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"Virtual flow cytometry" of immunostained lymphocytes on microscopic tissue slides: iHCFlow tissue cytometry.

BACKGROUND: A method and approach is developed for fully automated measurements of immunostained lymphocytes in tissue sections by means of digital color microscopy and patent pending advanced cell analysis. The validation data for population statistic measurements of immunostained lymphocytes in tissue sections using tissue cytometry (TC) is presented. The report is the first to describe the conversion of immunohistochemistry (IHC) data to a flow cytometry-like two parameter dot-plot display, hence the technique is also a virtual flow cytometry. We believe this approach is a paradigm shift, as well as novel, and called the system iHCFlow TC. Seven issues related to technical obstacles to virtual flow cytometry (FC) are identified. DESIGN: Segmentation of a 512 x 474 RGB image and tabular display of statistical results table took 12-15 s using proprietary developed algorithms. We used a panel of seven antibodies for validation on 14 cases of mantle cell lymphoma giving percentage positive, total lymphocytes, and staining density. A total of 2,027 image frames with 810,800 cell objects (COBs) were evaluated. Antibodies to CD3, CD4, CD8, Bcl-1, Ki-67, CD20, CD5 were subjected to virtual FC on tissue. The results of TC were compared with manual counts of expert observers and with the results of flow cytometric immunophenotyping of the same specimen. RESULTS: The correlation coefficient and 95% confidence interval by linear regression analysis yielded a high concordance between manual human results (M), FC results, and TC results per antibody, (r = 0.9365 M vs. TC, r= 0.9537 FC vs. TC). The technical issues were resolved and the solutions and results were evaluated and presented. CONCLUSION: These results suggest the new technology of TC by iHCFlow could be a clinically valid surrogate for both M and FC analysis when only tissue IHC is available for diagnosis and prognosis. The application for cancer diagnosis, monitoring, and prognosis is for objective, rapid, automated counting of immunostained cells in tissues with percentage results. We report a new paradigm in TC that converts IHC staining of lymphocytes to automated results and a flow cytometry-like report. The dot plot histogram display is familiar, intuitive, informative, and provides the pathologists with an automated tool to rapidly characterize the staining and size distribution of the immunoreactive as well as the negative cell population in the tissue. This systems tool is a major improvement over existing ones and satisfies fully the criteria to perform Cytomics (Ecker and Tarnok, Cytometry A 2005;65:1; Ecker and Steiner, Cytometry A 2004;59:182-190; Ecker et al., Cytometry A 2004;59:172-181).

B-Lymphocytes↗

Analysis of multilocus zygotic associations.

While nonrandom associations between zygotes at different loci (zygotic associations) frequently occur in Hardy-Weinberg disequilibrium populations, statistical analysis of such associations has received little attention. In this article, we describe the joint distributions of zygotes at multiple loci, which are completely characterized by heterozygosities at individual loci and various multilocus zygotic associations. These zygotic associations are defined in the same fashion as the usual multilocus linkage (gametic) disequilibria on the basis of gametic and allelic frequencies. The estimation and test procedures are described with details being given for three loci. The sampling properties of the estimates are examined through Monte Carlo simulation. The estimates of three-locus associations are not free of bias due to the presence of two-locus associations and vice versa. The power of detecting the zygotic associations is small unless different loci are strongly associated and/or sample sizes are large (>100). The analysis of zygotic associations not only offers an effective means of packaging numerous genic disequilibria required for a complete characterization of multilocus structure, but also provides opportunities for making inference about evolutionary and demographic processes through a comparative assessment of zygotic association vs. gametic disequilibrium for the same set of loci in nonequilibrium populations.

Computer Simulation↗

Why is breast-cancer mortality declining?

Population statistics indicate that age-adjusted breast-cancer mortality rates began to decline during the early 1990s in many developed countries. For several decades before 1990, breast-cancer mortality rates in these countries had been either stable or increasing. Many investigators attribute the decline in mortality to mammography screening. However, randomised prospective trials indicate that there is a delay of 10 years before the effect of such screening can be seen in mortality statistics. In many developed countries, screening programmes were launched in the late 1980s and early 1990s, so the sudden decline in breast-cancer mortality in the early 1990s was much too soon to be attributable to mammography screening. In this review, we argue that although some of the decline in breast-cancer mortality is due to a reduction in breast-cancer risk, most of it can probably be attributed to adjuvant systemic therapy and the earlier detection of palpable tumours. We also explain why advances in the treatment of breast cancer might be outpacing the value of mammography screening. Since age-adjusted mortality rates are the most basic measure of progress in the treatment of breast cancer, we suggest that careful scrutiny of recent trends in breast-cancer mortality may provide important insights into the effectiveness of novel strategies for diagnosis and treatment.

Breast Neoplasms↗

Unintentional carbon monoxide-related deaths in the United States, 1979 through 1988.

OBJECTIVE: To describe the epidemiology of recent unintentional carbon monoxide poisoning deaths in the United States. DESIGN: Descriptive analysis of carbon monoxide-related deaths in the United States from 1979 through 1988, based on death certificate reports compiled by the National Center for Health Statistics. POPULATION STUDIED: All US deaths, 1979 through 1988. RESULTS: We reviewed data from 56,133 death certificates that contained codes implicating carbon monoxide as a contributing cause of death. Of these, 25,889 were suicides, 210 were homicides, 15,523 were associated with severe burns or house fires, and 11,547 were classified as unintentional. The number of unintentional deaths decreased steadily by about 63 deaths per year, from 1513 in 1979 to 878 in 1988. The highest death rates occurred in winter and among males, blacks, the elderly, and residents of northern states. Motor vehicle exhaust gas caused 6552 (57%) of the unintentional deaths; 5432 (83%) of these were associated with stationary automobiles. CONCLUSIONS: The rate of unintentional death from carbon monoxide poisoning is decreasing. This may be attributable to improvements in automobile pollution control systems and improved safety of cooking and heating appliances. Prevention programs should target young drivers, males, and the elderly.

Adolescent↗

Beyond switches: ratcheting a particle energetically uphill with a compartmentalized molecular machine.

Here we correlate chemical (covalent), physical (thermodynamic), and statistical (population distribution) descriptions of behavior with the way that two new types of simple molecular machines (the threads of rotaxanes) perform the task of transporting a Brownian substrate (the rotaxane macrocycle) between two distinguishable binding sites. The first machine-substrate ensemble is a [2]rotaxane that operates through a mechanism that intrinsically causes it to change the average position of the macrocycle irreversibly. This contrasts with the behavior of classic stimuli-responsive molecular shuttles that act as reversible molecular switches. The second system is a compartmentalized molecular machine that is able to pump its substrate energetically uphill using the energy provided by a photon by means of an olefin photoisomerization. Resetting this compartmentalized molecular machine does not undo the work it has carried out or the task performed, a significant difference to a simple molecular switch and a characteristic we recognize as "ratcheting" (see Scheme 8). The ratcheting mechanism allows the [2]rotaxane to carry out the transport function envisaged for the historical thought-machines, Smoluchowski's Trapdoor and Maxwell's Pressure Demon, albeit via an unrelated mechanism and using an input of energy. We define and exemplify the terms "ratcheting" and "escapement" in mechanical terms for the molecular level and outline the fundamental phenomenological differences that exist between what constitutes a two-state Brownian switch, a two-state Brownian memory or "flip-flop", and a (two-stroke) Brownian motor. We also suggest that considering the relationship between the parts of a molecular machine and a substrate in terms of "statistical balance" and "linkage" could be useful in the design of more complex systems and in helping to understand the role of individual amino acids and peptide fragments during the directional transport of substrates by biological pumps and motors.

Journal Article↗

Do impaired older persons with health care needs occupy U.S. assisted living facilities? An analysis of six national studies.

OBJECTIVES: The assisted living facility (ALF) is the fastest-growing noninstitutional long-term care alternative for frail older persons in the United States. This analysis assesses the extent to which older persons with physical and cognitive disabilities and health care needs occupy ALFs in the United States. METHODS: Information on study design and six indicators of the occupancy patterns of older persons in ALFs were abstracted from six national studies. The collected data were based on reports by the administrators of ALFs. RESULTS: The six reviewed studies had several methodologic weaknesses, resulting in different statistical populations of ALFs, samples with very different numerical and attribute properties, and findings based on disparate indicators. The older residents in ALFs were less physically and cognitively impaired than those in nursing homes. ALF facilities were more likely to admit or retain frail older persons when they had relatively minor or less serious physical or cognitive impairment or health care needs. DISCUSSION: ALFs are currently serving older residents who require less nursing care and who are less functionally and cognitively impaired than those found in nursing homes. The more restrictive admitting and discharge criteria of a substantial share of ALFs guarantee their less frail occupant profile. This is, however, an extraordinarily diverse shelter and care alternative, and very frail older persons with serious chronic health problems can be found in ALFs. Average duration of stays may be as long as 3 years. Researchers must conduct more carefully executed studies with replicable methodologies that produce unbiased and generalized findings.

Activities of Daily Living↗

The effect of revised populations on mortality statistics for the United States, 2000.

OBJECTIVES: This report presents revised mortality statistics for the year 2000 based on April 1, 2000, population figures from the 2000 census. Death rates are presented by race, Hispanic origin, sex, age, and cause of death. Life expectancies are presented by race (white and black), sex, and age. The revised statistics are compared with previously published statistics that used July 1, 2000, postcensal population estimates based on the 1990 census. METHODS: Data in this report are based on information from all death certificates filed in the 50 States and the District of Columbia. The statistics presented in this report are computed on the basis of two sets of population figures provided by the U.S. Census Bureau. The first set includes July 1, 2000, postcensal population estimates based on the 1990 decennial census. The second set includes April 1, 2000, populations from the 2000 decennial census bridged to single race categories. RESULTS: Crude death rates were lower for all groups using the April 1, 2000, populations. Age-specific death rates were generally lower for most age groups, except for infants and the very old for which death rates were higher. Age-specific death rates for males were lower for most age groups, except infants and those 75 years and over. For females, with the exception of infants, age-specific death rates were lower. Race-specific pattems by age for the white and black populations were similar to all races combined. For the American Indian population, age-specific death rates were substantially lower for ages under 75 years. For ages 75 years and over, American Indian death rates were dramatically higher. Age-specific death rates for the Asian or Pacific Islander (API) population were higher for ages under 15 years; lower for ages 15-84 years, especially for the 15-34 year age group; and higher for those 85 years and over. For the Hispanic population, age-specific death rates were substantially lower for those age 15-34 years and higher for those age 55 years and over, especially for those age 85 years and over. For the total white and total black populations, the age-adjusted death rate was somewhat higher for males and lower for females. For API the pattern was reversed. For the American Indian and Hispanic populations, age-adjusted death rates were higher for both males and females. For the 15 leading causes of death, age-adjusted death rates based on the April 1, 2000, population figures were lower for heart disease, cancer, chronic liver disease, septicemia, diabetes, chronic lower respiratory diseases, unintentional injuries, homicide, suicide, and hypertension. Age-adjusted death rates were higher for pneumonitis, Alzheimer's disease, and stroke. Rates were unchanged for influenza and pneumonia and nephritis, nephrotic syndrome and nephrosis. Life expectancy at birth was higher for the entire population and both the white and black populations using the April 1, 2000, population figures. It was 0.1 year higher for the whole population as well as for the total white and total black populations. For the total male population, life expectancy at birth was 0.1 year higher while it was 0.2 years higher for the female population. The increase in life expectancy at birth was 0.1 year for both sexes within the white and black populations. This observed gain in life expectancy at birth based on the revised population figures is reversed for life expectancy at the oldest age groups for the whole population and for males. A similar pattern is observed for both white and black males; however, the magnitude of the decline in life expectancy at older ages is much greater among black males. Among females of both race groups and the total population, there is either no change or an increase in life expectancy in the oldest age groups. CONCLUSIONS: Revised death rates and life expectancies are, in many cases, significantly different from previously published mortality statistics calculated using 1990-based postcensal estimates for 2000. Thus, previously published mortality statistics for 2000 using the 1990-based populations will not be comparable to the corresponding statistics that will be published for 2001. The data in this report will provide comparable 2000 data. Efforts are also underway to revise previously published mortality tables for 2000 as well as previously published data for 1991-99.

Adolescent↗

Aggressive traffic enforcement: a simple and effective injury prevention program.

PURPOSE: To investigate whether an aggressive traffic violation enforcement program could reduce motor vehicle crashes (MVCs), injury collisions, fatalities, and fatalities related to speed, and decrease injury severity in crash victims treated at the trauma center. METHODS: A vigorous enforcement program was established within Fresno, Calif, city boundaries using increased traffic patrol officers. Data on citations, collisions, fatal collisions, and fatalities related to speed, as well as injury severity from the trauma registry, were collected for the year before program onset (2002), during the first year (2003), and after full implementation (2004). U.S. Census Bureau information was used for population. Statistical analysis was performed using Fisher's exact test and independent samples t test with significance attributed to p < 0.05. RESULTS: There were significant increases in citations issued, with marked decreases in motor vehicle crashes, injury collisions, fatalities, and fatalities related to speed. There was a decrease in admissions from MVCs, a significant decrease in the number of patients with moderate injury severity (Injury Severity Score of 10-16; p < 0.01), a decrease in hospital length of stay for all MVC victims, and a decrease in hospital charges for MVC patients. These changes were not seen in the area of Fresno County outside the area of increased enforcement. CONCLUSIONS: Aggressive traffic enforcement decreased MVCs, crash fatalities, and fatalities related to speed, and it decreased injury severity. This is a simple, easily implemented injury prevention program with immediate benefit.

Acceleration↗

Speech and language therapy service delivery for bilingual children: A survey of three cities in Great Britain.

BACKGROUND: Speech and language therapy (SLT) managers are expected to ensure that there are appropriate services available for bilingual and multilingual clients in order to ensure an equitable service to all clients. However, there is a paucity of data available to inform service planning. AIMS: To identify the level to which SLT services in three UK cities meet the recommendations of The Royal College of Speech and Language Therapists (RCSLT) Good Practice Guidelines. Socio-demographic information is provided about the number of children from ethnic minorities in the population and the proportion of (bilingual) children from ethnic minorities on the speech and language therapy caseload. Based on this information, it is estimated whether there is proportionate representation of bilingual children on SLT caseloads, and whether services are in place to meet the needs of those clients. METHODS & PROCEDURES: Population statistics were gathered from Census data and data were gleaned from Local Education Authorities. The study used a combination of interview and postal questionnaires to SLTs, with particular emphasis on the issues that may affect service provision. OUTCOMES & RESULTS: As in previous studies, it was difficult to find reliable data. However, two of the three cities studied appeared to be offering a proportionate service to both monolingual and bilingual children in terms of the relative numbers of children on caseloads. Only one city was confident that their SLT service was fully meeting the RCSLT Good Practice Guidelines on bilingualism, although all three cities were aware of them and appeared to be making an effort at varying levels to address the principles of those guidelines. CONCLUSIONS: There is a need for a change in how data on linguistic diversity in society are collected and disseminated, both at a national level and within SLT services, so that informed decisions can influence the future of quality services to minority groups.

Child↗

Trends in leprosy case detection worldwide since 1985.

Trends in case detection and case detection rate (CDR) since 1985 are described at regional and national levels. Annual case detection by WHO Region was available for 1994-2000. Using different sources, complete time series for case detection were constructed for 1985-1998 for a group of 33 endemic countries cumulatively (top 33), and for 14 individual countries (top 14). Population statistics were used to derive CDRs. India contributed 79% to global case detection in 1998. Africa, the Americas and South-East Asia each contributed about 30% when India is excluded. During 1994-2000, case detection did not decrease in these three WHO Regions. The 33 countries contributed 99% and 98% to global case detection in 1994 and 1998, respectively. Cumulative case detection for the top 33 minus India gradually increased, overall almost doubling. The contribution of the top 14 to case detection of the top 33 hardly changed over time, equalling 96% in 1998 (81% when India is excluded). In terms of annual case detection, Brazil was always ranked second after India; it accounted for 27% of 1998 case detection in the top 33 except India. In 1998, seven of the top 14 countries--including India and Brazil--had CDRs above 2 per 10,000. The CDR did not exceed 1 per 10,000 for the other half. Decreasing tendencies in CDR, either for the whole period or in the 1990s, are observed for four of the top 14 countries (Guinea and three Western Pacific countries: China, Vietnam and the Philippines). In conclusion, there is no general decline in case detection to date, and several important countries still have high CDRs. Prevalence is an irrelevant indicator for monitoring epidemiological changes in leprosy. Trends in the transmission and incidence of leprosy are still completely unclear, necessitating further research. The target to eliminate leprosy as a public health problem, defined as a prevalence of less than 1 per 10,000, is therefore also an inadequate yardstick for decision making on leprosy control.

Africa↗

Keratoacanthoma. A clinical study.

Keratoacanthoma (KA) is a relatively common tumor believed to be a benign epidermal neoplasm. Ninety patients with one or more KAs were observed in regard to clinical, therapeutic, and prognostic implications. In particular, we were able to analyze the relationship of KA to internal malignant neoplasms in 78 patients. Keratoacanthoma is a disease of the elderly (mean patient age, 64.1 years). It is associated with other nonmelanoma cutaneous neoplasias in 21% of cases, a figure lower than that seen with squamous cell carcinomas. When solitary, KA is not associated with concurrent or subsequent internal malignant neoplasms more often than would be predicted by population statistics. Therapy is generally curative, but about 8% of the patients had recurrences. These patients may be successfully treated with several existing modalities.

Adult↗

Responses to exercise in children with sickle cell trait.

To determine whether responses to exercise in children with sickle cell trait (AS) are different from those of normal children, we performed dynamic cycle ergometer stress testing in 48 children with AS, aged 4 to 21 years. We compared these data with those obtained from 184 healthy black children. No subject with AS demonstrated definite ischemia on the exercise ECG, but four (8.3%) had equivocal ischemia. Population statistics derived from Z score values showed that the subjects with AS had lower exercise values for heart rate and work load than the controls. The BP response to exercise was normal in subjects with AS. Since no ischemia or complications occurred, exercise in subjects with AS appears to be safe. Further studies are needed to define the mechanism for the impaired pulse rate and work load variables.

Adolescent↗

Proportionate mortality among unionized construction ironworkers.

This report presents the results of proportionate mortality ratios (PMR) and proportionate cancer mortality ratios (PCMR) among 13,301 members of the International Union of Bridge, Structural, and Ornamental Ironworkers who had been members for a minimum of 1 year, were actively paying dues into the death beneficiary fund, and had died between 1984-1991. Using the United States proportionate mortality rates as the comparison population, statistically significant elevated risks, using 95% confidence intervals (CI), were observed for several types of injuries: falls (N = 259, PMR = 3.57, CI = 3.15-4.03), transportation injuries (N = 363, PMR = 1.22, CI = 1.10-1.35), and other types of injuries (N = 225, PMR = 1.63, CI = 1.43-1.86). The deaths due to falls were significantly elevated for each 10-year age group under age 60 (PMR > 7.00) and for those workers with < 20 years in the union (PMR > 6.00). Elevated mortality risks were also observed for all malignant neoplasms combined (N = 3,682, PMR = 1.09, CI = 1.06-1.13) as well as for site-specific malignant neoplasms of the lung (N = 1,523, PMR = 1.28, CI = 1.21-1.35), pleural mesothelioma (N = 7, PMR = 1.67, CI = 0.67-3.44) and "other and unspecified sites" (N = 307, PMR = 1.29, CI = 1.15-1.44). The category "pneumoconiosis and other respiratory diseases" was also significantly elevated (N = 690, PMR = 1.11, CI = 1.03-1.20); in this category, deaths due to asbestosis had the greatest elevated risk (N = 10, PMR = 3.56, CI = 1.70-6.54). No elevation in risk was found for kidney cancer or for chronic nephritis which were of interest because of Ironworkers' potential exposure to lead. The present study underscores the importance of fall protection and other injury prevention efforts in the construction industry, as well as the need to control airborne exposures to asbestos, welding fumes and other respirable disease hazards.

Accidents, Occupational↗

The chronic effects of mechanical trauma to the skin: a review of the literature.

This paper summarizes the findings of a NIOSH reported entitled "The Chronic Effects of Repeated Mechanical Trauma to the Skin: A Description of the Problem in the Workplace" (the Trauma Report). Medical literature and U.S. health statistics (population surveys and occupational health reports) were reviewed to determine the long-range impact of repeated mechanical trauma sustained in the workplace. Trauma was rarely recognized as contributing to dermatological disorders. Conventional sources of information were found to be inadequate for precise estimation of costs. A minimal estimate of the annual cost of cutaneous disorders resulting from repeated mechanical trauma to the skin is $15 million.

Disability Evaluation↗

Suicide, cancer, and other causes of death among California veterinarians, 1960-1992.

Previous studies reporting on mortality patterns in veterinarians have been restricted to deaths among white male veterinarians. In an effort to examine the mortality of male and female veterinarians of all races, we conducted a standardized proportionate mortality ratio (SPMR) analysis of 450 California veterinarians who died between January 1960 and December 1992. In comparison to State of California general population statistics, white male veterinarians had significantly elevated mortality from malignant melanoma of the skin (SPMR 3.47, 95% CI 1.74, 6.94), cancer of the large intestine (SPMR 1.74, 95% CI 1.04, 2.09), rheumatic heart disease (SPMR 3.50, 95% CI 1.90, 6.43), and suicide (SPMR 2.50, 95% CI 1.84, 3.38). White female veterinarians had significantly elevated mortality from suicide (SPMR 5.89, 95% CI 3.02, 11.48). We also examined veterinary mortality for different lengths of time in the profession. Significantly elevated SPMRs were noted for suicide in veterinarians in the profession for less than 30 years; deaths due to malignant melanoma of the skin and rheumatic heart disease in veterinarians in the profession 20 years or more; and cancer of the large intestine in veterinarians in the profession 30 years or more. Because of significant findings in mortality from suicide among veterinarians of both sexes, it was recommended that future studies and efforts toward suicide prevention include both male and female veterinarians.

Adult↗

Proportionate mortality among construction laborers.

This report presents the results of proportionate mortality ratio (PMR) analyses and proportionate cancer mortality ratio (PCMR) analyses among the 11,685 members of the Laborers' International Union of North America (LIUNA), who died between 1985-1988, using U.S. proportionate mortality rates as the comparison population. Statistically significant elevated mortality risks were observed for all malignant neoplasms (N = 3285, PMR = 1.13, CI = 1.09-1.17), as well as for site-specific neoplasms of the lung (N = 1208, PCMR = 1.06, CI = 1.00-1.12), stomach (N = 170, PCMR = 1.44, CI = 1.23-1.68), and thyroid gland (N = 10, PCMR = 2.24, CI = 1.07-4.12). The PCMRs for these malignant neoplasms were elevated among both white and non-white males, regardless of length of union membership, in most 10-year categories of age at death above 40 and for the three largest LIUNA regions examined. The study also observed 20 mesothelioma deaths, which indicated that some LIUNA members had been previously exposed to asbestos. Statistically significant elevated risks were also observed for deaths from transportation injuries (N = 448, PMR = 1.37, CI = 1.25-1.51), falls (N = 85, PMR = 1.34, CI = 1.07-1.66), and other types of injuries (N = 245, PMR = 1.61, CI = 1.42-1.83). The deaths due to injuries were most often observed among those members who had the shortest amount of time within the union, were younger, and first entered the union after 1955. This is the first study that has examined the general mortality experience limited to construction laborers only (Bureau of Census code 869).

Accidents, Occupational↗

Cystic fibrosis in Ontario.

The incidence of cystic fibrosis in Ontario, Canada has been determined from clinical data, from the cystic fibrosis database of the Hospital for Sick Children, Toronto, and from population statistics in the Province of Ontario. The survey included 420 confirmed cases of cystic fibrosis born during the period 1966-1980. The mean incidence during this period was one in 2,927. In the last 5-year period, a decline was noted in incidence that may have reflected in part the effectiveness of early diagnosis and genetic counseling in affected families. During the period of the survey, over 60% of cases were diagnosed within the first year of life, 74% by age 2 years, and 90% by age 5 years. Clinical diagnosis in the first year of life was more common in males (65%) than in females (54%), a consistent finding during the period of the survey. The incidence of meconium ileus was 15.7% of ascertained cases of cystic fibrosis, with similar incidences in males (16.4%) and females (14.4%). Although survival has not been the subject of this survey, mortality in the neonatal period was significantly higher in males than in females with cystic fibrosis.

Age Factors↗

Blood groups among Brahmin and Kamma caste populations of Coastal Andhra Pradesh.

Blood specimens from Brahmin and Kamma caste populations of Coastal Andhra Pradesh, India are examined for A1A2BO, MNSs, and Rhesus blood groups. Predominance of A group in Brahmins and B group in Kammas is observed. Phenotype A2 records less than 4% in both populations. High frequencies of genes M, s, D, and e are exhibited among both populations. Statistically significant differences are found only for A1A2BO system between Brahmins and Kammas.

ABO Blood-Group System↗