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Improving access to and quality of maternal and infant healthcare are important leverage points to address worsening maternal and infant health disparities in the USA. This study evaluates the comprehensiveness of existing maternal and infant quality-of-care measures to identify aspects of quality that need greater attention in quality measurement.
Study design:
We conducted a structured, team-based qualitative review of 88 maternal and infant health measures indexed by the National Quality Forum (NQF), the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare and Medicaid Services (CMS), and the National Committee for Quality Assurance (NCQA). We assessed discrete elements relevant to meaningfulness, feasibility, and usability following AHRQ National Quality Strategy (NQS) criteria, with input from researcher, clinician, and citizen scientist investigators. Descriptive statistics on coded measures were calculated using SPSS.
Results:
The most common AHRQ NQS priorities addressed were mortality (60%) and safety (48%). Average scores across elements were 59% for feasibility, 61% for practice usability, and 31% for policy usability. Fewer measures addressed coordination, affordability, or patient engagement in the postpartum period. Only 23% of measures were endorsed by NQF, only 17% of measures had publicly available benchmarks, and only 14% had specifications updated in the year prior to review.
Conclusions:
Findings from this study can inform the specification of a comprehensive, updated system for maternal and infant quality-of-care evaluation and can facilitate the development of new quality-of-care measures that address underrepresented maternal and infant health issues.
Educational attainment (EduA) is correlated with life outcomes, and EduA itself is influenced by both cognitive and non-cognitive factors. A recent study performed a ‘genome-wide association study (GWAS) by subtraction,’ subtracting genetic effects for cognitive performance from an educational attainment GWAS to create orthogonal ‘cognitive’ and ‘non-cognitive’ factors. These cognitive and non-cognitive factors showed associations with behavioral health outcomes in adults; however, whether these correlations are present during childhood is unclear.
Methods
Using data from up to 5517 youth (ages 9–11) of European ancestry from the ongoing Adolescent Brain Cognitive DevelopmentSM Study, we examined associations between polygenic scores (PGS) for cognitive and non-cognitive factors and cognition, risk tolerance, decision-making & personality, substance initiation, psychopathology, and brain structure (e.g. volume, fractional anisotropy [FA]). Within-sibling analyses estimated whether observed genetic associations may be consistent with direct genetic effects.
Results
Both PGSs were associated with greater cognition and lower impulsivity, drive, and severity of psychotic-like experiences. The cognitive PGS was also associated with greater risk tolerance, increased odds of choosing delayed reward, and decreased likelihood of ADHD and bipolar disorder; the non-cognitive PGS was associated with lack of perseverance and reward responsiveness. Cognitive PGS were more strongly associated with larger regional cortical volumes; non-cognitive PGS were more strongly associated with higher FA. All associations were characterized by small effects.
Conclusions
While the small sizes of these associations suggest that they are not effective for prediction within individuals, cognitive and non-cognitive PGS show unique associations with phenotypes in childhood at the population level.
Phenological studies for Cuban bulrush [Oxycaryum cubense (Poepp. & Kunth) Lye] have been limited to the monocephalous form in Lake Columbus (Mississippi). Accordingly, there is little available information on potential phenological differences among O. cubense forms (monocephalous vs. polycephalous) and populations in other geographic locations in the United States. Therefore, seasonal patterns of biomass and starch allocation in O. cubense were quantified from two populations in Lake Columbus on the Tennessee-Tombigbee Waterway in Mississippi (monocephalous), two populations from Lake Martin in Louisiana (polycephalous), and two populations from Orange Lake in Florida (polycephalous). Monthly samples of O. cubense inflorescence, emergent, and submersed tissue were harvested from two plots per state from October 2021 to September 2022. During monthly data collection, air temperature and photoperiod were recorded. Starch allocation patterns were similar among all sites, with starch storage being less than 1.5% dry weight for all plant tissues. Biomass was greatest in Lake Columbus (monocephalous; 600.7 g dry weight [DW] m−2) followed by Lake Martin (polycephalous; 392.3 g DW m−2) and Orange Lake (polycephalous; 233.85 g DW m−2). Peak inflorescence biomass occurred in the winter for the Lake Martin and Orange Lake populations and in the summer for the Lake Columbus population. Inflorescence biomass in Lake Columbus had a positive relationship (r2 = 0.53) with warmer air temperatures. Emergent and submersed biomass generally had negative relationships with both photoperiod and temperature (r2 = 0.02 to 0.77) in all sites. Peak biomass was also negatively related to temperature and photoperiod. Results from this study indicate that there are differences in biomass allocation between the two growth forms of O. cubense and that growth can occur at temperatures below freezing. Low temperature tolerance may allow this species to expand its range farther north than previously suspected.
Although the link between alcohol involvement and behavioral phenotypes (e.g. impulsivity, negative affect, executive function [EF]) is well-established, the directionality of these associations, specificity to stages of alcohol involvement, and extent of shared genetic liability remain unclear. We estimate longitudinal associations between transitions among alcohol milestones, behavioral phenotypes, and indices of genetic risk.
Methods
Data came from the Collaborative Study on the Genetics of Alcoholism (n = 3681; ages 11–36). Alcohol transitions (first: drink, intoxication, alcohol use disorder [AUD] symptom, AUD diagnosis), internalizing, and externalizing phenotypes came from the Semi-Structured Assessment for the Genetics of Alcoholism. EF was measured with the Tower of London and Visual Span Tasks. Polygenic scores (PGS) were computed for alcohol-related and behavioral phenotypes. Cox models estimated associations among PGS, behavior, and alcohol milestones.
Results
Externalizing phenotypes (e.g. conduct disorder symptoms) were associated with future initiation and drinking problems (hazard ratio (HR)⩾1.16). Internalizing (e.g. social anxiety) was associated with hazards for progression from first drink to severe AUD (HR⩾1.55). Initiation and AUD were associated with increased hazards for later depressive symptoms and suicidal ideation (HR⩾1.38), and initiation was associated with increased hazards for future conduct symptoms (HR = 1.60). EF was not associated with alcohol transitions. Drinks per week PGS was linked with increased hazards for alcohol transitions (HR⩾1.06). Problematic alcohol use PGS increased hazards for suicidal ideation (HR = 1.20).
Conclusions
Behavioral markers of addiction vulnerability precede and follow alcohol transitions, highlighting dynamic, bidirectional relationships between behavior and emerging addiction.
Oxygen isotopic compositions were determined for coexisting mixed-layer serpentine-chlorite (Sp-Ch) and illite-smectite (I-S) from 5 Tuscaloosa Formation sandstone cores sampled between 1937 and 5470 m burial depth. High gradient magnetic separation (HGMS) was used to concentrate Sp-Ch and I-S from the <0.5 μm fraction of each core sample into fractions with a range in the Sp-Ch: I-S ratio, and end-member δ18O compositions were determined by extrapolation. The Sp-Ch δ18O values range from + 10.4 to 13.7% and increase with burial between 3509 and 5470 m. The only exception is Sp-Ch from 1937 m, which has an anomalously high δ18O value of +12.6‰ The I-S δ18O values range from +16.1 to 17.3% and do not change significantly between 3509 and 5470 m burial depth.
Pore water δ18O compositions calculated from Sp-Ch and I-S values and measured borehole temperatures range from −2.6 to +10.3‰ The isotopically light values indicate that Sp-Ch formed at shallow burial depths in the presence of brackish to marine water and/or meteoric water. The depth-related increase in δ18O of Sp-Ch is attributed to oxygen exchange between mineral and pore water during diagenetic mineral reactions. Increasing δ18O values, in conjunction with XRD and SEM data, indicate that transformation of serpentine layers to chlorite layers and Ibb polytype layers to Iaa polytype layers occurred on a layer-by-layer basis when individual layers dissolved and recrystallized within the confines of coherent crystals. Possible explanations for the variation in I-S δ18O values include depth-related differences in pore water δ18O values present at the time of I-S crystallization, contamination by detrital 2M, mica and 1M polytype rotations that facilitated oxygen exchange.
The chemical composition of mixed-layer serpentine/chlorite (Sp/Ch) in Tuscaloosa Formation sandstone was analyzed by energy dispersive X-ray spectroscopy (EDX) in the scanning electron miscroscope (SEM) and by X-ray diffraction (XRD). EDX results indicate little depth-controlled variation in composition, whereas XRD results suggest distinct decreases in octahedral Fe and tetrahedral Al. XRD-determined compositions appear to be erroneous and actually reflect progressive changes in Sp/Ch unit-cell dimensions caused by polytype transformations of Ibb layers to Iaa layers in a mixed-layer Ibb/Iaa polytype. The relative lack of variation in Sp/Ch composition, especially when compared to other studies of chlorite minerals over similar temperature ranges, is attributed to a reaction mechanism whereby mineralogic transformations (serpentine layers to chlorite layers and Ibb layers to Iaa layers) occur on a layer-by-layer basis within coherent crystallites, rather than by dissolution-precipitation crystal growth.
The lack of titanium in chlorite minerals is attributed to high levels of octahedral Al3+ that prohibit inclusion of the highly charged Ti4+ in the octahedral sheet. Anatase (TiO2) in the Tuscaloosa Formation apparently formed when Ti was liberated during crystallization of Sp/Ch following the breakdown of a Ti-bearing precursor (detrital ultramafic clasts and/or odinite). Odinite, an Fe-rich 7-Å phyllosilicate that forms in some shallow marine sands, apparently existed as a short-lived, poorly crystallized intermediary between dissolution of the ultramafic clasts and formation of Sp/Ch.
When present at elevated levels in drinking water, arsenic is toxic, and magnesian clays are gaining recognition as a source of elevated arsenic in groundwater. In the crust and upper mantle of Earth, arsenic incorporation into clay minerals is influenced by geochemical conditions associated with hydrothermal fluids and metamorphic processes (e.g. serpentinization), meaning that As is a useful tracer of fluid-flow in the deep Earth. To improve understanding of arsenic speciation in groundwater, sediments, soils, and hydrothermal-metamorphic systems, the present study examined arsenic incorporation into magnesian clays by synthesis of serpentine minerals (200oC, 10 d) with varied concentrations of Si, Al, As5+, and As3+. The synthesis experiments produced two distinct crystal types, tubular and platy serpentines, each with 10–15% randomly interstratified talc layers. X-ray absorption spectroscopy indicated that As5+ and As3+ occurred in the tetrahedral sheet. Single-crystal analysis revealed that tubular crystals contained up to 1 wt.% arsenic [Mg2.8(Si1.8As0.2)O5(OH)4] (mean 0.2 wt.% As). The mean composition of platy, high-Al crystals is (Mg1.8Al0.7)(Si2.0)O5(OH)4, and that of platy, medium-Al crystals with As3+ is (Mg2.07Al0.52) (Si1.97As3+0.03)O5(OH)4. Charge, geometry, and radius of tetrahedral AsO43– oxyanions are similar to tetrahedral SiO44–, and this facilitates fixation of As5+ into the tetrahedral sheet of clay minerals. The geometry and size of the larger As3+ in tetrahedral sites (as a pyramidal AsO33– oxyanion) may limit incorporation relative to As5+. Arsenic-bearing Mg clays crystallize in alkaline environments where AsO43– or AsO33– are the dominant As species and where high pH accompanies crystallization of serpentine, talc, chlorite, or Mg-smectite. The presence of tetrahedral As in these clays raises the possibility of tetrahedral As in other Mg clays (e.g. sepiolite or kerolite) as well.
Tropical soils range from nutrient-depleted lateritic soils rich in halloysite or kaolinite to Inceptisols rich in interstratified kaolinite-smectite (K-S), smectite, or related 2:1 clays. Given the strong influence of clay minerals on tropical soil quality, better understanding of factors influencing their occurrence is important for modeling and managing tropical environments. This study examines the alteration of smectite to kaolinite by way of intermediate K-S and halloysite in a 120 ka moist tropical chronosequence. Iron-rich smectite (11.6 ± 2.2% Fe2O3) is the dominant mineral in Holocene soils (1–8 ka) originating from sediments rich in plagioclase and clinopyroxene. The cation exchange capacity (CEC) of smectite is 54–84 cmolc/kg and pH is 6.1 to 7.4. Within 50 ka, smectite fixes Al-hydroxy complexes into interlayers, K+ is retained preferentially over Ca2+, and 2:1 layers are stripped of tetrahedral sheets; the resulting K-S inherits flaky smectite crystal habit and the 2:1 layers — which only expand partially — include Al-hydroxy smectite and some illite-like layers. After 50 ka, the dominant mineral is K-S, the CEC is 18–28 cmolc/kg, and the pH is 5.3. Flaky Fe-kaolinite with ~10% residual smectite layers and halloysite (7.4% Fe2O3) also occur in 50 ka soil. The 120 ka soils are dominated by flaky Fe-kaolinite (<10% residual smectite layers) and halloysite (4.9% Fe2O3), and Fe-poor hexagonal kaolinite also occurs (5–10% of soil). The CEC is 11–16 cmolc/kg and the pH is 4.7–5.3.
Changes in crystal chemistry of the soil clays (decreasing Fe, Mg, Ca, and K; increasing Al) over time reflects two reaction mechanisms: (1) cell-preserved transformation of smectite layers to kaolinite layers that accompanies conversion of smectite to K-S and eventually kaolinite; this results in the formation of flaky Fe-rich kaolinites after 50 ka; and (2) dissolution of K-S followed by crystallization of halloysite. Neoformation of hexagonal kaolinite and/or halloysite with low Fe (<3% Fe2O3) follows dissolution of Fe-kaolinite or halloysite after 100 ka. This sequence is probably common in moist tropical soils and these findings may inform modeling of soil composition in tropical landscapes where tectonic, volcanic, or geomorphic activity periodically exposes unweathered parent material, producing a range of soil ages.
What explains the variation in the ways countries and individuals have responded to the COVID-19 pandemic? Anti-mask protests in the United States, Germany, and England stand in stark contrast to socially-distanced protests in Serbia, Pakistan, and Mexico, where doctors and the public have demanded a more robust government response. Countries as diverse as New Zealand, Senegal, Vietnam, and South Korea have been praised for their effective responses to the pandemic, while Brazil, the United States, Mexico, and Sweden have seen their responses criticized both at home and abroad. Scholars of political culture see participating in anti-mask protests or the adoption of specific government response strategies as rooted in human attempts to make sense of the world that occur within particular cultural contexts. We develop a typology of “National Public Health Cultures,” drawing on legal, political, and social indicators measured prior to the pandemic. We use principal component analysis (PCA) along with the experiences of several key countries, including the United States, Germany, Mexico, South Korea, Kenya, and New Zealand, to develop our typology. A systematic analysis of national public health cultures improves our understanding of the varied responses to COVID-19 and integrates the proliferation of single-factor explanations of pandemic-handling success into a broader framework.
A varicocele is an abnormal dilation of the veins within the testicular pampiniform plexus. Varicoceles can be found in approximately 15 percent of the general male population and are more prevalent in men presenting with subfertility or infertility [1, 2]. Forty percent of men being evaluated for infertility may be found to have a varicocele, and varicoceles have been implicated in as many as 80 percent of men presenting with secondary infertility [2, 3]. In fact, varicoceles remain the most common reversible cause of male infertility [4]. Additionally, the inheritance of varicoceles may be genetically linked, as 56 percent of men with a first-degree relative diagnosed with a known varicocele will also have a varicocele, independent of varicocele grade or laterality [5]. With the large variability in varicocele phenotype, biomarkers to predict the development and clinical outcomes of a varicocele do not yet currently exist. However, with the advent of next-generation sequencing, studies are being conducted to identify the genetic and epigenetic changes associated with varicoceles in hopes of early detection and treatment of patients who may benefit from varicocele intervention [6].
Suicide mortality rates are a strong indicator of population mental-health and can be used to determine the efficacy of prevention measures. Monitoring suicide mortality rates in real-time provides an evidence-base to inform targeted interventions in a timely manner and accelerate suicide prevention responses. This paper outlines the importance of real-time suicide surveillance in the context of policy and practice, with a particular focus on public health and humanitarian crises.
Perennial grain crops are emerging as a promising addition to sustainable agricultural systems because of their low-input requirements and delivery of ecosystem services. However, adoption of these crops is expected to bring novel management challenges, including those related to plant diseases. In New York, fungal pathogens of annual grains have a significant impact on crop yield and value and are generally controlled through a combination of host resistances, cultural practices and chemical fungicides. Without the availability of crop rotation and soil tillage practices, disease control in perennial grain systems may be problematic, and little is known about perennial grain crop susceptibility to local plant pathogen populations. During 2017 and 2018, ongoing field trials of two perennial grain crops recently introduced in New York, intermediate wheatgrass (IWG; Thinopyrum intermedium) and perennial cereal rye (PCR; Secale cereale), were assessed for the presence of putative fungal pathogens on actively growing plants, overwintered crop residue and harvested grain. A total of nine potential host–pathogen combinations were recorded based on symptomology, pathogen morphology and DNA sequences. Common annual crop pathogens were recovered most frequently, but, at one site, Phyllachora graminis, causal fungus of tar spot and a pathogen not previously reported on crops in New York, was found on IWG. Residue colonization by an important toxigenic pathogen (Fusarium graminearum) was high in both crops, though mycotoxin levels in associated grain were low, indicating either the hosts or environment were unsuitable for disease development. Seed-borne fungal communities differed across crops and locations, and black point, a condition caused by Alternaria and Bipolaris fungi and indicative of compromised grain quality, was prevalent in PCR under some conditions. Growing PCR with intercropped red clover (Trifolium pratense L.) resulted in less Stagonospora colonization of stem residue, and PCR grown with an oat (Avena sativa L.) nurse crop had a reduced incidence of black point. These alternative cultural practices may prove useful for managing disease in perennial grains. Our results suggest that the incorporation of perennial crops into the agricultural landscape will lead to familiar plant disease problems requiring new solutions as well as new problems that may require significant research investments.
Psychosocial deficits, such as emotional, behavioral and social problems, reflect the most common and disabling consequences of pediatric traumatic brain injury (TBI). Their causes and recovery likely differ from physical and cognitive skills, due to disruption to developing brain networks and the influence of the child's environment. Despite increasing recognition of post-injury behavioral and social problems, there exists a paucity of research regarding the incidence of social impairment, and factors predicting risk and resilience in the social domain over time since injury.
Methods
Using a prospective, longitudinal design, and a bio-psychosocial framework, we studied children with TBI (n = 107) at baseline (pre-injury function), 6 months, 1 and 2-years post-injury. We assessed intellectual ability, attention/executive function, social cognition, social communication and socio-emotional function. Children underwent structural magnetic resonance imaging (MRI) at 2–8 weeks post-injury. Parents rated their child's socio-emotional function and their own mental health, family function and perceived burden.
Results
We distinguished five social recovery profiles, characterized by a complex interplay between environment and pre- and post-TBI factors, with injury factors playing a lesser role. Resilience in social competence was linked to intact family and parent function, intact pre-injury adaptive abilities, post-TBI cognition and social participation. Vulnerability in the social domain was related to poor pre- and post-injury adaptive abilities, greater behavioral concerns, and poorer pre- and post-injury parent health and family function.
Conclusions
We identified five distinct social recovery trajectories post-child-TBI, each characterized by a unique biopsychosocial profile, highlighting the importance of comprehensive social assessment and understanding of factors contributing to social impairment, to target resources and interventions to children at highest risk.
Background: Spinal cord compression from degenerative cervical myelopathy is characterized by progressive loss of hand dexterity, alongside changes in the metabolite profiles in the brain and spinal cord. Correlating the changing metabolite profile with measures of dexterity following decompression surgery may assist in identifying which patients may benefit most from surgery. Methods: Thirty operative myelopathy patients consented to receive spectroscopy and GRASSP-M dexterity assessments both preoperatively and 6-weeks postoperatively. Magnetic resonance spectroscopy (TE=135) was performed in the motor cortex using a 3 Tesla Siemens MRI scanner at Robarts Research Institute. Spearman correlations were used to evaluate associations between metabolite levels and dexterity (p<0.05 was considered significant). Paired two-tailed Student t-tests were used to assess for postoperative changes in metabolite levels. Results: Postoperatively, we observed a statistically significant (p<0.05) negative correlation (r=-0.44) between the N-acetylaspartate-to-creatine ratio (NAA/Cr) and GRASSP-M dexterity scores. There was no significant difference in NAA, Cr, or NAA/Cr postoperatively. Conclusions: These findings demonstrate that patients with lower postoperative NAA/Cr usually have better recovery of dexterity. This link between the myelopathic metabolite profile and clinically meaningful dexterity values requires further investigation to understand the role of both NAA and Cr in mechanisms of postoperative recovery from myelopathy.
Colleges and universities around the world engaged diverse strategies during the COVID-19 pandemic. Baylor University, a community of ˜22,700 individuals, was 1 of the institutions which resumed and sustained operations. The key strategy was establishment of multidisciplinary teams to develop mitigation strategies and priority areas for action. This population-based team approach along with implementation of a “Swiss Cheese” risk mitigation model allowed small clusters to be rapidly addressed through testing, surveillance, tracing, isolation, and quarantine. These efforts were supported by health protocols including face coverings, social distancing, and compliance monitoring. As a result, activities were sustained from August 1 to December 8, 2020. There were 62,970 COVID-19 tests conducted with 1435 people testing positive for a positivity rate of 2.28%. A total of 1670 COVID-19 cases were identified with 235 self-reports. The mean number of tests per week was 3500 with approximately 80 of these positive (11/d). More than 60 student tracers were trained with over 120 personnel available to contact trace, at a ratio of 1 per 400 university members. The successes and lessons learned provide a framework and pathway for similar institutions to mitigate the ongoing impacts of COVID-19 and sustain operations during a global pandemic.
Toxoplasma gondii (T. gondii) is an important human disease-causing parasite. In the USA, T. gondii infects >10% of the population, accrues economic losses of US$3.6 billion/year, and ranks as the second leading culprit of foodborne illness-related fatalities. We assessed toxoplasmosis risk among the Old Order Amish, a mostly homogenous population with a high prevalence of T. gondii seropositivity, using a questionnaire focusing on food consumption/preparation behaviours and environmental risk factors. Analyses were conducted using multiple logistic regression. Consuming raw meat, rare meat, or unpasteurised cow or goat milk products was associated with increased odds of seropositivity (unadjusted Odds Ratios: 2.192, 1.613, and 1.718 , respectively). In separate models by sex, consuming raw meat, or consuming unpasteurised cow or goat milk products, was associated with increased odds of seropositivity among women; washing hands after touching meat with decreased odds of seropositivity among women (adjusted OR (AOR): 0.462); and cleaning cat litterbox with increased odds of seropositivity among men (AOR: 5.241). This is the first study to assess associations between behavioural and environmental risk factors and T. gondii seropositivity in a US population with high seroprevalence for T. gondii. Our study emphasises the importance of proper food safety behaviours to avoid the risk of infection.
With the implementation of the European Green Paper on Mental Health, and the development of the Mental Health Pact, the strategic importance of Mental Health promotion and illness reduction as keystones of a European mental health policy and practice has never been greater.
The PROMISE project is a EU project and is financed by the European Commission, Directorate General for Health and Consumers, DG Sanco. It aims to develop and disseminate guidelines for generic training and education with respect to Mental Health Promotion and Illness Reduction. The best practice guidelines will specifically focus on the prevention of suicide, depression, and alcohol and drug abuse, and the promotion of healthy living.
A specific innovation is the involvement of mental health service users as non-traditional actors by developing multi-disciplinary training guidelines and training programs with a special emphasis on positive mental health, healthy living, diet and exercise project.
Project partners are all ‘multiplier’ organizations from 8 different European countries and have extensive previous expertise in their designated roles.
The role of Parc de Salut Mar, Barcelona PROMISE is: Identify best practice media guidelines for engaging press and media with the mental health promotion agenda through the use of positive role models. Monitor the implementation of the best practice guidelines through the design and development of local case studies in 7 sites across Europe.
Outcomes are an integrated and comprehensive set of training guidelines and model training programs accessed through an interactive website, endorsed by European level professional body and university networks.
Recommending nitrofurantoin to treat uncomplicated cystitis was associated with increased nitrofurantoin use from 3.53 to 4.01 prescriptions per 1,000 outpatient visits, but nitrofurantoin resistance in E. coli isolates remained stable at 2%. Concomitant levofloxacin resistance was a significant risk for nitrofurantoin resistance in E. coli isolates (odds ratio [OR], 2.72; 95% confidence interval [CI], 1.04–7.17).
Cambodia supports populations of three Critically Endangered vulture species that are believed to have become isolated from the rest of the species’ global range. Until recently Cambodia’s vulture populations had remained stable. However a recent spike in the number of reports of the use of poisons in hunting practices suggests the need to re-evaluate the conservation situation in Cambodia. Population trend analysis showed that since 2010 populations of the White-rumped Vulture Gyps bengalensis and Red-headed Vulture Sarcogyps calvus have declined, while the Slender-billed Vulture Gyps tenuirostris may also have started to decline since 2013. These trends are supported by evidence of reduced nesting success. A survey of veterinary drug availability revealed that diclofenac, the non-steroid anti-inflammatory drug responsible for vulture declines in South Asia was not available for sale in any of the 74 pharmacies surveyed. However, a poisoned Slender-billed Vulture tested positive for carbofuran in toxicology tests. This provides the first evidence of a vulture mortality resulting from carbofuran in Cambodia. The findings suggest the urgent need to tackle use of carbamate pesticides in hunting. Proposed conservation actions are: a) prevention of poisoning through national bans on harmful carbamate pesticides and diclofenac and education campaigns to reduce demand and use; b) training of personnel in priority protected areas in detection and response to poisoning incidents; c) maintenance of a safe and reliable food source through vulture restaurants to ensure short-term survival, and d) protection and restoration of large areas of deciduous dipterocarp forests to enable long-term species recovery.