text:
One day in December, 2010, the German violinist Christian Tetzlaff began rehearsals with an ensemble of young musicians at Carnegie Hall. The piece was György Ligeti's iridescent Violin Concerto, a complex score of disorienting beauty, completed in 1993, in which the soloist often plays a cadenza of his own invention. Tetzlaff frequently performs the work, and has devised a brief fantasy on the concerto's themes; at a certain point, he echoes one of Ligeti's wispily haunting woodwind melodies by mimicking the sound of a pan flute on his violin.
Tetzlaff plays on a modern violin, made by the Bonn-based luthier Stefan-Peter Greiner, which can produce an unusually wide range of tones, from the refined to the wild. That versatility suits Tetzlaff, because he rejects the facile association of classical music with Old World elegance, or what he calls "the cliché of the Stradivarius." A compact man with close-cropped blond hair, a refined nose, and the streamlined build of a gymnast, he often plays with his upper body bouncing, in dancelike motions, or tossing like a palm tree in a hurricane.
When, at the rehearsal, he arrived at the pan-flute moment in the cadenza for the first time, virtually every member of the orchestra turned his way in surprise. Tetzlaff was drawing his bow, at lightning speed, over a precise point on the fingerboard, unlocking strange and ghostly resonances. He had produced a violin color that the other musicians didn't know existed, and his imitation of a wind instrument was uncanny. The English conductor Simon Rattle, who was leading the rehearsal, told me, "It wasn't as if everyone was thinking, Oh, what a beautiful color. We were all thinking exactly the same thing—That is a pan flute."
Since the time of Paganini, violin virtuosos have tried to overwhelm audiences with feats of agility. Tetzlaff is after something different. A character actor in a field of matinée idols, he prefers to disappear into the sound world he creates onstage. "You become the thing," he says. "Or that's the hope." The Finnish conductor Esa-Pekka Salonen, with whom Tetzlaff has worked for more than two decades, says, "What always strikes me when I hear him playing, and when I work with him myself, is that it's not about the violin. It's about music being realized, and abstraction becoming reality, through the violin. He happens to play it extremely well, but that's not the point."
Tetzlaff began eying Ligeti's Violin Concerto in the mid-nineteen-nineties, when the first soloist's exclusive rights to the piece were about to expire. When he obtained the printed music, however, he noticed some puzzling conflicts between the published solo part and Ligeti's handwritten full score. Ligeti, a severe Hungarian who died in 2006, had revised the work after the first soloist informed him that the piece was unplayable. But for Tetzlaff the earlier version was not only playable but more effective, so he obtained Ligeti's permission to perform the original.
Tetzlaff came to see the piece as a Janus-faced score, shifting between an older, Bartókian longing for homeland and an avant-gardist's fierce exploratory zeal. He expressed this view to the German press around the time of his first European performances of the piece, in 1999. Not long afterward, a plain postcard appeared in the mail:
Dear Mr. Tetzlaff,
I've read your interview and feel very close to you. Not only do you play my concerto PERFECTLY but you talk about it with so much understanding and compassion. For a living composer it is the most beautiful thing to be so understood by an interpreter.
Warmly, György Ligeti
Most players would frame such a note, but when I visited Tetzlaff last year at his home, outside Frankfurt, he had trouble locating it among his papers. The most prominent thing on the walls of his small second-floor practice room is music itself—choice measures from Schumann's "Dichterliebe," taken from manuscript facsimiles and placed inside discreet frames.
For many years, Tetzlaff, who is forty-six, performed wearing wire-rimmed glasses of the Trotsky-Mahler variety, which fuelled his reputation as an ascetic intellectual. (He now wears contact lenses.) He carries himself in public with cool North German reserve, speaks precise, lightly accented English, and quotes Nietzsche and eighteenth-century violin treatises with equally intimidating fluency. He owns very few recordings of other violinists, finding more inspiration in the score itself, especially since a soloist's determination to dazzle, he believes, often trumps the composer's stated wishes. (He cites, for instance, the habit among soloists of ignoring Tchaikovsky's request that a mute be used during the slow movement of his Violin Concerto.)
Yet the image of Tetzlaff as a crisp and imperiously cerebral soloist grows more complicated when you watch him perform. For much of the 2010-11 season, a huge photograph mounted above the entrance to Carnegie Hall showed him playing with his eyes closed, eyebrows arching skyward in a look of rapture not far from tears. When he plays, the lines on his face can suddenly soften, as if a protective mask had been removed. Sometimes, he attacks the music with a vehemence that seems almost surreally at odds with his offstage restraint. The pianist Lars Vogt, a friend and frequent collaborator, says, "There's hardly anybody I know who knows so much about music but who is also at the same time such an intuitive and wild musician, who comes at it directly from the stomach."
These days, Tetzlaff plays more than a hundred concerts a year, in Europe, North America, and the Far East. He appears with most of the top orchestras, and is capable of flooring critics even with familiar masterworks, which remain at the heart of his repertoire. ("The most extraordinarily intense and dramatic rendition of this great piece I have heard," Ivan Hewett wrote, in the London Daily Telegraph, after Tetzlaff performed the Brahms Violin Concerto at the 2011 Proms.) Musicians express similar enthusiasm, with less formality. After a chamber concert in Amherst, Massachusetts, last year, the young piano soloist Gilles Vonsattel whispered to me, "That was fucking amazing."
Nevertheless, Tetzlaff remains unknown to most casual concertgoers. In addition to avoiding flamboyance, he does not tailor his recitals for the sake of the box office, and his seriousness can turn off those seeking lighter pleasures from a concert. Although he records regularly, he does not have a major label behind him. Most important, he refuses to embrace what might be called the School of the Big Tone: the broad, velvety sound, sustained with uniformly wide vibrato, that many listeners in the age of Itzhak Perlman have come to think is how a violin should sound. Tetzlaff's palette extends to harsh or crushed tones, even to sounds that he has purposefully leached of color. An older French musician of my acquaintance dislikes Tetzlaff's playing precisely because such ugliness is allowed in the door. Critics, too, occasionally balk. Reviewing a recent album of Schumann Trios in the Guardian, Andrew Clements wrote, "What isn't conveyed, though, is any sense of involvement or affection for the music."
For Tetzlaff, a degree of distance can at times be deliberate. He believes that too much prettiness limits a piece's narrative potential. "The listener loses the ear for the most beautiful sounds if they've been used for arbitrary, non-important things," he says. As he once told a roomful of students, with mock severity, "Beauty is the enemy of expression!"
That's not a phrase that makes great marketing copy. Yet Tetzlaff's uncompromising attitude has served him well in the past decade, as too many celebrity soloists have coasted on their reputations, and the crossover star David Garrett has played Pachelbel alongside Metallica. At a time when the modern conservatory system has rendered technical virtuosity a commonplace, Tetzlaff is distinguished by his deep musical empathy—his ability to open a window onto a composer's inner life.
Tetzlaff is not a religious man, but he describes his art in frankly spiritual terms. Performing music, he says, "is the job that has the most to do with the belief in the existence of a soul. I deal in Berg's soul, in Brahms's soul—that's my job. And, you can challenge me, but I find that music is humans' most advanced achievement, more so than painting and writing, because it's more mysterious, more magical, and it acts in such a direct way. Trying to turn lead into gold is nothing compared to taking something mechanical like an instrument—a string and a bow—and using it to evoke a human soul, preserved through the centuries."
One of Tetzlaff's earliest memories is of drifting off to sleep in his family home, in Hamburg, as his parents, both amateur musicians, rehearsed with a chamber choir late into the night, motets of Schütz, Bach, and Brahms floating up the stairs into his darkened room.
For both his mother and his father, singing filled a void. They were young children during the Second World War. His mother has memories of running through the streets of Potsdam to reach her home during air raids, and she lost her father in the German Army. Tetzlaff's father was born in Stettin (now Szczecin, Poland), and, after the war, his family trekked westward, through cities of rubble, before arriving in Hamburg. Tetzlaff's parents met there, in a church choir. "They bravely went their way and suppressed a lot of things," Tetzlaff told me. "But with music, of course, you can let go."
Tetzlaff's father became a Lutheran minister. As a boy, every other Sunday Tetzlaff listened to his father's sermon and performed music in the church service with his three siblings, all of whom became professional musicians. His older sister, Angela, teaches flute at the conservatory in Lübeck; his older brother, Stephan, is the music director of the State Theatre of Bremerhaven; and his younger sister, Tanja, is a cellist with whom he plays in a string quartet.
Tetzlaff started playing the violin when he was six years old, and showed great talent, but he was not pushed to perform high-profile concerts at a young age. He recalls years of practicing less than half an hour a day and often letting his mind wander, memorizing pieces and then playing them while simultaneously reading paperback adventures by the German writer Karl May, many of them set in an imagined Wild West. When Tetzlaff was ten, his parents gave him a two-volume biographical dictionary that surveyed the lives of the great composers. It became a kind of portal. "This was the book I read over and over," he told me. "I really felt so in tune with them—I knew all the dates of their lives, what they had been doing, where they had been. They were always my heroes, creating something fantastic against all odds, and against their real life."
The violinist Heime Müller, a childhood friend and a co-founder of the Artemis String Quartet, remembers hearing Tetzlaff play at this age. "I had never heard anybody sink into the music like that," Müller told me. Around this time, Tetzlaff sight-read the major violin concertos with his brother, Stephan, at the piano and decided that he would become a soloist. "It was just something I thought would be right," he recalls.
This slow-brewed approach to a soloist career is hardly the norm. At the age of thirteen, the German violinist Anne-Sophie Mutter, who is three years Tetzlaff's senior, performed with the Berlin Philharmonic. At that age, Tetzlaff was playing soccer and taking long breaks from practicing solo repertoire in order to perform in a youth orchestra, losing himself in the oceanic symphonies of Bruckner, Brahms, Sibelius, and Mahler. When he turned fourteen, his parents found a new teacher for him, Uwe-Martin Haiberg, the concertmaster of the North German Radio Symphony Orchestra, who told me that he was overwhelmed by Tetzlaff's talent and hesitant to take him on. He described Tetzlaff as a "beautiful and friendly" boy who had already read the complete works of Thomas Mann. (Tetzlaff insists that he was still reading Tolkien at that age, and that his Mann obsession came two years later.) Haiberg found himself cramming before their lessons, studying the music Tetzlaff was learning. "He soaked it all up like a sponge," Haiberg recalls.
During his student years, Tetzlaff tried composition, an experiment that yielded no inspired results but instilled in him a profound respect for the creative process. "Many of us can maybe sometimes imagine sounds, or have some musical ideas," he told me. "But to have them consistently building whole works, and to have the means of transforming something that's in your ear into handcrafted written notes that give back what you heard and what you felt—I find it just utterly miraculous."
At eighteen, Tetzlaff placed second in a major German competition, earning himself professional management and, potentially, the start of a concert career. Instead, he headed for Cincinnati, to study with his teacher's teacher, the violinist Walter Levin. Most players came to Levin intending to study flashy Romantic works, but Tetzlaff took an interest in the prickly violin concerto of Arnold Schoenberg, a piece that was almost never performed at the time. Then, as now, Tetzlaff could not understand the prejudice that many listeners hold against dissonant twentieth-century music, or the tendency to see it as an abrupt break with music's expressive past. As he put it to me, "Emotionally, why would anybody think that all of a sudden humans were less human?"
Toward the end of his student days, Tetzlaff auditioned for two eminent conductors—Sergiu Celibidache, in Munich, and Christoph von Dohnányi, in Cleveland—by playing the Tchaikovsky Violin Concerto. The auditions went well, but both men spotted on Tetzlaff's list of repertoire the far knottier Schoenberg Concerto, and both engaged him to perform it in major concerts. He was twenty-two.
At the time, it was unheard of for a young violinist to play the Schoenberg for his American début. In Cleveland, the critic Donald Rosenberg wrote that Tetzlaff's performance "almost overshadowed" the rest of the program. Another critic, Wilma Salisbury, presumably unaware of his original audition piece, wrote that Tetzlaff played Schoenberg's "dissonant themes as though they were melodious tunes by Tchaikovsky." Bravos broke out after the final chord, many of them from members of the orchestra.
Tetzlaff is still occasionally asked to perform the Schoenberg Concerto, and Esa-Pekka Salonen credits him with re-launching the work into the repertoire. "It had this strange reputation—considered to be unplayable and unlistenable, almost like a failure," Salonen told me. "But, when he started playing it, all of a sudden it became music."
Playing the violin is physically taxing, and the index finger of Tetzlaff's right hand has been warped rightward after years of applying pressure to the stick of the bow. Many soloists have been similarly marked by their profession. But the fingers on Tetzlaff's left hand have a story all their own.
I first met Tetzlaff in 2005, the morning after he gave a recital with Lars Vogt at the Kimmel Center, in Philadelphia. Tetzlaff's playing of the Brahms G-Major Violin Sonata had been so fluid that I was surprised when he told me it had been delivered in acute pain. Since the late nineties, he has suffered intermittently from a form of neurodermatitis that causes the skin on his fingers to become severely dry, especially in colder temperatures. If the symptoms occur while he is playing, he is forced to press harder on the fingerboard to retain the necessary traction, essentially cutting into his fingers with the metal strings.
The pain became so extreme that, in 2002, he began covering the index finger of his left hand with the cut-off fingertip of a cotton glove, fastened with tape at his first knuckle. He used these makeshift cotton thimbles in performance for a year, even while recording the Sibelius Violin Concerto, for Virgin Classics—a concession that might be compared to an Olympic sprinter, in search of ankle support, choosing to compete in hiking boots. Tetzlaff feared that his career was over. "I was on the edge and feeling desperate," he told me, in 2005. "I couldn't go on playing this way."
Eventually, Tetzlaff figured out how to treat his condition, using some unusual techniques. He discovered that practicing while riding an exercise bike helped his circulation, raised his body temperature, and reduced pain, with positive effects long afterward. He arranged for hotels to set up stationary bikes in his room. He also learned to request that house managers warm the concert hall, or at least turn off the air-conditioning, during his performance. Before a concert, if he is worried about losing traction on the instrument, he will dip the fingertips of his left hand in honey.
Tetzlaff lives in Bad Homburg, a leafy suburb of Frankfurt, in a comfortable but not extravagant house that is set back on a quiet street. He is married to Diemut Schneider, a clarinettist who plays in the orchestra of the Frankfurt Opera and speaks with the singsong intonation of southern Germany. Schneider has a sunny disposition, and she and Tetzlaff seem to navigate his international career with stolid pragmatism. On travel days, if her rehearsal schedule allows, she gives him a lift to the airport in the family's Volkswagen minivan.
They first met in the country's National Youth Orchestra, when Tetzlaff was twelve years old and Schneider was fifteen. When he was twenty-five, they married and quickly started a family, just at the point that Tetzlaff was building his international career—a process that is less glamorous than it may appear. Typically, a violinist flies into town, rehearses twice with an orchestra, and performs for a few nights; then it's on to the next city. With three young children at home, Tetzlaff insisted that tours be no longer than ten days. He also perfected the art of the quick exit—walking offstage and heading directly to the airport. Family life, he said, has provided him with emotional ballast: "Even if the concert didn't work out, I knew my life would not take a completely different turn."
Two of the Tetzlaff children—Marie and Simon, both teen-agers—still live at home and are highly musical, playing the oboe and the cello, respectively. (The older son, Leonard, is studying psychology at the University of Frankfurt.) When everyone is practicing at the same time, the Tetzlaff house takes on the beehivelike feel of a conservatory, but that doesn't happen very often. Tetzlaff typically practices less than an hour a day, which leaves him plenty of time to cook big family meals, sight-read chamber music, or play soccer, barefoot, in the back yard with the kids. Sitting at the dining-room table, he said, "When I'm here, the other life is basically gone."
After a few days in Bad Homburg, I flew with Tetzlaff to Vienna, where he was scheduled to play Alban Berg's Violin Concerto with the San Francisco Symphony, which was on tour with its conductor, Michael Tilson Thomas. At the Frankfurt airport, Tetzlaff darted through the terminals with a slim rolling suitcase, his violin case lashed lengthwise to his back, in the manner of a diver's oxygen tank.
On the flight, while passengers around him dozed, he laid out his views of the Berg—a piece written in 1935, the last year of the composer's life, and dedicated to the memory of Manon Gropius, the daughter of Alma Mahler and the architect Walter Gropius. Tetzlaff told me that this dedication is a "smoke screen"; it was Berg's own requiem. He holds the view that Berg laced the work with private memories, reminiscences of a clandestine love affair, and even a violent vision of death itself, during which the solo line leaps to a stratospherically high B, marked fortississimo_,_ in a desperate cry for help.
Tetzlaff cited musicologists and paraphrased Berg's letters to his secret lover, Hanna Fuchs-Robettin, sprinkling in memorized details from the score with the detached rigor of a cryptologist. "Berg's number, of course, was twenty-three," he said. "Everything important in his life always happened on the twenty-third, or when he was twenty-three, or in connection with that number. His first asthma attack happened when he was twenty-three. It is actually composed in the Violin Concerto, in the last movement. At measure twenty-three."
Tetzlaff can pivot quickly from abstract subjects to a much more personal register, and in the course of many discussions I began to wonder whether this tendency was connected to the years he'd spent performing music—responding, in real time, to calls for rapid shifts in emotion. On the plane, Tetzlaff allowed his theorizing to take an intimate turn when he explained that the secrets embedded in Berg's score were not intended for the listeners in the hall. They were there for the performer, whom Berg was addressing as a confidant. Interpretation, Tetzlaff believes, should ultimately be an act of compassion. "This concerto has always touched me," he said. "But the more I know about how Berg was really speaking from friend to friend about his own life, the more I'm enticed to try to be with him."
After landing in Vienna, Tetzlaff checked into a hotel, ate some schnitzel, and walked to the Konzerthaus, an imposing Art Nouveau building about five miles from the apartment where Berg lived for most of his life. It turned out that Tetzlaff had given more thought to the number twenty-three than to the matter of packing his concert suit pants. A replacement pair of trousers was hastily borrowed from an usher of complementary size and sartorial leanings. At around eight o'clock, Tetzlaff, seemingly unruffled, walked onto the stage of the gilded Great Hall to assume his spot in front of the San Francisco Symphony. He bowed politely, and the music began.
It is ferociously difficult to become a professional violin soloist, but, once you have achieved the coveted spot at the front of the orchestra, a new set of rules applies. Because the most popular Romantic concertos are so beloved, and their basic effects are so indestructible, if a soloist can play the notes with a modicum of accuracy, a pleasing tone, and the appearance of conviction, an ovation is almost guaranteed. If he or she is a classical-music celebrity, or a prodigy, it is a certainty. Against this backdrop, to give a performance that takes risks, courts vulnerability, or offers an unusual interpretation can seem like an act of reckless overexertion.
Tetzlaff remains unseduced by low expectations. In Vienna, he unspooled the melancholy confessions of Berg's opening pages in long, meltingly tender lines. When the solo part touched on a Carinthian folk melody that may be a coded reference to the domestic servant who was Berg's first love, and with whom he secretly fathered a child as a teen-ager, Tetzlaff's tone darkened and deepened. When Berg's score slid toward atonal cataclysm, capped by the death moment, Tetzlaff repeatedly folded his torso, then snapped straight, tearing at his instrument with unchecked fury.
Haiberg, his former teacher, once told me, "This is the great mystery of Christian Tetzlaff. He can create a catastrophe on his violin where he has never known one in real life."
At one point, I asked Tetzlaff about this quality. "Some may see the tortured existence of the musician as one where he's practicing like hell and being alone," he said. "I see it quite differently. Having three children, beautiful as it is, burdens you with terrible things often, with strong decisions and sleepless nights. This is real life. And then, of course—this is getting into very personal things—I see many parts of me that are what would be called the 'dark side.' I had a happy childhood, but what was happening in my family, my parents, and also the dark things that happened—between them and where they come from, the war—there is a lot that I could not put in easy words. But it's what most of us carry. It's just whether you have the ability to voice it in the music." Or maybe, he said, it just comes down to disposition—"whether you allow yourself to be touched by things, to be receptive to other people, to be in the pain of a composer."
When Tetzlaff took his bows in Vienna, the crowd seemed at once knocked off balance by the force of the Berg performance and relieved by the ritual comfort of applause. For an encore, Tetzlaff chose the tranquil Largo from Bach's C-Major Sonata for Solo Violin, and he played this wise, consolatory music with his eyes closed.
One of Tetzlaff's most striking technical gifts is an ability to project extremely soft sounds in a large hall; it's like whispering in a way so that two thousand people can still hear you. The feat involves subtle negotiations of bow speed, distribution, and pressure. The violinist Pamela Frank, who has known Tetzlaff since he was a teen-ager, told me, "Projection is one-third intellectual, one-third your soul, and one-third what you do with the right hand to spin those thoughts and feeling into sound." She added, "Christian is like a math genius of the bow."
Three measures before the end of his Bach encore, Tetzlaff tapered his sound down to a pianissimo so shiveringly soft and guileless that the massive hall appeared to shrink to the size of a chamber. I thought of something Tetzlaff had said earlier in the day: "I think that Bach wrote this movement for Berg."
Bach's solo sonatas and partitas, finished around 1720, stand at the heart of the violin literature. Studied by advanced players everywhere, they remain difficult to master: Bach's dense interweaving of multiple voices requires a single violin essentially to play beyond itself, to conjure a crowd. The six pieces add up to more than two hours of music, and are rarely tackled as a whole, but Tetzlaff has performed the full cycle widely, and recorded it twice. He sees the cycle as Bach's "personal prayer book."
Tetzlaff's mystical side comes out most strongly when he speaks of Bach. The violinist Isabel Trautwein, a friend and a former student of Tetzlaff's, recalls a lesson in which he amazed her by pointing out a series of hidden calligraphic details in Bach's manuscript. As the cycle progresses, the pen strokes that Bach used to form the letter "P" in the word "partita" gradually pull apart, until the lines of the "P" resemble his initials: "J.S." This paled, however, next to Tetzlaff's showstopper: he pointed out an apparent mistake on Bach's title page. Its two largest words are Sei Solo, usually translated as "Six Solos." Yet, in grammatically accurate Italian, Tetzlaff told her, the second word should be the plural, Soli. Or was it not a mistake? "The whole thing is a calligraphic masterpiece," Tetzlaff said, when I asked him about it. "And then for Bach to put Sei Solo, speaking Italian like an idiot? It just cannot be." Tetzlaff prefers the explanation that Bach had in mind a kind of spiritual double-entendre, since Sei Solo can also be rendered as "You are alone."
Shortly after the Berg performance in Vienna, I attended one of Tetzlaff's complete Bach performances, in Dresden. The concert took place in the Annenkirche, a medium-sized church near the city center, and I was surprised to find the space only about two-thirds full. More publicity no doubt would have helped, but billboards in town were aggressively promoting an appearance, six months later, of the genre-hopping celebrity violinist Nigel Kennedy.
The listeners who had turned out were enthusiastic and relatively young, and Tetzlaff seemed unperturbed by their modest numbers as he took his place at the front of the church. Previous generations of Bach interpreters have emphasized the music's steady Baroque symmetries and violinistic brilliance, but in Tetzlaff's hands Bach's faster movements leaped and swayed, as if recalling their past lives as dances. The slower movements were almost uncomfortably introverted, especially the monumental Chaconne of the D-Minor Partita. The scholar Helga Thoene has speculated that this movement was written just after Bach learned of the death of his first wife, and Tetzlaff's playing seemed to settle the matter, as familiar chromatic melodies took on a hushed and grief-stricken quality, the vast set of arpeggiations spread out with tragic grandeur.
After the epic Chaconne, the next sonata, nominally a fresh start in C major, might seem like a chance to clear the air. Tetzlaff initially emphasized its harmonic strangeness, making it seem as if the music could not escape the Chaconne's dark gravitational pull. Then he broke free in the second movement, a fugue full of jubilant chords and athletic string-crossings. It was hot inside the church, and beads of sweat collected on the tip of Tetzlaff's nose, each one falling, with a little splash, onto his suit jacket.
A marathon Bach recital could easily try the endurance of people seated in hard pews, but the concertgoers in Dresden sat in rapt silence. I attributed this to a distinctive aspect of Tetzlaff's charisma. Onstage, many violin soloists adopt a confident swagger, but in Dresden Tetzlaff, as whenever he plays Bach, seemed to expose layer after layer of vulnerability, creating an atmosphere of naked confession.
"Bach's music confronts the player and the audience in a very personal situation, in a very alone way," he explained. "And I try at that moment to put away pretensions—in levels of violin playing, pretensions of being a strong man, of being invulnerable—and instead say, 'This is where all of us have common ground.' Most of the time, we try to tell ourselves 'I'm confident' or 'I'm doing well.' But then, in a moment alone at home, you feel how close you are to some kind of abyss."
He continued, "Music, even at terrible moments, can make you accept so much more—accept your dark sides, or the things that happen to you. Maybe it's just because you see that this is a common trait for all of us. You see that we are not alone." He said this with such quiet intensity that it seemed the opposite of sentimental. "And that's what the concert situation is about for me, when I'm sitting in the hall and also when I'm playing myself. It's about communication—I almost want to say 'communion.' As a player, you really don't interpret anymore. You listen, together, with the audience." ♦


text:
Federal authorities are piecing together a new timeline of Monday's mass shooting at the Washington, D.C., Navy Yard as they learn more about the movements of gunman Aaron Alexis that day.
They say the first call for help came at 8:21 a.m. that morning, and it took officers another 30 minutes to find Alexis.
Investigators believe that Alexis was concealing a shotgun with a sawed-off barrel and stock when he entered the building, though they still don't know if that gun was in the bag he was carrying or concealed in his clothing. And they know that the people he shot and killed were mostly on the third and fourth floors.
In a tragic twist, one of Alexis' victims was standing outside Building 197, in an alley, when he was shot by a bullet that passed through a door, the FBI told NBC News' Pete Williams Thursday.
U.S. & World
The gunman was shot by a team comprising U.S. Park Police and D.C.'s Metropolitan Police who found him in an area filled with cubicles, U.S. Park Police said.
The team had to clear each cubicle, one by one, until Alexis engaged them and they shot him.
In all, 12 victims were killed, eight were injured and Alexis was shot and killed in the shooting Monday morning, the deadliest single event in Washington in decades.
Williams reports Alexis did not speak during the shooting, contradicting previous reports.
The new information, provided to Williams Thursday and in a U.S. Park Police press conference, is slightly different from some of what was reported earlier this week. The gunman never shot down into the atrium of Building 197, investigators now believe. And they know more about his weapons, one of which was taken from a victim.
Here is the new timeline of events during Monday's shooting:
At about 8 a.m., Alexis drove onto base and parked in a garage next to Building 197, the headquarters of the Naval Sea Systems Command. He swiped himself into the building using a valid pass, and carrying his bag.
Alexis went to a bathroom on the fourth floor. When he left the bathroom, he started shooting.
Alexis shot his victims mostly on the fourth and third floors, shooting randomly and with no apparent pattern, federal investigators said. At one point, he went to the first floor and shot a security guard, taking the guard's Beretta handgun, which he didn't use until he ran out of shotgun shells he was storing inside his cargo pants.
The shooting continued for 30 minutes before police and other first responders encountered Alexis, hidden in a maze of cubicles. Authorities have still not said which of the mulitple law enforcement agents shot and killed the gunman, but have confirmed "friendly gunfire" did not hit any of the victims.
They continue to probe Alexis' motive as well. Williams reports the shotgun Alexis used had the words "better off this way" and "my ELF weapon" carved into it, though it's not clear what those sayings mean. They believe he was suffering from serious mental problems, including paranoia and a sleep disorder.
It has been reported Alexis' background check years ago was done by the same company that cleared Edward Snowden.
Meanwhile, the families of 12 men and women killed were briefed by the FBI today and assigned Navy officers to help them. The first memorial service for a victim was held on Thursday.
The survivors, witnesses and first responders continue to grapple with the chaos and tragedy that they experienced.
The U.S. Park Police Officer who was one of the officers who shot Alexis had only been on the job three years and three months, and had to pass by people asking for help so they could enter the building to get to Alexis, Glick said. "That weighs heavy on your mind."
The Navy Yard reopened for business Thursday after being closed since Monday, though Building 197 still is considered a crime scene.

subset: commoncrawl


text:
Pointed Toe Square Heel Buckle Women's Pumps Thick DoraTasia nsacbo1423-New Shoes
At Retirement Planning Center of the Rockies, we understand that retirees face many important decisions that can affect their long-term financial success. Some of these decisions revolve around creating an income they can't outlive, as well as creating strategies to help protect against the impacts of inflation, taxation, and rising healthcare costs.
Because over ninety percent of our clients are retirees with similar concerns, we are in a good position to approach such challenges with experience and skill.
Most of our clients lack the time, the desire, or the experience to manage many of these financial decisions. We consider it an honor and a privilege to help them analyze their options and make sound choices that will help contribute to a secure and enjoyable future.
At Retirement Planning Center of the Rockies, we have made a commitment to excellence in everything we do. Our goal is to exceed our clients' expectations at all times, and most importantly, help them "Sleep Well At Night."
Shiney 2018 Women's New Martin Boots Warm Cotton shoes with Lace Side Zipper Thick Stick Boots for Autumn and Winter
DoraTasia Women's Lace up Pointed Toe Ankle Heel Boots
What's the deal with your yearly free credit report?
Preparing for the eventual distribution of your assets may not sound enticing. But a will puts the power in your hands.
Xiaoyouny Fashionable Women's Soft Material Buckle Peep Toe High-Heels Assorted color Sandals
Simple steps may help you foil hackers and protect your privacy.


text:
Elevator Constructor Apprentice
- Lakewood,CA
- Aug , 5
- Skilled Trades : General Skilled Trades
Applications for the International Union of Elevator Constructors Joint Apprentice Training Program for NEIEP LOCAL 18 LOS ANGELES, CA will be accepted from 9:00AM AUGUST 26, 2019 through 9:00AM SEPTEMBER 4, 2019. This recruitment will close once the first 1,000 applications are submitted.
Elevator Constructor Apprentices are responsible for assisting in the installation, maintenance, and repair of passenger and freight elevators, escalators, dumbwaiters, and moving sidewalks under the direction of a Mechanic.
This description is intended to describe the general content, identify the essential functions, and set forth the requirements for performance of the Elevator Constructor Apprentice position. Other duties may be assigned and this is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.
- Manually loads, unloads and moves materials, equipment and tools from vehicles to work areas. Requires lifting parts weighing up to 100 lbs.
- Manually cleans elevator car tops, machine rooms, pits, rails, and hoistways within non-controlled climate field setting.
- Manually paints machine rooms and pit.
- Uses periods of high concentration and knowledge of elevator systems to assist Mechanic in electrical and mechanical installation, repair or service operations. Requires following written or verbal directions of mechanic and/or field superintendent. Requires color perception to distinguish color-coded wiring components.
- Maintains elevator lighting fixtures.
- Visually and audibly monitors equipment operation to determine faulty functioning. Requires ability to withstand heights and cramped working conditions.
- Applicants must be 18 years of age to apply.
- Applicants must possess and upload an original copy of a H.S. Diploma, H.S. Transcript, or GED with their online application.
- Applicants must pass an examination designed to test reading, math skills, and aptitude for employment in the elevator industry.
- Applicants will take a Tool Assessment designed to assess knowledge of basic tools and their use, as well as basic measuring skills.
- All Applicants must be capable of performing the physical requirements of the job without posing a threat to the health and safety of themselves or others.
- Upon selection, applicants must pass a drug test. (Paid by the employer)
- A photo ID must be presented during the application process.
- The exam will be administered at a later date.
Employment as an Elevator Constructor presents an extremely challenging, yet highly rewarding career to individuals with strong ambition, solid skills, and a willingness to learn. Our Apprenticeship Training Program provides highly qualified mechanics to an industry that insists on superior quality and craftsmanship.
For more information and to APPLY ONLINE go to: https://www.neiep.org/careers.aspx. Click on the "All Other Apprenticeships" tab. Select the LOS ANGELES, CA recruitment.
Applications will be accepted from 9:00AM AUGUST 26, 2019 through 9:00AM SEPTEMBER 4, 2019. This recruitment will close once the first 1,000 applications are submitted.
Any questions regarding the application process please e-mail the Local Area Coordinator at email@example.com
The Elevator Industry is committed to a policy of Equal Employment Opportunity, and all qualified applicants will receive consideration without regard to race, color, religion, age (40 or older), sex (including pregnancy and gender identity), military/veteran status, sexual orientation, gender, national origin, status as an individual with a disability, marital status, arrest record, genetic information, or any other legally protected status.
The Elevator Constructors are an Equal Opportunity Employer and a Drug Free Workplace.


text:
The 2012 Gratitude Special - Snap #328
"'Tis the Season!" This week Snap Judgment proudly presents the ALL-NEW "2012 Gratitude Special" from PRX and NPR.
Non-Traditional Teachings
A fellow student gives Glynn insight into what really matters.
Producer: Mark Ristich
A young aid worker goes to teach school in a Kenyan village, and finds the roles reversed when the students teach the most valuable lesson of all.
Producer: Anna Sussman
Team Rubicon
Jake Wood, a decorated Marine Corps Scout-Sniper comes home from war, and returns to a new kind of battlefield, using his wartime skills to save countless lives.
(Big thanks to Jake Wood and William McNulty.)
Produced by Anna Sussman and Glynn Washington
Stealing Ann
Stealing is not cool..unless it saves a life, or two. Animator and storyteller Scott Kravitz explains why he stole from a homeless person, and wins over our Snap Judgment audience with his sneaky charisma.
Original Music by Alex Mandel
Performed Live by Alex Mandel and The Snap Judgment Players
Dark Shadow by April Wolfe
April Wolfe's car literally had a mind of its own. April knew exactly whose mind it was--her Aunt Janice's. Only thing was, Aunt Janice had died years ago.
Produced by Stephanie Foo
White Lines by Storn White
When he hears the roar, Storn White knows he made a mistake, and prays for the mountain to forgive him. The mountain has other plans.
Story by Storn White.
Producer: Mark Ristich
Interview: Glynn Washington


text:
Re-do search in this area
Bennett Cove
Monticello, GA
Ocean/Waterfront View, Outdoor
Starting from $3,777 to $8,227 for 50 guests
Bennett Cove is Atlanta's serene destination wedding venue. Experience the ultimate southern hospitality and elegance away from the hustle and bustle of Atlanta. Located just an hour from the city, it's the perfect location for you and your guests to celebrate and exchange vows! The gated estate and...
Showing other similar Wedding Venues Venues in Georgia
Chota Falls Estate
Clayton, GA
Event Center, Private Estate, Church/Temple, Mountain, Vintage/Rustic, Outdoor
Starting from $22,841 to $35,996 for 50 guests
Full weekend rental with lodging for up to 30 guests! Could there be anything dreamier than exchanging vows in front of a cascading private waterfall? Or dancing beneath chandeliers in a two-story ballroom and then bonding with your loved at a starlit bonfire afterparty? Only one thing: the ability ...
Hyatt Regency Savannah
Savannah, GA
Hotel/Resort, Event Center, Ocean/Waterfront View, Ballrooms, Modern
Starting from $8,025 to $13,225 for 50 guests
Welcome to the charming South! Hyatt Regency Savannah is a sophisticated and contemporary oasis sitting on the Savannah River, steps away from River Street and the Historic District. Everything you need for a memorable wedding weekend is available, from rehearsal dinner to morning-after brunch. Wedd...
The Temple Macon
Macon, GA
Ballrooms, Outdoor, Modern
Starting from $7,327 to $10,040 for 50 guests
Celebrate your once in a lifetime event at the Temple Macon in Macon, Georgia. Built in 1930, this former Al Sihah Shrine temple boasts a magnificent Grand Ballroom with 27-foot decorative ceilings, beautiful murals created by one of Georgia's most prominent artists, and gorgeous hardwood floors. Ab...
Lanier Islands
Buford, GA
Hotel/Resort, Golf Course, Park/Garden, Ocean/Waterfront View, Ballrooms, Outdoor
Starting from $7,374 to $9,202 for 50 guests
Bring your nuptials to Lanier Island and create a lifetime of memories when you host your wedding celebration at this stunning lakeside destination. Breathe in the crisp air and marvel at the wooded surroundings that create an idyllic backdrop for your wedding ceremony. The 1,500-acre property boast...
Hashemites Banquet Hall
Duluth, GA
Banquet Hall/Restaurant, Event Center, Ballrooms, Outdoor, Modern
Starting from $9,095 to $10,974 for 50 guests
Exceptional service and beautiful event space make Hashemite's Banquet Hall a spectacular place to tie the knot. Located in Duluth, Georgia, this flexible venue boasts a gorgeous ballroom with stunning crystal chandeliers, white porcelain floor tiles, and elegant drapings; it's perfect for both your...
Atlanta Marriott Northwest at Galleria
Atlanta, GA
Banquet Hall/Restaurant, Hotel/Resort, Event Center, Modern
Starting from $4,485 to $6,654 for 50 guests
Planning the wedding of your dreams will be a breeze at the Atlanta Marriott Northwest at Galleria in Marietta, Georgia. Featuring over 18,000 square feet of well-appointed event space, including three elegant ballrooms, this upscale hotel can accommodate intimate parties, elaborate celebrations, an...
Hyatt Regency Atlanta Perimeter at Villa...
Atlanta, GA
Hotel/Resort, Event Center, Park/Garden, Ballrooms, Outdoor, Modern
Starting from $20,588 to $29,092 for 50 guests
Gracious Southern hospitality defines the welcome you will receive at the newly opened Hyatt Atlanta Perimeter at Villa Christina. Located inside the Perimeter and just minutes from ultra-chic Buckhead, Atlanta's new luxury urban resort offers all the comforts of a resort nestled in the quiet cove o...
The Factory at Walton Mill
Monroe, GA
Banquet Hall/Restaurant, Event Center, Ballrooms, Modern
Starting from $2,152 to $5,655 for 50 guests
Find industrial elegance at The Factory at Walton Mill, Monroe's newest wedding venue located at the historic Walton Mill! Nestled amidst a row of gorgeously renovated warehouses, The Factory at Walton Mill retains its original industrial charm while boasting fresh, sleek amenities to make your day ...
Dunaway Gardens
Newnan, GA
Park/Garden, Outdoor
Starting from $4,353 to $10,265 for 50 guests
The majestic Dunaway Gardens have exclusive grounds perfect for your elegant celebration. Guests can wander across the 25 acres of lush botanical garden and discover the hidden jewels of the beautiful rock and floral gardens. Choose from the popular hidden Hanging Gardens, ancient Wedding Tree, hist...
Prime Experiences at the City Gardens of...
Fayetteville, GA
Banquet Hall/Restaurant, Event Center, Outdoor
Thank you for considering Prime Experiences! Over the last five years, we have coordinated over 500 weddings or events. We believe the "Little Things Matter" in creating an amazing wedding celebration with minimal stress, worry or work for you. Our team consists of a certified experience creat...
Twelve Hotels Atlantic Station
Atlanta, GA
Banquet Hall/Restaurant, Hotel/Resort, City/Skyline View, Ballrooms, Outdoor, Modern
Starting from $1,235 to $6,217 for 50 guests
A chic and timeless locale located in Midtown Atlanta, the stylish Twelve Hotels Atlantic Station is sure to impress your family and friends. This highly customizable venue is ideal for midsize weddings. Out-of-towners will love the convenience of staying in the Twelve Hotel and will especially enjo...
Venue 92
Woodstock, GA
Banquet Hall/Restaurant, Event Center, Park/Garden, Loft, Outdoor, Modern
Starting from $5,102 to $7,278 for 50 guests
Say, "I Do," at Venue 92. The gorgeous special events facility, Venue 92, is the perfect place to start your happily ever after. Your entire wedding celebration from ceremony, to cocktail hour, to reception, can all be accommodated right on site. The stunning venue boasts two levels of polished ceme...
In The Woods
Rockmart, GA
Banquet Hall/Restaurant, Event Center, Vintage/Rustic, Outdoor
Starting from $11,036 to $18,170 for 50 guests
Hidden away in the foothills of Georgia, In The Woods awaits to host your dream rustic wedding. You'll pull through the charming wooden gates at the entrance and immediately feel the peacefulness of the natural landscape. 250 acres of beautiful greenery and lush woodlands surround you, casting a fai...
Ray's On The River
Sandy Springs, GA
Banquet Hall/Restaurant, Park/Garden, Ocean/Waterfront View
Starting from $12,116 to $21,647 for 50 guests
Ideal for an intimate waterfront wedding, Ray's on the River offers a picturesque wedding venue nestled against the Chattahoochee River. As an Atlanta Tradition since 1984, Ray's on the River offers serene views while enjoying a menu filled with fresh seafood flown-in daily, prime cut steaks & chops...
Hightower Falls
Cedartown, GA
Historic/Landmark Building, Barn/Farm/Ranch, Park/Garden, Ocean/Waterfront View, Vintage/Rustic, Out...
Starting from $7,277 to $10,177 for 50 guests
Hightower Falls is a lovely wedding venue located in the foothills of the Appalachian mountains. The natural ambiance Hightower Falls provides your wedding celebration is stunning. The 80-foot cascading spring-fed fall runs by an 1850 stone grist mill. Imagine an outdoor ceremony in this picturesque...
Willow Falls Resort & Wedding Venue
Blue Ridge, GA
Banquet Hall/Restaurant, Barn/Farm/Ranch, Park/Garden, Ocean/Waterfront View, Vintage/Rustic, Outdoo...
Starting from $5,612 to $11,300 for 50 guests
Dazzling sunsets and the endless north Georgia mountains make a stunning backdrop for your wedding weekend. This is a place for those who love the outdoors — a little rough-and-tumble, with activities like river rafting and mountain biking on the agenda! The property's 50 acres feature a pond and la...
Georgia International Horse Park
Conyers, GA
Event Center, Outdoor
Starting from $2,787 to $5,999 for 50 guests
For equestrians, horse-lovers, and all who appreciate simple Southern elegance, the Georgia International Horse Park boasts several venues for a refined, fabulous affair. The Carriage Room can accommodate up to 250 guests and provides a view of the charming courtyard. It can double as a banquet room...
Historic Dekalb Courthouse
Decatur, GA
Historic/Landmark Building, Museum/Gallery, City/Skyline View
Starting from $4,870 to $7,345 for 50 guests
Nestled in DeKalb County, Georgia resides the DeKalb History Center. This historic Old Courthouse is a beautiful building, perfect for your special day. The luxurious interior adds romance to every wedding celebration. The DeKalb History Center has a lovely ballroom and is close to the downtown of D...
Del'avant Event Center
LaGrange, GA
Event Center, Loft, Modern
Starting from $2,120 to $5,960 for 50 guests
Celebrate your nuptials in a place where southern charm and elegance meet, Del'avant Event Center. Nestled in downtown LaGrange, the charm and character of the historic Del'avant Event Center makes the stunning venue a unique choice for your wedding celebration. The spectacular Del'avant Event Cente...
Suada Studio
Atlanta, GA
Banquet Hall/Restaurant, Event Center, Ballrooms, Modern
Starting from $8,754 to $17,060 for 50 guests
Everyone wants an incomparable event combined with fantasy and style. We create stunning, one-of-a-kind events produced and styled to perfection. From traditional to modern, elegant to relaxed, our focus is on the exquisite execution of any event we plan. Our venue offers 'extras' in our wedding ...
Shamrock Community Use Building
Jonesboro, GA
Event Center, Community Center, Outdoor
Starting from $1,629 to $6,107 for 50 guests
The Clayton County Water Authority's Shamrock Community Use Building (CUB) is nestled in the woods between Blalock Reservoir and Shamrock Lake. The beautifully-appointed facility features a finished basement and loft area that overlooks the great room, as well as a wrap-around deck with two covered ...
Lillian Gardens
Newnan, GA
Historic/Landmark Building, Event Center, Mansion, Park/Garden, Ballrooms, Outdoor
Starting from $4,000 to $8,329 for 50 guests
Make an 1859 antebellum Georgian mansion the site of your wedding day celebration. Lillian Gardens in Newnan, Georgia is a charming combination of old elegance and fresh style. Imagine a wedding ceremony held on the mansion lawn. You and your guests will enjoy an intimate ceremony surrounded by mani...
173 Carlyle House
Norcross, GA
Banquet Hall/Restaurant, Historic/Landmark Building, Event Center, Park/Garden, Ballrooms, Outdoor
Starting from $3,254 to $9,967 for 50 guests
Carlyle House is a special events facility in historical downtown Norcross. The house was built in the 1800's and has been beautifully renovated with exquisite imported chandeliers in the large grand ballroom and all five of the more intimate sized rooms. The charming turn-of-the-century structure h...
Wahoo! Events
Decatur, GA
Banquet Hall/Restaurant, Park/Garden, Vintage/Rustic, Outdoor
Starting from $3,852 to $8,025 for 50 guests
Wahoo! is an enchanting site for a garden wedding celebration. Enjoy the romantic scenery of this green paradise. We feature a stunning garden with a stone patio, brick walls, romantic vines, lush flowers and mossy rocks. You and your guests will be swept away by this enchanting venue! Exchange vows...
Atlanta Botanical Garden
Atlanta, GA
Event Center, Park/Garden, Ballrooms, Outdoor
Starting from $7,365 to $9,541 for 50 guests
When a perfect event is ready to bloom there's no better place to celebrate than the Atlanta Botanical Garden. The Garden is the most beautiful venue in Atlanta and a celebration here will take your breath away. Natural beauty is in constant evolution at this urban oasis. Centrally located in the he...
Toccoa House Properties
Blue Ridge, GA
Private Estate, Ocean/Waterfront View, Bed & Breakfast/Inn, Mountain, Vintage/Rustic, Outdoor
Starting from $5,815 to $8,520 for 50 guests
Nestled in the mountains of Blue Ridge, Georgia, Toccoa House Properties is ready to host your wedding festivities with its five distinct rental cabins and 16 acres of secluded mountain paradise. With convenient access to the river as well as great restaurants, downtown shops, and more, Toccoa House...
Glen Mary Historic Home and Gardens
Sparta, GA
Historic/Landmark Building, Park/Garden, Plantation, Vintage/Rustic, Outdoor
Starting from $5,046 to $5,496 for 50 guests
Indulge your craving for Southern charm and elegance at the iconic Glen Mary estate. Situated on a hilltop overlooking the beautiful Georgia countryside, Glen Mary boasts a grand, historic manor, lush gardens, and an original barn to add a touch of rustic chic. Built around 1848, Glen Mary is regard...
Gwinnett Environmental & Heritage Center
Buford, GA
Event Center, Museum/Gallery, Ballrooms, Vintage/Rustic, Outdoor, Modern
Starting from $4,343 to $6,881 for 50 guests
One of metro-Atlanta's most enchanting event venues, the Gwinnett Environmental and Heritage Center provides the perfect location for an extraordinary indoor or outdoor wedding and reception with a variety of spaces for your dreams of a contemporary, nature infused, or vintage inspired theme. Co...
The Sky Room
Atlanta, GA
Event Center, City/Skyline View, Modern
Starting from $8,102 to $12,963 for 50 guests
Elevate your event. We invite you to visit our stunning event space on the 25th floor of the Crowne Plaza Atlanta Midtown with over 4,800 square feet of space featuring floor-to-ceiling windows and a 360 degree view of Atlanta's Magnificent skyline. The Sky Room offers a breathtaking backdrop for yo...
Gb Event Facility
Decatur, GA
Event Center
Starting from $1,995 to $5,670 for 50 guests
Whether you're looking for the ultimate reception hall or the perfect place to hold all the festivities for your special day, GB Event Facility may be the perfect venue for you. The beautiful, multifaceted facility boasts four elegantly-appointed rooms, each decorated with a unique theme. You are fr...
Inn at the Peachtrees, an Ascend Hotel C...
Atlanta, GA
Hotel/Resort, Bed & Breakfast/Inn, Outdoor
Starting from $1,451 to $4,677 for 50 guests
Inn at the Peachtrees is a hotel that is downtown Atlanta, Georgia's best kept secret. A proud member of the Ascend Hotel Collection, you can expect to receive the best service, hospitality, and amenities of Georgia! An oasis among the soaring skyscrapers, Inn at the Peachtrees makes a perfect place...
The Highland Inn Ballroom Lounge
Atlanta, GA
Historic/Landmark Building, Ballrooms, Bed & Breakfast/Inn, Vintage/Rustic, Outdoor
Starting from $2,423 to $5,498 for 50 guests
Looking for an alternative to traditional hotel venues? You've found it! The Highland Inn Ballroom Lounge is a unique private events venue located beneath the historic Highland Inn Hotel in Atlanta, Georgia. Built in 1927, the Ballroom Lounge has a distinctive retro style, roughly broken down to o...
Gwinnett Historic Courthouse
Lawrenceville, GA
Historic/Landmark Building, Event Center, Park/Garden, Ballrooms, Vintage/Rustic, Outdoor
Starting from $1,552 to $3,251 for 50 guests
Let the lush landscape and rich history of Gwinnett Historic Courtyard set a memorable backdrop for your big day! Romance and charm flow from every corner, leaving no shortage of picture-perfect backdrops for your photos. With an outdoor gazebo framed by trees and a courthouse that boasts vintage ch...
Unity Atlanta Church
Norcross, GA
Starting from $920 to $2,685 for 50 guests
The Unity Atlanta Church is a church where a close knit community values lie in the statement: "Faith is our foundation; Love is our creed; Serving is our way of life." Start your commitment to one another in this house of love. Drive up a road lined with tall swaying trees to arrive at a property w...


text:
If you are a subscriber to the JCSM (including members of the AASM), please login to access the journal.
Click here to Subscribe:
$75/volume year for individuals or $140/volume year for institutions to access all current articles and archives published in JCSM.
Click Here to DOWNLOAD the article*:
$20 to access a PDF version of a specific article from the current issue of JCSM.
*Purchase of an electronic download of JCSM provides permission to access and print the issue/article for personal scholarly, research and educational use. Please note: access to the article is from the computer on which the article is purchased ONLY. Purchase of the article does not permit distribution, electronic or otherwise, of the article without the written permission of the AASM. Further, purchase does not permit the posting of article text on an online forum or website.
Subscribers can download and print full articles from current and past issues of the JCSM
Login to JCSM
Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership
Obstructive sleep apnea (OSA) is prevalent in the surgical population, and it has been suggested that preoperative patients should be screened and treated for OSA. However, it remains unclear whether patients diagnosed with OSA in the preoperative period adhere to prescribed CPAP therapy.
Our aim was to objectively quantify CPAP adherence, investigate predictors of poor CPAP adherence, and to establish an optimal CPAP setting in a cohort of presurgical patients diagnosed with OSA as part of the preoperative work-up.
In a retrospective observational study, we collected data on all adult presurgical patients seen by the Anesthesia Perioperative Medicine Clinic (APMC) who screened positive for OSA on the STOP-Bang questionnaire and underwent an in-laboratory diagnostic polysomnogram (PSG) before surgery. CPAP was offered to patients with moderate or severe OSA. Objective CPAP adherence was recorded during the perioperative period. Factors associated with reduced CPAP adherence were delineated. Patient characteristics were compared between those with STOP-Bang scores of 3-4 and those with higher scores (STOP-Bang score ≥ 5).
During a 2-year period, 431 patients were referred and 211 patients completed a PSG. CPAP therapy was required in 65% of patients, and the optimal level was 9 ± 2 cm H2O. Objective CPAP adherence was available in 75% of patients who received CPAP therapy; median adherence was 2.5 h per night, without any significant difference between the STOP-Bang subgroups. African American race, male gender, and depressive symptomatology were independent predictors of reduced CPAP adherence. Severe OSA was significantly more prevalent in patients with a STOP-Bang score ≥ 5 than those whose score was 3-4 (55.1% versus 34.4%, p = 0.005). However, optimum CPAP pressure levels and adherence to therapy did not differ between the 2 STOP-Bang groups.
Adherence to prescribed CPAP therapy during the perioperative period was extremely low. African American race, male gender, and depressive symptoms were independently associated with reduced CPAP usage. Further research is needed to identify and overcome barriers to CPAP acceptance and adherence in the perioperative setting.
Guralnick AS; Pant M; Minhaj M; Sweitzer BJ; Mokhlesi B. CPAP adherence in patients with newly diagnosed obstructive sleep apnea prior to elective surgery. J Clin Sleep Med 2012;8(5):501-506.
Since its initial description more than 40 years ago, OSA has been gaining more interest among anesthesiologists, and there is accumulating evidence that moderate to severe OSA can increase perioperative complications.1–3 Given the important implications of untreated OSA,4–9 the American Society of Anesthesiologists (ASA) recommends screening presurgical patients for OSA and implementing treatment if significant OSA is present.10 There is lack of consensus on the most appropriate method of screening, diagnosis, and timing of therapy implementation.11 Although most studies have focused on screening and diagnosis of OSA, less is known about CPAP therapy and adherence during the perioperative period.
In this study we aimed to objectively quantify perioperative CPAP adherence and optimal CPAP pressure settings in a cohort of patients diagnosed preoperatively with moderate or severe OSA. We also examined patient characteristics associated with reduced CPAP adherence. We tested the hypothesis that patients with higher scores on the STOP-Bang screening questionnaire, a validated screening tool for the preoperative setting, would have a higher prevalence of moderate or severe OSA than those with lower, yet positive scores and require a higher level of CPAP pressure for successful treatment.
Current Knowledge/Study Rationale: Moderate to severe obstructive sleep apnea (OSA) may increase postoperative complications and there are recommendations suggesting that preoperative patients should undergo screening for OSA and be treated during the perioperative period. To date, it has not been established whether patients newly diagnosed with OSA prior to elective surgery are adherent with CPAP therapy. This study sought to objectively quantify perioperative CPAP adherence in patients with moderate or severe OSA.
Study Impact: Pre-surgical patients with newly diagnosed OSA had very poor adherence to CPAP therapy. These results should encourage future investigations to determine barriers to CPAP adherence in the perioperative period.
Between March 2009 and February 2011, adult presurgical patients who were identified at high risk for OSA by the STOP-Bang screening survey administered during their visit to the Anesthesia Perioperative Medicine Clinic (APMC) were recommended to undergo a diagnostic in-laboratory PSG prior to elective surgery.12,13 Patients with prior diagnosis of OSA were excluded from our cohort. The STOP-Bang surveys were completed by the patients; APMC medical assistants measured the neck circumference, weight, and height, and the body mass index (BMI) was calculated by the preoperative computerized program used by the APMC. A request for an expedited in-laboratory PSG was submitted by the APMC staff to the sleep laboratory, and an appointment for the PSG was made within 3 days of the initial APMC visit as long as the patient was willing to undergo the PSG. In order to avoid any delay in surgery, split-night PSGs (first half of the study to establish diagnosis and the second half dedicated to CPAP titration) were performed on those patients who demonstrated at least moderate OSA (AHI ≥ 15).14 Given the long wait times in the sleep clinic and in order to avoid delaying surgery, the patients were not evaluated by a sleep physician preoperatively. However, patients were seen in consultation by a sleep physician 6 to 8 weeks after surgery.
PSGs were staged and scored according to the 2007 American Academy of Sleep Medicine Manual for the Scoring of Sleep and Related Events.15 Hypopneas were scored if the magnitude of ventilation signal decreased by ≥ 50% of the baseline amplitude of the nasal pressure transducer ≥ 10 sec and were associated with either ≥ 3% drop in oxygen saturation as measured by finger pulse oximetry, or an electroencephalographic microarousal.15 The 3% oxygen desaturation index (ODI) indicated the number of 3% desaturations per hour of sleep. A patient was considered not to have OSA if the AHI was < 5, to have mild OSA if the AHI was 5-14, moderate OSA if the AHI was 15-29, and severe OSA if the AHI was ≥ 30. CPAP titration was considered successful if, on optimal CPAP pressure, the residual AHI was < 5 and included supine REM sleep.16 The sleep studies were reviewed by sleep specialists the day after the PSG, and those with moderate or severe OSA were prescribed and received an auto-titrating CPAP device. The pressure range of the auto-titrating device was determined based on the optimal CPAP level obtained during the titration portion of the PSG. As an example, if the optimal CPAP pressure was 9 cm H2O, the minimum pressure setting of the auto-CPAP device would be set at 2 cm H2O below the optimal pressure and the maximum pressure would be set at 3 cm H2O above the optimal pressure (e.g., 7 to 12 cm H2O). The patients were systematically educated by a trained respiratory therapist on the importance of adherence to therapy during the perioperative period, underwent appropriate mask fitting, and were instructed on how to use their auto-titrating CPAP device. Patients received the auto-titrating CPAP devices the day after the in-laboratory PSG and were instructed to bring their auto-CPAP devices with them on the day of surgery. All patients were contacted by a sleep physician the day after the sleep study to briefly discuss the findings of the polysomnogram and the importance of adhering to CPAP therapy before and after surgery. There were no additional communication between the sleep laboratory staff and the patient until the sleep clinic consultation 6-8 weeks after surgery.
The study was approved by the Institutional Review Board of the University of Chicago (IRB protocol # 11-0120). Given the retrospective nature of the study, the need for informed consent was waived.
On the night of the PSG, patients completed a routine questionnaire, which included demographics, medical history, Epworth Sleepiness Scale (ESS),17 and the Center for Epidemiologic Studies Depression Scale (CES-D), a validated depression questionnaire.18 BMI was calculated using weight and height measurements obtained on the day of the PSG. The patient's neck circumference was obtained from the measurement done in the APMC. The patient's age and sex were obtained from the electronic medical record. Race was self-reported and was categorized into African American and non-African American. Self-reported education level was categorized into "high school degree or less" and "more than high school degree."
CPAP adherence during the first 30 days of therapy was determined objectively when patients were seen in consultation by a sleep physician 6 to 8 weeks after surgery.
Means or proportions of all variables were calculated for the entire cohort and then separately for those with STOP-Bang scores of 3-4 and those with STOP-Bang scores ≥ 5. The distribution of each continuous variable was examined. Continuous variables that were normally distributed were summarized as mean ± standard deviation (SD) and were compared using Student's t-test. Continuous variables that were not normally distributed were summarized as median and interquartile range (IQR) and were compared using the Mann-Whitney nonparametric test. Differences in proportions were tested using the χ2 test. We performed a linear regression model to adjust for possible confounding variables in order to identify independent predictors of CPAP adherence. Differences were considered statistically significant when p value was ≤ 0.05. All analyses were performed using PASW Statistics (v.18.0, SPSS, Inc., Chicago, IL).
Over a 2-year period, 431 patients who screened at high risk for OSA were referred for an in-laboratory PSG. Of the 431 referred patients, 211 scheduled and completed the in-laboratory PSG. The remainder of the patients did not show up for the scheduled polysomnogram (Figure 1). Our population of patients who had a PSG included those undergoing elective orthopedic surgery (29%), genitourinary surgery (18%), general surgery (12%), vascular surgery (8%), head and neck surgeries (7%), gynecologic surgery (5%), thoracic surgery (3%), and all other surgeries (18%). None of the patients underwent a sleep consultation prior to the diagnostic polysomnogram.
Flow diagram of patients in the study that were referred to the sleep laboratory
(more ...)
Of the 211 patients who screened high risk for OSA and underwent a diagnostic PSG, 6% did not have OSA, 20% had mild OSA, 28% had moderate OSA, and 46% had severe OSA. However, the prevalence of severe OSA increased from 36% in patients with STOP-Bang score of 3 to 79% in patients with STOP-Bang scores of 7-8 (Figure 2). We divided the cohort into 2 STOP-Bang subgroups with similar sample sizes. Among the 211 patients who underwent PSG, we compared 93 patients (44%) with STOP-Bang scores of 3-4 to 118 patients (56%) with STOP-Bang scores of 5-8 (Tables 1, 2). Severe OSA was significantly more prevalent in patients with a STOP-Bang scores of 5-8 (55.1% vs. 34.4, p = 0.005) (Table 1). The group with STOP-Bang scores of 5-8 included a significantly higher proportion of men and had a larger neck circumference, higher BMI, and more severe indices of OSA as measured by AHI, ODI, and percent of total sleep time below oxygen saturation of 90% (T90) (Table 2,Figure 3).
Prevalence of moderate or severe OSA across all STOP-Bang scores in 211 patients who underwent in-laboratory polysomnogram
Prevalence of OSA severity in the two STOP-Bang categories
Patient characteristics
Lower and upper boundaries of the box indicate 25th and 75th percentages. A solid line within the box marks the median, and vertical lines indicate the 10th and 90th percentages. Circles are outliers. ODI 3% and T90 were significantly higher in patients with STOP-Bang scores of 5-8 (p = 0.001 and p = 0.003, respectively).
Box plots showing the distribution of and differences in 3% oxygen desaturation index (ODI 3%) and percent of total sleep time below oxygen saturation of 90% (T90) across the two STOP-Bang categoriesLower and upper boundaries of the box indicate 25th and 75th percentages. A solid line within the box marks...
CPAP therapy was required and provided to a total of 138 out of 211 patients (65%). On average, patients were started on CPAP therapy 4 days before the date of surgery. Not surprisingly, a higher proportion of patients with STOP-Bang scores ≥ 5 required CPAP therapy (73% vs. 56%, p = 0.01). However, among patients who underwent CPAP titration in the 2 groups, there was no significant difference in the CPAP levels required to optimally treat OSA (Table 2). Objective CPAP adherence data during the first 30 days of therapy was available in 104 of the 138 patients who received CPAP therapy (75%). There was no significant difference in the proportion of patients with CPAP adherence data available in the 2 STOP-Bang categories (p = 0.15). CPAP adherence was quantified as a continuous variable (mean daily usage over 30 days of therapy) as well as a categorical variable (percentage of patients using CPAP ≥ 4 h/night). The overall median adherence to CPAP during the first 30 days of therapy was quite suboptimal at 2.5 h/night (interquartile range of 0.7-4.5 h/night), and there was no significant difference in CPAP adherence between the 2 STOP-Bang categories. Based on this distribution, only 25% of patients prescribed CPAP therapy were using their CPAP devices for ≥ 4.5 h/night. As expected, adherence was also poor when examined as a categorical variable since only 33% of patients used CPAP ≥ 4 h/night (Table 2). In a fully adjusted linear regression model, African American race, male gender, and the presence of depressive symptomatology were each independently associated with approximately 1 h less of CPAP use per night after adjustment for OSA severity, STOP-Bang category, hypersomnolence, and education level (Table 3). We also found that the majority of patients were optimally treated with CPAP pressure of 9 ± 2 cm H2O, and there was no significant difference in the optimal CPAP pressure between the 2 STOP-Bang groups.
Significant predictors of mean CPAP adherence over the first 30 days of therapy in minutes from a fully adjusted multiple linear regression model*
Our study demonstrates that in an urban tertiary care academic medical center, a high proportion of presurgical patients that underwent polysomnographic evaluation had severe OSA. Overall CPAP adherence during the first 30 days of perioperative period was extremely low compared to known CPAP adherence at our institution, as well as reported national averages of 4.7 hours/night.19–23 Indeed, only a third of patients were using CPAP at least 4 hours/night. Moreover, African American race, male gender, and the presence of depressive symptoms were significant predictors of reduced CPAP adherence. These are novel findings that have not been previously investigated in this patient population.
Further investigation into why perioperative patients are less adherent to CPAP and interventions to overcome noncompliance is needed if successful therapy is desired. While we have previously reported that OSA patients seen by sleep physicians are more adherent to CPAP therapy,19 none of the patients underwent a sleep consultation prior to the diagnostic polysomnogram. It remains to be elucidated whether a sleep consultation in the preoperative period would lead to improvement in CPAP adherence. In a recent study, 88 patients identified as having OSA who received CPAP therapy during the preoperative period were surveyed with a mailed questionnaire two years after surgery to assess "subjective" CPAP adherence.24 Although the study reported 45% of patients being adherent with therapy, the findings were limited by not having objective CPAP adherence data, as well as lack of information about the more immediate perioperative CPAP use. It is important to recognize that CPAP adherence is frequently overestimated by patients.20,22 Notwithstanding these limitations, the study reported that patients adherent with CPAP therapy experienced greater symptomatic benefit.24 Although long-term CPAP non-adherence is associated with increased cardiovascular morbidity and mortality,4,9 the impact of CPAP non-adherence in the perioperative period has not been evaluated in a systematic fashion.
We also found that despite removing administrative barriers and ensuring that there would be full availability of resources from the sleep laboratory to obtain a confirmatory in-laboratory PSG in a timely fashion without delaying surgery, a large proportion of patients were unable or unwilling to undergo a PSG. It is noteworthy that others have also reported a low patient acceptance rate of in-laboratory PSG in either a clinical or research setting.13,25 Our study was not designed to elucidate the reasons for which patients refused or deferred a PSG. However, we speculate that the inconvenience of an overnight in-laboratory PSG, cost, under-appreciation of the implications of OSA, lack of understanding of the consequences of untreated OSA or unwillingness to use CPAP may have all contributed.
Our data also demonstrates that the average CPAP level required to optimally treat patients is approximately 9 ± 2 cm H2O. Therefore an auto-titrating CPAP device with a minimum pressure setting of 7 cm H2O and a maximum pressure setting of 12 cm H2O adequately treated the vast majority of our patients. In practice, we have noted that some anesthesiologists at our institution start empiric CPAP at 5 cm H2O in the postoperative period in patients with suspected OSA. Most likely, this treatment approach will not give full resolution of upper airway obstruction; based on our findings, higher pressure needs to be prescribed for successful treatment. This is an important finding, given that the vast majority of patients with OSA are not typically diagnosed preoperatively, but can be suspected to have OSA based on patient characteristics, by using the STOP-Bang screening tool, or by nocturnal oximetry.26–28
Our study has several limitations. Although we objectively measured CPAP adherence, we were unable to obtain adherence data on all the patients. However, objective CPAP adherence data were available in 75% of patients who received CPAP therapy. There is a possibility of a selection bias leading to a high proportion of patients having moderate or severe OSA in our study. Patients with more severe symptoms may have been more willing to undergo a PSG. We cannot calculate sensitivity or specificity for the STOP-Bang cutoffs used in our study, since we did not systematically test patients who screened at low risk for OSA on the questionnaire (scores below 3). Given that overall serious postoperative complications due to OSA are rare, our study was neither powered nor designed to ascertain rates of postoperative complications between patients with higher and lower STOP-Bang scores or between patients that were adherent and non-adherent to CPAP therapy. Finally, the findings in our inner-city urban cohort may not be applicable to other populations. As such, further studies are needed to confirm our findings.
In summary, the willingness of patients who screen at high risk for OSA to submit to an in-laboratory PSG during the immediate preoperative period is low. However, those identified as high risk by STOP-Bang scores of 5-8 have a high likelihood of moderate-severe OSA. The adherence to prescribed CPAP therapy in the perioperative period in our population was extremely low. Further research is needed to identify barriers to CPAP adherence in this patient population, or efforts directed towards diagnosis are likely to be wasted. Ultimately, large multicenter randomized trials with clinically important and relevant end points are needed to test the validity and cost-effectiveness of various approaches in diagnosing and treating OSA in the perioperative setting.
This was not an industry supported study. The authors have indicated no financial conflicts of interest.
Kaw R, Pasupuleti V, Walker E, et al., authors. Postoperative complications in patients with obstructive sleep apnea. Chest. 2012;141:436–41. [PubMed]
Memtsoudis S, Liu SS, Ma Y, et al., authors. Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg. 2011;112:113–21. [PubMed]
Flink BJ, Rivelli SK, Cox EA, et al., authors. Obstructive sleep apnea and incidence of postoperative delirium after elective knee replacement in the nondemented elderly. Anesthesiology. 2012;116:788–96. [PubMed]
Campos-Rodriguez F, Martinez-Garcia MA, de la Cruz-Moron I, et al., authors. Cardiovascular mortality in women with obstructive sleep apnea with or without continuous positive airway pressure treatment: a cohort study. Ann Intern Med. 2012;156:115–22. [PubMed]
Gami AS, Howard DE, Olson EJ, et al., authors. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005;352:1206–14. [PubMed]
Punjabi NM, Caffo BS, Goodwin JL, et al., authors. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009;6:e1000132[PubMed Central][PubMed]
Young T, Finn L, Peppard PE, et al., authors. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31:1071–8. [PubMed Central][PubMed]
Somers VK, White DP, Amin R, et al., authors. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol. 2008;52:686–717. [PubMed]
Marin JM, Carrizo SJ, Vicente E, et al., authors. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046–53. [PubMed]
Gross JB, Bachenberg KL, Benumof JL, et al., authors. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2006;104:1081–93; quiz 1117-1088. [PubMed]
Isono S, author. Obstructive sleep apnea of obese adults: pathophysiology and perioperative airway management. Anesthesiology. 2009;110:908–21. [PubMed]
Chung F, Yegneswaran B, Liao P, et al., authors. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology. 2008;108:822–30. [PubMed]
Chung F, Yegneswaran B, Liao P, et al., authors. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108:812–21. [PubMed]
Khawaja IS, Olson EJ, van der Walt C, et al., authors. Diagnostic accuracy of split-night polysomnograms. J Clin Sleep Med. 2010;6:357–62. [PubMed Central][PubMed]
Iber C, Ancoli-Israel S, Chesson AL, Quan S, authors. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 2007. Westchester, IL: American Academy of Sleep Medicine;
Kushida CA, Chediak A, Berry RB, et al., authors. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 2008;4:157–71. [PubMed Central][PubMed]
Johns MW, author. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5. [PubMed]
Radloff LS, author. The CES-D Scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401
Pamidi S, Knutson KL, Ghods F, et al., authors. The impact of sleep consultation prior to a diagnostic polysomnogram on continuous positive airway pressure adherence. Chest. 2012;141:51–57. [PubMed]
Kribbs NB, Pack AI, Kline LR, et al., authors. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis. 1993;147:887–95. [PubMed]
Engleman HM, Martin SE, Douglas NJ, authors. Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax. 1994;49:263–6. [PubMed Central][PubMed]
Reeves-Hoche MK, Meck R, Zwillich CW, authors. Nasal CPAP: an objective evaluation of patient compliance. Am J Respir Crit Care Med. 1994;149:149–54. [PubMed]
Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE, authors. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011;15:343–56. [PubMed]
Mehta V, Subramanyam R, Shapiro CM, Chung F, authors. Health effects of identifying patients with undiagnosed obstructive sleep apnea in the preoperative clinic: a follow-up study. Can J Anaesth. 2012;59:544–55. [PubMed Central][PubMed]
Fidan H, Fidan F, Unlu M, Ela Y, Ibis A, Tetik L, authors. Prevalence of sleep apnoea in patients undergoing operation. Sleep Breath. 2006;10:161–5. [PubMed]
Chung F, Liao P, Elsaid H, Islam S, Shapiro CM, Sun Y, authors. Oxygen desaturation index from nocturnal oximetry: a sensitive and specific tool to detect sleep-disordered breathing in surgical patients. Anesth Analg. 2012;114:993–1000. [PubMed]
Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y, authors. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012;108:768–75. [PubMed Central][PubMed]
Farney RJ, Walker BS, Farney RM, et al., authors. The STOP-Bang equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the apnea/hypopnea index. J Clin Sleep Med. 2011;7:459–465B. [PubMed Central][PubMed]


text:
Apply for free Galileoscopes, courtesy of the EurAstro association - Important update!
11 October 2009
Free Galileoscopes from EurAstro - applications closed
It was a nice surprise for us to see such a quick and overwhelming response to our offer. Now, all of our Galileoscopes have been allocated. No further applications will be considered. Thank you for your commitment towards astronomy. Jean-Luc Dighaye for EurAstro
The EurAstro association, an organisational node of IYA2009, was awarded 200 Galileoscopes in the frame of the Cornerstone project "Developing Astronomy Globally". These will be shared between Germany, in particular but not exclusively in the Munich area, and the Republic of Mali. They are intended to be used by deserving schoolchildren and institutions during the end of IYA2009 and beyond.
They are ideally suited for the upcoming Cornerstone project called "Galilean Nights", which has special focus on observations during the 22-24 October 2009. EurAstro and Galilean Nights will provide further free information and educational material such as sky maps. Supported languages will be English, French, German, and Italian.
If you are interested in astronomical activities for children, typically in middle school curriculum but possibly also in junior/lower school, please apply for free Galileoscopes by contacting EurAstro's Jean-Luc Dighaye by e-mailing jdighaye(at)eurastro.de. Please indicate how many of them you would need, who would use them, and for which purposes.
The Galileoscopes will be granted according to the following criteria:
- order of the received applications for Galileoscopes;
- merits of the intended purposes of use. To organise a Galilean Nights event is considered of high merit;
- willingness to participate in the shipping costs.
You will be informed about delivery details if your application is selected.
Galilean Nights: http://www.galileannights.org/
EurAstro: http://www.eurastro.de/
Galileoscope: https://www.galileoscope.org/gs/
Developing Astronomy Globally: http://www.astronomy2009.org/globalprojects/cornerstones/developingastronomy/
Search IYA2009 Updates
National Nodes: 148
Organisational Nodes: 40
Organisational Associates:33
National Websites: 111
Cornerstone Projects: 12
Special Task Groups: 11
Special Projects:16
Official Products:8
Media Partners:22


text:
saltyboys gay sailing cruises to the most stunning destinations worldwide for international gay guys
saltyboys au naturel nude sailing cruises around stunning scenery for international gay naturist guys
saltyboys yacht & crew for customized worldwide sailing trips with a saltyboys gay skipper or crew
Fun & relaxing gay sailing holidays for single guys, male couples and groups of friends, roughly in their 20's to their 50's.
Sailing experience is not needed. Click for more info on the images..


text:
Apr 29 - Royal newlyweds Prince William and Kate Middleton emerge from Buckingham palace in a dark blue convertible Aston Martin after a reception. The couple waved to well-wishers while Prince William drove his bride to nearby St. James Palace. The vehicle belongs to Prince Charles, who has owned it for 30 years. Rough Cut (no reporter narration).
Video: James Bond moment for royal newlyweds Prince William and Kate


text:
TLC has confirmed hair stylist Lindsay Yamashita and makeup artist Raychel Wade as the new beauty team for season two of RANDY TO THE RESCUE, slated to premiere in May 2013. Throughout season two Randy will be visiting Denver, Seattle, Oklahoma City, San Francisco, Los Angeles, Austin, Miami, Savannah, D.C., and Chicago.
Hair stylist Lindsay Yamashita has 10 years of experience perfecting the techniques of her passion, hair design and styling. She has a broad background of experience ranging from hair extensions, to color specialist, as well as a haircutting platform artist for various product companies. Lindsay has done hundreds of weddings spanning her nearly long decade career.
From CEOs to recent college grads, brides to baby boomers, A-listers to Fashion Week models, makeup artist Raychel Wade has worked her makeup magic on them all. In addition to celebrities and photo shoots, Raychel has found herself to be one of the most sought after makeup artists for brides-to-be.
In each episode of RANDY TO THE RESCUE, bridal guru Randy Fenoli makes brides' fantasies come true as he goes off the runway and behind the wheel of a big rig - to bring his favorite gowns, his unsurpassed dress knowledge, and his signature "head-to-hem" styling approach to brides around the country. As Randy visits different cities, he creates the ultimate trunk shows and dishes out his top tips on bridal style, do's and don'ts, and the hottest trends for the season. From dresses and accessories to makeup and hair, he offers the complete look from head-to-hem for lucky brides-to-be.
Inside each space created by The Wedding Guys, Randy has a team of consultants from local bridal salons in each city, working various fitting stations, to help each bride find the perfect dress.
RANDY TO THE RESCUE is produced by Half Yard Productions for TLC.


text:
The Upper West Side nanny charged with murder in the stabbing deaths of two small children under her care has appeared in court for the first time.
Yoselyn Ortega was hospitalized for weeks with stab wounds police said were self-inflicted after the Oct. 25 killings. She was arraigned at the hospital in November but has since been released.
She appeared in court Friday wearing glasses and her hair in braids.
Lawyers say psychiatric evaluations for Ortega are not complete, and they need more time to review medical records to determine whether she is fit for trial.
Authorities say Ortega stabbed 6-year-old Lucia Krim and her 2-year-old brother, Leo, while the children's mother was out with a third child.
The three were found in the bathroom of their apartment.


text:
How to
Use the Activities
Inquiry Question
In this lesson, students learn about one of the nation's most important conservation laws--the Antiquities Act of 1906--and how its passage preserved important cultural sites such as Tonto National Monument, which preserves remnants of the Salado culture prior to European contact. The following activities will help them apply what they have learned.
Activity 1: Cliff Dwelling Research
Activity 2: Preservation Debate
Activity 3: The First Inhabitants of Your Community


text:
|League Schedule Creator
Below is our League Scheduler, which can also be used as a Round Robin Tournament Scheduler. After filling in the information below and clicking the "Next Step" button you will be taken to a page that will allow you to enter the days of the week and the times the games will be played.
New! Fillable BracketsEdit Your Brackets!
Poster Size Brackets
Football Square Scratch-Offs
Large Football Squares
Trending Now
Tournament Brackets
Office Pools
- Football Pools
- NFL Weekly Pick'em
- College Football Pick'em
- NFL Spread'em Pools
- NFL Confidence Pools
- NFL Survivor Pool
- Football Squares
- 10 Line Football Squares
- Super Bowl 100 Squares
- Super Bowl 50 Squares
- Super Bowl 25 Squares
- 10 Line Super Bowl Pool
- Super Bowl Prop Pool
- Super Bowl Party Games
- Best Super Bowl Squares
- College Bowl Schedule
- March Madness Bracket
- March Madness Squares
- Madness Block Pool
- March Madness Office Pools
- Basketball Pools
- World Cup Bracket
- All Office Pools
Printable Schedules
- NFL Weekly Schedules
- College Football Team Schedules
- Printable NFL Schedules
- College Football Weekly Schedules
- NCAA College Basketball Schedules
- March Madness T.V. Schedule
- Printable NBA Schedules
- Printable NHL Schedules
- Printable MLB Schedules
- Printable Nascar Schedule
- Nascar Xfinity Series
- Printable IndyCar Schedule
- Formula 1 Racing Schedule
- Fantasy Football Leauge Schedules
- College Basketball Championships
Game Brackets
How to Organize
Cool Tools
Playoff Brackets
Sports Team Logos
Fantasy Football
Team Coloring Pages
Funny Sports Images
Our Store
Scratch Off Squares


text:
GOP fears Obama's advantage
It's not only the size of the sequester that has House Republicans fretting. It's not like the GOP expects the stock market to plummet or furloughs across the federal government to drive up unemployment.
House Republicans fear the massive spending cuts set to take effect Friday will result in Congress continuing to cede its constitutional power of the purse.
Story Continued Below
Republicans are fretting that the $85 billion in cuts will transfer big power to the administration. Lawmakers say President Barack Obama's administration will have unilateral leeway to shutter federal programs and spend the government's money without any input from them.
( PHOTOS: Malarkey, baloney and frogs: Sequester quotes gone wild)
The argument is just emerging, and ignores the idea that many Republicans now support the sequester cuts as a way for the government to tighten its belt, barring any better budget-reduction plan. It also belies the reality that Republicans largely supported the sequester idea to begin with when it first passed Congress as part of debt ceiling negotiations in summer 2011.
But as the spending cuts become real, Republicans are crying foul and worry the sequester will be used to implement a host of Obama's top priorities.
The GOP fear was cemented this week when the U.S. Immigration and Customs Enforcement agency freed illegal immigrants who were detained — ICE officials said they did so to save money before the sequester hit. The administration denied involvement, but Republicans were buzzing that the executive branch and agencies will take drastic actions to force the GOP to the negotiating table.
( Also on POLITICO: Sequester showdown: Obama summons Hill leaders)
Some Republicans think Obama will add money to support his health care law.
"One of the things that they mention is that we've been able to control spending in Obamacare, and if we give [the White House] flexibility, they may fund all these parts of Obamacare we don't want to fund," Appropriations Committee Rep. Mike Simpson (R-Idaho) said.
Others think the Office of Management and Budget will shutter programs in certain congressional districts to pressure lawmakers.
"I've watched this administration for two years up close and personal, and they will absolutely behave in ways that are intensely political," Rep. Mike Pompeo (R-Kan.) said.
"The president having ability to reprogram, which means the ability to punish his enemies and reward his friends, is beyond any reasonable constitutional justification," Rep. Darrell Issa (R-Calif.) said.
Both sides agree the sequester cuts are likely to take hold on Friday. What happens next is the bigger question.
The House Republican leadership is trying to help dictate how the Pentagon spends its cash. In a closed-meeting Wednesday, Republicans gave broad approval to language in an upcoming government-funding bill known as the continuing resolution that dictates funding priorities for the Pentagon once the sequester goes into effect.
"Let's say you're closing down a commissary one day a week," said Rep. Jack Kingston (R-Ga.), a member of the Appropriations Committee. "We want to make sure that's what you do as opposed to reducing a training mission that would effect the readiness and the ability to deploy the right people to do the job."


text:
Associate | London
firstname.lastname@example.com | 44 (20) 79204009
Adam Westhead is an associate based in the London office of Morrison & Foerster and is a member of the Corporate practice group.
Mr. Westhead advises on a wide range of corporate transactions, including public and private company M&A, venture capital, corporate finance and corporate reorganisations, acting for clients ranging from large international corporates to individual sellers, buyers and investors. Mr. Westhead has worked for both private and public companies in a number of industry sectors, with a particular focus on technology and media.
Before his training contract, Mr. Westhead worked for the UK's tax and customs authority, HMRC.
After obtaining a B.A. (Hons) in History from the University of Newcastle in 2008, Mr. Westhead completed the Post Graduate Diploma in Law in 2010 and the Legal Practice Course in 2011 and received an LLB (Hons) from the College of Law, Manchester.
Mr. Westhead completed his training contract in the London office of Morrison & Foerster prior to his qualification as a solicitor in September 2014.
As an associate, Mr. Westhead also spent six months working in the Los Angeles office where he focused on U.S. public and private transactions in the technology sector.
Mr. Westhead is qualified as a solicitor in England and Wales.Show More
Unsolicited e-mails and information sent to Morrison & Foerster will not be considered confidential, may be disclosed to others pursuant to our Privacy Policy, may not receive a response, and do not create an attorney-client relationship with Morrison & Foerster. If you are not already a client of Morrison & Foerster, do not include any confidential information in this message. Also, please note that our attorneys do not seek to practice law in any jurisdiction in which they are not properly authorized to do so.