A Distinction Without a Difference? ERISA Preemption and the Untenable Differential Treatment of Revocation-on-Divorce and Slayer Statutes

The Employee Retirement Income Security Act of 1974 (ERISA) was enacted in large part to protect employee benefit plan participants. Yet ERISA’s broad preemption clause may actually thwart this goal in certain cases by imposing unexpected consequences on participants who die before appropriately updating their beneficiary designations. For instance, although many state laws presume divorce to revoke the former spouse’s beneficiary status, the U.S. Supreme Court’s 2001 decision in Egelhoff v. Egelhoff ex rel. Breiner made clear that ERISA preempts such state-level wills doctrines, enabling a former spouse to benefit when the deceased participant likely intended otherwise. The rationale behind this broad preemption provision applies equally to other wills doctrines such as “slayer statutes,” which prevent murderers from benefitting from their crimes. Therefore, it is likely impossible to confine the impact of this pre-emptive effect to the divorce realm. Moreover, in the wake of Kennedy v. Plan Administrator for DuPont Savings & Investment Plan, decided by the U.S. Supreme Court in 2009, the federal common law no longer appears to be a valid solution to this problem of effecting the likely intent of deceased plan participants. Congressional action to amend ERISA is therefore necessary to avoid these inequitable results

Deferential Dilemmas: \u3cem\u3ePinholster v. Ayers\u3c/em\u3e and Federal Habeas Claims of Ineffective Assistance of Counsel After AEDPA

On December 9, 2009, the Ninth Circuit Court of Appeals, sitting en banc, concluded that Scott Lynn Pinholster had received deficient, prejudicial assistance of counsel at the penalty phase of his capital case, vacating an earlier decision by a panel of the Ninth Circuit. The U.S. Supreme Court subsequently granted certiorari to consider whether this was an appropriate application of both Strickland v. Washington and the Antiterrorism and Effective Death Penalty Act of 1996. This Comment argues that the latter en banc majority opinion more effectively ensures that capital defendants such as Pinholster are permitted to vindicate their Sixth Amendment rights to effective assistance of counsel because the position advocated by the dissent would largely erode these fundamental constitutional protections

Gender Undone: Confronting Bias in the Nuclear Field

In the face of evolving security needs, diversity is critical in nonproliferation, nuclear security, and other related fields. Despite multiple studies highlighting the need for gender balance and diversity in the nuclear nonproliferation and security space and targeted recruitment and capacity-building efforts by the International Atomic Energy Agency and states, gains in the representation of women (as well as historically underrepresented groups) have been set back by the gendered effects of the COVID-19 pandemic and slow cultural change at nuclear facilities and organizations. This issue is in large part due to the inability of initiatives aimed at diversity, equity, inclusion, and accessibility (DEIA) to deal with the structural biases of who belongsin nuclear security. Accordingly, this paper will address potential solutions and good practices for reforming organizational nuclear security culture in the United States. Integrating policies to actively confront and undo structural biases and gendered assumptions about women in nuclear security is the start of building DEIA into the broader nuclear industry and its associated organizations. Although bias is an inevitable symptom of the human condition, employers in the nuclear field can work to check biases by integrating DEIA values and assumptions that deal with gender representation into the organizational culture. This paper finds that significantly more transparency and public data reporting is needed in the sector to understand the scope of the challenge and posits the creation of a DEIA nuclear security organizational culture more reflective of DEIA values to strengthen nuclear security and improve the diversity of the nuclear field in the long term

Patient empowerment: The need to consider it as a measurable patient-reported outcome for chronic conditions

Background: Health policy in the UK and elsewhere is prioritising patient empowerment and patient evaluations of healthcare. Patient reported outcome measures now take centre-stage in implementing strategies to increase patient empowerment. This article argues for consideration of patient empowerment itself as a directly measurable patient reported outcome for chronic conditions, highlights some issues in adopting this approach, and outlines a research agenda to enable healthcare evaluation on the basis of patient empowerment. Discussion: Patient empowerment is not a well-defined construct. A range of condition-specific and generic patient empowerment questionnaires have been developed; each captures a different construct e.g. personal control, self-efficacy/self-mastery, and each is informed by a different implicit or explicit theoretical framework. This makes it currently problematic to conduct comparative evaluations of healthcare services on the basis of patient empowerment. A case study (clinical genetics) is used to (1) illustrate that patient empowerment can be a valued healthcare outcome, even if patients do not obtain health status benefits, (2) provide a rationale for conducting work necessary to tighten up the patient empowerment construct (3) provide an exemplar to inform design of interventions to increase patient empowerment in chronic disease. Such initiatives could be evaluated on the basis of measurable changes in patient empowerment, if the construct were properly operationalised as a patient reported outcome measure. To facilitate this, research is needed to develop an appropriate and widely applicable generic theoretical framework of patient empowerment to inform (re)development of a generic measure. This research should include developing consensus between patients, clinicians and policymakers about the content and boundaries of the construct before operationalisation. This article also considers a number of issues for society and for healthcare providers raised by adopting the patient empowerment paradigm. Summary: Healthcare policy is driving the need to consider patient empowerment as a measurable patient outcome from healthcare services. Research is needed to (1) tighten up the construct (2) develop consensus about what is important to include (3) (re)develop a generic measure of patient empowerment for use in evaluating healthcare (4) understand if/how people make trade-offs between empowerment and gain in health status

Developing a short-form of the Genetic Counselling Outcome Scale: The Genomics Outcome Scale

The Genetic Counselling Outcome Scale (GCOS-24) is a 24-item patient reported outcome measure for use in evaluations of genetic counselling and testing services. The aim of this study was to develop a short form of GCOS-24. The study comprised three phases. Phase I: Cognitive interviews were used to explore interpretability of GCOS-24 items and which GCOS-24 items were most valued by the target population. Phase II: The Graded Response Model was used to analyse an existing set of GCOS-24 responses (n = 395) to examine item discrimination. Phase III: Item Selection. Three principles guided the approach to item selection (i) Items with poor discriminative properties were not selected; (ii) To avoid redundancy, items capturing a similar outcome were not selected together; item information curves and cognitive interview findings were used to establish superior items. (iii) Rasch analysis was then used to determine the optimal scale. In Phase I, ten cognitive interviews were conducted with individuals affected by or at risk for a genetic condition, recruited from patient support groups. Analysis of interview transcripts identified twelve GCOS-24 items which were highly valued by participants. In Phase II, Graded Response Model item characteristic curves and item information curves were produced. In Phase III, findings from Phases I and II were used to select ten highly-valued items that perform well. Finally, items were iteratively removed and permutated to establish optimal fit statistics under the Rasch model. A six-item questionnaire with a five-point Likert Scale was produced (The Genomics Outcome Scale (GOS)). Correlation between GCOS-24 and GOS scores is high (r = 0.838 at 99% confidence), suggesting that GOS maintains the ability of GCOS-24 to capture empowerment, whilst providing a less burdensome scale for respondents. This study represents the first step in developing a preference-based measure which could be used in the evaluation of technologies and services used in genomic medicine

Age at First Concussion Influences Number of Subsequent Concussions

Background: Individuals that sustain their first concussion during childhood may be at greater risk for sustaining multiple concussions throughout their lifetime, due to a longer window of vulnerability. Purpose: To estimate the association between age at first concussion with number of subsequent concussions. Methods: A total of 23,582 collegiate athletes from 26 universities and military cadets from three military academies completed a concussion history questionnaire (65% males, age: 19.9±1.4years). Participants self-reported concussions and age at time of each injury. Participants with a history of concussion (n=3,647, 15.5%) were categorized as having sustained their first concussion during childhood (<10 years old - yo) or adolescence (≥10yo & ≤18yo). Poisson regression was used to model age group (childhood, adolescence) predicting number of subsequent concussions (0, 1, 2+). A second Poisson regression was developed to determine whether age at first concussion predicted number of subsequent concussions. Results: Participants self-reporting their first concussion during childhood had an increased risk of sustaining subsequent concussions (RR=2.19, 95% CI: 1.82, 2.64) compared to participants self-reporting their first concussion during adolescence. For every one-year increase in age at first concussion, we observed a 16% reduction in the risk of subsequent concussion (RR=0.84, 95% CI:0.82,0.86). Conclusion(s): Individuals self-reporting a concussion at a young age sustained a higher number of concussions prior to the age of 18. Concussion prevention, recognition, and reporting strategies are of particular need at the youth level

Age at First Concussion Influences Number of Subsequent Concussions

Background: Individuals that sustain their first concussion during childhood may be at greater risk for sustaining multiple concussions throughout their lifetime, due to a longer window of vulnerability. Purpose: To estimate the association between age at first concussion with number of subsequent concussions. Methods: A total of 23,582 collegiate athletes from 26 universities and military cadets from three military academies completed a concussion history questionnaire (65% males, age: 19.9±1.4years). Participants self-reported concussions and age at time of each injury. Participants with a history of concussion (n=3,647, 15.5%) were categorized as having sustained their first concussion during childhood (<10 years old - yo) or adolescence (≥10yo & ≤18yo). Poisson regression was used to model age group (childhood, adolescence) predicting number of subsequent concussions (0, 1, 2+). A second Poisson regression was developed to determine whether age at first concussion predicted number of subsequent concussions. Results: Participants self-reporting their first concussion during childhood had an increased risk of sustaining subsequent concussions (RR=2.19, 95% CI: 1.82, 2.64) compared to participants self-reporting their first concussion during adolescence. For every one-year increase in age at first concussion, we observed a 16% reduction in the risk of subsequent concussion (RR=0.84, 95% CI:0.82,0.86). Conclusion(s): Individuals self-reporting a concussion at a young age sustained a higher number of concussions prior to the age of 18. Concussion prevention, recognition, and reporting strategies are of particular need at the youth level