Cost-effectiveness of alternative methods of surgical repair of inguinal hernia

Objectives: To assess the relative cost-effectiveness of laparoscopic methods of inguinal hernia repair compared with open flat mesh and open non-mesh repair. Methods: Data on the effectiveness of these alternatives came from three systematic reviews comparing: (i) laparoscopic methods with open flat mesh or non-mesh methods; (ii) open flat mesh with open non-mesh repair; and (iii) methods that used synthetic mesh to repair the hernia defect with those that did not. Data on costs were obtained from the authors of economic evaluations previously conducted alongside trials included in the reviews. A Markov model was used to model cost-effectiveness for a five-year period after the initial operation. The outcomes of the model were presented using a balance sheet approach and as cost per hernia recurrence avoided and cost per extra day at usual activities. Results: Open flat mesh was the most cost-effective method of preventing recurrences. Laparoscopic repair provided a shorter period of convalescence and less long-term pain compared with open flat mesh but was more costly. The mean incremental cost per additional day back at usual activities compared with open flat mesh was €38 and €80 for totally extraperitoneal and transabdominal preperitoneal repair, respectively. Conclusions: Laparoscopic repair is not cost-effective compared with open flat mesh repair in terms of cost per recurrence avoided. Decisions about the use of laparoscopic repair depend on whether the benefits (reduced pain and earlier return to usual activities) outweigh the extra costs and intraoperative risks. On the evidence presented here, these extra costs are unlikely to be offset by the short-term benefits of laparoscopic repair.Luke Vale, Adrian Grant, Kirsty McCormack, Neil W. Scott and the EU Hernia Trialists Collaboratio

Recent Revisions to PVWATTS

PVWATTS is an Internet-accessible software program that allows the user to easily calculate the energy production and cost savings for grid-connected photovoltaic (PV) systems located throughout the United States. To ensure that PVWATTS continues to meet its users' needs, an online survey form was provided to users to identify areas for improvement. The results of the survey were used to prioritize improvements to PVWATTS in FY2005. PVWATTS was revised by changing the PV system specification input for system size from an AC power rating to a nameplate DC power rating; adding an input for an overall DC to AC derate factor; updating the residential electric rates; adding monthly and yearly solar radiation values for the PV array; and simplifying the user interface for Version 2

Ward's Hierarchical Clustering Method: Clustering Criterion and Agglomerative Algorithm

The Ward error sum of squares hierarchical clustering method has been very widely used since its first description by Ward in a 1963 publication. It has also been generalized in various ways. However there are different interpretations in the literature and there are different implementations of the Ward agglomerative algorithm in commonly used software systems, including differing expressions of the agglomerative criterion. Our survey work and case studies will be useful for all those involved in developing software for data analysis using Ward's hierarchical clustering method.Comment: 20 pages, 21 citations, 4 figure

FastJet user manual

FastJet is a C++ package that provides a broad range of jet finding and analysis tools. It includes efficient native implementations of all widely used 2-to-1 sequential recombination jet algorithms for pp and e+e- collisions, as well as access to 3rd party jet algorithms through a plugin mechanism, including all currently used cone algorithms. FastJet also provides means to facilitate the manipulation of jet substructure, including some common boosted heavy-object taggers, as well as tools for estimation of pileup and underlying-event noise levels, determination of jet areas and subtraction or suppression of noise in jets.Comment: 69 pages. FastJet 3 is available from http://fastjet.fr

Autonomous clustering using rough set theory

This paper proposes a clustering technique that minimises the need for subjective human intervention and is based on elements of rough set theory. The proposed algorithm is unified in its approach to clustering and makes use of both local and global data properties to obtain clustering solutions. It handles single-type and mixed attribute data sets with ease and results from three data sets of single and mixed attribute types are used to illustrate the technique and establish its efficiency

New Circumspection of the Genus \u3ci\u3eGamochaeta\u3c/i\u3e (Asteraceae, Gnaphalieae) Inferred From Nuclear and Plastid DNA Sequences

Gamochaeta (tribe Gnaphalieae, Asteraceae) is composed of ca. 60 species primarily distributed in tropical and subtropical America. Within the tribe Gnaphalieae, the genus is characterized by capitula arranged in spikes or head-like clusters, few hermaphroditic central florets, truncate style branches with apical sweeping trichomes, pappus bristles connate at the base into a ring falling as a unit, and achenes with globose twin trichomes. Previous molecular phylogenetic studies have suggested the paraphyly of the genus, but have not provided a basis for redefining generic limits due to incomplete taxon sampling. To address this problem, DNA sequences from the plastid (trnL-F) and nuclear (ETS and ITS) genomes were analyzed from a broad taxon sample representing the full range of morphological variation known in the genus. Our results affirm that Gamochaeta is paraphyletic as presently circumscribed. Two clades can be recognized: one clade that includes the majority of the species currently assigned to Gamochaeta and a second clade that includes Gamochaetopsis, Stuckertiella and seven species of Gamochaeta. We present here a new circumscription of Gamochaeta, including two new combinations, Gamochaeta alpina and Gamochaeta peregrina, and the resurrection of Gamochaeta capitata. Our results also show Omalotheca supina, O. norvegica and O. sylvatica, which were placed by some authors in Gamochaeta or in Gnaphalium, form a monophyletic group distantly related to both genera