Backyard aerosol pollution monitors: foliar surfaces, dust enrichment, and factors influencing foliar retention.

Air pollution is one of the leading causes of death from noncommunicable diseases globally, and in Arizona, both mining activities and abandoned agriculture can generate erodible dust. This dust is transported via wind and can carry high amounts of toxic pollutants. Industry-adjacent communities, or "fenceline communities," are generally closer to the pollution sources and are disproportionally impacted by pollution, or in this case, dust. The dust transported from the mine settles into nearby rivers, gardens, and homes, and increases the concentrations of elements beyond their naturally occurring amounts (i.e., enriched). This study was built upon previous community science work in which plant leaves were observed to collect similar concentrations to an accepted dust collection method and illustrated promise for their use as low-cost air quality monitors in these communities. This work investigated the concentration of Na, Mg, Al, K, Ca, Mn, Co, Cu, Zn, Mo, and Ba in dust from the leaves of community-collected backyard and garden plants (foliar dust), as well as if certain variables affected collection efficacy. This assessment evaluated (1) foliar concentration versus surface area for 11 elements, (2) enrichment factor (EF) values and ratios, (3) comparisons of foliar, garden, and yard samples to US Geological Survey data, and (4) what variable significantly affected dust collection efficacy. The EF results indicate that many of the samples were enriched (anthropogenically contaminated) and that the foliar samples were generally more contaminated than the yard and garden soil samples. Leaf surface area was the most influential factor for leaf collection efficiency (p < 0.05) compared to plant family or sampling location. Further studies are needed that standardize the plant species and age and include multiple replicates of the same plant species across partnering communities. This study has demonstrated that foliar dust is enriched in the participating partnering communities and that plant leaf samples can serve as backyard aerosol pollution monitors. Therefore, foliar dust is a viable indicator of outdoor settled dust and aerosol contamination and this is an adoptable monitoring technique for "fenceline communities."

Minimization of measuring points for the electric field exposure map generation in indoor environments by means of Kriging interpolation and selective sampling.

In a world with increasing systems accessing to radio spectrum, the concern for exposure to electromagnetic fields is growing and therefore it is necessary to check limits in those areas where electromagnetic sources are working. Therefore, radio and exposure maps are continuously being generated, mainly in outdoor areas, by using many interpolation techniques. In this work, Surfer software and Kriging interpolation have been used for the first time to generate an indoor exposure map. A regular measuring mesh has been generated. Elimination of Less Significant Points (ELSP) and Geometrical Elimination of Neighbors (GEN) strategies to reduce the measuring points have been presented and evaluated. Both strategies have been compared to the map generated with all the measurements by calculating the root mean square and mean absolute errors. Results indicate that ELSP method can reduce up to 70% of the mesh measuring points while producing similar exposure maps to the one generated with all the measuring points. GEN, however, produces distorted maps and much higher error indicators even for 50% of eliminated measuring points. As a conclusion, a procedure for reducing the measuring points to generate radio and exposure maps is proposed based on the ELSP method and the Kriging interpolation.

Ecology of the collapse of Rapa Nui society.

Collapses of food producer societies are recurrent events in prehistory and have triggered a growing concern for identifying the underlying causes of convergences/divergences across cultures around the world. One of the most studied and used as a paradigmatic case is the population collapse of the Rapa Nui society. Here, we test different hypotheses about it by developing explicit population dynamic models that integrate feedbacks between climatic, demographic and ecological factors that underpinned the socio-cultural trajectory of these people. We evaluate our model outputs against a reconstruction of past population size based on archaeological radiocarbon dates from the island. The resulting estimated demographic declines of the Rapa Nui people are linked to the long-term effects of climate change on the island's carrying capacity and, in turn, on the 'per-capita food supply'.

Phytoremediation Reduces Dust Emissions from Metal(loid)-Contaminated Mine Tailings.

Environmental and health risk concerns relating to airborne particles from mining operations have focused primarily on smelting activities. However, there are only three active copper smelters and less than a dozen smelters for other metals compared to an estimated 500000 abandoned and unreclaimed hard rock mine tailings in the US that have the potential to generate dust. The problem can also extend to modern tailings impoundments, which may take decades to build and remain barren for the duration before subsequent reclamation. We examined the impact of vegetation cover and irrigation on dust emissions and metal(loid) transport from mine tailings during a phytoremediation field trial at the Iron King Mine and Humboldt Smelter Superfund (IKMHSS) site. Measurements of horizontal dust flux following phytoremediation reveals that vegetated plots with 16% and 32% canopy cover enabled an average dust deposition of 371.7 and 606.1 g m-2 y-1, respectively, in comparison to the control treatment which emitted dust at an average rate of 2323 g m-2 y-1. Horizontal dust flux and dust emissions from the vegetated field plots are comparable to emission rates in undisturbed grasslands. Further, phytoremediation was effective at reducing the concentration of fine particulates, including PM1, PM2.5, and PM4, which represent the airborne particulates with the greatest health risks and the greatest potential for long-distance transport. This study demonstrates that phytoremediation can substantially decrease dust emissions as well as the transport of windblown contaminants from mine tailings.

Episodic replacement of clotting factor concentrates does not prevent bleeding or musculoskeletal damage - the MUSFIH study.

PATIENTS AND METHODS: A longitudinal study was carried out in 255 children from 10 centres in nine developing countries over 5 years to assess the musculoskeletal outcome of children on episodic factor replacement. Outcome was documented by assessment of the annual joint bleeding rate (AJBR), WFH clinical and Pettersson radiological joint scores as well as the FISH score for activities. Of the 203 patients for whom data was available at the end of 5 years, 164 who had received only episodic treatment are included in this report. RESULTS: The median age at the beginning of the study was 10 years (IQR 7-12). The median clotting factor concentrate (CFC) usage was 662 IU kg-1 year-1 (IQ range: 280-1437). The median AJBR was 10 (IQ range: 5-17). The median AJBR was higher in the older children with the median being 5 for the 5 year old child, while it was 9 for the 10 year old and 11 for children older than 15. Given the episodic nature of the replacement therapy, those with a higher AJBR used significantly greater annual CFC doses (P < 0.001); The median change in WFH clinical score and Pettersson radiological score over the 5 years was 0.4/year for each, while the FISH deteriorated at a rate of 0.2/year with poor correlation of these changes with CFC dose. WFH and FISH scores were significantly worse in those with an AJBR of >3 per year (P = 0.001). The change in the Pettersson score was significantly more in those with an AJBR of >5 per year (P = 0.020). Significant changes in FISH scores were only noted after 10 years of age. CONCLUSION: Episodic CFC replacement over a large range of doses does not alter the natural course of bleeding in haemophilia or the musculoskeletal deterioration and should not be recommended as a long term option for treatment. Prophylaxis is the only way to preserve musculoskeletal function in haemophilia.

Abortion in goats by Caprine alphaherpesvirus 1 in Spain.

An abortion outbreak occurred in a goat herd of Murciano-Granadina breed in Almeria Region in Spain where 80 pregnant females aborted. All bacteriological and parasitological examinations resulted negative, whereas virological investigations and real-time PCR assay showed the presence of Caprine alphaherpesvirus 1 DNA in the pathological specimens from aborted foetuses. Nucleotide sequence analysis revealed that the DNA was highly close related to the Swiss strain E-CH (99.7%) and a little less extent to the Italian BA.1 strain (99.4%). Histopathological examination revealed multifocal, well-circumscribed, 50- to 200-µm-diameter foci of coagulative necrosis in the liver, lungs and kidneys of three foetuses. In the periphery of the necrosis, there were frequently epithelial cells with the chromatin emarginated by large, round, amphophilic intranuclear viral inclusion bodies. The source of the infection in the herd could not clearly find out even some hypothesis were formulated. This seems to be the first report of an abortion outbreak due to Caprine alphaherpesvirus 1 in a goat herd in Spain.

Evaluating the effects of pollinator-mediated interactions using pollen transfer networks: evidence of widespread facilitation in south Andean plant communities.

Information about the relative importance of competitive or facilitative pollinator-mediated interactions in a multi-species context is limited. We studied interspecific pollen transfer (IPT) networks to evaluate quantity and quality effects of pollinator sharing among plant species on three high-Andean communities at 1600, 1800 and 2000 m a.s.l. To estimate the sign of the effects (positive, neutral or negative), the relation between conspecific and heterospecific pollen deposited on stigmas was analysed with GLMMs. Network analyses showed that communities were characterised by the presence of pollen hub-donors and receptors. We inferred that facilitative and neutral pollinator-mediated interactions among plants prevailed over competition. Thus, the benefits from pollinator sharing seem to outweigh the costs (i.e. heterospecific deposition and conspecific pollen loss). The largest proportion of facilitated species was found at the highest elevation community, suggesting that under unfavourable conditions for the pollination service and at lower plant densities facilitation can be more common.

Women with congenital factor VII deficiency: clinical phenotype and treatment options from two international studies.

INTRODUCTION: A paucity of data exists on the incidence, diagnosis and treatment of bleeding in women with inherited factor VII (FVII) deficiency. AIM: Here we report results of a comprehensive analysis from two international registries of patients with inherited FVII deficiency, depicting the clinical picture of this disorder in women and describing any gender-related differences. METHODS: A comprehensive analysis of two fully compatible, international registries of patients with inherited FVII deficiency (International Registry of Factor VII deficiency, IRF7; Seven Treatment Evaluation Registry, STER) was performed. RESULTS: In our cohort (N = 449; 215 male, 234 female), the higher prevalence of mucocutaneous bleeds in females strongly predicted ensuing gynaecological bleeding (hazard ratio = 12.8, 95% CI 1.68-97.6, P = 0.014). Menorrhagia was the most prevalent type of bleeding (46.4% of patients), and was the presentation symptom in 12% of cases. Replacement therapies administered were also analysed. For surgical procedures (n = 50), a receiver operator characteristic analysis showed that the minimal first dose of rFVIIa to avoid postsurgical bleeding during the first 24 hours was 22 µg kg(-1) , and no less than two administrations. Prophylaxis was reported in 25 women with excellent or effective outcomes when performed with a total weekly rFVIIa dose of 90 µg kg(-1) (divided as three doses). CONCLUSION: Women with FVII deficiency have a bleeding disorder mainly characterized by mucocutaneous bleeds, which predicts an increased risk of ensuing gynaecological bleeding. Systematic replacement therapy or long-term prophylaxis with rFVIIa may reduce the impact of menorrhagia on the reproductive system, iron loss and may avoid unnecessary hysterectomies.

Hygroscopic Properties and Respiratory System Deposition Behavior of Particulate Matter Emitted By Mining and Smelting Operations.

This study examines size-resolved physicochemical data for particles sampled near mining and smelting operations and a background urban site in Arizona with a focus on how hygroscopic growth impacts particle deposition behavior. Particles with aerodynamic diameters between 0.056-18 µm were collected at three sites: (i) an active smelter operation in Hayden, AZ, (ii) a legacy mining site with extensive mine tailings in Iron King, AZ, and (iii) an urban site, inner-city Tucson, AZ. Mass size distributions of As and Pb exhibit bimodal profiles with a dominant peak between 0.32 and 0.56 µm and a smaller mode in the coarse range (>3 µm). The hygroscopicity profile did not exhibit the same peaks owing to dependence on other chemical constituents. Submicrometer particles were generally more hygroscopic than supermicrometer ones at all three sites with finite water-uptake ability at all sites and particle sizes examined. Model calculations at a relative humidity of 99.5% reveal significant respiratory system particle deposition enhancements at sizes with the largest concentrations of toxic contaminants. Between dry diameters of 0.32 and 0.56 µm, for instance, ICRP and MPPD models predict deposition fraction enhancements of 171%-261% and 33%-63%, respectively, at the three sites.

Three-dimensional computational fluid dynamics modeling of particle uptake by an occupational air sampler using manually-scaled and adaptive grids.

This work presents fluid flow and particle trajectory simulation studies to determine the aspiration efficiency of a horizontally oriented occupational air sampler using computational fluid dynamics (CFD). Grid adaption and manual scaling of the grids were applied to two sampler prototypes based on a 37-mm cassette. The standard k-ε model was used to simulate the turbulent air flow and a second order streamline-upwind discretization scheme was used to stabilize convective terms of the Navier-Stokes equations. Successively scaled grids for each configuration were created manually and by means of grid adaption using the velocity gradient in the main flow direction. Solutions were verified to assess iterative convergence, grid independence and monotonic convergence. Particle aspiration efficiencies determined for both prototype samplers were undistinguishable, indicating that the porous filter does not play a noticeable role in particle aspiration. Results conclude that grid adaption is a powerful tool that allows to refine specific regions that require lots of detail and therefore better resolve flow detail. It was verified that adaptive grids provided a higher number of locations with monotonic convergence than the manual grids and required the least computational effort.

Flow Field Penetration in Thin Nanoporous Polymer Films under Laminar Flow by Förster Resonance Energy Transfer Coupled with Total Internal Reflectance Fluorescence Microscopy.

Polymer-fluid interfaces are used widely in a variety of applications, including separations, which require exposure of the polymer to dynamic flow conditions. Despite the ubiquity of such interfaces, the importance of convective mass transport within the near-interface region of a polymer is a fundamental process that is still poorly defined. As a step toward better defining mass transport behavior within the near-interface portion of a polymer, in this work, a new application of a spectroscopic method based on the combination of Förster resonance energy transfer (FRET) and total internal reflectance fluorescence microscopy (TIRFM) is reported that allows quantification of the penetration depth of a laminar flow field (i.e., the slip length) in a densely grafted, thin poly(N-isopropylacrylamide) (pNIPAM) film as a model polymer system. Specifically, decay curves from FRET of an acceptor with a donor attached at the substrate surface are fit to a combined Taylor-Aris-Fickian mass transport model to extract apparent linear diffusion coefficients of acceptor molecules for different flow rates. Apparent diffusion coefficients range from 1.9 × 10(-12) to 9.1 × 10(-12) cm(2)/s for near-surface flow linear velocities ranging from 192 to 2952 µm/s. This increase in apparent diffusion coefficient with fluid flow rate suggests increasing contributions from convective mass transport that are indicative of flow field penetration into the polymer film. The depth of penetration of the flow field is estimated to range from ∼6% of the polymer film thickness in a good solvent at ∼192 µm/s to ∼60% of the film thickness at ∼2952 µm/s. Thus, flow field penetration into polymer thin films, with its concomitant contributions from convective mass transport within the near-interface region of the polymer, is demonstrated and quantified experimentally.

Favourable impact of regular swimming in young people with haemophilia: experience derived from 'Desafio del Caribe' project.

Swimming is beneficial for persons with haemophilia (PWH) providing good maintenance of the cardiovascular and musculoskeletal system and improving many psychological characteristics. In the Desafío del Caribe Project, young PWH from Venezuela and Mexico took part in an open water competition in the Gulf of Mexico under a multidisciplinary team supervision. Eight severe haemophilia A, two moderate haemophilia A, one severe haemophilia B and two moderate haemophilia B subjects were included. Haematological, musculoskeletal and psychological evaluations were carried out before and during training for the competition. Training program included physical exercise routines and swimming practices that alternated between pools and open water. Swimmers had coverage with factor concentrates before pool and open water trainings. In physiatric evaluations, the Hemophilia Joint Health Score (HJHS) was used. The objective of the psychology area was to analyse self-esteem, precompetition anxiety, coping mechanisms and relaxation levels. The need of factor prophylaxis before intense trainings was confirmed. In the musculoskeletal system a decrease of elbow pain as well as an increase of muscle strength in the ankles were observed. In the psychological area significant differences between the first and second test in self-esteem levels, cognitive anxiety and group cohesion were found. PWH must be provided with orientation and encouragement to practice swimming regularly. High competition exercise must be supervised by a multidisciplinary team which must evaluate the pros and cons of the activity to make relevant recommendations.

Musculoskeletal evaluation in severe haemophilia A patients from Latin America.

There is a paucity of literature on haemophilia treatment in Latin American countries, a region characterized by rapidly improving systems of care, but with substantial disparities in treatment between countries. The aim of this study was to evaluate the musculoskeletal status of haemophilia patients from Latin America and to examine the relationship between musculoskeletal status and treatment practices across countries. The Committee of Latin America on the Therapeutics of Inhibitor Groups conducted a survey of its member country representatives on key aspects of haemophilia treatment in 10 countries. Musculoskeletal status of patients was obtained during routine comprehensive evaluations between March 2009 and March 2011. Eligible patients had severe haemophilia A (factor VIII <1%) without inhibitors (<0.6 BU mL(-1) ) and were ≥5 years of age. Musculoskeletal status was compared between three groups of countries, based primarily on differences in the availability of long-term prophylaxis. Overall, 143 patients (5-66 years of age) were enrolled from nine countries. In countries where long-term prophylaxis had been available for at least 10 years (Group A), patients aged 5-10 years had significantly better mean World Federation of Hemophilia clinical scores, fewer target joints and fewer affected joints than patients from countries where long-term prophylaxis has been available for about 5 years (Group B) or was not available (Group C). In Latin America, the musculoskeletal status of patients with severe haemophilia without inhibitors has improved significantly in association with the provision of long-term prophylaxis. As more countries in Latin America institute this practice, further improvements are anticipated.

Modeling the emission, transport and deposition of contaminated dust from a mine tailing site.

Mining operations are potential sources of airborne particulate metal and metalloid contaminants through both direct smelter emissions and wind erosion of mine tailings. The warmer, drier conditions predicted for the Southwestern US by climate models may make contaminated atmospheric dust and aerosols increasingly important, due to potential deleterious effects on human health and ecology. Dust emissions and dispersion of contaminants from the Iron King Mine tailings in Dewey-Humboldt, Arizona, a Superfund site, are currently being investigated through in situ field measurements and computational fluid dynamics modeling. These tailings are significantly contaminated with lead and arsenic with an average soil concentration of 1616 and 1420 ppm, respectively. Similar levels of these contaminants have also been measured in soil samples taken from the area surrounding the mine tailings. Using a computational fluid dynamics model, we have been able to model dust transport from the mine tailings to the surrounding region. The model includes a distributed Eulerian model to simulate fine aerosol transport and a Lagrangian approach to model fate and transport of larger particles. In order to improve the accuracy of the dust transport simulations both regional topographical features and local weather patterns have been incorporated into the model simulations.

Nuclear shell-model simulation in digital quantum computers.

The nuclear shell model is one of the prime many-body methods to study the structure of atomic nuclei, but it is hampered by an exponential scaling on the basis size as the number of particles increases. We present a shell-model quantum circuit design strategy to find nuclear ground states by exploiting an adaptive variational quantum eigensolver algorithm. Our circuit implementation is in excellent agreement with classical shell-model simulations for a dozen of light and medium-mass nuclei, including neon and calcium isotopes. We quantify the circuit depth, width and number of gates to encode realistic shell-model wavefunctions. Our strategy also addresses explicitly energy measurements and the required number of circuits to perform them. Our simulated circuits approach the benchmark results exponentially with a polynomial scaling in quantum resources for each nucleus. This work paves the way for quantum computing shell-model studies across the nuclear chart and our quantum resource quantification may be used in configuration-interaction calculations of other fermionic systems.

Concentration of trichloroethylene in breast milk and household water from Nogales, Arizona.

The United States Environmental Protection Agency has identified quantification of trichloroethylene (TCE), an industrial solvent, in breast milk as a high priority need for risk assessment. Water and milk samples were collected from 20 households by a lactation consultant in Nogales, Arizona. Separate water samples (including tap, bottled, and vending machine) were collected for all household uses: drinking, bathing, cooking, and laundry. A risk factor questionnaire was administered. Liquid-liquid extraction with diethyl ether was followed by GC-MS for TCE quantification in water. Breast milk underwent homogenization, lipid hydrolysis, and centrifugation prior to extraction. The limit of detection was 1.5 ng/mL. TCE was detected in 7 of 20 mothers' breast milk samples. The maximum concentration was 6 ng/mL. TCE concentration in breast milk was significantly correlated with the concentration in water used for bathing (ρ = 0.59, p = 0.008). Detection of TCE in breast milk was more likely if the infant had a body mass index <14 (RR = 5.2, p = 0.02). Based on average breast milk consumption, TCE intake for 5% of the infants may exceed the proposed U.S. EPA Reference Dose. Results of this exploratory study warrant more in depth studies to understand risk of TCE exposures from breast milk intake.

Hygroscopic and chemical properties of aerosols collected near a copper smelter: implications for public and environmental health.

Particulate matter emissions near active copper smelters and mine tailings in the southwestern United States pose a potential threat to nearby environments owing to toxic species that can be inhaled and deposited in various regions of the body depending on the composition and size of the particles, which are linked by particle hygroscopic properties. This study reports the first simultaneous measurements of size-resolved chemical and hygroscopic properties of particles next to an active copper smelter and mine tailings by the towns of Hayden and Winkelman in southern Arizona. Size-resolved particulate matter samples were examined with inductively coupled plasma mass spectrometry, ion chromatography, and a humidified tandem differential mobility analyzer. Aerosol particles collected at the measurement site are enriched in metals and metalloids (e.g., arsenic, lead, and cadmium) and water-uptake measurements of aqueous extracts of collected samples indicate that the particle diameter range of particles most enriched with these species (0.18-0.55 µm) overlaps with the most hygroscopic mode at a relative humidity of 90% (0.10-0.32 µm). These measurements have implications for public health, microphysical effects of aerosols, and regional impacts owing to the transport and deposition of contaminated aerosol particles.

[Impact of the COVID-19 pandemic on patient safety incident and medication error reporting systems]. / Impacto de la pandemia COVID-19 en los sistemas de notificación de incidentes de seguridad del paciente y errores de medicación.

BACKGROUND AND AIM: To determine the impact of the COVID-19 pandemic on the epidemiology of safety incidents (SI) and medication errors (ME) reported to the CISEMadrid notification system in the hospital and primary care settings of the Madrid Health Service (SERMAS). MATERIALS AND METHODS: Observational and descriptive study with a retrospective analysis of data including all CISEMadrid notifications from 01-Jan-2018 to 31-Dec-2020, from 33 hospitals and 262 health care centres of the SERMAS. The two periods in 2020 with the greatest increase in COVID-19 cases were identified to compare incidents reported in the pre-pandemic and pandemic periods. RESULTS: 36,494 incidents were reported. Comparing both periods, an overall decrease in pandemic notifications of 60.7% was observed, being higher in primary care, falling to 33% of previous levels. The reduction in notifications was similar in the peaks and valleys of the waves. The three most frequent SIs in both periods and care settings were: diagnostic tests, medical devices/equipment/clinical furniture and organisational management/citations. In ME, dose failure and inappropriate selection were the most frequent in both settings and periods. There were no relevant differences in patient consequences in both periods. CONCLUSIONS: During the pandemic, patient safety notifications decreased although the most frequent types remained the same, as did their impact on the patient, both in hospitals and in primary care. The safety culture of organisations is a critical aspect for the maintenance of reporting systems.

Cultural and linguistic adaptation of the Oxford Cognitive Screen to the Spanish population.

INTRODUCTION: Stroke is the sixth leading cause of disability in Spain. Patients may present motor, sensory, or cognitive sequelae, which can be minimised with early treatment. To this end, there is a need for quick-to-administer assessment tools to evaluate deficits in these areas. The Oxford Cognitive Screen (OCS) is a brief test specifically designed to assess cognitive function in patients with stroke. Our aim in this study is to report the linguistic and cultural adaptation of a Spanish-language version of the test (OCS-S). METHODS: The linguistic validation was conducted with a process of double translation and 10 consensus meetings of the multidisciplinary research team. We also performed 3 pilot studies, with 5 potential users, 23 healthy individuals, and 23 patients with stroke (ischaemic in 61% of cases and haemorrhagic in 39%), respectively; participants were aged between 31 and 88 years. RESULTS: The OCS-S includes the 10 subtests, the coding of responses, and the scoring system from the original version. We modified and extended the instructions for administration in order to ensure the reliability of the content and its application. Five tasks were modified (images, numbers, and sentences) and the praxis subtest was modified to evaluate both hands. The pilot studies confirmed comprehension in the target population, independently of any cognitive problems. CONCLUSION: The OCS-S is conceptually and linguistically equivalent to the original test, enabling psychometric assessment and application of the test in the Spanish population. The OCS-S may be a useful screening tool for quickly assessing cognitive function after stroke.

Elective surgery in patients with congenital coagulopathies and inhibitors: experience of the National Haemophilia Centre of Venezuela.

Elective surgery in patients with congenital haemophilia with inhibitors carries a high risk of bleeding. However, inhibitor patients also have a high risk of haemarthroses and other orthopaedic complications, and surgery could improve their quality of life. Successful elective surgery has been reported in inhibitor patients under haemostatic cover with plasma-derived activated prothrombin complex concentrate (pd-aPCC) or recombinant activated factor VII (rFVIIa). Recombinant FVIIa has recently become available in Venezuela and, unlike pd-aPCC, has not been associated with an anamnestic response. The aim of this study was to assess our experience using rFVIIa as a first-line and sustained treatment in elective invasive surgical procedures at the National Haemophilia Centre in Venezuela. Surgical procedures were classified as major or minor, under haemostatic cover with rFVIIa. A total of 13 patients (12 with haemophilia A with high-responding inhibitors and one with von Willebrand's disease type 3) underwent a total of 19 surgical procedures under rFVIIa cover. Thirteen procedures were classified as major surgeries. Intraoperative haemostasis was achieved in the majority of patients. Only two patients required an additional dose of rFVIIa, at 30 min and 75 min, respectively, with good results. Postoperative haemostasis was considered effective in 16 of 18 (89%) of the procedures in haemophilia A patients. Treatment was considered to be ineffective in two patients because of excessive postoperative bleeding. Data from the study provide no safety concerns, and demonstrate that rFVIIa provides effective haemostatic cover in elective surgery in patients with inhibitors; research is ongoing to determine the optimal dose for such procedures.