Clinical assessment of extrapyramidal signs in nursing home patients given antipsychotic medication

BACKGROUND: We sought to quantify the relationship between antipsychotic drug use and clinical evidence of extrapyramidal dysfunction in a large population of elderly nursing home patients. METHODS: Subjects were 251 residents (mean age, 84.1 years; range, 65 to 105 years) who were taking psychoactive drugs in 12 long-term care facilities. Patient characteristics and all medication use (both scheduled and as needed) were measured during a 1-month observation period. We then performed neuropsychological and functional testing on residents who received any psychoactive medications during the study month. The presence of rigidity, bradykinesia, or masklike facies was assessed in each patient by a research assistant who was unaware of diagnoses and medication use. RESULTS: The parkinsonian signs studied were found in 127 (50.6%) of these residents. Using logistic regression modeling to adjust for potential confounding, we found this outcome to be increased more than threefold in patients who took low-potency neuroleptics (odds ratio [OR], 3.49 for > or = 50 mg/d of chlorpromazine-type drugs; 95% confidence interval [CI], 1.28 to 9.57) and more than sixfold for use of 1 mg/d or more of haloperidol (OR, 6.42; 95% CI, 2.16 to 19.04). Age, gender, and use of nonneuroleptic psychoactive drugs were not associated with an increase in parkinsonian signs. CONCLUSIONS: Clinical evidence of extrapyramidal dysfunction is three to six times more common in institutionalized elderly patients given antipsychotic medication than in comparable patients not using such drugs. Its risk is substantially increased even in patients given low-potency chlorpromazine-type drugs, as well as those taking haloperidol. The effect is not explained by age or mental status and is not seen with other psychoactive medications. The expected frequency of parkinsonian symptoms can help to inform the balancing of risks vs therapeutic effect when the use of all drugs in this class is considered.     

Performance relationships in PVC–plasticizer dry blending

The phenomenon of plasticizer acceptance by poly(vinyl chloride) (PVC) in hotprocess dry blending is examined via scanning electron microscopy, mercury intrusion porosimetry, and torque rheometer measurements. The effects of granule porosity, resin molecular weight, and synthesis recipe in PVC manufacture by the suspension process are related to the rate of plasticizer acceptance. For a PVC resin to dry blend, i.e., to become a free-flowing powder when mixed with plasticizer under hot-processing conditions, the resin granules must be porous. Porosity arises from interstices between primary PVC particles. At a given granule porosity, an increase in primary particle agglomeration adversely affects dry blend performance. At constant molecular weight and for resins manufactured by a given recipe, dry-blend performance is quantitatively described by granule porosity. With an increase in resin molecular weight, a greater granule porosity is required to maintain an equivalent dry-blend time (DBT). Accordingly, for most suspending agent recipes, DBT is dependent directly upon granule porosity and inversely upon molecular weight. However, if the suspending agent used in resin manufacture is an excessively rapid film former, dry-blend performance with molecular weight variation is dependent upon the suspending agent's concentration, not upon granule porosity, which must be adequate, nor upon the resin's molecular weight. An interfacial film-forming suspending agent enhances fusion of primary PVC particles at the suspension granule—water interface, increasing the granule's “pericellular membrane” thickness. This membrane, a PVC skin, does not significantly influence dry-blend performance with low- or intermediate-viscosity plasticizers. The particle skin does impede dry-blend rates with high-viscosity, poorly solvating plasticizers, but this effect can be negated in part by increasing the diameter of pore openings in the topographical skin. Dry blending occurs below the glass transition temperature (T_g) of PVC with low-viscosity plasticizers and above the T_g with high-viscosity, poorly solvating modifiers. The influence of resin and plasticizer variables indicates the dry-blend phenomenon to be a diffusion-controlled process. The rate of dry blending is dependent upon two mechanisms: (1) the rate of pore penetration—which exposes the plasticizer to a much greater surface area than if it remained exterior, encapsulating the granule—and (2) the rate of plasticizer diffusion into the PVC matrix.     

Introduction: In-Use,In-Situ: Extending Field Research Methods—Part 2

This study used protocol analyses and user drawings of their models of the system to investigate the “getting lost” problem in hypertext navigation. The “getting lost” problem is viewed as occurring when routine expectations of naive users, concerning appropriate linear sequences, are violated. Several ways in which users persistently attempt to work within a linear model, despite its inapplicability, are examined. The transition to more hierarchical user models is described.     

Water sorption and cooking time of red kidney beans (Phaseolus vulgaris L.): part I – Effect of freezing and drying conditions on water sorption and cooking time

Water sorption and cooking time of kidney beans were determined. The beans were manually harvested at 19.2 ± 0.1% moisture content and stored at ?20 and ?10 °C for about half a year. The beans were further dried at 30, 40 and 50 °C inside a thin‐layer drier for 7.5 h or under room conditions for 4 week. The freezing storage temperature before the beans were dried did not influence their cooking time and water sorption. The saturated kernel volumes decreased approximately 7% after drying. The beans decreased their sphericity during water sorption and had a larger swelling ratio in the thickness direction than in other directions. Lower initial moisture content, especially with a higher drying temperature, decreased water sorptivity and resulted in higher percentage of uncooked kernels if the beans were not soaked before cooking. However, there was no relationship between initial moisture content and uncooked percentage if the beans were soaked before cooking. High drying temperature resulted in hard‐to‐cook (HTC) phenomenon.     

Wheat-Legume Composite Flour Quality

Wheat-legume composite flours were produced by blending Canada Western Extra Strong (CWES) and Canada Western Red Spring (CWRS) wheat with varying amounts of three legume proteins. Legume protein addition produced breads with lower specific loaf volume, coarser crumb and firmer texture, and cooked white-salted noodles with greater compression stress and less cutting stress than the wheat controls. The CWES wheat compensated for the negative baking effects of the legume proteins as much as the CWRS wheat. End-use quality did not change at 2% soybean protein addition. Yellow pea protein produced the greatest quality changes, followed by chickpea and soybean protein.     

Multipliers for residue-number-arithmetic digital filters

A recently proposed residue-number-arithmetic digital filter offers major cost and speed advantages over binary-arithmetic digital filters, but suffers one major drawback. The filter coefficients must be constant, since the lack of a fast method of multiplication by a fraction in residue arithmetic requires the coefficients to be realised by a fixed table look-up read-only memory. Two multipliers are proposed which realise a completely general fractional multiply and are suitable for digital-filtering applications.