Experiencia de extrañamiento en los desplazamientos migratorios : la migración como trayecto de subjetivación

A partir de dos estudios diferentes sobre procesos migratorios internacionales dentro de América Latina (de carácter sur-sur), que tuvieron como destino la ciudad de Santiago (Chile), reflexionamos en torno a la experiencia de extrañamiento respecto a sí mismo y a los otros en estos desplazamientos migratorios, entendida como una interpelación que impulsa procesos de subjetivación vinculados a la condición de extranjeridad, que emergió como hallazgo en ambas investigaciones. La exploración de esta idea se realiza a partir de relatos de migración construidos mediante el trabajo de campo de ambos estudios, de carácter cualitativo. El primero recurrió a la construcción de relatos de migración de mujeres dominicanas, mientras que el segundo utilizó relatos de vida de migrantes peruanos y colombianos con subjetivaciones sexogenéricas no heteronormativas. El objetivo de este escrito es describir esas experiencias para delinear esta noción de extrañamiento en los procesos migratorios y poner atención en los impactos subjetivos que esta experiencia imprime en el migrante. El recorrido permite concluir que este se enfrenta a la experiencia de descalce y extrañamiento de sí, que deviene de la imagen de alteridad que le devuelve la sociedad receptora. Ante esto, reacciona haciendo incorporaciones, resistencias o ajustes a sus maneras de hacer, muchas veces de modo situacional y estratégico para el logro de sus fines, en los que no necesariamente se encuentra del todo identificado/a. Estas experiencias impulsan procesos de reflexión acerca de su imagen identitaria que abren nuevas posiciones enunciativas y transformaciones en los procesos de subjetivación.A partir de dos estudis diferents sobre processos migratoris internacionals dins l'Amèrica Llatina (de caràcter sud-sud), que van tenir com a destinació la ciutat de Santiago de Xile, reflexionem entorn de l'experiència d'estranyament respecte d'un mateix i dels altres en aquests desplaçaments migratoris, entesa com una interpel·lació que impulsa processos de subjectivació vinculats a la condició d'estrangeritat, que va emergir com a troballa en ambdues recerques. L'exploració d'aquesta idea es fa a partir de relats de migració construïts mitjançant el treball de camp d'ambdós estudis de caràcter qualitatiu. El primer va recórrer a la construcció de relats de migració de dones dominicanes, mentre que el segon va utilitzar relats de vida de migrants peruans i colombians amb subjectivacions sexogenèriques no heteronormatives. L'objectiu d'aquest escrit és descriure aquestes experiències per delinear aquesta noció d'estranyament en els processos migratoris i posar atenció en els impactes subjectius que aquesta experiència imprimeix en el migrant. El recorregut permet concloure que aquest s'enfronta a l'experiència de descalçament i estranyament de si mateix, que esdevé la imatge d'alteritat que li retorna la societat receptora. Davant d'això, reacciona fent incorporacions, resistències o ajustos a les seves maneres de fer, moltes vegades d'una manera situacional i estratègica per aconseguir els seus fins, amb els quals no necessàriament es troba del tot identificat/ada. Aquestes experiències impulsen processos de reflexió sobre la seva imatge identitària que obren noves posicions enunciatives i transformacions en els processos de subjectivació.Based on the findings of two different studies on international migration processes within Latin America (south-south), which had as their destination the city of Santiago (Chile), we reflect on the experience of estrangement from oneself and from each other. The others in these migratory movements, understanding it as an interpellation that promotes processes of subjectivation linked to the condition of foreignness, which emerged as a finding in both investigations. The exploration of this idea is carried out from migration stories constructed through fieldwork in both studies, of a qualitative nature: the first of them recurred to the construction of migration stories of Dominican women, while the second used stories of Life of Peruvian and Colombian migrants with non-heteronormative sex-generic subjectivations. The objective of this paper is to describe those experiences to delineate this notion of estrangement in migratory processes, paying attention to the subjective impacts that this experience impresses on the migrant. The tour allows us to conclude that he faces the experience of what does not fit and the estrangement from oneself, which comes from the image of otherness that the host society returns to him. Faced with this, he reacts by making additions, resistances or adjustments to his ways of doing, often in a situational and strategic way to achieve his goals, in which he is not necessarily fully identified. These experiences promote processes of reflection about their identity image that open up new enunciative positions and transformations in the processes of subjectivation

Study protocol for two complementary trials of non-steroidal or opioid analgesia use for children aged 6 to 17 years with musculoskeletal injuries (the No OUCH study)

Introduction Musculoskeletal (MSK) injuries are a frequent cause for emergency department (ED) visits in children. MSK injuries are associated with moderate-to-severe pain in most children, yet recent research confirms that the management of children\u27s pain in the ED remains inadequate. Clinicians are seeking better oral analgesic options for MSK injury pain with demonstrated efficacy and an excellent safety profile. This study aims to determine the efficacy and safety of adding oral acetaminophen or oral hydromorphone to oral ibuprofen and interpret this information within the context of parent/caregiver preference. Methods and analysis Using a novel preference-informed complementary trial design, two simultaneous trials are being conducted. Parents/caregivers of children presenting to the ED with acute limb injury will be approached and they will decide which trial they wish to participate in: an opioid-inclusive trial or a non-opioid trial. Both trials will follow randomised, double-blind, placebo-controlled, superiority-trial methodology and will enrol a minimum of 536 children across six Canadian paediatric EDs. Children will be eligible if they are 6 to 17 years of age and if they present to the ED with an acute limb injury and a self-reported verbal Numerical Rating Scale pain score ≥5. The primary objective is to determine the effectiveness of oral ibuprofen+oral hydromorphone versus oral ibuprofen+oral acetaminophen versus oral ibuprofen alone. Recruitment was launched in April 2019. Ethics and dissemination This study has been approved by the Health Research Ethics Board (University of Alberta), and by appropriate ethics boards at all recruiting centres. Informed consent will be obtained from parents/guardians of all participants, in conjunction with assent from the participants themselves. Study data will be submitted for publication regardless of results. This study is funded through a Canadian Institutes of Health Research grant. Trial registration number NCT03767933, first registered on 07 December 2018

Corrigendum: Pain management practices surrounding lumbar punctures in children: A survey of Canadian emergency physicians (Canadian Journal of Emergency Medicine (2018) DOI: 10.1017/cem.2018.382)

In the original publication of this article, Pediatric Emergency Research Canada (PERC) was not listed as an author. The authors regret this error. The original version has been updated

The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study.

BACKGROUND: Emergency department overcrowding has been associated with increased odds of hospital admission and mortality after discharge from the emergency department in predominantly adult cohorts. The objective of this study was to evaluate the association between crowding and the odds of several adverse outcomes among children seen at a pediatric emergency department. METHODS: We conducted a retrospective cohort study involving all children visiting 8 Canadian pediatric emergency departments across 4 provinces between 2010 and 2014. We analyzed the association between mean departmental length of stay for each index visit and hospital admission within 7 days or death within 14 days of emergency department discharge, as well as hospital admission at index visit and return visits within 7 days, using mixed-effects logistic regression modelling. RESULTS: A total of 1 931 465 index visits occurred across study sites over the 5-year period, with little variation in index visit hospital admission or median length of stay. Hospital admission within 7 days of discharge and 14-day mortality were low across provinces (0.8%-1.5% and \u3c 10 per 100 000 visits, respectively), and their association with mean departmental length of stay varied by triage categories and across sites but was not significant. There were increased odds of hospital admission at the index visit with increasing departmental crowding among visits triaged to Canadian Triage and Acuity Scale (CTAS) score 1-2 (odds ratios [ORs] ranged from 1.01 to 1.08) and return visits among patients with a CTAS score of 4-5 discharged at the index visit at some sites (ORs ranged from 1.00 to 1.06). INTERPRETATION: Emergency department crowding was not significantly associated with hospital admission within 7 days of the emergency department visit or mortality in children. However, it was associated with increased hospital admission at the index visit for the sickest children, and with return visits to the emergency department for those less sick

Kids' Outcomes And Long-term Abilities (KOALA): protocol for a prospective, longitudinal cohort study of mild traumatic brain injury in children 6 months to 6 years of age

Introduction: Mild traumatic brain injury (mTBI) is highly prevalent, especially in children under 6 years. However, little research focuses on the consequences of mTBI early in development. The objective of the Kids' Outcomes And Long-term Abilities (KOALA) study is to document the impact of early mTBI on children's motor, cognitive, social and behavioural functioning, as well as on quality of life, stress, sleep and brain integrity. Methods and analyses KOALA is a prospective, multicentre, longitudinal cohort study of children aged 6 months to 6 years at the time of injury/recruitment. Children who sustain mTBI (n=150) or an orthopaedic injury (n=75) will be recruited from three paediatric emergency departments (PEDs), and compared with typically developing children (community controls, n=75). A comprehensive battery of prognostic and outcome measures will be collected in the PED, at 10 days, 1, 3 and 12 months postinjury. Biological measures, including measures of brain structure and function (magnetic resonance imaging, MRI), stress (hair cortisol), sleep (actigraphy) and genetics (saliva), will complement direct testing of function using developmental and neuropsychological measures and parent questionnaires. Group comparisons and predictive models will test the a priori hypotheses that, compared with children from the community or with orthopaedic injuries, children with mTBI will (1) display more postconcussive symptoms and exhibit poorer motor, cognitive, social and behavioural functioning;(2) show evidence of altered brain structure and function, poorer sleep and higher levels of stress hormones. A combination of child, injury, socioenvironmental and psychobiological factors are expected to predict behaviour and quality of life at 1, 3 and 12 months postinjury. Ethics and dissemination The KOALA study is approved by the Sainte-Justine University Hospital, McGill University Health Centre and University of Calgary Conjoint Health Research Ethics Boards. Parents of participants will provide written consent. Dissemination will occur through peer-reviewed journals and an integrated knowledge translation plan

A Viral Discovery Methodology for Clinical Biopsy Samples Utilising Massively Parallel Next Generation Sequencing

Here we describe a virus discovery protocol for a range of different virus genera, that can be applied to biopsy-sized tissue samples. Our viral enrichment procedure, validated using canine and human liver samples, significantly improves viral read copy number and increases the length of viral contigs that can be generated by de novo assembly. This in turn enables the Illumina next generation sequencing (NGS) platform to be used as an effective tool for viral discovery from tissue samples

Emergency department conditions associated with the number of patients who leave a pediatric emergency department prior to physician assessment

As emergency department (ED) waiting times and volumes increase, substantial numbers of patients LWBS (leave after registration but prior to physician assessment). The objective of this study was to identify ED conditions reflecting patient input, throughput and output associated with the number of patients who LWBS in a pediatric setting. Multivariate analysis was used to examine the impact of variables describing the timing of patient arrival and ED conditions including patient acuity, volume and waiting times on the number of patients who LWBS. During the study period there were 138,361 patient visits; 11,055 (7.99%) of patients LWBS. The throughput variables, time from triage to physician assessment (rate ratio 2.11 (95% CI 2.01-2.21)) and time from registration to triage (rate ratio 1.55 (95% CI 1.25 - 1.90)) had the largest impact on the number of patients who LWBS. Interventions designed to decrease the number of patients who LWBS should focus on improving ED throughput.Avec l'augmentation du débit et du temps d'attente dans les services des urgences, un nombre élevé de patients ayant rempli les formulaires d'accueil quittent avant d'avoir été vus par un médecin. Cette étude avait pour but de déterminer les conditions du service des urgences reflétant l'inscription, le temps de prise en charge ainsi que le débit de patients, et ayant un lien avec le nombre de personnes qui, dans un milieu pédiatrique, quittent avant d'avoir vu un médecin. Une analyse multivariée a été utilisée afin d'examiner l'effet de variables décrivant le moment de l'arrivée du patient et les conditions qui prévalent au service des urgences (y compris l'acuité des patients, le volume de patients et le délai d'attente), sur le nombre de personnes qui quittent sans avoir été examinés. Un total de 138,361 patients se sont présentés à l'urgence au cours de l'étude et 11,055 (7,99%) ont quitté avant d'avoir vu un médecin. Les résultats de l'étude révèlent que les variables liées au temps de prise en charge, soit le délai entre le moment du triage et l'examen du médecin (ratio des taux = 2,11; intervalle de confiance [IC] de 95% : 2,01 - 2,21) et le délai entre l'inscription et le triage (ratio des taux = 1,55; IC de 95% : 1,25 - 1,90) exercent la plus grande influence sur le nombre de patients quittant avant d'avoir été vus par un médecin. Les interventions visant à réduire le nombre de départs prématurés devraient être orientées en vue d'améliorer le temps de prise en charge dans les services d'urgence

Políticas migratorias y de diversidad sexual en Chile: tensionando la retórica del consenso posdictatorial

Acabada la dictadura cívico-militar, en Chile se inició una transición sociopolítica marcada por una retórica del “consenso”, que tuvo como efecto la neutralización de las diferencias, llevando a experiencias LGBTI+ y migrantes a situarse en un lugar de no-contradicción. Este artículo se propone observar cómo en el periodo de posdictadura se tensionó la forma de comprensión de la ciudadanía, a partir de las demandas LGBTI+ y migrantes en el país. Presentamos un análisis documental crítico —desde un enfoque feminista queer— de políticas de sexualidades y migración, que evidencian un claro corte asimilativo, en función de una idea de “ciudadano” no disruptiva de la paz transicional. Se pone el acento en las contradicciones entre la gran narrativa de acuerdo de paz y cohesión posdictatorial y las invisibilizaciones que atravesaron los colectivos LGBTI+ y migrantes; y, asimismo, se resaltan los usos generalistas de la diversidad como una renovada forma de asimilación. La originalidad de este análisis radica en que revisa de forma interseccional la manera como las políticas suelen pensarse bajo un único vector de diferencia —clase, procedencia o sexualidad—, sin poner en la palestra la articulación de estructuras sociales diferenciadoras en que se estructura el nuevo proceso transicional. Se concluye que en los procesos de diferenciación que reificaron estas normas se colocó a las disidencias y a las migraciones como una “otredad problemática”, sobre la que se ejerció gobierno, principalmente con el fin de evitar una desviación de los marcos aceptados como “normales” para la seguridad de la reciente democracia chilena.With the end of the civil-military dictatorship, Chile began a socio-political transition marked by a rhetoric of “consensus,” which resulted in the neutralization of differences, leading LGBTI+ and migrant experiences to situate themselves in a place of non-contradiction. This article aims to observe the tension in understanding citizenship in the post-dictatorship period based on the demands of LGTBI+ and migrants in the country. We present a critical documentary analysis —from a queer feminist approach— of sexuality and migration policies, which show a clear assimilationist slant based on an idea of “citizen” that does not disrupt transitional peace. Emphasis is placed on the contradictions between the grand narrative of the peace agreement and post-dictatorship cohesion and the invisibilizations that LGBTI+ and migrant collectives went through. Likewise, the generalist uses of diversity as a renewed form of assimilation are highlighted. The originality of this analysis lies in the fact that it provides an intersectional review of how policies are usually thought of under a single vector of difference —class, origin, or sexuality— without bringing to the forefront the articulation of differentiating social structures in which the new transitional process is structured. We conclude that, in the processes of differentiation that reified these norms, dissidents and migrants were labeled as a “problematic otherness,” over which government was exercised, mainly to avoid a deviation from the frameworks accepted as “normal” for the security of the recent Chilean democracy.Finalizada a ditadura cívico-militar, no Chile, iniciou-se uma transição sociopolítica marcada por uma retórica do “consenso”, que teve como efeito a neutralização das diferenças, levando experiências LGBTI+ e migrantes a se situar num lugar de não contradição. Neste artigo, propõe-se observar como, no período de pós-ditadura, tensionou-se a forma de compreensão da cidadania a partir das demandas LGTBI+ e migrantes no país. Apresentamos uma análise documental crítica — de uma abordagem feminista cuir — de políticas de sexualidades e de migração, que tornam evidente um claro corte assimilacionista em função de uma ideia de “cidadão” não disruptiva da paz de transição. Enfatiza-se nas contradições entre a grande narrativa de acordo de paz e coesão pós-ditadura e as invisibilizações que os coletivos LGBTI+ e migrantes atravessaram; além disso, são ressaltados os usos generalistas da diversidade como uma renovada forma de assimilação. A originalidade desta análise está em que revisa interseccionalmente como as políticas costumam pensar condicionadas a um único vetor de diferença — a classe, a procedência ou a sexualidade —, sem pôr em questão a articulação de estruturas sociais diferenciadoras em que se estrutura o novo processo de transição. Conclui-se que, nos processos de diferenciação que reificaram essas normas, colocaram-se as dissidências e as migrações como uma “outridade problemática”, sobre a qual foi exercido governo, principalmente com o objetivo de evitar um desvio de referenciais aceitos como “normais” para a segurança da recente democracia chilena

Editorial - Migrações transfronteiriças: memórias e trajetórias de pessoas LGBTQIA+

En este número quisimos visualizar precisamente cómo el ejercicio ciudadano se tensiona por diversos ejes de diferenciación, en este caso, poniendo énfasis en el que se establece en el cruce de la extranjeridad -asociada a condición migratoria, nacionalidad, ascendencia étnica y procesos de racialización (Stang et al., 2022)- con el de la sexualidad y las subjetivaciones sexo-genéricas. Es un hecho que, en general, ha primado una mirada des-corporizada (Parrini et al., 1986) y desexualizada de los/as migrantes y de los procesos migratorios; la sobredeterminación del sujeto migrante como mano de obra, que ha dominado por mucho tiempo en este campo de estudios, ha invisibilizado en buena medida esta dimensión de las migraciones, a expensas de otras aristas que se han considerado más relevantes, también a causa de que cuerpos y sexualidades han sido un objeto de estudio largamente deslegitimado, y despolitizado, en las ciencias sociales.Nesta edição pretendemos refletir sobre como o exercício da cidadania é tensionado por diferentes eixos de diferenciação, enfatizando o cruzamento entre a estrangeiridade - associada à condição migratória, nacionalidade, ascendência étnica e processos de racialização (Stang et al., 2022)- com a sexualidade e subjetivações sexo-genéricas. É fato que, em geral, tem prevalecido um olhar descorporizada (Parrini et al. al., 1986) e dessexualizado dos e das migrantes e processos migratórios; a sobredeterminação do sujeito migrante como força de trabalho, que dominou por muito tempo este campo de estudos, invisibilizou em grande medida esta dimensão das migrações, em detrimento de outros aspectos que têm sido considerados mais relevantes, também porque os corpos e as sexualidades têm sido objeto de estudo por muito tempo deslegitimado, e despolitizado, nas ciências sociais.

Quality Indicators for the Assessment and Management of Pain in the Emergency Department: A Systematic Review

BACKGROUND: Evidence indicates that pain is undertreated in the emergency department (ED). The first step in improving the pain experience for ED patients is to accurately and systematically assess the actual care being provided. Identifying gaps in the assessment and treatment of pain and improving patient outcomes requires relevant, evidence-based performance measures.OBJECTIVE: To systematically review the literature and identify quality indicators specific to the assessment and management of pain in the ED.METHODS: Four major bibliographical databases were searched from January 1980 to December 2010, and relevant journals and conference proceedings were manually searched. Original research that described the development or collection of data on one or more quality indicators relevant to the assessment or management of pain in the ED was included.RESULTS: The search identified 18,078 citations. Twenty-three articles were included: 15 observational (cohort) studies; three before-after studies; three audits; one quality indicator development study; and one survey. Methodological quality was moderate, with weaknesses in the reporting of study design and methodology. Twenty unique indicators were identified, with the majority (16 of 20) measuring care processes. Overall, 91% (21 of 23) of the studies reported indicators for the assessment or management of presenting pain, as opposed to procedural pain. Three of the studies included children; however, none of the indicators were developed specifically for a pediatric population.CONCLUSION: Gaps in the existing literature include a lack of measures reflecting procedural pain, patient outcomes and the pediatric population. Future efforts should focus on developing indicators specific to these key areas.Peer Reviewe