Nursing in preventing hospital Essay

The aim of this essay is to ascertain what hospital acquired infection entails, the detrimental effects it causes and to highlight the active role nurses can take in the prevention of this type of infection. Hospital acquired (or nosocomial) infection is: ‘one that originated in the hospital environment; i.e. was not present or incubating on admission and which appeared 48h or more after admission’ (Azzam et al. 2001). Infection is caused by pathogenic organisms which invade the hosts immunological defence mechanism; this can be through wounds left by invasive procedures whereby the host’s natural body defences have been bypassed. It is the nurses’ responsibility to know the factors that can increase patients’ susceptibility to infection (i.e. age, underlying disease, drug therapy, or if they are undergoing surgery), this enables nurses to be able to assess which patients are most at risk so that they can develop a care plan and therefore they will know what extra, if any, precautions to take and protocols to follow. Sproat and Inglis (1992) cited by Mallett et al. (2000, p, 40) suggest that the assessment of a patient’s risk of infection to others, in nursing care plans, before the commencement of any procedure is a fundamental principle of infection control. The Bowell-Webster risk assessment guide for identifying patients at risk of infection (1990) cited in Alexander et al. (2000, p, 595) can be used to decide which protocols to follow. Steed (1999) states that not all nosocomial infections relate directly to the patients’ underlying disease but that many are caused by the actions of healthcare workers. Therefore great care must be taken by healthcare workers, especially nurses, who are directly involved in the care of patients. In this essay I am going to discuss the procedures followed by nurses to eradicate, if at all possible, cross infection. There are two ways of acquiring an infection in hospital: Cross (or exogenous) infection is when the infection has been spread from other people, either patients, visitors, hospital staff or even food and the surrounding environment; whereas self (or endogenous) infection is when the  infection is caused by microbes carried by the patient on their body, usually from septic areas. Compliance with universal precautions should be rigorous as to avoid spread of infection. For example, failure to change gloves between interactions with different patients can lead to the spread of disease (Piro et al. 2001). Ayliffe et al. (1992) contended that the regularity of infection in hospitals, caused by multiple types of bacteria, could increase to epidemic amounts if aseptic and hygienic measures in the hospital collapsed. According to the Healthcare-associated Infection surveillance Centre (2000) approximately 30% of nosocomial infections are due to urinary tract infections, another 30% are due to bloodstream infections, 20% due to surgical site infections and 20% due to pneumonia. These infections tend to occur during invasive procedures or when the body is very susceptible due to illness. The NHSSB infection control manual (1996) states that the inter-hospital transportation of infected patients is the main means of spreading infection and in extreme circumstances of spreading an epidemic strain. The spread of infection in hospitals between patients, or between patients and staff, cannot be entirely eradicated but it can be reduced, especially by nurses using methods I will discuss later. Evidence supporting the importance of infection control can be seen in a study by Worsley (1993) cited in Mallett et al. (2000, p,47) who found that in 1991 out of 175 patients who had developed nosocomial Clostridium difficile diarrhoea, 17 died and the organism was a contributing factor in a further 43 deaths. The cost of managing this outbreak was at least  £75000. Also in a study conducted by Plowman et al. (2001) they concluded that approximately 10% of patients will get infected during a stay in hospital and that this can lead to costs of up to one billion pounds per year in the U.K alone. These pieces of evidence and others (Chaudhuri, 1993) demonstrate the prevalence of nosocomial infection, the dire effects of it and also the extreme financial losses it incurs. Hospital acquired infection has many different consequences, it can: Delay or prevent recovery; Cause increased pain, discomfort and anxiety; Increase the patients stay in hospital which has financial losses due to drugs bills and extra staffing costs; Cause psychological stress as a result of long periods spent in isolation (Knowles, 1993, cited by Mallett et al. 2000, p, 47); it is demoralising for both staff, patients and their families which can lead to decreased public confidence in hospitals and doctors. Mc Millan Jackson (1999) insists that infection prevention and control is essential in healthcare settings to reduce the risks of morbidity and mortality in patients and healthcare workers. Nurses share responsibility with other healthcare professionals to reduce the risk of infection in patients. Patients have a right to be protected from preventable infection and nurses have a duty to safeguard the well-being of their patients (King, 1998, cited by Mallett et al. 2000, p, 39). The Nursing and Midwifery Council (NMC) Code of Professional Conduct (2002) outlines the nurses’ professional code, and also has implications for the role of the nurse in infection control, requiring them to protect patients and fellow healthcare workers from risks such as cross-infection. Clause 1 of the code informs nurses that, ‘You have a duty of care to your patients and clients, who are entitled to receive safe and competent care’. To fulfil these criteria, nurses must ensure that care is taken to ensure that dangerous or potentially harmful substances (e.g. drugs) or articles are handled and stored safely and that all equipment and appliances are properly maintained. Nurses are role models to the people with whom they come into contact, whether it is patients, visitors, students, or any healthcare workers. Therefore they should insist on compliance with basic procedures and practices as part of their job. They must assume responsibility for these practices as they are also held accountable under the NMC code of conduct and so should be at the forefront of efforts to prevent and control infections. Many infections are acquired through the patient’s own lack of knowledge of the effectiveness of simple procedure, such as hand washing, therefore the nurse has role to fulfil in providing education for patients and their families to give them a greater understanding of the importance of the need for thorough compliance of these procedures. ‘Standard precautions are designed to define a high standard of routine care that will be effective in reducing the transmission of potential pathogens between patients/ clients whilst protecting staff from pathogens carried by patients/ clients’ (NHSSB, infection control policy, 1996). General principles of infection control which all nurses must adhere to according to the Royal College of Nursing (1995) are, to: Wash hands before and after general patient care; Cover all cuts and abrasions with impermeable dressings; Use disposable gloves and aprons where necessary; Clean up spills and body fluids immediately according to local guidelines; Use and dispose of sharps safely, do not resheath needles; Dispose of clinical waste according to local guidelines; Handle and transport specimens safely by following local guidelines; Handle soiled linen according to guidelines; Use disinfection and sterilisation procedures following guidelines. Healthcare professionals need to have basic knowledge about the steps in the chain of infection to be able to determine how to control infection itself. These are: the causative agent; the reservoir; the portal of exit from reservoir; the mode of transmission from reservoir to susceptible host; the portal of entry into susceptible host; and the susceptible host. The main ways to interrupt the transmission of infection between humans and therefore break this chain is through the mode of transmission, this is achieved by: hand washing; aseptic technique; sterilisation and disinfection; and isolation procedures. Overviews of epidemiological evidence (Gould, 1991, Sharir, 2001) have shown that hand washing techniques are often inadequate and infrequent, and that the quality of hand washing is more important than the quantity (Van der  Broek et al. 2001). These conclude that hand medicated transmission is a major contributing factor in the current infection threats to hospital patients. According to RCN guidelines (1995) hands should be washed: before and after any duty which involves close contact with a patient; before and after aseptic technique or invasive procedures; after contact with body secretions/ excretions; after handling contaminated laundry or equipment; after removal of gloves, masks and aprons; before administration of food, drink and drugs; and at the end of a span of duty. Precautions adopted to destroy pathogens, prevent the spread of infection and to protect patients against infection during their stay in hospital, include the use of barrier nursing and the aseptic technique. These are adopted to increase the patient’s resistance to infection, to eradicate the sources or potential sources of infection and to minimise, or if possible stop, the means of bacterial transfer to the uninfected patient. The idea of barrier nursing is to keep an infectious patient, and materials they have been in contact with, apart from vulnerable others. This can be achieved by isolating the patient in a single room or by isolating a number of infectious patients in a purpose built ward. Another method used is to isolate patients whose immune systems are severely depressed thereby protecting them from harmful organisms. This is usually referred to as reverse barrier nursing. Aseptic technique is the use of sterile equipment and fluids, when carrying out any invasive procedure that breaches the body’s normal anatomical defences, to prevent contamination of wounds and other vulnerable sites by pathogens in the operating theatre, the ward, and other treatment areas. These procedures can only be effective if the healthcare professional, i.e. nurses who are in contact with the patients adhere to the general policies relating to the care of patients, especially infectious ones, such as hand washing and protection of personal clothing. It is my personal responsibility as a student nurse to ensure that I am fully immunised against common diseases, and diseases I may be in contact with in the  healthcare setting, if there is a vaccine available. If I feel that I am ill and suspect that my illness may put patients at risk of infection, it is my duty to inform the necessary people and to stay off work. It is also my duty to remove any jewellery (with the exception of a wedding ring) before work, to keep my nails short and clean, and to keep my hair (if long) tied back. Recent studies have proven the importance of wearing a clean uniform each day to work, and that you should ensure that your uniform is laundered at as high a temperature as the garment allows (Perry et al. 2001). During my clinical placement I had to adopt barrier nursing techniques due to a patient on my ward having Methicillin Resistant Staphylococcus Aureus (MRSA). I was therefore required to adhere to more thorough precautions when dealing with this particular patient. Source isolation was partially used to deal with this patient as I was working in an open mental health ward, therefore the patient could only be segregated to a certain degree. The nursing staff then needed to be aware of this patient’s movement so that we were effectively able to disinfect the areas she came into contact with as detailed in the local procedure we used. During meal times this patient had her meal brought into the ward to her on a tray, once she was finished I had to follow the local procedure by washing my hands with chlorhexidine gluconate 4% before donning gloves, I then had to place her used tray in an alginate polythene bag (which dissolves in the dishwasher), where it would then have been brought to the kitchens to be cleaned separately and at a higher temperature from the usual dishes. Next I had to change my gloves and then disinfect the table and chair, at which the patient had been sitting, with Haz tab solution, then rinse the area with fresh water and let air dry. Finally I remove and dispose of my gloves appropriately and wash my hands, with chlorhexidine in 70% Isopropyl alcohol solution, and dry with paper towels. In this way staff and the other patients are protected from contamination. As I have shown many hospital acquired infections can be easily prevented by the compliance of simple procedures, thereby reducing the extra costs hospital trusts and governments have had to pay, and most importantly reducing the ill effects caused to patients and their families. Not all  hospital acquired infection can be prevented, but with nurses and other healthcare workers working together in the constant assessment and evaluation of all techniques utilised, so that they remain consistent and be improved if necessary, there is no reason why they cannot be severely reduced. In conclusion it is clear to see that it is the nurse who has the primary role in implementing procedures used for the control and prevention of infection, with the intension to curb its spread and thereby ensuring that all patients are able to be cared for in a safe environment, as is their right. REFERENCES Alexander, M.F., Fawcett, J.N. and Runciman, P.J. (editors) (2nd edition) (2000) Nursing practice: Hospital and Home – The adult. Edinburugh: Churchill Livingstone. Ayliffe, G.A.J., Lowbury, E.J.L., Geddes, A.M., Williams, J.D. (editors) (3rd edition) (1992) Control of Hospital Infection, A practical handbook. London: Chapman and Hall Medical Azzam, R. and Dramaix, M. (2001) A one-day prevalence survey of hospital- acquired infections in Lebanon. Journal of Hospital Infection, 49: 74-78. Chaudhuri, A.K. (1993) Infection control in hospitals: has its quality enhancing and cost effective role been appreciated? Journal of Hospital Infection, 25: 1-6. Gould, D. (1991) Nurses’ hands as vectors of hospital-acquired infection: a review. Journal of Advanced Nursing, 16: 1216-1225. Symth, E.T.M. (director) Healthcare- associated Infection Surveillance Centre (2000). Mallett, J. and Dougherty, L. (editors) (5th edition) (2000) The Royal Marsden Hospital: Manual of Clinical Nursing Procedures. Oxon: Blackwell Science. Mc Millan Jackson, M. Nursing Clinics of north America: Contemporary Infection Control for Nurses. The healthcare marketplace in the next millennium and nurses’ roles in infection prevention and control. Vol 34, number 2, June 1999. Northern Health and Social Services Board, (1996) infection control manual. Nursing and Midwifery Council, Code of Professional Conduct, (2002). London: NMC. Perry, C., Marshall, R. and Jones, E. (2001) Bacterial contamination of uniforms. Journal of Hospital infection, 48: 238- 241. Piro, S., Sammud, M., Badi, S. and Al Ssabi, L. (2001) Hospital acquired malaria transmitted by contaminated gloves. Journal of Hospital Infection, 47: 156-158. Plowman, R., Graves, N., Griffin, M.A.S., Roberts, J.A., Swan, A.V., Cookson, B. and Taylor, L. (2001) The rate and cost of hospital-acquired infections occurring in patients admitted to selected specialties of a district general hospital in England and the national burden imposed. Journal of Hospital infection, 47: 198- 209. Royal College of Nursing: Guidelines on Infection Control, for nurses in general practice. (1995) London: RCN. Sharir, R., Teitler, N., Lavi, I. and Raz, R. (2001) High-level handwashing compliance in a community teaching hospital: a challenge that can be met! Journal of Hospital infection, 49: 55- 58. Steed, C.J. Nursing Clinics of North America: Contemporary Infection Control for Nurses. Common infections acquired in the hospital, the nurses role in Prevention. Vol 34, Number 2, June 1999. Van der Broek, P.J., Verbakel-Salomons, E.M.A. and Bernords, A.T. (2001) Handwashing quality not quantity. Journal of Hospital Infection, 49: 297.

How to Meet People in College

How to Meet People in College Knowing how to meet people in college can be more challenging than you might have expected. There are tons of students, yes, but it can be hard to make individual connections in the crowds. If youre not sure where to start, consider one of these ten ideas: Join a club. You dont need to know anyone in the club to join; you just need to have a general interest about the clubs activities and mission. Find a club that interests you and head to a meeting even if its the middle of the semester. Join an intramural sports team. Intramurals can be one of the best features of being in school. Youll get some exercise in, learn some great athletic skills, and of course! make some great friends in the process. Volunteer on or off campus. Volunteering can be an easy way to meet people. If you find a volunteer program or group that shares your values, you can make a difference in your community while also making some personal connections with people just like you. Win-win! Attend a religious service on-campus. Religious communities can be like a home away from home. Find a service you like and the relationships will naturally bloom. Get an on-campus job. One of the easiest ways to meet folks is to get an on-campus job that involves interacting with lots of people. Whether its making coffees in a campus coffee shop or delivering mail, working with others is a great way to get to know a lot of people. Get involved with a leadership opportunity. Being shy or an introvert doesnt mean you dont have strong leadership skills. Whether youre running for student government or just volunteering to organize a program for your club, serving in a leadership role can allow you to connect with others. Start a study group. While the main goal of a study group is to focus on academics, theres also an important social side. Find a few people who you think would work well in a study group and see if everyone wants to help each other out. Work for the campus newspaper. Whether your campus produces a daily newspaper or a weekly one, joining the staff can be a great way to meet other people. Youll not only connect with your fellow staff members, but youll also connect with all sorts of other folks doing interviews and research. Work for the campus yearbook. Just like the newspaper, the campus yearbook can be a great way to connect. Youll meet tons of folks while working hard to document all that happ ens during your time in school. Start your own club or organization! it may sound silly or even intimidating at first, but starting your own club or organization can be a great way to meet other people. And even if only a few folks show up for your first meeting, thats still a victory. Youll have found a few people you share something in common with and who, ideally, you can get to know a little better.

Free Essays on Poes The Cask Of Amontillado

Poe’s â€Å"The Cask Of Amontillado† Poe’s â€Å"The Cask of Amontillado† is a story about revenge and the workings of the twisted mind of a man who is fixed on it. In this short story, there are many examples of symbolism and foreshadowing. The theme that is prevalent is man’s domination of his fortune which has been unkind to him. Edgar Allen Poe utilizes the characters, Montressor and Fortunato, to represent two distinct psychological entities in his short story, "The Cask of Amontillado." Montressor, who represents the human emotion of revenge, portrays an angry man who will stop at nothing to seek revenge on his friend, Fortunato, who insulted and humiliated him. Fortunato, on the other hand, represents the human emotion of pride. Because he insists that he is the only one who can tell the difference between "Amontillado and Sherry," he ultimately sets himself up for his own demise. Montressor, like many villains who prey on the faults and weaknesses of their victims, realizes early on in his plot to kill Fortunato, that his friend's passion for wine will be the most effective way to seize him down into the vaults where he intends to bury him. He nonchalantly mentions to Fortunato that he has purchased a bottle of wine at the carnival, but is unsure if the wine is Amontillado or an imposter. He tells Fortunato that he is going to ask Luchresi, a proclaimed vintage wine connoisseur, to decipher the type Caputo 2 of wine in the bottle. Montressor knows that Fortunato's pride will not allow him to let Luchresi test the wine. Fortunato insists that he is the only one that can accurately tell what type of wine was purchased, and therefore insists on tasting the wine himself. Montressor acts surprised by his friend's decision and even acts sympathetic towards Fortunato's failing health issues, but deep down he knows that his plot is working e... Free Essays on Poe's The Cask Of Amontillado Free Essays on Poe's The Cask Of Amontillado Poe’s â€Å"The Cask Of Amontillado† Poe’s â€Å"The Cask of Amontillado† is a story about revenge and the workings of the twisted mind of a man who is fixed on it. In this short story, there are many examples of symbolism and foreshadowing. The theme that is prevalent is man’s domination of his fortune which has been unkind to him. Edgar Allen Poe utilizes the characters, Montressor and Fortunato, to represent two distinct psychological entities in his short story, "The Cask of Amontillado." Montressor, who represents the human emotion of revenge, portrays an angry man who will stop at nothing to seek revenge on his friend, Fortunato, who insulted and humiliated him. Fortunato, on the other hand, represents the human emotion of pride. Because he insists that he is the only one who can tell the difference between "Amontillado and Sherry," he ultimately sets himself up for his own demise. Montressor, like many villains who prey on the faults and weaknesses of their victims, realizes early on in his plot to kill Fortunato, that his friend's passion for wine will be the most effective way to seize him down into the vaults where he intends to bury him. He nonchalantly mentions to Fortunato that he has purchased a bottle of wine at the carnival, but is unsure if the wine is Amontillado or an imposter. He tells Fortunato that he is going to ask Luchresi, a proclaimed vintage wine connoisseur, to decipher the type Caputo 2 of wine in the bottle. Montressor knows that Fortunato's pride will not allow him to let Luchresi test the wine. Fortunato insists that he is the only one that can accurately tell what type of wine was purchased, and therefore insists on tasting the wine himself. Montressor acts surprised by his friend's decision and even acts sympathetic towards Fortunato's failing health issues, but deep down he knows that his plot is working e...

Advanced English Tense Review (ESL, EFL, TESL, TOEFL)

Advanced English Tense Review (ESL, EFL, TESL, TOEFL) Its back-to-school time. Before you or your students get down to studying the specifics of various grammar structures, it is a good idea to review the basic English tenses. If you are an advanced student, a review will help remind you of the tenses and also point out any weaknesses or insecurity that you may have. If you are an upper-level student but not yet aware of all the tenses, these exercises will make a good introduction to some of the important structures ahead. For an overview of conjugation in detail of all 12 tenses in English, use the tense tables for reference. Teachers can use theses guides on how to teach tenses for further activities and lesson plans in class The following exercises serve two purposes: Re-familiarization of standard tense names Tense conjugation practice The first exercise is very important as you may not remember exactly the names of the various tenses. This exercise will help you remember the names of the tenses. Once you have finished the first exercise, read the text through one more time to familiarize yourself with it completely. Go on to the next exercise that asks you to conjugate the verbs in the extract. You should be very familiar with the extract so you can concentrate on the correct conjugation. Notice how the tenses relate to each other in time. Remember that many verbs are conjugated based on how they relate to one another. Teachers can use these exercises in class by using the following lesson plan which includes the exercises in a format useful for the classroom. Tense Review Lesson Plan and Materials Here is the original text. Once you have finished, click on the exercise link to begin exercise one. John has always traveled a lot. In fact, he was only two years old when he first flew to the US. His mother is Italian and his father is American. John was born in France, but his parents had met in Cologne, Germany after they had been living there for five years. They met one day while Johns father was reading a book in the library and his mother sat down beside him. Anyway, John travels a lot because his parents also travel a lot. As a matter of fact, John is visiting his parents in France at the moment. He lives in New York now, but has been visiting his parents for the past few weeks. He really enjoys living in New York, but he also loves coming to visit his parents at least once a year. This year he has flown over 50,000 miles for his job. He has been working for Jackson Co. for almost two years now. Hes pretty sure that hell be working for them next year as well. His job requires a lot of travel. In fact, by the end of this year, hell have traveled over 120,000 miles! His next journey will be to Australia. He really doesnt like going to Australia because it is so far. This time he is going to fly from Paris after a meeting with the companys French partner. Hell have been sitting for over 18 hours by the time he arrives! John was talking with his parents earlier this evening when his girlfriend from New York telephoned to let him know that Jackson Co. had decided to merge with a company in Australia. The two companies had been negotiating for the past month, so it really wasnt much of a surprise. Of course, this means that John will have to catch the next plane back to New York. Hell be meeting with his boss at this time tomorrow. Follow the links to begin the exercise: Exercise One: Tense Identification Exercise Two: Tense Conjugation

Sociology Project Summary and Annotated Bibliography Essay

Sociology Project Summary and Annotated Bibliography - Essay Example ROCKS, Sydney. Information Website. http://www.therocks.com/. (August 9, 2009). This website offers a huge amount of information about Rocks, Sydney Australia. The informations within this website gives a particular insisting information about the different sites that are directly effective and elemental in showing the historical background of the place in concern. Besides that, it could also be noticed how the entire website introduces a good consideration on the major operations that are taken into consideration with regards the promotion of culture in the area. Around Australia Website. http://www.sydney.com.au/rocks.htm. (August 9, 2009). The in depth presentation of Australia and the consideration focused on the detailed history of Rocks, Sydney is a huge implicative presentation of how the entire place is actually moulded through the history that it passes through. It could be noticed how this site helps the non-knowing individuals to gain a bit of familiarization with the place and gain interest on its culture and history as well. From this website, it could be considered how important history is actually a huge factor that shapes up a particular society and how that society is able to shape the entire place where the said group of human population is living in. The Australian Heritage. http://www.sydney.com.au/heritage.htm. (August 9, 2009). This website on Australian heritage gives a clear vision on the different issues that are embedded within the Australian society. This website posts a regular update with regards the regular things that are happening in Rocks, Australia; these updates are regularly given a particular focus so as to help outsiders have a knowledgeable understanding about the developments happening in Rocks, Australia. Emanuel, Cedric. (1979). The Rocks: Sydney's Most Historic Area. Cassel Australia Limited Publishing. This book's author is known for his knowledge of Australia and its history and the effective presentations that he handles to introduce the country as well as certain cities of Australia towards the world. This written book then gives a particular description that serves as a practical mirror about Australia and the different elements that make up the said society that leads up towards the progress of the entire country. The historical background of Rocks, Australia have been etched through this reading and presented with an interesting picture that creates a great picture towards the possible understanding of the world towards the truth behind the growth of Rock, Sydney Australia. Kelly, Max. (1997). Anchored in a Small Cove a History and Archaeology of the Rocks, Sydney. National Library of Australia. Archaeology is a very important factor of human history, an elemental matter that creates a fine description on how people lived before and how their life actually progressed because of these past cultures and traditions that the ancient Australians had to live with before. Basically, the process to which everyone progressed in that particular part of the country has been outlined through this reading; allowing for a more progressive understanding about the people and about the country that is most needed to be known by those who are interested in gaining a more in depth understanding

Macro5 Essay Example | Topics and Well Written Essays - 1000 words

Macro5 - Essay Example Every labour market depending on the economy has its own fluctuations and structural characteristics. In addition, every job always retains its core characteristics like working conditions, required qualifications, working hours and compensation. Furthermore, each employee is represented through professional qualifications, personal abilities and work expectations. Practically, employment occurs when an employee and particular position are matched. In any economy, there are situations when some positions remain unfulfilled, qualified workers are unemployed and some workers are not included in the labour force. When employees and positions are matched poorly and those employees remain in labour force, this trend results in both additional vacancies and additional unemployment. Partially, natural rate of rate is determined by the dynamics of new job creation and termination of current jobs because of decision made on microlevel by individual employees and businesses. Therefore, if othe r aspects of the economy remain constant, simultaneous creation and termination of jobs leads to a higher rate of unemployment. In addition, turnover rates among current employed workforce are also associated with higher unemployment, and are significantly influenced by the nature of jobs and the age mix of the adult population. According to McConnell, Brue and Flynn (2008), inflation is defined as the rate at which the general level of prices for goods and services is increasing, and, subsequently, purchasing power of consumers is decreasing. From this definition, it is evident that inflation is a negative economic trend. Indeed, two digit inflation rate indicators in the early 1980s in the United States are a good illustration for â€Å"bad† inflation. General decline in purchasing power, particularly among consumers with fixed income, compromised

Fundamental concepts of managerial economics Assignment - 1

Fundamental concepts of managerial economics - Assignment Example Changes in the price (P) of the good or service will result only in movement along the demand curve, whereas changes in any of the other demand determinants in the demand function (PS, PC, Y, A, AC, N, CP, PE, and so on) shift the demand curve. When two goods are substitutes, such as Chevy-volt and Toyota Prius, an increase in the price of Chevy-volt, results in an increase in the quantity demanded of Toyota Prius, holding other factors constant, such as the price of Toyota Prius, other prices, income, and so on, or vice versa. The price of a gallon of regular octane gasoline skyrocketed from $3.00 per gallon to $4.10. The previous summer, when gas prices had hovered around $3 per gallon, Americans had cut back only slightly on non-essential driving. In the summer of 2008, with regular gasoline at $4.10 per gallon, not only summer driving vacations but urban commuting itself changed in extraordinary ways. Overall, customer demand by the typical two-person urban household shrank from 16 gallons per week to 11.5 gallons. Faced with $4.10 per gallon gasoline, as ExxonMobil and Shell sought to recover their extraordinary input costs for crude, American consumers decided to vacate their SUVs, join carpools, and ride the buses and trains to work. Urban mass transit system ridership shot up 20 percent in a matter of months. Other Americans purchased fuel efficient hybrids like the Toyota Prius. Several determinants of demand and supply were identified as possible explanations for the spike in gasoline’s equilibrium market price. This therefore lead to the decreases in the demand for SUVs to a point that the Enterprise Rental Car Co. charged various models of rental cars such as SUVs at $37 on one-day return while the subcompacts were charged at $41 on one-day return. This therefore led to the decline in the equilibrium price of SUVs. Cash flows of Investment A have a larger coefficient of variation (0.80) than do cash flows of Investment B (0.50); therefore,