SEARCH · Search NASA
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.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
We present a study of weather-related incident reports submitted to NASA’s Aviation Safety Reporting System (ASRS) by air carrier pilots in the US. Using specific examples, we examine the relevant aspects of human performance and resilience management exhibited during these incidents. We describe the common narrative about human error and how ASRS data can be used to change it.
This presentation provides an aviation SME's human factors analysis of selected Low Altitude and Controlled Flight Towards Terrain (CFTT) events involving Part 121 air carriers as reported to the Aviation Safety Reporting System (ASRS).
Recent studies have shown that a more efficient use of airspace may involve shared airspace operations, i.e., temporal as well as spatial separation of arrival and departure flows [1][2]. Temporal separation would permit a departure aircraft to fly through an arrival flow, depending on an available gap. This would necessitate careful and precise coordination between controllers in different sectors. Three methods of coordination which permit the penetration of a controller's airspace by another controller's aircraft are described: point out, look-and-go, and prearranged coordination procedure. Requirements of each method are given, along with associated problems that have surfaced in the field as described by Aviation Safety and Reporting System (ASRS) and other reports. A Human-in-the-Loop simulation was designed to compare two of the methods: point out and prearranged coordination procedures. In prearranged coordination procedures (P-ACP), the controllers control an aircraft in another controller's airspace according to specified prearranged procedures, without coordinating each individual aircraft with another controller, as is done with point outs. In the simulation, three experienced controllers rotated through two arrival sectors and a non-involved arrival sector of a Terminal Radar Approach Control (TRACON) airspace. Results of eighteen one-hour simulation runs (nine in each of the two conditions) showed no impact of the coordination method on separation violations nor on arrival times for 208 departing aircraft crossing an arrival stream. Participant assessment indicated that although both coordination conditions were acceptable, the prearranged coordination procedure condition was slightly safer, more efficient, timely, and overall, worked better operationally. Problems arose in the point out condition regarding controllers noticing acceptance of point outs. Also, in about half of the point-out runs, time pressure was felt to have had an impact on when and if the departures could cross an arrival stream. An additional problem with point outs may be confusion in the field about which controller has responsibility for separating point-out aircraft from other aircraft.
No abstract available
National databases that collect various kinds of textual threat reports such as ASRS, CERT, and NVD manually process their reports individually. They then offer data products to disseminate the aggregate information, like newsletters, alerts or individual report searching. The goal of this research is to connect these individual reports thematically and temporally to identify emerging or recurring threats, by analyzing large collections of text, source code, collaboration and communication patterns. This capability, I argue, enables us to identify the emergence and recurrence of such themes, and the contexts in which they re-occur, facilitating faster and more capable mitigation. I propose two models to shed light on this goal: An empirical model of vulnerabilities as bugs, the commit flow model, and one of the vulnerabilities and aviation safety threats as topics, the topic flow model. I use as gold standard existing manual workflows in both domains, reflected in the existing data products by these organizations, and empirically evaluate if the automated model scan match or outperform existing manual practices.
A three-month study (February to April 2010) of the NASA Aviation Safety (AvSafe) program was conducted. This study comprised three components: (1) a statistical analysis of currently available civilian subsonic aircraft data from the National Transportation Safety Board (NTSB), the Federal Aviation Administration (FAA), and the Aviation Safety Information Analysis and Sharing (ASIAS) system to identify any significant or overlooked aviation safety issues; (2) a high-level qualitative identification of future safety risks, with an assessment of the potential impact of the NASA AvSafe research on the National Airspace System (NAS) based on these risks; and (3) a detailed, top-down analysis of the NASA AvSafe program using an established and peer-reviewed systems analysis methodology. The statistical analysis identified the top aviation "tall poles" based on NTSB accident and FAA incident data from 1997 to 2006. A separate examination of medical helicopter accidents in the United States was also conducted. Multiple external sources were used to develop a compilation of ten "tall poles" in future safety issues/risks. The top-down analysis of the AvSafe was conducted by using a modification of the Gibson methodology. Of the 17 challenging safety issues that were identified, 11 were directly addressed by the AvSafe program research portfolio.
As world-wide air traffic continues to grow even at a modest pace, the overall complexity of the system will increase significantly. This increased complexity can lead to a larger number of fatalities per year even if the extremely low fatality rate that we currently enjoy is maintained. One important source of information about the safety of the aviation system is in Aviation Safety Text Reports which are written by members of the flight crew, air traffic controllers, and other parties involved with the aviation system. These anonymized narrative reports contain fixed-field contextual information about the flight but also contain free-form narratives that describe, in the author s own words, the nature of the safety incident and, in many cases, the contributing factors that led to the safety incident. Several thousand such reports are filed each month, each of which is read and analyzed by highly trained experts. However, it is possible that there are emerging safety issues due to the fact that they may be reported very infrequently and in different contexts with different descriptions. The goal of this research paper is to develop correlated topic models which uncover correlations in the subspaces defined by the intersection of numerous fixed fields and discovered correlated topics. This task requires the discovery of latent topics in the text reports and the creation of a topic cube. Furthermore, because the number of potential cells in the topic cube is very large, we discuss novel methods of pruning the search space in the topic cells, thereby making the analysis feasible. We demonstrate the new algorithms on an analysis of pilot fatigue and its contributing factors, as well as the safety incidents that are correlated with this phenomenon.
During the analysis of flight data and safety reports done in ASAP and FOQA programs, airline personnel are not able to access relevant aviation data for a variety of reasons. We have developed the Aviation Data Integration System (ADIS), a software system that provides integrated heterogeneous data to support safety analysis. Types of data available in ADIS include weather, D-ATIS, RVR, radar data, and Jeppesen charts, and flight data. We developed three versions of ADIS to support airlines. The first version has been developed to support ASAP teams. A second version supports FOQA teams, and it integrates aviation data with flight data while keeping identification information inaccessible. Finally, we developed a prototype that demonstrates the integration of aviation data into flight data analysis programs. The initial feedback from airlines is that ADIS is very useful in FOQA and ASAP analysis.
Aviation is one of the critical modes of our national transportation system. As such, it is essential that new technologies be continually developed to ensure that a safe mode of transportation becomes even safer in the future. The NASA Aviation Safety Program (AvSP) is managing the development of new technologies and interventions aimed at reducing the fatal aviation accident rate by a factor of 5 by year 2007 and by a factor of 10 by year 2022. A portfolio assessment is currently being conducted to determine the projected impact that the new technologies and/or interventions may have on reducing aviation safety system risk. This paper reports on advanced risk analytics that combine the use of a human error taxonomy, probabilistic Bayesian Belief Networks, and case-based scenarios to assess a relative risk intensity metric. A sample case is used for illustrative purposes.
This is a report of work in progress. In it, I summarize the status of the research and development of the Aviation Performance Measuring System (APMS) for managing, processing, and analyzing digital flight-recorded data, The objectives of the NASA-FAA APMS research project are to establish a sound scientific and technological basis for flight-data analysis, to define an open and flexible architecture for flight-data analysis systems, and to articulate guidelines for a standardized database structure on which to continue to build future flight-data-analysis extensions. APMS offers to the air transport community an open, voluntary standard for flight-data-analysis software; a standard that will help to ensure suitable functionality and data interchangeability among competing software programs. APMS will develop and document the methodologies, algorithms, and procedures for data management and analyses to enable users to easily interpret the implications regarding safety and efficiency of operations. APMS does not entail the implementation of a nationwide flight-data-collection system. It is intended to provide technical tools to ease the large-scale implementation of flight-data analyses at both the air-carrier and the national-airspace levels in support of their Flight Operations and Quality Assurance (FOQA) Programs and Advanced Qualifications Programs (AQP). APMS cannot meet its objectives unless it develops tools that go substantially beyond the capabilities of the current commercially available software and supporting analytic methods that are mainly designed to count special events. These existing capabilities, while of proven value, were created primarily with the needs-of aircrews in mind. APMS tools must serve the needs of the government and air carriers, as well as aircrews, to fully support the FOQA and AQP programs. They must be able to derive knowledge not only through the analysis of single flights (special-event detection), but also through statistical evaluation of the performance of large groups of flights. This paper describes the integrated suite of tools that will assist analysts in evaluating the operational performance and safety of the national air transport system, the air carrier, and the aircrew.
NASA’s vision for Advanced Air Mobility (AAM) Mission is to help emerging aviation markets to safely develop an air transportation system that moves people and cargo between places previously not served or underserved by aviation. The integration of new operational paradigms and vehicle classes in this system requires a transformation of the National Airspace System (NAS) that includes substantive changes critical for assuring safety. These changes are compelled by unique challenges posed by AAM to the safety management system (SMS). These challenges were assessed by committees of the National Academies in their reports on a vision for an In-time Aviation Safety Management System (IASMS) and a blueprint for AAM [1,2]. In their description of an IASMS, the top recommendation was development of a concept of operations (ConOps) for IASMS. This paper describes the high-priority recommendations from the National Academies for its IASMS vision and how they are addressed through a distributed system-of-systems architecture. The IASMS architecture is structured on the services, functions, and capabilities (SFCs) necessary for In-time System-wide Safety Assurance (ISSA)initially developed for urban air mobility (UAM). The paper then posits where these SFCs would reside across vehicles, airspace, or service suppliers such as Supplemental Data Service Providers (SDSPs), and how SFCs scale with increasing complexity in design and operations of AAM. SFCs are foundational building blocks for a system that targets an individual or family of risks using a Monitor-Assess-Mitigate risk paradigm for anomalies, precursors and trends. An IASMS could be conceived that uses a portfolio of SFCs for AAM in general or prioritizes SFCs for a specific domain or operation.
The National Aviation Operational Monitoring Service (NAOMS) was a research project under NASA s Aviation Safety Program during the years from 2000 to 2005. The purpose of this project was to develop a methodology for gaining reliable information on changes over time in the rates-of-occurrence of safety-related events as a means of assessing the safety of the national airspace. The approach was a scientifically designed survey of the operators of the aviation system concerning their safety-related experiences. This report presents the results of the methodology developed and a demonstration of the NAOMS concept through a survey of nearly 20,000 randomly selected air-carrier pilots. Results give evidence that the NAOMS methodology can provide a statistically sound basis for evaluating trends of incidents that could compromise safety. The approach and results are summarized in the report and supporting documentation and complete analyses of results are presented in 14 appendices.
Assuring safety in the NAS with the inclusion of new entrants, such as Advanced Air Mobility (AAM), will require overcoming unique safety challenges that result from combining innovative technologies with novel airspace concepts for moving people and cargo using autonomous vehicles. The focus of the In-time Aviation Safety Management System (IASMS) is to overcome AAM’s safety assurance challenges. The IASMS Concept of Operations (ConOps) describes an interconnected set of services, functions, and capabilities (SFCs) designed to manage operational risks, identify unknown risks, and inform system designs. This paper describes an approach for defining SFCs based on technology trends in research, assessment of known and unknown risks in voluntary safety reports, and causal and contributing factors in aviation accidents and incidents. This approach would identify potential SFCs that further expand the Monitor, Assess, and Mitigate (M-A-M) functionality that represents the enabling framework of the IASMS. Safety implications that will result from integration of AAM in the transformation of the National Airspace System (NAS) were addressed in National Academies committees reports on AAM and IASMS. Development of a ConOps for IASMS was a top recommendation and can be represented as a reframing of safety assurance that builds on real-time alerting such as the Traffic Alert and Collision Avoidance System, and adds the more encompassing in-time temporal parameter in recognition of the different timelines for collecting and assessing safety data for risk mitigations. For example, mining for safety trends from data sources such as the Aviation Safety Information Analysis and Sharing system occurs over a longer time period. Research on AAM operations poses that SFCs can be designed to monitor the safety margin appropriate for AAM including with regards to the distance between current flight parameters and nominal ideal conditions. These in-time comparisons will become more complex as the density of operations increases at least in certain areas and can include planned and actual 4D trajectory, and in-time comparisons having implications on conflict modeling and prediction including expected and actual departure time, fix/waypoint crossing times, and arrival time. These comparisons would be integrated as part of SFCs that redefine and inform new safety margin. An increased safety margin improves management of operational risks while reducing the potential for anomalies. An increased safety margin also has implications for operator confidence in the certainty of its operations and trust in automation. Technology trends in research could be used to refine existing SFCs and define needs for additional SFCs that provide safety improvements to the design and operation of vehicles, airspace design, and operator performance requirements. NASA is developing innovative approaches to safeguard against major accidents and incidents that have occurred in the NAS and those anticipated with the inclusion of envisioned AAM operations. The innovations use operational performance data to monitor, detect, and predict flight variations exceeding safe nominal patterns, such as would be caused by navigational error, severe weather complications, or hijacking of UAS controls. These innovative approaches have high potential to prevent accidents and incidents in the new AAM era. It is anticipated that elements of the innovations will evolve into SFCs for the IASMS. Voluntary safety reports can be monitored to identify anomalies related to design or operational performance risks. Reports could be periodically monitored and assessed for specific topics. Reports might serve as weak signals or precursors indicative of emergent risk such as when combined with other safety information. The architecture could include SFCs that are based on voluntary safety reports recognizing the periodic temporal nature of data analysis. As previously mentioned, aviation accidents with their causal and contributing precursors can inform the need for SFCs in the IASMS. Accidents and incidents at San Francisco International Airport such as Asiana 214 and Air Canada 759 illustrate how combinations of different factors lead to increased risk. These types of precursors and different factors have implications on the types of SFCs that could be needed to monitor and manage different sources and types of design and operational risk. Continuing to assure the safety of AAM as designs and operations gain in complexity can be accompanied by defining SFCs that also increase in complexity. These SFCs can leverage information from findings and recommendations synthesized across on-going research, voluntary safety reports, and accident and incident reports. These SFCs can serve to refine accuracy of algorithms and resolve limitations with current practices. The IASMS architecture represents the framework for the SFCs and their critical role in safety assurance.
The objective of the Aviation System Monitoring and Modeling (ASMM) project of NASA s Aviation Safety and Security Program was to develop technologies that will enable proactive management of safety risk, which entails identifying the precursor events and conditions that foreshadow most accidents. This presents a particular challenge in the aviation system where people are key components and human error is frequently cited as a major contributing factor or cause of incidents and accidents. In the aviation "world", information about what happened can be extracted from quantitative data sources, but the experiential account of the incident reporter is the best available source of information about why an incident happened. This report describes a conceptual model and an approach to automated analyses of textual data sources for the subjective perspective of the reporter of the incident to aid in understanding why an incident occurred. It explores a first-generation process for routinely searching large databases of textual reports of aviation incident or accidents, and reliably analyzing them for causal factors of human behavior (the why of an incident). We have defined a generic structure of information that is postulated to be a sound basis for defining similarities between aviation incidents. Based on this structure, we have introduced the simplifying structure, which we call the Scenario as a pragmatic guide for identifying similarities of what happened based on the objective parameters that define the Context and the Outcome of a Scenario. We believe that it will be possible to design an automated analysis process guided by the structure of the Scenario that will aid aviation-safety experts to understand the systemic issues that are conducive to human error.
The objective of the Aviation System Monitoring and Modeling project of NASA's Aviation Safety and Security Program was to develop technologies to enable proactive management of safety risk, which entails identifying the precursor events and conditions that foreshadow most accidents. Information about what happened can be extracted from quantitative data sources, but the experiential account of the incident reporter is the best available source of information about why an incident happened. In Volume I, the concept of the Scenario was introduced as a pragmatic guide for identifying similarities of what happened based on the objective parameters that define the Context and the Outcome of a Scenario. In this Volume II, that study continues into the analyses of the free narratives to gain understanding as to why the incident occurred from the reporter s perspective. While this is just the first experiment, the results of our approach are encouraging and indicate that it will be possible to design an automated analysis process guided by the structure of the Scenario that can achieve the level of consistency and reliability of human analysis of narrative reports.
The growth of new emerging operations involving Advanced Air Mobility (AAM) necessitates developing a perspective for an In-time Aviation Safety Management System (IASMS). This perspective advances from the National Academies report on IASMS and its recommendation for developing a Concept of Operations (ConOps) for IASMS. A ConOps has been developed for In-time System-Wide Safety Assurance (ISSA) from which the IASMS ConOps pivots to provide a robust scope commensurate with the broad vision defined by the National Academies. The IASMS ConOps focuses on emerging operations and spans innovations in Unmanned Aircraft System (UAS) and an increasingly complex ecosystem comprised of a widening mix of vehicles and technologies, Urban Air Mobility (UAM) with industry-federated services, traditional operations, as well as new supersonic aircraft and space launch systems.The challenge for the IASMS ConOps is to be broad to encompass innovations in the coming years and decades while agile to ensure levels of safety compatible with operational and certification requirements of the National Airspace System (NAS). The IASMS ConOps interweaves increasing complexity of operational safety capabilities and unlocking UAS Maturity Levels (UMLs). The relationships between increased complexity of automation and automated systems, fewer operators who are not as traditionally higher skilled, more complex operational environments, and aviation operations management with mixed aircraft and equipage pose a multi-dimensional space for IASMS capabilities essential for safety assurance and risk management. Instantiating IASMS capabilities and how they would be integral to AAM operations and increasing maturity of UAM could be accomplished through a series of Safety Demonstrators. These Safety Demonstrators could provide increased understanding and insight into use of controls for risk mitigation, means of compliance for certification, and operational experience with safety services such as in relation to contingency management. The IASMS capabilities can be viewed as initially residing with the vehicle, airspace, and Supplemental Data Service Provider (SDSP). For example, vehicle capabilities include communications including the command and control link, Remote Identification (ID), conflict advisory/alerting, and UAS system monitoring. These capabilities monitor and assess data such as battery health, aircraft state, and human performance. Complexity of ISAMS capabilities depends on a number of factors. These factors are intendedonly as a notional categorization with the purpose being to reflect the complexity of the AAM ecosystem that would drive up the complexity of ISSA capabilities including systems, sensors, models, standards, and controls. Factors could include the Vehicle Flight Management, Environment, Airspace, and Contingency Management. Each of these factors can be comprised of multiple sub-factors that contribute to increasing complexity. For example, Airspace at a lower level of complexity could be dedicated to UTM operations that are unmonitored, and at a higher level of complexity could involve mixed UTM and ATM operations. The IASMS concept includes safety services that provide data and information to different participants in AAM. The roles and responsibilities of participants can be defined using the Responsible-Accountable-Consulted-Informed (RACI) analysis. For example, for the safety service involving the Remote ID, the Operator would be accountable for providing the data, the Vehicle would be responsible for transmitting it, and the USS, SDSP, Vertiports, FIMS (FAA), and Public Entities such as safety services would be informed by receiving the data. The IASMS ConOps identifies the capabilities needed for risk mitigation and safety assurance in the increasingly complex national airspace. The ConOps serves as a pathway for engaging with industry to gain operational experience including through the Safety Demonstrator series, the RACI analysis, and operational complexity factors. The ConOps serves to integrate these different perspectives to build a cohesive and cogent approach to an AAM safety management system.
The Aviation System Monitoring and Modeling (ASMM) Project was one of the projects within NASA s Aviation Safety Program from 1999 through 2005. The objective of the ASMM Project was to develop the technologies to enable the aviation industry to undertake a proactive approach to the management of its system-wide safety risks. The ASMM Project entailed four interdependent elements: (1) Data Analysis Tools Development - develop tools to convert numerical and textual data into information; (2) Intramural Monitoring - test and evaluate the data analysis tools in operational environments; (3) Extramural Monitoring - gain insight into the aviation system performance by surveying its front-line operators; and (4) Modeling and Simulations - provide reliable predictions of the system-wide hazards, their causal factors, and their operational risks that may result from the introduction of new technologies, new procedures, or new operational concepts. This report is a documentation of the history of this highly successful project and of its many accomplishments and contributions to improved safety of the aviation system.
The transition from the current air traffic system to the next generation air traffic system will require the introduction of new automated systems, including transferring some functions from air traffic controllers to on-board automation. This report describes a new design verification and validation (V&V) methodology for assessing aviation safety. The approach involves a detailed computer simulation of work practices that includes people interacting with flight-critical systems. The research is part of an effort to develop new modeling and verification methodologies that can assess the safety of flight-critical systems, system configurations, and operational concepts. The 2002 Ueberlingen mid-air collision was chosen for analysis and modeling because one of the main causes of the accident was one crew's response to a conflict between the instructions of the air traffic controller and the instructions of TCAS, an automated Traffic Alert and Collision Avoidance System on-board warning system. It thus furnishes an example of the problem of authority versus autonomy. It provides a starting point for exploring authority/autonomy conflict in the larger system of organization, tools, and practices in which the participants' moment-by-moment actions take place. We have developed a general air traffic system model (not a specific simulation of Überlingen events), called the Brahms Generalized Ueberlingen Model (Brahms-GUeM). Brahms is a multi-agent simulation system that models people, tools, facilities/vehicles, and geography to simulate the current air transportation system as a collection of distributed, interactive subsystems (e.g., airports, air-traffic control towers and personnel, aircraft, automated flight systems and air-traffic tools, instruments, crew). Brahms-GUeM can be configured in different ways, called scenarios, such that anomalous events that contributed to the Überlingen accident can be modeled as functioning according to requirements or in an anomalous condition, as occurred during the accident. Brahms-GUeM thus implicitly defines a class of scenarios, which include as an instance what occurred at Überlingen. Brahms-GUeM is a modeling framework enabling "what if" analysis of alternative work system configurations and thus facilitating design of alternative operations concepts. It enables subsequent adaption (reusing simulation components) for modeling and simulating NextGen scenarios. This project demonstrates that BRAHMS provides the capacity to model the complexity of air transportation systems, going beyond idealized and simple flights to include for example the interaction of pilots and ATCOs. The research shows clearly that verification and validation must include the entire work system, on the one hand to check that mechanisms exist to handle failures of communication and alerting subsystems and/or failures of people to notice, comprehend, or communicate problematic (unsafe) situations; but also to understand how people must use their own judgment in relating fallible systems like TCAS to other sources of information and thus to evaluate how the unreliability of automation affects system safety. The simulation shows in particular that distributed agents (people and automated systems) acting without knowledge of each others' actions can create a complex, dynamic system whose interactive behavior is unexpected and is changing too quickly to comprehend and control.