Design of Interventional Biomedical Devices

Design of Interventional Biomedical Devices 1. Neurovascular Catheters and Engineering Design 1. Case Study 1. The following catheter found in the cathlabdigest written by Gill Laroya discusses the advancement of the design of interventional biomedical devices from an engineering perspective and how engineers enhance the design of catheters to prevent problems such as kink. The article discusses areas such as the history of biomedical devices, the materials involved, design challenges and the interface. It discusses a specific example in terms of catheters and their use. If a catheter must travel a long distance within the neurovascular anatomy, the engineer designing the product might decide to incorporate a shaft support component, such as a stainless steel braid in order to enhance the micro catheters kink resistance. The down side of incorporating the stainless steel braid is its ability to travel within tight sections and irregular shaped bends within the neurovascular system. In order to solve this problem a stainless steel coil support is added to the distal end of the catheter, the ad dition of the coil support enhances lateral flexibility and adding hoop strength to even better the kink resistance of the micro catheter. Also, the engineer can add a lubricous hydrophilic coating to the catheter to improve axial and rotational handling of the device and reduce trauma on the walls of the veins and arteries. The study shows us how we can design micro catheters to prevent problems such as kink occurring. Cathlabdigest.com. (2016). The Design of Interventional Devices: An Engineers Perspective | Cath Lab Digest. 2. Neurovascular Catheter Design The following article was posted in Medical Tubing Types by Shana Leonard on December 12, 2014. Form the article it is predicted that by 2020 the neurovascular market will reach $600 million, according to iData Research. A key factor contributing to the growth of this sector is down to the various advancements of the biomedical device. The design goal for minimally invasive surgical devices is to strive towards engineering the smallest possible outside diameter for a micro catheter device without compromising any of the performance characteristics. Designing neurovascular catheters to meet these constraints must take into account the intricate neurovascular anatomy. Mddionline.com. (2016). Key Considerations for Designing Neurovascular Microcatheters | MDDI Medical Device and Diagnostic Industry News Products and Suppliers. According to Steven W. Berhow, president of Rogers, MN-based Biomerics Advanced Catheter, he believes that upon designing neurovascular catheters they must contain the following traits; Good torque within the shaft from the proximal to distal end. Flexibility in the distal portion of the catheter. Kink Resistance. Visibility under fluoroscopy. Low Stretch. High Pressure. Good guidewire movement. These 7 traits stand as basic constraints when it comes to designing intricate, complicated neurovascular minimally invasive devices. Figure 2. Neurovascular Catheter Design.   Mddionline.com. (2016). Key Considerations for Designing Neurovascular Microcatheters | MDDI Medical Device and Diagnostic Industry News Products and Suppliers. 3. Advanced Catheters The first thing you need to know is what an advanced catheter is. So according to Bill Alexander, Director of Business Development at Biomerics Advanced Catheter, an advanced catheter is a minimally invasive medical device that typically consists of a thin walled, braid reinforced tube or shaft with multiple durometers. An advanced catheter has the ability to navigate through the neurovascular anatomy and deliver implants and devices such as coils, heart stents etc. The difference between advanced catheters and traditional catheters can be mainly seen when it comes to manufacturing the product. A little error in the materials used in an advanced catheter can lead to larger errors as the specific wall thickness requirement of an advance catheter are very strict to ensure optimal performance. Characteristics such as pushability, trackability, torqueability and kink resistance are crucial for the advanced catheter design. Traditional catheters and advanced catheters are not mutually exclusive and can be used to benefit each other and improve patient surgical results. (2016). Advanced catheters What you need to know about this growing medical device market. Figure 3 Advanced Catheters and Traditional Catheters.   (2016). Advanced catheters What you need to know about this growing medical device market. Advanced catheters have the ability to incorporate new technologies and have a more complex design than traditional catheters. 2. Human Neurovascular and Cardiovascular Anatomy 1. Cardiovascular System The cardiovascular system consists of the heart and blood vessels along with blood itself. It transports oxygen, nutrients, hormones and more and is powered by the heart. The heart consists of 2 circulatory loops, the pulmonary circulation loop and the systematic circulation loop. The pulmonary circulation transports deoxygenated blood from the right atrium and ventricle to the lungs. The systematic circulation carries oxygenated blood from the left atrium and left ventricle to all around the body. The cardiovascular system consists of blood vessels, coronary circulation (hearts own set of blood vessels), hepatic portal circulation (veins of stomach and intestines) and the blood itself (red blood cells, white blood cells, platelets and plasma). An understanding of the complex network and its physical structures are important when designing non-invasive medical devices. System, C. (2016). Cardiovascular System. InnerBody.   Figure 4 Cardiovascular System. Slideshare.net. (2016). Circulatory system PowerPoint Blood vessels are the road network by which blood transports around the body and returns back to the heart again. This intricate tiny transportation system of blood vessels has a major part to play when engineering advanced catheters and ensuring problems such as kinking dont occur. 2. Structure and Functions of Blood Vessels Blood vessels consist of arteries and veins. Arteries bring blood away from the heart. As the arteries are brought away from the heart they eventually become smaller and are broken down to the smallest arteries called arterioles which further branch into capillaries where gases and nutrients are excreted or exchanged. Veins have a larger structure and bring blood back to the heart again. As can be seen below in figure 4, the cardiovascular circuit can be seen where two main circulatory systems occur. The pulmonary circulatory system and systematic circulatory system. Each providing their own different structural differences that engineers must take into account when designing minimally invasive medical devices. Philschatz.com. (2016). Structure and Function of Blood Vessels  · Anatomy and Physiology. Figure 5 Structure of Blood Vessels. ] Philschatz.com. (2016). The structure of blood vessels can be seen below. The artery and the veins vary in thickness as can be seen from the micrograph in figure 6. From figure 5, it can be seen that Arteries have a thicker Tunica media than Veins but veins have a larger tunica externa than arteries. Figure 6 Arteries vs Veins Structural differences. Philschatz.com. (2016).  Ã‚   Figure 7 Micrograph showing the relevant difference in thickness. Philschatz.com. (2016). As can be seen in figure 6 and 5, vein walls are considerably thinner than Artery walls meaning veins withstand a much lower pressure of blood passing through them. Table 1 Appearance of Arteries and Veins. Philschatz.com. (2016). Arteries Veins General Appearance Thick walls, small lumen Rounded appearance Thin walls, large lumen Flattened appearance Conor Patrick Goold, DME4. 7 3. Shapes of Catheters in the Neurovascular Anatomy 1. Guide Catheters and shapes in the Neurovascular system. The following is an example of a Stryker neurovascular catheter called the DAC catheter. From figure 8, it can be seen that the DAC catheter accesses the distal neurovasculature. It achieves this by providing enhanced stability through a braided shaft and this in turn also provides resistance to ovulation. Preventing shapes such as snaking and reducing friction against the blood vessel walls. Stryker.com. (2016). Neurovascular Intervention DACâ„ ¢ Catheter: Stryker. Figure 8 Catheters, Shapes and Uses. Stryker.com. (2016). Neurovascular Intervention DACâ„ ¢ Catheter: Stryker. 2. Neurovascular Catheters in the Brain. The following images are obtained through a technique that requires the use of a minimally invasive advanced neurovascular catheter. What these images do is they give a visual understanding of the intricate nature in which the catheters must travel within the cardio vascular system. To do this the catheter is guided under x-ray guidance through neurovascular and cardiovascular system. The catheter for this procedure is usually brought to a blood vessel located in the neck and a non-ionic x-ray contrast agent is injected into the blood vessels which then in turn travels through to the brain. Prior to this procedure the catheter is then removed through the groin and the bleeding is stopped through direct manual compression or by using a vascular closure device. Neuroangio.org. (2016). Introductory Brain Angiography | neuroangio.org. Figure 9 ICA Internal Carotid Artery. Neuroangio.org. (2016). Introductory Brain Angiography | neuroangio.org. In order to reach such distances in the neurovascular system, many advanced catheters are used to travel so far. The deployment of a large support catheter through the groin goes first and then a variation of other smaller catheters are deployed through the larger catheter in order to reach the required location and deploy medical devices such as coils and stents. Figure 10. CT scan of Brain. Neuroangio.org. (2016). Introductory Brain Angiography | neuroangio.org. 3. Neurovascular Catheters in the heart. Figure 11 shows the placement of a pacemaker into the heart by the deployment from a minimally invasive advanced catheter. The catheter enters the body through the collar bone on the left hand side of the heart and enters through the veins to place an electronic or mechanical pacemaker into the heart to overcome heart problems such as tachyarrhythmias, which occurs when your heart beats too fast or bradyarrhythmias, which occurs when your heart beats too slow. System, C. (2016). Cardiovascular System. Figure 11 Advanced Catheters in the Heart. System, C. (2016). Cardiovascular System. From figure 11, the C shaped position of the catheter can be seen. A number of issues can occur from an engineering perspective when a catheter must bend into the shape of a C. Kinking can occur at the maximum area of stress and strain. Engineers must design their advanced catheters in order to prevent kink from occurring and so a reinforcement braid is usually added to increase the hoop stresses of the catheter and the addition of this braid also provides better torqueability and pushability of the medical delivery device to allow it to bend to the required positions to deploy a pacemaker in the heart. 4. Research into Existing Test Methods 1. Simple existing Test methods The following is the most basic of test methods implemented by physicians when no Standard test method is available and time is of the essence. This method was applied when surgeons were experiences kinking in catheters when deployed into patients. In order to predetermine kink from happening the physicians used a simple bending technique to test for the kinking limit of catheters. If the catheter kinked, the unit was rendered useless, if not it was determined safe to use. This method is clearly not an optimal solution so further investigation into the kinking limit of catheters had to be researched and developed. Beamer, J. and French, G. (2016). A simple method for testing for the kinking epidural catheter. Figure 12 Simple Test Method No kink LHS and Kinked RHS. Beamer, J. and French, G. (2016). A simple method for testing for the kinking epidural catheter. 1.1 Simple existing test methods The catheter bends around the pin, having a predetermined diameter, D. The diameter can range from a number of different values, 5mm 50mm. The catheter is bent around the template and contacts the template at 2 tangential locations, to generate a curve and predetermine L = D. Figure 13 Kink resistance Test Method. Anon, (2016). 2. Guidance for Industry and FDA Staff Non-Clinical Engineering Tests and Recommended Labelling for Intravascular Stents and Associated Delivery Systems The following FDA guidelines outline the standards to abide by when dealing with stents and associated delivery systems. It details how the content and format of test data should be summarised in a report as well as detailing the test reports and test protocol procedures to carry out. For this test method, a review of the non-clinical engineering section was undertaken focusing on the section B (Stent Dimensions and Functional attributes) of the non-clinical engineering test, part 16. Part 16 gave FDA guidelines in kink resistance. The significance of outlining FDA guidelines for stents which are delivered by advanced catheters, it to prevent kink occurring when the normal body is in motion such as an elbow joint flexing and to ensure that no deformation to the stent occurs. This also applied to the stent delivery system when the physician deploying the stent into the human anatomy as the advanced catheter must be engineered to prevent kink from occurring upon deployment. The recommended outcome to prevent kink from happening, according to the FDA guidance document, is to determine the smallest radius of curvature that the stent can withstand and recover to its original shape and size. The test carried out to determine the smallest radius of curvature must replicate the area to which the stent will be deployed i.e. the femoral arteries. This recommended advice for implementing stents to the human body can be tailored towards the stent delivery systems also i.e. the advanced catheters. Therefore these guidelines will be taken into account when developing a test method to determine the kinking limit of catheters. See appendices for further detail regarding the FDA guidance documents discussed. Fda.gov. (2016). Guidance for Industry and FDA Staff Non-Clinical Engineering Tests and Recommended Labeling for Intravascular Stents and Associated Delivery Systems. 3. Standards and guidelines ProtomedLabs provide a list of standards and regulations that relate to flexibility and kink resistance test methods. Information on the state of the art available testing equipment is provided such as the interventional device testing equipment (IDTE) from MSI which will be discussed further in part 4 of this section (MSI Catheter testing equipment). The ProtomedLabs provide information on flexibility kink resistance regarding applicable standards, related tests and test method descriptions. Applicable standards such as the FDA guidelines discussed in heading 2 above as well as ASTM standard guide for three point bending of balloon expandable vascular stents and stent systems which will be further discussed in section 5 of the literature review. Protomedlabs.com. (2016). Flexibility Kink Resistance Protomed Labs. 4. MSI Catheter testing equipment State of the art interventional device testing equipment (IDTE), compares tests and analyses performance catheters, quantifying the data of each catheter being tested. The PC allows for simple and repeatable tests with instantaneous feedback on design changes of the catheter. The IDTE was designed taking into account several different standards and test regulations such as ISO standard 25539-1 which covers cardiovascular implants endovascular devices and ISO 15539 Cardiovascular implants Endovascular Prostheses. The product is the most state of the art catheter testing equipment available right now and differentiates itself from the rest of the market by having the ability to test catheters in extremely realistic and challenging conditions. MSI. (2016). Catheter Testing MSI. Figure 14. IDTE Test Equipment. MSI. (2016). Catheter Testing MSI. The IDTE has a high temperature range with ambient temperatures of 50oC, a water bath with a temperature accuracy of +/- 2oC. It has auxiliary load cells of 100g and distal load cells of 1kg. It has the ability to test track force which is the force needed to advance a catheter, push efficiency which measures the amount of force being measured from the proximal end to the distal end, flexibility, torqueability a measure of the rotational response, retractability a measure of the amount of force required to withdraw a catheter and the crossability which measures the ability of a catheter to cross the abnormal narrowing of a passage in the body. The machine itself weighs 250kg with a height of 1372mm, width of 1194mm and a depth of 940mm. the output data of each tested is outputted onto a computer where numerical or graphical results can be formulated. MSI. (2016). Catheter Testing MSI. 5. Current Test Methods available to determine Kinking Point 1. ASTM F2606 Standard guide for three-point bending of balloon expandable vascular stents and stent systems The three point bending of stent system guidelines provide a test method that can be used to compare the flexibility of different advanced catheters by comparing load deflection curves and by comparison of calculated slopes of the curves. The test method uses a simple 3 point bending test. The upper single load applier and the two static load supporters as seen below in figure 14 must have a radius of 6.35mm. Another requirement of this test is that both the upper load applier and the two bottom static load supporters must be made of a material with a low friction coefficient so that they do contribute to the results outputted from carrying out this experiment. This test method can also be carried out in a bath of 37oC, which replicates the ambient body temperature and realistic conditions, if this application is necessary, the fixtures can be made from stainless steel or other materials that will not rust. Figure 15 Example of a three point bending test. YouTube. (2017). Catheter Bend Test at Anecto. This test has many benefits as it can many advanced catheters can be used with this method and it is applicable to many different products. It does not cause damage to the product prior to testing and can test the kinking limit along different material junctions. The test method ASTM F2606 uses a tensile tester to output its results to a computer in numerical or graphical form. Instron.us. (2017). ASTM F2606 Three-Point Bending Balloon Expandable Vascular Stents and Stent Systems Instron. 3. BS EN 13868 Catheters test methods for kinking of single lumen catheters and medical tubing This standard test method looks at the kinking of catheters being used for short term or long term uses. The short term use determines the kinking limit of a catheter being used less in than an hour and the long term is above an hour. The tube is defined as being kinked when the flow meter (Labelled 4 in figure 15 below) is outputting a reading 50% lower than the original reading. The original reading is read when the kink tools (Labelled 7) are either 50mm, 100mm or 200mm apart, depending on the users required starting distance. When the kinking tools are being compressed by the tensile tester (Labelled 7) the mass flow rate of the water flowing from the beakers (Labelled 2) will begin to reduce. Once the mass flow rate reduces to 50% of its original the catheter is said to be kinked and the test is complete. The results are outputted to a computer which gives numerical and graphical results. This test method is very beneficial as it is convenient, safe and fit for purpose. Difficulties may arise when using this test method when it comes to the fittings of the flow meter with the different sized catheters. As all catheters vary in sizes, the universal fitting of the flow meter may be difficult to mate with the distal/proximal ends of the various advanced catheters. See Appendices for more detail regarding BS EN 13868 kinking of single lumen catheters. European Standard, (2002). Catheters Test methods for kinking of single lumen catheters and medical tubing. BS EN 13868:2002. Figure 16 Short Term (LHS) and Long Term (RHS) Test methods for kinking single lumen catheters and medical tubings European Standard, (2002). Catheters Test methods for kinking of single lumen catheters and medical tubing. BS EN 13868:2002. 6. Proposed Mathematical Methods for Determining Optimal Test Method significant factors. 1. Analysis of Variance (ANOVA) Testing. The analysis of variance method determines if groups (related or unrelated) are statistically significant to each other. In order to carry out an ANOVA test, a hypothesis must first be determined. A hypothesis is a standard procedure about testing a claim about a property of a population. First a null hypothesis is formed. The Null hypothesis will test the significance of the hypothesis by either rejecting or failing to reject the claim of the null hypothesis. The Null hypothesis will claim that no difference exist between the population and the alternative hypothesis will claim that a difference exists between the populations. The alternative hypothesis will state that one or more of the parameters involved in a population will differ from the null hypothesis. The next step in an ANOVA test is to determine if the null hypothesis should be rejected or is it better to fail to reject the null hypothesis. In order to do so, an understanding of a type 1 and type 2 error is needed. A type 1 error is when the null hypothesis is rejected when in fact it should be accepted. The symbol ÃŽ ± is used to represent a type 1 error. A type 2 error is the mistake of failing to reject the null hypothesis when in fact it is false. The symbol to represent a type 2 error is ÃŽ ². In order to determine when the results are statistically significand and when the null hypothesis should be rejected, then p < ÃŽ ±, therefore the result is statistically significant and the null hypothesis should be rejected. If p > ÃŽ ±, then the null hypothesis should fail to be rejected and the results are statistically insignificant. Lacey, S. (2017). Mathematics for Engineers 402. 2. Analysis of Variance (ANOVA) Examples. To show how the ANOVA method can be applied to the parameters involved in determining the kinking limit of catheters and which factors attribute to the kinking limit the most i.e. which are statistically significant or insignificant, an example where an experiment was undertaken to test the effect of temperature and bar size on the UTS of a weld. The results from the experiment are show below in figure 16 and analysis of variance was carried out in order to determine the level of significance each parameter had on the strength of a weld. Lacey, S. (2017). Mathematics for Engineers 402. Figure 17 Analysis of Variance Example Dr. Sean Lacey, 2016, Mathematics for Engineers 402. Figure 18 Analysis of Variance Example Dr. Sean Lacey, 2016, Mathematics for Engineers 402. Figure 19 Analysis of Variance Example Dr. Sean Lacey, 2016, Mathematics for Engineers 402. Figure 20 Analysis of Variance Example Dr. Sean Lacey, 2016, Mathematics for Engineers 402. 7. Material Properties of Neurovascular Catheters Advanced catheters are engineered to perform an increasing number of minimally invasive surgeries. They must be able to guide their way through the intricate pathways of the neurovascular, cardiovascular and other anatomies. In order to achieve these demands, using ultra small catheters of 0.5 mm, the design must be near perfect and material selection for this design is key. Catheters consists mainly of 3 layers, the liner, the braiding and the outer sheath. They can be made up to lengths ranging from 900mm 1200 mm. the best material for use in catheters are fluoropolymers such as PTFE and FEP due to their biocompatibility and lubricous properties. PTFE is the most lubricous polymer on the market today followed by FEP. The materials can undergo secondary processing steps such as etching and cutting, along with post extrusion expansion such as heat-shrinking. The liner layer mainly is made from PTFE for it lubricity, ability to maintain a thin wall and have a small diameter. The braid reinforcement layer is mainly made from Type 304 or 306 stainless steel. This layer increase is strength and rigidity without kinking the catheter. It increases the rigidity at the proximal end with a smaller pitch between winds and decrease rigidity at the distal end with a larger pitch between winds. This is done to provide greater torque transition from the proximal to distal tip of the catheter. The coil provides a greater kink resistance to the catheter along with reinforcing the catheters liner against ovalization by maximising the hoop stress. The outer sheath is made up of high performance materials such as Pebax, FEP, PTFE, ETFE, polyurethane, polyethylene and nylon. Mddionline.com. (2016). Think Extrusion and Beyond for Optimal Catheter Design | MDDI Medical Device and Diagnostic Industry News Products and Suppliers. Figure 21 Material layers of a Neurovascular Catheter. Mddionline.com. (2016). Think Extrusion and Beyond for Optimal Catheter Design | MDDI Medical Device and Diagnostic Industry News Products and Suppliers.

Children Growing Up to Fast

Scott 1 What if you were in the body of a transgender? How would you feel about your health? Is the cost and risk of health toward being trans worth it? Access to health care is a fundamental human right. Transgender people face the greatest barriers to qualify health care and finding acceptance. Transgenders are considered a minority and abnormal still in the generation today. Tran’s gender is a term used to describe people whose gender identity differs from their assigned sex at birth. Transgender persons are often reluctant to seek medical care through a traditional provider-patient relationship.Some are even turned away by providers. A doctor who refuses to treat a trans person may be acting out of fear and transphobia, or may have a religious bias against LGBT patients. It's also possible that the doctor simply doesn't have the knowledge or experience he needs. Furthermore, health care related to transgender issues is usually not covered by insurance, so it is more expens ive. Whatever the reasons, transgender people have sometimes become very ill because they were afraid to visit their providers.Tran’s persons may hide important details of their health history from their doctors. Perhaps they fear being denied care if their history is known. Even many years after surgery, they may omit the history of their transition when seeing a new provider. Patients should see their provider as an equal partner in their health care, not as a gatekeeper or an obstacle to be overcome. Health risk factors of trans people needs to be exposed to others. National gay and lesbian task force and National Centers for Transgenders surveyed: .Nearly 1 in 5 (19 percent) reported being refused care outright because they were transgender or gender non-conforming. .Survey participants reported very high levels of postponing medical care when sick or injured due to discrimination and disrespect (28 percent). .50 percent if trans do not have any form of health insurance. .Harassment: 28 percent of respondents were subjected to harassment in medical settings. Scott 2 .Significant lack of provider knowledge: 50 percent of the sample reported having to teach their medical providers about transgender care. Respondents reported more than four times the national average of HIV infection, 2. 64 percent transgender compared to 0. 6 percent in the general population (Tanis). Transgender man Jay Kallio is shining a light on LGBT discrimination in the medical community. After his own physician failed to inform him of a cancer diagnosis. When Kallio, 56, underwent a medical exam at a major New York hospital, he claims that the surgeon appeared bewildered by his patient's body. Though the doctor ordered a mammogram, he failed to inform Kallio that the lump on his breast had tested positive for cancer.Kallio, which transitioned from female to male six years ago, learned of his condition â€Å"accidentally† when a lab technician called to inquire about the diagnosis. â€Å"Which diagnosis? † Kallio asked, bewildered as well. â€Å"I kept hitting this stone wall of non-acceptance,† Kallio told the New York Daily News (Reynolds). Laws that protect transgender: The Affordable Care Act (passed by President Obama) prohibits sex discrimination in hospitals and other health programs or facilities receiving federal financial assistance.In recent years, courts have increasingly held that sex nondiscrimination protections prohibit discrimination against people who are transgender or who fail to conform to gender stereotypes. The Health Insurance Portability and Accountability Act (HIPAA) protects the privacy of individually identifiable health information, including information related to a person’s transgender status and transition. It also gives patients the right to access, inspect, and copy their protected health information held by hospitals, clinics, and health plans.A state and local nondiscrimination law, nearly eve ry state prohibits sex discrimination in public accommodations, which usually includes health care facilities. The following states, as well as more than 150 cities and counties, also currently explicitly prohibit both gender identity and sexual orientation discrimination in health care facilities: California, Colorado, Connecticut, District of Columbia, Hawaii, Illinois, Iowa, Maine, Minnesota, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, and Washington. Others laws that stops discriminationScott 3 are Medicare and Medicaid regulations, Hospital Accreditation Standards and The Nursing Home Reform Act. (â€Å"Health care rights and transgender people†). Cross-gender hormone therapy give desirable feminizing (or masculinizing) effects, but carries its own unique risks. Average monthly cost of prescriptions range from $50-200 and hormone therapy can last up to 2 or 5 years depending on how long it takes to fully achieve the body figure you want. Hormones are d elivered through the body by oral ingestion pills, injections, pellets under the skin.Vaginal cream or patch (â€Å"Transgender Health†). Estrogen has the potential to increase the risk of blood clotting, high blood pressure, elevated blood sugar, water retention; reduction of sperm count, decrease of male sex drive, changes in hunger patterns. Anti-androgens such as spironolactone can produce dehydration, low blood pressure, and electrolyte disturbances. Testosterone, especially when given orally or in high doses, carries the risk of liver damage and increased risk of Alzheimer’s disease. Hormone use should be appropriately monitored by the patient and provider.Some trans people tend to obtain hormones and other treatment through indirect means, by passing the health care system. Taking hormones without supervision can result in doses too high or too low, with undesired results. Trans can minimize some dangers of hormone therapy by regular checkups, exercise, and work ing closely with a doctor to follow a healthy diet (â€Å"Hormones and their effects†). Hormone-related cancer (breast in trans women, liver in women or men) is very rare but should be included in health screening. A greater worry is cancer of the reproductive organs (â€Å"Access to Care and Cancer Disparity Fact Sheet†).Trans men who have not had removal of the uterus, ovaries, or breasts are still at risk to develop cancer of these organs and are unlikely to have a mammogram. Tran’s women remain at risk, although low, for cancer of the prostate. They avoid prostate screening because they do not identify with that part anymore. Furthermore, some providers are uncomfortable with treating such cancers in trans people. Some cases have been reported in which persons delay seeking treatment, or are refused treatment, until the cancer has spread (â€Å"Facts for life Lesbian, Gay, Bisexual†).Scott 4 Cardiovascular health refers to the heart and blood of a hum an being. Many trans people use smoking to cope with stress. Trans persons may be at increased risk for heart attack or stroke, not only from hormone use but from cigarette smoking, obesity, hypertension, and failure to monitor cardiovascular risks. Tran’s women may fear that a provider who finds them at risk for cardiovascular disease will instruct them to stop their hormones, and so they do not seek medical attention even when they have early warning signs of heart disease or stroke.Tran’s people can reduce their risk by cutting down/ stop smoking, limit alcohol use, eating healthy, being physically active, and not taking more hormones than what’s been prescribed. Alcohol abuse is common in transgender people who experience family and social rejection, and the depression with accompanies such rejection. Alcohol combined with sex hormone administration increases the risk of liver damage. Tobacco use is high among all trans persons, especially those who use toba cco to maintain weight loss. Risks of heart attack and stroke are increased in persons who smoke tobacco and take estrogen or testosterone.Also an increased risk of lung and liver cancer due to taking hormones and doing drugs. A study showed 59% of teenagers who identified themselves as transgender reported using tobacco products, compared to 35% of straight teenagers (â€Å"ALCOHOL, TOBACCO & OTHER DRUG PROBLEMS†). Many trans people are overweight. Exercise or fitness is not a priority, and they may be working long hours to support their transitions. A healthy diet and a frequent exercise routine are just as important for trans persons as for the public.Exercise prior to sex reassignment surgery will reduce a person's operative risk and promote faster recovery. Also it will help your cardiovascular health by reducing blood pressure, mental stress, and improving blood circulation. Trans people, especially youth, may be rejected by their families and find themselves homeless. They may be forced into sex work to make a living, and therefore at high risk for STDs including HIV. Other trans people may practice unsafe sex when they are beginning to experience sexuality in their desired gender. Safe sex is still possible even in transgender relationships (CiChocki).Some reuse or share needles to inject their hormones because of the Scott 5 insurance industry’s unwillingness to cover hormonal therapy. As in any population, these sexual behaviors and sharing needles increase HIV transmission risk (â€Å"HIV among transgender people†). Some trans women want physical feminization without having to wait for the effects of estrogen. They expect injectable silicone to give them â€Å"instant curves. † The silicone is toxic to the body it could migrate into the tissues of the body and cause disfigurement, pain, swelling, and blistering of the skin.It is usually not medical grade, may contain many contaminants, and is often injected using a shared needle. Hepatitis or HIV/ AIDS may be spread through use of contaminated needles. Also toxic poisoning due to low-grade, non-medical silicone. Hormones or plastic surgery is the safest options for feminizing the body. The National Coalition for LGBT Health has deemed injection silicone use among transgender populations in the U. S. (â€Å"HEALTH IMPACT OF ADULTERATED SILICONE ON TRANSGENDER HEALTH†). For many reasons, trans people are particularly prone to depression and anxiety.In addition to loss of family and friends, bullying and harassment in school, social isolation, they face job stress and the risk of unemployment. Tran’s people (especially children/ teens) who have not transitioned and remain in their birth gender are very prone to depression and anxiety. Suicide is a risk, both prior to transition and afterward or overdosing on hormones . One of the most important aspects of the transgender therapy relationship is management of depression and/or anxiety. Chr onic stress is known for heart disease.For trans people who are not out, the stress of keeping the secret and fear of being discovered as trans can be trandensly stressful. Living in a transphobic society, they believe there is something wrong with being trans. Being uncomfortable around other trans people, not accepting yourself as a trans or having low self-esteem. For some people peer support and activism are useful ways of overcoming and building pride. Professional counseling can also be helpful. LGBT task force surveyed a staggering: . 1 percent of respondents reported attempting suicide compared to 1. 6 percent of the general population. .At least one transgender is murdered every month Scott 6 .55 percent of trans youth report being physically attacked .More than half tran was bullied, harassed or assaulted in school because of their identity and has tried to commit suicide. (In my opinion words kill people) An example could be 31 year old in Philadelphia, Stacy Blahnik (tra nsgender) was found murdered in her home on October 11, 2010 by being strangled to death (â€Å"Glaads transgender resources†). See picture of Stacy on after work cited page) This issue is closely similar to the article A Boys Life by, JoAnn Wypijewski. On October 7, 1997 a young, gay, collage boy named Matthew Shepard was brutally beaten, tied to the fence and left to die. He was found 18 hours later unconscious. Matthew was taken to a hospital, where he later died. The author suggests that the murder of Matthew by Aaron McKinney and Russell Henderson was not because he was gay but because Aaron and Russell were straight. It was considered a hate crime because of Matthews’s sexual orientation (Wypijewski 589-591).Our goal today is to improve health, safety and wellbeing lesbian, gay, bisexual, and transgender (LGBT) individuals so they feel accepted into the world. We are all made the same. We all have a heart, a brain, etc. But why do we judge people by their appeara nce and their thoughts or mind? Or what type of person they are? For all you know they could be sweet and kind but you never knew that because you didn’t give them a chance or get to know them. I know two transgender from school. Named Sean from Salem Hyde elementary and Aliyiah from Henninger high school.I gave them a chance and we still talk on and off today. Tran’s people will always face discrimination, bullying, violence feel hatred, and be confused. But it’s up to us to stop it by trying to help them, put Tran’s people in media so people could get used to seeing Trans people, being their friend, participating in antidiscrimination organizations, having neutral bathrooms, and standing up to them. If a majority of people in our world did this maybe Tran’s people would feel they are normal and accepted in society. What do you think?

Self Introduction Essay for Job Application Samples Secrets That No One Else Knows About

Self Introduction Essay for Job Application Samples Secrets That No One Else Knows About The Good, the Bad and Self Introduction Essay for Job Application Samples You may also find a variety of discounts on our site which will help you to save some more money for future orders or anything you want to spend them on. I think that if I become a cardiologist I would delight in these tasks and might not feel that my occupation is an immense responsibility. Share about why you wish to do JOB so. I am prepared to lead and donate to the success of this expanding operation. I think that my wealth of knowledge and excellent expertise may add much value to your good organization. In fact, it plays a substantial role in the application process of scholarships in a wide variety of schools and universities not only in the united states, but many different countries too. It is among the top rated common diseases in the nation. Writing a letter of introduction for a work application can oc casionally be tricky especially should you not understand ways to present yourself in a manner it can make an impact to the men and women who will review your application. So I wished to study English Language and Literature along with my important course. A self introduction essay is in the majority of cases written utilizing the very first person viewpoint. A self-introduction essay is, in most circumstances, written utilizing the first-person standpoint. Introducing yourself in a fashion which is both creative and memorable isn't always such an effortless job. It includes some crucial stipulations so there isn't any ambiguity and there's a very clear understanding between the concerned parties. The objective of such may act as a requirement for your own personal company or academic use. There are plenty of examples of introduction letters, for example, it might be written to initiate in work, to set up a business rapport with new client, customer and so forth. Once you' ve read through the instructions a couple of occasions and gathered your notes, you can begin creating an outline to organize your essay and make a decision as to what message you wish to send. You might also see application writings. There have been several little instances much like this. Ruthless Self Introduction Essay for Job Application Samples Strategies Exploited We'll write a custom made sample essay on a work application. Our samples analyze tons of other intriguing subtopics which might be of amazing excitement for you. If you are in possession of a similar assignment, you might be interested in reading samples on this theme. Remain true to the theme, and you'll get a coherent piece that will get you a very good grade. What Self Introduction Essay for Job Application Samples Is - and What it Is Not These paragraphs have to be composed of just a few sentences each to avert any confusion. A sample letter is also rather valuable if you're in the wit's conclusion abo ut the way you can approach a possible employer when you're looking for work. It's an official document and so follows the arrangement of an official letter. Don't worry about the deadline you'll get your report delivered over the shortest timeframe. The letter is a kind of cover letter. It has to be kept to one page in length. Your letter must be direct. The Self Introduction Essay for Job Application Samples Pitfall The goal in writing your self-introduction essay is going to be to earn a lasting impression on your reader in a fashion that sets you apart from the remainder of the candidates. Make sure your character will likewise be highlighted by writing a brief information regarding your work ethics and personal character in the job environment. Use this to your benefit by writing considerable qualities about yourself that individuals might or might not know about. No matter what's the objective of your essay there's a preset number of points that you'll be expected to deal with. Make certain you include all the essential points a prospective candidate should convey to the interviewers. Write a couple of things that you know more about the work position that you're applying for. This means we may need to work slightly harder for us to receive the best position. The Nuiances of Self Introduction Essay for Job Application Samples Self Introduction Letter is written through a person to introduce himself formally in the job place. It's a genuine kind of communication which will help you organize everything you're into brief, coherent thoughts. It's a remarkable way to examine reading comprehension. There's more than one way to complete a book report. Top Choices of Self Introduction Essay for Job Application Samples You can also see obituary writing. Writing a novel is quite straightforward. At did you consider the book. Monthly, you're very likely to finish a single book study on a certified fictional book. Instead you would like your report to encourage people to read the book. You could also see book writings.

Mexican American And Mexican Americans Essay - 1126 Words

Introduction One of the largest Hispanic-origin population in the United states are Mexicans (Gonzales-Barrera Lopez, 2013). Mexican American’s are considered minorities in the United States. There are many reason why I am choosing to explore Mexican Americans for this paper. As a minority myself, I can relate to some of the struggles that Mexican American’s may face. However, there are some things that I will never relate to or know the personal aspect of the Mexican culture. Just like any other population, Mexican Americans have their own culture, values, and challenges. Strengths Mexican Americans find their strength through their culture, family, relationships and networks. Mexican Americans have strengths with their extended family. â€Å"Mexican American families frequently function within extended family networks that include godparents and members of other families† (Miley, M., L., 2013). There is more advantage when you have more network with extended family and other families. It essentially means a larger support system. â€Å"One of the major strengths of Mexican American families is a quantitative rather than a qualitative difference from other ethnic groups† (Miley, M., L., 2013). Some people may not realize that Mexican Americans tend to stick together and support each other because it is a part of their cultural background. Just like religion is a part of Mexican American’s cultural background as well. Most of the time Mexican American’s share similar spiritualShow MoreRelatedMexican American And Mexican Americans173 1 Words   |  7 Pages II. Mexican Americans A. Brief explanation regarding the history of this ethnic group Mexican’s American who are they, and why did they migrate to American; what were they in search of. 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An Ideological Exploration Of Macklemore s Racial...

An Ideological Exploration of Macklemore’s Racial Redemption As a musical genre and cultural movement, Hip Hop and Rap have been both cultural phenomena and musical genres within the United States that have reached internationally and driven conversations on sociopolitical troubles such as war, violence, and racism. Hip Hop and rap which at times have been used interchangeably, have seen drastic changes in both their reception as musical genres and have garnered vast visibility within the United States. Hip Hop and Rap artists have been integral to driving conversations that are often ignored. As musical genres, Hip Hop and Rap create a space of situated knowledge and reveal the underlying dominant hegemonic ideologies within society. Whiteness as the modus operandi becomes a central place of questioning that music and specifically Hip Hop and Rap help put into question. Questioning of Whiteness through these genres of music help reveal the co-constitutive nature of music and ideology. My goals within this paper are not an attempt to explore musicality or the power of music; rather, I am interested in how ideology becomes constituted within lyrics and what they reveal about the intersections of identity, authenticity, Whiteness, and race. Within these intersections is where we are able to see meaning be negotiated, and through communication we are able to explore how different meanings get constituted as hegemonic. Nakayama and Krizek offer us a starting point for analysis

What happened to the Mt Helen Free Essays

Mount St. Helens, located in southwestern Washington about 50 miles northeast of Portland, Oregon, is one of many volcanic peaks that dominate the Cascade Range of the Pacific Northwest; the range extends from Mount Garibaldi in British Columbia, Canada, to Lassen Peak in northern California. Geologists call Mount St. We will write a custom essay sample on What happened to the Mt Helen? or any similar topic only for you Order Now Helens a composite volcano (or stratovolcano), a term for steep sided, often symmetrical cones constructed of alternating layers of lava flows, ash, and other volcanic debris. Composite volcanoes tend to erupt explosively and pose considerable danger to nearby life and property. In contrast, the gently sloping shield volcanoes, such as those in Hawaii, typically erupt nonexplosively, producing fluid lavas that can flow great distances from the active vents. Although Hawaiian-type eruptions may destroy property, they rarely cause death or injury. Before 1980, snow-capped, gracefully symmetrical Mount St. Helens was known as the â€Å"Fujiyama of America.† Mount St. Helens, other active Cascade volcanoes, and those of Alaska form the North American segment of the circum-Pacific â€Å"Ring of Fire,† a notorious zone that produces frequent, often destructive, earthquake and volcanic activity. (1) Basic Data Location: South central Washington State (Cowlitz County). Latitude: 46 °20†² N Longitude: 122 °18†² W. Type:Stratovolcano Size comparison: Mt. St. Helens is the smallest of the five major volcanoes in Washington State, and also the youngest of these. It’s last eruption was 123 years earlier. Elevation : 9,677 feet before; 8,363 feet after; 1,314 feet removed Main Eruption: May 18, 1980, 8:32 a.m. (Pacific time) Pyroclastic flow speed : at least 300 miles per hour (some material traveled much faster). Pyroclastic flow temperature : As high as 1,300 degrees F (700 degrees C) Energy released: 24 megatons thermal energy (7 by blast, rest through release of heat); 50 times more powerful than the Hiroshima atomic blast. Landslide note : The landslide is the World’s largest recorded event EVER! Ash plume height : Reached about 80,000 feet in less than 15 minutes Ash cloud dispersal : Spread across U.S. in 3 days; circled Earth in 15 days. Deaths : At least 60-65 persons, and thousands of animals, birds, and insects.(2) On May 18, 1980, at 8:32 a.m. Pacific Daylight Time, a magnitude 5.1 earthquake shook Mount St. Helens, releasing an enormous burst of energy, instantly transforming a peaceful wilderness into a hellish landscape. As soon as the eruption was over, the process of rebirth and renewal began. The mountain is still in the spotlight after 20 years. Come and see the story of this amazing wonder of nature in this commemorative of the anniversary of the day that chaos reigned. October 1, 2004: Mount St. Helens Activity Increases. We probably will not see an event to match the 1980 eruptions of this now-famous volcano, but recent activity has intensified and researchers are watching closely. What did we learn from it? We can learn some facts from it.(1) An active volcano can be destructive at any point of time. So you have to be very careful about that. (2) You just can not predict what exactly going to happen in nature. (3) We should except one thing: what ever we have achieved in science and technology or whatever, â€Å" NATURE IS THE BOSS AND WILL ALWAYS BE† Why earth science is important to people? Earth science affects all our lives. Our landscape has been shaped by natural processes such as tectonics, weathering, and biological activity over billions of years. We use natural materials everyday, everything from building stone and oil to metals such as iron, copper and gold, and even diamonds have all been extracted from the ground. Natural hazards such as volcanoes, earthquakes, floods and droughts can dramatically affect lives. Earth science is the study of all these processes, put simply it is the study of our planet. Understanding how our planet works is essential if we are to properly manage our environment, and if we are to predict how the environment will change in the future. Earth scientists can monitor changes in our environment, model our impact on the environment and suggest solutions to our environmental problems. Environmental issues being studied by earth scientists include, the effects of water extraction from our rivers, the distribution of pollutants in the landscape and the environmental impact of industrial activity, such as mining and landfill. Natural hazards such as earthquakes, volcanoes and floods are responsible for many deaths, and for the loss of many more homes and livelihoods. Increased knowledge of natural hazards will improve predictions of the occurrence and scale of these potentially life threatening events, giving people a chance to prepare.(4) REFERENCES: (1) The history of Mt Helen is taken from http://www.weathersage.com/storms/mthelen/ sited on May 18,2007 (2) Basic data of Mt Helen is taken from http://ublib.buffalo.edu/libraries/asl/guides/msh.html sited on May 18,2007 (3) Why earth science is important to people? Is taken from http://www.nerc.ac.uk/research/areas/earth/importance.asp sited on May 18,2007             How to cite What happened to the Mt Helen?, Essay examples

Strategic Human Management Organization †Myassignmenthelp.Com

Question: Discuss About The Strategic Human Management Organization? Answer: Introducation Woolworths is one of the chief Australian companies with a wide retail interest across Australia and New Zealand. It is the second largest brand in Australia after Wesfarmers. Woolworths is known for the extensive retail services. Their broad range of goods includes food, clothing home ware and digital goods. Woolworths is also providing with financial services in association with Absa bank. The first store was opened in Pitt Street Sydney in the year 1924. The group is made up of familiar retailing deals with millions of customers in Australia (Woolworths, 2017). Background The brand is targeting the high income earners group through differential marketing strategy. Woolworths is known for supplying quality products in stores. The overall purpose is to match up with the customers expectations. The retail sector in Australia is very competitive. There is a huge competition not only from the local brands but also from the international brands. For the reason there is a continuous fight among the brand to gain a market stature. In such a condition it is necessary for a brand like Woolworths to be conscious about different marketing strategies. These marketing strategies will help them to stand against the local and international retailers. The report analyse the strategic issues faced by them and provides with a solution in order to remain competitive (King Thobela,2014). In the recent time Woolworths has faced problem related to a high employee turnover. In order to reduce the employee turnover ratio, the report furnishes effective training and developme nt tools. Adult learners program is an effective tool used to reduce the strategic impacts of high employee turnover ratio. The report provides current issues that can be resolved through a strategic implementation of training mechanism at Woolworths (Marketing Strategy,2017). Need for training to address current problem Training of employees is important for the business organization in order to carry out business orientation. Training is an important procedure for developing the skills, ability and awareness of employees for managing job. In order to manage the organization Training process it is important to shape up the learning behavior of the employees. It is permanent and never ending in nature (Hendry, 2012). Training is one of the vital and effective processes used by organizational development and achievement. Training is specified on four basic grounds: Training and development in an organization are given to enhance the overall productivity training. The training and development help in attaining requisite results. In this way the organization and employees can seek a long term bond. The overall purpose is to meet the organizational assignment, visualization, rules and regulations and the working conditions (Khanka, 2007). The existing employees are being trained to revive and improve their acquaintance. It is one of the important aspects for a team to develop itself in a well-organized way. In this manner they can improv knowledge of work (Armstrong Taylor, 2014). For an organization it is important to develop learning tools in order to implement any update and to amend any change in technology. Training therefore allows in developing a better understanding in the employees, it gives ample of chances to the employees to cope up with the changes. For instance, employees should be given proper training to use new equipments and work methods. In order to gain efficiency at work training act as an important tool in order to promote career growth. Training is considered as one of the important tool in meeting with employees expectations (Sparrow, Brewster Chung, 2016). Issues at Woolworths The organization is facing an issue of a high employee turnover. The Woolworth employee turnover is very high. Many people leave job and join another organization due to lack of growth opportunities. People are uncomfortable with the working condition at Woolworth. This has been creating a wide gap in achievement of goals. Poor working condition is one of the primary reasons for employees to leave the organization. This is because a lot of company employees part- time students who are in need of temporary job (Low,2017). They leave the job after completion of the course. This is eventually the reasons behind a high employee turnover. Very few people want to work on a continuous basis at Woolworths. This has raised a serious concern at Woolworths creating a need of a proper training procedure. The overall role is to develop an effective training mechanism by understanding individual characteristics. By analyzing the trends one can understand the reason behind the high employee turnove r. To reduce the outflow of labor, there is a need to implement an effective alternative learning program to lower the number of employees leaving the business. In such a scenario it is important to manage the employees in the best possible way through specialized learning procedure (Keith, 2012). Characteristic of adult learners to be developed Adult leaning is a process through which effective learning behavior in adults is developed. By understanding the problem adults are being trained in a well and effective manner. Maturity brings exceptional individuality that have an effect on how adults are provoked to learn. By tempting to the exclusive character of adult learners, one can design more effective and motivating learning program(Storey, 2014). Below mentioned are the list of characteristics that need to be developed in all learners in order to motivate learning and development. Woolworths is facing an issue of a high employee turnover. In such a situation it is recommended to develop an effective learner program for the employees in order to gain growth (Cameron,2015). self-sufficiency Adults typically favor a sense of organizing in nature . Employees at Woolworhs feel extreme pressure from the manager. They dont get autonomy at work. By developing autnomy at work employees will gain a sense of accomplishment. Goal-oriented. Many adults are having have specific goals. They prefer to contribute in learning activities that help them get to their objective(Knowles, et al 2014). sensible Adults in the office favor practical information and understanding that create work easier or give significant skills. In other words, it is significant for an individual to develop learning activities. Learning by experience It is important for an individual to develop an effectie adults prefer to learn by doing rather than listening(Aswathappa, 2013). Wealth of Knowledge An individual should be open to learning. He should be ready to accumulate a unique store of knowledge and experiences. In this way he is able to manage in different learning situation. Purposeful The training at work should meet all the grounds. For the pupose it is important to impart training and development . Workplace training is an important part of learning behavior. Adults desire to be acquainted with the reason of guidance and the incentive underlying an organizations training proposal. Emotional Barriers Adults have fear of subject, have nervousness about a subject or experience annoyance about compulsory changes in job tasks or rule. In order to gain competency it is essential to promote long term learning process in an individual. Learning can only be enhanced if an individual is eager to grab knowledge. Outside responsibilities Job security is one of the important factor that is increasing the employees Turnover. Most adult learners have frequent household tasks and commitments to family, friends etc. In case if they are unable to balance life and work, the productivity is been suffered. Big Picture Poor working condition is one of the primary reasons for employees to leave the organization. In such a condition it is relevant for the business organization to set a big picture view of what theyre learning. Responsible for Self It is an impotant exercise that need to be promoted at work. Employess should be responsible for self. beginner frequently take liability for their success or failure at learning. Strategies to implement proposed training program In order to gain long term sustainability at Woolworths it is essential to develop a proper training program. Training should be provided to workers to furnish them with multi skills. In this manner they will be able to match up with their expectations. This will eventually reduce the switch from one job to another. Employees will feel more motivated which will lead to employees becoming more provoked than before. This will benifit Woolworths in managing their targets. Employees at Woolworths would be eventually able to do more than one job. In order to match up with the expectations it is important to develop an effective plan. training program is a systematic process used to adopt sucess step-by step(Arli, et al 2013). In todays competetive scenario it is important to develop a coherent training procedure in order to meet both employee and employer expectations(Nickson, 2013). 1) Assess Training Needs: At an initial level it is important for an organization to develop a training program by identifying needs. Employee training need to be in a well established manner. It should be well-synchronized with the organizations strategic, human resources plans. Training assessment is an important part of overall success if one is developing a fresh plan. 2) Set Organizational Training Objectives: In order to gain success it is important to assimilate the training needs. This will recognize gaps in current training initiatives and employee skill sets. One should conduct a 360 degree evaluation inorder to understand the training procedure. 3) Create Training Action Plan: The next step is to generate a complete action plan. The plan includes learning theories, design, content, materials for training. The Resources are developed in order to create a better understanding. While developing the program, it is important to understand participants learning styles. For the purpose it is suggested to run a pilot project. Success of the training program in this case can be gathered by feedback to make alteration before initiation of program company-wide(Baum, 2016). 4) Implement Training Initiatives: the next step is to implement the training process.The organization need to make a decision one will get training in-house or outwardly coordinated. This includes the preparation of training program to be officially opened, promoted and conducted. 5) Evaluate Revise Training: the last step of the process is to evaluate the overall training and learning process. As mentioned, the training program is necessary to be monitored continually. At the end, the complete program should be assess to decide victory. Feedback should be attained from the stakeholders to decide program and coach efficiency and also information or skill attainment. Examining the feedback will permit the organization to recognize weaknesses in the program. At this point, it is importnat for the employees at Woolworths to be given with an effective training and development program. Timely revision of the learning program is important to meet the expectations. Evaluation method to be used to assess the effectiveness of the training program Visual confirmation In order to evalaute the overall learnng process it is important to assess the overall training nd development progra. Technology allows as an important tool to take role-plays a step further. The sense of accomplishment of the training program can be gained through an effective learners program. Visual confirmation is an effective method to seek confirmation from the employees. Visual confirmation doesnt only change learning but also impact the way training is been imparted in an organizaation. By taking a closer look at those initiatives one can measure the overall consequences. Social Ownership The other part is to understand the role of trainer in the form of highest mastery of a subject. Social Ownership creates an effective position by showing how the training process is been applied in their real world. This training process at Woolworths will foster peer-teaching by having peer-peer workshops. in the end a new way to get employees concerned and occupied can be gained. In this way one can establish effective relationship in the organization. Skill Assessments The next process is to Create a visual appraisal of an employees ability set and presentation Theis will enhance overall ability to clear picture of act and skill improvement. One can examine the training process by testing a sales persons present sales skills previous to training, then retesting the entity after the training in order to seek the changes . There are so many development going on in this area. By comparing it from the previous avialable data one can directly gain results on a long run. Strategic recommendations Conclusion In order to gain competency it is important for the Strategic HR professionals to implement an effective learning behavior in the employees. The SHRM is the modern agae tool that is been used by the employer to match up with the performance. By examining the operating models of other competitor companies, HR professionals can develop an effective training and development model. This will allow them to identify the gap in performance Then, they can design, develop and put into practice training programs to get employees on track. In the current situation, Woolwoths need to implement an effective adult learners plan to brings exceptional individuality that have an effect on how adults are provoked to learn. By tempting to the exclusive character of adult learners, one can design more effective and motivating learning program. in addition, there is a necessity to match up with the strategic decisions that are required to obtain an official recognition to ensure a smmoth road to the comp any's strategic goals.The only way to reduce the employee turnover is by developing an effective learning and development program. Refrences Arli, V., Dylke, S., Burgess, R., Campus, R. A Soldo, E., (2013). Woolworths Australia and Walmart US: Best practices in supply chain collaboration.Journal of Economics, Business Accountancy Ventura,16(1). Armstrong, M., Taylor, S. (2014). Armstrong's handbook of human resource management practice. Kogan Page Publishers. Aswathappa, K. (2013). Human resource management: Text and cases. Tata McGraw-Hill Education. Baum, T. (Ed.). (2016). Human resource issues in international tourism. Elsevier. Cameron, N.(2015). Woolworths details 3-year strategy to become customer centric. Online.Retrieved from: https://www.cmo.com.au/article/574302/woolworths-details-3-year-strategy-become-customer-centric/ Accessed on: 10 August 2017 Hendry, C. (2012). Human resource management. Routledge. Keith, S., (2012). Coles, Woolworths and the local.Locale: The Australasian-Pacific Journal of Regional Food Studies,2, pp.47-81. Khanka, S. S. (2007). Human resource management. S. Chand Publishing. King, L. Thobela, S., (2014). Woolworths farming for the future.International Food and Agribusiness Management Review,17(B). Knowles, M. S., Holton III, E. F., Swanson, R. A. (2014). The adult learner: The definitive classic in adult education and human resource development. Routledge. Low,C.(2017). Suppliers back Woolworths' brand strategy as Coles feels pressure. (Online).Retrieved from: https://www.smh.com.au/business/retail/suppliers-back-woolies-brand-strategy-20170301-gunukx.html Accessed on: 10 August 2017 Marketing Strategy,(2017).(Online). Retrieved from: https://orreconomics.weebly.com/marketing-strategy.html Accessed on: 10 August 2017 Nickson, D., 2013. Human resource management for hospitality, tourism and events. Routledge. Riley, M. (2014). Human resource management in the hospitality and tourism industry. Routledge. Sparrow, P., Brewster, C. Chung, C.,( 2016). Globalizing human resource management. Routledge. Storey, J., 2014. New Perspectives on Human Resource Management (Routledge Revivals). Routledge. Woolworths,(2017). (Online).Retrieved from: https://www.woolworthsgroup.com.au/ Accessed on: 10 August 2017