Water-Food-Energy Nexus is imposing new challenges to research and modelling, as a result of the integration and complexity of these fields, while sharing same concerns and goals. According to the System’s Theory, the nexus is defined as a centre point, or a centre of various connections, similarly with the way that Water-Food-Energy jointly considered as pillars of environmental security, economic prosperity and social equity (Bazilian et al., 2011). The international experience on this Nexus indicates that research focuses on these pillars mostly independently from different perspectives, because each one of its components is a large and complex field itself (WBCSD Leadership Program., 2018). For example, water managers see food and energy systems as users, aiming to minimise their consumption to conserve resources; the food perspective sees water and energy as inputs for exploitation; while the energy perspective sees water as input and food as the output of the procedure. The lack of integration of the analysis (research) and planning (decision-making) of those different sub-systems divides the problem’s components and leads to sub-optimal solutions (optimal only for one sub-system). However, analysing the nexus and its components as a single system can lead to overall optimum and highly efficient solutions and policies. Limited understanding of the nexus concept and the lack of systemic thinking can be often impediments to such approaches. So, training and education of key stakeholders to build on commonly understandable bases is an essential starting point, to reach to the convergence of the different ideas under a more holistic thinking.

Greece has been slow to examine the Nexus based on systems analysis, with the exception of the recent studies of Laspidou et al. In 2018 they enriched the Water-Food-Energy nexus with the land use and climate components, and argued about the interlinkages of these five elements, while a year later they created a scoring system for these interlinkages (Laspidou et al., 2019a). Laspidou et al. (2019b) presented a System Dynamics Model (SDM) to establish and quantify the interlinkages among these five Nexus dimensions for Greece, using thematic models which produced forecasted trends up to 2050 for various climatic scenarios. Nexus studies on Greek agricultural catchments are very limited, given the difficulties in data collection and stakeholder cooperation (Psomas et al., 2018).

In order to achieve the systemic analysis of the Nexus, and provide optimum solutions, the literature increasingly proposes the co-existence of two parallel procedures (Albrecht et al., 2018; Yung et al., 2019; Endo et al., 2020; Alamanos et al., 2021):

• The science; to enhance the understanding of interactions within the nexus, support its systemic approach, and critically form models aiming to overall optimum solutions,

• A proper stakeholder analysis and engagement, integrating local knowledge; to collaborate, co-design future visions and ensure a healthy two-way feedback.

Both procedures must be based on the principles of transparency and openness, fairness, equality and respect, efficiency, collegiality and tolerance, common goal-visions, and commitment, under the purpose of the community’s and individuals’ good (Alamanos et al., 2021). The analysis of Laspidou et al. (2020) notes that to move from a general nexus thinking to an operational nexus concept, it is important to focus on data availability and scale. Using a regional scale will require such data, while stakeholder analysis is a key to achieve sustainability through the Nexus. However, the international experience has limited, and the Greek literature has no examples, of stakeholder-based approaches, aiming to communicate a systemic Nexus thinking, and using it as a basis for sustainable planning.

The main goal of this study is to cover this gap, analysing the Nexus in the Basin District of Thessaly (regional scale) and its key stakeholders in a series of meetings, by demonstrating a combination of the two parallel procedures mentioned above, introducing two novel frameworks: The Framework for Integrated Land and Landscape Management (FILLM) and the Systems Innovation Approach (SIA). FILLM is used as a conceptual model for understanding the Nexus components as a single system and SIA is used to unite the different interests of the region under a common vision for the future (An Fóram Uisce, 2021). The paper focuses on the methods of SIA and FILLM, as ways to achieve deep understanding of each stakeholder’s view on the presented problems, and reach to common objectives. This effort is part of an ongoing project–experiment designed to address realistic situations, problems, different interests, and policy “on the making,” in order to achieve socially acceptable and tangible solutions.

Study Area

The Nexus in this study is considered according to the approach of Laspidou et al. (2018) namely, Water-Land-Climate-Food-Energy components, in order to provide a holistic assessment of the study area (described in the following sections) and highlight their interlinkages to the stakeholder group.


The Basin District of Thessaly covers a total area of 13,377 km2 in Central Greece. Although the region accounts only for the 5% of the national GDP (7,853 out of 155,780 million€ in 2018), it is the second biggest agricultural producer in the country (935 million€ of Gross-Value-Added from agriculture) (ELSTAT, 2021). Subsequently, it is the largest water consumer of the country and one of its driest areas with an average precipitation of 600–800 mm/year and average annual temperature of 16–17°C. This leads to great losses because of evapotranspiration, almost 60% of the total average annual precipitation (Koutsoyiannis et al., 2008). Figure 1 shows the main land uses.

Figure 1. The Basin District of Thessaly, and main land uses.

Agriculture is the biggest pressure on water availability and pollution, while its economic management and regulatory control is challenging. Wheat and other cereals (except maize) are the main crops, followed by cotton, and tree-crops.

Water Deficits

Irrigation uses around 92% of the total water consumption, urban water uses 6.63%, livestock 0.91%, and industry 0.62% according to the River Basin Management Plans (RBMPs) of the Greek Ministry of Environment and Climate Change (GMECC, 2017). The annual hydrological balance of the Basin District is constantly negative, leading to the overexploitation of the non-renewable groundwater stocks (Koutsoyiannis et al., 2008; Alamanos et al., 2019). The highly-demanding irrigation is covered by surface (24%) and by groundwater resources (76%) through legal or illegal and unregistered drills (GMECC, 2017). Urban water demand is covered only from groundwater, with the exception of the town of Karditsa, which uses surface water from the neighbouring lake. Subsidies and product prices have expanded areas of water-consuming crops. Hence the intensified water abstraction from every surface Water Body (WB), while the 33% of the groundwater resources are historically in “bad status”—overexploited. Subsequently, the energy demand and costs are dramatically increasing.

Qualitative Degradation

Livestock units are dominant regarding the point pollution concentrations (74% of the total BOD, 60.4% of Nitrogen, and 62% of Phosphorous), followed by Wastewater-Treatment Plants, discharges of sewerage networks, large hotels, industrial units, and aquaculture. Unorganised pasture and fertilisers and pesticides, are the major non-point pollution sources. All these types of pressures are uniformly distributed in the Basin District, while farming plays the dominant role (and is also affected because of the quality of water used for irrigation and food production). Figure 2 is indicative of the quantitative, qualitative (chemical/ecological) and overall degradation of the Basin District, according to the RBMPs. The RBMPs grouped the WBs’ status into different classes depending on the pressures levels (concentrations of pollutants).

Figure 2. (A) qualitative and (B) quantitative status of groundwater WBs. (C) ecological and (D) overall status of surface WBs (Adapted from GMECC, 2017).

According to the GMECC’s assessment, the ecological status of river WBs is 1.4% unknown, 16.67% missing, 4.17% bad, 22.22% medium, and 55.5% good. 22.22% of rivers have “below good” chemical status. With respect to the three reported lakes, one is of Good, one of Bad and one of Unknown Status. Finally, groundwater bodies have 30.3% bad quantitative and 12.1% have bad chemical status.

Administrative and Economic Challenges

The Greek Committee for Environment coordinates the related policies and the programs of measures in cooperation with the Prefecture of Thessaly. The Agricultural Agency of Land Reclamation (AALR) is responsible for the agricultural water management, the actions in local level are coordinated by the Local Agencies of Land Reclamation (LALR). The other water uses are mainly responsibilities of the Water Utilities. LARLs rely on farmers’ payments for irrigation, which are based on the cultivated area (e.g. €/km2). LARLs are facing high debts, farmers state that they do not even know how much water they consume, but when there is a shortage they consider the other farmers as responsible, and they open private (legal or not) drills (Mylopoulos and Fafoutis, 2014). This situation creates huge revenue losses to the LALRs and also environmental degradation. The concept of the ‘full cost recovery’ according to the Water Framework Directive (WFD) is far from achievable, since only a small part of the monetary cost is being recovered, while natural resource and environmental costs are unknown concepts (Alamanos et al., 2020a,b).

Currently, there is no infrastructure or policy actions to change the economic management of agriculture or support monitoring. LARLs lack of basic data (many cases of “unknown status”), personnel, and complete understanding of their responsibilities, while the water efficiency is low (irrigation with open channels and sprinklers) (Alamanos et al., 2020a,b). Production expectations are increasing, following the markets’ trends and the subsidies, however not all products are exploited by the local communities. There is no integrated or central planning on water-land-food production issues and the inefficient management creates high energy (and production and environmental) costs. Thus, the “nexus” case of Thessaly is very challenging. Furthermore, the region suffers from continuous extreme phenomena, as the following sections explain.


Several indices have been proposed to describe the drought intensity and duration or spatial distribution, based on historical data (time-series observations) (Tsakiris et al., 2007). The GMECC, 2014) followed a modified approach of the Water Exploitation Index (WEI) to express the situation of Thessaly, which indicates a “severe water-stress” status. The WEI of the central part of Thessaly was found 49% (2014), while the region historically suffers from droughts (Loukas and Vasiliades, 2004; Kanellou et al., 2008; Tigkas, 2008). Loukas et al. (2008) proved that drought severity, duration and intensity increased (compared to the historic period 1960–1990), and spatially extended droughts would be expected in the future decades (2020 and onwards), indicating the necessity of mitigation and adaptation actions.


It is known that the plain of Thessaly suffered from floods since antiquity, when several structures had been built to control Pinios river 2,500 years ago (Mimikou and Koutsoyiannis, 1995). The Basin District is continuously affected by flood events and has attracted the interest of many scholars: Psomiadis et al. (2019) applied remote sensing to observe flash floods, define risk zones and estimate damages (Papaioannou et al., 2018, 2021) combined hydrological and hydraulic methods to guide the implementation of the Flood Directive in Greece, using also case studies from Thessaly. Bathrellos et al. (2018) analysed the spatiotemporal flood event distribution and its severity based on the associated damages. Many areas in Thessaly that are historically affected by floods are still being damaged today (Figure 3 shows the most flood prone areas and the maximum expected water depths). The lack of organised central and local planning, and wildfires have been identified as the major causes (Batelis and Nalbantis, 2014). Thessaly is the most vulnerable Basin District of Greece, and the flood-risk zones cover the 31.2% of its area (GMECC, 2017).

Impacts of Climate Change

Changes of the future climate will affect the parameters of the hydrological cycle and the human activities. Climate projections refer to increased temperatures and reduced rainfalls. This will reduce the available water supply, since the evaporation losses will be higher, while surface runoff and groundwater recharge will be reduced (Mimikou et al., 2000). The water demand will increase (e.g. more irrigation water will be needed to cover driest conditions), hence the annual water balances will become more deficit. The Bank of Greece (2011) studied the climate change’s impacts on the increased energy demand (electricity, cooling and heating), general ecosystems degradation (soil, erosion, biodiversity, built environment, etc.), and related activities (food production, fishing, tourism, leisure), and on transport, health, mining, etc. (describing actually a Nexus problem). Moreover, disasters due to extreme phenomena are expected to occur more frequently (Loukas et al., 2008). Exactly these situations have been noted in Thessaly and prove that water quantity-quality degradation are connected for surface and groundwater resources.

The literature highlights the importance of a more efficient water management, especially in agriculture, as the achievement of good-quality food is necessary, and the integration of the socio-economic impacts (production, revenue losses and increased production costs) must be considered (Alcamo et al., 2007; McDonald and Girvetz, 2013; Calzadilla et al., 2014). Several studies in Thessaly show that the situation can still be reversed, and prove that water resources are more affected by human exploitation and management, than by climate change (Loukas et al., 2015; Tzabiras et al., 2016; Mylopoulos et al., 2017).

Methodology: Systems Innovations as a Nexus Approach

Our research team participates in a project for integrated and sustainable planning in Thessaly, through understanding and co-designing solutions with key-stakeholders, providing continuous scientific support and technological solutions. For the first time, to our knowledge, the Nexus is used for the development of a framework to communicate the above challenges as functions of a single system, according to the Systems Theory. The FILLM is used for that purpose, with the simple goal to promote the “thinking out of the borehole” to the locals, enlarging their field of understanding towards cause-effect relations and integrated catchment management. Thus, water-land-food-energy-economy can be coordinated to find overall optimum solutions, avoiding “one-sided” management. Alamanos et al. (2021) analysed FILLM’s structure and toolkits, so in this study we will briefly mention that its central idea is to:

• understand the nexus components (air-atmosphere-land-soil-water-energy-economy) and their interactions or cause-effect relations (becoming conscious),

model them with environmental (engineering models) which will provide a detailed catchment and WB characterisation, assess and optimise the different measures, and support the decision-making process,

• scientific and committed stakeholder analysis (parallel process) with continuous feedback for the decision-making (co-design common long-run visions) and measures’ implementation (see next section), and

• continuous progress tracking (inspection and re-feeding the described loop).

This framework was firstly proposed in Ireland in the end of 2020 and this is its first application in Greece, where the stakeholders have well-receipted it so far.

For the stakeholder analysis-engagement, the description of the study area (section Study Area) is an essential starting point for the living labs that will follow, based on the “Systems Innovation Approach” (SIA). Systems innovation is a conceptual framework for stakeholder analysis, defined as an “interconnected set of innovations, where each influences the other, with innovation both in the parts of the system and in the ways in which they interconnect” (Mulgan and Leadbeater, 2013). SIA reflects a fundamental change in the way that the creation of knowledge is perceived and endorsed. It shifts attention away from technological inventions and research, towards the whole process of innovation, where research is only one component. This framework sets the basis for future developments of Nexus problems, where technological solutions are not sufficient and the collaboration of the key stakeholders is required.

The foundations of SIA are lying on developing the suitable setting for unfolding the stakeholders’ perspectives seeking to understand the challenge in a holistic manner. Agreeing on the problems understanding and the Nexus’ components interactions, paves the way to create integrated solutions. In this project, we use a series of monthly meetings with 27 key-stakeholders of the Basin District (representatives from the government, local authorities, experts and experienced professionals, start-ups and technological solutions, agricultural co-operations and local agencies), ensuring scientific support, analysis and democratic feedback for the design of commonly accepted actions for a sustainable future (Table 1).

Table 1. The stages of the SIA process (indicative as any problem, stakeholder group, and solutions differ).

Stakeholder co-development of the trajectories of change can offer validity to national and sectoral interpretations and reveal important uncertainties or deficiencies. Pecl et al. (2019) argue that engaging the public on scientific issues may possibly contribute to changes in community knowledge, attitudes, and behaviours. This approach seeks to ensure the commitment of the stakeholders in the co-developed solutions, testing the assumption that the sense of “belonging” and “co-developing” will lead to behavioural change in order to best manage all components involved in the Nexus. Obviously, this approach requires extensive prior research for the study area and international practises, hence the understanding of the context and efficient workshop coordination are ensured, and necessary information is available to share with stakeholders.

The process of SIA serves as a guide to coordinate the discussion during the meetings process, and the tools mentioned can be applied through the use of visual collaboration platforms, such as Miro (2020), that enables the efficient and effective intuitive collaboration of the stakeholders.


Following the process of Table 1 each stage is accomplished through monthly workshops (Table 2). Due to COVID-19 restrictions the meetings are held on Zoom, and MIRO software is often used for the analysis. Each stage is enriched and supported by a variety of tools based on the needs of each workshop and the specificities of the living lab (stakeholders’ interests, needs, conflict points etc).

Table 2. Timeline of the Living Labs and workshop structure.

In the first workshop, the goals of the living labs and the expectations from the process were reflected from the team and the participants. Each one introduced him/herself and while they were glad to be part of a transdisciplinary group, they feel pessimistic about the project’s outcomes. They feel that the lack of political will and/or capacity to “make works and solutions happen” can hardly change. The first phase of SIA started in our second meeting, when the challenges were presented in detail (as described in the study area section). The participants agreed with the issues presented, then tried to unravel the challenges taking into consideration the policy, environmental, social, economic and technological angles of this challenge. The role of MIRO is to visualise positions and/or priorities set by the stakeholders (Figure 4), making it easier to group them and understand their relationships (3rd workshop).

Figure 4. (A) The Pentagonal problem. It is indicatively showing how the participants simultaneously described the: Environmental, Technological, Economic, Political and Social challenges they feel to face, by putting a note-description in the respective section of the pentagon. More explanatory notes can be added (sticky notes), as well as certain connections to indicate agreements and links between observations. (B) Importance—Timeframe matrix. This is indicatively showing how the participants evaluated the different challenges (black post-its) regarding their severity (y-axis) and the time-frame needed to address them (x-axis). Three break-out rooms were used, hence the three diagrams, and each participant posted a sticky note with a representative phrase indicating how important or not is to address a specific problem in the short or long-term. The stakeholders’ comments are in Greek, as the exercises were elaborated in Greek, but are indicative, only to show two examples of the various exercises of parallel actions carried out in MIRO together with the discussions.

There is an understanding of the magnitude of the problems, perceived as a Nexus problem with intense socio-political aspects. Most stakeholders recognise agricultural pressures; however, the local authorities see agriculture as the only way towards economic (and political) benefits in the region. All stakeholders agree on the severity of the water scarcity issues, and believe that things may be even worse than reported. Stakeholders from LALRs feel that the situation is too bad and almost unreversible in terms of water quantity and quality deterioration. The debts they face make it difficult to operate, have the required staff, and make any investments. The stakeholders also recognise the changing climatic conditions, they have faced extreme phenomena with serious economic losses, and they seek mechanisms that will be able to respond promptly and efficiently are needed. During these stages, the FILLM was used (references and examples—presentations, material, infographics, etc. as in Alamanos et al., 2021) in order to adopt the “nexus thinking,” accepting that all disciplines are interconnected. Moreover, the importance of data availability and transparency is highlighted, both in small and large scales. Stakeholders also discussed solutions considering either large-scale long-term solutions referring to supply management (e.g. partial diversion from Acheloos river basin—Tyralis et al., 2017) or smaller scale “mild” targeted interventions aiming to demand management for a more efficient and reasonable water use (e.g. crop replacement, smart agriculture based on monitoring, more efficient water use, new technologies). Building on this discussion, all the actions proposed from the state (RBMPs’ measures, action under the Resilience and Recovery Plan), the academia (literature review presented), private sector and local initiatives (presented from the participants) were evaluated. Moreover, the pros and cons of each approach were discussed. Around 50 specific actions were evaluated and discussed in order to find out which of them are acceptable or not and why, and why most of them have not been implemented: Basic measures (EU Directives), water demand and supply management, project management, Acheloos diversion works, and non-state initiatives were the categories evaluated. We found that:

• The majority of the participants are more familiar, have expertise and work on projects for demand management. Although they have significant experience, their suggestions have received very limited attention from the local authorities.

• Their priorities are the completion of uncompleted water supply works, a proper, clear and transparent project management, demand management works, and finally Acheloos diversion.

• The participants identified many common views and rationale in their approaches to solve the problems outlined. This serves as the basis for their co-operation in order to create our common vision (according to SIA’s principles).

• Issues of individual political interests, lack of long-term vision and commitment (mainly because of changing governments), planning, practical implementation, and transparency were identified as the main obstacles so far. Most stakeholders see this situation as the root of most problems, and find it difficult to change.

A take-away message from the above is that a more reasonable management aiming to environmental and economic sustainability and resilience is mandatory, as it will benefit all stakeholders, with different ways. Reaching to an agreement on this matter is crucial: In this study we built on the acceptance of the nexus concept (using FILLM), and then, according to SIA, each participant needs to understand the expected benefits, overall and individually (using examples, presentations, or the appropriate arguments within our conversations).

Primary Results and Future Steps

During the discussions, and especially during the evaluation of specific measures, on the occasion of highlighting the necessity for upgrading and modernising Local Authorities, the idea of a Water Management Body was suggested by several participants. This idea was again suggested as an option to achieve the common goal of the group, “a more reasonable management aiming to environmental and economic sustainability and resilience,” as mentioned. Of course, this goal requires cooperative action and initiative from all stakeholders, in order to provide the means to be successful. Given the absence and/or poor performance of the existing mechanisms to deal with larger scale—than the limits of the Basin District—actions (e.g. finish incomplete water-transfer works), address issues affecting the nexus (water quantity and quality degradation, extreme phenomena, economic and administrative problems, difficulties to produce adequate and high quality food products, increasing energy costs), the inability of the local authorities to undertake and complete the planned works, leading to unexploited EU funds, the formation of a National Water Management Body (NWMB) was considered necessary from the participants. When questioned, the stakeholders set this as a priority—umbrella objective (more than 85% agreement). The desire of a NWMB has been stated even from the first meetings, and it is seen as a way of having a fairer management with greater technical, executable, and regulatory capacity. At this point, we have set two questions to be answered in the future: (a) what should the NWMB do and how to ensure its successful operation? (b) can the state cover these needs from the existing or other mechanisms, and how?

The answer to the first question is actually addressed by the goal of “achieving sustainability and resilience,” and develops our “common-vision.” An initial effort to shape this is presented in Figure 5: Balancing all the components of supply and demand (systems and sub-systems) will bring sustainability—while the proper response (minimising failures and recovering timely) will enhance the systems resilience. Strong policy instruments and finance, as well as the necessary educational bases will provide the tools and the achievement towards sustainability and resilience. A NWMB will be responsible to provide in a coherent and efficient way the policy basis and instruments to manage these elements for overall benefits, according to the Nexus concept.

Figure 5. The most common components of the supply and demand sides, which must be balanced to achieve sustainability (environmental, economic, etc.); the challenges that our systems are facing trying to become more resilient. The policy-finance frameworks and education will ensure this managerial approach.

Ensuring that all stakeholders and relevant bodies are regularly reminded of this vision and their role in achieving and supporting it, becomes easier and more efficient through a NWMB engaging stakeholders. The provision of a unifying platform within the NWMB for multiple and sometimes competing interests to work together in a collaborative manner, and drawing on each other’s expertise and experience, addressing the many challenges to the vision, is also a function to be explored. Other crucial points are the exploitation of EU funds, and the capacity building to manage effectively all components of Figure 5. Further questions-details with respect to the role of such a Body, and leadership, technical, financial issues are to be developed in the upcoming workshops, and majorly depend on the answer to the second question. The group prefers to find the answer to a reformulation of the existing State’s mechanisms and support their operation, although it is challenging. In any case, the criteria to ensure the successful operation of this Body will have a strong connection with the understanding of the nexus, adopting integrated systemic approaches, and of course having the support of the group’s stakeholders. In the following workshops we will engage with the responsible people from the Greek Ministry of Environment in order to assess their structures and potential, and identify areas for cooperation in order to reach this vision.


In this work, a Nexus complex problem is presented and a methodological framework for its management is described. The situation in the Basin District of Thessaly, one of the most challenging case-studies in Europe, regarding water scarcity, was analysed, providing a comprehensive review for each aspect of the problem for the first time so far, to our knowledge. Another novel element is the combination of a “whole-of-systems” approach (SIA) including a “whole-of-environment” sub-systemic approach (FILLM). In this work, the combination of SIA and FILLM in the context of living labs was presented to address complex nexus problems, and was successful as a means of reaching to common visions, and motivating different stakeholders to cooperate for this vision. The living labs reflect deeper issues of the Greek society, that extent to the perception of the nexus and its management, in a rural and water-scarce Basin District. The proposed systematic approach is covering a wide range of topics and seems to adequately contribute to the assessment of technical, economic, social, political-governance challenges (analysing and understanding their severity, time-horizon for tacking them, and necessary behavioural changes). Of course, each application is different, however, following these general principles is recommended in similar exercises: SIA (with the proper scientific support) can be a powerful tool, particularly useful for better understanding and systematically analysing the interactions between the nexus’ components, and to move towards a more coordinated management and across sectors and scales (Figure 5). Moreover, it reveals and addresses deeper shortcomings of the institutional framework, the behaviour of the State, misleading perceptions, and the obstacles for more efficient cooperation between stakeholder groups.

One challenging aspect through the process is the self-improvement through education, in the form of a continuous loop of inform and being informed (both for the research team and the stakeholders). Aristotle considers that humans are inherently political beings –not as parts of political parties, but as components of the society/community—a community that has Good as its end. The co-development of a common vision is a key-driver that builds on common understanding and goals, under a common purpose, higher than the individual interest but without undermining it. As SIA relies on stakeholder engagement, it recognises the importance of moving from opinion-based to knowledge-driven decision-makers. This assumption is essential in order to avoid blindly-defended positions, and cultivate the need of each individual to find optimal ways, reconsidering and improving him/herself. Again, to quote Aristotle, Good is an outcome of virtue, which is a function of “per-head” effort, defined by right and healthy purposes (Aristotle, 2006, Ethics). The necessary scientific support in methodological terms (the “know-how” to achieve the end’s application) guided by the necessary experience to avoid strategies that may be based on empathy, must be ensured at every stage of the process.

Data Availability Statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Author Contributions

AA and PK contributed to conception and design of the study. AA wrote the first draft of the manuscript. AA, PK, LP, and TP wrote sections of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

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