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Cold surges are synoptic weather systems that occur over the Maritime Continent during the boreal winter. They are characterized by the strengthening of prevailing low‐level northerly to north‐easterly winds, temperature falls of a few degrees over several days, and in some cases, heavy prolonged rainfall and flooding. We investigate the synoptic structure and development of cold surges through composites of dry, moderate and wet surges. Each surge category is defined by the distribution of precipitation averaged within a specified domain over the equatorial South China Sea. Dry surges are characterized by cross‐equatorial flow and positive mean sea‐level pressure anomalies that reach the Southern Hemisphere, and enhanced descent or weaker ascent. Wet surges are characterized by limited cross‐equatorial flow, low‐pressure anomalies over the equator, and enhanced moisture and ascent. The local diurnal precipitation patterns are consistent with the convection being controlled by the mid‐tropospheric buoyancy of an idealized entraining plume. This buoyancy diagnostic suggests that wet surges are characterized by a moister free troposphere because this reduces the effect of entrainment and allows deep convection to develop. On the large scale, the environment in which wet or dry cold surges form is closely related to the Madden‐Julian Oscillation (MJO) phase. Dry and moderate surges occur predominantly in the suppressed phases of the MJO, while wet surges often herald the eastward propagation of the MJO convective envelope. Finally, convectively active phases in the Australian monsoon are more likely following dry cold surges, and are sometimes associated with the MJO. Plain Language Summary: Cold surges are large‐scale monsoon weather systems that bring strong north‐easterly winds, colder air, and sometimes very heavy rainfall and flooding over the Maritime Continent region between November and March of each year. We investigate the structure and development of dry, moderate, and wet cold surges. The three categories are defined based on rainfall averages over a domain located near the equator. The rainfall, on which the categories are defined, is primarily influenced by the Madden‐Julian Oscillation (MJO). The MJO has a major influence on tropical weather on weekly to monthly timescales. Of the three categories, dry surges are characterized by the highest mean sea‐level pressure anomalies, and by north‐easterly winds that cross the equator into the Southern Hemisphere and then turn to become westerly over Java and northern Australia. The westerly winds are often associated with activity in the Australian summer monsoon. In contrast, wet surges are characterized by low‐pressure anomalies over the equator, and weak westerly or easterly winds over southern Java and northern Australia. Key Points: Cold surges occur on approximately 18% of days over a 20‐year analysis period, and account for approximately 30% of the total rainfallLocally, wet cold surges are characterized by a moister free troposphere, which allows convection to penetrate the lower troposphereRegionally, dry (wet) surges usually form in the suppressed (active) Madden‐Julian Oscillation phases and are sometimes linked to the Australian summer monsoon [ABSTRACT FROM AUTHOR]

Describes an Australian undergraduate teacher education program, "Issues in Cross Cultural Education." Designed to respond to the demands of Australia as a pluralist, multicultural society, it examines the ways in which the racial and ethnic minority presence has shaped and transformed the minority culture. (SM)

Barn production systems in Australia are either an indoor-housing floor system or an aviary system with multilevel structures, equipped with nesting boxes, perches and feeding and watering systems. These systems offer hens the freedom of movement and an opportunity to display a repertoire of favourable behaviours as well as interact with complex housing elements as compared with caged systems. However, the system can create prospects for the hens to express detrimental behaviours such as feather pecking and cannibalism. Other aspects of welfare that may be compromised when compared with cage systems include incidence of fractures and injuries during navigation of hens among elements of housing that may result in collision or falls. Barn production systems may have an advantage over free-range production systems in relation to the protection they offer from predators and predator stress, and diseases and parasites that can be contracted from range areas. Barn systems also offer better biosecurity due to lack of direct access to wild birds and their faeces. The aim of the present review is to assess the welfare status of birds housed in barn (and aviary) production systems, while considering husbandry factors that affect welfare outcomes, the health and disease implications and sustainability. To maintain a high welfare outcome in barn production systems, it is important to keep the enclosed environmental conditions optimum by managing air quality, ventilation and lighting within sheds. Sustainability of these production systems depends on consumer preference, cost of production, environmental footprint and suitable genetics of hens. [ABSTRACT FROM AUTHOR]

Rapid Response Teams (RRTs) are specialised teams introduced into hospitals to improve the outcomes of deteriorating ward patients. Although Rapid Response Systems (RRSs) were developed by the intensive care unit (ICU) community, there is variability in their delivery, and consultant involvement, supervision and leadership appears to be relatively infrequent. In July 2014, the Australian and New Zealand Intensive Care Society (ANZICS) convened the first conference on the role of intensive care medicine in RRTs in Australia and New Zealand. The conference explored RRSs in the broader role of patient safety, resourcing and staffing of RRTs, effect on ICU workload, different RRT models, the outcomes of RRT patients and original research projects in the area of RRSs. Issues around education and training of both ICU registrars and nurses were examined, and the role of team training explored. Measures to assess the effectiveness of the RRS and RRT at the level of health system and hospital, team performance and team effectiveness were discussed, and the need to develop a bi-national ANZICS RRT patient database was presented. Strategies to prevent patient deterioration in the 'pre-RRT' period were discussed, including education of ward nurses and doctors, as well as an overarching governance structure. The role of the ICU in deteriorating ward patients was debated and an integrated model of acute care presented. This article summarises the findings of the conference and presents recommendations on the role of intensive care medicine in RRTs in Australia and New Zealand. [ABSTRACT FROM AUTHOR]

The recent increase in free-range meat and egg production and consumption has led to extensive investigation in this area and has revealed that the level of animal performance achieved in such systems is low compared with that achieved in conventional production systems. In Australia, this difference has been attributed either to the absence of in-feed antibiotics or to range access, which may result in exposure to detrimental climatic conditions, predators, disease, welfare challenges and nutrient dilution. Moreover, although poultry in free-range systems have ready access to outside runs, not all birds utilise them optimally. Pasture consumption results in dilution of energy and protein intake and may cause impaction and dietary electrolyte imbalance. This paper provides an overview of these issues to provide a conceptual framework for further study in this area. With a growing demand for free-range poultry products producers will need to address the issues that contribute to the performance gap between the free-range and conventional systems to remain cost-effective. Factors such as range use and enrichment, pasture consumption, and its effects on nutrition and health should be considered and quantified. This review will summarise current knowledge in these areas and propose solutions and opportunities for the future. [ABSTRACT FROM AUTHOR]

Slow-growing broilers offer differentiation in the chicken meat market for consumers who have distinct preferences based on perceived higher welfare indices and willingness to pay a higher price for the product. Although breeding for slow-growing broilers is relatively advanced in Europe and the United States, it is limited in Australia. Crossbreeding is one of the approaches taken to developing slow-growing broiler strains. Thus, the aim of this study was to compare performance, immune response, leg health, carcass characteristics, and meat quality of a novel crossbred slow-growing broiler breed (SGB) with the conventional, fast-growing Cobb 500 broiler (CB) to assess their suitability as an alternative for chicken meat production in Australia. A total of 236 one-day-old broiler chicks (116 SGB and 120 fast-growing CB) were reared on standard commercial diet in an intensive production system. Birds and feed were weighed on a weekly basis and feed intake and feed conversion ratio calculated. At 21 d of age, a 2% suspension of sheep red blood cells was injected subcutaneously into 8 broilers of each breed to compare their antibody response. Birds from both breeds were grown to a final live weight of 2.0–2.2 kg, before a latency-to-lie (LTL) test, carcass analysis and apparent metabolizable energy (AME) assay were performed. The SGB reached the target weight at 55 d of age compared with 32 d in CB. However, SGB stood for longer during LTL, had higher thigh, drumstick, and wing yields (as a percentage of carcass weight) as well as darker and redder meat in comparison with the CB. The CB had better feed conversion efficiency, higher antibody (IgM) production, higher AME, heavier breast yield, and lower meat drip loss than the SGB. Although fast-growing CB outperformed the SGB for traditional performance parameters, the crossbred in this study was comparable with other slow-growing broiler breeds and strains across different countries and is thus a suitable candidate for a slow-growing alternative in Australia. [ABSTRACT FROM AUTHOR]

Spotty liver disease (SLD) is recognized to be caused by infection with Campylobacter hepaticus in adult layer hens farmed in cage-free environments. SLD is an emerging disease as cage-free egg production increases in popularity in response to desires for improved welfare of poultry. Outbreaks of SLD are frequently experienced around peak egg production in flocks, commonly between 25 and 40 wk of age. The disease becomes manifest with increased exposure and access of the birds to the feces of the flock. This study follows from a previous epidemiological survey of free-range and barn flocks in Australia which identified the presence of a scratch area within the laying house as a major risk factor for the occurrence of SLD. However, that survey also observed SLD occurrence in 45% of houses with a fully slatted floor (no scratch area). The present study describes a further analytical survey aimed at identification of risk factors for SLD in houses with fully slatted flooring. A comprehensive questionnaire was completed for 49 cage-free flocks from point of lay until 40 wk of age across Australia, retrieving information on house design, bird breed, flock size, stocking densities, bird growth, and performance and the occurrence of SLD. Multiple logistic regression model building was used to separate factors and identify important management factors that may be amenable to modify the occurrence of SLD in egg layers. Key determinants of SLD identified from the analyses were that houses with mechanical ventilation (such as tunnel ventilation) have some protection from SLD and an increase of an extra 1 bird/m 2 of nest space increased odds of occurrence of SLD by 1.172 times. A recommendation to not exceed 112 brown egg layer hens/m 2 of nest space in naturally ventilated houses with a full slat floor was suggested. A delay in birds reaching 60% hen day production (HD) by 1 wk is suggested as a possible predictor for a subsequent outbreak of SLD., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Spotty Liver Disease (SLD) is a serious problem in laying hens farmed in cage-free systems. The causative organism, Campylobacter hepaticus, is regarded as having a fecal-oral method of transmission and hence may build up and spread readily in housing systems which allow ease of direct contact of hens with the flock's fecal material. The epidemiology of SLD has not been thoroughly investigated. An initial cross-sectional analytical epidemiological survey of SLD in free range and barn layer systems was conducted in Australia over 2019 to 2021.The survey involved rearing flocks (n = 32) which were then followed through into laying flocks (n = 24) up to 40 wk of age. Cloacal swabs were collected during rearing and lay for C. hepaticus detection by PCR. Flocks were classified as "Cases" (n = 18) where clinical SLD according to the case definition was observed or "Controls" (n = 6) which were clinically unaffected. No C. hepaticus was detected in cloacal swabs from rearing houses whereas the organism was detected in 18 Case flocks in lay and from 2 Control flocks in lay. All layer houses that incorporated a scratch area (n = 13) were categorized as Cases. Thus, having a scratch area is a key determinant for SLD and no analyses of further contributory factors from these flocks were able to be made. Of the remaining 11 flocks which had floors fully covered by slats, 5 were Cases (45%). Further risk factor analysis was compromised by this small sample size and identification of other significant associations was not possible. A larger survey investigating flocks laying in houses with fully slatted floors was undertaken to further the understanding of SLD epidemiology and is reported in a companion paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Cancer of unknown primary (CUP) is a syndrome defined by clinical absence of a primary cancer after standardised investigations. Gene expression profiling (GEP) and DNA sequencing have been used to predict primary tissue of origin (TOO) in CUP and find molecularly guided treatments; however, a detailed comparison of the diagnostic yield from these two tests has not been described. Here, we compared the diagnostic utility of RNA and DNA tests in 215 CUP patients (82% received both tests) in a prospective Australian study. Based on retrospective assessment of clinicopathological data, 77% (166/215) of CUPs had insufficient evidence to support TOO diagnosis (clinicopathology unresolved). The remainder had either a latent primary diagnosis (10%) or clinicopathological evidence to support a likely TOO diagnosis (13%) (clinicopathology resolved). We applied a microarray (CUPGuide) or custom NanoString 18-class GEP test to 191 CUPs with an accuracy of 91.5% in known metastatic cancers for high-medium confidence predictions. Classification performance was similar in clinicopathology-resolved CUPs - 80% had high-medium predictions and 94% were concordant with pathology. Notably, only 56% of the clinicopathology-unresolved CUPs had high-medium confidence GEP predictions. Diagnostic DNA features were interrogated in 201 CUP tumours guided by the cancer type specificity of mutations observed across 22 cancer types from the AACR Project GENIE database (77,058 tumours) as well as mutational signatures (e.g. smoking). Among the clinicopathology-unresolved CUPs, mutations and mutational signatures provided additional diagnostic evidence in 31% of cases. GEP classification was useful in only 13% of cases and oncoviral detection in 4%. Among CUPs where genomics informed TOO, lung and biliary cancers were the most frequently identified types, while kidney tumours were another identifiable subset. In conclusion, DNA and RNA profiling supported an unconfirmed TOO diagnosis in one-third of CUPs otherwise unresolved by clinicopathology assessment alone. DNA mutation profiling was the more diagnostically informative assay. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland., (© 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.)

Introduction: Epidemiological evidence suggests that both poor cardiovascular fitness and low muscle mass or strength markedly increase the rate of cognitive decline and incident dementia in older adults. Results from exercise trials for the improvement of cognition in older adults with mild cognitive impairment (MCI) have reported mixed results. This is possibly due to insufficient exercise intensities. The aim of the Balance, Resistance, And INterval (BRAIN) Training Trial is to determine the effects of two forms of exercise, high-intensity aerobic interval training (HIIT) and high-intensity power training (POWER) each compared with a sham exercise control group on cognition in older adults with MCI., Methods and Analysis: One hundred and sixty community-dwelling older (≥ 60 years) people with MCI have been randomised into the trial. Interventions are delivered supervised 2-3 days per week for 12 months. The primary outcome measured at baseline, 6 and 12 months is performance on a cognitive composite score measuring the executive domain calculated from a combination of computerised (NeuroTrax) and paper-and-pencil tests. Analyses will be performed via repeated measures linear mixed models and generalised linear mixed models of baseline, 6-month and 12-month time points, adjusted for baseline values and covariates selected a priori. Mixed models will be constructed to determine the interaction of GROUP × TIME., Ethics and Dissemination: Ethical approval was obtained from the University of Sydney (HREC Ref.2017/368), University of Queensland (HREC Ref. 2017/HE000853), University of British Columbia (H16-03309), and Vancouver Coastal Health Research Institute (V16-03309) Human Research Ethics. Dissemination will be via publications, conference presentations, newsletter articles, social media, talks to clinicians and consumers and meetings with health departments/managers.It is expected that communication of results will allow for the development of more effective evidence-based exercise prescription guidelines in this population while investigating the benefits of HIIT and POWER on subclinical markers of disease., Trial Registration Number: ACTRN12617001440314 Australian New Zealand Clinical Trials Registry., Competing Interests: Competing interests: JMH, JSC and TL-A report funding received from a subcontract between USYD and their institutions to support the conduct of this study; PSS receives funding from a NHMRC Investigator Grant and is a member of Advisory Committee for Biogen Australia and Roche Australia., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Anthocyanins are present in bright colored fruit and vegetables with growing evidence for their health benefits. Several methods exist in the literature to measure the total monomeric anthocyanin content in foods. Although the simplest method uses UV-Vis spectrophotometry, it requires the use of anthocyanin molar absorption coefficients (Ɛ). While commonly reported for some compounds, these values vary substantially between studies. This study collated and compared existing Ɛ values for a range of anthocyanin-3-glucosides, measured new Ɛ values for these compounds and underwent an inter-laboratory validation of spectrometry methods. The Ɛ values used for the determination of anthocyanin content in Australian blueberries, were shown to greatly affect the estimated total anthocyanin. Significant differences in the Ɛ values were observed when measured at 520 nm, or their absorbance maximum and substantial difference in the estimated total anthocyanins were observed when expressed as equivalent of cya-3-glu or mal-3-glu., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Around 40% of cancers occur in working-age adults. Improvements in screening and treatment mean that most are expected to live years beyond their diagnosis. However, many experience persistent impairments from treatment such as fatigue, cognitive difficulties, and emotional distress. Work is a key occupation for this population and is an important occupational performance area for occupational therapy intervention. However, little is understood about working with cancer in the Australian context., Aim: To pilot a survey to identify factors associated with work participation among cancer survivors, and to determine if the survey collected useful information to build on for further study., Methods: A cross-sectional online survey was developed to measure work participation and factors associated with successful work. Study participants aged 20-65 years, employed at diagnosis, with basic English and computer literacy were recruited from a cancer clinic in Western Sydney over a 3-month period., Results: Nineteen survey responses were received and analysed. Participants had returned or remained at work (n = 9, 47.4%), unsuccessfully attempted to return to work (RTW; n = 2, 10.5%), or were on leave from work (n = 8, 42.1%). Of those on leave, most did not plan to RTW (n = 6, 31.6%). Fatigue (n = 15, 78.9%), difficulty concentrating (n = 8, 42.1%), memory issues (n = 8, 42.1%), stomach upset (n = 7, 36.8%), sleep disturbance, (n = 7, 36.8%), and psychological distress (n = 7, 36.8%) impacted perceived work ability. Physically demanding work (n = 8, 42.1%), length of the workday (n = 6, 31.6%), productivity demands (n = 5, 26.3%), and commuting (n = 4, 21.1%) were challenging to manage after cancer. A supportive workplace was a facilitator for work., Conclusion: Cancer survivors in Western Sydney may face challenges engaging in work after treatment. Work participation may be influenced by side effects of treatment, difficulty performing work demands, and the work environment. Services may be needed for cancer survivors to navigate RTW., (© 2020 Occupational Therapy Australia.)

Objective: For patients with locally advanced rectal cancer (LARC), adjuvant chemotherapy selection following surgery remains a major clinical dilemma. Here, we investigated the ability of circulating tumour DNA (ctDNA) to improve risk stratification in patients with LARC., Design: We enrolled patients with LARC (T3/T4 and/or N+) planned for neoadjuvant chemoradiotherapy. Plasma samples were collected pretreatment, postchemoradiotherapy and 4-10 weeks after surgery. Somatic mutations in individual patient's tumour were identified via massively parallel sequencing of 15 genes commonly mutated in colorectal cancer. We then designed personalised assays to quantify ctDNA in plasma samples. Patients received adjuvant therapy at clinician discretion, blinded to the ctDNA results., Results: We analysed 462 serial plasma samples from 159 patients. ctDNA was detectable in 77%, 8.3% and 12% of pretreatment, postchemoradiotherapy and postsurgery plasma samples. Significantly worse recurrence-free survival was seen if ctDNA was detectable after chemoradiotherapy (HR 6.6; P<0.001) or after surgery (HR 13.0; P<0.001). The estimated 3-year recurrence-free survival was 33% for the postoperative ctDNA-positive patients and 87% for the postoperative ctDNA-negative patients. Postoperative ctDNA detection was predictive of recurrence irrespective of adjuvant chemotherapy use (chemotherapy: HR 10.0; P<0.001; without chemotherapy: HR 22.0; P<0.001). Postoperative ctDNA status remained an independent predictor of recurrence-free survival after adjusting for known clinicopathological risk factors (HR 6.0; P<0.001)., Conclusion: Postoperative ctDNA analysis stratifies patients with LARC into subsets that are either at very high or at low risk of recurrence, independent of conventional clinicopathological risk factors. ctDNA analysis could potentially be used to guide patient selection for adjuvant chemotherapy., Competing Interests: Competing interests: KK, NP, LD and BV are founders of PapGene and Personal Genome Diagnostics and members of the Scientific Advisory Boards of Morphotek and Sysmex-Inostics. IK is an employee of PapGene. These companies and others have licensed patent applications on genetic technologies from Johns Hopkins, some of which result in royalty payments to KK, NP, LD, BV, and IK. The terms of these arrangements are being managed by Johns Hopkins University in accordance with its conflict of interest policies., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

As of 2018, Australia has experienced seven outbreaks of highly pathogenic avian influenza (HPAI) in poultry since 1976, all of which involved chickens. There is concern that increases in free-range farming could heighten HPAI outbreak risk due to the potential for greater contact between chickens and wild birds that are known to carry low pathogenic avian influenza (LPAI). We use mathematical models to assess the effect of a shift to free-range farming on the risk of HPAI outbreaks of H5 or H7 in the Australian commercial chicken industry, and the potential for intervention strategies to reduce this risk. We find that a shift of 25% of conventional indoor farms to free-range farming practices would result in a 6-7% increase in the risk of a HPAI outbreak. Current practices to treat water are highly effective, reducing the risk of outbreaks by 25-28% compared to no water treatment. Halving wild bird presence in feed storage areas could reduce risk by 16-19% while halving wild bird access of potential bridge-species to sheds could reduce outbreak risk by 23-25%, and relatively small improvements in biosecurity measures could entirely compensate for increased risks due to the increasing proportion of free-range farms in the industry. The short production cycle and cleaning practices for chicken meat sheds considerably reduce the risk that an introduced low pathogenic avian influenza virus is maintained in the flock until it is detected as HPAI through increased mortality of chickens. These findings help explain HPAI outbreak history in Australia and suggest practical changes in biosecurity practices that could reduce the risk of future outbreaks., (Crown Copyright © 2019. Published by Elsevier B.V. All rights reserved.)

Objectives: Using the prediction of cancer outcome as a model, we have tested the hypothesis that through analysing routinely collected digital data contained in an electronic administrative record (EAR), using machine-learning techniques, we could enhance conventional methods in predicting clinical outcomes., Setting: A regional cancer centre in Australia., Participants: Disease-specific data from a purpose-built cancer registry (Evaluation of Cancer Outcomes (ECO)) from 869 patients were used to predict survival at 6, 12 and 24 months. The model was validated with data from a further 94 patients, and results compared to the assessment of five specialist oncologists. Machine-learning prediction using ECO data was compared with that using EAR and a model combining ECO and EAR data., Primary and Secondary Outcome Measures: Survival prediction accuracy in terms of the area under the receiver operating characteristic curve (AUC)., Results: The ECO model yielded AUCs of 0.87 (95% CI 0.848 to 0.890) at 6 months, 0.796 (95% CI 0.774 to 0.823) at 12 months and 0.764 (95% CI 0.737 to 0.789) at 24 months. Each was slightly better than the performance of the clinician panel. The model performed consistently across a range of cancers, including rare cancers. Combining ECO and EAR data yielded better prediction than the ECO-based model (AUCs ranging from 0.757 to 0.997 for 6 months, AUCs from 0.689 to 0.988 for 12 months and AUCs from 0.713 to 0.973 for 24 months). The best prediction was for genitourinary, head and neck, lung, skin, and upper gastrointestinal tumours., Conclusions: Machine learning applied to information from a disease-specific (cancer) database and the EAR can be used to predict clinical outcomes. Importantly, the approach described made use of digital data that is already routinely collected but underexploited by clinical health systems.

This report provides a summary of the background and inputs of various groups who attended the Global Forum on Safety of Herbal and Traditional Medicine conference held in the Gold Coast, Australia, on July 7, 2001. Keynote presentations covered the status of regulation of complementary medicine in Australia and comparative examples from Africa and Bangladesh. There was substantial input about work to date on databases, reflecting the need to have a focus on safety outcomes as a point of direction for the forum. Safety evaluation, which incorporates quality procedures, was identified as another point of focus. Clear evidence for the nonutilization of plants known to contain certain compounds producing deleterious effects was exemplified via data and information on the dangers of ingesting pyrrolizidine alkaloids.

Background: Simple, reliable measures of the quality of the environment in which a child was reared that can be used in clinical research and practice are lacking., Method: The reliability and validity of a global scale to retrospectively appraise the quality of that environment were examined. Fifty-three clinicians from 4 centers in Australia and 1 in Hong Kong, People's Republic of China, used the scale to rate 7 case vignettes; 4 clinicians rated 20 medical records, and 49 rated 211 subjects after clinical interviews., Results: Interrater reliability (intraclass correlation coefficient) was 0.82 (time 1) and 0.84 (time 2) for case vignettes, 0.90 for medical records, and 0.89 for clinical interviews. Consistency in time was high (r = 0.91). Lower ratings, indicative of a less adequate environment, were associated with a clinical diagnosis of oppositional defiant or conduct disorder., Conclusions: Our simple-to-use scale appears to measure reliably a relevant clinical construct and fills a gap among the instruments available. Ratings may be useful as a cost-effective index to consider in outcome studies, when examining response to treatment, or in other clinical research.

This paper examines the performance of the SF-36 as a self-reported outcome measure in a diverse sample of Australian hospital in-patients. The data derive from the Care Continuum and Health Outcomes Project with a total of 2088 randomly selected patients, yielding a response rate of 80%. Distributions, completion rates and, in particular, correlates of measures were used to investigate the validity of the SF-36 according to clinical and psychometric criteria. Physical functioning, bodily pain, role limitations-physical, general health and vitality scales better represented physical than mental health, with the relative strength decreasing in that order; while mental health, role limitations-emotional and social functioning scales better represented mental health, with the relative strength decreasing in order. A cultural dimension was a strong independent correlate of all scales. While the SF-36 performed satisfactorily, there were weaknesses: the social functioning scale was too narrow to cover social health, both role limitations scales had crude response categories and particular subgroups, the frail elderly and those with complex health conditions, required measures with finer gradings for scales such as physical functioning and bodily pain. Further testing is needed to develop self-reports for use in hospital outcomes measurement which is already proposed in Australia.