Delivering on diversity: The challenges of commissioning for Whānau Ora

As the populations of Western, so-called “first-world” countries grow; so too do the pressures for the funding, purchasing, and provision of high-quality health care for their citizens.  The drive to purchase and monitor outcomes, as opposed to simply accounting for outputs, has grown in strength in New Zealand and elsewhere, as a means of ensuring greater accountability for spending and ensuring every dollar invested in health care has some positive, downstream impact. This paper, based on a small qualitative research study, explores a specific model of purchasing for outcomes, namely the Te Pou Matakana (TPM) model of Whānau Ora commissioning. We explore how commissioning as a particular model for purchasing services has fared in terms of delivering for Whānau Ora. The paper provides a brief history of Māori health provider development, as a means of establishing the roots of the TPM commissioning approach. We then explore in greater detail the commissioning approach unique to this case study site before presenting the study itself, our data collection methods, results, and analysis of those results. The paper concludes that in the New Zealand context, commissioning as a purchasing model has benefited from alignment with Whānau Ora principles, to the extent that an Indigenous model of commissioning is apparent in the TPM commissioning approach

E hoki mai nei ki te ūkaipō—Return to Your Place of Spiritual and Physical Nourishment

This paper presents the findings of the Perceptions of Papakāinga project, which explores the connection between place, genealogy, and identity for two Māori (New Zealand’s Indigenous people) communities: one living within an iwi (tribal) context, and one living within an urban context. The research explores how Māori-specific concepts which define home and identity are perceived and enacted across all participants, and how participants define ‘home’ in relation to fluid understandings of genealogy, community, and identity. Across the diverse experiences of participants, the concept of ‘whakapapa’ (genealogy), can be seen to act as a way to understand the connections between identity, people and place

“Ko Au te Whenua, Ko te Whenua Ko Au: I Am the Land, and the Land Is Me”: Healer/Patient Views on the Role of Rongoā Māori (Traditional Māori Healing) in Healing the Land

In Rongoā Māori (traditional Māori healing), the connection with the land stems from seeing Papatūānuku/Mother Earth as a part of our identity/whakapapa (genealogy), our culture, and our wellbeing. This qualitative study aimed to explore the holistic nature and meaning of Rongoā Māori. There were 49 practitioner and patient participants who participated in semi-structured interviews and focus groups across Aotearoa/New Zealand. The findings showed four themes: land as an intrinsic part of identity; land as a site and source of healing; reciprocity of the healing relationship; and the importance of kaitiakitanga/conservation to Rongoā Māori. Participants shared narratives of connections between the people and the land that showed that when the land is well, the people are well. Implications of these themes for Indigenous wellbeing and the conservation and protection of our natural environments led to three recommendations to reconnect with the land, support Rongoā Māori healing, and to participate in the conservation and preservation of local land and waterways. It is hoped that in learning more about the connection between the land and Rongoā Māori healing, we begin to place greater value on the need to conserve and preserve both the land and our connections to her through traditional healing practices

p120-Catenin regulates leukocyte transmigration through an effect on VE-cadherin phosphorylation

Vascular endothelial–cadherin (VE-cad) is localized to adherens junctions at endothelial cell borders and forms a complex with α-, β-, γ-, and p120-catenins (p120). We previously showed that the VE-cad complex disassociates to form short-lived “gaps” during leukocyte transendothelial migration (TEM); however, whether these gaps are required for leukocyte TEM is not clear. Recently p120 has been shown to control VE-cad surface expression through endocytosis. We hypothesized that p120 regulates VE-cad surface expression, which would in turn have functional consequences for leukocyte transmigration. Here we show that endothelial cells transduced with an adenovirus expressing p120GFP fusion protein significantly increase VE-cad expression. Moreover, endothelial junctions with high p120GFP expression largely prevent VE-cad gap formation and neutrophil leukocyte TEM; if TEM occurs, the length of time required is prolonged. We find no evidence that VE-cad endocytosis plays a role in VE-cad gap formation and instead show that this process is regulated by changes in VE-cad phosphorylation. In fact, a nonphosphorylatable VE-cad mutant prevented TEM. In summary, our studies provide compelling evidence that VE-cad gap formation is required for leukocyte transmigration and identify p120 as a critical intracellular mediator of this process through its regulation of VE-cad expression at junctions

The influence of training and experience on memory strategy

© 2015, Psychonomic Society, Inc. This paper investigates whether, and if so how much, prior training and experience overwrite the influence of the constraints of the task environment on strategy deployment. This evidence is relevant to the theory of soft constraints that focuses on the role of constraints in the task environment (Gray, Simms, Fu, & Schoelles, Psychological Review, 113: 461–482, 2006). The theory explains how an increase in the cost of accessing information induces a more memory-based strategy involving more encoding and planning. Experiments 1 and 3 adopt a traditional training and transfer design using the Blocks World Task in which participants were exposed to training trials involving a 2.5-s delay in accessing goal-state information before encountering transfer trials in which there was no access delay. The effect of prior training was assessed by the degree of memory-based strategy adopted in the transfer trials. Training with an access delay had a substantial carry-over effect and increased the subsequent degree of memory-based strategy adopted in the transfer environment. However, such effects do not necessarily occur if goal-state access cost in training is less costly than in transfer trials (Experiment 2). Experiment 4 used a fine-grained intra-trial design to examine the effect of experiencing access cost on one, two, or three occasions within the same trial and found that such experience on two consecutive occasions was sufficient to induce a more memory-based strategy. This paper establishes some effects of training that are relevant to the soft constraints theory and also discusses practical implications