The identification of risk factors associated with patient and healthcare system delays in the treatment of tuberculosis in Tabriz, Iran.

BACKGROUND: Tuberculosis (TB) is a serious health concern, particularly in developing countries. Various delays, such as patient delay (PD) and healthcare system delay (HSD) in the TB process, are exacerbating the disease burden and increasing the rates of transmission and mortality in various global communities. Therefore, the aim of this study is to identify risk factors associated with PD and HSD in TB patients in Tabriz, Iran. METHODS: A cross-sectional study was conducted on 173 TB patients in Tabriz, Iran from 2012 to 2014. Patients were interviewed with a semi-structured questionnaire. Frequencies and percentages were reported for patient categories of sex, age, and education. The median and interquartile range (IQR) were reported for the time intervals of delays. Univariate and multivariate logistic regressions of delay in respect to socio-demographic and clinical variables were performed. Statistical significance was set at p < 0.05. RESULTS: The median values for delays were 53 days for HSD (IQR = 73) and 13 days for PD (IQR = 57). Odds ratios (OR) associated with PD were: employed vs. unemployed (OR = 5.86, 95% CI: 1.59 to 21.64); public hospitals vs. private hospitals (OR = 2.64, 95% CI: 1.01 to 6.85); ≥ 3 vs. < 3 visits to health facilities before correct diagnosis (OR = 2.35, 95% CI: 1.08 to 5.11); and male vs. female (OR = 2.28, 95% CI: 1.29 to 4.39). The OR associated with HSD were: ≥ 3 vs. < 3 visits to health facilities before correct diagnosis (OR = 9.44, 95% CI: 4.50 to 19.82), without vs. with access to TB diagnostic services (OR = 3.56, 95% CI: 1.85 to 6.83), and misdiagnosis as cold or viral infection vs. not (OR = 2.62, 95% CI: 1.40 to 4.91). CONCLUSIONS: The results provide for an important understanding of the risk factors associated with PD and HSD. One of the major recommendations is to provide more TB diagnostic knowledge and tools to primary health providers and correct diagnoses for patients during their initial visit to the health care facilities. The knowledge generated from this study will be helpful for prioritizing and developing strategies for minimizing delays, initiating early treatment to TB patients, and improving TB-related training programs and healthcare systems in Tabriz, Iran.

Light-emitting diodes as an illumination source for plants: a review of research at Kennedy Space Center.

The provision of sufficient light is a fundamental requirement to support long-term plant growth in space. Several types of electric lamps have been tested to provide radiant energy for plants in this regard, including fluorescent, high-pressure sodium, and metal halide lamps. These lamps vary in terms of spectral quality, which can result in differences in plant growth and morphology. Current lighting research for space-based plant culture is focused on innovative lighting technologies that demonstrate high electrical efficiency and reduced mass and volume. Among the lighting technologies considered for space are light-emitting diodes (LEDs). The combination of red and blue LEDs has proven to be an effective lighting source for several crops, yet the appearance of plants under red and blue lighting is purplish gray, making visual assessment of plant health difficult. Additional green light would make the plant leaves appear green and normal, similar to a natural setting under white light, and may also offer psychological benefits for the crew. The addition of 24% green light (500-600 nm) to red and blue LEDs enhanced the growth of lettuce plants compared with plants grown under cool white fluorescent lamps. Coincidentally, these plants grown under additional green light would have the additional aesthetic appeal of a green appearance.

Stomatal conductance of lettuce grown under or exposed to different light qualities.

BACKGROUND AND AIMS: The objective of this research was to examine the effects of differences in light spectrum on the stomatal conductance (Gs) and dry matter production of lettuce plants grown under a day/night cycle with different spectra, and also the effects on Gs of short-term exposure to different spectra. METHODS: Lettuce (Lactuca sativa) plants were grown with 6 h dark and 18 h light under four different spectra, red-blue (RB), red-blue-green (RBG), green (GF) and white (CWF), and Gs and plant growth were measured. KEY RESULTS AND CONCLUSIONS: Conductance of plants grown for 23 d under CWF rose rapidly on illumination to a maximum in the middle of the light period, then decreased again before the dark period when it was minimal. However, the maximum was smaller in plants grown under RB, RGB and GF. This demonstrates that spectral quality during growth affects the diurnal pattern of stomatal conductance. Although Gs was smaller in plants grown under RGB than CWF, dry mass accumulation was greater, suggesting that Gs did not limit carbon assimilation under these spectral conditions. Temporarily changing the spectral quality of the plants grown for 23 d under CWF, affected stomatal responses reversibly, confirming studies on epidermal strips. This study provides new information showing that Gs is responsive to spectral quality during growth and, in the short-term, is not directly coupled to dry matter accumulation.

Influence of nitrogen nutrition management on biomass partitioning and nitrogen use efficiency indices in hydroponically grown potato.

The National Aeronautics and Space Administration (NASA) has been conducting controlled environment research with potatoes (Solanum tuberosum L.) in recirculating nutrient film technique (NFT)-hydroponic systems as a human life support component during long-duration spaceflight. Standard nutrient solution management approaches include constant pH regulation with nitric acid (HNO3) and daily adjustment of electrical conductivity (EC) equivalent to half-strength modified Hoagland's solution, where nitrate (NO3-) is the sole nitrogen (N) source. Although tuber yields have been excellent with such an approach, N use efficiency indices are expected to be low relative to tuber biomass production. Furthermore, the high amount of N used in NFT-hydroponics, typically results in high inedible biomass, which conflicts with the need to minimize system mass, volume, and expenditure of resources for long-duration missions. More effective strategies of N fertilization need to be developed to more closely match N supply with demand of the crop. Hence, the primary objective of this study was to identify the optimal N management regime and plant N requirement to achieve high yields and to avoid inefficient use of N and excess inedible biomass production. In separate 84-day cropping experiments, three N management protocols were tested. Treatments which decreased NO3(-)-N supply indirectly through lowering nutrient solution EC (Expt. I), or disabling pH control, and/or supplying NH4(+)-N (Expt. III) did not significantly benefit tuber yield, but did influence N use efficiency indices. When supplied with an external 7.5 mM NO3(-)-N for the first 42 days after planting (DAP), lowered to 1.0 mM NO3(-)-N during the final 42 days (Expt. II), plants were able to achieve yields on par with plants which received constant 7.5 mM NO3(-)-N (control). By abruptly decreasing N supply at tuber initiation in Expt. II, less N was taken up and accumulated by plants compared to those which received high constant N (control). However, proportionately more plant accumulated N was used (N use efficiency) to produce tuber biomass when N supply was abruptly lowered at tuber initiation in Expt. II. Hence, a hydroponic nutrient solution N management system may be modified to elicit greater plant N-use while maintaining overall high tuber yield as opposed to achieving high tuber yields through excess N supply and shoot growth.

Green-light supplementation for enhanced lettuce growth under red- and blue-light-emitting diodes.

Plants will be an important component of future long-term space missions. Lighting systems for growing plants will need to be lightweight, reliable, and durable, and light-emitting diodes (LEDs) have these characteristics. Previous studies demonstrated that the combination of red and blue light was an effective light source for several crops. Yet the appearance of plants under red and blue lighting is purplish gray making visual assessment of any problems difficult. The addition of green light would make the plant leave appear green and normal similar to a natural setting under white light and may also offer a psychological benefit to the crew. Green supplemental lighting could also offer benefits, since green light can better penetrate the plant canopy and potentially increase plant growth by increasing photosynthesis from the leaves in the lower canopy. In this study, four light sources were tested: 1) red and blue LEDs (RB), 2) red and blue LEDs with green fluorescent lamps (RGB), 3) green fluorescent lamps (GF), and 4) cool-white fluorescent lamps (CWF), that provided 0%, 24%, 86%, and 51% of the total PPF in the green region of the spectrum, respectively. The addition of 24% green light (500 to 600 nm) to red and blue LEDs (RGB treatment) enhanced plant growth. The RGB treatment plants produced more biomass than the plants grown under the cool-white fluorescent lamps (CWF treatment), a commonly tested light source used as a broad-spectrum control.