Family practice physicians' firearm safety counseling beliefs and behaviors

The purpose of this study was to identify family physicians' firearm safety counseling beliefs and behaviors. A survey was mailed to a random sample of 600 members of the American Academy of Family Physicians. A three wave mailing technique was used to maximize the response rate and yielded 271 usable surveys (55% response rate). Outcome measures included training experience in firearm safety counseling, the prevalence of firearm safety counseling by family physicians, and their perceptions regarding such counseling. The majority (78%) of family physicians lacked formal training on how to counsel patients about firearm safety and 49% believed more time should be spent in residency programs on firearm safety counseling. The majority (84%) of respondents never or rarely counseled patients on firearm safety and 50% believed firearm safety counseling should be a low priority in their delivery of primary care. The majority of respondents did not regularly counsel patients about firearm safety, did not believe firearm safety counseling should be a priority, and did not believe firearm safety counseling would be effective in reducing firearm-related trauma.     

Frequent clones of p53-mutated keratinocytes in normal human skin

The multiple genetic hit model of cancer predicts that normal individuals should have stable populations of cancer-prone, but noncancerous, mutant cells awaiting further genetic hits. We report that whole-mount preparations of human skin contain clonal patches of p53-mutated keratinocytes, arising from the dermal-epidermal junction and from hair follicles. These clones, 60-3000 cells in size, are present at frequencies exceeding 40 cells per cm2 and together involve as much as 4% of the epidermis. In sun-exposed skin, clones are both more frequent and larger than in sun-shielded skin. We conclude that, in addition to being a tumorigenic mutagen, sunlight acts as a tumor promoter by favoring the clonal expansion of p53-mutated cells. These combined actions of sunlight result in normal individuals carrying a substantial burden of keratinocytes predisposed to cancer.     

A risk approach to the management of boiler tube thinning

A large set of industrial thickness inspection data covering four boiler units of a power station over a period of five years was made available to the authors. The measurements were made in regions of the boiler where corrosion/erosion was the major cause of failure of the boiler tubes. There were over 40,000 separately measured data points in the data and all were collected with some care and expense.In the development of maintenance strategies for equipment, this type of data is typical of the data that must be collected and assessed. This data thus represents an opportunity to evaluate the ability to generate a useful risk approach to the management of the tubing.An important example of a risk-based approach is the American Petroleum Institute (API) Risk Based Inspection (“RBI”), API 581. A variety of problems were encountered applying this to boiler tubes. The problems include irrelevant API 581 corrosion rate tables, lack of information on how to analyse inspection data, difficulty of dealing with multiple inspection categories and lack of suitable direction for programming inspection intervals.