The effects of integrated care: a systematic review of UK and international evidence

BACKGROUND: Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS: The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS: One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS: Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION: Prospero registration number: 42016037725

Global Variations in Regolith Properties on Asteroid Vesta from Dawn's Low-Altitude Mapping Orbit

We investigate the depth, variability, and history of regolith on asteroid Vesta using data from the Dawn spacecraft. High-resolution (15-20 m pixel(sup -1)) Framing Cameraimages are used to assess the presence of morphologic indicators of a shallow regolith,including the presence of blocks in crater ejecta, spur-and-gully-type features in crater walls,and the retention of small (less than 300 m) impact craters. Such features reveal that the broad,regional heterogeneities observed on Vesta in terms of albedo and surface composition extend to the physical properties of the upper approx. 1 km of the surface. Regions of thin regolithare found within the Rheasilvia basin and at equatorial latitudes from approx. 0-90 deg. E and approx.260-360 deg. E. Craters in these areas that appear to excavate material from beneath the regolithhave more diogenitic (Rheasilvia, 090 deg. E) and cumulate eucrite (260-360 deg. E) compositions.A region of especially thick regolith, where depths generally exceed 1 km, is found from approx.100-240 deg. E and corresponds to heavily cratered, low-albedo surface with a basaltic eucritecomposition enriched in carbonaceous chondrite material. The presence of a thick regolithin this area supports the idea that this is an ancient terrain that has accumulated a larger component of exogenic debris. We find evidence for the gardening of crater ejecta towardmore howarditic compositions, consistent with regolith mixing being the dominant form of "weathering" on Vesta

Proceedings of the 4th World Conference on Research Integrity

CITATION: O’Brien, S. P., et al. 2016. Proceedings of the 4th World Conference on Research Integrity. Research Integrity and Peer Review, 1:9, doi:10.1186/s41073-016-0012-9.The original publication is available at https://researchintegrityjournal.biomedcentral.comThese Proceedings contain the abstracts of the presentations given at the 4th World Conference in concurrent sessions, partner symposia, and poster sessions. Also included are summaries of the discussions in three focus tracks, which allowed delegates to consider and work on questions about the roles of funders, institutions, and countries in improving research systems and strengthening research integrity. Videos of the plenary presentations are available at the conference website (www.wcri2015.org).https://researchintegrityjournal.biomedcentral.com/articles/10.1186/s41073-016-0012-