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[Music]

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you know as I was getting ready and

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preparing for this talk I was sitting in

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school and this is one of my associates

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came up to me and asked me what I was

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doing and I said well I'm preparing a

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talk he says what's it about

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nice it's gonna be on premonitions and

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he says I don't believe that stuff and I

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said I know you'd say that

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okay well that's that was just a joke so

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here here's a real question that was

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proposed by a student I have a couple

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classes and I am was stuck my neck out

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in the last week of the semester I have

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what I call psychic phenomena and we

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talk about mostly the things which are

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have really good science behind him and

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I had this one student kind of a crusty

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old construction guy probably a framer

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or something like that and he raises his

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hand and this is what he said what's the

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point and he said why are we learning

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about this stuff and so I think we've

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all heard people express that and so

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what I hope to do today is to probably

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provide some answer to that and I had a

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good answer for him but we'll we'll move

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on oh I talked about reliability and

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reliability engineering so we just need

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to make a definition reliability is just

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the attribute the system has to continue

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to give you the functions for which it

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was designed

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that's pretty simple right if we buy a

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car we want it to continue to go down

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the road

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see how do I use this thing like that

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there we go it's got a nasty definition

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called coordinated holistic proactive

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approach to improving asset availability

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now the assets that we have

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the people we work with the physical

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plants and things that we have and the

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knowledge that we have and we all want

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those to be able to improve the

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availability of those actions and to

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protect the humans that interact with

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them now part of the reliability

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engineering is a sub concept called

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situational awareness and situational

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awareness is very important we all need

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to keep track of what's going on around

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us especially if we're driving you know

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you don't want to have people running

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into you or you running into someone

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else and so situational awareness is

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knowing what's going on around you now

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if you have poor situational awareness

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your consciousness doesn't have a good

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grip on on what's going on and the

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project of the prospects for that is

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that the safety and the integrity and of

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the human the physical and the knowledge

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systems you have it's doubtful okay

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so what a premonitions got to do with

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any of this let's kind of shift gears

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now and talk about something a little

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bit related we get information and this

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is kind of the realm of thye we get

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information from the past comes to us

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near-death experiences past life

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recollections things through mediums and

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and things like that

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we also get information from the remote

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present and we've talked in here there

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in this meeting about remote viewing and

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messages from others without hardware

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things like that and then we get

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information from the future and that's

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premonitions or precognition so we have

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all of these kinds of information that

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come to us now they're all transfers of

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information these are all in the SCI

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realm and they help us to be more

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situationally aware know better about

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what's going on around us so that we can

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be aware of all the facts that are

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relevant to the safety of the people we

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deal with the physical plant we have and

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the knowledge that we contain and this

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is especially true with regard to

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premonitions

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now here's probably something somebody's

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gonna wonder about I'm saying that

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premonitions and other well-established

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sigh things where we have good tech

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science behind it has become a knowledge

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base and is therefore technology now

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technology really some people think the

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only thing technology means is computers

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I get this at school a lot you know

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because I'm in technology management

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program when we we deal with all kinds

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of things not just computers and I don't

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deal with the computers and then

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criticized for that sometimes so things

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like premonitions now were Dean Radin

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experiments have p-values that are in

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the astronomically known numbers yeah

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that's that's technology and that stuff

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that we can use technology is what we

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have for the benefit of humanity ok now

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this got this stuff that I'm talking

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about Gus started several years ago back

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in the mid 80s there was a professor of

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psychology at University of Texas and

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there a NASA contract he was given the

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research project to study what factors

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are common to incidents in systems and

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his aim really was to learn to predict

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when accidents were imminent that was

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that was the NASA project now him Rick

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and his associates discovered by things

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that enhance situational awareness we're

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not going to go over these but these are

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the things that people do that will

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enhance their situational awareness

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spatial orientation is when our kids our

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students have a hard time with that just

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means where you are in space and time

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with your surroundings okay so but more

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importantly what they did discover

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we're 11 clues that situational

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awareness had been lost

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they studied several thousand I don't

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know exactly what they studied

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incidentally I've tried to find his

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research and I can't find it I actually

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had a funk had a conversation with him I

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went and visited him when we were

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working with this and I don't know where

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it is and what I got I was working with

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flight safety international and failure

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announced associate Stu to use this

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technology in in industrial locations

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but these are the 11 clues that tells

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you you're out of it you don't know what

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you're doing and we won't go over all of

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them just maybe like departure from a

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standard operating procedures now an

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operating procedure that you have you

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alright procedures at one time another

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in your life and when you're doing

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something at a safety critical industry

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you want the best thinking of the best

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minds on that subject to make the

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procedure right ok but when you depart

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from it you move into a realm that is

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outside where the best thinking of the

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best minds have considered ok and so

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then you have lost situational awareness

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because you don't know where you are

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no one flying the plane nobody in

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control and it might amaze you and

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invest real situations I have seen that

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happen on numerous occasions there's

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nobody monitoring or in control of

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anything and that's pretty pretty scary

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when you got 200 million dollar piece of

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junk sitting out there and and it's at

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1,200 degrees and and you got oil in it

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and you've got oxygen in it and nobody's

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in control ambiguities and big unities

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are things that don't make sense you you

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have instruments that give you this

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information and this information and

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they don't they don't mess they don't

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mesh those those that means you don't

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know what's going on and now down here

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the one that they found number 11 an

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apprehensive or gut feel

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that something is wrong now that's a

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pure premonition that gut feeling that

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something is wrong so let's move on a

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little bit here this is what they

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discovered if if you're in some sort of

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a operating procedure and and you

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discover that four or five of these

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clues are present the statistics on

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there's a research study by Helmerich so

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that an incident was imminent and that

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what you should do is put things into

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idle go to the safe position and find

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out what's wrong the one that I thought

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was really interesting was every time

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they found somebody had this premonition

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that something bad was going on 100% of

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the time there was an incident now when

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an incident can be doesn't have to hurt

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people but it can there's a potential

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for hurting people and but a lot of the

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times when you have an incident you

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don't hurt somebody but you can lose

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hundreds and hundreds of thousands of

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dollars in just a flash of eyelash

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sometimes so you know we have all kinds

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of incidents that can happen now one of

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the things that I have noticed is that

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there there's an exponential factor in

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premonitions now I've got 29 grandkids

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as of today and that means I have small

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children in my dinner table every once

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in a while and if I see a glass of milk

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go from out front of the plate where I

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put it over here to the edge of the

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table I can see it going on the floor

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now I've had that happen a lot of times

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see now the first time that happened not

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likely no well that may not be to safer

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place but but what this does is help us

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to recognize things and take appropriate

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actions and so as we go through the

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things here we have the opportunity of

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seeing things that are not normal now

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what they can do for us then is help us

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be trained to recognize the premonitions

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because when you see those things we

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train people to well they're gone we one

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of the things we do to train them as we

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go through a training procedure which

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trains them to recognize those clues and

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they aren't necessarily premonitions in

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and of themselves but they are things

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that will help you recognize a

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premonition and because you've had the

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training then it motivates you to do

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something about it okay

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and that's that's the value of this now

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the FAA has required on for a long many

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years now that this kind of training be

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given to commercial airline crews and

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then it includes the stewardesses also

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and so you have these and and we often

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get religious and spiritual leaders who

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are encouraging this to pay attention to

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this kind of information so we consider

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and we've trained a lot of people now we

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spent we had a refinery in southern

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Kansas in which we had 420 people

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everybody in the plant was given this

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training and a few months later on one

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of one of the units there was a it

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wasn't working very good and there was

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below this and that and they were

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struggling and turning the knobs and

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noting that happening right and one of

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the guys said look there's there's five

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of those clues the foreman says hit the

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panic button and that's an emergency

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shutdown they did that they resolved the

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issues very quickly when an hour two

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came back up and only lost a minimal

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amount of money now in another area

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same kind of thing different unit

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different kind of personality

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somebody call attention to that some of

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these clues to the company said hi he

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says we're not going we work through

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this we've done this before you just

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it's just getting after and get listen

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fixed within a few hours

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everything coked up on every pipe and

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every vessel was full solid carbon and

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they were down for a month cleaning it

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out nobody got hurt lots of money lost

277
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and the instructions of the workers

278
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whenever you see four or five of these

279
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things to losing the situational

280
00:14:05,520 --> 00:14:03,070
awareness move to a safe position if the

281
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Premonition factors present do it right

282
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now quick now here's one last example

283
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okay Flying Tiger Airlines bad

284
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communications failure to act on

285
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premonitions flying tiger Airlines came

286
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from the Flying Tigers of World War two

287
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Fame and they had a an air air freight

288
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company and they were they were

289
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traveling from Borneo to Kuala Lumpur in

290
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Malaysia and it was a dark night it was

291
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it couldn't really see much there was no

292
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moon and as they got on approach here to

293
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Kuala Lumpur the air traffic controlling

294
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look couldn't in Kuala Lumpur called in

295
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and said you need to fly around and come

296
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in from the other direction because the

297
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instrument landing system is not in

298
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service from the direction you're coming

299
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in same kind of comment I'll come on how

300
00:15:09,390 --> 00:15:07,690
we you know he was kind of a cowboy yeah

301
00:15:11,100 --> 00:15:09,400
we can do this we've done manual

302
00:15:12,840 --> 00:15:11,110
landings before we don't need to we

303
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don't need to do that besides that'll

304
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take us another hour to get around there

305
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and come back and he says we're not

306
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going to do it well three times during

307
00:15:29,100 --> 00:15:26,050
this approach thing the person the

308
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second officer said oh come on Captain

309
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let's just fly around I really don't

310
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feel good about this he did that three

311
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times and he was rebuffed each time and

312
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the air traffic controller cleared them

313
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to go to she said you are cleared to fly

314
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to two four zero zero and they were

315
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arguing about which which frequency they

316
00:16:01,280 --> 00:15:58,350
should be on that was a distraction and

317
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what the crew heard was you are cleared

318
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to four zero zero so at that point in

319
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time right here they reset the glide

320
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slope on the automatic pilot to go to

321
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400 feet instead of 2400 they began to

322
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still began to continue because of the

323
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distraction they did not recognize any

324
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of these because this wasn't part of the

325
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training at the time and they flew into

326
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a mountain and of course they're killed

327
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and those were the ones that they were

328
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not doing so I'm firmly convinced that

329
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this training works it worked in in all

330
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sorts of critical safety critical

331
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industries and we've trained people in

332
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it and it's got a premonition part of it

333
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and I think it the it helps is

334
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premonition area with the other clues

335
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because it helps you recognize what's

336
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going on and and act and be motivated to

337
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act ok

338
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[Applause]

339
00:17:14,250 --> 00:17:05,409
yes thank you John very interesting

340
00:17:16,949 --> 00:17:14,260
okay I'm wondering hi yeah very

341
00:17:20,340 --> 00:17:16,959
fascinating talk my brother works for

342
00:17:22,829 --> 00:17:20,350
the Navy he's at Bremerton Jim yard he

343
00:17:25,079 --> 00:17:22,839
was involved in refueling submarines and

344
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we've talked on many occasions about

345
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their safety procedures and he recently

346
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turned me to a book I can't remember the

347
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author sorry but it's called root cause

348
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analysis okay so I was wondering looking

349
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at that it seemed quite limited to me

350
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and I wanted to know if if you had seen

351
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that practice and how how you would

352
00:17:46,169 --> 00:17:43,480
think of it well that's a subject that

353
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we teach in and with relation to this

354
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here also root cause failure analysis

355
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that's two things is it's a technique of

356
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building an error chain where you start

357
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where the sharp end of the error chain

358
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is that's where it hurts okay and you

359
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say what caused that and then what

360
00:18:03,779 --> 00:18:02,320
caused that and then what caused that

361
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and then what caused that and so you

362
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develop an error chain that you can

363
00:18:12,960 --> 00:18:10,659
analyze and then take actions to solve a

364
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lot of problems and so that's one thing

365
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and then there is also a computer

366
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program you can buy that will walk you

367
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through it called root cause failure

368
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analysis very very very valuable

369
00:18:28,139 --> 00:18:26,440
technique yeah yeah no it doesn't but

370
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one of the things I've done in my

371
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classes I I take that that lemon clues

372
00:18:37,380 --> 00:18:34,000
sheet and we use that an incident

373
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investigation to see if there was human

374
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error because they had missed one or two

375
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or more or five of those clues to losing

376
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awareness so in that respect yeah we do

377
00:18:51,419 --> 00:18:49,450
yeah oh right here

378
00:18:53,580 --> 00:18:51,429
thanks John um my work for a company

379
00:18:54,810 --> 00:18:53,590
that talks about safety but doesn't

380
00:18:58,080 --> 00:18:54,820
really do anything about safety

381
00:19:00,930 --> 00:18:58,090
is there anything typical yeah yeah and

382
00:19:04,380 --> 00:19:00,940
we've had accidents there but I just got

383
00:19:11,590 --> 00:19:04,390
brushed under the rug any commercial

384
00:19:15,430 --> 00:19:13,570
well I think there are yeah I think

385
00:19:18,340 --> 00:19:15,440
there are some there are people who

386
00:19:20,110 --> 00:19:18,350
because the FAA requires it's called

387
00:19:22,390 --> 00:19:20,120
crew resource management is the

388
00:19:24,370 --> 00:19:22,400
technical term for the entire training

389
00:19:28,680 --> 00:19:24,380
program okay so I think there are yeah

390
00:19:34,659 --> 00:19:28,690
I'll google that thank you all

391
00:19:37,200 --> 00:19:34,669
situationally aware or unaware Thanks so

392
00:19:39,340 --> 00:19:37,210
it's very fascinating presentation

393
00:19:41,500 --> 00:19:39,350
looking at the camera I know I'm gonna

394
00:19:43,149 --> 00:19:41,510
be further than Todd once the DVDs get

395
00:19:45,190 --> 00:19:43,159
out but I was looking at the eleven

396
00:19:47,320 --> 00:19:45,200
point least and it looked to me like a

397
00:19:50,649 --> 00:19:47,330
perfect checklist for a systemic

398
00:19:52,180 --> 00:19:50,659
business failure and in the case I was

399
00:19:54,490 --> 00:19:52,190
thinking about was a big telecoms

400
00:19:55,899 --> 00:19:54,500
manufacturer from Finland so you may

401
00:19:57,909 --> 00:19:55,909
have heard about it and it's recent

402
00:20:01,750 --> 00:19:57,919
troubles so I'm thinking do you think

403
00:20:05,710 --> 00:20:01,760
this list has applicability beyond the

404
00:20:08,830 --> 00:20:05,720
technical logical reliability does yeah

405
00:20:11,980 --> 00:20:08,840
matter of fact you can use it in your

406
00:20:14,560 --> 00:20:11,990
family for instance if you get a phone

407
00:20:17,770 --> 00:20:14,570
call at 3:00 in the morning saying your

408
00:20:20,820 --> 00:20:17,780
sins in jail you need to come get him

409
00:20:24,669 --> 00:20:20,830
that's bad situational and parent and in

410
00:20:26,890 --> 00:20:24,679
the kind of your parenting and I nearly

411
00:20:28,210 --> 00:20:26,900
had a guy in my office who came home one

412
00:20:29,590 --> 00:20:28,220
day and the first of the month bills

413
00:20:31,510 --> 00:20:29,600
come in and all of a sudden here is

414
00:20:32,830 --> 00:20:31,520
credit card bills from about six

415
00:20:35,830 --> 00:20:32,840
different places he didn't know he had a

416
00:20:38,649 --> 00:20:35,840
credit card for and here was an $18,000

417
00:20:40,390 --> 00:20:38,659
total charge all piled up his wife had

418
00:20:42,580 --> 00:20:40,400
gone out and spent that much money and

419
00:20:47,470 --> 00:20:42,590
they had nothing to show for it the

420
00:20:49,480 --> 00:20:47,480
thing that they thought was she must

421
00:20:51,370 --> 00:20:49,490
have bought a lot of stuff and there was

422
00:20:54,010 --> 00:20:51,380
receipts and things but she didn't have

423
00:20:55,630 --> 00:20:54,020
him and she gave it away it was what it

424
00:20:57,310 --> 00:20:55,640
was happen to the show so there's all

425
00:21:01,149 --> 00:20:57,320
kinds financial situational awareness

426
00:21:03,940 --> 00:21:01,159
credit cards is a big one so the it's a

427
00:21:05,590 --> 00:21:03,950
really powerful powerful one additional

428
00:21:07,810 --> 00:21:05,600
continued question do you think it makes

429
00:21:11,620 --> 00:21:07,820
any sense to move the premonition from

430
00:21:14,020 --> 00:21:11,630
the 11th spot to the top well it's

431
00:21:16,330 --> 00:21:14,030
probably one of the better ones as

432
00:21:19,330 --> 00:21:16,340
you're teaching that you run into the

433
00:21:21,549 --> 00:21:19,340
problem do they believe that one down

434
00:21:23,260 --> 00:21:21,559
there ok but when you give them the rest

435
00:21:23,600 --> 00:21:23,270
of them and then people start coming up

436
00:21:26,330 --> 00:21:23,610
and

437
00:21:32,870 --> 00:21:26,340
with examples then that makes lots of

438
00:21:33,370 --> 00:21:32,880
sense - yeah okay okay thank you John