Politics, ecologies and professional regulation: The case of British Columbia's Professional Governance Act

A variety of theories have been proposed to explain why states pass legislation to regulate professional groups, and why, more recently, they have acted to curtail professional privileges. While these theories have drawn attention to the importance of power dynamics and public protection, among other factors, the role of political interests has been downplayed. This article builds on ecological theory to argue that, with some modifications, the theory illuminates the centrality of state-profession relations and politics to regulatory change. The theory is applied to a case study of regulatory change in British Columbia, Canada impacting resources-sector professions, with particular attention to the controversies and political considerations that shaped reform. The case study suggests that when the political and professions ecologies are overlapping and symbiotic, as they were in BC, a challenge in the political ecology can implicate professions, prompting a solution that brings change within both ecologies.

Virtual care during COVID-19: The perspectives of older adults and their healthcare providers in a cardiac rehabilitation setting

The present study aimed to explore the perspectives of older adults and health providers on cardiac rehabilitation care provided virtually during COVID-19. A qualitative exploratory methodology was used. Semi-structured interviews were conducted with 15 older adults and 6 healthcare providers. Five themes emerged from the data: (1) Lack of emotional intimacy when receiving virtual care, (2) Inadequacy of virtual platforms, (3) Saving time with virtual care, (4) Virtual care facilitated accessibility, and (5) Loss of connections with patients and colleagues. Given that virtual care continues to be implemented, and in some instances touted as an optimal option for the delivery of cardiac rehabilitation, it is critical to address the needs of older adults living with cardiovascular disease and their healthcare providers. This is particularly crucial related to issues accessing and using technology, as well as older adults' need to build trust and emotional connection with their providers.

Transitional Care from Hospital to Cardiac Rehabilitation During COVID-19: The Perspectives of Older Adults and Their Healthcare Providers

Transitional care to cardiac rehabilitation during the pandemic was a complex process for older adults, with additional challenges for decision-making and participation. This study aimed to explore the perspectives of older adults and health providers on transitional care from the hospital to cardiac rehabilitation, focusing on patient participation in decision-making. A qualitative exploratory design was used. Semi-structured interviews were conducted with 15 older adults and 6 healthcare providers. Document analysis and reflexive journaling were used to support triangulation of findings. Six themes emerged from the data, related to insufficient follow-up from providers, the importance of patients' emotional and psychological health and the support provided by family members, the need for information tailored to patients' needs and spaces for participation in decision-making, as well as challenges during COVID-19, including delayed medical procedures, rushed discharge and isolating hospital stays. The findings of this study indicated a number of potential gaps in the provision of transitional care services as reported by older adults who had a cardiovascular event, often during the first few weeks post hospital discharge.

Protecting the public interest while regulating health professionals providing virtual care: A scoping review

Technology is transforming service delivery in many health professions, particularly with the rapid shift to virtual care during the COVID-19 pandemic. Health profession regulators must navigate legal and ethical complexities to facilitate virtual care while upholding their mandate to protect the public interest. The objectives of this scoping review were to examine how the public interest is protected when regulating health professionals who provide virtual care, discuss policy and practice implications of virtual care, and make recommendations for future research. We searched six multidisciplinary databases for academic literature published in English between January 2015 and May 2021. We also searched specific databases and websites for relevant grey literature. After screening, 59 academic articles and 18 grey literature sources were included for analysis. We identified five key findings: the public interest when regulating health professionals providing virtual care was only implicitly considered in most of the literature; when the public interest was discussed, the dimension of access was emphasized; criticism in the literature focused on social ideologies driving regulation that may inhibit more widespread use of virtual care; subnational licensure was viewed as a barrier; and the demand for virtual care during COVID-19 catalyzed licensure and scope of practice changes. Overall, virtual care introduces new areas of risk, potential harm, and inequity that health profession regulators need to address as technology continues to evolve. Regulators have an essential role in providing clear standards and guidelines around virtual care, including what is required for competent practice. There are indications that the public interest concept is evolving in relation to virtual care as regulators continue to balance public safety, equitable access to services, and economic competitiveness.

Protecting the public interest when regulating health professionals providing virtual care: a scoping review protocol

BACKGROUND

Virtual care is transforming the nature of healthcare, particularly with the accelerated shift to telehealth and virtual care during the COVID-19 pandemic. Health profession regulators face intense pressures to safely facilitate this type of healthcare while upholding their legislative mandate to protect the public. Challenges for health profession regulators have included providing practice guidance for virtual care, changing entry-to-practice requirements to include digital competencies, facilitating interjurisdictional virtual care through licensure and liability insurance requirements, and adapting disciplinary procedures. This scoping review will examine the literature on how the public interest is protected when regulating health professionals providing virtual care.

METHODS

This review will follow the Joanna Briggs Institute (JBI) scoping review methodology. Academic and grey literature will be retrieved from health sciences, social sciences, and legal databases using a comprehensive search strategy underpinned by Population-Concept-Context (PCC) inclusion criteria. Articles published in English since January 2015 will be considered for inclusion. Two reviewers will independently screen titles and abstracts and full-text sources against specific inclusion and exclusion criteria. Discrepancies will be resolved through discussion or by a third reviewer. One research team member will extract relevant data from the selected documents and a second will validate the extractions.

DISCUSSION

Results will be presented in a descriptive synthesis that highlights implications for regulatory policy and professional practice, as well as study limitations and knowledge gaps that warrant further research. Given the rapid expansion of virtual care provision by regulated health professionals in response to the COVID-19 pandemic, mapping the literature on how the public interest is protected in this rapidly evolving digital health sector may help inform future regulatory reform and innovation.

SYSTEMATIC REVIEW REGISTRATION

This protocol is registered with the Open Science Framework ( https://doi.org/10.17605/OSF.IO/BD2ZX ).

Regulating for-profit virtual care in Canada: Implications for medical profession regulators and policy-makers

For-profit virtual medical care has been expanding rapidly in Canada, creating new societal and practical challenges requiring policy and regulatory reform. We mapped the current state of regulatory policy across 10 Canadian provinces by analyzing practice standards and guidelines for virtual care from medical profession regulators. Through a comparative framework, we assessed the extent to which virtual practice policies addressed issues around mobility and licensure, equitable access, privacy, complaints, and continuity of care. We also compared these regulatory documents to the model standards from the Canadian medical regulatory consortium and considered implications for practicing in for-profit virtual environments. We found considerable variation across provincial regulatory bodies, with most existing frameworks not adequately addressing equity, access, and practitioner competency and not providing flexible, nuanced, or risk-based approaches to virtual care provision. As we compared jurisdictions, we identified gaps and leading practices to inform recommendations for professional regulators and policy-makers.

Regulating in the public interest: Lessons learned during the COVID-19 pandemic

This article has three aims. First, to reflect on how conceptualizations of the public interest may have shifted due to COVID-19. Second, to focus on the implications of regulatory responses for the health workforce and corresponding lessons as health leaders and systems transition from pandemic response to pandemic recovery. Third, to identify how these lessons lead to potential directions for future research, connecting regulation in a whole-of-systems approach to health system safety and health workforce capacity and sustainability. Pandemic regulatory responses highlighted both strengths and limitations of regulatory structures and frameworks. The COVID-19 pandemic may have introduced new considerations around regulating in the public interest, particularly as the impact of regulatory responses on the health workforce continues to be examined. Clearly articulating practitioner practice parameters, reducing barriers to practice, and working collaboratively with stakeholders were primary aspects of regulators' pandemic responses that impacted the health workforce.

Drivers of regulatory reform in Canadian health professions: Institutional isomorphism in a shifting social context

Research has documented how the decline in professional self-regulation in the UK and Australia was led by policy-makers in response to regulatory failures. In Canada, professional self-regulation is currently in decline as well, and while policy-makers have driven some change it is also the case that self-regulating professions have begun to transform themselves from within: altering their structure, make-up, and processes to enhance fairness, public input, and accountability, while reducing professional control. Why would they do so? This paper draws on the concept of institutional isomorphism to understand why professional regulators would invoke changes that, on the surface, might seem to counteract their own interests. Analysing data from 46 interviews with leaders in healthcare profession regulation, this paper examines how coercive, mimetic, and normative processes drive regulatory reform in a changing regulatory field.

"The workload is staggering": Changing working conditions of stay-at-home mothers under COVID-19 lockdowns

The COVID-19 pandemic has drawn attention to the home as a work environment, but the focus has centered on the experiences of paid workers. Stay-at-home mothers (SAHMs), for whom the home was already a workplace, have received little attention. This article explores how pandemic-induced lockdowns impacted SAHMs' working conditions and their experiences of childrearing. Combining a Marxist-feminist conceptualization of domestic labor with a labor process framework, we performed a qualitative content analysis of vignettes SAHMs shared about their day-to-day domestic labor in an online mothering community. Our findings show that, under lockdown conditions, the primacy given to partners' paid work combined with children's increased demands for care and attention reduced SAHMs work autonomy and exacerbated gender inequalities in the home. Combining labor process theory with literature on motherwork illuminates the home as a gendered work environment and enhances understanding of how changing conditions of domestic labor can intensify gender inequalities (and workers' awareness of them) that typically remain "hidden in the household."

How gender shapes interprofessional teamwork in the operating room: a qualitative secondary analysis

BACKGROUND

Despite substantial implications for healthcare provider practice and patient outcomes, gender has yet to be systematically explored with regard to interprofessional operating room (OR) teamwork. We aimed to explore and describe how gender and additional social identity factors shape experiences and perceptions of teamwork in the OR.

METHODS

This study was a qualitative secondary analysis of semi-structured interviews with OR team members conducted between November 2018 and July 2019. Participants were recruited across hospitals in Ontario, Canada. We conducted both purposive and snowball sampling until data saturation was reached. Transcripts were analyzed thematically by two independent research team members, moving from open to axial coding.

RESULTS

Sixty-six interviews of OR healthcare professionals were completed: anesthesia (n=17), nursing (n=19), perfusion (n=2), and surgery (n=26). Traditional gender roles, norms, and stereotypes were perceived and experienced by both women and men, but with different consequences. Both women and men participants described challenges that women face in the OR, such as being perceived negatively for displaying leadership behaviours. Participants also reported that interactions and behaviours vary depending on the team gender composition, and that other social identities, such as age and race, often interact with gender. Nevertheless, participants indicated a belief that the influence of gender in the OR may be modified.

CONCLUSIONS

The highly gendered reality of the OR creates an environment conducive to breakdowns in communuication and patient safety risks in addition to diminishing team morale, psychological safety, and provider well-being. Consequently, until teamwork interventions adequately account for gender, they are unlikely to be optimally effective or sustainable.

Health professional regulation in historical context: Canada, the USA and the UK (19th century to present)

BACKGROUND

There is no widespread agreement over what form healthcare professional regulation should take, and the evidence base concerning the effectiveness and fairness of regulatory systems and practices is limited. Those urging policy change argue there is a need to modernize; however, there is much we can learn from reviewing the history of healthcare professional regulation.

MAIN BODY

An overview of the history of regulation in Canada, with consideration of the United States of America and the United Kingdom, is provided. Self-regulating professions emerged in the nineteenth century, influenced by a variety of stakeholders responding to local concerns for healthcare quality, access and professional training. Regulatory practices changed over the course of the twentieth and twenty-first centuries in response to changing stakeholders and shifting interests.

CONCLUSIONS

Reviewing the history of healthcare professional regulation reveals lessons to inform policy in a range of settings.

From protective to connective professionalism: Quo Vadis professional exclusivity?

This essay is composed of commentaries from four scholars critically evaluating Noordegraaf’s article ‘Protective or Connective Professionalism? How Connected Professionals Can (Still) Act as Autonomous and Authoritative Experts’. All four scholars, in different ways and from their different perspectives, question the dichotomy at the heart of Noordegraaf’s article, arguing that professionals have always been connective and connected, and moreover, that protective professionalism has not disappeared. They recommend more conceptual development to unpack the changing nature of connectivity and protectionism, as well as more attention to inequalities within and among professions, power, and professional agency.

Connective professionalism: Towards (yet another) ideal type

In this essay, four leading scholars provide critical commentary on an article entitled ‘Protective or Connective Professionalism? How Connected Professionals Can (Still) Act as Autonomous and Authoritative Experts’ (Noordegraaf, 2020, Journal of Professions and Organization, 7/2). Of central concern to all four commentators is Noordegraaf’s use of ideal types as a heuristic device to make his case and capture historical change over time. While some question the usefulness of ideal types, others question Noordegraaf’s use of them. The commentators raise additional concerns, especially the limited attention to variations across professions, geographic regions, and limited attention to social–historical contexts.

Professional employees and professional managers: conflicting logics, hybridity, and restratification

A plethora of studies have documented the changing nature of professional work and the organizations in which it takes place. Among the most documented trends are the emergence of managerial–professional hybrid workers and professional (re)stratification. Although the links between these two trends have been noted, their interconnections have not been fully explored. This article analyzes data from a mixed-methods study of professional engineers in Ontario, Canada, to explore the extent to which they experience conflicting logics, hybridity, resistance, and restratification. Findings indicate that many engineers could be classified as hybrid, as they see managerial roles as an extension of engineering. At the same time, many others see managers as oppositional to engineers, with different priorities. On the whole, there is evidence of restratification as the work experiences, professional attitudes, and responses to conflicting logics (hybridity or resistance) vary between managers and employees. This restratification has the potential to undermine professional unity.

Chiropody/Podiatry: Interprovincial Differences in Profession Formation

The regulation of foot health care professionals varies across provinces in Canada. In Ontario, the regulated health profession is chiropody. Chiropodists are foot specialists with a limited scope of practice. In contrast, British Columbia and five other provinces regulate podiatrists, who are highly trained foot physicians with an extensive scope of practice. This article explores the history of chiropody/podiatry in Ontario and British Columbia from the early 1900s through the 1980s in order to understand how professional development in this field took such divergent paths within Canada. In so doing, it not only sheds light on a health practice that has received little scholarly attention, but it also highlights the centrality of inter-professional conflict and state actors' agendas to professional regulatory outcomes.

"Drop dead … I need your job": An exploratory study of intra-professional conflict amongst nurses in two Ontario cities

Past studies have focused on inter-professional conflict and its implication for professional status and work. However, there is a dearth of research on intra-professional conflict and its implications for professions. This study explores intra-professional conflicts among nurses in Ontario, using a qualitative research design, drawing on in-depth interviews with 66 nurses. The study identifies conflicts along race and age: Visible minority and younger nurses report more conflict, with visible minority nurses particularly vulnerable and racially marginalized. Members of Visible minorities and young nurses responded to workplace conflict by demonstrating competence, seeking support from colleagues, and either ignoring the abuse or standing up for themselves. These strategies do nothing to challenge professional unity. Nonetheless, intra-professional conflict has negative consequences for professionals and their work.

Feminism and Women's Health Professions in Ontario

Historically, prevailing gender ideologies were an important element in both the exclusionary strategies employed by male occupational groups and the countervailing responses by female groups. The way in which evolving gender ideologies, and feminism in particular, influence the continuing struggle for greater status and recognition by female professions, however, remains to be fully explored. In this paper, we examine the impact and the role of feminism and feminist ideologies within three female professional projects: nursing, dental hygiene and midwifery in Ontario. We argue that feminism provides an ideology of opposition that enables leaders in these professions to battle against professional inequalities by laying bare the gender inequalities that underlie them. Framing their struggles in feminist terms, female professions also seek recognition for the uniquely female contribution they make to the health care division of labour. At the same time, there exists a tension between ideals of feminism and ideals of professionalism, that has the potential to undermine female professional projects.

Attitudes to independent dental hygiene practice: dentists and dental hygienists in Ontario

This study examined Ontario dentists' and dental hygienists' attitudes to independent dental hygiene practice and changing the scope of practice. Data were collected from a mail survey of a systematic, stratified sample of Ontario dentists (483 respondents) and dental hygienists (437 respondents) conducted in the winter and spring of 2002 to assess what practising dentists and dental hygienists think about independent practice and other professional issues. Contrary to previous research, this study found that male and female dentists did not differ in their attitudes to independent dental hygiene practice and university education for dental hygienists: both strongly opposed the former and tended to support the latter. Similarly, few differences in attitude amongst dentists by specialty were found. Dental hygienists were generally supportive of independent practice and of expanding their scope of practice. On some measures, however, sex and age differences in attitudes were evident: at times dental hygienists who were older or male seemed to be stronger advocates for professional change than others.

Inter-professional conflict and professionalization: dentistry and dental hygiene in Ontario

In Ontario, Canada, an inter-professional struggle is occurring between the professions of dentistry and dental hygiene over who should be the primary oral health care provider for the public; that is, when someone seeks dental treatment, who should they see first? This conflict has been spurred by recent changes in the regulation of health care professions, changing markets for professional services, and the professional projects pursued by dental hygiene and dentistry. An examination of the history and dimensions of dentistry-dental hygiene relations, reveals the extent to which professionalization both provokes and is shaped by inter-professional conflict.

Professionalization, gender and female-dominated professions: dental hygiene in Ontario

This paper explores the influence of gender and feminism on the professional projects of female-dominated professions, through a case study of dental hygiene in Ontario. Full professional status has eluded many female-dominated professions, including dental hygiene. Historically, dental hygiene was defined as work for women, to be performed strictly under the control of male dentists. In recent years, dental hygiene has pursued a professional project and struggled for greater independence from dentistry. Ideas about gender and, particularly, feminism have been central to their professional project.

Children's illness drawings and asthma symptom awareness

This study examines the relationship between children's abilities to perceive their symptoms of asthma via several previously researched subjective and objective procedures compared with their performance on a standardized children's drawing task and scale criteria. Results indicated that girls verbalized significantly more emotions about their drawings and were better able to detect airflow changes in their small airways than boys. The Gabriels Asthma Perception Drawing Scales (GAPDS) is a promising clinical tool for assessing children's perceptions and emotions about asthma via nonverbal methods. Varying methods of measuring asthma symptom awareness are not highly correlated; thus, more than one methodology is appropriate for use with children.

Activator protein 1 transcription factors are fundamental to v-rasHa-induced changes in gene expression in neoplastic keratinocytes

The induction of mouse skin papillomas by initiation-promotion protocols is associated with aberrant expression of epithelial markers in the tumor mass. Similarly, initiation of mouse keratinocytes with a retrovirus encoding the v-rasHa gene (v-rasHa keratinocytes) causes characteristic alterations of epidermal gene expression (A. A. Dlugosz et at, Cancer Res., 54: 6413-6420, 1994). Because activator protein 1 (AP-1) proteins are likely targets of Ras activation, we have examined the role of AP-1 factors in v-rasHa keratinocytes. Introduction of v-rasHa into keratinocytes up-regulates c-Fos, deltaFos B, and Fra-1 transcripts and protein levels in nuclear extracts. The expression of Jun proteins is not significantly altered in v-rasHa keratinocytes. Transduction of cells with v-rasHa results in increased AP-1-dependent transcriptional activity, which is also simulated by transfection of keratinocytes with either c-Fos or deltaFos B but not Fra-1, suggesting that the up-regulation of c-Fos and deltaFos B contributes to this effect. To explore the role of AP-1 proteins in regulating keratinocyte markers in v-rasHa keratinocytes, we blocked the binding of AP-1 proteins to DNA by infecting keratinocytes with an adenovirus encoding a dominant-negative Fos mutant (A-FOS). A-FOS replaces endogenous Fos proteins in the formation of heterodimers with Jun family members and thus prevents the AP-1 transcription factor from binding to DNA. In v-rasHa keratinocytes, the A-FOS virus reversed the suppression of keratins 1 and 10 transcripts and protein, which is characteristically seen in tumors and v-rasHa keratinocytes. A-FOS also increased protein levels but reduced transcripts for the late marker, loricrin, a component of the cornified envelope. These findings indicate that AP-1 proteins are involved in the changes in gene expression that define the v-rasHa phenotype in mouse keratinocytes.

CRE DNA binding proteins bind to the AP-1 target sequence and suppress AP-1 transcriptional activity in mouse keratinocytes

Previously, we have shown that nuclear extracts from cultured mouse keratinocytes induced to differentiate by increasing the levels of extra-cellular calcium contain Fra-1, Fra-2, Jun B, Jun D and c-Jun proteins that bind to the AP-1 DNA binding sequence. Despite this DNA binding activity, AP-1 reporter activity was suppressed in these cells. Here, we have detected the CREB family proteins CREB and CREMalpha as additional participants in the AP-1 DNA binding complex in differentiating keratinocytes. AP-1 and CRE DNA binding activity correlated with the induction of CREB, CREMalpha and ATF-1 and CREB phosphorylation at ser133 (ser133 phospho-CREB) in the transition from basal to differentiating keratinocytes, but the activity of a CRE reporter remained unchanged. In contrast, the CRE reporter was activated in the presence of the dominant-negative (DN) CREB mutants, KCREB and A-CREB, proteins that dimerize with CREB family members and block their ability to bind to DNA. The increase in CRE reporter activity in the presence of these mutants suggests that CRE-mediated transcriptional activity is suppressed in keratinocytes through protein-protein interactions involving a factor that dimerizes with the CREB leucine zipper. In experiments where the A-CREB mutant was co-transfected with an AP-1 reporter construct, transcriptional activity was also increased indicating that a CREB family member binds AP-1 sites and represses AP-1 transcriptional activity as well. Exogenous expression of the transcriptional repressor CREMalpha down-regulated both CRE and AP-1 reporters in keratinocytes suggesting that this factor may contribute to the suppression of AP-1 transcriptional activity observed in differentiating keratinocytes.

Developing a clinical competency examination in radiology: part II--test results

BACKGROUND

This is the second of two articles introducing a clinical competency examination in radiology. The first article described the structure, administration, and postexamination student comments for two versions of the radiology competency examination. This article reports the results obtained from these two administrations of the examinations.

OBJECTIVE

To measure and identify potential outcome predictors of student aptitude in clinical film interpretation.

DESIGN

Experimental.

METHODS

An examination was developed to simulate the radiologic interpretive skills needed in clinical chiropractic practice. Two versions of the examination were given to a class of 210 ninth trimester students in a 10-trimester chiropractic program. Linear regression and bivariate correlations were performed on possible predictors of student success and test scores on the version 2 examination.

RESULTS

On version 1 of the examination, students were able to identify an average of 59.6% of the normal cases as normal and 51.6% of abnormal cases as abnormal. On version 2, 55.6% of the normal cases were recognized as normal and 58.2% of abnormal cases as abnormal. On both versions, students were less successful at correctly categorizing, managing, or naming pathologic conditions they found. Of the predictors evaluated, only the students' grades in the third radiology course (tumors, arthritides, and extremity trauma) and the scores on the diagnostic imaging section of National Boards part II were significant predictors.

DISCUSSION

Our results should cause some concern for educators who use content-based radiology curricula. Students demonstrated poor abilities to recognize, categorize, manage, and identify common radiographic pathologic conditions. Educators cannot rely on National Board scores and course grades to determine student clinical competency. More radiology clinical competency exercises that emphasize film interpretation need to be incorporated into content-based curricula.

Developing a clinical competency examination in radiology: part I--test structure

BACKGROUND

There is a need for radiology educational outcome measures that evaluate clinical competency. This is the first of two articles introducing a clinical competency examination in radiology. This first article describes the evolution and structure of the examination. The second article presents the results of two administrations of the examination and evaluates possible outcome predictors.

OBJECTIVE

To develop a measure of clinical competency in radiology.

DESIGN

Descriptive.

METHODS

A test was developed to simulate the radiologic interpretive skills needed in clinical chiropractic practice. Students were timed as they responded to questions regarding the localization, categorization, management, and identification of pathologic conditions presented on plain film images of the spine and chest. Twenty-five radiographic cases were displayed at individual viewbox stations, and student responses to the 4 questions were compared with the consensus responses of 2 radiology instructors.

RESULTS

Two versions of the test, using different cases, were given to the same ninth trimester class of 210 chiropractic students in a 10-trimester program. Of the 210 students, 116 (55.2%; 86 men and 30 women) took version 1 of the examination, and 1 month later 181 (86.2%: 138 men and 43 women) took version 2 of the examination. Student comments after each examination were favorable.

CONCLUSION

The test structure uniquely provides information related to the student's ability to localize, categorize, manage, and identify pathologic conditions on imaging studies. At present the examination is instructor time intensive; further refinement is needed before wide implementation can occur.

Curriculum integration in nutrition and mathematics

Today's school-aged children face a multitude of health issues that affect their well-being and academic performance. Partnerships have developed between health and education agencies to help American children succeed at math and science and to prepare them to make healthful, lifelong decisions. Curriculum integration provides a framework for children to apply knowledge from several disciplines and to use this knowledge to solve real-life problems at work and at play. Goals for instruction focus on the needs not only of the individual but also of society. Nutrition science and mathematics form a natural partnership. Nutrition science incorporates numerous mathematical concepts and procedures such as sorting, classifying, statistics, probability, estimation, and rates and proportion. In preparation for participation in a global and technological society that will require citizens to be quantitative thinkers, educators must endeavor to assist all children in becoming adults who are mathematically literate and competent.

Surveys yield data on practice overhead, compensation, and productivity

Results of three separate surveys conducted in 1996 on group practice costs, management and physician compensation, and productivity showed surprising results. Family practice has the highest overhead of any specialty. Medical practices seem willing to pay premium rates to hire experienced managed care administrators and/or those with large medical practice experience. And even though specialty physicians' productivity is increasing faster than that of primary care physicians, the primary care physicians' pay is increasing faster.

Yunnanxane and its homologous esters from cell cultures of Taxus chinensis var. mairei

From cell cultures of Taxus chinensis var. mairei, yunnanxane [2 alpha, 5 alpha, 10-beta triacetoxy-14 beta-(2'-methyl-3'-hydroxyl)-butyryloxy-4(20),11-taxadiene, [1], and four new homologous esters, 2 alpha, 5 alpha, 10 beta, 14 beta- tetra-acetoxy-4(20),11-taxadiene [2], 2 alpha, 5 alpha, 10 beta- triacetoxy-14 beta-propionyloxy-4(20),11-taxadiene [3], 2 alpha, 5 alpha, 10 beta- triacetoxy-14 beta-isobutyryloxy-4(20),11- taxadiene [4], and 2 alpha, 5 alpha, 10 beta- triacetoxy-14 beta-(2'-methyl)-butyryloxy-4(20),11- taxadiene [5] have been isolated. Their structures were determined by spectroscopic methods.

New bioactive taxoids from cell cultures of Taxus baccata

Four new taxoids were isolated from cell cultures of Taxus baccata. Their structures were elucidated by spectroscopic analyses. Two were the aglycones corresponding to previously isolated 7-O-xylosides of taxol C [1] and 10-deacetyltaxol C [2]. The third [3] had an N-methylated side-chain, while the fourth, named taxcultine [4], contained an n-propyl group on the side-chain. All four compounds actively promoted tubulin assembly. Taxol C [1] showed potent and selective cytotoxicity in the NCI human cell line screen.