A preoperative package of care for osteoarthritis, consisting of weight loss, orthotics, rehabilitation, and topical and oral analgesia (OPPORTUNITY): a two-centre, open-label, randomised controlled feasibility trial.

BACKGROUND: Osteoarthritis of the knee is a major cause of disability worldwide. Non-operative treatments can reduce the morbidity but adherence is poor. We hypothesised that adherence could be optimised if behavioural change was established in the preoperative period. Therefore, we aimed to assess feasibility, acceptability, and recruitment and retention rates of a preoperative package of non-operative care in patients awaiting knee replacement surgery. METHODS: We did an open-label, randomised controlled, feasibility trial in two secondary care centres in the UK. Eligible participants were aged 15-85 years, on the waiting list for a knee arthroplasty for osteoarthritis, and met at least one of the thresholds for one of the four components of the preoperative package of non-operative care intervention (ie, weight loss, exercise therapy, use of insoles, and analgesia adjustment). Participants were randomly assigned (2:1) to either the intervention group or the standard of care (ie, control) group. All four aspects of the intervention were delivered weekly over 12 weeks. Participants in the intervention group were reviewed regularly to assess adherence. The primary outcome was acceptability and feasibility of delivering the intervention, as measured by recruitment rate, retention rate at follow-up review after planned surgery, health-related quality of life, joint-specific scores, and adherence (weight change and qualitative interviews). This study is registered with ISRCTN, ISRCTN96684272. FINDINGS: Between Sept 3 2018, and Aug 30, 2019, we screened 233 patients, of whom 163 (73%) were excluded and 60 (27%) were randomly assigned to either the intervention group (n=40) or the control group (n=20). 34 (57%) of 60 participants were women, 26 (43%) were men, and the mean age was 66·8 years (SD 8·6). Uptake of the specific intervention components varied: 31 (78%) of 40 had exercise therapy, 28 (70%) weight loss, 22 (55%) analgesia adjustment, and insoles (18 [45%]). Overall median adherence was 94% (IQR 79·5-100). At the final review, the intervention group lost a mean of 11·2 kg (SD 5·6) compared with 1·3 kg (3·8) in the control group (estimated difference -9·8 kg [95% CI -13·4 to -6·3]). A clinically significant improvement in health-related quality o life (mean change 0·078 [SD 0·195]) were reported, and joint-specific scores showed greater improvement in the intervention group than in the control group. No adverse events attributable to the intervention occurred. INTERPRETATION: Participants adhered well to the non-operative interventions and their health-related quality of life improved. Participant and health professional feedback were extremely positive. These findings support progression to a full-scale effectiveness trial. FUNDING: Versus Arthritis.

The Lived Experiences of Female Relatives of Child Sexual Abuse Material (CSAM) Offenders in Ireland and the United Kingdom.

There is a limited understanding about how an association with those that download Child Sexual Abuse Material (CSAM), a highly stigmatized crime, impacts the lives of their innocent family members. Non-offending family members are often considered a valuable protective resource for offender desistance and in safeguarding children from abuse. Therefore, the present study aimed to explore the lived experiences of female family members of CSAM offenders in Ireland and the United Kingdom to both identify and target areas for intervention thus ameliorating their ability to protect. A qualitative research design was adopted, and data analyzed via reflexive thematic analysis. Fifteen individuals self-selected for participation and interviews resulted in the identification of three key themes: Shattered Worldview, The Injured Self; Contamination by Association. The analysis highlighted how non-offending family members experienced considerable shame, trauma, and stigma with consequences that reached into every aspect of their lives. The findings are discussed in the context of the limited available literature along with research implications and recommendations for both policy and practice.

Feasibility of comparing medical management and surgery (with neurosurgery or stereotactic radiosurgery) with medical management alone in people with symptomatic brain cavernoma - protocol for the Cavernomas: A Randomised Effectiveness (CARE) pilot trial.

INTRODUCTION: The top research priority for cavernoma, identified by a James Lind Alliance Priority setting partnership was 'Does treatment (with neurosurgery or stereotactic radiosurgery) or no treatment improve outcome for people diagnosed with a cavernoma?' This pilot randomised controlled trial (RCT) aims to determine the feasibility of answering this question in a main phase RCT. METHODS AND ANALYSIS: We will perform a pilot phase, parallel group, pragmatic RCT involving approximately 60 children or adults with mental capacity, resident in the UK or Ireland, with an unresected symptomatic brain cavernoma. Participants will be randomised by web-based randomisation 1:1 to treatment with medical management and with surgery (neurosurgery or stereotactic radiosurgery) versus medical management alone, stratified by prerandomisation preference for type of surgery. In addition to 13 feasibility outcomes, the primary clinical outcome is symptomatic intracranial haemorrhage or new persistent/progressive focal neurological deficit measured at 6 monthly intervals. An integrated QuinteT Recruitment Intervention (QRI) evaluates screening logs, audio recordings of recruitment discussions, and interviews with recruiters and patients/parents/carers to identify and address barriers to participation. A Patient Advisory Group has codesigned the study and will oversee its progress. ETHICS AND DISSEMINATION: This study was approved by the Yorkshire and The Humber-Leeds East Research Ethics Committee (21/YH/0046). We will submit manuscripts to peer-reviewed journals, describing the findings of the QRI and the Cavernomas: A Randomised Evaluation (CARE) pilot trial. We will present at national specialty meetings. We will disseminate a plain English summary of the findings of the CARE pilot trial to participants and public audiences with input from, and acknowledgement of, the Patient Advisory Group. TRIAL REGISTRATION NUMBER: ISRCTN41647111.

On Cultural Differences of Heroes: Evidence From Individualistic and Collectivistic Cultures.

Building on earlier research that examined the characteristics people associate with heroes, our research examined similarities and differences of the hero stereotype across cultures. Specifically, in Study 1 (N = 209) and Study 2 (N = 298), we investigated lay perceptions of heroes among participants from a collectivistic culture. In Study 3 (N = 586), we examined whether group membership could be determined by participants' centrality ratings of the combined set of hero features. In Study 4 (N = 197), we tested whether the hero features that distinguish American and Chinese participants, when used to describe a target person, influence the impression that the target person is a hero. In Study 5 (N = 158) and Study 6 (N = 591), we investigated cultural differences in perceptions of different types of heroes (e.g., social, martial, civil) and the influence of individualism and collectivism on the perception of those heroes.

In it together?: Exploring solidarity with frontline workers in the United Kingdom and Ireland during COVID-19.

The phrase 'in it together' has been used liberally since the outbreak of COVID-19, but the extent that frontline workers felt 'in it together' is not well understood. Here, we consider the factors that built (or eroded) solidarity while working through the pandemic, and how frontline workers navigated their lives through periods of disconnection. Semi-structured interviews with 21 frontline workers, across all sectors, were conducted in the United Kingdom and Ireland. The qualitative data were analysed systematically using reflexive thematic analysis. The three themes identified in the data were: (1) Solidarity as central to frontline experiences; (2) Leadership as absent, shallow and divisive: highlighting 'us-them' distinctions and (3) The rise of 'us' and 'we' among colleagues. Our research offers insights into how frontline workers make sense of their experiences of solidarity and discordance during the first year of the COVID-19 pandemic, with relevance for government and organizational policy-makers shaping future conditions for frontline workers.

Solidarity appraisal, meaning, and markers of welfare in frontline workers in the UK and Ireland during the Covid-19 pandemic.

Throughout the Covid-19 pandemic, frontline workers have carried out essential roles to keep society going, while the public have been called to minimise the infection rate to limit the burden on frontline workers. In this sense, navigating Covid-19 has necessitated interdependence between frontline workers and key stakeholder groups (such as their colleagues, organisations, their government, and the public). Reports suggest that frontline workers have perceived varying degrees of solidarity with others throughout the pandemic, yet the influence of perceived solidarity on psychological welfare has received limited empirical or theoretical attention. The aim of the present study was to test the importance of perceived solidarity (or solidarity appraisal) by assessing the relationship between perceptions of solidarity and psychological welfare in frontline workers - across all sectors - during Covid-19, and explore the role of a potential mechanism (i.e., meaning in life) for explaining this relationship. To assess this proposed model, we used cross-sectional and longitudinal data from a project tracking a cohort of frontline workers in the UK and Ireland since March 2020. Participants were surveyed at baseline (T1), at six months (T2), and 12 months (T3). At T3, participants (N â€‹= â€‹414) reported their perceived solidarity (with colleagues, organisations, government, and public) along with a range of psychological welfare measures. Overall, frontline workers' levels of meaning in life dropped significantly over time. Lower levels of perceived solidarity were predictive of poorer wellbeing, and higher anxiety, burnout, post-traumatic stress symptoms, and somatic stress symptoms, and these relationships were mediated by the presence of meaning in life. These findings suggest that perceived solidarity with interdependent social groups may imbue life with meaning, which can in turn have a positive influence on psychological welfare in chronic and cumulatively stressful occupational settings.

New group memberships formed after an acquired brain injury and posttraumatic growth: A prospective study.

Predicting positive psychosocial outcomes following an Acquired Brain Injury (ABI) remains a challenge. Considerable research demonstrates that social group memberships can have positive effects on psychological well-being, particularly during life transitions. Social group memberships are argued to help people derive a sense of self. This prospective study examined if social group memberships (number of groups and connectedness with groups) could predict posttraumatic growth (PTG) in those affected by ABI. Thirty-six participants (10 females, Mage = 46.56, SD = 11.46) engaged in community rehabilitation services completed measures at two time-points. Mediation analyses demonstrated that the number of new group memberships (groups formed post-injury) predicted greater PTG at time 2, via stronger connectedness with these new group memberships (controlling for initial PTG). The observed results suggest that a focus on developing and strengthening connections with new group memberships may promote positive adjustment after brain injury.

Moral Judgment as Categorization (MJAC).

Observed variability and complexity of judgments of "right" and "wrong" cannot be readily accounted for within extant approaches to understanding moral judgment. In response to this challenge, we present a novel perspective on categorization in moral judgment. Moral judgment as categorization (MJAC) incorporates principles of category formation research while addressing key challenges of existing approaches to moral judgment. People develop skills in making context-relevant categorizations. They learn that various objects (events, behaviors, people, etc.) can be categorized as morally right or wrong. Repetition and rehearsal result in reliable, habitualized categorizations. According to this skill-formation account of moral categorization, the learning and the habitualization of the forming of moral categories occur within goal-directed activity that is sensitive to various contextual influences. By allowing for the complexity of moral judgments, MJAC offers greater explanatory power than existing approaches while also providing opportunities for a diverse range of new research questions.

"We shouldn't waste a good crisis": the lived experience of working on the frontline through the first surge (and beyond) of COVID-19 in the UK and Ireland.

OBJECTIVE: Frontline workers have shown extraordinary resilience and sustained efforts since the outbreak of COVID-19. The present study used semi-structured interviews with 38 frontline workers in the UK and Ireland to explore the psychological impact of working through COVID-19. DESIGN: The qualitative data were analysed systematically using thematic analysis. RESULTS: Four themes were interpreted: 1)) "I've stopped turning the telly on. I've had to because the news was making me ill": An ecosystem of influence; 2) "Dead, dead, dead": The emotional and psychological toll: 3) "It's shone a light on what we're failing on as well": Injustices, hierarchies and heroes: and 4) "I definitely think COVID happened for a reason to stop us in our tracks and to slow us down": Unexpected positives. CONCLUSION: This research offers insights into how frontline workers make sense of their experiences during periods of enormous societal and occupational stress. The learnings generated have relevance for government and organisational policy-makers who have opportunities to shape future conditions for frontline workers.

High ideals: the misappropriation and reappropriation of the heroic label in the midst of a global pandemic.

The purpose of this article is to offer an alternative, more nuanced analysis of the labelling of frontline workers as heroes than originally proposed. Here, we argue that the hero narrative in itself need not be problematic, but highlight a number of wider factors that have led to the initial rise (and subsequent fall) in support for labelling frontline workers as heroes. Through our related work, we have gathered similar stories from frontline workers where they feel betrayed, let down or otherwise short-changed by the hero label, and we have sought to make sense of this through understanding more about how the hero label is used rather than what it means. In this article, we propose a way forward where there is greater discussion around the hero label in this context where individuals can be heroes but still struggle, still fail and still feel vulnerable, and where heroism is viewed as a state of interdependence between heroic actor and the wider group. It is true that heroes can inspire, lead, guide and build morale and camaraderie, but collective responsibility is held with us all. We can draw hope and energy from our heroes, but we must dig deep and be proactive, particularly in the face of adversity. In doing so, we support the heroes to lead from the front and ensure that even though we cannot physically help; we are not making their situation worse.

"It's Like a Kick in the Teeth": The Emergence of Novel Predictors of Burnout in Frontline Workers During Covid-19.

The context of Covid-19 has offered an unusual cultural landscape for examining how workers view their own position relative to others, and how individuals respond to prolonged exposure to workplace stress across different sectors and cultures. Through our recent work tracking the well-being of frontline workers in the UK and Ireland (the CV19 Heroes project), we have uncovered additional psychological factors that have not been accounted for in previous models of occupational stress or burnout. In recent months, frontline workers have worked to protect the community from the threat of SARS-CoV-2 and, simultaneously, have evaluated their perceptions of collective efforts of others as either congruent or incongruent with collective goals (e.g., lowered mortality and morbidity): we call this novel aspect solidarity appraisal. These frontline workers have been hailed as heroes, which we argue has led to the creation of an implicit psychological contract (the hero contract) between frontline workers and the public. Here, the heroes are willing to "go above and beyond" for the greater good, with the expectation that we (the public) do our part by adhering to public health guidelines. Where frontline workers perceive incongruence between the words and actions of others in working toward collective goals this drives negative affect and subsequent burnout. In this perspective article, we evaluate the cultural context of the pandemic in the UK and Ireland and suggest important socio-cultural factors that contribute to perceptions of solidarity, and how this may relate to burnout and worker welfare during and beyond the pandemic context.

Ubiquitin-protein ligase Ubr5 cooperates with hedgehog signalling to promote skeletal tissue homeostasis.

Mammalian Hedgehog (HH) signalling pathway plays an essential role in tissue homeostasis and its deregulation is linked to rheumatological disorders. UBR5 is the mammalian homologue of the E3 ubiquitin-protein ligase Hyd, a negative regulator of the Hh-pathway in Drosophila. To investigate a possible role of UBR5 in regulation of the musculoskeletal system through modulation of mammalian HH signaling, we created a mouse model for specific loss of Ubr5 function in limb bud mesenchyme. Our findings revealed a role for UBR5 in maintaining cartilage homeostasis and suppressing metaplasia. Ubr5 loss of function resulted in progressive and dramatic articular cartilage degradation, enlarged, abnormally shaped sesamoid bones and extensive heterotopic tissue metaplasia linked to calcification of tendons and ossification of synovium. Genetic suppression of smoothened (Smo), a key mediator of HH signalling, dramatically enhanced the Ubr5 mutant phenotype. Analysis of HH signalling in both mouse and cell model systems revealed that loss of Ubr5 stimulated canonical HH-signalling while also increasing PKA activity. In addition, human osteoarthritic samples revealed similar correlations between UBR5 expression, canonical HH signalling and PKA activity markers. Our studies identified a crucial function for the Ubr5 gene in the maintenance of skeletal tissue homeostasis and an unexpected mode of regulation of the HH signalling pathway.

The breaking bad effect: Priming with an antihero increases sensation seeking.

Antiheroes are characters that share features with both heroes and villains, typified as selfish and rule breakers, but who end up doing something good for society. In this research, we examined how priming people with antiheroes (vs. heroes) affected their sensation seeking. We reason that antiheroes (vs. heroes) are more associated with temporally close (vs. past and future) events. Given that sensation seeking is related to being focused on the present (vs. past or future), we hypothesized that if people are primed with antiheroes (vs. heroes) they are more likely to seek sensation. Findings from a series of five experimental studies provide insights into the effect of priming with an antihero on people's sensation seeking, providing directions for future research in psychology and practical applications in the areas of marketing strategy and consumer behaviour.

Benefits of heroes to coping with mortality threats by providing perceptions of personal power and reducing unhealthy compensatory consumption.

Mortality threats are among the strongest psychological threats that an individual can encounter. Previous research shows that mortality threats lead people to engage in unhealthy compensatory consumption (i.e., overeating), as a maladaptive coping response to threat. In this paper, we propose that reminders of heroes when experiencing mortality threat increases perceptions of personal power, which in turn buffers the need to engage in unhealthy compensatory consumption. We test and find support for our predictions in a series of four studies that include real-world Twitter data after a series of terrorist attacks in 2016-2017, and three experimental studies conducted online and in the field with behavioral measures after Day of the Dead and during COVID-19 pandemic. These findings advance the literature on compensatory consumption, mortality threats, and the psychological functions of heroes.

Correction to: Osteoarthritis Preoperative Package for care of Orthotics, Rehabilitation, Topical and oral agent Usage and Nutrition to Improve ouTcomes at a Year (OPPORTUNITY); a feasibility study protocol for a randomised controlled trial.

After publication of our article [1] we have been notified that two of the author names have been mistakenly removed from the authorship list: Colin R. Howie and Nicholas D. Clement.

Osteoarthritis Preoperative Package for care of Orthotics, Rehabilitation, Topical and oral agent Usage and Nutrition to Improve ouTcomes at a Year (OPPORTUNITY); a feasibility study protocol for a randomised controlled trial.

BACKGROUND: Patients' pre-operative health and physical function is known to influence their post-operative outcomes. In patients with knee osteoarthritis, pharmacological and non-pharmacological options are often not optimised prior to joint replacement. This results in some patients undergoing surgery when they are not as fit as they could be. The aim of this study is to assess the feasibility and acceptability of a pre-operative package of non-operative care versus standard care prior to joint replacement. METHODS/DESIGN: This is a multicentre, randomised controlled feasibility trial of patients undergoing primary total knee replacement for osteoarthritis. Sixty patients will be recruited and randomised (2:1) to intervention or standard care arms. Data will be collected at baseline (before the start of the intervention), around the end of the intervention period and a minimum of 90 days after the planned date of surgery. Adherence will be reviewed each week during the intervention period (by telephone or in person). Participants will be randomised to a pre-operative package of non-operative care or standard care. The non-operative care will consist of (1) a weight-loss programme, (2) a set of exercises, (3) provision of advice on analgesia use and (4) provision of insoles. The intervention will be started as soon as possible after patients have been added to the waiting list for joint replacement surgery to take advantage of the incentive for behavioural change that this will create. The primary outcomes of this study are feasibility outcomes which will indicate whether the intervention and study protocol is feasible and acceptable and whether a full-scale effectiveness trial is warranted. The following will be measured and used to inform study feasibility: rate of recruitment, rate of retention at 90-day follow-up review after planned surgery date, and adherence to the intervention estimated through review questionnaires and weight change (for those receiving the weight-loss aspect of intervention). In addition the following information will be assessed qualitatively: analysis of qualitative interviews exploring acceptability, feasibility, adherence and possible barriers to implementing the intervention, and acceptability of the different outcome measures. DISCUSSION: The aims of the study specifically relate to testing the feasibility and acceptability of the proposed effectiveness trial intervention and the feasibility of the trial methods. This study forms the important first step in developing and assessing whether the intervention has the potential to be assessed in a future fully powered effectiveness trial. The findings will also be used to refine the design of the effectiveness trial. TRIAL REGISTRATION: ISRCTN registry, ID: ISRCTN96684272. Registered on 18 April 2018.

Grace Under Pressure: Resilience, Burnout, and Wellbeing in Frontline Workers in the United Kingdom and Republic of Ireland During the SARS-CoV-2 Pandemic.

The coronavirus pandemic has necessitated extraordinary human resilience in order to preserve and prolong life and social order. Risks to health and even life are being confronted by workers in health and social care, as well as those in roles previously never defined as "frontline," such as individuals working in community supply chain sectors. The strategy adopted by the United Kingdom (UK) government in facing the challenges of the pandemic was markedly different from other countries. The present study set out to examine what variables were associated with resilience, burnout, and wellbeing in all sectors of frontline workers, and whether or not these differed between the UK and Republic of Ireland (RoI). Individuals were eligible if they were a frontline worker (in health and social care, community supply chain, or other emergency services) in the UK or RoI during the pandemic. Part of a larger, longitudinal study, the participants completed an online survey to assess various aspects of their daily and working lives, along with their attitudes toward their government's handling of the crisis, and measurement of psychological variables associated with heroism (altruism, meaning in life, and resilient coping). A total of 1,305 participants (N = 869, 66.6% from the UK) provided sufficient data for analysis. UK-based workers reported lower wellbeing than the RoI-based participants. In multivariate models, both psychological and pandemic-related variables were associated with levels of resilience, burnout, and wellbeing in these workers, but which pandemic-related variables were associated with outcomes differed depending on the country. The judgment of lower timeliness in their government's response to the pandemic appeared to be a key driver of each outcome for the UK-based frontline workers. These findings provide initial evidence that the different strategies adopted by each country may be associated with the overall wellbeing of frontline workers, with higher detriment observed in the UK. The judgment of the relatively slow response of the UK government to instigate their pandemic measures appears to be associated with lower resilience, higher burnout, and lower wellbeing in frontline workers in the UK.

Collective influences on individual functioning: Multiple group memberships, self-regulation, and depression after acquired brain injury.

A growing body of research demonstrates the role that social groups play in protecting health and well-being in the context of adjusting to acquired brain injury (ABI). However, the psychological processes that underpin this relationship are less well understood. The present research extends this work by testing a theoretically derived model about the role of multiple social group belonging in contributing to improved self-regulation and depression symptoms. A cross sectional survey was conducted involving 50 adults with ABI (Mage = 45 years, SD = 12.10; range 22-67 years) who completed a series of self-report measures indexing social group membership, self-regulation, and depression. Support for the predicted model was found with mediation analysis showing that multiple group belonging predicted lowered depression symptoms, by providing a basis for enhancing self-regulation. The findings suggest that belonging to multiple groups provides individuals with multiple opportunities for social interaction with which to trial and develop self-regulatory skills, which, in turn, has a positive influence on depression.

On the Existential Road From Regret to Heroism: Searching for Meaning in Life.

We investigated whether regret predicted the motivation to act heroically. In a series of studies, we examined the relationship between regret, search for meaning in life, and heroism motivation. First, Study 1 (a and b) investigated the association between regret and search for meaning in life, considering regret as a whole, action regret, and inaction regret. As expected, regret correlated positively with search for meaning in life. In two additional studies (Study 2 and 3), we examined whether regret predicted heroism motivation and whether this effect was mediated through search for meaning in life. Study 2 confirmed this hypothesis for individual differences in regret, using a correlational design. Study 3 confirmed the hypothesis for temporary experiences of regret, using an experimental design. In addition, in Study 3 we found that heroism motivation was stronger for people with high self-enhancement needs than for those with lower self-enhancement needs. We discuss the relationship between regret and heroism in light of these results and explore their implications.