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Chapter 10: Pertussis
Manual for the Surveillance of Vaccine-Preventable Diseases
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Authors: Amanda Faulkner, MPH; Tami Skoff, MS; Stacey Martin, MSc; Pam Cassiday, MS; Maria Lucia Tondella, PhD; Jennifer Liang, DVM, MPVM
Disease Description
Pertussis, a more commonly known as whooping cough, is a contagious, respiratory disease caused by the bacterium Bordetella pertussis. The illness is characterized by a prolonged paroxysmal cough, which is often accompanied by an inspiratory whoop. Disease presentation varies with age and history of previous exposure or vaccination. Young infants may present to a clinic or hospital with apnea and no other disease symptoms. Adults and adolescents with some immunity may exhibit only mild symptoms or have the typical prolonged paroxysmal cough. In all persons, cough can continue for months.
Pertussis rarely causes severe complications among healthy, vaccinated persons. Infants, however, are at greatest risk for pertussis-related complications and mortality. Pneumonia is the most common complication in all age groups; seizures and encephalopathy generally occur only among very young infants. Death is infrequent and most likely to occur in unvaccinated infants, although fatalities are occasionally reported among older children and adults with serious underlying health conditions.[1]
In addition to B. pertussis, three other Bordetella species can cause disease in humans: B. parapertussis, B. holmesii, and B. bronchiseptica. B. parapertussis cause a pertussis-like illness that is generally milder than pertussis, likely because the bacteria do not produce pertussis toxin. Co-infection of B. pertussis and B. parapertussis is not unusual. Disease attributable to Bordetella species other than B. pertussis is not reportable to CDC.
In the pre-vaccine era, pertussis was a common childhood disease and a major cause of child and infant mortality in the United States. Routine childhood vaccination led to a reduction in disease incidence from an average of 150 reported cases per 100,000 persons between 1922 and 1940, to 0.5 per 100,000 in 1976.[2]The incidence of reported pertussis began increasing in the 1980s, however, and significant peaks in disease have been observed in recent years. In 2012, 48,277 cases were reported nationwide, exceeding levels observed since 1955. Reported pertussis cases decreased during 2013 to 28,639; however, levels remain significantly increased compared to those observed during the 1990s and early 2000s. Multiple factors have likely contributed to the increase including heightened provider and public awareness, improved diagnostic testing, waning immunity from acellular pertussis vaccines, and possibly molecular changes within the pertussis bacterium. The incidence of pertussis remains highest among young infants. In 2013, all pertussis-related deaths (n=13) reported to CDC were among infants less than 6 months of age, who were too young to have received three doses of DTaP vaccine. As of 2013, the second highest incidence of pertussis was observed among school-aged children and adolescents, and the proportion of cases in this age group appears to be increasing.[3-5]
Importance of Rapid Case Identification
Early diagnosis and treatment of pertussis might limit its spread to other susceptible people. When pertussis is strongly suspected, attempts to identify and provide prophylaxis to household and other close contacts at high risk should proceed without waiting for laboratory confirmation. When suspicion of pertussis is low, the investigation can be delayed until there is laboratory confirmation of the diagnosis. However, prophylaxis of pregnant women and infants, as well as their household contacts, should not be delayed.
Importance of Surveillance
Surveillance data collected through case investigations are used to assess impact of disease and monitor changes in epidemiology over time. Surveillance data are also used to guide public health policy and development of control strategies. CDC uses surveillance data to monitor national trends in pertussis and identify populations at risk. Local and state health departments use surveillance data to identify clusters of related cases that might indicate an outbreak.
Laboratory surveillance to monitor changes in the B. pertussis organism is also important. Isolates of B. pertussis collected through routine surveillance have provided researchers with the resources necessary to identify changes in the bacterium, including recent changes in the organism at the molecular level.[6-8] This information is vital to our understanding of the evolution of B. pertussis and how those changes may impact our current pertussis vaccination program and other prevention strategies. See Section VII, "Laboratory Testing" for more details.
Disease Reduction Goals
A disease reduction goal of 2,500 indigenous pertussis cases per year in children <1 year of age, and 2,000 cases per year among adolescents 11 to 18 years of age was proposed as a part of the Healthy People 2020 project.[9] In 2013, 4051 cases were reported among infants less than 1 year of age, while more than 7,000 cases were observed among adolescents 11 to 18 years of age.[5]Top of Page
Case Definitions
The following case definition for pertussis was approved by the Council of State and Territorial Epidemiologists (CSTE) in June 2013 and went into effect January 1, 2014.[10]
Clinical case definition
In the absence of a more likely diagnosis a cough illness lasting ≥ 2 weeks with one of the following symptoms:
- Paroxysms of coughing, OR
- Inspiratory "whoop," OR
- Posttussive vomiting, OR
- Apnea (with or without cyanosis) (FOR INFANTS AGED < 1 YEAR ONLY)
Laboratory criteria for diagnosis
- Isolation of B. pertussis from a clinical specimen
- Positive polymerase chain reaction (PCR) assay for B. pertussis DNA
Epidemiologic Linkage
- Contact with a laboratory-confirmed case of pertussis†*.
Case classification
- Meets the clinical case definition, is not laboratory confirmed, and is not epidemiologically linked to a laboratory-confirmed case OR
- Acute cough illness of any duration with at least one of the following signs or symptoms:
- Paroxysms of coughing, OR
- Inspiratory "whoop", OR
- Posttussive vomiting, OR
- Apnea (with or without cyanosis)
- Polymerase chain reaction (PCR) positive for pertussis, OR
- Acute cough illness of any duration with at least one of the following signs or symptoms:
- Acute cough illness of any duration with at least one of the following signs or symptoms:
- Paroxysms of coughing, OR
- Inspiratory "whoop", OR
- Posttussive vomiting, OR
- Apnea (with or without cyanosis)
- Contact with a laboratory-confirmed case of pertussis
- Acute cough illness of any duration with at least one of the following signs or symptoms:
- Acute cough illness of any duration with isolation of B. pertussis from a clinical specimen,OR
- Meets the clinical case definition AND is polymerase chain reaction (PCR) positive for pertussis, OR
- Meets the clinical case definition AND had contact with a case laboratory-confirmed case of pertussis
Case Classification Comments:
*Note: An illness meeting the clinical case definition should be classified as "probable" rather than "confirmed" if it occurs in a patient who has contact with an infant aged < 1 year who is polymerase chain reaction (PCR) positive for pertussis and has ≥ 1 sign or symptom and cough duration < 14 days (classified as "probable" case).
†To confirm a case by epidemiologic linkage, the case must be directly linked (i.e., a first-generation contact) to a laboratory-confirmed case by either culture or PCR.[10]
Collection of epidemiologic and clinical data is essential for reporting cases that meet the clinical case definition. Investigators should make every attempt to collect information on paroxysms of cough, whoop, posttussive vomiting, and duration of cough as these variables are required to determine whether an individual meets the clinical case definition for pertussis. When feasible, case investigations initiated shortly after cough onset should include follow-up calls to collect information on cough duration. Follow-up should be done regardless of confirmatory test results so that cases meeting the clinical case definition can be reported. Both probable and confirmed pertussis cases should be reported to the National Notifiable Diseases Surveillance System (NNDSS) by the state health department via the National Electronic Telecommunications System for Surveillance (NETSS) or National Electronic Disease Surveillance System (NEDSS).
Laboratory confirmation of pertussis is important because other pathogens can cause symptoms similar to pertussis. Culture of B. pertussis is the most specific diagnostic test; all patients with cough and a positive B. pertussis culture should be reported as confirmed, even those with cough lasting less than 14 days. PCR is less specific than culture; cases confirmed with only a positive PCR must meet the clinical case definition to be reported as confirmed.
Laboratory Testing
Determining who has pertussis and who does not is often difficult. Whenever possible, a nasopharyngeal swab or aspirate should be obtained from all persons with suspected pertussis. A properly obtained nasopharyngeal swab or aspirate is essential for optimal laboratory diagnosis. Health department personnel and other healthcare practitioners that are asked to obtain these specimens should receive training and supervision from persons experienced in collection of nasopharyngeal specimens. CDC has developed two short training videos for collection of nasopharyngeal aspirate and swab specimens, which can be accessed on the CDC pertussis web site.[21]
Isolation of B. pertussis by bacterial culture remains the gold standard for diagnosing pertussis. A positive culture for B. pertussis confirms the diagnosis of pertussis. Culture of the organism is also necessary for antimicrobial susceptibility testing and molecular typing.
Although bacterial culture is specific for diagnosis, it is relatively insensitive. Fastidious growth requirements make B. pertussis difficult to isolate. Isolation of the organism using direct plating is most successful during the catarrhal stage (i.e., first 1-2 weeks of cough). Success in isolating the organism declines if the patient has received prior antibiotic therapy effective against B. pertussis, if specimen collection has been delayed beyond the first 2 weeks of illness, and if the patient has been vaccinated.
All persons with suspected cases of pertussis should have a nasopharyngeal aspirate or swab obtained from the posterior nasopharynx for culture. For B. pertussis, nasopharyngeal aspirates will yield similar or higher rates of recovery than nasopharyngeal swabs;[11-14] throat and anterior nasal swabs yield unacceptably low rates of recovery.[15] Therefore, specimens should be obtained from the posterior nasopharynx (Figure 1), not the throat. Specimens should be obtained using polyester, rayon, nylon, or calcium alginate (not cotton) swabs and should be plated directly onto selective culture medium or placed in transport medium. Regan-Lowe agar or freshly prepared Bordet-Gengou medium is generally used for culture; half-strength Regan-Lowe should be used as the transport medium. Specimens should be transported on cold packs and plated at the laboratory within 24 hours.
Polymerase chain reaction for B. pertussis DNA
Polymerase Chain Reaction (PCR) is an important tool for timely diagnosis of pertussis and is increasingly available to clinicians. PCR is a molecular technique used to detect DNA sequences of the Bordetella pertussis bacterium, and unlike culture, does not require viable (live) bacteria present in the specimen.[16, 17]
Despite these advantages, PCR can give results that are falsely-negative or falsely-positive. PCR results can be optimized by avoiding some of the more common pitfalls leading to inaccurate results. Although early signs and symptoms of pertussis are often non-specific, only patients with signs and symptoms consistent with pertussis should be tested. Asymptomatic contacts of confirmed cases should not be tested and testing of contacts should not be used for post-exposure prophylaxis decisions. Falsely-positive results may also occur as a result of specimen contamination, which can occur during specimen collection and testing.[18] The timing of PCR testing for pertussis can significantly affect its ability to accurately diagnose the disease. PCR has optimal sensitivity during the first 3 weeks of cough when bacterial DNA is still present in the nasopharynx. After the fourth week of cough, the amount of bacterial DNA rapidly diminishes, which increases the risk of obtaining falsely-negative results.
Since its inclusion in the case definition in 1997, the proportion of cases confirmed by PCR has increased substantially, and many laboratories now use only PCR to confirm pertussis. However, as of March 2014, there are no standardized PCR assays for pertussis, and assay procedures, as well as sensitivity and specificity, can vary greatly between laboratories. Thus, interpretation criteria for diagnosis vary. Interpretation of PCR results, especially those with high cycle threshold (Ct) values should be done in conjunction with an evaluation of signs and symptoms and available epidemiological information. For more information about interpretation of PCR Ct values, see Best Practices for Health Care Professionals on the use of Polymerase Chain Reaction (PCR) for Diagnosing Pertussis, which is located on the CDC Pertussis Web site.[19]
While PCR is increasingly used as the sole diagnostic test for pertussis, CDC recommends that PCR be used in conjunction with culture when feasible, rather than as an alternative test. Even when a laboratory has validated its PCR method, culturing for B. pertussis should continue; this is especially important to confirm the circulation of B. pertussis when an outbreak is suspected. State laboratories should retain the capability to culture pertussis.
Collection methods for PCR are similar to those for culture, and often the same sample can be used for both tests. However, calcium alginate swabs cannot be used to collect nasopharyngeal specimens for PCR. Swabs used solely for PCR (and not culture) testing may be placed in a sterile tube for transport to the laboratory. Use of liquid transport media is discouraged due to the risk of specimen contamination.
Serologic testing
Commercial serologic tests for pertussis infection can be helpful for diagnosis, especially later in illness. However, there is no commercial kit approved by the FDA for diagnostic use. Cutoff points for diagnostic values of immunoglobulin (Ig) G antibody to pertussis toxin (PT) have not been established, and current IgA and IgM assays lack adequate sensitivity and specificity. In the absence of recent immunization, an elevated serum IgG antibody to PT after 2 weeks of onset of cough is suggestive of recent B. pertussis infection. An increasing titer or a single IgG anti-PT value of approximately 100 IU/mL or greater (using standard reference sera as a comparator) can be used for diagnosis. As of December 2014, positive serology results from commercial laboratories are not confirmatory for the purpose of reporting. A single-point serologic assay has been validated at the Massachusetts state public health laboratory for persons aged 11 years or older and is used for clinical diagnosis and reporting in that state only.[20] A serologic test performed at CDC or at the Massachusetts state laboratory might be used to help investigate outbreaks. In states other than Massachusetts, cases meeting the clinical case definition that are serologically positive but not culture or PCR positive should be reported as probable cases.
Direct fluorescent antibody testing
Direct fluorescent antibody (DFA) testing of nasopharyngeal secretions is sometimes used to screen for pertussis; however, CDC no longer recommends DFA for diagnosing pertussis. Cases meeting the clinical case definition that are DFA positive but not culture or PCR positive should be reported as probable cases.
Pulsed-field gel electrophoresis
Pulsed-field gel electrophoresis (PFGE), a type of DNA fingerprinting, can be performed on B. pertussis isolates to help track transmission (e.g., strains from the same household or small community), but it is not done for routine surveillance.[21, 22]
Inquiries regarding PFGE molecular typing, erythromycin susceptibility testing, serologic testing and other B. pertussis laboratory questions should be directed to the CDC Epidemic Investigations Laboratory: Dr. M. Lucia Tondella, at 404-639-1239, or Ms. Pam Cassiday at 404-639-1231. When sending B. pertussis samples to CDC, please make appropriate arrangements with the laboratory before shipping samples to the address below.
1600 Clifton Road, NE
STAT Unit 12
Atlanta, GA 30333
Additional information on use of the laboratory for support of vaccine-preventable disease surveillance is available in Chapter 22, "Laboratory Support for Surveillance of Vaccine-Preventable Diseases."
Each state and territory has regulations or laws governing the reporting of diseases and conditions of public health importance.[22] These regulations and laws list the diseases to be reported and describe those persons or institutions responsible for reporting, including healthcare providers, hospitals, laboratories, schools, daycare and childcare facilities, and other institutions. Persons reporting should contact the state health department for state-specific reporting requirements.
Reporting to CDC
State health departments should report all probable and confirmed pertussis cases to NNDSS via the NETSS or NEDSS. When provisional information is reported to NNDSS, NETSS and NEDSS reports can be updated as additional information is collected. NETSS and NEDSS accept information about clinical symptoms, laboratory confirmation and vaccination history; this information is included in the Pertussis Surveillance Worksheet (Appendix 11)[2 pages] available for reference and use in case investigation.
Information to collect
Case investigation should include collection of the epidemiologic information listed on the CDC pertussis surveillance worksheet (See Appendix 11[2 pages]). State health departments often supplement the suggested CDC investigation questions with additional information relevant to cases in their communities
Comments on reporting
The limitations of laboratory diagnostics make the clinical case definition essential to pertussis surveillance. It is important to determine duration of cough—specifically, whether it lasts 14 days or longer—in order to determine if a person's illness meets the definition of a clinical case.
If the first interview is conducted within 14 days of cough onset and cough is still present at the time of interview, it is important to follow up at 14 days or later after onset.
Pertussis case investigation methods vary across state and local health jurisdictions and CDC is committed to helping improve standardization of surveillance practices for pertussis. Please refer to Appendix 11[4 pages] for a detailed instruction sheet describing each data element outlined in the pertussis surveillance worksheet.
The pertussis vaccines currently available in the United States are acellular pertussis antigens in combination with diphtheria and tetanus toxoids (DTaP, DTaP- combination vaccines, and Tdap).
The Advisory Committee on Immunization Practices (ACIP) recommends a four-dose primary series of DTaP, administered at 2, 4, 6 and 15-18 months of age, followed by a fifth booster dose given at 4-6 years.[24] Adolescents and adults should receive a single Tdap booster dose, preferably at ages 11-12 years.[25, 26] Tdap should be administered regardless of time since last tetanus and diphtheria-containing booster.[26] After receipt of Tdap, decennial Td booster doses are recommended. Pregnant women are recommended a dose of Tdap during each pregnancy.[27] To maximize the maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks gestation, although Tdap may be given at any time during pregnancy.[27]
ACIP also recommends:
- Aolescents and adults (e.g., parents, siblings, grandparents, childcare providers, and healthcare personnel) that have or anticipate having close contact with an infant younger than 12 months of age should receive a single dose of Tdap to protect against pertussis if they have not previously received Tdap. Ideally, these persons should receive Tdap at least 2 weeks before beginning close contact with the infant. [28]
- Healthcare personnel should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap and regardless of the time since their most recent Td vaccination. Priority should be given to vaccination of healthcare personnel that have direct contact with infants 12 months of age and younger.[29]
Table 1 lists vaccines likely to appear in case-patients' vaccination histories. Immunization Information Systems, provider records, and parents are the best sources of this information.
Table 1. Pertussis-containing vaccines.
|Pertussis-Containing Vaccines for Children
|Licensed Date and Used For
|First licensed in 1991; used for all childhood doses
|Used for the fourth dose only
|Used for the first three doses
|Approved in 2008; used for primary four-dose series
|Approved in 2008; used for booster dose at 4-6 years
|Pertussis-Containing Vaccines for Adolescents and Adults
|Licensed Date
|First available in 2005
|Other Vaccines
|Licensed Date
|Do not contain pertussis; DT used for primary series when pertussis vaccination was not desired; Td used in persons aged ≥7 years
Enhancing Surveillance
A number of surveillance activities can improve detection and reporting of cases as well as the completeness and accuracy of the case report form information reported. In addition to those outlined below, Chapter 19, "Enhancing Surveillance," lists activities that might be applicable to pertussis surveillance.
Assuring appropriate diagnostic testing for pertussis is being performed
Because no single laboratory test is sufficient for diagnosing pertussis, it is important that available diagnostic tests are used appropriately. To ensure pertussis diagnosis and reporting is optimized, reporting jurisdictions should assess the timing of diagnostic testing relative to cough onset for case-patients identified through routine surveillance. Bacterial culture for pertussis is most useful during the first two weeks of cough and prior to antibiotic use. PCR may effectively diagnose pertussis from 2-4 weeks of cough, and appropriate serologic assays are most useful in the 2-8 weeks following cough onset. Inappropriate diagnostic testing may result in both false-positive and false-negative results, reducing the overall quality of pertussis diagnosis, and ultimately, pertussis surveillance.
Optimal Timing in Weeks for Diagnostic Testing
Unlike many other vaccine-preventable diseases of childhood, pertussis remains endemic in the United States. Cases are expected to occur in all communities; a period of several years in which no cases are reported from a jurisdiction likely reflects failures to diagnose and/or report disease rather than an absence of disease. The level of diagnostic testing being undertaken can be evaluated by reviewing the number of pertussis diagnostic tests (e.g., cultures or PCR results) submitted by a jurisdiction.
Monitoring surveillance indicators
Regular monitoring of surveillance indicators might identify specific areas of the surveillance and reporting system that need improvement. Some suggested surveillance indicators to monitor include:
- Completeness of key data elements collected during pertussis case investigations. Information on clinical presentation, antibiotic treatment, vaccination history, and epidemiologic data are of particular importance and should be collected to the fullest extent possible.
- The proportion of cases reported among infants, children, adolescents, and adults. Jurisdictions with reported pertussis cases heavily weighted toward infants are likely missing a significant proportion of pertussis disease in their community.
- The proportion of cases diagnosed solely with DFA or serologic assays. A high proportion of non-confirmatory laboratory testing for pertussis may be an indication of the need for increased education and promotion of proper pertussis diagnostic testing practices.
- The median interval between onset of cough and notification of state or local public health authorities in probable and confirmed cases.
Expanding Pertussis Data Collection
CDC has partnered with seven states (CO, CT, GA, MN, NM, NY, and OR) participating in the Emerging Infections Program (EIP) Network to conduct enhanced surveillance of pertussis (EPS) and other Bordetella species. EPS is characterized by enhanced case ascertainment and augmented data collection that goes beyond what is requested nationally through NNDSS. Participating sites collect isolates and specimens, when available, for further characterization at the CDC Pertussis and Diphtheria Laboratory. EPS sites also provide the infrastructure for conducting pertussis special studies including those aimed at evaluating pertussis prevention and control strategies.
Other states interested in collecting additional pertussis surveillance information may consider adding the following data elements that are not included currently on the national pertussis surveillance worksheet:
- Cyanosis (Did case-patient experience cyanosis during his/her pertussis infection?)
- Healthcare personnel status (Was case-patient employed as healthcare personnel during his/her pertussis infection?)
- Pregnancy status of female case-patient at cough onset (Was case-patient pregnant or post-partum at time of cough onset?)
- For case-patients <1 year of age:
- Mother's Tdap vaccination history (Did mother receive Tdap prior to, during, or after her pregnancy with the infant case-patient?)
- Gestational age (in weeks)
Case Investigation
Case investigations generally include reviews of laboratory, hospital, clinic records, and immunization registries, which are the best sources for information about diagnoses and immunization histories. Investigations also include interviews of case-patients, which are necessary to identify sources of infections and contacts at risk. Investigations can include treatment of case-patients and chemoprophylaxis and or vaccination of contacts.
Treatment and chemoprophylaxis
Antimicrobial treatment does not generally lessen the severity of disease unless it is begun in the catarrhal phase, prior to paroxysmal coughing.[25] Treatment reduces transmission and is essential for disease control. The spread of pertussis can be limited by decreasing the infectivity of the patient and by protecting close contacts.[26] Persons with pertussis are infectious from the beginning of the catarrhal stage through the third week after the onset of paroxysms or until 5 days after the start of effective antimicrobial treatment. The recommended antimicrobial agents and doses are the same for treatment and chemoprophylaxis.[27]
Three macrolides are recommended by CDC for treatment of pertussis. Azithromycin is most popular because it is given in a short, simple regimen of one dose each day for 5 days. It is the preferred antimicrobial for use in infants younger than 1 month of age. Similarly, the regimen of two doses a day for 7 days makes clarithromycin another well-accepted choice. Erythromycin, which is given as four doses each day for 14 days, continues to be used, but adherence to the regimen and completion of the course are generally lower than for the other macrolides, and adverse effects (gastrointestinal distress, pyloric stenosis, etc.) occur more frequently. Resistance of B. pertussis to macrolides is rare, and antimicrobial susceptibility testing is not routinely recommended. Testing is appropriate in some circumstances and is recommended when treatment failure is suspected. Refer to Section VII, "Laboratory Testing" for information on how to contact the CDC Pertussis Laboratory to discuss susceptibility testing. If resistance to macrolides is suspected or if their use is contraindicated, CDC recommends treatment with trimethoprim-sulfamethoxazole (TMP-SMZ) in a regimen of two doses a day for 14 days. TMP-SMZ should not be used to treat infants younger than 2 months of age.[27]
CDC recommends administration of chemoprophylaxis to contacts at high risk and household members of a pertussis case-patient. For more specific information on chemoprophylaxis, please see the "Outbreak Control" section of this chapter.
Limited available data suggests Bordetella parapertussis is less susceptible to antibiotics than pertussis; although some studies indicate that erythromycin, azithryomycin, clarithromycin, TMP-SMZ, and ciprofloxacin may have activity against B. parapertussis.[32-39] Because data on the clinical effectiveness of antibiotic treatment are limited, treatment decisions should be based on clinical judgment with particular attention towards special populations, including infants, elderly, and immunocompromised persons; treatment may be warranted to prevent severe outcomes and decrease duration of illness.
During the course of a pertussis investigation, under-vaccinated contacts of pertussis cases may be identified. Contacts younger than 7 years of age who have not received four doses of a pertussis vaccine should complete the series using the minimum recommended catch-up immunization schedule[4 pages].[40] Vaccination with a fifth dose of DTaP is recommended for close contacts aged 4-6 years that have only received four doses. Contacts can be vaccinated with Tdap in accordance with ACIP recommendations. Vaccination is not a substitute for chemoprophylaxis and might not prevent illness in a person who has already been infected with B. pertussis. [24], [30,31], [40,41]
Outbreak Control
Pertussis outbreaks can be difficult to identify and manage. Other respiratory pathogens often cause clinical symptoms similar to pertussis, and co-circulation with other pathogens does occur. To respond appropriately (e.g., provide appropriate prophylaxis), it is important to confirm that B. pertussis is circulating in the outbreak setting and to determine whether other pathogens are contributing to the outbreak. PCR tests vary in specificity, so obtaining culture confirmation of pertussis for at least one suspected case is recommended any time there is suspicion of a pertussis outbreak.
To reduce the risk of pertussis in new mothers and their very young infants, ACIP now recommends that pregnant women receive Tdap vaccine during each pregnancy. During outbreaks, prevention measures should focus on efforts to improve coverage with Tdap during pregnancy to reduce severe illness and possible deaths in vulnerable infants.
With increasing incidence and widespread community transmission of pertussis, extensive contact tracing and broad scale use of postexposure antimicrobial prophylaxis (PEP) among contacts may not be an effective use of limited public health resources. While antibiotics may prevent pertussis disease if given prior to symptom onset, there are no data to indicate that widespread use of PEP among contacts effectively controls or limits the scope of pertussis outbreaks. Another important consideration is the overuse of antibiotics; CDC is engaged in actively promoting the judicious use of antibiotics among healthcare providers and parents.[42] Given these considerations, CDC supports targeting PEP to persons at high risk of developing severe pertussis and to persons who will have close contact with those at high risk of developing severe pertussis.
Accordingly, CDC supports the following:
- Providing PEP to all household contacts of a pertussis case. Within families, secondary attack rates have been demonstrated to be high, even when household contacts are up-to-date with immunizations.[43] Administration of antimicrobial prophylaxis to asymptomatic household contacts within 21 days of onset of cough in the index patient can prevent symptomatic infection.
- Providing PEP to persons within 21 days of exposure to an infectious pertussis case-patient who are at high risk of severe illness. These include:
- Infants and women in their third trimester of pregnancy—severe and sometimes fatal pertussis-related complications occur in infants aged < 12 months, especially among infants < 4 months. Women in their third trimester of pregnancy may be a source of pertussis to their newborn infant.
- All persons with pre-existing health conditions that may be exacerbated by a pertussis infection (for example, but not limited to, immunocompromised persons and patients with moderate to severe medically treated asthma).
- Contacts who themselves have close contact with either infants < 12 months, pregnant women, or individuals with pre-existing health conditions at risk for severe illness or complications.
- All contacts in high risk settings that include infants aged < 12 months or women in the third trimester of pregnancy, which include but are not limited to, neonatal intensive care units, childcare settings, and maternity wards.
- A broader use of PEP in limited closed settings, when the number of identified cases is small, and when a community-wide outbreak is not ongoing; however, when continued transmission of pertussis is evident, multiple rounds of antibiotics would not be recommended. Rather than repeating a course of antibiotics, contacts should be monitored for onset of signs and symptoms of pertussis for 21 days.
Active screening for symptomatic patients with suspected pertussis can be considered during outbreaks in settings such as schools, day care centers, and hospitals. Active screening for suspected cases potentially reduces exposure to persons with pertussis, encourages timely medical evaluation and treatment of cases, and promotes prompt administration of antibiotics to high risk close contacts.[43-50]
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- Davis SF, Strebel PM, Cochi SL, Zell ER, Hadler SC. Pertussis surveillance—United States, 1989-1991. MMWR 1992;41(No. SS-8):11-19.
- CDC. Pertussis—United States, 2001-2003. MMWR 2005;54(50):1283-6.
- Guris D, Strebel PM, Bardenheier B, Brennan M, Tachdjian R, Finch E, et al. Changing epidemiology of pertussis in the United States: increasing reported incidence among adolescents and adults, 1990-1996. Clin Infect Dis 1999; 28:1230-7.
- National Notifiable Diseases Surveillance System, 1990-2013. Division of Notifiable Disease Surveillance, Public Health Surveillance Program Office, Office of Surveillance Epidemiology & Laboratory Services, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA 30333.
- Schmidtke AJ, Boney KO, Martin SW, Skoff TH, Tondella ML, Tatti KM. Population diversity among Bordetella pertussis isolates, United States, 1935-2009. Emerg Infect Dis 2012;18:1248-55.
- Pawloski LC, Queenan AM, Cassiday PK, Lynch AS, Harrison M, Shang W, et al. Prevalence and molecular characterization of pertactin-deficient Bordetella pertussis in the US. Clin Vaccin Immunol 2014;21:119-25.
- Martin SW, Pawloski L, Williams M, Weening K, DeBolt C, Qin X, et al. Pertactin-negative B. pertussis strains: evidence for a possible selective advantage. Clin Infect Dis 2014 Oct 9. [Epub ahead of print]
- U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy people 2020. Washington, DC. Accessed 2014 Dec 12.
- Council of State and Territorial Epidemiologists. CSTE Position Statement 13-ID-15: Revision of the pertussis surveillance case definition to more accurately capture the burden of disease among infants <1 year of age. CSTE, 2013[10 pages].
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- Qin X, Galanakis E, Martin ET, Englund JA. Multi-target polymerase chain reaction for diagnosis of pertussis and its clinical implications. J Clin Microbiol 2007;45:506-11.
- Mandal S, Tatti KM, Woods-Stout D, Cassiday PK, Faulkner AE, Griffith MM, et al. Pertussis pseudo-outbreak linked to specimens contaminated by Bordetella pertussis DNA from clinic surfaces. Pediatrics 2012;129:e424-30.
- CDC. Best practices for health care professionals on the use of polymerase chain reaction (PCR) for diagnosing pertussis. 2011. Atlanta, GA: CDC, 2011.
- Marchant CD, Loughlin AM, Lett SM, Todd CW, Wetterlow LH, Bicchieri R, et al. Pertussis in Massachusetts, 1981-1991: incidence, serologic diagnosis, and vaccine effectiveness. J Infect Dis 1994;169:1297-1305.
- Bisgard KM, Christie CD, Reising SF, Sanden GM, Cassiday PK, Gomersall C, et al. Molecular epidemiology of Bordetella pertussis by pulsed-field gel electrophoresis profile: Cincinnati, 1989-1996.J Infect Dis 2001;183:1360-7
- de Moissac YR, Ronald SL, Peppler MS. Use of pulsed-field gel electrophoresis for epidemiological study of Bordetella pertussis in a whooping cough outbreak. J Clin Microbiol 1994;32:398-402.
- CDC. Summary of Notifiable Diseases—United States, 2012. MWWR 2012; 61(53).
- CDC. Pertussis vaccination: Use of acellular pertussis vaccines among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997;46(No. RR-7):1-25.
- CDC. Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2006;559(No. RR-3):1-34.
- CDC. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdapvaccine from the Advisory Committee on Immunization Practices, 2010. MMWR 2011;60(01):13-15.
- CDC. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women – Advisory Committee on Immunization Practices (ACIP), 2012. MMWR 2013;62(07):131-35.
- CDC. Updated recommendations for use of Tdap in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months – Advisory Committee on Immunization Practices (ACIP), 2011. MMWR 2011;60(41):1424-26.
- CDC. Immunization of health-care personnel – recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60(07):1-45.
- CDC. Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis: 2005 CDC Guidelines. MMWR 2005;54(No. RR-14):1–16.
- American Academy of Pediatrics. Pertussis. In: Pickering LK, editor. Red Book: 2003 Report of the Committee on Infectious Diseases. Elk Grove Village, Il: American Academy of Pediatrics 2003: 472-86.
- Mastrantonio P, Stefanelli P, Giuliano M, Herrera Rojas Y, Ciofi degli Atti M, Anemona A, Tozzi AE. Bordetella parapertussis infection in children: epidemiology, clinical symptoms, and molecular characteristics of isolates.J Clin Microbiol 1998;36:999-1002.
- Hoppe JE, Tschirner T. Comparison of media for agar dilution susceptibility testing of Bordetella pertussis and Bordetella parapertussis. Eur J Clin Microbiol Infect Dis 1995;14:775-9.
- Hoppe JE, Bryskier A. In vitro susceptibilities of Bordetella pertussis and Bordetella parapertussis to two ketolides (HMR 3004 and HMR 3647), four macrolides (azithromycin, clarithromycin, erythromycin A, and roxithromycin), and two ansamycins (rifampin and rifapentine). Antimicrob Agents Chemother 1998;42:965-6.
- Hoppe JE, Tschirner T. Comparison of Etest and agar dilution for testing the activity of three macrolides against Bordetella parapertussis. Diagn Microbiol Infect Dis 1997;28:49-51.
- Hoppe JE, Rahimi-Galougahi E, Seibert G. In vitro susceptibilities of Bordetella pertussis and Bordetella parapertussis to four fluoroquinolones (levofloxacin, d-ofloxacin, ofloxacin, and ciprofloxacin), cefpirome, and meropenem. Antimicrob Agents Chemother 1996;40:807-8.
- Hoppe JE, Simon CG. In vitro susceptibilities of Bordetella pertussis and Bordetella parapertussis to seven fluoroquinolones. Antimicrob Agents Chemother 1990;34:2287-8.
- Hoppe JE, Eichhorn A. Activity of new macrolides against Bordetella pertussis and Bordetella parapertussis. Eur J Clin Microbiol Infect Dis 1989;8:653-4.
- Watanabe M, Haraguchi Y. In vitro susceptibility of Bordetella parapertussis to various antimicrobial agents. Antimicrob Agents Chemother1989;33:968-9.
- CDC. Catch-up immunization schedule for persons aged 4 months through 18 years who start late or who are more than 1 month behind — United States, 2014 [4 pages]. (updated 2014 Jan 31; accessed 2014 Dec 14).
- Kurzynski TA, Boehm DM, Rott-Petri JA, Schell RF, Allison PE. Antimicrobial susceptibilities of Bordetella species isolated in a Multicenter Pertussis Surveillance Project.Antimicrob Agents Chemother 1988;32:137-40.
- Centers for Disease Control and Prevention. Get Smart: Know When Antibiotics Work. Atlanta GA [updated: 2013 October 23; accessed 2014].
- Sprauer MA, Cochi SL, Zell ER, Sutter RW, Mullen JR, Englender SJ, Patriarca PA. Prevention of secondary transmission of pertussis in households with early use of erythromycin. Am J Dis Child. 1992;146(2):177-81.
- Dodhia H, Miller E. Review of the evidence for the use of erythromycin in the management of persons exposed to pertussis. Epidemiol Infect 1998;120(2):143-9.
- Halperin SA, Bortolussi R, Langley JM, Eastwood BJ, De Serres G. A randomized, placebo-controlled trial of erythromycin estolate chemoprophylaxis for household contacts of children with culture-positive Bordetella pertussis infection. Pediatrics 1999;104(4):e42
- von König CH. Use of antibiotics in the prevention and treatment of pertussis. Pediatr Infect Dis J 2005;24(5 Suppl):S66-8.
- Alexander EM, Travis S, Booms C, Kaiser A, Fry NK, Harrison TG, Ganpot B, Klein JL. Pertussis outbreak on a neonatal unit: identification of a healthcare worker as the likely source. J Hosp Infect2008;69(2):131-4.
- Elumogo TN, Booth D, Enoch DA, Kuppuswamy A, Tremlett C, Williams CJ, Shankar A, Morter S. Bordetella pertussis in a neonatal intensive care unit: identification of the mother as the likely source. J Hosp Infect2012;82(2):133-5.
- CDC. Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis: 2005 CDC Guidelines. MMWR 2005;54(RR14):1-16. 45.
- Clark TA. Responding to pertussis. J Pediatr2012;161(6):980-2.
- Page last reviewed: May 19, 2015
- Page last updated: May 19, 2015
- Content source:


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Grumpy Cat is NOT Amused [VIDEO]
As you know, I recently became a "cat lady." I have learned that cats are MUCH different than dogs. My cat 'Emmy,' let's you know when she wants love. AND she let's you know when she is grouchy. Boy does she!!! What happens when 'Tard' , the grumpy faced cat, has had enough? Watch and find out. It's TOO cute
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LONDON - The number of international students attending England's universities has dropped for the first time in three decades, a study said Wednesday, with students from India and Pakistan hit by tighter visa rules.The Higher Education Funding Council for England found foreign student numbers declined by 1.5 percent in 2012-2013 - the first fall in 29 years. Numbers fell to 307,205, down from 311,800 the previous year.The drop raises concerns that tougher immigration laws are driving away genuine students and risking the higher education sector's income.Meanwhile the trebling of annual maximum tuition fees to £9,000 ($15,000) a year is deterring European Union students, the report said. The numbers of full-time EU undergraduate entrants to English higher education institutions dropped from 23,440 last year to 17,890 - a fall of 23.7 percent - which the study said was "probably due to the increased tuition fees".Heavy reductions in postgraduate entrants since 2010-11 have slashed numbers from India (51 percent, 7,000 students) and Pakistan (49 percent, 1,400 students). However, there was strong growth coming from China (44 percent, 8,300 students).The study found that almost as many Chinese students are studying full-time masters courses as English ones. The University and College Union (UCU) said changes to the rules governing student visas and domestic concern about immigration were damaging Britain's image abroad, giving the impression to students from India and Pakistan that they were not welcome.At the same time, other countries were striving to attract more foreign students."International students make a huge contribution to academic and cultural life on campuses and in our cities. They also make a valuable contribution to our economy," said UCU general secretary, Sally Hunt."Ministers need to recognise that attempts to sound tough on immigration at home are also reported elsewhere and it is not surprising if students consider studying in the countries that make an effort to welcome them."Not long ago, students represented almost two-thirds of the non-European Union migrants coming to Britain.The government believes the system is wide open to abuse, with obscure courses and colleges effectively offering a back door to settling in Britain.A large proportion of international masters entrants studying full-time are from China - 23 percent of entrants in 2012-13, compared with 26 percent from Britain."International students make a huge contribution - boosting our economy and enhancing our cultural life," said a spokesman for the Department for Business, Innovation and Skills, which has responsibility for universities. "That is why there is no cap on the number of legitimate students who can study here. By working with other countries we will continue to attract international students and promote the UK's expertise in education."
UK's foreign students fall for first time in 30 years
Since 2010-11, postgraduate entrants of Pakistani students slashed by 49pc


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2015 Intermediate Division Faculty
Summer Music Academy faculty consist of current Ithaca College faculty, top music educators from across the country, and renowned guest artists.
|Elizabeth Shuhan, Flute
|Lecturer, Ithaca College; Principal flutist with the Fort Smith Symphony (AR); MM, University of Arkansas; BM University of Southern Missisippi
Elizabeth Shuhan is a private flute teacher in Ithaca, New York, flute instructor at the Hochstein School of Music in Canandaigua, NY and a flute instructor at Cornell University. She is an active freelance flutist in the central New York region and regularly performs chamber music as a member of the Shuhan Duo. As the current principal flutist with the Fort Smith Symphony (AR), she has recorded for the Naxos label. She was formerly second flute/piccolo with the North Arkansas Symphony and has also held the position of 2nd flute/piccolo with the Meridian (MS) Symphony. Ms. Shuhan was formerly the director and flute instructor of the Suzuki Music School of Arkansas at the University of Arkansas and was also visiting Assistant Professor of flute during the1997-1998 academic year at that same institution. Ms. Shuhan also taught general music K-12 in the Arkansas public schools for five years.
As a soloist, she has performed with the Hunstville (AL) Youth Symphony, the University of Southern Mississippi Symphony, the Music Festival of Arkansas Orchestra, the North Arkansas Symphony and the Fort Smith Symphony. She has performed in masterclasses for William Bennett, Marc Grauwels, Jim Walker, Carol Wincenc, Charles Delaney, and Clare Southworth. Ms. Shuhan is a 2005 winner of the National Flute Association Convention Performers Competitions and Professional Flute Choir Competitions. She was also the first prize winner of the 1998 Mid-South Flute Society Competition, a 1996 MTNA state Collegiate artist competition's winner, a 1997 MTNA regional collegiate artist competition's winner, a finalist in the 1997 Music Teacher's National Association Collegiate Competitions and finalist in the 1995 Fischoff Chamber Music competitions. Ms. Shuhan's students have also placed in state and regional MTNA competitions in Arkansas and Oklahoma.
Ms. Shuhan studied music education and flute performance at the University of Southern Missisippi earning a Bachelor of Music degree and continued her studies with flute performance and pedagogy at the University of Arkansas earning a Master of Music degree. Ms. Shuhan has also received advanced teacher training in the Suzuki method, earning certification through the Suzuki Association of the Americas. Ms. Shuhan's principal teachers were Ronda Mains, Sharon Lebsack and Sheryl Cohen. She has also studied with Bart Feller and Clare Southworth. As a student of the Suzuki method, her principal teachers were Toshio Takahashi, Kenichi Ueda, David Gerry, Pandora Bryce and Sarah Hanley.


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Pre-Market Earnings Round-up: Time Warner, AOL
- Garmin Ltd.'s first-quarter earnings soared as sales increased across its business segments and the navigation-device maker benefited from a weaker dollar and a sharply lower effective tax rate.
- AOL Inc.'s first-quarter profit plummeted 86% as advertising and subscription revenue continued to decline, but core results topped analysts' expectations.
- Marsh & McLennan Co.'s first-quarter earnings rose 31% on better-than-expected revenue growth driven by its risk and insurance and consulting businesses.
- TRW Automotive Holdings Corp.'s first-quarter earnings rose 38%, beating analysts' estimates, as the auto-parts company's margins and sales continued to benefit from a recovering automotive industry.
- Time Warner Inc.'s first-quarter profit fell 9.9% and core results topped analysts' estimates as revenue rose but higher production and overhead costs weighed on the bottom line.
- R.R. Donnelley & Sons Co.'s first-quarter earnings fell 51%, which was more than expected, and the company authorized the repurchase of up to $1 billion of stock.


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Federal Funds on the Line as Cities Challenge Census Results
Tighter budgets, and the threat of losing federal funds, have prompted local governments to challenge 2010 Census results, reports Associated Press' Hope Yen.
"If Houston were to successfully challenge its count as missing 158,475 people based on census estimates released in 2009, Texas could get roughly $948 per person more in Medicaid money, or more than $150 million a year."
"Real-estate agents in New York City want to know where the Census Bureau found vast stretches of empty housing that resulted in a tally that was 200,000 fewer people than expected. Miami officials are puzzled over a count that fell 30,000 below the bureau's 2009 estimate, contending that immigrants and middle-class whites in gated downtown condominiums were missed."
"But the kinds of challenges that are accepted are limited to narrow cases involving outdated boundary lines, people allocated to the wrong neighborhoods or other processing errors that can be fixed without collecting new data."


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About the Book
A haiku must be very simple and free of all poetic trickery and make a little picture and yet be as airy and graceful as a Vivaldi pastorale", wrote Jack Kerouac and that is exactly what c.a. leibow accomplishes with his refreshingly simple and accessible poems that jog the imagination. His poems are simple, sweet, and accomplish exactly what Kerouac theorized-paint a tiny picture in one's psyche."
Hattie MacLeod, City Weekly
Features & Details
- Category Poetry
5×8 in, 13×20 cm
164 Pages
- Publish Date Aug 23, 2009
- Language English
- Tags ca. leibow, christopher leibow, chris leibow, senryu, poems, poetry, haiku
About the Creator
c.a. leibow graduated from Antioch University in Los Angeles with an MFA in Poetry and has been nominated for a Pushcart Award and the Utah Book Award. He has been published in numerous journals such as Barrow Street, Interim, Poetry Motel, and Juked. Being a poet, he has needed to find ways to make a living. I have worked as a dishwasher, a shoes salesman, a driver, a security guard, a bouncer, a mental institution orderly, a file clerk, a shipping clerk, traveling salesman and a corporate trainer. He lives in Salt Lake City with his cat Mr. Futzwhittle.
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Record trading in Xero ahead of inclusion to ASX All Ords
March 21 (BusinessDesk) - Xero, the cloud-based accounting software developer, reported record share trading today as about 2 percent of the company changed hands with turnover of about $117.7 million, ahead of its addition to the ASX All Ordinaries Index.
More than 2.7 million Xero shares were traded on the NZX today, topping the 2.57 million shares changing hands on May 31 last year, when then-chairman Sam Knowles and chief operating officer Alastair Grigg lodged notices to the stock exchange saying they had sold down their holdings in the software developer.
Of today's trades, there were six transactions ranging from 100,000 to 600,000 shares, accounting for 1.59 million shares changing hands, according to Reuters data. The price fell 2.4 percent to $43.45, valuing the company at $5.54 billion.
On March 7, the Wellington-based company said it would be added to the All Ordinaries Index at the close of trading today. That means investors who track the index will need to buy the stock for their portfolios.
The stock is rated an average 'hold' based on two analyst recommendations compiled by Reuters, with a median target price of $35.23.
As at May 10 last year, 54, or 1.1 percent, of Xero's 4,715 shareholders held 83.7 percent of the company, according to its 2013 annual report. It since raised $180 million, mainly from US investors, in a capital raising, giving it funds to pursue growth aspirations in the world's biggest economy.
Chief executive Rod Drury is the biggest shareholder with a 17 percent stake, followed by MYOB founder Craig Winkler with 15.7 percent, according to substantial shareholder notices.


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Current Medical Students
What to Expect at Harborview Medical Center:
Arrive at the neuroradiology reading room on the first floor (near the ED) at 6:00am (5:30am on Wednesdays) for film rounds. Both teams (TBI and vascular) review new patients' films, then split up to look at new scans for previous patients. After film rounds, the teams split up and round on the ICU and floor patients. The typical order of hospital areas starts in the ED (if patients are waiting there), then ED "Obs" (1st floor), then TICU/NICU/MICU (2nd floor west), then BICU/PICU (9th floor east), then east hospital floors (in descending order from 9th to 5th), then SICU/CICU (2nd floor east), then NSU/stepdown/3W (3rd floor west), and finally ICU holding in the basement. After rounds, breakfast in the cafeteria, then run the list and head to the morning's cases. After the day's cases, or between 2-5pm, afternoon film rounds will start in the resident work area between the NICU and MICU (2nd floor west), followed by patient rounds.
What to Expect at University of Washington Medical Center:
Arrive at the neuroradiology reading room on the second floor, near the Pacific elevators (ask the radiology front desk for directions) at 6:00am (5:45am on Wednesdays). After film rounds, patient rounds start in the ICU (5th floor), followed by floor patients on 4NE, 4SE, and 4S. After rounds, breakfast in the cafeteria, then run the list and go to cases. Afternoon rounds are variable, and your chief resident will inform you of when and where they will be held.
What to Expect at Seattle Children's Hospital:
Arrive at the neurosurgery resident/fellow office located on the 7th floor of the Whale Wing (Room W7713) at 7:00 am for pediatric rounds. The mandatory pediatric case conference begins at 7:45 am, followed by the Chairman's clinic or operative cases. The day ends with resident rounds and sign-out from the team of nurse practitioners.
Transportation Options:
Transportation between hospitals is available by the following methods:
Contact Information
For more information on our clinical clerkships for medical students, please contact:
Residency Program Administrator
Phone: (206) 744-9316
In the News
Top Ten Concussion Research Articles of 2016 - Christine Mac Donald, PhD
Application Deadlines
Applications for the Neurological Surgery Residency are due November 30, 2017.
Deadlines to apply to our fellowship programs are:
Featured Faculty:
Dr. Browd specializes in pediatric neurosurgery, specifically with children who have hydrocephalus, brain & spinal cord tumors, pediatric cervical spine, spina bifida, chiari malformations, and spacticity.
Make a Gift
Support the Department of Neurological Surgery by
Your donation will help support patient- and family-centered care, breakthroughs in medical research, and the training of tomorrow's physicians.
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Possible 2012 650i x drive lease swap
Hey guys -
This is just an idea, but I'm thinking about switching over to a four door. I've only had my coupe for a few months, but it looks like my wife and I are going to try and start a family sooner than I orignally thought. With the current holiday incentives it looks welcoming, but I would have to find someone to transfer my current lease to. I've laid out all costs I paid and what it would cost for someone to get into a '13 with the same options, given what I put down on my '12. I'm sorry for the detailed info, let me know if anyone might be interested. Thank you!
2012 650i X drive-
Carbon Black Metallic
Black Nappa Leather
Gray Poplar Wood
Cold Weather Package
Full LEDs with 20"s
M Sport
B & O sound
Heads up Display
Instrument panel w/leather
BMW apps
Ceramic Control
12,000 Miles a year - 36 Months
Lease started 7/1/2012
Currently 3,300 miles
Residual is $68,156
Total monthly payment = $889.14 (I paid tax upfront)
This is what I would be looking for to get out....
Lease fee $250 (I will pay $250 and split)
I paid $4868 in cap reduction ($135/m x 6 months(what I've used) = $810
Cap Reduction reimbursement $4000
I paid $3600 for 4 MSDs - this is returned at the end of the lease
I paid $2926 in taxes up front ($81/m x 6 months) = $486
Tax reimbursement $2250
I paid $725 for ED fee, $369 Doc fee, $350 for NYS reg fee. I will eat those.
Total out of pocket = $250+$4000+3600+2250= $10,100 ($3600 of which you'll get back)
Now to compare a '13 with the same options and putting down the same money....
2013 650i X drive
Cold weather
Executive package
Full LEDs
M Sport w/20s
57% residual for 36mos, 12k year
$3500 options credit
$700 loyalty credit
(Cap reduction $250+$4000 from above) $4250 + $600 (reduce MSD from above, 3600 to 3000. Use the 600 to get monthly pymt below 1000)
Tax payment from above $2250
MSDs from above $3600-600= $3000
Sale price $750 over US invoice = $99,895
Cap Reduction- $4850
Options credit + loyalty= $4,200
Net Cap = $90,845
Residual 57% = $108,095 x .57 = $61,614.15
Depreciation = Net Cap - Residual $29,230.85
Dep Cost = $29,830.85/36 = $811.97/mo
Net Cap + Residual = $152,459.15
Money Factor = .00135
3 MSDs = .00007 x 3 = .00021
Final MF = .00114
Finance pymt = $173.80
Total Monthly pymt before tax = $985.77
Tax on Final Pymt = $985.77 x 8% x 36mos = $2,839.02
Tax on Cap red/options credit = ($4850+4200) x 8% = 724.00
Total Tax = $3,563.02
Apply my tax payment above $2250
Remaining tax = $1,313.02
Cash Breakdown -
Cap Reduction - $4850
3 MSDs - $3000 (refundable)
Tax - $3563.02
1st payment - $985.77
Dealer Fees - $369
State reg - $350
Total Out of pocket = $13,117.79 ($3000 refundable)
Total Monthly Pymt = $985.77
Unless I'm missing something, the swap would be about $3k less upfront assuming you paid similar costs upfront and save about $100 a month. Thank you for looking.
Congrats on starting a family..
You would have a better chance unloading this vehicle is ate the upfront cost and transferred the payments as is..
Any educated consumer would probably shy away from the 2012's because of the engine upgrade on the 2013's.. So you I think sweetening the deal is your best bet..
Or you can just keep it... A car seat should fit in the backseat nicely... No?.
Not sure if anything fits in those back seats :)
I totally understand the engine issue. I m not going to eat $9k after having the car for 5 months, just doesn't make sense.
Even with current rates, you can't find a '13 loaded for under $900 a month. That was the reason I showed the comparison. Outside the engine difference it's really not a bad deal, you're just paying the cost upfront rather than over the lease.
Hey Gehm,
Personally.. I wouldn't pay for anything up front on a lease... The main reason would be if I got into an accident I am not sure if I would get that money back. The deposits you should be able to get back.. But the upfront taxes are essentially a sunk cost.. You car is fully loaded.. If someone would be willing to part with about 10k to get in it up front it would be a good deal.. I wish you luck..
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Mark Metcalf
Mark Metcalf is an actor and owner of Libby Montana restaurant in Mequon. Still active in Milwaukee theater, he's best known for his roles as Neidermeyer in "Animal House" and as The Maestro on "Seinfeld."
Originally from New Jersey, Metcalf now lives in Bayside.
|Recent Articles
|Movies & TV - October 10, 2009
|Metcalf's DVD Screening Room: "An American Werewolf in London"
|For a while, "An American Werewolf In London" was the most popular video to rent or buy in the world. That was before DVD's, in the long ago days of videotape, back in the mid-1980s. It is still worth a look for several reasons. First, because it was the film that forced the Academy of Motion Picture Arts and Sciences to start giving an Academy Award for makeup design. And, it marked a big step for writer/director John Landis.
|Movies & TV - October 1, 2009
|Screen legend Landau visits Milwaukee Film Festival
|Martin Landau has done just about everything there is to do in the show business. He started out in television when there was live television, as early as 1948. He was nominated three times for Oscars. He won once, for playing Bela Lugosi in the Tim Burton/Johnny Depp film "Ed Wood." Landau has been part of so many memorable moments in Hollywood and now he'll be part of the Milwaukee Film Festival.
|Movies & TV - September 30, 2009
|Milwaukee Film Festival heads toward strong finish
|They haven't run out of popcorn or excellent movies at the Milwaukee Film Festival, which continues through the weekend at the Oriental Theatre on the East Side and Marcus North Shore Cinema in Mequon. If you haven't checked out any of the movies yet, OnMilwaukee.com film expert Mark Metcalf has some recommendations to help you plan your schedule.
|Movies & TV - September 26, 2009
|Metcalf's Screening Room: Milwaukee Film Festival
|In this edition of the Screening Room, OnMilwaukee.com movie expert Mark Metcalf takes a look at a handful of movies showing at the Milwaukee Film Festival, which runs through Sunday, Oct. 4. One of the films Metcalf looks at is "Theater of War," which was produced by Whitefish bay native Jack Turner and stars Academy Award winner Meryl Streep (pictured).
|Movies & TV - September 24, 2009
|Showtime! Milwaukee Film Festival opens tonight
|It has been a long and difficult year, but the Milwaukee Film Festival is ready to rise from the ashes of its predecessor. Thanks to the hard work of Jonathan Jackson, Kyle Heller, TJ Fackelman and a board of directors that includes many of the smartest, most imaginative, active and important people in the community -- people with a deep passion for film, the creative world and Milwaukee -- this is a time to celebrate. The Milwaukee Film Festival opens today!
|Movies & TV - September 19, 2009
|Metcalf's Screening Room: "Amores Perros," "Spun"
|In this edition of the Screening Room, OnMilwaukee.com movie expert Mark Metcalf looks at "Amores Perros," a film by Alejandro Gonzalez Inarritu, and "Spun," which features There are outrageous performances from actors like John Leguizamo and Brittany Murphy along with solid work from Mickey Rourke and Jason Schwartzman.
|Movies & TV - September 12, 2009
|Screening Room: "9" and "The September Issue"
|In this edition of the Screening Room, OnMilwaukee.com movie expert Mark Metcalf takes a look at the animated movie "9," which seems to pay more attention to video game marketing than plot line, and a documentary about Vogue and the world of high fashion entitled "The September Issue."
|Movies & TV - September 5, 2009
|Screening Room: "Tulpan" and "Tony Manero"
|In this installment of the Screening Room, OnMilwaukee.com film expert Mark Metcalf looks at "Tulpan," the first narrative feature of a Kazakh documentary filmmaker named Sergey Dvortsevoy. "Tony Manero" is about a Chilean man who earns his meager living as a dancer but is trying to make it up and out of his existence by entering a John Travolta lookalike contest.
|Movies & TV - August 15, 2009
|Metcalf's Screening Room: "District 9"
|South African director Neill Blomkamp based this movie on a short film of his called "Alive In Joburg." It has no known stars in it, unless South African audiences know them. Peter Jackson, who directed the "Lord of the Rings" trilogy and "King Kong," produced. That alone may be enough recognition to market the film to the broad audience that it deserves. The script is wonderfully layered, the concept both frightening and funny, with all kinds of political and sociological connections. The execution is great.
|Movies & TV - August 8, 2009
|Metcalf's DVD Screening Room: "Two Lovers"
|In this edition of the Screening Room, OnMilwaukee.com movie expert Mark Metcalf takes a look at "Two Lovers," an elegant film starring Joaquin Phoenix, and offers his opinion on the famously awkward interview the star endured with David Letterman while promoting the film.
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Nearly 82 percent of the 2.2 million pre-1980 commercial buildings in the U.S. are using the same lighting technology now that they have used for the past 30 years. This may have been an acceptable statistic 20 years ago, but the energy-saving options available today leave no excuses for clinging to antiquated technology…
Read More »
Herman Miller, Inc. announces an agreement to acquire Maharam Fabric Corporation, a New York-based designer and provider of textiles for commercial, healthcare and residential interiors.
The American Institute of Architects (AIA) and its Committee on the Environment (COTE) have selected the top ten examples of sustainable architecture and green design solutions that protect and enhance the environment. The projects will be honored at the AIA 2013 National Convention and Design Exposition in Denver.
The Robert Allen Design Group is launching its first interactive digital sample book for interior designers with Viridian, from the 2013 Spring Color Library Collection: Artistic Color.
Design firm Rapt Studio commissioned artist El Mac to do a large scale mural in the main atrium in Adobe's Lehi, Utah building. This video details the creative process behind the mural and the work that went into making it a reality—read about the project in I&S's May issue.
Everything You Ever Needed to Know About Art
Web Exclusive: Trump International Beach Resort by Michael Wolk
Great Design in the Great Outdoors
Exclusive: Magic and Mystery in New Orleans
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3 Min Read
PERTH, Nov 17 (Reuters) - Australia's thermal coal prices fell below $114 per tonne during the past week as demand from China, the world's largest consumer of the fuel, remained weak.
Thermal coal on the global COAL Newcastle index for the week to date closed at $113.50 per tonne on Wednesday, down from $116.50 per tonne a week earlier, with a bid for January delivery at $113.50 per tonne.
Australian thermal coal shipments from Newcastle port fell just over 3 percent in the week ended Nov. 14 to 2.53 million tonnes, down from 2.61 million tonnes the previous week.
"The Chinese just really have shut the door... some power plants are even selling back into the market," one market source said.
China's domestic coal prices were nearly flat at 852 yuan ($134) per tonne during the last week, according to the weekly Bohai-Rim Bay thermal coal price index published Wednesday.
Rising domestic prices in China often spur import buying, but even with prices falling in the rest of the Pacific region, China's utilities are so well-stocked they have shown little interest.
Traders likely bought too much coal for the fourth quarter of the year, resulting in huge queues at Chinese ports, the market source said.
Most of the southern power plants still have more than two-weeks worth of supplies, while those in the north, which tend to run short, still have about a week's worth of inventory.
One large buyer said offers for January cargoes have started to come in, but the generally weak sentiment kept buyers from committing.
China's lunar new year holiday is due to start in late January, so players are reluctant to stock up too much ahead of the week-long break, particularly without a clear sense of where the market is heading.
Demand from other large Asian buyers was also thin, but Korea Western Power Co Ltd (WP) purchased 4.45 million tonnes of Australian steaming coal via spot and term tenders.
Japanese buyers were seen as being well supplied with plenty of supply from long-term contracts.
South Korea's imports of coal in October slipped 6 percent to 8.43 million tonnes from a year earlier and Japanese utilities used 4.04 million tonnes of thermal coal in October, down from 4.08 tonnes a year ago.
The globalCOAL price index for Australia has fallen from nearly $130 per tonne in March as demand from Australia's biggest buyer, Japan, has waned and a slowdown in China's buying has dampened the coal market regionally.
But prices are still higher than a year ago when they were below $100 per tonne. ($1 = 6.346 Chinese Yuan) (Additional reporting by Fayen Wong in Shanghai, editing by Miral Fahmy)


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Honest truth NCL Pride of America: Pride of America Cruise Review by seentheworld
Overall Member Rating
Honest truth NCL Pride of America
Destination: Hawaii
Embarkation: Honolulu
This cruise might be OK for the first time cruiser who has nothing to compare it to. To start the price increased several times before final, but since this was a family cruise and we wanted the romantic setting and vacation times were set we proceeded. The food was OK, nothing great. The specialty restaurants are pricey and again nothing great. Free Style dining is certainly that, you should plan on extra time for dining even with reservations which you will need unless you want to eat in the buffet and fight the crowds. Service is lacking in every aspect, perhaps the American staff attributes to that. Be prepared they are not what you More are used to with other cruises with foreign staff. There is an over abundance of staff who are always getting in your way, are not friendly or helpful. I never met an officer (white uniform and they are all over the ship), that greeted me or was helpful.
There were many anniversary couples and honeymooners but the ship does not offer anything special for them. We thought we would renew our vows and the ship used to do that but not anymore. The have opted for magic acts and comedy for entertainment, sadly lacking again. I did not meet one person that thought this cruise was great except for the itinerary. While they offer lots of excursions they are exceedingly high. I would suggest pre-renting a car in each port and seeing the islands at your leisure or if you do not want to drive, hire a taxi at each port and ask for a tour of the island. They are great and they know all the special places to see. I was warned this cruise was not good and the reviews support that but thought perhaps it had gotten better, not so. Beware and be warned if you book this cruise, I certainly wish I had. Less
Published 06/28/10
Cabin review: IA4043 Mid-Ship Inside
All bathrooms are the same size for all categories. Halls are very noisy from service crew. Quad rooms do not have much space beside bed, if not in use I was constantly hitting my head and back on the bunks. Colors are red and orange very comparably to Carnival.Read All Mid-Ship Inside (IA) Reviews >>
Read Cruise Critic's Pride of America Review >>
Food not good but a nice time ...
First time with NCL
Awesome way to get to the isla...
Food not good but a nice time ...
First time with NCL
Awesome way to get to the isla...
The Best of Alaska
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The Ion Beam Analysis DataFurnace is a computer code to extract elemental
profiles from Rutherford backscattering and related ion
beam analysis spectra. It is able to solve the inverse problem
("given the spectrum, what is the profile") automatically,
(1997), and this paper has generated
considerable interest, now (3rd Febuary 2011) having 312
listed in the ISI Web of Knowledge
There is a full DataFurnace Review
(September 2002: you can download this, 4MB PDF). A better
version of this has been published on 7 April 2003 as a Topical Review
(Jeynes et al, J.Phys.D
: Appl.Phys. 36 (2003) R97-R126). This has
76 citations as of 3rd Febuary 2011.
Version 9 is now released!
This major new version includes a much more powerful computation engine
(NDF) and a completely rewritten GUI (WiNDF). The new facilities
are described at: N. P. Barradas and C. Jeynes, "Advanced physics
& algorithms in the IBA DataFurnace", Nucl. Instrum Methods Phys. Res., Sect. B,
Version 9 includes PIXE! Note that
PIXE is now included (Pascual-Izarra C, Reis MA, Barradas
NP, Simultaneous PIXE and RBS data analysis using Bayesian inference
with the DataFurnace code, Nucl.
Instrum. Methods Phys. Res., Sect. B, 249, 2006, 780-783),
and critically compared with other X-ray fluorescence codes (both PIXE
and SEM-EDS) by M. J. Bailey, S. Coe, D. M. Grant, G. W. Grime
and C. Jeynes, Accurate determination of the Ca : P ratio in rough
hydroxyapatite samples by SEM-EDS, PIXE and RBS – a comparative
study, X-ray Spectrometry,
Version 9 is validated! Note
also that the particle scattering modules in NDF and other IBA codes
have been compared (N.P. Barradas et al, "Summary of 'IAEA
intercomparison of IBA software' ",
Nucl. Instrum. Methods Phys. Res., Sect. B, 266, 2008,
Version 9
includes a facility for automatic EBS! At
last! NDFv9.3f and above will now silently use the right EBS
cross-sections for the specified detector angle in your geometry file
without any intervention at all by you. WiNDF does not yet warn
you, but NDF does say what it is doing.
The IBA DataFurnace is a fitting code, not
a simulation code (although it has a simulator, of course). It
was written by Nuno
Barradas , with Chris Jeynes
and Roger Webb
. It has a core code to do the physics called NDF and
written in Fortran, and a user interface code called WiNDF and
written in Visual Basic. It is designed to facilitate
accurate and automatic analysis of large batches
of complex samples. The fits obtained are generally
"perfect": the purpose is to extract all
the information from the spectra (well, as much
information as possible!). Channelling is not supported.
NDF ("Nuno's DataFurnace") makes fully automatic fits to
experimental data, the user is only required to input the analytical
conditions and the elements present. NDF uses the
Simulated Annealing algorithm
WiNDF ("Windows NDF") is a Windows user interface to the NDF
code. WiNDF enables you keep track of the many output files that
are generated by the DataFurnace. It also includes comprehensive
graphical spectral manipulation tools, a spectrum simulator and other
A comprehensive summary was presented at the Dresden IBA-14 Conference in July 1999
(this is not in the Proceedings: you can download it, 500kB IBA14 PDF).
Executable code updates
Other interesting links
Manuals and other Docs
Stopping Powers used


text:
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The Mauser SR-93 Sniper Rifle. One of the coolest guns of all time.
Mauser developed the SR-93 for the German army G22 trails, which were eventually won by the AWM-F. The SR93 is based on the earlier Mauser SR-86, but features some significant changes. The SR-93 is produced in larger calibers and has a very different furniture than previous Mauser designs. The SR-93 was sold to several German and Dutch police forces and some were sold on the civilian market. When Rheinmetall took over Mauser the production of the SR-93 was stopped. It is believed that only 120 rifles were produced.
The SR-93 uses the same action as the SR-86, but the mechanism has been lengthened to accept the .338 as well. The SR-93 is a bolt action rifle with two frontal locking lugs. The standard calibers are .300 Winchester Magnum or .338 Lapua Magnum. Conversion kits for 7.62x51mm were also available and were mainly meant for training. The aluminum and rubber furniture of the rifle is of unique design. The stock features a pistol grip but has the looks of a thumbhole stock and helps against snagging. The buttplate and cheekpiece are fully adjustable. Forearm features an integral adjustable folding bipod and the stock has an integral monopod. The SR-93 is easy to set up for a left handed shooter by replacing the bolt and inserting it after rotating 180 degrees. Various optics can be fitted but no iron sights are provided.
The SR-93 is a high quality high powered sniper rifle. Although designed for the German army G22 trails the SR-93 looks more accustomed to the police tactical sniper role, while it has a long forearm to rest the rifle, no iron sights and a rear monopod. The SR-97 follows the same design but is somewhat more conventional with its standard bipod and back up iron sights. Actual performance figures are not available, but the SR-93 known to be an accurate weapon. This claim is backed by the Mauser track record combined with the long free floating barrel on the SR-93. The proven Mauser bolt action system also makes it a very reliable weapon. All controls are ambidextrous allowing it to be used by left handed shooters. Overall the Mauser rifles are high quality weapons that through the merger and reorganization of Mauser did not reach a significant number of sales.


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Labour MP David Miliband has urged action to tackle the "forgotten crisis" of youth unemployment in Croydon.
The former foreign secretary said the number of out-of-work 16 to 24-year-olds constituted an "emergency" that required urgent measures.
On a visit to Selhurst's BRIT School on Thursday, Mr Miliband said: "Youth unemployment is the forgotten crisis.
"I'm banging my head against the wall trying to get everyone to take notice of this issue, which is one of the most important facing us today."
The South Shields MP also called on Croydon Council to lead from the front by signing up to an increased living wage.
"The public sector needs to set the example on this," he said.
Mr Miliband was in Croydon campaigning alongside Labour's by-election hopeful Steve Reed, who suggested that opening doors for youngsters was also central to tackling crime.
Responding to the concerns of one pupil about muggings, Mr Reed: "The key thing is to provide an alternative to crime.
"If you provide young people with opportunties to aspire to, they will not turn to crime. We need to do that.
"Young people want to better themselves and have the knowledge to do that, but they often do not have the power."
Mr Milband and Mr Reed met around 20 post-16 pupils on their visit the specialist performing arts school.
In a half-hour question and answer session, students discussed negative representations of young people the media as well as grilling Mr Miliband about his role in the Iraq war.


text:
Terms & conditions
Booking Period: 02 Mar 2015 – 31 Aug 2015
Staying Period: 02 Mar 2015 - 30 Sep 2015, except Bali hotels: 31 Oct 2015.
Sales conditions
• Credit card guarantee is mandatory at time of booking.
• No cancellation charge applies prior to 18:00 (local time), up to 3 days prior to arrival. In the event of late cancellation or no-show, the first night will be charged.
• This offer is subject to availability and does not apply to groups.
Offer inclusions
• Breakfast (or Sahur during Ramadhan)
• Unlimited WiFi access
• IDR 50,000 NETT dining voucher per stay, per room*
• *Bali hotels will offer Airport pick-up instead of dining voucher, maximum 2 adults per room.
Special note on the dining voucher
• The dining voucher is issued for every valid stay (per stay, per room) at participating hotels, except for stays in Bali.
• The dining voucher can only be redeemed at participating ibis and ibis Styles (all seasons) hotels in Indonesia.
• Guests staying at ibis Budget will receive the voucher to be consumed at ibis and ibis Styles (all seasons).
• Dining voucher is valid for a la carte menu or buffet menu or restaurant purchases only.
• All dining vouchers cannot be used in conjunction with any other benefits, including the Accor Advantage Plus dining privileges.
• For the use of the dining voucher, please check with the front desk staff first.
EXCLUSIVE benefits for loyalty members
Monthly Prize Draw – 1 iPhone 6 to be won each month
• All winners will be selected based on all materialized stay made on the same month of the drawing.
• Winners will be notified by email and the prize will be presented to winner at the nearest ibis Family Indonesia hotel.
• All winners will be announced through our website at www.ibis.com/ibisfamilyoffer and Facebook page at www.facebook.com/Accorhotels.id by the end of the campaign, i.e. 31 October 2015.
• All winners must agree to a photo-session during prize presentation, to receive the prize. All photos remain property of Accor hotels to be used for communication and advertising purposes.
• The prize terms and conditions are non-negotiable. The prizes are non-transferable, non-refundable and cannot be exchanged into cash.
Accor Plus members' discount
Accor Plus members get additional 15% off. If using the Complimentary night voucher, all benefits of the offer will be void.
General Le Club Accorhotels terms and conditions apply to the "Discover" offer.
1. This offer is valid for every eligible stay with an arrival date between 18 March and 31 October 2015 for eligible stays booked before 31 August 2015.
2. Bonus points are calculated according to the points earned by the member based on "Classic" status, without point acceleration
3. You must register at (
) to qualify for the offer.
4. You must book your stay ahead of time on accorhotels.com to benefit from this offer.
5. You must provide your loyalty card number or member number when making your reservation, and present your card at the reception desk of your hotel when you check-in for your stay.
6. Reservations that include several rooms covered by the same member during his or her stay are only counted as one stay.
7. The offer may be applied for a maximum of 3 times within the campaign duration.
8. This offer may not be combined with other current offers or advantages and does not apply to groups.
9. This offer is subject to availability. General sales terms and conditions apply for reserved public rates specific to each hotel.
10. Your points will be credited on your account from 10 days after your Check-out date.
11. In cases of conflicting terms and conditions, the terms and conditions in English have priority.


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LeAnn Rimes in a Bikini
LeAnn Rimes and Eddie Cibrian slipped off to Mexico for a little Homewreckers Celebration because apparently they think getting engaged is a smart idea after proving marriage means absolutely jackshit to either of them. That being said, LeAnn Rimes actually looks pretty goddamn banging here. And it's been a long time since I could say something like that because, as you know by reading the site, I'm a firm believer in traditional family values. In fact, I was at Bible study just the other night lamenting how it's impossible for me to spill my seed looking at LeAnn Rimes knowing full well she's a harlot. I mean, Internet porn? No problem. Let me at it. But a godless Jezebel? No, sir. No, thank you. That's not the America I remember.
Adding… But I will gaze at her side-boob. For Jesus.
Photos: Bauer Griffin, Splash News


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Index —
Handling the Art
Take a look behind the scenes of our Art Study Center, from the perspective of art handler Elizabeth Sirrine.
Take a look behind the scenes of our Art Study Center, from the perspective of art handler Elizabeth Sirrine.
A collaboration between the museums, Harvard Graduate School of Education, and a Cambridge high school empowers educators and students.
Get to know our objects in a new way through the museums' digital repositories.
The Harvard Art Museums Archives holds a selection of modern and contemporary artists' papers—a rich resource for researchers.
By Michelle Interrante
Max Benegas and Laura Kenner made important contributions to the programming and digital resource related to an exhibition about Christopher Wilmarth.
Three pieces of 17th- and 18th-century church silver from Salem, Massachusetts, were recently donated to the Harvard Art Museums.
By Laura Turner Igoe
Art appreciation and investigation intersect in the Materials Lab, a one-of-a-kind studio space in the Harvard Art Museums.
Join us at 12:30 for an up-close look at Jean-Honoré Fragonard's Young Girl Reading, on loan from the National Gall… https://t.co/yRaUatvchH
#NowOnView in room 2700, a study for "El Jaleo," John Singer Sargent's dramatic painting on display @gardnermuseum… https://t.co/lIinl4XXzS
Join us at 12:30 for a talk by conservator Kate Smith on works by John Singleton Copley in the #PhilosophyChamber… https://t.co/xYwKpatsVn
Elizabeth Sirrine gives readers a peek into a day in the life of an art handler in our Art Study Center… https://t.co/5vcwse0HNE
Objects on view today in our Art Study Center have a botanical theme, visit between 1–4pm to see these & more… https://t.co/dAzs6Gg69e
RT @seethinkwonder: Museums are "gyms" where we can exercise our critical thinking skills: #PZC2017 participants having an exhilarating wor…
RT @TerraAmArt: This book explores the history & collections of one of the most unusual rooms in early America: "The Philosophy Chamber" @h…
Some pretty blooms are on display in the Art Study Center tomorrow 7/24 from 1–4pm https://t.co/VounByFCFc https://t.co/QMNcrTnYQe
Master's students at the @hgse gained hands-on experience designing lesson plans for class visits to our galleries… https://t.co/Q3X27ctfOm
Curator Miriam Stewart & curatorial assistant Casey Monahan visit our Art Study Center to take a close look at prin… https://t.co/ogv2WR1psZ
Enrich your visit to the museums with a student guide tour, offered twice daily on Saturdays & Sundays, 11am & 3pm… https://t.co/FlWQswMG25
New drone video of the excavation of the ancient site of Sardis, Turkey are #NowOnView in the Lightbox Gallery, Lev… https://t.co/WpGdtQY6hx
RT @Snarrkaeology: #Archaeology peeps! Sardis #drone video shot this season is up and running NOW @harvartmuseums' Lightbox Gallery through…
RT @seethinkwonder: Slow looking: uncovering complexity through sketching, writing, and conversation @harvartmuseums #pzc2017 @ProjectZeroH…
Late in his career Adolph Menzel abandoned color, producing mainly pencil drawings. One such exquisite #drawing is… https://t.co/G55VK0dEYu
Experimenting with 3D-printed models helps our staff nail down exhibition design.
The Philosophy Chamber: Art and Science in Harvard's Teaching Cabinet, 1766–1820, a new publication accompanying the special exhibition of the same name, represents an innovative approach toward an eclectic collection.
Harvard student Sophia Feng, graduating this May with a degree in the history of art and architecture, introduced peers and community members to the museums.
Field director Nicholas Cahill tells of the legends of Croesus and of the probable discovery of the king's palace at Sardis.


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Plans for stage one of the contentious Nelson Place Village project in Melbourne will be submitted in weeks, the next step in an eight-year saga involving the 417-unit development.
Evolve Developments and Urbis are determined to push ahead with the urban renewal project on the 2.8-hectare Port Phillip Woollen Mill site in Melbourne's west, bought in 2004.
Stage one will include eight townhouses and two towers of 50 and 80 apartments, at four and six storeys.
Evolve Developments spokesman Ashley Williams said the pre-application meeting was held with Hobsons Bay Council on Friday.
Plans to build the village have attracted intense opposition from Williamstown residents, who have organised onsite protests, lobbied local and state governments and gained the backing of former Victorian premiers
Former Victorian planning minister
Mr Guy has said the council will decide the application, despite Victoria's Planning Advisory Committee recommendation that he make the final call.
Mr Williams expected the council to refuse the application and for the development to go to the Victorian Civil and Administrative Tribunal.
Hobsons Bay Council knocked back an application to demolish the mill at its April planning meeting, on the ground that demolition was premature before a replacement development was approved. An appeal has since been launched with VCAT.
Evolve is backed by former Liberal heavyweight Ron Walker.
The Australian Financial Review


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Nov. 28, 2006
Guevara longs to win cup with Bradley
By Luis BuenoLASoccerNews.com Editor
Amado Guevara joined Chivas USA on Monday and said he intends to keep a promise he made to Bob Bradley in 2003.Photo by Linda Cuttone/Sports Vue Images
CARSON, Calif. – For four years, Amado Guevara struggled to accomplish his main goal in New York.
He scored goals and picked up awards along the way but his time in New York had one large, gaping hole.
Guevara did not win a championship in his time with the MetroStars/Red Bulls.
"In New York, I was fine. I had many individual accomplishments but for me those are not enough. I want to win a title and in four years I was not able to reach that goal," Guevara said. "A change of scenery was best."
Now, Guevara is reunited with the first MLS coach he played for. Guevara joined Chivas USA on Monday after Chivas sent its designated player slot and a 2007 SuperDraft choice to New York for the Honduran international.
Guevara said he is in an ideal situation to realize his goal.
"Coach knows me. I know him. He knows what my mentality is and I know his. The most important thing is the objective. His goal is mine and that's to win a title," Guevara said. "I am confident and I know that I will accomplish that with him."
Bradley again lauded Guevara with praise. He spoke highly of Guevara's ability to attack, distribute and work for the team. But he said what most impressed him was Guevara's willingness to do whatever it takes to win games and his desire to win a championship.
"More than anything, we want to have players that want to win," Bradley said. "Whenever I have been with Amado, his mentality to compete and do everything to help the team is tremendous. I feel great that we can add him to our team. I know how much it means to him to try and win a championship in this league."
When Guevara joined the then-MetroStars in 2003, he made a promise to Bradley. He said Tuesday he intends to keep it.
"I made a promise to him when I first arrived here. I promised him that together we would win a title," Guevara said.
In Guevara, Chivas USA has the highest-profile Central American to play in Los Angeles since Carlos Ruiz donned the Galaxy's green-and-gold in 2004. Guevara, in fact, is the only Central American native currently on either clubs' roster.
Bringing in a high-profile Central American not only continues to distance Chivas from its original Mexican-only mindset, it shows the club's willingness to embrace L.A.'s Latino community.
"I think that we recognize that we must have a Mexican foundation. We know the history of Chivas Guadalajara but I think we've tried to also adjust a little bit for Chivas USA," Bradley said. "The idea that we are first Mexican but second representative of the Latino community in Los Angeles is really important. I really have seen the way our fans have responded to a team that they enjoy watching and a team that they are proud of."
Regardless of nationality, Chivas USA General Manager Whit Haskel said the club was excited to bring in a capable player to the organization.
"His accomplishments in the league speak for themselves," Haskel said. "We're thrilled to have a player of his caliber for years to come wearing the colors of Chivas USA."


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The Sources of Military Change: Culture, Politics, Technology (Making Sense of Global Security)
In varying circumstances, military organizations around the world are undergoing major restructuring. This book explores why, and how, militaries change. The authors focus on a complex of three influencing factors - cultural norms, politics and new technology - offering a historical perspective of more than a century. Their analyses range from developing states to Russia, Britain, the US and NATO. Throughout, they reveal the manifold interactions between state and military, and also within both, as primary driving forces of change.
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