Regular Review Research Articles

The World History Commons

The Journal of American History publishes regular reviews of digital history projects. The digital history reviews are edited by Jeffrey McClurken Please contact him at jmcclurk@umw.edu if you would like to suggest a digital history project for review or write a review. We also welcome comments on our review guidelines, which are available at http://jah.oah.org/submit/digital-history-reviews/. The World History Commons (Whc), funded from 2018 to 2021 by the National Endowment for the Humanities and a Digital Humanities Advancement Grant, includes long-running digital projects, many developed and launched by the Roy Rosenzweig Center for History and New Media from 2003 to 2018. To sources from such instructional classics as “Making the History of 1989” and the “Amboyna Conspiracy Trial” have been added newly produced resources for instructors and students of world history. The principal investigators Kelly Schrum and Jessica Otis, both of George Mason University, also received expanded funding by the American Council of Learned Societies Digital Extension Grant (2020–2022) for “Expanding the Commons: Supporting Emerging World History Scholars and Community Colleges through the World History Commons.” Besides the principal investigators, the steering committee for the Whc includes Merry Wiesner-Hanks, professor emerita at the University of Wisconsin–Milwaukee, Adam Clulow of the University of Texas at Austin, and Nate Sleeter of George Mason University.

The Mediating Role of English Speaking Skills in the Relationship between Social Literacy and the Engagement of Students

This study determined the mediating role of English speaking skills in the relationship between social literacy and student engagement in colleges and universities in Davao Oriental, Philippines. A non-experimental quantitative research design using descriptive-correlational research design was applied and employed stratified random sampling with 313 Education college students as a sample. Data collection was made through a survey instrument. Data analysis was done through Mean, Pearson-r, Multiple Regression, and Medgraph using the Sobel z-test. Results revealed that English speaking skills, social literacy, and engagement were high. A positive correlation between English speaking skills and social literacy, English speaking skills and student engagement, and social literacy and student engagement was proven in the study. The findings affirmed that English speaking skills played a partial mediation, thus it cannot fully account for the influence of social literacy on student engagement. Moreover, a high level of English-speaking skills helped increase the students’ capability to be highly engaged in academics and other school-related activities. It is recommended that the administrators of tertiary education continue to have regular reviews, evaluations, and implementation of the existing curriculum. Also, there is a need to implement strengthen the English language as a medium of instruction on subjects that use the English language. For instance, an English-only policy is one of the best practices that schools should impose. Lastly, the researcher recommends the regular conduct of interviews such as entrance, yearly, and exit interviews using the English language.

Asynchronous digital health interventions for reviewing asthma: A mixed-methods systematic review protocol.

People living with asthma require regular reviews to address their concerns and questions, assess control, review medication, and support self-management. However, practical barriers to attending face-to-face consultations might limit routine reviews. Reviewing asthma using asynchronous digital health interventions could be convenient for patients and an efficient way of maintaining communication between patients and healthcare professionals and improving health outcomes. We, therefore, aim to conduct a mixed-methods systematic review to assess the effectiveness of reviewing asthma by asynchronous digital health interventions and explore the views of patients and healthcare professionals about the role of such interventions in delivering asthma care. We will search MEDLINE, Embase, Scopus, PsycInfo, CINAHL, and Cochrane Library from 2001 to present without imposing any language restrictions. We are interested in studies of asynchronous digital health interventions used either as a single intervention or contributing to mixed modes of review. Two review authors will independently screen titles and abstracts, and retrieve potentially relevant studies for full assessment against the eligibility criteria and extract data. Disagreements will be resolved by discussion with the review team. We will use 'Downs and Black' checklist, 'Critical Appraisal Skills Programme', and 'Mixed Methods Appraisal Tool' to assess methodological quality of quantitative, qualitative, and mixed-methods studies respectively. After synthesising quantitative (narrative synthesis) and qualitative (thematic synthesis) data separately, we will integrate them following methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions. The findings of this review will provide insights into the role of asynchronous digital health interventions in the routine care of people living with asthma. Systematic review registration: PROSPERO registration number: CRD42022344224.

Post-vitrectomy delayed retinal breaks in proliferative diabetic retinopathy

PurposeTo report a series of cases of post-operative new secondary retinal breaks following vitrectomy for proliferative diabetic retinopathy (PDR).MethodsThis retrospective case series included data of patients diagnosed with post-operative retinal breaks following uneventful vitrectomy surgery for PDR from January 2018 to December 2021.ResultsNew post-vitrectomy retinal breaks in PDR were seen in 7% of eyes (n = 10/148 eyes; 10 patients). Age of study patients ranged from 45 to 69 years and there were 8 males. Vitreous surgery was performed for vitreous hemorrhage in six eyes, macular tractional retinal detachment in three eyes and epiretinal membrane in one eye. Tractional fibrovascular proliferation near the retinal break prior to its development was noted either pre- or intra-operatively in 8 eyes. Mean time interval between the vitreous surgery and secondary retinal break development was 6.4 months. Residual fibrous tissue post-surgery adjacent to the break was noted in 4 cases. Sclerosed retinal vessel was noted in 4 eyes and associated inner retinal thinning or schisis in 5 eyes. No retinal detachment was noted in any case. Prophylactic barrage was done in 4 eyes. Last follow-up interval ranged from 4 to 53 months and visual acuity ranged from 6/6 to 6/60. No subretinal fluid, traction or break enlargement was noted at the last visit.ConclusionDelayed post-operative retinal breaks following vitrectomy are uncommon in PDR eyes. Careful preoperative evaluation of the retinal proliferations, intraoperative dissection of the membranes and regular post-operative reviews are vital in anticipating the development of delayed post-vitrectomy retinal breaks. Observation could be the management strategy for these breaks.

Anorexia Assessed by Simplified Nutritional Appetite Questionnaire and Association with Medication in Older Patients Undergoing Hemodialysis.

Anorexia is a common symptom in older patients undergoing hemodialysis (HD) and has become a serious problem in dialysis facilities with the aging of patients. Polypharmacy, defined as the prescription of several medications, is known to cause drug-induced anorexia. Although polypharmacy is also common in older patients undergoing HD, only a few studies have examined the association between anorexia and polypharmacy. This study used the Simplified Nutritional Appetite Questionnaire for Japanese Elderly (SNAQ-JE) to evaluate patients' appetite, and examined its association with medications. This cross-sectional study included 233 patients (aged ≥65 years) who underwent HD in October 2021. Among the 233 patients (median age, 73.0 [interquartile range (IQR), 69.0-80.5] years; men, 57.3%; median dialysis vintage, 62.0 [IQR, 30.0-122.0] months), 116 and 117 were classified into the poor (SNAQ-JE total score ≤14) and good (>14) appetite groups, respectively. Although the total number of medications prescribed was not significantly different between the two groups (p = 0.12), the number of antihypertensive drugs was significantly lower (p = 0.03), and that of sleeping medications was significantly higher (p = 0.002) in the poor appetite group. Multivariable logistic regression analysis showed that the number of sleeping medications was associated with poor appetite (odds ratio, 2.08; 95% confidence interval, 1.32-3.27; p < 0.001). The findings suggest that the number of sleeping medications is an important contributing factor to poor appetite in older patients undergoing HD. A proper and regular review of prescriptions may be necessary to improve anorexia.

P670 “What Matters To You?” – How do patient views compare with a patient experience framework and UK national standards of care?

Abstract Background There is increasing focus on the organisation of services for people with IBD. Patient experience of care is an important consideration in service delivery. The United Kingdom NHS Long Term Plan indicates the importance of support that is more differentiated for individuals, with more personalised care when needed, which starts with the question ‘What matters to you?”. This is particularly important for people with inflammatory bowel disease (IBD). Methods The aim was to identify ‘What matters to you?’ for people attending a single UK teaching centre IBD service and to relate it to patient experience and national standards of care. Invitations to take part in the AWARE-IBD quality improvement programme were sent to 4082 patients receiving IBD care at a single UK teaching centre in 2 rounds (October 2021 and May 2022). Invitation letters included an anonymous open-ended questionnaire asking patients “what matters to you?”. Responses were extracted as qualitative data and coded using two frameworks: Patient experience domains (Bull et al) (Communication, Patient-centred Care, Quality, Integration, Involvement, Accessibility, Environment and Facilities, Discomfort) and national IBD UK Standards. Frequencies for each coding strategy were calculated to determine the most important patient experience domains and IBD UK standards. Results Responses were received from 408 and 205 patients from each recruitment round (n=613). Figure 1 displays frequencies for each patient experience domain. Accessibility (47.5% and 53.2% respectively), Communication (19.6% and 12.7%) and Patient-Centred Care (15.7% and 11.2%) were expressed most frequently. Sub-themes included access to and contact with IBD nurse specialists, timely and accessible appointments and regular contact with a specialist IBD health care professional (HCP). Responses were coded to IBD UK standards, where possible (Table 1). Responses most frequently coded to statements relating to shared decision making, having a personalised care plan, access to an IBD nurse specialist including helpline and regular clinical review. 77 responses could not be coded to an IBD UK standard. Conclusion Access to the IBD service when needed matters most to patients with good communication of information and personalised, patient-centred care. Service organisation should therefore reflect these facets of patient experience and defined standards. Patient views that are not currently represented in published standards should be considered in future iterations. This study also highlights personalised written care plans and improved access to the IBD Nurse Advice line.

Redefining shelter: humanitarian sheltering.

Shelter is one of the most 'intractable problems' in humanitarian aid and yet there is little clarity on an overarching definition. Terminology for shelter and housing is often conflated, and the most prominent definition does not fully reflect recent progress in the Shelter and Settlements Sector. This paper explores the varying terminology utilised in definitions of shelter within humanitarian aid since 1990, reflecting on the concepts of 'shelter' and 'housing', alongside surrounding perceptions of 'house' versus 'home', and related measures of adequacy. The current, most prolific definition is also deconstructed, demonstrating ambiguity in some of terminology such as 'dignity' and 'privacy', and revealing that interpretation of this definition depends on the reader's knowledge. Lastly, a new definition of 'sheltering' is proposed, encompassing five key reflections: the concept of process over object; the inclusion of communities and individuals; the commonality of long-term sheltering; the wider effects of shelter; and the impacts on host communities and environment.

Preparing for the Next Pandemic: An After-Action Review of Infection Prevention and Control Audit Strategies Within Airport and Hotel Quarantine Program.

Effective infection prevention and control (IPAC) practices within the New South Wales (NSW) Airport Operations and Hotel Quarantine Program (Quarantine Program) were required to mitigate the risk of COVID-19 being transmitted to staff, other guests, contractors, and the community. The Quarantine Program relied on complex logistical arrangements and an end-to-end process that included all steps from the time travelers boarded the returning flight until completion of the quarantine period. This required compliance with relevant IPAC standards historically reserved for health care and the implementation of a quality assurance audit framework. The Clinical Excellence Commission (CEC) as the NSW Health Pillar for quality and safety and the lead in IPAC provided training and resources coupled with an IPAC quality audit framework after program commencement. This approach ensured a clear governance structure and a regular review process to minimize risk and support continuous improvement within the program.

1362 ANTICHOLINERGIC PRESCRIBING HABITS AND ITS ASSOCIATIONS IN A COMMUNITY POPULATION OF PEOPLE LIVING WITH DEMENTIA

Abstract Introduction Many commonly prescribed medications have inadvertent anticholinergic effects. People with Dementia (PwD) are more vulnerable to these effects and at risk of adverse outcomes, the risk being higher with a greater degree of anticholinergic exposure. We investigated prescribing patterns and Anticholinergic burden (ACB) in a cohort of community-dwelling older adults with dementia and aimed to explore the effect of ACB on cognition, mood, and quality of life(QoL). Method The medication and demographic information for 87 (39 female) community-dwelling PwD were obtained from Electronic Care Summaries. We used the German Anticholinergic Burden Scale (GABS) to measure ACB. Additionally, we investigated associations between ACB and cognitive (ADAS-Cog), functional (BADL) and QoL (DemQoL) assessments. Results 28.7% of participants had a clinically significant score (ACB&amp;gt; 2). The most commonly prescribed medications with ACB were Lansoprazole(18.3%), Mirtazapine(12.6%) and Codeine(12.6%). ACB was higher in males and negatively correlated with age, r(87)=-.21,p=.03. There was no association between ACB and cognition, QoL, functional independence, and neuropsychiatric symptoms. Over six months, PLWD with no ACB had a greater negative change in neuropsychiatric symptoms[t(18)=2.27,p=.04] and functional independence[t(23)=-3.8,p=.001], indicating greater dependence and worsening neuropsychiatric symptoms. Conclusion A third of PLWD in the community had clinically significant ACB. No ACB was associated with worsening neuropsychiatric symptoms and functional dependence over a six-month period. Community prescribers should consider regular medication reviews with PLWD and carers to ensure medications are prescribed safely and appropriately.

1271 A NOVEL PRESSURE INJURY CARE BUNDLE FOR DEPENDENT PATIENTS WITH PRESSURE INJURIES IN BERMUDA

Abstract Introduction Pressure injury (PI) management is a challenge in dependent patients in acute care wards (ACW) despite standard care (regular pressure relief measures, incontinence management, debridement, optimisation of hydration and nutrition). Method A Pressure Injury Care Bundle (PICB), introduced by the Department of Geriatrics, enhanced standard care by diligent and regular interdisciplinary team monitoring of patients with PIs following transfer to Long Term Care (LTC) wards and thus may improve outcomes. The PICB was delivered by multiple PI Nurse Champions with education of all nurse assistants and medical staff into PI aetiology/management. Progress was monitored with weekly PI measurements/photography and Nurse Champion-lead team review of all PIs. Data are presented as mean+/-1SD. After 96+/-103 days in the ACW, the PICB was applied to 30 consecutive patients aged 80+/-14 years, (19(60 %) were female). All had stage 2-4 PIs (present in 25(83%) on admission to ACW). On transfer to LTC wards, all patients had severe physical dependency with a mean Charlson Comorbidity Index of 7+/-3, 27(90%) had palliative needs and 24(80%) were bedfast. Cognitive impairment was present in 22(68%) patients with 12(37%) dying due to advanced dementia. Patients were followed for 116+/-274 days. Results PI improvement by &amp;gt;2 stages occurred in 11(36%) patients after a mean of 103 days. Ulcers closed fully after 154+/-48 days in a further 15(50 %) patients. However, new ulcers emerged or preterminal (&amp;lt;21 days prior to death) deterioration occurred in 5(17%) patients, related to severe contractures, preterminal poor nutrition and sarcopenia with 16(54%) patients dying. Conclusion These results suggest that an intensive multimodal intervention involving best practice enhanced by PI Nurse Champions and delivered by educated staff with regular PI team progress reviews results in significant improvement/healing of PIs in severely dependent patients with palliative needs. Expansion of the PICB to other wards with prospective evaluation has been planned.

Nitrate contamination in drinking water and adverse reproductive and birth outcomes: a systematic review and meta-analysis

Exposure to low levels of nitrate in drinking water may have adverse reproductive effects. We reviewed evidence about the association between nitrate in drinking water and adverse reproductive outcomes published to November 2022. Randomized trials, cohort or case–control studies published in English that reported the relationship between nitrate intake from drinking water and the risk of perinatal outcomes were included. Random-effect models were used to pool data. Three cohort studies showed nitrate in drinking water is associated with an increased risk of preterm birth (odds ratio for 1 mg/L NO3-N increased (OR1) = 1.01, 95% CI 1.00, 1.01, I2 = 23.9%, 5,014,487 participants; comparing the highest versus the lowest nitrate exposure groups pooled OR (ORp) = 1.05, 95% CI 1.01, 1.10, I2 = 0%, 4,152,348 participants). Case–control studies showed nitrate in drinking water may be associated with the increased risk of neural tube defects OR1 = 1.06, 95% CI 1.02, 1.10; 2 studies, 2196 participants; I2 = 0%; and ORp = 1.51, 95% CI 1.12, 2.05; 3 studies, 1501 participants; I2 = 0%). The evidence for an association between nitrate in drinking water and risk of small for gestational age infants, any birth defects, or any congenital heart defects was inconsistent. Increased nitrate in drinking water may be associated with an increased risk of preterm birth and some specific congenital anomalies. These findings warrant regular review as new evidence becomes available.

P577: Gene panels for skeletal dysplasia and epilepsy: Maximizing clinical utility through careful design, regular review, and clinician-laboratory collaboration

P577: Gene panels for skeletal dysplasia and epilepsy: Maximizing clinical utility through careful design, regular review, and clinician-laboratory collaboration

Управління ризиками на підприємстві: сутність, підходи та методи

The purpose of the article is to substantiate the features of risk management at the enterprise in conditions of uncertainty of the situation to increase its adaptive capabilities and maneuverability, as well as to outline the basic principles and methods allowing to quickly respond to existing and potential threats and to limit the negative impact of risks on the activities of the enterprise. The author identifies the transformation of the approach to the formation of a risk management system from financially-oriented to personnel-oriented. It is found that in the process of risk management, a register of risks along with a risk map should be formed and appropriate management measures should be worked out, which should not formally, but actually improve the quality of management. Based on the changing circumstances of business functioning, the basic principles of risk management in the enterprise are identified, including the following: systematicity, integratedness, comprehensiveness, efficiency, dynamism, prevention, consistency, multi-variateness. The stages of risk management in the enterprise are allocated, the quality of which affects the overall result that will be obtained in the end. Approaches to risk management in the enterprise are substantiated and attention is focused on the need for their regular review and adaptation to the conditions, which will ensure compliance with the requirements of dynamism and flexibility of business decision-making. The methods of risk management in the enterprise are systematized. It is proved that the methods can be applied both at the stage of preliminary elaboration of risks and managerial decision-making regarding them, and in the process of their transformation consequently to a certain level of uncertainty inherent in both the external and the internal environment.

The contribution of research and knowledge accumulation in the development of the Norwegian battery electric vehicle market

This paper investigates the role of research and knowledge building in developing the world's leading BEV market in Norway 1990-2020. Review of research articles/reports and other documents revealed that Politicians in the early years had little research-based knowledge to build decisions on. The Ministry of Transport therefore financed basic research to evaluate BEVs potential. Incentives suggested by lobbyist, were introduced at negligible cost to support testing/industrialization towards 2000 and 2010, without knowing their far-reaching future consequences. Norwegian industrialization failed by 2010. The policies started working after 2010 when OEM BEVs came. Researcher have after 2010 supported political decisions with market models and by analyzing user needs and policy effects. The early decisions should have been supported by research-based knowledge and regular policy reviews.

Fórum: Política externa, emoções e segurança ontológica

Abstract This forum, as a part of the special issue on New Directions for Foreign Policy Analysis (FPA), provides a diversity of answers to the question of how affects and emotions, and the search for ontological security, relate to foreign policy. By foregrounding the various ways to conceive the relationship between foreign policy, ontological security, collective identities, states’ autobiographical narratives, emotions and affective investments, the contributors to this forum examine and chart fruitful directions in FPA. Resende explores the analytical potentials of combining the theory of Ontological Security, Foreign Policy Analysis and Memory Studies to investigate how states invest in practices of ontological security by creating, remaking and defending their national narratives through historical memory. Solomon recollects how the September 11th attacks and the ensuing War on Terror contributed to his search for approaches which took affects and emotions seriously in IR, and which could help make sense of why some discourses, including foreign policy discourses, resonate with and are accepted by the audience in certain contexts. Finally, Sandrin provides an account of her encounters with the literature on the role of emotions in foreign policy and conveys how these texts helped her make sense of some puzzling aspects of Turkish foreign policy. Jimmy Casas Klausen served as lead editor of this forum. The manuscript passed through the regular double-blind peer review process to insure anonymity.

Have telemedicine consultations been beneficial as follow-up appointments for people with multiple sclerosis?

Introduction: This study ascertained whether telemedicine appointments have been beneficial for follow-up appointments for people who have multiple sclerosis (MS). The Covid-19 pandemic forced many services to adapt and change the way in which people with long-term conditions were reviewed. Initially, local MS services employed the use of telephone appointments, but quickly introduced telemedicine appointments, which enabled the clinician and patient to see each other via video technology. The initial feedback from the patients was mixed, with some patients preferring face-to-face appointments and others happy with the change. Since, telemedicine appointments have remained part of many MS services. As restrictions in the country have been lifted, the decision needs to be made whether MS teams across the country continue to use technology in the form of telemedicine appointments or return to face-to-face clinics in the hospital outpatient setting. Methods: A sample of patients were invited to complete an online questionnaire, which was issued through the member list of a local MS therapy centre. A thematical approach was then used to assess the gathered information. Results: The results of the questionnaire showed the preferred type of follow-up appointment was a face-to-face clinical setting, which the majority of participants found more personal, making it easier to communicate with their specialist nurse. However, when asked if they would prefer to be reviewed through face-to-face appointments only, telemedicine appointments only, or a combination of the two, the majority of participants preferred a combination of face-to-face and telemedicine follow ups. Conclusions: This study showed that the rapid uptake of telemedicine during the Covid-19 pandemic was useful to maintain regular reviews of people with MS. However, given the small sample size and limited age range, further research will be required to ascertain whether people with MS find telelmedicince follow-up appointments as beneficial as face-to-face appointments.

Patient representation in New Zealand general practice and rural health case-based teaching: a quality improvement exercise.

Introduction Healthcare inequity disproportionately affects minority populations in Aotearoa New Zealand. Healthcare providers may contribute to inequity due to their biases. Medical education can unintentionally promote biases by reinforcing stereotypes or limiting exposure to diversity. Teaching staff from the Department of General Practice and Rural Health suggested a need to review current teaching materials to ascertain if they have the potential to contribute to this bias. Aim The aim of this study was to review case-based teaching material to determine its representation of the New Zealand population, and whether there is potential to contribute to implicit bias. Methods Document analysis of 135 cases used to teach fourth- and fifth-year medical students in the Department of General Practice and Rural Health, Otago Medical School was performed. Demographic, clinical and social features of each case were recorded and analysed. Results Cases typically included patient age (129/135, 95.6%), sex (127/135, 94.1%) and occupation status (91/136, 66.9%). Ethnicity (31/135, 23.0%), living situation (55/135, 40.7%), relationship status (57/135, 42.2%) and sexual orientation (52/135, 40.0%) were less frequently defined. Cases typically represented the population majority norms. Discussion Case-based teaching materials require regular review and updating to match population demographics. There is potential to improve representation of diversity, and hence cultural safety, though review and revision of written teaching cases.

Red cell requisition and utilization pattern in a tertiary care hospital of South India.

The equilibrium between supply and demand for red blood cells is increasing unpredictably in many countries. An understanding of trends in blood usage profile and current usage can help predict future trends in demand and to put efforts to reduce use in particular areas. This study helps in analyzing the pattern of red blood cell utilization in a tertiary care hospital. This retrospective study was conducted in a blood bank, tertiary care hospital over a period of 6 months. All the requests coming to blood bank with information regarding patient's demographic details, diagnosis and indication for transfusion, type of request, blood transfused or returned were collected and reviewed. Crossmatch transfusion (CT) ratio, transfusion index (TI), and transfusion probability were also calculated. A total of 10,364 patients (20,399 requests) utilized total 32,608 units of blood and its components, out of those 14,195 units of packed red cells units were utilized. March month had maximum number of requests and utilization. Most of the requests for blood were from the inpatients (wards) and were requested and utilized in the age group of 21-30 years with male predominance. Patients in the division of medicine utilized most blood. Although the division of surgery requested most of the blood, on an average, they utilized only one-third of the requested product. Overall, anemia was the most common indication for red cell utilization. In surgical group, spine surgery had a maximum CT ratio. Neurosurgery and hand surgery had the lowest TI in all specialties. Hand surgery and spine surgery had a lowest transfusion probability. Overall, utilization rate in our study was 59.8%. A regular review of blood unit's usage is very important to estimate the blood utilization pattern in any hospital. Profile of blood utilization will act as indicator for quality management of blood bank.

The Influence of the National E-Procurement System on Employees’ Performance in Selected Public Institutions in Tanzania

The study assessed the influence of the Tanzania National E-Procurement System (TANePS) on employees’ performance in the selected public institutions in Tanzania. Specifically, we investigated the extent to which TANePS is being adopted, and its influence on employee performance at the following institutions: Government Procurement Services Agency (GPSA), and the Public Procurement Regulatory Authority (PPRA). We conducted a self administered questionnaire survey to 200 employees at the selected institutions, with a rate of return of 66 per cent. The study found that most respondents (84%, n=168) frequently completed their daily tasks easily by using TANePS. In particular, most of the respondents frequently used TANePS for e-tendering, and e-payment, while user registration and e-contract management had low use. On factors enabling adoption of TANEPS, the software design had a positive impact on the IT readiness (b=0.696, p=0.042). Management policies negatively affected internal resistance (b= -0.517, p=0.002), and internal resistance negatively affected adoption of TANePS (b= -0.506, p=0.002). At the same time, two factors (i.e., management policies (b= 0.649, p=0.002) and IT-readiness (b= 474, p=0.002)) had a positive effect on adoption of TANePS. Consequently, adoption of TANePS had a positive effect on the effective procurement (b=0.674, p=0.007), and the reduction of imperfections (b=0.721, p=0.001). The study further found that the use of TANePS led to better performance (p&gt;0.045 [F (2, 183=26.737, p=0.045]), increased accuracy of production capacity (p&gt;0.045 [F (2, 183=3.190, p=0.045]), and shortened process cycle times (p&gt;0.024 [F (2, 183=17.347, p=0.024]). The study recommends that government procurement authorities and public institutions in Tanzania and other countries of similar environment should ensure that an e-procurement system is designed based on user needs; there are supportive management policies, there is a regular system review and maintenance, adequate technical user support and training, user friendly software design, a secure system, and stable network. These suggestions will increase the number of bidders and enhance stiff and fair competition among them.

Prolonged Effects of Dental Trauma Managed by Conservative Means and Their Medico-legal Implications: A Case Report

Dental injuries are frequently associated with multiple complications. An array of problems may present at different times, from immediate to ones that appear after decades. Careful assessment is mandatory to predict the possible complications, determine the damage, possible rehabilitation options, cost to be incurred, and the medico-legal implications. The case described here is trauma to multiple teeth which have presented with late complications. It describes the importance of regular review, conservative management options, and the medico-legal aspects. This also describes how the clinician can contribute to preventing the transformation of an injury to the grievous category.