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Clinicians and laboratories routinely use urinalysis (UA) parameters to determine whether antimicrobial treatment and/or urine cultures are needed. Yet the performance of individual UA parameters and common thresholds for action are not well defined and may vary across different patient populations.
Methods:
In this retrospective cohort study, we included all encounters with UAs ordered 24 hours prior to a urine culture between 2015 and 2020 at 3 North Carolina hospitals. We evaluated the performance of relevant UA parameters as potential outcome predictors, including sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We also combined 18 different UA criteria and used receiver operating curves to identify the 5 best-performing models for predicting significant bacteriuria (≥100,000 colony-forming units of bacteria/mL).
Results:
In 221,933 encounters during the 6-year study period, no single UA parameter had both high sensitivity and high specificity in predicting bacteriuria. Absence of leukocyte esterase and pyuria had a high NPV for significant bacteriuria. Combined UA parameters did not perform better than pyuria alone with regard to NPV. The high NPV ≥0.90 of pyuria was maintained among most patient subgroups except females aged ≥65 years and patients with indwelling catheters.
Conclusion:
When used as a part of a diagnostic workup, UA parameters should be leveraged for their NPV instead of sensitivity. Because many laboratories and hospitals use reflex urine culture algorithms, their workflow should include clinical decision support and or education to target symptomatic patients and focus on populations where absence of pyuria has high NPV.
People often assess the reasonableness of another person’s judgments. When doing so, the evaluator should set aside knowledge that would not have been available to the evaluatee to assess whether the evaluatee made a reasonable decision, given the available information. But under what circumstances does the evaluator set aside information? On the one hand, if the evaluator fails to set aside prior information, not available to the evaluatee, they exhibit belief bias. But on the other hand, when Bayesian inference is called for, the evaluator should generally incorporate prior knowledge about relevant probabilities in decision making. The present research integrated these two perspectives in two experiments. Participants were asked to take the perspective of a fictitious evaluatee and to evaluate the reasonableness of the evaluatee’s decision. The participant was privy to information that the fictitious evaluatee did not have. Specifically, the participant knew whether the evaluatee’s decision judgment was factually correct. Participants’ judgments were biased (Experiments 1 and 2) by the factuality of the conclusion as they assessed the evaluatee’s reasonableness. We also found that the format of information presentation (Experiment 2) influenced the degree to which participants’ reasonableness ratings were responsive to the evaluatee’s Bayesian rationality. Specifically, responsivity was greater when the information was presented in an icon-based, graphical, natural-frequency format than when presented in either a numerical natural-frequency format or a probability format. We interpreted the effects of format to suggest that graphical presentation can help organize information into nested sets, which in turn enhances Bayesian rationality.
To evaluate the pattern of blood-culture utilization among a cohort of 6 hospitals to identify potential opportunities for diagnostic stewardship.
Methods:
We completed a retrospective analysis of blood-culture utilization during adult inpatient or emergency department (ED) encounters in 6 hospitals from May 2019 to April 2020. We investigated 2 measures of blood-culture utilization rates (BCURs): the total number of blood cultures, defined as a unique accession number per 1,000 patient days (BCX) and a new metric of blood-culture events per 1,000 patient days to account for paired culture practices. We defined a blood-culture event as an initial blood culture and all subsequent samples for culture drawn within 12 hours for patients with an inpatient or ED encounter. Cultures were evaluated by unit type, positivity and contamination rates, and other markers evaluating the quality of blood-culture collection.
Results:
In total, 111,520 blood cultures, 52,550 blood culture events, 165,456 inpatient admissions, and 568,928 patient days were analyzed. Overall, the mean BCUR was 196 blood cultures per 1,000 patient days, with 92 blood culture events per 1,000 patient days (range, 64–155 among hospitals). Furthermore, 7% of blood-culture events were single culture events, 55% began in the ED, and 77% occurred in the first 3 hospital days. Among all blood cultures, 7.7% grew a likely pathogen, 2.1% were contaminated, and 5.9% of first blood cultures were collected after the initiation of antibiotics.
Conclusions:
Blood-culture utilization varied by hospital and was heavily influenced by ED culture volumes. Hospital comparisons of blood-culture metrics can assist in identifying opportunities to optimize blood-culture collection practices.
To assess the variables associated with incomplete and unscheduled cardiology clinic visits among referred children with a focus on equity gaps.
Study design:
We conducted a retrospective chart review for patients less than 18 years of age who were referred to cardiology clinics at a single quaternary referral centre from 2017 to 2019. We collected patient demographic data including race, an index of neighbourhood socio-economic deprivation linked to a patient’s geocoded address, referral information, and cardiology clinic information. The primary outcome was an incomplete clinic visit. The secondary outcome was an unscheduled appointment. Independent associations were identified using multivariable logistic regression.
Results:
There were 10,610 new referrals; 6954 (66%) completed new cardiology clinic visits. Black race (OR 1.41; 95% CI 1.22–1.63), public insurance (OR 1.29; 95% CI 1.14–1.46), and a higher deprivation index (OR 1.32; 95% CI 1.08–1.61) were associated with higher odds of incomplete visit compared to the respective reference groups of White race, private insurance, and a lower deprivation index. The findings for unscheduled visit were similar. A shorter time elapsed from the initial referral to when the appointment was made was associated with lower odds of incomplete visit (OR 0.62; 95% CI 0.52–0.74).
Conclusion:
Race, insurance type, neighbourhood deprivation, and time from referral date to appointment made were each associated with incomplete referrals to paediatric cardiology. Interventions directed to understand such associations and respond accordingly could help to equitably improve referral completion.
By the early 1930s the sexagenarian Thomaskantor had taken on an old man's mien, his hair receded and white. The stress-related issues that had stopped him in his tracks in August 1935 portended a long decline. Despite warning signs, his schedule remained as punishing as ever, the pressures unrelenting. As 1936 dawned, Max Hinrichsen continued to fire off regular news that customers were anticipating the Bach edition and inquiring as to its progress. Having been reminded the previous fall about his roots in England, and mindful now to exercise those connections, Straube had escaped to Hamburg in late March 1936 to hear the choir of King's College, Cambridge, at the Jakobikirche, one of the final stops on its northern European tour. “The Thomaner surpass the English choir by far in terms of sound,” he confided to Hertha. “But despite that, there is a wonderful peace and beauty to the choir's singing, something expressly English, something sweet and tranquil, I can't express it any other way.” It was not “his” sound, but one that had captured his imagination in London some ten years earlier. “The English felt it was a great honor that I came,” he continued, clearly gratified.
That same spring Straube became light-headed during a rehearsal and again during a business meeting. On May 22, for the second time in a year, he was off to the Glottertal on medical orders to quiet his nerves. “My duties will be assumed by Herr Helmut Kästner, who, as a former Thomaner and first prefect will lead rehearsals and the church music in my sense and according to my practice,” he informed the new rector Alfred Jentzsch. Kästner, who had stepped into the breach during the 1935 episode, was again engaged on the enthusiastic recommendation of both cantor and rector. The latter had hastened to add in his official assessment, “Aryan ancestry unquestionable. He is intimately acquainted with the Thomanerchor and so is the most appropriate substitute in the rehearsals.”
Actually it seems that the most “intimate” and “appropriate” Kenner to have taken the reins would have been the cantor-in-waiting Günther Ramin.
Around 1910 the “Straube system” had yet to unfold to its full extent, but Straube already worked at a breathless pace on several fronts simultaneously, not without noticeable bumps along the way. One question naturally arising concerns family life on the Dorotheenplatz, which was intensely guarded at the time and only sporadically illumined in the surviving sources. Nevertheless, the dynamics of hearth and home unquestionably constituted another of the many balls Straube was trying to keep in the air. His marriage was seven years old in 1910, Elisabet aged six. The received picture has been one of an essentially sunny home life. But troubles in the marriage were going to arise, whatever their ultimate causes. Karl's overblown schedule demanded a great deal of time away from home, in addition to long stretches of uninterrupted practice, study, score preparation, and correspondence. The interlocking of his many commitments and his stubbornly ambitious nature meant that dedicated vacation time, when it arose at all, was perpetually threatened. Hertha and Elisabet seem often to have traveled independently, leaving Karl with his work or to take his hiking holidays by himself. He had not experienced an ideal domestic environment in Berlin with his unengaged or perhaps even belligerent father, a circumstance that inevitably shaped the expectations he brought to his own home life. Now he was approaching forty, at the top of his game as an organist, thoroughly ensconced in a high-caliber musical culture. It would have been extraordinary if the stress of his professional life had not spilled over into the home.
The trouble began innocently enough. In autumn 1909 Straube studied the Mass in B Minor with his Bach-Verein, mounting on November 15 what he recalled with pride as the “first uncut performance” in Leipzig. He had hired a new alto soloist called Emmi Leisner, a gifted student in Berlin and the daughter of a musical family in Flensburg on the Danish border. At twenty-four, she was twelve years his junior. Soon, Leisner would go on to a distinguished opera career, and in an unpublished biographical essay drafted much after the fact, she pegged Straube's B-minor Mass performance as her professional departure point. He continued to follow her development sympathetically and indeed actively, engaging her again for the May 1911 Leipzig Bachfest as soloist in the St. John Passion.
It is unclear when and under what circumstances Straube met Heinrich Reimann. It seems likely the connection was made over the younger man's regular attendance at concerts of the Philharmonic, which Reimann served as organist and program-note writer. Probably reproducing Straube's own conflicting recollections made at different points in his life, Wolgast put the date at 1888, Fischer at 1892. Like Dienel, Reimann had come to Berlin from elsewhere, the former as a student in 1863, the latter as a grammar school teacher in 1879 and, after time away, again in 1887. Reimann had come from Catholic Lower Silesia, an area with eighteenth-century ties to Prussia, absorbed into the new Reich in 1871. Son of the prolific church music composer Ignaz Reimann, he had earned a philology degree at Breslau in 1875, laying the foundations for a career as a serious writer on musical topics from Byzantium to Brahms. He likewise had studied organ playing with the Breslau cathedral organist, composer, and Royal Music Director Moritz Brosig, himself a writer on historical Catholic music. By the time Reimann moved permanently to Berlin in 1887, he had converted to Protestantism, no doubt largely under patriotic fervor for the new imperial culture. When Straube crossed paths with him shortly thereafter, Reimann's extraordinarily varied career was in ascendancy as a composer, critic, organist, and librarian at the Staatsbibliothek, where he would become a curator in 1893, and where he equally could have met the young man. For a brief time thereafter, he taught organ and theory at the new Klindworth-Schaarwenka Conservatory, where Straube's piano teacher Leipholz served on faculty.
As an organist, Reimann stood at least superficially in Dienel's camp, positioned against conservative voices like Haupt—organ professor and later director of the Berlin Church Music Institute, and probably teacher to Johannes Straube during his time there—and Salamon Kümmerle, both of whom cautioned against the newfangled technologies and shallow effects of the “modern organ.” The Schlag Philharmonie organ of 1888, over which Reimann presided as organist to the orchestra through late 1896, and on which Straube perhaps had lessons with him, generally would have suited his purposes, with its two Swell chambers, electropneumatic action, variable wind pressures, a proliferation of registration aids, and more.
On June 15, 1935, the Deutsche Akademie in Munich, founded during the Weimar period but since co-opted for Nazi propaganda, had announced Straube's appointment as senator. The timing of the award was made to coincide with the opening of the Reichs-Bach-Fest in Leipzig, a marathon of concerts and events scheduled from June 16 through 24, the final four days under the auspices of the NBG. Just before its launch Mayor Goerdeler directed a congratulatory letter to the cantor, together with thanks “that you have defied all temptations aiming to prepare a worthy domain elsewhere for your masterly abilities and personality. We thank you for the loyalty with which you have retained the office of Thomaskantor.” Writer and recipient knew that “loyalty” had not come easily, achieved only after months of wrangling. Amid all the subcutaneous malcontent, and while the Berlin question had loomed, Straube's busy schedule had rolled on mercilessly. Not least on the agenda had been preparations for the longest and most demanding Bach festival yet, marking its namesake's 250th birthday. As with such occasions in the past, he had been integrally involved in the planning for some time.
The festival capped a series of nationwide events around the triple anniversaries of Schütz, Handel, and Bach, many of which had featured the Thomanerchor. The outsized program of the Leipzig celebration reflected the hypernationalism of the moment and the propensity of the NS machine to assert itself in high-profile gatherings with the potential to galvanize the country. “From the work of Sebastian Bach speaks the spirit of the German nation,” proclaimed one newspaper, pushing the official line that the festivities would instill Bach's music—“rigorous, disciplined to the last, and thoroughly German”—in the hearts and minds of the “Aryan” Volk, not just the privileged educated classes. To this end a breathless schedule offered performances of both Passions, the B-minor Mass, the Musical Offering (J. N. David), The Art of Fugue (Graeser), and much besides. An exhibition at the Gohliser Schlösschen, designated locus of the NS-Kulturgemeinde, displayed eighteenth-century artifacts alongside a Bach family tree, the latter calculated to demonstrate the master's Teutonic blood line.
[St. Thomas Church] is almost as it was about a generation ago, when, up at the organ that he had outfitted by his own means, Karl Straube performed during the night hours for a small host of delighted and musically enthusiastic students, playing the great organ works of the venerable Johann Sebastian and putting forth, virginally so to speak, the newest thing that Max Reger had just written. Then, only the quivering strips of the streetlamps scampered over the windows, and the only light glowed overwhelmingly from the organ console, amplified by the white pages of the score. But in the darkness of the nave's high arches, all the good spirits were awake.
—Franz Adam Beyerlein, “Verdunkelte Motette,” ca. 1940; StAL Thomasschule 21, undated memoir appended to Marie Luise Fischer, “Singet dem Herrn. Annalen und Chronik von St. Thomae nach vorhandenen Urkunden bearbeitet” (typescript, October 1935), 278
A final strand in the counterpoint of Straube's “treadmill” concerns the nexus of loosely coordinated, quasi-antiquarian initiatives commonly called Orgelbewegung (organ reform movement). The dominant image has been the one offered in Wolgast's seminal 1928 biography, published so to speak in medias res, where an “ever young” Straube was intent on embracing new knowledge with open arms. “It is wonderful,” enthused Wolgast, “with what energy and elasticity Karl Straube promotes the new Orgelbewegung not only as an organizer, but also as an artist. This is all the more so in that it amounts to a renunciation [Abkehr] of the ideal that had informed the entire glorious era of his virtuoso years.” The problem with this view is not that it shows its subject as keeping up with trends in the organ world, or even that it affirms the cantor's robust ethical nature, spawning advocacy for new aesthetic impulses where they appeared worthwhile. Rather, the flaw lodges with the fact that Straube was not good at constructing his world as a series of mutually exclusive options, as a zero-sum game in which the striking of one path meant the all-out disavowal of another. The drawn-out hesitancy with which he had embraced the cantorate itself is but the most vivid example. Categorical renunciation or Abkehr was not his game.
The tensions in Straube's personality meant that on virtually every level— career advancement, political allegiances, aesthetic, and historical assessments—conflicts and contradictions abounded, some of them downright debilitating and intensifying with age. His interactions would always be subject to a propensity for indecision, a need to think things through from multiple perspectives, never granting one solution the absolute upper hand over another. Further, his frequently expressed anti-materialism sensitized him to the transience of human striving. “I say again and again, vanitas, vanitas vanitatum,” he would declare to Manfred Mezger in 1945, bringing the words of Ecclesiastes to bear upon the open-ended task of the Bach edition. That sentiment was already much in evidence during the 1920s, when he pondered if and how to go forward with the project. “He often has been approached to complete the Bach organ edition,” wrote Wolgast.
Contrary to Straube's prediction, Germany was still very much at war in spring 1918. On March 3, just as negotiations around his candidacy were getting serious traction, the new Soviet Russian government had ceded the Baltic States in the harsh peace treaty of Brest-Litovsk imposed by the German and Austrian Empires. Now turning its full strategic attention to the western front, Germany launched a series of offensives through mid-July, when the Second Battle of the Marne turned the tides decisively in favor of the Allies. As May gave way to June in faraway Leipzig, there still seemed reason to imagine that the fatherland could prevail against its western enemies, even as the national resolve continued to be severely tested.
These circumstances surely swirled in the minds of the faculty, students, and alumni of the Thomasschule as they gathered on Monday, June 3, to welcome the new cantor in a solemn but simple ceremony. At this moment, they stood on the unstable precipice not only of new political realities, but also of a Thomaskantor who manifestly was not going to conform to the time-honored mold. An alumni choir performed Schreck's “Führe mich,” op. 33, no. 3, and his setting of Psalm 23, “Der Herr ist meine Hirte,” op. 42, memorializing Straube's predecessor and, undoubtedly for some, recalling the fact that the cantorate until now had been a composing office. According to the press account, Rector Tittel welcomed Straube with the pointed wish, “May the assumption of the cantorate, which necessitates the grave relinquishment of certain cherished artistic activities, bring blessings and impart rich fulfillment”—a deliberate way of putting things that will not have escaped Straube's attentive ears, and in which he could perceive the residues of concern over his hitherto “fragmented” schedule. In prepared remarks, the new cantor addressed the issue, at least obliquely, as well as the reservations of those who felt he was going to allow his artistic ambitions to override the larger objective of the boys’ humanist education. “As little as he regards composition as the task that corresponds to his nature,” read the report that paraphrased Straube's brief speech, “he will all the more take care to cultivate the formidable tradition of the past.”
“Old age has arrived with me,” a plaintive Straube had written Mezger late in 1945. “Everything taken together has made of me a fretful, sullen geezer, as is the way of the world.” Mezger had accepted Straube's commission to write a foreword to the chorale-based volumes of the Bach edition, which, as the latter pointed out in the same letter, needed to emphasize “the religious content” and “reveal also to the French and the Americans knowledge of the spiritual values in this wonderful art.” He was nothing if not determined, now framing his work as a last opportunity to preach Bach abroad. By March 1946, and evidently at his own urging, he had in hand a contract from Peters promising 1,200 marks as honorarium for each of nine volumes. Incredibly, for the first time in decades, there was an official mandate to proceed.
Yet Straube continued to stew over the work's ultimate relevance. He fixated on his old conviction about the vanity of human striving, even as he became painfully conscious of himself as a relic. The war's destruction had exacerbated these perceptions, not only because it had taken a toll on his health, but also because it had driven a vivid wedge between past and future. He had issued from a world that now lay in rubble. How could his views on Bach claim currency in a new era? Going forward, such questions played on a loop in his mind, even as those to whom he articulated them offered encouragement. “The name Karl Straube is magical and will remain so,” Hella von Hausegger admonished him. “And particularly given today's uncertainty about style, it's very important that someone like you, who knows the right approach, nails down his thoughts.” He was increasingly prone to compare his “right approach” to the work of others, particularly those west of the Rhine. With evident cynicism he told Mezger that requests for “an instructive foreword” had come from the Americans, “who it seems have not been completely convinced by the program-music interpretations of an Albert Schweitzer.” Now more than ever after the Allied victory, he remained aware of the French bias among American organists, even as he aired disdain for what he had long regarded as Schweitzer's dabbling dressed up as authenticity.
As the assaults on Leipzig's institutions unfolded, Straube stepped up his reading regimen. He now had more free time and wished to keep his mind nimble, sharpening the intellectual faculties he was sure the cantorate's unrelenting musical demands had blunted. Perhaps his insatiable consumption of literature during this period—classical and contemporary, fiction and non-fiction, musical and socio-political history alongside analysis of current events—betrayed an escapism from the deterioration of the cultured world he thought he knew. But as best he could, he also was trying to make sense of that world as it splintered, in part by situating the present in a long narrative arc.
In November 1940 he had plunged into Heinrich Mitteis's Der Staat des hohen Mittelalters, a demanding study in comparative constitutional history of the Middle Ages. Like Haller's Papsttum, this one bore Straube's name as the dedicatee, here in gratitude for “the deepest impressions of my youth.” The eminent legal historian and medievalist Mitteis had studied at the Thomasschule and the University of Leipzig during Straube's virtuoso years and, again like Haller, had bonded with him over common interests in music and history. Mitteis had shown such promise as a musician that Straube had drawn on him to conduct the Bach-Verein. On the cantor's urging he ultimately would pursue an academic career. In the introductory chapter of his book Mitteis wrote that “already the [medieval] Germanic state rested completely on relationships between leaders and those led,” equating this incipient notion of government to “the strong feeling of attachment of all members of the Volk to success and failure,” in which they were invested equally. “Hence also the right of the people to rebel against the king if he should fail to show true loyalty.” Further, “the Germanic world is a world of rights,” and “the deepest sense of legal history” lay in the tracing of how the notion of rights is demonstrated through time. Mitteis's treatment of classed society's relationship to just systems of governance touched a topic that long had piqued Straube's interest. It was at the heart of his concern for “the masses” and their posture toward “the national cause,” the issue he had articulated to Haller back in 1922.
In January 1927, some ten years into his tenure, Straube offered a would-be visitor a candid window into his daily routine. “From 9:00 to 1:00, meeting of the committee for state examinations of the Leipzig Conservatory,” began the intonation of his Saturday obligations. Then: “1:30, Motette; 2:30–3:30, rehearsal with the sopranos, then sleep; 5:00–6:00, rehearsal with the altos; 6:00–7:30, rehearsal with the entire choir; 8:00–10:00, Conservatory teaching. So it goes day in and day out.” At least until Easter “I am on the treadmill of my three offices and actually never free. It may be wrong, but I am not in control of my life and take it as it comes. The more I have to work, the better, because then no bleak thoughts [keine trüben Gedanken] arise.” At fifty-four, Straube felt he was riding a wave not of his own making. The punishing routine rattled off here amounted to a bulwark against a tide of trübe Gedanken, probably a clinical depression now some three years after Elisabet's death. His propensity for sustained hard work was itself nothing new, but his attitude toward it had taken a dark turn by the middle of the decade, stained by personal loss and accumulated bitterness. Each New Year and birthday likely prompted reflection. Almost exactly two years earlier, he had told Raasted that “the only anesthetic” for Elisabet's loss “is work, the more of it and the more desolate, the better… . Thank God that someday this life too will pass.” This talking point would surface repeatedly now, betraying a Weltschmerz that would gain the upper hand in Straube's psyche by the 1940s.
And work he did. Over the second half of the 1920s, as the Republic appeared to stabilize under Hindenburg, and as a newly constituted Nazi party began to incubate on the margins, Straube embraced a bewildering counterpoint of demanding, highly visible projects that would further his status and erode his health, all framed as deeply personal strategies to deflect trübe Gedanken. First, there was the German Handel Festival of June 6–8, 1925, in Leipzig, mounted under his initiative, reflecting a national (and nationalist) interest arising in tandem with Friedrich Chrysander and the Händel-Gesellschaft's edition completed in 1902.
“You aren't able to accompany a chorale!” Reimann exclaimed to him one day. The older man well may have been justified in his criticism concerning a skill he must have observed when Straube deputized at the Kaiser Wilhelm Memorial Church. After all, during the mid-1890s Straube seems to have concentrated on technique and repertory, not necessarily on service playing and its attendant proficiencies. Writing much after the fact, Wolgast would capture something of the young man's thinking when he remarked that church and organ music since Bach's death “had slept the deepest sleep,” and that “the stature of the organist had lost more and more credibility.” But the way back to that credibility did not run through the church. Rehabilitation was “possible only in connection and on the same front with the other arts, but detached from all ecclesial actualities. The organ had to be lifted from the constrictions of epigonic church art and placed as a concert instrument on the front lines of a vibrant musical life.” This is a striking position for a young man whose family claimed such deep roots in theology and evangelical religion. If Wolgast got it right, though, the attitude goes some way to explaining why Straube may have neglected the cultivation of liturgical skills in favor of repertory playing. Furthermore, the framing of one's task as the liberation of the organ from the church, however backward-looking the environment, could have amounted to a rebellion against a religiously conservative home life. In any case, this had been neither Reimann's nor Dienel's position. Both believed that the organ, even in modernized guise, was by its nature an instrument that enabled religious devotion, that led a congregation “to an animated thinking, feeling, willing, and doing,” to return to Dienel's words.
Despite the brand of secular idealism Wolgast proffered, ultimately the organ would not be disentangled from the church environment, and neither would Straube. If he was going to realize his mission of renovating “the stature of the organist,” of clothing Bach and others in compelling up-to-date form, and of attracting the musical avant-garde to this ancient instrument, he was going to have to do it from inside the church out, not the other way around.
The splendidly decorated rooms of Frankfurt's Café Bauer served as a favorite meeting place for the city's residents and visitors alike. Centrally located around the corner from the stock market, the Bauer occupied the first two floors of a monumental structure completed in 1885 on the site of the old Bavaria brewery. The building exuded the expansionist spirit of optimism and progress typical of the Reich and the pulsing financial center of Frankfurt. Besides its dining and drinking spaces, it offered a capacious reading room as well as dedicated rooms for billiards and cards. If ever a modern Reger enthusiast would wish to have been a fly on the wall somewhere during the years of the composer's development, it would have been here, late on Tuesday evening, March 29, 1898, when Karl Straube and Max Reger enjoyed a long anticipated first meeting into the early hours of the following morning. The rendezvous was surely prearranged in correspondence now lost and lubricated by generous portions of Pilsner. In one of his first outward engagements during his Wesel tenure, Straube had come to Frankfurt to perform a series of three recitals in the nearby Paulskirche on March 29, April 1, and April 5. The church itself was a national symbol, having been selected as the site of the first assembly to elect a German parliament in the wake of the March Revolution of 1848. The organ, built by a young E. F. Walcker for the new edifice between 1829 and 1833, claimed a no less significant position in the history of German organ building. Erected directly above the chancel in an oval sanctuary, it offered a progressive disposition which emphasized gravity and fundamental tone in three manual and two pedal divisions, the latter played from two pedalboards and featuring a pair of open 32′ flue stops. The success achieved by this instrument, a consequential early step in the direction of nineteenth-century tonal concepts, launched its builder's career. Now the organ would play a key role in the advancement of Straube's own. The connections that brought him to Frankfurt are not known, but a highly publicized series of solo recitals in a historic venue was clearly no business-as-usual affair.