An important landmark is reached in the evolu- tion of a scientific field when classification of its subject matter is based on the relevant, funda- mental processes involved rather than on des- criptions of the appearances of the phenomena of interest.In illustration, a fundamental turning point was reached when the debilitation and progressive susceptibility to bruising of ship- board scurvy could for the first time be classified as the process resulting from a deficiency of consumption of something variously present in fruits and vegetables (much later identified as ascorbic acid, vitamin C).In fact, such transi- tion from classifications consisting essentially only of a description of appearances to those based on fundamental processes is basic to scientific progress generally; hence, examples abound from the full gamut of scientific con- cerns.Additional illustrations, among the many, include the classificatory and conceptual tran- sitions that followed recognition: a.That rocks could be grouped on the basis of the processes involved in their formation -as sedimentary, igneous, metamorphic.b.That the variations among the Galapagos finches studied by Darwin were the result of differential ecologic processes.c.That earthquakes were one aspect of tec- tonic processes.d.That the epidemic disease of the young which could for decades be described only as 'infantile paralysis' was a rare variant of a commonplace process initiated by infection with one of several similar and previously unknown viruses.e.That plague was a process in which a specific pathogen, Pasteurella pestis, rats, fleas, and people interacted.

Oxidative modification of human low-density lipoprotein (LDL) is thought to play an important role in the development of atherosclerosis. LDL oxidizability is believed to be strongly influenced by factors such as (a) content of preexisting lipid hydroperoxides (LOOHs) and (b) content of endogenous antioxidants such as α-tocopherol and β-carotene. The purpose of this study was to examine the prooxidant role of preexisting LDL-LOOHs, using a recently developed method for ultrasensitive and selective LOOH analysis: high-performance liquid chromatography with mercury drop electrochemical detection (HPLC-EC). Exceedingly low detection limits for LDL-LOOHs have been achieved by HPLC-EC, e.g., ∼100 fmol for cholesteryl ester hydroperoxide (CEOOH). This sensitivity has allowed us to monitor LDL-LOOHs at levels that are undetectable by most other methods. Fresh LDL prepared with the utmost care to prevent autoxidation was found to contain small, yet significant amounts of CEOOH, 6-12 pmol/mg protein. Our data suggest that these peroxides could not have arisen during LDL isolation or sample work-up for HPLC-EC. Incubation with GSH and phospholipid hydroperoxide glutathione peroxidase resulted in nearly complete reduction of the CEOOH. This LDL was found to be much more resistant to Cu2+-induced peroxidation than starting material, exhibiting a lag period that was at least six times greater. We have also determined that LDL becomes progressively more susceptible to Cu2+-induced lipid peroxidation (as evidenced by a shortened lag) when it is preloaded with increasing amounts of photochemically generated LOOHs. Taken together, these results provide strong support for the idea that preexisting LOOHs in LDL are important determinants of its overall oxidizability.

The paper holds that research and preventive measures to reduce injuries stemming from the use of alcohol and other drugs in relation to motor vehicles need not always be concerned with the pharmacologic agents in crash initiation and with the characteristics of their users. It would be more constructive from the standpoint of reducing injuries to give more emphasis to those characteristics of these events whose practical modification would ameliorate or completely prevent the final result, injury of given severity. The author presents a matrix to sort out the pieces of comprehensive data collection, research, preventive or other approach to losses associated with vehicle use. The matrix also points out where alcohol and other drugs fit in the overall picture. In this matrix, the general sequence of events which lead to given totals of losses on public or private balance sheets divides into three phases of interactions which are labelled PreEvent, Event, and PostEvent. The use of the matrix and the method is discussed.

A logical system for preventing injury and death in motor vehicle crashes is based on the sequence of events (precrash, crash, and postcrash) and types of factors involved (human, vehicle and equipment, physical environment and roadway, and socioeconomic environment). By forming a matrix, various options and evidence of their effectiveness can be individually evaluated. Although screening for high-risk drivers has not been generally effective, young drivers with previous crash records have exceptionally high fatal crash involvement which suggests that these drivers should lose their driver's license after the first violation. High school driver education programs have been linked to increased licensing of 16-17 year old drivers, resulting in increased fatalities for this age group. No favorable results from high school driver training have been shown, even for drivers over 18 years of age. Alcohol abuse is a significant contributor to injury and death. Although data on vehicle safety inspection are inconclusive, evidence indicates that adding a simple, midline rear brake light will greatly reduce rear-end collisions. Vehicle crash phase programs include designing vehicle fronts less hostile to pedestrians and others, designing trucks to prevent underride by impacting cars and greatly improving the crash packaging of vehicle occupants. Crash packaging improvements encompass laminated windshields firmly anchored in place, steering assemblies and dashboards that cushion impacting occupants, doors that stay shut in crashes, protected fuel tanks, and limiting vehicle speeds to levels within the vehicle's capability to protect occupants. Passive restraints will augment the already demonstrated protection provided by seat belts, and further reduction in fatalities is expected in 1982 when these systems will be required on every new car. Precrash, physical environment, and roadway factors include nonskid road surfaces, the elimination of pedestrian crossings on highways, and the separation of vehicle and pedestrian pathways. Crash, physical environment, and roadway actions involve design, installation, and maintenance of guardrails; provision of clear roadside deceleration areas; removel of fixed poles from the roadside; provision of energy-absorbing systems where objects intrude on traffic flow; and use of breakaway sign, light, and telephone poles in high accident areas. Consideration is given to such socioeconomic factors as the quality of emergency medical care, laws affecting alcohol use, public information campaigns, and motorcycle crash helmet use. A summary of panel discussions on highway safety in Israel follows.

Successful injury control measures (stoplights, sprinkler systems, electrical insulation, evacuation) have long been commonplace. However, progress in injury control has been hampered by the failure to recognize that injuries cannot occur without the action of specific agents analogous to those of the infectious diseases and likewise transmitted by vehicles and vectors. These agents are the several forms of injury. Varying and interacting with the characteristics of the host and the environment, they constitute the classic epidemiologic triads that determine injury distributions, none of which are random. The injury-disease dichotomy, a universal in most of the world's major languages, may have resulted from the fact that at least some of the causes of injuries (for example, wild animals or falling trees) are more identifiable and proximate than the causes of diseases. The etiology of injuries suggests that for epidemiologic and public health purposes, the term injury should probably be defined so as to encompass those kinds of damage to the body that are produced by energy exchanges and that are manifested within 48 hours, or usually within considerably shorter periods. Strategies for injury control can be extended to the control of other pathological conditions. The active-passive distinction (the dimension expressing the extent to which control measures require people to do something) has a direct bearing on the success of public health programs, because passive approaches have historically had a far better record of success than active ones. Ten basic strategies have been identified that provide options for reducing the damage to people (and property) caused by all kinds of environmental hazards.

To the Editor.— The MEDICAL NEWS article, A Capsule History of US Emergency Medical Care (1980;243:1019), contains major errors of omission and commission. First, the National Highway Safety Act of 1966, signed by President Johnson in September of that year, did not just authorize funding of emergency medical services and projects; it also directed the agency, which became the present National Highway Traffic Safety Administration, to issue standards for state highway safety programs that were specifically to include one for emergency services. The National Academy of Sciences study, Accidental Death and Disability: The Neglected Disease of Modern Society , was actually published many weeks after the act was passed, by which time initial discussions were already being held between the then National Highway Safety Bureau and representatives of the governors of all 50 states. These discussions resulted in the appointment by mid-1967 by each governor of a coordinator, whose job

* Insurance Institute for Highway Safety, Washington, D.C. 20037. Second Annual William S. Stone Lecture given at the Fifth Annual Meeting of the American Trauma Society, Houston, Texas, 30 April, 1977. Figs. 1–5 reprinted with permission from “To Prevent Harm”® 1978 Insurance Institute for Highway Safety. Fig. 6, Photo by J. Linko.

A controlled study of the effect of television messages on safety belt use. L S Robertson, A B Kelley, B O'Neill, C W Wixom, R S Eiswirth, and W Haddon, JrCopyRight https://doi.org/10.2105/AJPH.64.11.1071 Published Online: October 07, 2011

The problem of human injury has been misunderstood and neglectedfor too long. Although scientific approaches have been applied to the problem of human damage from traditionally recognized environmental hazards-such as lead and pathogenic organisms-analogous approaches for controlling injuries have been largely ignored. This paper describes the etiologic agents of injuries and methods of preventing or reducing their harmful effects on man. Effective strategies for reducing human losses due to injuries go far beyond traditional concepts of accident prevention : even when cannot be prevented, there are many ways to prevent or reduce the frequency and severity of injuries and their sequelae. Important considerations in choosing injury countermeasures include effectiveness, economic constraints, and reduction of the amount of individual cooperation that is necessary. As infectious diseases gradually yield to scientific approaches, injuries assume increasing importance as a major health problem. In many countries, injuries are now the leading cause of death from early childhood through most of the fourth decade of life. Among the very young and the aged, injury deaths are primarily due to non-motor-vehicle accidents such as falls and fires. During the most productive years of life, and in many countries during childhood as well, motor-vehicle fatalities comprise the largest category of injury deaths. Increases in the number and use of motor vehicles have been accompanied by dramatic increases in the number of deaths and injuries, especially among teen-agers and young adults (Aldman and Thorson, 1971). Despite its magnitude, the problem of injury has been the subject of more folklore and less competent scientific attention than has any other serious problem in medicine. Most of the folklore has been associated with the word accident, with its connotations of fate, chance, and unexpectedness. However, the notion of fate is inappropriate, because injuries can be prevented or reduced in their severity; they are not chance or random events but the predictable results of specific combinations of human and environmental factors; and they are no more unexpected than most diseases.

A method for comparing death rates of groups of injured persons was developed, using hospital and medical examiner data for more than two thousand persons. The first step was determination of the extent to which injury severity as rated by the Abbreviated Injury Scale correlates with patient survival. Substantial correlation was demonstrated. Controlling for severity of the primary injury made it possible to measure the effect on mortality of additional injuries. Injuries that in themselves would not normally be life-threatening were shown to have a marked effect on mortality when they occurred in combination with other injuries. An Injury Severity Score was developed that correlates well with survival and provides a numerical description of the overall severity of injury for patients with multiple trauma. Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma.

The buzzer-light reminder system and safety belt use. L S Robertson, and W Haddon, JrCopyRight https://doi.org/10.2105/AJPH.64.8.814 Published Online: October 07, 2011

A major class of ecologic phenomena involves the transfer of energy in such ways and amounts, and at such rapid rates, that inanimate or animate structures are damaged. The harmful interactions with people and property of hurricanes, earthquakes, projectiles, moving vehicles, ionizing radiation, lightning, conflagrations, and the cuts and bruises of daily life illustrate this class. There are ten strategies for reducing the human and other losses that make this class of social concern. These are identified in logical sequence and copiously illustrated by tactics widely employed. The reduction of animate and inanimate damage due to interaction with most environmental hazards, including pollutants, drugs, and microorganisms can be approached in the same manner, as can strategies for population control. Appendices provide additional examples and four illustrative case studies concerned, respectively, with reducing: losses associated with femoral fractures among the elderly; thermal energy damage to children and others; drownings; mob damage to the White House or other private or public building.

An important landmark is reached in the evolution ofa scientific field when classification of its subject matter is based on the relevant, fundamental processes involved rather than on descriptions of the appearances of the phenomena of interest. In illustration, a fundamental turning point was reached when the debilitation and progressive susceptibility to bruising of shipboard scurvy could for the first time be classified as the process resulting from a deficiency of consumption of something variously present in fruits and vegetables (much later identified as ascorbic acid, vitamin C). In fact, such transition from classifications consisting essentially only of a description of appearances to those based on fundamental processes is basic to scientific progress generally; hence, examples abound from the full gamut of scientific concerns. Additional illustrations, among the many, include the classificatory and conceptual transitions that followed recognition: a. That rocks could be grouped on the basis ofthe processes involved in their formation as sedimentary, igneous, metamorphic. b. That the variations among the Galapagos finches studied by Darwin were the result of differential ecologic processes. c. That earthquakes were one aspect of tectonic processes. d. That the epidemic disease of the young which could for decades be described only as 'infantile paralysis' was a rare variant of a commonplace process initiated by infection with one of several similar and previously unknown viruses. e. That plague was a process in which a specific pathogen, Pasteurella pestis, rats, fleas, and people interacted.

A LOGICAL FRAMEWORK FOR CATEGORIZING HIGHWAY SAFETY PHENOMENA AND ACTIVITY WILLIAM HADDON; The Journal of Trauma: Injury, Infection, and Critical Care

Automobile head restraints--frequency of neck injury claims in relation to the presence of head restraints. B O'Neill, W Haddon, Jr, A B Kelley, and W W SorensonCopyRight https://doi.org/10.2105/AJPH.62.3.399 Published Online: October 07, 2011

ENVIRONMENT, POWER, AND SOCIETY William Haddon, Jr. CopyRight https://doi.org/10.2105/AJPH.61.10.2142-b Published Online: August 29, 2011