Healthcare.gov statistics: lines of code.

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Java        13,481  419,643    847,982  2,399,683
HTML         1,635   50,124     16,845    515,494
Javascript   1,631   56,298    102,140    322,192
XSD          5,227    1,238     20,945    156,696
XML            659    6,436     13,073    136,827
CSS            205   14,000      9,420    109,815
Maven          275      737      1,421     47,449
XSLT           383    2,357      1,476     21,624
Bourne Shell   248    2,305      1,446      8,830
SQL             28      860        139      8,487
JavaServer Face 35      766          0      3,770
DOS Batch       48      235        118        849
Ant              8       77         45        810
Perl            18      161         45        646
Visualforce Com 39        0          0        626
Groovy           4       68         15        361
Python           5       55         90        263
Visual Basic     1        3          0         25
DTD              1        8          0         17
JSP              3        0          0         13
ASP.Net          1        0          0         11

TOTALS        23,935  555,371  1,015,200  3,734,488

Source: Reddit post by agenaille.

Aloha Friday: Kimo Henderson Hula

Raiatea sings a song written by famous kapuna Helen Beamer about Hilo philanthropist James Henderson.

Kimo Hula - Words & music by Helen D. Beamer
Aia i ka u ka o Pi`ihonua Ke kîhâpai pua ulumâhiehie I laila au la `ike i ka nani O nâ pua `ala a he nui wale Ho`ohihi nâ manu o ke kuahiwi Nâ `i`iwi maka pôlena I ka `ono i ka wai o nâ pua O Moanike`ala i ka uluwehiwehi Mahalo `iâ `oe e ka hoa aloha I ka ho`okipa e nâ malihini Eia kô lei poina `ole O Leimakani lei onaona Ha`ina `ia mai ana ka puana Moanike`ala i ka uluwehiwehi Hea aku mâkou e ô mai `oe Kimo o ka uka `iu `iu he inoa		In the uplands of Pi`ihonua A flower garden in beautiful arrayThere I see the beautyOf the fragrant flowers in great profusion The birds of the forest are attracted hereThe yellow eyed `i`iwi At the sweet nectar of the flowers Of Moanike`ala's beautiful gardens Thank you dear friendFor gracious hospitality to visitors Here is your unforgettable, belovedLeimakani, a lei so fragrant The story is toldMoanike`ala, beautifully verdant We call, you answerJim of the highlands, your name-song
Source: Songs of Helen Desha Beamer, Copyright 1953 Harriett Beamer Magoon - Composed for James Kimo Henderson, "James of the Highlands" a poetic reference to Scotland, his birthplace. Moanike`ala was the name of the Henderson home in Pi`ihonua, above Hilo. Leimakani was Kimo Henderson's wife.

David Lewis (1976) on Triviality: Reflections on the Triviality Theorem

In 1976, David Lewis proved that iIf we say that belief in a proposition  X -> Y is defined as the amount of credence in Y given X, so that:

P(X -> Y) = P(Y|X)

...what follows is that the likelihood that X -> Y cannot mean what we think it means.

Lewis showed that since the chance that Y given X is defined as P(Y|X) =  P( X & Y) / P(X), we have

P(X -> Y) = P(X & Y) / P(X).

Lewis showed, unfortunately, that this cannot fit our ideas of what tht likelihood X -> Y means, because he was able to derive

P( X -> Y ) = P(Y) from the above.

Interestingly, we can also use this theorem to derive the following:

If P( X -> Y) = P(Y)       by Lewis’ theorem

then P(X->Y) P(X) = P(Y) P(X).

but P(X->Y) P(X) = P(Y|X) (P(X) = ( P(X & Y) / P(X) ) P(X) by substitution of the above, so

P(X->Y) P(X) = P(X)P(Y) = P(X & Y)

So Lewis’s theorem implies that

P( Y & X ) = P(X)P(Y).

This is interesting, since it implies that

(1) P(X -> Y) = P(Y|X), iff P( X & Y) = P(X)P(Y).

But if we look at the mathematics of probability,  (1) is true only if X and y are fully independent variables. This suggests that the problem with defining P(X->Y) as P(Y|X) is that it fails to capture the causal dependence of Y on X that we often expect in the real world when we say that A implies B. If fact, such causal dependence is EXCLUDED by the above.

So the probability that X -> Y cannot in general possibly resemble “the probability of Y given X” unless X and Y are NOT causally associated.

In other words, P( X -> Y ) can be properly expressed by P(Y|X) iff X and Y are causally unrelated.

------------------------------------------------

Reference:

• Lewis, D. (1976) “Probability of Conditionals and Conditional Probabilities”, Philosophical Review, 85: 297-315; reprinted in Harper et al. (eds.) (1981) Ifs, Dordrecht: D. Reidel.

The CGRP Receptor and Migraine: New Treatments

Episodic migraine has long been theorized to occur via a cascading pathway which has at its center release of substances from the trigeminal gangion, which sits at the base of the skull. Just which substances released from that ganglion was chiefly causative of the headache was poorly understood until the past 10 years, when evidence has been increasing regarding the major role of calcitonin gene-related peptide (CGRP), a 37 amino acid length peptide structurally related to the hormone calcitonin. Unlike calcitonin, CGRP has little effect on calcium metabolism Instead, it appears to play a role in signaling for pain and inflammation in many areas of the body, but especially in the head. The trigeminal ganglion is well supplied with CGRP secreting ability. Both triptans like suratriptan and neurotoxins like botulinim toxins inhibit CGRP release from the trigeminal gangion, which suggests a way in which these agents help migraine.

At the AAN meeting this past week in Philadelphia, two similar monoclonal antibodies against CGRP were announced to have migraine prevention ability. Such antibodies are likely binding CGRP before it can bind to pain and inflammation promoting sites. Although both of these medications will be expensive to make and be given by injection, they point the way to a future new class of medication agents for persons with headache.

=========================================

AAN PRESENTATION (May 2,2014)

Speaker: David Dodick, MD

Title: CGRP Monoclonal Antibody LY2951742 for the Prevention of Migraine: A Phase 2, Randomized, Double-Blind, Placebo-Controlled Study

Brief Talk Description: The rationale, study design, results and conclusion of a recent phase II study evaluating the efficacy and tolerability of a novel anti-CGRP monoclonal antibody for the prevention of migraine.

Biographical Information: David W. Dodick, MD, FRCP (C), FACP, is Professor of Neurology at the Mayo Clinic College of Medicine and a consultant in neurology at the Mayo Clinic, in Phoenix, Arizona. He is the Program Director of the Mayo Clinic Neurology Residency Program and Headache Medicine Fellowship Program....[etc]

---------------------------------------------------------

ABSTRACT

Abstract Title: Randomized, Double-blind, Placebo-controlled Trial of ALD403, an Anti-CGRP Peptide Antibody in the Prevention of Frequent Episodic Migraine

Authors: Peter Goadsby; David Dodick; Stephen Silberstein; Richard Lipton; Jes Olesen; Messoud Ashina; Kerri Wilks; David Kudrow; Robin Kroll; Bruce Kohrman; Robert Bargar; Joe Woodinville; Jeff Smith

Objective: To evaluate the efficacy and safety of ALD403, a genetically engineered humanized anti-CGRP antibody (IgG1), for migraine prevention.

Background: Calcitonin gene-related peptide (CGRP) is crucially involved in the pathophysiology of migraine.

Design/Methods: Patients with 5 to 14 migraine days per month were randomized to receive a single intravenous dose of ALD403 1000 mg or placebo in a double-blind fashion. The primary endpoint was the mean change in frequency of migraine days from baseline to migraine days during weeks 5-8. Patients were followed for 24 weeks for additional safety and efficacy analyses

Results: Of 174 patients randomized, 163 patients received either ALD403 (81) or placebo (82). There were no significant differences in baseline demographics or characteristics between the two treatment groups. The mean change in migraine days between weeks 5-8 and baseline was -5.6 days (66% decrease) for ALD403 vs. -4.6 days (52% decrease) for placebo (one-sided p = 0.03). The proportion of patients with a 50%, 75%, and 100% reduction in migraine days at 12 weeks for ALD403 and placebo was 60% vs 33% (p < 0.001); 32% vs 9% (p < 0.001); and 16% vs 0% (p < 0.001), respectively. There were no differences in the type or frequency of adverse events, vital signs, or laboratory safety data between the two treatment groups.

Conclusions: A single intravenous dose of ALD403 1000 mg demonstrated efficacy for the preventive treatment of migraine in patients with a high monthly frequency of migraine days. ALD403 was generally safe and well tolerated. These results support the conduct of larger randomized, placebo-controlled studies and may potentially represent a new era in disease-specific and mechanism-based preventive therapy for migraine.

Aloha Friday: Hilo Hanakahi

Hilo Hanakahi I ka ua Kanilehua   Puna paia ʻala I ka paia ʻala i ka hala   Kaʻū i ka makani I ka makani puwehuwehu   Kona i ke kai I ke kai māʻokiʻoki   Kawaihae i ke kai I ke kai hāwanawana   Kohala i ka makani I ka makani ʻĀpaʻapaʻa   Waimea i ka ua I ka ua Kīpuʻupuʻu Hāmākua i ka pali I ka pali l koaʻe Haʻina ka puana I ka ua kani lehua

Hilo of Hanakahi Where the rain is in the lehua forest   Puna of the fragrant bowers Fragrant with the blossoms of the hala   Kaʻū , a windy district Wind that scatters the dust   Kona, land of calm seas Sea marked with sea lanes   Kawaihae has a sea A sea that whispers   Kohala has a wind A gusty wind   Waimea has the rain A cold pelting rain   Hāmākua cliffs Cliffs where the bird soars   This is the end of my song Of the rain in the lehua forest

From http://www.huapala.org/ Source: King's Songs of Hawai`i - Verse 1, stanza 1, Hanakahi was an ancient beloved chief of the Hilo district and is still honored by his association with Hilo. Stanza 2, Kanilehua is the name of the rain in that district. Verse 4, stanza 2, the sea off the Kona coast has various colored stripes when viewed from the slopes above, sometimes referred to as sea lanes. Verse 6, stanza 2, ʻĀpaʻapaʻa is the name of the wind of that district. Verse 7, stanza 2, the name of the wind in that district is Kīpuʻupuʻu. Copyright 1938 Charles E. King.

Control of Lifestyle Risk Factors Lowers Mortality After Stroke

Many patients who suffer stroke, even minor stroke, enter a period of depression or have feelings of helplessness and hopelessness. This may result in a decreased motivation or willingness to make changes to avoid further vascular disease.

A study reported this week at the AAN meeting suggests that managing at least 4 of 7 changes after a stroke is life-preserving:

1. Not smoking

2. Regular physical activity (exercise)

3. Eating a healthy diet

4. Maintaining normal weight

5. Controlling serum cholesterol (LDL)

6. Keeping blood pressure normal

7. Keeping blood glucose levels under control.

Note that even though points 5, 6, and 7 might require medications, the first 4 can be often be manged without any additional medications.

================

ABSTRACT

M Lin, D Markovic, B Ovbiagele, A Towfighi

The association between meeting Life's Simple 7 goals and mortality after stroke in the US

Summary: Individuals who met a greater number of the Life's Simple 7 cardiovascular health metrics as put forth by the American Heart Association had a lower all-cause mortality after stroke in an inverse dose-dependent fashion. Results from this study suggest that interventions specifically targeting these 7 factors--not smoking, regular physical activity, eating a healthy diet, maintaining normal weight, and controlling serum cholesterol, blood pressure, and blood glucose levels--could have a profound impact on long-term outcomes after stroke.

Methods:

Researchers conducted this study to determine the association between cardiovascular health metric scores and all-cause mortality after stroke.

They assessed all-cause mortality among a nationally representative sample of US adults (≥18 years) with self-reported stroke (n=649), from participation in NHANES in 1988-1994 through mortality assessment in 2006.

They also assessed the adherence of participants to the AHA's Life's Simple 7, which ranged from 0 to 7, and calculated adjusted survival curves for cumulative all-cause mortality by the cardiovascular health metrics under the Cox proportional hazards model after adjustment for socio-demographic factors and trend tests for difference in mortality risk across health metric score under this model.

Results:

Less than 1% of all stroke survivors met all 7 ideal health metrics.

Over a median duration of 98 months (range 53-159), researchers observed a dose-dependent relationship between number of ideal lifestyle metrics met and 10-year adjusted mortality: 0-1: 57%; 2: 48%; 3: 43%; 4: 36%, and ≥5: 30%.

Those who met ≥4 health metrics had significantly lower mortality rates than those who met 0-1 (HR 0.51; 95% CI 0.28-0.92).

After adjusting for socio-demographics (age, sex, race, income, and education), higher health metrics score was associated with reduced risk of all-cause mortality (trend P-value: 0.022).