Current regulations specify the minimum number of operators required per nuclear power plant. However, these requirements are based on the operation of large nuclear power plants, which are not inherent safe and can result in a meltdown. For newly developed small nuclear reactors, the current number of operators seems to be excessive causing the technology to be less competitive. Before the number of required operators can be optimised, it should be demonstrated that human errors will not endanger or cause risk to the plant or public. For this study, a small pebble bed High Temperature Reactor (HTR) Nuclear Power Plant (NPP), the Th-100, was evaluated. The inherent safety features of this type of nuclear reactor include independent barriers for fission product capture and passive heat dissipation during a loss of coolant. The control and instrumentation architecture include two independent protection systems. The Control and Limitation System is the first protection system to react if the reactor parameters exceed those of the normal operational safe zone. If the Control and Limitation System fail to maintain the reactor within the safe zone, the Reactor Protection System would at that time operate and force the reactor to a safe state. Both these automated protection systems are installed in a control room local to the reactor building, protected from adverse conditions. In addition, it is connected to a semi-remote control room, anticipated as a multi-unit control room to include the monitoring and control of the auxiliary systems. Probable case studies of human error associated with multi-unit control rooms were evaluated against the logic of the Control and Limitation System. Fault Tree Analysis was used to investigate all possible failures. The evaluation determined the reliability of the Control and Limitation System and highlighted areas which design engineers should take into account if a higher reliability is required. The scenario was expanded, applying the same methods, to include the large release of fission products in order to verify the reliability calculations. The probability of a large release of fission products compared with studies done on other nuclear installations revealed to be much less for the evaluated HTR as was expected. As the study has proved that human error cannot have a negative influence on the safety of the reactor, it can be concluded that the first step has been met which is required, when applying for a waiver to utilise a multi-unit control room for the small pebble bed HTR NPP. Also, from the study, it is recommended that a practical approach be applied for the evaluation of operator duties on a live plant, to optimise the number of operators required. This in turn will position the inherent safe HTR competitively over other power stations. / MIng (Nuclear Engineering), North-West University, Potchefstroom Campus, 2015

Current regulations specify the minimum number of operators required per nuclear power plant. However, these requirements are based on the operation of large nuclear power plants, which are not inherent safe and can result in a meltdown. For newly developed small nuclear reactors, the current number of operators seems to be excessive causing the technology to be less competitive. Before the number of required operators can be optimised, it should be demonstrated that human errors will not endanger or cause risk to the plant or public. For this study, a small pebble bed High Temperature Reactor (HTR) Nuclear Power Plant (NPP), the Th-100, was evaluated. The inherent safety features of this type of nuclear reactor include independent barriers for fission product capture and passive heat dissipation during a loss of coolant. The control and instrumentation architecture include two independent protection systems. The Control and Limitation System is the first protection system to react if the reactor parameters exceed those of the normal operational safe zone. If the Control and Limitation System fail to maintain the reactor within the safe zone, the Reactor Protection System would at that time operate and force the reactor to a safe state. Both these automated protection systems are installed in a control room local to the reactor building, protected from adverse conditions. In addition, it is connected to a semi-remote control room, anticipated as a multi-unit control room to include the monitoring and control of the auxiliary systems. Probable case studies of human error associated with multi-unit control rooms were evaluated against the logic of the Control and Limitation System. Fault Tree Analysis was used to investigate all possible failures. The evaluation determined the reliability of the Control and Limitation System and highlighted areas which design engineers should take into account if a higher reliability is required. The scenario was expanded, applying the same methods, to include the large release of fission products in order to verify the reliability calculations. The probability of a large release of fission products compared with studies done on other nuclear installations revealed to be much less for the evaluated HTR as was expected. As the study has proved that human error cannot have a negative influence on the safety of the reactor, it can be concluded that the first step has been met which is required, when applying for a waiver to utilise a multi-unit control room for the small pebble bed HTR NPP. Also, from the study, it is recommended that a practical approach be applied for the evaluation of operator duties on a live plant, to optimise the number of operators required. This in turn will position the inherent safe HTR competitively over other power stations. / MIng (Nuclear Engineering), North-West University, Potchefstroom Campus, 2015

L'homme reste l'un des éléments essentiels des opérations de transport modernes. Les méthodes d'analyse de la fiabilité humaine (HRA) fournissent une approche multidisciplinaire pour évaluer l'interaction entre les humains et le système. Cette thèse propose une nouvelle méthodologie HRA appelée PRELUDE (Performance shaping factor based human REliability assessment using vaLUation-baseD systems). Les facteurs de performance sont utilisés pour caractériser un contexte opérationnel dangereux. Le cadre de la théorie des fonctions de croyance et des systèmes d'évaluation (VBS) utilise des règles mathématiques pour formaliser l'utilisation de données d'experts et la construction d'un modèle de fiabilité humaine, il est capable de représenter toutes sortes d'incertitudes. Pour prédire la probabilité d'erreur humaine dans un contexte donné, et de fournir une remontée formelle pour réduire cette probabilité. La deuxième partie de ce travail démontre la faisabilité de PRELUDE avec des données empiriques. Un protocole pour obtenir des données à partir de simulateurs, et une méthode de transformation et d'analyse des données sont présentés. Une campagne expérimentale sur simulateur est menée pour illustrer la proposition. Ainsi, PRELUDE est en mesure d'intégrer des données provenant de sources (empiriques et expertes) et de types (objectifs et subjectifs) différents. Cette thèse aborde donc le problème de l'analyse des erreurs humaines, en tenant compte de l'évolution du domaine des méthodes HRA. Elle garde la facilité d'utilisation de l'industrie ferroviaire, fournissant des résultats qui peuvent facilement être intégrés avec les analyses de risques traditionnelles. Dans un monde de plus en plus complexe et exigeant, PRELUDE fournira aux opérateurs ferroviaires et aux autorités réglementaires une méthode permettant de s'assurer que le risque lié à l'interaction humaine est compris et géré de manière appropriée dans son contexte. / Humans are and remain one of the critical constituents of modern transport operations. Human Reliability Analysis (HRA) methods provide a multi-disciplinary approach: systems engineering and cognitive science methods to evaluate the interaction between humans and the system. This thesis proposes a novel HRA methodology acronymed PRELUDE (Performance shaping factor based human REliability assessment using vaLUation-baseD systEms). Performance shaping factors (PSFs) are used to characterize a dangerous operational context. The proposed framework of Valuation-based System (VBS) and belief functions theory (BFT) uses mathematical rules to formalize the use of expert data and construction of a human reliability model capable of representing all kinds of uncertainty. PRELUDE is able to predict the human error probability given a context, and also provide a formal feedback to reduce the said probability. The second part of this work demonstrates the feasibility of PRELUDE with empirical data from simulators. A protocol to obtain data, a transformation and data analysis method is presented. An experimental simulator campaign is carried out to illustrate the proposition. Thus, PRELUDE is able to integrate data from multiple sources (empirical and expert) and types (objective and subjective). This thesis, hence address the problem of human error analysis, taking into account the evolution of the HRA domain over the years by proposing a novel HRA methodology. It also keeps the rail industry’s usability in mind, providing a quantitative results which can easily be integrated with traditional risk analyses. In an increasingly complex and demanding world, PRELUDE will provide rail operators and regulatory authorities a method to ensure human interaction-related risk is understood and managed appropriately in its context.

Automatiska flygningssystem och kontrollpresentationsenheter utvecklas hela tiden inom flygteknik. Avionik företag skapar datoriserade system som ska kunna automatisera ytterligare aspekter av de operationer som sker i cockpit. Att flyga ska inte bedömas vara något riskfyllt och för att säkerställa säkerhetssynen är det betydelsefullt att ta reda på om människor uppfattar teknikens framgång som positiv. Syftet är att ta reda på människans uppfattning och inställning till automatiserade flygplan. Frågeställningen besvaras genom en empirisk studie där först en noggrann bakgrundsundersökning gjorts för att få fram information om var automatiserade flygplan befinner sig gällande dess utveckling och framgång. Med hjälp av en gedigen bakgrund har en kvantitativ enkät undersökning genomförts som på bästa sätt ger svar på frågeställningen om automatiserade flygplan anses vara ett säkert transportmedel. Majoriteten av respondenterna, 86,9%, anser det vara viktigt eller väldigt viktigt att det finns en pilot som styr flygplanet. Automatiserade fraktflygplan är det som ligger närmast i framtiden jämfört med civila flygplan. Det har framförts att ökad förståelse om teknik ger en ökad tillit till AI och ju mer tillit till AI desto större chans till att skapa en bättre trygghetskänsla till automatiserade flygplan. Det kan även konkluderas att pilotlösa flygplan som styrs från kontrollrum på marken inte bör agera som en övergång till helt automatiserade flygplan. Istället föredras en stegvis automatisering i form av en digital andrepilot som hjälpmedel. Det måste dessutom skapas en större medvetenhet i hur flygplanen opererar för att få passagerare mottagbara till vidare utveckling. Slutligen måste inte automatiserade flygplan vara helt perfekta och eftersträva en omöjlig standard. / Automatic flight systems and control presentation units are constantly being developed in aviation technology. Avionic companies create computerized systems that will be able to automate additional aspects of the operations that take place in the cockpit. Flying should not be judged to be somewhat risky and to ensure safety, it is important to find out whether people perceive the technology's success as positive. The purpose is to find out about the people’s perception and attitude towards automated aircraft. The question is answered through an empirical study in which a thorough background study was first made to obtain information about where automated aircraft are located in relation to its development and success. With the help of a solid background, a quantitative questionnaire survey has been conducted that best answers the question of whether automated aircraft are considered a safe means of transport. The majority of respondents, 86.9%, consider it important or very important that there is a pilot who controls the aircraft. Automated cargo aircraft are the closest in the future compared to civil aircraft. It has been argued that increased understanding of technology gives increased confidence in AI and the more confidence in AI the greater the chance of creating a better sense of security for automated aircraft. It can also be concluded that pilotless aircraft controlled from control rooms on the ground should not act as a transition to fully automated aircraft. Instead, a step-by-step automation in the form of a digital second pilot is preferred. In addition, a greater awareness must be created in how the aircraft operate to get passengers susceptible to further development. Finally, automated aircraft need not be perfectly perfect and strive for an impossible standard.

<p>I ulykkessammenheng går to av de vanligste undersøkelsesmetodene ut på henholdsvis å kartlegge det juridiske ansvaret for ulykken og å klarlegge årsaksforholdene. I media får vi stort sett bare høre om førstnevnte i form av oppslag om at ulykken skyldes menneskelig svikt. Årsaksforholdene tar gjerne lengre tid å kartlegge og har heller ikke elementer av helt eller syndebukk i seg, og er således mindre interessante å skrive om. I forebyggende sammenheng er det likevel gjerne her det er mest å hente. I erkjennelsen av at mennesket er og blir feilbarlig, bør man nettopp gripe tak i disse bakenforliggende årsakene, gjerne kalt latente feil, som også kan medvirke til å avverge at et tilløp får lov å utvikle seg til en ulykke. I denne oppgaven blir det gjort rede for bakenforliggende årsaker til en alvorlig samferdselsulykke på Vestlandet i 1999, nemlig hurtigbåten MS Sleipners forlis. Det blir også vist hvordan ulykken kunne vært unngått, eller i det minste at skadeomfanget kunne vært vesentlig redusert, dersom det hadde vært større fokus på å avdekke slike latente forhold. For å få offentligheten til å forstå viktigheten av slik årsakskartlegging, og ikke minst at ansvarlige instanser følger opp funnene i ettertid, er det viktig at media griper fatt i problemstillingen og setter den på dagsorden.</p> / <p>Two of the most common forms of investigations after accidents are the search for the judicial aspects of guilt on the one hand and the investigation to find the causes of the accident on the other hand. Media mainly tell us the result of the first one, namely that “the cause of the accident was human error”. Usually it takes more time to establish an understanding of the underlying causes. This investigation does not point out a hero, neither a scapegoat. Therefore the real causes are less interesting to the media. Still, when it comes to accident prevention, this is where one should make an effort. By recognizing the fact that humans are eligible to fail, it is here one should try to take preventive measures. By recognizing these latent conditions one may succeed to avoid potentially dangerous situations from developing to serious accidents. In this paper the underlying causes related to a serious accident that struck public transportation in Western Norway will be presented. The accident is the shipwreck of the high speed craft MS Sleipner in 1999. It will also be shown how this accident could have been prevented, or at least how the extent of the damage could have been substantially reduced, if only latent conditions had been paid a little more attention to. To make the general public understand the importance of uncovering such latent conditions, not to say make sure that they who are responsible take action to remove these conditions, it is vital that the media put these questions on the agenda.</p>

I ulykkessammenheng går to av de vanligste undersøkelsesmetodene ut på henholdsvis å kartlegge det juridiske ansvaret for ulykken og å klarlegge årsaksforholdene. I media får vi stort sett bare høre om førstnevnte i form av oppslag om at ulykken skyldes menneskelig svikt. Årsaksforholdene tar gjerne lengre tid å kartlegge og har heller ikke elementer av helt eller syndebukk i seg, og er således mindre interessante å skrive om. I forebyggende sammenheng er det likevel gjerne her det er mest å hente. I erkjennelsen av at mennesket er og blir feilbarlig, bør man nettopp gripe tak i disse bakenforliggende årsakene, gjerne kalt latente feil, som også kan medvirke til å avverge at et tilløp får lov å utvikle seg til en ulykke. I denne oppgaven blir det gjort rede for bakenforliggende årsaker til en alvorlig samferdselsulykke på Vestlandet i 1999, nemlig hurtigbåten MS Sleipners forlis. Det blir også vist hvordan ulykken kunne vært unngått, eller i det minste at skadeomfanget kunne vært vesentlig redusert, dersom det hadde vært større fokus på å avdekke slike latente forhold. For å få offentligheten til å forstå viktigheten av slik årsakskartlegging, og ikke minst at ansvarlige instanser følger opp funnene i ettertid, er det viktig at media griper fatt i problemstillingen og setter den på dagsorden. / Two of the most common forms of investigations after accidents are the search for the judicial aspects of guilt on the one hand and the investigation to find the causes of the accident on the other hand. Media mainly tell us the result of the first one, namely that “the cause of the accident was human error”. Usually it takes more time to establish an understanding of the underlying causes. This investigation does not point out a hero, neither a scapegoat. Therefore the real causes are less interesting to the media. Still, when it comes to accident prevention, this is where one should make an effort. By recognizing the fact that humans are eligible to fail, it is here one should try to take preventive measures. By recognizing these latent conditions one may succeed to avoid potentially dangerous situations from developing to serious accidents. In this paper the underlying causes related to a serious accident that struck public transportation in Western Norway will be presented. The accident is the shipwreck of the high speed craft MS Sleipner in 1999. It will also be shown how this accident could have been prevented, or at least how the extent of the damage could have been substantially reduced, if only latent conditions had been paid a little more attention to. To make the general public understand the importance of uncovering such latent conditions, not to say make sure that they who are responsible take action to remove these conditions, it is vital that the media put these questions on the agenda.

This report recommends a strategy for the introduction of aviation style Crew Resource Management (CRM) to the offshore drilling industry. The purpose of this study was to investigate ways CRM could be applied to the offshore drilling industry as a means of mitigating the risks of human error, and in particular risks to health and safety. Research has been conducted in accordance with accepted social science research methodologies. Key processes involved a formal literature review plus the formation of a Nominal Reference Group and application of the Delphi Technique as the primary data gathering method. Case studies have been used throughout this report to provide examples of key points and to illustrate the need for effective management of human error in both the aviation and drilling industries. Results from this study provided the basis for the development of a preferred implementation plan as a practical means for adopting the principles of CRM to the offshore drilling industry. Recommendations for furthering this work include the need to benchmark training as a means of providing better evidence that CRM leads to improved safety and operational performance, the need to develop a business plan to justify the cost and effort, the need to further involve key stakeholders in the process, and they need to solicit endorsement for this project from influential industry bodies.

The general purpose of this study was to determine whether a relationship exists between emotional awareness and human error in aviation. A quantitative analysis approach was used to explore this by means of a cross-sectional survey design. The independent variable emotional awareness and the dependent variable human error were contextualised and operationalised. During the empirical phase, biographical information was collected and the Hartmann Emotional Boundary Questionnaire was administered to a purposive sample consisting of 173 aircrew members within the South African Air Force. Factor analysis revealed an eight-factor structure: involved; exactness; blend; openness; structured; unstructured; flexibility; and imagination. No differentiation was found between the mustering groups in relation to emotional awareness and human error. However, correlations differentiated between aircrew with zero human error and aircrew with “more than ten years’ aviation experience”. The test for differences between human error and the emotional awareness sub-construct "imagination" indicated a medium significance. From this relationship, the researcher deducted that “imaginative aircrew are prone to err”. / Industrial and Organisational Psychology / M. Com. (Industrial and organisational Psychology

Usability studies are important in today’s context. However, the increased security level of authentication systems is reducing the usability level. Thus, to provide secured but yet usable authentication systems is a challenge for researchers to solve till now. Learnability and human errors are influential factors of the usability of authentication systems. There are not many specific studies on the learnability and human errors concentrating on authentication systems. The authors’ aim of this study is to explore the human errors and the learnability situation of authentication systems to contribute to the development of more usable authentication systems. The authors investigated through observations and interviews to achieve the aim of this study. A minimalist portable test lab was developed in order to conduct the observation process in a controlled environment. At the end of the study, the authors showed the list of identified human errors and learnability issues, and provided recommendations, which the authors believe will help researchers to improve the overall usability of authentication systems. To achieve the aim of the study, the authors started with a systematic literature review to gain knowledge on the state of art. For the user study, a direct investigation, in form of observations and interviews was then applied to gather more data. The collected data was then analyzed and interpreted to identify and assess the human errors and the learnability issues. / This study addressed the usability experiences of users by exploring the human errors and the learnability situation of the authentication systems. Authors conducted a case study to explore the situation of human errors and learnability of authentication systems. Observation and interviews were adapted to gather data. Then analysis through SHERPA (to evaluate human errors) and Grossman et al. learnability metric (to evaluate learnability) had been conducted. First, the authors identified the human errors and learnability issues on the authentication systems from user’s perspective, from the gathered raw data. Then further analysis had been conducted on the summary of the data to identify the features of the authentication systems which are affecting the human errors and learnability issues. The authors then compared the two different categories of authentication systems, such as the 1-factor and the multi-factor authentication systems, from the gathered information through analysis. Finally, the authors argued the possible updates of the SHERPA’s human error metric and additional measurable learnability issues comparing to Grossman et al. learnability metrics. The studied authentication systems are not human errors free. The authors identified eight human errors associated with the studied authentication systems and three features of the authentication systems which are influencing the human errors. These errors occurred while the participants in this study took too long time locating the login menu or button or selecting the correct login method, and eventually took too long time to login. Errors also occurred when the participants failed to operate the code generating devices, or failed to retrieve information from errors messages or supporting documents, and/or eventually failed to login. As these human errors are identifiable and predictable through the SHERPA, they can be solved as well. The authors also found the studied authentication systems have learnability issues and identified nine learnability issues associated with them. These issues were identified when very few users could complete the task optimally, or completed without any help from the documentation. Issues were also identified while analyzing the participants’ task completion time after reviewing documentations, operations on code generating devices, and average errors while performing the task. These learnability issues were identified through Grossman et al. learnability metric, and the authors believe more study on the identified learnability issues can improve the learnability of the authentication systems. Overall, the authors believe more studies should be conducted on the identified human errors and learnability issues to improve the overall human errors and learnability situation of the studied authentication systems at presence. Moreover, these issues also should be taken into consideration while developing future authentication systems. The authors believe, in future, the outcome of this study will also help researchers to propose more usable, but yet secured authentication systems for future growth. Finally, authors proposed some potential research ares, which they believe will have important contribution to the current knowledge. In this study, the authors used the SHERPA to identify the human errors. Though the SHERPA (and its metrics) is arguably one of the best methods to evaluate human errors, the authors believe there are scopes of improvements in the SHERPA’s metrics. Human’s perception and knowledge is getting changed, and to meet the challenge, the SHERPA’s human error metrics can be updated as well. Grossman et al. learnability metrics had been used in this study to identify learnability issues. The authors believe improving the current and adding new metrics may identify more learnability issues. Evaluation of learnability issues may have improved if researchers could have agreed upon a single learnability definition. The authors believe more studies should be conducted on the definition of learnability in order to achieve more acceptable definition of the learnability for further research. Finally, more studies should be conducted on the remedial strategies of the identified human errors, and improvement on the identified learnability issues, which the authors believe will help researchers to propose more usable, but yet secured authentication systems for the future growth. / 30/1, Shideshwari Lane, Shantinagar, Ramna, Dhaka, Bangladesh, Post Code 1217. Contact: +88017130 16973

Dans le milieu aéronautique professionnel (un des secteurs professionnels les plus sûr au monde), la gestion des conséquences des erreurs humaines doit être améliorée pour garantir une sécurité maximum. Pour ce faire, il est nécessaire de mettre en place des techniques de conception centrées sur l’utilisateur. Cependant, la mise en place de ces techniques est rendue difficile par les particularités des systèmes sociotechniques complexes (la certification, la complexité des systèmes conçus, le nombre de personnes impliquées…). Notre étude a pour but de développer et de valider des outils d’aide à la conception centrée sur l’utilisateur, notamment pour le traitement automatique de grande quantité de données. Pour ce faire, nous avons, dans un premier temps, réalisé une étude basée sur le jugement d’expert visant à identifier, dans une base de données, des scenarii susceptibles de contenir une erreur de l’équipage. Les résultats de cette méthode par jugement d’expert ont été comparés à ceux obtenus à l’aide d’outils de traitement automatique. Cette comparaison a permis :1/ D’identifier des algorithmes pertinents pour l’extraction d’information dans des bases de données (algorithme des plus proches voisins et de filtrage bayesien) ;2/ De proposer une méthodologie permettant l’extraction automatique de situations à risque pouvant donner lieu à des études plus approfondies, sur simulateur par exemple. Cette étape est primordiale dans cadre de la conception centrée utilisateur.Les liens établis avec les études des incidents/accidents laissent envisager des impacts positifs sur la sécurité aérienne. / In the professional aeronautical field (one of the safest in the world), human error management must be improved to reach a better safety level. To do this, a user centred design process has to be implemented. However, due to the complexity of socio technical systems, the implementation of an efficient user centred design process could be challenging. To ease this process, our study aims to develop and validate specific tools, particularly for processing large amounts of textual data. In our study, we will firstly undertake an extraction of scenarios that can contain human errors in a specific database. This extraction will be based on expert judgment (control condition). Secondly, we will confront the control condition with results obtained automatically. The results of this comparison allow:1/ The identification of relevant algorithms for automatic information extraction within large textual databases (Nearest Neighbour, Bayesian filtering);2/ The identification of a methodology to extract risk situations that could be included in specific studies. This step is very important for the user centred design process.Links that we have established between our results and incident/accident studies allow us to consider positive impacts on aviation safety.