Background: Syphilis infection has recently resurfaced as a significant public health problem. Although there has been a tremendous amount of research on the epidemiology of syphilis, there has been limited work done to synthesize the extensive body of research and systematically estimate patterns of disease within high-risk groups in the Americas. The purpose of this systematic review and meta-analysis is to (1) summarize recent patterns of syphilis infection in North and South America among four high-risk groups (MSM, transgender women, sex workers, and incarcerated individuals) from 1980 to 2016, (2) identify and differentiate regional geographic epidemiologic characteristics, and (3) compare the epidemics of the economically developed countries of North America from the developing countries and public health systems of Latin America and the Caribbean. Methods/design: Primary studies reporting syphilis prevalence and/or incidence in at least one of the four high-risk groups will be identified from Medline/PubMed, Embase, Lilacs, SciELO, The Cochrane Library, Web of Science, Scopus, ProQuest, CINAHL, Clase, and Periódica, as well as "gray" literature sources (conference abstracts, country reports, etc.). Studies published from 1980 through 2016 will be included. Data will be extracted from studies meeting inclusion and exclusion criteria and a random effects meta-analysis of prevalence and incidence estimates will be conducted. Heterogeneity, risk of bias, and publication bias will be assessed. Pooled prevalence and incidence estimates will be calculated for comparisons based on geographic region, risk factors, and time period. Discussion: Our systematic review and meta-analysis aims to contribute to an improved understanding of global epidemiologic patterns of syphilis infection in most-at-risk populations. Through systematic classification of the existing literature, and comparison of disease patterns across regional, temporal and socio-behavioral differences, we hope to improve public health surveillance and improve efforts to control the spread of disease across the Americas. Systematic review registration: PROSPERO CRD42016047306.

Unemployment among formerly incarcerated citizens is a complex problem that continues to grow. Previous reentry studies describe the collateral effects of incarceration on employment from the perspective of formerly incarcerated individuals, yet little academic research exists regarding reentry practitioners' perceptions of constraints during the job search process. Using Goldratt's theory of constraints as the foundation, the purpose of this case study of reentry and employment in a mid-Atlantic state was to explore from the perspective of practitioners, the types of constraints individuals with criminal records face during the job search process, the most difficult phase of the job search process, and recommendations on improving employment outcomes. Data for this study were obtained from 20 reentry professionals in Maryland, who completed an online, open-ended response survey. Data were inductively coded and subjected to thematic analysis procedure. The results showed that practitioners perceived the background check to be the most difficult phase in the job search process, and that external and environmental constraints such as employer bias and social stigma prevent individuals with criminal records from securing job offers. The results also showed that reentry professionals support automatic record expungement, record shielding, employer partnerships, and employment programming that provides job leads, resume building, and mock interview assistance. The positive social change implications stemming from this study include policy recommendations to policy makers to include centralizing and expanding the location of statewide employment centers, record shielding under the Second Chance Act, and fair education access through Ban-the Box for state colleges.