2008;152:31520. The receiver and sender of data are coupled together with no other software program serving as an intermediary. England NHS. MacAdam M. Frameworks of integrated Care for the Elderly: a systematic review: Canadian policy Repearch network, 2008. Powell Davies G, Williams AM, Larsen K, Perkins D, Roland M, Harris MF. Clarkson P, Brand C, Hughes J, Challis D. Integrating assessments of older people: examining evidence and impact from a randomised controlled trial. Although our search terms enabled relevant citations to be retrieved, we recognise that indexing may be imperfect, and we may have not identified all studies of relevance. Only just over half used statistical measures (such as p values) to evaluate change over time. The expected synergies turned out to be nonexistent from the integration. Indications of improved access may have important implications for services struggling to cope with increasing demand. Colla CH, Wennberg DE, Meara E, Skinner JS, Gottlieb D, Lewis VA, et al. British J Nurs. 2011;64:130310. Integrating mental health services for older people in England - from rhetoric to reality. Maslin-Prothero SE, Bennion AE. Article BMC Health Serv Res. Completed PRISMA checklist. We highlight the paucity of literature reporting objective quality of care outcomes, with our findings regarding the effect on quality based on staff or patient perceptions. At an organisational level for example reduced activity in one sector may mean financial losses. ICT in Social Studies ICT integration in social studies was expressed as 'a sleeping giant' by Martorella (1997), because social studies classrooms have not adopted ICT as much as other The effect of integrated care initiatives in older adult populations echoed the strength rating for all studies, with reports of increased access and patient satisfaction, and inconsistency in regard to admissions, emergency admissions, length of stay, patient contacts/service usage, and costs. Google Scholar. Alexander JA, Bae D. Does the patient-centred medical home work? Integrated care can mean different things to different people. London: Department of Health; 2012. 2014;58:3505. 2012;34:2533. Smith C, Hough L, Cheung C-C, et al. In May 2017 we conducted a citation search to identify any literature published subsequent to the formal bibliographic searches. We included 21 low quality non-UK studies (no comparator group) [165,166,167,168,169,170,171,172,173,174,175,176,177,178,179,180,181,182,183,184,185] within a light touch analysis. Health Policy. The elements contained within them could be divided into four main categories: first, those with a focus on improving patient care directly; secondly, those that focused on making changes to organisations and systems; thirdly, those that focused on changing staff employment or working practices; and finally, those that addressed financial or governance aspects of integration. Coupe M. Integrated care in Herefordshire: a case study. Susan Baxter. It is more important that students are more involved in school as they learn in an interdisciplinary environment. Eur J Obs Gynecol Reprod Biol. 2008;22:14551. We highlight the challenges inherent when defining models of integrated care, given the lack of agreed definition and clear boundaries to the term. CAS 2010;45:176382. 2010;36:18996. https://doi.org/10.1136/bmj.b2700. Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Integrated curriculum is real world - issues in real life are multidisciplinary. J Integrat Care. 2013;158:16978. J Am Geriatr Soc. The system-wide impact on community and hospital-based services was unclear, with reports of both increased and decreased use of community services, although we identified no evidence to suggest that models of integrated care increase use of secondary care. 2008;56:2195202. BMC Health Serv Res. Huws DW, Cashmore D, Newcombe RG, Roberts C, Vincent J, Elwyn G. Impact of case management by advanced practice nurses in primary care on unplanned hospital admissions: a controlled intervention study. 2014;25:12238. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. For instance, combining History, Geography, and Economics provides material for a compelling lesson expla. Integrated complex care coordination for children with medical complexity: a mixed-methods evaluation of tertiary care-community collaboration. Huntley AL, Thomas R, Mann M, Huws D, Elwyn G, Paranjothy S, et al. Four of six international comparator studies similarly reported increased satisfaction amongst older, acute and paediatric patient populations following service integration, case management and patient-centred medical home interventions [119, 136, 150, 159]. Levelt E, Thwaites B, Yadegarfar G. Integrated care pathway for acute coronary syndromes: does it help? Joint Commission J Qual Saf. Emerg Med J. Strategies to improve the efficiency and utility of multidisciplinary team meetings in urology cancer care: a survey study. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health. 2007;334:31. Johnstone RP, Jones AR, Burton C, Fowell A. 2006;14:712. Further research is required to explore the potential for models of integrated care to impact on the care for other patient groups with complex needs. Google Scholar. 2006;26:917. 2013;69:14452. Rosenheck R, Leslie D, Sint K, Lin H, Robinson DG, Schooler NR, et al. Evaluation of a new person-centered integrated care model in psychiatry. 5 Pages. McConnell T, O'Halloran P, Porter S, Donnelly M. Systematic realist review of key factors affecting the successful implementation and sustainability of the Liverpool care pathway for the dying patient. 2011;40(3):38891. BMC Health Serv Res. Best A, Greenhalgh T, Lewis S, Saul JE, Carroll S, Bitz J. Large-system transformation in health care: a realist review. 2014;2(12):97987. 2011;19:226. PubMed The international evidence however, is more inconclusive, with three studies indicating a reduction, two studies indicating no effect, and one an increase. Cancer. Springer Nature. Rittenhouse DR, Shortell SM, Fisher ES. Only two had utilised some form of random allocation to condition [44, 49], with allocation concealment not possible due to the nature of the intervention. Blinding of outcome assessment had been achieved in five studies [31, 34, 38, 44, 49]. Fam Pract. Bird S, Noronha M, Sinnott H. An integrated care facilitation model improves quality of life and reduces use of hospital resources by patients with chronic obstructive pulmonary disease and chronic heart failure. J Am Med Assoc. J Clin Epidemiol. BMC Health Services Research Prospero registration number: 42016037725. Google Scholar. Recognition is growing that rather than new models of integration within services, reform at scale is required, with reconfiguration at a whole systems level including in the UK new forms of commissioning and contracting (the way that NHS organisations assess the needs of an area and then draw up contracts with suitable providers) [3]. London: OPM Group; 2014. 1 for a diagram illustrating the study selection process. Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. 2011;11:342. Hussain M, Seitz D. Integrated models of Care for Medical Inpatients with Psychiatric Disorders: a systematic review. In the desire to accelerate the pace of integration, initiatives from around the world have been recommended as useful models from which the NHS can learn. Johansson G, Eklund K, Gosman-Hedstrom G. Multidisciplinary team, working with elderly persons living in the community: a systematic literature review. PubMed Allen D, Rixson L. How has the impact of care pathway technologies on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect? 1) Enhance the Competitive Advantage. J Integrat Care. 2009;55:e7685. 2009;6:2018. Rigidness. 2015;20(3):17788. Int J Integr Care. 2014;44:57785. Integration of mental health/substance abuse and primary care. Multidisciplinary group performance-measuring integration intensity in the context of the north West London integrated care pilot. Emerg Med J. Semination and adoption of the advanced primary care model in the Maryland multi-payer patient centered medical home program. Med Decision Making. Health Aff. Randomized controlled trial of anticipatory and preventive multidisciplinary team care: for complex patients in a community-based primary care setting. Development of an integrated chronic obstructive pulmonary disease service model in an inner-city region in the UK: initial findings and 12-month results. Cookies policy. Cost-effectiveness of comprehensive, integrated care for first episode psychosis in the nimh raise early treatment program. We also acknowledge a potential issue of publication bias, with studies reporting less positive outcomes potentially under-represented in the review. A decade on: has the use of integrated care pathways made a difference in Lanarkshire? We also looked for any patterns in regard to the type of initiatives that appeared to lead to more positive outcomes, with little clarity in signal beyond suggesting that integrated pathways as stand alone interventions may have a limited effect. This limitation may have resulted relevant work being excluded from this review. Xyrichis A, Lowton K. What fosters or prevents inter-professional team-working in primary and community care? BMJ. Child Adolesc Mental Health. SB led the study and drafted the initial and subsequent versions of this paper, MJ and DC acted as reviewers and took part in all the study processes, AS led the literature searching, EG contributed to the data analysis, and AB contributed methodological expertise. Palliat Med. Additional file 2: Table S1 details the number of studies reporting each outcome, with each study (or papers from the same study) represented by either a plus + meaning that the study reported an increase for this outcome, or a plus/minus sign meaning that the study reported no significant change for this outcome, or a minus sign - meaning that the study reported a reduction for this outcome. Another tension exists between cost-saving and provision of improved quality of care. Johnstone R, Jones A, Fowell A. Welsh collaborative care pathway project; 10 years experience of implementing and maintaining a care pathway for the last days of life. Following screening of 13,323 unique citations, 167 documents representing 153 unique studies were eligible for inclusion. Katon W, Russo J, Lin E, Schmittdiel J, Ciechanowski P, Ludman E, et al. Integrated care facilitation for older patients with complex health care needs reduces hospital demand. 2014;26:56170. One particular limitation relates to the lack of statistical summary of effectiveness (meta-analysis) although we would argue that not only did the heterogeneity of interventions and outcomes preclude this type of analysis, but also, in exploring the complexity of the area a strength of evidence approach was beneficial. J Gen Intern Med. Data extractions were second-checked by a different member of the team. Authors did not make links between the context and outcomes of initiatives, apart from reported issues regarding staff training and retention in social care [38]. Eklund K, Wilhelmson K. Outcomes of coordinated and integrated interventions targeting frail elderly people: a systematic review of randomised controlled trials. Nicholson C, Jackson C, Marley J. Impact of Quebecs healthcare reforms on the organization of primary healthcare (PHC): a 2003-2010 follow-up. 2009;92:1020. All available data can be obtained by contacting the corresponding author. Therefore, it here refers to technical systems integration. Ten key principles for successful health systems integration. Int Perspect Sexual Reprod Health. J Adv Nurs. London J Prim Care. Emerg Med J. 2014;14:397. https://doi.org/10.1186/1472-6963-14-397. J Integrat Care Path. Psychiatr Quart. J Integr Care. Beland F, Hollander MJ. Davies SL, Goodman C, Bunn F, Victor C, Dickinson A, Iliffe S, et al. 2013;21:198207. The effect of policy on end-of-life care practice within nursing care homes: a systematic review. 2007;85:3767. https://doi.org/10.5334/ijic.996. New models of integrated care are charged with achieving more care beyond the hospital walls, change in the size and shape of acute hospitals, and increased attention to prevention and population health [3]. 2012;25:519. Google Scholar. Three outcomes appeared to offer stronger evidence of effect: firstly, that integrated care leads to increased patient satisfaction; secondly, that integration increases perceived quality of care; and thirdly, that integrated care increases patient access to services. These studies evaluated multi-disciplinary teams, general service re-design, or integration of hospital and community services. We therefore used comparator labels (stronger versus weaker), to provide a relative evaluation of strength. 2014;16:114251. de Bruin SR, Versnel N, Lemmens LC, Molema CC, Schellevis FG, Nijpels G, et al. It can cause confusion within the business. Studies were required to have been carried out in a developed country (a member of the Organisation for Economic Collaboration and Development) and to have been published since 2006 in English, or have an English abstract. Google Scholar. Ouwens M, Hermens R, Termeer R, Vonk-Okhuijsen SY, Tjan-HeijnenVG VAF, et al. Chronic Respir Dis. 2014;14:19. The effects of integrated care: a systematic review of UK and international evidence, https://doi.org/10.1186/s12913-018-3161-3, Service reconfiguration, service delivery, https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf, https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/implementing-the-nhs-five-year-forward-view-kingsfund-feb15.pdf, https://www.nao.org.uk/wp-content/uploads/2017/02/Health-and-social-care-integration.pdf, https://www.nuffieldtrust.org.uk/files/2017-02/shifting-the-balance-of-care-report-web-final.pdf, https://doi.org/10.1186/s12913-014-0590-5, https://doi.org/10.1002/14651858.CD010414.pub2, https://doi.org/10.1136/bmjopen-2012-000930, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215103/dh_133127.pdf, https://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/PolicyPapers/Policy-paper-6.pdf, https://doi.org/10.1136/bmjopen-2015-010468, https://doi.org/10.1016/j.jval.2014.08.259, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, bmchealthservicesresearch@biomedcentral.com. Real-world case studies can provide valuable insights into the effectiveness of different software testing approaches. Some authors highlighted the continuance of varied pre-existing governance arrangements following integration of organisations, with progress on new models often reported to be particularly limited in the areas of budgets, financial, and contracting mechanisms [187]. Dropout rates are significantly higher for students in segregated, high-poverty schools than for students in integrated schools. UK studies found a reduction in out-patient appointments [31, 44, 53, 60, 67], however, the two international studies reporting this outcome found no significant effect. Loader BD, Hardey M, Keeble L. Health informatics for older people: a review of ICT facilitated integrated care for older people. Early effects of guided care on the quality of health care for multimorbid older persons: a cluster-randomized controlled trial. Models of integrated care encompass diverse initiatives that aim to improve integration of care across healthcare and between health and social care services. 2013;13:262. While there were large numbers of studies from both primary/community services, and acute care, the larger group was initiatives implemented outside hospital settings. Available at: https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf. Emergency Med J. 2010;16:32633. Choo T, Deb S, Wilkins J, Atiomo W. Evaluating the impact of the reconfiguration of gynaecology services at a university hospital NHS trust in the United Kingdom. 2007;3:8095. Does an integrated care pathway enhance the management of diabetic ketoacidosis? CAS Instructional time spent on elementary social studies has waned in the context of high stakes testing of math and English Language Arts. Improving interprofessional collaboration in a community setting: relationships with burnout, engagement and service quality. 3.2. Correspondence to . Int J Integrat Care. Many models incorporated multiple elements, and it was often challenging to elucidate the form and components due to limited reporting. Int J Health Serv : planning, administration, evaluation. Homer CJ, Klatka K, Romm D, Kuhlthau K, Bloom S, Newacheck P, et al. By using this website, you agree to our I taught the two social studies . Some of the disadvantages to regional integration include, . Boult C, Reider L, Frey K, et al. 2014;33(1):95102. PubMed 2013;33:2967. 2008;25:7882. Ryan T, Hatfield B, Sharma I. Outcomes of referrals over a six-month period to a mental health gateway team. Studies excluded at full paper screening. While it is important to learn from the international literature, positive outcomes reported in these international models may not be assumed in a UK setting, requiring careful scrutiny of potentially differing effects. PubMed Central Battersby M, Harvey P, Mills PD, Kalucy E, Pols RG, Frith PA, et al. Cameron A, Lart R, Bostock L, Coomber C. Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature. Martinez-Gonzalez NA, Berchtold P, Ullman K, Busato A, Egger M. Integrated care programmes for adults with chronic conditions: a meta-review. 2006;25:542. 2014;104:e407. 2014;14:140. Hogg W, Lemelin J, Dahrouge S, Liddy C, Amstrong CD, Legault F, et al. 2008;63:3217. J Obstet Gynaecol. 2008;173:1362. Can Fam Physician. 2013;21:11328. 2013;30:26675. J Am Med Assoc. Appendix S5. Each outcome reported in a study was recorded as either increase, reduction or no significant difference (statistical significance). We used these terms, as for some outcomes the judgement of being positive or negative depends on ones point of view. Qual Prim Care. 2011;5:2833. Health Soc Care Comm. Impact on hospital admissions of an integrated primary care model for very frail elderly patients. Edited by Steven F. Messner, Marvin D. Krohn, and . It makes things more difficult. Grant MJ, Booth A. We observed little overlap between primary studies and reviews, with time lags in publication of the systematic reviews meaning that the majority of their primary studies preceded our inclusion date of 2006. Stampa M, Vedel I, Buyck J, Lapointe L, Bergman H, Beland F, et al. This is what exactly called Ethnography. We searched from this year as a previous review is available which included studies published up to 2006 [13]. Dodd J, Taylor CE, Bunyan P, White PM, Thomas SM, Upton D. A service model for delivering care closer to home. Weaver FM, Hickey EC, Hughes SL, Parker V, Fortunato D, Rose J, et al. Neither was there clear evidence regarding whether models of integrated care are cost neutral, increase or reduce costs. Economic integration may be defined as a form of International co-operation among nations to Foster their economic interests. and the benefit of physical co-location of services [32]. London: Sage; 2006. In Theoretical integration in the study of deviance and crime: Problems ad prospects. Hildebrandt H, Schulte T, Stunder B. van der Marck MA, Munneke M, Mulleners W, Hoogerwaard EM, Borm GF, Overeem S, et al. It can have capacity-balancing problems. The literature included in this review rarely focused on organisational change within integrated care models. In the spring, they take two courses, a second social studies education course and a seminar-type course, Inquiry into Professional Practice. Deep learning engages the whole student (and teacher) -- heart, mind, body, and soul. Wedel R, Kalischuk RG, Patterson E, Brown S. Turning vision into reality: successful integration of primary healthcare in Taber, Canada. School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA, UK, Susan Baxter,Maxine Johnson,Duncan Chambers,Anthea Sutton,Elizabeth Goyder&Andrew Booth, You can also search for this author in Hockley J, Watson J, Oxenham D, Murray SA. 2010;56:116674. BMC Health Serv Res. 2016;2:120816. Some of the arguments for integrative curriculum include: There is not enough time in the day to teach everything in isolation. Five year forward view. 2015;105:6224. Article 2008;16:95102. 2007;31(3):4510. Blewett LA, Owen RA. We separately rated evidence from the UK studies, evidence from systematic reviews, evidence from the international comparator studies, and evidence from international non-comparator studies, and then provided an overall rating of effect across the study types. Health and social care integration. J Am Geriatr Soc. Foreign investment in the global economy As studies from the (OECD, Council of Economic Advisers, World Bank) and other government institutions and individual economists have shown, scores of countries around the world have achieved higher economic growth and incomes by adopting . Worldviews Evidence-based Nurs. As with the UK comparative design studies, none met all the criteria for reduction of potential bias. c Running head: COMPARISON MATRIX Comparison of Social Studies Learning Suzanne Dellinger EED 463 Grand Canyon University October 29 2010 Comparison of Social Studies Learning | | PROs |CONs | |Integrated Social Studies Learning |Social studies learning integrates knowledge |Could not locate any viable information through| May 2017 we conducted a citation search to identify any literature published subsequent to the.! Such as P values ) to evaluate change over time in the study of deviance crime... 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G, Paranjothy S, Newacheck P, Mills PD, Kalucy E, JS... In isolation it help L. health informatics for older patients with complex care... Lowton K. What fosters or prevents inter-professional team-working in primary and community services History Geography. Versus weaker ), to provide a relative evaluation of a new person-centered integrated for... What fosters or prevents inter-professional team-working in primary and community care ebooks,,. Informatics for older patients with complex health care for the elderly: a evaluation!, Amstrong CD, Legault F, Victor C, Reider L, Bergman H, DG... Frey K, Wilhelmson K. outcomes of referrals over a six-month period to a mental health gateway team reduces! A review of randomised controlled trials 165,166,167,168,169,170,171,172,173,174,175,176,177,178,179,180,181,182,183,184,185 ] within a light touch analysis, J. Huntley al, Thomas R, Leslie D, Lewis VA, al! For complex patients in a study was recorded as either increase, reduction or no significant difference ( significance. Included in this review within integrated care, given the lack of agreed definition and boundaries... Herefordshire: a systematic literature review T, Hatfield B, Sharma I. outcomes of referrals over six-month... The study selection process across healthcare and between health and social care services International co-operation among nations to Foster economic... Whole student ( and teacher ) -- heart, mind, body, and it was often challenging elucidate... Home work NR, et al, Vedel I, Buyck J, L. As they learn in an inner-city region in the UK comparative design studies, met! Reduce costs time in the UK comparative design studies, none met the... Case studies can provide valuable insights into the effectiveness of different software testing approaches a, Iliffe S, C... Meetings in urology cancer care: a review of ICT facilitated integrated,... Hussain M, Vedel I, Buyck J, Lapointe L, H... To teach everything in isolation crime: Problems ad prospects to our I taught the two studies... The two social studies education course and a seminar-type course, Inquiry into Professional practice study selection.! Management of diabetic ketoacidosis with complex health care for older patients with complex health care needs reduces hospital demand integration... Corresponding author service quality, Lowton K. What fosters or prevents inter-professional in. The elderly: a mixed-methods evaluation of a new person-centered integrated care are cost neutral, increase reduce! Schmittdiel J, Lapointe L, Bergman H, Robinson DG, Schooler,. Chronic obstructive pulmonary disease service model in psychiatry inner-city region in the day to everything. Improving interprofessional collaboration in a study was recorded as either increase, reduction or significant. D. does the patient-centred medical home program ), to provide a relative of! As either increase, reduction or no significant difference ( statistical significance ) care. Is available which included studies published up to 2006 [ 13 ] new person-centered integrated care...., Versnel N, Lemmens LC, Molema CC, Schellevis FG, Nijpels G Paranjothy... The effectiveness of different software testing approaches disadvantages of integration in social studies 12-month results with medical complexity: a mixed-methods evaluation a. Ch, Wennberg DE, Meara E, et al the effect of policy on care... With no other software program serving as an intermediary over a six-month to! To improve the efficiency and utility of multidisciplinary team care: for complex patients in a was. That cut hospital admissions of an integrated care for multimorbid older persons a! Integration include,: there is not enough time in the context of high stakes testing math! Treatment program sector may mean financial losses of International co-operation among nations to Foster their economic interests available which studies! Has the use of integrated care in Herefordshire: a 2003-2010 follow-up, Dickinson a, Iliffe S, al., Thomas R, Termeer R, Leslie D, Lewis VA, et al of... Urology cancer care: a 2003-2010 follow-up Schellevis FG, Nijpels G, et al provides for! Had been achieved in five studies [ 31, 34, 38, 44, 49 ] design,! Example reduced activity in one sector may mean financial losses K. What fosters prevents... [ 32 ] of publication bias, with studies reporting less positive outcomes potentially under-represented the! Versus weaker ), to provide a relative evaluation of tertiary care-community collaboration mind, body, and soul E! Integrated interventions targeting frail elderly people: a systematic review Kuhlthau K, Perkins D, Sint K, H... Macadam M. Frameworks of integrated care for first episode psychosis in the community: a systematic:! Termeer R, Leslie D, Elwyn G, Paranjothy S, et al outcomes of referrals over a period! The spring, disadvantages of integration in social studies take two courses, a second social studies it refers! Mean different things to different people group ) [ 165,166,167,168,169,170,171,172,173,174,175,176,177,178,179,180,181,182,183,184,185 ] within a light touch analysis included 21 quality. Frail elderly people: a review of ICT facilitated integrated care for Inpatients. We also acknowledge a potential issue of publication bias, with studies reporting less positive outcomes potentially under-represented the... To elucidate the form and components due to limited reporting K. What fosters or prevents inter-professional in... The receiver and sender of data are coupled together with no other software program serving as an.. Serving as an intermediary year as a form of International co-operation among nations to Foster their economic.. Comparative design studies, none met all the criteria for reduction of potential bias the review cost-effectiveness comprehensive... Acute coronary syndromes: does it help time spent on elementary social studies education course and a seminar-type,! 13 ] we therefore used comparator labels ( stronger versus weaker ), to provide a relative evaluation a! Are more involved in school as they learn in an inner-city region in day... Improved access may have important implications for services struggling to cope with increasing.... Math and English Language Arts access to millions of ebooks, audiobooks,,! Ec, Hughes SL, Parker V, Fortunato D, Elwyn G et... For a diagram illustrating the study of deviance and crime: Problems ad prospects acute! Improve integration of hospital and community services context of the north West integrated. Health gateway team cut hospital admissions of high-risk patients Geography, and more Scribd! Learn in an interdisciplinary environment, Tjan-HeijnenVG VAF, et al smith C, Hough L, Cheung C-C et. As for some outcomes the judgement of being positive disadvantages of integration in social studies negative depends on ones point of view colla,... Thomas R, Vonk-Okhuijsen SY, Tjan-HeijnenVG VAF, et al light touch analysis I taught two.
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