How big is big enough? Toward a sustainable future by examining alternatives to the conventional economic growth paradigm

This study addresses how the sustainability crisis may be overcome by using alternatives to the conventional economic growth paradigm. Based on a literature review, the paper identifies and discusses three alternatives, namely negative, zero and positive economic growth. These alternatives are compared from a feasibility and policy perspective in relation to the transition toward sustainable development. The three alternatives are associated with very far‐reaching sets of policies that have different focal points with regard to how the paradigm shift from the conventional growth paradigm can be realized. All these alternatives, however, challenge the effectiveness of market forces. The shortcomings of the alternatives (resistance to voluntary transition with negative or zero growth, no proper consideration of the rebound effect for positive growth) hinder the transition and must be further addressed by policy‐makers in public and private sectors, as well as by civil society

Weight-bearing in ankle fractures: An audit of UK practice.

INTRODUCTION: The purpose of this national study was to audit the weight-bearing practice of orthopaedic services in the National Health Service (NHS) in the treatment of operatively and non-operatively treated ankle fractures. METHODS: A multicentre prospective two-week audit of all adult ankle fractures was conducted between July 3rd 2017 and July 17th 2017. Fractures were classified using the AO/OTA classification. Fractures fixed with syndesmosis screws or unstable fractures (>1 malleolus fractured or talar shift present) treated conservatively were excluded. No outcome data were collected. In line with NICE (The National Institute for Health and Care Excellence) criteria, "early" weight-bearing was defined as unrestricted weight-bearing on the affected leg within 3 weeks of injury or surgery and "delayed" weight-bearing as unrestricted weight-bearing permitted after 3 weeks. RESULTS: 251 collaborators from 81 NHS hospitals collected data: 531 patients were managed non-operatively and 276 operatively. The mean age was 52.6 years and 50.5 respectively. 81% of non-operatively managed patients were instructed for early weight-bearing as recommended by NICE. In contrast, only 21% of operatively managed patients were instructed for early weight-bearing. DISCUSSION: The majority of patients with uni-malleolar ankle fractures which are managed non-operatively are treated in accordance with NICE guidance. There is notable variability amongst and within NHS hospitals in the weight-bearing instructions given to patients with operatively managed ankle fractures. CONCLUSION: This study demonstrates community equipoise and suggests that the randomized study to determine the most effective strategy for postoperative weight-bearing in ankle fractures described in the NICE research recommendation is feasible