Healthcare Policies to Eliminate Neglected Tropical Diseases (NTDs) in India: A Roadmap.

The need for systemic healthcare policies to systematically eliminate NTDs globally and in India has been stressed for more than two decades. Yet, the present policies and the research on them do not meet the need. We present an ontological framework, a research roadmap, and a policy brief to address the gap. The ontology clearly, concisely, and comprehensively represents the combinations of diseases, the objectives regarding the diseases, the entities to address them, the outcomes sought, and the potential policy instruments to invoke. The paper explicates the state of the-policies and state of the research on policies to eliminate NTDs in India. It highlights the significant gaps in the diseases covered, balance in the objectives, comprehensiveness of policies, portfolio of outcomes, and involvement of entities. Last, it presents a set of systemic policies congruent with the ontology to systematically address the gaps. The recommendations are aligned with the present research, policies, practices, and recommendations in India and of the WHO, UN agencies, and other similar bodies. The approach can be generalized to provide roadmaps for other countries facing a similar challenge and for other diseases of similar complexity. The roadmaps, with continuous feedback and learning, can help navigate the challenge efficiently and effectively.

Geographical and temporal analysis of bio-medical waste management in India.

In India, a large quantity of bio-medical waste is generated by healthcare facilities. This study analyses the geographical and temporal variations in bio-medical waste management (BMWM) in India systematically. A comprehensive BMWM inventory of India's states and union territories for the period 2008-2017 was prepared and analysed. The objectives of this study were to analyse BMWM implementation geographically across the country to assess its performance, and to understand its policy implementation gaps over time. During 2008-2017, the total bio-medical waste generation increased from 409 to 558 Mg/day. Among all the states and union territories, Maharashtra, Karnataka, and Gujarat have the highest number of healthcare facilities. The quantity of waste generated is the highest in Karnataka, Maharashtra, Tamil Nadu, Uttar Pradesh, Kerala, Bihar, West Bengal, and Gujarat. The quantity of waste treated has also increased with the enforcement of the Bio-Medical Waste Rules (2016). The quantity of bio-medical waste treatment is highest in Karnataka and Maharashtra. This analysis will help to improve the practice of BMWM, and it can be used to bridge the gaps in effective and efficient management of bio-medical waste in India.

Access to Geriatric Disability Care in India: A Roadmap for Research.

This paper presents an ontological review of the global research on access to geriatric disability care and a roadmap for future research to address the problem in India. First, the dominant research focus is on resources (human, financial, and spatial) that affect access to disability care; there is little focus on informational and technological resources. Second, functional disabilities are the dominant focus of the research, followed by cognitive, mental, and locomotor disabilities; there is little focus on speech, hearing, and visual disabilities. Third, barriers, inhibitors, and catalysts of physical access are the dominant focus, with relatively less focus on virtual access; there is very little emphasis on the drivers to access. Fourth, the primary, although not dominant, focus is on access for urban and rural populations; there is very little focus on access for underserved and indigenous populations. Future research must address these gaps systematically to improve access. This paper adds: (a) a systemic framework for the study of an important, complex, emerging problem; (b) a systematic review of the global research on the problem; and (c) a research roadmap to address the emerging problem in India.

State of Mental Health Research of Adolescents and Youth in Chile: An Ontological Analysis.

Knowing the state of mental health research in adolescents and youth can be an important tool for decision-making, especially in contexts of limited resources. The aim of this study is to map the scientific research on adolescent and youth mental health in Chile using an ontological framework. We have mapped the population of research articles on mental health of adolescents and youth in Chile in Scopus, Web of Science, and SciELO databases onto the ontology. The PRISMA reporting guidelines were used to screen the 1688 items based on relevance, duplication, and version. The corpus of 346 articles was coded into the ontology through an iterative process among the seven authors. This ontological mapping shows isolated research efforts that have been carried out in Chile to explain the whole state of mental health in adolescents and youth. There is a lack of coordination between the priorities established by the decision-makers and the researchers. Our results coincide with the need to strengthen mental health research in the country, and to prioritizing those topics that contribute to decision-making based on the needs of the population.

Toward strengthening active case finding for ending tuberculosis in India.

Active case finding (ACF) is critical for the timely detection and treatment of diseases like tuberculosis (TB). ACF is crucial in India, where health-seeking behaviour across various populations is low and non-reporting is a barrier to breaking disease transmission cycles and eliminating the disease. As an integral part of India's national TB control programs, there is further scope for improvement in its design. This paper outlines a roadmap for ACF for TB in the country. It is based on current national strategic plans for public health monitoring and TB case identification. It suggests that ACF should be strengthened by developing it as a learning surveillance system involving a change from a siloed public health approach to a more comprehensive surveillance exercise. It defines operational requirements for establishing predictive capabilities and introducing feedback and learning in the system as a precondition. It highlights the importance of establishing proper processes, as well as extending and expanding on existing infrastructural and human resource, and inter-programmatic coordination and collaboration in the health sector.

Ontological Analysis of COVID-19 Vaccine Roll out Strategies: A Comparison of India and the United States of America.

The unprecedented outbreak of the COVID-19 pandemic has forced governments to devise national strategies to curtail its spread. The present study analyzes the national strategies of India and the United States for the COVID-19 vaccine roll out. The paper presents an ontology of COVID-19 vaccine roll out, maps the national strategies, identifies, analyzes the emphases and gaps in them, and proposes corrections to the same. The analysis shows that the national strategies are selective in their focus and siloed in their approach. They must be systematized to address the emerging challenges effectively. Thus, there is need for a systemic understanding and analysis to reinforce the effective pathways to manage vaccine roll out, reposition the ineffective ones, and engineer new ones through feedback and learning.

Linking nursing education to practice in India.

Governed by central and state nursing Acts that are dated and disconnected, and numbers below global norms, nursing education and practice function within caste- and gender-based prejudices in India. Nursing education is fragmented and siloed, and nursing practice is delinked from education. The study strategically relooks at the Acts and highlights pathways that can strengthen, sustain, or weaken nursing education and practice, and suggests how nursing education can be linked to practice.

Access to Healthcare during COVID-19.

Ensuring access to healthcare is critical to prevent illnesses and deaths from COVID-19 and non-COVID-19 cases in health systems that have deteriorated during the pandemic. This study aims to map the existing literature on healthcare access after the appearance of COVID-19 using an ontological framework. This will help us to formalize, standardize, visualize and assess the barriers to and drivers of access to healthcare, and how to continue working towards a more accessible health system. A total of 131 articles are included and considered for mapping in the framework. The results were also compared to the World Health Organization guidelines on maintaining essential health services to determine the overlapping and nonoverlapping areas. We showed the benefits of using ontology to promote a systematic approach to address healthcare problems of access during COVID-19 or other pandemics and set public policies. This systematic approach will provide feedback to study the existing guidelines to make them more effective, learn about the existing gaps in research, and the relationship between the two of them. These results set the foundation for the discussion of future public health policies and research in relevant areas where we might pay attention.

Envisioning a learning surveillance system for tuberculosis.

Surveillance is critical for interrupting transmission of global epidemics. Research has highlighted gaps in the surveillance for tuberculosis that range from failure to collect real-time data to lack of standardization of data for informed decision-making at different levels of the health system. Our research aims to advance conceptual and methodological foundations for the development of a learning surveillance system for Tuberculosis, that involves systematic collection, analysis, interpretation, and feedback of outcome-specific data. It would concurrently involve the health care delivery system, public health laboratory, and epidemiologists. For our study, we systemically framed the cyber environment of TB surveillance as an ontology of the learning surveillance system. We validated the ontology by binary coding of dimensions and elements of the ontology with the metadata from an existing surveillance platform-GPMS TB Transportal. Results show GPMS TB Transportal collects a critical range of data for active case investigation and presumptive case screening for identifying and detecting confirmed TB cases. It is therefore targeted at assisting the Active Case Finding program. Building on the results, we demonstrate enhanced surveillance strategies for GPMS that are enumerated as pathways in the ontology. Our analysis reveals the scope for embedding learning surveillance pathways for digital applications in Direct Benefit Transfer, and Drug Resistance Treatment in National TB Elimination Programme in India. We discuss the possibilities of developing the transportal into a multi-level computer-aided decision support system for TB, using the innumerable pathways encapsulated in the ontology.

Ontological Review of Persuasion Support Systems (PSS) for Health Behavior Change through Physical Activity.

Persuasion Support Systems (PSS) for health behavior change can play an important role in promoting health and well-being through physical activity. It is an emerging application at the crossroad between information systems, persuasion, and healthcare. We propose an ontology to systematically and systemically describe the construct of PSS for health behavior change. The ontology deconstructs the construct into its constituent dimensions and elements, and assembles them into a complete, parsimonious description of the same. We then map the corpus of literature on PSS for health behavior change through physical activity onto the ontology. The resulting ontological map highlights the research topics that are highly- and lightly-emphasized, as well as those with little or no emphasis. It illuminates the landscape of research in the corpus; it highlights biases in emphases that can help and hinder the advancement of the corpus. It can be used to develop a roadmap for future research.

An ontology of and roadmap for mHealth research.

PURPOSE: Mobile health or mHealth research has been growing exponentially in recent years. However, the research on mHealth has been ad-hoc and selective without a clear definition of the mHealth domain. Without a roadmap for research we may not realize the full potential of mHealth. In this paper, we present an ontological framework to define the mHealth domain and illuminate a roadmap. METHODS: We present an ontology of mHealth. The ontology is developed by systematically deconstructing the domain into its primary dimensions and elements. We map the extent research on mHealth in 2014 onto the ontology and highlight the bright, light, and blind/blank spots which represent the emphasis of mHealth research. FINDINGS: The emphases of mHealth research in 2014 are very uneven. There are a few bright spots and many light spots. The research predominantly focuses on individuals' use of mobile devices and applications to capture or obtain health-related data mostly to improve quality of care through mobile intervention. CONCLUSIONS: We argue that the emphases can be balanced in the roadmap for mHealth research. The ontological mapping plays an integral role in developing and maintaining the roadmap which can be updated periodically to continuously assess and guide mHealth research.

Envisioning Precision Healthcare Informatics: A Unified Framework.

We present a unified framework for envisioning precision healthcare informatics (PHI). The framework, presented as a high-level ontology, deconstructs PHI into six dimensions derived from the informatics and healthcare disciplines-the structure, function, and semiotics of informatics, and the stakeholders, care, and value of precision healthcare. Each dimension is articulated as a taxonomy of its constituent elements. Thus, the framework encapsulates the combinatorial complexity of PHI and can be used to describe its 37,800 potential components in natural English. The framework will help envision PHI systematically, systemically, an symmetrically in contrast to the often simplified, selective, and skewed approaches. The framework can be used to map the state-of-the-research, -practice, and -policy on PHI, discover the gaps within and between the states, and develop a roadmap for the future. It can be scaled and extended as PHI evolves by adding dimensions, and extending/refining the taxonomies.

China's National Health Policies: An Ontological Analysis.

The health care system in China is facing a multitude of challenges owing to the changing demographics of the country, the evolving economics of health care, and the emerging epidemiology of health as well as diseases. China's many national health care policies are documented in Chinese text documents. It is necessary to map the policies synoptically, systemically, and systematically to discover their emphases and biases, assess them, and modify them in the future. Using a logically constructed ontology of health care policies based on the common bodies of knowledge as a lens, we map the current policies to reveal their 'bright', 'light', and 'blind/blank' spots. The ontological map will help (a) develop a roadmap for future health care policies in China, and (b) compare and contrast China's health care policies with other countries'.

National Healthcare Policies in Chile: An Ontological Meta-Analysis.

We present an ontological meta-analysis of the national healthcare policies in Chile. Using a logically constructed ontology based on the common body of knowledge as a lens, we map the 39 key policies. The ontological map provides a synoptic, systematic, and systemic view of the policies, and highlight their emphases and biases.

Semiotic web for translational medicine.

The semiotic web for translational medicine generalizes the concept of the semantic web. We present the functions of the semiotic web as a simple ontology with three dimensions, namely: (a) the four steps of semiotics, (b) the two processes in semiotics, and (c) the four types of research. The resulting 32 combinations represent all its functions.