Increasing temperatures on a global scale and locally deteriorating water quality affect coral distribution and health. Mechanisms that convey environmental robustness are poorly understood and have been attributed to the coral host, algal symbionts, and prokaryotic associates. Flexibility of the host’s (bacterial) microbiome has been suggested to contribute to environmental robustness, but the underlying mechanisms are unclear. We therefore utilised the vastly contrasting water quality gradient present along Hong Kong’s highly urbanised coastline to explore whether flexibility in the microbiome of Oulastrea crispata relates to spatial variations in temperature, salinity, dissolved oxygen, pH, nitrate, nitrite, ammonia, total nitrogen, phosphorus, turbidity, and chlorophyll a. We identified differences in the coral microbiomes between sites, but the measured environmental variables only explained ~ 23% of the variation suggesting other factors are contributing substantially. The observed structural complexity of the microbiome (based on alpha diversity indices) appears to be relatively conserved across the environmental gradient even at sites where no other hard coral can survive. Therefore, we conclude that, at least in O. crispata, flexibility in the microbiome does not appear to underpin the robustness of this broadly distributed coral.

Background . Although rapid response teams (RRTs) decrease in-house cardiac arrests, signifi cant debate exists surrounding their impact on patient outcomes. We have implemented the continuum of care (CoC) model for the surgical services in our center as a novel approach to patient care. Methods . This study was designed to assess the utilization of RRT resources and cardiac arrests between RRT and CoC coverage. Results . Whereas hospital-wide RRT activations increased in incidence from 2007 to 2010 by 45%, CoC patients experienced steadily decreasing percentage of total RRT activations. Rapid response triggers that led to cardiac arrest under the CoC were 8% in comparison with 17% in the control group. Non-CoC model/RRT activations increased dramatically from 0.3% to 1.5% of total admissions over 4 years whereas CoC RRT activation rates minimally increased from 0.3% to 0.4% (events per total admission per year). Cardiac arrests occurred in 0.4% of non-CoC patients while only occurring in 0.03% of CoC patients, P < .0001. Conclusion . The implementation of the CoC model reduces events requiring RRT activations, preserves continuity of care by closely following high-risk patients, and reduces cardiac arrests via proactive intervention by critical care specialists.

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