SEARCH · Engineering Papers

Results for “ACCIDENTS - CAUSES”

Search indexed NASA NTRS and DOE OSTI research on propulsion, heat transfer, battery materials and energy systems. Follow report and document links to the original sources.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,045 records · Page 58

All sources NASA NTRS DOE OSTI

NASA NTRS2009

Semantic Theme Analysis of Pilot Incident Reports

Pilots report accidents or incidents during take-off, on flight and landing to airline authorities and Federal aviation authority as well. The description of pilot reports for an incident contains technical terms related to Flight instruments and operations. Normal text mining approaches collect keywords from text documents and relate them among documents that are stored in database. Present approach will extract specific theme analysis of incident reports and semantically relate hierarchy of terms assigning weights of themes. Once the theme extraction has been performed for a given document, a unique key can be assigned to that document to cross linking the documents. Semantic linking will be used to categorize the documents based on specific rules that can help an end-user to analyze certain types of accidents. This presentation outlines the architecture of text mining for pilot incident reports for autonomous categorization of pilot incident reports using semantic theme analysis.

Thirumalainambi, Rajkumar↗

NASA NTRS2014

A Multiple Parameters Biodosimetry Tool with Various Blood Cell Counts - the Hemodose Approach

There continue to be important concerns about the possibility of the occurrence of acute radiation syndromes following nuclear and radiological terrorism or accidents that may result in mass casualties in densely populated areas. To guide medical personnel in their clinical decisions for effective medical management and treatment of the exposed individuals, biological markers are usually applied to examine radiation induced biological changes to assess the severity of radiation injury to sensitive organ systems. Among these the peripheral blood cell counts are widely used to assess the extent of radiation induced bone marrow injury. This is due to the fact that the hematopoietic system is the most vulnerable part of the human body to radiation damage. Particularly, the lymphocyte, granulocyte, and platelet cells are the most radiosensitive of the blood elements, and monitoring their changes after exposure is regarded as a practical and recommended laboratory test to estimate radiation dose and injury. Based upon years of physiological and pathophysiological investigation of mammalian hematopoietic systems, and rigorous coarse-grained bio-mathematical modeling and validation on species from mouse, to dog, monkey, and human, we have developed a set of software tools Hemodose, which can use single or serial granulocyte, lymphocyte, leukocyte, or platelet counts after exposure to estimate absorbed doses of adult victims very rapidly and accurately. Some patient data from historical accidents are utilized as examples to demonstrate the capabilities of these tools as a rapid point-of-care diagnostic or centralized high-throughput assay system in a large-scale radiological disaster scenario. Most significant to the improvement of national and local preparedness of a potential nuclear/radiological disaster, this HemoDose approach establishes robust correlations between the absorbed doses and victim's various types of blood cell counts not only in the early time window (1 or 2 days), but also in the very late phase (up to 4 weeks) after exposure.

Hu, Shaowen↗

NASA NTRS2014

An Overview of the Launch Vehicle Blast Environments Development Efforts

NASA has been funding an ongoing development program to characterize the explosive environments produced during a catastrophic launch vehicle accident. These studies and small-scale tests are focused on the near field environments that threaten the crew. The results indicate that these environments are unlikely to result in immediate destruction of the crew modules. The effort began as an independent assessment by NASA safety organizations, followed by the Ares program and NASA Engineering and Safety Center and now as a Space Launch Systems (SLS) focused effort. The development effort is using the test and accident data available from public or NASA sources as well as focused scaled tests that are examining the fundamental aspects of uncontained explosions of Hydrogen and air and Hydrogen and Oxygen. The primary risk to the crew appears to be the high-energy fragments and these are being characterized for the SLS. The development efforts will characterize the thermal environment of the explosions as well to ensure that the risk is well understood and to document the overall energy balance of an explosion. The effort is multi-path in that analytical, computational and focused testing is being used to develop the knowledge to understand potential SLS explosions. This is an ongoing program with plans that expand the development from fundamental testing at small-scale levels to large-scale tests that can be used to validate models for commercial programs. The ultimate goal is to develop a knowledge base that can be used by vehicle designers to maximize crew survival in an explosion.

Richardson, Erin↗

NASA NTRS2015

An Empirical Non-TNT Approach to Launch Vehicle Explosion Modeling

In an effort to increase crew survivability from catastrophic explosions of Launch Vehicles (LV), a study was conducted to determine the best method for predicting LV explosion environments in the near field. After reviewing such methods as TNT equivalence, Vapor Cloud Explosion (VCE) theory, and Computational Fluid Dynamics (CFD), it was determined that the best approach for this study was to assemble all available empirical data from full scale launch vehicle explosion tests and accidents. Approximately 25 accidents or full-scale tests were found that had some amount of measured blast wave, thermal, or fragment explosion environment characteristics. Blast wave overpressure was found to be much lower in the near field than predicted by most TNT equivalence methods. Additionally, fragments tended to be larger, fewer, and slower than expected if the driving force was from a high explosive type event. In light of these discoveries, a simple model for cryogenic rocket explosions is presented. Predictions from this model encompass all known applicable full scale launch vehicle explosion data. Finally, a brief description of on-going analysis and testing to further refine the launch vehicle explosion environment is discussed.

Blackwood, James M.↗

NASA NTRS2014

Modeling Increased Complexity and the Reliance on Automation: FLightdeck Automation Problems (FLAP) Model

This paper highlights the development of a model that is focused on the safety issue of increasing complexity and reliance on automation systems in transport category aircraft. Recent statistics show an increase in mishaps related to manual handling and automation errors due to pilot complacency and over-reliance on automation, loss of situational awareness, automation system failures and/or pilot deficiencies. Consequently, the aircraft can enter a state outside the flight envelope and/or air traffic safety margins which potentially can lead to loss-of-control (LOC), controlled-flight-into-terrain (CFIT), or runway excursion/confusion accidents, etc. The goal of this modeling effort is to provide NASA's Aviation Safety Program (AvSP) with a platform capable of assessing the impacts of AvSP technologies and products towards reducing the relative risk of automation related accidents and incidents. In order to do so, a generic framework, capable of mapping both latent and active causal factors leading to automation errors, is developed. Next, the framework is converted into a Bayesian Belief Network model and populated with data gathered from Subject Matter Experts (SMEs). With the insertion of technologies and products, the model provides individual and collective risk reduction acquired by technologies and methodologies developed within AvSP.

Ancel, Ersin↗

NASA NTRS1967

Report of Apollo 204 Review Board to the Administrator, National Aeronautics and Space Administration : Schedule of Physical Evidence - Appendix F

Immediately following the Apollo 204 accident of January 27, 1961. all associated equipment and material were impounded. Release of this equipment and material for normal use was under the close control of the Apollo 204 Review Board. Apollo Review Board Administrative Procedure No. 11, February 11, 1961, established the Apollo 204 Review Board Material Release Record (MRR). This MRR was the official form used to release material from full impoundment and was valid only after being approved by the Board and signed by a Member. The form was used as the authority to place any impounded item into one of the three Categories defined in Administrative Procedure No. 11. This appendix contains all of the authorized MRR's. Each item submitted on an MRR was given a control number; a description, including the part number and serial number; the relevance and location to the accident; any constraints before release; and the control category. The categories placed on the equipment were as follows: Category A - Items which may have a significant influence or bearing on the results or findings of the Apollo 204 Review Board; Category B - All material other than Category A which is considered relevant to the Apollo 204 Review Board investigation; Category C - Material released from Board jurisdiction. Several classes of equipment were released by special Board action prior to the establishment of the MRR system. The operating procedure for release of these classes is Enclosure F-l to this appendix.

Source record↗

NASA NTRS2017

Prediction of Cognitive States During Flight Simulation Using Multimodal Psychophysiological Sensing

The Commercial Aviation Safety Team found the majority of recent international commercial aviation accidents attributable to loss of control inflight involved flight crew loss of airplane state awareness (ASA), and distraction was involved in all of them. Research on attention-related human performance limiting states (AHPLS) such as channelized attention, diverted attention, startle/surprise, and confirmation bias, has been recommended in a Safety Enhancement (SE) entitled "Training for Attention Management." To accomplish the detection of such cognitive and psychophysiological states, a broad suite of sensors was implemented to simultaneously measure their physiological markers during a high fidelity flight simulation human subject study. Twenty-four pilot participants were asked to wear the sensors while they performed benchmark tasks and motion-based flight scenarios designed to induce AHPLS. Pattern classification was employed to predict the occurrence of AHPLS during flight simulation also designed to induce those states. Classifier training data were collected during performance of the benchmark tasks. Multimodal classification was performed, using pre-processed electroencephalography, galvanic skin response, electrocardiogram, and respiration signals as input features. A combination of one, some or all modalities were used. Extreme gradient boosting, random forest and two support vector machine classifiers were implemented. The best accuracy for each modality-classifier combination is reported. Results using a select set of features and using the full set of available features are presented. Further, results are presented for training one classifier with the combined features and for training multiple classifiers with features from each modality separately. Using the select set of features and combined training, multistate prediction accuracy averaged 0.64 +/- 0.14 across thirteen participants and was significantly higher than that for the separate training case. These results support the goal of demonstrating simultaneous real-time classification of multiple states using multiple sensing modalities in high fidelity flight simulators. This detection is intended to support and inform training methods under development to mitigate the loss of ASA and thus reduce accidents and incidents.

Harrivel, Angela R.↗

NASA NTRS2017

Emergency Locator Transmitter Survivability and Reliability Study

A comprehensive study of Emergency Locator Transmitter (ELT) performance was conducted over a three year period concluding in 2016 in support of the Search and Rescue (SAR) Mission Office at National Aeronautics and Space Administration (NASA) Goddard Space Flight Center (GSFC). The study began with a review of reported performance cited in a collection of works published as early as 1980 as well as analysis of a focused set of contemporary aviation crash reports. Based on initial research findings, a series of subscale and fullscale system tests were performed at NASA Langley Research Center (LaRC) with the goals of investigating ELT system failure modes and developing recommended improvements to the Radio Technical Commission for Aeronautics (RTCA) Minimum Operational Performance Specification (MOPS) that will result in improved system performance. Enhanced performance of ELT systems in aviation accidents will reduce unnecessary loss of human life and make SAR operations safer and less costly by reducing the amount of time required to locate accident sites.

Stimson, Chad M.↗

NASA NTRS2017

Assessment of a Conceptual Flap System Intended for Enhanced General Aviation Safety

A novel multielement trailing-edge flap system for light general aviation airplanes was conceived for enhanced safety during normal and emergency landings. The system is designed to significantly reduce stall speed, and thus approach speed, with the goal of reducing maneuveringflight accidents and enhancing pilot survivability in the event of an accident. The research objectives were to assess the aerodynamic performance characteristics of the system and to evaluate the extent to which it provided both increased lift and increased drag required for the low-speed landing goal. The flap system was applied to a model of a light general aviation, high-wing trainer and tested in the Langley 12- Foot Low-Speed Wind Tunnel. Data were obtained for several device deflection angles, and component combinations at a dynamic pressure of 4 pounds per square foot. The force and moment data supports the achievement of the desired increase in lift with substantially increased drag, all at relatively shallow angles of attack. The levels of lift and drag can be varied through device deflection angles and inboard/outboard differential deflections. As such, it appears that this flap system may provide an enabling technology to allow steep, controllable glide slopes for safe rapid descent to landing with reduced stall speed. However, a simple flat-plate lower surface spoiler (LSS) provided either similar or superior lift with little impact on pitch or drag as compared to the proposed system. Higher-fidelity studies are suggested prior to use of the proposed system.

Campbell, Bryan A.↗

NASA NTRS2017

Quantifying Pilot Contribution to Flight Safety during Hydraulic Systems Failure

Kramer, Lynda J.↗

NASA NTRS2017

Flame Retardant Fibers for Human Space Exploration - Past, Present, and Future

The National Aeronautics and Space Administration (NASA) has led in the development of unique flame retardant fibers for human spaceflight since the beginning of the Apollo program. After the Apollo 1 fire which killed Command Pilot Virgil I 'Gus' Grissom, Senior Pilot Edward H. White II, and Pilot Roger B. Chaffee from cardiac arrest on January 27, 1967, the accident investigators found severe third degree burns and melted spacesuits on the astronauts bodies. NASA immediately initiated an extensive research program aimed at developing flame retardant and flame resistant fibers for the enriched oxygen atmosphere of the Apollo crew cabin. Fibers are flame retardant when they have been modified by chemical and thermal treatments. Fibers are flame resistant when they are made of inherently flame resistant materials (i.e. glass, ceramic, highly aromatic polymers). Immediately after this tragic accident, NASA funded extensive research in specifically developing flame retardant fibers and fabrics. The early developmental efforts for human spaceflight were for the outer layer of the Apollo spacesuit. It was imperative that non-flammable fabrics be used in a 100% oxygen environment. Owens-Corning thus developed the Beta fiber that was immediately used in the Apollo program and later in the Space Shuttle program. Aside from the urgent need for protective fabrics for the spacesuit, NASA also needed flame retardant fabrics for both clothing and equipment inside the spacecraft. From the mid-1960s to the early 1980's, NASA contracted with many companies to develop inherently flame retardant fibers and flame retardant finishes for existing fibers. Fluorocarbons and aromatic polyamides were the polymers of great interest for the development of new inherently flame retardant fibers for enriched oxygen environments. These enriched environments varied for different space programs. For example, the Apollo program requirements were for materials that would not support combustion in a 70%/30% oxygen/nitrogen environment at 6.3 pounds per square inch (psi). The Skylab program flammability requirements were set at 80%/20% oxygen/nitrogen ratios at 5 psi. While many fibers produced under several NASA contracts were never used, a few have become commercial products. The intent of this paper is to present the developmental history of some of these new or modified textile fibers. These developmental efforts are presented at various levels of details depending on the source of the historical records.

Orndoff, Evelyne↗

NASA NTRS2017

Quantifying Pilot Contribution to Flight Safety during Drive Shaft Failure

Accident statistics cite the flight crew as a causal factor in over 60% of large transport aircraft fatal accidents. Yet, a well-trained and well-qualified pilot is acknowledged as the critical center point of aircraft systems safety and an integral safety component of the entire commercial aviation system. The latter statement, while generally accepted, cannot be verified because little or no quantitative data exists on how and how many accidents/incidents are averted by crew actions. A joint NASA/FAA high-fidelity motion-base simulation experiment specifically addressed this void by collecting data to quantify the human (pilot) contribution to safety-of-flight and the methods they use in today's National Airspace System. A human-in-the-loop test was conducted using the FAA's Oklahoma City Flight Simulation Branch Level D-certified B-737-800 simulator to evaluate the pilot's contribution to safety-of-flight during routine air carrier flight operations and in response to aircraft system failures. These data are fundamental to and critical for the design and development of future increasingly autonomous systems that can better support the human in the cockpit. Eighteen U.S. airline crews flew various normal and non-normal procedures over a two-day period and their actions were recorded in response to failures. To quantify the human's contribution to safety of flight, crew complement was used as the experiment independent variable in a between-subjects design. Pilot actions and performance during single pilot and reduced crew operations were measured for comparison against the normal two-crew complement during normal and non-normal situations. This paper details the crew's actions, including decision-making, and responses while dealing with a drive shaft failure - one of 6 non-normal events that were simulated in this experiment.

Kramer, Lynda J.↗

NASA NTRS2017

Quantifying Pilot Contribution to Flight Safety During Dual Generator Failure

Accident statistics cite flight crew error in over 60% of accidents involving transport category aircraft. Yet, a well-trained and well-qualified pilot is acknowledged as the critical center point of aircraft systems safety and an integral safety component of the entire commercial aviation system. No data currently exists that quantifies the contribution of the flight crew in this role. Neither does data exist for how often the flight crew handles non-normal procedures or system failures on a daily basis in the National Airspace System. A pilot-in-the-loop high fidelity motion simulation study was conducted by the NASA Langley Research Center in partnership with the Federal Aviation Administration (FAA) to evaluate the pilot's contribution to flight safety during normal flight and in response to aircraft system failures. Eighteen crews flew various normal and non-normal procedures over a two-day period and their actions were recorded in response to failures. To quantify the human's contribution, crew complement was used as the experiment independent variable in a between-subjects design. Pilot actions and performance when one of the flight crew was unavailable were also recorded for comparison against the nominal two-crew operations. This paper details diversion decisions, perceived safety of flight, workload, time to complete pertinent checklists, and approach and landing results while dealing with a complete loss of electrical generators. Loss of electrical power requires pilots to complete the flight without automation support of autopilots, flight directors, or auto throttles. For reduced crew complements, the additional workload and perceived safety of flight was considered unacceptable.

Etherington, Timothy J.↗

NASA NTRS2017

Verification Testing: Meet User Needs Figure of Merit

Verification is the process through which Modeling and Simulation(M&S) software goes to ensure that it has been rigorously tested and debugged for its intended use. Validation confirms that said software accurately models and represents the real world system. Credibility gives an assessment of the development and testing effort that the software has gone through as well as how accurate and reliable test results are. Together, these three components form Verification, Validation, and Credibility(VV&C), the process by which all NASA modeling software is to be tested to ensure that it is ready for implementation. NASA created this process following the CAIB (Columbia Accident Investigation Board) report seeking to understand the reasons the Columbia space shuttle failed during reentry. The reports conclusion was that the accident was fully avoidable, however, among other issues, the necessary data to make an informed decision was not there and the result was complete loss of the shuttle and crew. In an effort to mitigate this problem, NASA put out their Standard for Models and Simulations, currently in version NASA-STD-7009A, in which they detailed their recommendations, requirements and rationale for the different components of VV&C. They did this with the intention that it would allow for people receiving MS software to clearly understand and have data from the past development effort. This in turn would allow the people who had not worked with the MS software before to move forward with greater confidence and efficiency in their work. This particular project looks to perform Verification on several MATLAB (Registered Trademark)(The MathWorks, Inc.) scripts that will be later implemented in a website interface. It seeks to take note and define the limits of operation, the units and significance, and the expected datatype and format of the inputs and outputs of each of the scripts. This is intended to prevent the code from attempting to make incorrect or impossible calculations. Additionally, this project will look at the coding generally and note inconsistencies, redundancies, and other aspects that may become problematic or slow down the codes run time. Certain scripts lacking in documentation also will be commented and cataloged.

validation↗

NASA NTRS2018

Measurements of Parachute Dynamics in the World's Largest Wind Tunnel by Stereo Photogrammetry

Between 2012 and 2017, parachutes for four NASA Projects were tested in the 80- by 120-Ft test section of the National Full-Scale Aerodynamic Complex (NFAC) at NASA Ames Research Center. These projects were: (1) Low-Density Supersonic Decelerator (LDSD); (2) Capsule Parachute Assembly System (CPAS, for Orion); (3) Interior Exploration using Seismic Investigations, Geodesy and Heat Transport (InSight, a Mars mission); and (4) Mars 2020. In all tests stereo photogrammetry was used to measure time-dependent positions of features on the canopies. For the LDSD and CPAS tests, where the purpose was to study the trade-off between stability and drag of different parachute designs, the pendulum motion of the canopies about the riser attachment point was measured by calibrated cameras in the diffuser. The CPAS test also included static measurements where the inflated parachutes were pulled to the side by a system of tethers. The Insight tests were structural qualification tests where each canopy was packed in a bag and launched from a mortar. Cameras in the diffuser measured the trajectory of the bag and the stripping of the bag from the canopy. The Mars 2020 test was a workmanship verification test where the canopies were either launched from a mortar or deployed from a sleeve stretched along the tunnel axis. The deployments were recorded from many directions by thirteen high-speed cameras distributed in the diffuser and test section. Photogrammetry was not planned; however, after a tunnel-related accident ended the test prematurely, photogrammetric measurements were bootstrapped from the images to support the accident investigations. This paper describes how the photogrammetry measurements were made in each test and presents typical results.

Schairer, Edward T.↗

NASA NTRS2018

NASA: 60 Years and Counting...

Sputnik launched on 4 Oct 1057. On July 29, 1958, Eisenhower signed the National Aeronautics and Space Act, the creation of NASA. The Soviets launched the first human into orbit, Yuri Gagarin, on April 12, 1961. On 5 May 1961, Alan Shepard's Freedom 7 Mercury capsule lifted off at 9:34 a.m. from Launch Complex 5 at Cape Canaveral Air Force Station, and flew a suborbital trajectory lasting 15 minutes and 22 seconds, America's first man in space. On 25 May 1961, Kennedy delivered a speech to a joint session of Congress. In that speech, he stated "I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the earth." The rest, as they say, is history. Project Mercury, the first U.S. program to put humans in space, made 25 flights, six of which carried astronauts between 1961 and 1963. The Gemini program primarily tested equipment and mission procedures and trained astronauts and ground crews for future Apollo missions to the Moon. Exactly eight years, one month and 26 days after President Kennedy challenged Americans to reach for the Moon, Project Apollo landed the first humans on the lunar surface and returned them safely to Earth. In 1973, Skylab expeditions paved the way for the International Space Station. Over 30 years, NASA's space shuttle fleet, ”Columbia, Challenger, Discovery, Atlantis and Endeavour,” flew 135 missions and carried 355 different people to space. The space shuttle carried people into orbit repeatedly; launched, recovered and repaired satellites; conducted cutting-edge research; and built the largest structure in space, the International Space Station. Tragically, NASA lost two crews of seven in the 1986 Challenger accident and the 2003 Columbia accident. The International Space Station is a model for global cooperation and scientific advancements that is enabling growth of private industry in low-Earth orbit and development of new technologies to advance human space exploration. Built between 1998 and 2011, the space station has housed humans continuously since Nov. 2, 2000. NASA has contracted with commercial companies SpaceX, Orbital ATK, and Sierra Nevada Corporation to deliver science investigations, cargo, and supplies to the crews living in space, and soon Boeing and SpaceX will transport astronauts to and from the station. Today, NASA is working on many fronts to advance man's presence in space. NASA's Exploration Campaign will establish U.S. preeminence in cislunar space through the operations and the deployment of a U.S.-led Lunar Orbital Platform-Gateway (LOPG). Together with the Orion and SLS Programs, the LOPG is central to advancing and sustaining human space exploration goals, and is the unifying single stepping off point for human cislunar operations, lunar surface access and missions to Mars. As one might expect, EMC for all this activity is challenging, to say the least. In the next half-hour or so, I will talk about some of those challenges and how the different programs are meeting them.

Scully, Bob↗

NASA NTRS2016

Real-Time Early Warning Techniques

Contemporary approaches to aerospace vehicle system monitoring rely heavily on thresholds that represent a compromise between providing warning early enough to avert a mishap while simultaneously minimizing false alarms. While this reliance on thresholds has been in place for decades and has permeated both cockpits and control rooms, we often find it insufficient when retrospectively analyzing data from an accident. To modernize and enhance flight test safety, we introduce new methods of monitoring for anomalous patterns of interaction rather than for thresholds exceedance. For systems with a well characterized baseline we show how the Inductive Monitoring System (IMS), utilized by NASA in the aftermath of the Columbia accident, might be implemented in real-time to provide earlier warning than currently employed techniques. For systems without such a baseline, we introduce new developments in statistical methods relating to critical slowing down, first applied in medicine and physics, which show promise for adaptation to flight test. Finally, the familiar resource constrained environment leads to a reliance on increased instrumentation that is challenging the limits of the current one-sensor, one-indicator threshold paradigm. Existing methods thus fail to accurately reflect the true complexity of a vehicle rich with interdependent interacting systems. We highlight these concepts in a brief summary of the 2001 Air Transat Flight 236 deadstick landing in the Azores. We then suggest control room and cockpit modifications to better display the information gleaned using these novel monitoring methods.

Javorsek, Dan↗

NASA NTRS2016

Enhancing Flight Test Safety with Real-Time Early Warning Techniques

Contemporary approaches to aerospace vehicle system monitoring rely heavily on thresholds that represent a compromise between providing warning early enough to avert a mishap while simultaneously minimizing false alarms. While this reliance on thresholds has been in place for decades and has permeated both cockpits and control rooms, we often find it insufficient when retrospectively analyzing data from an accident. To modernize and enhance flight test safety, we introduce new methods of monitoring for anomalous patterns of interaction rather than for thresholds exceedance. For systems with a well characterized baseline we show how the Inductive Monitoring System (IMS), utilized by NASA in the aftermath of the Columbia accident, might be implemented in real-time to provide earlier warning than currently employed techniques. For systems without such a baseline, we introduce new developments in statistical methods relating to critical slowing down, first applied in medicine and physics, which show promise for adaptation to flight test. Finally, the familiar resource constrained environment leads to a reliance on increased instrumentation that is challenging the limits of the current "one-sensor, one-indicator" threshold paradigm. Existing methods thus fail to accurately reflect the true complexity of a vehicle rich with interdependent interacting systems. We highlight these concepts in a brief summary of the 2001 Air Transat Flight 236 deadstick landing in the Azores. We then suggest control room and cockpit modifications to better display the information gleaned using these novel monitoring methods.

Javorsek, Daniel, II↗