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Article Text
Objective There is a lack of high-quality evidence for physiotherapy post lumbar discectomy. Substantial heterogeneity in treatment effects may be explained by variation in quality, administration and components of interventions. An optimised physiotherapy intervention may reduce heterogeneity and improve patient benefit. The objective was to describe, analyse and evaluate an optimised 1:1 physiotherapy outpatient intervention for patients following primary lumbar discectomy, to provide preliminary insights.
Design A descriptive analysis of the intervention embedded within an external pilot and feasibility trial.
Setting Two UK spinal centres.
Participants Participants aged ≥18; post primary, single level, lumbar discectomy were recruited.
Intervention The intervention encompassed education, advice, mobility and core stability exercises, progressive exercise, and encouragement of early return to work/activity. Patients received ≤8 sessions for ≤8 weeks, starting 4 weeks post surgery (baseline).
Outcomes Blinded outcome assessment at baseline and 12 weeks (post intervention) included the Roland Morris Disability Questionnaire. STarT Back data were collected at baseline. Statistical analyses summarised participant characteristics and preplanned descriptive analyses. Thematic analysis grouped related data.
Findings Twenty-two of 29 allocated participants received the intervention. STarT Back categorised n=16 (55%) participants 'not at low risk'. Physiotherapists identified reasons for caution for 8 (36%) participants, commonly risk of overdoing activity (n=4, 18%). There was no relationship between STarT Back and physiotherapists' evaluation of caution. Physiotherapists identified 154 problems (mean (SD) 5.36 (2.63)). Those 'not at low risk', and/or requiring caution presented with more problems, and required more sessions (mean (SD) 3.14 (1.16)).
Conclusions Patients present differently and therefore require tailored interventions. These differences may be identified using clinical reasoning and outcome data.
Trial registration number ISRCTN33808269; post results.
- Lumbar discectomy
- Physiotherapy
- clinical reasoning
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Strengths and limitations of this study
The study employed a rigorous process to analyse and evaluate an optimised 1:1 physiotherapy outpatient intervention for patients following primary lumbar discectomy.
To reflect current practice, the nine-item STarT Back may have been more valuable to avoid reducing the tool's discriminative power.
Although specific interventions were indicated as used, free text sections were often left unanswered thereby limited depth of information was gained, perhaps reflecting the increasing demands placed on National Health Service physiotherapists.
The study conclusions are limited by the low numbers of patients but some valuable insights can now be used to develop further work.
With a lifetime prevalence of 80%, low back pain (LBP) represents a considerable health issue1 with extensive financial (estimated £10 668 million annually) and societal cost.2 Surgical management is the largest single component of expenditure, with lumbar discectomy a common procedure to excise part of a prolapsed intervertebral disc for a primary indication of leg pain.3 Data support high numbers of patients undergoing surgery, with 8478 operations performed within the UK National Health Service (NHS) in the 2013/2014 year4; and annual estimates of 12 000 in the Netherlands,5 and 287 122 in the USA.6 Lumbar discectomy is considered effective, with documented success of 46–75% at 6–8 weeks, and 78–95% at 1–2 years post surgery.3
However, evidence suggests ongoing disability for some patients, with 70% fit to return to work 12 months after surgery7 and 30–70% experiencing residual pain.8 Reoperation is also an issue, estimated as 3–12% patients in the Netherlands,9 and 14% in the UK.4 With a low mean working age of 45 years for patients undergoing surgery and short mean hospital stay of 2.3 days,4 postoperative outpatient rehabilitation is a key issue.
Post operative advice and rehabilitation is variable from surgeon10 and physiotherapist perspectives.11 In some spinal centres (44%), individual outpatient physiotherapy is provided for all patients, and in others only for patients experiencing residual problems (further 46% centres).11 Content and advice of physiotherapy management were variable, with 1–20 sessions and a wide range of interventions advocated.
Our systematic review12 focused on the effectiveness of physiotherapy outpatient intervention post first single level lumbar discectomy. Only 1 of 16 included trials was low risk of bias, and only 3 trials investigated individualised physiotherapy outpatient management, reflective of current practice11 in several countries including the UK. The others investigated group management. Evidence was inconclusive overall. Some evidence suggested physiotherapy improved disability, with a potential benefit of more intensive intervention; and weak evidence suggested improved movement/physical impairment; all in the short-term. The findings mirrored a recently updated Cochrane review that investigated effectiveness of rehabilitation programmes that included physiotherapy.3 Only 10 of 22 included trials were low risk of bias. Of particular interest, is a potential positive effect of exercise on pain and function; with very low/low quality evidence supporting high>low intensity exercise programmes short term, and low quality evidence supporting physiotherapy starting at 4–6 weeks compared with no treatment/education only. The evidence from their previous review13 of n=14 trials had been stronger, with low to moderate evidence supporting effectiveness of exercise compared with no treatment, and high intensity exercises as more effective than low intensity for pain and improved physical impairment.
These data raise questions regarding optimal rehabilitation. An adequately powered low risk of bias trial is required to identify whether individualised physiotherapy is effective/cost-effective. Substantial heterogeneity in treatment effects across all systematic reviews could be explained by variation in quality, administration and components of interventions, illustrated by the documented variability in management and advice.10 ,11 Therefore, prior to planning a trial, an optimised 1:1 physiotherapy outpatient intervention was developed through a rigorous process14 to reflect best practice, with flexibility to tailor management to individual patients in line with Medical Research Council (MRC) guidance regarding the development of complex interventions (see online supplementary file S1).15 The intervention was evaluated through an external pilot and feasibility study16 that enabled description and analysis of the intervention and physiotherapist decision-making.
supplementary file
To describe, analyse and evaluate application of the optimised 1:1 physiotherapy outpatient intervention for patients following primary lumbar discectomy.
Design and setting
A descriptive analysis of the optimised (designed to reflect best practice) 1:1 physiotherapy outpatient intervention embedded within an external pilot and feasibility study in preparation for a randomised controlled trial (RCT) reported elsewhere.16 This was a descriptive analysis of one arm of a small-scale parallel RCT design, randomising consenting patients across two UK sites, the Queen Elizabeth Hospital Birmingham (QEHB) and the Salford Royal Foundation Trust (SRFT), to either the optimised intervention including patient leaflet or patient leaflet alone. The two sites delivered the same intervention (as far as could be standardised) and for this reason and owing to low numbers, there was no intention to compare between sites.
Eligibility criteria
Patients aged >18 years; post primary, single level, lumbar discectomy (including microdiscectomy),17 and able to communicate in English. Exclusion criteria: previous surgery at same spinal level; comorbidities that might impact on ability to participate in interventions including cauda equina compression, cognitive dysfunction, uncontrolled cardiovascular disease,17 osteoporotic fracture, spondylolisthesis, multiple sclerosis, tumour;18 complications from surgery;17 ,19 and participation in a concurrent trial.
Patients at both sites were invited to participate prior to discharge. Interested and eligible patients were provided with a Participant Information Sheet, their questions answered, and asked to provide written consent to be contacted with an appointment 4 weeks post surgery. The patient leaflet was provided and discussed. At 4 weeks, written informed consent was gained from eligible patients, and patients were randomised. The patient leaflet is described elsewhere.20
Ethics approval
R&D approval was gained. The West Midlands—Solihull Research Ethics Committee granted ethical approval (reference number 12/WM/0224).
Physiotherapy intervention
The 1:1 physiotherapy outpatient intervention (detailed in online supplementary file 1) encompassed education, advice, mobility exercises, core stability exercises, a progressive approach to exercise to increase intensity and encouragement of early return to work/activity. It was designed14 to reflect best practice, based on current evidence,10–13 and enabled the physiotherapist to select components of the intervention that best addressed the individual patient's problems. It was developed and agreed by the research team following consultation with clinical experts and spinal surgeons at five spinal centres, physiotherapists and patients; and is fully reported elsewhere.14 This ensured an intervention informed by the evidence base that discouraged the use of treatments for which there is evidence of no effect. Although developed prior to the recently updated Cochrane review,3 the intervention remains consistent with best evidence. Patients could attend ≤8 physiotherapy sessions ≤8 weeks, allowing patient choice and local practice variation.
The intervention started 4 weeks post surgery to provide optimal care.3 ,12 First, a list of guiding principles provided the basis for and guided the individual physiotherapist's decisions for selecting treatment content, dose and progression, etc. Second, a table of dual purpose provided a description of the intervention and structure to enable physiotherapists to record the delivered intervention. In line with MRC guidance,15 the intervention incorporated flexibility to tailor management to individual patient's needs following the physiotherapist's assessment of the individual patient and identification of their problems; ensuring patient centred care based on clinical reasoning. Physiotherapy clinical reasoning is complex and many trial interventions fail to capture and describe these processes. The developed intervention was acceptable to patients and clinicians.14 ,16
Demographic data and outcome assessment
Blinded outcome assessment was 4 weeks after surgery (baseline), and following intervention at 12 weeks postbaseline (primary end point). Demographic data including age, gender, duration of symptoms prior to surgery, planned or emergency surgery, presence of leg and/or back pain, analgesia, employment status and ethnicity were collected to describe participant characteristics. The primary outcome was the Roland Morris Disability Questionnaire (RMDQ), and the choice of secondary measures was informed by patients, surgeons and physiotherapists: Global Perceived Effect (GPE) (1=completely recovered, 2=much improved, 3=slightly improved, 4=not changed, 5=slightly worse, 6=much worse and 7=worse than ever compared with presurgery), Visual Analogue Scale leg pain and back pain (0–10 cm, with 0 'no pain' and 10 'worst pain ever'), EQ-5D 5L, time to return to work/normal function/full duty, Tampa Scale for Kinesiophobia (17 items, each rated as 1 'strongly disagree', 2 'disagree', 3 'agree', or, 4 'strongly agree', total score out of 68), Fear Avoidance and Beliefs Questionnaire (FABQ) (16 items rated 0–6 informing two subscales: FABQ physical activity total score 24, and FABQ work 42), Straight Leg Raise, range of lumbar movement, analgesia and reoperation.16 Adherence was measured. The outcomes at 4 and 12 weeks post surgery are reported in full elsewhere14 and results were promising for both interventions.
Keele STarT Back tool
The Keele STarT Back tool was also part of data collection at baseline.21 It was developed for patients presenting with LBP in primary care to inform stratification of care based on identification of barriers to recovery. The tool possesses high reliability,21 and validity compared to the Örebro Musculoskeletal Pain Screening Questionnaire.22 Researchers have investigated the predictive value of STarT Back in secondary care, in physical therapy clinics in USA23 ,24 and Danish specialist care;25 ,26 finding it less effective than in primary care, but equivalent to other measures such as pain intensity or activity limitation. The six-item tool was used for consideration of participant questionnaire burden (referred leg pain, disability, catastrophising, depression and overall impact items) that stratifies patients into low risk/not at low risk of poor outcome. It has not been validated in a post operative population and was therefore used descriptively in this study to provide preliminary data.
Eligible treating physiotherapists were any band (grade) and working within the outpatient department. They were blinded to baseline STarT Back and outcome measure data. Training (from AR/PG) standardised intervention delivery and answered questions.
Detail of intervention data collection
Physiotherapists and service users informed the development of the data collection tool that enabled capture of key components of the physiotherapy assessment to inform delivery of the intervention14 (see online supplementary file 1).
Data analysis
Data were transferred to SPSS (V.21, IBM, New York, New York, USA) and all data were checked to ensure their integrity. Statistical analyses included a summary of participant characteristics and pre-planned descriptive analyses. Thematic analysis was used to group related data27 to enable descriptive analysis that explored: demographics, treatment detail and whether physiotherapists identified a need for caution (aspects of clinical reasoning), and STarT Back data; in the context of treatment duration, frequency of interventions, problems identified, number of sessions and discharge data.
The study ran from January 2013 to July 2014, inclusive of recruitment, intervention, outcome assessment and focus groups. Figure 1 presents the trial Consolidated Standards of Reporting Trials (CONSORT) diagram. Twenty-nine patients were randomly allocated to the 1:1 physiotherapy and patient leaflet intervention (n=11 QEHB, n=18 SRFT), and their characteristics are detailed in table 1. The recruitment factor was 25/77 (32%) at the QEHB site (randomised/introduced) and 34/175 (19%) at the SRFT site; travel was the key issue for patients not interested in participating.
Most surgical procedures were planned and the mean age of participants reflects a working population with 83% participants working (employed/self-employed). At the 4-week baseline 28% (n=8) were back at work. The mean duration of symptoms prior to surgery was 61 months. Table 2 illustrates the clinical presentation of participants. All participants presented with pain and the majority with leg pain (93%) prior to surgery. Paraesthesia and numbness were common. At baseline, participants presented overall as moderate disability and although pain was mostly of low severity at this point, most required analgesia. The median GPE of 2 reflected considerable improvement from the surgery, perhaps also reflected in the high health related quality of life scores. Patients presented with a high TAMPA reflecting issues of kinesiophobia.
The STarT Back data (table 3) illustrate that n=16 (55%) participants scored ≥3 and would be categorised as not at low risk of chronicity/poor recovery and therefore physiotherapy would be recommended.
Of the n=29 participants allocated to the optimised intervention, n=22 received the intervention. N=1 QEHB and n=6 SRFT did not receive the intervention (five female, two male), and five of seven were categorised not at low risk using STarT Back. No adverse events were reported and no participant required further surgery.
Treating physiotherapist assessment of n=22 participants who received the intervention
Eight participants (36%) had reasons for caution identified by the physiotherapists, the most common being at risk of overdoing activity (n=4, 18%) through returning to work early (n=1), keen to return to heavy work/weight training (n=1), tendency to overdo exercise (n=1), and diagnosis of post-traumatic stress disorder, using training as a coping strategy (n=1). Other reasons included: care with neural mobilisations as assessment of SLR exacerbated pain for 4 days, previous trauma and orthopaedic surgery of left hip and right foot, and normal precautions. There was no relationship between STarT Back and the physiotherapist's evaluation of caution (50% of those evaluated as requiring caution were evaluated as low risk).
Physiotherapy diagnosis
Table 4 details the physiotherapy diagnoses grouped according to the nature of the diagnosis.
Participants' problems
Treating physiotherapists highlighted a total of 154 problems (mean 5.36, SD 2.63). Those categorised as STarT Back not at low risk, and those evaluated as requiring caution by physiotherapists presented with a greater number of problems. Patients with a greater number of problems required more treatment sessions (table 5).
The identified clinical problems were detailed within the framework of the 1:1 physiotherapy intervention (table 6). The most common problem was reduced trunk stabilisation.
The treatments employed by physiotherapists to manage the identified problem are detailed in online supplementary file S2. As treatment progressed, only one participant was documented with a problem of not responding/condition deteriorating/experiencing complications. This participant was not initially identified as requiring caution, but did present with the highest number of problems (n=9) and STarT Back not at low risk. Reduced progress/plateau in improvement was identified as a problem for 4 patients (n=2 were STarT Back not at low risk and n=1 had a problem of impaired recovery owing to psychological factors). Only two participants were evaluated as having a problem of psychological factors affecting recovery.
supplementary file
Number of treatment sessions
The mean (SD) number of treatment sessions was 3.14 (1.16), range of 1–6 (figure 2). No participant required the maximum of eight sessions. Table 7 illustrates that participants classified as STarT Back not at low risk, and participants requiring caution required a greater number of treatment sessions.
Participants demonstrated 100% adherence at 12 weeks, although the nature of adherence did vary and was affected by factors that included their motivation. Some participants reported exercising three times per day and others 'as able to' around other activities such as work or gym. Participants provided reasons for reducing their exercises including: pain, increasing other activities such as golf and walking, cycling, or returning to work; but also increasing exercises, for example, exercising in response to days of increased pain.
Patient outcome data
Table 8 details the patient outcome data at baseline and at 12 weeks after completion of the optimised intervention.
For the primary outcome measure the RMDQ, sensitivity to change was assessed at 12 weeks with mean (SD) change −6.18 (5.59), 95% CI −9.01 to −3.30 for the individualised 1:1 physiotherapy outpatient intervention. Full data and statistical analysis is reported elsewhere.16
Patient discharge data
Of the treating physiotherapists who included their assessment of the patient's status at discharge (n=12), all felt that the patient had improved. The data highlights that n=3 patients required further care (see online supplementary file S3).
supplementary file
The mean duration of symptoms prior to surgery of 68 months is substantial and illustrates the chronic nature of patients. Their clinical presentation was characteristic of disc problems affecting the nerve roots with all patients presenting with pain and the majority with leg pain (93%); most accompanied with paraesthesia and numbness. The mean age of participants of 44 years emphasises the importance of returning to work/function. The demographic profile closely resembles the populations in existing clinical trials,3 ,12 and wider UK data.4
At 4 weeks post surgery (optimal intervention timing)3 ,12 in the subacute stage of healing, participants were characterised by moderate disability (mean RMDQ 10.52), and although pain was of overall low severity, most still required analgesia. There was considerable variability in disability (range 0–23, SD 5.94) highlighting heterogeneity of this population. While the median GPE of 2 and high health related quality of life scores reflected considerable improvement from surgery, participants did present with high kinesiophobia. The mean TAMPA of 40.48 (SD 6.47) was ≥37, the recommended cut-off.28 This may reflect a lack of confidence in returning to function following surgery. In contrast, the mean (SD) FABQ activity score of 13.15 (4.52) and FABQ work of 19.96 (11.15) were not elevated according to preliminary data regarding cut-off scores.29 ,30 These differences are interesting as some overlap between these two measures in a chronic LBP population is proposed, and a strong relationship exists between disability and increased FABQ.31
Use of STarT Back suggested that at baseline, 55% of participants required physiotherapy; being evaluated not at low risk of poor outcome. Physiotherapy evaluation designated other patients as requiring caution in their management, and others with multiple problems that were not detected using STarT Back. Leg pain—a question on STarT Back is the main indicator for lumbar discectomy and so this may have affected the data, reflecting an obvious limitation of STarT Back in this population. Interestingly, five of seven patients who did not attend for physiotherapy were classified as low risk of poor outcome which may have informed their decision not to attend. This is the first time the STarT Back tool has been used in secondary care with post operative patients, as previous secondary care studies excluded post operative patients23 or included a broad range of conditions.24 ,26 The STarT Back tool has less predictive ability in secondary care but its performance equals alternative measures.26 Overall, STarT Back may therefore be useful in combination with other factors to inform decisions regarding patients that require more than minimal physiotherapy intervention. This merits further investigation to explore potential stratification of this population.
Physiotherapist clinical reasoning
Diagnosis and caution
Physiotherapists used a range of diagnostic categories following their assessment of patients, with most focused on the surgical procedure, distinguishing discectomy, microdiscectomy and level of procedure; reflecting a biomedical approach. The most common levels were low lumbar specifically L4,5,S1. Physiotherapists designated n=8 participants as requiring caution, the main reason being a risk of overdoing activity at a time when tissues are still healing; and this evaluation did not reflect STarT Back. This does suggest, unsurprisingly that STarT Back is not focused on all relevant issues for this population, and that the intervention framework facilitated further discrimination between patients.
Participants' problems
The mean of 5.36 (SD 2.63) problems highlighted the substantive issues still experienced by participants 4 weeks following surgery. The higher number of problems was consistent with the physiotherapist reasoning around caution and STarT Back not at low risk. The nature of the identified problems reflected the chronicity and complexity of patients undergoing surgery, and therefore the requirement of intervention to support their ability to self-manage. The nature of problems reflected a focus on function with the key issues being muscle strength, range of movement, general conditioning and fitness.
Physiotherapy treatment
Clarity of a framework for the intervention15 perhaps contributed to a consistent approach to physiotherapy management that did not reflect previously identified variability.11 Treatments reflected an emphasis on education, advice and progressing activity and function, with the use of manual therapy, specific exercises, and general exercise interventions. Reduced neural mobility was identified as a problem for n=10 participants but few specific treatment interventions were implemented; suggesting that neural symptoms resolved through other interventions/time. There was an emphasis on progression of management, for example, exercises for an individual, but not the emphasis on high intensity exercises within the literature;3 ,12 perhaps limited by the exclusion of exercise class interventions in this study. Psychological issues were only identified for n=2 participants and so psychologically informed interventions were not widely used (cognitive–behavioural approaches, pacing or goal setting). This suggests that physiotherapists were happy using education, advice and other interventions to address kinesiophobia. The number of physiotherapy sessions ranging 1–6 was not reflective of the UK survey of 1–20 sessions perhaps reflecting a change in more recent practice.11 The physiotherapists reasoned that participants with a greater number of problems, or in situations where caution was required, needed a greater number of sessions.
Outcome data
The data demonstrate that participants improved in most outcomes by 12 weeks. In particular, the return to work data was promising with 59% participants back at work and 65% back to usual activities by 12 weeks compared to 28% and 24% at baseline. This compares to 70% fit to return to work 12 months after surgery.7 For the RMDQ, sensitivity to change at 12 weeks was promising. These positive outcomes were reflected in the physiotherapists' discharge summaries, and physiotherapists identified that n=3 participants required further management, identifying a small number of participants who required greater intervention than the defined parameters. Although improved, an issue that requires further consideration is kinesiophobia as at 12 weeks the TAMPA remained close to the ≥37 cut-off.28
While some potentially interesting differences between participants are highlighted and areas for further investigation identified, it is difficult to draw meaningful conclusions from this data owing to the low number of participants. To reflect current practice, the nine-item STarT Back may have been more valuable to avoid reducing the tool's discriminative power.25 Although specific interventions were indicated as used, free text sections were often left unanswered thereby limited depth of information was gained. It is difficult to establish whether this represents a training issue regarding data collection, or the increasing demands placed on NHS physiotherapists. The wide inclusion of all bands of physiotherapist, with some less experienced in managing this population, may also have contributed to these issues.
These data suggest that patients present differently postlumbar discectomy and therefore require different interventions. These differences can be identified by clinical reasoning and a tool such as STarT Back, although the congruence between the two merits further consideration, and these findings merit further investigation in a larger sample. The crux of this issue is the identification and targeted treatment of patients to ensure that patients at low risk of poor outcome are not over treated and patients not at low risk of poor outcome are not under treated. This is a key issue in this climate of austerity and the move towards more resourceful healthcare, improving quality and safety, and minimising costs by avoiding unnecessary treatment.32
Claire Littleford and Christopher Bayliss, patient users. Christine Wright, who was initially the study statistician prior to retirement.
Contributors AR and PG are Senior Lecturers in physiotherapy and NH is a lecturer in physiotherapy. MC is a Professor of outcomes methodology. AC, AH and LW are clinical specialists and extended scope practitioners working in spinal surgery. AR, PG, NH, AC, AH and LW have long-standing professional interests in the rehabilitation of patients following spinal surgery, and all have a professional focus to musculoskeletal physiotherapy. AR, PG, AH and LW were responsible for the conception of the study. AR, MC, PG and NH were responsible for the design and methodology. AR, AC and NH were responsible for the data analysis. All authors have contributed to the study and have been involved in developing the content of the article. AR and AC wrote the first draft of the paper. AR has worked with all authors reworking content into subsequent drafts. All authors gave final approval of the version to be published. AR is the guarantor.
Funding Queen Elizabeth Hospital Birmingham Charity, Birmingham, UK to support the costs of developing and evaluating the intervention. Project 17-3-780.
Competing interests None declared.
Ethics approval West Midlands – Solihull Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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High net-worth individual investors are currently faced with a dilemma on allocating their portfolio between stocks, bonds and alternative investments, including commercial real estate. The stock market has roared back over the past several years with double-digit returns for most investments based on several economic factors, including confidence that President Trump's tax policies will be advantageous to investors. However, there are also portfolio managers and investors who feel the stock market may be overheated and time may be due for a correction soon, regardless of how well Trump's tax policies help the market.
As a commercial real estate professional, I have helped many high net-worth individual investors properly allocate their investment portfolio to commercial and/or investment real estate. According to many wealth management companies and portfolio managers, approximately 25 percent of an investor's portfolio should be allocated to some other type of alternative investment, including commercial real estate. Commercial real estate is a great investment product to produce cash flow or yield to an investor. Although there are many other benefits such as appreciation, hedge against inflation and depreciation, cash flow is the main reason investors seek to invest a portion of their wealth in commercial real estate. Many lower risk properties can still achieve an 8 percent or higher cash on cash return, regardless of leverage. According to the National Real Estate Investor Magazine's November/December 2017 issue, the five (5) main reasons high net-worth individuals invest in commercial real estate are listed below.
First is preservation of wealth. To most investors, not putting their capital at risk is the most important consideration when looking for investment vehicles. The cash on cash return is extremely important, but the risk of the investment must be considered in order to get a return of your investment. The most popular Investor of all time, Warrant Buffet, said the number 1 rule of investing is "Don't Lose Money". The second rule is "Remember Rule Number 1". This is a lesson not easily learned in the commercial real estate industry. High leverage from investors in the economic meltdown of 2008 caused many high net-worth investors to lose some or all of their equity in many projects.
Second is income or cash flow. As mentioned previously, one of the distinct advantages of commercial real estate is this investment vehicle is meant to provide cash flow. Appreciation is great, but most Investors look to commercial real estate to provide steady cash flow which comes from the property's tenants. This is not always the case with other alternative investments and/or the stock market where returns are primarily measured by growth and appreciation.
Third is asset growth and appreciation. Most markets in the U.S. have been on the rise since the great economic recession. Properties in these markets have experienced rental rate growth, which leads to an increase of net operating income (NOI) and appreciation. In addition, interest rates have been the lowest in U.S. history, which has caused cap rate compression. This has greatly affection asset growth and appreciation and many investors have capitalized on this sharp increase in valuations by selling to private equity and institutional investors. Others have held onto their investments and enjoying the high rate of returns from locking into fixed rate mortgages.
Fourth is tax purposes. If there is one thing I have learned after being in the CRE industry for over 20 years is that any person who buys real estate solely for tax purposes will probably lose. However, investment real estate does have tax advantages that other forms of investments do not enjoy, such as depreciation and interest deduction and the ability to transfer taxable gains via a 1031 tax deferred exchange. When purchasing CRE on basic fundamentals, the tax advantages offered for CRE help to boost the overall rate of return to the investor. However, commercial real estate should not be purchased for tax purposes alone.
Fifth is estate planning. Estate planning is usually something that most high net-worth investors don't consider until they are in their late 50s or early 60s and usually at the point their kids or family members are not interested in becoming a part of the business. However, these investors have been able to build up a sizeable portfolio and enough equity to create generational wealth and the dilemma is trying to figure out whether the current portfolio is the right kind of investment to pass to the next generation. Sometimes transferring these investments into more passive and/or predictable income streams is ideal and can be done using 1031 Exchanges, which allows all taxable gain to be transferred into another CRE investment.
Overall, there will continue to be a shift to commercial real estate as a part of most net high worth portfolio. If done correctly, this can increase cash flow to the investor and spread the risk profile among several types of investment vehicles. Although the most popular property types for HNWIs are multifamily, industrial and medical office, respectively; there are countless other types of CRE investment properties that may be best to fit the HNWIs investment criteria and long range goals.
» BRIAN E. ESTES is president and investment advisor with the Estes Group and can be reached at email@example.com.
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(BOURBON, MO) - Imperial Headwear has been named the Official Headwear of the prestigious Solheim Cup that will be taking place Sept. 18-20 at St. Leon-Rot Golf Club near Heidelberg, Germany.
This biennial, trans-Atlantic team match-play competition matches the best U.S.-born players from the Ladies Professional Golf Association (LPGA) Tour and the best European members from the Ladies European Tour (LET).
The U.S. squad holds an 8-5 lead in the series, which began in 1990, and is coming off back-to-back losses (2011, 2013) for the first time in history. Juli Inkster is captain of the U.S. Team, while Sweden's Carin Koch leads the European squad.
"From an event perspective, it doesn't get any bigger than the Solheim Cup in ladies professional golf," says Darren Schubert, events manager at Imperial Headwear. "We are truly honored to have the best players in the world wearing Imperial during competition."
For further information, visit imperialsports.com, www.solheimcup.com, www.lpga.com and www.solheimcupeurope.com.


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|Denard Span crossing home plate off his solo home run in the first inning.
Last night certainly started out great at Nats' Park. The second pitch to Denard Span in the first inning and he hits a home run.
That was the scoring highlight for the Nats. Tanner Roark pitched really well. He allowed just two runs over six innings. Chances for scoring came. The bases were loaded in the second and well I think the Post put it best:
The Nationals threatened to expand their lead in the second, but poor execution and unfortunate timing stymied them. Ian Desmond and Tyler Moore started the inning with singles. After Espinosa popped up, Simon walked Nate McLouth to load the bases with one out. To the plate came Roark. Keeping the bat on his shoulder would have been the optimal strategy. Instead, he dribbled a grounder to second with two strikes, and the Reds turned an inning-ending double play.
They got close again in the eighth. Span was up again and hit the ball to left. It was originally called a catch by the Red's Billy Hamilton's diving effort. The Nats challenged and, after review, the call was overturned. Span got as far a third but no one could get him home. The final score was 2-1.
The night show cased the things the Nats can do very well. But also showing the problems that beset them at this time too.
On personal note the guys that sat behind us talked the entire game. Well one guy in particular just could not shut up and did indeed talk the entire game. I learned all sorts of things that were going on in his life that I had absolutely no interesting in knowing. What a blessed relief when during the rain delay they went and got food but unfortunately they came back when played resumed.
Yes, it was a frustrating night.


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Vacancy - A job opening which is offered by a company that wants to hire an employee. An available room in a hotel.
Vacancy Rate - The percentage of unoccupied rental space or units, e.g hotel rooms, compared to total available rental area at a given time.
Vanity Publishing - The author pays the publisher.
Valid - Legally or formally acceptable or binding. Unexpired, e.g. a passport.
Value-Added Reseller - VAR. A company which purchases a product and modifies or enhances it before reselling it to the consumer. This practice is common in the computer industry.
Value Engineering - In manufacturing, a method of producing a product at the lowest price but without sacrificing quality, safety, etc., and at the same time meeting the customers needs.
Valued Policy - An insurance policy in which the insurer agrees to pay a claim for a specified amount in the event of loss, damage, etc., for items insured, such as works of art.
Value Investor - An investor who buys shares, etc., which they believe to be underpriced, in order to make a profit by selling them when they price rises.
Value Share - A share, etc., which is considered to be underpriced and is therefore a good investment prospect.
Vanilla - Plain and ordinary without any extras. Basic.
Vapourware - Term used to describe computer software which is advertised before it has been, and may never be, developed, often to damage sales of a competitor's product which has already been launched.
Variable Cost - In business, costs which vary according to the changes in activity, production, etc. of the company, such as overheads, labour and material costs.
VAT - Value Added Tax. A tax paid by consumers which is added to the price of certain goods and services.
VDU - Visual/Video Display Unit. A computer screen or monitor which displays text and/or pictures.
Vendee - A person or business who buys goods, property, etc.,
Vendor - A person or business who sells goods, property, etc.
Venture Capital - Money invested in a new business which is expected to make a lot of profit but which also involves considerable risk.
Verbal Judo - The use of voice tone and body language to diffuse a potentially aggressive or violent situation without being confrontational. Described as Tactical Communications, Verbal Judo was developed in 1983 by American literary professor, martial arts expert and later serving policeman, Dr George ('Doc Rhino') Thompson, initially for the US police. Verbal Judo has since become a more widely applicable training program for handling conflict for all sectors, alongside the popularity of Thompson's books, notably Verbal Judo (1993) and the Verbal Judo Institute.
Vertical Disintegration - A situation in which a company that previously produced parts and materials is now buying them from other suppliers.
Vertical Equity - A concept of economic fairness, for example people who are better off should contribute more taxes than those who are less well off.
Vertical Integration - A situation in which a company acquires one or more of the companies which are involved in the production or distribution processes of its goods/services, for example a brewer which buys a pub chain, or a clothing retailer which buys a knitwear factory.
Vertical Market/Vertical Sector - or vertical market sector - Often shortened to 'vertical' - this refers to an industrial activity or trade comprising producers, manufacturers, makers, providers and users, etc - basically the supply chain or all the linked purchasers - of the same products/services, for example media, coal production, healthcare, automotive, education, retail, etc. Imagine a bar chart in which each vertical bar is an industry; or imagine a series of vertical lines, each one connecting suppliers and customers in a supply chain for a single industry. A sub-section of a vertical market sector, such as car magazines (within the media vertical), or private schools (within education), or shoe-shops (within retail) is typically called a niche or a niche market. Often used with the term Horizontal Sector, these two structural ways (vertical and horizontal) of viewing the entire market-place form a matrix. The nature of this matrix and the horizontal and vertical sectors within it mean that every niche (for example office cleaning services, or a manufacturer of nuts and bolts, or dentistry practices, or anything else you might imagine) is both a part of a vertical sector and a horizontal sector. The application of 'vertical' or 'horizontal' terminology depends often on the situation and context, and especially who is selling/marketing what to whom, (or who is acquiring whom). For example a supplier of IT services which is selling to the automotive vertical would refer, again for example, to 'vertical marketing'; to the 'vertical market'; the automotive 'vertical', etc. A supplier of IT services which sells to finance departments across several verticals (i.e., industries, e.g., automotive, media, local government, education, etc) would instead refer to selling or marketing 'horizontally' (to different verticals), and having a 'horizontal' strategy. And to illustrate the switchable nature of the matrix, an automotive supplier which sells/markets to IT organizations would refer to the IT 'vertical market', as would any other seller targeting the IT 'vertical'. (N.B. I have mentioned 'education' and 'local government' above, which are wholly/largely/partly considered as state/public services activities. Traditionally such sectors are not regarded as involved in marketing or selling, but actually increasingly such 'providers' can easily be represented as sellers or marketers or providers of products/services, albeit in a figurative sense. As such it is perfectly possible and reasonable to show such sectors as being sellers/providers of products/services to vertical sectors and even to horizontal sectors, should the need arise; and we should expect over time for the nature of horizontal/vertical marketing terminology - and other marketing terminology - to become increasingly widely applicable and inclusive. Every type of organization is both a 'supplier' and a 'customer' of some sort.)
Vested Interest - When an individual, business or group has a special interest in something, such as property, an activity, etc., from which there is a personal or financial gain.
Veto - Latin for 'I Forbid'. To vote against. The right to block a law, etc.
Vexatious Litigant - A person or party who regularly brings unsustainable lawsuits against another party in order to harass or annoy them.
Viable - Capable of being done or working successfully.
Vicarious Liability - Having legal responsibility for the actions of another, e.g. the liabilty of an organisation for the actions of its employees.
Vigorish - A slang term, also abbreviated to vig, for the commission or fee charged by a bookmaker or casino on a wager. Also the interest on a loan from a loan shark or unregulated loan provider. The term is Yiddish (Jewish) deriving from the Russian word vyigrysh, meaning winnings.
Viral Marketing - Also known as Word Of Mouth. An advertising and marketing technique which encourages people to pass on information about a product, etc., often by e-mail or from one Internet website to another.
Virtual Memory - On a computer, a technique of simulating additional memory by moving data between the computers memory and a hard disk.
Virtual Reality - An artificial three-dimentional (3-D) image or experience, created by a computer, and which seems real to the person looking at it.
Virus - A computer program with a hidden code, designed to infect a computer without the owners knowledge, and which causes harm to the computer or destroys data, etc.
Vocation - An occupation for which a person is strongly suited and/or to which they are dedicated.
Vocational - Relating to an occupation for which a person has undergone special training or has special skills.
Voice-Over - A presenter or actor in a TV commercial or program who is heard but who is not seen on the screen.
Voice Recognition - Technology which allows computers, mobile phones, etc., to be operated by being spoken to.
Void - A contract, agreement, document, etc., which is no longer valid or legal.
Voluntary Bankruptcy - A situation in which a debtor voluntary files for bankruptcy because they cannot pay their creditors.
Voluntary Liquidation - A situation where the owners/directors of a solvent company decide to cease business, sell the company's assets and pay all the creditors.
Vote Of No Confidence - A vote which shows that the majority of those voting have lost confidence in something, usually a government.
Voting Shares - Called Voting Stock in the US. A company share which gives the shareholder the right to vote on matters regarding company policy, etc.
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© Businessballs 2009-2014


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As a Senior Associate of DeSimone's Miami office, Michael Cuevas is responsible for providing expert forensic structural analysis as part of the firm's Forensics Practice.
Mr. Cuevas has over 20 years of experience in the field of forensics and has provided expert forensic analysis of buildings and structures damaged by fires, wind, floods, storm surges, explosions, tree impacts, vehicle impacts, freezing temperatures, moisture intrusion, and construction defects including catastrophe responses.
Mr. Cuevas is a licensed Professional Engineer in the states of Connecticut, Massachusetts, Rhode Island, New York, Pennsylvania, and Texas. He also earned his Master of Engineering degree in Structural Engineering from Rensselaer Polytechnic Institute, and his Bachelor of Science in Civil Engineering from the University of Hartford.


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Luxury Bridal Expo
As noted on the Australian Bridal Service's Luxury Bridal Expo website, "spectacular" fashion shows to be seen, it was sure from my front row experience a spectacular fashion show today indeed! I arrived a bit earlier then when the doors were opened at this particular bridal expo and fashion show and anxiously waited for this exciting event, mainly to come early to get a good view of the first repeated fashion show of the day. The successful Luxury Bridal Expo have been going for some time now and it was my first time to attend such an Australian Bridal Service event. With beautiful clothing from grooms' menswear, bridal dresses, bridesmaids' dresses and much more to be offered, the fashion show is something not to be missed. This expo goes on for two days but started today. Don't miss out tomorrow's full day of fashion shows and lots of interesting things to see for the wedding enthusiast, engaged couple and so on.
The professional commentary over the fashion show was something that's not very common during fashion shows but, should be more present during fashion shows as it adds a pinch of professionalism to it, which from my personal experience, I enjoyed.
Everlasting Bridal Couture By Ping
Disney Fairytale Weddings By Alfred Angelo
Spurling Bridal and Formalwear
Hayley Paige & Tara Keely
Make-up Mode
Hair Styling:
VH Hair
Alan Pinkus
If you do end up using photos, please do not remove the watermark and tag my instagram @suzannedang OR public figure page, Suzanne Dang - thank you!


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Arguably the largest collection of Arabian wildlife in the world, discover the amazing diversity of indigenous fauna found on the Arabian Peninsula.
Arabia's Wildlife Centre is one of the best places in the world to see the critically endangered Arabian leopard. It showcases the diversity of fauna found in Sharjah, with a reptile and insect house, indoor aviary and large outdoor enclosures for oryx, cheetahs and flamingos.
The centre is located 30km east of Sharjah city. It is part of the Sharjah Desert Park, which also houses botanical gardens, a natural history museum and a children's farm.
You can wander through the free-flying aviary and observe most animals in air-conditioned comfort from behind large glass panels. There is also a café and picnic facilities in the grounds.


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In a special show, Mack talks with Sharon Weinberger, author of the best-selling, "The Imagineers of War – the Untold Story of DARPA." This little-known military agency invented the Internet, Stealth fighters, precision weapons, Siri…as well as a mechanical elephant, a rubber airplane and a combat helmet that would allow soldiers to read minds. Also, Mack is interviewed about what goes on behind-the-scenes with the MMMX-Files gang and why the origin of the show is still classified. Special Guest: Steve Ward.
Mack, Juan-Juan & Switch talk to Dr. Louis Turi about his work in Astropsychology and his UFO abduction experiences. Long-time super-fan & pilot LJ Lilliman calls in to talk about her unopened collection of Wingman books. Ella the Psychic guesses what Switch, Security Chief Willy Clubb and Pistol Pete look like just by hearing their voices. Switch reports on people seeing strange things in the sky that aren't UFOS.
Mack, Cobra & Switch talk with producer Gary Shoefield about the Alien Autopsy movie, his hit pop-star hologram shows and his son, Luke Brandon Field, who stars in the Oscar-winning movie, Jojo Rabbit. Also, LA publicist Heather Burgett on her grandfather's miraculous final bombing mission in a B-17 and what it's like to be visited by a ghost. Plus, Switch reports on a remote viewing experiment that found ancient structures on Mars.
In a special show, Mack, Juan-Juan, Cobra & Switch talk to authors Marc Cushman (Star Wars) and John Jackson Miller (Star Trek) about which iconic franchise is more awesome. Also, Switch with a new Report from the Fringe and Ella the Psychic tries to guess what Switch, Pistol Pete & Willy Clubb look like just by hearing their voices.
In a special show, Mack, Juan-Juan, Cobra & Switch welcome empath Valerie Lafaso to the Distant Thunder studios. Switchy talks about a UFO found with only dead people aboard. Rev. Matt Silberman & his wife Tanya reveal the many levels of universal consciousness and why it's unwise to counsel an 800-pound exotic dancer. Also, 10 Questions for Juan-Juan. Special guest: Meaghan Reagan.
Mack, Juan-Juan, Cobra & Switch talk about the U.S. Navy's famous Tic-Tac UFO video and why it might have been cooked up by the Pentagon itself. UFO writer and researcher Karyn Dolan surprises Juan-Juan on the air. A preview of the new "Mack After Dark" segment plus 10 questions for JJ. Special guest: Meaghan Reagan.
In a highly requested show, Mack, Juan-Juan & Switchblade Steve talk to Experiencer Barbara With about her encounters with a man who could make anchors float. Also -- Cindy Bailey Dove on the world's most frightening drone. Switchblade Steve with a bizarre Men in Black episode. Plus, Ten Questions for Juan-Juan and Week 2 of the Big Mack Trivia contest. Special guest: Meaghan Reagan.
In one of the most controversial MMMX episodes ever, Mack, Juan-Juan, Agent X and Switchblade Steve moderate a no-holds-barred discussion between CIA agent Jason Hanson and the mysterious Sandy Zhang who may or may not be a Chinese government spy. Special guests: Pistol Pete, Nurse Kayla & Meaghan Reagan.
Mack, Juan-Juan, Commander Cobra & Switchblade Steve discuss the wave of mysterious airship sightings in the late 1800s and early 1900s. UK correspondent Ross Sharp reports on the Scareships of Britain. Also, Ten Questions for Juan-Juan, What's New in Paranormal TV shows, plus Mack & Juan-Juan talk about a strange encounter with a shadowy person who may have been a government agent. Special guests: Agent X and Meaghan Reagan.
In a special show, Mack, Juan-Juan, Cobra & Switch talk with famous Hollywood author Gary Olsen about the Top Ten angel movies of all time and how many have a military connection. Also, Cindy Bailey Dove on mysterious drones spotted over Colorado. Special guests: Nurse Kayla and show security chief, Willy Clubb.
Mack, Juan-Juan and Switchy talk about a variety of military X-files including the Pentagon's robot elephant, the plan to burn down half of Vietnam and one military scientist's dream to put a net over the entire United States. Plus, Lois Lane returns to remind Mack to plug his new book. Also, 10 Doomsday Questions for Juan-Juan and a tease for "Mack After Dark," the soon-to-come 3rd hour of the MMMX podcast. Special Guest: Meaghan Reagan.
Mack & Juan-Juan ring in the New Year with one of the show's most requested re-broadcasts. Author Ani Anderson explains how a single word can change a person's existence. Rock star/UFO author Merrell Fankhauser calls in with an update on his search for the Lost Continent of Mu. Switchblade Steve tells the story of what went wrong with America's nuclear-powered bomber. Special guest: Agent X.


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News & Events
Awards and Achievements
ALERT Researchers Awarded Patent May 29, 2019
May 29, 2019
ALERT researchers, Professor Carey Rappaport and Professor Jose Martinez-Lorenzo of Northeastern University were awarded a patent for an "On-the-Move Millimeter Wave Interrogation System with a Hallway of Multiple Transmitters and Receivers" on May 21, 2019.
In conventional screening systems that use radar imaging for surveillance and detection purposes, an object of interest may be illuminated (using millimeter wave) and the scattered field measured and processed to reconstruct a feature of the object. These systems may generate an image that profiles a detectable shape, outline and/or movement of an object or subject; however, conventional radar systems, such as a portal-based system, constrains a subject from movement. Professor Rappaport and Professor Martinez-Lorenzo's patented solution allows for screening an unconstrained subject, meaning an individual could be scanned for foreign objects attached to their bodies (such as explosives and weapons hidden under clothing) as they moved through a hallway of transmitters and receivers. Such a system could lead to faster and more accurate screening of individuals as they make their way through security checkpoints.
Read more about the "On-the-Move Millimeter Wave Interrogation System with a Hallway of Multiple Transmitters and Receivers" patent here.
To learn more about the work Professor Rappaport and Professor Martinez-Lorenzo are doing to make screening for explosives and weapons more effective and efficient, visit their respective project pages: Projects R3-A.2 and R3-A.3, and Project R3-B.1.
Infographic: ALERT's Year 5 (2017-2018) Accomplishments January 29, 2019
January 29, 2019
As we begin the New Year, we are also looking back on the previous year! Check out our newest infographic on ALERT's Year 5 (2017-2018) Accomplishments.
ALERT Researchers Selected as IEEE Fellows January 29, 2019
January 29, 2019
Please join us in congratulating the newly elevated IEEE Fellows for the Class of 2019! We are especially proud of ALERT researchers Mario Sznaier of Northeastern University, and David Castañón and Venkatesh Saligrama of Boston University for this significant achievement. IEEE Fellow is a distinction reserved for select IEEE members whose extraordinary accomplishments in any of the IEEE fields of interest are deemed fitting of this prestigious grade elevation. The total number selected in any one year does not exceed one-tenth of one percent of the total voting IEEE membership.
Mario Sznaier is a Northeastern University ECE Professor and co-leads ALERT Project R4-A.1. Sznaier has been elevated to an IEEE Fellow for his contributions to identification of switched systems and multiobjective control. His work on Project R4-A.1 aims to substantially enhance our ability to exploit surveillance camera networks to predict and isolate threats from explosive devices in heavily crowded public spaces, and to guide complementary detection modalities, subsequent to a threat alert.
David Castañón and Venkatesh Saligrama are Boston University ECE Professors and collaborators on ALERT Project R4-A.2. Castañón has been elevated to an IEEE Fellow for his contributions to discrete-time stochastic control and information fusion. Saligrama has been elevated to an IEEE Fellow for his contributions to distributed detection and estimation of structured signals. Their work on Project R4-A.2 aims to leverage machine learning and computer vision methods for surveillance over multi-camera networks and to develop methods that are capable of real-time and forensic detection of suspicious activity.
ALERT Awarded Two New Task Orders November 29, 2018
Maturation and Validation of Dielectric Characterization Algorithms Task Order
ALERT has received a task order contract from the Department of Homeland Security (DHS) Science & Technology Directorate (S&T) to mature and operationalize the Advanced Imaging Technology material characterization (complex dielectric constant) algorithms being developed in ALERT Projects R3-A.2 and R3-B.1, led by ALERT Researchers, Dr. Carey Rappaport and Dr. Jose Martinez-Lorenzo of Northeastern University, respectively.
The task order, known as the "Maturation and Validation of Dielectric Characterization Algorithms," will allow ALERT to use DHS owned images captured originally for the DHS S&T/TSA "Passenger Screening Algorithm Challenge." The data for this prize competition was originally captured on the Apex Screening at Speed (SaS) High Definition – Advanced Imaging Technology (HD-AIT) laboratory prototype designed by Pacific Northwest National Lab. These images are available in several different file formats, including raw reflectivity formats. The data also includes ground truth information including relative body zone and materials for objects of interest. In the future, this data set may be augmented with additional images from future data collections. The end state for this development is an operationally functioning algorithm that is able to:
- Integrate with provided open file formats to add material characterization capabilities to existing Automatic Threat Recognition (ATR) algorithms;
- Demonstrate performance improvements (namely false alarm rate reduction while maintaining probability of detection) over current ATR algorithms;
- Run in near-real time, almost suitable for an operational environment; and
- Provide TSO-friendly output that will classify a foreign object into one of three categories (unlikely to be explosive, possible explosive threat, and undetermined).
Correlation of Luggage and Specific Passengers (CLASP) Algorithm Maturation and Deployment Task Order
ALERT has also received a DHS S&T task order contract, titled "Correlation of Luggage and Specific Passengers (CLASP) Algorithm Maturation and Deployment," to mature algorithms developed under the ALERT CLASP Program so that the passenger-baggage tracking capability is sufficiently robust to support operational pilots and to support risk-based screening in an airport environment. DHS S&T has a variety of projects supporting the development of next-generation aviation security capabilities as a part of its Apex Screening at Speed (SaS) Program. Under the Apex SaS Program, passenger and carry-on screening requirements have necessitated adoption of a risk-based screening approach to the aviation checkpoint. In support of these risk-based screening requirements, the Apex SaS Program seeks to develop video analytics algorithms capable of associating passengers and their carry-on items as they travel through the airport checkpoint. Combined with existing TSA technologies, these algorithms will enable risk-based screening to occur on a per passenger and per item basis, improving screening efficiency and increasing overall passenger throughput. As a secondary benefit, effective video analytics will be able to identify thefts or items left behind at the checkpoint.
DHS S&T is seeking the following from the ALERT CLASP Algorithms project to further meet the needs of the Apex SaS Program:
- Algorithms capable of associating passengers and their carry-on items as they traverse the airport checkpoint that are robust to variations in lighting, passenger density, glare, camera angles, etc;
- Requirements and best practices for algorithm deployment in an operational environment (recommended hardware, configurations, etc.); and
- Algorithms capable of leveraging passenger/bag association information to identify actions at the checkpoint (such as interaction with scanning equipment, item theft, or items left behind).
ALERT Researchers Awarded Best Paper at 2018 ICDSC Conference September 27, 2018
September 27, 2018
Dr. Octavia Camps (Project R4-A.1; Northeastern University), Dr. Richard Radke (Project R4-A.3; Rensselaer Polytechnic Institute), and their research team received the Best Paper Award at the 2018 International Conference on Distributed Smart Cameras (ICDSC) in Eindhoven, Netherlands on September 3-4, 2018.
The paper, titled "Correlating Belongings with Passengers in a Simulated Airport Security Checkpoint," is co-authored by Ashraful Islam, Yuexi Zhang, Dong Yin, Octavia Camps and Richard Radke. The research for this paper was done using data collected for CLASP (Correlating Luggage and Specific Passengers) project at ALERT's Video Analytics Lab located at the Kostas Research Institute for Homeland Security at Northeastern University.
According to the paper's abstract, "Automatic algorithms for tracking and associating passengers and their divested objects at an airport security screening checkpoint would have great potential for improving checkpoint efficiency, including flow analysis, theft detection, line-of-sight maintenance, and risk-based screening. In this paper, we present algorithms for these tracking and association problems and demonstrate their effectiveness in a full-scale physical simulation of an airport security screening checkpoint. Our algorithms leverage both hand-crafted and deep-learning-based approaches for passenger and bin tracking, and are able to accurately track and associate objects through a ceiling-mounted multi-camera array. We validate our algorithm on ground-truthed datasets collected at the simulated checkpoint that reflect natural passenger behavior, achieving high rates of passenger/object/transfer event detection while maintaining low false alarm and mismatch rates."
Click here to read the paper and learn more about this research.
2018 DHS COE Summit Facilitates Collaboration and Advances DHS Mission July 31, 2018
ALERT, along with other current and emeritus DHS Centers of Excellence (COEs), hosted the 2018 Centers of Excellence Summit in Arlington, Virginia on May 30-31, 2018. The event focused on the topic of "University Research and Development to Protect the Homeland." The DHS COE Summit provided the Centers of Excellence an opportunity to showcase their innovative solutions to homeland security challenges and facilitate collaboration across homeland security enterprise leadership and component end-users and industry participants. According to ALERT Center Director, Michael B. Silevitch,
"One of the most valuable aspects of the Summit was the teamwork needed to pull it together. It required a concerted effort by all of the COEs to organize and orchestrate the event. Going forward, this teamwork will lead to meaningful cross-center collaboration."
The agenda for the two-day long summit was launched with a keynote address from Christopher C. Krebs, Senior Official Performing the Duties of Under Secretary, National Protection and Programs Directorate (NPPD) and included talks by various security administrators, panel discussions, student posters, and a technology showcase.
Director Silevitch moderated a panel focused on "Transportation and Critical Infrastructure" on the first day of the summit. Panelists Carl Crawford, Eva Lee, David Nicol, and Detlof VonWinterfeldt addressed four questions related to this topic:
- What are some of the grand challenges that need to be addressed to enable the next generation of Homeland Security transportation and critical infrastructure solutions?
- What research needs to be done in order to address these challenges?
- How can the research outcomes be effectively transitioned to the field?
- What metrics can be used to enable a cost-benefit analysis of the research/transition impact?
ALERT's Transition Team made connections with end users at the technology showcase and featured some of ALERT's latest solutions in multi-view air cargo CT scanners, effective personnel screening, video tracking at the airport security checkpoint, and K9 explosives training aids.
COEs excel in advancing the state of the art thanks in large part to their student researchers. To acknowledge this, the summit provided students with the opportunity to present their work to attendees. Katherine Graham, one of ALERT's talented undergraduate researchers, took home the Best Poster Award for her work on "Compressive Reflector Antennas for High-Sensing Capacity Imaging Applications." These antenna designs provide a less complex and lower cost solution for high-sensing capacity millimeter wave imaging systems. Millimeter wave imaging systems have the potential for use in several near-field imaging applications such as security screening, non-destructive testing, autonomous driving, and biotechnology. The abstracts for the COE Summit student posters are available for download on the COE Summit 2018 website.
The summit provided an all-hands-on-deck approach to addressing homeland security challenges by bringing together some of the nation's best academic, public, and private sector leaders to discuss strategies for advancing the mission of the Department of Homeland Security. ALERT looks forward to the next DHS COE Summit, and hopes you will join us there!
ALERT Research Highlight: The Largest and Most Systematic Re-id Benchmark to Date May 30, 2018
May 30, 2018
ALERT researchers Professor Octavia Camps (Northeastern University, Project R4-A.1) and Professor Rich Radke (Rensselaer Polytechnic Institute, Project R4-A.3) and their students, Srikrishna Karanam, Mengran Gou, Ziyan Wu, and Angels Rates-Borras, were recently published in the Institute of Electrical and Electronics Engineers' (IEEE) monthly journal, Transactions on Pattern Analysis and Machine Intelligence (download here). The paper, "A Systematic Evaluation and Benchmark for Person Re-Identification: Features, Metrics, and Datasets," provides an extensive review and performance evaluation of existing person re-identification algorithms.
Person identification, or re-id, matches observations of individuals across multiple camera views in a network of surveillance cameras, and represents a critical task in most surveillance and security applications. For example, a law enforcement officer may want to automatically follow a person of interest tagged at a check-in counter through the branching concourses of an airport. The research team's recent review and evaluation of re-id algorithms helps characterize what re-id algorithms are currently capable of accomplishing, as well as what is missing and what is possible in the future. In this paper, the researchers discuss insights gained from their study, as well as put forth research directions and recommendations for re-id researchers that would help develop better algorithms in the future. Both Professor Camps and Professor Radke are involved with ALERT's Research Thrust 4, which focuses on video surveillance and the analysis of video data with novel algorithms. This publication was the result of years of research and collaboration between their respective labs.
The fundamental re-id problem is to compare a person of interest as seen in a "probe" camera view to a "gallery" of candidates captured from a camera that does not overlap with the probe camera. If a true match to the probe exists in the gallery, it should have a high matching score, or rank, compared to incorrect candidates. Since the body of research in re-id is increasing, researchers can begin to draw conclusions about the best combinations of algorithmic subcomponents. In this paper, the researchers present a careful, fair, and systematic evaluation of feature extraction, metric learning, and multi-shot ranking algorithms proposed for re-id on a wide variety of benchmark datasets. Their general evaluation framework considers hundreds of combinations of feature extraction and metric learning algorithms for single-shot and multi-shot datasets.
The research team evaluated 276 algorithm combinations on 10 single-shot re-id datasets and 646 algorithm combinations on 7 multi-shot re-id datasets, making the proposed study the largest and most systematic re-id benchmark to date. Approaches were evaluated using 17 datasets that mimic real world settings, including the ALERT Airport Re-Identification Dataset. As part of the evaluation, the researchers built a public code library with an easy-to-use input/output code structure and uniform algorithm parameters that includes 11 contemporary feature extraction and 22 metric learning and ranking algorithms. Both the code library and the complete benchmark results are publicly available for community use.
Student Researchers Selected for ALERT Professional Development Award November 27, 2017
November 27, 2017
Three ALERT student researchers have been selected to receive the first ALERT Professional Development Award in November 2017. The winners are Qi Feng, a Ph.D. student working with Prof. Stan Sclaroff at Boston University; Ashraful Islam, a Ph.D. student working with Prof. Richard Radke at Rensselaer Polytechnic Institute; and Abubakar Siddique, a Ph.D. student working with Prof. Henry Medeiros at Marquette University.
The ALERT Professional Development Award is intended to encourage ALERT students to participate in professional development activities throughout the year and to facilitate their future participation in networking and career development opportunities. ALERT selects up to three students each year to win a $1,500 stipend that can be used towards attendance at a professional or academic conference and/or to visit and collaborate with a lab related to their ALERT research project. This year, applications were accepted August through October 2017. More information about next year's award cycle is forthcoming.
Rappaport Delivers IEEE Distinguished Lectures in Australia and New Zealand November 27, 2017
November 27, 2017
ALERT Deputy Director and Northeastern University Electrical and Computer Engineering Distinguished Professor, Carey Rappaport, delivered three IEEE Distinguished Lectures in Australia and New Zealand earlier this month. The IEEE Antennas and Propagation Society (AP-S) selected Professor Rappaport as a Distinguished Lecturer for 2017-2019. The IEEE AP-S Distinguished Lecturer Program sends experts, the Distinguished Lecturers, to visit active IEEE AP-S Chapters around the world and give talks on topics of interest and importance to the Antennas and Propagation community. Professor Rappaport gave the following talks during his recent visit to Australia and New Zealand:
- "Electromagnetic Sensing and Treatment of Living Things: Using Microwaves to Detect and Treat Disease in Humans and Trees" (Melbourne, Australia)
- "A High Gain Toroidal Reflector Antenna for Multistatic 3D Whole Body Millimeter-Wave Imaging" (Queenstown, New Zealand)
- "Multifocal Bootlace Lens Design Concepts" (Sydney, Australia)
On the value of being an IEEE Distinguished Lecturer, Professor Rappaport states, "The IEEE Distinguished Lecturer Program supports one of the fundamental precepts of academic research: extending the dissemination of knowledge and cutting-edge discovery to as wide an audience as possible. In presenting my team's engineering work around the world, I have been able to help engineers extend their scientific awareness beyond their traditional themes, and occasionally outside their comfort zones. Although the travel commitment is time-consuming, it has been a great opportunity to meet people and exchange technical ideas." Professor Rappaport will be delivering another IEEE Distinguished Lecture in January 2018 to the IEEE AP-S chapter in Orlando, Florida.
Professor Rappaport has been a Northeastern University faculty member since 1987, becoming a full professor in Electrical and Computer Engineering in July 2000, and receiving an appointment as a College of Engineering Distinguished Professor in 2011. Professor Rappaport has written over 400 technical journal articles and conference papers on various topics, including electromagnetic wave propagation and scattering computation, microwave antenna design, and bioelectromagnetics. He has also received two reflector antenna patents, two biomedical device patents, and four subsurface sensing device patents.
Student Spotlight: Elizabeth Wig September 27, 2017
Congratulations to Elizabeth Wig, a Northeastern University (NU) Electrical Engineering undergraduate conducting ALERT research, for receiving the Society of Women Engineers GE Women's Network Scholarship! Elizabeth will receive this award, which comes with a $5,000 stipend, in October 2017 at the SWE Annual Conference in Austin, Texas. Elizabeth has been working with ALERT R3 Thrust Leader, Professor Carey Rappaport since Summer 2016, conducting research on "Computational Models & Algorithms for Millimeter Wave Whole Body Scanning for AIT," in collaboration with Smiths Detection (Project R3-A.2). When asked how Elizabeth got involved with the project so early on in her undergraduate career, she explained that she met Professor Rappaport at a NU-sponsored ski event and found out about his research while riding up the mountain on a chairlift. However, Elizabeth explained that her interest in this research began much earlier, "When my high school physics class did its electricity and magnetism unit, the symmetry was strikingly beautiful. I loved the way relatively few equations could describe so much of what makes up our world, from why sunrises are so beautiful to the way molecules hold together to Wi-Fi." The aspect of her research that she is most passionate about is math, and learning about the different ways mathematics can be used to describe and explain our world. This fits in well with her role on the project, which involves developing the model used to detect and characterize potential explosives threats and eliminate false alarms using a millimeter-wave body scanner. She has been working to make and refine the model to improve the accuracy in characterization.
Beyond her recent award, Elizabeth has also published a paper on her work with Mahdiar Sadeghi, a Northeastern graduate student, and Professor Rappaport, and is currently working on her second paper. She and Mahdiar were also asked to present their work at the ADSA15 (Advanced Development for Security Applications) Workshop in November 2016.
Elizabeth has already gained valuable work experience through her Spring 2017 co-op position at Draper Laboratories in Cambridge, MA. There she worked on electrical engineering projects in their Sensors and Imaging Systems group. As for her future career, she hopes to continue her education and complete a Ph.D. program, and if possible, get the opportunity to travel more internationally and work with NASA!
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Xmas Box
Send Xmas Gift Box to Kids in Refugee Camps.
Every year we want to send Xmas Gift Box to Kids in Refugee Camps. This year around Easter we want to send Gifts to Refugee Kids at Kasenyi Refugee Camp in Masisi – Congo.. We also want to give them hope that as Jesus resurrected so He resurrected with them meaning that their plight will soon be over. By donating to this campaign you are putting a smile on the faces of the most vulnerable kids.
Partner with us and become a member so that we make this dream come true for the kids of refugee families


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Introduction of SZS Series Double Drum Gas/Oil Fired Steam Boiler: SZS series oil and gas fired boiler is also known as packaged water tube steam boiler or Vibrating grate/traveling grate boiler, with double drums and D-type layout.It is an ideal environmental protection product with high efficiency, low energy consumption and less pollution which will play an important role in the applicationGet a Quote
2019-4-8 · SZS series oil and gas fired boiler is a packaged water tube boiler with double drums and D-type layout. Burning oil and gas, this boiler has lower emission of carbon dioxide, NOx (nitrous oxide), SOx (sulfur dioxide) than coal fuels. As an ideal environmental protection product, it obtains approval from government and factories with high efficiency, low energy consumption and less pollution.Get a Quote
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D-type fully automatic oil & gas fired boiler is an advanced high-tech complete boiler system which includes auxiliaries, such as instruments, burner, heat exchanger and control. The boiler has a D-type layout, double drums and a longitudinal layout.Get a Quote
2017-7-22 · fire-return,fire-tube boiler … SZS type Package Fuel Oil(gas) Steam Boiler. hot water heating boiler, steam boiler,SZS gas fired boiler,gas & oil … SZS series oil and gas fired boiler is a packaged water tube boiler with double … D-type Double-Drum style …Get a Quote
2016-3-8 · boiler solutions for commercial and industrial applications. D Type Water tube Boiler The SZS is a modern D-type water tube boiler design, with gas tight membrane wall construction for all furnace walls including the front wall to maximise heat transfer. Tube manipulations for burner and man door penetration maintains optimum circulation.Get a Quote
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D-type fully automatic oil & gas fired boiler is an advanced high-tech complete boiler system which includes auxiliaries, such as instruments, burner, heat exchanger and control. The boiler has a D-type layout, double drums and a longitudinal layout.Get a Quote
2019-8-30 · SZS series gas steam boiler is designed and engineered with D-type arrangement, natural recycling, double-drum water tube boiler. Our SZS series gas steam boiler has the characteristics of compact structure, high burning efficiency, longitudinal drum, full membrane wall structure and slightly positive pressure combustion.Get a Quote
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Clarence Primary School
Designed by LEON C | CPS Computer Room
Each week a group of learners attend the Youth Press Team as their extra mural. It is here with Mrs S. Omarjee that they discuss matters that are affecting the youth of South Africa such as drugs, bullying and the spread of Aids.
This year, Clarence Primary School decided to take part in the Aids-Free Generation campaign headed by iSchool Africa. Each week they've learnt the facts about the virus, they've watched videos to help them understand the stigma behind it, as well as learnt how to change their attitude towards other people with HIV so that they can become a change-maker in South Africa and lead the way towards an Aids Free Generation.
Once we understood the concept we created a 3 minute video to showcase our understanding towards this goal. This video was entered into the Youth Press category in the Apple in Education awards that is held each year. We are proud to announce that this video was shortlisted into the top 15 videos in the country. That in itself was a huge achievement as we were up against High schools and other primary school across South Africa.
iSchool Press Teams along with PEPFAR sponsored the Clarence Primary Youth Press Team along with Mrs S. Omarjee to fly up to Johannesburg on the 26th of October, attend the prestigious awards in Melrose Arch, stay over for the night and return to Durban the following day. The Youth Press Team went on to win in the Most Original and most Powerful Story Category. Each learner won an ipod.
The video was "#blessedwithoutablesser
We so Proud of our Press Team


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Click here for a quick week-at-a-glance view of new television content to meet the needs of students at home.
Click here for additional educational resources that align with the programming. #LearnAtHome
Click here for a quick week-at-a-glance view of new television content to meet the needs of students at home.
Click here for additional educational resources that align with the programming. #LearnAtHome
This morning, women's head basketball coach, Bob Boldon announced it has added Marwan Miller to its coaching staff for the 2016-2017 season. "We are very excited to bring Marwan back to Ohio," Boldon said. Miller served last year as an offensive coordinator at Saint Francis (Pa.) and lead The Red Flash to an average of 74.5 point… Read More
Redshirt freshman Kelly Karlis was named to Women's Basketball Academic All-Mid American Conference team on Wednesday. The Academic All-MAC honor is for student-athletes who have excelled in athletics as well as academics. All those named must have a minimum cumulative GPA of 3.20 and have participated in at least half of the contests for the sport… Read More
Ohio (26-6) is one of the 16 teams remaining in the Women's National Invitation Tournament after defeating ACC foe Virginia Tech (18-14) 64-57 Sunday afternoon. Virginia Tech was very ineffective in the first quarter of play. The Hokies tried to implement a flex zone. Ohio found gaps in that zone and attacked the paint scoring… Read More
In the first ever Women's National Invitational Tournament visit for Ohio Women's basketball (25-6) the 'Cats defeat the Marshall Thundering Herd (21-12), 76-68, to claim their first postseason victory in school history. In the early portion the 'Cats owned the Thundering Herd on the defensive side of the basketball. Their offense was not too shabby… Read More
Ohio University Women's basketball team hosts their first game in the WNIT on Thursday. The Bobcats will take on Marshall for the first round in the Convocation Center at 7 pm. The last time the two teams faced off was in 2011 where Ohio took the win, 68-56. This is the first WNIT appearance for… Read More
The Buffalo Bulls tripped up Ohio for third time this season winning the MAC Tournament quarterfinal matcup 72-60 Wednesday. Through most of the first three quarters, the game was back and fourth, but that all changed as the Bulls completely outplayed the Bobcats from the halfway point in the third until the end of the game. Buffalo was… Read More
Four Bobcats found their names on the MAC's all-conference teams, as senior Lexie Baldwin, senior Kiyanna Black, junior Quiera Lampkins, and junior Jasmine Weatherspoon all received honors. Black earned a spot on the All-MAC first team for the second year in a row. She was third in the MAC in scoring, averaging 18.4 points per game. The… Read More
Ohio finished their spectacular regular season spoiling Miami's (OH) senior night with a 77-58 victory. Even though games are technically won in the fourth quarter, Ohio won this one in the first. The 'Cats started off hot, starting the game on an 8-0 run and found themselves up 24-7 going into the second quarter. Every quarter… Read More
It seemed like just another day at the office for the Ohio Bobcats (22-4, 14-1) as they dominated the Kent State Golden Flashes (5-20, 2-13) 86-52. The 'Cats drove the lane early and often, attacking the basket the entire night en route to 44 points in the paint. Hannah Boesinger finished with a season-high 15 points thanks… Read More


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In my project I use MultiSpectral Optoacoustic Tomography (MSOT) to measure blood oxygenation in the tumour in vivo. Both spatial and temporal changes in oxygenation can give us insight into the oxygen delivery and consumption by the cancer cells, which can be very valuable to monitor tumour development and response to treatment.
Brief CV
- MPhys Mathematical Physics, University of Edinburgh (2010-2014)
Publication Highlights
Best conference attended so far
WMIC Philadelphia 2017


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BSQL Hacker v0.9 Beta Release
This is beta release for BSQL Hacker GUI/Console v0.9
Developed in in VS 2008, GPL. Enjoy and send your comments, bugs etc.
Console Version Manual
BSQL Hacker Console Manual
this is not latest and totally finished but you need it to use console version
BSQL Hacker Beta v0.9 Binaries
BSQL Hacker Beta v0.9 Source Code
This post will be updated with more information...


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Mrs.Frances Ann Seckler Jestes, 60, of Chapel Hill, NC went home to be with God on August 14th, 2011 after a courageous fight with melanoma cancer at Beacon Place in Greensboro. Born June 25th, 1951 in Guilford County, Ann was the oldest of four daughters of William Francis Seckler and Grace Ann Seckler. She attended High Point City Schools and obtained an education degree from Appalachian State University. Ann began her career teaching middle school in Davidson County and then taught at Horton Middle School in Chatham County until her health declined. Teaching was one of Ann's greatest passions and she was well loved by her coworkers and the many students whose lives she touched. She enjoyed gardening, antique shopping, dancing and her many cats.
Ann is survived by her husband, Roger Clinton Jestes of 27 years, her daughter, Rebekah Anne Jestes, her grandchildren, Michael Clinton Whitt, Anna Alexis Jestes and Alexander Lee Carroll, all of Chapel Hill. She is also survived by her parents, Bill and Grace Ann Seckler of High Point and her three sisters, Susan Gordon Ross of Matthews, NC, Kathy Weekly Joe of High Point and Julie Goff Frank of Gladys, VA along with many nieces and nephews.
A memorial service to celebrate the life of Ann Seckler Jestes will be held at the Hall-Wynne Funeral Home, 396 West Street, Pittsboro, NC on Thursday, August 18th, 2011 at 3:00pm. The family requests that memorials be made to the American Cancer Society and Greensboro Hospice, Beacon Place.
Arrangements are under the care of Hall-Wynne Funeral Service, Pittsboro. Online Condolences at www.hallwynne.com.


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Christmas Tree Disposal
Until January 13, 2020
Christmas Tree drop off site:
20th Street & 47 Ave / St. John's Ambulance Lot
Residents of the City of Vernon, District of Coldstream, and B.X. are invited to take their Christmas trees to the drop-off site located at 47th Ave and 20th Street in the vacant lot next to St. John's Ambulance, up to January 13, 2020.
Christmas Trees will not be picked up with your residential refuse. No plastic bags or other debris is to be left at the site. Christmas trees can also be taken to Regional landfills free of charge until the end of January 2020.
For further information, please call 250 549-6757.
The program is advertised in the local paper to make the citizens of Vernon aware of the location and dates of this service.


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Telegraph Park Pond - ACA Fish Stocking (D3-108)
Site Details
This pond is bordered by Highway 617, Highway 21, and RR 215. The access road runs south off Highway 617, southeast of Hay Lakes. ACA annually stocks this pond with rainbow, brown, and brook trout, typically before the May long weekend.
Refer to the latest edition of Alberta Guide to Sportfishing Regulations.
Alberta Conservation Association, Alberta Environment and Parks, Village of Hay Lakes
Quarter Sections
Make sure you have the latest Hunting and Sportfishing Regulations.


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Madison police officers recognized for helping family
Family said it escaped shootings in Chicago
MADISON, Wis. — Two Madison police officers are being recognized for their efforts to help a homeless family found on State Street.
A downtown patrol officer noticed a pile of blankets and some belongings in the 200 block of State Street Sunday morning and was called back to the site a short time later when a man said he heard a baby crying. The officer said she found four adults and six children huddled together under the blanket.
The extended family included a 5-month-old, a 9-year-old and a 13-year-old.
The adults told the officer they escaped shootings in the Englewood neighborhood on Chicago's south side. They told the officer it was just too dangerous to stay.
The officer said the family appeared to have been living on the streets for a couple of weeks.
She and another officer started contacting organizations to help the family and found three churches, First United Methodist, Second Baptist, and Community of Hope UCC, to help with food or money for short term hotel stays.
The officers supplied them with a few items donated to the MPD for those times when officers encounter people in crisis: stuffed animals, blankets and books.
A MPD sergeant, who assisted in the move from the streets, said one of the group's adult men "was choked up and had difficulty expressing himself. Clearly his gratitude was overwhelming," he said.
The sergeant submitted a performance recognition report commending the officers for showing compassion and empathy.
"They could have checked the welfare of the children and left; the day was warming and no further threat. They did not. They made sure that this family was provided reprieve from the unpleasant reality their current situation has provided," the statement read.
Members of the family are seeking or have found work.


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Synopsis: An American family find themselves under attack by their doppelgangers while on vacation.
Director: Jordan Peele
Runtime: 116 minutes
MPAA Rating: R
IMDb: 6.9/10 Rotten Tomatoes: 93%
Netflix (US): No
Tags: Home Invasion, Mystery
Jump Scares: 11 (0 major, 11 minor)
Jump Scare Rating: There are jump scares in Us although they are minor and far less intrusive than one might expect from a modern home invasion horror movie. Most of the jump scares occur in the middle of the movie between the 40 and 90 minute mark.
Show Descriptions
Jump Scare Times
6:47 – After a girl enters the Vision Quest building, a mechanical owl jumps out at her.
18:15 – Jason, wearing a mask, jumps out at Zora in the bathroom.
27:38 – A Frisbee whizzes past Adelaide and Kitty as they talk on the beach.
40:12 – There are several loud bangs on the door.
40:47 – A masked person pops up outside the window beside Zora.
43:51 – There is a loud crash as a boy crawls out from behind Zora, Jason, and Adelaide.
1:02:36 – After Jason runs to Adelaide, his doppelganger suddenly appears in the hallway behind him.
1:20:50 – Adelaide grabs a saucepan and swings around to attack one of the doppelganger twins who jumps on her.
1:23:05 – The Zora doppelganger breaks through the sun roof.
1:24:25 – The doppelganger girl reaches out towards Adelaide as she searches for her in the bushes.
1:31:11 – The mechanical owl jumps out at Adelaide as she enters the house of mirrors.
Download a .srt file of the jump scares in Us [more info].