Uncertainty in non-CO2 greenhouse gas mitigation contributes to ambiguity in global climate policy feasibility

Despite its projected crucial role in stringent, future global climate policy, non-CO 2 greenhouse gas (NCGG) mitigation remains a large uncertain factor in climate research. A revision of the estimated mitigation potential has implications for the feasibility of global climate policy to reach the Paris Agreement climate goals. Here, we provide a systematic bottom-up estimate of the total uncertainty in NCGG mitigation, by developing 'optimistic', 'default' and 'pessimistic' long-term NCGG marginal abatement cost (MAC) curves, based on a comprehensive literature review of mitigation options. The global 1.5-degree climate target is found to be out of reach under pessimistic MAC assumptions, as is the 2-degree target under high emission assumptions. In a 2-degree scenario, MAC uncertainty translates into a large projected range in relative NCGG reduction (40-58%), carbon budget (±120 Gt CO 2) and policy costs (±16%). Partly, the MAC uncertainty signifies a gap that could be bridged by human efforts, but largely it indicates uncertainty in technical limitations

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Uncertainty in non-CO2 greenhouse gas mitigation contributes to ambiguity in global climate policy feasibility

Abstract Despite its projected crucial role in stringent, future global climate policy, non-CO2 greenhouse gas (NCGG) mitigation remains a large uncertain factor in climate research. A revision of the estimated mitigation potential has implications for the feasibility of global climate policy to reach the Paris Agreement climate goals. Here, we provide a systematic bottom-up estimate of the total uncertainty in NCGG mitigation, by developing ‘optimistic’, ‘default’ and ‘pessimistic’ long-term NCGG marginal abatement cost (MAC) curves, based on a comprehensive literature review of mitigation options. The global 1.5-degree climate target is found to be out of reach under pessimistic MAC assumptions, as is the 2-degree target under high emission assumptions. In a 2-degree scenario, MAC uncertainty translates into a large projected range in relative NCGG reduction (40–58%), carbon budget (±120 Gt CO2) and policy costs (±16%). Partly, the MAC uncertainty signifies a gap that could be bridged by human efforts, but largely it indicates uncertainty in technical limitations