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At least 109 records · Page 6

Altitude deviations: Breakdowns of an error-tolerant system

Pilot reports of aviation incidents to the Aviation Safety Reporting System (ASRS) provide a window on the problems occurring in today's airline cockpits. The narratives of 10 pilot reports of errors made in the automation-assisted altitude-change task are used to illustrate some of the issues of pilots interacting with automatic systems. These narratives are then used to construct a description of the cockpit as an information processing system. The analysis concentrates on the error-tolerant properties of the system and on how breakdowns can occasionally occur. An error-tolerant system can detect and correct its internal processing errors. The cockpit system consists of two or three pilots supported by autoflight, flight-management, and alerting systems. These humans and machines have distributed access to clearance information and perform redundant processing of information. Errors can be detected as deviations from either expected behavior or as deviations from expected information. Breakdowns in this system can occur when the checking and cross-checking tasks that give the system its error-tolerant properties are not performed because of distractions or other task demands. Recommendations based on the analysis for improving the error tolerance of the cockpit system are given.

Palmer, Everett A.↗

Analysis of general aviation single-pilot IFR incident data obtained from the NASA Aviation Safety Reporting System

An analysis of incident data obtained from the NASA Aviation Safety Reporting System (ASRS) has been made to determine the problem areas in general aviation single-pilot IFR (SPIFR) operations. The Aviation Safety Reporting System data base is a compilation of voluntary reports of incidents from any person who has observed or been involved in an occurrence which was believed to have posed a threat to flight safety. This paper examines only those reported incidents specifically related to general aviation single-pilot IFR operations. The frequency of occurrence of factors related to the incidents was the criterion used to define significant problem areas and, hence, to suggest where research is needed. The data was cataloged into one of five major problem areas: (1) controller judgment and response problems, (2) pilot judgment and response problems, (3) air traffic control (ATC) intrafacility and interfacility conflicts, (4) ATC and pilot communication problems, and (5) IFR-VFR conflicts. In addition, several points common to all or most of the problems were observed and reported. These included human error, communications, procedures and rules, and work load.

Bergeron, H. P.↗

Personal Electronic Devices and Their Interference with Aircraft Systems

A compilation of data on personal electronic devices (PEDs) attributed to having created anomalies with aircraft systems. Charts and tables display 14 years of incidents reported by pilots to the Aviation Safety Reporting System (ASRS). Affected systems, incident severity, sources of anomaly detection, and the most frequently identified PEDs are some of the more significant data. Several reports contain incidents of aircraft off course when all systems indicated on course and of critical events that occurred during landings and takeoffs. Additionally, PEDs that should receive priority in testing are identified.

Ross, Elden↗

An investigation of reports of Controlled Flight Toward Terrain (CFTT)

Some 258 reports from more than 23,000 documents in the files of the Aviation Safety Reporting System (ASRS) were found to be to the hazard of flight into terrain with no prior awareness by the crew of impending disaster. Examination of the reports indicate that human error was a casual factor in 64% of the incidents in which some threat of terrain conflict was experienced. Approximately two-thirds of the human errors were attributed to controllers, the most common discrepancy being a radar vector below the Minimum Vector Altitude (MVA). Errors by pilots were of a much diverse nature and include a few instances of gross deviations from their assigned altitudes. The ground proximity warning system and the minimum safe altitude warning equipment were the initial recovery factor in some 18 serious incidents and were apparently the sole warning in six reported instances which otherwise would most probably have ended in disaster.

Porter, R. F.↗

Informing NLP Learning Tasks by Tracking User Features: An ASRS Use Case using Kaona

There has been growing interest in utilizing natural language processing (NLP) algorithms in Aviation Safety. This interest has extended to leveraging the decades of records publicly available on the Aviation Safety Reporting System (ASRS). While related literature has given more emphasis in lessons learned from the narratives, our prior work has focused on using NLP to support narrative search in the ASRS. Specifically, we evaluated if the use of alternative search mechanisms to keyword search, such as the retrieval of related narratives even without matching keywords could improve narrative discovery. A difficulty in experimenting alternative search mechanisms in any information retrieval task is the lack of ground truth. To address this limitation, we propose Kaona, a lightweight interface which enables the prototyping of alternative search retrieval tasks, by tracking user experience both explicitly (user-specified feedback), or implicitly (user navigation through interface affordances). Differently from distracting requests for feedback during user navigation, Kaona collects explicit feedback from users by mapping them to affordances which support the user workflow, while obtaining ground truth information for learning tasks.

human-computer-interaction↗

SafeAeroBERT: Towards a Safety-Informed Aerospace-Specific Language Model

As aviation systems continue to operate with high traffic, large amounts of documents containing safety-relevant data continue to be generated via reporting systems such as the Aviation Safety Reporting System (ASRS). Advanced natural language processing techniques, specifically pre-trained language models, have shown great success in domain-specific applications; however, the text in aviation safety reports is inundated with jargon and thus not fully utilized by general pre-trained models. In this research, we work towards developing a safety-informed aerospace-specific language model by pre-training a Bidirectional Encoder Representations from Transformer (BERT) model on reports from the Aviation Safety Reporting System and the National Transportation Safety Board. The resulting model, called SafeAeroBERT, is fine-tuned for the specific task of document classification, and can be further tuned for named-entity recognition, relation detection, information retrieval, and summarization. Results from the classification task are compared between SafeAeroBERT, the base BERT, and SciBERT models and show SafeAeroBERT outperforms the general BERT and SciBERT on classifying reports about weather and procedure. SafeAeroBERT can be used on custom tasks, not limited to document classification, and is intended to aid an intelligent knowledge manager for safety report repositories.

Aviation↗

System Driven Workarounds

The Aviation Safety Reporting System (ASRS) in a partnership between the National Aeronautics and Space Administration (NASA), the Federal Aviation Administration (FAA), participating carriers, and labor organizations. It is designed to improve the National Airspace System by collecting and studying reports detailing unsafe conditions and events in the aviation industry. Employees are able to report safety issues or concerns with confidentiality and without fear of discipline. Safety reports highlighting system driven workarounds for the aviation community highlight the human workaround for the complex aviation system.

aviation safety↗

Cabin Safety Issues Related to Pre-Departure and Inflight Issues

The Aviation Safety Reporting System (ASRS) in a partnership between the National Aeronautics and Space Administration (NASA), the Federal Aviation Administration (FAA), participating carriers, and labor organizations. It is designed to improve the National Airspace System by collecting and studying reports detailing unsafe conditions and events in the aviation industry. Employees are able to report safety issues or concerns with confidentiality and without fear of discipline. Safety reports highlighting the human element in cabin safety issues and concerns.

confidential reporting↗

Trouble with Troubleshooting

The Aviation Safety Reporting System (ASRS) in a partnership between the National Aeronautics and Space Administration (NASA), the Federal Aviation Administration (FAA), participating carriers, and labor organizations. It is designed to improve the National Airspace System by collecting and studying reports detailing unsafe conditions and events in the aviation industry. Employees are able to report safety issues or concerns with confidentiality and without fear of discipline.

Connell, Linda↗

Dangers on the Ramp: Aviation Safety Reporting System

The Aviation Safety Reporting System (ASRS) in a partnership between the National Aeronautics and Space Administration (NASA), the Federal Aviation Administration (FAA), participating carriers, and labor organizations. It is designed to improve the National Airspace System by collecting and studying reports detailing unsafe conditions and events in the aviation industry. Employees are able to report safety issues or concerns with confidentiality and without fear of discipline.

confidential reporting↗

Fuel Policies and Filed Alternates

The Aviation Safety Reporting System (ASRS) in a partnership between the National Aeronautics and Space Administration (NASA), the Federal Aviation Administration (FAA), participating carriers, and labor organizations. It is designed to improve the National Airspace System by collecting and studying reports detailing unsafe conditions and events in the aviation industry. Employees are able to report safety issues or concerns with confidentiality and without fear of discipline. Safety reports highlighting fuel policies and alternate requirements for the aviation community highlight the human element in the complex aviation system.

Connell, Linda↗

Airport ramp safety and crew performance issues

This study examined 182 ramp operations incident reports from the Aviation Safety Reporting System (ASRS) database, to determine which factors influence ramp operation incidents. It was found that incidents occurred more often during aircraft arrival operations than during departure operations; incidents occurred most often at the gate stop area, less so at the gate entry/exit areas, and least on the ramp fringe areas; and reporters cited fewer incidents when more ground crew were present. The authors offer suggestions for both airline management and flight crews to reduce the rate of ramp incidents.

Chamberlin, Roy↗

Joint ASRS and NASA Callback on FANS-1 Datalink Operational Incidents

The recent certification and implementation of the Future Air Navigation System (FANS- 1) was based on the benefits of reduced separation minima, ability to optimize flight plans enroute, and the prompt transmission and reception of messages between oceanic controllers and 747-400 aircraft transiting the Pacific. In addition, FANS was intended to supersede High Frequency (HF) radio which has been the staple, yet problematic, long distance communication link for years. However, in the three initial years of operation, FANS has revealed its own unique operational issues. Although some technical and engineering problems have been studied and addressed, little research has been conducted on human factors issues associated with the use of FANS on the flight deck. This lack of prior data on the operational use of FANS prompted a joint NASA/Aviation Safety Reporting System (ASRS) inquiry into FANS datalink. In addition, two foreign air carriers and their respective safety agencies were recruited to participate. This international FANS research effort consisting of three aviation safety agencies and three international commercial air-carriers has provided a unique opportunity for conducting human factors research in an operational environment. An ASRS 'callback' format was chosen for the study as a practical and viable method for capturing FANS events on the flight deck. Initially, 747-400 pilots were encouraged to submit reports to their respective safety agencies if they had experienced any positive or negative incidents with the use of FANS. Upon receipt of a report, it was evaluated and if deemed pertinent to the study, a telephone interview or 'callback' was conducted on the FANS incident to elicit further details, capture the key events, and gather contextual information. Once the operational data collection phase was completed, the reports and interviews were analyzed with two purposes in mind: primarily to identify and address problematic human factors issues with current FANS technology, and, secondarily, to provide 'lessons learned' for future datalink systems and implementation.

Moses, John↗

Influence of the distribution of expansive sites in aggregates on microscopic damage caused by alkali-silica reaction: Insights into the mechanical origin of expansion

The origin of damage in concrete due to the alkali-silica reaction (ASR) is attributed to the expansion site in the aggregate. To investigate the cracking process of the aggregate during ASR and its consequences on concrete damage, the effect of the distribution of the expansive sites in the aggregate on ASR expansion and the crack patterns must be evaluated. Thus, in this study, a mesoscale discrete model was applied to ASR modeling to represent the propagation of cracking during ASR accurately. The distribution of the expansive sites in the aggregate was based on the gel pocket and reaction rim models, which are two ASR mechanisms reported in the literature. These two expansion models highlight the different crack patterns obtained based on the aggregate characteristics. Further, the expansion cracking processes determined based on the gel pocket and reaction rim models are consistent with the evolution of cracking with the expansion level.

36 MATERIALS SCIENCE↗

EMS helicopter incidents reported to the NASA Aviation Safety Reporting System

The objectives of this evaluation were to: Identify the types of safety-related incidents reported to the Aviation Safety Reporting System (ASRS) in Emergency Medical Service (EMS) helicopter operations; Describe the operational conditions surrounding these incidents, such as weather, airspace, flight phase, time of day; and Assess the contribution to these incidents of selected human factors considerations, such as communication, distraction, time pressure, workload, and flight/duty impact.

Connell, Linda J.↗

A Practical Guide to Interpretation of Large Collections of Incident Narratives Using the QUORUM Method

Analysis of incident reports plays an important role in aviation safety. Typically, a narrative description, written by a participant, is a central part of an incident report. Because there are so many reports, and the narratives contain so much detail, it can be difficult to efficiently and effectively recognize patterns among them. Recognizing and addressing recurring problems, however, is vital to continuing safety in commercial aviation operations. A practical way to interpret large collections of incident narratives is to apply the QUORUM method of text analysis, modeling, and relevance ranking. In this paper, QUORUM text analysis and modeling are surveyed, and QUORUM relevance ranking is described in detail with many examples. The examples are based on several large collections of reports from the Aviation Safety Reporting System (ASRS) database, and a collection of news stories describing the disaster of TWA Flight 800, the Boeing 747 which exploded in mid- air and crashed near Long Island, New York, on July 17, 1996. Reader familiarity with this disaster should make the relevance-ranking examples more understandable. The ASRS examples illustrate the practical application of QUORUM relevance ranking.

McGreevy, Michael W.↗

Cross-Cultural Barriers to Effective Communication in Aviation

Recent research on communication and performance in airline flight crews has led to a concept of shared mental models that is associated with effective, efficient team coordination in problem solving and decision making situations. Elements that characterize efficient communication have been identified. This research, however, was based strictly on US crews. More recent studies supported by NASA have identified cultural factors that influence communication among team members who vary in their status and roles. Research is just beginning to identify commonalities and culturally distinct strategies for accomplishing joint tasks. ASRS incident reports have been analyzed to identify language barriers in flight that have safety consequences. Implications of these concepts and findings for multi-cultural command and control will be explored.

Orasanu, Judith↗

Identification of Error Patterns in Terminal-Area ATC Communications

Advancing air traffic management technologies have enabled a greater number of aircraft to use the same airspace more effectively. As aircraft separations are reduced and final approaches are more finely timed, there is less room for error. The present study examined 122 terminal-area, loss-of-separation and procedure violation incidents reported to the Aviation Safety Reporting System (ASRS) by air traffic controllers. Narrative description codes were used for the incidents for type of violation, contributing factors, recovery strategies, and consequences. Usually multiple errors occurred prior to the violation. Error sequences were analyzed and common patterns of errors were identified. In half of the incidents, errors were noticed in time to correct mistakes. Of these, almost 43% committed additional errors during the recovery attempt. This analysis shows that redundancies in the present air traffic control system may not be sufficient to support large increases in traffic density. Error prevention and design considerations for air traffic management systems are discussed.

Quinn, Cheryl↗