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Applied Animal Behaviour Science

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In press

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Final Revision – NOT EDITED by the journal

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Relationships between behaviour and health in

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working horses, donkeys, and mules in developing

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countries

8 Charlotte C. Burn1*, Tania L. Dennison2 & Helen R. Whay3

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Veterinary Clinical Sciences, The Royal Veterinary College, UK; 2Brooke Hospital

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for Animals, London, UK; 3Clinical Veterinary Sciences, University of Bristol, UK

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Short title: Behaviour and health of working equids

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*Corresponding author: Dr C. C. Burn, Centre for Animal Welfare, Department of

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Clinical Veterinary Sciences, The Royal Veterinary College, Hawkshead Lane,

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Hertfordshire, AL9 7TA, UK 1

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Abstract Recent studies raise serious welfare concerns regarding the estimated 93.6

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million horses, donkeys and mules in developing countries. Most equids are used for

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work in poor communities, and are commonly afflicted with wounds, poor body

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condition, respiratory diseases, parasites, dental problems, and lameness. Non-

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physical welfare problems, such as fear of humans, are also of concern. Interventions

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to improve working equine welfare aim to prioritise the conditions that cause the most

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severe impositions on the animals’ subjectively experienced welfare, but data

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identifying which conditions these may be, are lacking. Here we describe a stage in

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the validation of behavioural welfare indicators that form part of a working equine

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welfare assessment protocol. Over four years, behavioural and physical data were

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collected from 5481 donkeys, 4504 horses, and 858 mules across nine developing

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countries. Behaviours included the animals’ general alertness, and their responses to

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four human-interaction tests, using the unfamiliar observer as the human stimulus.

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Avoidance behaviours correlated significantly with each other across the human-

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interaction tests, with 21% of animals avoiding the observer, but they showed no

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associations with likely anthropogenic injuries. Over 13% of equids appeared

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‘apathetic’: lethargic rather than alert. Measures of unresponsiveness correlated with

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each other across the five tests, and were associated with poor body condition,

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abnormal mucous membrane colour, faecal soiling, eye abnormalities, more severe

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wounds, and older age, depending on the equine species. This suggests that working

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equids in poor physical health show an unresponsive behavioural profile, consistent

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with sickness behaviour, exhaustion, chronic pain, or depression-like states.

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Keywords: Animal welfare; Developing countries; Equine; Human-animal

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relationships; Inactivity; Sickness behaviour

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Introduction An estimated 39 million donkeys, 40.5 million horses and 12.3 million mules

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live in developing countries, constituting over 85% of the world’s equids (FAOSTAT,

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2006). In developing countries, equids are mostly used as working animals, often

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carrying out tasks under harsh and impoverished conditions for long hours each day.

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Consequently, previous research has shown that they have many physical and clinical

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problems, such as wounds, poor body condition, respiratory diseases, high parasite

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burdens, dental problems, and lameness (de Aluja, 1998; Pritchard et al., 2005;

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Tesfaye & Curran, 2005; Regan, 2009a; Burden et al., in press; Burn et al., in press;

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Saul et al., in press). These problems are likely to reduce the work efficiency of the

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animals, indirectly reducing the income of the often very poor people who rely on

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them. The physical/clinical problems are also likely to cause poor welfare for the

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animals themselves, since similar conditions in humans are associated with pain,

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weakness, exhaustion, and depression (Kelley et al., 2003). Hence, charities, such as

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the Brooke Hospital for Animals (‘the Brooke’) who provided data for the current

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study, work to attempt to improve working equine health and welfare.

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To date, despite growing information on working equine health, little is known

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about the animal welfare implications (in the sense of the animals’ subjective

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experiences) of the myriad physical conditions these animals accumulate. For

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example, some physical conditions might be associated with pain (Broster et al., 2009;

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Regan, 2009b) or exhaustion (the high creatine kinase concentrations in working

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equids indicates that muscle damage from overwork is prevalent: Tadich et al., 1997;

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Pritchard et al., 2009), while others may barely be perceived by the animals even if

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they harm their health and longevity. This is of applied importance because funding

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and resources to improve animal welfare should ideally be targeted towards problems

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likely to cause the most suffering as perceived by the animals themselves, which may

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be those causing deviations from normal behaviour. It would also be of value to have 3

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easily observed behavioural welfare indicators, so that the individual animals likely to

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be in most need of welfare improvement can be identified rapidly before a full

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assessment is done. Here we describe a stage in the validation of behavioural welfare

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indicators in working equids to assess their potential for providing information

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towards these purposes.

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The behavioural indicators here formed part of a non-invasive welfare

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assessment that was developed in 2003 by the University of Bristol in collaboration

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with the Brooke. It should be noted that the data were not collected for the purposes of

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this study, but instead for the internal monitoring purposes of the Brooke. The data

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thus take the form of a series of standardised surveys of working equine populations,

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and we use an epidemiological approach, exploiting the natural variation within these

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populations, to investigate relationships between variables of interest. The welfare

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assessment protocol was intended to be brief and appropriate for field conditions,

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where observers were often interrupting the animals’ work. The welfare indicators

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were chosen to be simple, to minimise assessment time and to facilitate repeatability

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between observers. The behaviours included an observation of general alertness

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versus unresponsiveness to the environment. Unresponsiveness can be a component of

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chronic pain (Ashley et al., 2005), sickness behaviour (Aubert, 1999; Millman, 2007;

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Weary et al., 2009), depression (Vollmayr & Henn, 2003; Dunn et al., 2005) and

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exhaustion; but equally it can be associated with neutral or even good welfare if an

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animal perceives its situation to be secure enough to allow reduced vigilance (Paul et

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al., 2005). The human-interaction tests, which were proposed as measures of fear,

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aversion, or friendliness towards humans, incorporated brief assessments of the

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animals’ avoidance and other responses when a human approached, and their

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acceptance of human contact (e.g. for farm animals de Passille & Rushen, 2005;

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Waiblinger et al., 2006, and for sports and companion horses Hausberger et al., 2008).

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Pain behaviours were not explicitly included in the assessment, since they are highly

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diverse, differing with the source, nature, and time-scale of the pain (Ashley et al.,

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2005; Regan, 2009a).

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Like many large-scale, multi-centre epidemiological studies, data were

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collected by a number of trained observers (e.g. Waters et al., 2002; Dawkins et al.,

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2004; Rutherford et al., 2009). The observers in the current study were only those

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attaining ≥80% agreement with the trainer for all indicators, but the more general

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inter- and intra-observer reliability of the physical and behavioural indicators in the

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welfare assessment have also been tested (Burn et al., 2009): the population was too

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homogenous to conclusively test all the indicators, but while alertness showed

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acceptable intra-observer reliability, it showed poor reliability between observers.

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This suggests that some observers have different thresholds or use different cues for

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deciding when equids are alert or not, despite having been trained using the same

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guidance notes and photographs. These differences will have added unsystematic

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noise to the data analysed here, but the variable was included because so little is

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currently known about working equine behaviour, and – with modification – a

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measure of general alertness could be important in future equine welfare assessments.

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The responses to the four human-interaction tests did show acceptable reliability

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between observers. The only physical indicator in the current study that attained poor

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reliability was mucous membrane colour, but it was included here because of its

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clinical relevance as a field test for endotoxaemia or gastrointestinal illness (Hailat et

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al., 1997; Thoefner et al., 2001; Hillyer, 2004).

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In the current study, we investigated how the behaviours related to each other,

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and how they related to potentially relevant physical measures. Our hypotheses were

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broadly that (a) unresponsiveness should correlate across the tests and (b)

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unresponsiveness should be associated with an overall reduced prevalence of physical

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problems if it signifies good welfare, or with an increased prevalence of physical

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problems if it indicates negative welfare (i.e. we tested whether responsiveness in 5

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these animals had a relationship in either direction with physical welfare). Also, if

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aversion to humans is consistent within individual animals, animals that show

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aversion to humans in one of the tests should (c) show aversion to humans in the three

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other human-interaction tests, and (d) have more physical signs of anthropogenic

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harm e.g. wounds on the hindquarters, potentially indicating beating.

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Methods

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Animals and observers

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Non-invasive behavioural and physical data were collected from 5481

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donkeys, 4504 horses, and 858 mules across 60 locations in nine developing

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countries: Afghanistan, Egypt, Ethiopia, Guatemala, India, Jordan, Kenya, Pakistan

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and The Gambia. The data were collected over a 4-year period (March 2003-

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February 2007). The locations were areas where the Brooke was working or

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considering working in the future, or where a collaborating organisation was working

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(see Acknowledgements for collaborating organisations). Details of the locations and

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dates are reported by Burn and colleagues (in press).

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Welfare assessments were carried out by 42 trained observers, the vast

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majority of whom were veterinarians, but who were otherwise animal behaviour

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scientists, agricultural experts, or social scientists. All observers underwent a 6-10 day

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training course (described in Burn et al., 2009), the length being determined by the

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previous experience and English-language skills of participants; the course was based

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around a detailed, 102-page, photographic guide (available upon request from the

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authors: Pritchard & Whay, 2003 (unpublished), 2004 (unpublished)), which the

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participants kept. Only those participants who attained ≥80% agreement with the

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trainer on all measures were selected for data collection in this study. A welfare

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assessment trainer assessed about 5-30% of the animals in each location to help

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ensure consistency between the locations (the percentage of animals varied due to the 6

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logistical constraints of visiting developing countries, gaining owner permission to

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assess each animal, and a paucity of data available on equine populations at the

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planning stages of the study). Animals were selected in locations that the observers

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had experience of working in, and between 5% and 100% of animals were assessed in

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each location depending on the size of the population, with it being possible to

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examine a higher proportion of animals in smaller populations within a single visit.

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Until 2004, observers were requested to sample systematically from known animal

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populations, e.g. every third donkey in the market or on the roadside; thereafter,

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observers were instructed to sample randomly by writing ‘encounter numbers’ (e.g.

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1st, 2nd, 3rd etc animal encountered) or owner names on pieces of paper, which were

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folded, mixed, and then blindly selected until the required sample size had been drawn

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for that day.

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Behaviour and health measurement

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The data were collected using a welfare assessment protocol that included 41

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animal-based measures potentially relevant to welfare (Pritchard & Whay, 2003

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(unpublished), 2004 (unpublished)); but only a subset of the measurements were

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analysed in the current study and they are summarised and briefly described in Table

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1. The welfare indicators included physical health measures, as well as the animals’

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general alertness (versus the opposite, labelled ‘apathy’ but while acknowledging that

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this is not necessarily the associated emotional state; Table 1) and their behavioural

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responses to human presence and human contact. The welfare assessment protocol

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was modified slightly for some of the measurements from 2004 onwards, as described

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in detail by Burn and colleagues (2009).

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Broadly, the sequence and procedure for taking the measurements, including those described in Table 1, was as follows:

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1. Without disturbing the animal (and where possible, before asking the owner’s

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permission to observe the animal), the observer assessed the animal’s general

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alertness from a distance of at least 3 m away, and for up to 10 s.

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2. After gaining permission from the owner, the observer approached the animal

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from 3 m away at a normal pace, looking at the animal’s neck or breast. The

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observer approached at an angle of about 20o, rather than from directly ahead of

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the animal, and then stopped 30 cm from the animal’s head and recorded the

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animal’s response at the moment they stopped.

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3. The observer walked alongside the animal towards its rear and back again,

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maintaining a distance of about 30 cm from its body, and recorded any signs of

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attention to them and whether donkeys showed a tail-tuck response (tail-tucking

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was not observed in horses or mules).

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4. The observer gently placed their hand under the animal’s chin, contacting it

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enough to take some weight but not so as to lift the head. If the animal moved its

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head away from the hand, the observer would not pursue it. This was the first

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point of physical contact between the observer and the animal, unless the animal

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itself had already initiated contact.

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5. The observer then recorded physical health, starting with observing the lips and

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head, and any eye abnormalities. They inserted a thumb or finger into the corner

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of the animal’s mouth and lifted the top lip until the gums and teeth were easily

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visible. The observer stood back to assign a body condition score (BCS), before

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walking to the rear to record faecal soiling. The observer tested skin tent duration

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on the animal’s neck and observed any behavioural signs of heat stress (discussed

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elsewhere in Pritchard et al., 2006, 2007; Pritchard et al., 2008). Ectoparasites and

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lesions were assessed across the body and limbs. Visible swellings of the flexor

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tendon or fetlock joints were recorded, followed by hoof health, including picking

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up the right fore-foot to examine the sole surface. Finally, gait was assessed by

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watching the animal walk as the owner led it for approximately six paces in a

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straight line away from, and then back towards, the observer; if the animal was

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hitched to a cart, time-constraints required that its gait was assessed while pulling

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the cart, once the cart had gained momentum (i.e. not while the animal was

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starting from stationary).

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Statistical analyses

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Data were analysed using generalised linear mixed models for binary

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outcomes (glmmML and glmmPQL, R, version 2.58). The three species were

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analysed separately, and the precise sample sizes depended on how many animals fell

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into each of the categories comprising the predictors in each model. In all models the

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Location nested within Country was included as a random effect (this took into

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account the location effects themselves as well as systematic ‘noise’ between

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locations: changes over the 4-year period, the two assessment versions, and the

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different observers). Predictors always included characteristics of the animals

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themselves (species, age, sex, and BCS) to control known variation. They also

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included the animal’s main work-type, but in some cases this caused multicollinearity

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(identified from inflated standard errors in the models). When this occurred, an

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urbanisation score was included instead of work-type (since it predicted the work type

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to some extent); urbanisation and work-type could not be included together in the

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models. Model fit was assessed using the deviance and Akaike's information criterion.

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The models were selected to test: (1) interrelationships between the

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behaviours, (2) relationships between general alertness/ responsiveness to human

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interaction and measures of physical health, and (3) relationships between human 9

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avoidance behaviours and physical signs of anthropogenic harm (firing lesions, slit

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nostrils, and lesions on the hindquarters and tail were chosen here as proxies to reflect

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anthropogenic harm).

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The number of tests carried out was limited to those that were biologically

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relevant according to the scientific literature and working equine experts. Even so,

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because 59 tests were carried out for each species, the false discovery rate was

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controlled for (Benjamini & Hochberg, 1995), which determined that the appropriate

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significance level was P ≤ 0.016. In addition, because this is an exploratory study,

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intended to suggest relationships worthy of future research rather than only to test

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existing hypotheses (Bender & Lange, 2001), P-values between 0.016 and the

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traditional significance level of 0.05 are reported as ‘trends’; these will require

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confirmation through further research before they can be treated as significant.

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Results

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Correlations between behaviours

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The prevalences of each behaviour for the three species are given in Table 2,

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showing that over 13% of equids appeared apathetic or depressed (the two categories

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are combined in the current study because only 0.6% of the animals (70 individuals)

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appeared depressed). Measures of unresponsiveness correlated positively with each

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other across the behavioural tests (Table 3). For example, in all three species, apathy

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correlated with a lack of response to the observer walking beside the animal, and

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unresponsiveness to the observer approach correlated with unresponsiveness both to

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the observer walking beside the animal and to chin-contact. Also, in horses and

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donkeys, apathy was associated with unresponsiveness to the observer approach. It

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should be noted that because all these results are correlational, the effect direction can

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be stated either way around, i.e. alert individuals were more responsive in the human-

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interaction tests. There were a total of 300 highly unresponsive individuals who 10

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appeared apathetic and responded to none of the human-interaction tests, equating to

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2.8% of all the animals (2.5% of donkeys, 3.1% of horses, and 2.9% of mules).

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Behaviours that were proposed to test aversion to humans also correlated

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positively with each other across the tests (Table 3). In particular, avoidance of chin-

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contact was associated, in all three species, with avoidance of observer approach, and

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in donkeys and horses, with an aggressive response to observer approach. Tail-tucking

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in donkeys was similarly associated with avoidance of the observer and avoidance of

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chin-contact. Avoidance of the observer approach was seen in about 26% of donkeys,

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14% of horses, and 23% of mules (Table 2). Across all species, 6.6% of animals either

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avoided or showed aggression to the observer and avoided chin-contact, and 2.6% of

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donkeys showed both those responses as well as tail-tucking.

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Even the species-specific associations showed similar patterns to the above,

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indicating either unresponsiveness or aversion to humans (Table 3).

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Correlations between behaviours and physical welfare problems

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Apathy was associated with a number of indicators of poor health, including –

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in all three species – a low BCS and abnormal mucous membrane colour (and

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possibly more numerous and severe skin lesions, but this was only a trend in horses

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and mules) (Table 4). The odds ratios show that the effect sizes could be large, such

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as a one-point decrease in BCS approximately doubling the chance that an animal

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would appear apathetic. In general, apathy and unresponsiveness to the observer were

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associated with lower BCSs, older age, and other health problems that depended on

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the species. It is also worth specifically noting that limb and foot problems (swollen

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tendons and/or joints in donkeys, and abnormal gaits in horses) reduced the chance

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that animals would show an avoidance of the observer approach. Conversely,

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proactive behaviours – including alertness, human avoidance behaviours, and

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aggressive or friendly responses to the observer – were usually associated with

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measures such as higher BCSs and younger ages.

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Exceptions to this pattern were that abnormal soles and abnormal hoof shapes

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were associated with alertness. There were also non-significant trends indicating that

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older horses might be more likely to avoid chin-contact than younger ones were; and

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that faecal soiling in donkeys might be associated with a friendly response to the

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observer.

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We found no significant relationships or trends between responses to humans

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and anthropogenic injuries, between avoidance of chin-contact and lesions on the lips/

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head, or between tail-tuck behaviour and lesions on the hindquarters/ tail.

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Discussion

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The results suggest that the behavioural tests incorporated into this welfare

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assessment have potential as welfare indicators for identifying individual animals with

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negative welfare, in an unresponsive state, or that consistently show behavioural

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aversion to unfamiliar humans.

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Unresponsiveness as a working equine welfare indicator

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It appears that equids with more severe and numerous physical problems enter

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a state of behavioural unresponsiveness, consistent across the five measurements

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taken here. The association with physical problems makes it highly unlikely that the

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behavioural unresponsiveness we have observed in the context of working equids

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reflects neutral or positive welfare, such as resting or relaxed states. Instead, it implies

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that the animals’ resources are being stretched to their limits and their fitness is

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compromised; the animals – of prey species – are conserving ‘energy’, possibly even

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at the risk of not responding appropriately to potentially threatening stimuli. In terms

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of the sentient experiences of these animals, this behaviour could indicate any of 12

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several different negative welfare states, such as malaise (Kelley et al., 2003;

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Millman, 2007), exhaustion from overwork (Tadich et al., 1997; Pritchard et al.,

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2009), chronic pain (Ashley et al., 2005), apathy, or depression (Dunn et al., 2005),

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which may differ depending on the physical problem in question.

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Most of these states can be associated with sickness behaviour, which is

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underlain by a ubiquitous, non-specific proinflammatory cytokine response to a range

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of problems (Hart, 1988; Kelley et al., 2003; Dantzer & Kelley, 2007). The generality

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of the response means that it is useful for identifying vulnerable animals initially, but

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that further diagnostic tests are required to elucidate the specific problem in each case.

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Sickness behaviour is adaptive in that it allows the body’s resources to be diverted

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towards the immune system, but the costs include reduced vigilance and a lack of

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maintenance behaviours, such as eating and grooming: as Hart (1988) states, “The

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sick individual is viewed as being at a life or death juncture and its behavior is an all-

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out effort to overcome the disease”. In farm animals, recommendations suggest that

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individuals exhibiting sickness behaviour should be rested in a quiet area to aid their

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recovery (e.g. Millman, 2007), but working equids in developing countries can rarely

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be rested, because of the extreme dependency of their owners on the daily income and

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subsistence provided by their animals.

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Approximately 2.8% of equids appeared apathetic and failed to respond to any

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of the human-interaction tests, even when the observer made physical contact with

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their chins. While a relatively small percentage of animals, this may signify a severe

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welfare problem because of the association we have found between unresponsiveness

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and many physical problems, and it suggests that if we scale up from the 10,843

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equids here to the 93.6 million equids in developing countries as a whole,

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approximately 2.6 million working equids may be in this unresponsive state

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worldwide.

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The unresponsive measure that was associated with the most physical

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problems in the three species was an apathetic general attitude, in which state

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approximately 13% of the equids were classified. This attained acceptable reliability

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within observers, but poor reliability between observers (Burn et al., 2009)

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(remembering that the observers in the current study were only those who attained at

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least 80% agreement with the trainer). This suggests that some observers used

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different thresholds or differing cues for ascribing the more ambiguous animals to one

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category of alertness or another. However, the biologically plausible associations

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between apathy, unresponsiveness in the other tests, and physical problems, suggest

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that the alertness/apathy distinction describes an underlying biological construct that

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was strong enough to be observed here despite this. Alertness/apathy in working

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equids could therefore constitute a sensitive, if non-specific, marker of underlying

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problems that would otherwise only be identified on closer inspection; another such

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indicator in these animals is BCS, which correlates with many other diverse physical

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problems (Burn et al., in press).

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Nevertheless, assessment of alertness/apathy should be refined, particularly for

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studies where this brief, broad-brush assessment protocol could be replaced with a

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more focussed and in-depth assessment. The behavioural assessment could be

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improved by breaking alertness down into its observable components (e.g. ear

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movement and position, eye closure, head position, and foot and tail movement, etc),

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or by adding a greater number of subjective ‘whole animal’ descriptors (e.g. rigid

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posture, restless, relaxed, asleep/resting or eating, etc). A refined system could not

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only improve inter-observer reliability, but would also allow greater discrimination

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between different negative, unresponsive welfare states; for example, a rigid stance,

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inattentive to the external environment, is often associated with chronic pain (Ashley

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et al., 2005), and thus might be distinguishable from the more ‘slumped’ stance

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associated with depression/exhaustion. Similarly, the associations observed here

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between foot abnormalities and alertness in donkeys, might be attributed to foot pain 14

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causing weight-shifting behaviour (Ashley et al., 2005) (foot movement constitutes

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part of the ‘alert’ descriptor here), rather than donkeys with abnormal feet being alert

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per se. Other suggestions of pain in the animals observed here were the associations

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between reduced observer avoidance and presence of limb swellings/ gait

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abnormalities in donkeys and horses, respectively.

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Human-equine interactions

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Aversion to the observer was suggested through the significant associations

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between avoidance or aggression towards the observer approach, a tail-tuck response

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in donkeys, and avoidance of chin-contact. The trend associating a friendly response

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to the observer with acceptance of chin-contact in donkeys lends some weight towards

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this being more than just an active/ passive distinction between responses to the

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observer. The acceptable inter-observer reliability of these tests further suggests that

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individual animals are consistent in how they respond to different unfamiliar strangers

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(Burn et al., 2009).

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These tests did not actually correlate with any likely anthropogenic

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pathologies, so we have no evidence to suggest that aversion to the observer indicates

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fear of being physically injured by them. Of course, a lack of significance does not

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mean that no relationship exists, but with the large total number of animals sampled

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here, we should have had sufficient power to at least detect strong associations within

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the current dataset. More sensitive and diverse measurements might reveal more

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subtle relationships, as the measurements here were not recorded for the purposes of

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the current study, so they are quite limited. Another limitation was that the response to

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the (unfamiliar) observer may not reflect the response to the animals’ regular

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handlers, but the animal attendants would not have been able to carry out the human-

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interaction tests in a standardised manner; hence trained observers were used as the

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stimuli instead.

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To confirm whether the aversion to the observer assessed here reflects fear or

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aversion to humans, rather than, say, aversion to any novel stimuli, more focused

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experimental studies will be required. Well validated indicators of fear should

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correlate with the proposed fear or aversion behaviours. For example, opportunistic

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observations of owner/ user behaviours that are known to cause poor welfare and/or

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aversions to humans in farm animals, such as slapping, beating or shouting (Rushen et

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al., 1999; Hemsworth, 2003), could be informative. Such observations might be

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expected to show that animals that are regularly slapped, beaten or shouted at by their

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users would generally respond with more behaviours or physiological responses that

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indicate fear or aversion to humans (possibly including learned helplessness in some

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extreme cases of chronic stress: Vollmayr & Henn, 2003).

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Nevertheless, the correlations between tests again suggest that the behaviours

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are rooted in a biological construct that is consistent within individual equids, and

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which generalises to different unfamiliar humans. If this represents fear of humans or

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of novel stimuli generally, it is of concern because some of the behaviours were fairly

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prevalent: for example, approximately a quarter of donkeys and mules attempted to

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avoid the observer approach. Clearly this is a topic that merits further research, and

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interventions may be necessary to facilitate an improvement in the relationships

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between working equids and their human handlers.

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Physical problems that were most strongly associated with behavioural effects A final aspect of welfare significance that these results bring to light, is the

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relative importance of particular physical problems in terms of the behavioural

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associations seen here. The physical problems that correlated most strongly with

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unresponsiveness can be summarised as low BCS, abnormal mucous membrane

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colour, and to a lesser extent, numerous and severe skin lesions, where the association

16

414

with apathy and at least one other measure of unresponsiveness was observed across

415

all three species. As mentioned previously, lower BCS correlates with many other

416

physical problems in working equids, which is of concern since over 29% of working

417

equids were scored as ‘very thin’ (≤1.5 on a scale of 1 – 5: very thin – very fat) (Burn

418

et al., in press). The causes of low BCS are multifactorial, and likely to include

419

malnutrition, overwork, parasitism, and disease, which could simultaneously cause

420

behavioural unresponsiveness. Conversely, behavioural unresponsiveness may

421

include a reduced appetite, as in sickness (Hart, 1988; Dantzer & Kelley, 2007; Weary

422

et al., 2009) and depression (Vollmayr & Henn, 2003), which would further reduce

423

BCS. Skin lesions in these animals are also known to be severe and numerous, with

424

over 25% of equids having at least one moderate or deep lesion, and 62% having 1 –

425

13 lesions larger than 2x2 cm (Burn et al., in press). The lesions could cause apathy

426

through pain and/or infection, or conversely an apathetic animal may be more prone

427

to lesions if it stumbles or collides with objects. It is well known that thinner equids

428

have more lesions (e.g. Pritchard et al., 2005; Burn et al., in press), but this correlation

429

does not explain the association between apathy and lesion severity, because the

430

association remained significant even when BCS was included in the model.

431

The relationship between apathy and abnormal mucous membrane colour was

432

more unexpected, because mucous membrane colour is subjective, and it attained poor

433

inter-observer reliability (Burn et al., 2009). Nevertheless, in the current study, the

434

relationship was significant in all three species, and abnormal mucous membrane

435

colour does appear to give a clinically useful indication of anaemia, including

436

illnesses, such as colic (e.g. Thoefner et al., 2001), diarrhoea (Hillyer, 2004), or

437

babesiosis (Hailat et al., 1997). The current study therefore suggests that illnesses like

438

these are associated with an apathetic behavioural state in working equids, consistent

439

with sickness induced lethargy and/or pain (Aubert, 1999; Millman, 2007; Weary et

440

al., 2009). In previous haematological studies, even apparently healthy equids

441

working in Pakistan, had lower concentrations of haemoglobin, erythrocytes and 17

442

haematocrit than those seen in horses in developed countries, indicating that sub-

443

clinical anaemia is prevalent in these working equids (Gul et al., 2007; Pritchard et al.,

444

2009).

445

The observer reliability of mucous membrane colour assessment requires

446

improvement by including more categories than simply ‘normal’ or ‘abnormal’. For

447

example, it could include standardised colour descriptors as in the study by Thoefner

448

and colleagues (2001), as well as an ordinal score indicating whether the abnormality

449

was mild, moderate or pronounced.

450

Other physical problems that were significantly associated with apathy or

451

unresponsiveness to the human-interaction tests in more than one species were faecal

452

soiling (indicative of diarrhoea) and older age (Table 4). Eye abnormalities also more

453

than doubled the chance of a horse appearing apathetic; eye closure formed part of the

454

classification of an animal as apathetic, but this result may suggest that many eye

455

abnormalities could be painful, in horses at least. It should be noted that other

456

physical problems not reaching significance in the current study might also have

457

detrimental effects on equine welfare, such as acute, localised pain, or general

458

anxiety, which we did not attempt to measure here.

459

The only positive welfare indicator in the current study was a friendly

460

response to the observer approach. This shows promise, as it was significantly

461

associated with a younger age and better BCS. More ambiguously, however, there

462

was a non-significant trend towards a higher likelihood of faecal soiling, indicating

463

diarrhoea, in friendlier donkeys. This may be a Type I error, but is worth mentioning

464

speculatively because some owners or tourists may hand-feed the animals certain

465

inappropriate foods, making the animals more friendly but also inadvertently giving

466

them diarrhoea. Other positive welfare indicators could help identify additional subtle

467

effects of the physical conditions on welfare. Few positive welfare indicators have yet

468

been validated in animal welfare science (Boissy et al., 2007; Yeates & Main, 2008), 18

469

but it would be worth incorporating such measures into a field assessment protocol

470

once that becomes practicable in the future.

471

Summary

472

In summary, behavioural unresponsiveness correlated across the behavioural

473

measures in the current study, and was associated with more numerous or severe

474

physical conditions. The strongest associations were found between an apathetic

475

general attitude and lower BCS, abnormal mucous membrane colour, older age, and

476

(in horses) eye abnormalities; apathy/alertness may therefore provide a useful – if

477

non-specific –indicator for rapidly identifying animals most in need of welfare

478

interventions. Behaviours that were proposed to indicate aversion to humans

479

correlated across the four human-interaction tests, but showed no significant

480

relationships with physical problems that might suggest injury by humans. Further

481

research will be necessary to investigate fear of humans in these animals, since 21%

482

of equids avoided the observer. Many of the measurements taken here should be

483

refined for future, more in-depth welfare assessments, especially alertness and

484

mucous membrane colour, which showed poor inter-observer agreement.

485

Nevertheless, our results suggest that the behaviours included in this welfare

486

assessment show promise as working equine welfare indicators, and deepen our

487

understanding of the relationships between behaviour and physical health in these

488

animals. The associations found here are correlational, so experimental research will

489

be required to understand their causal relationships, and to develop effective

490

interventions to improve working equine welfare.

491 492 493

Acknowledgements This study was supported and funded by the Brooke Hospital for Animals.

494

Many thanks to all the owners who kindly permitted their animals to be used in this

495

study, and to the observers who collected the data. We are grateful for Dr Joy C. 19

496

Pritchard’s constructive comments on the manuscript. We would also like to thank the

497

Kenya Network for Dissemination of Agricultural Technologies, Equinos Sano para

498

El Pueblo (ESAP, Guatemala), Gambia Horse and Donkey Trust, and the Aga Khan

499

Rural support programme (Chitral, Pakistan) for their collaboration; the Afghanistan

500

data were collected in association with the Committee for Rehabilitation of Aid to

501

Afghanistan; also, in 2003 Help in Suffering and The Blue Cross assisted with the

502

Jaipur and the Hyderabad welfare assessments in India, respectively.

503

References

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Ashley, F.H., Waterman-Pearson, A.E., Whay, H.R., 2005. Behavioural assessment of pain in horses and donkeys: application to clinical practice and future studies. Equine Vet. J. 37, 565-575. Aubert, A., 1999. Sickness and behaviour in animals: a motivational perspective. Neurosci. Biobehav. Rev. 23, 1029-1036. Bender, R., Lange, S., 2001. Adjusting for multiple testing--when and how? J. Clin. Epidemiol. 54, 343-349. Benjamini, Y., Hochberg, Y., 1995. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J. Roy. Stat. Soc. B. 57, 289-300. Boissy, A., Manteuffel, G., Jensen, M.B., Moe, R.O., Spruijt, B., Keeling, L.J., Winckler, C., Forkman, B., Dimitrov, I., Langbein, J., Bakken, M., Veissier, I., Aubert, A., 2007. Assessment of positive emotions in animals to improve their welfare. Physiol. Behav. 92, 375-397. Broster, C.E., Burn, C.C., Barr, A.R.S., Whay, H.R., 2009. The range and prevalence of pathological abnormalities associated with lameness in working horses from developing countries. Equine Vet. J. 41, 474-481. Burden, F.A., Du Toit, N., Hernandez-Gil, M., Prado-Ortiz, O., Trawford, A.F., in press. Selected health and management issues facing working donkeys presented for veterinary treatment in rural Mexico: some possible risk factors and potential intervention strategies. Trop. Anim. Health Prod. Burn, C.C., Pritchard, J.C., Whay, H.R., 2009. Observer reliability for working equine welfare assessment: problems with high prevalences of certain results. Anim. Welf. 18, 177-187. Burn, C.C., Dennison, T.L., Whay, H.R., in press. Environmental and demographic risk factors for poor welfare in working horses, donkeys, and mules in developing countries. Vet. J. Dantzer, R., Kelley, K.W., 2007. Twenty years of research on cytokine-induced sickness behavior. Brain. Behav. Immun. 21, 153-160. Dawkins, M.S., Donnelly, C.A., Jones, T.A., 2004. Chicken welfare is influenced more by housing conditions than by stocking density. Nature 427, 342-344. de Aluja, A.S., 1998. The welfare of working equids in Mexico. Appl. Anim. Behav. Sci. 59, 19-29.

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de Passille, A.M., Rushen, J., 2005. Can we measure human-animal interactions in on-farm animal welfare assessment?: Some unresolved issues. Appl. Anim. Behav. Sci. 92, 193-209. Dunn, A.J., Swiergiel, A.H., Beaurepaire, R.d., 2005. Cytokines as mediators of depression: What can we learn from animal studies? Neurosci. Biobehav. Rev. 29, 891-909. FAOSTAT. (2006). FAO statistical database website. Food and Agricultural Organisation of the United Nations. Retrieved 7 July 2008, from http://faostat.fao.org/site/409/default.aspx Gul, S.T., Ahmad, M., Khan, A., Hussain, I., 2007. Haemato-biochemical observations in apparently healthy equine species. Pak. Vet. J. 27, 155-158. Hailat, N.Q., Lafi, S.Q., Al-Darraji, A.M., Al-Ani, F.K., 1997. Equine babesiosis associated with strenuous exercise: clinical and pathological studies in Jordan. Vet. Parasitol. 69, 1-8. Hart, B.L., 1988. Biological basis of the behavior of sick animals. Neurosci. Biobehav. Rev. 12, 123-137. Hausberger, M., Roche, H., Henry, S., Visser, E.K., 2008. A review of the humanhorse relationship. Appl. Anim. Behav. Sci. 109, 1-24. Hemsworth, P.H., 2003. Human-animal interactions in livestock production. Appl. Anim. Behav. Sci. 81, 185-198. Hillyer, M., 2004. A practical approach to diarrhoea in the adult horse. In Pract. 26, 211. Kelley, K.W., Bluthé, R.-M., Dantzer, R., Zhou, J.-H., Shen, W.-H., Johnson, R.W., Broussard, S.R., 2003. Cytokine-induced sickness behavior. Brain. Behav. Immun. 17, S112-S118. Millman, S.T., 2007. Sickness behaviour and its relevance to animal welfare assessment at the group level. Anim. Welf. 16, 123-125. Paul, E.S., Harding, E.J., Mendl, M., 2005. Measuring emotional processes in animals: the utility of a cognitive approach. Neurosci. Biobehav. Rev. 29, 469491. Pritchard, J.C., Whay, H.R., 2003 (unpublished). Guidance notes to accompany working equine welfare assessment. Bristol: University of Bristol. Pritchard, J.C., Whay, H.R., 2004 (unpublished). Guidance notes to accompany working equine welfare assessment. Bristol: University of Bristol. Pritchard, J.C., Lindberg, A.C., Main, D.C.J., Whay, H.R., 2005. Assessment of the welfare of working horses, mules and donkeys, using health and behaviour parameters. Prev. Vet. Med. 69, 265-283. Pritchard, J.C., Barr, A.R.S., Whay, H.R., 2006. Validity of a behavioural measure of heat stress and a skin tent test for dehydration in working horses and donkeys. Equine Vet. J. 38, 433-438. Pritchard, J.C., Barr, A.R.S., Whay, H.R., 2007. Repeatability of a skin tent test for dehydration in working horses and donkeys. Anim. Welf. 16, 181-183. Pritchard, J.C., Burn, C.C., Barr, A.R.S., Whay, H.R., 2008. Validity of indicators of dehydration in working horses: a longitudinal study of changes in skin tent duration, mucous membrane dryness and drinking behaviour. Equine Vet. J. 40, 558-564. Pritchard, J.C., Burn, C.C., Whay, H.R., 2009. Haematological and serum biochemical reference values for apparently healthy working horses in Pakistan. Res. Vet. Sci. 87, 389-395.

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Regan, F.H., 2009a. Behavioural indicators of pain in working donkeys. Unpublished PhD thesis, University of Bristol, Bristol. Regan, F.H., 2009b. Behavioural responses to the provision of a non-steroidal antiinflammatory drug (meloxicam) (Chapter 4) In: Behavioural Indicators of Pain in Working Donkeys. Unpublished PhD thesis, University of Bristol, Bristol. Rushen, J., Taylor, A.A., de-Passille, A.-M., 1999. Domestic animals' fear of humans and its effect on their welfare. Appl. Anim. Behav. Sci. 65, 285-303. Rutherford, K.M.D., Langford, F.M., Jack, M.C., Sherwood, L., Lawrence, A.B., Haskell, M.J., 2009. Lameness prevalence and risk factors in organic and nonorganic dairy herds in the United Kingdom. Vet. J. 180, 95-105. Saul, C., Siefert, L., Opuda-Asibo, J., in press. Disease and health problems of donkeys: a case study from eastern Uganda. In Donkeys and donkey technology: Animal Traction Network for Eastern and Southern Africa. Tadich, N., Mendez, G., Wittwer, F., Meyer, K., 1997. Valores bioquímicos sanguíneos de equinos que tiran carretones en la ciudad de Valdivia (Chile) (Blood biochemical values of loadcart draught horses in the city of Valdivia (Chile)). Arch. Med. Vet. 29, 45-53. Tesfaye, A., Curran, M.M., 2005. A longitudinal survey of market donkeys in Ethiopia. Trop. Anim. Health Prod. 37, 87-100. Thoefner, M.B., Ersbøll, A.K., Jensen, A.L., Hesselholt, M., 2001. Factor analysis of the interrelationships between clinical variables in horses with colic. Prev. Vet. Med. 48, 201-214. Vollmayr, B., Henn, F.A., 2003. Stress models of depression. Clin. Neurosci. Res. 3, 245-251. Waiblinger, S., Boivin, X., Pedersen, V., Tosi, M.-V., Janczak, A.M., Visser, E.K., Jones, R.B., 2006. Assessing the human-animal relationship in farmed species: A critical review. Appl. Anim. Behav. Sci. 101, 185-242. Waters, A.J., Nicol, C.J., French, N.P., 2002. Factors influencing the development of stereotypic and redirected behaviours in young horses: findings of a four year prospective epidemiological study. Equine Vet. J. 34, 572-579. Weary, D.M., Huzzey, J.M., von Keyserlingk, M.A.G., 2009. Using behavior to predict and identify ill health in animals. J. Anim. Sci. 87, 770-777. Yeates, J.W., Main, D.C.J., 2008. Assessment of positive welfare: A review. Vet. J. 175, 293-300.

22

620

Table 1

621 Variable

Possible categorisations

Brief definition

Age

<5 / 5-15 / >15

(Assessed by observing the teeth)

Sex

stallion / gelding / mare

N/A

Work type

Tourism (riding)/ Tourism (carriage)/ Human transport (carriage)/ Human transport (riding)/ Goods transport (cart)/ Goods transport (pack)/ Agriculture/ Brick kiln (cart)/ Brick kiln (pack)/ Ceremonial/ Foal of working mother/ or Other

N/A

General alertness

alert / apathetic / depressed (apathetic and depressed were combined in the current study)

Responding to surroundings e.g. ears moving and often forward, eyes open, feet may be moving, tail swishing, head up unless sniffing or eating/ passive response to surroundings e.g. small ear movements, some tail swishing, feet may be moving, eyes may be half-closed, head may be lowered/ Unresponsive to surroundings, e.g. ears still and lowered, eyes closed or half-closed, no tail-swishing or foot movement, head lowered.

Observer approach

moves away / turns head away / no response / friendly/ aggressive (moves away and turns away were combined in the current study)

Moves or attempts to move away/ turns head away/ no obvious response/ Turns head towards, ears forward / Attempts to bite, rear, kick or strike with foreleg; ears held back or flattened

Walk-beside

no response / signs of attention

No obvious response/ signs of attention e.g. ears turn towards, head turns towards, moves towards or away, attempts to kick

Tail-tuck (donkeys only)

no response/ tail-tuck

Tail remains relaxed/ clamps down tail or tucks in hindquarters

Chin-contact

accepts / avoids

Shows no response chin-contact/ Moves its head to avoid or reject contact

Body condition

1 – 5 (including half-scores)

Ribs, spine and hips prominent, neck topline concave, hollow pelvis/ Ribs, spine and hips visible, flat pelvis/ Spine just visible, neck topline straight, slightly rounded pelvis/ Spine not visible, neck topline slightly convex, rounded pelvis/ neck topline distinctly convex, rounded pelvis with ‘gutter’ along spine

Faecal soiling

faecal soiling present / absent

Spattered faecal matter, dried or fresh, on inner thighs or back of hocks/ absent e.g. no staining or staining from mud, grass or other materials

Ectoparasites

present / absent

Ticks, mites, bot eggs, lice, or lice eggs anywhere on

General

Behaviour

General health

23

the body/ none observed Eyes

no abnormalities / abnormal

Healthy eyes/ At least one eye with wet eyelashes, discharge, redness, swelling, opacity or injury

Mucous membranes

normal colour / abnormal

Pink/ Abnormal e.g. yellowish, pale, reddish, greyish or purpleish

Teeth missing

yes / no (only assessed during 2003-2004)

At least one tooth missing/ All teeth present

General lesions

Severity score (0, 1, 2, 3) x number of affected locations on body

Severity scores: <2x2 cm / superficial / broken skin / deep Locations of lesions: breast,and shoulders, ears, forelegs, girth and belly, head, hindlegs, hindquarters, knees, lips, neck, point-of -hock, ribs, flank, tail and tailbase, withers and spine

Firing lesions

Severity score (0, 1, 2, 3)

Severity scores: 0 - 2x2 cm / superficial / broken skin / deep

Swollen tendons and joints

yes / no

Cannon bone, suspensory ligament, flexor tendons and fetlock joint are clearly visible and distinct from each other in all four legs/ In one or more legs, the distinction between the suspensory ligament, tendons and joint become unclear; the lower part of the tendon and the back of the fetlock joint may look bulgy, lumpy or square in shape

Hoof horn quality

normal / abnormal

Healthy / abnormalities e.g. broken hoof wall, cracks, ridges, wavy or non-parallel rings

Hoof shape

normal / abnormal

Medio-laterally symmetrical, coronary band horizontal, and toe and heel wall slopes parallel / Medio-laterally asymmetrical, coronary band slanted, and toe and heel not parallel (e.g. toe overgrown or excessively short)

Sole shape and structure

normal / abnormal

Round in horses; keyhole-shaped in donkeys; symmetrical, with intact frog, distinct bars and slightly cupped sole / asymmetrical, cracked, oval or pearshaped; frog narrow, hard, atrophied or missing; bars missing; sole flat; or sheared heels

Gait

normal / abnormal

Normal and even / any reluctance to put weight on a limb, asymmetrical dropping or raising of hip, uneven nodding of head, short or uneven stride length

Skin lesions

Limb and foot pathology

622 623 624 625 626 627

Brief descriptions of the behavioural and physical measures taken as part of a working equine welfare assessment. More detailed descriptions can be found in a 102-page, illustrated guidance booklet (Pritchard & Whay, 2003 (unpublished); 2004 (unpublished), available upon request from the authors). The protocol and sequence in which these measurements were taken are described in the text.

24

628

629 630 631 632 633 634

Table 2 Behavioural response

Donkeys (%)

Horses (%)

Mules (%)

General alertness - Apathetic/ depressed

13.1

13.7

13.4

Observer approach - No response

64.6

68.7

61.5

Observer approach - Avoidance

25.9

14.2

23.0

Observer approach - Aggression

0.3

1.7

0.7

Observer approach - Friendly

11.3

15.5

14.8

Walk-beside - Signs of attention

91.2

86.6

90.0

Tail-tuck

21.2

N/A

N/A

Chin-contact - Avoidance

16.4

20.6

15.4

The percentages of each working equine species displaying the behaviours recorded here. The percentages are compiled from 5481 donkeys, 4504 horses, and 858 mules across nine developing countries. In the general alertness measurement, apathy and depression were combined, and in the observer approach test, moving and turning away were summed as ‘avoidance’.

25

635

Table 3 Behaviour General alertness Apathetic/ depressed

Predictor Observer approach - No response Walk-beside - No response

Observer approach Avoidance

Chin-contact Avoidance Walk-beside - Signs of attention

Observer approach No response

Walk-beside - No response Chin-contact - Accepts

Observer approach Aggression

Chin-contact Avoidance

Observer approach Friendly

Walk-beside - Signs of attention

Walk-beside - No response Tail-tuck

636 637 638 639 640 641 642 643 644 645

Chin-contact - Accepts Chin-contact - Accepts Observer approach Avoidance Walk-beside - Signs of attention Chin-contact Avoidance

Species Donkey

Odds ratio ± SE 1.361 ± 1.110

P-value 0.0030

Horse Donkey

1.401 ± 1.124 3.177 ± 1.124

0.0042 <0.0001

Horse Mule Donkey

2.307 ± 1.126 3.815 ± 1.298 2.408 ± 1.091

<0.0001 <0.0001 <0.0001

Horse Mule Donkey

2.214 ± 1.104 3.022 ± 1.234 1.931 ± 1.140

<0.0001 <0.0001 <0.0001

Mule Donkey

3.130 ± 1.527 2.361 ± 1.129

0.0071 <0.0001

Horse Mule Donkey Horse Mule Donkey

2.344 ± 1.125 4.183 ± 1.411 1.982 ± 1.088 1.859 ± 1.089 2.012 ± 1.240 3.158 ± 1.428

<0.0001 <0.0001 <0.0001 <0.0001 0.0012 0.0012

Horse Donkey

5.104 ± 1.244 2.377 ± 1.251

<0.0001 0.0001

Horse Mule Donkey Horse

2.678 ± 1.182 3.180 ± 1.692 1.377 ± 1.156 1.445 ± 1.138

<0.0001 0.0281† 0.0268† 0.0043

Donkey

2.257 ± 1.087

<0.0001

Donkey

2.416 ± 1.181

<0.0001

Donkey

1.623 ± 1.096

<0.0001

Statistically significant associations between behaviours recorded as part of a working equine welfare assessment, split by equine species. Five behavioural measurements were made: general alertness, observer approach, walk-beside, tail-tuck (in donkeys only), and chin-contact. Because the study was correlational, the associations between the behaviours in the first and second columns could be stated either way around, but the way they are reported in the table reflects the statistical models. The effect sizes are presented as odds ratios (± SE), and the alpha level was set at a P-value of 0.016 to adjust for the false discovery rate; †indicates trends for which P <0.05, but which failed to meet the adjusted significance level.

26

646

Table 4 Behaviour

Predictor

Species

P-value

Donkey

Odds ratio ± SE 2.570 ± 1.093

General alertness Apathetic/ depressed

Lower body condition score

Horse Mule Donkey Horse Mule Donkey Horse Mule Donkey Horse Donkey Horse Donkey Horse Horse Horse Donkey Donkey Donkey

1.859 ± 1.094 2.654 ± 1.271 1.166 ± 1.046 1.133 ± 1.058 1.350 ± 1.146 1.279 ± 1.097 1.379 ± 1.115 1.786 ± 1.259 1.224 ± 1.103 1.283 ± 1.108 2.052 ± 1.071 1.310 ± 1.080 1.300 ± 1.130 2.034 ± 1.433 2.356 ± 1.256 2.492 ± 1.586 1.527 ± 1.163 1.944 ± 1.307 1.504 ± 1.067

<0.0001 0.0001 0.0006 0.0258† 0.0275† 0.0085 0.0031 0.0120 0.0403† 0.0156 <0.0001 0.0005 0.0320† 0.0485† 0.0002 0.0479† 0.0051 0.0131 <0.0001

Abnormal mucous membranes Higher body condition score

Horse Mule Donkey Horse Mule Donkey

1.156 ± 1.064 1.571 ± 1.192 1.225 ± 1.054 1.339 ± 1.064 1.636 ± 1.213 1.328 ± 1.070

0.0194† 0.0103 0.0001 <0.0001 0.0112 <0.0001

Fewer tendon/joint swellings Normal gait Higher body condition score

Donkey Horse Donkey

1.310 ± 1.117 2.004 ± 1.208 2.509 ± 1.297

0.0144 0.0002 0.0004

Younger age Younger age

Mule Donkey

3.963 ± 1.586 1.324 ± 1.083

0.0029 0.0004

Horse Donkey Mule Donkey Donkey Horse Donkey Mule Donkey Mule Horse Horse

1.537 ± 1.077 1.358 ± 1.097 1.632 ± 1.221 1.357 ± 1.140 1.212 ± 1.082 1.252 ± 1.078 1.347 ± 1.103 1.933 ± 1.278 1.150 ± 1.061 1.974 ± 1.269 1.099 ± 1.046 1.363 ± 1.102

<0.0001 0.001 0.0148 0.0204† 0.0147 0.0027 0.0023 0.0073 0.0186† 0.0043 0.0383† <0.0001

More severe lesions Abnormal mucous membranes Faecal soiling Older age

General alertness - Alert Observer approach - No response

Ectoparasites Abnormal gait Eye abnormalities Teeth missing Abnormal hoof shape Sole abnormalities Lower body condition score

Older age Observer approach Avoidance Observer approach Aggression Observer approach Friendly

Higher body condition score Walk-beside - No response

Faecal soiling Older age Lower body condition score

Tail-tuck Chin-contact - Accepts

647 648 649 650 651

Younger age Faecal soiling More severe lesions Younger age

<0.0001

Statistically significant associations between behaviours and physical problems recorded as part of a working equine welfare assessment, split by equine species. Five behavioural measurements were made: general alertness, observer approach, walkbeside, tail-tuck (in donkeys only), and chin-contact. Because the study was 27

652 653 654 655 656 657

correlational, the associations between the variables in the first and second columns could be stated either way around, but the way they are reported in the table reflects the way they were tested in the statistical models. The effect sizes are presented as odds ratios (± SE), and the alpha level was set at a P-value of ≤0.016 to adjust for the false discovery rate; †indicates trends for which P <0.05, but which failed to meet the adjusted significance level.

28

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