An Assessment of the Factors that Increase the Likeliness of Hispanic Students to Attend Higher Education in Northeast Tennessee

From 2000 to 2014 the number of Hispanics grew 230%, representing an 8.6% of the national\u27s youth (Tennessee Higher Education Commission, 2016). Although the population is growing, the educational attainment does not reflect this growth. This research tries to identify what factors influence individuals\u27 decision to pursue higher education in rural Tennessee. Intrinsic (grit, hardiness, and motivation to lead) and extrinsic factors (Status in the U.S., caregivers’ education, involvement in high school and others) were explored. Sixty-six complete responses were submitted to our online survey. Hypothesis testing with Pearson chi-square, difference of means (ANOVA and two sample t-test), and correlational analysis were conducted. It was concluded that regardless of the level of education, caregivers will motivate their students to pursue higher education. In addition, first generation students tend to showcase more grit than their counter parts and that the more education the individual has, the more they exemplify grit, hardiness, and motivation to lead

Scientists' Warning to Humanity on Threats to Indigenous and Local Knowledge Systems

The knowledge systems and practices of Indigenous Peoples and local communities play critical roles in safeguarding the biological and cultural diversity of our planet. Globalization, government policies, capitalism, colonialism, and other rapid social-ecological changes threaten the relationships between Indigenous Peoples and local communities and their environments, thereby challenging the continuity and dynamism of Indigenous and Local Knowledge (ILK). In this article, we contribute to the “World Scientists' Warning to Humanity,” issued by the Alliance of World Scientists, by exploring opportunities for sustaining ILK systems on behalf of the future stewardship of our planet. Our warning raises the alarm about the pervasive and ubiquitous erosion of knowledge and practice and the social and ecological consequences of this erosion. While ILK systems can be adaptable and resilient, the foundations of these knowledge systems are compromised by ongoing suppression, misrepresentation, appropriation, assimilation, disconnection, and destruction of biocultural heritage. Three case studies illustrate these processes and how protecting ILK is central to biocultural conservation. We conclude with 15 recommendations that call for the recognition and support of Indigenous Peoples and local communities and their knowledge systems. Enacting these recommendations will entail a transformative and sustained shift in how ILK systems, their knowledge holders, and their multiple expressions in lands and waters are recognized, affirmed, and valued. We appeal for urgent action to support the efforts of Indigenous Peoples and local communities around the world to maintain their knowledge systems, languages, stewardship rights, ties to lands and waters, and the biocultural integrity of their territories—on which we all depend.Peer reviewe

Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2-15.1], 13 J/min [IQR 10-17], and 14 J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22). Conclusions: Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation

An assessment of the factors that increase the likeliness of Hispanics students to attend higher education

By 2043, its projected that there will not be one single racial or ethnic group that would dominate the minority group (Tennessee Higher Education Commission, 2016). However, the number of Hispanics grew 230% from 2000 to 2014, representing an 8.6% of the national\u27s youth (Tennessee Higher Education Commission, 2016). Hispanic population in states like California, New Mexico, Texas, and Arizona constitutes more than 30% (U.S. Census Bureau, 2016). However, in Tennessee, it only constitutes a 5.20%. Going further, in the Tri-Cities it constitutes a 2.34% of the population. Since states with larger Hispanic communities can provide a variety of resources, experiences, and support organization that a state with a small percentage might not consider in providing or may not be able to provide, this research tries to identify what factors influence individuals\u27 decision to go to higher education. By doing so, we will be able to identify the areas that need more attention to better serve the population. To get this information, we obtained IRB approval to send our survey to ETSU Hispanic students. It is expected to see that the students whose parents have obtain an education past high school will be more encouraged to attend to higher education, than those whose parents earned less than a high school diploma. It is also expected to find that the student’s grit, hardiness, and motivation to lead will vary according to the grades that the students had in the United States, finally it is expected to find that students’ grit, hardiness, and motivation to lead will depend on whether or not they are a first generation student

Extubation in neurocritical care patients: the ENIO international prospective study

Purpose: Neurocritical care patients receive prolonged invasive mechanical ventilation (IMV), but there is poor specific information in this high-risk population about the liberation strategies of invasive mechanical ventilation. Methods: ENIO (NCT03400904) is an international, prospective observational study, in 73 intensive care units (ICUs) in 18 countries from 2018 to 2020. Neurocritical care patients with a Glasgow Coma Score (GCS) ≤ 12, receiving IMV ≥ 24 h, undergoing extubation attempt or tracheostomy were included. The primary endpoint was extubation failure by day 5. An extubation success prediction score was created, with 2/3 of patients randomly allocated to the training cohort and 1/3 to the validation cohort. Secondary endpoints were the duration of IMV and in-ICU mortality. Results: 1512 patients were included. Among the 1193 (78.9%) patients who underwent an extubation attempt, 231 (19.4%) failures were recorded. The score for successful extubation prediction retained 20 variables as independent predictors. The area under the curve (AUC) in the training cohort was 0.79 95% confidence interval (CI95) [0.71-0.87] and 0.71 CI95 [0.61-0.81] in the validation cohort. Patients with extubation failure displayed a longer IMV duration (14 [7-21] vs 6 [3-11] days) and a higher in-ICU mortality rate (8.7% vs 2.4%). Three hundred and nineteen (21.1%) patients underwent tracheostomy without extubation attempt. Patients with direct tracheostomy displayed a longer duration of IMV and higher in-ICU mortality than patients with an extubation attempt (success and failure). Conclusions: In neurocritical care patients, extubation failure is high and is associated with unfavourable outcomes. A score could predict extubation success in multiple settings. However, it will be mandatory to validate our findings in another prospective independent cohort

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes