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Motor Spinal cord and deep brain stimulation can be of reorganization of the dorsal horn safe 20 mg apcalis sx, and (d) changes benefit in selected patients generic apcalis sx 20 mg on line. Lumbar sympathetic blocks as standard treatment until the offending agent is even with passive range of motion order cheapest apcalis sx. The greatest benefit i s derived when fracture 20mg apcalis sx with mastercard, nerve injury (defining type 2), and stroke nail and hair growth abnormalities, and they are used in the context of a pain management with significant paresis. Pregnancy has been associated with pelvis and the lower limb, and this study can also exclude a focal inflammatory or infectious process. Any disease associated with a small fiber neuropathy, such as diabetes and collagen- vascular disorders. Typically a nonsedating tricyclic is administered Spinal cord stimulation in patients with chronic during the day such as imipramine or This drug is most often effective when sympathetic blocks have produced pain relief. The total Intrathecal baclofen for the treatment of dystonia tricyclic dosage usually begins at 20 to 30 mg Calcitonin:the only other agent with significant in patients with :,.. Neurol Clin 1998; prolongation, hypertension or hypotension, for particular movement disturbances. N/A Selective serotonin reuptake inhibitors: generally not used to treat pain directly, with the possible exception of venlafaxine, but can be very helpful in high doses to manage concomitant Follow-Up depression. May be used in double the usual dose to treat depression, to achieve the desired pain control. Drugs should be regular follow-up with their primary care physician, started at the lowest available dose and with support from the pain specialist as needed. Incidence/Prevalence with a deficiency of a-methylacyl-CoA racemase Dietary treatment needs to be Lifelong. There may be a number of disease, other hereditary neuropathies, and vitamin deformities may be necessary in some patients. Point characteristic shortening of the fourth toe, which can mutations and deletions have been described. This results in Nerve conduction studies show evidence of a accumulation of phytanic acid with elevated levels in demyelinating neuropathy. Plasma levels of phytanic acid are The mechanism of phytanic acid toxicity is unclear. Clinical and biochemical heterogeneity in conditions with phytanic acid accumulation. Tricyclic be awakened by the sensations or they may occur choice of which type of movement to perform. Other conditions with less well- Symptoms are worse at rest with partial and immediately quenched by movement of the extremity established associations include: but frequently returns when movement ceases. Age without symptoms followed by nightly Although the syndrome tends to appear in middle occurrences. Symptoms are less prominent at night, restlessness, and worsening of the symptoms at relatives with similar symptoms, suggesting a genetic and consequently there is less sleep disturbance. In contrast, families have been associated with distal sensory loss or abnormal reflexes. A French-Canadian family was reported described as aching pain in the feet or toes with apparent autosomal-recessive mode of associated with involuntary writhing movements. An increase in right atrial filling pressures with subsequent increase in paraspinal venous volume associated with lumbar stenosis has been cited as the cause. The starting dose is 100 mg patient and bed partner about the quality of sleep evidence that daily vigorous exercise may improve levodopa and 25 mg carbidopa. Tardive dyskinesia, a possible Hot baths or cold or hot compresses to the long-term side effect of L-dopa, does not usually limbs. Clinical There is a 10% incidence of orthostatic symptomatology and treatment of restless legs hypotension with use of the dopamine agonists. This often causes the release of directly, but may also cause ischemia to the hemoglobinuria and porphyria. A history of myoglobin into the circulation and then into the muscle, resulting in muscle infarctions. Extreme recurrent pigmenturia suggests an inborn error in urine, resulting in myoglobinuria. Lipid-lowering Rhabdomyolysis that causes myoglobinuria often agents, especially in combination with fibrates, may causes severe myalgias and muscle swelling. Often Because of the many causes of rhabdomyolysis, the the patient is unable or unwilling to move due to exact incidence is unknown. Compartment cause of rhabdomyolysis associated with certain Pregnant women with carnitine syndrome may lead to arterial and nerve types of inhaled anesthetics. Although traumatic palmitoyltransferase deficiency or compression with near irreversible damage to the injury is the most frequent cause of a single myophosphorylase deficiency may benefit from limb. A drop in urine output is a warning of episode of rhabdomyolysis, many toxins, drugs, intravenous glucose at the time of delivery. With rhabdomyolysis, large infections, and metabolic derangements may releases of potassium from the muscle may cause induce the syndrome. Disseminated intravascular Genetics Acute renal failure coagulation is a rare complication. The glycolytic Compartment syndromes urine myoglobin are greater than 100 g/mL. More recently, rhabdomyolysis with mitochondrial and respiratory If the history suggests recurrent episodes of chain disorders have been described. Other rhabdomyolysis, a muscle biopsy with routine biochemical defects can cause recurrent episodes histochemistry and quantitation of enzymes including deficiencies of glucose-6-phosphate associated with rhabdomyolysis should be done. Compartment syndrome requires emergent several days after the onset of the illness. Myalgias often respond to intravenous fluid Patients with inborn errors of metabolism or a Neuropsychopharmacology 1996;15:395-405. Muscle Nerve 2002;25: 332- monitoring of renal function until the severity of the episode is determined. In severe synovitis of the spine typically occurs in the the severity of local synovitis. Tarsal tunnel syndrome presents as Incidence/Prevalence in women who use oral contraceptives. Age Serologic testing for rheumatoid factor and Diagnosis other autoantibodies is necessary. Cord and nerve compression is more likely to occur if there is an atlanto-dens Somatosensory evoked potentials can evaluate the involvement of the longitudinal ligaments, vertebral interval of greater than 9 mm. Peripheral neuropathy results from neck pain with radiation to the occiput and scalp. Nerve entrapment syndromes arise from Later signs of progression to cord compromise accurate method to diagnose compression inflamed synovial sacs and can affect the median, include myelopathy, lower motor neuron injury at neuropathies and peripheral neuropathies. Intradural spinal nodules can cause nerve root compression, spinal stenosis, and cord compression. Neurologic C1-2 arthrodesis stabilizes the atlantoaxial complex and usually eliminates occipital pain. The indications for surgery include basilar Follow-Up Rheum Dis Clin North Am 1993;19: 955-973. The surgical management instability, intractable neck and head pain, of patients with rheumatoid cervical spine vertebral artery compromise, and asymptomatic disease. The prognosis of the most likely subgroup to require admission, rheumatoid vasculitis is poor. Moderate to etiology characterized by multisystem granulomas that act as space-occupying lesions. Entities to be considered mononuclear and of the T-cell type, mostly of systemic involvement. Some B ce lls are evident parts of the nervous system including the brain, cryptococcosis, histoplasmosis, as well. Lyme disease; inflammatory disorders including and the presence of oligoclonal bands. Multiple In every patient with suspected sarcoidosis of southeastern part of the United States. Optic neuritis occurs, especially in phenotyping of the washed cells, and liver or A slight preponderance is reported in females.

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Interspecies pardinus) and non-natural mortality in central-southern transmission of cytauxzoon felis order 20 mg apcalis sx. A review of parasites in selected species of virus outbreak in the Doana Iberian lynx population purchase cheap apcalis sx on-line, in: game and protected mammals in the Bialowieza Forest (in Vargas purchase 20mg apcalis sx visa, A cheap apcalis sx 20 mg online. Retrovirus infections in non- domestic felids: Serological studies and attempts to isolate Mrner, T. Feline leukemia virus and other pathogens as important threats to the survival of the critically endangered Munson, L. Prevalence of antibodies to Toxoplasma gondii among bobcats of west Virginia and Meli, M. Serological survey of Toxoplasma gondii infecton in free-ranging Eurasian lynx (Lynx lynx) from Sweden. Journal of Helminthology 72, 47- and diseases in free-ranging Eurasian lynx from Switzerland 53. Verhandlungsbericht des Internationalen Symposiums ber die Erkrankungen der Zootiere 43, 300-304. Emergence of coprological study on helminth fauna in Eurasian lynx (Lynx congenital malformations in free-ranging lynx (Lynx lynx) lynx) from the Bialowieza Primeval Forest in Eastern Poland. Epizootiologic investigations of selected Beitrge zur Jagd- und Wildforschung 26, 281-298. Status and conservation of the the 1st workshop on lynx veterinary aspects, Doana, 4-6 Eurasian lynx (Lynx lynx) in Europe in 2001. Los incentivos para estos avances se derivan principalmente de los esfuerzos comerciales dirigidos a mejorar la produccin ganadera y tambin a resolver problemas sanitarios en humanos. En el sector ganadero, por ejemplo, la inseminacin artifcial ha permitido una amplia distribucin de genes (esperma) procedentes de padres particularmente aptos por ser genticamente superiores. Mediante la transferencia de embriones, se ha conseguido que hembras reproductoras 293 que normalmente slo tenan algunas cras a lo largo de su vida produzcan una gran progenie. La crioconservacin del esperma y los embriones ha permitido que, tanto en el ganado como en la especie humana, se pueda regular el momento de la reproduccin, en ocasiones incluso a lo largo de varias generaciones. Para las especies amenazadas en colecciones ex situ, el objetivo no es slo obtener un mayor nmero de cras, sino cras con un origen conocido y un genotipo adecuado para conservar la integridad de la especie, subespecie o poblacin. Esto a menudo implica cruzar dos individuos que tienen el genotipo adecuado pero tal vez sean sexualmente incompatibles o estn separados fsicamente por grandes distancias. Tambin puede ser ventajoso conservar a largo plazo los genes de un individuo valioso para incorporarlos peridicamente a la coleccin con el fn de maximizar su vigor gentico. Por la misma razn, puede ser til cruzar individuos o poblaciones en centros de cra con individuos que viven en estado silvestre. Los responsables de la gestin de especies silvestres deben tener en cuenta todas estas cuestiones. Desde hace ya bastante tiempo, las tecnologas reproductivas se consideran como una forma de ayudar al manejo gentico y la reproduccin de las especies amenazadas. Hasta el momento, las tcnicas de reproduccin asistida utilizadas de forma habitual en especies domsticas no han sido fciles de adaptar a las especies silvestres. Las diferencias entre especies en cuanto a la forma (anatoma/morfologa) y la funcin de la reproduccin (mecanismos que regulan el xito reproductor) limitan la aplicabilidad prctica de dichas tcnicas para la obtencin de progenie. Por lo tanto, el factor limitante es la falta de conocimientos bsicos sobre miles de especies que no han sido objeto de estudio, lo cual constituye la base esencial para la mejora de la reproduccin. Actualmente, existen claras evidencias de que las tecnologas reproductivas son de gran utilidad para estudiar cmo se reproducen las distintas especies, sobre todo cuando se defnen mecanismos nuevos y nicos. En este captulo, se analiza la situacin y relevancia de distintas tecnologas reproductivas tiles o prometedoras para felinos silvestres, con el fn de conseguir mejoras en su reproduccin, gestin y conservacin. Las tecnologas reproductivas son particularmente valiosas para esclarecer dichas diferencias fundamentales en las funciones biolgicas bsicas. Incentives largely have been derived from commercial efforts to increase livestock production and addressing human health issues. The ability to cryopreserve sperm and embryos permitted livestock managers and human couples to regulate the timing of offspring production, sometimes spread over generations. Compared with assisting livestock and humans, management and conservation of wildlife species have more complex expectations and logistics. For endangered species maintained ex situ, the aim is not only to produce more young, but offspring of known provenance and genotype that will preserve species integrity. This often requires the breeding of individuals of appropriate genotype, but which may be sexually incompatible or physically separated by distance. It also may be advantageous to preserve the genes of an individual for long durations to be periodically infused back into the collection to maximize genetic vigor. Reproductive technologies have long been considered a means of assisting in the genetic management and propagation of endangered species. So far, techniques that are routine in domesticated species are not easily adapted to wildlife. Species differences in reproductive form (anatomy/morphology) and function (mechanisms regulating reproductive success) limit practical applicability. The limiting factor is the lack of basic knowledge about thousands of unstudied species, the essential foundation to allow reproduction to be enhanced. There is excellent evidence that reproductive technologies are most useful as tools for studying how different species reproduce, especially defning unique mechanisms. Here, we review the relevance of various reproductive technologies for improving reproduction, management and conservation of wild felids. It is clear that species within the Felidae family vary markedly in reproductive mechanisms. Reproductive technologies are most valuable for elucidating these fundamental differences in basic biological function. The causes of population declines largely are related to habitat loss and fragmentation, although some wild cat species continue to be relentlessly persecuted by humans. While declines in wild felid numbers are signifcant, cats in general have the advantage of being charismatic, and their predatorial features (even the homicidal trait of 295 some of the great cats) intrigues us. In short, people generally like or at least tolerate felids, and this interest is advantageous to scientists who study and conserve wild felids. The public often is sympathetic to saving the worlds wild felids, and this attention often can be translated into helpful conservation policy or even fnancial support. Because reproduction is a key factor to species success, understanding how cats reproduce T helps to produce strategies for conservation and management. Much of the work in our laboratory is driven by the value of the domestic cat as a human biomedical model, especially for metabolic defects analogous to human congenital errors (e. However, most interesting have been the comparisons in reproductive phenomena between the domestic cat and its wild counterparts, as well as examining the utility of reproductive technologies for propagating and improving genetic management. Reviews of the roles of the reproductive sciences and related technologies for wild animal species are available from many sources, the most complete being a compendium for diverse taxa by Holt et al. There are two recently published articles on the value of conventional reproductive technologies for wildlife (Pukazhenthi and Wildt, 2004) as well as emerging techniques (Pukazhenthi et al. In this chapter, we share highlights of more than 25 years of experience on the value of such technologies for understanding, managing and conserving wild felids. This was a particularly serious gap in information because cats evolved throughout the world from within varied habitats and into wonderfully diverse morphotypes. Everyone assumed that all cats reproduced in a similar fashion, that is, males produced sperm throughout the year, but females were seasonal breeders and induced ovulators (the ova released in response to copulation). As recently as 1980, there were no clues about hormonal control of reproductive events in wild cats. Most scientists believed that it would be virtually impossible to study hormonal patterns in, for example, tigers. Zoos were realizing the need to become conservation catalysts rather than wildlife exploiters. It suddenly was anathema to take from nature, but rather to focus on developing self-sustaining wildlife populations that, in turn, were ambassadors for the wild that served to educate the public. If no more animals were to be removed from nature, then managers soon realized the need to develop state-of-the-art approaches for maintaining healthy populations of these complex species in artifcial environments. The concept of Species Survival Plans emerged, essentially the formation of zoo consortia that shared animals for breeding to maximize genetic heterozygosity.

Zapping Parasites Zapping is a way of killing bacteria and parasites electri- cally purchase generic apcalis sx online. You can make a zapping device yourself; the instructions are given in The Cure For All Cancers; total cost is around $35 20mg apcalis sx with amex. But some locations that are not reachable are tooth crevices proven apcalis sx 20mg, the intestinal tract order apcalis sx 20 mg online, gallstones, and the inside of tumors. In fact, I have preliminary evi- dence that zapping can raise immunity by removing the abnor- mal coating of ferritin on the outside of white blood cells. The reason for doing three seven minute sessions is that bacteria typically emerge from parasites that are killed. You can zap more than once a day or continually if you wish, but be sure to zap at least once a day. Because your own tumors will be reinfecting you, you need to mop up daily as well as kill parasites until tumors have shrunk. Because cysteine is a reducer and ozonated oil an oxidizer, they must not be taken together to retain effectiveness. Ozonated oil gives you oxidizing power that reaches into distant places like bile ducts. Since they have oppo- site actions, they must be kept apart for at least five hours. The cysteine should be the L variety, like l-cysteine, not d-cysteine which is unnatural. Ozonated oil gives you no noticeable side effects, but it should not be taken more than necessary. One could expect the extra oxygen to jump across from oil molecules to your fat molecules, aging them too soon. Yet it is advisable to take vitamin E (see Sources), a known anti-oxidant, after taking ozonated oil. Ozonated oil is not generally available in health food stores, and even if it were, it may have a short shelf life. I have not re- searched the effectiveness of ozonated olive oil kept at room temperature for more than a day, or refrigerated for longer than a week, or in the freezer for more than a month. Attach an aerator to the end of your ozonator hose and drop it to the bottom of the olive oil. So you may be tempted to skip the one tablespoon of ozonated olive oil that is required. Remember, it should be taken at least five hours after cysteine to avoid clashing with it. Reap The Benefits Killing Ascaris means you have gotten rid of 1,10- phenanthroline. Without phenanthroline in your vital organs, you are no longer attracting and chelating your precious iron and copper; more will be left for you instead. Without this inter- ference, your bone marrow, liver, and spleen can begin to regu- late your most vital functions again. Killing tapeworm larvae means you have gotten rid of phor- bol and dibenzanthracene from your vital organs, two other powerful mutagens. Without both parasites, p53 mutations are all but gone, only waiting for vanadium (dental) to be removed. Killing rabbit flukes means you are no longer bringing Clostridium nor Streptococcus into your body for distribution to teeth, colon, or tumors. While clostridia are our tumor-causing bacteria, streptococci are our pain-producers. Streptococci produce phenol which not only causes pains of many kinds, but also ages us. Phenol, al- though considered a reducer in regular chemistry, oxidizes our vitamin C into toxic oxidation products that cause wrinkling of skin, cataract formation and other aspects of aging! Perhaps health and youth would stay much longer in humans if we didnt regard Clostridium and Streptococcus as being normal colon flora! Stay Clean In all cases, where I have seen that a cancer victim did not get good results after using the parasite program and zapper de- scribed in The Cure For All Cancers, I found remaining para- sites! So I conclude that the biggest problem for a cancer suf- ferer is the ease with which they can become reinfected from food and their own tumors! The sources of reinfection with Ascaris, tapeworm, and rab- bit fluke eggs are so pervasive, you may reinfect faster than you can eliminate them! A glass of milk, a cheese sandwich or a green salad will reinfect you in five minutes if they are not ster- ilized first. Cancer victims have no ability to kill these para- sitestheir immune powers are gone! For a cancer patient, swallowing a few Ascaris eggs is equivalent to swallowing a few cholera bacteria or the ebola vi- rus. Manure does not simply wash off lettuce and strawberries as you clean them under the kitchen faucet. Remove the bedroom carpet, get a new mattress, dry clean the blankets and small rugs (laundering does not kill Ascaris eggs). Sterilize other carpets with a special stain-free iodine so- lution added to the carpet shampoo mixture (see Recipes). It is a good disinfectant, but supermarket bleach is itself polluted with heavy metals, solvents and dyes; besides, you would get too much chlorine. A one minute dip in very dilute Lugols solution or hydro- chloric acid kills everything it reaches. Our traditional methods of food preparation have never tried to make food sterile. That is why hospitals heat surgical instruments to 250F in a special pressurized oven called an autoclave instead of simply boiling at 212F. Even baking seldom raises the internal temperature of meats or other foods higher than 180F even if the temperature is set to 400! If you neglect sterilizing your fruits and vegetables, you can assume you have Ascaris, tapeworm eggs, and rabbit fluke eggs againimmediately repeat the parasite program. Kosher Foods to the Rescue During my testing foods labeled with a Kosher symbol were found to be far superior in cleanliness and purity. The second, your food, will be discussed in more detail in the Tumor Shrinking Diet chapter. After your body has been cleared of pathogens and toxins, your tumors must shrink. The contents must be detoxified and cleared slowly, in order not to overburden your vital organs. But before going on to the de- tailed instructions, we must pay attention to pain. You may be in excruciating pain, and on morphine because no other painkiller touches it. If a cancer sufferer has decided to give up the battle, this wish should be understood and re- spected. The simple act of pulling infected teeth can reduce the pain to half within hours even though the pain is at the hip or abdomen, far away from the teeth. They reside in numerous little pockets all over our bodies, even if we consider ourselves well, making phenol. When the phenol can no longer be detoxified at some location, it builds up to produce pain. Yet in a week you could be in a lot less pain by taking inositol and oregano oil before meals plus cayenne capsules with meals. Oregano oil may be taken as 3 drops placed in an empty capsule for moderate pain; 20 drops for severe pain, followed by bread. The cayenne dose must be worked up gradually to get to a dosage of six capsules three times a day for three days in a row. It is often due to the presence of asbestos or lanthanide metals, namely, local lack of immune power. I believe our major source of asbestos is food that has rolled along old asbestos-containing conveyor belts. Sticky foods like sugar pick it up and spread it to all sweetened foods in the mar- ketplace. Wherever a minuscule tuft of asbestos lands in your body, there is a location of low immunity because the local white blood cells (our immune soldiers) become coated with ferritin. Lanthanide metals ride along with fruit and vegetable dyes used to intensify their color, and with pesticide.

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The injured person worked as a mechanic for 9 months apcalis sx 20mg cheap, which involved static fixation of the upper arms above 60 degrees for the major part of the working day purchase apcalis sx cheap online. He developed a right-sided shoulder tendinitis buy apcalis sx 20 mg low cost, and there is good correlation between the onset of the disease and the performance of the work order generic apcalis sx pills. Example 23: Recognition of rotator cuff syndrome (insulation worker for 1 year) A 27-year-old woman worked as an insulation worker for well over 1 year. She held her upper arms lifted towards the ceiling for the major part of the working day. The claim qualifies for recognition on the basis of the list of occupational diseases. The injured person performed work that was characterised by static fixation of the upper arms above 60 degrees, for the major part of the working day, for well over 1 year. Even though she occasionally lowered her arms, this happened for such a short time that the shoulder did not get the time to rest before the arm was raised again to above 60 degrees. There is furthermore good time correlation between the work and the development of a right-sided rotator cuff syndrome. Example 24: Claim turned down degeneration in the long biceps tendon (plumber for more than 20 years) A 52-year-old man worked for more than 20 years as a plumber in a small business. He developed pain in his right upper arm, and a medical specialist made the diagnosis of right-sided degeneration of the long biceps tendon (biceps tendinitis). The injured person mainly performed varied work as a plumber, the arms only a few times being held statically lifted. Apart from that, there is no information of other work functions that were stressful for the upper arms. The work cannot be characterised as repetitive and strenuous, shoulder-loading work, in any combination with awkward work movements or postures. Nor has there been a continued load on the right upper arm in connection with static lifts of the arm to 60 degrees or more for several hours a day for a long period of time. Therefore the exposure has not been relevant for the development of the disease biceps tendinitis. These tendons co-ordinate and stabilise the joint and the movements together with other muscles around the shoulder joint 203 Rotator cuff lesion Fissure or other injury in the rotator cuff Tendinitis Inflammatory degeneration of a tendon The suffix it is Inflammation caused by micro organisms or inflammatory degeneration without micro organisms. Item on the list The following disease of the neck and shoulder region is included, according to the stated exposure, on the list of occupational diseases (group B, item 2): Disease Exposure B. Chronic neck and Quickly repeated movements of shoulder/upper arm, perhaps in shoulder pain combination with bending of the neck and/or static load on the neck and (cervicobrachial syndrome) shoulder girdle, for a considerable number of years 5. The medical diagnosis is made against the background of a combination of The injured persons subjective complaints (symptoms) A clinical, objective examination Symptoms Chronic (daily) pain of the neck and shoulder region Muscle tenderness of the neck and shoulder girdle (see figure below) Any aggravation of pain in connection with load on the region Any restricted motion In order for the disease to be covered by the list, there needs to be chronic (daily) pain. Indication of palpation tenderness in 12 areas of the neck and shoulder girdle (6 on each side), stating in a form, on a scale from 1 to 4, the pain in connection with palpation: 1 = no tenderness 2 = slight tenderness 3 = moderate tenderness 4 = considerable tenderness 2. Indication of the number of tender areas (out of the 12 areas) Before the diagnosis of cervicobrachial syndrome (chronic neck and shoulder pain) can be made, there must be moderate to considerable tenderness of several of the 12 muscle areas of the neck and shoulder girdle as well as moderate to considerable distribution of tenderness to several of the 12 muscle areas 205 The tenderness may be unevenly distributed on the two sides if there is good correlation between the uneven distribution and the load. It is the combination of the severity of the pain and the distribution of pain/tenderness which, together with the relevant exposures at work and the duration of the exposure, makes it possible to make the diagnosis of work-related, chronic neck and shoulder pain. Neck and shoulder pain with no or slight tenderness (rated 1 or 2) limited distribution of moderate to considerable tenderness (rated 3 or 4) to a few muscular areas does not meet the diagnostic requirements to the disease cervicobrachial syndrome (chronic neck and shoulder pain). In addition to palpation tenderness there may be restricted motion of neck and shoulder and/or increased muscular consistency. Restricted motion or increased muscular consistency is not a diagnostic requirement, however. The work may have involved different work functions, and thus a certain job variety, in the course of the working day. If different functions were carried out in the course of the working day, an assessment will be made, for each function, of the concrete load on the neck and shoulder region. The duration of the various types of loads usually needs to be equivalent to at least half of the working day (3-4 hours). To this could be added two other functions without quickly repeated movements of shoulders/upper arms, lasting in total a little less than half of the working day and not meeting the exposure requirements. In this case there is alternation between four different work functions in the course of the working day, two of these functions meeting the relevant exposure requirements. As these two functions at the same time stretch over more than half of the working day, the claim will qualify for recognition on the basis of the list. The time requirements There must have been a load on the neck and shoulder for a considerable period of time. This usually means that neck and shoulder loading work must have been performed a. The total duration requirement in terms of years cannot be reduced to less than 6 years. Particular neck and shoulder exposures that may contribute to a reduction in the time requirement: Extremely quickly repeated movements of shoulders/upper arms Long-lasting bending of the neck Long-lasting, static load on the neck and shoulder girdle Strenuous movements of the shoulder/upper arm A very prolonged, daily exposure (more than 8 hours per day) Extremely quick movements of the shoulder/upper arm usually means at least 25-30 movements of the shoulder/upper arm per minute, or more. Long-lasting and considerable bending of the neck for large parts of the working day, without any chances of restitution (rest) and straightening of the muscles of the neck, may reduce the requirements to the total duration of the exposure, but not to less than 6 years. Besides, a reduction in the time requirement to not less than 6 years will depend on a concrete assessment of the extent and scope of the special neck and shoulder exposures. Other load requirements Quickly repeated movements of the shoulder/upper arm In order for the work to be characterised as relevant neck and shoulder loading work within the meaning of the list, there need to have always been quickly repeated movements of the shoulder/upper arm, of a certain frequency/intensity, for at least half of a normal working day (3-4 hours per day). Movements of the shoulder/upper arm are movements of the shoulder joint and/or the upper arm. This number may be reduced, but not to less than 10 movements per minute, if the work was characterised by special load factors. The following special load factors may contribute to reducing the requirement to the number of repeated movements per minute, but not to less than 10 movements per minute: Bending of the neck A static load on the neck and shoulder girdle Very strenuous movements of the shoulder/upper arm A very prolonged, daily load (more than 8 hours per day) A very prolonged load period (15 years or more) There is no requirement that the quickly repeated movements were made with both shoulders/upper arms. If the load was one-sided, however, it should always be consistent with clear symptoms with regard to the diagnostic criteria for chronic neck and shoulder pain on the side that suffered the relevant exposure. On the other hand, clear symptoms on both sides would not speak against recognition, even if the load was relatively one-sided. The list does not cover monotonous precision work performed close to the body and involving repeated movements of the hand, forearm and/or elbow, or any static load on the neck and shoulder girdle and/or bending of the neck without simultaneous, quickly repeated movements of shoulder/upper arm. Bending of the neck Work with bending of the neck is work that is characterised by being performed in postures where the neck is fixated in a flexed position for some time while quickly repeated movements are being made with the shoulder/upper arm. If the work was generally characterised by bending of the neck, it is possible to reduce the requirement to the number of repeated movements of the shoulder/upper arm per minute, but not to less than 10 movements per minute. Short-term or very slight bending of the neck in the course of the working day will not be characterised as relevant bending of the neck within the meaning of the list. Bending of the neck without simultaneous, quickly repeated movements of the shoulder/upper arm is not covered by the list. Static load on the neck and shoulder girdle Static load on the neck and shoulder girdle means that the work is characterised by working postures where the neck and shoulder girdle is fixated in the same posture for some time while quickly repeated work movements are being made with the shoulders/upper arms. But the work needs to have involved a certain amount of continued fixation of the neck-and- shoulder girdle musculature, in largely the same posture, for long intervals at a time. If the work generally was characterised by a static load on the neck and shoulder girdle, it is possible to reduce the requirement to the number of repeated movements of the shoulder/upper arm per minute, but not to less than 10 movements per minute. A static load on the neck and shoulder musculature without simultaneous, quickly repeated movements of the shoulder/upper arm is not covered by the list. Strenuous movements of the shoulder/upper arm If the work involved quickly repeated movements of the shoulder/upper arm in combination with a certain exertion of the shoulders/upper arms and perhaps also the neck, this might be able to reduce he requirement to the number of repeated movements per minute or the requirement to the duration of the load over time. In order for the work to be characterised as relevantly strenuous with regard to the neck and shoulder musculature, there must always have been strenuous movements of the shoulder/upper arm, but not necessarily exertion of the muscles of the neck. If the work did involve exertion of the neck musculature, however, this will also be included in the overall assessment of the load. In order for the work to be seen as characterised by strenuous movements of the shoulder/upper arm, there needs to have been exertion somewhat in excess of what would normally be required to lift and turn the arm without the influence of particular loads. This applies in particular in cases where the work is characterised by repeated movements without any simultaneous, stressful working postures for the shoulder/upper arm. Relevantly strenuous movements of the shoulder/upper arm may for instance be work that involves a lot of pushing, pulling or lifting with the application of a great deal of muscular force in the shoulder, perhaps with simultaneous twisting and turning movements of the shoulder joint (for instance in connection with deboning in a slaughterhouse). The assessment of whether the work can be regarded as strenuous in a relevant way for the neck and shoulder musculature includes the degree of using muscular force of the shoulder/upper arm and perhaps neck whether the unit offers resistance whether there are simultaneous twisting or turning movements of the shoulder joint and perhaps the neck whether the work is performed in awkward postures of shoulder/upper arm and perhaps the neck, for instance in extreme postures If the work was in general characterised by strenuous movements of the shoulder/upper arm, it will be possible to reduce the requirement to the total duration of the load, but not to less than 6 years.

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