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Background Ankle fractures account for 9% of all fractures with a quarter of these occurring in adults over 60 years. The short term disability and long-term consequences of this injury can be considerable. Current opinion favours open reduction and internal fixation (ORIF) over non-operative treatment (fracture manipulation and the application of a standard moulded cast) for older people. Both techniques are associated with complications but the limited published research indicates higher complication rates of fracture malunion (poor position at healing) with casting. The aim of this study is to compare ORIF with a modification of existing casting techniques, Close Contact Casting (CCC). We propose that CCC may offer an equivalent functional outcome to ORIF and avoid the risks associated with surgery. Methods/Design This study is a pragmatic multi-centre equivalence randomised controlled trial. 620 participants will be randomised to receive ORIF or CCC after sustaining an isolated displaced unstable ankle fracture. Participants will be recruited from a minimum of 20 National Health Service (NHS) acute hospitals throughout England and Wales. Participants will be aged over 60 years and be ambulatory prior to injury. Follow-up will be at six weeks and six months after randomisation. The primary outcome is the Olerud & Molander Ankle Score, a functional patient reported outcome measure, at 6 months. Follow-up will also include assessments of mobility, ankle range of movement, health related quality of life and complications. The six-month follow-up will be conducted face-to-face by an assessor blinded to the allocated intervention. A parallel economic evaluation will consider both a health service and a broader societal perspective including the individual and their family. In order to explore patient experience of their treatment and recovery, a purposive sample of 40 patients will also be interviewed using a semi-structured interview schedule between 6-10 weeks post treatment. Discussion This multicentre study was open to recruitment July 2010 and recruitment is due to be completed in December 2013. Trial registration Current Controlled Trials ISRCTN04180738 .

The repo market has been viewed as a potential source of financial instability since the 2007 to 2009 financial crisis, based in part on findings that margins increased sharply in a segment of this market. This paper provides evidence suggesting that there was no system-wide run on repo. Using confidential data on tri-party repo, a major segment of this market, we show that, the level of margins and the amount of funding were surprisingly stable for most borrowers during the crisis. However, we also document a sharp decline in the tri-party repo funding of Lehman in September 2008.

This article presents a basic Kaleckian model, enriched by the simultaneous addition of an Harrodian investment function and an autonomous expenditure component that grows at an exogenous rate. The model shows that the usual short-run properties (wage-led growth) are only transient, since the long-run growth rate converges towards that of autonomous expenditures. However, the impact on the level of variables (output, capital stock, labour, etc.) is permanent. The model also provides a conditional solution to the 'second' Harrod knife-edge problem: the destabilising behaviour of firms (as they adjust their investment decisions to the discrepancy between the actual and the normal rates of capacity utilisation) is now required to achieve the normal rate of capacity utilisation.

Popular support for the welfare state varies greatly across nations and policy domains. We argue that these variations—vital to understanding the politics of the welfare state—reflect in part the degree to which economic disadvantage (low income) and economic insecurity (high risk) are correlated. When the disadvantaged and insecure are mostly one and the same, the base of popular support for the welfare state is narrow. When the disadvantaged and insecure represent two distinct groups, popular support is broader and opinion less polarized. We test these predictions both across nations within a single policy area (unemployment insurance) and across policy domains within a single polity (the United States, using a new survey). Results are consistent with our predictions and are robust to myriad controls and specifications. When disadvantage and insecurity are more correlated, the welfare state is more contested.

This study examines the impact of sustainability efforts on financial performance by analyzing the relationship between Environmental, Social, and Governance (ESG) scores and financial performance in 653 companies across the European Union, with a focus on the \"Blue Banana\" region during the economic instability caused by the COVID-19 pandemic and the Russia-Ukraine war. Using financial indicators such as ROA, ROE, and ROI, the research challenges the belief that sustainability drives financial success and mitigates risks during periods of economic instability. The findings reveal a significant negative effect of the ESG disclosure score on ROA and ROI, while ROE remains unaffected. Companies with higher ESG scores incur additional costs related to sustainability, which can hinder short-term profitability and asset efficiency. Larger and older companies perform better financially, highlighting the role of operational maturity. Additionally, the environmental score negatively impacts ROA due to the costs associated with sustainability practices. These results suggest that the economic trade-offs of ESG integration are more pronounced during periods of instability, offering valuable insights for policymakers and business leaders. This paper contributes to the debate on corporate sustainability in mature markets during economic turmoil, questioning the presumed link between sustainability and financial performance in times of crisis.

We examine the likelihood of becoming a parent in Italy taking into account the employment (in)stability of both partners in a couple. We use data from four waves of the Italian section of the EU-SILC (Statistics on Income and Living Condition), 2004-2007, accounting for its longitudinal nature. Overall, our results suggest that Italian couples are neither fully traditional nor entirely modern: the \"first pillar\" (i.e., a male partner with a stable and well-paid job) is still crucial in directing fertility decisions, because, in our interpretation, it gives the household a feeling of (relative) economic security. But this “old” family typology is becoming rare. Increasingly, both partners are employed, and in this case the characteristics of their employment prove important. A permanent occupation for both partners is associated with higher fertility, while alternative job typologies for either of the two depress fertility.

Misguided U.S. policies since 1980 have created a large undocumented population within the United States. Border militarization curtailed circular undocumented migration from Mexico, and Cold War politics precluded the acceptance of refugees from Central America fleeing violence and economic turmoil unleashed by America’s intervention in the region. Although undocumented migration from Mexico has ended, resources devoted to border apprehensions and internal deportations continue to rise, pushing an ever larger number of Central Americans into an immigrant detention system that is ill‐equipped to handle them. Although the Trump administration portrays the situation as an immigration crisis, what is really unfolding along the border and within the United States is an unprecedented humanitarian cross that in so many ways is one of our own making.