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NASA NTRS2016

Pilot Critical Incident Reports as a Means to Identify Human Factors of Remotely Piloted Aircraft

It has been estimated that aviation accidents are typically preceded by numerous minor incidents arising from the same causal factors that ultimately produced the accident. Accident databases provide in-depth information on a relatively small number of occurrences, however incident databases have the potential to provide insights into the human factors of Remotely Piloted Aircraft System (RPAS) operations based on a larger volume of less-detailed reports. Currently, there is a lack of incident data dealing with the human factors of unmanned aircraft systems. An exploratory study is being conducted to examine the feasibility of collecting voluntary critical incident reports from RPAS pilots. Twenty-three experienced RPAS pilots volunteered to participate in focus groups in which they described critical incidents from their own experience. Participants were asked to recall (1) incidents that revealed a system flaw, or (2) highlighted a case where the human operator contributed to system resilience or mission success. Participants were asked to only report incidents that could be included in a public document. During each focus group session, a note taker produced a de-identified written record of the incident narratives. At the end of the session, participants reviewed each written incident report, and made edits and corrections as necessary. The incidents were later analyzed to identify contributing factors, with a focus on design issues that either hindered or assisted the pilot during the events. A total of 90 incidents were reported. Human factor issues included the impact of reduced sensory cues, traffic separation in the absence of an out-the-window view, control latencies, vigilance during monotonous and ultra-long endurance flights, control station design considerations, transfer of control between control stations, the management of lost link procedures, and decision-making during emergencies. Pilots participated willingly and enthusiastically in the study, and generally had little difficulty recalling critical incidents. The results suggest that pilot interviews can be a productive method of gathering information on incidents that might not otherwise be reported. Some of the issues described in the reports have received significant attention in the literature, or are analogous to human factors of manned aircraft. In other cases, incident reports involved human factors that are poorly understood, and have not yet been the subject of extensive study. Although many of the reported incidents were related to pilot error, the participants also provided examples of the positive contribution that humans make to the operation of highly-automated systems.

unmanned aircraft systems↗

NASA NTRS2016

The Cognitive Challenges of Flying a Remotely Piloted Aircraft

A large variety of Remotely Piloted Aircraft (RPA) designs are currently in production or in development. These aircraft range from small electric quadcopters that are flown close to the ground within visual range of the operator, to larger systems capable of extended flight in airspace shared with conventional aircraft. Before RPA can operate routinely and safely in civilian airspace, we need to understand the unique human factors associated with these aircraft. The task of flying an RPA in civilian airspace involves challenges common to the operation of other highly-automated systems, but also introduces new considerations for pilot perception, decision-making, and action execution. RPA pilots participated in focus groups where they were asked to recall critical incidents that either presented a threat to safety, or highlighted a case where the pilot contributed to system resilience or mission success. Ninety incidents were gathered from focus-groups. Human factor issues included the impact of reduced sensory cues, traffic separation in the absence of an out-the-window view, control latencies, vigilance during monotonous and ultra-long endurance flights, control station design considerations, transfer of control between control stations, the management of lost link procedures, and decision-making during emergencies. Some of these concerns have received significant attention in the literature, or are analogous to human factors of manned aircraft. The presentation will focus on issues that are poorly understood, and have not yet been the subject of extensive human factors study. Although many of the reported incidents were related to pilot error, the participants also provided examples of the positive contribution that humans make to the operation of highly-automated systems.

remote pilot station↗

DOE OSTI2024

The Challenges of Safe Troubleshooting Work

Troubleshooting work presents electrical and other workers with a challenging combination of physical hazards, working conditions, and time pressure, which can lead to unwanted outcomes if not carefully managed. Summaries of several incidents in which workers were injured or at risk of injury while performing troubleshooting work are presented, identifying organizational weaknesses and error precursors that contributed to each incident. The primary challenges include: Deranged equipment. Equipment that needs troubleshooting is not in a normal operating condition. Actions that are safe when the equipment is in a normal state may not be safe in the deranged state. Work planning and control. The steps taken in troubleshooting are most often determined by the results of the immediately previous diagnostic test, making effective work planning challenging. Multiple types of hazards. Most equipment will present a troubleshooting worker with several types of hazards, including hazardous energy as defined in 29 CFR 1910.147. Portions of the troubleshooting activity may be infeasible without these hazards present. Time pressure. Restoring operation of failed equipment often involves an explicit or implicit sense of urgency. There are effective methods for addressing each challenge, most of which require a combination of advance preparation and management commitment.

Mertz, David E.↗

NASA NTRS2009

Metrology System for a Large, Somewhat Flexible Telescope

A proposed metrology system would be incorporated into a proposed telescope that would include focusing optics on a rigid bench connected via a deployable mast to another rigid bench holding a focal-plane array of photon counting photodetectors. Deformations of the deployable mast would give rise to optical misalignments that would alter the directions (and, hence, locations) of incidence of photons on the focal plane. The metrology system would measure the relative displacement of the focusing- optics bench and the focal-plane array bench. The measurement data would be used in post-processing of the digitized photodetector outputs to compensate for the mast-deformation-induced changes in the locations of incidence of photons on the focal plane, thereby making it possible to determine the original directions of incidence of photons with greater accuracy. The proposed metrology system is designed specifically for the Nuclear Spectroscopic Telescope Array (NuSTAR) a proposed spaceborne x-ray telescope. The basic principles of design and operation are also applicable to other large, somewhat flexible telescopes, both terrestrial and spaceborne. In the NuSTAR, the structural member connecting the optical bench and the photodetector array would be a 10-m-long deployable mast, and there is a requirement to keep errors in measured directions of incidence of photons below 10 arc seconds (3 sigma). The proposed system would include three diode lasers that would be mounted on the focusing-optics bench. For clarity, only one laser is shown in the figure, which is a greatly simplified schematic diagram of the system. Each laser would be aimed at a position-sensitive photodiode that would be mounted on the detector bench alongside the aforementioned telescope photodetector array. The diode lasers would operate at a wavelength of 830 nm, each at a power of 200 mW. Each laser beam would be focused to a spot of .1-mm diameter on the corresponding position-sensitive photodiode. To reduce the effect of sunlight on the measurements, a one-stage light baffle and an 830-nm transmission filter of 10-nm bandwidth would be placed in front of the position- sensitive photodiode. For each metrology reading, the output of the position-sensitive detector would be sampled and digitized twice: once with the lasers turned on, then once with the lasers turned off. The data from these two sets of samples would be subtracted from each other to further reduce the effects of sun glints or other background light sources.

Liebe, Carl Christian↗

NASA NTRSDate not supplied

Identifying Human Errors and Error Mechanisms From Accident Reports Using Large Language Models

Emerging operational concepts for aviation hinge on novel paradigms for human machine interaction. Critical to their safe operation is early consideration of human error into the design process. Existing methods for consideration of human error require significant expert input, which is challenging both in early design and in novel systems for which there is little existing safety expertise. In this research, we propose a methodology for identifying human error, error producing factors, and mechanisms in early design from historical incident reports. Additionally, we hypothesize that cross-domain sharing of lessons learned can aid with early design human considerations in circumstances where data is not relevant or incomplete. This is addressed by identifying causes of human error in aviation and railway domains through applying state-of-the art natural language processing techniques to historical incident reports. Using this method, it is possible to extract extensive reports on human error from past incidents. Using the proposed approach, we identify nine human errors from railway reports and fourteen from aviation reports, with three errors common to both domains. There is at least one error producing conditions for each human error while a majority of the errors have more than one error mechanism. We also found that a majority of the human errors, error producing factors, and error mechanisms (even if they are not common between the domains) can be used to inform safe operations across domains as long as the errors are not domain specific and are interpreted and contextualized using engineering judgement.

Human Errors↗

NASA NTRS2019

Human Performance Contributions to Safety in Commercial Aviation

Every day in aviation, pilots, air traffic controllers, and other front-line personnel perform countless correct judgments and actions in a variety of operational environments. These judgments and actions are often the difference between an accident and a non-event. Ironically, data on these behaviors are rarely collected or analyzed. Data-driven decisions about safety management and design of safety-critical systems are limited by the available data, which influence how decision makers characterize problems and identify solutions. Large volumes of data are collected on the failures and errors that result in infrequent incidents and accidents, but in the absence of data on behaviors that result in routine successful outcomes, safety management and system design decisions are based on a small sample of nonrepresentative safety data. This assessment aimed to find and document “safety successes” made possible by human operators. With many Aeronautics Research Mission Directorate (ARMD) Programs and Projects focusing on increased automation and autonomy and decreased human involvement, failure to fully consider the human contributions to successful system performance in civil aviation represents a significant risk — a risk that has not been recognized to date. Without understanding how humans contribute to safety, any estimate of predicted safety of autonomous capabilities is incomplete and inherently suspect. Furthermore, understanding the ways in which humans contribute to safety can promote strategic interactions among safety technologies, functions, procedures and the people using them. Without this understanding, the full benefits of an integrated, optimized human/technology or autonomous system will not be realized. Historically, safety has been consistently defined in terms of the occurrence of accidents or recognized risks (i.e., in terms of things that go wrong). These adverse outcomes are explained by identifying their causes, and safety is restored by eliminating or mitigating these causes. An alternative to this approach is to focus on what goes right and identify how to replicate that process. Focusing on the rare cases of failures attributed to “human error” provides little information about why human performance routinely prevents adverse events. Hollnagel has proposed that things go right because people continuously adjust their work to match their operating conditions. These adjustments become increasingly important as systems continue to grow in complexity. Thus, the definition of safety should reflect not only “avoiding things that go wrong” but “ensuring that things go right.” The basis for safety management requires developing an understanding of everyday activities. However, few mechanisms to monitor everyday work exist in the aviation domain, which limits opportunities to learn how designs function in reality. This concept of safety thinking and safety management is reflected in the emerging field of resilience engineering. According to Hollnagel, a system is resilient if it can sustain required operations under expected and unexpected conditions by adjusting its functioning prior to, during, or following changes, disturbances, and opportunities. To explore “positive” behaviors that contribute to resilient performance in commercial aviation, the assessment team examined a range of existing sources of data about pilot and air traffic control (ATC) tower controller performance, including subjective interviews with domain experts and objective aircraft flight data records. These data were used to identify strategies that support resilient performance, methods for exploring and refining those strategies in existing data, and proposed methods for capturing and analyzing new data.

Null, Cynthia H.↗

NASA NTRS1984

Preparing for the unexpected - A psychologist's case for improved training

In the procedures designed to minimize human errors that lead to aircraft incidents, the improved human factor engineering and automation approaches must be supplemented by new training methods. Changes are suggested in the preprogrammed training principles which are currently based almost exclusively on the procedures-oriented environment, with insufficient training for cognitive processing and awareness. Use of the Line-Oriented Flight Training procedure, in which a training simulator is supplemented by a highly structured script or scenario to simulate the total line operational environment for the purpose of simultaneously training the entire flight crew, offers one way of providing pilots and other crewmembers with the experience of dealing with unexpected or stressful events. Of primary importance is maximal coordination between the aircraft captain and other crewmembers during the flight, which puts emphasis on the importance of teamwork and personal relations among all other crewmembers. The current FARs governing training and proficiency will have to be modified to accommodate new training appoaches.

Foushee, H. C.↗

NASA NTRS1991

Effect of rain on Ku-band scatterometer wind measurements

The impact of precipitation on scatterometer wind measurements is investigated. A model is developed which includes the effects of rain attenuation, rain backscatter, and storm horizontal structure. Rain attenuation is found to be the dominant error source at low radar incidence angles and high wind speeds. Volume backscatter from the rain-loaded atmosphere, however, is found to dominate for high incidence angles and low wind speeds.

Spencer, Michael↗

NASA NTRS1993

Non-contact heat flux measurement using a transparent sensor

A working non-contact heat flux sensor was demonstrated using a transparent material (sapphire) and a multiwavelength pyrometer. The pyrometer is used to measure the temperatures of the two surfaces of the sensor from the spectrum of radiation originating from them. The heat conducted through the material is determined from the temperature difference of the two surfaces and the thermal conductivity of the material. The measured heat flux is equal to the incident heat flux within experimental error indicating that no calibration would be necessary. A steady state heat flux of 100 kW/sq m was easily achieved.

Ng, Daniel↗

NASA NTRS2003

MOBY, A Radiometric Buoy for Performance Monitoring and Vicarious Calibration of Satellite Ocean Color Sensors: Measurement and Data Analysis Protocols

The Marine Optical Buoy (MOBY) is the centerpiece of the primary ocean measurement site for calibration of satellite ocean color sensors based on independent in situ measurements. Since late 1996, the time series of normalized water-leaving radiances L(sub WN)(lambda) determined from the array of radiometric sensors attached to MOBY are the primary basis for the on-orbit calibrations of the USA Sea-viewing Wide Field-of-view Sensor (SeaWiFS), the Japanese Ocean Color and Temperature Sensor (OCTS), the French Polarization Detection Environmental Radiometer (POLDER), the German Modular Optoelectronic Scanner on the Indian Research Satellite (IRS1-MOS), and the USA Moderate Resolution Imaging Spectrometer (MODIS). The MOBY vicarious calibration L(sub WN)(lambda) reference is an essential element in the international effort to develop a global, multi-year time series of consistently calibrated ocean color products using data from a wide variety of independent satellite sensors. A longstanding goal of the SeaWiFS and MODIS (Ocean) Science Teams is to determine satellite-derived L(sub WN)(labda) with a relative combined standard uncertainty of 5 %. Other satellite ocean color projects and the Sensor Intercomparison for Marine Biology and Interdisciplinary Oceanic Studies (SIMBIOS) project have also adopted this goal, at least implicitly. Because water-leaving radiance contributes at most 10 % of the total radiance measured by a satellite sensor above the atmosphere, a 5 % uncertainty in L(sub WN)(lambda) implies a 0.5 % uncertainty in the above-atmosphere radiance measurements. This level of uncertainty can only be approached using vicarious-calibration approaches as described below. In practice, this means that the satellite radiance responsivity is adjusted to achieve the best agreement, in a least-squares sense, for the L(sub WN)(lambda) results determined using the satellite and the independent optical sensors (e.g. MOBY). The end result of this approach is to implicitly absorb unquantified, but systematic, errors in the atmospheric correction, incident solar flux, and satellite sensor calibration into a single correction factor to produce consistency with the in situ data.

Clark, Dennis K.↗

NASA NTRS2016

The Human Challenges of Remotely Piloted Aircraft Systems

Remotely Piloted Aircraft (RPA) range from small electric quadcopters that are flown close to the ground within visual range of the operator, to larger systems capable of extended flight in airspace shared with conventional aircraft. Before RPA can operate routinely and safely in civilian airspace, we need to understand the unique human factors associated with these aircraft. RPA pilots participated in focus groups where they were asked to recall critical incidents that either presented a threat to safety, or highlighted a case where the pilot contributed to system resilience or mission success. Ninety incidents were gathered from focus-groups. Human factor issues included the impact of reduced sensory cues, traffic separation in the absence of an out-the-window view, control latencies, vigilance during monotonous and ultra-long endurance flights, control station design considerations, transfer of control between control stations, the management of lost link procedures, and decision-making during emergencies. Some of these concerns have received significant attention in the literature, or are analogous to human factors of manned aircraft. Although many of the reported incidents were related to pilot error, the participants also provided examples of the positive contribution that humans make to the operation of highly-automated systems.

Hobbs, Alan↗

NASA NTRS2000

In-flight observations of multiple-bit upset in DRAMs

In-flight data is examined showing a very high incidence of multiple-bit errors in a solid-state recorder that incorporates error detection and correction. The high MBU rate is shown to be a consequence of the physical selection of memory cell locations in the recorder architecture.

single↗

NASA NTRS1989

Off-nadir radar altimetry

The characteristics of nadir versus off-nadir altimetry are reviewed and contrasted and a potentially serious problem has been pointed out that has been overlooked by earlier investigators, who focused on the nongeophysical error sources in off-nadir altimetry. Spatial gradients of radar cross section on the sea surface, caused by wind or current gradients or the variation of radar cross section with incidence angle, could introduce significant range errors in off-nadir altimeter. This potentially crippling effect can be overcome by leaving the traditional 13-GHz frequency and implementing the multibeam altimeter at 36 GHz. A multibeam altimeter proposed for the EOS (Earth Observing System) is described as well as a multimode airborne radar altimeter being developed to study problems inherent in off-nadir altimetry.

Parsons, Chester L.↗

NASA NTRS2012

Wavefront Sensing Analysis of Grazing Incidence Optical Systems

Wavefront sensing is a process by which optical system errors are deduced from the aberrations in the image of an ideal source. The method has been used successfully in near-normal incidence, but not for grazing incidence systems. This innovation highlights the ability to examine out-of-focus images from grazing incidence telescopes (typically operating in the x-ray wavelengths, but integrated using optical wavelengths) and determine the lower-order deformations. This is important because as a metrology tool, this method would allow the integration of high angular resolution optics without the use of normal incidence interferometry, which requires direct access to the front surface of each mirror. Measuring the surface figure of mirror segments in a highly nested x-ray telescope mirror assembly is difficult due to the tight packing of elements and blockage of all but the innermost elements to normal incidence light. While this can be done on an individual basis in a metrology mount, once the element is installed and permanently bonded into the assembly, it is impossible to verify the figure of each element and ensure that the necessary imaging quality will be maintained. By examining on-axis images of an ideal point source, one can gauge the low-order figure errors of individual elements, even when integrated into an assembly. This technique is known as wavefront sensing (WFS). By shining collimated light down the optical axis of the telescope and looking at out-of-focus images, the blur due to low-order figure errors of individual elements can be seen, and the figure error necessary to produce that blur can be calculated. The method avoids the problem of requiring normal incidence access to the surface of each mirror segment. Mirror figure errors span a wide range of spatial frequencies, from the lowest-order bending to the highest order micro-roughness. While all of these can be measured in normal incidence, only the lowest-order contributors can be determined through this WFS technique.

Rohrbach, Scott↗

NASA NTRS1981

A review of in-flight emergencies in the ASRS data base

A series of 154 in-flight emergencies as reported to the Aviation Safety Reporting System are described. The various types of emergencies are examined and an attempt is made to determine the human errors and other factors associated with each incident, as well as the measures taken to resolve the emergency. It is concluded that nearly one half of those emergencies reported were related to failure or malfunction of aircraft subsystems. Of all the emergencies, nearly one quarter were associated with power plant failure. Other frequently encountered emergency types are associated with operation in instrument meteorological conditions without appropriate clearance or qualification, and with low fuel state situations. Human error is prominently featured in many of the incidents, appearing in the actions of pilots and air traffic controllers.

Porter, R. F.↗

NASA NTRS1977

Random and systematic measurement errors in acoustic impedance as determined by the transmission line method

The effect of random and systematic errors associated with the measurement of normal incidence acoustic impedance in a zero-mean-flow environment was investigated by the transmission line method. The influence of random measurement errors in the reflection coefficients and pressure minima positions was investigated by computing fractional standard deviations of the normalized impedance. Both the standard techniques of random process theory and a simplified technique were used. Over a wavelength range of 68 to 10 cm random measurement errors in the reflection coefficients and pressure minima positions could be described adequately by normal probability distributions with standard deviations of 0.001 and 0.0098 cm, respectively. An error propagation technique based on the observed concentration of the probability density functions was found to give essentially the same results but with a computation time of about 1 percent of that required for the standard technique. The results suggest that careful experimental design reduces the effect of random measurement errors to insignificant levels for moderate ranges of test specimen impedance component magnitudes. Most of the observed random scatter can be attributed to lack of control by the mounting arrangement over mechanical boundary conditions of the test sample.

Parrott, T. L.↗

NASA NTRS2016

Examining the Angular Resolution of the Astro-H's Soft X-Ray Telescopes

The international x-ray observatory ASTRO-H was renamed Hitomi after launch. It covers a wide energy range from a few hundred eV to 600 keV. It is equipped with two soft x-ray telescopes (SXTs: SXT-I and SXT-S) for imaging the soft x-ray sky up to 12 keV, which focus an image onto the respective focal-plane detectors: CCD camera (SXI) and a calorimeter (SXS). The SXTs are fabricated in a quadrant unit. The angular resolution in half-power diameter (HPD) of each quadrant of the SXTs ranges between 1.1 and 1.4 arc min at 4.51 keV. It was also found that one quadrant has an energy dependence on the HPD. We examine the angular resolution with spot scan measurements. In order to understand the cause of imaging capability deterioration and to reflect it to the future telescope development, we carried out spot scan measurements, in which we illuminate all over the aperture of each quadrant with a square beam 8 mm on a side. Based on the scan results, we made maps of image blurring and a focus position. The former and the latter reflect figure error and positioning error, respectively, of the foils that are within the incident 8 mm x 8 mm beam. As a result, we estimated those errors in a quadrant to be approx. 0.9 to 1.0 and approx. 0.6 to 0.9 arc min, respectively. We found that the larger the positioning error in a quadrant is, the larger its HPD is. The HPD map, which manifests the local image blurring, is very similar from quadrant to quadrant, but the map of the focus position is different from location to location in each telescope. It is also found that the difference in local performance causes energy dependence of the HPD.

Astro-H/Hitomi; soft x-ray telescope; SXT; Wolter ↗

NASA NTRS2012

Performance Data Errors in Air Carrier Operations: Causes and Countermeasures

Several airline accidents have occurred in recent years as the result of erroneous weight or performance data used to calculate V-speeds, flap/trim settings, required runway lengths, and/or required climb gradients. In this report we consider 4 recent studies of performance data error, report our own study of ASRS-reported incidents, and provide countermeasures that can reduce vulnerability to accidents caused by performance data errors. Performance data are generated through a lengthy process involving several employee groups and computer and/or paper-based systems. Although much of the airline indUStry 's concern has focused on errors pilots make in entering FMS data, we determined that errors occur at every stage of the process and that errors by ground personnel are probably at least as frequent and certainly as consequential as errors by pilots. Most of the errors we examined could in principle have been trapped by effective use of existing procedures or technology; however, the fact that they were not trapped anywhere indicates the need for better countermeasures. Existing procedures are often inadequately designed to mesh with the ways humans process information. Because procedures often do not take into account the ways in which information flows in actual flight ops and time pressures and interruptions experienced by pilots and ground personnel, vulnerability to error is greater. Some aspects of NextGen operations may exacerbate this vulnerability. We identify measures to reduce the number of errors and to help catch the errors that occur.

countermeasures↗