Wrestling with MUDs To Pin Down the Truth About Special Districts

Federal, state, and local governments encourage and empower special districts--board-run, special purpose local government units that are administratively and fiscally independent from general purpose local governments. Special districts receive incentives, grants, and freedom from limitations (such as limitations on tax and debt) imposed on general purpose local governments. Special districts are treated favorably because they are small in size, which theoretically means they foster democratic participation; are limited in purpose, meaning that states can tailor special districts\u27 powers to serve specific problems; and are viewed as efficient solutions to specific problems. Though special districts have tripled in number over the last fifty years, the rationale justifying their favorable treatment has not been thoroughly scrutinized. One obstacle to such scrutiny is the difficulty in determining a metric of assessment: Too many different kinds of special districts exist, and the scope of districts changes constantly. An imperfect, but no less revealing, method is a close investigation of one type of special district. This Article provides one of the few in-depth reviews of special districts in the academic literature, focusing on the Texas municipal utility district (MUD), originally designed to supply water to unincorporated areas. MUDs--the most common type of special district in the state with the third largest number of special districts--embody both the strengths and weaknesses of special districts. Texas\u27s failure to address MUDs\u27 negative effects reflects our nationwide failure to analyze and correct problematic special districts. This Article discusses MUDs\u27 formation, powers, and scope, and analyzes how MUDs operate without real democratic checks, have too much power, and ineffectively work toward their goals. Throughout, it attempts to engage the central question in modern local government law: the optimality of certain units of government

Beyond Worship: The Religious Land Use and Institutionalized Persons Act of 2000 and Religious Institutions\u27 Auxiliary Uses

Religious institutions have long offered their congregants services that go beyond worship. From access to schools or community halls to services as basic as parking, religious institutions necessarily use their land and resources for more than just religious observance. But particularly in the last two decades, they have begun expanding far beyond their traditional offerings to a wider and more diverse array of auxiliary uses --non-worship uses that are affiliated with a religious institution. Religious institutions now run insurance agencies, hospitals, health maintenance organizations, and transportation companies. They manage retail stores that sell religiously themed merchandise, incorporate popular franchises like Starbucks and McDonald\u27s, finance recording studios, and operate credit unions and banks. The nation\u27s second-largest church (with 30,000 congregants) has even begun developing both a 1200-home neighborhood and a 280-unit gated retirement community. The expanding breadth of the auxiliary uses offered by modem religious institutions raises the critical question considered by this Note: Which auxiliary uses should government protect, and how far should those protections be extended

A coalition-driven examination of organization capacity to address food insecurity in Greater Houston: a qualitative research study

BackgroundEconomic and social hardships have worsened food insecurity, particularly among low income and racial-ethnic minority groups. Given the core goal of the 150+ member Houston Health Equity Collective (HEC) to reduce food insecurity by 5% in 2025, we explored member organizations' capacity and challenges faced in screening and responding to food insecurity through care coordination efforts.MethodsA twice-administered Qualtrics XM survey (Provo, Utah) with 76 organizations, followed by five focus groups with 22 of these organizations, explored reach and response efforts to food insecurity. Qualitative assessments lasted between 0.5 to 1.5 h, were audio-recorded, cleaned, coded, and thematically analyzed using NVivo, version 11 (Burlington, Massachusetts). The qualitative study was guided by a general inductive approach. In total, over 6 h of audiovisual recording were extracted, and over 100 pages of text exported to NVivo for data analysis. The research team read and coded transcripts independently using the codebook, and met routinely to discuss and resolve codes -resulting in numerous revisions to the codebook. Coding structure was discussed at multiple meetings and differences were addressed through consensus. Predominant qualitative themes impacting food insecurity screening were “stigma and cultural-related barriers”, “clinic capacity and attitudes”, “need to focus on upstream influences of food insecurity and SDOH needs”, “impact of COVID-19”, and “need for HEC system responses”. Main recommendations to enhance screening and reach included improving staff culture, enhancing cultural sensitivity across organizational practices, and using shared technology to coordinate care. Respondents stated that the HEC can drive these recommendations through networking opportunities, use of shared resource directory, and placing focus on upstream factors.ConclusionsRecommendations to target food insecurity must focus on organizational staff responsiveness and sensitivity to patients' needs. Of equal importance is the need for increased attention to the upstream influencers and integration of systems-level interventions to holistically target the barriers impacting food insecurity

Adolescent Engagement in Dangerous Behaviors Is Associated with Increased White Matter Maturity of Frontal Cortex

Background: Myelination of white matter in the brain continues throughout adolescence and early adulthood. This cortical immaturity has been suggested as a potential cause of dangerous and impulsive behaviors in adolescence. Methodology/Principal Findings: We tested this hypothesis in a group of healthy adolescents, age 12–18 (N = 91), who underwent diffusion tensor imaging (DTI) to delineate cortical white matter tracts. As a measure of real-world risk taking, participants completed the Adolescent Risk Questionnaire (ARQ) which measures engagement in dangerous activities. After adjusting for age-related changes in both DTI and ARQ, engagement in dangerous behaviors was found to be positively correlated with fractional anisotropy and negatively correlated with transverse diffusivity in frontal white matter tracts, indicative of increased myelination and/or density of fibers (ages 14–18, N = 60). Conclusions/Significance: The direction of correlation suggests that rather than having immature cortices, adolescents who engage in dangerous activities have frontal white matter tracts that are more adult in form than their more conservative peers

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Wrestling with MUDs To Pin Down the Truth About Special Districts

Federal, state, and local governments encourage and empower special districts--board-run, special purpose local government units that are administratively and fiscally independent from general purpose local governments. Special districts receive incentives, grants, and freedom from limitations (such as limitations on tax and debt) imposed on general purpose local governments. Special districts are treated favorably because they are small in size, which theoretically means they foster democratic participation; are limited in purpose, meaning that states can tailor special districts\u27 powers to serve specific problems; and are viewed as efficient solutions to specific problems. Though special districts have tripled in number over the last fifty years, the rationale justifying their favorable treatment has not been thoroughly scrutinized. One obstacle to such scrutiny is the difficulty in determining a metric of assessment: Too many different kinds of special districts exist, and the scope of districts changes constantly. An imperfect, but no less revealing, method is a close investigation of one type of special district. This Article provides one of the few in-depth reviews of special districts in the academic literature, focusing on the Texas municipal utility district (MUD), originally designed to supply water to unincorporated areas. MUDs--the most common type of special district in the state with the third largest number of special districts--embody both the strengths and weaknesses of special districts. Texas\u27s failure to address MUDs\u27 negative effects reflects our nationwide failure to analyze and correct problematic special districts. This Article discusses MUDs\u27 formation, powers, and scope, and analyzes how MUDs operate without real democratic checks, have too much power, and ineffectively work toward their goals. Throughout, it attempts to engage the central question in modern local government law: the optimality of certain units of government

Beyond Worship: The Religious Land Use and Institutionalized Persons Act of 2000 and Religious Institutions\u27 Auxiliary Uses

Religious institutions have long offered their congregants services that go beyond worship. From access to schools or community halls to services as basic as parking, religious institutions necessarily use their land and resources for more than just religious observance. But particularly in the last two decades, they have begun expanding far beyond their traditional offerings to a wider and more diverse array of auxiliary uses --non-worship uses that are affiliated with a religious institution. Religious institutions now run insurance agencies, hospitals, health maintenance organizations, and transportation companies. They manage retail stores that sell religiously themed merchandise, incorporate popular franchises like Starbucks and McDonald\u27s, finance recording studios, and operate credit unions and banks. The nation\u27s second-largest church (with 30,000 congregants) has even begun developing both a 1200-home neighborhood and a 280-unit gated retirement community. The expanding breadth of the auxiliary uses offered by modem religious institutions raises the critical question considered by this Note: Which auxiliary uses should government protect, and how far should those protections be extended