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Leaders face an unprecedented diversity in follower expectations and value systems as the workforce expands to four distinctly unique generations, ranging from Millennials to the Silent Generation. Rapid advances in technology have amplified the generational differences and increased the complexity of an increasingly disconnected workforce. Business sustainability and success depend upon a leader’s ability to cost-effectively deliver financial results, employee performance, and employee satisfaction given these mounting challenges. The purpose of this exploratory qualitative study was to discover leadership practices proven effective in addressing the complexities of a technologically enabled, multi-generational workforce. Eighteen insurance industry senior executives were interviewed by phone using a semi-structured process consisting of nine open-ended questions, six on leadership practices and three on influencing factors. Transformational and authentic leadership were selected as the theoretical framework for reviewing the described practices. The study’s findings supported authentic leadership as the foundation for effective practices while indicating the need to incorporate select aspects of transformational leadership. By blending the two theories into an effective framework, the importance of having a more unified theory of leadership was also reinforced. The results of study were three-pronged: confirming generational differences as a critical consideration in defining effective leadership, blending authentic and transformational leadership theory into an integrated set of effective leadership practices, and highlighting technology as an integral leadership construct with significant influence on effective communication practices.

Claims operations are getting headline coverage lately, driven in no small part by recent references to Accenture's claims survey that lists core systems replacement, data and analytics, and workforce growth as the top three priorities and Celent's claims fraud report highlighting reduction in fraud as one of the key levers to near term profitability. Executives appear to be in agreement that improving combined ratios will be more easily achieved than increasing underwriting profits, at least until the economy returns to a more reasonable footing. At the same time, increased competitive intensity has executives asking their claims departments to improve their delivery of service excellence and their operational efficiency. Apparently, the previously achieved efficiencies have been quickly absorbed by increased investments in technology, putting most claims departments back where they started. The race is on to pair carriers with the solutions needed to deliver on these demands.

Uncertainty over election results, the fiscal cliff, and economic direction appear to have been addressed, allowing industry leaders to focus on a return to competitive advantage and sustainable profitability. Even with gradual improvements in the economy, companies remain faced with increasingly costly catastrophe losses and near-term minimal investment returns. Further complicating the challenges leadership faces are continued increases in consumer expectations for products and service, an increasingly diversified market, distribution challenges, and nonstop technological advances. Bottom line, the insurance industry requires game changers to improve performance in any meaningful manner. User-based insurance (UBI) offers one possible example of a game changer, but like all shifts it comes with it is own set of challenges. Layering a strong analytics solution on top of policy admin data and other data sources allows carriers to focus on four areas where analytics can bring significantly amplified results. In priority order based on potential impact, including: 1. risk assessment, 2. claims handling, 3. agent effectiveness, and 4. customer awareness.

The property and casualty industry has not had a return on equity (ROE) better than the Fortune 500 since 1987. The last times it was even close were 1991 and 1993. Even if the Fortune 500 is not considered the right benchmark, the industry average ROE has declined from a high of 12.7 percent in 2006 to an estimated 3.9 percent in 2011. Even more relevant, the industry ROE has been measurably lower than the average cost of capital since 2008. Running a business returning less than its cost of capital is rarely a sustainable model, as evidenced by the number of property & casualty impairments occurring since 2007.

Economic conditions for 2012 do not look particularly promising, challenging companies to find unique ways to generate sustainable growth and profitability. Continued high unemployment, near zero interest rates, limited growth in the economy, increased consumer diversity, extended low investment returns, intensified service expectations, expanded competition, and a probability of additional natural disasters converge to create yet another challenging year for the insurance industry in general. Constrained by the combination of these profit-compressing variables with little room to maneuver, earnings are likely to remain low throughout 2012.

In many areas of oncology, we lack sensitive tools to track low-burden disease. Although cell-free DNA (cfDNA) shows promise in detecting cancer mutations, we found that the combination of low tumor fraction (TF) and limited number of DNA fragments restricts low-disease-burden monitoring through the prevailing deep targeted sequencing paradigm. We reasoned that breadth may supplant depth of sequencing to overcome the barrier of cfDNA abundance. Whole-genome sequencing (WGS) of cfDNA allowed ultra-sensitive detection, capitalizing on the cumulative signal of thousands of somatic mutations observed in solid malignancies, with TF detection sensitivity as low as 10 −5 . The WGS approach enabled dynamic tumor burden tracking and postoperative residual disease detection, associated with adverse outcome. Thus, we present an orthogonal framework for cfDNA cancer monitoring via genome-wide mutational integration, enabling ultra-sensitive detection, overcoming the limitation of cfDNA abundance and empowering treatment optimization in low-disease-burden oncology care. A new approach for whole-genome sequencing of plasma circulating tumor DNA allows for dynamic monitoring of disease burden and ultra-sensitive detection of minimal residual disease.

Chromosome organization is crucial for genome function. Here, we present a method for visualizing chromosomal DNA at super-resolution and then integrating Hi-C data to produce three-dimensional models of chromosome organization. Using the super-resolution microscopy methods of OligoSTORM and OligoDNA-PAINT, we trace 8 megabases of human chromosome 19, visualizing structures ranging in size from a few kilobases to over a megabase. Focusing on chromosomal regions that contribute to compartments, we discover distinct structures that, in spite of considerable variability, can predict whether such regions correspond to active (A-type) or inactive (B-type) compartments. Imaging through the depths of entire nuclei, we capture pairs of homologous regions in diploid cells, obtaining evidence that maternal and paternal homologous regions can be differentially organized. Finally, using restraint-based modeling to integrate imaging and Hi-C data, we implement a method-integrative modeling of genomic regions (IMGR)-to increase the genomic resolution of our traces to 10 kb.

A modular leadless pacemaker in wireless communication with a subcutaneous implantable cardioverter–defibrillator was shown to be safe and exceeded performance goals for communication between the pacemaker and ICD.

Background Jimsonweed ( Datura stramonium ) contains toxic alkaloids that cause gastrointestinal and central nervous system symptoms when ingested. This can be lethal at high doses. The plant may grow together with leguminous crops, mixing with them during harvesting. On 13 March 2019, more than 200 case-patients were admitted to multiple health centres for acute gastrointestinal and neurologic symptoms. We investigated to determine the cause and magnitude of the outbreak and recommended evidence-based control and prevention measures. Methods We defined a suspected case as sudden onset of confusion, dizziness, convulsions, hallucinations, diarrhoea, or vomiting with no other medically plausible explanations in a resident of Napak or Amudat District from 1 March—30 April 2019. We reviewed medical records and canvassed all villages of the eight affected subcounties to identify cases. In a retrospective cohort study conducted in 17 villages that reported the earliest cases, we interviewed 211 residents about dietary history during 11–15 March. We used modified Poisson regression to assess suspected food exposures. Food samples underwent chemical (heavy metals, chemical contaminants, and toxins), proteomic, DNA, and microbiological testing in one national and three international laboratories. Results We identified 293 suspected cases; five (1.7%) died. Symptoms included confusion (62%), dizziness (38%), diarrhoea (22%), nausea/vomiting (18%), convulsions (12%), and hallucinations (8%). The outbreak started on 12 March, 2–12 h after Batch X of fortified corn-soy blend (CSB +) was distributed. In the retrospective cohort study, 66% of 134 persons who ate CSB + , compared with 2.2% of 75 who did not developed illness (RR adj  = 22, 95% CI = 6.0–81). Samples of Batch X distributed 11–15 March contained 14 tropane alkaloids, including atropine (25-50 ppm) and scopolamine (1-10 ppm). Proteins of Solanaceae seeds and Jimsonweed DNA were identified. No other significant laboratory findings were observed. Conclusion This was the largest documented outbreak caused by food contamination with tropane alkaloids. Implicated food was immediately withdrawn. Routine food safety and quality checks could prevent future outbreaks.