Background Preventing sexually transmitted diseases (STD) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) remains a public health challenge. The U.S. Preventive Services Task Force suggests STD screening among men will likely lead to a decrease in infection rates of women. However, innovative approaches are necessary to increase the traditionally low rates of male screening. The purpose of this study is to compare the acceptability and effectiveness of home-based versus clinic-based urine screening for CT/GC in men. Methods We conducted a randomized clinical trial of 200 men ages 18-45 years who reside in St. Louis, Missouri. Men were enrolled via telephone and randomly assigned to receive a free urine CT/GC screening kit in-person at the research clinic or mailed to a preferred address. Participants completed questionnaires at baseline and 10-12 weeks post-enrollment. The primary outcome was whether a STD screening kit was completed. Results Sixty percent (120/200) completed STD screening. Men assigned to home-based screening were 60% more likely to complete screening compared to clinic-based screening (72% versus 48%, RRadj=1.6, 95% CI, 1.3, 2.00). We identified four cases of CT or GC in the home-based group compared to three cases of CT in the clinic group. Men who completed screening were significantly more likely to be white, younger, and college-educated. Conclusions Home-based screening for CT and GC among men is more acceptable than clinic-based screening and resulted in higher rates of screening completion. Incorporating home-based methods as adjuncts to traditional STD screening options shows promise in improving STD screening rates in men.

INTRODUCTIONSickle cell-related pain is the most common morbidity experienced by children and adults with sickle cell disease (SCD). Acute chest syndrome (ACS), though second to SCD-pain in frequency, contributes significantly to both morbidity and mortality in children with SCD. ACS is responsible for up to one-quarter of sickle cell-related mortality [1], and almost half of the deaths due to ACS are in children <20 years of age [2]. Furthermore, ACS during childhood negatively impacts long-term lung function [3], and predisposes children to subsequent episodes [4,5]. A report from the Cooperative Study of Sickle Cell Disease found that three-quarters of patients who died from ACS initially presented with lower extremity pain due to sickle cell vaso-occlusion, and that death from ACS primarily occurred within 48 hr of symptom onset. For patients who did not die, 50% of adults and 11% of children were presented with SCD-pain prior to the onset of ACS [2]. Consequently, a close temporal relationship exists between ACS and SCD-pain.The pathophysiology of ACS is not fully understood, yet multiple risk factors have been identified including splenectomy [6], abdominal surgery [7], asthma [4], infection [8], fat emboli and pain [9]. Therapies to prevent the development of ACS are limited and they are risk factor dependent. For example, pre-operative blood transfusion reduces the rate of ACS in the surgical setting [10] as does the use of laparascopic rather than open abdominal procedures [11]. The use of controller medications in patients with asthma [12] and hydroxyurea in patients with frequent episodes of ACS reduces ongoing risk, but these therapies are not used to treat an acute episode [13]. Additionally, the use of incentive spirometry reduces the development of pulmonary complications in children admitted with pain [14]. Lastly, in a retrospective study that examined the frequency of ACS development, patients who received nalbuphine, a mixed opioid agonist-antagonist, compared to morphine had a lower rate of ACS [15].In this study, we evaluated the impact of a multi-modal intervention combining standardized orders and education for the inpatient management of SCD-pain on the rate of subsequent ACS episodes. The use of incentive spirometry substantially decreases the rate of ACS among individuals hospitalized for pain [15], though we observed that many patients are not compelled to consistently use incentive spirometry while hospitalized. We, therefore, tested the hypothesis that a standard treatment for pain episodes including specific orders to nursing staff regarding monitoring incentive spirometry would decrease the rate of ACS in patients admitted with SCD. METHODSThe protocol was approved by the Washington University School of Medicine Human Research Protection Office. A prospective cohort study was performed to assess the effect of a multi-modal intervention aimed at reducing 30-day hospital readmission for children admitted with SCD-pain. Secondary outcome measures obtained in the cohort study included ...

MachineLearning or Artificial Intelligence algorithms have gained considerable scrutiny in recent times owing to their propensity towards imitating and amplifying existing prejudices in society. This has led to a niche but growing body of work that identifies and attempts to fix these biases.A first step towards making these algorithms more fair is designing metrics that measure unfairness. Most existing work in this field deals with either a binary view of fairness (protected vs. unprotected groups) or politically defined categories (race or gender). Such categorization misses the important nuance of intersectionality -biases can often be amplified in subgroups that combine membership from different categories, especially if such a subgroup is particularly underrepresented in historical platforms of opportunity.In this paper, we discuss why fairness metrics need to be looked at under the lens of intersectionality, identify existing work in intersectional fairness, suggest a simple worst case comparison method to expand the definitions of existing group fairness metrics to incorporate intersectionality, and finally conclude with the social, * Work done as a research intern at Fiddler.

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Historically marginalized populations are disproportionately affected by many diseases that commonly affect the retina, yet they have been traditionally underrepresented in prospective clinical trials. This study explores whether this disparity affects the clinical trial enrollment process in the retina field and aims to inform future trial recruitment and enrollment. Age, gender, race, ethnicity, preferred language, insurance status, social security number (SSN) status, and median household income (estimated using street address and zip code) for patients referred to at least one prospective, retina-focused clinical trial at a large, urban, retina-based practice were retrospectively extracted using electronic medical records. Data were collected for the 12-month period from 1 January 2022, through 31 December 2022. Recruitment status was categorized as Enrolled, Declined, Communication (defined as patients who were not contacted, were contacted with no response, were waiting for a follow-up, or were scheduled for screening following a clinical trial referral.), and Did Not Qualify (DNQ). Univariable and multivariable analyses were used to determine significant relationships between the Enrolled and Declined groups. Among the 1477 patients, the mean age was 68.5 years old, 647 (43.9%) were male, 900 (61.7%) were White, 139 (9.5%) were Black, and 275 (18.7%) were Hispanic. The distribution of recruitment status was: 635 (43.0%) Enrolled, 232 (15.7%) Declined, 290 (19.6%) Communication, and 320 (21.7%) DNQ. In comparing socioeconomic factors between the Enrolled and Declined groups, significant odds ratios were observed for age (p < 0.02, odds ratio (OR) = 0.98, 95% confidence interval (CI) [0.97, 1.00]), and between patients who preferred English versus Spanish (p = 0.004, OR = 0.35, 95% CI [0.17, 0.72]. Significant differences between the Enrolled and Declined groups were also observed for age (p < 0.05), ethnicity (p = 0.01), preferred language (p < 0.05), insurance status (p = 0.001), and SSN status (p < 0.001). These factors may contribute to patient participation in retina-focused clinical trials. An awareness of these demographic and socioeconomic disparities may be valuable to consider when attempting to make clinical trial enrollment an equitable process for all patients, and strategies may be useful to help address these challenges.