text:
Self-sufficiency is promoted by ensuring active participation in the economy and society by all members of a society. Two indicators are used to assess how well a country is facilitating self-sufficiency among its population: income of disabled people and jobless youth.
The jobless youth indicator measures the proportion of people aged 20–24 who are neither working nor attending school. It sheds light on whether the school-to-work transition is successful in a given country. This transition depends on the length and quality of the schooling received and on general labour market and economic conditions. For most people, being employed is the most important means of achieving self-sufficiency.
Most societies want their young people between the ages of 20 and 24 to be either in school or working. If they are neither, they are not acquiring the skills to ensure their future economic autonomy and social inclusion.
With 15 per cent of Canadian youth not in school or working, Canada rates a "B" on this indicator. This means a sizable proportion of young people have not made the transition from formal schooling to work as quickly or as seamlessly as possible. They are leaving school without the skills and experience needed to move into a career path that will ensure lifelong self-sufficiency. Compared with their peers, these youth are at greater risk of unemployment, poverty, and social exclusion throughout their lives.
The recession had a more severe effect on youth than on older workers. The youth unemployment rate in Canada rose from 9.5 per cent in 2007 to 14.8 per cent in 2009. The rate then declined to 12.4 per cent in 2011, but it remains worryingly high compared with the 6.3 per cent unemployment rate for those aged 25 to 64.
Canada's youth unemployment rate is, however, lower than that of many of its peers, including the U.S., the U.K., Sweden, and Ireland. The recession hit Ireland particularly hard—its youth unemployment rate was almost 34 per cent last year. The proportion of Ireland's youth that are neither working nor in school was also high—26 per cent. Even for those with post-secondary education, the unemployment rate was 17 per cent.
The OECD notes that the high youth unemployment rate in many OECD countries underscores "the need for countries to examine measures that can productively engage people in this crucial age group, such as vocational education and training programmes and opportunities for non-formal education and training."1
Much policy discussion has centred on what to do about persistently high rates of youth unemployment. Two approaches have been adopted, in varying degrees, in OECD countries over the years; one focuses on increasing participation in schooling, and the other on active labour market programs to help youth find jobs. In addition, programs in some countries target youth experiencing homelessness, drug abuse, or crime.
Recent policies are placing more emphasis on vocational education; the OECD notes that "countries with well-established vocational and apprenticeship programmes have been more effective in holding the line on youth unemployment by smoothing the transition from education to work."2
Canada devotes less than 0.4 per cent of gross domestic product (GDP) to active labour market programs (for all age groups) such as training and skill development, career information, and job search and placement supports. This amount trails most of its peer countries. The link between spending and reductions in jobless youth, however, is not straightforward.
Canadian youth face serious challenges when trying to break into the labour market:
Employer demand for skilled tradespeople exceeds the available supply in Canada. Unlike some of its peer countries—Germany, for example—Canada does not have a tradition of developing skilled trades. The Canadian education system has tended to promote the acquisition of academic skills, which can be a challenge for youth who do not intend to pursue post-secondary education.
For example, in 2010, less than 6 per cent of upper-secondary students in Canada were enrolled in vocational or pre-vocational programs. The remaining 94 per cent were enrolled in general academic programs. This was the lowest rate of the peer countries for which data are available. In nine peer countries, over half of upper-secondary students were pursuing or vocational or pre-vocational programs.
From an institutional perspective, skilled trades tend to be considered as an afterthought for those who lack the academic aptitude to pursue the normal course from high school through to post-secondary school. There is little in the mainstream system that encourages young people to pursue skilled trades after high school.
Solving the Skilled Trades Shortage, Ottawa: The Conference Board of Canada, 2002.
Canada's relative grade has been a "B" in the 1990s and 2000s.
Denmark and the Netherlands have been "A" performers in all three decades. Japan and Switzerland have been "A" performers in the 1990s and 2000s. (Data were not available for these countries for the 1980s.) Italy has been a consistent "D" performer.
1 OECD, Education at a Glance 2012: OECD Indicators (Paris: OECD, 2012), 15 (accessed October 25, 2012).
2 OECD, Education at a Glance 2012: OECD Indicators (Paris: OECD, 2012), 323 (accessed October 25, 2012).
Proportion of people aged 20–24 not going to school or working.
Please note:
The data on this page are current as of January 2013.


text:
Click here to read February 2020 Tax Tips
Click here to read January 2020 Tax Tips
Click Here to read December 2019 Tax Tips
Click Here to read November 2019 Tax Tips
Click here to read August 2019 Tax Tips
On July 4, President Donald Trump signed into law a Paycheck Protection Program (PPP) application extension bill that Congress had quickly passed just before the Independence Day holiday. According to several senators, the measure was "surprisingly" introduced and approved by unanimous consent in the Senate late on June 30. It cleared the House the evening of July 1.
Most notably, the bill pushes out the PPP application window deadline five weeks from June 30 to August 8. "The resources are there. The need is there. We just need to change the date," Sen. Ben Cardin, D-Md., said. Prior to the extension, the small business loan program was set to expire at midnight on July 1 with over $130 billion left in funding.
Mnuchin, Rettig TestifyTreasury Secretary Steven Mnuchin and IRS Commissioner Charles "Chuck" Rettig testified before House and Senate committees on June 30, just hours before the PPP application period was set to close.
"There appears to be bipartisan support to repurpose the [remaining] $134 billion for PPP," Mnuchin told lawmakers during a House Financial Services Committee hearing on June 30. Mnuchin stated that "it should be done," and that the administration is looking toward targeted industry-specific relief.
Additionally, Mnuchin told lawmakers that he has been having discussions about more PPP-related relief with the House and Senate Small Business Committees. Reportedly, lawmakers are currently considering an extension or a second round of the PPP.
As for "phase four" of Congress's next economic relief package, Mnuchin again alluded to a narrower approach. "We would anticipate that any additional relief would be targeted to certain industries that have been especially hard-hit by the pandemic, with a focus on jobs and putting all American workers who lost their jobs, through no fault of their own, back to work."
Meanwhile, several PPP-related bills have been introduced in the Senate over the last few weeks, and most recently a bipartisan PPP Forgiveness bill introduced on June 30. The Paycheck Protection Small Business Forgiveness Bill, authored by bipartisan members of the Senate Banking Committee, would streamline the forgiveness of certain PPP loans.
Senate Minority Leader Chuck Schumer, D-NY, also called for an extension of the small business loan program. "It is the last day small business can apply for PPP, but the economic crisis is not over. Senators Cardin, Shaheen, Coons and I will take to the Senate floor and demand we pass a bill to extend it," Schumer said in a June 30 tweet.
IRS 2020 Filing Season, Agency RedesignIn other news, Rettig testified on June 30 before the Senate Finance Committee (SFC) on IRS operations during the 2020 tax filing season. Notably, Rettig told senators that the decision not to further extend the 2019 tax year filing and payment deadline beyond July 15 was made in consultation with professional services organizations, adding that too many due dates can be confusing for taxpayers.
To that end, Treasury first signaled in a June 29 press release that it would not further extend the 2020 filing season. "Treasury and IRS encourage taxpayers to file their taxes by July 15, or file for an automatic extension of time to file to October 15," the press release stated.
"The IRS understands that those affected by the coronavirus may not be able to pay their balances in full by July 15, but we have many payment options to help taxpayers," Rettig said in the press release. "These easy-to-use payment options are available on IRS.gov, and most can be done automatically without reaching out to an IRS representative."
Additionally, Rettig told SFC members that the IRS is well underway in its redesign of the agency for the first time in over 20 years. As noted in Rettig's testimony, the foundational components of a new holistic taxpayer experience will include the following:
"If you can look into the seeds of time, and say which grain will grow and which will not, speak then unto me." — William Shakespeare
The Paycheck Protection Program (PPP) was enacted under the bipartisan Coronavirus Aid, Relief, and Economic Security (CARES) Act ( P.L. 116-136) on March 27, 2020. The PPP, a seemingly ever-evolving small business loan program, was derived from an unprecedented partnership between certain private lending institutions and the U.S. Small Business Administration (SBA). After its enactment in late March, the program quickly went from concept to implementation when it launched on April 3, 2020.
Fast forward to a somewhat rocky roll-out with several speed bumps and shake-ups, akin to a Shakespearean plotline, President Donald Trump on June 5, 2020, signed into law the bipartisan Paycheck Protection Program Flexibility Act (PPPFA) of 2020 ( P.L. 116-142). The PPPFA makes several enhancements to the swiftly implemented loan program, including providing for an extension of the expense forgiveness period from 8-to-24 weeks. The legislation also reduces the 75 percent payroll ratio requirement to 60 percent, extends the two-year loan repayment requirement to five years for future borrowers (existing PPP loans can be extended up to five years if lender/borrower agree), allows payroll tax deferment for PPP recipients, and extends the June 30, 2020, rehiring deadline to December 31, 2020.
Accordingly, the SBA, in consultation with Treasury, officially published in the Federal Register updated interim final rules (effective immediately upon publication, as opposed to the "regular order" of first issuing a proposed rule with a preliminary comment period) on June 16 and June 18, and issued new and revised forgiveness applications forms on June 17. Additional guidance is expected. The SBA is accepting comments through the Federal eRulemaking Portal at www.regulations.gov.
Wolters Kluwer recently spoke with Daniel G. Strickland, an associate with Eversheds Sutherland, about some of the underlying tax policy issues and lingering complexities with the PPP, and subsequent legislation and guidance. Strickland, who regularly works with the IRS on behalf of taxpayers to obtain benefits offered by the IRS, and with taxpayers to resolve tax controversy disputes with the IRS, currently serves as co-chair of the Federal Bar Association's Tax Practice and Procedure Committee, as well as chair of the D.C. Bar Association's New Tax Practitioner Subcommittee. Prior to tax practice, Strickland clerked for several years at the U.S. Tax Court.
To Double-Dip, or not to Double-Dip: That is the Question…(Well, One of Them)Wolters Kluwer: Can you expand upon the preventive double-benefit tax policy position behind the IRS's controversial Notice 2020-32, I.R.B. 2020-21, 837, which states that business expenses paid with tax-exempt income, i.e. a forgivable PPP loan, are not deductible under Code Sec. 265? Treasury Secretary Steven Mnuchin said recently, "if the money that is coming is not taxable, you can't double dip."
Daniel Strickland: Good question. As you correctly state, the IRS published Notice 2020-32 to address the tax treatment of expenses that would otherwise be deductible but that were paid using PPP loan proceeds that are forgiven.
From the IRS's perspective, Congress only exempted the amount of forgiveness from taxation; it did not allow deductions for the expenses paid with forgiven proceeds. Notice 2020-32 points to section 265 as providing legal support for the proposition that otherwise-deductible expenses are not allowable for deduction to the extent that the income is wholly exempt from taxation.
My take is that the IRS is drawing a line at government-sponsored business expenses. In other words, for the taxpayers to receive forgiveness, the loan proceeds must be spent in a certain way. If they are, then it is as if the government paid those expenses directly in a valiant effort to prop up the COVID-affected small businesses. But there is an issue with the IRS's position: a borrower cannot know the extent to which it will even be eligible for forgiveness—let alone whether its substantiation will be sufficient. And given the deadline for application for forgiveness, borrowers might not even know in the same tax year.
Wolters Kluwer: Sen. John Cornyn, R-Tex., recently introduced the bipartisan Small Business Expense Protection Act ( S. 3612), which moves to essentially nullify Notice 2020-32, clarifying congressional intent that the receipt and forgiveness of a PPP loan would not affect the deductibility of ordinary business expenses. What is your take on the underlying policy of this bill, and do you see the IRS reversing Notice 2020-32 before the measure moves through Congress?
Daniel Strickland: Senator Cornyn has the right idea. In my mind, a few simple examples show the logic: If I borrowed money from a bank and spent the proceeds on deductible expenses, I could deduct those expenses from my income when I file my taxes. If the bank forgave my debt, I would need to recognize the forgiven amount as income. If, on the other hand, I received a gift, I could also use that gift to pay for deductible expenses and then deduct those expenses from my income. I would not generally include the gift in my income – setting aside the differences between corporate taxes and individual taxes—since many small businesses are sole proprietorships or disregarded entities. When the CARES Act provided that the forgiven PPP loan amounts were not subject to tax, conceptually, the loans are turned into gifts. The deductibility should be no different. And the tax treatment should be the same irrespective of the type of corporate entity involved.
That is where the Senator is coming from. Unfortunately, the existence of a bill in Congress isn't going to be enough to convince the IRS to about-face. The fact that there are still holds on Senator Cornyn's bill is concerning to me.
"Know You of This Taxation?"Wolters Kluwer: Are there other tax-related implications taxpayers and practitioners should keep in mind specific to PPP loan forgiveness?
Daniel Strickland: There are always tax implications. In the absence of congressional action on the deductibility question, another arises regarding timing. As detailed in the SBA's interim final rule, SBA-2020-0035:
If you do not submit to your lender a loan forgiveness application within 10 months after the end of your loan forgiveness covered period, you must begin paying principal and interest after that period. For example, if a borrower's PPP loan is disbursed on June 25, 2020, the 24-week period ends on December 10, 2020. If the borrower does not submit a loan forgiveness application to its lender by October 10, 2021, the borrower must begin making payments on or after October 10, 2021.
Taxpayers may not know whether—or to what extent—their PPP loans are forgiven until 2021, and some may not know until after they file their 2020 income tax returns. How should the deductions be reported?
In addition, we don't know how the state and local taxing authorities will react.
Wolters Kluwer: Although the SBA, in consultation with Treasury, has addressed the PPPFA's 60 percent "cliff" to allow for partial forgiveness if the 60 percent threshold is not reached, an added variable to the equation now exists. According to a June 8 joint Treasury/SBA statement and now updated guidance, partial forgiveness will be subject to at least 60 percent of the loan forgiveness amount having been used for payroll costs. What is your interpretation of this new variable, and is the solution to the 60 percent "cliff," as termed by Sen. Susan Collins, R-Me., who was recently drafting a bill to address the issue, correctly addressed through regulatory guidance? Do you foresee any pushback?
Daniel Strickland: If I am honest, this one took me a couple times to read to understand that it isn't internally inconsistent:
If a borrower uses less than 60 percent of the loan amount for payroll costs during the forgiveness covered period, the borrower will continue to be eligible for partial loan forgiveness, subject to at least 60 percent of the loan forgiveness amount having been used for payroll costs.
I certainly understand what the SBA is trying to do here, but I think the better explanation is in the SBA's updated interim final rule, Docket No. SBA-2020-0035. The SBA does a great job explaining the math behind the partial forgiveness.
But to your question, I am not sure that this falls within the realm of regulatory guidance. The hurdle is going to be with the language of the PPPFA:
LIMITATION ON FORGIVENESS.—To receive loan forgiveness under this section, an eligible recipient shall use at least 60 percent of the covered loan amount for payroll costs, and may use up to 40 percent of such amount for any payment of interest on any covered mortgage obligation (which shall not include any prepayment of or payment of principal on a covered mortgage obligation), any payment on any covered rent obligation, or any covered utility payment.
That being said, the SBA is creating a taxpayer-favorable solution to the PPPFA's 60 percent "cliff." I am not sure who in their right mind will object, but given the pressure put onto the SBA's rules in courts across the country, it will be interesting to see what happens next and how the agencies show reasoned decision-making in their rules that diverge from the statutory text.
"All's Well That Ends Well?"Wolters Kluwer: The PPP application process is scheduled to expire on June 30, 2020. Notably, prior to Senate approval of the PPPFA, the congressional record was updated with a letter from the bipartisan, bicameral PPPFA authors and policy architects to state that the PPPFA's "extension of the covered period does not authorize the [SBA] to issue any new PPP loans after June 30, 2020, as this date remains fixed by section 1102(b) of the CARES Act." Furthermore, Treasury and the SBA, too, recently reaffirmed the June 30 cutoff date.
However, Mnuchin told lawmakers recently that another round of loans is on the discussion table, following Sen. Tim Scott's, R-S.C., inquiry as to whether there is an appetite for further enhancing and extending the PPP. Moreover, fellow Senate Small Business Committee members Chris Coons, D-Del., and Ben Cardin, D-Md., have introduced the Prioritized Paycheck Protection Program (P4) Bill, which would authorize new lending under the PPP to borrowers with 100 employees or less who have or will soon exhaust the original PPP loan. A Democratic companion bill was introduced in the House on June 18.
Are you aware of any calls among taxpayers or practitioners to extend PPP loan applications beyond June?
Daniel Strickland: The SBA has been processing loans fast, processing more than 14 years' worth of loans in 14 days in the initial round of funding. Since then, however, things have slowed down. I haven't heard any calls for extension recently. But at the same time, the most recent numbers I saw suggested that there is still more than $125 billion available. The next round of published data will give us some indication of what happens. If there is still a significant amount of money left over, and if there is a need, I can certainly see Congress extending the loan application deadline without expanding the available funds. It would be additional taxpayer relief at no additional cost to the government. But with the PPPFA's changes, we might see the remaining funds mostly or completely extended. In that case, I think we wouldn't see an extension without another tranche of available funding.
"Confusion Now Hath Made His Masterpiece"Wolters Kluwer: As for when pension expenses are paid and incurred, current guidance does not indicate whether the amount that is "paid by Borrower" can include retirement contributions attributable to all of 2019, 2020, or even the two years combined. Absent any further guidance, how would you advise taxpayers and practitioners on the matter?
Daniel Strickland: That is a tough question. The short answer is that there are a lot of unanswered questions like this one. The SBA and IRS are publishing guidance as quickly as they can, but it isn't possible to give the requisite considered decision-making and answer all of the outstanding questions at the same time. What that means for taxpayers and practitioners is that each situation needs to be carefully considered. Without specific guidance, there is a risk that certain expenses don't qualify for forgiveness or that a portion of the loan could be called for repayment.
The first thing that I advise is to work with an attorney to evaluate the specific facts of each situation and to look at the tax and business consequences of each option. In general, where there is no clear answer, having advice in writing from your attorney that the answer you choose is the right answer can help protect businesses from some of the negative consequences of being wrong.
Wolters Kluwer: Outside the most recently published interim final rules, are there other unanswered questions for which you think Treasury and the SBA could issue additional PPP guidance?
Daniel Strickland: There are a number of unanswered questions with respect to definitions. As you reference above, the one that makes most practitioners' lists is this issue of paid versus incurred. The loan amount is determined using "monthly payments by the applicant for payroll costs incurred." And forgiveness is determined based on "the sum of the following costs incurred and payments made during the covered period." Another outstanding question is how the forgiveness reduction exemptions will work with the cure date being shifted to December 31 and how the "option to use an eight-week covered period" for those taxpayers who have already received their loan proceeds will work if the June 30 cure date falls within the 8-week covered period.
These are just the tip of the iceberg of unanswered questions.
Wolters Kluwer: Executive agencies, including the IRS and SBA, have been increasingly reliant on sub-regulatory FAQs as a means for issuing guidance lately. What are some potential consequences or drawbacks to this method?
Daniel Strickland: Receiving guidance by FAQ is certainly an efficient way to push information out to taxpayers and practitioners. But as you allude, there are some potential issues—both legal and practical. The first for me is in the second introductory paragraph:
Borrowers and lenders may rely on the guidance provided in this document as SBA's interpretation of the Paycheck Protection Program Interim Final Rules . . . . The U.S. government will not challenge lender PPP actions that conform to this guidance 1[.]
Footnote 1 provides:
This document does not carry the force and effect of law independent of the statute and regulations on which it is based.
Although "borrowers . . . may rely on the guidance," it is only the SBA's interpretation of its own interim final rules. There is certainly an open question as to the level of deference to which the FAQs are entitled.
Second to that is the issue of whether the government will challenge taxpayer actions that conform to the guidance. Although the guidance provides some comfort to lenders, and the lenders will be the ones approving loan forgiveness applications, there are still a slew of potential consequences in the fine print that could be asserted against borrowers.
Third is the complexity in advising clients. If you are paying daily attention to the guidance, the tempo of guidance isn't a big deal, but what I am noticing is that the guidance is changing—think about the initial PPP interest rate of 0.50 percent fixed rate announced by Treasury that was later changed to 1.00 percent fixed rate—and few of the published thought guidance pieces are being updated. For practitioners who are trying to play catchup after receiving a client question, this can be complicated and a great deal of time can be lost spinning their wheels trying to figure out why two seemingly well-reasoned articles have divergent facts or conclusions.
Last, but not least, for taxpayers who are looking for answers online, this could be devastating when it comes to applications for forgiveness. If practitioners are having to sift through the outdated legal analysis by comparison to the newest FAQ iteration, how can taxpayers be confident that they are only relying on the correct version. And when the next round of guidance comes out, those taxpayers must rinse and repeat.
"Tomorrow, and Tomorrow, and Tomorrow…"Wolters Kluwer: Looking ahead, any closing thoughts or advice for practitioners related to the PPP moving forward?
Daniel Strickland: We all want to get to the right answer. For taxpayers and practitioners alike, it is important to ask questions. The SBA, for example, is receptive to discussing concerns and comments. And given the frequency of guidance, it is more important than ever to be involved in the process. For taxpayers specifically, asking questions of their advisers can protect small businesses against the "penny-wise, pound-foolish" adage. I know I want to protect my clients from missteps and help them take fullest advantage of these benefits.
The U.S. Supreme Court upheld the Trump Administration's rule under the Affordable Care Act (P.L. 111-148) that any nongovernment, nonpublicly traded employer can refuse to offer contraceptive coverage for moral or religious reasons, and that publicly traded employers can refuse to do so for religious reasons. Application of this rule had been halted by litigation, but the Administration is now free to apply it.
The issues in the case were: (1) whether the ACA actually requires contraceptive coverage or was that just a creature of regulations that any administration may change, and (2) whether the administration complied with Administrative Procedures Act (APA) in light of the surprising breadth of the regulation going well beyond religious objections to include any moral objection.
Contraceptive RegulationThe prior version of this regulation included an exception for religious employers and small businesses with a religious objection. They had to self-certify that they qualified. Some objected. Shortly after the Administration changed hands, it issued a new version as an interim final regulation.
The Treasury, Health and Human Services (HHS), and Labor Departments have nearly identical versions of these rules. The Treasury version is Reg. §54.9815-2713(a)(1)(iv), but it references HHS regulations (45 CFR 147.131–147.133), and that is where much of the change was made.
The new rule provides that a nongovernment employer that has religious or moral objections to providing coverage for some or all forms of birth control can simply not provide the coverage. These rules also apply to colleges and universities providing student health insurance coverage. The religious exemption is open to any nongovernment employer, including both nonprofit and for-profit entities. The same holds true for the moral exemption, except only the religious exemption is available for publicly traded employers. An objecting employer need not file anything with the government, though affected plan participants need to be notified of mid-plan year coverage changes. Employers are free to pick and choose among contraceptives if they do decide to offer contraceptive coverage.
These regulations extend the exemption for objecting employers to objecting health insurance issuers, and to objecting individuals under which a health insurance issuer may offer a separate benefit package option to any individual who objects to coverage or payments for some or all contraceptive services based on the individual's sincerely held religious beliefs or moral convictions.
Authority Under ACAThe majority opinion by Justice Thomas viewed the ACA as blank slate on what it required for women's preventive health. The relevant ACA provision provides that, with respect to women, a group health plan and a health insurance issuer shall, at a minimum provide additional preventive care and screenings "as provided for" in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA), an agency of the Department of Health and Human Services (HHS). At the time of the ACA's enactment, these guidelines were not yet written.
The HRSA Guidelines were based on recommendations compiled by the Institute of Medicine (now called the National Academy of Medicine). The Guidelines included the contraceptive mandate, which required health plans to provide coverage for all contraceptive methods and sterilization procedures approved by the Food and Drug Administration, as well as related education and counseling.
The same day the Guidelines were issued in 2011, the Departments of Labor, Health and Human Services, and the Treasury (the Departments) issued interim final regulations requiring contraceptive coverage, with exceptions for churches. The Departments determined that it was appropriate that HRSA take into account the mandate's effect on certain religious employers, and concluded that HRSA had the discretion to do so through the creation of an exemption. Ever since, the HRSA has been tasked (according to the majority opinion) with devising religious exemptions. The majority opinion concluded that ACA granted the HRSA broad authority to define preventive care and screenings, which implies that the HRSA also has broad power to create any religious and moral exemptions. Thus, if the HRSA changes its mind, there is nothing in the ACA to prevent it.
Justice Ginsburg's dissent (joined by Justice Sotomayor) argued the legislative language HRSA in fact only delegates to the HRSA the task of compiling a list of services that should be provided. The ACA did not delegate the authority to determine who must provide the coverage for these services. Justice Kagan's concurrence (joined by Justice Breyer) disagreed with the majority and dissent about the clarity of the ACA's language on this, but from the beginning the Departments acted as if it were up to the HRSA to make this call. Under the Chevron doctrine, the interpretation of unclear legislation by the agency tasked with enforcement is owed due deference by the courts.
No "Open-Mindedness" TestThe majority opinion found no violation of the Administrative Procedures Act. The fact that the final rules made only minor alterations to the interim final regulations did not render the final rules procedurally invalid, because nothing in the record suggested that the Departments maintained an open mind during the post-promulgation process. The "open-mindedness" test has no basis in the APA, according to Justice Thomas.
The majority opinion also addressed the issue of calling the document containing the interim final rules "Interim Final Rules with Request for Comments" instead of "General Notice of Proposed Rulemaking." The request for comments readily satisfied the APA notice requirements, Justice Thomas ruled. Even assuming that the APA requires an agency to publish a document entitled "notice of proposed rulemaking," there was no prejudicial error here.
Justice Kagan's opinion questioned whether the rule was not arbitrary and capricious. The rule went beyond what the Departments' justification supported, raising doubts about whether the solution lacks a "rational connection" to the problem described. Few employers have expressed reservations about self-certification, and in any case the new exemption includes any employer (except publicly traded employers) with a moral objection whether it is religious or not.
Where's RFRA?The majority opinion stopped its authority analysis at holding that the ACA authorized the regulation, and stated that it did not need go into the requirements of the Religious Freedom Restoration Act of 1993 (RFRA). Justice Alito (joined by Justice Gorsuch) filed a concurrence taking the position that RFRA compels an exemption for the Little Sisters and any other employer with a similar objection to what has been called the accommodation to the contraceptive mandate.
The IRS has issued guidance to employers on the requirement to report the amount of qualified sick and family leave wages paid to employees under the Families First Coronavirus Response Act (Families First Act) ( P.L. 116-127). This reporting provides employees who are also self-employed with information necessary for properly claiming qualified sick leave equivalent or qualified family leave equivalent credits under the Families First Act.
BackgroundUnder the Families First Act, many employers with fewer than 500 employees must provide paid leave to employees due to circumstances related to the Coronavirus Disease 2019 (COVID-19). Certain employers must provide an employee with up to 80 hours of paid sick leave if the employee cannot work or telework because he or she:
The employee is entitled to paid sick leave at his or her regular pay rate (or if higher, the applicable federal, state, or local minimum wage), up to:
The Families First Act also amends the Family and Medical Leave Act of 1993 to require employers to provide expanded paid family and medical leave to employees who cannot work or telework for reasons related to COVID-19. An employee can receive up to 10 weeks of paid family and medical leave at two-thirds the employee's regular rate of pay, up to $200 per day ($10,000 in the aggregate) if the employee cannot work because he or she is caring for a son or daughter whose school or place of care is closed, or whose child care provider is unavailable, for reasons related to COVID-19.
Eligible employers may receive a refundable payroll credit for required qualified sick leave wages or qualified family leave wages paid to an employee, plus allocable qualified health plan expenses. An equivalent credit is available to self-employed individuals carrying on a trade or business, if the self-employed individual would be entitled to receive paid leave if he or she were an employee of an employer (other than himself or herself). The refundable credits apply to qualified leave wages paid with respect to the period beginning on April 1, 2020, and ending on December 31, 2020.
Reporting Qualified Leave WagesIn addition to reporting qualified sick leave wages paid and qualified family leave wages paid in Boxes 1, 3 (up to the social security wage base), and 5 of Form W-2 (or, in the case of compensation subject to the Railroad Retirement Tax Act (RRTA), in Boxes 1 and 14 of Form W-2), employers must report to the employee the following types and amounts of the wages that were paid, with each amount separately reported either in Box 14 of Form W-2 or on a separate statement:
If a separate statement is provided and the employee receives a paper Form W-2, the statement must be included with the Form W-2 provided to the employee. If the employee receives an electronic Form W-2, the statement must be provided in the same manner and at the same time as the Form W-2.
Self-Employed IndividualsSelf-employed individuals who are claiming qualified sick leave equivalent or qualified family leave equivalent credits, and who are also eligible for qualified sick leave and qualified family leave wages as employees, must report the qualified leave wage amounts described above on Form 7202, Credits for Sick Leave and Family Leave for Certain Self-Employed Individuals, included with their income tax returns. They also must reduce (but not below zero) any qualified sick leave or qualified family leave equivalent credits by the amount of these qualified leave wages.
The IRS has issued guidance and temporary relief for required minimum distribution (RMD) changes in 2020. Distributions that would have been RMDs under old law are treated as eligible rollover distributions. The 60-day rollover period deadline for any 2020 RMDs already taken has been extended to August 31, 2020. Notice 2007-7, I.R.B. 2007-5, 395 is modified.
SECURE and CARES ActsThe new guidance addresses RMD issues arising from recent unexpected changes in the rules. The Setting Every Community Up for Retirement Enhancement Act of 2019 (SECURE Act) ( P.L. 116-94), enacted at the end of 2019, changed the required beginning date for RMDs for individuals turning age 70-1/2 in 2020. The Coronavirus Aid, Relief, and Economic Security (CARES) Act ( P.L. 116-136), enacted in March 2020, waived the RMD requirements for 2020.
Plans, administrators, and individuals were taken by surprise. Some plans and participants treated distributions as RMDs even though they were not under new rules then in effect. The SECURE Act provided no relief. However, the CARES Act allowed plans and participants to treat would-be RMDs as eligible rollover distributions. Still, under the rules, individuals have 60 days to recontribute distributions, and can only do that once in a 12-month period. That left individuals who took early distributions twisting in the wind, not to mention people taking monthly RMD installments.
60-Day Deadline ExtendedUnder the new relief, any distribution already taken in 2020 that would have been an RMD under the old rules has a 60-day recontribution deadline of no earlier than August 31. For example, if someone took a distribution in January 2020 that would have been an RMD under the old rules (either sets of old rules), they have until August 31 to recontribute it to an eligible plan or IRA.
For an IRA owner or beneficiary who has already received a distribution that would have been an RMD in 2020 but for the 2020 RMD waiver under the CARES Act or the change in the required beginning date under the SECURE Act, the recipient may repay the distribution to the distributing IRA, even if the repayment is made more than 60 days after the distribution, provided the repayment is made no later than August 31, 2020. The repayment will be treated as a rollover, but will be subject to the one rollover per 12-month period limitation or the restriction on nonspousal beneficiary rollovers.
SECURE Act ReliefDistributions that were intended as RMDs but in fact are not due to the SECURE Act change in required beginning date are treated as eligible rollover distributions. RMDs do not have to satisfy rules regarding mandatory withholding, the option of a direct rollover, and notice of that right. Under this relief, individuals and plans can still treat these as eligible rollover distributions.
2020 Waiver GuidanceThe IRS has clarified that the CARES Act relief applies for 2020 distributions that would have been RMDs, had it not been for the 2020 RMD waiver. These include distributions to a plan participant paid in 2020 (or paid in 2021 for the 2020 calendar year in the case of an employee who has a required beginning date of April 1, 2021) if the payments equal the amounts that would have been RMDs in (or for) 2020 had it not been for 2020 RMD waiver. They also include distributions that are one or more payments (that include the 2020 RMDs) in a series of substantially equal periodic payments made at least annually and expected to last for the participant's life or life expectancy, the joint lives (or joint life expectancies) of the participant and the participant's designated beneficiary, or for a period of at least 10 years.
For a plan participant with a required beginning date of April 1, 2021, distributions paid in 2021 that would have been an RMD for 2021 had it not been for the CARES Act are treated as eligible rollover distributions. However, a plan participant with a required beginning date of April 1, 2021, must still receive RMD for the 2021 calendar year by December 31, 2021. If the employee receives a distribution during 2021, that distribution is an RMD for the 2021 calendar year to the extent the total RMD for 2021 has not been satisfied even if the distribution is made on or before April 1, 2021, and accordingly, is not an eligible rollover distribution. However, to the extent the RMD for 2021 has been satisfied, subsequent amounts distributed in 2021 that would otherwise not be eligible rollover distributions may be rolled over.
Extended Deadlines Due to 2020 WaiverIf a plan permits an employee or beneficiary to elect whether the 5-year rule or the life expectancy rule applies in determining RMDs, then the deadline for making that election typically would be the end of calendar year following the calendar year of the employee's death. For example, if a 50-year-old employee in a plan providing the election died in 2019 with his sister as his designated beneficiary, the plan provision would require the election by the end of 2020. However, that type of plan may be amended to permit the extension of the election deadline to the end of 2021.
The RMD waiver extends the time for making a direct rollover for a nonspouse designated beneficiary if the participant died in 2019. A special rule provides that if the 5-year rule applies to a benefit under a plan, the nonspouse designated beneficiary may determine the amount that is not eligible for rollover because it is an RMD using the life expectancy rule in the case of a distribution made prior to the end of the year following the year of death. This special rule is modified so that if the employee's death occurred in 2019, the nonspouse designated beneficiary has until the end of 2021 to make the direct rollover and use the life expectancy rule.
Plan AmendmentsThe guidance provides a sample plan amendment for defined contribution plans that plan sponsors may adopt to implement waiver rules. Any plan amendment must be adopted no later than the last day of the first plan year beginning on or after January 1, 2022 (January 1, 2024, for governmental plans), and must reflect operation of the plan beginning with the effective date of the plan amendment. Timely adoption of the amendment must be shown by a written document signed and dated by the employer (including an adopting employer of a pre-approved plan). IRAs do not need to be amended.
The IRS has clarified and provided relief for mid-year amendments reducing safe harbor contributions. An updated safe harbor notice and an election opportunity must be provided even if the change is only for highly compensated employees. Coronavirus (COVID-19) relief applies if a plan amendment is adopted between March 13, 2020, and August 31, 2020. For nonelective contribution plans, the supplemental notice requirement is satisfied if provided no later than August 31, 2020, and the amendment that reduces or suspends contributions is adopted no later than the effective date of the reduction or suspension. Notice 2016-16, I.R.B., 2016-7, 318, is clarified.
Mid-Year AmendmentsSafe harbor contributions for a plan year may be amended during the plan year to reduce or suspend future matching or nonelective contributions only under certain conditions. Among them are that the employer must either (1) be operating at an economic loss for the plan year, or (2) have included in the plan's safe harbor notice for the plan year a statement that the plan may be amended during the plan year to reduce or suspend safe harbor contributions, and that the reduction or suspension will not apply earlier than 30 days after all eligible employees are provided notice of the reduction or suspension.
The reduction or suspension of safe harbor contributions may be effective no earlier than the later of the date the amendment is adopted or 30 days after eligible employees are provided in a supplemental notice. Eligible employees must be given a reasonable opportunity (including a reasonable period after receipt of the supplemental notice) prior to the reduction or suspension of safe harbor contributions to change their cash or deferred elections and, if applicable, their employee contribution elections.
Safe Harbor ContributionsReductions or suspensions of contributions. If a plan amendment that reduces or suspends safe harbor matching or nonelective contributions during a plan year is adopted between March 13, 2020, and August 31, 2020, then the plan will not be treated as failing to satisfy the requirement that the employer either (1) is operating at an economic loss; or (2) has included in the plan's safe harbor notice for the plan year a statement that (a) the plan may be amended during the plan year to reduce or suspend the safe harbor contributions and (b) the reduction or suspension will not apply until at least 30 days after all eligible employees are provided notice of the reduction or suspension.
Supplemental notice requirement. If a plan amendment that reduces or suspends safe harbor nonelective contributions during a plan year is adopted between March 13, 2020, and August 31, 2020, then the plan will not be treated as failing to satisfy the supplemental notice requirements merely because it is not provided to eligible employees at least 30 days before the reduction or suspension of safe harbor nonelective contributions is effective, provided that (1) the supplemental notice is provided to eligible employees no later than August 31, 2020, and (2) the plan amendment that reduces or suspends safe harbor nonelective contributions is adopted no later than the effective date of the reduction or suspension of safe harbor nonelective contributions.
There is no relief with respect to the timing of supplemental notices for a mid-year reduction or suspension of safe harbor matching contributions because matching contribution levels communicated to employees directly affect employee decisions regarding elective contributions (and, if applicable, employee contributions).
HCE ContributionsThe new notice clarifies that an updated safe harbor notice and an election opportunity (as required by Notice 2016-16, I.R.B. 2016-7, 318) must be provided to highly compensated employees (HCEs) to whom the mid-year change applies, determined as of the date of issuance of the updated safe harbor notice. This rule applies even if the change only applies to HCEs.
The IRS amended final regulations with guidance on the Code Sec. 199A deduction for suspended losses and shareholders of regulated investment companies (RICs). The amendments address the treatment of suspended losses included in qualified business income (QBI), the deduction allowed to a shareholder in a regulated investment company (RIC), and additional rules related to trusts and estates. The IRS had previously issued final and proposed regulations addressing these issues (NPRM REG-134652-18)
The IRS amended final regulations with guidance on the Code Sec. 199A deduction for suspended losses and shareholders of regulated investment companies (RICs). The amendments address the treatment of suspended losses included in qualified business income (QBI), the deduction allowed to a shareholder in a regulated investment company (RIC), and additional rules related to trusts and estates. The IRS had previously issued final and proposed regulations addressing these issues ( NPRM REG-134652-18)
BackgroundCode Sec. 199A provides a deduction of up to 20 percent of qualified business income (QBI) from a U.S. trade or business operated as a sole proprietorship, or through a partnership, S corporation, trust, or estate. If the taxpayer's taxable income exceeds the threshold amount in Code Sec. 199A(e)(2), the deduction may be limited. Statutory limitations are subject to phase-in rules. Code Sec. 199A also provides individuals and some trusts and estates a deduction of up to 20 percent of their combined qualified real estate investment trust (REIT) dividends and qualified publicly traded partnership (PTP) income.
461(l) LossesUnder Reg. §1.199A-3(b)(1)(iv), previously disallowed losses or deductions allowed in the tax year are generally taken into account for computing QBI, except to the extent the losses or deductions were disallowed, suspended, limited, or carried over from tax years ending before January 1, 2018. The final regulations amend Reg. §1.199A-3(b)(1)(iv)(A) to specifically reference excess business losses disallowed by Code Sec. 461(l) and treated as a net operating loss (NOL) carryover for the tax year for purposes of determining any NOL carryover in subsequent tax years. The IRS notes that the list of statutes in the regulation is not exhaustive
Phase-in Rules for SSTB LossesThe amendments also clarify how the phase-in rules apply when a taxpayer has a suspended or disallowed loss or deduction from a specified service trade or business (SSTB). If the individual's taxable income is at or below the threshold amount in the year the loss or deduction is incurred, the entire disallowed loss or deduction is treated as QBI from a separate trade or business in the later tax year in which the loss is allowed. If the individual's taxable income is within the phase-in range, only a percentage of the disallowed loss or deduction is taken into account in the later tax year. If the individual's taxable income exceeds the phase-in range, the loss or deduction is not included in QBI.
Conduit TreatmentThe final regulations provide conduit treatment for qualified REIT dividends earned by a RIC. Conduit treatment happens when a RIC treats dividends paid to a shareholder in the same or similar manner as the shareholder would treat the underlying item of income or gain if the shareholder realized it directly. The Treasury Department and IRS continue to consider comments on whether to provide conduit treatment for qualified PTP income, and for RIC income from an activity that would generate QBI if conducted by a partnership or an S corporation.
Separate Share RuleThe separate share applies for a trust or estate described in Code Sec. 663(c) with substantially separate and independent shares for multiple beneficiaries. Under the final regulations, the trust or estate will be treated as a single trust or estate for determining taxable income, net capital gain, net QBI, W-2 wages, unadjusted basis immediately after acquisition (UBIA) of qualified property, qualified REIT dividends, and qualified PTP income for each trade or business of the trust or estate, and for computing the W-2 wage and UBIA of qualified property limitations.
ApplicabilityThe amended regulations apply to tax years beginning 60 days after publication in the Federal Register. However, taxpayers may choose to apply the amendments before that date. Taxpayers who chose to rely on the proposed regulations issued in February 2019 may continue to do so until the date these amendments are published.
The Treasury Department and the IRS have released drafts of proposed partnership forms for tax year 2021 (the 2022 filing season). The proposed forms are intended to provide greater clarity for partners on how to compute their U.S. income tax liability for relevant international tax items, including claiming deductions and credits. The redesigned forms and instructions will also give useful guidance to partnerships on how to provide international tax information to their partners in a standardized format.
The draft forms are:
These proposed forms would apply to a partnership required to file Form 1065 only if it has "items of international tax relevance" (i.e., generally, foreign activities or foreign partners). The changes would not affect domestic partnerships with no international tax items to report.
Partner Reporting of International ItemsPartners must report international tax information on their tax returns on several tax forms and schedules. They generally obtain this information from their partnerships, usually through narrative statements attached to one or more Schedules K-1 (Form 1065), Partner's Share of Income, Deductions, Credits, etc. Since partnerships compile these statements in a variety of formats, partners might have difficulties translating the statements onto their own returns.
To ease this burden, the Treasury and IRS state that the proposed changes would provide a standard format that offers greater clarity to both partnerships and their partners. This standard format is designed to better align the information that partnerships provide on the schedules with the tax forms used by partners, so that partners can more easily prepare their tax returns, and the IRS can more efficiently verify taxpayer compliance. It is intended that all information to be reported on the new schedules is already necessary for the partnership to provide to partners or is available to the partnership.
Draft Schedules K-2 and K-3Any partnership that is required to file Form 1065, U.S. Return of Partnership Income, and has items relevant to the determination of the U.S. tax or certain withholding tax or reporting obligations of its partners under the international provisions of the Code, will be required to complete the relevant parts of Schedule K-2 and Schedule K-3.
The proposed parts included in new Schedule K-2 (Form 1065) replace portions of existing Form 1065, Schedule K, lines 16(a) through 16(r). The proposed schedule provides for international tax information to be reported in a standardized manner. The partnership will attach Schedule K-2 to its Form 1065.
The proposed parts included in new Schedule K-3 (Form 1065) replace portions of Schedule K-1 (Form 1065), Part III, Boxes 16 and 20. The proposed schedule provides information to the partner generally in the format of the following forms that the partner might need to complete:
The partnership will provide Schedule K-3 to its partners according to the timeline for providing Schedule K-1.
Comments RequestedThe draft schedules and instructions have been released to allow partnerships and other stakeholders time to consider the proposed changes and provide comments that can be taken into account in finalizing the schedules and instructions. The Treasury and IRS will be actively engaged with stakeholders to solicit input on these proposed changes before the forms are finalized later in 2020.
Affected stakeholders can submit comments through September 14, 2020. Written comments should be sent to the following email address: firstname.lastname@example.com with the subject line: "International Form Changes."
For additional information and updates, see https://www.irs.gov/businesses/1065-form-changes.
Other RevisionsThe Treasury and IRS plan similar revisions, as applicable, to Form 1120-S, U.S. Income Tax Return for an S Corporation, and Form 8865, Return of U.S. Persons With Respect to Certain Foreign Partnerships. They welcome comments on similar changes to be made to these forms for the 2021 tax year.
The Treasury and IRS have issued final regulations covering the Code Sec. 250 deduction for foreign-derived intangible income (FDII) and global intangible low-taxed income (GILTI). Proposed regulations were issued on March 6, 2019 (NPRM REG-104464-18). The final regulations maintain the basic approach and structure of the proposed regulations and provide guidance on computation of the deduction and the determination of FDII, including in the consolidated return context. Additionally, rules requiring the filing of Form 8993, Section 250 Deduction for Foreign-Derived Intangible Income and Global Intangible Low-Taxed Income, are finalized.
Section 250 DeductionThe Code Sec. 250 deduction is available to domestic corporations for:
The deduction is available with respect to a domestic corporation's "excess return" or return in excess of fixed return on tangible assets, derived from serving foreign markets. FDII is the portion of the excess return derived from serving foreign markets directly from the United States. GILTI is the portion of the excess return derived through foreign affiliates. The deduction results in a lower effective U.S. tax rate on a U.S. corporation's FDII and GILTI.
Documentation RequirementsThe proposed regulations defined terms and provide specific documents that were required to establish that income was derived from serving foreign markets. Commentators found that the proposed regulations could present compliance burdens. Accordingly, the final regulations provide a more flexible approach than the specific documentation requirements.
For many types of sales and services, eligibility for the Code Sec. 250 deduction is subject to the general requirement under the Code that deductions must be supported by sufficient substantiation, including the use of available business records.
More specific substantiation requirements are required for:
The requirements include either:
Taxpayers may choose a method of substantiation among the methods. The specific substantiation requirements do not apply to businesses with less than $25 million in gross receipts. The final regulations also eliminate references to the use of market research to establish foreign use.
The final regulations clarify how to establish foreign use for sales of digital content and how to establish a recipient's location outside of the United States with respect to electronically supplied services and advertising services. The final regulations:
The final regulations add two subcategories of general services:
In these cases, the location of the recipient is where the content is accessed or viewed.
Foreign Military Sales and ServicesThe proposed regulations provided special rules to cover U.S. Defense Contractors' military sales of equipment and provision of services to the U.S. government that are subsequently sold or provided to a foreign government.
The final regulations adopt the proposed regulations, which treat sales and services provided to the U.S. government under the Arms Export Control Act as a sale or provision of services to the foreign government that is eligible for the deduction. The final regulations relax the substantiation requirements, so that the general substantiation requirements apply.
Ratio of FDDEI to DEIA corporation's FDII is defined as its deemed intangible income (DII) multiplied by the corporation's foreign-derived ratio. This is the ratio of the corporation's foreign-derived deduction eligible income (FDDEI) to its deduction eligible income (DEI).
The final regulations retain the rule that the domestic corporation must allocate expenses to its gross FDDEI to determine the numerator of the foreign-derived ratio.
Deduction for IndividualsThe final regulations extend the Code Sec. 250 deduction with respect to GILTI, to individuals—including individual partners and individual S corporation shareholders—making the Code Sec. 962 election to be treated as a domestic corporation.
Additional ChangesAdditional changes in the final regulations generally expand situations in which a transaction will be an FDDEI transaction, including:
Taxpayers can also use any reasonable method to determine the ordering of rules that limit deductions based on taxable income until additional rules are issued.
The IRS is calling on any taxpayers involved in syndicated conservation easement transactions who receives a settlement offer from the agency to accept it soon. The Service made this request in the wake of the Tax Court's recent strike down of four additional abusive syndicated conservation easement transactions.
Settlement OffersTime-limited settlement offers, which the IRS announced on June 25 ( IR-2020-130), are only being made to certain taxpayers with pending docketed Tax Court cases involving this type of abusive transaction. The IRS declared that these and other recent Tax Court decisions support the abusive nature of the underlying syndicated conservation easement deduction.
The four recent Tax Court decisions in question disallowed conservation easement deductions totaling nearly $21 million ( Village at Effingham, LLC, TC Memo. 2020-102, Dec. 61,715(M); Riverside Place, LLC, TC Memo. 2020-103, Dec. 61,716(M); Maple Landing, LLC, TC Memo. 2020-104, Dec. 61,717(M); Englewood Place, LLC, TC Memo. 2020-105, Dec. 61,718(M)).
Abusive TransactionsWhile recognizing the important role of legitimate conservation easement deductions in incentivizing land preservation for future generations, the IRS pointed out that abusive syndicated conservation easement transactions have been of concern for several years.
In listed syndicated conservation easement structures, promoters syndicate ownership interests in real property through partnerships, using promotional materials to suggest that prospective investors may be entitled to a share of a conservation easement contribution deduction that equals or exceeds two and one-half times the investment amount. The promoters obtain an appraisal that greatly inflates the value of the conservation easement, based on a fictional and unrealistic highest and best use of the property before it was encumbered with the easement. After the investors invest in the partnership, the partnership donates a conservation easement to a land trust. Investors in the partnership then claim a deduction based on an inflated value. According to the IRS, the investors typically claim charitable contribution deductions that grossly multiply their actual investment in the transaction and defy common sense.
The IRS is aware that some promoters of these abusive transactions have downplayed the significance of the string of recent court decisions holding in the government's favor, arguing that their cases are somehow different or that those decisions might be reversed on appeal. These promoters ignore common sense and argue that the real dispute is about value, neglecting to explain how the reporting of short-term appreciation, often exceeding many multiples of reality, could possibly withstand judicial scrutiny. "Taxpayers should ignore this nonsense, take an objective look at their cases, and cut their losses," said IRS Chief Counsel Mike Desmond; "abusive transactions, like settlement offers, do not get better with time, and this is a good opportunity to get out," he added.

subset: commoncrawl


text:
This is a case of a wide complex, regular and very rapid rhythm in a young (remarkably minimally symptomatic) man. There are several possible causes of an arrhythmia this fast in the young patient.
Little was known about this young man when he presented to the Emergency Room – which was just as the ER doctors saw him. There was a rush to treat him - to do something, but careful reasoning can help in the decision making process with such a case. It is helpful, therefore, to review the differential diagnoses. Possible causes of such a wide comlpex arrhythmia include:
- Ventricular tachycardia (VT) - Certainly, in the elderly patient with such a wide complex, regular tachycardia the most likely diagnosis would be ventricular tachycardia. But ventricular tachycardia can occur in the young patient with prior structural or congenital heart disease. So called "normal heart ventricular tachycardias" of the right ventricular outflow tract variety (manifest my a left bundle branch, inferior axis ventricular tachycardia) or idiopathic left septal ventricular tachycardia (manifest by a right bundle superiorly directed axis) can also present like this patient.
- Supraventricular tachycardia (SVT) with aberrancy – at this rate and with this regular rhythm, atrial flutter with 1:1 conduction would be the most common diagnosis, although some focal atrial tachycardias could also occur at this rate. Certainly, athletic, healthy individuals can occassionally conduct one-to-one down the normal conduction system (AV node), but often one of the distal bundle branches cannot support this rate, leading to aberrant conduction. Note that the morphology of lead V1 is not that of a characteristic right bundle branch block (no rSR' morphology is seen) and it is not characteristic of a left bundle branch block (no QS morphology either). Much more likely, however, is 1:1 conduction of atrial flutter across an accessory pathway. The presence of a large RS complex in lead V1 would suggest anterograde conduction accross a left-sided accessory pathway - but left ventricular ventricular tachycardia remains in the differential here as well.
- Finally, antidromic atrioventricular reentrant tachycardia (down an accessory pathway to the ventricle and retrograde up the AV node or a second accessory pathway to the atrium) is a much rarer, but possible cause for the arrhythmia seen. (For review, recall that "ortho-" means "straight." Since orthodromic atrioventricular reentrant tachycardia proceeds down the AV node to the ventricle and retrograde back up the accessory pathway to the atrium, it creates a narrow-complex supraventricular tachycardia (SVT). This is NOT what was seen in this case.)
So What Should You Do?
While there are no absolute correct answers, there are a few caveats that can be shared. First, electricity (synchronized cardioversion, typically after sedation) is a very acceptable option. When such a patient presents to the Emergency Room, one cannot be sure whether the rhythm is an SVT or VT, but cardioversion would correct either arrhythmia.
Alternatively, some might attempt treating this patient with a medication since he appeared fairly stable on presentation. But not any medication will do. First of all, Adenosine could be attempted, but here's one scenario that could play out: if he has atrial flutter that then converts to atrial fibrillation, his atrial rate might go even faster and conduct across the accessory pathway, fibrillating the patient. (oops!). Verapamil is also contraindicated in this situation since it changes the fibrillatory threshold of the ventricle and may facilitate conduction over the accessory pathway, leading to ventricular fibrillation (oops!). A beta blocker might drop the blood pressure precipitously but would not slow and accessory pathway's conduction (if indeed this is what the patient had). Amiodarone slows conduction in both the AV node and accessory pathway, and could treat ventricular tachycardia, but it takes too long before a measurable clinical effect can be identified. As such, it is not the best drug in this situation.
Perhaps the best drug to use in this circumstance due to its ability to be rapidly administered and its ability to slow conduction in both the AV node and accessory pathway while also being effective for ventricular tachycardia, is procainamide (Pronestyl).
So What Happened?
Well, the doctors weren't sure what was happening, but they had extensive experience giving Amiodarone IV for ventricular tachycardia in the ER, so they started this medication. Unfortunately, the diluent in IV Amiodarone can cause blood pressure to drop if the drug is given too quickly – and that's what happened. He became hypotensive and uncomfortable, so the doctors did the right thing and sedated him. Unfortunately, they only used 50 Joules of energy, and the following EKG was noted after the cardioversion:
Now there is an irregular rhythm that is mostly wide. Note that after very rapidly-coupled beats, there is a gap and a single narrow beat noted – this is where the atrial fibrillation rate actually exceeds the refractory period of this patient's accessory pathway, and so one beat is narrow, before aberrant conduction across the accessory pathway resumes. Unfortunately, the doctors were still confused, but called for help.
Procainamide (1 gram over 20-30 minutes) was administered, and the rhythm spontaneously converted to sinus rhythm after approximately 30 minutes. The EKG then looked like:
Note the characteristic delta waves, perhaps most easily seen in lead I. What was also interesting was the "pseudo-Q" waves in II, III, and aVF caused by a "negative" delta wave. Such a finding localizes the pathway on the posterior aspect of the heart. With continued slowing, these "pseudo-Q" waves in II, III, and aVF became more prominent:
Final diagnosis: Atrial flutter and atrial fibrillation with evidence of a manifest left posterior accessory pathway (Wolff-Parkinson-White Syndrome).
Epilogue: The patient was taken to the Electrophysiology Laboratory and a left posterior mitral annular accessory pathway was successfully ablated. During the electrophysiology study, both atrial fibrillation and atrial flutter were demonstrated but did not persist. Here is the EKG after ablation:
Note the new inverted T waves in II, III, aVL. This finding is fondly called "T-wave memory" in electrophysiology parlance following catheter ablation. It is thought that the abnormal depolarization over an accessory pathway results in abnormal repolarization, and following ablation of an accessory pathway, the cells near the prior accessory pathway have persistent abnormal repolarization for a period of time. This finding usually resolves in a week or two. This is NOT due to myocardial ischemia (lack of oxygen).
Hope this was informative. Thanks to all the brave souls out there who risked it all to play along! Have a great weekend.


text:
View All Calendars is the default. Choose Select a Calendar to view a specific calendar. Subscribe to calendar notifications by clicking on the Notify Me® button, and you will automatically be alerted about the latest events in our community.
February 2, 2019, 10:00 AM - 2:00 PM @ Arcata Plaza
Visit the Arcata Plaza Winter Farmers' Market to purchase the freshest Humboldt-County-grown and GMO-free produce along with plants, meats and other wonderful locally-grown or made products. Plus, visit the North Coast Growers' Association information booth for educational materials, recipes and garden growing guides. Please leave your 4-legged friends at home because multiple State, County and Municipal regulations prohibit pets at Certified Farmers' Markets and food facilities. Please also note that smoking of any kind or unauthorized vending is not permitted.
February 2, 2019, 8:30 AM - 11:00 AM @ Arcata Marsh & Wildlife Sanctuary
Bring your binoculars and have a great morning birding! Join Redwood Region Audubon Society volunteers for a guided bird walking tour of the Arcata Marsh Wildlife Sanctuary. No reservations are required! This free tour takes place rain or shine and is open to all-ages.
Participants are instructed to meet in the parking lot at the end of South I Street near Klopp Lake at 8:30 am.
February 2, 2019, 2:00 PM - 3:30 PM @ Arcata Marsh Interpretive Center
Join Friends of the Arcata Marsh (FOAM) volunteers for a tour of the wildlife sanctuary. This free tour takes place rain or shine! No reservations are necessary. Participants are instructed to meet at the Interpretive Center at 2 PM.


text:
book (one) on (something)
book (one) on (something)
To reserve a spot for oneself or another on a mode of transportation, such as a train or plane. My flight was canceled, but someone at the airline was able to book me on another one that leaves today, thank goodness.
book someone on something
to reserve a place for someone on some travel conveyance. They booked us on a direct flight to San Juan. He booked himself on a flight to Manaus.


text:
UPDATE: Kevin Hicks brought a class action lawsuit against multiple California wineries for selling wine containing undisclosed high concentrations of arsenic in March 2015. I've posted about that here.
I received an unusual "story" by way of Palate Press this week. It looked like this:
Alcoholic beverage testing company, BeverageGrades has discovered lead
and arsenic present in wine at levels that exceed the Environmental
Protection Agency (EPA) standard Maximum Contaminant Levels for
drinking water.
Independent laboratory testing has been conducted on the top selling
white wines in the United States. Approximately one in every three
bottles tested was found to contain either arsenic or lead levels that
exceed the Maximum Contaminant Level.
Regular consumption of these elements, even at low levels, can present
a serious health risk.
Topic (wine, food, wine pairing, travel, etc.)
Wine Science
Suggested Title
High Levels of Arsenic and Lead Detected in Wine
Approximately one third of the top selling wines in the United States
found to contain lead and arsenic.
Your Website or Other Writing Sample
Preferred payment method:
Mailing Address (Check)
7000 Broadway
Suite 307
Denver, CO
PayPal email
BeverageGrades, it seems, is a young company creating a private database of beverage health information, summarized in their trademarked "grades." They say that they run a bottle – of wine at the moment, of beer, spirits, and coolers in the future – through a pile of lab tests to create a profile for each product. Users can see calories, sugar, and carbohydrates per serving, plus a set of "grades" that are supposed to indicate how healthy a wine is overall, how "skinny" it is, how "pure" it is, how likely it is to trouble your allergies, and how likely it is to give you a headache. The problem with HealthyPour™, SkinnyGrade™, and the rest of these ratings is that if you're looking for more information on how they're calculated, you're out of luck. New users have to click "I do" to having read BeverageGrade's methodologies page, but those "methodologies" say nothing more detailed than "we take lots of measurements of lots of stuff." And, rather than showing numbers for any of these measurements, wines are rated as average or better or worse than average.
Concerns about proprietary details aside, that's not enough information. What in tarnation does "pure" mean? What counts as a "contaminant" or an "additive" in BeverageGrade-speak? How do they summarize how healthful a wine is when a whole pile of scientists are still trying to figure out how and why and whether wine is healthy? They list sodium and "vitamins and minerals," but should I care about sodium in wine, and is wine a good source of "vitamins and minerals" in the first place?
Instead of seeking to educate consumers, BeverageGrades is patronizing them with overly simplistic branded products while hiding information. And that brings us back to arsenic.
Arsenic is found in wine. Recent studies in New Hampshire and France have shown higher arsenic concentrations (in toenails and urine) in wine drinkers versus non-wine drinkers (fish, beer, and Brussels sprouts were similarly implicated, as has been rice in studies based in Asian countries). Arsenic is found in water and soil; drinking water remains, in fact, our most significant source of arsenic exposure. Grapevines and some other plants seem to take up and concentrate it and other heavy metals. The FDA has set maximum limits on how much arsenic can be present in apple and pear juices in the US and is working on similar limits for rice; wine very well may be next on the list. If we stop here, things look bad.
But stopping there means withholding important information. Saying that arsenic is found in wine is, crucially, different from saying that arsenic in wine poses a significant health risk. Arsenic in wine and arsenic as a health risk in general aren't things we understand well yet. We don't yet have a clear picture of how much arsenic is too much arsenic (the same is true for a lot of environmental toxins, including lead).
The several recent studies I found all indicate that arsenic in wine probably doesn't pose a significant risk to most drinkers. The "probably," "significant," and "most" hedges in the previous sentence are all a nod to that yet-unsolved "how much arsenic is too much" problem. But an analysis of arsenic in wine, sake, and beer for sale in Central Europe concluded that it's not a significant risk to consumers. A comparative risk assessment of fifteen "known and suspected human carcinogens" judged that ethanol was the only really significant carcinogen in alcoholic beverages; the rest, including arsenic, "may pose risks below thresholds normally tolerated for food contaminants." In other words, these fish are too small to bother frying.
I suspect that BeverageGrades isn't counting alcohol itself against a wine's HealthyPour™ rating – though I don't know for sure, since they're not sharing that information. In any case, I appreciated a comment made by one reader of a popular press story about arsenic in wine, who suggested that not just drinking, but eating and breathing and sleeping were hazardous to our health, too, and that we should probably stop doing all of those things. Wine, unlike breathing, isn't a necessity. But if we try to eliminate every risk from our way of life, we'll end up not living at all.


text:
Moms everywhere can breathe a sigh of relief -- the Eggo frozen waffle is no longer an endangered species. Kellogg's has announced all four waffle-making plants are back up and running.
The supply won't be at 100 percent for a few more months, but officials say the crisis has passed.
"But it'll still be mid-2010 before we're back to normal. Production is increasing, but we're still not up to where we need to be from an inventory perspective," said Kellogg's spokeswoman Kris Charles.
U.S. & World
Production hiccups at two of the plants were responsible for the nationwide shortage.