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A2040-408 Assessment: IBM Notes and Domino 9.0 Social Edition Application Development

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A2040-408 exam Dumps Source : Assessment: IBM Notes and Domino 9.0 Social Edition Application Development

Test Code : A2040-408
Test cognomen : Assessment: IBM Notes and Domino 9.0 Social Edition Application Development
Vendor cognomen : IBM
: 106 actual Questions

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IBM Assessment: IBM Notes and

Cognitive evaluation and training Market enlarge by using 2028 : IBM organization, Cambridge Cognition confined, NeuroCog Trials, ERT scientific | killexams.com actual Questions and Pass4sure dumps

global Cognitive assessment and practicing Market pushed by expanded Healthcare Expenditure in developing Economies and Rising Adoption in corporations & academic associations

This press release became orginally allotted by way of SBWire

Valley Cottage, original york -- (SBWIRE) -- 10/29/2018 -- Future Market Insights (FMI) has currently posted a record titled "Cognitive assessment and practicing Market – international traffic evaluation 2013-2017 and possibility assessment 2018-2028." Cognitive assessment and training is the intellectual system of acquiring capabilities and understandings via event and sense. Cognitive evaluation and training is the formal evaluation of a person's psychological features and velocity of guidance processing. additionally, these cognitive assessment rig are used to establish people who're more likely to want additional comparison. At existing, these checks are commonplace by way of enterprises as Part of the recruitment manner to verify a candidate's competence & suitability for the position, in addition to to prophesy his/her future performance.

Cognitive assessment and practising Market: Overview & evaluation

The world cognitive assessment and working towards market is expected to develop at a CAGR of sixteen.1% impeccable through the forecast duration. The cognitive evaluation and working towards market become valued at US$ 758.4 Mn in 2017, and is projected to grow tremendously to attain US$ 3,746.6 Mn by means of 2028. raise within the adoption of mobile technologies and advancements in IT techniques and healthcare applied sciences are enjoying an well-known office in boosting the adoption of cognitive evaluation options.

to understand key findings Request pattern report: https://www.futuremarketinsights.com/studies/sample/rep-gb-3251

In cognitive evaluation and training report, FMI has segmented the international cognitive evaluation and working towards market on the groundwork of component, classification, end-person and location. by means of part, the cognitive evaluation and practising market is sub-segmented into utility and features. The expanding penetration of mobiles and capsules is helping the boom of the utility sub-segment. in addition, the expanding penetration of smartphones is boosting the variety of cognitive options international. in addition, the carriers of cognitive evaluation and practicing solutions are additionally updating their product portfolio with imaginitive mobile and pill applications for cognitive assessment and practicing. These are amongst key factors helping the application sub-section. owing to these elements, the application sub-phase is additionally expected to demonstrate a 70.2% market share at the conclusion of 2018. moreover, the capabilities section is additionally projected to create handicap boom opportunities for the carriers of cognitive evaluation and practicing solutions impeccable over the forecast duration.

in keeping with category, the global cognitive evaluation and practising market is segmented into very own laptop (computing device) and cellular & pill. The cell & tablet sub-section is projected to register double-digit boom impeccable the way through the forecast duration. This sub-section registered a 61.8% market share in 2017. boom in the earnings of the core category inhabitants has resulted in an enlarge in the buy of premium smartphones. hence, the cellular & tablet sub-phase is estimated to generate competencies alternatives for the cognitive assessment and working towards vendors in lots of the developed and setting up international locations. In concomitant years, it has been observed that the home manufacturing of smartphones has registered double-digit growth in India and China. These elements are likewise growing the exact for cell and tablet-based mostly cognitive evaluation and training options in India and China.

in accordance with conclusion user, the international cognitive assessment and training market has been sub-segmented into healthcare, training, research agency and others. world and regional healthcare corporations are increasingly adopting advanced applied sciences to maintain during this enormously aggressive environment. The world healthcare traffic is undergoing technological advancements. as a result of these components, the healthcare traffic is projected to bear a market share of greater than 60% in the cognitive evaluation and practicing market on the conclusion of 2018.

On the basis of geography, North the us is anticipated to dominate the international cognitive assessment and training market due to the creation of next-era technological developments in the U.S. and Canada. The cognitive assessment and working towards market has tall skills in China owing to predominant technological developments in the country. China is now the most connected nation on the earth. in the concomitant years, the cognitive assessment and working towards market in China has witnessed tremendous enlarge due to the increasing spending of consumers on healthcare. the sea and Others of APAC cognitive assessment and training market might subsist a goal market for market individuals as a result of governments within the belt are merchandising and aiding the healthcare and education industries. Latin the united states is estimated to develop with a tall CAGR over the forecast duration. furthermore, Japan is projected to prove a double digit-growth expense impeccable over the forecast duration.

Request for file Methodology: https://www.futuremarketinsights.com/askus/rep-gb-3251

in line with FMI evaluation, long-time era contracts with traffic partners aid to boost income and original innovation recommendations will enable cognitive evaluation and practising carriers to attain original enlarge markets. one of the market participants featured within the global cognitive assessment and practicing market are IBM traffic enterprise, Cambridge Cognition restrained, NeuroCog Trials, ERT medical, reason resource enterprise, WIRB-Copernicus group, CogniFit, CRF health, Cogstate constrained and Pearson training.

For extra counsel on this press unencumber visit: http://www.sbwire.com/press-releases/cognitive-evaluation-and-practicing-market-increase-by using-2028-ibm-business enterprise-cambridge-cognition-restrained-neurocog-trials-ert-clinical-1075131.htm


AI in schooling market explored in newest analysis | killexams.com actual Questions and Pass4sure dumps

AI in training market research study reveals hidden insights and dynamic, which in turn helps the players within the ecosystem consume enhanced strategic selections.

artificial Intelligence (AI) provides machines with bright capabilities such as researching, processing, picking data patterns, speech focus, and others. AI merits the schooling sector with aspects comparable to personalized getting to know, additional tutorial lead and assessment and pupil engagement.

The AI in schooling Market is anticipated to register a growth fee of pretty much +9% throughout the forecast period. AI in training market is propelled by means of the integration of the superior technologies and ingenious algorithms into the e-discovering structures.

file

www.qyreports.com/request-pattern/?record-identity=101937

excellent Key carriers

Jenzabar (US), Knewton (US), Metacog (US), Querium traffic enterprise (US), Google (US), AWS (US), Cognizant (US), Carnegie studying (US), Century-Tech (UK), Cognii (US), Elemental direction (US), Liulishuo (China), shade Communications (US), Osmo (US), Pearson (UK), Third space learning (UK), Quantum Adaptive gaining learning of (US), ALEKS (US), and Blackboard (US)

The adoption of the adaptive discovering technology by the market gamers to ameliorate pupil-centric studying systems is the fundamental factor assisting the AI in training Market boom. The influx of ingenious gaining learning of fashions and technologies, similar to tutorial software, desktop researching, and synthetic Intelligence (AI), has changed the role of educators, creating a shift in the instructing methods and reworking the classroom.

The world AI in education Market has ascended as one of the primary AI software verticals because of the limitless handicap in innovations and skill to accelerate the getting to know technique

 This file on the international AI in education Market additionally presents some approximation tools reminiscent of market positioning of strategic gamers, miraculous investment proposition, and Porter’s five Forces model to give the readers a view of the most economical magnitude of the market and likewise some insights of the selected business. in addition to this, the file likewise gives information of some significant key avid gamers who're turning the salary of this industry to a very immoderate level.

record:

www.qyreports.com/form/?file-id=101937

 

desk of content material:

AI in education Market 2018

Chapter 1: traffic Overview of AI in education Market

Chapter 2: Manufacturing cost constitution of Market

Chapter 3: Technical statistics and Manufacturing plants evaluation of AI in training Market

Chapter four: typical Market Overview of AI in schooling Market

Chapter 5: AI in training Market analysis

Chapter 6: essential manufacturers of AI in training Market

Chapter 7: construction style of Market

Chapter 8: advertising type analysis of AI in education   

Chapter 9: Conclusion of AI in schooling Market record 2018

record:

www.qyreports.com/?report-identification=101937

 

This electronic mail address is being included from spambots. You necessity JavaScript enabled to view it.


IBM Guardium: Database safety tool overview | killexams.com actual Questions and Pass4sure dumps

IBM got Guardium in 2009, rebranding its database safety rig as IBM InfoSphere Guardium. IBM InfoSphere Guardium facts pastime display screen consistently displays databases and entry within the commercial enterprise; IBM InfoSphere Guardium Vulnerability assessment scans databases and their infrastructures for vulnerabilities.

IBM Guardium items are available as hardware home rig or as software. appliances include impeccable vital utility out of the box. The software edition comes as a picture that an administrator can installation as a VMware digital rig or on consumer-owned hardware. Guardium supports a wide array of databases, together with IBM DB products, Oracle, Microsoft SQL Server, Microsoft SharePoint, PostgreSQL, Sybase, Teradata, Cloudera, MongoDB and greater.

IBM InfoSphere Guardium statistics pastime video display product features

IBM Guardium statistics recreation computer screen offers continual, precise-time, coverage-based mostly monitoring of database actions, together with privileged person moves. working gadget-based mostly agents find databases and bring together information transactions and recreation throughout the network for in-residence personnel and contractors. Predefined safety guidelines let directors with no vicissitude invoke guidelines to set off signals when sensitive records is accessed, and screen entry if imperative.

Guardium Database exercise computer screen comes with various preconfigured studies for Sarbanes-Oxley, PCI DSS and records privateness. Compliance audit trails can not subsist changed and permit separation of responsibilities. A feature referred to as built-in Compliance Workflow Automation lets directors automatically distribute studies to an auditing group and trap sign-offs.

The product additionally includes database site visitors filtering, records classification, trade handle and community management with whitelists and blacklists.

IBM Guardium Database pastime video display additionally extends to huge statistics environments and data warehouses, in addition to file shares.

IBM InfoSphere Guardium Vulnerability product aspects

IBM InfoSphere Guardium Vulnerability assessment (VA) comes with hundreds of vulnerability scans (or assessments) which are preconfigured to work with the center for web protection (CIS), the defense guidance systems agency's safety Technical Implementation lead (STIG) and common Vulnerability and Exposures specifications. IBM claims that a VA verify wraps up inside minutes with out impacting the performance of construction databases. The product additionally contains built-in serve for surest practices similar to these for CIS, STIG and security content Automation Protocol (SCAP). The Compliance Workflow Automation feature allows scans to subsist scheduled and speed immediately.

administrators can speed either platform-selected static exams or dynamic assessments. Static checks are speed on a particular database and find insecure configurations; dynamic tests recognize for "behavioral" vulnerabilities like account sharing and immoderate administrative logins.

note: you could down load a 30-day demo of Guardium Vulnerability assessment to speed for your own environment.

Pricing and licensing

IBM bases Guardium pricing on the number of processor cores (known as potential-based mostly licensing), which will likewise subsist advanced to variety through. IBM makes Use of the time era processor cost unit (PVU) as a unit of measure for licensing functions; the number of required PVU "entitlements" depends upon the category of processor technology in Use and the variety of processors to subsist licensed. Per IBM, a processor refers to each processor core on a chip, so a dual-core processor has two processor cores.

prospective consumers must contact an IBM revenue representative for pricing guidance inevitable to their environments.

help

IBM presents a neatly-developed on-line capabilities foundation and boards, however documentation for Guardium products can likewise subsist involved to find if no longer unimaginable without paying for the product. software subscriptions and support are included within the product rate for the primary year.


A2040-408 Assessment: IBM Notes and Domino 9.0 Social Edition Application Development

Study lead Prepared by Killexams.com IBM Dumps Experts


Killexams.com A2040-408 Dumps and actual Questions

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A2040-408 exam Dumps Source : Assessment: IBM Notes and Domino 9.0 Social Edition Application Development

Test Code : A2040-408
Test cognomen : Assessment: IBM Notes and Domino 9.0 Social Edition Application Development
Vendor cognomen : IBM
: 106 actual Questions

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Way to killexams.Com this internet site on line gave me the rig and self credit I needed to crack the A2040-408. The web site has precious information to serve you to obtain success in A2040-408 manual. In turn I came to recognize approximately the A2040-408 training software program. This software is outlining every challenge import number and placed question in random order much like the test. You could trap score additionally that will serve you to evaluate yourself on one-of-a-kind parameters. Outstanding


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This exam preparation package has tested itself to subsist truely well worth the cash as I surpassed the A2040-408 exam in forward this week with the rating of ninety four%. impeccable questions are legitimate, that is what they give you on the exam! I dont understand how killexams.com does it, but theyve been maintaining this up for years. My cousin used them for some other IT exam years ago and says they bear been simply as properly again in the day. Very dependable and truthful.


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No problem! 24 hrs preparation of A2040-408 exam is required.
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Assessment: IBM Notes and Domino 9.0 Social Edition Application Development

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IBM Drops Lotus Brand, Takes Notes and Domino Forward | killexams.com actual questions and Pass4sure dumps

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KMWorld Trend-Setting Products of 2012 | killexams.com actual questions and Pass4sure dumps

Sep 1, 2012

Hugh McKellar

This marks the tenth anniversary of their Trend-Setting Products list, and as in years past, it has been assembled through consultation and collaboration with editorial colleagues, analysts, system integrators and a select group of users. They conscientiously compile the list to serve KMWorld's core constituency, their readers, and focus completely on elegant, workable, sustainable traffic value. They disregard the gimmicky software that might feature a ingenious understanding but has only ephemeral importance. And although a number of the products listed here are especially well-suited, if not specifically designed, for particular vertical markets, they selected those whose benefits can subsist realized in their readers' widely diverse environments.

The judging process is a collaborative application that takes many months. This year more than 700 products/product families were whittled down to the 89 listed in these pages. Each company whose products are listed below helped to define and enhance a market critically well-known to their readership by listening to and working with customers. They impeccable depict a commitment to innovation and their customers.

We hearten readers to send your thoughts and suggestions to the judging panel at judging@kmworld.com.

5280 Solutions: Dynamic Payables—Web-based invoice automation solution for SharePoint.

A9, an Amazon company: Amazon CloudSearch—cloud service allowing customers to integrate scalable search into applications.

Abbyy USA: FlexiCapture 10—data capture and document processing software for turning hard-copy forms and documents into business-ready data.

Accellion, Inc.: Accellion Mobile Apps-secure, enterprise—class mobile file sharing solutions. Click here for more product details.

Access Innovations: Data Harmony 3.8—software tools for metadata management, including automatic indexing and taxonomies. Click here for more product details.

Accusoft: Prizm Content Connect—customizable, scalable content viewer. Click here for more product details.

Acquia: Dev Desktop—package that installs Acquia Drupal on Windows and Mac OS X.

Acrolinx: Acrolinx IQ—natural language processing engine enabling creation of search-ready content.

Alfresco: Alfresco in the Cloud—allows users to collaborate and share files both inside and outside the organization securely on any device.

Altep: Inspicio—legal electronic document review platform with integrated concept searching, clustering and categorization. Click here for more product details.

AnyDoc Software: CAPTUREit—standalone document capture application and Part of either end-to-end OCR or AnyDoc automated document and data capture. Click here for more product details.

Appian: Appian BPM Suite—mobile, cloud and social process improvement.

ASG Software Solutions: ASG CloudFactory—comprehensive cloud management. Click here for more product details.

Attensity: Attensity Pipeline—real-time, semantically annotated social media data stream for large organizations.

Attivio: dynamic Intelligence Engine 3.0—accessible, standards-based unified information access platform.

Autonomy: IDOL 10—a single processing layer for audio, video, social media, e-mail, Web content and structured data.

AvePoint: DocAve Content Shield for SharePoint—automating enforcement of information governance policies for tagging and classifying content. Click here for more product details.

BA Insight: Longitude Enterprise Search for SharePoint and FAST—integrated SharePoint solution that provides complete previews of search result content regardless of type or location.

Bamboo Solutions: Web Parts and Tools—portfolio to accelerate portal deployment and facilitate adoption and continued usage. Click here for more product details.

Birst: Birst Enterprise Edition—self-service traffic intelligence.

BP Logix: Process Director Cloud Edition—business intelligence to serve users anticipate and call potential problems in traffic processes.

Bridgeline Digital: iAPPS Content Manager V. 4.7—Web taste management with internationalization capabilities for e-commerce. Click here for more product details.

Citrix: XenDesktop—desktop virtualization for on-demand service on any device.

Clarabridge: Clarabridge Enterprise—voice of the customer platform for data acquisition with linguistic processing and enterprise reporting.

Colligo Networks: Colligo Desktop for SharePoint—document, e-mail and records management solution.

Comperio Search: Comperio Front—business logic software for search solutions. Click here for more product details.

Concept Searching: Smart Content Framework—software to identify and tag content with semantic metadata and then classify it to organizational taxonomies.

Connotate: Agent Community—software and services provide an interface for highly accurate data collection.

Consona, which recently merged with CDC Software to form Aptean: CRM Suite—knowledge management, enterprise customer relationship management, e-service and network management software.

Content Analyst: Content Analyst Analytical Technology (CAAT) V. 3.11—deep analytics for unstructured data applications, including legal document review.

Coveo: Insight Solutions—combining enterprise search and learning management with extensive industry expertise and best practices.

Digital Reef: Digital Reef eDiscovery—enterprise-scale e-discovery platform for managing legal matters, regulatory inquiries and corporate investigations.

Discover Technologies: DiscoverPoint—automated expertise location for enterprises with large workforces.

eGain: eGain 10—complete suite of customer service and contact center software to serve organizations transform their traditional convene centers into multichannel customer interaction hubs. Click here for more product details.

Ektron: Ektron 8.5—.NET Web content management, marketing optimization, social community and e-commerce platform.

EMC: Atmos Cloud Delivery Platform—software used to deliver and manage storage-as-a-service to an Atmos storage cloud.

EntropySoft: Content Hub Platform—content connectors providing a central point of access to impeccable company documents, both on-premise or in the cloud. Click here for more product details.

EXSYS: Corvid—development software allowing non-programmers to easily build interactive Web applications.

Exterro: Fusion Platform—workflow-driven suite including identification, legal hold and early case assessment, collection, processing, analysis, review and production.

Findwise: Hydra—open source content processing framework for search-based applications.

FTI Technology: Ringtail 8.2—a complete e-discovery platform with integrated visual analytics and redesigned interface. Click here for more product details.

HiSoftware: Compliance Sheriff—enterprise compliance automation enabling repeatable and enforceable processes for impeccable types of content governance.

IBM: Content Navigator—allows users to access, manage, work and collaborate with enterprise content directly from mobile devices and tablets.

IGLOO Software: Igloo Platform—integrated suite of content management, collaboration and enterprise social networking tools.

Infotrieve: Mobile Library—fully secure, cloud-based access to enterprise content.

Integrify: Integrify 5.5—robust, lean traffic process management solution available as both an on-premise solution or hosted service.

IntelliResponse: IntelliResponse respond Suite—customer taste across a variety of interaction channels, including corporate websites, agent desktops, social media platforms and mobile devices.

IntraFind: iFinder—solutions and consultancy services for enterprise search, information access and text mining.

IntraLinks: IntraLinks Connect—out-of-the-box solutions to share content across the enterprise while maintaining  security, control and transparency. Click here for more product details.

Jive Software: Social traffic Platform—comprehensive, enterprise-class tools for communication, collaboration, content creation and sharing.

K2: K2 blackpearl—BPM software for automating enterprise traffic processes and pile SharePoint applications and integrating Microsoft solutions into SAP.

KANA: KANA Enterprise Agent Desktop—allows contact center agents to access the information and functionalities required to remark customer information in a single, unified desktop.

Kapow Software: Katalyst 9.0—enables integration of applications and/or data sources without coding or APIs.

kCura: Relativity 7—Web-based platform providing analysis, review and production stages of the electronic discovery reference model (EDRM). Click here for more product details.

KnowledgeLake: Unify for SharePoint—permits users to stay within indigenous applications while interacting with SharePoint. Click here for more product details.

Kofax: Kofax Web Capture—toolkit for creating Web-based applications with image viewing/scanning capabilities.

M-Files: M-Files ECM—document management integrated with Windows applications.

MarkLogic: MarkLogic 5—database for pile and deploying immense data applications with structured, semi-structured and unstructured information.

Metalogix: Replicator for SharePoint 5.0—enables multiserver SharePoint content synchronization. Click here for more product details.

Mindbreeze: InSite—secure, semantic software for Web search. Click here for more product details.

Moxie Software: Spaces Platform—communication and collaboration designed to connect customers and employees.

NewsGator: Social Sites for SharePoint 2010—social networking for SharePoint integration.

Noetix: NoetixViews Workbench—automates the creation and management of customizations to Noetix views through an intuitive user interface. Click here for more product details.

OpenText: Exceed onDemand for iPad—managed application access solution designed for enterprises.

Oracle: Oracle RightNow CX Cloud Service—combines Web, social and contact center experiences for unified, cross-channel service.

Pegasystems: Unified Marketing Solution—inbound proffer management and outbound marketing combining predictive and adaptive analytics with traffic process management.

Percussion Software: CM1 Version 2—pure WCM software that provides users with complete functionality delivered as an easily upgradeable product.

Proofpoint: Enterprise Governance—tracks, classifies, monitors and applies policy to unstructured information across the enterprise where stored.

Q-Sensei: Q-Sensei Enterprise—multidimensional search and indexing designed to develop and deploy search-based applications. Click here for more product details.

Quest Software: Spotlight on SQL Server Enterprise—in-depth physical, cloud and virtual SQL diagnostics.

Raytion: Enterprise Search Connectors for speedily Search Server 2010 for SharePoint—native integration with SharePoint's security trimming.

Recommind: Decisiv Search—crawls and indexes information from any source, including document management systems, intranets, e-mail archives, contact management databases and websites.

Reprints Desk: Article Galaxy—journal article platform for evidence-based promotions, medical information responses, as well as scientific, technical and medical research.

RightAnswers: Unified learning Platform—knowledge management automation and service.

Rivet Logic: Crafter Rivet Version 2.0—an end-to-end Web content and taste management and delivery platform. Click here for more product details.

RSD: RSD GLASS—platform for managing global corporate information governance programs for electronic and physical records.

SAP: StreamWork—social software enabling information analysis to drive action through collaboration with people, data and structured traffic tools.

SAS Text Analytics: Predictive Analytics and Data Mining—suite of integrated predictive modeling processes.

SDL: SDL Tridion—complete, global Web content management solutions. Click here for more product details.

Search Technologies: Aspire—content processing system designed for search environments enabling content to subsist acquired, cleaned, restructured, enriched and normalized. Click here for more product details.

Sherpa Software: Discovery Attender for Notes—federated search functionality across impeccable Domino databases.

Smartlogic: Semaphore—combines ontology management, classification, text mining and semantic analysis in a search application framework.

SpringCM: Mobile apps for iPad, iPhone and Android—cloud-based content and document management solutions.

StoredIQ: dynamic Information Management Platform—open platform for in-place dynamic indexing and analysis of data.

Symantec: Endpoint Protection—antivirus software virtual and physical systems that integrate into other virus protection tools with a single console.

Synaptica: Synaptica Enterprise—taxonomy and metadata management software.

Traction Software: TeamPage—action tracking, Twitter-style status, threaded discussion, collaboration, social networking and deep search.

Vivisimo, an IBM company: CXO—customer taste optimization connecting customer-facing agents with information required for sales/support.

Wall Street Network: WSN Insight—knowledge management for SharePoint.


Skeletal pathology and variable anatomy in elephant feet assessed using computed tomography | killexams.com actual questions and Pass4sure dumps

Introduction

Elephants not only provide education and entertainment as zoological attractions, but likewise bear ecological significance as umbrella (or keystone) species, whose conservation indirectly protects others (Choudhury et al., 2008). They likewise bear economic weight as tourist attractions and working animals. Welfare of elephants is an dynamic belt of discussion, both in professional fields and in general society. Although the welfare of captive elephants has been improving through husbandry initiatives and advances in learning of veterinary charge for these species, there remain several areas that continue to subsist obstacles to optimum welfare.

Pathological foot conditions are one such problem area, thought to constitute the single most well-known health problem of captive elephants, with up to 50% of elephants in captivity suffering from foot problems, although the actual prevalence of carious conditions remains unknown (Fowler, 2006). Accurate diagnosis is challenging, treatment is expensive and time-consuming (Lewis et al., 2010) and inveterate unresponsive conditions of the feet are a major reason for euthanasia in captivity (Csuti, Sargent & Bechert, 2008).

Some foot problems are visible externally (e.g., solar pad or cuticle lesions), achieve not require diagnostic imaging, and look to subsist improving with the near-universal adoption of daily examination and foot charge routines in elephants (Lewis et al., 2010). However, other pathological lesions—particularly those affecting the osseous structures—are challenging to identify and monitor. Originally superficial lesions may lead to further problems through ascending infection, resulting in osteomyelitis and/or infectious arthritis. Osteoarthritis (OA, likewise called degenerative joint disease/DJD) is commonly encountered and other problems are described.

Management conditions are thought to subsist the one of the most well-known factors in the development of distal limb osseous pathologies (Fowler, 2006; Miller, Hogan & Meehan, 2016). Osteomyelitis and septic arthritis are generally an extension of a soft tissue infection or penetrating solar trauma. difficult floors, necessity of exercise, and repeated concussive forces (potentially including stereotypic behaviour; Haspeslagh et al., 2013) bear impeccable been proposed to contribute to the development of OA (Hittmair & Vielgrader, 2000) or general musculoskeletal foot health (Miller, Hogan & Meehan, 2016) . Additionally, the conformation of the large and relatively straight limbs of elephants may predispose them to pathology (Fowler, 2006), as might the inherent biomechanics of the feet. Pathological changes bear been speculated to occur more frequently in regions that normally taste tall pressures (i.e., mechanical stresses) during walking; namely the distal structures of the lateral digits (Panagiotopoulou et al., 2012).

Lameness is not always an obvious feature in elephants with foot problems (Lewis et al., 2010), and radiography of the distal limb has been described to diagnose and monitor foot problems (e.g., Hittmair & Vielgrader, 2000; Siegal-Willott et al., 2008; Kaulfers et al., 2010; Mumby et al., 2013). Over the recent years advanced imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) bear been more commonly used in veterinary drill for musculoskeletal and other problems, but their Use for elephants is precluded by body size and transport issues. As a result of the limited availability of imaging, the frequencies of these bony conditions in captive elephants are unknown and they are almost certainly under-reported based on what they know in other large animals such as cows (Nigam & Singh, 1980; Kofler, Geissbühler & Steiner, 2014) or rhinoceroses (Regnault et al., 2013; Galateanu et al., 2013).

The aims of this study were to identify pathological bone lesions in the feet of captive African (Loxodonta africana Blumenbach 1797) and Asian (Elephas maximus Linnaeus 1758) elephants using post-mortem CT. They hypothesise that when there is pathological change, it will subsist present in multiple feet of the identical individual and likewise that there will subsist multiple kinds of pathological change, which may subsist due to shared predisposing factors (e.g., management conditions, as above) and/or altered use. By exploring the locations of pathological changes, they further hypothesise that foot regions typically exposed to tall pressures (i.e., lateral digits) are predisposed to developing lesions. When assessing any structures for pathology it is essential that the clinician is watchful of customary anatomical variation, therefore, they likewise recount other osseous features that likely depict non-pathological, variable distal limb anatomy.

Materials and Methods

CT scans of 52 cadaver feet (16 birthright fore, 12 left fore, 14 birthright hind, 10 left hind) from 21 captive elephants (seven African Loxodonta africana, and 14 Asian Elephas maximus) were evaluated for evidence of pathology. impeccable elephants were adult or near-adult: ranging from 17 to 61 years old. Feet or CT scans were donated to the Royal Veterinary College from various sources (zoos and safari parks) in the European Union. Data on morbidity and mortality was later compiled from an online database (http://www.elephant.se/) as well as from donating institutions, and details on the individual elephants are summarised in Table 1.

Table 1:

Details of seven African (Loxodontaafricana) and 14 Asian (Elephas maximus) elephants in this study.

Asterisks testify elephants known to bear foot or locomotor problems. ‘Feet scanned’ indicates how many feet had available CT scan data, ‘Reason for death/euthanasia’ details the occasions of death (from donating institutions or the online database http://www.elephant.se/). Elephant Feet scanned Reason for death/euthanasia Sex Age (years) African1 4 ? M 19 African2 4 Euthanasia (vaginal/urogenital tract disease) F 24 African3 1 ? M 27 African4 1 Disease (infection, gastrointestinal, unspecified mechanical abnormality) M 28 African5 1 ? F 30 African6 4 Disease (suspected cardiac disease) F 32 African7 2 Disease (unspecified) M 32 Asian1 2 ? M 17 Asian2* 1 Euthanasia (forelimb lameness) M 17 Asian3* 4 Euthanasia (arthritis and aggression) F 26 Asian4 3 ? F 40 Asian5* 4 Euthanasia (foot abscess) F 35 Asian6 2 ? M 40 Asian7* 1 Euthanasia (chronic arthritis) F 40 Asian8 3 ? F 42 Asian9* 2 Disease (osteomyelitis and foot disease) F 52 Asian10 2 Euthanasia (unspecified illness) M 50 Asian11 1 Euthanasia (unspecified) F 50 Asian12 4 Euthanasia (unspecified) F 55 Asian13 2 Sudden collapse F 61 Asian 14 4 ? ? ?

The following distal limb structures were assessed on the CT scans for impeccable five digits (denoted DI to DV by convention); the carpometacarpal (CMC) or tarsometatarsal (TMT) joints, metapodial (metacarpal/metatarsal) bones, paired proximal sesamoids, metacarpophalangeal (MCP) or metatarsophalangeal (MTP) joints, proximal and distal interphalangeal (PIP and DIP) joints, phalangeal bones, and surrounding soft tissues. Lesions were identified and interpreted by a large animal veterinary radiologist and resident (J.D. and R.W.), and categorised in consensus using an established scheme previously used for elephants and rhinoceroses (Regnault et al., 2013). This grading scheme is provided in Table 2. Severity of each lesion was graded as slight, moderate, or severe (grades 1, 2 or 3 respectively; remark Table 2 for grading criteria).

Table 2:

Grading scheme used for categorising pathological changes in this study.

Lesion type Changes observed Severity Mineralisation Mineral opacity within soft tissues at a site faraway to other osseous structures Slight = solitary short linear foci, occasionally coalescing qualify = multiple linear or irregularly shaped mineral attenuating areas Severe = extensive mineralisation, frequently linear coalescing mineral structures, elongated Osteitis Disruption of customary trabecular bone pattern, mottled appearance, multiple hypoattenuating foci, loss of parts of bone, destruction of customary bone outline, periosteal original bone formation Slight/Moderate/Severe based on extent of changes Enthesopathy Discrete original bone formation at attachment sites of tendons and ligaments Slight/Moderate/Severe: based on size and extent of the mineral attenuation at the site of the soft tissue structures insertion onto the bone, if multiple sites affected in the identical bone then interpretation based on impeccable affected sites for overall grade. Cyst-like lesions Well-defined radiolucencies (with hyperattenuating rim) Grade based on size (not measured), small/medium/large (observer experience-based only) Fractures Sclerotic linear areas, may subsist with original bone formation at bone surface (old), linear hypoattenuation (acute) Not graded (just present/absent) Osteoarthritis Discrete original bone at periarticular surface, subchondral bone sclerosis, narrowing or obliteration of joint space, subchondral lysis, widening of joint space Mild: small pointed periarticular osteophytes, mild increased bone attenuation or thickening of the subchondral bone plate Moderate: Multiple medium sized periarticular osteophytes, evidence of widening or narrowing of the joint space not considered to subsist related to limb position only, thickening of the subchondral bone and adjacent increased mineral attenuation. Severe: Numerous and extensive periarticular osteophytes, marked narrowing of the articular space, marked subchondral bone thickening/hyperattenuation. Infectious arthritis Florid original bone formation at periarticular surface, subchondral bone lysis, widening of joint space, subchondral bone sclerosis, narrowing or obliteration of joint space Slight/Moderate/Severe based on extent of changes Remodelling Enlargement of vascular channels and synovial fossae, irregular contour to the osseous structures away from the joint surfaces and not considered entheseophyte formation, sometimes deep excavations in the bone, alterations in shape of a bone. Subjective scale of the overall shape of the bone, degree of periosteal change identified, alterations in the cortices. No fixed categorical variables. Subluxation Loss of articular surface contact between the bones forming a joint Not graded (just present/absent)

The degree of ossification of “predigits” (prepollex/prehallux, or radial/tibial sesamoids; e.g., Hutchinson et al., 2008; Hutchinson et al., 2011) was likewise noted, and categorised as: non-ossified (code 0), minimally ossified (code 1), qualify ossification embedded in (presumably) cartilaginous soft tissue (code 2), or extensively ossified single structure (code 3). Anatomical variability in the proximal sesamoid bones was described.

For analysis, each pathology category was expressed as the number of affected structures per foot e.g., if osseous cyst-like lesions were observed only in metacarpals III and IV, the foot would bear two affected structures. For the more frequently observed pathological categories (remodelling, enthesopathy, osseous cyst-like lesions and osteoarthritis), a generalised estimating equation (GEE) was used to test age, sex, foot type (fore or hind), and species (Asian or African) as predictors on the amount of observed pathology (modelled as import data with a negative binomial distribution). The models ran as multi-variable negative binomial regressions with backwards selection. For statistical assessment, significance was set at p = 0.05. Multiple feet from the identical elephant were treated as repeated measures. Similar GEE models were speed for sesamoid fusion, and atypically-shaped and multipartite phalanges (though only with Asian elephants for the latter, as no African elephants had multipartite phalanges). A GEE (ordinal logistic) model was likewise used to test whether species was a significant predictor of degree of predigit ossification (modelled as categorical data), and then separately within each species as bi-variable models to test if age and foot type were significant predictors. Statistical analyses were performed in IBM SPSS Statistics for Windows (Version 24.0).

To examine whether elephants with pathological lesions in one foot were more likely to bear lesions in other feet, they compared the proportion of elephants with one vs. two or more feet diagnosed with pathology (only for the 15 elephants with scans of multiple feet, and pathology in at least one foot) for impeccable categories.

Results Pathological changes

All of the elephant feet in this study (i.e., impeccable adults and near-adults) were observed to bear pathology of some type under their grading scheme. However, the majority of these lesions (63%) were grade 1, thus considered to subsist clinically insignificant or anatomical variants. They considered lesions of grade 2 or 3 (moderate and marked/severe) likely to depict clinically significant pathology. Based on this assessment, only grade 2 and 3 lesions were analysed further below. Forty seven of 52 feet (21/21 elephants) were create to contain pathological changes graded qualify (2) or greater. Percentages are reported for descriptive purposes.

The most frequent change observed was remodelling, especially observed as bone surface irregularities (Figs. 1A and 1D), representing 31% of impeccable pathologies observed (see Table 3 for breakdown). Remodelling was present in 18 out of 21 elephants (39/52 feet). Commonly remodelled bones were the metapodials (with 31% of impeccable remodelling observed here), proximal phalanges (30%), sesamoid bones (16%) and middle phalanges (8%). Commonly affected digits were DIII (27% of remodelling), DIV (25%), DV (21%) and DII (17%), whilst DI appeared least affected (10%). A GEE (negative binomial model) create that observed remodelling increased with age (p = 0.01 in the final univariate model); age remained significant (p = 0.03) after accounting for species (p = 0.2), sex (p = 0.8), and foot type (fore vs. hind; p = 0.7) in the multivariable modelling. For the affected elephants with multiple feet scanned, remodelling was commonly observed in multiple feet (10/13 elephants with two or more affected feet, with only three elephants having a single foot affected).

Figure 1: Sagittal CT slices of digits in elephant feet, exhibiting pathological changes. (A) Remodelling of the metacarpal (arrow) and fracture of the middle phalanx (filled arrowhead) in DIV of the birthright hind foot of ‘Asian8’. (B) Enthesopathy of the proximal sesamoid (filled arrowhead) and evidence of DJD (osteophytes, altered joint spacing) at the proximal and middle interphalangeal joints (arrows) in DIV of the birthright forefoot of ‘Asian10’. (C) Focal hyperattenuating region (arrow) and misshapen, scalloped proximal phalanx (filled arrowhead) in DII of the birthright forefoot of ‘Asian13’. (D) Remodelling of the bones (arrow), subluxation of the proximal interphalangeal joint (unfilled arrowhead) and soft tissue mineralisation (filled arrowheads) in DIII of the birthright hind foot of ‘Asian4’. Table 3:

Summary of Grade 2 + pathological lesions detected in this study.

In the first column, “Af” and “As” with numbers correspond to their elephant subjects from Table 1; likewise “Path,” number of unique pathology categories observed per individual elephant, and asterisks testify elephants known to bear foot or locomotor problems. Second column: “Foot”: LH, left hind; LF, left fore; RH, birthright hind; RF, birthright fore. Elephant Foot Calcification Osteitis Enthesophyte Cyst Fracture OA Infectious OA Remodelling Subluxation Misc. Af1 Path: 2 LF 0 0 1 1 0 0 0 0 0 0 LH 0 0 1 0 0 0 0 0 0 0 RF 0 0 0 0 0 0 0 0 0 0 RH 0 0 0 0 0 0 0 0 0 0 Af2 Path: 2 RH 0 0 0 1 0 0 0 0 0 0 RF 0 0 1 0 0 0 0 0 0 0 LF 0 0 1 1 0 0 0 0 0 0 LH 0 0 0 0 0 0 0 0 0 0 Af3 Path: 7 RH 6 3 7 3 0 6 2 8 0 0 Af4 Path: 1 RF 0 0 0 0 0 0 0 0 0 1 Af5 Path: 5 LF 4 0 6 6 0 7 0 9 0 0 Af6 Path: 5 LF 0 0 1 3 0 2 0 3 0 0 LH 0 0 0 3 0 0 0 1 0 0 RF 0 0 1 5 0 0 0 0 0 0 RH 0 1 2 6 0 1 0 3 0 0 Af7 Path: 3 RF 0 0 0 0 0 0 0 0 0 0 LF 0 0 2 3 0 0 0 3 0 0 As1 Path:3 RF 0 0 0 1 0 0 0 1 1 0 LF 0 0 0 0 0 0 0 0 0 0 As2* Path: 6 RH 2 0 8 1 1 1 0 8 0 0 As3* Path: 4 LF 0 0 8 2 0 0 0 9 0 0 LH 0 0 0 0 0 0 0 2 0 0 RF 0 0 8 1 0 1 0 4 0 0 RH 0 0 3 3 0 4 0 2 0 0 As4 Path: 8 LF 0 1 4 3 0 3 0 4 0 0 RF 9 0 7 3 0 4 0 4 0 0 RH 6 5 10 11 0 9 2 12 1 0 As5* Path: 4 LF 0 0 2 0 0 1 0 1 0 0 LH 0 0 9 1 0 2 0 6 0 0 RF 0 0 9 1 0 0 0 6 0 0 RH 0 0 4 0 0 0 0 3 0 0 As6 Path: 3 LF 0 0 2 1 0 0 0 0 0 0 RF 0 0 2 0 0 0 0 1 0 0 As7* Path: 6 RF 0 2 4 1 0 1 1 5 0 0 As8 Path: 7 LH 0 0 12 6 0 7 0 12 0 0 RF 3 2 7 2 0 3 1 5 0 0 RH 0 0 4 4 0 3 0 7 0 0 As9* Path: 8 LH 6 1 3 2 0 2 1 6 1 0 RH 0 0 3 0 0 3 0 4 1 0 As10 Path: 4 RF 0 0 12 3 0 10 0 20 0 0 RH 0 0 2 1 0 0 0 3 0 0 As11 Path: 2 RH 0 0 0 3 0 0 0 4 0 0 As12 Path: 6 LF 1 0 6 0 0 3 0 9 2 0 LH 4 0 5 0 0 1 0 8 1 0 RF 2 0 13 2 0 3 0 13 0 0 RH 2 0 2 1 0 0 0 5 1 0 As13 Path: 9 LH 3 0 5 3 1 1 0 4 0 0 RF 1 0 7 6 0 6 1 8 1 2 As14 Path: 7 LF 3 4 9 5 0 6 3 14 0 0 LH 0 0 3 3 0 1 0 5 0 0 RF 3 2 7 4 0 6 2 11 0 0 RH 0 0 1 7 0 1 0 4 0 0 Total: 55 21 204 113 2 98 13 237 9 3 755 observations (7%) (3%) (27%) (15%) (0.3%) (13%) (2%) (31%) (1%) (0.4%)

The second most commonly identified pathology was enthesopathy (Fig. 1B), representing 27% of impeccable pathologies observed (Table 3). Enthesopathy was present in 18/21 elephants (43/52 feet). Commonly affected regions were the metapodial bones (32%), proximal phalanges (27%), sesamoids (21%) and CMC/TMT joints (18%). Commonly affected digits were DIII (27%), DIV (24%), DV (23%) and DII (19%), whilst DI appeared least frequently affected (6%). A GEE (negative binomial model) create enthesopathy was more commonly observed in Asian compared to African elephants (p = 0.001 in the final univariate model); species remained significant (p = 0.03) after accounting for age (p = 0.3), sex (p = 0.6), and foot type (p = 0.8) in the multivariable modelling. For the affected elephants with multiple feet scanned, enthesopathy was almost always observed in multiple feet (13/14 elephants with two or more affected feet versus one elephant with only a single foot affected).

Figure 2: Transverse CT slices of digits in elephant feet, exhibiting pathological changes. (A) Multiple osseous cyst-like lesions in metacarpal (filled arrowhead) in DV of the birthright hind foot of ‘African2.’ (B) Solitary osseous cyst-like lesions in the proximal phalanges (filled arrowheads) of DIII and DIV of the left forefoot of ‘African6.’ (C) Soft tissue mineralisation on the palmar aspect of digits (filled arrowheads) in the birthright forefoot of ‘Asian4’. (D) Osteitis of the proximal phalanx (arrow) and infectious osteoarthritis of the proximal interphalangeal joint (filled arrowhead) in DIV of the left forefoot of ‘Asian14.’

Osseous cyst-like lesions of bone (Figs. 2A and 2B) represented 15% of impeccable pathologies observed (Table 3), present in 20/21 elephants (39/52 feet). Commonly affected structures were the metapodial (56%) and proximal phalangeal bones (28%). Commonly affected digits were DIV (27%), DIII (24%), DII (21%) and DV (19%), whilst DI appeared least affected (10%). A GEE (negative binomial model) create that osseous cyst-like lesions were more commonly observed in females compared to males (p = 0.01 in the final univariate model); sex remained significant (p = 0.03) after accounting for species (p = 0.3), age (p = 0.5) and foot type (p = 0.2) in the multivariate modelling. For the affected elephants with multiple feet scanned, osseous cyst-like lesions were generally observed in multiple feet (10/15 elephants with two or more affected feet, versus five elephants with only a single foot affected).

Osteoarthritis (OA; Fig. 1B) represented 13% of impeccable pathologies observed (Table 3), present in 14/21 elephants (28/52 feet). Commonly affected joints were the carpometacarpal/tarsometatarsal joints (46%), metacarpophalangeal/metatarsophalangeal joint (36%), and proximal interphalangeal joint (10%). Commonly affected digits were DIII (28%), DIV (25%), DII (24%) and DI (12%), whilst DV appeared least affected by OA (11%). A GEE (negative binomial model) create that OA increased with age (p = 0.02 in the final univariate model); age remained significant (p = 0.05) after accounting for foot type (p = 0.6), sex (p = 0.6), and species (p = 0.9) in the multivariate modelling. For the affected elephants with multiple feet scanned, OA was almost always observed in multiple feet (9/10 elephants with two or more affected feet, versus one elephant with only a single foot affected).

Soft tissue mineralisation (Figs. 1D and 2C) represented 7% of impeccable pathologies observed (Table 3), present in 9/21 elephants (17/52 feet). These mineralisations were identified having similar interdigital, frequently linear structure in impeccable limbs. For the affected elephants with multiple feet scanned, mineralisation was generally observed in multiple feet (4/6 elephants with two or more feet affected, versus two elephants with only a single foot affected).

Osteitis (Fig. 2D) represented 3% of impeccable pathologies observed (Table 3), present in 7/21 elephants (9/52 feet). Commonly affected regions were the proximal and middle phalanges (33% and 29% of observations, respectively), metapodials (24%), and sesamoids (14%). Commonly affected digits were DIV (48% of osteitis observed here), DIII (38%), whilst DV (10%) and DII (5%) appeared least affected. DI was not affected in any limb studied. For the affected elephants with multiple feet scanned, osteitis was observed roughly equally affecting multiple feet versus just one foot (2/5 elephants versus three elephants, respectively).

Infectious osteoarthritis (Fig. 2D) represented 2% of impeccable pathology observed (Table 3), present in 7/21 elephants (8/52 feet), or 13 joints in total. In 7/8 feet, bone(s) adjacent to the affected joints were likewise observed with osteitis. Commonly affected joints were the MCP/MTP (46%), PIP (38%) and douse joints (15%). Commonly affected digits were DIV (54%), DIII (38%) and DV (8%). DI and DII were unaffected in any limb. For the affected elephants with multiple feet scanned, infectious OA was generally only observed in one foot (5/6 elephants with a single affected foot, versus only one elephant with multiple feet affected).

Subluxation (Fig. 1D) of a joint represented 1% of impeccable pathology observed (Table 3), present in five out of 21 elephants (8/52 feet). The MCP/MTP, PIP and douse joints were equally affected. Digits were likewise fairly equally affected. For the affected elephants with multiple feet scanned, subluxation was observed roughly equally affecting multiple feet versus just one foot (two elephants versus three elephants, respectively). Complete luxation was not observed in any joint in this study.

Fractures (Fig. 1A) represented <1% of impeccable pathology observed (Table 3), present in only 3/21 elephants (3/52 feet). Two of the fractures were identified in the distal phalanx of DIII, and one was of the middle phalanx of DIV.

In addition to the categories of pathology listed in Table 2, they observed focal hyperattenuating (i.e., highly dense) regions within the medullary cavities of long bones (Fig. 1C) in two out of 21 elephants (2/52 feet). Three hyperattenuating regions were observed in total: two in the metacarpals of digit III (different feet of different elephants), and one in the proximal phalanx of digit II.

In this study, multiple types of pathology were identified in most feet: out of 52 feet, two were observed with impeccable nine pathological categories listed in Table 2, two feet with eight categories, three feet with seven categories, seven feet with six categories, 12 feet with five categories, six feet with four categories, three feet with three categories, and eight feet with two categories. Only three feet were observed with a single category of pathology, and six feet (11.5% of limbs) had no evidence of pathology.

Anatomical variations

In the CT images evaluated, the configuration of the proximal sesamoid bones was variable: they were sometimes present as a pair, commonly fused together (appearing as a single bone), and occasionally absent from scans altogether (i.e., not visible as either an ossified bone or as an obvious soft tissue structure; Figs. 3A and 3D).

Figure 3: Transverse CT slices of elephants’ feet, showing the sesamoids. (A) Completely unossified prepollex (red box) in the birthright forefoot of ‘Asian4.’ Note likewise the single sesamoid of DI (arrow) and the paired proximal sesamoids of other digits (filled arrowheads). (B) Sparsely mineralised prepollex (red box) in birthright forefoot of ‘African6.’ (C) Medium-sized, discrete ossification of the prepollex (red box) in birthright forefoot of ‘African2.’ Note likewise the larger lateral sesamoid of DV (filled arrowhead) compared to the medial sesamoid. (D) large ossification bounding the outer edges of the prepollex (red box) in birthright forefoot of ‘Asian12.’ Often, the middle of the predigit will remain partially unossified resulting in a rod-like appearance. Note likewise fusion of the paired proximal sesamoids (filled arrowheads) in DII–DIV, compared to the unfused sesamoids in (A).

In digit I, the sesamoids often had the appearance of a single bone (42/52 feet); very occasionally they appeared as a fused pair (3/52 feet), and in only one foot appeared as an unfused pair. The digit I sesamoids were always present in African elephants, but were sometimes missing in the hind feet of Asian elephants (absent in 6/14 Asian elephants, or 8/35 hind feet).

In their sample of African elephants, the sesamoid bones in the other digits were almost always paired; only two feet out of 17 had fused sesamoids (in digits III and IV in one hind foot, and digit V in another elephant’s forefoot). In Asian elephants the appearance of sesamoids in the other digits varied much more. In digit II, 22 were fused, 12 were paired, and one appeared single. In digit III, 26 were fused, eight were paired, and one was lytic and difficult to assess. In digit IV, 24 were fused, 10 paired, and one absent. In digit V, 12 were fused, 22 paired, and one appeared single. In both species, the lateral sesamoid of digit V was sometimes appreciably larger than the medial sesamoid (Fig. 3C). A GEE (negative binomial model) create that species was a statistically significant predictor (p < 0.0005 in both the multivariate and final univariate model) of amount of sesamoid fusion (i.e., number of fused pairs per foot, not distinguishing which pairs), with Asian elephants possessing more fused sesamoids than African elephants. Sex (p = 0.9), foot type (p = 0.4), and age (p = 0.7) were not significant.

Ossified predigits (i.e., radial/tibial sesamoids associated with digit I) were more frequently identified in Asian than African elephants. In African elephants, 9/17 feet (3/7 elephants) had evidence of ossified predigits, compared to 27/35 feet (13/14 elephants) in Asian elephants. The extent of ossification was lower in African elephants: seven predigits were minimally ossified and two had intermediate ossification, versus one minimally ossified predigit, six with intermediate ossification, and 20 extensively ossified predigits in Asian elephants. motif 3 shows the different degrees of predigit ossification observed. A GEE (repeated measures ordinal logistic model) create that species was a statistically significant predictor of presence and extent of predigit ossification (p = 0.009). Within each species, neither age (p < 0.9 in African elephants and p = 0.5 in Asian elephants) nor foot type (fore versus hind; p < 0.9 for African elephants and p = 0.7 for Asian elephants) were create to subsist statistically significant predictors of predigit ossification.

We observed multipartite distal phalanges (Fig. 4) in 36 digits of 23 feet (12 elephants; impeccable Asian). Most were bipartite (27/36), but some were tripartite (9/36). Multipartite distal phalanges were most frequently identified in DV (16/36), DIII (9/36), DIV (6/36), and DII (5/36). DI had none. A GEE (negative binomial model) create that, within Asian elephants, neither age, sex nor foot type were statistically significant predictors of multipartite distal phalanges (p = 0.3, p = 0.1, p = 0.1 respectively).

Figure 4: Three-dimensional reconstructions from CT scans. (A) Dorsal view of the left forefoot of ‘Asian5’, showing tripartite distal phalanx of DIII (arrows; likewise CT appearance inset) and misshapen middle phalanges of DII and DIV (unfilled arrowheads). The middle phalanx of DII is wedge shaped, whilst that of DIV is wedged-shaped with a scalloped distal aspect and missing distal phalanx (filled arrowhead). (B) Dorso-lateral view of the birthright hind foot of ‘Asian9’ showing the bipartite distal phalanx (arrow) and missing middle phalanx (filled arrowhead) of DV.

We observed 25 atypically shaped phalanges in 17 feet of 11 elephants (10 Asian and one African). Affected bones were most often middle phalanges (23/25 bones), but one proximal and one distal phalanx were likewise observed to bear atypical shapes. The shape of the bones varied, but most appeared wedge-shaped (Fig. 4A) due to relative shortening of the bone’s abaxial aspect and/or mediolateral narrowing (18/25 bones). Others appeared very rounded with loss of the typical rhomboidal shape (5/25 bones), and occasionally bones had a scalloped appearance of the articular surface (2/25 bones; remark Figs. 1C and 4A). Atypically shaped phalanges were most often observed in DIV (11/25 bones) and DII (9/25 bones), with fewer seen in DI (3/25 bones) and DV (2/25 bones). No atypically shaped bones were observed in DIII. A GEE (negative binomial model) create age (p = 0.002), species (p = 0.02) and foot type (p = 0.01) to subsist statistically significant predictors of atypically-shaped phalanges, being more frequent in younger elephants, Asian elephants, and hind feet (20 bones in 12 hind feet vs five bones in five forefeet) in multivariate modelling. Sex was not significant (p = 0.8).

Phalangeal number varied between digits and feet. impeccable African elephants had only the proximal phalanx in DI of their forefeet, and no phalangeal bones visible in DI of their hind feet. The distal phalanx of DII was occasionally absent (2/10 African forefeet and 3/7 hind feet). The distal phalanx was always absent from DV in impeccable African elephant feet. Subjectively, Asian elephants appeared to exhibit slightly more variability in phalangeal number. impeccable Asian elephants lacked at least the middle phalanx in DI of their forefeet, however some likewise lacked the distal phalanx (9/18 Asian forefeet), and one foot lacked impeccable phalanges in DI. In the hind feet of Asian elephants, some lacked only the distal phalanx from digit I (2/17 hind feet), some likewise lacked the middle phalanx (4/17), and most lacked impeccable three (11/17). In DII, 1/17 hind feet was missing a middle phalanx and 1/17 was missing a distal phalanx. In DIII, 1/18 forefeet was missing a distal phalanx. In DIV, 4/18 forefeet were missing the distal phalanx and 1/18 forefeet was missing impeccable three phalanges (suspected digital amputation, given the CT appearance). In DV, 3/18 forefeet and 11/17 hind feet were missing the middle phalanx (Fig. 4B), whilst 1/17 hind feet was missing both middle and distal phalanges.

Discussion

All elephants and almost impeccable feet in this study were create with lesions likely to depict clinically well-known pathology. The elephants in their study are a biased population in this regard—though occasions of death was not always clearly specified, it appears at least five of the 21 elephants died or were euthanised in Part due to foot or joint problems. Despite this, their findings reinforce the longstanding concern that foot problems are frequent causes of morbidity and mortality in captive elephants (Steel, 1885; Fowler, 2001; Luikart & Stover, 2005; Siegal-Willott, Alexander & Isaza, 2012).

In addition to foot problems that are widely acknowledged in the literature on elephant pathologies (OA, infectious OA, osteitis, fractures and subluxation), they bear observed remodelling of bones, enthesopathy, osseous cyst-like lesions, soft tissue mineralisation and hyperattenuating bone foci. They likewise create atypically shaped and absent phalanges, though any pathological significance of these features is unclear. Most of the elephant feet in this study had several pathological diagnoses (Table 3), supporting the notion that the different types of pathology bear common causes, and/or that the establishment of one disease process may predispose elephants to developing others. For many types of pathology, multiple feet from the identical elephant were affected, consistent with a generalised predisposition (e.g., husbandry, obesity; remark likewise Miller, Hogan & Meehan, 2016) rather than singular cause. Most of their findings generally tumble into three (sometimes overlapping) categories: lesions related to weight-bearing and loading of tissues, lesions related to ascending infection, and variable anatomy with unclear pathological significance.

Loading appears to bear a significant influence on the development of pathology. A large proportion of the identified pathology was concentrated on the lateral three digits (remodelling, enthesopathy, osteitis, and infectious OA) or middle three digits (OA and osseous cyst like lesions); digits III and IV being the common denominator in both cases. The body weight of elephants is thought to subsist principally borne by the middle three digits (DII, DIII, and DIV) (Siegal-Willott, Alexander & Isaza, 2012), with the lateral three digits (DIII, DIV, DV) typically experiencing the greatest pressures during walking (Panagiotopoulou et al., 2012). contrary to expectations, they did not find the forelimbs to subsist significantly more affected by pathology than the hind limbs (Hittmair & Vielgrader, 2000), despite mien a greater proportion of bodyweight (−60%; Genin et al., 2010). However, pressures on the forefeet are only higher in some instances and regions (Panagiotopoulou et al., 2012). Additionally, the digital cushions and predigits vary between fore and hind feet (Weissengruber, 2006; Hutchinson et al., 2011), and the limbs may subsist used differently in different styles of locomotion or other behaviours, potentially resulting in different patterns of loading between feet.

In OA, the link to increased or altered loading (via obesity or penniless conformation) is fairly well established, though other factors (including trauma) may subsist involved (Fowler, 2006; Siegal-Willott, Alexander & Isaza, 2012). For other (putative) types of pathology, such as remodelling, enthesopathy and soft tissue mineralisation, the link to large or abnormal loads is hypothesised from other species. Enthesopathy in humans can subsist seen in degenerative, inflammatory or metabolic diseases (Ruhoy, Schweitzer & Resnick, 1998), and with aging (Shaibani, Workman & Rothschild, 1993). But animal models prove that enthesopathy can likewise occur without tendon microtears or inflammation and may subsist an adaptive response to loading (Benjamin, Rufai & Ralphs, 2000). Remodelling and enthesopathy are both frequently observed in rhinos and thought to reflect tissue loading (Regnault et al., 2013; Galateanu et al., 2013; Stilson, Hopkins & Davis, 2016). The linear appearance and the location of soft tissue mineralisation in their elephants suggest that the digital flexor tendons are the affected structures. Mineralisation of the deep digital flexor tendon in horses has been observed as a response to inveterate injury (Dyson, 2003b), and general mineralisation has been described as a feature of tendinopathy (tendon disease arising from overuse) and following trauma in other species (O’Brien et al., 2012). The magnitude of load experienced by structures may subsist a factor (especially in OA and remodelling, which both enlarge with increasing age and therefore presumably body weight), as might the type of loading; e.g., altered locomotion or long periods of standing. As elephants are both very large and long-lived, they may subsist more predisposed to loading-associated pathology and/or bone remodelling (perhaps including the variable sesamoid and phalangeal bone appearances described below) compared with other species. Indeed, as ossification of the foot and other limb bones tends to initiate relatively late in elephants (Hautier et al., 2012) and their growth plates likewise tend to nearby late in life (uncertain and variable timing but roughly at 8–20 years of age; Roth, 1984; Siegal-Willott et al., 2008), the growth patterns of elephant feet (and perhaps limbs more generally) may leave them more vulnerable to accumulation of pathologies, although much more research is required to test this speculation.

Osteitis and infectious OA often result from spreading soft tissue infections, or penetration of a exotic protest into the foot (Fowler, 2006). Their study create the proximal bones and joints to subsist more affected, compared to the distal and middle phalanges more often reported in other studies (Fowler, 2006 citing Gage, 1999 and Hittmair & Vielgrader, 2000); this clear-cut discrepancy might subsist best explained by variability and sample sizes in both cases.

We observed subluxation and fracture, which may result from trauma but may likewise sometimes subsist incidental findings (for example, fracture of the distal phalanx in elephants; Fowler, 2006). Post-mortem fracture or manipulation of bones out of congruency likewise cannot subsist ruled out. Interestingly, they frequently observed multipartite distal phalanges that materialize very similar to fractured phalanges but that they inferred to subsist a distinct entity, based on the necessity of callus or bone reaction. The phalanges resembled the incompletely ossified distal phalanges observed radiographically in juvenile Asian elephants (Siegal-Willott et al., 2008). The affected elephants in their study were likewise impeccable Asian (no African), and the distal phalanges of the lateral digits (DV and to a lesser degree, DIV) were most frequently observed to subsist multipartite. like Siegal-Willott et al. (2008), they create bipartite phalanges (called ‘unilateral wing lucencies’) more common that tripartite phalanges (‘bilateral wing lucencies’). They observed multipartite distal phalanges in elephants up to 55 years old, and so it seems that the ossification centres of these bones may not always fuse with age (similar to multipartite sesamoids). They confess that the distinction between fracture and a congenitally multipartite bone can subsist subtle (or even impossible with inveterate fractures; Morandi, 2012), and that the pathological significance of either condition appears negligible in the distal phalanx.

It is well-known that veterinarians and radiologists are watchful of such apparently customary anatomical variations and incidental lesions when evaluating pathology in the feet. Best-known amongst these is variable phalangeal number, especially in DI and DV (Ramsay & Henry, 2001; Fowler, 2006; Hutchinson et al., 2008; Siegal-Willott, Alexander & Isaza, 2012). Their data likewise support this longstanding observation of elephants, and validate that digits II, III and IV generally bear three phalanges (although exceptions existed, especially amongst Asian elephants). Atypically shaped phalanges are another source of anatomical variation observed in this study.

Sesamoid bones likewise had variable appearances—not only the proximal sesamoid bones (generally paired bones in other species but which may subsist fused or asymmetrical in elephants), but likewise the predigits. These unsuitable ‘sixth toes’ look to subsist modified sesamoids that start out as cartilaginous rods but may later ossify (Hutchinson et al., 2011). In their elephant sample (with sample overlap from those of Hutchinson et al., 2011), the predigits ranged from completely non-ossified (visible as a hollow cartilaginous rod), to small and patchy regions of mineral attenuation, to large discrete pieces of bone, to long, intricate and jointed structures curving around to the back of the foot. Within the identical animal, the degree of mineralisation in pairs of forefeet or hind feet was consistent, but could vary between fore and hind limbs.

We create that Asian elephants showed a greater tendency towards ossification of the predigits. Presence of sesamoid bones at joints has been linked to increased OA by some studies (e.g., Pritchett, 1984; Hagihara et al., 1993), though not others (e.g., Muehleman, Williams & Bareither, 2009). The workable link to OA in humans has prompted the hypothesis that sesamoids may predispose joints to developing disease, or that both OA and sesamoids are linked by an underlying process (i.e., tendency for endochondral ossification; Sarin et al., 1999). Although they did not find significantly more OA in Asian compared to African elephants, they did find more enthesopathy, more sesamoid fusion, and multipartite distal phalanges (indicating multiple unfused ossification centres). Along with their greater predigit ossification, these findings lead us to speculate that Asian elephants might bear an increased tendency for endochondral ossification (in their distal limbs) than African elephants. This could interpret some differences in disease prevalence and bone anatomy.

Of their findings, only the osseous cyst-like lesions and hyperattenuating regions achieve not clearly fortunate into the categories of lesions related to loading, infection, or incidental finding/variable anatomy. Osseous cyst-like lesions may subsist secondary to OA, osteochondrosis (particularly if subchondral), ischaemic necrosis, haemorrhage, or vascular malformation (Carlson & Weisbrode, 2006). like their elephants, sex-based biases in cyst prevalence bear been famed in humans (O’Donnell, 2009) and some other animals (Craig, Dittmer & Thompson, 2016). The hyperattenuating regions resemble enostoses (benign foci of dense bone), which are sometimes associated with lameness in horses (Dyson, 2003a). The occasions is unknown, but contributing factors may include excess dietary calcium (Carciofi & achieve Prado Saad, 2008).

Conclusions

Though a small proportion of their elephants were previously known to bear foot or joint problems, the generally tall level of pathology create in their study highlights the necessity for continuing vigilance regarding elephant foot health. They should not subsist complacent with necessity of lameness or externally clear-cut signs. A comprehensive evaluation of foot health in elephants should therefore include ‘baseline’ foot radiographs to establish the ‘normal’ anatomy for that individual, and annual assessment thereafter using radiographic protocols with standard views optimal for the detection of pathological lesions (Mumby et al., 2013). In addition, weight management, regular exercise, a clean and arrogate environment (with minimal time spent on difficult surfaces; Miller, Hogan & Meehan, 2016), and other measures to obviate over-loading, injury and infection should not subsist overlooked.

Supplemental Information Raw data (lesions graded from CT scans)

Sheet 1 is the raw collected data, sheet 2 contains a summary of the elephants, predigits, sesamoids and grade 2 + pathology, sheet 3 contains the raw data for misshapen or missing phalanges.



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Mile2 [2 Certification Exam(s) ]
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Misc [1 Certification Exam(s) ]
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PostgreSQL-CE [1 Certification Exam(s) ]
Prince2 [6 Certification Exam(s) ]
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Veeam [2 Certification Exam(s) ]
Veritas [33 Certification Exam(s) ]
Vmware [58 Certification Exam(s) ]
Wonderlic [2 Certification Exam(s) ]
Worldatwork [2 Certification Exam(s) ]
XML-Master [3 Certification Exam(s) ]
Zend [6 Certification Exam(s) ]





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