ContributorsGIW wrote and revised the manuscript in response to co-author comments. He finalized all the figures and tables, performed the literature search, and assisted with data interpretation. HJK critically reviewed the manuscript and made important suggestions to improve it. He assisted with data interpretation. IBA performed the data analysis, constructed the figures and tables, and made important suggestions to improve the manuscript. H-CK assisted with the data analysis and also reviewed the manuscript. GRC critically reviewed the manuscript and made important suggestions to improve it. He assisted with data interpretation. All other authors were given the opportunity to review the manuscript and make suggestions which GIW received, either revising the paper or providing explanations. All who are not deceased were involved with approval of the manuscript.

Sulfasalazine does not prevent EDSS score progression in the subset of MS patients studied by this protocol. Treatments may improve relapse-related outcomes in MS, at least temporarily, without providing sustained slowing of EDSS progression. Phase III MS trials should be of sufficient length to determine a meaningful impact on disease course.

Background: Chronic kidney disease with metabolic acidosis is common in older people, but the effectiveness of oral sodium bicarbonate therapy in this group is unclear. We tested whether oral sodium bicarbonate provides net health benefit for older people with advanced chronic kidney disease and serum bicarbonate concentrations < 22 mmol/L. Methods: Pragmatic multicentre, parallel group, double-blind, placebo-controlled randomised trial. We recruited adults aged ≥ 60 years with estimated glomerular filtration rate of < 30 mL/min/1.73 m 2 , not receiving dialysis, with serum bicarbonate concentration < 22 mmol/L, from 27 nephrology and geriatric medicine departments in the UK. Participants received oral sodium bicarbonate (up to 3 g/day) or matching placebo given for up to 2 years, randomised in a 1:1 ratio. The primary outcome was between-group difference in the Short Physical Performance Battery (SPPB) at 12 months, adjusted for baseline values, analysed by intention to treat. Secondary outcomes included generic and disease-specific quality of life (EQ-5D and KDQoL tools), anthropometry, renal function, walk distance, blood pressure, bone and vascular health markers, and incremental cost per quality-adjusted life year gained.

The Regulations governing Materials Recovery Facilities (MRFs) in England require that they report on the quality of both the incoming mixed wastes and the single-stream recyclate products, with the results being made available on a public register. In this investigation, tests were conducted on a number of mixed wastes from different suppliers being processed at a qualifying MRF to evaluate how effective the Regulations (or MRF Code of Practice (MRF CoP)) were in generating useful, meaningful information. The empirical evidence obtained showed that MRF CoP in its current form has a number of serious flaws which detract from the validity and value of the reported operational data. The statutory definition of ‘material particles’ in the mixed wastes given in the MRF CoP means that compliance with the MRF CoP is impracticable, and in order to overcome this it will be necessary to re-word the definition of ‘material particles’. Empirical evidence also invalidated the explicit assumption made in the MRF CoP that the composition of the material particles is identical to that of the bulk materials, and consequently the basis for the mandatory apportioning of the weight of the material particles has no logical foundation and apportioning leads to distortion in the reported data. Changes will be required to the present statutory requirements for reporting operational results if the recorded information is to have meaning and relevance for stakeholders in the system.

No abstract