Navigating Oxygen Management Challenges amidst COVID-19 pandemic and beyond in India: A Modified Total Interpretive Structural Modeling (m-TISM) Approach

Navigating Oxygen Management Challenges amidst COVID-19 pandemic and beyond in India: A Modified Total Interpretive Structural Modeling (m-TISM) Approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Navigating Oxygen Management Challenges amidst COVID-19 pandemic and beyond in India: A Modified Total Interpretive Structural Modeling (m-TISM) Approach Mansi Singh, Sanjay Dhir, Jayendra Kasar, Lisa Smith, Ranjan Choudhury, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5503121/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Nov, 2025 Read the published version in BMC Health Services Research → Version 1 posted 10 You are reading this latest preprint version Abstract Background Given the unprecedented surge in COVID-19 infections, the heightened demand for medical oxygen prompted numerous national and global initiatives to bridge the gap between supply and demand. This was crucial for ensuring adequate treatment for patients suffering from acute respiratory distress syndrome and requiring oxygen therapy. This research aims to explore the factors influencing medical oxygen management in India during the pandemic and beyond, examining both facilitators and barriers. Method Through a thorough review of literature, secondary research, and interviews with key stakeholders, critical factors affecting oxygen management were identified. These factors were then analyzed using a modified total interpretive structural modeling (m-TISM) approach and MICMAC (Matrice d’ Impacts croises multiplication applique an classment) analysis to comprehend their hierarchical relationships and driving forces. Results The study identifies fourteen key factors that act as facilitators and barriers to oxygen management during the Covid-19 pandemic. These factors also influence medical oxygen management during non-pandemic period. The development of an m-TISM model gives us the hierarchical interrelationships between these factors, including oxygen management as one of the factors itself. The findings identify key strategic levers to strengthen the national oxygen management ecosystem and cross-sectoral collaborations. Conclusion This study provides insights into strengthening the oxygen ecosystem, enabling policymakers and program implementers to make informed decisions and implement pre-emptive measures to address future threats from the virus or similar crises. Oxygen Management COVID-19 Barriers Facilitators m-TISM MICMAC Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction Since the initial report of COVID-19 declared as a pandemic, it remained a pressing global crisis. During mid-May 2023, WHO has declared that COVID-19 no longer constitutes a public health emergency of international concern, however, occurrence of any pandemic remains a pressing global priority. Various strategies have been deployed across different levels of governance to mitigate the spread of the virus. The pandemic has strained public health systems worldwide, resulting in millions of deaths ( 1 ). Economic and social disruptions caused by widespread lockdowns have further exacerbated the situation. Daily routines have undergone significant changes globally, with numerous countries experiencing economic downturns ( 2 ). While some nations have effectively managed to curb the virus's spread, others continue to grapple with recurring outbreaks. Following the devastating Delta variant wave in early 2021, the emergence of the Omicron variant led to another surge in infections, whose repercussions have persisted into early 2023. The virus has afflicted over 600 million individuals worldwide, claiming the lives of more than six million, with thousands enduring post-COVID-19 conditions globally ( 3 , 4 ). Governments and institutions worldwide have tirelessly collaborated to contain transmission, conduct widespread testing and treatment, minimize fatalities, and ensure vaccine accessibility for their populations ( 5 – 8 ). As countries become more interconnected, the spread of viruses like COVID-19 has no borders. This exceptional pandemic underlines the importance of medical oxygen as a critical care component in treating those infected with the virus ( 9 – 11 ). Oxygen therapy is provided to patients with respiratory distress, requiring supplemental oxygen as a treatment. This oxygen provided to patients should be of a certain quality (ranging from more than 82% through oxygen concentrators to 99.5% produced through air-liquefaction process) and free from any contamination ( 12 ). Since liquid medical oxygen, the primary source of medical oxygen is available in limited amounts and not produced at the healthcare facility, meeting the steep increase in demand during the pandemic required a multi-pronged approach involving various stakeholders in the oxygen supply chain. The situation was much worse in low and middle-income countries (LMICs) with a higher caseload, leading to millions of deaths. Managing this heterogenous medical oxygen crisis required a global, national, and regional strategy to ensure sufficient availability and accessibility of oxygen in different contexts and situations ( 13 – 16 ). Given the unprecedented demand for the oxygen needed for COVID-19 patients during the pandemic, various initiatives were taken by countries around the world to be equipped and prepared to meet the gap between the demand and supply of oxygen to ensure proper treatment of patients with acute respiratory distress syndrome requiring oxygen therapy. Therefore, this study aims to identify the factors that facilitate or act as barriers to medical oxygen management in India during the COVID-19 pandemic and non-pandemic period during regular functioning of health facilities and understand the hierarchical interrelations between them. After conducting an exhaustive literature review, secondary research, and interviews with key stakeholders, this study has pinpointed fourteen crucial factors influencing oxygen management. The following are the barriers and facilitators of Oxygen Management: 1.1 Oxygen Purity : Ensuring high-purity medical oxygen is crucial. Producers, storage providers, logistics teams, and healthcare facilities must meet stringent standards set by governments and WHO based on pharmacopeia guidelines ( 4 , 12 ). 1.2 Medical Equipment and Maintenance : Proper procurement, usage, and maintenance of oxygen-related medical equipment, including PSA plants, LMO tanks, and concentrators, are vital. Nationwide initiatives were undertaken to train staff to handle diverse equipment needs ( 4 , 17 , 18 ). 1.3 Production Capacity : Expanding oxygen production was critical. Some measures to increase production capacity included upgrading existing plants, diverting industrial oxygen, deploying concentrators, setting up new PSA plants, importing equipment, and incentivizing private investment( 4 , 19 – 21 ). 1.4 Regulatory Framework : Governments at the central and state levels eased regulations to boost production, streamline supply chains, and address logistical barriers. Fast-tracked approvals enabled multiple oxygen sources and smoother transportation( 4 , 22 ). 1.5 Oxygen Stewardship : Efficient oxygen use was crucial during crises like COVID-19. States implemented monitoring measures, audit committees, protocols, and assigned oxygen nurses to minimize wastage ( 4 , 16 , 23 ). 1.6 Network of Distribution Systems : As oxygen is not always produced on-site, distribution is key ( 24 , 25 ). States optimized transport regulations, subsidized logistics, and used a hub-and-spoke model to ensure efficient supply ( 4 ). 1.7 Procurement and Acquisition System : Governments explored new oxygen sources, updated procurement strategies, and imported supplies. Donations from ADB, WHO, UNICEF, and USAID also strengthened infrastructure ( 26 ). 1.8 Workforce Capacity and Training : Staff shortages were mitigated through private sector participation, provisional medical licenses, and volunteer efforts. Training was essential for safe and effective oxygen therapy ( 27 , 28 ). 1.9 International Collaboration : Partnerships with high-income countries, NGOs, and organizations like WHO and USAID helped supply oxygen to overwhelmed health systems, preventing inefficiencies ( 4 , 29 ). 1.10 Public-Private Collaboration : Private sector engagement eased burdens on public healthcare ( 30 , 31 ). States like Delhi, Kerala, Rajasthan and Maharashtra incentivized private oxygen production, logistics support, and supply chain participation. AIIGMA and private LMO manufacturers played a vital role ( 32 , 33 ). 1.11 Monitoring and Audits : Robust audit systems ensured adequate supply and minimized wastage. States used digital tools like ODTS, ODAS, and OCMIS for real-time tracking and distribution efficiency ( 16 , 34 ). 1.12 Preparedness and Planning : Proactive planning helps manage oxygen supply efficiently, mitigate future crises, and leverage digital tools for demand forecasting, production, and distribution ( 4 , 35 – 37 ). 1.13 Digital Technology : Dashboards and digital tools like ODTS, ODAS, and OCMIS helped track supply, demand, and logistics. IoT, GPS, GIS, and RFID ensured real-time monitoring of distribution channels ( 4 , 38 – 40 ). 1.14 Oxygen Management : Managing oxygen supply chains is crucial during pandemics due to strain on the existing supply chain of medical oxygen. It is critical to ensure timely and sufficient access for critically ill patients ( 41 – 43 ). Employing a modified total interpretive structural modeling (m-TISM) approach, these factors were analyzed to elucidate their hierarchical structure and the driving and dependence forces at play. This analysis aims to fortify the oxygen ecosystem comprehensively, aiding policymakers and program implementers in formulating strategic decisions and preemptive measures to confront future threats posed by the virus and similar scenarios. Given COVID-19's recurrent nature and its profound impacts on the global economy, this study's findings are instrumental in effecting dynamic and strategic changes to bolster and sustain the oxygen ecosystem. By establishing a logical hierarchical framework, interventions in oxygen management can be guided effectively, thereby assisting overwhelmed healthcare facilities in mounting a comprehensive response to unforeseen contingencies and potential future catastrophic events. 2. Research Methodology 2.1 Study Design The study employs a mixed-method approach, integrating insights from secondary research and expert interviews of key stakeholders. Fourteen factors were identified as barriers and facilitators of oxygen management in India during the COVID-19 pandemic following an extensive literature review and secondary research. They are explained in detail in Section 1. These factors help in developing a structured interpretive model for analysing interdependencies among various factors. The modified total interpretive structural modeling (m-TISM) is used which is an extension of ISM and TISM methodology that has been extensively applied in literature across multiple disciplines ( 44 , 45 ). This methodology involves advanced qualitative modelling widely accepted as a decision-making approach which helps to understand unstructured mental models of complex issues. These models go through multiple iterative steps by identifying and interpreting their hierarchy to understand the system better ( 46 – 49 ). Furthermore, this approach has been applied in the healthcare industry to explore topics such as manufacturing processes during pandemics and emerging infectious diseases, as well as agile performance within healthcare organizations( 50 – 52 ). This method will help uncover not only the ‘what’ and ‘how’, but also the ‘why’ behind the interrelationships between barriers and facilitators of oxygen management. By incorporating expert insights in situations where quantitative data is limited, it supports more informed and effective decision-making for policymakers and healthcare administrators. The m-TISM methodology will assist in not just a logical interpretation of successive paired comparisons but also transitive links in the hierarchy ( 44 , 45 , 49 ). It will be followed by MICMAC analysis to understand the driving and dependence powers of the factors. The steps of the m-TISM methodology are provided in Fig. 1 ( 44 ). Using thematic analysis, transcripts from the stakeholder interviews were reviewed iteratively by the research team, resulting in identification of ten themes. [Insert Fig. 1 here] 2.2 Data Collection 2.2.1 Participant Selection A total of 12 interviews were conducted with the stakeholders selected from around seven states and the national level. A purposive sampling approach was used to select key stakeholders directly involved in oxygen management during COVID-19 pandemic. These includes a mix of private sector organizations, public sector departments, government authorities, and international organizations. A list of stakeholders is provided in the Table 1 . Table 1 List of stakeholders Sr. N. Stakeholders Department/Institutions that will be referred for various officials (stakeholders) interviewed No. of Interviewees* 1 Government Ministries/Health Departments/State-District Municipals for regulations, policy decisions, and implementation 4 2 International Organizations Technical/infrastructure support from organizations like WHO, UNDP, UNICEF, USAID, etc. 5 3 Website/app Developers Development, operation, and maintenance of apps/websites/dashboards/database 1 4 State or District technical support teams State or District officials and technical departments e.g. NIC 3 5 Academic and technical institutions Technical and research support 3 6 Doctors/Healthcare providers Demand assessment by emergency medicine, hospital medicine, critical care, respiratory therapy 2 7 Distributors Cylinder Suppliers; Transportation departments or companies, etc. 2 8 Private Sector Private hospitals, NGOs, other countries, start-ups 2 9 Human Resource Maintenance staff at the health facility and manufacturing/transport facility 2 10 Special Task Forces For monitoring, communication management, grievances handling, emergency response organizations, workforce training 1 * Note - Some of the interviewees had multiple roles and responsibilities related to the oxygen management during COVID-19, therefore, they were interviewed for more than one role [Insert Table 1 here] 2.2.2 Interview Process After completing secondary research, and expert opinion, semi-structured interviews were conducted with the key stakeholders to gain the insights into barriers and facilitators of oxygen management in India and the relations of all the identified variables. The interviews discussion was initiated by defining their roles and responsibilities leading to the factors and challenges that were involved in the smooth functioning of the oxygen management Towards the concluding part, suggestions and recommendations were sought from the respondents that may help strengthen the oxygen ecosystem in India in case any such arise or in general. Each interview lasted for around 45 minutes to one hour. The data from these interactions were analysed using thematic analysis. 2.2.3 Ethical Considerations This study received ethics approval from the Western Copernicus Group Institutional Review Board. All participants provided informed consent before participating in the study. The study ensured the confidentiality and anonymity of participants, following standard ethical research guidelines. 2.3 Modelling 2.3.1 m-TISM The following steps were followed in the m-TISM methodology: Step 1 Identification and definition of the factors This step involves identifying the factors that act as facilitators or barriers in oxygen management in India and defining them using an extensive literature review, interviews with the experts, and various other stakeholders of oxygen management. A list of all the 14 variables is provided in Table 2 . Table 2 List of factors and codes S.No. Factor Code 1 Oxygen Purity F1 2 Medical Equipment and Maintenance F2 3 Production Capacity F3 4 Regulatory Framework F4 5 Oxygen Stewardship F5 6 Network of Distribution Systems F6 7 Procurement and Acquisition System F7 8 Workforce Capacity and Training F8 9 International Collaboration F9 10 Public-Private Collaboration F10 11 Monitoring and Audits F11 12 Preparedness and Planning F12 13 Digital Technology F13 14 Oxygen Management F14 [Insert Table 2 here] Step 2 Relationship between the factors identified This step involves establishing the relationships between the barriers and facilitators that were identified in Step 1. This is done following the existing literature and expert opinions. For instance, Factor F1 influences Factor F2 and vice versa. Step 3 Interpretation of the relationship This step involves interpreting the relationship that was defined in Step 2. For instance, it is established how Factor F1 influences or enhances Factor 2. Here, the goal is to interpret how one barrier or facilitator of oxygen management influences the other. Step 4 Pairwise comparison, reachability, and transitivity matrix In this step, an interpretive logic-knowledge base (Appendix A) is made to do a pairwise comparison of the factors. This is further used to make the reachability matrix, which is constructed using binary digits 1 and 0. In this matrix, a 1 is placed in case of a direct relationship or impact from one factor to another, and a 0 is placed in case of no relationship. Simultaneously, the factors are checked for transitivity. If Factor A Influences Factor B, then Factor B influences Factor C, then Factor A and Factor C have a transitive relationship. In the reachability matrix, 1* marks the transitive relationships between the factors identified. Step 5 Level Partitioning Level partitioning is done using the reachability set (factors that are influenced by factor X), antecedent set (factors that affect or influence Factor X), and intersection set (present in both reachability and antecedent sets). Level partitions are created by identifying factors that have the same reachability and intersection set. This iterative method is repeated till all the m-TISM levels are identified. Step 6 Diagraph A Diagraph is made to depict the relationships between the factors with both the direct and indirect linkages between them. The m-TISM digraph is made using the level partitions identified in the above steps. Step 7 The m-TISM model The final step or outcome of the above steps is the modified total interpretive structural model. Figure 3 depicts the final m-TISM model along with the interpretation of the relationships between them. 2.3.2 MICMAC The subsequent analysis after identifying the m-TISM hierarchy is the MICMAC (Matrice d’ Impacts croises multiplication applique an classment) analysis. It is conducted using the dependence and driving powers of the factors using the reachability matrix with transitive links ( 46 ). In this analysis, the driving power is calculated as the row total, that is, the number of factors influenced by a factor. The dependence power is calculated as the column total, that is, the number of factors that influence a particular factor. Further, MICMAC analysis categorizes factors into four quadrants of the two-dimensional Cartesian coordinate system with driving forces on the Y axis and dependence forces on the X axis. The results of this analysis will assist in making the outcomes of the m-TISM method more meaningful by visually quantifying their driving and dependence powers. 3. Results 3.1. m-TISM Analysis The study identifies fourteen key factors that act as facilitators and barriers to oxygen management during the COVID-19 pandemic. The m-TISM analysis gives us the hierarchical relationship between these factors. Table 3 depicts reachability matrix. 1* marks the transitive relationships between the factors identified in the reachability matrix. In the level partitioning, iterative method is repeated till all the m-TISM levels are identified. In Table 4 , for the first iteration, it can be noted that for Oxygen Management (F14), the reachability set and the intersection set are the same, placing F14 at Level I. At the next level, it is the same for factors F1, F2, and F5, which are at Level II of the hierarchy. These factors are subsequently removed in the following iteration table, and the process continues until all the levels are identified. The results of the hierarchical level partitioning (Table 4 ) enabled the identification of different levels in the m-TISM hierarchy. Table 3 Reachability Matrix Factor Codes F1 F2 F3 F4 F5 F6 F7 F8 F9 F10 F11 F12 F13 F14 F1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 F2 1 1 0 0 1* 0 0 0 0 0 0 0 0 1* F3 1* 1 1 0 1* 1 1 1* 1* 1* 0 1 1 1* F4 1* 1* 1 1 1* 1* 1* 1* 1* 1* 1 1* 1* 1* F5 1 1* 0 0 1 0 0 0 0 0 0 0 0 1 F6 1* 1 0 0 1* 1 1 1 1 1 0 0 0 1* F7 1* 1* 0 0 1* 1 1 1* 1* 1* 0 0 0 1* F8 1* 1* 0 0 1* 1 1* 1 1* 1* 0 0 0 1* F9 1 1* 0 0 1* 0 0 0 1 1 0 0 0 1* F10 1* 1* 0 0 1* 0 0 0 1 1 0 0 0 1* F11 1* 1* 1* 1 1* 1* 1* 1* 1* 1* 1 1 1 1* F12 1* 1* 1 0 1* 1* 1* 1* 1* 1* 0 1 1 1* F13 1* 1* 1* 0 1* 1* 1* 1* 1* 1* 0 1 1 1* F14 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Table 4 Hierarchical Partitioning Factor Codes Reachability Set Antecedent Set Intersection Set Level Iteration 1 F1 1,2,5,14 1,2,3,4,5,6,7,8,9,10,11,12,13 1,2,5 F2 1,2,5,14 1,2,3,4,5,6,7,8,9,10,11,12,13 1,2,5 F3 1,2,3,5,6,7,8,9,10,12,13,14 3,4,11,12,13 3,12,13 F4 1,2,3,4,5,6,7,8,9,10,11,12,13,14 4,11 4,11 F5 1,2,5,14 1,2,3,4,5,6,7,8,9,10,11,12,13 1,2,5 F6 1,2,5,6,7,8,9,10,14 3,4,6,7,8,11,12,13 6,7,8 F7 1,2,5,6,7,8,9,10,14 3,4,6,7,8,11,12,13 6,7,8 F8 1,2,5,6,7,8,9,10,14 3,4,6,7,8,11,12,13 6,7,8 F9 1,2,5,9,10,14 3,4,6,7,8,9,10,11,12,13 9,10 F10 1,2,5,9,10,14 3,4,6,7,8,9,10,11,12,13 9,10 F11 1,2,3,4,5,6,7,8,9,10,11,12,13,14 4,11 4,11 F12 1,2,3,5,6,7,8,9,10,12,13,14 3,4,11,12,13 3,12,13 F13 1,2,3,5,6,7,8,9,10,12,13,14 3,4,11,12,13 3,12,13 F14 14 1,2,3,4,5,6,7,8,9,10,11,12,13,14 14 I Iteration 2 F1 1,2,5 1,2,3,4,5,6,7,8,9,10,11,12,13 1,2,5 II F2 1,2,5 1,2,3,4,5,6,7,8,9,10,11,12,13 1,2,5 II F3 1,2,3,5,6,7,8,9,10,12,13 3,4,11,12,13 3,12,13 F4 1,2,3,4,5,6,7,8,9,10,11,12,13 4,11 4,11 F5 1,2,5 1,2,3,4,5,6,7,8,9,10,11,12,13 1,2,5 II F6 1,2,5,6,7,8,9,10 3,4,6,7,8,11,12,13 6,7,8 F7 1,2,5,6,7,8,9,10 3,4,6,7,8,11,12,13 6,7,8 F8 1,2,5,6,7,8,9,10 3,4,6,7,8,11,12,13 6,7,8 F9 1,2,5,9,10 3,4,6,7,8,9,10,11,12,13 9,10 F10 1,2,5,9,10 3,4,6,7,8,9,10,11,12,13 9,10 F11 1,2,3,4,5,6,7,8,9,10,11,12,13 4,11 4,11 F12 1,2,3,5,6,7,8,9,10,12,13 3,4,11,12,13 3,12,13 F13 1,2,3,5,6,7,8,9,10,12,13 3,4,11,12,13 3,12,13 Iteration 3 F3 3,6,7,8,9,10,12,13 3,4,11,12,13 3,12,13 F4 3,4,6,7,8,9,10,11,12,13 4,11 4,11 F6 6,7,8,9,10 3,4,6,7,8,11,12,13 6,7,8 F7 6,7,8,9,10 3,4,6,7,8,11,12,13 6,7,8 F8 6,7,8,9,10 3,4,6,7,8,11,12,13 6,7,8 F9 9,10 3,4,6,7,8,9,10,11,12,13 9,10 III F10 9,10 3,4,6,7,8,9,10,11,12,13 9,10 III F11 3,4,6,7,8,9,10,11,12,13 4,11 4,11 F12 3,6,7,8,9,10,12,13 3,4,11,12,13 3,12,13 F13 3,6,7,8,9,10,12,13 3,4,11,12,13 3,12,13 Iteration 4 F3 3,6,7,8,12,13 3,4,11,12,13 3,12,13 F4 3,4,6,7,8,11,12,13 4,11 4,11 F6 6,7,8 3,4,6,7,8,11,12,13 6,7,8 IV F7 6,7,8 3,4,6,7,8,11,12,13 6,7,8 IV F8 6,7,8 3,4,6,7,8,11,12,13 6,7,8 IV F11 3,4,6,7,8,11,12,13 4,11 4,11 F12 3,6,7,8,12,13 3,4,11,12,13 3,12,13 F13 3,6,7,8,12,13 3,4,11,12,13 3,12,13 Iteration 5 F3 3,12,13 3,4,11,12,13 3,12,13 V F4 3,4,11,12,13 4,11 4,11 F11 3,4,11,12,13 4,11 4,11 F12 3,12,13 3,4,11,12,13 3,12,13 V F13 3,12,13 3,4,11,12,13 3,12,13 V Iteration 6 F4 4,11 4,11 4,11 VI F11 4,11 4,11 4,11 VI [Insert Tables 3 & 4 here] Figure 2 demonstrates the m-TISM digraph of barriers and facilitators of oxygen management during COVID-19 in India. Relevant transitive links were retailed in the final digraph, and the rest were dropped. Figure 3 depicts the final m-TISM model along with the interpretation of the relationships between them. [Insert Figs. 2 & 3 here] 3.2. MICMAC Analysis MICMAC analysis categorizes factors into four quadrants of the two-dimensional Cartesian coordinate system with driving forces on the Y axis and dependence forces on the X axis. Table 5 details the calculation of the degree of driving and dependence powers. Figure 4 depicts the MICMAC analysis quadrants and the positioning of the factors affecting oxygen management. Table 5 Degree of driving and dependence power of factors Factor Codes F1 F2 F3 F4 F5 F6 F7 F8 F9 F10 F11 F12 F13 F14 Driving Power (Y) F1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 4 F2 1 1 0 0 1* 0 0 0 0 0 0 0 0 1* 4 F3 1* 1 1 0 1* 1 1 1* 1* 1* 0 1 1 1* 12 F4 1* 1* 1 1 1* 1* 1* 1* 1* 1* 1 1* 1* 1* 14 F5 1 1* 0 0 1 0 0 0 0 0 0 0 0 1 4 F6 1* 1 0 0 1* 1 1 1 1 1 0 0 0 1* 9 F7 1* 1* 0 0 1* 1 1 1* 1* 1* 0 0 0 1* 9 F8 1* 1* 0 0 1* 1 1* 1 1* 1* 0 0 0 1* 9 F9 1 1* 0 0 1* 0 0 0 1 1 0 0 0 1* 6 F10 1* 1* 0 0 1* 0 0 0 1 1 0 0 0 1* 6 F11 1* 1* 1* 1 1* 1* 1* 1* 1* 1* 1 1 1 1* 14 F12 1* 1* 1 0 1* 1* 1* 1* 1* 1* 0 1 1 1* 12 F13 1* 1* 1* 0 1* 1* 1* 1* 1* 1* 0 1 1 1* 12 F14 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 Dependence Power (X) 13 13 5 2 13 8 8 8 10 10 2 5 5 14 [Insert Table 5 & Fig. 4 here] Quadrant 1 (Autonomous Variables) The factors in this quadrant are weaker and have a lower driving and dependence power. They are generally disconnected from the other variables and are difficult to influence even with concentrated efforts. In this analysis, there are no autonomous variables. Quadrant 2 (Dependent Variables) The factors in this quadrant have high dependence power and low driving power. These factors are driven by the factors which have a high driving power. In this analysis, factors the top three levels are dependent factors. Oxygen Management (F14) is at Level I, Oxygen Purity (F1), Medical Equipment and Maintenance (F2), Oxygen Stewardship (F5) at Level II, and International Collaboration (F9) and Public Private Collaboration (F10) at Level III are dependent variables. These are driven by factors that have a high driving power (Quadrant 4) Quadrant 3 (Linkage Variables) The factors that lie in this quadrant have both high driving and dependence powers and stay connected with factors in Quadrant 2 and Quadrant 4. These are critical in the hierarchy since any changes in them impact all the other variables. In this analysis, the Network of Distribution Systems (F6), Procurement and Acquisition System (F7), and Workforce Capacity and Training (F8) are linkage variables. Quadrant 4 (Independent/Driving Variables) The factors in this quadrant have high driving power and play a very important role as key influencers in the model. They ultimately drive the other factors (dependent factors). The critical driving factors in this analysis are Production Capacity (F3), Regulatory Framework (F4), Monitoring and Audits (F11), Preparedness and Planning (F12), and Digital Technology (F13). These factors are placed at the lower levels of the m-TISM hierarchy. 3.3 Thematic Analysis A total of 12 interviews were conducted with key stakeholders, and the transcripts were analyzed using thematic analysis. Themes were identified through multiple rounds of iteration and review among the research team. This process led to the emergence of ten broad themes, presented in Table 6 , which reflect both the challenges and enablers of effective oxygen management. The identified challenges include infrastructure gaps, lack of coordination, logistical delays, insufficient workforce training, and safety concerns. Conversely, the enablers comprise inter-sectoral support, emergency preparedness, monitoring tools, online training, digital technology, and effective resource allocation. These emerging themes are closely aligned with the critical factors identified for the m-TISM modeling, thereby supporting its practical relevance and applicability. Table 6 Themes identified from Stakeholders Interview Themes Stakeholder Types Quotes Infrastructure Gaps Hospital Admin “There were insufficient cylinders to meet the demand and limited refining facilities.” Lack of Coordination International Organization “The government, hospital, and private supplier were all working in silos.” Safety Concerns Doctors “Sometimes, oxygen purity is in question; it didn’t feel safe to administer.” Lack of Trained Workforce Healthcare Providers “Even if we received cylinders, no really knew how to handle or monitor them.” Logistics delays Cylinder Suppliers “There were delays in oxygen supply due to inter-state permissions, which led to trucks stuck for hours.” Transportation departments “There were mismatches in container specifications with liquid medical oxygen leading to delays in oxygen transportation.” Inter-sectoral support Government “Development partners helped us in resource allocation, maintenance, and training of human resources.” Emergency Preparedness State or District technical support teams “Our preparedness for emergency measures ensured prompt oxygen delivery to needy patients. Availability of trained workforce and funding were the main challenges for us” Online Training NGO Representatives “Online training of human resources on handling concentrators and leak prevention helped oxygen wastage using e-learning modules.” Digital Technology Website/app developers “Devices with IoTs, RFID, and GPS enabled us to track oxygen movement in real time and helped redirect it based on the requirement.” State Technical Unit “Oxygen dashboards by states were assisting in procurement and quick mobilization of oxygen.” Data Analytics Academic institutional support “Prediction and forecasting of demand helped in taking production decisions. Also, data-backed decisions strengthened the preparedness for non-pandemic aspects as well.” [Insert Table 6 here] 4. Discussion The m-TISM analysis gives us the hierarchical relationship between these factors. The results of the hierarchical level partitioning (Table 4 ) enabled the identification of different levels in the m-TISM hierarchy. Level VI of the hierarchy consists of ‘Regulatory Framework’ and ‘Monitoring and Audit’, followed by ‘Production Capacity’, ‘Preparedness and Planning’, and ‘Digital Technology’ on Level V. The factors placed at the lower levels of the m-TISM hierarchy are critical elements in the model. The regulatory framework of the country plays an indispensable role in managing the production as well as the logistic supply chain while also ensuring policy refinements wherever necessary ( 53 , 54 ). Regulatory frameworks of the country directly impact the monitoring and audit of oxygen supply by ensuring appropriate guidelines and standards are in place for production, allocation, and distribution to ensure that an adequate amount of safe medical oxygen reaches the patients ( 4 , 16 ). Robust audit and monitoring mechanisms would help to design the interoperability of the digital systems, universal accessibility of these systems, and streamlining of information and communication of guidelines or SOPs. Moreover, the regulations and monitoring would help in capacity building to generate medical oxygen at different levels such as hospitals, districts, or states, and low third-party dependency that may assist for in-house production of medical oxygen such as PSA plants due to its cost-effectiveness ( 55 ). The regulatory framework also dictates how different digital tools and interventions will be implemented, managed, and monitored to comply with the needs of COVID 19 patients' oxygen needs in different states ( 10 , 56 – 58 ). The data analytics and data-backed decisions would help in preparedness for non-pandemic loads, contingent situations, and crises. The medical oxygen demand aggregation and forecasting led to decide the production capacity as it happened during the pandemic when industrial oxygen production was diverted towards medical oxygen production. Transportation of medical oxygen or LMO tankers through railways and airways plays a crucial role in oxygen management. At level V, the limited production capacity of oxygen in a certain country or region impacts their procurement and acquisition systems to minimize shortages and ensure oxygen is available at affordable prices( 3 , 4 ). This requires a prompt response by both the procurement and the network of distribution systems by coordinating with all the stakeholders in the medical oxygen management supply chain to plan and stay prepared with a well-functioning, flexible, transparent, and efficient system to provide oxygen to patients in need ( 3 , 57 , 59 ). A well-planned and thoroughly prepared response will assist the authorities in employing digital tools like oxygen dashboards to procure or acquire adequate oxygen supplies and ensure quick mobilization of those oxygen resources by transporting them to health facilities on time to reduce delays in treatment and mortality rates. Being planned and organized will also help in making sure that healthcare workers, trainees, and volunteers know the proper use of oxygen equipment (local and internationally procured) as well the protocols to be followed while administering and adjusting medical oxygen supply to COVID-19 patients ( 60 – 62 ). Digital tools like Oxygen Digital Tracking System (ODTS), Oxygen Demand Aggregation System (ODAS), OxyCare- Management Information System (OCMIS), platforms to manage oxygen concentrators, IoT devices, GPS, QR codes, and RFID based tracking of oxygen cylinders, and virtual training will assist in surveillance and monitoring, providing telemedicine facilities, remote learning and training of the workforce, predictive analysis to forecast demand, communication and information sharing as well as supply chain management ( 4 ). Automated ODTS (oxygen demand tracking system), GPS, and SIM cards to track the vehicle through the generation of an e-way bill provided details of the driver and the vehicle that helped to communicate and coordinate. Digital interventions helped in making data-backed decisions leading to the optimal usage and allocation of medical oxygen. E-Learning modules can reach different parts of the country in local languages not limited to the times of a crisis but for the long run too. Next, on Level IV are ‘Procurement and Acquisition System’, ‘Network of Distribution Systems’, and ‘Workforce Capacity and Training’, followed by ‘International Collaboration’ and ‘Public-Private Collaboration’ at Level III. Some of the challenges faced during the COVID-19 oxygen crisis were the transportation of medical oxygen from the manufacturing plant to the health facility, mismatch in the container specifications containing liquid medical oxygen from different sources lack of availability of tankers for distribution of medical oxygen. Another key concern was the inadequate infrastructure in the medical oxygen ecosystem which was not sufficient to cater to the medical oxygen demand during the peak surge. For instance, cylinders were not enough to support the demand, limited number of cylinder refiling facilities, and testing facilities were not there. Efficient procurement and acquisition systems play a crucial role in ensuring sufficient quantities of high-quality medical oxygen are available to be distributed by coordinating with oxygen producers and suppliers, setting up quick contracts, and monitoring the requirements and deliveries ( 4 , 9 ). Human Resources was another major area that requires attention in terms of training, awareness, and motivation. Coordination among human resources helps minimize time and optimize resource sharing. Moreover, lack of awareness about the technology, PSA plants, oxygen rationing, medical oxygen wastage or leakage prevention, and requirement of appropriate purity level of medical oxygen were areas that are directly related to human resource capacity building. Logistic management requires a trained workforce to manage storing, handling, and distributing oxygen-delivery equipment. This will facilitate timely and cost-effective distribution domestically and also internationally to other countries with a higher caseload and medical oxygen deficiency ( 14 , 63 – 65 ). At the same time, efficient procurement and distribution networks combined with a competent healthcare workforce will ensure coordination, sufficient funding, innovation, and adequate resource allocation by incentivizing and providing subsidies to private players to reduce some of the burdens on the public healthcare system through public-private partnerships and collaborations with international organizations. Moreover, these international collaborations and public-private partnerships will assist in the sharing of oxygen resources and expertise, effective coordination, joint funding efforts, necessary technology, and oxygen equipment transfers to enable a cohesive global approach to managing oxygen supplies during the pandemic ( 66 – 68 ). These were helpful in many ways such as getting technical assistance in maintenance, establishing global alliances, additional funds and grants, and medical equipment donations by international agencies or other countries. Whereas, public-private collaboration and including inter-sectoral support among different government departments helped in diverting industrial oxygen to medical oxygen to optimize oxygen rationing and allocation. Corporate funding in the form of CAPEX is supported in building the infrastructure, maintenance, and medical equipment availability. Finally, at level II are ‘Medical Equipment and Maintenance’, ‘Quality and Purity’, and ‘Oxygen Stewardship’ with ‘Oxygen Management’ at Level I. The global collaborations and public-private partnerships (Level III) enabled the sharing of best practices and knowledge of oxygen management along with easing the strain on healthcare systems by providing the required medical equipment like oxygen concentrators, oxygen tanks, and ventilators that meet high technical standards ( 15 , 56 , 69 , 70 ). The private sector, third-party organizations such as technology companies or NGOs played a supportive role in developing training modules prepared for quality and purity of the medical oxygen required for the treatment. Technology platforms equipped the human resource and emergency response teams to minimize the oxygen wastage and improved oxygen stewardship which was central to the generation of quality data. This ensures patients get consistent and reliable oxygen therapy treatment with minimum or no wastage of this critical care component during the pandemic. Availability and proper maintenance of the right medical equipment further ensure that they are functioning correctly and providing safe and effective oxygen support to patients while also ensuring minimum wastage and following the protocols and guidelines set by international organizations like WHO and different government bodies ( 4 , 12 , 16 , 71 ). Figure 5 depicts the m-TISM digraph with hierarchical relationships. [Insert Fig. 5 here] The outcomes derived from the m-TISM modelling will serve as a roadmap for international organizations and government authorities, assisting them in formulating and executing policies and regulations to ensure the safe and reliable supply of medical oxygen. By prioritizing the driving factors identified at the lower levels of the m-TISM model, efforts can be directed towards influencing the dependent factors at the higher levels. For instance, streamlining regulatory frameworks can expedite oxygen production, procurement, and distribution, while emergency measures can be implemented to ensure prompt delivery of medical oxygen to patients in need. Additionally, readiness to scale up production capacity, ongoing monitoring, and integration of digital solutions will facilitate the efficient organization and distribution of medical oxygen, thereby minimizing delays and barriers to access for both the general public and frontline healthcare workers. Furthermore, policymakers must address linkage factors and broader healthcare considerations such as the availability of medical equipment, workforce training and capacity building, and international collaborations, all of which have overarching implications for oxygen management across various levels of healthcare delivery. While existing WHO reports and national guidelines offer foundational recommendations, this study provides new, context-specific insights by highlighting how these elements interact in practice and identifying overlooked implementation challenges and enablers. Key areas for attention include infrastructure and human resource capacity building, targeted workforce training initiatives, optimization and consistent operation of infrastructure like Pressure Swing Adsorption (PSA) plants, enhancement of data accuracy and quality, establishment of actionable and locally adaptable audit guidelines, and fostering partnerships with the private sector and international organizations for resource sharing and technical assistance. Additionally, this study highlights the need to actively dispel persistent misconceptions regarding the costs, operational functionality, and installation requirements of PSA plants—issues often inadequately addressed in broader policy frameworks. Future research could look into expanding this study in different geography and uncover region-specific validation of factors and also modelling it further for specific factors like digital interventions and networks of distribution systems in detail to enhance health equity at global scale. Moreover, scholars can focus on modeling other critical aspects of the pandemic, like vaccination, economic impact, and psychological and social impacts. Other domains of healthcare management can also be modeled using this methodology and for critical aspects of other health diseases. Finally, this study is conducted in the context of oxygen management in India. Scholars can also look into similar studies in the context of different regions to learn from the experiences of other countries since the recurring disease requires a long-term global strategy while focussing on managing the immediate and acute impact of the virus. 5. Conclusion We have seen the times when the world was at a pivotal moment in the Covid pandemic, where it was perplexing to understand how the virus would evolve as new variants of different transmission rates were continuously emerging and intensified. COVID-19 is not yet gone, however, there is still global hope for ending the COVID-19 pandemic through combined efforts of international organizations, government authorities, and society as a whole ( 2 , 72 ). Controlling the future threats or ending the pandemic requires a multi-pronged approach with cooperation from all stakeholders worldwide, widespread vaccination, public health measures, and more research in understanding and treating the virus. The results of the m-TISM modeling highlight that Production Capacity, Regulatory Framework, Monitoring and Audits, Preparedness and Planning, and Digital Technology were placed at the lowest levels of the hierarchy making them critical forces that ultimately drive the dependent factors Oxygen Management, Quality and Purity, Medical Equipment and Maintenance, Oxygen Stewardship, International Collaboration, and Public Private Collaboration. The results also emphasize the role of the Network of Distribution Systems, Procurement and Acquisition System, and Workforce Capacity and Training as linkage factors, which impact both the driving (bottom levels) and the dependent (top levels) factors. In the analysis, some of the factors identified are specific to oxygen management and affect the ability of a country to ensure that sufficient and safe oxygen is available to patients who are severely affected by the virus. These factors act as facilitators in the oxygen management ecosystem by supporting all the key stakeholders involved in ensuring optimal and sustainable oxygen systems are in place to treat patients. Moreover, factors that relate to healthcare management in general help ensure that patients have affordable and timely access to high-quality healthcare services in general and medical oxygen, in particular, for improving health services. If these factors do not function well in the oxygen ecosystem, they tend to act as barriers to providing a reliable, efficient, and continuous supply of quality medical oxygen. Therefore, it is pertinent to keep a check on these facilitators of healthcare management to make sure there is a robust healthcare system in place. This will ensure that medical oxygen, a non-substitutable essential drug, is available in abundance at health facilities in case of a future crisis or similar contingencies. Abbreviations ADB Asian Development Bank AIIGMA All India Industrial Gas Manufacturers Association GPS Global Positioning System ICU Intensive Care Unit IoT Internet of Things LMIC Low and middle-income countries LMO Liquid medical oxygen m-TISM Modified Total Interpretive Structural Modeling MICMAC Matrice d’ Impacts croises multiplication applique an classment NGO Non-governmental Organization NIC National Informatics Centre OCMIS OxyCare- Management Information System ODAS Oxygen Demand Aggregation System ODTS Oxygen Digital Tracking System PSA Pressure swing adsorption SOP Standard operating procedure UNICEF United Nations International Children's Emergency Fund USAID United States Agency for International Development WHO World Health Organisation Declarations Ethics approval and consent to participate : This study received ethics approval from the Western Copernicus Group Institutional Review Board (WCG IRB Tracking Number: 20235125) on 28th November 2023. The IRB was in full compliance with Good Clinical Practices, FDA regulations, HHS regulations, and ICH guidelines. All participants provided informed consent before participating in the study. A detailed consent form, titled " Informed Consent Document", was approved by the WCG IRB on 28th November 2023 and used during data collection. This includes a clear explanation of the study's purpose, risks, and confidentiality measures. This document has been uploaded with supplementary documents. Consent for publication : Not applicable Availability of data and materials: No/Not applicable (this manuscript does not report data generation or analysis). Competing interests : The authors declare that they have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Funding : The study is conducted with the collaboration of PATH and IIT Delhi, PATH being the funding agency Authors' contributions: MS: M ade substantial contributions to the conception and design of the work; t he acquisition, analysis, and interpretation of data; has drafted the work and has approved the submitted version SD: M ade substantial contributions to the conception and design of the work; t he acquisition, analysis, and interpretation of data; has drafted the work and has approved the submitted version JK: M ade substantial contributions to the conception and design of the work; t he acquisition, analysis, and interpretation of data; has drafted the work and has approved the submitted version LS: M ade substantial contributions to the conception and design of the work; t he acquisition, analysis, and interpretation of data; has drafted the work and has approved the submitted version RC: M ade substantial contributions to the conception and design of the work; t he acquisition, analysis, and interpretation of data; has drafted the work and has approved the submitted version NT: M ade substantial contributions to the conception and design of the work; t he acquisition, analysis, and interpretation of data; has drafted the work and has approved the submitted version Acknowledgements : The authors would like to acknowledge the contribution of Dr. Aishwarya Kharade for her Project Management role as a former PATH Program Officer References Qamar MA. 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Supplementary Files QuestionnairePATHStudy.pdf AppendixArev.pdf Cite Share Download PDF Status: Published Journal Publication published 12 Nov, 2025 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 19 May, 2025 Reviews received at journal 18 May, 2025 Reviewers agreed at journal 08 May, 2025 Reviewers agreed at journal 08 May, 2025 Reviews received at journal 26 Apr, 2025 Reviewers agreed at journal 21 Apr, 2025 Reviewers agreed at journal 16 Apr, 2025 Reviewers invited by journal 14 Apr, 2025 Submission checks completed at journal 08 Apr, 2025 First submitted to journal 07 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5503121","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":442537548,"identity":"8c1465ea-25f3-41ac-94af-b2d9f740426c","order_by":0,"name":"Mansi Singh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYLCCBAM2O375wweATAkZIrUU8CVLzmBLAGnhIdKaD3KMG27wGICYhLXotp89/OGBgRmzwe2ez69u1FjwMLAfProBnxazM3lpEgkGaXySd85us845BnQYT1raDbxaDuSYAb1/jJnvQO424xw2oBYJHjP8Ws6/Mf6QYPCfseFAzjPjnH/EaLmRYwB0GBvjhBs5zI9z24jS8sYMpCVZsueYGXNunwQPG0G/nM8x/vjjDzAq2Zsff875VifHz374GF4tyIBNAkwSqxwEmD+QonoUjIJRMApGDgAATQBJbM6Ld7MAAAAASUVORK5CYII=","orcid":"","institution":"Jindal Global Business School, O. P. Jindal Global University","correspondingAuthor":true,"prefix":"","firstName":"Mansi","middleName":"","lastName":"Singh","suffix":""},{"id":442537550,"identity":"9ec7dae7-9f07-4328-93c1-a13107b62637","order_by":1,"name":"Sanjay Dhir","email":"","orcid":"","institution":"Indian Institute of Technology Delhi","correspondingAuthor":false,"prefix":"","firstName":"Sanjay","middleName":"","lastName":"Dhir","suffix":""},{"id":442537552,"identity":"59f0a188-626c-4e31-a563-01424d3ddbd3","order_by":2,"name":"Jayendra Kasar","email":"","orcid":"","institution":"PATH Organization","correspondingAuthor":false,"prefix":"","firstName":"Jayendra","middleName":"","lastName":"Kasar","suffix":""},{"id":442537554,"identity":"aab06de0-edc2-4420-bc22-6ad43c7cede4","order_by":3,"name":"Lisa Smith","email":"","orcid":"","institution":"PATH Organization","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"","lastName":"Smith","suffix":""},{"id":442537555,"identity":"564ec8fb-52c5-4a59-aaa3-dd1f832f8453","order_by":4,"name":"Ranjan Choudhury","email":"","orcid":"","institution":"National Health Systems Resource Centre","correspondingAuthor":false,"prefix":"","firstName":"Ranjan","middleName":"","lastName":"Choudhury","suffix":""},{"id":442537558,"identity":"05c05d85-18aa-49f3-97e2-e27084bd5d86","order_by":5,"name":"Navya Tondak","email":"","orcid":"","institution":"Indian Institute of Technology Delhi","correspondingAuthor":false,"prefix":"","firstName":"Navya","middleName":"","lastName":"Tondak","suffix":""}],"badges":[],"createdAt":"2024-11-22 08:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5503121/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5503121/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-025-13655-z","type":"published","date":"2025-11-12T15:58:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":80730141,"identity":"9376b2ac-a539-4d92-80c5-b5ff9847763e","added_by":"auto","created_at":"2025-04-16 12:24:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":237679,"visible":true,"origin":"","legend":"\u003cp\u003eSteps in m-TISM methodology (44)\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5503121/v1/5e1b9a0161beacabaf4d2c3e.png"},{"id":80729009,"identity":"db578b69-b40a-42af-85a7-945725b895b7","added_by":"auto","created_at":"2025-04-16 12:16:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":417487,"visible":true,"origin":"","legend":"\u003cp\u003eDigraph showing direct and transitive linkages between the factors\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5503121/v1/a6b80fc53ea26c20fa14450f.png"},{"id":80731990,"identity":"e613eb18-99d3-4c73-84fc-ee5e632a06be","added_by":"auto","created_at":"2025-04-16 12:48:53","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":179756,"visible":true,"origin":"","legend":"\u003cp\u003eDigraph showing the hierarchical relationship among factors\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5503121/v1/e24f9a73a4738ec42c421a4e.png"},{"id":80731621,"identity":"068dd69b-cac3-49d9-855a-a3e795eec5a7","added_by":"auto","created_at":"2025-04-16 12:40:53","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":95901,"visible":true,"origin":"","legend":"\u003cp\u003eMICMAC analysis (driving and dependence relationship of factors)\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-5503121/v1/9e7f5ff0e47c585c347a794e.png"},{"id":80728996,"identity":"dd00e32b-428f-461c-96df-f0c3c9a3b6ba","added_by":"auto","created_at":"2025-04-16 12:16:53","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":244223,"visible":true,"origin":"","legend":"\u003cp\u003em-TISM digraph of barriers and facilitators of oxygen management\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-5503121/v1/e2dfd48e7d713b204f36aefa.png"},{"id":96106098,"identity":"feaa965c-f520-42b0-8ce6-0189cdc5be10","added_by":"auto","created_at":"2025-11-17 16:12:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3556901,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5503121/v1/cfccd9c1-6d34-41cb-90e7-f69189bc40b5.pdf"},{"id":80728987,"identity":"c9613a97-b20f-4e54-a34b-852d157b4cb3","added_by":"auto","created_at":"2025-04-16 12:16:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":45632,"visible":true,"origin":"","legend":"","description":"","filename":"QuestionnairePATHStudy.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5503121/v1/24622a93d882577ac23f13fa.pdf"},{"id":80728991,"identity":"c4f24e2a-f14e-44f8-89de-c73d7a2f6155","added_by":"auto","created_at":"2025-04-16 12:16:53","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":122233,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixArev.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5503121/v1/168e1652980f8dad4f1130d9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Navigating Oxygen Management Challenges amidst COVID-19 pandemic and beyond in India: A Modified Total Interpretive Structural Modeling (m-TISM) Approach","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSince the initial report of COVID-19 declared as a pandemic, it remained a pressing global crisis. During mid-May 2023, WHO has declared that COVID-19 no longer constitutes a public health emergency of international concern, however, occurrence of any pandemic remains a pressing global priority. Various strategies have been deployed across different levels of governance to mitigate the spread of the virus. The pandemic has strained public health systems worldwide, resulting in millions of deaths (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e). Economic and social disruptions caused by widespread lockdowns have further exacerbated the situation. Daily routines have undergone significant changes globally, with numerous countries experiencing economic downturns (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e). While some nations have effectively managed to curb the virus\u0026apos;s spread, others continue to grapple with recurring outbreaks. Following the devastating Delta variant wave in early 2021, the emergence of the Omicron variant led to another surge in infections, whose repercussions have persisted into early 2023. The virus has afflicted over 600\u0026nbsp;million individuals worldwide, claiming the lives of more than six million, with thousands enduring post-COVID-19 conditions globally (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e). Governments and institutions worldwide have tirelessly collaborated to contain transmission, conduct widespread testing and treatment, minimize fatalities, and ensure vaccine accessibility for their populations (\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAs countries become more interconnected, the spread of viruses like COVID-19 has no borders. This exceptional pandemic underlines the importance of medical oxygen as a critical care component in treating those infected with the virus (\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e). Oxygen therapy is provided to patients with respiratory distress, requiring supplemental oxygen as a treatment. This oxygen provided to patients should be of a certain quality (ranging from more than 82% through oxygen concentrators to 99.5% produced through air-liquefaction process) and free from any contamination (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e). Since liquid medical oxygen, the primary source of medical oxygen is available in limited amounts and not produced at the healthcare facility, meeting the steep increase in demand during the pandemic required a multi-pronged approach involving various stakeholders in the oxygen supply chain. The situation was much worse in low and middle-income countries (LMICs) with a higher caseload, leading to millions of deaths. Managing this heterogenous medical oxygen crisis required a global, national, and regional strategy to ensure sufficient availability and accessibility of oxygen in different contexts and situations (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eGiven the unprecedented demand for the oxygen needed for COVID-19 patients during the pandemic, various initiatives were taken by countries around the world to be equipped and prepared to meet the gap between the demand and supply of oxygen to ensure proper treatment of patients with acute respiratory distress syndrome requiring oxygen therapy. Therefore, this study aims to identify the factors that facilitate or act as barriers to medical oxygen management in India during the COVID-19 pandemic and non-pandemic period during regular functioning of health facilities and understand the hierarchical interrelations between them.\u003c/p\u003e\n\u003cp\u003eAfter conducting an exhaustive literature review, secondary research, and interviews with key stakeholders, this study has pinpointed fourteen crucial factors influencing oxygen management. The following are the barriers and facilitators of Oxygen Management:\u003c/p\u003e\n\u003cp\u003e1.1 \u003cem\u003eOxygen Purity\u003c/em\u003e: Ensuring high-purity medical oxygen is crucial. Producers, storage providers, logistics teams, and healthcare facilities must meet stringent standards set by governments and WHO based on pharmacopeia guidelines (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e1.2 \u003cem\u003eMedical Equipment and Maintenance\u003c/em\u003e: Proper procurement, usage, and maintenance of oxygen-related medical equipment, including PSA plants, LMO tanks, and concentrators, are vital. Nationwide initiatives were undertaken to train staff to handle diverse equipment needs (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e). \u003cspan\u003e1.3 \u003cem\u003eProduction Capacity\u003c/em\u003e: Expanding oxygen production was critical. Some measures to increase production capacity included upgrading existing plants, diverting industrial oxygen, deploying concentrators, setting up new PSA plants, importing equipment, and incentivizing private investment(\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e1.4 \u003cem\u003eRegulatory Framework\u003c/em\u003e: Governments at the central and state levels eased regulations to boost production, streamline supply chains, and address logistical barriers. Fast-tracked approvals enabled multiple oxygen sources and smoother transportation(\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e,\u0026nbsp;\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e1.5 \u003cem\u003eOxygen Stewardship\u003c/em\u003e: Efficient oxygen use was crucial during crises like COVID-19. States implemented monitoring measures, audit committees, protocols, and assigned oxygen nurses to minimize wastage (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e,\u0026nbsp;\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e1.6 \u003cem\u003eNetwork of Distribution Systems\u003c/em\u003e: As oxygen is not always produced on-site, distribution is key (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e). States optimized transport regulations, subsidized logistics, and used a hub-and-spoke model to ensure efficient supply (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e1.7 \u003cem\u003eProcurement and Acquisition System\u003c/em\u003e: Governments explored new oxygen sources, updated procurement strategies, and imported supplies. Donations from ADB, WHO, UNICEF, and USAID also strengthened infrastructure (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e1.8 \u003cem\u003eWorkforce Capacity and Training\u003c/em\u003e: Staff shortages were mitigated through private sector participation, provisional medical licenses, and volunteer efforts. Training was essential for safe and effective oxygen therapy (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e,\u0026nbsp;\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e1.9 \u003cem\u003eInternational Collaboration\u003c/em\u003e: Partnerships with high-income countries, NGOs, and organizations like WHO and USAID helped supply oxygen to overwhelmed health systems, preventing inefficiencies (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e,\u0026nbsp;\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e1.10 \u003cem\u003ePublic-Private Collaboration\u003c/em\u003e: Private sector engagement eased burdens on public healthcare (\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e). States like Delhi, Kerala, Rajasthan and Maharashtra incentivized private oxygen production, logistics support, and supply chain participation. AIIGMA and private LMO manufacturers played a vital role (\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e,\u0026nbsp;\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e1.11 \u003cem\u003eMonitoring and Audits\u003c/em\u003e: Robust audit systems ensured adequate supply and minimized wastage. States used digital tools like ODTS, ODAS, and OCMIS for real-time tracking and distribution efficiency (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e,\u0026nbsp;\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e1.12 \u003cem\u003ePreparedness and Planning\u003c/em\u003e: Proactive planning helps manage oxygen supply efficiently, mitigate future crises, and leverage digital tools for demand forecasting, production, and distribution (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e1.13 \u003cem\u003eDigital Technology\u003c/em\u003e: Dashboards and digital tools like ODTS, ODAS, and OCMIS helped track supply, demand, and logistics. IoT, GPS, GIS, and RFID ensured real-time monitoring of distribution channels (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e1.14 \u003cem\u003eOxygen Management\u003c/em\u003e: Managing oxygen supply chains is crucial during pandemics due to strain on the existing supply chain of medical oxygen. It is critical to ensure timely and sufficient access for critically ill patients (\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e).\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eEmploying a modified total interpretive structural modeling (m-TISM) approach, these factors were analyzed to elucidate their hierarchical structure and the driving and dependence forces at play. This analysis aims to fortify the oxygen ecosystem comprehensively, aiding policymakers and program implementers in formulating strategic decisions and preemptive measures to confront future threats posed by the virus and similar scenarios.\u003c/p\u003e\n\u003cp\u003eGiven COVID-19\u0026apos;s recurrent nature and its profound impacts on the global economy, this study\u0026apos;s findings are instrumental in effecting dynamic and strategic changes to bolster and sustain the oxygen ecosystem. By establishing a logical hierarchical framework, interventions in oxygen management can be guided effectively, thereby assisting overwhelmed healthcare facilities in mounting a comprehensive response to unforeseen contingencies and potential future catastrophic events.\u003c/p\u003e"},{"header":"2. Research Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design\u003c/h2\u003e \u003cp\u003eThe study employs a mixed-method approach, integrating insights from secondary research and expert interviews of key stakeholders. Fourteen factors were identified as barriers and facilitators of oxygen management in India during the COVID-19 pandemic following an extensive literature review and secondary research. They are explained in detail in Section 1. These factors help in developing a structured interpretive model for analysing interdependencies among various factors.\u003c/p\u003e \u003cp\u003eThe modified total interpretive structural modeling (m-TISM) is used which is an extension of ISM and TISM methodology that has been extensively applied in literature across multiple disciplines (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). This methodology involves advanced qualitative modelling widely accepted as a decision-making approach which helps to understand unstructured mental models of complex issues. These models go through multiple iterative steps by identifying and interpreting their hierarchy to understand the system better (\u003cspan additionalcitationids=\"CR47 CR48\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). Furthermore, this approach has been applied in the healthcare industry to explore topics such as manufacturing processes during pandemics and emerging infectious diseases, as well as agile performance within healthcare organizations(\u003cspan additionalcitationids=\"CR51\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). This method will help uncover not only the \u0026lsquo;what\u0026rsquo; and \u0026lsquo;how\u0026rsquo;, but also the \u0026lsquo;why\u0026rsquo; behind the interrelationships between barriers and facilitators of oxygen management. By incorporating expert insights in situations where quantitative data is limited, it supports more informed and effective decision-making for policymakers and healthcare administrators. The m-TISM methodology will assist in not just a logical interpretation of successive paired comparisons but also transitive links in the hierarchy (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). It will be followed by MICMAC analysis to understand the driving and dependence powers of the factors. The steps of the m-TISM methodology are provided in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Using thematic analysis, transcripts from the stakeholder interviews were reviewed iteratively by the research team, resulting in identification of ten themes.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e[Insert\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 \u003cb\u003eData Collection\u003c/b\u003e\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Participant Selection\u003c/h2\u003e \u003cp\u003eA total of 12 interviews were conducted with the stakeholders selected from around seven states and the national level. A purposive sampling approach was used to select key stakeholders directly involved in oxygen management during COVID-19 pandemic. These includes a mix of private sector organizations, public sector departments, government authorities, and international organizations. A list of stakeholders is provided in the Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eList of stakeholders\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSr. N.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStakeholders\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDepartment/Institutions that will be referred for various officials (stakeholders) interviewed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo. of Interviewees*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMinistries/Health Departments/State-District Municipals for regulations, policy decisions, and implementation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternational Organizations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTechnical/infrastructure support from organizations like WHO, UNDP, UNICEF, USAID, etc.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWebsite/app Developers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDevelopment, operation, and maintenance of apps/websites/dashboards/database\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eState or District technical support teams\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eState or District officials and technical departments e.g. NIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcademic and technical institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTechnical and research support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctors/Healthcare providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDemand assessment by emergency medicine, hospital medicine, critical care, respiratory therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDistributors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCylinder Suppliers; Transportation departments or companies, etc.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate Sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrivate hospitals, NGOs, other countries, start-ups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHuman Resource\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaintenance staff at the health facility and manufacturing/transport facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecial Task Forces\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFor monitoring, communication management, grievances handling, emergency response organizations, workforce training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*\u003cem\u003eNote - Some of the interviewees had multiple roles and responsibilities related to the oxygen management during COVID-19, therefore, they were interviewed for more than one role\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 \u003cb\u003eInterview Process\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eAfter completing secondary research, and expert opinion, semi-structured interviews were conducted with the key stakeholders to gain the insights into barriers and facilitators of oxygen management in India and the relations of all the identified variables. The interviews discussion was initiated by defining their roles and responsibilities leading to the factors and challenges that were involved in the smooth functioning of the oxygen management Towards the concluding part, suggestions and recommendations were sought from the respondents that may help strengthen the oxygen ecosystem in India in case any such arise or in general. Each interview lasted for around 45 minutes to one hour. The data from these interactions were analysed using thematic analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 \u003cb\u003eEthical Considerations\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThis study received ethics approval from the Western Copernicus Group Institutional Review Board. All participants provided informed consent before participating in the study. The study ensured the confidentiality and anonymity of participants, following standard ethical research guidelines.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Modelling\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 m-TISM\u003c/h2\u003e \u003cp\u003eThe following steps were followed in the m-TISM methodology:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStep 1\u003c/strong\u003e \u003cp\u003eIdentification and definition of the factors\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThis step involves identifying the factors that act as facilitators or barriers in oxygen management in India and defining them using an extensive literature review, interviews with the experts, and various other stakeholders of oxygen management. A list of all the 14 variables is provided in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eList of factors and codes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS.No.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCode\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOxygen Purity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical Equipment and Maintenance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProduction Capacity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegulatory Framework\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOxygen Stewardship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNetwork of Distribution Systems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProcurement and Acquisition System\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorkforce Capacity and Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternational Collaboration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic-Private Collaboration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMonitoring and Audits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreparedness and Planning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDigital Technology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOxygen Management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStep 2\u003c/strong\u003e \u003cp\u003eRelationship between the factors identified\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThis step involves establishing the relationships between the barriers and facilitators that were identified in Step 1. This is done following the existing literature and expert opinions. For instance, Factor F1 influences Factor F2 and vice versa.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStep 3\u003c/strong\u003e \u003cp\u003eInterpretation of the relationship\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThis step involves interpreting the relationship that was defined in Step 2. For instance, it is established how Factor F1 influences or enhances Factor 2. Here, the goal is to interpret how one barrier or facilitator of oxygen management influences the other.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStep 4\u003c/strong\u003e \u003cp\u003ePairwise comparison, reachability, and transitivity matrix\u003c/p\u003e \u003c/p\u003e \u003cp\u003eIn this step, an interpretive logic-knowledge base (Appendix A) is made to do a pairwise comparison of the factors. This is further used to make the reachability matrix, which is constructed using binary digits 1 and 0. In this matrix, a 1 is placed in case of a direct relationship or impact from one factor to another, and a 0 is placed in case of no relationship. Simultaneously, the factors are checked for transitivity. If Factor A Influences Factor B, then Factor B influences Factor C, then Factor A and Factor C have a transitive relationship. In the reachability matrix, 1* marks the transitive relationships between the factors identified.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStep 5\u003c/strong\u003e \u003cp\u003eLevel Partitioning\u003c/p\u003e \u003c/p\u003e \u003cp\u003eLevel partitioning is done using the reachability set (factors that are influenced by factor X), antecedent set (factors that affect or influence Factor X), and intersection set (present in both reachability and antecedent sets). Level partitions are created by identifying factors that have the same reachability and intersection set. This iterative method is repeated till all the m-TISM levels are identified.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStep 6\u003c/strong\u003e \u003cp\u003eDiagraph\u003c/p\u003e \u003c/p\u003e \u003cp\u003eA Diagraph is made to depict the relationships between the factors with both the direct and indirect linkages between them. The m-TISM digraph is made using the level partitions identified in the above steps.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStep 7\u003c/strong\u003e \u003cp\u003eThe m-TISM model\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe final step or outcome of the above steps is the modified total interpretive structural model. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e depicts the final m-TISM model along with the interpretation of the relationships between them.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 MICMAC\u003c/h2\u003e \u003cp\u003eThe subsequent analysis after identifying the m-TISM hierarchy is the MICMAC (Matrice d\u0026rsquo; Impacts croises multiplication applique an classment) analysis. It is conducted using the dependence and driving powers of the factors using the reachability matrix with transitive links (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). In this analysis, the driving power is calculated as the row total, that is, the number of factors influenced by a factor. The dependence power is calculated as the column total, that is, the number of factors that influence a particular factor. Further, MICMAC analysis categorizes factors into four quadrants of the two-dimensional Cartesian coordinate system with driving forces on the Y axis and dependence forces on the X axis. The results of this analysis will assist in making the outcomes of the m-TISM method more meaningful by visually quantifying their driving and dependence powers.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.1. m-TISM Analysis\u003c/h2\u003e \u003cp\u003eThe study identifies fourteen key factors that act as facilitators and barriers to oxygen management during the COVID-19 pandemic. The m-TISM analysis gives us the hierarchical relationship between these factors. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e depicts reachability matrix. 1* marks the transitive relationships between the factors identified in the reachability matrix. In the level partitioning, iterative method is repeated till all the m-TISM levels are identified. In Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, for the first iteration, it can be noted that for Oxygen Management (F14), the reachability set and the intersection set are the same, placing F14 at Level I. At the next level, it is the same for factors F1, F2, and F5, which are at Level II of the hierarchy. These factors are subsequently removed in the following iteration table, and the process continues until all the levels are identified. The results of the hierarchical level partitioning (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) enabled the identification of different levels in the m-TISM hierarchy.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReachability Matrix\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"15\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" 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align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e 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\u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHierarchical Partitioning\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003cp\u003eCodes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReachability Set\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAntecedent Set\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntersection Set\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eIteration 1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,2,3,4,5,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,2,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,2,3,4,5,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,2,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,3,5,6,7,8,9,10,12,13,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,3,4,5,6,7,8,9,10,11,12,13,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,2,3,4,5,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,2,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5,6,7,8,9,10,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5,6,7,8,9,10,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5,6,7,8,9,10,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5,9,10,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5,9,10,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,3,4,5,6,7,8,9,10,11,12,13,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,3,5,6,7,8,9,10,12,13,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,3,5,6,7,8,9,10,12,13,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,2,3,4,5,6,7,8,9,10,11,12,13,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eIteration 2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,2,3,4,5,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,2,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,2,3,4,5,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,2,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,3,5,6,7,8,9,10,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,3,4,5,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,2,3,4,5,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,2,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5,6,7,8,9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5,6,7,8,9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5,6,7,8,9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5,9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,5,9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,3,4,5,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,3,5,6,7,8,9,10,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2,3,5,6,7,8,9,10,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eIteration 3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,6,7,8,9,10,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,4,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,7,8,9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,7,8,9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,7,8,9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,4,6,7,8,9,10,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,6,7,8,9,10,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,6,7,8,9,10,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eIteration 4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,6,7,8,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,4,6,7,8,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,6,7,8,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,7,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,4,6,7,8,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,6,7,8,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,6,7,8,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eIteration 5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,4,11,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eIteration 6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e[Insert\u003c/em\u003e Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u0026amp; \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e demonstrates the m-TISM digraph of barriers and facilitators of oxygen management during COVID-19 in India. Relevant transitive links were retailed in the final digraph, and the rest were dropped. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e depicts the final m-TISM model along with the interpretation of the relationships between them.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e[Insert\u003c/em\u003e Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u0026amp; \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.2. MICMAC Analysis\u003c/h2\u003e \u003cp\u003eMICMAC analysis categorizes factors into four quadrants of the two-dimensional Cartesian coordinate system with driving forces on the Y axis and dependence forces on the X axis. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e details the calculation of the degree of driving and dependence powers. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e depicts the MICMAC analysis quadrants and the positioning of the factors affecting oxygen management.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDegree of driving and dependence power of factors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"16\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor Codes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eF5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eF6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eF7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eF8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eF9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eF10\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eF11\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eF12\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eF13\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003eF14\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c16\"\u003e \u003cp\u003eDriving\u003c/p\u003e \u003cp\u003ePower (Y)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1*\u003c/p\u003e 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align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e 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colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e 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colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e 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\u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependence\u003c/p\u003e \u003cp\u003ePower (X)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e \u003cem\u003e\u0026amp;\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eQuadrant 1 (Autonomous Variables)\u003c/strong\u003e \u003cp\u003eThe factors in this quadrant are weaker and have a lower driving and dependence power. They are generally disconnected from the other variables and are difficult to influence even with concentrated efforts. In this analysis, there are no autonomous variables.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eQuadrant 2 (Dependent Variables)\u003c/strong\u003e \u003cp\u003eThe factors in this quadrant have high dependence power and low driving power. These factors are driven by the factors which have a high driving power. In this analysis, factors the top three levels are dependent factors. Oxygen Management (F14) is at Level I, Oxygen Purity (F1), Medical Equipment and Maintenance (F2), Oxygen Stewardship (F5) at Level II, and International Collaboration (F9) and Public Private Collaboration (F10) at Level III are dependent variables. These are driven by factors that have a high driving power (Quadrant 4)\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eQuadrant 3 (Linkage Variables)\u003c/strong\u003e \u003cp\u003eThe factors that lie in this quadrant have both high driving and dependence powers and stay connected with factors in Quadrant 2 and Quadrant 4. These are critical in the hierarchy since any changes in them impact all the other variables. In this analysis, the Network of Distribution Systems (F6), Procurement and Acquisition System (F7), and Workforce Capacity and Training (F8) are linkage variables.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eQuadrant 4 (Independent/Driving Variables)\u003c/strong\u003e \u003cp\u003eThe factors in this quadrant have high driving power and play a very important role as key influencers in the model. They ultimately drive the other factors (dependent factors). The critical driving factors in this analysis are Production Capacity (F3), Regulatory Framework (F4), Monitoring and Audits (F11), Preparedness and Planning (F12), and Digital Technology (F13). These factors are placed at the lower levels of the m-TISM hierarchy.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Thematic Analysis\u003c/h2\u003e \u003cp\u003eA total of 12 interviews were conducted with key stakeholders, and the transcripts were analyzed using thematic analysis. Themes were identified through multiple rounds of iteration and review among the research team. This process led to the emergence of ten broad themes, presented in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, which reflect both the challenges and enablers of effective oxygen management. The identified challenges include infrastructure gaps, lack of coordination, logistical delays, insufficient workforce training, and safety concerns. Conversely, the enablers comprise inter-sectoral support, emergency preparedness, monitoring tools, online training, digital technology, and effective resource allocation. These emerging themes are closely aligned with the critical factors identified for the m-TISM modeling, thereby supporting its practical relevance and applicability.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThemes identified from Stakeholders Interview\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStakeholder Types\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfrastructure Gaps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospital Admin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;There were insufficient cylinders to meet the demand and limited refining facilities.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of Coordination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternational Organization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The government, hospital, and private supplier were all working in silos.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSafety Concerns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes, oxygen purity is in question; it didn\u0026rsquo;t feel safe to administer.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of Trained Workforce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthcare Providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Even if we received cylinders, no really knew how to handle or monitor them.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLogistics delays\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCylinder Suppliers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;There were delays in oxygen supply due to inter-state permissions, which led to trucks stuck for hours.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTransportation departments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;There were mismatches in container specifications with liquid medical oxygen leading to delays in oxygen transportation.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInter-sectoral support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Development partners helped us in resource allocation, maintenance, and training of human resources.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency Preparedness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eState or District technical support teams\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Our preparedness for emergency measures ensured prompt oxygen delivery to needy patients. Availability of trained workforce and funding were the main challenges for us\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnline Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNGO Representatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Online training of human resources on handling concentrators and leak prevention helped oxygen wastage using e-learning modules.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDigital Technology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWebsite/app developers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Devices with IoTs, RFID, and GPS enabled us to track oxygen movement in real time and helped redirect it based on the requirement.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eState Technical Unit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Oxygen dashboards by states were assisting in procurement and quick mobilization of oxygen.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eData Analytics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcademic institutional support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Prediction and forecasting of demand helped in taking production decisions. Also, data-backed decisions strengthened the preparedness for non-pandemic aspects as well.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe m-TISM analysis gives us the hierarchical relationship between these factors. The results of the hierarchical level partitioning (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) enabled the identification of different levels in the m-TISM hierarchy. Level VI of the hierarchy consists of \u0026lsquo;Regulatory Framework\u0026rsquo; and \u0026lsquo;Monitoring and Audit\u0026rsquo;, followed by \u0026lsquo;Production Capacity\u0026rsquo;, \u0026lsquo;Preparedness and Planning\u0026rsquo;, and \u0026lsquo;Digital Technology\u0026rsquo; on Level V. The factors placed at the lower levels of the m-TISM hierarchy are critical elements in the model. The regulatory framework of the country plays an indispensable role in managing the production as well as the logistic supply chain while also ensuring policy refinements wherever necessary (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). Regulatory frameworks of the country directly impact the monitoring and audit of oxygen supply by ensuring appropriate guidelines and standards are in place for production, allocation, and distribution to ensure that an adequate amount of safe medical oxygen reaches the patients (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Robust audit and monitoring mechanisms would help to design the interoperability of the digital systems, universal accessibility of these systems, and streamlining of information and communication of guidelines or SOPs. Moreover, the regulations and monitoring would help in capacity building to generate medical oxygen at different levels such as hospitals, districts, or states, and low third-party dependency that may assist for in-house production of medical oxygen such as PSA plants due to its cost-effectiveness (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). The regulatory framework also dictates how different digital tools and interventions will be implemented, managed, and monitored to comply with the needs of COVID 19 patients' oxygen needs in different states (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR57\" citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). The data analytics and data-backed decisions would help in preparedness for non-pandemic loads, contingent situations, and crises. The medical oxygen demand aggregation and forecasting led to decide the production capacity as it happened during the pandemic when industrial oxygen production was diverted towards medical oxygen production. Transportation of medical oxygen or LMO tankers through railways and airways plays a crucial role in oxygen management. At level V, the limited production capacity of oxygen in a certain country or region impacts their procurement and acquisition systems to minimize shortages and ensure oxygen is available at affordable prices(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This requires a prompt response by both the procurement and the network of distribution systems by coordinating with all the stakeholders in the medical oxygen management supply chain to plan and stay prepared with a well-functioning, flexible, transparent, and efficient system to provide oxygen to patients in need (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e). A well-planned and thoroughly prepared response will assist the authorities in employing digital tools like oxygen dashboards to procure or acquire adequate oxygen supplies and ensure quick mobilization of those oxygen resources by transporting them to health facilities on time to reduce delays in treatment and mortality rates. Being planned and organized will also help in making sure that healthcare workers, trainees, and volunteers know the proper use of oxygen equipment (local and internationally procured) as well the protocols to be followed while administering and adjusting medical oxygen supply to COVID-19 patients (\u003cspan additionalcitationids=\"CR61\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e). Digital tools like Oxygen Digital Tracking System (ODTS), Oxygen Demand Aggregation System (ODAS), OxyCare- Management Information System (OCMIS), platforms to manage oxygen concentrators, IoT devices, GPS, QR codes, and RFID based tracking of oxygen cylinders, and virtual training will assist in surveillance and monitoring, providing telemedicine facilities, remote learning and training of the workforce, predictive analysis to forecast demand, communication and information sharing as well as supply chain management (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Automated ODTS (oxygen demand tracking system), GPS, and SIM cards to track the vehicle through the generation of an e-way bill provided details of the driver and the vehicle that helped to communicate and coordinate. Digital interventions helped in making data-backed decisions leading to the optimal usage and allocation of medical oxygen. E-Learning modules can reach different parts of the country in local languages not limited to the times of a crisis but for the long run too. Next, on Level IV are \u0026lsquo;Procurement and Acquisition System\u0026rsquo;, \u0026lsquo;Network of Distribution Systems\u0026rsquo;, and \u0026lsquo;Workforce Capacity and Training\u0026rsquo;, followed by \u0026lsquo;International Collaboration\u0026rsquo; and \u0026lsquo;Public-Private Collaboration\u0026rsquo; at Level III. Some of the challenges faced during the COVID-19 oxygen crisis were the transportation of medical oxygen from the manufacturing plant to the health facility, mismatch in the container specifications containing liquid medical oxygen from different sources lack of availability of tankers for distribution of medical oxygen. Another key concern was the inadequate infrastructure in the medical oxygen ecosystem which was not sufficient to cater to the medical oxygen demand during the peak surge. For instance, cylinders were not enough to support the demand, limited number of cylinder refiling facilities, and testing facilities were not there. Efficient procurement and acquisition systems play a crucial role in ensuring sufficient quantities of high-quality medical oxygen are available to be distributed by coordinating with oxygen producers and suppliers, setting up quick contracts, and monitoring the requirements and deliveries (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Human Resources was another major area that requires attention in terms of training, awareness, and motivation. Coordination among human resources helps minimize time and optimize resource sharing. Moreover, lack of awareness about the technology, PSA plants, oxygen rationing, medical oxygen wastage or leakage prevention, and requirement of appropriate purity level of medical oxygen were areas that are directly related to human resource capacity building. Logistic management requires a trained workforce to manage storing, handling, and distributing oxygen-delivery equipment. This will facilitate timely and cost-effective distribution domestically and also internationally to other countries with a higher caseload and medical oxygen deficiency (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR64\" citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e). At the same time, efficient procurement and distribution networks combined with a competent healthcare workforce will ensure coordination, sufficient funding, innovation, and adequate resource allocation by incentivizing and providing subsidies to private players to reduce some of the burdens on the public healthcare system through public-private partnerships and collaborations with international organizations. Moreover, these international collaborations and public-private partnerships will assist in the sharing of oxygen resources and expertise, effective coordination, joint funding efforts, necessary technology, and oxygen equipment transfers to enable a cohesive global approach to managing oxygen supplies during the pandemic (\u003cspan additionalcitationids=\"CR67\" citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). These were helpful in many ways such as getting technical assistance in maintenance, establishing global alliances, additional funds and grants, and medical equipment donations by international agencies or other countries. Whereas, public-private collaboration and including inter-sectoral support among different government departments helped in diverting industrial oxygen to medical oxygen to optimize oxygen rationing and allocation. Corporate funding in the form of CAPEX is supported in building the infrastructure, maintenance, and medical equipment availability. Finally, at level II are \u0026lsquo;Medical Equipment and Maintenance\u0026rsquo;, \u0026lsquo;Quality and Purity\u0026rsquo;, and \u0026lsquo;Oxygen Stewardship\u0026rsquo; with \u0026lsquo;Oxygen Management\u0026rsquo; at Level I. The global collaborations and public-private partnerships (Level III) enabled the sharing of best practices and knowledge of oxygen management along with easing the strain on healthcare systems by providing the required medical equipment like oxygen concentrators, oxygen tanks, and ventilators that meet high technical standards (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e). The private sector, third-party organizations such as technology companies or NGOs played a supportive role in developing training modules prepared for quality and purity of the medical oxygen required for the treatment. Technology platforms equipped the human resource and emergency response teams to minimize the oxygen wastage and improved oxygen stewardship which was central to the generation of quality data. This ensures patients get consistent and reliable oxygen therapy treatment with minimum or no wastage of this critical care component during the pandemic. Availability and proper maintenance of the right medical equipment further ensure that they are functioning correctly and providing safe and effective oxygen support to patients while also ensuring minimum wastage and following the protocols and guidelines set by international organizations like WHO and different government bodies (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). Figure\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e depicts the m-TISM digraph with hierarchical relationships.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e[Insert\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThe outcomes derived from the m-TISM modelling will serve as a roadmap for international organizations and government authorities, assisting them in formulating and executing policies and regulations to ensure the safe and reliable supply of medical oxygen. By prioritizing the driving factors identified at the lower levels of the m-TISM model, efforts can be directed towards influencing the dependent factors at the higher levels. For instance, streamlining regulatory frameworks can expedite oxygen production, procurement, and distribution, while emergency measures can be implemented to ensure prompt delivery of medical oxygen to patients in need. Additionally, readiness to scale up production capacity, ongoing monitoring, and integration of digital solutions will facilitate the efficient organization and distribution of medical oxygen, thereby minimizing delays and barriers to access for both the general public and frontline healthcare workers.\u003c/p\u003e \u003cp\u003eFurthermore, policymakers must address linkage factors and broader healthcare considerations such as the availability of medical equipment, workforce training and capacity building, and international collaborations, all of which have overarching implications for oxygen management across various levels of healthcare delivery. While existing WHO reports and national guidelines offer foundational recommendations, this study provides new, context-specific insights by highlighting how these elements interact in practice and identifying overlooked implementation challenges and enablers. Key areas for attention include infrastructure and human resource capacity building, targeted workforce training initiatives, optimization and consistent operation of infrastructure like Pressure Swing Adsorption (PSA) plants, enhancement of data accuracy and quality, establishment of actionable and locally adaptable audit guidelines, and fostering partnerships with the private sector and international organizations for resource sharing and technical assistance. Additionally, this study highlights the need to actively dispel persistent misconceptions regarding the costs, operational functionality, and installation requirements of PSA plants\u0026mdash;issues often inadequately addressed in broader policy frameworks.\u003c/p\u003e \u003cp\u003eFuture research could look into expanding this study in different geography and uncover region-specific validation of factors and also modelling it further for specific factors like digital interventions and networks of distribution systems in detail to enhance health equity at global scale. Moreover, scholars can focus on modeling other critical aspects of the pandemic, like vaccination, economic impact, and psychological and social impacts. Other domains of healthcare management can also be modeled using this methodology and for critical aspects of other health diseases. Finally, this study is conducted in the context of oxygen management in India. Scholars can also look into similar studies in the context of different regions to learn from the experiences of other countries since the recurring disease requires a long-term global strategy while focussing on managing the immediate and acute impact of the virus.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eWe have seen the times when the world was at a pivotal moment in the Covid pandemic, where it was perplexing to understand how the virus would evolve as new variants of different transmission rates were continuously emerging and intensified. COVID-19 is not yet gone, however, there is still global hope for ending the COVID-19 pandemic through combined efforts of international organizations, government authorities, and society as a whole (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e). Controlling the future threats or ending the pandemic requires a multi-pronged approach with cooperation from all stakeholders worldwide, widespread vaccination, public health measures, and more research in understanding and treating the virus.\u003c/p\u003e \u003cp\u003eThe results of the m-TISM modeling highlight that Production Capacity, Regulatory Framework, Monitoring and Audits, Preparedness and Planning, and Digital Technology were placed at the lowest levels of the hierarchy making them critical forces that ultimately drive the dependent factors Oxygen Management, Quality and Purity, Medical Equipment and Maintenance, Oxygen Stewardship, International Collaboration, and Public Private Collaboration. The results also emphasize the role of the Network of Distribution Systems, Procurement and Acquisition System, and Workforce Capacity and Training as linkage factors, which impact both the driving (bottom levels) and the dependent (top levels) factors. In the analysis, some of the factors identified are specific to oxygen management and affect the ability of a country to ensure that sufficient and safe oxygen is available to patients who are severely affected by the virus. These factors act as facilitators in the oxygen management ecosystem by supporting all the key stakeholders involved in ensuring optimal and sustainable oxygen systems are in place to treat patients. Moreover, factors that relate to healthcare management in general help ensure that patients have affordable and timely access to high-quality healthcare services in general and medical oxygen, in particular, for improving health services. If these factors do not function well in the oxygen ecosystem, they tend to act as barriers to providing a reliable, efficient, and continuous supply of quality medical oxygen. Therefore, it is pertinent to keep a check on these facilitators of healthcare management to make sure there is a robust healthcare system in place. This will ensure that medical oxygen, a non-substitutable essential drug, is available in abundance at health facilities in case of a future crisis or similar contingencies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"737\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eADB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eAsian Development Bank\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eAIIGMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eAll India Industrial Gas Manufacturers Association\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eGPS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eGlobal Positioning System\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eIntensive Care Unit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eIoT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eInternet of Things\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eLMIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eLow and middle-income countries\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eLMO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eLiquid medical oxygen\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003em-TISM\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eModified Total Interpretive Structural Modeling\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eMICMAC\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eMatrice d\u0026rsquo; Impacts croises multiplication applique an classment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eNGO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eNon-governmental Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eNIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eNational Informatics Centre\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eOCMIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eOxyCare- Management Information System\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eODAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003e\u0026nbsp;Oxygen Demand Aggregation System\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eODTS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eOxygen Digital Tracking System\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003ePSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003ePressure swing adsorption\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eSOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eStandard operating procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eUNICEF\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eUnited Nations International Children\u0026apos;s Emergency Fund\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eUSAID\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eUnited States Agency for International Development\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 651px;\"\u003e\n \u003cp\u003eWorld Health Organisation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThis study received ethics approval from the Western Copernicus Group Institutional Review Board (WCG IRB\u003c/strong\u003e \u003cstrong\u003eTracking Number: 20235125) on 28th November 2023. The IRB was in full compliance with Good Clinical Practices, FDA regulations, HHS regulations, and ICH guidelines.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAll participants provided\u003c/strong\u003e \u003cstrong\u003einformed consent before participating in the study. A detailed consent form, titled \u0026quot; Informed Consent Document\u0026quot;, was approved by the WCG IRB on 28th November 2023 and used during data collection. This includes a clear explanation of the study\u0026apos;s purpose, risks, and confidentiality measures. This document has been uploaded with supplementary documents.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003cstrong\u003e: \u003cem\u003eNot applicable\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: \u003cstrong\u003e\u003cem\u003eNo/Not applicable (this manuscript does not report data generation or analysis).\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003cstrong\u003e: \u003cem\u003eThe authors declare that they have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding\u003cstrong\u003e: \u003cem\u003eThe study is conducted with the collaboration of PATH and IIT Delhi, PATH being the funding agency\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMS: M\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eade substantial contributions to the conception and\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003edesign of the work; t\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ehe acquisition, analysis, and\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003einterpretation of data;\u0026nbsp;has\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003edrafted the work and has approved the submitted version\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSD: M\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eade substantial contributions to the conception and\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003edesign of the work; t\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ehe acquisition, analysis, and\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003einterpretation of data;\u0026nbsp;has\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003edrafted the work and has approved the submitted version\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eJK: M\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eade substantial contributions to the conception and\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003edesign of the work; t\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ehe acquisition, analysis, and\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003einterpretation of data;\u0026nbsp;has\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003edrafted the work and has approved the submitted version\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLS: M\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eade substantial contributions to the conception and\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003edesign of the work; t\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ehe acquisition, analysis, and\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003einterpretation of data;\u0026nbsp;has\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003edrafted the work and has approved the submitted version\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRC: M\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eade substantial contributions to the conception and\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003edesign of the work; t\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ehe acquisition, analysis, and\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003einterpretation of data;\u0026nbsp;has\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003edrafted the work and has approved the submitted version\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNT: M\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eade substantial contributions to the conception and\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003edesign of the work; t\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ehe acquisition, analysis, and\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003einterpretation of data;\u0026nbsp;has\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003edrafted the work and has approved the submitted version\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\n\u003cp\u003eAcknowledgements\u003cstrong\u003e: \u003cem\u003eThe authors would like to acknowledge the contribution of Dr. Aishwarya Kharade for her Project Management role as a former PATH Program Officer\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\n\n\n\n\n\n\n\n\n\n\n\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eQamar MA. 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Public-Private-People Partnerships (4P) for Improving the Response to COVID-19 in Iran. Disaster Med Public Health Prep. 2021;15(1). \u003c/li\u003e\n\u003cli\u003eStayt LC, Merriman C, Bench S, M. Price A, Vollam S, Walthall H, et al. \u0026lsquo;Doing the best we can\u0026rsquo;: Registered Nurses\u0026rsquo; experiences and perceptions of patient safety in intensive care during COVID-19. J Adv Nurs [Internet]. 2022 Oct 1 [cited 2023 Feb 7];78(10):3371\u0026ndash;84. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jan.15419\u003c/li\u003e\n\u003cli\u003eDubb SS. Coronavirus pandemic: applying a whole-of-society model for the whole-of-the world. British Journal of Oral and Maxillofacial Surgery. 2020 Sep 1;58(7):838\u0026ndash;42. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Oxygen Management, COVID-19, Barriers, Facilitators, m-TISM, MICMAC","lastPublishedDoi":"10.21203/rs.3.rs-5503121/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5503121/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eGiven the unprecedented surge in COVID-19 infections, the heightened demand for medical oxygen prompted numerous national and global initiatives to bridge the gap between supply and demand. This was crucial for ensuring adequate treatment for patients suffering from acute respiratory distress syndrome and requiring oxygen therapy. This research aims to explore the factors influencing medical oxygen management in India during the pandemic and beyond, examining both facilitators and barriers.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThrough a thorough review of literature, secondary research, and interviews with key stakeholders, critical factors affecting oxygen management were identified. These factors were then analyzed using a modified total interpretive structural modeling (m-TISM) approach and MICMAC (Matrice d\u0026rsquo; Impacts croises multiplication applique an classment) analysis to comprehend their hierarchical relationships and driving forces.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study identifies fourteen key factors that act as facilitators and barriers to oxygen management during the Covid-19 pandemic. These factors also influence medical oxygen management during non-pandemic period. The development of an m-TISM model gives us the hierarchical interrelationships between these factors, including oxygen management as one of the factors itself. The findings identify key strategic levers to strengthen the national oxygen management ecosystem and cross-sectoral collaborations.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study provides insights into strengthening the oxygen ecosystem, enabling policymakers and program implementers to make informed decisions and implement pre-emptive measures to address future threats from the virus or similar crises.\u003c/p\u003e","manuscriptTitle":"Navigating Oxygen Management Challenges amidst COVID-19 pandemic and beyond in India: A Modified Total Interpretive Structural Modeling (m-TISM) Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-16 12:16:48","doi":"10.21203/rs.3.rs-5503121/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-19T18:07:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-18T09:28:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83343005968160513295635343965809770353","date":"2025-05-08T10:32:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29745677223116003811842256299615261897","date":"2025-05-08T04:12:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-26T16:29:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"120903470741702677286430652998909909558","date":"2025-04-21T07:14:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230454121438562270216575057529607299861","date":"2025-04-16T13:50:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-14T07:20:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-08T07:26:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-04-07T19:05:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"399bf73e-71e1-43fc-8dc4-97e127f77df9","owner":[],"postedDate":"April 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T16:10:53+00:00","versionOfRecord":{"articleIdentity":"rs-5503121","link":"https://doi.org/10.1186/s12913-025-13655-z","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2025-11-12 15:58:34","publishedOnDateReadable":"November 12th, 2025"},"versionCreatedAt":"2025-04-16 12:16:48","video":"","vorDoi":"10.1186/s12913-025-13655-z","vorDoiUrl":"https://doi.org/10.1186/s12913-025-13655-z","workflowStages":[]},"version":"v1","identity":"rs-5503121","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5503121","identity":"rs-5503121","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}