Principles for embedding learning and adaptation into New Zealand health system functioning: the example of the Viable System Model.

This article makes the case for taking a model-based management approach, specifically using the Viable System Model (VSM), to embed learning and adaptation into the New Zealand health system so it can function as a learning health system. We draw on a case study of a specialist clinical service where the VSM was used to guide semi-structured interviews and workshops with clinicians and managers and to guide analysis of the findings. The VSM analysis revealed a lack of clarity of organisational functioning, and of the systems, processes and integrated IT infrastructure necessary to support the fundamental requirements of a learning health system.

Next Steps for Medical Specialist Enterprises in the Netherlands: Building Strong Clinical Governance and Leadership Comment on "Alignment in the Hospital-Physician Relationship: A Qualitative Multiple Case Study of Medical Specialist Enterprises in the Netherlands".

This commentary article responds to the research into development of medical specialist enterprises (MSEs) in the Netherlands conducted by Ubels and van Raaij. The MSEs are a relatively new phenomenon in the Netherlands and similar conceptually to medically-led developments in other health systems. With the foundation for medical specialist organisation in place this provides several opportunities for further development.

Erratum: Flavor Identification of Reconstructed Hadronic Jets [Phys. Rev. Lett. 130, 161901 (2023)].

This corrects the article DOI: 10.1103/PhysRevLett.130.

Pollen food allergy syndrome secondary to molds and raw mushroom cross-reactivity: a case report.

Background: Pollen food allergy syndrome (PFAS) is an immunoglobulin E (IgE) mediated reaction that causes oropharyngeal pruritus or angioedema due to homologous proteins present in the culprit food as well as a sensitizing aeroallergen. This cross-reactivity has been well established between pollen and fruits/vegetables. Given the evolutionary similarity between all fungi; cross-reactivity between spore forming microfungi and edible macrofungi have been suggested, however only a limited number of case reports have ever been published on this phenomenon.

Impact of health system governance on healthcare quality in low-income and middle-income countries: a scoping review.

Introduction: Improving healthcare quality in low-/middle-income countries (LMICs) is a critical step in the pathway to Universal Health Coverage and health-related sustainable development goals. This study aimed to map the available evidence on the impacts of health system governance interventions on the quality of healthcare services in LMICs.

Methods: We conducted a scoping review of the literature.

How did New Zealand's regional District Health Board groupings work to improve service integration and health outcomes: a realist evaluation.

Objectives: In Aotearoa New Zealand (NZ), integration across the healthcare continuum has been a key approach to strengthening the health system and improving health outcomes. A key example has been four regional District Health Board (DHB) groupings, which, from 2011 to 2022, required the country's 20 DHBs to work together regionally. This research explores how this initiative functioned, examining how, for whom and in what circumstances regional DHB groupings worked to deliver improvements in system integration and health outcomes and equity.

Flavor Identification of Reconstructed Hadronic Jets.

Identifying the flavor of reconstructed hadronic jets is critical for precision phenomenology and the search for new physics at collider experiments, as it allows one to pinpoint specific scattering processes and reject backgrounds. Jet measurements at the LHC are almost universally performed using the anti-k_{T} algorithm; however, no approach exists to define the jet flavor for this algorithm that is infrared and collinear safe. We propose a new approach, a flavor-dressing algorithm, that is infrared and collinear safe in perturbation theory and can be combined with any definition of a jet.

What is important for high quality rural health care? A qualitative study of rural community and provider views in Aotearoa New Zealand.

Introduction: While the general principles of healthcare quality are well articulated internationally, less has been written about applying these principles to rural contexts. Research exploring patient and provider views of healthcare quality in rural communities is limited. This study investigated what was important in healthcare quality particularly for hospital-level care for rural communities in Aotearoa New Zealand.

Thiophosphinoyl-Tethered Ylide-Substituted Heavier Carbenes: Synthesis, Structures and Stabilities.

The synthesis and structure analysis of a series of mono and diylide-substituted tetrylenes of type YEX and Y E (E=Ge, Sn, Pb; X=Cl or Br) using a thiophosphinoyl-tethered metallated ylide (Y=Ph P(S)-C-P(pip)Ph with pip=piperidyl) is reported, amongst the first ylide-substituted plumbylenes. The tetrylenes feature distinct trends in the spectroscopic and structural properties of the ylide ligand with increasing atomic number of the tetrel element. For instance, an increasingly high-field shifted signal for the thiophosphinoyl group is observed in the P{ H} NMR spectrum as a consequence of the increasing polarity of the element-carbon bond, which likewise results in a shortening of the ylidic C-P bond in the solid-state structure.

New Zealand Healthcare Reforms 2022: Viable by Design? A Qualitative Study Using the Viable System Model.

Background: The New Zealand (NZ) (Healthy Futures) health reforms came into effect in July 2022 with the establishment of Health New Zealand (HNZ) (Te Whatu Ora) and the Māori Health Authority (MHA) (Te Aka Whai Ora) - the organisations charged for healthcare provision and delivery. Given these changes represent major health system reform, we aimed to conduct an early evaluation of the design of the reforms to determine if they can deliver a viable and sustainable NZ health system going forward.

Methods: The evaluation was informed by Beer's viable system model (VSM).

Lessons learnt from the implementation of new models of care delivery through alliance governance in the Southern health region of New Zealand: a qualitative study.

Objectives: To explore the process of implementation of the primary and community care strategy (new models of care delivery) through alliance governance in the Southern health region of New Zealand (NZ).

Design: Qualitative semistructured interviews were undertaken. A framework-guided rapid analysis was conducted, informed by implementation science theory-the Consolidated Framework for Implementation Research.

Catalytic Activation of Imines by Chalcogen Bond Donors in a Povarov [4+2] Cycloaddition Reaction.

Recently, chalcogen bonding has been investigated in more detail in organocatalysis and the scope of activated functionalities continues to increase. Herein, the activation of imines in a Povarov [4+2] cycloaddition reaction with bidentate cationic chalcogen bond donors is presented. Tellurium-based Lewis acids show superior properties compared to selenium-based catalysts and inactive sulfur-based analogues.

Social determinants and inequitable maternal and perinatal outcomes in Aotearoa New Zealand.

Objectives: Aotearoa New Zealand has demonstrable maternal and perinatal health inequity. We examined the relationships between adverse outcomes in a total population sample of births and a range of social determinant variables representing barriers to equity.

Methods: Using the Statistics New Zealand Integrated Data Infrastructure suite of linked administrative data sets, adverse maternal and perinatal outcomes (mortality and severe morbidity) were linked to socio-economic and health variables for 97% of births in New Zealand between 2003 and 2018 (~970,000 births).

What makes an effective Quality Improvement Manager? A qualitative study in the New Zealand Health System.

Purpose: Quality improvement is an international priority, and health organisations invest heavily in this endeavour. Little, however, is known of the role and perspectives of Quality Improvement Managers who are responsible for quality improvement implementation. We explored the quality improvement managers' accounts of what competencies and qualities they require to achieve day-to-day and long-term quality improvement objectives.

A methodology for identifying high-need, high-cost patient personas for international comparisons.

Objective: To establish a methodological approach to compare two high-need, high-cost (HNHC) patient personas internationally.

Data Sources: Linked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States.

Study Design: We outline a methodological approach to identify HNHC patient types for international comparisons that reflect complex, priority populations defined by the National Academy of Medicine.

Synthesis, Crystal and Electronic Structures of a Thiophosphinoyl- and Amino-Substituted Metallated Ylide.

Invited for this month's cover is the group of Viktoria H. Gessner at the Ruhr-University in Bochum (Germany). The cover shows the structure of the newly reported, isolated metallated ylide.

Synthesis, Crystal and Electronic Structures of a Thiophosphinoyl- and Amino-Substituted Metallated Ylide.

α-Metallated ylides have revealed themselves to be versatile reagents for the introduction of ylide groups. Herein, we report the synthesis of the thiophosphinoyl and piperidyl (Pip) substituted α-metallated ylide [Ph (Pip)P=C-P(S)Ph ]M (M=Li, Na, K) through a four-step synthetic procedure starting from diphenylmethylphosphine sulfide. Metallation of the ylide intermediate was successfully accomplished with different alkali metal bases delivering the lithium, sodium and potassium salts, the latter isolable in high yields.

International comparison of spending and utilization at the end of life for hip fracture patients.

Objective: To identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries.

Data Sources: Individual-level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC).

Study Design: We retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs.

Ylide-Substituted Phosphines with a Cyclic Ylide-Backbone: Angle Dependence of the Donor Strength.

Ylide-substituted phosphines (YPhos) have been shown to be highly electron-rich and efficient ligands in a variety of palladium catalyzed transformations. Here, the synthesis and characterization of novel YPhos ligands containing a cyclic backbone architecture are reported. The ligands are easily synthesized from a cyclic phosphonium salt and the chlorophosphines CyPCl () and Cy(Flu)PCl (, with Flu = 9-methylfluorenyl) and were characterized in both solution and solid states.