"It's Wrong because It Could Be My Sister, Wife, or Mother": Workplace Sexual Harassment among Men and Women Farmworkers in USA and Mexico.

These findings from focus groups explore attitudes, beliefs, perspectives, and experiences relevant to workplace sexual harassment (WSH) among men and women farmworkers in California, USA, and Michoacán, Mexico. Focus groups are stratified by country and gender, with two in California (10 men and 10 women) and two in Michoacán (8 men and 5 women). This community-based participatory research includes Community Advisory Boards (CABs) consisting of farmworkers, academicians, non-profit organizations, attorneys, industry personnel, and community leaders who took part in strategy and the development of materials. Themes are related to the experience of, responses to, and farmworkers' recommendations for prevention of WSH. Although men and women faced WSH, women's experiences were more severe and frequent. Participants condemned WSH as contrary to principles of caballerosidad, cortesía, respeto - cultural values promoting respect for others and protection for vulnerable persons. Participants endorsed the notion that women are responsible for WSH. Although farmworkers try to resolve WSH on their own with help from co-workers, family, and leadership, they face significant barriers that silence victims and allow WSH to persist. All farmworkers recommended that management set a good example and enforce consequences for offenders. Implications include directly appealing to cultural values (emphasizing respect), incorporating bystander education, and countering the myth that women are responsible for WSH in workplace training. WSH is a recognized occupational hazard that affects all directly or indirectly exposed workers. We emphasize that employers are ultimately responsible for their workers' safety, supported by a governmental regulatory role. Enforcement of existing policy is needed in California , whereas awareness and policy development is needed in Michoacán. These findings will support the researchers, agricultural community, educators, and organizations working to prevent WSH.

In Vitro Activity of Delafloxacin and Microbiological Response against Fluoroquinolone-Susceptible and Nonsusceptible Staphylococcus aureus Isolates from Two Phase 3 Studies of Acute Bacterial Skin and Skin Structure Infections.

Delafloxacin is an investigational anionic fluoroquinolone antibiotic with broad-spectrum in vitro activity, including activity against Gram-positive organisms, Gram-negative organisms, atypical organisms, and anaerobes. The in vitro activity of delafloxacin and the percent microbiological response in subjects infected with fluoroquinolone-susceptible and nonsusceptible Staphylococcus aureus isolates were determined from two global phase 3 studies of delafloxacin versus vancomycin plus aztreonam in patients with acute bacterial skin and skin structure infections (ABSSSI). Patients from 23 countries, predominately the United States but also Europe, South America, and Asia, were enrolled. The microbiological intent-to-treat (MITT) population included 1,042 patients from which 685 S. aureus isolates were submitted for identification and susceptibility testing per CLSI guidelines at the central laboratory (JMI Laboratories, North Liberty, IA). The comparator fluoroquinolone antibiotics included levofloxacin and ciprofloxacin. Nonsusceptibility to these antibiotics was determined using CLSI breakpoints. S. aureus isolates were 33.7% levofloxacin nonsusceptible (LVX-NS). The delafloxacin MIC90 values against levofloxacin-nonsusceptible S. aureus, methicillin-resistant S. aureus (MRSA), and methicillin-susceptible S. aureus isolates were all 0.25 µg/ml. Delafloxacin demonstrated high rates of microbiological response against LVX-NS isolates as well as isolates with documented mutations in the quinolone resistance-determining region (QRDR). S. aureus was eradicated or presumed eradicated in 98.4% (245/249) of delafloxacin-treated patients. Similar eradication rates were observed for delafloxacin-treated subjects with levofloxacin-nonsusceptible S. aureus isolates (80/81; 98.8%) and MRSA isolates (70/71; 98.6%). Microbiological response rates of 98.6% were observed with delafloxacin-treated subjects with S. aureus isolates with the S84L mutation in gyrA and the S80Y mutation in parC, the most commonly observed mutations in global phase 3 studies. The data suggest that delafloxacin could be a good option for the treatment of infections caused by S. aureus isolates causing ABSSSI, including MRSA isolates, where high rates of ciprofloxacin and levofloxacin nonsusceptibility are observed. (The phase 3 studies described in this paper have been registered at ClinicalTrials.gov under identifiers NCT01984684 and NCT01811732.).

Region of birth, sex, and agricultural work of immigrant Latino farm workers: the MICASA study.

Agricultural work is hazardous, and immigrant workers perform the majority of production tasks, yet there are few data describing agricultural work and use of protective measures by demographic characteristics. We examined cross-sectionally the influence of region of birth (Mexico vs. Central America) and sex on agricultural work and use of protective measures in the MICASA cohort of immigrant Latino farm workers in Mendota, California. Of 445 participants, 293 (65.8%) were born in Mexico (163 men, 130 women) and 152 (34.2%) were born in Central America (80 men, 72 women). Men worked on average 74.4 more days than women (95% CI 62.0, 86.9) and were more likely to perform tasks requiring high levels of training or strength, such as machine operation, pruning, picking, planting, and irrigation; more likely to work in dusty conditions; and more likely to work directly with pesticides. Women predominated in packing. Respondents from Mexico were more likely to work with tomatoes and less likely to work with melon and lettuce. Central America-born respondents were less likely to engage in planting, irrigation, and pesticide use. Use of task-appropriate personal protective measures on at least a half-time basis was rare, with the exception of persons working with pesticides (a group limited to men) and for facial scarves among Central American women. Further work should focus on identifying barriers to use of preventive measures and programs to further their use. Educational models accounting for cultural factors and driving social norm change, employer engagement, and use of community health workers (promotores) may be helpful in promoting use of preventive measures.

The California Agricultural Workers Health Survey.

The California Agricultural Workers Health Survey was a statewide cross-sectional household survey of 970 hired farm laborers. Randomly selected participants residing in randomly selected dwellings were recruited in seven communities representing all of the state's agricultural regions. Participants were interviewed in their preferred language by professional staff. The response rate was 83%. The comprehensive interview included self-reported health conditions, doctor-reported health conditions, work history, workplace health conditions, field sanitation, and work-related injuries. A farm workplace injury during the twelve-month period prior to the interview was reported by 6% of male workers (95% CI: 4% - 8%) and 2% of female workers (95% CI: 1% - 3%). Significant numbers of both male (41%) and female (40%) workers reported persistent pain (every day for more than one week) in the back, neck, knees, shoulders, hands, feet, or multiple body parts. The number of body parts in which female workers reported persistent pain correlated with increased years of U.S. hired farm work (Spearman r = 0.24, p < 0.01). Direct contact with pesticides from being sprayed or drifted upon among both male and female workers was associated with multiple workplace health conditions such as irritated, itchy, or water eyes (male: OR 2.9, 95% CI: 1.6 - 5.0; female: OR 13.8, 95% CI: 4.3 - 44.7). Persistent stomach aches among male and female participants was associated with being required to taste unwashed grapes for sweetness while picking (male: OR 4.6, 95% CI: 2.1 - 9.9; female: OR 5.8, 95% CI: 2.6 - 12.6).

Recognition of hemophilia A in an elderly patient.

Hemophilia A (classic hemophilia) is an hereditary coagulation disorder characterized by the absence, severe deficiency, or defective functioning of plasma coagulation factor VIII. It is inherited in an X-linked recessive manner and occurs almost exclusively in males. The first manifestations of bleeding are usually first noted as a young child since most of the patients with hemophilia A have a profound deficiency of factor VIII (less than 1% of normal value). However, in mild hemophilia (5-25% of normal level of factor VIII) the condition may escape detection with many of the patients developing bleeding only after trauma or surgery. Hemophilia A is the result of a recent genetic mutation in approximately one third of patients, for whom often there is no family history of a bleeding disorder. Here we present an elderly male patient with spontaneous bleeding in an extremity that has coagulation studies consistent with the diagnosis of hemophilia A. Physicians must be aware that mild hemophilia can present in this unusual manner and should consider this possibility in patients that have unexplained bleeding even if there is no clear personal or family history of an hereditary coagulation disorder.

Hemostatic abnormalities associated with monoclonal gammopathies.

To confirm and expand previous observations about the association of monoclonal gammopathies with hemostatic defects, a prospective evaluation was made in 42 patients with lymphoplasmacytic disorders. The incidence of bleeding complications was low, despite the diversity of abnormal hemostatic tests observed in these patients. Patients with myeloma frequently had abnormal coagulation tests, including thrombin time (64%), fibrin degradation products (32%), platelet aggregation tests with different agonist (30% to 55%), and bleeding time (22%). The lack of platelet response to ristocetin and normal ristocetin cofactor activity in four patients with myeloma may suggest a Bernard-Soulier-type defect. Serum viscosity was negatively correlated with platelet aggregation with collagen, ristocetin, and adenosine diphosphate. In patients with immunoglobulin myeloma, there was a positive correlation between an increased viscosity and a prolonged thrombin time. This study demonstrates the wide variety of coagulation abnormalities in lymphoplasmacytic disorders, usually without significant clinical implications.

Compression volume in adult ventilator circuits: a comparison of five disposable circuits and a nondisposable circuit.

UNLABELLED: Although the concept of ventilator circuit compression is well known, it is not fully appreciated clinically. We compared the compression volume of five adult disposable ventilator circuits and a nondisposable circuit. METHODS: Five brands of disposable circuits (Inspiron, Intertech, Marquest, Seamless, and U-Mid) and one nondisposable brand (Bennett) were used. The circuits were attached to the outlet of a Bennett MA-1 ventilator in the standard manner, and the filter and humidifier were bypassed to eliminate their contribution to compression volume. The ventilator delivered 1 L of gas to a Michigan Instruments Test Training Lung at a flow of 60 L/min and a rate of 12/min. A valve system was placed between the Y-connector and the TTL to partition circuit compression volume from the volume delivered to the test lung. The compression factor was calculated by dividing the compression volume by the ventilating pressure. Five compliance settings were used on the TTL (0.1, 0.05, 0.03, 0.02, and 0.015 L/cm) to simulate different ventilating pressures. Pressure at the Y-connector, compressible volume, and volume delivered to the TTL were measured using a calibrated Timeter RT200 volume-pressure analyzer. Five measurements were made with each brand. A new circuit was used for each run with a disposable circuit, and a different circuit from the respiratory care department stock was used for each run with a nondisposable circuit. RESULTS: There were significant differences between the compression factors at different TTL compliance settings (p less than 0.001), and brands of circuits evaluated (p less than 0.001). There was a significant interaction effect for compression factors between TTL compliance setting and circuit brands (p less than 0.001). The compression factors for all disposable circuits were greater than the compression factors for the nondisposable circuits (p less than 0.05). CONCLUSIONS: There were differences in circuit compression factors as a function of the ventilating pressure and the brand of circuit. Although these differences are too small to be clinically important in many cases, they may be important during ventilation with low tidal volumes and high pressures.