Sample records for tank failure modes

  1. Failure mode and effects analysis: an empirical comparison of failure mode scoring procedures.

    PubMed

    Ashley, Laura; Armitage, Gerry

    2010-12-01

    To empirically compare 2 different commonly used failure mode and effects analysis (FMEA) scoring procedures with respect to their resultant failure mode scores and prioritization: a mathematical procedure, where scores are assigned independently by FMEA team members and averaged, and a consensus procedure, where scores are agreed on by the FMEA team via discussion. A multidisciplinary team undertook a Healthcare FMEA of chemotherapy administration. This included mapping the chemotherapy process, identifying and scoring failure modes (potential errors) for each process step, and generating remedial strategies to counteract them. Failure modes were scored using both an independent mathematical procedure and a team consensus procedure. Almost three-fifths of the 30 failure modes generated were scored differently by the 2 procedures, and for just more than one-third of cases, the score discrepancy was substantial. Using the Healthcare FMEA prioritization cutoff score, almost twice as many failure modes were prioritized by the consensus procedure than by the mathematical procedure. This is the first study to empirically demonstrate that different FMEA scoring procedures can score and prioritize failure modes differently. It found considerable variability in individual team members' opinions on scores, which highlights the subjective and qualitative nature of failure mode scoring. A consensus scoring procedure may be most appropriate for FMEA as it allows variability in individuals' scores and rationales to become apparent and to be discussed and resolved by the team. It may also yield team learning and communication benefits unlikely to result from a mathematical procedure.

  2. Findings from the X-33 Hydrogen Tank Failure Investigation

    NASA Technical Reports Server (NTRS)

    Niedermeyer, Melinda; Munafo, Paul M. (Technical Monitor)

    2001-01-01

    The X-33 Hydrogen tank failed during test in November of 1999 at MSFC. The tank completed the structural loading phase of the test successfully and was drained of hydrogen prior to the failure. The failure initiated in the acreage of Lobe 1 and was instantaneous, peeling the outer skin and core away from the inner skin. It was determined there were several factors that provided the opportunity for the tank to fail in this way. The factor giving life to these opportunistic circumstances was hydrogen infiltration into the core of the tank. The mechanism for this phenomenon will be discussed in this presentation.

  3. Failure Diagnosis for the Holdup Tank System via ISFA

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Li, Huijuan; Bragg-Sitton, Shannon; Smidts, Carol

    This paper discusses the use of the integrated system failure analysis (ISFA) technique for fault diagnosis for the holdup tank system. ISFA is a simulation-based, qualitative and integrated approach used to study fault propagation in systems containing both hardware and software subsystems. The holdup tank system consists of a tank containing a fluid whose level is controlled by an inlet valve and an outlet valve. We introduce the component and functional models of the system, quantify the main parameters and simulate possible failure-propagation paths based on the fault propagation approach, ISFA. The results show that most component failures in themore » holdup tank system can be identified clearly and that ISFA is viable as a technique for fault diagnosis. Since ISFA is a qualitative technique that can be used in the very early stages of system design, this case study provides indications that it can be used early to study design aspects that relate to robustness and fault tolerance.« less

  4. Failure Mode Identification Through Clustering Analysis

    NASA Technical Reports Server (NTRS)

    Arunajadai, Srikesh G.; Stone, Robert B.; Tumer, Irem Y.; Clancy, Daniel (Technical Monitor)

    2002-01-01

    Research has shown that nearly 80% of the costs and problems are created in product development and that cost and quality are essentially designed into products in the conceptual stage. Currently, failure identification procedures (such as FMEA (Failure Modes and Effects Analysis), FMECA (Failure Modes, Effects and Criticality Analysis) and FTA (Fault Tree Analysis)) and design of experiments are being used for quality control and for the detection of potential failure modes during the detail design stage or post-product launch. Though all of these methods have their own advantages, they do not give information as to what are the predominant failures that a designer should focus on while designing a product. This work uses a functional approach to identify failure modes, which hypothesizes that similarities exist between different failure modes based on the functionality of the product/component. In this paper, a statistical clustering procedure is proposed to retrieve information on the set of predominant failures that a function experiences. The various stages of the methodology are illustrated using a hypothetical design example.

  5. X-33 LH2 Tank Failure Investigation Findings

    NASA Technical Reports Server (NTRS)

    Niedermeyer, Mindy; Clinton, R. G., Jr. (Technical Monitor)

    2000-01-01

    This presentation focuses on the tank history, test objectives, failure description, investigation and conclusions. The test objectives include verify structural integrity at 105% expected flight load limit varying the following parameters: cryogenic temperature; internal pressure; and mechanical loading. The Failure description includes structural component of the aft body, quad-lobe design, and sandwich - honeycomb graphite epoxy construction.

  6. X-33 LH2 Tank Failure Investigation Findings

    NASA Technical Reports Server (NTRS)

    Niedermeyer, M.

    2001-01-01

    The X-33 liquid hydrogen tank failure investigation found the following: (1) The inner skin microcracked and hydrogen infiltrated into it; (2) The cracks grew larger under pressure; (3) When pressure was removed, the cracks closed slightly; (4) When the tank was drained and warmed, the cracks closed and blocked the leak path; (5) Foreign object debris (FOD) and debond areas provided an opportunity for a leak path; and (6) There is still hydrogen in the other three lobes today.

  7. Effect of Geometrical Imperfection on Buckling Failure of ITER VVPSS Tank

    NASA Astrophysics Data System (ADS)

    Jha, Saroj Kumar; Gupta, Girish Kumar; Pandey, Manish Kumar; Bhattacharya, Avik; Jogi, Gaurav; Bhardwaj, Anil Kumar

    2017-04-01

    The ‘Vacuum Vessel Pressure Suppression System’ (VVPSS) is part of ITER machine, which is designed to protect the ITER Vacuum Vessel and its connected systems, from an over-pressure situation. It is comprised of a partially evacuated tank of stainless steel approximately 46 m long and 6 m in diameter and thickness 30 mm. It is to hold approximately 675 tonnes of water at room temperature to condense the steam resulting from the adverse water leakage into the Vacuum Vessel chamber. For any vacuum vessel, geometrical imperfection has significant effect on buckling failure and structural integrity. Major geometrical imperfection in VVPSS tank depends on form tolerances. To study the effect of geometrical imperfection on buckling failure of VVPSS tank, finite element analysis (FEA) has been performed in line with ASME section VIII division 2 part 5 [1], ‘design by analysis method’. Linear buckling analysis has been performed to get the buckled shape and displacement. Geometrical imperfection due to form tolerance is incorporated in FEA model of VVPSS tank by scaling the resulted buckled shape by a factor ‘60’. This buckled shape model is used as input geometry for plastic collapse and buckling failure assessment. Plastic collapse and buckling failure of VVPSS tank has been assessed by using the elastic-plastic analysis method. This analysis has been performed for different values of form tolerance. The results of analysis show that displacement and load proportionality factor (LPF) vary inversely with form tolerance. For higher values of form tolerance LPF reduces significantly with high values of displacement.

  8. Modes of failure in disordered solids

    NASA Astrophysics Data System (ADS)

    Roy, Subhadeep; Biswas, Soumyajyoti; Ray, Purusattam

    2017-12-01

    The two principal ingredients determining the failure modes of disordered solids are the strength of heterogeneity and the length scale of the region affected in the solid following a local failure. While the latter facilitates damage nucleation, the former leads to diffused damage—the two extreme natures of the failure modes. In this study, using the random fiber bundle model as a prototype for disordered solids, we classify all failure modes that are the results of interplay between these two effects. We obtain scaling criteria for the different modes and propose a general phase diagram that provides a framework for understanding previous theoretical and experimental attempts of interpolation between these modes. As the fiber bundle model is a long-standing model for interpreting various features of stressed disordered solids, the general phase diagram can serve as a guiding principle in anticipating the responses of disordered solids in general.

  9. X-33 LH2 Tank Failure Investigation Findings

    NASA Technical Reports Server (NTRS)

    Niedermeyer, Melinda; Munafo, Paul (Technical Monitor)

    2002-01-01

    This viewgraph presentation gives an overview of the X-33 LH2 tank failure investigation findings. The conclusions of the investigation include the following: (1) the inner skin microcracked and hydrogen infiltrated; (2) the cracks grew larger under pressure; (3) when pressure was removed, the cracks closed slightly; (4) when the tank was drained and warmed, the cracks closed and blocked the leak path; (5) FOD and debond areas provided an opportunity for a leak path; and (6) there is still hydrogen in the the other three lobes today.

  10. X-33 Tank Failure During Autoclave Fabrication

    NASA Technical Reports Server (NTRS)

    Nettles, Alan T.; Munafo, Paul (Technical Monitor)

    2001-01-01

    During a repair cure cycle on tank #1 of the X-33 liquid hydrogen tanks, a skin to core disbond occurred. Both the inner skin and outer skin of the lobe #1 sandwich panel was noted to have been disbonded and cracked- An investigation was undertaken to determine the cause of this failure. The investigation consisted of reviewing all of the processing data and performing testing on the failed lobe #1, as well as the other lobes, which did not fail during the cure cycle. The tests consisted of residual stress measurements in one of the intact lobes and "plug-pulls" to assess skin to core strength on all of the remaining lobes. Results showed an extremely low bondline strength due to lack of proper filleting of the adhesive, in addition, tests showed a very rapid decrease in strength with increasing temperature, as well as a further decrease in strength with a larger number of cycles. Also, the honeycomb used was not vented so pressure could build up within the cells. All of these factors appeared to be contributors to the failure.

  11. Failure Mode, Effects, and Criticality Analysis (FMECA)

    DTIC Science & Technology

    1993-04-01

    Preliminary Failure Modes, Effects and Criticality Analysis (FMECA) of the Brayton Isotope Power System Ground Demonstration System, Report No. TID 27301...No. TID/SNA - 3015, Aeroject Nuclear Systems Co., Sacramento, California: 1970. 95. Taylor , J.R. A Formalization of Failure Mode Analysis of Control...Roskilde, Denmark: 1973. 96. Taylor , J.R. A Semi-Automatic Method for Oualitative Failure Mode Analysis. Report No. RISO-M-1707. Available from a

  12. A streamlined failure mode and effects analysis

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ford, Eric C., E-mail: eford@uw.edu; Smith, Koren; Terezakis, Stephanie

    Purpose: Explore the feasibility and impact of a streamlined failure mode and effects analysis (FMEA) using a structured process that is designed to minimize staff effort. Methods: FMEA for the external beam process was conducted at an affiliate radiation oncology center that treats approximately 60 patients per day. A structured FMEA process was developed which included clearly defined roles and goals for each phase. A core group of seven people was identified and a facilitator was chosen to lead the effort. Failure modes were identified and scored according to the FMEA formalism. A risk priority number,RPN, was calculated and usedmore » to rank failure modes. Failure modes with RPN > 150 received safety improvement interventions. Staff effort was carefully tracked throughout the project. Results: Fifty-two failure modes were identified, 22 collected during meetings, and 30 from take-home worksheets. The four top-ranked failure modes were: delay in film check, missing pacemaker protocol/consent, critical structures not contoured, and pregnant patient simulated without the team's knowledge of the pregnancy. These four failure modes hadRPN > 150 and received safety interventions. The FMEA was completed in one month in four 1-h meetings. A total of 55 staff hours were required and, additionally, 20 h by the facilitator. Conclusions: Streamlined FMEA provides a means of accomplishing a relatively large-scale analysis with modest effort. One potential value of FMEA is that it potentially provides a means of measuring the impact of quality improvement efforts through a reduction in risk scores. Future study of this possibility is needed.« less

  13. A streamlined failure mode and effects analysis.

    PubMed

    Ford, Eric C; Smith, Koren; Terezakis, Stephanie; Croog, Victoria; Gollamudi, Smitha; Gage, Irene; Keck, Jordie; DeWeese, Theodore; Sibley, Greg

    2014-06-01

    Explore the feasibility and impact of a streamlined failure mode and effects analysis (FMEA) using a structured process that is designed to minimize staff effort. FMEA for the external beam process was conducted at an affiliate radiation oncology center that treats approximately 60 patients per day. A structured FMEA process was developed which included clearly defined roles and goals for each phase. A core group of seven people was identified and a facilitator was chosen to lead the effort. Failure modes were identified and scored according to the FMEA formalism. A risk priority number,RPN, was calculated and used to rank failure modes. Failure modes with RPN > 150 received safety improvement interventions. Staff effort was carefully tracked throughout the project. Fifty-two failure modes were identified, 22 collected during meetings, and 30 from take-home worksheets. The four top-ranked failure modes were: delay in film check, missing pacemaker protocol/consent, critical structures not contoured, and pregnant patient simulated without the team's knowledge of the pregnancy. These four failure modes had RPN > 150 and received safety interventions. The FMEA was completed in one month in four 1-h meetings. A total of 55 staff hours were required and, additionally, 20 h by the facilitator. Streamlined FMEA provides a means of accomplishing a relatively large-scale analysis with modest effort. One potential value of FMEA is that it potentially provides a means of measuring the impact of quality improvement efforts through a reduction in risk scores. Future study of this possibility is needed.

  14. Debonding Stress Concentrations in a Pressurized Lobed Sandwich-Walled Generic Cryogenic Tank

    NASA Technical Reports Server (NTRS)

    Ko, William L.

    2004-01-01

    A finite-element stress analysis has been conducted on a lobed composite sandwich tank subjected to internal pressure and cryogenic cooling. The lobed geometry consists of two obtuse circular walls joined together with a common flat wall. Under internal pressure and cryogenic cooling, this type of lobed tank wall will experience open-mode (a process in which the honeycomb is stretched in the depth direction) and shear stress concentrations at the junctures where curved wall changes into flat wall (known as a curve-flat juncture). Open-mode and shear stress concentrations occur in the honeycomb core at the curve-flat junctures and could cause debonding failure. The levels of contributions from internal pressure and temperature loading to the open-mode and shear debonding failure are compared. The lobed fuel tank with honeycomb sandwich walls has been found to be a structurally unsound geometry because of very low debonding failure strengths. The debonding failure problem could be eliminated if the honeycomb core at the curve-flat juncture is replaced with a solid core.

  15. Failure analysis of storage tank component in LNG regasification unit using fault tree analysis method (FTA)

    NASA Astrophysics Data System (ADS)

    Mulyana, Cukup; Muhammad, Fajar; Saad, Aswad H.; Mariah, Riveli, Nowo

    2017-03-01

    Storage tank component is the most critical component in LNG regasification terminal. It has the risk of failure and accident which impacts to human health and environment. Risk assessment is conducted to detect and reduce the risk of failure in storage tank. The aim of this research is determining and calculating the probability of failure in regasification unit of LNG. In this case, the failure is caused by Boiling Liquid Expanding Vapor Explosion (BLEVE) and jet fire in LNG storage tank component. The failure probability can be determined by using Fault Tree Analysis (FTA). Besides that, the impact of heat radiation which is generated is calculated. Fault tree for BLEVE and jet fire on storage tank component has been determined and obtained with the value of failure probability for BLEVE of 5.63 × 10-19 and for jet fire of 9.57 × 10-3. The value of failure probability for jet fire is high enough and need to be reduced by customizing PID scheme of regasification LNG unit in pipeline number 1312 and unit 1. The value of failure probability after customization has been obtained of 4.22 × 10-6.

  16. Failure mode analysis to predict product reliability.

    NASA Technical Reports Server (NTRS)

    Zemanick, P. P.

    1972-01-01

    The failure mode analysis (FMA) is described as a design tool to predict and improve product reliability. The objectives of the failure mode analysis are presented as they influence component design, configuration selection, the product test program, the quality assurance plan, and engineering analysis priorities. The detailed mechanics of performing a failure mode analysis are discussed, including one suggested format. Some practical difficulties of implementation are indicated, drawn from experience with preparing FMAs on the nuclear rocket engine program.

  17. Failure Mode and Effects Analysis (FMEA) Introductory Overview

    DTIC Science & Technology

    2012-06-14

    Failure Mode and Effects Analysis ( FMEA ) Introductory Overview TARDEC Systems Engineering Risk Management Team POC: Kadry Rizk or Gregor Ratajczak...2. REPORT TYPE Briefing Charts 3. DATES COVERED 01-05-2012 to 23-05-2012 4. TITLE AND SUBTITLE Failure Mode and Effects Analysis ( FMEA ) 5a...18 WELCOME Welcome to “An introductory overview of Failure Mode and Effects Analysis ( FMEA )”, A brief concerning the use and benefits of FMEA

  18. High-throughput sequencing: a failure mode analysis.

    PubMed

    Yang, George S; Stott, Jeffery M; Smailus, Duane; Barber, Sarah A; Balasundaram, Miruna; Marra, Marco A; Holt, Robert A

    2005-01-04

    Basic manufacturing principles are becoming increasingly important in high-throughput sequencing facilities where there is a constant drive to increase quality, increase efficiency, and decrease operating costs. While high-throughput centres report failure rates typically on the order of 10%, the causes of sporadic sequencing failures are seldom analyzed in detail and have not, in the past, been formally reported. Here we report the results of a failure mode analysis of our production sequencing facility based on detailed evaluation of 9,216 ESTs generated from two cDNA libraries. Two categories of failures are described; process-related failures (failures due to equipment or sample handling) and template-related failures (failures that are revealed by close inspection of electropherograms and are likely due to properties of the template DNA sequence itself). Preventative action based on a detailed understanding of failure modes is likely to improve the performance of other production sequencing pipelines.

  19. Failure-Modes-And-Effects Analysis Of Software Logic

    NASA Technical Reports Server (NTRS)

    Garcia, Danny; Hartline, Thomas; Minor, Terry; Statum, David; Vice, David

    1996-01-01

    Rigorous analysis applied early in design effort. Method of identifying potential inadequacies and modes and effects of failures caused by inadequacies (failure-modes-and-effects analysis or "FMEA" for short) devised for application to software logic.

  20. Structural Health Monitoring of Above-Ground Storage Tank Floors by Ultrasonic Guided Wave Excitation on the Tank Wall.

    PubMed

    Lowe, Premesh S; Duan, Wenbo; Kanfoud, Jamil; Gan, Tat-Hean

    2017-11-04

    There is an increasing interest in using ultrasonic guided waves to assess the structural degradation of above-ground storage tank floors. This is a non-invasive and economically viable means of assessing structural degradation. Above-ground storage tank floors are ageing assets which need to be inspected periodically to avoid structural failure. At present, normal-stress type transducers are bonded to the tank annular chime to generate a force field in the thickness direction of the floor and excite fundamental symmetric and asymmetric Lamb modes. However, the majority of above-ground storage tanks in use have no annular chime due to a simplified design and/or have a degraded chime due to corrosion. This means that transducers cannot be mounted on the chime to assess structural health according to the present technology, and the market share of structural health monitoring of above-ground storage tank floors using ultrasonic guided wave is thus limited. Therefore, the present study investigates the potential of using the tank wall to bond the transducer instead of the tank annular chime. Both normal and shear type transducers were investigated numerically, and results were validated using a 4.1 m diameter above-ground storage tank. The study results show shear mode type transducers bonded to the tank wall can be used to assess the structural health of the above-ground tank floors using an ultrasonic guided wave. It is also shown that for the cases studied there is a 7.4 dB signal-to-noise ratio improvement at 45 kHz for the guided wave excitation on the tank wall using shear mode transducers.

  1. Structural Health Monitoring of Above-Ground Storage Tank Floors by Ultrasonic Guided Wave Excitation on the Tank Wall

    PubMed Central

    Kanfoud, Jamil; Gan, Tat-Hean

    2017-01-01

    There is an increasing interest in using ultrasonic guided waves to assess the structural degradation of above-ground storage tank floors. This is a non-invasive and economically viable means of assessing structural degradation. Above-ground storage tank floors are ageing assets which need to be inspected periodically to avoid structural failure. At present, normal-stress type transducers are bonded to the tank annular chime to generate a force field in the thickness direction of the floor and excite fundamental symmetric and asymmetric Lamb modes. However, the majority of above-ground storage tanks in use have no annular chime due to a simplified design and/or have a degraded chime due to corrosion. This means that transducers cannot be mounted on the chime to assess structural health according to the present technology, and the market share of structural health monitoring of above-ground storage tank floors using ultrasonic guided wave is thus limited. Therefore, the present study investigates the potential of using the tank wall to bond the transducer instead of the tank annular chime. Both normal and shear type transducers were investigated numerically, and results were validated using a 4.1 m diameter above-ground storage tank. The study results show shear mode type transducers bonded to the tank wall can be used to assess the structural health of the above-ground tank floors using an ultrasonic guided wave. It is also shown that for the cases studied there is a 7.4 dB signal-to-noise ratio improvement at 45 kHz for the guided wave excitation on the tank wall using shear mode transducers. PMID:29113058

  2. [Failure mode effect analysis applied to preparation of intravenous cytostatics].

    PubMed

    Santos-Rubio, M D; Marín-Gil, R; Muñoz-de la Corte, R; Velázquez-López, M D; Gil-Navarro, M V; Bautista-Paloma, F J

    2016-01-01

    To proactively identify risks in the preparation of intravenous cytostatic drugs, and to prioritise and establish measures to improve safety procedures. Failure Mode Effect Analysis methodology was used. A multidisciplinary team identified potential failure modes of the procedure through a brainstorming session. The impact associated with each failure mode was assessed with the Risk Priority Number (RPN), which involves three variables: occurrence, severity, and detectability. Improvement measures were established for all identified failure modes, with those with RPN>100 considered critical. The final RPN (theoretical) that would result from the proposed measures was also calculated and the process was redesigned. A total of 34 failure modes were identified. The initial accumulated RPN was 3022 (range: 3-252), and after recommended actions the final RPN was 1292 (range: 3-189). RPN scores >100 were obtained in 13 failure modes; only the dispensing sub-process was free of critical points (RPN>100). A final reduction of RPN>50% was achieved in 9 failure modes. This prospective risk analysis methodology allows the weaknesses of the procedure to be prioritised, optimize use of resources, and a substantial improvement in the safety of the preparation of cytostatic drugs through the introduction of double checking and intermediate product labelling. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  3. Cycles till failure of silver-zinc cells with competing failure modes - Preliminary data analysis

    NASA Technical Reports Server (NTRS)

    Sidik, S. M.; Leibecki, H. F.; Bozek, J. M.

    1980-01-01

    The data analysis of cycles to failure of silver-zinc electrochemical cells with competing failure modes is presented. The test ran 129 cells through charge-discharge cycles until failure; preliminary data analysis consisted of response surface estimate of life. Batteries fail through low voltage condition and an internal shorting condition; a competing failure modes analysis was made using maximum likelihood estimation for the extreme value life distribution. Extensive residual plotting and probability plotting were used to verify data quality and selection of model.

  4. Mechanics of dual-mode dilative failure in subaqueous sediment deposits

    NASA Astrophysics Data System (ADS)

    You, Yao; Flemings, Peter; Mohrig, David

    2014-07-01

    We introduce dual-mode dilative failure with flume experiments. Dual-mode dilative failure combines slow and steady release of sediments by breaching with periodic sliding, which rapidly releases an internally coherent wedge of sediments. It occurs in dilative sandy deposits. This periodic slope failure results from cyclic evolution of the excess pore pressure in the deposit. Sliding generates large, transient, negative excess pore pressure that strengthens the deposit and allows breaching to occur. During breaching, negative excess pore pressure dissipates, the deposit weakens, and ultimately sliding occurs once again. We show that the sliding frequency is proportional to the coefficient of consolidation. We find that thicker deposits are more susceptible to dual-mode dilative failure. Discovery of dual-mode dilative failure provides a new mechanism to consider when interpreting the sedimentary deposits linked to submarine slope failures.

  5. On a common critical state in localized and diffuse failure modes

    NASA Astrophysics Data System (ADS)

    Zhu, Huaxiang; Nguyen, Hien N. G.; Nicot, François; Darve, Félix

    2016-10-01

    Accurately modeling the critical state mechanical behavior of granular material largely relies on a better understanding and characterizing the critical state fabric in different failure modes, i.e. localized and diffuse failure modes. In this paper, a mesoscopic scale is introduced, in which the organization of force-transmission paths (force-chains) and cells encompassed by contacts (meso-loops) can be taken into account. Numerical drained biaxial tests using a discrete element method are performed with different initial void ratios, in order to investigate the critical state fabric on the meso-scale in both localized and diffuse failure modes. According to the displacement and strain fields extracted from tests, the failure mode and failure area of each specimen are determined. Then convergent critical state void ratios are observed in failure area of specimens. Different mechanical features of two kinds of meso-structures (force-chains and meso-loops) are investigated, to clarify whether there exists a convergent meso-structure inside the failure area of granular material, as the signature of critical state. Numerical results support a positive answer. Failure area of both localized and diffuse failure modes therefore exhibits the same fabric in critical state. Hence, these two failure modes prove to be homological with respect to the concept of the critical state.

  6. Prediction of mode of death in heart failure: the Seattle Heart Failure Model.

    PubMed

    Mozaffarian, Dariush; Anker, Stefan D; Anand, Inder; Linker, David T; Sullivan, Mark D; Cleland, John G F; Carson, Peter E; Maggioni, Aldo P; Mann, Douglas L; Pitt, Bertram; Poole-Wilson, Philip A; Levy, Wayne C

    2007-07-24

    Prognosis and mode of death in heart failure patients are highly variable in that some patients die suddenly (often from ventricular arrhythmia) and others die of progressive failure of cardiac function (pump failure). Prediction of mode of death may facilitate decisions about specific medications or devices. We used the Seattle Heart Failure Model (SHFM), a validated prediction model for total mortality in heart failure, to assess the mode of death in 10,538 ambulatory patients with New York Heart Association class II to IV heart failure and predominantly systolic dysfunction enrolled in 6 randomized trials or registries. During 16,735 person-years of follow-up, 2014 deaths occurred, which included 1014 sudden deaths and 684 pump-failure deaths. Compared with a SHFM score of 0, patients with a score of 1 had a 50% higher risk of sudden death, patients with a score of 2 had a nearly 3-fold higher risk, and patients with a score of 3 or 4 had a nearly 7-fold higher risk (P<0.001 for all comparisons; 1-year area under the receiver operating curve, 0.68). Stratification of risk of pump-failure death was even more pronounced, with a 4-fold higher risk with a score of 1, a 15-fold higher risk with a score of 2, a 38-fold higher risk with a score of 3, and an 88-fold higher risk with a score of 4 (P<0.001 for all comparisons; 1-year area under the receiver operating curve, 0.85). The proportion of deaths caused by sudden death versus pump-failure death decreased from a ratio of 7:1 with a SHFM score of 0 to a ratio of 1:2 with a SHFM score of 4 (P trend <0.001). The SHFM score provides information about the likely mode of death among ambulatory heart failure patients. Investigation is warranted to determine whether such information might predict responses to or cost-effectiveness of specific medications or devices in heart failure patients.

  7. Apollo 16 Mission: Oxidizer Deservicing Tank Failure. No. 1; Anomaly Report

    NASA Technical Reports Server (NTRS)

    1972-01-01

    An explosive failure of a ground support equipment decontamination unit tank occurred during the postflight deactivation of the oxidizer (nitrogen tetroxide) portion of the Apollo 16 command module reaction control system. A discussion of the significant aspects of the incident and conclusions are included.

  8. Failure Modes and Effects Analysis (FMEA): A Bibliography

    NASA Technical Reports Server (NTRS)

    2000-01-01

    Failure modes and effects analysis (FMEA) is a bottom-up analytical process that identifies process hazards, which helps managers understand vulnerabilities of systems, as well as assess and mitigate risk. It is one of several engineering tools and techniques available to program and project managers aimed at increasing the likelihood of safe and successful NASA programs and missions. This bibliography references 465 documents in the NASA STI Database that contain the major concepts, failure modes or failure analysis, in either the basic index of the major subject terms.

  9. Microstructure-failure mode correlations in braided composites

    NASA Technical Reports Server (NTRS)

    Filatovs, G. J.; Sadler, Robert L.; El-Shiekh, Aly

    1992-01-01

    Explication of the fracture processes of braided composites is needed for modeling their behavior. Described is a systematic exploration of the relationship between microstructure, loading mode, and micro-failure mechanisms in carbon/epoxy braided composites. The study involved compression and fracture toughness tests and optical and scanning electron fractography, including dynamic in-situ testing. Principal failure mechanisms of low sliding, buckling, and unstable crack growth are correlated to microstructural parameters and loading modes; these are used for defining those microstructural conditions which are strength limiting.

  10. Mechanical Failure Mode of Metal Nanowires: Global Deformation versus Local Deformation

    PubMed Central

    Ho, Duc Tam; Im, Youngtae; Kwon, Soon-Yong; Earmme, Youn Young; Kim, Sung Youb

    2015-01-01

    It is believed that the failure mode of metal nanowires under tensile loading is the result of the nucleation and propagation of dislocations. Such failure modes can be slip, partial slip or twinning and therefore they are regarded as local deformation. Here we provide numerical and theoretical evidences to show that global deformation is another predominant failure mode of nanowires under tensile loading. At the global deformation mode, nanowires fail with a large contraction along a lateral direction and a large expansion along the other lateral direction. In addition, there is a competition between global and local deformations. Nanowires loaded at low temperature exhibit global failure mode first and then local deformation follows later. We show that the global deformation originates from the intrinsic instability of the nanowires and that temperature is a main parameter that decides the global or local deformation as the failure mode of nanowires. PMID:26087445

  11. Failure modes and effects analysis (FMEA) for Gamma Knife radiosurgery.

    PubMed

    Xu, Andy Yuanguang; Bhatnagar, Jagdish; Bednarz, Greg; Flickinger, John; Arai, Yoshio; Vacsulka, Jonet; Feng, Wenzheng; Monaco, Edward; Niranjan, Ajay; Lunsford, L Dade; Huq, M Saiful

    2017-11-01

    Gamma Knife radiosurgery is a highly precise and accurate treatment technique for treating brain diseases with low risk of serious error that nevertheless could potentially be reduced. We applied the AAPM Task Group 100 recommended failure modes and effects analysis (FMEA) tool to develop a risk-based quality management program for Gamma Knife radiosurgery. A team consisting of medical physicists, radiation oncologists, neurosurgeons, radiation safety officers, nurses, operating room technologists, and schedulers at our institution and an external physicist expert on Gamma Knife was formed for the FMEA study. A process tree and a failure mode table were created for the Gamma Knife radiosurgery procedures using the Leksell Gamma Knife Perfexion and 4C units. Three scores for the probability of occurrence (O), the severity (S), and the probability of no detection for failure mode (D) were assigned to each failure mode by 8 professionals on a scale from 1 to 10. An overall risk priority number (RPN) for each failure mode was then calculated from the averaged O, S, and D scores. The coefficient of variation for each O, S, or D score was also calculated. The failure modes identified were prioritized in terms of both the RPN scores and the severity scores. The established process tree for Gamma Knife radiosurgery consists of 10 subprocesses and 53 steps, including a subprocess for frame placement and 11 steps that are directly related to the frame-based nature of the Gamma Knife radiosurgery. Out of the 86 failure modes identified, 40 Gamma Knife specific failure modes were caused by the potential for inappropriate use of the radiosurgery head frame, the imaging fiducial boxes, the Gamma Knife helmets and plugs, the skull definition tools as well as other features of the GammaPlan treatment planning system. The other 46 failure modes are associated with the registration, imaging, image transfer, contouring processes that are common for all external beam radiation therapy

  12. Burst Pressure Failure of Titanium Tanks Damaged by Secondary Plumes from Hypervelocity Impacts on Aluminum Shields

    NASA Technical Reports Server (NTRS)

    Nahra, Henry; Ghosn, Louis; Christiansen, Eric; Davis, B. Alan; Keddy, Chris; Rodriquez, Karen; Miller, Joshua; Bohl, William

    2011-01-01

    Metallic pressure tanks used in space missions are inherently vulnerable to hypervelocity impacts from micrometeoroids and orbital debris; thereby knowledge of impact damage and its effect on the tank integrity is crucial to a spacecraft risk assessment. This paper describes tests that have been performed to assess the effects of hypervelocity impact (HVI) damage on Titanium alloy (Ti-6Al-4V) pressure vessels burst pressure and characteristics. The tests consisted of a pair of HVI impact tests on water-filled Ti-6Al-4V tanks (water being used as a surrogate to the actual propellant) and subsequent burst tests as well as a burst test on an undamaged control tank. The tanks were placed behind Aluminum (Al) shields and then each was impacted with a 7 km/s projectile. The resulting impact debris plumes partially penetrated the Ti-6Al-4V tank surfaces resulting in a distribution of craters. During the burst tests, the tank that failed at a lower burst pressure did appear to have the failure initiating at a crater site with observed spall cracks. A fracture mechanics analysis showed that the tanks failure at the impact location may have been due to a spall crack that formed upon impact of a fragmentation on the Titanium surface. This result was corroborated with a finite element analysis from calculated Von-Mises and hoop stresses.

  13. Stingray Failure Mode, Effects and Criticality Analysis: WEC Risk Registers

    DOE Data Explorer

    Ken Rhinefrank

    2016-07-25

    Analysis method to systematically identify all potential failure modes and their effects on the Stingray WEC system. This analysis is incorporated early in the development cycle such that the mitigation of the identified failure modes can be achieved cost effectively and efficiently. The FMECA can begin once there is enough detail to functions and failure modes of a given system, and its interfaces with other systems. The FMECA occurs coincidently with the design process and is an iterative process which allows for design changes to overcome deficiencies in the analysis.Risk Registers for major subsystems completed according to the methodology described in "Failure Mode Effects and Criticality Analysis Risk Reduction Program Plan.pdf" document below, in compliance with the DOE Risk Management Framework developed by NREL.

  14. Mod 1 wind turbine generator failure modes and effects analysis

    NASA Technical Reports Server (NTRS)

    1979-01-01

    A failure modes and effects analysis (FMEA) was directed primarily at identifying those critical failure modes that would be hazardous to life or would result in major damage to the system. Each subsystem was approached from the top down, and broken down to successive lower levels where it appeared that the criticality of the failure mode warranted more detail analysis. The results were reviewed by specialists from outside the Mod 1 program, and corrective action taken wherever recommended.

  15. A Framework for Creating a Function-based Design Tool for Failure Mode Identification

    NASA Technical Reports Server (NTRS)

    Arunajadai, Srikesh G.; Stone, Robert B.; Tumer, Irem Y.; Clancy, Daniel (Technical Monitor)

    2002-01-01

    Knowledge of potential failure modes during design is critical for prevention of failures. Currently industries use procedures such as Failure Modes and Effects Analysis (FMEA), Fault Tree analysis, or Failure Modes, Effects and Criticality analysis (FMECA), as well as knowledge and experience, to determine potential failure modes. When new products are being developed there is often a lack of sufficient knowledge of potential failure mode and/or a lack of sufficient experience to identify all failure modes. This gives rise to a situation in which engineers are unable to extract maximum benefits from the above procedures. This work describes a function-based failure identification methodology, which would act as a storehouse of information and experience, providing useful information about the potential failure modes for the design under consideration, as well as enhancing the usefulness of procedures like FMEA. As an example, the method is applied to fifteen products and the benefits are illustrated.

  16. PV Degradation Curves: Non-Linearities and Failure Modes

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Jordan, Dirk C.; Silverman, Timothy J.; Sekulic, Bill

    Photovoltaic (PV) reliability and durability have seen increased interest in recent years. Historically, and as a preliminarily reasonable approximation, linear degradation rates have been used to quantify long-term module and system performance. The underlying assumption of linearity can be violated at the beginning of the life, as has been well documented, especially for thin-film technology. Additionally, non-linearities in the wear-out phase can have significant economic impact and appear to be linked to different failure modes. In addition, associating specific degradation and failure modes with specific time series behavior will aid in duplicating these degradation modes in accelerated tests and, eventually,more » in service life prediction. In this paper, we discuss different degradation modes and how some of these may cause approximately linear degradation within the measurement uncertainty (e.g., modules that were mainly affected by encapsulant discoloration) while other degradation modes lead to distinctly non-linear degradation (e.g., hot spots caused by cracked cells or solder bond failures and corrosion). The various behaviors are summarized with the goal of aiding in predictions of what may be seen in other systems.« less

  17. Analysis and test of low profile aluminum aerospace tank dome

    NASA Technical Reports Server (NTRS)

    Ahmed, R.; Wilhelm, J. M.

    1993-01-01

    In order to increase the structural performance of cryogenic tanks, the aerospace industry is beginning to employ low-profile bulkheads in new generation launch vehicle designs. This report details the analysis and test of one such dome made from 2219 aluminum. Such domes have two potential failure modes under internal pressure, general tensile failure and hoop compression buckling (in regions near the equator). The test determined the buckling load and ultimate tensile load of the hardware and showed that both compared well with the analysis predictions. This effort was conducted under the auspices of NASA and the General Dynamics Cryogenic Tank Technology Program (CTTP).

  18. Analysis and test of low profile aluminum aerospace tank dome

    NASA Astrophysics Data System (ADS)

    Ahmed, R.; Wilhelm, J. M.

    1993-12-01

    In order to increase the structural performance of cryogenic tanks, the aerospace industry is beginning to employ low-profile bulkheads in new generation launch vehicle designs. This report details the analysis and test of one such dome made from 2219 aluminum. Such domes have two potential failure modes under internal pressure, general tensile failure and hoop compression buckling (in regions near the equator). The test determined the buckling load and ultimate tensile load of the hardware and showed that both compared well with the analysis predictions. This effort was conducted under the auspices of NASA and the General Dynamics Cryogenic Tank Technology Program (CTTP).

  19. Failure Modes and Effects Analysis (FMEA) Assistant Tool Feasibility Study

    NASA Technical Reports Server (NTRS)

    Flores, Melissa; Malin, Jane T.

    2013-01-01

    An effort to determine the feasibility of a software tool to assist in Failure Modes and Effects Analysis (FMEA) has been completed. This new and unique approach to FMEA uses model based systems engineering concepts to recommend failure modes, causes, and effects to the user after they have made several selections from pick lists about a component s functions and inputs/outputs. Recommendations are made based on a library using common failure modes identified over the course of several major human spaceflight programs. However, the tool could be adapted for use in a wide range of applications from NASA to the energy industry.

  20. Failure Modes and Effects Analysis (FMEA) Assistant Tool Feasibility Study

    NASA Astrophysics Data System (ADS)

    Flores, Melissa D.; Malin, Jane T.; Fleming, Land D.

    2013-09-01

    An effort to determine the feasibility of a software tool to assist in Failure Modes and Effects Analysis (FMEA) has been completed. This new and unique approach to FMEA uses model based systems engineering concepts to recommend failure modes, causes, and effects to the user after they have made several selections from pick lists about a component's functions and inputs/outputs. Recommendations are made based on a library using common failure modes identified over the course of several major human spaceflight programs. However, the tool could be adapted for use in a wide range of applications from NASA to the energy industry.

  1. Optoelectronic Devices with Complex Failure Modes

    NASA Technical Reports Server (NTRS)

    Johnston, A.

    2000-01-01

    This part of the NSREC-2000 Short Course discusses radiation effects in basic photonic devices along with effects in more complex optoelectronic devices where the overall radiation response depends on several factors, with the possibility of multiple failure modes.

  2. Space Shuttle Stiffener Ring Foam Failure Analysis, a Non-Conventional Approach

    NASA Technical Reports Server (NTRS)

    Howard, Philip M.

    2015-01-01

    The Space Shuttle Program made use of the excellent properties of rigid polyurethane foam for cryogenic tank insulation and as structural protection on the solid rocket boosters. When foam applications de-bond, classical methods of failure analysis did not provide root cause of the failure of the foam. Realizing that foam is the ideal media to document and preserve its own mode of failure, thin sectioning was seen as a logical approach for foam failure analysis to observe the three dimensional morphology of the foam cells. The cell foam morphology provided a much greater understanding of the failure modes than previously achieved.

  3. Comparison of mode of failure between primary and revision total knee arthroplasties.

    PubMed

    Liang, H; Bae, J K; Park, C H; Kim, K I; Bae, D K; Song, S J

    2018-04-01

    Cognizance of common reasons for failure in primary and revision TKA, together with their time course, facilitates prevention. However, there have been few reports specifically comparing modes of failure for primary vs. revision TKA using a single prosthesis. The goal of the study was to compare the survival rates, modes of failure, and time periods associated with each mode of failure, of primary vs. revision TKA. The survival rates, modes of failure, time period for each mode of failure, and risk factors would differ between primary and revision TKA. Data from a consecutive cohort comprising 1606 knees (1174 patients) of primary TKA patients, and 258 knees (224 patients) of revision TKA patients, in all of whom surgery involved a P.F.C ® prosthesis (Depuy, Johnson & Johnson, Warsaw, IN), was retrospectively reviewed. The mean follow-up periods of primary and revision TKAs were 9.2 and 9.8 years, respectively. The average 10- and 15-year survival rates for primary TKA were 96.7% (CI 95%,±0.7%) and 85.4% (CI 95%,±2.0%), and for revision TKA 91.4% (CI 95%,±2.5%) and 80.5% (CI 95%,±4.5%). Common modes of failure included polyethylene wear, loosening, and infection. The most common mode of failure was polyethylene wear in primary TKA, and infection in revision TKA. The mean periods (i.e., latencies) of polyethylene wear and loosening did not differ between primary and revision TKAs, but the mean period of infection was significantly longer for revision TKA (1.2 vs. 4.8 years, P=0.003). Survival rates decreased with time, particularly more than 10 years post-surgery, for both primary and revision TKAs. Continuous efforts are required to prevent and detect the various modes of failure during long-term follow-up. Greater attention is necessary to detect late infection-induced failure following revision TKA. Case-control study, Level III. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  4. Failure modes and effects analysis automation

    NASA Technical Reports Server (NTRS)

    Kamhieh, Cynthia H.; Cutts, Dannie E.; Purves, R. Byron

    1988-01-01

    A failure modes and effects analysis (FMEA) assistant was implemented as a knowledge based system and will be used during design of the Space Station to aid engineers in performing the complex task of tracking failures throughout the entire design effort. The three major directions in which automation was pursued were the clerical components of the FMEA process, the knowledge acquisition aspects of FMEA, and the failure propagation/analysis portions of the FMEA task. The system is accessible to design, safety, and reliability engineers at single user workstations and, although not designed to replace conventional FMEA, it is expected to decrease by many man years the time required to perform the analysis.

  5. Decomposition-Based Failure Mode Identification Method for Risk-Free Design of Large Systems

    NASA Technical Reports Server (NTRS)

    Tumer, Irem Y.; Stone, Robert B.; Roberts, Rory A.; Clancy, Daniel (Technical Monitor)

    2002-01-01

    When designing products, it is crucial to assure failure and risk-free operation in the intended operating environment. Failures are typically studied and eliminated as much as possible during the early stages of design. The few failures that go undetected result in unacceptable damage and losses in high-risk applications where public safety is of concern. Published NASA and NTSB accident reports point to a variety of components identified as sources of failures in the reported cases. In previous work, data from these reports were processed and placed in matrix form for all the system components and failure modes encountered, and then manipulated using matrix methods to determine similarities between the different components and failure modes. In this paper, these matrices are represented in the form of a linear combination of failures modes, mathematically formed using Principal Components Analysis (PCA) decomposition. The PCA decomposition results in a low-dimensionality representation of all failure modes and components of interest, represented in a transformed coordinate system. Such a representation opens the way for efficient pattern analysis and prediction of failure modes with highest potential risks on the final product, rather than making decisions based on the large space of component and failure mode data. The mathematics of the proposed method are explained first using a simple example problem. The method is then applied to component failure data gathered from helicopter, accident reports to demonstrate its potential.

  6. NASA Prototype All Composite Tank Cryogenic Pressure Tests to Failure with Structural Health Monitoring

    NASA Technical Reports Server (NTRS)

    Werlink, Rudolph J.; Pena, Francisco

    2015-01-01

    This Paper will describe the results of pressurization to failure of 100 gallon composite tanks using liquid nitrogen. Advanced methods of health monitoring will be compared as will the experimental data to a finite element model. The testing is wholly under NASA including unique PZT (Lead Zirconate Titanate) based active vibration technology. Other technologies include fiber optics strain based systems including NASA AFRC technology, Acoustic Emission, Acellent smart sensor, this work is expected to lead to a practical in-Sutu system for composite tanks.

  7. An efficient scan diagnosis methodology according to scan failure mode for yield enhancement

    NASA Astrophysics Data System (ADS)

    Kim, Jung-Tae; Seo, Nam-Sik; Oh, Ghil-Geun; Kim, Dae-Gue; Lee, Kyu-Taek; Choi, Chi-Young; Kim, InSoo; Min, Hyoung Bok

    2008-12-01

    Yield has always been a driving consideration during fabrication of modern semiconductor industry. Statistically, the largest portion of wafer yield loss is defective scan failure. This paper presents efficient failure analysis methods for initial yield ramp up and ongoing product with scan diagnosis. Result of our analysis shows that more than 60% of the scan failure dies fall into the category of shift mode in the very deep submicron (VDSM) devices. However, localization of scan shift mode failure is very difficult in comparison to capture mode failure because it is caused by the malfunction of scan chain. Addressing the biggest challenge, we propose the most suitable analysis method according to scan failure mode (capture / shift) for yield enhancement. In the event of capture failure mode, this paper describes the method that integrates scan diagnosis flow and backside probing technology to obtain more accurate candidates. We also describe several unique techniques, such as bulk back-grinding solution, efficient backside probing and signal analysis method. Lastly, we introduce blocked chain analysis algorithm for efficient analysis of shift failure mode. In this paper, we contribute to enhancement of the yield as a result of the combination of two methods. We confirm the failure candidates with physical failure analysis (PFA) method. The direct feedback of the defective visualization is useful to mass-produce devices in a shorter time. The experimental data on mass products show that our method produces average reduction by 13.7% in defective SCAN & SRAM-BIST failure rates and by 18.2% in wafer yield rates.

  8. Cycles till failure of silver-zinc cells with completing failures modes: Preliminary data analysis

    NASA Technical Reports Server (NTRS)

    Sidik, S. M.; Leibecki, H. F.; Bozek, J. M.

    1980-01-01

    One hundred and twenty nine cells were run through charge-discharge cycles until failure. The experiment design was a variant of a central composite factorial in five factors. Preliminary data analysis consisted of response surface estimation of life. Batteries fail under two basic modes; a low voltage condition and an internal shorting condition. A competing failure modes analysis using maximum likelihood estimation for the extreme value life distribution was performed. Extensive diagnostics such as residual plotting and probability plotting were employed to verify data quality and choice of model.

  9. UAV Swarm Behavior Modeling for Early Exposure of Failure Modes

    DTIC Science & Technology

    2016-09-01

    Systems Center Atlantic, for his patience with me through this two-year process. He worked with my schedule and was very understanding of the...emergence of new failure modes? The MP modeling environment provides a breakdown of all potential event traces. Given that the research questions call...for the revelation of potential failure modes, MP was selected as the modeling environment because it provides a substantial set of results and data

  10. Apollo 16 Mission Anomaly Report No. 1: Oxidizer Deservicing Tank Failure

    NASA Technical Reports Server (NTRS)

    1972-01-01

    The command module reaction control system is emptied of all remaining propellant using ground support equipment designed to provide an acid/base neutralization of the propellant in both the liquid and gaseous phases so that it may be disposed of safely. During the deactivation operation of the oxidizer from the Apollo 16 command module on 7 May 1972, the scrubber tank of the decontamination unit exploded, destroying the ground support equipment unit and damaging the building that housed the operation. Only minor injuries were received by the personnel in the area and the command module was not damaged. Test results show that the failure was caused by an insufficient quantity of neutralizer for the quantity of oxidizer. This insufficiency lead to exothermic nitration-type reactions which produced large quantities of gas at a very high rate and failed the decontamination tank.

  11. Sounds of Failure: Passive Acoustic Measurements of Excited Vibrational Modes

    NASA Astrophysics Data System (ADS)

    Brzinski, Theodore A.; Daniels, Karen E.

    2018-05-01

    Granular materials can fail through spontaneous events like earthquakes or brittle fracture. However, measurements and analytic models which forecast failure in this class of materials, while of both fundamental and practical interest, remain elusive. Materials including numerical packings of spheres, colloidal glasses, and granular materials have been known to develop an excess of low-frequency vibrational modes as the confining pressure is reduced. Here, we report experiments on sheared granular materials in which we monitor the evolving density of excited modes via passive monitoring of acoustic emissions. We observe a broadening of the distribution of excited modes coincident with both bulk and local plasticity, and evolution in the shape of the distribution before and after bulk failure. These results provide a new interpretation of the changing state of the material on its approach to stick-slip failure.

  12. Sounds of Failure: Passive Acoustic Measurements of Excited Vibrational Modes.

    PubMed

    Brzinski, Theodore A; Daniels, Karen E

    2018-05-25

    Granular materials can fail through spontaneous events like earthquakes or brittle fracture. However, measurements and analytic models which forecast failure in this class of materials, while of both fundamental and practical interest, remain elusive. Materials including numerical packings of spheres, colloidal glasses, and granular materials have been known to develop an excess of low-frequency vibrational modes as the confining pressure is reduced. Here, we report experiments on sheared granular materials in which we monitor the evolving density of excited modes via passive monitoring of acoustic emissions. We observe a broadening of the distribution of excited modes coincident with both bulk and local plasticity, and evolution in the shape of the distribution before and after bulk failure. These results provide a new interpretation of the changing state of the material on its approach to stick-slip failure.

  13. New understandings of failure modes in SSL luminaires

    NASA Astrophysics Data System (ADS)

    Shepherd, Sarah D.; Mills, Karmann C.; Yaga, Robert; Johnson, Cortina; Davis, J. Lynn

    2014-09-01

    As SSL products are being rapidly introduced into the market, there is a need to develop standard screening and testing protocols that can be performed quickly and provide data surrounding product lifetime and performance. These protocols, derived from standard industry tests, are known as ALTs (accelerated life tests) and can be performed in a timeframe of weeks to months instead of years. Accelerated testing utilizes a combination of elevated temperature and humidity conditions as well as electrical power cycling to control aging of the luminaires. In this study, we report on the findings of failure modes for two different luminaire products exposed to temperature-humidity ALTs. LEDs are typically considered the determining component for the rate of lumen depreciation. However, this study has shown that each luminaire component can independently or jointly influence system performance and reliability. Material choices, luminaire designs, and driver designs all have significant impacts on the system reliability of a product. From recent data, it is evident that the most common failure modes are not within the LED, but instead occur within resistors, capacitors, and other electrical components of the driver. Insights into failure modes and rates as a result of ALTs are reported with emphasis on component influence on overall system reliability.

  14. TSS-1R Failure Mode Evaluation

    NASA Technical Reports Server (NTRS)

    Vaughn, Jason A.; McCollum, Matthew B.; Kamenetzky, Rachel R.

    1997-01-01

    Soon after the break of the tether during the Tethered Satellite System (TSS-1R) mission in February, 1996, a Tiger Team was assembled at the George C. Marshall Space Flight Center to determine the tether failure mode. One possible failure scenario was the Kevlar' strength member of the tether failed because of degradation due to electrical discharge or electrical arcing. During the next several weeks, extensive electrical discharge testing in low vacuum and plasma environments was conducted in an attempt to reproduce the electrical activity recorded by on-board science instruments during the mission. The results of these tests are presented in this paper.

  15. Space Shuttle Stiffener Ring Foam Failure, a Non-Conventional Approach

    NASA Technical Reports Server (NTRS)

    Howard, Philip M.

    2007-01-01

    The Space Shuttle makes use of the excellent properties of rigid polyurethane foam for cryogenic tank insulation and as structural protection on the solid rocket boosters. When foam applications debond, classical methods of analysis do not always provide root cause of the failure of the foam. Realizing that foam is the ideal media to document and preserve its own mode of failure, thin sectioning was seen as a logical approach for foam failure analysis. Thin sectioning in two directions, both horizontal and vertical to the application, was chosen to observe the three dimensional morphology of the foam cells. The cell foam morphology provided a much greater understanding of the failure modes than previously achieved.

  16. Use of failure mode and effects analysis for proactive identification of communication and handoff failures from organ procurement to transplantation.

    PubMed

    Steinberger, Dina M; Douglas, Stephen V; Kirschbaum, Mark S

    2009-09-01

    A multidisciplinary team from the University of Wisconsin Hospital and Clinics transplant program used failure mode and effects analysis to proactively examine opportunities for communication and handoff failures across the continuum of care from organ procurement to transplantation. The team performed a modified failure mode and effects analysis that isolated the multiple linked, serial, and complex information exchanges occurring during the transplantation of one solid organ. Failure mode and effects analysis proved effective for engaging a diverse group of persons who had an investment in the outcome in analysis and discussion of opportunities to improve the system's resilience for avoiding errors during a time-pressured and complex process.

  17. A structured analysis of in vitro failure loads and failure modes of fiber, metal, and ceramic post-and-core systems.

    PubMed

    Fokkinga, Wietske A; Kreulen, Cees M; Vallittu, Pekka K; Creugers, Nico H J

    2004-01-01

    This study sought to aggregate literature data on in vitro failure loads and failure modes of prefabricated fiber-reinforced composite (FRC) post systems and to compare them to those of prefabricated metal, custom-cast, and ceramic post systems. The literature was searched using MEDLINE from 1984 to 2003 for dental articles in English. Keywords used were (post or core or buildup or dowel) and (teeth or tooth). Additional inclusion/exclusion steps were conducted, each step by two independent readers: (1) Abstracts describing post-and-core techniques to reconstruct endodontically treated teeth and their mechanical and physical characteristics were included (descriptive studies or reviews were excluded); (2) articles that included FRC post systems were selected; (3) in vitro studies, single-rooted human teeth, prefabricated FRC posts, and composite as the core material were the selection criteria; and (4) failure loads and modes were extracted from the selected papers, and failure modes were dichotomized (distinction was made between "favorable failures," defined as reparable failures, and "unfavorable failures,"defined as irreparable [root] fractures). The literature search revealed 1,984 abstracts. Included were 244, 42, and 12 articles in the first, second, and third selection steps, respectively. Custom-cast post systems showed higher failure loads than prefabricated FRC post systems, whereas ceramic showed lower failure loads. Significantly more favorable failures occurred with prefabricated FRC post systems than with prefabricated and custom-cast metal post systems. The variable "post system" had a significant effect on mean failure loads. FRC post systems more frequently showed favorable failure modes than did metal post systems.

  18. WE-G-BRA-08: Failure Modes and Effects Analysis (FMEA) for Gamma Knife Radiosurgery

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Xu, Y; Bhatnagar, J; Bednarz, G

    2015-06-15

    Purpose: To perform a failure modes and effects analysis (FMEA) study for Gamma Knife (GK) radiosurgery processes at our institution based on our experience with the treatment of more than 13,000 patients. Methods: A team consisting of medical physicists, nurses, radiation oncologists, neurosurgeons at the University of Pittsburgh Medical Center and an external physicist expert was formed for the FMEA study. A process tree and a failure mode table were created for the GK procedures using the Leksell GK Perfexion and 4C units. Three scores for the probability of occurrence (O), the severity (S), and the probability of no detectionmore » (D) for failure modes were assigned to each failure mode by each professional on a scale from 1 to 10. The risk priority number (RPN) for each failure mode was then calculated (RPN = OxSxD) as the average scores from all data sets collected. Results: The established process tree for GK radiosurgery consists of 10 sub-processes and 53 steps, including a sub-process for frame placement and 11 steps that are directly related to the frame-based nature of the GK radiosurgery. Out of the 86 failure modes identified, 40 failure modes are GK specific, caused by the potential for inappropriate use of the radiosurgery head frame, the imaging fiducial boxes, the GK helmets and plugs, and the GammaPlan treatment planning system. The other 46 failure modes are associated with the registration, imaging, image transfer, contouring processes that are common for all radiation therapy techniques. The failure modes with the highest hazard scores are related to imperfect frame adaptor attachment, bad fiducial box assembly, overlooked target areas, inaccurate previous treatment information and excessive patient movement during MRI scan. Conclusion: The implementation of the FMEA approach for Gamma Knife radiosurgery enabled deeper understanding of the overall process among all professionals involved in the care of the patient and helped identify

  19. Failure mode and effects analysis drastically reduced potential risks in clinical trial conduct.

    PubMed

    Lee, Howard; Lee, Heechan; Baik, Jungmi; Kim, Hyunjung; Kim, Rachel

    2017-01-01

    Failure mode and effects analysis (FMEA) is a risk management tool to proactively identify and assess the causes and effects of potential failures in a system, thereby preventing them from happening. The objective of this study was to evaluate effectiveness of FMEA applied to an academic clinical trial center in a tertiary care setting. A multidisciplinary FMEA focus group at the Seoul National University Hospital Clinical Trials Center selected 6 core clinical trial processes, for which potential failure modes were identified and their risk priority number (RPN) was assessed. Remedial action plans for high-risk failure modes (RPN >160) were devised and a follow-up RPN scoring was conducted a year later. A total of 114 failure modes were identified with an RPN score ranging 3-378, which was mainly driven by the severity score. Fourteen failure modes were of high risk, 11 of which were addressed by remedial actions. Rescoring showed a dramatic improvement attributed to reduction in the occurrence and detection scores by >3 and >2 points, respectively. FMEA is a powerful tool to improve quality in clinical trials. The Seoul National University Hospital Clinical Trials Center is expanding its FMEA capability to other core clinical trial processes.

  20. Application of failure mode and effect analysis in an assisted reproduction technology laboratory.

    PubMed

    Intra, Giulia; Alteri, Alessandra; Corti, Laura; Rabellotti, Elisa; Papaleo, Enrico; Restelli, Liliana; Biondo, Stefania; Garancini, Maria Paola; Candiani, Massimo; Viganò, Paola

    2016-08-01

    Assisted reproduction technology laboratories have a very high degree of complexity. Mismatches of gametes or embryos can occur, with catastrophic consequences for patients. To minimize the risk of error, a multi-institutional working group applied failure mode and effects analysis (FMEA) to each critical activity/step as a method of risk assessment. This analysis led to the identification of the potential failure modes, together with their causes and effects, using the risk priority number (RPN) scoring system. In total, 11 individual steps and 68 different potential failure modes were identified. The highest ranked failure modes, with an RPN score of 25, encompassed 17 failures and pertained to "patient mismatch" and "biological sample mismatch". The maximum reduction in risk, with RPN reduced from 25 to 5, was mostly related to the introduction of witnessing. The critical failure modes in sample processing were improved by 50% in the RPN by focusing on staff training. Three indicators of FMEA success, based on technical skill, competence and traceability, have been evaluated after FMEA implementation. Witnessing by a second human operator should be introduced in the laboratory to avoid sample mix-ups. These findings confirm that FMEA can effectively reduce errors in assisted reproduction technology laboratories. Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  1. Failure mode and effects analysis drastically reduced potential risks in clinical trial conduct

    PubMed Central

    Baik, Jungmi; Kim, Hyunjung; Kim, Rachel

    2017-01-01

    Background Failure mode and effects analysis (FMEA) is a risk management tool to proactively identify and assess the causes and effects of potential failures in a system, thereby preventing them from happening. The objective of this study was to evaluate effectiveness of FMEA applied to an academic clinical trial center in a tertiary care setting. Methods A multidisciplinary FMEA focus group at the Seoul National University Hospital Clinical Trials Center selected 6 core clinical trial processes, for which potential failure modes were identified and their risk priority number (RPN) was assessed. Remedial action plans for high-risk failure modes (RPN >160) were devised and a follow-up RPN scoring was conducted a year later. Results A total of 114 failure modes were identified with an RPN score ranging 3–378, which was mainly driven by the severity score. Fourteen failure modes were of high risk, 11 of which were addressed by remedial actions. Rescoring showed a dramatic improvement attributed to reduction in the occurrence and detection scores by >3 and >2 points, respectively. Conclusions FMEA is a powerful tool to improve quality in clinical trials. The Seoul National University Hospital Clinical Trials Center is expanding its FMEA capability to other core clinical trial processes. PMID:29089745

  2. Failure mode and effect analysis-based quality assurance for dynamic MLC tracking systems

    PubMed Central

    Sawant, Amit; Dieterich, Sonja; Svatos, Michelle; Keall, Paul

    2010-01-01

    Purpose: To develop and implement a failure mode and effect analysis (FMEA)-based commissioning and quality assurance framework for dynamic multileaf collimator (DMLC) tumor tracking systems. Methods: A systematic failure mode and effect analysis was performed for a prototype real-time tumor tracking system that uses implanted electromagnetic transponders for tumor position monitoring and a DMLC for real-time beam adaptation. A detailed process tree of DMLC tracking delivery was created and potential tracking-specific failure modes were identified. For each failure mode, a risk probability number (RPN) was calculated from the product of the probability of occurrence, the severity of effect, and the detectibility of the failure. Based on the insights obtained from the FMEA, commissioning and QA procedures were developed to check (i) the accuracy of coordinate system transformation, (ii) system latency, (iii) spatial and dosimetric delivery accuracy, (iv) delivery efficiency, and (v) accuracy and consistency of system response to error conditions. The frequency of testing for each failure mode was determined from the RPN value. Results: Failures modes with RPN≥125 were recommended to be tested monthly. Failure modes with RPN<125 were assigned to be tested during comprehensive evaluations, e.g., during commissioning, annual quality assurance, and after major software∕hardware upgrades. System latency was determined to be ∼193 ms. The system showed consistent and accurate response to erroneous conditions. Tracking accuracy was within 3%–3 mm gamma (100% pass rate) for sinusoidal as well as a wide variety of patient-derived respiratory motions. The total time taken for monthly QA was ∼35 min, while that taken for comprehensive testing was ∼3.5 h. Conclusions: FMEA proved to be a powerful and flexible tool to develop and implement a quality management (QM) framework for DMLC tracking. The authors conclude that the use of FMEA-based QM ensures efficient

  3. The Application of Failure Modes and Effects Analysis Methodology to Intrathecal Drug Delivery for Pain Management

    PubMed Central

    Patel, Teresa; Fisher, Stanley P.

    2016-01-01

    Objective This study aimed to utilize failure modes and effects analysis (FMEA) to transform clinical insights into a risk mitigation plan for intrathecal (IT) drug delivery in pain management. Methods The FMEA methodology, which has been used for quality improvement, was adapted to assess risks (i.e., failure modes) associated with IT therapy. Ten experienced pain physicians scored 37 failure modes in the following categories: patient selection for therapy initiation (efficacy and safety concerns), patient safety during IT therapy, and product selection for IT therapy. Participants assigned severity, probability, and detection scores for each failure mode, from which a risk priority number (RPN) was calculated. Failure modes with the highest RPNs (i.e., most problematic) were discussed, and strategies were proposed to mitigate risks. Results Strategic discussions focused on 17 failure modes with the most severe outcomes, the highest probabilities of occurrence, and the most challenging detection. The topic of the highest‐ranked failure mode (RPN = 144) was manufactured monotherapy versus compounded combination products. Addressing failure modes associated with appropriate patient and product selection was predicted to be clinically important for the success of IT therapy. Conclusions The methodology of FMEA offers a systematic approach to prioritizing risks in a complex environment such as IT therapy. Unmet needs and information gaps are highlighted through the process. Risk mitigation and strategic planning to prevent and manage critical failure modes can contribute to therapeutic success. PMID:27477689

  4. Comprehensive Deployment Method for Technical Characteristics Base on Multi-failure Modes Correlation Analysis

    NASA Astrophysics Data System (ADS)

    Zheng, W.; Gao, J. M.; Wang, R. X.; Chen, K.; Jiang, Y.

    2017-12-01

    This paper put forward a new method of technical characteristics deployment based on Reliability Function Deployment (RFD) by analysing the advantages and shortages of related research works on mechanical reliability design. The matrix decomposition structure of RFD was used to describe the correlative relation between failure mechanisms, soft failures and hard failures. By considering the correlation of multiple failure modes, the reliability loss of one failure mode to the whole part was defined, and a calculation and analysis model for reliability loss was presented. According to the reliability loss, the reliability index value of the whole part was allocated to each failure mode. On the basis of the deployment of reliability index value, the inverse reliability method was employed to acquire the values of technology characteristics. The feasibility and validity of proposed method were illustrated by a development case of machining centre’s transmission system.

  5. Failure mode and effects analysis and fault tree analysis of surface image guided cranial radiosurgery.

    PubMed

    Manger, Ryan P; Paxton, Adam B; Pawlicki, Todd; Kim, Gwe-Ya

    2015-05-01

    Surface image guided, Linac-based radiosurgery (SIG-RS) is a modern approach for delivering radiosurgery that utilizes optical stereoscopic imaging to monitor the surface of the patient during treatment in lieu of using a head frame for patient immobilization. Considering the novelty of the SIG-RS approach and the severity of errors associated with delivery of large doses per fraction, a risk assessment should be conducted to identify potential hazards, determine their causes, and formulate mitigation strategies. The purpose of this work is to investigate SIG-RS using the combined application of failure modes and effects analysis (FMEA) and fault tree analysis (FTA), report on the effort required to complete the analysis, and evaluate the use of FTA in conjunction with FMEA. A multidisciplinary team was assembled to conduct the FMEA on the SIG-RS process. A process map detailing the steps of the SIG-RS was created to guide the FMEA. Failure modes were determined for each step in the SIG-RS process, and risk priority numbers (RPNs) were estimated for each failure mode to facilitate risk stratification. The failure modes were ranked by RPN, and FTA was used to determine the root factors contributing to the riskiest failure modes. Using the FTA, mitigation strategies were formulated to address the root factors and reduce the risk of the process. The RPNs were re-estimated based on the mitigation strategies to determine the margin of risk reduction. The FMEA and FTAs for the top two failure modes required an effort of 36 person-hours (30 person-hours for the FMEA and 6 person-hours for two FTAs). The SIG-RS process consisted of 13 major subprocesses and 91 steps, which amounted to 167 failure modes. Of the 91 steps, 16 were directly related to surface imaging. Twenty-five failure modes resulted in a RPN of 100 or greater. Only one of these top 25 failure modes was specific to surface imaging. The riskiest surface imaging failure mode had an overall RPN-rank of eighth

  6. Space tug propulsion system failure mode, effects and criticality analysis

    NASA Technical Reports Server (NTRS)

    Boyd, J. W.; Hardison, E. P.; Heard, C. B.; Orourke, J. C.; Osborne, F.; Wakefield, L. T.

    1972-01-01

    For purposes of the study, the propulsion system was considered as consisting of the following: (1) main engine system, (2) auxiliary propulsion system, (3) pneumatic system, (4) hydrogen feed, fill, drain and vent system, (5) oxygen feed, fill, drain and vent system, and (6) helium reentry purge system. Each component was critically examined to identify possible failure modes and the subsequent effect on mission success. Each space tug mission consists of three phases: launch to separation from shuttle, separation to redocking, and redocking to landing. The analysis considered the results of failure of a component during each phase of the mission. After the failure modes of each component were tabulated, those components whose failure would result in possible or certain loss of mission or inability to return the Tug to ground were identified as critical components and a criticality number determined for each. The criticality number of a component denotes the number of mission failures in one million missions due to the loss of that component. A total of 68 components were identified as critical with criticality numbers ranging from 1 to 2990.

  7. Photovoltaic failure and degradation modes

    DOE PAGES

    Jordan, Dirk C.; Silverman, Timothy J.; Wohlgemuth, John H.; ...

    2017-01-30

    The extensive photovoltaic field reliability literature was analyzed and reviewed. Future work is prioritized based upon information assembled from recent installations, and inconsistencies in degradation mode identification are discussed to help guide future publication on this subject. Reported failure rates of photovoltaic modules fall mostly in the range of other consumer products; however, the long expected useful life of modules may not allow for direct comparison. In general, degradation percentages are reported to decrease appreciably in newer installations that are deployed after the year 2000. However, these trends may be convoluted with varying manufacturing and installation quality world-wide. Modules inmore » hot and humid climates show considerably higher degradation modes than those in desert and moderate climates, which warrants further investigation. Delamination and diode/j-box issues are also more frequent in hot and humid climates than in other climates. The highest concerns of systems installed in the last 10 years appear to be hot spots followed by internal circuitry discoloration. Encapsulant discoloration was the most common degradation mode, particularly in older systems. In newer systems, encapsulant discoloration appears in hotter climates, but to a lesser degree. Lastly, thin-film degradation modes are dominated by glass breakage and absorber corrosion, although the breadth of information for thin-film modules is much smaller than for x-Si.« less

  8. Photovoltaic failure and degradation modes

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Jordan, Dirk C.; Silverman, Timothy J.; Wohlgemuth, John H.

    The extensive photovoltaic field reliability literature was analyzed and reviewed. Future work is prioritized based upon information assembled from recent installations, and inconsistencies in degradation mode identification are discussed to help guide future publication on this subject. Reported failure rates of photovoltaic modules fall mostly in the range of other consumer products; however, the long expected useful life of modules may not allow for direct comparison. In general, degradation percentages are reported to decrease appreciably in newer installations that are deployed after the year 2000. However, these trends may be convoluted with varying manufacturing and installation quality world-wide. Modules inmore » hot and humid climates show considerably higher degradation modes than those in desert and moderate climates, which warrants further investigation. Delamination and diode/j-box issues are also more frequent in hot and humid climates than in other climates. The highest concerns of systems installed in the last 10 years appear to be hot spots followed by internal circuitry discoloration. Encapsulant discoloration was the most common degradation mode, particularly in older systems. In newer systems, encapsulant discoloration appears in hotter climates, but to a lesser degree. Lastly, thin-film degradation modes are dominated by glass breakage and absorber corrosion, although the breadth of information for thin-film modules is much smaller than for x-Si.« less

  9. [Failure modes and effects analysis in the prescription, validation and dispensing process].

    PubMed

    Delgado Silveira, E; Alvarez Díaz, A; Pérez Menéndez-Conde, C; Serna Pérez, J; Rodríguez Sagrado, M A; Bermejo Vicedo, T

    2012-01-01

    To apply a failure modes and effects analysis to the prescription, validation and dispensing process for hospitalised patients. A work group analysed all of the stages included in the process from prescription to dispensing, identifying the most critical errors and establishing potential failure modes which could produce a mistake. The possible causes, their potential effects, and the existing control systems were analysed to try and stop them from developing. The Hazard Score was calculated, choosing those that were ≥ 8, and a Severity Index = 4 was selected independently of the hazard Score value. Corrective measures and an implementation plan were proposed. A flow diagram that describes the whole process was obtained. A risk analysis was conducted of the chosen critical points, indicating: failure mode, cause, effect, severity, probability, Hazard Score, suggested preventative measure and strategy to achieve so. Failure modes chosen: Prescription on the nurse's form; progress or treatment order (paper); Prescription to incorrect patient; Transcription error by nursing staff and pharmacist; Error preparing the trolley. By applying a failure modes and effects analysis to the prescription, validation and dispensing process, we have been able to identify critical aspects, the stages in which errors may occur and the causes. It has allowed us to analyse the effects on the safety of the process, and establish measures to prevent or reduce them. Copyright © 2010 SEFH. Published by Elsevier Espana. All rights reserved.

  10. Fracture - An Unforgiving Failure Mode

    NASA Technical Reports Server (NTRS)

    Goodin, James Ronald

    2006-01-01

    During the 2005 Conference for the Advancement for Space Safety, after a typical presentation of safety tools, a Russian in the audience simply asked, "How does that affect the hardware?" Having participated in several International System Safety Conferences, I recalled that most attention is dedicated to safety tools and little, if any, to hardware. The intent of this paper on the hazard of fracture and failure modes associated with fracture is my attempt to draw attention to the grass roots of system safety - improving hardware robustness and resilience.

  11. Evaluating the operational risks of biomedical waste using failure mode and effects analysis.

    PubMed

    Chen, Ying-Chu; Tsai, Pei-Yi

    2017-06-01

    The potential problems and risks of biomedical waste generation have become increasingly apparent in recent years. This study applied a failure mode and effects analysis to evaluate the operational problems and risks of biomedical waste. The microbiological contamination of biomedical waste seldom receives the attention of researchers. In this study, the biomedical waste lifecycle was divided into seven processes: Production, classification, packaging, sterilisation, weighing, storage, and transportation. Twenty main failure modes were identified in these phases and risks were assessed based on their risk priority numbers. The failure modes in the production phase accounted for the highest proportion of the risk priority number score (27.7%). In the packaging phase, the failure mode 'sharp articles not placed in solid containers' had the highest risk priority number score, mainly owing to its high severity rating. The sterilisation process is the main difference in the treatment of infectious and non-infectious biomedical waste. The failure modes in the sterilisation phase were mainly owing to human factors (mostly related to operators). This study increases the understanding of the potential problems and risks associated with biomedical waste, thereby increasing awareness of how to improve the management of biomedical waste to better protect workers, the public, and the environment.

  12. [Failure mode and effects analysis (FMEA) of insulin in a mother-child university-affiliated health center].

    PubMed

    Berruyer, M; Atkinson, S; Lebel, D; Bussières, J-F

    2016-01-01

    Insulin is a high-alert drug. The main objective of this descriptive cross-sectional study was to evaluate the risks associated with insulin use in healthcare centers. The secondary objective was to propose corrective measures to reduce the main risks associated with the most critical failure modes in the analysis. We conducted a failure mode and effects analysis (FMEA) in obstetrics-gynecology, neonatology and pediatrics. Five multidisciplinary meetings occurred in August 2013. A total of 44 out of 49 failure modes were analyzed. Nine out of 44 (20%) failure modes were deemed critical, with a criticality score ranging from 540 to 720. Following the multidisciplinary meetings, everybody agreed that an FMEA was a useful tool to identify failure modes and their relative importance. This approach identified many corrective measures. This shared experience increased awareness of safety issues with insulin in our mother-child center. This study identified the main failure modes and associated corrective measures. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  13. Weighted Fuzzy Risk Priority Number Evaluation of Turbine and Compressor Blades Considering Failure Mode Correlations

    NASA Astrophysics Data System (ADS)

    Gan, Luping; Li, Yan-Feng; Zhu, Shun-Peng; Yang, Yuan-Jian; Huang, Hong-Zhong

    2014-06-01

    Failure mode, effects and criticality analysis (FMECA) and Fault tree analysis (FTA) are powerful tools to evaluate reliability of systems. Although single failure mode issue can be efficiently addressed by traditional FMECA, multiple failure modes and component correlations in complex systems cannot be effectively evaluated. In addition, correlated variables and parameters are often assumed to be precisely known in quantitative analysis. In fact, due to the lack of information, epistemic uncertainty commonly exists in engineering design. To solve these problems, the advantages of FMECA, FTA, fuzzy theory, and Copula theory are integrated into a unified hybrid method called fuzzy probability weighted geometric mean (FPWGM) risk priority number (RPN) method. The epistemic uncertainty of risk variables and parameters are characterized by fuzzy number to obtain fuzzy weighted geometric mean (FWGM) RPN for single failure mode. Multiple failure modes are connected using minimum cut sets (MCS), and Boolean logic is used to combine fuzzy risk priority number (FRPN) of each MCS. Moreover, Copula theory is applied to analyze the correlation of multiple failure modes in order to derive the failure probabilities of each MCS. Compared to the case where dependency among multiple failure modes is not considered, the Copula modeling approach eliminates the error of reliability analysis. Furthermore, for purpose of quantitative analysis, probabilities importance weight from failure probabilities are assigned to FWGM RPN to reassess the risk priority, which generalize the definition of probability weight and FRPN, resulting in a more accurate estimation than that of the traditional models. Finally, a basic fatigue analysis case drawn from turbine and compressor blades in aeroengine is used to demonstrate the effectiveness and robustness of the presented method. The result provides some important insights on fatigue reliability analysis and risk priority assessment of structural

  14. A Summary of Taxonomies of Digital System Failure Modes Provided by the DigRel Task Group

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Chu T. L.; Yue M.; Postma, W.

    2012-06-25

    Recently, the CSNI directed WGRisk to set up a task group called DIGREL to initiate a new task on developing a taxonomy of failure modes of digital components for the purposes of PSA. It is an important step towards standardized digital I&C reliability assessment techniques for PSA. The objective of this paper is to provide a comparison of the failure mode taxonomies provided by the participants. The failure modes are classified in terms of their levels of detail. Software and hardware failure modes are discussed separately.

  15. Preliminary Sizing Study of Ares-I and Ares-V Liquid Hydrogen Tanks

    NASA Technical Reports Server (NTRS)

    Oliver, Stanley T.; Harper, David W.

    2012-01-01

    A preliminary sizing study of two cryogenic propellant tanks was performed using a FORTRAN optimization program to determine weight efficient orthogrid designs for the tank barrels sections only. Various tensile and compressive failure modes were considered, including general buckling of cylinders with a shell buckling knockdown factor. Eight independent combinations of three design requirements were also considered and their effects on the tanks weight. The approach was to investigate each design case with a variable shell buckling knockdown factor, determining the most weight efficient combination of orthogrid design parameters. Numerous optimization analyses were performed, and the results presented herein compare the effects of the different design requirements and shell buckling knockdown factor. Through a series of comparisons between design requirements or shell buckling knockdown factors, the relative change in overall tank barrel weights is shown. The findings indicate that the design requirements can substantually increase the tank weight while a less conservative shell buckling knockdown factor can modestly reduce the tank weight.

  16. Clinical risk analysis with failure mode and effect analysis (FMEA) model in a dialysis unit.

    PubMed

    Bonfant, Giovanna; Belfanti, Pietro; Paternoster, Giuseppe; Gabrielli, Danila; Gaiter, Alberto M; Manes, Massimo; Molino, Andrea; Pellu, Valentina; Ponzetti, Clemente; Farina, Massimo; Nebiolo, Pier E

    2010-01-01

    The aim of clinical risk management is to improve the quality of care provided by health care organizations and to assure patients' safety. Failure mode and effect analysis (FMEA) is a tool employed for clinical risk reduction. We applied FMEA to chronic hemodialysis outpatients. FMEA steps: (i) process study: we recorded phases and activities. (ii) Hazard analysis: we listed activity-related failure modes and their effects; described control measures; assigned severity, occurrence and detection scores for each failure mode and calculated the risk priority numbers (RPNs) by multiplying the 3 scores. Total RPN is calculated by adding single failure mode RPN. (iii) Planning: we performed a RPNs prioritization on a priority matrix taking into account the 3 scores, and we analyzed failure modes causes, made recommendations and planned new control measures. (iv) Monitoring: after failure mode elimination or reduction, we compared the resulting RPN with the previous one. Our failure modes with the highest RPN came from communication and organization problems. Two tools have been created to ameliorate information flow: "dialysis agenda" software and nursing datasheets. We scheduled nephrological examinations, and we changed both medical and nursing organization. Total RPN value decreased from 892 to 815 (8.6%) after reorganization. Employing FMEA, we worked on a few critical activities, and we reduced patients' clinical risk. A priority matrix also takes into account the weight of the control measures: we believe this evaluation is quick, because of simple priority selection, and that it decreases action times.

  17. Failure Modes and Effects Analysis of bilateral same-day cataract surgery

    PubMed Central

    Shorstein, Neal H.; Lucido, Carol; Carolan, James; Liu, Liyan; Slean, Geraldine; Herrinton, Lisa J.

    2017-01-01

    PURPOSE To systematically analyze potential process failures related to bilateral same-day cataract surgery toward the goal of improving patient safety. SETTING Twenty-one Kaiser Permanente surgery centers, Northern California, USA. DESIGN Retrospective cohort study. METHODS Quality experts performed a Failure Modes and Effects Analysis (FMEA) that included an evaluation of sterile processing, pharmaceuticals, perioperative clinic and surgical center visits, and biometry. Potential failures in human factors and communication (modes) were identified. Rates of endophthalmitis, toxic anterior segment syndrome (TASS), and unintended intraocular lens (IOL) implantation were assessed in eyes having bilateral same-day surgery from 2010 through 2014. RESULTS The study comprised 4754 eyes. The analysis identified 15 significant potential failure modes. These included lapses in instrument processing and compounding error of intracameral antibiotic that could lead to endophthalmitis or TASS and ambiguous documentation of IOL selection by surgeons, which could lead to unintended IOL implantation. Of the study sample, 1 eye developed endophthalmitis, 1 eye had unintended IOL implantation (rates, 2 per 10 000; 95% confidence intervals [CI] 0.1–12.0 per 10 000), and no eyes developed TASS (upper 95% CI, 8 per 10 000). Recommendations included improving oversight of cleaning and sterilization practices, separating lots of compounded drugs for each eye, and enhancing IOL verification procedures. CONCLUSIONS Potential failure modes and recommended actions in bilateral same-day cataract surgery were determined using a FMEA. These findings might help improve the reliability and safety of bilateral same-day cataract surgery based on current evidence and standards. PMID:28410711

  18. [Failure mode and effects analysis to improve quality in clinical trials].

    PubMed

    Mañes-Sevilla, M; Marzal-Alfaro, M B; Romero Jiménez, R; Herranz-Alonso, A; Sanchez Fresneda, M N; Benedi Gonzalez, J; Sanjurjo-Sáez, M

    The failure mode and effects analysis (FMEA) has been used as a tool in risk management and quality improvement. The objective of this study is to identify the weaknesses in processes in the clinical trials area, of a Pharmacy Department (PD) with great research activity, in order to improve the safety of the usual procedures. A multidisciplinary team was created to analyse each of the critical points, identified as possible failure modes, in the development of clinical trial in the PD. For each failure mode, the possible cause and effect were identified, criticality was calculated using the risk priority number and the possible corrective actions were discussed. Six sub-processes were defined in the development of the clinical trials in PD. The FMEA identified 67 failure modes, being the dispensing and prescription/validation sub-processes the most likely to generate errors. All the improvement actions established in the AMFE were implemented in the Clinical Trials area. The FMEA is a useful tool in proactive risk management because it allows us to identify where we are making mistakes and analyze the causes that originate them, to prioritize and to adopt solutions to risk reduction. The FMEA improves process safety and quality in PD. Copyright © 2018 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. EVALUATION OF SAFETY IN A RADIATION ONCOLOGY SETTING USING FAILURE MODE AND EFFECTS ANALYSIS

    PubMed Central

    Ford, Eric C.; Gaudette, Ray; Myers, Lee; Vanderver, Bruce; Engineer, Lilly; Zellars, Richard; Song, Danny Y.; Wong, John; DeWeese, Theodore L.

    2013-01-01

    Purpose Failure mode and effects analysis (FMEA) is a widely used tool for prospectively evaluating safety and reliability. We report our experiences in applying FMEA in the setting of radiation oncology. Methods and Materials We performed an FMEA analysis for our external beam radiation therapy service, which consisted of the following tasks: (1) create a visual map of the process, (2) identify possible failure modes; assign risk probability numbers (RPN) to each failure mode based on tabulated scores for the severity, frequency of occurrence, and detectability, each on a scale of 1 to 10; and (3) identify improvements that are both feasible and effective. The RPN scores can span a range of 1 to 1000, with higher scores indicating the relative importance of a given failure mode. Results Our process map consisted of 269 different nodes. We identified 127 possible failure modes with RPN scores ranging from 2 to 160. Fifteen of the top-ranked failure modes were considered for process improvements, representing RPN scores of 75 and more. These specific improvement suggestions were incorporated into our practice with a review and implementation by each department team responsible for the process. Conclusions The FMEA technique provides a systematic method for finding vulnerabilities in a process before they result in an error. The FMEA framework can naturally incorporate further quantification and monitoring. A general-use system for incident and near miss reporting would be useful in this regard. PMID:19409731

  20. Failure modes and effects criticality analysis and accelerated life testing of LEDs for medical applications

    NASA Astrophysics Data System (ADS)

    Sawant, M.; Christou, A.

    2012-12-01

    While use of LEDs in Fiber Optics and lighting applications is common, their use in medical diagnostic applications is not very extensive. Since the precise value of light intensity will be used to interpret patient results, understanding failure modes [1-4] is very important. We used the Failure Modes and Effects Criticality Analysis (FMECA) tool to identify the critical failure modes of the LEDs. FMECA involves identification of various failure modes, their effects on the system (LED optical output in this context), their frequency of occurrence, severity and the criticality of the failure modes. The competing failure modes/mechanisms were degradation of: active layer (where electron-hole recombination occurs to emit light), electrodes (provides electrical contact to the semiconductor chip), Indium Tin Oxide (ITO) surface layer (used to improve current spreading and light extraction), plastic encapsulation (protective polymer layer) and packaging failures (bond wires, heat sink separation). A FMECA table is constructed and the criticality is calculated by estimating the failure effect probability (β), failure mode ratio (α), failure rate (λ) and the operating time. Once the critical failure modes were identified, the next steps were generation of prior time to failure distribution and comparing with our accelerated life test data. To generate the prior distributions, data and results from previous investigations were utilized [5-33] where reliability test results of similar LEDs were reported. From the graphs or tabular data, we extracted the time required for the optical power output to reach 80% of its initial value. This is our failure criterion for the medical diagnostic application. Analysis of published data for different LED materials (AlGaInP, GaN, AlGaAs), the Semiconductor Structures (DH, MQW) and the mode of testing (DC, Pulsed) was carried out. The data was categorized according to the materials system and LED structure such as AlGaInP-DH-DC, Al

  1. Use of Failure Mode and Effects Analysis to Improve Emergency Department Handoff Processes.

    PubMed

    Sorrentino, Patricia

    2016-01-01

    The purpose of this article is to describe a quality improvement process using failure mode and effects analysis (FMEA) to evaluate systems handoff communication processes, improve emergency department (ED) throughput and reduce crowding through development of a standardized handoff, and, ultimately, improve patient safety. Risk of patient harm through ineffective communication during handoff transitions is a major reason for breakdown of systems. Complexities of ED processes put patient safety at risk. An increased incidence of submitted patient safety event reports for handoff communication failures between the ED and inpatient units solidified a decision to implement the use of FMEA to identify handoff failures to mitigate patient harm through redesign. The clinical nurse specialist implemented an FMEA. Handoff failure themes were created from deidentified retrospective reviews. Weekly meetings were held over a 3-month period to identify failure modes and determine cause and effect on the process. A functional block diagram process map tool was used to illustrate handoff processes. An FMEA grid was used to list failure modes and assign a risk priority number to quantify results. Multiple areas with actionable failures were identified. A majority of causes for high-priority failure modes were specific to communications. Findings demonstrate the complexity of transition and handoff processes. The FMEA served to identify and evaluate risk of handoff failures and provide a framework for process improvement. A focus on mentoring nurses to quality handoff processes so that it becomes habitual practice is crucial to safe patient transitions. Standardizing content and hardwiring within the system are best practice. The clinical nurse specialist is prepared to provide strong leadership to drive and implement system-wide quality projects.

  2. The assessment of low probability containment failure modes using dynamic PRA

    NASA Astrophysics Data System (ADS)

    Brunett, Acacia Joann

    Although low probability containment failure modes in nuclear power plants may lead to large releases of radioactive material, these modes are typically crudely modeled in system level codes and have large associated uncertainties. Conventional risk assessment techniques (i.e. the fault-tree/event-tree methodology) are capable of accounting for these failure modes to some degree, however, they require the analyst to pre-specify the ordering of events, which can vary within the range of uncertainty of the phenomena. More recently, dynamic probabilistic risk assessment (DPRA) techniques have been developed which remove the dependency on the analyst. Through DPRA, it is now possible to perform a mechanistic and consistent analysis of low probability phenomena, with the timing of the possible events determined by the computational model simulating the reactor behavior. The purpose of this work is to utilize DPRA tools to assess low probability containment failure modes and the driving mechanisms. Particular focus is given to the risk-dominant containment failure modes considered in NUREG-1150, which has long been the standard for PRA techniques. More specifically, this work focuses on the low probability phenomena occurring during a station blackout (SBO) with late power recovery in the Zion Nuclear Power Plant, a Westinghouse pressurized water reactor (PWR). Subsequent to the major risk study performed in NUREG-1150, significant experimentation and modeling regarding the mechanisms driving containment failure modes have been performed. In light of this improved understanding, NUREG-1150 containment failure modes are reviewed in this work using the current state of knowledge. For some unresolved mechanisms, such as containment loading from high pressure melt ejection and combustion events, additional analyses are performed using the accident simulation tool MELCOR to explore the bounding containment loads for realistic scenarios. A dynamic treatment in the

  3. Model-OA wind turbine generator - Failure modes and effects analysis

    NASA Technical Reports Server (NTRS)

    Klein, William E.; Lali, Vincent R.

    1990-01-01

    The results failure modes and effects analysis (FMEA) conducted for wind-turbine generators are presented. The FMEA was performed for the functional modes of each system, subsystem, or component. The single-point failures were eliminated for most of the systems. The blade system was the only exception. The qualitative probability of a blade separating was estimated at level D-remote. Many changes were made to the hardware as a result of this analysis. The most significant change was the addition of the safety system. Operational experience and need to improve machine availability have resulted in subsequent changes to the various systems, which are also reflected in this FMEA.

  4. SU-F-T-246: Evaluation of Healthcare Failure Mode And Effect Analysis For Risk Assessment

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Harry, T; University of California, San Diego, La Jolla, CA; Manger, R

    Purpose: To evaluate the differences between the Veteran Affairs Healthcare Failure Modes and Effect Analysis (HFMEA) and the AAPM Task Group 100 Failure and Effect Analysis (FMEA) risk assessment techniques in the setting of a stereotactic radiosurgery (SRS) procedure were compared respectively. Understanding the differences in the techniques methodologies and outcomes will provide further insight into the applicability and utility of risk assessments exercises in radiation therapy. Methods: HFMEA risk assessment analysis was performed on a stereotactic radiosurgery procedure. A previous study from our institution completed a FMEA of our SRS procedure and the process map generated from this workmore » was used for the HFMEA. The process of performing the HFMEA scoring was analyzed, and the results from both analyses were compared. Results: The key differences between the two risk assessments are the scoring criteria for failure modes and identifying critical failure modes for potential hazards. The general consensus among the team performing the analyses was that scoring for the HFMEA was simpler and more intuitive then the FMEA. The FMEA identified 25 critical failure modes while the HFMEA identified 39. Seven of the FMEA critical failure modes were not identified by the HFMEA and 21 of the HFMEA critical failure modes were not identified by the FMEA. HFMEA as described by the Veteran Affairs provides guidelines on which failure modes to address first. Conclusion: HFMEA is a more efficient model for identifying gross risks in a process than FMEA. Clinics with minimal staff, time and resources can benefit from this type of risk assessment to eliminate or mitigate high risk hazards with nominal effort. FMEA can provide more in depth details but at the cost of elevated effort.« less

  5. Tank 241-AZ-102 Privatization Push Mode Core Sampling and Analysis Plan

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    RASMUSSEN, J.H.

    1999-08-02

    This sampling and analysis plan (SAP) identifies characterization objectives pertaining to sample collection, laboratory analytical evaluation, and reporting requirements for samples obtained from tank 241-AZ-102. The purpose of this sampling event is to obtain information about the characteristics of the contents of 241-AZ-102 required to satisfy the Data Quality Objectives For TWRS Privatization Phase I: Confirm Tank TIS An Appropriate Feed Source For High-Level Waste Feed Batch X(HLW DQO) (Nguyen 1999a), Data Quality Objectives For TWRS Privatization Phase 1: Confirm Tank TIS An Appropriate Feed Source For Low-Activity Waste Feed Batch X (LAW DQO) (Nguyen 1999b), Low Activity Waste andmore » High Level Waste Feed Data Quality Objectives (L&H DQO) (Patello et al. 1999) and Characterization Data Needs for Development, Design, and Operation of Retrieval Equipment Developed through the Data Quality Objective Process (Equipment DQO) (Bloom 1996). The Tank Characterization Technical Sampling Basis document (Brown et al. 1998) indicates that these issues, except the Equipment DQO apply to tank 241-AZ-102 for this sampling event. The Equipment DQO is applied for shear strength measurements of the solids segments only. Poppiti (1999) requires additional americium-241 analyses of the sludge segments. Brown et al. (1998) also identify safety screening, regulatory issues and provision of samples to the Privatization Contractor(s) as applicable issues for this tank. However, these issues will not be addressed via this sampling event. Reynolds et al. (1999) concluded that information from previous sampling events was sufficient to satisfy the safety screening requirements for tank 241 -AZ-102. Push mode core samples will be obtained from risers 15C and 24A to provide sufficient material for the chemical analyses and tests required to satisfy these data quality objectives. The 222-S Laboratory will extrude core samples, composite the liquids and solids, perform chemical

  6. Application of failure mode and effects analysis to intracranial stereotactic radiation surgery by linear accelerator.

    PubMed

    Masini, Laura; Donis, Laura; Loi, Gianfranco; Mones, Eleonora; Molina, Elisa; Bolchini, Cesare; Krengli, Marco

    2014-01-01

    The aim of this study was to analyze the application of the failure modes and effects analysis (FMEA) to intracranial stereotactic radiation surgery (SRS) by linear accelerator in order to identify the potential failure modes in the process tree and adopt appropriate safety measures to prevent adverse events (AEs) and near-misses, thus improving the process quality. A working group was set up to perform FMEA for intracranial SRS in the framework of a quality assurance program. FMEA was performed in 4 consecutive tasks: (1) creation of a visual map of the process; (2) identification of possible failure modes; (3) assignment of a risk probability number (RPN) to each failure mode based on tabulated scores of severity, frequency of occurrence and detectability; and (4) identification of preventive measures to minimize the risk of occurrence. The whole SRS procedure was subdivided into 73 single steps; 116 total possible failure modes were identified and a score of severity, occurrence, and detectability was assigned to each. Based on these scores, RPN was calculated for each failure mode thus obtaining values from 1 to 180. In our analysis, 112/116 (96.6%) RPN values were <60, 2 (1.7%) between 60 and 125 (63, 70), and 2 (1.7%) >125 (135, 180). The 2 highest RPN scores were assigned to the risk of using the wrong collimator's size and incorrect coordinates on the laser target localizer frame. Failure modes and effects analysis is a simple and practical proactive tool for systematic analysis of risks in radiation therapy. In our experience of SRS, FMEA led to the adoption of major changes in various steps of the SRS procedure.

  7. Stress Analysis and Testing at the Marshall Space Flight Center to Study Cause and Corrective Action of Space Shuttle External Tank Stringer Failures

    NASA Technical Reports Server (NTRS)

    Wingate, Robert J.

    2012-01-01

    After the launch scrub of Space Shuttle mission STS-133 on November 5, 2010, large cracks were discovered in two of the External Tank intertank stringers. The NASA Marshall Space Flight Center, as managing center for the External Tank Project, coordinated the ensuing failure investigation and repair activities with several organizations, including the manufacturer, Lockheed Martin. To support the investigation, the Marshall Space Flight Center formed an ad-hoc stress analysis team to complement the efforts of Lockheed Martin. The team undertook six major efforts to analyze or test the structural behavior of the stringers. Extensive finite element modeling was performed to characterize the local stresses in the stringers near the region of failure. Data from a full-scale tanking test and from several subcomponent static load tests were used to confirm the analytical conclusions. The analysis and test activities of the team are summarized. The root cause of the stringer failures and the flight readiness rationale for the repairs that were implemented are discussed.

  8. Characterization of mode 1 and mixed-mode failure of adhesive bonds between composite adherends

    NASA Technical Reports Server (NTRS)

    Mall, S.; Johnson, W. S.

    1985-01-01

    A combined experimental and analytical investigation of an adhesively bonded composite joint was conducted to characterize both the static and fatigue beyond growth mechanism under mode 1 and mixed-mode 1 and 2 loadings. Two bonded systems were studied: graphite/epoxy adherends bonded with EC 3445 and FM-300 adhesives. For each bonded system, two specimen types were tested: a double-cantilever-beam specimen for mode 1 loading and a cracked-lapshear specimen for mixed-mode 1 and 2 loading. In all specimens tested, failure occurred in the form of debond growth. Debonding always occurred in a cohesive manner with EC 3445 adhesive. The FM-300 adhesive debonded in a cohesive manner under mixed-mode 1 and 2 loading, but in a cohesive, adhesive, or combined cohesive and adhesive manner under mode 1 loading. Total strain-energy release rate appeared to be the driving parameter for debond growth under static and fatigue loadings.

  9. Failure mode analysis in adrenal vein sampling: a single-center experience.

    PubMed

    Trerotola, Scott O; Asmar, Melissa; Yan, Yan; Fraker, Douglas L; Cohen, Debbie L

    2014-10-01

    To analyze failure modes in a high-volume adrenal vein sampling (AVS) practice in an effort to identify preventable causes of nondiagnostic sampling. A retrospective database was constructed containing 343 AVS procedures performed over a 10-year period. Each nondiagnostic AVS procedure was reviewed for failure mode and correlated with results of any repeat AVS. Data collected included selectivity index, lateralization index, adrenalectomy outcomes if performed, and details of AVS procedure. All AVS procedures were performed after cosyntropin stimulation, using sequential technique. AVS was nondiagnostic in 12 of 343 (3.5%) primary procedures and 2 secondary procedures. Failure was right-sided in 8 (57%) procedures, left-sided in 4 (29%) procedures, bilateral in 1 procedure, and neither in 1 procedure (laboratory error). Failure modes included diluted sample from correctly identified vein (n = 7 [50%]; 3 right and 4 left), vessel misidentified as adrenal vein (n = 3 [21%]; all right), failure to locate an adrenal vein (n = 2 [14%]; both right), cosyntropin stimulation failure (n = 1 [7%]; diagnostic by nonstimulated criteria), and laboratory error (n = 1 [7%]; specimen loss). A second AVS procedure was diagnostic in three of five cases (60%), and a third AVS procedure was diagnostic in one of one case (100%). Among the eight patients in whom AVS ultimately was not diagnostic, four underwent adrenalectomy based on diluted AVS samples, and one underwent adrenalectomy based on imaging; all five experienced improvement in aldosteronism. A substantial percentage of AVS failures occur on the left, all related to dilution. Even when technically nondiagnostic per strict criteria, some "failed" AVS procedures may be sufficient to guide therapy. Repeat AVS has a good yield. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  10. TU-AB-BRD-02: Failure Modes and Effects Analysis

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Huq, M.

    2015-06-15

    Current quality assurance and quality management guidelines provided by various professional organizations are prescriptive in nature, focusing principally on performance characteristics of planning and delivery devices. However, published analyses of events in radiation therapy show that most events are often caused by flaws in clinical processes rather than by device failures. This suggests the need for the development of a quality management program that is based on integrated approaches to process and equipment quality assurance. Industrial engineers have developed various risk assessment tools that are used to identify and eliminate potential failures from a system or a process before amore » failure impacts a customer. These tools include, but are not limited to, process mapping, failure modes and effects analysis, fault tree analysis. Task Group 100 of the American Association of Physicists in Medicine has developed these tools and used them to formulate an example risk-based quality management program for intensity-modulated radiotherapy. This is a prospective risk assessment approach that analyzes potential error pathways inherent in a clinical process and then ranks them according to relative risk, typically before implementation, followed by the design of a new process or modification of the existing process. Appropriate controls are then put in place to ensure that failures are less likely to occur and, if they do, they will more likely be detected before they propagate through the process, compromising treatment outcome and causing harm to the patient. Such a prospective approach forms the basis of the work of Task Group 100 that has recently been approved by the AAPM. This session will be devoted to a discussion of these tools and practical examples of how these tools can be used in a given radiotherapy clinic to develop a risk based quality management program. Learning Objectives: Learn how to design a process map for a radiotherapy process Learn

  11. Design review report for rotary mode core sample truck (RMCST) modifications for flammable gas tanks, preliminary design

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Corbett, J.E.

    1996-02-01

    This report documents the completion of a preliminary design review for the Rotary Mode Core Sample Truck (RMCST) modifications for flammable gas tanks. The RMCST modifications are intended to support core sampling operations in waste tanks requiring flammable gas controls. The objective of this review was to validate basic design assumptions and concepts to support a path forward leading to a final design. The conclusion reached by the review committee was that the design was acceptable and efforts should continue toward a final design review.

  12. Ageing and degradation determines failure mode on sea urchin spines.

    PubMed

    Merino, Monica; Vicente, Erika; Gonzales, Karen N; Torres, Fernando G

    2017-09-01

    Sea urchin spines are an example of a hard natural composite with mineral and organic phases. The role of the organic phase in the response to mechanical stress was assessed by promoting the degradation of such spines by exposing them to ageing and ultraviolet (UV) irradiation. Thermal and structural characterization of the irradiated samples show that this UV irradiation treatment promotes degradation of the organic and inorganic phase of spines. Uniaxial compression tests carried out on aged and UV irradiated samples showed that both treatments affected the mechanical properties of the spines. Scanning electron microscopy (SEM) images of failed specimens were used to analyze the failure mechanisms of the compressed spines. The analysis of the fracture surfaces showed that the failure mechanisms of spines were modified as a consequence of UV irradiation, leading in the last case to mostly brittle fracture surfaces. We suggest that the proteins responsible for the formation of calcite also determine the mechanical properties and the failure mode of spines. This system can be used as a model for the study of the failure modes of other natural and synthetic hard composites. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. SU-E-T-627: Failure Modes and Effect Analysis for Monthly Quality Assurance of Linear Accelerator

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Xie, J; Xiao, Y; Wang, J

    2014-06-15

    Purpose: To develop and implement a failure mode and effect analysis (FMEA) on routine monthly Quality Assurance (QA) tests (physical tests part) of linear accelerator. Methods: A systematic failure mode and effect analysis method was performed for monthly QA procedures. A detailed process tree of monthly QA was created and potential failure modes were defined. Each failure mode may have many influencing factors. For each factor, a risk probability number (RPN) was calculated from the product of probability of occurrence (O), the severity of effect (S), and detectability of the failure (D). The RPN scores are in a range ofmore » 1 to 1000, with higher scores indicating stronger correlation to a given influencing factor of a failure mode. Five medical physicists in our institution were responsible to discuss and to define the O, S, D values. Results: 15 possible failure modes were identified and all RPN scores of all influencing factors of these 15 failue modes were from 8 to 150, and the checklist of FMEA in monthly QA was drawn. The system showed consistent and accurate response to erroneous conditions. Conclusion: The influencing factors of RPN greater than 50 were considered as highly-correlated factors of a certain out-oftolerance monthly QA test. FMEA is a fast and flexible tool to develop an implement a quality management (QM) frame work of monthly QA, which improved the QA efficiency of our QA team. The FMEA work may incorporate more quantification and monitoring fuctions in future.« less

  14. Procedure for Failure Mode, Effects, and Criticality Analysis (FMECA)

    NASA Technical Reports Server (NTRS)

    1966-01-01

    This document provides guidelines for the accomplishment of Failure Mode, Effects, and Criticality Analysis (FMECA) on the Apollo program. It is a procedure for analysis of hardware items to determine those items contributing most to system unreliability and crew safety problems.

  15. External Tank Program Legacy of Success

    NASA Technical Reports Server (NTRS)

    Welzyn, Ken; Pilet, Jeff

    2010-01-01

    I.Goal: a) Extensive TPS damage caused by extreme hail storm. b) Repair plan required to restore TPS to minimize program manifest impacts. II. Challenges: a) Skeptical technical community - Concerned about interactions of damage with known/unknown failure modes. b) Schedule pressure to accommodate ISS program- Next tank still at MAF c)Limited ET resources. III. How d We Do It?: a) Developed unique engineering requirements and tooling to minimize repairs. b) Performed large amount of performance testing to demonstrate understanding of repairs and residual conditions. c) Effectively communicated results to technical community and management to instill confidence in expected performance.

  16. Application of failure mode and effect analysis in a radiology department.

    PubMed

    Thornton, Eavan; Brook, Olga R; Mendiratta-Lala, Mishal; Hallett, Donna T; Kruskal, Jonathan B

    2011-01-01

    With increasing deployment, complexity, and sophistication of equipment and related processes within the clinical imaging environment, system failures are more likely to occur. These failures may have varying effects on the patient, ranging from no harm to devastating harm. Failure mode and effect analysis (FMEA) is a tool that permits the proactive identification of possible failures in complex processes and provides a basis for continuous improvement. This overview of the basic principles and methodology of FMEA provides an explanation of how FMEA can be applied to clinical operations in a radiology department to reduce, predict, or prevent errors. The six sequential steps in the FMEA process are explained, and clinical magnetic resonance imaging services are used as an example for which FMEA is particularly applicable. A modified version of traditional FMEA called Healthcare Failure Mode and Effect Analysis, which was introduced by the U.S. Department of Veterans Affairs National Center for Patient Safety, is briefly reviewed. In conclusion, FMEA is an effective and reliable method to proactively examine complex processes in the radiology department. FMEA can be used to highlight the high-risk subprocesses and allows these to be targeted to minimize the future occurrence of failures, thus improving patient safety and streamlining the efficiency of the radiology department. RSNA, 2010

  17. X-33 LH2 Tank Failure Investigation Findings

    NASA Technical Reports Server (NTRS)

    Niedermeyer, Melinda

    2003-01-01

    This viewgraph presentation provides information on the composite sandwich-honeycomb structure of the liquid hydrogen tank of the X-33 reusable launch vehicle, and describes why the the first pressure test to determine the tank's structural integrity failed. The presentation includes images of the tank before and after the failed test, including photomicrographs. It then reaches conclusions on the nature of the microcracks which caused the liquid hydrogen leakage.

  18. Failure Mode Analysis of V-Shaped Pyrotechnically Actuated Valves

    NASA Technical Reports Server (NTRS)

    Sachdev, Jai S.; Hosangadi, A.; Chenoweth, James D.; Saulsberry, Regor L.; McDougle, Stephen H.

    2012-01-01

    Current V-shaped stainless steel pyrovalve initiators have rectified many of the deficiencies of the heritage Y-shaped aluminum design. However, a credible failure mode still exists for dual simultaneous initiator (NSI) firings in which low temperatures were detected at the booster cap and less consistent ignition was observed than when a single initiator was fired. In order to asses this issue, a numerical framework has been developed for predicting the flow through pyrotechnically actuated valves. This framework includes a fully coupled solution of the gas-phase equation with a non-equilibrium dispersed phase for solid particles as well as the capability to model conjugate gradient heat transfer to the booster cap. Through a hierarchy of increasingly complex simulations, a hypothesis for the failure mode of the nearly simultaneous dual NSI firings has been proven. The simulations indicate that the failure mode for simultaneous dual NSI firings may be caused by flow interactions between the flame channels. The shock waves from each initiator interact in the booster cavity resulting in a high pressure that prevents the gas and particulate velocity from rising in the booster cap region. This impedes the bulk of the particulate phase from impacting the booster cap and reduces the heat transfer to the booster cap since the particles do not impact it. Heat transfer calculations to the solid metal indicate that gas-phase convective heat transfer may not be adequate by itself and that energy transfer from the particulate phase may be crucial for the booster cap burn through.

  19. Failure mode and effect analysis in blood transfusion: a proactive tool to reduce risks.

    PubMed

    Lu, Yao; Teng, Fang; Zhou, Jie; Wen, Aiqing; Bi, Yutian

    2013-12-01

    The aim of blood transfusion risk management is to improve the quality of blood products and to assure patient safety. We utilize failure mode and effect analysis (FMEA), a tool employed for evaluating risks and identifying preventive measures to reduce the risks in blood transfusion. The failure modes and effects occurring throughout the whole process of blood transfusion were studied. Each failure mode was evaluated using three scores: severity of effect (S), likelihood of occurrence (O), and probability of detection (D). Risk priority numbers (RPNs) were calculated by multiplying the S, O, and D scores. The plan-do-check-act cycle was also used for continuous improvement. Analysis has showed that failure modes with the highest RPNs, and therefore the greatest risk, were insufficient preoperative assessment of the blood product requirement (RPN, 245), preparation time before infusion of more than 30 minutes (RPN, 240), blood transfusion reaction occurring during the transfusion process (RPN, 224), blood plasma abuse (RPN, 180), and insufficient and/or incorrect clinical information on request form (RPN, 126). After implementation of preventative measures and reassessment, a reduction in RPN was detected with each risk. The failure mode with the second highest RPN, namely, preparation time before infusion of more than 30 minutes, was shown in detail to prove the efficiency of this tool. FMEA evaluation model is a useful tool in proactively analyzing and reducing the risks associated with the blood transfusion procedure. © 2013 American Association of Blood Banks.

  20. Practical Implementation of Failure Mode and Effects Analysis for Safety and Efficiency in Stereotactic Radiosurgery

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Younge, Kelly Cooper, E-mail: kyounge@med.umich.edu; Wang, Yizhen; Thompson, John

    2015-04-01

    Purpose: To improve the safety and efficiency of a new stereotactic radiosurgery program with the application of failure mode and effects analysis (FMEA) performed by a multidisciplinary team of health care professionals. Methods and Materials: Representatives included physicists, therapists, dosimetrists, oncologists, and administrators. A detailed process tree was created from an initial high-level process tree to facilitate the identification of possible failure modes. Group members were asked to determine failure modes that they considered to be the highest risk before scoring failure modes. Risk priority numbers (RPNs) were determined by each group member individually and then averaged. Results: A totalmore » of 99 failure modes were identified. The 5 failure modes with an RPN above 150 were further analyzed to attempt to reduce these RPNs. Only 1 of the initial items that the group presumed to be high-risk (magnetic resonance imaging laterality reversed) was ranked in these top 5 items. New process controls were put in place to reduce the severity, occurrence, and detectability scores for all of the top 5 failure modes. Conclusions: FMEA is a valuable team activity that can assist in the creation or restructuring of a quality assurance program with the aim of improved safety, quality, and efficiency. Performing the FMEA helped group members to see how they fit into the bigger picture of the program, and it served to reduce biases and preconceived notions about which elements of the program were the riskiest.« less

  1. Failure mode and effects analysis using intuitionistic fuzzy hybrid weighted Euclidean distance operator

    NASA Astrophysics Data System (ADS)

    Liu, Hu-Chen; Liu, Long; Li, Ping

    2014-10-01

    Failure mode and effects analysis (FMEA) has shown its effectiveness in examining potential failures in products, process, designs or services and has been extensively used for safety and reliability analysis in a wide range of industries. However, its approach to prioritise failure modes through a crisp risk priority number (RPN) has been criticised as having several shortcomings. The aim of this paper is to develop an efficient and comprehensive risk assessment methodology using intuitionistic fuzzy hybrid weighted Euclidean distance (IFHWED) operator to overcome the limitations and improve the effectiveness of the traditional FMEA. The diversified and uncertain assessments given by FMEA team members are treated as linguistic terms expressed in intuitionistic fuzzy numbers (IFNs). Intuitionistic fuzzy weighted averaging (IFWA) operator is used to aggregate the FMEA team members' individual assessments into a group assessment. IFHWED operator is applied thereafter to the prioritisation and selection of failure modes. Particularly, both subjective and objective weights of risk factors are considered during the risk evaluation process. A numerical example for risk assessment is given to illustrate the proposed method finally.

  2. Chemical Safety Alert: Catastrophic Failure of Storage Tanks

    EPA Pesticide Factsheets

    Aboveground, atmospheric storage tanks can fail when flammable vapors in the tank explode and break either the shell-to-bottom or side seam, resulting in hazardous release accidents. Proper maintenance practices can help prevent accidents.

  3. Failure mode and effects analysis of witnessing protocols for ensuring traceability during IVF.

    PubMed

    Rienzi, Laura; Bariani, Fiorenza; Dalla Zorza, Michela; Romano, Stefania; Scarica, Catello; Maggiulli, Roberta; Nanni Costa, Alessandro; Ubaldi, Filippo Maria

    2015-10-01

    Traceability of cells during IVF is a fundamental aspect of treatment, and involves witnessing protocols. Failure mode and effects analysis (FMEA) is a method of identifying real or potential breakdowns in processes, and allows strategies to mitigate risks to be developed. To examine the risks associated with witnessing protocols, an FMEA was carried out in a busy IVF centre, before and after implementation of an electronic witnessing system (EWS). A multidisciplinary team was formed and moderated by human factors specialists. Possible causes of failures, and their potential effects, were identified and risk priority number (RPN) for each failure calculated. A second FMEA analysis was carried out after implementation of an EWS. The IVF team identified seven main process phases, 19 associated process steps and 32 possible failure modes. The highest RPN was 30, confirming the relatively low risk that mismatches may occur in IVF when a manual witnessing system is used. The introduction of the EWS allowed a reduction in the moderate-risk failure mode by two-thirds (highest RPN = 10). In our experience, FMEA is effective in supporting multidisciplinary IVF groups to understand the witnessing process, identifying critical steps and planning changes in practice to enable safety to be enhanced. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  4. Failure modes and effects analysis for ocular brachytherapy.

    PubMed

    Lee, Yongsook C; Kim, Yongbok; Huynh, Jason Wei-Yeong; Hamilton, Russell J

    The aim of the study was to identify potential failure modes (FMs) having a high risk and to improve our current quality management (QM) program in Collaborative Ocular Melanoma Study (COMS) ocular brachytherapy by undertaking a failure modes and effects analysis (FMEA) and a fault tree analysis (FTA). Process mapping and FMEA were performed for COMS ocular brachytherapy. For all FMs identified in FMEA, risk priority numbers (RPNs) were determined by assigning and multiplying occurrence, severity, and lack of detectability values, each ranging from 1 to 10. FTA was performed for the major process that had the highest ranked FM. Twelve major processes, 121 sub-process steps, 188 potential FMs, and 209 possible causes were identified. For 188 FMs, RPN scores ranged from 1.0 to 236.1. The plaque assembly process had the highest ranked FM. The majority of FMs were attributable to human failure (85.6%), and medical physicist-related failures were the most numerous (58.9% of all causes). After FMEA, additional QM methods were included for the top 10 FMs and 6 FMs with severity values > 9.0. As a result, for these 16 FMs and the 5 major processes involved, quality control steps were increased from 8 (50%) to 15 (93.8%), and major processes having quality assurance steps were increased from 2 to 4. To reduce high risk in current clinical practice, we proposed QM methods. They mainly include a check or verification of procedures/steps and the use of checklists for both ophthalmology and radiation oncology staff, and intraoperative ultrasound-guided plaque positioning for ophthalmology staff. Copyright © 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  5. Modes of failure of Osteonics constrained tripolar implants: a retrospective analysis of forty-three failed implants.

    PubMed

    Guyen, Olivier; Lewallen, David G; Cabanela, Miguel E

    2008-07-01

    The Osteonics constrained tripolar implant has been one of the most commonly used options to manage recurrent instability after total hip arthroplasty. Mechanical failures were expected and have been reported. The purpose of this retrospective review was to identify the observed modes of failure of this device. Forty-three failed Osteonics constrained tripolar implants were revised at our institution between September 1997 and April 2005. All revisions related to the constrained acetabular component only were considered as failures. All of the devices had been inserted for recurrent or intraoperative instability during revision procedures. Seven different methods of implantation were used. Operative reports and radiographs were reviewed to identify the modes of failure. The average time to failure of the forty-three implants was 28.4 months. A total of five modes of failure were observed: failure at the bone-implant interface (type I), which occurred in eleven hips; failure at the mechanisms holding the constrained liner to the metal shell (type II), in six hips; failure of the retaining mechanism of the bipolar component (type III), in ten hips; dislocation of the prosthetic head at the inner bearing of the bipolar component (type IV), in three hips; and infection (type V), in twelve hips. The mode of failure remained unknown in one hip that had been revised at another institution. The Osteonics constrained tripolar total hip arthroplasty implant is a complex device involving many parts. We showed that failure of this device can occur at most of its interfaces. It would therefore appear logical to limit its application to salvage situations.

  6. An improved method for risk evaluation in failure modes and effects analysis of CNC lathe

    NASA Astrophysics Data System (ADS)

    Rachieru, N.; Belu, N.; Anghel, D. C.

    2015-11-01

    Failure mode and effects analysis (FMEA) is one of the most popular reliability analysis tools for identifying, assessing and eliminating potential failure modes in a wide range of industries. In general, failure modes in FMEA are evaluated and ranked through the risk priority number (RPN), which is obtained by the multiplication of crisp values of the risk factors, such as the occurrence (O), severity (S), and detection (D) of each failure mode. However, the crisp RPN method has been criticized to have several deficiencies. In this paper, linguistic variables, expressed in Gaussian, trapezoidal or triangular fuzzy numbers, are used to assess the ratings and weights for the risk factors S, O and D. A new risk assessment system based on the fuzzy set theory and fuzzy rule base theory is to be applied to assess and rank risks associated to failure modes that could appear in the functioning of Turn 55 Lathe CNC. Two case studies have been shown to demonstrate the methodology thus developed. It is illustrated a parallel between the results obtained by the traditional method and fuzzy logic for determining the RPNs. The results show that the proposed approach can reduce duplicated RPN numbers and get a more accurate, reasonable risk assessment. As a result, the stability of product and process can be assured.

  7. X-33 Tank Failure During Autoclave Fabrication

    NASA Technical Reports Server (NTRS)

    Nettles, Alan T.; Munafo, Paul (Technical Monitor)

    2001-01-01

    The composite liquid hydrogen tank (tank #1 of 2) for the X-33 flight vehicle is made up of four lobes that have a sandwich construction, bonded to a frame of longerons. Lobes 1 and 4 showed local disbonds to the longerons they were bonded to. The 'bad' areas were cut away and patched with new material. The new material was cured by placing the entire tank in a heated autoclave with no pressure. Upon removal from the autoclave, it was noted that lobe 1 had severe skin/core disbonds on the inner and outer skins. The skins on this lobe were cracked as well. The core was disbonded from the inner skin across the entire acreage, except for spots around the lobe perimeter. The outer skin was separated from the core in a region near the center of the lobe. Lobe 1 was removed from the tank on January 13, 1999. Bolts were placed through the lobe to hold it together and the cuts on the inner skin were not continuous, but 'tabs' were left for final cutting and removal. Upon closer inspection of the disbonded basesheet, it was noted that there was a lack of filleting into the honeycomb core. Good fillets are critical to bond strength.

  8. Effects of soil-engineering properties on the failure mode of shallow landslides

    USGS Publications Warehouse

    McKenna, Jonathan Peter; Santi, Paul Michael; Amblard, Xavier; Negri, Jacquelyn

    2012-01-01

    Some landslides mobilize into flows, while others slide and deposit material immediately down slope. An index based on initial dry density and fine-grained content of soil predicted failure mode of 96 landslide initiation sites in Oregon and Colorado with 79% accuracy. These material properties can be used to identify potential sources for debris flows and for slides. Field data suggest that loose soils can evolve from dense soils that dilate upon shearing. The method presented herein to predict failure mode is most applicable for shallow (depth 8), with few to moderate fines (fine-grained content <18%), and with liquid limits <40.

  9. Linear and nonlinear 2D finite element analysis of sloshing modes and pressures in rectangular tanks subject to horizontal harmonic motions

    NASA Astrophysics Data System (ADS)

    Virella, Juan C.; Prato, Carlos A.; Godoy, Luis A.

    2008-05-01

    The influence of nonlinear wave theory on the sloshing natural periods and their modal pressure distributions are investigated for rectangular tanks under the assumption of two-dimensional behavior. Natural periods and mode shapes are computed and compared for both linear wave theory (LWT) and nonlinear wave theory (NLWT) models, using the finite element package ABAQUS. Linear wave theory is implemented in an acoustic model, whereas a plane strain problem with large displacements is used in NLWT. Pressure distributions acting on the tank walls are obtained for the first three sloshing modes using both linear and nonlinear wave theory. It is found that the nonlinearity does not have significant effects on the natural sloshing periods. For the sloshing pressures on the tank walls, different distributions were found using linear and nonlinear wave theory models. However, in all cases studied, the linear wave theory conservatively estimated the magnitude of the pressure distribution, whereas larger pressures resultant heights were obtained when using the nonlinear theory. It is concluded that the nonlinearity of the surface wave does not have major effects in the pressure distribution on the walls for rectangular tanks.

  10. An Abrupt Transition to an Intergranular Failure Mode in the Near-Threshold Fatigue Crack Growth Regime in Ni-Based Superalloys

    NASA Astrophysics Data System (ADS)

    Telesman, J.; Smith, T. M.; Gabb, T. P.; Ring, A. J.

    2018-06-01

    Cyclic near-threshold fatigue crack growth (FCG) behavior of two disk superalloys was evaluated and was shown to exhibit an unexpected sudden failure mode transition from a mostly transgranular failure mode at higher stress intensity factor ranges to an almost completely intergranular failure mode in the threshold regime. The change in failure modes was associated with a crossover of FCG resistance curves in which the conditions that produced higher FCG rates in the Paris regime resulted in lower FCG rates and increased ΔK th values in the threshold region. High-resolution scanning and transmission electron microscopy were used to carefully characterize the crack tips at these near-threshold conditions. Formation of stable Al-oxide followed by Cr-oxide and Ti-oxides was found to occur at the crack tip prior to formation of unstable oxides. To contrast with the threshold failure mode regime, a quantitative assessment of the role that the intergranular failure mode has on cyclic FCG behavior in the Paris regime was also performed. It was demonstrated that even a very limited intergranular failure content dominates the FCG response under mixed mode failure conditions.

  11. Precursory changes in seismic velocity for the spectrum of earthquake failure modes

    PubMed Central

    Scuderi, M.M.; Marone, C.; Tinti, E.; Di Stefano, G.; Collettini, C.

    2016-01-01

    Temporal changes in seismic velocity during the earthquake cycle have the potential to illuminate physical processes associated with fault weakening and connections between the range of fault slip behaviors including slow earthquakes, tremor and low frequency earthquakes1. Laboratory and theoretical studies predict changes in seismic velocity prior to earthquake failure2, however tectonic faults fail in a spectrum of modes and little is known about precursors for those modes3. Here we show that precursory changes of wave speed occur in laboratory faults for the complete spectrum of failure modes observed for tectonic faults. We systematically altered the stiffness of the loading system to reproduce the transition from slow to fast stick-slip and monitored ultrasonic wave speed during frictional sliding. We find systematic variations of elastic properties during the seismic cycle for both slow and fast earthquakes indicating similar physical mechanisms during rupture nucleation. Our data show that accelerated fault creep causes reduction of seismic velocity and elastic moduli during the preparatory phase preceding failure, which suggests that real time monitoring of active faults may be a means to detect earthquake precursors. PMID:27597879

  12. Sliding Mode Control of the X-33 with an Engine Failure

    NASA Technical Reports Server (NTRS)

    Shtessel, Yuri B.; Hall, Charles E.

    2000-01-01

    Ascent flight control of the X-3 is performed using two XRS-2200 linear aerospike engines. in addition to aerosurfaces. The baseline control algorithms are PID with gain scheduling. Flight control using an innovative method. Sliding Mode Control. is presented for nominal and engine failed modes of flight. An easy to implement, robust controller. requiring no reconfiguration or gain scheduling is demonstrated through high fidelity flight simulations. The proposed sliding mode controller utilizes a two-loop structure and provides robust. de-coupled tracking of both orientation angle command profiles and angular rate command profiles in the presence of engine failure, bounded external disturbances (wind gusts) and uncertain matrix of inertia. Sliding mode control causes the angular rate and orientation angle tracking error dynamics to be constrained to linear, de-coupled, homogeneous, and vector valued differential equations with desired eigenvalues. Conditions that restrict engine failures to robustness domain of the sliding mode controller are derived. Overall stability of a two-loop flight control system is assessed. Simulation results show that the designed controller provides robust, accurate, de-coupled tracking of the orientation angle command profiles in the presence of external disturbances and vehicle inertia uncertainties, as well as the single engine failed case. The designed robust controller will significantly reduce the time and cost associated with flying new trajectory profiles or orbits, with new payloads, and with modified vehicles

  13. Failure mode and effect analysis: improving intensive care unit risk management processes.

    PubMed

    Askari, Roohollah; Shafii, Milad; Rafiei, Sima; Abolhassani, Mohammad Sadegh; Salarikhah, Elaheh

    2017-04-18

    Purpose Failure modes and effects analysis (FMEA) is a practical tool to evaluate risks, discover failures in a proactive manner and propose corrective actions to reduce or eliminate potential risks. The purpose of this paper is to apply FMEA technique to examine the hazards associated with the process of service delivery in intensive care unit (ICU) of a tertiary hospital in Yazd, Iran. Design/methodology/approach This was a before-after study conducted between March 2013 and December 2014. By forming a FMEA team, all potential hazards associated with ICU services - their frequency and severity - were identified. Then risk priority number was calculated for each activity as an indicator representing high priority areas that need special attention and resource allocation. Findings Eight failure modes with highest priority scores including endotracheal tube defect, wrong placement of endotracheal tube, EVD interface, aspiration failure during suctioning, chest tube failure, tissue injury and deep vein thrombosis were selected for improvement. Findings affirmed that improvement strategies were generally satisfying and significantly decreased total failures. Practical implications Application of FMEA in ICUs proved to be effective in proactively decreasing the risk of failures and corrected the control measures up to acceptable levels in all eight areas of function. Originality/value Using a prospective risk assessment approach, such as FMEA, could be beneficial in dealing with potential failures through proposing preventive actions in a proactive manner. The method could be used as a tool for healthcare continuous quality improvement so that the method identifies both systemic and human errors, and offers practical advice to deal effectively with them.

  14. Predictions of High Strain Rate Failure Modes in Layered Aluminum Composites

    NASA Astrophysics Data System (ADS)

    Khanikar, Prasenjit; Zikry, M. A.

    2014-01-01

    A dislocation density-based crystalline plasticity formulation, specialized finite-element techniques, and rational crystallographic orientation relations were used to predict and characterize the failure modes associated with the high strain rate behavior of aluminum layered composites. Two alloy layers, a high strength alloy, aluminum 2195, and an aluminum alloy 2139, with high toughness, were modeled with representative microstructures that included precipitates, dispersed particles, and different grain boundary distributions. Different layer arrangements were investigated for high strain rate applications and the optimal arrangement was with the high toughness 2139 layer on the bottom, which provided extensive shear strain localization, and the high strength 2195 layer on the top for high strength resistance The layer thickness of the bottom high toughness layer also affected the bending behavior of the roll-bonded interface and the potential delamination of the layers. Shear strain localization, dynamic cracking, and delamination are the mutually competing failure mechanisms for the layered metallic composite, and control of these failure modes can be used to optimize behavior for high strain rate applications.

  15. Utility of Failure Mode and Effect Analysis to Improve Safety in Suctioning by Orotracheal Tube.

    PubMed

    Vázquez-Valencia, Agustín; Santiago-Sáez, Andrés; Perea-Pérez, Bernardo; Labajo-González, Elena; Albarrán-Juan, Maria Elena

    2017-02-01

    The objective of the study was to use the Failure Mode and Effect Analysis (FMEA) tool to analyze the technique of secretion suctioning on patients with an endotracheal tube who were admitted into an intensive care unit. Brainstorming was carried out within the service to determine the potential errors most frequent in the process. After this, the FMEA was applied, including its stages, prioritizing risk in accordance with the risk prioritization number (RPN), selecting improvement actions in which they have an RPN of more than 300. We obtained 32 failure modes, of which 13 surpassed an RPN of 300. After our result, 21 improvement actions were proposed for those failure modes with RPN scores above 300. FMEA allows us to ascertain possible failures so as to later propose improvement actions for those which have an RPN of more than 300. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  16. SU-F-T-247: Collision Risks in a Modern Radiation Oncology Department: An Efficient Approach to Failure Modes and Effects Analysis

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Schubert, L; Westerly, D; Vinogradskiy, Y

    Purpose: Collisions between treatment equipment and patients are potentially catastrophic. Modern technology now commonly involves automated remote motion during imaging and treatment, yet a systematic assessment to identify and mitigate collision risks has yet to be performed. Failure modes and effects analysis (FMEA) is a method of risk assessment that has been increasingly used in healthcare, yet can be resource intensive. This work presents an efficient approach to FMEA to identify collision risks and implement practical interventions within a modern radiation therapy department. Methods: Potential collisions (e.g. failure modes) were assessed for all treatment and simulation rooms by teams consistingmore » of physicists, therapists, and radiation oncologists. Failure modes were grouped into classes according to similar characteristics. A single group meeting was held to identify implementable interventions for the highest priority classes of failure modes. Results: A total of 60 unique failure modes were identified by 6 different teams of physicists, therapists, and radiation oncologists. Failure modes were grouped into four main classes: specific patient setups, automated equipment motion, manual equipment motion, and actions in QA or service mode. Two of these classes, unusual patient setups and automated machine motion, were identified as being high priority in terms severity of consequence and addressability by interventions. The two highest risk classes consisted of 33 failure modes (55% of the total). In a single one hour group meeting, 6 interventions were identified. Those interventions addressed 100% of the high risk classes of failure modes (55% of all failure modes identified). Conclusion: A class-based approach to FMEA was developed to efficiently identify collision risks and implement interventions in a modern radiation oncology department. Failure modes and interventions will be listed, and a comparison of this approach against traditional FMEA

  17. Physics-Based Fragment Acceleration Modeling for Pressurized Tank Burst Risk Assessments

    NASA Technical Reports Server (NTRS)

    Manning, Ted A.; Lawrence, Scott L.

    2014-01-01

    As part of comprehensive efforts to develop physics-based risk assessment techniques for space systems at NASA, coupled computational fluid and rigid body dynamic simulations were carried out to investigate the flow mechanisms that accelerate tank fragments in bursting pressurized vessels. Simulations of several configurations were compared to analyses based on the industry-standard Baker explosion model, and were used to formulate an improved version of the model. The standard model, which neglects an external fluid, was found to agree best with simulation results only in configurations where the internal-to-external pressure ratio is very high and fragment curvature is small. The improved model introduces terms that accommodate an external fluid and better account for variations based on circumferential fragment count. Physics-based analysis was critical in increasing the model's range of applicability. The improved tank burst model can be used to produce more accurate risk assessments of space vehicle failure modes that involve high-speed debris, such as exploding propellant tanks and bursting rocket engines.

  18. Risk assessment of failure modes of gas diffuser liner of V94.2 siemens gas turbine by FMEA method

    NASA Astrophysics Data System (ADS)

    Mirzaei Rafsanjani, H.; Rezaei Nasab, A.

    2012-05-01

    Failure of welding connection of gas diffuser liner and exhaust casing is one of the failure modes of V94.2 gas turbines which are happened in some power plants. This defect is one of the uncertainties of customers when they want to accept the final commissioning of this product. According to this, the risk priority of this failure evaluated by failure modes and effect analysis (FMEA) method to find out whether this failure is catastrophic for turbine performance and is harmful for humans. By using history of 110 gas turbines of this model which are used in some power plants, the severity number, occurrence number and detection number of failure determined and consequently the Risk Priority Number (RPN) of failure determined. Finally, critically matrix of potential failures is created and illustrated that failure modes are located in safe zone.

  19. [High Pressure Gas Tanks

    NASA Technical Reports Server (NTRS)

    Quintana, Rolando

    2002-01-01

    Four high-pressure gas tanks, the basis of this study, were especially made by a private contractor and tested before being delivered to NASA Kennedy Space Center. In order to insure 100% reliability of each individual tank the staff at KSC decided to again submit the four tanks under more rigorous tests. These tests were conducted during a period from April 10 through May 8 at KSC. This application further validates the predictive safety model for accident prevention and system failure in the testing of four high-pressure gas tanks at Kennedy Space Center, called Continuous Hazard Tracking and Failure Prediction Methodology (CHTFPM). It is apparent from the variety of barriers available for a hazard control that some barriers will be more successful than others in providing protection. In order to complete the Barrier Analysis of the system, a Task Analysis and a Biomechanical Study were performed to establish the relationship between the degree of biomechanical non-conformities and the anomalies found within the system on particular joints of the body. This relationship was possible to obtain by conducting a Regression Analysis to the previously generated data. From the information derived the body segment with the lowest percentage of non-conformities was the neck flexion with 46.7%. Intense analysis of the system was conducted including Preliminary Hazard Analysis (PHA), Failure Mode and Effect Analysis (FMEA), and Barrier Analysis. These analyses resulted in the identification of occurrences of conditions, which may be becoming hazardous in the given system. These conditions, known as dendritics, may become hazards and could result in an accident, system malfunction, or unacceptable risk conditions. A total of 56 possible dendritics were identified. Work sampling was performed to observe the occurrence each dendritic. The out of control points generated from a Weighted c control chart along with a Pareto analysis indicate that the dendritics "Personnel not

  20. Failure mode analysis of silicon-based intracortical microelectrode arrays in non-human primates

    PubMed Central

    Barrese, James C; Rao, Naveen; Paroo, Kaivon; Triebwasser, Corey; Vargas-Irwin, Carlos; Franquemont, Lachlan; Donoghue, John P

    2016-01-01

    Objective Brain–computer interfaces (BCIs) using chronically implanted intracortical microelectrode arrays (MEAs) have the potential to restore lost function to people with disabilities if they work reliably for years. Current sensors fail to provide reliably useful signals over extended periods of time for reasons that are not clear. This study reports a comprehensive retrospective analysis from a large set of implants of a single type of intracortical MEA in a single species, with a common set of measures in order to evaluate failure modes. Approach Since 1996, 78 silicon MEAs were implanted in 27 monkeys (Macaca mulatta). We used two approaches to find reasons for sensor failure. First, we classified the time course leading up to complete recording failure as acute (abrupt) or chronic (progressive). Second, we evaluated the quality of electrode recordings over time based on signal features and electrode impedance. Failure modes were divided into four categories: biological, material, mechanical, and unknown. Main results Recording duration ranged from 0 to 2104 days (5.75 years), with a mean of 387 days and a median of 182 days (n = 78). Sixty-two arrays failed completely with a mean time to failure of 332 days (median = 133 days) while nine array experiments were electively terminated for experimental reasons (mean = 486 days). Seven remained active at the close of this study (mean = 753 days). Most failures (56%) occurred within a year of implantation, with acute mechanical failures the most common class (48%), largely because of connector issues (83%). Among grossly observable biological failures (24%), a progressive meningeal reaction that separated the array from the parenchyma was most prevalent (14.5%). In the absence of acute interruptions, electrode recordings showed a slow progressive decline in spike amplitude, noise amplitude, and number of viable channels that predicts complete signal loss by about eight years. Impedance measurements showed

  1. Failure mode analysis of silicon-based intracortical microelectrode arrays in non-human primates

    NASA Astrophysics Data System (ADS)

    Barrese, James C.; Rao, Naveen; Paroo, Kaivon; Triebwasser, Corey; Vargas-Irwin, Carlos; Franquemont, Lachlan; Donoghue, John P.

    2013-12-01

    Objective. Brain-computer interfaces (BCIs) using chronically implanted intracortical microelectrode arrays (MEAs) have the potential to restore lost function to people with disabilities if they work reliably for years. Current sensors fail to provide reliably useful signals over extended periods of time for reasons that are not clear. This study reports a comprehensive retrospective analysis from a large set of implants of a single type of intracortical MEA in a single species, with a common set of measures in order to evaluate failure modes. Approach. Since 1996, 78 silicon MEAs were implanted in 27 monkeys (Macaca mulatta). We used two approaches to find reasons for sensor failure. First, we classified the time course leading up to complete recording failure as acute (abrupt) or chronic (progressive). Second, we evaluated the quality of electrode recordings over time based on signal features and electrode impedance. Failure modes were divided into four categories: biological, material, mechanical, and unknown. Main results. Recording duration ranged from 0 to 2104 days (5.75 years), with a mean of 387 days and a median of 182 days (n = 78). Sixty-two arrays failed completely with a mean time to failure of 332 days (median = 133 days) while nine array experiments were electively terminated for experimental reasons (mean = 486 days). Seven remained active at the close of this study (mean = 753 days). Most failures (56%) occurred within a year of implantation, with acute mechanical failures the most common class (48%), largely because of connector issues (83%). Among grossly observable biological failures (24%), a progressive meningeal reaction that separated the array from the parenchyma was most prevalent (14.5%). In the absence of acute interruptions, electrode recordings showed a slow progressive decline in spike amplitude, noise amplitude, and number of viable channels that predicts complete signal loss by about eight years. Impedance measurements showed

  2. Rapid repair of severely earthquake-damaged bridge piers with flexural-shear failure mode

    NASA Astrophysics Data System (ADS)

    Sun, Zhiguo; Wang, Dongsheng; Du, Xiuli; Si, Bingjun

    2011-12-01

    An experimental study was conducted to investigate the feasibility of a proposed rapid repair technique for severely earthquake-damaged bridge piers with flexural-shear failure mode. Six circular pier specimens were first tested to severe damage in flexural-shear mode and repaired using early-strength concrete with high-fluidity and carbon fiber reinforced polymers (CFRP). After about four days, the repaired specimens were tested to failure again. The seismic behavior of the repaired specimens was evaluated and compared to the original specimens. Test results indicate that the proposed repair technique is highly effective. Both shear strength and lateral displacement of the repaired piers increased when compared to the original specimens, and the failure mechanism of the piers shifted from flexural-shear failure to ductile flexural failure. Finally, a simple design model based on the Seible formulation for post-earthquake repair design was compared to the experimental results. It is concluded that the design equation for bridge pier strengthening before an earthquake could be applicable to seismic repairs after an earthquake if the shear strength contribution of the spiral bars in the repaired piers is disregarded and 1.5 times more FRP sheets is provided.

  3. Biomarkers of Myocardial Stress and Fibrosis as Predictors of Mode of Death in Patients with Chronic Heart Failure

    PubMed Central

    Ahmad, Tariq; Fiuzat, Mona; Neely, Ben; Neely, Megan; Pencina, Michael J.; Kraus, William E.; Zannad, Faiez; Whellan, David J.; Donahue, Mark; Piña, Ileana L.; Adams, Kirkwood; Kitzman, Dalane W.; O’Connor, Christopher M.; Felker, G. Michael

    2014-01-01

    Objective To determine whether biomarkers of myocardial stress and fibrosis improve prediction of mode of death in patients with chronic heart failure. Background The two most common modes of death in patients with chronic heart failure are pump failure and sudden cardiac death. Prediction of mode of death may facilitate treatment decisions. The relationship between NT-proBNP, galectin-3, and ST2, biomarkers that reflect different pathogenic pathways in heart failure (myocardial stress and fibrosis), and mode of death is unknown. Methods HF-ACTION was a randomized controlled trial of exercise training vs. usual care in patients with chronic heart failure due to left ventricular systolic dysfunction (LVEF<35%). An independent clinical events committee prospectively adjudicated mode of death. NT-proBNP, galectin-3, and ST2 levels were assessed at baseline in 813 subjects. Associations between biomarkers and mode of death were assessed using cause-specific Cox-proportional hazards modeling, and interaction testing was used to measure differential association between biomarkers and pump failure versus sudden cardiac death. Discrimination and risk reclassification metrics were used to assess the added value of galectin-3 and ST2 in predicting mode of death risk beyond a clinical model that included NT-proBNP. Results After a median follow up of 2.5 years, there were 155 deaths: 49 from pump failure 42 from sudden cardiac death, and 64 from other causes. Elevations in all biomarkers were associated with increased risk of both pump failure and sudden cardiac death in both adjusted and unadjusted analyses. In each case, increases in the biomarker had a stronger association with pump failure than sudden cardiac death but this relationship was attenuated after adjustment for clinical risk factors. Clinical variables along with NT-proBNP levels were stronger predictors of pump failure (C statistic: 0.87) than sudden cardiac death (C statistic: 0.73). Addition of ST2 and

  4. Metal Whiskers: Failure Modes and Mitigation Strategies

    NASA Technical Reports Server (NTRS)

    Brusse, Jay A.; Leidecker, Henning

    2007-01-01

    Metal coatings especially tin, zinc and cadmium are unpredictably susceptible to the formation of electrically conductive, crystalline filaments referred to as metal whiskers. The use of such coatings in and around electrical systems presents a risk of electrical shorting. Examples of metal whisker formation are shown with emphasis on optical inspection techniques to improve probability of detection. The failure modes (i.e., electrical shorting behavior) associated with metal whiskers are described. Based on an almost 9- year long study, the benefits of polyurethane conformal coat (namely, Arathane 5750) to protect electrical conductors from whisker-induced short circuit anomalies is discussed.

  5. Biomarkers of myocardial stress and fibrosis as predictors of mode of death in patients with chronic heart failure.

    PubMed

    Ahmad, Tariq; Fiuzat, Mona; Neely, Benjamin; Neely, Megan L; Pencina, Michael J; Kraus, William E; Zannad, Faiez; Whellan, David J; Donahue, Mark P; Piña, Ileana L; Adams, Kirkwood F; Kitzman, Dalane W; O'Connor, Christopher M; Felker, G Michael

    2014-06-01

    The aim of this study was to determine whether biomarkers of myocardial stress and fibrosis improve prediction of the mode of death in patients with chronic heart failure. The 2 most common modes of death in patients with chronic heart failure are pump failure and sudden cardiac death. Prediction of the mode of death may facilitate treatment decisions. The relationship between amino-terminal pro-brain natriuretic peptide (NT-proBNP), galectin-3, and ST2, biomarkers that reflect different pathogenic pathways in heart failure (myocardial stress and fibrosis), and mode of death is unknown. HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) was a randomized controlled trial of exercise training versus usual care in patients with chronic heart failure due to left ventricular systolic dysfunction (left ventricular ejection fraction ≤35%). An independent clinical events committee prospectively adjudicated mode of death. NT-proBNP, galectin-3, and ST2 levels were assessed at baseline in 813 subjects. Associations between biomarkers and mode of death were assessed using cause-specific Cox proportional hazards modeling, and interaction testing was used to measure differential associations between biomarkers and pump failure versus sudden cardiac death. Discrimination and risk reclassification metrics were used to assess the added value of galectin-3 and ST2 in predicting mode of death risk beyond a clinical model that included NT-proBNP. After a median follow-up period of 2.5 years, there were 155 deaths: 49 from pump failure, 42 from sudden cardiac death, and 64 from other causes. Elevations in all biomarkers were associated with increased risk for both pump failure and sudden cardiac death in both adjusted and unadjusted analyses. In each case, increases in the biomarker had a stronger association with pump failure than sudden cardiac death, but this relationship was attenuated after adjustment for clinical risk factors. Clinical

  6. Preliminary Failure Modes and Effects Analysis of the US DCLL Test Blanket Module

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Lee C. Cadwallader

    2010-06-01

    This report presents the results of a preliminary failure modes and effects analysis (FMEA) of a small tritium-breeding test blanket module design for the International Thermonuclear Experimental Reactor. The FMEA was quantified with “generic” component failure rate data, and the failure events are binned into postulated initiating event families and frequency categories for safety assessment. An appendix to this report contains repair time data to support an occupational radiation exposure assessment for test blanket module maintenance.

  7. Preliminary Failure Modes and Effects Analysis of the US DCLL Test Blanket Module

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Lee C. Cadwallader

    2007-08-01

    This report presents the results of a preliminary failure modes and effects analysis (FMEA) of a small tritium-breeding test blanket module design for the International Thermonuclear Experimental Reactor. The FMEA was quantified with “generic” component failure rate data, and the failure events are binned into postulated initiating event families and frequency categories for safety assessment. An appendix to this report contains repair time data to support an occupational radiation exposure assessment for test blanket module maintenance.

  8. 14 CFR 25.1015 - Oil tank tests.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Oil tank tests. 25.1015 Section 25.1015... STANDARDS: TRANSPORT CATEGORY AIRPLANES Powerplant Oil System § 25.1015 Oil tank tests. Each oil tank must be designed and installed so that— (a) It can withstand, without failure, each vibration, inertia...

  9. 14 CFR 29.1015 - Oil tank tests.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Oil tank tests. 29.1015 Section 29.1015... STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Powerplant Oil System § 29.1015 Oil tank tests. Each oil tank must be designed and installed so that— (a) It can withstand, without failure, any vibration, inertia, and...

  10. Quantitative Approach to Failure Mode and Effect Analysis for Linear Accelerator Quality Assurance

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    O'Daniel, Jennifer C., E-mail: jennifer.odaniel@duke.edu; Yin, Fang-Fang

    Purpose: To determine clinic-specific linear accelerator quality assurance (QA) TG-142 test frequencies, to maximize physicist time efficiency and patient treatment quality. Methods and Materials: A novel quantitative approach to failure mode and effect analysis is proposed. Nine linear accelerator-years of QA records provided data on failure occurrence rates. The severity of test failure was modeled by introducing corresponding errors into head and neck intensity modulated radiation therapy treatment plans. The relative risk of daily linear accelerator QA was calculated as a function of frequency of test performance. Results: Although the failure severity was greatest for daily imaging QA (imaging vsmore » treatment isocenter and imaging positioning/repositioning), the failure occurrence rate was greatest for output and laser testing. The composite ranking results suggest that performing output and lasers tests daily, imaging versus treatment isocenter and imaging positioning/repositioning tests weekly, and optical distance indicator and jaws versus light field tests biweekly would be acceptable for non-stereotactic radiosurgery/stereotactic body radiation therapy linear accelerators. Conclusions: Failure mode and effect analysis is a useful tool to determine the relative importance of QA tests from TG-142. Because there are practical time limitations on how many QA tests can be performed, this analysis highlights which tests are the most important and suggests the frequency of testing based on each test's risk priority number.« less

  11. WE-G-BRA-09: Microsphere Brachytherapy Failure Mode and Effects Analysis in a Dual-Vendor Environment

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Younge, K C; Lee, C I; Feng, M

    2015-06-15

    Purpose: To improve the safety and quality of a dual-vendor microsphere brachytherapy program with failure mode and effects analysis (FMEA). Methods: A multidisciplinary team including physicists, dosimetrists, a radiation oncologist, an interventional radiologist, and radiation safety personnel performed an FMEA for our dual-vendor microsphere brachytherapy program employing SIR-Spheres (Sirtex Medical Limited, Australia) and Theraspheres (BTG, England). We developed a program process tree and step-by-step instructions which were used to generate a comprehensive list of failure modes. These modes were then ranked according to severity, occurrence rate, and detectability. Risk priority numbers (RPNs) were calculated by multiplying these three scores together.more » Three different severity scales were created: one each for harmful effects to the patient, staff, or the institution. Each failure mode was ranked on one or more of these scales. Results: The group identified 164 failure modes for the microsphere program. 113 of these were ranked using the patient severity scale, 52 using the staff severity scale, and 50 using the institution severity scale. The highest ranked items on the patient severity scale were an error in the automated dosimetry worksheet (RPN = 297.5), and the incorrect target specified on the planning study (RPN = 135). Some failure modes ranked differently between vendors, especially those corresponding to dose vial preparation because of the different methods used. Based on our findings, we made several improvements to our QA program, including documentation to easily identify which product is being used, an additional hand calculation during planning, and reorganization of QA steps before treatment delivery. We will continue to periodically review and revise the FMEA. Conclusion: We have applied FMEA to our dual-vendor microsphere brachytherapy program to identify potential key weaknesses in the treatment chain. Our FMEA results were used

  12. Application of failure mode and effects analysis (FMEA) to pretreatment phases in tomotherapy

    PubMed Central

    Broggi, Sara; Cantone, Marie Claire; Chiara, Anna; Muzio, Nadia Di; Longobardi, Barbara; Mangili, Paola

    2013-01-01

    The aim of this paper was the application of the failure mode and effects analysis (FMEA) approach to assess the risks for patients undergoing radiotherapy treatments performed by means of a helical tomotherapy unit. FMEA was applied to the preplanning imaging, volume determination, and treatment planning stages of the tomotherapy process and consisted of three steps: 1) identification of the involved subprocesses; 2) identification and ranking of the potential failure modes, together with their causes and effects, using the risk probability number (RPN) scoring system; and 3) identification of additional safety measures to be proposed for process quality and safety improvement. RPN upper threshold for little concern of risk was set at 125. A total of 74 failure modes were identified: 38 in the stage of preplanning imaging and volume determination, and 36 in the stage of planning. The threshold of 125 for RPN was exceeded in four cases: one case only in the phase of preplanning imaging and volume determination, and three cases in the stage of planning. The most critical failures appeared related to (i) the wrong or missing definition and contouring of the overlapping regions, (ii) the wrong assignment of the overlap priority to each anatomical structure, (iii) the wrong choice of the computed tomography calibration curve for dose calculation, and (iv) the wrong (or not performed) choice of the number of fractions in the planning station. On the basis of these findings, in addition to the safety strategies already adopted in the clinical practice, novel solutions have been proposed for mitigating the risk of these failures and to increase patient safety. PACS number: 87.55.Qr PMID:24036868

  13. Application of failure mode and effects analysis (FMEA) to pretreatment phases in tomotherapy.

    PubMed

    Broggi, Sara; Cantone, Marie Claire; Chiara, Anna; Di Muzio, Nadia; Longobardi, Barbara; Mangili, Paola; Veronese, Ivan

    2013-09-06

    The aim of this paper was the application of the failure mode and effects analysis (FMEA) approach to assess the risks for patients undergoing radiotherapy treatments performed by means of a helical tomotherapy unit. FMEA was applied to the preplanning imaging, volume determination, and treatment planning stages of the tomotherapy process and consisted of three steps: 1) identification of the involved subprocesses; 2) identification and ranking of the potential failure modes, together with their causes and effects, using the risk probability number (RPN) scoring system; and 3) identification of additional safety measures to be proposed for process quality and safety improvement. RPN upper threshold for little concern of risk was set at 125. A total of 74 failure modes were identified: 38 in the stage of preplanning imaging and volume determination, and 36 in the stage of planning. The threshold of 125 for RPN was exceeded in four cases: one case only in the phase of preplanning imaging and volume determination, and three cases in the stage of planning. The most critical failures appeared related to (i) the wrong or missing definition and contouring of the overlapping regions, (ii) the wrong assignment of the overlap priority to each anatomical structure, (iii) the wrong choice of the computed tomography calibration curve for dose calculation, and (iv) the wrong (or not performed) choice of the number of fractions in the planning station. On the basis of these findings, in addition to the safety strategies already adopted in the clinical practice, novel solutions have been proposed for mitigating the risk of these failures and to increase patient safety.

  14. Degradation analysis of anode-supported intermediate temperature-solid oxide fuel cells under various failure modes

    NASA Astrophysics Data System (ADS)

    Lee, Tae-Hee; Park, Ka-Young; Kim, Ji-Tae; Seo, Yongho; Kim, Ki Buem; Song, Sun-Ju; Park, Byoungnam; Park, Jun-Young

    2015-02-01

    This study focuses on mechanisms and symptoms of several simulated failure modes, which may have significant influences on the long-term durability and operational stability of intermediate temperature-solid oxide fuel cells (IT-SOFCs), including fuel/oxidation starvation by breakdown of fuel/air supply components and wet and dry cycling atmospheres. Anode-supported IT-SOFCs consisting of a Ba0.5Sr0.5Co0.8Fe0.2O3-δ (BSCF)-Nd0.1Ce0.9O2-δ (NDC) composite cathode with an NDC electrolyte on a Ni-NDC anode substrate are fabricated via dry-pressings followed by the co-firing method. Comprehensive and systematic research based on the failure mode and effect analysis (FMEA) of anode-supported IT-SOFCs is conducted using various electrochemical and physiochemical analysis techniques to extend our understanding of the major mechanisms of performance deterioration under SOFC operating conditions. The fuel-starvation condition in the fuel-pump failure mode causes irreversible mechanical degradation of the electrolyte and cathode interface by the dimensional expansion of the anode support due to the oxidation of Ni metal to NiO. In contrast, the BSCF cathode shows poor stability under wet and dry cycling modes of cathode air due to the strong electroactivity of SrO with H2O. On the other hand, the air-depletion phenomena under air-pump failure mode results in the recovery of cell performance during the long-term operation without the visible microstructural transformation through the reduction of anode overvoltage.

  15. A Sliding Mode Controller Using Nonlinear Sliding Surface Improved With Fuzzy Logic: Application to the Coupled Tanks System

    NASA Astrophysics Data System (ADS)

    Boubakir, A.; Boudjema, F.; Boubakir, C.

    2008-06-01

    This paper proposes an approach of hybrid control that is based on the concept of combining fuzzy logic and the methodology of sliding mode control (SMC). In the present works, a first-order nonlinear sliding surface is presented, on which the developed control law is based. Mathematical proof for the stability and convergence of the system is presented. In order to reduce the chattering in sliding mode control, a fixed boundary layer around the switch surface is used. Within the boundary layer, since the fuzzy logic control is applied, the chattering phenomenon, which is inherent in a sliding mode control, is avoided by smoothing the switch signal. Outside the boundary, the sliding mode control is applied to driving the system states into the boundary layer. Experimental studies carried out on a coupled Tanks system indicate that the proposed fuzzy sliding mode control (FSMC) is a good candidate for control applications.

  16. Failure Modes in Capacitors When Tested Under a Time-Varying Stress

    NASA Technical Reports Server (NTRS)

    Liu, David (Donhang)

    2011-01-01

    Steady step surge testing (SSST) is widely applied to screen out potential power-on failures in solid tantalum capacitors. The test simulates the power supply's on and off characteristics. Power-on failure has been the prevalent failure mechanism for solid tantalum capacitors for decoupling applications. On the other hand, the SSST can also be reviewed as an electrically destructive test under a time-varying stress. It consists of rapidly charging the capacitor with incremental voltage increases, through a low resistance in series, until the capacitor under test is electrically shorted. Highly accelerated life testing (HALT) is usually a time-efficient method for determining the failure mechanism in capacitors; however, a destructive test under a time-varying stress like SSST is even more effective. It normally takes days to complete a HALT test, but it only takes minutes for a time-varying stress test to produce failures. The advantage of incorporating specific time-varying stress into a statistical model is significant in providing an alternative life test method for quickly revealing the failure modes in capacitors. In this paper, a time-varying stress has been incorporated into the Weibull model to characterize the failure modes. The SSST circuit and transient conditions to correctly test the capacitors is discussed. Finally, the SSST was applied for testing polymer aluminum capacitors (PA capacitors), Ta capacitors, and multi-layer ceramic capacitors with both precious metal electrode (PME) and base-metal-electrodes (BME). It appears that testing results are directly associated to the dielectric layer breakdown in PA and Ta capacitors and are independent on the capacitor values, the way the capacitors being built, and the manufactures. The testing results also reveal that ceramic capacitors exhibit breakdown voltages more than 20 times the rated voltage, and the breakdown voltages are inverse proportional to the dielectric layer thickness. The possibility of

  17. Failure mode and effects analysis based risk profile assessment for stereotactic radiosurgery programs at three cancer centers in Brazil.

    PubMed

    Teixeira, Flavia C; de Almeida, Carlos E; Saiful Huq, M

    2016-01-01

    The goal of this study was to evaluate the safety and quality management program for stereotactic radiosurgery (SRS) treatment processes at three radiotherapy centers in Brazil by using three industrial engineering tools (1) process mapping, (2) failure modes and effects analysis (FMEA), and (3) fault tree analysis. The recommendations of Task Group 100 of American Association of Physicists in Medicine were followed to apply the three tools described above to create a process tree for SRS procedure for each radiotherapy center and then FMEA was performed. Failure modes were identified for all process steps and values of risk priority number (RPN) were calculated from O, S, and D (RPN = O × S × D) values assigned by a professional team responsible for patient care. The subprocess treatment planning was presented with the highest number of failure modes for all centers. The total number of failure modes were 135, 104, and 131 for centers I, II, and III, respectively. The highest RPN value for each center is as follows: center I (204), center II (372), and center III (370). Failure modes with RPN ≥ 100: center I (22), center II (115), and center III (110). Failure modes characterized by S ≥ 7, represented 68% of the failure modes for center III, 62% for center II, and 45% for center I. Failure modes with RPNs values ≥100 and S ≥ 7, D ≥ 5, and O ≥ 5 were considered as high priority in this study. The results of the present study show that the safety risk profiles for the same stereotactic radiotherapy process are different at three radiotherapy centers in Brazil. Although this is the same treatment process, this present study showed that the risk priority is different and it will lead to implementation of different safety interventions among the centers. Therefore, the current practice of applying universal device-centric QA is not adequate to address all possible failures in clinical processes at different radiotherapy centers. Integrated approaches to

  18. Minimizing treatment planning errors in proton therapy using failure mode and effects analysis.

    PubMed

    Zheng, Yuanshui; Johnson, Randall; Larson, Gary

    2016-06-01

    Failure mode and effects analysis (FMEA) is a widely used tool to evaluate safety or reliability in conventional photon radiation therapy. However, reports about FMEA application in proton therapy are scarce. The purpose of this study is to apply FMEA in safety improvement of proton treatment planning at their center. The authors performed an FMEA analysis of their proton therapy treatment planning process using uniform scanning proton beams. The authors identified possible failure modes in various planning processes, including image fusion, contouring, beam arrangement, dose calculation, plan export, documents, billing, and so on. For each error, the authors estimated the frequency of occurrence, the likelihood of being undetected, and the severity of the error if it went undetected and calculated the risk priority number (RPN). The FMEA results were used to design their quality management program. In addition, the authors created a database to track the identified dosimetric errors. Periodically, the authors reevaluated the risk of errors by reviewing the internal error database and improved their quality assurance program as needed. In total, the authors identified over 36 possible treatment planning related failure modes and estimated the associated occurrence, detectability, and severity to calculate the overall risk priority number. Based on the FMEA, the authors implemented various safety improvement procedures into their practice, such as education, peer review, and automatic check tools. The ongoing error tracking database provided realistic data on the frequency of occurrence with which to reevaluate the RPNs for various failure modes. The FMEA technique provides a systematic method for identifying and evaluating potential errors in proton treatment planning before they result in an error in patient dose delivery. The application of FMEA framework and the implementation of an ongoing error tracking system at their clinic have proven to be useful in error

  19. Tensile and compressive failure modes of laminated composites loaded by fatigue with different mean stress

    NASA Technical Reports Server (NTRS)

    Rotem, Assa

    1990-01-01

    Laminated composite materials tend to fail differently under tensile or compressive load. Under tension, the material accumulates cracks and fiber fractures, while under compression, the material delaminates and buckles. Tensile-compressive fatigue may cause either of these failure modes depending on the specific damage occurring in the laminate. This damage depends on the stress ratio of the fatigue loading. Analysis of the fatigue behavior of the composite laminate under tension-tension, compression-compression, and tension-compression had led to the development of a fatigue envelope presentation of the failure behavior. This envelope indicates the specific failure mode for any stress ratio and number of loading cycles. The construction of the fatigue envelope is based on the applied stress-cycles to failure (S-N) curves of both tensile-tensile and compressive-compressive fatigue. Test results are presented to verify the theoretical analysis.

  20. Tank 241-AY-101 Privatization Push Mode Core Sampling and Analysis Plan

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    TEMPLETON, A.M.

    2000-01-12

    This sampling and analysis plan (SAP) identifies characterization objectives pertaining to sample collection, laboratory analytical evaluation, and reporting requirements for samples obtained from tank 241-AY-101. The purpose of this sampling event is to obtain information about the characteristics of the contents of 241-AY-101 required to satisfy Data Quality Objectives For RPP Privatization Phase I: Confirm Tank T Is An Appropriate Feed Source For High-Level Waste Feed Batch X(HLW DQO) (Nguyen 1999a), Data Quality Objectives For TWRS Privatization Phase I : Confirm Tank T Is An Appropriate Feed Source For Low-Activity Waste Feed Batch X (LAW DQO) (Nguyen 1999b), Low Activitymore » Waste and High-Level Waste Feed Data Quality Objectives (L and H DQO) (Patello et al. 1999), and Characterization Data Needs for Development, Design, and Operation of Retrieval Equipment Developed through the Data Quality Objective Process (Equipment DQO) (Bloom 1996). Special instructions regarding support to the LAW and HLW DQOs are provided by Baldwin (1999). Push mode core samples will be obtained from risers 15G and 150 to provide sufficient material for the chemical analyses and tests required to satisfy these data quality objectives. The 222-S Laboratory will extrude core samples; composite the liquids and solids; perform chemical analyses on composite and segment samples; archive half-segment samples; and provide subsamples to the Process Chemistry Laboratory. The Process Chemistry Laboratory will prepare test plans and perform process tests to evaluate the behavior of the 241-AY-101 waste undergoing the retrieval and treatment scenarios defined in the applicable DQOs. Requirements for analyses of samples originating in the process tests will be documented in the corresponding test plans and are not within the scope of this SAP.« less

  1. Tank 241-AY-101 Privatization Push Mode Core Sampling and Analysis Plan

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    TEMPLETON, A.M.

    2000-05-19

    This sampling and analysis plan (SAP) identifies characterization objectives pertaining to sample collection, laboratory analytical evaluation, and reporting requirements for samples obtained from tank 241-AY-101. The purpose of this sampling event is to obtain information about the characteristics of the contents of 241-AY-101 required to satisfy ''Data Quality Objectives For RPP Privatization Phase I: Confirm Tank T Is An Appropriate Feed Source For High-Level Waste Feed Batch X(HLW DQO)' (Nguyen 1999a), ''Data Quality Objectives For TWRS Privatization Phase I: Confirm Tank T Is An Appropriate Feed Source For Low-Activity Waste Feed Butch X (LAW DQO) (Nguyen 1999b)'', ''Low Activity Wastemore » and High-Level Waste Feed Data Quality Objectives (L&H DQO)'' (Patello et al. 1999), and ''Characterization Data Needs for Development, Design, and Operation of Retrieval Equipment Developed through the Data Quality Objective Process (Equipment DQO)'' (Bloom 1996). Special instructions regarding support to the LAW and HLW DQOs are provided by Baldwin (1999). Push mode core samples will be obtained from risers 15G and 150 to provide sufficient material for the chemical analyses and tests required to satisfy these data quality objectives. The 222-S Laboratory will extrude core samples; composite the liquids and solids; perform chemical analyses on composite and segment samples; archive half-segment samples; and provide sub-samples to the Process Chemistry Laboratory. The Process Chemistry Laboratory will prepare test plans and perform process tests to evaluate the behavior of the 241-AY-101 waste undergoing the retrieval and treatment scenarios defined in the applicable DQOs. Requirements for analyses of samples originating in the process tests will be documented in the corresponding test plans and are not within the scope of this SAP.« less

  2. Application of Failure Mode and Effects Analysis to Intraoperative Radiation Therapy Using Mobile Electron Linear Accelerators

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ciocca, Mario, E-mail: mario.ciocca@cnao.it; Cantone, Marie-Claire; Veronese, Ivan

    2012-02-01

    Purpose: Failure mode and effects analysis (FMEA) represents a prospective approach for risk assessment. A multidisciplinary working group of the Italian Association for Medical Physics applied FMEA to electron beam intraoperative radiation therapy (IORT) delivered using mobile linear accelerators, aiming at preventing accidental exposures to the patient. Methods and Materials: FMEA was applied to the IORT process, for the stages of the treatment delivery and verification, and consisted of three steps: 1) identification of the involved subprocesses; 2) identification and ranking of the potential failure modes, together with their causes and effects, using the risk probability number (RPN) scoring system,more » based on the product of three parameters (severity, frequency of occurrence and detectability, each ranging from 1 to 10); 3) identification of additional safety measures to be proposed for process quality and safety improvement. RPN upper threshold for little concern of risk was set at 125. Results: Twenty-four subprocesses were identified. Ten potential failure modes were found and scored, in terms of RPN, in the range of 42-216. The most critical failure modes consisted of internal shield misalignment, wrong Monitor Unit calculation and incorrect data entry at treatment console. Potential causes of failure included shield displacement, human errors, such as underestimation of CTV extension, mainly because of lack of adequate training and time pressures, failure in the communication between operators, and machine malfunctioning. The main effects of failure were represented by CTV underdose, wrong dose distribution and/or delivery, unintended normal tissue irradiation. As additional safety measures, the utilization of a dedicated staff for IORT, double-checking of MU calculation and data entry and finally implementation of in vivo dosimetry were suggested. Conclusions: FMEA appeared as a useful tool for prospective evaluation of patient safety in

  3. Long-term lumen depreciation behavior and failure modes of multi-die array LEDs

    NASA Astrophysics Data System (ADS)

    Jayawardena, Asiri; Marcus, Daniel; Prugue, Ximena; Narendran, Nadarajah

    2013-09-01

    One of the main advantages of multi-die array light-emitting diodes (LEDs) is their high flux density. However, a challenge for using such a product in lighting fixture applications is the heat density and the need for thermal management to keep the junction temperatures of all the dies low for long-term reliable performance. Ten multi-die LED array samples for each product from four different manufacturers were subjected to lumen maintenance testing (as described in IES-LM-80-08), and their resulting lumen depreciation and failure modes were studied. The products were tested at the maximum case (or pin) temperature reported by the respective manufacturer by appropriately powering the LEDs. In addition, three samples for each product from two different manufacturers were subjected to rapid thermal cycling, and the resulting lumen depreciation and failure modes were studied. The results showed that the exponential lumen decay model using long-term lumen maintenance data as recommended in IES TM-21 does not fit for all package types. The failure of a string of dies and single die failure in a string were observed in some of the packages.

  4. Assessment of the hydrogen external tank pressure decay anomaly on Space Transportation System (STS) 51-L

    NASA Technical Reports Server (NTRS)

    Buckley, Theresa M.

    1988-01-01

    Following the Challenger tragedy, an evaluation of the integrated main propulsion system flight data revealed a premature decay in the hydrogen external tank ullage pressure. A reconstruction of predicted ullage pressure versus time indicated an inconsistency between predicted and measured ullage pressure starting at approximately 65.5 seconds into the flight and reaching a maximum value between 72 and 72.9 seconds. This discrepancy could have been caused by a hydrogen gas leak or by a liquied hydrogen leak that occurred either in the pressurization system or in the external tank. The corresponding leak rates over the time interval from 65.5 to 72.9 seconds were estimated to range from 0.28 kg/s (0.62 lbm/s) + or - 41 percent to between 0.43 and 0.51kg/s (0.94 and 1.12lbs/s) + or - 1 percent for a gas leak and from 72.9 kg/s (160.5 lbs/s) + or - 41 percent to between 111.6 and 133.2 kg/s (245.8 and 293.3 lbs/s) + or - 1 percent for a liquid leak. No speculation is made to ascertain whether the leak is liquid or gas, as this cannot be determined from the analysis performed. Four structural failures in the hydrogen external tank were considered to explain the leak rates. A break in the 5-cm (2 in) pressurization line, in the 13-cm (5 in) vent line, or in the 43-cm (17 in) feedline is not likely. A break in the 10-cm (4 in) recirculation line with a larger structural failure occurring in the 72 to 73-second time period, the time of the visibly identified premature pressure decay, does seem plausible and the most likely of the four modes considered. These modes are not all-inclusive and do not preclude the possibility of a leak elsewhere in the tank.

  5. Failure modes and conditions of a cohesive, spherical body due to YORP spin-up

    NASA Astrophysics Data System (ADS)

    Hirabayashi, Masatoshi

    2015-12-01

    This paper presents transition of the failure mode of a cohesive, spherical body due to The Yarkovsky-O'Keefe-Radzievskii-Paddack (YORP) spin-up. On the assumption that the distribution of materials in the body is homogeneous, failed regions first appearing in the body at different spin rates are predicted by comparing the yield condition of an elastic stress in the body. It is found that as the spin rate increases, the locations of the failed regions move from the equatorial surface to the central region. To avoid such failure modes, the body should have higher cohesive strength. The results by this model are consistent with those by a plastic finite element model. Then, this model and a two-layered-cohesive model first proposed by Hirabayashi et al. are used to classify possible evolution and disruption of a spherical body. There are three possible pathways to disruption. First, because of a strong structure, failure of the central region is dominant and eventually leads to a breakup into multiple components. Secondly, a weak surface and a weak interior make the body oblate. Thirdly, a strong internal core prevents the body from failing and only allows surface shedding. This implies that observed failure modes may highly depend on the internal structure of an asteroid, which could provide crucial information for giving constraints on the physical properties.

  6. Ultimate strength analysis of inland tank barges

    DOT National Transportation Integrated Search

    1997-06-16

    In an effort to understand the cause of recent catastrophic failures of inland tank barges and reduce the possibility of future casualties, the Coast Guard Marine Safety Center (MSC) studied the buckling" phenomenon. In conclusion, inland tank barges...

  7. Use of failure mode effect analysis (FMEA) to improve medication management process.

    PubMed

    Jain, Khushboo

    2017-03-13

    Purpose Medication management is a complex process, at high risk of error with life threatening consequences. The focus should be on devising strategies to avoid errors and make the process self-reliable by ensuring prevention of errors and/or error detection at subsequent stages. The purpose of this paper is to use failure mode effect analysis (FMEA), a systematic proactive tool, to identify the likelihood and the causes for the process to fail at various steps and prioritise them to devise risk reduction strategies to improve patient safety. Design/methodology/approach The study was designed as an observational analytical study of medication management process in the inpatient area of a multi-speciality hospital in Gurgaon, Haryana, India. A team was made to study the complex process of medication management in the hospital. FMEA tool was used. Corrective actions were developed based on the prioritised failure modes which were implemented and monitored. Findings The percentage distribution of medication errors as per the observation made by the team was found to be maximum of transcription errors (37 per cent) followed by administration errors (29 per cent) indicating the need to identify the causes and effects of their occurrence. In all, 11 failure modes were identified out of which major five were prioritised based on the risk priority number (RPN). The process was repeated after corrective actions were taken which resulted in about 40 per cent (average) and around 60 per cent reduction in the RPN of prioritised failure modes. Research limitations/implications FMEA is a time consuming process and requires a multidisciplinary team which has good understanding of the process being analysed. FMEA only helps in identifying the possibilities of a process to fail, it does not eliminate them, additional efforts are required to develop action plans and implement them. Frank discussion and agreement among the team members is required not only for successfully conducing

  8. Application of failure mode and effects analysis to treatment planning in scanned proton beam radiotherapy

    PubMed Central

    2013-01-01

    Background A multidisciplinary and multi-institutional working group applied the Failure Mode and Effects Analysis (FMEA) approach to the actively scanned proton beam radiotherapy process implemented at CNAO (Centro Nazionale di Adroterapia Oncologica), aiming at preventing accidental exposures to the patient. Methods FMEA was applied to the treatment planning stage and consisted of three steps: i) identification of the involved sub-processes; ii) identification and ranking of the potential failure modes, together with their causes and effects, using the risk probability number (RPN) scoring system, iii) identification of additional safety measures to be proposed for process quality and safety improvement. RPN upper threshold for little concern of risk was set at 125. Results Thirty-four sub-processes were identified, twenty-two of them were judged to be potentially prone to one or more failure modes. A total of forty-four failure modes were recognized, 52% of them characterized by an RPN score equal to 80 or higher. The threshold of 125 for RPN was exceeded in five cases only. The most critical sub-process appeared related to the delineation and correction of artefacts in planning CT data. Failures associated to that sub-process were inaccurate delineation of the artefacts and incorrect proton stopping power assignment to body regions. Other significant failure modes consisted of an outdated representation of the patient anatomy, an improper selection of beam direction and of the physical beam model or dose calculation grid. The main effects of these failures were represented by wrong dose distribution (i.e. deviating from the planned one) delivered to the patient. Additional strategies for risk mitigation, easily and immediately applicable, consisted of a systematic information collection about any known implanted prosthesis directly from each patient and enforcing a short interval time between CT scan and treatment start. Moreover, (i) the investigation of

  9. Folded fabric tunes rock deformation and failure mode in the upper crust.

    PubMed

    Agliardi, F; Dobbs, M R; Zanchetta, S; Vinciguerra, S

    2017-11-10

    The micro-mechanisms of brittle failure affect the bulk mechanical behaviour and permeability of crustal rocks. In low-porosity crystalline rocks, these mechanisms are related to mineralogy and fabric anisotropy, while confining pressure, temperature and strain rates regulate the transition from brittle to ductile behaviour. However, the effects of folded anisotropic fabrics, widespread in orogenic settings, on the mechanical behaviour of crustal rocks are largely unknown. Here we explore the deformation and failure behaviour of a representative folded gneiss, by combining the results of triaxial deformation experiments carried out while monitoring microseismicity with microstructural and damage proxies analyses. We show that folded crystalline rocks in upper crustal conditions exhibit dramatic strength heterogeneity and contrasting failure modes at identical confining pressure and room temperature, depending on the geometrical relationships between stress and two different anisotropies associated to the folded rock fabric. These anisotropies modulate the competition among quartz- and mica-dominated microscopic damage processes, resulting in transitional brittle to semi-brittle modes under P and T much lower than expected. This has significant implications on scales relevant to seismicity, energy resources, engineering applications and geohazards.

  10. A novel approach for evaluating the risk of health care failure modes.

    PubMed

    Chang, Dong Shang; Chung, Jenq Hann; Sun, Kuo Lung; Yang, Fu Chiang

    2012-12-01

    Failure mode and effects analysis (FMEA) can be employed to reduce medical errors by identifying the risk ranking of the health care failure modes and taking priority action for safety improvement. The purpose of this paper is to propose a novel approach of data analysis. The approach is to integrate FMEA and a mathematical tool-Data envelopment analysis (DEA) with "slack-based measure" (SBM), in the field of data analysis. The risk indexes (severity, occurrence, and detection) of FMEA are viewed as multiple inputs of DEA. The practicality and usefulness of the proposed approach is illustrated by one case of health care. Being a systematic approach for improving the service quality of health care, the approach can offer quantitative corrective information of risk indexes that thereafter reduce failure possibility. For safety improvement, these new targets of the risk indexes could be used for management by objectives. But FMEA cannot provide quantitative corrective information of risk indexes. The novel approach can surely overcome this chief shortcoming of FMEA. After combining DEA SBM model with FMEA, the two goals-increase of patient safety, medical cost reduction-can be together achieved.

  11. Use of failure mode, effect and criticality analysis to improve safety in the medication administration process.

    PubMed

    Rodriguez-Gonzalez, Carmen Guadalupe; Martin-Barbero, Maria Luisa; Herranz-Alonso, Ana; Durango-Limarquez, Maria Isabel; Hernandez-Sampelayo, Paloma; Sanjurjo-Saez, Maria

    2015-08-01

    To critically evaluate the causes of preventable adverse drug events during the nurse medication administration process in inpatient units with computerized prescription order entry and profiled automated dispensing cabinets in order to prioritize interventions that need to be implemented and to evaluate the impact of specific interventions on the criticality index. This is a failure mode, effects and criticality analysis (FMECA) study. A multidisciplinary consensus committee composed of pharmacists, nurses and doctors evaluated the process of administering medications in a hospital setting in Spain. By analysing the process, all failure modes were identified and criticality was determined by rating severity, frequency and likelihood of failure detection on a scale of 1 to 10, using adapted versions of already published scales. Safety strategies were identified and prioritized. Through consensus, the committee identified eight processes and 40 failure modes, of which 20 were classified as high risk. The sum of the criticality indices was 5254. For the potential high-risk failure modes, 21 different potential causes were found resulting in 24 recommendations. Thirteen recommendations were prioritized and developed over a 24-month period, reducing total criticality from 5254 to 3572 (a 32.0% reduction). The recommendations with a greater impact on criticality were the development of an electronic medication administration record (-582) and the standardization of intravenous drug compounding in the unit (-168). Other improvements, such as barcode medication administration technology (-1033), were scheduled for a longer period of time because of lower feasibility. FMECA is a useful approach that can improve the medication administration process. © 2015 John Wiley & Sons, Ltd.

  12. SU-E-T-421: Failure Mode and Effects Analysis (FMEA) of Xoft Electronic Brachytherapy for the Treatment of Superficial Skin Cancers

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Hoisak, J; Manger, R; Dragojevic, I

    Purpose: To perform a failure mode and effects analysis (FMEA) of the process for treating superficial skin cancers with the Xoft Axxent electronic brachytherapy (eBx) system, given the recent introduction of expanded quality control (QC) initiatives at our institution. Methods: A process map was developed listing all steps in superficial treatments with Xoft eBx, from the initial patient consult to the completion of the treatment course. The process map guided the FMEA to identify the failure modes for each step in the treatment workflow and assign Risk Priority Numbers (RPN), calculated as the product of the failure mode’s probability ofmore » occurrence (O), severity (S) and lack of detectability (D). FMEA was done with and without the inclusion of recent QC initiatives such as increased staffing, physics oversight, standardized source calibration, treatment planning and documentation. The failure modes with the highest RPNs were identified and contrasted before and after introduction of the QC initiatives. Results: Based on the FMEA, the failure modes with the highest RPN were related to source calibration, treatment planning, and patient setup/treatment delivery (Fig. 1). The introduction of additional physics oversight, standardized planning and safety initiatives such as checklists and time-outs reduced the RPNs of these failure modes. High-risk failure modes that could be mitigated with improved hardware and software interlocks were identified. Conclusion: The FMEA analysis identified the steps in the treatment process presenting the highest risk. The introduction of enhanced QC initiatives mitigated the risk of some of these failure modes by decreasing their probability of occurrence and increasing their detectability. This analysis demonstrates the importance of well-designed QC policies, procedures and oversight in a Xoft eBx programme for treatment of superficial skin cancers. Unresolved high risk failure modes highlight the need for non

  13. Using the failure mode and effects analysis model to improve parathyroid hormone and adrenocorticotropic hormone testing

    PubMed Central

    Magnezi, Racheli; Hemi, Asaf; Hemi, Rina

    2016-01-01

    Background Risk management in health care systems applies to all hospital employees and directors as they deal with human life and emergency routines. There is a constant need to decrease risk and increase patient safety in the hospital environment. The purpose of this article is to review the laboratory testing procedures for parathyroid hormone and adrenocorticotropic hormone (which are characterized by short half-lives) and to track failure modes and risks, and offer solutions to prevent them. During a routine quality improvement review at the Endocrine Laboratory in Tel Hashomer Hospital, we discovered these tests are frequently repeated unnecessarily due to multiple failures. The repetition of the tests inconveniences patients and leads to extra work for the laboratory and logistics personnel as well as the nurses and doctors who have to perform many tasks with limited resources. Methods A team of eight staff members accompanied by the Head of the Endocrine Laboratory formed the team for analysis. The failure mode and effects analysis model (FMEA) was used to analyze the laboratory testing procedure and was designed to simplify the process steps and indicate and rank possible failures. Results A total of 23 failure modes were found within the process, 19 of which were ranked by level of severity. The FMEA model prioritizes failures by their risk priority number (RPN). For example, the most serious failure was the delay after the samples were collected from the department (RPN =226.1). Conclusion This model helped us to visualize the process in a simple way. After analyzing the information, solutions were proposed to prevent failures, and a method to completely avoid the top four problems was also developed. PMID:27980440

  14. SU-E-T-420: Failure Effects Mode Analysis for Trigeminal Neuralgia Frameless Radiosurgery

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Howe, J

    2015-06-15

    Purpose: Functional radiosurgery has been used successfully in the treatment of trigeminal neuralgia but presents significant challenges to ensuring the high prescription dose is delivered accurately. A review of existing practice should help direct the focus of quality improvement for this treatment regime. Method: Failure modes and effects analysis was used to identify the processes in preparing radiosurgery treatment for TN. The map was developed by a multidisciplinary team including: neurosurgeon, radiation oncology, physicist and therapist. Potential failure modes were identified for each step in the process map as well as potential causes and end effect. A risk priority numbermore » was assigned to each cause. Results: The process map identified 66 individual steps (see attached supporting document). Corrective actions were developed for areas of high risk priority number. Wrong site treatment is at higher risk for trigeminal neuralgia treatment due to the lack of site specific pathologic imaging on MR and CT – additional site specific checks were implemented to minimize the risk of wrong site treatment. Failed collision checks resulted from an insufficient collision model in the treatment planning system and a plan template was developed to address this problem. Conclusion: Failure modes and effects analysis is an effective tool for developing quality improvement in high risk radiotherapy procedures such as functional radiosurgery.« less

  15. Medium Fidelity Simulation of Oxygen Tank Venting

    NASA Technical Reports Server (NTRS)

    Sweet, Adam; Kurien, James; Lau, Sonie (Technical Monitor)

    2001-01-01

    The item to he cleared is a medium-fidelity software simulation model of a vented cryogenic tank. Such tanks are commonly used to transport cryogenic liquids such as liquid oxygen via truck, and have appeared on liquid-fueled rockets for decades. This simulation model works with the HCC simulation system that was developed by Xerox PARC and NASA Ames Research Center. HCC has been previously cleared for distribution. When used with the HCC software, the model generates simulated readings for the tank pressure and temperature as the simulated cryogenic liquid boils off and is vented. Failures (such as a broken vent valve) can be injected into the simulation to produce readings corresponding to the failure. Release of this simulation will allow researchers to test their software diagnosis systems by attempting to diagnose the simulated failure from the simulated readings. This model does not contain any encryption software nor can it perform any control tasks that might be export controlled.

  16. Minimizing treatment planning errors in proton therapy using failure mode and effects analysis

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Zheng, Yuanshui, E-mail: yuanshui.zheng@okc.procure.com; Johnson, Randall; Larson, Gary

    Purpose: Failure mode and effects analysis (FMEA) is a widely used tool to evaluate safety or reliability in conventional photon radiation therapy. However, reports about FMEA application in proton therapy are scarce. The purpose of this study is to apply FMEA in safety improvement of proton treatment planning at their center. Methods: The authors performed an FMEA analysis of their proton therapy treatment planning process using uniform scanning proton beams. The authors identified possible failure modes in various planning processes, including image fusion, contouring, beam arrangement, dose calculation, plan export, documents, billing, and so on. For each error, the authorsmore » estimated the frequency of occurrence, the likelihood of being undetected, and the severity of the error if it went undetected and calculated the risk priority number (RPN). The FMEA results were used to design their quality management program. In addition, the authors created a database to track the identified dosimetric errors. Periodically, the authors reevaluated the risk of errors by reviewing the internal error database and improved their quality assurance program as needed. Results: In total, the authors identified over 36 possible treatment planning related failure modes and estimated the associated occurrence, detectability, and severity to calculate the overall risk priority number. Based on the FMEA, the authors implemented various safety improvement procedures into their practice, such as education, peer review, and automatic check tools. The ongoing error tracking database provided realistic data on the frequency of occurrence with which to reevaluate the RPNs for various failure modes. Conclusions: The FMEA technique provides a systematic method for identifying and evaluating potential errors in proton treatment planning before they result in an error in patient dose delivery. The application of FMEA framework and the implementation of an ongoing error tracking system at

  17. Recent Advances In Structural Vibration And Failure Mode Control In Mainland China: Theory, Experiments And Applications

    NASA Astrophysics Data System (ADS)

    Li, Hui; Ou, Jinping

    2008-07-01

    A number of researchers have been focused on structural vibration control in the past three decades over the world and fruit achievements have been made. This paper introduces the recent advances in structural vibration control including passive, active and semiactive control in mainland China. Additionally, the co-author extends the structural vibration control to failure mode control. The research on the failure mode control is also involved in this paper. For passive control, this paper introduces full scale tests of buckling-restrained braces conducted to investigate the performance of the dampers and the second-editor of the Code of Seismic Design for Buildings. For active control, this paper introduces the HMD system for wind-induced vibration control of the Guangzhou TV tower. For semiactive control, the smart damping devices, algorithms for semi-active control, design methods and applications of semi-active control for structures are introduced in this paper. The failure mode control for bridges is also introduced.

  18. Interface failure modes explain non-monotonic size-dependent mechanical properties in bioinspired nanolaminates.

    PubMed

    Song, Z Q; Ni, Y; Peng, L M; Liang, H Y; He, L H

    2016-03-31

    Bioinspired discontinuous nanolaminate design becomes an efficient way to mitigate the strength-ductility tradeoff in brittle materials via arresting the crack at the interface followed by controllable interface failure. The analytical solution and numerical simulation based on the nonlinear shear-lag model indicates that propagation of the interface failure can be unstable or stable when the interfacial shear stress between laminae is uniform or highly localized, respectively. A dimensionless key parameter defined by the ratio of two characteristic lengths governs the transition between the two interface-failure modes, which can explain the non-monotonic size-dependent mechanical properties observed in various laminate composites.

  19. Failure modes and materials design for biomechanical layer structures

    NASA Astrophysics Data System (ADS)

    Deng, Yan

    Ceramic materials are finding increasing usage in the area of biomechanical replacements---dental crowns, hip and bone implants, etc.---where strength, wear resistance, biocompatibility, chemical durability and even aesthetics are critical issues. Aesthetic ceramic crowns have been widely used in dentistry to replace damaged or missing teeth. However, the failure rates of ceramic crowns, especially all-ceramic crowns, can be 1%˜6% per year, which is not satisfactory to patients. The materials limitations and underlying fracture mechanisms of these prostheses are not well understood. In this thesis, fundamental fracture and damage mechanisms in model dental bilayer and trilayer structures are studied. Principle failure modes are identified from in situ experimentation and confirmed by fracture mechanics analysis. In bilayer structures of ceramic/polycarbonate (representative of ceramic crown/dentin structure), three major damage sources are identified: (i) top-surface cone cracks or (ii) quasiplasticity, dominating in thick ceramic bilayers; (iii) bottom-surface radial cracks, dominating in thin ceramic bilayers. Critical load P for each damage mode are measured in six dental ceramics: Y-TZP zirconia, glass-infiltrated zirconia and alumina (InCeram), glass-ceramic (Empress II), Porcelain (Mark II and Empress) bonded to polymer substrates, as a function of ceramic thickness d in the range of 100 mum to 10 mm. P is found independent of d for mode (i) and (ii), but has a d 2 relations for mode (iii)---bottom surface radial cracking. In trilayer structures of glass/core-ceramic/polycarbonate (representing veneer porcelain/core/dentin structures), three inner fracture origins are identified: radial cracks from the bottom surface in the (i) first and (ii) second layers; and (iii) quasiplasticity in core-ceramic layer. The role of relative veneer/core thickness, d1/d 2 and materials properties is investigated for three core materials with different modulus (114--270GPa

  20. Compatibility of the Radio Frequency Mass Gauge with Composite Tanks

    NASA Technical Reports Server (NTRS)

    Zimmerli, Greg; Mueller, Carl

    2015-01-01

    The radio frequency mass gauge (RFMG) is a low-gravity propellant quantity gauge being developed at NASA for possible use in long-duration space missions utilizing cryogenic propellants. As part of the RFMG technology development process, we evaluated the compatibility of the RFMG with a graphite-epoxy composite material used to construct propellant tanks. The key material property that can affect compatibility with the RFMG is the electrical conductivity. Using samples of 8552IM7 graphite-epoxy composite, we characterized the resistivity and reflectivity over a range of frequencies. An RF impedance analyzer was used to characterize the out-of-plane electrical properties (along the sample thickness) in the frequency range 10 to 1800 MHZ. The resistivity value at 500 MHz was 4.8 ohm-cm. Microwave waveguide measurements of samples in the range 1.7 2.6 GHz, performed by inserting the samples into a WR-430 waveguide, showed reflectivity values above 98. Together, these results suggested that a tank constructed from graphite-epoxy composite would produce good quality electromagnetic tank modes, which is needed for the RFMG. This was verified by room-temperature measurements of the electromagnetic modes of a 2.4 m diameter tank constructed by Boeing from similar graphite-epoxy composite material. The quality factor Q of the tank electromagnetic modes, measured via RF reflection measurements from an antenna mounted in the tank, was typically in the range 400 Q 3000. The good quality modes observed in the tank indicate that the RFMG is compatible with graphite-epoxy tanks, and thus the RFMG could be used as a low-gravity propellant quantity gauge in such tanks filled with cryogenic propellants.

  1. Some failure modes and analysis techniques for terrestrial solar cell modules

    NASA Technical Reports Server (NTRS)

    Shumka, A.; Stern, K. H.

    1978-01-01

    Analysis data are presented on failed/defective silicon solar cell modules of various types and produced by different manufacturers. The failure mode (e.g., internal short and open circuits, output power degradation, isolation resistance degradation, etc.) are discussed in detail and in many cases related to the type of technology used in the manufacture of the modules; wherever applicable, appropriate corrective actions are recommended. Consideration is also given to some failure analysis techniques that are applicable to such modules, including X-ray radiography, capacitance measurement, cell shunt resistance measurement by the shadowing technique, steady-state illumination test station for module performance illumination, laser scanning techniques, and the SEM.

  2. Fracture Resistance and Mode of Failure of Ceramic versus Titanium Implant Abutments and Single Implant-Supported Restorations.

    PubMed

    Sghaireen, Mohd G

    2015-06-01

    The material of choice for implant-supported restorations is affected by esthetic requirements and type of abutment. This study compares the fracture resistance of different types of implant abutments and implant-supported restorations and their mode of failure. Forty-five Oraltronics Pitt-Easy implants (Oraltronics Dental Implant Technology GmbH, Bremen, Germany) (4 mm diameter, 10 mm length) were embedded in clear autopolymerizing acrylic resin. The implants were randomly divided into three groups, A, B and C, of 15 implants each. In group A, titanium abutments and metal-ceramic crowns were used. In group B, zirconia ceramic abutments and In-Ceram Alumina crowns were used. In group C, zirconia ceramic abutments and IPS Empress Esthetic crowns were used. Specimens were tested to failure by applying load at 130° from horizontal plane using an Instron Universal Testing Machine. Subsequently, the mode of failure of each specimen was identified. Fracture resistance was significantly different between groups (p < .05). The highest fracture loads were associated with metal-ceramic crowns supported by titanium abutments (p = .000). IPS Empress crowns supported by zirconia abutments had the lowest fracture loads (p = .000). Fracture modes of metal-ceramic crowns supported by titanium abutments included screw fracture and screw bending. Fracture of both crown and abutment was the dominant mode of failure of In-Ceram/IPS Empress crowns supported by zirconia abutments. Metal-ceramic crowns supported by titanium abutments were more resistant to fracture than In-Ceram crowns supported by zirconia abutments, which in turn were more resistant to fracture than IPS Empress crowns supported by zirconia abutments. In addition, failure modes of restorations supported by zirconia abutments were more catastrophic than those for restorations supported by titanium abutments. © 2013 Wiley Periodicals, Inc.

  3. Failure mode and effects analysis outputs: are they valid?

    PubMed Central

    2012-01-01

    Background Failure Mode and Effects Analysis (FMEA) is a prospective risk assessment tool that has been widely used within the aerospace and automotive industries and has been utilised within healthcare since the early 1990s. The aim of this study was to explore the validity of FMEA outputs within a hospital setting in the United Kingdom. Methods Two multidisciplinary teams each conducted an FMEA for the use of vancomycin and gentamicin. Four different validity tests were conducted: · Face validity: by comparing the FMEA participants’ mapped processes with observational work. · Content validity: by presenting the FMEA findings to other healthcare professionals. · Criterion validity: by comparing the FMEA findings with data reported on the trust’s incident report database. · Construct validity: by exploring the relevant mathematical theories involved in calculating the FMEA risk priority number. Results Face validity was positive as the researcher documented the same processes of care as mapped by the FMEA participants. However, other healthcare professionals identified potential failures missed by the FMEA teams. Furthermore, the FMEA groups failed to include failures related to omitted doses; yet these were the failures most commonly reported in the trust’s incident database. Calculating the RPN by multiplying severity, probability and detectability scores was deemed invalid because it is based on calculations that breach the mathematical properties of the scales used. Conclusion There are significant methodological challenges in validating FMEA. It is a useful tool to aid multidisciplinary groups in mapping and understanding a process of care; however, the results of our study cast doubt on its validity. FMEA teams are likely to need different sources of information, besides their personal experience and knowledge, to identify potential failures. As for FMEA’s methodology for scoring failures, there were discrepancies between the teams’ estimates

  4. Failure mode and effects analysis outputs: are they valid?

    PubMed

    Shebl, Nada Atef; Franklin, Bryony Dean; Barber, Nick

    2012-06-10

    Failure Mode and Effects Analysis (FMEA) is a prospective risk assessment tool that has been widely used within the aerospace and automotive industries and has been utilised within healthcare since the early 1990s. The aim of this study was to explore the validity of FMEA outputs within a hospital setting in the United Kingdom. Two multidisciplinary teams each conducted an FMEA for the use of vancomycin and gentamicin. Four different validity tests were conducted: Face validity: by comparing the FMEA participants' mapped processes with observational work. Content validity: by presenting the FMEA findings to other healthcare professionals. Criterion validity: by comparing the FMEA findings with data reported on the trust's incident report database. Construct validity: by exploring the relevant mathematical theories involved in calculating the FMEA risk priority number. Face validity was positive as the researcher documented the same processes of care as mapped by the FMEA participants. However, other healthcare professionals identified potential failures missed by the FMEA teams. Furthermore, the FMEA groups failed to include failures related to omitted doses; yet these were the failures most commonly reported in the trust's incident database. Calculating the RPN by multiplying severity, probability and detectability scores was deemed invalid because it is based on calculations that breach the mathematical properties of the scales used. There are significant methodological challenges in validating FMEA. It is a useful tool to aid multidisciplinary groups in mapping and understanding a process of care; however, the results of our study cast doubt on its validity. FMEA teams are likely to need different sources of information, besides their personal experience and knowledge, to identify potential failures. As for FMEA's methodology for scoring failures, there were discrepancies between the teams' estimates and similar incidents reported on the trust's incident

  5. Failure Mode and Effect Analysis for Delivery of Lung Stereotactic Body Radiation Therapy

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Perks, Julian R., E-mail: julian.perks@ucdmc.ucdavis.edu; Stanic, Sinisa; Stern, Robin L.

    2012-07-15

    Purpose: To improve the quality and safety of our practice of stereotactic body radiation therapy (SBRT), we analyzed the process following the failure mode and effects analysis (FMEA) method. Methods: The FMEA was performed by a multidisciplinary team. For each step in the SBRT delivery process, a potential failure occurrence was derived and three factors were assessed: the probability of each occurrence, the severity if the event occurs, and the probability of detection by the treatment team. A rank of 1 to 10 was assigned to each factor, and then the multiplied ranks yielded the relative risks (risk priority numbers).more » The failure modes with the highest risk priority numbers were then considered to implement process improvement measures. Results: A total of 28 occurrences were derived, of which nine events scored with significantly high risk priority numbers. The risk priority numbers of the highest ranked events ranged from 20 to 80. These included transcription errors of the stereotactic coordinates and machine failures. Conclusion: Several areas of our SBRT delivery were reconsidered in terms of process improvement, and safety measures, including treatment checklists and a surgical time-out, were added for our practice of gantry-based image-guided SBRT. This study serves as a guide for other users of SBRT to perform FMEA of their own practice.« less

  6. Testing and recommended practices to improve nurse tank safety, phase I.

    DOT National Transportation Integrated Search

    2013-10-01

    This research project studied causes and possible remediation inspection strategies to prevent failures for anhydrous ammonia (NH3) nurse tanks. Nurse tanks are steel tanks used to transport NH3 locally over public roadways and farm fields. Many of t...

  7. Testing and Recommended Practices to Improve Nurse Tank Safety, Phase I

    DOT National Transportation Integrated Search

    2013-10-01

    This research project studied causes and possible remediation inspection strategies to prevent failures for anhydrous ammonia (NH3) nurse tanks. Nurse tanks are steel tanks used to transport NH3 locally over public roadways and farm fields. Many of t...

  8. How to make the most of failure mode and effect analysis.

    PubMed

    Stalhandske, Erik; DeRosier, Joseph; Patail, Bryanne; Gosbee, John

    2003-01-01

    Current accreditation standards issued by the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) require hospitals to carry out a proactive risk assessment on at least 1 high-risk activity each year for each accredited program. Because hospital risk managers and patient safety managers generally do not have the knowledge or level of comfort for conducting a proactive risk assessment, they will appreciate the expertise offered by biomedical equipment technicians (BMETs), occupational safety and health professionals, and others. The skills that have been developed by BMETs and others while conducting job safety analyses or failure mode effect analysis can now be applied to a health care proactive analysis. This article touches on the Health Care Failure Mode and Effect Analysis (HFMEA) model that the Department of Veterans Affairs (VA) National Center for Patient Safety developed for proactive risk assessment within the health care community. The goal of this article is to enlighten BMETs and others on the growth of proactive risk assessment within health care and also on the support documents and materials produced by the VA. For additional information on HFMEA, visit the VA website at www.patientsafety.gov/HFMEA.html.

  9. Deriving Function-failure Similarity Information for Failure-free Rotorcraft Component Design

    NASA Technical Reports Server (NTRS)

    Roberts, Rory A.; Stone, Robert B.; Tumer, Irem Y.; Clancy, Daniel (Technical Monitor)

    2002-01-01

    Performance and safety are the top concerns of high-risk aerospace applications at NASA. Eliminating or reducing performance and safety problems can be achieved with a thorough understanding of potential failure modes in the design that lead to these problems. The majority of techniques use prior knowledge and experience as well as Failure Modes and Effects as methods to determine potential failure modes of aircraft. The aircraft design needs to be passed through a general technique to ensure that every potential failure mode is considered, while avoiding spending time on improbable failure modes. In this work, this is accomplished by mapping failure modes to certain components, which are described by their functionality. In turn, the failure modes are then linked to the basic functions that are carried within the components of the aircraft. Using the technique proposed in this paper, designers can examine the basic functions, and select appropriate analyses to eliminate or design out the potential failure modes. This method was previously applied to a simple rotating machine test rig with basic functions that are common to a rotorcraft. In this paper, this technique is applied to the engine and power train of a rotorcraft, using failures and functions obtained from accident reports and engineering drawings.

  10. Using failure mode and effects analysis to plan implementation of smart i.v. pump technology.

    PubMed

    Wetterneck, Tosha B; Skibinski, Kathleen A; Roberts, Tanita L; Kleppin, Susan M; Schroeder, Mark E; Enloe, Myra; Rough, Steven S; Hundt, Ann Schoofs; Carayon, Pascale

    2006-08-15

    Failure mode and effects analysis (FMEA) was used to evaluate a smart i.v. pump as it was implemented into a redesigned medication-use process. A multidisciplinary team conducted a FMEA to guide the implementation of a smart i.v. pump that was designed to prevent pump programming errors. The smart i.v. pump was equipped with a dose-error reduction system that included a pre-defined drug library in which dosage limits were set for each medication. Monitoring for potential failures and errors occurred for three months postimplementation of FMEA. Specific measures were used to determine the success of the actions that were implemented as a result of the FMEA. The FMEA process at the hospital identified key failure modes in the medication process with the use of the old and new pumps, and actions were taken to avoid errors and adverse events. I.V. pump software and hardware design changes were also recommended. Thirteen of the 18 failure modes reported in practice after pump implementation had been identified by the team. A beneficial outcome of FMEA was the development of a multidisciplinary team that provided the infrastructure for safe technology implementation and effective event investigation after implementation. With the continual updating of i.v. pump software and hardware after implementation, FMEA can be an important starting place for safe technology choice and implementation and can produce site experts to follow technology and process changes over time. FMEA was useful in identifying potential problems in the medication-use process with the implementation of new smart i.v. pumps. Monitoring for system failures and errors after implementation remains necessary.

  11. Apollo 13 Mission: Cryogenic Oxygen Tank 2 Anomaly Report

    NASA Technical Reports Server (NTRS)

    1970-01-01

    There were two investigative aspects associated with the loss of the cryogenic oxygen tank pressure during the Apollo 13 flight. First, what was the cause of the flight failure of cryogenic oxygen tank 2. Second, what possible contributing factors during the ground history of the tank could have led to the ultimate failure in flight. The first flight indication of a problem occurred when the quantity measurement in the tank went full scale about 9 hours before the incident. This condition in itself could not have contributed to ignition in the tank, since the energy in the circuit is restricted to about 7 milli-joules. Data from the electrical system provided the second indication of a problem when the fans in tank 2 were activated to reduce any stratification which might have been present in the supercritical oxygen in the tank. Several short-circuits were detected and have been isolated to the fan circuits of tank 2. The first short-circuit could have contained as much as 160 joules of energy, which is within the current-protection level of the fan circuits. Tests have shown that two orders of magnitude less energy than this is sufficient to ignite the polytetrafluoroethylene insulation on the fan circuits in the tank. Consequently, the evidence indicates that the insulation on the fan wiring was ignited by the energy in the short-circuit.

  12. Operations analysis (study 2.1). Contingency analysis. [of failure modes anticipated during space shuttle upper stage planning

    NASA Technical Reports Server (NTRS)

    1974-01-01

    Future operational concepts for the space transportation system were studied in terms of space shuttle upper stage failure contingencies possible during deployment, retrieval, or space servicing of automated satellite programs. Problems anticipated during mission planning were isolated using a modified 'fault tree' technique, normally used in safety analyses. A comprehensive space servicing hazard analysis is presented which classifies possible failure modes under the catagories of catastrophic collision, failure to rendezvous and dock, servicing failure, and failure to undock. The failure contingencies defined are to be taken into account during design of the upper stage.

  13. Fatigue Failure Modes of the Grain Size Transition Zone in a Dual Microstructure Disk

    NASA Technical Reports Server (NTRS)

    Gabb, Timothy P.; Kantzos, Pete T.; Palsa, Bonnie; Telesman, Jack; Gayda, John; Sudbrack, Chantal K.

    2012-01-01

    Mechanical property requirements vary with location in nickel-based superalloy disks. In order to maximize the associated mechanical properties, heat treatment methods have been developed for producing tailored grain microstructures. In this study, fatigue failure modes of a grain size transition zone in a dual microstructure disk were evaluated. A specialized heat treatment method was applied to produce varying grain microstructure in the bore to rim portions of a powder metallurgy processed nickel-based superalloy disk. The transition in grain size was concentrated in a zone of the disk web, between the bore and rim. Specimens were extracted parallel and transversely across this transition zone, and multiple fatigue tests were performed at 427 C and 704 C. Grain size distributions were characterized in the specimens, and related to operative failure initiation modes. Mean fatigue life decreased with increasing maximum grain size, going out through the transition zone. The scatter in limited tests of replicates was comparable for failures of uniform gage specimens in all transition zone locations examined.

  14. A Case Study on Improving Intensive Care Unit (ICU) Services Reliability: By Using Process Failure Mode and Effects Analysis (PFMEA)

    PubMed Central

    Yousefinezhadi, Taraneh; Jannesar Nobari, Farnaz Attar; Goodari, Faranak Behzadi; Arab, Mohammad

    2016-01-01

    Introduction: In any complex human system, human error is inevitable and shows that can’t be eliminated by blaming wrong doers. So with the aim of improving Intensive Care Units (ICU) reliability in hospitals, this research tries to identify and analyze ICU’s process failure modes at the point of systematic approach to errors. Methods: In this descriptive research, data was gathered qualitatively by observations, document reviews, and Focus Group Discussions (FGDs) with the process owners in two selected ICUs in Tehran in 2014. But, data analysis was quantitative, based on failures’ Risk Priority Number (RPN) at the base of Failure Modes and Effects Analysis (FMEA) method used. Besides, some causes of failures were analyzed by qualitative Eindhoven Classification Model (ECM). Results: Through FMEA methodology, 378 potential failure modes from 180 ICU activities in hospital A and 184 potential failures from 99 ICU activities in hospital B were identified and evaluated. Then with 90% reliability (RPN≥100), totally 18 failures in hospital A and 42 ones in hospital B were identified as non-acceptable risks and then their causes were analyzed by ECM. Conclusions: Applying of modified PFMEA for improving two selected ICUs’ processes reliability in two different kinds of hospitals shows that this method empowers staff to identify, evaluate, prioritize and analyze all potential failure modes and also make them eager to identify their causes, recommend corrective actions and even participate in improving process without feeling blamed by top management. Moreover, by combining FMEA and ECM, team members can easily identify failure causes at the point of health care perspectives. PMID:27157162

  15. 14 CFR 25.963 - Fuel tanks: general.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... tank must be able to withstand, without failure, the vibration, inertia, fluid, and structural loads... criteria in order to avoid loss of hazardous quantities of fuel: (1) All covers located in an area where... difference between the inside and the outside of the tank. [Doc. No. 5066, 29 FR 18291, Dec. 24, 1964, as...

  16. 14 CFR 25.963 - Fuel tanks: general.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... tank must be able to withstand, without failure, the vibration, inertia, fluid, and structural loads... criteria in order to avoid loss of hazardous quantities of fuel: (1) All covers located in an area where... difference between the inside and the outside of the tank. [Doc. No. 5066, 29 FR 18291, Dec. 24, 1964, as...

  17. 14 CFR 25.963 - Fuel tanks: general.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... tank must be able to withstand, without failure, the vibration, inertia, fluid, and structural loads... criteria in order to avoid loss of hazardous quantities of fuel: (1) All covers located in an area where... difference between the inside and the outside of the tank. [Doc. No. 5066, 29 FR 18291, Dec. 24, 1964, as...

  18. 14 CFR 25.963 - Fuel tanks: general.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... tank must be able to withstand, without failure, the vibration, inertia, fluid, and structural loads... criteria in order to avoid loss of hazardous quantities of fuel: (1) All covers located in an area where... difference between the inside and the outside of the tank. [Doc. No. 5066, 29 FR 18291, Dec. 24, 1964, as...

  19. 14 CFR 25.963 - Fuel tanks: general.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... tank must be able to withstand, without failure, the vibration, inertia, fluid, and structural loads... criteria in order to avoid loss of hazardous quantities of fuel: (1) All covers located in an area where... difference between the inside and the outside of the tank. [Doc. No. 5066, 29 FR 18291, Dec. 24, 1964, as...

  20. Residence time distribution measurements in a pilot-scale poison tank using radiotracer technique.

    PubMed

    Pant, H J; Goswami, Sunil; Samantray, J S; Sharma, V K; Maheshwari, N K

    2015-09-01

    Various types of systems are used to control the reactivity and shutting down of a nuclear reactor during emergency and routine shutdown operations. Injection of boron solution (borated water) into the core of a reactor is one of the commonly used methods during emergency operation. A pilot-scale poison tank was designed and fabricated to simulate injection of boron poison into the core of a reactor along with coolant water. In order to design a full-scale poison tank, it was desired to characterize flow of liquid from the tank. Residence time distribution (RTD) measurement and analysis was adopted to characterize the flow dynamics. Radiotracer technique was applied to measure RTD of aqueous phase in the tank using Bromine-82 as a radiotracer. RTD measurements were carried out with two different modes of operation of the tank and at different flow rates. In Mode-1, the radiotracer was instantaneously injected at the inlet and monitored at the outlet, whereas in Mode-2, the tank was filled with radiotracer and its concentration was measured at the outlet. From the measured RTD curves, mean residence times (MRTs), dead volume and fraction of liquid pumped in with time were determined. The treated RTD curves were modeled using suitable mathematical models. An axial dispersion model with high degree of backmixing was found suitable to describe flow when operated in Mode-1, whereas a tanks-in-series model with backmixing was found suitable to describe flow of the poison in the tank when operated in Mode-2. The results were utilized to scale-up and design a full-scale poison tank for a nuclear reactor. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. The Utility of Failure Modes and Effects Analysis of Consultations in a Tertiary, Academic, Medical Center.

    PubMed

    Niv, Yaron; Itskoviz, David; Cohen, Michal; Hendel, Hagit; Bar-Giora, Yonit; Berkov, Evgeny; Weisbord, Irit; Leviron, Yifat; Isasschar, Assaf; Ganor, Arian

    Failure modes and effects analysis (FMEA) is a tool used to identify potential risks in health care processes. We used the FMEA tool for improving the process of consultation in an academic medical center. A team of 10 staff members-5 physicians, 2 quality experts, 2 organizational consultants, and 1 nurse-was established. The consultation process steps, from ordering to delivering, were computed. Failure modes were assessed for likelihood of occurrence, detection, and severity. A risk priority number (RPN) was calculated. An interventional plan was designed according to the highest RPNs. Thereafter, we compared the percentage of completed computer-based documented consultations before and after the intervention. The team identified 3 main categories of failure modes that reached the highest RPNs: initiation of consultation by a junior staff physician without senior approval, failure to document the consultation in the computerized patient registry, and asking for consultation on the telephone. An interventional plan was designed, including meetings to update knowledge of the consultation request process, stressing the importance of approval by a senior physician, training sessions for closing requests in the patient file, and reporting of telephone requests. The number of electronically documented consultation results and recommendations significantly increased (75%) after intervention. FMEA is an important and efficient tool for improving the consultation process in an academic medical center.

  2. Cryogenic glass-filament-wound tank evaluation

    NASA Technical Reports Server (NTRS)

    Morris, E. E.; Landes, R. E.

    1971-01-01

    High-pressure glass-filament-wound fluid storage vessels with thin aluminum liners were designed, fabricated, and tested at ambient and cryogenic temperatures which demonstrated the feasibility of producing such vessels as well as high performance and light weight. Significant developments and advancements were made in solving problems associated with the thin metal liners in the tanks, including liner bonding to the overwrap and high strain magnification at the vessel polar bosses. The vessels had very high burst strengths, and failed in cyclic fatigue tests by local liner fracture and leakage without structural failure of the composite tank wall. The weight of the tanks was only 40 to 55% of comparable 2219-T87 aluminum and Inconel 718 tanks.

  3. Safety and feasibility of STAT RAD: Improvement of a novel rapid tomotherapy-based radiation therapy workflow by failure mode and effects analysis.

    PubMed

    Jones, Ryan T; Handsfield, Lydia; Read, Paul W; Wilson, David D; Van Ausdal, Ray; Schlesinger, David J; Siebers, Jeffrey V; Chen, Quan

    2015-01-01

    The clinical challenge of radiation therapy (RT) for painful bone metastases requires clinicians to consider both treatment efficacy and patient prognosis when selecting a radiation therapy regimen. The traditional RT workflow requires several weeks for common palliative RT schedules of 30 Gy in 10 fractions or 20 Gy in 5 fractions. At our institution, we have created a new RT workflow termed "STAT RAD" that allows clinicians to perform computed tomographic (CT) simulation, planning, and highly conformal single fraction treatment delivery within 2 hours. In this study, we evaluate the safety and feasibility of the STAT RAD workflow. A failure mode and effects analysis (FMEA) was performed on the STAT RAD workflow, including development of a process map, identification of potential failure modes, description of the cause and effect, temporal occurrence, and team member involvement in each failure mode, and examination of existing safety controls. A risk probability number (RPN) was calculated for each failure mode. As necessary, workflow adjustments were then made to safeguard failure modes of significant RPN values. After workflow alterations, RPN numbers were again recomputed. A total of 72 potential failure modes were identified in the pre-FMEA STAT RAD workflow, of which 22 met the RPN threshold for clinical significance. Workflow adjustments included the addition of a team member checklist, changing simulation from megavoltage CT to kilovoltage CT, alteration of patient-specific quality assurance testing, and allocating increased time for critical workflow steps. After these modifications, only 1 failure mode maintained RPN significance; patient motion after alignment or during treatment. Performing the FMEA for the STAT RAD workflow before clinical implementation has significantly strengthened the safety and feasibility of STAT RAD. The FMEA proved a valuable evaluation tool, identifying potential problem areas so that we could create a safer workflow

  4. Reliability and failure modes of implant-supported zirconium-oxide fixed dental prostheses related to veneering techniques

    PubMed Central

    Baldassarri, Marta; Zhang, Yu; Thompson, Van P.; Rekow, Elizabeth D.; Stappert, Christian F. J.

    2011-01-01

    Summary Objectives To compare fatigue failure modes and reliability of hand-veneered and over-pressed implant-supported three-unit zirconium-oxide fixed-dental-prostheses(FDPs). Methods Sixty-four custom-made zirconium-oxide abutments (n=32/group) and thirty-two zirconium-oxide FDP-frameworks were CAD/CAM manufactured. Frameworks were veneered with hand-built up or over-pressed porcelain (n=16/group). Step-stress-accelerated-life-testing (SSALT) was performed in water applying a distributed contact load at the buccal cusp-pontic-area. Post failure examinations were carried out using optical (polarized-reflected-light) and scanning electron microscopy (SEM) to visualize crack propagation and failure modes. Reliability was compared using cumulative-damage step-stress analysis (Alta-7-Pro, Reliasoft). Results Crack propagation was observed in the veneering porcelain during fatigue. The majority of zirconium-oxide FDPs demonstrated porcelain chipping as the dominant failure mode. Nevertheless, fracture of the zirconium-oxide frameworks was also observed. Over-pressed FDPs failed earlier at a mean failure load of 696 ± 149 N relative to hand-veneered at 882 ± 61 N (profile I). Weibull-stress-number of cycles-unreliability-curves were generated. The reliability (2-sided at 90% confidence bounds) for a 400N load at 100K cycles indicated values of 0.84 (0.98-0.24) for the hand-veneered FDPs and 0.50 (0.82-0.09) for their over-pressed counterparts. Conclusions Both zirconium-oxide FDP systems were resistant under accelerated-life-time-testing. Over-pressed specimens were more susceptible to fatigue loading with earlier veneer chipping. PMID:21557985

  5. 14 CFR 25.981 - Fuel tank ignition prevention.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Powerplant Fuel System § 25.981 Fuel tank... system where catastrophic failure could occur due to ignition of fuel or vapors. This must be shown by... established, as necessary, to prevent development of ignition sources within the fuel tank system pursuant to...

  6. 14 CFR 25.981 - Fuel tank ignition prevention.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Powerplant Fuel System § 25.981 Fuel tank... system where catastrophic failure could occur due to ignition of fuel or vapors. This must be shown by... established, as necessary, to prevent development of ignition sources within the fuel tank system pursuant to...

  7. 14 CFR 25.981 - Fuel tank ignition prevention.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Powerplant Fuel System § 25.981 Fuel tank... system where catastrophic failure could occur due to ignition of fuel or vapors. This must be shown by... established, as necessary, to prevent development of ignition sources within the fuel tank system pursuant to...

  8. 14 CFR 25.981 - Fuel tank ignition prevention.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Powerplant Fuel System § 25.981 Fuel tank... system where catastrophic failure could occur due to ignition of fuel or vapors. This must be shown by... established, as necessary, to prevent development of ignition sources within the fuel tank system pursuant to...

  9. 14 CFR 25.981 - Fuel tank ignition prevention.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Powerplant Fuel System § 25.981 Fuel tank... system where catastrophic failure could occur due to ignition of fuel or vapors. This must be shown by... established, as necessary, to prevent development of ignition sources within the fuel tank system pursuant to...

  10. Using Failure Mode and Effects Analysis to design a comfortable automotive driver seat.

    PubMed

    Kolich, Mike

    2014-07-01

    Given enough time and use, all designs will fail. There are no fail-free designs. This is especially true when it comes to automotive seating comfort where the characteristics and preferences of individual customers are many and varied. To address this problem, individuals charged with automotive seating comfort development have, traditionally, relied on iterative and, as a result, expensive build-test cycles. Cost pressures being placed on today's vehicle manufacturers have necessitated the search for more efficient alternatives. This contribution aims to fill this need by proposing the application of an analytical technique common to engineering circles (but new to seating comfort development), namely Design Failure Mode and Effects Analysis (DFMEA). An example is offered to describe how development teams can use this systematic and disciplined approach to highlight potential seating comfort failure modes, reduce their risk, and bring capable designs to life. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  11. Application of failure mode and effect analysis in managing catheter-related blood stream infection in intensive care unit

    PubMed Central

    Li, Xixi; He, Mei; Wang, Haiyan

    2017-01-01

    Abstract In this study, failure mode and effect analysis (FMEA), a proactive tool, was applied to reduce errors associated with the process which begins with assessment of patient and ends with treatment of complications. The aim of this study is to assess whether FMEA implementation will significantly reduce the incidence of catheter-related bloodstream infections (CRBSIs) in intensive care unit. The FMEA team was constructed. A team of 15 medical staff from different departments were recruited and trained. Their main responsibility was to analyze and score all possible processes of central venous catheterization failures. Failure modes with risk priority number (RPN) ≥100 (top 10 RPN scores) were deemed as high-priority-risks, meaning that they needed immediate corrective action. After modifications were put, the resulting RPN was compared with the previous one. A centralized nursing care system was designed. A total of 25 failure modes were identified. High-priority risks were “Unqualified medical device sterilization” (RPN, 337), “leukopenia, very low immunity” (RPN, 222), and “Poor hand hygiene Basic diseases” (RPN, 160). The corrective measures that we took allowed a decrease in the RPNs, especially for the high-priority risks. The maximum reduction was approximately 80%, as observed for the failure mode “Not creating the maximal barrier for patient.” The averaged incidence of CRBSIs was reduced from 5.19% to 1.45%, with 3 months of 0 infection rate. The FMEA can effectively reduce incidence of CRBSIs, improve the security of central venous catheterization technology, decrease overall medical expenses, and improve nursing quality. PMID:29390515

  12. Compatibility of the Radio Frequency Mass Gauge with Graphite-Epoxy Composite Tanks

    NASA Technical Reports Server (NTRS)

    Zimmerli, G. A.; Mueller, C. H.

    2015-01-01

    The radio frequency mass gauge (RFMG) is a low-gravity propellant quantity gauge being developed at NASA for possible use in long-duration space missions utilizing cryogenic propellants. As part of the RFMG technology development process, we evaluated the compatibility of the RFMG with a graphite-epoxy composite material used to construct propellant tanks. The key material property that can affect compatibility with the RFMG is the electrical conductivity. Using samples of 8552/IM7 graphite-epoxy composite, we characterized the resistivity and reflectivity over a range of frequencies. An RF impedance analyzer was used to characterize the out-of-plane electrical properties (along the sample thickness) in the frequency range 10 to 1800 MHZ. The resistivity value at 500 MHz was 4.8 ohm-cm. Microwave waveguide measurements of samples in the range 1.7 - 2.6 GHz, performed by inserting the samples into a WR-430 waveguide, showed reflectivity values above 98%. Together, these results suggested that a tank constructed from graphite/epoxy composite would produce good quality electromagnetic tank modes, which is needed for the RFMG. This was verified by room-temperature measurements of the electromagnetic modes of a 2.4 m diameter tank constructed by Boeing from similar graphite-epoxy composite material. The quality factor Q of the tank electromagnetic modes, measured via RF reflection measurements from an antenna mounted in the tank, was typically in the range 400 less than Q less than 3000. The good quality modes observed in the tank indicate that the RFMG is compatible with graphite-epoxy tanks, and thus the RFMG could be used as a low-gravity propellant quantity gauge in such tanks filled with cryogenic propellants.

  13. Testing and recommended practices to improve nurse tank safety, phase I : [research brief].

    DOT National Transportation Integrated Search

    2013-10-01

    This study focuses on determining causes and possible inspection remediation strategies to reduce the occurrence of anhydrous ammonia (NH3) nurse tank failures. Nurse tanks are cylindrical steel tank shells with hemispherical or elliptical end caps r...

  14. Fuzzy Risk Evaluation in Failure Mode and Effects Analysis Using a D Numbers Based Multi-Sensor Information Fusion Method.

    PubMed

    Deng, Xinyang; Jiang, Wen

    2017-09-12

    Failure mode and effect analysis (FMEA) is a useful tool to define, identify, and eliminate potential failures or errors so as to improve the reliability of systems, designs, and products. Risk evaluation is an important issue in FMEA to determine the risk priorities of failure modes. There are some shortcomings in the traditional risk priority number (RPN) approach for risk evaluation in FMEA, and fuzzy risk evaluation has become an important research direction that attracts increasing attention. In this paper, the fuzzy risk evaluation in FMEA is studied from a perspective of multi-sensor information fusion. By considering the non-exclusiveness between the evaluations of fuzzy linguistic variables to failure modes, a novel model called D numbers is used to model the non-exclusive fuzzy evaluations. A D numbers based multi-sensor information fusion method is proposed to establish a new model for fuzzy risk evaluation in FMEA. An illustrative example is provided and examined using the proposed model and other existing method to show the effectiveness of the proposed model.

  15. Fuzzy Risk Evaluation in Failure Mode and Effects Analysis Using a D Numbers Based Multi-Sensor Information Fusion Method

    PubMed Central

    Deng, Xinyang

    2017-01-01

    Failure mode and effect analysis (FMEA) is a useful tool to define, identify, and eliminate potential failures or errors so as to improve the reliability of systems, designs, and products. Risk evaluation is an important issue in FMEA to determine the risk priorities of failure modes. There are some shortcomings in the traditional risk priority number (RPN) approach for risk evaluation in FMEA, and fuzzy risk evaluation has become an important research direction that attracts increasing attention. In this paper, the fuzzy risk evaluation in FMEA is studied from a perspective of multi-sensor information fusion. By considering the non-exclusiveness between the evaluations of fuzzy linguistic variables to failure modes, a novel model called D numbers is used to model the non-exclusive fuzzy evaluations. A D numbers based multi-sensor information fusion method is proposed to establish a new model for fuzzy risk evaluation in FMEA. An illustrative example is provided and examined using the proposed model and other existing method to show the effectiveness of the proposed model. PMID:28895905

  16. Application of failure mode and effect analysis in managing catheter-related blood stream infection in intensive care unit.

    PubMed

    Li, Xixi; He, Mei; Wang, Haiyan

    2017-12-01

    In this study, failure mode and effect analysis (FMEA), a proactive tool, was applied to reduce errors associated with the process which begins with assessment of patient and ends with treatment of complications. The aim of this study is to assess whether FMEA implementation will significantly reduce the incidence of catheter-related bloodstream infections (CRBSIs) in intensive care unit.The FMEA team was constructed. A team of 15 medical staff from different departments were recruited and trained. Their main responsibility was to analyze and score all possible processes of central venous catheterization failures. Failure modes with risk priority number (RPN) ≥100 (top 10 RPN scores) were deemed as high-priority-risks, meaning that they needed immediate corrective action. After modifications were put, the resulting RPN was compared with the previous one. A centralized nursing care system was designed.A total of 25 failure modes were identified. High-priority risks were "Unqualified medical device sterilization" (RPN, 337), "leukopenia, very low immunity" (RPN, 222), and "Poor hand hygiene Basic diseases" (RPN, 160). The corrective measures that we took allowed a decrease in the RPNs, especially for the high-priority risks. The maximum reduction was approximately 80%, as observed for the failure mode "Not creating the maximal barrier for patient." The averaged incidence of CRBSIs was reduced from 5.19% to 1.45%, with 3 months of 0 infection rate.The FMEA can effectively reduce incidence of CRBSIs, improve the security of central venous catheterization technology, decrease overall medical expenses, and improve nursing quality. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  17. 49 CFR 179.500-15 - Handling of tanks failing in tests.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Handling of tanks failing in tests. 179.500-15 Section 179.500-15 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND... 107A) § 179.500-15 Handling of tanks failing in tests. (a) Tanks rejected for failure in any of the...

  18. 49 CFR 179.500-15 - Handling of tanks failing in tests.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Handling of tanks failing in tests. 179.500-15 Section 179.500-15 Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS...-113 and 107A) § 179.500-15 Handling of tanks failing in tests. (a) Tanks rejected for failure in any...

  19. 49 CFR 179.500-15 - Handling of tanks failing in tests.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 3 2011-10-01 2011-10-01 false Handling of tanks failing in tests. 179.500-15 Section 179.500-15 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND... 107A) § 179.500-15 Handling of tanks failing in tests. (a) Tanks rejected for failure in any of the...

  20. 49 CFR 179.500-15 - Handling of tanks failing in tests.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 3 2012-10-01 2012-10-01 false Handling of tanks failing in tests. 179.500-15 Section 179.500-15 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND... 107A) § 179.500-15 Handling of tanks failing in tests. (a) Tanks rejected for failure in any of the...

  1. 49 CFR 179.500-15 - Handling of tanks failing in tests.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 3 2014-10-01 2014-10-01 false Handling of tanks failing in tests. 179.500-15 Section 179.500-15 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND... 107A) § 179.500-15 Handling of tanks failing in tests. (a) Tanks rejected for failure in any of the...

  2. Failure mode and effects analysis: too little for too much?

    PubMed

    Dean Franklin, Bryony; Shebl, Nada Atef; Barber, Nick

    2012-07-01

    Failure mode and effects analysis (FMEA) is a structured prospective risk assessment method that is widely used within healthcare. FMEA involves a multidisciplinary team mapping out a high-risk process of care, identifying the failures that can occur, and then characterising each of these in terms of probability of occurrence, severity of effects and detectability, to give a risk priority number used to identify failures most in need of attention. One might assume that such a widely used tool would have an established evidence base. This paper considers whether or not this is the case, examining the evidence for the reliability and validity of its outputs, the mathematical principles behind the calculation of a risk prioirty number, and variation in how it is used in practice. We also consider the likely advantages of this approach, together with the disadvantages in terms of the healthcare professionals' time involved. We conclude that although FMEA is popular and many published studies have reported its use within healthcare, there is little evidence to support its use for the quantitative prioritisation of process failures. It lacks both reliability and validity, and is very time consuming. We would not recommend its use as a quantitative technique to prioritise, promote or study patient safety interventions. However, the stage of FMEA involving multidisciplinary mapping process seems valuable and work is now needed to identify the best way of converting this into plans for action.

  3. Statistical analysis of lithium iron sulfide status cell cycle life and failure mode

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Gay, E.C.; Battles, J.E.; Miller, W.E.

    1983-08-01

    A statistical model was developed for life cycle testing of electrochemical cell life cycle trials and verified experimentally. The Weibull distribution was selected to predict the end of life for a cell, based on a 20 percent loss of initial stabilized capacity or a decrease to less than 95 percent coulombic efficiency. Groups of 12 or more Li-alloy/FeS cells were cycled to determine the mean time to failure (MTTF) and also to identify the failure modes. The cells were all full size electric vehicle batteries with 150-350 A-hr capacity. The Weibull shape factors were determined and verified in prediction ofmore » the number of cell failures in two 10 cell modules. The short circuit failure in the cells with BN-felt and MgO powder separators were found to be caused by the formation of Li-Al protrusions that penetrated the BN-felt separators, and the extrusion of active material at the edge of the electrodes.« less

  4. Over-the-road testing of the instrumented tank car : a load environment study.

    DOT National Transportation Integrated Search

    2010-05-01

    Fractures have been observed on stub sill tank cars for many years. Undetected and unattended, these fractures can develop into a variety of tank car failures. While tank car ruptures are relatively rare, the potential for a catastrophic HAZMAT relea...

  5. Failure Mode and Effect Analysis (FMEA) may enhance implementation of clinical practice guidelines: An experience from the Middle East.

    PubMed

    Babiker, Amir; Amer, Yasser S; Osman, Mohamed E; Al-Eyadhy, Ayman; Fatani, Solafa; Mohamed, Sarar; Alnemri, Abdulrahman; Titi, Maher A; Shaikh, Farheen; Alswat, Khalid A; Wahabi, Hayfaa A; Al-Ansary, Lubna A

    2018-02-01

    Implementation of clinical practice guidelines (CPGs) has been shown to reduce variation in practice and improve health care quality and patients' safety. There is a limited experience of CPG implementation (CPGI) in the Middle East. The CPG program in our institution was launched in 2009. The Quality Management department conducted a Failure Mode and Effect Analysis (FMEA) for further improvement of CPGI. This is a prospective study of a qualitative/quantitative design. Our FMEA included (1) process review and recording of the steps and activities of CPGI; (2) hazard analysis by recording activity-related failure modes and their effects, identification of actions required, assigned severity, occurrence, and detection scores for each failure mode and calculated the risk priority number (RPN) by using an online interactive FMEA tool; (3) planning: RPNs were prioritized, recommendations, and further planning for new interventions were identified; and (4) monitoring: after reduction or elimination of the failure mode. The calculated RPN will be compared with subsequent analysis in post-implementation phase. The data were scrutinized from a feedback of quality team members using a FMEA framework to enhance the implementation of 29 adapted CPGs. The identified potential common failure modes with the highest RPN (≥ 80) included awareness/training activities, accessibility of CPGs, fewer advocates from clinical champions, and CPGs auditing. Actions included (1) organizing regular awareness activities, (2) making CPGs printed and electronic copies accessible, (3) encouraging senior practitioners to get involved in CPGI, and (4) enhancing CPGs auditing as part of the quality sustainability plan. In our experience, FMEA could be a useful tool to enhance CPGI. It helped us to identify potential barriers and prepare relevant solutions. © 2017 John Wiley & Sons, Ltd.

  6. Comparative Evaluation of Fracture Resistance and Mode of Failure of Zirconia and Titanium Abutments with Different Diameters.

    PubMed

    Shabanpour, Reza; Mousavi, Niloufar; Ghodsi, Safoura; Alikhasi, Marzieh

    2015-08-01

    The purpose of the current study was to compare the fracture resistance and mode of failure of zirconia and titanium abutments with different diameters. Fourteen groups of abutments including prefabricated zirconia, copy-milled zirconia and titanium abutments of an implant system (XiVE, Dentsply) were prepared in different diameters. An increasing vertical load was applied to each specimen until failure occurred. Fracture resistance was measured in each group using the universal testing machine. Moreover, the failure modes were studied and categorized as abutment screw fracture, connection area fracture, abutment body fracture, abutment body distortion, screw distortion and connection area distortion. Groups were statistically compared using univariate and post-hoc tests. The level of statistical significance was set at 5%. Fabrication method (p = 0.03) and diameter (p < 0.001) had significant effect on the fracture resistance of abutments. Fracture resistance of abutments with 5.5 mm diameter was higher than other diameters (p < 0.001). The observed modes of failure were dependent on the abutment material as well. All of the prefabricated titanium abutments fractured within the abutment screw. Abutment screw distortion, connection area fracture, and abutment body fracture were the common failure type in other groups. Diameter had a significant effect on fracture resistance of implant abutments, as abutments with greater diameters were more resistant to static loads. Copy-milled abutments showed lower fracture resistance as compared to other experimental groups. Although zirconia abutments have received great popularity among clinicians and even patients selecting them for narrow implants should be with caution.

  7. Radio-Frequency Tank Eigenmode Sensor for Propellant Quantity Gauging

    NASA Technical Reports Server (NTRS)

    Zimmerli, Gregory A.; Buchanan, David A.; Follo, Jeffrey C.; Vaden, Karl R.; Wagner, James D.; Asipauskas, Marius; Herlacher, Michael D.

    2010-01-01

    Although there are several methods for determining liquid level in a tank, there are no proven methods to quickly gauge the amount of propellant in a tank while it is in low gravity or under low-settling thrust conditions where propellant sloshing is an issue. Having the ability to quickly and accurately gauge propellant tanks in low-gravity is an enabling technology that would allow a spacecraft crew or mission control to always know the amount of propellant onboard, thus increasing the chances for a successful mission. The Radio Frequency Mass Gauge (RFMG) technique measures the electromagnetic eigenmodes, or natural resonant frequencies, of a tank containing a dielectric fluid. The essential hardware components consist of an RF network analyzer that measures the reflected power from an antenna probe mounted internal to the tank. At a resonant frequency, there is a drop in the reflected power, and these inverted peaks in the reflected power spectrum are identified as the tank eigenmode frequencies using a peak-detection software algorithm. This information is passed to a pattern-matching algorithm, which compares the measured eigenmode frequencies with a database of simulated eigenmode frequencies at various fill levels. A best match between the simulated and measured frequency values occurs at some fill level, which is then reported as the gauged fill level. The database of simulated eigenmode frequencies is created by using RF simulation software to calculate the tank eigenmodes at various fill levels. The input to the simulations consists of a fairly high-fidelity tank model with proper dimensions and including internal tank hardware, the dielectric properties of the fluid, and a defined liquid/vapor interface. Because of small discrepancies between the model and actual hardware, the measured empty tank spectra and simulations are used to create a set of correction factors for each mode (typically in the range of 0.999 1.001), which effectively accounts for

  8. Failure mode and effects analysis of skin electronic brachytherapy using Esteya® unit

    PubMed Central

    Bautista-Ballesteros, Juan Antonio; Bonaque, Jorge; Celada, Francisco; Lliso, Françoise; Carmona, Vicente; Gimeno-Olmos, Jose; Ouhib, Zoubir; Rosello, Joan; Perez-Calatayud, Jose

    2016-01-01

    Purpose Esteya® (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden) is an electronic brachytherapy device used for skin cancer lesion treatment. In order to establish an adequate level of quality of treatment, a risk analysis of the Esteya treatment process has been done, following the methodology proposed by the TG-100 guidelines of the American Association of Physicists in Medicine (AAPM). Material and methods A multidisciplinary team familiar with the treatment process was formed. This team developed a process map (PM) outlining the stages, through which a patient passed when subjected to the Esteya treatment. They identified potential failure modes (FM) and each individual FM was assessed for the severity (S), frequency of occurrence (O), and lack of detection (D). A list of existing quality management tools was developed and the FMs were consensually reevaluated. Finally, the FMs were ranked according to their risk priority number (RPN) and their S. Results 146 FMs were identified, 106 of which had RPN ≥ 50 and 30 had S ≥ 7. After introducing the quality management tools, only 21 FMs had RPN ≥ 50. The importance of ensuring contact between the applicator and the surface of the patient’s skin was emphasized, so the setup was reviewed by a second individual before each treatment session with periodic quality control to ensure stability of the applicator pressure. Some of the essential quality management tools are already being implemented in the installation are the simple templates for reproducible positioning of skin applicators, that help marking the treatment area and positioning of X-ray tube. Conclusions New quality management tools have been established as a result of the application of the failure modes and effects analysis (FMEA) treatment. However, periodic update of the FMEA process is necessary, since clinical experience has suggested occurring of further new possible potential failure modes. PMID:28115958

  9. Relationship Between Unusual High-Temperature Fatigue Crack Growth Threshold Behavior in Superalloys and Sudden Failure Mode Transitions

    NASA Technical Reports Server (NTRS)

    Telesman, J.; Smith, T. M.; Gabb, T. P.; Ring, A. J.

    2017-01-01

    An investigation of high temperature cyclic fatigue crack growth (FCG) threshold behavior of two advanced nickel disk alloys was conducted. The focus of the study was the unusual crossover effect in the near-threshold region of these type of alloys where conditions which produce higher crack growth rates in the Paris regime, produce higher resistance to crack growth in the near threshold regime. It was shown that this crossover effect is associated with a sudden change in the fatigue failure mode from a predominant transgranular mode in the Paris regime to fully intergranular mode in the threshold fatigue crack growth region. This type of a sudden change in the fracture mechanisms has not been previously reported and is surprising considering that intergranular failure is typically associated with faster crack growth rates and not the slow FCG rates of the near-threshold regime. By characterizing this behavior as a function of test temperature, environment and cyclic frequency, it was determined that both the crossover effect and the onset of intergranular failure are caused by environmentally driven mechanisms which have not as yet been fully identified. A plausible explanation for the observed behavior is proposed.

  10. Flexural strength and failure modes of layered ceramic structures.

    PubMed

    Borba, Márcia; de Araújo, Maico D; de Lima, Erick; Yoshimura, Humberto N; Cesar, Paulo F; Griggs, Jason A; Della Bona, Alvaro

    2011-12-01

    To evaluate the effect of the specimen design on the flexural strength (σ(f)) and failure mode of ceramic structures, testing the hypothesis that the ceramic material under tension controls the mechanical performance of the structure. Three ceramics used as framework materials for fixed partial dentures (YZ--Vita In-Ceram YZ; IZ--Vita In-Ceram Zirconia; AL--Vita In-Ceram AL) and two veneering porcelains (VM7 and VM9) were studied. Bar-shaped specimens were produced in three different designs (n=10): monolithic, two layers (porcelain-framework) and three layers (TRI) (porcelain-framework-porcelain). Specimens were tested for three-point flexural strength at 1MPa/s in 37°C artificial saliva. For bi-layered design, the specimens were tested in both conditions: with porcelain (PT) or framework ceramic (FT) layer under tension. Fracture surfaces were analyzed using stereomicroscope and scanning electron microscopy (SEM). Young's modulus (E) and Poisson's ratio (ν) were determined using ultrasonic pulse-echo method. Results were statistically analyzed by Kruskal-Wallis and Student-Newman-Keuls tests. Except for VM7 and VM9, significant differences were observed for E values among the materials. YZ showed the highest ν value followed by IZ and AL. YZ presented the highest σ(f). There was no statistical difference in the σ(f) value between IZ and IZ-FT and between AL and AL-FT. σ(f) values for YZ-PT, IZ-PT, IZ-TRI, AL-PT, AL-TRI were similar to the results obtained for VM7 and VM9. Two types of fracture mode were identified: total and partial failure. The mechanical performance of the specimens was determined by the material under tension during testing, confirming the study hypothesis. Copyright © 2011 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

  11. Proactive risk assessment of blood transfusion process, in pediatric emergency, using the Health Care Failure Mode and Effects Analysis (HFMEA).

    PubMed

    Dehnavieh, Reza; Ebrahimipour, Hossein; Molavi-Taleghani, Yasamin; Vafaee-Najar, Ali; Noori Hekmat, Somayeh; Esmailzdeh, Hamid

    2014-12-25

    Pediatric emergency has been considered as a high risk area, and blood transfusion is known as a unique clinical measure, therefore this study was conducted with the purpose of assessing the proactive risk assessment of blood transfusion process in Pediatric Emergency of Qaem education- treatment center in Mashhad, by the Healthcare Failure Mode and Effects Analysis (HFMEA) methodology. This cross-sectional study analyzed the failure mode and effects of blood transfusion process by a mixture of quantitative-qualitative method. The proactive HFMEA was used to identify and analyze the potential failures of the process. The information of the items in HFMEA forms was collected after obtaining a consensus of experts' panel views via the interview and focus group discussion sessions. The Number of 77 failure modes were identified for 24 sub-processes enlisted in 8 processes of blood transfusion. Totally 13 failure modes were identified as non-acceptable risk (a hazard score above 8) in the blood transfusion process and were transferred to the decision tree. Root causes of high risk modes were discussed in cause-effect meetings and were classified based on the UK national health system (NHS) approved classifications model. Action types were classified in the form of acceptance (11.6%), control (74.2%) and elimination (14.2%). Recommendations were placed in 7 categories using TRIZ ("Theory of Inventive Problem Solving.") The re-engineering process for the required changes, standardizing and updating the blood transfusion procedure, root cause analysis of blood transfusion catastrophic events, patient identification bracelet, training classes and educational pamphlets for raising awareness of personnel, and monthly gathering of transfusion medicine committee have all been considered as executive strategies in work agenda in pediatric emergency.

  12. General Monte Carlo reliability simulation code including common mode failures and HARP fault/error-handling

    NASA Technical Reports Server (NTRS)

    Platt, M. E.; Lewis, E. E.; Boehm, F.

    1991-01-01

    A Monte Carlo Fortran computer program was developed that uses two variance reduction techniques for computing system reliability applicable to solving very large highly reliable fault-tolerant systems. The program is consistent with the hybrid automated reliability predictor (HARP) code which employs behavioral decomposition and complex fault-error handling models. This new capability is called MC-HARP which efficiently solves reliability models with non-constant failures rates (Weibull). Common mode failure modeling is also a specialty.

  13. Multi-institutional application of Failure Mode and Effects Analysis (FMEA) to CyberKnife Stereotactic Body Radiation Therapy (SBRT).

    PubMed

    Veronese, Ivan; De Martin, Elena; Martinotti, Anna Stefania; Fumagalli, Maria Luisa; Vite, Cristina; Redaelli, Irene; Malatesta, Tiziana; Mancosu, Pietro; Beltramo, Giancarlo; Fariselli, Laura; Cantone, Marie Claire

    2015-06-13

    A multidisciplinary and multi-institutional working group applied the Failure Mode and Effects Analysis (FMEA) approach to assess the risks for patients undergoing Stereotactic Body Radiation Therapy (SBRT) treatments for lesions located in spine and liver in two CyberKnife® Centres. The various sub-processes characterizing the SBRT treatment were identified to generate the process trees of both the treatment planning and delivery phases. This analysis drove to the identification and subsequent scoring of the potential failure modes, together with their causes and effects, using the risk probability number (RPN) scoring system. Novel solutions aimed to increase patient safety were accordingly considered. The process-tree characterising the SBRT treatment planning stage was composed with a total of 48 sub-processes. Similarly, 42 sub-processes were identified in the stage of delivery to liver tumours and 30 in the stage of delivery to spine lesions. All the sub-processes were judged to be potentially prone to one or more failure modes. Nineteen failures (i.e. 5 in treatment planning stage, 5 in the delivery to liver lesions and 9 in the delivery to spine lesions) were considered of high concern in view of the high RPN and/or severity index value. The analysis of the potential failures, their causes and effects allowed to improve the safety strategies already adopted in the clinical practice with additional measures for optimizing quality management workflow and increasing patient safety.

  14. Mode I Failure of Armor Ceramics: Experiments and Modeling

    NASA Astrophysics Data System (ADS)

    Meredith, Christopher; Leavy, Brian

    2017-06-01

    The pre-notched edge on impact (EOI) experiment is a technique for benchmarking the damage and fracture of ceramics subjected to projectile impact. A cylindrical projectile impacts the edge of a thin rectangular plate with a pre-notch on the opposite edge. Tension is generated at the notch tip resulting in the initiation and propagation of a mode I crack back toward the impact edge. The crack can be quantitatively measured using an optical method called Digital Gradient Sensing, which measures the crack-tip deformation by simultaneously quantifying two orthogonal surface slopes via measuring small deflections of light rays from a specularly reflective surface around the crack. The deflections in ceramics are small so the high speed camera needs to have a very high pixel count. This work reports on the results from pre-crack EOI experiments of SiC and B4 C plates. The experimental data are quantitatively compared to impact simulations using an advanced continuum damage model. The Kayenta ceramic model in Alegra will be used to compare fracture propagation speeds, bifurcations and inhomogeneous initiation of failure will be compared. This will provide insight into the driving mechanisms required for the macroscale failure modeling of ceramics.

  15. Notch strengthening or weakening governed by transition of shear failure to normal mode fracture

    PubMed Central

    Lei, Xianqi; Li, Congling; Shi, Xinghua; Xu, Xianghong; Wei, Yujie

    2015-01-01

    It is generally observed that the existence of geometrical discontinuity like notches in materials will lead to strength weakening, as a resultant of local stress concentration. By comparing the influence of notches to the strength of three typical materials, aluminum alloys with intermediate tensile ductility, metallic glasses with no tensile ductility, and brittle ceramics, we observed strengthening in aluminum alloys and metallic glasses: Tensile strength of the net section in circumferentially notched cylinders increases with the constraint quantified by the ratio of notch depth over notch root radius; in contrast, the ceramic exhibit notch weakening. The strengthening in the former two is due to resultant deformation transition: Shear failure occurs in intact samples while samples with deep notches break in normal mode fracture. No such deformation transition was observed in the ceramic, and stress concentration leads to its notch weakening. The experimental results are confirmed by theoretical analyses and numerical simulation. The results reported here suggest that the conventional criterion to use brittleness and/or ductility to differentiate notch strengthening or weakening is not physically sound. Notch strengthening or weakening relies on the existence of failure mode transition and materials exhibiting shear failure while subjected to tension will notch strengthen. PMID:26022892

  16. Failure modes of vacuum plasma spray tungsten coating created on carbon fibre composites under thermal loads

    NASA Astrophysics Data System (ADS)

    Hirai, T.; Bekris, N.; Coad, J. P.; Grisolia, C.; Linke, J.; Maier, H.; Matthews, G. F.; Philipps, V.; Wessel, E.

    2009-07-01

    Vacuum plasma spray tungsten (VPS-W) coating created on a carbon fibre reinforced composite (CFC) was tested under two thermal load schemes in the electron beam facility to examine the operation limits and failure modes. In cyclic ELM-like short transient thermal loads, the VPS-W coating was destroyed sub-layer by sub-layer at 0.33 GW/m 2 for 1 ms pulse duration. At longer single pulses, simulating steady-state thermal loads, the coating was destroyed at surface temperatures above 2700 °C by melting of the rhenium containing multilayer at the interface between VPS-W and CFC. The operation limits and failure modes of the VPS-W coating in the thermal load schemes are discussed in detail.

  17. Maximum likelihood estimation for life distributions with competing failure modes

    NASA Technical Reports Server (NTRS)

    Sidik, S. M.

    1979-01-01

    Systems which are placed on test at time zero, function for a period and die at some random time were studied. Failure may be due to one of several causes or modes. The parameters of the life distribution may depend upon the levels of various stress variables the item is subject to. Maximum likelihood estimation methods are discussed. Specific methods are reported for the smallest extreme-value distributions of life. Monte-Carlo results indicate the methods to be promising. Under appropriate conditions, the location parameters are nearly unbiased, the scale parameter is slight biased, and the asymptotic covariances are rapidly approached.

  18. Common Cause Failure Modes

    NASA Technical Reports Server (NTRS)

    Wetherholt, Jon; Heimann, Timothy J.; Anderson, Brenda

    2011-01-01

    High technology industries with high failure costs commonly use redundancy as a means to reduce risk. Redundant systems, whether similar or dissimilar, are susceptible to Common Cause Failures (CCF). CCF is not always considered in the design effort and, therefore, can be a major threat to success. There are several aspects to CCF which must be understood to perform an analysis which will find hidden issues that may negate redundancy. This paper will provide definition, types, a list of possible causes and some examples of CCF. Requirements and designs from NASA projects will be used in the paper as examples.

  19. Tank Insulation

    NASA Technical Reports Server (NTRS)

    1979-01-01

    For NASA's Apollo program, McDonnell Douglas Astronautics Company, Huntington Beach, California, developed and built the S-IVB, uppermost stage of the three-stage Saturn V moonbooster. An important part of the development task was fabrication of a tank to contain liquid hydrogen fuel for the stage's rocket engine. The liquid hydrogen had to be contained at the supercold temperature of 423 degrees below zero Fahrenheit. The tank had to be perfectly insulated to keep engine or solar heat from reaching the fuel; if the hydrogen were permitted to warm up, it would have boiled off, or converted to gaseous form, reducing the amount of fuel available to the engine. McDonnell Douglas' answer was a supereffective insulation called 3D, which consisted of a one-inch thickness of polyurethane foam reinforced in three dimensions with fiberglass threads. Over a 13-year development and construction period, the company built 30 tanks and never experienced a failure. Now, after years of additional development, an advanced version of 3D is finding application as part of a containment system for transporting Liquefied Natural Gas (LNG) by ship.

  20. Material wear and failure mode analysis of breakfast cereal extruder barrels and screw elements

    NASA Astrophysics Data System (ADS)

    Mastio, Michael Joseph, Jr.

    2005-11-01

    Nearly seventy-five years ago, the single screw extruder was introduced as a means to produce metal products. Shortly after that, the extruder found its way into the plastics industry. Today much of the world's polymer industry utilizes extruders to produce items such as soda bottles, PVC piping, and toy figurines. Given the significant economical advantages of extruders over conventional batch flow systems, extruders have also migrated into the food industry. Food applications include the meat, pet food, and cereal industries to name just a few. Cereal manufacturers utilize extruders to produce various forms of Ready-to-Eat (RTE) cereals. These cereals are made from grains such as rice, oats, wheat, and corn. The food industry has been incorrectly viewed as an extruder application requiring only minimal energy control and performance capability. This misconception has resulted in very little research in the area of material wear and failure mode analysis of breakfast cereal extruders. Breakfast cereal extruder barrels and individual screw elements are subjected to the extreme pressures and temperatures required to shear and cook the cereal ingredients, resulting in excessive material wear and catastrophic failure of these components. Therefore, this project focuses on the material wear and failure mode analysis of breakfast cereal extruder barrels and screw elements, modeled as a Discrete Time Markov Chain (DTMC) process in which historical data is used to predict future failures. Such predictive analysis will yield cost savings opportunities by providing insight into extruder maintenance scheduling and interchangeability of screw elements. In this DTMC wear analysis, four states of wear are defined and a probability transition matrix is determined based upon 24,041 hours of operational data. This probability transition matrix is used to predict when an extruder component will move to the next state of wear and/or failure. This information can be used to determine

  1. Single-Shell Tanks Leak Integrity Elements/ SX Farm Leak Causes and Locations - 12127

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Girardot, Crystal; Harlow, Don; Venetz, Theodore

    2012-07-01

    related to leak detection. In-tank parameters can include temperature of the supernatant and sludge, types of waste, and chemical determination by either transfer or sample analysis. Ex-tank information can be assembled from many sources including design media, construction conditions, technical specifications, and other sources. Five conditions may have contributed to SX Farm tank liner failure including: tank design, thermal shock, chemistry-corrosion, liner behavior (bulging), and construction temperature. Tank design did not apparently change from tank to tank for the SX Farm tanks; however, there could be many unknown variables present in the quality of materials and quality of construction. Several significant SX Farm tank design changes occurred from previous successful tank farm designs. Tank construction occurred in winter under cold conditions which could have affected the ductile to brittle transition temperature of the tanks. The SX Farm tanks received high temperature boiling waste from REDOX which challenged the tank design with rapid heat up and high temperatures. All eight of the leaking SX Farm tanks had relatively high rate of temperature rise. Supernatant removal with subsequent nitrate leaching was conducted in all but three of the eight leaking tanks prior to leaks being detected. It is possible that no one characteristic of the SX Farm tanks could in isolation from the others have resulted in failure. However, the application of so many stressors - heat up rate, high temperature, loss of corrosion protection, and tank design working jointly or serially resulted in their failure. Thermal shock coupled with the tank design, construction conditions, and nitrate leaching seem to be the overriding factors that can lead to tank liner failure. The distinction between leaking and sound SX Farm tanks seems to center on the waste types, thermal conditions, and nitrate leaching. (authors)« less

  2. SINGLE-SHELL TANKS LEAK INTEGRITY ELEMENTS/SX FARM LEAK CAUSES AND LOCATIONS - 12127

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    VENETZ TJ; WASHENFELDER D; JOHNSON J

    2012-01-25

    related to leak detection. In-tank parameters can include temperature of the supernatant and sludge, types of waste, and chemical determination by either transfer or sample analysis. Ex-tank information can be assembled from many sources including design media, construction conditions, technical specifications, and other sources. Five conditions may have contributed to SX Farm tank liner failure including: tank design, thermal shock, chemistry-corrosion, liner behavior (bulging), and construction temperature. Tank design did not apparently change from tank to tank for the SX Farm tanks; however, there could be many unknown variables present in the quality of materials and quality of construction. Several significant SX Farm tank design changes occurred from previous successful tank farm designs. Tank construction occurred in winter under cold conditions which could have affected the ductile to brittle transition temperature of the tanks. The SX Farm tanks received high temperature boiling waste from REDOX which challenged the tank design with rapid heat up and high temperatures. All eight of the leaking SX Farm tanks had relatively high rate of temperature rise. Supernatant removal with subsequent nitrate leaching was conducted in all but three of the eight leaking tanks prior to leaks being detected. It is possible that no one characteristic of the SX Farm tanks could in isolation from the others have resulted in failure. However, the application of so many stressors - heat up rate, high temperature, loss of corrosion protection, and tank design - working jointly or serially resulted in their failure. Thermal shock coupled with the tank design, construction conditions, and nitrate leaching seem to be the overriding factors that can lead to tank liner failure. The distinction between leaking and sound SX Farm tanks seems to center on the waste types, thermal conditions, and nitrate leaching.« less

  3. Proactive Risk Assessment of Blood Transfusion Process, in Pediatric Emergency, Using the Health Care Failure Mode and Effects Analysis (HFMEA)

    PubMed Central

    Dehnavieh, Reza; Ebrahimipour, Hossein; Molavi-Taleghani, Yasamin; Vafaee-Najar, Ali; Hekmat, Somayeh Noori; Esmailzdeh, Hamid

    2015-01-01

    Introduction: Pediatric emergency has been considered as a high risk area, and blood transfusion is known as a unique clinical measure, therefore this study was conducted with the purpose of assessing the proactive risk assessment of blood transfusion process in Pediatric Emergency of Qaem education- treatment center in Mashhad, by the Healthcare Failure Mode and Effects Analysis (HFMEA) methodology. Methodology: This cross-sectional study analyzed the failure mode and effects of blood transfusion process by a mixture of quantitative-qualitative method. The proactive HFMEA was used to identify and analyze the potential failures of the process. The information of the items in HFMEA forms was collected after obtaining a consensus of experts’ panel views via the interview and focus group discussion sessions. Results: The Number of 77 failure modes were identified for 24 sub-processes enlisted in 8 processes of blood transfusion. Totally 13 failure modes were identified as non-acceptable risk (a hazard score above 8) in the blood transfusion process and were transferred to the decision tree. Root causes of high risk modes were discussed in cause-effect meetings and were classified based on the UK national health system (NHS) approved classifications model. Action types were classified in the form of acceptance (11.6%), control (74.2%) and elimination (14.2%). Recommendations were placed in 7 categories using TRIZ (“Theory of Inventive Problem Solving.”) Conclusion: The re-engineering process for the required changes, standardizing and updating the blood transfusion procedure, root cause analysis of blood transfusion catastrophic events, patient identification bracelet, training classes and educational pamphlets for raising awareness of personnel, and monthly gathering of transfusion medicine committee have all been considered as executive strategies in work agenda in pediatric emergency. PMID:25560332

  4. True Triaxial Strength and Failure Modes of Cubic Rock Specimens with Unloading the Minor Principal Stress

    NASA Astrophysics Data System (ADS)

    Li, Xibing; Du, Kun; Li, Diyuan

    2015-11-01

    True triaxial tests have been carried out on granite, sandstone and cement mortar using cubic specimens with the process of unloading the minor principal stress. The strengths and failure modes of the three rock materials are studied in the processes of unloading σ 3 and loading σ 1 by the newly developed true triaxial test system under different σ 2, aiming to study the mechanical responses of the rock in underground excavation at depth. It shows that the rock strength increases with the raising of the intermediate principal stress σ 2 when σ 3 is unloaded to zero. The true triaxial strength criterion by the power-law relationship can be used to fit the testing data. The "best-fitting" material parameters A and n ( A > 1.4 and n < 1.0) are almost located in the same range as expected by Al-Ajmi and Zimmerman (Int J Rock Mech Min Sci 563 42(3):431-439, 2005). It indicates that the end effect caused by the height-to-width ratio of the cubic specimens will not significantly affect the testing results under true triaxial tests. Both the strength and failure modes of cubic rock specimens under true triaxial unloading condition are affected by the intermediate principal stress. When σ 2 increases to a critical value for the strong and hard rocks (R4, R5 and R6), the rock failure mode may change from shear to slabbing. However, for medium strong and weak rocks (R3 and R2), even with a relatively high intermediate principal stress, they tend to fail in shear after a large amount of plastic deformation. The maximum extension strain criterion Stacey (Int J Rock Mech Min Sci Geomech Abstr 651 18(6):469-474, 1981) can be used to explain the change of failure mode from shear to slabbing for strong and hard rocks under true triaxial unloading test condition.

  5. Composite overwrapped metallic tanks

    NASA Technical Reports Server (NTRS)

    Caudill, C. L.; Kirlin, R. L.

    1972-01-01

    Work is reported for fabricating and testing the fiberglass overwrapped titanium pressure vessel for cryogenic service. Difficulties encountered in the tank liner fabrication phase involved explosive forming, vacuum annealing, chemical milling and electron beam welding. While each of these processes and the nondestructive test methods employed are normally considered to be individually reliable, the combination of poor material together with fabrication and development reversals prevented the full achievement of the desired end results. Eight tanks plus a prototype and tool proofing article were produced. Six of the vessels failed during the hydrostatic sizing operation. One of the remaining tanks was hydrostatically pressurized to burst and the other was pressurized repeatedly at 75 F from 100 psi to the operating pressure until failure occurred. As a result, it is not possible to draw firm conclusions as to the true value of the design concept due to the problems encountered in the program.

  6. Deformation modes in an Icelandic basalt: From brittle failure to localized deformation bands

    NASA Astrophysics Data System (ADS)

    Adelinet, M.; Fortin, J.; Schubnel, A.; Guéguen, Y.

    2013-04-01

    According to the stress state, deformation mode observed in rocks may be very different. Even in the brittle part of the crust a differential stress can induce shear failure but also localized compacting deformation, such as compaction bands in porous sedimentary rocks. The mode of deformation controls many hydrodynamic factors, such as permeability and porosity. We investigate in this paper two different modes of deformation in an Icelandic basalt by using laboratory seismological tools (elastic waves and acoustic emissions) and microstructural observations. First of all, we show that at low effective confining pressure (Peff = 5 MPa) an axial loading induces a shear failure in the basalt with an angle of about 30° with respect to the main stress direction. On the contrary, at high effective confining pressure (Peff ≥ 75 MPa and more) an increase of the axial stress induces a localization of the deformation in the form of subhorizontal bands again with respect to the main stress direction. In this second regime, focal mechanisms of the acoustic emissions reveal an important number of compression events suggesting pore collapse mechanisms. Microstructural observations confirm this assumption. Similar compaction structures are usually obtained for porous sedimentary rocks (20-25%). However, the investigated basalt has an initial total porosity of only about 10% so that compaction structures were not expected. The pore size and the ratio of pore to grain size are likely to be key factors for the particular observed mechanical behavior.

  7. CFD Fuel Slosh Modeling of Fluid-Structure Interaction in Spacecraft Propellant Tanks with Diaphragms

    NASA Technical Reports Server (NTRS)

    Sances, Dillon J.; Gangadharan, Sathya N.; Sudermann, James E.; Marsell, Brandon

    2010-01-01

    Liquid sloshing within spacecraft propellant tanks causes rapid energy dissipation at resonant modes, which can result in attitude destabilization of the vehicle. Identifying resonant slosh modes currently requires experimental testing and mechanical pendulum analogs to characterize the slosh dynamics. Computational Fluid Dynamics (CFD) techniques have recently been validated as an effective tool for simulating fuel slosh within free-surface propellant tanks. Propellant tanks often incorporate an internal flexible diaphragm to separate ullage and propellant which increases modeling complexity. A coupled fluid-structure CFD model is required to capture the damping effects of a flexible diaphragm on the propellant. ANSYS multidisciplinary engineering software employs a coupled solver for analyzing two-way Fluid Structure Interaction (FSI) cases such as the diaphragm propellant tank system. Slosh models generated by ANSYS software are validated by experimental lateral slosh test results. Accurate data correlation would produce an innovative technique for modeling fuel slosh within diaphragm tanks and provide an accurate and efficient tool for identifying resonant modes and the slosh dynamic response.

  8. Fracture resistance and primary failure mode of endodontically treated teeth restored with a carbon fiber-reinforced resin post system in vitro.

    PubMed

    Raygot, C G; Chai, J; Jameson, D L

    2001-01-01

    This study was undertaken to characterize the fracture resistance and mode of fracture of endodontically treated incisors restored with cast post-and-core, prefabricated stainless steel post, or carbon fiber-reinforced composite post systems. Ten endodontically treated teeth restored with each technique were subjected to a compressive load delivered at a 130-degree angle to the long axis until the first sign of failure was noted. The fracture load and the mode of fracture were recorded. The failure loads registered in the three groups were not significantly different. Between 70%, and 80% of teeth from any of the three groups displayed fractures that were located above the simulated bone level. The use of carbon fiber-reinforced composite posts did not change the fracture resistance or the failure mode of endodontically treated central incisors compared to the use of metallic posts.

  9. Poster - Thur Eve - 05: Safety systems and failure modes and effects analysis for a magnetic resonance image guided radiation therapy system.

    PubMed

    Lamey, M; Carlone, M; Alasti, H; Bissonnette, J P; Borg, J; Breen, S; Coolens, C; Heaton, R; Islam, M; van Proojen, M; Sharpe, M; Stanescu, T; Jaffray, D

    2012-07-01

    An online Magnetic Resonance guided Radiation Therapy (MRgRT) system is under development. The system is comprised of an MRI with the capability of travel between and into HDR brachytherapy and external beam radiation therapy vaults. The system will provide on-line MR images immediately prior to radiation therapy. The MR images will be registered to a planning image and used for image guidance. With the intention of system safety we have performed a failure modes and effects analysis. A process tree of the facility function was developed. Using the process tree as well as an initial design of the facility as guidelines possible failure modes were identified, for each of these failure modes root causes were identified. For each possible failure the assignment of severity, detectability and occurrence scores was performed. Finally suggestions were developed to reduce the possibility of an event. The process tree consists of nine main inputs and each of these main inputs consisted of 5 - 10 sub inputs and tertiary inputs were also defined. The process tree ensures that the overall safety of the system has been considered. Several possible failure modes were identified and were relevant to the design, construction, commissioning and operating phases of the facility. The utility of the analysis can be seen in that it has spawned projects prior to installation and has lead to suggestions in the design of the facility. © 2012 American Association of Physicists in Medicine.

  10. Reliability and mode of failure of bonded monolithic and multilayer ceramics.

    PubMed

    Alessandretti, Rodrigo; Borba, Marcia; Benetti, Paula; Corazza, Pedro Henrique; Ribeiro, Raissa; Della Bona, Alvaro

    2017-02-01

    To evaluate the reliability of monolithic and multilayer ceramic structures used in the CAD-on technique (Ivoclar), and the mode of failure produced in ceramic structures bonded to a dentin analog material (NEMA-G10). Ceramic specimens were fabricated as follows (n=30): CAD-on- trilayer structure (IPS e.max ZirCAD/IPS e.max Crystall./Connect/IPS e.max CAD); YLD- bilayer structure (IPS e.max ZirCAD/IPS e.max Ceram); LDC- monolithic structure (IPS e.max CAD); and YZW- monolithic structure (Zenostar Zr Translucent). All ceramic specimens were bonded to G10 and subjected to compressive load in 37°C distilled water until the sound of the first crack, monitored acoustically. Failure load (L f ) values were recorded (N) and statistically analyzed using Weibull distribution, Kruskal-Wallis test, and Student-Newman-Keuls test (α=0.05). L f values of CAD-on and YZW structures were statistically similar (p=0.917), but higher than YLD and LDC (p<0.01). Weibull modulus (m) values were statistically similar for all experimental groups. Monolithic structures (LDC and YZW) failed from radial cracks. Failures in the CAD-on and YLD groups showed, predominantly, both radial and cone cracks. Monolithic zirconia (YZW) and CAD-on structures showed similar failure resistance and reliability, but a different fracture behavior. Copyright © 2016 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

  11. Failure detection system risk reduction assessment

    NASA Technical Reports Server (NTRS)

    Aguilar, Robert B. (Inventor); Huang, Zhaofeng (Inventor)

    2012-01-01

    A process includes determining a probability of a failure mode of a system being analyzed reaching a failure limit as a function of time to failure limit, determining a probability of a mitigation of the failure mode as a function of a time to failure limit, and quantifying a risk reduction based on the probability of the failure mode reaching the failure limit and the probability of the mitigation.

  12. Failure mode and effects analysis: a comparison of two common risk prioritisation methods.

    PubMed

    McElroy, Lisa M; Khorzad, Rebeca; Nannicelli, Anna P; Brown, Alexandra R; Ladner, Daniela P; Holl, Jane L

    2016-05-01

    Failure mode and effects analysis (FMEA) is a method of risk assessment increasingly used in healthcare over the past decade. The traditional method, however, can require substantial time and training resources. The goal of this study is to compare a simplified scoring method with the traditional scoring method to determine the degree of congruence in identifying high-risk failures. An FMEA of the operating room (OR) to intensive care unit (ICU) handoff was conducted. Failures were scored and ranked using both the traditional risk priority number (RPN) and criticality-based method, and a simplified method, which designates failures as 'high', 'medium' or 'low' risk. The degree of congruence was determined by first identifying those failures determined to be critical by the traditional method (RPN≥300), and then calculating the per cent congruence with those failures designated critical by the simplified methods (high risk). In total, 79 process failures among 37 individual steps in the OR to ICU handoff process were identified. The traditional method yielded Criticality Indices (CIs) ranging from 18 to 72 and RPNs ranging from 80 to 504. The simplified method ranked 11 failures as 'low risk', 30 as medium risk and 22 as high risk. The traditional method yielded 24 failures with an RPN ≥300, of which 22 were identified as high risk by the simplified method (92% agreement). The top 20% of CI (≥60) included 12 failures, of which six were designated as high risk by the simplified method (50% agreement). These results suggest that the simplified method of scoring and ranking failures identified by an FMEA can be a useful tool for healthcare organisations with limited access to FMEA expertise. However, the simplified method does not result in the same degree of discrimination in the ranking of failures offered by the traditional method. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. WE-H-BRC-01: Failure Mode and Effects Analysis of Skin Electronic Brachytherapy Using Esteya Unit

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ibanez-Rosello, B; Bautista-Ballesteros, J; Bonaque, J

    Purpose: A failure mode and effect analysis (FMEA) of skin lesions treatment process using Esteya™ device (Elekta Brachyterapy, Veenendaal, The Netherlands) was performed, with the aim of increasing the quality of the treatment and reducing the likelihood of unwanted events. Methods: A multidisciplinary team with experience in the treatment process met to establish the process map, which outlines the flow of various stages for such patients undergoing skin treatment. Potential failure modes (FM) were identified and the value of severity (S), frequency of occurrence (O), and lack of detectability (D) of the proposed FM were scored individually, each on amore » scale of 1 to 10 following TG-100 guidelines of the AAPM. These failure modes were ranked according to our risk priority number (RPN) and S scores. The efficiency of existing quality management tools was analyzed through a reassessment of the O and D made by consensus. Results: 149 FM were identified, 43 of which had RPN ≥ 100 and 30 had S ≥ 7. After introduction of the tools of quality management, only 3 FM had RPN ≥ 100 and 22 FM had RPN ≥ 50. These 22 FM were thoroughly analyzed and new tools for quality management were proposed. The most common cause of highest RPN FM was associated with the heavy patient workload and the continuous and accurate applicator-patient skin contact during the treatment. To overcome this second item, a regular quality control and setup review by a second individual before each treatment session was proposed. Conclusion: FMEA revealed some of the FM potentials that were not predicted during the initial implementation of the quality management tools. This exercise was useful in identifying the need of periodic update of the FMEA process as new potential failures can be identified.« less

  14. Failure mode and effects analysis: A community practice perspective.

    PubMed

    Schuller, Bradley W; Burns, Angi; Ceilley, Elizabeth A; King, Alan; LeTourneau, Joan; Markovic, Alexander; Sterkel, Lynda; Taplin, Brigid; Wanner, Jennifer; Albert, Jeffrey M

    2017-11-01

    To report our early experiences with failure mode and effects analysis (FMEA) in a community practice setting. The FMEA facilitator received extensive training at the AAPM Summer School. Early efforts focused on department education and emphasized the need for process evaluation in the context of high profile radiation therapy accidents. A multidisciplinary team was assembled with representation from each of the major department disciplines. Stereotactic radiosurgery (SRS) was identified as the most appropriate treatment technique for the first FMEA evaluation, as it is largely self-contained and has the potential to produce high impact failure modes. Process mapping was completed using breakout sessions, and then compiled into a simple electronic format. Weekly sessions were used to complete the FMEA evaluation. Risk priority number (RPN) values > 100 or severity scores of 9 or 10 were considered high risk. The overall time commitment was also tracked. The final SRS process map contained 15 major process steps and 183 subprocess steps. Splitting the process map into individual assignments was a successful strategy for our group. The process map was designed to contain enough detail such that another radiation oncology team would be able to perform our procedures. Continuous facilitator involvement helped maintain consistent scoring during FMEA. Practice changes were made responding to the highest RPN scores, and new resulting RPN scores were below our high-risk threshold. The estimated person-hour equivalent for project completion was 258 hr. This report provides important details on the initial steps we took to complete our first FMEA, providing guidance for community practices seeking to incorporate this process into their quality assurance (QA) program. Determining the feasibility of implementing complex QA processes into different practice settings will take on increasing significance as the field of radiation oncology transitions into the new TG-100 QA

  15. 49 CFR 172.331 - Bulk packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 2 2012-10-01 2012-10-01 false Bulk packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks. 172.331 Section 172.331 Transportation Other Regulations... packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks. (a) Each person...

  16. 49 CFR 172.331 - Bulk packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Bulk packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks. 172.331 Section 172.331 Transportation Other Regulations... packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks. (a) Each person...

  17. 49 CFR 172.331 - Bulk packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 2 2014-10-01 2014-10-01 false Bulk packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks. 172.331 Section 172.331 Transportation Other Regulations... packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks. (a) Each person...

  18. 49 CFR 172.331 - Bulk packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 2 2011-10-01 2011-10-01 false Bulk packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks. 172.331 Section 172.331 Transportation Other Regulations... packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks. (a) Each person...

  19. 49 CFR 172.331 - Bulk packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 2 2013-10-01 2013-10-01 false Bulk packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks. 172.331 Section 172.331 Transportation Other Regulations... packagings other than portable tanks, cargo tanks, tank cars and multi-unit tank car tanks. (a) Each person...

  20. Fuzzy-based failure mode and effect analysis (FMEA) of a hybrid molten carbonate fuel cell (MCFC) and gas turbine system for marine propulsion

    NASA Astrophysics Data System (ADS)

    Ahn, Junkeon; Noh, Yeelyong; Park, Sung Ho; Choi, Byung Il; Chang, Daejun

    2017-10-01

    This study proposes a fuzzy-based FMEA (failure mode and effect analysis) for a hybrid molten carbonate fuel cell and gas turbine system for liquefied hydrogen tankers. An FMEA-based regulatory framework is adopted to analyze the non-conventional propulsion system and to understand the risk picture of the system. Since the participants of the FMEA rely on their subjective and qualitative experiences, the conventional FMEA used for identifying failures that affect system performance inevitably involves inherent uncertainties. A fuzzy-based FMEA is introduced to express such uncertainties appropriately and to provide flexible access to a risk picture for a new system using fuzzy modeling. The hybrid system has 35 components and has 70 potential failure modes, respectively. Significant failure modes occur in the fuel cell stack and rotary machine. The fuzzy risk priority number is used to validate the crisp risk priority number in the FMEA.

  1. A failure modes and effects analysis study for gynecologic high-dose-rate brachytherapy.

    PubMed

    Mayadev, Jyoti; Dieterich, Sonja; Harse, Rick; Lentz, Susan; Mathai, Mathew; Boddu, Sunita; Kern, Marianne; Courquin, Jean; Stern, Robin L

    2015-01-01

    To improve the quality of our gynecologic brachytherapy practice and reduce reportable events, we performed a process analysis after the failure modes and effects analysis (FMEA). The FMEA included a multidisciplinary team specifically targeting the tandem and ring brachytherapy procedure. The treatment process was divided into six subprocesses and failure modes (FMs). A scoring guideline was developed based on published FMEA studies and assigned through team consensus. FMs were ranked according to overall and severity scores. FM ranking >5% of the highest risk priority number (RPN) score was selected for in-depth analysis. The efficiency of each existing quality assurance to detect each FM was analyzed. We identified 170 FMs, and 99 were scored. RPN scores ranged from 1 to 192. Of the 13 highest-ranking FMs with RPN scores >80, half had severity scores of 8 or 9, with no mode having severity of 10. Of these FM, the originating process steps were simulation (5), treatment planning (5), treatment delivery (2), and insertion (1). Our high-ranking FM focused on communication and the potential for applicator movement. Evaluation of the efficiency and the comprehensiveness of our quality assurance program showed coverage of all but three of the top 49 FMs ranked by RPN. This is the first reported FMEA process for a comprehensive gynecologic brachytherapy procedure overview. We were able to identify FMs that could potentially and severely impact the patient's treatment. We continue to adjust our quality assurance program based on the results of our FMEA analysis. Published by Elsevier Inc.

  2. Lunar Module ECS (Environmental Control System) - Design Considerations and Failure Modes. Part 1

    NASA Technical Reports Server (NTRS)

    Interbartolo, Michael

    2009-01-01

    Design considerations and failure modes for the Lunar Module (LM) Environmental Control System (ECS) are described. An overview of the the oxygen supply and cabin pressurization, atmosphere revitalization, water management and heat transport systems are provided. Design considerations including reliability, flight instrumentation, modularization and the change to the use of batteries instead of fuel cells are discussed. A summary is provided for the LM ECS general testing regime.

  3. Sharing of Tank Information

    NASA Technical Reports Server (NTRS)

    Tamminga, Joshua D.

    2011-01-01

    Test Rationale -- Attempt to Address 10% vs. 25+% effects of crater penetration on full scale titanium alloy tanks and comparison to plate tests Utilize Baseline Burst Pressure versus HVI impacted vessels as gauge of effects Examine craters (post test) to determine penetration characteristics on a fluid filled vessel versus plate tests. Examine crater effects leading to vessel failure (if any).

  4. Hanford Double-Shell Tank Extent-of-Condition Review - 15498

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Johnson, J. M.; Baide, D. D.; Barnes, T. J.

    2014-11-19

    During routine visual inspections of Hanford double-shell waste tank 241-AY-102 (AY-102), anomalies were identified on the annulus floor which resulted in further evaluations. Following a formal leak assessment in October 2012, Washington River Protection Solutions, LLC (WRPS) determined that the primary tank of AY-102 was leaking. A formal leak assessment, documented in RPP-ASMT-53793, Tank 241-AY-102 Leak Assessment Report, identified first-of-a-kind construction difficulties and trial-and-error repairs as major contributing factors to tank failure.1 To determine if improvements in double-shell tank (DST) construction occurred after construction of tank AY-102, a detailed review and evaluation of historical construction records was performed for Hanford’smore » remaining twenty-seven DSTs. Review involved research of 241 boxes of historical project documentation to better understand the condition of the Hanford DST farms, noting similarities in construction difficulties/issues to tank AY-102. Information gathered provides valuable insight regarding construction difficulties, future tank operations decisions, and guidance of the current tank inspection program. Should new waste storage tanks be constructed in the future, these reviews also provide valuable lessons-learned.« less

  5. 75 FR 71346 - Special Conditions: Boeing Model 787-8 Airplane; Lightning Protection of Fuel Tank Structure To...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-23

    ... Boeing Model 787-8 airplane will incorporate a fuel tank nitrogen generation system (NGS) that actively... ignition source in the fuel tank system could not result from any single failure, from any single failure... of fuel systems. We do not intend to apply the alternative standards used under these special...

  6. Margins Associated with Loss of Assured Safety for Systems with Multiple Time-Dependent Failure Modes.

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Helton, Jon C.; Brooks, Dusty Marie; Sallaberry, Cedric Jean-Marie.

    Representations for margins associated with loss of assured safety (LOAS) for weak link (WL)/strong link (SL) systems involving multiple time-dependent failure modes are developed. The following topics are described: (i) defining properties for WLs and SLs, (ii) background on cumulative distribution functions (CDFs) for link failure time, link property value at link failure, and time at which LOAS occurs, (iii) CDFs for failure time margins defined by (time at which SL system fails) – (time at which WL system fails), (iv) CDFs for SL system property values at LOAS, (v) CDFs for WL/SL property value margins defined by (property valuemore » at which SL system fails) – (property value at which WL system fails), and (vi) CDFs for SL property value margins defined by (property value of failing SL at time of SL system failure) – (property value of this SL at time of WL system failure). Included in this presentation is a demonstration of a verification strategy based on defining and approximating the indicated margin results with (i) procedures based on formal integral representations and associated quadrature approximations and (ii) procedures based on algorithms for sampling-based approximations.« less

  7. Failure modes in electroactive polymer thin films with elastic electrodes

    NASA Astrophysics Data System (ADS)

    De Tommasi, D.; Puglisi, G.; Zurlo, G.

    2014-02-01

    Based on an energy minimization approach, we analyse the elastic deformations of a thin electroactive polymer (EAP) film sandwiched by two elastic electrodes with non-negligible stiffness. We analytically show the existence of a critical value of the electrode voltage for which non-homogeneous solutions bifurcate from the homogeneous equilibrium state, leading to the pull-in phenomenon. This threshold strongly decreases the limit value proposed in the literature considering only homogeneous deformations. We explicitly discuss the influence of geometric and material parameters together with boundary conditions in the attainment of the different failure modes observed in EAP devices. In particular, we obtain the optimum values of these parameters leading to the maximum activation performances of the device.

  8. Tank 241-T-204, core 188 analytical results for the final report

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Nuzum, J.L.

    TANK 241-T-204, CORE 188, ANALYTICAL RESULTS FOR THE FINAL REPORT. This document is the final laboratory report for Tank 241 -T-204. Push mode core segments were removed from Riser 3 between March 27, 1997, and April 11, 1997. Segments were received and extruded at 222-8 Laboratory. Analyses were performed in accordance with Tank 241-T-204 Push Mode Core Sampling and analysis Plan (TRAP) (Winkleman, 1997), Letter of instruction for Core Sample Analysis of Tanks 241-T-201, 241- T-202, 241-T-203, and 241-T-204 (LAY) (Bell, 1997), and Safety Screening Data Qual@ Objective (DO) ODukelow, et al., 1995). None of the subsamples submitted for totalmore » alpha activity (AT) or differential scanning calorimetry (DC) analyses exceeded the notification limits stated in DO. The statistical results of the 95% confidence interval on the mean calculations are provided by the Tank Waste Remediation Systems Technical Basis Group and are not considered in this report.« less

  9. Application of multi attribute failure mode analysis of milk production using analytical hierarchy process method

    NASA Astrophysics Data System (ADS)

    Rucitra, A. L.

    2018-03-01

    Pusat Koperasi Induk Susu (PKIS) Sekar Tanjung, East Java is one of the modern dairy industries producing Ultra High Temperature (UHT) milk. A problem that often occurs in the production process in PKIS Sekar Tanjung is a mismatch between the production process and the predetermined standard. The purpose of applying Analytical Hierarchy Process (AHP) was to identify the most potential cause of failure in the milk production process. Multi Attribute Failure Mode Analysis (MAFMA) method was used to eliminate or reduce the possibility of failure when viewed from the failure causes. This method integrates the severity, occurrence, detection, and expected cost criteria obtained from depth interview with the head of the production department as an expert. The AHP approach was used to formulate the priority ranking of the cause of failure in the milk production process. At level 1, the severity has the highest weight of 0.41 or 41% compared to other criteria. While at level 2, identifying failure in the UHT milk production process, the most potential cause was the average mixing temperature of more than 70 °C which was higher than the standard temperature (≤70 ° C). This failure cause has a contributes weight of 0.47 or 47% of all criteria Therefore, this study suggested the company to control the mixing temperature to minimise or eliminate the failure in this process.

  10. Influence of surface finishing on fracture load and failure mode of glass ceramic crowns.

    PubMed

    Mores, Rafael Tagliari; Borba, Márcia; Corazza, Pedro Henrique; Della Bona, Álvaro; Benetti, Paula

    2017-10-01

    Ceramic restorations often require adjustments using diamond rotary instruments, which damage the glazed surface. The effect of these adjustments on the fracture behavior of these restorations is unclear. The purpose of this in vitro study was to evaluate the influence of induced surface defects on the fracture load and mode of failure of lithium disilicate-based (LDS) glass ceramic restorations. Premolar crowns were obtained from LDS computer-aided design and computer-aided manufacturing blocks (n=60) and glazed. The crowns were bonded to dentin analog dies and divided into 5 groups (n=12), as follows: glaze; abrasion (diamond rotary instrument 2135); abrasion and reglaze; abrasion and polishing (diamond rotary instrument 2135F, 2135 FF, and polishing devices); and polishing. The topography of the crowns was examined by scanning electron microscopy, and roughness was measured. A compressive load (0.5 mm/min) was applied by a piston to the center of the lingual cusp until fracture. The fracture load was recorded and data were statistically analyzed by ANOVA and the Tukey HSD test (α=.05). Fractured crowns were examined to determine the fracture origin. Polishing and/or reglazing resulted in lower roughness than for the abraded group (P<.05), which did not affect the fracture loads (P=.696). Catastrophic fracture with origin at the intaglio surface was the mode of failure for all the crowns. The experiment design successfully submitted the crowns to a clinical stress state, resulting in a clinically relevant failure. Reglazing or polishing were effective in reducing surface defects. Surface treatments had no effect on the immediate catastrophic failure of LDS crowns. Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  11. Auxiliary resonant DC tank converter

    DOEpatents

    Peng, Fang Z.

    2000-01-01

    An auxiliary resonant dc tank (ARDCT) converter is provided for achieving soft-switching in a power converter. An ARDCT circuit is coupled directly across a dc bus to the inverter to generate a resonant dc bus voltage, including upper and lower resonant capacitors connected in series as a resonant leg, first and second dc tank capacitors connected in series as a tank leg, and an auxiliary resonant circuit comprising a series combination of a resonant inductor and a pair of auxiliary switching devices. The ARDCT circuit further includes first clamping means for holding the resonant dc bus voltage to the dc tank voltage of the tank leg, and second clamping means for clamping the resonant dc bus voltage to zero during a resonant period. The ARDCT circuit resonantly brings the dc bus voltage to zero in order to provide a zero-voltage switching opportunity for the inverter, then quickly rebounds the dc bus voltage back to the dc tank voltage after the inverter changes state. The auxiliary switching devices are turned on and off under zero-current conditions. The ARDCT circuit only absorbs ripples of the inverter dc bus current, thus having less current stress. In addition, since the ARDCT circuit is coupled in parallel with the dc power supply and the inverter for merely assisting soft-switching of the inverter without participating in real dc power transmission and power conversion, malfunction and failure of the tank circuit will not affect the functional operation of the inverter; thus a highly reliable converter system is expected.

  12. Risk assessment of component failure modes and human errors using a new FMECA approach: application in the safety analysis of HDR brachytherapy.

    PubMed

    Giardina, M; Castiglia, F; Tomarchio, E

    2014-12-01

    Failure mode, effects and criticality analysis (FMECA) is a safety technique extensively used in many different industrial fields to identify and prevent potential failures. In the application of traditional FMECA, the risk priority number (RPN) is determined to rank the failure modes; however, the method has been criticised for having several weaknesses. Moreover, it is unable to adequately deal with human errors or negligence. In this paper, a new versatile fuzzy rule-based assessment model is proposed to evaluate the RPN index to rank both component failure and human error. The proposed methodology is applied to potential radiological over-exposure of patients during high-dose-rate brachytherapy treatments. The critical analysis of the results can provide recommendations and suggestions regarding safety provisions for the equipment and procedures required to reduce the occurrence of accidental events.

  13. Common Cause Failures and Ultra Reliability

    NASA Technical Reports Server (NTRS)

    Jones, Harry W.

    2012-01-01

    A common cause failure occurs when several failures have the same origin. Common cause failures are either common event failures, where the cause is a single external event, or common mode failures, where two systems fail in the same way for the same reason. Common mode failures can occur at different times because of a design defect or a repeated external event. Common event failures reduce the reliability of on-line redundant systems but not of systems using off-line spare parts. Common mode failures reduce the dependability of systems using off-line spare parts and on-line redundancy.

  14. Reliability and Failure Modes of a Hybrid Ceramic Abutment Prototype.

    PubMed

    Silva, Nelson Rfa; Teixeira, Hellen S; Silveira, Lucas M; Bonfante, Estevam A; Coelho, Paulo G; Thompson, Van P

    2018-01-01

    A ceramic and metal abutment prototype was fatigue tested to determine the probability of survival at various loads. Lithium disilicate CAD-milled abutments (n = 24) were cemented to titanium sleeve inserts and then screw attached to titanium fixtures. The assembly was then embedded at a 30° angle in polymethylmethacrylate. Each (n = 24) was restored with a resin-cemented machined lithium disilicate all-ceramic central incisor crown. Single load (lingual-incisal contact) to failure was determined for three specimens. Fatigue testing (n = 21) was conducted employing the step-stress method with lingual mouth motion loading. Failures were recorded, and reliability calculations were performed using proprietary software. Probability Weibull curves were calculated with 90% confidence bounds. Fracture modes were classified with a stereomicroscope, and representative samples imaged with scanning electron microscopy. Fatigue results indicated that the limiting factor in the current design is the fatigue strength of the abutment screw, where screw fracture often leads to failure of the abutment metal sleeve and/or cracking in the implant fixture. Reliability for completion of a mission at 200 N load for 50K cycles was 0.38 (0.52% to 0.25 90% CI) and for 100K cycles was only 0.12 (0.26 to 0.05)-only 12% predicted to survive. These results are similar to those from previous studies on metal to metal abutment/fixture systems where screw failure is a limitation. No ceramic crown or ceramic abutment initiated fractures occurred, supporting the research hypothesis. The limiting factor in performance was the screw failure in the metal-to-metal connection between the prototyped abutment and the fixture, indicating that this configuration should function clinically with no abutment ceramic complications. The combined ceramic with titanium sleeve abutment prototype performance was limited by the fatigue degradation of the abutment screw. In fatigue, no ceramic crown or ceramic

  15. Comparison of Failure Modes in 2-D and 3-D Woven Carbon Phenolic Systems

    NASA Technical Reports Server (NTRS)

    Rossman, Grant A.; Stackpoole, Mairead; Feldman, Jay; Venkatapathy, Ethiraj; Braun, Robert D.

    2013-01-01

    NASA Ames Research Center is developing Woven Thermal Protection System (WTPS) materials as a new class of heatshields for entry vehicles (Stackpoole). Currently, there are few options for ablative entry heatshield materials, none of which is ideally suited to the planetary probe missions currently of interest to NASA. While carbon phenolic was successfully used for the missions Pioneer Venus and Galileo (to Jupiter), the heritage constituents are no longer available. An alternate carbon phenolic would need to be qualified for probe missions, which is most efficient at heat fluxes greater than those currently of interest. Additional TPS materials such as Avcoat and PICA are not sufficiently robust for the heat fluxes required. As a result, there is a large TPS gap between the materials efficient at very high conditions (carbon phenolic) and those that are effective at low-moderate conditions (all others). Development of 3D Woven TPS is intended to fill this gap, targeting mid-density weaves that could with withstand mid-range heat fluxes between 1100 W/sq cm and 8000 W/sq cm (Venkatapathy (2012). Preliminary experimental studies have been performed to show the feasibility of WTPS as a future mid-range TPS material. One study performed in the mARC Jet Facility at NASA Ames Research Center characterized the performance of a 3D Woven TPS sample and compared it to 2D carbon phenolic samples at ply angles of 0deg, 23.5deg, and 90deg. Each sample contained similar compositions of phenolic and carbon fiber volume fractions for experimental consistency. The goal of this study was to compare the performance of the TPS materials by evaluating resulting recession and failure modes. After exposing both samples to similar heat flux and pressure conditions, the 2D carbon phenolic laminate was shown to experience significant delamination between layers and further pocketing underneath separated layers. The 3D Woven TPS sample did not experience the delamination or pocketing

  16. Lifecycle Verification of Tank Liner Polymers

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Anovitz, Lawrence; Smith, Barton

    2014-03-01

    This report describes a method that was developed for the purpose of assessing the durability of thermoplastic liners used in a Type IV hydrogen storage tank during the tank s expected service life. In the method, a thermoplastic liner specimen is cycled between the maximum and minimum expected working temperatures while it is differentially pressurized with high-pressure hydrogen gas. The number of thermal cycling intervals corresponds to those expected within the tank s design lifetime. At prescribed intervals, hydrogen permeation measurements are done in situ to assess the ability of the liner specimen to maintain its hydrogen barrier properties andmore » to model its permeability over the tank lifetime. Finally, the model is used to assess whether the steady-state leakage rate in the tank could potentially exceed the leakage specification for hydrogen fuel cell passenger vehicles. A durability assessment was performed on a specimen of high-density polyethylene (HDPE) that is in current use as a tank liner. Hydrogen permeation measurements were performed on several additional tank liner polymers as well as novel polymers proposed for use as storage tank liners and hydrogen barrier materials. The following technical barriers from the Fuel Cell Technologies Program MYRDD were addressed by the project: D. Durability of on-board storage systems lifetime of at least 1500 cycles G. Materials of construction vessel containment that is resistant to hydrogen permeation M. Lack of Tank Performance Data and Understanding of Failure Mechanisms And the following technical targets1 for on-board hydrogen storage systems R&D were likewise addressed: Operational cycle life (1/4 tank to full) FY 2017: 1500 cycles; Ultimate: 1500 cycles Environmental health & safety Permeation and leakage: Meets or exceeds applicable standards Loss of useable H2: FY 2017: 0.05 g/h/kg H2; Ultimate: 0.05 g/h/kg H2« less

  17. Risk Assessment Planning for Airborne Systems: An Information Assurance Failure Mode, Effects and Criticality Analysis Methodology

    DTIC Science & Technology

    2012-06-01

    Visa Investigate Data Breach March 30, 2012 Visa and MasterCard are investigating whether a data security breach at one of the main companies that...30). MasterCard and Visa Investigate Data Breach . New York Times . Stamatis, D. (2003). Failure Mode Effect Analysis: FMEA from Theory to Execution

  18. Model of the Radio Frequency (RF) Excitation Response from Monopole and Dipole Antennas in a Large Scale Tank

    NASA Technical Reports Server (NTRS)

    Wilson, Jeffrey D.; Zimmerli, Gregory A.

    2012-01-01

    Good antenna-mode coupling is needed for determining the amount of propellant in a tank through the method of radio frequency mass gauging (RFMG). The antenna configuration and position in a tank are important factors in coupling the antenna to the natural electromagnetic modes. In this study, different monopole and dipole antenna mounting configurations and positions were modeled and responses simulated in a full-scale tank model with the transient solver of CST Microwave Studio (CST Computer Simulation Technology of America, Inc.). The study was undertaken to qualitatively understand the effect of antenna design and placement within a tank on the resulting radio frequency (RF) tank spectrum.

  19. Catalytic Reactor for Inerting of Aircraft Fuel Tanks

    DTIC Science & Technology

    1974-06-01

    Aluminum Panels After Triphase Corrosion Test 79 35 Inerting System Flows in Various Flight Modes 82 36 High Flow Reactor Parametric Data 84 37 System...AD/A-000 939 CATALYTIC REACTOR FOR INERTING OF AIRCRAFT FUEL TANKS George H. McDonald, et al AiResearch Manufacturing Company Prepared for: Air Force...190th Street 2b. GROUP Torrance, California .. REPORT TITLE CATALYTIC REACTOR FOR INERTING OF AIRCRAFT FUEL TANKS . OESCRIP TIVE NOTEs (Thpe of refpoft

  20. Seismic Response Analysis of an Unanchored Steel Tank under Horizontal Excitation

    NASA Astrophysics Data System (ADS)

    Rulin, Zhang; Xudong, Cheng; Youhai, Guan

    2017-06-01

    The seismic performance of liquid storage tank affects the safety of people’s life and property. A 3-D finite element method (FEM) model of storage tank is established, which considers the liquid-solid coupling effect. Then, the displacement and stress distribution along the tank wall is studied under El Centro earthquake. Results show that, large amplitude sloshing with long period appears on liquid surface. The elephant-foot deformation occurs near the tank bottom, and at the elephant-foot deformation position maximum hoop stress and axial stress appear. The maximum axial compressive stress is very close to the allowable critical stress calculated by the design code, and may be local buckling failure occurs. The research can provide some reference for the seismic design of storage tanks.

  1. Hanford Double-Shell Tank Extent-of-Condition Construction Review

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Venetz, Theodore J.; Johnson, Jeremy M.; Gunter, Jason R.

    2013-11-14

    During routine visual inspections of Hanford double-shell waste tank 241-AY-102 (AY-102), anomalies were identified on the annulus floor which resulted in further evaluations. Following a formal leak assessment in October 2012, Washington River Protection Solutions, LLC (WRPS) determined that the primary tank of AY-102 was leaking. The formal leak assessment, documented in RPP-ASMT-53793,Tank 241-AY-102 Leak Assessment Report, identified first-of-a-kind construction difficulties and trial-and-error repairs as major contributing factors to tank failure. To determine if improvements in double-shell tank (DST) construction occurred after construction of tank AY-102, a detailed review and evaluation of historical construction records were performed for the firstmore » three DST tank farms constructed, which included tanks 241-AY-101, 241-AZ-101, 241-AZ-102, 241-SY-101, 241-SY-102, and 241-SY-103. The review for these six tanks involved research and review of dozens of boxes of historical project documentation. These reviews form a basis to better understand the current condition of the three oldest Hanford DST farms. They provide a basis for changes to the current tank inspection program and also provide valuable insight into future tank use decisions. If new tanks are constructed in the future, these reviews provide valuable "lessons-learned" information about expected difficulties as well as construction practices and techniques that are likely to be successful.« less

  2. SU-F-T-245: The Investigation of Failure Mode and Effects Analysis and PDCA for the Radiotherapy Risk Reduction

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Xie, J; Wang, J; P, J

    2016-06-15

    Purpose: To optimize the clinical processes of radiotherapy and to reduce the radiotherapy risks by implementing the powerful risk management tools of failure mode and effects analysis(FMEA) and PDCA(plan-do-check-act). Methods: A multidiciplinary QA(Quality Assurance) team from our department consisting of oncologists, physicists, dosimetrists, therapists and administrator was established and an entire workflow QA process management using FMEA and PDCA tools was implemented for the whole treatment process. After the primary process tree was created, the failure modes and Risk priority numbers(RPNs) were determined by each member, and then the RPNs were averaged after team discussion. Results: 3 of 9 failuremore » modes with RPN above 100 in the practice were identified in the first PDCA cycle, which were further analyzed to investigate the RPNs: including of patient registration error, prescription error and treating wrong patient. New process controls reduced the occurrence, or detectability scores from the top 3 failure modes. Two important corrective actions reduced the highest RPNs from 300 to 50, and the error rate of radiotherapy decreased remarkably. Conclusion: FMEA and PDCA are helpful in identifying potential problems in the radiotherapy process, which was proven to improve the safety, quality and efficiency of radiation therapy in our department. The implementation of the FMEA approach may improve the understanding of the overall process of radiotherapy while may identify potential flaws in the whole process. Further more, repeating the PDCA cycle can bring us closer to the goal: higher safety and accuracy radiotherapy.« less

  3. Association between bilirubin and mode of death in severe systolic heart failure.

    PubMed

    Wu, Audrey H; Levy, Wayne C; Welch, Kathleen B; Neuberg, Gerald W; O'Connor, Christopher M; Carson, Peter E; Miller, Alan B; Ghali, Jalal K

    2013-04-15

    The bilirubin level has been associated with worse outcomes, but it has not been studied as a predictor for the mode of death in patients with systolic heart failure. The Prospective Randomized Amlodipine Evaluation Study (PRAISE) cohort (including New York Heart Association class IIIB-IV patients with left ventricular ejection fraction <30%, n = 1,135) was analyzed, divided by bilirubin level: ≤0.6 mg/dl, group 1; >0.6 to 1.2 mg/dl, group 2; and >1.2 mg/dl, group 3. Multivariate Cox proportional hazards models were used to determine the association of bilirubin with the risk of sudden or pump failure death. Total bilirubin was entered as a base 2 log-transformed variable (log2 bilirubin), indicating doubling of the bilirubin level corresponding to each increase in variable value. The higher bilirubin groups had a lower ejection fraction (range 19% to 21%), sodium (range 138 to 139 mmol/L), and systolic blood pressure (range 111 to 120 mm Hg), a greater heart rate (range 79 to 81 beats/min), and greater diuretic dosages (range 86 to 110 furosemide-equivalent total daily dose in mg). The overall survival rates declined with increasing bilirubin (24.3, 31.3, and 44.3 deaths per 100 person-years, respectively, for groups 1, 2, and 3). Although a positive relation was seen between log2 bilirubin and both pump failure risk and sudden death risk, the relation in multivariate modeling was significant only for pump failure mortality (hazard ratio 1.47, 95% confidence interval 1.19 to 1.82, p = 0.0004), not for sudden death mortality (hazard ratio 1.21, 95% confidence interval 0.98 to 1.49, p = 0.08). In conclusion, an increasing bilirubin level was significantly associated with the risk of pump failure death but not for sudden death in patients with severe systolic heart failure. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. 49 CFR 172.330 - Tank cars and multi-unit tank car tanks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 2 2013-10-01 2013-10-01 false Tank cars and multi-unit tank car tanks. 172.330..., TRAINING REQUIREMENTS, AND SECURITY PLANS Marking § 172.330 Tank cars and multi-unit tank car tanks. (a... material— (1) In a tank car unless the following conditions are met: (i) The tank car must be marked on...

  5. 49 CFR 172.330 - Tank cars and multi-unit tank car tanks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 2 2012-10-01 2012-10-01 false Tank cars and multi-unit tank car tanks. 172.330..., TRAINING REQUIREMENTS, AND SECURITY PLANS Marking § 172.330 Tank cars and multi-unit tank car tanks. (a... material— (1) In a tank car unless the following conditions are met: (i) The tank car must be marked on...

  6. 49 CFR 172.330 - Tank cars and multi-unit tank car tanks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 2 2014-10-01 2014-10-01 false Tank cars and multi-unit tank car tanks. 172.330..., TRAINING REQUIREMENTS, AND SECURITY PLANS Marking § 172.330 Tank cars and multi-unit tank car tanks. (a... material— (1) In a tank car unless the following conditions are met: (i) The tank car must be marked on...

  7. Finite element modelling of woven composite failure modes at the mesoscopic scale: deterministic versus stochastic approaches

    NASA Astrophysics Data System (ADS)

    Roirand, Q.; Missoum-Benziane, D.; Thionnet, A.; Laiarinandrasana, L.

    2017-09-01

    Textile composites are composed of 3D complex architecture. To assess the durability of such engineering structures, the failure mechanisms must be highlighted. Examinations of the degradation have been carried out thanks to tomography. The present work addresses a numerical damage model dedicated to the simulation of the crack initiation and propagation at the scale of the warp yarns. For the 3D woven composites under study, loadings in tension and combined tension and bending were considered. Based on an erosion procedure of broken elements, the failure mechanisms have been modelled on 3D periodic cells by finite element calculations. The breakage of one element was determined using a failure criterion at the mesoscopic scale based on the yarn stress at failure. The results were found to be in good agreement with the experimental data for the two kinds of macroscopic loadings. The deterministic approach assumed a homogeneously distributed stress at failure all over the integration points in the meshes of woven composites. A stochastic approach was applied to a simple representative elementary periodic cell. The distribution of the Weibull stress at failure was assigned to the integration points using a Monte Carlo simulation. It was shown that this stochastic approach allowed more realistic failure simulations avoiding the idealised symmetry due to the deterministic modelling. In particular, the stochastic simulations performed have shown several variations of the stress as well as strain at failure and the failure modes of the yarn.

  8. Ambulatory heart rate range predicts mode-specific mortality and hospitalisation in chronic heart failure

    PubMed Central

    Cubbon, Richard M; Ruff, Naomi; Groves, David; Eleuteri, Antonio; Denby, Christine; Kearney, Lorraine; Ali, Noman; Walker, Andrew M N; Jamil, Haqeel; Gierula, John; Gale, Chris P; Batin, Phillip D; Nolan, James; Shah, Ajay M; Fox, Keith A A; Sapsford, Robert J; Witte, Klaus K; Kearney, Mark T

    2016-01-01

    Objective We aimed to define the prognostic value of the heart rate range during a 24 h period in patients with chronic heart failure (CHF). Methods Prospective observational cohort study of 791 patients with CHF associated with left ventricular systolic dysfunction. Mode-specific mortality and hospitalisation were linked with ambulatory heart rate range (AHRR; calculated as maximum minus minimum heart rate using 24 h Holter monitor data, including paced and non-sinus complexes) in univariate and multivariate analyses. Findings were then corroborated in a validation cohort of 408 patients with CHF with preserved or reduced left ventricular ejection fraction. Results After a mean 4.1 years of follow-up, increasing AHRR was associated with reduced risk of all-cause, sudden, non-cardiovascular and progressive heart failure death in univariate analyses. After accounting for characteristics that differed between groups above and below median AHRR using multivariate analysis, AHRR remained strongly associated with all-cause mortality (HR 0.991/bpm increase in AHRR (95% CI 0.999 to 0.982); p=0.046). AHRR was not associated with the risk of any non-elective hospitalisation, but was associated with heart-failure-related hospitalisation. AHRR was modestly associated with the SD of normal-to-normal beats (R2=0.2; p<0.001) and with peak exercise-test heart rate (R2=0.33; p<0.001). Analysis of the validation cohort revealed AHRR to be associated with all-cause and mode-specific death as described in the derivation cohort. Conclusions AHRR is a novel and readily available prognosticator in patients with CHF, which may reflect autonomic tone and exercise capacity. PMID:26674986

  9. 49 CFR 174.63 - Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 2 2014-10-01 2014-10-01 false Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car tanks. 174.63 Section 174.63 Transportation Other....63 Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car...

  10. 49 CFR 174.63 - Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car tanks. 174.63 Section 174.63 Transportation Other....63 Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car...

  11. 49 CFR 174.63 - Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 2 2011-10-01 2011-10-01 false Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car tanks. 174.63 Section 174.63 Transportation Other....63 Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car...

  12. 49 CFR 174.63 - Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 2 2013-10-01 2013-10-01 false Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car tanks. 174.63 Section 174.63 Transportation Other....63 Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car...

  13. 49 CFR 174.63 - Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 2 2012-10-01 2012-10-01 false Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car tanks. 174.63 Section 174.63 Transportation Other....63 Portable tanks, IM portable tanks, IBCs, Large Packagings, cargo tanks, and multi-unit tank car...

  14. Development of deep drawn aluminum piston tanks

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Whitehead, J.C.; Bronder, R.L.; Kilgard, L.W.

    1990-06-08

    An aluminum piston tank has been developed for applications requiring lightweight, low cost, low pressure, positive-expulsion liquid storage. The 3 liter (183 in{sup 3}) vessel is made primarily from aluminum sheet, using production forming and joining operations. The development process relied mainly on pressurizing prototype parts and assemblies to failure, as the primary source of decision making information for driving the tank design toward its optimum minimum-mass configuration. Critical issues addressed by development testing included piston operation, strength of thin-walled formed shells, alloy choice, and joining the end cap to the seamless deep drawn can. 9 refs., 8 figs.

  15. How to apply clinical cases and medical literature in the framework of a modified "failure mode and effects analysis" as a clinical reasoning tool--an illustration using the human biliary system.

    PubMed

    Wong, Kam Cheong

    2016-04-06

    Clinicians use various clinical reasoning tools such as Ishikawa diagram to enhance their clinical experience and reasoning skills. Failure mode and effects analysis, which is an engineering methodology in origin, can be modified and applied to provide inputs into an Ishikawa diagram. The human biliary system is used to illustrate a modified failure mode and effects analysis. The anatomical and physiological processes of the biliary system are reviewed. Failure is defined as an abnormality caused by infective, inflammatory, obstructive, malignancy, autoimmune and other pathological processes. The potential failures, their effect(s), main clinical features, and investigation that can help a clinician to diagnose at each anatomical part and physiological process are reviewed and documented in a modified failure mode and effects analysis table. Relevant medical and surgical cases are retrieved from the medical literature and weaved into the table. A total of 80 clinical cases which are relevant to the modified failure mode and effects analysis for the human biliary system have been reviewed and weaved into a designated table. The table is the backbone and framework for further expansion. Reviewing and updating the table is an iterative and continual process. The relevant clinical features in the modified failure mode and effects analysis are then extracted and included in the relevant Ishikawa diagram. This article illustrates an application of engineering methodology in medicine, and it sows the seeds of potential cross-pollination between engineering and medicine. Establishing a modified failure mode and effects analysis can be a teamwork project or self-directed learning process, or a mix of both. Modified failure mode and effects analysis can be deployed to obtain inputs for an Ishikawa diagram which in turn can be used to enhance clinical experiences and clinical reasoning skills for clinicians, medical educators, and students.

  16. Seismic response of elevated rectangular water tanks considering soil structure interaction

    NASA Astrophysics Data System (ADS)

    Visuvasam, J.; Simon, J.; Packiaraj, J. S.; Agarwal, R.; Goyal, L.; Dhingra, V.

    2017-11-01

    The overhead staged water tanks are susceptible for high lateral forces during earthquakes. Due to which, the failure of beam-columns joints, framing elements and toppling of tanks arise. To avoid such failures, they are analyzed and designed for lateral forced induced by devastating earthquakes assuming the base of the structures are fixed and considering functional needs, response reduction, soil types and severity of ground shaking. In this paper, the flexible base was provided as spring stiffness in order to consider the effect of soil properties on the seismic behaviour of water tanks. A linear time history earthquake analysis was performed using SAP2000. Parametric studies have been carried out based on various types of soils such as soft, medium and hard. The soil stiffness values highly influence the time period and base shear of the structure. The ratios of time period of flexible to fixed base and base shear of flexible to fixed base were observed against capacities of water tank and the overall height of the system. The both responses are found to be increased as the flexibility of soil medium decreases

  17. Memories and NASA Spacecraft: A Description of Memories, Radiation Failure Modes, and System Design Considerations

    NASA Technical Reports Server (NTRS)

    LaBel, Kenneth A.; Ladbury, Ray; Oldhamm, Timothy

    2010-01-01

    As NASA has evolved it's usage of spaceflight computing, memory applications have followed as well. In this slide presentation, the history of NASA's memories from magnetic core and tape recorders to current semiconductor approaches is discussed. There is a brief description of current functional memory usage in NASA space systems followed by a description of potential radiation-induced failure modes along with considerations for reliable system design.

  18. Numerical Model for the Study of the Strength and Failure Modes of Rock Containing Non-Persistent Joints

    NASA Astrophysics Data System (ADS)

    Vergara, Maximiliano R.; Van Sint Jan, Michel; Lorig, Loren

    2016-04-01

    The mechanical behavior of rock containing parallel non-persistent joint sets was studied using a numerical model. The numerical analysis was performed using the discrete element software UDEC. The use of fictitious joints allowed the inclusion of non-persistent joints in the model domain and simulating the progressive failure due to propagation of existing fractures. The material and joint mechanical parameters used in the model were obtained from experimental results. The results of the numerical model showed good agreement with the strength and failure modes observed in the laboratory. The results showed the large anisotropy in the strength resulting from variation of the joint orientation. Lower strength of the specimens was caused by the coalescence of fractures belonging to parallel joint sets. A correlation was found between geometrical parameters of the joint sets and the contribution of the joint sets strength in the global strength of the specimen. The results suggest that for the same dip angle with respect to the principal stresses; the uniaxial strength depends primarily on the joint spacing and the angle between joints tips and less on the length of the rock bridges (persistency). A relation between joint geometrical parameters was found from which the resulting failure mode can be predicted.

  19. Fracture resistance and failure mode of posterior fixed dental prostheses fabricated with two zirconia CAD/CAM systems

    PubMed Central

    López-Suárez, Carlos; Gonzalo, Esther; Peláez, Jesús; Rodríguez, Verónica

    2015-01-01

    Background In recent years there has been an improvement of zirconia ceramic materials to replace posterior missing teeth. To date little in vitro studies has been carried out on the fracture resistance of zirconia veneered posterior fixed dental prostheses. This study investigated the fracture resistance and the failure mode of 3-unit zirconia-based posterior fixed dental prostheses fabricated with two CAD/CAM systems. Material and Methods Twenty posterior fixed dental prostheses were studied. Samples were randomly divided into two groups (n=10 each) according to the zirconia ceramic analyzed: Lava and Procera. Specimens were loaded until fracture under static load. Data were analyzed using Wilcoxon´s rank sum test and Wilcoxon´s signed-rank test (P<0.05). Results Partial fracture of the veneering porcelain occurred in 100% of the samples. Within each group, significant differences were shown between the veneering and the framework fracture resistance (P=0.002). The failure occurred in the connector cervical area in 80% of the cases. Conclusions All fracture load values of the zirconia frameworks could be considered clinically acceptable. The connector area is the weak point of the restorations. Key words:Fixed dental prostheses, zirconium-dioxide, zirconia, fracture resistance, failure mode. PMID:26155341

  20. Oscillations in the reduction of permanganate by hydrogen peroxide or by ninhydrin in a batch reactor and mixed-mode oscillations in a continuous-flow stirred tank reactor

    NASA Astrophysics Data System (ADS)

    Tóthová, Mária; Nagy, Arpád; Treindl, Ľudovít.

    1999-01-01

    The periodical reduction of permanganate by hydrogen peroxide or by ninhydrin with transient oscillations in a closed system has been observed and discussed in relation to the first two permanganate oscillators described earlier. The mixed-mode oscillations of the permanganate-H 2O 2 oscillating system in a continuous-flow stirred tank reactor have been described.

  1. Suppression of Material Failure Modes in Titanium Armors

    DTIC Science & Technology

    2003-12-01

    Little follow-on work with larger threats was conducted due to the prohibitive cost of the titanium. Recently, the U.S. Army Tank-Automotive Research...PRETORIA 0001 SOUTH AFRICA 1 BATTELLE INGENIEURTECHNIKGMBH W FUCKE DUESSELDORFFER STR 9 D 65760 ESCHBORN GERMANY 1 CARLOS III

  2. Failure Analysis of a Helicopter External Fuel-Tank Pylon

    NASA Technical Reports Server (NTRS)

    Newman, John A.; Piascik, Robert S.; Lindenberg, Richard A.

    2002-01-01

    An eight-inch-long (0.2 m) crack was found in an external fuel-tank pylon of a U.S. Coast Guard HH-60 helicopter. The damaged pylon was removed from service and destructively examined at NASA Langley Research Center (LaRC) to determine the cause of the crack. Results of the analysis revealed that crack initiation occurred at corrosion pits in a fastener hole and crack propagation was a result of cyclic loading.

  3. Meteorological Satellites (METSAT) and Earth Observing System (EOS) Advanced Microwave Sounding Unit-A (AMSU-A) Failure Modes and Effects Analysis (FMEA) and Critical Items List (CIL)

    NASA Technical Reports Server (NTRS)

    1996-01-01

    This Failure Modes and Effects Analysis (FMEA) is for the Advanced Microwave Sounding Unit-A (AMSU-A) instruments that are being designed and manufactured for the Meteorological Satellites Project (METSAT) and the Earth Observing System (EOS) integrated programs. The FMEA analyzes the design of the METSAT and EOS instruments as they currently exist. This FMEA is intended to identify METSAT and EOS failure modes and their effect on spacecraft-instrument and instrument-component interfaces. The prime objective of this FMEA is to identify potential catastrophic and critical failures so that susceptibility to the failures and their effects can be eliminated from the METSAT/EOS instruments.

  4. Outcomes of a Failure Mode and Effects Analysis for medication errors in pediatric anesthesia.

    PubMed

    Martin, Lizabeth D; Grigg, Eliot B; Verma, Shilpa; Latham, Gregory J; Rampersad, Sally E; Martin, Lynn D

    2017-06-01

    The Institute of Medicine has called for development of strategies to prevent medication errors, which are one important cause of preventable harm. Although the field of anesthesiology is considered a leader in patient safety, recent data suggest high medication error rates in anesthesia practice. Unfortunately, few error prevention strategies for anesthesia providers have been implemented. Using Toyota Production System quality improvement methodology, a multidisciplinary team observed 133 h of medication practice in the operating room at a tertiary care freestanding children's hospital. A failure mode and effects analysis was conducted to systematically deconstruct and evaluate each medication handling process step and score possible failure modes to quantify areas of risk. A bundle of five targeted countermeasures were identified and implemented over 12 months. Improvements in syringe labeling (73 to 96%), standardization of medication organization in the anesthesia workspace (0 to 100%), and two-provider infusion checks (23 to 59%) were observed. Medication error reporting improved during the project and was subsequently maintained. After intervention, the median medication error rate decreased from 1.56 to 0.95 per 1000 anesthetics. The frequency of medication error harm events reaching the patient also decreased. Systematic evaluation and standardization of medication handling processes by anesthesia providers in the operating room can decrease medication errors and improve patient safety. © 2017 John Wiley & Sons Ltd.

  5. Global Failure Modes in Composite Structures

    NASA Technical Reports Server (NTRS)

    Knauss, W. G.; Gonzalez, Luis

    2001-01-01

    Composite materials provide well-known advantages for space and aeronautical applications in terms of strength and rigidity to weight ratios and other mechanical properties. As a consequence, their use has experienced a constant increase in the past decades and it is anticipated that this trend will be maintained in the near future. At the same time, being these materials relatively new compared to metals, and having failure characteristics completely different from them, their damage growth and their failure mechanisms are not as well understood in a predictive sense. For example, while in metals fracture produces "clean" cracks with their well defined analytically stress fields at the crack tip, composite fracture is a more complex phenomenon. Instead of a crack, we confront a "damage zone" that may include fiber breakage, fiber microbuckling, fiber pullout, matrix cracking, delamination, debonding or any combination of all these different mechanisms. These phenomena are prevalent in any failure process through an aircraft structure, whether one addresses a global failure such as the ripping of a fuselage or wing section, or whether one is concerned with the failure initiation near a thickness change at stringers or other reinforcement. Thus the topic that has been under consideration has wide application in any real structure and is considered an essential contribution to the predictive failure analysis capability for aircraft containing composite components. The heterogeneity and the anisotropy of composites are not only advantageous but essential characteristics, yet these same features provide complex stress fields, especially in the presence of geometrical discontinuities such as notches, holes or cutouts or structural elements such as stiffeners, stringers, etc. To properly address the interaction between a damage/crack front and a hole with a stringer it is imperative that the stress and deformation fields of the former be (sufficiently well) characterized

  6. Ambulatory heart rate range predicts mode-specific mortality and hospitalisation in chronic heart failure.

    PubMed

    Cubbon, Richard M; Ruff, Naomi; Groves, David; Eleuteri, Antonio; Denby, Christine; Kearney, Lorraine; Ali, Noman; Walker, Andrew M N; Jamil, Haqeel; Gierula, John; Gale, Chris P; Batin, Phillip D; Nolan, James; Shah, Ajay M; Fox, Keith A A; Sapsford, Robert J; Witte, Klaus K; Kearney, Mark T

    2016-02-01

    We aimed to define the prognostic value of the heart rate range during a 24 h period in patients with chronic heart failure (CHF). Prospective observational cohort study of 791 patients with CHF associated with left ventricular systolic dysfunction. Mode-specific mortality and hospitalisation were linked with ambulatory heart rate range (AHRR; calculated as maximum minus minimum heart rate using 24 h Holter monitor data, including paced and non-sinus complexes) in univariate and multivariate analyses. Findings were then corroborated in a validation cohort of 408 patients with CHF with preserved or reduced left ventricular ejection fraction. After a mean 4.1 years of follow-up, increasing AHRR was associated with reduced risk of all-cause, sudden, non-cardiovascular and progressive heart failure death in univariate analyses. After accounting for characteristics that differed between groups above and below median AHRR using multivariate analysis, AHRR remained strongly associated with all-cause mortality (HR 0.991/bpm increase in AHRR (95% CI 0.999 to 0.982); p=0.046). AHRR was not associated with the risk of any non-elective hospitalisation, but was associated with heart-failure-related hospitalisation. AHRR was modestly associated with the SD of normal-to-normal beats (R(2)=0.2; p<0.001) and with peak exercise-test heart rate (R(2)=0.33; p<0.001). Analysis of the validation cohort revealed AHRR to be associated with all-cause and mode-specific death as described in the derivation cohort. AHRR is a novel and readily available prognosticator in patients with CHF, which may reflect autonomic tone and exercise capacity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. Spherical Cryogenic Hydrogen Tank Preliminary Design Trade Studies

    NASA Technical Reports Server (NTRS)

    Arnold, Steven M.; Bednarcyk, Brett A.; Collier, Craig S.; Yarrington, Phillip W.

    2007-01-01

    A structural analysis, sizing optimization, and weight prediction study was performed by Collier Research Corporation and NASA Glenn on a spherical cryogenic hydrogen tank. The tank consisted of an inner and outer wall separated by a vacuum for thermal insulation purposes. HyperSizer (Collier Research and Development Corporation), a commercial automated structural analysis and sizing software package was used to design the lightest feasible tank for a given overall size and thermomechanical loading environment. Weight trade studies were completed for different panel concepts and metallic and composite material systems. Extensive failure analyses were performed for each combination of dimensional variables, materials, and layups to establish the structural integrity of tank designs. Detailed stress and strain fields were computed from operational temperature changes and pressure loads. The inner tank wall is sized by the resulting biaxial tensile stresses which cause it to be strength driven, and leads to an optimum panel concept that need not be stiffened. Conversely, the outer tank wall is sized by a biaxial compressive stress field, induced by the pressure differential between atmospheric pressure and the vacuum between the tanks, thereby causing the design to be stability driven and thus stiffened to prevent buckling. Induced thermal stresses become a major sizing driver when a composite or hybrid composite/metallic material systems are used for the inner tank wall for purposes such as liners to contain the fuel and reduce hydrogen permeation.

  8. Decentralized Sliding Mode Observer Based Dual Closed-Loop Fault Tolerant Control for Reconfigurable Manipulator against Actuator Failure.

    PubMed

    Zhao, Bo; Li, Chenghao; Liu, Derong; Li, Yuanchun

    2015-01-01

    This paper considers a decentralized fault tolerant control (DFTC) scheme for reconfigurable manipulators. With the appearance of norm-bounded failure, a dual closed-loop trajectory tracking control algorithm is proposed on the basis of the Lyapunov stability theory. Characterized by the modularization property, the actuator failure is estimated by the proposed decentralized sliding mode observer (DSMO). Moreover, the actuator failure can be treated in view of the local joint information, so its control performance degradation is independent of other normal joints. In addition, the presented DFTC scheme is significantly simplified in terms of the structure of the controller due to its dual closed-loop architecture, and its feasibility is highly reflected in the control of reconfigurable manipulators. Finally, the effectiveness of the proposed DFTC scheme is demonstrated using simulations.

  9. Decentralized Sliding Mode Observer Based Dual Closed-Loop Fault Tolerant Control for Reconfigurable Manipulator against Actuator Failure

    PubMed Central

    Zhao, Bo; Li, Yuanchun

    2015-01-01

    This paper considers a decentralized fault tolerant control (DFTC) scheme for reconfigurable manipulators. With the appearance of norm-bounded failure, a dual closed-loop trajectory tracking control algorithm is proposed on the basis of the Lyapunov stability theory. Characterized by the modularization property, the actuator failure is estimated by the proposed decentralized sliding mode observer (DSMO). Moreover, the actuator failure can be treated in view of the local joint information, so its control performance degradation is independent of other normal joints. In addition, the presented DFTC scheme is significantly simplified in terms of the structure of the controller due to its dual closed-loop architecture, and its feasibility is highly reflected in the control of reconfigurable manipulators. Finally, the effectiveness of the proposed DFTC scheme is demonstrated using simulations. PMID:26181826

  10. Optimization of armored spherical tanks for storage on the lunar surface

    NASA Technical Reports Server (NTRS)

    Bents, D. J.; Knight, D. A.

    1992-01-01

    A redundancy strategy for reducing micrometeroid armoring mass is investigated, with application to cryogenic reactant storage for a regenerative fuel cell (RFC) on the lunar surface. In that micrometeoroid environment, the cryogenic fuel must be protected from loss due to tank puncture. The tankage must have a sufficiently high probability of survival over the length of the mission so that the probability of system failure due to tank puncture is low compared to the other mission risk factors. Assuming that a single meteoroid penetration can cause a storage tank to lose its contents, two means are available to raise the probability of surviving micrometeoroid attack to the desired level. One can armor the tanks to a thickness sufficient to reduce probability of penetration of any tank to the desired level or add extra capacity in the form of space tanks that results in survival of a given number out of the ensemble at the desired level. A combination of these strategies (armor and redundancy) is investigated.

  11. Effect of Different Groundwater Levels on Seismic Dynamic Response and Failure Mode of Sandy Slope

    PubMed Central

    Huang, Shuai; Lv, Yuejun; Peng, Yanju; Zhang, Lifang; Xiu, Liwei

    2015-01-01

    Heavy seismic damage tends to occur in slopes when groundwater is present. The main objectives of this paper are to determine the dynamic response and failure mode of sandy slope subjected simultaneously to seismic forces and variable groundwater conditions. This paper applies the finite element method, which is a fast and efficient design tool in modern engineering analysis, to evaluate dynamic response of the slope subjected simultaneously to seismic forces and variable groundwater conditions. Shaking table test is conducted to analyze the failure mode and verify the accuracy of the finite element method results. The research results show that dynamic response values of the slope have different variation rules under near and far field earthquakes. And the damage location and pattern of the slope are different in varying groundwater conditions. The destruction starts at the top of the slope when the slope is in no groundwater, which shows that the slope appears obvious whipping effect under the earthquake. The destruction starts at the toe of the slope when the slope is in the high groundwater levels. Meanwhile, the top of the slope shows obvious seismic subsidence phenomenon after earthquake. Furthermore, the existence of the groundwater has a certain effect of damping. PMID:26560103

  12. Comprehensive protocol of traceability during IVF: the result of a multicentre failure mode and effect analysis.

    PubMed

    Rienzi, L; Bariani, F; Dalla Zorza, M; Albani, E; Benini, F; Chamayou, S; Minasi, M G; Parmegiani, L; Restelli, L; Vizziello, G; Costa, A Nanni

    2017-08-01

    Can traceability of gametes and embryos be ensured during IVF? The use of a simple and comprehensive traceability system that includes the most susceptible phases during the IVF process minimizes the risk of mismatches. Mismatches in IVF are very rare but unfortunately possible with dramatic consequences for both patients and health care professionals. Traceability is thus a fundamental aspect of the treatment. A clear process of patient and cell identification involving witnessing protocols has to be in place in every unit. To identify potential failures in the traceability process and to develop strategies to mitigate the risk of mismatches, previously failure mode and effects analysis (FMEA) has been used effectively. The FMEA approach is however a subjective analysis, strictly related to specific protocols and thus the results are not always widely applicable. To reduce subjectivity and to obtain a widespread comprehensive protocol of traceability, a multicentre centrally coordinated FMEA was performed. Seven representative Italian centres (three public and four private) were selected. The study had a duration of 21 months (from April 2015 to December 2016) and was centrally coordinated by a team of experts: a risk analysis specialist, an expert embryologist and a specialist in human factor. Principal investigators of each centre were first instructed about proactive risk assessment and FMEA methodology. A multidisciplinary team to perform the FMEA analysis was then formed in each centre. After mapping the traceability process, each team identified the possible causes of mistakes in their protocol. A risk priority number (RPN) for each identified potential failure mode was calculated. The results of the FMEA analyses were centrally investigated and consistent corrective measures suggested. The teams performed new FMEA analyses after the recommended implementations. In each centre, this study involved: the laboratory director, the Quality Control & Quality

  13. Using failure mode and effects analysis to improve the safety of neonatal parenteral nutrition.

    PubMed

    Arenas Villafranca, Jose Javier; Gómez Sánchez, Araceli; Nieto Guindo, Miriam; Faus Felipe, Vicente

    2014-07-15

    Failure mode and effects analysis (FMEA) was used to identify potential errors and to enable the implementation of measures to improve the safety of neonatal parenteral nutrition (PN). FMEA was used to analyze the preparation and dispensing of neonatal PN from the perspective of the pharmacy service in a general hospital. A process diagram was drafted, illustrating the different phases of the neonatal PN process. Next, the failures that could occur in each of these phases were compiled and cataloged, and a questionnaire was developed in which respondents were asked to rate the following aspects of each error: incidence, detectability, and severity. The highest scoring failures were considered high risk and identified as priority areas for improvements to be made. The evaluation process detected a total of 82 possible failures. Among the phases with the highest number of possible errors were transcription of the medical order, formulation of the PN, and preparation of material for the formulation. After the classification of these 82 possible failures and of their relative importance, a checklist was developed to achieve greater control in the error-detection process. FMEA demonstrated that use of the checklist reduced the level of risk and improved the detectability of errors. FMEA was useful for detecting medication errors in the PN preparation process and enabling corrective measures to be taken. A checklist was developed to reduce errors in the most critical aspects of the process. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  14. Matrix Failure Modes and Effects Analysis as a Knowledge Base for a Real Time Automated Diagnosis Expert System

    NASA Technical Reports Server (NTRS)

    Herrin, Stephanie; Iverson, David; Spukovska, Lilly; Souza, Kenneth A. (Technical Monitor)

    1994-01-01

    Failure Modes and Effects Analysis contain a wealth of information that can be used to create the knowledge base required for building automated diagnostic Expert systems. A real time monitoring and diagnosis expert system based on an actual NASA project's matrix failure modes and effects analysis was developed. This Expert system Was developed at NASA Ames Research Center. This system was first used as a case study to monitor the Research Animal Holding Facility (RAHF), a Space Shuttle payload that is used to house and monitor animals in orbit so the effects of space flight and microgravity can be studied. The techniques developed for the RAHF monitoring and diagnosis Expert system are general enough to be used for monitoring and diagnosis of a variety of other systems that undergo a Matrix FMEA. This automated diagnosis system was successfully used on-line and validated on the Space Shuttle flight STS-58, mission SLS-2 in October 1993.

  15. Rock-bed thermocline storage: A numerical analysis of granular bed behavior and interaction with storage tank

    NASA Astrophysics Data System (ADS)

    Sassine, Nahia; Donzé, Frédéric-Victor; Bruch, Arnaud; Harthong, Barthélemy

    2017-06-01

    Thermal Energy Storage (TES) systems are central elements of various types of power plants operated using renewable energy sources. Packed bed TES can be considered as a cost-effective solution in concentrated solar power plants (CSP). Such a device is made up of a tank filled with a granular bed through which heat-transfer fluid circulates. However, in such devices, the tank might be subjected to catastrophic failure induced by a mechanical phenomenon known as thermal ratcheting. Thermal stresses are accumulated during cycles of loading and unloading until the failure happens. This paper aims at studying the evolution of tank wall stresses over granular bed thermal cycles, taking into account both thermal and mechanical loads, with a numerical model based on the discrete element method (DEM). Simulations were performed to study two different thermal configurations: (i) the tank is heated homogenously along its height or (ii) with a vertical gradient of temperature. Then, the resulting loading stresses applied on the tank are compared as well the response of the internal granular material.

  16. Random safety auditing, root cause analysis, failure mode and effects analysis.

    PubMed

    Ursprung, Robert; Gray, James

    2010-03-01

    Improving quality and safety in health care is a major concern for health care providers, the general public, and policy makers. Errors and quality issues are leading causes of morbidity and mortality across the health care industry. There is evidence that patients in the neonatal intensive care unit (NICU) are at high risk for serious medical errors. To facilitate compliance with safe practices, many institutions have established quality-assurance monitoring procedures. Three techniques that have been found useful in the health care setting are failure mode and effects analysis, root cause analysis, and random safety auditing. When used together, these techniques are effective tools for system analysis and redesign focused on providing safe delivery of care in the complex NICU system. Copyright 2010 Elsevier Inc. All rights reserved.

  17. Assessment of Technologies for the Space Shuttle External Tank Thermal Protection System and Recommendations for Technology Improvement - Part III: Material Property Characterization, Analysis, and Test Methods

    NASA Technical Reports Server (NTRS)

    Gates, Thomas S.; Johnson, Theodore F.; Whitley, Karen S.

    2005-01-01

    The objective of this report is to contribute to the independent assessment of the Space Shuttle External Tank Foam Material. This report specifically addresses material modeling, characterization testing, data reduction methods, and data pedigree. A brief description of the External Tank foam materials, locations, and standard failure modes is provided to develop suitable background information. A review of mechanics based analysis methods from the open literature is used to provide an assessment of the state-of-the-art in material modeling of closed cell foams. Further, this report assesses the existing material property database and investigates sources of material property variability. The report presents identified deficiencies in testing methods and procedures, recommendations for additional testing as required, identification of near-term improvements that should be pursued, and long-term capabilities or enhancements that should be developed.

  18. Failure modes of single and multi-bolted joint in the pultruded fiber reinforced polymer composite members

    NASA Astrophysics Data System (ADS)

    Kim, S. Y.; Yoo, J. H.; Kim, H. K.; Shin, K. Y.; Yoon, S. J.

    2018-06-01

    In this paper, we discussed the structural behavior of bolted lap-joint connections in pultruded FRP structural members. Especially, bolted connections in pultruded FRP members are investigated for their failure modes and strength. Specimens with single and multiple bolt-holes are tested in tension under bolt-loading conditions. All of the specimens are instrumented with strain gages and the load-strain responses are monitored. The failed specimens are examined for the cracks and failure patterns. The purpose of this paper is to predict the failure strength by using the ratio of the results obtained by the experiment and the finite element analysis. In the study, several tests are conducted to determine the mechanical properties of pultruded FRP materials before the main experiment. The results are used in the finite element analysis for single and multiple bolted lap-joint specimens. The results obtained by the experiment are compared with the results obtained by the finite element analysis.

  19. Tensile failure criteria for fiber composite materials

    NASA Technical Reports Server (NTRS)

    Rosen, B. W.; Zweben, C. H.

    1972-01-01

    The analysis provides insight into the failure mechanics of these materials and defines criteria which serve as tools for preliminary design material selection and for material reliability assessment. The model incorporates both dispersed and propagation type failures and includes the influence of material heterogeneity. The important effects of localized matrix damage and post-failure matrix shear stress transfer are included in the treatment. The model is used to evaluate the influence of key parameters on the failure of several commonly used fiber-matrix systems. Analyses of three possible failure modes were developed. These modes are the fiber break propagation mode, the cumulative group fracture mode, and the weakest link mode. Application of the new model to composite material systems has indicated several results which require attention in the development of reliable structural composites. Prominent among these are the size effect and the influence of fiber strength variability.

  20. Computer modeling of tank track elastomers

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Lesuer, D.R.; Goldberg, A.; Patt, J.

    Computer models of the T142, T156 and the British Chieftain tank tracks have been studied as part of a program to examine the tank-track-pad failure problem. The modeling is based on the finite element method with two different models being used to evaluate the thermal and mechanical response of the tracks. Modeling has enabled us to evaluate the influence of track design, elastomer formulation and operating scenario on the response of the track. the results of these analyses have been evaluated with experimental tests that quantify the extent of damage development in elastomers and thus indicate the likelihood of padmore » failure due to ''cutting and chunking.'' The primary characteristics influencing the temperatures achieved in the track are the heat-generation rate and the track geometry. The heat-generation rate is related to the viscoelastic material properties of the elastomer, track design and loading/operating scenario. For all designs and materials studied, stresses produced during contact with a flat roadway surface were not considered large enough to damage the pad. Operating scenarios were studied in which the track pad contacts rigid bars representing idealized obstacles in cross country terrain. A highly localized obstacle showed the possibility for subsurface mechanical damage to the track pad due to obstacle contact. Contact with a flat rigid bar produced higher tensile stresses that were near the damage thresholds for this material and thus capable of producing cutting and chunking failures.« less

  1. Runtime and Pressurization Analyses of Propellant Tanks

    NASA Technical Reports Server (NTRS)

    Field, Robert E.; Ryan, Harry M.; Ahuja, Vineet; Hosangadi, Ashvin; Lee, Chung P.

    2007-01-01

    Multi-element unstructured CFD has been utilized at NASA SSC to carry out analyses of propellant tank systems in different modes of operation. The three regimes of interest at SSC include (a) tank chill down (b) tank pressurization and (c) runtime propellant draw-down and purge. While tank chill down is an important event that is best addressed with long time-scale heat transfer calculations, CFD can play a critical role in the tank pressurization and runtime modes of operation. In these situations, problems with contamination of the propellant by inclusion of the pressurant gas from the ullage causes a deterioration of the quality of the propellant delivered to the test article. CFD can be used to help quantify the mixing and propellant degradation. During tank pressurization under some circumstances, rapid mixing of relatively warm pressurant gas with cryogenic propellant can lead to rapid densification of the gas and loss of pressure in the tank. This phenomenon can cause serious problems during testing because of the resulting decrease in propellant flow rate. With proper physical models implemented, CFD can model the coupling between the propellant and pressurant including heat transfer and phase change effects and accurately capture the complex physics in the evolving flowfields. This holds the promise of allowing the specification of operational conditions and procedures that could minimize the undesirable mixing and heat transfer inherent in propellant tank operation. It should be noted that traditional CFD modeling is inadequate for such simulations because the fluids in the tank are in a range of different sub-critical and supercritical states and elaborate phase change and mixing rules have to be developed to accurately model the interaction between the ullage gas and the propellant. We show a typical run-time simulation of a spherical propellant tank, containing RP-1 in this case, being pressurized with room-temperature nitrogen at 540 R. Nitrogen

  2. Shuttle Gaseous Hydrogen Venting Risk from Flow Control Valve Failure

    NASA Technical Reports Server (NTRS)

    Drummond, J. Philip; Baurle, Robert A.; Gafney, Richard L.; Norris, Andrew T.; Pellett, Gerald L.; Rock, Kenneth E.

    2009-01-01

    This paper describes a series of studies to assess the potential risk associated with the failure of one of three gaseous hydrogen flow control valves in the orbiter's main propulsion system during the launch of Shuttle Endeavour (STS-126) in November 2008. The studies focused on critical issues associated with the possibility of combustion resulting from release of gaseous hydrogen from the external tank into the atmosphere during assent. The Shuttle Program currently assumes hydrogen venting from the external tank will result in a critical failure. The current effort was conducted to increase understanding of the risk associated with venting hydrogen given the flow control valve failure scenarios being considered in the Integrated In-Flight Anomaly Investigation being conducted by NASA.

  3. Fluid-structure interaction analysis of the drop impact test for helicopter fuel tank.

    PubMed

    Yang, Xianfeng; Zhang, Zhiqiang; Yang, Jialing; Sun, Yuxin

    2016-01-01

    The crashworthiness of helicopter fuel tank is vital to the survivability of the passengers and structures. In order to understand and improve the crashworthiness of the soft fuel tank of helicopter during the crash, this paper investigated the dynamic behavior of the nylon woven fabric composite fuel tank striking on the ground. A fluid-structure interaction finite element model of the fuel tank based on the arbitrary Lagrangian-Eulerian method was constructed to elucidate the dynamic failure behavior. The drop impact tests were conducted to validate the accuracy of the numerical simulation. Good agreement was achieved between the experimental and numerical results of the impact force with the ground. The influences of the impact velocity, the impact angle, the thickness of the fuel tank wall and the volume fraction of water on the dynamic responses of the dropped fuel tank were studied. The results indicated that the corner of the fuel tank is the most vulnerable location during the impact with ground.

  4. Nanowire failure: long = brittle and short = ductile.

    PubMed

    Wu, Zhaoxuan; Zhang, Yong-Wei; Jhon, Mark H; Gao, Huajian; Srolovitz, David J

    2012-02-08

    Experimental studies of the tensile behavior of metallic nanowires show a wide range of failure modes, ranging from ductile necking to brittle/localized shear failure-often in the same diameter wires. We performed large-scale molecular dynamics simulations of copper nanowires with a range of nanowire lengths and provide unequivocal evidence for a transition in nanowire failure mode with change in nanowire length. Short nanowires fail via a ductile mode with serrated stress-strain curves, while long wires exhibit extreme shear localization and abrupt failure. We developed a simple model for predicting the critical nanowire length for this failure mode transition and showed that it is in excellent agreement with both the simulation results and the extant experimental data. The present results provide a new paradigm for the design of nanoscale mechanical systems that demarcates graceful and catastrophic failure. © 2012 American Chemical Society

  5. Mechanical failure modes of chronically implanted planar silicon-based neural probes for laminar recording

    PubMed Central

    Kozai, Takashi D. Y.; Catt, Kasey; Li, Xia; Gugel, Zhannetta V.; Olafsson, Valur T.; Vazquez, Alberto L.; Cui, X. Tracy

    2014-01-01

    Penetrating intracortical electrode arrays that record brain activity longitudinally are powerful tools for basic neuroscience research and emerging clinical applications. However, regardless of the technology used, signals recorded by these electrodes degrade over time. The failure mechanisms of these electrodes are understood to be a complex combination of the biological reactive tissue response and material failure of the device over time. While mechanical mismatch between the brain tissue and implanted neural electrodes have been studied as a source of chronic inflammation and performance degradation, the electrode failure caused by mechanical mismatch between different material properties and different structural components within a device have remained poorly characterized. Using Finite Element Model (FEM) we simulate the mechanical strain on a planar silicon electrode. The results presented here demonstrate that mechanical mismatch between iridium and silicon leads to concentrated strain along the border of the two materials. This strain is further focused on small protrusions such as the electrical traces in planar silicon electrodes. These findings are confirmed with chronic in vivo data (133–189 days) in mice by correlating a combination of single-unit electrophysiology, evoked multi-unit recordings, electrochemical impedance spectroscopy, and scanning electron microscopy from traces and electrode sites with our modeling data. Several modes of mechanical failure of chronically implanted planar silicon electrodes are found that result in degradation and/or loss of recording. These findings highlight the importance of strains and material properties of various subcomponents within an electrode array. PMID:25453935

  6. Application of Function-Failure Similarity Method to Rotorcraft Component Design

    NASA Technical Reports Server (NTRS)

    Roberts, Rory A.; Stone, Robert E.; Tumer, Irem Y.; Clancy, Daniel (Technical Monitor)

    2002-01-01

    Performance and safety are the top concerns of high-risk aerospace applications at NASA. Eliminating or reducing performance and safety problems can be achieved with a thorough understanding of potential failure modes in the designs that lead to these problems. The majority of techniques use prior knowledge and experience as well as Failure Modes and Effects as methods to determine potential failure modes of aircraft. During the design of aircraft, a general technique is needed to ensure that every potential failure mode is considered, while avoiding spending time on improbable failure modes. In this work, this is accomplished by mapping failure modes to specific components, which are described by their functionality. The failure modes are then linked to the basic functions that are carried within the components of the aircraft. Using this technique, designers can examine the basic functions, and select appropriate analyses to eliminate or design out the potential failure modes. The fundamentals of this method were previously introduced for a simple rotating machine test rig with basic functions that are common to a rotorcraft. In this paper, this technique is applied to the engine and power train of a rotorcraft, using failures and functions obtained from accident reports and engineering drawings.

  7. Structural Continuum Modeling of Space Shuttle External Tank Foam Insulation

    NASA Technical Reports Server (NTRS)

    Steeve, Brian; Ayala, Sam; Purlee, T. Eric; Shaw, Phillip

    2006-01-01

    This document is a viewgraph presentation reporting on work in modeling the foam insulation of the Space Shuttle External Tank. An analytical understanding of foam mechanics is required to design against structural failure. The Space Shuttle External Tank is covered primarily with closed cell foam to: Prevent ice, Protect structure from ascent aerodynamic and engine plume heating, and Delay break-up during re-entry. It is important that the foam does not shed unacceptable debris during ascent environment. Therefore a modeling of the foam insulation was undertaken.

  8. Risk management for outsourcing biomedical waste disposal – Using the failure mode and effects analysis

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Liao, Ching-Jong; Ho, Chao Chung, E-mail: ho919@pchome.com.tw

    Highlights: • This study is based on a real case in hospital in Taiwan. • We use Failure Mode and Effects Analysis (FMEA) as the evaluation method. • We successfully identify the evaluation factors of bio-medical waste disposal risk. - Abstract: Using the failure mode and effects analysis, this study examined biomedical waste companies through risk assessment. Moreover, it evaluated the supervisors of biomedical waste units in hospitals, and factors relating to the outsourcing risk assessment of biomedical waste in hospitals by referring to waste disposal acts. An expert questionnaire survey was conducted on the personnel involved in waste disposalmore » units in hospitals, in order to identify important factors relating to the outsourcing risk of biomedical waste in hospitals. This study calculated the risk priority number (RPN) and selected items with an RPN value higher than 80 for improvement. These items included “availability of freezing devices”, “availability of containers for sharp items”, “disposal frequency”, “disposal volume”, “disposal method”, “vehicles meeting the regulations”, and “declaration of three lists”. This study also aimed to identify important selection factors of biomedical waste disposal companies by hospitals in terms of risk. These findings can serve as references for hospitals in the selection of outsourcing companies for biomedical waste disposal.« less

  9. Mechanical behavior and localized failure modes in a porous basalt from the Azores

    NASA Astrophysics Data System (ADS)

    Loaiza, S.; Fortin, J.; Schubnel, A.; Guéguen, Y.; Moreira, M.; Vinciguerra, S.

    2012-04-01

    Basaltic rocks are the main component of the oceanic upper crust. This is of potential interest for water and geothermal resources, or for storage of CO2. The aim of our work is to investigate experimentally the mechanical behavior and the failure modes of porous basalt as well as the permeability evolution during deformation. Cylindrical basalt samples, from the Azores, of 30 mm in diameter and 60 mm in length were deformed the triaxial cell of the Laboratoire de Geologie at the Ecole Normale Supérieure (Paris) at room temperature and at a constant axial strain rate of 10-5 s-1. The initial porosity of the sample was 18%. The Geodesign triaxial cell can reach 300MPa confining pressure; axial load is performed through a piston and can reach 900 MPa (for a 30mm diameter sample); maximum pore pressure is 100MPa (applied using two precision volumetric pumps). In our study, a set of experiments were performed at confining pressure in the range of 25-290 MPa. The samples were deformed under saturated conditions at a constant pore pressure of 5MPa. Two volumetric pumps kept the pore pressure constant, and the pore volume variations were recorded. The evolution of the porosity was calculated from the total volume variation inside the volumetric pumps. Permeability measurements were performed using the steady-state technique. Our result shows that two modes of deformation can be highlighted in this basalt. At low confining pressure (Pc < 50 MPa), the differential stress attains a peak before the sample undergoes strain softening; the failure of sample occurs by shear localization. Yet, the brittle regime is commonly observed in this low Pc range, the experiments performed at confining pressure higher than 50 MPa, show a totally different mode of deformation. In this second mode of deformation, an appreciable inelastic porosity reduction is observed. Comparing to the hydrostatic loading, the rock sample started to compact beyond a critical stress state; and from then

  10. Modification of a liquid hydrogen tank for integrated refrigeration and storage

    NASA Astrophysics Data System (ADS)

    Swanger, A. M.; Jumper, K. M.; Fesmire, J. E.; Notardonato, W. U.

    2015-12-01

    The modification and outfitting of a 125,000-liter liquid hydrogen tank was performed to provide integrated refrigeration and storage capability. These functions include zero boil-off, liquefaction, and densification and therefore require provisions for sub-atmospheric tank pressures within the vacuum-jacketed, multilayer insulated tank. The primary structural modification was to add stiffening rings inside the inner vessel. The internal stiffening rings were designed, built, and installed per the ASME Boiler and Pressure Vessel Code, Section VIII, to prevent collapse in the case of vacuum jacket failure in combination with sub-atmospheric pressure within the tank. For the integrated refrigeration loop, a modular, skeleton-type heat exchanger, with refrigerant temperature instrumentation, was constructed using the stiffening rings as supports. To support the system thermal performance testing, three custom temperature rakes were designed and installed along the 21-meter length of the tank, once again using rings as supports. The temperature rakes included a total of 20 silicon diode temperature sensors mounted both vertically and radially to map the bulk liquid temperature within the tank. The tank modifications were successful and the system is now operational for the research and development of integrated refrigeration technology.

  11. An unusual mode of failure of a tripolar constrained acetabular liner: a case report.

    PubMed

    Banks, Louisa N; McElwain, John P

    2010-04-01

    Dislocation after primary total hip arthroplasty (THA) is the most commonly encountered complication and is unpleasant for both the patient and the surgeon. Constrained acetabular components can be used to treat or prevent instability after primary total hip arthroplasty. We present the case of a 42-year-old female with a BMI of 41. At 18 months post-primary THA the patient underwent further revision hip surgery after numerous (more than 20) dislocations. She had a tripolar Trident acetabular cup (Stryker-Howmedica-Osteonics, Rutherford, New Jersey) inserted. Shortly afterwards the unusual mode of failure of the constrained acetabular liner was noted from radiographs in that the inner liner had dissociated from the outer. The reinforcing ring remained intact and in place. We believe that the patient's weight, combined with poor abductor musculature caused excessive demand on the device leading to failure at this interface when the patient flexed forward. Constrained acetabular components are useful implants to treat instability but have been shown to have up to 42% long-term failure rates with problems such as dissociated inserts, dissociated constraining rings and dissociated femoral rings being sited. Sometimes they may be the only option left in difficult cases such as illustrated here, but still unfortunately have the capacity to fail in unusual ways.

  12. [THE FAILURE MODES AND EFFECTS ANALYSIS FACILITATES A SAFE, TIME AND MONEY SAVING OPEN ACCESS COLONOSCOPY SERVICE].

    PubMed

    Gingold-Belfer, Rachel; Niv, Yaron; Horev, Nehama; Gross, Shuli; Sahar, Nadav; Dickman, Ram

    2017-04-01

    Failure modes and effects analysis (FMEA) is used for the identification of potential risks in health care processes. We used a specific FMEA - based form for direct referral for colonoscopy and assessed it for procedurerelated perforations. Ten experts in endoscopy evaluated and computed the entire referral process, modes of preparation for the endoscopic procedure, the endoscopic procedure itself and the discharge process. We used FMEA assessing for likelihood of occurrence, detection and severity and calculated the risk profile number (RPN) for each of the above points. According to the highest RPN results we designed a specific open access referral form and then compared the occurrence of colonic perforations (between 2010 and 2013) in patients who were referred through the open access arm (Group 1) to those who had a prior clinical consultation (non-open access, Group 2). Our experts in endoscopy (5 physicians and 5 nurses) identified 3 categories of failure modes that, on average, reached the highest RPNs. We identified 9,558 colonoscopies in group 1, and 12,567 in group 2. Perforations were identified in three patients from the open access group (1:3186, 0.03%) and in 10 from group 2 (1:1256, 0.07%) (p = 0.024). Direct referral for colonoscopy saved 9,558 pre-procedure consultations and the sum of $850,000. The FMEA tool-based specific referral form facilitates a safe, time and money saving open access colonoscopy service. Our form may be adopted by other gastroenterological clinics in Israel.

  13. SNS STRIPPER FOIL FAILURE MODES AND THEIR CURES

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Galambos, John D; Luck, Chris; Plum, Michael A

    2010-01-01

    The diamond stripper foils in use at the Spallation Neutron Source worked successfully with no failures until May 3, 2009, when we started experiencing a rash of foil system failures after increasing the beam power to ~840 kW. The main contributors to the failures are thought to be 1) convoy electrons, stripped from the incoming H beam, that strike the foil bracket and may also reflect back from the electron catcher, and 2) vacuum breakdown from the charge developed on the foil by secondary electron emission. In this paper we will detail these and other failure mechanisms, and describe themore » improvements we have made to mitigate them.« less

  14. Tank 241-AP-105, cores 208, 209 and 210, analytical results for the final report

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Nuzum, J.L.

    1997-10-24

    This document is the final laboratory report for Tank 241-AP-105. Push mode core segments were removed from Risers 24 and 28 between July 2, 1997, and July 14, 1997. Segments were received and extruded at 222-S Laboratory. Analyses were performed in accordance with Tank 241-AP-105 Push Mode Core Sampling and Analysis Plan (TSAP) (Hu, 1997) and Tank Safety Screening Data Quality Objective (DQO) (Dukelow, et al., 1995). None of the subsamples submitted for total alpha activity (AT), differential scanning calorimetry (DSC) analysis, or total organic carbon (TOC) analysis exceeded the notification limits as stated in TSAP and DQO. The statisticalmore » results of the 95% confidence interval on the mean calculations are provided by the Tank Waste Remediation Systems Technical Basis Group, and are not considered in this report. Appearance and Sample Handling Two cores, each consisting of four segments, were expected from Tank 241-AP-105. Three cores were sampled, and complete cores were not obtained. TSAP states core samples should be transported to the laboratory within three calendar days from the time each segment is removed from the tank. This requirement was not met for all cores. Attachment 1 illustrates subsamples generated in the laboratory for analysis and identifies their sources. This reference also relates tank farm identification numbers to their corresponding 222-S Laboratory sample numbers.« less

  15. Compression failure of composite laminates

    NASA Technical Reports Server (NTRS)

    Pipes, R. B.

    1983-01-01

    This presentation attempts to characterize the compressive behavior of Hercules AS-1/3501-6 graphite-epoxy composite. The effect of varying specimen geometry on test results is examined. The transition region is determined between buckling and compressive failure. Failure modes are defined and analytical models to describe these modes are presented.

  16. Failure mode and bending moment of canine pancarpal arthrodesis constructs stabilized with two different implant systems.

    PubMed

    Wininger, Fred A; Kapatkin, Amy S; Radin, Alex; Shofer, Frances S; Smith, Gail K

    2007-12-01

    To compare failure mode and bending moment of a canine pancarpal arthrodesis construct using either a 2.7 mm/3.5 mm hybrid dynamic compression plate (HDCP) or a 3.5 mm dynamic compression plate (DCP). Paired in vitro biomechanical testing of canine pancarpal arthrodesis constructs stabilized with either a 2.7/3.5 HDCP or 3.5 DCP. Paired cadaveric canine antebrachii (n=5). Pancarpal arthrodesis constructs were loaded to failure (point of maximum load) in 4-point bending using a materials-testing machine. Using this point of failure, bending moments were calculated from system variables for each construct and the 2 plating systems compared using a paired t-test. To examine the relationship between metacarpal diameter and screw diameter failure loads, linear regression was used and Pearson' correlation coefficient was calculated. Significance was set at P<.05. HDCP failed at higher loads than DCP for 9 of 10 constructs. The absolute difference in failure rates between the 2 plates was 0.552+/-0.182 N m, P=.0144 (95% confidence interval: -0.58 to 1.68). This is an 8.1% mean difference in bending strength. There was a significant linear correlation r=0.74 (P-slope=.014) and 0.8 (P-slope=.006) between metacarpal diameter and failure loads for the HDCP and 3.5 DCP, respectively. There was a small but significant difference between bending moment at failure between 2.7/3.5 HDCP and 3.5 DCP constructs; however, the difference may not be clinically evident in all patients. The 2.7/3.5 HDCP has physical and mechanical properties making it a more desirable plate for pancarpal arthrodesis.

  17. Monitoring and analysis of liquid storage in LNG tank based on different support springs

    NASA Astrophysics Data System (ADS)

    He, Hua; Sun, Jianping; Li, Ke; Wu, Zheng; Chen, Qidong; Chen, Guodong; Cao, Can

    2018-04-01

    With the rapid development of social modernization, LNG vehicles are springing up in daily life. However, it is difficult to monitor and judge the liquid storage tanks accurately and quickly. Based on this, this paper presents a new method of liquid storage monitoring, LNG tank on-line vibration monitoring system. By collecting the vibration frequency of LNG tank and tank liquid and supporting spring system, the liquid storage quality in the tank can be calculated. In this experiment, various vibration modes of the tank spring system are fully taken into account. The vibration effects of different types of support springs on the LNG tank system were investigated. The results show that the spring model has a great influence on the test results. This study provides a technical reference for the selection of suitable support springs for liquid storage monitoring.

  18. Mechanics of Unidirectional Fiber-Reinforced Composites: Buckling Modes and Failure Under Compression Along Fibers

    NASA Astrophysics Data System (ADS)

    Paimushin, V. N.; Kholmogorov, S. A.; Gazizullin, R. K.

    2018-01-01

    One-dimensional linearized problems on the possible buckling modes of an internal or peripheral layer of unidirectional multilayer composites with rectilinear fibers under compression in the fiber direction are considered. The investigations are carried out using the known Kirchhoff-Love and Timoshenko models for the layers. The binder, modeled as an elastic foundation, is described by the equations of elasticity theory, which are simplified in accordance to the model of a transversely soft layer and are integrated along the transverse coordinate considering the kinematic coupling relations for a layer and foundation layers. Exact analytical solutions of the problems formulated are found, which are used to calculate a composite made of an HSE 180 REM prepreg based on a unidirectional carbon fiber tape. The possible buckling modes of its internal and peripheral layers are identified. Calculation results are compared with experimental data obtained earlier. It is concluded that, for the composite studied, the flexural buckling of layers in the uniform axial compression of specimens along fibers is impossible — the failure mechanism is delamination with buckling of a fiber bundle according to the pure shear mode. It is realized (due to the low average transverse shear modulus) at the value of the ultimate compression stress equal to the average shear modulus. It is shown that such a shear buckling mode can be identified only on the basis of equations constructed using the Timoshenko shear model to describe the deformation process of layers.

  19. Analysis of Gas Turbine Engine Failure Modes.

    DTIC Science & Technology

    1974-01-01

    failure due to factors ex- ternal (foreign to the power plant. Because in practice it is virtually impossible to distinguish accurately between the two, all...45 55 APPEN’DIX E WHEN DISCO ’=RED z z J-79 ENGINE AND HIGH FAILURE COMPONENTS H z Compressor R or242 Copeo R F4 -C H C s SeH UPi 0. 0- H U 4 C, Engine

  20. Failure Atlas for Rolling Bearings in Wind Turbines

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Tallian, T. E.

    2006-01-01

    This Atlas is structured as a supplement to the book: T.E. Tallian: Failure Atlas for Hertz Contact Machine Elements, 2nd edition, ASME Press New York, (1999). The content of the atlas comprises plate pages from the book that contain bearing failure images, application data, and descriptions of failure mode, image, and suspected failure causes. Rolling bearings are a critical component of the mainshaft system, gearbox and generator in the rapidly developing technology of power generating wind turbines. The demands for long service life are stringent; the design load, speed and temperature regimes are demanding and the environmental conditions including weather,more » contamination, impediments to monitoring and maintenance are often unfavorable. As a result, experience has shown that the rolling bearings are prone to a variety of failure modes that may prevent achievement of design lives. Morphological failure diagnosis is extensively used in the failure analysis and improvement of bearing operation. Accumulated experience shows that the failure appearance and mode of failure causation in wind turbine bearings has many distinguishing features. The present Atlas is a first effort to collect an interpreted database of specifically wind turbine related rolling bearing failures and make it widely available. This Atlas is structured as a supplement to the book: T. E. Tallian: Failure Atlas for Hertz Contact Machine Elements, 2d edition, ASME Press New York, (1999). The main body of that book is a comprehensive collection of self-contained pages called Plates, containing failure images, bearing and application data, and three descriptions: failure mode, image and suspected failure causes. The Plates are sorted by main failure mode into chapters. Each chapter is preceded by a general technical discussion of the failure mode, its appearance and causes. The Plates part is supplemented by an introductory part, describing the appearance classification and failure

  1. Application of ISO22000 and Failure Mode and Effect Analysis (fmea) for Industrial Processing of Poultry Products

    NASA Astrophysics Data System (ADS)

    Varzakas, Theodoros H.; Arvanitoyannis, Ioannis S.

    Failure Mode and Effect Analysis (FMEA) model has been applied for the risk assessment of poultry slaughtering and manufacturing. In this work comparison of ISO22000 analysis with HACCP is carried out over poultry slaughtering, processing and packaging. Critical Control points and Prerequisite programs (PrPs) have been identified and implemented in the cause and effect diagram (also known as Ishikawa, tree diagram and fishbone diagram).

  2. Analysis of rotary balance data for the F-15 airplane including the effect of conformal fuel tanks

    NASA Technical Reports Server (NTRS)

    Barnhart, B.

    1982-01-01

    F-15 rotary balance data was analyzed, and the influence of control deflections, Reynolds number and airplane components, i.e., body, wing, horizontal and vertical tails, as well as conformal tanks, on the aerodynamics up to 90 degrees angle of attack are discussed. Steady state spin mode predictions using these data are presented, which show excellent correlation with spin tunnel and flight test results. Generally, the data shows damped yawing moment slopes with rotation at all angles of attack, and good control effectiveness. Differences in the rotary aerodynamics due to the addition of conformal tanks are minimal. The small differences in the region of the flat spin do, however, indicate that the resulting spin mode would be slightly flatter and faster for a conformal tank equipped airplane. The addition of conformal tanks make the airplane more departure susceptible.

  3. Failure mode and effects analysis to reduce risk of anticoagulation levels above the target range during concurrent antimicrobial therapy.

    PubMed

    Daniels, Lisa M; Barreto, Jason N; Kuth, John C; Anderson, Jeremy R; Zhang, Beilei; Majka, Andrew J; Morgenthaler, Timothy I; Tosh, Pritish K

    2015-07-15

    A failure mode and effects analysis (FMEA) was conducted to analyze the clinical and operational processes leading to above-target International Normalized Ratios (INRs) in warfarin-treated patients receiving concurrent antimicrobial therapy. The INRs of patients on long-term warfarin therapy who received a course of trimethoprim-sulfamethoxazole, metronidazole, fluconazole, miconazole, or voriconazole (highly potentiating antimicrobials, or HPAs) between September 1 and December 31, 2011, were compared with patients on long-term warfarin therapy who did not receive any antimicrobial during the same period. A multidisciplinary team of physicians, pharmacists, and a systems analyst was then formed to complete a step-by-step outline of the processes involved in warfarin management and concomitant HPA therapy, followed by an FMEA. Patients taking trimethoprim-sulfamethoxazole, metronidazole, or fluconazole demonstrated a significantly increased risk of having an INR of >4.5. The FMEA identified 134 failure modes. The most common failure modes were as follows: (1) electronic medical records did not identify all patients receiving warfarin, (2) HPA prescribers were unaware of recommended warfarin therapy when HPAs were prescribed, (3) HPA prescribers were unaware that a patient was taking warfarin and that the drug interaction is significant, and (4) warfarin managers were unaware that an HPA had been prescribed for a patient. An FMEA determined that the risk of adverse events caused by concomitantly administering warfarin and HPAs can be decreased by preemptively identifying patients receiving warfarin, having a care process in place, alerting providers about the patient's risk status, and notifying providers at the anticoagulation clinic. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  4. Comparison of fracture strength and failure mode of different ceramic implant abutments.

    PubMed

    Elsayed, Adham; Wille, Sebastian; Al-Akhali, Majed; Kern, Matthias

    2017-04-01

    The whitish color of zirconia (ZrO 2 ) abutments offers favorable esthetics compared with the grayish color of titanium (Ti) abutments. Nonetheless, ZrO 2 has greater opacity, making it difficult to achieve natural tooth color. Therefore, lithium disilicate (LaT) abutments have been suggested to replace metal abutments. The purpose of this in vitro study was to evaluate the fracture strength and failure mode of single-tooth implant restorations using ZrO 2 and LaT abutments, and to compare them with titanium (Ti) abutments. Five different types of abutments, Ti; ZrO 2 with no metal base; ZrO 2 with a metal base (ZrT); LaT; and LaT combination abutment and crown (LcT) were assembled on 40 Ti implants and restored with LaT crowns. Specimens were subjected to quasistatic loading using a universal testing machine, until the implant-abutment connection failed. As bending of the metal would be considered a clinical failure, the values of force (N) at which the plastic deformation of the metal occurred were calculated, and the rate of deformation was analyzed. Statistical analysis was done using the Mann-Whitney U test (α=.05). Group ZrO 2 revealed the lowest resistance to failure with a mean of 202 ±33 N. Groups ZrT, LaT, and LaC withstood higher forces without fracture or debonding of the ceramic suprastructure, and failure was due to deformation of metal bases, with no statistically significant differences between these groups regarding the bending behavior. Within the limitations of this in vitro study, it was concluded that LaT abutments have the potential to withstand the physiological occlusal forces that occur in the anterior region and that ZrO 2 abutments combined with Ti inserts have much higher fracture strength than pure ZrO 2 abutments. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  5. Hazards/Failure Modes and Effects Analysis MK 1 MOD 0 LSO-HUD Console System.

    DTIC Science & Technology

    1980-03-24

    AsI~f~ ! 127 = 3gc Z Isre -0 -q ~sI I I 𔃻~~~ ~ _ _ 3_______ II! -0udC Z Z’ P4 12 d-U * ~s ’:i~i42 S- 60 -, Uh ~ U3l I OM -C ~ . - U 4~ dcd 8U-q Ali...8 VI SCOPE AND METHODOLOGY OF ANALYSIS ........ 1O FIGURE 1: H/ FMEA /(SSA) WORK SHEET FORMAT ........... 14 APPENDIX A: HAZARD/FAILURE MODES AND...EFFECTS ANALYSIS (H/ FMEA ) -- WORK SHEETS ......... 15(A-O) TABLE: SUBSYSTEM: UNIT I Heads-Up Display Console .............. 17(A-1) UNIT 2 Auxiliary

  6. Failure Mode Classification for Life Prediction Modeling of Solid-State Lighting

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sakalaukus, Peter Joseph

    2015-08-01

    Since the passing of the Energy Independence and Security Act of 2007, the U.S. government has mandated greater energy independence which has acted as a catalyst for accelerating and facilitating research efforts toward the development and deployment of market-driven solutions for energy-saving homes, buildings and manufacturing, as well as sustainable transportation and renewable electricity generation. As part of this effort, an emphasis toward advancing solid-state lighting technology through research, development, demonstration, and commercial applications is assisting in the phase out of the common incandescent light bulb, as well as developing a more economical lighting source that is less toxic thanmore » compact fluorescent lighting. This has led lighting manufacturers to pursue SSL technologies for a wide range of consumer lighting applications. An SSL luminaire’s lifetime can be characterized in terms of lumen maintenance life. Lumen maintenance or lumen depreciation is the percentage decrease in the relative luminous flux from that of the original, pristine luminous flux value. Lumen maintenance life is the estimated operating time, in hours, when the desired failure threshold is projected to be reached at normal operating conditions. One accepted failure threshold of SSL luminaires is lumen maintenance of 70% -- a 30% reduction in the light output of the luminaire. Currently, the only approved lighting standard that puts forth a recommendation for long-term luminous flux maintenance projections towards a specified failure threshold of an SSL luminaire is the IES TM-28-14 (TM28) standard. iii TM28 was derived as a means to compare luminaires that have been tested at different facilities, research labs or companies. TM28 recommends the use of the Arrhenius equation to determine SSL device specific reaction rates from thermally driven failure mechanisms used to characterize a single failure mode – the relative change in the luminous flux output or

  7. Analytical Method to Evaluate Failure Potential During High-Risk Component Development

    NASA Technical Reports Server (NTRS)

    Tumer, Irem Y.; Stone, Robert B.; Clancy, Daniel (Technical Monitor)

    2001-01-01

    Communicating failure mode information during design and manufacturing is a crucial task for failure prevention. Most processes use Failure Modes and Effects types of analyses, as well as prior knowledge and experience, to determine the potential modes of failures a product might encounter during its lifetime. When new products are being considered and designed, this knowledge and information is expanded upon to help designers extrapolate based on their similarity with existing products and the potential design tradeoffs. This paper makes use of similarities and tradeoffs that exist between different failure modes based on the functionality of each component/product. In this light, a function-failure method is developed to help the design of new products with solutions for functions that eliminate or reduce the potential of a failure mode. The method is applied to a simplified rotating machinery example in this paper, and is proposed as a means to account for helicopter failure modes during design and production, addressing stringent safety and performance requirements for NASA applications.

  8. Failure mode prediction for composite structural insulated panels with MgO board facings

    NASA Astrophysics Data System (ADS)

    Smakosz, Łukasz; Kreja, Ireneusz

    2018-01-01

    Sandwich panels are readily used in civil engineering due to their high strength to weight ratio and the ease and speed of assembly. The idea of a sandwich section is to combine thin and durable facings with a light-weight core and the choice of materials used allows obtaining the desired behaviour. Panels in consideration consist of MgO (magnesium oxide) board facings and expanded polystyrene core and are characterized by immunity to biological corrosion, a high thermal insulation and a relatively low impact on environment. Customizing the range of panels to meet market needs requires frequent size changes, leading to different failure modes, which are identified in a series of costly full-scale laboratory tests. A nonlinear numerical model was created with a use of a commercial ABAQUS code and a user-defined procedure, which is able to reproduce observed failure mechanisms; its parameters were established on the basis of small-scale tests and numerical experiments. The model was validated by a comparison with the results of the full-scale bending and compression tests. The results obtained were in satisfactory agreement with the test data.

  9. Chemical failure modes of AlQ3-based OLEDs: AlQ3 hydrolysis.

    PubMed

    Knox, John E; Halls, Mathew D; Hratchian, Hrant P; Schlegel, H Bernhard

    2006-03-28

    Tris(8-hydroxyquinoline)aluminum(III), AlQ3, is used in organic light-emitting diodes (OLEDs) as an electron-transport material and emitting layer. The reaction of AlQ3 with trace H2O has been implicated as a major failure pathway for AlQ3-based OLEDs. Hybrid density functional calculations have been carried out to characterize the hydrolysis of AlQ3. The thermochemical and atomistic details for this important reaction are reported for both the neutral and oxidized AlQ3/AlQ3+ systems. In support of experimental conclusions, the neutral hydrolysis reaction pathway is found to be a thermally activated process, having a classical barrier height of 24.2 kcal mol(-1). First-principles infrared and electronic absorption spectra are compared to further characterize AlQ3 and the hydrolysis pathway product, AlQ2OH. The activation energy for the cationic AlQ3 hydrolysis pathway is found to be 8.5 kcal mol(-1) lower than for the neutral reaction, which is significant since it suggests a role for charge imbalance in promoting chemical failure modes in OLED devices.

  10. Compression failure of angle-ply laminates

    NASA Technical Reports Server (NTRS)

    Peel, Larry D.; Hyer, Michael W.; Shuart, Mark J.

    1991-01-01

    The present work deals with modes and mechanisms of failure in compression of angle-ply laminates. Experimental results were obtained from 42 angle-ply IM7/8551-7a specimens with a lay-up of ((plus or minus theta)/(plus or minus theta)) sub 6s where theta, the off-axis angle, ranged from 0 degrees to 90 degrees. The results showed four failure modes, these modes being a function of off-axis angle. Failure modes include fiber compression, inplane transverse tension, inplane shear, and inplane transverse compression. Excessive interlaminar shear strain was also considered as an important mode of failure. At low off-axis angles, experimentally observed values were considerably lower than published strengths. It was determined that laminate imperfections in the form of layer waviness could be a major factor in reducing compression strength. Previously developed linear buckling and geometrically nonlinear theories were used, with modifications and enhancements, to examine the influence of layer waviness on compression response. The wavy layer is described by a wave amplitude and a wave length. Linear elastic stress-strain response is assumed. The geometrically nonlinear theory, in conjunction with the maximum stress failure criterion, was used to predict compression failure and failure modes for the angle-ply laminates. A range of wave length and amplitudes were used. It was found that for 0 less than or equal to theta less than or equal to 15 degrees failure was most likely due to fiber compression. For 15 degrees less than theta less than or equal to 35 degrees, failure was most likely due to inplane transverse tension. For 35 degrees less than theta less than or equal to 70 degrees, failure was most likely due to inplane shear. For theta less than 70 degrees, failure was most likely due to inplane transverse compression. The fiber compression and transverse tension failure modes depended more heavily on wave length than on wave amplitude. Thus using a single

  11. Human factors process failure modes and effects analysis (HF PFMEA) software tool

    NASA Technical Reports Server (NTRS)

    Chandler, Faith T. (Inventor); Relvini, Kristine M. (Inventor); Shedd, Nathaneal P. (Inventor); Valentino, William D. (Inventor); Philippart, Monica F. (Inventor); Bessette, Colette I. (Inventor)

    2011-01-01

    Methods, computer-readable media, and systems for automatically performing Human Factors Process Failure Modes and Effects Analysis for a process are provided. At least one task involved in a process is identified, where the task includes at least one human activity. The human activity is described using at least one verb. A human error potentially resulting from the human activity is automatically identified, the human error is related to the verb used in describing the task. A likelihood of occurrence, detection, and correction of the human error is identified. The severity of the effect of the human error is identified. The likelihood of occurrence, and the severity of the risk of potential harm is identified. The risk of potential harm is compared with a risk threshold to identify the appropriateness of corrective measures.

  12. Ideas for Policymakers: Enhancing the Impact of Think Tanks. Policy Insight, Volume 1, Issue 2

    ERIC Educational Resources Information Center

    Montoya, Silvia; Swanger, Rachel M.

    2007-01-01

    As think tanks have become more numerous, visible, and seemingly influential, scholars have begun to pay more attention to them--analyzing their characteristics, their modes of operation, and their roles in policymaking. This "Policy Insight" builds on this work and examines the role of think tanks in civil society, with an emphasis on…

  13. Evaluation of Window Failure Modes

    DTIC Science & Technology

    1999-12-01

    U.S. Coast Guard Research and Development Center 1082 Shennecossett Road, Groton, CT 06340-6096 Report No. CG-D-08-00 EVALUATION OF WINDOW FAILURE...States Coast Guard Research & Development Center 1082 Shennecossett Road Groton, CT 06340-6096 11 I.Report No. CG-D-08-00 Technical Report...Development Center 1082 Shennecossett Road Groton,CT 06340-6096 12. Sponsoring Organization Name and Address U.S. Department of Transportation United

  14. Soil load above Hanford waste storage tanks (2 volumes)

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Pianka, E.W.

    1995-01-25

    This document is a compilation of work performed as part of the Dome Load Control Project in 1994. Section 2 contains the calculations of the weight of the soil over the tank dome for each of the 75-feet-diameter waste-storage tanks located at the Hanford Site. The chosen soil specific weight and soil depth measured at the apex of the dome crown are the same as those used in the primary analysis that qualified the design. Section 3 provides reference dimensions for each of the tank farm sites. The reference dimensions spatially orient the tanks and provide an outer diameter formore » each tank. Section 4 summarizes the available soil surface elevation data. It also provides examples of the calculations performed to establish the present soil elevation estimates. The survey data and other data sources from which the elevation data has been obtained are printed separately in Volume 2 of this Supporting Document. Section 5 contains tables that provide an overall summary of the present status of dome loads. Tables summarizing the load state corresponding to the soil depth and soil specific weight for the original qualification analysis, the gravity load requalification for soil depth and soil specific weight greater than the expected actual values, and a best estimate condition of soil depth and specific weight are presented for the Double-Shell Tanks. For the Single-Shell Tanks, only the original qualification analysis is available; thus, the tabulated results are for this case only. Section 6 provides a brief overview of past analysis and testing results that given an indication of the load capacity of the waste storage tanks that corresponds to a condition approaching ultimate failure of the tank. 31 refs.« less

  15. Dynamic Behaviour and Seismic Response of Ground Supported Cylindrical Water Tanks

    NASA Astrophysics Data System (ADS)

    Asha, Joseph; Glory, Joseph

    2018-05-01

    Liquid storage tank such as in water distribution systems, petroleum plants etc., constitute a vital component of life line systems. Reducing earthquake effects on liquid storage tanks, to minimize the environmental and economic impact of these effects, have always been an important engineering concern. In this paper, the dynamic behavior of cylindrical ground supported concrete water tanks with different aspect ratios is investigated using finite element software ANSYS. The natural frequencies and modal responses are obtained for impulsive and convective modes of vibration. The natural frequency of vibration of the tank is observed to be the lowest at maximum water depth. The fundamental impulsive frequency increases as water level reduces and for water level less than 1/3 of tank height, there is significantly no change in impulsive frequency. The effect of wall flexibility on dynamic behavior of the tank is investigated by performing the modal analysis of flexible and rigid tanks. For a partially filled tank, the results of the present study are of significant relevance. The response of the tank to the transient loading as horizontal ground motion of El Centro earthquake is studied for various water heights. As the height of water on the tank increases, the ultimate maximum seismic response parameters are also observed to be increased. The location of maximum hoop stress varies in accordance with the variations in input ground motion and water fill condition whereas shear and bending moment are maximum at the base.

  16. Software For Design And Analysis Of Tanks And Cylindrical Shells

    NASA Technical Reports Server (NTRS)

    Luz, Paul L.; Graham, Jerry B.

    1995-01-01

    Skin-stringer Tank Analysis Spreadsheet System (STASS) computer program developed for use as preliminary design software tool that enables quick-turnaround design and analysis of structural domes and cylindrical barrel sections in propellant tanks or other cylindrical shells. Determines minimum required skin thicknesses for domes and cylindrical shells to withstand material failure due to applied pressures (ullage and/or hydrostatic) and runs buckling analyses on cylindrical shells and skin-stringers. Implemented as workbook program, using Microsoft Excel v4.0 on Macintosh II. Also implemented using Microsoft Excel v4.0 for Microsoft Windows v3.1 IBM PC.

  17. Breadboard RL10-11B low thrust operating mode

    NASA Technical Reports Server (NTRS)

    Kmiec, Thomas D.; Galler, Donald E.

    1987-01-01

    Cryogenic space engines require a cooling process to condition engine hardware to operating temperature before start. This can be accomplished most efficiently by burning propellants that would otherwise be dumped overboard after cooling the engine. The resultant low thrust operating modes are called Tank Head Idle and Pumped Idle. During February 1984, Pratt & Whitney conducted a series of tests demonstrating operation of the RL10 rocket engines at low thrust levels using a previously untried hydrogen/oxygen heat exchanger. The initial testing of the RL10-11B Breadboard Low Thrust Engine is described. The testing demonstrated operation at both tank head idle and pumped idle modes.

  18. Comprehensive reliability allocation method for CNC lathes based on cubic transformed functions of failure mode and effects analysis

    NASA Astrophysics Data System (ADS)

    Yang, Zhou; Zhu, Yunpeng; Ren, Hongrui; Zhang, Yimin

    2015-03-01

    Reliability allocation of computerized numerical controlled(CNC) lathes is very important in industry. Traditional allocation methods only focus on high-failure rate components rather than moderate failure rate components, which is not applicable in some conditions. Aiming at solving the problem of CNC lathes reliability allocating, a comprehensive reliability allocation method based on cubic transformed functions of failure modes and effects analysis(FMEA) is presented. Firstly, conventional reliability allocation methods are introduced. Then the limitations of direct combination of comprehensive allocation method with the exponential transformed FMEA method are investigated. Subsequently, a cubic transformed function is established in order to overcome these limitations. Properties of the new transformed functions are discussed by considering the failure severity and the failure occurrence. Designers can choose appropriate transform amplitudes according to their requirements. Finally, a CNC lathe and a spindle system are used as an example to verify the new allocation method. Seven criteria are considered to compare the results of the new method with traditional methods. The allocation results indicate that the new method is more flexible than traditional methods. By employing the new cubic transformed function, the method covers a wider range of problems in CNC reliability allocation without losing the advantages of traditional methods.

  19. The use of failure mode and effects analysis to construct an effective disposal and prevention mechanism for infectious hospital waste

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ho, Chao Chung, E-mail: ho919@pchome.com.tw; Liao, Ching-Jong

    Highlights: > This study is based on a real case in a regional teaching hospital in Taiwan. > We use Failure mode and effects analysis (FMEA) as the evaluation method. > We successfully identify the risk factors of infectious waste disposal. > We propose plans for the detection of exceptional cases of infectious waste. - Abstract: In recent times, the quality of medical care has been continuously improving in medical institutions wherein patient-centred care has been emphasized. Failure mode and effects analysis (FMEA) has also been promoted as a method of basic risk management and as part of total qualitymore » management (TQM) for improving the quality of medical care and preventing mistakes. Therefore, a study was conducted using FMEA to evaluate the potential risk causes in the process of infectious medical waste disposal, devise standard procedures concerning the waste, and propose feasible plans for facilitating the detection of exceptional cases of infectious waste. The analysis revealed the following results regarding medical institutions: (a) FMEA can be used to identify the risk factors of infectious waste disposal. (b) During the infectious waste disposal process, six items were scored over 100 in the assessment of uncontrolled risks: erroneous discarding of infectious waste by patients and their families, erroneous discarding by nursing staff, erroneous discarding by medical staff, cleaning drivers pierced by sharp articles, cleaning staff pierced by sharp articles, and unmarked output units. Therefore, the study concluded that it was necessary to (1) provide education and training about waste classification to the medical staff, patients and their families, nursing staff, and cleaning staff; (2) clarify the signs of caution; and (3) evaluate the failure mode and strengthen the effects.« less

  20. Intelligent Design and Intelligent Failure

    NASA Technical Reports Server (NTRS)

    Jerman, Gregory

    2015-01-01

    Good Evening, my name is Greg Jerman and for nearly a quarter century I have been performing failure analysis on NASA's aerospace hardware. During that time I had the distinct privilege of keeping the Space Shuttle flying for two thirds of its history. I have analyzed a wide variety of failed hardware from simple electrical cables to cryogenic fuel tanks to high temperature turbine blades. During this time I have found that for all the time we spend intelligently designing things, we need to be equally intelligent about understanding why things fail. The NASA Flight Director for Apollo 13, Gene Kranz, is best known for the expression "Failure is not an option." However, NASA history is filled with failures both large and small, so it might be more accurate to say failure is inevitable. It is how we react and learn from our failures that makes the difference.

  1. Recognising and referring children exposed to domestic abuse: a multi-professional, proactive systems-based evaluation using a modified Failure Mode and Effects Analysis (FMEA).

    PubMed

    Ashley, Laura; Armitage, Gerry; Taylor, Julie

    2017-03-01

    Failure Modes and Effects Analysis (FMEA) is a prospective quality assurance methodology increasingly used in healthcare, which identifies potential vulnerabilities in complex, high-risk processes and generates remedial actions. We aimed, for the first time, to apply FMEA in a social care context to evaluate the process for recognising and referring children exposed to domestic abuse within one Midlands city safeguarding area in England. A multidisciplinary, multi-agency team of 10 front-line professionals undertook the FMEA, using a modified methodology, over seven group meetings. The FMEA included mapping out the process under evaluation to identify its component steps, identifying failure modes (potential errors) and possible causes for each step and generating corrective actions. In this article, we report the output from the FMEA, including illustrative examples of the failure modes and corrective actions generated. We also present an analysis of feedback from the FMEA team and provide future recommendations for the use of FMEA in appraising social care processes and practice. Although challenging, the FMEA was unequivocally valuable for team members and generated a significant number of corrective actions locally for the safeguarding board to consider in its response to children exposed to domestic abuse. © 2016 John Wiley & Sons Ltd.

  2. 33 CFR 157.15 - Slop tanks in tank vessels.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Slop tanks in tank vessels. 157... (CONTINUED) POLLUTION RULES FOR THE PROTECTION OF THE MARINE ENVIRONMENT RELATING TO TANK VESSELS CARRYING OIL IN BULK Design, Equipment, and Installation § 157.15 Slop tanks in tank vessels. (a) Number. A...

  3. 33 CFR 157.15 - Slop tanks in tank vessels.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Slop tanks in tank vessels. 157... (CONTINUED) POLLUTION RULES FOR THE PROTECTION OF THE MARINE ENVIRONMENT RELATING TO TANK VESSELS CARRYING OIL IN BULK Design, Equipment, and Installation § 157.15 Slop tanks in tank vessels. (a) Number. A...

  4. 33 CFR 157.15 - Slop tanks in tank vessels.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Slop tanks in tank vessels. 157... (CONTINUED) POLLUTION RULES FOR THE PROTECTION OF THE MARINE ENVIRONMENT RELATING TO TANK VESSELS CARRYING OIL IN BULK Design, Equipment, and Installation § 157.15 Slop tanks in tank vessels. (a) Number. A...

  5. 33 CFR 157.15 - Slop tanks in tank vessels.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Slop tanks in tank vessels. 157... (CONTINUED) POLLUTION RULES FOR THE PROTECTION OF THE MARINE ENVIRONMENT RELATING TO TANK VESSELS CARRYING OIL IN BULK Design, Equipment, and Installation § 157.15 Slop tanks in tank vessels. (a) Number. A...

  6. TankSIM: A Cryogenic Tank Performance Prediction Program

    NASA Technical Reports Server (NTRS)

    Bolshinskiy, L. G.; Hedayat, A.; Hastings, L. J.; Moder, J. P.; Schnell, A. R.; Sutherlin, S. G.

    2015-01-01

    Accurate prediction of the thermodynamic state of the cryogenic propellants in launch vehicle tanks is necessary for mission planning and successful execution. Cryogenic propellant storage and transfer in space environments requires that tank pressure be controlled. The pressure rise rate is determined by the complex interaction of external heat leak, fluid temperature stratification, and interfacial heat and mass transfer. If the required storage duration of a space mission is longer than the period in which the tank pressure reaches its allowable maximum, an appropriate pressure control method must be applied. Therefore, predictions of the pressurization rate and performance of pressure control techniques in cryogenic tanks are required for development of cryogenic fluid long-duration storage technology and planning of future space exploration missions. This paper describes an analytical tool, Tank System Integrated Model (TankSIM), which can be used for modeling pressure control and predicting the behavior of cryogenic propellant for long-term storage for future space missions. It is written in the FORTRAN 90 language and can be compiled with any Visual FORTRAN compiler. A thermodynamic vent system (TVS) is used to achieve tank pressure control. Utilizing TankSIM, the following processes can be modeled: tank self-pressurization, boiloff, ullage venting, and mixing. Details of the TankSIM program and comparisons of its predictions with test data for liquid hydrogen and liquid methane will be presented in the final paper.

  7. Revised Risk Priority Number in Failure Mode and Effects Analysis Model from the Perspective of Healthcare System

    PubMed Central

    Rezaei, Fatemeh; Yarmohammadian, Mohmmad H.; Haghshenas, Abbas; Fallah, Ali; Ferdosi, Masoud

    2018-01-01

    Background: Methodology of Failure Mode and Effects Analysis (FMEA) is known as an important risk assessment tool and accreditation requirement by many organizations. For prioritizing failures, the index of “risk priority number (RPN)” is used, especially for its ease and subjective evaluations of occurrence, the severity and the detectability of each failure. In this study, we have tried to apply FMEA model more compatible with health-care systems by redefining RPN index to be closer to reality. Methods: We used a quantitative and qualitative approach in this research. In the qualitative domain, focused groups discussion was used to collect data. A quantitative approach was used to calculate RPN score. Results: We have studied patient's journey in surgery ward from holding area to the operating room. The highest priority failures determined based on (1) defining inclusion criteria as severity of incident (clinical effect, claim consequence, waste of time and financial loss), occurrence of incident (time - unit occurrence and degree of exposure to risk) and preventability (degree of preventability and defensive barriers) then, (2) risks priority criteria quantified by using RPN index (361 for the highest rate failure). The ability of improved RPN scores reassessed by root cause analysis showed some variations. Conclusions: We concluded that standard criteria should be developed inconsistent with clinical linguistic and special scientific fields. Therefore, cooperation and partnership of technical and clinical groups are necessary to modify these models. PMID:29441184

  8. Mode-coupling theory

    NASA Astrophysics Data System (ADS)

    Reichman, David R.; Charbonneau, Patrick

    2005-05-01

    In this set of lecture notes we review the mode-coupling theory of the glass transition from several perspectives. First, we derive mode-coupling equations for the description of density fluctuations from microscopic considerations with the use the Mori Zwanzig projection operator technique. We also derive schematic mode-coupling equations of a similar form from a field-theoretic perspective. We review the successes and failures of mode-coupling theory, and discuss recent advances in the applications of the theory.

  9. 27 CFR 24.229 - Tank car and tank truck requirements.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Tank car and tank truck... BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL WINE Spirits § 24.229 Tank car and tank truck requirements. Railroad tank cars and tank trucks used to transport spirits for use in wine production will be constructed...

  10. 27 CFR 24.229 - Tank car and tank truck requirements.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Tank car and tank truck... BUREAU, DEPARTMENT OF THE TREASURY LIQUORS WINE Spirits § 24.229 Tank car and tank truck requirements. Railroad tank cars and tank trucks used to transport spirits for use in wine production will be constructed...

  11. 27 CFR 24.229 - Tank car and tank truck requirements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Tank car and tank truck... BUREAU, DEPARTMENT OF THE TREASURY LIQUORS WINE Spirits § 24.229 Tank car and tank truck requirements. Railroad tank cars and tank trucks used to transport spirits for use in wine production will be constructed...

  12. 27 CFR 24.229 - Tank car and tank truck requirements.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Tank car and tank truck... BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL WINE Spirits § 24.229 Tank car and tank truck requirements. Railroad tank cars and tank trucks used to transport spirits for use in wine production will be constructed...

  13. 27 CFR 24.229 - Tank car and tank truck requirements.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Tank car and tank truck... BUREAU, DEPARTMENT OF THE TREASURY LIQUORS WINE Spirits § 24.229 Tank car and tank truck requirements. Railroad tank cars and tank trucks used to transport spirits for use in wine production will be constructed...

  14. Incident Learning and Failure-Mode-and-Effects-Analysis Guided Safety Initiatives in Radiation Medicine

    PubMed Central

    Kapur, Ajay; Goode, Gina; Riehl, Catherine; Zuvic, Petrina; Joseph, Sherin; Adair, Nilda; Interrante, Michael; Bloom, Beatrice; Lee, Lucille; Sharma, Rajiv; Sharma, Anurag; Antone, Jeffrey; Riegel, Adam; Vijeh, Lili; Zhang, Honglai; Cao, Yijian; Morgenstern, Carol; Montchal, Elaine; Cox, Brett; Potters, Louis

    2013-01-01

    By combining incident learning and process failure-mode-and-effects-analysis (FMEA) in a structure-process-outcome framework we have created a risk profile for our radiation medicine practice and implemented evidence-based risk-mitigation initiatives focused on patient safety. Based on reactive reviews of incidents reported in our departmental incident-reporting system and proactive FMEA, high safety-risk procedures in our paperless radiation medicine process and latent risk factors were identified. Six initiatives aimed at the mitigation of associated severity, likelihood-of-occurrence, and detectability risks were implemented. These were the standardization of care pathways and toxicity grading, pre-treatment-planning peer review, a policy to thwart delay-rushed processes, an electronic whiteboard to enhance coordination, and the use of six sigma metrics to monitor operational efficiencies. The effectiveness of these initiatives over a 3-years period was assessed using process and outcome specific metrics within the framework of the department structure. There has been a 47% increase in incident-reporting, with no increase in adverse events. Care pathways have been used with greater than 97% clinical compliance rate. The implementation of peer review prior to treatment-planning and use of the whiteboard have provided opportunities for proactive detection and correction of errors. There has been a twofold drop in the occurrence of high-risk procedural delays. Patient treatment start delays are routinely enforced on cases that would have historically been rushed. Z-scores for high-risk procedures have steadily improved from 1.78 to 2.35. The initiatives resulted in sustained reductions of failure-mode risks as measured by a set of evidence-based metrics over a 3-years period. These augment or incorporate many of the published recommendations for patient safety in radiation medicine by translating them to clinical practice. PMID:24380074

  15. Processing Mode Causally Influences Emotional Reactivity

    PubMed Central

    Watkins, Ed; Moberly, Nicholas J.; Moulds, Michelle L.

    2008-01-01

    Three studies are reported showing that emotional responses to stress can be modified by systematic prior practice in adopting particular processing modes. Participants were induced to think about positive and negative scenarios in a mode either characteristic of or inconsistent with the abstract-evaluative mind-set observed in depressive rumination, via explicit instructions (Experiments 1 and 2) and via implicit induction of interpretative biases (Experiment 3), before being exposed to a failure experience. In all three studies, participants trained into the mode antithetical to depressive rumination demonstrated less emotional reactivity following failure than participants trained into the mode consistent with depressive rumination. These findings provide evidence consistent with the hypothesis that processing mode modifies emotional reactivity and support the processing-mode theory of rumination. PMID:18540752

  16. Intelligent on-line fault tolerant control for unanticipated catastrophic failures.

    PubMed

    Yen, Gary G; Ho, Liang-Wei

    2004-10-01

    As dynamic systems become increasingly complex, experience rapidly changing environments, and encounter a greater variety of unexpected component failures, solving the control problems of such systems is a grand challenge for control engineers. Traditional control design techniques are not adequate to cope with these systems, which may suffer from unanticipated dynamic failures. In this research work, we investigate the on-line fault tolerant control problem and propose an intelligent on-line control strategy to handle the desired trajectories tracking problem for systems suffering from various unanticipated catastrophic faults. Through theoretical analysis, the sufficient condition of system stability has been derived and two different on-line control laws have been developed. The approach of the proposed intelligent control strategy is to continuously monitor the system performance and identify what the system's current state is by using a fault detection method based upon our best knowledge of the nominal system and nominal controller. Once a fault is detected, the proposed intelligent controller will adjust its control signal to compensate for the unknown system failure dynamics by using an artificial neural network as an on-line estimator to approximate the unexpected and unknown failure dynamics. The first control law is derived directly from the Lyapunov stability theory, while the second control law is derived based upon the discrete-time sliding mode control technique. Both control laws have been implemented in a variety of failure scenarios to validate the proposed intelligent control scheme. The simulation results, including a three-tank benchmark problem, comply with theoretical analysis and demonstrate a significant improvement in trajectory following performance based upon the proposed intelligent control strategy.

  17. Risk based inspection for atmospheric storage tank

    NASA Astrophysics Data System (ADS)

    Nugroho, Agus; Haryadi, Gunawan Dwi; Ismail, Rifky; Kim, Seon Jin

    2016-04-01

    Corrosion is an attack that occurs on a metallic material as a result of environment's reaction.Thus, it causes atmospheric storage tank's leakage, material loss, environmental pollution, equipment failure and affects the age of process equipment then finally financial damage. Corrosion risk measurement becomesa vital part of Asset Management at the plant for operating any aging asset.This paper provides six case studies dealing with high speed diesel atmospheric storage tank parts at a power plant. A summary of the basic principles and procedures of corrosion risk analysis and RBI applicable to the Process Industries were discussed prior to the study. Semi quantitative method based onAPI 58I Base-Resource Document was employed. The risk associated with corrosion on the equipment in terms of its likelihood and its consequences were discussed. The corrosion risk analysis outcome used to formulate Risk Based Inspection (RBI) method that should be a part of the atmospheric storage tank operation at the plant. RBI gives more concern to inspection resources which are mostly on `High Risk' and `Medium Risk' criteria and less on `Low Risk' shell. Risk categories of the evaluated equipment were illustrated through case study analysis outcome.

  18. Improved Re-Configurable Sliding Mode Controller for Reusable Launch Vehicle of Second Generation Addressing Aerodynamic Surface Failures and Thrust Deficiencies

    NASA Technical Reports Server (NTRS)

    Shtessel, Yuri B.

    2002-01-01

    In this report we present a time-varying sliding mode control (TV-SMC) technique for reusable launch vehicle (RLV) attitude control in ascent and entry flight phases. In ascent flight the guidance commands Euler roll, pitch and yaw angles, and in entry flight it commands the aerodynamic angles of bank, attack and sideslip. The controller employs a body rate inner loop and the attitude outer loop, which are separated in time-scale by the singular perturbation principle. The novelty of the TVSMC is that both the sliding surface and the boundary layer dynamics can be varied in real time using the PD-eigenvalue assignment technique. This salient feature is used to cope with control command saturation and integrator windup in the presence of severe disturbance or control effector failure, which enhances the robustness and fault tolerance of the controller. The TV-SMC is developed and tuned up for the X-33 sub-orbital technology demonstration vehicle in launch and re-entry modes. A variety of nominal, dispersion and failure scenarios have tested via high fidelity 6DOF simulations using MAVERIC/SLIM simulation software.

  19. 49 CFR 180.519 - Periodic retest and inspection of tank cars other than single-unit tank car tanks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Periodic retest and inspection of tank cars other than single-unit tank car tanks. 180.519 Section 180.519 Transportation Other Regulations Relating to... of Tank Cars § 180.519 Periodic retest and inspection of tank cars other than single-unit tank car...

  20. Failure mode and effects analysis of the universal anaesthesia machine in two tertiary care hospitals in Sierra Leone

    PubMed Central

    Rosen, M. A.; Sampson, J. B.; Jackson, E. V.; Koka, R.; Chima, A. M.; Ogbuagu, O. U.; Marx, M. K.; Koroma, M.; Lee, B. H.

    2014-01-01

    Background Anaesthesia care in developed countries involves sophisticated technology and experienced providers. However, advanced machines may be inoperable or fail frequently when placed into the austere medical environment of a developing country. Failure mode and effects analysis (FMEA) is a method for engaging local staff in identifying real or potential breakdowns in processes or work systems and to develop strategies to mitigate risks. Methods Nurse anaesthetists from the two tertiary care hospitals in Freetown, Sierra Leone, participated in three sessions moderated by a human factors specialist and an anaesthesiologist. Sessions were audio recorded, and group discussion graphically mapped by the session facilitator for analysis and commentary. These sessions sought to identify potential barriers to implementing an anaesthesia machine designed for austere medical environments—the universal anaesthesia machine (UAM)—and also engaging local nurse anaesthetists in identifying potential solutions to these barriers. Results Participating Sierra Leonean clinicians identified five main categories of failure modes (resource availability, environmental issues, staff knowledge and attitudes, and workload and staffing issues) and four categories of mitigation strategies (resource management plans, engaging and educating stakeholders, peer support for new machine use, and collectively advocating for needed resources). Conclusions We identified factors that may limit the impact of a UAM and devised likely effective strategies for mitigating those risks. PMID:24833727

  1. [Failure mode and effects analysis on computerized drug prescriptions].

    PubMed

    Paredes-Atenciano, J A; Roldán-Aviña, J P; González-García, Mercedes; Blanco-Sánchez, M C; Pinto-Melero, M A; Pérez-Ramírez, C; Calvo Rubio-Burgos, Miguel; Osuna-Navarro, F J; Jurado-Carmona, A M

    2015-01-01

    To identify and analyze errors in drug prescriptions of patients treated in a "high resolution" hospital by applying a Failure mode and effects analysis (FMEA).Material and methods A multidisciplinary group of medical specialties and nursing analyzed medical records where drug prescriptions were held in free text format. An FMEA was developed in which the risk priority index (RPI) was obtained from a cross-sectional observational study using an audit of the medical records, carried out in 2 phases: 1) Pre-intervention testing, and (2) evaluation of improvement actions after the first analysis. An audit sample size of 679 medical records from a total of 2,096 patients was calculated using stratified sampling and random selection of clinical events. Prescription errors decreased by 22.2% in the second phase. FMEA showed a greater RPI in "unspecified route of administration" and "dosage unspecified", with no significant decreases observed in the second phase, although it did detect, "incorrect dosing time", "contraindication due to drug allergy", "wrong patient" or "duplicate prescription", which resulted in the improvement of prescriptions. Drug prescription errors have been identified and analyzed by FMEA methodology, improving the clinical safety of these prescriptions. This tool allows updates of electronic prescribing to be monitored. To avoid such errors would require the mandatory completion of all sections of a prescription. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  2. Intralaminar and Interlaminar Progressive Failure Analysis of Composite Panels with Circular Cutouts

    NASA Technical Reports Server (NTRS)

    Goyal, Vinay K.; Jaunky, Navin; Johnson, Eric R.; Ambur, Damodar

    2002-01-01

    A progressive failure methodology is developed and demonstrated to simulate the initiation and material degradation of a laminated panel due to intralaminar and interlaminar failures. Initiation of intralaminar failure can be by a matrix-cracking mode, a fiber-matrix shear mode, and a fiber failure mode. Subsequent material degradation is modeled using damage parameters for each mode to selectively reduce lamina material properties. The interlaminar failure mechanism such as delamination is simulated by positioning interface elements between adjacent sublaminates. A nonlinear constitutive law is postulated for the interface element that accounts for a multi-axial stress criteria to detect the initiation of delamination, a mixed-mode fracture criteria for delamination progression, and a damage parameter to prevent restoration of a previous cohesive state. The methodology is validated using experimental data available in the literature on the response and failure of quasi-isotropic panels with centrally located circular cutouts loaded into the postbuckling regime. Very good agreement between the progressive failure analyses and the experimental results is achieved if the failure analyses includes the interaction of intralaminar and interlaminar failures.

  3. OVERVIEW OF ENHANCED HANFORD SINGLE-SHELL TANK (SST) INTEGRITY PROJECT - 12128

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    VENETZ TJ; BOOMER KD; WASHENFELDER DJ

    2012-01-25

    analysis of current mechanics properties. The work on the liner leak integrity has examined the leaks from 23 tanks with liner failures. Individual leak assessments are being developed for each tank to identify the leak cause and location. Also a common cause study is being performed to take the data from individual tanks to look for trends in the failure. Supporting this work is an assessment of the leak rate from tanks at both Hanford and the Savannah River Site and a new method to locate leak sites in tank liner using ionic conductivity. A separate activity is being conducted to examine the propensity for corrosion in select single shell tanks with aggressive waste layers. The work for these two main efforts will provide the basis for the phase two planning. If the margins identified aren't sufficient to ensure the integrity through the life of the mission, phase two would focus on activities to further enhance the understanding of tank integrity. Also coincident with any phase-two work would be the integrity analysis for the tanks, which would be complete in 2018. With delays in the completion of waste treatment facilities at Hanford, greater reliance on safe, continued storage of waste in the single shell tanks is increased in importance. The goal of integrity assessment would provide basis to continue SST activities till the end of the treatment mission.« less

  4. A numerical procedure for failure mode detection of masonry arches reinforced with fiber reinforced polymeric materials

    NASA Astrophysics Data System (ADS)

    Galassi, S.

    2018-05-01

    In this paper a mechanical model of masonry arches strengthened with fibre-reinforced composite materials and the relevant numerical procedure for the analysis are proposed. The arch is modelled by using an assemblage of rigid blocks that are connected together and, also to the supporting structures, by mortar joints. The presence of the reinforcement, usually a sheet placed at the intrados or the extrados, prevents the occurrence of cracks that could activate possible collapse mechanisms, due to tensile failure of the mortar joints. Therefore, in a reinforced arch failure generally occurs in a different way from the URM arch. The numerical procedure proposed checks, as a function of an external incremental load, the inner stress state in the arch, in the reinforcement and in the adhesive layer. In so doing, it then provides a prediction of failure modes. Results obtained from experimental tests, carried out on four in-scale models performed in a laboratory, have been compared with those provided by the numerical procedure, implemented in ArchiVAULT, a software developed by the author. In this regard, the numerical procedure is an extension of previous works. Although additional experimental investigations are necessary, these former results confirm that the proposed numerical procedure is promising.

  5. Potential for Fuel Tank Fire and Hydrodynamic Ram from Uncontained Aircraft Engine Debris

    DOT National Transportation Integrated Search

    1997-01-01

    This report addresses the potential consequences of the impact and penetration of fuel tanks by debris from uncontained engine failures on commercial jet aircraft. The report presents a brief review of accident data and of the pertinent technical lit...

  6. Think Tanks

    NASA Technical Reports Server (NTRS)

    2001-01-01

    A new inspection robot from Solex Robotics Systems was designed to eliminate hazardous inspections of petroleum and chemical storage tanks. The submersible robot, named Maverick, is used to inspect the bottoms of tanks, keeping the tanks operational during inspection. Maverick is able to provide services that will make manual tank inspections obsolete. While the inspection is conducted, Maverick's remote human operators remain safe outside of the tank. The risk to human health and life is now virtually eliminated. The risk to the environment is also minimal because there is a reduced chance of spillage from emptying and cleaning the tanks, where previously, tons of pollutants were released through the process of draining and refilling.

  7. A Study of Energy Management Systems and its Failure Modes in Smart Grid Power Distribution

    NASA Astrophysics Data System (ADS)

    Musani, Aatif

    The subject of this thesis is distribution level load management using a pricing signal in a smart grid infrastructure. The project relates to energy management in a spe-cialized distribution system known as the Future Renewable Electric Energy Delivery and Management (FREEDM) system. Energy management through demand response is one of the key applications of smart grid. Demand response today is envisioned as a method in which the price could be communicated to the consumers and they may shift their loads from high price periods to the low price periods. The development and deployment of the FREEDM system necessitates controls of energy and power at the point of end use. In this thesis, the main objective is to develop the control model of the Energy Management System (EMS). The energy and power management in the FREEDM system is digitally controlled therefore all signals containing system states are discrete. The EMS is modeled as a discrete closed loop transfer function in the z-domain. A breakdown of power and energy control devices such as EMS components may result in energy con-sumption error. This leads to one of the main focuses of the thesis which is to identify and study component failures of the designed control system. Moreover, H-infinity ro-bust control method is applied to ensure effectiveness of the control architecture. A focus of the study is cyber security attack, specifically bad data detection in price. Test cases are used to illustrate the performance of the EMS control design, the effect of failure modes and the application of robust control technique. The EMS was represented by a linear z-domain model. The transfer function be-tween the pricing signal and the demand response was designed and used as a test bed. EMS potential failure modes were identified and studied. Three bad data detection meth-odologies were implemented and a voting policy was used to declare bad data. The run-ning mean and standard deviation analysis method proves to be

  8. Dual Tank Fuel System

    DOEpatents

    Wagner, Richard William; Burkhard, James Frank; Dauer, Kenneth John

    1999-11-16

    A dual tank fuel system has primary and secondary fuel tanks, with the primary tank including a filler pipe to receive fuel and a discharge line to deliver fuel to an engine, and with a balance pipe interconnecting the primary tank and the secondary tank. The balance pipe opens close to the bottom of each tank to direct fuel from the primary tank to the secondary tank as the primary tank is filled, and to direct fuel from the secondary tank to the primary tank as fuel is discharged from the primary tank through the discharge line. A vent line has branches connected to each tank to direct fuel vapor from the tanks as the tanks are filled, and to admit air to the tanks as fuel is delivered to the engine.

  9. Development of STS/Centaur failure probabilities liftoff to Centaur separation

    NASA Technical Reports Server (NTRS)

    Hudson, J. M.

    1982-01-01

    The results of an analysis to determine STS/Centaur catastrophic vehicle response probabilities for the phases of vehicle flight from STS liftoff to Centaur separation from the Orbiter are presented. The analysis considers only category one component failure modes as contributors to the vehicle response mode probabilities. The relevant component failure modes are grouped into one of fourteen categories of potential vehicle behavior. By assigning failure rates to each component, for each of its failure modes, the STS/Centaur vehicle response probabilities in each phase of flight can be calculated. The results of this study will be used in a DOE analysis to ascertain the hazard from carrying a nuclear payload on the STS.

  10. Failure and Degradation Modes of PV modules in a Hot Dry Climate: Results after 4 and 12 years of field exposure

    NASA Astrophysics Data System (ADS)

    Mallineni, Jaya krishna

    This study evaluates two photovoltaic (PV) power plants based on electrical performance measurements, diode checks, visual inspections and infrared scanning. The purpose of this study is to measure degradation rates of performance parameters (Pmax, Isc, Voc, Vmax, Imax and FF) and to identify the failure modes in a "hot-dry desert" climatic condition along with quantitative determination of safety failure rates and reliability failure rates. The data obtained from this study can be used by module manufacturers in determining the warranty limits of their modules and also by banks, investors, project developers and users in determining appropriate financing or decommissioning models. In addition, the data obtained in this study will be helpful in selecting appropriate accelerated stress tests which would replicate the field failures for the new modules and would predict the lifetime for new PV modules. The study was conducted at two, single axis tracking monocrystalline silicon (c-Si) power plants, Site 3 and Site 4c of Salt River Project (SRP). The Site 3 power plant is located in Glendale, Arizona and the Site 4c power plant is located in Mesa, Arizona both considered a "hot-dry" field condition. The Site 3 power plant has 2,352 modules (named as Model-G) which was rated at 250 kW DC output. The mean and median degradation of these 12 years old modules are 0.95%/year and 0.96%/year, respectively. The major cause of degradation found in Site 3 is due to high series resistance (potentially due to solder-bond thermo-mechanical fatigue) and the failure mode is ribbon-ribbon solder bond failure/breakage. The Site 4c power plant has 1,280 modules (named as Model-H) which provide 243 kW DC output. The mean and median degradation of these 4 years old modules are 0.96%/year and 1%/year, respectively. At Site 4c, practically, none of the module failures are observed. The average soiling loss is 6.9% in Site 3 and 5.5% in Site 4c. The difference in soiling level is attributed

  11. 33 CFR 157.15 - Slop tanks in tank vessels.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... tank. (2) A new vessel of 70,000 tons DWT or more must have at least two slop tanks. (b) Capacity. Slop tanks must have the total capacity to retain oily mixtures from cargo tank washings, oil residue, and ballast water containing an oily mixture of 3 percent or more of the oil carrying capacity. Two percent...

  12. A multidimensional anisotropic strength criterion based on Kelvin modes

    NASA Astrophysics Data System (ADS)

    Arramon, Yves Pierre

    A new theory for the prediction of multiaxial strength of anisotropic elastic materials was proposed by Biegler and Mehrabadi (1993). This theory is based on the premise that the total elastic strain energy of an anisotropic material subjected to multiaxial stress can be decomposed into dilatational and deviatoric modes. A multidimensional strength criterion may thus be formulated by postulating that the failure would occur when the energy stored in one of these modes has reached a critical value. However, the logic employed by these authors to formulate a failure criterion based on this theory could not be extended to multiaxial stress. In this thesis, an alternate criterion is presented which redresses the biaxial restriction by reformulating the surfaces of constant modal energy as surfaces of constant eigenstress magnitude. The resulting failure envelope, in a multidimensional stress space, is piecewise smooth. Each facet of the envelope is expected to represent the locus of failure data by a particular Kelvin mode. It is further shown that the Kelvin mode theory alone provides an incomplete description of the failure of some materials, but that this weakness can be addressed by the introduction of a set of complementary modes. A revised theory which combines both Kelvin and complementary modes is thus proposed and applied seven example materials: an isotropic concrete, tetragonal paperboard, two orthotropic softwoods, two orthotropic hardwoods and an orthotropic cortical bone. The resulting failure envelopes for these examples were plotted and, with the exception of concrete, shown to produce intuitively correct failure predictions.

  13. Failure mode and effects analysis (FMEA) for the Space Shuttle solid rocket motor

    NASA Technical Reports Server (NTRS)

    Russell, D. L.; Blacklock, K.; Langhenry, M. T.

    1988-01-01

    The recertification of the Space Shuttle Solid Rocket Booster (SRB) and Solid Rocket Motor (SRM) has included an extensive rewriting of the Failure Mode and Effects Analysis (FMEA) and Critical Items List (CIL). The evolution of the groundrules and methodology used in the analysis is discussed and compared to standard FMEA techniques. Especially highlighted are aspects of the FMEA/CIL which are unique to the analysis of an SRM. The criticality category definitions are presented and the rationale for assigning criticality is presented. The various data required by the CIL and contribution of this data to the retention rationale is also presented. As an example, the FMEA and CIL for the SRM nozzle assembly is discussed in detail. This highlights some of the difficulties associated with the analysis of a system with the unique mission requirements of the Space Shuttle.

  14. Annular Air Leaks in a liquid hydrogen storage tank

    NASA Astrophysics Data System (ADS)

    Krenn, AG; Youngquist, RC; Starr, SO

    2017-12-01

    Large liquid hydrogen (LH2) storage tanks are vital infrastructure for NASA, the DOD, and industrial users. Over time, air may leak into the evacuated, perlite filled annular region of these tanks. Once inside, the extremely low temperatures will cause most of the air to freeze. If a significant mass of air is allowed to accumulate, severe damage can result from nominal draining operations. Collection of liquid air on the outer shell may chill it below its ductility range, resulting in fracture. Testing and analysis to quantify the thermal conductivity of perlite that has nitrogen frozen into its interstitial spaces and to determine the void fraction of frozen nitrogen within a perlite/frozen nitrogen mixture is presented. General equations to evaluate methods for removing frozen air, while avoiding fracture, are developed. A hypothetical leak is imposed on an existing tank geometry and a full analysis of that leak is detailed. This analysis includes a thermal model of the tank and a time-to-failure calculation. Approaches to safely remove the frozen air are analyzed, leading to the conclusion that the most feasible approach is to allow the frozen air to melt and to use a water stream to prevent the outer shell from chilling.

  15. Reliability and failure modes of narrow implant systems.

    PubMed

    Hirata, Ronaldo; Bonfante, Estevam A; Anchieta, Rodolfo B; Machado, Lucas S; Freitas, Gileade; Fardin, Vinicius P; Tovar, Nick; Coelho, Paulo G

    2016-09-01

    Narrow implants are indicated in areas of limited bone width or when grafting is nonviable. However, the reduction of implant diameter may compromise their performance. This study evaluated the reliability of several narrow implant systems under fatigue, after restored with single-unit crowns. Narrow implant systems were divided (n = 18 each), as follows: Astra (ASC); BioHorizons (BSC); Straumann Roxolid (SNC), Intra-Lock (IMC), and Intra-Lock one-piece abutment (ILO). Maxillary central incisor crowns were cemented and subjected to step-stress accelerated life testing in water. Use level probability Weibull curves and reliability for a mission of 100,000 cycles at 130- and 180-N loads (90 % two-sided confidence intervals) were calculated. Scanning electron microscopy was used for fractography. Reliability for 100,000 cycles at 130 N was ∼99 % in group ASC, ∼99 % in BSC, ∼96 % in SNC, ∼99 % in IMC, and ∼100 % in ILO. At 180 N, reliability of ∼34 % resulted for the ASC group, ∼91 % for BSC, ∼53 % for SNC, ∼70 % for IMC, and ∼99 % for ILO. Abutment screw fracture was the main failure mode for all groups. Reliability was not different between systems for 100,000 cycles at the 130-N load. A significant decrease was observed at the 180-N load for ASC, SNC, and IMC, whereas it was maintained for BSC and ILO. The investigated narrow implants presented mechanical performance under fatigue that suggests their safe use as single crowns in the anterior region.

  16. Tank System Integrated Model: A Cryogenic Tank Performance Prediction Program

    NASA Technical Reports Server (NTRS)

    Bolshinskiy, L. G.; Hedayat, A.; Hastings, L. J.; Sutherlin, S. G.; Schnell, A. R.; Moder, J. P.

    2017-01-01

    Accurate predictions of the thermodynamic state of the cryogenic propellants, pressurization rate, and performance of pressure control techniques in cryogenic tanks are required for development of cryogenic fluid long-duration storage technology and planning for future space exploration missions. This Technical Memorandum (TM) presents the analytical tool, Tank System Integrated Model (TankSIM), which can be used for modeling pressure control and predicting the behavior of cryogenic propellant for long-term storage for future space missions. Utilizing TankSIM, the following processes can be modeled: tank self-pressurization, boiloff, ullage venting, mixing, and condensation on the tank wall. This TM also includes comparisons of TankSIM program predictions with the test data andexamples of multiphase mission calculations.

  17. Establishment of design criteria for acceptable failure modes and fail safe considerations for the space shuttle structural system

    NASA Technical Reports Server (NTRS)

    Westrup, R. W.

    1972-01-01

    Investigations of fatigue life, and safe-life and fail-safe design concepts as applied to space shuttle structure are summarized. The results are evaluated to select recommended structural design criteria to provide assurance that premature failure due to propagation of undetected crack-like defects will not occur during shuttle operational service. The space shuttle booster, GDC configuration B-9U, is selected as the reference vehicle. Structural elements used as basis of detail analyses include wing spar caps, vertical stabilizer skins, crew compartment skin, orbiter support frame, and propellant tank shell structure. Fatigue life analyses of structural elements are performed to define potential problem areas and establish upper limits of operating stresses. Flaw growth analyses are summarized in parametric form over a range of initial flaw types and sizes, operating stresses and service life requirements. Service life of 100 to 500 missions is considered.

  18. Design criteria: data acquisition system for waste tank liquid level gauges and SX Tank Farm thermocouples

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Martin, G.E.; Oliver, R.G.

    1972-02-17

    This design criteria revision (revision 2) will cancel revision 1 and will provide complete functional supervision of the liquid level gauges. A new.counter and an electronic supervisory circuit will be installed in each waste tank liquid level gauge. The electronic supervisory circuit will monitor (via the new counter and a signal from the gauge electronics) cycling of the gauge on a one minute time cycle. This supervisory circuit will fulfill the intent of revision 1 (monitor AC power to the gauge) and, in addition, will supervise all other aspects of the gauge including: the electronics, the drive motor, all sprocketsmore » and chain linkages, and the counter. If a gauge failure should occur, this circuit will remove the +12 volts excitation from the data acquisition system inferface board; and the computer will be programmed to recognize this condition as a gauge failure. (auth)« less

  19. 49 CFR 179.400 - General specification applicable to cryogenic liquid tank car tanks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... liquid tank car tanks. 179.400 Section 179.400 Transportation Other Regulations Relating to... MATERIALS REGULATIONS SPECIFICATIONS FOR TANK CARS Specification for Cryogenic Liquid Tank Car Tanks and... liquid tank car tanks. ...

  20. 49 CFR 179.100 - General specifications applicable to pressure tank car tanks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... car tanks. 179.100 Section 179.100 Transportation Other Regulations Relating to Transportation...) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.100 General specifications applicable to pressure tank car tanks. ...

  1. 49 CFR 179.100 - General specifications applicable to pressure tank car tanks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... car tanks. 179.100 Section 179.100 Transportation Other Regulations Relating to Transportation...) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.100 General specifications applicable to pressure tank car tanks. ...

  2. 49 CFR 179.100 - General specifications applicable to pressure tank car tanks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... car tanks. 179.100 Section 179.100 Transportation Other Regulations Relating to Transportation... REGULATIONS SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.100 General specifications applicable to pressure tank car tanks. ...

  3. 49 CFR 179.100 - General specifications applicable to pressure tank car tanks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... car tanks. 179.100 Section 179.100 Transportation Other Regulations Relating to Transportation...) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.100 General specifications applicable to pressure tank car tanks. ...

  4. Increasing the endurance of electrodes of heating salt tanks

    NASA Astrophysics Data System (ADS)

    Kulikov, A. I.

    1997-05-01

    Electrodes used for heating, melting, and sustaining the requisite temperature regime in salt tanks for heat treatment of metals and alloys operate under severe conditions (heating to 1300°C, aggressive medium of the melts of salts of alkali and alkali-earth metals). This causes early failure of the electrodes, and the heat treatment unit is stopped for repair. For example, the design service life of electrodes for SVS 2.3/13I tanks is two months, but as a rule it does not exceed one month of continuous operation. The replacement of conventional low-carbon electrode steel (for example, of grade 10) by a more expensive heat- and corrosion-resistant steel has not proved effective but rather increased the cost of the electrodes and hence the cost of the produced parts. In this connection, it is interesting to get acquainted with works devoted to increasing the service life of salt-tank electrodes for heat treatment shops of machine-building and tool plants. The present paper describes such an attempt.

  5. SU-F-P-07: Applying Failure Modes and Effects Analysis to Treatment Planning System QA

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Mathew, D; Alaei, P

    2016-06-15

    Purpose: A small-scale implementation of Failure Modes and Effects Analysis (FMEA) for treatment planning system QA by utilizing methodology of AAPM TG-100 report. Methods: FMEA requires numerical values for severity (S), occurrence (O) and detectability (D) of each mode of failure. The product of these three values gives a risk priority number (RPN). We have implemented FMEA for the treatment planning system (TPS) QA for two clinics which use Pinnacle and Eclipse TPS. Quantitative monthly QA data dating back to 4 years for Pinnacle and 1 year for Eclipse have been used to determine values for severity (deviations from predeterminedmore » doses at points or volumes), and occurrence of such deviations. The TPS QA protocol includes a phantom containing solid water and lung- and bone-equivalent heterogeneities. Photon and electron plans have been evaluated in both systems. The dose values at multiple distinct points of interest (POI) within the solid water, lung, and bone-equivalent slabs, as well as mean doses to several volumes of interest (VOI), have been re-calculated monthly using the available algorithms. Results: The computed doses vary slightly month-over-month. There have been more significant deviations following software upgrades, especially if the upgrade involved re-modeling of the beams. TG-100 guidance and the data presented here suggest an occurrence (O) of 2 depending on the frequency of re-commissioning the beams, severity (S) of 3, and detectability (D) of 2, giving an RPN of 12. Conclusion: Computerized treatment planning systems could pose a risk due to dosimetric errors and suboptimal treatment plans. The FMEA analysis presented here suggests that TPS QA should immediately follow software upgrades, but does not need to be performed every month.« less

  6. Identification and classification of failure modes in laminated composites by using a multivariate statistical analysis of wavelet coefficients

    NASA Astrophysics Data System (ADS)

    Baccar, D.; Söffker, D.

    2017-11-01

    Acoustic Emission (AE) is a suitable method to monitor the health of composite structures in real-time. However, AE-based failure mode identification and classification are still complex to apply due to the fact that AE waves are generally released simultaneously from all AE-emitting damage sources. Hence, the use of advanced signal processing techniques in combination with pattern recognition approaches is required. In this paper, AE signals generated from laminated carbon fiber reinforced polymer (CFRP) subjected to indentation test are examined and analyzed. A new pattern recognition approach involving a number of processing steps able to be implemented in real-time is developed. Unlike common classification approaches, here only CWT coefficients are extracted as relevant features. Firstly, Continuous Wavelet Transform (CWT) is applied to the AE signals. Furthermore, dimensionality reduction process using Principal Component Analysis (PCA) is carried out on the coefficient matrices. The PCA-based feature distribution is analyzed using Kernel Density Estimation (KDE) allowing the determination of a specific pattern for each fault-specific AE signal. Moreover, waveform and frequency content of AE signals are in depth examined and compared with fundamental assumptions reported in this field. A correlation between the identified patterns and failure modes is achieved. The introduced method improves the damage classification and can be used as a non-destructive evaluation tool.

  7. Shear Fracture of Dual Phase AHSS in the Process of Stamping: Macroscopic Failure Mode and Micro-level Metallographical Observation

    NASA Astrophysics Data System (ADS)

    Wang, Wurong; Wei, Xicheng; Yang, Jun; Shi, Gang

    2011-08-01

    Due to its excellent strength and formability combinations, dual phase (DP) steels offer the potential to improve the vehicle crashworthiness performance without increasing car body weight and have been increasingly used into new vehicles. However, a new type of crack mode termed as shear fracture is accompanied with the application of these high strength DP steel sheets. With the cup drawing experiment to identify the limit drawing ratio (LDR) of three DP AHSS with strength level from 600 MPa to 1000 MPa, the study compared and categorized the macroscopic failure mode of these three types of materials. The metallographical observation along the direction of crack was conducted for the DP steels to discover the micro-level propagation mechanism of the fracture.

  8. 49 CFR 179.102 - Special commodity requirements for pressure tank car tanks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... car tanks. 179.102 Section 179.102 Transportation Other Regulations Relating to Transportation... REGULATIONS SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.102 Special commodity requirements for pressure tank car tanks. (a) In addition to...

  9. MO-D-213-02: Quality Improvement Through a Failure Mode and Effects Analysis of Pediatric External Beam Radiotherapy

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Gray, J; Lukose, R; Bronson, J

    2015-06-15

    Purpose: To conduct a failure mode and effects analysis (FMEA) as per AAPM Task Group 100 on clinical processes associated with teletherapy, and the development of mitigations for processes with identified high risk. Methods: A FMEA was conducted on clinical processes relating to teletherapy treatment plan development and delivery. Nine major processes were identified for analysis. These steps included CT simulation, data transfer, image registration and segmentation, treatment planning, plan approval and preparation, and initial and subsequent treatments. Process tree mapping was utilized to identify the steps contained within each process. Failure modes (FM) were identified and evaluated with amore » scale of 1–10 based upon three metrics: the severity of the effect, the probability of occurrence, and the detectability of the cause. The analyzed metrics were scored as follows: severity – no harm = 1, lethal = 10; probability – not likely = 1, certainty = 10; detectability – always detected = 1, undetectable = 10. The three metrics were combined multiplicatively to determine the risk priority number (RPN) which defined the overall score for each FM and the order in which process modifications should be deployed. Results: Eighty-nine procedural steps were identified with 186 FM accompanied by 193 failure effects with 213 potential causes. Eighty-one of the FM were scored with a RPN > 10, and mitigations were developed for FM with RPN values exceeding ten. The initial treatment had the most FM (16) requiring mitigation development followed closely by treatment planning, segmentation, and plan preparation with fourteen each. The maximum RPN was 400 and involved target delineation. Conclusion: The FMEA process proved extremely useful in identifying previously unforeseen risks. New methods were developed and implemented for risk mitigation and error prevention. Similar to findings reported for adult patients, the process leading to the initial treatment has

  10. Optimization of armored spherical tanks for storage on the lunar surface

    NASA Technical Reports Server (NTRS)

    Bents, D. J.; Knight, D. A.

    1992-01-01

    A redundancy strategy for reducing micrometeroid armoring mass is investigated, with application to cryogenic reactant storage for a regenerative fuel cell (RFC) on the lunar surface. In that micrometeoroid environment, the cryogenic fuel must be protected from loss due to tank puncture. The tankage must have a sufficiently high probability of survival over the length of the mission so that the probability of system failure due to tank puncture is low compared to the other mission risk factors. Assuming that a single meteoroid penetration can cause a storage tank to lose its contents, two means are available to raise the probability of surviving micrometeoroid attack to the desired level. One can armor the tanks to a thickness sufficient to reduce probability of penetration of any tank to the desired level or add extra capacity in the form of spare tanks that results in survival of a given number out of the ensemble at the desired level. A combination of these strategies (armoring and redundancy) is investigated. The objective is to find the optimum combination which yields the lowest shielding mass per cubic meter of surviving fuel out of the original ensemble. The investigation found that, for the volumes of fuel associated with multikilowatt class cryo storage RFC's, and the armoring methodology and meteoroid models used, storage should be fragmented into small individual tanks. Larger installations (more fuel) pay less of a shielding penalty than small installations. For the same survival probability over the same time period, larger volumes will require less armoring mass per unit volume protected.

  11. Predictions and Experimental Microstructural Characterization of High Strain Rate Failure Modes in Layered Aluminum Composites

    NASA Astrophysics Data System (ADS)

    Khanikar, Prasenjit

    Different aluminum alloys can be combined, as composites, for tailored dynamic applications. Most investigations pertaining to metallic alloy layered composites, however, have been based on quasi-static approaches. The dynamic failure of layered metallic composites, therefore, needs to be characterized in terms of strength, toughness, and fracture response. A dislocation-density based crystalline plasticity formulation, finite-element techniques, rational crystallographic orientation relations and a new fracture methodology were used to predict the failure modes associated with the high strain rate behavior of aluminum layered composites. Two alloy layers, a high strength alloy, aluminum 2195, and an aluminum alloy 2139, with high toughness, were modeled with representative microstructures that included precipitates, dispersed particles, and different grain boundary (GB) distributions. The new fracture methodology, based on an overlap method and phantom nodes, is used with a fracture criteria specialized for fracture on different cleavage planes. One of the objectives of this investigation, therefore, was to determine the optimal arrangements of the 2139 and 2195 aluminum alloys for a metallic layered composite that would combine strength, toughness and fracture resistance for high strain-rate applications. Different layer arrangements were investigated for high strain-rate applications, and the optimal arrangement was with the high toughness 2139 layer on the bottom, which provided extensive shear strain localization, and the high strength 2195 layer on the top for high strength resistance. The layer thickness of the bottom high toughness layer also affected the bending behavior of the roll-boned interface and the potential delamination of the layers. Shear strain localization, dynamic cracking and delamination were the mutually competing failure mechanisms for the layered metallic composite, and control of these failure modes can be optimized for high strain

  12. 49 CFR 179.102 - Special commodity requirements for pressure tank car tanks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... car tanks. 179.102 Section 179.102 Transportation Other Regulations Relating to Transportation...) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.102 Special commodity requirements for pressure tank car tanks. (a) In addition to §§ 179.100 and...

  13. 49 CFR 179.102 - Special commodity requirements for pressure tank car tanks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... car tanks. 179.102 Section 179.102 Transportation Other Regulations Relating to Transportation...) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.102 Special commodity requirements for pressure tank car tanks. (a) In addition to §§ 179.100 and...

  14. 49 CFR 179.102 - Special commodity requirements for pressure tank car tanks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... car tanks. 179.102 Section 179.102 Transportation Other Regulations Relating to Transportation...) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.102 Special commodity requirements for pressure tank car tanks. (a) In addition to §§ 179.100 and...

  15. 27 CFR 24.230 - Examination of tank car or tank truck.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Examination of tank car or... TRADE BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL WINE Spirits § 24.230 Examination of tank car or tank truck. Upon arrival of a tank car or tank truck at the bonded wine premises, the proprietor shall...

  16. 27 CFR 24.230 - Examination of tank car or tank truck.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Examination of tank car or... TRADE BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL WINE Spirits § 24.230 Examination of tank car or tank truck. Upon arrival of a tank car or tank truck at the bonded wine premises, the proprietor shall...

  17. 27 CFR 24.230 - Examination of tank car or tank truck.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Examination of tank car or... TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS WINE Spirits § 24.230 Examination of tank car or tank truck. Upon arrival of a tank car or tank truck at the bonded wine premises, the proprietor shall...

  18. 27 CFR 24.230 - Examination of tank car or tank truck.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Examination of tank car or... TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS WINE Spirits § 24.230 Examination of tank car or tank truck. Upon arrival of a tank car or tank truck at the bonded wine premises, the proprietor shall...

  19. 27 CFR 24.230 - Examination of tank car or tank truck.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Examination of tank car or... TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS WINE Spirits § 24.230 Examination of tank car or tank truck. Upon arrival of a tank car or tank truck at the bonded wine premises, the proprietor shall...

  20. Mode I Toughness Measurements of Core/Facesheet Bonds in Honeycomb Sandwich Structures

    NASA Technical Reports Server (NTRS)

    Nettles, Alan T.; Ratcliffe, James G.

    2006-01-01

    Composite sandwich structures will be used in many future applications in aerospace, marine and offshore industries due to the fact that the strength and stiffness to mass ratios surpass any other structural type. Sandwich structure also offers advantages over traditional stiffened panels such as ease of manufacturing and repair. During the last three decades, sandwich structure has been used extensively for secondary structure in aircraft (fuselage floors, rudders and radome structure). Sandwich structure is also used as primary structure in rotorcraft, the most common example being the trailing edge of rotor blades. As with other types of composite construction, sandwich structure exhibits several types of failure mode such as facesheet wrinkling, core crushing and sandwich buckling. Facesheet/core debonding has also been observed in the marine and aerospace industry. During this failure mode, peel stresses applied to an existing facesheet/core debond or an interface low in toughness, results in the facesheet being peeled from the core material, possibly leading to a significant loss in structural integrity of the sandwich panel. In an incident during a test on a liquid hydrogen fuel tank of the X-33 prototype vehicle, the outer graphite/epoxy facesheet and honeycomb core became debonded from the inner facesheet along significant areas, leading to failure of the tank. As a consequence of the accident; significant efforts were made to characterize the toughness of the facesheet/core bond. Currently, the only standardized method available for assessing the quality of the facesheet/core interface is the climbing drum peel test (ASTM D1781). During this test a sandwich beam is removed from a panel and the lip of one of the facesheets is attached to a drum, as shown in Fig. 1. The drum is then rotated along the sandwich beam, causing the facesheet to peel from the core. This method has two major drawbacks. First, it is not possible to obtain quantitative fracture data

  1. 49 CFR 179.500 - Specification DOT-107A * * * * seamless steel tank car tanks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... car tanks. 179.500 Section 179.500 Transportation Other Regulations Relating to Transportation...) SPECIFICATIONS FOR TANK CARS Specification for Cryogenic Liquid Tank Car Tanks and Seamless Steel Tanks (Classes DOT-113 and 107A) § 179.500 Specification DOT-107A * * * * seamless steel tank car tanks. ...

  2. 49 CFR 179.101 - Individual specification requirements applicable to pressure tank car tanks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... to pressure tank car tanks. 179.101 Section 179.101 Transportation Other Regulations Relating to... MATERIALS REGULATIONS SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT... tank car tanks. Editorial Note: At 66 FR 45186, Aug. 28, 2001, an amendment published amending a table...

  3. 49 CFR 179.400 - General specification applicable to cryogenic liquid tank car tanks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... liquid tank car tanks. 179.400 Section 179.400 Transportation Other Regulations Relating to... (CONTINUED) SPECIFICATIONS FOR TANK CARS Specification for Cryogenic Liquid Tank Car Tanks and Seamless Steel Tanks (Classes DOT-113 and 107A) § 179.400 General specification applicable to cryogenic liquid tank car...

  4. 49 CFR 179.500 - Specification DOT-107A * * * * seamless steel tank car tanks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... car tanks. 179.500 Section 179.500 Transportation Other Regulations Relating to Transportation... REGULATIONS SPECIFICATIONS FOR TANK CARS Specification for Cryogenic Liquid Tank Car Tanks and Seamless Steel Tanks (Classes DOT-113 and 107A) § 179.500 Specification DOT-107A * * * * seamless steel tank car tanks. ...

  5. 49 CFR 179.500 - Specification DOT-107A * * * * seamless steel tank car tanks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... car tanks. 179.500 Section 179.500 Transportation Other Regulations Relating to Transportation...) SPECIFICATIONS FOR TANK CARS Specification for Cryogenic Liquid Tank Car Tanks and Seamless Steel Tanks (Classes DOT-113 and 107A) § 179.500 Specification DOT-107A * * * * seamless steel tank car tanks. ...

  6. 49 CFR 179.500 - Specification DOT-107A * * * * seamless steel tank car tanks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... car tanks. 179.500 Section 179.500 Transportation Other Regulations Relating to Transportation...) SPECIFICATIONS FOR TANK CARS Specification for Cryogenic Liquid Tank Car Tanks and Seamless Steel Tanks (Classes DOT-113 and 107A) § 179.500 Specification DOT-107A * * * * seamless steel tank car tanks. ...

  7. 49 CFR 179.400 - General specification applicable to cryogenic liquid tank car tanks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... liquid tank car tanks. 179.400 Section 179.400 Transportation Other Regulations Relating to... (CONTINUED) SPECIFICATIONS FOR TANK CARS Specification for Cryogenic Liquid Tank Car Tanks and Seamless Steel Tanks (Classes DOT-113 and 107A) § 179.400 General specification applicable to cryogenic liquid tank car...

  8. 49 CFR 179.400 - General specification applicable to cryogenic liquid tank car tanks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... liquid tank car tanks. 179.400 Section 179.400 Transportation Other Regulations Relating to... (CONTINUED) SPECIFICATIONS FOR TANK CARS Specification for Cryogenic Liquid Tank Car Tanks and Seamless Steel Tanks (Classes DOT-113 and 107A) § 179.400 General specification applicable to cryogenic liquid tank car...

  9. Nonlinear Analysis of the Space Shuttle Superlightweight LO2 Tank. Part 2; Behavior Under 3g End-of-Flight Loads

    NASA Technical Reports Server (NTRS)

    Nemeth, Michael P.; Young, Richard D.; Collins, Timothy J.; Starnes, James H.,Jr.

    1998-01-01

    Results of linear bifurcation and nonlinear analyses of the Space Shuttle super lightweight (SLWT) external liquid-oxygen (LO2) tank are presented for an important end-of-flight loading condition. These results illustrate an important type of response mode for thin-walled shells, that are subjected to combined mechanical and thermal loads, that may be encountered in the design of other liquid-fuel launch vehicles. Linear bifurcation analyses are presented that predict several nearly equal eigenvalues that correspond to local buckling modes in the aft dome of the LO2 tank. In contrast, the nonlinear response phenomenon is shown to consist of a short-wavelength bending deformation in the aft elliptical dome of the LO2 tank that grows in amplitude in a stable manner with increasing load. Imperfection sensitivity analyses are presented that show that the presence of several nearly equal eigenvalues does not lead to a premature general instability mode for the aft dome. For the linear bifurcation and nonlinear analyses, the results show that accurate predictions of the response of the shell generally require a large-scale, high fidelity finite-element model. Results are also presented that show that the SLWT LO2 tank can support loads in excess of approximately 1.9 times the values of the operational loads considered.

  10. Double-Shell Tank Visual Inspection Changes Resulting from the Tank 241-AY-102 Primary Tank Leak

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Girardot, Crystal L.; Washenfelder, Dennis J.; Johnson, Jeremy M.

    2013-11-14

    As part of the Double-Shell Tank (DST) Integrity Program, remote visual inspections are utilized to perform qualitative in-service inspections of the DSTs in order to provide a general overview of the condition of the tanks. During routine visual inspections of tank 241-AY-102 (AY-102) in August 2012, anomalies were identified on the annulus floor which resulted in further evaluations. In October 2012, Washington River Protection Solutions, LLC determined that the primary tank of AY-102 was leaking. Following identification of the tank AY-102 probable leak cause, evaluations considered the adequacy of the existing annulus inspection frequency with respect to the circumstances ofmore » the tank AY-102 1eak and the advancing age of the DST structures. The evaluations concluded that the interval between annulus inspections should be shortened for all DSTs, and each annulus inspection should cover > 95 percent of annulus floor area, and the portion of the primary tank (i.e., dome, sidewall, lower knuckle, and insulating refractory) that is visible from the annulus inspection risers. In March 2013, enhanced visual inspections were performed for the six oldest tanks: 241-AY-101, 241-AZ-101,241-AZ-102, 241-SY-101, 241-SY-102, and 241-SY-103, and no evidence of leakage from the primary tank were observed. Prior to October 2012, the approach for conducting visual examinations of DSTs was to perform a video examination of each tank's interior and annulus regions approximately every five years (not to exceed seven years between inspections). Also, the annulus inspection only covered about 42 percent of the annulus floor.« less

  11. The Finite Element Modelling and Dynamic Characteristics Analysis about One Kind of Armoured Vehicles’ Fuel Tanks

    NASA Astrophysics Data System (ADS)

    Gao, Yang; Ge, Zhishang; Zhai, Weihao; Tan, Shiwang; Zhang, Feng

    2018-01-01

    The static and dynamic characteristics of fuel tank are studied for the armoured vehicle in this paper. The CATIA software is applied to build the CAD model of the armoured vehicles’ fuel tank, and the finite element model is established in ANSYS Workbench. The finite element method is carried out to analyze the static and dynamic mechanical properties of the fuel tank, and the first six orders of mode shapes and their frequencies are also computed and given in the paper, then the stress distribution diagram and the high stress areas are obtained. The results of the research provide some references to the fuel tanks’ design improvement, and give some guidance for the installation of the fuel tanks on armoured vehicles, and help to improve the properties and the service life of this kind of armoured vehicles’ fuel tanks.

  12. 33 CFR 157.147 - Similar tank design: Inspections on foreign tank vessels.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Similar tank design: Inspections... § 157.147 Similar tank design: Inspections on foreign tank vessels. (a) If a foreign tank vessel has..., for only one of those tanks to be inspected under § 157.140(a)(1). (b) Only one tank of a group of...

  13. 27 CFR 27.174 - Tank cars and tank trucks to be sealed.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Tank cars and tank trucks... Tank cars and tank trucks to be sealed. Where a shipment of distilled spirits from customs custody to the distilled spirits plant is made in a tank car or tank truck, all openings affording access to the...

  14. 27 CFR 27.174 - Tank cars and tank trucks to be sealed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Tank cars and tank trucks... Tank cars and tank trucks to be sealed. Where a shipment of distilled spirits from customs custody to the distilled spirits plant is made in a tank car or tank truck, all openings affording access to the...

  15. 27 CFR 27.174 - Tank cars and tank trucks to be sealed.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Tank cars and tank trucks... Tank cars and tank trucks to be sealed. Where a shipment of distilled spirits from customs custody to the distilled spirits plant is made in a tank car or tank truck, all openings affording access to the...

  16. 46 CFR 153.250 - Double-bottom and deep tanks as cargo tanks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 5 2011-10-01 2011-10-01 false Double-bottom and deep tanks as cargo tanks. 153.250... Equipment Cargo Tanks § 153.250 Double-bottom and deep tanks as cargo tanks. Except in those cases in which Commandant (CG-522) specifically approves another arrangement, such as a double-bottom or deep tank as a...

  17. 46 CFR 153.250 - Double-bottom and deep tanks as cargo tanks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 5 2013-10-01 2013-10-01 false Double-bottom and deep tanks as cargo tanks. 153.250... Equipment Cargo Tanks § 153.250 Double-bottom and deep tanks as cargo tanks. Except in those cases in which Commandant (CG-ENG) specifically approves another arrangement, such as a double-bottom or deep tank as a...

  18. 46 CFR 153.250 - Double-bottom and deep tanks as cargo tanks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Double-bottom and deep tanks as cargo tanks. 153.250... Equipment Cargo Tanks § 153.250 Double-bottom and deep tanks as cargo tanks. Except in those cases in which Commandant (CG-522) specifically approves another arrangement, such as a double-bottom or deep tank as a...

  19. 46 CFR 153.250 - Double-bottom and deep tanks as cargo tanks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 5 2014-10-01 2014-10-01 false Double-bottom and deep tanks as cargo tanks. 153.250... Equipment Cargo Tanks § 153.250 Double-bottom and deep tanks as cargo tanks. Except in those cases in which Commandant (CG-ENG) specifically approves another arrangement, such as a double-bottom or deep tank as a...

  20. 46 CFR 153.250 - Double-bottom and deep tanks as cargo tanks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 5 2012-10-01 2012-10-01 false Double-bottom and deep tanks as cargo tanks. 153.250... Equipment Cargo Tanks § 153.250 Double-bottom and deep tanks as cargo tanks. Except in those cases in which Commandant (CG-ENG) specifically approves another arrangement, such as a double-bottom or deep tank as a...

  1. 49 CFR 179.301 - Individual specification requirements for multi-unit tank car tanks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...-unit tank car tanks. 179.301 Section 179.301 Transportation Other Regulations Relating to... (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for Multi-Unit Tank Car Tanks (Classes DOT-106A and 110AW) § 179.301 Individual specification requirements for multi-unit tank car tanks. (a) In addition to...

  2. 49 CFR 179.301 - Individual specification requirements for multi-unit tank car tanks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...-unit tank car tanks. 179.301 Section 179.301 Transportation Other Regulations Relating to... MATERIALS REGULATIONS SPECIFICATIONS FOR TANK CARS Specifications for Multi-Unit Tank Car Tanks (Classes DOT-106A and 110AW) § 179.301 Individual specification requirements for multi-unit tank car tanks. (a) In...

  3. 49 CFR 179.301 - Individual specification requirements for multi-unit tank car tanks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...-unit tank car tanks. 179.301 Section 179.301 Transportation Other Regulations Relating to... (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for Multi-Unit Tank Car Tanks (Classes DOT-106A and 110AW) § 179.301 Individual specification requirements for multi-unit tank car tanks. (a) In addition to...

  4. 49 CFR 179.301 - Individual specification requirements for multi-unit tank car tanks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...-unit tank car tanks. 179.301 Section 179.301 Transportation Other Regulations Relating to... (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for Multi-Unit Tank Car Tanks (Classes DOT-106A and 110AW) § 179.301 Individual specification requirements for multi-unit tank car tanks. (a) In addition to...

  5. Detection of system failures in multi-axes tasks. [pilot monitored instrument approach

    NASA Technical Reports Server (NTRS)

    Ephrath, A. R.

    1975-01-01

    The effects of the pilot's participation mode in the control task on his workload level and failure detection performance were examined considering a low visibility landing approach. It is found that the participation mode had a strong effect on the pilot's workload, the induced workload being lowest when the pilot acted as a monitoring element during a coupled approach and highest when the pilot was an active element in the control loop. The effects of workload and participation mode on failure detection were separated. The participation mode was shown to have a dominant effect on the failure detection performance, with a failure in a monitored (coupled) axis being detected significantly faster than a comparable failure in a manually controlled axis.

  6. 241-AY-101 Tank Construction Extent of Condition Review for Tank Integrity

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Barnes, Travis J.; Gunter, Jason R.

    2013-08-26

    This report provides the results of an extent of condition construction history review for tank 241-AY-101. The construction history of tank 241-AY-101 has been reviewed to identify issues similar to those experienced during tank AY-102 construction. Those issues and others impacting integrity are discussed based on information found in available construction records, using tank AY-102 as the comparison benchmark. In tank 241-AY-101, the second double-shell tank constructed, similar issues as those with tank 241-AY-102 construction reoccurred. The overall extent of similary and affect on tank 241-AY-101 integrity is described herein.

  7. 241-AP Tank Farm Construction Extent of Condition Review for Tank Integrity

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Barnes, Travis J.; Gunter, Jason R.; Reeploeg, Gretchen E.

    2014-04-04

    This report provides the results of an extent of condition construction history review for the 241-AP tank farm. The construction history of the 241-AP tank farm has been reviewed to identify issues similar to those experienced during tank AY-102 construction. Those issues and others impacting integrity are discussed based on information found in available construction records, using tank AY-102 as the comparison benchmark. In the 241-AP tank farm, the sixth double-shell tank farm constructed, tank bottom flatness, refractory material quality, post-weld stress relieving, and primary tank bottom weld rejection were improved.

  8. 49 CFR 180.519 - Periodic retest and inspection of tank cars other than single-unit tank car tanks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 3 2011-10-01 2011-10-01 false Periodic retest and inspection of tank cars other than single-unit tank car tanks. 180.519 Section 180.519 Transportation Other Regulations Relating to... (CONTINUED) CONTINUING QUALIFICATION AND MAINTENANCE OF PACKAGINGS Qualification and Maintenance of Tank Cars...

  9. 49 CFR 180.519 - Periodic retest and inspection of tank cars other than single-unit tank car tanks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Periodic retest and inspection of tank cars other than single-unit tank car tanks. 180.519 Section 180.519 Transportation Other Regulations Relating to... (CONTINUED) CONTINUING QUALIFICATION AND MAINTENANCE OF PACKAGINGS Qualification and Maintenance of Tank Cars...

  10. 49 CFR 180.519 - Periodic retest and inspection of tank cars other than single-unit tank car tanks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 3 2012-10-01 2012-10-01 false Periodic retest and inspection of tank cars other than single-unit tank car tanks. 180.519 Section 180.519 Transportation Other Regulations Relating to... (CONTINUED) CONTINUING QUALIFICATION AND MAINTENANCE OF PACKAGINGS Qualification and Maintenance of Tank Cars...

  11. 49 CFR 180.519 - Periodic retest and inspection of tank cars other than single-unit tank car tanks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 3 2014-10-01 2014-10-01 false Periodic retest and inspection of tank cars other than single-unit tank car tanks. 180.519 Section 180.519 Transportation Other Regulations Relating to... (CONTINUED) CONTINUING QUALIFICATION AND MAINTENANCE OF PACKAGINGS Qualification and Maintenance of Tank Cars...

  12. 49 CFR 179.500 - Specification DOT-107A * * * * seamless steel tank car tanks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 3 2014-10-01 2014-10-01 false Specification DOT-107A * * * * seamless steel tank...) SPECIFICATIONS FOR TANK CARS Specification for Cryogenic Liquid Tank Car Tanks and Seamless Steel Tanks (Classes DOT-113 and 107A) § 179.500 Specification DOT-107A * * * * seamless steel tank car tanks. ...

  13. ADM. Tanks: from left to right: fuel oil tank, fuel ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    ADM. Tanks: from left to right: fuel oil tank, fuel pump house (TAN-611), engine fuel tank, water pump house, water storage tank. Camera facing northwest. Not edge of shielding berm at left of view. Date: November 25, 1953. INEEL negative no. 9217 - Idaho National Engineering Laboratory, Test Area North, Scoville, Butte County, ID

  14. Risk Based Inspection Methodology and Software Applied to Atmospheric Storage Tanks

    NASA Astrophysics Data System (ADS)

    Topalis, P.; Korneliussen, G.; Hermanrud, J.; Steo, Y.

    2012-05-01

    A new risk-based inspection (RBI) methodology and software is presented in this paper. The objective of this work is to allow management of the inspections of atmospheric storage tanks in the most efficient way, while, at the same time, accident risks are minimized. The software has been built on the new risk framework architecture, a generic platform facilitating efficient and integrated development of software applications using risk models. The framework includes a library of risk models and the user interface is automatically produced on the basis of editable schemas. This risk-framework-based RBI tool has been applied in the context of RBI for above-ground atmospheric storage tanks (AST) but it has been designed with the objective of being generic enough to allow extension to the process plants in general. This RBI methodology is an evolution of an approach and mathematical models developed for Det Norske Veritas (DNV) and the American Petroleum Institute (API). The methodology assesses damage mechanism potential, degradation rates, probability of failure (PoF), consequence of failure (CoF) in terms of environmental damage and financial loss, risk and inspection intervals and techniques. The scope includes assessment of the tank floor for soil-side external corrosion and product-side internal corrosion and the tank shell courses for atmospheric corrosion and internal thinning. It also includes preliminary assessment for brittle fracture and cracking. The data are structured according to an asset hierarchy including Plant, Production Unit, Process Unit, Tag, Part and Inspection levels and the data are inherited / defaulted seamlessly from a higher hierarchy level to a lower level. The user interface includes synchronized hierarchy tree browsing, dynamic editor and grid-view editing and active reports with drill-in capability.

  15. A bivariate model for analyzing recurrent multi-type automobile failures

    NASA Astrophysics Data System (ADS)

    Sunethra, A. A.; Sooriyarachchi, M. R.

    2017-09-01

    The failure mechanism in an automobile can be defined as a system of multi-type recurrent failures where failures can occur due to various multi-type failure modes and these failures are repetitive such that more than one failure can occur from each failure mode. In analysing such automobile failures, both the time and type of the failure serve as response variables. However, these two response variables are highly correlated with each other since the timing of failures has an association with the mode of the failure. When there are more than one correlated response variables, the fitting of a multivariate model is more preferable than separate univariate models. Therefore, a bivariate model of time and type of failure becomes appealing for such automobile failure data. When there are multiple failure observations pertaining to a single automobile, such data cannot be treated as independent data because failure instances of a single automobile are correlated with each other while failures among different automobiles can be treated as independent. Therefore, this study proposes a bivariate model consisting time and type of failure as responses adjusted for correlated data. The proposed model was formulated following the approaches of shared parameter models and random effects models for joining the responses and for representing the correlated data respectively. The proposed model is applied to a sample of automobile failures with three types of failure modes and up to five failure recurrences. The parametric distributions that were suitable for the two responses of time to failure and type of failure were Weibull distribution and multinomial distribution respectively. The proposed bivariate model was programmed in SAS Procedure Proc NLMIXED by user programming appropriate likelihood functions. The performance of the bivariate model was compared with separate univariate models fitted for the two responses and it was identified that better performance is secured by

  16. Direct modeling parameter signature analysis and failure mode prediction of physical systems using hybrid computer optimization

    NASA Technical Reports Server (NTRS)

    Drake, R. L.; Duvoisin, P. F.; Asthana, A.; Mather, T. W.

    1971-01-01

    High speed automated identification and design of dynamic systems, both linear and nonlinear, are discussed. Special emphasis is placed on developing hardware and techniques which are applicable to practical problems. The basic modeling experiment and new results are described. Using the improvements developed successful identification of several systems, including a physical example as well as simulated systems, was obtained. The advantages of parameter signature analysis over signal signature analysis in go-no go testing of operational systems were demonstrated. The feasibility of using these ideas in failure mode prediction in operating systems was also investigated. An improved digital controlled nonlinear function generator was developed, de-bugged, and completely documented.

  17. 241-AW Tank Farm Construction Extent of Condition Review for Tank Integrity

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Barnes, Travis J.; Gunter, Jason R.; Reeploeg, Gretchen E.

    2013-11-19

    This report provides the results of an extent of condition construction history review for the 241-AW tank farm. The construction history of the 241-AW tank farm has been reviewed to identify issues similar to those experienced during tank AY-102 construction. Those issues and others impacting integrity are discussed based on information found in available construction records, using tank AY-102 as the comparison benchmark. In the 241-AW tank farm, the fourth double-shell tank farm constructed, similar issues as those with tank 241-AY-102 construction occured. The overall extent of similary and affect on 241-AW tank farm integrity is described herein.

  18. Failure modes for pipelines in landslide areas

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Bruschi, R.; Spinazze, M.; Tomassini, D.

    1995-12-31

    In recent years a number of incidences of pipelines affected by slow soil movements have been reported in the relevant literature. Further related issues such as soil-pipe interaction have been studied both theoretically and through experimental surveys, along with the environmental conditions which are responsible for hazard to the pipeline integrity. A suitable design criteria under these circumstances has been discussed by several authors, in particular in relation to a limit state approach and hence a strain based criteria. The scope of this paper is to describe the failure mechanisms which may affect the pipeline in the presence of slowmore » soil movements impacting on the pipeline, both in the longitudinal and transverse direction. Particular attention is paid to environmental, geometric and structural parameters which steer the process towards one or other failure mechanism. Criteria for deciding upon remedial measures required to guarantee the structural integrity of the pipeline, both in the short and in the long term, are discussed.« less

  19. Mechanical behavior and localized failure modes in a porous basalt from the Azores

    NASA Astrophysics Data System (ADS)

    Loaiza, S.; Fortin, J.; Schubnel, A.; Gueguen, Y.; Vinciguerra, S.; Moreira, M.

    2012-10-01

    Basaltic rocks are the main component of the oceanic upper crust, thus of potential interest for water and geothermal resources, storage of CO2 and volcanic edifice stability. In this work, we investigated experimentally the mechanical behavior and the failure modes of a porous basalt, with an initial connected porosity of 18%. Results were acquired under triaxial compression experiments at confining pressure in the range of 25-200 MPa on water saturated samples. In addition, a purely hydrostatic test was also performed to reach the pore collapse critical pressure P*. During hydrostatic loading, our results show that the permeability is highly pressure dependent, which suggests that the permeability is mainly controlled by pre-existing cracks. When the sample is deformed at pressure higher than the pore collapse pressure P*, some very small dilatancy develops due to microcracking, and an increase in permeability is observed. Under triaxial loading, two modes of deformation can be highlighted. At low confining pressure (Pc < 50 MPa), the samples are brittle and shear localization occurs. For confining pressure > 50 MPa, the stress-strain curves are characterized by strain hardening and volumetric compaction. Stress drops are also observed, suggesting that compaction may be localized. The presence of compaction bands is confirmed by our microstructure analysis. In addition, the mechanical data allows us to plot the full yield surface for this porous basalt, which follows an elliptic cap as previously observed in high porosity sandstones and limestones.

  20. 49 CFR 179.101 - Individual specification requirements applicable to pressure tank car tanks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... to pressure tank car tanks. 179.101 Section 179.101 Transportation Other Regulations Relating to... (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.101 Individual specification requirements applicable to pressure tank car...

  1. 49 CFR 179.101 - Individual specification requirements applicable to pressure tank car tanks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... to pressure tank car tanks. 179.101 Section 179.101 Transportation Other Regulations Relating to... (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.101 Individual specification requirements applicable to pressure tank car...

  2. 49 CFR 179.101 - Individual specification requirements applicable to pressure tank car tanks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... to pressure tank car tanks. 179.101 Section 179.101 Transportation Other Regulations Relating to... (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.101 Individual specification requirements applicable to pressure tank car...

  3. A Combustion Model for the TWA 800 Center-Wing Fuel Tank Explosion

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Baer, M.R.; Gross, R.J.

    1998-10-02

    In support of the National Transportation Safety Board investigation of the TWA Flight 800 accident, a combined experimental/computational effort was conducted that focused on quarter-scale testing and simulation of the fuel-air explosion in the Boeing 747 center wing fuel tank. This report summarizes the modeling approach used at Sandia National Laboratories. In this approach approximations are introduced that capture the essential physics associated with turbulent flame propagation in multiple compartment fuel tanks. This model efficiently defines the pressure loading conditions during a jet-fuel air explosion in a fuel tank confinement. Modeling calculations compare favorably with a variety of experimental quarter-scalemore » tests conducted in rigid confinement. The modeling describes well the overpressure history in several geometry configurations. Upon demonstrating a reasonable comparison to experimental observations, a parametric study of eight possible ignition sources is then discussed. Model calculations demonstrate that different loading conditions arise as the location of the ignition event is varied. By comparing the inferred damage and calculated impulses to that seen in the recovered tank, it maybe possible to reduce the number of likely sources. A possible extension of this work to better define tank damage includes coupling the combustion model as a pressure loading routine for structural failure analysis.« less

  4. Polymer/Silicate Nanocomposites Used to Manufacture Gas Storage Tanks With Reduced Permeability

    NASA Technical Reports Server (NTRS)

    Campbell, Sandi G.; Johnston, Chris

    2004-01-01

    Over the past decade, there has been considerable research in the area of polymer-layered silicate nanocomposites. This research has shown that the dispersion of small amounts of an organically modified layered silicate improves the polymer strength, modulus, thermal stability, and barrier properties. There have been several reports on the dispersion of layered silicates in an epoxy matrix. Potential enhancements to the barrier properties of epoxy/silicate nanocomposites make this material attractive for low permeability tankage. Polymer matrix composites (PMCs) have several advantages for cryogenic storage tanks. They are lightweight, strong, and stiff; therefore, a smaller fraction of a vehicle's potential payload capacity is used for propellant storage. Unfortunately, the resins typically used to make PMC tanks have higher gas permeability than metals. This can lead to hydrogen loss through the body of the tank instead of just at welds and fittings. One approach to eliminate this problem is to build composite tanks with thin metal liners. However, although these tanks provide good permeability performance, they suffer from a substantial mismatch in the coefficient of thermal expansion, which can lead to failure of the bond between the liner and the body of the tank. Both problems could be addressed with polymersilicate nanocomposites, which exhibit reduced hydrogen permeability, making them potential candidates for linerless PMC tanks. Through collaboration with Northrop Grumman and Michigan State University, nanocomposite test tanks were manufactured for the NASA Glenn Research Center, and the helium permeability was measured. An organically modified silicate was prepared at Michigan State University and dispersed in an epoxy matrix (EPON 826/JeffamineD230). The epoxy/silicate nanocomposites contained either 0 or 5 wt% of the organically modified silicate. The tanks were made by filament winding carbon fibers with the nanocomposite resin. Helium permeability

  5. Carbon Fiber Strand Tensile Failure Dynamic Event Characterization

    NASA Technical Reports Server (NTRS)

    Johnson, Kenneth L.; Reeder, James

    2016-01-01

    There are few if any clear, visual, and detailed images of carbon fiber strand failures under tension useful for determining mechanisms, sequences of events, different types of failure modes, etc. available to researchers. This makes discussion of physics of failure difficult. It was also desired to find out whether the test article-to-test rig interface (grip) played a part in some failures. These failures have nothing to do with stress rupture failure, thus representing a source of waste for the larger 13-00912 investigation into that specific failure type. Being able to identify or mitigate any competing failure modes would improve the value of the 13-00912 test data. The beginnings of the solution to these problems lay in obtaining images of strand failures useful for understanding physics of failure and the events leading up to failure. Necessary steps include identifying imaging techniques that result in useful data, using those techniques to home in on where in a strand and when in the sequence of events one should obtain imaging data.

  6. Fuel tank integrity research : fuel tank analyses and test plans

    DOT National Transportation Integrated Search

    2013-04-15

    The Federal Railroad Administrations Office of Research : and Development is conducting research into fuel tank : crashworthiness. Fuel tank research is being performed to : determine strategies for increasing the fuel tank impact : resistance to ...

  7. Failure mode effect analysis and fault tree analysis as a combined methodology in risk management

    NASA Astrophysics Data System (ADS)

    Wessiani, N. A.; Yoshio, F.

    2018-04-01

    There have been many studies reported the implementation of Failure Mode Effect Analysis (FMEA) and Fault Tree Analysis (FTA) as a method in risk management. However, most of the studies usually only choose one of these two methods in their risk management methodology. On the other side, combining these two methods will reduce the drawbacks of each methods when implemented separately. This paper aims to combine the methodology of FMEA and FTA in assessing risk. A case study in the metal company will illustrate how this methodology can be implemented. In the case study, this combined methodology will assess the internal risks that occur in the production process. Further, those internal risks should be mitigated based on their level of risks.

  8. Design criteria monograph for metal tanks and tank components

    NASA Technical Reports Server (NTRS)

    1975-01-01

    Significant elements in detail tank design are wall and end structures, weld joints at bulkhead and attachment junctures, and ports and access openings. Additional design considerations are influence and effect of fabrication processes on tank component design, and finally, testing and inspection that are required to establish confidence in tank design.

  9. 49 CFR 179.103 - Special requirements for class 114A * * * tank car tanks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Special requirements for class 114A * * * tank car...) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.103 Special requirements for class 114A * * * tank car tanks. (a) In addition to the applicable...

  10. 49 CFR 179.103 - Special requirements for class 114A * * * tank car tanks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 3 2011-10-01 2011-10-01 false Special requirements for class 114A * * * tank car...) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.103 Special requirements for class 114A * * * tank car tanks. (a) In addition to the applicable...

  11. 49 CFR 179.103 - Special requirements for class 114A * * * tank car tanks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 3 2012-10-01 2012-10-01 false Special requirements for class 114A * * * tank car...) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.103 Special requirements for class 114A * * * tank car tanks. (a) In addition to the applicable...

  12. 49 CFR 179.103 - Special requirements for class 114A * * * tank car tanks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Special requirements for class 114A * * * tank car... SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.103 Special requirements for class 114A * * * tank car tanks. (a) In addition to the applicable...

  13. 49 CFR 179.201 - Individual specification requirements applicable to non-pressure tank car tanks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... to non-pressure tank car tanks. 179.201 Section 179.201 Transportation Other Regulations Relating to... MATERIALS REGULATIONS SPECIFICATIONS FOR TANK CARS Specifications for Non-Pressure Tank Car Tanks (Classes... car tanks. ...

  14. Researchers at NREL Find Fewer Failures of PV Panels and Different

    Science.gov Websites

    10, 2017 Overall failure rates for photovoltaic (PV) solar panels have fallen dramatically when Failures of PV Panels and Different Degradation Modes in Systems Installed after 2000 Researchers at NREL Find Fewer Failures of PV Panels and Different Degradation Modes in Systems Installed after 2000 April

  15. 49 CFR 179.201 - Individual specification requirements applicable to non-pressure tank car tanks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... to non-pressure tank car tanks. 179.201 Section 179.201 Transportation Other Regulations Relating to... (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for Non-Pressure Tank Car Tanks (Classes DOT-111AW and 115AW) § 179.201 Individual specification requirements applicable to non-pressure tank car tanks. ...

  16. 49 CFR 179.201 - Individual specification requirements applicable to non-pressure tank car tanks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... to non-pressure tank car tanks. 179.201 Section 179.201 Transportation Other Regulations Relating to... (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for Non-Pressure Tank Car Tanks (Classes DOT-111AW and 115AW) § 179.201 Individual specification requirements applicable to non-pressure tank car tanks. ...

  17. 49 CFR 179.201 - Individual specification requirements applicable to non-pressure tank car tanks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... to non-pressure tank car tanks. 179.201 Section 179.201 Transportation Other Regulations Relating to... (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for Non-Pressure Tank Car Tanks (Classes DOT-111AW and 115AW) § 179.201 Individual specification requirements applicable to non-pressure tank car tanks. ...

  18. Light water reactor lower head failure analysis

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rempe, J.L.; Chavez, S.A.; Thinnes, G.L.

    1993-10-01

    This document presents the results from a US Nuclear Regulatory Commission-sponsored research program to investigate the mode and timing of vessel lower head failure. Major objectives of the analysis were to identify plausible failure mechanisms and to develop a method for determining which failure mode would occur first in different light water reactor designs and accident conditions. Failure mechanisms, such as tube ejection, tube rupture, global vessel failure, and localized vessel creep rupture, were studied. Newly developed models and existing models were applied to predict which failure mechanism would occur first in various severe accident scenarios. So that a broadermore » range of conditions could be considered simultaneously, calculations relied heavily on models with closed-form or simplified numerical solution techniques. Finite element techniques-were employed for analytical model verification and examining more detailed phenomena. High-temperature creep and tensile data were obtained for predicting vessel and penetration structural response.« less

  19. 49 CFR 179.101 - Individual specification requirements applicable to pressure tank car tanks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... to pressure tank car tanks. 179.101 Section 179.101 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109...

  20. Tank 241-C-112 vapor sampling and analysis tank characterization report. Revision 1

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Huckaby, J.L.

    1995-05-31

    Tank 241-C-112 headspace gas and vapor samples were collected and analyzed to help determine the potential risks to tank farm workers due to fugitive emissions from the tank. The drivers and objectives of waste tank headspace sampling and analysis are discussed in {open_quotes}Program Plan for the Resolution of Tank Vapor Issues.{close_quotes} Tank 241-C-112 was vapor sampled in accordance with {open_quotes}Data Quality Objectives for Generic In-Tank Health and Safety Issue Resolution.{close_quotes}

  1. Pressurization and expulsion of a flightweight liquid hydrogen tank

    NASA Technical Reports Server (NTRS)

    Vandresar, N. T.; Stochl, R. J.

    1993-01-01

    Experimental results are presented for pressurization and expulsion of a flight-weight 4.89 cu m liquid hydrogen storage tank under normal gravity conditions. Pressurization and expulsion times are parametrically varied to study the effects of longer transfer times expected in future space flight applications. It is found that the increase in pressurant consumption with increased operational time is significant at shorter pressurization or expulsion durations and diminishes as the duration lengthens. Gas-to-wall heat transfer in the ullage is the dominant mode of energy exchange, with more than 50 percent of the pressurant energy being lost to tank wall heating in expulsions and the long duration pressurizations. Advanced data analysis will require a multidimensional approach combined with improved measurement capabilities of liquid-vapor interfacial transport phenomena.

  2. Liquid rocket metal tanks and tank components

    NASA Technical Reports Server (NTRS)

    Wagner, W. A.; Keller, R. B. (Editor)

    1974-01-01

    Significant guidelines are presented for the successful design of aerospace tanks and tank components, such as expulsion devices, standpipes, and baffles. The state of the art is reviewed, and the design criteria are presented along with recommended practices. Design monographs are listed.

  3. Electromigration failure mode concerning negative resistance shift of Cu interconnects buried in porous low-k dielectric

    NASA Astrophysics Data System (ADS)

    Zheng, Hui; Yin, Binfeng; Yu, Hewei; Chen, Leigang; Gao, Lin; Zhou, Ke; Kuo, Chinte

    2017-02-01

    Electromigration failure mode concerning a negative resistance shift of 4%-11% and cathode burnout was reported for Cu interconnects buried in porous low-k in this paper. Evidence for oxidation and debonding of Ta/TaN liner at high temperature was revealed, which was demonstrated to have been enabled by the unsealed porous low-k due to moisture uptake. The cathode burnout was thus attributed to severe Joule heating induced in the insulated liner after oxidation. The resistance decay of Cu also exhibited to be mainly consistent with the calculation from specularity recovery of electron scattering at the Cu/Ta interface after oxidation and debonding of the liner, although other factors like strain relaxation may also have some contribution.

  4. Predicting the occurrence of mixed mode failure associated with hydraulic fracturing, part 2 water saturated tests

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Bauer, Stephen J.; Broome, Scott Thomas; Choens, Charles

    2015-09-14

    Seven water-saturated triaxial extension experiments were conducted on four sedimentary rocks. This experimental condition was hypothesized more representative of that existing for downhole hydrofracture and thus it may improve our understanding of the phenomena. In all tests the pore pressure was 10 MPa and confirming pressure was adjusted to achieve tensile and transitional failure mode conditions. Using previous work in this LDRD for comparison, the law of effective stress is demonstrated in extension using this sample geometry. In three of the four lithologies, no apparent chemo-mechanical effect of water is apparent, and in the fourth lithology test results indicate somemore » chemo-mechanical effect of water.« less

  5. Commercial Submersible Mixing Pump For SRS Tank Waste Removal - 15223

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Hubbard, Mike; Herbert, James E.; Scheele, Patrick W.

    canned motor pumps designed to fit within available risers and have significant agitation capabilities to suspend waste solids. Waste removal and closure of two tanks has been accomplished with agitation provided by 3 SMPs installed within the tanks. In 2012, a team was assembled to investigate alternative solids removal technologies to support waste removal for closing tanks. The goal of the team was to find a more cost effective approach that could be used to replace the current mixing pump technology. This team was unable to identify an alternative technology outside of mixing pumps to support waste agitation and removal from SRS waste tanks. However, the team did identify a potentially lower cost mixing pump compared to the baseline SLPs and SMPs. Rather than using the traditional procurement using an engineering specification, the team proposed to seek commercially available submersible mixer pumps (CSMP) as alternatives to SLPs and SMPs. SLPs and SMPs have a high procurement cost and the actual cost of moving pumps between tanks has shown to be significantly higher than the original estimates that justified the reuse of SMPs and SLPs. The team recommended procurement of “off-the-shelf” industry pumps which may be available for significant savings, but at an increased risk of failure and reduced operating life in the waste tank. The goal of the CSMP program is to obtain mixing pumps that could mix from bulk waste removal through tank closure and then be abandoned in place as part of tank closure. This paper will present the development, progress and relative advantages of the CSMP.« less

  6. Lunar Module Electrical Power System Design Considerations and Failure Modes

    NASA Technical Reports Server (NTRS)

    Interbartolo, Michael

    2009-01-01

    This slide presentation reviews the design and redesign considerations of the Apollo lunar module electrical power system. Included in the work are graphics showing the lunar module power system. It describes the in-flight failures, and the lessons learned from these failures.

  7. 241-AZ Tank Farm Construction Extent of Condition Review for Tank Integrity

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Barnes, Travis J.; Boomer, Kayle D.; Gunter, Jason R.

    2013-07-30

    This report provides the results of an extent of condition construction history review for tanks 241-AZ-101 and 241-AZ-102. The construction history of the 241-AZ tank farm has been reviewed to identify issues similar to those experienced during tank AY-102 construction. Those issues and others impacting integrity are discussed based on information found in available construction records, using tank AY-102 as the comparison benchmark. In the 241-AZ tank farm, the second DST farm constructed, both refractory quality and tank and liner fabrication were improved.

  8. Critical laboratory value notification: a failure mode effects and criticality analysis.

    PubMed

    Saxena, Sunita; Kempf, Raymond; Wilcox, Susan; Shulman, Ira A; Wong, Louise; Cunningham, Glenn; Vega, Elaine; Hall, Stephanie

    2005-09-01

    The Failure Mode Effects and Criticality Analysis (FMECA) was applied to improve the timeliness of reporting and the timeliness of receipt by the responsible licensed caregiver of critical laboratory values (CLVs) for outpatients and non-critical care inpatients. Through a risk prioritization process, the most important areas for improvement, including contacting the provider, assisting the provider in contacting the patient, and educating the provider in follow-up options available during off hours, were identified. A variety of systemic improvements were made; for example, the CLV notification process was centralized in the customer service center, with databases to help providers select options and make arrangements for follow-up care and an electronic abstract form to document the CLV notification process. Review of documentation and appropriateness of CLV follow-up care was integrated into the quality monitoring process to detect any variations or problems. The average CLV notification time for the month steadily declined during an eight-month period. Compliance was 100% for the "read-back" requirement and documentation in patient's health record. This proactive risk assessment project successfully modified the CLV notification program from a high- to a low-risk process, identified activities to further improve the process, and helped ensure compliance with a variety of requirements.

  9. Abutments with reduced diameter for both cement and screw retentions: analysis of failure modes and misfit of abutment-crown-connections after cyclic loading.

    PubMed

    Moris, Izabela Cristina Maurício; Faria, Adriana Cláudia Lapria; Ribeiro, Ricardo Faria; Rodrigues, Renata Cristina Silveira

    2017-04-01

    The aim of this study was to analyze failure modes and misfit of abutments with reduced diameter for both cement and screw retentions after cyclic loading. Forty morse-taper abutment/implant sets of titanium were divided into four groups (N = 10): G4.8S-4.8 abutment with screw-retained crown; G4.8C-4.8 abutment with cemented crown; G3.8S-3.8 abutment with screw-retained crown; and G3.8C-3.8 abutment with cemented crown. Copings were waxed on castable cylinders and cast by oxygen gas flame and injected by centrifugation. After, esthetic veneering ceramic was pressed on these copings for obtaining metalloceramic crowns of upper canine. Cemented crowns were cemented on abutments with provisional cement (Temp Bond NE), and screw-retained crowns were tightened to their abutments with torque recommended by manufacturer (10 N cm). The misfit was measured using a stereomicroscope in a 10× magnification before and after cyclic loading (300,000 cycles). Tests were visually monitored, and failures (decementation, screw loosening and fractures) were registered. Misfit was analyzed by mixed linear model while failure modes by chi-square test (α = 0.05). Cyclic loading affected misfit of 3.8C (P ≤ 0.0001), 3.8S (P = 0.0055) and 4.8C (P = 0.0318), but not of 4.8S (P = 0.1243). No differences were noted between 3.8S with 4.8S before (P = 0.1550) and after (P = 0.9861) cyclic loading, but 3.8C was different from 4.8C only after (P = 0.0015) loading. Comparing different types of retentions at the same diameter abutment, significant difference was noted before and after cyclic loading for 3.8 and 4.8 abutments. Analyzing failure modes, retrievable failures were present at 3.8S and 3.8C groups, while irretrievable were only present at 3.8S. The cyclic loading decreased misfit of cemented and screw-retained crowns on reduced diameter abutments, and misfit of cemented crowns is greater than screw-retained ones. Abutments of reduced diameter failed more than

  10. Pyrotechnic shock at the orbiter/external tank forward attachment

    NASA Technical Reports Server (NTRS)

    Rogers, W. F.; Grissom, D. S.; Rhodes, L. R.

    1980-01-01

    During the initial certification test of the forward structural attachment of the space shuttle orbiter to the external tank, pyrotechnic shock from actuation of the separation device resulted in structural failure of the thermal protection tiles surrounding the attachment. Because of the high shock associated with the separation bolt, the development of alternative low shock separation designs was initiated. Two concepts that incorporate a 5.08 centimeter frangible nut as the release device were developed and tested.

  11. SU-E-T-179: Clinical Impact of IMRT Failure Modes at Or Near TG-142 Tolerance Criteria Levels

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Faught, J Tonigan; Balter, P; Johnson, J

    2015-06-15

    Purpose: Quantitatively assess the clinical impact of 11 critical IMRT dose delivery failure modes. Methods: Eleven step-and-shoot IMRT failure modes (FMs) were introduced into twelve Pinnacle v9.8 treatment plans. One standard and one highly modulated plan on the IROC IMRT phantom and ten previous H&N patient treatment plans were used. FMs included physics components covered by basic QA near tolerance criteria levels (TG-142) such as beam energy, MLC positioning, and MLC modeling. Resultant DVHs were compared to those of failure-free plans and the severity of plan degradation was assessed considering PTV coverage and OAR and normal tissue tolerances and usedmore » for FMEA severity scoring. Six of these FMs were physically simulated and phantom irradiations performed. TLD and radiochromic film results are used for comparison to treatment planning studies. Results: Based on treatment planning studies, the largest clinical impact from the phantom cases was induced by 2 mm systematic MLC shift in one bank with the combination of a D95% target under dose near 16% and OAR overdose near 8%. Cord overdoses of 5%–11% occurred with gantry angle, collimator angle, couch angle, MLC leaf end modeling, and MLC transmission and leakage modeling FMs. PTV coverage and/or OAR sparing was compromised in all FMs introduced in phantom plans with the exception of CT number to electron density tables, MU linearity, and MLC tongue-and-groove modeling. Physical measurements did not entirely agree with treatment planning results. For example, symmetry errors resulted in the largest physically measured discrepancies of up to 3% in the PTVs while a maximum of 0.5% deviation was seen in the treatment planning studies. Patient treatment plan study results are under analysis. Conclusion: Even in the simplistic anatomy of the IROC phantom, some basic physics FMs, just outside of TG-142 tolerance criteria, appear to have the potential for large clinical implications.« less

  12. 49 CFR 179.100 - General specifications applicable to pressure tank car tanks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... car tanks. 179.100 Section 179.100 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120...

  13. 49 CFR 179.102 - Special commodity requirements for pressure tank car tanks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... car tanks. 179.102 Section 179.102 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120...

  14. Proposal on How To Conduct a Biopharmaceutical Process Failure Mode and Effect Analysis (FMEA) as a Risk Assessment Tool.

    PubMed

    Zimmermann, Hartmut F; Hentschel, Norbert

    2011-01-01

    With the publication of the quality guideline ICH Q9 "Quality Risk Management" by the International Conference on Harmonization, risk management has already become a standard requirement during the life cycle of a pharmaceutical product. Failure mode and effect analysis (FMEA) is a powerful risk analysis tool that has been used for decades in mechanical and electrical industries. However, the adaptation of the FMEA methodology to biopharmaceutical processes brings about some difficulties. The proposal presented here is intended to serve as a brief but nevertheless comprehensive and detailed guideline on how to conduct a biopharmaceutical process FMEA. It includes a detailed 1-to-10-scale FMEA rating table for occurrence, severity, and detectability of failures that has been especially designed for typical biopharmaceutical processes. The application for such a biopharmaceutical process FMEA is widespread. It can be useful whenever a biopharmaceutical manufacturing process is developed or scaled-up, or when it is transferred to a different manufacturing site. It may also be conducted during substantial optimization of an existing process or the development of a second-generation process. According to their resulting risk ratings, process parameters can be ranked for importance and important variables for process development, characterization, or validation can be identified. Health authorities around the world ask pharmaceutical companies to manage risk during development and manufacturing of pharmaceuticals. The so-called failure mode and effect analysis (FMEA) is an established risk analysis tool that has been used for decades in mechanical and electrical industries. However, the adaptation of the FMEA methodology to pharmaceutical processes that use modern biotechnology (biopharmaceutical processes) brings about some difficulties, because those biopharmaceutical processes differ from processes in mechanical and electrical industries. The proposal presented here

  15. Optimisation of shock absorber process parameters using failure mode and effect analysis and genetic algorithm

    NASA Astrophysics Data System (ADS)

    Mariajayaprakash, Arokiasamy; Senthilvelan, Thiyagarajan; Vivekananthan, Krishnapillai Ponnambal

    2013-07-01

    The various process parameters affecting the quality characteristics of the shock absorber during the process were identified using the Ishikawa diagram and by failure mode and effect analysis. The identified process parameters are welding process parameters (squeeze, heat control, wheel speed, and air pressure), damper sealing process parameters (load, hydraulic pressure, air pressure, and fixture height), washing process parameters (total alkalinity, temperature, pH value of rinsing water, and timing), and painting process parameters (flowability, coating thickness, pointage, and temperature). In this paper, the process parameters, namely, painting and washing process parameters, are optimized by Taguchi method. Though the defects are reasonably minimized by Taguchi method, in order to achieve zero defects during the processes, genetic algorithm technique is applied on the optimized parameters obtained by Taguchi method.

  16. SINDA/FLUINT Stratified Tank Modeling for Cryrogenic Propellant Tanks

    NASA Technical Reports Server (NTRS)

    Sakowski, Barbara

    2014-01-01

    A general purpose SINDA/FLUINT (S/F) stratified tank model was created to simulate self-pressurization and axial jet TVS; Stratified layers in the vapor and liquid are modeled using S/F lumps.; The stratified tank model was constructed to permit incorporating the following additional features:, Multiple or singular lumps in the liquid and vapor regions of the tank, Real gases (also mixtures) and compressible liquids, Venting, pressurizing, and draining, Condensation and evaporation/boiling, Wall heat transfer, Elliptical, cylindrical, and spherical tank geometries; Extensive user logic is used to allow detailed tailoring - Don't have to rebuilt everything from scratch!!; Most code input for a specific case is done through the Registers Data Block:, Lump volumes are determined through user input:; Geometric tank dimensions (height, width, etc); Liquid level could be input as either a volume percentage of fill level or actual liquid level height

  17. Tank vapor mitigation requirements for Hanford Tank Farms

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rakestraw, L.D.

    1994-11-15

    Westinghouse Hanford Company has contracted Los Alamos Technical Associates to listing of vapors and aerosols that are or may be emitted from the High Level Waste (HLW) tanks at Hanford. Mitigation requirements under Federal and State law, as well as DOE Orders, are included in the listing. The lists will be used to support permitting activities relative to tank farm ventilation system up-grades. This task is designated Task 108 under MJB-SWV-312057 and is an extension of efforts begun under Task 53 of Purchase Order MPB-SVV-03291 5 for Mechanical Engineering Support. The results of that task, which covered only thirty-nine tanks,more » are repeated here to provide a single source document for vapor mitigation requirements for all 177 HLW tanks.« less

  18. Global Failure Modes in High Temperature Composite Structures

    NASA Technical Reports Server (NTRS)

    Knauss, W. G.

    1998-01-01

    Composite materials have been considered for many years as the major advance in the construction of energy efficient aerospace structures. Notable advances have been made in understanding the special design considerations that set composites apart from the usual "isotropic" engineering materials such as the metals. As a result, a number of significant engineering designs have been accomplished. However, one shortcoming of the currently favored composites is their relatively unforgiving behavior with respect to failure (brittleness) under seemingly mild impact conditions and large efforts are underway to rectify that situation, much along the lines of introducing thermoplastic matrix materials. Because of their relatively more pronounced (thermo) viscoelastic behavior these materials respond with "toughness" in fracture situations. From the point of view of applications requiring material strength, this property is highly desirable. This feature impacts several important and distinct engineering problems which have been' considered under this grant and cover the 1) effect of impact damage on structural (buckling) stability of composite panels, the 2) effect of time dependence on the progression of buckling instabilities, and the 3) evolution of damage and fracture at generic thickness discontinuities in structures. The latter topic has serious implications for structural stability problems (buckling failure in reinforced shell structures) as well as failure progression in stringer-reinforced shell structures. This grant has dealt with these issues. Polymer "toughness" is usually associated with uncrosslinked or thermo-plastic polymers. But, by comparison with their thermoset counterparts they tend to exhibit more pronounced time dependent material behavior; also, that time dependence can occur at lower temperatures which places restriction in the high temperature use of these "newer and tougher" materials that are not quite so serious with the thermoset matrix

  19. Failure modes for compression loaded angle-ply plates with holes

    NASA Technical Reports Server (NTRS)

    Burns, S. W.; Herakovich, C. T.; Williams, J. G.

    1987-01-01

    A combined theoretical-experimental investigation of failure in notched, graphite-epoxy, angle-ply laminates subjected to far-field compression loading indicates that failure generally initiates on the hole boundary and propagates along a line parallel to the fiber orientation of the laminate. The strength of notched laminates with specimen width-to-hole diameter ratios of 5 and 10 are compared to the strength of unnotched laminates. The experimental results are complemented by a three-dimensional finite element stress analysis that includes interlaminar stresses around holes in (+/- theta)s laminates. The finite element predictions indicate that failure is initiated by shear stresses at the hole boundary.

  20. 46 CFR 32.65-30 - Tank vessels with independent tanks-TB/ALL.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Tank vessels with independent tanks-TB/ALL. 32.65-30 Section 32.65-30 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY TANK VESSELS SPECIAL EQUIPMENT, MACHINERY, AND HULL REQUIREMENTS Hull Requirements for Tank Vessels Constructed On or After November 10...

  1. 46 CFR 32.65-30 - Tank vessels with independent tanks-TB/ALL.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Tank vessels with independent tanks-TB/ALL. 32.65-30 Section 32.65-30 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY TANK VESSELS SPECIAL EQUIPMENT, MACHINERY, AND HULL REQUIREMENTS Hull Requirements for Tank Vessels Constructed On or After November 10...

  2. 46 CFR 32.65-30 - Tank vessels with independent tanks-TB/ALL.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 1 2014-10-01 2014-10-01 false Tank vessels with independent tanks-TB/ALL. 32.65-30 Section 32.65-30 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY TANK VESSELS SPECIAL EQUIPMENT, MACHINERY, AND HULL REQUIREMENTS Hull Requirements for Tank Vessels Constructed On or After November 10...

  3. 46 CFR 32.65-30 - Tank vessels with independent tanks-TB/ALL.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Tank vessels with independent tanks-TB/ALL. 32.65-30 Section 32.65-30 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY TANK VESSELS SPECIAL EQUIPMENT, MACHINERY, AND HULL REQUIREMENTS Hull Requirements for Tank Vessels Constructed On or After November 10...

  4. Failure Mode and Effects Analysis: views of hospital staff in the UK.

    PubMed

    Shebl, Nada; Franklin, Bryony; Barber, Nick; Burnett, Susan; Parand, Anam

    2012-01-01

    To explore health care professionals' experiences and perceptions of Failure Mode and Effects Analysis (FMEA), a team-based, prospective risk analysis technique. Semi-structured interviews were conducted with 21 operational leads (20 pharmacists, one nurse) in medicines management teams of hospitals participating in a national quality improvement programme. Interviews were transcribed, coded and emergent themes identified using framework analysis. Themes identified included perceptions and experiences of participants with FMEA, validity and reliability issues, and FMEA's use in practice. FMEA was considered to be a structured but subjective process that helps health care professionals get together to identify high risk areas of care. Both positive and negative opinions were expressed, with the majority of interviewees expressing positive views towards FMEA in relation to its structured nature and the use of a multidisciplinary team. Other participants criticised FMEA for being subjective and lacking validity. Most likely to restrict its widespread use were its time consuming nature and its perceived lack of validity and reliability. FMEA is a subjective but systematic tool that helps identify high risk areas, but its time consuming nature, difficulty with the scores and perceived lack of validity and reliability may limit its widespread use.

  5. Study Of The Risks Arising From Natural Disasters And Hazards On Urban And Intercity Motorways By Using Failure Mode Effect Analysis (FMEA) Methods

    NASA Astrophysics Data System (ADS)

    DELİCE, Yavuz

    2015-04-01

    Highways, Located in the city and intercity locations are generally prone to many kind of natural disaster risks. Natural hazards and disasters that may occur firstly from highway project making to construction and operation stages and later during the implementation of highway maintenance and repair stages have to be taken into consideration. And assessment of risks that may occur against adverse situations is very important in terms of project design, construction, operation maintenance and repair costs. Making hazard and natural disaster risk analysis is largely depending on the definition of the likelihood of the probable hazards on the highways. However, assets at risk , and the impacts of the events must be examined and to be rated in their own. With the realization of these activities, intended improvements against natural hazards and disasters will be made with the utilization of Failure Mode Effects Analysis (FMEA) method and their effects will be analyzed with further works. FMEA, is a useful method to identify the failure mode and effects depending on the type of failure rate effects priorities and finding the most optimum economic and effective solution. Although relevant measures being taken for the identified risks by this analysis method , it may also provide some information for some public institutions about the nature of these risks when required. Thus, the necessary measures will have been taken in advance in the city and intercity highways. Many hazards and natural disasters are taken into account in risk assessments. The most important of these dangers can be listed as follows; • Natural disasters 1. Meteorological based natural disasters (floods, severe storms, tropical storms, winter storms, avalanches, etc.). 2. Geological based natural disasters (earthquakes, tsunamis, landslides, subsidence, sinkholes, etc) • Human originated disasters 1. Transport accidents (traffic accidents), originating from the road surface defects (icing

  6. Two-Pendulum Model of Propellant Slosh in Europa Clipper PMD Tank

    NASA Technical Reports Server (NTRS)

    Ng, Wanyi; Benson, David

    2017-01-01

    The objective of this fluids analysis is to model propellant slosh for the Europa Clipper mission using a two-pendulum model, such that controls engineers can predict slosh behavior during the mission. Propellant slosh causes shifts in center of mass and exerts forces and torques on the spacecraft which, if not adequately controlled, can lead to mission failure. The two-pendulum model provides a computationally simple model that can be used to predict slosh for the Europa Clipper tank geometry. The Europa Clipper tank is cylindrical with a domed top and bottom and includes a propellant management device (PMD). Due to the lack of experimental data in low gravity environments, computational fluid dynamics (CFD) simulation results were used as 'real' slosh behavior for two propellants at three fill fractions. Key pendulum parameters were derived that allow the pendulum model's center of mass, forces, and moments to closely match the CFD data. The parameter trends were examined as a function of tank fill fraction and compared with solutions to analytic equations that describe the frequency of slosh in tanks with simple geometries. The trends were monotonic as expected, and parameters resembled analytical predictions; any differences could be explained by the specific differences in the geometry of the tank. This paper summarizes the new method developed at Goddard Space Flight Center (GSFC) for deriving pendulum parameters for two-pendulum equivalent sloshing models. It presents the results of this method and discusses the validity of the results. This analysis is at a completed stage and will be applied in the immediate future to the evolving tank geometry as Europa Clipper moves past its preliminary design review (PDR) phase.

  7. Mode of action and effects of standardized collaborative disease management on mortality and morbidity in patients with systolic heart failure: the Interdisciplinary Network for Heart Failure (INH) study.

    PubMed

    Angermann, Christiane E; Störk, Stefan; Gelbrich, Götz; Faller, Hermann; Jahns, Roland; Frantz, Stefan; Loeffler, Markus; Ertl, Georg

    2012-01-01

    Trials investigating efficacy of disease management programs (DMP) in heart failure reported contradictory results. Features rendering specific interventions successful are often ill defined. We evaluated the mode of action and effects of a nurse-coordinated DMP (HeartNetCare-HF, HNC). Patients hospitalized for systolic heart failure were randomly assigned to HNC or usual care (UC). Besides telephone-based monitoring and education, HNC addressed individual problems raised by patients, pursued networking of health care providers and provided training for caregivers. End points were time to death or rehospitalization (combined primary), heart failure symptoms, and quality of life (SF-36). Of 1007 consecutive patients, 715 were randomly assigned (HNC: n=352; UC: n=363; age, 69±12 years; 29% female; 40% New York Heart Association class III-IV). Within 180 days, 130 HNC and 137 UC patients reached the primary end point (hazard ratio, 1.02; 95% confidence interval, 0.81-1.30; P=0.89), since more HNC patients were readmitted. Overall, 32 HNC and 52 UC patients died (1 UC patient and 4 HNC patients after dropout); thus, uncensored hazard ratio was 0.62 (0.40-0.96; P=0.03). HNC patients improved more regarding New York Heart Association class (P=0.05), physical functioning (P=0.03), and physical health component (P=0.03). Except for HNC, health care utilization was comparable between groups. However, HNC patients requested counseling for noncardiac problems even more frequently than for cardiovascular or heart-failure-related issues. The primary end point of this study was neutral. However, mortality risk and surrogates of well-being improved significantly. Quantitative assessment of patient requirements suggested that besides (tele)monitoring individualized care considering also noncardiac problems should be integrated in efforts to achieve more sustainable improvement in heart failure outcomes. URL: http://www.controlled-trials.com. Unique identifier: ISRCTN23325295.

  8. Independent Orbiter Assessment (IOA): Analysis of the orbiter main propulsion system

    NASA Technical Reports Server (NTRS)

    Mcnicoll, W. J.; Mcneely, M.; Holden, K. A.; Emmons, T. E.; Lowery, H. J.

    1987-01-01

    The results of the Independent Orbiter Assessment (IOA) of the Failure Modes and Effects Analysis (FMEA) and Critical Items List (CIL) are presented. The IOA approach features a top-down analysis of the hardware to determine failure modes, criticality, and potential critical items (PCIs). To preserve independence, this analysis was accomplished without reliance upon the results contained within the NASA FMEA/CIL documentation. The independent analysis results for the Orbiter Main Propulsion System (MPS) hardware are documented. The Orbiter MPS consists of two subsystems: the Propellant Management Subsystem (PMS) and the Helium Subsystem. The PMS is a system of manifolds, distribution lines and valves by which the liquid propellants pass from the External Tank (ET) to the Space Shuttle Main Engines (SSMEs) and gaseous propellants pass from the SSMEs to the ET. The Helium Subsystem consists of a series of helium supply tanks and their associated regulators, check valves, distribution lines, and control valves. The Helium Subsystem supplies helium that is used within the SSMEs for inflight purges and provides pressure for actuation of SSME valves during emergency pneumatic shutdowns. The balance of the helium is used to provide pressure to operate the pneumatically actuated valves within the PMS. Each component was evaluated and analyzed for possible failure modes and effects. Criticalities were assigned based on the worst possible effect of each failure mode. Of the 690 failure modes analyzed, 349 were determined to be PCIs.

  9. Microcircuit failure analysis using the SEM. [Scanning Electron Microscopes

    NASA Technical Reports Server (NTRS)

    Nicolas, D. P.

    1974-01-01

    The scanning electron microscope adds a new dimension to the knowledge that can be obtained from a failed microcircuit. When used with conventional techniques, SEM assists and clarifies the analysis, but it does not replace light microscopy. The most advantageous features for microcircuit analysis are long working distances and great depth of field. Manufacturer related failure modes of microcircuits are metallization defects, poor bonding, surface and particle contamination, and design and fabrication faults. User related failure modes are caused by abuse, such as overstress. The Physics of Failure Procedure followed by the Astrionics Laboratory in failure analysis is described, which is designed to obtain maximum information available from each step.

  10. 49 CFR 179.201 - Individual specification requirements applicable to non-pressure tank car tanks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... to non-pressure tank car tanks. 179.201 Section 179.201 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for Non-Pressure Tank Car Tanks (Classes DOT-111AW...

  11. Application of Failure Mode and Effect Analysis (FMEA), cause and effect analysis, and Pareto diagram in conjunction with HACCP to a corn curl manufacturing plant.

    PubMed

    Varzakas, Theodoros H; Arvanitoyannis, Ioannis S

    2007-01-01

    The Failure Mode and Effect Analysis (FMEA) model has been applied for the risk assessment of corn curl manufacturing. A tentative approach of FMEA application to the snacks industry was attempted in an effort to exclude the presence of GMOs in the final product. This is of crucial importance both from the ethics and the legislation (Regulations EC 1829/2003; EC 1830/2003; Directive EC 18/2001) point of view. The Preliminary Hazard Analysis and the Fault Tree Analysis were used to analyze and predict the occurring failure modes in a food chain system (corn curls processing plant), based on the functions, characteristics, and/or interactions of the ingredients or the processes, upon which the system depends. Critical Control points have been identified and implemented in the cause and effect diagram (also known as Ishikawa, tree diagram, and the fishbone diagram). Finally, Pareto diagrams were employed towards the optimization of GMOs detection potential of FMEA.

  12. MO-FG-202-03: Efficient Data Collection of Continuous 2D and Discrete Relative Dosimetric Data for Annual LINAC QA Using TrueBeam Developer Mode and a 1D Scanning Tank

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Knutson, N; Schmidt, M; University of Rhode Island, Kingston, RI

    2016-06-15

    Purpose: To develop a method to exploit real-time dynamic machine and couch parameter control during linear accelerator (LINAC) beam delivery to facilitate efficient performance of TG-142 suggested, Annual LINAC QA tests. Methods: Varian’s TrueBeam Developer Mode (Varian Medical Systems, Palo Alto, CA) facilitates control of Varian’s TrueBeam LINAC via instructions provided in Extensible Markup Language (XML) files. This allows machine and couch parameters to be varied dynamically, in real-time, during beam delivery. Custom XML files were created to allow for the collection of (1) continuous Tissue Maximum Ratios (TMRs), (2) beam profiles, and (3) continuous output factors using a 1D-scanningmore » tank. TMRs were acquired by orienting an ionization chamber (IC) at isocenter (depth=25cm) and synchronizing a depth scan towards the water surface while lowering the couch at 1mm/s. For beam profiles, the couch was driven laterally and longitudinally while logging IC electrometer readings. Output factors (OFs) where collected by continually varying field sizes (4×4 to 30×30-cm{sup 2}) at a constant speed of 6.66 mm/s. To validate measurements, comparisons were made to data collected using traditional methods (e.g. 1D or 3D tank). Results: All data collecting using the proposed methods agreed with traditionally collected data (TMRs within 1%, OFs within 0.5% and beam profile agreement within 1% / 1mm) while taking less time to collect (factor of approximately 1/10) and with a finer sample resolution. Conclusion: TrueBeam developer mode facilitates collection of continuous data with the same accuracy as traditionally collected data with a finer resolution in less time. Results demonstrate an order of magnitude increase in sampled resolution and an order of magnitude reduction in collection time compared to traditional acquisition methods (e.g. 3D scanning tank). We are currently extending this approach to perform other TG-142 tasks.« less

  13. Life Cost Based FMEA Manual: A Step by Step Guide to Carrying Out a Cost-based Failure Modes and Effects Analysis

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rhee, Seung; Spencer, Cherrill; /Stanford U. /SLAC

    2009-01-23

    Failure occurs when one or more of the intended functions of a product are no longer fulfilled to the customer's satisfaction. The most critical product failures are those that escape design reviews and in-house quality inspection and are found by the customer. The product may work for a while until its performance degrades to an unacceptable level or it may have not worked even before customer took possession of the product. The end results of failures which may lead to unsafe conditions or major losses of the main function are rated high in severity. Failure Modes and Effects Analysis (FMEA)more » is a tool widely used in the automotive, aerospace, and electronics industries to identify, prioritize, and eliminate known potential failures, problems, and errors from systems under design, before the product is released (Stamatis, 1997). Several industrial FMEA standards such as those published by the Society of Automotive Engineers, US Department of Defense, and the Automotive Industry Action Group employ the Risk Priority Number (RPN) to measure risk and severity of failures. The Risk Priority Number (RPN) is a product of 3 indices: Occurrence (O), Severity (S), and Detection (D). In a traditional FMEA process design engineers typically analyze the 'root cause' and 'end-effects' of potential failures in a sub-system or component and assign penalty points through the O, S, D values to each failure. The analysis is organized around categories called failure modes, which link the causes and effects of failures. A few actions are taken upon completing the FMEA worksheet. The RPN column generally will identify the high-risk areas. The idea of performing FMEA is to eliminate or reduce known and potential failures before they reach the customers. Thus, a plan of action must be in place for the next task. Not all failures can be resolved during the product development cycle, thus prioritization of actions must be made within the design group. One definition of detection

  14. Tank characterization report for double-shell tank 241-AW-105

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sasaki, L.M.

    1997-06-05

    One of the major functions of the Tank Waste Remediation System (TWRS) is to characterize wastes in support of waste management and disposal activities at the Hanford Site. Analytical data from sampling and analysis, along with other available information about a tank, are compiled and maintained in a tank characterization report (TCR). This report and its appendices serve as the TCR for double-shell tank 241-AW-105. The objectives of this report are to use characterization data in response to technical issues associated with tank 241-AW-105 waste; and to provide a standard characterization of this waste in terms of a best-basis inventorymore » estimate. The response to technical issues is summarized in Section 2.0, and the best-basis inventory estimate is presented in Section 3.0. Recommendations regarding safety status and additional sampling needs are provided in Section 4.0. Supporting data and information are contained in the appendices. This report supports the requirements of the Hanford Federal Facility Agreement and Consent Order milestone Characterization. information presented in this report originated from sample analyses and known historical sources. While only the results of a recent sampling event will be used to fulfill the requirements of the data quality objectives (DQOs), other information can be used to support or question conclusions derived from these results. Historical information for tank 241-AW-105 is provided in Appendix A, including surveillance information, records pertaining to waste transfers and tank operations, and expected tank contents derived from a process knowledge model. The recent sampling event listed, as well as pertinent sample data obtained before 1996, are summarized in Appendix B along with the sampling results. The results of the 1996 grab sampling event satisfied the data requirements specified in the sampling and analysis plan (SAP) for this tank. In addition, the tank headspace flammability was measured, which

  15. Failure of a laminated composite under tension-compression fatigue loading

    NASA Technical Reports Server (NTRS)

    Rotem, A.; Nelson, H. G.

    1989-01-01

    The fatigue behavior of composite laminates under tension-compression loading is analyzed and compared with behavior under tension-tension and compression-compression loading. It is shown that for meaningful fatigue conditions, the tension-compression case is the dominant one. Both tension and compression failure modes can occur under the reversed loading, and failure is dependent on the specific lay-up of the laminate and the difference between the tensile static strength and the absolute value of the compressive static strength. The use of a fatigue failure envelope for determining the fatigue life and mode of failure is proposed and demonstrated.

  16. Peridynamics for failure and residual strength prediction of fiber-reinforced composites

    NASA Astrophysics Data System (ADS)

    Colavito, Kyle

    Peridynamics is a reformulation of classical continuum mechanics that utilizes integral equations in place of partial differential equations to remove the difficulty in handling discontinuities, such as cracks or interfaces, within a body. Damage is included within the constitutive model; initiation and propagation can occur without resorting to special crack growth criteria necessary in other commonly utilized approaches. Predicting damage and residual strengths of composite materials involves capturing complex, distinct and progressive failure modes. The peridynamic laminate theory correctly predicts the load redistribution in general laminate layups in the presence of complex failure modes through the use of multiple interaction types. This study presents two approaches to obtain the critical peridynamic failure parameters necessary to capture the residual strength of a composite structure. The validity of both approaches is first demonstrated by considering the residual strength of isotropic materials. The peridynamic theory is used to predict the crack growth and final failure load in both a diagonally loaded square plate with a center crack, as well as a four-point shear specimen subjected to asymmetric loading. This study also establishes the validity of each approach by considering composite laminate specimens in which each failure mode is isolated. Finally, the failure loads and final failure modes are predicted in a laminate with various hole diameters subjected to tensile and compressive loads.

  17. 49 CFR 179.103 - Special requirements for class 114A * * * tank car tanks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 3 2014-10-01 2014-10-01 false Special requirements for class 114A * * * tank car...) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120...

  18. Experimental, Numerical, and Analytical Slosh Dynamics of Water and Liquid Nitrogen in a Spherical Tank

    NASA Technical Reports Server (NTRS)

    Storey, Jedediah Morse

    2016-01-01

    Understanding, predicting, and controlling fluid slosh dynamics is critical to safety and improving performance of space missions when a significant percentage of the spacecraft's mass is a liquid. Computational fluid dynamics simulations can be used to predict the dynamics of slosh, but these programs require extensive validation. Many experimental and numerical studies of water slosh have been conducted. However, slosh data for cryogenic liquids is lacking. Water and cryogenic liquid nitrogen are used in various ground-based tests with a spherical tank to characterize damping, slosh mode frequencies, and slosh forces. A single ring baffle is installed in the tank for some of the tests. Analytical models for slosh modes, slosh forces, and baffle damping are constructed based on prior work. Select experiments are simulated using a commercial CFD software, and the numerical results are compared to the analytical and experimental results for the purposes of validation and methodology-improvement.

  19. Hybrid Composite Cryogenic Tank Structure

    NASA Technical Reports Server (NTRS)

    DeLay, Thomas

    2011-01-01

    A hybrid lightweight composite tank has been created using specially designed materials and manufacturing processes. The tank is produced by using a hybrid structure consisting of at least two reinforced composite material systems. The inner composite layer comprises a distinct fiber and resin matrix suitable for cryogenic use that is a braided-sleeve (and/or a filamentwound layer) aramid fiber preform that is placed on a removable mandrel (outfitted with metallic end fittings) and is infused (vacuum-assisted resin transfer molded) with a polyurethane resin matrix with a high ductility at low temperatures. This inner layer is allowed to cure and is encapsulated with a filamentwound outer composite layer of a distinct fiber resin system. Both inner and outer layer are in intimate contact, and can also be cured at the same time. The outer layer is a material that performs well for low temperature pressure vessels, and it can rely on the inner layer to act as a liner to contain the fluids. The outer layer can be a variety of materials, but the best embodiment may be the use of a continuous tow of carbon fiber (T-1000 carbon, or others), or other high-strength fibers combined with a high ductility epoxy resin matrix, or a polyurethane matrix, which performs well at low temperatures. After curing, the mandrel can be removed from the outer layer. While the hybrid structure is not limited to two particular materials, a preferred version of the tank has been demonstrated on an actual test tank article cycled at high pressures with liquid nitrogen and liquid hydrogen, and the best version is an inner layer of PBO (poly-pphenylenebenzobisoxazole) fibers with a polyurethane matrix and an outer layer of T-1000 carbon with a high elongation epoxy matrix suitable for cryogenic temperatures. A polyurethane matrix has also been used for the outer layer. The construction method is ideal because the fiber and resin of the inner layer has a high strain to failure at cryogenic

  20. Clinical implementation and failure mode and effects analysis of HDR skin brachytherapy using Valencia and Leipzig surface applicators.

    PubMed

    Sayler, Elaine; Eldredge-Hindy, Harriet; Dinome, Jessie; Lockamy, Virginia; Harrison, Amy S

    2015-01-01

    The planning procedure for Valencia and Leipzig surface applicators (VLSAs) (Nucletron, Veenendaal, The Netherlands) differs substantially from CT-based planning; the unfamiliarity could lead to significant errors. This study applies failure modes and effects analysis (FMEA) to high-dose-rate (HDR) skin brachytherapy using VLSAs to ensure safety and quality. A multidisciplinary team created a protocol for HDR VLSA skin treatments and applied FMEA. Failure modes were identified and scored by severity, occurrence, and detectability. The clinical procedure was then revised to address high-scoring process nodes. Several key components were added to the protocol to minimize risk probability numbers. (1) Diagnosis, prescription, applicator selection, and setup are reviewed at weekly quality assurance rounds. Peer review reduces the likelihood of an inappropriate treatment regime. (2) A template for HDR skin treatments was established in the clinic's electronic medical record system to standardize treatment instructions. This reduces the chances of miscommunication between the physician and planner as well as increases the detectability of an error. (3) A screen check was implemented during the second check to increase detectability of an error. (4) To reduce error probability, the treatment plan worksheet was designed to display plan parameters in a format visually similar to the treatment console display, facilitating data entry and verification. (5) VLSAs are color coded and labeled to match the electronic medical record prescriptions, simplifying in-room selection and verification. Multidisciplinary planning and FMEA increased detectability and reduced error probability during VLSA HDR brachytherapy. This clinical model may be useful to institutions implementing similar procedures. Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.