Inclusion criteria for the acceptability study were any child aged 0 to 59 months with parent or guardian consent. Exclusion criteria for children in all elements of the study were those with general danger signs of convulsions or no movement for children aged 0 to 59 months and lethargy or unconsciousness for children aged 2 to 59 months [ 3 ], those with a parent or guardian aged younger than 16 years, those not having parent or guardian consent, or those having any device manufacturer safety exclusion criteria.
The primary outcome was the proportion of consultations on children aged 5 years and younger where CHWs using an ARIDA adhered to all WHO requirements to assess fast breathing and device manufacturer instructions for use after 2 months of routine use. Secondary outcomes included the difference in proportion of consultations on children aged 5 years and younger where CHWs using an ARIDA adhered to WHO requirements to assess fast breathing and device manufacturer instructions for use immediately after training and after 2 months of routine use; number of errors made during the consultation of the sick child assessment, classification, treatment, referral immediately after training and after 2 months of using an ARIDA routinely; mean time taken to complete the sick child consultation; number of unsuccessful attempts using an ARIDA; number of times no ARIDA reading could be obtained in up to 3 attempts; number of children assessed for respiratory signs and symptoms by CHWs with an ARIDA during routine practice; and for Rad-G, number of children assessed for respiratory signs and symptoms by CHWs with standard practice in the same period of the previous year.
Qualitative outcomes focused on acceptability were derived from the 7 facets of acceptability as presented in the work by Sekhon et al [ 21 ]. The research teams and trainers then separately attended a third day of training which was more specific to their role in the study.
The 7 research teams focused on the study procedures including the informed consent process, how to use the CommCare data collection application version 2. Before the second observation, there was a 1-day training on conducting the qualitative semistructured exit interviews with caregivers, HEWs, and FLHFWs for all research teams led by the Malaria Consortium project team.
Each cohort was trained over 2 days by one trainer supported by a member of the Malaria Consortium project team, implementing partner project team, and local research teams, as required. The training consisted of the following modules: introduction to training, ARIDA study overview, assessment of fast breathing with an ARIDA, field evaluation data forms, case management of pneumonia, and ethical considerations and subject safety. For each study, a comprehensive job aid was developed and provided to each health worker.
The job aid contained all the information to conduct the required WHO case management and device manufacturer instructions for use, along with further information on pneumonia prevention Multimedia Appendix 1. The training included a half-day practice session that allowed each health worker to practice using the device on a range of different aged children.
All CHWs had to pass a competency-based assessment at the end of the training in order to be included in the study. One research team and trainer participated in a 5-day master pretest of all procedural activities that followed the exact procedures of the study to ensure all members of the research team and trainers were conversant with the study procedures and data collection materials.
The research team visited up to 3 research sites with a trainer and conducted the quantitative assessment. There was a 5-day debrief, revision, and finalization of all quantitative study data collection materials after the pretest, plus translation of relevant study materials. There was a second 1-day pretest for all 7 quantitative research assistants to practice using the finalized data collection tools. Within each research team, one research assistant participated in a 1-day pretest of qualitative data collection tools before the second quantitative evaluation during the 2 months of routine data collection.
There was a 1-day debrief, revision, and finalization of the qualitative data collection materials after the pretest, plus translation of relevant study materials.
For each consultation, 2 research assistants independently observed the CHW conduct the sick child consultation and silently recorded their actions on tablet-based observation checklists. In some instances, the research assistants needed to capture source documentation in the form of photographs of the age group selected and the ARIDA RR reading.
The research assistants also took photographs of the patient registers for later review. Once the evaluation was completed, the research assistants gave feedback to the CHWs if they had observed any incorrect actions. There were also 8 steps that were observed when the Rad-G was used Table 3. Steps of the child consultation that community health workers using Rad-G were observed completing. Once the assessment was completed, the CHW recorded the result of the RR and informed the research assistants of the classification and treatment.
If an RR count could not be obtained on the first attempt, the attempt was recorded as unsuccessful and repeated up to two more times before the CHW moved to current practice ARI timer, phone, watch. On completion of the assessment, the CHW explained the classification to the caregiver and gave them treatment, referral, or home care advice as appropriate.
CHWs were asked to use ARIDA during the 2 months of routine use but could revert to standard practice if they needed to and were instructed to record which device they used in their patient register using colored stickers one patient register per health post. Quantitative data was collected using an electronic data collection platform CommCare installed onto password-protected 7C Pro Tecno Mobile tablets and backed up to a protected cloud server.
Unique identification codes were used to anonymize patient data and CHW data. All RR evaluation data were independently entered by each research assistant. The data manager downloaded data daily and entered it into a data checker with in-built validation checks. Trial conduct was audited internally and externally.
Malaria Consortium created a QA form template Multimedia Appendix 2 which was completed by team members when shadowing the research teams. All data collected by research assistants from the CHW assessments was checked and verified by the Malaria Consortium research team daily.
A 1-day refresher training was provided to the quantitative research team before the start of the second data collection. Qualitative data was audiorecorded for each semistructured interview, and all audio recordings were translated into English and transcribed by the research assistants. The project had an person advisory committee of global experts to facilitate dissemination and uptake of any findings within participating countries as well as with key partners in the global childhood pneumonia community.
Descriptive information about the CHWs will be presented including CHW participation number trained and number completing first and second observation , sex, district, number of years qualified as a CHW, CHW education level, last integrated refresher training and last supervision Ethiopia only , and literacy level Nepal only.
Descriptive information about the number of children enrolled, number of evaluations started, number of evaluations completed by ARIDA and standard practice, and child age and sex will also be presented. The primary outcome will be calculated as the proportion of consultations with children aged 5 years and younger where CHWs using an ARIDA adhered to all WHO requirements to assess fast breathing and device manufacturer instructions for use after 2 months of routine use. This analysis will be disaggregated by age group, breath rate, and SpO 2 classification Rad-G only.
Secondary outcomes including the proportion of CHWs correctly performing steps reflecting the device manufacturer instructions for use and steps that reflect all WHO requirements to assess fast breathing will also presented, as will the difference in the proportion of consultations that were completed correctly between observation 1 and observation 2.
A sensitivity analysis using less conservative observations will also be presented. The mean time taken to complete the full assessment will be calculated for ChARM as from the time the CHW straps on the device to when the device displays an RR reading. The number of children who were assessed for signs of respiratory illness by CHWs with ARIDA or standard practice during routine care will also be presented. For the qualitative analysis, semistructured interview data will be summarized and presented for caregivers and front-line health workers separately.
Underlying themes should emerge iteratively. Each theme will be critically analyzed by the research team until the final themes are agreed upon. Price then makes a second pulback into the same demand zone before making another large move higher. Once you have learned how to spot obvious supply and demand zones on your charts, you can then start using them to find both high probability trades and also manage your trades.
You can use these levels to make very high reward trades and also to set your stop loss and profit targets. The next two examples of supply and demand trades are setups you will see and be able to use in your trading over and over again.
They form on all time frames and repeat themselves time and again. In the first example you identify a clear demand level. Price has clearly found demand at this level multiple times. If you are very aggressive you could just enter a long trade right from this level.
If you are more conservative you could look to increase the odds of your trade by using a bullish Japanese candlestick to confirm your trade. In this example price forms a bullish engulfing bar at the demand level to confirm a long trade higher. In the second example you notice that price is starting to make a move and trend lower. You also notice price break through a clear support level. When price moves back into this supply level you could start looking for short trades. Short trades here would be at an obvious supply level and inline with the trend lower.
Just like the first example you could also use a candlestick pattern to confirm the bearish move lower. In this example price forms a shooting star pattern to signal a move back lower. Being able to accurately identify and use supply and demand levels can take some time and practice.
It is not as easy as downloading and using an indicator that tells you what to do and what direction to trade. However, there are many benefits to supply and demand trading once you have mastered it.
You can use it to find trades on all time frames and it will also help you with your stops and profit targets. Make sure you test out any new strategies on free demo charts before you ever risk any real money so you know that they work for you and you are completely comfortable with them.
This is a bullish reversal pattern. At the open, sellers were in control until the price reached the point indicated by the bottom of the wick. At that point, buyers took over and pushed the price back close to the open or higher. There are several other candlestick patterns, but there is no need to learn them. If you analyze all of the candlestick reversal patterns, you will find that if you add the candles together, they will form a hammer for the bullish reversal patterns and a shooting star for the bearish reversal patterns, except they are just forming over a longer period of time In later chapters when talking about supply and demand trading, you will learn that the faster the price moves in and out of a pivot point, the stronger the imbalance of supply and demand.
For this reason, we only want to use the hammers and shooting stars for our trade set ups. The following shows a few of these reversal patterns. To add the candles together, you take the open of the first candle, the close of the last candle, and the highest high and lowest low in the pattern to draw the wicks. If the close is lower than the open, you have a red candle, otherwise you have a green candle.
This is the most important chapter in the book. So make sure to read this several times. Do not skim! Make sure you fully understand it. You are about to learn the secret to the markets. There are generally two schools of thought when it comes to the markets. The first is the Random Walk Theory, sometimes referred to as the Efficient Market Hypothesis, which states that price movements in securities are unpredictable.
Because of this random walk, investors cannot expect to consistently outperform the market as a whole. Proponents of the Random Walk Theory will argue that applying fundamental or technical analysis to attempt to time the market is a waste of time that will simply lead to underperformance.
Investors would, according to this theory, be better off buying and holding an index fund. This theory argues that stock prices are efficient because they reflect all known information earnings, expectations, and dividends. Prices quickly adjust to new information, and it is virtually impossible to act on this information.
Furthermore, price moves only with the advent of new information, and this information is random and unpredictable. Opponents to the Random Walk Theory believe that future price action can be predicted by previous price action. They tend to buy into technical analysis and believe that technical indicators, chart patterns, and trend lines can help predict future price action.
The opponents to the Random Walk Theory have it partially rightyou can predict future price action based on previous price history, but not using technical indicators. We use previous price action to show us where areas of excess supply or demand are.
The forces that drive price action in a market are supply and demand. In this book, you will learn how to plot these areas of excess supply and excess demand.
When you know there is a high probability of excess supply or excess demand, you can utilize this information to make better decisions when making a trade in any type of market. The good news is that you will find this book useful regardless of your investing beliefs. Whether you buy into the Random Walk Theory or believe in technical analysis, what you learn in this book will make you a better trader or investor. Now let us get to the core of what this book is aboutsupply and demand.
Supply and demand are the forces that drive price in any market. If you have ever taken a microeconomics course, you know that supply and demand is an economic model of price determination in a market. It concludes that in a competitive market, the unit price for a particular good will vary until it settles at a point where the quantity demanded by consumers at current price will equal the quantity supplied by producers at current price , resulting in an economic equilibrium for price and quantity.
The four basic laws of supply and demand are: 1. If demand increases and supply remains unchanged, a shortage occurs, leading to a higher equilibrium price. If demand decreases and supply remains unchanged, a surplus occurs, leading to a lower equilibrium price. If demand remains unchanged and supply increases, a surplus occurs, leading to a lower equilibrium price. If demand remains unchanged and supply decreases, a shortage occurs, leading to a higher equilibrium price.
Applying this to trading, supply represents willing sellers and demand represents willing buyers. Look at the following chart. Every time price direction changes, the relationship between supply and demand changed. The areas marked with a red dot are points where supply became greater than demand and the areas marked with blue dots are areas where demand became stronger than supply forcing a trend reversal. When markets are trending upward, demand is greater than supply, and the opposite is true for markets trending down.
Areas where the stock trades sideways in a tight range are areas where supply and demand are in balance. We can gain a competitive edge as traders if we know where these areas of supply and demand are.
We plot them on our charts as supply zones and as demand zones. We can determine where these areas of supply and demand are by looking at previous price action. We need to first learn how to plot these zones, and then we need to learn how to identify the zones that have the highest probability of giving us a profitable trade setup.
Plotting zones Let us start with the different methods of identifying and plotting areas of supply and demand.
The easiest zone to spot is when you have an obvious change in the direction of the trend. The candle that forms the pivot is the candle that is used to plot the zone. The following chart illustrates an example of a supply and a demand zone using this method.
Simply place a horizontal line on the top and the bottom of the candle that forms the pivot, and fill the zone in with a rectangle tool if your trading platform has one. Many times a daily candle will form too large of a zone. When this happens, simply bring up your hourly chart for the day that the zone was formed, place your zone around the hourly candle, and transfer that information to your daily chart.
The top of the supply zone and the bottom of the demand zone are always going to be plotted at the extreme price point, but by using the hourly chart we can plot a narrower zone. You will see the importance of this when we discuss how to trade using supply and demand zones.
The next method of identifying zones is to look for an area where price has been trading sideways and in a tight range for several bars, and then dramatically shoots away from that range. On the left side of the chart, we see price trading in a tight range for 6 bars and then drops dramatically. The next time price came into the zone the trend reversed, giving us a short opportunity.
On the left side of the chart, we see price trading in a tight range for several bars and then shoots up dramatically. The next time price came into the zone the trend reversed, giving us a great buy opportunity.
The third method of identifying a zone is to look for areas of indecision roughly halfway through a strong downtrend for a supply zone, or vice versa for a demand zone.
The easiest way to spot areas of indecision is a doji candle. After XOM opened, the price rallied one direction, reversed and rallied past the open in the other direction, and then reversed again closing close to where it opened.
The last method of identifying zones is by looking for gaps. When a stock gaps either up or down, there has been a sudden change in the balance of supply and demand.
The price it gapped from is very likely to be a strong support or resistance line. You need to keep this in mind when managing your trades, but plotting the actual zone is the same as the above techniques. You need to look at the chart as if the gap was one big candle. The following chart illustrates this. There are actually two gaps. For clarity purposes, I drew the candles in blue instead of red so you can see where the gap was on the chart before I drew the candle.
The two areas that price gapped down from will likely provide resistance on the way back up, but we still draw our supply zone as if the candles were as shown. Determining the strength of the zones Every time the trend changes direction, it is because of a change in the balance of supply and demand, but to use this to our advantage we need to know the likelihood of that imbalance being there the next time price returns to that zone.
Supply and demand zones are similar to support and resistance lines in that supply zones provide resistance and demand zones provide support. When price breaks through a supply zone it becomes a demand zone, and when price breaks through a demand zone it becomes a supply zonethe same way a resistance line turns into support when broken and a support line turns into resistance.
The similarities end there, though. A support or resistance line requires at least two points separated by time to be drawn, where a supply or demand zone can be plotted from one candle. Most traders will tell you that you should have three points for a support or resistance line to be drawn. Traders are also taught that the more times price bounces off of a support or resistance line, the stronger that line is.
The opposite is actually true. Think about what causes a supply or demand area. It is an excess of sellers or buyers at that price point. Every time price moves into that area, that excess of sellers or buyers is being used up until eventually they are gone and the price breaks through. When we look for areas to plot a zone, we look for areas where price has moved away quickly.
If price moved into the area quickly that is even better. Notice how price moved into and away from this zone quickly, indicating there is a strong excess of supply at that price point. Chances are extremely high that when price returns to the zone, the sellers will still be there. Next, we want to look at how many times price has tested that zone.
Your highest percentage trade is a fresh zone that has never been tested. When you plot a supply or demand zone, move to the left on your chart to see if the candle that created the zone is not actually a retest of a previous zone.
If it is, then it is not a fresh zone. I like to go back at least five years on my charts when I do this. We have a supply zone where price moved away quickly, but when price returned it actually broke through the zone.
If we look to the left of the bar that we used to define the zone, we see that this bar was actually the second time price returned to the zone. This appeared at first to be a strong supply zone but by looking a little further we see that it is not a fresh zone. Our high probability trades are the first time price returns to the zone. The following chart shows us the same zone with more information. The original supply zone was colored blue for clarity. This example is obvious, but many times we have to look a little harder to make sure it is not a retest of a previous zone.
This is extremely important because a fresh zone is always the strongest zone. Let us recap. When looking for a strong zone, we want to see price move quickly into the zone and quickly out of it, and we want to make sure the zone is a fresh zone, i. If the zone was created by a reversal in the trend of the price, then we also want to see the price remain in the zone a short amount of timethe shorter, the better.
If the zone was created by price trading sideways in a tight range followed by a break out, then three to six candles in the zone is acceptable. If, after reading this book, you decide to continue with your current strategy, then at least get these three concepts down.
If you follow these rules you will pay for the cost of this book many times over. Do not buy into supply. In other words, if there is a supply zone directly above your entry price, you must either wait until the price breaks through the zone or do not take the trade.
Do not sell into demand. If you are shorting a stock and there is a demand zone directly below your entry price, then either wait until the price breaks through the demand zone or do not take the trade.
Look for the nearest supply or demand zone, depending on whether you are going short or long, and set your stop a few pennies above the supply zone or a few pennies below the demand zone. If doing this creates too much risk, then do not take the trade.
Now would be a good time to take a break from reading this book and try plotting several supply and demand zones. Look for strong zones, and then look where price came back to that zone for the first time.
Do this on several different equities and several different time frames. You will begin to see the power of trading zones. Try plotting your zones on the last five losing trades you had and see if applying the concepts above would have kept you out of the trade. Spend at least one hour with this before returning to this book. Go on. I will be here when you get back.
Now that you understand what supply and demand zones are and how to plot them, it is time to look at how we use them in our trading. Like the title of this book suggests, by using supply and demand zones you do not need to use any technical indicators. Whether you are a long term investor, a swing trader, or a day trader, applying supply and demand strategies will make you a better trader. Long term investing If you are a long term investor, you will use a weekly chart.
Long term investors usually trade more on fundamentals than technical data, but by looking at where the long term supply and demand levels are you can find better entry prices and also know when it is appropriate to hedge your position to protect profits.
This is a weekly chart of Exxon Mobile. Let us say that you thought XOM was a good long term buy, and you bought somewhere around the point A. The area around point B formed a fresh demand zone, and the area around point C created a fresh supply zone. When price returned to the supply zone at point D, you now have a decision to make.
This is a strong supply zone, so chances are high that the price will drop from here. You could just sell your stock and lock in your gains, but if you are subject to paying capital gains tax you may not want to sell because you have not owned the stock long enough for the gains to be long term capital gains.
Page You could also buy a put contract that would protect your gains. The best option would be to buy a JAN 12 This will protect you up to the third Friday in January of If price broke through the top of the supply zone, you would sell your put for a small loss. This would now qualify as long term capital gains. If the only reason you would not want to sell your stock at point D is capital gains taxes, then you could sell a JAN The prices would be about the same, so you are basically getting your put for free or at a very low cost.
Options can be executed at any time, but it is unlikely they would be executed before the expiration date unless the price went up dramatically. If you bought back in around point E, you would repeat the same strategy at point F that you did at point D. At point G, you would close out your hedge position because of the strong demand zone formed a few weeks earlier. Point H is a major supply zone, and I would close all positions.
I would then wait for price to break through the top of the demand zone to re-enter the tradeassuming I still thought XOM was a good buy. Swing trading Swing traders would use a daily chart to look for trade setups. There are two basic swing trading strategies we can use by applying supply and demand principles. I am sure you have heard the phrase The trend is your friend. When you trade with the trend, you enter your trade on a retrace of the current trend. Many traders like to use moving averages or Bollinger bands to find their entry points.
By applying what we now know about supply and demand, we can use that knowledge to find our trade setups. For a short trade, we want to look for a bearish candle where the top wick is in a supply zone.
For a long trade, we are looking for a bullish candle where the bottom wick is in a demand zone. When trading this method, we do not necessarily care how strong the zone is, we just want to make sure a zone is there. Your stop should be a few pennies above the top of the supply zone for a short trade and a few pennies below the demand zone for a long trade.
The price then rapidly moves up into a supply zone, giving us a bearish candle. We would enter the trade after the formation of this candle, placing our stop a few pennies above the supply zone. Here are two long opportunities from the same demand zone. Note that the demand was a supply zone that turned into a demand zone when price broke through it. These trade setups are shown by the two green arrows.
It is important to note that not all retracements are going to be into an existing supply or demand zone, but the ones that do retrace into a zone are a higher probability trade and they allow us to define our stop price.
We can also trade against the trend. When trading against the prevailing trend, we are only looking for strong supply and demand zones. We enter the trade as close as possible to the bottom of a demand zone and as close as possible to the top of a supply zone. This gives us a higher reward to risk ratio because we are entering the trade closer to our stop price.
The following charts show examples of a long and a short trade using this strategy. The red and green arrows show where price moved into our supply and demand zones. We do not wait for a confirmation candleinstead, we just take the trade and set our stop a few pennies above the supply zone and a few pennies below the demand zone. Since our risk is determined by the difference between our entry price and our stop you can see that this strategy has a considerably higher reward to risk ratio.
This chart shows another short setup and also shows the price breaking through the supply zone. The supply zone is now a demand zone, and the next day, indicated by the green arrow, we had an extremely low risk, high reward trade at the bottom of the new demand zone. Day trading This is where trading with supply and demand zones gets really exciting. If you are currently day trading stocks or options, you will throw away your indicators after reading this.
The same principles apply to Forex and futures trading, but most people do not have the patience to wait for a good trade setup.
If you are currently day trading forex or futures, I would still encourage you to trade with supply and demand zones. Be sure to realize you may not get as many trade setups as you might receive using indicators.
Your trade setups will be higher quality setups, and you will make more money if you have the patience. First, I would like to talk about the differences I have in regards to day trading compared to what is being taught in most day trading courses. Most day traders will tell you to spread your risk out among several positions. I disagree with this. It is harder to manage multiple positions in a day trading environment.
There is nothing wrong with being in a few positions but no more than two or three at the same time. Only trade stocks with high average daily volume. This seems logical, but a stock that normally trades low volume can very easily trade several million shares on a day with news. You will miss out on a lot of quality trades by only monitoring stocks with high volume.
Only trade stocks with a price between twenty dollars and one hundred dollars. I cringe every time I hear this one. Only trade stocks with a high ATR. ATR, or average true range, is the average amount a stock moves in one day. Think about this for a minute. What you really want to look for is the average true range as a percentage of the stock price. Ok, now that I got that off of my chest, let us look at how we can apply our supply and demand knowledge to day trading.
You really need to start with more than that because if you lose money on your first trade, your account equity will drop below the minimum required. With the exception of liquid options with less than three days until expiration, I would highly recommend trading the stock and not the options when day trading.
Your brokerage firm will give you four times the available cash to trade with. This is based on the cash balance in your account at the start of each trading day. You can trade as many times as you want during the day, but Page Profits for the day do not count towards your buying power until the next day. When we day trade, we want to use daily charts for our entry, and hourly or even down to 5 minute charts for our exits. The reason we use daily charts for our entry is the zones will be a lot stronger.
When trading in this manner, we want to make sure they are strong zones and fresh zones, meaning price moved in and out of them quickly and they are not part of another zone. These zones have never been tested. Look at the following example. In the daily chart, you see a fresh zone formed on the left side of the yellow rectangle. Six days later, price moves back up into the zone. We see a bullish candle very close to the top of the zone on the five minute chart.
As the price started moving down, you would adjust your stop on every retrace. The horizontal red lines indicate where the stops would be moved to as the price went down. This trade resulted in a reward to risk ratio of almost Many times price is moving rapidly towards a zone, and it can be a little scary to enter the trade. You have probably heard the saying, Do not try to catch a falling knife.
0コメント