document_title: Left- and right-hand traffic

question_text: when did france change to driving on the right

text: Left- and right-hand traffic

text: History[edit]

text: Ancient Greek, Egyptian, and Roman troops kept to the left when marching.[7] In 1998, archaeologists found a well-preserved double track leading to a Roman quarry near Swindon, in southern England. The grooves in the road on the left side (viewed facing down the track away from the quarry) were much deeper than those on the right side, suggesting LHT, at least at this location, since carts would exit the quarry heavily loaded, and enter it empty.[8]

text: The first reference in English law to an order for LHT was in 1756, with regard to London Bridge.[9]

text: Some historians, such as C. Northcote Parkinson, believed that ancient travellers on horseback or on foot generally kept to the left, since most people were right-handed. If two men riding on horseback were to start a fight, each would edge toward the left.[7] In the year 1300, Pope Boniface VIII directed pilgrims to keep left.[7]

text: In the late 1700s, traffic in the United States was RHT based on teamsters' use of large freight wagons pulled by several pairs of horses. The wagons had no driver's seat, so the (typically right-handed) postilion held his whip in his right hand and thus sat on the left rear horse. Seated on the left, the driver preferred that other wagons pass him on the left so that he could be sure to keep clear of the wheels of oncoming wagons.[10]

text: In France, traditionally foot traffic had kept right, while carriage traffic kept left. Following the French Revolution, all traffic kept right.[9] Following the Napoleonic Wars, the French imposed RHT on parts of Europe.[citation needed] During the colonial period, RHT was introduced by the French in New France, French West Africa, the Maghreb, French Indochina, the West Indies, French Guiana and the Réunion, among others.

text: Meanwhile, LHT was introduced by the British in parts of Canada (Atlantic Canada and British Columbia), Australia, New Zealand, the East Africa Protectorate (now Kenya, Tanzania and Uganda), British India, Rhodesia and the Cape Colony (now Zambia, Zimbabwe and South Africa), British Malaya (now Malaysia, Brunei and Singapore), British Guiana, and British Hong Kong. LHT was also introduced by the Portuguese Empire in Portuguese Macau, Colonial Brazil, Portuguese Timor, Portuguese Mozambique, and Portuguese Angola.

text: The first keep-right law for driving in the United States was passed in 1792 and applied to the Philadelphia and Lancaster Turnpike.[11] New York formalized RHT in 1804, New Jersey in 1813 and Massachusetts in 1821.[12]

text: In the early 1900s some countries including Canada, Spain, and Brazil had different rules in different parts of the country. During the 1900s many countries standardised within their jurisdictions, and changed from LHT to RHT, mostly to conform with regional custom. Currently nearly all countries use one side or the other throughout their entire territory. Most exceptions are due to historical considerations and/or involve islands with no road connection to the main part of a country. China is RHT except the Special Administrative Regions of China of Hong Kong and Macau. The United States is RHT except the United States Virgin Islands.[13] The United Kingdom is LHT, but its overseas territories of Gibraltar and British Indian Ocean Territory are RHT.

text: Changing sides[edit]

text: Europe[edit]

text: Influential in Europe was the 1920 Paris Convention, which advised driving on the right-hand side of the road, in order to harmonise traffic across a continent with many borders. This was despite the fact that left-hand traffic was still widespread: in 1915 for example, LHT was introduced everywhere in the Austro-Hungarian Empire.[14] However, three years later the Empire was split up into several countries, and they all changed eventually to RHT, notably including when Nazi Germany introduced RHT with almost immediate effect in Czechoslovakia in 1938-39.[15]

text: Sweden was LHT from about 1734 to 1967,[16] despite having land borders with RHT countries, and approximately 90 percent of cars being left-hand drive (LHD) vehicles.[17] A referendum was held in 1955, with an overwhelming majority voting against a change to RHT. Nevertheless, some years later the government ordered a conversion, which took place at 5 am on Sunday, 3 September 1967. The accident rate dropped sharply after the change,[18] but soon rose back to near its original level.[19] The day was known as Dagen H ("H-Day"), the 'H' being for Högertrafik ("right traffic"). When Iceland switched the following year, it was known as H-dagurinn, again meaning "H-Day".[20]

text: In the late 1960s, the UK Department for Transport considered switching to RHT, but declared it unsafe and too costly for such a built-up nation.[21] Road building standards, for motorways in particular, allow asymmetrically designed road junctions, where merge and diverge lanes differ in length.[22]

text: Today, four countries in Europe continue to use left-hand traffic, all island nations: the UK, Cyprus, Ireland, and Malta. The unrecognized Turkish Republic of Northern Cyprus continued to drive on the left after separating from the south in 1974.

text: Asia and the Pacific[edit]

text: Nationalist China adopted RHT in 1946. This convention was preserved when the CCP took the mainland and the KMT retreated to Taiwan. Hong Kong and Macau continue to be LHT.

text: Both North Korea and South Korea switched to RHT in September 1945 after liberation from Japan which was defeated and surrendered by the Allies.

text: Myanmar switched to RHT in 1970.[23]

text: Samoa, a former German colony, had been RHT for more than a century. It switched to LHT in 2009,[24] being the first territory in almost 30 years to switch.[25] The move was legislated in 2008 to allow Samoans to use cheaper right-hand drive (RHD) vehicles--which are better suited for left-hand traffic--imported from Australia, New Zealand or Japan, and to harmonise with other South Pacific nations. A political party, The People's Party, was formed to try to protest against the change, a protest group which launched a legal challenge,[26] and an estimated 18,000 people attending demonstrations against it.[27] The motor industry was also opposed, as 14,000 of Samoa's 18,000 vehicles are designed for RHT and the government has refused to meet the cost of conversion.[25] After months of preparation, the switch from right to left happened in an atmosphere of national celebration. There were no reported incidents.[2] At 05:50 local time, Monday 7 September, a radio announcement halted traffic, and an announcement at 6:00 ordered traffic to switch to LHT.[24] The change coincided with more restrictive enforcement of speeding and seat-belt laws.[28] That day and the following day were declared public holidays, to reduce traffic.[29] The change included a three-day ban on alcohol sales, while police mounted dozens of checkpoints, warning drivers to drive slowly.[2]

text: The Philippines was mostly LHT during its Spanish[30] and American colonial periods,[31][32] as well as during the Commonwealth era.[33] During the Japanese occupation the Philippines remained LHT,[34] also because LHT had been required by the Japanese;[35] but during the Battle of Manila the liberating American forces drove their tanks to the right for easier facilitation of movement. RHT was formally finalised by Executive Order No. 34 signed by President Sergio Osmeña on 10 March 1945.[36]

text: Africa[edit]

text: A number of non-contiguous former British colonies in West Africa originally drove LHT and switched to RHT in the early 1970s to match the surrounding countries. Sierra Leone switched to RHT in 1971, Nigeria in 1972 and Ghana in 1974. Before this period The Gambia, a country entirely contained within RHT Senegal, had officially switched to RHT in 1965.[37]

text: Rwanda, a former Belgian colony in central Africa, is RHT but is considering switching to LHT, to bring the country in line with other members of the East African Community (EAC).[38] A survey, carried out in 2009, indicated that 54% of Rwandans were in favour of the switch. Reasons cited were the perceived lower costs of RHD vehicles as opposed to LHD versions of the same model, easier maintenance and the political benefit of harmonisation of traffic regulations with other EAC countries. The same survey also indicated that RHD cars are 16 to 49 per cent cheaper than their LHD equivalents.[39] In 2014 an internal report from consultants to the Ministry of Infrastructure recommended a switch to LHT.[40] In 2015, the ban on RHD vehicles was lifted; RHD trucks from neighbouring countries cost $1000 less than LHD models imported from Europe.[41][42]

text: Safety[edit]

text: In one study, researchers concluded that left-hand traffic may be safer for elderly drivers,[43] since humans are more commonly right-eye dominant than left-eye dominant.[44] Comparing accident statistics between countries operating either LHT or RHT, Leeming concluded that LHT is superior.[45] However, Watson has criticised the small sample size and dismisses the notion.[3]

text: Changing sides at borders[edit]

text: Although many LHT jurisdictions are on islands, there are cases where vehicles may be driven from LHT across a border into a RHT area. The Vienna Convention on Road Traffic regulates the use of foreign registered vehicles in the 74 countries that have ratified it.

text: LHT Thailand has three RHT neighbors: Cambodia, Laos, Myanmar. Most of its borders use a simple traffic light to do the switch, but there are also interchanges which enable the switch while keeping up a continuous flow of traffic.[46]

text: There are four road border crossing points between Hong Kong and Mainland China. In 2006, the daily average number of vehicle trips recorded at Lok Ma Chau was 31,100.[47] The next largest is Man Kam To, where there is no changeover system and the border roads on the mainland side Wenjindu intersect as one-way streets with a main road.

text: The Takutu River Bridge (which links LHT Guyana and RHT Brazil[48]) is the only border in the Americas where traffic changes sides.

text: Although the United Kingdom is separated from Continental Europe by the English Channel, the level of cross-Channel traffic is very high; the Channel Tunnel alone carries 3.5 million vehicles per year, by rail, between the UK and France.

text: Road vehicle configurations[edit]

text: Driver seating position[edit]

text: In RHT jurisdictions, vehicles are configured with LHD, with the driver sitting on the left side. In LHT jurisdictions, the reverse is true. The driver's side, the side closest to the centre of the road, is sometimes called the offside, while the passenger side, the side closest to the side of the road, is sometimes called the nearside.[49]

text: Historically there was less consistency in the relationship of the position of the driver to the handedness of traffic. Most American cars produced before 1910 were RHD.[11] In 1908 Henry Ford standardised the Model T as LHD in RHT America,[11] arguing that with RHD and RHT, the passenger was obliged to "get out on the street side and walk around the car" and that with steering from the left, the driver "is able to see even the wheels of the other car and easily avoids danger."[50] By 1915 other manufacturers followed Ford's lead, due to the popularity of the Model T.[11]

text: In specialised cases, the driver will sit on the nearside, or kerbside. Examples include:

text:
Where the driver needs a good view of the nearside, e.g. street sweepers, or vehicles driven along unstable road edges.[51]
Where it is more convenient for the driver to be on the nearside, e.g. delivery vehicles. The Grumman LLV postal delivery truck is widely used with RHD configurations in RHT North America. Some Unimogs are designed to switch between LHD and RHD to permit operators to work on the more convenient side of the truck.

text: Generally, the convention is to mount a motorcycle on the left,[52] and kickstands are usually on the left[53] which makes it more convenient to mount on the safer kerbside[53] as is the case in LHT. Some jurisdictions prohibit fitting a sidecar to a motorcycle's offside.[54][55]

text: Headlamps and other lighting equipment[edit]

text: Most low-beam headlamps produce an asymmetrical light suitable for use on only one side of the road. Low beam headlamps in LHT jurisdictions throw most of their light forward-leftward; those for RHT throw most of their light forward-rightward, thus illuminating obstacles and road signs while minimising glare for oncoming traffic.

text: In Europe, headlamps approved for use on one side of the road must be adaptable to produce adequate illumination with controlled glare for temporarily driving on the other side of the road,[56]:p.13 ¶5.8. This may be achieved by affixing masking strips or prismatic lenses to a part of the lens or by moving all or part of the headlamp optic so all or part of the beam is shifted or the asymmetrical portion is occluded.[56]:p.13 ¶5.8.1 Some varieties of the projector-type headlamp can be fully adjusted to produce a proper LHT or RHT beam by shifting a lever or other movable element in or on the lamp assembly.[56]:p.12 ¶5.4 Some vehicles adjust the headlamps automatically when the car's GPS detects that the vehicle has moved from LHT to RHT and vice versa.[citation needed]

text: Because blackout strips and adhesive prismatic lenses reduce the safety performance of the headlamps, most countries require all vehicles registered or used on a permanent or semi-permanent basis within the country to be equipped with headlamps designed for the correct traffic-handedness.[citation needed]

text: Without sidecars attached, motorcycles, motor scooters, mopeds, and bicycles are almost symmetric with their handlebars in the centre. However, motorcycles are often equipped with automotive-type asymmetrical-beam headlamps that likewise require adjustments or replacement when brought into a country with opposite traffic-handedness.[citation needed]

text: Rear fog lamps[edit]

text: In the European Union, vehicles must be equipped with one or two red rear fog lamps. A single rear fog lamp must be located between the vehicle's longitudinal centreline and the outer extent of the driver's side of the vehicle.[57]

text: Crash testing differences[edit]

text: An Australian news source reports that some RHD cars imported to that country didn't perform as well on crash tests as the LHD versions, although the cause is unknown, and may be due to differences in testing methodology.[58]

text: Worldwide distribution by country[edit]

text: Of the 193 countries currently recognised by the United Nations (and the unrecognised Palestine), 140 use RHT and 54 use LHT. A country and its territories and dependencies is counted once.

text:
Country
Road traffic
Road switched sides
Multi-track rail traffic generally
Notes

Afghanistan
RHT

RHT/LHT
Was LHT until the 1950s, in line with neighbouring British Raj and later Pakistan.[59]

Albania
RHT[60]

RHT

Algeria
RHT[60]

RHT

Andorra
RHT[60]

Angola
RHT[60]
1928

Antigua and Barbuda
LHT[60]

Former British colony.

Argentina
RHT
1945
10 June

LHT
The anniversary on 10 June is still observed each year as Día de la Seguridad Vial (road safety day).[61]
The Premetro and Metrotranvía Mendoza use RHT.

Armenia
RHT[60]

RHT

Australia
LHT[62]

LHT
Commonwealth. Includes Christmas Island, Cocos Islands, Norfolk Island

Austria
RHT
1921–1938
RHT[63]
Originally LHT, like most of former Austria-Hungary. Switched sides in 1921 in Vorarlberg, 1930 in North Tyrol, 1935 in Carinthia and East Tyrol, and in 1938 in the rest of the country.

Azerbaijan
RHT[60]

RHT

Bahamas
LHT[60]

In Bahamas LHD vehicles are common due to the import of used cars from the United States.[64][65]

Bahrain
RHT
1967

Former British protectorate. Switched to same side as neighbours.[66]

Bangladesh
LHT[60]

LHT

Barbados
LHT

Belgium
RHT[60]
1899
LHT
The Brussels Metro is nominally RHT, with LHT on the circle line west of Halle Gate. This was done to enable unidirectional vehicles to use island platforms.

Belarus
RHT[60]

RHT

Belize
RHT
1961[1]

Former British colony. Switched to same side as neighbours.

Benin
RHT[60]

Bhutan
LHT[60]

Under British protection before 1949.

Bolivia
RHT[60]

Bosnia and Herzegovina
RHT[60]
1918
RHT[67]
Switched sides after the collapse of Austria-Hungary.

Botswana
LHT[60]

Brazil
RHT
1928[60]
RHT
A Portuguese colony until the early 19th century as LHT and retained it at least partially following independence, switched some states still on LHT to RHT in 1928, the same year as Portugal.[68][69] While some areas in present-day Brazil formerly belonged to Bolivia were already in RHT.

Brunei
LHT[60]

Bulgaria
RHT[60]

RHT

Burkina Faso
RHT[60]

Burundi
RHT

Considering switching to LHT[70] in line with neighbours Tanzania, Kenya and Uganda.

Cambodia
RHT

RHT implemented while part of French Indochina. RHD cars, many of which were smuggled from Thailand, were banned from 2001, even though they accounted for 80% of vehicles in the country.[71]

Cameroon
RHT[60]
1961

Canada
RHT
1920s
RHT
Territories now in Canada have always been RHT, except British Columbia, which changed to RHT in stages from 1920 to 1923,[72][73] and New Brunswick, Nova Scotia, and Prince Edward Island which changed in 1922, 1923, and 1924 respectively.[74] Newfoundland and Labrador changed to RHT in 1947 while still a dominion of the British Empire, two years before joining Canada.[75]

Cape Verde
RHT[60]
1928

Central African Republic
RHT[60]

Chad
RHT[60]

Chile
RHT[60]
1920s
LHT
The Santiago Metro uses RHT.

China
RHT
1946
RHT/LHT
At one time, northern provinces were RHT due to American influence, while southern provinces were LHT due to British influence. LHT was uniform in the 1930s. Hong Kong and Macau are all on LHT due to their colonial heritage. Most metro systems use RHT, except for the Hong Kong MTR and the Macau LRT.

Colombia
RHT[60]

RHT

Comoros
RHT[60]

Congo
RHT[60]

Democratic Republic of Congo
RHT[60]

Costa Rica
RHT[60]

Côte d'Ivoire
RHT[60]

Croatia
RHT[60]

RHT
Istria and Dalmatia were RHT, while Croatia-Slavonia was LHT when Croatia was part of Austria-Hungary[76]. The LHT regions switched to RHT on joining the Kingdom of Yugoslavia.

Cuba
RHT[60]

Cyprus
LHT[60]

Former British colony.

Czech Republic
RHT[60]
1939
RHT
Was LHT, like most of former Austria-Hungary, switched during the German occupation of Czechoslovakia.

Denmark
RHT

RHT[77]
Includes Faroe Islands and Greenland

Djibouti
RHT[60]

Dominica
LHT[60]

Former British colony.

Dominican Republic
RHT[60]

East Timor
LHT
1976

Originally LHT, like its colonial power Portugal. Switched to RHT with Portugal in 1928.[1] Under the Indonesian occupation of East Timor, changed back to LHT in 1976.

Ecuador
RHT[60]

LHT
The Quito Metro and Cuenca tram system will use RHT.

Egypt
RHT[60]

LHT
Road vehicles are RHT due to French influence, but railway system was built by British companies.

El Salvador
RHT[60]

Equatorial Guinea
RHT[60]

Eritrea
RHT[60]
1964

Estonia
RHT[60]

RHT

Ethiopia
RHT[60]
1964
LHT
The Addis Ababa Light Rail uses RHT.

Fiji
LHT

Finland
RHT
1858
RHT/LHT
Formerly ruled as part of LHT Sweden, switched to RHT as the Grand Duchy of Finland by Russian decree.[78] Most of the Helsinki commuter rail lines use LHT, but the Helsinki Metro uses RHT.

France
RHT
1792
LHT[79]/RHT
Includes French Polynesia, New Caledonia, Saint Pierre and Miquelon, Wallis and Futuna, French Guiana, Réunion, Saint Barthélemy, Collectivity of Saint Martin, Guadeloupe, Mayotte.
Railways in Alsace and Moselle use RHT as a former part of German Empire. CDGVAL uses RHT. Most metro systems use RHT, except for the Lyon Metro.

Gabon
RHT[60]

Gambia
RHT
1965[37]

Georgia
RHT[60]

RHT
About 40% vehicles in Georgia are RHD due to the low cost of used cars imported from Japan[80]. The Batumi Ropeway uses LHT.

Germany
RHT[81]

RHT

Ghana
RHT
1974[82]

Former British colony. When changing to RHT, a Twi language slogan was "Nifa, Nifa Enan" or "Right, Right, Fourth".[83]

Greece
RHT[60]

RHT

Grenada
LHT[60]

Guatemala
RHT[60]

Guinea
RHT[60]

Guinea-Bissau
RHT[60]
1928

Guyana
LHT[60]

Haiti
RHT[60]

Honduras
RHT[60]

Hong Kong
LHT[60]

Former British Colony.

Hungary
RHT[60]
1941
RHT
Originally LHT, like most of Austria-Hungary.

Iceland
RHT
1968

The day of the switch was known as H-dagurinn. Most passenger cars were already LHD.

Iran
RHT[60]

RHT

Iraq
RHT[60]

LHT

India
LHT[60]

LHT
Former British colony.

Indonesia
LHT[62]

RHT[84]
Roads were built by British, but railways are RHT due to Netherlands influence. The Jakarta MRT will also use RHT.

Ireland
LHT[60]

LHT
Part of the United Kingdom until 1922.

Israel
RHT[60]

LHT
The Jerusalem Light Rail uses RHT.

Italy
RHT
1920s
LHT
Until 1927 the countryside was RHT while cities were LHT.[85] Rome changed to RHT in 1924 and Milan in 1926. Alfa Romeo and Lancia did not produce LHD cars until as late as 1950 and 1953 respectively, as many drivers favoured the RHD layout even in RHT as this offered the driver a clearer view of the edge of the road in mountainous regions at a time when many such roads lacked barriers or walls.[86]
The metro systems in Brescia, Genoa, Milan, and Turin use RHT, as well as all tram systems.

Jamaica
LHT[60]

Japan
LHT[87]

LHT/RHT
Post-World War II Okinawa was ruled by the United States Civil Administration of the Ryukyu Islands and was RHT. It was returned to Japan in 1972 but did not convert back to LHT until 1978.[88] The conversion operation was known as 730 (Nana-San-Maru, which means Nana(7)-San(3)-Maru(0)). Okinawa is one of few places to have changed from RHT to LHT in the late 20th century. The Hakone Ropeway uses RHT. Also then has been several geared RHT vehicles, imported from North American and Europe including muscle cars, luxury cars, performance cars and sport cars. It begin to starts selling all cars and unveiled at car shows instead using the LHTs importers by country, currently it uses as a mixture between LHTs and RHTs in Japan.

Jordan
RHT[60]

RHT, despite the Mandate for Palestine and the Transjordan memorandum being under British rule till 1946.

Kazakhstan
RHT[60]

RHT

Kenya
LHT[89]

British colony until 1963.

Kiribati
LHT[60]

North Korea
RHT
1946
LHT/RHT
Korea had been LHT because of the influence of Japan in the 1900s. Switched to RHT under Soviet and American occupation after 1945.
The metro system in Pyongyang uses a mixture of RHT and LHT.

South Korea
RHT
1946
LHT/RHT
Korea had been LHT because of the influence of Japan in the 1900s. Switched to RHT under Soviet and American occupation after 1945.
Most metro systems in South Korea use RHT (exceptions include lines 1 and 4 of the Seoul Metropolitan Subway, the Bundang Line, and the Shinbundang Line).

Kuwait
RHT[60]

Kyrgyzstan
RHT

RHT
Former part of RHT Soviet Union. In 2012, over 20,000 cheaper used RHD cars were imported from Japan.[90]

Laos
RHT[60]

LHT
RHT implemented while part of French Indochina.

Latvia
RHT[60]

RHT

Lebanon
RHT[60]

Former French mandate.

Lesotho
LHT[60]

Liberia
RHT[60]

Libya
RHT[60]

Liechtenstein
RHT[60]

RHT

Lithuania
RHT[60]

RHT

Luxembourg
RHT[60]

RHT

Macedonia
RHT[60]

RHT

Madagascar
RHT[60]

Malawi
LHT[60]

Malaysia
LHT[60]

LHT
Former British colony.

Maldives
LHT[60]

Mali
RHT[60]

Malta
LHT[60]

British colony until 1964.

Marshall Islands
RHT[60]

Mauritania
RHT

Mining roads between Fdérik and Zouérat are LHT.[91]

Mauritius
LHT[60]

Former British colony. Island nation.

Mexico
RHT[60]

RHT

Micronesia
RHT[60]

Moldova
RHT[60]

RHT

Monaco
RHT[60]

LHT

Mongolia
RHT[60]

RHT

Montenegro
RHT[60]

RHT

Morocco
RHT[60]

RHT

Mozambique
LHT[92]

LHT

Myanmar
RHT
1970
LHT
Much of infrastructure still geared to LHT, most cars are pre-owned RHD vehicles, imported from Japan.[93]

Netherlands
RHT
1906[94]
RHT
Rotterdam was LHT until 1917.[95] Includes Curaçao, Sint Maarten, and Aruba

Namibia
LHT
1918

RHT as a German colony. After South Africa occupied German South-West Africa during World War I, switched to LHT.[1] South-West Africa was made a South African mandate by the League of Nations, and the new rule of the road was established in law.[96]

Nauru
LHT[60]
1918

Nepal
LHT[97]

New Zealand
LHT[62]

LHT
Includes territories Niue and Cook Islands

Nicaragua
RHT[60]

Niger
RHT[60]

Nigeria
RHT
1972[98]
LHT
Former British colony. Switched to RHT as it is surrounded by former French RHT colonies.

Norway
RHT[60]

RHT

Oman
RHT

Not a party to the Vienna Convention on Road Traffic and bans all foreign-registered RHD vehicles.[99]

Palau
RHT[60]

RHT

Palestine
RHT[60]

Pakistan
LHT[60]

LHT
Was part of undivided India

Panama
RHT
1943[100]
RHT

Papua New Guinea
LHT[60]

Paraguay
RHT
1945[101]

Peru
RHT[60]

LHT

Philippines
RHT
1946[36]
RHT
Was LHT during the Spanish and American colonial periods. Switched to RHT during Battle of Manila in 1945.

Poland
RHT

RHT
Partitions of Poland belonging to the German Empire and the Russian Empire were RHT. Partitions that were part of Austria-Hungary were LHT and changed to RHT in the 1920s.[102]

Portugal
RHT[62]
1928
LHT
Colonies Goa, Macau and Mozambique, which had land borders with LHT countries, did not switch and continue to drive on the left.[92] The Porto Metro uses RHT.

Qatar
RHT[60]

Romania
RHT[60]

RHT
Transylvania was LHT like most of former Austria-Hungary, while Wallachia and Moldavia were already RHT.

Russia
RHT[60]

RHT
In the Russian Far East RHD vehicles are common due to the import of used cars from nearby Japan.[103] Railway between Moscow and Ryazan is LHT. Sormovskaya line in Nizhny Novgorod Metro also uses LHT.

Rwanda
RHT[70]

Former Belgian mandate. Considering switching to LHT[70][104] like its neighbours Tanzania, Kenya and Uganda.

Saint Kitts and Nevis
LHT

Former British colony.

Saint Lucia
LHT

Former British colony.

Saint Vincent and the Grenadines
LHT

Former British colony.

Samoa
LHT
2009

Switched to LHT to allow the import of cars more cheaply from Australia, New Zealand and Japan.[62]

San Marino
RHT[60]

São Tomé and Príncipe
RHT[60]
1928

Saudi Arabia
RHT[60]

LHT
The Makkah Metro and the Riyadh Metro use RHT.

Senegal
RHT[60]

Serbia
RHT[60]

RHT
Vojvodina was LHT while part of Austria-Hungary.

Seychelles
LHT[60]

Sierra Leone
RHT
1971[105]

Importation of RHD vehicles was banned in 2013.[106]

Singapore
LHT[60]

LHT
Former British colony.

Slovakia
RHT[60]
1939–41
RHT
Was LHT like most of former Austria-Hungary. Switched to RHT when it became a client state of Nazi Germany.

Slovenia
RHT[60]

LHT
Was LHT like most of Austria-Hungary. Switched to RHT to unite with Croatia-Slavonia, Dalmatia, Bosnia and Herzegovina, Serbia and Montenegro to form with Kingdom of Serbs, Croats and Slovenes.

Solomon Islands
LHT[60]

Somalia
RHT
1968[107]

South Africa
LHT[108][109]

LHT
Former British colony.

South Sudan
RHT
1973

Was LHT during the period of British colonial rule. Split from Sudan in 2011 after the majority of the population voted for independence.

Spain
RHT
1924
RHT
Up to the 1920s Barcelona was RHT, and Madrid was LHT until 1924. The Madrid and Bilbao metro systems use LHT.[110]

Sri Lanka
LHT[60]

LHT
Former British colony.

Sudan
RHT[60]
1973

Former British colony.

Suriname
LHT[60]

Swaziland
LHT[60]

Sweden
RHT[60]
1967
3 September

LHT
The day of the switch was known as Dagen H. Most passenger cars were already LHD. The tram systems in Gothenburg (except for a short part), Norrköping and Stockholm are RHT.[111] The railways in Malmö use RHT due to the connection to Denmark.

Switzerland
RHT[60]

LHT
The tram system in Zurich and the Lausanne Metro use RHT.

Syria
RHT[60]

Taiwan
RHT
1946
LHT
Was LHT during the period of Japanese rule. The government of the Republic of China changed Taiwan to RHT in 1946 along with the rest of China.[112] Most metro systems use RHT.

Tajikistan
RHT[60]

RHT

Tanzania
LHT[60]

Thailand
LHT[62]

LHT
One of the few LHT countries not a former British colony. Shares long land border with RHT Laos and Cambodia.

Togo
RHT[60]

Tonga
LHT[60]

Trinidad and Tobago
LHT[113]

Former British colony.

Tunisia
RHT[60]

LHT
French RHT was enforced in the French protectorate of Tunisia from 1881.

Turkey
RHT[60]

RHT

Turkmenistan
RHT[60]

RHT

Tuvalu
LHT[60]

Uganda
LHT[60]

Ukraine
RHT
1922[102]
RHT
West Ukraine was LHT, like most of former Austria-Hungary. Carpathian Ruthenia remained LHT as part of Czechoslovakia before switching in 1941 as part of Hungary. The rest of Ukraine, having been part of the Russian Empire, already drove on the right.
Some sections of Kryvyi Rih Metrotram use LHT due to tramcars have doors only on right side, which makes it impossible to use RHT at stations with island platforms.[114]

United Arab Emirates
RHT[60]

RHT

United Kingdom
LHT
(Mainland UK)
RHT
(Gibraltar, British Indian Ocean Territory)
1929
(in Gibraltar)
LHT
Includes Crown Dependencies and Overseas Territories Isle of Man, Guernsey, Jersey, Anguilla, Bermuda, British Virgin Islands, Cayman Islands, Falkland Islands, Montserrat, Pitcairn Islands, Turks and Caicos Islands, Saint Helena, Ascension, Tristan da Cunha are all LHT. Gibraltar has been RHT since 1929 because of its land border with Spain.[115] The British Indian Ocean Territory is the only other overseas territory driving on the right. The Channel Islands (Jersey and Guernsey) drove on the right under German occupation until their liberation in 1945.[116] The Falkland Islands similarly drove on the right during their occupation by Argentina in 1982.[117] The PRT system at London Heathrow Airport Terminal 5 uses RHT. On the London Underground, there are three sections where RHT is used: a section of the Central line between East Acton and Shepherd's Bush, a section of the Victoria line between Highbury & Islington station and Oxford Circus, and a section of the Jubilee line in the vicinity of the Baker Street station.

United States
RHT
LHT
(U.S. Virgin Islands)

RHT/LHT[118]
Includes American Samoa, Guam, Northern Mariana Islands, Puerto Rico. U.S. Virgin Islands is LHT, like much of the Caribbean.

Uruguay
RHT
1945[119]
LHT
Became LHT in 1918, but as in some other countries in South America, changed to RHT on 2 September 1945.[119] A speed limit of 30 km/h (19 mph) was observed until 30 September for safety.

Uzbekistan
RHT[60]

RHT

Vanuatu
RHT[120]

Venezuela
RHT[60]

LHT
The Caracas Metro uses RHT.

Vietnam
RHT[60]

LHT
Became RHT as French Indochina.

Yemen
RHT
1977[1]

South Yemen, formerly the British colony of Aden, changed to RHT in 1977. A series of postage stamps commemorating the event was issued.[121] North Yemen was already RHT.

Zambia
LHT[60]

Zimbabwe
LHT

LHT
Former British colony. In 2010 the government attempted to ban LHD vehicles.[122]

text: Traffic rules[edit]

text:
Manoeuvre
LHT
RHT

Unless overtaking stay on the
left
right

In roundabouts traffic rotates
clockwise
anti-clockwise

Oncoming traffic is seen coming from the
right
left

Traffic must cross oncoming traffic when turning
right
left

Most traffic signs are on the
left
right

Pedestrians crossing a two-way road look first for traffic from their
right
left

Dual carriageway ramps are on the
left
right

After stopping at a red light it may be legal to turn
left
right

text: Rail traffic[edit]

text: Several states in Europe have RHT for roads but LHT for trains. France has mainly LHT for trains, except in Alsace-Lorraine, an eastern French territory which belonged to Germany for much of its history.

text: Gallery[edit]

text:
Gibraltar has been RHT (since 1929)

A sign reminding motorists to keep left in Australia

Vehicles entering and leaving Macau cross over each other at the Lotus Bridge.

Sign reminding motorists to drive on the left in Ireland


document_title: Aortic valve replacement

question_text: during valve replacement surgery a valve that comes from an animal is known as

root

text: Aortic valve replacement

text: Medical uses[edit]

text: As risk of aortic valve surgery has decreased and long term data on the survival and quality of life of people after valve replacement has become available, evidence-based guidelines for aortic valve replacement have been developed.  The American Heart Association and American College of Cardiology Guidelines for the Management of Patients with Valvular Heart Disease are a widely accepted source of information for cardiologists and surgeons.[1]

tag: p

text: Aortic stenosis[edit]

text: Patients with severe aortic stenosis, where the aortic valve is narrowed and blood flow from the heart is obstructed are candidates for surgery when they develop symptoms or when the heart function is impacted.  Certain asymptomatic patients may also be candidates for surgery, especially if exercise stress testing is positive.

text: Aortic insufficiency[edit]

text: Patients with leaky aortic valves (aortic insufficiency) often tolerate even severe degrees of insufficiency for a relatively long time before symptoms develop.  Surgery is indicated for symptoms such as shortness of breath, and in cases where the heart has begun to enlarge (dilate) from pumping the increased volume of blood that leaks back through the valve.

text: Types of valves[edit]

text: There are two basic types of artificial heart valve: mechanical valves and tissue valves.

text: Tissue valves[edit]

text: Tissue heart valves are usually made from animal tissue, either animal heart valve tissue or animal pericardial tissue. The tissue is treated to prevent rejection and calcification.

text: There are alternatives to animal tissue valves. In some cases a homograft - a human aortic valve—can be implanted.  Homograft valves are donated by patients and recovered after the patient dies. The durability of homograft valves is comparable to porcine and bovine tissue valves.[citation needed] Another procedure for aortic valve replacement is the Ross procedure (or pulmonary autograft). In a Ross procedure, the aortic valve is removed and replaced with the patient's own pulmonary valve. A pulmonary homograft (pulmonary valve taken from a cadaver) is then used to replace the patient's own pulmonary valve.  This procedure was first used in 1967 and is used primarily in children, as the procedure allows the patient's own pulmonary valve (now in the aortic position) to grow with the child.

text: Mechanical valves[edit]

text: Mechanical valves are designed to outlast the patient, and have typically been stress-tested to last several hundred years.  Although mechanical valves are long-lasting and generally present a one-surgery solution, there is an increased risk of blood clots forming with mechanical valves. As a result, mechanical valve recipients must take anticoagulant (blood thinning) drugs such as warfarin for the rest of their lives, making the patient more prone to bleeding.  The sound of mechanical valves may be heard and decrease the quality of life.[2]

text: Valve selection[edit]

text:
Tissue valves tend to wear out faster with increased flow demands - such as with a more active (typically younger) person. Tissue valves are increasing lasting longer - now typically approximately 20 years, but they might wear out faster in younger people.[3]
When a tissue valve wears out and needs replacement, the person must undergo another valve replacement surgery. For this reason, younger patients often receive mechanical valves to prevent the increased risk (and inconvenience) of another valve replacement.[citation needed]

text: Surgical procedure[edit]

text: Aortic valve replacement is most frequently done through a median sternotomy, meaning the incision is made by cutting through the sternum. Once the pericardium has been opened, the patient is put on a cardiopulmonary bypass machine, also known as the heart-lung machine. This machine takes over the task of breathing for the patient and pumping their blood around while the surgeon replaces the heart valve.

text: Once the patient is on bypass, a cut is made in the aorta and a crossclamp applied. The surgeon then removes the patient's diseased aortic valve and a mechanical or tissue valve is put in its place. Once the valve is in place and the aorta has been closed, the patient is taken off the heart-lung machine. Transesophageal echocardiogram (TEE, an ultra-sound of the heart done through the esophagus) can be used to verify that the new valve is functioning properly. Pacing wires are usually put in place, so that the heart can be manually paced should any complications arise after surgery. Drainage tubes are also inserted to drain fluids from the chest and pericardium following surgery. These are usually removed within 36 hours while the pacing wires are generally left in place until right before the patient is discharged from the hospital.

text: Hospital stay and recovery time[edit]

text: After aortic valve replacement, the patient will frequently stay in an intensive care unit for 12–36 hours.  The patient is often able to go home after this, in about four days, unless complications arise. Common complications include heart block, which typically requires the permanent insertion of a cardiac pacemaker.

text: Recovery from aortic valve replacement will take about three months, if the patient is in good health. Patients are advised not to do any heavy lifting for 4–6 months after surgery, to avoid damage to the sternum (the breast bone).

text: Outcomes[edit]

text: The risk of death or serious complications from aortic valve replacement is typically quoted as being between 1-3%, depending on the health and age of the patient[4]. Older patients, as well as those who are frail and/or have multiple comorbidities (i.e. other health problems), may face significantly higher surgical risk.

text: Minimally invasive surgery[edit]

text: More recently, some cardiac surgeons have been performing aortic valve replacement procedures using an approach referred to as minimally invasive cardiac surgery (MICS), in which the surgeon replaces the valve through small incisions between two and four inches in length using specialized surgical instruments rather than by cutting a six to ten-inch incision down the center of the sternum. MICS typically involves shorter recovery time and more attractive cosmetic results.[5]

text: Another promising alternative for many high risk and older patients is transcatheter aortic valve replacement (TAVR), which delivers a new valve to the site of the diseased valve through a catheter.[6] The replacement valve is collapsed and packaged in a way similar to a stent. Once in place it is expanded, pushing the old valve’s leaflets out of the way, and functions in place of the old valve. The catheter may be inserted through the femoral artery or through a small incision in the chest and then through a large artery or the tip of the left ventricle.[7]

text: Guidelines suggest TAVR for most patients over 75 and surgical replacement for most patients less than 75.[8] Ultimately, the best treatment choice is a decision based on many individual factors.[8][9]

text: History[edit]

text: Early surgical approaches to aortic valve disease were limited by the necessity of operating with the heart beating.  In the 1950s the Hufnagel valve was implanted in the descending thoracic aorta in patients with aortic insufficiency.  The first successful replacement of the aortic valve was reported in 1960 by Harken, and early adoption of this technique proceeded slowly based on the limitations of available replacement valves and relatively primitive techniques for protecting the heart during surgery which were available at the time.  With the evolution of mechanical heart valves and gradual developments in cardiopulmonary bypass (the heart lung machine) and cardioplegia which allow the heart to be stopped safely during surgery, aortic valve replacement became accepted therapy for patients with severe aortic insufficiency or regurgitation.


document_title: All Is Fair in Love and War

question_text: who said everthing is fair in love and war

text: All Is Fair in Love and War

text: All Is Fair in Love and War may refer to:

text:
"All is fair in love and war", a proverb attributed to John Lyly's Euphues
All Is Fair in Love and War (album), an album by Blessed by a Broken Heart
"All Is Fair in Love and War" (song), a song by Ronnie Milsap

tag: ul

text:
Disambiguation page providing links to articles with similar titles
This disambiguation page lists articles associated with the title All Is Fair in Love and War.
If an internal link led you here, you may wish to change the link to point directly to the intended article.

tag: table

text: Disambiguation pages

text: Disambiguation pages with short descriptionAll article disambiguation pagesAll disambiguation pages


document_title: The Fly (1986 film)

question_text: where did be afraid be very afraid come from

question_tokens: where did be afraid be very afraid come from

text: The Fly (1986 film)

text: Plot[edit]

text: Seth Brundle, a brilliant but eccentric scientist, meets Veronica Quaife, a science journalist, at a press event. He takes her back to his warehouse home and laboratory and shows her his invention: a set of "telepods" that allows instantaneous teleportation from one pod to another. Seth convinces Veronica to keep the invention secret in exchange for exclusive rights to the story, and she begins to document his work. Although the telepods can transport inanimate objects, they mutilate live tissue, as is demonstrated when a baboon is turned inside-out during an experiment.

text: Seth and Veronica begin a relationship. Their first sexual encounter inspires Seth to reprogram the telepod to cope with living tissue, and he successfully teleports a second baboon. Veronica departs before they can celebrate, and Seth worries that she is rekindling her relationship with her editor Stathis Borans; in reality, Veronica has left to confront Stathis about a veiled threat, spurred by his jealousy of Seth, to publish the telepod story without her consent. Seth decides to teleport himself alone, unaware that a housefly has slipped inside the transmitter pod with him. He emerges from the receiving pod seemingly normal.

text: Seth and Veronica reconcile. Seth begins to exhibit increased strength, stamina, and sexual potency, which he believes is a result of the teleportation "purifying" his body. He has sugar cravings and Veronica is concerned about Seth's insanity and strange, bristly hairs growing from his back. He becomes arrogant and violent, insisting that the teleportation process is beneficial, and tries to force Veronica to undergo teleportation. When she refuses, he abandons her, goes to a bar and partakes in an arm-wrestling match, leaving his opponent with a compound fracture. He meets a woman named Tawny and brings her back to his warehouse, where Veronica rescues her from teleportation. Seth throws Veronica out, but when his fingernails begin falling off, he realizes something went wrong during his teleportation. He checks his computer's records and discovers that the telepod computer, confused by the presence of two lifeforms in the sending pod, merged him with the fly at the molecular-genetic level.

text: Seth continues to deteriorate, losing body parts and becoming less human in appearance. He reconnects with Veronica and theorizes that he is becoming "Brundlefly," a hybrid of human and insect. He has begun vomiting digestive enzymes onto his food to dissolve it and has gained the ability to cling to walls and ceilings. He realizes he is losing his human reason and compassion, driven by primitive impulses he cannot control.

text: Seth installs a fusion program into the Telepod computer, planning to dilute the fly genes in his body with human DNA. Veronica learns that she is pregnant by Seth and has a nightmare of giving birth to a giant maggot. She has Stathis persuade a doctor to perform an abortion in the middle of the night. Having overheard their conversation, Seth abducts Veronica before the abortion can take place and begs her to carry the child to term, since it may be the last remnant of his humanity. Stathis breaks into Seth's lab with a shotgun, but Seth disfigures him with his corrosive vomit.

text: Seth reveals his desperate plan to Veronica: He will use the telepods to fuse himself and Veronica, together with their unborn child, into one entity. As Seth drags her into one of the telepods, she accidentally rips off his jaw and an enormous insectoid-human creature bursts from Seth's skin. It traps Veronica inside the first telepod and enters the other. The wounded Stathis uses his shotgun to sever the cables connecting Veronica's telepod to the computer, allowing Veronica to escape. Breaking out of its own pod just as the fusion process is activated, Brundlefly is gruesomely fused with the metal door and cabling of Telepod 2. As the deformed Brundlefly/Telepod creature crawls out of the receiving pod, it begs Veronica to end its suffering with the shotgun, and Veronica tearfully shoots it.

text: Cast[edit]

text:
Jeff Goldblum as Seth Brundle
Geena Davis as Veronica "Ronnie" Quaife
John Getz as Stathis Borans
Joy Boushel as Tawny
Leslie Carlson as Dr. Brent Cheevers
George Chuvalo as Marky
David Cronenberg as Gynecologist

text: Production[edit]

text: This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (October 2016) (Learn how and when to remove this template message)

text: In the early 1980s, co-producer Kip Ohman approached screenwriter Charles Edward Pogue with the idea of remaking the classic science fiction horror film The Fly.[4] Pogue began by reading George Langelaan's short story and then watching the original film, which he had never seen. Deciding that this was a project in which he was interested, he talked with producer Stuart Cornfeld about setting up the production, and Cornfeld very quickly agreed.[5] The duo then pitched the idea to executives at 20th Century Fox and received an enthusiastic response, and Pogue was given money to write a first draft screenplay. He initially wrote an outline similar to that of Langelaan's story, but both he and Cornfeld thought that it would be better to rework the material to focus on a gradual metamorphosis instead of an instantaneous monster. However, when executives read the script, they were so unimpressed that they immediately withdrew from the project. After some negotiation, Cornfeld orchestrated a deal whereby Fox would agree to distribute the film if he could set up financing through another source.[4]

text: The new producer was Mel Brooks and the film was to be produced by his company, Brooksfilms. Cornfeld was a frequent collaborator and friend of Brooks, who together also produced David Lynch's film The Elephant Man.[5] Cornfeld gave the script to Brooks, who liked it but felt that a different writer was needed. Pogue was then removed from the project and Cornfeld hired Walon Green for a rewrite, but it was felt that his draft was not a step in the right direction, so Pogue was then brought back to polish the material.[4] At the same time, Brooks and Cornfeld were trying to find a suitable director. Their first choice was David Cronenberg, but he was working on an adaptation of Total Recall for Dino De Laurentiis and was unable to accept.[5] Cornfeld decided on a young British director named Robert Bierman after seeing one of his short films. Bierman was flown to Los Angeles to meet with Pogue, and the film was in the very early stages of preproduction when tragedy struck. Bierman's family had been vacationing in South Africa and his daughter was killed in an accident.[5] Bierman boarded a plane to go to his family, and Brooks and Cornfeld waited for a month before approaching him about resuming work on the picture. Bierman told them that he was unable to start working so soon, and Brooks told him that he would wait three months and contact him again. At the end of the three months, Bierman told him that he could not commit to the project. Brooks told him that he understood and had freed him from his contract. Brooks left his name off the credits so as people would not go to the movie expecting what one would expect from Mel Brooks.

text: Cornfeld then heard that Cronenberg was no longer associated with Total Recall and once again approached him with The Fly.[5] Cronenberg agreed to sign on as director if he would be allowed to rewrite the script.[6][7][8]

text: Geoff and Barbara Powell are a happily married couple. Geoff, a brilliant scientist, has been working on a teleportation machine, but is unwilling to tell his employer, Phillip DeWitt, or his friend, Harry Chandler, about the nature of the project. DeWitt is greatly displeased by this, and threatens to pull his funding of the mystery project unless he is given full disclosure. After several failed experiments, such as a monkey's atoms never reintegrating after disintegration, Geoff eventually is successful in teleporting both inanimate and living objects. However, when he tries it on himself, a housefly slips into the booth with him. Seemingly normal at first, Geoff soon develops incredible strength, stamina, and energy. After sprouting fly-hairs and losing his fingernails, Geoff eventually discovers that the fly has been absorbed into his body, and that its cells are now taking over his own.

text: As he slowly mutates into a giant fly, Geoff loses body parts, and becomes able to climb walls, as well as digest food with corrosive vomit. Barb is horrified to learn that she is pregnant by Geoff, and cannot be sure if the child was conceived before or after his teleportation. Eventually, Chandler discovers the teleporter's existence, reveals it to DeWitt, and demonstrates it on a cat, only to have the lost monkey atoms return from the ether and create a horrible "monkey-cat" creature, which DeWitt beats to death with a metal rod. Despite this failed experiment, DeWitt sees the substantial monetary value of the device, and so takes possession of the teleporter. Geoff (now mostly transformed into a fly-monster and unable to speak) learns of this, and goes to DeWitt's office building, followed by Barb. Geoff confronts DeWitt, starts a fire in the lab where the teleporter is now housed, and kills DeWitt by vomiting and feeding on him. He then traps himself in one of the teleportation booths just as Barb arrives to watch the fire kill him and destroy the teleporter—his intent all along. In a coma, Barb dreams of giving birth to a giant maggot, only to wake up in a hospital, where it is revealed that she's given birth to a healthy baby boy.

text: The revised script differed greatly from Pogue's screenplay, though it still retained the basic plot and the central concept of a gradual mutation. Cronenberg rewrote the characters and most of the dialogue from scratch (as well as fusing DeWitt and Chandler--who had romantic intentions toward Barb in the Pogue draft--into Stathis Borans), and carried over a few key moments and concepts. Certain aspects of the transformation from Pogue's draft (such as the hero's loss of body parts) were expanded upon, and Cronenberg also layered in his trademark themes of sexuality, body horror, and personal identity. He also made it a point to keep Seth Brundle as articulate as possible for as long as possible, as opposed to Pogue's draft, in which Geoff Powell loses his ability to speak two-thirds of the way through the script.

text: Seth Brundle's increasing mania and personality changes in the early stages of the transformation were emphasized in the rewrites, and the notion of the transformation itself being a horrible (and very metaphorical) disease became a key factor in the new script. Also, in this version, Brundle was clearly transforming into a bizarre hybrid creature as the result of a genetic fusion, whereas in Pogue's version, Powell was being taken over by the fly's cells, which had been absorbed into his body (thus slowly transforming him literally into a giant fly, rather than Brundle's deformed man-fly mixture). Cronenberg's version also retained such moments as Brundle catching a fly in mid-air, the fingernail-pulling, and the maggot-baby dream (which was moved to an earlier point in the story, and used for thematic and plot purposes rather than as an end-of-film shock moment).

text: The "monkey-cat" of Pogue's script was repurposed by Cronenberg into a twisted, desperate attempt by Brundle to find a cure, and Pogue's sequence of a fly leg hatching from Geoff's side was taken one step further, with Brundle amputating the twitching limb with his teeth. Pogue's script also featured a bag lady being murdered by Geoff in an alley, and Cronenberg revised this so that the woman was killed by vomit-drop (as with DeWitt's murder at the end of the original draft) rather than Geoff cutting her throat accidentally (however, Cronenberg never filmed his version of this sequence, which was written out of the final shooting script). While Cronenberg's script did not end with Veronica Quaife giving birth, it did end with a coma which revealed that she was pregnant with a normal baby, conceived by Borans after Brundle's death (and the abortion of Brundle's possibly tainted fetus).

text: Despite the extensive rewrite of Pogue's script, Cronenberg insisted during Writers Guild arbitrations that he and Pogue share screenplay credit, since he felt that his version could not have come to pass without Pogue's script to serve as a foundation.[6]

text: With a script that everyone approved of, Cronenberg assembled his usual crew and began the process of casting the picture, ultimately deciding on Jeff Goldblum and Geena Davis for the leads. Chris Walas, who had designed the creatures in Gremlins, was hired to handle the film's extensive special effects. Filming took place in Toronto in 1985–1986.

text: The producers also commissioned musician Bryan Ferry to record a song for the film for promotional purposes. The resulting track was entitled "Help Me". A music video was made for the song, and footage from the film was prominently featured in it. Cronenberg admitted to liking the song, but felt that it was inappropriate to the film itself. Brooks and Cornfeld originally wanted to play the song over the closing credits, but after Cronenberg screened it for them, they agreed with the director that it did not mesh with the movie. As a result, the song is featured only briefly in the film, in the background during the scene where Brundle challenges Marky in the bar. "Help Me" became rather obscure as it was not included on the film's soundtrack release. The song resurfaced in 1993 on the Roxy Music/Bryan Ferry compact disc Ultimate Collection.[9]

text: The design of Brundle's telepods was inspired by the engine cylinder of Cronenberg's Ducati Desmo.[10]

text: Deleted and alternate scenes[edit]

text: After filming ended early in 1986, a rough cut of The Fly was shown to Fox executives, who were very impressed. A rough cut was then previewed at Toronto's Uptown Theatre in the spring of that year. Due to a strong audience reaction, the graphic and infamous "monkey-cat" sequence was cut from the film to make it easier for audiences to maintain sympathy for Brundle's character. Another preview screening was subsequently held at the Fox lot in Los Angeles, and this version featured the "butterfly baby" coda. As before, the screening results dictated that the scene be cut.[6][7]

text: As with most of David Cronenberg's movies, The Fly was tightly edited to maintain a strong pace and to downplay the gore. The final cut runs a brisk 95 minutes, and although very few full scenes were cut, many others were trimmed down. The DVD and Blu-ray editions of the film feature both the shooting script and a great deal of deleted, extended and alternate footage which had never been seen before.

text: The most notable deleted and alternate scenes include:

text:
Second interview: a short scene that features Veronica Quaife conducting a videotaped interview with Seth Brundle (after his superhuman exercise as seen in the completed film), in which he mistakenly theorizes that being teleported has somehow improved him. A slightly different version of this scene appears in The Fly II, which contains alternate takes and dialogue that does not appear in the workprint version of the scene as presented on the DVD. Additionally, Geena Davis's dialogue is overdubbed by Saffron Henderson, who took over the role of Veronica in the sequel.
Monkey-cat: a legendary and infamous sequence in which the desperate Brundle (in a transitional makeup stage which appears only in this scene) uses the Telepods to merge an alley cat and the surviving baboon together in an attempt to find a cure for his condition. However, the resulting "monkey-cat" creature comes out of the receiving Telepod terribly deformed and in unendurable pain. The creature attacks Brundle, who ends up beating the two-headed creature to death with a metal pipe so as to end its misery. The sequence goes on to show the disturbed Brundle scaling the wall of his lab up to the roof, only to feel a sharp pain in his left side (specifically, in the hernia-like bulge seen in the final cut of the film when Brundle first demonstrates his wall-crawling powers). He accidentally slips off the roof, slides down the wall, lands on a metal awning, and watches as a small, fly-like leg emerges from his torso. Horrified by this new appendage, Brundle amputates it with his teeth.

text: Brundle's motivation for fusing the two animals together was intended to be somewhat ambiguous in the context of the sequence, which featured a "test run" for Brundle's fusion "cure" seen at the end of the movie. Thematically, the point of the scene was that Brundle was trying to find some kind of cure for his rapidly deteriorating condition, but was clearly losing his sanity at the same time. The end of the sequence also revealed exactly what the hernia-like bulge on Brundle's torso was, as well as revealing the final fate of the second baboon, story points that are both left unresolved in the final cut.

text: As noted, this sequence was included in the rough cut shown at the Toronto preview screening. The audience had a strong reaction, with at least one person alleged to have vomited. The general consensus from the preview audience was that Brundle was being cruel to the animals (and thus the scene played as being gratuitous, which was not the filmmakers' intent) and, as a result, they lost sympathy for him for the duration of the film. The scene was cut, and remained lost for nearly 20 years. For the 2005 DVD, the scene was restored from the original negative (which was editorially conformed to the workprint version), with tracked-in sound effects and music taken from the completed film.

text: After amputating the insect leg, the script additionally called for Brundle to encounter a homeless woman in the alley, upon whose face he would vomit and subsequently consume. However, this segment was written out of The Fly before filming, even though an actress had already been hired to play the baglady. The scripted sequence appears on the DVD.

text: Butterfly baby; the film's deleted epilogue was shot four different ways (all of which can be seen on the DVD and Blu-Ray releases of the film). In the version of the scene that was originally scripted (and previewed for the Los Angeles test audience), Veronica Quaife is seen in bed with Stathis Borans (having married him) some time after Seth Brundle's death. She awakens from another nightmare in which she gives birth to Brundle's child, and Stathis reassures her that she is safe, and that the baby she is now carrying (having presumably aborted Brundle's) is his. Veronica then falls back to sleep, and she is now dreaming of a beautiful human baby with butterfly wings hatching from a cocoon and flying off towards a distant light source.

text:
Veronica in bed with Stathis (much the same as the version that was previewed), but without her being pregnant. Instead, Stathis reassures her that "there's no baby". She then falls back to sleep and has the butterfly-baby dream.
Veronica waking up alone and in her own bed, then falling back asleep and having the butterfly-baby dream. In this version, she is clearly still pregnant with Brundle's baby.
Veronica waking up alone and in her own bed, then having the butterfly-baby dream. In this version, she is not visibly pregnant (thus leaving the ending ambiguous).

text: The epilogue was intended as an upbeat bookend for Veronica's earlier maggot-baby dream, and to give the surviving characters a more hopeful ending. However, the coda did not fare well with the preview audience, since they were too stunned by the film's climax to focus on the coda, which raised a number of questions. Further, due to the dynamics between the characters that evolved during filming, the chemistry between Brundle and Ronnie proved so strong that no one wanted to see her end up with Stathis Borans (which is one reason why the alternate, Borans-less versions of the coda were shot). The filmmakers also agreed that the story should end with Brundle's mercy-killing at Veronica's hands, despite the unanswered questions about Veronica's unborn child that would be raised by the deletion of the epilogue.

text: The climax of the film also went through several incarnations in the various drafts of the script before the final version was filmed:

text: In one early version of the ending, Veronica is unconscious after Brundlefly throws her into Telepod 1. When the Brundlepod emerges from the prototype Telepod, the raging and mortally wounded creature crawls toward the injured Stathis Borans, who manages to grab a loose wire jutting from the Telepod-human-fly hybrid creature's back and jams it into an electrical socket. The Brundlepod is liquified by the electricity.

text: A later version of the scene is nearly identical, except that the Brundlepod crawls toward Stathis (whether it wants to attack him or is just desperate for help is left ambiguous) and then dies.

text: In the version of the script that appears on the 2005 DVD, Veronica is conscious during the final scene, and when the Brundlepod emerges from the receiving Telepod and crawls toward her, she aims Stathis' shotgun at it, but the creature ends up dying at her feet. Eventually, this was slightly changed to the mercy-killing seen in the completed film.

text: Makeup and creature effects[edit]

text: The Academy Award-winning makeup was designed and executed by Chris Walas, Inc. over a period of three months. The final "Brundlefly" creature was designed first, and then the various steps needed to carry protagonist Seth Brundle to that final incarnation were designed afterwards. The transformation was intended to be a metaphor for the aging process. To that end, Brundle loses hair, teeth and fingernails, with his skin becoming more and more discolored and lumpy. The intention of the filmmakers was to give Brundle a bruised and cancerous look that gets progressively worse as the character's altered genome slowly asserts itself, with the final Brundlefly hybrid creature literally bursting out of Brundle's hideously-deteriorated human skin. The creature itself was designed to appear horribly asymmetrical and deformed, and not at all a viable or robust organism.

text: Various looks were tested for the makeup effects. Some early test footage can be seen on the 2005 The Fly: Collector's Edition DVD, as well as the Blu-ray release.

text: The transformation was broken up into seven distinct stages, with Jeff Goldblum spending many hours in the makeup chair for Brundle's later incarnations.[7]

text:
Stages 1 and 2: subtle, rash-like skin discoloration that leads to facial lesions and sores, with tiny fly hairs dotting Goldblum's face, in addition to the patch of fly hairs growing out of the wound on Brundle's back.
Stages 3 and 4-A: piecemeal prosthetics covering Goldblum's face (and later his arms, feet, and torso), wigs with bald spots, and crooked, prosthetic teeth (beginning with stage 4-A).
Stage 4-B: deleted from the film, this variant of stage 4 was seen only in the "monkey-cat" scene, and required Goldblum to wear the first of two full-body foam latex suits, as Brundle has stopped wearing clothing, at this point.
Stage 5: the second full-body suit, with more exaggerated deformities, and which also required Goldblum to wear distorting contact lenses that made one eye look larger than the other.
Stage 6: the final "Brundlefly" creature (referred to as the "space bug" by the film's crew), depicted by various partial and full-body cable- and rod-controlled puppets.
Stage 7: another puppet which represented the mortally-injured Brundlefly-Telepod fusion creature (initially dubbed the "Brundlebooth" and later the "Brundlething" by the crew) as seen in the film's final moments.

text: Music[edit]

text: The score to The Fly was composed and conducted by Howard Shore, and performed by the London Philharmonic Orchestra. It was released on record, cassette and compact disc (with three additional tracks exclusively included on the latter) by Varese Sarabande, and in 2005 was remastered and reissued on a two-disc set with Christopher Young's album for The Fly II.

text: Titles in bold are exclusive to the CD release.

text:
Main Title 1:54
Plasma Pool 1:54
The Last Visit 2:25
Stathis Enters 2:20
The Phone Call 2:07
Seth Goes Through 2:02
Ronnie Comes Back 0:55
The Jump 1:21
Seth and the Fly 2:21
Particle Magazine 1:02
The Armwrestle 0:51
Brundlefly 1:43
Ronnie's Visit 0:35
The Street 0:43
The Stairs 1:25
The Fingernails 2:35
Baboon Teleportation 0:58
The Creature 2:08
Steak Montage 0:59
The Maggot/Fly Graphic 1:37
Success With Baboon 0:58
The Ultimate Family 1:59
The Finale 2:51

tag: ol

text: Reception and legacy[edit]

text: The Fly was critically acclaimed with most praise going to Goldblum's performance and the special effects. Despite being a gory remake of a classic made by a controversial, non-mainstream director, the film was a commercial success, the biggest of Cronenberg's career, and was the top-grossing film in the United States for two weeks, earning a total domestic gross of $40,456,565. Audiences reacted strongly to the graphic creature effects and the tragic love story, and the film received much attention at the time of its release.

text: David Cronenberg was surprised when The Fly was seen by some critics as a cultural metaphor for AIDS, since he originally intended the film to be a more general analogy for disease itself, terminal conditions like cancer and, more specifically, the aging process:

text: If you, or your lover, has AIDS, you watch that film and of course you'll see AIDS in it, but you don't have to have that experience to respond emotionally to the movie and I think that's really its power. This is not to say that AIDS didn't have an incredible impact on everyone and, of course, after a certain point, people were seeing AIDS stories everywhere, so I don't take any offense that people see that in my movie. For me though, there was something about The Fly story that was much more universal: aging and death—something all of us have to deal with.[9][11][12][13]

text: Film critic Gene Siskel named The Fly as the tenth best film of 1986.[14] In 1989, Premiere and American Film magazines both conducted independent polls of American film critics, directors and other such groups to determine the best films of the 1980s, and The Fly appeared on both lists.

text: The Fly holds a 91% approval rating on Rotten Tomatoes, based on 57 reviews.[15] In 2005, Time magazine film critics Richard Corliss and Richard Schickel included The Fly in their list of the All-TIME 100 Greatest Movies.[16] Time later named it one of the 25 best horror films.[17] The film was ranked #33 on Bravo's 100 Scariest Movie Moments.[18] Similarly, the Chicago Film Critics Association named The Fly the 32nd scariest film ever made.[19]

text: In 2008, the American Film Institute distributed ballots to 1,500 directors, critics and other people associated with the film industry in order to determine the top ten American films in ten different genre categories. Cronenberg's version of The Fly was nominated under the science fiction category, although it did not make the top ten.[20] It was also nominated for AFI's 100 Years... 100 Thrills[21] and AFI's 100 Years...100 Passions[22] and Veronica's warning to Tawny in the film—"Be afraid. Be very afraid."—was nominated for AFI's 100 Years... 100 Movie Quotes.[23]

text: The quote "Be afraid. Be very afraid." was also used as the film's marketing tagline, and became so ingrained in popular culture (as it—and variants—have appeared in countless films and TV series) that a large number of people who are familiar with the phrase are unaware that it originated in The Fly.[9]

text: Awards and nominations[edit]

text: The Fly was nominated for the awards in the chart below. Many genre fans and film critics at the time thought that Jeff Goldblum's performance would receive a Best Actor Oscar nomination,[24] but this did not come to pass. Gene Siskel subsequently stated that Goldblum most likely "got stiffed" out of a nomination because the older academy voters generally do not honor horror films.[25]

text:
Award
Category
Subject
Result

Academy Award
Best Makeup
Chris Walas & Stephan Dupuis
Won

BAFTA Award
Best Makeup and Hair
Nominated

Hugo Award
Best Dramatic Presentation
Nominated

Saturn Award
Best Actor
Jeff Goldblum
Won

Best Actress
Geena Davis
Nominated

Best Makeup
Chris Walas
Won

Best Horror Film
Won

Best Director
David Cronenberg
Nominated

text: Sequels[edit]

text: Whereas the 1958 original was followed by two sequels, Cronenberg has said that the stories in his films have definitive beginnings and endings, and he has never considered making a sequel to one of his own films, although others have made sequels to Cronenberg films, including Scanners (1981).

text: The Fly II[edit]

text: The Fly II (1989) was directed by Chris Walas, the man behind the makeup and creature effects of both films, and is a direct continuation of The Fly. It features Veronica Quaife giving birth to Brundle's mutant son before dying, and focuses on the Bartok company's attempts to get the Telepods working again.

text: David Cronenberg was not involved with the project. The only actor to return for the sequel was John Getz as an embittered Stathis Borans. Veronica Quaife appears briefly in the film, and is played by Saffron Henderson, since Geena Davis declined to reprise the role. Jeff Goldblum appears in archival footage of Seth Brundle in two scenes, including the post-teleportation interview segment that was deleted from the first film, but put to good use for the sequel.

text: An early treatment for a sequel, written by Tim Lucas, involved Veronica Quaife dealing with the evils of the Bartok company. Brundle's consciousness had somehow survived within the Telepod computer, and the Bartok scientists had enslaved him and were using him to develop the system for cloning purposes. Brundle becomes able to communicate with Veronica through the computer, and he eventually takes control of the Bartok complex's security systems to gruesomely attack the villains. Eventually, Veronica frees Brundle by conspiring with him to reintegrate a non-contaminated version of his original body. Cronenberg endorsed this concept at the time. Geena Davis was open to doing a sequel (and only pulled out of The Fly II because her character was to be killed in the opening scene), while Goldblum was not (although he was okay with a cameo), and this treatment reflects that.[26] However, a later treatment written by Jim and Ken Wheat was used as the basis for the final script, written by Frank Darabont. Mick Garris also wrote a treatment, with elements incorporated into the final film.

text: The Fly: Outbreak[edit]

text: Beginning in March 2015 IDW Publishing released a five-issue comic book miniseries titled The Fly: Outbreak, written by Brandon Seifert.[27] The story is a direct sequel to the events of The Fly II, and features Seth Brundle's son, Martin, inadvertently causing a transgenic outbreak while attempting to cure Anton Bartok, to whom he'd previously transferred his mutant genes at the end of The Fly II.

text: Other projects[edit]

text: Renny Harlin's alternate sequel[edit]

text: In the 1990s, Geena Davis was reportedly involved with an alternate sequel to The Fly, to be directed by her then-husband, Renny Harlin, titled Flies. The script by Richard Jefferies was said to feature a story where Veronica gives birth to twin boys, and herself survives the ordeal.[citation needed]

text: Todd Lincoln's second remake[edit]

text: In 2003, it was announced that a second remake of The Fly was being developed, to be directed by Todd Lincoln, produced by Fox Searchlight Pictures, and released in 2006, but this did not happen.[28][29]

text: David Cronenberg's sequel[edit]

text: In 2009, it was rumored that David Cronenberg himself was preparing to direct a second remake of The Fly,[30] but it was not until 2011 that the director addressed the rumors. Cronenberg stated that he had written not a remake, but rather a "sort of" sequel script to his 1986 version, and would film it if 20th Century Fox gave the project the go-ahead:

text: I have written a script that is more of a strange lateral, let's say oblique sequel than it is a true sequel, and it's certainly not a remake of the original. It's financed by Fox, and whether it will get made or not, I cannot say at the moment because there are a lot of up-in-the-air factors that deal with internal studio politics and a bunch of other things that I'm not in control of. But I would make it if they greenlight it, let's put it that way.

text: Cronenberg elaborated further when interviewed by Empire in 2012:

text: Well, I did talk to Fox, because my agent found out that they were approaching people to do a remake of my film. He sort of said, "Well, you know, what about David?" And they said, "Well, we never thought of that!" I think they'd been to Guillermo del Toro and Michael Bay. I said, "Long ago I proposed a sequel to Mel Brooks when he said he wanted to make a sequel." He didn't like what I proposed because he said it wasn't the same as the original movie. "A sequel," he said, "should be more of the same." And I said, "Well, Mel, then I'm not interested." And he went off and did his sequels [sic] and they had nothing to do with me and they weren't very successful. But I still had this idea in mind—which no, I won't tell you—and I said to Fox, "I'll write that idea up because, as I think of it, it could be interesting." And they were excited about it enough to pay me to write a script. And then for various reasons it kind of got bogged down. I don't know exactly why. It seems now that it's not going to happen. But it's a script that I like and would do. It's not exactly a sequel, and it's certainly not a remake. More a meditation [...] it involves teleportation.[31]

text: In a late 2012 interview, Cronenberg provided additional details on why the project had stalled, citing

text: Budget constraints and other things. I think maybe the script that I wrote was a little too radical for Fox, and they felt it really needed to be a very low-budget film at that point. However, what was in it that attracted them could not be done low-budget. So I think that was the problem.[32]

text: He also described the project as "more of a sequel or a sidebar. It was a meditation on fly-ness. None of the same characters or anything and, of course, with an understanding of modern technology."[33]

text: Despite Cronenberg's prior assertions that he does not make sequels to his films, he returned to The Fly for the opera The Fly in 2008, and his proposed sequel film project would mark a second return to the material, as well as his first sequel to one of his previous movies.[34][35] However, the film is not moving forward.[36]

text: Merchandise[edit]

text: A 6-inch figure of "Brundlefly" was created by McFarlane Toys for their Movie Maniacs line in 2000. Also, a 15-inch polystone statue of "Brundlefly" was made by Sideshow Collectibles in 2008.[citation needed]


document_title: ABO blood group system

question_text: the person responsible for the abo classification system for blood is

text: ABO blood group system

text: History of discoveries of the blood types[edit]

text: The ABO blood group system is widely credited to have been discovered by the Austrian scientist Karl Landsteiner, who identified the O, A, and B blood types in 1900.[5][6] Landsteiner originally described the O blood type as type "C", and in parts of Europe it is rendered as "0" (zero), signifying the lack of A or B antigen. Landsteiner was awarded the Nobel Prize in Physiology or Medicine in 1930 for his work.[5] Alfred von Decastello and Adriano Sturli discovered the fourth type, AB, in 1902.[7][8]

text: It was subsequently found that the Czech serologist Jan Janský had independently pioneered the classification of human blood into four groups in 1907,[9] but Landsteiner's independent discovery had been accepted by the scientific world while Janský remained then in relative obscurity. However, in 1921 an American medical commission acknowledged Janský's classification. Jan Janský is nowadays credited with the first classification of blood into the four types (I, II, III, IV).

text: Janský's classification remains in use today. In Russia and states of the former USSR, blood types O, A, B, and AB are respectively designated I, II, III, and IV.[10] The designation A and B with reference to blood groups was proposed by Ludwik Hirszfeld.

text: In America, W.L. Moss published his own (very similar) work in 1910.[11]

text: Ludwik Hirszfeld and E. von Dungern discovered the heritability of ABO blood groups in 1910–11. Felix Bernstein demonstrated the correct blood group inheritance pattern of multiple alleles at one locus in 1924.[12] Watkins and Morgan, in England, discovered that the ABO epitopes were conferred by sugars, to be specific, N-acetylgalactosamine for the A-type and galactose for the B-type.[13][14][15] After much published literature claiming that the ABH substances were all attached to glycosphingolipids, Finne et al. (1978) found that the human erythrocyte glycoproteins contain polylactosamine chains[16] that contains ABH substances attached and represent the majority of the antigens.[17][18][19] The main glycoproteins carrying the ABH antigens were identified to be the Band 3 and Band 4.5 proteins and glycophorin.[20] Later, Yamamoto's group showed the precise glycosyl transferase set that confers the A, B and O epitopes.[21]

text: Alteration of ABO antigens for transfusion[edit]

text: In April 2007, an international team of researchers announced in the journal Nature Biotechnology an inexpensive and efficient way to convert types A, B, and AB blood into type O.[23] This is done by using glycosidase enzymes from specific bacteria to strip the blood group antigens from red blood cells. The removal of A and B antigens still does not address the problem of the Rh blood group antigen on the blood cells of Rh positive individuals, and so blood from Rh negative donors must be used. Patient trials will be conducted before the method can be relied on in live situations.

text: Another approach to the blood antigen problem is the manufacture of artificial blood, which could act as a substitute in emergencies.[24]

text: Genetics[edit]

text: Blood groups are inherited from both parents. The ABO blood type is controlled by a single gene (the ABO gene) with three types of alleles inferred from classical genetics: i, IA, and IB. The I designation stands for isoagglutinogen, another term for antigen.[25] The gene encodes a glycosyltransferase—that is, an enzyme that modifies the carbohydrate content of the red blood cell antigens. The gene is located on the long arm of the ninth chromosome (9q34).

text: The IA allele gives type A, IB gives type B, and i gives type O. As both IA and IB are dominant over i, only ii people have type O blood. Individuals with IAIA or IAi have type A blood, and individuals with IBIB or IBi have type B. IAIB people have both phenotypes, because A and B express a special dominance relationship: codominance, which means that type A and B parents can have an AB child. A couple with type A and type B can also have a type O child if they are both heterozygous (IBi,IAi) The cis-AB phenotype has a single enzyme that creates both A and B antigens. The resulting red blood cells do not usually express A or B antigen at the same level that would be expected on common group A1 or B red blood cells, which can help solve the problem of an apparently genetically impossible blood group.[26]

text:
Blood group inheritance

Blood type

O
A
B
AB

Genotype
ii (OO)
IAi (AO)
IAIA (AA)
IBi (BO)
IBIB (BB)
IAIB (AB)

O
ii (OO)
O
OO OO OO OO
O or A
AO OO AO OO
A
AO AO AO AO
O or B
BO OO BO OO
B
BO BO BO BO
A or B
AO BO AO BO

A
IAi (AO)
O or A
AO AO OO OO
O or A
AA AO AO OO
A
AA AA AO AO
O, A, B or AB
AB AO BO OO
B or AB
AB AB BO BO
A, B or AB
AA AB AO BO

IAIA (AA)
A
AO AO AO AO
A
AA AO AA AO
A
AA AA AA AA
A or AB
AB AO AB AO
AB
AB AB AB AB
A or AB
AA AB AA AB

B
IBi (BO)
O or B
BO BO OO OO
O, A, B or AB
AB BO AO OO
A or AB
AB AB AO AO
O or B
BB BO BO OO
B
BB BB BO BO
A, B or AB
AB BB AO BO

IBIB (BB)
B
BO BO BO BO
B or AB
AB BO AB BO
AB
AB AB AB AB
B
BB BO BB BO
B
BB BB BB BB
B or AB
AB BB AB BB

AB
IAIB (AB)
A or B
AO AO BO BO
A, B or AB
AA AO AB BO
A or AB
AA AA AB AB
A, B or AB
AB AO BB BO
B or AB
AB AB BB BB
A, B, or AB
AA AB AB BB

text: The table above summarizes the various blood groups that children may inherit from their parents.[27][28] Genotypes are shown in the second column and in small print for the offspring: AO and AA both test as type A; BO and BB test as type B. The four possibilities represent the combinations obtained when one allele is taken from each parent; each has a 25% chance, but some occur more than once.

text:
Blood group inheritance by phenotype only

Blood type
O
A
B
AB

O
O
O or A
O or B
A or B

A
O or A
O or A
O, A, B or AB
A, B or AB

B
O or B
O, A, B or AB
O or B
A, B or AB

AB
A or B
A, B or AB
A, B or AB
A, B or AB

text: Historically, ABO blood tests were used in paternity testing, but in 1957 only 50% of American men falsely accused were able to use them as evidence against paternity.[29] Occasionally, the blood types of children are not consistent with expectations—for example, a type O child can be born to an AB parent—due to rare situations, such as Bombay phenotype and cis AB.[30]

text: Subgroups[edit]

text: The A blood type contains about 20 subgroups, of which A1 and A2 are the most common (over 99%). A1 makes up about 80% of all A-type blood, with A2 making up almost all of the rest.[31] These two subgroups are not always interchangeable as far as transfusion is concerned, as some A2 individuals produce antibodies against the A1 antigen. Complications can sometimes arise in rare cases when typing the blood.[31]

text: With the development of DNA sequencing, it has been possible to identify a much larger number of alleles at the ABO locus, each of which can be categorized as A, B, or O in terms of the reaction to transfusion, but which can be distinguished by variations in the DNA sequence. There are six common alleles in white individuals of the ABO gene that produce one's blood type:[32][33]

text:
A
B
O

A101 (A1)
A201 (A2)
B101 (B1)
O01 (O1)
O02 (O1v)
O03 (O2)

text: The same study also identified 18 rare alleles, which generally have a weaker glycosylation activity. People with weak alleles of A can sometimes express anti-A antibodies, though these are usually not clinically significant as they do not stably interact with the antigen at body temperature.[34]

text: Cis AB is another rare variant, in which A and B genes are transmitted together from a single parent.

text: Distribution and evolutionary history[edit]

text: The distribution of the blood groups A, B, O and AB varies across the world according to the population. There are also variations in blood type distribution within human subpopulations.

text: In the UK, the distribution of blood type frequencies through the population still shows some correlation to the distribution of placenames and to the successive invasions and migrations including Norsemen, Danes, Saxons, Celts, and Normans who contributed the morphemes to the placenames and the genes to the population.[35]

text: The two common O alleles, O01 and O02, share their first 261 nucleotides with the group A allele A01.[36] However, unlike the group A allele, a guanosine base is subsequently deleted. A premature stop codon results from this frame-shift mutation. This variant is found worldwide, and likely predates human migration from Africa. The O01 allele is considered to predate the O02 allele.[citation needed]

text: Some evolutionary biologists theorize that there are four main lineages of the ABO gene and that mutations creating type O have occurred at least three times in humans.[37] From oldest to youngest, these lineages comprise the following alleles: A101/A201/O09, B101, O02 and O01. The continued presence of the O alleles is hypothesized to be the result of balancing selection.[37] Both theories contradict the previously held theory that type O blood evolved first.[citation needed]

text: Origin theories[edit]

text: It is possible that food and environmental antigens (bacterial, viral, or plant antigens) have epitopes similar enough to A and B glycoprotein antigens. The antibodies created against these environmental antigens in the first years of life can cross-react with ABO-incompatible red blood cells that it comes in contact with during blood transfusion later in life. Anti-A antibodies are hypothesized to originate from immune response towards influenza virus, whose epitopes are similar enough to the α-D-N-galactosamine on the A glycoprotein to be able to elicit a cross-reaction. Anti-B antibodies are hypothesized to originate from antibodies produced against Gram-negative bacteria, such as E. coli, cross-reacting with the α-D-galactose on the B glycoprotein.[38]

text: However, it is more likely that the force driving evolution of allele diversity is simply negative frequency-dependent selection; cells with rare variants of membrane antigens are more easily distinguished by the immune system from pathogens carrying antigens from other hosts. Thus, individuals possessing rare types are better equipped to detect pathogens. The high within-population diversity observed in human populations would, then, be a consequence of natural selection on individuals.[39]

text: HIV can be neutralized in in vitro experiments using antibodies against blood group antigens specifically expressed on the HIV-producing cell lines.[40][41]

text: Clinical relevance[edit]

text: The carbohydrate molecules on the surfaces of red blood cells have roles in cell membrane integrity, cell adhesion, membrane transportation of molecules, and acting as receptors for extracellular ligands, and enzymes. ABO antigens are found having similar roles on epithelial cells as well as red blood cells.[42][43]

text: Bleeding and thrombosis (von Willebrand factor)[edit]

text: The ABO antigen is also expressed on the von Willebrand factor (vWF) glycoprotein,[44] which participates in hemostasis (control of bleeding). In fact, having type O blood predisposes to bleeding,[45] as 30% of the total genetic variation observed in plasma vWF is explained by the effect of the ABO blood group,[46] and individuals with group O blood normally have significantly lower plasma levels of vWF (and Factor VIII) than do non-O individuals.[47][48] In addition, vWF is degraded more rapidly due to the higher prevalence of blood group O with the Cys1584 variant of vWF (an amino acid polymorphism in VWF):[49] the gene for ADAMTS13 (vWF-cleaving protease) maps to the ninth chromosome (9q34), the same locus as ABO blood type. Higher levels of vWF are more common amongst people who have had ischemic stroke (from blood clotting) for the first time.[50] The results of this study found that the occurrence was not affected by ADAMTS13 polymorphism, and the only significant genetic factor was the person's blood group.

text: Disease risks[edit]

text: Compared to O group individuals, non-O group (A, AB, and B) individuals have a 14% reduced risk of squamous cell carcinoma and 4% reduced risk of basal cell carcinoma.[51] Conversely, type O blood is associated with a reduced risk of pancreatic cancer.[52][53] The B antigen links with increased risk of ovarian cancer.[54] Gastric cancer has reported to be more common in blood group A and least in group O.[55]

text: According to Glass, Holmgren, et al., those in the O blood group have an increased risk of infection with cholera, and those O-group individuals who are infected have more severe infections. The mechanisms behind this association with cholera are unclear in the literature.[56]

text: ABO hemolytic disease of the newborn[edit]

text: ABO blood group incompatibilities between the mother and child does not usually cause hemolytic disease of the newborn (HDN) because antibodies to the ABO blood groups are usually of the IgM type, which do not cross the placenta. However, in an O-type mother, IgG ABO antibodies are produced and the baby can potentially develop ABO hemolytic disease of the newborn.

text: Clinical applications[edit]

text: In human cells, the ABO alleles and their encoded glycosyltransferases have been described in several oncologic conditions.[57] Using anti-GTA/GTB monoclonal antibodies, it was demonstrated that a loss of these enzymes was correlated to malignant bladder and oral epithelia.[58][59] Furthermore, the expression of ABO blood group antigens in normal human tissues is dependent the type of differentiation of the epithelium. In most human carcinomas, including oral carcinoma, a significant event as part of the underlying mechanism is decreased expression of the A and B antigens.[60] Several studies have observed that a relative down-regulation of GTA and GTB occurs in oral carcinomas in association with tumor development.[60][61] More recently, a genome wide association study (GWAS) has identified variants in the ABO locus associated with susceptibility to pancreatic cancer.[62]

text: Clinical marker[edit]

text: A multi-locus genetic risk score study based on a combination of 27 loci, including the ABO gene, identified individuals at increased risk for both incident and recurrent coronary artery disease events, as well as an enhanced clinical benefit from statin therapy. The study was based on a community cohort study (the Malmo Diet and Cancer study) and four additional randomized controlled trials of primary prevention cohorts (JUPITER and ASCOT) and secondary prevention cohorts (CARE and PROVE IT-TIMI 22).[63]

text: Pseudoscience[edit]

text: During the 1930s, connecting blood groups to personality types became popular in Japan and other areas of the world.[64] Studies of this association have yet to confirm its existence definitively.[65][66]

text: Other popular but unsupported ideas include the use of a blood type diet, claims that group A causes severe hangovers, group O is associated with perfect teeth, and those with blood group A2 have the highest IQs. Scientific evidence in support of these concepts is nonexistent.[67]

text: Data tables[edit]

text:
ABO allele frequencies in Korean, Japanese and German populations

Population

ABO allele

A(Pro)
A(Leu)
B
O(T)
O(A)
O2

Korean (n = 253)
0.022a,c
0.209c
0.209c
0.360a,e
0.200b
0d

Japanese1 (n = 520)
0.071
0.216
0.178
0.273
0.262
0

German2 (n = 169)
0.213
0.077
0.047
0.426
0.216
0.021

aKorean versus Japanese, p < 0.001. bKorean versus Japanese, p < 0.01.
cKorean versus German, p < 0.001. dKorean versus German, p < 0.01.
eKorean versus German, p < 0.05 (Fisher's exact probability test).
1Fukumori et al., 1996. 2Nishimukai et al., 1996.

Source: Table 2, Page 333, Kang Sung-ha et al. (1997)[68]