Blastocystis Hominis and Colorectal Cancer

Blastocystis Hominis and Colorectal Cancer Blastocystis hominis (B.hominis) is the most common unicellular protozoan parasite that is found in the human gastrointestinal tract (Windsor et al. 2002). The prevalence of B. hominis in both developed and developing countries is reported to be up to 10% and 50% respectively (Wong et al. 2008; Stenzel and Boreham. 1996). On the other hand, B. hominis shows a diverse morphologies which include vacuolar, granular, amoeboid and cyst forms (Zierdt. 1988). Furthermore, B. hominis isolates from human and animals have been reported to exhibit an extensive genetic and karyotypic heterogeneity (Parkar et al. 2010; Stensvold et al. 2009; Tan et al. 2009; Dogruman-Al et al. 2009; Abe. 2004; Yoshikawa et al. 2004). Although many researchers have attempted to identify the pathogenesis of B. hominis in human hosts, however the pathogenic potential of B. hominis has remained controversial as it is present in both symptomatic and asymptomatic individual (Tan. 2008; Garcia. 2007; Tan et al. 2002). The gastrointestinal symptoms that are associated with B. hominis infection include diarrhea, vomiting, anorexia, flatulence, abdominal discomfort and other associated non-specific symptoms. To date, experiments have shown that rats that are inoculated with human B. hominis isolate have demonstrated an elevation in oxidative damage (Chandramathi et al. 2009). Many studies have been done on the genetic and molecular characterization of B. hominis isolates derived from human as well as animal. Recent molecular characterization of Blastocystis isolates suggested that there are 13 subtypes (ST1-ST13) which have been isolated from mammalian, reptilian, avian and amphibian hosts (U. Parkar et al. 2010; Stensvold et al. 2007a; Noà «l et al. 2005, 2003; Yoshikawa et al. 2004b). Recently, many studies have been done to determine the pathogenic potential of different Blastocystis subtypes in human hosts by genotypic analysis as well as molecular characterization of B. hominis isolated from symptomatic and asymptomatic individuals (Dominguez-Mà ¡rquez et al. 2009; Eroglu et al. 2009; Jones et al. 2009; Hussein et al. 2008; Tan et al. 2008). Nevertheless, only limited numbers of studies have shown correlation between the different B. hominis subtypes on the pathogenesis in human hosts (Hussein et al. 2008). Infectious agents such as bacteria, virus and parasites, often have an oncogenic potential. The International Agency on Research of Cancer (IARC) has estimated that 16% of cancer worldwide is caused by infection, including parasites. However, there has been no research done on the association between B. hominis infection and colorectal cancer. A recent study has suggested that B. hominis may possess the ability to induce the growth of colorectal cancer cell lines by inhibiting the apoptotic effect of colon cancer cells. Furthermore, the antigens that are isolated from B. hominis were postulated to be able to promote the proliferation of cancer cells via down-regulation of host immune cellular responses (Chandramathi et al. 2010). In general, inflammation is activated by a variety of stimuli such as trauma, bacterial/viral/parasitic infections, endotoxemia and heating (Ley, 2001; Hart, 2002). Inflammation caused by infectious agents such as parasites will cause an increase in the production of reactive oxygen species (ROS) such as nitric oxide, hydrogen peroxide and superoxide as a consequence of cell mediated phagocyte dependent immune response (Rosen et al. 1995). A persistent and chronic inflammatory response can be detrimental to human host as it can produce a chronic damage by releasing a variety of pro-inflammatory and anti-inflammatory cytokines which then leads to mutagenesis, carcinogenesis, neurodegenerative disorder, inflammatory bowel syndrome and atherosclerosis (Kà ¼hn et al. 1993; Perry et al. 1998; Ludewig et al. 2002; Shacter et al. 2002). Several studies have shown correlation between the inflammation that is caused by infectious agents such as parasites and the development of cancer in huma n (Fitzpatrick. 2001). Thus, it is important for us to evaluate the immunomodulation, cytopathic and cellular cytokines responses as a result of B. hominis infection especially in colorectal carcinomas. Since B. hominis is often present in most stool cultures, it is pertinent to investigate the association between B. hominis infection and the development of colorectal cancer in the gastrointestinal tract of infected host system. B. hominis isolated from an asymptomatic individual could facilitate the proliferation and growth of cancer cells and has the potential to down-regulate the host immune response (Chandramathi et al. 2010). However, only limited numbers of studies have shown the cytopathic effects and cellular cytokine responses of Blastocystis hominis infection (Puthia et al. 2008; Long et al. 2001; Walderich et al. 1998). These studies only investigated on Interleukin 8 and Granulocyte-macrophage colony stimulating factor (GM-CSF) which are pro-inflammatory cytokines. We hypothesized that B. hominis infection in human host system has a potential carcinogenic effect and could influence the growth of colorectal cancer cells especially in colorectal cancer patients and that the B. hominis subtypes may exert varying degree of pathogenecity. Therefore, in this study, the differences between the effects of solubilized antigen of B. hominis from both symptomatic and asymptomatic isolates on the cell viability in the peripheral blood mononuclear cells (PBMCs, which represent the immune cells) as well as colorectal cancer cell line was evaluated. Besides that, the gene expression of cytokine, apoptotic mediators, and nuclear transcriptional factors in response to the symptomatic and asymptomatic B. hominis antigen in both PBMCs and colorectal cancer cell was compared. The knowledge and understanding in the association between Blastocystis hominis infection and colorectal cancer as well as the role of various cytokines involved in the tumour progression may provide an insight into prevention and/or development of new immune-therapeutical strategies to combat colorectal cancer. OBJECTIVE The objectives of the present study are:- To study the effects of solubilized antigen of B. hominis from symptomatic and asymptomatic individual isolates on viability of both the peripheral blood mononuclear cells (PBMCs, which represent the normal immune cells) as well as colorectal cancer cells (HCT 116, colorectal cancer cell line). To investigate the gene expression of cytokine, transcriptional factors and apoptotic mediators such as interleukin 6, interleukin 8, tumour necrosis factor-ÃŽ ±, interferon gamma, nuclear factor kappa light chain enhancer of activated B cells, cathepsin B, transforming growth factor-ÃŽ ², and protein 53 upon exposure to B. hominis antigen in both the PBMCs and colorectal cancer cells MATERIALS AND METHODS Sample collection and axenization of Blastocystis hominis B. hominis was isolated from stool samples of symptomatic as well as asymptomatic individuals. The B. hominis cysts were then isolated from feacal sample using the Ficoll-Paque Technique according to Zaman and Khan (1994). The harvested cysts of B. hominis from both the symptomatic and asymptomatic individual isolates were washed in sterile phosphate-buffered saline (PBS). The washed harvested cysts were cultured in Jones medium, supplemented with 10% of heat-inactivated horse serum and incubated at 37 °C in CO2 incubator (Suresh and Smith. 2004). Axenization was conducted after the isolates have been incubated for 2 to 3 days. Isolation of solubilized antigen from symptomatic and asymptomatic cultures The axenic B. hominis species were collected using Ficoll-Paque density gradient centrifugation method and the harvested parasites were resuspended in basal Jones medium without the addition of heat-inactivated horse serum. Then, the harvested organisms were lysed by sonication method and the homogenate was incubated at 4 °C, overnight. The homogenate was centrifuged at 13000xg for 15 minutes at 4 °C after the overnight incubation. The supernatant which contains the solubilized antigen of B. hominis was filter-sterilized and the protein concentration of the antigen was determined using Bradford assay (Bio-Rad, USA). Subtyping of Blastocystis isolates from symptomatic and asymptomatic cultures Genomic DNA Extraction: The genomic DNA of symptomatic and asymptomatic isolates of Blastocystis hominis were extracted from the 3 to 4 days old culture with QIAmp DNA stool mini kit (Qiagen, Hilden, Germany) according to the manufacturers protocol. DNA Purity and Concentration: The genomic DNA yields were estimated using measurement of absorbance at 260nm and 280nm using a spectrophotometer. The ratio of absorbance at 260nm to 280nm determines the purity of the genomic DNA yielded. According to the manufacturers protocol, the ratio of 1.7-1.9 indicates that the DNA yields are pure. PCR Typing by STS Primers: The genotype of B. hominis was determined by using PCR amplification with subtype-specific sequence tagged site (STS) primers (SB83, SB155, SB227, SB332, SB340, SB336, and SB337). The PCR reaction mixtures (20  µl of total volume) consisted of PCR buffer, 2.5 U/ µl of Taq DNA polymerase (Fermantas, SB38), 1.5 mM MgCl2, 1.25  µM of dNTPs (Fermantas, RO191), 0.5 pmol of forward primer, 0.5 pmol of reverse primer, and 1.0  µl of the DNA samples. In addition, the PCR conditions were set as follows: one cycle denaturing at 94 °C for 3 min, 30 cycles including denaturing at 94 °C for 30 seconds, annealing at 56.3 °C for 30 seconds, extending at 72 °C for 60 s, , and additional cycle with a 10 min chain elongation at 72 °C. The PCR products obtained were then electrophoresed in 1.5% agarose gel with 1X Tris-boric-EDTA (TBE) buffer. The fragments of the DNA were visualized using UV illuminator under UV light. The fragment sizes of the genomic DNA were confirmed with bands of a DNA ladder (50-1,000 bp DNA markers, Fermentas). Cultivation and collection of HCT116 Human colorectal carcinoma cell line, HCT116, was cultured in 25 cm ³ culture flask containing 5 ml of RPMI 1640 growth medium, supplemented with 5% of FBS, 2mM L-glutamine, 100 U/ml penicillin-streptomycin, and 2.5 ÃŽ ¼g/ml fungizone. The HCT116 cell line was then incubated in a CO2 incubator set at 100% humidity, atmosphere containing 5% of CO2 and a temperature of 37 °C. Prior to the introduction of antigen from Blastocystis hominis isolates, the cells were harvested from the substratum of the culture flask by using 0.25% trypsin-EDTA. The harvested cells were then washed with phosphate-buffered saline (PBS) thrice and resuspended in RPMI 1640 growth medium before introducing the solubilized antigen of Blastocystis hominis from symptomatic and asymptomatic isolates. Isolation of peripheral blood mononuclear cells (PBMCs) PBMCs were collected from fresh human blood sample (12 ml) in sterile EDTA tubes. The PBMCs were then isolated from the blood sample by using Histopaque ®-1077 (Sigma-Aldrich, USA) according to the density gradient centrifugation method (Boyum. 1974). The isolated PBMCs were then washed with PBS thrice and resuspended in 5 ml of RPMI 1640 growth medium, supplemented with 10% of FBS, 2mM L-glutamine, 100 U/ml penicillin-streptomycin, and 2.5 ÃŽ ¼g/ml fungizone in a 25 cm ³ culture flask prior to the introduction of solubilized antigen of Blastocystis hominis isolates. Introduction of the solubilized symptomatic and asymptomatic derived Blasto antigen into PBMCs and colorectal cancer cell line, HCT116 Harvested HCT116 cells (1 x 103 cells per well) in 100 ÃŽ ¼l of RPMI growth medium with 5% FBS and freshly isolated PBMCs (5 x 104 cells per well) in 100 ÃŽ ¼l of RPMI growth medium with 10% FBS were seeded into 96 well plates. After the overnight incubation in a CO2 incubator containing 5% CO2 at 37 °C, Blasto-antigen of B. hominis from symptomatic and asymptomatic individuals at final concentration ranging from 0.001 to 10ÃŽ ¼g/ml was added to each well containing the PBMCs and HCT116 cells and were further incubated for 48 hours. Then, the cell proliferation/viability was measured using the MTT assay (Mosmann. 1983). Quantitative Real-time Reverse Transcription Polymerase Chain Reaction (rtRT-PCR) Concentration of symptomatic and asymptomatic Blasto-antigen that yields the optimal proliferation and inhibition in the preliminary tests (MTT assay) was used to introduce into each culture flask containing PBMCs and HCT 116 cells respectively. For controls, PBS was introduced into both types of cells. After 48 hours of incubation, the RNA was isolated from the PBMCs and HCT 116 cells using Ambion RNAqueous Micro Kit (Ambion, CA, USA). The purified RNA obtained was then used to synthesize complementary DNA (cDNA) using High-Capacity RNA-to-cDNA kit (Applied Biosystems, USA) by the PCR method. Finally, Real-time reverse transcription PCR analysis was performed using inventoried primers (TaqMan ® Gene Expression Assays, Applied Biosystems). In this study, the genes of interest were IL-6, IL-8, tumour necrosis factor alpha (TNF-ÃŽ ±), nuclear factor kappa light chain enhancer of activated B cells (NF-ÃŽ ºB), interferon gamma (IFN-ÃŽ ³), protein 53 (p53), transforming growth factor be ta (TGF-ÃŽ ²), and cathepsin B (CTSB). The PCR reaction will be prepared according to the protocol that is generated by StepOneTM Software v2.0. Statistical Analysis In order to analyze the real-time RT-PCR gene expressions, the à ¢Ã‹â€ Ã¢â‚¬  CT value of the treated samples with symptomatic and asymptomatic Blasto-antigen was compared against the non-treated sample (control with PBS) using the Students t test. A P value of 0.05 was considered to be the minimum threshold of significance. RESULTS AND DISCUSSIONS In the present study, the symptomatic and asymptomatic isolates were genotyped by PCR amplification using the well-known seven sets of STS primers. The extracted DNA of symptomatic isolate showed positive amplification with SB83 and thus determined as subtype 1 (Yoshikawa et al. 2004). Nevertheless, the extracted DNA of asymptomatic isolate did not show any positive amplification with all the seven sets of STS primers that was used in this study. Hence, it is postulated that the asymptomatic isolate may be subtype 8 to 13 which was not amplified by the STS primers used in this study (Dominguez-Mà ¡rquez et al. 2009; Eroglu et al. 2009; Jones et al. 2009; Hussein et al. 2008; Tan et al. 2008). Molecular phylogenetic analysis need to be carried out in order to further characterized the subtype of asymptomatic isolate used in this study (Noel et al. 2005; Stensvold et al. 2007; Yoshikawa et al. 2007). In this study, the Blasto-Ag isolated from both symptomatic as well as asymptomatic isolates have caused an inhibition of PBMC cells proliferation which leads to the speculation that the Blasto-Ag may have caused apoptosis in the immune cells to prevent the propagation of immune cells to combat with the Blastocystis infection. The symptomatic isolate has caused a greater inhibition of PBMCs as compare to asymptomatic isolates. However, the Blasto-Ag mediated PBMCs cell inhibition is contrast to our previous report (Chandramathi et al. 2010). Our previous study showed that Blasto-Ag caused stimulation of PBMCs cell proliferation (Chandramathi et al. 2010). However, the molecular genotyping of the B. hominis isolates used in that study was not carried out. Past studies have reported that there may be a correlation between different B. hominis subtypes on the pathogenesis in human hosts (Dominguez-Mà ¡rquez et al. 2009; Eroglu et al. 2009; Jones et al. 2009; Hussein et al. 2008; Tan et al. 2008). This contrasting result observed in the cell viability of PBMCs may suggest the different subtypes of B. hominis may give different effects on the immune cells. Hence, further investigation is required to investigate the potential pathogenesis of different B. hominis subtypes. In the current study, increase in cell proliferation has been observed in colorectal carcinoma cell line, HCT116 cells upon exposure to antigen from symptomatic as well as asymptomatic isolates. HCT116 cells have shown significantly higher increase in cell proliferation stimulated by symptomatic Blasto-Ag as compared to asymptomatic antigen. The increase in the cell proliferation may further suggest that Blastocystis infection could facilitate the growth of colorectal cancer cells (Chandramathi et al. 2010). It is evident from the present study that symptomatic Blasto-Ag is more pathogenic as compared to asymptomatic Blasto-Ag. Hence, it may be essential to treat the Blastocystis infection in symptomatic colorectal cancer patients for better prognosis. On the other hand, a diverse pattern of cytokine, nuclear transcription factor as well as apoptotic gene expressions were observed upon the stimulation of HCT116 cells and PBMCs by symptomatic and asymptomatic derived Blasto-Ag. In the present study a noticeable up-regulation of Th1 (IFN-ÃŽ ³ and TNF-ÃŽ ±) and Th2 (IL6, IL8 and TGF-ÃŽ ²) cytokines was observed in HCT116 following exposure to symptomatic Blasto-Ag may lead to the speculation that B. hominis has activated the cellular and humoral immune responses in clearing the Blastocystis infection. This is accordance to the previous study that extracellular parasites such as B. hominis would be more effective in counteracted by a combination of Th1 and Th2 cytokines (Daugelat et al. 1996). Nevertheless, a more significant up-regulation of Th2 cytokines as compared to Th1 cytokines observed in HCT116 upon exposure to symptomatic and asymptomatic Blasto-Ag may lead to the postulation that symptomatic Blasto-Ag may resulting in a Th2- dominated responses and has the potential in weakening the cellular immune response, allowing the progression and growth of an existing tumour cells. On the other hand, HCT116 exposed to symptomatic Blasto-Ag has resulted in a more noticeable up-regulation of Th2 cytokines then asymptomatic Blasto-Ag which may lead to the speculation that asymptomatic Blasto-Ag is less pathogenic than symptomatic derived Blasto-Ag. Furthermore, the up-regulation of TGF-ÃŽ ² in the colorectal cancer cells has the potential role of anti-inflammatory and resulting in host immunosuppression by inhibiting the cell mediated immune responses against the tumour cells (Zou, 2005; Seruga et al. 2008). In addition, it is widely-accepted that humoral immunity is activated by extracellular microbes such as bacteria (Romagnani, 1996). B. hominis, being an extracellular allergen, has triggered the activation of host humoral immune responses which is evident by the significant up-regulation of Th2 cytokines in the PBMCs upon exposure to symptomatic and asymptomatic Blasto-Ag. Moreover, this results can be supported by the recent finding which shown an elevation of IL6 and IL8 level in the monocytes of healthy volunteers exposed to Leishmania infection (Menezes et al. 2008). In spite of that, an interesting finding has been observed in PBMCs stimulated by symptomatic and asymptomatic Blasto-Ag, besides activating the humoral immune responses, PBMCs exposed by Blasto-Ag has also triggered the activation of cellular mediated immune response characterized by Th1 cytokines. As described earlier, extracellular parasites may be more effective counteracted by a combination of Th1 and Th2 cytoki nes mediated immune responses (Daugelat et al. 1996). However, the activation of cellular mediated immune responses which is reflected by a significant up-regulation of TNF-ÃŽ ± and IFN-ÃŽ ³ may lead to the speculation that Blasto-Ag isolated from symptomatic as well as asymptomatic individual has the ability in causing extensive inflammatory damage in the host tissue as a result of macrophage mediated responses towards the parasitic infections. In addition, an up-regulation of NF-ÃŽ ºB and pro-inflammatory cytokines IL6 and IL8 was observed in HCT116 stimulated by symptomatic Blasto-Ag. Furthermore, these findings were also observed in PBMCs stimulated by symptomatic and asymptomatic Blasto-Ag. Nevertheless, HCT116 exposed to asymptomatic Blasto-Ag has exhibited an insignificant down-regulation of NF-à Ã‚ ºB gene expression which then leads to a significant lower expression in IL6 and IL8 as compared to HCT116 stimulated by symptomatic Blasto-Ag. Although the previous reports by Chandramathi et al. 2010 has stated the potential role of asymptomatic Blasto-Ag in causing the up-regulation of NF-à Ã‚ ºB and pro-inflammatory cytokines IL6 and IL8, however, the similar trend was not observed in the current study. As described earlier, different Blastocystis subtypes may have different effects on HCT116 cells as well as causing different gene expression profile in HCT116. To further characterize the gene expression profiles a s well as pathogenic potential of each subtype on HCT116 and PBMCs, more samples on different subtypes need to be recruited for the future study. Apart from this, NF-à Ã‚ ºB is also related to the apoptotic mediator genes namely p53 and CTSB. NF-à Ã‚ ºB has been postulated to play a role in inhibiting the apoptosis; hence it is hypothesized that the down-regulation of NF-à Ã‚ ºB gene expression will lead to the up-regulation of p53 and vice versa (Baldwin, 2001; Chwieralski et al. 2006). Although the recent study has suggested that CTSB may contribute to the cell apoptosis, however the studies have only reported on CTSB-mediated apoptosis in breast cancer cells as well as hepatocytes apoptosis in fulminant hepatic failure (Sandes et al, 2007; Yan et al. 2009). Nevertheless, the possibility of CTSB participation in the apoptosis of colorectal cancer cells has not been investigated. Moreover, there are a number of studies have shown that over expression of CTSB mRNA and elevation of its protein activity have been associated with the invasive and metastasis properties of various cancers (Campo et al. 1994; Yan et al, 1998; Hirai et al. 1999; Sanjeeva et al. 2001). The similar findings were observed in the current study where the HCT116 cells stimulated by symptomatic as well as asymptomatic Blasto-Ag have caused a significant up-regulation of CTSB. The over expression of CTSB in HCT116 cells stimulated by symptomatic and asymptomatic Blasto-Ag may implicate the potential of Blasto-Ag in causing the invasive and metastasis of colorectal cancer (Campo et al. 1994; Yan et al. 1998; Dora et al. 2003). In the present study, the insignificant down-regulation of p53 gene expressions observed in PBMCs may indicates that the symptomatic and asymptomatic Blasto-Ag may have prevented the PBMC cells to undergo the apoptosis process. The observation of p53 gene expressions obtained was contrary to the expectation. This may be due to the latent effects of the host immunity to down-regulate the apoptotic mediator gene in order to combat with the invasive B. hominis as well as to prevent persistent inflammation which can lead to carcinogenesis. Although the down-regulation pattern was observed, it does not causing a significant effect (0.95 and 0.96 fold decrease respectively). In contrast to PBMCs, stimulation of symptomatic Blasto-Ag in HCT116 has insignificantly down-regulated the gene expressions of p53. The insignificant down-regulation observed in HCT116 stimulated by symptomatic Blasto-Ag may be explained that it could be the reason that HCT116 cells to have low level of NF-à Ã‚ ºB gene expression level (1.34 fold increase). Nevertheless, the down-regulation observed may further suggest that symptomatic Blasto-Ag may has enhance the proliferation and progression of existing tumour besides causing an extensive release of pro-inflammatory cytokines. On the other hand, an interesting finding was observed in HCT116 exposed to asymptomatic Blasto-Ag, instead of causing down-regulation of p53 gene expression, asymptomatic Blasto-Ag has caused an up-regulation of p53 (1.09 fold increase) in HCT116. The findings and observations obtained from the current study are still far to characterize the mechanism of the potential pathogenic role of B. hominis in PBMCs as well as HCT116 cells. However, the current study was able to give an overview of the potential pathogenesis of symptomatic and asymptomatic derived Blasto-Ag in HCT116 and PBMCs. Moreover, the findings also suggest that symptomatic derived Blasto-Ag is more pathogenic as compare to asymptomatic Blasto-Ag. More studies still need to be done on the association of this emerging parasite on the association with the colorectal cancer. CONCLUSION The MTT cell proliferative assay and gene expression profile in this study has shown that the solubilized antigen isolated from symptomatic and asymptomatic individuals, at a particular concentration, could facilitate the proliferation and growth of colorectal carcinoma while having the ability to induce apoptosis on PBMCs immune cells. Moreover, the cell proliferative assay also successfully reported that antigen isolated from symptomatic individual is more pathogenic as compare to asymptomatic isolates, as it causes a significantly higher increase in cell proliferation of HCT116 colorectal carcinoma cell lines and a significantly higher increase in inhibition of PBMCs immune cells. Moreover, symptomatic isolate of B. hominis has exhibited a more evident increase in the gene expression of Th1 and Th2 cyokines. Hence, there is a vital need to screen colorectal cancer patients for B. hominis infection.

Child Observation Essay -- Child Development Project

Leroy is a 2nd grade African American student at Martin Luther King Elementary School. He is 8 years old and lives with his mother and two older brothers. His favorite school subject is math. He likes to play video games and basketball, especially when he is playing with his friends. Leroy’s favorite holiday is Christmas, for he gets to visit his grandma and enjoy all the delicious foods that his mom and grandma cook. When asked where would he go if he can go anywhere, he responded with Skate Park. He likes to skate around the park with his brothers. Leroy wishes to be like his older brother when he grows up. Leroy is a competitive student even among his friends. He likes to read at the same table as his friends or in the same room with them. When his friends are present, Leroy is more cooperative. He follows instructions, and he puts more effort into his readings. He wants to perform better than his friends; however, once he begins to struggle, Leroy loses his motivation to succeed in the task. According to Svinicki (2005), Leroy’s behavior and attitudes portray a student with a performance goal. To be more specific, a student with a performance approach goal, for Leroy’s main interest is to appear competent. The main reasons for the effort he puts in are to surpass his peers in order to receive recognition and attention. After determining Leroy’s goal orientation, my goal was to encourage him to shift from performance approach goal to achievement goal. I believe shifting Leroy’s goal orientation will benefit Leroy in numerous ways. He will be intrinsically motivated to read, which will increase his engagement in the reading games that we perform together. When he is engaged in learning the contents for himself, h... ...uring challenging tasks. In order to encourage Leroy to shift his goal orientation from performance approach goal to mastery goal, a variety of supports may need to be provided. Leroy needs to learn in an environment that minimizes competition and supports failures as learning opportunities. He needs to witness his accomplishments and recognizes that it is his effort and not ability or inability that resulted in his success. It may take some time for Leroy to shift his goal orientation from a performance approach to an achievement goal, but I believe with the right support and encouragement, Leroy will be able to develop a mastery goal. Works Cited Dweck, C.S. (2007). The perils and promises of praise. Educational Leadership, 65(2), 34-39. Svinicki, M. (2005, February). Student goal orientation, motivation, and learning. Idea paper #41, Idea Center.

Interpretations of American History Essay

There has been a notable change in the American History from the last 400 years until now. At the beginning the American History the subjects that the historians interpreted were politics, diplomacy and war. The only people who could do the interpreting were only white male Americans. The contemporary American historians wrote nearly about everything that affected everybody. This times were very different from what they are now, when you read history, you are reading the historian’s point of view or encounter with the world. The historians were fully dedicated to this, they spend hours, days, years of their life’s to prove the reality comes away. They were characterized by nationality or their school of thought. The historians can be Jeffersonian liberal, nationalist, progressive, feminist or postmodernist; for example, Perry Miller in the twentieth century American liberalism, Kenneth Stampp’s was engaged with the civil rights movement, Kathryn Sklar’s ideas were feminist (p. 72). In those times everything was like they African American people couldn’t be historians, because they only accepted white male Americans, also they were male chauvinist, women couldn’t be historians and not only that, they were excluded from everything, they didn’t have the right to vote, to be in the politics, work, they Jimenez 2 could not do anything. History is successful when it tells you how things where, the only thing that could take you there was the imagination, but now, with all the technology that we have, we even can make a picture or a sketch of how the things were. basing on the things that had been found also. One of the things that the historians did, they constantly criticize, correct and supplement other historian point of view, they get closer to the truth arguing with one another. Historiography reminds you that history is not a closed book, is a reminder that there is always something to argue in history, it make us think or see what was before everything, the changes that have been in the growth of America, politics changes, racial justice, sex, differences in the society, education, labor. There has been a notorious change or evolution on how America has change. There are four stages in which the writing of American history has passed: the providential, the rationalist, the nationalist and the professional. The providential history in the United States from the seventeenth and eighteenth, ministers and magistrates and wrote a made of form of providential history. The puritans who settled in the United States believed that they were chosen by god that led to the form of their history to a holy chronicle one. Puritans used this form of writing for all men anybody that believed in god. The rationalism, they were very different with the providential because they didn’t believed that they were only chosen by god, they believed that opinions or actions should act on reason and knowledge not on their religious belief. They were ruled by the natural law was the idea of Newton, Locke, and the French philosophers (p. 75). The rationalist Jimenez 3 historians were the educated class in the colonies, the new story they told was of progress and reason. most of the historians of the eighteenth century were layer-politicians, planter-aristocrats, merchants or professionals. Tomas Jefferson was influenced by this movement and later on write a book named Notes on the State of Virginia in 1785. This book allow to men to discover and pursue their destiny and believed that they were free. After that, no one was free from slavery. This proves that the history during the rationalism the politicians only tells you what you want to hear, like right now it happens the same, everything was and is only about wealth, power, rights. In nationalist history changed the fact that in this stage the women contributed and argue in theirs perspectives or points of view. historians of women rewrote the story of America from the beginning to the recent past. They did not give women a place in the existing narratives, they just reconceived whole fields of history. An example of the women historians were Hanna Adams, Susanna Rowson, Elizabeth Peabody, and Emma Willard (p. 76) The professional historians started by the middles class that became educated through college or university which became commonly to only white males. History became a profession and the only way to access was to practice it and be at a advanced level in the subject. Their high opinion on distinguish scientifically and prove the truth from a romantic notion. In this time we can see through what has passed American History and learned about the different changes that our history has had, and also this has help to have America Jimenez 4 how is it now. Right now we see the thing different, for example, women can vote, women can do a lot more things that they couldn’t in the past, there is no slavery, everyone is free and follow their dreams and conquer their goals and that’s a big change.

The Legality of Military Intervention in Syria - Free Essay Example

Sample details Pages: 7 Words: 2249 Downloads: 4 Date added: 2017/06/26 Category Politics Essay Type Analytical essay Level High school Did you like this example? It is not about taking sides in the Syrian conflict, not about invading, not about regime change or working closely with the opposition, but it is about the large scale use of chemical weapons and our response to war crime, nothing else, said the Prime Minister David Cameron in a debate held in the parliament regarding military intervention in Syria.[1] The prime minister announced for military intervention in Syria following a suspected chemical weapons attack in the suburbs of the capital Damascus on 21st of August 2013, where an enormous number of people have died. Even though US and UK holds Assad government responsible, the rebels were blamed, denying the accusation.[2] Syria is a member of the 1925 Geneva Gas protocol, which restricts the use in war of asphyxiating toxic gases and liquids, materials or devices.[3] Under international humanitarian law, using chemical weapons are prohibited not only in international armed conflicts but also in civil wars l ike the current crisis in Syria.[4] This is established in the Tadic case[5][6], where the ICTY declared the prohibition of chemical weapons in internal warfare.[7] Under the 2001 report of ICISS, the doctrine of Responsibility to Protect (R2P) establishes that it is suitable for military intervention when its main motive is to stop human suffering and if believed that lesser non-military measures would not have succeeded.[8] Following the large scale loss of lives, property and effects of the chemical attack; as the UN secretary general Ban Ki-Moon said, most significant confirmed use of chemical weapons against civilians since Saddam Hussein used them in Halabja in 1988[9], the prime minister decided on military intervention. The UK has a partially written, uncodified constitution built on common law, case law, historical documents, Acts of parliament and European legislation. Don’t waste time! Our writers will create an original "The Legality of Military Intervention in Syria" essay for you Create order Its quality of being flexible makes it simply amendable by passing an Act of parliament and no special procedure being followed, adapting to new circumstances easily.[10] It is also of a monarchial background where the queen is the head of the state and reigns according to the constitution. These are known as the powers of royal prerogative. However, the political powers that have been consumed by her, is now diminishing as it is her majestys government which makes decisions and execute real executive power on behalf of her.[11] The judiciary, legislature, and the executive acts as a watchdog over the operations of each other. The judiciary controls the exercise of power by the state through the procedure of judicial review. The Human Rights Act 1998 notably increased the power of the judiciary to control the functioning of the parliament and the executive, sustaining Montesquieus classical exposure to the concept of separation of powers. The case of A and X and others v Secretary of State for the Home Department (2004)[12] illustrates the pressure between the roles of the judiciary, parliament and the executive.[13] The role of the executive is to implement policies and enact laws. Parliament is the most supreme legislative authority which makes new laws, termed as legislature.[14] Under a written constitution, the constitution is considered to be supreme as interpreted by the Supreme Court. However under the constitution of UK; being unwritten, the highest form of law is considered to be Acts passed by the parliament. According to Diceys view, all law-making powers are derived, not from a constitutional document, but from the sovereignty of the legislature, which is the parliament. He further stated that no person or body is recognized by the law of England as having a right to override or set aside the legislation of parliament. The validity of an Act of parliament can never be questioned, and in the case of Pickin v British Railways Board (1974)[15], Lord Reid said that, even though in the past, many lawyers seemed to believe that an Act of parliament could be disregarded, since the supremacy of the parliament was finally demonstrated by the revolution of 1688, any such idea has become obsolete. The doctrine of implied repeal states that a parliament may legislate on any matter, that no parliament may be bound by a previous or a further parliament and that the validity of an Act of parliament cannot be challenged as established in cases, Vauxhall Estates Ltd v Liverpool Cooperation (1932)[16] and Ellen Street Estates Ltd v Minister of Health (1934)[17], Blackburn v Attorney General [1971][18].[19] A recent discussion was raised about this viewpoint in the UK Supreme Court Blog and it said that, under no circumstances can the UK Supreme Court strike down legislation put forward by the UK parliament.[20] With the effect of parliamentary sovereignty, following the decision of military intervention in Syria, the prime minister wh o is a member of the executive, put it to a vote in the parliament. The UK is a rainbow nation with a variety of cultures and ethnic groups making up its population and the parliament is the representative of all these parties. Hence David Cameron consulted the opinion of all those multiracial people including ethnic minorities regarding military action against Syria, by holding a vote in the parliament in a participatory approach democratically. However, the results showed that British parliament ministers dismissed UKs involvement in US- led military action against Syria. The prime minister David Camerons decision regarding military intervention was rejected by 285 272 votes compelling UK to keep itself away from any joint military action, even though he is still in favour of it.[21] The labour leader Ed Miliband commented that the House of Commons had spoken for the people of Britain and that the people are deeply concerned about the chemical weapons attacks in Syria, but they want us to learn the lessons of Iraq, and that they dont want a rush to war. They want things done in the right way, working with the international community. [22] The prime minister responded during a debate in the parliament, I am deeply mindful of the lessons of previous conflicts and in particular, deep concerns in the country caused by what went wrong with the Iraq conflict in 2003. He further claimed that the difference with the Iraq war in 2003 was expanding that, back then Europe and NATO was split over what actions to be taken, but now they have agreed with the view that use of chemical weapons must not be allowed. Further, the Arab league had disagreed to act back then, but now they call for it, holding the Syrian government at fault and requesting the international community to act against them.[23] In a survey that was conducted regarding this matter, 60% of the British public opposed UK military action against Syria. When the public were asked that, with UKs involve ment in conflicts such as Libya, Afghanistan and Iraq, whether they have been made more or less supportive in UK intervening in countries and conflicts abroad, majority were less supportive. Further, it was found that the suggestion made by the majority regarding what action should be taken against the Syrian regime, by both UK and the international community, was that greater diplomatic pressure be put on the Syrian regime by means of economic sanctions. This reflects peoples participation in administrative decisions taken by the executive, making them well representative of the society.[24] The Defense Secretary, Philip Hammond declared that he and the prime minister were discontented with the result claiming that it would cause damage UKs special relationship with USA. However, Mr. Miliband responded saying that the relationship would remain strong even with the vote, and also that Britain must work in its national interest, even if it is to do with something different to Amer ica.[25] Nevertheless, the prime minister by all means has the power to declare war against Syria, by powers of royal prerogative, in the name of the queen. Back in 2003, despite failing the vote in the House of Commons, Tony Blair waged war against Iraq by using the prerogative powers on behalf of the queen. The Green paper called governance of Britain focuses on prerogative powers exercised by ministers, mostly regarding the conduct of foreign affairs like deploying and using the Armed Forces overseas, making and ratifying treaties. The decision to use the armed forces overseas does not need any approval or confirmation by parliament and may be taken by the Government. Such decisions are usually beyond the reach of judicial review, even if the circumstance is that the deployment would be opposing international law. After the GCHQ case[26], the courts have approved over some exercises of the prerogative, though making it clear at the same time that other matters remained beyond their jurisdiction.[27] Moreover, the prime minister claimed, The well of public opinion was well and truly poisoned by the Iraq episode[28]. Labour leader Ed Miliband stated however that Britain doesnt need reckless and impulsive leadership, it needs calm and measured leadership.[29] Furthermore, According to R2P, the country and the international community have the responsibility to rebuild in the aftermath of destruction caused by the war, by means of providing assistance with recovery, reconstruction and reconciliation as well as lookup to address the causes of the conflict.[30] Mr. Cameron announced at the G20 summit that the UK would give aids worth additional  £52m ($80m) for Syria much of it for medical training and equipment to help victims targeted by chemical attacks.[31] This will bring the UKs total expenditure on aid for Syria and neighboring states to  £400m.[32] Nevertheless, there can be nothing worse than the loss of lives, which will be a consequence if Britain rushes into war. As a matter of fact, even if the Syrian regime uses chemical weapons against the countries that intervene in military action or not, it is anyway going to result in bloodshed, not only of their civilians but also of the armed forces of the international community. Also when the Britains defense budget is spent for military action, it will have a direct impact on spending for domestic services such as health, education, social security as a means of developing the country. When such needs of people are not fulfilled, it results in the breach of right to life, right to health, right to protection, etc under UDHR. Moreover, it is necessarily the tax payers money that is spent for this, which will result in impacting inflation and subsequently the downfall of the economy of Britain. Therefore, alternative measures which would be rather peaceful should be taken in place of rushing into wars that may result in gruesome world wars. 1 | Page [1] Youtube, British parliament debates military action against Syria Part1, (29th August 2013), https://www.youtube.com/watch?v=SJLxBdhGBNE [2] World Observer Online, Syria crisis: Cameron loses Commons vote on Syria action, 30/08/2013, https://worldobserveronline.com/2013/08/30/syria-crisis-cameron-loses-commons-vote-on-syria-action/ [3] Ilias Bantekas, International criminal law: War crimes and grave breaches  (4th edition, Hart publishing,22 September 2010) at pg.176, In accordance with customary law, Article 8(2)(b)(xvii) prohibits the employment of poison or poisoned weapons, if the substance released from the weapon cause death or serious damage to health in the ordinary course of events, through its toxic properties. [4] Human Rights Watch, Attacks on Ghouta: Analysis of alleged use of chemical weapons in Syria, (De Standaard, September 2013), at pg.21 [5] ICTY, The Prosecutor v. Dusko Tadic, Appeals chamber judgment (15/07/1999) [6] Ilias Bantekas; note 3 above, at pgs.138,141 [7] Customary IHL, Rule 74. Chemical weapons, https://www.icrc.org/customary-ihl/eng/docs/v1_rul_rule74 [8] Fionna Bezaire and Bhaskar S. Manda, responsibility to protect, https://r2pcoalition.org/content/view/22/93/ [9] Jared Feldschreiber, United Nations Report: Sec. Gen. Ban Ki Moon Confirms Unequivocally Objectively Chemical Weapons Used in Syria, https://www.lawyerherald.com/articles/4056/20130916/united-nations-report-secretary-general-ban-ki-moon-confirms-unequivocally.htm [10] Neil Parpworth, Constitutional and Administrative law: The meaning of a constitution  (6th edition,Oxford University Press), at pg. 7 [11] Neil Parpworth, note 10 above, at pg 11 [12] A and X and others v Secretary of State for the Home Department [2004] UKHL 56; [2005] 2 AC 68 [13] Catherine Elliot and Frances Quinn,   The English Legal System: The role of judges  (12th edition, Pearson) at pg 148 [14]  Parliament and Government, https://www.par liament.uk/about/how/role/parliament-government/ [15] Pickin v British Railway Board (1974) AC 765 [16] Vauxhall Estates Ltd v Liverpool Cooperation [1932] 1 KB 733 [17] Ellen Street Estates Ltd v Minister of Health [1934] 1 KB 590 [18] Blackburn v Attorney General [1971] 1 WLR 1037; 2 All ER 1380 [19] Hilaire Barnett, Constitutional and Administrative Law: Parliamentary Sovereignty  (10th edition, Routledge) at pgs 110,113,124,125,136 [20] The Guardian, Does parliamentary sovereignty still reign supreme? (Adam Wagner,27th January 2011), https://www.theguardian.com/law/2011/jan/27/supreme-court-parliamentary-sovereignty [21] BBC, US to act in its best interests over Syria crisis (30th August 2013), https://www.bbc.co.uk/news/uk-politics-23894173 [22] BBC, Syria crisis, Cameron loses Commons vote on Syria action (30th August 2013), https://www.bbc.co.uk/news/uk-politics-23892783 [23] Youtube, note 1 above, https://www.youtube.com/watch?v=SJLxBdhGBNE [2 4] The Guardian, Observer/ Opiniom Politics Polls (Toby Helm, 31st August 2013), https://www.theguardian.com/politics/2013/aug/31/poll-british-military-action-syria [25] World Observer Online, note 2 above, https://worldobserveronline.com/2013/08/30/syria-crisis-cameron-loses-commons-vote-on-syria-action/ [26] Council of Civil Service Unions v Minister for the Civil Service [1983] UKHL 6 (GCHQ) [27]  The Governance of Britain (Colin Warbrick, 2008), https://login.westlaw.co.uk/maf/wluk/app/document?srguid=ia744cc630000014397915ad408901209docguid=IFB8EF8814A4611DDBF1596BDF21EBB6Ahitguid=IFB8EF8814A4611DDBF1596BDF21EBB6Arank=1spos=1epos=1td=340crumb-action=appendcontext=10resolvein=true [28] Youtube, note 1 above, https://www.youtube.com/watch?v=SJLxBdhGBNE [29] World Observer Online, note 2 above, https://worldobserveronline.com/2013/08/30/syria-crisis-cameron-loses-commons-vote-on-syria-action/ [30] Fionna Bezaire and Bhaskar S. Manda, note 8 above, https://r2pco alition.org/content/view/22/93/ [31] BBC, Syria crisis: where key countries stand, (17th September 2013), https://www.bbc.co.uk/news/world-middle-east-23849587 [32] BBC, Tony Blair: Iraq war made UK hesitant over Syria intervention, (6th September,2013), https://www.bbc.co.uk/news/uk-23983036

Red White and Blue Shooter Recipe

Heres a recipe for a density column thats a layered cocktail. Its perfect for the 4th of July or Memorial Day or pretty much any holiday with a red, white and blue theme. Red White and Blue Shooter Ingredients Bottom Red Layer: Chambord or Framboise (or Grenadine)Middle White Layer: Irish Cream or Half and Half or any cream liqueurTop Blue Layer: Blue Curacao (or you could dye vodka or rum with blue food coloring) You may also want to add a float of Goldschlager to get a golden gilttery firework effect. Layer the Red White Blue Shooter Fill a shot glass about a third of the way full of the red drink.Place a spoon, back side up, just above the top of the red liquid. Slowly pour the half-and-half over the back of the spoon. This will layer it over the red with minimal mixing.Use a clean spoon to repeat the process to layer the blue liquid over the white. Add some Goldschlager if you wish. I (of course) would also set this drink on fire, but thats just me. To ignite the drink, add a small amount of high proof alcohol to the top. Everclear or 151 rum are good choices. Enjoy your alcoholic density column!

Critique of Transformational Transactional Leadership

Critique of Transformational Leadership Transactional Leadership â€Å"Leadership without perspective and point of view isn’t leadership-and of course it must be your own perspective, your own point of view. You cannot borrow a point of view any more than you can borrow someone else’s eyes. It must be authentic, and if it is, it will be original, because you are original†. (Bennis, 1992, p.122) Introduction This paper assesses two popular leadership theories: Transformational Leadership Transactional Leadership. It further looks at the criticisms that are pitched against both theories. Extra emphasis will be placed on the criticisms that challenge both theories on the basis of certain flaws that are considered fundamental. It further†¦show more content†¦Transformational leadership demands for productivity from its followers without coming out right to reward actions however at the end of every self-evaluation and ability to transcend above one’s self interest, a follower will perform more at his workplace which will increase productivity output and could lead to unsolicited rewards from employers. However many critics have come up to explain the difference that alienates one from the other, both theories juxtapose one another in such a way that one theory leans towards the other at the end and both leaders want same thing from the employee: optimum performance. Bass et al, 1999 argues that â€Å"to be truly transformational, leadership must be grounded in moral foundations†. Wren et 1998 also believe the â€Å"ethics of transformational leadership rests upon three pillars; the moral character of the leader, the ethical legitimacy of the values embedded in the leaders vision, articulation, and program which followers either embrace or reject and the morality of the processes of social ethical choice and actions that leaders and followers engage in and collectively pursue†. Bass et al, 1988 believes that while transformational leadership models are grounded world view of self-interest of leaders even though some ethicists still believe exclusive pursuit of self-interest isShow MoreRelatedThe Effects Of Leadership Characteristics On Pediatric Registered Nurses Job Satisfaction844 Words   |  4 PagesResearch Critique: Effects of Leadership Characteristics on Pediatric Registered Nurses’ Job Satisfaction Nursing job satisfaction continues to rank high as an area of concern for Nurse Executives. 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NIST Definition of Cloud Computing System †MyAssignmenthelp.com

Question: Discuss about the NIST Definition of Cloud Computing System. Answer: Introduction Human resource management is a relatively new approach that has gained a lot of importance in the business world since the past few decades. Human resource management is an approach that aims at optimising the performance of the workforce in business organisations by helping the employers in establishing better work relations with the employees and by improving the work conditions for them (Hendry, 2012). There are a number of core functions, such as performance management, training and development, career development, etc. and non-core functions, such as job analysis, attracting and retaining employees, etc. that help business organisations in achieving better organisational results (Armstrong Taylor, 2014). The Yorkshire and Humberside Regional Health Authority, also known as YHRA, has undertaken an audit of its existing human resource management practices. Through the audit, the management of the company has identified a number of key areas where there is a scope for improvement. In order to bring improvements in their human resource management practices, attract a greater government financing and also develop a more consumer focused approach, the company wants to employee specialist nurses and doctors and a performance evaluation system, which will help the company in ensuring that the employees are collectively contributing towards the achievement of the companys new strategic goals. In the last six months, an article was published by the British Medical Journal, You cant be a person and a doctor: the work life balance of doctors in training. The article heavily criticised the work life balance of all those junior doctors who have been working in Yorkshire and Humberside. The CEO of YHRA has been alerted because of the article and is concerned with his companys reputation. As a result, he has also suggested to implement strategies that would help the junior doctors in exercising a better balance between their personal lives and work lives. Therefore, this r eport has been prepared to suggest strategies and methods that can be used by the health authority in achieving its strategic goals and becoming more competitive in the industry. Human resource models for the healthcare authority The concept of human resource management has greatly evolved over the past few decades. It was started as a subject but has now reached a level where business organisations consider human resource management as a strategic business partner. Till date, a number of human resource management models have been prepared and all of them have almost the same purpose to solve. The models used in human resource management provide a framework to business organisations to build up their human resource managerial strategies and design all the human resource management practices involved in the business. There are a number of human resource management models, such as the Fombrun model, The Harvard Model, the Warwick model, etc. that can be used by YHRA to meet its strategic goals but The Guest Model is one model that will satisfy all the needs of the healthcare unit (Managementstudyhq, n.d.). The Guest Model of human resource management was developed by David Guest in 1997 and is said to be a superior model than all the other models in the field. The crux of the model is that all human resource managers have certain strategies to begin with, which will demand specific practices and when these practices are executed, they will result in outcomes, which include behavioural, performance and financial rewards. The model prepared by David Guest is divided into a logical sequence of six components i.e. Human resource strategy, human resource practice, human resource outcomes, behavioural outcomes, performance results and financial consequences (Briefingwire, 2013). In the case of YHRA, the senior level management wants to uplift the condition of its human resources and optimise their performance level in order to establish a better image in the market as a brand and also to attract a higher government investment. To achieve its strategic goals, the management will have to redesign a number of its human resource management practices by aligning them with their human resource strategic goals. The management also wants to introduce a system of performance management in the workplace so that the workplace environment can be more performance oriented. Even more, the management wants to recruit new doctors and nurses and wants to offer a better work life balance to their existing staff. All these strategic goals can only be achieved by following an effective human resource model that would provide a framework to the company to design new human resource strategies, implement human resource practices, identify human resource outcomes of the new practic es, measure the behavioural changes demonstrated by the workforce, evaluate the change in performance and keep a check on the financial consequences. In such a scenario, the model prepared by David Guest looks like it was tailored to meet the needs of YHRA and help the healthcare organisation in achieving its strategic goals and also to help the company in aligning its human resource management practices with its long term objectives (Price). Recruitment and talent management strategies Recruitment is a process where business organizations identify vacancies in their workplaces that they are likely going to encounter in the near future and inviting applications for the fulfilment of the vacancies (McGraw, 2013). On the other hand, talent management is an approach where business organisations implement a number of strategies to attract, recruit, engage, motivate and retain a talented pool of employees (Arissa, Cascio, Paauwe, 2014). One of the new strategic goals of YHRA is to attract a greater financial investment from the local government and to achieve it, the company is planning to recruit specialist nurses and doctors. In the healthcare industry, recruitment and selection of employees is one of the biggest challenges that the employers face. Due to an alarming increase in the global population and because of the decline in availability of healthcare professionals, the recruitment and selection process is becoming very difficult and challenging for the employers(Matike Martorell, 2005). There is a huge race for recruiting the fresh graduates in the healthcare industry and most of them are willing to work for established brands, which makes it difficult to find the right talent at the right time. Thus, YHRA needs to carefully and urgently design certain strategies that will help it in recruiting a large pool of specialist doctors and nurses. Some strategies that can help YHRA in strengthening its recruitment process are discussed below: First of all, YHRA needs to establish itself as a major healthcare organisation in the market. It needs to promote itself as an employer of choice in the market by making its work conditions favourable for the employees. To attract a larger pool of talented and specialist doctors and nurses, YHRA can design compensation and benefit plans that are above the market average and are highly competitive (Flanagan, 2016). Offering better workplace conditions and compensation and benefit plans will provide an upper hand to the health care organisation in the recruitment process and a larger pool of talented candidates will be willing to work for the company. Secondly, to gain a competitive edge in the recruitment and selection process, it is important for YHRA to collaborate with some of the top medical colleges located in its vicinity. Getting into collaboration with such medical institutes, the company will be able to conduct recruitment and selection events even before the students complete their graduation or post-graduation (Hirsch, 2013). The students will obviously get job opportunity while YHRA will be able to make a selection choice from a large pool of talented graduates. Thirdly, a major problem that is surrounding the health care industry at present is the high number of baby boomers that are retiring in thousands of number every day. This leaves the healthcare industry in a deficit as the experienced doctors and nurses are retiring and are creating an alarming need for new talent in the industry. To cope up with high turnover rates in the industry, YHRA can start to practice a balance between the number of baby boomers and fresh talent in its healthcare units. It should recruit a good number of fresh graduates, who are specialists in different medical fields, so that the it does not have to encounter a sudden rise in its human resource demand because of baby boomers retiring in large numbers. Fourthly, offering work life balance opportunities to the employees can prove to be one of the best ways in attracting, motivating as well as in retaining a large pool of specialist doctors and nurses. Healthcare industry is one industry where the employees are not able to maintain a balance between their work lives and personal lives. Because of an alarming increase in the health related problems and diseases, healthcare institutes and hospitals are flooded with patients at all time of the day and night, which keeps the employees really busy (Cocca, 2015). As a result, a healthcare organisation that values the work life balance of its employees can establish a great reputation in the market, which can help in attracting a greater pool of talented employees and retaining those who have already been working with the organisation. Lastly, the management at YHRA needs to ensure that it undertakes human resource planning as a continuous process. Human resource planning is a process that allows business organisations to forecast job vacancies that they likely going to encounter in the near future and identifying ways to fulfil theses vacancies (Undercoverrecruiter, 2017). Human resource planning will help YHRA in strengthening its recruitment and selection process as it will provide a better overview of the overall human resource requirement of the health care centre in the coming future. The global healthcare industry is changing at a rapid pace. Most of the healthcare organisations are striving to increase their reach in the market and to get their hands on fresh graduates who can join their institutes and help them in offering better healthcare services to the clients. A lot of health care institutes are not implementing the right strategies that could help them in managing their talent and recruiting a talented pool of employees. The employers working in the health care institutes are relying more upon job portals to find talented candidates or are trying to recruit some expert doctors and nurses that have had some past experience in the field of their specialisation. Further, they are also focusing more upon compensation and benefits as a factor for keeping the employees motivated and engaged while they are more likely to ignore the importance that work life balance can have in keeping the employees engaged and motivated. Therefore, it is important for the human resource management of YHRA to carefully understand the issues that are related with recruitment and selection in the healthcare industry and look for effective strategies that would help them in managing their workforce in an effective way. Employee motivation, engagement and performance strategies Motivation is defined as the reason that forces or derives an induvial to act towards the achievement of his or her goals and needs. Employee motivation is an important concept that requires organisations to keep their employees motivated in order to achieve higher efficiency, performance level and productivity (Managementstudyguide, n.d.). Employee engagement is a concept in human resource management which requires business organisations to offer appropriate work conditions to the human resources so that they can give their best each day, feel motivated and are committed to the values and goals of the organisation on the whole (Engageforsuccess, 2016). Employee engagement has gained a lot of importance in the past few years as business organisations have identified the positive impact that an engaged workforce can have on the productivity of a company. The work conditions in a health care centre are not normal. Working in the health care industry requires the employees to be strong hearted and to be able to deal with all kind of emergencies that they encounter. The work conditions are so harsh that the employees can be called by the management at any point of time, if there is a case of emergency, even if it is a holiday. As the employees working in the healthcare industry are offering health care services that can make a huge difference in the life of an individual, it is important that they are engaged in their jobs and are motivated to work harder at all times but given the work conditions and the setup, it is difficult for the management of healthcare institutes to keep their employees motivated and engaged. Some strategies that can help YHRA in keeping the employees motivated and engaged are discussed below: First of all, to keep the employees motivated and engaged, one of the best strategies is to consistently recognize an employee that performs well in his or her job. The management can use different sources to thank the employees for their exceptional efforts, such as eCards, verbal recognition, e-mails and can even display their names on a blackboard (Irvin, 2015). Further, selecting employees of the day, week and of the month can also help the management in keeping the staff highly engaged and motivated to perform better in their job roles. Secondly, it is important for the managers of the healthcare institutes to continuously talk with their employees and inform them of the importance that they have in the organisation and how their performance can help people in surviving difficult situations. When employees perceive that their efforts add value to the organisation and its success, they are more likely to be engaged and motivated in their job roles (Precheck, 2015). Thus, it can be an efficient strategy for the managers to communicate with the employees and keep them informed about how their roles and efforts fit with the organisational goals and objectives. Thirdly, one of the most important that the managers can do to keep the employees motivated and engaged is to get out of their way and minimise the obstacles or barriers that they can face while carrying out their job duties and responsibilities. For example, in healthcare institutes, making changes or getting supplies requires a lot of paperwork. The management of healthcare institutes should look into such matters and eliminate all the unnecessary paperwork so that the employees do not feel harassed or overburdened with something that is not important. Fourthly, the management can schedule regular meetings where the entire staff is invited. In these meetings, the management can discuss important matters related to the work conditions in the institute. To make things even more efficient, the management can also conduct surveys and gather feedbacks from the employees about their grievances during these meetings (Schultz, 2017). Such actions will help the management in recognizing all those conditions that are unfavourable to the employees and are messing up their motivation or engagement levels. Lastly, to keep the employees motivated, engaged and to ensure high performance levels, it is important that the management is able to offer them a certain degree of freedom to maintain a healthy balance between their work lives and personal lives. Even though work life balance does not contribute much towards employee motivation, engagement and performance, but the absence of a healthy work life balance can demotivate the employees and disengage them from their jobs (Robinson, n.d.). Ultimately, they are more likely to show workplace absenteeism and a greater tendency to quit their organisations. Therefore, work life balance is also equally important in keeping the employees motivated and engaged. Work life balance policies for junior doctors Work life balance is defined as the balance between an employees personal life and his or her work life. The concept of work life balance has emerged in the past few decades as a result of a number of studies that brought the harmful effects of improper work life balance on the health of employees into limelight (Sandoiu, 2016). It has been found that employees are more likely to experience stress and health related problems if they are not able to take out time from work and devote their time to their families of personal lives. Further, employees that are not able to maintain a healthy work life balance have also been found to become addict to alcohol and other types of drugs (Andersen, 2015). YHRA has been losing its reputation in the market as an employer because of the article that presented a bad picture of the company in helping its employees to maintain a healthy work life balance. Further, the strategic goals and objectives of the company demand the company to recruit professional doctors and nurses so that the government can invest more into their institute but the present reputation of the company, as an employer, will prevent it from achieving its goals (Soper, 2016). Therefore, it is important for the company to implement strategies that will help it in improving the work life balance of its employees so that it can improve its reputation as an employer. Some strategies that the company can use to improve work life balance policies for junior doctors are discussed below: First of all, it is important to understand that the healthcare industry cannot practice a perfect work life balance because of human life at stake. Therefore, it is important for organisations like YHRA to take certain steps that can allow their employees to take some time off and relax while at work itself (Kennedy Pearce Consulting, n.d.). The management at YHRA can introduce some welfare activities, such as a gym, inside the institute itself, where the employees can spend their time while they are not occupied with work. Secondly, a major concern for the employees working in healthcare industry is their family and children in particular. Not being able to take out time for their children can demotivate and disengage the employees, who would then show less commitment towards the organisation and their jobs (Barton Team, 2016). In order to offer a better work life balance to the employees, YHRA can introduce an onsite childcare service where a pool of trusted staff can take care of the employees children while they are busy with their work. Further, the employees can also spend time with their children whenever they find time in between, which will be helpful for them and will keep them motivated. Thirdly, healthcare is an industry where the employees are subjected to a lot of pressure and just like any other human being, they can have bad days too. To help them in maintaining a peaceful balance between their work lives and personal lives, the management at YHRA can build a quiet space, which will not contain anything related to the job but will contain plants, flowers, seating, lighting, reading material, a canteen, etc. (Pingboard, n.d.).The employees working at YHRA can then visit this quiet space in their free time and can calm themselves down. Such a strategy will help the employees in easing up their minds and maintaining their calm during bad days. Managing relations with trade unions A trade union is an organisation that comprises of employee representatives. The basic idea behind the formation of trade unions is to ensure that the employers behave ethically towards the employees and do not implement strategies that are against the laws or not in the interest of the employees (Chand, n.d.). Trade unions are also important from an employees point of view because they offer an opportunity to the employees for expressing their views and interests. Trade unions also play an important role in the bargaining process when there are human resource management practices being designed by the employers. Maintaining good relations with trade unions is an important task for business organisations as they can have a lot of impact on the existing workforce and can also make it difficult for an organisation to recruit new workforce. For an institute like YHRA, the need to maintain proper relations with becomes even more when its reputation as an employer is dwindling in the market. YHRA also plans to recruit new talent for attracting a greater investment from the government, which also adds up to its need to establish good relations with trade unions. Some strategies that can help YHRA in establishing good relations with the trade unions are given below: First of all, the management at YHRA needs to give recognition to trade unions that are associated with its business model or the ones that have been joined by their workforce. The management should make it a point that it involves the trade unions associated with its industry while taking important decisions related to its human resources so that there is no resistance at later stages and a collective decision can be taken. Secondly, the management also needs to give its employees a fair chance to join any trade union that they want to and behave ethically towards them so that they are not offended by the actions of the employers or by any human resource management policy that they introduce. Having its own employees as members of the trade unions will help YHRA in establishing peaceful and effective relations with the trade unions. Lastly, the management at YHRA needs to understand that peaceful relations with trade unions can only be maintained when they are given an equal importance. The management needs to consider them as an important part of their business and whenever there is an issue that erupts between a trade union and the management, collective bargaining should be treated as a way out, rather than taking firm stands or resorting to strikes. Conclusion The Yorkshire and Humberside Regional Health Authority is facing a tough condition where it has to achieve its organisation strategies but its reputation as an employer in the market is at an all-time low. Also, the organisation is operating in the health care industry, where a competitive edge can only be achieved if an organisation has a talented pool of employees and effective human resource management strategies. Thus, the importance of managing the human resources properly increases even further. To become more efficient in managing the human resources, keeping the employees motivated and engaged, optimising the performance of the individuals, helping the employees in maintaining a healthy work life balance and to establish better relations with the trade unions, the management at YHRA can look into the above recommendations as they will greatly help the company in achieving its organisational goals and strategies. Bibliography Hendry, C. (2012). Human Resource Management . Routledge. Armstrong, M., Taylor, S. (2014). Armstrong's Handbook of Human Resource Management Practice . Kogan Page Publishers. Managementstudyhq. (n.d.). Human Resource Management Models. 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