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I suggest that two features of Adam Smith's talk of justice and liberty reflect a priority on instilling duties, as opposed to instilling rights. The first feature has to do [...]

BackgroundAdults with HIV have an increased burden of non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease. The objective of this study was to estimate the population attributable fractions (PAFs) of preventable or modifiable HIV-related and traditional risk factors for non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease outcomes.MethodsWe included participants receiving care in academic and community-based outpatient HIV clinical cohorts in the USA and Canada from Jan 1, 2000, to Dec 31, 2014, who contributed to the North American AIDS Cohort Collaboration on Research and Design and who had validated non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, or end-stage renal disease outcomes. Traditional risk factors were tobacco smoking, hypertension, elevated total cholesterol, type 2 diabetes, renal impairment (stage 4 chronic kidney disease), and hepatitis C virus and hepatitis B virus infections. HIV-related risk factors were low CD4 count (400 copies per mL), and history of a clinical AIDS diagnosis. PAFs and 95% CIs were estimated to quantify the proportion of outcomes that could be avoided if the risk factor was prevented.FindingsIn each of the study populations for the four outcomes (1405 of 61 500 had non-AIDS-defining cancer, 347 of 29 515 had myocardial infarctions, 387 of 35 044 had end-stage liver disease events, and 255 of 35 620 had end-stage renal disease events), about 17% were older than 50 years at study entry, about 50% were non-white, and about 80% were men. Preventing smoking would avoid 24% (95% CI 13-35) of these cancers and 37% (7-66) of the myocardial infarctions. Preventing elevated total cholesterol and hypertension would avoid the greatest proportion of myocardial infarctions: 44% (30-58) for cholesterol and 42% (28-56) for hypertension. For liver disease, the PAF was greatest for hepatitis C infection (33%; 95% CI 17-48). For renal disease, the PAF was greatest for hypertension (39%; 26-51) followed by elevated total cholesterol (22%; 13-31), detectable HIV RNA (19; 9-31), and low CD4 cell count (13%; 4-21).InterpretationThe substantial proportion of non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease outcomes that could be prevented with interventions on traditional risk factors elevates the importance of screening for these risk factors, improving the effectiveness of prevention (or modification) of these risk factors, and creating sustainable care models to implement such interventions during the decades of life of adults living with HIV who are receiving care.FundingNational Institutes of Health, US Centers for Disease Control and Prevention, the US Agency for Healthcare Research and Quality, the US Health Resources and Services Administration, the Canadian Institutes of Health Research, the Ontario Ministry of Health and Long Term Care, and the Government of Alberta.

BackgroundThere is persistent confusion as to whether abacavir (ABC) increases the risk of myocardial infarction (MI), and whether such risk differs by type 1 (T1MI) or 2 (T2MI) MI in adults with HIV.MethodsIncident MIs in North American Cohort Collaboration on Research and Design participants were identified from 2001 to 2013. Discrete time marginal structural models addressed channeling biases and time-dependent confounding to estimate crude hazard ratio (HR) and adjusted hazard ratio (aHR) and 95% confidence intervals; analyses were performed for T1MI and T2MI separately. A sensitivity analysis evaluated whether Framingham risk score (FRS) modified the effect of ABC on MI occurrence.ResultsEight thousand two hundred sixty-five adults who initiated antiretroviral therapy contributed 29,077 person-years and 123 MI events (65 T1MI and 58 T2MI). Median follow-up time was 2.9 (interquartile range 1.4-5.1) years. ABC initiators were more likely to have a history of injection drug use, hepatitis C virus infection, hypertension, diabetes, impaired kidney function, hyperlipidemia, low (

BackgroundPrevious studies of cardiovascular disease (CVD) among HIV-infected individuals have been limited by the inability to validate and differentiate atherosclerotic type 1 myocardial infarctions (T1MIs) from other events. We sought to define the incidence of T1MIs and risk attributable to traditional and HIV-specific factors among participants in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and compare adjusted incidence rates (IRs) to the general population Atherosclerosis Risk in Communities (ARIC) cohort.MethodsWe ascertained and adjudicated incident MIs among individuals enrolled in 7 NA-ACCORD cohorts between 1995 and 2014. We calculated IRs, adjusted incidence rate ratios (aIRRs), and 95% confidence intervals of risk factors for T1MI using Poisson regression. We compared aIRRs of T1MIs in NA-ACCORD with those from ARIC.ResultsAmong 29,169 HIV-infected individuals, the IR for T1MIs was 2.57 (2.30 to 2.86) per 1000 person-years, and the aIRR was significantly higher compared with participants in ARIC [1.30 (1.09 to 1.56)]. In multivariable analysis restricted to HIV-infected individuals and including traditional CVD risk factors, the rate of T1MI increased with decreasing CD4 count [≥500 cells/μL: ref; 350-499 cells/μL: aIRR = 1.32 (0.98 to 1.77); 200-349 cells/μL: aIRR = 1.37 (1.01 to 1.86); 100-199 cells/μL: aIRR = 1.60 (1.09 to 2.34);

Upwards of 70% of the Covid19 death toll in Sweden has been people in elderly care services (as of mid-May 2020). We summarize the Covid19 tragedy in elderly care in Sweden, particularly in the City of Stockholm. We explain the institutional structure of elderly care administration and service provision. Those who died of Covid19 in Stockholm's nursing homes had a life-remaining median somewhere in the range of 5 to 9 months. Having contextualized the Covid19 problem in City of Stockholm, we present an interview of Barbro Karlsson, who works at the administrative heart of the Stockholm elderly care system. Her institutional knowledge and sentiment offer great insight into the concrete problems and challenges. There are really two sides to the elderly care Covid19 challenge: The vulnerability and frailty of those in nursing homes and the problem of nosocomial infection-that is, infection caused by contact with others involved in the elderly care experience. The problem calls for targeted solutions by those close to the vulnerable individuals., Author(s): Charlotta Stern [sup.1] , Daniel B. Klein [sup.2] Author Affiliations: (1) grid.10548.38, 0000 0004 1936 9377, Department of Sociology, Stockholm University, , SE-106 91, Stockholm, Sweden (2) grid.22448.38, 0000 [...]

#WalkAway signifies walking away from the Democratic Party. The movement was launched in June 2018 by Brandon Straka, when he uploaded what became the prototypical video of an individual telling his or her story about walking away. During 130 days, 150 erstwhile Democrats provided video testimonials at Straka's official YouTube channel. Of the 150 erstwhile Democrats, 23% report catching a lot of grief, plus another 16% report catching some grief, for questioning or deviating from leftist opinions. Most importantly, 70% suggest a civility gap between the left and non-left. These are lower bounds, since the testimonials are spontaneous monologues, not replies to questions. Many other observed features are reported, to deepen our thinking about ideological migration. However, filters involved in the sample must be borne in mind. A linked Excel file contains complete data., Author(s): Daniel B. Klein [sup.1] , Cy Fleming [sup.1] Author Affiliations: (1) grid.22448.38, 0000 0004 1936 8032, Mercatus Center, George Mason University, , 22031, Fairfax, VA, USA #WalkAway signifies walking [...]

Prompted by Emily Chamlee-Wright's fine essay 'Self-censorship and Associational Life in the Liberal Academy' (the symposium lead essay), I present a scheme that focuses on something that might not seem to fit Emily's focus on self-censorship. But after presenting my Scheme I will suggest that it does. My scheme focuses on the wrestling we engage in to alter the composite character of the communities we belong to. It turns out that one of the dimensions of dissimilitude within the community, a dimension to some extent beyond politics, is liberal arts affirmation versus solidaric political affirmation., Author(s): Daniel B. Klein [sup.1] Author Affiliations: (1) grid.22448.38, 0000 0004 1936 8032, Mercatus Center, George Mason University, , 22031, Fairfax, VA, USA Emily Chamlee-Wright (2019) presents the central dilemma: [...]

Hepatitis C virus (HCV) co-infection and biological sex may each affect response to antiretroviral therapy (ART), yet no studies have examined HIV-associated outcomes by both HCV status and sex. We conducted a cohort study of HIV-infected adults initiating ART in Kaiser Permanente California during 1996-2011. We used piecewise linear regression to assess CD4 changes by sex and HCV status over 5 years. We used Cox regression to estimate hazard ratios (HR) by sex and HCV status for HIV RNA

Ostension is the act or process of showing, as in showing a child a fossil while saying 'fossil.' Here collected are 59 quotations about language, discourse, ostension, and semantics. A theme is the 'facts are theory-laden' spiral between language and discourse, between explananda and explanation - the philosophy-of-science problem (and the pervasive political problem) of justifying our judgment in favor of one over against another outlook. The collection highlights individual personage - and hence history, or historicity - as conditioning the content of a theory (or the complex that spans explanandum and explanation). The individual personage infuses meaning into words or signs in showing his own doings including speech acts (discourse, parole). Multiple quotations are authored by Thomas Kuhn, J.G.A. Pocock, Karl Kraus, Adam Smith, Josep Pieper, Friedrich Hayek, Oliver Wendall Holmes, Sr., Otto Jespersen, Iain McGilchrist, and Steven Mithen. A single quotation is authored by John Milton, Edmund Burke, Gershom Carmichael, Ralph Waldo Emerson, Søren Kierkegaard, Kenneth Burke, Michael Polanyi, Thomas Schelling, Wayne Booth, and William Graham Sumner., Author(s): Daniel B. Klein [sup.1] Author Affiliations: (Aff1) 0000 0004 1936 8032, grid.22448.38, Mercatus Center, George Mason University, , Fairfax, VA, USA Thomas Kuhn 1970, 271 #1. What they had [...]

Jordan Peterson says that postmodernists say no interpretation is better than another. I would no sooner identify Peterson's adversaries as those who have been misled by 'postmodernism' than I would identify them as misled by 'sustainability,' 'diversity,' 'multiculturalism,' or 'intersectionality.' Such fare is mainly symptomatic. 'Postmodern' invocations are often like 'sustainability' invocations: inessential. This piece is not a defense of postmodernism. It is a critique of PoMo-bashing., Author(s): Daniel B. Klein [sup.1] Author Affiliations: (Aff1) 0000 0004 1936 8032, grid.22448.38, Mercatus Center, George Mason University, , 22031, Fairfax, VA, USA Jordan Peterson positions himself in opposition to [...]

The name Erik Gustaf Geijer (1783-1847) is little known outside of Sweden, but the volume Freedom in Sweden: Selected Works of Erik Gustaf Geijer (Geijer 2017 (See CR3)) translates choice works and presents Geijer to modern readers. In this essay we provide an introduction to Geijer (pronounced yay-yer). We raise the question of whether his declaring, in 1838, in dramatic fashion, for liberalism was an ideological migration or a coming out of the closet. We discuss the scope and flavor of his discourse, and suggest that he belongs in the company of moral philosophers and historians of civilization such as David Hume, Adam Smith, Edmund Burke, and Alexis de Tocqueville. We highlight his essay 'An Economic Dream,' which prefigured Hayek's likening of the price system to an allegory of society-spanning communication and intelligence., Author(s): Björn Hasselgren [sup.1] , Daniel B. Klein [sup.1] Author Affiliations: (Aff1) 0000 0004 1936 8032, grid.22448.38, Mercatus Center, George Mason University, , 22031, Fairfax, VA, USA [Displayed Quote]A new [...]

I arrived here at the UC Transportation Center just nine months ago. A former lawyer and aspiring writer, I had only a layman's knowledge of transportation systems, mostly based on my personal experiences. Growing up in Hilo, Hawaii, I thought traffic jams meant having to circle the parking lot twice to find a space. No one worried about ozone or took cars in for smog checks. Every desirable destination - shopping malls, movie theaters, beaches, even downtown - was within a few minutes' drive.

The 1990 amendments to the Clean Air Act mandated that local governments that violate federal ozone (urban smog) standards abide by a dizzying array of regulations, many of the most controversial of which--centralized state inspection and maintenance programs, carpooling requirements, zero- emission vehicle sales quotas, use of alternative fuels, and new-vehicle emission standards--are intended to control automobile emissions.

Urban transit has traditionally been conceived and governed within a paradigm of regulation and government ownership. This study explains how the alternative paradigm of property rights, which works so well in other sectors of the economy, can apply to urban transit. The key to a property rights framework is defining the building-block properties of the system. The study explains why the essential properties for the case of fixed-route urban transit are curbspaces, or bus stops, at which a scheduled service can secure for itself the passenger congregations generated by its investments. The study proposes a system of curb fights, including exclusive curb zones leased by auction and owned like property, and common curb zones where freewheeling jitney services can pick-up passengers. The study also offers property-rights interpretations of diverse transit experiences, and proposes privatization and deregulation for all forms of transit.

The paper shows how variations in systems of property rights explain diverse experiences of urban jitneys and buses. Scheduled bus service entails route specific investments and cultivation of a market. If these investments can be expropriated by interloping jitneys, scheduled service will be dissolved. Property rights in curbspace determine whether scheduled service will be preserved, and whether jitney services will co-exist. We analyze the dynamics of thick and thin transit markets, with and without curb rights. We develop a governance system of curb rights that would let bus operators appropriate their own investments in scheduled service, yet would avoid monopoly by letting jitneys and competing scheduled services operate along the same route. A property rights system dispenses with government ownership, franchise contracting, and regulation.

The experience of British bus deregulation has resulted in less on-the-road competition than anticipated, and a high degree of industry concentration. We argue that the specific form of deregulation in Britain has created a property rights problem in the cultivation of passenger congregations at the curb. The result has been schedule jockeying and route swamping. From a property rights perspective, the disappointing results can be seen as a commons problem. A nuanced approach to property right at bus stops, permitting scheduled service to appropriate its investment in cultivating passenger congregations, and allowing freewheeling jitneys to compete on the route, could bring the benefits that many had expected from deregulation.

Reducing emissions of pollutants from cars requires that new vehicles be designed and built to pollute less, and also requires some ongoing inspection and maintenance programme to ensure that a vehicle's operation conforms to those design standards. This paper focuses on these programmes, commonly called Smog Check programmes. The most extensive and well-studied Smog Check programme in the United States is in California. Though that state is not typical in all respects, examining its experience is instructive.

I select 46 passages from George Will's Statecraft as Soulcraft: What Government Does (1983 (See CR3)), because they deserve a fresh hearing., Author(s): Daniel B. Klein [sup.1] Author Affiliations: (1) Mercatus Center, George Mason University, 0000 0004 1936 8032, grid.22448.38, , 22031, Fairfax, VA, USA During the past 15 years I have [...]

With county and state government unable to effect road improvement, California lawmakers immediately opened the field to private initiative. At least 159 private companies successfully built and operated toll roads in California. Compared to earlier toll roads in the eastern U.S., the California roads were concentrated in ownership and more profit-oriented in operation. Even so, the quest for mere road improvement was often also an important impetus for taking toll road stock. Voluntary association assumed the corporate form to achieve its several goals.

A consensus is emerging among transportation economists that the best way to deal with freeway congestion is to charge for driving during peak hours. The main barrier to implementation is political: drastic change is politically unpopular. This paper proposes a way of overcoming the political obstacles by phasing in congestion pricing over a period of many years.

Barcelona commuters receive a monthly highway bill, without ever having stopped at a tollbooth. Cars on the Autostrada, which connects Milan, Florence, Rome and Naples, whiz past roadside electronic readers that automatically deduct credit from prepaid smartcards which are similar to the copycards familiar to library users. Electronic toll collection is now used on the Esterel-Cote d'Azur; two toll-ring systems in Norway; the Dallas North Tollway; the Oklahoma Turnpikes; and two facilities in New Orleans. Reliability and accuracy rates run as high as 99.9 per cent. Unless there is successful labour resistance, by the year 2000 electronic toll collection will be operating on every major toll facility in the United States. Stopping at tollbooths will be obsolete for all but the infrequent traveller.The advance in technology is accompanied by a shift in policy. The franchising of highway services is now under way: California has four projects in progress; Virginia, one project; and planning is in hand in many other states. Furthermore, the Intermodal Surface Transportation Efficiency Act of 1991 will bring a tide of new projects, as it permits the commingling of federal and private funds. Different approaches to franchising have been used. This article investigates the alternatives and proposes a plan for highway franchising.

From 1847 to 1853 New Yorkers built more than 3,500 miles of wooden roads. Financed primarily by residents of declining rural townships, plank roads were seen as a means of linking isolated areas to the canal and railroad network. A broad range of individuals invested in the roads, suggesting that the drive for bigger markets was supported by a large cross section of the population. Considerable community spirit animated the movement, indicating that New Yorkers used the social capital of the community to reach their entrepreneurial aspirations.

The first issue of ACCESS seems to have been well received, so we're pleased to continue these summaries of our research. Paralleling the spurt of work on new transportation technology, there's been renewed attention to institutional means for improving the nation's transport system. We focus here on several such fiscal and organizational tools for decreasing solo driving, increasing transit riding, and thereby reducing highway congestion, air pollution, and energy consumption.

California has authorized four toll roads to be constructed and operated by private groups, and it is considering more. Construction on a similar 14-mile project in Virginia will begin in 1992. Florida, Texas, and Colorado are considering proposals for private toll roads, and there is talk of a 500-mile private connection between Chicago and Kansas City. Outside the United States, private groups are operating toll roads in France and Italy. Indeed, the idea of private toll roads is making a comeback.We say "comeback" because many regions of the United States were once laced with private toll roads. In the early 1800s turnpiking was the leading form of transportation improvement. At mid-century an elaborate system of short turnpikes and plank roads served as feeders to the canals and railroads. In Colorado and California private toll roads served the early mining camps. By the year 1900 scores of rustic toll roads continued to traverse rural areas nation-wide. During the 19th century at least 2,000 private companies operated toll roads.

The years 1800-1830 are sometimes designated "the turnpike era," since in the 1830s canals and railroads began eclipsing the old wagon roads. Its true that long distance travel went by water and rail, but the journey often began on one of the many short toll roads feeding the system. This paper documents the changing composition of the New York toll road system as a whole, and provides some firm-level data. Toll roads continued to play an important role up to the Civil War and afterwards.

The notion of private highways, which must have seemed fantastic to Americans just a few years ago, was commonplace to our great-great-grandparents. Built in the 1790s in the growing Republic, the first toll roads stimulated commerce, settlement, and population. Fiscal constraints and insufficient administrative manpower led communities to search outside the public sector for help. During the 19th century more than 2,000 private companies financed, built, and operated toll roads. A glimpse at our history may provide a useful perspective on today's budding toll-road movement.

Modern experimentation with privately built and operated toll roads has an enormous precedent in 19th century America. Over 2,000 private companies operated toll roads, financed mainly by voluntary stock subscription. The paper describes the old movement and makes a point by-point comparison between the old toll roads and the modern toll roads. Proponents of modern toll road can benefit from a knowledge of their predecessors' experience with regulation, concessions based on equity, and the role of local communities in deciding the fate of projects.