System Accident
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System Accident
A system accident (or normal accident) is an "unanticipated interaction of multiple failures" in a complex system. This complexity can either be of technology or of human organizations, and is frequently both. A system accident can be easy to see in hindsight, but extremely difficult in foresight because there are simply too many action pathways to seriously consider all of them. Charles Perrow first developed these ideas in the mid-1980s. William Langewiesche in the late 1990s wrote, "the control and operation of some of the riskiest technologies require organizations so complex that serious failures are virtually guaranteed to occur." Safety systems themselves are sometimes the added complexity which leads to this type of accident. Maintenance problems are common with redundant systems. Maintenance crews can fail to restore a redundant system to active status. They are often overworked or maintenance is deferred due to budget cuts, because managers know that they system wil ...
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Normal Accidents
''Normal Accidents: Living with High-Risk Technologies'' is a 1984 book by Yale sociologist Charles Perrow, which provides a detailed analysis of complex systems from a sociological perspective. It was the first to "propose a framework for characterizing complex technological systems such as air traffic, marine traffic, chemical plants, dams, and especially nuclear power plants according to their riskiness". Perrow argues that multiple and unexpected failures are built into society's complex and tightly coupled systems. Such accidents are unavoidable and cannot be designed around. Perrow's argument, based on systemic features and human error, is that big accidents tend to escalate, and technology is not the problem, the organizations are. Each of these principles is still relevant today. System accidents "Normal" accidents, or system accidents, are so-called by Perrow because such accidents are inevitable in extremely complex systems. Given the characteristic of the system invol ...
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Three Mile Island Accident
The Three Mile Island accident was a partial meltdown of the Three Mile Island, Unit 2 (TMI-2) reactor in Pennsylvania, United States. It began at 4 a.m. on March 28, 1979. It is the most significant accident in U.S. commercial nuclear power plant history. On the seven-point International Nuclear Event Scale, it is rated Level 5 – Accident with Wider Consequences. The accident began with failures in the non-nuclear secondary system followed by a stuck-open pilot-operated relief valve (PORV) in the primary system that allowed large amounts of nuclear reactor coolant to escape. The mechanical failures were compounded by the initial failure of plant operators to recognize the situation as a loss-of-coolant accident (LOCA). The failure of operators is attributed to the out-of-the-loop performance problem. TMI training and procedures left operators and management ill-prepared for the deteriorating situation. During the event these inadequacies were compounded by design ...
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University Corporation For Atmospheric Research
The University Corporation for Atmospheric Research (UCAR) is a US nonprofit consortium of more than 100 colleges and universities providing research and training in the atmospheric and related sciences. UCAR manages the National Center for Atmospheric Research (NCAR) and provides additional services to strengthen and support research and education through its community programs. Its headquarters, in Boulder, Colorado, include NCAR's Mesa Laboratory, designed by I.M. Pei. UCAR was established in 1959 by faculty from 14 leading universities to support and nourish the atmospheric sciences. They were motivated by a newly recognized need for pooled observational and computational facilities and a strong research staff, which together would allow the academic community to carry out complex, long-term scientific programs beyond the reach of individual universities. This group’s first major action, in partnership with the National Science Foundation, was to establish NCAR. Since then, U ...
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Journal Of Contingencies And Crisis Management
The ''Journal of Contingencies and Crisis Management'' (''JCCM'') is a multi-disciplinary, peer-reviewed academic journal that covers all theoretical and practical aspects relating to crisis management. ''JCCM'' is the leading journal on the subject of crisis management. It was founded in 1993 by Prof. Uriel Rosenthal and Prof. Alexander Kouzmin (University of Plymouth). The current editor is Prof. Ira Helsloot (Radboud Universiteit Nijmegen). Subject areas include: emergency management, risk management, contingency plans, foreign policies, ecological crisis, financial crisis, international relations, security policies, and conflict resolution. ''JCCM'' is published by Wiley-Blackwell Wiley-Blackwell is an international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons. It was formed by the merger of John Wiley & Sons Global Scientific, Technical, and Medical business with Blackwell Publish .... Reviews from older issues are regularly re- ...
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International Journal Of Aviation Psychology
''The International Journal of Aerospace Psychology'' (formerly ''The International Journal of Aviation Psychology'' until 2017) is a quarterly peer-reviewed academic journal covering research on the "development and management of safe, effective aviation systems from the standpoint of the human operators." It draws on aspects of the academic disciplines of engineering and computer science, psychology, education, and physiology. It was established in 1991 and is published by Taylor and Francis on behalf of the Association of Aviation Psychology. The editor-in-chief is Dennis B. Beringer. Abstracting and indexing The journal is abstracted and indexed in: According to the ''Journal Citation Reports'', the journal has a 2012 impact factor The impact factor (IF) or journal impact factor (JIF) of an academic journal is a scientometric index calculated by Clarivate that reflects the yearly mean number of citations of articles published in the last two years in a given journal, as i ...
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Pearson Education
Pearson Education is a British-owned education publishing and assessment service to schools and corporations, as well for students directly. Pearson owns educational media brands including Addison–Wesley, Peachpit, Prentice Hall, eCollege, Longman, Scott Foresman, and others. Pearson is part of Pearson plc, which formerly owned the ''Financial Times''. It claims to have been formed in 1840, with the current incarnation of the company created when Pearson plc purchased the education division of Simon & Schuster (including Prentice Hall and Allyn & Bacon) from Viacom and merged it with its own education division, Addison-Wesley Longman, to form Pearson Education. Pearson Education was rebranded to Pearson in 2011 and split into an International and a North American division. Although Pearson generates approximately 60 percent of its sales in North America, it operates in more than 70 countries. Pearson International is headquartered in London, and maintains offices across Eu ...
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Unintended Consequences
In the social sciences, unintended consequences (sometimes unanticipated consequences or unforeseen consequences) are outcomes of a purposeful action that are not intended or foreseen. The term was popularised in the twentieth century by American sociologist Robert K. Merton and expanded by economist Thomas Sowell and psychologist Stuart Vyse.Robert K. Merton, Versatile Sociologist and Father of the Focus Group, Dies at 92
Michael T. Kaufman, ''''
Unintended consequences can be grouped into three types: * ''Unexpected benefit'': ...
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Nadine Sarter
Nadine Barbara Sarter (born 1959) is a German-American industrial engineer interested in multimodal interaction, touch user interfaces, aircraft cockpit controls, and the ergonomics of human-machine interfaces. She is Richard W. Pew Collegiate Professor of Industrial & Operations Engineering at the University of Michigan, where she directs the Center for Ergonomics and is also affiliated with the Robotics Institute and Department of Aerospace Engineering. Education and career Sarter earned bachelor's and master's degree in psychology at the University of Hamburg in Germany, in 1981 and 1983 respectively. She worked in human factors and ergonomics in Germany for several years before emigrating to the US with her husband, psychologist Martin Sarter, and returning to graduate study in engineering. She completed a Ph.D. in industrial and systems engineering at Ohio State University in 1994, under the supervision of David Woods. After completing her doctorate, she became an assistant ...
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Air France Flight 447
Air France Flight 447 (AF447 or AFR447) was a scheduled international passenger flight from Rio de Janeiro, Brazil, to Paris, France. On 1 June 2009, inconsistent airspeed indications led to the pilots inadvertently stalling the Airbus A330 serving the flight, failing to recover from it and eventually crashing into the Atlantic Ocean at 02:14 UTC, killing all 228 passengers and crew on board. The Brazilian Navy recovered the first major wreckage, and two bodies, from the sea within five days of the accident, but the investigation by France's Bureau of Enquiry and Analysis for Civil Aviation Safety (BEA) was hampered because the aircraft's flight recorders were not recovered from the ocean floor until May 2011, nearly two years later. The BEA's final report, released at a news conference on 5 July 2012, concluded that the aircraft suffered temporary inconsistencies between the airspeed measurements—likely resulting from ice crystals obstructing the aircraft's pitot tubes— ...
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Synthetic CDO
A synthetic CDO (collateralized debt obligation) is a variation of a CDO that generally uses credit default swaps and other derivatives to obtain its investment goals.Lemke, Lins and Picard, ''Mortgage-Backed Securities'', §5:16 (Thomson West, 2017-2018 ed.). As such, it is a complex derivative financial security sometimes described as a bet on the performance of other mortgage (or other) products, rather than a real mortgage security. The value and payment stream of a synthetic CDO is derived not from cash assets, like mortgages or credit card payments – as in the case of a regular or "cash" CDO—but from premiums paying for credit default swap "insurance" on the possibility of default of some defined set of "reference" securities—based on cash assets. The insurance-buying " counterparties" may own the "reference" securities and be managing the risk of their default, or may be speculators who've calculated that the securities will default. Synthetics thrived for a brief time ...
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Credit Default Swap
A credit default swap (CDS) is a financial swap agreement that the seller of the CDS will compensate the buyer in the event of a debt default (by the debtor) or other credit event. That is, the seller of the CDS insures the buyer against some reference asset defaulting. The buyer of the CDS makes a series of payments (the CDS "fee" or "spread") to the seller and, in exchange, may expect to receive a payoff if the asset defaults. In the event of default, the buyer of the credit default swap receives compensation (usually the face value of the loan), and the seller of the CDS takes possession of the defaulted loan or its market value in cash. However, anyone can purchase a CDS, even buyers who do not hold the loan instrument and who have no direct insurable interest in the loan (these are called "naked" CDSs). If there are more CDS contracts outstanding than bonds in existence, a protocol exists to hold a credit event auction. The payment received is often substantially less ...
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CDO-Squared
CDO-Squared is a collateralized debt obligations backed primarily by the tranches issued by other CDOs. These instruments became popular before the financial crisis of 2007–08. There were 36 CDO-Squared deals made in 2005, 48 in 2006 and 41 in 2007. Merrill Lynch was a big producer, creating and selling 11 of them. The collapse of the market for collateralized debt obligations and CDO-Squared contributed to the 2008 subprime mortgage crisis. Goldman Sachs Goldman Sachs () is an American multinational investment bank and financial services company. Founded in 1869, Goldman Sachs is headquartered at 200 West Street in Lower Manhattan, with regional headquarters in London, Warsaw, Bangalore, H ... appears to be the last bank to hold CDOs-Squared, holding $50 million in June 2018. 2004 *Abacus 2004-2 *Abacus 2004-3 *ACA 2004-1 *Cascade Funding I *Crystal Cove *Davis Square Funding III *Dunhill *E-Trade III *Glacier Funding I *Glacier Funding II *Independence V *Jupiter Hi ...
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