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Following this scheme order serpina 60 caps on-line anxiety symptoms men, the Programme could achieve its population target of 60 individuals by 2009 and reintroduction of captive-raised lynxes could begin in 2010 60 caps serpina amex anxiety synonyms, provided that adequate habitat was prepared order 60 caps serpina otc anxiety symptoms even on medication. Originally cheap serpina 60caps line anxiety symptoms chest pains, modelling predicted the availability of 12 to 13 captive-born lynxes 61 annually from 2011 through 2019 (Lacy and Vargas, 2004). A recent update of the projections, using data from actual captive reproduction over the past 5 years, indicates that the annual number of animals available for release every year will oscillate between 20 and 40 iberian lynxes (Godoy et al. During the past seven years (from Spring 2002 to 2008), the Andalusian government has extracted 26 wild-born iberian lynxes for the captive Breeding Programme; in addition, 10 more lynxes were brought into captivity because they had problems that compromised their survival in the wild (Simn et al. The year 2008 marked the end of the planned extractions of wild lynxes for incorporation into the breeding population; still, those found injured or handicapped with compromised probabilities of survival in the wild will continue to trickle into the Breeding Programme. To provide the captive space needed to achieve the Programmes genetic goals, construction of two new iberian lynx breeding centers Granadilla (Extremadura) y Odelouca (Silves, Portugal) is underway. An additional center in cabaeros (castille-La Mancha) is also scheduled for future construction. All breeding centers are strategically placed so they can be co-managed by administrations that commit to habitat preparation for future reintroductions. All centers considered, the captive population will be managed as a metapopulation, a genetic counterpart to the Sierra Morena and Doana free-ranging populations (Godoy et al. One of the Programmes key husbandry challenges is to strike a balance between fostering natural behaviours in captivity (hunting, territoriality, social interactions, etc. For this reason, the Breeding Programme favours naturalistic enclosures and promotes natural behaviours via environmental enrichment (Manteca, this book; Martos, this book). Some of these include obtaining regular weights by having the lynx step on a measuring scale. Such techniques are designed to avoid using invasive methods, which would stress the animals, and they also serve as a way to strengthen the trust between the animals and their keepers. Special care is taken to avoid domestication of captive lynxes, although this becomes a greater challenge in the case of hand-reared, abandoned cubs (Rivas et al. Breeding season in captivity mostly takes place throughout January and February, with most births occurring in March and April, as it is the case in the wild (Palomares et al. The actual mating period lasts between two and three days during which lynxes copulate an average of 28 times (range: 13-65; n=460 copulatory bouts in 21 pairs; Table 1). Gestation period, counted from the time of the frst copulation, ranges from 63-66 days (n=12). All parturitions that have occurred before 61 gestational days (n=4) have resulted in the birth of either dead or weak and not completely developed young, which were considered premature. Although variation between individuals is very high, most females are very consistent regarding their own timing to enter estrous and regarding the number of days they are gravid (Table 1). Labour during whelping (regarded as the time lapsed between the frst visible contractions until the delivery 63 of the last offspring) varies widely between females, with some of them delivering each young within 10-15 min intervals while others taking up to 9 hours between the delivery of each offspring (Table 1). Primiparous females have a higher rate of failure to raise their young than multiparous ones. Out of the eight females that have whelped at El Acebuche center, only two frst-time mothers Saliega and Aura managed to nurse all their young until weaning age. Two other dams Esperanza and Boj kept only one of their cubs after whelping and abandoned the rest of the offspring in their frst litter, while three other females Adelfa, Aliaga and Brisa miscarried one of their offspring and delivered the rest of the cubs prematurely during their frst gestation. This non-intrusive surveillance system has also allowed us to identify the existence of a sensitive period when iberian lynx cubs become highly competitive to the point of siblicide (Vargas et al. Spontaneous aggression erupted at 44 days of age in the frst iberian lynx litter born in captivity. The largest cub (a female) in a litter of three was killed by a brother who delivered lethal bites to the larynx and skull. Agonistic behaviour has been observed in nine of eleven subsequent iberian lynx litters of two or more cubs, with the most intensive fghting occurring around the end of the sixth and seventh post-natal weeks, respectively (Antonevich et al. This same phenomenon has been observed in the Eurasian lynx by Russian scientists at the Tcherngolovka facility who recorded aggressive behaviour in 16 of 31 litters, with deaths occurring in four cases (naidenko and Antonevich, this book). The authors indicate that the highest prevalence of agonistic behaviour in Eurasian lynx cubs occurred at 36 to 64 days of age, with the greatest frequency during the seventh post-natal week. Although siblicide in iberian lynx has not been directly observed in nature, a 1-month-old cub was found in the wild in 2003 with severe injuries compatible with bites from another cub. Sibling aggression in iberian lynx has infuenced programme husbandry as staff must be vigilant and prepared to break up aggressive bouts during the sensitive period. Because relatively little was known about the diseases affecting the iberian lynx, actions to improve our knowledge of the main diseases affecting the species was imperative. To improve the understanding of the various diseases that could potentially affect the species, the Programmes main lines of action involve the establishment of preventive disease protocols for the captive population, capacity building of veterinary staff working with in situ and ex situ populations, and conducting research on general veterinary science (Martnez et al. Research projects have helped determine the incidence and prevalence of infectious pathogens in captive and wild lynx populations (Milln, 2006; Meli et al. The results of research, protocol development, and standardization efforts, coupled with dissemination and sharing of knowledge and experience among veterinarians working in the Programme are all contributing to 65 more consistent diagnosis and treatment. Re P R o d u c t I v e P h y s I o l o g y Reproductive physiology studies and associated technologies increase the success rate of any captive-breeding programme and are important in helping with the conservation of wild felids in captivity (Wildt et al. Reproductive technologies are available for three major purposes: 1) assessing fertility and monitoring reproductive status; 2) assisting in breeding and maintenance of gene diversity; and 3) learning more about reproductive mechanisms of the endangered iberian lynx. Faecal hormone monitoring has demonstrated that females experience ovarian cycles from January through May whereas males maintain testosterone year-round (Pelican et al. But species peculiarities also have been revealed, for example, oestrogen metabolite concentrations during pregnancy are signifcantly greater than in other felid species (Pelican et al. Additionally, progestin excretion profles are unusually lengthy, largely because ovarian corpora lutea (sites of earlier ovulations) remain active much longer than in most other felids (Gritz et al. Prolonged non-pregnant luteal activity has also been described in the closely related Eurasian lynx (Lynx lynx; Jewgenow et al. Regarding male reproductive physiology, sperm traits seen in the iberian lynx are lower than those reported for some other felid species, yet higher than those reported for the Eurasian lynx and the bobcat (Gan et al. The ex situ population is also being used to explore a novel means of diagnosing pregnancy. Because all ovulating lynxes produce rising progesterone (regardless of conception), conventional hormone monitoring is not useful for identifying a gestating female (Pelican et al. However, increasing concentrations of the hormone relaxin (in blood or urine) are indicative of pregnancy in felids (Van Dorsser et al. A unique non-invasive means of collecting blood has been developed using blood-sucking Triatomine bugs (Rhodnius prolixus or Dipetalogaster maxima) placed in specially-drilled hiding holes in the lynxs cork nestbox (Voigt et al. As much as 2 ml of blood can be extracted per bug, more than adequate for the assay. Urine is captured using special collection devices distributed throughout the animals enclosure. Pregnant females express a positive relaxin signal from 32 to 56 days post-copulation of a 65-day gestation (Braun et al. The conservation of gametes will allow the Breeding Programme to extend future options without the limitation of space or the risk of disease transmission, while opening the opportunity of prolonging the possibilities of reproduction for individual animals after their death (Roldan et al. ReIntRoductIon The small size of current iberian lynx free-ranging populations renders them highly vulnerable to stochastic events. Prior to any reintroduction/translocation a detailed viability study is required (iUcn Guidelines for reintroductions: iUcn, 1998).

Chances are high that alleles only present in this individual will be lost from the population order serpina 60 caps on-line anxiety symptoms natural remedies. For an individual with a high mean kinship value generic serpina 60 caps otc anxiety symptoms 9 days, chances are high that the majority of its gene diversity is also present in its many relatives effective 60 caps serpina anxiety symptoms in women physical symptoms. Individuals with high mean kinship values are therefore given lower breeding priority purchase 60 caps serpina overnight delivery anxiety symptoms psychology. Furthermore, efforts should be made to combine individuals with similar mean kinship values. If an animal with low mean kinship would be combined with one with high mean kinship, the resulting offspring would be half important and half not important. Every time this offspring is bred, not only the rare alleles are spread, but also the already common alleles of the individual with high mean kinship value (Wilcken & Lees, 1998). The offspring is also going to be related to many individuals in the population which will make it harder to fnd breeding opportunities for it that do not result in inbreeding. Apart from basing breeding priority and pair combinations on mean kinship, it is also important to minimise the level of inbreeding in a population. Inbreeding not only increases the level of homozygosity and reduces the amount of gene diversity retained, it often also causes inbreeding depression (a reduction in ftness of the inbred individual), partly due to an increased probability for homozygosity of recessive deleterious or lethal alleles (Frankham et al. Inbreeding depression may express itself in many forms, some of which may not be immediately obvious unless one consciously sets out to investigate them, e. Despite earlier skepticism about the importance of inbreeding depression in wildlife populations, numerous wild populations have now been shown to suffer from inbreeding depression (Roelke et al. Captive populations too have been shown to suffer from inbreeding depression (Ralls and Ballou, 1986; Ralls et al. The level of inbreeding depression signifcantly infuences the extinction risk of a population (OGrady et al. In addition, populations with a high level of inbreeding that appear to be coping well enough in captivity may have signifcantly lower success rates upon reintroduction (i. For example, inbred white-footed mice (Peromyscus leucopus) showed signifcantly lower survival upon reintroduction than non-bred individuals (Jimnez et al. Inbreeding is reversible, meaning that when an inbred individual is mated with an unrelated animal, the resulting offspring are no longer inbred. For this reason, it may sometimes be preferable to allow a modest level of inbreeding among low mean kinship animals, rather than pairing unrelated individuals with very different mean kinship levels. Naturally, these theoretically ideal breeding strategies for captive management need to be married with the specifc social and life history strategies of the species. Especially for species as critically endangered as the Iberian lynx, the temptation is large to start reintroducing as soon as possible. Reintroductions are risky and the probability for whole or partial failure of particularly the frst release attempts is high. The urge to reintroduce is therefore best contained until the required, secure, reliable nucleus breeding population has been obtained (Lacy, 1994). Rather than limiting breeding to keep the population at carrying capacity, growth can at this stage be maintained and the surplus animals used for reintroduction. This automatically leads to the question, which individuals are best chosen for reintroduction? It is obvious that reintroduced individuals have to help improve the genetic and demographic health of the wild population. What is often forgotten however is that the removal of the animals destined for reintroduction should also not compromise the genetic and demographic health of the nucleus ex situ breeding population. For that reason, individuals for reintroduction are preferably those that beneft the gene diversity of the wild population (i. Once release methods have been tested and fne tuned and once survival and reproduction in the reintroduced population have improved, animals more valuable to the wild population can be added (Frankham et al. Leus is also affliated with the European Association of Zoos and Aquaria, and wishes to thank the Flemish Government for structural support to the Centre for Research and Conservation of the Royal Zoological Society of Antwerp. Cambridge University inbreeding depression and purging in captive pedigreed Press, Cambridge, pp. National Foundation for Research in Zoological Gardens, population size: demography meets population genetics. Convention on the Conservation of European inbreeding depression strongly affect extinction risk in wild Wildlife and Natural Habitats (Bern Convention). Efecto de la Extraccin de Linces Ibricos of inbreeding depression in wild golden lion tamarins, in: en las Poblaciones Donantes de Doana y Sierra de Andjar Young, A. Informe sin viability of fragmented populations, Cambridge University publicar preparado para la Consejera de Medio Ambiente de Press, Cambridge, pp. Current range and status of the Iberian lynx Felis pardina Temminck, 1824 in Spain. The consequences of demographic reduction and genetic depletion in the endangered Florida panther. Australasian Regional Association of Zoological Parks and Aquaria: Sydney, Australia. Estas recomendaciones se deben ajustar a las particularidades de la historia de vida, demogrfca y evolutiva de la especie La vitalidad en cuestin. Para el establecimiento del Programa de conservacin Ex situ se revela no del Lince Ibrico la primera decisin que hubo que tomar fue si haba que mezclar las dos poblaciones silvestres (Sierra Morena y Doana) o tratarlas 87 solamente en como dos unidades separadas. Aunque la diferenciacin para marcadores moleculares entre estos grupos es grande, esto se puede explicar por la accin la capacidad de predominante de la deriva gentica en tiempos recientes. Adems, hasta la persistir sino en fecha no se han encontrado diferencias en caractersticas potencialmente adaptativas entre estas poblaciones y stas son poco probables considerando la de volver a la historia demogrfca y la capacidad de dispersin que tiene esta especie. El siguiente paso fue determinar la proporcin de individuos que haba que capturar de cada poblacin para maximizar la diversidad gentica de partida. Francis Scott Teniendo en cuenta las diferencias en la composicin gentica de las dos Fitzgerald poblaciones, la contribucin ptima de cada una de ellas a la poblacin cautiva se estim en un 64% de individuos de Sierra Morena y un 36% de individuos de (1896-1940) Doana. A mediados del 2008 la poblacin cautiva inclua cuatro fundadores de Doana y 24 de Sierra Morena. El anlisis emprico de la poblacin cautiva revel una heterocigosidad esperada algo por debajo del mximo potencial, debido principalmente a una representacin insufciente de la poblacin de Doana. La gestin de la poblacin cautiva ha sido guiada por dos criterios principales: asegurar la reproduccin de todos los fundadores (para que su informacin gentica no se pierda) y la aplicacin de un diseo de cruzamientos basado en la estrategia de mnima coancestra. Siguiendo este principio, se han favorecido los cruzamientos entre individuos procedentes de distintas poblaciones, que podemos estar seguros que estn menos relacionados que las parejas procedentes de una sola poblacin. El Programa Ex situ ha tenido tanto xito que se han superado las proyecciones de crecimiento iniciales y se ha alcanzado la capacidad de carga original dos aos antes de lo previsto. Se necesita urgentemente, por tanto, continuar con la expansin del Programa a nuevos centros para acomodar este crecimiento poblacional.

If the immune defenses are working properly discount serpina 60 caps on line anxiety quotes images, the periodontium is pro tected from the harmful effect of pathogenic substances secreted by the microorganisms generic serpina 60 caps free shipping anxiety 6th sense. The immunocompetent host is able to defend itself against microbial attacks that occur every day serpina 60caps low price anxiety management. We can say that the periodontal inflammation is a local reaction to a tissue injury whose purpose is the destruction of the causal factor buy serpina 60 caps fast delivery anxiety rash pictures, dilution or its encapsulation. The human immune system can be classified according to their function within the perio dontium, follows: Secretory system Neutrophils, antibodies and complement system Leukocytes and macrophages Immune regulation system. The system formed by neutrophils, antibodies and complement is crucial to the immune de fense against periodontal infections. When functional defects of neutrophils occur, it increas es the frequency of serious marginal periodontitis [4]. Oxidative stress A phenomenon that occurs within the periodontal disease is called oxidative stress. A fundamental characteristic of the reactions of free radicals is that act of chain reactions, where a radical reaction generates another consecutively. The tetravalent reduction of oxygen to produce water through the electron transport chain in mitochondria is relatively safe. The most important function is serving as a10 suppressor of primary free radicals, located in the membranes in the vicinity of unsaturated lipid chains. There are less established functions that include the oxidation/reduction of the control of the origin and transmission of signals in cells that induce the expression of gender, the control of membrane channels, the structure and solubility in lipids [7]. The living organism has adapted to an existence under a continuous output of radi cal free flow. Between the different antioxidant defense mechanism adaptation mechanism is of great importance. Antioxidants are "those substances that when they are present in lower concentrations compared to the substrate of an oxidizable, significantly delay or in hibit the oxidation of the substrate". The various possible mechanisms that antioxidants can offer protection against damage from free radicals are: The prevention of the formation of radical free. Antioxidant defense system is very dynamic and responsive to any disturbance that occurs in the body redox balance. Antioxidants can be regulated and neutralize the formation of radical free that can occur due to oxidative stress, such as the factor transcription factors Ac tivator protein 1 and nuclear-kb are redox sensitive. The presence of inflammatory infiltrate is a constant feature in periodontal disease. It is known that these cells release lots of free radicals; it is suspected that these metabolites are involved in the pathogenesis of the disease. The presence of a dense inflammatory infiltrate in periodontal disease leads to the suspicion that the relationship of periodontal leukocyte- tissue has a double aspect. This increase is related to clinical periodontal status and is reversed by therapy. Its activity has been increased in the crevicular fluid of sites with gingivitis and perio dontitis with respect to healthy sites. There is a close relationship between free radical production by leukocytes and activation of proteases. Altogether these actions could have profound effects on the function and integri ty of the gingival epithelium. The above evidence leads to consider that in the inflammatory periodontal disease, the gen eral etiological factors causing the breakup of physiological systems of inhibition of lipid peroxidation, creates a low level of antioxidant protection of periodontal tissues. In these cir cumstances, the local factors lead to the migration of neutrophils to the gingiva and gingival fluid. This lipid peroxidation is the mechanism that triggers the develop ment of morphofunctionalchangesin periodontium and their vessels, which results in de struction of collagen and bone resorption. These concepts empha size the utility of antioxidants in the prophylaxis and treatment of periodontal disease and therefore justify the search of new antioxidant preparations for this purpose. In some cases, however, the inflammation occurs regardless of these fac tors, suggesting the existence of other stimulating immune. Although its magnitude is relatively low, its impact on affected patients and their costs in health systems is high. There is a considerable variation in the incidence and mortality rates around the world. Squamous cell cancer of the posterior lateral border of the tongue in a 28-year-old woman. In a very general overview, the balance between tu mor suppressor genes and those genes that induce cell cycle is altered. Allowing cells to es cape cell cycle control and developing an unpredictable biological behavior. Subsequently, the cells express molecules that allow them to acquire an invasive phenotype, a phenomen on known as epithelial-mesenchymal transition. Free radicals are products of the oxidation-reduction systems of the cell and its participation in cellular metabolic functions is essential for cell survival. The involvement of free radicals in cancer development has been studied for 3 decades, and there is sufficient evidence that implicates theirs in the multistage theory of carcinogenesis. It should be added that oxidative protein damage participates in facilitating the development of cancer. The results agree that there is an imbalance between the high amount of free radicals and insufficient antioxidant system activity. Added to this, some researchers have observed that high levels of lipid-peroxidation combined with low levels of thiols and anti oxidant status, correlate with poor survival rate in patients with oral cancer [16]. It is considered that the smoke from cigarettes have 4000 chemicals, 40 of which have carcinogenic potential. It has been shown that ciga rette smoke contains pro-oxidants that are capable of initiating the process of lipid-peroxida tion and deplete levels of antioxidants from the diet [17,18]. In contrast, there is epidemiological evidence that demonstrates the protective effect of diet on some populations [19-21]. For example in Greece, which has the lowest rates of oral can cer among European countries,its population is exposed to latent risk factors such as alcohol intake and smoking; micronutrients consume such as riboflavin, magnesium and iron corre lated inversely with oral cancer [19]. Consequently, several authors have proposed the ingestion of diverse exogenous antioxi dants; supporting in those epidemiological studies, where the diet offers protection for the development of cancer, and taking into account that the endogenous antioxidant systems have been overwhelmed by oxidative stress. For example, vitamin C is one of the most extensively evaluated antioxidants in oral cancer alternative co-therapies. Low or even undetectable levels of vitamin C correlate with the presence of oral cancer [17, 22]; in contrast, is one of the micronutrients that have a consis tent inverse correlation in different studies [23]. Vitamin C acts as a scavenger of free radicals and impedes the detrimental chain reactions triggered by the free radicals. The l-glutamine is administered in the diet as a complementary ther apy; the proposal is that restores glutathione cascade system [15].

She subsequently developed chronic neck and shoulder pain with considerable tenderness in a large part of the neck and shoulder region generic 60 caps serpina with visa anxiety 5 point scale, and there is good correlation between the load on the neck and shoulder region musculature and the onset of the disease buy serpina 60caps mastercard anxiety or heart problem. Even though the work was mainly performed with the right upper arm/shoulder generic 60caps serpina overnight delivery anxiety vs depression, this does not speak against her having developed neck and shoulder pain on both her right and left side buy generic serpina 60caps on line anxiety or heart problem. The main thing is that she suffered relevant exposure 213 on her right side, where the diagnostic requirements to the spreading and severity of the tenderness are fully met. The whole working day, the work involved sewing of different canvas materials, typically rather coarse and relatively heavy fabric. She typically made 15-18 movements per minute of both shoulders/upper arms, using a great deal of muscular force when handling the big canvas pieces to and from the machine and during the sewing itself, and she often had to turn over and reposition the pieces. Towards the end of the period she developed constant pain and tenderness of the neck and shoulder region, and a medical specialist made the diagnosis of chronic neck and shoulder pain with considerable tenderness (rated 3-4) in nine of the areas of the neck and shoulder region. Throughout the working day, the sail maker performed repeated movements of the shoulders/upper arms, 15-18 times a minute, with some exertion of the shoulders. As the work involved exertion of the shoulders, it is possible to reduce the requirement to the total duration of the exposure from the usual 8-10 years to, in this case, 7. Example 7: Recognition of chronic neck and shoulder pain (industrial butcher for 6 years) An industrial butcher worked full time for a little over 6 years in a large turkey slaughterhouse. His work partly consisted in suspending 8 to18-kilo turkey hens and cocks on moving hooks. The lifting height was from knee height to above shoulder height and the suspension required some exertion of both shoulders/upper arms. Suspending the turkeys, he made about 20 movements of both upper arms/shoulders per minute. The cutting was made at shoulder height, and he was able to handle 5-8 turkeys per minute. As each cutting required several movements of primarily his right shoulder, the work typically involved 16-20 movements of the right upper arm/shoulder per minute and some exertion of the shoulder. The last third of the working day he pulled out guts from suspended turkeys, 10-16 sets of guts per minute. He pulled with both arms, with his hands at shoulder height and the upper arms almost extended. Each pull typically required 1-2 very powerful movements of both shoulders/upper arms, or a total of 10-32 movements per minute. Towards the end of the period he developed pain of the neck and shoulder girdle, mainly on his right side. A medical specialist found considerable muscular tenderness (rated 3-4) in seven muscle areas of the neck and shoulder region, six of them being on the right side, as well as restricted motion of the neck and right shoulder. The industrial butcher developed chronic neck and shoulder pain with considerable tenderness in seven out of 12 muscle areas of the neck and shoulder region, mainly on the right side. He performed quickly repeated movements, typically 16-20 times a minute, of the upper arms/shoulders for the major part of the working day, the heaviest load being on the right shoulder. Example 8: Recognition of chronic neck and shoulder pain (fishing industry worker for 6. Her work partly consisted in cutting out frozen fish blocks and partly in lifting and handling boxes of fish. Then she separated the frozen fish blocks and with a knife cut them into smaller, 2. The 214 separation of the frozen blocks and cutting them into smaller blocks involved strenuous and quickly repeated, twisting movements of mainly the right shoulder, about 30 times per minute. She then with a circular saw cut the smaller blocks into filets, which also required very quickly repeated movements of the shoulder. Finally the filets were put into boxes able to contain 20-25 kilos of fish and were lifted onto pallets. This work involved quickly repeated movements of both shoulders/upper arms, about 25 times per minute. In the end she developed pain of the neck and shoulder region, and a medical specialist found moderate to con- siderable tenderness (rated 3-4) on the right side, in five of the 12 muscle areas of the neck and shoulder girdle. The medical specialist made the diagnosis of chronic, right-sided neck and shoulder pain with severe myogenous degeneration and impingement syndrome of the right shoulder. The fishing industry worker performed extremely quickly repeated movements of the right shoulder, between 25 and 30 times per minute for the entire working day. As the work involved extremely quickly repeated shoulder movements 25-30 times per minute, there are grounds for reducing the requirement to the total duration of the exposure from 8-10 years to, in this case, 6. There is also good correlation between the various work functions, which primarily constituted a load on the right upper arm/shoulder, and the chronic neck and shoulder pain rated at 3-4 in 5 muscle areas on the right side of the neck and shoulder girdle. The right- sided impingement syndrome is part of the neck and shoulder disorder and will therefore be included when the amount of the compensation is determined. Example 9: Recognition of chronic neck and shoulder pain (punching work in the metal industry for 9 years) A man worked full time for well over 9 years in an industrial company that produced various metal units. The work consisted in placing metal sheets in the punching machine and activating the latter by means of two handles. The sheets were taken from a carriage at the side of the machine and lifted to the punching machine from below hip height to above hip height. This required some exertion in connection with the lift itself and when placing the sheet in the machine. He punched about 2,000 units per day, each unit typically requiring four movements of both shoulders/upper arms. A medical specialist later made the diagnosis of chronic neck and shoulder pain with findings of considerable tenderness of eight areas of the neck and shoulder musculature as well as restricted motion of the neck. An x-ray examination also showed signs of moderate degenerative arthritis of the cervical neck without nerve involvement. For 9 years the metal industry worker performed quickly repeated movements of both shoulders/upper arms, more than 15 times per minute and for the entire working day, and he developed chronic neck and shoulder pain with a tenderness rated 3-4 in eight out of 12 muscle areas. When determining the compensation there are no grounds for making a deduction for the degenerative cervical arthritis, the arthritis so far being moderate and asymptomatic. Two thirds of the time her work consisted in lifting stacks of printed forms from machines and packing them into cartons. She packed about 125 cartons per hour with typically eight handlings and shoulder movements per carton. First she lifted stacks of paper into smaller piles, which she subse- quently assembled with a powerful grip with both arms and banged against the table. Subsequently the assembled piles had to be lifted up onto the edge of the carton with lifts above shoulder height and with extended arms. This work also involved a large number of repeated move- ments of upper arms/shoulders, typically 20 times per minute. A medical specialist diagnosed her with chronic neck and shoulder pain with moderate to considerable tenderness in five out of 12 muscle areas of the neck and shoulder region.