The “Principal Purpose” Driven Life: How Hospitals Should Apply ERISA’s Church Plan Exemption After Advocate v. Stapleton

The United States’ health care industry is filled with numerous protections for individuals and entities who have objections based on religious beliefs and moral convictions. For example, there is a long history of conscience protections for individuals that object to performing or assisting in the performance of abortion or sterilization procedures or assisted suicide (including euthanasia or mercy killing). Over time, as more medical entities declare affiliation with religious entities, Congress has expanded conscience protections to cover more than just the daily activities of medical professionals. Generally, churches have to comply with the Employee Retirement Income Security Act (ERISA or the Act) just like any other employer. Yet, Congress provided an exception from ERISA for the administration of “church plans.” This exemption has existed for many years without issue until recently, when this exemption became the subject of increased litigation. ERISA defines “church plan” to apply more broadly than merely to plans covering people who work in houses of worship; schools, nursing homes, and hospitals may also comply if they are controlled or owned by religious entities. Most recently, questions have risen regarding whether the employee pension plans used by religiously-affiliated hospitals have been correctly classified as “church plans” exempt from ERISA. The answers to these questions carry with it large consequences because qualified church plans are excused from certain coverage, vesting, benefit accrual, and funding requirements of ERISA and the Internal Revenue Code (IRC) that otherwise apply to tax-qualified plans. In the 2017 landmark case Advocate Health Care Network v. Stapleton, one question that had long been debated between circuit courts regarding the extent of this exemption was resolved; the Court determined that a plan established and maintained by a church includes a plan maintained by a principal purpose organization. This ruling means that any religiously-controlled entity that manages an employee benefit plan no longer must be created by a religious entity in order to qualify for this exemption. Regardless of how (and by whom) the entity was first established, an organization may still take advantage of this exemption from ERISA as long as the entity is maintained by a principal purpose organization. This Supreme Court ruling is far from a full resolution of the issue. Advocate left a few issues unresolved, such as the definition of “principle purpose organization.” This leaves religiously-affiliated hospitals in a sticky place: unsure if they qualify for—and therefore can rely on—the ERISA church exemption. Since there are many potentially devastating effects on non-qualifying hospitals that mistakenly relied on this exemption, it is important for the qualifying factors to be clear. No longer should religiously-affiliated hospitals seek and rely on non-binding (and sometimes inaccurate) private letter rulings (PLRs) issued by the IRS in order to determine their exemption status. In Part I, this Comment will discuss ERISA’s church plan exemption pre- and post-Advocate. Additionally, it will cover a brief overview of the history of employee benefit plans in the healthcare system and describe the roles of different governmental entities. In Part II, this Comment will discuss the landmark case Advocate v. Stapleton and its impact on the employee benefit industry, and the current status of ERISA’s principal purpose requirement. Last, Part III will suggest a new set of factors that each religiously-controlled hospital and its employee benefit subcommittees can rely on in determining if it meets the “principal purpose” requirement

Corn Residue Use by Livestock in the United States

Corn (Zea mays L.) residue grazing or harvest provides a simple and economical practice to integrate crops and livestock, but limited information is available on how widespread corn residue utilization is practiced by US producers. In 2010, the USDA Economic Research Service surveyed producers from 19 states on corn grain and residue management practices. Total corn residue grazed or harvested was 4.87 million ha. Approximately 4.06 million ha was grazed by 11.7 million livestock (primarily cattle) in 2010. The majority of grazed corn residue occurred in Nebraska (1.91 million ha), Iowa (385,000 ha), South Dakota (361,000 ha), and Kansas (344,000 ha). Average grazing days ranged from 10 to 73 d (mean = 40 d). Corn residue harvests predominantly occurred in the central and northern Corn Belt, with an estimated 2.9 Tg of corn residue harvested across the 19 states. This survey highlights the importance of corn residue for US livestock, particularly in the western Corn Belt

Does leadership development need to care about neuro-ethics?

In this essay, we ask whether leadership development needs to care more about neuro-ethics in an era when neuroscientific interventions gain credence at work? Informed by emerging discussions amongst neuroscientists, we address two main issues. First, recent debates cast significant doubt on the validity of neurofeedback (especially neurofeedback using electroencephalography). These studies argue instead that it works through placebo rather than real effects. Second, further ethical concerns arise in response to (i) questionable commercial practice, (ii) issues of organizational in/justice and (iii) tendencies to ignore or downplay practical wisdom. Our discussion incites us to be both critical of neuro-feedback’s scientistic credentials and aware of its broader historical conditions of possibility. We complement these cautions with a call to action for leader development researchers and practitioners

Comparing two facets of emotion perception across multiple neurodegenerative diseases.

Deficits in emotion perception (the ability to infer others' emotions accurately) can occur as a result of neurodegeneration. It remains unclear how different neurodegenerative diseases affect different forms of emotion perception. The present study compares performance on a dynamic tracking task of emotion perception (where participants track the changing valence of a film character's emotions) with performance on an emotion category labeling task (where participants label specific emotions portrayed by film characters) across seven diagnostic groups (N = 178) including Alzheimer's disease (AD), behavioral variant frontotemporal dementia (bvFTD), semantic variant primary progressive aphasia (svPPA), non-fluent variant primary progressive aphasia (nfvPPA), progressive supranuclear palsy (PSP), corticobasal syndrome and healthy controls. Consistent with hypotheses, compared to controls, the bvFTD group was impaired on both tasks. The svPPA group was impaired on the emotion labeling task, whereas the nfvPPA, PSP and AD groups were impaired on the dynamic tracking task. Smaller volumes in bilateral frontal and left insular regions were associated with worse labeling, whereas smaller volumes in bilateral medial frontal, temporal and right insular regions were associated with worse tracking. Findings suggest labeling and tracking facets of emotion perception are differentially affected across neurodegenerative diseases due to their unique neuroanatomical correlates

State and trait characteristics of anterior insula time-varying functional connectivity.

The human anterior insula (aINS) is a topographically organized brain region, in which ventral portions contribute to socio-emotional function through limbic and autonomic connections, whereas the dorsal aINS contributes to cognitive processes through frontal and parietal connections. Open questions remain, however, regarding how aINS connectivity varies over time. We implemented a novel approach combining seed-to-whole-brain sliding-window functional connectivity MRI and k-means clustering to assess time-varying functional connectivity of aINS subregions. We studied three independent large samples of healthy participants and longitudinal datasets to assess inter- and intra-subject stability, and related aINS time-varying functional connectivity profiles to dispositional empathy. We identified four robust aINS time-varying functional connectivity modes that displayed both "state" and "trait" characteristics: while modes featuring connectivity to sensory regions were modulated by eye closure, modes featuring connectivity to higher cognitive and emotional processing regions were stable over time and related to empathy measures

The Lantern Vol. 2, No. 2, March 1934

• Fulfillment Through Expression • Ole Man Ennis • Nos Illusions by Philippe Vallee • A Celtic May Day Festival • Dew Drops • Baker Street Fiction • March Winds • Winter Sunset • Book Review: No Second Spring • A Thought • The Cask of Amontillado • Illustrationhttps://digitalcommons.ursinus.edu/lantern/1002/thumbnail.jp

Affinity enrichment of extracellular vesicles from plasma reveals mRNA changes associated with acute ischemic stroke

Currently there is no in vitro diagnostic test for acute ischemic stroke (AIS), yet rapid diagnosis is crucial for effective thrombolytic treatment. We previously demonstrated the utility of CD8(+) T-cells’ mRNA expression for AIS detection; however extracellular vesicles (EVs) were not evaluated as a source of mRNA for AIS testing. We now report a microfluidic device for the rapid and efficient affinity-enrichment of CD8(+) EVs and subsequent EV’s mRNA analysis using droplet digital PCR (ddPCR). The microfluidic device contains a dense array of micropillars modified with anti-CD8α monoclonal antibodies that enriched 158 ± 10 nm sized EVs at 4.3 ± 2.1 × 109 particles/100 µL of plasma. Analysis of mRNA from CD8(+) EVs and their parental T-cells revealed correlation in the expression for AIS-specific genes in both cell lines and healthy donors. In a blinded study, 80% test positivity for AIS patients and controls was revealed with a total analysis time of 3.7 h

Impact of peripheral immune status on central molecular responses to facial nerve axotomy

When facial nerve axotomy (FNA) is performed on immunodeficient recombinase activating gene-2 knockout (RAG-2-/-) mice, there is greater facial motoneuron (FMN) death relative to wild type (WT) mice. Reconstituting RAG-2-/- mice with whole splenocytes rescues FMN survival after FNA, and CD4+ T cells specifically drive immune-mediated neuroprotection. Evidence suggests that immunodysregulation may contribute to motoneuron death in amyotrophic lateral sclerosis (ALS). Immunoreconstitution of RAG-2-/- mice with lymphocytes from the mutant superoxide dismutase (mSOD1) mouse model of ALS revealed that the mSOD1 whole splenocyte environment suppresses mSOD1 CD4+ T cell-mediated neuroprotection after FNA. The objective of the current study was to characterize the effect of CD4+ T cells on the central molecular response to FNA and then identify if mSOD1 whole splenocytes blocked these regulatory pathways. Gene expression profiles of the axotomized facial motor nucleus were assessed from RAG-2-/- mice immunoreconstituted with either CD4+ T cells or whole splenocytes from WT or mSOD1 donors. The findings indicate that immunodeficient mice have suppressed glial activation after axotomy, and cell transfer of WT CD4+ T cells rescues microenvironment responses. Additionally, mSOD1 whole splenocyte recipients exhibit an increased astrocyte activation response to FNA. In RAG-2-/- + mSOD1 whole splenocyte mice, an elevation of motoneuron-specific Fas cell death pathways is also observed. Altogether, these findings suggest that mSOD1 whole splenocytes do not suppress mSOD1 CD4+ T cell regulation of the microenvironment, and instead, mSOD1 whole splenocytes may promote motoneuron death by either promoting a neurotoxic astrocyte phenotype or inducing Fas-mediated cell death pathways. This study demonstrates that peripheral immune status significantly affects central responses to nerve injury. Future studies will elucidate the mechanisms by which mSOD1 whole splenocytes promote cell death and if inhibiting this mechanism can preserve motoneuron survival in injury and disease