Diagnosing and treating operational and implementation barriers in synoptic marketing planning

Strategic marketing planning is now widely adopted by business-to-business organizations. While marketing planning principles are well established, practitioners attempting to implement the process often find their progress impeded by a variety of barriers. These barriers are explored through a review of published evidence and case study analysis of several organizations. This analysis exposes three levels of barriers to effective business-to-business marketing planning, relating to (i) organizational infrastructure, (ii) the planning process and (iii) implementation. These barriers reflect the synoptic nature of planning in many organizations. The findings lead to the development of a practitioner-oriented diagnostic and treatment tool which guides managers through the marketing planning process. Although this diagnostic deals specifically with issues which are relevant to the marketing planner, its wider implications for strategic planning are also explored.

Barriers and facilitators for the implementation of advanced pharmaceutical services

Poster presented at the 5th PCNE Working Symposium 2016: “Work in Progress – Progress in Work”, 19-20 February 2016, Hillerød, Denmark.

Implementation rules to bridge the theory/practice divide in market segmentation

Despite an extensive market segmentation literature, applied academic studies which bridge segmentation theory and practice remain a priority for researchers. The need for studies which examine the segmentation implementation barriers faced by organisations is particularly acute. We explore segmentation implementation through the eyes of a European utilities business, by following its progress through a major segmentation project. The study reveals the character and impact of implementation barriers occurring at different stages in the segmentation process. By classifying the barriers, we develop implementation "rules" for practitioners which are designed to minimise their occurrence and impact. We further contribute to the literature by developing a deeper understanding of the mechanisms through which these implementation rules can be applied.

Home and group-based implementation of the "Growing Up Happily in the Family" program in at-risk psychosocial contexts

"Growing Up Happily in the Family" is a program to prevent child maltreatment targeted at parents of children aged 0-5 years old in at-risk psychosocial contexts. The program is delivered via either a group-based or a home-visit format. The objective of this study was to evaluate the impact of various implementation components in the home and group versions on changes in parental attitudes about child development and education. At-risk and non at-risk parents participated in the group-based (196 participants in 26 groups) and home-visit (95 participants) versions of the program delivered through local social services. We analyzed program adherence, adaptations, participant responsiveness, quality of delivery, and implementation barriers as predictors of changes in parental attitudes. The results showed that greater program adherence, better quality of delivery and participant responsiveness, and positive climate predicted changes in parental attitudes in both formats. Therefore, it is important to take into account the quality of the implementation process when testing the effectiveness of early group-based and home-visit interventions in at-risk families.

Perceptions of evidence-based practice: A survey of Australian occupational therapists

Evidence-based practice (EBP) requires clinicians to access, appraise and integrate research literature with clinical experience and clients' perspectives. Currently, little is known about occupational therapists' attitudes to EBP, their perception of implementation barriers or their educational needs. A questionnaire reflecting these issues was sent to a proportionate random sample of 1491 members of the national professional occupational therapy association, OT AUSTRALIA. The questionnaire was completed by 649 (44%) participants. Occupational therapists were positive about EBP with most (96%) agreeing that EBP is important to occupational therapy. Although 56% used research to make clinical decisions, more relied on clinical experience (96%), information from continuing education (82%) and colleagues (80%). Lack of time, evidence and skills were identified as the main barriers to the implementation of EBP. Over half (52%) expressed strong interest in EBP skills training, and most (80%) indicated an interest in the availability of brief summaries of evidence. Targeted educational initiatives, resources and systems are needed to support EBP in occupational therapy.

Barreiras e facilitadores à implementação de um modelo de gestão de cuidados em Saúde Mental

RESUMO: Enquadramento teórico - Os estudos epidemiológicos demonstram que apesar de todo o progresso científico, muitas pessoas continuam sem acesso aos Serviços de Saúde Mental (SSM) e que, em muitos casos, os cuidados não têm a qualidade suficiente. A experiência de vários países mostra que os processos de implementação de modelos de intervenção terapêutica, como é o da Gestão de Cuidados, são lentos e complexos, não dependendo somente do grau de efectividade ou da complexidade das práticas a implementar. O Modelo de Gestão de Cuidados (MGC), é definido como uma prática baseada na evidência, utilizada para ajudar os doentes nos seus processos de recuperação. As estratégias para implementar práticas baseadas na evidência são críticas para a melhoria dos serviços. Existem, apesar de toda a evidência, muitas barreiras à implementação. Ao constatarmos que as práticas validadas pela ciência estão longe de estar claramente disseminadas nos serviços de saúde mental, fundamentamos a necessidade de utilizar metodologia de implementação que, além da efectividade das práticas, permita uma efectividade da implementação. Para responder às necessidades de formação e no âmbito da implementação do Plano Nacional de Saúde Mental, foram formados, em Portugal, 170 profissionais de saúde mental provenientes de serviços públicos e do sector social, de todas as regiões de Portugal Continental. Considerando que estes profissionais adquiriram competências específicas no MGC, através de um programa de formação nacional idêntico para todos os serviços de saúde mental, investigámos o grau de implementação deste modelo, bem como os facilitadores e as barreiras à sua correcta implementação. Existem vários estudos internacionais sobre as barreiras e os facilitadores à implementação de práticas baseadas na evidência, embora a maior parte desses estudos seja baseado em entrevistas semi-estruturadas a profissionais. Por outro lado, não existem, em Portugal, estudos sobre as barreiras e os facilitadores à implementação de práticas de saúde mental. Objectivos 1. Estimar o grau da implementação do MGC nos serviços de saúde mental portugueses 2. Caracterizar as regiões onde a implementação do MGC tenha ocorrido em maior grau. 3. Identificar os factores facilitadores e as barreiras à implementação do MGC, entre as regiõesde saúde do país. 4. Explorar as relações entre a fidelidade da implementação, as barreiras e os facilitadores da implementação, a cultura organizacional e as características dos serviços de saúde mental. Metodologia Estudo observacional, transversal e descritivo, com características exploratórias. População: profissionais dos serviços de saúde mental públicos e do sector social que frequentaram o Programa Nacional de Formação em Saúde Mental Comunitária no curso “Cuidados Integrados e Recuperação”, da Coordenação Nacional para a Saúde Mental / Ministério da Saúde, entre Outubro de 2008 e Dezembro de 2009, (n=71). Avaliação Fidelidade de implementação do Modelo de Gestão de Cuidados - IMR-S (Illness Management and Recovery Scale); Qualidade das guidelines utilizadas na implementação do Modelo de Gestão de Cuidados - AGREE II-PT (Appraisal of Guidelines, for Research and Evaluation); Avaliação das Barreiras e Facilitadores à implementação do MGC - BaFAI (Barriers and Facilitators Assessment Instrument); Avaliação da Cultura Organizacional dos serviços de saúde mental - CVF-I (Competing Values Framework Instrument). Análise Estatística Para a descrição dos dados foram aplicados métodos de estatística descritiva. Para a comparação de subgrupos foram utilizados os testes de Mann Whitney e Kruskall-Wallis. Para a investigação de associações foram utilizados os métodos de correlação de Spearman e a Regressão Múltipla. O tratamento e análise dos dados foram realizados utilizando o programa estatístico IBM SPSS Statistics® para Mac/Apple® nas versões 19 e 20. Resultados Serviços: A articulação com os cuidados de saúde primários existe na maioria dos serviços (56.34%) e 77.46% dos serviços têm autonomia para definir os cuidados a prestar. A maioria dos serviços (63.38%) realiza duas ou mais reuniões clínicas por mês e a quase totalidade (95.77%) recebe estagiários e/ou internos. A área da investigação tem níveis considerados baixos, quando comparados com outros países da Europa, tanto para a globalidade das áreas de investigação (25.35%), como para as áreas psicossociais (22.54%). Considerando componentes fundamentais para a implementação de modelos de gestão de cuidados, os resultados nacionais indicam que 66.20% dos serviços fazem registos em processo clínico único. As percentagens de utilização de planos individuais de cuidados são globalmente baixas (46.48%). Por seu turno, a utilização de guidelines, nos serviços do país, tem uma percentagem média nacional de 57.75%. Profissionais: São, na sua maioria, do sexo feminino (69.01%), com idades entre os 25 e os 56 anos (média 38.9, ± 7.41). Pertencem, maioritariamente, aos grupos profissionais da enfermagem (23.94%) e da psicologia (49.30%). A formação dos profissionais é de nível superior em todos os grupos, com uma percentagem total de licenciados de 80.3%, tendo os restantes uma formação ao nível do mestrado. Apesar dos valores baixos (17%) de formação prévia em modelos de gestão de cuidados, 39% dos profissionais indicou utilizar algumas vertentes destes modelos na sua prática. Apesar de 97,18% dos profissionais ter participado em dois ou mais encontros científicos, num período de dois anos, apenas 38.03% apresentou alguma comunicação científica no mesmo intervalo. Guideline: Os resultados da avaliação da guideline do MGC indicaram percentagens mais altas, quanto à qualidade do seu desenvolvimento, nos Domínios 1 (Objectivo e finalidade, com 72.2%) e 4 (Clareza de Apresentação, 77.7%). O Domínio 5 (Aplicabilidade) foi pontuado no limite inferior do desenvolvimento com qualidade suficiente (54.1%), ao passo que a guideline obteve uma pontuação negativa nos Domínios 2 (Envolvimento das partes interessadas, com 41.6%) e 3 (Rigor do Desenvolvimento, com 28.1%). Adicionalmente não foi possível às avaliadoras cotar o Domínio 6 (Independência editorial), por ausência de referências neste contexto. A guideline teve uma avaliação global positiva (66%), com recomendação de aceitação com modificações. Cultura Organizacional: O perfil de liderança com maior frequência nos serviços de saúde mental portugueses foi o de Mentor (45.61%). As percentagens mais baixas pertenceram aos perfis Monitor e Inovador (3.51%). Na perspectiva da cultura organizacional dos serviços, apontuação mais alta foi a da Cultura das Relações Humanas (74.07%). A estratégia de liderança, com predomínio em todas as regiões, foi a estratégia de Flexibilidade (66.10%). Os resultados mostram que a única associação positivamente significativa com o grau da implementação do MGC é a do perfil Produtor, com um peso específico de 14.55% na prevalência dos perfis de liderança nos serviços de saúde mental portugueses. Barreiras: As barreiras à implementação da prática do MGC, identificadas pelos profissionais dos serviços de saúde mental, com percentagens mais altas nos totais do país, foram: o tempo (57.7%), o conhecimento sobre o modelo e a motivação (40.8%), a colaboração dos outros profissionais (33.7%), o número de contactos reduzidos com os doentes (35.2%), as insuficiências do ponto de vista dos espaços (70.4%) e dos instrumentos disponíveis (69%) para implementar o MGC. Existiu uma variação entre as regiões de saúde do país. Os resultados mostram que houve uma correlação negativa, de forma significativa, entre a implementação do MGC e as barreiras: da resistência à utilização de protocolos, do formato da prática, da necessidade de mais treino e da não cooperação dos profissionais. Foram encontradas diferenças estatisticamente significativas entre as barreiras à implementação e as características dos serviços, dos profissionais e da cultura organizacional. Implementação: A média nacional da fidelidade de implementação do MGC (41.48) teve valores aproximados aos de estudos similares. Na pontuação por regiões, a implementação com maior fidelidade ocorreu no Alentejo. Se considerarmos a implementação com fidelidade esta ocorreu em 57.75% dos serviços e uma boa implementação em 15.49%. Os métodos de regressão permitiram confirmar a capacidade preditiva das barreiras e da cultura organizacional quanto à fidelidade da implementação do MGC. Discussão: No universo das hipóteses inicialmente colocadas foi possível verificar a variação da implementação do MGC entre as regiões do país. O estudo permitiu, adicionalmente, concluir pela existência de denominadores comuns de maior sucesso da implementação do MGC. Foi ainda possível verificar uma relação significativa, existente entre o grau de implementação e as dimensões das barreiras, a cultura organizacional e os recursos dos SSM (aqui definidos pelas características dos serviços e dos profissionais). De uma forma mais conclusiva podemos afirmar que existem outros factores, que não estão relacionados com a avaliação restrita dos recursos financeiros ou humanos, associados à qualidade da implementação de práticas baseadas na evidência, como o MGC. Exemplo disso são os achados referentes à região de saúde do Alentejo, onde a distância dos grandes centros urbanos e as conhecidas dificuldades de acessibilidade, combinadas com os problemas conhecidos da falta de recursos, não impediram que fosse a região com os valores mais altos da fidelidade de implementação. Conclusões: Foram encontradas inúmeras barreiras à implementação do MGC. Existem barreiras diferentes entre regiões, que resultam das características dos serviços, dos profissionais e da cultura organizacional. Para existir implementação é necessária a consideração de metodologias próprias que vão para além dos tradicionais programas de formação. As práticas baseadas na evidência, amplamente defendidas, exigem implementações baseadas na evidência.-------------ABSTRACT: Introduction - Several epidemiological studies show that, despite all scientific progress, many people still continue to have no access to mental health services and in many situations the quality of care is poor. The experiences of several countries show that progress towards case management implementation is slow and complex, depending not only from the degree of effectiveness or the complexity of the practice. Case management is defined as an evidence-based practice used to help patients in the recovery process. Strategies to implement evidence-based practices are critical to services improvement. There are many barriers to their implementation, despite all available evidence. Realising that practices of proved scientific value are far from being clearly implemented, justifies the need to use implementation methodologies that, beyond practice effectiveness, allow implementation effectiveness. To answer training needs and in the framework of the National Mental Health Plan implementation, 170 mental health (MH) professionals from portuguese public and private sectors were trained. Considering that case management skills were acquired, as a result of this training programme, we decided to study the degree of implementation in the services.Barriers and facilitators to the implementation were studied as well. There are several studies related with barriers and facilitators to the implementation of evidence-based practices, but most of them use semi-structured interviews with professionals. Additionally, there are no studies in Portugal related with barriers and facilitators to the implementation of mental health practices. Objectives1. Estimate the degree of case management implementation in Portuguese MH Services. 2.Describe regions where implementation occurred with higher fidelity degree. 3. Identify barriers and facilitators to case management implementation across country regions. 4. Explore the relationships between implementation, barriers and facilitators, organisational culture and services characteristics. Methodology - Cross sectional, descriptive study. Assessments - Implementation fidelity - IMR-S (Illness Management and Recovery Scale); Guideline quality - AGREE II-PT (Appraisal of Guidelines, for Research and Evaluation); Barriers and facilitators assessment - BaFAI (Barriers and Facilitators Assessment Instrument); Organisational culture assessment - CVF-I (Competing Values Framework Instrument). Statistical analysis - Descriptives and cross-tabs. Subgroups comparison: Mann-Witney and Kruskall-Wallis. Associations between variables were calculated using Spearman correlation's and Multiple Regression. Results - Services: Liaison with primary care is done in most services (56.34%) and 77.46% have autonomy to determine care. Most services have regular clinical meetings and almost all give internship training (95.77%). Research activity is low compared with other European countries, for both general and psychosocial research. Considering key components for the case management implementation, 66.20% of all services use single clinical records. The use of individual care plans is globally low (46.48%) and there is a use of guidelines in 57.75% of services. Human Resources: most are women (69.01%), with age ranging from 25-56 (average 39.9, SD 7.41). The majority are psychologists (49.30%) and nurses (23.94%). All have a university degree, 19.7% have a masters degree and 83% didn’t have any case management training before the above mentioned national training. Despite the low levels of preceding case management training, 39% have used model components in day-to-day practice and although 97.18% of the workforce have attended scientific meetings in the last 2 years, only 38.03% presented communications in the same period. Guideline: Results show that higher scores were obtained in Domain 1. Scope and Purpose (72.2.%),and Domain 4. Clarity of presentation (77.7%). Domain 5. pplicability scored near low boundary (54.1%) and negative scores were found in Domain 2. Stakeholder Involvement (41.6%) and Domain 3. Rigour of Development (28.1%). Global score was 66% and the guideline was recommended with modifications. Organisational Culture: The most frequent leadership profile was the Mentor profile (45.61%). Lower scores belonged to Innovator and Monitor profiles (3.51%). On the organisational culture overall, higher scores were found in the Human Relations culture (74.07%). The higher leadership strategy was the strategy of flexibility (66.10%). The results additionally showed that the only leadership profile associated with case management implementation was the Producer profile, representing 14.55% of all leadership profiles in the country.Barriers: The barriers identified by MH professionals, with high percentages, were: lack of time (57.7%), knowledge and motivation (40.8%), other colleagues cooperation (33.7%), low number of contacts with patients (35.2%), lack of facilities (70.4%) and lack of instruments (69%) to implement case management, varying across regions. Results show that there was a negative correlation between implementation and the following barriers: using protocols, practice format, need for more training and lack of cooperation from colleagues. Additionally, statistical differences were found between barriers to implementation and: services characteristics, workforce characteristics, organisational culture. Implementation: The national average results of case management implementation fidelity was (41.48), close to values found in similar studies. In the regional scores South Region Alentejo had the highest implementation score. If we look at minimum scores to assume implementation fidelity, these occurred in 57.75% of services and a good implementation occurred in 15.49% of these. Regression methods allowed to confirm that implementation score prediction was possible using the combination of barriers and organisational culture scores. Discussion - Considering the initial study hypotheses, it was possible to confirm the variation of case management implementation across country regions. Additionally, we could conclude that common denominators exist when successful implementation occurred. It was possible to observe a significant relationship between implementation degree and the dimensions of barriers, organisational culture and services resources (defined as professionals and services characteristics). In a more conclusive way, we can say that there are factors, other than financial and human resources, that are associated with evidence based practices implementation like case management. An example is the Alentejo region, were the distance from urban centres, and the known difficulties associated with accessibility, plus the lack of financial and human resources, have not impeded the regional higher score on implementation. Conclusions: Case management implementation had several barriers to implementation. There are different barriers across country regions, resulting from organisational culture, services and professionals characteristics. To reach implementation it is necessary to consider specific methodologies that go beyond traditional training programs and evident practices, widely promoted. Evidence-based practices require evidence-based implementations.

Análise dos fatores para implantação de estratégias na perspectiva de gerentes de nível médio de um grande banco nacional

No campo de “Estratégia Empresarial”, diversos estudos dos anos 1990 e 2000 tratam de como as estratégias devem ser formuladas para garantir o sucesso das organizações. Porém, nesse mesmo período, apenas alguns deles se debruçaram sobre o tema modelos e obstáculos na implantação das estratégias. Considerando que os gerentes médios são parte fundamental no sucesso da implantação das estratégias organizacionais, essa dissertação tem como objeto identificar o que motiva e influencia a atuação desses profissionais na condução da equipe e assimilação das diretrizes da empresa. Por meio de entrevistas estruturadas com gerentes médios de um grande banco nacional, esse trabalho apresenta uma investigação empírica e identifica os pontos de convergência e divergência dos entrevistados com a literatura de implantação de estratégia. Retomando as pesquisas de Hornsby (2002), Okumus (2001), Noble (1999), Littler (2000) entre outros autores, verificou-se que a visão dos gerentes médios converge e aprofunda os pontos apresentados na literatura como fundamentais na implantação das estratégias tais como: comunicação transacional, frequente, descentralizada; processos de implantação mais abrangentes, com abordagem qualitativa; alta gestão mais participativa na execução das estratégias, ambiente favorável a mudança, possibilidade de se assumir riscos e definição clara dos papéis e dos ganhos de cada membro no projeto

Side-Channel Attack Protection Techniques in FPGA Systems using Enhanced Dual-Rail Solutions

Esta tesis doctoral se centra principalmente en técnicas de ataque y contramedidas relacionadas con ataques de canal lateral (SCA por sus siglas en inglés), que han sido propuestas dentro del campo de investigación académica desde hace 17 años. Las investigaciones relacionadas han experimentado un notable crecimiento en las últimas décadas, mientras que los diseños enfocados en la protección sólida y eficaz contra dichos ataques aún se mantienen como un tema de investigación abierto, en el que se necesitan iniciativas más confiables para la protección de la información persona de empresa y de datos nacionales. El primer uso documentado de codificación secreta se remonta a alrededor de 1700 B.C., cuando los jeroglíficos del antiguo Egipto eran descritos en las inscripciones. La seguridad de la información siempre ha supuesto un factor clave en la transmisión de datos relacionados con inteligencia diplomática o militar. Debido a la evolución rápida de las técnicas modernas de comunicación, soluciones de cifrado se incorporaron por primera vez para garantizar la seguridad, integridad y confidencialidad de los contextos de transmisión a través de cables sin seguridad o medios inalámbricos. Debido a las restricciones de potencia de cálculo antes de la era del ordenador, la técnica de cifrado simple era un método más que suficiente para ocultar la información. Sin embargo, algunas vulnerabilidades algorítmicas pueden ser explotadas para restaurar la regla de codificación sin mucho esfuerzo. Esto ha motivado nuevas investigaciones en el área de la criptografía, con el fin de proteger el sistema de información ante sofisticados algoritmos. Con la invención de los ordenadores se ha acelerado en gran medida la implementación de criptografía segura, que ofrece resistencia eficiente encaminada a obtener mayores capacidades de computación altamente reforzadas. Igualmente, sofisticados cripto-análisis han impulsado las tecnologías de computación. Hoy en día, el mundo de la información ha estado involucrado con el campo de la criptografía, enfocada a proteger cualquier campo a través de diversas soluciones de cifrado. Estos enfoques se han fortalecido debido a la unificación optimizada de teorías matemáticas modernas y prácticas eficaces de hardware, siendo posible su implementación en varias plataformas (microprocesador, ASIC, FPGA, etc.). Las necesidades y requisitos de seguridad en la industria son las principales métricas de conducción en el diseño electrónico, con el objetivo de promover la fabricación de productos de gran alcance sin sacrificar la seguridad de los clientes. Sin embargo, una vulnerabilidad en la implementación práctica encontrada por el Prof. Paul Kocher, et al en 1996 implica que un circuito digital es inherentemente vulnerable a un ataque no convencional, lo cual fue nombrado posteriormente como ataque de canal lateral, debido a su fuente de análisis. Sin embargo, algunas críticas sobre los algoritmos criptográficos teóricamente seguros surgieron casi inmediatamente después de este descubrimiento. En este sentido, los circuitos digitales consisten típicamente en un gran número de celdas lógicas fundamentales (como MOS - Metal Oxide Semiconductor), construido sobre un sustrato de silicio durante la fabricación. La lógica de los circuitos se realiza en función de las innumerables conmutaciones de estas células. Este mecanismo provoca inevitablemente cierta emanación física especial que puede ser medida y correlacionada con el comportamiento interno del circuito. SCA se puede utilizar para revelar datos confidenciales (por ejemplo, la criptografía de claves), analizar la arquitectura lógica, el tiempo e incluso inyectar fallos malintencionados a los circuitos que se implementan en sistemas embebidos, como FPGAs, ASICs, o tarjetas inteligentes. Mediante el uso de la comparación de correlación entre la cantidad de fuga estimada y las fugas medidas de forma real, información confidencial puede ser reconstruida en mucho menos tiempo y computación. Para ser precisos, SCA básicamente cubre una amplia gama de tipos de ataques, como los análisis de consumo de energía y radiación ElectroMagnética (EM). Ambos se basan en análisis estadístico y, por lo tanto, requieren numerosas muestras. Los algoritmos de cifrado no están intrínsecamente preparados para ser resistentes ante SCA. Es por ello que se hace necesario durante la implementación de circuitos integrar medidas que permitan camuflar las fugas a través de "canales laterales". Las medidas contra SCA están evolucionando junto con el desarrollo de nuevas técnicas de ataque, así como la continua mejora de los dispositivos electrónicos. Las características físicas requieren contramedidas sobre la capa física, que generalmente se pueden clasificar en soluciones intrínsecas y extrínsecas. Contramedidas extrínsecas se ejecutan para confundir la fuente de ataque mediante la integración de ruido o mala alineación de la actividad interna. Comparativamente, las contramedidas intrínsecas están integradas en el propio algoritmo, para modificar la aplicación con el fin de minimizar las fugas medibles, o incluso hacer que dichas fugas no puedan ser medibles. Ocultación y Enmascaramiento son dos técnicas típicas incluidas en esta categoría. Concretamente, el enmascaramiento se aplica a nivel algorítmico, para alterar los datos intermedios sensibles con una máscara de manera reversible. A diferencia del enmascaramiento lineal, las operaciones no lineales que ampliamente existen en criptografías modernas son difíciles de enmascarar. Dicho método de ocultación, que ha sido verificado como una solución efectiva, comprende principalmente la codificación en doble carril, que está ideado especialmente para aplanar o eliminar la fuga dependiente de dato en potencia o en EM. En esta tesis doctoral, además de la descripción de las metodologías de ataque, se han dedicado grandes esfuerzos sobre la estructura del prototipo de la lógica propuesta, con el fin de realizar investigaciones enfocadas a la seguridad sobre contramedidas de arquitectura a nivel lógico. Una característica de SCA reside en el formato de las fuentes de fugas. Un típico ataque de canal lateral se refiere al análisis basado en la potencia, donde la capacidad fundamental del transistor MOS y otras capacidades parásitas son las fuentes esenciales de fugas. Por lo tanto, una lógica robusta resistente a SCA debe eliminar o mitigar las fugas de estas micro-unidades, como las puertas lógicas básicas, los puertos I/O y las rutas. Las herramientas EDA proporcionadas por los vendedores manipulan la lógica desde un nivel más alto, en lugar de realizarlo desde el nivel de puerta, donde las fugas de canal lateral se manifiestan. Por lo tanto, las implementaciones clásicas apenas satisfacen estas necesidades e inevitablemente atrofian el prototipo. Por todo ello, la implementación de un esquema de diseño personalizado y flexible ha de ser tomado en cuenta. En esta tesis se presenta el diseño y la implementación de una lógica innovadora para contrarrestar SCA, en la que se abordan 3 aspectos fundamentales: I. Se basa en ocultar la estrategia sobre el circuito en doble carril a nivel de puerta para obtener dinámicamente el equilibrio de las fugas en las capas inferiores; II. Esta lógica explota las características de la arquitectura de las FPGAs, para reducir al mínimo el gasto de recursos en la implementación; III. Se apoya en un conjunto de herramientas asistentes personalizadas, incorporadas al flujo genérico de diseño sobre FPGAs, con el fin de manipular los circuitos de forma automática. El kit de herramientas de diseño automático es compatible con la lógica de doble carril propuesta, para facilitar la aplicación práctica sobre la familia de FPGA del fabricante Xilinx. En este sentido, la metodología y las herramientas son flexibles para ser extendido a una amplia gama de aplicaciones en las que se desean obtener restricciones mucho más rígidas y sofisticadas a nivel de puerta o rutado. En esta tesis se realiza un gran esfuerzo para facilitar el proceso de implementación y reparación de lógica de doble carril genérica. La viabilidad de las soluciones propuestas es validada mediante la selección de algoritmos criptográficos ampliamente utilizados, y su evaluación exhaustiva en comparación con soluciones anteriores. Todas las propuestas están respaldadas eficazmente a través de ataques experimentales con el fin de validar las ventajas de seguridad del sistema. El presente trabajo de investigación tiene la intención de cerrar la brecha entre las barreras de implementación y la aplicación efectiva de lógica de doble carril. En esencia, a lo largo de esta tesis se describirá un conjunto de herramientas de implementación para FPGAs que se han desarrollado para trabajar junto con el flujo de diseño genérico de las mismas, con el fin de lograr crear de forma innovadora la lógica de doble carril. Un nuevo enfoque en el ámbito de la seguridad en el cifrado se propone para obtener personalización, automatización y flexibilidad en el prototipo de circuito de bajo nivel con granularidad fina. Las principales contribuciones del presente trabajo de investigación se resumen brevemente a continuación: Lógica de Precharge Absorbed-DPL logic: El uso de la conversión de netlist para reservar LUTs libres para ejecutar la señal de precharge y Ex en una lógica DPL. Posicionamiento entrelazado Row-crossed con pares idénticos de rutado en redes de doble carril, lo que ayuda a aumentar la resistencia frente a la medición EM selectiva y mitigar los impactos de las variaciones de proceso. Ejecución personalizada y herramientas de conversión automática para la generación de redes idénticas para la lógica de doble carril propuesta. (a) Para detectar y reparar conflictos en las conexiones; (b) Detectar y reparar las rutas asimétricas. (c) Para ser utilizado en otras lógicas donde se requiere un control estricto de las interconexiones en aplicaciones basadas en Xilinx. Plataforma CPA de pruebas personalizadas para el análisis de EM y potencia, incluyendo la construcción de dicha plataforma, el método de medición y análisis de los ataques. Análisis de tiempos para cuantificar los niveles de seguridad. División de Seguridad en la conversión parcial de un sistema de cifrado complejo para reducir los costes de la protección. Prueba de concepto de un sistema de calefacción auto-adaptativo para mitigar los impactos eléctricos debido a la variación del proceso de silicio de manera dinámica. La presente tesis doctoral se encuentra organizada tal y como se detalla a continuación: En el capítulo 1 se abordan los fundamentos de los ataques de canal lateral, que abarca desde conceptos básicos de teoría de modelos de análisis, además de la implementación de la plataforma y la ejecución de los ataques. En el capítulo 2 se incluyen las estrategias de resistencia SCA contra los ataques de potencia diferencial y de EM. Además de ello, en este capítulo se propone una lógica en doble carril compacta y segura como contribución de gran relevancia, así como también se presentará la transformación lógica basada en un diseño a nivel de puerta. Por otra parte, en el Capítulo 3 se abordan los desafíos relacionados con la implementación de lógica en doble carril genérica. Así mismo, se describirá un flujo de diseño personalizado para resolver los problemas de aplicación junto con una herramienta de desarrollo automático de aplicaciones propuesta, para mitigar las barreras de diseño y facilitar los procesos. En el capítulo 4 se describe de forma detallada la elaboración e implementación de las herramientas propuestas. Por otra parte, la verificación y validaciones de seguridad de la lógica propuesta, así como un sofisticado experimento de verificación de la seguridad del rutado, se describen en el capítulo 5. Por último, un resumen de las conclusiones de la tesis y las perspectivas como líneas futuras se incluyen en el capítulo 6. Con el fin de profundizar en el contenido de la tesis doctoral, cada capítulo se describe de forma más detallada a continuación: En el capítulo 1 se introduce plataforma de implementación hardware además las teorías básicas de ataque de canal lateral, y contiene principalmente: (a) La arquitectura genérica y las características de la FPGA a utilizar, en particular la Xilinx Virtex-5; (b) El algoritmo de cifrado seleccionado (un módulo comercial Advanced Encryption Standard (AES)); (c) Los elementos esenciales de los métodos de canal lateral, que permiten revelar las fugas de disipación correlacionadas con los comportamientos internos; y el método para recuperar esta relación entre las fluctuaciones físicas en los rastros de canal lateral y los datos internos procesados; (d) Las configuraciones de las plataformas de pruebas de potencia / EM abarcadas dentro de la presente tesis. El contenido de esta tesis se amplia y profundiza a partir del capítulo 2, en el cual se abordan varios aspectos claves. En primer lugar, el principio de protección de la compensación dinámica de la lógica genérica de precarga de doble carril (Dual-rail Precharge Logic-DPL) se explica mediante la descripción de los elementos compensados a nivel de puerta. En segundo lugar, la lógica PA-DPL es propuesta como aportación original, detallando el protocolo de la lógica y un caso de aplicación. En tercer lugar, dos flujos de diseño personalizados se muestran para realizar la conversión de doble carril. Junto con ello, se aclaran las definiciones técnicas relacionadas con la manipulación por encima de la netlist a nivel de LUT. Finalmente, una breve discusión sobre el proceso global se aborda en la parte final del capítulo. El Capítulo 3 estudia los principales retos durante la implementación de DPLs en FPGAs. El nivel de seguridad de las soluciones de resistencia a SCA encontradas en el estado del arte se ha degenerado debido a las barreras de implantación a través de herramientas EDA convencionales. En el escenario de la arquitectura FPGA estudiada, se discuten los problemas de los formatos de doble carril, impactos parásitos, sesgo tecnológico y la viabilidad de implementación. De acuerdo con estas elaboraciones, se plantean dos problemas: Cómo implementar la lógica propuesta sin penalizar los niveles de seguridad, y cómo manipular un gran número de celdas y automatizar el proceso. El PA-DPL propuesto en el capítulo 2 se valida con una serie de iniciativas, desde características estructurales como doble carril entrelazado o redes de rutado clonadas, hasta los métodos de aplicación tales como las herramientas de personalización y automatización de EDA. Por otra parte, un sistema de calefacción auto-adaptativo es representado y aplicado a una lógica de doble núcleo, con el fin de ajustar alternativamente la temperatura local para equilibrar los impactos negativos de la variación del proceso durante la operación en tiempo real. El capítulo 4 se centra en los detalles de la implementación del kit de herramientas. Desarrollado sobre una API third-party, el kit de herramientas personalizado es capaz de manipular los elementos de la lógica de circuito post P&R ncd (una versión binaria ilegible del xdl) convertido al formato XDL Xilinx. El mecanismo y razón de ser del conjunto de instrumentos propuestos son cuidadosamente descritos, que cubre la detección de enrutamiento y los enfoques para la reparación. El conjunto de herramientas desarrollado tiene como objetivo lograr redes de enrutamiento estrictamente idénticos para la lógica de doble carril, tanto para posicionamiento separado como para el entrelazado. Este capítulo particularmente especifica las bases técnicas para apoyar las implementaciones en los dispositivos de Xilinx y su flexibilidad para ser utilizado sobre otras aplicaciones. El capítulo 5 se enfoca en la aplicación de los casos de estudio para la validación de los grados de seguridad de la lógica propuesta. Se discuten los problemas técnicos detallados durante la ejecución y algunas nuevas técnicas de implementación. (a) Se discute el impacto en el proceso de posicionamiento de la lógica utilizando el kit de herramientas propuesto. Diferentes esquemas de implementación, tomando en cuenta la optimización global en seguridad y coste, se verifican con los experimentos con el fin de encontrar los planes de posicionamiento y reparación optimizados; (b) las validaciones de seguridad se realizan con los métodos de correlación y análisis de tiempo; (c) Una táctica asintótica se aplica a un núcleo AES sobre BCDL estructurado para validar de forma sofisticada el impacto de enrutamiento sobre métricas de seguridad; (d) Los resultados preliminares utilizando el sistema de calefacción auto-adaptativa sobre la variación del proceso son mostrados; (e) Se introduce una aplicación práctica de las herramientas para un diseño de cifrado completa. Capítulo 6 incluye el resumen general del trabajo presentado dentro de esta tesis doctoral. Por último, una breve perspectiva del trabajo futuro se expone, lo que puede ampliar el potencial de utilización de las contribuciones de esta tesis a un alcance más allá de los dominios de la criptografía en FPGAs. ABSTRACT This PhD thesis mainly concentrates on countermeasure techniques related to the Side Channel Attack (SCA), which has been put forward to academic exploitations since 17 years ago. The related research has seen a remarkable growth in the past decades, while the design of solid and efficient protection still curiously remain as an open research topic where more reliable initiatives are required for personal information privacy, enterprise and national data protections. The earliest documented usage of secret code can be traced back to around 1700 B.C., when the hieroglyphs in ancient Egypt are scribed in inscriptions. Information security always gained serious attention from diplomatic or military intelligence transmission. Due to the rapid evolvement of modern communication technique, crypto solution was first incorporated by electronic signal to ensure the confidentiality, integrity, availability, authenticity and non-repudiation of the transmitted contexts over unsecure cable or wireless channels. Restricted to the computation power before computer era, simple encryption tricks were practically sufficient to conceal information. However, algorithmic vulnerabilities can be excavated to restore the encoding rules with affordable efforts. This fact motivated the development of modern cryptography, aiming at guarding information system by complex and advanced algorithms. The appearance of computers has greatly pushed forward the invention of robust cryptographies, which efficiently offers resistance relying on highly strengthened computing capabilities. Likewise, advanced cryptanalysis has greatly driven the computing technologies in turn. Nowadays, the information world has been involved into a crypto world, protecting any fields by pervasive crypto solutions. These approaches are strong because of the optimized mergence between modern mathematical theories and effective hardware practices, being capable of implement crypto theories into various platforms (microprocessor, ASIC, FPGA, etc). Security needs from industries are actually the major driving metrics in electronic design, aiming at promoting the construction of systems with high performance without sacrificing security. Yet a vulnerability in practical implementation found by Prof. Paul Kocher, et al in 1996 implies that modern digital circuits are inherently vulnerable to an unconventional attack approach, which was named as side-channel attack since then from its analysis source. Critical suspicions to theoretically sound modern crypto algorithms surfaced almost immediately after this discovery. To be specifically, digital circuits typically consist of a great number of essential logic elements (as MOS - Metal Oxide Semiconductor), built upon a silicon substrate during the fabrication. Circuit logic is realized relying on the countless switch actions of these cells. This mechanism inevitably results in featured physical emanation that can be properly measured and correlated with internal circuit behaviors. SCAs can be used to reveal the confidential data (e.g. crypto-key), analyze the logic architecture, timing and even inject malicious faults to the circuits that are implemented in hardware system, like FPGA, ASIC, smart Card. Using various comparison solutions between the predicted leakage quantity and the measured leakage, secrets can be reconstructed at much less expense of time and computation. To be precisely, SCA basically encloses a wide range of attack types, typically as the analyses of power consumption or electromagnetic (EM) radiation. Both of them rely on statistical analyses, and hence require a number of samples. The crypto algorithms are not intrinsically fortified with SCA-resistance. Because of the severity, much attention has to be taken into the implementation so as to assemble countermeasures to camouflage the leakages via "side channels". Countermeasures against SCA are evolving along with the development of attack techniques. The physical characteristics requires countermeasures over physical layer, which can be generally classified into intrinsic and extrinsic vectors. Extrinsic countermeasures are executed to confuse the attacker by integrating noise, misalignment to the intra activities. Comparatively, intrinsic countermeasures are built into the algorithm itself, to modify the implementation for minimizing the measurable leakage, or making them not sensitive any more. Hiding and Masking are two typical techniques in this category. Concretely, masking applies to the algorithmic level, to alter the sensitive intermediate values with a mask in reversible ways. Unlike the linear masking, non-linear operations that widely exist in modern cryptographies are difficult to be masked. Approved to be an effective counter solution, hiding method mainly mentions dual-rail logic, which is specially devised for flattening or removing the data-dependent leakage in power or EM signatures. In this thesis, apart from the context describing the attack methodologies, efforts have also been dedicated to logic prototype, to mount extensive security investigations to countermeasures on logic-level. A characteristic of SCA resides on the format of leak sources. Typical side-channel attack concerns the power based analysis, where the fundamental capacitance from MOS transistors and other parasitic capacitances are the essential leak sources. Hence, a robust SCA-resistant logic must eliminate or mitigate the leakages from these micro units, such as basic logic gates, I/O ports and routings. The vendor provided EDA tools manipulate the logic from a higher behavioral-level, rather than the lower gate-level where side-channel leakage is generated. So, the classical implementations barely satisfy these needs and inevitably stunt the prototype. In this case, a customized and flexible design scheme is appealing to be devised. This thesis profiles an innovative logic style to counter SCA, which mainly addresses three major aspects: I. The proposed logic is based on the hiding strategy over gate-level dual-rail style to dynamically overbalance side-channel leakage from lower circuit layer; II. This logic exploits architectural features of modern FPGAs, to minimize the implementation expenses; III. It is supported by a set of assistant custom tools, incorporated by the generic FPGA design flow, to have circuit manipulations in an automatic manner. The automatic design toolkit supports the proposed dual-rail logic, facilitating the practical implementation on Xilinx FPGA families. While the methodologies and the tools are flexible to be expanded to a wide range of applications where rigid and sophisticated gate- or routing- constraints are desired. In this thesis a great effort is done to streamline the implementation workflow of generic dual-rail logic. The feasibility of the proposed solutions is validated by selected and widely used crypto algorithm, for thorough and fair evaluation w.r.t. prior solutions. All the proposals are effectively verified by security experiments. The presented research work attempts to solve the implementation troubles. The essence that will be formalized along this thesis is that a customized execution toolkit for modern FPGA systems is developed to work together with the generic FPGA design flow for creating innovative dual-rail logic. A method in crypto security area is constructed to obtain customization, automation and flexibility in low-level circuit prototype with fine-granularity in intractable routings. Main contributions of the presented work are summarized next: Precharge Absorbed-DPL logic: Using the netlist conversion to reserve free LUT inputs to execute the Precharge and Ex signal in a dual-rail logic style. A row-crossed interleaved placement method with identical routing pairs in dual-rail networks, which helps to increase the resistance against selective EM measurement and mitigate the impacts from process variations. Customized execution and automatic transformation tools for producing identical networks for the proposed dual-rail logic. (a) To detect and repair the conflict nets; (b) To detect and repair the asymmetric nets. (c) To be used in other logics where strict network control is required in Xilinx scenario. Customized correlation analysis testbed for EM and power attacks, including the platform construction, measurement method and attack analysis. A timing analysis based method for quantifying the security grades. A methodology of security partitions of complex crypto systems for reducing the protection cost. A proof-of-concept self-adaptive heating system to mitigate electrical impacts over process variations in dynamic dual-rail compensation manner. The thesis chapters are organized as follows: Chapter 1 discusses the side-channel attack fundamentals, which covers from theoretic basics to analysis models, and further to platform setup and attack execution. Chapter 2 centers to SCA-resistant strategies against generic power and EM attacks. In this chapter, a major contribution, a compact and secure dual-rail logic style, will be originally proposed. The logic transformation based on bottom-layer design will be presented. Chapter 3 is scheduled to elaborate the implementation challenges of generic dual-rail styles. A customized design flow to solve the implementation problems will be described along with a self-developed automatic implementation toolkit, for mitigating the design barriers and facilitating the processes. Chapter 4 will originally elaborate the tool specifics and construction details. The implementation case studies and security validations for the proposed logic style, as well as a sophisticated routing verification experiment, will be described in Chapter 5. Finally, a summary of thesis conclusions and perspectives for future work are included in Chapter 5. To better exhibit the thesis contents, each chapter is further described next: Chapter 1 provides the introduction of hardware implementation testbed and side-channel attack fundamentals, and mainly contains: (a) The FPGA generic architecture and device features, particularly of Virtex-5 FPGA; (b) The selected crypto algorithm - a commercially and extensively used Advanced Encryption Standard (AES) module - is detailed; (c) The essentials of Side-Channel methods are profiled. It reveals the correlated dissipation leakage to the internal behaviors, and the method to recover this relationship between the physical fluctuations in side-channel traces and the intra processed data; (d) The setups of the power/EM testing platforms enclosed inside the thesis work are given. The content of this thesis is expanded and deepened from chapter 2, which is divided into several aspects. First, the protection principle of dynamic compensation of the generic dual-rail precharge logic is explained by describing the compensated gate-level elements. Second, the novel DPL is originally proposed by detailing the logic protocol and an implementation case study. Third, a couple of custom workflows are shown next for realizing the rail conversion. Meanwhile, the technical definitions that are about to be manipulated above LUT-level netlist are clarified. A brief discussion about the batched process is given in the final part. Chapter 3 studies the implementation challenges of DPLs in FPGAs. The security level of state-of-the-art SCA-resistant solutions are decreased due to the implementation barriers using conventional EDA tools. In the studied FPGA scenario, problems are discussed from dual-rail format, parasitic impact, technological bias and implementation feasibility. According to these elaborations, two problems arise: How to implement the proposed logic without crippling the security level; and How to manipulate a large number of cells and automate the transformation. The proposed PA-DPL in chapter 2 is legalized with a series of initiatives, from structures to implementation methods. Furthermore, a self-adaptive heating system is depicted and implemented to a dual-core logic, assumed to alternatively adjust local temperature for balancing the negative impacts from silicon technological biases on real-time. Chapter 4 centers to the toolkit system. Built upon a third-party Application Program Interface (API) library, the customized toolkit is able to manipulate the logic elements from post P&R circuit (an unreadable binary version of the xdl one) converted to Xilinx xdl format. The mechanism and rationale of the proposed toolkit are carefully convoyed, covering the routing detection and repairing approaches. The developed toolkit aims to achieve very strictly identical routing networks for dual-rail logic both for separate and interleaved placement. This chapter particularly specifies the technical essentials to support the implementations in Xilinx devices and the flexibility to be expanded to other applications. Chapter 5 focuses on the implementation of the case studies for validating the security grades of the proposed logic style from the proposed toolkit. Comprehensive implementation techniques are discussed. (a) The placement impacts using the proposed toolkit are discussed. Different execution schemes, considering the global optimization in security and cost, are verified with experiments so as to find the optimized placement and repair schemes; (b) Security validations are realized with correlation, timing methods; (c) A systematic method is applied to a BCDL structured module to validate the routing impact over security metric; (d) The preliminary results using the self-adaptive heating system over process variation is given; (e) A practical implementation of the proposed toolkit to a large design is introduced. Chapter 6 includes the general summary of the complete work presented inside this thesis. Finally, a brief perspective for the future work is drawn which might expand the potential utilization of the thesis contributions to a wider range of implementation domains beyond cryptography on FPGAs.

Negative symptoms of schizophrenia and psychosocial treatment: thematic analysis of stakeholders’ perspectives

Objectives. Recent literature indicates variance in psychosocial treatment preferences for negative symptoms of schizophrenia. Attempts at defining therapeutic aims and outcomes for negative symptoms to date have not included major stakeholder groups. The aim of the present study was to address this gap through qualitative methods. Design. Thematic Analysis was applied to qualitative semi-structured interview data to gather the opinions of people who experience negative symptoms, carers, and healthcare professionals. Participants were recruited from two mental health sites (inpatient/community) to increase generalisability of results. Ten people participated in the research. Methods. Semi-structured interview scripts were designed utilising evidence from the review in Chapter 1 of effective psychosocial intervention components for specific negative symptoms. Interviews were audio recorded and transcribed verbatim. Thematic analysis was employed to analyse data. Results. A common theme across groups was the need for a personalised approach to intervention for negative symptoms. Other themes indicated different opinions in relation to treatment targets and the need for a sensitive and graded approach to all aspects of therapy. This approach needs to be supported across systemic levels of organisation with specific training needs for staff addressed. Conclusions. There is disparity in treatment preferences for negative symptoms across major stakeholders. The findings suggest an individualised approach to intervention of negative symptoms that is consistent with recovery. Implementation barriers and facilitators were identified and discussed. There remains a need to develop a better understanding of treatment preferences for patients.

Time- and Fluid-Sensitive Resuscitation for Hemodynamic Support of Children in Septic Shock Barriers to the Implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support Guidelines in a Pediatric Intensive Care Unit in a Developing World

Objectives: To analyze mortality rates of children with severe sepsis and septic shock in relation to time-sensitive fluid resuscitation and treatments received and to define barriers to the implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support guidelines in a pediatric intensive care unit in a developing country. Methods: Retrospective chart review and prospective analysis of septic shock treatment in a pediatric intensive care unit of a tertiary care teaching hospital. Ninety patients with severe sepsis or septic shock admitted between July 2002 and June 2003 were included in this study. Results: Of the 90 patients, 83% had septic shock and 17% had severe sepsis; 80 patients had preexisting severe chronic diseases. Patients with septic shock who received less than a 20-mL/kg dose of resuscitation fluid in the first hour of treatment had a mortality rate of 73%, whereas patients who received more than a 40-mL/kg dose in the first hour of treatment had a mortality rate of 33% (P < 0.05.) Patients treated less than 30 minutes after diagnosis of severe sepsis and septic shock had a significantly lower mortality rate (40%) than patients treated more than 60 Minutes after diagnosis (P < 0.05). Controlling for the risk of mortality, early fluid resuscitation was associated with a 3-fold reduction in the odds of death (odds ratio, 0.33; 95% confidence interval, 0.13-0.85). The most important barriers to achieve adequate severe sepsis and septic shock treatment were lack of adequate vascular access, lack of recognition of early shock, shortage of health care providers, and nonuse of goals and treatment protocols. Conclusions: The mortality rate was higher for children older than years, for those who received less than 40 mL/kg in the first hour, and for those whose treatment was not initiated in the first 30 Minutes after the diagnosis of septic shock. The acknowledgment of existing barriers to a timely fluid administration and the establishment of objectives to overcome these barriers may lead to a more successful implementation of the American College of Critical Care Medicine guidelines and reduced mortality rates for children with septic shock in the developing world.

How can we teach EBM in clinical practice? : an analysis of barriers to implementation of on-the-job EBM teaching and learning.

Introduction: Evidence-based medicine (EBM) improves the quality of health care. Courses on how to teach EBM in practice are available, but knowledge does not automatically imply its application in teaching. We aimed to identify and compare barriers and facilitators for teaching EBM in clinical practice in various European countries. Methods: A questionnaire was constructed listing potential barriers and facilitators for EBM teaching in clinical practice. Answers were reported on a 7-point Likert scale ranging from not at all being a barrier to being an insurmountable barrier. Results: The questionnaire was completed by 120 clinical EBM teachers from 11 countries. Lack of time was the strongest barrier for teaching EBM in practice (median 5). Moderate barriers were the lack of requirements for EBM skills and a pyramid hierarchy in health care management structure (median 4). In Germany, Hungary and Poland, reading and understanding articles in English was a higher barrier than in the other countries. Conclusion: Incorporation of teaching EBM in practice faces several barriers to implementation. Teaching EBM in clinical settings is most successful where EBM principles are culturally embedded and form part and parcel of everyday clinical decisions and medical practice.

Flipped classroom technology from teachers’ perspective: implementation experience, barriers and perspectives

Blended learning approaches rise their popularity, however not all professors apply them and find them useful and appropriate. This research focuses on study of flipped classroom arrangement and effectiveness of this concept implementation. The Master’s Thesis explores impact of flipped classroom implementation on resource savings for proffesors. The research is based on the literature review of different education arrangements and results of their implementation, on the survey conducted among proffesors from different Universities and on two experiments of flipped classroom implementation. The results reveal advantages and disadvantages of the concept, professors’ attitude to it and possibility to future research and practice in this field

Clinician-Perceived Bridges and Barriers to Parental Implementation of Picture Exchange Communication System (PECS): An evaluation.

Picture Exchange Communication System (PECS) is an augmentative and alternative communicative system that improves communication and decreases problem behaviors in children with Developmental Disabilities and Autism. The mediator model is a validated approach that clinicians use to train parents to perform evidence-based interventions. Parental non-adherence to treatment recommendations is a documented problem. This qualitative study investigated clinician-perceived factors that influence parental adherence to PECS recommendations. Three focus groups (n=8) were conducted with Speech Language Pathologists and Behavior Therapists experienced in providing parents with PECS recommendations. Constant comparison analysis was used. In general, clinicians believed that PECS was complex to implement. Thirty-one bridges were identified to overcome complexity. Twenty-two barriers and 6 other factors also impacted parental adherence. Strategies to address these factors were proposed based on a review of the literature. Future research will be performed to validate these findings using parents and a larger sample size.

Retrospective Exploration of the 3Rs Education Program: Systemic Facilitators and Barriers to Implementation

Individuals with intellectual disabilities (ID) have historically been denied basic rights and thus have been subjected to abuse. The 3Rs: Rights, Respect and Responsibility Human Rights Education Program was implemented and researched through a partnership with Community Living Welland Pelham and Brock University initially and then cascade training on the program was provided to five developmental service sector agencies from across the Niagara Region. This research evaluated the role of the 3Rs education program on the shift to a rights-based service agenda across those five agencies. Interviews were conducted with the Executive Director and Liaison staff from each of the agencies and a thematic analysis was used to describe factors that facilitated organizational changes and a cultural shift. Systemic barriers to the change were also explored. The results indicated that the 3Rs education program provides the catalyst necessary for the shift to a rights-based service agenda and that the resultant changes in practices now embedded in the organizations are reflective of a shift to a rights-based service agenda.