Development of an Emergency Department Case Management Case-Finding Tool.

PURPOSE OF STUDY: Identifying emergency department (ED) patients who are at high risk for return visits is an important goal for case management to improve patient care. This quality improvement study describes the development and evaluation of the Emergency Department Case Management Priority Score (EDCMPS), an electronic medical record (EMR)-based "case-finding" system, and its ability to identify these high-risk patients. In addition, the authors present data about its acceptability among emergency department case managers (ED CMs). PRIMARY PRACTICE SETTINGS: Emergency departments with case management availability and staffing. METHODOLOGY AND SAMPLE: A retrospective analysis at Duke University Hospital ED compared patient data pre- and postimplementation of the EDCMPS. The tool was developed using the LEAN and Plan-Do-Study-Act (PDSA) quality improvement methodologies, with ED CM participation. ED return and hospitalization rates within 7 and 30 days between both methods were compared, and a survey evaluated CM satisfaction with the EDCMPS. RESULTS: The 2-month preintervention period (July 1, 2022, to August 31, 2022) included 8,677 patients discharged from the ED, with 897 patients (10.3%) identified as at high risk for return based on the previous manual methodology. In the 3-month postintervention period (September 1, 2022, to November 30, 2022), there were 13,566 patients discharged, with 692 patients (5.1%) identified as at high risk for return using the EDCMPS. The EDCMPS outperformed the manual method, yielding a significantly higher odds ratio (OR) for 7- and 30-day ED return or hospitalization (e.g., 30-day any return OR = 4.21 vs. 1.69). The survey showed broad ED CM agreement on the tool's superior performance, especially in organizing outpatient resources and referring to support programs. However, challenges in securing primary care follow-up, housing, and health insurance applications were identified. The tool's collaborative development approach ensured its fit to ED CM needs, contributing to its success. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The EDCMPS showcases promise in enhancing ED CM efficiency, with strong frontline staff endorsement. It pinpoints areas needing focus for patient support and has the potential to reduce ED revisits and therefore health care utilization. Its methodology offers insights for similar future implementations in health care institutions.

Integrative taxonomy to investigate species boundaries within Culicoides (Diptera: Ceratopogonidae): a case study using subgenus Avaritia from Australasia and Eastern Asia.

In this study, species boundaries were examined for 15 described and 2 undescribed species within the economically important Culicoides subg. Avaritia Fox from Australasia and Eastern Asia. We used an integrative taxonomic approach incorporating DNA barcoding, nuclear gene sequencing, and retrospective morphological analyses. Some arbovirus vector species such as Culicoides fulvus Sen and Das Gupta and Culicoides wadai Kitaoka were genetically and morphologically uniform across sampled distributions, but others including Culicoides actoni Smith and Culicoides brevipalpis Delfinado contained 2 or more genetically independent populations of 'cryptic species' that in some cases were sympatric. Some of these 'cryptic species' exhibited consistent morphological differences, while differences are yet to be found for others species. Additionally, an undescribed species, C. Avaritia sp. No. 3, was found to be synonymous with C. fulvus. These results refine our understanding of the distribution of individual species of C. subg. Avaritia and demonstrate that species descriptions and distribution records need revision for part of the Culicoides fauna. Furthermore, because vector competence studies for most of these species are based entirely on Australian populations, the competence of the putative cryptic species identified elsewhere will require independent assessment. Finally, integrative taxonomic assessment requires genetic and morphological assessment of material from the type localities in order to clarify the status and distribution of species, especially for clades containing cryptic species. International collaboration is needed to facilitate this research.

Morphology, distribution, and abundance of antennal sensilla of male and female macropterous and brachypterous small brown planthopper, Laodelphax striatellus (Fallén) (Hemiptera: Delphacidae).

The antennal sensilla of both genders of macropterous and brachypterous adults of the small brown planthopper, Laodelphax striatellus (Fallén) (Hemiptera: Delphacidae) were examined using light and scanning electron microscopy. Scanning electron microscopy revealed seven types of antennal sensilla in adult L. striatellus which were not evenly distributed on all antennal segments. Sensilla chaetica, a sensillum campaniformium and a Böhm bristle were found on the scape. Sensilla chaetica, sensilla trichodea, sensilla placodea which always present as plaque organs, sensilla basiconica and a sensillum campaniformium were present on the pedicel. Three sensilla basiconica and one sensillum coeloconicum containing two sensory pegs were located on the swollen sensory region of the basal flagellum. Pores observed on the surface of s. trichodea and s. placodea suggest these organs probably play a role in olfaction, whereas the aporous s. chaetica with flexible sockets probably function as mechanoreceptors. The aporous s. basiconica with inflexible sockets are probable to be thermo-hygroreceptors while the Böhm bristle and s. campaniformia may act as antennal proprioceptors. The function of s. coeloconicum remains uncertain. The numerical dominance of antennal olfactory receptors suggests olfaction is an important function of the antenna in L. striatellus. Although a small degree of sexual/wing dimorphism was observed in the numbers of sensilla and in the length and width of antennae and antennal segments, the basic shape and structure of the antennae and antennal sensilla did not differ between the gender or wing form in L. striatellus.