Hotel on the Corner of Bitter and Sweet Essay

One should not stop going for what they want. Through the struggles and obstacles being thrown at two people who are in love but the others may not be able to see it, they will always find a way back to each other. This book demonstrates the hardship two young people who are in love to find a way to each other even though at the time, interracial dating was not very common and looked down upon. During the Japanese internment in WWII, Henry, who is a first-generation Chinese American, went to an only non-white school was forced to work in the kitchen during lunch and clean after school because that was how his â€Å"scholarship† was being paid for. At that school, he met a Japanese-American girl named Keiko and became friends instantly. Even though Henry’s father was not very fond of the â€Å"enemy† Japanese people, that did not stop Henry from being her friend. One night, both Henry and Keiko snuck out to see each other. When they saw each other, Keiko gave him her family pictures because all Japanese had to get rid of any possession that could link them being known as Japanese so they could avoid being taken away. Japantown was filled with families and businesses who were forced to shut down and leave to the safer internment camps. Henry had to go through that pain of watching Keiko’s entire family leave, he was helpless to stop them but at the same time afraid that he would be herded with them for his similar physical appearance. Because it was a tradition for the Chinese to send their children back to China to complete their schooling, that is what Henry’s father did. He sent him back to China. He agrees to go if his father saves the Panama Hotel where Keiko’s family stored a lot of their belongings when they were shipped to the internment camps. While sending letters back and forth letters to Keiko, that is how Henry met the women he ended up marrying, Ethel. She worked at the post office and befriended him. As the war was going on, Keiko’s letters stop coming. The only reason why Keiko’s letter stops coming because his father interfered with the delivery of the mail for Henry’s own good. That is when Henry eventually moves on with his life, finishes school and marrying Ethel, but does not forget about Keiko. After the wife dies of  cancer he tries to find meaning for living. By doing so he goes back and visits the last Japanese habitation, which was the Panama Hotel. He never really forgot about Keiko, that was his first love. Even though Henry’s son, Marty, and Henry were not close, slowly but surely he eventually told him about Keiko. Marty and his fiancà © go out finding Keiko and sends Henry to New York to be reunited with his first love, Keiko. Being in Henry’s father’s shoes, I could see why he stopped the communication between Henry and Keiko. He was really just doing what is best for his children. At that time interracial relationships were not common but I guess nowadays parents cannot really choose who is going to marry their children. You cannot help how you feel and when you feel a certain way you will do whatever it takes to be back with the one you love. I think it was so cute how Keiko and Henry sent letters back and forth, nowadays it is only text messages or snapchats being sent. There was no sentimental feeling like there was before. Now we rely on technology as our form of communication and that is why some relationships fail. It is hard bringing your culture to America especially when you want to live the American lifestyle or culture. I know Henry’s father did not want him speaking Cantonese at home because if he spoke English, he would be more acceptable as an American. He was proud that Henry was going to an American school but of course he was not going to let some of the traditions go so therefore sends him to China. Henry’s father’s morals are very different with Henry as he grows up to being a father. When Henry has a son who is planning on marrying an American girl. At that time, dating outside the race is more acceptable. With me dating outside the Filipino race, my parents are okay with that. To them race does not matter. What matters is how the other person feels about you and vice versa. One that cares for you, takes care of you, and how they treat you should be the bigger concern and not the race. I always thought I would have to date within my race because I know that is what my parents would want, but they told me race should not matter. It is just how the other person can make you feel that matters the most. As long as I am happy, my parents are happy. I wish Henry’s father saw that Henry was happy with Keiko, but since his father was not very fond of the  Japanese, he did everything he can for them not to keep in contact. The story ends on a sweet note. The first thing Henry says when they meet was a Japanese phrase to tell her how beautiful she was, that he learned when he was a boy. Through the search from the city and pain and memories Henry had in the past, finding Keiko was the main purpose in his life. He wanted to be rekindled with his first love again. Hotel on the Corner of Bitter and Sweet did a good job at alternating between telling the story at adolescent Henry’s war years with his later life in 1986. The author manages to tell the story of the Japanese evacuation, of the struggles between generations in immigrant families, and of the friendship that later turned into love between Henry and Keiko. This book also tells an important story, that of the internment of Japanese-Americans during World War II and it was heartbreaking to watch Keiko’s family as they were evacuated, despite the fact that her family was more â€Å"American† than Japanese, and that Keiko was born in the U.S. Keiko’s frustration at seeing those of Japanese heritage taken away and her family’s strength as they are forced to leave behind their entire life is hard. I cannot image being taken to an unknown place with my family because of who we were. I liked how the author incorporated the generation of Chinese-American Henry and his immigrant parents. Henry’s father demands that he speak only English in their home, despite the fact that this leaves Henry unable to communicate with his parents but be more acceptable to the American culture. This book was overall a touching book. It was more than a love story between two people, it was the hardships that was going on during the WWII that kept those two from being with each other and with Henry’s father stopping communication between Keiko and Henry. I had mixed emotions because I was happy they found their way back to each other but at the same time I was upset because I wanted to know what would happen next.

To Clone or Not to Clone...That is the Question. This essay provides reasonable arguments going for human cloning.

To Clone or Not to Clone...That is the Question. This essay provides reasonable arguments going for human cloning. Wouldn't it be great if people could have children regardless of any diseases or even of their gender? Well, with human cloning, this may no longer be a dilemma to the human race. This is one of the many reasons why you should support human cloning. In addition to having a great and positive medical perspective, cloning allows individuals of great genius or talent to be duplicated and infertile or homosexual couples offspring.First of all, cloning has a very positive medical perspective. "Cloning would help scientists to understand the causes of miscarriages ? and eventually treat stillbirths or spontaneous abortion." Parents who risk passing defects into their children (through natural reproduction) can easily avoid the problems by using cloning. If a sick husband had some sort of disease, then the robust wife of that couple can just be cloned to produce a fit baby. Furthermore, damaged nervous systems could be easily treated through cloning, too.The symbol for the Raà «lian Founda tion can be seen...In the end, many diseases such as mental or physical retardation could be avoided.Secondly, cloning can allow families or societies to reproduce individuals of great genius or talent. Famous and bright scientist may be cloned so they can invent better technology or bring more intelligence to the world. We could also clone individuals who are alive and then being them together to work as a team. They may even find a cure for deadly diseases such as a cancer. Can you imagine how exceptional our world would be if we created another Steven Hawkings? Therefore, we are not harming anyone or anything with human cloning, but we are instead working for a better future by adding useful knowledge to the world.Lastly, human cloning offers infertile or homosexual couples children. There are many people who dream of and try to...

Writing with Rhythm

Writing with Rhythm Writing with Rhythm Writing with Rhythm By Guest Author This is a guest post by Hugh Ashton. If you want to write for Daily Writing Tips check the guidelines here. When I was substantially younger than I am now, I wrote masses of anguished adolescent poetry. My favorite verse form was the sonnet, a style and format that is maybe little surprising for a teenager to be writing. For those who slept through this part of their English course, a sonnet is a formal 14-line poem with a complex rhyme scheme in iambic pentameter. I no longer indulge in such musings, but I learned many tricks and techniques from writing my sonnets and other poems. First and foremost, writing poetry, especially formal poetry, tells you a good deal about the internal rhythms of the English language. Most of the spoken English language moves to a fundamental iambic rhythm: di-DUM di-DUM di-DUM. Put five of these together and you have a line of blank verse: Now is the winter of our discontent Or Is this the face that launched a thousand ships? Or The stars move still, time runs, the clock will strike, The devil will come, and Faustus must be damnd. In the second line of the last quotation, note how Marlowe breaks the rhythm slightly for emphasis (if you dont slur the word devil into one syllable, that is), and then reverts to the set rhythm for the second half of the line. You dont have to write in this formal style, of course, but you should make yourself aware of the internal stresses in English prose, and how they carry readers through your writing. Until relatively recently (a few hundred years ago), all reading was done out loud everyone read by vocalising the written words. When these rules of internal rhythm are broken, as in this quotation from a camera manual, the result is clotted prose prose which does not flow: Depth of field is the area of acceptable sharpness in front of and behind the subject in focus. The larger the F-number used (from F2.8 to F22), the deeper the depth of field. On the contrary, the smaller the F-number (from F22 to F2.8), the shallower this zone of acceptable sharpness. Its not bad English its free of jargon but its not good either. Another reason why these sentences do not flow is the lack of macro rhythm,the pauses for comprehension (and breath!) in the middle of a sentence. For another example, take this sentence from a recent Pentagon report: There is a crisis of confidence among Afghans in both their government and the international community that both undermines our credibility and emboldens the insurgents. If you read this out loud, its all got to be done in one breath. Theres no pattern to the sentence. By the time youve got to the end, you forget what the beginning was like. Heres a suggested rewriting: The Afghan people are experiencing a crisis of confidence in both their own government and the international community, and this is undermining our credibility, as well as emboldening the insurgents. Not perfect Id probably split this sentence into two but the sentence now has a beginning, a middle, and an end. Note how there is also an implied contrast between the Afghan people and the insurgents in my version that is somewhat lacking in the Pentagon original. Returning to my youthful bad poetry (and here is an example of super-macro rhythm in a piece of writing the thematic tie-up between the start of a piece and the end), the other major thing I learned from writing formal verse was to use a mental thesaurus, and not to be afraid to change the order of my words. I say a mental thesaurus, because a paper thesaurus can be too restrictive; wandering around the canyons of your mind can produce some interesting twists and turns that would never be explored using a printed page. Its all too easy to write bad ungrammatical verse: As on my bed I toss and turn Remembering things I tried to learn But relatively easy to recast these lines into something more grammatical and natural: Im lying wide-eyed in my bed While half-learned facts race round my head By forcing the grammar to be natural, I have also forced myself to think of different words and thereby avoid clichà ©s and hackneyed phrases. It works for prose too. Try to read your work out loud before you submit it. Does it work as a live reading? Does the language flow? Do the sentences hang together? Does the piece have thematic coherency? In other words, have you got rhythm? Hugh Ashton is a writer and journalist who has lived in Japan for the past 21 years. As a copywriter and rewriter of translated material, he has become increasingly pernickety and critical of his own writing and that of others. His latest published work is an alternate history novel, Beneath Gray Skies, which is available from Amazon, etc. Details of the book may be found at beneathgrayskies.com. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Writing Basics category, check our popular posts, or choose a related post below:50 Synonyms for â€Å"Leader†8 Types of Parenthetical PhrasesCapitalizing Titles of People and Groups

Standardization of English in the British Isles Coursework

Standardization of English in the British Isles - Coursework Example Standardization of the English language was achievable for Britain soon after the borrowing of numerous vocabularies from its colonies all over the globe. The English utilized by Britain was comprehensive or all-inclusive offering diversity to the language. English was rarely exploited before standardization since other languages such as Latin and Norman French were utilized in various distinctive fields of study and administration. However, the respectability of the English language progressively rose through the years in an attempt to acquire full standards. Standardization of English within the British Isles meant normalization, which is considered containment of any prevalent discretionary variations concerning the grammatical aspects (Trudgill 1984, 32). This implied that standardization could only be accomplished within the written channel.In view of changes that took place in presenting what is considered Standard English numerous restructurings were carried out to bring about these changes. Reconstructing pronunciation, therefore, can be considered, one of the elements that contributed to the standardization of the English language inside the British Isles (Cote 2006, 3). Writers between the 16th and 17th century imparted efforts on pronunciation. Reconstructions were also done on spelling both casual and informal in individual letters in dissimilar dialects.In the past, the populace utilized dialects as forms of interactions in their societal contexts. During this time, little existed about Standard English all over the globe, since the tongue had not been integrated, with other languages, to develop the standard language. Therefore, there existed disparities in spoken English within different societal contexts, due to the existence of diverse dialects for different factions of the populace. Although dialects were as a result of geographical and social incidences. Dialects have been associated markedly with sociolinguistics, which relates to social att itudes. However, with time dialect has lost its value with the emergence of status among the general populace. The dialect lost its value during the years in history when people started gaining identities, and social status leading to the development of more formal language free of dialects. Introduction of Standard English in the British Isles, therefore, became a reality with the subject of identity and social status.

Apple Strategy (1984-2004) Essay Example | Topics and Well Written Essays - 2500 words

Apple Strategy (1984-2004) - Essay Example It employs about 14,800 people. Apple experienced good success during the late 1980s but testing times during the 90s. John Sculley, previously the CEO joined Apple in 1983. Sculley had the valuable experience of the 'Cola-War' between Coke and Pepsi. He was full of marketing ideas and wanted to implement them in Apple as well. Steven Jobs, more of technology oriented initially found this approach little weird, but later gave Sculley a free hand. Realizing the importance of strategic alliance, Apple had a tie up with IBM in 1991 to target the areas where Apple lacked the developmental skills but owing to cultural and other differences the alliance did not last long. Sculley did an introspection and identified some key areas where more professionalism was required in the approach of Apple. For example discipline, work schedule and cost management were the areas put on notice. As part of marketing strategy, Apple also reduced the prices of existing products. But somehow this resulted in losses for Apple. In the meantime Sculley also propagated the 'Newton' series of notebooks, but somehow this series did not have many takers in the market, which resulted in further financial losses. Sculley was then replace with Michael Spindler in 1993 who lasted only three years making way for Gil Amelio, who came out with the Macintosh product range for designers and artists. From here onward Apple brought out radical changes in the marketi ng strategies as well. Amelio also realized that the 'free for all' culture where anybody was free to defy anybody in the company, is causing losses to the company. He believed in more conventional strategy where project managers are supposed to sincerely implement the strategies devised by the strategists, whatever the outcome. Apple thrived on its core competency of 'making the technology easy to use'. Amelio decided to make fullest use of this core competency in areas other than the PC segment. Apple started working on 'Copeland' the new operating system. IT experts started predicting that with the Copeland -1996 will prove to be an advance version of Windows-95. But declining sales and falling profits did not allow the launch of Copeland on time. However Apple acquired another software company NeXT with Steven Jobs back in saddle. NeXT too did not find wide acceptability in the market. This resulted in another round of introspection in Apple hierarchy. Executives from NeXT took over majority of the management portfolios. Workforce was drastically reduced, which paved the way for exit of Amelio. This, coupled with declining sales, gave rise to intense speculation in the industry about the future course of action that Apple will be taking. In August 1997 Steve Jobs announced a strategic tie-up with its lon g time rival Microsoft. Microsoft invested $150 million in Apple and the agreement stated that, 'Microsoft would develop and distribute office applications fro the Apple Macintosh while Apple would bundle Microsoft's Internet Explorer in future Mac products.' This provided a new lease of life for Apple, while for Microsoft it was a strategic move to lower the level of competition in the industry. As a result of this tie up Apple became profitable again in 1998. Now the challenging task for Jobs was to widen the market for Mac, because so far Mac was popular amongst

Physical Geography Articles Essay Example | Topics and Well Written Essays - 250 words

Physical Geography Articles - Essay Example This article tries to define sand dune and ripples and the cause-effect relationship. The author argues that sand dunes are result of sand waves which piles up with a particular pattern over a large area mostly of desert. However, the article shows that bedforms that result to such land forms are not only caused by wind but any other fluid. It is therefore important to note that climate factor which in turn influences movement of wind and water is responsible for the various landforms that characterize Earth surface. The central idea of the article is that Dunes and ripples are considered bedforms. Increasing changes in global climate has significant effect on various land forms. The deserts are particularly in danger as temperatures plummets and humidity dwindles. The little vegetation that covers desert landforms is at the brink of complete elimination. In other words, deserts that already have scanty vegetation cover are likely to be transformed to bare land. This would lead to other features like sand dunes among others. Besides, the trend in the desert change is closely associated with rising water levels due to increasing global temperature that melts ice. This article therefor offers an insight into the complex consequences of climate change of various landforms. This article centers on the unforeseen benefits of global warming as the ice melts. The Glacial melt constitute shift of more iron deposits which are seen as facilitating growth of phytoplankton. These phytoplankton in turn help in absorbing excess carbon dioxide with marginal reduction in greenhouse effect. This fertilization observation is attributed to the silver lining that can be observed on glacial landscapes. The author of the article therefore offers an insight into the existing relationship between physical geography and climate

Amniotic Fluid Volume In Pregnancy

Amniotic Fluid Volume In Pregnancy Objectives . To assess the relationship between the amniotic fluid volume (AFV) in low risk pregnancy and the perinatal outcome, using either AFI or SDP, and to evaluate the effects of different fetal positions and Attitudes on those measurements Methods . A prospective study was performed, in which a sample of 3000 low-risk pregnant women were studied using routine ultrasound, including fetal biometry and measurement of AFI, and SDP. Data were analysed using multiple linear regression, and constructing a curve for both the AFI, and SDP measurements, according to gestational age, the fetal positions and attitudes, in addition to the assessment of the final perinatal outcome. Results . The 50th percentile remained practically constant at approximately 150 mm between the 20th and 33rd week, after which there was a decline in volume, which became evident after the 38th week. At the 40th week, the 10th percentile was around 62 mm and the 2.5th percentile around 33 mm. Among the group with intact membranes, no significant differences in perinatal outcome could be seen in relationship to the AFI and SDP, although a 50% increase in emergency operations for fetal distress was seen in women with oligohydramnios. Fetal position had significantly affected the AFI, which was remarkably lower in breech pregnancies, but without similar effect on SDP. There was no significant difference for either SDP (P = 0.8) or AFI (P = 0.3) between fetuses lying on the right or the left side of the maternal abdomen. Conclusions . The percentiles incidence of amniotic fluid measurements in low-risk pregnant women showed significant decrease with gestational age, especially after the 33rd week pregnancy. Fetal position and laterality had affected significantly the AFI, but not the SDP. Key words: Amniotic fluid index, low-risk pregnancy, obstetric ultrasonography Abbreviations: AFI: amniotic fluid index, AFV: amniotic fluid volume, GA: gestational age, p: percentile Introduction The importance of variations in volume of amniotic fluid to fetal well-being has been particularly well-established, and are closely correlated to an increase in perinatal mortality and morbidity rates (1, 2), although some doubts have recently been raised (3). Fetal well-being is an important question that can, however, remain unanswered in many situations, but progress in diagnostic techniques has resulted in better perinatal outcomes, and has also contributed to understanding the complex physiological and pathological interaction between fetus and mother (4, 5). AFI and SDP are the sonographic parameters most commonly used to estimate amniotic fluid volume. Both use a two-dimensional measurement to estimate a three- dimensional parameter and are therefore subject to error. Amniotic fluid index (AFI), a semiquantitative ultrasound measure used to denote the volume of amniotic fluid, was first described in 1987 by Phelan et al. (6, 7). Since AFI involves measurements in four quadrants and SDP only measures the deepest pocket, it is possible that fetal position would affect these two indices differently. The relative accuracy of SDP and AFI is still controversial. Using invasive methods, some studies have shown these methods to be comparable, while others have shown that one index might be better than the other. However, none of these studies took into account the potential effect of fetal position on the amniotic fluid volume indices (8). Many studies have shown an increased risk of intrapartal fetal distress in parturient women with oligohydramnios, as identified by ultrasound examination. The exact pathophysiologic mechanism of olighydramnios has not been defined, but one likely explanation is an increased risk of umbilical cord compression during uterine contractions (7,9). However, doubts remain concerning normal values of AFI for each gestational age. The reference curves established some years ago are still in use in current obstetrical practice, but there is a need for new data, using a reliable reference low-risk pregnant women sample, to establish the limits of AFI that would indicate perinatal risk (9). Some existing curves (10 13), were based on relatively small sample sizes, and normal AFI for each gestational age was not yet definitely established. The purpose of this study was to estimate the curve for the amniotic fluid volume in low risk pregnancy, using a set of obstetric sonograms of women between the 20th and 42nd week, using two established parameters, the AFI and SDP, and to assess the effects of those measurements on the final perinatal outcome, in addition to studying the effects of different fetal positions and attitudes on those measured parameters. Material and methods A prospective study was carried out to estimate and evaluate the reference curve of AFI values in low-risk pregnant women, and to follow its effects on the final perinatal outcome. The study was performed at the Feto-maternal Unit, Department of Obstetrics and Gynecology at El-Minya University, Egypt. Inclusion criteria were: gestational age clearly established by last menstrual period, and confirmed by early ultrasound examination performed in first trimester of pregnancy; and gestational age between 20 and 42 weeks. Women excluded were those with pregnancy-induced hypertension, diabetes mellitus, chronic hypertension, gestational diabetes, fetal macrosomia, ruptured membranes, placental senescence, twin pregnancy, fetal growth restriction, fetal abnormalities, fetal death, fetal isoimmunisation, or other conditions, such as metabolic disorders, kidney and heart disorders, and hypo- and hyperthyroidism. Amniotic fluid volume was measured using a 3.5 MHz linear transducer linked to a ALOKA SS 280. A scanner using the 4-quadrant technique for the assessment of AFV, described by Phelan et al.(6, 7, 9), with a modification proposed by Jeng et al.(11). A total of 3000 women between the 20th and 42nd week of pregnancy were evaluated in this study, between August 2008 and December 2010. In order to avoid any possible bias due to repetition of examinations in women with some undetected problem, an independent sample was chosen. Therefore, only the first ultrasonographic examination of each woman was included in the study, and different sample populations were used for each gestational age, in a cross-sectional design. A formal consent had been taken form the women included in the study, after full explanation and counseling, and approval of the regional ethical committee. The uterus was imaginarily divided into right and left halves along the linea nigra on the surface of the maternal abdomen. Using the mid-point between the fundus uteri and the pubic symphysis, the uterus was also divided into upper and lower halves. With the transducer head perpendicular to the ground, the largest amniotic fluid pocket in each quadrant was identified. The vertical diameter of this largest pocket of each one of the four quadrants was then measured. The AFI was defined as the sum of the measurements of each quadrant in millimeters. All examinations were performed by only one professional in order to avoid inter-observer variability. The intra-observer variability of the measures performed with this technique was estimated to be high (correlation coefficient 0.92) (14-18). Both AFI and SDP were measured at the same time during the examination. SDP was obtained by measuring the depth of the single deepest vertical amniotic fluid pocket that was clear of umbilical cord or fetal parts (19,20). AFI was calculated as the sum of the depths of the deepest pockets from each of the four quadrants of the uterus. The position of the fetal trunk was characterized by three parameters. Initially, the ultrasound probe was placed transversely on the maternal abdominal wall, with the midpoint of the probe over the sagittal midline of the maternal abdomen, at the level of the fetal abdominal circumference (Figure 1). A vertical line (Line Y) was drawn downwards from the center of the ultrasound probe. A horizontal line (Line X) was drawn across the maximum diameter of the fetal abdominal circumference. Line X was thus divided by Line Y into a shorter part (S) and a longer part (L). The first parameter to be determined was the position of the fetal trunk. This was assigned as either fetal trunk left or fetal trunk right depending on whether L was on the left or the right side, respectively, of the maternal abdomen (21-24). Next, we determined by how much the fetal trunk lay to one side of the uterus, by calculating the laterality score, defined as S/(S + L). This score ranged from 0 to 0.5; a score of exactly 0.5 meant that the fetal trunk was on the sagittal midline of the maternal abdomen, and a score of 0 meant that the fetal trunk was to the side and did not cross over Line Y. The use of the laterality score has not been reported previously. Finally, we determined the orientation of the ventral part of the fetal abdomen: a line (Line Z) was drawn from the fetal hepatic vein to the fetal spine, and the angle (A) between Lines Z and Y was determined. Fetuses were classified into one of three groups: ventral anterior (A = 300.1 360- or0-60-), ventral lateral (A = 60.1 120- or 240.1 300-) and ventral posterior (A= 120.1 240-). Figure I. The study population was categorized into different groups according to the fetal position, and AFI and SDP in the different groups were compared. Pearsons correlation coefficient between laterality score and AFI was considered the primary outcome measure. For an r of 0.25, a minimum of 62 cases was needed at a Type I error of 0.05. Based on the curve of Jeng et al. (25), and adopting a mean AFI measurement of 140 mm at 40 weeks, and a standard deviation of 48 mm, a sample size of at least 120 measurements for each week of pregnancy was estimated, assuming an ÃŽ ± error of 0.05 and a maximum difference of 10 mm between population and sample measurements. The AFI was correlated to perinatal outcome based on the Apgar score, umbilical cord blood pH, birthweight, frequency of cesarean section for fetal distress, operative delivery for fetal distress, including both cesarean section, vaginal forceps, and ventous extractions, and referral to the neonatal intensive care unit (NICU). Fishers exact test was used for statistical evaluation. P < 0.05 was considered statistically significant. The computer program nQuary Advisor Release 3 (Statistical Solutions Ltd, Cork, Ireland) was used to calculate the sample size needed in order to obtain significance levels at p < 0.05 and 0.01 with 90% confidence intervals (CI). Data were analysed using multiple linear regression, and by constructing a curve of the 2.5th, 10th, 50th, 90th and 97.5th percentiles of the amniotic fluid measurements according to gestational age. All statistical analyses were performed using the Statistical Package for Social Sciences for Windows version 10.0 (SPSS Inc, Chicago, IL, USA). Students t- test, Pearsons correlation coefficient, linear regression and ANOVA were used as appropriate. A P-value of < 0.05 was considered statistically significant. Results The 3000 pregnant women included in the study had a mean age of 25.9 years (range 13 46), with low parity (45% were primigravida). The sample was basically from a low risk population because of the exclusion criteria used. The values of the 2.5th, 10th, 50th, 90th and 97.5th percentiles of the AFI, and SDP according to gestational age are shown in Figure II, III and IV show the data after being submitted to a smoothing process using quadratic polynomial adjustments. Analysis of the 50th percentile measurements of the AFI, and SDP curve at different gestational ages revealed that these values remained practically constant, at around 150 mm, between the 20th and 33rd week of pregnancy. At this point, values began to decrease, and this decline became particularly evident after the 38th week, reaching 130 mm at the 39th week, 120 mm at the 41st week and 116 mm at the 42nd week of gestation. Table I, and II The mean gestational age at the time of examination was 33.3 Â ± 2.8 weeks. The mean SDP and AFI were 5.5 (range, 2.8 9.3) cm and 14.5 (range, 6.7 29.3) cm, respectively. There were no significant differences in mean AFI measurements when these data were controlled for age, race, literacy, parity or previous caesarean scar (data already published elsewhere) (18). Measurements of the 10th percentile remained 100 mm until the 33rd week, when an accentuated decrease started, declining even more sharply after the 38th week of gestation, reaching values 80 mm and 40 mm at the 42nd week. According to the published normal ranges, six cases had polyhydramnios (AFI = 29.3 cm at 29 weeks gestation, SDP = 9.1 cm at 37 weeks and SDP = 9.3 cm at 33 weeks gestation) and two cases had oligohydramnios (AFI = 6.7 cm at 36 weeks gestation). Twelve hundreds and five (42%) cases were fetal trunk right and 1663 (58%) were fetal trunk left. There were no significant differences between these groups with respect to gestational age (33.1 Â ± 2.4 vs. 33.4 Â ± 2.7 weeks, P = 0.7), mean SDP (5.4 Â ± 1.3 vs. 5.5 Â ± 1.4 cm, P = 0.3) and mean AFI (15.1 Â ± 5.1 vs. 14.1 Â ± 4.0 cm, P = 0.8).Table III In fact, our results showed that fetal position had a significant effect on AFI but not on SDP; the more the fetus was positioned to one side of the uterus, the lower was the AFI. Both methods show good correlation between the measurements and the actual volume of amniotic fluid. The effect of laterality score on amniotic fluid volume indices was assessed by Pearsons correlation coefficient and linear regression. It had no significant effect on SDP (r = 0.13, ÃŽ ² = 1.1, standard error = 0.9, P = 0.23). However, it did significantly influence AFI (r = 0.31, ÃŽ ² = Transverse section of maternal trunk level of fetal abdomen8.7, standard error = 3.0, P = 0.005). The regression line is shown in Figure III. In other words, when the laterality score increased, the AFI increased proportionately. When the laterality score was 0.5 (fetal trunk positioned at the midline of the maternal abdomen), the AFI was, on average, 4.35 cm higher than it was when the laterality score was 0 (fetal trunk lay on the side and did not cross the midline of the maternal sagittal plane). Figure III, IV. There were two case of high AFI (29.3 cm) in the study population. In order to exclude the possibility that the results were influenced by this single case, we repeated the analysis quadrants of the ipsilateral side, the vertical depth of these two quadrants being be much shallower compared with those on the contralateral side. Although amniotic fluid should be displaced to the contralateral side, this may not be reflected completely in a two-dimensional measurement of the depth of the other two pockets. Therefore, it is not surprising to find that AFI measurement is lower when the fetus lies on one side of the uterus instead of centrally. The difference was statistically significant and is clinically important. When the fetus lay on one side of the uterus, the AFI was, on average, 4.35 cm lower compared with the AFI for a fetus lying centrally. On the contrary, SDP is apparently rather inert to fetal position. Since SDP only measures the deepest pocket, it is understandable that the effect of fetal position on its measurement is less. Based on the results of this study, SDP may be a better index for estimation of amniotic fluid volume than is AFI, because the association between SDP and laterality score remained non-significant (P = 0.4, ÃŽ ² = 0.8, standard error = 0.9). Further analysis was also performed with linear regression to control for the effect of gestational age. These results showed that the laterality score had a significant effect on AFI (ÃŽ ² = 9.6, standard error = 3.0, P = 0.002) that was independent of gestational age (ÃŽ ² = −0.4, standard error = 0.2, P = 0.019). AFI was significantly higher in cephalic fetal position, more than with breech ones. This result had been clearly apparent after 32 weeks gestation, and with less AFI with the ventral fetal trunk attitude with the breech position, than other. SDP had not show the same picture in different fetal positions, either breech or cephalic, so SDP as an AFV parameter had not been affected with the different fetal positions. Of the 3000 fetuses, 345 were ventral anterior, 1720 were ventral lateral and 803 were ventral posterior. The respective gestational ages of these groups were 33.5 Â ± 2.7, 32.8 Â ± 2.7 and 34.2 Â ± 2.8 weeks, the SDPs were 5.5 Â ± 1.4, 5.5 Â ± 1.3 and 5.5 Â ± 1.4 cm, and the AFIs were 14.5 Â ± 5.3, 14.4 Â ± 4.4 and 14.8 Â ± 4.4 cm. None of these was significantly different between the three groups (P = 1.0, P = 0.14 and P = 0.9, respectively). The 3000 pregnant women were divided into two subgroups according to the status of the fetal membranes. The membranes were found to be ruptured at the time of the examination in 1400 (44%) women; 750 (25%) had oligohydramnios. The membranes were intact in 1600 (55); 350 (15%) had hydramnios. Table I shows the maternal variables of the two groups. The median interval between the ultrasound examination and delivery was 4 h (range 0-24 h) in the group with ruptured membranes and 6 h (range 0-70 h) in those with intact membranes. In the group with ruptured membranes there was a significant difference in the frequency of operative delivery due to feta distress between the parturients with oligohydramnios and those with a normal volume of amniotic fluid [10.6% and 3.0%, respectively, p < 0.02, OR 3.86 (range 1.34-1.11)]. No significant differences were found regarding the other variables of perinatal outcome (Table II). In the group with intact membranes, there was a 50% increased risk of operative intervention due to fetal distress (OR 1.5), though not significant (CI 0.48-4.63) (Table III). Discussion There is a variation in AFI measurements according to gestational age. Values in the current study remain relatively constant until the 33rd week of pregnancy when a progressive decrease starts, becoming particularly evident after the 38th week of gestation. The normal lower and upper limit values of the AFI commonly used up to now, which vary between 50 and 200 mm, are similar to those found in the present study up to the 40th week of pregnancy. When adopting reference values between 80 and 180 mm for every week of pregnancy (19,20), incorrect diagnosis are likely to occur. Our findings, suggested a strong influence of fetal position on sonographic indices of amniotic fluid volume. Furthermore, we recruited women with apparently normal pregnancies and hence most likely with normal amniotic fluid volumes. Further studies should look at the relationship between fetal position and amniotic fluid volume indices in cases of oligohydramnios and polyhydramnios. Pregnant women, who are classified as having oligohydramnios by these criteria, may possibly be considered normal if a reference curve of AFI specific to gestational age were used, especially in term and post-term pregnancies. The adopted limit values indicating an alteration in the AFV are variable. For the fetal biophysical profile, the measurement of just one pocket is adopted, varying from 1 to 3 cm, and considered the lower normal limit by some authors (21,22); however, in this case, total volume would be considered decreased if the AFI were used. In fact, a RCT comparing both techniques showed an overestimation of abnormal results with AFI in post term pregnancies, increasing the number of obstetric interventions (23). These variations in classifying oligohydramnios reflect doubts regarding which percentiles best express the correlation between the decrease in AFV and poor fetal outcome. When the 50th percentile AFI was compared with that reported in a previous study (14), measurements were always higher in our study at all gestational ages by approximately 50 mm up to 28 weeks, and by 30 40 mm between 32 and 40 weeks of pregnancy. On the other hand, the current 50th percentile showed fewer variations, around 10 mm at all gestational ges, compared to the results of the indian study population (15). The importance of a curve that includes the 10th and 90th percentiles is reflected in its greater capacity to identify abnormal cases. Therefore, if the 10th percentile is used as the lower normal limit, there would be less likelihood of missing a case of real oligohydramnios. A curve that included the 2.5th and 97.5th percentiles would diagnose fewer cases of abnormal AFI, and this could result in more cases of oligohydramnios or polyhydramnios being included within the normal range. By adopting the 10th percentile of AFI as the diagnosis for oligohydramnios in our population, the values are higher than those found for the Chinese study up to 36 weeks, but similar around 40 weeks of pregnancy (14). When we compare the results of this study to previous published curves (10-17), similarities can be seen for the 50th percentile of AFT at all gestational ages. However, when comparing the 2.5th percentile, it is evident that the measurements in Moore and Cayles curve are lower up to the 35th week of pregnancy, after which they are higher than the values found in our study curve. The 97.5th percentile of the Moore and Cayle curve is slightly higher at all gestational ages except for the 41st and 42nd weeks. The lower limit of 2 standard-deviations and the mean values of the Jeng et al. (11) curve are slightly lower in relation to the present curve at corresponding gestational ages, except from the 37th to the 42nd week, when values remain higher than those in the present curve. The definition of normal AFI cannot, in itself, guarantee good perinatal outcome. For instance, a 42-week pregnancy with an AFI of 45 mm would be considered normal, but how physiological this value is and what real risk it represents are questions that still need to be fully answered. If the correlation between AFV and perinatal outcome can be established, this curve may have a broader clinical application in prenatal diagnosis and care. Moreover, the curve of the 2.5th, 10th, 50th, 90th and 97.5th percentiles of the AFI measurements shows a significant decrease according to gestational age, especially after the 32nd week. This measurement could, therefore, considered a normal reference curve for the evaluation of AFI. The results of the present study suggest that oligohydramnios after rupture of the membranes in low-risk pregnancies is associated with a nearly four-fold increased risk of operative delivery due to fetal distress. An ultrasound examination of AFI could thus identify those who may need intensified fetal surveillance during labor. The present study was performed on a selected group of women with low-risk pregnancy. As AFI is one of the parameters checked in high-risk pregnancies at our hospital, these parturients were excluded in order to make the study blind. By adding high-risk pregnancies, a much smaller sample size would be needed. The frequency of oligohydramnios in cases with intact membranes was unexpectedly high: 15% instead of 5% in the controls. Although our pregnancies were low-risk, a few showed signs of pregnancy complications on admission to the labor ward (Table I), which might explain the higher frequency of oligohydramnios in this group. Although there was a significant correlation between operative delivery due to fetal distress and oligohydramnios in cases of ruptured membrane (Table II), sensitivity was low (11%), and false-positive and negative rates were 46% and 23%, respectively. Thus the knowledge of oligohydramnios in these low-risk pregnancies did not cause any immediate action, only more intense surveillance during labor. In the present study there was a 50% increased risk of operative fetal delivery due to fetal distress in parturients with oligohydramnios and intact membranes. Teoh et al. studied 120 pregnancies as an admission study in early labor with intact membranes. The frequency of oligohydramnios (AFI < 5 cm) in their study was 22%, and operative delivery due to fetal distress frequency among these was 27%. Based on these data, a sample size of 100 would be sufficient. We chose, however, three times that size, as the low-risk status of their population was uncertain (9, 11). The pathophysiology of oligohydramnios before membrane rupture is unclear. One theory is that a reduced perfusion of the placenta causes hypovolemia in the fetus, and/or an automatic redistribution of fetal blood volume to vital organs with a resultant reduced blood supply to the kidneys. This in turn could lead to reduced production of urine, and thus reduce the volume of amniotic fluid. Bar- Hava et al. studied signs of redistribution, renal blood flow, and signs of oligohydramnios, but could find no correlation. There was no change in the renal artery pulsatility index (12, 14, 19). Oligohydramnios in labor after the rupture of membranes in a low-risk pregnancy is probably not caused by a reduced perfusion of the placenta, but is more probably caused by the loss of large amounts of amniotic fluid at the time of the rupture. One explanation for the significantly increased risk of operative delivery due to fetal distress in the group with ruptured membranes might be that there is an increased risk of the umbilical cord becoming trapped in an ad- verse position, at the time of the rupture, if a large amount of amniotic fluid is lost. Amnioinfusion may be a way to treat such cases in order to restore the volume of amniotic fluid and reduce the risk of compression of the umbilical cord, thus averting the need for operative delivery (11, 21, 23). As a conclusion of the current study, assessment of the AFV during pregnancy using the SDP appears to be more accurate than the AFI, especially the SDP evaluation has not been affected significantly with either different fetal positions or attitudes, but still we are in need for further controlled studies to compare the accuracy of the two modes of AFV assessment. Another conclusion drawn from our study is that an ultrasound examination, including measurement of AFI as an admission test for women presenting at the labor ward with ruptured membranes after an uneventful pregnancy, could help identify those with an increased risk of intrapartum fetal distress, namely those with oligohydramnios. Moreover Measuring AFI in low-risk pregnancies on admission to the labor ward might detect cases needing special surveillance. We are currently preparing a new ongoing study, as an extension to the current study, comparing the previous two parameters of AFV assessment in high risk pregnancies, and the preliminary results could confirm the previously mentioned results, but it is too early to get to a final conclusion.