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Tailoring a Human Reliability Analysis to Your Industry Needs

Companies at risk of accidents caused by human error that result in catastrophic consequences include: airline industry mishaps, medical malpractice, medication mistakes, aerospace failures, major oil spills, transportation mishaps, power production failures and manufacturing facility incidents. Human Reliability Assessment (HRA) is used to analyze the inherent risk of human behavior or actions introducing errors into the operation of a system or process. These assessments can be used to identify where errors are most likely to arise and the potential risks involved if they do occur. Using the basic concepts of HRA, an evolving group of methodologies are used to meet various industry needs. Determining which methodology or combination of techniques will provide a quality human reliability assessment is a key element to developing effective strategies for understanding and dealing with risks caused by human errors. There are a number of concerns and difficulties in "tailoring" a Human Reliability Assessment (HRA) for different industries. Although a variety of HRA methodologies are available to analyze human error events, determining the most appropriate tools to provide the most useful results can depend on industry specific cultures and requirements. Methodology selection may be based on a variety of factors that include: 1) how people act and react in different industries, 2) expectations based on industry standards, 3) factors that influence how the human errors could occur such as tasks, tools, environment, workplace, support, training and procedure, 4) type and availability of data, 5) how the industry views risk & reliability, and 6) types of emergencies, contingencies and routine tasks. Other considerations for methodology selection should be based on what information is needed from the assessment. If the principal concern is determination of the primary risk factors contributing to the potential human error, a more detailed analysis method may be employed versus a requirement to provide a numerical value as part of a probabilistic risk assessment. Industries involved with humans operating large equipment or transport systems (ex. railroads or airlines) would have more need to address the man machine interface than medical workers administering medications. Human error occurs in every industry; in most cases the consequences are relatively benign and occasionally beneficial. In cases where the results can have disastrous consequences, the use of Human Reliability techniques to identify and classify the risk of human errors allows a company more opportunities to mitigate or eliminate these types of risks and prevent costly tragedies.

DeMott, D. L.↗

Reliable Transport over SpaceWire for James Webb Space Telescope (JWST) Focal Plane Electronics (FPE) Network

NASA's James Webb Space Telescope (JWST) faces difficult technical and budgetary challenges to overcome before it is scheduled launch in 2010. The Integrated Science Instrument Module (ISIM), shares these challenges. The major challenge addressed in this paper is the data network used to collect, process, compresses and store Infrared data. A total of 114 Mbps of raw information must be collected from 19 sources and delivered to the two redundant data processing units across a twenty meter deployed thermally restricted interface. Further data must be transferred to the solid-state recorder and the spacecraft. The JWST detectors are kept at cryogenic temperatures to obtain the sensitivity necessary to measure faint energy sources. The Focal Plane Electronics (FPE) that sample the detector, generate packets from the samples, and transmit these packets to the processing electronics must dissipate little power in order to help keep the detectors at these cold temperatures. Separating the low powered front-end electronics from the higher-powered processing electronics, and using a simple high-speed protocol to transmit the detector data minimize the power dissipation near the detectors. Low Voltage Differential Signaling (LVDS) drivers were considered an obvious choice for physical layer because of their high speed and low power. The mechanical restriction on the number cables across the thermal interface force the Image packets to be concentrated upon two high-speed links. These links connect the many image packet sources, Focal Plane Electronics (FPE), located near the cryogenic detectors to the processing electronics on the spacecraft structure. From 12 to 10,000 seconds of raw data are processed to make up an image, various algorithms integrate the pixel data Loss of commands to configure the detectors as well as the loss of science data itself may cause inefficiency in the use of the telescope that are unacceptable given the high cost of the observatory. This combination of requirements necessitates a redundant, fault tolerant, high- speed, low mass, low power network with a low Bit error Rate(1E-9- 1E-12). The ISIM systems team performed many studies of the various network architectures that meeting these requirements. The architecture selected uses the Spacewire protocol, with the addition of a new transport and network layer added to implement end-to-end reliable transport. The network and reliable transport mechanism must be implemented in hardware because of the high average information rate and the restriction on the ability of the detectors to buffer data due to power and size restrictions. This network and transport mechanism was designed to be compatible with existing Spacewire links and routers so that existing equipment and designs may be leveraged upon. The transport layer specification is being coordinated with European Space Agency (ESA), Spacewire Working Group and the Consultative Committee for Space Data System (CCSDS) PlK Standard Onboard Interface (SOIF) panel, with the intent of developing a standard for reliable transport for Spacewire. Changes to the protocol presented are likely since negotiations are ongoing with these groups. A block of RTL VHDL that implements a multi-port Spacewire router with an external user interface will be developed and integrated with an existing Spacewire Link design. The external user interface will be the local interface that sources and sinks packets onto and off of the network (Figure 3). The external user interface implements the network and transport layer and handles acknowledgements and re-tries of packets for reliable transport over the network. Because the design is written in RTL, it may be ported to any technology but will initially be targeted to the new Actel Accelerator series (AX) part. Each link will run at 160 Mbps and the power will be about 0.165 Watt per link worst case in the Actel AX.

Rakow, Glenn↗

NASA trend analysis procedures

This publication is primarily intended for use by NASA personnel engaged in managing or implementing trend analysis programs. 'Trend analysis' refers to the observation of current activity in the context of the past in order to infer the expected level of future activity. NASA trend analysis was divided into 5 categories: problem, performance, supportability, programmatic, and reliability. Problem trend analysis uncovers multiple occurrences of historical hardware or software problems or failures in order to focus future corrective action. Performance trend analysis observes changing levels of real-time or historical flight vehicle performance parameters such as temperatures, pressures, and flow rates as compared to specification or 'safe' limits. Supportability trend analysis assesses the adequacy of the spaceflight logistics system; example indicators are repair-turn-around time and parts stockage levels. Programmatic trend analysis uses quantitative indicators to evaluate the 'health' of NASA programs of all types. Finally, reliability trend analysis attempts to evaluate the growth of system reliability based on a decreasing rate of occurrence of hardware problems over time. Procedures for conducting all five types of trend analysis are provided in this publication, prepared through the joint efforts of the NASA Trend Analysis Working Group.

Source record↗

Digital image processing of bone - Problems and potentials

The development of a digital image processing system for bone histomorphometry and fluorescent marker monitoring is discussed. The system in question is capable of making measurements of UV or light microscope features on a video screen with either video or computer-generated images, and comprises a microscope, low-light-level video camera, video digitizer and display terminal, color monitor, and PDP 11/34 computer. Capabilities demonstrated in the analysis of an undecalcified rat tibia include the measurement of perimeter and total bone area, and the generation of microscope images, false color images, digitized images and contoured images for further analysis. Software development will be based on an existing software library, specifically the mini-VICAR system developed at JPL. It is noted that the potentials of the system in terms of speed and reliability far exceed any problems associated with hardware and software development.

Morey, E. R.↗

ETARA PC version 3.3 user's guide: Reliability, availability, maintainability simulation model

A user's manual describing an interactive, menu-driven, personal computer based Monte Carlo reliability, availability, and maintainability simulation program called event time availability reliability (ETARA) is discussed. Given a reliability block diagram representation of a system, ETARA simulates the behavior of the system over a specified period of time using Monte Carlo methods to generate block failure and repair intervals as a function of exponential and/or Weibull distributions. Availability parameters such as equivalent availability, state availability (percentage of time as a particular output state capability), continuous state duration and number of state occurrences can be calculated. Initial spares allotment and spares replenishment on a resupply cycle can be simulated. The number of block failures are tabulated both individually and by block type, as well as total downtime, repair time, and time waiting for spares. Also, maintenance man-hours per year and system reliability, with or without repair, at or above a particular output capability can be calculated over a cumulative period of time or at specific points in time.

Hoffman, David J.↗

Automated real-time software development

A Computer-Aided Software Engineering (CASE) system has been developed at the Charles Stark Draper Laboratory (CSDL) under the direction of the NASA Langley Research Center. The CSDL CASE tool provides an automated method of generating source code and hard copy documentation from functional application engineering specifications. The goal is to significantly reduce the cost of developing and maintaining real-time scientific and engineering software while increasing system reliability. This paper describes CSDL CASE and discusses demonstrations that used the tool to automatically generate real-time application code.

Jones, Denise R.↗

Cu-Au Alloys Using Monte Carlo Simulations and the BFS Method for Alloys

Semi empirical methods have shown considerable promise in aiding in the calculation of many properties of materials. Materials used in engineering applications have defects that occur for various reasons including processing. In this work we present the first application of the BFS method for alloys to describe some aspects of microstructure due to processing for the Cu-Au system (Cu-Au, CuAu3, and Cu3Au). We use finite temperature Monte Carlo calculations, in order to show the influence of 'heat treatment' in the low-temperature phase of the alloy. Although relatively simple, it has enough features that could be used as a first test of the reliability of the technique. The main questions to be answered in this work relate to the existence of low temperature ordered structures for specific concentrations, for example, the ability to distinguish between rather similar phases for equiatomic alloys (CuAu I and CuAu II, the latter characterized by an antiphase boundary separating two identical phases).

Bozzolo, Guillermo↗

Battery Study for the Shuttle Orbiter EAPU Upgrade

The use of Electric Auxiliary Power Unit (EAPU) in commercial, and military aviation, and in commercial electric automobiles, is reviewed. The specifications of the battery to be used in the space shuttle are reviewed, and the possible vendors discussed. The testing activity and the reliability and the safety features are presented.

Otzinger, Burton↗

Estimation of Model Error Variances During Data Assimilation

Data assimilation is all about understanding the error characteristics of the data and models that are used in the assimilation process. Reliable error estimates are needed to implement observational quality control, bias correction of observations and model fields, and intelligent data selection. Meaningful covariance specifications are obviously required for the analysis as well, since the impact of any single observation strongly depends on the assumed structure of the background errors. Operational atmospheric data assimilation systems still rely primarily on climatological background error covariances. To obtain error estimates that reflect both the character of the flow and the current state of the observing system, it is necessary to solve three problems: (1) how to account for the short-term evolution of errors in the initial conditions; (2) how to estimate the additional component of error caused by model defects; and (3) how to compute the error reduction in the analysis due to observational information. Various approaches are now available that provide approximate solutions to the first and third of these problems. However, the useful accuracy of these solutions very much depends on the size and character of the model errors and the ability to account for them. Model errors represent the real-world forcing of the error evolution in a data assimilation system. Clearly, meaningful model error estimates and/or statistics must be based on information external to the model itself. The most obvious information source is observational, and since the volume of available geophysical data is growing rapidly, there is some hope that a purely statistical approach to model error estimation can be viable. This requires that the observation errors themselves are well understood and quantifiable. We will discuss some of these challenges and present a new sequential scheme for estimating model error variances from observations in the context of an atmospheric data assimilation system.

Dee, Dick↗

Ceratopteris richardii: a productive model for revealing secrets of signaling and development

Ceratopteris richardii is an aquatic fern grown in tropical and subtropical regions of the world. It is proven to be a productive model system for studies in the genetics, biochemistry, and cell biology of basic biologic processes that occur in early gametophytic development. It provides several advantages to biologists, especially those interested in gravitational biology, polarity development, and in the genetics of sexual development. It is easy to culture, has a relatively short life cycle, and offers an array of attractive features that facilitate genetic studies. The germination and early development of large populations of genetically identical spores are easy to synchronize, and both the direction of polarity development and cell-level gravity responses can be measured and readily manipulated within the first 24 h of spore development. Although there is no reliable transformation system available yet in Ceratopteris, recent studies suggest that the technique of RNA interference can be used to block translation of specific genes in a related fern, Marsilea, and current studies will soon reveal the applicability of this approach, as well as of other transformation approaches, in Ceratopteris. A recently completed expressed sequence tag (EST) sequencing project makes available the partial sequence of more than 2000 cDNAs, representing a significant percentage of the genes being expressed during the first 24 h of spore germination, when many developmentally interesting processes are occurring. A microarray of these ESTs is being constructed, so especially for those scientists interested in basic cellular phenomena that occur early in spore germination, the availability of the ESTs and of the microarray will make Ceratopteris an even more attractive model system.

NASA Discipline Plant Biology↗

Design for Validation

The use of computer hardware and software in life-critical applications, such as for civil air transports, demands the use of rigorous formal mathematical validation procedures. However, formal specification and verification will only be tractable if the system is designed in a manner that lends itself to formal methods. Likewise, accurate reliability analysis will only be tractable if the number of interacting components that must be individually included in a single reliability model is kept to a low number and if their failure behavior interactions can be modeled simply. Also, the system must be designed such that the system reliability does not directly depend on system parameters that cannot be accurately determined. This paper presents a design methodology based on the concept of designing a system in such a manner that it can be rigorously validated, or "design for validation."

Johnson, Sally C.↗

Formal Safety Certification of Aerospace Software

In principle, formal methods offer many advantages for aerospace software development: they can help to achieve ultra-high reliability, and they can be used to provide evidence of the reliability claims which can then be subjected to external scrutiny. However, despite years of research and many advances in the underlying formalisms of specification, semantics, and logic, formal methods are not much used in practice. In our opinion this is related to three major shortcomings. First, the application of formal methods is still expensive because they are labor- and knowledge-intensive. Second, they are difficult to scale up to complex systems because they are based on deep mathematical insights about the behavior of the systems (t.e., they rely on the "heroic proof"). Third, the proofs can be difficult to interpret, and typically stand in isolation from the original code. In this paper, we describe a tool for formally demonstrating safety-relevant aspects of aerospace software, which largely circumvents these problems. We focus on safely properties because it has been observed that safety violations such as out-of-bounds memory accesses or use of uninitialized variables constitute the majority of the errors found in the aerospace domain. In our approach, safety means that the program will not violate a set of rules that can range for the simple memory access rules to high-level flight rules. These different safety properties are formalized as different safety policies in Hoare logic, which are then used by a verification condition generator along with the code and logical annotations in order to derive formal safety conditions; these are then proven using an automated theorem prover. Our certification system is currently integrated into a model-based code generation toolset that generates the annotations together with the code. However, this automated formal certification technology is not exclusively constrained to our code generator and could, in principle, also be integrated with other code generators such as RealTime Workshop or even applied to legacy code. Our approach circumvents the historical problems with formal methods by increasing the degree of automation on all levels. The restriction to safety policies (as opposed to arbitrary functional behavior) results in simpler proof problems that can generally be solved by fully automatic theorem proves. An automated linking mechanism between the safety conditions and the code provides some of the traceability mandated by process standards such as DO-178B. An automated explanation mechanism uses semantic markup added by the verification condition generator to produce natural-language explanations of the safety conditions and thus supports their interpretation in relation to the code. It shows an automatically generated certification browser that lets users inspect the (generated) code along with the safety conditions (including textual explanations), and uses hyperlinks to automate tracing between the two levels. Here, the explanations reflect the logical structure of the safety obligation but the mechanism can in principle be customized using different sets of domain concepts. The interface also provides some limited control over the certification process itself. Our long-term goal is a seamless integration of certification, code generation, and manual coding that results in a "certified pipeline" in which specifications are automatically transformed into executable code, together with the supporting artifacts necessary for achieving and demonstrating the high level of assurance needed in the aerospace domain.

Denney, Ewen↗

Design for Reliability and Safety Approach for the NASA New Launch Vehicle

The United States National Aeronautics and Space Administration (NASA) is in the midst of a space exploration program intended for sending crew and cargo to the international Space Station (ISS), to the moon, and beyond. This program is called Constellation. As part of the Constellation program, NASA is developing new launch vehicles aimed at significantly increase safety and reliability, reduce the cost of accessing space, and provide a growth path for manned space exploration. Achieving these goals requires a rigorous process that addresses reliability, safety, and cost upfront and throughout all the phases of the life cycle of the program. This paper discusses the "Design for Reliability and Safety" approach for the NASA new crew launch vehicle called ARES I. The ARES I is being developed by NASA Marshall Space Flight Center (MSFC) in support of the Constellation program. The ARES I consists of three major Elements: A solid First Stage (FS), an Upper Stage (US), and liquid Upper Stage Engine (USE). Stacked on top of the ARES I is the Crew exploration vehicle (CEV). The CEV consists of a Launch Abort System (LAS), Crew Module (CM), Service Module (SM), and a Spacecraft Adapter (SA). The CEV development is being led by NASA Johnson Space Center (JSC). Designing for high reliability and safety require a good integrated working environment and a sound technical design approach. The "Design for Reliability and Safety" approach addressed in this paper discusses both the environment and the technical process put in place to support the ARES I design. To address the integrated working environment, the ARES I project office has established a risk based design group called "Operability Design and Analysis" (OD&A) group. This group is an integrated group intended to bring together the engineering, design, and safety organizations together to optimize the system design for safety, reliability, and cost. On the technical side, the ARES I project has, through the OD&A environment, implemented a probabilistic approach to analyze and evaluate design uncertainties and understand their impact on safety, reliability, and cost. This paper focuses on the use of the various probabilistic approaches that have been pursued by the ARES I project. Specifically, the paper discusses an integrated functional probabilistic analysis approach that addresses upffont some key areas to support the ARES I Design Analysis Cycle (DAC) pre Preliminary Design (PD) Phase. This functional approach is a probabilistic physics based approach that combines failure probabilities with system dynamics and engineering failure impact models to identify key system risk drivers and potential system design requirements. The paper also discusses other probabilistic risk assessment approaches planned by the ARES I project to support the PD phase and beyond.

Safie, Fayssal, M.↗

100-LBF LO2/LCH4 - Reaction Control Engine Technology Development for Future Space Vehicles

The National Aeronautics and Space Administration (NASA) has identified liquid oxygen (LO2)/liquid methane (LCH4) propulsion systems as promising options for some future space vehicles. NASA issued a contract to Aerojet to develop a 100-lbf (445 N) LO2/LCH4 Reaction Control Engine (RCE) aimed at reducing the risk of utilizing a cryogenic reaction control system (RCS) on a space vehicle. Aerojet utilized innovative design solutions to develop an RCE that can ignite reliably over a broad range of inlet temperatures, perform short minimum impulse bits (MIB) at small electrical pulse widths (EPW), and produce excellent specific impulse (Isp) across a range of engine mixture ratios (MR). These design innovations also provide a start transient with a benign MR, ensuring good thrust chamber compatibility and long life. In addition, this RCE can successfully operate at MRs associated with main engines, enabling the RCE to provide emergency backup propulsion to minimize vehicle propellant load and overall system mass.

Robinson, Philip J.↗

100-Lb(f) LO2/LCH4 Reaction Control Engine Technology Development for Future Space Vehicles

The National Aeronautics and Space Administration (NASA) has identified liquid oxygen (LO2)/liquid methane (LCH4) propulsion systems as promising options for some future space vehicles. NASA issued a contract to Aerojet to develop a 100-lbf (445 N) LO2/LCH4 Reaction Control Engine (RCE) aimed at reducing the risk of utilizing a cryogenic reaction control system (RCS) on a space vehicle. Aerojet utilized innovative design solutions to develop an RCE that can ignite reliably over a broad range of inlet temperatures, perform short minimum impulse bits (MIB) at small electrical pulse widths (EPW), and produce excellent specific impulse (Isp) across a range of engine mixture ratios (MR). These design innovations also provide a start transient with a benign MR, ensuring good thrust chamber compatibility and long life. In addition, this RCE can successfully operate at MRs associated with main engines, enabling the RCE to provide emergency backup propulsion to minimize vehicle propellant load and overall system mass.

Robinson, Philip J.↗

A Distributed Approach to System-Level Prognostics

Prognostics, which deals with predicting remaining useful life of components, subsystems, and systems, is a key technology for systems health management that leads to improved safety and reliability with reduced costs. The prognostics problem is often approached from a component-centric view. However, in most cases, it is not specifically component lifetimes that are important, but, rather, the lifetimes of the systems in which these components reside. The system-level prognostics problem can be quite difficult due to the increased scale and scope of the prognostics problem and the relative Jack of scalability and efficiency of typical prognostics approaches. In order to address these is ues, we develop a distributed solution to the system-level prognostics problem, based on the concept of structural model decomposition. The system model is decomposed into independent submodels. Independent local prognostics subproblems are then formed based on these local submodels, resul ting in a scalable, efficient, and flexible distributed approach to the system-level prognostics problem. We provide a formulation of the system-level prognostics problem and demonstrate the approach on a four-wheeled rover simulation testbed. The results show that the system-level prognostics problem can be accurately and efficiently solved in a distributed fashion.

Daigle, Matthew J.↗

Automated Translation of Safety Critical Application Software Specifications into PLC Ladder Logic

The numerous benefits of automatic application code generation are widely accepted within the software engineering community. A few of these benefits include raising the abstraction level of application programming, shorter product development time, lower maintenance costs, and increased code quality and consistency. Surprisingly, code generation concepts have not yet found wide acceptance and use in the field of programmable logic controller (PLC) software development. Software engineers at the NASA Kennedy Space Center (KSC) recognized the need for PLC code generation while developing their new ground checkout and launch processing system. They developed a process and a prototype software tool that automatically translates a high-level representation or specification of safety critical application software into ladder logic that executes on a PLC. This process and tool are expected to increase the reliability of the PLC code over that which is written manually, and may even lower life-cycle costs and shorten the development schedule of the new control system at KSC. This paper examines the problem domain and discusses the process and software tool that were prototyped by the KSC software engineers.

Leucht, Kurt W.↗

AlMn Transition Edge Sensors for Advanced ACTPol

Advanced ACTPol (Adv ACT) will use an array of multichroic polarization sensitive AIMn transition edge sensor (TES) bolometers read out through time-division multiplexing. Aluminum doped with a low concentration of manganese can be deposited to a bulk film thickness for a more reliable superconducting critical temperature uniformity compared to thin bilayers. To build the TES, the AlMn alloy is deposited, over Nb wiring, to a specific thickness to set the TES normal resistance. The doping concentration of manganese coarsely defines the TES critical temperature, while a fine tuning is achieved by heating the deposited film to a specific temperature. The TES island is connected to the thermal bath via four silicon-nitride membranes, where their geometry defines the thermal conductance to the temperature of the bath. Lastly, the TES heat capacity is increased by addition of PdAu electrically connected to the AlMn film. Designs and performance characteristics of these AlMn TESs are presented for use in AdvACT.

Advanced ACTPol (AdvACT)↗