Circular bioeconomy in African food systems: What is the status quo? Insights from Rwanda, DRC, and Ethiopia.

Increasing global food insecurity amidst a growing population and diminishing production resources renders the currently dominant linear production model insufficient to combat such challenges. Hence, a circular bioeconomy (CBE) model that ensures more conservative use of resources has become essential. Specifically, a CBE model that focuses on recycling and reusing organic waste is essential to close nutrient loops and establish more resilient rural-urban nexus food systems. However, the CBE status quo in many African food systems is not established. Moreover, scientific evidence on CBE in Africa is almost inexistent, thus limiting policy guidance to achieving circular food systems. Using a sample of about 2,100 farmers and consumers from key food value chains (cassava in Rwanda, coffee in DRC, and bananas in Ethiopia), we explored existing CBE practices; awareness, knowledge, and support for CBE practices; consumers' opinions on eating foods grown on processed organic waste (CBE fertilizers), and determinants of such opinions. We analysed data in Stata, first descriptively, and then econometrically using the ordered logistic regression, whose proportional odds assumption was violated, thus resorting to the generalized ordered logistic regression. Results show that communities practice aspects of CBE, mainly composting, and are broadly aware, knowledgeable, supportive of CBE practices, and would broadly accept eating foods grown CBE fertilizers. Households with heads that used mobile phones, or whose heads were older, or married, or had a better education and agricultural incomes were more likely to strongly agree that they were knowledgeable and supportive of CBE practices and would eat CBE foods (foods grown on processed organic waste). However, the reverse was true for households that were severely food insecure or lived farther from towns. Rwandan and Ethiopian households compared to DRC were less likely to eat CB foods. Policies to stimulate CBE investments in all three countries were largely absent, and quality scientific evidence to guide their development and implementation is currently insufficient.

Providing laypeople with results from dynamic infectious disease modelling studies affects their allocation preference for scarce medical resources-a factorial experiment.

BACKGROUND: Allocation of scarce medical resources can be based on different principles. It has not yet been investigated which allocation schemes are preferred by medical laypeople in a particular situation of medical scarcity like an emerging infectious disease and how the choices are affected by providing information about expected population-level effects of the allocation scheme based on modelling studies. We investigated the potential benefit of strategic communication of infectious disease modelling results. METHODS: In a two-way factorial experiment (n = 878 participants), we investigated if prognosis of the disease or information about expected effects on mortality at population-level (based on dynamic infectious disease modelling studies) influenced the choice of preferred allocation schemes for prevention and treatment of an unspecified sexually transmitted infection. A qualitative analysis of the reasons for choosing specific allocation schemes supplements our results. RESULTS: Presence of the factor "information about the population-level effects of the allocation scheme" substantially increased the probability of choosing a resource allocation system that minimized overall harm among the population, while prognosis did not affect allocation choices. The main reasons for choosing an allocation scheme differed among schemes, but did not differ among those who received additional model-based information on expected population-level effects and those who did not. CONCLUSIONS: Providing information on the expected population-level effects from dynamic infectious disease modelling studies resulted in a substantially different choice of allocation schemes. This finding supports the importance of incorporating model-based information in decision-making processes and communication strategies.

The role of trust and risk perception in current German nuclear waste management.

One of the lessons learned in various countries that have to deal with spent nuclear fuel is that finding a proper place and siting a repository for high-level nuclear waste (HLW) cannot be achieved without public consent. After decades of obstruction, Germany recently launched a new, participatory, site-selection process for the disposal of HLW in deep geological formations. Nonetheless, significant opposition is assumed. Therefore, citizens' trust in the procedure and the agents involved may be paramount. We conducted an online survey (N ≈ 5000) in March/April 2020 to test a theoretical model on trust, perceived risks and benefits, and acceptance. We differentiated acceptance as a dependent variable according to distinct phases: the procedure, a possible decision on a disposal location, and the repository facility itself. The results show that trust is mainly important for explaining acceptance of the ongoing procedure and less so for the acceptance of the decision or the repository facility itself. Moreover, our investigation of the sample using a cluster analysis reveals characteristic patterns of trust, risk perception, and acceptance by three clusters: a cluster focusing on risk perception, an ambivalent cluster, and an indifferent cluster. Trust is lowest in the risk-focused cluster and highest in the ambivalent cluster.

Sharp discrepancies between nuclear and conventional toxic waste: Technical analysis and public perception.

Partly due to failed approaches in nuclear waste (NW) governance, years of high levels of attention have resulted in novel, more participatory avenues in Switzerland and other countries. What can be said about the case of conventional hazardous waste (CHW) from households? What technical and legal aspects are similar to or different from those of the NW domain? How does the public perceive CHW and its handling? We address these (so far) open questions in this study that comprises multiple methodological approaches. We combine a technical and system assessment with a societal (perception) assessment, based on a representative survey (N = 3082) among the German-speaking population of Switzerland. We draw some conclusions for a possible way forward in hazardous waste policy and governance. We find a remarkable disparity between technical analysis and public perception. The community should discuss whether the current NW management is forward-looking and may serve as a model for CHW. For CHW, the multiplicity of agents and the heterogeneity of substances may make the situation too complex, non-transparent, and thus less salient in the public perception. Paradoxically, the ubiquity of conventional waste, traditional community landfills, and everyday handling of some waste may make it appear less alarming than NW.

Solid waste management of small island developing states-the case of the Seychelles: a systemic and collaborative study of Swiss and Seychellois students to support policy.

Solid waste management (SWM) is a significant challenge for the Seychelles. Waste generation, fueled by economic development and tourism, increases steadily, while landfilling continues to be the main disposal path, thus exacerbating the island nation's specific weaknesses. Due to the small scale of the Seychelles economy, there is little capital available to stimulate innovations in SWM and generate the knowledge for setting priorities and guiding SWM action. Students from ETH Zurich and UniSey conducted a transdisciplinary case study (tdCS) to fill this knowledge gap and gain insights into the obstacles and opportunities related to sustainable SWM. The tdCS approach allowed students to gain comprehensive and in-depth knowledge about the SWM system required to set priorities for action and next steps. The government should streamline the different financial frameworks according to a clear principle (e.g., polluter pays principle). Specific biogenic waste streams represent a potential source of energy and fertilizers. Expanding the scope and densifying the network of collection points could help raise recycling rates of other waste fractions. Diverting biogenic waste and recycling more glass, metals, paper, and plastics would also significantly reduce landfilling rates. Regardless of future amounts of waste ending up on landfills, the latter must be reengineered before the surrounding environment suffers major adverse impacts. All these actions imply a government-driven approach which integrates the views of stakeholders and consumers alike.

Patient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in Guatemala.

BACKGROUND: Up to one half of the population in Africa, Asia and Latin America has little access to high-quality biomedical services and relies on traditional health systems. Medical pluralism is thus in many developing countries the rule rather than the exception, which is why the World Health Organization is calling for intercultural partnerships to improve health care in these regions. They are, however, challenging due to disparate knowledge systems and lack of trust that hamper understanding and collaboration. We developed a collaborative, patient-centered boundary mechanism to overcome these challenges and to foster intercultural partnerships in health care. To assess its impact on the quality of intercultural patient care in a medically pluralistic developing country, we conducted and evaluated a case study. METHODS: The case study took place in Guatemala, since previous efforts to initiate intercultural medical partnerships in this country were hampered by intense historical and societal conflicts. It was designed by a team from ETH Zurich's Transdisciplinarity Lab, the National Cancer Institute of Guatemala, two traditional Councils of Elders and 25 Mayan healers from the Kaqchikel and Q'eqchi' linguistic groups. It was implemented from January 2014 to July 2015. Scientists and traditional political authorities collaborated to facilitate workshops, comparative diagnoses and patient referrals, which were conducted jointly by biomedical and traditional practitioners. The traditional medical practices were thoroughly documented, as were the health-seeking pathways of patients, and the overall impact was evaluated. RESULTS: The boundary mechanism was successful in discerning barriers of access for indigenous patients in the biomedical health system, and in building trust between doctors and healers. Learning outcomes included a reduction of stereotypical attitudes towards traditional healers, improved biomedical procedures due to enhanced self-reflection of doctors, and improved traditional health care due to refined diagnoses and adapted treatment strategies. In individual cases, the beneficial effects of traditional treatments were remarkable, and the doctors continued to collaborate with healers after the study was completed. Comparison of the two linguistic groups illustrated that the outcomes are highly context-dependent. CONCLUSIONS: If well adapted to local context, patient-centered boundary mechanisms can enable intercultural partnerships by creating access, building trust and fostering mutual learning, even in circumstances as complex as those in Guatemala. Creating multilateral patient-centered boundary mechanisms is thus a promising approach to improve health care in medically pluralistic developing countries.

How to Fairly Allocate Scarce Medical Resources: Ethical Argumentation under Scrutiny by Health Professionals and Lay People.

BACKGROUND: Societies are facing medical resource scarcities, inter alia due to increased life expectancy and limited health budgets and also due to temporal or continuous physical shortages of resources like donor organs. This makes it challenging to meet the medical needs of all. Ethicists provide normative guidance for how to fairly allocate scarce medical resources, but legitimate decisions require additionally information regarding what the general public considers to be fair. The purpose of this study was to explore how lay people, general practitioners, medical students and other health professionals evaluate the fairness of ten allocation principles for scarce medical resources: 'sickest first', 'waiting list', 'prognosis', 'behaviour' (i.e., those who engage in risky behaviour should not be prioritized), 'instrumental value' (e.g., health care workers should be favoured during epidemics), 'combination of criteria' (i.e., a sequence of the 'youngest first', 'prognosis', and 'lottery' principles), 'reciprocity' (i.e., those who provided services to the society in the past should be rewarded), 'youngest first', 'lottery', and 'monetary contribution'. METHODS: 1,267 respondents to an online questionnaire were confronted with hypothetical situations of scarcity regarding (i) donor organs, (ii) hospital beds during an epidemic, and (iii) joint replacements. Nine allocation principles were evaluated in terms of fairness for each type of scarcity along 7-point Likert scales. The relationship between demographic factors (gender, age, religiosity, political orientation, and health status) and fairness evaluations was modelled with logistic regression. RESULTS: Medical background was a major predictor of fairness evaluations. While general practitioners showed different response patterns for all three allocation situations, the responses by lay people were very similar. Lay people rated 'sickest first' and 'waiting list' on top of all allocation principles-e.g., for donor organs 83.8% (95% CI: [81.2%-86.2%]) rated 'sickest first' as fair ('fair' is represented by scale points 5-7), and 69.5% [66.2%-72.4%] rated 'waiting list' as fair. The corresponding results for general practitioners: 'prognosis' 79.7% [74.2%-84.9%], 'combination of criteria' 72.6% [66.4%-78.5%], and 'sickest first' 74.5% [68.6%-80.1%); these were the highest-rated allocation principles for donor organs allocation. Interestingly, only 44.3% [37.7%-50.9%] of the general practitioners rated 'instrumental value' as fair for the allocation of hospital beds during a flu epidemic. The fairness evaluations by general practitioners obtained for joint replacements: 'sickest first' 84.0% [78.8%-88.6%], 'combination of criteria' 65.6% [59.2%-71.8%], and 'prognosis' 63.7% [57.1%-70.0%]. 'Lottery', 'reciprocity', 'instrumental value', and 'monetary contribution' were considered very unfair allocation principles by both groups. Medical students' ratings were similar to those of general practitioners, and the ratings by other health professionals resembled those of lay people. CONCLUSIONS: Results are partly at odds with current conclusions proposed by some ethicists. A number of ethicists reject 'sickest first' and 'waiting list' as morally unjustifiable allocation principles, whereas those allocation principles received the highest fairness endorsements by lay people and to some extent also by health professionals. Decision makers are advised to consider whether or not to give ethicists, health professionals, and the general public an equal voice when attempting to arrive at maximally endorsed allocations of scarce medical resources.

Maya phytomedicine in Guatemala - Can cooperative research change ethnopharmacological paradigms?

ETHNOPHARMACOLOGICAL RELEVANCE: This paper presents one of the first large-scale collaborative research projects in ethnopharmacology, to bring together indigenous stakeholders and scientists both in project design and execution. This approach has often been recommended but rarely put into practice. The study was carried out in two key indigenous areas of Guatemala, for which very little ethnopharmacological fieldwork has been published. AIM OF THE STUDY: To document and characterize the ethno-pharmacopoeias of the Kaqchikel (highlands) and Q'eqchi' (lowlands) Maya in a transdisciplinary collaboration with the two groups Councils of Elders. MATERIALS AND METHODS: The project is embedded in a larger collaboration with five Councils of Elders representing important indigenous groups in Guatemala, two of which participated in this study. These suggested healing experts reputed for their phytotherapeutic knowledge and skills. Ethnobotanical fieldwork was carried out over 20 months, accompanied by a joint steering process and validation workshops. The field data were complemented by literature research and were aggregated using a modified version of the International Classification of Diseases (ICD-10) and Trotter & Logan's consensus index. RESULTS: Similar numbers of species were collected in the two areas, with a combined total of 530 species. This total does not represent all of the species used for medicinal purposes. Remedies for the digestive system, the central nervous system & behavioral syndromes, and general tissue problems & infections were most frequent in both areas. Furthermore, remedies for the blood, immune & endocrine system are frequent in the Kaqchikel area, and remedies for the reproductive system are frequent in the Q'eqchi' area. Consensus factors are however low. The Kaqchikel, in contrast to the Q'eqchi', report more remedies for non-communicable illnesses. They also rely heavily on introduced species. DISCUSSION AND CONCLUSIONS: The transdisciplinary research design facilitated scientifically rigorous and societally relevant large-scale fieldwork, which is clearly beneficial to indigenous collaborators. It provided access and built trust as prerequisites for assembling the largest comparative ethnopharmacological collection, vastly extending knowledge on Maya phytotherapy. The collection represents knowledge of the two groups' most reputed herbalists and is a representative selection of the Guatemalan medicinal flora. ICD-10 proved useful for making broad comparisons between the groups, but more refined approaches would be necessary for other research objectives. Knowledge in the two areas is highly diverse and seems fragmented. New approaches are required to assess how coherent Maya phytotherapy is. The documented 'traditional' ethno-pharmacopoeias demonstrate dynamic change and acculturation, reflecting the two linguistic groups' sociocultural history and context. This highlights the adaptive potential of phyto-therapeutic knowledge and calls the equation of local indigenous pharmacopoeias with 'traditional' medicine into question. We suggest using the term 'local' pharmacopoeias, and reserving the term 'traditional' for the study of indigenous pharmacopoeias with a clear delineation of ancient knowledge.

Relationships that Heal: Beyond the Patient-Healer Dyad in Mayan Therapy.

Biomedicine fosters particular styles of interaction and behaviors, with the therapeutic relationship seen as occurring between a doctor and patient. In contrast, where alternative modalities of healing are practiced, relationships go beyond a dyadic interaction and include wider social networks. In this article, we propose the existence of a 'therapeutic unit' in Maya healing practices in Guatemala that binds healer, wellness seeker, family, and community members, along with the spiritual and natural realms, into a coherent system requiring all of these elements to achieve success. Drawing on interviews with 67 Maya healers, we describe healers' understanding of raxnaq'il nuk'aslemal (well-being), and show how these interactions activate wider networks that play crucial roles during treatments. We highlight how holism is expressed in relationships typical of indigenous healing systems, and how an appreciation of this is important for developing culturally appropriate health care provision systems.

Transdisciplinary Research on Cancer-Healing Systems Between Biomedicine and the Maya of Guatemala: A Tool for Reciprocal Reflexivity in a Multi-Epistemological Setting.

Transdisciplinarity (TD) is a participatory research approach in which actors from science and society work closely together. It offers means for promoting knowledge integration and finding solutions to complex societal problems, and can be applied within a multiplicity of epistemic systems. We conducted a TD process from 2011 to 2014 between indigenous Mayan medical specialists from Guatemala and Western biomedical physicians and scientists to study cancer. Given the immense cultural gap between the partners, it was necessary to develop new methods to overcome biases induced by ethnocentric behaviors and power differentials. This article describes this intercultural cooperation and presents a method of reciprocal reflexivity (Bidirectional Emic-Etic tool) developed to overcome them. As a result of application, researchers observed successful knowledge integration at the epistemic level, the social-organizational level, and the communicative level throughout the study. This approach may prove beneficial to others engaged in facilitating participatory health research in complex intercultural settings.

Science with society in the anthropocene.

Interdisciplinary scientific knowledge is necessary but not sufficient when it comes to addressing sustainable transformations, as science increasingly has to deal with normative and value-related issues. A systems perspective on coupled human-environmental systems (HES) helps to address the inherent complexities. Additionally, a thorough interaction between science and society (i.e., transdisciplinarity = TD) is necessary, as sustainable transitions are sometimes contested and can cause conflicts. In order to navigate complexities regarding the delicate interaction of scientific research with societal decisions these processes must proceed in a structured and functional way. We thus propose HES-based TD processes to provide a basis for reorganizing science in coming decades.

Perceived risk and benefit of nuclear waste repositories: four opinion clusters.

Local public resistance can block the site-selection process, construction, and operation of nuclear waste repositories. Social science has established that the perception of risks and benefits, trust in authorities, and opinion on nuclear energy play important roles in acceptance. In particular, risk and benefit evaluations seem critical for opinion formation. However, risks and benefits have rarely been studied independently and, most often, the focus has been on the two most salient groups of proponents and opponents. The aim of this exploratory study is to examine the often-neglected majority of people holding ambivalent or indifferent opinions. We used cluster analysis to examine the sample (N = 500, mailed survey in German-speaking Switzerland) in terms of patterns of risk and benefit perception. We reveal four significantly different and plausible clusters: one cluster with high-benefit ratings in favor of a repository and one cluster with high-risk ratings opposing it; a third cluster shows ambivalence, with high ratings on both risk and benefit scales and moderate opposition, whereas a fourth cluster seems indifferent, rating risks and benefits only moderately compared to the ambivalent cluster. We conclude that a closer look at the often neglected but considerable number of people with ambivalent or indifferent opinions is necessary. Although the extreme factions of the public will most probably not change their opinion, we do not yet know how the opinion of the ambivalent and indifferent clusters might develop over time.

The crucial role of nomothetic and idiographic conceptions of time: interdisciplinary collaboration in nuclear waste management.

The disposal of nuclear waste involves extensive time scales. Technical experts consider up to 1 million years for the disposal of spent fuel and high-level waste in their safety assessment. Yet nuclear waste is not only a technical but also a so-called sociotechnical problem and, therefore, requires interdisciplinary collaboration between technical, natural, social sciences, and the humanities in its management. Given that these disciplines differ in their language, epistemics, and interests, such collaboration might be problematic. Based on evidence from cognitive psychology, we suggest that, in particular, a concept like time is presumably critical and can be understood differently. This study explores how different scientific disciplines understand extensive time scales in general and then focuses on nuclear waste. Eighteen qualitative exploratory interviews were conducted with experts for time-related phenomena of different disciplines, among them experts working in nuclear waste management. Analyses revealed two distinct conceptions of time corresponding to idiographic and nomothetic research approaches: scientists from the humanities and social sciences tend to have a more open, undetermined conception of time, whereas natural scientists tend to focus on a more determined conception that includes some undetermined aspects. Our analyses lead to reflections on potential difficulties for interdisciplinary teams in nuclear waste management. We focus on the understanding of the safety assessment, on potential implications for communication between experts from different disciplines (e.g., between experts from the humanities and engineering for risk assessment and risk communication), and we reflect on the roles of different disciplines in nuclear waste management.