University of Sheffield

• Heat accumulation with build height is geometry-dependent. • Samples wider than ∼4 mm can be treated as “bulk” components. • Conduction losses between the melt pool and the surrounding materials are strongly non-linear with wall thicknesses. • Convection and radiation contribute up to 35% of heat losses in the melt pool during the fabrication of thin walls by DED. • Minimum heat losses in the melt pool occur at 2.1 mm wall thickness, increasing by 39% in narrower walls. Heat flow conditions vary significantly in Directed Energy Deposition (DED), such as during the repair of structures with varying cross sections. While classical thermal analyses emphasize conduction, heat losses through convection and radiation can be consequential in thin-wall geometries. This can lead to certain geometries experiencing heat accumulation with build height, while in other geometries, the temperature decreases as the build height increases. To quantify how heat flow mechanisms vary with wall thickness, in this study, in-situ coaxial monitoring was combined with a finite element (FE) model that accounts for conduction, convection, and radiation. Measured melt pool thermal intensities during the deposition of 9 Inconel 718 walls with thicknesses ranging from thin- to thick-wall regimes are compared with FE-based predictions. The results show that conduction is the dominant heat transfer mechanism between the melt pool and the surrounding materials in all cases during deposition; however, convective and radiative losses of the melt pool are non-negligible in thin-wall regimes, being responsible for up to 35 % of the total heat losses. Meanwhile, the relative importance of convection/radiation of the melt pool was found to increase as sections narrow. In addition, the minimum heat loss of the melt pool (and the maximum thermal intensity) was observed at an intermediate wall thickness (2.1 mm), while the total heat losses of the melt pool increased by 39 % in a 1.1 mm wall thickness and by 17 % in a 9.1 mm wall thickness. These strongly non-linear thermal relationships lead to the conclusion that samples wider than 4 mm can be treated as “bulk”, for which conduction-dominated assumptions are adequate in thermal analysis; sections with a thickness less than 4 mm require convection and radiation to be considered. These findings could provide guidance in the selection of deposition parameters and modeling assumptions to ensure consistent DED repairs across highly variable cross-sections.

There is evidence that over one quarter of patients return to National Health Service (NHS) talking therapies (TT) services, and the needs of these patients are poorly understood and catered for. This project investigated the acceptability and effectiveness of delivering cognitive analytic therapy (CAT) for patients with depression returning to a TT service with childhood trauma and associated relational difficulties. A case-controlled pilot study using TT sessional outcome measures. A 16-session CAT was offered to N = 76 patients who had previously received a high-intensity intervention (mainly cognitive-behavioural therapy; CBT) in the same TT service. Dropout rates, recovery rates and when recovery occurred during the CAT treatment episode were calculated. CAT outcomes were compared against the previous treatment episodes (n = 47) and also benchmarked against the evidence base. Patients were followed up after receiving CAT (n = 16) to assess the durability of change. The number then returning to the TT service after receiving CAT was also tracked. The dropout rate for CAT was 16.9% and the reliable recovery rate was 40%. Reliable and/or clinically significant reductions in depression tended to occur during early CAT sessions. At a group level, there were significant reductions in depression during CAT. There was no evidence of relapse at follow-up. The return rate to the service following CAT was 28.94%. CAT appears useful to consider in the offer for patients returning to TT services. Clinical trials now need to focus on the treatment return patient group in TT services across the stepped care model.

Population growth debates often posit that depopulation would reduce ecological strains. We explore that premise through the case of Japan, where population decline coincides with rising affluence, dietary change, and growing dependence on food imports. Using environmentally-extended multi-regional input-output analysis, we examine changes in Japan’s food-system footprints between 2008-2022 and apply decomposition analysis to identify key drivers. Our findings show that despite a shrinking population, absolute footprints remained stable, while per-capita shares increased by 21-30%, driven primarily by consumption of ultra-processed and animal-based foods, underpinned by affluence and dietary change. Most critically, Japan’s ultra-globalized food system offshores around 90% of its virtual land and water demand, while 54% of embodied GHG emissions are sourced domestically. Hence, Japan’s experience foreshadows a broader structural shift, whereby affluent societies generate disproportionately large per-capita environmental footprints. We emphasize the primacy of consumption and trade in shaping sustainability outcomes in the Anthropocene. • Depopulation in Japan has not reduced food consumption footprints • Rising affluence and caloric intake offset anticipated gains from depopulation • Ultra-processed and animal food products drive most land, water, and GHG footprints • Japan’s consumption footprints are increasingly displaced via international trade • Human depopulation alone is insufficient for sustainable food system transitions

Rising living costs and changes to alcohol taxation influence drinking behaviours. This study aimed to examine associations between financial hardship and alcohol reduction attempts in the context of a cost-of-living crisis and alcohol tax reforms in Great Britain. We analysed data from 6063 adults (≥18 years) drinking at risky levels (AUDIT-C ≥5) participating in a nationally representative survey during January-March 2023, 2024, and 2025. Data were analysed cross-sectionally and pooled across years for the primary analysis. Participants were asked whether they had attempted to reduce their alcohol consumption in the past year and, if so, whether the most recent attempt was motivated by cost. They also reported their level of alcohol consumption, perceived financial situation, housing tenure, past-year rent/mortgage arrears, and past-month psychological distress. Overall, 38.3% [36.9-39.7%] reported attempting to reduce their alcohol consumption, and 7.3% [6.5-8.1%] reported cost as a motive for these attempts. Cost-motivated attempts were strongly patterned by socioeconomic circumstances, being most common among those experiencing financial hardship, younger adults, women, those drinking more heavily, and individuals with elevated psychological distress. Odds of cost-motivated reduction attempts increased progressively with greater financial hardship (e.g., adjusted OR up to 5.42 [95%CI 3.13-9.40] among those finding their financial situation very difficult vs. those living comfortably). By contrast, there was no clear association between hardship and alcohol reduction attempts in general. Associations between hardship and cost-motivated reduction attempts were consistent across levels of alcohol consumption, psychological distress, and survey year. Amid the cost-of-living crisis and recent alcohol duty reforms, cost has emerged as a key motive for alcohol reduction attempts among adults drinking at risky levels, particularly those facing financial and psychological vulnerability. Support for these groups is critical to ensure cost-driven attempts translate into meaningful reductions in alcohol-related harm.

To determine whether alcohol consumption in England had returned to pre-pandemic levels by December 2024, after the initial rise in 2020 across the total population and subgroups. Monthly representative surveys were conducted through face-to-face interviews until February 2020, and then by telephone. England, March 2014 to December 2024. 208 010 adults aged 18+ living in private households. Mean weekly alcohol consumption (in UK units), prevalence of risky drinking (Alcohol Use Disorders Identification Test for Consumption [AUDIT-C] score≥5), and possible dependence (AUDIT-C ≥ 11). Further measures included age, gender, and social grade. All outcomes increased in April 2020: prevalence of risky drinking by 30.3% (95% confidence interval [CI]: 26.8, 33.8, from 26.2% in February 2020 to 34.0% in April 2020), prevalence of possible dependence by 90.2% (95% CI: 62.2, 122.9, from 0.9% to 1.7%) and mean weekly alcohol consumption by 34.5% (95% CI: 31.0, 38.0, from 5.0units to 6.6units). When adjusting for the survey mode change from face-to-face to telephone interviews, the step changes between February and April 2020 remained but were substantially attenuated. The post-pandemic trend declined more quickly than the pre-pandemic trend for the prevalence of risky drinking (difference: -1.5%/year, 95% CI: -2.4, -0.6) and mean weekly alcohol consumption (difference: -2.4%/year, 95% CI: -3.3, -1.6), indicating a slow but incomplete return to pre-pandemic levels. The trend in prevalence of possible dependence was similarly stable before and after the pandemic (difference: -1.3%/year, 95% CI: -6.2, 3.8). Alcohol consumption declined more slowly among people from less advantaged than from more advantaged social grades. The prevalence of risky drinking and mean weekly alcohol consumption in England appear to be trending towards pre-pandemic levels but the prevalence of dependent drinking in England appears to have increased since the start of the pandemic and remains elevated compared with pre-pandemic levels. Alcohol-related inequalities may be worsening due to slower declines in consumption following the pandemic among less advantaged drinkers.

Blood transfusion is one of the most common interventions in hospitals. Blood tests that support this widespread practice are considered routine, such as 'group and save' (also known as 'type and screen'), yet there has been very limited evaluation of the needs for these tests and the associated costs. The aim of this systematic review is to synthesise international evidence on the costs of group and save and crossmatch tests and their component processes. Seventy-two studies published between 2012 and 2023 were identified and data were extracted. Most cost estimates were derived from local institutional sources with few using national reference data, and reporting methods varied widely. Median unit costs for group and save tests were £19.8 (interquartile range [IQR] £11.8-£52.5) overall, £13.8 in the United Kingdom and £57.4 in the United States. Crossmatch costs were £9.6 (IQR £5.9-£37.3). Understanding costs for group and save testing will inform hospital teams making decisions about sample requirements for procedures with a low likelihood of transfusion. It also provides benchmarking to assess the impact of implementing electronic systems to improve safety and efficiency of transfusion practice.