Kaiser Family Foundation

This JAMA Forum discusses US health insurance, including the rise and fall of health maintenance organizations, consumer problems with insurance today, and the need for consumer protections.

As part of a collaborative research effort (The NHERI TallWood Project), an extensive shake table test program was undertaken on a full-scale 10-story mass timber building with a resilient posttensioned mass timber rocking wall lateral system. Over a three-year period, academic and industry partners collaborated on the design, construction, and testing of a 34 m (113 ft) tall, 10-story mass timber building at the world’s largest outdoor shake table facility (NHERI@UC San Diego). The test building incorporated a resilient mass timber rocking wall lateral system, gravity connection details designed to remain damage-free under design level earthquakes as well as innovative nonstructural systems detailed to tolerate moderate building drifts without significant damage. A total of 88 earthquake tests at different intensity levels were conducted, including several at the risk targeted maximum considered earthquake intensity for the building’s design location. Experimental results indicate that a tall wood building with the systems and details employed in this study can withstand design basis and maximum considered earthquake level events repeatedly with no notable residual drift, no structural member or connection damage, while only experiencing moderate nonstructural damage that would be repairable, meeting the intended resilience goals. This paper provides a summary of the design, construction, testing, and primary results from this experimental program.

The Person-Centered Contraceptive Care measure (PCCC) evaluates patient experience of contraceptive counseling, a construct not represented within United States surveillance metrics of contraceptive care. We explore use of PCCC in a national probability sample and examine predictors of person-centered contraceptive care. Among 2228 women from the 2017-2019 National Survey of Family Growth who reported receiving contraceptive care in the last year, we conducted univariate and multivariable linear regression to identify associations between individual characteristics and PCCC scores. PCCC scores were high ( : 17.84, CI: 17.59-18.08 on a 4-20 scale), yet varied across characteristics. In adjusted analyses, Hispanic identity with Spanish language primacy and non-Hispanic other or multiple racial identities were significantly associated with lower average PCCC scores compared to those of non-Hispanic white identity (B = -1.232 [-1.970, -0.493]; B = -0.792 [-1.411, -0.173]). Gay, lesbian, or bisexual identity was associated with lower average PCCC scores compared to heterosexual (B = -0.673 [-1.243, -0.103]). PCCC scores had a positive association with incomes of 150%-299% and ≥300% of the federal poverty level compared to those of income <150% (150%-299%: B = 0.669 [0.198, 1.141]; ≥300%: B = 0.892 [0.412, 1.372]). Cannabis use in the past year was associated with lower PCCC scores (B = -0.542 [-0.971, -0.113]). The PCCC can capture differential experiences of contraceptive care to monitor patient experience and to motivate and track care quality over time. Differences in reported quality of care have implications for informing national priorities for contraceptive care improvements.

This JAMA Forum discusses the increasingly privatized public health insurance programs in the US and the current debates over payment reform and prior authorization.

PurposeThe purpose of this paper is to describe how resilience unfolded in a project-based organization with the support of organizational values through changing leadership styles. The rapidly announced restrictions on businesses during the coronavirus disease 2019 (COVID-19) provided an opportunity to observe and study resilience unfold.Design/methodology/approachThe process-perspective case study approach of a structural and civil engineering design firm in San Francisco, California, USA, integrates interviews, observations, document analysis and information tracking via email and Microsoft Teams. The researchers adopted a leadership perspective, where the units of analysis are the internal management and the employees' behaviors.FindingsIn the case examined, the capability represented in the organizational values influenced the choice of situation-appropriate leadership styles to support employees. The values of relationship, passion and trust influenced the dominant choice of a transformational style, where stability and excellence facilitate a transactional style – all equally important for the balance and resilience of the project-based organization.Originality/valueThis study demonstrated that when organizational values support leaders in cultivating a learning environment, those values provide stability for leaders to promote resilience. To the best of the researchers' knowledge, no previous work described how situational-, transformational- and transactional-leadership styles evolve in response to a crisis and together facilitate organizational resilience.

This paper provides a summary of the design, construction, and test planning of a shake table test program of a full-scale ten-story mass timber building. The shake table test program is a component of the experimental research work conducted as part of the NHERI TallWood project funded by the U.S. National Science Foundation. The goal of the NHERI TallWood project is to develop resilience-based seismic design methods for tall wood buildings through the adoption of a mass timber rocking wall lateral system and various detailing strategies for deformation-tolerant structural and non-structural connections and subassemblies. In this paper, the design configuration of the test structure is introduced, the construction process of both the structural and non-structural systems is explained, and the intended testing plan is presented. At the time of this writing, the construction of the building has been completed while the instrumentation process is ongoing. The authors intended to present initial results from the tests at the WCTE 2023 conference.

This JAMA Forum discusses upcoming debt ceiling debates in the US Congress and potential cuts to entitlement programs within the context of the current wider reach of Medicaid than Medicare, Medicaid expansion under the Affordable Care Act, and the possible end to the COVID-19 public health emergency and a recession.

The Masonry Society committee in charge of the publication Building Code Requirements for Masonry Structures, TMS 402, rewrote the chapter containing provisions for masonry veneer in the 2022 edition. One change incorporated in this new chapter was an engineered method for anchored veneer design. A key design criterion of the engineered design method is that the designer know the veneer tie stiffness and strength. However, there is no standard method for testing veneer ties that captures these properties. This paper proposes a conceptual standard for veneer tie testing. In this proposed test method, the measured ultimate load of the tie is based on the peak strength, or the load at a defined deformation. The nominal tie strength is then related to the 75th percent confidence level of the 5th-percentile value using a lognormal distribution. The stiffness is determined as a secant stiffness between two load levels. For adjustable ties, the test configuration is important, as both the strength and stiffness can vary significantly depending on the configuration. A procedure to determine a single representative strength and stiffness for design is presented, with these quantities being representative of the average tie strength for various configurations, and with an ultimate strength being limited to 1.5 times the strength determined at the configuration that results in the lowest nominal strength.