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A quirk in the Social Security benefit formula interacting with the sharp economic downturn due to the COVID-19 pandemic could cause certain groups of near-retirees to suffer significant and permanent reductions to their Social Security retirement benefits. A sudden decline in the Social Security Administration (SSA)'s measure of economywide average wages in the year a worker turns 60 causes the Social Security benefit formula to devalue all the worker's earnings prior to age 60, resulting in a lower measure of career-average earnings and a lower benefit in retirement. A middle-income worker aged 60 in 2020 could receive an annual Social Security benefit reduction of around 9%, with losses through retirement approaching $46,000. Individuals becoming eligible for Social Security Disability Insurance benefits would be subject to similar reductions in percentage terms. Several methods are discussed to reduce or eliminate the likelihood of similar benefit ‘notches’ occurring in the future.
STATUTES ARE USUALLY TAKEN for granted as one of the definitional features of medieval, and indeed modern, collegiate life. As a form of document, however, they emerged in response to particular constraints in the late thirteenth century and were widely taken up in the mid-fourteenth century. This type of document was important to their institutions, and often remained in use until dissolution, or, in the case of the English cathedrals, until modern renegotiations. For this reason they have often been used as descriptions of what life in a medieval college was like. They have also been used as a basis for categorising institutions. In making such categorisations, historians have followed the pioneering work of Alexander Hamilton Thompson from the first decades of the twentieth century. He used collegiate statutes as a class of document displaying what collegiate life as a whole could be, and to divide colleges into two types: chantry colleges and older institutions in the ‘cathedral model’. The key difference between chantry colleges and colleges following the cathedral model was the differing expectation of residence set out in their respective regulations. Finally, statutes have more recently been seen as proscriptive and regulatory texts that were part of founders’ efforts to ensure accountability and good management by the community.
This essay comes out of a conversation with Mark Ormrod in the early months of my doctoral work, as part of a discussion about a fragment of the almost entirely lost statutes of St Stephen's College, Westminster, from 1355. He asked me ‘what were medieval statutes?’ Part of the answer emerged in a reconstruction of what might have been included in the statutes of St Stephen's using the provisions in the statutes surviving from large royal and noble foundations in the fourteenth and fifteenth centuries. This essay extends that assessment by discussing how statutes became the standard and routine definitional document in the lives of collegiate communities after 1340, when colleges began to be a popular form of lay foundation, and how statutes subsequently became an expected and ubiquitous part of the collegiate foundation process in the fifteenth century.
Opioid use disorder is a major public health crisis, and evidence suggests ways of better serving patients who live with opioid use disorder in the emergency department (ED). A multi-disciplinary team developed a quality improvement project to implement this evidence.
The intervention was developed by an expert working group consisting of specialists and stakeholders. The group set goals of increasing prescribing of buprenorphine/naloxone and providing next day walk-in referrals to opioid use disorder treatment clinics. From May to September 2018, three Alberta ED sites and three opioid use disorder treatment clinics worked together to trial the intervention. We used administrative data to track the number of ED visits where patients were given buprenorphine/naloxone. Monthly ED prescribing rates before and after the intervention were considered and compared with eight nonintervention sites. We considered whether patients continued to fill opioid agonist treatment prescriptions at 30, 60, and 90 days after their index ED visit to measure continuity in treatment.
The intervention sites increased their prescribing of buprenorphine/naloxone during the intervention period and prescribed more buprenorphine/naloxone than the controls. Thirty-five of 47 patients (74.4%) discharged from the ED with buprenorphine/naloxone continued to fill opioid agonist treatment prescriptions 30 days and 60 days after their index ED visit. Thirty-four patients (72.3%) filled prescriptions at 90 days.
Emergency clinicians can effectively initiate patients on buprenorphine/naloxone when supports for this standardized evidence-based care are in place within their practice setting and timely follow-up in community is available.
Background: Since January 1, 2016 2358 people have died from opioid poisoning in Alberta. Buprenorphine/naloxone (bup/nal) is the recommended first line treatment for opioid use disorder (OUD) and this treatment can be initiated in emergency departments and urgent care centres (EDs). Aim Statement: This project aims to spread a quality improvement intervention to all 107 adult EDs in Alberta by March 31, 2020. The intervention supports clinicians to initiate bup/nal for eligible individuals and provide rapid referrals to OUD treatment clinics. Measures & Design: Local ED teams were identified (administrators, clinical nurse educators, physicians and, where available, pharmacists and social workers). Local teams were supported by a provincial project team (project manager, consultant, and five physician leads) through a multi-faceted implementation process using provincial order sets, clinician education products, and patient-facing information. We used administrative ED and pharmacy data to track the number of visits where bup/nal was given in ED, and whether discharged patients continued to fill any opioid agonist treatment (OAT) prescription 30 days after their index ED visit. OUD clinics reported the number of referrals received from EDs and the number attending their first appointment. Patient safety event reports were tracked to identify any unintended negative impacts. Evaluation/Results: We report data from May 15, 2018 (program start) to September 31, 2019. Forty-nine EDs (46% of 107) implemented the program and 22 (45% of 49) reported evaluation data. There were 5385 opioid-related visits to reporting ED sites after program adoption. Bup/nal was given during 832 ED visits (663 unique patients): 7 visits in the 1st quarter the program operated, 55 in the 2nd, 74 in the 3rd, 143 in the 4th, 294 in the 5th, and 255 in the 6th. Among 505 unique discharged patients with 30 day follow up data available 319 (63%) continued to fill any OAT prescription after receiving bup/nal in ED. 16 (70%) of 23 community clinics provided data. EDs referred patients to these clinics 440 times, and 236 referrals (54%) attended their first follow-up appointment. Available data may under-report program impact. 5 patient safety events have been reported, with no harm or minimal harm to the patient. Discussion/Impact: Results demonstrate effective spread and uptake of a standardized provincial ED based early medical intervention program for patients who live with OUD.
What then does St Stephen's College say about the practices of kingship and the ways in which it was displayed at Westminster over the two centuries of the college's existence? First, that the college's work played out through liturgy and the politics of commemoration. St Stephen's offered legitimation to the kings of England at their principal palace through institutional identity and the maintenance of the liturgy. The kings of England could use the chapel as a place for liturgical ceremony and royal spectacle, as seen in the services for which there are surviving written descriptions. These events functioned as a way for the kings to associate themselves with their ancestors and with Edward III's vision of kingship. The college also offered them support after their deaths. St Stephen's was first and foremost an institution that offered prayers for the dead, and particularly prayers for the royal dynasty, as set by Edward III. It so happened that inclusion in the royal dynasty in this period was itself contested, and thus the college's remembrances were given added significance. Its round of liturgy, as added to financially or structurally by every king after Edward III, with the two obvious exceptions of Richard III and Edward V, served as another imagined mausoleum to parallel the mausoleum of Westminster Abbey as it developed over the fourteenth and fifteenth centuries as the habitual resting place of the kings of England. The music of St Stephen’s, elaborated alongside the Chapel Royal in this period, emphasised the support given to the maintenance of the liturgy offered through gifts and through his presence by the king of England as a pious son of the Church. As a secular college, St Stephen's offered a continuous round of prayers and Masses, which could be augmented not just by the king, but also by others who wished to associate themselves with this royal chapel. The range of those who took up that offer was large, from William Lyndwood, bishop of St David’s, through to those individuals from Westminster and beyond who left money in the sixteenth century for prayers at the altar of Scala Coeli, as well as the canons and vicars themselves.
St Stephen's College occupied an important chapel that dominated the Thames riverfront of the medieval Palace of Westminster among the offices of government and the royal lodgings. The chapel offered a vantage point to observe displays of kingly legitimation, collaborations between the kings of England and the Church, and the audiences who thronged to Westminster to seek access to governance. Its liturgy and music reflected royal piety and commemoration of the royal dead. Each chapter here deals with St Stephen's from a slightly different perspective as the college and the expectations of kingship changed over two centuries. It first examines the religious and political contexts in which the college was founded and in which it had to establish its rights, until a final settlement with Westminster Abbey was reached in 1394. From 1377, Richard II adapted his grandfather's foundation as his own as he sought to remake the palace in his own image. During the dynastically troubled fifteenth century, the dean and canons of St Stephen's used its importance to the kings of England to maintain and develop its position as the ‘king's chief chapel’. The increasing presence of the populace as an audience to events at Westminster shaped the college's development and buildings after 1471 before, finally, the Reformation both revitalised and then destroyed it. The empty chapel then became the first permanent home of the House of Commons. This book examines St Stephen's College as a key institution within the most important English palace: its buildings, its personnel and its relationships with every king between 1348 and 1548.
[F]or with huse [us] is myche trobull, and every manne dowtes other.
Simon Stallworth, who was writing from his collegiate house on Canon Row in the troubled days between the ascension of Edward V and the usurpation of Richard III, could have been speaking for the dynastic crises of the fifteenth century more broadly. The period from the deposition of Richard II in 1399 to the victory of Henry VII at Bosworth in 1485 was the most unsettled length of time dynastically for the English Crown during the Middle Ages, and consequently for ideas around legitimate kingship, as at no point in this period was there one wholly undisputed occupant of the English throne. At each moment of regime change the new king had to come to some accommodation not only with the political community of the realm, including the great magnates, but also with those whose service he had inherited from his predecessor, particularly those who worked in and around the Palace of Westminster. The response of St Stephen's to moments of regime change reflected concern to maintain its privileges, develop the careers of its canons, and to ensure that it maintained its status as the king's chapel within the palace. As such, it interacted with the personal and expected pieties of the six men who were king in these eighty-odd years. Each of these kings had to engage with the Church as a patron as well as a source of validation and legitimation. This chapter examines the ways in which all of these kings of England responded to the imagery and institution of Edward III, from whom they all were descended, and who by the 1390s had come to be seen as the perfect king. All of these kings spent time at Westminster and at St Stephen's Chapel and all were remembered in its rounds of commemorative services, with the unsurprising exceptions of Edward V and Richard III. This chapter also examines the institutional response of St Stephen's College to the political and economic difficulties that surrounded them. The college succeeded in maintaining and even improving their financial position even as other institutions and their sister college of St George's Windsor were to struggle with financial difficulties and debt in this period.
Richard II, the second English king to be the patron of St Stephen's College, shaped its relationship with kingship, royal administration, the household and the wider built environment of the Palace of Westminster. His relationship with the college was mixed and often ambivalent, depending on whether the college met his own priorities and interests. During his minority, his council protected his financial interests against the sweeping legacy of his grandfather's will to the college, which he continued after 1381. Yet as an adult he adapted the college's site and its buildings to meet his own desires and display his power, and supported it against Westminster Abbey. As such, he was the first king to grapple with the question of how to make the chapel and college his own when it was so strongly associated with his grandfather and his grandfather's dynastic priorities. The malleability of the collegiate form made his partial reinvention of St Stephen's possible. Richard and those around him visually and institutionally added his version of kingship to his grandfather's while maintaining the college's dynastic connections. Richard's association with Westminster has long been discussed in terms of two projects, which have been seen as separate: his work on Westminster Hall and his patronage of the abbey. Both of the projects were significant, but also connected in a wider scheme to develop and elaborate the surroundings of monarchy in a particularly important palace that was personally important to the king. More widely, his interests in visual magnificence at court have received historiographical attention, not least because of the spectacular artistic survivals of the Westminster Portrait and the Wilton Diptych. At St Stephen's both the pious and royal aspects of Richard's kingship were on display to contemporary commentators. Richard adapted the college's buildings and its institutional shape as part of his wider strategies to make Westminster reflect his visual ideals of kingship and to commemorate his wife, Anne of Bohemia. The college's staff also came to reflect Richard's priorities and his household, including his rewards for his controversial favourites.
For two hundred years at any one time a group of twenty-six priests, four singing men, about six choristers, a verger and a keeper of the chapel of St Mary le Pew served the king's palace chapels of St Stephen, St Mary Undercroft and the oratory of St Mary le Pew within the Palace of Westminster. These men, who belonged to the royal college of St Stephen the Protomartyr, knew their role was to pray daily for the royal family, the dead who had asked to be commemorated in the chapel, and for the kingdom of England as a whole. Their prayers were expressed through the daily round of liturgy and music enjoined upon them by their own regulations, the statutes, which modified the common liturgical practice of the southern English Church, known as the Sarum Use. Their roles had been set by the college's founder, the English king Edward III, when in a letter patent dated 6 August 1348 he had commanded the foundation of the college ‘to the honour of God, St Stephen the Protomartyr, and the Virgin Mary’. On the same day he founded St George’s, Windsor, the home of the Order of the Garter. With modifications and a considerable increase in the numbers of people prayed for, the basic pattern set in 1348 was still true at Easter 1548, when another Edward, Edward VI, dissolved all remaining institutions that had as their primary purpose to pray for the dead in Purgatory, including St Stephen’s. St George's was exempted from that act. The twenty-six priests at both colleges were divided into two groups. The dean and the twelve canons were appointed by the king, and so were drawn from the world of royal service, where they also worked in the king's administration or his household and were in consequence rewarded with ecclesiastical positions at institutions with no parochial responsibilities. Their presence was expected at the main mass of the day and when otherwise required, but much of their time could be devoted to the work of administration and government in the Palace of Westminster, and they might have many other additional ecclesiastical posts.
‘My lorde if in ye courte you do keep such holly dayes & fastynge dayes as be abrogated, when shal we p[er]suade ye people to ceasse fro[m] kepynge they[m]? For the kynges own house shal be an example unto al ye realme to break his own ordinance.’
This letter from the archbishop of Canterbury, Thomas Cranmer, to Thomas Cromwell in August 1537 expressed his exasperation with the Chapel Royal and its lack of conformity to the religious changes and abolition of saints’ days of the Henrician Reformation. Here he pointed to the possibilities of the Chapel Royal, and the royal chapels more generally in showing correct practice at a time when royal ordinances were in theory radically reshaping the country's experience of worship. By this point the Chapel Royal was firmly established elsewhere, at the great standing houses and when at Westminster at Whitehall rather than the old palace. But the same complaint could have been levelled at St Stephen's College, still visibly one of the king's chapels, and one that the needs of the Reformation had reinvigorated. The college's responses to the liturgical demands of the Reformation were equivocal and often surprisingly reluctant given its status within what continued to be the royal palace devoted to administration. Ten years before the letter, when the divorce case that would become the impetus for Henry VIII's break from Rome began, St Stephen's had not been at the forefront of the English Church's theology; Stephen Gardiner canvassed the universities rather than the secular colleges. But as the king came to need to reward the priests who were creating the structures of his new Church, St Stephen's became a throughroad to the episcopacy for such as wished promotion. In this final phase in the existence of St Stephen's College, routine personal kingship began to be disassociated from the institution because the king was no longer habitually resident at the palace, however much time he spent at Whitehall. It was that disassociation that allowed the college to become redundant and to be dissolved in 1548.
From its foundation in 1348 to the end of a legal dispute in 1394 St Stephen's College sought to define its purpose and its role within the king's palace at Westminster. Its foundation was very much a royal project of Edward III, but one that conflicted with the rights of Westminster Abbey within the manor of Westminster. The king intended that it be treated as one of the royal free chapels, traditionally set apart from the ordinary structures of the Church with their own jurisdictions and ecclesiastical and financial privileges. As a royal free chapel, the staff of St Stephen's expected to be allowed their rights, which would have given the college jurisdiction over all who lived within or worked at the Palace of Westminster as an extension of royal power. Founding a new institution required co-operation and goodwill from a variety of individuals both within and outside the Church, and then defining its place required litigation. It was devoted to the commemoration of the royal dead and, in adding to the permanent provision of worship within the king's palace, a display of royal piety to those who worked at or visited Westminster. Edward III founded the college as a chantry to pray for the royal family, but turning that idea into practical reality supported by a landed endowment and with the necessary agreements and privileges was the work of others, including his treasurer, William Edington, and the individuals who belonged to the college. The college's own canons played an important role in creating the financial and physical fabric that would be distinctively marked out as belonging to them, within the palace precinct. Instead of Edward's envisaged role for the college, however, twenty years of litigation with Westminster Abbey would confine its jurisdiction to simply its own staff and servants. The results of negotiation, high-handed assumptions, petitioning and lawsuits combined in 1394 to create an agreement that, along with the earlier statutes, would set the pattern for the college's existence for the rest of the Middle Ages. By 1394, the college had been the work of several generations of canons with royal support, and its interpretation and reinterpretation would continue until it was dissolved in the sixteenth century.