Efficacy of Early Intervention for Infants With Cerebral Palsy in an LMIC: An RCT.

OBJECTIVE: To test efficacy of a parent-delivered multidomain early intervention (Learning through Everyday Activities with Parents [LEAP-CP]) for infants with cerebral palsy (CP) compared with equal-dose of health advice (HA), on (1) infant development; and (2) caregiver mental health. It was hypothesized that infants receiving LEAP-CP would have better motor function, and caregivers better mental health. METHODS: This was a multisite single-blind randomized control trial of infants aged 12 to 40 weeks corrected age (CA) at risk for CP (General Movements or Hammersmith Infant Neurologic Examination). Both LEAP-CP and HA groups received 15 fortnightly home-visits by a peer trainer. LEAP-CP is a multidomain active goal-directed intervention. HA is based on Key Family Practices, World Health Organization. Primary outcomes: (1) infants at 18 months CA: Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT mobility); and (2) caregiver: Depression Anxiety and Stress Scale. RESULTS: Of eligible infants, 153 of 165 (92.7%) were recruited (86 males, mean age 7.1±2.7 months CA, Gross Motor Function Classification System at 18 m CA: I = 12, II = 25, III = 9, IV = 18, V = 32). Final data were available for 118 (77.1%). Primary (PEDI-CAT mobility mean difference = 0.8 (95% CI -1.9 to 3.6) P = .54) and secondary outcomes were similar between-groups. Modified-Intention-To-Treat analysis on n = 96 infants with confirmed CP showed Gross Motor Function Classification System I and IIs allocated to LEAP-CP had significantly better scores on PEDI-CAT mobility domain (mean difference 4.0 (95% CI = 1.4 to 6.5), P = .003) compared with HA. CONCLUSIONS: Although there was no overall effect of LEAP-CP compared with dose-matched HA, LEAP-CP lead to superior improvements in motor skills in ambulant children with CP, consistent with what is known about targeted goal-directed training.

Adsorptive remediation of aqueous inorganic mercury with surfactant enhanced bismuth sulfide nanoparticles.

Heavy metal contamination in water is a growing threat, endangering the environmental stability. Mercury (Hg) is one of the most lethal heavy metals damaging the immune and nervous system irreversibly. A novel synthetic route to prepare bismuth sulfide (Bi2S3) nanoparticles in presence of the surfactant Pluronic (P123) was illustrated in this work. The sorption of Hg (II) by the nanoparticles was investigated. The surfactant assisted nanoparticles showed enhanced surface area and potential compared to the unmodified ones. The effects of adsorbent dose, pH, initial concentration, and temperature were investigated. The maximum Hg (II) adsorption capacity for the surfactant enhanced Bi2S3 was 832 mg/g at 303 K and pH 5. The distribution coefficient (Kd) of the order ∼106 ml/g indicated high selectivity of the synthesized adsorbent toward mercury ions. Chemisorption was identified to be the dominant mechanism of adsorption. The adsorbent also showed excellent reusability (>95%) after 5 cycles. The transport parameters involved in the adsorption, the effective pore diffusivity (Dp: 7.36 × 10-12 m2/s) and the mass transfer coefficient (kf: 1.52 × 10-6 m/s) were estimated from a first principle-based model.