The strengths and failures of incentive mechanisms in notional defined contribution pension systems

Public pension systems based on the Notional Defined Contribution (NDC) principle were introduced during the ‘90s in Italy, Sweden and Poland, among other countries. They mimic private savings, in that individuals get back, as pensioners, what they contributed to social security during working life, plus returns. As such, NDC systems should realize actuarial equity and incentive neutrality. However, when one considers the presence of NDC pensions together with minimum and social assistance pensions, this is no longer true. Indeed, in all the three countries considered, the NDC system shows a regressive feature, which disincentivizes contributions, particularly from low earners, who would be better off entering, or staying in, the shadow economy. In order to reduce the extent of this phenomenon, we examine the effects of introducing, or increasing, the possibility of accumulation of social assistance and NDC pensions, which would also improve pension adequacy. A complete accumulation of the two would solve the incentive problem, but would be costly and would require a structural reform of the pension system financing mechanism, altering the current balance between social contributions and general fiscal revenues. We show the effects of a change in the cumulation rules for social assistance and NDC pensions in Italy using CAPP_DYN, a population-based dynamic microsimulation model, which allows assessment of the evolution of the pension system in the coming decades and the distributional implications of such reform.

How we treat bleeding associated with direct oral anticoagulants

Direct oral anticoagulants are at least as effective as vitamin K antagonists for the prevention and treatment of thromboembolism. Unfortunately, differently from vitamin K antagonists, they have the great drawback of lacking specific antidotes in the case of bleeding or emergency situations such as trauma, stroke requiring thrombolysis, and urgent surgery. The progressive development of antidotes for these new drugs, which, it is hoped, will become available in the near future, will allow better and safer management of the rapid reversal of their anticoagulant effect

The management of a blood donor bitten by a snake

The worldwide burden of snakebite is high and venomous snakes are found in many regions of the world and are a threat to public health. In Italy, for instance, viper bites are an infrequent but not negligible event. Although people who have been bitten by a snake rarely wish to donate blood within a "short" time, it is however important to evaluate their eligibility to donate blood or blood components as their donation could be a problem for donor management, especially if a specific policy is not in place. The aim of this manuscript is to summarise the worldwide existing donor deferral policy for snakebites and to provide some indications in order to facilitate decision-making and to guarantee maximum safety for the donors as well as for the recipients

Fibrinogen concentrate in surgery

Fibrinogen is a plasma glycoprotein synthesised by the liver which plays a critical role in haemostasis by acting as an endogenous substrate for fibrin formation and by inducing clot formation and platelet aggregation

Leucoreduction of blood components. an effective way to increase blood safety?

Over the past 30 years, it has been demonstrated that removal of white blood cells from blood components is effective in preventing some adverse reactions such as febrile non-haemolytic transfusion reactions, immunisation against human leucocyte antigens and human platelet antigens, and transmission of cytomegalovirus. In this review we discuss indications for leucoreduction and classify them into three categories: evidence-based indications for which the clinical efficacy is proven, indications based on the analysis of observational clinical studies with very consistent results and indications for which the clinical efficacy is partial or unproven

The use of fibrinogen concentrate for the management of trauma-related bleeding. A systematic review and meta-analysis

Haemorrhage following injury is associated with significant morbidity and mortality. The role of fibrinogen concentrate in trauma-induced coagulopathy has been the object of intense research in the last 10 years and has been systematically analysed in this review. A systematic search of the literature identified six retrospective studies and one prospective one, involving 1,650 trauma patients. There were no randomised trials. Meta-analysis showed that fibrinogen concentrate has no effect on overall mortality (risk ratio: 1.07, 95% confidence interval: 0.83-1.38). Although the metaanalytic pooling of the current literature evidence suggests no beneficial effect of fibrinogen concentrate in the setting of severe trauma, the quality of data retrieved was poor and the final results of ongoing randomised trials will help to further elucidate the role of fibrinogen concentrate in traumatic bleeding

Strain rate, temperature and deformation state effect on Ecoflex 00-50 silicone mechanical behaviour

Silicone elastomers are extremely attractive materials due to their wide range of possible applications, from biomedical engineering to soft robotics. In this work, an extensive thermo-mechanical characterization of Ecoflex Shore hardness 00–50, a commercially available silicone elastomer, has been carried out to compensate for the lack of relevant literature. The mechanical behaviour of the material has been characterized by performing monotonic and cyclic loading tests. These tests were performed in different deformation states, i.e. uniaxial tension, pure shear and biaxial tension, at different strain rates and temperatures. Experimental findings allowed to highlight the material time-dependent response and quantify the contribution of dissipative deformation phenomena to the overall strain energy. Uniaxial tensile tests performed at different temperatures (between −40 °C and 140 °C) showed that the material mechanical behaviour is sensitive to temperature in this range: a decrease of the ultimate stress and strain has been observed with increasing temperature. Finally, the data obtained from the latter tests have been used to define a failure envelope, applied for the first time to Ecoflex silicones, and valuable to describe the material ultimate stress and strain at any temperature and strain rate

Tharros - Capo San Marco in the Phoenician and Punic Age. Geophysical investigations and virtual rebuilding

The project described in this paper was started in 2012 and concerns the study of the relationship between the urban and suburban districts of the Phoenician and Punic city of Tharros (Cabras, Oristano). The structures of Phoenician and Punic Tharros have been largely cancelled by the Roman occupation. For this reason it is very difficult to determine the original function of many of the neighbourhoods during the Carthaginian period. The archaeological excavation primarily involved the southern necropolis of Capo San Marco. The cemetery must still be fully explored and understood under several aspects, mainly because of the devastation of the site caused by the repeated plundering of the ancient tombs which occurred during the 19th century. In addition to the new dig activities, a 3D topographical survey aimed at the complete documentation of the site and at the virtual rebuilding of the Phoenician and Punic funerary landscape was completed. Another goal of the project is the insertion of this sector of the promontory into the usual tourist route, in order to foster the public fruition of Capo San Marco, while continuing to adopt proper scientific methods and modern techniques. In this direction, geophysical prospecting surveys were carried out in the southern sector of the Capo San Marco, near the so-called ‘Rustic Temple’, in order to assess human presence in the farthest point of the Sinis peninsula (characterised by the presence of the Late Punic ruins of a probable light-house with sacred functions), and across the whole isthmus Sa Codriola towards the hill of San Giovanni, with the aim of analysing the northern boundary of the cemetery and its relationship to the city. The Punic-Roman settlement is now enclosed in the archaeological park, which is a fraction of what was supposed to be the administrative capital of Carthage in Sardinia. 3D modelling and virtual reconstructions were focused also on the residential Punic and Roman area inside the park. The integrated application of the most advanced topographical and geophysical techniques to the site greatly contributed to the recording and understanding of the ancient landscape

Human parvovirus B19 and blood product safety. A tale of twenty years of improvements

Parvovirus B19 (B19V), long known to be the causative agent of erythema infectiosum (fifth disease), is not a newly emerging agent. The aim of this review is to analyse the role played by this virus in compromising safety in transfusion medicine and the progressive measures to reduce the risks associated with the virus