Evidence-informed decision-making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient-centered. The Standardized Outcomes in Nephrology−Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis. Key stakeholders including eight patients/caregivers and 47 health professionals (nephrologists, policy makers, industry, researchers) attended the workshop. Attendees suggested that identifying core outcomes required equitable stakeholder engagement to ensure relevance across patient populations; flexibility to consider evolving priorities over time; deconstruction of language and meaning for conceptual consistency and clarity; understanding of potential overlap and associations between outcomes; and an assessment of applicability to the range of interventions in hemodialysis. For implementation, they proposed that core outcomes must have simple, inexpensive and validated outcome measures that could be used in clinical care (quality ndicators) and trials (including pragmatic trials), and endorsement by regulatory agencies. Integrating these recommendations may foster acceptance and optimize the uptake and translation of core outcomes in hemodialysis, leading to more informative research, for better treatment, and improved patient outcomes.

PLATES XX-XXII)THE purpose of the present investigation was to study the changes in the vesical circulation following distension of the bladder, to elucidate the mechanism of production of these changes and to define their place in the pathogenesis of cystitis. METHODS The circulation in the urinary bladderA modification of Seneviratne's technique (1949-50) of transilluminating living structures for microscopic study has been extended to the circulation in the rat's urinary bladder. The apparatus, shown in fig. 1, consists of the i. A light source in the form of a mercury vapour lamp (250 watts) kindly lent to me by Dr H. C. Wright of the Royal Naval Physiological Laboratories, Alverstoke. The lamp produces brilliant light of low heat content since only a very small fraction of its energy is radiated in the infra-red region. It is kept cool by enclosing it in an asbestos case, 12 X 12 x 2 6 cm., through which air circulates. For taking photographs, a compound lens and an Abbe condenser are introduced between the lamp and the receiving end of the quartz rod.ii. A movable straight quartz rod, 18 cm. long and 4 m. square in transverse section, used to convey light from the lamp to the object. The receiving end of the rod is cut square and the delivery end bevelled a t 45' and polished. The intensity of illumination is regulated by varying the distance between the receiving end of the rod and the light source.The anasthetised rat is fixed to a 15 x 12 cm. cork mat which is placed in a shallow Perspex tray and supported on a raised wooden platform so that the microscope can slide underneath it. iv. A Leitz microscope from which the mechanical stage has been removed, fitted with 25, 16 and 4 mm. objectives and 5 and 10 x eyepieces.Every possible care is exercised to prevent alterations in the tissue temperature, for a variation of even a few degrees suEices t o produce reactive hyperemia in the rat's delicate bladder. Quartz being a very poor conductor of heat and an air gap being interposed between the lamp and the receiving end of the quartz rod, little heat from the light source reaches the object. To remove heat developed from transformation of light energy by the illuminated object, a slow drip of Ringer solution warmed to 38°C. is arranged on the delivery end of the quartz rod and the object from an apparatus shown in fig. 2. The Ringer drip also prevents a fall in the temperature of the bladder due to dissipation of heat to the surrounding atmosphere during the observation.following :-iii. An animal stand.

In a simulated environment, early intervention enabled by RTM reduced healthcare resource utilization and associated costs.

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Dengue type 2 virus was inoculated intracerebrally in 20 adult swiss albino mice. Thigh muscles were removed after 24 h 3, 5 and 7 days after virus inoculation. Electron microscopic studies of the striated muscles show destruction of myofibrils, rarification of the sarcoplasmic reticulum network and changes in the mitochondria. Aggregates of electron-dense material as well as glycogen particles were also seen in the cytoplasm.