Behavior of Forging Steels under Cyclic Loading — the Benefit of Air‐Hardening Martensites

The development of air‐hardening martensitic forging (LHD: luft härtend duktil) steels offers high material performance with a short and simple process route. In this study, five alloys (L1–L5), based on the existing LHD alloy concept but with different contents of aluminum, titanium, boron, and molybdenum, are cast at laboratory scale. The casted blocks are hot forged into semifinished products and cooled in air (uncontrolled). The tensile properties, the Charpy V‐notch impact energy, the cyclic material behavior, and the fatigue strength of the alloys L1–L5 are opposed to each other. Furthermore, the material properties are compared with the standard quench and tempered (Q+T) steel 42CrMo4 (reference material) and ranked against previously developed forging steels. The tensile properties and Charpy V‐notch impact energy are comparable with those of the reference material, whereas the new alloy concepts show a significantly higher cyclic yield strength and fatigue strength

Prescribing cascades in ambulatory care: A structured synthesis of evidence

The strength of evidence for specific ambulatory care prescribing cascades, in which a marker drug is used to treat an adverse event caused by an index drug, has not been well characterized. To perform a structured, systematic, and transparent review of the evidence supporting ambulatory care prescribing cascades. Ninety-four potential prescribing cascades identified through a previously published systematic review. Systematic search of the literature to further characterize prescribing cascades. (1) Grading of evidence based on observational studies investigating associations between index and marker drugs, including: Level I—strong evidence [i.e. multiple high-quality studies]; Level II—moderate evidence [i.e. single high-quality study]; Level III—fair evidence [no high-quality studies but one or more moderate-quality studies]; and Level IV—poor evidence [other]. (2) Listing of the adverse event associated with the index drug in the product's United States Food and Drug Administration (FDA) label. (3) Synthesis of the evidence supporting mechanisms linking index drugs and associated adverse events. Of 99 potential cascades, 94 were supported by one or more confirmatory observational studies and were therefore included in this review. The 94 cascades related to 30 types of adverse drug reactions affecting 10 different anatomic/physiologic systems and were investigated by a total of 88 confirmatory studies, including prescription sequential symmetry analysis (n = 51), cohort (n = 30), and case–control (n = 7) studies. Overall, the evidence from observational studies was strong for 18 (19.1%) prescribing cascades, moderate for 61 (64.9%), fair for 13 (13.8%), and poor for 2 (2.1%). Although the evidence supporting mechanisms that link index drugs and associated adverse events was variable, FDA labels included information about the adverse event associated with the index drug for most (n = 86) but not all of the 94 prescribing cascades. Although we identified 18 of 94 prescribing cascades supported by strong clinical evidence and most adverse events associated with index drugs are included in FDA label, the evidentiary basis for prescribing cascades varies, with many requiring further evidence of clinical relevance

Prescribing cascades: how to detect them, prevent them, and use them appropriately

Dreischulte T, Shahid F, Muth C, Schmiedl S, Haefeli WE. Prescribing cascades: how to detect them, prevent them, and use them appropriately. Deutsches Ärzteblatt international. 2022;119:745-52