The cost-effectiveness of providing antenatal lifestyle advice for women who are overweight or obese: the LIMIT randomised trial

BACKGROUND: Overweight and obesity during pregnancy is common, although robust evidence about the economic implications of providing an antenatal dietary and lifestyle intervention for women who are overweight or obese is lacking. We conducted a health economic evaluation in parallel with the LIMIT randomised trial. Women with a singleton pregnancy, between 10(+0)-20(+0) weeks, and BMI ≥25 kg/m(2) were randomised to Lifestyle Advice (a comprehensive antenatal dietary and lifestyle intervention) or Standard Care. The economic evaluation took the perspective of the health care system and its patients, and compared costs encountered from the additional use of resources from time of randomisation until six weeks postpartum. Increments in health outcomes for both the woman and infant were considered in the cost-effectiveness analysis. Mean costs and effects in the treatment groups allocated at randomisation were compared, and incremental cost effectiveness ratios (ICERs) and confidence intervals (95%) calculated. Bootstrapping was used to confirm the estimated confidence intervals, and to generate acceptability curves representing the probability of the intervention being cost-effective at alternative monetary equivalent values for the outcomes avoiding high infant birth weight, and respiratory distress syndrome. Analyses utilised intention to treat principles. RESULTS: Overall, the increase in mean costs associated with providing the intervention was offset by savings associated with improved immediate neonatal outcomes, rendering the intervention cost neutral (Lifestyle Advice Group $11261.19±$14573.97 versus Standard Care Group $11306.70±$14562.02; p=0.094). Using a monetary value of $20,000 as a threshold value for avoiding an additional infant with birth weight above 4 kg, the probability that the antenatal intervention is cost-effective is 0.85, which increases to 0.95 when the threshold monetary value increases to$45,000. CONCLUSIONS: Providing an antenatal dietary and lifestyle intervention for pregnant women who are overweight or obese is not associated with increased costs or cost savings, but is associated with a high probability of cost effectiveness. Ongoing participant follow-up into childhood is required to determine the medium to long-term impact of the observed, short-term endpoints, to more accurately estimate the value of the intervention on risk of obesity, and associated costs and health outcomes. TRIALS REGISTRATION: Australian and New Zealand Clinical Trials Registry (ACTRN12607000161426).Jodie M Dodd, Sharmina Ahmed, Jonathan Karnon, Wendy Umberger, Andrea R Deussen, Thach Tran, Rosalie M Grivell, Caroline A Crowther, Deborah Turnbull, Andrew J McPhee, Gary Wittert, Julie A Owens, Jeffrey S Robinson and For the LIMIT Randomised Trial Grou

An estimation of exponential sums associated with sextic polynomial

We have completed a 350 MHz Drift-scan Survey using the Robert C. Byrd Green Bank Telescope with the goal of finding new radio pulsars, especially millisecond pulsars that can be timed to high precision. This survey covered ~10,300 deg2 and all of the data have now been fully processed. We have discovered a total of 31 new pulsars, 7 of which are recycled pulsars. A companion paper by Boyles et al. describes the survey strategy, sky coverage, and instrumental setup, and presents timing solutions for the first 13 pulsars. Here we describe the data analysis pipeline, survey sensitivity, and follow-up observations of new pulsars, and present timing solutions for 10 other pulsars. We highlight several sources—two interesting nulling pulsars, an isolated millisecond pulsar with a measurement of proper motion, and a partially recycled pulsar, PSR J0348+0432, which has a white dwarf companion in a relativistic orbit. PSR J0348+0432 will enable unprecedented tests of theories of gravity

The Green Bank Telescope 350 MHz Drift-scan survey. I: Survey Observations and the Discovery of 13 Pulsars

Over the summer of 2007, we obtained 1191 hr of "drift-scan" pulsar search observations with the Green Bank Telescope at a radio frequency of 350 MHz. Here we describe the survey setup, search procedure, and the discovery and follow-up timing of 13 pulsars. Among the new discoveries, one (PSR J1623-0841) was discovered only through its single pulses, two (PSRs J1327-0755 and J1737-0814) are millisecond pulsars, and another (PSR J2222-0137) is a mildly recycled pulsar. PSR J1327-0755 is a 2.7 ms pulsar at a dispersion measure (DM) of 27.9 pc cm-3 in an 8.7 day orbit with a minimum companion mass of 0.22 M ☉. PSR J1737-0814 is a 4.2 ms pulsar at a DM of 55.3 pc cm-3 in a 79.3 day orbit with a minimum companion mass of 0.06 M ☉. PSR J2222-0137 is a 32.8 ms pulsar at a very low DM of 3.27 pc cm-3 in a 2.4 day orbit with a minimum companion mass of 1.11 M ☉. It is most likely a white-dwarf-neutron-star system or an unusual low-eccentricity double neutron star system. Ten other pulsars discovered in this survey are reported in the companion paper Lynch et al