Paul Area Research Articles

ACCOMMODATION TO THE LOCAL MAJORITY NORM BY HMONG AMERICANS IN THE TWIN CITIES, MINNESOTA

This study investigates selected English sounds spoken by immigrants in a region of the United States undergoing vowel space restructuring. The vowels of Hmong Americans in the Minneapolis–St. Paul area are compared to those of local white middle-class speakers. Results of this comparison suggest that young white speakers produce a fronted bat vowel and a lowered and backed bet. Males reduce the mean bot-bought spectral distance, leaving the impression of an apparent merger. Younger Hmong Americans who arrived in the United States at a young age accommodate to local norms for bat fronting and raising but not to the apparent low-back merger, regardless of speaker age, sex, generation, or social mobility.

Geographical Distribution of Perfluorinated Compounds in Fish from Minnesota Lakes and Rivers

In response to growing interest in human exposure to perfluorinated compounds (PFCs), the state of Minnesota measured and reported PFC concentrations in fish collected from the Minneapolis-St. Paul area. To better determine the geographical distribution of PFC contamination throughout Minnesota, fish were collected from 59 lakes throughout the state and several areas along the Mississippi River. Composite fish samples were analyzed for 10 PFC analytes by solid-phase extraction (SPE) and liquid chromatography-tandem mass spectrometry (LC/MS/MS). PFOS (perfluorooctanesulfonate) was the most commonly detected PFC, occurring in 73% of fish from the Mississippi River but only 22% of fish from lakes. Fish from Mississippi River Pool 2 near the Minneapolis-St. Paul area had the highest levels of PFOS, whereas locations upstream had PFOS concentrations below 40 ng/g, the concentration at which Minnesota issues "one meal per week" fish consumption advice. Fish from most Minnesota lakes tested (88%) had PFOS concentrations below 3 ng/g. Two lakes, McCarrons and Zumbro, contained fish with PFOS levels above 40 ng/g. The results reported here will help researchers to better understand the extent of PFC contamination in Minnesota fish and evaluate potential sources of contamination and will provide a basis for comprehensive fish consumption advice.

The Effect of Federal Fuel Sulfur Regulations on In-Use Fleets: On-Road Heavy-Duty Source Apportionment

From 2002 to 2007 fuel sulfur content in the Minneapolis/St Paul area decreased from about 325 ppm S to <15 ppm S as a result of EPA regulations. We hypothesized that the reduction in fuel sulfur would result in a reduction of fuel specific heavy duty (HD) particle number emissions for the on-road diesel fleet. Fuel specific emissions were estimated by collecting on-road aerosol data, and exploiting the difference in the relative volumes of HD and light duty (LD) traffic on the roadway. Fuel-specific particle number emissions for HD vehicles were measured to be 9.1 +/- 6.6 x 10(15) and 3.2 +/- 2.8 x 10(15) particles/kg of fuel burned, in 2006 and 2007, respectively, a reduction of 65%. In an earlier study in 2002 particle number emissions for the in-use HD fleet were 4.2 +/- 0.6 x 10(15) particles/km compared to the current measurements of 2.8 +/- 2.1 x 10(15) and 9.9 +/- 8.7 x 10(14) particles/km in 2006 and 2007, respectively. The HD particle mass emission standard remained unchanged from 1994 through 2006 and few 2007 HD vehicles were on the road at the time of this study so the decreases in number observed emissions are more likely due to reductions in the sulfur content of the fuel than to changes in engine and aftertreatment design.

Evaluation of Surveillance Methods for Staphylococcal Toxic Shock Syndrome

We compared passive surveillance and International Classification of Diseases, 9th Revision, codes for completeness of staphylococcal toxic shock syndrome (TSS) surveillance in the Minneapolis–St. Paul area, Minnesota, USA. TSS-specific codes identified 55% of cases compared with 30% by passive surveillance and were more sensitive (p = 0.0005, McNemar χ2 12.25).

Use And Costs Of Care In Retail Clinics Versus Traditional Care Sites

Retail clinics have generated much interest, promising convenient, lower-cost service for the treatment of minor conditions than conventional care sites can offer. Using health plan claims data, we describe utilization trends, patient mix, and cost per episode of care for the five conditions most frequently treated at a retail clinic chain in the Minneapolis-St. Paul area, as compared with other care settings. Retail clinic use for these conditions is increasing at about 3 percent per year and offers savings of $50-$55 per episode. However, it accounts for only 6 percent of such episodes, and the impact on overall cost and quality remains undetermined.

Perfluorinated compounds in common carp ( Cyprinus carpio) fillets from the Upper Mississippi River

Ten different perfluoroalkyl acids (PFAAs), including perfluooctane sulfonate (PFOS), were measured in 30 common carp ( Cyprinus carpio) fillets collected from three sites on the Upper Mississippi River in Minnesota in an effort to evaluate the potential impact of PFAA emissions in this area. Samples upstream of the city of St. Cloud (reference site) had median PFOS concentrations of 8.1 ng/g wet weight (ng/g wet wt), but median levels increased significantly downstream in the Minneapolis–St. Paul urban area, with concentrations from the Pig's Eye Lake site at 26 ng/g wet wt ( p = 0.0015) and the Spring Lake site at 40 ng/g wet wt ( p = 0.0004). This latter PFOS concentration is within the advisory range for limiting fish consumption to one meal a week according to the Minnesota Department of Health. Other PFAAs were also found to increase significantly between the reference site and the Minneapolis–St. Paul area, but maximal concentrations remained below 2.0 ng/g wet wt. This study demonstrates the bioaccumulation of PFAAs in a ubiquitous fish species in a major urban area known to have historical inputs of various PFAA compounds. The full extent of this contamination and the potential for accumulation in other species remain to be evaluated.

Associations between Watching TV during Family Meals and Dietary Intake Among Adolescents

Objective To examine associations between watching television during family meals and dietary intake among adolescents. Design Cross-sectional study using survey data from a diverse sample of adolescents. Setting Data were collected from a school-based survey during the 1998-1999 school year. Participants Middle and high school students (N = 4746) from 31 public schools in the Minneapolis-St. Paul area. Response rate was 81.5%. Variables Measured Intake of fruits, total vegetables, dark green/yellow vegetables, calcium-rich food, grains, soft drinks, fried food, snack food, calories, family meal frequency, and watching television during meals. Analysis General linear modeling comparing dietary intake across 3 groups. Results 33.5% of boys and 30.9% of girls reported watching television during family meals. Adolescents watching television were found to have lower intakes of vegetables, dark green/yellow vegetables, calcium-rich food, and grains and higher intakes of soft drinks compared to adolescents not watching television during meals. However, watching television during family meals was associated with a more healthful diet than not eating regular family meals. Conclusions and Implications Watching television during family meals was associated with poorer dietary quality among adolescents. Health care providers should work with families and adolescents to promote family meals, emphasizing turning the TV off at meals.

Hope by Charles Huntington

Charles Huntington, an American Indian artist of Ojibwe descent, was born in Niagara, Wis, on May 29, 1925. His family moved to the Minneapolis-St Paul area when he was an infant, and his formative years were spent there. After a 4-year tour of duty in the US Navy from 1942 to 1946 and subsequent employment as an auto mechanic, Huntington attended the Minneapolis School of Art (now known as the Minnesota College of Art and Design) for 1 year (1959-1960). For the next 3 years, he was an assistant to Paul Granlund (1925-2003), another well-known Minnesota sculptor who was an artist-in-residence at Gustavus Adolphus College in St Peter, Minn. Huntington honed his skills in sculpture under Granlund's tutelage, learning to build sculptures from found objects and by casting metal. He was invited to be an artist-in-residence for the Minneapolis Public School system and is the subject of a Minneapolis Public School teacher's guide on Native American art and artists.1Charles Huntington, Ojibwe Sculptor: With Teacher's Guide: Native Americans of the Twentieth Century. Minneapolis Public Schools, Minneapolis, Minn1979Google Scholar Standing approximately 3 ft by 9 ft on a 20-in pedestal, Hope is an abstract cast and painted steel configuration in bright orange. Depending on the viewer's imagination, a variety of symbols can be perceived in the sculpture. The individual letters of the word hope can be divined from the curves and angles. A figure eight—the symbol for infinity, a component of the enduring nature of hope—can also be inferred. The bright orange color suggests the fire of life, and the silver of the metal edges could invoke a silver-lined cloud. Like the emotion of hope, a feeling that is sometimes elusive and must be sought out, visitors to Rochester need to look in a somewhat out-of-the-way corner off the beaten path to get a close-up view of the sculpture. Hope was commissioned by the Ronald Raimondo family and presented to Mayo Foundation in memory of Barbara Raimondo in May 1983. It is located between the Conrad Hilton Building and the Mitchell Student Center on the Mayo Clinic Rochester campus. A small walkway of pavers provides visitors a more intimate view of Hope.

Participation in Weight-Related Sports Is Associated with Higher Use of Unhealthful Weight-Control Behaviors and Steroid Use

Objective To determine whether adolescents who participate in a weight-related sport are at increased risk for unhealthful weight-control behaviors and steroid use. Design This was a population-based study (Project EAT [Eating Among Teens]). Subjects/Setting Subjects were 4,746 adolescents (50.2% males, 49.8% females) from 31 public middle and high schools in the Minneapolis/St Paul area of Minnesota. Statistical Analysis Performed Descriptive statistics, χ 2 analyses, and multiple logistic regression were used. Data were adjusted for sociodemographic variables and body mass index. Main Outcome Variables Unhealthful weight-control behaviors and steroid use. Results More males (20.4%) than females (16.2%) reported participation in a weight-related sport. Males who reported participation in a weight-related sport had an increased risk of past-week vomiting (odds ratio [OR]=5.7), laxative use (OR=6.8), as well as past-year vomiting (OR=4.9), laxative use (OR=3.4), diuretic use (OR=6.0), and steroid use (OR=3.7), compared with those males who did not report participation. Females who reported participation in a weight-related sport had an increased risk of past week vomiting (OR=2.1), as well as past year vomiting (OR=2.0), laxative use (OR=2.6), and steroid use (OR=2.6), compared with those who did not report participation in a weight-related sport. Conclusions The current study shows that participation in a sport that adolescents perceive as emphasizing weight is strongly associated with unhealthful weight-control behaviors and steroid use. Preventive efforts, targeting parents, coaches, and adolescents are needed to decrease this risk.

Trends in Hospitalization Rate, Hospital Case Fatality, and Mortality Rate of Stroke by Subtype in Minneapolis-St. Paul, 1980–2002

Background: The stroke mortality rates have been declining in the USA for decades. Less is known about trends in stroke incidence rates, but some studies indicate they have declined. The stroke case fatality has also been declining. Little information exists on trends in stroke subtypes. We examined trends in mortality, hospitalization rate, and hospital case fatality of stroke by subtype in the Minneapolis-St. Paul area from 1980 to 2002. Methods: We estimated hospitalization rates and case fatality for ≧30-year-olds with data from the Minnesota Hospital Association. We estimated mortality rates with counts from the Minnesota Department of Health. Rates were age adjusted to the US 2000 standard by the direct method using census estimates. We tested for significant trends using linear regression. Results: Total stroke mortality and hospital case fatality both declined by almost 50% over the study period, while the rate of stroke hospitalization was relatively stable. Ischemic stroke hospitalization rates increased, while hospital case fatality and mortality rates decreased. Subarachnoid hemorrhage in-hospital case fatality and mortality rates declined, while the hospitalization rate was stable. Intracerebral hemorrhage hospitalization rates increased minimally, hospital case fatality declined, and the mortality rate was stable. Conclusion: These data suggest that declines in total stroke case fatality are contributing most to declining mortality rates in the presence of stable total stroke attack rates.

Integrating Social Science Research into Studio Teaching: Housing New Immigrants

Armed with an understanding of cultural differences in housing needs, designers can develop residential prototypes that accommodate diverse values and ways of living. Culturally sensitive designs ease the adjustment process of new immigrant groups and contribute to the well-being of communities and the country as a whole. Responding to multiculturalism, design education must prepare graduates for cross-cultural practice by engaging them in the consideration of cultural differences. The paper presents the example of two upper level undergraduate studios, taught in Spring 2002 and Fall 2003 in the Department of Architecture at the University of Minnesota, that exposed students to the design process through the exploration of cultural differences in housing design. Undertaken by an instructor trained in both architecture and social science, these studios integrated social science research into the teaching of design. The projects explored culturally sensitive housing for Hmong and Somali refugees, two of the Minneapolis/Saint Paul area's largest new immigrant groups. Students used verbal narratives collected through focused interviews with members of the Hmong and Somali communities living in the Twin Cities metropolitan area to define both the programmatic and conceptual stages of their designs. The paper elaborates on the theoretical framework that guided students' inquiries; states the methodology and process used to accomplish the research within the constraints of a semester; and outlines the challenges and opportunities afforded through this teaching technique. By focusing on the research phase of these studios, the paper hopes to inspire further development of pedagogies that cater to the changing demographics and respond to cultural differences.

Improving Minnesota's Stratified Ramp Control Strategy

Minnesota's most recent stratified zone ramp metering (SZM) strategy, the successor of the ZONE metering algorithm, has been deployed in the Minneapolis–St. Paul area since late 2002. The SZM strategy is intended to maximize freeway throughput while keeping ramp waiting times below a predetermined threshold. Preliminary evaluation results confirmed the overall effectiveness of the SZM strategy but also revealed that the freeway performance was compromised by the restrictive maximum ramp waiting constraint. Consequently, improvements were sought. These focus on a better determination of the minimum release rate for each ramp and its integration with the overall SZM strategy. Both the current and the enhanced SZM strategies are tested in two freeway sites under various demand scenarios through a state-of-the-art microscopic simulator. The simulation results indicate that the enhanced SZM strategy is effective for delaying and decreasing the freeway congestion and results in smoother freeway traffic flow compared with the original SZM strategy without violating the maximum ramp delay requirement.

Improving Minnesota's Stratified Ramp Control Strategy

Minnesota's most recent stratified zone ramp metering (SZM) strategy, the successor of the ZONE metering algorithm, has been deployed in the Minneapolis-St. Paul area since late 2002. The SZM strategy is intended to maximize freeway throughput while keeping ramp waiting times below a predetermined threshold. Preliminary evaluation results confirmed the overall effectiveness of the SZM strategy but also revealed that the freeway performance was compromised by the restrictive maximum ramp waiting constraint. Consequently, improvements were sought. These focus on a better determination of the minimum release rate for each ramp and its integration with the overall SZM strategy. Both the current and the enhanced SZM strategies are tested in two freeway sites under various demand scenarios through a state-of-the-art microscopic simulator. The simulation results indicate that the enhanced SZM strategy is effective for delaying and decreasing the freeway congestion and results in smoother freeway traffic flow com...

Use of Nonprescription Medications for Perceived Cardiovascular Health

Nonprescription products (over-the-counter drugs; vitamins/minerals; and nonvitamin, nonmineral supplements) are promoted or advertised for cardiovascular health. The extent of nonprescription products used specifically for perceived cardiovascular health (NONRX-CVH) is unknown. This study aimed to (1) determine prevalence and types of nonprescription medications used for NONRX-CVH, (2) compare the demographics of NONRX-CVH users to persons using nonprescription medications in general, and (3) determine the prevalence of use of NONRX-CVH among those taking a prescription medication for a cardiovascular reason. A cross-sectional survey comprised the probability sample of 3128 adults in the Minneapolis-St. Paul area in the 2000-2002 Minnesota Heart Survey. Trained interviewers collected medication information from participants using a structured medication inventory approach. Analysis in 2005 shows that 10% of participants (n=315) self-reported taking one or more nonprescription medications in the past 2 weeks for a perceived cardiovascular health purpose. Among these individuals, prevalence of use of vitamin/mineral supplements, nonvitamin/nonmineral supplements, and over-the-counter products for a cardiovascular purpose was 37.5%, 21.3%, and 54.6%, respectively. Popular NONRX-CVHs were aspirin (52.1%), vitamin E (24.4%), garlic (9.8%), and omega-3/fish oils/fatty acids (3.8%). NONRX-CVH users were older than general nonprescription users (p<0.001). Of 613 people using a prescription drug for cardiovascular reasons, 135 (22%) reported using one or more NONRX-CVH medications. Use of NONRX-CVHs, especially aspirin, vitamin E, and herbals, is common, and older patients may use aspirin or dietary supplements for this purpose. Physicians having patients with cardiovascular disease should ask about nonprescription medication usage, as some NONRX-CVHs may be inappropriate.

Credibility Perceptions of News Coverage of Ethnic Groups: The Predictive Roles of Race and News Use

ABSTRACT The authors examined the roles that race and news use play in predicting perceived credibility of news coverage of ethnic groups. With data from a 2000 telephone survey of the Minneapolis-St. Paul area, analyses were conducted specific to news use and news perceptions of three media outlets: the Minneapolis Star-Tribune, the St. Paul Pioneer Press, and WCCO-TV news. Race played an important role in predicting credibility perceptions, but news use did not. Specifically, being Black (or not) played a stronger role than being White (or not) in predicting credibility perceptions of news coverage of Blacks and credibility perceptions of news coverage of Whites. In addition, Blacks viewed news coverage of Blacks as being less credible than did non-Blacks, and Blacks viewed news coverage of Whites as being more credible than did non-Blacks.

Contamination of Retail Foods, Particularly Turkey, from Community Markets (Minnesota, 1999–2000) with Antimicrobial-Resistant and Extraintestinal PathogenicEscherichia coli

To assess the food supply as a possible vehicle for antimicrobial-resistant and extraintestinal pathogenic Escherichia coli (ExPEC), we defined the prevalence, density, clonal diversity, virulence characteristics, and antimicrobial resistance profiles of E. coli among diverse retail food items. A microbiological survey was undertaken of 346 food items (vegetables, produce, beef, pork, chicken, and turkey) purchased as a convenience sample from 16 retail markets within the Minneapolis-St. Paul area in 1999-2000, with selective cultures for E. coli and extensive molecular and phenotypic characterization of E. coli isolates. Meats, particularly turkey products, were often extensively contaminated with antimicrobial-resistant E. coli and ExPEC, to a much greater extent than were produce items, even those from farmer's markets. Moreover, meat-source E. coli differed substantially from produce-source E. coli with respect to phylogenetic background (more commonly from virulence-associated phylogenetic groups B2 or D), virulence genotype (more extensive), and antimicrobial resistance profile (more extensive). Molecular typing methods matched four turkey-source isolates to selected human clinical and fecal isolates representing the O7:K1:H-, O83:K1, and O73/O77:K52:H18 ("clonal group A") clonal groups of ExPEC. Meats purchased in grocery stores, particularly turkey products, are frequently contaminated with antimicrobial-resistant E. coli and ExPEC. Further study is needed regarding the origins and health consequences of these foodborne organisms, both to clarify the need for and to guide the possible development of appropriate regulatory and monitoring systems and preventive interventions.

Antimicrobial‐Resistant and Extraintestinal PathogenicEscherichia coliin Retail Foods

Extraintestinal Escherichia coli infections are associated with specialized extraintestinal pathogenic E. coli (ExPEC) strains and, increasingly, with antimicrobial resistance. The food supply may disseminate ExPEC and antimicrobial-resistant E. coli. In a prospective survey of 1648 diverse food items from 10 retail markets in the Minneapolis-St. Paul area during 2001-2003, selective cultures and disk-diffusion assays for the isolation and characterization of antimicrobial-resistant E. coli and polymerase chain reaction-based assays and O serotyping to define ExPEC-associated traits were performed. E. coli contamination exhibited a prevalence gradient from miscellaneous foods (9%), through beef or pork (69%), to poultry (92%; P<.001). Among E. coli-positive samples, similar prevalence gradients were detected for antimicrobial resistance (27%, 85%, and 94% of samples, respectively; P<.001) and ExPEC contamination (4%, 19%, and 46%, respectively; P<.001). By multivariate analysis, beef or pork and poultry from natural-food stores exhibited reduced risks of E. coli contamination and antimicrobial resistance. Indirect evidence suggested on-farm selection of resistance. Four food-source ExPEC isolates (from pea pods, turkey parts, ground pork, and vegetable dip) closely resembled selected human clinical isolates by O antigen and genomic profile. Retail foods may be an important vehicle for community-wide dissemination of antimicrobial-resistant E. coli and ExPEC, which may represent a newly recognized group of medically significant foodborne pathogens.

Pharmacy-Related Health Disparities Experienced by Non–English-Speaking Patients: Impact of Pharmaceutical Care

To identify the availability of foreign language services in pharmacies near a medical clinic serving a large immigrant population and determine whether the type of observed drug therapy problems differed between English- and non-English-speaking patients at this clinic. A community health care center in a diverse neighborhood of Minneapolis, Minnesota. 40 pharmacies near the clinic and in the surrounding Minneapolis-St. Paul area known to provide services to patients in languages in addition to English and 91 clinic patients, including 38 for whom English was not their primary language, seen for full pharmaceutical care assessments. Comprehensive drug therapy assessments were conducted for English- and non-English-speaking patients (with assistance from interpreters) in a primary care setting secondary to physician referral. Patient-specific data and the results of the pharmacist's assessment were recorded in a patient management database. Language services provided by area pharmacies, frequency of drug therapy problems in English- and non-English-speaking patients, and the status of patient's medication conditions before and after provision of pharmaceutical care. Of the six primary languages other than English (Vietnamese, Hmong, Laotian, Somali, Spanish, and Cambodian) spoken by clinic patients, written or verbal information was available for five languages in one or more area pharmacies. The clinic pharmacist completed comprehensive assessments for 91 patients via 230 patient encounters, identifying 186 drug therapy problems. Problems related to adherence were significantly more prevalent in non-English-speaking patients compared with English-speaking patients (31% versus 12%). In all 91 patients, the percentage achieving desired drug therapy outcomes improved by 24% after a pharmacist joined the team of clinic providers. Despite the availability of clinic-based interpreters and foreign language services in pharmacies, adherence-related problems are significantly more common in non-English-speaking patients. Pharmacists committed to providing pharmaceutical care must consider the impact of language barriers when working to optimize drug therapy outcomes.

Minnesota's New Ramp Control Strategy: Design Overview and Preliminary Assessment

Freeway ramp control has been successfully implemented in the Minneapolis-St. Paul area since the early 1970s. However, the recent ramp metering controversy highlighted the need for a less restrictive ramp control strategy that maximizes freeway capacity utilization while limiting ramp wait times. As a result, a new multilayer ramp control strategy called stratified ramp control was recently developed and deployed systemwide in the Twin Cities metropolitan area. This strategy determines the metering rates from freeway conditions as well as from real-time ramp demand and ramp queue size, indicating a shift of emphasis away from freeway flow toward the balance between both freeway efficiency and reduced ramp delays. Minnesota's new ramp control strategy is detailed along with a preliminary assessment of its effectiveness. The evaluation is accomplished by comparing the new strategy to its predecessor, ZONE metering, through rigorous micro-simulation. The preliminary results suggest that the stratified ramp control strategy is effective in reducing ramp delays and limiting ramp wait times below the prescribed value. However, peak-hour freeway congestion is extended in both time and space as opposed to that with the ZONE metering strategy and reveals a compromised freeway performance in favor of virtually reducing ramp delays.

Isolation and molecular characterization of nalidixic acid-resistant extraintestinal pathogenic Escherichia coli from retail chicken products.

Fluoroquinolone use in poultry production may select for resistant Escherichia coli that can be transmitted to humans. To define the prevalence and virulence potential of poultry-associated, quinolone-resistant E. coli in the United States, 169 retail chicken products from the Minneapolis-St. Paul area (1999 to 2000) were screened for nalidixic acid (Nal)-resistant E. coli. Sixty-two (37%) products yielded Nal-resistant E. coli. From 55 products that yielded both Nal-resistant and susceptible E. coli, two isolates (one resistant, one susceptible) per sample were further characterized. Twenty-three (21%) of the 110 E. coli isolates (13 resistant, 10 susceptible) satisfied criteria for extraintestinal pathogenic E. coli (ExPEC), i.e., exhibited >or=2 of pap (P fimbriae), sfa/foc (S/F1C fimbriae), afa/dra (Dr binding adhesins), iutA (aerobactin receptor), and kpsMT II (group 2 capsule synthesis). Compared with other isolates, ExPEC isolates more often derived from virulence-associated E. coli phylogenetic groups B2 or D (74% versus 32%; P < 0.001) and exhibited more ExPEC-associated virulence markers (median, 10.0 versus 4.0; P < 0.001). In contrast, the Nal-resistant and -susceptible populations were indistinguishable according to all characteristics analyzed, including pulsed-field gel electrophoresis profiles. These findings indicate that Nal-resistant E. coli is prevalent in retail poultry products and that a substantial minority of such strains represent potential human pathogens. The similarity of the Nal-resistant and -susceptible populations suggests that they derive from the same source population, presumably the avian fecal flora, with Nal resistance emerging by spontaneous mutation as a result of fluoroquinolone exposure.