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The article analyzes the applicability of the innovation action research method for activities related to the preparation of a concept of a costing standard for healthcare providers which is subject to legal regula- tion. This legislation regulates the way providers, reporting data for the purpose of the regulated pricing of health services, identify and calculate costs. A 39-month long research project was carried out in ac- cordance with the innovation action research approach, which resulted in the creation of a novel concept of a costing model. The generation of new knowledge occurred as a result of a collaboration between researchers and practitioners, which is a basic assumption of action research. The consecutive steps of the research have been characterized in order to present the influence of the research method on the devel- opment and modification of the initial concept.

W artykule przedstawiono próbę zastosowania podejścia innovation action research do działań związa-nych z przygotowaniem modelu rachunku kosztów dla podmiotów leczniczych, będącego przedmiotem regulacji w postaci rozporządzenia. Ten akt prawny ma za zadanie regulować sposób gromadzenia i kalkulacji kosztów usług zdrowotnych w podmiotach leczniczych dostarczających danych na potrzeby regulowanej wyceny usług zdrowotnych. Przeprowadzono 39-miesięczny projekt badawczy zorganizo-wany zgodnie z metodą innovation action research, którego efektem był nowy model rachunku kosztów. Proces tworzenia nowej wiedzy wynikał ze współpracy badaczy i praktyków, co jest podstawowym założeniem podejścia action research. W artykule scharakteryzowano kolejne etapy projektu, wskazując na wpływ zastosowanej koncepcji badawczej na rozwój i modyfikację tworzonego modelu.

BackgroundExposure to horses can cause severe allergic reactions in sensitized individuals. The breed, American Bashkir Curly Horse is categorized as hypoallergenic, primarily due to reports of allergic patients experiencing fewer symptoms while handling this special breed. The possible reasons for this phenomenon could be lower allergen production and/or reduced allergen release into the air because of increased sebum content in their skin and hair compared to other breeds. Therefore, the aim of the current study was to compare different horse breeds in relation to allergen content in hair and airborne dust samples.MethodsIn total, 224 hair samples from 32 different horse breeds were investigated. Personal nasal filters were used to collect airborne dust during the grooming of 20 Curly Horses and 20 Quarter Horses. Quantitative analysis of all samples was performed using two newly developed immunoassays for the detection of horse dander (HD) antigens and the major allergen Equ c 1 and the commercial assay for Equ c 4. Results were analyzed using multiple linear regression models for hair samples and the Mann Whitney U test for airborne samples.ResultsHorse antigen and allergen levels differed up to four orders of magnitude between individual animals. Despite enormous variability, levels of HD antigen, Equ c 1 and Equ c 4 in hair were significantly related to the breed and gender combined with the castration status of male animals. Curly Horses had significantly higher concentrations of all three tested parameters compared to the majority of the investigated breeds (medians: 11800 μg/g for HD antigen, 2400 μg/g for Equ c 1, and 258 kU/g for Equ c 4). Tinker Horses, Icelandic Horses and Shetland Ponies were associated with approximately 7-fold reduced levels of HD antigen and Equ c 1, and up to 25-fold reduced levels of Equ c 4 compared to Curly Horses. Compared to mares, stallions displayed increased concentrations of HD antigens, Equ c 1 and Equ c 4 by a factor 2.2, 3.5 and 6.7, respectively. No difference was observed between mares and geldings. No differences in airborne allergen concentrations collected with personal nasal filters during grooming were found between Curly and Quarter Horses.ConclusionBreed and castration status had a significant influence on the antigen and allergen levels of horse hair. However, these differences were smaller than the wide variability observed among individual horses. Compared to other breeds, Curly Horses were not associated with lower allergen levels in hair and in air samples collected during grooming. Our approach provides no molecular explanation why Curly Horses are considered to be hypoallergenic.

The observation that the membranes of flagella are enriched in sterols and sphingolipids has led to the hypothesis that flagella might be enriched in raft-forming lipids. However, a detailed lipidomic analysis of flagellar membranes is not available. Novel protocols to detach and isolate intact flagella from Trypanosoma brucei procyclic forms in combination with reverse-phase liquid chromatography high-resolution tandem mass spectrometry allowed us to determine the phospholipid composition of flagellar membranes relative to whole cells. Our analyses revealed that phosphatidylethanolamine, phosphatidylserine, ceramide and the sphingolipids inositol phosphorylceramide and sphingomyelin are enriched in flagella relative to whole cells. In contrast, phosphatidylcholine and phosphatidylinositol are strongly depleted in flagella. Within individual glycerophospholipid classes, we observed a preference for ether-type over diacyl-type molecular species in membranes of flagella. Our study provides direct evidence for a preferential presence of raft-forming phospholipids in flagellar membranes of T. brucei.

[b]Introduction[i][/i][/b][i]. Borrelia burgdorferi [/i]sensu lato (s.l.) and Anaplasma phagocytophilum are well known zoonotic pathogens, whereas[i] Ehrlichia canis[/i] is usually considered to be of veterinary concern, although on the basis of recent reports it also seems to be able to infect humans. [b]objective[/b]. The aim of the study was to determine the seroprevalence of [i]B. burgdorferi [/i]s.l., A. phagocytophilum and [i]E. canis[/i] in an Italian canine population, and to verify if there are differences between dogs living in urban areas and those from a rural environment. [b]materials and method.[/b] Blood sera of 1,965 dogs, 1,235 from cities and 730 from rural areas, were tested by indirect immunofluorescent assay (IFAT). [b]results[/b]. The overall seroprevalence was highest for E. canis (7.07%), followed by [i]A. phagocytophilum[/i] (4.68%), and [i]B. burgdorferi[/i] s.l. (1.47%). Rural dogs showed the highest seroprevalence to [i]B. burgdorferi[/i] s.l. and [i]A. phagocytophilum[/i]. No significant differences were observed between rural and urban [i]E. canis[/i]-positive dogs. A low percentage (1.32%) of dogs with dual seropositivity was detected, and no triple positive reactions were observed. No significant differences were detected in the seroprevalence of the three agents in relationship to the age and gender of the dogs. Seroprevalence in the five years considered were not statistically different, except for the lowest rate for [i]E. canis[/i] observed in 2012. [b]conclusions[/b]. The results confirm the presence of [i]B. burgdorferi[/i] s.l., [i]A. phagocytophilum[/i] and [i]E. canis[/i] in Italian dogs in both urban and rural areas. Monitoring pet dogs, which share the same environment with their owners, is useful for identifying the presence of tick-borne disease agents of both veterinary and public health significance

[b]introduction and objective[/b]. The relationship between allergic rhinitis and allergic asthma is well characterized. However, it remains unknown whether an association exists between symptoms of upper and lower airway diseases and occupational bioaerosol exposure beyond the scope of allergy. [b]materials and methods[/b]. The current cross-sectional study focuses on 190 current and 59 former compost workers exposed to bioaerosols. Work-related symptoms indicative of conjunctivitis, rhinitis and lower airway irritation were assessed and compared with 38 non-exposed control subjects. Allergic asthma was diagnosed using a calculated score, and chronic obstructive pulmonary disease (COPD) was spirometrically determined. [b]results.[/b] 12 current, 8 former and 5 non-exposed subjects were diagnosed with allergic asthma and excluded from further analysis. Multivariate logistic regression models suggested that cough and chronic bronchitis in current compost workers were associated with eye irritation (OR 2.75 (0.93–8.07); OR 7.22 (1.12–46.5)). Chronic bronchitis in former workers was strongly associated with work-related eye irritation (OR 38.6 (1.33- >1000) and nose irritation (OR 25.0 (1.21–513)). [b]conclusions[/b]. After excluding allergic asthmatics, there was no evidence that eye or nose irritation was due to an underlying atopic disease, but rather to non-allergic mucous membrane irritation syndrome. Therefore, the higher incidence of chronic bronchitis in former compost workers may reflect a chronic irritative process triggered by exposure to bioaerosols.

The purpose of the article was to verify whether the object-based costing provides information about the costs and benefits that arise in the enterprise as a result of activities related to environmental and socio-economic factors. The constructive approach method was used for this purpose. The object-based costing model for healthcare providers has been designed and subjected to empirical verification. The critical analysis proved its usefulness for economic evaluation of sustainable development. The obtained results demonstrate its utility and applicability.

A new precipitation climatology (DWD/BfG-HYRAS-PRE) is presented which covers the river basins in Germany and neighbouring countries. In order to satisfy hydrological requirements, the gridded dataset has a high spatial resolution of 1 km2 and a daily temporal resolution that is based on up to 6200 precipitation stations within the spatial domain. The period of coverage extends from 1951 to 2006 for which gridded, daily precipitation fields were calculated from the station data using the REGNIE method. This is a combination between multiple linear regression considering orographical conditions and inverse distance weighting. One of the main attributes of the REGNIE method is the preservation of the station values for their respective grid cells. A detailed validation of the data set using cross-validation and Jackknifing showed both seasonally- and spatially-dependent interpolation errors. These errors, through further applications of the HYRAS data set within the KLIWAS project and other studies, provide an estimate of its certainty and quality. The mean absolute error was found to be less than 2 mm/day, but with both spatial and temporal variability. Additionally, the need for a high station network density was shown. Comparisons with other existing data sets show good agreement, with areas of orographical complexity displaying the largest differences within the domain. These errors are largely due to uncertainties caused by differences in the interpolation method, the station network density available, and the topographical information used. First climatological applications are presented and show the high potential of this new, high-resolution data set. Generally significant increases of up to 40% in winter precipitation and light decreases in summer are shown, whereby the spatial variability of the strength and significance of the trends is clearly illustrated.

OBJECTIVES: Wood dust exposure may cause Immunoglobulin E (IgE)-mediated allergic diseases. Our objectives were to estimate pine and beech dust sensitization rates among woodworkers and a reference group, explore the association between exposure and sensitization and between sensitization and respiratory symptoms, and finally investigate the impact of proteinogenic specific IgE (sIgE) epitopes on respiratory symptoms. METHODS: In a Danish study among 52 furniture factories and 2 reference factories, we evaluated the workers’ asthma and rhinitis status using questionnaires and blood samples collected from 1506 woodworkers and 195 references. Workers with asthma symptoms (N=298), a random study sample (N=399) and a random rhinitis sample (N=100) were evaluated for IgE-mediated sensitization to pine and beech dust. RESULTS: The prevalence of pine and beech sensitization among current woodworkers was 1.7 and 3.1%, respectively. No differences in sensitization rates were found between woodworkers and references, but the prevalence of wood dust sensitization was dose-dependently associated with the current level of wood dust exposure. No relation was observed between wood dust sensitization per se and respiratory symptoms. Only symptomatic subjects had proteinogenic IgE epitopes to pine. Increased odds ratios for sIgE based on proteinogenic epitopes to beech and respiratory symptoms were found, although they were not statistically significant. CONCLUSIONS: Sensitization rates to pine and beech were the same for woodworkers and references but dependent on the current wood dust exposure level. The importance of beech and pine wood sensitization is limited, but may be of clinical significance for a few workers if the IgE epitopes are proteinogenic.

Simulations of the regional climate models CCLM and REMO, forced by different runs of the global model ECHAM5, are used to quantify changes in the local winter gust extremes over the next decades. The horizontal resolution of the models is smaller than 20 km. The gust wind speed conditions are characterised through the comparison of gusts in the control (1971-2000) and the projection period (2021-2050) for the SRES scenarios A1B, A2 and B1. Extreme value statistics is applied to calculate gust wind speeds for different return periods at each grid point. The results show that the individual regional model runs differ considerably in the change signal and the significance of the single simulations is limited to some main features. The spatial variability of the gusts is only marginally influenced by the return period, but the significance decrease with increasing return period. However, the global model determines the general features of the change signal in the individual regional simulations. Therefore a seven member ensemble provides the opportunity to study the main features of the changes in the gust wind speeds. Over Northern Germany, the change between the two periods in wind gust speed for a 10-year return period studied was found to lie between +6 % and −1.5 % with median, 25th and 75th percentile of 1.5 %, 0.7 % and 2.8 %, respectively. This is confirmed by the majority of the model runs. Over the rest of Germany, the results are not uniform. Nevertheless, over some parts over Southern and Central Germany the majority of the simulations projects a slight decrease of gust wind speeds. According to these results, the current high level of storm activity will not substantially drop until 2050 and will even rise in Northern Germany.

Furry mammals kept as pets, farm and laboratory animals are important allergen sources. The prevalence of sensitization to furred mammals appears to be increasing worldwide. Several mammalian allergens from diverse species are well characterized with regard to their molecular structure and immunogenicity, and some are already available for component-resolved allergy diagnostics. The distribution of various mammalian allergens has been extensively studied during the past few decades. Animal allergens were found to be ubiquitous in the human environment, even in places where no animals reside, with concentrations differing considerably between locations and geographical regions. This review presents an overview of identified mammalian respiratory allergens classified according to protein families, and compiles the results of allergen exposure assessment studies conducted in different public and occupational environments.

BackgroundIndoor air quality has an effect on respiratory health. Children are more vulnerable to a decreased indoor air quality as their lungs are still developing. We measured levels of allergens and β-(1,3)-glucans in 19 school buildings and determined whether measured levels could be reproduced. School levels were compared to those in 169 homes and the effect of building characteristics on both home and school exposure was explored.MethodsElectrostatic Dust fall Collectors were placed in school buildings for 8 weeks and in homes for 2 weeks to collect settled airborne dust. Cat, dog, and mouse allergen levels, domestic mite antigen levels and β-(1,3)-glucans were measured in the extracts from the collectors. Results were corrected for sampling duration. Using questionnaire data, relations between measured levels and building and classroom characteristics were explored.ResultsIn schools, exposure levels were highest in classrooms and were influenced by the socioeconomic status of the children, the season measurements were performed, moisture status of the building and pet ownership. Repeated measurements in different seasons and over the years showed significantly different levels. Home exposure was influenced by socioeconomic status, occupancy and pet ownership. Domestic mite antigen was found in higher levels in extracts from homes compared to schools while pet allergen levels were 13 times higher in schools compared to homes without pets. For mouse allergen overall levels of exposure were low but still two times higher in schools compared to homes. Levels of β-(1,3)-glucans were also approximately two times higher in schools than in homes.ConclusionExposure levels of several allergens and β-(1,3)-glucans in schools differ over time and are higher than in homes. For children, exposure levels measured at school could contribute to their total exposure as especially animal allergen levels can be much higher in schools compared to homes.

In rooms with moisture damage, the indoor air can be enriched with microorganisms causing a variety of symptoms. Due to the highly diverse composition of bioaerosols and the multiple effects on humans, an assessment of the health risk is not sufficiently possible. The aim of this study was to characterize the features of innate immunity using blood from subjects exposed to moisture damage compared to control subjects living in houses without visible moisture damage. We investigated the expression of TLR-2, TLR-4 and dectin-1 on the surface of monocytes from both fresh blood and after in vitro stimulation with the model substances E. coli endotoxin, zymosan A, Pam3Cys and Aspergillus versicolor in 25 exposed subjects and 25 control subjects. In vitro stimulation of whole blood with the same components was performed for 20 h and the release of inflammatory mediators IL-8 and IL-1β were quantified. In addition to an enhanced number of blood leucocytes, the expression of the receptors TLR-2, TLR-4 and dectin-1 on blood monocytes was significantly enhanced in exposed subjects. In contrast, no different alteration in expression was detected between exposed and control group after in vitro stimulation with the model substances. The release of IL-8 and IL-1β after stimulation of whole blood with A. versicolor was increased in subjects exposed to moisture damage. Furthermore, in the exposed subjects the IL-1β release was significantly enhanced after in vitro stimulation with E. coli endotoxin (1000 pg/mL). In conclusion, features of the innate immune system (receptor expression and mediator release of monocytes) are altered in subjects exposed to moisture damage which may be a potential explanation for the increased incidence of respiratory health diseases observed in these populations.

ObjectivesAllergens produced by domestic mites (DM) are among the most common allergic sensitizers and risk factors for asthma. To compare exposure levels between workplaces and living areas a new assay able to measure airborne DM antigen concentrations was developed.MethodsAt workplaces and in living areas, 213 floor dust samples and 92 personal inhalable dust samples were collected. For sensitive quantification of DM antigens, a new enzyme immunoassay (EIA) based on polyclonal antibodies to Dermatophagoides farinae extract was developed. Reactivity of five house dust mite and four storage mite species was tested. All dust samples were tested with the new EIA and with the Der f 1 and Der p 1-EIAs (Indoor Biotechnologies, UK) which detect major allergens from D. farinae and D. pteronyssinus by monoclonal antibodies. Samples below the detection limit in the DM-EIA were retested in an assay variant with a fluorogenic substrate (DM-FEIA).ResultsThe newly developed DM-EIA detects antigens from all nine tested domestic mite species. It has a lower detection limit of 200 pg/ml of D.farinae protein, compared to 50 pg/ml for the DM-FEIA. DM antigens were detected by DM-EIA/FEIA in all floor dust and 80 (87%) of airborne samples. Der f 1 was found in 133 (62%) floor dust and in only 6 airborne samples, Der p 1 was found in 70 (33%) of floor samples and in one airborne sample. Der f 1 and DM concentrations were highly correlated. DM-antigens were significantly higher in inhalable airborne samples from textile recycling, bed feather filling, feed production, grain storage and cattle stables in comparison to living areas.ConclusionsA new sensitive EIA directed at DM antigens was developed. DM antigen quantities were well correlated to Der f 1 values and were measurable in the majority (87%) of airborne dust samples. Some workplaces had significantly higher DM antigen concentrations than living areas.

OBJECTIVE: The quality of life (QOL) and work ability of health care workers allergic to natural rubber latex (NRL) were assessed after implementation of regulations on powder-free NRL gloves in Germany. METHODS: 196 HCW with reported NRL allergy answered a questionnaire (response rate 58%) containing the Work Ability Index (WAI), Mini Asthma Quality of Life Questionnaire (MiniAQLQ), and Dermatology Life Quality Index (DLQI). RESULTS: 63.2% still had NRL-related symptoms during the last 6 month. However on a scale from 0 to 10, the intensity of NRL-related symptoms decreased from 8.5 before to 2.3 after implementation of regulations on powder-free NRL gloves. A higher number of subjects were able to avoid NRL in the private than in the work environment (85% vs. 61%). NRL-related symptoms decreased and WAI increased with successful avoidance of NRL at workplace (b = 0.23, p = 0.003). QOL was only little affected by NRL allergy (mean: MiniAQLQ = 6.0; DLQI = 4.1). CONCLUSIONS: Although there was improvement after implementation of powder-free NRL gloves, there is still a considerable number of HCW with NRL-related symptoms. Further investigations on latex avoidance and the cause of persisiting allergic symptoms in HCW with NRL allergy are therefore needed.

High-resolution (5×5km2$5\times5\,\text{km}^2$) gridded daily data sets of surface air temperature (DWD/BfG-HYRAS-TAS) and relative humidity (DWD/BfG-HYRAS-HURS) are presented in this study. The data sets cover Germany and the bordering river catchments and last from 1951 to 2006. Their data bases consist of daily station observations from Austria, Belgium, Czech Republic, France, Germany, Luxembourg, the Netherlands and Switzerland. The interpolation of the measurement data to the regular grid is performed using a method based upon Optimal Interpolation. A first climatological analysis for Germany and Central European river catchments of first and second order is performed. For the Rhine river catchment a summer mean temperature of 16.1 °C and relative humidity of 74 % are found. In contrast, the mean temperature of heat summer 2003 amounts to 19.9 °C with a related relative humidity of 65 % in this river catchment. The extreme character of this summer is also remarkable in the presented climate indices, e.g., the increased amount of summer hot days. The first validations of both data sets reveal a bias within the range of the provided data precisions. In addition, an elevation dependency of error scores is identified for temperature. Error scores increase with an increasing station height because height differences between station and grid cell increases with height. A comparison of HYRAS-TAS to another gridded temperature data set reveals a good agreement with again fewer differences at lower altitudes. The presented DWD/BfG-HYRAS data sets have a high spatial and temporal resolution which is unique for Germany and the bordering river catchments so far. They have a high potential for detailed studies of smaller scale structures in Central Europe and are already used as input for hydrological impact modelling, as climatological reference and for bias correction of regional climate models within the German research project KLIWAS. HYRAS-TAS and HURS are part of the DWD/BfG-HYRAS data set which will finally include high-resolution gridded daily data of precipitation, temperature, relative humidity, solar radiation and wind speed.