Gallagher (United States)

Homeowner insurance is a cornerstone of modern society. It underpins broader housing markets, provides financial security for families and individuals, and is a source of resilience for communities recovering from disasters. However, climate change and urban development in hazard-prone areas are undermining this critical institution, forcing private insurers to retreat from high-risk regions and leaving homeowners in the lurch precisely when they are most in need of coverage. This perspective explores the cascading effects of this crisis and advocates for a multi-faceted set of reforms that address three interrelated problem domains—enhancing innovations in pricing and underwriting, improving transparency of data and risk assessment practices, and bolstering resilience of the built environment—to ensure sustainable protection for the future.

ABSTRACT Real-time flood forecasting requires computationally efficient models, and implicit flood models are often preferred due to their ability to use larger time steps, enhancing computational efficiency. However, these models may suffer from spurious checkerboard oscillations, causing unrealistic predictions of water depth and velocity. While some models employ the Rhie and Chow interpolation technique to mitigate these oscillations, this approach depends on the under-relaxation factor, affecting convergence and computation time. This study introduces IITMFLO-2D, an implicit 2D flood model developed using the SIMPLE-Consistent (SIMPLEC) algorithm on a non-staggered grid system, with two novel modifications to reduce checkerboard oscillations. The first modification uses an explicit equation, similar to Roe-type averaging, for the momentum weighting factor based on local flow depths. The second introduces a Courant–Friedrichs–Lewy (CFL)-based weighting factor to determine interfacial water levels, adapting to local flow dynamics. These adaptive weighting factors vary spatially and temporally. Performance of IITMFLO-2D is verified through analytical test cases, hypothetical flood simulations, and experimental events, showing significant reductions in computation time and improved accuracy compared to other models such as HECRAS-2D and TELEMAC-2D. These innovations make IITMFLO-2D suitable for real-time flood forecasting and applicable to other numerical models with complex meshes.

A nearly stationary low-pressure system generated significant rainfall across central Europe in September 2024 resulting in life-threatening and costly flooding in Central and Eastern Europe. Catastrophic floods also struck southern Spain in October and southern Germany from late May to early June. These events marked an escalation in severity compared to 2023, which saw major flood events impacting Italy and Greece in June and September, respectively. This escalating pattern of widespread, severe flooding, coupled with rising financial losses and risks, has drawn significant attention from (re)insurers.We present a retrospective on these events using the Gallagher Re Europe Flood Model, a pan-European flood catastrophe model designed to assess the potential financial impact of floods in terms of their magnitude and likelihood. By using quantitative indexes to compare observed flooding with thousands of stochastic event footprints included in the model, we show that a complementary qualitative analysis is necessary to identify the most representative events. This hazard-based analysis is than complemented by the estimation of financial losses. The results reveal a range of losses for near-similar events, reflecting the complexities involved in modelling the financial impact of flooding. These complexities include, but are not limited to, the granularity of the peril, the geo-localization of the exposure and the impact of flood defences. For example, by leveraging the flexibility of our model, we show an estimate of the financial implications for a (re)insurer should the defences have failed during the development of major events.    In conclusion, while there is no control on the meteorological drivers of such events, our  analyses shows the relevance and importance of catastrophe models to support (re)insurers in targeted exposure management and improved risk assessment.

When severe European winter windstorms cluster in time, socioeconomic impacts and losses are magnified. Yet, the behaviour and drivers on shorter, intra-seasonal timescales have not been fully investigated. The impact-relevant footprint of the storm system is identified using the wind-based impact-oriented tracking algorithm WiTRACK (Leckebusch et al., 2008), for the core winter seasons (DJF) 1980/01-2022/23 from ERA5 reanalysis. Derived from a Poisson Process, we quantify the magnitude of clustering through the widely established dispersion statistic (Mailier et al., 2006). On fixed 45- and 30-day timescales, the spatial distribution of the dispersion statistic has been analysed. The time-development of the dispersion statistic on shorter time horizons is investigated through 21-, 15- and 11-day moving windows. Preliminary results reveal an increase in clustering in the latter half of the winter season on the fixed 45- and 30-day timescales. Shorter time horizons reveal clear peaks at the middle and the end of the season.To analyse mechanisms that drive the defined intra-seasonal behaviour on the shorter time horizons (

Abstract The 2023 Atlantic hurricane season was above normal, producing 20 named storms, 7 hurricanes, 3 major hurricanes, and seasonal accumulated cyclone energy that exceeded the 1991–2020 average. Hurricane Idalia was the most damaging hurricane of the year, making landfall as a Category 3 hurricane in Florida, resulting in eight direct fatalities and 3.6 billion U.S. dollars in damage. The above-normal 2023 hurricane season occurred during a strong El Niño event. El Niño events tend to be associated with increased vertical wind shear across the Caribbean and tropical Atlantic, yet vertical wind shear during the peak hurricane season months of August–October was well below normal. The primary driver of the above-normal season was likely record warm tropical Atlantic sea surface temperatures (SSTs), which effectively counteracted some of the canonical impacts of El Niño. The extremely warm tropical Atlantic and Caribbean were associated with weaker-than-normal trade winds driven by an anomalously weak subtropical ridge, resulting in a positive wind–evaporation–SST feedback. We tested atmospheric circulation sensitivity to SSTs in both the tropical and subtropical Pacific and the Atlantic using the atmospheric component of the Community Earth System Model, version 2.3. We found that the extremely warm Atlantic was the primary driver of the reduced vertical wind shear relative to other moderate/strong El Niño events. The concentrated warmth in the eastern tropical Pacific in August–October may have contributed to increased levels of vertical wind shear than if the warming had been more evenly spread across the eastern and central tropical Pacific.

Trauma screening is recommended for pregnant persons with opioid use disorder (OUD), but there is limited literature on screening results from buprenorphine treatment. This study's objectives were to 1) describe the types, and severity, of traumatic events reported and 2) evaluate the associations between trauma and health-related quality of life (HRQoL). Baseline data from an ongoing trial were analyzed. Participants were 155 pregnant persons with OUD receiving, or enrolling in, buprenorphine treatment at one of 13 sites. The experience, and relative severity, of 14 high magnitude stressors were assessed with the trauma history screen. The Patient-Reported Outcomes Measurement Information System-29+2 was used to assess 8 HRQoL domains. Traumatic stressors were reported by 91% of the sample (n = 155), with 54.8% reporting a lifetime persisting posttraumatic distress (PPD) event and 29.7% reporting a childhood PPD event. The most prevalent lifetime PPD event was sudden death of a close family/friend (25.8%); physical abuse was the most prevalent childhood PPD event (10.3%). Participants with lifetime PPD, relative to no PPD, reported significantly greater pain interference ( P = 0.02). Participants with childhood PPD, relative to no PPD, had significantly worse HRQoL overall ( P = 0.01), and worse pain intensity ( P = 0.002), anxiety ( P = 0.003), depression ( P = 0.007), fatigue ( P = 0.002), and pain interference ( P < 0.001). A majority of pregnant persons enrolled/enrolling in buprenorphine treatment reported persisting posttraumatic distress with sudden death of close family/friend being the most prevalent originating event; clinicians should consider the impact that the opioid-overdose epidemic may be having in increasing trauma exposure in patients with OUD.

Occupational therapy is a profession with origins rooted in Western values. As culture plays an important role in shaping theory and practice, the curriculum design of academic programs that train future rehabilitation professionals should reflect the local context. As part of an international partnership, a dual-degree graduate program in occupational therapy was established between a Chinese and an American university. A team composed of members from both institutions collaborated on culturally adapting an entry-level master's program in occupational therapy for China, based on a U.S. program, which welcomed its first cohort in September 2019. This article details the timeline and process of program design and adaptation from conception, through implementation to evaluation and revision, with the aim of offering a framework for curriculum adaptation of other academic programs in the U.S. and internationally. The adapted curriculum includes the program mission, vision, and philosophy; the curriculum model with program outcomes and threads; the program scope and sequence; materials and resources; and course-specific objectives, learning activities, and assessments. The authors also share lessons learned through this experience of international collaboration as well as next steps for program evaluation and sustainability. The detailed overview of this international collaboration offers suggestions for individuals and institutions seeking to develop global partnerships and adapt curricula across cultural contexts.

Cancer caregiving is burdensome with unique needs, highlighting the importance of assessing caregivers' distress. Caregivers often accompany patients to healthcare visits, presenting an opportunity to complete distress screening at patients' point-of-care. To evaluate the feasibility of caregiver distress screening at patients' point-of-care and implementing a caregiver psychoeducational session. We approached caregivers in outpatient cancer clinic waiting rooms. Participants completed depression, burden, anxiety, quality of life, and stress measures. A psychoeducational session with a psychologist was offered to those meeting clinical cutoffs for depression and/or burden. Fifty caregivers completed 1+ measure; however, due to incomplete consent documentation, findings from 23 caregivers are reported. 22% of caregivers screened positive for depression, 30% burden, and 70% anxiety. More than half rated stress as moderate or higher. Mental wellbeing was slightly below that of the general population. More than 75% screened positive on 1+ distress measure. Of the 9 caregivers who met cutoffs for depression and/or burden, two (22%) accepted the psychoeducational session. Caregivers were moderately receptive to distress screening during patients' visits, but were less receptive to engaging in the psychoeducational session due to time constraints and privacy concerns. Assessing caregivers' distress can facilitate referrals for supportive services. Offering caregivers psychoeducational intervention outside of patient care may not be acceptable. Future research may evaluate the integration of routine caregiver screening within patient care to promote engagement with mental health services. This research offers a unique method of assessing cancer caregivers' distress.

Despite substantial investment in expanding access to treatment for opioid use disorder (OUD), overdose deaths continue to increase. Primary care holds enormous potential to expand access to OUD treatment, but few patients receive medications for OUD (MOUD) in primary care. Understanding both patient and clinician experiences is critical to expanding access to patient-centered MOUD care, yet relatively little research has examined patient perspectives on primary care-based MOUD. We sought to examine the care experiences of patients with OUD receiving medication-based treatment in a primary care setting. We conducted semistructured interviews with patients receiving MOUD at a single primary care site at the University of Utah. Interviews were performed and transcribed by qualitative researchers, who used rapid qualitative analysis using a grounded theory-based approach to identify key themes pertaining to patient experiences receiving medication-based OUD treatment in primary care. Twenty-one patients were screened, and 14 completed the interview. In general, participants had numerous medical and psychiatric comorbidities. The following key themes pertaining to primary care-based OUD treatment were identified: (1) overall health improvement, (2) team-based care, (3) comparing primary care to specialty addiction treatment, (4) access to medications for OUD, and (5) discrimination and stigma. Patients reported many advantages to receiving primary care-based MOUD treatment. In particular, the flexibility and added support of team-based care along with the convenience of receiving addiction treatment alongside regular medical care were highly valued. These findings can be used to develop patient-centered initiatives aimed at expanding OUD treatment within primary care.