In recent years, pharmacists have been involved in expanded patient care responsibilities, for example patient counseling in self-medication, medication review and pharmaceutical care, which require graduates to develop the necessary competences. Consequently, reorientation of pharmacy education has become necessary. As such, active learning strategies have been introduced into classrooms to increase problem-solving and critical thinking skills of students. The objective of this study was to evaluate the performance and perceptions of competency of students in a new pharmaceutical care course that uses active learning methodologies.This pharmaceutical care course was conducted in the first semester of 2014, in the Federal University of Sergipe. In the pharmaceutical care course, active learning methods were used, consisting of dialogic classroom expository, simulation and case studies. Student learning was evaluated using classroom tests and instruments that evaluated the perception of competency in pharmaceutical care practice. Furthermore, students' satisfaction with the course was evaluated.Thirty-three students completed the four evaluations used in the course ; 25 were female (75.75%), and the median age was 23.43 (SD 2.82) years. The overall mean of student scores, in all evaluation methods was 7.97 (SD 0.59) on a scale of 0 to 10 points, and student performance on the virtual patient method was statistically superior to other methods. With respect to the perception of competency in pharmaceutical care practice, a comparison of pre- and post-test scores revealed statistically significant improvement for all evaluated competences. At the end of the semester, the students presented positive opinions of the pharmaceutical care course.The results suggest that an active learning course can enhance the learning of pharmaceutical care competences. In future studies it will be necessary to compare active learning to traditional methods. In recent years, health systems in both the developed and developing world have faced the challenges of financial constraints, a high prevalence of non-communicable diseases, and an increase in problems related to pharmacotherapy and morbidity and mortality associated with drug use ,2. TheseIn response to economic and societal needs, the pharmacy profession has adopted pharmaceutical care as a philosophy of practice. Pharmaceutical care is defined as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life . This phSince the introduction of this concept, numerous studies have been conducted to evaluate the pharmacist’s capacity to positively influence the results of drug therapy through pharmaceutical care –12. In tIn this context, active learning strategies have been introduced into classrooms to increase problem-solving and critical-thinking skills of students in a more student-centered environment . ExampleACPE supports the use of active learning techniques in every phase of pharmacy students’ education and in pharmacists’ continuing professional development . In consIn Brazil, the National Guidelines for Undergraduate Education in Pharmacy recommend professionals' training to consist of a generalist, humanist education, which develops critical thinking skills with respect to health care. In addition, the recommendations target theoretical and practical training in patient care . In 2013Independent of the teaching method chosen, quality in higher education should be measured in terms of what students know, understand, and can do at the end of the curriculum . To meetSpecific objectives of this research study were: (1) to evaluate the performance of students in the course, (2) to measure students’ perceptions of their pharmaceutical care competencies before and after the course, and (3) to determine students’ perception of the value of the course to professional practice.The pharmaceutical care course was redesigned in 2013, by one teacher and two other course developers, with the objective of making it more learner-centered. The teacher has a PhD in pharmaceutical care, and ten years of experience in teaching and practice; the two developers were PhD students in pharmacy. One of the two developers was a hospital pharmacist for two years and the teacher of a pharmaceutical services course for one year, while the other had been a community pharmacist for three years and a preceptor in a pharmaceutical care clerkship. All three individuals also served as course instructors.Before initiating changes in the course, a focus group of expert teachers was convened to support the development of the course syllabus. The focus group aimed to (1) identify the competencies that are necessary for the practice of pharmaceutical care, and (2) develop specific learning activities and teaching methods that would foster these competencies. Furthermore, the three developers held meetings to share ideas about the needs, objectives, teaching strategies, and content of the course.After the contents and teaching strategies were determined, the new pharmaceutical care course was implemented in 2013 to evaluate the students’ experiences with the course and obtain information about their preferences regarding the learner-centered approach. In this step, the vast majority of the students reacted positively to the innovative course. Changes to the course were implemented based on feedback received from these previous classes.The overall goals of the course included obtaining an understanding of the pharmaceutical care philosophy and developing the competencies required  to provide pharmaceutical care. The pharmaceutical care model embraced by this course was based on the Strand and Hepler philosophy of the processes of care . BrieflyIn the pharmaceutical care course, students were required to participate in a variety of direct and indirect patient care activities in order to develop skills and knowledge adequate to ensure effective, safe, and convenient drug therapy for patients. All of the students who were enrolled in the pharmaceutical care course of the undergraduate pharmacy program at the Federal University of Sergipe in the first semester of 2014 were asked to participate in the study. The students were advised of the goals of the study and the fact that the collected data would be confidential. Information on the participants’ age, gender, and year in the undergraduate pharmacy program was collected. Only students who did not consent to participate were excluded from the study.To evaluate performance, during the course students were subjected to several university-required evaluations of knowledge, all based on the learning objectives established for the pharmaceutical care course. The first evaluation consisted of a discursive written exam of five questions, in which students were required to explain how the pharmacist can act as a health professional in order to reduce morbidity and mortality related to drugs, to describe the concept of pharmaceutical care, to explain which patients are eligible to participate in pharmaceutical care services, to identify drug-related needs of patients, to identify drug-related problems, and to propose pharmacotherapeutic interventions.Students were also evaluated via seminars based on the resolution of clinical cases. This evaluation method focused on identifying the drug-related needs of patients, identifying and solving drug-related problems, prioritizing drug-related problems, and establishing measurable endpoints and care plan development. Furthermore, the Objective Structured Clinical Examination (OSCE) was used, with the objective of assessing the students’ competency in measurement of clinical parameters, patient counseling regarding drug administration, communication with patients, and invitation to use pharmaceutical care services. It is worth noting that in the OSCE, students are also asked to perform self-assessment of their performance.Finally, students were evaluated using virtual patient software. This software was developed in 2010 by the Laboratory of Education and Research in Social Pharmacy and the Laboratory of Computer Science of the Federal University of Sergipe, Brazil, with aim of improving the competencies of students in pharmaceutical care practice . The leaStudents received scores from 0 to 10 on each evaluation method. At the end of the semester, students were asked to answer four questions about the evaluation methods: (1) In this type of method I feel a lot of pressure to perform well, (2) This method is useful in verifying my learning, (3) The criteria for correctness of the assessments were appropriate, (4) The assigned grade reflects my learning. The questions were answered using a Likert scale ranging from 1 (“strongly disagree”) to 5 (“strongly agree”).In addition to the university-required evaluations, students completed two instruments pertaining to the course activities. One of these assessed the perception of competence in pharmaceutical care practice, and the other evaluated student satisfaction with the course.Perception of competence in pharmaceutical care practice: A quasi-experimental, two-group pretest and posttest design was utilized to evaluate students’ perception of their preparedness to perform pharmaceutical care competencies. The survey instrument was designed by the authors, based on other instruments reported in the literature –26. FurtEvaluation of satisfaction with the course: A student opinion survey was conducted in the final week of the semester that assessed general aspects of the course, including whether the teacher had been able to provide them with the intended types of experience, and their own performance on the course. Survey items were answered using a five-point Likert scale ranging from 1 (“strongly disagree”) to 5 (“strongly agree”). The instrument used was developed by the authors based on the related literature , 28–31. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), version 17. Descriptive statistics were calculated for the questionnaire items, consisting of means, standard deviations (SDs), and percentages of agreement or disagreement with each item. The Shapiro-Wilk test of normality indicated that the data were not normally distributed. Thus, a Wilcoxon sign-ranked test was performed to compare overall pre-test and post-test scores on the instrument measuring the perception of competence in pharmaceutical care practice. The Kruskal-Wallis test was used to examine differences among the students’ performance in the evaluation methods used in the course, and their preference for teaching method.p < 0.05. All of the responses were anonymous.The level of significance for all statistical analyses was set at The study was approved by the Human Research Ethics Committee of the Federal University of Sergipe (CAAE: 26429413.8.0000.5546). The participants provide their written informed consent to participate in this study and the Human Research Ethics Committee of the Federal University of Sergipe approve this consent procedure.Thirty-four students were enrolled in the course. A different number of students completed each of the assessment/evaluation components due to a time gap between the assessments. Thirty-three students (97%) completed the four evaluations used in the course . The median age was 23.43 years (SD 2.82 years) and 25 were female (75.75%). All students were in the fourth year of the undergraduate pharmacy program.For this pharmaceutical care course, no students failed. The overall average grade of students was 7.97 (± 0.59) on a scale of 0 to 10 points. The students’ average scores for each examination are presented in Thirty of the 34 students were involved in the pre-test evaluation of their perception competence in pharmaceutical care practice and 32 students completed the post-course evaluation. The mean test scores for the pre-test and post-test are given in p < 0.05) for all evaluated competencies.In the pre-test, the worst scores were obtained for the competencies “conduct a complete anamnesis in a patient”  and “measure clinical parameters” . For the post-test, the competencies with the lowest scores were “detect nonverbal signals during patient care”  and “conduct a complete anamnesis in a patient” . Comparison of pre- and post-test scores revealed statistically significant improvement  affirmed that they preferred the pharmaceutical care course using active learning methods to a traditional method, and 96.67% of respondents preferred to use active learning methodologies in other disciplines, indicating that the students were comfortable with learning in a self-directed manner.In recent years, expanded roles for pharmacists, as providers of health-care services, are increasingly recognized and valued. Moreover, traditional pharmacy education has failed to systematically link practice competencies to patient and population health needs . Thus, pAccording to the International Pharmaceutical Federation (FIP), the capacity to improve therapeutic outcomes, patients’ quality of life, scientific advancement, and public health imperatives are dependent on a foundation of competence . In thisIn this study a significant improvement in the competencies of students was observed after a pharmaceutical care course that used active learning methods. Several studies have shown that incorporating active learning methods into pharmaceutical care courses can produce positive results in student’s competencies , 36–39. Bulatova et al.  demonstrAccording to Cipolle et al. , the thrSurveys that capture the perceptions and opinions of students are commonly used in health science research , 41. HowIn the pharmaceutical care course that is the subject of this report, the teachers wanted to provide students with multiple methods of assessment in class, according to the learning objectives, and to increase the number of opportunities students had to demonstrate application of learning. The tests for the evaluation course were carefully developed so that students were required to use the information to demonstrate mastery of specific course objectives rather than simply recalling memorized facts. Hence the use of a discursive written exam with use of video for resolution of problem situations, seminars with clinical cases, OSCE with evaluation of student performance facing a simulated situation, and virtual patients.The results of these assessment methods are in accord with results of previous studies on the advantages of active methods in learning –46. StewIn evaluation the methods applied for the current study, the best assessment method for students was the virtual patient. Additionally, the use of this technology was noted as one of the strengths of the course by students. As active learning techniques have been encouraged in pharmacy education, an increase in the use of technology has often followed . The virOverall, students were positive in their evaluations of instructional content and methods of the course. Most students agreed that the pharmaceutical care course would help them apply skills in actual pharmaceutical practice, and they affirmed that they preferred a course using active learning methods rather than traditional methods. Similar results are found in literature ,37. One However, the course also presented some limitations as the little contact with real patients. According to Hudgens and Chirico , studentIn this study, in view of the limited availability of actual patients to develop pharmaceutical care practice, a set of active learning techniques were used that can decrease the gap between training and actual patient experience. The literature notes that the laboratory setting is ideal for providing students with hands-on experience in a low-risk environment, by instilling both confidence and competence in students . The FIPMany health care educators have described the use of simulation as a successful teaching strategy –56. SimuIt is noteworthy that all experiences used in a pharmaceutical care course should have well defined outcomes that lead to the primary aim of optimizing the educational experience for the student . To achiThe present study is not without limitations. First, limitations inherent in this method include differences in personal factors among the participants. Second, since the active learning approach was not compared to a traditional teaching methodology, it cannot be determined whether the former is the superior approach for the teaching of pharmaceutical care. Furthermore, the active learning strategies were not test individually, which prevents to evaluate the importance of each in the learning process.By incorporating active learning methods in a Brazilian pharmaceutical care course, students demonstrated significant improvements in their competencies and expressed satisfaction with the course. Although the results are limited to the study population, it appears that an active learning course with a combination of several teaching and evaluation methods can enhance learning pharmaceutical care competencies. Future studies should compare active learning to traditional methods.


To enhance instruction in higher education, many universities in the Middle East have chosen to introduce learning management systems (LMS) to their institutions. However, this new educational technology is not being used at its full potential and faces resistance from faculty members. To investigate this phenomenon, we conducted an empirical research study to uncover factors influencing faculty members' acceptance of LMS. Thus, in the Fall semester of 2014, Information Technology faculty members were surveyed to better understand their perceptions of the incorporation of LMS into their courses. The results showed that personal factors such as motivation, load anxiety, and organizational support play important roles in the perception of the usefulness of LMS among IT faculty members. These findings suggest adding these constructs in order to extend the Technology acceptance model (TAM) for LMS acceptance, which can help stakeholders of the university to implement the use of this system. This may assist in planning and evaluating the use of e-learning.  The impact of information and communication technologies (ICT) has influenced teaching and learning strategies ; specifiA learning management system (LMS) is a software application used to deliver online material and training programs to students while tracking their progress and generating related reports . An LMS Recently, the Ministry of Education in Saudi Arabia approved e-learning as a component of its national plan. This plan calls for the adoption of e-learning, distance learning, and blended learning in higher education . One of While numerous studies focused on usage intention and behavior toward LMS acceptance, little research has highlighted the impact of external variables on LMS usage as suggested by –7. ThereIn the present study, we focus on understanding the antecedents of LMS usage in higher education at King Saud University, especially among Information Technology faculty members, and we assess how the factors of interest interact with each other.The organization of this paper is as follows: first, we state the research problem and objectives along with research hypotheses related to the latent variables of acceptance of the technology model. Subsequently, a survey of the proposed acceptance models is presented in Literature Review. Next, we establish the layout of the research design and methodology consisting of study setting, data collection instruments, design of the study process, and data analysis procedures. We then present the findings of this research and provide meaningful analysis based on faculty members' comments as well as on regression models. Finally, we conclude our paper and provide some suggestions for future work.At KSU LMS has been adapted for several years; some faculty members have embraced it while others have not. Among the faculties who resisted the acceptance of LMS are the majority of Information Technology (IT) faculties. Presently quarter or less of the IT faculty members use LMS (Blackboard) in their teaching. They also have experienced low motivation toward training and using this tool in their daily classroom activities. The problem under investigation revolves around understanding reasons for the lower rate of usage of LMS for teaching and learning within the IT Department. The level of acceptance and the causes of resistance had to be identified to provide insights to encourage the successful implementation of LMS (Blackboard) as e-learning platform. According to previous studies , 8–11 moThis study will adopt part of the technology acceptance model (TAM)  to studyAn increase of positive organizational support, perceived usefulness, perceived ease of use, and reduced load anxiety toward Blackboard will lead to a statistically significant increase in the motivation variable.An increase of positive motivation, organizational support, perceived usefulness, and perceived ease of use toward Blackboard will lead to a statistically significant reduction in load anxiety among IT faculty.An increase of positive motivation, perceived usefulness, reduced load anxiety, and perceived ease of use toward Blackboard will lead to a statistically significant increase in organizational support.An increase of positive motivation, organizational support, reduced load anxiety, and perceived ease of use toward Blackboard will lead to a statistically significant increase in perceived usefulness.The purpose of our study was to investigate the correspondence between faculty usage of LMS and the following variables: motivation, load anxiety, support, perceived usefulness, and perceived ease of use. The following question was asked: What are the relationships between these external variables and faculty attitudes related to the adoption of e-learning technologies? From this research question, we have derived the following hypotheses:The literature addressing the acceptance of technology has witnessed a significant increase of research in the last decade. This research was mainly conducted to understand technology acceptance in the industrial environment. In , technolE-learning describes a technology-rich learning environment. It has been discussed in much research as a tool for improving student learning processes and enhancing teaching practices. Learning management systems are considered to be essential tools to facilitate e-learning and are being employed by numerous universities to facilitate and expand learning opportunities. Nevertheless, this technology is often not used to its full potential.Teachers are ultimately responsible for the final decision to either use or avoid technology. To understand why teachers accept or reject e-learning, one must understand why teachers accept or reject technology .Many models designed to evaluate user acceptance are cited in the literature; an overview of these studies is presented in . The tecThus, the TAM, besides having been validated several times by various researchers, was also subjected to various improvements and adaptations, beginning with its author. In a subsequent project, Venkatesh and Davis  developeAdditionally, in , the autAlong the same lines, the authors in  examinedWhile different versions of TAM have focused on utility, usability, and acceptability of IS in business contexts, other authors , 18–20 hOne interesting study in  used theFurthermore, another useful study  analyzedMore recently, researchers have focused on faculty acceptance of using web-based e-learning rather than traditional classroom formats. They relied on the technology acceptance model (TAM) as a basis to understand the adoption of e-learning in higher education. We will report some of these studies in the following section.In , the autA seminal study in this area is the work presented in . The autIn , the autOther studies emphasize their research on the external variables  and theiIn , the resFurthermore, a study in  focused In , the autFollowing the literature, over the years, research studies have identified numerous factors influencing the acceptance of technology with different external variables according to the context and culture in which this technology is used; there is no unique model that effectively applies to all contexts. Therefore, our study will investigate the resistance of our faculty members to using LMS through the usage of various constructs; this will be discussed next.Based on the previous research that demonstrated the influence of usefulness and ease of use on the usage of e-learning , 20, we King Saud University (KSU), similar to numerous other universities in the Middle East, introduced Blackboard as a learning management system in its institutions to serve as an online teaching and learning solution . KSU has-type scale questions were used to collect empirical data. In addition, open-ended questions were included in the survey to allow respondents to express their personal views. Questions were checked for clarity and appropriateness. The survey for faculty was designed to elicit responses about teaching and learning using the online learning management system of Blackboard. It comprised 4 sections: The first section collected characteristics of participants as well as experience in teaching, number of students in classes, and level of education. The second one covered questions to assess faculty perceptions of Blackboard in teaching in terms of motivation, organizational support, load anxiety, perceived usefulness, perceived ease of use, and actual use. The third section evaluated the features that were most often used and the degree of satisfaction in using these features. In the final section, faculty members were asked about the functionalities they desired in Blackboard. This survey also used binary (yes or no) questions to determine who is using Blackboard and their familiarity with the functions of Blackboard. The survey measured the relationships between the variables of perceived usefulness, perceived ease of use, motivation, load anxiety, perceptions of organizational support, and actual use.All teaching staff within the IT Department was invited to participate in this study. Data for this study were retrospectively collected from a survey instrument. Questions in the survey were selected among items previously published and validated in , 24, 25.This is a regression study of faculty usage of LMS within the Information Technology (IT) Department, at the College of Computer and Information Sciences at King Saud University. A total of 50 faculty members work in the IT Department. Among them, we received 20 responses, which corresponded to a response rate of 40%. This corresponds to less than 50% of the total population providing feedback, but our sample size was sufficiently large. Among the 20 faculty participants, 16 instructors were using Blackboard and 4 were not using it during the Fall 2014 semester. All respondents were full-time female faculty. The majority of those faculty members who responded to the survey reported that they have used Blackboard while teaching 1–5 courses, and one faculty member had used it with more than 5 courses. The distribution of teaching experience was as follows: 1 faculty member had less than 1 year, 13 had 2–5 years, 5 had 6–10 years, and one faculty member had more than 10 years of traditional teaching experience. From these values, it can be seen that the surveyed faculty members were characterized by a large range of teaching experience.After the surveys were collected, the data were entered into SPSS Version 16 software to perform further analysis using Cronbach's alpha, regression, and descriptive statistics. Cronbach's alpha was used to measure internal consistency using the Reliability Analysis function in SPSS.Data analysis was conducted in two stages. The first stage involved testing the various variables of perceived ease of use, perceived usefulness, motivation, load anxiety, and perceived organizational support for reliability using Cronbach's alpha. The second stage involved testing the dependent variables from the external variables using regression.The purpose of this study was to investigate the correspondence between faculty members' attitudes toward the use of Blackboard and their perceptions with regard to the constructs of motivation, load anxiety, perceived usefulness, perceived ease of use, organizational support, and actual use.An internal consistency reliability test for the variables was conducted. The reliability test was performed in SPSS Version 16 using the Scale Reliability Analysis function. Cronbach's alpha coefficients of the scales are presented in Furthermore, we conducted correlation analysis among the variables as shown in R2, F-values, regression coefficients, P values, and results of the testing of hypotheses.A standard regression analysis was performed between the dependent variable (one of each of the variables) and the independent variables (the remaining variables). Analysis was performed using SPSS regression as shown in We noticed from P < 0.05) among the independent variables, excepting perceived ease of use. The regression model for motivation and ease of use had P > 0.05, which was not statistically significant. This supports the findings of Regression analysis revealed as shown in R2 value is 0.789, where the independent variables are all of the external inputs . This could result because these input variables have a larger impact on the faculty perception of Blackboard more than the individual variable does. If an IT faculty member feels that LMS will reduce part of her teaching load, that it is useful and easy to use, and that support is available if needed, she will be more motivated to learn and use Blackboard.Furthermore, we note that the highest P < 0.05. But, organizational support and ease of use had P > 0.05, which were found not to statistically significantly affect the reduction in load anxiety.Similarly, the second hypothesis (H2) models the dependent variable load anxiety with other variables . The results were found to be statistically significantly predicting IT faculty members' attitudes toward LMS, with IT faculty members are exposed to a variety of software applications and tools that can reduce their teaching load. Indeed, we have noticed from the faculty's feedback and survey responses that a large proportion of faculty members do not feel comfortable with Blackboard as an LMS. They believe that using Blackboard requires time and effort, which in turn increases their workloads. They recognized that Blackboard has some useful functions, but they perceived that this application is not intuitive to use.Analogously, we examined the result of the third hypothesis (H3) where the dependent variable is organizational support and the independent variables are motivation, load anxiety, perceived usefulness, and perceived ease of use. We found a significant relationship between the organizational support and motivation and perceived usefulness. This could be due to the fact that the IT faculty members were observing the efforts from the e-learning deanship to support the usage of LMS. The deanship offers training during the year, answers faculty members' inquiries in a timely manner, and offers after-hours chat support. This kind of support makes LMS attractive to be used. However, IT faculty members still do not believe that this application will reduce their time and effort. We can see that the relationship between organizational support and load anxiety was found to be nonsignificant.Finally, the last hypothesis (H4) related the dependent variable of perceived usefulness and the independent variables of motivation, organizational support, and perceived ease of use. We found the relationship between the LMS usefulness and the other independent variables to be significant.From Faculty Members' CommentsI find Blackboard useful and that it provides much functionality.It is a very useful tool; however, it is slow and notifications are sometimes delayed.My impression is that Blackboard is very useful especially in holding the course, gathering assignments, assigning grades through the grading center, and sending announcements.It is good for announcements but usually takes a long time to notify students about contents.It makes interaction with students easy.I like it as a tool to replace blogs, especially it offers so much more such as an SMS tool …etc.From these comments, we can conclude that most faculty members surveyed who use Blackboard  found it useful as both a repository of course materials and a communication tool. The findings also indicated that some faculty members believe that several functionalities in Blackboard are complicated and that it takes a long time to complete a task.Of the 20 faculty respondents, 16 were using Blackboard in the Fall 2014 semester, with the other 4 indicating that they were not using Blackboard to communicate with their students or to provide them with course materials.The findings showed that most faculty respondents use Blackboard in the following ways to manage their courses: posting materials of their lectures (80%) as slides and assignments; communicating with their students through email (100%), SMS (65%), announcements (90%), and posting and calculating grades (55%). The most surprising aspect of the data was that nearly half (45%) of the faculty do not use it to deliver exams and quizzes and that the majority (55%) do not use it to conduct surveys. Interestingly, only 35% of the faculty respondents make use of the discussion board and assignment tool to assign, collect, and grade student work.Further analysis shows that more than half (55%) of faculty members do not use reports to view lecture usage, 75% do not use Web 2.0 Tools, 40% do not use the calendar function, and 75% do not use chat or the virtual classroom.Most faculty members indicated that they mainly use Blackboard to manage their courses. Interestingly, many instructors appreciated the features offered by Blackboard that enhance communication between them and their students, especially through email. However, other faculty respondents found that Blackboard is tedious, unclear, and difficult to use.Features Desired to Be Added in Blackboard. When asked what they would most like to be added as features in a future version of Blackboard (ackboard , facultyThese findings indicate an overall convergence between the desires and perceptions of Blackboard as a learning tool and its usage, expressed previously by faculty members. Faculty respondents felt that they were not able to design their courses in the way they wanted. They found that Blackboard lacks customization, while so many of them wish to have tools to build courses in ways to meet their specific needs. However, one faculty member reported that “in Blackboard Learn 9.1, the following tools are available as built in tools and are sufficient so far: YouTube video, Blog, Wikis, WileyPLUS. Lecture Capture, Recording & Interactive Whiteboard are embedded in Elluminate Live. News articles can be seen in the system Journal, Google Docs can be seen in the system KSU Drive.”These findings show that faculty members are not necessarily aware of all functionalities available in Blackboard as shown in Learning management systems have been implemented in higher education in Saudi Arabia for many years. Nevertheless, teachers are not using it effectively, and sometimes this tool is not used at all. Our study intended to understand the personal factors influencing IT faculty members' acceptance or rejection of LMS. The researchers surveyed faculty perceptions of LMS as a teaching and a learning tool, respectively, including their level of satisfaction using LMS and an assessment of its degree of utilization in the IT Department. Data were collected via a survey distributed to all of the lecturers in the IT Department. Over 20 responses were received from faculty members, representing a response rate of 40%, which is an acceptable response rate for this kind of research within this field. Although this response rate is sufficiently large, the sample size remains a limitation of this study and does not allow the findings to be generalized. The study does not examine the comprehensive adaptation of the TAM to LMS usage. It focuses only on the latent variables, which are termed external variables in the TAM. This is due to a lack of data, since only a few faculty members who use LMS responded to the survey. Future studies should increase the scope and incorporate data from other departments, colleges, and disciplines within the university.Similar to prior studies such as McFarland's research , 11, theOne interesting result of this study is that motivation, organizational support, and ease of use together are strong antecedents to the perceived usefulness construct of the TAM. Also, we found that the LMS ease of use alone has no impact on LMS usefulness. This can be explained by the fact that IT faculty members believe that they are able to manipulate any LMS or any other technological tool. Another interesting result is that motivation is impacted by the combination of organizational support, PEOU, load anxiety, and PU. This might indicate that the faculties are not willing to engage in new methods of teaching.Findings from this study suggest that, by providing resources and fostering a supportive environment through the provision of time release to faculty members to manage their workload, leaders can reduce load anxiety and increase motivation and may consequently influence LMS use in the IT Department.On the other hand, results from our survey showed that when faculty did use LMS, they did so to effectively manage their courses by providing materials to students and to send out announcements, emails, and sometimes SMS communications. Overall, this study shows that LMS is used essentially as an administrative tool rather than a teaching or learning tool.The findings from this study have been determined to be consistent with the findings of several related studies on perceptions, usage, and attitudes of faculty members toward LMS such as Blackboard . Most fa


Blood-borne monocyte derived cells play a pivotal, initially unrecognized, role in most central nervous system disorders, including diseases initially classified as purely neurodegenerative . Their trafficking to the brain and spinal cord has been extensively studied in classical neuroinflammatory disorders such as multiple sclerosis. Central nervous system resident myeloid cells, namely microglia and perivascular macrophages, also are in the spotlight of investigations on neurological disorders. Myeloid cells, such as infiltrating macrophages and microglia, have been described as having both protective and destructive features in neurological disorders, thus identification of their functional phenotype during disease evolution would be of paramount importance. Extracellular vesicles, namely exosomes and shed vesicles, are released by virtually any cell type and can be detected and identified in terms of cell origin in biological fluids. They therefore constitute an ideal tool to access information on cells residing in an inaccessible site such as the brain. We will review here available information on extracellular vesicles detection in neurological disorders with special emphasis on neurodegenerative diseases. Data in the human setting are, however, very difficult to obtain since there is currently no way to investigate the functional phenotype of CNS-resident myeloid cells during disease development. Taking AD as a prototypical example, we will try in the present review to suggest a possible line of investigation able to contribute novel data on the role of myeloid cells during neurological disorders.Phagocytes, and in particular macrophages and microglia, are in the spotlight of investigations on the pathogenesis of neurodegeneration, involving disorders such as the progressive phase of multiple sclerosis (MS) and more classical neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease (AD and PD). While in all these cases, classical anti-inflammatory therapies have failed, and there is no doubt that an inflammatory component is always present. The hypothesis that malfunctioning or dysregulated myeloid cells are the cause of chronic inflammation associated to neurodegeneration also derives from the knowledge that the innate immune system is highly plastic. In this respect, it may control the initiation of the inflammatory process as well as transition from a purely destructive process to termination of inflammation and tissue reconstruction. Data available in the literature do not compose a coherent picture for several reasons. Inflammation is clearly a protective process, and it is difficult to identify and distinguish the altered component, if present. Second, there are numerous different myeloid cells in the brain, such as microglia, infiltrating and perivascular macrophages and dendritic cells. All are very plastic in their functional phenotype and endowed with peculiar abilities, playing different roles during neuroinflammation. This confusing picture has lead to the common use of an oversimplified definition of these functional phenotypes  and to a superficial definition of their role in the pathogenesis of neurodegeneration . Data in experimental models, however, are not in accordance with this straightforward working hypothesis, and the M1/M2 paradigm is no longer the consensus in the field, knowing that the myeloid cell phenotype 1–42) and the deposit of neurofibrillary tangles (NFTs), more recently several investigators have explored the role of the immune system in AD. The inflammatory response associated with AD is primarily driven by the resident cells of the brain such as microglia, perivascular macrophages, and reactive astrocytes and by non-CNS resident cells like monocytes/macrophages. It is not very clear when inflammatory response starts in AD. It was originally assumed that neuroinflammation occurs only at late stages of AD and that glial cell activation accompanies but does not significantly contribute to amyloid pathology -PK11195  and in human MS patients, we described that microglia release microvesicles that can be detected in the CSF and that can contribute to disease pathogenesis by delivering a pro-inflammatory signal .in vitro entities, as considered for many years, has somehow revolutionized the field of cell-to-cell communication. There is a growing interest of researchers for microvesicles, and it seems that there is no field of biomedicine where they are not investigated.The recent discovery that cell-derived extracellular microvesicles (EVs) are not artifactual Circulating EVs contribute to the development of cancer, autoimmune, and cardiovascular diseases, and the elevated number of shedding vesicles in plasma and/or other biological fluids   correlatSo far, two main EVs types have been isolated and described according to their different size and density: shedding vesicles and exosomes. Shedding vesicles are 100–1000 nm sized vesicles derived from the cell plasma membrane upon surface bending and budding as a consequence of lipid scrambling and cytoskeleton remodeling Figure  whose ovThis influence is relevant in physiology, but of course also during pathology. Particularly relevant is the influence on the immune system, the system devoted to protect tissues from insults and to foster regenerative processes. Extracellular vesicles are involved in all immune activities, and thus their effect in neurological disorders can be protective or detrimental, as the influence of the immune system itself .Multiple lines of research indicate that extracellular vesicles are involved in the pathogenesis of AD. To date, the potential role of EVs in AD is object of debate and evidences for either beneficial or detrimental action have been reported –26.1–42. Authors proposed to use exosomes as a novel therapeutic approach to prevent plaque deposition in AD  measured in CSF of AD and mild cognitive impairment (MCI) patients correlates with classical biomarkers of neuronal injury , demonstrating the diagnostic potential of EVs (1–42in vitro promote formation of soluble neurotoxic Aβ1–42 species from extracellular insoluble aggregates in neuron cultures thereby acting as potent drivers of neuronal damage (The neurotoxic role of EVs in AD is also sustained by data showing the increase of microglial EVs production in patients with neurodegenerative diseases , 18. Recl of EVs . Moreovel damage . The obsl damage  suggestsl damage , 37. In l damage  show thal damage . Neverthl damage .in vitro and in vivo (Figure Overall, increased levels of EVs in the CSF, together with altered value of soluble proteins in AD patients, may represent an emerging strategy for the identification of possible predictive biomarkers and/or therapeutic targets for AD. There is no doubt, however, that additional information may be gained by analyzing the EVs content. While, in fact, available data link the release of EVs in the CSF to microglia activation, we still do not have a tool to investigate the functional phenotype of activated microglia. In particular, toxic or protective role of EVs in AD may be linked to the functional phenotype of their parent cells. Since EVs represent, in their content, the cell of origin, microglia microvesicles are potentially the source of this information. Our group provided proof of principle for myeloid cells showing how M1 and M2 markers in microvesicles allow the identification of the phenotype of parental macrophages, o Figure .There is a growing interest in myeloid cells in neurodegenerative disorders such as the progressive forms of MS, AD, PD, and ALS. In general terms, this originates from the presence of an immune/inflammatory signature in all of these diseases on one side and on the failure of classical anti-inflammatory or even immune-suppressive treatments on the other. CNS-resident and CNS-infiltrating myeloid cells are able to modify their phenotype according to the environment in a matter of hours and their location behind the blood brain barrier makes the scarcely accessible to current treatments. The variety of activation patterns and stimuli of these cells and the lack of knowledge on their involvement in neurodegeneration leaves open the door to all sorts of speculations on their protective rather than pathogenic role in neurodegeneration. Investigating their biology and their behavior would be possible in experimental mouse models, but both the model for progressive MS and those for neurodegenerative diseases, such as AD, are scarcely representative of the final effector mechanisms affecting neurons. Neurodegeneration is indeed substantially absent or very poor in these models. In human patients, on the other side, to investigate CNS myeloid cells is extremely difficult. We think that myeloid extracellular vesicles, representing a “liquid biopsy” of their parental cells, may provide the answers to some of the many question open in this field. Knowing the functional phenotype of myeloid cells during the development of neurological disorders would at least allow to start to investigate their role, protective or damaging, during pathogenic processes. The development of appropriate technologies able to detect, sort, and analyze microvesicles in biological fluids is the necessary pre-requisite. There is considerable pressure to reach these goals, given the implication this would have for relevant fields such as oncology. The sorting and analysis of extracellular vesicles released by neural or CNS-infiltrating cells would be, however, of paramount importance for clinical neurosciences, providing information on an otherwise almost inaccessible organ.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.


This study examines a pathway for building urban climate change mitigation policies by presenting a multi-dimensional and transdisciplinary approach in which technical, economic, environmental, social, and political dimensions interact. Now, more than ever, the gap between science and policymaking needs to be bridged; this will enable judicious choices to be made in regarding energy and climate change mitigation strategies, leading to positive social impacts, in particular for the populations at-risk at the local level. Through a case study in Juarez, Chihuahua, Mexico, we propose a multidimensional and transdisciplinary approach with the role of scientist as policy advisers to improve the role of science in decision-making on mitigation policies at the local level in Mexico. The United States, China, Brazil, India, and various other countries have been unsuccessful at reducing their greenhouse gas emissions . More thIn Mexico, a weak annual GDP growth rate and steep drops in oil production over the past ten years are driving the need to open the country’s energy sector to foreign and national investments, which could boost its gas and electricity sectors. Reforms in the power generation sector will also be critical for economic growth and environmental and social sustainability  2e [Mexico is the 11th largest emitter of greenhouse gases (GHGs), accounting for approximately 2% of the world’s emissions, which amount to 683 million metric tons of carbon dioxide equivalent CO2e ,6,7. At the 2015 Paris Climate Change Summit Mexico committed to the ambitious target of reducing its GHG emissions by 22% by 2030 and 50% by 2050. To achieve these goals, two strategies have been identified in the electricity sector: the use of natural gas resources and renewable, and energy-efficiency technologies.2 emissions. Considering direct and indirect emissions, urban areas account for 67%–76% of global energy use and 71%–76% of global energy-related CO2 emissions. As of 2011, more than 52% of the world’s population (roughly 3.6 billion) lived in urban areas. By 2050, the urban population is expected to increase to 5.6–7.1 billion, or 64%–69% of the world’s population. As a result of this growth, an urban land cover is projected to expand by 56%–310% between 2000 and 2030 [Urban areas account for more than half of global primary energy use and energy-related COand 2030 ,9. This Urban areas are positioned to make key contributions toward aggressive national targets for emission reductions. This is possible because mayors, as decision makers, have the opportunity to exert a strong influence on the main policies that could lead to emissions reductions, such as building energy efficiency standards, urban planning, public transportation, and promotion of renewables to meet a portion of their municipality’s energy needs ,11,12.Decision makers frequently encounter complex issues, and the role of the scientists as policy advisers on these matters is not always clearly defined or is not part of the process at all . In addiMerton, in 1945 wrote on the role of scientists in policy making and addressed the lack of empirical data on the roles of experts on public policy. He suggested that common divergences between scientist and decision maker’s interaction were related to conflicts of values and the different modes in which bureaucratic and academic organization function ,16.Scientists’ roles as advisers have remained mostly theoretical. Existing theories about science systems can be used to study real policy advice process. Unfortunately, empirical proof for the roles and process described in those theories are very limited ,18,19. We present an empirical multidimensional and transdisciplinary approach of scientists as advisers on policy making such that climate change mitigation policies are intended to have positive technical, economic, environmental, and social impacts. The methodology presented was empirically derived trough a study case to highlight the importance of multidimensional and interdisciplinary approaches to propose and enact climate change mitigation policies supported by reliable science knowledge, under the assumption that a shared understanding of science and its implications would help resolve opposing points of view held by scientist and decision makers for the benefit of society. Researchers working as advisers to decision-makers can take advantage of the insights provided in this paper. The study case presented in the manuscript is a combination of an exploratory and explanatory type and focused on each stage of the process of “scientist in the role of adviser” throughout the study case and present the outcomes of this research. The stakeholders  involved in this process at the local level in Ciudad Juarez are very similar in their views towards science and government as shown in other studies ,20, alloet al. [Science-policy interfaces are avenues for finding solutions for environmental challenges throughout strengthening collaboration between research disciplines and public administrators . Spruijtet al.  presenteWe propose a multidimensional and interdisciplinary approach that consist of five dimensional  methodological approach to building climate change mitigation policies, with an aim to provide reliable scientific information, based on the particular conditions of the urban areas, to the decision makers. The proposed methodology was derived by carrying out a case study on energy efficiency in Ciudad Juarez, Chihuahua, Mexico. The methodology presented was developed from a study case, which we consider having significant strengths such as novelty, testability, and empirical validity. These strengths arise from the intimate relationship with the empirical data and experience throughout the study case research. The independence from prior literature is particularly well-suited to this area of research in which most had been theoretical. Scientist roles as advisers have remained mostly theoretical. Unfortunately, empirical proof for the roles and process described in those theories are very limited ,16. The . Despite the efforts, these approaches have not been widely adopted for two main reasons: (1) their application is targeted at a particular problem and there is a lack of general application to different climate change adaptation or mitigation scenarios, and (2) there is a lack of successful cases reported in the literature at local governmental level [Multidimensional methodologies for decision-making and for implementing environmental policies have been reported in the past . Despiteal level ,22,23,24The proposed multidimensional methodology  consistsIn practice, the circular model shown is much more complex and iterative, and throughout the study case, the steps were not clearly separated as the model shows. The steps of the circular model were conceptualized retrospectively, trying to capture the whole process as best as possible in the eight steps presented in A description of the five dimensions involved in this methodology is as follows.1. Technical dimension: The technical dimension refers to all quantitative and measured information derived from scientific knowledge, local indicators, technology roadmaps, journal publications, and case studies related to climate change mitigation and environmental policies in urban areas. It has become clear that climate change, which is one of the greatest challenges in human history, cannot be addressed by technical, scientific knowledge alone, although this knowledge is critical to understanding the physical phenomena involved. In this context, building relationships among different disciplines will improve the chances of success of public policies regarding climate change mitigation in urban areas [an areas .2. Environmental dimension: The environmental dimension refers to the body of information about climate change mitigation potential and its indicators and impacts regarding the economic, social, and political dimensions. For this study, the environmental dimension is considered to be constrained by the characteristics of the particular urban areas for which public policies are being tailored.3. Economic dimension: The economic dimension refers to the information derived from the financial analyzes of the proposed climate mitigation strategies and the opportunities and challenges involved in implementing the associated policy. Economics provides useful tools for assessing the benefits and costs of taking or not taking action for climate change mitigation, and of adaptation measures implemented to achieve competing societal goals. These understandings can help make policy decisions on climate change mitigation and can influence the actions taken by countries, institutions, and individuals [ividuals . Many ecividuals .4. Social dimension: The social dimension refers to the information derived from indicators that describe societal values and needs and the effects of these indicators on climate change mitigation. The significance of the social dimension and the role of ethics and economics are emphasized by Article 2 of the United Nations Framework Convention on Climate Change, which indicates that the ultimate objective of the convention is to avoid dangerous anthropogenic interference with the climate system [e system . IPCC coe system . Determie system . Ethics 5. Political dimension: The political dimension refers to the political agenda prioritized according to pressures from the social, economic, and environmental dimensions, which influence decision makers’ policy choices.Ciudad Juarez is the largest city in the state of Chihuahua, and the second most populated Mexican city on the US–Mexico border. Juarez has a population of approximately 1.5 million and is the eighth-largest metropolitan area in Mexico.2, which has the second-largest number of maquiladoras (factories that manufacture products for export) in Mexico. The growth of the maquiladora industry fueled an unprecedented increase in the local population, with job opportunities attracting people from Chihuahua and many other parts of the country [Approximately 40% of Chihuahua’s population lives in Juarez County, an area measuring approximately 4854 km country ,31. 2e/year. These savings could be achieved by changing the 100,000 existing streetlights.In the framework of the proposed multidimensional methodology, we present a case study where the energy efficiency of street lighting was improved through the use of light-emitting diode (LED) lamps, with energy savings of 64% and emission reductions of ~30,000 tCOThe successful application of our proposed methodology and promising results from the case study led us to the opportunity to work with the State Congress.Step 1: Identification of Mitigation Strategies This step involved identification of options for climate change mitigation strategies at the local governmental level  by taking the social and political dimensions into account.A marginal abatement cost curve (MACC) is a convenient way to present low-carbon options as alternatives to business-as-usual economic activities. An MACC can provide a brief overview of the potential and costs of low-carbon technologies for the economy as a whole or a particular sector .Mexico’s MACC for the period of 2009–2030 ,33 was uOptimizing routes for public transportation.Public lighting system.Cargo transportation by rail.Urban densification.Urban mass transportation.Furthermore, we identified mitigation strategies based on scientific knowledge and local indicators . The strategies identified were as follows.Step 2: Classification by Mitigation Potential Classification of mitigation strategies at the local governmental level provides a roadmap that decision makers can use to align their environmental policies and actions. The strategies for climate change mitigation were classified by their mitigation potential using the MACC curve. The classification is as follows. Step 3: Initial Assessment An initial assessment based on scientific knowledge and local indicators  is needed to define the potential of a proposed solution to become policy. A thorough review of the social and political dimensions is critical to achieving policy acceptance; the costs of implementation play a smaller role in decision-making in some cases.For the purpose of our study, through the bi-weekly public hearings that the local government holds in different areas of the city, we identified some of the most recurrent citizen petitions: (1) improvement and expansion in the coverage of the street lighting system, (2) decrease in the criminal activities and (3) employment generation. From the MACC-derived strategies in In A census of the Public Services Department showed that there are 100,000 lamps installed in Juarez. Almost 95% of these lamps are used on secondary and primary streets, where the majority of the population lives. Lack of maintenance of the street lighting has resulted in approximately 20,000 lamps  being turned off. This has, in turn, led to insecurity, especially in the most impoverished areas of the city.Municipal tax for the right to public lighting (DAP in Spanish) is paid by all citizens and is included in the electric bill. Unfortunately, this tax does not provide enough revenue to meet the costs of electricity for the street lighting, and it is a challenge for the municipal budget to recover the difference.Two types of street lighting are in use in Ciudad Juarez. The first one consists of lighting in upper-middle-class and high welfare areas that has its own infrastructure  and is designed based on local street lighting regulations. In these areas, a bill is issued by the national electrical utility to the municipality. For the purpose of our study, we refer to this as the measured street lighting system. The second type of street lighting is primarily found in the poorer and very impoverished parts of the city. This type of lighting lacks a proper infrastructure and is connected directly to the national electric utility grid. This makes it impossible to determine precisely electricity consumption; therefore, the usage is roughly estimated, and the municipalities are billed whether or not the lamps are in use. There are no regulations concerning the design and installation of these lighting systems, and we refer to them as the non-measured or unmeasured street lighting system.Furthermore, we obtained data on the number of lamps, their nominal power, and their application  from the census performed by the local municipality and on the number of felonies related to the lack of street lighting, and equivalent carbon dioxide emission reductions through energy savings with different public lighting technologies ,35. The Step 4: Cost-Benefit Analysis A series of trade-offs among the technical, economic, social, and political dimensions is required to arrive at a policy that would be politically and socially attractive to the city council. For our study, a more efficient model for the street lighting and replacing non-measured street lighting with a measured lighting system was required. An initial investment of around 50 to 80 million dollars (depending on the lighting technology) was estimated for carrying out improvements in the street lighting system. We proposed that the debt could be paid through the DAP, energy savings, and federal incentives provided to the municipalities to improve their energy efficiency.2.5), sulfur dioxide (SO2), nitrogen oxides (NOx) and carbon dioxide (CO2). The estimation was based on the assumption that electric energy consumption will be reduced by 21,718,147 kWh/year from CFE CT  Benito Juarez , which is a fuel oil plant, and from CFE CC  Benito Juarez , which is a natural gas plant. Based on this assumption, we used the intake fraction to determine the changes in exposure concentration of PM2.5 [.Furthermore, an estimation of health effects in terms of implementing the proposed energy efficiency project was made. The main air pollutants chosen were fine particulate matter . The value of statistical life (VSL) for Mexico is $1.2 Million US dollars with a 95% confidence interval of  [The Harvard Six Cities Study , states 76, 2.9) .The health benefits of improving the energy efficiency of the street lighting in Juarez was estimated to be 11.7 million US dollars/year. The other benefit was the prevention of 9.31 cases/year of mortality by cardiovascular diseases.Step 5: Institutional Support There is no standard definition of public policy; this case study defined public policy as a course of governmental action or inaction in response to public problems, reflecting the most important societal values and the conflicts between these values. Policies clarify which of many different values are assigned the highest priority in a given decision .Our strategy was to appeal to some of the more mainstream complex issues, such as the challenge of climate change and improving the quality of life, and that the economic savings be used to support populations in areas that are more at risk. The support of influential non-governmental stakeholders including universities, civil associations, the media, and research centers moved the decision maker from a state of strong influence–low interest to one of strong influence–strong interest.A multidisciplinary technical committee for the improvement of the public lighting system was implemented. In this committee, the Universidad Autónoma de Ciudad Juarez, Tecnologico de Monterrey Campus Ciudad Juarez, Camara Mexicana de la Industria de la Construccion  y el Colegio de Ingenieros Mecanicos Electricos y Electricistas del Estado de Chihuahua , and members of the city council participated; the members discussed different options in terms of lighting technology, economic viability, and environmental impact.The multidisciplinary committee had several meetings to address the different dimensions  involved in the study case to prepare and evaluate different scenarios to be presented to local government officials for the decision-making process.One of the many trials faced during the study case was that some political actors (mainly from the opposition to the ruling party) were skeptical about the impartiality of some members of the multidisciplinary committee  on issues such as illumination technology selection, telemetry, and general equipment required to implement the project. To include different interests from the public and private sector stakeholders, the multidisciplinary committee produced different public policy scenarios for the decision-making process, which included the preferred options from various actors.Once the city council selected one of the scenarios that were presented, some political actors that were members of the multidisciplinary committee and had signed the scenarios that were produced, denounced the policy-making process since the selected scenario was not their preferred choice. A spatial analysis was carried out on the collected information to produce thematic maps that could illustrate the relationship between street lighting and socio-demographic indicators, with two primary objectives: (1) obtain a broad understanding of the problem that requires solving and of the potential for climate mitigation, and (2) develop a simple, graphical format for communicating the problem, potential, and local indicators to decision makers for the support stage ,50,51,52Other thematic maps obtained during this initial assessment indicated crimes or felonies related to the lack of street lighting. These maps included robberies, murders, vehicle accidents, and pedestrian accidents, and helped to highlight the urgent need to address security and crime on the political agenda .2e per year as a result of energy savings.After a thorough review of several street lights manufacturers, we proposed to the local government that LED lamps would provide the highest energy savings (~64%) relative to the existing lights, have a strong positive social effect in terms of improved security, and help avoid emissions of more than 30,000 tCOStep 6: Policy Proposal In this step, a very close working relationship is developed with the local government to decide what needs to be added or updated in the case of existing environmental policies or the creation of new ones, supported by the technical, economic, and socio-political aspects of the scientific report.We proposed that the existing street lighting regulation is updated  to include energy efficiency and climate change mitigation as design key variables. Our proposal recommended the use of best available technology for street lighting and prohibition of sodium vapor lamps in future developments. This update was suggested to ensure continuity of this effort regardless of any political changes in the local government. Through the efforts of the multidisciplinary technical committee, five different scenarios were presented for decision-making and their possible implementation through policy proposal.Step 7: Decision Making A close relationship and dialogue with the local government is required in this step as well to explain the policy proposal in detail to different political stakeholders (Mayor and City Council). Final modifications at this stage could be made to support the decision-making.Based on the results of Steps 1–7, we proposed a public policy, which consisted of updating the street lighting regulations, more than a decade after their first publication, and addressing climate change mitigation and energy efficiency as key points in the current and future public lighting designs. The policy was approved unanimously by the city council and has already been enforced. Several branches of the local government, with the authors of this paper as advisors, were commissioned with the task of creating an implementation plan for the public policy.Step 8: Policy Implementation i.e., 50 million dollars, to change the existing 100,000 lamps, replace the non-measured street lighting system with a measured one and expanding the coverage of this service to the entire population. As we prepare this content (March 2015), the local government is in the process of obtaining the financial resources, The implementation of this policy is dependent on the decision makers at the local government level; however, by completing Step 7 and through maintaining non-governmental institutional support, we believe it is only a matter of time implemented the policy. Local government officials specifically requested that the group working in an advising role in this study case do not participate in the matters related to the funding of the project since there were some political issues on this subject and they wanted to have control of this area.2e/year. These savings achieved by changing the 100,000 existing streetlights. Following our successful experiment, the street lighting regulation was updated to ensure that energy efficiency and climate change mitigation taken as fundamental considerations in the current and future design and applications for street lighting.Through the implementation of our methodology, we were able to improve the energy efficiency of street lighting, through the use of light-emitting diode (LED) lamps, with energy savings of 64% and emission reductions of ~30,000 tCOThe implementation of the proposed multidimensional methodology for building climate change mitigation policies in urban areas in Mexico has presented and explained with the help of a case study of energy-efficient street lighting in Juarez, Chihuahua, Mexico. We had a leadership-absent local government scenario which poses an opportunity for the members of the research project to take a leadership role derived in communication with decision makers, strengthen the institutional structures available to implement the recommendations from our research encouraging decision and action. The stakeholders involved in this process at the local level in Ciudad Juarez are very similar in their views towards science and government as shown in other studies, allowing us to present a methodology which in principle can apply to other geographical areas in Mexico or internationally. While multidimensional transdisciplinary research is considered as an important aspect towards sustainability, the concept is complex and still under development and empirical experimentation. Some potential obstacles found during the study case which originates from the fact that scientist from different disciplines and academic traditions need to collaborate and integrate their knowledge and experience . Also, aOne of the challenges for climate change mitigation policies arises from the interactions among the technical, environmental, economic, social, and political dimensions that increase the complexities for the decision makers, including timeframe mismatches between researchers and election cycles. Our approach to convert mitigation strategies into public policies is an attempt to create a bridge between the scientific community and the decision makers at the local governmental level (urban areas) by providing reliable information to support the decision-making process.A new protocol for communication between the decision-makers and the scientific community is essential to achieving the common goal of implementing climate change mitigation policies. We learned from this experience that public health impacts and spatial analyzes are powerful tools to communicate complex technical, economic, environmental, and social information to decision makers in a clear manner and facilitate the decision-making process. Further work using the proposed methodology regarding of other mitigation strategies and a further refinement of the steps are needed.


The recent occurrence and spread of African swine fever (ASF) in Eastern Europe is perceived as a serious risk for the pig industry in the European Union (EU). In order to estimate the potential risk of ASF virus (ASFV) entering the EU, several pathways of introduction were previously assessed separately. The present work aimed to integrate five of these assessments  into a modular tool that facilitates the visualization and comprehension of the relative risk of ASFV introduction into the EU by each analyzed pathway.The framework’s results indicate that 48% of EU countries are at relatively high risk (risk score 4 or 5 out of 5) for ASFV entry for at least one analyzed pathway. Four of these countries obtained the maximum risk score for one pathway: Bulgaria for legally imported products during the high risk period (HRP); Finland for wild boar; Slovenia and Sweden for legally imported pigs during the HRP. Distribution of risk considerably differed from one pathway to another; for some pathways, the risk was concentrated in a few countries , whereas other pathways incurred a high risk for 4 or 5 countries .The modular framework, developed to estimate the risk of ASFV entry into the EU, is available in a public domain, and is a transparent, easy-to-interpret tool that can be updated and adapted if required. The model’s results determine the EU countries at higher risk for each ASFV introduction route, and provide a useful basis to develop a global coordinated program to improve ASFV prevention in the EU. The European Union (EU) has an ever-increasingly highly industrialized and specialized pig production sector , and is ASF is one of the most devastating swine diseases given its high mortality, economic losses as a result of trade restrictions, and the fact that no vaccine is available for its control . TraditiSus scrofa L.) populations. More recently, in January and February 2014, ASF was confirmed in dead wild boars in Lithuania and Poland [Since its introduction into Georgia in 2007 , ASFV had Poland . This sid Poland ,11.Since there is no vaccine available for ASFV, disease prevention and rapid control require safe disposal of waste from international ports and airports, effective surveillance, disease awareness in high-risk areas, and regularly updated control and contingency plans. The design of tailored prevention and control strategies benefits from knowledge of the identification and allocation of the risks for ASFV introduction, which can be generated transparently through risk assessment .Various EU countries have already made country-specific risk assessments. Finland has analyzed the potential routes of ASFV introduction by emphasizing the risk of wild boar infection in the country, as well as the importance of biosecurity measures to prevent domestic pigs coming into contact with ASFV . GermanyThe risk of ASFV entry into the EU has been analyzed by the authors of the present study for five different pathways, these being: i) legal imports of live pigs during the high-risk period  ; ii) lega via each analyzed pathway: legal imports of live pigs, legal imports of pig products, illegal imports of pig products, transport-associated fomites, and wild boar movements. The risk pathways included in the analysis were based on a literature review that considers ASFV transmission mechanisms, known routes of introduction into previously free areas, and the current epidemiological situation.A modular risk assessment framework was developed to separately integrate the risk assessments for the five main routes of entry Figure  in orderAll five modules, and consequently the modular framework that integrates them, correspond to the entry assessment component as defined in the OIE risk analysis framework, where entry addresses the likelihood of a commodity infected by a certain pathogen (hazard) being released into a particular territory . The expDifferent approaches were taken to develop the five risk assessment modules after considering pathway-specific characteristics and data availability. The risk of entry via legal import pathways was estimated by quantitative models, whereas risk was assessed by semi-quantitative models for illegal imports, wild boar and transport-associated fomites.The legal import (live pigs and pig products) risk assessments provided risk estimates as probability distributions for ASFV introduction. In order to facilitate the visualization and interpretation of these results, the mean probabilities of ASFV introduction were categorized into six risk scores (risk scores from 0 to 5) based on natural breaks calculated by Jenks algorithm . All theThe detailed structure, parameters, inputs and outputs for these modules are available in separate publications -22. The For both legal import pathways , two quantitative risk assessments ,19 were As data on illegal imports are very scarce and the probabilities associated with most steps of the risk pathway would be difficult to estimate quantitatively, a different approach was adopted. Illegal importation of pig products for personal consumption and for commercial purposes was modeled semi-quantitatively using ten social, economic and geographical factors, also called proxy indicators, which were assumed to influence the risk of illegal import  movements was estimated for those EU countries sharing borders with non EU countries from Eastern Europe, considered to be the origin of the risk. For this purpose, a semi-quantitative model was employed that considered two sources of infection: wild boar infection in the country of origin through contact with ASF-infected wildlife  or through contact with ASF-infected domestic pigs. Afterward, the introduction of ASFV into the EU was assumed to occur through the natural movement of infected wild boars or through contacts of infected wild boars with other wild boars. The detailed structure and parameters considered in the model are described in Table The risk of ASFV introduction through wild boar  and is available as an additional file  for each pathway when using the different categorization methods is presented in descending order (from highest to lowest) in Table A sensitivity index was also calculated to assess the magnitude of the influence of the categorization methods on each module results. This sensitivity index (SI) was computed after considering the number of countries for which the risk score changed “CC”, the extent of this change “EC” , and the total chances of change for this pathway “TC”. This TC represents the sum of the potential levels of change for all the countries by this pathway . The sum of the possibilities for all the countries composed the TC for this pathway. The SI was computed as follows: The model and its results are available as an Excel file in a public domain (www. asfrisk.eu) and as Additional file The list of countries at higher risk  per pathway is provided in Table Among the 12 countries with lower risk scores , some countries presented similar risk profiles, with the same risk scores for the same pathways.The results compiled in Table The SIs calculated by the pathway and categorization method are presented in Table The modular framework herein presented integrates the methodology and outputs from five pathway-specific risk assessments to produce specific risk profiles for ASFV routes of entry into the EU. All the modules used the best data available, which need to be consistent and homogenously collected across EU member states. Due to the limited availability of detailed data and the huge variability between EU member states in terms of pig production characteristics, trade, environmental and even socio-cultural features, the results generated by this modular risk assessment framework need to be interpreted with caution. Some of the EU databases used for model parameterization were not as complete and detailed as national ones . It has The present framework integrates the calculations and results of five risk analyses using diverse methodological approaches for risk estimation. Legal import pathways were estimated by using stochastic quantitative models; consequently, an absolute probability of the risk of ASFV entry was obtained per country , module structure, methods applied, the parameters used as risk indicators (based on data availability), and categorization and weighting methods . Attempts were made to minimize these limitations by means of the model’s transparency and the systematic application of the chosen approaches, which occurred with data categorization. After testing several categorization methods, natural breaks were used as this is the method that best adapts to the different distributions presented for all the input data. Within this method, the optimization method using Jenks algorithm was employed for most pathways to minimize intra-class variance and to maximize inter-class variances . For theThe sensitivity analysis assessed the impact of the categorization methods on the model’s outcomes and suggested satisfactory model robustness for all the pathways, except for the legal imports of products, which presented the greatest EC, with an average SI of 34. In addition, a maximum extent of change of 3 levels took place for eight countries for the legal imports of products pathway when modifying categorization. Within this pathway, data categorization was used only for transforming risk probabilities into risk scores, but conferred no additional value to the calculations , with a maximum extent of 2 levels of risk  and 1 (transport fomites and wild boar). This confirms the robustness of the model structure, especially for the semi-quantitative pathways where data categorization proved an important element to assess risk.Besides the analysis of the EC observed (SI), the comparison of the main study output, specifically the list of countries at highest risk per pathway, revealed good consistency among the different categorization methods employed. Indeed the order of countries at highest risk changed only for the illegal pathway  and for TAF . Specifically for TAF, the values of two countries interchanged from second and third positions at risk, but both remained in the same risk category. For all the other pathways, no changes were observed in the list of the highest risk countries, except for the inclusion of some countries at the end of the list. These results suggest that the main model’s outputs were not influenced when other categorizing methods were used.All five modules within the framework provided relative risk scores on a scale of risk scores from 0 to 5, the equivalent to risk probabilities from negligible to very high. Despite the use of different methodologies for each pathway module inhibits a direct comparison of the results among the pathways, as the same methodology was used for all the countries within each module, it was possible to compare the countries’ risk scores for a given pathway. Accordingly, these results can be used at the EU level to determine the countries/areas at higher risk per route of introduction. The application of specific control measures (adapted to the pathway’s origin of this risk) in these high-risk countries/pathways could prove beneficial for the whole EU. Based on this assumption, special attention should be paid to Sweden and Slovenia (risk of 5), followed by Finland, France and Greece (4), for the legal import of pigs pathway during the HRP. In relation with legal imports of products during the HRP, the only country at high risk was Bulgaria (5), followed by Romania and Germany (4). For illegal imports, no country presented the highest score (5), but a risk score of 4 was estimated for France, Germany, Italy and the United Kingdom. Something similar occurred with the transport associated fomites pathway, for which Lithuania and Poland obtained the highest scores (4). Finally, the risk deriving from the wild boar movement route was estimated with a score of 5 for Finland, followed by Latvia, Poland and Romania with a risk score of 4.Some countries, like Finland, Romania, Germany, Poland and France, obtained risk scores of 4 and/or 5 for several pathways. These countries would benefit from further national research to elucidate which pathways are at higher risk for their country and which actions can be implemented to prevent these risks. Countries with similar risk profiles are also often similar in terms of external trade, geographic location, wild pig movements, and other factors that have been considered in the assessment. Germany and the UK obtained high risk scores for illegal imports, legal import and transport, which reflect their vast volume of trade with third countries . They opTransport and wild boar obtained risk scores of 4 or 5 in Lithuania, Finland or Poland, which reflects their geographical proximity to affected areas and, consequently, the facility of entrance by these routes influenced by distance. These results have been recently validated by the notification of ASF cases in dead wild boar in territories of Lithuania and Poland . Malta aIn addition to these logical and biological arguments, the results obtained in the present framework agree with previous country-specific risk assessments. In a previous risk assessment for Finland, introduction by wild boar was considered to be the riskiest pathway , which aThe analysis of the present results per pathway also provides interesting information on risk management. In some of the pathways analyzed, risk concentrated mainly in very few countries (transport fomites in two countries), whereas other pathways proved relevant for many countries . These findings suggest the benefits of a coordinated EU program for preventing and controlling the disease.The outcomes obtained with this modular framework can be used to inform about the development of targeted risk management measures in the EU by implementing preventive measures in those pathways and countries that obtained higher risk scores. Additionally, the modular framework provided in the additional file can be used as a template to estimate the risk of ASFV introduction into other geographic areas or timeframes as more data become available.A modular framework has been implemented to estimate the risk of ASFV entry into the EU through five different introduction routes: the legal imports of pigs and products during the high risk period, the illegal imports of products, the transport associated fomites and the movement of wild boar. The framework, available in a public domain, integrates the five risk assessment modules and offers a transparent, easy-to-interpret tool that can be easily updated as data become available and can also be adapted to other regions of interest. The model’s results identify the EU countries at higher risk per route of ASFV introduction, and acts as a useful basis to develop a coordinated EU program and to, ultimately, improve ASFV prevention in the EU.aCroatia was the EU country not included in the analysis given its recent inclusion in the EU (1/7/2013).The authors declare that they have no competing interests.This work is the result of the long-term coordinated efforts made between three institutions . LM, BML, MM and JMSV carried out the analysis for the legal imports and transport fomites pathways. SC, BJ, FSV, DUP and BW made the illegal assessment. AT, MM and MJR developed the assessment for the wild boar pathway. The respective teams did the sensitivity analyses in the corresponding pathways (varying the categorization methods) and adapted their pathway analysis in order to integrate a common structure. LM integrated the modules into the common structure and wrote the draft of this manuscript. All the authors participated in the discussions about the selection of the methodologies used, the interpretation of the results, and the preparation of the manuscript by reviewing the results, and by notably modifying and suggesting changes to improve the study. All authors read and approved the final manuscript.Modular framework for estimating the risk of ASF introduction into European Union. The present file includes input data, calculations and results of the five pathways assessed in the study. In addition, explanations about the structure and source of data were also included in separate sheets.Click here for file