The affordances of clinical simulation immersive technology within healthcare education: a scoping review.

Whilst clinical simulation is established as an effective education tool within the healthcare community, the inability to offer authentic educational learning environments remains problematic. Advances in technology such as immersive virtual reality offer new opportunities to enhance traditional practice to an extent that may transform learning. However, with traditional clinical simulation stress and anxiety can both hinder performance and learning, yet it is unknown what nuances are applicable within a clinical virtual simulation environment. Determining potential benefits, drawbacks (including related stress and anxiety) and affordances of immersive technology clinical simulation designs may help provide an understanding of its usefulness. The aim of this scoping review is to investigate the range and nature of evidence associated with immersive virtual reality clinical simulation and education design. In addition, the review will describe authentic immersive technology clinical simulation use and reported stress response measurements. A search of seven electronic database and grey literature was performed in accordance with the Joanna Briggs Institute methodology. A key term search strategy was employed with five themes identified and investigated: (1) Healthcare professionals, (2) Clinical simulation, (3) Immersive virtual reality, (4) Stress/anxiety and (5) Authentic learning design. Application of the search strategy resulted in a hit total of 212 articles. Twelve articles met inclusion criteria. With most literature focusing on procedural performance and non-transferable education needs, there was a paucity of research that specifically investigated immersive virtual reality clinical simulation education and related stress. Therefore, this scoping review contributes new understandings by providing valuable insight and potential research gaps into current immersive virtual reality clinical simulation, its relationship to stress and the education design models currently being utilised to develop these concepts.

Influences of zinc loads in urban catchment runoff: Roof type, land use type, climate and management strategies.

The contribution of ecotoxic dissolved metals from metallic roofs into urban waterways is a global issue. Identifying the specific origin of dissolved metals is critical to enabling appropriate stormwater management approaches that can provide the intended outcome of cleaner urban waterways. An event load pollutant model, Modelled Estimates of Discharges for Urban Stormwater Assessments (MEDUSA2.0), was used to predict the zinc load contributed from individual roof surfaces, under a wide range of rainfall conditions. Zinc was chosen as the pollutant of most concern given the extensive area of zinc-based roof surfaces, and the prevalence and mobility of zinc within urban waterways. The model categorized each roof by surface material and condition, and was run for individual rain events across multiple years to illustrate the influences on zinc loads from both surface type and rainfall conditions. Scenarios of future management were also assessed through the model to compare their benefits in terms of load reductions against the current baseline loadings. To understand how the load prediction and scenario modelling can provide valuable guidance for stormwater management decision-makers, the model was applied to a large urban catchment in Christchurch, New Zealand. Seven representative subcatchments of the varying proportions of industrial, commercial and residential land use type were also modelled to compare zinc loads generated. Results showed that an individual catchment's composition of roof types was the main driver of zinc load generation rather than the catchment's land use type. The modelled management scenarios demonstrated that reductions of 30% zinc could be achieved by changing only 4-13% of a subcatchment's unpainted zinc-based roof surfaces.

Associations of built environment and proximity of food outlets with weight status: Analysis from 14 cities in 10 countries.

The study aimed to examine associations of neighborhood built environments and proximity of food outlets (BE measures) with body weight status using pooled data from an international study (IPEN Adult). Objective BE measures were calculated using geographic information systems for 10,008 participants (4463 male, 45%) aged 16-66 years in 14 cities. Participants self-reported proximity to three types of food outlets. Outcomes were body mass index (BMI) and overweight/obesity status. Male and female weight status associations with BE measures were estimated by generalized additive mixed models. Proportion (95% CI) of overweight (BMI 25 to <30) ranged from 16.6% (13.1, 19.8) to 41.1% (37.3, 44.7), and obesity (BMI ≥ 30) from 2.9% (1.3, 4.4) to 31.3% (27.7, 34.7), with Hong Kong being the lowest and Cuernavaca, Mexico highest for both proportions. Results differed by sex. Greater street intersection density, public transport density and perceived proximity to restaurants (males) were associated with lower odds of overweight/obesity (BMI ≥ 25). Proximity to public transport stops (females) was associated with higher odds of overweight/obesity. Composite BE measures were more strongly related to BMI and overweight/obesity status than single variables among men but not women. One standard deviation improvement in the composite measures of BE was associated with small reductions of 0.1-0.5% in BMI but meaningful reductions of 2.5-5.3% in the odds of overweight/obesity. Effects were linear and generalizable across cities. Neighborhoods designed to support public transport, with food outlets within walking distance, may contribute to global obesity control.

Ethical Issues in the Neurology of Pregnancy.

Decision making for pregnant women and fetuses who suffer brain injuries is emotionally difficult and conceptually challenging. Occasionally, both the pregnant woman and the fetus have suffered an injury that confers a poor neurological prognosis, and decisions about one of them will have implications for the other-making the process of decision making even more problematic. In this article, decision-making standards and principles are reviewed for both pregnant women and fetuses, using a real case from the author's institution. Practical suggestions are made regarding deliberative processes and consultative models that can help with these difficult cases.

Implementation of cardiovascular disease prevention in primary health care: enhancing understanding using normalisation process theory.

BACKGROUND: The reorientation of primary health care towards prevention is fundamental to addressing the rising burden of chronic disease. However, in Australia, cardiovascular disease prevention practice in primary health care is not generally consistent with existing guidelines. The Model for Prevention study was a whole-of-system cardiovascular disease prevention intervention, with one component being enhanced lifestyle modification support and addition of a health coaching service in the general practice setting. To determine the feasibility of translating intervention outcomes into real world practice, implementation work done by stakeholders was examined using Normalisation Process Theory as a framework. METHODS: Data was collected through interviews with 40 intervention participants and included general practitioners, practice nurses, practice managers, lifestyle advisors and participants. Data analysis was informed by normalisation process theory constructs. RESULTS: Stakeholders were in agreement that, while prevention is a key function of general practice, it was not their usual work. There were varying levels of engagement with the intervention by practice staff due to staff interest, capacity and turnover, but most staff reconfigured their work for required activities. The Lifestyle Advisors believed staff had varied levels of interest in and understanding of, their service, but most staff felt their role was useful. Patients expanded their existing relationships with their general practice, and most achieved their lifestyle modification goals. While the study highlighted the complex nature of the change required, many of the new or enhanced processes implemented as part of the intervention could be scaled up to improve the systems approach to prevention. Overcoming the barriers to change, such as the perception of CVD prevention as a 'hard sell', is going to rely on improving the value proposition for all stakeholders. CONCLUSIONS: The study provided a detailed understanding of the work required to implement a complex cardiovascular disease prevention intervention within general practice. The findings highlighted the need for multiple strategies that engage all stakeholders. Normalisation process theory was a useful framework for guiding change implementation.

Outcomes of a four-year specialist-taught physical education program on physical activity: a cluster randomized controlled trial, the LOOK study.

BACKGROUND: The objective of this study was to investigate the effect of a 4-year specialist-taught Physical Education (PE) program on physical activity (PA) among primary school children. METHODS: A 4-year cluster randomised controlled trial was conducted in children (initially aged 8 years) from 29 primary schools (13 Intervention, 16 Control). Intervention students (N = 457) received 2 × 45 min PE lessons per week from specialist-trained PE teachers (68 lessons per year, 272 lessons over 4 years). Control group students (N = 396) received usual practice PE from generalist classroom teachers. PA during PE lessons was examined using the System for Observing Fitness Instruction Time (SOFIT). Pedometers (steps/day) were worn for 7 days each year, and accelerometers were worn concurrently in the final two years to assess moderate to vigorous (MVPA) and sedentary activity. Linear and generalized mixed models were used to determine differences in Intervention and Control student PA and the proportion of students meeting PA guidelines. RESULTS: The intervention increased SOFIT-observed student MVPA during PE lessons by 6.5 mins (16.7 v 10.2, p < 0.001). Within intervention schools, participants increased their whole-day step counts (boys = 449 [CI,140 to 756]; girls = 424 [CI,222 to 626]) and minutes of MVPA (boys = 8.0 [CI,6.8 to 9.2]; girls = 3.5 [CI,1.7 to 5.4]) on PE days. However, compared to the Control group the Intervention did not: increase habitual steps/day or MVPA when averaged over 7 days; elicit greater improvements in these measures over time; or increase the odds of meeting step/day or MVPA recommendations. At age 11 years Intervention group boys were 20 mins less sedentary per day (380 [CI,369 to 391] vs 360 [CI,350 to 369]) and this effect was sustained at age 12 years. CONCLUSIONS: Well-designed specialist-taught PE can improve student PA during PE lessons. However for PE to be a significant contributor to improving habitual PA in pre-adolescent children, daily classes are likely to be required, and even this would need to be supplemented with a wider multicomponent strategy. Our finding of a reduction in sedentary time among Intervention boys warrants further investigation into the potential role PE could play in influencing sedentary behaviour.

The Effects of Closed-Loop Medical Devices on the Autonomy and Accountability of Persons and Systems.

Closed-loop medical devices such as brain-computer interfaces are an emerging and rapidly advancing neurotechnology. The target patients for brain-computer interfaces (BCIs) are often severely paralyzed, and thus particularly vulnerable in terms of personal autonomy, decisionmaking capacity, and agency. Here we analyze the effects of closed-loop medical devices on the autonomy and accountability of both persons (as patients or research participants) and neurotechnological closed-loop medical systems. We show that although BCIs can strengthen patient autonomy by preserving or restoring communicative abilities and/or motor control, closed-loop devices may also create challenges for moral and legal accountability. We advocate the development of a comprehensive ethical and legal framework to address the challenges of emerging closed-loop neurotechnologies like BCIs and stress the centrality of informed consent and refusal as a means to foster accountability. We propose the creation of an international neuroethics task force with members from medical neuroscience, neuroengineering, computer science, medical law, and medical ethics, as well as representatives of patient advocacy groups and the public.

Community-based lifestyle modification workforce: an underutilised asset for cardiovascular disease prevention.

This paper reports on a qualitative study exploring the capacity of the community sector to support a whole-of-system response to cardiovascular disease prevention in primary health care. As a component of the Model for Prevention (MoFoP) study, community-based lifestyle modification providers were recruited in the Australian Capital Territory to participate in focus group discussions; 34 providers participated across six focus groups: 20 Allied Health Professionals (four groups) and 14 Lifestyle Modification Program providers (two groups). Thematic analysis of focus group transcripts was undertaken using a mixed deductive and inductive approach. Participant responses highlight several barriers to their greater contribution to cardiovascular disease prevention. These included that prevention activities are not valued, limited sector linkages, inadequate funding models and the difficulty of behaviour change. Findings suggest that improvements in the value proposition of prevention for all stakeholders would be supported by improved funding mechanisms and increased opportunities to build relationships across health and community sectors.

Influence of school community and fitness on prevalence of overweight in Australian school children.

The study objectives were (1) to determine the variation in prevalence of overweight between school communities, (2) to evaluate the relationship between cardiorespiratory fitness and the probability of being overweight among different school communities, and (3) to test whether this relationship varies between school communities. Using a repeated cross-sectional design, data from 31,424 (15,298 girls, 16,126 boys) Australian school children who had objective assessments of body composition and physical performance were used. Ninety-one schools located across 5 states and territories were included. Independent samples were taken across 12 school years (2000-2011). Analysis used generalised linear mixed models in R with a two-level hierarchical structure-children, nested within school communities. Predictor variables considered were: level 1-gender, age, cardiorespiratory fitness and year of measurement; level 2-school community. A total of 24.6% of the children were overweight and 69% were of low fitness. Variation in the prevalence of overweight between school communities was significant, ranging from 19% to 34%. The probability of being overweight was negatively associated with increasing cardiorespiratory fitness. The relationship was steepest at low fitness and varied markedly between school communities. Children of low fitness had probabilities of being overweight ranging between 26% and 75% depending on school community, whereas those of high fitness had probabilities of <2%. Our findings suggest that most might be gained from a public health perspective by focusing intervention on the least fit children in the worst-performing communities.

Effect of age and rainfall pH on contaminant yields from metal roofs.

Metal roofs are recognized for conveying significant metal loads to urban streams through stormwater runoff. Metal concentrations in urban runoff depend on roof types and prevailing weather conditions but the combined effects of roof age and rainfall pH on metal mobilization are not well understood. To investigate these effects on roof runoff, water quality was analysed from galvanized iron and copper roofs following rainfall events and also from simulating runoff using a rainfall simulator on specially constructed roof modules. Zinc and copper yields under different pH regimes were investigated for two roof materials and two different ages. Metal mobilization from older roofs was greater than new roofs with 55-year-old galvanized roof surfaces yielding more Zn, on average increasing by 45% and 30% under a rainfall pH of 4 and 8, respectively. Predominantly dissolved (85-95%) Zn and Cu concentrations in runoff exponentially increased as the rainfall pH decreased. Results also confirmed that copper guttering and downpipes associated with galvanized steel roof systems can substantially increase copper levels in roof runoff. Understanding the dynamics of roof surfaces as a function of weathering and rainfall pH regimes can help developers with making better choices about roof types and materials for stormwater improvement.

Exploring mobile mixed reality for critical thinking in nursing and healthcare education: A systematic review.

BACKGROUND: The shortage of nursing and healthcare clinical placements has prompted the investigation of ways to supplement authentic learning. Mobile mixed reality has become increasingly available, however, the affordances and design principles for the facilitation of critical thinking are yet to be explored. OBJECTIVE: To examine how mobile mixed reality facilitates critical thinking in nursing and healthcare higher education. DESIGN: Systematic review. REVIEW METHODS: A search in seven databases (MEDLINE, PsychINFO, AMED, ERIC, Scopus, Cochrane, and Web of Science) was conducted with 3488 titles and abstracts screened. The quality of the included studies was evaluated using the Mixed Methods Assessment Tool (MMAT). RESULTS: A total of 12 studies with 1108 participants were included. The breadth of healthcare disciplines was limited to five disciplines that utilised bespoke scenarios on head-mounted displays. Most scenarios were emergency or critical response, with limited time for pre-brief, debrief, or overall user time. Only two studies directly measured critical thinking, with others including indirect reference to diagnoses, interpretation, analysis, or evaluation of healthcare scenarios. Affordances and design principles for the future development of mobile mixed reality for critical thinking in nursing and healthcare higher education are identified. CONCLUSIONS: While some pedagogical affordances of mobile mixed reality can be identified in a narrow number of healthcare disciplines, there remain to be limited valid measures of critical thinking used to quantify effectiveness. Future studies would benefit from considering scenarios beyond emergency and critical responses, including longitudinal studies that reflect the development of critical thinking over time, and exploration of co-designed scenarios with and by nursing and healthcare students.

Longitudinal patterns of physical activity in children aged 8 to 12 years: the LOOK study.

BACKGROUND: Data on longitudinal monitoring of daily physical activity (PA) patterns in youth over successive years is scarce but may provide valuable information for intervention strategies aiming to promote PA. METHODS: Participants were 853 children (starting age ~8 years) recruited from 29 Australian elementary schools. Pedometers were worn for a 7-day period each year over 5 consecutive years to assess PA volume (steps per day) and accelerometers were worn concurrently in the final 2 years to assess PA volume (accelerometer counts (AC) per day), moderate and vigorous PA (MVPA), light PA (LPA) and sedentary time (SED). A general linear mixed model was used to examine daily and yearly patterns. RESULTS: A consistent daily pattern of pedometer step counts, AC, MVPA and LPA emerged during each year, characterised by increases on school days from Monday to Friday followed by a decrease on the weekend. Friday was the most active and Sunday the least active day. The percentage of girls and boys meeting international recommendations of 11,000 and 13,000 steps/day respectively on a Monday, Friday and Sunday were 36%, 50%, 21% for boys and 35%, 45%, 18% for girls. The equivalent percentages meeting the recommended MVPA of >60 min/day on these days were 29%, 39%, 16% for boys and 15%, 21%, 10% for girls. Over the 5 years, boys were more active than girls (mean steps/day of 10,506 vs 8,750; p<0.001) and spent more time in MVPA (mean of 42.8 vs 31.1 min/day; p<0.001). Although there was little evidence of any upward or downward trend in steps/day from age 8 to 12 years, there was a trend toward lower MVPA, LPA and a corresponding increase in SED from age 11 to 12 years. CONCLUSION: A weekly pattern of PA occurred in children as young as age 8 on a day by day basis; these patterns persisting through to age 12. In addition to supporting previous evidence of insufficient PA in children, our data, in identifying the level and incidence of insufficiency on each day of the week, may assist in the development of more specific strategies to increase PA in community based children.

Cross-sectional review of the response and treatment uptake from the NHS Health Checks programme in Stoke on Trent.

BACKGROUND: As part of national policy to manage the increasing burden of chronic diseases, the Department of Health in England has launched the NHS Health Checks programme, which aims to reduce the burden of the major vascular diseases on the health service. METHODS: A cross-sectional review of response, attendance and treatment uptake over the first year of the programme in Stoke on Trent was carried out. Patients aged between 32 and 74 years and estimated to be at ≥20% risk of developing cardiovascular disease were identified from electronic medical records. Multi-level regression modelling was used to evaluate the influence of individual- and practice-level factors on health check outcomes. RESULTS: Overall 63.3% of patients responded, 43.7% attended and 29.8% took up a treatment following their health check invitation. The response was higher for older age and more affluent areas; attendance and treatment uptake were higher for males and older age. Variance between practices was significant (P < 0.001) for response (13.4%), attendance (12.7%) and uptake (23%). CONCLUSIONS: The attendance rate of 43.7% following invitation to a health check was considerably lower than the benchmark of 75%. The lack of public interest and the prevalence of significant comorbidity are challenges to this national policy innovation.

The flood pulse as the underlying driver of vegetation in the largest wetland and fishery of the Mekong Basin.

The Tonle Sap is the largest wetland in Southeast Asia and one of the world's most productive inland fisheries. The Mekong River inundates the Tonle Sap every year, shaping a mosaic of natural and agricultural habitats. Ongoing hydropower development, however, will dampen the flood pulse that maintains the Tonle Sap. This study established the current underlying relationship among hydrology, vegetation, and human use. We found that vegetation is strongly influenced by flood duration; however, this relationship was heavily distorted by fire, grazing, and rice cultivation. The expected flood pulse alteration will result in higher water levels during the dry season, permanently inundating existing forests. The reduction of the maximum flood extent will facilitate agricultural expansion into natural habitats. This study is the most comprehensive field survey of the Tonle Sap to date, and it provides fundamental knowledge needed to understand the underlying processes that maintain this important wetland.

Off-protocol access to study therapies.

The ethics of allowing off-protocol access to a study therapy are explored, using the example of recombinant factor VIIa for intracerebral hemorrhage. rVIIa was later found to be ineffective. While the studies were being performed, researchers struggled with the question of whether a critically ill patient with intracerebral hemorrhage was actually indifferent between the treatment and placebo arms of the trial.

Risk of Guillain-Barré syndrome after meningococcal conjugate vaccination.

PURPOSE: A new meningococcal conjugate vaccine (MCV4) was introduced in 2005. Shortly after, case reports of Guillain-Barré syndrome (GBS), a serious demyelinating disease, began to be reported to the Vaccine Adverse Event Reporting System. In 2006, the Centers for Disease Control and Prevention and the Food and Drug Administration requested the evaluation of GBS risk after MCV4 vaccination. We conducted a study to assess the risk of GBS after MCV4 vaccination using health plan administrative and claims data together with the review of primary medical records of potential cases. METHODS: Retrospective cohort study among 12.6 million 11- to 21-year-old members of five US health plans with a total membership of 50 million. Automated enrollment and medical claims data from March 2005 through August 2008 were used to identify the population, the vaccinations administered, and the medical services associated with possible GBS. Medical records were reviewed and adjudicated by a neurologist panel to confirm cases of GBS. The study used distributed data analysis methods that minimized sharing of protected health information. RESULTS: We confirmed 99 GBS cases during 18,322,800 person-years (5.4/1,000,000 person-years). More than 1.4 million MCV4 vaccinations were observed. No confirmed cases of GBS occurred within 6 weeks after vaccination. The upper 95% CI for the attributable risk of GBS associated with MCV4 is estimated as 1.5 cases per 1,000,000 doses. CONCLUSIONS: Among members of five US health plans, MCV4 vaccination was not associated with increased GBS risk.

NHS health checks through general practice: randomised trial of population cardiovascular risk reduction.

BACKGROUND: The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century. The Department of Health in England has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk. The aims of this study were to monitor population changes in cardiovascular disease (CVD) risk factors over the first year of the new service and to assess the value of tailored lifestyle support, including motivational interview with ongoing support and referral to other services. METHODS: Randomised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent, England. Thirty eight general practices and 601 (365 usual care, 236 additional lifestyle support) patients were recruited and randomised independently between September 2009 and February 2010. Changes in population CVD risk between baseline and one year follow-up were compared, using intention-to-treat analysis. The primary outcome was the Framingham 10 year CVD risk score. Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories. Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for: weight management, physical activity, cook and eat and positive thinking. RESULTS: Average population CVD risk decreased from 32.9% to 29.4% (p <0.001) in the NHS Health Check only group and from 31.9% to 29.2% (p <0.001) in the NHS Health Check plus additional lifestyle support group. There was no significant difference between the two groups at either measurement point. Prevalence of high blood pressure, high cholesterol and smoking were reduced significantly (p <0.01) in both groups. Prevalence of central obesity was reduced significantly (p <0.01) in the group receiving additional lifestyle support but not in the NHS Health Check only group. CONCLUSIONS: The NHS Health Check service in Stoke on Trent resulted in significant reduction in estimated population CVD risk. There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction.

Atmospheric deposition and storm induced runoff of heavy metals from different impermeable urban surfaces.

Contaminants deposited on impermeable surfaces migrate to stormwater following rainfall events, but accurately quantifying their spatial and temporal yields useful for mitigation purposes is challenging. To overcome limitations in current sampling methods, a system was developed for rapid quantification of contaminant build-up and wash-off dynamics from different impervious surfaces. Thin boards constructed of concrete and two types of asphalt were deployed at different locations of a large carpark to capture spatially distributed contaminants from dry atmospheric deposition over specified periods of time. Following experimental exposure time, the boards were then placed under a rainfall simulator in the laboratory to generate contaminant runoff under controlled conditions. Single parameter effects including surface roughness and material composition, number of antecedent dry days, rain intensity, and water quality on contaminant build-up and wash-off yields could be investigated. The method was applied to quantify spatial differences in deposition rates of contaminants (TSS, zinc, copper and lead) at two locations varying in their distance to vehicle traffic. Results showed that boards exposed at an unused part of the carpark >50 m from vehicular traffic captured similar amounts of contaminants compared with boards that were exposed directly adjacent to the access route, indicating substantial atmospheric contaminant transport. Furthermore, differences in contaminant accumulation as a function of surface composition were observed. Runoff from asphalt boards yielded higher zinc loads compared with concrete surfaces, whereas runoff from concrete surfaces resulted in higher TSS concentrations attributed to its smoother surfaces. The application of this method enables relationships between individual contaminant behaviour and specific catchment characteristics to be investigated and provides a technique to derive site-specific build-up and wash-off functions required for modelling contaminant loads from impermeable surfaces.

Quantifying changes in flooding and habitats in the Tonle Sap Lake (Cambodia) caused by water infrastructure development and climate change in the Mekong Basin.

The economic value of the Tonle Sap Lake Floodplain to Cambodia is arguably among the highest provided to a nation by a single ecosystem around the world. Nonetheless, the Mekong River Basin is changing rapidly due to accelerating water infrastructure development (hydropower, irrigation, flood control, and water supply) and climate change, bringing considerable modifications to the flood pulse of the Tonle Sap Lake in the foreseeable future. This paper presents research conducted to determine how the historical flooding regime, together with human action, influenced landscape patterns of habitats in the Tonle Sap Lake, and how these habitats might shift as a result of hydrological changes. Maps of water depth, annual flood duration, and flood frequency were created for recent historical hydrological conditions and for simulated future scenarios of water infrastructure development and climate change. Relationships were then established between the historical flood maps and land cover, and these were subsequently applied to assess potential changes to habitat cover in future decades. Five habitat groups were clearly distinguishable based on flood regime, physiognomic patterns, and human activity: (1) Open water, flooded for 12 months in an average hydrological year; (2) Gallery forest, with flood duration of 9 months annually; (3) Seasonally flooded habitats, flooded 5-8 months and dominated by shrublands and grasslands; (4) transitional habitats, flooded 1-5 months and dominated by abandoned agricultural fields, receding rice/floating rice, and lowland grasslands; and (5) Rainfed habitats, flooded up to 1 month and consisting mainly of wet season rice fields and village crops. It was found that water infrastructure development could increase the area of open water (+18 to +21%) and the area of rainfed habitats (+10 to +14%), while reducing the area covered with seasonally flooded habitats (-13 to -22%) and gallery forest (-75 to -83%). Habitat cover shifts as a result of climate change include a net increase of open water (2-21%), as well as a reduction of rainfed habitats by 2-5% and seasonally flooded habitats by 5-11%. Findings from this study will help guide on-going and future conservation and restoration efforts throughout this unique and critical ecosystem.