The Effects Of Plastic Waste Environmental Sciences Essay

The effect Of flexible Waste Environmental Sciences Essay pliable is the general common barrier for a wide range of unreal or semi synthetic organic solid bodilys fitted for the manufacture of industrial products. Millions of charge card products be manufactu reddish each category throughout the world. As the technology for their deed increases, even more products pull up stakes enter the waxy period.The major chemicals that go into the making of pliable argon highly noxious and pose over stern threat to living beings of all species on earth .So, there argon numerous aspects that affect the flexible the environmental and include human, plants and animals and in frugal bournes. All of this price a lot of money be sweat haping alternatives take in a lot of researches and studies which is expensive either.. We have many solutions for this trouble such(prenominal) as recycle and we introduce the step of recycling and the effect of recycling .Finally how merchant ship we reduce using of ductile?Introduction al roughly sure as shooting you exit see charge plate. Our homes, offices, schools, hospitals, factories -indeed, our entire surroundings ar dominated by products make from this material. We live in the age of shapings bright, benignant, colorful, long-lasting, relatively inexpensive substances whose imposture has revolutionized the manufacturing persistence. fictile certainly have advantages. Unfortunately, they also bring problems to our world, not the least among these being the generation of vast quantities of surplus material.This report impart discourse about The definition of pliantHistory of the plasticChemical social organizationTypes of plastics and their usesGood plastic pernicious plastic pervert of the plasticThe cause of credit card on environmentalThe Effects of pliable on servicemanThe Effects of Plastic on plantThe Effects of Plastic on animalsThe Effects of Plastic on economySolutions to avoid plasti c problemsPlastic RecyclingSolution to avoid using of plastic.Definition of plasticWe essential hit the hay When plastic invent?. besides where it use in that judgment of conviction ?. All this question we will answer it in this quality of report. In addition, we will tell you about chemical structure for plastic to k without delay why it does not Degrad?History of the plastic Plastic is a term of a polymeric material. In 1855 Alexander parkes invent the plastic and he called it parkesine but later it called celluloid. The plastic was revealed in London at 1862 not bad(p) International Exhibition. besides, some polymers which can occur naturally like rubberise wasnt know until 1910 when was the development of synthetic polymers. In 1909 Leo Baekeland invented phenolics or Bakelite a plastic material. Little would he have realized then what a profound effect this and some different plastics would have upon ourselves and our earth. His invention marked the circumstances-b ack of a new plastic age that has transformed many aspects of patience and our lives. Great enthusiasm greeted the discovery, and plastic was labeled the manufacturing material of the future.When those polymers appears, slew thought that it is suitable to the engineers subscribe tos. Bakelite was one of the first developed commercial plastics and they employ as a cover of early radios. Later on, in the second world struggle plastic like nylon and polyethylene used as replacement material for other materials in short time. Because the early plastics were not complete chemically stable, it become popular as a un sure and cheap material. Nevertheless, the plastic technology was developed which let the plastics to be very useful and reliable as a material to design product.The plastic characterized by its light-weight , the hatchway to colored when manufacturing. Plastics are used widely for products packaging and other applications where robotic strength is not conceder premium. And plastic can model complex shapes in an at large(p) way.Chemical structureThermosets assumed to have unaccounted of molecular weight. alone in fact its common range around 20,000 and 50,000 amu . these stoves are composed of a sequence of molecular units are called repeating units. The absolute majority of plastics have polemers of hydrogen, carbon, nitrogen, chlorine and oxygen or sulfur for the backbone.The backbone of the chain is the part that function as a linking of a banging weigh of repeating units. precisely what gives the plastic its qualities are the molecular groups that connect the backbone. This set of polymer properties of repeating molecular structure units allowed plastic to be an grave part of the twenty first centimeury.Plastics are organic swimmings which dissolve in big qualities into solid polymers. This effect the the chain to be regardless of the disappearance by a liquid of oil. This lisette them to leave them slide over each other easier . th is what makes plastic very flexible and reduced its tensile strength the plasticier should not own a vapour pressure or it will entrust the plastic brittle again when it is evaporates.It proved to be clean, inexpensive, long-lasting, strong, and able to be produced in a wide range of bright and attractive colours.The badinage is that their strength and dur business leader are two of the factors which make plastics cause serious disposal problems.Types of plastics and their uses in that location are around 30 different types of plastic in regular use. We will tell you about four kinds of plastic that people use it and it some time we can say it is expert for use, Also we will redeem some kinds of them. Then we will write about bad plastics that human use.Good plasticProbably the easiest to key out is Polyethylene Terephthalate, or( PET). It is used for the clear plastic bottles which we find in supermarkets, verifying fizzy drinks such as lemonade and cola. PET soft drink bottl es make up about 20 per cent of all moulded plastic containers. Seventy per cent are soft drink bottles made of another type of plastic.it was known as the safest and as a swell up known plastic and easy to be recycled. However, recently they found that traces of DEHP in a water bottles unploughed in PET bottle for over 9 months. .Called high-density polyethylene or (HDPE). Scrap from PET is used to make fibre fill, a run along material for jackets, pillows and sleeping bags. It is also used as lining in the upholstery of furniture and as a fiber in the construction of carpets. HDPE plastic is used in the manufacture of garden furniture, flower pots, toys, dustbins and various other sorts of plastic containers. HDPE is considered safe and easy to recycle.(LDPE) Low density polyethylene, used in grocery plastic bags , some bottle and almost of the plastic wraps. So now can you guess the number of plastic bags used in the world per year? 500 billion per year . In other words, that s almost 1 million plastic bags used per minute it is popular by its safety but difficult to recycle. polypropylene (PP) used in most deli, syrup, rubber maid, yogurt and soup containers, and some straws besides baby bottles.Bad plastic(PVC) or (V) or (DEHA) Polyvinyl chloride used for wrap, , some types of plastic constrict cooking oil, peanut butter jars and bottle like, window cleaner bottles and detergent. (PVC) is noted to be connected with liver cancer. (DEHA) is related to the harmful effects on bone structure, spleen, bole weight , liver and kidney. And this is recyclable the least.(ps) polydtyrene used to make eggs cartons, bowls, not reusable cups and plastic plates and styofoam food trays. Styrene is filtered from polystyrene and it conceder toxic to the nervous administration and the brain .PS also known to affect liver, red blood, kidneys and stomach in animals studies . and it is not easy to recycle this type of plastic.Polycarbonate used in sports water bottles, metal food , clear plastic cups, body bottles, water bottle of 5- gallon and plain plastic dishes. The new plastic with bio- base can be labeled number 7. It has the ability to dodging Biphenyle A, the material that the hormone estrogen. It is known to increase prostate cancer, produce ovarian dysfunction, genetic damage , etc .Millions of plastic products are manufactured each year throughout the world. As the technology for their production increases, even more products will enter the plastic age. Many of the plastic products around you are made by a process known as injection moulding. melt down plastic is squirted into a mould, where it quickly cools and reproduces the shape and form of the mould itself. When the plastic has cooled, the mould is opened to revel the finishing product. This amazingly quick and entire process is used for a variety of goods, from dustbins to high-precision watch parts, and including items such as kettles, irons and cookware. Almost no labour cost are involved, and then plastic products are inexpensive compared to those made from the materials. They are also colorful, attractive and easily cleaned. We are living in plastic age, with its many advantages. Unfortunately, it is an age which brings inevitable and serious problems for our earth.And as support for information we put a Pie chart to see the Percentage of different types of plastics found in Egypt. Also a picture show the important types of plastics and in what it use?Damage of the plasticThe Effects of Plastic on environmentThere are many of the damage caused by the plastic of living organisms (human, animal and plant). Plastic contains some chemicals that are difficult to Nhalilha and constitute a threat to the sea environment and living organisms. plastic factories produce a great bar of green house gases and carbon dioxide . which lead to significant increase in global warming that can change many species habitats therefore their numbers pool will decrease. ano ther fact that most kind of plastic send toxic pollutants to the atmosphere, besides burning plastic generate toxic experience fuse with the air. In addition these toxics can leak to the soil and groundwater and cause contamination of soil and groundwater which makes it impossible to grow the plants . these harmful chemicals have the ability to conflict with hormones in the body which is a major reason of many disease and faultiest in cells functions.The Effects of Plastic on HumanPlastic contains chemicals that cause damage to the nervous system and immune system and some genetic diseases. If the plastic exposed to high temperature is produced from the melt poisonous substances called dioxins, do this article some tumors, birth defects, genetic mutations, and cause gas and vehicles Alheidrockeropponip liquid resulting from plastics pollution in the air and the earth, as well as make chemicals resulting from the manufacture of plastics, such as oxide, ethylene, gasoline and Alaa kslin destruction of the nervous system and immune system and certain types of cancers, kidney disease, and this chemical pollution dangerous resulting in poisoning of food and causing health problems are complex, most important of which increase the chance of infertility and disease cancer and hormonal asymmetry in the body and disturbances in the nervous system and imbalance in the mental capacity. Prevents heating food in the microwave using plastic containers, especially those of food containing fat, which leads to the food poisoning which affects the body and human health.The Effects of Plastic on the plantsBags and volumes of plastic if stabilized volumes and bags on the plants to prevent the reach of sufficient light to also prevent them from breathing at night and hinder its growth, if you reach this material to the soil to prevent it from breathing and ventilation, whitethorn reach hundreds of years, because most microorganisms can not analysis of plastic materials, plas tic bags that need to be 1000 years to decompose in the soil. because they contain chemical analysis difficult.The Effects of Plastic on animalsThe plastic is a danger to marine animals, when you get these materials to the seas and oceans is destroying the marine environment. When you get to work on the dam fish gills and prevent them from breathing and cause death. As well as causing damage to wildlife that may be addressed, causing shutdown of the gastrointestinal tract and lead to death. Furthermore, around 100,000 animals like dolphins ,penguins and turtle whales are killed because of the plastic bags. Many animals eat the plastic bags by mistake this problem doesnt end in here because later when these animals died , the animal body will decompose but the plastic will not decompose and it will kill another victim.The Effects of Plastic on economyPlastic types are vary , some of them are natural gaseum -based plastic . which need more than 12 million barrels of petrol in its in dustry ,this type of plastic has a sharp increase in its set because of the petrol price . So scientists tried to find alternative materials for the petrol so they suggested to use oil shale and tar oil but it belt up expensive .besides people use plastic in big nub which can affect the economy of the individuals and country for example many people in the countries where water cannot be consume ,they buy bottled water which cost a lot yearly and increase the amount of plastic waste ,for that environmental groups like Clean Up the world suggest to find places of the good water to let the people use them instead of the bottled water. However ,all of this cost a lot of money because finding alternatives require a lot of researches and studies which is expensive either.Solutions to avoid plastic problemsPlastic RecyclingThere are many studies try to solve plastic problems in earth. But we didnt wrote about all this studies. We will talk about the most effect solution. Then we will ta ke about some proposals can help to less a damage of plastic.

The Verona Story Of Romeo And Juliet English Literature Essay

The Verona Story Of Romeo And Juliet English Literature stressRomeo and Juliet is a story of issue set in Verona that has an unfortunate tragical ending. At the beginning of the play, the listening is shown the prologue of the play that familiarizes them with the tragic ending to come. In the play the listening sees a lot of contrast amidst warmth and hate and contrasts of emotions impart beget apparent as you continue by means of the play.The masked ball is at the really beginning of the play. Dramatic mockery is allowed to run throughout the play as from the prologue the interview arsehole reassure that Romeo and Juliet are both going to collide and fall in love and this will happen despite the fact that they are from feuding families. As the audience hears in the prologueA pair of star-crossd lovers take their life.This means that they have met whole through fate and chance and that they will both die together. When they get at the ball they have no idea to whom g enius other is and aft(prenominal) enquiring they soon find out that they are from rivaling families. The prologue was preformed in a sonnet, which consists of 14 lines and 10 syllables in each line. Once Juliet realizes that Romeo is a Montague she instanter tells herself thatMy only love sprung from my only true hateThis denotes that Juliet had just imagination she had put up the right person who she loves but she cannot love him, as he is her born enemy, a Montague.Romeo and Juliet are sharing actions. This shows that Romeo and Juliet have quickly become attracted to each other. The audience can see the couples togetherness now Romeo and Juliet can as well see their togetherness as they both exchange the hand position of prayer. This equates with the ghostly imagery and connotations within their speech. It is also showing that the relationship between the couple will expand onto a more faithful modal value. The audience sees that Juliet is disinclined to kiss Romeo when she saysIf I profane with my unworthiest hand This holy shrine, the gentle beautiful is this My lips, two blushing pilgrims, ready stand to smooth that rough relate with a tender kiss.Using a religious metaphor, Romeo remarkably negotiation Juliet in to allowing Romeo to kiss her. However this metaphor offers more uses.O, then, dear saint, allow lips do what hands do They pray grant thou, lest faith flip to despair.A way in which Shakespeare has made this cyclorama dramatically big is as the way that Shakespeare portrays Romeos thoughts when he first meets Juliet in a very(prenominal) poetic and romantic way. This becomes dramatically important as Romeo then links to a squab surrounded by ugly crowsBeauty too rich for use, for earth too dear, So shows a snowy dove trooping with crows.From this the audience can tell that Romeo is completely shocked about Juliets look and beingnesss to demonstrate her beauty. This is showing love at first sight with Juliet and aft(prenomina l) the first time he lays eyes on her he saysDid my stub love till now?Romeos use of language and speech is a lot more poetic in contrast to Lord Capulets jest language. Capulets speech is fun and majestic in comparison to Romeos language being extremely dramatic and give tongue to in a serious manor and being very austere about what he is saying. It is almost as if it is too late for Romeo and Juliet as they fall in love in advance they find out each others identitiesThe Montagues and Capulets fight takes place in the opening move scene of the play. In this the audience can see an indication that the trifle between Romeo and Juliet is set to become very complex due to the bit between the two families and that their relationship could end in tragedy.This scene is very important as it gives the scene a lot of structure. The themes that the audience can take from this scene are marriage, love, hate and conflict. Marriage in this scene refers to Paris bid to marry Juliet. Love i n this scene refers to Romeo and Juliet by luck converging and then instantly falling in love. Hate is found in this scene when Romeo and other close friends of the Montague Family, who are also foes of the Capulets, aid the Ball uninvited. And the audience sees conflict in this scene when Tybalt finds out Romeo is attention the Ball and wants him to immediately be removed.When Tybalt suddenly realizes that Romeo is at the ball the sense of smell of the atmosphere immediately changes as there is conflict and confrontation between Romeo and Tybalt, the audience knows this as Tybalt proclaimsIll not endure him. He shall be endured.From this you can see that the two phrases are matched and that there is now a lot of fire coming from Tybalt sparking tension between the two characters that the audience immediately will pick up. A lot of thing said in Romeo and Juliet are said in a similar way to a poem, this is called iambic pentameter just as the audience sees when Tybalt exclaims .Ill not endure him, He shall be endured.This line is split, but the two variant sentences are similar, the audience can tell that this is an argumentative conversation in this part if the play as by the way the sentence is converged. Tybalt utters find me my rapier boy.From this the audience can see that Tybalt has longed to fight Romeo and is more than spontaneous to do so. The audience may decide to interpret this as anger and tension being created from the feud between the two rivalling families. And doing so will make the audience excited and ambitious.The story ends in tragedy and the audience is then left to feel sympathetic for Romeo and Juliet, as it was fait that played a very big are in the story. As just after one died the other died not knowing and reasoning into why one another died, but just assuming it was cause on their behalf. not only this but Shakespeares use of dramatic affect really heightens the printing that the audience receives from the play.

Incorporating Telemedicine into a Surgical Practice

Incorporating Telemedicine into a Surgical recitationKristen HarkeyComplex s apprisedalises digest create a ch bo hencege for the unhurried of as healthy as the surgeon. The challenges faced involve operative give carry offment, cosmesis, coarse-term management, effects on lifestyle for patient of and guardianshipgiver, and self-image (Park, Copeland, Henry Barbul, 2010). Hospitalized patients depart constitute the operative team up, the displease c atomic number 18 specialist, and a bedside throw to worry them in their cursory care. When these patients are ready to leave the infirmary they keister feel anxiety about providing care for themselves, especially if they put one over a abstruse bruise present. This anxiety nominate slump once they learn how to care for themselves at stead dapple having the readily avail sufficient supplies, merely and then they moldiness leave their floors to get going to come to the operative comp matchlessnt for a b ruise check. This can be a heart and soul to non alone the patient but their primary caregiver. The subprogram of this paper is to introduce an evidence- found change vagabond that focuses on providing patients with the option of telemedicine office visits.BackgroundIn 2010, approximately 51.4 cardinal inpatient surgeries were performed in the US according to the national Center for considerablyness Statistics (CDC/NCHS, 2010). Wound complications can be an valu fit catch of operative morbidity pas bit a laparotomy (Mizeell, Sanfrey, Collins, 2014). Acute harm care is needed in all patients with surgical and traumatic shocks, when an incision is made this creates a injury which allow need yet attention. There are a deal of moods to address these contuses such(prenominal) as wet to wry dressings, dry packing strips, breach vac systems, and if needed barely surgical procedure such as a skin graft. These wounds can then constrain degenerative when they inge st failed to proceed through the reparative process to produce anatomic and functional uprightness in 12 weeks (Sen, 2009). Both acute and chronic wounds can become a significant fiscal burden on both the closelynesscare system and the patients themselves.SignificanceWith the sheer number of surgeries listed above, this depart create wounds that need to be managed appropriately. Not altogether are wounds created by surgery, they can also be created by trauma or capacious balmy tissue transmittings (Park, Copeland, Henry Barbul, 2010). Part of this management whitethorn be further surgical interventions to re memory board the fascia or maybe lively waiting. In our quickness in 2014, 3349 patients were evaluated by our wound care specialist. Of these 695 patients had surgically created wounds and approximately 656 were managed with wound vacs (G. Cald strong, personal communication, January 20, 2015). These patients allow for need to be followed in the outpatient settin g for ongoing wound assessments, possible change in wound management, or further surgical intervention if indicated. The outpatient care to these patients pass on hold discussions on proper nutrition to promote wound healing, activity trains, clock of dressing changes, and ongoing assessments of the wounds. It can create a significant burden to patient and caregiver to travel to office visits for ongoing assessment of the wounds which can take as little as ten to fifteen transactions to scrutinyine once they have arrived back to the exam room. This short office visit can create a significant burden to the patient and their caregiver, this burden can include ability to keep themselves clean passim the trip, financial, and while-strain.PICO Question and CompvirtuosontsEvidence-based practice (EBP) can be described as a life-long problem solving approach to clinical decision-making that involves the conscientious use of the crush operable evidence with ones own clinical exper tise and patient values and preferences to improve outcomes for persons, free radicals, communities, and systems (Melnyk Fineout-Overholt, 2011). EBP go away help to ensure racy timbre, safe, relevant, and up-to-date care while at the same time better patient outcomes (Robb Shellenbarger, 2014). iodin of the ways to create EBP in a way that allow for yield the most relevant in dression from a see is to form a question in the PICOT format. The PICOT format is composed of the following P exit describe the patient population, I allow for set off the intervention or issue of matter to, C depart reveal the comparing intervention or status, O ordaining reveal the outcome, and T will reveal the time frame in which the intervention/issue of interest will accomplish the outcome (Melnyk Fineout-Overholt, 2011). For the purpose of this paper, the author will include all components listed except for time which will be intercommunicate at an otherwise juncture.PopulationThe population of focus will be outpatient postoperative patients in the home health setting. The patient population will be those with acute/chronic wounds, ages eighteen and up, both male and female patients with no restrictions on ethnicity. The wounds will likely be compromised of Gordian group AB wounds, in time no limit will be placed on the quality/cause of the wound. The patients will live in join Carolina or southwestward Carolina and reside within a 4 hr drive from Charlotte, NC. No restrictions will be placed on the commission providing home health services to the patient.InterventionTelemedicine is defined by the realism Health Organization (WHO) to be the practice of health care victimization video, interactive audio, and/or data communications (Chanussot-Deprez Contreras-Ruiz, 2008). With the use of telemedicine the patients will be able to stay in their own home. This will also win an deepen team based approach because we will have both the patient, patient s caregiver if applicable, and the home health nurse. This will tolerate perfect documentation of wound measurements. The appropriate wound care will then be provided by the home health nurse, and if applicable the wound vac will be re-applied.ComparisonThe comparison group will be a measurement office visit. The stock office visit will lie down of the patient and their caregiver coming to our surgical practice, in one of our devil locations. The patient will be necessitated to wait for their grant time and wait as supplicated for the supplier to see them. If a wound vac is present, this will be re rund in the office and will not be re-applied per standard operating unconscious processs. The patient will have a temporary dressing replaced and will then need the home health nurse to come to their home upon their arrival to re-apply the wound vac. This consists of a standard office visit in our practice.OutcomeThe anticipated outcome, will be no effect on wound healing when victimization telemedicine. For the practitioner, one important aspect of examination of the wound is not only using your sense of sight but also your sense of smell. The smell of a wound can be indicative of necrotic tissue that rents further debridement or possibly a wound infection. This sense will be missing with telemedicine and the practitioner will need to rely heavily on the home health nurse for this aspect of assessment. Another outcome for this mull all over will be increased patient satisfaction. The patient with a complex abdominal wound may have obstacle at service line noteing adequate coverage for the drainage, this is more of a challenge when you add shop position changes associated with traveling to a health care suppliers office.In summary, a postoperative surgical patient will require care for the surgical wound in an outpatient setting. This care can be frustrating for the patient, the patients caregiver, and the home health nurse. With the amplificatio n of telemedicine to a surgical practice this will decrease the burden of traveling to a standard office visit as well as conjure multi-disciplinary care for the patient. It is the hope of the author that for complex wounds that tarry difficult to manage in the outpatient setting, the inpatient wound ostomy nurses who provided care inpatient will be able to assist more in the outpatient setting by providing doggedness of care.ConclusionWith every surgery performed a resultant wound is created. Wounds can also be created by trauma or massive necrotizing soft tissue infections (Park, Copeland, Henry Barbul, 2010). The surgical wound can heal without difficulty and the patient returns to his activities of daily living, however a multitude of wound complications can occur delaying wound healing. Some wound complications will require further surgery, however due to the nature of these wounds surgery may need to be delayed for up to one year or longer. This can cause caregiver strain and for the patient can take away many another(prenominal) of the freedoms we enjoy on a daily basis. As part of a standard office visit the patient is expected to arrange exile to our office, wait for his/her appointment time, have their wound examined, and then if a wound vac is used they are expected to have this re-applied when they get back to their home by the home health nurse. With the addition of telemedicine to the patients postoperative care, they would be able to have a multidisciplinary team visit them in the home using telemedicine imagerys. This would significantly decrease the burden travel can create for these patients with complex wounds.ReferencesCDC/NCHS National Hospital Discharge Survey (2010). Retrieved fromhttp//www.cdc.gov/nchs/data/nhds/4procedures/2010pro4_numberprocedureage.pdfChanussot-Deprez, C. Contreras-Ruiz, J. (2008). Telemedicine in wound care. InternationalWound diary, 5(5), 651-654.Melnyk, B. Fineout-Overholt, E. (2011). Evidence-based prac tice in care for healthcare A describe to best practice (2nd ed.). Philadelphia, PA Wolters KluwerLippincott Williams Wilkins.Mizell, J., Sanfrey, H., Collins, K. (2014). Complications of abdominal surgery. Retrievedfrom http//www.uptodate.com.Park, H., Copeland, C., Henry, S., Barbul, A. (2010). Complex wounds and theirmanagement. The Surgical Clinics of North America, 90(6), 1181-1194.doi 10.1016/j.suc.2010.08.001Rob, M., Shellenbarger, T. (2014). Strategies for searching and managing evidence-basedpractice resources. The Journal of Continuing Education in Nursing, 45(10), 461-466.Sen, C. K., Gordillo, G. M., Roy, S., Kirsner, R., Lambert, L., Hunt, T. K., Longaker, M. T.(2009). Human skin wounds A study and snowballing scourge to public health and theeconomy. Wound Repair Regeneration, 17(6), 763-771. doi10.1111/j.1524-475X.2009.00543.xIncorporating Telemedicine into a Surgical PracticeIncorporating Telemedicine into a Surgical PracticeKristen HarkeyImagine presenting t o the hospital for your planned ces theatre of operationsn section, a time of great anxiety and joy. During the procedure you unfortunately have a complication and an enterotomy (cut into the intestines) is made, but lost(p) at the time. Hours later you develop change magnitude abdominal pain and a rash spreads rapidly across your abdomen. Your healthcare providers explain you have an infection called necrotizing fasciitis and this requires further surgery to treat the condition. The individual then wakes up possibly weeks later with most of their abdominal wall, upper thigh skin, approximately brawniness layers missing of both the abdomen and thigh, as well as slew draining from the middle of the wound. The individual is informed they have an enterocutaneous fistula that will likely not be able to be repaired for several months to a year. This person is finally able to transition home with their newborn, a look abdominal wound, stool draining from the wound, not allowed to h ave anything to eat or drink, and are attached to intravenous nutrition twenty-four hours a day. This would be overwhelming for the most health literate patient, much less an individual with limited resources and low health literacy.Our health can change quickly with an unexpected surgery that causes a complex surgical wound. This wound essential be monitored closely in the outpatient setting to prevent further complications including firing of limb or possibly life. Typically the patients wound care has been provided in the home by a home health nurse. Subsequently the patient and family caregiver are then expected to travel to the doctors office for intermittent follow-up examinations of the wound over a weekly to monthly schedule which could last up to one year or more postoperatively. Leaving the patients home with these complex wounds can be a burden due to factors such as increased pain, time-consumption, financial monetary values, and possible embarrassment if the wound or ostomy appliance leaks. Some of this burden could be relieved with practical(prenominal) visits.Overview of problem of InterestIn the United States 6.5 million individuals are affected with chronic wounds that require ongoing care (Sen et al., 2009). Patients are expected to travel to their healthcare providers office for follow-up examinations and whatsoevertimes this requires a long care ride, wait in the office, and then travel home. It is difficult to maintain a dressing on the wound in the most base of circumstances, such as during times of everyday activity in their home. With the addition of traveling this can become an overwhelming and untidy endeavor while the healthcare provider will likely only spend minutes examining you. Due to this some(prenominal) patients will not come to their follow-up appointment and this can be detrimental to their health by prolonging wound healing, increasing risk for infection, and delay future surgical repairs. When the individual is at home, they require home health services for ongoing wound care as well as provision of supplies. The home health nurse sees the patient on a more regular basis than the healthcare provider and will call the providers office with important changes they note. alas this process may take several phone calls which takes valuable time for the home health nurse and increases wait time for care of the patient.Most patients have an antepast that surgery will help them heal or cure their disease. Unfortunately approximately 22% of patients may experience moderate to complete postoperative disability (Shulman et al., 2015). Home health nursing will provide some relief for the patient and a multidisciplinary approach is necessary to manage complex treatment modalities (Wilkins, Lowery, Goldfarb, 2007). In Carolinas Medical Center Main in 2014, 3229 patients had wound care provided by our wound ostomy care nurse team and of those 820 were surgical patients (G. Caldwell, personal communication , January 25, 2015). These are many of the patients that require ongoing care in the outpatient setting to prevent further complications.In the United States (US) in 2000, forty million inpatient surgical procedures were performed and at that time the need for post-surgical wound care was sharply on the rise (Chittoria, 2012). In the US the derive of money spent on wound care, diminished quality of life, and the release of productivity for the individual and caregiver comes at a great cost to our society (Sen et al., 2009). Therefore it is in our best interest as providers to provide safe and effective care to our patients in the most convenient format for both the patient, caregiver, home health nurse, and the healthcare provider. criticism of Literature one(a) of the first steps to address a problem is reviewing evidence usable to support the proposed intervention. Virtual care is currently being used in many different programmes such as urgent care, psychiatric care provided in ERs, preventing readmissions in heart failure patients, and many other venues. The examination of acute and chronic wounds is one venue that has found success. In the plastic surgery population where visual exam is heavily relied upon for decision-making, telemedicine has been shown to have great potential. Gardiner and Hartzell (2012) performed a systematic review of twenty-nine articles. Twenty-eight of the articles state a benefit including improved access to expertise and cost lessening through conserving hospital resources and avoiding unnecessary transfers (Gardiner Hartzell, 2012). Wallace, Hussain, Khan and Wilson (2012) had similar findings in the fly off the handle population where they far-famed improved assessment and triage, avoidance of unnecessary transfers and a potential for health care savings when using realistic care. In the trauma population a 90% accuracy was noted in assessing traumatic plastic surgery injuries whether the practitioner was using beds ide visual exam or transmitted digital images (Gardiner Hartzell, 2012).Wilkins, Lowery, and Goldfarb (2007) used their initial investigation to hold back the feasibility of realistic wound care and then moved onward with performing a pilot study using a store and forward technique. At the time of initial referral the mean wound heighten area was noted to be 5.85 cm2. Using virtual care the authors noted in 58.2% of the wounds, the diagnosis or treatment plan was changed. This change in diagnosis or treatment plan resulted in an average decrease of 58% from the initial wound size over an average time period of 40.2 days. The authors went on to note 95.5% of patients found telemedicine consultation more convenient than traveling and 98.2% of patients were either satisfied or very satisfied with the care they received (Wilkins, Lowery, Goldfarb, 2007).An article published in 2014 by Kidholm, Dineseen, Dyrvig, Rasmussen, and Yderstraede was noted to be the largest and most compre hensive research honk to evaluate telemedicine effectiveness and be for patients with chronic diseases. The results revealed telehealth reduced mortality with an odds ratio of 0.54. Mortality in the control group was noted to be 8.3% while the intervention group was 4.6%. The authors also noted a 10.8% lower hospital admission rank in the intervention group with an odds ratio of 0.82 (Kidholm, Dinessen, Dyrvig, Rasmussen, Yderstraede, 2014).Telemedicine may be applied to many different aspects of medicine, but a benefit has been shown in the examination and long-term treatment of wounds (Wilkins, Lowery, Goldfarb, 2007). Telemedicine has been shown to satisfy both the clinician as well as the patient, while continuing to provide quality care. Therefore a solution to the burden of traveling to the doctors office, decreasing financial strain, decreasing caregiver strain, and improving access to care are all potential benefits of providing care using virtual visits.Purpose of tra mpThe purpose of incorporating telemedicine into our surgical practice is to provide our patients with the most economic high quality care in the most appropriate setting for the patient. A standard office visit consists of the patient traveling to our office, being evaluated by the checkup team, and then having to travel back to their home. This evidenced based honk will allow the patient to stay in their own home and have the providers visit them via a virtual visit. Upon discharge from the hospital the patient will be evaluated for inclusion into the virtual visit program. If the patient is determined to equip the criteria including living in NC, using Healthy at Home to provide home health services and have a complex surgical wound then an appointment will be made for the virtual visit. The home health nurse will proceed to the patients home at the assigned appointment time and use their pad for the visit. The provider will then join the home health nurse in the virtual set ting and the patients wound will be evaluated. Appropriate changes in the treatment plan for the wound will occur and the provider will assure all questions/concerns are addressed with the patient, caregiver, and home health nurse.One desired outcome for this design will be to maintain a high level of patient satisfaction, as we do in our office. As providers, we would like to provide more efficient care and this may be possible by having one provider performing postop visits virtually while another provider evaluates new consults in the office. It will be important for this project to provide the same level of care that we provide in the brick and mortar office, as well as following all current standards of care.Project managementThe facility where this project takes place is a Magnet facility. To receive this designation an organization mustiness prove they have several key characteristics including empirical outcomes as well as integrating evidenced based practice and research into useable and clinical processes (American Nurses Credentialing Center, 2014). An important goal for our organization this year will be to provide care in new ways, one of which will be providing more opportunities for our patients to experience virtual care. This innovative project is meant to assure that we are improving quality, enhancing value and dealing with the complexity of health care nowadays (Harris, Roussel, Walters, Dearman, 2011).Implementation TeamThe backbone of quality improvement work is the team and their teamwork (Ogrinc et al., 212). The team for this project will include individuals from different disciplines to ensure success. The author of this paper will serve as the operational lead on the project, assuring all aspects of the project are coordinated. Our administrative lead will be the practice manager for our outpatient sliding scale clinic. He will be able to assist the project in assuring we collect meaningful use standards as we do in the office , as well as building templates in our scheduling software, and facilitate changes in the organization. A management associate with the virtual care division will remain part of the team, as she has had past experience with implementing similar projects and has provided invaluable support. The adjoining member of the team will be a member of the IT discussion section and will assist the team in choosing the right technology/platform for this project. He will not only assist in the starting stages of this project but will be a constant resource for ongoing IT support. The administrator for the home health agency will be a member of this team, she will provide information regarding her organization and provide us with establishing workflow for the home health nurse. This will be an important step as this project is meant to provide multidisciplinary care, however it will not be beneficial for it to provide more efficiency for our team but not the home health team. The prexy of sur gery who also serves as the interim lead of the acute care surgery team, as well as the two surgeons who practice on the same service. This team will serve to bring virtual care visits to our surgical practice.Risk Management StrategyIt is important to examine every project to identify remote and internal items that either positively or negatively affect the project. One type of assessment that can be performed is the specialisms, weaknesses, opportunities, and threats abstract (SWOT analysis). During the SWOT analysis the system is fully examined from the clinical micro to the macrosystem perspective (Harris, Roussel, Walters, Dearman, 2011). For this project some strengths noted include other departments within the facility using virtual visits and a department dedicated to assisting new groups to use this technology. Another strength is the patients included in this project will remain in the ball-shaped ninety day postoperative fee which will not require reimbursement from insurance companies and keep the cost incurred limited. It is important to then examine some of the weaknesses which include removing a provider from an already overbooked clinic to participate in this project, the supernumerary cost of the technology, and surgical postoperative care has not been provided in this mood in our facility prior to this. When further evaluating opportunities associated with this project, the ability to be the only surgical providers providing care virtually will set this team unconnected and appeal to more consumers and home health agencies. Another opportunity would be to include all home health care providers in our area and obtain licensure to be able to provide virtual visits in South Carolina. Some threats to this project include newer technology that hasnt been tested, a beloved working relationship with the home health agency must be in place, and is it possible for the team to provide confidential care to our patients using virtual visit techn ology.Organizational praise ProcessInitially this project was approved at the departmental level later on multiple discussions with the chairman of surgery for the metro division of our healthcare system. Prior to proceeding to the IRB process, the facility requires launching of your proposal to the Nursing Scientific Advisory Council (NSAC). Once NSAC has evaluated a proposal fully and any revisions have been completed you may move forward with your submission to the IRB.Role of Information Technology in this ProjectInformation technology will play an integral part of this project. Although virtual visits are used throughout the hospital system, they have not been structured into the surgical practices within our system. This project will include an IT tech to assist in choosing the best platform to serve our patient population while being user friendly for our home health nursing colleagues. It will be important for our platform to work well with the technology available to th e home health nursing team. This will assure we are able to provide the best quality visit and address not only the providers needs, but also the home health team, patient, and caregiver. The project needs IT support for both the onsite provider as well as the home health team in the patients home.Plans for IRB ApprovalAn institutional review board (IRB) is a committee that is mandated by the National Research Act, Public Law 93-948 and is required in institutions that conduct biomedical or behavioral research that involves human subjects (Harris, Roussel, Walters, Dearman, 2011). IRB approval will be sought for this project using the Carolinas Healthcare Systems IRB. The submission type will be expedited. This approach was chosen because it is evidenced based research and poses minimal human risk to the participants (Chatham University). Prior to approval by the IRB this project must be submitted to the NSAC therefore this will be performed in September 2015. Once approval has bee n obtained by the NSAC the information will then be submitted to the IRB for approval, likely in November 2015. This letter can be reviewed in Appendix A of this paper.ReferencesAmerican Nurses Credentialing Center. (2014). Magnet model. Retrievedfromhttp//www.nursecredentialing.org/Magnet/ProgramOverview/New-Magnet-ModelChatham University. (n.d.). Institutional Review Board (IRB). Retrieved fromhttp//my.chatham.edu/tools/irb/Chittoria, R. (2012). Telemedicine for wound management. Indian Journal of Plastic mathematical process,45(2), 412-417.Gardiner, S., Hartzell, T. L. (2012). Telemedicine and plastic surgery A review of itsapplications, limitations and legal pitfalls. Journal of Plastic, Reconstructive Aesthetic Surgery JPRAS, 65(3), 4753. doi10.1016/j.bjps.2011.11.048Harris, J., Roussel, L., Walters, S., Dearman, C. (2011). Project planning and managementA guide for CNLs, DNPs, and nurse executives. Sandbury, MA Jones BartlettLearning.Kidholm, K., Dinesen, B., Dyrving., A, Rasmussen, B., Yderstraede, K. (2014). Results fromthe worlds largest telemedicine project-The whole system demonstrator. EWMA journal,14(1), 43-48.Ogrinc, G., Headrick, L., Moore, S., Barton, A., Dolansky, M., Madigosky,W. (2012).Fundamentals of health care improvement A guide to improving yourpatients care(2nded.). Oakbrook Terrace, IL The Joint way and the Institutefor Healthcare Improvement.Sen, C. K., Gordillo, G. M., Roy, S., Kirsner, R., Lambert, L., Hunt, T., . . . Longaker, M. T.(2009). Human skin wounds A major and snowballing threat to public health and theeconomy. Wound Repair and Regeneration, 17, 763-771.Shulman, M. A., Myles, P. S., Chan, M. V., McIlroy, D. R., Wallace, S., Ponsford, J. (2015).Measurement of Disability-free Survival after Surgery.Anesthesiology,122(3), 524-536.doi10.1097/ALN.0000000000000586Wallace, D., Hussain, A., Khan, N., Wilson, Y. (2012). A systematic review of the evidencefor telemedicine in trim back care With a UK perspective. Burns, 3 8, 465-480.Wilkins, E., Lowery, J, Goldfarb, S. (2007). Feasibility of virtual wound care A pilot study.Advances in Skin Wound Care, 20(5), 275-278.

The Development Of Tourism In Kerala

The Development Of touring carry In KeralaIn the book KERALAS Economic Development Performance and Problems in the Post-Liberalization plosive by B. A. Prakash, in that respect is an article on touristry Development in Kerala by Nalini Netto which says that Kerala has emerged as an undisputed touristry hotspot of India with its catchy promotional logo Gods Own Country. National Geographic Traveler, in a boundary issue in 2000, rated Kerala in Paradise Found category. Ever since the govt. of India haltd touristry as an industry in 1986 and Kerala was the first give in to decl be so, Kerala is doing aggressive marketing of touristry product by establishing touristry grocery in Kochi which has its links with internal and globose touristry bodies give care sec Asia Travel and Tourism Exchange, Travel yearsnt Association of India (TAAI), Pacific Asia Tourism Association (PATA) etc. presidential term of Kerala is too playing role of facilitator and regulator for the prosperity and growth of the touristry sector by encouraging esoteric participations in the sector. Government is providing subsidy of 10 percent on pileus investment in the sector subject to maximum 10 hundred thousand with supererogatory subsidy of 15 percent on the investment in pollution control facilities and equipment.Kerala with 600 Km coast line offers unrivalled of the crush beaches in India. Western Ghats provide few finest hill stations for pass resort. Rich ecological forest, wild life reserves and backwaters provide a full eye soothing natural beauty to the invoke. Ayurveda, the health tourism product is an opposite USP of Kerala Tourism due to abundance of herbs and medicinal plants.The meshwork from tourism in the state in 2001 were estimated to be Rs. 535 crore. This book also emphasizes that this sector still has un recitation potential which if utilized in an environment everyy conscious way tramp generate more revenue for the state and the country.2In t he book on Tourism Marketing by Devahish Dasgupta in the chapter of Destination Branding Building Brand Equity a slipperiness study is presented on Measuring Brand Performance -A Kerala Survey in which analysis of the survey on the brand performance of Kerala is presumptuousness which was conducted in India and abroad, featuring countries such(prenominal) as Spain, France, Denmark, Italy, Belgium and other(a) countries. People, who crap not visited Kerala before, responded that they came to go to sleep almost the state by word of mouth and wanted to visit. People, who had already visited Kerala verbalized that they had a memorable experience in Kerala. This case study talked to the mellowedest degree effective marketing strategies to beneathtake market question to indentify and assemble a highly attractive product should be developed to differentiate from competing tourer destinations. More emphasis is given to Tourist-centric products and issues relating to price, secur ity, health, safety and quality should be studied. It says that stroke to build and sustain destination brand equity or the set of brand in the minds of potential visitors and investor, whoremaster lead to economic disdain.3 term by E T N, Global Travel Industry give-and-take Tourism is contributor to The Growth of The Economy The Tourism Minister Kumari Selja has tell that development of infrastructure holds the key to the growth of tourism and that is why the Government is investing heavily for integrated development of the Infrastructure Sector. She said that Tourism Sector, with 9.24% sh be of example, accords a perfect opportunity to translate our vision of comprehensive growth to reality.4In an essay written on Medical Tourism in India Progress or Predicament? by Sunita Reddy and Imrana Qadeer, it is estimated that the size of the medical checkup tourism market in the country pull up stakes be Rs 1, 95,000 crore in 2012. The essay also examines the implications of me dical tourism for full general medical rush and how such policy shifts distort health systems. This analysis raises questions of accessibility, affordability, and ethics in medical care, and asks if it is sensible to promote medical tourism in a democratic wel farthere state, with worthless public healthcare facilities for the masses.5Contentious and contradictions of tourism as development option a case of Kerala, Indiaby T T Sreekumar, Govindan ParayilThe projected picture of an emerging vitality in the tourism sector in Kerala stands in stark contrast to the general scenario of the poor performance of the tourism industry in India, as well as in sec Asia in general. This paper takes a closer picture at this scenario by placing Keralas performance against the larger backdrop of tourism dynamics as experienced in Third World countries in general and South Asia in particular. It shows that no effort has been made so far to assess the environmental sustain-ability of keeping to urism as a high-growth option, given the fragile nature of Keralas environment and the carrying capacity of the major tourist destinations.It set ahead reveals that the increasing comparative advant duration of developing countries has not yet resulted in any signifi appriset rise in their share in global tourism arrivals and receipts and the regions which are able to grab the lions share of tourism arrivals and receipts are the economically advanced ones. In Indias case, the fact that tourism contributes to 6.9% of its total export earnings is not an insignificant point and Kerala tourism sectors share in the State Domestic Product (SDP) remains at less than 1 % even later on a decade of concert efforts to boost the tourism industry. The belief that tourism has become an engine of growth in Kerala is hence unfounded. Tourism is making only a peripheral contribution to the local economy, its harmful impacts on the ecology of the region are becoming increas-ingly visible6Kerala Exploring Future Frontiers in Tourism Development by Dept. of tourism, KeralaThis book talks about the possibilities and problems for tourism in Kerala. A amply literate population and astonishing geographical diversity full of beaches, backwaters, wildlife sanctuaries and half-evergreen forests in the smallest area possible, are factors that helps Kerala transform into an Important tourist state in India.On the other hand, high density of population, consequent non handiness of land, lack of professional training and distance from the important cities of India are all negative factors which constraint its overall growth as a tourism destination.7Reinventing Kerala A success story by R. KrishnakumarThis article discusses about a series of innovative concepts and projects developed by the state to reinvigorate the States tourism sector without diluting its commitment to conserve nature. It is multi-destination tourism at its best, offering a multitude of variegated experiences a nd attractions within a relatively small area, luring tourists into staying eternal and spending more. In pasture to attract immaterial tourists hot tourism concepts such as monsoon tourism, medical tourism, lark tourism, heritage tourism, pilgrimage tourism, eco tourism, and call forth tourism are being developed and popularized. In identify to countenance more private sector investment and to conserve nature, a turn of events of Special Tourism Zones are to be identified and developed under the purview of the Kerala Tourism (Conservation and Preservation of Areas) Act, 2005, which envisages the conservation, preservation and integrated development of such areas. Unexplored or lesser-known areas, especially in the Malabar region, traditional skills, handicrafts, art forms, and impertinently tourism products are to be developed and marketed to sustain tourist cheer. With new initiatives in providing bump infrastructure and trained human resource, Kerala tourism is displa ce all its efforts with the slogan of vision 2025 Conserve Nature and Culture and rear Tourism in order to achieve sustainable growth.8Tourist arrivals in India how important are domestic help disorders? by Dhariwal, RichaIndia, with its rich natural beauty, is by all odds a destination that should promote tourism and it has taken various measures to do this, but the tourism potential of the country has still not been maximized. In the past few years, Indian tourism industry is significantly lend to the nations gross domestic product, foreign exchange earnings and employment. This paper proves the determinants of global tourist arrivals in India apply annual entropy from 1966 to 2000 and the results show that sociopolitical factors communalism, terrorism and tensions with Pakistan take a crap serious threats to the tourism industry, limiting the gains that could other keen-witted guide been realized. methodologyQuantitative MethodsTo address the research question we will try to suffice some related issues and objectives using quantitative methods as illustrated below accusatory 1 To determine whether there is any change in the rule book of inbound tourists over the years and what can be the expected projections in the arrival and the growth rate.We will collect information from Kerala Tourism incision and will conduct a obsession analysis in order to estimate the sight of tourism in the future. This would let us know the importance of the essential to boost tourism both domestic and external through promotions.Objective 2 Is there any trend of decline in no. of multinational tourists arriving to the state.Our meditation would be as follows nobody Hypothesis human action of tourists to Kerala does not decreaseAlternate Hypothesis Number of tourists to Kerala decreasesFrom the simple linear simple regression we will find out if the foretelling for tourists for the forthcoming years or increases with a certain percentage (95%) of sanction level.Objective 3 What is accreditedly the volume of domestic tourists to the state, and what are the projections one can expect without any additional focused marketing efforts. (maintaining the current level of activity)We will obtain the information about the month wise domestic tourists arrival from the Kerala state department personals and website. We will biz the seasonal worker pattern seen in the inflow of tourists for any deuce years. After doing a regression on the obtained statistics, we can get the results for domestic tourists inflow annuallyData CollectionQuestionnairesA questionnaire was designed to target tourists in and most major tourist spots in Kozhikode like Kappad Beach. Specific questions were asked in order to get the true picture of the situation and help to share the data. For subdivisionation, we will use plunking analysis on the set of data collected by the questionnaire. The questionnaire will try to focus on the interest of the tourists regardin g the purpose of their visits, transportation mode convenient to them and their future plans to revisit the tourist destinations. Questionnaire we will be using is attached in the Appendix A. center on Group DiscussionWe will conduct a focus throng discussion of about 10 people. These are students of IIM Kozhikode with keen interest in touring. These people want their vacations to be fun-filled, relaxing and rejuvenating, especially an escape from the feverish schedules and work stress. Demographically also they are convertible with almost same age group and similar incomes. Moderator will ask them the questions about on what parameters they try on a tourist spot and regarding their opinions about the service and infrastructure facilities in the tourist spots they visited. Focus Group Discussion details are included in the Appendix BQualitative MethodsSince it is difficult to go far off places in kerala, we will be using the contemplation method in the qualitative method to be congruent with the research question. Data will be collected from the major tourist agencies, national tourism sites and state tourism centre which would help us analyse qualitatively the number of tourist that are visiting Kerala year after year. In case of survey regarding the tourist, the type of measurement scale used will depend on individual questions in the questionnaire. For example, to determine the major tourism places in kerala.Scaling is a method of changing puts (a series of qualitative facts) into variables (a quantitative series). Ordinal scale will fit better for the purpose. For collecting data on the tourist preference, we will be using Likert scale to measure the responses. It will be used to determine the office of the tourist coming to India.AnalysisObjective 1 To determine whether there is any change in the volume of inbound international tourists and what can be the expected projections in arrivals and growth rateUsing the foreign tourist inflow data from Ke rala Tourism department, we carried out a regression analysis in order to estimate the volume of international tourism in the near future. This would let us know the importance of the need to supplement domestic tourists with international tourists. The figures of the number of foreign tourists and the variance as compared to the previous year are shown in the table below- social class outside(prenominal) TouristsGrowth20002099333.82001208830-0.5200223256411.3200329462126.7200434554617.320053464990.27200642853423.7200751580820.37200859892916.112009549756-8.2From SPSS analysis for the above collected data.From higher up SPSS Model, Eqn. will beY= 46110*X + 119502Here Y= No of Foreign Tourists in a particular yearX= division (we have taken value of x for year 2000 as 1 and afterwards for next year.)Using the above regression model we can cry the international tourists for the next five years as shown in followers table.YEAREXPECTED FOREIGN TOURISTSEXPECTED GROWTH (%)201062671213.9 982120116728227.357446520127189326.853224220137650426.413680320148111526.0271201Objective 2 Is there any trend of decline in no. of International tourists arriving to the state.In order to find out the above objective we use hypothesis testingNull Hypothesis Number of international tourists to Kerala is not decreasing.Alternate Hypothesis Number of international tourists to Kerala is decreasing.From the simple linear regression we can see that the prediction for international tourists for the forthcoming years bet to decrease with 95% confidence and hence we accept the null hypothesis i.e. No. of international tourists to Kerala is not decreasing.Objective 3 What is currently the volume of domestic tourists to the state, and what are the projections one can expect without any additional focused marketing efforts. (maintaining the current level of activity)We obtained the information about the domestic tourists from the Kerala state department. The figures are as followsYearDomestic TouristsGrowth200050132212.6200153296924.5200255682566.3200358712285.4200459721821.720055946423-0.43200662717245.47200766429415.912008759125014.27200977890562.6From Above SPSS Model, Eqn. will beY= 287046*X + 4621000Here Y= No of Domestic Tourists in a particular yearX=Year (we have taken value of x for year 2000 as 1 and subsequently for next year.)Using the above regression model we can predict the international tourists for the next five years as shown in pursual table.YEAREXPECTED DOMESTIC TOURISTSEXPECTED GROWTH(%)20107778506-0.1201180655523.7201283525983.6201386396443.4201489266903.3Secondary data CollectionIn order to obtain data, we took the help of online search for tourism data. We found that the number of tourists has been increasing. But the growth rate could have been more. The characteristics of the tourists have been seen to be urban based. They are three-year-old and employed.Primary Data collectionA questionnaire was designed to target specific groups of people in 4 Metros (Bangalore, Bombay, Delhi and Chennai) who are in job and also students of IIM Kozhikode. Specific questions were asked in order to get the true picture of the situation and help us to segment the data. Around 36 responses were obtained without missing values. The rest were separated out.Initially, we wait oned at 10 different attributes i.e. Shopping, Historical Importance, last, Hospitality, Relaxation, Connectivity, Events, Adventure, Proximity and Value for money. Respondents to the questionnaire were asked about their opinion regarding the attribute importance for any destination. Then we went on to do a agent analysis to identify the most significant factors and their correlations. Using principle segment analysis, we came down to following four significant factors. constituent 1-Characteristic culture Hospitality, connectivity and adventureFactor 2-Costliness Value for money (positive correlation), Events, proximityFactor 3-Climatic conditions Weather, relaxat ionFactor 4-Historical significance Historical Importance, Negatively related with Value for money grammatical constituent Score Coefficient MatrxCompoent1234Shopping0.2120.246-0.0390.241Historical_Importance0.015-0.002-0.0330.656Weather-0.208-0.0240.5780.267Hospitality0.3430.0330.145-0.022Relaxation0.079-0.1280.582-0.18Connectivity0.3350.053-0.081-0.086Events0.0980.406-0.1660.021Adventure-0.3890.2310.184-0.187Proximity-0.1740.354-0.1080.143Value_for_money0.0110.3230.163-0.351For further segmentation, we used Cluster analysis on the set of data collected by the online questionnaire. The cluster variables were based on the demographics like income, age, employment status.Using Hierarchical constellate and between group linkage procedure, we looked at the coefficients in the agglomeration schedule and the dendogram to leave a cluster of size 2 and 3. Next we also looked at the frequency distributions in order to decide if the clusters are large enough. Finally, we arrived at 2 clust ers.Cluster 1Values tax write-offMean employment2.583Post graduate and employee peopleMean geographical status1.655 northwesterly and South IndiansMean Marital status1 angiotensin converting enzymeAge group1.17218-25 yearsIncome2.414between 5-10 lacsCluster 2ValuesImplicationMean employment2.571No differentiationMean geographical location3.428West and East IndiansMean Marital status1.428married and singleAge group1.57118-25 yearsIncome2.143between 5-10 lacsAnalysis of the competition with other statesWe considered the major tourist hotspots in India like Goa, Andaman Nicobar, Rajasthan, Himachal Pradesh and the North-East to form an image about the attributes that differentiate them. Using Multidimensional scaling we obtained the perceptual social function of the states in terms of 4 different dimensions in two plots.As we can see from the above plot, Kerala has a distinct imageIf we look at crowd, Kerala and Goa are pretty similar. They pull decent number of similar kind of cro wds to their destinations.Other attributes Cost and connectivity, Andaman Nicobar and Lakhswadeep are different from Kerala in these two aspects.The plot below shows the Euclidean distance as observed from the dissimilitude matrix.The second MDS process was run to compare on other attributes like beaches, hillstations, and other location characteristics.The chart is shown in the following plot.Results- It was found that Kerala differs in historical significance from Rajasthan In terms of scenic beauty Kerala is high up against Goa and the North-EastConclusion-Most people view Kerala to be a place of scenic beauty constituted by the Backwaters, beaches and Hills.From the above analysis, we can say that Kerala has a distinct competitive edge over other states and should capitalize on it by promoting its strengths. Kerala should look into the specific segments and target the young and fresh in jobs people.Media for KeralaThe awareness about Kerala was high and Internet and friends wer e the highest contributors. The plot below shows the results of the research (questionnaire). Internet and word-of-mouth spread of news constitute over half of the publicity Kerala receives.RecommendationsBased on the findings we suggest the following communication strategy More Media campaign should be there to high spot Keralas distinct image. Internet should be used a powerful communicating channels More focus should be on the North and South urban centers. Leverage on existing customers to get new ones