The microbiomes of tropical reef-building corals are actively studied using 16S rRNA gene amplicons to understand microbial roles in coral health, metabolism, and disease resistance. However, primers targeting bacterial and archaeal 16S rRNA genes may additionally amplify organelle rRNA genes from the coral, associated microbial eukaryotes, and encrusting organisms. In this manuscript, we show that standard workflows using SILVA or Greengenes taxonomies under-annotate mitochondrial sequences in 1 272 short-read coral microbiomes from the Earth Microbiome Project. This under-annotation prevents even domain-level annotation of >95% of reads in some samples. Worse, mitochondrial under-annotation varies from species to species and across anatomy, biasing comparisons of α- and β-diversity. By supplementing existing taxonomic references with diverse mitochondrial rRNA sequences, we resolve ~97% of unique unclassified sequences as mitochondrial, without increasing misannotation in mock communities. We recommend using these extended taxonomies for coral microbiome analysis, and encourage vigilance regarding similar issues in other hosts.

Sutherland et al., 2004). Despite the high incidence and prevalence of coral diseases and their devastating impacts on coral reefs, little is known about the mechanisms of pathogen transmission and defense, as well as agents responsible for infection (Bruno et al., 2007;Kline & Vollmer, 2011). Montipora white syndrome (MWS) is a disease that results in tissue loss in the reef building coral, Montipora

ImportancePatients with limited English proficiency (LEP) experience disparities in prehospital care. On-scene interactions between patients with LEP and emergency medical services (EMS) providers (ie, firefighters/emergency medical technicians [EMTs] and paramedics) are critical to high-quality care and have been minimally explored.ObjectiveTo identify EMS-perceived barriers and facilitators to providing high-quality prehospital care for patients with LEP.Design, Setting, and ParticipantsIn this qualitative study, semi-structured focus groups were conducted with firefighters/EMTs and paramedics with all levels of experience from urban areas with a high proportion of residents with LEP from July to September 2018. Data were analyzed from July 2018 to May 2019.ExposuresProviding prehospital care for patients with LEP.Main Outcomes and MeasuresThe main outcomes were barriers and facilitators to prehospital care for patients with LEP, assessed using thematic analysis. Four domains of interest were examined: (1) overall impressions of interactions with patients with LEP, (2) barriers and facilitators to communication, (3) barriers and facilitators to providing care, and (4) ideas for improving prehospital care for patients with LEP.ResultsThirty-nine EMS providers participated in 8 focus groups: 26 firefighters/EMTs (66%) and 13 paramedics (33%). The median age of participants was 46 years (range, 23-63 years), and 35 (90%) were male. Participants described barriers to optimal care as ineffective interpretation, cultural differences, high-stress scenarios (eg, violent events), unclear acuity of patient’s condition, provider bias, and distrust of EMS. Perceived facilitators to optimal care included using an on-scene interpreter, high-acuity disease, relying on objective clinical findings, building trust and rapport, and conservative decision-making regarding treatment and transport. Providers reported transporting most patients with LEP to hospitals regardless of illness severity due to concern for miscommunication and unrecognized problems. Better speed and technology for interpretation, education for communities and EMS providers, and community-EMS interactions outside emergencies were cited as potential strategies for improvement.Conclusions and RelevanceIn this study, EMS providers described many barriers to high-quality care during prehospital emergency response for patients with LEP yet were unaware that these barriers impacted quality of care. Barriers including ineffective interpretation, provider bias, distrust of EMS, and cultural differences may contribute to outcome disparities and overutilization of resources. Future work should focus on the development of targeted interventions to improve modifiable barriers to care, such as improving interpretation and cultural humility and increasing trust.