Adult age differences in noninstrumental information-seeking strategies.

We often seek information without any explicit incentives or goals (i.e., noninstrumental information seeking, often noted as a manifestation of curiosity). Does noninstrumental information-seeking change with age? We tried to answer the question by making a critical distinction between two information-seeking behaviors: diversive information seeking (i.e., information seeking for topics a person knows little about) and specific information seeking (i.e., information seeking to deepen a person's existing knowledge of a topic). Five hundred participants (age range: 12-79 years old) spontaneously read new facts about different topics. After reading each fact, participants were given the choice to read more facts about the current topic or return to the selection menu to learn about a new topic. We found that with increasing age, participants chose to explore more facts within a topic (i.e., increased specific information seeking) and switched less frequently to new topics (i.e., decreased diversive information seeking). These results indicate that while young people seek out a broader range of information, as people grow older, they develop a preference to deepen their existing knowledge. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The impact of the multi-disciplinary molecular tumour board and integrative next generation sequencing on clinical outcomes in advanced solid tumours.

Background: The integration of next-generation sequencing (NGS) comprehensive gene profiling (CGP) into clinical practice is playing an increasingly important role in oncology. Therefore, the HKU-HKSH Multi-disciplinary Molecular Tumour Board (MTB) was established to advance precision oncology in Hong Kong. A multicenter retrospective study investigated the feasibility of the HKU-HKSH MTB in determining genome-guided therapy for treatment-refractory solid cancers in Hong Kong. Methods: Patients who were presented at the HKU-HKSH MTB between August 2018 and June 2022 were included in this study. The primary study endpoints were the proportion of patients who receive MTB-guided therapy based on genomic analysis and overall survival (OS). Secondary endpoints included the proportion of patients with actionable genomic alterations, objective response rate (ORR), and disease control rate (DCR). The Kaplan-Meier method was used in the survival analyses, and hazard ratios were calculated using univariate Cox regression. Findings: 122 patients were reviewed at the HKU-HKSH MTB, and 63% (n = 77) adopted treatment per the MTB recommendations. These patients achieved a significantly longer median OS than those who did not receive MTB-guided therapy (12.7 months vs. 5.2 months, P = 0.0073). Their ORR and DCR were 29% and 65%, respectively. Interpretation: Our study demonstrated that among patients with heavily pre-treated advanced solid cancers, MTB-guided treatment could positively impact survival outcomes, thus illustrating the applicability of NGS CGPs in real-world clinical practice. Funding: The study was supported by the Li Shu Pui Medical Foundation. Dr Aya El Helali was supported by the Li Shu Pui Medical Foundation Fellowship grant from the Li Shu Pui Medical Foundation. Funders had no role in study design, data collection, data analysis, interpretation, or writing of the report.

Consensus Statements on Precision Oncology in the China Greater Bay Area.

BACKGROUND: Next-generation sequencing comprehensive genomic panels (NGS CGPs) have enabled the delivery of tailor-made therapeutic approaches to improve survival outcomes in patients with cancer. Within the China Greater Bay Area (GBA), territorial differences in clinical practices and health care systems and strengthening collaboration warrant a regional consensus to consolidate the development and integration of precision oncology (PO). Therefore, the Precision Oncology Working Group (POWG) formulated standardized principles for the clinical application of molecular profiling, interpretation of genomic alterations, and alignment of actionable mutations with sequence-directed therapy to deliver clinical services of excellence and evidence-based care to patients with cancer in the China GBA. METHODS: Thirty experts used a modified Delphi method. The evidence extracted to support the statements was graded according to the GRADE system and reported according to the Revised Standards for Quality Improvement Reporting Excellence guidelines, version 2.0. RESULTS: The POWG reached consensus in six key statements: harmonization of reporting and quality assurance of NGS; molecular tumor board and clinical decision support systems for PO; education and training; research and real-world data collection, patient engagement, regulations, and financial reimbursement of PO treatment strategies; and clinical recommendations and implementation of PO in clinical practice. CONCLUSION: POWG consensus statements standardize the clinical application of NGS CGPs, streamline the interpretation of clinically significant genomic alterations, and align actionable mutations with sequence-directed therapies. The POWG consensus statements may harmonize the utility and delivery of PO in China's GBA.

High Pain Catastrophizing Scale Predicts Lower Patient-Reported Outcome Measures in the Foot and Ankle Patient.

BACKGROUND: Postoperative outcomes may be affected by the patient's preoperative morbidity. It is hypothesized that patient's pain catastrophization prior to foot and ankle surgery may affect their patient-reported outcomes. Methods: This study prospectively assessed a consecutive cohort of 46 patients undergoing foot and ankle reconstruction to describe the relationship between Pain Catastrophizing Scale (PCS) and patient-reported outcomes measured by 12-item Short Form Health Survey and Foot and Ankle Outcome Score (FAOS). RESULTS: The 1-year postoperative FAOS pain, activities of daily living, and quality of life scores correlated significantly with all baseline PCS subcategories. We found that the mental domain of the SF-12 had a statistically significant correlation with the rumination and helplessness PCS subcategories. CONCLUSION: This study showed a significant association between a high preoperative PCS and a worse 1-year FAOS. As such, catastrophization could be screened for and potentially treated preoperatively to improve patient-reported outcomes in elective foot and ankle surgery. LEVEL OF EVIDENCE: Therapeutic, Level III Evidence.

SARS-CoV-2 detection using reverse transcription strand invasion based amplification and a portable compact size instrument.

Rapid nucleic-acid based tests that can be performed by non-professionals outside laboratory settings could help the containment of the pandemic SARS-CoV-2 virus and may potentially prevent further widespread lockdowns. Here, we present a novel compact portable detection instrument (the Egoo Health System) for extraction-free detection of SARS-CoV-2 using isothermal reverse transcription strand invasion based amplification (RT-SIBA). The SARS-CoV-2 RT-SIBA assay can be performed directly on crude oropharyngeal swabs without nucleic acid extraction with a reaction time of 30 min. The Egoo Health system uses a capsule system, which is automatically sealed tight in the Egoo instrument after applying the sample, resulting in a closed system optimal for molecular isothermal amplification. The performance of the Egoo Health System is comparable to the PCR instrument with an analytical sensitivity of 25 viral RNA copies per SARS-CoV-2 RT-SIBA reaction and a clinical sensitivity and specificity between 87.0-98.4% and 96.6-98.2% respectively.

Immune-Related Endocrine Dysfunctions in Combined Modalities of Treatment: Real-World Data.

The number of immune-related endocrine dysfunctions (irEDs) has concurrently increased with the widespread use of immunotherapy in clinical practice and further expansion of the approved indications for immune checkpoint inhibitor (ICI) in cancer management. A retrospective analysis was conducted on consecutive patients ≥18 years of age with advanced solid malignancies who had received at least one dose of anti-programmed cell death protein 1 (anti-PD-1) and/or anti-CTLA4 antibodies between January 2014 and December 2019 at a university hospital in Hong Kong. Patients were reviewed up to two months after the last administration of an ICI. The types, onset times and grades of irEDs, including hypothyroidism, hyperthyroidism, adrenal insufficiency and immune-related diabetes mellitus, were recorded. Factors associated with irEDs were identified using multivariate analysis. A total of 953 patients (male: 603, 64.0%; median age: 62.0 years) were included. Of these, 580 patients (60.9%) used ICI-alone, 132 (13.9%) used dual-ICI, 187 (19.6%) used an ICI combined with chemotherapy (chemo + ICI), and 54 (5.70%) used immunotherapy with a targeted agent (targeted + ICI). A significantly higher proportion of patients using targeted + ICI had irEDs and hypothyroidism; in contrast, a higher proportion of patients using dual-ICI had adrenal insufficiency. There was no significant difference in the incidence of irED between the younger (<65 years) and older (≥65 years) patients. Using logistic regression, only treatment type was significantly associated with irEDs. Notably, older patients had a higher risk of having immune-related diabetes mellitus. This large, real-world cohort demonstrates that targeted + ICI has a higher risk of overall irED and hypothyroidism. Immunotherapy is safe and well-tolerated regardless of age, but close monitoring of fasting glucose is essential in older populations.

Analgesic effect of perineural local anesthetics, steroids, and conventional medical management for trauma and compression-related peripheral neuropathic pain: a retrospective cohort study.

INTRODUCTION: Trauma and compression are common causes of peripheral neuropathic pain (NP) refractory to conventional medical management (CMM). The role of perineural interventions in relieving this type of pain is unclear. OBJECTIVES: The objectives of this retrospective study were to determine the analgesic benefits of adding a combination of perineural local anesthetic and steroids (LA-S) to CMM compared with CMM alone in patients who had moderate-to-severe refractory NP after trauma to the ankle and the foot. METHODS: Health care records of 60 patients in exposed (3 injections of perineural LA-S at weekly intervals with CMM) and 60 in unexposed (CMM) cohorts were reviewed. Data on patient characteristics, pain, and mental and physical function were extracted at baseline and at the postintervention follow-up. Data were analyzed to evaluate analgesic benefit from the study interventions and the impact of baseline characteristics. RESULTS: Perineural LA-S with CMM cohort had lower pain numerical rating scale scores at 1 to 3 months after the intervention as compared to the CMM alone cohort (5.50 [interquartile range 4.00-7.00] and 7.00 [interquartile range 5.00-8.00], respectively; P < 0.01). However, multivariable analysis did not show an independent beneficial analgesic effect with the addition of perineural LA-S to CMM compared with CMM alone. A greater severity of preintervention catastrophizing (each unit increase in pain catastrophizing score increased pain score at follow-up by 0.04, 95% confidence interval: 0.01-0.07) was associated with reduction in the analgesic benefit. CONCLUSION: Perineural local anesthetic and steroid injections do not confer an analgesic benefit for trauma- or compression-related peripheral NP.

Magic Curiosity Arousing Tricks (MagicCATs): A novel stimulus collection to induce epistemic emotions.

There has been considerable interest in empirical research on epistemic emotions, i.e., emotions related to knowledge-generating qualities of cognitive tasks and activities such as curiosity, interest, and surprise. One big challenge when studying epistemic emotions is systematically inducting these emotions in restricted experimental settings. The current study created a novel stimulus set called Magic Curiosity Arousing Tricks (MagicCATs): a collection of 166 short magic trick video clips that aim to induce a variety of epistemic emotions. MagicCATs are freely available for research and can be used in a variety of ways to examine epistemic emotions. Rating data also support that the magic tricks elicit a variety of epistemic emotions with sufficient inter-stimulus variability, demonstrating good psychometric properties for their use in psychological experiments.

Focused attention meditation changes the boundary and configuration of functional networks in the brain.

Research has shown that focused attention meditation not only improves our cognitive and motivational functioning (e.g., attention, mental health), it influences the way our brain networks [e.g., default mode network (DMN), fronto-parietal network (FPN), and sensory-motor network (SMN)] function and operate. However, surprisingly little attention has been paid to the possibility that meditation alters the architecture (composition) of these functional brain networks. Here, using a single-case experimental design with intensive longitudinal data, we examined the effect of mediation practice on intra-individual changes in the composition of whole-brain networks. The results showed that meditation (1) changed the community size (with a number of regions in the FPN being merged into the DMN after meditation) and (2) led to instability in the community allegiance of the regions in the FPN. These results suggest that, in addition to altering specific functional connectivity, meditation leads to reconfiguration of whole-brain network architecture. The reconfiguration of community architecture in the brain provides fruitful information about the neural mechanisms of meditation.

A Rare Case of Metastatic Primary Peritoneal Ependymoma: A Case Report and Literature Review.

BACKGROUND: Primary peritoneal ependymoma is an exceedingly rare tumour with only four cases reported in the literature. It typically follows an indolent disease course. We describe a rare case of metastatic primary peritoneal ependymoma which was treated with chemotherapy and radiotherapy resulting in prolonged survival to date for 10 years. Case Presentation. The patient was a 23-year-old female on presentation. She presented with right upper quadrant pain associated with an abdominal mass. Computed tomography demonstrated a large mass displacing the liver. Debulking surgery was done revealing a tumour arising from the peritoneum as well as multiple metastatic pleural and peritoneal nodules. Pathology was consistent with primary peritoneal ependymoma. The patient was then treated with multiple lines of chemotherapy containing etoposide as the backbone. She also received palliative radiotherapy to the thoracic metastases with good and durable response. CONCLUSION: We reported a rare case of metastatic primary peritoneal ependymoma. Etoposide containing the chemotherapy regimen is effective in the treatment of peritoneal ependymoma. Radiotherapy is also effective for palliation of local symptoms with durable response.

Shared striatal activity in decisions to satisfy curiosity and hunger at the risk of electric shocks.

Curiosity is often portrayed as a desirable feature of human faculty. However, curiosity may come at a cost that sometimes puts people in harmful situations. Here, using a set of behavioural and neuroimaging experiments with stimuli that strongly trigger curiosity (for example, magic tricks), we examine the psychological and neural mechanisms underlying the motivational effect of curiosity. We consistently demonstrate that across different samples, people are indeed willing to gamble, subjecting themselves to electric shocks to satisfy their curiosity for trivial knowledge that carries no apparent instrumental value. Also, this influence of curiosity shares common neural mechanisms with that of hunger for food. In particular, we show that acceptance (compared to rejection) of curiosity-driven or incentive-driven gambles is accompanied by enhanced activity in the ventral striatum when curiosity or hunger was elicited, which extends into the dorsal striatum when participants made a decision.

Delineating the cognitive-neural substrates of writing: a large scale behavioral and voxel based morphometry study.

The current study investigated the cognitive and neural substrates that underpin writing ability. We explored similarities and differences in writing numbers and words and compared these to language and manual actions in a large group of sub-acute, stroke patients (n = 740). The behavioral data showed association and dissociation in the ability to write words and numbers. Comorbidities of writing deficits with both language and motor impairments were prevalent, with less than a handful showing deficits restricted to the writing tasks. A second analysis with a subset of patients (n = 267) explored the neural networks that mediate writing abilities. Lesion to right temporal contributed to writing words, while lesions to left postcentral contributed to writing numbers. Overlapping neural mechanisms included the bilateral prefrontal cortex, right inferior parietal, left middle occipital and the right cerebellum. With the former regions associated with error pattern typical to writing based on prior knowledge (the lexical route), while lesion to left MOG was associated with errors to the phonological (non-lexical) route. Using principle components extracted from the behavioral data, we showed that right prefrontal and right parietal contributed to the ability to use pen, while lesion to bilateral prefrontal, inferior temporal and cerebellum supported unique use of pen for writing. The behavioral and imaging data suggested that writing numbers and words primarily relied on overlapping cognitive and neural functions. Incidents of pure writing deficits, in the absence of motor or language deficits were rare. Nevertheless, the PCA and neural data suggested that writing abilities were associated with some unique neuro-cognitive functions, specifically dedicated to the use of pen and the ability to transform meaning to motor command.

Long-term outcomes and recurrence pattern of 18F-FDG PET-CT complete metabolic response in the first-line treatment of metastatic colorectal cancer: a lesion-based and patient-based analysis.

BACKGROUND: 18F-FDG PET-CT is commonly used to monitor treatment response in patients with metastatic colorectal cancer (mCRC). With improvement in systemic therapy, complete metabolic response (CMR) is increasingly encountered but its clinical significance is undefined. The study examined the long-term outcomes and recurrence patterns in these patients. METHODS: Consecutive patients with mCRC who achieved CMR on PET-CT during first-line systemic therapy were retrospectively analysed. Measurable and non-measurable lesions identified on baseline PET-CT were compared with Response Criteria in Solid Tumors (RECIST) on CT on a per-lesion basis. Progression free (PFS) and Overall Survival (OS) were compared with clinical parameters and treatment characteristics on a per-patient basis. RESULTS: Between 2008 and 2011, 40 patients with 192 serial PET-CT scans were eligible for analysis involving 44 measurable and 38 non-measurable lesions in 59 metastatic sites. On a per-lesion basis, 46% also achieved Complete Response (CR) on RECIST criteria and sustained CMR was more frequent in these lesions (OR 1.727, p = 0.0031). Progressive metabolic disease (PMD) was seen in 12% of lesions, with liver metastasis the most common. Receiver operating characteristics (ROC) curve analysis revealed the optimal value of SUVmax for predicting PMD of a lesion was 4.4 (AUC 0.734, p = 0.004). On a per-patient basis, 14 patients achieved sustained CMR and their outcomes were better than those with PMD (median OS not reached vs 37.7 months p = 0.0001). No statistical difference was seen in OS between patients who achieved PR or CR (median OS 51.4 vs 44.2 months p = 0.766). CONCLUSION: Our results provided additional information of long-term outcomes and recurrence patterns of patients with mCRC after achieving CMR. They had improved survival and sustained CMR using systemic therapy alone is possible. Discordance between morphological and metabolic response was consistent with reported literature but in the presence of CMR the two groups had comparable outcomes.

Vancouver Foot and Ankle WNS (Wound, Nerve, and Systemic) Classification System for Foot and Ankle Orthopedic Surgery.

BACKGROUND: Adverse events require consistent recording to determine the effect of alternate treatments. This study was undertaken to evaluate the Vancouver Foot and Ankle WNS complication scale to capture complications (W: wound, N: nerve, S: systemic) to assist in outcome recording. METHODS: Interrater reliability was tested in 2 settings: (1) between 2 blinded clinicians in a live clinical setting and (2) between 8 orthopedic surgeons using case vignettes based on a retrospective analysis of 500 foot and ankle procedures performed at the Toronto Western Hospital, Department of Orthopaedics. The intrarater reliability of the WNS scale was tested in a single rater using the case vignettes. Inter- and intrarater reliability were assessed using the Fleiss and Cohen weighted kappa ( k), respectively and 95% confidence intervals (CIs). There was adequate power over 0.8. RESULTS: In the live clinical setting, the Cohen weighted k (95% CI) values for the W (0.935 [0.862, 1.01]), N (0.914 [0.752, 1.08]), and S (1 [1, 1]) parameters, indicating a near perfect level of agreement between raters. In the broader community of professional foot and ankle surgeons, the Fleiss k values (95% CI) had moderate agreement for the W (0.712 [0.688, 0.735]), N (0.775 [0.738, 0.811]), and high agreement for S (0.834 [0.802, 0.866]) parameters based on case vignettes. However, the Fleiss k values continued to indicate moderate to strong agreement between raters for all parameters. CONCLUSIONS: The WNS scale provided a standardized method of measuring foot and ankle surgical complications. There was at least moderate-strong interrater agreement for all parameters measured on case vignettes and excellent concordance in the live setting. LEVEL OF EVIDENCE: Level III, comparative series.

Functional outcome and cost-effectiveness of outpatient vs inpatient care for complex hind-foot and ankle surgery. A retrospective cohort study.

STUDY OBJECTIVE: To compare the postoperative functional outcome and the total cost associated with outpatient vs inpatient care following complex hind-foot and ankle surgery. DESIGN: Retrospective, cohort study. SETTING: Tertiary care center. PATIENTS: Forty patients, American Society of Anesthesiologists 1-3, of either sex undergoing elective complex hind-foot and ankle surgery (fusion, osteotomy, or multiple ligament repair). INTERVENTIONS: Both inpatients and outpatients received a continuous perineural infusion of local anesthetic for 48 hours at the core of a multimodal analgesic regimen. Patients were retrospectively identified, and an outpatient cohort was matched to an inpatient cohort in a 1:1 ratio for age, sex, baseline functional score, and type of surgery. MEASUREMENTS: The primary outcome was functional outcome upon discharge of the surgical program as measured by the Lower Extremity Functional Score. Secondary outcomes were the incidence of surgical or anesthetic complications and the total perioperative cost of care. RESULTS: Patients in both cohorts had similar functional outcome on discharge of the surgical program. Analgesia was effective in both groups, and no complications were reported. The cost of care for outpatients was 54% lower than that for inpatients. CONCLUSION: This retrospective study suggests that outpatient care including an ambulatory perineural infusion of local anesthetic may be a cost-effective alternative to inpatient care after complex foot and ankle surgery.

Total Ankle Arthroplasty: An Overview of the Canadian Experience.

Total ankle arthroplasty use has increased across Canada over the last two decades. Multiple implant designs are readily available and implanted across Canada. Although arthrodesis is a reliable procedure for treating end-stage ankle arthritis, ankle replacement is often the preferred surgical treatment by patients. A recent prospective study evaluated intermediate-term outcomes of ankle replacement and arthrodesis at multiple centers across Canada, with variability in prosthesis type, surgeon, and surgical technique. Intermediate-term clinical outcomes of total ankle replacement and ankle arthrodesis were comparable in a diverse cohort in which treatment was tailored to patient presentation; however, rates of reoperation and major complications were higher after ankle replacement.

Study protocol for a pilot, randomised, double-blinded, placebo controlled trial of perineural local anaesthetics and steroids for chronic post-traumatic neuropathic pain in the ankle and foot: the PREPLANS study.

INTRODUCTION: Peripheral neuropathic pain (PNP) associated with trauma is often refractory to treatment. Administration of local anaesthetics (LA) and steroids around injured nerves has been proposed as an option for patients unresponsive to conventional treatments for refractory PNP following trauma. There is insufficient evidence to support a large, potentially expensive, full-scale randomised controlled trial (RCT) that involves comparison of effects of perineural steroids and LA against LA or saline injections on analgesia, physical and psychological functioning, and quality of life. There is also a lack of data that would allow estimation of analgesic efficacy or sample size for the full-scale RCT. The objective of this pilot RCT is to yield information to support planning of a full-scale RCT in this population. METHODS AND ANALYSIS: 30 participants with post-traumatic PNP in the ankle and foot of moderate-to-severe intensity and duration of more than 3 months will be enrolled in this pilot RCT. Participants will be randomised to receive three ultrasound-guided perineural injections of 0.9% saline, 0.25% bupivacaine (a long-acting LA) or a combination of 0.25% bupivacaine and a steroid (methylprednisolone 16 mg per nerve) at weekly intervals. The primary objectives are to determine the feasibility and sample size of a full-scale RCT in this population. The secondary objectives are to evaluate the effect of study interventions on analgesia, persistence of neuropathic pain, psychological and physical function, quality of life and participants' global impression of change at 1 and 3 months after the interventions. In addition, adverse effects associated with perineural injections and with systemic absorption of steroids will also be recorded. ETHICS AND DISSEMINATION: The protocol was approved by the University Health Network Research Ethics Board (UHN REB number 15-9584-A). The results will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER: NCT02680548; Pre-results.

Lesion-symptom mapping of a complex figure copy task: A large-scale PCA study of the BCoS trial.

Complex figure copying is a commonly used neuropsychological test. Here we explored the neural basis of the factors underlying complex figure copying (CFC), using data from the Birmingham Cognitive Screen (BCoS) in a large group of sub-acute, ischemic stroke patients (239). We computed two analyses: in the first we assessed the contribution of co-morbid deficits (i.e. in gesture processing, object use, visual neglect, pictures naming and sustained attention) to the lesions associated with CFC. In a second analysis a Principle Component Analysis (PCA) was used to isolate different underlying task components and to link to clinical neuroimaging scans. A voxel-based morphometry (VBM) analysis showed that poor CFC performance was associated with lesions to bi-lateral thalamus, lingual, right fusiform and right inferior parietal cortices (rIPC). The latter association with the posterior parietal cortex was diminished after controlling for neglect. Follow up analysis showed the neglect partially mediated the correlation of CFC and rIPC. The PCA revealed three main underlying components: (1) a component associated with high-level motor control common to different measures of apraxia and linked to the left postcentral gyrus, the right thalamus and middle frontal gyrus; (2) a visuo-motor transformation component unique to the CFC and associated with lesions to the posterior occipital and sensory cortices; (3) a component associated with multistep object use tasks which was correlated with lesions to the left inferior frontal orbital gyrus, the right fusiform and cerebellum. Using clinical symptoms, cognitive profiles and lesion mapping we showed that beyond visual perception, CFC performance is supported by three functional networks: one for high-level motor control, a visuo-motor transformation component, and multistep object use network.

Cross-Sectional Contrast Between Individuals With Foot/Ankle vs Knee Osteoarthritis for Obesity and Low Education on Health-Related Quality of Life.

BACKGROUND: Improving health-related quality of life (HRQoL) necessitates an understanding of the influence of patient characteristics on, and interrelationship among, HRQoL domains. In osteoarthritis (OA), these associations have predominantly been examined in hip/knee populations. We investigated whether there were differences in these associations between foot/ankle and knee OA samples. METHODS: Individuals seeking orthopedic care for foot/ankle or knee OA completed a questionnaire pre-consultation, including HRQoL domains (bodily pain [BP], physical [PF] and social functioning [SF], and mental [MH] and general health [GH]), obesity, comorbidity, and sociodemographic characteristics. Associations were examined via stratified path analysis (foot/ankle vs knee). Foot/ankle: n = 180, mean age = 55 (range: 25 to 82), 52% female. Knee: n = 253, mean age = 62 (range: 26 to 92), 51% female. RESULTS: The interrelationship among HRQoL domains was generally similar between groups. However, the influence of patient characteristics differed. Low educational status was associated with worse scores for GH, MH, and SF in the foot/ankle group, whereas no significant effects were found in the knee group. Obesity was associated with worse scores for SF, BP, and GH in the foot/ankle compared to the knee group. Patient characteristics explained considerably more of the variation in domain scores in the foot/ankle group. CONCLUSION: There are significant differences in the impact of patient characteristics on HRQoL domains in foot/ankle versus knee OA patients. Therefore, a universal approach to patient education/intervention to improve HRQoL in lower-extremity OA is not likely to achieve optimal results. Based on these findings, we recommend joint-specific patient education, with a particular emphasis on patient characteristics among the foot/ankle OA population. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

The Hong Kong version of the Oxford Cognitive Screen (HK-OCS): validation study for Cantonese-speaking chronic stroke survivors.

This study reports the validation of the Hong Kong version of Oxford Cognitive Screen (HK-OCS). Seventy Cantonese-speaking healthy individuals participated to establish normative data and 46 chronic stroke survivors were assessed using the HK-OCS, Albert's Test of Visual Neglect, short test of gestural production, and Hong Kong version of the following assessments: Western Aphasia Battery, MMSE, MoCA, Modified Barthel Index, and Lawton Instrumental Activities of Daily Living scale. The validity of the HK-OCS was appraised by the difference between the two participant groups. Neurologically unimpaired individuals performed significantly better than stroke survivors on the HK-OCS. Positive and significant correlations found between cognitive subtests in the HK-OCS and related assessments indicated good concurrent validity. Excellent intra-rater and inter-rater reliabilities, fair test-retest reliability, and acceptable internal consistency suggested that the HK-OCS had good reliability. Specific HK-OCS subtests including semantics, episodic memory, number writing, and orientation were the best predictors of functional outcomes.