Comparative study on current trading system and online trading: the case of Ethiopia commodity exchange

The Ethiopia Commodity Exchange [ECX] is an organized market place that brings buyers and sellers to trade standardized contracts using its floor based trading system. The fundamental factors to establish successful commodity exchange includes having an efficient and robust trading platform. The focus of this research is to analyze the economic significance and limitations of the current trading system and assess the prospects and challenges of online trading and factors affecting its feasibility of implementation in ECX. The study used a mix of quantitative and qualitative research method to collect and analyze data relevant for the study. Questionnaire and in-depth interview were used to gather relevant data for the study. The study collected data from 375 members and clients out of which 279 are found to be good for analysis. In-depth interview was conducted with experts. Descriptive statistics was used to analyze the data. The study found that there is significant capacity problem with major skills gap with traders. The current system has its own significance in balancing the power of negotiation of traders by disseminating reliable data, and limitations in lack of market integrity, poor price discovery mechanisms and limitations in session and ticket writing times. It also found that there is good perception towards online trading system. Moreover, the exchange expects transparency, greater market oversight, market integrity and more commodities by deploying online trading system and challenges mainly infrastructural problems, and capacity of traders. Based on the findings, the paper recommends deploying an integrated surveillance system, reasonable allocation of session time, awareness on rules, in-depth training of staff and traders and building a redundant system were recommended for both trading systems accordingly.Keywords: Ethiopia Commodity Exchange [ECX], Floor Based Trading, Online Tradin

CryoPlasty therapy of the superficial femoral and popliteal arteries: A reappraisal after 44 months' experience

ObjectivesLong-term patency remains a significant hurdle in the minimally invasive treatment of arteriosclerosis in the superficial femoral (SFA) and popliteal arteries. CryoPlasty therapy (PolarCath, Boston Scientific Corp, Natick, Mass) is a novel approach designed to significantly reduce injury, elastic recoil, neointimal hyperplasia, and constrictive remodeling. The technique combines the dilatation forces of percutaneous transluminal angioplasty (PTA) with cold thermal energy applied to the plaque and vessel wall. We previously reported a technical success rate of 96% and a 12-month freedom from restenosis rate of 82.2%. However, a review of the original cohort supplemented by experience with a further 47 lesions has demonstrated less desirable results.MethodsFrom December 2003 through July 2007, 92 lesions in 64 consecutive patients were treated and followed up for a median of 16 months with statistically significant follow-up at 24 months.ResultsThe immediate technical success rate was 88%. Nine stents were immediately required after unsuccessful CryoPlasty (9.8%) five of which were as a result of a dissection. No unanticipated adverse events occurred, specifically, no thrombus, acute occlusions, distal embolizations, aneurysms, or groin complications. Vascular calcification was responsible for technical failure in six of the 11 immediately unsuccessful procedures. Freedom from restenosis for successfully treated lesions was 57% and 49% at 12 and 24 months, respectively. CryoPlasty of heavily calcified lesions, vein graft lesions, and in-stent stenosis faired poorly. Excluding these lesions from analysis would have resulted in an immediate success of 94% (81 of 86) and freedom from restenosis of 61% and 52% at 12 and 24 months, respectively. However, on an intention-to-treat basis, freedom from restenosis was 47% and 38% at 12 and 24 months, and CryoPlasty added approximately $1700 to the cost of each procedure.ConclusionAnalysis of this expanded, longer-term data suggests that our earlier, smaller study provided an overly optimistic appraisal of the benefits of CryoPlasty. It is possible that a larger analysis might have identified a subset of patients or lesions that would benefit from CryoPlasty, but considering the additional cost, we no longer use this technique in our practice

Contralateral carotid artery occlusion is not a contraindication to carotid endarterectomy even if shunts are not routinely used

ObjectiveAlthough controversial, carotid artery stenting (CAS) has been proposed as being safer than carotid endarterectomy (CEA) for patients with a contralateral internal carotid occlusion (CCO). Arguably, with a CCO, CAS should be even safer than CEA if a shunt is not used. Accordingly, we reviewed our experience with 2183 CEAs performed routinely without a shunt to evaluate the risk of CEA performed in a subset of 147 patients with a CCO.MethodsBetween 1988 and 2011, 147 CEAs (111 men [75%], 36 women [25%]) were routinely performed without a shunt despite CCO. Of these patients, 76% were asymptomatic. CEAs were performed by seven surgeons using standard techniques (not eversion), with patients under general anesthesia and blood pressure maintained at >130 mm Hg. All patients received heparin (7500 U), and protamine reversal was routine. Median cross-clamp time was 20 minutes (range, 14-40 minutes).ResultsThree neurologic events occurred ≤30 days (2.0%). One transient ischemic attack (TIA) occurred immediately, and one occurred on the first postoperative day due to occlusion of the endarterectomy site. One patient sustained an immediate stroke and died of a large computed tomography-documented atheroembolic shower.ConclusionsOur data demonstrate the safety of CEA in the presence of a CCO, even when performed without a shunt. It is unlikely that the stroke or delayed TIA could be attributed to nonshunting or CCO. Even if so, the stroke and death rates would be lower than those previously reported for patients undergoing CEA in the presence of a CCO. This may be due to short cross-clamp times, careful technique, general anesthesia, and blood pressure support. Given these low adverse event rates, our experience refutes the assumption that patients with a CCO are at such a high risk for CEA that the only alternative is CAS

Treatment utilization and outcomes in elderly patients with locally advanced esophageal carcinoma: A review of the National Cancer Database

For elderly patients with locally advanced esophageal cancer, therapeutic approaches and outcomes in a modern cohort are not well characterized. Patients ≥70 years old with clinical stage II and III esophageal cancer diagnosed between 1998 and 2012 were identified from the National Cancer Database and stratified based on treatment type. Variables associated with treatment utilization were evaluated using logistic regression and survival evaluated using Cox proportional hazards analysis. Propensity matching (1:1) was performed to help account for selection bias. A total of 21,593 patients were identified. Median and maximum ages were 77 and 90, respectively. Treatment included palliative therapy (24.3%), chemoradiation (37.1%), trimodality therapy (10.0%), esophagectomy alone (5.6%), or no therapy (12.9%). Age ≥80 (OR 0.73), female gender (OR 0.81), Charlson-Deyo comorbidity score ≥2 (OR 0.82), and high-volume centers (OR 0.83) were associated with a decreased likelihood of palliative therapy versus no treatment. Age ≥80 (OR 0.79) and Clinical Stage III (OR 0.33) were associated with a decreased likelihood, while adenocarcinoma histology (OR 1.33) and nonacademic cancer centers (OR 3.9), an increased likelihood of esophagectomy alone compared to definitive chemoradiation. Age ≥80 (OR 0.15), female gender (OR 0.80), and non-Caucasian race (OR 0.63) were associated with a decreased likelihood, while adenocarcinoma histology (OR 2.10) and high-volume centers (OR 2.34), an increased likelihood of trimodality therapy compared to definitive chemoradiation. Each treatment type demonstrated improved survival compared to no therapy: palliative treatment (HR 0.49) to trimodality therapy (HR 0.25) with significance between all groups. Any therapy, including palliative care, was associated with improved survival; however, subsets of elderly patients with locally advanced esophageal cancer are less likely to receive aggressive therapy. Care should be taken to not unnecessarily deprive these individuals of treatment that may improve survival

Paecilomyces lilacinus Vaginitis in an Immunocompetent Patient

Paecilomyces lilacinus, an environmental mold found in soil and vegetation, rarely causes human infection. We report the first case of P. lilacinus isolated from a vaginal culture in a patient with vaginitis

Acute complications of percutaneous transluminal coronary angioplasty for total occlusion

The incidence of major complications after percutaneous coronary angioplasty (PTCA) of a totally occluded artery was assessed retrospectively. A total of 1649 PTCA procedures were analyzed. After exclusion of procedures for acute myocardial infarction or total occlusion that resulted from restenosis, 90 patients wer

Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

Abstract Background Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Methods Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS) to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR), and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The process and experiences described provide a model for development of other DSSs that translate written guidelines into actionable, real-time clinical recommendations.http://deepblue.lib.umich.edu/bitstream/2027.42/78267/1/1748-5908-5-26.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/2/1748-5908-5-26.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/3/1748-5908-5-26-S3.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/4/1748-5908-5-26-S2.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/5/1748-5908-5-26-S1.TIFFPeer Reviewe

First radial velocity results from the MINiature Exoplanet Radial Velocity Array (MINERVA)

The MINiature Exoplanet Radial Velocity Array (MINERVA) is a dedicated observatory of four 0.7m robotic telescopes fiber-fed to a KiwiSpec spectrograph. The MINERVA mission is to discover super-Earths in the habitable zones of nearby stars. This can be accomplished with MINERVA's unique combination of high precision and high cadence over long time periods. In this work, we detail changes to the MINERVA facility that have occurred since our previous paper. We then describe MINERVA's robotic control software, the process by which we perform 1D spectral extraction, and our forward modeling Doppler pipeline. In the process of improving our forward modeling procedure, we found that our spectrograph's intrinsic instrumental profile is stable for at least nine months. Because of that, we characterized our instrumental profile with a time-independent, cubic spline function based on the profile in the cross dispersion direction, with which we achieved a radial velocity precision similar to using a conventional "sum-of-Gaussians" instrumental profile: 1.8 m s$^{-1}$ over 1.5 months on the RV standard star HD 122064. Therefore, we conclude that the instrumental profile need not be perfectly accurate as long as it is stable. In addition, we observed 51 Peg and our results are consistent with the literature, confirming our spectrograph and Doppler pipeline are producing accurate and precise radial velocities.Comment: 22 pages, 9 figures, submitted to PASP, Peer-Reviewed and Accepte