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The emissions of hydrofluorocarbons (HFCs) have increased significantly in the past 2 decades, primarily as a result of the phaseout of ozone-depleting substances under the Montreal Protocol and the use of HFCs as their replacements. In 2015, large increases were projected in HFC use and emissions in this century in the absence of regulations, contributing up to 0.5 ∘C to global surface warming by 2100. In 2019, the Kigali Amendment to the Montreal Protocol came into force with the goal of limiting the use of HFCs globally, and currently, regulations to limit the use of HFCs are in effect in several countries. Here, we analyze trends in HFC emissions inferred from observations of atmospheric abundances and compare them with previous projections. Total CO2 eq. inferred HFC emissions continue to increase through 2019 (to about 0.8 GtCO2eq.yr-1) but are about 20 % lower than previously projected for 2017–2019, mainly because of the lower global emissions of HFC-143a. This indicates that HFCs are used much less in industrial and commercial refrigeration (ICR) applications than previously projected. This is supported by data reported by the developed countries and the lower reported consumption of HFC-143a in China. Because this time period preceded the beginning of the Kigali provisions, this reduction cannot be linked directly to the provisions of the Kigali Amendment. However, it could indicate that companies transitioned away from the HFC-143a with its high global warming potential (GWP) for ICR applications in anticipation of national or global mandates. There are two new HFC scenarios developed based (1) on current trends in HFC use and Kigali-independent (K-I) control policies currently existing in several countries and (2) current HFC trends and compliance with the Kigali Amendment (KA-2022). These current policies reduce projected emissions in 2050 from the previously calculated 4.0–5.3 GtCO2eq.yr-1 to 1.9–3.6 GtCO2eq.yr-1. The added provisions of the Kigali Amendment are projected to reduce the emissions further to 0.9–1.0 GtCO2eq.yr-1 in 2050. Without any controls, projections suggest a HFC contribution of 0.28–0.44 ∘C to global surface warming by 2100, compared to a temperature contribution of 0.14–0.31 ∘C that is projected considering the national K-I policies current in place. Warming from HFCs is additionally limited by the Kigali Amendment controls to a contribution of about 0.04 ∘C by 2100.

Chlorofluorocarbon (CFC) banks from uses such as air conditioners or foams can be emitted after global production stops. Recent reports of unexpected emissions of CFC-11 raise the need to better quantify releases from these banks, and associated impacts on ozone depletion and climate change. Here we develop a Bayesian probabilistic model for CFC-11, 12, and 113 banks and their emissions, incorporating the broadest range of constraints to date. We find that bank sizes of CFC-11 and CFC-12 are larger than recent international scientific assessments suggested, and can account for much of current estimated CFC-11 and 12 emissions (with the exception of increased CFC-11 emissions after 2012). Left unrecovered, these CFC banks could delay Antarctic ozone hole recovery by about six years and contribute 9 billion metric tonnes of equivalent CO 2 emission. Derived CFC-113 emissions are subject to uncertainty, but are much larger than expected, raising questions about its sources. Following international agreements, the use of chlorofluorocarbons in production is supposed to be phased out. Here, the authors present a new estimate of these products already in use and their emissions and show that they are larger than expected and that not recovering these banks leads to a substantial delay in the polar ozone hole recovery.

Sulfur hexafluoride (SF 6 ) is a potent greenhouse gas. Here we use long-term atmospheric observations to determine SF 6 emissions from China between 2011 and 2021, which are used to evaluate the Chinese national SF 6 emission inventory and to better understand the global SF 6 budget. SF 6 emissions in China substantially increased from 2.6 (2.3-2.7, 68% uncertainty) Gg yr −1 in 2011 to 5.1 (4.8-5.4) Gg yr −1 in 2021. The increase from China is larger than the global total emissions rise, implying that it has offset falling emissions from other countries. Emissions in the less-populated western regions of China, which have potentially not been well quantified in previous measurement-based estimates, contribute significantly to the national SF 6 emissions, likely due to substantial power generation and transmission in that area. The CO 2 -eq emissions of SF 6 in China in 2021 were 125 (117-132) million tonnes (Mt), comparable to the national total CO 2 emissions of several countries such as the Netherlands or Nigeria. The increasing SF 6 emissions offset some of the CO 2 reductions achieved through transitioning to renewable energy in the power industry, and might hinder progress towards achieving China’s goal of carbon neutrality by 2060 if no concrete control measures are implemented. Atmospheric measurements show that China’s emissions of the potent greenhouse gas, sulfur hexafluoride, grew rapidly between 2011 and 2021. This rise could offset some of China’s progress towards its greenhouse gas emission reduction goal.

The growth in global methane (CH₄) concentration, which had been ongoing since the industrial revolution, stalled around the year 2000 before resuming globally in 2007. We evaluate the role of the hydroxyl radical (OH), the major CH₄ sink, in the recent CH₄ growth. We also examine the influence of systematic uncertainties in OH concentrations on CH₄ emissions inferred from atmospheric observations. We use observations of 1,1,1-trichloroethane (CH₃CCl₃), which is lost primarily through reaction with OH, to estimate OH levels as well as CH₃CCl₃ emissions, which have uncertainty that previously limited the accuracy of OH estimates. We find a 64–70% probability that a decline in OH has contributed to the post-2007 methane rise. Our median solution suggests that CH₄ emissions increased relatively steadily during the late 1990s and early 2000s, after which growth was more modest. This solution obviates the need for a sudden statistically significant change in total CH₄ emissions around the year 2007 to explain the atmospheric observations and can explain some of the decline in the atmospheric 13CH₄/12CH₄ ratio and the recent growth in C₂H₆. Our approach indicates that significant OH-related uncertainties in the CH₄ budget remain, and we find that it is not possible to implicate, with a high degree of confidence, rapid global CH₄ emissions changes as the primary driver of recent trends when our inferred OH trends and these uncertainties are considered.

Emissions of ozone-depleting substances, including trichlorofluoromethane (CFC-11), have decreased since the mid-1980s in response to the Montreal Protocol 1 , 2 . In recent years, an unexpected increase in CFC-11 emissions beginning in 2013 has been reported, with much of the global rise attributed to emissions from eastern China 3 , 4 . Here we use high-frequency atmospheric mole fraction observations from Gosan, South Korea and Hateruma, Japan, together with atmospheric chemical transport-model simulations, to investigate regional CFC-11 emissions from eastern China. We find that CFC-11 emissions returned to pre-2013 levels in 2019 (5.0 ± 1.0 gigagrams per year in 2019, compared to 7.2 ± 1.5 gigagrams per year for 2008–2012, ±1 standard deviation), decreasing by 10 ± 3 gigagrams per year since 2014–2017. Furthermore, we find that in this region, carbon tetrachloride (CCl 4 ) and dichlorodifluoromethane (CFC-12) emissions—potentially associated with CFC-11 production—were higher than expected after 2013 and then declined one to two years before the CFC-11 emissions reduction. This suggests that CFC-11 production occurred in eastern China after the mandated global phase-out, and that there was a subsequent decline in production during 2017–2018. We estimate that the amount of the CFC-11 bank (the amount of CFC-11 produced, but not yet emitted) in eastern China is up to 112 gigagrams larger in 2019 compared to pre-2013 levels, probably as a result of recent production. Nevertheless, it seems that any substantial delay in ozone-layer recovery has been avoided, perhaps owing to timely reporting 3 , 4 and subsequent action by industry and government in China 5 , 6 . Atmospheric data and chemical-transport modelling show that CFC-11 emissions from eastern China have again decreased, after increasing in 2013–2017, and a delay in ozone-layer recovery has probably been avoided.

Background The objective of this study is to compare the oncologic outcomes of CO 2 transoral laser microsurgery (TLM) and radiotherapy (RT) for treatment of T1 glottic carcinoma. Methods A literature search was conducted in the following databases: Medline/PubMed, Web of Science, EMBASE, and the Cochrane Library. Search results were screened, and publications comparing oncologic outcomes of T1N0M0 glottic carcinoma treated with TLM or RT were included. Data was extracted independently by two authors, and publication quality was graded according to the Oxford Centre for Evidence-based Medicine. Meta-analysis was performed for overall survival, disease specific survival, laryngeal preservation, and local control. Results Sixteen studies were included in the meta-analysis, the majority being retrospective cohort studies with two prospective cohort studies. Included studies were rated as either Level II or III evidence. Meta-analysis favoured treatment with TLM for T1 glottic carcinoma patients for the following outcomes: overall survival (odds ratio [OR], 1.52; 95% confidence interval [CI], 1.07–2.14; P  = 0.02), disease specific survival (OR, 2.70; CI, 1.32–5.54; P  = 0.007), and laryngeal preservation (OR, 6.31; CI, 3.77–10.56; P  < 0.00001). There was no difference in local control between TLM and RT in T1 glottic cancer (OR, 1.19; CI, 0.79–1.81; P  = 0.40). Discussion Our study provides a current and thorough comparison of TLM and RT outcomes in T1 glottic carcinoma. Limitations of our study include lack of randomized control trials, and non-randomized allocation of patients to treatment groups. Our meta-analysis suggests that TLM is the superior modality in terms of overall survival, disease specific survival, and laryngeal preservation. Future prospective randomized controlled studies are required for confirming these findings and developing appropriate clinical practice guidelines. Level of evidence 2A; as per the Centre of Evidence Based Medicine.

With the successful implementation of the Montreal Protocol on Substances that Deplete the Ozone Layer, the atmospheric abundance of ozone-depleting substances continues to decrease slowly and the Antarctic ozone hole is showing signs of recovery. However, growing emissions of unregulated short-lived anthropogenic chlorocarbons are offsetting some of these gains. Here, we report an increase in emissions from China of the industrially produced chlorocarbon, dichloromethane (CH 2 Cl 2 ). The emissions grew from 231 (213–245) Gg yr −1 in 2011 to 628 (599–658) Gg yr −1 in 2019, with an average annual increase of 13 (12–15) %, primarily from eastern China. The overall increase in CH 2 Cl 2 emissions from China has the same magnitude as the global emission rise of 354 (281−427) Gg yr −1 over the same period. If global CH 2 Cl 2 emissions remain at 2019 levels, they could lead to a delay in Antarctic ozone recovery of around 5 years compared to a scenario with no CH 2 Cl 2 emissions. Dichloromethane (CH 2 Cl 2 ) is an unregulated ozone depleting substance whose emissions have strongly increased in recent years. Here, the authors show that rising emissions of dichloromethane in China between 2011 and 2019 can explain much of this global increase.

Chloroform contributes to the depletion of the stratospheric ozone layer. However, due to its short lifetime and predominantly natural sources, it is not included in the Montreal Protocol that regulates the production and uses of ozone-depleting substances. Atmospheric chloroform mole fractions were relatively stable or slowly decreased during 1990–2010. Here we show that global chloroform mole fractions increased after 2010, based on in situ chloroform measurements at seven stations around the world. We estimate that the global chloroform emissions grew at the rate of 3.5% yr−1 between 2010 and 2015 based on atmospheric model simulations. We used two regional inverse modelling approaches, combined with observations from East Asia, to show that emissions from eastern China grew by 49 (41–59) Gg between 2010 and 2015, a change that could explain the entire increase in global emissions. We suggest that if chloroform emissions continuously grow at the current rate, the recovery of the stratospheric ozone layer above Antarctica could be delayed by several years.

Background The Bethesda System is the most widely used for reporting fine needle aspiration (FNA) cytology. It recommends a repeat FNA (rFNA) when initial results are category I or III. It is unclear how often rFNA provides additional diagnostic information. We sought to investigate its utility at our institution. Methods A retrospective chart review was performed of patients who had a category I or III FNA result and underwent rFNA of the same thyroid nodule between 2013 and 2015 at the QE II Health Sciences Centre in Nova Scotia, Canada. Results of initial FNA and ultrasound characteristics, rFNA, demographic data, surgical details, and pathology were collected. Results A total of 237 patients (474 thyroid FNAs) were included. Most initial FNAs were category I (82%), the remainder category III (18%). rFNA yielded a different category 60% of the time. However, 60% remained category I or III. rFNA results of benign or malignant were found in 40% of cases; 1% were SFN/SFM. Twenty-seven percent of patients had surgery after rFNA; of those 68% had category I or III rFNA results. Of all nodules that underwent surgery, 46% were malignant, including 32% with category I rFNA results, and 42% category III. Conclusions rFNA for category I and III nodules provided a definitive diagnosis in only 40% of cases, which is important for patient counseling. Malignancy rates at our centre were higher for these categories than predicted by Bethesda. Clinical management should consider institution specific malignancy rates, patient factors, and ultrasound findings.

China’s anthropogenic methane emissions are the largest of any country in the world. A recent study using atmospheric observations suggested that recent policies aimed at reducing emissions of methane due to coal production in China after 2010 had been largely ineffective. Here, based on a longer observational record and an updated modelling approach, we find a statistically significant positive linear trend (0.36 ± 0.04 ( ± 1 σ ) Tg CH 4 yr −2 ) in China’s methane emissions for 2010–2017. This trend was slowing down at a statistically significant rate of -0.1 ± 0.04 Tg CH 4 yr −3 . We find that this decrease in growth rate can in part be attributed to a decline in China’s coal production. However, coal mine methane emissions have not declined as rapidly as production, implying that there may be substantial fugitive emissions from abandoned coal mines that have previously been overlooked. We also find that emissions over rice-growing and aquaculture-farming regions show a positive trend (0.13 ± 0.05 Tg CH 4 yr −2 for 2010–2017) despite reports of shrinking rice paddy areas, implying potentially significant emissions from new aquaculture activities, which are thought to be primarily located on converted rice paddies.