High Assurance Research Articles

VTrust: Remotely Executing Mobile Apps Transparently With Local Untrusted OS

Increasingly, many security and privacy sensitive applications (apps for short) are running in the mobile platforms. However, as the mobile operating systems are becoming increasingly sophisticated, they are vulnerable to various attacks. In addressing the need of running high assurance mobile apps in a secure environment even though the operating systems are untrusted, this paper presents VTRUST, a new mobile app trusted execution environment, which offloads the general execution and storage of a mobile app to a trusted remote server (e.g., a VM running in a cloud) and secures the I/O between the server and the mobile device with the aid of a trusted hypervisor on the mobile device. Specifically, VTRUST establishes an encrypted I/O channel between the local hypervisor and the remote server, such that any sensitive data flowing through the mobile OS, which is hosted by the hypervisor, is encrypted from the perspective of the local mobile OS. To enhance the performance of VTRUST, we have also designed multiple optimizations, such as output data compression and selective sensor data transmission. We have implemented VTRUST and our evaluation shows that it has limited impact on both user experience and the app performance.

The Use of Digital Technologies for the Purpose of Improving Methodological Approaches to the Creation of a Pharmaceutical Quality System at Enterprises for the Production of Medicines

Introduction. The article is devoted to the aspects of improving methodological approaches to the creation of a pharmaceutical quality system (PQS) at enterprises for the production of medicines, taking into account the possibility of using tools and means of digitalization. The relevance of the study is associated with the enduring importance of comprehensive high quality assurance in the development, production and release of medicines into circulation. The implementation of PQS requires numerous transformations of management and production processes, which can be facilitated by tools and elements of digitalization.Aim. To consider the potential and specific areas of application of digital technologies to improve the methodology and practice of developing and implementing PQS.Materials and methods. The state in the subject area was assessed on the basis of the results of economic and statistical analysis and forecasting of the implementation of PQS at Russian pharmaceutical enterprises that have positive and comparatively long experience in this area: the companies LLC "OZON" and JSC "AKRIKHIN". The assessment was carried out by calculating the integral indicator of the effectiveness of the functioning of PQS, which is a set of weighted key performance indicators (KPI) for quality.Results and discussion. The importance of the introduction of PQS for the development of pharmaceutical enterprises and the presence of numerous difficulties in the implementation of PQS, which necessitates the improvement of methodological approaches in the subject area, are stated. It has been proven that even at those enterprises where PQS has been introduced with varying degrees of success, the use of digitalization tools would contribute to a faster, more systematic and high-quality implementation of PQS. Among the key areas of application of digital tools, the authors propose monitoring of quality indicators (using neural network cards) and the use of blockchain platforms and smart contracts to register the release of drugs of appropriate quality.Conclusion. Digital tools contribute to complex improvement in many areas of socio-economic activity. Their active use at pharmaceutical enterprises is intended to contribute to ensuring the proper implementation and uninterrupted functioning of pharmaceutical quality systems, through constant monitoring of the quality of manufactured products and registration of manufactured batches in high-precision information storage systems.

A Verified Formal Specification of A Secured Communication Method For Smart Card Applications

In remote villages without access to modern IT technology, simple devices such as smartcards can be used to carry out business transactions. These devices typically store multiple business applications from multiple vendors. Although devices must prevent malicious or accidental security breaches among the applications, a secure communication channel between two applications from different vendors is often required. In this paper, first, we propose a method of establishing secure communication channels between applications in embedded operating systems that run on multi-applet smart cards. Second, we enforce the high assurance using an intransitive noninterference security policy. Thirdly, we formalize the method through the Z language and create the formal specification of the proposed secure system. Finally, we verify its correctness using Rushby's unwinding theorem.

Assurance quality, disclosed connectivity of the capitals and information asymmetry – An interaction analysis for the case of integrated reporting

PurposeCredibility concerns regarding integrated reports can harm the intended decrease of information asymmetry between a firm and its investors. Therefore, it is crucial to examine whether voluntary third-party assurance enhances the credibility of integrated reports and, thus, decreases information asymmetry. Furthermore, this study aims to investigate the interaction effect between assurance quality and the disclosed connectivity of the capitals, a distinguishing feature of integrated reports.Design/methodology/approachContent analysis is performed of the 176 assurance statements included in the 269 integrated reports of Forbes Global 2000 firms disclosed from 2013 to 2015 and the 269 integrated reports themselves. Regression analyzes are applied to examine the associations between assurance, the disclosed connectivity of the capitals and information asymmetry.FindingsThe presence of an assurance statement in an integrated report significantly decreases information asymmetry. Surprisingly, assurance quality is not significantly associated with information asymmetry. However, an interaction analysis reveals that combining high assurance quality with high disclosed connectivity of the capitals allows a significant decrease in information asymmetry.Research limitations/implicationsThe paper demonstrates that the connectivity of the capitals of integrated reports and assurance quality are connected and together are associated with information asymmetry.Practical implicationsThe results imply, both for report preparers and standard setters, that assurance quality is advantageous only when combined with disclosed connectivity of the capitals.Social implicationsMore information on non-financial information measured by the connectivity of the capitals of integrated reporting has an interaction effect together with assurance quality on information asymmetry.Originality/valueThis paper builds on a unique data set derived from the contents of integrated reports and accompanying assurance statements. Furthermore, it extends the integrated reporting literature by investigating the interaction between assurance quality and the disclosed connectivity of the capitals, which had not previously been examined in combination.

A Framework for Model and Verification of Safety-Critical Operating System Based on ARINC653

As the scale and complexity of safety-critical software continue to grow, it is necessary to ensure safety and reliability to avoid minor errors leading to catastrophic disasters. Meantime, the traditional method, such as testing and simulation alone is insufficient to ensure the correctness of systems. This leads to using formal methods to provide sufficient evidence for systems. However, design a high assurance safety-critical system by formal methods is challenging due to the complexity of operating systems. In addition, the traditional interactive theorem prover used in system verification requires hand-written proofs, which are more expensive. Therefore, the efforts of providing a standardized formal framework as well as safety proofs, are notable for the develop a safety-critical system. The purpose of this paper is to provide a safety framework to establish a highly reliable and safety-critical operating system based on the ARINC653 standard, a multilevel and standardized formal model. To verify the functional correctness of this model, we propose a context-based formal proof method for programs. To achieve this goal, we first model 57 core services of ARINC653 and define the high-level requirements as pre-and post-conditions. Then, we construct a set of specification statements a formal axiom system transformed into logical sentences, and the core service model is transformed into a logical sentence sequence to be proved. Finally, a context-based formal proof system for specification correctness is developed. We have verified the correctness of safety-critical operating system core services with this system. Experience shows that the verification system we developed can be achieved the functional correctness of a complete OS with a low implement burden, and that can simplify the difficulty of automated verification and increase the degree of automation of proof.

Development of a Performance Monitoring Instrument for Rating Explosives Search Dog Performance

The growing body of working dog literature includes many examples of scales robustly developed to measure aspects of dog behavior. However, when comparing behavior to working dog ability, most studies rely on training organizations' own long-established ratings of performance, or simply pass/fail at selection or certification as measures of success. Working ability is multifaceted, and it is likely that different aspects of ability are differentially affected by external factors. In order to understand how specific aspects of selection, training, and operations influence a dog's working ability, numerous facets of performance should be considered. An accurate and validated method for quantifying multiple aspects of performance is therefore required. Here, we describe the first stages of formulating a meaningful performance measurement tool for two types of working search dogs. The systematic methodology used was: (1) interviews and workshops with a representative cross-section of stakeholders to produce a shortlist of behaviors integral to current operational performance of vehicle (VS) and high assurance (HAS) search dogs; (2) assessing the reliability and construct validity of the shortlisted behavioral measures (at the behavior and the individual rater level) using ratings of diverse videoed searches by experienced personnel; and (3) selecting the most essential and meaningful behaviors based on their reliability/validity and importance. The resulting performance measurement tool was composed of 12 shortlisted behaviors, most of which proved reliable and valid when assessed by a group of raters. At the individual rater level, however, there was variability between raters in the ability to use and interpret behavioral measures, in particular, more abstract behaviors such as Independence. This illustrates the importance of examining individual rater scores rather than extrapolating from group consensus (as is often done), especially when designing a tool that will ultimately be used by single raters. For ratings to be practically valuable, individual rater reliability needs to be improved, especially for behaviors deemed as essential (e.g., control and confidence). We suggest that the next steps are to investigate why individuals vary in their ratings and to undertake efforts to increase the likelihood that they reach a common conceptualization of each behavioral construct. Plausible approaches are improving the format in which behaviors are presented, e.g., by adding benchmarks and utilizing rater training.

A goal‐driven approach for the joint deployment of safety and security standards for operators of essential services

SummaryDesigning safety‐critical software in domains ensuring essential services like transportation, energy, or health requires high assurance techniques and compliance with domain specific standards. As a result of the global interconnectivity and the evolution toward cyber‐physical systems, the increasing exposure to cyber threats calls for the adoption of cyber security standards and frameworks. Although safety and security have different cultures, both fields share similar concepts and tools and are worth being investigated together. This paper provides the background to understand emerging co‐engineering approaches. It advocates for the use of a model‐based approach to provide a sound risk‐oriented process and to capture rationales interconnecting top‐level standards/directives to concrete safety/security measures. We show the benefits of adopting goal‐oriented analysis that can be transposed later to domain‐specific frameworks. Both qualitative and quantitative reasoning aspects are analyzed and discussed, especially to support trade‐off analysis. Our work is driven by a representative case study in drinking water utility in the scope of the NIS regulation for operator of essential services.

Role-Based Profiling Using Fuzzy Adaptive Resonance Theory for Securing Database Systems

Very large amounts of time and effort have been invested by the research community working on database security to achieve high assurance of security and privacy. An important component of a secure database system is intrusion detection system which has the ability to successfully detect anomalous behavior caused by applications and users. However, modeling the normal behavior of a large number of users in a huge organization is quite infeasible and inefficient. The main purpose of this research investigation is thus to model the behavior of roles instead of users by applying adaptive resonance theory neural network. The observed behavior which deviates from any of the established role profiles is treated as malicious. The proposed model has the advantage of identifying insider threat and is applicable for large organizations as it is based on role profiling instead of user profiling. The proposed system is capable of detecting intrusion with high accuracy along with minimized false alarms.

RFID Tracking Implementation for Supplier Chain Management at Toyota USA: Proposal of Development of Advanced TPS for Global Production Strategy

In order to achieve simultaneous, worldwide high quality assurance and other global production developments, Advanced TPS was proposed as a global production technology and management model, especially designed to realize high productivity and cost performance in global production. On this model, the inventory management is the key method at any manufacturing facility operating with Just-in-Time (JIT). On the other hand, the current inventory systems at manufacturing facilities do not provide real inventory data. So out-of-stock conditions sometimes have caused major productivity losses by causing the production line to stop. Therefore, the authors have proposed to create component inventory tool, which RFID tag can be replaced onto the containers with the trial parts and thus both the supplier and main manufacturing facility. This tool could provide constant feedback to ordering, logistics, and assembly conveyance groups in order to maintain and improve current JIT system. Concretely, this can also provide current information on components being shipped by the supplier and list what items are available in the production area by part number and supplier. The effectiveness of this proposal has been verified into Toyota Motor Manufacturing, Texas (TMMTX), which is unique for onsite supplier locations. This has been proven that RFID can prove to be an efficient tool with which to track inventory and generate cost savings.

Metacognitive Ability and Academic Self-Efficacy: Their Relations to Role Transition as Perceived by Nursing students

Background: Nursing students are challenged to think and impart in ways that will prepare them for practical work in a complex healthcare environment, Metacognition ability refers to an individual’s knowledge of his thinking allowing them to design their thinking properly. In addition, high self-efficacy enhances students' accomplishment and personal well-being since student with high assurance in their capabilities approach difficult tasks as challenges to be mastered. Aim: To explore metacognitive ability and academic self-efficacy and their relation to role transition as perceived by nursing students. Design: Descriptive correlation design was utilized. Setting: The study was conducted at Faculty of nursing, Benha University. Subjects: A convenient sample of 4th year nursing students who enrolled in nursing administration department in the first term of academic year 2020/2021, the final number of sample size was 214. Tools: Three tools were used for data collection as follows; Metacognitive ability scale, Academic self-efficacy scale and Modified Perceptions of role transition questionnaire. Results: Two thirds of nursing students have high level of metacognitive abilities, more than half of them have high level of academic self-efficacy and more than two fifth perceived role transition moderately. Conclusion: There was a highly statistically significant correlation between metacognitive ability and academic self-efficacy, and a highly statistically significant positive correlation between academic self-efficacy and role-transition. Recommendations: Implementing learning strategies that promote nursing students' development of metacognitive abilities, studying the impact of academic self-efficacy and meta-cognitive ability on clinical decision-making ability among nursing students. And providing an orientation program for nursing students about role transition.

Does Benchmarking of Rating Scales Improve Ratings of Search Performance Given by Specialist Search Dog Handlers?

Rating scales are widely used to rate working dog behavior and performance. Whilst behaviour scales have been extensively validated, instruments used to rate ability have usually been designed by training and practitioner organizations, and often little consideration has been given to how seemingly insignificant aspects of the scale design might alter the validity of the results obtained. Here we illustrate how manipulating one aspect of rating scale design, the provision of verbal benchmarks or labels (as opposed to just a numerical scale), can affect the ability of observers to distinguish between differing levels of search dog performance in an operational environment. Previous studies have found evidence for range restriction (using only part of the scale) in raters' use of the scales and variability between raters in their understanding of the traits used to measures performance. As provision of verbal benchmarks has been shown to help raters in a variety of disciplines to select appropriate scale categories (or scores), it may be predicted that inclusion of verbal benchmarks will bring raters' conceptualization of the traits closer together, increasing agreement between raters, as well as improving the ability of observers to distinguish between differing levels of search dog performance and reduce range restriction. To test the value of verbal benchmarking we compared inter-rater reliability, raters' ability to discriminate between different levels of search dog performance, and their use of the whole scale before and after being presented with benchmarked scales for the same traits. Raters scored the performance of two separate types of explosives search dog (High Assurance Search (HAS) and Vehicle Search (VS) dogs), from short (~30 s) video clips, using 11 previously validated traits. Taking each trait in turn, for the first five clips raters were asked to give a score from 1, representing the lowest amount of the trait evident to 5, representing the highest. Raters were given a list of adjective-based benchmarks (e.g., very low, low, intermediate, high, very high) and scored a further five clips for each trait. For certain traits, the reliability of scoring improved when benchmarks were provided (e.g., Motivation and Independence), indicating that their inclusion may potentially reduce ambivalence in scoring, ambiguity of meanings, and cognitive difficulty for raters. However, this effect was not universal, with the ratings of some traits remaining unchanged (e.g., Control), or even reducing in reliability (e.g., Distraction). There were also some differences between VS and HAS (e.g., Confidence reliability increased for VS raters and decreased for HAS raters). There were few improvements in the spread of scores across the range, but some indication of more favorable scoring. This was a small study of operational handlers and trainers utilizing training video footage from realistic operational environments, and there are potential cofounding effects. We discuss possible causal factors, including issues specific to raters and possible deficiencies in the chosen benchmarks, and suggest ways to further improve the effectiveness of rating scales. This study illustrates why it is vitally important to validate all aspects of rating scale design, even if they may seem inconsequential, as relatively small changes to the amount and type of information provided to raters can have both positive and negative impacts on the data obtained.

Koord: a language for programming and verifying distributed robotics application

A robot’s code needs to sense the environment, control the hardware, and communicate with other robots. Current programming languages do not provide suitable abstractions that are independent of hardware platforms. Currently, developing robot applications requires detailed knowledge of signal processing, control, path planning, network protocols, and various platform-specific details. Further, porting applications across hardware platforms remains tedious. We present Koord—a domain specific language for distributed robotics—which abstracts platform-specific functions for sensing, communication, and low-level control. Koord makes the platform-independent control and coordination code portable and modularly verifiable. Koord raises the level of abstraction in programming by providing distributed shared memory for coordination and port interfaces for sensing and control. We have developed the formal executable semantics of Koord in the K framework. With this symbolic execution engine, we can identify assumptions (proof obligations) needed for gaining high assurance from Koord applications. We illustrate the power of Koord through three applications: formation flight, distributed delivery, and distributed mapping. We also use the three applications to demonstrate how platform-independent proof obligations can be discharged using the Koord Prover while platform-specific proof obligations can be checked by verifying the obligations using physics-based models and hybrid verification tools.

Formalization of Camera Pose Estimation Algorithm based on Rodrigues Formula

Abstract Camera pose estimation is key to the proper functioning of robotic systems, supporting critical tasks such as robot navigation, target tracking, camera calibration, etc.Whilemultiple algorithms solving this problem have been proposed, their correctness has rarely been validated using formal techniques. This is true despite the fact that the adoption of formal verification is essential for the reliability of safety-critical systems, and for their certification to high assurance levels. In this article, we present an effort in formally verifying an algorithm for camera pose estimation in an interactive theorem prover. The algorithm leverages the power of Rodrigues formula to solve the pose estimation problem under conditions for which existing solutions cannot be applied. The technical ingredients include (but are not limited to) mechanized proofs of the Rodrigues formula (along with its Cayley decomposition form) and the least squares method for fitting data. Based on the formalization of the algorithm, we formally derive and verify its general solution and unique solution.

The geoforensic search strategy: A high assurance search method to assist law enforcement locate graves and contraband associated with homicide, counter terrorism and serious and organised crime

The geoforensic search strategy: A high assurance search method to assist law enforcement locate graves and contraband associated with homicide, counter terrorism and serious and organised crime

Making Teaching Relevant: Enhancing Students’ Self-Efficacy Through Teachers’ Enthusiasm for More Active Classroom Engagement

A strong sense of self-efficacy supports human accomplishment. Learners with high assurance in their capacities could approach difficult tasks as challenges to be handled rather than threats to be avoided. Such an outlook fosters those learners’ activities’ engrossment and their intrinsic interests of the learned contents. Therefore, learners set themselves goals and keep a strong commitment to these designated goals. To face failure, learners heighten and sustain their efforts by attributing this failure to insufficient effort and deficient knowledge and skills which ought to be acquired. To this end, those learners utilize their prior knowledge assurance to overcome the confronted threats.Concurrently, teachers ought to provide the relevant instruction that empowers their students. Consequently, learners could raise their expectations of the relevance of the perceived cognition and make sense of their world. Make learning relevance deemed a catalyst towards learners’ self- efficacy, motivation, and engagement with the learning processes. This article examines the irrevocable relationship between learners’ self- efficacy and their learning relevance towards mastery learning and active classroom engagement. The article raises some teaching challenges and suggests some research-based strategies to help teachers appreciate the broad panorama of learning and teaching in classrooms characterized by teaching self-efficacy and enthusiasm.

New Operational Availability Model to Evaluate Manufacturing Throughput: Advanced TPS for Global Production

To achieve simultaneous, worldwide high quality assurance and other global production developments, today's task is to maintain high reliability in production facilities and operations. In response to the increasing expansion of overseas plants, it is necessary to improve and maintain highly accurate production equipment and operations through the development of intelligence operators. The authors have clarified Advanced TPS as a global production technology and management model designed to realize high quality assurance in global production. Manufacturing throughput (Throughput) is oriented toward the reduction of time required by the manufacturing process, so that the profitability can be increased. Therefore, the authors have recognized the operational availability a key indicator in order to evaluate the throughput. This paper will introduce a new operational availability model to identify 1) the development of throughput to link the impact from one step to following step and 2) the contribution of each factors and each step for manufacturing process to pinpoint the bottleneck of the throughput. With improvement to these bottlenecks, the business will be successful while minimizing cost. The effectiveness of this system has been verified at the Toyota USA.

Provenance-enabled packet path tracing in the RPL-based internet of things

The interconnection of resource-constrained and globally accessible things with unreliable Internet make them vulnerable to attacks such as, but not limited to, data forging, false data injection, and packet drop. Such attacks may affect mission-critical applications that rely on sensor data for decision-making processes, hence, necessitates high assurance of trustworthy data. For the data trustworthiness, provenance is considered to be an effective mechanism that tracks both data acquisition and data transmission. However, provenance management for IoT networks is faced with several challenges such as low energy, bandwidth consumption, and efficient storage. In this paper, we propose a bi-fold Provenance-enabled Packed Path Tracing (PPPT) approach to identify packet drop (either maliciously or due to network disruptions) and detect faulty or misbehaving nodes in the Routing protocol for low-Power and Lossy networks (RPL). Firstly, ordered system-level provenance information encapsulates the data generating nodes and the forwarding nodes in the data packet. Secondly, to closely monitor the dropped packets, a node-level provenance in the form of the packet sequence number is enclosed as a routing entry in the routing table of each participating node. Lossless in nature, both approaches conserve provenance size satisfying processing and storage requirements of IoT devices. The experimental results show that the provenance size remains constant (i.e., 2 bytes) in the proposed scheme, irrespective of the number of hops or number of sent packets. Therefore, it does not affect factors such as memory usage (additional RAM and ROM usage: 504 and 3874 bytes respectively), energy consumption, and processing efficiency for provenance generation time in comparison to RPL-only approach. Furthermore, our proposed provenance-enabled RPL (PPPT) outperforms the RPL-only approach from the perspective of added security such as data trustworthiness and features such as identification of malicious nodes and other disruptions in the network.

Views of corporate managers on assurance of sustainability reporting: evidence from Japan

The demand for assurance in sustainability reporting has increased significantly in recent years. The objective of this study is to examine the views of corporate managers on the current state of, and future prospects for, this emerging assurance practice in Japan. The research is based on a small program of six semi-structured interviews and a questionnaire survey of the top 500 companies listed in the Tokyo Stock Exchange (Nikkei 500 companies). The findings show that respondents are still reluctant to adopt assurance on sustainability reporting. In contrast, they prefer third-party comment, a unique practice in Japan to enhance the credibility of the reported information. The study also identifies the determinants, stakeholders’ influence for the adoption of assurance and third-party comment on sustainability reporting. It shows that main impediments to adopting assurance service include high assurance fees, less demand for sustainability assurance from stakeholders, and a lengthy assurance process. The findings are explained through the lens of legitimacy theory. While the extant literature concentrated on European practice, this is the first known study that informs the adoption of assurance and third-party comment on sustainability reporting in Japan, the leading country in the world to publish such non-financial reports.

Assuring Clonality on the Beacon Digital Cell Line Development Platform.

During biomanufacturing cell lines development, the generation and screening for single-cell derived subclones using methods that enable assurance of clonal derivation can be resource- and time-intensive. High-throughput miniaturization, automation, and analytic strategies are often employed to reduce such bottlenecks. The Beacon platform from Berkeley Lights offers a strategy to eliminate these limitations through culturing, manipulating, and characterizing cells on custom nanofluidic chips via software-controlled operations. However, explicit demonstration of this technology to provide high assurance of a single cell progenitor has not been reported. Here, a methodology that utilizes the Beacon instrument to ensure high levels of clonality is described. It is demonstrated that the Beacon platform can efficiently generate production cell lines with a superior clonality data package, detailed tracking, and minimal resources. A stringent in-process quality control strategy is established to enable rapid verification of clonal origin, and the workflow is validated using representative Chinese hamster ovary-derived cell lines stably expressing either green or red fluorescence protein. Under these conditions, a >99% assurance of clonal origin is achieved, which is comparable to existing imaging-coupled fluorescence-activated cell sorting seeding methods.

P188 QUALITY ASSURANCE OF SURGICAL INTERVENTION WITHIN RANDOMIZED CONTROLLED TRIALS FOR GASTRO-ESOPHAGEAL REFLUX DISEASE

Abstract Aim Randomized controlled trials provide level 1 evidence for surgical intervention in the treatment of gastro-esophageal reflux disease (GERD). This systematic review aimed to investigate the practice of surgical quality assurance in RCTs concerning surgical interventions in GERD. Background & Methods A systematic literature search for articles was performed in Medline, Embase, Web of Science and Cochrane library for randomized controlled trials (RCT) evaluating surgical intervention in the management of GERD. Each RCT was assesses for surgical quality assurance (SQA) using an eight-point checklist in three main areas and given a SQA score out of 8. Clinical outcomes from each trial including reoperation rates were then compared against the SQA score. Results Thirty-one publications were included compromising 5803 patients. The assurance of surgical quality was poor with the randomized controlled trials included, ranging from 3% to 68% for the factors examined: Credentialing surgeon experience before entry into the trial by; 1. Case volume – 26% (8/31) 2. Operative reports – 6% (2/31) 3. Video assessment – 6% (2/31) 4. Live operating room evaluation – 3% (1/31) Pre-trial standardization by; 5. Education of surgeons – 13% (13%) 6. Consensus for standardization – 68% (21/31) Monitoring surgical performance during the trial by; 7. Video assessment – 10% (3/31) 8. Monitoring of data – 3% (1/31) RCTs with a high SQA score had a reduced average rate of reoperation (SQA score 4 to 8 vs. 0 to 3; 0% vs. 3.19%; P<0.05). Credentialing surgeons by case volume before entry into the trial was also associated with a reduced rate of reoperation (0.04% vs. 3%; P<0.05). Conclusion Surgical quality assurance has been largely lacking in randomized controlled trials for GERD previously. High surgical quality assurance was associated with reduced reoperation rates within RCTs, highlighting the need for good SQA within these types of trials. Future RCTs in benign UGI conditions with surgical interventions should ensure SQA in three main areas: (i) Credentialing surgeon experience before trial; to ensure they are past learning curve. (ii) Standardizing the surgical technique; to ensure less heterogeneity in operative performance. (iii) Monitoring performance during trial; to ensure standard of surgical quality is maintained within the trial.