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TECHNOLOGY ASSESSMENT, BIOMEDICAL --- TECHNOLOGY ASSESSMENT, BIOMEDICAL

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Technology Assessment, Biomedical --- trends.

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Approximately 15 percent of Norwegian women are Rhesus D (RhD)-negative. During pregnancy and birth, there is a danger that these women produce antibodies against fetal blood cells (alloimmunization), if the fetus is RhD-positive. These antibodies may cross the placenta and cause hemolytic disease of the fetus, which may become life threatening. Today, all RhD-negative pregnant women are closely followed-up during pregnancy, and the newborns are routinely tested for RhD-type at birth. Upon detection of an RhD-positive child, the mother will get anti-D prophylaxis within 72 hours after birth to prevent the formation of anti-D antibodies that may cause problems in subsequent pregnancies. Alloimmunization may occur throughout the whole pregnancy, especially during the last trimester. Therefore, in the Guidance for obstetrics 2014 published by the Norwegian Gynecological Association, it is recommended that anti-D prophylaxis should be offered RhD-negative women also during pregnancy, if they carry an RhD-positive fetus. With a blood sample from the pregnant woman, it can be tested whether the fetus is RhD-negative or -positive. The technology is based on analysis of free fetal DNA present in the woman's blood during pregnancy, and is often referred to as non-invasive prenatal testing (NIPT). The result of NIPT can be used to provide targeted prophylactic treatment to the pregnant women who can benefit from it, and to avoid unnecessary treatment of pregnant women with RhD negative fetuses. In this report, we summarize research studies on diagnostic accuracy of NIPT, as well as clinical effectiveness and health economic and ethical consequences of introducing NIPT for fetal RhD typing in all RhD-negative pregnant women. The main findings are: Diagnostic accuracy1. It is likely that NIPT gives a very accurate RhD typing of the fetus. The documentation is of high quality. Clinical effectiveness1. We identified no systematic reviews on clinical effectiveness of introducing NIPT for fetal RhD typing in all RhD-negative pregnant women. Health economic evaluation1. Introduction of a program with NIPT-guided anti-D prophylaxis will give an additional cost of approximately 4 million Norwegian kroner per year. The cost per avoided RhD-alloimmunization is approximately 106,000 Norwegian kroner. These numbers are based on effectiveness data from a Swedish cohort study. Ethics1. NIPT is an ethically controversial technology. NIPT for RhD typing, when used after the legal time limit for abortion has passed, avoids many of the ethical issues, but alternative or extended applications may be ethically challenging.

Globulins. --- Technology Assessment, Biomedical.

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Ce petit ouvrage s'adresse à tous les curieux de l'intelligence artificielle (IA). C'est une introduction au sujet, volontairement brève, aussi élémentaire que possible, afin d'être accessible au plus grand nombre. Elle est écrite par un groupe de spécialistes reconnus. Tout ceci en fait un livre unique en son genre ayant l'ambition de couvrir l'intelligence artificielle dans tous ses aspects et dans toute sa diversité. Il comporte un historique, une présentation des concepts clés de l'IA; il décrit les grands domaines où l'IA est à l'œuvre, les interactions de l'IA avec les autres disciplines, et répond à des questions que l'on se pose souvent à propos de l'IA. Un glossaire des termes techniques employés, et un choix de références le complètent.

Artificial Intelligence --- Technology Assessment, Biomedical

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Economics, Medical. --- Technology Assessment, Biomedical.