Using the Kano model to associate the number of confirmed cases of COVID-19 in a population of 100,000 with case fatality rates: An observational study.

BACKGROUND: An important factor in understanding the spread of COVID-19 is the case fatality rate (CFR) for each county. However, many of research reported CFRs on total confirmed cases (TCCs) rather than per 100,000 people. The disparate definitions of CFR in COVID-19 result in inconsistent results. It remains uncertain whether the incident rate and CFR can be compared to identify countries affected by COVID-19 that are under (or out of) control. This study aims to develop a diagram for dispersing TCC and CFR on a population of 100,000 (namely, TCC100 and CFR100) using the Kano model, to examine selected countries/regions that have successfully implemented preventative measures to keep COVID-19 under control, and to design an app displaying TCC100 and CFR100 for all infected countries/regions. METHODS: Data regarding confirmed cases and deaths of COVID-19 in countries/regions were downloaded daily from the GitHub website. For each country/region, 3 values (TCC100, CFR100, and CFR) were calculated and displayed on the Kano diagram. The lower TCC100 and CFR values indicated that the COVID-19 situation was more under control. The app was developed to display both CFR100/CFR against TCC100 on Google Maps. RESULTS: Based on 286 countries/regions, the correlation coefficient (CC) between TCC100 and CFR100 was 0.51 (t = 9.76) in comparison to TCC100 and CFR with CC = 0.02 (t = 0.3). As a result of the traditional scatter plot using CFR and TCC100, Andorra was found to have the highest CFR100 (=6.62%), TCC100 (=935.74), and CFR (=5.1%), but lower CFR than New York (CFR = 7.4%) and the UK (CFR = 13.5%). There were 3 representative countries/regions that were compared: Taiwan [TCC100 (=1.65), CFR100 (=2.17), CFR (=1%)], South Korea [TCC100 (=20.34), CFR100 (=39.8), CFR (=2%), and Vietnam [TCC100 (=0.26), CFR100 (=0), CFR (=0%)]. CONCLUSION: A Kano diagram was drawn to compare TCC100 against CFT (or CFR100) to gain a better understanding of COVID-19. There is a strong association between a higher TCC100 value and a higher CFR100 value. A dashboard was developed to display both CFR100/CFR against TCC100 for countries/regions.

Using the Kano model to associate the number of confirmed cases of COVID-19 in a population of 100,000 with case fatality rates: An observational study

Background: An important factor in understanding the spread of COVID-19 is the case fatality rate (CFR) for each county. However, many of research reported CFRs on total confirmed cases (TCCs) rather than per 100,000 people. The disparate definitions of CFR in COVID-19 result in inconsistent results. It remains uncertain whether the incident rate and CFR can be compared to identify countries affected by COVID-19 that are under (or out of) control. This study aims to develop a diagram for dispersing TCC and CFR on a population of 100,000 (namely, TCC100 and CFR100) using the Kano model, to examine selected countries/regions that have successfully implemented preventative measures to keep COVID-19 under control, and to design an app displaying TCC100 and CFR100 for all infected countries/regions. Methods: Data regarding confirmed cases and deaths of COVID-19 in countries/regions were downloaded daily from the GitHub website. For each country/region, 3 values (TCC100, CFR100, and CFR) were calculated and displayed on the Kano diagram. The lower TCC100 and CFR values indicated that the COVID-19 situation was more under control. The app was developed to display both CFR100/CFR against TCC100 on Google Maps. Results: Based on 286 countries/regions, the correlation coefficient (CC) between TCC100 and CFR100 was 0.51 (t = 9.76) in comparison to TCC100 and CFR with CC = 0.02 (t = 0.3). As a result of the traditional scatter plot using CFR and TCC100, Andorra was found to have the highest CFR100 (=6.62%), TCC100 (=935.74), and CFR (=5.1%), but lower CFR than New York (CFR = 7.4%) and the UK (CFR = 13.5%). There were 3 representative countries/regions that were compared: Taiwan [TCC100 (=1.65), CFR100 (=2.17), CFR (=1%)], South Korea [TCC100 (=20.34), CFR100 (=39.8), CFR (=2%), and Vietnam [TCC100 (=0.26), CFR100 (=0), CFR (=0%)]. Conclusion: A Kano diagram was drawn to compare TCC100 against CFT (or CFR100) to gain a better understanding of COVID-19. There is a strong association between a higher TCC100 value and a higher CFR100 value. A dashboard was developed to display both CFR100/CFR against TCC100 for countries/regions.

Comparison of prediction accuracies between mathematical models to make projections of confirmed cases during the COVID-19 pandamic by country/region.

BACKGROUND: The COVID-19 pandemic caused >0.228 billion infected cases as of September 18, 2021, implying an exponential growth for infection worldwide. Many mathematical models have been proposed to predict the future cumulative number of infected cases (CNICs). Nevertheless, none compared their prediction accuracies in models. In this work, we compared mathematical models recently published in scholarly journals and designed online dashboards that present actual information about COVID-19. METHODS: All CNICs were downloaded from GitHub. Comparison of model R2 was made in 3 models based on quadratic equation (QE), modified QE (OE-m), and item response theory (IRT) using paired-t test and analysis of variance (ANOVA). The Kano diagram was applied to display the association and the difference in model R2 on a dashboard. RESULTS: We observed that the correlation coefficient was 0.48 (t = 9.87, n = 265) between QE and IRT models based on R2 when modeling CNICs in a short run (dated from January 1 to February 16, 2021). A significant difference in R2 was found (P < .001, F = 53.32) in mean R2 of 0.98, 0.92, and 0.84 for IRT, OE-mm, and QE, respectively. The IRT-based COVID-19 model is superior to the counterparts of QE-m and QE in model R2 particularly in a longer period of infected days (i.e., in the entire year in 2020). CONCLUSION: An online dashboard was demonstrated to display the association and difference in prediction accuracy among predictive models. The IRT mathematical model was recommended to make projections about the evolution of CNICs for each county/region in future applications, not just limited to the COVID-19 epidemic.

Using the absolute advantage coefficient (AAC) to measure the strength of damage hit by COVID-19 in India on a growth-share matrix.

BACKGROUND: The COVID-19 pandemic occurred and rapidly spread around the world. Some online dashboards have included essential features on a world map. However, only transforming data into visualizations for countries/regions is insufficient for the public need. This study aims to (1) develop an algorithm for classifying countries/regions into four quadrants inn GSM and (2) design an app for a better understanding of the COVID-19 situation. METHODS: We downloaded COVID-19 outbreak numbers daily from the Github website, including 189 countries/regions. A four-quadrant diagram was applied to present the classification of each country/region using Google Maps run on dashboards. A novel presentation scheme was used to identify the most struck entities by observing (1) the multiply infection rate (MIR) and (2) the growth trend in the recent 7 days. Four clusters of the COVID-19 outbreak were dynamically classified. An app based on a dashboard aimed at public understanding of the outbreak types and visualizing of the COVID-19 pandemic with Google Maps run on dashboards. The absolute advantage coefficient (AAC) was used to measure the damage hit by COVID-19 referred to the next two countries severely hit by COVID-19. RESULTS: We found that the two hypotheses were supported: India (i) is in the increasing status as of April 28, 2021; (ii) has a substantially higher ACC(= 0.81 > 0.70), and (iii) has a substantially higher ACC(= 0.66 < 0.70) as of May 17, 2021. CONCLUSION: Four clusters of the COVID-19 outbreak were dynamically classified online on an app making the public understand the outbreak types of COVID-19 pandemic shown on dashboards. The app with GSM and AAC is recommended for researchers in other disease outbreaks, not just limited to COVID-19.

An online time-to-event dashboard comparing the effective control of COVID-19 among continents using the inflection point on an ogive curve: Observational study.

BACKGROUND: During the COVID-19 pandemic, one of the frequently asked questions is which countries (or continents) are severely hit. Aside from using the number of confirmed cases and the fatality to measure the impact caused by COVID-19, few adopted the inflection point (IP) to represent the control capability of COVID-19. How to determine the IP days related to the capability is still unclear. This study aims to (i) build a predictive model based on item response theory (IRT) to determine the IP for countries, and (ii) compare which countries (or continents) are hit most. METHODS: We downloaded COVID-19 outbreak data of the number of confirmed cases in all countries as of October 19, 2020. The IRT-based predictive model was built to determine the pandemic IP for each country. A model building scheme was demonstrated to fit the number of cumulative infected cases. Model parameters were estimated using the Solver add-in tool in Microsoft Excel. The absolute advantage coefficient (AAC) was computed to track the IP at the minimum of incremental points on a given ogive curve. The time-to-event analysis (a.k.a. survival analysis) was performed to compare the difference in IPs among continents using the area under the curve (AUC) and the respective 95% confidence intervals (CIs). An online comparative dashboard was created on Google Maps to present the epidemic prediction for each country. RESULTS: The top 3 countries that were hit severely by COVID-19 were France, Malaysia, and Nepal, with IP days at 263, 262, and 262, respectively. The top 3 continents that were hit most based on IP days were Europe, South America, and North America, with their AUCs and 95% CIs at 0.73 (0.61-0.86), 0.58 (0.31-0.84), and 0.54 (0.44-0.64), respectively. An online time-event result was demonstrated and shown on Google Maps, comparing the IP probabilities across continents. CONCLUSION: An IRT modeling scheme fitting the epidemic data was used to predict the length of IP days. Europe, particularly France, was hit seriously by COVID-19 based on the IP days. The IRT model incorporated with AAC is recommended to determine the pandemic IP.

Using Social Network Analysis to Identify Spatiotemporal Spread Patterns of COVID-19 around the World: Online Dashboard Development.

The COVID-19 pandemic has spread widely around the world. Many mathematical models have been proposed to investigate the inflection point (IP) and the spread pattern of COVID-19. However, no researchers have applied social network analysis (SNA) to cluster their characteristics. We aimed to illustrate the use of SNA to identify the spread clusters of COVID-19. Cumulative numbers of infected cases (CNICs) in countries/regions were downloaded from GitHub. The CNIC patterns were extracted from SNA based on CNICs between countries/regions. The item response model (IRT) was applied to create a general predictive model for each country/region. The IP days were obtained from the IRT model. The location parameters in continents, China, and the United States were compared. The results showed that (1) three clusters (255, n = 51, 130, and 74 in patterns from Eastern Asia and Europe to America) were separated using SNA, (2) China had a shorter mean IP and smaller mean location parameter than other counterparts, and (3) an online dashboard was used to display the clusters along with IP days for each country/region. Spatiotemporal spread patterns can be clustered using SNA and correlation coefficients (CCs). A dashboard with spread clusters and IP days is recommended to epidemiologists and researchers and is not limited to the COVID-19 pandemic.

An App for Classifying Personal Mental Illness at Workplace Using Fit Statistics and Convolutional Neural Networks: Survey-Based Quantitative Study.

BACKGROUND: Mental illness (MI) is common among those who work in health care settings. Whether MI is related to employees' mental status at work is yet to be determined. An MI app is developed and proposed to help employees assess their mental status in the hope of detecting MI at an earlier stage. OBJECTIVE: This study aims to build a model using convolutional neural networks (CNNs) and fit statistics based on 2 aspects of measures and outfit mean square errors for the automatic detection and classification of personal MI at the workplace using the emotional labor and mental health (ELMH) questionnaire, so as to equip the staff in assessing and understanding their own mental status with an app on their mobile device. METHODS: We recruited 352 respiratory therapists (RTs) working in Taiwan medical centers and regional hospitals to fill out the 44-item ELMH questionnaire in March 2019. The exploratory factor analysis (EFA), Rasch analysis, and CNN were used as unsupervised and supervised learnings for (1) dividing RTs into 4 classes (ie, MI, false MI, health, and false health) and (2) building an ELMH predictive model to estimate 108 parameters of the CNN model. We calculated the prediction accuracy rate and created an app for classifying MI for RTs at the workplace as a web-based assessment. RESULTS: We observed that (1) 8 domains in ELMH were retained by EFA, (2) 4 types of mental health (n=6, 63, 265, and 18 located in 4 quadrants) were classified using the Rasch analysis, (3) the 44-item model yields a higher accuracy rate (0.92), and (4) an MI app available for RTs predicting MI was successfully developed and demonstrated in this study. CONCLUSIONS: The 44-item model with 108 parameters was estimated by using CNN to improve the accuracy of mental health for RTs. An MI app developed to help RTs self-detect work-related MI at an early stage should be made more available and viable in the future.

USING THE SEPARATION INDEX TO IDENTIFY THE MOST DOMINANT ROLE: A CASE OF APPLICATION ON COVID-19 OUTBREAK

The study aimed to introduce a new application of the separation index (SI) that allows objective determination of the dominant role in the COVID-19 outbreak which started in the city of Wuhan, China in December 2019 and subsequently spread to other provinces/regions of China as well as the rest of the world. The separation index is capable of determining the dominance, also defined as the absolute advantage (or disadvantage) in a comparable group of measures. We downloaded COVID-19 outbreak data on a daily basis from Google Sheet that provides information on confirmed cases in more than 30 Chinese locations and other countries/regions. Choropleth maps and Kano diagrams were drawn incorporating the 4SQ diagram. Three factors were assessed to determine which region played the most dominant role based on (1) the total number of confirmed cases, (2) the death rate, and (3) the SI of daily increase of confirmed cases using the separation index ranging from 0 to 1.0 (cutting at 0.70). We programmed Microsoft Excel VBA routines to arrange the data. Visual dashboards were created to display the results on Google Maps. We observed that as of February 17, 2020, the top three countries/regions within the three respective elements investigated were Hubei (China), Philippines, and British Columbia, with SI of 0.98, 0.61, and 0.52, respectively. The separation index is shown useful and capable in identifying the dominant role in a group. Further applications within and outside the context of COVID-19 are worthy of research effort.

Geographic risk assessment of COVID-19 transmission using recent data: An observational study.

BACKGROUND: The US Centers for Disease Control and Prevention (CDC) regularly issues "travel health notices" that address disease outbreaks of novel coronavirus disease (COVID)-19 in destinations worldwide. The notices are classified into 3 levels based on the risk posed by the outbreak and what precautions should be in place to prevent spreading. What objectively observed criteria of these COVID-19 situations are required for classification and visualization? This study aimed to visualize the epidemic outbreak and the provisional case fatality rate (CFR) using the Rasch model and Bayes's theorem and developed an algorithm that classifies countries/regions into categories that are then shown on Google Maps. METHODS: We downloaded daily COVID-19 outbreak numbers for countries/regions from the GitHub website, which contains information on confirmed cases in more than 30 Chinese locations and other countries/regions. The Rasch model was used to estimate the epidemic outbreak for each country/region using data from recent days. All responses were transformed by using the logarithm function. The Bayes's base CFRs were computed for each region. The geographic risk of transmission of the COVID-19 epidemic was thus determined using both magnitudes (i.e., Rasch scores and CFRs) for each country. RESULTS: The top 7 countries were Iran, South Korea, Italy, Germany, Spain, China (Hubei), and France, with values of {4.53, 3.47, 3.18, 1.65, 1.34 1.13, 1.06} and {13.69%, 0.91%, 47.71%, 0.23%, 24.44%, 3.56%, and 16.22%} for the outbreak magnitudes and CFRs, respectively. The results were consistent with the US CDC travel advisories of warning level 3 in China, Iran, and most European countries and of level 2 in South Korea on March 16, 2020. CONCLUSION: We created an online algorithm that used the CFRs to display the geographic risks to understand COVID-19 transmission. The app was developed to display which countries had higher travel risks and aid with the understanding of the outbreak situation.

The computation of case fatality rate for novel coronavirus (COVID-19) based on Bayes theorem: An observational study.

BACKGROUND: When a new disease such starts to spread, the commonly asked questions are how deadly is it? and how many people are likely to die of this outbreak? The World Health Organization (WHO) announced in a press conference on January 29, 2020 that the death rate of COVID-19 was 2% on the case fatality rate (CFR). It was underestimated assuming no lag days from symptom onset to deaths while many CFR formulas have been proposed, the estimation on Bays theorem is worthy of interpretation. Hence, it is hypothesized that the over-loaded burdens of treating patients and capacities to contain the outbreak (LSBHRS) may increase the CFR. METHODS: We downloaded COVID-19 outbreak numbers from January 21 to February 14, 2020, in countries/regions on a daily basis from Github that contains information on confirmed cases in >30 Chinese locations and other countries/regions. The pros and cons were compared among the 5 formula of CFR, including [A] deaths/confirmed; [B] deaths/(deaths + recovered); [C] deaths/(cases x days ago); [D] Bayes estimation based on [A] and the outbreak (LSBHRS) in each country/region; and [E] Bayes estimation based on [C] deaths/(cases x days ago). The coefficients of variance (CV = the ratio of the standard deviation to the mean) were applied to measure the relative variability for each CFR. A dashboard was developed for daily display of the CFR across each region. RESULTS: The Bayes based on (A)[D] has the lowest CV (=0.10) followed by the deaths/confirmed (=0.11) [A], deaths/(deaths + recoveries) (=0.42) [B], Bayes based on (C) (=0.49) [E], and deaths/(cases x days ago) (=0.59) [C]. All final CFRs will be equal using the formula (from, A to E). A dashboard was developed for the daily reporting of the CFR. The CFR (3.7%) greater than the prior CFR of 2.2% was evident in LSBHRS, increasing the CFR. A dashboard was created to present the CFRs on COVID-19. CONCLUSION: We suggest examining both trends of the Bayes based on both deaths/(cases 7 days ago) and deaths/confirmed cases as a reference to the final CFR. An app developed for displaying the provisional CFR with the 2 CFR trends can improve the underestimated CFR reported by WHO and media.