Hello, everybody—this is Gavin Verhey on behalf of the Pauper Format Panel. Today, we are making a change in Pauper. We want to walk you through the background of the change and why we’re making it.
We’ll start with the top line: High Tide is banned in Pauper. This ban takes effect immediately and will be live shortly on Magic Online.
Back in March, we unbanned High Tide as part of something new called trial unbans. The idea was that we could unban a card on a probationary basis, see how it performed, and then decide if we wanted to keep it off or return it to the banned list. This is a great way to investigate cards and potentially bring cards back into the format that people enjoy. At that time, we unbanned Prophetic Prism, which has been a success. It’s seen some play and helped decks like Urzatron, but ultimately it has been just fine. The format is very different than when Prophetic Prism was initially banned.
High Tide is a much more nuanced discussion.
At the time, we said this:
“Our hope is that the deck ends up, at best, an option in the metagame beneath the very best decks. If it ends up not being played after some experimentation, that’s a fine outcome. If it ends up fringe or playable but not in the best decks, that’s the ideal outcome. These scenarios will leave it unbanned.
“If it breaks through and enables one of the three most successful decks in the metagame, however, we will likely ban High Tide again at the end of the trial—having a kill-from-hand combo deck as one of the best three decks can be frustrating. Not every color can interact with that stretch super well.”
Event Results
First, let’s dive into data and results.
High Tide’s results started off slow as people began working to coalesce on the best versions. Eventually, players have refined the deck into a strong Psychic Puppetry and splice engine that casts High Tide and splices Psychic Puppetry onto Arcane spells to stay even or net mana, generating an immense amount of mana in a single long turn to eventually kill by looping Stream of Thought. This usually kills, when unimpeded, on turn four or five, but very occasionally on turn three.
There are a couple flexible card slots, but the majority of decklists tend to have near-identical main decks. Here’s a recent version that won a Magic Online challenge:
4 Brainstorm
1 Deep Analysis
1 Gigadrowse
3 Hidden Strings
4 High Tide
4 Ideas Unbound
13 Island
4 Merchant Scroll
4 Lórien Revealed
1 Muddle the Mixture
4 Peer Through Depths
3 Pieces of the Puzzle
4 Preordain
4 Psychic Puppetry
2 Reach Through Mists
2 Snow-Covered Island
2 Stream of Thought
1 Deep Analysis
2 Blue Elemental Blast
2 Dispel
1 Envelop
3 Fallaji Archaeologist
2 Gigadrowse
1 Muddle the Mixture
3 Snap
In terms of win rate, the deck started at just above 50% when it comes to its Magic Online win rate and didn’t have a large real-world showing at events like Paupergeddon—that’s more than fine. However, I’m really glad we took the extra time, because we have watched High Tide‘s success rate tick increasingly upward. It has crept some weeks on Magic Online to above 55%, sitting at or near the top of the metagame.
Unlike many other decks, it tends to vary a lot from week to week—despite its success, it has a smaller portion of the metagame and can be very matchup dependent (more on that later). It’s a deck that takes a large amount of play skill and experience to pilot optimally, and it’s very possible that it has taken time to slowly rise for that reason. While, as far as we can tell, the play rates online and in real life tend to be lower, historically complicated and slow combo decks tend to not show up as much in droves.
The success of High Tide alone debatably meets our threshold for banning. It is the other elements in concert with its success, however, that push it over the edge.
Problematic Gameplay and Tournament Logistics
High Tide is a card which certainly has a pedigree of slow turns—any longtime Legacy player can tell you about that. Some of that is not a surprise. However, Pauper’s version is likely even potentially more egregious than versions we’ve seen in the past.
It’s not uncommon for a High Tide combo turn to take ten or even fifteen minutes to execute, even in the hands of a skilled pilot. Unlike other formats which often have some big hammer card that helps make it clear to the opponent it’s time to pack things in, like a large Mind’s Desire, the incredibly incremental nature of the combo in Pauper means that things don’t really come to that major turning point. There is a version with a single Petals of Insight, so you can start generating infinite mana with it and enough copies of Psychic Puppetry, but many would say that’s suboptimal to play—drawing an ineffectual card with this deck can be the difference between winning and losing.
Speaking from my own personal experience, I have played a lot of High Tide now. I even played eleven rounds worth of it at in-person side events during this past Paupergeddon. I would be executing my combo for ten minutes and still not be sure if I was going to win the game. I had multiple opponents concede to me during moments where I thought I was more likely to fizzle. And while I don’t want to ascribe too much to an individual game or situation, the fact that the right play is always to fully force the opponent to play it out further compounds the time it takes.
The High Tide player will always try to combo off if they look like they’re about to lose the next turn, which means that you can expect some amount of a combo turn in every game of a match. This all boils down to a miserable gameplay experience, where the High Tide player takes up the majority of gameplay time while the other player sits there.
While it’s far from the only deck that can take a lot of time to execute—a deck like Familiars can also make games go long and monopolize the clock—at least in those cases you get to take another turn and play Magic. With High Tide, you will often watch for minutes on end with the result often being you don’t get another turn. Additionally, a deck like Familiars still leans on creatures for its combo, which the Pauper card pool is better suited to handle than something entirely from hand.
This additionally compounds in matters of tournament logistics. Because a single turn can take so long, even when plays are made at a reasonable pace, if the High Tide player begins their combo as the round is running out of time, it can cause the event to run over on time. This provides a poor event experience for everybody. While this happening is mostly situational, having it happen even just a couple times in an event can cause large delays.
While neither of these on their own are reasons for a ban—for example, we’re not taking action against Cycle Storm for its long turns—these factors in conjunction with it being a strong deck to play make it a serious problem and compound the issues.
Format Impact
While High Tide has not been the most played deck, that doesn’t mean its effects haven’t rippled across the entire format.
High Tide is a deck with extremely polar matchups. Many matchups, Game 1 is just a near-automatic loss, as the opponent has no interaction with the stack or hand, so unless they can kill by turn four, they’re relying on sideboarded games—unless your deck has a good Game 1 matchup against Tide, in which case Tide is probably in very rough shape.
To give some examples, against Mono-Blue Faeries, Tide’s worst matchup, some weeks its win rate has dipped below 20%. That is massively polar! While other matchups that don’t have Game 1 interaction have done the opposite. You sit down for Game 1 and you already often know who is going to win the first game (unless there’s a horrendous draw involved).
The result of this has been twofold.
The first is that decks that are advantaged or have a chance against High Tide in Game 1—Faeries, Tolarian Terror, Mono-Red—gain a large boost in the metagame. That’s not inherently bad. Decks becoming better because they beat up on other decks happens all the time. But it has contributed to the popularity of already popular decks and cemented Terror as a top deck.
The second piece, though, which is problematic, is that it has made it a lot more about decks racing past one another to see who can win first. Something a lot of players enjoy about Pauper is the incremental nature of the format. But if you’re trying to beat High Tide, you can either disrupt it or just try and run past it since it won’t interact with you. More decks doing the latter means the whole format gets more compressed and less interactive as people are zooming to die before High Tide’s fundamental turn.
Put another way: High Tide preys on midrange, meaning decks that can go under it but are weak to midrange become good counters. But we’ve been doing so much work over the past couple years to help slow down the format and make it more interactive: the more Pauper is about people just throwing cards at one another and seeing who wins as opposed to interactive games, generally the worse off it is. That doesn’t mean fast decks shouldn’t exist, but incentivizing the format to try to win quickly and interact very little is a negative.
Of course, after sideboarding, players gain access to options against and disruption for High Tide. Often it turns into how many sideboard cards you draw—though the deck is more resilient than many would give it credit. But this gameplay isn’t the best either when you have these very polar matchups where you lose Game 1 and then sideboard in a ton of cards to try and flip them. We’ve previously banned cards out of Mono-Red (like Monastery Swiftspear) for causing a level of polarity within the format that is lower than what High Tide is bringing to the table.
Despite the play rates being moderate, the impact on the format is outsized.
The High Tide Ban and Beyond
Ultimately, we had to ask ourselves the question, “Is High Tide making the format better or more enjoyable?” In the aggregate, and in looking at all the above reasons, the answer is no.
It’s a deck that has had outlier win rates, is hard to interact with, has caused large ripple effects, and creates a poor play and tournament experience.
Taking these elements into account together, we collectively made the decision to ban High Tide.
I want to stress that we are still happy with the experiment here. Trying something out, letting the community experiment with a card, creating discussion, and learning an outcome about a card that has essentially never been legal in the wider Pauper format is a positive result, even if the outcome was banning the card again. We have no plans for future trial unbans at this time, but I also wouldn’t be surprised to see us try it again in the future.
I will say that while we did need extra time to see how the format evolved with a deck this complicated and that took time to fully see the impact of, we do want to apologize for the moving window here. While each individual reason made sense—asking for more time over the summer to see how the deck played out and aligning with the regular announcement cadence once the window moved up two weeks—it still created a shifting date as players were trying to make plans and understand if they should invest time into learning this deck and acquiring the cards. This isn’t generally what you should expect from us, and we’ll try to not let this happen in any future trial unbans.
So, what about the other cards in the format?
Well, we looked across the whole format for any other changes to be made at this time. The deck which most caught our eye as potentially in the range of a ban is the Tolarian Terror decks. These decks have been consistently strong for most of this year and over the past six months have risen to the top in both play and win rate.
However, as mentioned earlier, we believe High Tide had an outsized impact on the format and what decks people chose. Many of the decks advantaged against Terror were ones that couldn’t compete with the speed of a deck like High Tide, and many sideboard slots that could have been used for Terror were taken up by hate for Tide. We want to monitor this now that we’ve removed High Tide as an arm of the format and see how it evolves from here.
The other deck we have had our eye on are the new Spy Combo decks that have been showing up. Here’s an example from a recent Magic Online Challenge, noting there is still experimentation with the exact mix of cards.
3 Avenging Hunter
4 Balustrade Spy
2 Dread Return
2 Elves of Deep Shadow
3 Forest
2 Gatecreeper Vine
4 Generous Ent
4 Land Grant
4 Lead the Stampede
2 Lotleth Giant
3 Masked Vandal
1 Mesmeric Fiend
4 Overgrown Battlement
3 Quirion Ranger
3 Saruli Caretaker
1 Snow-Covered Forest
4 Sagu Wildling
1 Swamp
3 Tinder Wall
3 Wall of Roots
4 Winding Way
This fairly new hybrid combo deck can kill fast with Balustrade Spy setting up a lethal (or at least highly damaging) Dread Return on Lotleth Giant after milling most of its library; it also has the secondary plan of Walls accelerating into its big threats. It has definitely caught our eye as something to watch. Balustrade Spy and Dread Return both have a pedigree as extremely strong cards that can fuel problematic decks. However, there are still plenty of moments to interact with the combo and some clear sideboard options. We’ll want to continue watching to see how this develops, but it certainly looks a lot more appropriate in terms of overall impact than High Tide so far.
Overall, the format has looked healthy—which is partially why we were reserved about making this change. The impacts of a deck like High Tide are a lot less surface level than other problematic decks. Our hope is that this will nudge the format back a bit more toward interaction and drop a few percentage points off the decks that were preying on Tide being around. But, as with all things, we’ll have to wait and see.
Pauper Championships kick off this week on Magic Online, and I know we’ll eagerly be watching to see what happens both there and at Paupergeddon later this month out in Italy. As always, we’ll be out there reading everything you all have to write about this as well.
Thanks for reading, playing the format, and being up for trying something as experimental as a trial unban. It was a worthwhile experiment, and maybe we’ll try it again in the future.
This has been Gavin Verhey, now signing off on behalf of the Pauper Format Panel.
Alex Ullman Alexandre Weber Emma Partlow Gavin Verhey Mirco Ciavatta Paige Smith Ryuji Saito
Vascular injuries in pediatric trauma cases are relatively rare, representing just 0.6% to 1.4% of all injuries in children.1,2 Despite their rarity, the serious implications of these injuries make them a major concern in trauma management. Pediatric vascular trauma presents unique challenges due to the smaller diameter of blood vessels, increased likelihood of vasospasm, limited intravascular volume, and the necessity to accommodate future vessel growth. Moreover, the long-term viability of vascular repairs and the diagnostic complexity of such injuries add further difficulty to their treatment.3 These injuries can be difficult to detect, as vasospasm and concurrent trauma may mask their presence, making swift diagnosis and treatment critical. In younger children, the typical signs of vascular injury—such as visible pulsatile bleeding—are often less noticeable.4 In Somalia, due to the high prevalence of terrorism and conflict-related violence, blast and gunshot injuries are particularly common.5 The ongoing conflict in Somalia dates back to the collapse of Siad Barre’s regime, with varying levels of intensity over the years. Its primary drivers are terrorism and inter-clan disputes.6 Despite this context, there is a lack of comprehensive studies detailing the patterns, causes, surgical strategies, and outcomes of pediatric vascular injuries within Somali conflict zones. Our hospital, located in Mogadishu—the capital of Somalia—was established through a bilateral agreement between the health ministries of Somalia and Türkiye, aimed at strengthening collaboration in healthcare and medical services. It serves as a key referral center for vascular surgery across the country, receiving patients from both Mogadishu and other regions with traumatic vascular injuries.
This five-year retrospective study seeks to address the existing knowledge gap by examining pediatric vascular trauma cases treated at selected Somali hospitals. The study’s objectives include documenting the mechanisms of injury, anatomical sites affected, types of surgical interventions performed, and patient outcomes such as limb salvage and mortality. In conflict-affected systems, delayed prehospital transport, limited imaging, and scarce graft materials compound ischemia time and increase the risk of limb loss. We aimed to quantify patterns and mechanisms of injury, describe operative strategies, and report limb-salvage and mortality, while identifying modifiable system factors (eg, time-to-care).
Methods
Study Design and Setting
This was a retrospective cohort study conducted at Mogadishu Somali-Türkiye Training and Research Hospital, the national referral center in Somalia. The study period spanned five years, from April 2019 to April 2024. Data were extracted from the hospital’s FONET electronic medical records system and are available from the corresponding author upon reasonable request.
Participants
Eligible participants included all pediatric patients (≤18 years) presenting with clinically or radiologically confirmed arterial or major venous injuries due to trauma and managed at our center. Exclusion criteria were iatrogenic catheter-related injuries, and cases with missing operative or outcome data.
Data Collection and Variables
A single investigator performed the retrospective review and collected socio-demographic (age, sex, time to admission), clinical, and operative data. Mechanisms of injury were categorized as penetrating trauma (gunshot wounds, stabbings, glass cuts, saw-related injuries, shrapnel, or blast trauma) or blunt trauma (falls, motor vehicle accidents, or sports injuries). Associated injuries recorded included bone fractures, nerve injuries, and compartment syndrome. Complications of interest included infection, graft failure, limb amputation, and in-hospital mortality. All patients underwent initial evaluation by the cardiovascular surgery team upon admission. Resuscitation followed Advanced Trauma Life Support (ATLS) principles. Diagnosis of vascular injury was based on clinical examination supplemented by: handheld Doppler; color Doppler ultrasonography; computed tomography angiography (CTA) in hemodynamically stable patients with equivocal findings; or immediate surgical exploration in the presence of “hard signs” of vascular injury (pulsatile hemorrhage, expanding hematoma, bruit/thrill, or distal ischemia). Bone fractures were confirmed by plain radiographs when clinically indicated. Surgical management followed standard vascular repair principles. After vascular exposure, proximal and distal control was established, and systemic heparin (100 IU/kg) was administered unless contraindicated. Inflow and outflow were assessed, with thrombectomy performed when necessary. Definitive repair included: primary repair or end-to-end anastomosis when feasible; interposition grafting with the great saphenous vein (preferred), or cephalic/basilic veins for brachial artery injuries; polytetrafluoroethylene (PTFE) grafts when autologous vein was unavailable. Orthopedic stabilization was performed following revascularization to minimize ischemia time. Four-compartment fasciotomy was performed when reperfusion was delayed or compartment syndrome was suspected. Concomitant nerve injuries identified intraoperatively were repaired as appropriate. For patients presenting after >6 hours or with reduced distal mobility, the decision between revascularization and primary amputation was guided by intraoperative assessment of muscle viability via fasciotomy and contractility testing. The statistical analysis of this study was performed with the use of Statistical Package for Social Sciences Version 24.0 software (SPSS Inc., Chicago, IL, USA).
Ethical Approval
Ethical approval was obtained from the Mogadishu Somali Türkiye Training and Research Hospital’s institutional review board MSTH/16842 reference number available upon request. The study adhered to the principles of the Declaration of Helsinki and local ethical guidelines. Informed consent was obtained from each patient’s legal guardian.
Results
Among the 54 patients, 38 (70.4%) were aged between 13 and 18 years. The majority were male, with 45 patients (83.3%) being boys. The most common time for admission was during the evening hours from 6:00 PM to midnight, when 24 patients (44.4%) were hospitalized. In terms of injury mechanisms, penetrating trauma accounted for the majority of cases, affecting 44 patients (81.5%). These injuries included gunshot wounds, blast injuries, stab wounds, penetrating saw injuries, glass lacerations, and shrapnel wounds. Blunt trauma was less common, seen in 10 patients (18.5%), resulting from motor vehicle accidents, falls from heights, and sports-related blunt injuries such as those sustained during football, as shown in Table 1. The most frequently injured sites were the upper and lower limbs. The brachial artery in the upper limb was involved in 14 cases, highlighting its vulnerability, while the superficial femoral artery in the lower limb was affected in 12 cases. Venous injuries were less frequent but mainly involved the femoral vein, with 4 cases. Notable injuries were also recorded in the head and neck region, including 4 injuries to the common carotid artery and 3 to the internal jugular vein. Overall, arterial injuries (56 cases) were more common than venous injuries (10 cases), as detailed in Table 2. Regarding treatment, primary repair was the most frequently used method, performed in 22 patients (40.7%). Vein graft interposition was used in 19 patients (35.2%), and a combination of primary repair and vein grafting was applied in 6 patients (11.1%), reflecting a tailored approach in some cases to improve outcomes. Two patients (3.7%) received vein grafts with fasciotomy, and one patient (1.9%) underwent vein grafting combined with a muscle flap, indicating more complex interventions. Conservative management was chosen for two patients (3.7%), with an additional two patients (3.7%) receiving conservative treatment alongside fasciotomy, suggesting that even non-surgical approaches sometimes required intervention for complications, as shown in Table 3. A notable 23 patients (42.6%) had no associated injuries. Among those with additional trauma, fractures were the most common, with 14 patients (25.9%) sustaining upper extremity fractures and 11 patients (20.4%) having lower extremity fractures. Nerve injuries were present in 4 patients (7.4%) affecting the upper extremity, and one patient (1.9%) developed compartment syndrome. There was also one case (1.9%) involving both a lower extremity fracture and nerve injury, as outlined in Table 4. Most patients (49, or 90.7%) experienced no complications following treatment. However, a small number faced adverse outcomes: 3 patients (5.6%) developed infections, one patient (1.9%) required amputation, and one patient (1.9%) died due to their injuries, as detailed in Table 5.
Table 1 Patient Demographics
Table 2 Site of Injury and Related Vessels
Table 3 Management of the Patients
Table 4 Associated Injuries
Table 5 Complications Resulted from the Injury
Discussion
In this study, the majority of patients were male (83.3%), with 70.4% between the ages of 13 and 18 years. This aligns with trends observed in other studies, where male pediatric patients are more frequently affected by traumatic vascular injuries, especially in conflict or violence-related settings.7,8 In addition, there was an unusual penetrating vascular injury caused by a wooden stick.9 This pattern is consistent with the higher rates of violence in regions such as Somalia, where these injuries are commonly encountered in pediatric trauma centers.7,8 The evening hours (6:00 PM to 12:00 AM) accounted for the majority of hospital admissions, which suggests that these injuries are often a result of violent events occurring during these times. Regarding injury mechanisms, the study found a predominant pattern of penetrating trauma, with 81.5% of patients sustaining injuries from firearms, explosive devices, and shrapnel. This is consistent with other studies that have reported a higher prevalence of penetrating injuries in conflict zones.7,10 Although blunt trauma accounted for 18.5% of cases, it is often associated with more complex multisystem involvement, complicating both diagnosis and treatment.10 Prompt recognition of blunt trauma facilitates early intervention, thereby minimizing complications.11 Furthermore, injuries related to motor vehicle accidents, falls, and sports-related trauma were present but less common, mirroring findings from other trauma studies.12,13 The upper and lower limbs were the anatomical regions most commonly affected, with the brachial artery in the upper limb (14 cases) and the superficial femoral artery in the lower limb (12 cases) being the most frequently injured vessels. This emphasizes the particular susceptibility of these arteries in pediatric trauma.10,14,15 In contrast, venous injuries were less common, with the femoral vein being most frequently injured. The head and neck region, though less commonly injured, still represented significant concerns, particularly for the common carotid artery and internal jugular vein (4 cases and 3 cases, respectively). Our rate of carotid and jugular injuries parallels findings from Villamaria et al, who reported similar distributions in wartime pediatric cohorts from Iraq and Afghanistan. The high frequency of arterial injuries, particularly in the lower limbs, is consistent with other studies where the lower extremities were the most commonly injured sites.10,12 Surgical management of vascular trauma predominated, with primary repair being the most commonly utilized approach (40.7%), followed by vein graft interposition (35.2%). The choice of surgical strategy was tailored to the nature and complexity of the injuries. Multiple arterial injuries were observed in 3.7% of cases, which compounded surgical complexity. Complex cases were addressed with a combination of primary repair and vein graft interposition (11.1%), while vein graft with fasciotomy and muscle flap were used in more challenging cases (3.7% and 1.9%, respectively). Conservative management was used for a small subset of patients (3.7%), particularly those who were hemodynamically stable with no clear signs of vascular injury. This mirrors the management trends observed in similar pediatric vascular trauma series, where open surgical repair remains the most frequently used approach.12,13,16 Fractures were the most prevalent associated injuries, especially in the upper and lower limbs. Additionally, nerve injuries were observed in several cases, and one patient developed compartment syndrome. The coexistence of fractures with vascular injuries often presents a challenge, complicating both surgical management and postoperative recovery. These findings align with previous research that underscores the complexity of pediatric vascular trauma.10,12 Most patients (90.7%) did not experience any postoperative complications. However, a small proportion developed infections (5.6%) or required limb amputation (1.9%). The most severe outcome observed in this group was the death of one patient due to a critical vascular injury. Bramparas et al reported a 13% mortality rate in their study of pediatric vascular trauma cases from the American College of Surgeons National Trauma Data Bank. This highlights the serious nature of pediatric vascular injuries, especially those involving major arteries such as the femoral artery, which has been associated with increased mortality in other studies.1,16
The significant peak in hospital admissions for pediatric vascular injuries in 2023, as reflected in the time series graph, suggests a potential increase in either the incidence of these injuries or improvements in detection and reporting mechanisms.
Our study demonstrates a remarkably high limb salvage rate of 98.1% despite the constraints of working in a conflict-affected, resource-limited setting, with an overall mortality of only 1.9%. These outcomes underscore the critical influence of system-level factors such as time-to-care, referral delays, and the availability of blood products on patient survival and limb viability. Compared with multicenter series from the United States and Europe, where penetrating trauma accounts for a smaller proportion of pediatric vascular injuries and repair strategies are similar, our cohort reflects the distinctive burden of conflict settings with a higher share of penetrating mechanisms and greater reliance on autogenous vein grafts. The findings highlight several actionable priorities: strict adherence to a standardized “hard signs → operating room” pathway, lowering thresholds for fasciotomy in delayed or high-risk reperfusion, systematic autologous vein harvesting protocols, establishment of a regional referral hotline, and creation of a trauma registry to strengthen coordinated care. Nonetheless, this study is limited by its retrospective, single-center design and the lack of long-term data on graft patency or functional outcomes. Future work should focus on prospective, multicenter registry development incorporating 6–12-month follow-up with duplex ultrasonography and validated functional measures such as the Pediatric Quality of Life (PedsQL) inventory and gait assessments to better define recovery trajectories and optimize outcomes for this vulnerable population.
Conclusion
Pediatric vascular trauma in Somalia is predominantly penetrating and closely linked to conflict-related mechanisms such as gunshot, blast, and shrapnel injuries, though unusual mechanisms such as wooden stick penetration were also observed. Despite severe injury patterns and resource limitations, timely surgical intervention achieved excellent limb salvage (98.1%) with very low mortality (1.9%). These findings highlight the critical importance of early recognition, rapid referral, and standardized management protocols to optimize outcomes. Strengthening system-level factors—including blood-bank capacity, referral networks, fasciotomy readiness, and vascular training—will be essential in reducing preventable limb loss and mortality in conflict-affected regions. Future multicenter prospective studies with long-term follow-up, including graft patency and functional outcomes, are warranted to guide evidence-based improvements in pediatric vascular trauma care.
Data Sharing Statement
The data for this study were obtained from the hospital’s FONET electronic system and can be accessed from the corresponding author upon reasonable request.
Author Contributions
All authors made a significant contribution to this work, whether that is, in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Funding
The authors declare that they have no funding source for this research.
Disclosure
The authors declare that they have no conflicts of interest.
References
1. Barmparas G, Inaba K, Talving P, et al. Pediatric vs adult vascular trauma: a national trauma databank review. J Pediatr Surg. 2010;45(7):1404–1412. doi:10.1016/j.jpedsurg.2009.09.017
2. Corneille MG, Gallup TM, Villa C, et al. Pediatric vascular injuries: acute management and early outcomes. J Trauma. 2011;70(4):823–828. doi:10.1097/TA.0b013e31820d0db6
3. Callcut RA, Mell MW. Modern advances in vascular trauma. Surg Clin North Am. 2013;93(4):941–961. doi:10.1016/j.suc.2013.04.010
4. Lyons NB, Berg A, Collie BL, et al. Management of lower extremity vascular injuries in pediatric trauma patients: 20-year experience at a level 1 trauma center. Trauma Surg Acute Care Open. 2024;9(1):1386. doi:10.1136/tsaco-2023-001263
5. Tahtabasi M, Er S, Karasu R. Bomb blast: imaging findings, treatment and clinical course of extremity traumas. BMC Emerg Med. 2021;7:1–10.
6. Bade ZA. Understanding Somali Confict: causes, consequences and strategies for peace-building. Dev Ctry Stud. 2021.
7. Ab Rahman N, von Delft D, Numanoglu A, Mohammad Aidid E, Arnold M. A decade of managing pediatric major traumatic vascular injuries: insights from a referral center. Pediatric Surg Int. 2024;40(1):1–9. doi:10.1007/s00383-024-05887-7
8. Hussein AM, Ali AA, Ahmed SA, Mohamud MF, Ahmed MA, Kizilay M. Our experience with blast and gunshot induced traumatic vascular injuries at Somalia’s major vascular referral center. Sci Rep. 2024;14(1):13004. doi:10.1038/s41598-024-63686-5
9. Ali AA, Mohamed AO, Ahmed FM, Abdi HK, Keinan HB, Ahmed SA. Unusual mechanism of vascular trauma: femoral artery penetration by wooden stick and delayed repair case report. Int J Surg Case Reports. 2025;26:111872. doi:10.1016/j.ijscr.2025.111872
10. Perea LL, Hazelton JP, Fox N, et al. Pediatric major vascular injuries a 16-year institutional experience from a combined adult and pediatric trauma center. Pediatr Emerg Care. 2018;37(8):403–406. doi:10.1097/PEC.0000000000001642
11. Ali AA, Hussein AM, Albay E, Siyad AA, Hassan MO, Ahmed SA. A blunt traumatic giant pseudoaneurysm of the brachiocephalic artery: a case report from Somalia. Int J Surg Case Reports. 2024;116:109329. doi:10.1016/j.ijscr.2024.109329
12. Wahlgren CM, Kragsterman B. Management and outcome of pediatric vascular injuries. J Trauma Acute Care Surg. 2015;79(4):563–567. doi:10.1097/TA.0000000000000812
13. Eslami MH, Saadeddin ZM, Rybin DV, et al. Trends and outcomes of pediatric vascular injuries in the United States: an analysis of the national trauma data bank. Ann Vasc Surg. 2019;56:52–61. doi:10.1016/j.avsg.2018.09.006
14. Kayssi A, Metias M, Langer JC, et al. The spectrum and management of noniatrogenic vascular trauma in the pediatric population. J Pediatr Surg. 2018;53(4):771–774. doi:10.1016/j.Jpedsurg.2017.04.015
15. Morão S, Ferreira RS, Camacho N, et al. Vascular trauma in children—review from a major paediatric center. Ann Vasc Surg. 2018;49:229–233. doi:10.1016/j.avsg.2017.10.036
16. Prieto JM, Van Gent JM, Calvo RY, et al. Evaluating surgical outcomes in pediatric extremity vascular trauma. J Pediatr Surg. 2020;55(2):319–323. doi:10.1016/j.surg.2023.04.060
Selective laser trabeculoplasty (SLT) and neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy are two of the most commonly performed ophthalmologic procedures.1,2 Approximately 150,000 United States Medicare beneficiaries with open angle glaucoma undergo SLT procedures each year3–5 and the incidence of Nd:YAG laser capsulotomy increases from 6% at one year to 38% at nine years following cataract extraction.6 In each of these procedures, focused laser energy is applied to the target tissue – the trabecular meshwork of eyes with glaucoma to improve aqueous outflow and reduce intraocular pressure (IOP)5 in SLT, and the opacified posterior lens capsule to surgically create an opening through which visual acuity is improved in Nd:YAG capsulotomy.7 For each procedure, a reusable or single-use disposable ophthalmic contact lens improves the surgeon’s visualization of the target tissue, thereby enabling more precise application of laser energy.8
Concerns have arisen over the spread of infectious diseases during procedures, and though transmission of human immunodeficiency virus (HIV), Hepatitis C, Hepatitis B, and prion diseases via these laser contact lenses has not been documented, cases of adenovirus and herpes simplex virus type 1 (HSV-1) have been linked to repeat-use tonometry tips.9–12 Consequently, ophthalmology practices attempt to mitigate the risk of infection by disinfecting reusable lenses or opting for single-use, disposable alternatives.5,13–17
Single-use, disposable plastic products in health care unfortunately constitute large volumes of plastic waste and create considerable expense.9,13,18,19 Disposable lenses and tips have become increasingly popular in recent decades13,20 with 59.1% of ophthalmology practices in the United Kingdom using disposable tonometry tips.13 Several authors, however, have reported that disposable lenses are functionally inferior to their reusable counterparts, are prone to damage, and may produce an inferior treatment effect.5,21–23
Disinfection techniques effectively prevent transmission of infections from reusable lenses and tips, with the American Academy of Ophthalmology reporting that sterilization with a dilute solution of sodium hypochlorite eliminates Adenovirus 8 and HSV-1.24 Further supporting the use of reusable lenses is the persistent risk of infection with disposable tonometer prisms. In the Sussex Eye Hospital, 50% of providers touched the disposable tonometer prism before measuring IOP, and subsequent cultures grew Staphylococcus epidermidis, Staphylococcus aureus, and Bacillus species.25 Thus, it is not clear that disposable lenses and tips prevent infection relative to their reusable counterparts.
Since single-use disposable lenses create substantial economic and environmental burdens, and are less effective, understanding the infection risks associated with reusable ophthalmic lenses becomes an important health and economic issue. This study aims to better understand the rate of conjunctivitis and/or keratitis due to reusable laser lenses that are cleaned with isopropyl alcohol, followed by soap and water, and thorough drying, after SLT and Nd:YAG laser capsulotomies.
Methods
Cohort and Consent
A retrospective chart review included all eyes undergoing a Nd:YAG capsulotomy or SLT procedure with reusable laser lenses between January 1, 2014, and December 31, 2023, at a single, nonprofit academic medical center (Mayo Clinic, Jacksonville, FL). During the study period, only reusable lenses were used. The study protocol was approved by the Mayo Clinic Institutional Review Board (IRB) on August 12, 2024 (IRB #24-006702), and informed consent was waived due to the retrospective study design. This study complies with the tenets outlined in the Declaration of Helsinki and adheres to the Health Insurance Portability and Accountability Act regulations.
Patient Data
For each procedure, patient demographic data (age at the date of the Nd:YAG laser capsulotomy and/or SLT procedure, race, and biological sex), procedure type, physician name, date of procedure, laterality, history of conjunctivitis and/or keratitis, and incidence of conjunctivitis and/or keratitis within two weeks post-procedure were recorded. Data from three ophthalmologists (R.D.T., S.K.D., D.D.M.) were included in the analysis. At the completion of the procedure, patients were instructed to contact the office immediately if they developed pain, blurred vision, redness, irritation, photosensitivity, discharge, photopsias, floaters, “curtains”, or “clouds”. For each patient who contacted the office with any of these symptoms, they were examined promptly (within 24 hours). For all Nd:YAG capsulotomy and SLT lasers, no topical antibiotics were instilled before or after the procedures. Prior to and after all Nd:YAG capsulotomy lasers, neither topical corticosteroids nor non-steroid anti-inflammatory drugs were instilled or prescribed. Prior to and after all SLT procedures, no topical corticosteroids were used. One ophthalmologist (R.D.T.) prescribed topical ketorolac 0.5% four times per day for one week after SLT. All patients received follow-up appointments approximately four weeks after each procedure.
Post-Use Sterilization of Reusable Lenses
Reusable lenses were thoroughly cleaned after each procedure with 70% ethyl alcohol followed by soap and water for at least two minutes. The lenses were then completely dried using sterile wipes prior to the next use.
Statistical Analysis
Data were analyzed with the SPSS 22.0 program (SPSS Inc., Chicago, IL). Demographic variables were expressed as percentages. The primary outcome was the incidence of conjunctivitis and/or keratitis (diagnosed by the treating surgeon) within the first two weeks after the laser procedure. The keratitis and conjunctivitis rates were calculated by dividing the total number of affected eyes by the total cohort size. For each new case of keratitis and/or conjunctivitis, the dates when symptoms first appeared and when they resolved were documented.
A cost analysis was conducted to assess the economic implications of using reusable versus disposable lenses for both laser procedures. A break-even analysis was used, calculating the per-procedure cost of reusable lenses by dividing the total cost of two lenses of each type ($755 × 2 for Nd:YAG laser capsulotomy; $719 × 2 for SLT) by the number of corresponding procedures and adding the sterilization cost per use. The analysis assumed that cleaning time incurred minimal cost and that reusable lenses required no replacement over a 10-year period. For purposes of this analysis, the per unit cost of each disposable Nd:YAG lens and SLT lens was $16.70 per lens. A medical waste analysis was performed incorporating the weight of the disposable lens along with the individual plastic packaging and the box (one for every ten disposable lenses).
Results
Baseline Characteristics
A total of 2285 eyes from 1363 patients were included in this study (Table 1). The mean age (standard deviation) of treated patients was 71.6 (7.4) years with most being female (57%) and Caucasian (83%). A low percentage of treated eyes (0.4%; four eyes with non-specific conjunctivitis and five eyes with chronic allergic conjunctivitis) had a history of conjunctivitis but none were active at the time of the laser surgery and none had a history of prior keratitis. A total of 1372 Nd:YAG laser capsulotomies and 913 SLT procedures were performed, accounting for 60% and 40% of the study population, respectively.
Table 1 Demographic Characteristics
Cases of Keratitis and/or Conjunctivitis
Of the 2285 eyes, one developed conjunctivitis within the two-week window after undergoing a Nd:YAG capsulotomy. Symptoms began within 24 hours of the laser and the patient was examined on the second post-operative day. A diagnosis of medicamentosa was made and the patient was treated with preservative-free lubricating ophthalmic eye drops with resolution of symptoms within five days. No cases of keratitis were seen.
Cost Analysis
Cost analysis results are presented in Table 2. The per-unit cost of a disposable lens was $16.70 for both Nd:YAG laser capsulotomy and SLT, while reusable lenses were priced at $755 (Nd:YAG) and $719 (SLT). Over the 10-year study period, two reusable lenses of each type were repeatedly used and remained fully functional without requiring replacement. As the manufacturer did not specify expiration or usage limits, reusable lens costs were amortized across the entire study duration. Reprocessing required minimal resources: one 70% isopropyl alcohol wipe ($0.011 per wipe), one pump of liquid soap (estimated $0.008 per wash), a 10-second tap water rinse (0.002 gallons at $0.005/gallon = $0.00001), and one paper tissue ($0.01 per tissue), resulting in an estimated supply cost of $0.03 per use. Manual cleaning, completed by clinical staff in under one minute, required no specialized equipment, detergents, or autoclaving, and did not disrupt clinic workflow. Break-even analysis indicated that reusable lenses became more cost-effective than disposable lenses after approximately 86 SLT procedures and 91 Nd:YAG laser capsulotomies (Table 2).
Table 2 Cost Analysis
Medical Waste
In terms of medical waste, a single Nd:YAG procedure produced approximately 12.1 g of waste with a disposable lens and 3.0 g with a reusable lens. Similarly, an SLT procedure generated 17.8 g and 3.0 g of waste with disposable and reusable lenses, respectively. Across 1372 Nd:YAG capsulotomies and 913 SLT procedures, the total waste from disposable lenses was estimated at 32.9 kg, compared to 6.9 kg for reusable lenses, which represents a 79% reduction with reusable lenses during the study period.
Discussion
This study identified low post-operative keratitis (0/2285; 0%) and conjunctivitis rates (1/2285; 0.044%) in patients undergoing SLT or Nd:YAG laser eye surgeries with reusable ophthalmic laser lenses. Because symptoms occurred within one day of the procedure, the single case of conjunctivitis was determined to be secondary to medicamentosa (ocular inflammation from ophthalmic drops with preservatives given prior to the procedure) and was not deemed to be infectious.26 The contralateral eye, which also underwent Nd:YAG laser capsulotomy using preservative-free topical drops, did not develop conjunctivitis, and the patient’s history of chronic dry eye syndrome likely contributed to the risk of an adverse reaction. The two week time window was used since symptoms of infectious conjunctivitis and keratitis present during this time period.27
The near total absence of keratitis and conjunctivitis in this study suggests that reusable ophthalmic laser lenses do not constitute a significant risk for infection after laser procedures and that transitioning to single-use, disposable ophthalmic lenses may be unnecessary. Given the lack of evidence linking reusable lenses to an increased infection risk, the benefits of disposable lenses may not outweigh their associated drawbacks, such as increased susceptibility to laser damage and reduced treatment efficacy.5,21–23
Reusable ophthalmic lenses are generally classified as semi-critical equipment, which includes devices that come into contact with mucous membranes or nonintact skin.28,29 As such, high-level disinfection, commonly achieved using hydrogen peroxide, glutaraldehyde, peracetic acid with hydrogen peroxide, or ortho-phthalaldehyde, with a minimum exposure time of 12 minutes, is recommended.29,30 In contrast, noncritical equipment, which contacts only intact skin, requires low-level disinfection31 with a minimum exposure of one minute to alcohol, sodium hypochlorite, or quaternary ammonium compounds.30,31 Since reusable capsulotomy and trabeculoplasty lenses rarely cause infection after low-level disinfection, it is reasonable to consider reclassifying them from semi-critical equipment requiring high-level disinfection to noncritical equipment requiring low-level disinfectants.
A recent study at the Mayo Clinic in Rochester, MN, analyzed laser-induced damage to disposable gonioscopy lenses used during 113 SLT procedures. Damage was found in 6.7 ± 7.5% of the total lens area, with 73% of lenses exhibiting damage to more than 1% of the area.5 The area of lens damage correlated with both total laser energy and mean energy per application, whereas patient and physician factors were not significant.5
Three small studies also support a strong association between laser and damage to single-use gonioscopy lenses.21–23 Damage to the reflective coating was noted after SLT in 16 of 17 (94%) disposable gonioscopy lenses in one study,21 2 of 2 (100%) in a second,22 and 6 of 6 (100%) in a third.23 The high susceptibility of disposable lenses to laser damage was thought to be attributed to their design, which consists of an external, unsupported silver coating over the gonioprism. In contrast, reusable lenses feature a first-surface anti-reflective mirror with the silver coating reinforced by a glass slide.22 Additional design differences of disposable lenses include increased adhesion to the ocular surface, which can make post-procedure removal challenging and can lead to corneal injury.
Damaged lens mirror coatings can scatter light, distort beams, and reduce delivery of laser energy to the trabecular meshwork, which can diminish efficacy.21 Two studies have examined the relationship between single-use gonioscopy lens damage and post-operative IOP reduction.5,21 One found an association between increased lens damage and decreased IOP reduction,5 while the other found no significant difference in IOP-reducing efficacy between disposable and reusable gonioscopy lenses following SLT.21 The different results noted in these two studies may result from the definition of lens damage, since the latter study measured the number of affected reflective coatings,21 and the former quantified the total ablated area of the reflective coating.5 Repeated exposure to disinfectants can damage reusable lenses but this can be mitigated by avoiding acetone and peroxide,28 routinely inspecting reusable lenses, and replacing them at the first sign of damage. This strategy can result in significant cost savings.9
There is an economic burden imposed by single-use ophthalmic products. A district general hospital in the United Kingdom found that disposable tonometry tips incur an excess cost of at least £15,000 annually (approximately $17,330 USD),13 and an ophthalmology outpatient service of comparable size to ours in the United States reported that single-use equipment, including gonioscopy lenses and applanation tonometry tips, generates an additional $65,185 in costs and 109.6 kg of plastic waste per year.9 In our analysis, reusable ophthalmic laser lenses became more cost-effective than disposable alternatives after 86 SLT procedures and 91 Nd:YAG capsulotomies, highlighting their potential for substantial cost savings. Reusable lenses also reduced medical waste, generating only 3.0 g per procedure compared to 12.1 g for Nd:YAG capsulotomies and 17.8 g for SLTs with disposable lenses. Across all procedures, this corresponded to a 79% reduction in total waste (6.9 kg vs 32.9 kg). These findings support reusable lenses as a cost-efficient and environmentally sustainable alternative in high-volume clinical settings, aligning with institutional goals to reduce healthcare costs and environmental impact without compromising clinical efficiency or patient safety.
Disposing of large quantities of plastic waste and consuming non-renewable petroleum resources, consequences of the increased use of plastic consumables, poses significant environmental concerns.32 Non-biodegradable plastic products accumulate in terrestrial, saltwater, and marine environments, where they adversely affect wildlife by releasing toxic chemicals and persistent organic pollutants. Wildlife can be injured by ingesting or becoming entangled by these pollutants.9,33,34 Considering the substantial financial and environmental impact of single-use disposable lenses and the lack of evidence supporting their prevention of infections, their routine use should be re-evaluated. Alternatives to disposable lenses, such as reusable trabeculoplasty and capsulotomy lenses that are less susceptible to laser-induced damage, may offer an equally safe and more cost-effective and sustainable option.5
To our knowledge, this is the first study to evaluate the post-procedure incidence of keratitis and conjunctivitis associated with reusable gonioscopy and capsulotomy lenses, thereby addressing an unmet need in the literature. Study limitations include the single-center design and the homogeneity of the patient population. The retrospective nature of this study may have led to an underestimation of mild or self-limiting infections. Additionally, assumptions made in the cost analysis, including minimal labor costs and no lens replacement over 10 years, may have led to an underestimation of the true cost of reusable lenses. The study’s strengths lie in its large sample size and long-term data, which provide valuable insights into the safe and effective use of reusable ophthalmic lenses.
Conclusion
Single-use disposable ophthalmic lenses impose significant economic and environmental burdens without offering a clear safety advantage, emphasizing the importance of understanding infection risks associated with reusable ophthalmic lenses. In this study of 2285 eyes undergoing Nd:YAG capsulotomy (1372 eyes) and SLT (913 eyes) with reusable lenses, only one case of postoperative conjunctivitis (0.044%), secondary to medicamentosa, occurred within two weeks, with no cases of keratitis. Reusable lenses became more cost-effective after approximately 86 SLT and 91 Nd:YAG capsulotomy procedures, and reduced medical waste by 79%. Given the negligible infection risk, substantial cost savings, and environmental benefits, the routine use of disposable ophthalmic lenses warrants reconsideration.
Data Sharing Statement
The author’s institution does not permit data sharing. Other queries and requests should be directed to the corresponding author (D.D.M.).
Consent for Publication
This study was carried out in accordance with the tenets of the Declaration of Helsinki. Approval from the Mayo Clinic Institutional Review Board was obtained. All data has been deidentified, and no personal identifying information is contained within this report.
Acknowledgments
We would like to thank Ms. Joyce Baker for her generous contributions to the Department of Ophthalmology, Mayo Clinic, Florida, United States.
Author Contributions
All authors made a significant contribution to the work reported (conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas); took part in drafting, revising or critically reviewing this article; gave final approval of the version to be published and agreed on the journal the article was submitted to; and agree to be accountable for all aspects of the work.
Disclosure
No funding or grant support was obtained. All authors report no conflicts of interest in this work.
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NEW YORK, Nov. 10, 2025 /PRNewswire/ — Gartner®, a company that delivers actionable, objective insights to executives and their teams, has recognized Deloitte as a Leader in the 2025 Gartner® Magic Quadrant™ for Digital Experience Services. Deloitte also scored highest in all five Use Cases in the accompanying 2025 Gartner Critical Capabilities for Digital Experience Services report.
Deloitte is placed in the Leaders Quadrant in the Gartner® Magic Quadrant™ for Digital Experience services, positioned highest on the “Ability to Execute” axis. Deloitte was also positioned furthest on the “Completeness of Vision” axis.
“For Deloitte Digital, this recognition from Gartner reflects our commitment to creating world-class customer, employee and citizen experiences that enable high-performing brands and drive profitable growth,” said Mark Lush, Deloitte Global Consulting Services Customer Offering Portfolio leader and Global Head of Deloitte Digital. “Our deep industry knowledge, advanced engineering, and Agentic AI capabilities enable our clients to confidently navigate today’s challenges and seize tomorrow’s opportunities for competitive advantage.”
Deloitte was the highest scoring provider across all Use Case categories in the new Critical Capabilities report. The report assessed how Deloitte delivers across five Use Cases: Experience Design, Experience Solution Implementation, Experience Solution Operations, Content & Creative Services, and Marketing Services.
“We are proud to be recognized as a Leader, especially in our Ability to Execute. This is an important part of our culture at Deloitte – to consistently deliver meaningful, impactful outcomes for our clients,” said Mike DeLone, Customer Offering Portfolio leader, Deloitte Consulting LLP. “Our industry depth, strategic insights, and digital transformation services help our clients envision what’s possible, and our teams’ focus on execution enables them to exceed their growth ambitions.”
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The UK is to investigate whether hundreds of Chinese-made buses can be controlled remotely by their manufacturer, amid increasing concerns over Beijing’s involvement in British infrastructure.
The Department for Transport and the National Cyber Security Centre are examining whether buses made by Yutong could be vulnerable to interference.
A spokesperson for the Department for Transport said: “We are looking into the case and working closely with the UK’s National Cyber Security Centre to understand the technical basis for the actions taken by the Norwegian and Danish authorities.
“The department takes security issues extremely seriously and works closely with the intelligence community to understand and mitigate potential risks.”
Yutong began as the Zhengzhou Bus Repair Factory in 1963 in the Central China province of Henan. It says it has exported nearly 110,000 buses to more than 100 countries, capturing more than 10% of the global market.
In the UK, its buses are used in Bristol, Essex, Leicester, Nottingham, south Wales and South Yorkshire, among other locations.
However, an investigation in Norway by Oslo’s public transport service, Ruter, found that Yutong buses could theoretically be “stopped or rendered inoperable” by the manufacturer. Denmark also opened an investigation after the Norwegian findings.
Ruter did not say there was any evidence that Yutong had tried to control the buses, and said it would impose “even stricter security requirements in future procurements”. It also said that the buses’ cameras are not connected to the internet, and “there is no risk of image or video transmission from the buses”.
Any evidence that a Chinese manufacturer had interfered with bus or car operations would probably have a devastating impact on vehicle exports, a key industrial aim for China’s government.
Nevertheless, digital security experts have warned for years that over-the-air updates to cars could be a security or privacy threat, either for a hostile state or criminal groups.
Ruter said it had tested two buses from Yutong and Dutch manufacturer VDL in a facility inside a mountain tunnel – a measure that would prevent remote tampering during tests. Yutong’s buses are capable of over-the-air software updates, meaning that the manufacturer has the ability to change software.
Ruter said: “There is access to the control system for battery and power supply via mobile network through a Romanian sim card. In theory, therefore, this bus can be stopped or rendered inoperable by the manufacturer.”
Over-the-air updates are a common feature of modern vehicles, including many mid-range cars made in the UK, US, Europe and China. With slick digital interfaces increasingly becoming one of the most important attractions for buyers, manufacturers and drivers value the ability to access the latest software.
Yutong did not immediately respond to a request for comment. The company previously told the Sunday Times that it “strictly complies with the applicable laws, regulations and industry standards of the locations where its vehicles operate”.
Carlsbad location is company’s third US-based radioligand therapy (RLT) manufacturing site
New site expands manufacturing footprint to meet future demand; ensures continued on-time delivery rate of >99.9% to patients across western US, Alaska and Hawaii
First to have delivered at scale, Novartis fortifies leadership in RLT innovation and infrastructure with California facility, additional plans for Florida and Texas
Basel, November 10, 2025 – Novartis, a leading global innovative medicines company, today announced the opening of a new 10,000-square-foot radioligand therapy (RLT) manufacturing facility in Carlsbad, California. This state-of-the-art site represents a key milestone in the company’s previously announced $23 billion investment in US infrastructure over the next five years.
The opening of the Carlsbad manufacturing facility allows Novartis to seamlessly meet future demand for RLT, adding additional capacity and augmenting the company’s world-class supply chain capabilities. The Carlsbad facility has been filed with the FDA as an additional US point of supply, and commercial manufacturing may begin once approval is granted.
RLTs are a form of precision medicine that combines a tumor-targeting molecule (ligand) with a therapeutic radioisotope, enabling the delivery of radiation to the tumor with the goal of limiting damage to the surrounding cells. Because each RLT dose is custom-made and time-sensitive, with a radioactive half-life measured in hours, proximity to treatment centers and transit hubs helps ensure patients receive their treatment when and where they need it.
“At Novartis, we tackle the toughest challenges in medicine by doing what’s never been done before for patients,” said Vas Narasimhan, CEO of Novartis. “Radioligand therapy is a breakthrough we’ve unlocked at scale, made possible by reimagining how innovation reaches patients. As the global leader in RLT for more than seven years, we’ve advanced this technology with a deep belief in its power to transform cancer care. The opening of our Carlsbad facility underscores our strong commitment to the US and dedication to bringing this pioneering treatment to patients across the country.”
Novartis is the only pharmaceutical company with a dedicated commercial RLT portfolio, and the Carlsbad facility is its third US RLT manufacturing site, reinforcing its global leadership in radioligand therapies with unmatched expertise in development, production, and delivery to patients worldwide. The Carlsbad facility is purpose-built to manufacture the company’s FDA-approved RLTs with capacity for future expansion.
“We commend Novartis for supporting our broader mission of bringing manufacturing capacity in the United States,” said FDA Commissioner Marty Makary, M.D., M.P.H.. “Our unique partnership approach is working.”
“Novartis is transforming the future of cancer care—and it’s happening right here in Carlsbad,” said Carlsbad City Council Member Melanie Burkholder. “This new advanced RLT production facility is a major milestone for our region, strengthening California’s position as a hub for life sciences innovation. It will bring exciting new opportunities for our community, including more engineering and manufacturing jobs. I’m proud our local community will be part of the future of cancer care.”
In addition to the Carlsbad opening, Novartis has announced multiple construction initiatives and future plans in the US, including:
Two additional RLT manufacturing facilities in Florida and Texas.
Expansion of existing sites in Durham, North Carolina, Indianapolis, Indiana, and Millburn, New Jersey.
Establishing its second global R&D hub in the US with a new state-of-the-art biomedical research innovation facility in San Diego, California.
These investments, enabled by a pro-innovation policy and regulatory environment in the US, reflect Novartis’ broad commitment to the market and building its infrastructure. Novartis expects to invest nearly $50 billion in its US operations over the next five years, including the $23 billion announced earlier this year, underscoring its long-term commitment to strengthening the US healthcare ecosystem.
Novartis and Radioligand Therapy (RLT)
Novartis is reimagining cancer care with RLT for patients with advanced cancers. By harnessing the power of targeted radiation and applying it to advanced cancers, RLT is designed to deliver treatment directly to target cells anywhere in the body3,4.
Novartis is actively investigating the application of RLTs across cancer types and settings, with one of the deepest and most advanced pipelines in the industry, with trials in prostate cancer, breast, colon, lung, brain, pancreatic and other cancers. Novartis has established global expertise, with specialized supply chain and manufacturing capabilities across its network of RLT production sites around the world.
Disclaimer
This press release contains forward-looking statements within the meaning of the United States Private Securities Litigation Reform Act of 1995. Forward-looking statements can generally be identified by words such as “potential,” “can,” “will,” “plan,” “may,” “could,” “would,” “expect,” “anticipate,” “look forward,” “believe,” “committed,” “investigational,” “pipeline,” “launch,” or similar terms, or by express or implied discussions regarding potential marketing approvals, new indications or labeling for the investigational or approved products described in this press release, or regarding potential future revenues from such products. You should not place undue reliance on these statements. Such forward-looking statements are based on our current beliefs and expectations regarding future events, and are subject to significant known and unknown risks and uncertainties. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those set forth in the forward-looking statements. There can be no guarantee that the investigational or approved products described in this press release will be submitted or approved for sale or for any additional indications or labeling in any market, or at any particular time. Nor can there be any guarantee that such products will be commercially successful in the future. In particular, our expectations regarding such products could be affected by, among other things, the uncertainties inherent in research and development, including clinical trial results and additional analysis of existing clinical data; regulatory actions or delays or government regulation generally; global trends toward health care cost containment, including government, payor and general public pricing and reimbursement pressures and requirements for increased pricing transparency; our ability to obtain or maintain proprietary intellectual property protection; the particular prescribing preferences of physicians and patients; general political, economic and business conditions, including the effects of and efforts to mitigate pandemic diseases; safety, quality, data integrity or manufacturing issues; potential or actual data security and data privacy breaches, or disruptions of our information technology systems, and other risks and factors referred to in Novartis AG’s current Form 20-F on file with the US Securities and Exchange Commission. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forward-looking statements contained in this press release as a result of new information, future events or otherwise.
About Novartis Novartis is an innovative medicines company. Every day, we work to reimagine medicine to improve and extend people’s lives so that patients, healthcare professionals and societies are empowered in the face of serious disease. Our medicines reach nearly 300 million people worldwide.
Reimagine medicine with us: Visit us at https://www.novartis.com and connect with us on LinkedIn, Facebook, X/Twitter and Instagram.
FORT LAUDERDALE, Fla., Nov. 10, 2025 /PRNewswire/ — Princess Cruises has announced Hampton Water Rosé as the latest addition to the Love Line Premium Liquors Collection. Known for its vibrant flavors and refined craftsmanship, the Hampton Water portfolio will offer Princess guests a still and sparkling rosé for toasting special moments at sea.
Hampton Water Rosé Joins Princess Cruises’ Love Line Premium Liquors Collection
Crafted in partnership with Jesse Bongiovi and his dad, Jon Bon Jovi, along with world-renowned winemaker, Gérard Bertrand, Hampton Water Rosé has received critical acclaim for its quality and lively fresh wine. The wines are available fleetwide and included in Princess Premier and Princess Plus beverage packages.
“Our Love Line Collection celebrates the spirit of connection through premium, celebrity-crafted libations that elevate the onboard experience,” said Sami Kohen, Princess Cruises Vice President of Food and Beverage. “Hampton Water Rosé is more than a wine – it’s a reflection of the lifestyle our guests embrace: vibrant, celebratory, and inspired by the stars they love.”
Princess Cruises Love Line Premium Liquors Collection features a selection of thoughtfully curated wines and spirits, offering both alcohol and non-alcoholic options with a diverse lineup of celebrity-crafted beverages:
Pantalones Organic Tequila by Camila and Matthew McConaughey
Meili Vodka by Jason Momoa and Blaine Halvorson
Sláinte Irish Whiskey by Liev Schreiber
Archer Roose co-owned by Elizabeth Banks
Seven Daughters Moscato by Taraji P. Henson
Melorosa Sauvignon Blanc and Red Blend co-founded by Jason Aldean, Kasi Wicks and Chuck Wicks
Love Prosecco by Romero Britto
Zero Alcohol Sparkling Rosé by Kylie Minogue
Betty Booze by Blake Lively
“Hampton Water is about bringing people together over great conversation and even better wine,” said Jesse Bongiovi. “To have it featured aboard Princess Cruises – a place where countless memories and connections are made – is an incredible opportunity to share our rosé with people who truly value celebration and togetherness.”
The addition of Hampton Water Rosé builds on Princess Cruises’ reputation for delivering exceptional culinary and beverage experiences, ensuring guests have access to innovative and exclusive offerings during their voyage.
For further details about the Love Line Premium Liquors Collection, visit www.princess.com.
Additional information about Princess Cruises is available through a professional travel advisor, by calling 1-800-Princess (1-800-774-6237) or by visiting www.princess.com.
*Princess’ Love Line non-alcohol beverages may contain up to 0.5% alcohol by volume (ABV). These beverages are classified as non-alcoholic under U.S. regulations but may contain trace amounts of alcohol.
About Hampton Water Jesse and his dad, Jon Bon Jovi, shared a vision to disrupt the wine category with a brand that is unlike all others. The father-son duo created the Hampton Water Wine brand concept, bringing on famed French winemaker, Gérard Bertrand. Launching in 2018 with Hampton Water Rosé, the brand quickly rose above the ranks to be more than just another celebrity brand. It is a family business that has earned four years of 90-point ratings from Wine Spectator, 91 points from Wine Enthusiast and Decanter, and was recognized as an Impact Hot Prospect brand two years in a row. With an incredibly engaged social media presence of over 625,000 followers, Hampton Water is making waves by taking a modern digital approach in an often-traditional category. Seeing such success with the still rosé, Hampton Water is proud to have expanded their brand portfolio with a sparkling rosé in 2024: Hampton Water Bubbly. The brand is creating loyal brand advocates, surpassing their category, and delivering double-digit volume growth year over year.
More information on the company can be found at www.hamptonwaterwine.com, www.facebook.com/hamptonwater, TikTok: @HamptonWater, Instagram: @HamptonWater, and X: @HamptonWater. Sip responsibly.
About Princess Cruises Princess Cruises is The Love Boat, the world’s most iconic cruise brand that delivers dream vacations to millions of guests every year in the most sought-after destinations on the largest ships that offer elite service personalization and simplicity customary of small, yacht-class ships. Well-appointed staterooms, world class dining, grand performances, award-winning casinos and entertainment, luxurious spas, imaginative experiences and boundless activities blend with exclusive Princess MedallionClass service to create meaningful connections and unforgettable moments in the most incredible settings in the world – the Caribbean, Alaska, Panama Canal, Mexican Riviera, Europe, South America, Australia/New Zealand, the South Pacific, Hawaii, Asia, Canada/New England, Antarctica, and World Cruises. Sun Princess, the brand’s new, next-level Love Boat named Condé Nast Traveler’s Mega Ship of the Year, introduces the groundbreaking Sphere Class platform and will be joined by sister ship, Star Princess, in Fall 2025. The company is part of Carnival Corporation & plc (NYSE/LSE:CCL; NYSE:CUK).
People walk past a Burger King restaurant with Chinese national flags displayed on a street during the National Day Golden Week holiday on October 5, 2024, in Chongqing, China.
Cheng Xin | Getty Images
Restaurant Brands International on Monday announced that it will form a joint venture with CPE, a Chinese alternative asset manager, to run Burger King’s restaurants in China.
Earlier this year, a subsidiary of Restaurant Brands acquired its equity interests from its previous Burger King China partners, Turkish-based operator TFI and U.S.-based private equity firm Cartesian Capital, for roughly $158 million in cash. At the time, the company said it planned to find a local operator as a partner.
Under the terms of the deal, CPE will own roughly 83% of Burger King China. Restaurant Brands will hold a minority stake of about 17%, along with a seat on the board of directors.
When the deal closes, CPE plans to invest $350 million into the joint venture. That investment will go toward a number of areas, from marketing to menu innovation, as well as restaurant expansion. Over the next decade, the joint venture aims to more than double the burger chain’s footprint in the market, from about 1,250 locations today to more than 4,000 by 2035.
“CPE is a well-capitalized, proven operator with exceptional leadership and extensive consumer and restaurant experience, making them an ideal partner to fuel the next chapter of Burger King China’s growth,” Restaurant Brands CEO Josh Kobza said in a statement.
The deal is expected to close in the first quarter of 2026, pending regulatory approval.
For decades, China’s massive population and fast-growing economy have made it an attractive market for U.S. companies, including restaurant chains. But in recent years, an economic slowdown have made some companies rethink their strategies. A week ago, Starbucks announced plans to form its own joint venture for its China business with Boyu Capital, a local alternative asset management firm.
A scoping exercise was carried out to assess the feasibility of a synthesis of MR studies with respect to survival. A query of the Guerra et al. [9] database indicated the number of mark–recapture studies with or without known-age releases, which is presented in Table 1. Though known-age studies are a minority, 51 were available with potential information. The set of ages-at-release in any study was usually small: single-age release, more occasionally two or three. A prime requirement was that MR data were available that could be put into the form of a capture history matrix or m-array (these data structures are explained further in the section hereafter). Scoping found that publications never reported the capture history matrix and rarely the full m-array but often reported m-array information directly in a tabular form or indirectly in graphical form. Single-release experiments were much more common and would usually yield information for a single-row m-array. Recapture was usually carried out with similar apparatus and effort from occasion to occasion. Mosquitoes were usually killed on recapture; experiments with re-release of recaptured mosquitoes were very unusual. The exercise concluded that there were no strong obstacles to a pooled analysis of studies making use of an age-dependent CJS model, and the assumption of time-independent capture probability was defensible.
Table 1 Counts of MR studies with or without known-age release from Ref. [9]
Data
The ‘capture history’ of the cohort(s) can be put in matrix form. This mark–recapture matrix forms a summary of the set of individual capture histories in the experiment, of which there are ({2}^{T}-1) possibilities where T is the number of recapture occasions. Under the assumptions of mark–recapture, an even more concise summary is provided by the ‘reduced m-array’ (henceforth ‘m-array’), which counts the numbers of mosquitoes released at i and next caught at j, without regard to the capture history prior to i or subsequent to j. The m-array is the usual form of reporting recapture data in publications.
When only a single release is carried out, the data reported can be structured as a single-row m-array, and this is the most common format. In some experiments, the release and/or recapture occasions are irregularly spaced.
An example m-array is shown here from Takagi et al. [14], in which three cohorts of 4-day old marked mosquitoes were released on three successive days (days 22, 23 and 24):
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
Uncaptured
1
4
14
2
1
12
5
6
2
1
3
0
4
241
1
2
0
0
6
3
3
1
0
0
1
0
144
7
0
1
3
2
5
1
1
0
0
0
229
The first to penultimate columns show a set of counts ({m}_{ij}) of animals released at occasion i and subsequently caught at occasion j. The final column shows the numbers released but not re-caught again over the course of the experiment. In this example, the final column was calculated from the supplied numbers released and numbers re-caught. No recaptures were attempted on days 32 and 35, so the columns are empty.
A much fuller expression of the study information contains m-arrays by age (the ‘full’ or ‘generalised’ m-array, McRea and Morgan [13]). This structure is a set of counts with ({m}_{ij}left(aright)) denoting the number of individuals which, when released on day i at age a days, are next captured at j. Accompanying it is an array ({R}_{i}left(aright)), which is the number of individuals released on day i of age a days. The generalised m-array is almost never reported directly but could in principle be surmised from the study report. A reduced m-array for an experiment with cohorts of known age can be expressed as a generalised m-array.
In the example above, the cohorts released were all of the same age on each occasion (multiple release, single age). An alternative is to release multiple ages simultaneously (single release, multiple ages), for which a full m-array data structure is required. Harrington et al. [15] simultaneously released ‘young’ and ‘old’ cohorts (3 and 13 days old, respectively) in Puerto Rico. The data can be formed to give the following R-array.
and generalised m-array:
Age
2
3
4
5
6
7
8
9
10
11
Uncaptured
3
20
15
9
0
3
0
1
1
0
1
92
13
13
3
1
1
0
0
0
0
1
0
103
Finally, different ages may be released at each occasion (single or multiple release and multiple age). For example, Eldridge and Reeves [16] released cohorts of ages 5, 1 and 2 on days 1, 4 and 7, respectively.
The MR and release data were extracted from the original studies and then entered into R as arrays.
A study may report more than one MR experiment, with releases separated in time and space. For example, Reisen et al. [17] reported separate experiments carried out in different months. When release cohorts overlap, for our study, a multiple-release m-array was formed where possible. Recaptures from separate releases were sometimes accumulated in the source publication in such a way that they could not be disaggregated and had to be treated as a single-release experiment, e.g. in Ref. [18].
Other aggregation or conditioning factors include experimental site, sex, mosquito species and age. For example, Reisen et al. [17] released and recaptured male and female cohorts of Cu. tarsalis and Cu. quinquefasciatus. However, the recapture data were only reported fully for Cu. tarsalis females. Table 2 presents a brief summary of study and dataset-level characteristics.
Table 2 Summary of included study characteristics
Searching
The references identified by Guerra et al. [9] were supplemented by a much smaller set of references collected ad hoc by the author (n = 26), and combined with a Web of Science search from 2014 to date [title terms: mosquito AND (surviv* OR longevity OR mortality)] to create the complete reference set, n = 188.
A flow diagram of the search and selection process is provided in Additional File 1: Supplementary Fig. S1 (Appendix S2). Studies in which a survival-related experimental negative intervention (e.g. genetic modification) was apparent from the title were excluded. Studies in which age of release was unknown were excluded. For example, Takken et al. [19] captured mosquitoes from houses with aspirators prior to marking, so the ages of these adults at release were not known. Studies without useable MR information were excluded. For example, the authors of Marini et al. [20] reported recapture numbers in aggregated form, e.g. in the first experiment as 2–5, 6–9 and 10–21 day totals; these data could not be put into the usual m-array form by recapture day, and the study was therefore excluded.
None of the selected datasets were exclusively concerned with males, and the majority contained female-specific MR information, so the analysis followed Ref. [9] in confining results to females. Similarly, the vast majority of datasets were in the three genera Anopheles, Aedes and Culex; other genera were excluded.
Studies were then filtered according to conditions established by simulation (details below). For example, Takagi et al. [14] released three laboratory-reared cohorts 4–5 days after emergence. Criteria established on the basis of simulation results excluded this single-age study because of the older age of the mosquito cohorts and the inadequate size (< 500) of the release cohorts (296, 161 and 249).
After exclusions, there were 73 MR datasets with ages known at release and, from these, 30 datasets of female mosquitoes with suitable MR information and experimental characteristics. The references supplying the final datasets are listed in Additional File 2.
Analysis
After the selection of studies described above, analysis is carried out in two stages. In the first stage, the parameters of a mark recapture model are estimated for each selected study, which include survival and capture parameters. The capture parameters have a modelling function, but the survival parameters are of primary interest. Study-specific capture probabilities are ascribed to each study, allowing study characteristics (experimental design, local conditions, etc.) to influence the data. For example, a study in which recapture uses baited recapture is allowed a different (probably higher) recapture probability to one that does not. In this way, important heterogeneity is modelled. In the second stage, the EL and its variance are estimated from the survival parameters, and this outcome is analysed by conventional meta-analysis.
In the first stage, each study is analysed using the CJS model. In our analysis, the Weibull survival curve determines the values of the discrete survival parameters in the CJS model, so the parameters in the likelihood are reduced from a potentially large set of discrete survival parameters to the small set of Weibull parameters that they map to. A summary of symbols used is presented in Table 3.
Table 3 Summary of symbols used (mostly from Ref. [13])
Analysis uses the age-specific CJS likelihood equation [13, p. 74] written here as:
$$L propto mathop prod limits_{a} mathop prod limits_{i = 1}^{T – 1} left{ {chi_{i} left( a right)^{{R_{i} left( a right) – sum m_{ij} left( a right)}} mathop prod limits_{j = i + 1}^{T} nu_{ij} left( a right)^{{m_{ij} left( a right)}} } right}$$
where ({R}_{i}left(aright)) and ({m}_{ij}left(aright)) are data arrays with examples given in the Data section, and for a mosquito of age a when released at occasion i, ({nu }_{ij}left(aright)) is the probability of next recapture at j, and ({chi }_{i}left(aright)) is the probability, of not being caught afterwards, so (chi_{i} left( a right) = 1 – mathop sum limits_{j} nu_{ij} left( a right).)
This is a multinomial likelihood and, leaving age aside for the purposes of explanation, includes:
the probability of no recapture (({chi }_{i})) raised to the power of the numbers not recaptured (({R}_{i}-sum {m}_{ij})); hence, the first term, and
the probabilities of recapture (({nu }_{ij})) raised to the power of the number of recaptures (({m}_{ij})); hence, the second term.
The parameters in the current analysis are relatively simple compared with the general form: p is the probability of capture on any recapture occasion, which is assumed time-independent, and (underset{_}{phi }) is a vector of probabilities, with element (phi left[kright]) the probability of surviving from age k to k + 1.
Then,
$$nu_{ij} left( a right) = left( {1 – p} right)^{j – i – 1} p times mathop prod limits_{k = i}^{j – 1} phi left[ {a + k – i} right]$$
Conventionally, discrete survival probabilities (({phi }_{k})) are used in MR analyses (see Ref. [13]). The analysis for age-dependence when interest lies in discrete age classes is set out by Pollock et al. [21], as is common in some fields (e.g. birds: immature and mature). Analysis with many age classes requires many parameters and associated limits on precision. Parametric age-dependence on a continuum has been additionally utilised in this paper because it provides a more compact parameterisation and potentially increased precision. The parameter vector for an individual study under the discrete survival formulation (with a time-independent capture model) is (left(p,{phi }_{1},…{phi }_{k}…right)), whereas under the compact parameterisation it is (for the Weibull survival model) (underset{_}{theta }=left(p,alpha ,eta right)).
A Weibull survival model is assumed with shape and scale parameters (alpha) and (eta). There are several textbook parameterisations of the Weibull, and the one adopted here corresponds to that coded in R. Note that the symbol for the Weibull scale parameter ((sigma)) in the R parameterisation is replaced in this paper with (eta) because (sigma) is also commonly used for measures of dispersion. The Weibull distribution is fairly flexible though monotonic, and it includes the exponential as a special case when (alpha =1).
For the Weibull, the continuous survival function is:
The conditional survival over a time step is (Sleft(k+1right)/Sleft(kright)) [22, p. 31], so the equation:
$$phi left( k right) = frac{{Sleft( {k + 1} right)}}{Sleft( k right)}$$
connects the continuous survival model with the discrete apparent survival of the CJS, in which (phi left(kright)) represents the probability of an animal alive at age (k) surviving to (k+1).
Weibull parameters are restricted to (alpha >0) and (eta >0). These constraints were implemented by numerical fitting with the Nelder–Mead method on the transformed variables (text{log}left(alpha right)) and (text{log}left(eta right)).
The EL of a mosquito is given by (int Sleft(tright)text{d}t) and has an analytic solution for the Weibull model for known parameter values. To incorporate the parameter uncertainty in estimates of (alpha) and (eta), further analysis is required. The calculation in this paper of the variance of the conditional mean of the EL under a Weibull model is described in Additional File 1: Appendix S3.
Meta-analysis was carried out using the metafor package in R. The meta-analysis on expected lifetimes used a log transformation for this positive-value outcome, with inverse-variance weighting. The variance of the log-transformed EL was approximated using the ‘delta method’, that is:
The pooled estimate from the meta-analysis used a random-effects model to account for heterogeneity, which incorporates extra ‘between-study’ variation in the estimates.
Each study receives its own (constant) capture probability, which means there are as many capture parameters as studies; however, it is the survival parameters that are of primary interest and the capture parameters serve a modelling function only. In the analysis with genus as a moderator, there is an average for each group (e.g. for genus Anopheles) shared by those studies.
Three sensitivity analyses were carried out with alternative constraints:
1.
For the overall model, with 0 < p < 0.05 and (alpha ge) 1. The analysis asserts increasing or constant mortality with age, and rules out capture probabilities > 0.05, which may be implausible.
2.
For the genus-specific model, 0 < p < 0.05 and (alpha) >0.1. The boundary on low values of (alpha) is a practical step to help avoid numerical difficulties, as discussed elsewhere.
3.
For the genus-specific model, a meta-analysis excluding any studies with (alpha <1), where simulations showed estimation, produced a high root mean square error (RSME) (Additional File 1: Appendix S4).
Simulations
Simulations of known-age MR experiments were carried out using known parameter values and known age, with time-independent capture probability and age-dependent survival. Four Weibull-derived survival models were used to generate simulated data, one exponential ((alpha =1)), two with larger shoulders and increasing mortality with age ((alpha >1)) and one where mortality fell with age ((alpha <1)). These survival curves are shown in Additional File 1: Supplementary Fig. S2 along with their parameter values. The capture probability was set to 0.01 throughout, and there were 1000 runs in each scenario. When summarising scenarios, simulated data were trimmed where (widehat{alpha }) > 30 or (widehat{eta })> 30. The proportion of simulations with these outliers was 0.13.
In broad terms, the simulations showed that bias and variance reduces with more recapture occasions and larger cohort sizes, with younger release ages, and with more releases. The following inclusion criteria were adopted, when mosquitoes are released at known age, to give broadly accurate estimates (details below): releases at young age (le 3), a sufficient number of recapture occasions (ge 8) and
1.
With single release, cohort size (Rge 1000)
2.
With multiple releases, (Rge 500)
The heuristic reasoning for allowing smaller cohort sizes for multiple release experiments (500 versus 1000 for single release) is that the resulting loss of efficiency from the smaller cohorts is somewhat balanced by further releases made within the same experiment. Studies that did not meet the inclusion criteria were excluded from the meta-analysis (see Appendix S2).
The statistical performance of the main outcome of interest in the present study (text{EL}), along with results for (alpha) and (eta), is summarised in Appendix S4. Under the inclusion criteria, it can be seen that the bias of (widehat{text{EL}}) is low (magnitude (lesssim) 0.5). Furthermore the RMSE of EL is rather smaller than the RMSE of (alpha) when (alpha gtrsim 2) (scenarios a and b). However, when (alpha <1) (scenario d), the RMSE of (widehat{text{EL}}) is large. The main conclusion of the simulations is that the bias of (widehat{text{EL}}) may be reduced to low-moderate levels by the inclusion criteria but that the RMSE of (widehat{text{EL}}) is especially high when (alpha <1). This is the region where Weibull variables are inherently most variable, and any estimates can be very imprecise.
Reaching out to strangers is a daunting prospect for many, but Carly Valancy has a “really special love” for networking, she says.
Valancy, 30, has had a wide-ranging career so far: she’s worked in tech, theater and marketing, before becoming the co-founder of Momentum Growth, a growth consultancy for female founders.
Through each professional pivot, networking has been key to her success, she says.
When she faced a career crossroads in her early 20s, Valancy challenged herself to contact one new person every day for 100 days, an idea inspired by Molly Beck’s networking strategy book “Reach Out.”
The experience “totally changed my life,” she says.
“Not only did it give me so many incredible opportunities, jobs and mentors, but it really gave me such a belief in myself — that I could ask for what I want, and I could reach out to a stranger and actually make a genuine connection.”
Five years later, Valancy is trying the 100 days of networking challenge again. She began in October, and the challenge — which, she clarifies, only takes place on weekdays — will conclude in March on her 31st birthday.
This time around, she already has a strong network by her side, so her main goal is to “plant seeds for my future self,” she says.
Her strategy for the challenge
The first time Valancy tried sending 100 messages in 100 days, she felt “chaotic and desperate to make a change.” By the end of it, she was feeling burnt out, she says.
“A lot of people turn to networking when they’re in those desperate situations, which makes sense,” she says. “Maybe you were laid off from a job, or maybe you’ve moved to a new city and all of a sudden you’re like, ‘Oh my gosh, I need to be networking.’”
This time, she’s being more intentional.
Having a concrete list of goals is crucial, Valancy says. Hers are to find “dream clients” for her consulting firm, make her personal brand “more visible” and to create “amazing experiences” for her family.
So far, Valancy has scheduled introductory meetings with potential clients, pitched herself to speak at a university, and secured sponsorship from her favorite baby brands for her son’s Formula 1-themed birthday party.
Valancy doesn’t plan who she reaches out to ahead of time, she says: “I don’t want it to feel like a to do list.”
Every day, she chooses a person to contact via LinkedIn, social media or email based on “just my curiosity of like, oh, this person seems really cool, or they’re doing work that I want to be doing in 5 years, or, they’ve written something that I really love.”
Valancy learned from her last attempt at the 100 days challenge that “the coolest opportunities came from the most random places and the most random people,” she says.
She logs every outreach message and response on Tether, an online platform she created to keep track of her networking efforts. Last time Valancy tried the challenge, she had a 70% response rate.
“It can be so easy to let these connections or attempts for connection just totally slip through our fingers,” she says, but Tether helps her stay organized.
How she overcomes networking nerves
Many people resist reaching out to others because they’re afraid “of being rejected or being judged,” Valancy says.
Even after sending hundreds of networking messages over the course of her career, Valancy still gets nervous: “The fear around putting yourself out there is so real, and to pretend it isn’t is such a lie,” she says.
Instead of letting that hold her back, Valancy chooses to be open about her feelings instead.
“It’s really disarming to just tell the truth, and to just say how you feel about attempting to connect with someone,” she says.
Valancy has found that people are more likely to respond positively when she openly acknowledges how stressful and awkward networking can be.
“I can’t tell you the amount of times I will reach out to someone and just be like, ‘You are way out of my league, and I feel so nervous to be reaching out to you right now,’” she says.
“The second that we can kind of like let our guard down, be honest, and share that with the person that we’re trying to connect with — first of all, the better it feels, the more genuine and truthful it feels, but also the better it is received,” Valancy continues.
Networking can feel “really icky” when people approach it from a transactional perspective, she says, but it doesn’t have to be that way.
She describes her networking ethos as “the anti-sales bro approach”: “I just want to like feel like myself when I talk to other people,” Valancy says.
The connections you make today can “have incredible effects on our life many years from now,” according to Valancy.
“Life really, really is about who you know,” she says. “The professional things, the personal things — all of the best things in our life are made possible by the people around us, and by the company we keep.”
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