People, Not Patients: An Analytical Critique of the Medical Approach to Racial Disparities in Premature Birth and Birthweight in the United States

This thesis unpacks the underlying causes of the racial disparity in premature birth and birthweight in the United States, specifically that African American women are 2.5 times more likely than white women to experience preterm birth (PTB) or deliver low birthweight (LBW) infants. Despite industrialization and medicalization in the U.S., these poor birth outcomes remain the leading cause of infant mortality in the U.S. and result in developmental health challenges for children if they live past 1 years old. This thesis argues that by medicalizing childbirth to improve birth outcomes, public health and medical domains overlook non-medical factors that contribute to these disparities. Through an analysis of interviews, biopolitical projects, healthcare coverage, privatized medicine, medical journals, public assistance policies, racial pseudoscience, and public health rhetorical strategies, this thesis demonstrates that the reproductive autonomy of poor women and women of color has been jeopardized and abused both historically and contemporaneously. The medical approach to alleviating the disparity reduces a sociopolitical issue stemming from structural discrimination to a medical condition, which limits the imagined methods of interventions and solutions

PRagMatic Pediatric Trial of Balanced vs nOrmaL Saline FlUid in Sepsis: study protocol for the PRoMPT BOLUS randomized interventional trial

Abstract Background/aims Despite evidence that preferential use of balanced/buffered fluids may improve outcomes compared with chloride-rich 0.9% saline, saline remains the most commonly used fluid for children with septic shock. We aim to determine if resuscitation with balanced/buffered fluids as part of usual care will improve outcomes, in part through reduced kidney injury and without an increase in adverse effects, compared to 0.9% saline for children with septic shock. Methods The Pragmatic Pediatric Trial of Balanced versus Normal Saline Fluid in Sepsis (PRoMPT BOLUS) study is an international, open-label pragmatic interventional trial being conducted at > 40 sites in the USA, Canada, and Australia/New Zealand starting on August 25, 2020, and continuing for 5 years. Children > 6 months to < 18 years treated for suspected septic shock with abnormal perfusion in an emergency department will be randomized to receive either balanced/buffered crystalloids (intervention) or 0.9% saline (control) for initial resuscitation and maintenance fluids for up to 48 h. Eligible patients are enrolled and randomized using serially numbered, opaque envelopes concurrent with clinical care. Given the life-threatening nature of septic shock and narrow therapeutic window to start fluid resuscitation, patients may be enrolled under “exception from informed consent” in the USA or “deferred consent” in Canada and Australia/New Zealand. Other than fluid type, all decisions about timing, volume, and rate of fluid administration remain at the discretion of the treating clinicians. For pragmatic reasons, clinicians will not be blinded to study fluid type. Anticipated enrollment is 8800 patients. The primary outcome will be major adverse kidney events within 30 days (MAKE30), a composite of death, renal replacement therapy, and persistent kidney dysfunction. Additional effectiveness, safety, and biologic outcomes will also be analyzed. Discussion PRoMPT BOLUS will provide high-quality evidence for the comparative effectiveness of buffered/balanced crystalloids versus 0.9% saline for the initial fluid management of children with suspected septic shock in emergency settings. Trial registration PRoMPT BOLUS was first registered at ClinicalTrials.gov ( NCT04102371 ) on September 25, 2019. Enrollment started on August 25, 2020