Facilitating return to work through early specialist health-based interventions (FRESH): protocol for a feasibility randomised controlled trial

Background Over one million people sustain traumatic brain injury each year in the UK and more than 10 % of these are moderate or severe injuries, resulting in cognitive and psychological problems that affect the ability to work. Returning to work is a primary rehabilitation goal but fewer than half of traumatic brain injury survivors achieve this. Work is a recognised health service outcome, yet UK service provision varies widely and there is little robust evidence to inform rehabilitation practice. A single-centre cohort comparison suggested better work outcomes may be achieved through early occupational therapy targeted at job retention. This study aims to determine whether this intervention can be delivered in three new trauma centres and to conduct a feasibility, randomised controlled trial to determine whether its effects and cost effectiveness can be measured to inform a definitive trial. Methods/design Mixed methods study, including feasibility randomised controlled trial, embedded qualitative studies and feasibility economic evaluation will recruit 102 people with traumatic brain injury and their nominated carers from three English UK National Health Service (NHS) trauma centres. Participants will be randomised to receive either usual NHS rehabilitation or usual rehabilitation plus early specialist traumatic brain injury vocational rehabilitation delivered by an occupational therapist. The primary objective is to assess the feasibility of conducting a definitive trial; secondary objectives include measurement of protocol integrity (inclusion/exclusion criteria, intervention adherence, reasons for non-adherence) recruitment rate, the proportion of eligible patients recruited, reasons for non-recruitment, spectrum of TBI severity, proportion of and reasons for loss to follow-up, completeness of data collection, gains in face-to-face Vs postal data collection and the most appropriate methods of measuring primary outcomes (return to work, retention) to determine the sample size for a larger trial. Discussion To our knowledge, this is the first feasibility randomised controlled trial of a vocational rehabilitation health intervention specific to traumatic brain injury. The results will inform the design of a definitive trial

The structural and hydration properties of heat-treated rice studied at multiple lenght scales

The impact of heat-treatment on structure and hydration properties of rice was studied at different length scales (µm–nm). Heat-treatment introduced micro- and macro-pores within rice kernels (µCT) and, within intact cell walls, disintegrated starch granules were observed (SEM, CSLM). In native kernels starch predominantly occurred as crystalline A-type starch and, upon heat treatment, amorphous and V-type starch appeared (XRD, 13C CP MAS NMR). Plasticization of amorphous starch by water was more pronounced for heat-treated than for native kernels (13C SPE MAS NMR). Within native kernels, more effective spin diffusion between water and starch chains was present (WISE-Exchange), confirming the inter-helical nanoscale order of amylose helices. Upon heat-treatment, this inter-helical nanoscale order was lost, as well as microscale granular compartmentalisation (TD NMR). These findings explain why, upon heat-treatment, vapour sorption is lower and starch is more prone to gelatinization (DSC)

The structural and hydration properties of heat-treated rice studied at multiple lenght scales

The impact of heat-treatment on structure and hydration properties of rice was studied at different length scales (µm–nm). Heat-treatment introduced micro- and macro-pores within rice kernels (µCT) and, within intact cell walls, disintegrated starch granules were observed (SEM, CSLM). In native kernels starch predominantly occurred as crystalline A-type starch and, upon heat treatment, amorphous and V-type starch appeared (XRD, 13C CP MAS NMR). Plasticization of amorphous starch by water was more pronounced for heat-treated than for native kernels (13C SPE MAS NMR). Within native kernels, more effective spin diffusion between water and starch chains was present (WISE-Exchange), confirming the inter-helical nanoscale order of amylose helices. Upon heat-treatment, this inter-helical nanoscale order was lost, as well as microscale granular compartmentalisation (TD NMR). These findings explain why, upon heat-treatment, vapour sorption is lower and starch is more prone to gelatinization (DSC)