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A rarely seen upwelling phenomena northwest off the Hainan Island (UNWHI) is witnessed by the in situ observation during July, 2015. Model simulation suggest that (1) the UNWHI is not a stationary phenomenon because it is the extension of upwelling west off the Hainan Island (UWHI) and located in the wake zone of the circling upwelling around the Hainan Island, (2) the generation mechanism for the UNWHI is tidal mixing and the favorable winds, where tidal mixing is the basic driving force and the local southwestly winds is the necessary condition for the UNWHI's occurrence, (3 net heat flux has limited effect on UNWHI,(4)variation of water temperature in NWHI and in WHI are highly correlated. [ABSTRACT FROM AUTHOR]

Background Patients with chronic critical illness (CCI) experience poor prognoses and incur high medical costs. However, there is currently limited clinical awareness of sepsis-associated CCI, resulting in insufficient vigilance. Therefore, it is necessary to build a machine learning model that can predict whether sepsis patients will develop CCI. Methods Clinical data on 19,077 sepsis patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were analyzed. Predictive factors were identified using the Student's t -test, Mann-Whitney U  test, or χ 2  test. Six machine learning classification models, namely, the logistic regression, support vector machine, decision tree, random forest, extreme gradient enhancement, and artificial neural network, were established. The optimal model was selected on the basis of its performance. Calibration curves were used to evaluate the accuracy of model classification, while the external validation dataset was used to evaluate the performance of the model. Results Thirty-seven characteristics, such as elevated alanine aminotransferase, rapid heart rate, and high Logistic Organ Dysfunction System scores, were identified as risk factors for developing CCI. The area under the receiver operating characteristic curve (AUROC) values for all models were above 0.73 on the internal test set. Among them, the extreme gradient enhancement model exhibited superior performance (F1 score = 0.91, AUROC = 0.91, Brier score = 0.052). It also exhibited stable prediction performance on the external validation set (AUROC = 0.72). Conclusion A machine learning model was established to predict whether sepsis patients will develop CCI. It can provide useful predictive information for clinical decision-making., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Beth Israel Deaconess Medical Center (BIDMC) and Massachusetts Institute of Technology (MIT) issued approval 2001-P-001699/14 and 0403000206. Medical Information Mart for Intensive Care (MIMIC) was approved for research by the institutional review boards of BIDMC (2001-P-001699/14) and the Massachusetts Institute of Technology (0403000206) without a requirement for individual patient informed consent because it is deidentified and publicly available. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mei et al.)

Background: A new type of silver alloy hydrogel-coated (SAH) catheter has been shown to prevent bacterial adhesion and colonization by generating a microcurrent, and to block the retrograde infection pathway. However, these have only been confirmed in ordinary patients. This study aims to evaluate the effectiveness of a SAH catheter for preventing urinary tract infections in critically ill patients., Methods: This was a prospective single-center, single-blind, randomized, controlled study. A total of 132 patients requiring indwelling catheterization in the intensive care unit (ICU) of the First Affiliated Hospital of the University of Science and Technology of China between October 2022 and February 2023 and who met the study inclusion/exclusion criteria were randomly divided into two groups. Patients in the SAH catheter group received a SAH catheter, while patients in the conventional catheter group received a conventional siliconized latex Foley catheter. The main outcome measure was the incidence of catheter-associated urinary tract infections (CAUTIs). Secondary outcome indicators included urine positivity for white blood cells and positive urine cultures on 3 days, 7 days, 10 days, and 14 days after catheterization, number of viable bacteria in the catheter biofilm on day 14, pathogenic characteristics of positive urine cultures, length of ICU stay, overall hospital stay, ICU mortality, and 28-day mortality. All the data were compared between the two groups., Results: A total of 68 patients in the conventional catheter group and 64 patients in the SAH catheter group were included in the study. On day 7 after catheter placement, the positivity rate for urinary white blood cells was significantly higher in the conventional catheter group than in the SAH catheter group (33.8% vs. 15.6%, P =0.016). On day 10, the rates of positive urine cultures (27.9% vs. 10.9%, P =0.014) and CAUTIs (22.1% vs. 7.8%, P =0.023) were significantly higher in the conventional catheter group than in the SAH catheter group. On day 14, the numbers of viable bacteria isolated from the catheter tip ([3.21±1.91]×10 6  colony-forming units [cfu]/mL vs. [7.44±2.22]×10 4  cfu/mL, P <0.001), balloon segment ([7.30±1.99]×10 7  cfu/mL vs. [3.48±2.38]×10 5  cfu/mL, P <0.001), and tail section ([6.41±2.07]×10 5  cfu/mL vs. [8.50±1.46]×10 3  cfu/mL, P <0.001) were significantly higher in the conventional catheter group than in the SAH catheter group. The most common bacteria in the urine of patients in both groups were Escherichia coli ( n =13) and Pseudomonas aeruginosa ( n =6), with only one case of Candida in each group. There were no significant differences between the two groups in terms of ICU hospitalization time, total hospitalization time, ICU mortality, and 28-day mortality., Conclusion: SAH catheters can effectively inhibit the formation of catheter-related bacterial biofilms in critically ill patients and reduce the incidence of CAUTIs, compared with conventional siliconized latex Foley catheters; however, regular replacement of the catheter is still necessary., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. All the authors of the manuscript have agreed to publish., (© 2023 The Authors. Published by Elsevier B.V. on behalf of Chinese Medical Association.)