Organizational and Implementation Factors Associated with Cirrhosis Care in the Veterans Health Administration.

BACKGROUND: The Veterans Health Administration provides care to more than 100,000 Veterans with cirrhosis. AIMS: This implementation evaluation aimed to understand organizational resources and barriers associated with cirrhosis care. METHODS: Clinicians across 145 Department of Veterans Affairs (VA) medical centers (VAMCs) were surveyed in 2022 about implementing guideline-concordant cirrhosis care. VA Corporate Data Warehouse data were used to assess VAMC performance on two national cirrhosis quality measures: HCC surveillance and esophageal variceal surveillance or treatment (EVST). Organizational factors associated with higher performance were identified using linear regression models. RESULTS: Responding VAMCs (n = 124, 86%) ranged in resource availability, perceived barriers, and care processes. In multivariable models, factors independently associated with HCC surveillance included on-site interventional radiology and identifying patients overdue for surveillance using a national cirrhosis population management tool ("dashboard"). EVST was significantly associated with dashboard use and on-site gastroenterology services. For larger VAMCs, the average HCC surveillance rate was similar between VAMCs using vs. not using the dashboard (47% vs. 41%), while for smaller and less resourced VAMCs, dashboard use resulted in a 13% rate difference (46% vs. 33%). Likewise, higher EVST rates were more strongly associated with dashboard use in smaller (55% vs. 50%) compared to larger (57% vs. 55%) VAMCs. CONCLUSIONS: Resources, barriers, and care processes varied across diverse VAMCs. Smaller VAMCs without specialty care achieved HCC and EVST surveillance rates nearly as high as more complex and resourced VAMCs if they used a population management tool to identify the patients due for cirrhosis care.

Core implementation strategies for improving cirrhosis care in the Veterans Health Administration.

BACKGROUND AND AIMS: The Veterans Health Administration (VHA) provides care for more than 80,000 veterans with cirrhosis. This longitudinal, multimethod evaluation of a cirrhosis care quality improvement program aimed to (1) identify implementation strategies associated with evidence-based, guideline-concordant cirrhosis care over time, and (2) use qualitative interviews to operationalize strategies for a manualized intervention. APPROACH AND RESULTS: VHA providers were surveyed annually about the use of 73 implementation strategies to improve cirrhosis care in fiscal years 2018 (FY18) and 2019 (FY19). Implementation strategies linked to guideline-concordant cirrhosis care were identified using bivariate statistics and comparative configurational methods. Semistructured interviews were conducted with 12 facilities in the highest quartile of cirrhosis care to specify the successful implementation strategies and their mechanisms of change. A total of 106 VHA facilities (82%) responded at least once over the 2-year period (FY18, n = 63; FY19, n = 100). Facilities reported using a median of 12 (interquartile range [IQR] 20) implementation strategies in FY18 and 10 (IQR 19) in FY19. Of the 73 strategies, 35 (48%) were positively correlated with provision of evidence-based cirrhosis care. Configurational analysis identified multiple strategy pathways directly linked to more guideline-concordant cirrhosis care. Across both methods, a subset of eight strategies was determined to be core to cirrhosis care improvement and specified using qualitative interviews. CONCLUSIONS: In a national cirrhosis care improvement initiative, a multimethod approach identified a core subset of successful implementation strategy combinations. This process of empirically identifying and specifying implementation strategies may be applicable to other implementation challenges in hepatology.

The developmental and professional activities of female international soccer players from five high-performing nations.

We study the developmental and professional activities engaged in by 86 female adult soccer players from the senior national teams of Australia, Canada, England, Sweden, and the United States of America. Players completed the Participation History Questionnaire (PHQ) to elicit the amount and type of activities engaged in across their developmental and professional years, including milestones, soccer-specific activity and engagement in other sport activity. Greater specialisation than diversification characterised their childhood developmental activities, including all players starting in soccer in childhood and accumulating more hours in soccer activity than other sports during this period. However, interindividual variation further characterised these childhood activities, with a proportion of players diversifying into other sports and/or soccer play to a greater or lesser degree during childhood when compared to the other players. The amount of coach-led soccer practice increased for all players across their development culminating in an average of 15-16 h/wk across a 40-week season in early adulthood. In contrast, the amount of engagement in other sports and soccer peer-led play varied between players but generally decreased across adolescence to negligible amounts in late adolescence. Findings are commensurate with the deliberate practice framework and early engagement.

Using drones and sirens to elicit avoidance behaviour in white rhinoceros as an anti-poaching tactic.

Poaching fuelled by international trade in horn caused the deaths of over 1000 African rhinoceros (Ceratotherium simum and Diceros bicornis) per year between 2013 and 2017. Deterrents, which act to establish avoidance behaviours in animals, have the potential to aid anti-poaching efforts by moving at-risk rhinos away from areas of danger (e.g. near perimeter fences). To evaluate the efficacy of deterrents, we exposed a population of southern white rhinos (C. simum simum) to acoustic- (honeybee, siren, turtle dove), olfactory- (chilli, sunflower), and drone-based stimuli on a game reserve in South Africa. We exposed rhinos to each stimulus up to four times. Stimuli were considered effective deterrents if they repeatedly elicited avoidance behaviour (locomotion away from the deterrent). Rhinos travelled significantly further in response to the siren than to the honeybee or turtle dove stimulus, and to low-altitude drone flights than to higher altitude flights. We found the drone to be superior at manipulating rhino movement than the siren owing to its longer transmission range and capability of pursuit. By contrast, the scent stimuli were ineffective at inciting avoidance behaviour. Our findings indicate that deterrents are a prospective low-cost and in situ method to manage rhino movement in game reserves.

The Year of Care approach: developing a model and delivery programme for care and support planning in long term conditions within general practice.

BACKGROUND: People with long term conditions (LTCs) make most of the daily decisions and carry out the activities which affect their health and quality of life. Only a fraction of each contact with a health care professional (HCP) is spent supporting this. This paper describes how care and support planning (CSP) and an implementation framework to redesign services, were developed to address this in UK general practice. Focussed on what is important to each individual, CSP brings together traditional clinical issues and the person's lived experience in a solution focussed, forward looking conversation with an emphasis on 'people not diseases'. METHODS: The components of CSP were developed in three health communities using diabetes as an exemplar. This model was extended and refined for other single conditions and multimorbidity across 40 sites and two nations, over 15 years. Working with local teams and communities the authors used theoretical models of care, implementation and spread, developing and tailoring training, support and resources to embed CSP as usual care, sharing learning across a community of practice. RESULTS: The purpose, content, process, developmental hurdles and impact of this CSP model are described, alongside an implementation strategy. There is now a robust, reproducible five step model; preparation, conversation, recording, actions and review. Uniquely, preparation, involving information sharing with time for reflection, enables an uncluttered conversation with a professional focussed on what is important to each person. The components of the Year of Care House act as a checklist for implementation, a metaphor for their interdependence and a flexible framework. Spreading CSP involved developing exemplar practices and building capacity across local health communities. These reported improved patient experience, practitioner job satisfaction, health behaviours and outcomes, teamwork, practice organisation, resource use, and links with wider community activities. CONCLUSIONS: Tested in multiple settings, CSP is a reproducible and practical model of planned care applicable to all LTCs, with the capacity to be transformative for people with LTCs and health care professionals. It recaptures relational dimensions of care with transactional elements in the background. Options for applying this model and implementation framework at scale now need to be explored.

Increased HCV Screening Yields Discordant Gains in Diagnoses Among Urban and Rural Veteran Populations in Texas: Results of a Statewide Quality Improvement Initiative.

BACKGROUND: Chronic hepatitis C virus (HCV) infection is a significant health burden among military veterans. Our goals were to increase monthly HCV screenings, diagnoses, and sustained virologic responses (SVR) among 88,652 unscreened birth cohort Veterans in Texas. METHODS: The interventions were enabled within six of the eight healthcare systems (HCSs) that compose Veteran's Integrated Service Network 17. The remaining two HCSs served as controls. The HCSs were separated into two groups: urban and rural; each composed of a control and three interventional HCSs. Decision support programming was embedded within the Computerized Patient Record System that prompted HCV screening among previously unscreened birth cohort patients. Clinical process design and educational efforts were enacted to enhance treatment capacity. RESULTS: Monthly screenings increased 4.89 times (p < 0.001) and 2.97 times (p < 0.001) during the postinterventional period relative to control for urban and rural HCSs, respectively. For urban HCSs, diagnoses increased 1.58 (p < 0.001) times more than the control group during the postinterventional period, but there was no difference in number of diagnoses in the rural HCSs (p = 0.86). Monthly SVR increased 2.69 times more than the control group during the postinterventional period (p < 0.001). CONCLUSION: Decision support improved HCV screening among birth cohort patients in both urban and rural HCSs. Increased screening boosted the monthly number of diagnoses in the urban HCSs, but not in the rural HCSs; which rebuts the utility of birth cohort screening among rurally residing veterans. These interventions significantly improved the rate of SVR achievement relative to control.

Individualisation of speed thresholds does not enhance the dose-response determination in football training.

This study examined the utility of a range of approaches used to develop player-dependent speed zones in time-motion analysis (TMA), in determining the dose-response (internal load) of daily football training. Daily external (10 Hz GPS) and internal load (heart rate metrics, ratings of perceived exertion [RPE], wellness ratings) measures were tracked for 22 International women's football players during a 21-day training camp. High-speed (HSR) and very high speed running (VHSR) were determined according to arbitrary speed thresholds, as well as using a range of different individualization approaches that included the velocities corresponding to the heart rate deflection point, maximal aerobic speed, YYIR1 performance, and maximal sprint speed (MSS). Within-player correlations between the TMA approaches versus internal load measures quantified the dose-response to training. Correlations between HSR and VHSR vs. RPE were large (r = 0.53-0.67), with the exception of VHSR for the MSS technique (moderate; r = 0.44). HSR was very-largely associated with heart rate indices (r = 0.72-0.78), again with the exception of MSS (large; r = 0.60-0.67). Using a range of different fitness characteristics to individualise speed thresholds did not enhance the dose-response determination to daily fluctuations in external load, and was worsened with MSS per se.

Outcomes of Adding Patient and Family Engagement Education to Fall Prevention Bundled Interventions.

Nurses strive to reduce risk and ensure patient safety from falls in health care systems. Patients and their families are able to take a more active role in reducing falls. The focus of this article is on the use of bundled fall prevention interventions highlighted by a patient/family engagement educational video. The implementation of this quality improvement intervention across 2 different patient populations was successful in achieving unit benchmarks.

The Dose-Response in Elite Soccer: Preliminary Insights From Menstrual-Cycle Tracking During the FIFA Women's World Cup 2019.

PURPOSE: This preliminary study examined the influence of estimated menstrual-cycle (MC) phase on responses to soccer matches and training sessions in preparation for and during the FIFA (Fédération internationale de football association) Women's World Cup 2019. METHODS: Twenty outfield players representing a national team were tracked over a 45-day period. External (10-Hz global positioning system; total and distance covered at high-metabolic power [≥20 W·kg-1]) and internal load measures (minutes ≥80% heart-rate maximum, sessional ratings of perceived exertion) were collected during all training and matches, with single-item wellness measures (fatigue, soreness, sleep quality, and sleep duration) collected each morning prior to activity. MC phase was estimated individually via an algorithm, informed from pretournament survey responses and ongoing symptom reporting (FitrWoman). Model comparison statistics were used to determine the impact of estimated MC phase in nonhormonal contraceptive users (n = 16). RESULTS: Sessional rating of perceived exertion responses to total distances ≥5 km were higher during the luteal phase (+0.6-1.0 au; P ≤ .0178) versus menstruation (phase 1), but no other observable dose-response trends were observed. Sleep, fatigue, and soreness ratings were not typically associated with MC phase, with the exception of exacerbated fatigue ratings in luteal versus follicular phase 48 hours postmatch (-0.73 au, P = .0275). CONCLUSIONS: Preliminary findings suggest that estimated MC phase may contribute to the understanding of the dose-response to soccer training and matches.

Inconsistencies in the perceived impact of the menstrual cycle on sport performance and in the prevalence of menstrual cycle symptoms: A scoping review of the literature.

OBJECTIVES: This scoping review aimed to summarize the findings of studies regarding the perceived impact of the menstrual cycle on athletic performance, as well as the prevalence of negative menstrual cycle symptoms. DESIGN: Scoping review. METHODS: Three databases were searched and the Preferred Reporting Items for Systematic reviews and Meta Analyses extension for Scoping Reviews (PRISMA-ScR) was used as guidance. RESULTS: A total of 39 studies were included in the final analysis. Between 2.8 and 100 % of athletes reported their performance being negatively impacted by their menstrual cycle, and the main reason was the occurrence of menstrual cycle symptoms. Additionally, a large variability in the prevalence of menstrual cycle symptoms was reported in the different studies mainly due to methodological differences and recall biases. CONCLUSIONS: Similarly, as to what has been reported in reviews summarizing performance outcomes during different menstrual cycle phases, this review highlights the high degree of variability between how athletes perceive to be impacted by their menstrual/hormonal contraceptive cycle. REGISTRATION: The protocol of this scoping review was registered at the Open Science Framework on 14 September 2023 (osf.io/efu9x).

Garden Scraps: Agonistic Interactions between Hedgehogs and Sympatric Mammals in Urban Gardens.

Hedgehogs occur within an urban mammal guild in the United Kingdom. This guild commonly utilizes anthropogenic food provision, which is potentially beneficial to wild animal populations, but may also bring competitors and predators into proximity, raising the question of how these species interact in urban gardens. In this study, we determined interactions between hedgehogs, foxes, badgers, and domestic cats using videos submitted via citizen science. We analyzed interactions within and between species to determine interaction type, hierarchical relationships, and effect of supplementary food presence/amount. We found that overall agonistic interactions between individuals occurred more frequently (55.4%) than neutral interactions (44.6%) and that interspecific interactions showed greater agonism (55.4%) than intraspecific ones (36%). Within intraspecific interactions, those between hedgehogs were the most agonistic (54.9%) and between badgers the least (6.7%). Species composition of the interaction affected agonism, with interactions between cats and foxes showing the highest level (76.7%). In terms of overall "wins", where access to garden resources was gained, badgers dominated cats, which were dominant or equal to foxes, which dominated hedgehogs. However, hedgehogs exhibited a greater overall proportion of wins (39.3%) relative to cats. Our findings are important in the context of the documented impact of patchy resources on urban wildlife behavior, and we show that provision of anthropogenic food can potentially result in unintended consequences. We recommend actions to reduce proximity of guild competitors in space and time to limit negative effects.

Getting to implementation: Adaptation of an implementation playbook.

Introduction: Implementation strategies supporting the translation of evidence into practice need to be tailored and adapted for maximum effectiveness, yet the field of adapting implementation strategies remains nascent. We aimed to adapt "Getting To Outcomes"® (GTO), a 10-step implementation playbook designed to help community-based organizations plan and evaluate behavioral health programs, into "Getting To Implementation" (GTI) to support the selection, tailoring, and use of implementation strategies in health care settings. Methods: Our embedded evaluation team partnered with operations, external facilitators, and site implementers to employ participatory methods to co-design and adapt GTO for Veterans Health Administration (VA) outpatient cirrhosis care improvement. The Framework for Reporting Adaptations and Modifications to Evidenced-based Implementation Strategies (FRAME-IS) guided documentation and analysis of changes made pre- and post-implementation of GTI at 12 VA medical centers. Data from multiple sources (interviews, observation, content analysis, and fidelity tracking) were triangulated and analyzed using rapid techniques over a 3-year period. Results: Adaptations during pre-implementation were planned, proactive, and focused on context and content to improve acceptability, appropriateness, and feasibility of the GTI playbook. Modifications during and after implementation were unplanned and reactive, concentrating on adoption, fidelity, and sustainability. All changes were collaboratively developed, fidelity consistent at the level of the facilitator and/or implementer. Conclusion: GTO was initially adapted to GTI to support health care teams' selection and use of implementation strategies for improving guideline-concordant medical care. GTI required ongoing modification, particularly in steps regarding team building, context assessment, strategy selection, and sustainability due to difficulties with step clarity and progression. This work also highlights the challenges in pragmatic approaches to collecting and synthesizing implementation, fidelity, and adaptation data. Trial registration: This study was registered on ClinicalTrials.gov (Identifier: NCT04178096).

Milk Phospholipid Profiling Among Japanese Women with Differing Docosahexaenoic Acid Levels.

To characterize the milk phospholipids (PLs) profile using phosphorus-31 nuclear magnetic resonance (31P-NMR) and to investigate the effect of elevated milk docosahexaenoic acid (DHA) levels on PLs profiles in Japanese mothers. Methods: Milk samples from eligible patients with high and low DHA from a former cross-sectional study (n = 20; n = 10 for each group) were included. Fifteen milk PLs were analyzed using 31P-NMR, and the profiles were compared group-wise using Mann-Whitney U-test. The P value of <0.05 was considered statistically significant. Results: The median DHA content in milk was 1.13% and 0.29% for the high and low milk DHA groups, respectively. Twelve PLs, excluding lysophosphatidylserine, cardiolipin, and phosphatidylglycerol, were detected in all participants with 100% positive results. The median concentrations and proportions of total PLs, sphingophospholipids, and glycerophospholipids were comparable between groups. The proportions of choline-containing glycerophospholipid were significantly higher in the high milk DHA group than that in the low milk DHA group (24.09% [median, interquartile range: 23.08%-26.38%] and 21.41% [20.74%-22.84%], P = 0.019). Although the proportions of phosphatidylinositol were significantly lower in the high milk DHA group than that in the low milk DHA group (6.62% [5.75%-6.72%] versus 7.63% [7.11%-8.16%], P = 0.002), while that of phosphatidylcholine (21.90% [18.51%-23.22%] versus 19.78% [18.17%-20.26%], P = 0.059) and alkyl-acyl phosphatidylcholine (0.60% [0.40%-0.74%] versus 0.33% [0.14%-0.51%], P = 0.059) were higher in the former than that in the latter. Conclusions: Our results were comparable to that of the previous literature. Large variations in the milk DHA might affect the composition of choline-containing glycerophospholipids in Japanese mothers. However, possible confounders were not excluded in the study populations.

Strategies to Improve Delivery of Cirrhosis Care.

Purpose of review: This review provides an overview of the current state of research around improving healthcare delivery for patients with cirrhosis in the outpatient, inpatient, and transitional care settings. Recent findings: Recent studies have broadly employed changes to the model of care delivery, team composition, and technology to improve cirrhosis care. In the outpatient setting, approaches have included engaging caregivers, patient navigators, and non-physicians and using virtual care, smartphone applications, and wearables. Inpatient care approaches have focused on the role of interdisciplinary teams, education interventions, and changes to the medical record system, while post-discharge interventions have included day hospitals and care coordinator interventions. This review also describes the Veterans Health Administration's novel, population-level approach to delivery of cirrhosis care, and addressed how the pandemic has impacted the delivery of cirrhosis care. Summary: Comprehensive, evidence-based approaches to delivering high-quality cirrhosis care continue to evolve to meet the needs of a growing population in an ever-changing healthcare environment.

COVID-19-Considerations for the Female Athlete.

The SARS CoV-2 virus (COVID-19) caused the whole sporting calendar to be paused. As we embark on the challenge of navigating through the return to play (RTP) process, there is a necessity to consider the needs of all athletes. This commentary specifically considers recommendations and requirements for the female athlete with a physiological emphasis during and following the COVID-19 pandemic, however, it will be relevant for any similar future scenarios that may present. It is important to acknowledge that there remain many unknowns surrounding COVID-19 and the female athlete both in the short- and long-term.

The Hepatic Innovation Team Collaborative: A Successful Population-Based Approach to Hepatocellular Carcinoma Surveillance.

After implementing a successful hepatitis C elimination program, the Veterans Health Administration's (VHA) Hepatic Innovation Team (HIT) Collaborative pivoted to focus on improving cirrhosis care. This national program developed teams of providers across the country and engaged them in using systems redesign methods and population health approaches to improve care. The HIT Collaborative developed an Advanced Liver Disease (ALD) Dashboard to identify Veterans with cirrhosis who were due for surveillance for hepatocellular carcinoma (HCC) and other liver care, promoted the use of an HCC Clinical Reminder in the electronic health record, and provided training and networking opportunities. This evaluation aimed to describe the VHA's approach to improving cirrhosis care and identify the facility factors and HIT activities associated with HCC surveillance rates, using a quasi-experimental design. Across all VHA facilities, as the HIT focused on cirrhosis between 2018-2019, HCC surveillance rates increased from 46% (IQR 37-53%) to 51% (IQR 42-60%, p < 0.001). The median HCC surveillance rate was 57% in facilities with high ALD Dashboard utilization compared with 45% in facilities with lower utilization (p < 0.001) and 58% in facilities using the HCC Clinical Reminder compared with 47% in facilities not using this tool (p < 0.001) in FY19. Increased use of the ALD Dashboard and adoption of the HCC Clinical Reminder were independently, significantly associated with HCC surveillance rates in multivariate models, controlling for other facility characteristics. In conclusion, the VHA's HIT Collaborative is a national healthcare initiative associated with significant improvement in HCC surveillance rates.

Dose-Response Relationship Between External Load and Wellness in Elite Women's Soccer Matches: Do Customized Velocity Thresholds Add Value?

PURPOSE: To examine the dose-response relationship between match-play high-speed running (HSR), very high-speed running (VHSR), and sprint (SPR) distances versus subsequent ratings of fatigue and soreness. METHODS: Thirty-six outfield players competing in the professional National Women's Soccer League (NWSL, United States) with a minimum of five 90-minute match observations were monitored during the 2016 and 2017 seasons (408 match observations, 11 [6]/player). HSR (≥3.47 m·s-1), VHSR (≥5.28 m·s-1), and SPR (≥6.25 m·s-1) were determined generically (GEN) in players using a 10-Hz global positioning system. HSR, VHSR, and SPR speed thresholds were also reconfigured according to player peak speed per se and in combination with the final velocity achieved in the 30:15 Intermittent Fitness Test (locomotor approach to establishing individual speed zones). On the morning following matches (match day [MD + 1]), players recorded subjective wellness ratings of fatigue and soreness using 7-point Likert scales. RESULTS: Fatigue (-2.32; 95% CI, -2.60 to -2.03 au; P < .0001) and soreness (-2.05; 95% CI, -2.29 to -1.81; P < .0001) ratings worsened on MD + 1. Standardized unit changes in HSRGEN (fatigue: -0.05; 95% CI, -0.11 to 0.02 and soreness: -0.02, 95% CI, -0.07 to 0.04) and VHSRGEN (fatigue: -0.06; 95% CI, -0.12 to 0.00 and soreness: -0.04; 95% CI, -0.10 to 0.02) had no influence on wellness ratings at MD + 1. Individualized speed thresholds did not improve the model fit. CONCLUSIONS: Subjective ratings of fatigue and wellness are not sensitive to substantial within-player changes in match physical performance. HSR, VHSR, and SPR thresholds customized for individual players' athletic qualities did not improve the dose-response relationship between external load and wellness ratings.

Spatial Aspects of Gardens Drive Ranging in Urban Foxes (Vulpes vulpes): The Resource Dispersion Hypothesis Revisited.

Red foxes are a well-established species of urban ecosystems in the UK and worldwide. Understanding the spatial ecology of foxes in urban landscapes is important for enhancement of urban biodiversity and effective disease management. The Resource Dispersion Hypothesis (RDH) holds that territory (home range) size is linked to distribution and richness of habitat patches such that aggregation of rich resources should be negatively associated with range size. Here, we tested the RDH on a sample of 20 red foxes (Vulpes vulpes) in the city of Brighton and Hove. We focused on residential garden areas, as foxes were associated with these in previous studies. We equipped 12 male and 8 female foxes with GPS collars recording at 15 min intervals during discrete seasons over four years. We regressed fox core area size against garden size, number of garden patches, and edge density within and between patches as extracted from GIS in a series of bivariate linear mixed models. We found that foxes used smaller core areas where gardens were large and well-connected and larger core areas where numerous, smaller gardens were fragmented by internal barriers (e.g., fences, walls) or bisected by other habitats such as managed grassland or built-up areas. Our findings confirm the RDH and help to inform future urban planning for wildlife.

Negligible hormonal response following dehorning in free-ranging white rhinoceros (Ceratotherium simum).

The white rhinoceros (Ceratotherium simum) is experiencing unsustainable poaching losses fuelled by a demand for horn. Increasingly, private and state reserves are dehorning their rhinoceros populations in an attempt to reduce poaching pressure. Rhinoceroses use their horns in social interactions as well as during resource access and so its partial removal as part of reserve management practices may adversely influence these behaviours. Physiological stress can correlate with animal welfare, reproductive state and health and thus acts as a useful indicator of these parameters. To establish whether dehorning causes a physiological stress response, glucocorticoid and gonadal steroid profiles of free-ranging white rhinoceroses were determined through the collection and analysis of faecal steroid metabolites before and after dehorning. Faecal corticoid profiles were not influenced by the number of occasions a rhinoceros had been dehorned or by the number of days that had elapsed since dehorning. Furthermore, there was no apparent suppression in the concentrations of testosterone or progesterone metabolites in males and females, respectively, after exposure to multiple dehorning procedures. These findings should increase wildlife managers' confidence that dehorning does not negatively impact white rhinoceros physiology as measured hormonally.

Over-Winter Survival and Nest Site Selection of the West-European Hedgehog (Erinaceus europaeus) in Arable Dominated Landscapes.

The West-European hedgehog (Erinaceus europaeus) has declined markedly in the UK. The winter hibernation period may make hedgehogs vulnerable to anthropogenic habitat and climate changes. Therefore, we studied two contrasting populations in England to examine patterns of winter nest use, body mass changes and survival during hibernation. No between-site differences were evident in body mass prior to hibernation nor the number of winter nests used, but significant differences in overwinter mass change and survival were observed. Mass change did not, however, affect survival rates; all deaths occurred prior to or after the hibernation period, mainly from predation or vehicle collisions. Hedgehogs consistently nested in proximity to hedgerows, roads and woodlands, but avoided pasture fields; differences between sites were evident for the selection for or avoidance of arable fields, amenity grassland and buildings. Collectively, these data indicate that hibernation was not a period of significant mortality for individuals that had attained sufficient weight (>600 g) pre-hibernation. Conversely, habitat composition did significantly affect the positioning of winter nests, such that different land management practices (historic and current) might potentially influence hibernation success. The limitations of this study and suggestions for future research are discussed.