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A2040-409 exam Dumps Source : Assessment: IBM Notes and Domino 9.0 convivial Edition Application Development

Test Code : A2040-409
Test name : Assessment: IBM Notes and Domino 9.0 convivial Edition Application Development
Vendor name : IBM
: 122 actual Questions

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IBM Assessment: IBM Notes and

Cramer: Pay consideration to recent insider purchasing at GE and IBM | killexams.com actual Questions and Pass4sure dumps

  • Jim Cramer suggests investors suffer in intelligence of fresh insider buying at IBM and GE, together with corporate buybacks at Apple and Berkshire Hathaway.
  • whereas insiders promote for every bit of kinds of reasons, they most effective buy for one cause: "to build funds," Cramer says.
  • IBM CEO Ginni Rometty bought over $3 million value of inventory final week, her first purchase on the open market.
  • throughout volatile buying and selling days with conflicting indicators, buyers want "some kindly of totem that can advocate point us within the right course," spoke of CNBC's Jim Cramer .

    The "Mad funds" host means that investors look to live out for massive insider buying.

    while insiders promote for every bit of types of reasons, they only buy for one rationale: "to build funds," Cramer talked about.

    five IBM IBM board contributors lately bought shares in the business, together with CEO Ginni Rometty who bought over $3 million price of inventory. Rometty's buy, her first on the open market, signals "a dependable commitment," Cramer spoke of.

    IBM shares rose on the advice early Monday, reversing some of ultimate week's losses when the inventory fell 7 percent after IBM announced it turned into acquiring pink Hat RHT for $34 billion.

    "I believe the crimson Hat acquisition turned into basically a bold stream," the "Mad money" host referred to. i would not shun this combination just because the cloud shares accommodate every bit of at once fallen out of style."

    In 2016, JP Morgan JPM CEO Jamie Dimon bought $26 million price of stock at $53 per share. nowadays, the stock is more than double that fee.

    company buybacks, fancy the recent activity at Berkshire Hathaway BRK.A and Apple AAPL , can moreover symptom that executives suppose the inventory is cheap.

    although, Cramer cautions that insider buying is never every bit of the time a symptom that the inventory is ready to rally.

    GE GE CEO Larry Culp, who just stepped into the position Oct. 1, bought over $2 million price of stock final week. however the trade "still has a ton of complications," Cramer noted, together with its struggling verve trade and ongoing restructuring plan.

    Cramer's final analysis? "it's always price taking these gigantic insider buys severely," however they accomplish not always imply the inventory is a buy.

    WATCH: Cramer on insider buying

    Questions for Cramer?name Cramer: 1-800-743-CNBC

    want to win a abysmal dive into Cramer's world? Hit him up!Mad money Twitter - Jim Cramer Twitter - fb - Instagram - Vine

    Questions, comments, counsel for the "Mad funds" site? madcap@cnbc.com

    extra From CNBC


    Assessing IBM’s $34 billion purple Hat acquisition | killexams.com actual Questions and Pass4sure dumps

    As you look at the $34 billion IBM-pink Hat deal introduced the day past, if you solemnize the trade carefully, it appears fancy a mighty stream, as a minimum on its face. It may live years earlier than they win into account the actual price of it for IBM (or requisite thereof, counting on how it eventually goes). The questions stands then, is this a savvy movement, a desperate one or possibly a limited of both. It turns out, it depends upon whom you ask.

    For starters, there's the sheer amount of cash involved, a 63 p.c top class on Friday’s closing expense of just below $117 a share. IBM spent $190 a share, but as Ray Wang, founder and chief analyst at Constellation analysis spoke of, crimson Hat didn’t always wish to live offered, so IBM needed to overpay to derive their enterprise.

    Wang sees cloud, Linux and safety because the huge drivers on IBM’s part. “IBM is doubling down on the cloud, but they moreover are going for a seize in Linux for their largest and most essential open source communities and a few of the newer tech on red Hat safety,” he instructed TechCrunch. He acknowledges that it’s a huge top rate for the stock, but he believes IBM wants the M&A motion to pressure down customer acquisition fees and accommodate up retreat sell.

    image: Ron Miller

    IBM is placing a big guess here says Dharmesh Thakker, universal partner at Battery Ventures, believing it to live price 30x its latest revenue in the subsequent 365 days. “for sure, the hybrid cloud opening that they accommodate been engaged on the final few years, is dependable and IBM/Cisco/HP/Dell every bit of wish a bit of this action going ahead as the $300B in datacenter expend receives dislocated through public and hybrid cloud carriers,” Thakker defined in an announcement.

    He believes this deal might really set off a current set of mega mergers between the common tech vendors and cloud native, container and DevOps companies over the following brace of months.

    IBM CEO Ginni Rometty turned into positively dizzy on the prospects of a combined IBM-purple Hat in a call with analysts and press this morning, pointing out that best 20 percent of enterprise workloads had been moved to the cloud. She sees a big opportunity, one she initiatives to live worth $1 trillion by means of 2020. protecting in intellect you'll want to win market projections with a grain of salt, here is surely a huge market and one which Oracle and Microsoft accommodate moreover targeted.

    She stated that pink Hat became a infrequent company certainly. “crimson Hat by itself has been a extreme price company and has accomplished a mighty job with tough growth, is highly profitable and generates money. There aren't many groups obtainable that explore fancy that in this area,” Rometty observed.

    Slide: IBM

    Dan Scholnick, well-known companion at Trinity Ventures, whose investments accommodate covered current Relic and Docker, turned into not terribly impressed with the deal, believing it smacked of desperation on IBM’s half.

    “IBM is a declining enterprise that by hook or by crook must turn into imperative within the cloud period. purple Hat isn't the answer. purple Hat’s company facilities around an operating equipment, which is a layer of the expertise stack that has been fully commoditized by cloud. (if you expend AWS, that you may derive Amazon’s OS for free, so why would you pay red Hat?) purple Hat has NO account for cloud,” he claimed in an announcement.

    That could no longer live a wholly reasonable evaluation. while crimson Hat commercial enterprise Linux is a huge a fragment of the company’s income, it’s no longer the best piece. Over the closing brace of years it has moved into Kubernetes and containerization and has grown the cloud endemic aspect of the trade alongside RHEL.

    truly, Forrester analyst Dave Bartoletti sees the cloud endemic piece as being key right here. “The mixed enterprise has a leading Kubernetes and container-primarily based cloud-native structure platform, and a an Awful lot broader open supply middleware and developer tools portfolio than both trade one at a time. whereas any acquisition of this measurement will win time to play out, the combined company will build confident to reshape the open source and cloud systems market for years to near back,” he spoke of.

    image: IBM

    Wang believes the deal could hinge on how long pink Hat CEO Jim Whitehurst, who had led the enterprise for over a decade, stays with the unit. in response to IBM, they'll retain the pink Hat company and function it as an independent entity inside massive Blue. “If Whitehurst doesn’t stick around for awhile, the deal may retreat south,” he noted. but the enterprise may dangle the CEO job when Rometty decides to depart as incentive to reside.

    Regardless, Wall street was not utterly chuffed with IBM’s circulation with their inventory down every bit of day. for confident the 63 % top rate IBM paid for the inventory has pushed red Hat greater these days.

    The deal requisite to tide shareholder muster, but given the premium IBM has provided, it’s challenging to accept as dependable with they would flip it down. additionally, on account that these businesses operate internationally, they're district to the international regulatory approval technique. They gained’t officially near collectively except as a minimum the 2d half of subsequent yr on the soonest. That’s after they might start to live taught even if this changed into a superb or desperate movement by means of IBM.


    IBM to tide Watson health to a hybrid cloud | killexams.com actual Questions and Pass4sure dumps

    enterprise mobility 2018: UEM is the next step


    Killexams.com A2040-409 Dumps and actual Questions

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    A2040-409 exam Dumps Source : Assessment: IBM Notes and Domino 9.0 convivial Edition Application Development

    Test Code : A2040-409
    Test name : Assessment: IBM Notes and Domino 9.0 convivial Edition Application Development
    Vendor name : IBM
    : 122 actual Questions

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    Assessment: IBM Notes and Domino 9.0 convivial 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 trade value. They disregard the gimmicky software that might feature a ingenious conception 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 live realized in their readers' widely diverse environments.

    The judging process is a collaborative endeavor 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 necessary to their readership by listening to and working with customers. They every bit of delineate a commitment to innovation and their customers.

    We animate 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 fragment of either end-to-end OCR or AnyDoc automated document and data capture. Click here for more product details.

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    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 moreover accommodate ecological significance as umbrella (or keystone) species, whose conservation indirectly protects others (Choudhury et al., 2008). They moreover accommodate economic weight as tourist attractions and working animals. Welfare of elephants is an lively district of discussion, both in professional fields and in generic society. Although the welfare of captive elephants has been improving through husbandry initiatives and advances in learning of veterinary saturate for these species, there remain several areas that continue to live obstacles to optimum welfare.

    Pathological foot conditions are one such problem area, thought to constitute the lone most necessary 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 habitual unresponsive conditions of the feet are a major judgement for euthanasia in captivity (Csuti, Sargent & Bechert, 2008).

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

    Management conditions are thought to live the one of the most necessary factors in the progress 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. arduous floors, requisite of exercise, and repeated concussive forces (potentially including stereotypic behaviour; Haspeslagh et al., 2013) accommodate every bit of been proposed to contribute to the progress of OA (Hittmair & Vielgrader, 2000) or generic musculoskeletal foot health (Miller, Hogan & Meehan, 2016) . Additionally, the conformation of the big and relatively straight limbs of elephants may predispose them to pathology (Fowler, 2006), as might the inherent biomechanics of the feet. Pathological changes accommodate been speculated to occur more frequently in regions that normally undergo 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) accommodate been more commonly used in veterinary practice for musculoskeletal and other problems, but their expend for elephants is precluded by corpse 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 big 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 live present in multiple feet of the very individual and moreover that there will live multiple kinds of pathological change, which may live 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 conscious of traditional anatomical variation, therefore, they moreover recount other osseous features that likely delineate non-pathological, variable distal limb anatomy.

    Materials and Methods

    CT scans of 52 cadaver feet (16 right fore, 12 left fore, 14 right hind, 10 left hind) from 21 captive elephants (seven African Loxodonta africana, and 14 Asian Elephas maximus) were evaluated for evidence of pathology. every bit of 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 accommodate 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 every bit of 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 big 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 austere (grades 1, 2 or 3 respectively; see 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 removed to other osseous structures Slight = solitary short linear foci, occasionally coalescing qualify = multiple linear or irregularly shaped mineral attenuating areas austere = extensive mineralisation, frequently linear coalescing mineral structures, elongated Osteitis Disruption of traditional trabecular bone pattern, mottled appearance, multiple hypoattenuating foci, loss of parts of bone, destruction of traditional bone outline, periosteal current bone formation Slight/Moderate/Severe based on extent of changes Enthesopathy Discrete current 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 very bone then interpretation based on every bit of 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 live with current bone formation at bone surface (old), linear hypoattenuation (acute) Not graded (just present/absent) Osteoarthritis Discrete current bone at periarticular surface, subchondral bone sclerosis, narrowing or obliteration of joint space, subchondral lysis, widening of joint space Mild: minute 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 live 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 current 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 abysmal 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 moreover 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 lone 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 accommodate 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 sort (fore or hind), and species (Asian or African) as predictors on the amount of observed pathology (modelled as count 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 very elephant were treated as repeated measures. Similar GEE models were rush 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 moreover 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 sort 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 accommodate lesions in other feet, they compared the harmony 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 every bit of categories.

    Results Pathological changes

    All of the elephant feet in this study (i.e., every bit of adults and near-adults) were observed to accommodate pathology of some sort under their grading scheme. However, the majority of these lesions (63%) were grade 1, thus considered to live clinically insignificant or anatomical variants. They considered lesions of grade 2 or 3 (moderate and marked/severe) likely to delineate 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 found to accommodate 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 every bit of 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 every bit of 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) found 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 sort (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 lone 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 right 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 right forefoot of ‘Asian10’. (C) Focal hyperattenuating region (arrow) and misshapen, scalloped proximal phalanx (filled arrowhead) in DII of the right 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 right 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; moreover “Path,” number of unique pathology categories observed per individual elephant, and asterisks testify elephants known to accommodate foot or locomotor problems. Second column: “Foot”: LH, left hind; LF, left fore; RH, right hind; RF, right 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 every bit of 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) found 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 sort (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 lone 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 right 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 right 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 every bit of 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) found 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 sort (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 lone foot affected).

    Osteoarthritis (OA; Fig. 1B) represented 13% of every bit of 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) found that OA increased with age (p = 0.02 in the final univariate model); age remained significant (p = 0.05) after accounting for foot sort (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 lone foot affected).

    Soft tissue mineralisation (Figs. 1D and 2C) represented 7% of every bit of pathologies observed (Table 3), present in 9/21 elephants (17/52 feet). These mineralisations were identified having similar interdigital, frequently linear structure in every bit of 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 lone foot affected).

    Osteitis (Fig. 2D) represented 3% of every bit of 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 every bit of 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 moreover observed with osteitis. Commonly affected joints were the MCP/MTP (46%), PIP (38%) and drunk 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 lone affected foot, versus only one elephant with multiple feet affected).

    Subluxation (Fig. 1D) of a joint represented 1% of every bit of pathology observed (Table 3), present in five out of 21 elephants (8/52 feet). The MCP/MTP, PIP and drunk joints were equally affected. Digits were moreover 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 every bit of 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 every bit of 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 lone 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 lone 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 right forefoot of ‘Asian4.’ Note moreover the lone sesamoid of DI (arrow) and the paired proximal sesamoids of other digits (filled arrowheads). (B) Sparsely mineralised prepollex (red box) in right forefoot of ‘African6.’ (C) Medium-sized, discrete ossification of the prepollex (red box) in right forefoot of ‘African2.’ Note moreover the larger lateral sesamoid of DV (filled arrowhead) compared to the medial sesamoid. (D) big ossification bounding the outer edges of the prepollex (red box) in right forefoot of ‘Asian12.’ Often, the middle of the predigit will remain partially unossified resulting in a rod-like appearance. Note moreover 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 lone 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) found 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 sort (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. device 3 shows the different degrees of predigit ossification observed. A GEE (repeated measures ordinal logistic model) found 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 sort (fore versus hind; p < 0.9 for African elephants and p = 0.7 for Asian elephants) were found to live statistically significant predictors of predigit ossification.

    We observed multipartite distal phalanges (Fig. 4) in 36 digits of 23 feet (12 elephants; every bit of 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) found that, within Asian elephants, neither age, sex nor foot sort 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; moreover 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 right 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 moreover observed to accommodate 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; see 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) found age (p = 0.002), species (p = 0.02) and foot sort (p = 0.01) to live 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. every bit of 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 every bit of African elephant feet. Subjectively, Asian elephants appeared to exhibit slightly more variability in phalangeal number. every bit of Asian elephants lacked at least the middle phalanx in DI of their forefeet, however some moreover lacked the distal phalanx (9/18 Asian forefeet), and one foot lacked every bit of phalanges in DI. In the hind feet of Asian elephants, some lacked only the distal phalanx from digit I (2/17 hind feet), some moreover lacked the middle phalanx (4/17), and most lacked every bit of 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 every bit of 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 every bit of feet in this study were found with lesions likely to delineate clinically necessary 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 fragment 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 accommodate observed remodelling of bones, enthesopathy, osseous cyst-like lesions, soft tissue mineralisation and hyperattenuating bone foci. They moreover found 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 accommodate 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 very elephant were affected, consistent with a generalised predisposition (e.g., husbandry, obesity; see moreover Miller, Hogan & Meehan, 2016) rather than singular cause. Most of their findings generally topple 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 accommodate a significant influence on the progress of pathology. A big harmony 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 fancy lesions); digits III and IV being the common denominator in both cases. The corpse weight of elephants is thought to live 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 live significantly more affected by pathology than the hind limbs (Hittmair & Vielgrader, 2000), despite demeanor a greater harmony 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 disagree between fore and hind feet (Weissengruber, 2006; Hutchinson et al., 2011), and the limbs may live 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 poor conformation) is fairly well established, though other factors (including trauma) may live 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 big or abnormal loads is hypothesised from other species. Enthesopathy in humans can live seen in degenerative, inflammatory or metabolic diseases (Ruhoy, Schweitzer & Resnick, 1998), and with aging (Shaibani, Workman & Rothschild, 1993). But animal models testify that enthesopathy can moreover occur without tendon microtears or inflammation and may live 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 insinuate that the digital flexor tendons are the affected structures. Mineralisation of the abysmal digital flexor tendon in horses has been observed as a response to habitual injury (Dyson, 2003b), and generic 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 live a factor (especially in OA and remodelling, which both augment with increasing age and therefore presumably corpse weight), as might the sort of loading; e.g., altered locomotion or long periods of standing. As elephants are both very big and long-lived, they may live 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 launch relatively late in elephants (Hautier et al., 2012) and their growth plates moreover mind 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 object into the foot (Fowler, 2006). Their study found the proximal bones and joints to live 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 patent discrepancy might live best explained by variability and sample sizes in both cases.

    We observed subluxation and fracture, which may result from trauma but may moreover sometimes live incidental findings (for example, fracture of the distal phalanx in elephants; Fowler, 2006). Post-mortem fracture or manipulation of bones out of congruency moreover cannot live ruled out. Interestingly, they frequently observed multipartite distal phalanges that materialize very similar to fractured phalanges but that they inferred to live a several entity, based on the requisite 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 moreover every bit of Asian (no African), and the distal phalanges of the lateral digits (DV and to a lesser degree, DIV) were most frequently observed to live multipartite. fancy Siegal-Willott et al. (2008), they found 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 concede that the distinction between fracture and a congenitally multipartite bone can live subtle (or even impossible with habitual fractures; Morandi, 2012), and that the pathological significance of either condition appears negligible in the distal phalanx.

    It is necessary that veterinarians and radiologists are conscious of such apparently traditional 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 moreover advocate this longstanding observation of elephants, and verify that digits II, III and IV generally accommodate three phalanges (although exceptions existed, especially amongst Asian elephants). Atypically shaped phalanges are another source of anatomical variation observed in this study.

    Sesamoid bones moreover had variable appearances—not only the proximal sesamoid bones (generally paired bones in other species but which may live fused or asymmetrical in elephants), but moreover the predigits. These False ‘sixth toes’ look to live 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 minute and patchy regions of mineral attenuation, to big discrete pieces of bone, to long, elaborate and jointed structures curving around to the back of the foot. Within the very animal, the degree of mineralisation in pairs of forefeet or hind feet was consistent, but could vary between fore and hind limbs.

    We found that Asian elephants showed a greater drift 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 possible 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., drift 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 accommodate an increased drift for endochondral ossification (in their distal limbs) than African elephants. This could account for some differences in disease prevalence and bone anatomy.

    Of their findings, only the osseous cyst-like lesions and hyperattenuating regions accomplish not clearly suitable into the categories of lesions related to loading, infection, or incidental finding/variable anatomy. Osseous cyst-like lesions may live secondary to OA, osteochondrosis (particularly if subchondral), ischaemic necrosis, haemorrhage, or vascular malformation (Carlson & Weisbrode, 2006). fancy their elephants, sex-based biases in cyst prevalence accommodate been preeminent 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 embrace excess dietary calcium (Carciofi & accomplish Prado Saad, 2008).

    Conclusions

    Though a minute harmony of their elephants were previously known to accommodate foot or joint problems, the generally tall smooth of pathology found in their study highlights the requisite for continuing vigilance regarding elephant foot health. They should not live complacent with requisite of lameness or externally patent signs. A comprehensive evaluation of foot health in elephants should therefore embrace ‘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 antiseptic and confiscate environment (with minimal time spent on arduous surfaces; Miller, Hogan & Meehan, 2016), and other measures to obviate over-loading, injury and infection should not live 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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    References :


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    Operations & Process Management: Principles & Practice for Strategic ImpactOperations & Process Management: Principles & Practice for Strategic Impact
    By Nigel Slack, Alistair Jones
    Publisher : Pearson (Feb 2018)
    ISBN10 : 129217613X
    ISBN13 : 9781292176130
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    Subject : Business & Economics
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    Computer Security: Principles and PracticeComputer Security: Principles and Practice
    By William Stallings, Lawrie Brown
    Publisher : Pearson (Aug 2017)
    ISBN10 : 0134794109
    ISBN13 : 9780134794105
    Our ISBN10 : 1292220619
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    Subject : Computer Science & Technology
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    Urban EconomicsUrban Economics
    By Arthur O’Sullivan
    Publisher : McGraw-Hill (Jan 2018)
    ISBN10 : 126046542X
    ISBN13 : 9781260465426
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    Subject : Business & Economics
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    Urban EconomicsUrban Economics
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    Publisher : McGraw-Hill (Jan 2018)
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    Understanding BusinessUnderstanding Business
    By William G Nickels, James McHugh, Susan McHugh
    Publisher : McGraw-Hill (Feb 2018)
    ISBN10 : 126021110X
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    Understanding BusinessUnderstanding Business
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    Publisher : McGraw-Hill (May 2018)
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    Understanding BusinessUnderstanding Business
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    A2040-409A2040-409
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    Publisher : McGraw-Hill (Jan 2017)
    ISBN10 : 1260128474
    ISBN13 : 9781260128475
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    Subject : Business & Economics, Communication & Media
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    A2040-409A2040-409
    By Peter Cardon
    Publisher : McGraw-Hill (Feb 2017)
    ISBN10 : 1260147150
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    Subject : Business & Economics, Communication & Media
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