Remittance micro-worlds and migrant infrastructure: circulations, disruptions, and the movement of money

Remittances are increasingly central to development discourses in Africa. The development sector seeks to leverage transnational migration and rapid innovations in financial technologies (fintech), to make remittance systems cheaper for end-users and less risky for states and companies. Critical scholarship, however, questions the techno-fix tendency, calling for grounded research on the intersections between remittances, technologies, and everyday life in African cities and beyond. Building on this work, we deploy the concepts of “micro-worlds” and “migrant infrastructure” to make sense of the complex networks of actors, practices, regulations, and materialities that shape remittance worlds. To ground the work, we narrate two vignettes of remittance service providers who operate in Cape Town, South Africa, serving the Congolese diaspora community. We showcase the important role of logistics companies in the “informal” provision of remittance services and the rise of fintech companies operating in the remittance space. These vignettes give substance to the messy and relational dynamics of remittance micro-worlds. This relationality allows us to see how remittances are circulations, not unidirectional flows; how they are not split between formal and informal, but in fact intersect in blurry ways; how digital technologies are central to the story of migrant infrastructures; and how migrants themselves are compositional of these networks. In doing so, we tell a more relational story about how remittance systems are constituted and configured

End-Tidal Carbon Dioxide Use for Tracheal Intubation: Analysis from the National Emergency Airway Registry for Children (NEAR4KIDS) Registry

© Copyright 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. Objective: Waveform capnography use has been incorporated into guidelines for the confirmation of tracheal intubation. We aim to describe the trend in waveform capnography use in emergency departments and PICUs and assess the association between waveform capnography use and adverse tracheal intubation-associated events. Design: A multicenter retrospective cohort study. Setting: Thirty-four hospitals (34 ICUs and nine emergency departments) in the National Emergency Airway Registry for Children quality improvement initiative. Patients: Primary tracheal intubation in children younger than 18 years. Interventions: None. Measurements and Main Results: Patient, provider, and practice data for tracheal intubation procedure including a type of end-tidal carbon dioxide measurement, as well as the procedural safety outcomes, were prospectively collected. The use of waveform capnography versus colorimetry was evaluated in association with esophageal intubation with delayed recognition, cardiac arrest, and oxygen desaturation less than 80%. During January 2011 and December 2015, 9,639 tracheal intubations were reported. Waveform capnography use increased over time (39% in 2010 to 53% in 2015; p \u3c 0.001), whereas colorimetry use decreased (\u3c 0.001). There was significant variability in waveform capnography use across institutions (median 49%; interquartile range, 25-85%; p \u3c 0.001). Capnography was used more often in emergency departments as compared with ICUs (66% vs. 49%; p \u3c 0.001). The rate of esophageal intubation with delayed recognition was similar with waveform capnography versus colorimetry (0.39% vs. 0.46%; p = 0.62). The rate of cardiac arrest was also similar (p = 0.49). Oxygen desaturation occurred less frequently when capnography was used (17% vs. 19%; p = 0.03); however, this was not significant after adjusting for patient and provider characteristics. Conclusions: Significant variations existed in capnography use across institutions, with the use increasing over time in both emergency departments and ICUs. The use of capnography during intubation was not associated with esophageal intubation with delayed recognition or the occurrence of cardiac arrest