Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

L'antibiothérapie empirique des infections péritoneales en dialyse péritoneale

ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

Made available in DSpace on 2019-09-12T16:53:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2014We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U. S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN. Copyright (C) 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.[Rosenthal, Victor Daniel] Int Nosocomial Infect Control Consortium, Corrientes Ave 4580,Fl 12,Apt D, RA-1195 Buenos Aires, DF, Argentina[Maki, Dennis George] Univ Wisconsin, Madison, WI USA[Mehta, Yatin] Medanta Medicity, New Delhi, India[Leblebicioglu, Hakan] Ondokuz Mayis Univ, Samsun, Turkey[Memish, Ziad Ahmed] Minist Hlth, Riyadh, Saudi Arabia[Al-Mousa, Haifaa Hassan] Minist Hlth, Kuwait, Kuwait[Balkhy, Hanan] King Saud Bin Abdulaziz Univ Hlth Sci, Riyadh, Saudi Arabia[Hu, Bijie] Fudan Univ, Zhongshan Hosp, Shanghai 200433, Peoples R China[Alvarez-Moreno, Carlos] Univ Nacl Colombia, Clin Univ Colombia, Bogota, Colombia[Medeiros, Eduardo Alexandrino] Hosp Sao Paulo, Sao Paulo, Brazil[Apisarnthanarak, Anucha] Thammasat Univ Hosp, Pathum Thani, Thailand[Raka, Lul] Prishtina Univ, Kosova & Med Sch, Natl Inst Publ Hlth, Prishtina, Kosovo, Serbia[Cuellar, Luis E.] Inst Nacl Enfermedades Neoplas, Lima, Peru[Ahmed, Altaf] Indus Hosp, Karachi, Pakistan[Navoa-Ng, Josephine Anne] St Lukes Med Ctr, Manila, Philippines[El-Kholy, Amani Ali] Cairo Univ Abu El Reesh, Children Hosp, Cairo, Egypt[Kanj, Souha Sami] Amer Univ, Beirut Med Ctr, Beirut, Lebanon[Bat-Erdene, Ider] Cent State Hosp 1, Ulaanbaatar, Mongol Peo Rep[Duszynska, Wieslawa] Wroclaw Univ Hosp, Wroclaw, Poland[Nguyen Van Truong] Hung Vuong Hosp, Ho Chi Minh City, Vietnam[Pazmino, Leonardo N.] Hosp Valles, Hosp Eugenio Espejo, Quito, Ecuador[See-Lum, Lucy Chai] Univ Malaya, Med Ctr, Kuala Lumpur, Malaysia[Fernandez-Hidalgo, Rosalia] Hosp Clin Bibl, San Jose, Costa Rica[Di-Silvestre, Gabriela] Hosp Clin Caracas, Caracas, Venezuela[Zand, Farid] Shiraz Univ Med Sci, Nemazee Hosp, Shiraz, Iran[Hlinkova, Sona] Catholic Univ Ruzomberok, Cent Mil Hosp Ruzomberok, Fac Hlth, Ruzomberok, Slovakia[Belskiy, Vladislav] Privolzhskiy Dist Med Ctr, Nizhnii Novgorod, Russia[Al-Rahma, Hussain] Dubai Hosp, Dubai, U Arab Emirates[Tulio Luque-Torres, Marco] Hosp Especialidades Ctr Med La Raza, Inst Hondureho Seguridad Social, Tegucigalpa, Honduras[Bayraktar, Nesil] Burhan Nalbantoglu Devlet Hastanesi, Nicosia, Cyprus[Mitrev, Zan] Special Hosp Surg Dis Filip Vtori, Skopje, Macedonia[Gurskis, Vaidotas] Hosp Lithuanian Univ, Hlth Sci Kauno Klin, Kaunas, Lithuania[Fisher, Dale] Natl Univ Singapore Hosp, Singapore, Singapore[Abu-Khader, Ilham Bulos] Jordan Univ Hosp, Amman, Jordan[Berechid, Kamal] Ibn Sina, Rabat, Morocco[Rodriguez-Sanchez, Arnaldo] Hosp Episcopal San Lucas Guayama, Guayama, Puerto Rico[Horhat, Florin George] Univ Med & Farm Timisoara, Clin Cty Hosp, Timisoara, Romania[Requejo-Pino, Osiel] Hosp Univ Gral Calixto Garc, Havana, Cuba[Hadjieva, Nassya] Univ Hosp Queen Giovanna ISUL, Sofia, Bulgaria[Ben-Jaballah, Nejla] Hop Enfants, Tunis, Tunisia[Garcia-Mayorca, Elias] Hosp Santo Tomas, Panama City, Panama[Kushner-Davalos, Luis] Caja Salud Banca Privada Reg Paz, La Paz, Bolivia[Pasic, Srdjan] Inst Mother Child Hlth Care Vukan Cupic, Belgrade, Serbia[Pedrozo-Ortiz, Luis E.] Hosp Reg Salto, Salto, Uruguay[Apostolopoulou, Eleni] Sotiria, Athens, Greece[Mejia, Nepomuceno] Hosp Gen Plaza Salud, Santo Domingo, Dominican Rep[Gamar-Elanbya, May Osman] Royal Care Int Hosp, Khartoum, Sudan[Jayatilleke, Kushlani] Sri Jayewardenepura Gen Hosp, Khartoum, Sudan[de Lourdes-Duenas, Miriam] Hosp Nacl Ninos Benjamin Bloom, San Salvador, El Salvador[Aguirre-Avalos, Guadalupe] Hosp Civil Guadalajara Fray Antonio Alcalde, Unidad Terapia Intens Adultos, Guadalajara, Mexico[Marcelo Maurizi, Diego; Montanini, Adriana; Laura Spadaro, Maria] Hosp Municipal Agudos Dr Leonidas Lucero, Bahia Blanca, Buenos Aires, Argentina[Santiago Marcos, Lorenzo; Botta, Priscila; Maria Jerez, Florencia; Constanza Chavez, Maria; Ramasco, Lucia; Isabel Colqui, Maria; Silvia Olivieri, Maria; Silvia Rearte, Ana; Edith Correa, Gladys; Deolinda Juarez, Paola; Fabiana Gallardo, Paola; Patricia Brito, Miriam; Horacio Mendez, Gabriel; Rosa Valdez, Julia; Paola Cardena, Lorena] Hosp Nino Jesus de Tucuman, San Miguel De Tucuman, Argentina[Maria Harystoy, Jose; Jorge Chaparro, Gustavo] Inst Med Platense, La Plata, Buenos Aires, Argentina[Gabriela Rodriguez, Claudia; Toomey, Rodolfo] Inst Med Adrogue, Almirante Brown, Argentina[Caridi, Maria] Centro Gallego Buenos Aires, Buenos Aires, Argentina[Viegas, Monica] Hosp Interzonal Gen Agudos Presidente Peron, Avellaneda, Argentina[Liliana Bernan, Marisa] Hgza San Roque Gonnet, La Plata, Argentina[Romani, Adriana] Clin Modelo Imagmed Soc Anonima, Lanus, Argentina[Beatriz Dominguez, Claudia] Obra Social Empleados Publ Sanatorio Fleming, Mendoza, Argentina[Kushner Davalos, Luis] Caja Salud Banca Privada Reg, La Paz, Bolivia[Richtmann, Rosana; Silva, Camila Almeida; Rodrigues, Tatiane T.] Hosp Maternidade Santa Joana, Sao Paulo, Brazil[Mielle Filho, Amaury; Seerig Palme, Ernandi Dagoberto; Besen, Aline; Lazzarini, Caroline; Cardoso, Caroline Batista] Hosp Santa Catarina, Blumenau, Brazil[Azevedo, Francisco Kennedy; Fontes Pinheiro, Ana Paula; Camacho, Aparecida] Hosp Jardim Cuiaba, Cuiaba, Brazil[De Carvalho, Braulio Matias; Monteiro De Assis, Maria Jose; Vasconcelos Carneiro, Ana Paula; Maciel Canuto, Maria Lilian; Pinto Coelho, Keyla Harten; Moreira, Tamiris; Oliveira, Agamenon Alves; Sousa Colares, Marcela Maria; De Paula Bessa, Marcia Maria; Pinheiro Gomes Bandeira, Tereza De Jesus; De Moraes, Renata Amaral; Campos, Danilo Amancio; Lima De Barros Araujo, Tania Mara] Hosp Messejana, Fortaleza, Brazil[Freitas Tenorio, Maria Tereza; Amorim, Simone; Amaral, Manuela; Lima, Julianne Da Luz; Da Silva Neta, Lindalva Pino; Batista, Caphiane; De Lima Silva, Fabio Jorge; Ferreira De Souza, Maria C.; Guimaraes, Katia Arruda] Santa Casa Misericordia Maceio, Maceio, Brazil[Maluf Lopes, Julia Marcia] Hosp Infantil Joao Paulo 2 Fhemig, Belo Horizonte, Brazil[Nogueira Napoles, Karina M.; Silva Neto Avelar, Lorena Luiza; Vieira, Lilian Aguiar] Santo Ivo, Belo Horizonte, Brazil[De Oliveira Cardo, Luis Gustavo] Hosp Clin Unicamp, Campinas, Brazil[Takeda, Christianne F. V.; Ponte, Glaydson A.; Aguiar Leitao, Fco Eduardo] Hosp Antonio Prudente, Fortaleza, Brazil[Kuchenbecker, Ricardo De Souza; Dos Santos, Rodrigo Pires] Hosp Clin Porto Alegre, Porto Alegre, Brazil[Onzi Siliprandi, Erci Maria] Inst Cardiologia Rio Grande Sul, Porto Alegre, Brazil[Baqueiro Freitas, Luiz Fernando] Hosp Santa Lydia, Ribeirao Preto, Brazil[Martins, Ianick Souto] Hosp Canc Inst Nacl Canc, Rio De Janeiro, Brazil[Casi, Daiane] Hosp Samaritano, Sao Paulo, Brazil[Maretti Da Silva, Maria Angela; Blecher, Sergio; Villins, Margarete; Salomao, Reinaldo] Hosp Santa Marcelina, Sao Paulo, Brazil[Oliveira Castro, Solange Regina; Da Silva Escudero, Daniela V.; Oliveira Reis, Mariana Andrade] Hosp Sao Paulo Escola Paulista Medicina Unifesp, Sao Paulo, Brazil[Mendonca, Marcelo; Furlan, Valter; do Amaral Baruzzi, Antonio Claudio] Totalcor, Sao Paulo, Brazil[Sanchez, Tarquino Eristidesg] Hosp Anchieta Ltda, Taguatinga, Brazil[Moreira, Marina] Hosp Universidade de Taubaté (Unitau)[de Freitas, Wania Vasconcelos; de Souza, Leonardo Passos] Hosp Casa Portugal, Rio de Janeiro, Brazil[Velinova, Velmira Angelova; Hadjieva, Nassya; Petrov, Michael M.; Karadimov, Dimitar Georgiev; Kostadinov, Emil D.; Dicheva, Violeta Jivkova] Queen Giovanna Isul, Sofia, Bulgaria[Wang, Chaohua; Guo, Xiuqin; Geng, Xihua; Wang, Shufang; Zhang, Jinzhi; Zhu, Ling; Zhuo, Shufang; Guo, Chunli] Dong E Peoples Hosp, Liaocheng Shi, Shandong, Peoples R China[Tao, Lili] First Hosp Shanxi Med Univ, Taiyuan, Peoples R China[Li, Ruisheng] Beijing Chao Yang Hosp, Beijing, Peoples R Chin

Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients

International audienceThe aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed

Guidance on mucositis assessment from the MASCC Mucositis Study Group and ISOO: an international Delphi studyResearch in context

Summary: Background: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. Methods: This study was conducted over two stages (January 2022–July 2023). The first phase involved a survey to MASCC-MSG members (January 2022–May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023–May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. Findings: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). Interpretation: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. Funding: No funding was received

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

The shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of scientific reductionism, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora.Brazilian Biodiversity Information System (SiBBr)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Brazilian FAPsFundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ)Inst Pesquisas Jardim Bot Rio de Janeiro, Rio De Janeiro, BrazilUniv Fed Rio de Janeiro, Rio De Janeiro, BrazilEmpresa Brasileira Pesquisa Agropecuaria, Brasilia, DF, BrazilInst Bot Sao Paulo, Sao Paulo, BrazilUniv Estadual Feira de Santana, Feira De Santana, BA, BrazilKew, Royal Bot Gardens, Richmond, Surrey, EnglandUniv Estadual Paulista, Sao Paulo, SP, BrazilUniv Fed Minas Gerais, Belo Horizonte, MG, BrazilUniv Fed Sao Carlos, Sao Carlos, SP, BrazilUniv Fed Pernambuco, Recife, PE, BrazilUniv Sao Paulo, Sao Paulo, SP, BrazilUniv Fed Paraiba, Joao Pessoa, Paraiba, BrazilUniv Fed Bahia, Salvador, BA, BrazilUniv Fed Parana, Curitiba, Parana, BrazilUniv Brasilia, Brasilia, DF, BrazilUniv Nacl La Plata, La Plata, ArgentinaUniv Fed Mato Grosso, Cuiaba, MG, BrazilUniv Estado Bahia, Salvador, BA, BrazilUniv Fed Fluminense, Niteroi, RJ, BrazilInst Bot Darwinion, Acassuso, BA, BrazilConservatoire & Jardin Bot Ville Geneve, Pregny Chambesy, SwitzerlandUniv Calif Berkeley, Berkeley, CA USAUSDA, Miami, FL USAMuseu Paraense Emilio Goeldi, Belem, Para, BrazilUniv Nacl Autonoma Mexico, Mexico City, DF, MexicoIKIAM Univ Reg Amazon, Tena, EcuadorUniv Fed Sergipe, Sao Cristova, Sergipe, BrazilPrefeitura Municipal Cariacica ES, Cariacica, ES, BrazilInst Fed Educ Ciencia & Tecnol Ceara, Fortaleza, Ceara, BrazilUniv Santa Cecilia, Santos, SP, BrazilCtr Univ Fac Metropolitanas Unidas, Sao Paulo, SP, BrazilUniv Fed Maranhao, Sao Luis, Maranhao, BrazilUniv Fed Sao Paulo, Sao Paulo, SP, BrazilInst Nacl Mata Atlantica, Santa Teresa, BrazilUniv Estado Minas Gerais, Belo Horizonte, MG, BrazilUniv Estado Rio de Janeiro, Rio De Janeiro, BrazilUniv Estadual Campinas, Campinas, SP, BrazilUniv Fed Tocantins, Palmas, BrazilFac Guanambi, Guanambi, BrazilUniv Fed Alagoas, Maceio, Alagoas, BrazilUniv Fed Juiz de Fora, Juiz De Fora, MG, BrazilUniv Fed Vicosa, Vicosa, MG, BrazilUniv Fed Santa Catarina, Florianopolis, SC, BrazilUniv Estadual Sudoeste Bahia, Candeias, BA, BrazilUniv Fed Espirito Santo, Vitoria, BrazilUniv Fed Rio Grande do Sul, Porto Alegre, RS, BrazilUniv Fed Rural Pernambuco, Recife, PE, BrazilUniv Reg Blumenau, Blumenau, SC, BrazilUniv Estadual Santa Cruz, Ilheus, BA, BrazilInst Bot Nordeste, Corrientes, ArgentinaBot Staatssammlung Munchen, Munich, GermanyInst Amparo Ciencia Tecnol & Inovacao Roraima, Sao Paulo, SP, BrazilUniv Estadual Ctr Oeste Parana, Guarapuava, Parana, BrazilUniv Fed Mato Grosso do Sul, Campo Grande, MS, BrazilUniv Fed Pampa, Bage, RS, BrazilUniv Estadual Amazonas, Manaus, Amazonas, BrazilMarie Selby Bot Gardens, Sarasota, FL USAUniv Estadual Londrina, Londrina, Parana, BrazilUniv Fed Goias, Goiania, Go, BrazilUniv Fed Rio Grande do Norte, Natal, RN, BrazilFundacao Univ Fed Grande Dourados, Dourados, MS, BrazilPontificia Univ Catolica de Minas Gerais, Belo Horizonte, MG, BrazilUniv Estadual Rio Grande do Sul, Porto Alegre, RS, BrazilNew York Bot Garden, Bronx, NY USAUniv Aarhus, Aarhus, DenmarkUniv Estado Amazonas, Manaus, Amazonas, BrazilNat Hist Museum Wien, Vienna, AustriaInst Patrimonio Hist & Artist Nacl, Sitio Burle Marx, Rio De Janeiro, BrazilUniv Fed Campina Grande, Campina Grande, Paraiba, BrazilColumbia Univ, New York, NY 10027 USAMississippi State Univ, Mississippi State, MS USAInst Tecnol Vale, Belem, Para, BrazilUniv Fed Uberlandia, Uberlandia, MG, BrazilConsejo Nacl Invest Cient & Tecn, INIBIOMA, San Carlos De Bariloche, Rio Negro, ArgentinaUniv Estado Santa Catarina, Florianopolis, SC, BrazilMilwaukee Publ Museum, Milwaukee, WI USAUniv Cidade Sao Paulo, Sao Paulo, SP, BrazilPontificia Univ Catolica Rio de Grande, Belo Horizonte, MG, BrazilUniv Fed Pelotas, Pelotas, RS, BrazilInst Nacl de Pesquisas da Amazonia, Manaus, Amazonas, BrazilMinist Publ Estado Amazonas, Manaus, Amazonas, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilUniv Fed Oeste Bahia, Barreiras, BrazilOhio Wesleyan Univ, Delaware, OH USAUniv Estadual Norte Fluminense, Rio De Janeiro, BrazilUniv Michigan, Ann Arbor, MI 48109 USAUniv Fed Amazonas, Manaus, Amazonas, BrazilUniv Fed Rural Rio de Janeiro, Rio De Janeiro, BrazilMuseo Argentino Ciencias Nat Bernardino Rivadavia, Buenos Aires, DF, ArgentinaUniv Tokyo, Tokyo 1138654, JapanRoyal Bot Garden Edinburgh, Edinburgh, Midlothian, ScotlandUniv Med Ctr Groningen, Groningen, NetherlandsUniv Fed Rural Amazonia, Belem, Para, BrazilInst Fed Farroupilha, Santa Maria, RS, BrazilUniv Estadual Vale Acarau, Sobral, Ceara, BrazilUniv Fed Reconcavo Bahia, Cruz Das Almas, BrazilSmithsonian Inst, Washington, DC 20560 USAUniv Fed Vales Jequitinhonha & Mucuri, Teofilo Otoni, MG, BrazilUniv Fed Sul Bahia, Itabuna, BrazilUniv Nacl Colombia, Bogota, ColombiaUniv Chile, Santiago, ChileUniv Caxias do Sul, Caxias Do Sul, RS, BrazilInst Fed Minas Gerais Campus Bambui, Bambui, MG, BrazilUniv Fed Triangulo Mineiro, Uberaba, MG, BrazilUniv Estacio Sa, Rio De Janeiro, BrazilThermo Fisher Sci, Waltham, MA USAUniv Estadual Maranhao, Sao Luis, Maranhao, BrazilUniv Estadual Mato Grosso, Caceres, MG, BrazilFac Marechal Rondon, Sao Manuel, SP, BrazilCalif Acad Sci, San Francisco, CA 94118 USAUniv Buenos Aires, Buenos Aires, DF, ArgentinaCtr Univ UNA, Belo Horizonte, MG, BrazilUniv Nacl Nordeste, Corrientes, ArgentinaUniv Fed Piaui, Teresina, BrazilInst Fed Piaui, Teresina, BrazilJardim Bot Cubatao, Cubatao, BrazilUniv Turku, Turku, FinlandUniv Nacl Cordoba, Cordoba, ArgentinaUniv Estadual Maringa, Maringa, Parana, BrazilJardim Bot Plantarum, Nova Odessa, SP, BrazilUniv Estadual Piaui, Teresina, BrazilUniv Fed Delta Parnaiba, Parnaiba, BrazilJardim Bot Brasilia, Brasilia, DF, BrazilInst Fed Educ Ciencia & Tecnol Para, Belem, Para, BrazilUniv Fed Vale Sao Francisco, Petrolina, BrazilJardim Bot Recife, Recife, PE, BrazilUniv Free State, Bloemfontein, South AfricaPrefeitura Municipal Mariana MG, Mariana, MG, BrazilPontificia Univ Catolica Rio de Janeiro, Rio De Janeiro, BrazilSecretaria Estadual Educ Rio de Janeiro, Rio De Janeiro, BrazilUniv Minnesota, Minneapolis, MN 55455 USAUniv Fed Sao Joao Del Rei, Sao Joao Del Rei, BrazilUniv Fed Estado Rio de Janeiro, Rio De Janeiro, BrazilUniv Estadual Paraiba, Campina Grande, Paraiba, BrazilUniv Laval, Quebec City, PQ G1K 7P4, CanadaUniv Fed Oeste Para, Santarem, Para, BrazilUniv Bayreuth, Bayreuth, GermanyUniv Fed Para, Belem, Para, BrazilSwedish Museum Nat Hist, Stockholm, SwedenUniv Fed Santa Maria, Santa Maria, RS, BrazilHillfield Strathallan Coll, Hamilton, ON, CanadaUniv Fed Integracao Latino Amer, Foz Do Iguacu, BrazilUniv Fed Rural Semi Arido, Mossoro, BrazilIPF Solucoes Florestais, Rio De Janeiro, BrazilUniv Tecnol Fed Parana, Curitiba, Parana, BrazilArboribus Consultoria & Planejamento Ambiental, Sao Paulo, SP, BrazilUniv Paris Saclay, CNRS, AgroParisTech, Paris, FranceUniv Fed Ouro Preto, Ouro Preto, MG, BrazilUniv Estadual Oeste Parana, Cascavel, Parana, BrazilFed Univ ABC, Santo Andre, SP, BrazilUniv Estadual Ceara, Fortaleza, Ceara, BrazilInst Fed Para, Belem, Para, BrazilInst Agron Campinas, Campinas, SP, BrazilInst Fed Bahia, Salvador, BA, BrazilUniv Utah, Salt Lake City, UT 84112 USAIowa State Univ, Iowa City, IA USAMuseu Nacl Hist Nat Paris, Paris, FranceUniv Nacl Rio Cuarto, Rio Cuarto, ArgentinaUniv Coimbra, Coimbra, PortugalInst Nacl Tecnol, Rio De Janeiro, BrazilUniv Fed Ciencias Saude Porto Alegre, Porto Alegre, RS, BrazilScientifik Consultoria Ltda, Sao Jose Dos Campos, SP, BrazilInst Fed Educ Ciencia & Tecnol Goias Campus Formo, Formosa, Goias, BrazilSecretaria Estadual Educ Cameta PA, Cameta, PA, BrazilInst Agron Pernambuco, Recife, PE, BrazilInst Fed Educ Ciencia & Tecnol Rio Grande do Sul, Rio Grande, RS, BrazilUniv Panama, Panama City, PanamaInst Anchietano Pesquisas, Sao Leopoldo, RS, BrazilCtr Univ Araguaia, Goiania, Go, BrazilUniv Mogi das Cruzes, Mogi Das Cruzes, SP, BrazilUniv Fed Acre, Rio Branco, BrazilMissouri Bot Garden, St Louis, MO USAInst Nacl Tecnol Agropecuaria, Buenos Aires, DF, ArgentinaRhein Friedrich Wilhelms Univ, Bonn, GermanyEastern Kentucky Univ, Richmond, KY USAMiami Univ, Oxford, OH 45056 USAUniv Vermont, Burlington, VT 05405 USAUniv Passo Fundo, Passo Fundo, RS, BrazilUniv Mayor San Andres, La Paz, BoliviaInst Invest Amazonia Peruana, Maynas, PeruField Museum Nat Hist, Chicago, IL USAUniv Fed Rondonia, Porto Velho, BrazilUniv Florida, Gainesville, FL 32611 USAUniv Gibraltar, Campus Europa Point, GibraltarMuseu Bot Municipal Curitiba, Curitiba, Parana, BrazilUniv Nilton Lins, Manaus, Amazonas, BrazilInst Pesquisas Cient & Tecnol Estado Amapa, Macapa, BrazilUniv Autonoma Madrid, Madrid, SpainBot Res Inst Texas, Ft Worth, TX USAInst Rech Dev, Marseille, FranceSecretaria Meio Ambiente & Infraestrutura RS Jard, Porto Alegre, RS, BrazilUniv Costa Rica, San Jose, Costa RicaUnilasalle Canoas, Canoas, BrazilCSIC, Real Jardin Bot, Madrid, SpainUniv Wisconsin, Madison, WI USAPrefeitura Cidade Rio de Janeiro, Rio De Janeiro, BrazilCtr Invest Cient Yucatan, Yucatan, MexicoUniv Fed Roraima, Boa Vista, Parana, BrazilInst Brasileiro Geog & Estat, Rio De Janeiro, BrazilUniv Nacl Mayor San Marcos, Lima, PeruInst Fed Educ Ciencia & Tecnol Mato Grosso, Cuiaba, BrazilUniv Estadual Ponta Grossa, Ponta Grossa, Parana, BrazilMaastricht Univ, Maastricht, NetherlandsUniv Pisa, Pisa, ItalyNat Hist Museum UK, London, EnglandInst Espanol Oceanog, Madrid, SpainUniv Antioquia, Medellin, Antioquia, ColombiaUniv Fed Rio Grande, Rio Grande, BrazilSenckenberg Res Inst Frankfurt M, Frankfurt, GermanyColorado Mesa Univ, Grand Junction, CO USAInst Chico Mendes Conservacao Biodiversidade, Brasilia, DF, BrazilUnited States Bot Garden, Washington, DC USAUniv Fed Lavras, Lavras, MG, BrazilNaturalis Biodivers Ctr Leiden, Leiden, NetherlandsInst Fed Goiano, Ceres, Go, BrazilUniv Arkansas, Fayetteville, AR 72701 USAUniv Franciscana, Santa Maria, RS, BrazilConnecticut State Univ, New Britain, CT USASecretaria Municipal Educ Vitoria ES, Vitoria, ES, BrazilLeibniz Ctr Agr Landscape Res, Muncheberg, GermanyFac Tecnol Estado Sao Paulo, Sao Paulo, BrazilUniv Simon Bolivar, Caracas, VenezuelaUniv Estadual Paulista, Sao Paulo, SP, Brazi