Different epidemiological characteristics between patients with non-hospital-onset and hospital-onset candidemia: a retrospective cohort study.

Candidemia is a life-threatening infectious disease that has varying incidences. Previous studies revealed the differences in clinical characteristics and outcomes between non-hospital-onset (NHO) and hospital-onset (HO) candidemia. This 4-year retrospective research included adult patients with candidemia in a tertiary medical centre in Taiwan, and cases were categorised as NHO and HO candidemia. Survival analysis and risk factors associated with in-hospital mortality were performed using the Kaplan-Meier method and multivariate Cox proportional-hazards models. The analysis included 339 patients, and the overall incidence was 1.50 per 1,000 admission person-year. Of the cases, 82 (24.18%) were NHO candidemia, and 57.52% (195/339) of patients were diagnosed with at least one malignancy. C. albicans was the most commonly isolated species, accounting for 52.21%. Patients with NHO candidemia had a higher proportion of C. glabrata but a lower ratio of C. tropicalis in comparison to the HO group. The all-cause in-hospital mortality rate was 55.75%. Multivariate Cox proportional-hazards models showed that NHO candidemia was a better outcome predictor (adjusted hazard ratio, 0.44). The administration of antifungal therapy within 2 days was a protective factor. In conclusion, NHO candidemia showed distinct microbiological characteristics and a better outcome than HO candidemia.

A global study of screening intensity and economic status on epidemic control performance during various epidemic periods of COVID-19 mutant strains.

This study analyzed global data on epidemic control measures and economic conditions in different countries during different mutant strain epidemic periods, including the Alpha, Delta, and Omicron strains. The study estimated the elasticity coefficient through a log-log model, which represents the percent change of the confirmed case number with respect to a percent change in the total number of screening tests in a country for epidemic control. The 7-day rolling data of screening tests and confirmed cases from the Our World in Data database for the pandemic periods of Alpha strain in 2020, Delta strain in 2021, and Omicron strain in 2022, suggest that the magnitude of the elasticity was associated with the economic condition of a country. Compared with the results during either Alpha or Delta pandemic period, the Omicron pandemic has a much higher estimated elasticity coefficient of 1.317 (Alpha: 0.827 and Delta: 0.885). Further examining economic conditions categorized by quartile ranges, the results indicate that the elasticity is statistically significantly lower in countries with gross domestic product (GDP) per capita between $11,354 and $26,651, and in countries with GDP per capita above $26,651 than in countries with GDP per capita below $3,335. These results suggest that countries should consider not only epidemiological measures but also economic conditions when formulating epidemic control strategies. This study highlights the importance of assessing the appropriateness of epidemic control strategies within a country and provides valuable insights into the effectiveness of such strategies, particularly in the context of community screening.

Employment of osmotic pump as a novel feeding system to operate the laminar-flow microfluidic microbial fuel cell.

Laminar-flow microfluidic microbial fuel cell (LMMFC) has attracted attention due to the advantage of the liquid-liquid interface between anolyte and catholyte without the use of membrane as a separator resulting in less fabrication cost. Unlike previous studies of LMMFC using syringe pumps, this study proposes the use of osmotic pumps to feed anolyte and catholyte in the microchannel without any additional power supply. The osmotic pump was constructed with two cylindrical chambers separated by a forward osmosis membrane, with the initial draw solution concentration of 90 g l-1 NaCl. We have, for the first time, demonstrated using the osmotic pumps to deliver both anolyte and catholyte and create co-laminar flow in LMMFC. Under the catholyte and anolyte flow rates of 18 ml/h and 40 ml/h respectively, LMMFC cultivated with Shewanella oneidensis produced the maximum power density of 87 mW m-2 and current density of 747 mA m-2 with the internal resistance of 1660 Ω. Further studies are warranted to develop osmotic pumps-fed LMMFC into a potential platform for portable biosensors.

Human chorionic gonadotropin (hCG)-induced ovulation occurs later but with equal occurrence in lactating dairy cows: comparing hCG and gonadotropin-releasing hormone protocols.

This study assessed the effects of two hormones, human chorionic gonadotropin (hCG) and gonadotropin-releasing hormone (GnRH), on ovulatory responses during different diestrous stages in lactating dairy cows. Estrous cycles of 21 cows were synchronized and were enrolled in stage 1 of the experiment. The cows were treated with a prostaglandin (PG) F2α analog either 9 to 10 days [mid-diestrus (MD) group] or 5.5 to 6.5 days [early-diestrus (ED) group] after synchronized ovulation (day 0 = first PGF2α administration). On day 2, the cows were administrated 250 µg GnRH or 3000 IU hCG. Ovulation was determined every 2 h from 24 to 36 h after GnRH or hCG administration, and then every 4 h up to 72 h until ovulation. Cows in stage 2 were administered these treatments in the reverse order. The results indicated that average ovulation times in cows treated with GnRH in the MD group (GnRH-MD group) and cows treated with GnRH in the ED group (GnRH-ED group) were 30.0 ± 1.0 h and 28.8 ± 0.4 h, respectively. However, ovulation times for cows treated with hCG in the MD group (hCG-MD group) and cows treated with hCG in the ED group (hCG-ED group) were 35.8 ± 4.6 h and 32.8 ± 2.2 h, respectively, and ovulation occurred significantly later in the hCG-treated groups than in the GnRH-treated groups. In summary, we found that hCG-induced ovulation occurred later than GnRH-induced ovulation regardless of different diestrous peroids; however, the two treatments did not differ in terms of percentage of ovulation.

The Use of Wearable Sensors for the Movement Assessment on Muscle Contraction Sequences in Post-Stroke Patients during Sit-to-Stand.

Electromyography (EMG) sensors have been used to study the sequence of muscle contractions during sit-to-stand (STS) in post-stroke patients. However, the majority of the studies used wired sensors with a limited number of placements. Using the latest improved wearable technology with 16 sensors, the current study was a thorough investigation to evaluate the contraction sequences of eight key muscles on the trunk and bilateral limbs during STS in post-stroke patients, as it became feasible. Multiple wearable sensors for the detection of muscle contraction sequences showed that the post-stroke patients performed STS with abnormal firing sequences, not only in the primary mover on the sagittal plane during raising, but also in the tibialis anterior, which may affect anticipatory postural adjustment in the gluteus medius, which may affect balance control. The abnormal tibialis anterior contraction until the early ascending phase and the delayed firing of the gluteus muscles highlight the importance of whole-kinetic-chain monitoring of contraction sequences using wearable sensors. The findings can be helpful for the design of therapeutic exercises.

Virulence of Japanese Encephalitis Virus Genotypes I and III, Taiwan.

The virulence of genotype I (GI) Japanese encephalitis virus (JEV) is under debate. We investigated differences in the virulence of GI and GIII JEV by calculating asymptomatic ratios based on serologic studies during GI- and GIII-JEV endemic periods. The results suggested equal virulence of GI and GIII JEV among humans.

Parallel evolution of a type IV secretion system in radiating lineages of the host-restricted bacterial pathogen Bartonella.

Adaptive radiation is the rapid origination of multiple species from a single ancestor as the result of concurrent adaptation to disparate environments. This fundamental evolutionary process is considered to be responsible for the genesis of a great portion of the diversity of life. Bacteria have evolved enormous biological diversity by exploiting an exceptional range of environments, yet diversification of bacteria via adaptive radiation has been documented in a few cases only and the underlying molecular mechanisms are largely unknown. Here we show a compelling example of adaptive radiation in pathogenic bacteria and reveal their genetic basis. Our evolutionary genomic analyses of the α-proteobacterial genus Bartonella uncover two parallel adaptive radiations within these host-restricted mammalian pathogens. We identify a horizontally-acquired protein secretion system, which has evolved to target specific bacterial effector proteins into host cells as the evolutionary key innovation triggering these parallel adaptive radiations. We show that the functional versatility and adaptive potential of the VirB type IV secretion system (T4SS), and thereby translocated Bartonella effector proteins (Beps), evolved in parallel in the two lineages prior to their radiations. Independent chromosomal fixation of the virB operon and consecutive rounds of lineage-specific bep gene duplications followed by their functional diversification characterize these parallel evolutionary trajectories. Whereas most Beps maintained their ancestral domain constitution, strikingly, a novel type of effector protein emerged convergently in both lineages. This resulted in similar arrays of host cell-targeted effector proteins in the two lineages of Bartonella as the basis of their independent radiation. The parallel molecular evolution of the VirB/Bep system displays a striking example of a key innovation involved in independent adaptive processes and the emergence of bacterial pathogens. Furthermore, our study highlights the remarkable evolvability of T4SSs and their effector proteins, explaining their broad application in bacterial interactions with the environment.

The study on setting priorities of zoonotic agents for medical preparedness and allocation of research resources.

The aim of this study is to develop a scoring platform to be used as a reference for both medical preparedness and research resource allocation in the prioritization of zoonoses. Using a case-control design, a comprehensive analysis of 46 zoonoses was conducted to identify factors influencing disease prioritization. This analysis provides a basis for constructing models and calculating prioritization scores for different diseases. The case group (n = 23) includes diseases that require immediate notification to health authorities within 24 hours of diagnosis. The control group (n = 23) includes diseases that do not require such immediate notification. Two different models were developed for primary disease prioritization: one model incorporated the four most commonly used prioritization criteria identified through an extensive literature review. The second model used the results of multiple logistic regression analysis to identify significant factors (with p-value less than 0.1) associated with 24-hour reporting, allowing for objective determination of disease prioritization criteria. These different modeling approaches may result in different weights and positive or negative effects of relevant factors within each model. Our study results highlight the variability of zoonotic disease information across time and geographic regions. It provides an objective platform to rank zoonoses and highlights the critical need for regular updates in the prioritization process to ensure timely preparedness. This study successfully established an objective framework for assessing the importance of zoonotic diseases. From a government perspective, it advocates applying principles that consider disease characteristics and medical resource preparedness in prioritization. The results of this study also emphasize the need for dynamic prioritization to effectively improve preparedness to prevent and control disease.

Potential prognostic indicators in dogs with advanced heart failure secondary to myxomatous mitral valve disease.

BACKGROUND: Advanced heart failure (AHF) secondary to myxomatous mitral valve disease (MMVD) in dogs has unclear predictive variables and survival time. METHODS: This retrospective study included 38 dogs with AHF and 38 with stable congestive heart failure (CHF), both due to MMVD. Predictive variables for AHF were analysed, and survival times were calculated using logistic regression and the Kaplan-Meier method. RESULTS: Left atrium to aortic root ratio, normalised left ventricular dimension at the end-diastole and end-systole, isovolumic relaxation time (IVRT) and early transmitral inflow velocity to IVRT ratio were associated with AHF progression. The median survival times were significantly longer in the stable group than in the AHF group. After AHF diagnosis, the median survival times for all-cause and cardiogenic mortality were 194 and 354 days, respectively. LIMITATIONS: This was a single-centre retrospective observational study. The study population was small, with breed bias (overrepresentation of Maltese dogs). Additionally, the treatment plans depended on clinical experience. CONCLUSIONS: AHF in dogs with CHF secondary to MMVD is linked to left heart chamber enlargement and increased left ventricular dimensions, significantly reducing survival time to around six months post-diagnosis. Early recognition and appropriate management may improve outcomes, highlighting the importance of advanced treatment strategies.

Detection of Rabies Virus in a Yellow-throated Marten (Martes flavigula chrysospila) in Taiwan.

In June 2021, a yellow-throated marten (Martes flavigula chrysospila) submitted for postmortem examination was diagnosed as rabid through laboratory testing. The rabies virus detected was closest phylogenetically to viruses of ferret badgers (Melogale moschata subaurantiaca) in Taiwan, indicating spillover infection from the primary reservoir in this area, the ferret badger.

Developing a novel computer numerical control-fabricated laminar-flow microfluidic microbial fuel cells as the bioelectrochemical sensor and power source: Enrichment, operation, and Cr(VI) detection.

By introducing the computer numerical control (CNC) engraving technology, this study fabricated the reusable CNC-fabricated membrane-less laminar flow microfluidic MFC (LMMFC) to develop the bioelectrochemical sensor and power source simultaneously. To verify its applicability, optimization of electroactive bacteria (EAB) cultivation and laminar-flow formation, performance of power density and long-term operation, and detection of Cr(VI) were evaluated. Results of EAB optimization showed under lower external resistance, shorter start-up time of current production, larger oxidation current, denser microbial distribution, and a higher percentage of Geobacter spp. were observed. Results of the laminar-flow operation indicated that increasing the density difference between two solutions and raising the anode flow velocity can minimize the interference of the diffusion zone. The power output of LMMFC could reach 2085 mW m-2 and achieve long-term stability for current production (∼150 h). Regarding the detection of Cr(VI), low-concentration (0.1∼1 ppm) and high-concentration (1-10 ppm) ranges reached the linear coefficient of determination of 0.98 and 0.97, respectively. Overall, these results suggest that an LMMFC which can both act as the power source and biosensor was successfully developed, showing potential for future self-power application.

Increased hip adductor activation during sit-to-stand improves muscle activation timing and rising-up mechanics in individuals with hemiparesis.

Long sit-to-stand (STS) time has been identified as a feature of impaired functional mobility. The changes in biomechanics of STS performance with simultaneous hip adductor contraction have not been studied, which may limit indications for use of hip adductor activation during STS training. Ten individuals with hemiplegia (mean age 61.8 years, injury time 29.8 ± 15.2 months) performed the STS with and without squeezing a ball between two legs. The joint moments, ground reaction force (GRF), chair reaction force and movement durations and temporal index of electromyography were calculated from the control condition for comparison with those from the ball squeezing condition. Under the squeeze condition, reduced peak vertical GRF during the ascension phase with increased loading rate was observed in the nonparetic limb, and the peak knee extensor moment occurred earlier in the paretic. Earlier activation of tibialis anterior and gluteus maximus, and gluteus medius were found in squeeze STS. Squeezing a ball between limbs during STS increased the contraction timing of tibialis anterior, gluteus maximus, gluteus medius, and soleus as well as a more symmetric rising mechanics encourage the use of squeezing a ball between limbs during STS for individuals with hemiparesis.

Epidemiology of Severe Fever with Thrombocytopenia Syndrome in Dogs and Cats in Taiwan.

Severe Fever with Thrombocytopenia Syndrome (SFTS), caused by the SFTS Virus (SFTSV), is a global health threat. SFTSV in Taiwan has only been reported in ruminants and wild animals. Thus, we aimed to investigate the infection statuses of dogs and cats, the animals with closer human interactions. Overall, the SFTSV RNA prevalence was 23% (170/735), with dogs showing a 25.9% (111/429) prevalence and cats at 19.3% (59/306) prevalence. Noticeably, the prevalence in stray animals (39.8% 77/193) was significantly higher than in domesticated ones (17.2%, 93/542). Among the four categories analyzed, the highest SFTSV prevalence was found in the stray dogs at 53.9% (120/193), significantly higher than the 24.2% prevalence noted in stray cats. In contrast, domesticated animals exhibited similar prevalence rates, with 17.1% for dogs and 17.2% for cats. It is noteworthy that in the domesticated animal groups, a significantly elevated prevalence (45%, 9/20) was observed among cats exhibiting thrombocytopenia compared to those platelet counts in the reference range (4.8%, 1/21). The high infection rate in stray animals, especially stray dogs, indicated that exposure to various outdoor environments influences the prevalence of infections. Given the higher human interaction with dogs and cats, there is a need for proactive measures to reduce the risk associated with the infection of SFTSV in both animals and humans.

The First Nationwide Surveillance of Severe Fever with Thrombocytopenia Syndrome in Ruminants and Wildlife in Taiwan.

Since the first discovery of severe fever with thrombocytopenia syndrome virus (SFTSV) in China in 2009, SFTSV has rapidly spread through other Asian countries, including Japan, Korea, Vietnam and Pakistan, in chronological order. Taiwan reported its first discovery of SFTSV in sheep and humans in 2020. However, the prevalence of SFTSV in domestic and wildlife animals and the geographic distribution of the virus within the island remain unknown. A total of 1324 animal samples, including 803 domestic ruminants, 521 wildlife animals and 47 tick pools, were collected from March 2021 to December 2022 from 12 counties and one terrestrial island. The viral RNA was detected by a one-step real-time reverse transcription polymerase chain reaction (RT-PCR). Overall, 29.9% (240/803) of ruminants showed positive SFTSV RNA. Sheep had the highest viral RNA prevalence of 60% (30/50), followed by beef cattle at 28.4% (44/155), goats at 28.3% (47/166), and dairy cows at 27.5% (119/432). The bovine as a total of dairy cow and beef cattle was 27.8% (163/587). The viral RNA prevalence in ticks (predominantly Rhipicephalus microplus) was similar to those of ruminants at 27.7% (13/47), but wild animals exhibited a much lower prevalence at 1.3% (7/521). Geographically the distribution of positivity was quite even, being 33%, 29.1%, 27.5% and 37.5% for northern, central, southern and eastern Taiwan, respectively. Statistically, the positive rate of beef cattle in the central region (55.6%) and dairy cattle in the eastern region (40.6%) were significantly higher than the other regions; and the prevalence in Autumn (September-November) was significantly higher than in the other seasons (p < 0.001). The nationwide study herein revealed for the first time the wide distribution and high prevalence of SFTSV in both domestic animals and ticks in Taiwan. Considering the high mortality rate in humans, surveillance of other animal species, particularly those in close contact with humans, and instigation of protective measures for farmers, veterinarians, and especially older populations visiting or living near farms or rural areas should be prioritized.

Comparison of genospecies and antimicrobial resistance profiles of isolates in the Acinetobacter calcoaceticus-Acinetobacter baumannii complex from various clinical specimens.

This study was conducted to compare the prevalences of antimicrobial resistance profiles of clinical isolates in the Acinetobacter calcoaceticus-Acinetobacter baumannii complex from sterile and nonsterile sites and to further study the relationship of antimicrobial resistance profiles and genospecies by amplified rRNA gene restriction analysis (ARDRA). A total of 1,381 isolates were tested with 12 different antibiotics to show their antimicrobial susceptibility profiles. A total of 205 clinical isolates were further analyzed by ARDRA of the intergenic spacer (ITS) region of the 16S-23S rRNA gene. It was found that the overall percentage of isolates from nonsterile sites (urine, sputum, pus, or catheter tip) that were resistant to the 12 antibiotics tested was significantly higher than that of isolates from sterile sites (cerebrospinal fluid [CSF], ascites fluid, and bloodstream) (46% versus 22%; P < 0.05). After ARDRA, it was found that 97% of the 62 isolates resistant to all antibiotics tested were the A. baumannii genospecies, which was identified in only 31% of the isolates susceptible to all antibiotics tested. More genospecies diversity was identified in the isolates susceptible to all antibiotics tested, including genospecies of 13TU (34%), genotype 3 (29%), and A. calcoaceticus (5%). Furthermore, as 91% (10/11) of the isolates from CSF were susceptible to all antibiotics tested, the A. calcoaceticus-A. baumannii complex isolates with multidrug resistance could be less invasive than the more susceptible isolates. This study also indicated current emergence of carbapenem-, fluoroquinolone-, aminoglycoside-, and cephalosporin-resistant A. calcoaceticus-A. baumannii complex isolates in Taiwan.

Identification of Escherichia coli genes associated with urinary tract infections.

Escherichia coli is the most common cause of urinary tract infections (UTIs). E. coli genes epidemiologically associated with UTIs are potentially valuable in developing strategies for treating and/or preventing such infections as well as differentiating uropathogenic E. coli from nonuropathogenic E. coli. To identify E. coli genes associated with UTIs in humans, we combined microarray-based and PCR-based analyses to investigate different E. coli source groups derived from feces of healthy humans and from patients with cystitis, pyelonephritis, or urosepsis. The cjrABC-senB gene cluster, sivH, sisA, sisB, eco274, and fbpB, were identified to be associated with UTIs. Of these, cjrABC-senB, sisA, sisB, and fbpB are known to be involved in urovirulence in the mouse model of ascending UTI. Our results provide evidence to support their roles as urovirulence factors in human UTIs. In addition, the newly identified UTI-associated genes were mainly found in members of phylogenetic groups B2 and/or D.

Application of purified recombinant antigenic spike fragments to the diagnosis of avian infectious bronchitis virus infection.

The spike (S) protein, containing two subunits, S1 and S2, is the major immunity-eliciting antigen of avian infectious bronchitis virus (IBV), a highly contagious disease of chickens. Several immunogenic regions, mainly located within the S1 subunit, have been identified. Nonetheless, these immune-dominant regions were defined using selected monoclonal antibodies or using a short peptide approach that involves only certain limited regions of the S protein. In addition, some immune-dominant regions are located in hypervariable regions (HVRs) which are not present in all serotypes. Hence, the aim of this study was to determine a broader range of antigenic regions that have strong antibody eliciting ability; these could then be applied for development of an IBV-diagnostic tool. Initially, the S1 and part of the S2 subunit protein (24-567 amino acids) were expressed as five fragments in prokaryotic system. The antigenicity was confirmed using IBV immunized sera. Performance of the S subfragments was evaluated by ELISA using a panel of field chicken sera with known IBV titres determined by a commercial kit. This indicated that, among the five antigenic recombinant proteins, the region S-E showed the highest specificity and sensitivity, namely 95.38 % and 96.29 %, respectively. The κ value for the in-house ELISA using the S-E fragment compared to a commercial kit was 0.9172, indicating a high agreement between these two methods. As region S-E harbors strong immunogenicity within the spike protein, it has the potential to be exploited as an antigen when developing a cost-effective ELISA-based diagnosis tool.

Do harder midsoles facilitate propulsion and do softer midsoles increase shock attenuation during taking-off and landing of scissor jump?

To determine the influence of midsole hardness on ground reaction force (GRF) features during badminton scissor jump takeoff and landing and the interactive effect of midsole hardness with playing and nonplaying limbs, data were collected from badminton athletes who performed scissor jumps while wearing shoes with two levels of midsole hardness. Temporal-spatial and GRF variables were calculated. Measurements of the soft and hard midsole conditions for playing versus non-playing sides were compared using two-way repeated measure analyses of variance. The playing and non-playing limbs showed different GRF features while performing scissor jump. During takeoff, no significant differences between the soft and hard midsole conditions were identified for the jump height in any of the GRF variables. During landing, the cushioning capacity might be affected by harder midsole indicated by higher vertical impact peak (p = 0.008). Meanwhile, the longer time-to-vertical impact peak (p = 0.007) and the lower loading rate of the vertical impact peak (p = 0.013) may be plausible indicators for cushioning. Current study indicated the playing-limb consistently showed dominance on both the propulsion and shock attenuation behaviours during scissor jump and that, for the footwear selection between 62C and 68C midsoles, expectation would be more on effects on landing characteristics than on propulsion performance.

A stochastic assessment to quantify the risk of introduction of African swine fever virus to Taiwan via illegal pork products carried by international travellers.

The current study quantified the risk of releasing African swine fever virus (ASFV) into Taiwan from pork products illegally carried by international travellers from 157 countries or territories through six international airports and three international seaports. The association between various factors and the number of pork products detected by the border control authorities was also examined. The risk was estimated with a stochastic process after modelling the number of undetected illegal pork products, probability of pork product detection at international airports and seaports and probability of ASFV contamination of pork products from various countries. The overall annual probability of ASFV release to Taiwan was estimated to be 1 [95% confidence interval (CI): 1-1] under no enhanced mitigation measures. All the median airport-level risks were higher than .921, and four of them reached 1. The total annual risk was .570 (95% CI: .109-.937) for international seaports. The country or territory level risk was estimated to be 1 for Vietnam, China, Hong Kong, the Philippines and South Korea, .999 (95% CI: .628-1) for Macao and .967 (95% CI: .359-1) for Indonesia. After the total number of travellers was factored in, the number of detected illegal pork products was the highest in January and February, and travellers from Vietnam [risk ratio to Japan (RR): 80.45; 95% CI: 58.68-110.3], the Philippines (RR: 37.67; 95% CI: 26.9-52.74) and Cambodia (RR: 28.39; 95% CI: 12.69-63.51) were most likely to bring pork products to Taiwan. Our study indicated a high risk of ASFV introduction through international travellers and also identified the factors associated with the risk. This information can be used as empirical evidence for cost-effective risk mitigation practices.

Nature-based solutions for securing contributions of water, food, and energy in an urban environment.

There is growing awareness that nature-based solutions (NBS) prevent negative effects and secure ecosystem services. However, the potential of NBS to provide intended benefits has not been rigorously assessed. Water, food, and energy (WFE) are essential for human well-being. This study highlights the importance of NBS in terms of water, food, and energy. A set of on-site NBS that includes permeable pavements, plant microbial fuel cells, bio-filtration basins, and rain gardens is used to determine the contribution of NBS to the environmental and economic development of urban environments. The results of this study show that NBSs benefit an urban environment in terms of water treatment, stormwater retention, food production and energy generation, carbon sequestration, pollination, sedimentation retention, and cultural services dimension. This research highlights an urgent need for the integration of water, food, and energy plans to ensure that NBSs contribute to the environment and for the conservation of ecosystem services.