Herd Immunity

Herd immunity is a key component of public vaccination campaigns that keep everyone healthy and safe from preventable diseases.  538 did an article on this topic recently, and included a reference to FRED.

FRED is pretty interesting.  You can pick a location and view the impact of a Measles case over time.  With an 80% vaccination rate, measles cases soar.  With rates of >95%, though, a case doesn’t spread.  The importance of high vaccination rates is pretty clear.

Response to Hospitals Are Dramatically Overpaying for Their Technology

HBR had an article that’s stuck with me all week about interoperability standards in healthcare technologies. They give a poignant example of how interoperability affects the delivery of care.

For critically ill patients on breathing machines, a simple step drastically improves their survival chances by almost 10% — from 60% to 70%. It involves programming the machine to deliver enough life-sustaining breaths, but not so much that it damages their lungs by overinflating them. Given that this intervention could prevent more suffering than many wonder drugs, one would expect that there would be zero market for a breathing machine that didn’t make lung-preventive ventilation as easy as possible. But in health care, few things work as expected. Fewer than half of patients, and in some hospitals fewer than 20%, receive this life-saving intervention.

One big reason why is that hospitals purchase technologies without requiring that they communicate with each other. The optimal air flow is based on a straightforward calculation using the height of the patient. Height data, however, resides in the electronic medical record, which typically does not communicate with the ventilator. As a result, physicians must retrieve this information from the medical record, perform the calculation (sometimes on paper), and enter the order. A respiratory therapist then takes the order and types it into the ventilator, often relying on memory.

Their primary recommendation is to have hospitals use their purchasing power to force vendors to improve interoperability.  Which this is a laudable goal, working at a major academic medical center I can see the challenges with that approach that would need to be overcome.

Power (and by extension funding) is often very diffuse, spread between different management structures.  In a more corporate environment, purchasing can be empowered to negotiate deals that embed certain requirements.  In our environment, on the other hand, different equipment can be purchased through different mechanisms.  Some items may be funded by the institution.  Other equipment, though, may be acquired through government grants, non-profit and private donations, or research contracts with private industry.  Because the processes, rules and ownership vary depending on the funding source, leveraging procurement to force this kind of interoperability is a significant challenge.

The recommendation needs to be further developed to address this type of structural challenge.


BIAPA Notice: Now is the time to let our Senators know about the potential impact of cuts to Medicaid in the American Health Care Act

Below is a message from the Brain Injury Alliance of PA.  Please offer your support!

Action Alert:Now is the time to let our Senators know about the potential impact of cuts to Medicaid in the American Health Care Act

The American Health Care Act (ACHA) proposes significant cuts to Medicaid.  The proposed per capita caps and cuts will have serious consequences for individuals with disabilities and seniors.  The Senate is currently writing the bill, so this is the time to communicate with our Senators to educate them about the potential impact and what it means to you personally.

DC Rally:

BIAA is co-sponsoring a Don’t Cap My Care Rally on June 6th at 11:30 am with Senator Casey (PA), Senator Van Hollen (MD), Hon. Tony Coelho, and other members of Congress. The rally is at 1st St SE & Constitution, across from the Supreme Court.

This rally was organized on short notice, and we encourage you to attend if you’re in the DC area or able to travel there, but it’s not the only way for you to participate as a brain injury advocate on that day.

June 6 No Caps Call-in Day and Social Media Action:

June 6th will also be a national call-in day and day of social media action focused on opposing Medicaid caps. You can download the Day of Action toolkit, compiled by the Consortium of Citizens with Disabilities which BIAA is an active member of, with information about calling in and social media (primary hashtag #SaveMedicaid and secondary of #NoCutsNoCaps).

One more way to help: Share your story

Senator Casey, one of our senators from Pennsylvania, shared that his office is collecting stories of how individuals with disabilities lives have been improved because of Medicaid. If you would like to send your story to Senator Casey, please email it to healthcare@casey.senate.gov

As always, thank you for your advocacy efforts on behalf of individuals with brain injury and their families.  Your voice is important.

Beware the Bots

HBR had an article today about how bots will help us become better versions of ourselves.  My overarching questions reading through the article is, will the bots really make us “better” versions of ourselves or just drive us toward some sort of homogeneity?  The underlying bias in the article, especially around management behavior, is that there is some sort of platonic ideal that bots will help us achieve.  Is that really true?

Two HBR Articles: Perspectives on Gender in the Workplace

HBR a few weeks ago had two interesting articles on gender in the workplace.  The unconscious biases highlighted in the VC funding article were eye-opening to me given that this occurred in what I perceive as a progressive northern European country.  The second article is a nice reminder on silly sex segregation ideas that just don’t go away.

B1G Stadium Sizes

Given some of the comments I heard surrounding the Rutgers – Penn State game about the size of Rutgers stadium, I was curious to see how the stadium stacked up to the competition.  I knew the stadium would not be in the top half of the list, but I was pleased to see that 1) Rutgers was not in the bottom 3, and 2) that it won’t take much to get Rutgers up near the middle of the pack.  My expectation is that a solid few years in the B1G will go a long way toward getting Rutgers stadium over 60,000.  Which, knowing how loud folks from the NJ area can be, will make it sound like there are 120,000 are in there when big games are played.

Home TeamStadium NameSize
Michigan WolverinesMichigan Stadium109,901
Penn State Nittany LionsBeaver Stadium106,572
Ohio State BuckeyesOhio Stadium104,944
Nebraska CornhuskersMemorial Stadium87,091
Wisconsin BadgersCamp Randall Stadium80,321
Michigan State SpartansSpartan Stadium75,005
Iowa HawkeyesKinnick Stadium70,585
Purdue BoilermakersRoss–Ade Stadium62,500
Illinois Fighting IlliniMemorial Stadium60,670
Indiana HoosiersMemorial Stadium52,929
Rutgers Scarlet KnightsHigh Point Solutions Stadium52,454
Maryland TerrapinsByrd Stadium51,802
Minnesota Golden GophersTCF Bank Stadium50,805
Northwestern WildcatsRyan Field49,256

Source: Wikipedia

Connecting to an RDS instance in a VPC

Disclaimer: For those who don’t know what RDS and VPC stand for, this post is not for you.

I was working on a project recently where I was developing a Java app that connected to a mysql database. For simplicity sake, I had set up the database in RDS on AWS and wanted to connect from my local machine. I figure I could test the code locally, then push it out to an EC2 instance later.

The problem (security benefit?) is that by default RDS instances in a VPC are not publicly accessible. The RDS team implemented an option when you create your RDS instance via the console to enable this, but since I had created mine as part of a larger CloudFormation script, I was out of luck. I also tried checking the AWS Command Line Interface (CLI) toolkit, but again, that option had not yet been implemented there, either.

Some additional internet searching led me to the idea of using a ssh tunnel to connect to my RDS instance via my EC2 instance running in my VPC. Since my EC2 instance was accessible, I could connect to it from my local laptop. My confusion, however, was two-fold. First, where does the tunnel run? And second, what configuration items need to be put in place to make this work. Here is what I learned.

1. Make sure that as part of your CloudFormation script you open the port you want to use on EC2 so that it is accessible. I’m using port 3306, so I added this port to my EC2 security group in my CloudFormation script.

"MyEc2SecurityGroup": {
      "Type": "AWS::EC2::SecurityGroup",
      "Properties": {
        "VpcId": {
          "Ref": "VPCId"
        "GroupDescription": "Enable SSH and MySQL access",
        "SecurityGroupIngress": [
            "IpProtocol": "tcp",
            "FromPort": "22",
            "ToPort": "22",
            "CidrIp": {
              "Ref": "SSHLocation"
            "IpProtocol": "tcp",
            "FromPort": "3306",
            "ToPort": "3306",
            "CidrIp": {
              "Ref": "SSHLocation"

2. The ssh tunnel actually runs on YOUR computer, not on the EC2 instance. As someone relatively inexperienced with creating ssh tunnels, this was a surprise to me.

3. Thekeesh.com provided a useful tutorial that helped me get my ssh tunnel running. You will need to open up a command line prompt to run this command.

The key piece his article was missing was the need to include a link to the PEM keyfile. My command to launch the ssh tunnel instead looked more like this.

ssh -i <path to keyfile.pem> -N -L 3306:<rds dns entry name>:3306 <ec2 user id>@<ec2 ip address>

For example, my ssh tunnel command might look like this if I were using ubuntu linux on EC2

ssh -i /users/me/mykey.pem -N -L 3306:abcd1234.efgh5678.us-east-1.rds.amazonaws.com:3306 ubuntu@

4. In my Java app, my connection string actually uses the local loopback IP to connect to RDS.