Radiotherapy In Management Research Articles

Southeast Asian expert perceptions of solar radiation management techniques and carbon dioxide removal approaches: caution, ambivalence, risk precaution, and research directions

As the climate crisis intensifies in its impacts, discussions around the deployment of geoengineering solutions in case other interventions fail or prove insufficient have figured in research and have even been on the agenda of the United Nations. There have been calls for more investigation of geoengineering techniques to address the climate crisis. Yet, this response presents technological unknowns and economic, political, and ethical risks. Producing knowledge on these techniques has been pushed in many research institutes in the global North, especially in the United States, Europe, and Australia. Still, contributions from global South researchers, including those in Southeast Asia, remain scant. This paper describes the responses of seventeen climate and energy experts from southeast Asia on a purposively designed survey that collected expert opinions on two geoengineering techniques: solar radiation modification (SRM) and carbon dioxide removal (CDR), their risks, impacts, and governance as they pertain to their countries and region. Respondents showed ambivalence towards these techniques, with many supporting ‘natural’ CDR research and deployment while being cautious about ‘technological’ SRM and CDR research and deployment. Although respondents would welcome research on these technologies, especially their risks and impacts, they also identified critical barriers in research capacity development and funding availability.

Modified Gap Arthroplasty for Temporomandibular Joint Ankylosis Following Radiotherapy for Rhabdomyosarcoma: Report of an Unusual Case and Brief Literature Review.

Radiotherapy at the temporomandibular joint (TMJ) area often results in trismus, however, post radiation ankylosis is extremely rare and has not been previously reported in literature. Radiation is known to impact the vasculature of bony structures leading to bone necrosis with certain risk factors including surgical intervention, even teeth extraction, that could lead to osteoradionecrosis. Accordingly, gap arthroplasty for such case seemed rather challenging. In this report, we introduce for the first time, a rare case of temporomandibular joint ankylosis post radiotherapy for management of rhabdomyosarcoma in a 12 years-old boy. A modified gap arthroplasty technique combined simultaneously with pterygo-masseteric muscle flap was applied to lower the risk of osteoradionecrosis due surgical trauma at irradiated area. Computed tomographic scan on the head indicated that the TMJ architecture was completely replaced by bone, with fusion of the condyle, sigmoid notch, and coronoid process to the zygomatic arch and glenoid fossa. The patient’s problem was totally solved with no osteoradionecrosis or relapse of ankylosis observed at follow up visits. Herein, the modified gap arthroplasty combined with pterygo-masseteric muscle flap could be recommended to be applied on other cases of ankylosis especially after receiving radiotherapy.

Radiation Proctitis and Management Strategies.

Radiotherapy (RT) is a treatment modality that uses high-energy rays or radioactive agents to generate ionizing radiation against rapidly dividing cells. The main objective of using radiation in cancer therapy is to impair or halt the division of the tumor cells. Over the past few decades, advancements in technology, the introduction of newer methods of RT, and a better understanding of the pathophysiology of cancers have enabled physicians to deliver doses of radiation that match the exact dimensions of the tumor for greater efficacy, with minimal exposure of the surrounding tissues. However, RT has numerous complications, the most common being radiation proctitis (RP). It is characterized by damage to the rectal epithelium by secondary ionizing radiation. Based on the onset of signs and symptoms, post-radiotherapy RP can be classified as acute or chronic, each with varying levels of severity and complication rates. The treatment options available for RP are limited, with most of the data on treatment available from case reports or small studies. Here, we describe the types of RT used in modern-day medicine and radiation-mediated tissue injury. We have primarily focused on the classification, epidemiology, pathogenesis, clinical features, treatment strategies, complications, and prognosis of RP.

Defining radio-recurrent intra-prostatic target volumes using PSMA-targeted PET/CT and multi-parametric MRI

PurposeOur purpose was to evaluate intra-prostatic cancer volumes for salvage radiotherapy in men with recurrent prostate cancer confined to the prostate post-primary radiotherapy using mpMRI and 18F-DCFPyL PET/CT (PET). MethodsMen with biochemical failure post-primary radiotherapy were enrolled in a multi-centre trial investigating mpMRI and PET. All men with isolated intra-prostatic recurrence are included in this secondary analysis. The intra-prostatic gross tumour volume (GTV) was manually delineated on mpMRI and was also delineated on PET using three methods: 1. manually, 2. using a 30% threshold of maximum intra-prostatic standard uptake value (SUVmax), and 3. using a 67% threshold of this SUVmax. Clinical target volumes (CTV) including expansions on each GTV were generated. Conformity indices were performed between the mpMRI CTV and each PET CTV. Correlation with biopsy and clinical outcomes were performed. ResultsOf the 36 men included, 30 (83%) had disease in two quadrants or less using the combination of mpMRI and PET. Mean target volume (union of CTV on mpMRI and CTV manually delineated on PET) was 12.2 cc (49% of prostate gland volume). 12/36 (33%) men had a biopsy. Per-patient sensitivity was 91% for mpMRI and 82% for PET. ConclusionsmpMRI and PET provide complementary information for delineation of intra-prostatic recurrent disease. Union of CTV on mpMRI and PET is often less than 50% of the prostate, suggesting this imaging could help define a target for focal salvage therapy.

Multiplatform Genomic Profiling and Immunohistochemistry Identify Prognostic and Predictive Signatures in Malignant Peripheral Nerve Sheath Tumors (MPNSTs)

Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive neoplasms arising either sporadically or in patients with neurofibromatosis type 1 (NF1). To elucidate markers of prognosis and treatment response, we retrospectively identified MPNST tumor resection specimens at a single institution and performed histopathologic evaluation, immunohistochemistry (IHC), DNA methylation profiling, and whole exome sequencing (WES).We identified a total of 54 consecutive patients treated at one institution between 1990 and 2019 with tumors meeting diagnostic criteria for MPNST and had sufficient tissue available for comprehensive histopathological evaluation (n = 54), DNA methylation profiling (n = 45) and whole exome sequencing (n = 35, n = 15 with paired normal). Overall survival (OS), metastasis free survival (MFS), and locoregional failure free rate (LFFR), were estimated using the Kaplan-Meier method. Log-rank test, Cox Proportional Hazards regression, and hierarchical clustering were performed in R.The median follow up was 22 months with no significant differences in LFFR, MFS, or OS between NF1 associated (n = 32) and sporadic MPNSTs (n = 22). Radiotherapy significantly improved LFFR (P = 0.05) but not OS. With regard to histopathologic and IHC analyses, increasing tumor grade using a two-tiered system (P = 0.01) and Ki-67 index (P = 0.01) were associated with worse OS. Unsupervised hierarchical clustering of DNA methylation profiles identified two groups with significant differences in chromosome instability and tumor purity but not clinical outcome. Recurrently identified copy number variants (CNVs) included chromosome 22q loss, 11q loss, 10 loss, 9p loss, 8q gain, and 1q loss. Chromosome 9p loss (P = 0.02) and 8q gain (P = 0.04) were significantly associated with worse OS. On WES analysis, recurrently mutated genes included NF1, EED, SUZ12, TP53, and CDKNA2A. Of these alterations, only CKND2A loss (on Chr9p) was associated with worse OS (P = 0.01). With regard to treatment response, MPNSTs exhibiting NF1 and H3K27 trimethylation loss demonstrated greater LFFR benefit from radiation therapy (P = 0.004) compared to NF1 and H3K27 trimethylation intact tumors (P = 0.83) with clinical NF1 diagnosis as the only significantly different baseline parameter between these two subgroups.MPNSTs are a common cause of death in adult patients with NF1. Radiotherapy improves LFFR in all patients, and integrated IHC and genomic analysis further identifies putative prognostic and predictive markers, including the identification of a patient subset in whom the benefit of radiotherapy is most pronounced. Taken together, these data support radiation therapy in management of MPNSTs and suggest molecular characterization may be important for counseling patients with MPNST or potentially informing clinical trial design. Prospective and multi-institutional analyses are needed to validate these findings.

A Randomized Control Trial Comparing Time to Healing of Radiation Induced Acute Skin Reactions Using Biological Membrane Dressing or Topical Methyl Pararosaniline Dye.

Management of radiation induced acute skin toxicity warrants titration between the overall treatment time necessary for optimal tumor control and treatment breaks necessary for repair of normal tissue toxicity. Hence interventions that reduce the treatment break time by promoting tissue repair becomes an absolute requisite. Biological (Amniotic) membrane, the innermost layer of placenta, has shown to induce re-epithelialization, regulate angiogenesis and reduce inflammation. The antibacterial, antifungal, and anthelminthic properties of methylpararosaniline dyes facilitates its use in acute skin reactions to prevent secondary infections and hence promote tissue healing. We have compared the time to acute skin reaction healing in head and neck and breast carcinomas when augmented with biological membrane dressing or topical methylpararosaniline dye MATERIALS/METHODS: 30 patients of head and neck and breast carcinomas undergoing radiation therapy with radiation induced acute grade III skin toxicity (RTOG GRADING), were randomized to receive biological membrane dressing or topical methylpararosaniline dye application. Patients were reviewed every alternate day till tissue healing and restart of radiation.In biological membrane dressing group,53% of cases had tissue repair in 4 days, 40% in 6 days and 7% in over 7 days whereas in topical dye group, 7% had tissue repair in 4 days,40% in 6 days and in 53% over 6 days.In our observation, addition of biological membrane dressing has reduced the treatment break time by promoting tissue healing, surpassing the healing augmented by topical dye application.

Ultra-Wideband Transparent Conductive Electrode for Electrochromic Synergistic Solar and Radiative Heat Management

Ultra-Wideband Transparent Conductive Electrode for Electrochromic Synergistic Solar and Radiative Heat Management

SC199 - There is no way to compensate a non-timely use of early salvage radiation therapy in men with recurrent prostate cancer after radical prostatectomy. a retrospective, multi-centre analyses on oncological and toxicity outcomes

SC199 - There is no way to compensate a non-timely use of early salvage radiation therapy in men with recurrent prostate cancer after radical prostatectomy. a retrospective, multi-centre analyses on oncological and toxicity outcomes

SC197 - What is the optimal duration of hormonal treatment during salvage radiotherapy in men with pN1 prostate cancer? Results form a large multi-institutional series

SC197 - What is the optimal duration of hormonal treatment during salvage radiotherapy in men with pN1 prostate cancer? Results form a large multi-institutional series

Impact of solar geoengineering on temperatures over the Indonesian Maritime Continent

AbstractClimate change has been projected to increase the intensity and magnitude of extreme temperature in Indonesia. Solar radiation management (SRM) has been proposed as a strategy to temporarily combat global warming, buying time for negative emissions. Although the global impacts of SRM have been extensively studied in recent years, regional impacts, especially in the tropics, have received much less attention. This article investigates the potential stratospheric sulphate aerosol injection (SAI) to modify mean and extreme temperature, as well as the relative humidity and wet bulb temperature (WBT) change over Indonesian Maritime Continent (IMC) based on simulations from three different earth system models. We applied a simple downscaling method and corrected the bias of model output to reproduce historical temperatures and relative humidity over IMC. We evaluated changes in geoengineering model intercomparison project (GeoMIP) experiment G4, an SAI experiment in 5 Tg of SO2 into the equatorial lower stratosphere between 2020 and 2069, concurrent with the RCP4.5 emissions scenario. G4 is able to significantly reduce the temperature means and extremes, and although differences in magnitude of response and spatial pattern occur, there is a generally consistent response. The spatial response of changes forced by RCP4.5 scenario and G4 are notably heterogeneous in the archipelago, highlighting uncertainties that would be critical in assessing socio‐economic consequences of both doing, and not doing G4. In general, SAI has bigger impacts in reducing temperatures over land than oceans, and the southern monsoon region shows more variability. G4 is also effective at reducing the likelihood of WBT > 27°C events compared with RCP4.5 after some years of SAI deployment as well as during the post‐termination period of SAI. Regional downscaling may be an effective tool in obtaining policy‐relevant information about local effects of different future scenarios involving SAI.

Warming world, changing ocean: mitigation and adaptation to support resilient marine systems.

Proactive and coordinated action to mitigate and adapt to climate change will be essential for achieving the healthy, resilient, safe, sustainably harvested and biodiverse ocean that the UN Decade of Ocean Science and sustainable development goals (SDGs) seek. Ocean-based mitigation actions could contribute 12% of the emissions reductions required by 2030 to keep warming to less than 1.5 ºC but, because substantial warming is already locked in, extensive adaptation action is also needed. Here, as part of the Future Seas project, we use a “foresighting/hindcasting” technique to describe two scenarios for 2030 in the context of climate change mitigation and adaptation for ocean systems. The “business-as-usual” future is expected if current trends continue, while an alternative future could be realised if society were to effectively use available data and knowledge to push as far as possible towards achieving the UN SDGs. We identify three drivers that differentiate between these alternative futures: (i) appetite for climate action, (ii) handling extreme events, and (iii) climate interventions. Actions that could navigate towards the optimistic, sustainable and technically achievable future include:(i)proactive creation and enhancement of economic incentives for mitigation and adaptation;(ii)supporting the proliferation of local initiatives to spur a global transformation;(iii)enhancing proactive coastal adaptation management;(iv)investing in research to support adaptation to emerging risks;(v)deploying marine-based renewable energy;(vi)deploying marine-based negative emissions technologies;(vii)developing and assessing solar radiation management approaches; and(viii)deploying appropriate solar radiation management approaches to help safeguard critical ecosystems.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11160-021-09678-4.

In search of weakened resolve: Does climate-engineering awareness decrease individuals’ commitment to mitigation?

As climate predictions become more dire, it is increasingly clear that society cannot rely on mitigation alone. In response, climatologists and engineers have been developing climate-engineering technology to directly intervene on the climate through strategies such as solar radiation management and carbon dioxide removal. While these technologies have some encouraging features, they also involve risk on many dimensions. One behavioral risk that concerns many observers is the possibility that the prominence of climate-engineering scenarios could decrease the public's commitment to mitigation, a concern variously described as moral hazard or weakened resolve. Across 8 experiments (N = 2514) we tested whether exposure to naturalistic information about climate-engineering technology decreases individuals' commitment to mitigation efforts. We did not find compelling evidence of strong or reliable effects. We draw from motivational theory to contextualize our findings in a literature characterized by mixed results, and we propose new directions for behavioral research on the weakened-resolve/moral-hazard concern with respect to climate engineering.

Adding Short-Term Androgen Deprivation Therapy to Radiation Therapy in Men With Localized Prostate Cancer: Long-Term Update of the NRG/RTOG 9408 Randomized Clinical Trial

For men with localized prostate cancer, NRG Oncology/Radiation Therapy Oncology Group (RTOG) 9408 demonstrated that adding short-term androgen deprivation therapy (ADT) to radiation therapy (RT) improved the primary endpoint of overall survival (OS) and improved disease-specific mortality (DSM), biochemical failure (BF), local progression, and freedom from distant metastases (DM). This study was performed to determine whether the short-term ADT continued to improve OS, DSM, BF, and freedom from DM with longer follow-up. From 1994 to 2001, NRG/RTOG 9408 randomized 2028 men from 212 North American institutions with T1b-T2b, N0 prostate adenocarcinoma and prostate-specific antigen (PSA) ≤20ng/mL to RT alone or RT plus short-term ADT. Patients were stratified by PSA, tumor grade, and surgical versus clinical nodal staging. ADT was flutamide with either goserelin or leuprolide for 4 months. Prostate RT (66.6 Gy) was started after 2 months. OS was calculated at the date of death from any cause or at last follow-up. Secondary endpoints were DSM, BF, local progression, and DM. Acute and late toxic effects were assessed using RTOG toxicity scales. Median follow-up in surviving patients was 14.8 years (range, 0.16-21.98). The 10-year and 18-year OS was 56% and 23%, respectively, with RT alone versus 63% and 23% with combined therapy (HR 0.94; 95% confidence interval [CI], 0.85-1.05; P=.94). The hazards were not proportional (P=.003). Estimated restricted mean survival time at 18 years was 11.8 years (95% CI, 11.4-12.1) with combined therapy versus 11.3 years with RT alone (95% CI, 10.9-11.6; P=.05). The 10-year and 18-year DSM was 7% and 14%, respectively, with RT alone versus 3% and 8% with combined therapy (HR 0.56; 95% CI, 0.41-0.75; P < .01). DM and BF favored combined therapy at 18 years. Rates of late grade ≥3 hepatic, gastrointestinal, and genitourinary toxicity were ≤1%, 3%, and 8%, respectively, with combined therapy versus ≤1%, 2%, and 5% with RT alone. Further follow-up demonstrates that OS converges at approximately 15 years, by which point the administration of 4 months of ADT had conferred an estimated additional 6 months of life.

A spectrally selective gap surface-plasmon-based nanoantenna emitter compatible with multiple thermal infrared applications

Wavelength-selective nanoantenna emitters have attracted considerable attention due to their widespread applications ranging from thermal radiation management to thermophotovoltaics. In this paper, we design a wavelength-selective nanoantenna emitter based on the excitation of gap-surface plasmon modes using a metal–insulator–metal configuration (silicon dioxide (SiO2) sandwiched between silver (Ag) layers) for satisfying multiple infrared applications. The proposed design, which is called design I, realizes triple narrowband perfect absorptions at the resonance wavelengths of , , and , which perfectly match the atmospheric absorption bands while maintaining relatively low emissivity in the atmospheric transparency windows of and . Later, the functionality of design I is extended, which is called design II, to include a broadband absorption at the near-infrared region to minimize the solar irradiation reflection from the nanoantenna emitter. Finally, single- and three-layer graphene are introduced to provide a real-time tuning of the infrared signature of the proposed nanoantenna emitter (design II). It is also demonstrated that the three-layer graphene structure can suppress an undesired absorption resonance wavelength related to the intrinsic vibrational modes (optical phonons) of the SiO2 layer by compared to for the single-layer one. The spectral analysis of design I is validated using both analytical and numerical approaches where the numerical simulation domain is extended for the analysis of design II. The thermal characteristic analyses of design I and design II (without/with graphene layers) reveal that infrared signatures of the blackbody radiation are significantly reduced for the whole wavelength spectrum at least by and within a wide temperature ranging from room temperature to , respectively.

Parametric study of solid-solid translucent phase change materials in building windows

Thermal energy storage and solar radiation management are crucial to improve the sustainability and energy efficiency of buildings. Compared with the implementation of phase change materials (PCMs) in opaque components, the energy saving potential of incorporating PCMs in transparent glazing windows is much less studied and not well understood. Here we present a comprehensive parametric study of novel PCM windows for building energy saving with a focus on optimizing and quantitatively distinguishing the contributions from the optical and thermal properties of the PCM, which is particularly useful for the design of solid-solid PCM windows. We investigate a reference commercial office building using EnergyPlus by developing an equivalent model of our PCM window that is compatible with EnergyPlus’s modeling capabilities. Compared with a clear-clear double-pane window, the integration of 3 mm solid-solid PCMs with optimal properties in warm, mixed, and cold climates can respectively save up to 17.2%, 14.0%, and 5.8% energy for the HVAC (heating, ventilation, and air conditioning) system, and 9.4%, 6.7%, and 3.2% energy for the whole building. We also demonstrate that these energy savings are most sensitive to the solar absorptance of PCMs for all three climates. The optimal transition temperature varies with climate and is related to the climate and solar radiation heat gain. Other issues are also briefly discussed, such as hysteresis, window orientations, and the effect of interior lighting. Although the optimal PCM windows show energy saving performance comparable with low-emissivity windows, the PCM windows provide a unique advantage in terms of shifting HVAC loads which can provide benefits to the electrical grid.

High-efficiency solar heat storage enabled by adaptive radiation management

Solar heat storage technology is urgently needed to harness intermittent solar energy to directly drive widespread heat-related applications. However, achieving high-efficiency solar heat storage remains elusive due to the loss of heat to the surroundings, especially through radiative processes. Here, we present a bioinspired light-adaptive shutter (LAS) with a multi-layer architecture that autonomously switches between open and closed states according to solar illumination fluctuations because of a photothermal-expansion mismatch effect. As a result, in a LAS-integrated solar heat storage system, the LAS governs the incident and dissipated radiation, suppresses the radiative heat dissipation by 20 times, and achieves high-efficiency solar heat storage with a near-zero net radiative heat dissipation. Furthermore, a LAS is demonstrated to enhance the temperature by >20°C in a 3-day field test. Given excellent responsiveness, scalable manufacturing, and feasibility under wide operating conditions, the LAS provides a promising radiation management strategy for high-efficiency solar heat storage. Light-adaptive shutter enable autonomous radiation management with solar fluctuations LASs suppress radiative heat dissipation by 20 times for efficient solar heat storage LASs are promising for applications, including smart windows, autonomous robots, etc. The efficiency of solar heat storage is limited by radiative heat dissipation. Liu et al. present a light-adaptive shutter (LAS) that autonomously governs incident solar radiation and dissipated heat radiation according to solar illumination fluctuations, which may provide a promising radiation management strategy.

PO-1208 Stereotactic MR-guided online adaptive radiation therapy for management of pancreatic malignancies

PO-1208 Stereotactic MR-guided online adaptive radiation therapy for management of pancreatic malignancies

Who May Geoengineer: Global Domination, Revolution, and Solar Radiation Management

This paper uses a novel account of non-ideal political action that can justify radical responses to severe climate injustice, including and especially deliberate attempts to engineer the climate system in order reflect sunlight into space and cooling the planet. In particular, it discusses the question of what those suffering from climate injustice may do in order to secure their fundamental rights and interests in the face of severe climate change impacts. Using the example of risky geoengineering strategies such as sulfate aerosol injections, I argue that peoples that are innocently subject to severely negative climate change impacts may have a special permission to engage in large-scale yet risky climate interventions to prevent them. Furthermore, this can be true even if those interventions wrongly harm innocent people.

Improving efficiency in the radiation management of multiple brain metastases using a knowledge-based planning solution for single-isocentre volumetric modulated arc therapy (VMAT) technique.

IntroductionThis study aimed to develop a single‐isocentre volumetric modulated arc therapy (si‐VMAT) technique for multiple brain metastases using knowledge‐based planning software, comparing it with a multiple‐isocentre stereotactic radiosurgery (mi‐SRS) planning approach.MethodsTwenty‐six si‐VMAT plans were created and uploaded into RapidPlanTM (RP) to create a si‐VMAT model. Ten patients, with 2 to 6 metastases (mets), were planned with a si‐VMAT technique utilising RP, and a mi‐SRS technique on Brainlab iPlan.Paddick Conformity Index (PCI) was used to compare conformity. The volumes of the brain receiving 15Gy, 12Gy, 10Gy, 7.5Gy and 3Gy were also compared.Retrospective treatment times from the last eight patients treated were averaged for pre‐imaging and beam on time to calculate treatment times for both techniques.ResultsThere was a significant difference in the PCI scores for the mi‐SRS plans (M = 0.667, SD = 0.114) and si‐VMAT plans (M = 0.728, SD = 0.088), with PCI values suggesting better prescription dose conformity with the si‐VMAT technique (P = 0.014). Percentage of total brain volume receiving low‐dose wash at four of the five different dose levels was significantly less (P < 0.05) with mi‐SRS.Average time to treat a single met with current mi‐SRS technique is 25.7 min, with each additional met requiring this same amount of time. The average time to treat 2–3 mets using si‐VMAT would be 25.3 min and 4+ metastases 33.5 min.ConclusionA knowledge‐based si‐VMAT approach was efficient in planning and treating multi metastases while achieving clinically acceptable dosimetry with respect to dose conformity and low‐dose fall off.

A Scheme for Jointly Trading off Costs and Risks of Solar Radiation Management and Mitigation Under Long-Tailed Climate Sensitivity Probability Density Distributions

Side effects of “solar-radiation management” (SRM) might be perceived as an important metric when society decides on implementing SRM as a climate policy option to alleviate anthropogenic global warming. We generalize cost-risk analysis that originally trades off expected welfare loss from climate policy costs and risks from transgressing climate targets to also include risks from applying SRM. In a first step of acknowledging SRM risks, we represent global precipitation mismatch as a prominent side effect of SRM under long-tailed probabilistic knowledge about climate sensitivity. We maximize a social welfare function for the following three scenarios, considering alternative relative weights of risks: temperature-risk-only, precipitation-risk-only, and equally-weighted both-risks. Our analysis shows that in the temperature-risk-only scenario, perfect compliance with the 2 °C-temperature target is attained for all numerically represented climate sensitivities, a unique feature of SRM, but the 2 °C-compatible precipitation corridor is violated. The precipitation-risk-only scenario exhibits an approximate mirror-image of this result. In addition, under the both-risks scenario, almost 90% and perfect compliance can be achieved for the temperature and precipitation targets, respectively. Moreover, in a mitigation-only analysis, the welfare loss from mitigation cost plus residual climate risks, compared to the no-climate-policy option, is approximately 4.3% (in terms of balanced growth equivalent), while being reduced more than 90% under a joint-mitigation-SRM analysis.