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Background: The MODEM project (A comprehensive approach to MODelling outcome and costs impacts of interventions for DEMentia) explores how changes in arrangements for the future treatment and care of people living with dementia, and support for family and other unpaid carers, could result in better outcomes and more efficient use of resources.Methods: MODEM starts with a systematic mapping of the literature on effective and (potentially) cost-effective interventions in dementia care. Those findings, as well as data from a cohort, will then be used to model the quality of life and cost impacts of making these evidence-based interventions more widely available in England over the period from now to 2040. Modelling will use a suite of models, combining microsimulation and macrosimulation methods, modelling the costs and outcomes of care, both for an individual over the life-course from the point of dementia diagnosis, and for individuals and England as a whole in a particular year. Project outputs will include an online Dementia Evidence Toolkit, making evidence summaries and a literature database available free to anyone, papers in academic journals and other written outputs, and a MODEM Legacy Model, which will enable local commissioners of services to apply the model to their own populations.Discussion: Modelling the effects of evidence-based cost-effective interventions and making this information widely available has the potential to improve the health and quality of life both of people with dementia and their carers, while ensuring that resources are used efficiently. [ABSTRACT FROM AUTHOR]

Prisons offer policymakers an opportunity to address the pre-existing high prevalence of physical and mental health issues among prisoners. This notion has been widely integrated into international and national prison health policies, including the Healthy Prisons Agenda, which calls for governments to address the health needs of prisoners and safeguard their health entitlement during imprisonment, and the Sustainable Development Goals 2030 concerning reducing inequality among disadvantaged populations. However, the implementation of the austerity policy in the United Kingdom since the re-emergence of the global financial crisis in 2008 has impeded this aspiration. This interdisciplinary paper critically evaluates the impact of austerity on prison health. The aforementioned policy has obstructed prisoners' access to healthcare, exacerbated the degradation of their living conditions, impeded their purposeful activities and subjected them to an increasing level of violence. This paper calls for alternatives to imprisonment, initiating a more informed economic recovery policy, and relying on transnational and national organizations to scrutinize prisoners' entitlement to health. These systemic solutions could act as a springboard for political and policy discussions at national and international forums with regard to improving prisoners' health and simultaneously meeting the aspirations of the Healthy Prisons Agenda and the Sustainable Development Goals. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to assess the role of local labour market conditions and pupil educational attainment as primary determinants of the post-compulsory schooling decision. Design/methodology/approach: Through the specification of a nested logit model, the restrictive independence of irrelevant alternatives (IIA) assumption inherent in the multinomial logit (MNL) model is relaxed across multiple unordered outcomes. Findings: The analysis shows that the factors influencing schooling decisions differ for males and females. For females, on average, the key drivers of the schooling decision are expected wage returns based on youth educational attainment, attitudes to school and parental aspirations, rather than local labour market conditions. For males, higher local unemployment rates encourage greater investment in education. Originality/value: The contribution of this paper to the existing literature is threefold. First, a nested logit model is proposed as an alternative to a MNL. The former can formally incorporate the structured and sequential decision-making process that youths may engage with in relation to the post-compulsory schooling decision, as well as relaxing the restrictive IIA assumption inherent in the MNL across multiple unordered outcomes, an issue the authors discuss in more detail in the Methodology section below. Second, the analysis is based on extremely rich socio-economic data from the Longitudinal Study of Young People in England, matched to local labour market data and administrative data from the National Pupil Database and Pupil Level Annual School Census, which provide a broad set of unusually high-quality measures of prior attainment. The authors argue that such high-quality data and an appropriate model specification allows identification of the determinants of the post-compulsory decision in a more detailed manner than many previous analyses. Third, the data have the scale necessary to consider whether the determinants of post-compulsory schooling decisions vary by gender, a particularly important issue given the differential education participation rates of males and females (e.g. in this cohort, females are about 10 percentage points more likely to go on to higher education in the UK than males), and the gendered choices of occupation (see, e.g. Bertrand, 2011). The work will, therefore, provide recent empirical evidence from England on gender differences in the determinants of education choices. [ABSTRACT FROM AUTHOR]

Background The evidence on public health interventions has traditionally focussed on a limited number of costs and benefits, adopted inconsistent methods and is not always relevant to the UK context. This paper develops a multi-criteria decision analysis (MCDA) approach to overcome these challenges. Methods A document review and stakeholder consultation was used to identify interventions and the criteria against which they should be assessed. The interventions were measured against these criteria using literature reviews and decision models. Criteria weights were generated using a discrete choice experiment. Results Fourteen interventions were included in the final ranking. Taxation was ranked as the highest priority. Mass-media campaigns and brief interventions ranked in the top half of interventions. School-based educational interventions, statins and interventions to address mental health problems ranked in the bottom half of interventions. Conclusions This paper demonstrates that it is possible to incorporate criteria other than cost-effectiveness in the prioritization of public health investment using an MCDA approach. There are numerous approaches available that adopt the MCDA framework. Further research is required to determine the most appropriate approach in different settings. [ABSTRACT FROM AUTHOR]

Background: Two to 4% of emergency hospital admissions are caused by preventable adverse drug events. The estimated costs of such avoidable admissions in England were £530 million in 2015. The data-driven quality improvement in primary care (DQIP) intervention was designed to prompt review of patients vulnerable from currently prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and anti-platelets and was found to be effective at reducing this prescribing. A process evaluation was conducted parallel to the trial, and this paper reports the analysis which aimed to explore response to the intervention delivered to clusters in relation to participants' perceptions about which intervention elements were active in changing their practice.Methods: Data generation was by in-depth interview with key staff exploring participant's perceptions of the intervention components. Analysis was iterative using the framework technique and drawing on normalisation process theory.Results: All the primary components of the intervention were perceived as active, but at different stages of implementation: financial incentives primarily supported recruitment; education motivated the GPs to initiate implementation; the informatics tool facilitated sustained implementation. Participants perceived the primary components as interdependent. Intervention subcomponents also varied in whether and when they were active. For example, run charts providing feedback of change in prescribing over time were ignored in the informatics tool, but were motivating in some practices in the regular e-mailed newsletter. The high-risk NSAID and anti-platelet prescribing targeted was accepted as important by all interviewees, and this shared understanding was a key wider context underlying intervention effectiveness.Conclusions: This was a novel use of process evaluation data which examined whether and how the individual intervention components were effective from the perspective of the professionals delivering changed care to patients. These findings are important for reproducibility and roll-out of the intervention.Trial Registration: ClinicalTrials.gov, NCT01425502 . [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to analyse the current nature and content of biodiversity reporting practices adopted by English local councils. By adopting a multi-theoretical framework that relies on economic and social theories such as agency, stakeholder, legitimacy and institutional theories, this study also aims to investigate the factors that explain the extent of biodiversity disclosure provided by local councils. Design/methodology/approach: This study uses a self-constructed disclosure index to analyse the biodiversity-related information published in the official websites of 351 English local councils. A multivariate analysis was conducted to analyse the association between local councils' characteristics and biodiversity disclosure. Findings: This study shows that the information disclosed on local biodiversity is limited and does not allow the interested stakeholders to get a comprehensive picture of the current status of local biodiversity. It also provides evidence that the level of biodiversity disclosure is significantly associated with the level of local council's population, the presence of councillors from environmentally oriented parties and environmental non-governmental organisations operating in the local council area, poor biodiversity management practices and local councils' visibility. Originality/value: This study is one of the few accounting studies that provides a comprehensive analysis of biodiversity disclosure by analysing its nature and content and investigating the factors associated with such disclosure. It extends agency, stakeholder, institutional and legitimacy theories, by showing that local councils use voluntary disclosures to satisfy the informational needs of the main stakeholders and to assure that their strategies and practices conform to the values and expectations of the community they represent. [ABSTRACT FROM AUTHOR]

This paper examines the treatment of ontology offered by critical realism. It addresses much of the material elaborated upon in two editions of this journal. Three main groups of criticisms are made here of the critical realist treatment of open systems. It is argued that critical realism, particularly in the project in economics emanating from Cambridge, UK, tends to define systems in terms of events. This definition is shown to be problematic. The exemplar of a closed system provided by critical realism of the solar system is shown to be flawed in that it is not closed according to the closure conditions identified by critical realism. Second, the negativity of the definitions adopted is problematic for heterodox traditions attempting to build positive programmes. Furthermore, the dualism of the definitions is also inconsistent with Dow's approach, which has ramifications for the coherence of post Keynesianism. Third, the definitions tend to polarize open and closed systems and ignore the degrees of openness evident in reality. The polarization of systems leads to polarized methodology and unsustainable arguments to reject so-called “closed-systems methods.” [ABSTRACT FROM AUTHOR]

For pilot or experimental employment programme results to apply beyond their test bed, researchers must select ‘clusters’ (i.e. the job centres delivering the new intervention) that are reasonably representative of the whole territory. More specifically, this requirement must account for conditions that could artificially inflate the effect of a programme, such as the fluidity of the local labour market or the performance of the local job centre. Failure to achieve representativeness results in Cluster Sampling Bias (CSB). This paper makes three contributions to the literature. Theoretically, it approaches the notion of CSB as a human behaviour. It offers a comprehensive theory, whereby researchers with limited resources and conflicting priorities tend to oversample ‘effect-enhancing’ clusters when piloting a new intervention. Methodologically, it advocates for a ‘narrow and deep’ scope, as opposed to the ‘wide and shallow’ scope, which has prevailed so far. The PILOT-2 dataset was developed to test this idea. Empirically, it provides evidence on the prevalence of CSB. In conditions similar to the PILOT-2 case study, investigators (1) do not sample clusters with a view to maximise generalisability; (2) do not oversample ‘effect-enhancing’ clusters; (3) consistently oversample some clusters, including those with higher-than-average client caseloads; and (4) report their sampling decisions in an inconsistent and generally poor manner. In conclusion, although CSB is prevalent, it is still unclear whether it is intentional and meant to mislead stakeholders about the expected effect of the intervention or due to higher-level constraints or other considerations. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) is a requirement for UK health and social care research funding. Evidence for how best to implement PPI in research programmes, such as National Institute for Health Research (NIHR) Collaborations for Applied Health Research and Care (CLAHRCs), remains limited. This paper reports findings from an action research (AR) project called IMPRESS, which aims to strengthen PPI within CLAHRC East of England (EoE). IMPRESS combines AR with Normalisation Process Theory (NPT) to explore PPI within diverse case study projects, identifying actions to implement, test and refine to further embed PPI. Methods: We purposively selected CLAHRC EoE case study projects for in-depth analysis of PPI using NPT. Data were generated from project PPI documentation, semi-structured qualitative interviews with researchers and PPI contributors and focus groups. Transcripts and documents were subjected to abductive thematic analysis and triangulation within case. Systematic across case comparison of themes was undertaken with findings and implications refined through stakeholder consultation. Results: We interviewed 24 researchers and 13 PPI contributors and analysed 28 documents from 10 case studies. Three focus groups were held: two with researchers (n = 4 and n = 6) and one with PPI contributors (n = 5). Findings detail to what extent projects made sense of PPI, bought in to PPI, operationalised PPI and appraised it, thus identifying barriers and enablers to fully embedded PPI. Conclusion: Combining NPT with AR allows us to assess the embeddedness of PPI within projects and programme, to inform specific local action and report broader conceptual lessons for PPI knowledge and practice informing the development of an action framework for embedding PPI in research programmes. To embed PPI within similar programmes teams, professionals, disciplines and institutions should be recognised as variably networked into existing PPI support. Further focus and research is needed on sharing PPI learning and supporting innovation in PPI. [ABSTRACT FROM AUTHOR]

Background Previous research suggests that the health effects of recessions are mixed and vary spatially between countries. Using the North-South English health divide as an example, this paper examines whether there are also spatial variations within countries. Methods Cross-sectional data on self-reported ‘not good health’ was obtained from the British Household Panel Survey and the Health Survey for England from 1991 to 2010. Age-adjusted generalized linear models were used to examine the effects of recessions (1990/91 and 2008/09) on self-reported health in the four English NHS Commissioning Regions (North, South, Midlands and London) with stratification by gender. Results Over the 20-year study period, the North had consistently higher rates of ‘not good health’ than the South [OR 1.50 (1.46–1.55) outside recessions and OR 1.29 (1.19–1.39) during recessions]. However, during periods of recession, this health divide narrowed slightly with a 2% decrease in the prevalence of ‘not good health’ in the North [OR 0.91 (0.86, 0.96)]. Conclusion This study is evidence of spatial variations in the health effects of recessions within England and the North-South divide appears to slightly reduce during recessions. Health in the North remains worse than the South. [ABSTRACT FROM PUBLISHER]

Background: The National Institute for Health and Care Excellence (NICE) recommends evidence-based parenting programmes as a first-line intervention for conduct disorders (CD) in children aged 5-11 years. As these are not effective in 25-33% of cases, NICE has requested research into second-line interventions. Child and Adolescent Psychotherapists (CAPTs) address highly complex problems where first-line treatments have failed and there have been small-scale studies of Psychoanalytic Child Psychotherapy (PCP) for CD. A feasibility trial is needed to determine whether a confirmatory trial of manualised PCP (mPCP) versus Treatment as Usual (TaU) for CD is practicable or needs refinement. The aim of this paper is to publish the abridged protocol of this feasibility trial.Methods and Design: TIGA-CUB (Trial on improving Inter-Generational Attachment for Children Undergoing Behaviour problems) is a two-arm, pragmatic, parallel-group, multicentre, individually randomised (1:1) controlled feasibility trial (target n = 60) with blinded outcome assessment (at 4 and 8 months), which aims to develop an optimum practicable protocol for a confirmatory, pragmatic, randomised controlled trial (RCT) (primary outcome: child's behaviour; secondary outcomes: parental reflective functioning and mental health, child and parent quality of life), comparing mPCP and TaU as second-line treatments for children aged 5-11 years with treatment-resistant CD and inter-generational attachment difficulties, and for their primary carers. Child-primary carer dyads will be recruited following a referral to, or re-referral within, National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) after an unsuccessful first-line parenting intervention. PCP will be delivered by qualified CAPTs working in routine NHS clinical practice, using a trial-specific PCP manual (a brief version of established PCP clinical practice). Outcomes are: (1) feasibility of recruitment methods, (2) uptake and follow-up rates, (3) therapeutic delivery, treatment retention and attendance, intervention adherence rates, (4) follow-up data collection, and (5) statistical, health economics, process evaluation, and qualitative outcomes.Discussion: TIGA-CUB will provide important information on the feasibility and potential challenges of undertaking a confirmatory RCT to evaluate the effectiveness and cost-effectiveness of mPCP.Trial Registration: Current Controlled Trials, ID: ISRCTN86725795 . Registered on 31 May 2016. [ABSTRACT FROM AUTHOR]

To present an approach to involving people with communication disorders in research. Background Patient and public involvement (PPI) is promoted at all stages of research, with everyone having a right to be involved. However, the high level of communication skills often required precludes the involvement of people with communication disorders. As people from several healthcare groups have communication difficulties, it is important to establish approaches that can help to involve them. Data source A study involving people with communication difficulties using computerised aphasia treatment. Review methods The paper describes techniques used to help an advisory group comprising people with aphasia and their carers to collaborate. Reflections on participating in a research group were elicited through videoed interviews. A thematic analysis of the video transcripts identified issues important to the group's members. Discussion The approach to patient and public involvement in research enabled collaboration with people with aphasia at all stages of research, including contributing to recruitment, refinement of protocols, new research methods and dissemination of project outcomes. Allowing time for careful preparation of group meetings, facilitation techniques and activities is crucial to achieve this level of involvement. Conclusion The group experienced increased confidence in communicating, stimulation and feelings of empowerment and being able to influence the future treatment of people with aphasia. Implications for practice/research People with communication difficulties need not be excluded from PPI activities designed to inform clinical practice or health research. Inclusion of this group can be made possible by using creative methods of exchanging ideas, reducing reliance on rapid, complex spoken interaction. [ABSTRACT FROM AUTHOR]

This paper examines Gilded Age affluence by focusing on apparently inconsequential decorative goods and assessing how such goods were part of shared transatlantic patterns that reached beyond the Gilded Age and the confines of urban America. The paper focuses on figurines recovered from nineteenth-century sites in London and underscores how the American Gilded Age amplified many early nineteenth-century material patterns and ideological practices that were well-established in the United Kingdom and continued after the height of Gilded Age affluence. This study examines the symbolism of such aesthetically eclectic goods and focuses on the socially grounded imagination that was invested in them borrowing from dominant ideologies and idiosyncratic personal experiences alike. [ABSTRACT FROM AUTHOR]

Background The need to make best use of limited resources in the English National Health Service is now greater than ever. This paper contributes to this endeavour by synthesizing data from cost-effectiveness evidence produced to support the development of public health guidance at the National Institute of Health and Clinical Excellence (NICE). No comprehensive list of cost-effectiveness estimates for public health interventions has previously been published in England. Methods Cost-effectiveness estimates using English cost data were collected and analysed from 21 (of 26) economic analyses underpinning public health guidance published by NICE between 2006 and 2010. Results Two hundred base-case cost-effectiveness estimates were analysed, 15% were cost saving (i.e. the intervention was more effective and cheaper than comparator). Eighty-five per cent were cost-effective at a threshold of £20 000 per quality-adjusted life year and 89% at the higher threshold of £30 000. A further 5.5% were above £30 000 and 5.5% of the interventions were dominated (i.e. the intervention was more costly and less effective than comparator). Conclusions The majority of public health interventions assessed are highly cost-effective. The next challenge is to provide commissioners with a framework that allows information from economic analyses to be combined with other criteria that supports making better investment decisions at a local level. [ABSTRACT FROM AUTHOR]

This paper looks at the recent archaeological evidence for industrial housing in Manchester, United Kingdom. The paper argues that a fragmented land-holding pattern developed in a number of city-centre areas during the second half of the eighteenth century. This land-holding pattern gave rise to overcrowding as a result of the domestic redevelopment of back yard plots and the conversion of older housing to tenements. This redevelopment was at its most acute during the peak decades of population growth in the city, 1800-40, and this led to the conditions of poverty, disease, and overcrowding recorded in contemporary accounts from the mid-nineteenth century. [ABSTRACT FROM AUTHOR]

Background In November 2008, the Secretary of State for Health (England) commissioned an independent review to propose effective strategies for reducing health inequalities. Review task groups were given just 3 months to make preliminary evidence-based recommendations. In this paper, we describe the methodology used, and the recommendations made, by the group tasked with inequalities in priority public health conditions. Methods A series of rapid literature reviews of the policy-relevant international evidence base was undertaken. Quantitative studies of any design, which looked at the effects on health inequalities, the social gradient or overall population health effects, of interventions designed to address the social determinants of selected public health priority conditions were examined. Recommendations were distilled using a Delphi approach. Results Five key policy proposals were made: reduce smoking in the most deprived groups; improve availability of and access to healthier food choices amongst low income groups; improve the early detection and treatment of diseases; introduce a minimum price per unit for alcohol and improve the links between physical and mental health care. Conclusion The combination of rapid review and Delphi distillation produced a shortlist of evidence-based recommendations within the allocated time frame. There was a dearth of robust evidence on the effectiveness and cost-effectiveness of the interventions we examined: our proposals had to be based on extrapolation from general population health effects. Extensive, specific and robust evidence is urgently needed to guide policy and programmes. In the meantime, our methodology provides a reasonably sound and pragmatic basis for evidence-based policy-making. [ABSTRACT FROM PUBLISHER]

Professor W. B. Reddaway (known to friends and colleagues as Brian Reddaway) was an exceptional economist who had a huge influence on how economics in Cambridge has been taught and researched. He held leadership positions in the Faculty of Economics and Politics at Cambridge for 25 years, between 1955 and 1980. The main purpose of this paper is to explain Reddaway's method and his distinct approach to economics. It also briefly reviews his life and times. The words in the title summarise his philosophy of research, as will become clear in the paragraphs which follow. [ABSTRACT FROM AUTHOR]

Background: Adult obesity is linked to a greater need for social care because of its association with the development of long term conditions and because obese adults can have physical and social difficulties which inhibit daily living. Obesity thus has considerable social care cost implications but the magnitude of these costs is currently unknown. This paper outlines an approach to estimating obesity-related social care costs in adults aged over 65 in England.Methods: We used univariable and multivariable logistic regression models to investigate the relation between the self-reported need for social care and potential determinants, including body mass index (BMI), using data from Health Survey for England. We combined these modelled estimates of need for social care with the mean hours of help received, conditional on receiving any help, to calculate the expected hours of social care received per adult by BMI.Results: BMI is positively associated with self-reported need for social care. A one unit (ie 1 kg/m2) increase in BMI is on average associated with a 5% increase in the odds of need for help with social care (odds ratio 1.05, 95% CI 1.04 to 1.07) in an unadjusted model. Adjusting for long term illness and sociodemographic characteristics we estimate the annual cost of local authority funded care for those who receive it is £599 at a BMI of 23 but £1086 at a BMI of 40.Conclusion: BMI is positively associated with self-reported need for social care after adjustment for sociodemographic factors and limiting long term illness. The increase in need for care with BMI gives rise to additional costs in social care provision which should be borne in mind when calculating the cost-effectiveness of interventions aimed at reducing obesity. [ABSTRACT FROM AUTHOR]

This paper employs data for the 1993-94 season to estimate a hedonic equation representing the determination of the price structure in the transfer market for professional players in the English football leagues. Player transfer proneness is modelled, and the Heckman two-step procedure is employed to take account of selection bias. The paper identifies those player attributes which affect either the probability of transfer or the transfer fee and evaluates the relative influence of such variables. [ABSTRACT FROM AUTHOR]

Background Adolescent mental health (AMH) needs in England have increased dramatically and needs exceed treatment availability. This study undertook a comparative assessment of the health and economic return on investment (ROI) of interventions to prevent and treat mental disorders among adolescents (10–19 years) and examined intervention affordability and readiness. Methods Interventions were identified following a review of published and grey literature. A Markov model followed a simulated adolescent cohort to estimate implementation costs and health, education, and economic benefits. Intervention affordability was assessed, comparing annual cost per adolescent with NHS England per capita spending, and an expert panel assessed intervention readiness using a validated framework. Results Over 10- and 80-year horizons, interventions to treat mild anxiety and mild depression were most cost-effective, with the highest individual lifetime ROI (GBP 5822 GBP 1 and GBP 257: GBP 1). Preventing anxiety and depression was most affordable and 'implementation ready' and offered the highest health and economic benefits. A priority package (anxiety and depression prevention; mild anxiety and mild depression treatment) would avert 5 million disability-adjusted life-years (DALYS) and achieve an ROI of GBP 15: GBP 1 over 10 years or 11.5 million DALYs (ROI of GBP 55: GBP 1) over 80 years. Conclusion The economic benefits from preventing and treating common adolescent mental disorders equivalent to 25% of NHS England's annual spending in 2021 over 10 years and 91% over 80 years. Preventing and early treatment for anxiety and depression had the highest ROIs and strong implementation readiness. [ABSTRACT FROM AUTHOR]

Background: The UK National Health Service Health Checks programme aims to reduce avoidable cardiovascular deaths, disability and health inequalities in England. However, due to the reported lower uptake of screening in specific black and minority ethnic communities who are recognised as being more at risk of cardiovascular disease, there are concerns that NHS Health Checks may increase inequalities in health. This study aimed to examine the feasibility and acceptability of community outreach NHS Health Checks targeted at the Afro-Caribbean community.Methods: This paper reports findings from an ethnographic study including direct observation of four outreach events in four different community venues in inner-city Bristol, England and follow up semi-structured interviews with attendees (n = 16) and staff (n = 4). Interviews and field notes were transcribed, anonymized and analysed thematically using a process of constant comparison.Results: Analysis revealed the value of community assets (community engagement workers, churches, and community centres) to publicise the event and engage community members. People were motivated to attend for preventative reasons, often prompted by familial experience of cardiovascular disease. Attendees valued outreach NHS Health Checks, reinforcing or prompting some to make healthy lifestyle changes. The NHS Health Check provided an opportunity for attendees to raise other health concerns with health staff and to discuss their test results with peers. For some participants, the communication of test results, risk and lifestyle information was confusing and unwelcome. The findings additionally highlight the need to ensure community venues are fit for purpose in terms of assuring confidentiality.Conclusions: Outreach events provide evidence of how local health partnerships (family practice staff and health trainers) and community assets, including informal networks, can enhance the delivery of outreach NHS Health Checks and in promoting the health of targeted communities. To deliver NHS Health Checks effectively, the location and timing of events needs to be carefully considered and staff need to be provided with the appropriate training to ensure patients are supported and enabled to make lifestyle changes. [ABSTRACT FROM AUTHOR]

Background: Systematic reviews suggest that multi-component interventions are effective in reducing bullying victimisation and perpetration. We are undertaking a phase III randomised trial of the INCLUSIVE multi-component intervention. This trial aims to assess the effectiveness and cost-effectiveness of the INCLUSIVE intervention in reducing aggression and bullying victimisation in English secondary schools. This paper updates the original trial protocol published in 2014 (Trials 15:381, 2014) and presents the changes in the process evaluation protocol and the secondary outcome data collection.Methods: The methods are summarised as follows.Design: cluster randomised trial.Participants: 40 state secondary schools. Outcomes assessed among the cohort of students at the end of year 7 (n = 6667) at baseline.Intervention: INCLUSIVE is a multi-component school intervention including a social and emotional learning curriculum, changes to school environment (an action group comprising staff and students reviews local data on needs to review rules and policies and determine other local actions) and staff training in restorative practice. The intervention will be delivered by schools supported in the first two years by educational facilitators independent of the research team, with a third intervention year involving no external facilitation but all other elements. Comparator: normal practice.Outcomes: Primary: Two primary outcomes at student level assessed at baseline and at 36 months: 1. Aggressive behaviours in school: Edinburgh Study of Youth Transitions and Crime school misbehaviour subscale (ESYTC) 2. Bullying and victimisation: Gatehouse Bullying Scale (GBS) Secondary outcomes assessed at baseline, 24 and 36 months will include measures relating to the economic evaluation, psychosocial outcomes in students and staff and school-level truancy and exclusion rates.Sample Size: 20 schools per arm will provide 90% power to identify an effect size of 0.25 SD with a 5% significance level. Randomisation: eligible consenting schools were randomised stratified for single-sex versus mixed-sex schools, school-level deprivation and measures of school attainment.Discussion: The trial involves independent research and intervention teams and is supervised by a Trial Steering Committee and a Data Monitoring Committee.Trial Registration: Current Controlled Trials, ISRCTN10751359 . Registered on 11 March 2014. [ABSTRACT FROM AUTHOR]

The strategy for NHS modernization in England is privileging individual choice over collective voice in the governance of healthcare. This paper explores the tension between economic and democratic strands in the current reform agenda, drawing on sociological conceptions of embeddedness and on theories of reflexive governance. Building on a Polanyian account of the disembedding effects of the increasing commercialization of health services, we consider the prospects for re-embedding economic relationships in this field. An analysis is provided of the limits of the present legal and regulatory framework of Patient and Public Involvement (PPI) in establishing the democratic and pragmatist conditions of social learning necessary for effective embedding. We show how the attainment of reflexive governance in the public interest is dependent on such conditions, and on the capacities of patients and the public to contribute to debate and deliberation in decision making, including on fundamental policy questions such as how services are provided and by whom.

This paper is concerned with the link between urban quality improvements and economic activity. A key question is whether improvements in the urban environment which might be achieved, for instance, through pedestrianisation, will affect business location choices--for example, are office or retail businesses particularly keen to locate in more pleasant urban places? The paper outlines the current state of development of the literature with respect to the influence of urban quality on economic activity, and proposes a framework for forecasting economic impacts based on three communities of reference: customers, employees, and the businesses themselves. The results from original modelling of a case study area in Manchester, England are reported and suggest that the positive uplifts that may be expected from environmental improvement programmes may well be on a scale which is significant. The research is obviously important for the urban regeneration and renaissance agendas which posit attractive and well-designed environments as a way to create the right conditions for promoting economic growth.

The article is in memory of Philip Andrews, with whom the author has worked in the journal, "Oxford Economic Papers." Philip's enthusiasm was unflagging and his energy inexhaustible. He was always full of ideas about the ways in which the policy should evolve and, at the same time, he was ready to devote unlimited effort to the exacting labor of producing the journal without secretarial assistance. Philip had a strong sense of continuity. He was anxious to ensure that the lines of research, both empirical and theoretical, with which he had been associated should be carried forward and he became the leading member of the Oxford Economists' Research Group. Philip read widely, far beyond the field of economics, both in philosophy and in general literature. Moreover, if he was, in one sense, a genuine revolutionary in his own subject, he was also a traditionalist in that he looked back with regret to the works of an earlier generation when the subject was less narrowly confined within a barrier of conventional assumptions and less exclusively concerned with the manipulation of equations.

This paper aims to estimate the service and social costs of headache presenting in primary care and to identify predictors of headache costs. Patients were recruited from GP practices in England and service use and lost employment recorded. Predictors of cost were identified using regression models. Service and social costs were available on 288 and 282 patients, respectively. Average service costs over 3 months were £117 whilst total costs (including lost production) were £582. Patients referred to neurologists had service costs that were £82 higher than those not referred (90% CI £36-£128). Costs including lost employment were higher by £150, but this was not significant (90% CI -£139-£439). The annual mean service and social costs, weighted to represent population rates of referral, were £468 and £2328, respectively. Higher costs were significantly related to pain. Age was linked to higher service costs and lower social costs. The figures extrapolated to the whole of the UK suggest £956 million due to service use and £4.8 billion including lost employment. These are likely to be underestimates because many people experiencing headaches do not consult their GP. [ABSTRACT FROM AUTHOR]

In this paper I argue for an expansion of the role of assemblage analysis in understanding daily life in nineteenth-century working-class neighborhoods. The close and systematic examination of quality manufacture of nineteenth-century domestic goods offers a material link to consumer decision-making. This is demonstrated in a study of material culture from working-class sites in Sydney and London. [ABSTRACT FROM AUTHOR]

This article discusses the spectacle and publicity that surrounded the exhibition and auction of the Fonthill Abbey in Wiltshire, which was home to writer and traveler William Beckford. When Beckford decided to sell the Fonthill Abbey and its contents due to low finances, an open house of the property thrust it to the national spotlight, and led magazines and papers to write about the Fonthill's opulence. Publicity led to the two portrayals of the Fonthill Abbey, which included one on its iconic grandeur and monetary value, and another on its proprietary and comfortable character. It is said that because the house, as well as its extension of private collections, was opened to the public for financial gain, the architectural vision was undermined by the publicity that surrounded the sale.

Why did England industrialize first? And why was Europe ahead of the rest of the world? Unified growth theory in the tradition of Galor and Weil (2000, American Economic Review, 89, 806–828) and Galor and Moav (2002, Quartely Journal of Economics, 177(4), 1133–1191) captures the key features of the transition from stagnation to growth over time. Yet we know remarkably little about why industrialization occurred much earlier in some parts of the world than in others. To answer this question, we present a probabilistic two-sector model where the initial escape from Malthusian constraints depends on the demographic regime, capital deepening and the use of more differentiated capital equipment. Weather-induced shocks to agricultural productivity cause changes in prices and quantities, and affect wages. In a standard model with capital externalities, these fluctuations interact with the demographic regime and affect the speed of growth. Our model is calibrated to match the main characteristics of the English economy in 1700 and the observed transition until 1850. We capture one of the key features of the British Industrial Revolution emphasized by economic historians — slow growth of output and productivity. Fertility limitation is responsible for higher per capita incomes, and these in turn increase industrialization probabilities. The paper also explores the availability of nutrition for poorer segments of society. We examine the influence of redistributive institutions such as the Old Poor Law, and find they were not decisive in fostering industrialization. Simulations using parameter values for other countries show that Britain’s early escape was only partly due to chance. France could have moved out of agriculture and into manufacturing faster than Britain, but the probability was less than 25%. Contrary to recent claims in the literature, 18th century China had only a minimal chance to escape from Malthusian constraints. [ABSTRACT FROM AUTHOR]

This article examines the distribution of residential property prices in 2001 across local areas in England using spatial econometric methods, showing that spatial variations in local income, income within commuting distance, the stock of residential properties and the quality of local schooling have significant effects. The residual spatial variation due to unknown factors is modelled by a proxy variable, but this does not rule out a significant spatial lag. The article argues that this represents endogenous interaction of property price levels between neighbouring areas, which is interpreted as the outcome of local market knowledge and preference, which produces greater price similarity between an area and its neighbours than one would anticipate from the levels of the exogenous price determinants. [ABSTRACT FROM AUTHOR]

Road pricing LESSONS FROM LONDON This paper assesses the original London Congestion Charging Scheme (LCCS) and its impacts, and it simulates the proposed extension which will include most of Kensington and Chelsea. It also touches upon the political economy of the congestion charge and the increase of the charge from £5 to £8 per day. The possibility of transferring the experience to Paris, Rome and New York is also discussed. The LCCS has had positive impacts. This was despite the considerable political influences on the charge level and location. It is difficult to assess the impacts of the increase of the charge from £5 to £8, which took place in July 2005, because no data have yet been released by Transport for London. The proposed extension of the charging zone does not seem to be an efficient change on economic grounds, at least for the specific boundaries, method of charging and level of charging that is currently planned. Our benefit cost ratios computed under different assumptions of costs and benefits are all below unity. Overall, the experience shows that simple methods of congestion charging, though in no way resembling first-best Pigouvian taxes, can do a remarkably good job of creating benefits from the reduction of congestion. Nevertheless, the magnitude of these benefits can be highly sensitive to the details of the scheme, which therefore need to be developed with great care. [ABSTRACT FROM AUTHOR]

Economic conditions exert a strong influence on regional migration. On the one hand, strong labour market conditions, as exemplified by low unemployment rates and high earnings, draw migrants into regions. On the other hand, strong housing market conditions can prevent movement since commuting may often be an alternative to migration. This can be thought of as giving rise to a migration equilibrium where high house prices choke off migration caused by strong labour market conditions. Expected capital gains in housing, however, can offset high levels of house prices, an effect ignored in previous literature. Migration can also be influenced more directly by the availability of housing relative to population without this being mediated through prices. This paper, by Gavin Cameron, John Muellbauer and Anthony Murphy, presents evidence on inter-regional net and gross migration between the regions of England and Wales that is broadly in accord with these expectations. [ABSTRACT FROM AUTHOR]

Creative industries development has been underway in the city of Stoke-on-Trent for the past fifteen years. Two urban quarters, a creative industries network, 'design-led' regeneration initiatives, and live-work spaces for craft businesses are some of the main projects undertaken in this period. In the past year, this raft of developments has been augmented by a creative industries mapping exercise, and a subsequent funding bid that seeks to draw on UK government and European structural funds in order to act on the research findings, and to put their recommendations into operation. This paper reviews this process both in terms of the political, economic, social, cultural and spatial context of the city, and in terms of broader urban agendas. It provides something of a corrective to the rather 'rose-tinted' picture often drawn of the role and significance of the creative industries for future economic and cultural well-being. [ABSTRACT FROM AUTHOR]

In contrast to traditional methods of instruction, hypermedia learning packages give students the opportunity to determine when instruction will occur and at what pace. However, the learner control provided may not necessarily enhance learning as students may lose task-orientation. Based on a case study of the use of WinEcon in two economics departments in England, this paper provides a descriptive and interpretive account of where and how WinEcon is situated in the course to support learner control and task-orientation among students. To enhance learning, introductory lessons to the hypermedia package and orienting activities must be organized to support the learner control provided by the package. These activities ensure that students are able to focus on and engage in the task, and hence, optimise the learner control in the hypermedia learning environment. [ABSTRACT FROM AUTHOR]

Feminist theories are concerned to analyse how women can transform society so that they are no longer subordinated, by understanding how patriarchal relations control and constrict them. (Abbott and Wallace, 1997: 284) Feminisms start from the position that women are oppressed within a society, which is patriarchal and socially constructed within knowledge which is malestream. This traditionally defines men such that they are rendered subordinate, within a social world constructed by men. Feminisms are engaged with making transparent patriarchal constructs, and illuminating the 'spaces' within which women-realities can become more visible. This paper presents research undertaken by two key services working with male sex workers in central London. The insights gained from this research are discussed, as they allow comparison between the traditionally subordinate position of women and the contextual experiences of the 'hidden' population of male sex industry workers. It demonstrates, that like women, for male sex workers, hegenomic and heterosexist constructs ensure that they also occupy a subordinated position within society. [ABSTRACT FROM AUTHOR]

Tissue viability services have been reconfigured and developed as a result of increased pressure on the NHS to deliver more efficient services that maintain quality of care. There is a need for tissue viability clinicians to develop the skills to outline and effect positive changes in practice. For this, they need business development skills, one of the most important of which is presentation skills. This article describes how to put together a presentation that will successfully promote a business case for change in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Child maltreatment is a significant public health problem. Group Family Nurse Partnership (gFNP) is a new intervention for young, expectant mothers implemented successfully in pilot studies. This study was designed to determine the effectiveness and cost-effectiveness of gFNP in reducing risk factors for maltreatment with a potentially vulnerable population.Methods: A multi-site, randomized controlled, parallel-arm trial and prospective economic evaluation was conducted, with allocation via remote randomization (minimization by site, maternal age group) to gFNP or usual care. Participants were expectant mothers aged below 20 years with at least one live birth, or aged 20-24 years with no live births and with low educational qualifications. Data from maternal interviews at baseline and when infants were 2, 6 and 12 months, and video-recording at 12 months, were collected by researchers blind to allocation. Cost information came from weekly logs completed by gFNP family nurses and other service delivery data reported by participants. Primary outcomes measured at 12 months were parenting attitudes (Adult-Adolescent Parenting Index, AAPI-2) and maternal sensitivity (CARE Index). The economic evaluation was conducted from a UK NHS and personal social services perspective with cost-effectiveness expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. The main analyses were intention-to-treat with additional complier average causal effects (CACE) analyses.Results: Between August 2013 and September 2014, 492 names of potential participants were received of whom 319 were eligible and 166 agreed to take part, 99 randomly assigned to receive gFNP and 67 to usual care. There were no between-arm differences in AAPI-2 total (7 · 5/10 in both, SE 0.1), difference adjusted for baseline, site and maternal age group 0 · 06 (95% CI - 0 · 15 to 0 · 28, p = 0 · 59) or CARE Index (intervention 4 · 0 (SE 0 · 3); control 4 · 7 (SE 0 · 4); difference adjusted for site and maternal age group - 0 · 68 (95% CI - 1 · 62 to 0 · 16, p = 0 · 25) scores. The probability that gFNP is cost-effective based on the QALY measure did not exceed 3%.Conclusions: The trial did not support gFNP as a means of reducing the risk of child maltreatment in this population but slow recruitment adversely affected group size and consequently delivery of the intervention.Trial Registration: ISRCTN78814904 . Registered on 17 May 2013. [ABSTRACT FROM AUTHOR]

The development of English first-class cricket in the modern era appears to conform very satisfactorily to the predictions of the model of industrial organization and behaviour selected in this paper. Around the turn of the twentieth century there emerged a centralized structure for making rules and enforcing controls, a formal cartel of first-class teams. And long before the advent of overt commercialism in the sixties, the cartel developed a clear profit consciousness, for reasons of survival, as evidenced in activity to (i) exclude outsiders who might dilute profit opportunities (both as new members of the group and as competitors in product and input markets), (ii) limit competitive bidding amongst group members in the labour market, (iii) enhance group revenues through demand promotion policies and the search for new sources of income, and (iv) contain costs in ways additional to the protection of labour market monopsony. At the same time, despite this profit orientation, delayed, modified and foregone exploitation of likely profit opportunities reveals patent divergencies from the simple goal of joint profit maximization. These lost opportunities appear capable of being explained in terms of (i) the simultaneous pursuit of the goals of international playing success and the defence of tradition as well as joint profit and (ii.) the protection of self-interest on the part of individual clubs. Thus, contrary to romantic myths concerning the character of cricket, activities of the cartel appear to have displayed a pronounced commercial strain and can in large measure be interpreted in the framework of rational optimizing behaviour. [ABSTRACT FROM AUTHOR]

This paper describes a large-scale experimental investigation into economic behaviour under uncertainty, carried out at EXEC, the Centre for Experimental Economics at the University of York. In particular, the paper considers an empirical investigation into consumption behaviour under uncertainty. The theory of optimal consumption under uncertainty is vast and well-developed, both at a theoretical and empirical level (see most famously, Hall (1978)), and there is available a number of well-defined and tested propositions using optimality techniques. The motivation for this study was to test how closely the predictions of the optimality theory fit the actual behaviour of subjects in an experimental setting. Our main conclusions are twofold: first, that actual behaviour differs significantly from optimal behaviour; second, that nevertheless the comparative static implications of actual behaviour appear to agree with those of optimality theory. The first of these does not surprise us in view of the complexity of the decision-problem. Whether the second is surprising is a matter for some debate. In our view, this indicates the way forward: economic theory ought to concentrate less on exploring relatively 'narrow' theories, such as Subjective Expected Utility theory and its derivatives, and more on exploring the range of assumptions that are necessary to derive certain testable hypotheses; empirical economics ought to search for robust empirical generalisations. We would like to think that this paper has shown the potential of experimental economics in this quest. [ABSTRACT FROM AUTHOR]

Background: Multiple long-term health conditions (MLTCs) are common and increasing among older people, yet there is limited understanding of their prevalence and association with social care expenditure. Aim: To estimate the prevalence of MTLCs and association with English social care expenditure. Methods: Our study population included those aged = 65 who died in England in the year 2018with any of the following long-term conditions recorded on their death certificate: diabetes; cardiovascular diseases (CVDs) including hypertension; dementia; stroke; respiratory; and chronic kidney diseases (CKDs). Prevalence was based on the proportion of death reported for older people with MTLCs (= 2) in each of the 152 English Local Authorities (LAs). Ordinary least square regression (OLS) was used to assess the relationship between prevalence of MTLCs and adult social care expenditure, adjusting for LA characteristics. Results: Of the 409551 deaths reported, 19.9% (n = 81395) had = 2 MTLCs, of which the combination of CVDs-diabetes was the most prevalent. Hospitals were the leading place of death for those with MTLCs. Results from the OLS regression model showed that an increased prevalence of MLTCs is associated with higher LA social care expenditure. A percentage point increase in prevalence of MLTCs is associated with an increase of about £8.13 in per capita LA social care expenditure. Conclusion: Our findings suggest that the increased prevalence of MTLCs is associated with increased LA social care expenditure. It is important for future studies to further explore the mechanisms or link between LA social care expenditure and the prevalence of MTLCs. [ABSTRACT FROM AUTHOR]

There is growing concern that the way that soils are used often results in their degradation, giving rise to significant costs, both to direct users of soils and to society as a whole. This paper develops and uses an approach to derive the total economic cost of soil degradation in England and Wales. An estimate was made of degradation costs at the national scale for dominant combinations of land cover and soils, defined as ‘soilscapes’. An ecosystem services framework was used to assess how degradation affects the capacity of soils to support a range of ‘final goods’, distinguishing between on-site and off-site costs, and market and non-market effects. Quantifiable soil degradation costs ranged between £0.9 bn and £1.4 bn per year, with a central estimate of £1.2 bn, mainly linked to loss of organic content of soils (47% of total cost), compaction (39%) and erosion (12%). Eighty percent of costs occur off-site and, as such, are often of limited concern to those whose actions may be causing soil degradation. The findings confirm that control of soil degradation has implications for a number of key policy areas such as flood risk management and climate change mitigation. [ABSTRACT FROM AUTHOR]

The article provides information about the research paper presented at the Center for Economic Performance/Center for Economic Policy Research Conference titled "Growth, Trade and the Labour Market" which was held at the London School of Economics in England from July 11-12, 1997.

Most of the papers in this symposium were presented at a conference on the economics of information held at Stanford in April 1975, under the auspices of the National Science Foundation—National Bureau of Economic Research (four of the papers, those by Heal, Salop, Spence and Stiglitz, had been submitted to the Review earlier, but because of the similarity of topic, are published with the conference papers). The papers, though all related to the problems arising from costly information, are diverse both with respect to the question addressed, the techniques of analysis employed and the particular markets investigated. A basic theme running through most of the papers is that imperfect information alters, in a fundamental way, the conventional notion of a market, with buyers and sellers coming together to trade; in a full information equilibrium there is a single price, markets clear and all individuals and firms view themselves as price takers. The price charged is independent of the quantity purchased. Although the notion of the market-place is often thought of as an idealization, even when there is not a single market-place at which all transactions occur, the economy behaves as if there were a single market-place; this will be true so long as there are some arbitrageurs to make sure that the "law of single price" prevails. Finally, conventional theory has shown that under fairly weak conditions such a competitive equilibrium exists and is Pareto Optimal. Recent developments in the economics of information, including the papers presented here, have shown that ail of these statements are questionable. In the papers presented here, there is not a single price in equilibrium; firms do not act as price takers; prices do more than just clear markets—they convey information; prices charged may depend on the quantity purchased; competitive equilibrium may not exist and may not be Pareto Optimal. The basic character of how we ought to view the competitive economy is altered if we take seriously imperfections of information. [ABSTRACT FROM AUTHOR]

Training through apprenticeship provided the main mechanism for occupational human capital formation in pre-industrial England. This paper demonstrates how training premiums (fees) complemented the formal legal framework surrounding apprenticeship to secure training contracts. Premiums varied in response to scarcity rents, the expected productivity of masters and apprentices, and served as compensation for the anticipated risk of default. In most trades premiums were small enough to allow access to apprenticeship training for youths from modest families. [ABSTRACT FROM AUTHOR]

ObjectiveTo estimate the costs per relevant unit (pupils and meals) associated with improvements to school food and the potential economic and health gains that may result.DesignCalculation of costs per relevant unit (pupils and meals) based on (i) Department for Education expenditure to support improvements in school food, 2005–2011 and (ii) measures of the changes in the number of pupils taking school lunch and the number of meals served over the same time period; plus examples of the use of linked data to predict longer-term economic and health outcomes of healthier eating at school.SettingEngland.SubjectsLocal authorities, government departments and non-departmental public bodies.ResultsAnalysis of investment over a 6-year period indicates that costs of setting up and maintaining a change organization such as the School Food Trust were low in relation to short-term benefits in nutrition and behaviour. Models that predict long-terms gains to the exchequer and to quality-adjusted life years need further elaboration.ConclusionsModest levels of government investment in the delivery and promotion of healthier school food is likely to yield both short-term and long-term benefits in relation to nutrition, learning, economics and health. [ABSTRACT FROM PUBLISHER]

This paper uses demographic data drawn from Wrigley et al.'s (1997) family reconstitutions of 26 English parishes to adjust Allen's (2001) real wages to the changing demography of early modem England. Using parity progression ratios (a fertility measure) and age specific mortality for children and parents, model families are predicted in two reference periods 1650-1700 and 1750-1800. These models yield two levels of interesting results. At the individual family level, we can measure how different families' real wages changed over the family life cycle as additional children were born. At the aggregate level, we can predict thousands of families using Monte Carlo simulation, creating a realistic distribution of median family real wages in the economy. There are two main findings. First, pregnancy and lactation do not create cyclical effects in the family's income. Instead, most families' welfare ratios decline steadily across the family life cycle until children begin to leave the household, increasing the welfare ratios. Second, Allen's real wages understate or match the median of the predicted demography-adjusted distributions. [ABSTRACT FROM AUTHOR]

This paper presents a new econometric model for analysing population growth at the village and town level. It develops and applies a theory of the equilibrium distribution of population over space. The theory emphasises geographical fundamentals, such as rivers as transport corridors, and soil types that govern agricultural specialisation; also institutional factors such as town government, market charters and the concentration of land ownership. Nineteenth century Oxfordshire is used as a case study, but the method can also be applied at a multi-county and national level. The results show that the development of railways in nineteenth-century Oxfordshire accelerated a long-term shake-out in the market system, whereby rural markets disappeared and urban markets grew. This shake-out had significant implications for population growth at the local level. [ABSTRACT FROM AUTHOR]

This article reports on the receipt of University of Cambridge, Cambridge, England Professor of Applied Economics David Newbery of the Outstanding Contributions to the Profession of Energy Economics Award in 2002 from the International Association for Energy Economics (IAEE). The Award was presented to Newbery at the IAEE Prague Conference in 2003. University of Cambridge has been the locus of his academic career, but he has spent time at other academic institutions, with organizations such as the World Bank, and has served on several commissions. His publication and research record is indeed prodigious, much of it relating to taxation, regulation, transportation, commodity pricing, cost-benefit analysis, resources, and especially of late, electricity. Here he has been spearheading research on electricity markets, dealing with the thorny problems of market liberalization, regulation, restructuring and privatization. His contributed paper on energy tax policy is indicative of his long term interest in this topic, an interest that dates back at least to the mid-1980s.

The profits of the Liverpool slave trade are infamous, if somewhat more realistically represented in recent literature. Contemporaries and historians have posited that these higher profits were required to entice merchants into the trade because of the higher risks. However, there is very little work which investigates whether the risks of the slave trade really were higher than other similar opportunities. This article uses the case study of Liverpool slave traders to investigate the risks within the slave trade compared to other Atlantic ventures, and how Liverpool merchants managed those risks. It will argue that the slave trade was indeed a relatively risky trade in comparison with other Atlantic ventures, but that Liverpool merchants not only understood these risks, but actively embraced them, allowing them to manage them extremely well. [ABSTRACT FROM AUTHOR]