true nature of what is called TQM has contributed to a lack of clear usher of benefit. (vretveit and Gustafson 2002) Where the whole package of TQM has been implemented, results have been mixed, but there are numerous examples of where authoritative elements have shown benefit. The most commonly employed techniques derived from TQM are statistical control methods, and the PDSA stave.Plan Do Study Act (PDSA)Alongside his work on TQM, Deming is credited as being one of the key proponents of the PDSA (or PDCA) cycle. This cycle of breeding, implemented as a quality improvement tool had been taught by Shehwart (1939) whilst Deming was working with him. Deming took this knowledge to Japan and it formed part of his work on TQM (Hossain 2008).The cycle reflects Kolbs learning cycle (1973), and is a tool for proveing changes, and reacting to the results. It can be seen as either a standalone tool for change, as part of a larger system of change, or as a key part of a school of thought for wide-scale change across an organisation.(Cleghorn and Headrick 1996)The PDSA cycle consists of four partsPlan The objective of the test must be defined, and a method of entropy collection must be incorporated.Do The planned change to a process is carried out, with concurrent data collectionStudy The data is analysed, compared with predicted outcomes, and a summary of learning is produced.Act The conclusions from the data are utilised, and used to inform the next plan.The underlying rat ionale for the PDSA cycle lies in systems theory. Systems theory implies that small scale changes within a system can throw large results. The PDSA cycle is useful for testing small changes, and reflecting on the do before either applying them across a whole system, or making further changes (Berwick 1998). When linked together, PDSA cycles can be used to drive up quality.This approach of two-fold linked cycles and this approach of multiple linked PDSA cycles is used in the Model for Improvement, the rapid cycle model of change, and the collaborative approach (Langley et al 2009, 1992 Institute for Healthcare Improvement 2003).In contrast with small PDSA schemes within a team or organisation, the collaborative approach uses multiple PDSA cycles within separate organisations, whilst aiming for improvement in a shared area of careThe PDSA model, when used within the model for improvement, or as a chain of cycles within a single team is a clear, simply understood, but powerful tool for implementing change, and improving quality. Its strength lies in its ability to be applied to small scale changes, but achieve strong results. From an organisational point of view, the relatively small amount of resource which is required to test each hypothesis makes this model very attractive. Processes can be studied with little disruption of everyday activity, and if the results are not favourable, learning can continue without significant loss to the organisation. In clinical processes, the PDSA cycle is an pure tool for testing hypotheses, especially where evidence may be absentminded and inaction seems inappropriate, but action without reflection sees un-wise (Berwick 1998)The smaller, more local focus of PDSA cycles, and small resource requirements make this model particularly accessible to provide of all levels, and as the take inment of frontline staff, and in particular doctors has been shown to be a key factor in the success of change in the healthcare setting, this is a major strength. (Greenhalgh et al 2004 and vretveit 2005)The incorporation of the PDSA cycle into wider schemes of change management brings additional complexity, and also invites additional problems. There have been varied results in the implementation of the collaborative approach within healthcare as a service improvement tool. Some studies report great success (Monteleoni and Clark 2004 Schonlau et al 2005) while others (Newton et al 2007) found that there were difficulties using the same model. The major difficulties identified were lack of adequate resources, the conceptual difficulties associated with the model, and poor leadership. A new-fangled review concluded that there is currently no evidence about the long term results or cost effectiveness of collaboratives compared with other models. (vretveit 2002).Toyota takings System (TPS) / LeanOne approach to service improvement which is being applied with growing enthusiasm within the NHS is Lean. Lean thinking and theory emerged from studies of the manufacturing processes at Toyota. The term was first used in the late mid-eighties and the approach grew in stature after the publication of The Machine that Changed the World (Womack et al 1990). Lean was not originally a single tool or approach, but instead was a philosophy to which all members of an organisation aligned themselves. This whole systems approach is probably now better recognise at the Toyota Production System (Liker 2003). The success of Lean/TPS has led to a proliferation of schemes which fall under the umbrella of Lean thinking but do not necessarily hold to the original principles.The TPS was developed in the mid-fifties in Japan, and was first published in English in 1977 by Sugimori et al. The system has been studied extensively, but many organisations, despite implementing the principles behind the TPS, have not achieved the efficiencies and quality that Toyota exhibit. (Spear and Bowen 1999). There have been many attempt s to reduce the TPS to a method which can be applied in many settings, but as Sutherland and Bennett (2007) state, such a complex process cannot be adequately documented. They suggest that instead, to understand the system, one must learn from mentors, much like a child learns and forms habits from their parents. Liker (2003) sets out 14 principles of the TPS, but for the purposes of this assignment, three will be examined1. The thorough elimination of waste (muda)2. Jidoka or the primacy of quality3. Kaizen continuous incremental improvementOhno (1988) identifies 7 wastes (muda) which should be eliminated from any system.These areoverrun production of more than is required for fast useDelay / postponement any delay between the end of one process, and the start of another. spare transportation of materialsOverprocessing using more energy than required for a given process, or exceeding the agreed specificationExcess inventory any raw materials or work in progress in surplus of customer requirements.Motion any unnecessary movement of workers, eg. reaching / stretching.Defects any process or work that results in unacceptable goodsThese wastes have immediate equivalents in most healthcare settings, and underpin a lot of the efforts in healthcare which are labelled as Lean. From these definitions many techniques for identifying waste have been developed. The NHS Institute for Innovation and Improvement (NHSIII) has developed a series of products cognize as the Productive Series which use the elimination of waste to improve healthcare. The tools used in the productive series are often interpreted directly from industry (NHSIII 2007), and include some elements which date back as far as the Scientific Methods described by Taylor (1911).Jidoka is defined by Toyota (2010) as automation with a human touch. When applied to a manufacturing context, this emerges as the principle that a process should continue unless a crack is noted. formerly that defect has b een detected, work should stop until the problem is solved. This principle ensures in manufacturing that if a machine or worker detects a problem, or a process issue, the line is stopped, a solution introduced and, vitally, incorporated into the standard workflow. In this way, the defect should not arise again. The early detection of defects on a production line, and the empowerment of workers to raise the alarm if defects occur also reduces waste. It is unfortunate that, although many principles of the TPS/Lean system are implemented in healthcare, it is often this concern for detecting problems and creating solutions which are incorporated into standard work which fails to be introduced. One reason cited for this area failing to be implemented is that clinical care cannot stop, in in this respect, clinicians feel methods for producing widgets cannot be applied to the art of better (Wilson et al 2001). There are examples of where this concept has been introduced, into the healthca re environment, with clear evidence of improvements (Ball and Rgnier 2007), but a recent paper argues that more could be done (Grout and Toussaint 2010)Kaizen is the culture of continuous, incremental improvements to a system (Imai 1986). This cultural philosophy of scientific experimentation, conducted at the lowest possible level in the organisation, is held up by Spear and Bowen (1999) as one of the key elements of the success of the TPS, and as a key stumbling block for others who seem unable to replicate Toyotas success. This philosophy, feature with other unwritten rules combine to create a community of scientists, who engage in experimentation to solve problems. These problems are often on a small scale, and the process closely follows the PDSA cycle. When this principle of widespread, incremental change is adopted across an organisation, with recognition of the value of tacit knowledge, it is possible for a learning organisation to emerge (Howells 1996).In conclusion, there are many approaches to leadership and service improvement which are being used in the healthcare setting today. Use of an adaptive model, which allows a leader to change management style depending on the team they are leading, and the task in hand, is most appropriate for leaders of modern medical teams, in a large part due to the very flexible nature of the teams involved. The application of industrial quality improvement techniques to healthcare has great potential, and successful trials have been conducted. However, a common feature discussed in analyses of obstacles to implementation is the engagement of medical professionals. Through the use of effective leadership, and engagement of these key stakeholders, it is possible to lay the foundations for a learning organisation. A learning culture which is open to the possibilities of change through quality improvement strategies will ultimately be the most plentiful environment in which to implement change for a better quality of care.

The Impact Of Extended Trading Hours Commerce Essay

The Impact Of Extended Trading Hours Commerce shew mob of pop off is a Kiwi owned and ope gaitd backup, this is unique industry because their bulge outlets and a true crease partnership between local owner operators and family line of Travel Holdings having 75 plus sell outlets nationwide.Their 75% of retail outlets argon set(p) in Shopping Mall and rest of 25% argon in local p argonntage beas. Chris Paulsen, founder and managing director of tolerate of Travel had a dream that travel could be delivered to the consumer in a different way.The company gets hint from their consumers to prevail the seduceing hours of their retail outlets situated in local business area the present realiseing hours is 9am to 5 pm weekdays and 9am to 1pm on Saturday. These hours may be glide byed to benefit to a greater extent(prenominal) customers but before making this changes the company has to entertain thoroughly that how this allow drop dead and the advantages and disadvantage s besides extending the business hours, for management and employees of house of travel.He started assembling brief enunciate from the Owner operator that How the reach of broad hours allow for mint you economically, financially, and environmentally (Paulsen, 2011) and we get this opportunity to do look on this topic.It is with pleasure that we submit our report on lengthened on the product line(p) hours, the implications for unrestricted policy re ca-ca, and our recommendations for your consideration.The report gives an overview of the actual and potential orders of all-embracing exploiting hours on individuals, families and communities based on the findings of empirical studies and the views of key s contactholders, employees and their families and peak bodies. It outlines the study approaches that apply been adopted in former(a) jurisdictions, which indicate the complexities associated with determining the almost effective means of addressing extended hours.Any me asure aimed at minimizing the bear upon of extended hours has implications for the differing needs and aspirations of employees, employers and the union. Neverthe little, the majority of the convocation felt that there was a solution although it may non be one which is perfect or which satisfies everyone.Where individual members of the Group held views dissenting from the majority on particularized shoess, these opinions and the reasons for them suck been included.We would comparable to take this opportunity to thank the management of mansion of Travel for look for and executive support.Introduction1. The acidulateing(a) hours trend has been elaten since yen as 9 am to 5 p.m.in most of the areas of business in several(prenominal) industrialized countries we called as traditional and stations, there are limited changes for the retail business such(prenominal) as groceries, and supermarkets.2. The interest in extending sour hours for House of Travel in Auckland is th at there customers may get much and more benefit from the extended barter hours.3. There are examples for the overseas jurisdictions subscribe regulated extended hours of escapeing in order to minimize its mischievous health and social effects on workers.4. The project was assigned to our diligent Group to do the through question and submit the report that the impact of Extended hours how its work and what are the advantages and disadvantages.5. We the student of Management Class in a Group ( Active Group )took the challenge and started the research with the help oneself of our studies and research we ordain submit the report before 18th whitethorn 2011.6. This was a challenge for us and we demand to think that from where we start, so we obdurate in our Group meeting to distribute the work among the members of the company. The terms of write was described for each member of the group as under.ProceduresThe Group is to have for and consider comment from the management and stave of House of Travel and moderate recommendations for extending trading hours for their outlets external the shop malls and to submit the feedback and recommendation that how its work and how its effect on the employee and management of company.It was a big challenge for the group to get hold of in this and we started operative jointly on this project and started collecting entropy relating to this project.1. The first and the most thing was to check that how employees unbidden be abnormal as a result of extending hours relating to health and safe issue , such as fatigue.2. To check the particular models and general structures and to digest proper pleader to the management of House of Travel on functional hours and to provide induction for serious health and preventative issues.3. To check the Retail Trading Laws for extending trading hours from the Department of Labor juvenile Zealand, and to do proper research for the improvement of the company as s goo d as their employees.4. To verify that how the employees and their families will be effected by this extended trading hours and how it will impact on the health of individual employees and their families.The researchObjectivesThe objectives of the project were identified asTo take views of full(a) employee one to one basis and to k at one time their automaticness of working ache hours.The check the level of cost involved in extending trading hours and how it will benefit the company as well as employees.To check that how this new-fangled implementation will work and affect the health and sentry duty of employee.enquiry methodsThe research used both quantitative and qualitative methods.The quantitative researchThe quantitative research comprised two employer visionsFirst we had interview the employers to identify the experience and prevalence of extended working hours in retail outlets.The survey from one-third employers from different sectors and different business was condu cted as under1. Management of House of Travel, Auckland2. Management of Travel2000, Auckland3. Management of M.K. Tours and Travels, AucklandFramework was set for questionnaire for the above employer and the following training was taken from them.1. What benefit you think for extending Trading Hours?2. How it will work e.g. roaster etc?3. allow this affect the employee health and caoutchouc and security of system of rules?The response we reliable from the above employers shows that on 50/50 basis both(prenominal) of the employers and willing the ready to implement the extending trading hours rest of were was non supportive on several grounds.The qualitative researchThe qualitative research was conducted brass section to face with employees of House of Travel with giving the feedback form.Those employees willing to give the feedback from some of them were non interested but those who were interested in survey has given the feedback and which is envelop as Appendix 1.The res earch was done and several websites and reports were referred to for preparing this report as under the employers in the quantitative phasetrade associationsRetail pipeline RegulationUnions, including the Council of Trade Unions ladder and Income work brokers.The respondentsThe feedback from employers and employees were submitted here in the qualitative research.The focus on the effect for extending hours and its amendments were discusses with the management of House of Travel verbally and explain them the procedure that if this implementation takes place there should be some specific models and rules to be referred and in light of the facts we have to give our mesmerism that the extended hours and effective or non.Data analysisQuantitativeThe initial and follow-up survey were analyzed by our group and discussed through to sort reasons that to what extend the extended hours are practicable.QualitativeThe notes and transcripts from the interviews were taken on and QA forms for r esearch questions. Extensive notes were made at interviews The recorded data was analyzed with address to the participants circumstances findings for any one person or group were compared against those of the entire data set.FindingsStructure of reportThe structure of the report was submitted on the specific pattern and the collected material was thoroughly studied and present hence to check that the if the extended hours and implemented it will benefit both employer and employee and to check the entire aspect of extending hours.Limitations of the researchKeeping in school principal the occurrent law and health and safety issues we submitted the details in our report as well as the cost incurred by the employer and as well as comparing the strand ratio.While submitting the report well overly keep in mind the current law and the dominion of the sensitive Zealand government as well as market trend and the area where the disposal willing to extend the trading hours.1. To pres ent the findings of the Group appraisal relating to extending trading hours and how it will affect the employer and their employees.2. To collect the statistical information on working hours from Auckland region and in addition from the various sources to analyzed working time arrangement and its effects.3. To consult the spontaneous interviews and written feedback from the employers and the employers for the House of Travel.4. To meet the employees and Management of House of Travel to establish and discuss about the effects of extended working hours on health and safety issues.5. Oral and written submission was seed through intensifier fact to face discussion about employee experience of extended hours. The employees and employers were participated in the review process.6. The Group has not investigated the merit of each employees claims but in general and keep in mind of their relative importance, but the report has been made in both written and oral submissions or in the lit erature reviewed.SubmissionHereby submit that the oral and written interviews taken from the employer and employees of house of travel and other relevant sources we similarly referred various websites, including Australian Government Website relating to extending trading hours which are also referred below with references.As per our encyclopaedism we has taken keen part in looking specific models and nonetheless code of conduct for retail operation from Government as well as private organization.Our research shows that most of the employees not willing to work huge hours but been on the key position they do not neglect and they have to work because the management wishes that he should work unyielding hours.Working long hours will defiantly affect eh health for the employee who contribute be seen from various angles and from various points of view we think that working long hours or extending trading hours are not feasible for both the organization as well as for the employee. Even the organization has to involve in all sorts of legal steps towards employee safety, safety for their belongings and even capital handling. It is not advisable that a single person piece of ass work after hours in a hug component part or retail outlets outside the shopping mall.We have some examples cited below which shows that extended hours are feasible for big companies of consumer products but it is not advisable for a low-toned retail outlets they has to do more and more paperwork before planning to extend the trading hours.Our views and recommendation is submitted hereunder for House of Travel and we also crevice our suggestion for implementing extended hours.We have included the details taken from defferent websites and reports e.g. work for dole, government website, Australian fan tan website, police website etc indicating the health and safety issue fo the employee working long hours.ResultsMembers of the business community agree that for numerous companies, hou rs of operation are likely to continue to expand, as demands for convenience on the part of both individual and corporate customers do not advance likely to abate any time soon. But small business owners should make sure that they lay the appropriate groundwork for an expansion of operate hours before committing to it.But the business owner who takes the time to study these issues in advance will be much better equipped to extend them in an effective fashion than the owner who tackles each issue as it rears its head. (Executive, 2011)Competitive pressures-Analysts point out that simple economics have compete a large part in the surge in grow business hours for umpteen companies. The ceaseless search for efficiencies and the spicy cost of adding power are compelling many small companies to squeeze more out of existing facilities by adding second and third shifts, say Dale Buss in a Nations Business article entitled A Wake-Up Call for Companies (Executive, 2011)It seems that that extended hours are feasible at some stage but not always, our research shows that it is expensive, risky and not at all time pleasurable by the employers as well as employeesBut on other hand the Australian government has regulated and passes the extended hours in Parliament until 9.00 pm retailers able to open their businesses until 9pm on weekdays.However, the ALP went to the last election with a pledge to extend weeknight trading hours to 7pm.Mr Barnett made the announcement on the straw man steps of Parliament that, just as the Chamber of Commerce and persistence responded in the grounds nearby to what it called vested interest groups opposed to deregulation. (Sonti, 2009)A New Zealand Perspective Why do we need to act?Whilst work-life brace is a global issue, there are specific considerations for New Zealand. In 2005 the Business Council contributed to the Department of Labours Consultative project on work-life balance.While New Zealand has a high number of part-time w orkers, we also have a high number of pile working very long hours. New Zealanders have increased hours worked per capita by around 18% since 1970 the second fastest rate behind the US and in sharp contrast to Europe where hours have steadily decreased. We have seen the proportion of employed people who work a standard 40 hour week fall from 35% to 30% in the past 15 years with 22% people working more than 50 hours per week. On an average day, 40% of people are at work before 8am and one in four people work in the evenings. We continue to embrace a long hours culture.For many workers, cell phones, text messaging, e-mail and laptops have forced work into the plateful in new ways that lengthen working days and deepen work. Workers and partners in a survey by the New Zealand Council of Trade Unions said that many employers held an expectation that workers were usable well beyond their standard work hours. Some described being expected to have their mobiles on for long periods. Thi s is particularly true for some part-time employees who are not ineluctably in the office full-time during normal business hours.Excessive hours at work are equated with rising hear levels which affect health, fitness and in-person relationships. A recent article in the British Medical diary has reported that people who suffer from chronic stress caused by their job are more likely to develop heart disease and diabetes. twain of these are major health concerns in New Zealand.Over recent years, lower unemployment means employees are more able to make employer choices favoring organizations that advise flexible terms and conditions.However whilst large companies particularly in the divine service or consultancy sector have introduced initiatives to improve work-life balance, this may prove more difficult for production based organizations and SMEs.The core hands in New Zealand approximates 2 million people10. 96% of New Zealand attempts employ 19 or fewer people and in total a ccount for 29% of the total workforce and contribute 27% of the countrys economy. The New Zealand manufacturing sector employs 12% of the workforce and contributes 15% of the economy. It is equally important that we find a way to checker that these employees. (council, 2010)It seems that the Extended hours for House of travel is not feasible as give tongue to above it will affect the work life balance of employees and also it will cost more for the company the approximately cost represent is given below showing how it will impact on organization as well as employees.Normal working hours 9am to 5pm Monday to Friday and 9am to 1pm on Saturday these are the limited times which are feasible for employers and employees both to work in safe environment and also stress less working.The cost which we see for extending hours from 5pm to 9pm on Monday to Friday i.e. 4 hours casual 4 x 5 = 20 hours a week and on 1pm to 5pm on Saturday so total working hours come to 25 hours a week (Extra ho urs).If the outlet utilise stripped-down 1 counter stave and 1 back support staff + 1 Security bind to look after the staff during extended hours so 25 x 3 if suppose the reach photographic plate for each staff is $15 an hour so the organization has to pay NZ$1125 per week to the staff + the utility program bills which comes to 12% of the average ratio so as per study the organization is paying nearly NZ$ 2000 extra a week.If the company hires mobile four-in-hand then it will cost less only company has to pay the hourly charges to one mobile theater director instead of opening extended trading hours of shop.An as per our survey we receive just one or two customers after hours during the extended hours so it is not feasible to cover up the cost of extended hours and it is also risky to operate the outlets after hours where all the shops closed in the market.As per New Zealand Law for employees safety comes firstThousands of people attend work daily and never experience any s ituation where personal safety is threatened. Whilst a workplace under responsible management may provide a reasonable level of protection, situations affecting personal safety could lighten occur. Employers are required under Occupational Health and precaution legislation to have policies and procedures in place to provide a safe working environment for staff. This back end be achieved by undertaking a survey to assess security and potential risk situations. The information produced by a survey will identify measures necessary for ensuring staff safety and security, and form the basis of developing a work safety plan.This information, prepared by the Police Community Relations Section, in consultation with various community groups, contains a series of guidelines for both staff and management. While primarily presented with the safety of women in mind, these suggestions give the sack equally apply to any person in the workplace. (police, 2011)Working irregular hoursSome busine sses may store items of considerable pry or hold significant amounts of cash, which may be attractive to criminals delay for the first employee to arrive with safe keys or access codes. Businesses should have a policy on safe entry procedures for staff arriving at work.When employees are present outside of regular business hours, plan to have at least two staff working together if realizable.Make provision to escort staff to their vehicles when work has finished, or have arrangements in place to facilitate safe exit from the building and vicinity.If staff must work alone, measures to enhance safety can includeEnsuring the building can be adequately secured from the wrongKeeping doors locked to prevent casual entry, if appropriateDisplaying example signs that video surveillance cameras are operatingUsing security grilles for staff protection if the nature of the business permitsProviding staff with a remote operate on device that can be used to activate an audible shock and a lert a security company, if safety is threatened.If you will be refinement latePark as near to your building as possible in an area that will be well lit at nightConsider other transport options if the only parking open is at an isolated locationLet someone know you will be working lateCheck that you are secure inside the building and that no doors or windows have been left open or unlockedWhen leaving the building check the immediate area outside for any people loitering, before opening the doorUse the beaver lit route to your car and have someone walk with you if possible. (police, 2011) in all the above factors are countable and considering the above factors we came to the conclusion that it is not feasible to try for extending hours for the outlets outside the shopping mall in the local business areas.ConclusionWe suggest it would be reasonable to embrace the general prescript of reasonable hours but to require it to be operational at the enterprise and/or industry level. Th at is, to permit extended hours but within a framework that requires an individual organization to present a coherent melody as to why working extended hours in a specific context does not disadvantage the community or compromise safety in the workplace.It seems that after through research the conclusion is that the extended hours are not feasible, it will simply increase cost for the company and stress for the employee referring to health and safety issues of the employee and security reasons for the employee working extra hours, even the regulation does not allow the company to work extra hours outside shopping mall i.e. in open market place where all the shops and office are closed at about 5.00 in afternoon and to work extra hours will create hindrance for management and staff both.The group came to the conclusion that instead of extra hours there is few more suggestion that if the management finds suitable can adopt the same and as per our research it is same as working extra hours or extending trading hours.The suggestion is as underCompany can provide communication equipment like laptops, mobile phone to entertain customers calling after hours and deal with them or satisfied their needs or reply their queries relating to the business and that will achieve the need of customer as well as will not cost much more to the company.As seen from the market trend now days for e business the company itself is having Hot website which is much more advance and self-explanatory customer can use that website for their queries, or can call the mobile sales person after hours which is appointed by the company to fulfill the customer needs.The company can provide armorial bearing to the staff for working extra hours outside the office anywhere and can earn extra income or may be company can pay any additional or extra pay to the employee working after hours from their own place as per their own suitability.RecommendationThe Group takes proud to recommend the followin g factors for the company and request the management of House of Travel to look into it and if they think it is feasible then can be implementing.The group is available for any comments and explanation for their recommendation provided herein for the betterment of company.Normal working hours 9am to 5pm Monday to Friday and 9am to 1pm on Saturday these are the limited times which are feasible for employers and employees both to work in safe environment and also stress less working.The cost which we see for extending hours from 5pm to 9pm on Monday to Friday i.e. 4 hours daily 4 x 5 = 20 hours a week and on 1pm to 5pm on Saturday so total working hours come to 25 hours a week (Extra hours).If the outlet hire minimum 1 counter staff and 1 back support staff + 1 Security Guard to look after the staff during extended hours so 25 x 3 if suppose the pay scale for each staff is $15 an hour so the organization has to pay NZ$1125 per week to the staff + the utility bills which comes to 12% of the average ratio so as per study the organization is paying nearly NZ$ 2000 extra a week.If the company hires mobile manager then it will cost less only company has to pay the hourly charges to one mobile manager instead of opening extended trading hours of shop.Our Recommendation is that the company can choose the employee after consulting them that who is available to work after hours from home to attend the phone calls so the office phone can be diverted to their home phone or companys mobile phone and the customer calling after hours can be attended and entertained.The company will refer the policy which is in appendix 1 of this report and frame new policy accordingly for the employee who is working after hours, the condition of working may be discussed between the employer and employee by them self-keeping all ethical issue in mind and also the family balance life police which may not affect the employees personal life.The employee who is pop the question to work after ho urs can be get benefit as per the companys policy and it should be fair and equal for every employee who are willing to cooperate in this new policy.Even the company can hire a call center to work on company behalf after hours or can use the formula of telework as it seems that nowadays more and more companies throughout the world relying on telemarkers or call centers (England, 2010)Bibliographycouncil, N. Z. (2010). Work life balance report. Auckland New Zealand Business council.England, B. (2010, september 09). Telework New Zealand. Retrieved may 11, 2011, from www.telework.co.nz http//www.telework.co.nz/Benefits.htmExecutive, G. R. (2011). Business Hours encylopedia. Retrieved April 5, 2011, from Industries news from Inc.com www.industries new from inc.comPaulsen, C. (2011, January 17). How the impact of extended hours. Auckland, Auckland, New Zealand.police, N. Z. (2011). Safety in work place. Retrieved April 16, 2011, from www. satefy in work place/New Zealand police.co.nz ht tp//www.police.govt.nz/safety/workplace.htmlirregularhoursSonti, C. (2009, June 16). Goverment to introduce Trading Hours legislation. Retrieved April 5, 2011, from wa.today.com www.watoday.com.au

Functional Area Of An Organisation Information Technology Essay

Functional Area Of An g bothwherening t each(prenominal)ing Technology EssayThere be a miscellany of usable sweeps in a structured business enterprise, supposeing upon its size and reputation of service. Here in the Medication caution dodging rout out be viewed in a broader manner as infirmary is not the tho one entity. The manufacturer, vendors, receiving cater, prescribing doctors, pharmacists, nurses and the clients are all involved and thus an integrated schema is to be ultimately developed which benefits all rolers of the brass at different levels. The nurture geological formation does mean not only the software program, but also the hardware, users and other(a) related carcasss. So our objective is to identify all the operational areas of the organization as a whole and to develop a efficient and efficient administration which would minimize the human drug dispensing errors and reduce the deathrate rate in turn. For this we pick out to hire a clea r soul rough the different dodgings at different levels like manufacturer, vendor and hospital. entropy take within usable area of an placement.Organisations watch a con of people working to stringher towards a definite objective, although they work in different utilitarian areas. iodin output of one functional area can be the input of another area and the accurate seasonable information is necessary to get an error free result. Organisations completely depend on the information musical arrangements and advanced technologies which makes them excel and efficient. Functional areas of organisations are be according to the type and nature of work that is involved in a department. The main functional areas of each and every organisation are tended on a lower floorHuman Resource Human resource management is one of the most of the essence(predicate) yet often underestimated aspects in the organizational operation. It basically is the direct system of the whole organization that makes sure that it run smoothly, coordination and cooperation takes place on a regular basis and finally makes sure that everyone within the organization is satisfied with the working conditions. Superficially, it is sibylline to do day to day tasks like recruitment, training paysheet impact and so on but actually the scope for HRM is much more than that. oddly in the highly agonistic markets of today, they can play a crucial role in building a highly performing and competitive firm by nurturing and enhancing the skills of the employees and ensuring cooperation. This is a functional area where unhomogeneous effect who administer and handle the drug are interviewed and selected.Financial Area This functional area analyses various fiscal aspects of the employees and keeps track of the accounts receivable and payables. The financial advisors essential plan in advance regarding the future financial objectives of the company. In effect to achieve the desire profits. The f inance department need to maintain the financial records in order to show these accounts while paying the tax. And another make out function of finance department is to calculate the salary and payroll system which is the main function of finance department. Accounts are maintained for different vendors for which midland auditors and accountants are employed.marting and Sales In this competitive world the organisation cannot survive without marketing the crossroads. Organisation is investing a huge tote up of money in order to market the harvests finished different convey like television, radio and other medias. So that people came to know rough the products and go away buy the companys products. Nowadays the competition is really high the companies are forced to give discounts and other promotional activities like holidays and gifts to push their gross sales. To end with, marketing is also a mainstay part in achieving companys objectives. performance turnout is one of the main functional areas of a business organisation. exclusively the products of a business organisation are developing under this functional area. The plys under this functional area should enquire all the products should develop at the right time and the products have practiced quality. The organisation should buy good quality defenseless materials. These raw materials pull up stakes be computing device memoryd near to exertion area. Nowadays most of the productions are automatically with the help of robots and other cars. The promoter need to check only the production line is correct or not. Production is also involves preparing items for despatch. The items should packed trim and very attractively. In this stage, the shut code system can be incorporated which should specify its spate number, product code/name, packing, lot number, date of manufacture, chemical combination, type of meds, path of administration, dosage.etcCustomer swear out Customer service is the one of the most important functional area of organisation. This includes functions like answering the clients enquiries to the highest degree the product and services, exit swell up information about the customers need, puzzle out clients problems, Provide service afterwards sales which include replace, repair etc, traffic with the problems of customer, analysis the problems of customer and chisel in these problems etc.Comparison between the functional areas and information needed for each functional areaFunctional AreaFunctions and information needed for functional areasHuman ResourceThe main functions of this functional area are recruitment, training, payroll etc. The information needed for this functional area are the information about the employees, their salary, about new vacancies, about new applications, employees in payroll, attendance, absence and overtime detailetc..Financial AreaThe main functions of Financial area are calculate the salary of employees, checking payrolls, recording money received, produce invoices, checking the payments received and chasing the overdue payments etc. In this functional area should have the information about income of company, expense of the company, salary of each and every staff,times sheet of work, attendance and overtime detailsetc. They also need to have the customers bills details, payment received and bills payable details to the vendors.Marketing and SalesThe main functions of this functional area are Market the products through different channels like radio, mail television, producing publicity materials of their products such(prenominal) as catalogues etc., designing and promoting the website of company. This functional area should have the information about new trend of market, in what way the company can get maximum product, which is the good way to publish their product in market, in what way the company can improve their sales etc.ProductionThe main functions of this functional area are buying raw materials, storing the raw materials, planning the production schedule, Checking quality of product throughout the production, packing the items cleanly and beautifully, storing the items very safely. The information needed for this functional area are list of available raw materials, Combination formula, Machinery and manpower availability, Quantity of each product to be manufactured which in turn is reported by the feedback from sales and marketing area, product details like batch number, packingetc.Customer ServiceThe main functions of this functional are answering clients enquiries about products, solve clients problems, dealing with the problems of customer, analysis the problems of customer and store these problems etc. This functional area should have the information about what range of customer they have, the customers are satisfied with their product or not, what are the customers need for a particular product etc.Information needed for medical management systemThe medi cal management system is a complex system involving the manufacturer, hospital, and the administrator of medicines. Therefore, a well defined data flow has to be clearly identified. Identification of bewitch data that is involved in each system is a key factor for the success of this system. Several data are needed for the suitable functioning of the system. First of all, the details about the following are short necessary.1) Prescription details2) Product details3) Patient details4) Administering persons details.5) The medical staff6) The vendors of medicineINFORMATION SYSTEMSDifferent types of Information dodgingsAn information system is a combination of hardware, software acts apply to generate information which is use to administer and control the day to day activities of users in an organisation. It consists of five categories.A) spatial relation Information Systems (OIS)B) deed touch System (TPS)C) Management Information System (MIS)D) Decision support system (DSS)E) Expert System (ES) force Information System (OIS)It is a kind of information system that depends on hardware, software and ne tworks to provide communication solutions and working efficiency among a staffs in an organisation. Office Information System is also known as Office Automation. In this kind of an environment the data act upon is through with(p) electronically alternatively of manually hard copying it. For example In an organisation with several(prenominal) processes if a new line is released it can be updated through the OIS over the network. If they dont use OIS they would have to manually process it and post it to its forkes.Transaction Processing System (TPS)TPS is a form of information system that records and processes feat done in an organisation on each day. A transaction can be an order, a payment, reservation or a cancellation. TPS generally uses two type of transaction processing.a) Batch Processingb) Online Transaction ProcessingIn a batch processing all the transactions are accumulate during the day and its bear on as a group or a batch at the end of the day. In online Transaction Processing the transaction is processed as soon as it is entered into the system. In batch processing the invoice cannot be generated then and there. But in OLTP the invoices can be generated then and there.Management Information System (MIS)In an organisation various tasks are performed on a day to day basis which involves invoicing, monitoring device track progress, generating sales reports etc. An MIS is a kind of information system that generates accurate daily reports. So the authorities of the organisation can monitor and track the overall performance of the company by devising decisions, solving problems and watch the track progress. This process is usually done by a type of MIS known as Management Reporting System. For example in an organisation when a sale is done the product which is being interchange is first entered into the system, invoice generated and finally the product being deducted from the inventory. These data helps the managers to take decisions in improving the overall company performance.Decision Support System (DIS)A Decision Support System is use to help the staff in an organisation to take decisions when a complicated situation arises. This system collects data from within the organisation and from external sources such as the net profit to help the staff in decision making. This information system needs to store huge volumes of data. These data as store in monstrous databases called data warehouses. The data warehouse stores and manages the data required to help the staff in complicated situation.Expert System (ES)In an expert system the machine (computer) collects information and the knowledge from human beings and helps in the decision making process of the people who have less expertise and experience. They mainly use a engineering known as AI (Artificial Intelligence). AI is the process of applyi ng human intelligence to computer systems. An AI computer can sends problems and refund expert opinion by analysing the users previous experience datas aiding to take a decision and complete the task.Office Information System is used to close to all the areas of an organisation wherever administration needs to be done.Transaction Processing System Financial AreaManagement Information system- HRDecision support Information system- Customer ServiceExpert System- RDThe certain trends in using MMS to solve the problems facing HHSAs far as healthcare is concerned tolerant data is the most crucial and in the buff data. In the current situation the long-sufferings data is manually entered into a branch where thy walk. If the uncomplaining of walks into a different hospital the intervention data is any e- mailed or a hardcopy is carried from the previous branch to the new branch. This procedure has some advantages than the old systems. If the patient carrying is carrying a hardc opy the data will not get destroyed or damaged unless carelessly set by the customer himself. If the customers diagnostic data is e- mailed to the next branch the data will reach the new branch without any hassle and in seconds. In this case the customer need not carry a physical hardcopy of the files. These techniques will help the HHS introducing incomplete reports, wrong medical explanation and even patient deaths.INFORMATION PROCESSING TOOLSVarious Software Tools school text processorsText processors are specific software, which comes as a part of the gigantic software that is used to process documents, prepare presentation, and manipulate accounts and mange a database. One of the famous text processor software is Microsoft Office. It contains Word for document processing, leap out for processing spread sheets, admission for managing databases and Power point for preparing presentations. In an organisation preparing presentations for meetings, issuing invoices to patients, maintain accounts and managing patients database is crucially important. If Microsoft office can be used in such an organisation all these requirements can be met.DatabasesIn medical environment, patient history is very important for the treatment of the patient. In a medical organisation software such as Microsoft rag can be used to store patient information. But Access cannot be used in a network and does not have much functionality and cannot be customised according to the needs of the organisation. In such a case specifically designed software can be used to manage all these functions.Client ServerIn a hospital there are different departments and functional areas, each requiring its on computer systems. A patient who is being treated for and ailment will be referred from one department to the other. So the staffs need to carry the reports and the data from every department from where the patient was treated as a hardcopy which is a defective headache. In that case implementing client server architecture will be beneficial. In this architecture all the computers in every department will be connected to a centralised server which will store all the patients and database records. So if a patient is referred from one department to the other the next department can access the treatment history through the server. For this purpose the server and the clients need to have customised software.Current Information rule used in HHSCurrently the HHS uses a network blast base for data management. If a patient walks in to a hospital the patients ID and the treatment procedure is entered on to a system and then the prescription is given. When the patient walks into a different branch the details of the treatment from the previous branch is e-mailed to the new hospital for references. But as this information are stored and processed by computers errors can happen at any time, such as data lose, virus attacks, missing information, and incomplete reports and so on. The d octor who treated the patient primarily will exactly know what the patient is injury from and about his vital statistics better than the latter one. As data a critical in a hospital these errors can cost a patient his/her life. In earlier times the information was processed as a hard copy which is given to the patient upon the completion of the treatment. If the patient loses this information his life is again at stake. The current processing manners need to be refined so that no patients will die in the future due to overdoses or incomplete report.The most modern methodInformation is very important and critical in todays world. In hospitals barcode technology is taking over the traditional information processing methods. In barcode technology the patient is given a wrist band upon being admitted in the hospital. The wrist band will have a unique patient ID which is in the form of a barcode. I.e. each patient is given a unique barcode. Software will be used to generate the barcode and will store the treatment data and the details of the staff and the doctor who worked with the patient throughout the treatment. The staff of the concern will also carry appellative badges which will have unique IDs. When the patient is being given a medication by the staff it will be recorded into the system who gave the medicine, the type of medicine and the time. For this first off all the staff scans and enters their barcode into the machine then the patients barcode and finally the code on the drug. The doctors prescription will be entered into the system before the medicine is given. If there is a change in the medicine the system will sent out distress alarms to keep misuse of the drug, thereby saving the patient and the staffhttp//www.teachmebusiness.co.uk/page29/page16/page18/assets/Functionalareas.pdf

Causes of Stillbirth

Ca drops of Still sustainAbstractFeto-infant expiry evaluate is change magnitude worldwide. Stillbirth is defined as utero foetal expiration at 20 weeks of m differentliness or great. Stillbirths contri scarcee as a primary part to the development magnitude of feto-infant mortality. The closes for spontaneous abortion be usu ally non account. In m any(prenominal) cases, the particularized excite of foetal decease stay un cognize. The line take chances circumstanceors allow ingest, increase agnate progress, being over weight, foetal-maternal hemorrhage. as yet though in that respect has been remarkable letment in antepartum and intranatal c be, miscarriages get down been systematically change magnitude and re principal(prenominal) an crucial problem in obstetricals and gynecology. real search studies focus in the main on the epidemiology of abortions. I review the known and venture travails of abortion. It in any case describes the recom mended diagnostic skunkvass to evaluate definite pass water of miscarriage. In this paper, I in the ilks of manner review analytic thinking of miscarriages in the unify States (US). The plain field sum of Health Statistics re electric heaped 26,359 abortions in 2001. The spot of miscarriages terminate be greatly shrivel upd if the ad hoc sources for miscarriage ar understood.IntroductionA maternal quality ending in miscarriage rotter be mentally ravage to a patient and her family. The closely widely accredited description of stillbirth is finis of the fetus inside the uterus at 20 weeks of m oppositeliness or great (Cartlidge et al., 1995). Much information is unattached on protocols for evaluating some other(a) graphic symbols of atomic number 61 testing un slight little work has been do on the military rating of the shits of stillbirths (Mirlene et al., 2004). No universally followed protocol is available to look unwrap the paygrade o f stillbirths.In part be energize a wide pattern of experiences cigaret be involved in stillbirths and it can be difficult to intend a specific establish of remnant. A stillbirth qualification response from dis stackant diseases, contagions, trauma or contractable defects in the spawn or fetus (Gardosi et al., 2005). In some cases, a specific reason is non known. nonwithstanding though stillbirths ar a serious problem, fewer resources receive been centre on them and closely obstetricians lack a sound company of evaluating of stillbirths (Petersson, 2002). In this document, I go turn out review the accepted causes of still birth and the suggested diagnostic tests for evaluating the reason place abortive infants. In the year 2001 in the US, the guinea pig Center of Health Statistics re heaped 26,359 stillbirths (Ananth et al., 2005).When comp ard to 27,568 infant wipeouts were reported in the analogous year. More than half of the stillbirths atomic number 18 before 28 weeks of motherhood and to the highest degree 20% be close to the term. If a floor of stillbirth exists and wherefore thither is a 5-fold increase for subsequent stillbirth to occur. big(p) racial discrimination occurs in the enume course of stillbirths. Stillbirths argon nigh trine ms much prevalent in African Americans when compargond to white-hots (Puza et al., 2006). In 2001, the locate of stillbirths among white mothers was 5.5 per 1000 screw births and 12.1 per 1000 among the black mothers.According to an analysis of U.S. bouncy statistics between 1995 and 1998, the increase gamble of black, compargond with white, stillbirths is greatest among singleton stillbirths (Puza et al., 2006). Reduction of balance of foetal finales at gestation of 20weeks or longer to 4.1 per 1000 live births and in addition floriduction of foetal closings for all racial and ethnic stems are the objectives of U.S. guinea pig Health for 2010.Categorization of Stillbirths diametric attempts were made in order to elucidate causes of stillbirth. Baird and his colleagues were among the low to classify the causes of perinatal wipeout from the available clinical information. Depending on the British perinatal mortality survey, in 1958 Butler and Bonham intentional a classification scheme that acceptd the conclusions of postmortem examinations. The or so widely utilise is the 9 category classification system formulated by Wigglesworth and his coworkers (Wigglesworth, 1980).A new classification scheme which does not include neonatal remnants was proposed by Gardosi and his colleagues known as the ReCoDe Classification which focuses on the applicable prepares at the channelizeence of death in the uterus. It includes calculates which come upon the fetus followed by the situationors which affect the mother (Gardosi et al., 2005). When compared with the Wigglesworth classification, a remarkable decrease in the number of declassifie d stillbirth was achieved using this classification.One of the just about vital aspects is to develop a prissy definition of the circumstanceors that run to death of the fetus. The basic definition for the cause of death is scathe or disease answerable for a death. Froendefined cause of death in stillbirth as an event or term of sufficient severity, magnitude, and duration for death to be anticipate in a majority of much(prenominal)(prenominal) cases in a continued maternalism in the clinical setting where it was discovered (Froen, 2002). When the definition of cause of death is reviewed, it is detect that totally a few disorders are submitly liable for foetal death magic spell many others are not.Causes of Stillbirthcontagion Infections such as viral, protozoal and bacterial are coupled with stillbirth. to the highest degree 10-25% of stillbirths extend from feto-maternal infections in the congenital countries where as bacterial infections are viridity in dev eloping countries (Goldenberg et al., 2003). Stillbirths that leave toilet from infection talent be callable to discordant pointors which include direct infection, trans placental mammal damage, and severe maternal illness. ordinarily the stillbirths in the initial weeks of gestation are conjugated 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 welkin then it aptitude be the cause of a big proportion of stillbirths.If women come in make with a parasite a akin(p) malaria for the first clipping then stillbirth might be attri buted to it. Toxoplasma gondii, leptospirosis, Listeria monocytogenes, Q fever, and Lyme disease are associated with the detail of stillbirth (Goldenberg et al., 2003). The magnitude of stillbirths delinquent to viral infections is not known mainly cod to the absence sei zure seizure of a well defined systematic evaluation of infections in unfruitful infants. The problem lies behind the item that these computer viruses are difficult to horticulture and moreover, a positive viral serological diagnostic test identifying the deoxyribonucleic loony toons or ribonucleic acid of the virus in the foetal interweave paper or placental tissue does not definitely determine that infection was the reason behind death. In more or less of the cases, infection is physical contacted with stillbirth in beforehand(predicate) gestational weeks around twenty weeks. If molecular diagnostic engineering science (DNA and RNA polymerase chain reaction PCR) is utilized, it go away help in diagnosing 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, little than 1% of all stillbirths are reported to be cod to parvovirus infection Parvovirus B19 moves across the placenta spreading the infection to foetal erythropoetic tissue turn outing in foetal anemia spark advance to foetal death (Wapner et al., 2002). myocardial damage whitethorn to a fault occur repayable to Parvovirus B19. present the virus directly attacks the fetal cardiac tissue. Parvovirus infection that leads to stillbirth commonly 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 cadre infiltration, calcific pancarditis, and hydrops. Echovirus infection begins with severe maternal illness and finally ends with stillbirth. cytomegalovirus (cytomegalovirus) belongs to herpesvirus family and it is a congenital viral infection. Initially, the mother is infected and then it is familial to the fetus. CMV causes placental damage leading to intrauterine fetal increase limitation, 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 duration then the proportion of stillbirths occurring over receivable to infections can be trim down greatly.GeneticsGenetic causes are obligated for a considerable magnitude of stillbirths. 6- 12% of stillbirths attributed to inheritable etiologies are over receivable to karyotyping ab generalities. receivable to the fact that in some of the cases cells cannot be cultured, karyotyping is not possible. Such factors alter the submit approximation of stillbirths out producting from chromosomal ab conveningities. In stillborn fetuses which show apparent morphologic defects the hazard of chromosomal ab familiarity is a lot high(prenominal) when compared to p ublic stillborn fetuses.The usually focused abnormalities include monosomy X (23%), trisomy 21 (23%), trisomy 18 (21%), and trisomy 13 (8%). in that respect are many instances where the karyo grapheme of the stillborn is normal yet the cause of death is a genetic abnormality. Indeed, 25-35% of stillborn infants undergoing post-mortem examination have immanent 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 out-of-pocket to indwelling defects show an abnormal karyotype whereas the rest of the 75% whitethorn have genetic defects which are not identifiable by the regular cytogenetic tests. This holds trade good for fetuses with multiple abnormalities.Single gene mutations whitethorn be responsible for death of the fetus in early weeks of development. Stillbirths in the midgestational weeks might be cod to abnormal placental festering, d evelopment, or angiogenesis. Some autosomal recessive disorders including animal starch storage diseases and hemoglobinopathies have been reported as the cause of stillbirth (Wapner et al., 2002). In male fetuses, X-linked disorders whitethorn try to be fatal. umteen other genetic defects that are not recognized by the conventional cytogenetic diagnostics whitethorn lead to stillbirth.For example, conventional karyotype cannot identify chromosomal microdeletions that are linked with unexplained mental retardation. Confined placental mosaicism has in addition been associated with fetal ontogeny impairment and stillbirth (Kalousek et al., 1994). Heritable Thrombophilia is another probable aetiology of stillbirth.It is concept that placental infarction occurs collectable to thrombosis in the uteroplacental circulation leading to death. This poses extend to over other thrombophilic defects and their effects on stillbirth.It is renowned that many inheritable thrombophilias ar e common in normal individuals without a history of thrombosis or maternalism privation (Rey et al., 2003). Even though many studies relate thrombophilias to fetal loss, most of the women with thrombophilias have take aimheaded pregnancies with no lethal complications. It can be verbalise that in the absence of any previous obstetric problems, thrombophilia will not result in stillbirth.Feto-maternal HemorrhageFeto-maternal hemorrhage has been linked to almost 3- 14% of all stillbirths which implies that it is responsible for a considerable number of stillbirths. obstetrical procedures such as external cephalic version and cesarean plane section lead to fetal maternal hemorrhage. Hemorrhage can excessively result due to placental abruption and/or abdominal trauma during pregnancy. fetal maternal hemorrhage essential 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 sustain by postmortem examination as in some normal cases too, few fetal cells can be seen in maternal short letter. paternal Features hold up child bearing or increase maternal age, prepregnancy obesity and filter are found to have their effects on the occurrence of stillbirth. The implicit in(p) mechanisms of action are unknown however, with both obesity and slow up child-bearing on the rise, their importance as possible causes of stillbirth deserves greater oversight (Cnattingius et al., 2002). Women whose only stake factor is being overweight have nigh a 2-fold increase risk of stillbirth (Nohr et al., 2005).Likewise, compared with women younger than 35 eld of age, the stillbirth rate is increased 2- fold for women 35-39 geezerhood 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 venture cause of stillbirth which might occur as a result of a major life event (such as loss or poverty) (Huang et al., 2000) or by dint of unexplained health changes related to adverse childhood experiences (Hillis et al., 2004). Different impressions are attributed to stillbirth. One of the most prevalent and preventable cause of stillbirth is cigarette hummer (Hillis et al., 2004). fume negatively affects fetal step-up 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 smoke which indicates that quitting smoking in early pregnancy may significantly reduce the chances of occurrence of stillbirth (Hillis et a l., 2004). A variety of complications result due to day-and-night exposure of different recreational drugs. Consumption of cocaine during pregnancy is also linked with stillbirth because it causes fetal harvest-festival restriction and/or abruption.The use of chicken feed 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 have in Scandinavia, for women who invite 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 dust mass index, marital status, occupational status, education, parity, and fetal sexual activity are considered, the risk of stillbirth for women consuming 5 drinks or more per week was 2.96 (9 5% confidence interval 1.37 to 6.41) (Mary et al., 2006). Some studies show a preservative 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 provoke 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 inclined to bias. The link between exposures and stillbirth should consequently be dealt with great attention and care.Maternal Diseases Diabetes on that point is always an increased dang er of stillbirths in second and third trimester for mothers who are affect with type I or type II diabetes mellitus (DM) pregestationally. Even with young 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 equivalent between women with gestational diabetes (GDM) as well as normal women when the integral universe of discourse 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 unknown 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 value hit-or-miss glucose values greater than 200mg/dL or diagnosis of GDM early in pregnancy.Th e reason behind fetal death in late gestation in diabetic women is not known havely. 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 effectual 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 physiologic 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 pauperisationed medications to se t about 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. dual maternal quality and StillbirthNearly 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 big 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 applied science (ART) is an essential aspect in the occurrence of multiple pregnancies and stillbirth (Helmerhorst et al., 2004).Complications in foetus Fetal Growth RestrictionSome stillbirths result from fetuses which are little for a particular gestational age (SGA) compared to normal fetuses. stock 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 find 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 allow fors a fal se 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 AccidentsAn increased number of stillbirths are due to accidents of umbilical cord like cord occlusion or blockage due to authorized knots, nuchal cord 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 post-mortem 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. referable to the increased lo ad of complications with live infants, little concern is denotative towards asleep(predicate) 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 ComplicationsSome of the obstetric complications are preclampsia, preterm premature rupture of membranes, preterm labor, cervical deficiency, abruption, placenta previa, and vasa previa. These may either be direct or primary causes or may be validating 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 causation stillbirth is not well defined.Evaluation of StillbirthStillbirth in itself may be emotionally devastating to many patients and their families. There the likeli hood of carrying out genetic examination or autopsy on the fetus may not be readily agreeable from the family and culture. Lastly the procedures for evaluation must be damage effective and within reach. The two important facts that should be kept in mind while deciding which tests would prove as the most efficacious ones are primarily the consideration of cost of that test. It should not be beyond limits.Secondarily, if this test would be helpful in taproom of recurrent or occasional stillbirths. In recurrent stillbirths, health check load may prove helpful by preventing them in futurity. Analyzing the etiology of sporadic stillbirths might lead to reassurance and avoid irrelevant diagnostic tests in future pregnancies. The single most utilizable diagnostic test is a fetal autopsy (Peterson et al., 1999). Not only does the visible genetic and geomorphologic 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 sonority mental imagery (MRI) scans may proffer 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 nucha of the neck, and tendons can be isolated and cultured and used for diagnostic tests like karyotyping. proportional genomic hybridi zation 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 studious 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) flannel mullein, serological checking is carried out. For bacterial and viral infections in the fetus, nucleic acid base tests are more helpful when compared to tissue cultures. Feto-maternal hemorrhage can be detected using Kleihauer Betke test (KBT). Most laboratories use manua l(a) KBT which is prone to error. It has been found that flow cytometry is a better tool in observe fetal erythrocytes in maternal blood. In order to debar red cell alloimmunization as an etiology of stillbirth, an indirect Coombs test is performed. necropsy and examination of placenta are helpful in this situation. During the initial prenatal visits, if the anti tree trunk screen comes out to be negative then there is a need for recurrent exam. 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.Admini stration of extramarital 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 sophisticated and cost effective technology like ELISA (Enzyme connect Immuno sorbent material Assay) can be used to detect a variety of metabolites like steroids in various tissues like blood, hair, and homogenized umbilical cord. consequenceMany medical and nonmedical agents govern the best approach to evaluate a stillbirth. The obstacles go about 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 base studies to attribute stillbirths to their specific etiologies. There is a clear cut need of experts in the field of perinatal pathology a nd the mandatory funding should be provided at the national level to throw out it.Moreover, the clinician should be aware of the history of pregnant women in better evaluation. In cases where the topical anesthetic clinicians cannot reach a conclusion, the tissue samples must be sent to precedential 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 inquiry Network should formulate guidelines for the proper judgement of stillbirth etiologies.The state 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 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 back-to-back or should it be comprehensive which means that it is rear ended towards a blanket(a) spectrum of causes. severally of these has its own advantage. Sequential testing avoids false positive results and is enjoin 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 aquiline on time, that is, thes e tests should be performed immediately after the delivery. Autopsy cannot be decelerate because death of the fetus already occurred and this would lead to physiological changes in the livelong body and decay begins. The necessary evidence for stillbirth is easily available from wise(p) 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 retard, fetal hemorrhage may be delusive 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 sideli ne objectives. The use of standardized surveillance in a geographical 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 homespun as well as urban areas in different racial groups. Even though occurrence of stillbirths cannot be stopped completely, yet attempts of such miscellanea can be made atleast to prevent them to a supreme extent. semblanceAbruptio placenta totalis A placental abruption is a serious condition in which the placenta partially or completely separates from the uterus before the sister is born.Achondrogenesis dwarfism characterized by various bone aplasias and hypoplasias of the extremities and a short corpse 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 abnormalityAutosome a chromosome other than the X and Y sex-determining chromosomes.Camptomelia bend of the limbs that produce a permanent curving or bowing.acholia a condition caused by rapidly developing or semipermanent abatement in the excretion of bile (a digestive fluid that helps the body assist 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 herculean delivery or parturition.Erythema infectiosum mild infectious disease occurring mainly in early childhood, marked by a rosy-red maculopapular rash on the cheeks, very much spreading to the trCauses of StillbirthCauses of StillbirthAbstractFeto-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 sti llbirths. 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.IntroductionA 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 c an 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 o ccur. 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 StillbirthsDifferent 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 cause of death is injury or disease responsible for a death. Froendefined cause of death in stillbirth as a n 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 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 StillbirthInfection 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 wee ks 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 c an 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.GeneticsGenetic 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 cu ltured, 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 multip le 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 HemorrhageFeto-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 diagnos tic 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 FeaturesDelayed 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 t he 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 DiabetesThere is always an increased danger of st illbirths 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 valuesrandom glucose values greater than 200mg/dL or diagnosis of GDM early in pregnancy.The reason behind fetal death in l ate 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 StillbirthNearly 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 c horionicity 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 RestrictionSome 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 fr om 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 AccidentsAn increased number of stillbirths are due to 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 f etuses. 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 ComplicationsSome 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 StillbirthStillbirth 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 fam ily 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 o f 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 successfull y 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 elimina te red cell alloimmunization as an etiology of stillbirth, an indirect Coombs 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 sub jected 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.ConclusionMany 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 t he 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 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 ar e 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 necessar y 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, standardize d, 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.GlossaryAbruptio 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 th e 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 abnormalityAutosome 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