Artykuły w czasopismach na temat „Ohio Historical Center”

During the last decade, roughly 40 state folk cultural, or folklife, programs have emerged throughout the United States, and more are being developed. In most states, these programs are a component of the state arts agency; elsewhere they are based in universities, in historical societies, or in other branches of state government. Examples include the Alabama Folk Arts Program, the Missouri Cultural Heritage Center, the Office of Folklife Programs in North Carolina, the Southwestern Lore Center in Arizona, and the Traditional Arts Research and Development Program of Ohio. I work with the Bureau of Florida Folklife, which is part of the Florida Division of Archives, History, and Records Management.

At the end of the Revolutionary War, the United States government acquired the Northwest Territory, including the city of Cincinnati. Given the city's position on the Ohio River, and the subsequent development and introduction of steamboats in the early 1800s, Cincinnati became a major center for commerce and trade. With a population of over 115,000 in 1850, Cincinnati was the sixth largest city in the United States—larger even than St. Louis and Chicago—the first major city west of the Allegheny Mountains, and the largest inland city in the nation. The city's growth and importance is mirrored by the history of one if its prized institutions, Good Samaritan Hospital—the oldest, largest, and busiest private teaching and specialty-care hospital in Greater Cincinnati and a national leader in many surgical fields.

The Wood County (Ohio) Historical Center and Museum has struggled with how to treat a controversial artifact a long time in its possession: a set of severed human fingers in a jar. Collected from a murder scene in 1881, “The Fingers in the Jar” have become a popular piece of the museum’s collection but for problematic reasons. This article traces the artifact’s life from creation to lurid objectification and proposes a new interpretation that recognizes its profound moral value. Such provocative exhibits can generate critical moral reflection and thus the museum is exploring ways to present these controversial human remains despite ethical concerns. Displaying them in a humanizing, pedagogically sound way fits squarely within the museum’s updated mission to promote social justice. The museum can offer a pathway toward public education on domestic homicide in all its brutality, historically and today.

Historic topographic maps, which are georeferenced and made publicly available by the United States Geological Survey (USGS) and the National Map’s Historical Topographic Map Collection (HTMC), are a valuable source of historic land cover and land use (LCLU) information that could be used to expand the historic record when combined with data from moderate spatial resolution Earth observation missions. This is especially true for landscape disturbances that have a long and complex historic record, such as surface coal mining in the Appalachian region of the eastern United States. In this study, we investigate this specific mapping problem using modified UNet semantic segmentation deep learning (DL), which is based on convolutional neural networks (CNNs), and a large example dataset of historic surface mine disturbance extents from the USGS Geology, Geophysics, and Geochemistry Science Center (GGGSC). The primary objectives of this study are to (1) evaluate model generalization to new geographic extents and topographic maps and (2) to assess the impact of training sample size, or the number of manually interpreted topographic maps, on model performance. Using data from the state of Kentucky, our findings suggest that DL semantic segmentation can detect surface mine disturbance features from topographic maps with a high level of accuracy (Dice coefficient = 0.902) and relatively balanced omission and commission error rates (Precision = 0.891, Recall = 0.917). When the model is applied to new topographic maps in Ohio and Virginia to assess generalization, model performance decreases; however, performance is still strong (Ohio Dice coefficient = 0.837 and Virginia Dice coefficient = 0.763). Further, when reducing the number of topographic maps used to derive training image chips from 84 to 15, model performance was only slightly reduced, suggesting that models that generalize well to new data and geographic extents may not require a large training set. We suggest the incorporation of DL semantic segmentation methods into applied workflows to decrease manual digitizing labor requirements and call for additional research associated with applying semantic segmentation methods to alternative cartographic representations to supplement research focused on multispectral image analysis and classification.

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It is common knowledge that having an individual or family disaster plan is vital for saving lives and property before, during and after a disaster. First responders have the daunting task of helping many people during a disaster. It would make their jobs easier if people had disaster plans before a disaster. However, for a variety of reasons, few people have a disaster plan. People often do not develop disaster plans due to the time required to devise a plan, a lack of knowledge of the benefits of having a plan, or the effort required for the primarily manual process of developing a disaster plan. Wilberforce University has designed a solution called Wilberforce's Information Library Boosting Emergency Recovery (WILBER) which is a customized, online tool to quickly and automatically generate disaster plans to help save lives and property as well as mitigate the impacts of a potential disaster. WILBER utilizes an interdisciplinary approach to automatically generate a basic disaster preparedness plan. The system addresses a wide range of disasters but focuses on floods, earthquakes and technological disasters such as terrorism and nuclear disasters. WILBER automatically processes locally relevant data intelligently and combines mathematical analysis; distributed computing; individual and business risk management; current and historical information from a comprehensive Geographical Information Systems (GIS) that includes imagery, infrastructure, demographic, and environmental data; and wireless sensors for real time condition assessment. Not planning for a disaster only increases the potential magnitude of a disaster. WILBER allows citizens to quickly establish immediate procedures in the event of an emergency which in turn can lessen the burden on first responders and reduces the likelihood of loss of life. This research is funded by the Department of Energy's National Nuclear Security Administration and conducted by the Wilberforce University Disaster Recovery Center in Wilberforce, Ohio, USA.

Addiction, a cultural construct long framed in moral, psychological, and social terms, is increasingly understood as biological and treated with medications. In the United States, methadone, buprenorphine, and a variety of psychopharmaceuticals are now commonly used to treat addiction alongside long-standing approaches such as 12-Step mutual aid. These biomedical interventions reshape the very condition they intervene on, influencing the ways treatment clients understand and experience addiction. Clients often experience medication treatment in tension with embodied and social practices of addiction: bodily routines, sensory experiences, temporalities, and social contexts of use. This article examines these tensions through theories of the social flesh and embodied citizenship. This analysis is based on a 20-month ethnography in and around “Sunrise” residential center in Northeast Ohio. Sunrise merges biomedical interventions with 12-Step, psychological and juridical approaches. These data show how biomedical practices alter client bodies and subjectivities, promoting body alienation at stark odds with the intense bodily connection clients established through drug use. This alienation results from rapid weight gain and heavy sedation clients attribute to medication effects, as well as mandated medication and adherence practices that strip clients of a sense of control of medication use. Many clients describe feeling “medicated out” of life: estranged from treatment peers and kin who oppose medications, counselors and other powerful authorities who demand their undivided attention, and friends with whom they are unable to relate when heavily medicated. Clients, however, do not passively accept this estrangement. They alter their bodily experiences by leveraging embodied practices developed during drug use. Through practices such as selectively taking medications based on historical bodily experience and illegal drug “testing” in the underground economy, clients reassert bodily connection and control, deriving a modicum of power—albeit constrained and risky—in a treatment system that strictly limits it.

This paper in its first part aims at contextualizing Abu Dhabi's urban development and understanding the factors that have governed its urban growth through a historical case study approach. Relying on archival records and primary sources five stages of urban growth are identified. Data mining of media archives allows for a first hand account of developments taking place thus grounding the depictions. The second part contextualizes this review through a case study of the Central Market project — also known as Abu Dhabi's World Trade Center. The paper concludes by elaborating on the significance of such a historical analysis as it shifts the discourse away from a focus on the ‘artificiality’ of cities in the Gulf to one that is based on a recognition about the historicity of its urban centers, however recent it may be. Additionally the pertinence of such an analysis for cities worldwide is discussed as well.

Commercial areas and bedestens (covered bazaars) are important public areas in Turkish cities and towns. These areas and buildings are essential in that they contribute vital economic and social characteristics to Turkish cities and towns. In the Ottoman period, these commercial areas, alongside inns, baths, mosques, and stores, were engaged in trading and manufacturing and formed a central part of life for the residents. The number of bedestens in a given city was dependent on the size of the city or town. All social, administrative, and economic activities were organized within these bedestens. Commercial structures, in which the bedestens are located, with different functions, such as arasta, inns, markets, covered markets, and stores, are the main components of the commercial districts. These structures were built by the order of the Sultan for the purpose of reviving and providing direction to the economic life of the city or town. One of the key components of these commercial structures was the bedestens. In terms of Turkish culture, a bedesten can be defined as the heart of the commercial district. Although these structures were built to sell textiles, they later functioned as places where antiques and/or valuable goods were also sold. Bedestens were usually a unique type of structure, with masonry masses between wooden stores located in the middle of the trade center of the city or town. The top of the bedesten, which was usually built as one storey and rectangular in shape, had a domed roof covered with lead. In this study, spatial analyses of these important architectural elements were conducted in terms of city planning, folk culture and commercial life. The bedestens selected for the study were those in historical cities located at major commercial road axes from the Ottoman period. The bedestens in these historical cities were examined, within the context of their planning, and assessments were made. The relations that these structures have with each other in general, and their common and different features, were also investigated.

Abstract The United States Environmental Protection Agency designates superfund sites as regions contaminated with hazardous waste. These sites have previously been associated with adverse health outcomes, including an increased incidence of cancer. Historically, communities with racial and ethnic minorities and people of low socioeconomic status have served as prime locations for these sites, as these communities have lacked the ability to advocate against this land use. Here, we ask whether racial and ethnic minorities are disproportionately exposed to these sites or other regions of hazardous waste in our catchment area at the Case Comprehensive Cancer Center, and in the state of Ohio. Further, we are examining whether areas of high exposure are associated with adverse health outcomes including higher cancer incidence and mortality. We utilized the Environmental Justice Index (EJI) database from the Centers for Disease Control and Prevention to assess, on a census tract level, the percent of racial and ethnic minorities in a region, defined as all persons except white, non-Hispanic individuals. We also queried hazardous and toxic waste sites including regions with a national priority list site, a toxic release inventory site, treatment, storage, and disposal sites, risk management plan sites, coal mines, and lead mines. We intersected these data and found that census tracts with a higher percentage of minority persons were more likely to be exposed to hazardous and toxic sites. Our current studies are assessing whether this high environmental burden is contributing to disproportionately worse cancer burden for these individuals. We will test this by comparing EJI data with data from the Ohio Cancer Incidence Surveillance System database to assess cancer incidence and mortality in Ohio. This will also provide an avenue for identifying specific exposures that may contribute to different cancer types. Further, we plan to assess if persons with low socioeconomic status or those living with disabilities are disproportionately affected by environmental burden. Overall, understanding environmental burden and health outcomes will facilitate the prioritization of communities at greatest need, contributing to greater health equity. Citation Format: Jessica R. Bobbitt, Fangzhou Liu, Jennifer Cullen, Ruth A. Keri. Assessment of racial and ethnic disparities in environmental exposure-related cancer burden [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 853.

Abstract Background: Despite treatment with trastuzumab-based therapy, up to half of patients with HER2+ advanced/metastatic breast cancer (MBC) will develop brain metastases (BrM). First-line therapy for advanced HER2+ MBC remains a taxane, trastuzumab, pertuzumab (TP) which demonstrates poor brain permeability. Isolated brain relapse with stable or absent extracranial disease remains a clinical problem in both the adjuvant (Untch et al., ESMO 2019 Congress) and metastatic settings (Noteware et al., Breast Cancer Res Treat. 2023). Current guidelines recommend continuing current systemic therapy in the setting of first isolated brain relapse following local therapy. Tucatinib, a brain-penetrable HER2-targeting tyrosine kinase inhibitor, when added to trastuzumab and capecitabine improves intracranial progression free survival (PFS) and overall survival (OS) in patients with stable or active HER2+ BrMs. We hypothesize that adding tucatinib to TP or T-DM1 in patients with HER2+ MBC with isolated brain relapse or progression could delay or prevent the development of further intracranial lesions and improve OS. Methods: BRIDGET (NCT05323955) is a single arm, phase II, multicenter study of tucatinib added to TP or T-DM1 after local therapy in patients with isolated brain relapse or progression. A total of 48 patients at 9 U.S. sites as part of the Hoosier Cancer Research Network (HCRN) with metastatic HER2+ breast cancer will be enrolled after 1st or 2nd BrM relapse or progression within 8 weeks of local therapy. Patients must currently be receiving standard of care treatment with TP or T-DM1 in the metastatic setting, or adjuvant trastuzumab-based or T-DM1 therapy with isolated brain recurrence. Extracranial disease must be stable per RECISTv1.1 or absent. Patients may not have leptomeningeal disease or untreated brain lesions over 5 mm. Patients will receive continuous tucatinib added to their current therapy (TP or T-DM1). The primary objective is intracranial PFS compared to a historical control (H0: PFS < 5 months (mos), HA: PFS > 8 mos) of the HER2CLIMB clinical trial where patients could continue on trial with isolated brain progression. In these patients, median time from brain progression to second progression or death was 7.6 mos (95% CI, 3.9 to 11.3 mos) in the tucatinib arm versus 3.1 mos (95% CI, 1.2 to 4.1 mos) in the control arm (Lin et al., J Clin Onc 2020). Secondary endpoints include PFS by RECISTv1.1, PFS of extracranial disease, locally treated versus new distant intracranial metastasis PFS, site of first progression (brain versus non-brain), OS, and toxicity in patients with BrM. Collection of correlative specimens including archival tissue, cerebrospinal fluid (optional), whole blood for ctDNA are planned. Patient-reported outcomes surveyed utilizing the FACT-BR and FACIT-Fatigue questionnaires are also included for future analyses. As of 7/06/23, accrual is 5 patients of the anticipated 48 patients overall, across 5 sites (Duke University, Dana Farber Cancer Institute, Ohio State University, Providence Portland Medical Center, and Washington University in St. Louis) currently open. An additional 4 sites are pending opening. Those interested in this trial can reach out to the study Principal Investigators, Carey Anders, MD (carey.anders@duke.edu) or Sarah Sammons, MD (sarahl_sammons@dfci.harvard.edu). Citation Format: Sarah Sammons, Amanda Van Swearingen, Laura Noteware, Nusayba Bagegni, Kelly Moulton, Stevie Threatt, Denise Jaggers, Shannon Shea, Eric Lipp, Erin Riley, Sin-Ho Jung, Gloria Broadwater, Masey Ross, Kimberly Strickland, Sasha Beyer, Alison Conlin, Aki Morikawa, Rashmi Murthy, Carey Anders. Secondary BRain metastases prevention after Isolated intracranial progression on trastuzumab/pertuzumab or T-DM1 in pts with aDvanced human epidermal Growth factor receptor 2+ brEast cancer with addition of Tucatinib (BRIDGET) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-20-02.

This special issue is the outcome of a generous invitation by the Center for Islamic Studies of Youngstown State University, Youngstown, Ohio, to arrange a seminar on Nordic Islam at Youngstown State and to publish the proceedings in the Center’s journal, Studies in Contemporary Islam. To make the proceedings available to Nordic audiences, the proceedings are also being published in the Tidsskrift for Islamforskning. The seminar was held on 25–26 October 2010, and was highly rewarding. The contributors are grateful for the hospitality they received during their stay in Youngstown. They are also grateful to Professor Rhys Williams, Director of the McNamara Center for the Social Study of Religion at Loyola University Chicago, for contributing to the seminar and the special issue. Rhys Williams’ perspective is that of an experienced researcher of religion in the USA, and represents the logical opposite of the Nordic state model and its way of organizing welfare, civil society, and religion. Dr. Williams’ perspective helps to highlight the specifics of the Nordic context. Last but not least, the contributors wish to thank the editors of the Tidsskrift for Islamforskning.The fact that this special issue about Islamic institutions and values in the context of the Nordic welfare state is intended for both American and Nordic readers has inspired the framework that introduces the issue. The first three contributions constitute one group, as they each deal with the significance that the two different welfare and civil society models represented by the Nordic countries and the USA may have for the institutionalization of Islam and Muslims’ public presence and values. First, Ulrika Mårtensson provides a historical survey of the Nordic welfare state and its developments, including debates about the impact of neoliberal models and (de)secularization. This survey is followed by Rhys Williams’ contribution on US civil society and its implications for American Muslims, identifying the significant differences between the US and the Nordic welfare and civil society models. The third contribution, by Tuomas Martikainen, is a critical response to two US researchers who unfavorably contrast European ‘religion-hostile’ management of religion and Islam with US ‘religion-friendly’ approaches. Martikainen , with reference to Finland, that globalized neoliberal ‘new public management’ and ‘governance’ models have transformed Finland into a ‘postsecular society’ that is much more accommodating of religion and Islam than the US researchers claim.The last seven contributions are all concerned with the ‘public’ dimensions of Nordic Islam and with relations between public and Islamic institutions and values. In the Danish context, Mustafa Hussain presents a quantitative study of relations between Muslim and non-Muslim residents in Nørrebro, a part of Copenhagen, the capital, which is often portrayed in the media as segregated and inhabited by ‘not well integrated’ Muslims. Hussain demonstrates that, contrary to media images, Nørrebro’s Muslim inhabitants feel that strong ties bind them to their neighborhood and to non-Muslims, and they trust the municipality and the public institutions, with one important exception, that of the public schools.From the horizon of the Norwegian capital, Oslo, Oddbjørn Leirvik explores public discourses on Islam and values with reference to national and Muslim identity and interreligious dialogue; Leirvik has personal experience of the latter since its start in 1993. From the Norwegian city of Trondheim, Eli-Anne Vongraven Eriksen and Ulrika Mårtensson chart the evolution of a pan-Islamic organization Muslim Society Trondheim (MST) from a prayer room for university students to the city’s main jami‘ mosque and Muslim public representative. The analytical focus is on dialogue as an instrument of civic integration, applied to the MST’s interactions with the church and the city’s public institutions. A contrasting case is explored in Ulrika Mårtensson’s study of a Norwegian Salafi organization, whose insistence on scriptural commands and gender segregation prevents its members from fully participating in civic organizational activities, which raises questions about value-driven conditions for democratic participation.In the Swedish context, Johan Cato and Jonas Otterbeck explore circumstances determining Muslims’ political participation through associations and political parties. They show that when Muslims make public claims related to their religion, they are accused of being ‘Islamists’, i.e., mixing religion and politics, which in the Swedish public sphere is a strong discrediting charge that limits the Muslims’ sphere of political action in an undemocratic manner. Next, Anne Sofie Roald discusses multiculturalism’s implications for women in Sweden, focusing on the role of ‘Swedish values’ in Muslims’ public deliberations about the Shari‘a and including the evolution of Muslims’ values from first- to second-generation immigrants. Addressing the question of how Swedish Islamic schools teach ‘national values’ as required by the national curriculum, Jenny Berglund provides an analysis of the value-contents of Islamic religious education based on observation of teaching practices. In the last article, Göran Larsson describes the Swedish state investigation (2009) of the need for a national training program for imams requested by the government as well as by some Muslims. The investigation concluded that there was no need for the state to put such programs in place, and that Muslims must look to the experiences of free churches and other religious communities and find their own ways to educate imams for service in Sweden.

Abstract Introduction It is well established that von Willebrand factor (VWF) levels increase with age among healthy adults. Recently, there is emerging research demonstrating this may also occur in patients with von Willebrand disease (VWD), particularly type 1 VWD, and may be related to comorbidities. Despite increasing VWF levels, it remains unclear as to whether or not this alters bleeding phenotype. It is also unclear why this occurs most commonly in patients with type 1 VWD, but VWF mutation status may play a role. Older patients commonly undergo invasive procedures, and all VWD patients require periprocedural VWD-specific therapy to ensure appropriate hemostasis. If older type 1 VWD patients have experienced normalization of VWF levels, and no longer have an increased risk of bleeding, VWD-specific therapy may increase thrombosis risk, especially among patients with underlying cardiovascular disease or related risk factors, subject the patient to other adverse reactions such as hyponatremia, and is unnecessarily costly. For these reasons, investigation into the effect of age on VWF levels and bleeding risk in type 1 VWD patients is sorely needed. Methods This is an NHLBI-funded K23 multicenter, cross-sectional study to determine the effect of age on VWF levels and bleeding risk in patients with type 1 VWD, and to determine if pathogenic VWF mutations alter this effect.Individuals with a new or historical diagnosis of type 1 VWD (defined as clinical symptoms consistent with VWD and VWF antigen level or ristocetin cofactor activity <0.50 IU/mL) and age 18 or older are enrolled during routine clinic visits at participating Hemophilia Treatment Centers (HTCs). Following enrollment, pertinent medical history is obtained; the condensed MCMDM-1 VWD Bleeding Assessment Tool is administered, with bleeding history based on bleeding symptoms during the past 5 years; and blood samples are collected for the following: VWF antigen (VWF:Ag) level, VWF ristocetin cofactor activity, factor VIII activity, blood type, and VWF gene sequencing. We hypothesize age is associated with increased VWF:Ag levels and lower condensed MCMDM-1 VWD bleeding scores in patients with type 1 VWD, and this association is weaker among those with a pathogenic VWF mutation. In addition, we hypothesize multimorbidity partially explains the association between age and VWF:Ag levels, and VWF:Ag levels partially explain the association between age and condensed MCMDM-1 VWD bleeding scores in patients with type 1 VWD. A sample size of 250 participants provides 90% power to detect an effect size of Beta=±0.032 points per year of age, which is much smaller than the observed effect size, Beta=-0.080, from preliminary data. The primary analyses will be based on multivariable linear regression models with adjustment for blood type O, exogenous estrogen therapy, multimorbidity (defined as 2 or more of the core set of 20 chronic conditions, i.e., cancer, hypertension, stroke, etc., as selected by the United States Department of Health and Human Services), and medications (aspirin, nonsteroidal antiinflammatory drugs, and anticoagulants). In the regression models, two-sided t-tests will be used with an alpha=0.05. Results This multicenter, cross-sectional study consists of seven HTCs: Hemophilia Center of Western Pennsylvania, Children's Hospital of Pennsylvania, Mary M. Gooley Hemophilia Center, Ohio State University, Bleeding & Clotting Disorders Institute, Mayo Clinic, and University of California, San Diego. During the first year of the study, site initiation visits were conducted, regulatory approval obtained, and contracts executed. Delays in these activities occurred in large part due to the COVID-19 pandemic. As the first year of the study concludes, all sites are now active and enrolling participants. Thus far, 43 participants have been enrolled (Table 1). No barriers to enrollment have been encountered and very few patients have declined study participation. Discussion In conclusion, this ongoing multicenter, cross-section study seeks to determine the effect age has on VWF levels and bleeding risk in patients with type 1 VWD while exploring the role of VWF mutations and multimorbidity in this process. The results will be used to justify a longitudinal study, which is the ideal approach to research the effects of aging in this population. Figure 1 Figure 1. Disclosures Seaman: Sanofi: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; HEMA Biologics: Consultancy, Honoraria. Ragni: Bioverativ (Sanofi): Membership on an entity's Board of Directors or advisory committees; Spark Therapeutics: Membership on an entity's Board of Directors or advisory committees; Takeda Therapeutics: Membership on an entity's Board of Directors or advisory committees; Alnylam (Sanofi): Membership on an entity's Board of Directors or advisory committees; University of Pittsburgh: Research Funding; BioMarin Pharmaceutical: Membership on an entity's Board of Directors or advisory committees. Kraut: Uniqure: Consultancy. Pruthi: CSL Behring: Honoraria; Bayer Healthcare AG: Honoraria; Instrumentation Laboratory: Honoraria; Genentech: Honoraria; HEMA Biologics: Honoraria; Merck: Honoraria. Raffini: CSL Behring: Consultancy; HEMA Biologics: Consultancy; Genentech: Consultancy; Bayer: Consultancy; XaTek: Consultancy. Roberts: Takeda; Speakers Bureau: Novo Nordisk, Octapharma, Sanofi, Takeda.: Research Funding; Genentech, Novo Nordisk, Octapharma, Pfizer, Sanofi, Takeda, uniQure: Consultancy. von Drygalski: Genentech: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; uniQure: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Biomarin: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; CSL Behring: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Research Funding; Novo Nordisk: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Hematherix, Inc: Membership on an entity's Board of Directors or advisory committees, Patents & Royalties: Super FVa.

Foodborne botulism is a potentially fatal paralytic illness caused by ingestion of neurotoxin produced by the spore-forming bacterium Clostridium botulinum. Historically, home-canned vegetables have been the most common cause of botulism outbreaks in the United States. During 2008 and 2009, the Centers for Disease Control and Prevention (CDC) and state and local health departments in Ohio and Washington State investigated three outbreaks caused by unsafe home canning of vegetables. We analyzed CDC surveillance data for background on food vehicles that caused botulism outbreaks from 1999 to 2008. For the three outbreaks described, patients and their family members were interviewed and foods were collected. Laboratory testing of clinical and food samples was done at the respective state public health laboratories. From 1999 to 2008, 116 outbreaks of foodborne botulism were reported. Of the 48 outbreaks caused by home-prepared foods from the contiguous United States, 38% (18) were from home-canned vegetables. Three outbreaks of Type A botulism occurred in Ohio and Washington in September 2008, January 2009, and June 2009. Home-canned vegetables (green beans, green bean and carrot blend, and asparagus) served at family meals were confirmed as the source of each outbreak. In each instance, home canners did not follow canning instructions, did not use pressure cookers, ignored signs of food spoilage, and were unaware of the risk of botulism from consuming improperly preserved vegetables. Home-canned vegetables remain a leading cause of foodborne botulism. These outbreaks illustrate critical areas of concern in current home canning and food preparation knowledge and practices. Similar gaps were identified in a 2005 national survey of U.S. adults. Botulism prevention efforts should include targeted educational outreach to home canners.

Materials surface heterogeneities obviously plays a crucial role in reactivity issues and generate various types of detrimental localized corrosion attacks. In corrosion science, a first question to be addressed is how these various materials microstructure affect oxidation / passivation and localized corrosion initiation mechanisms. A methodology for microscale characterization of initial stage of surface reactions has been developed based on the Atomic Force Microscopy (AFM) Scanning Kelvin Probe Force Microscopy (AFM-SKPFM). In very early work, potential mapping with micrometer lateral resolution (lateral detection limit of materials surface heterogeneities is better but the signal has to be deconvoluted) allowed to clearly identify "cathodic" and anodic sites on Al- alloys [1]. Careful potential calibration and surface conditioning with solution exposure generating the formation of an electrochemical double layer allow obtaining local thermodynamic information closely linked to "practical electrochemical potential series" measured in bulk solution conditions. This contribution will start by revisiting some "historical" examples of AFM-SKPFM characterization (a tribute to Jerry Frankel's activities) of aluminum and magnesium alloys [1,2]. These materials surfaces will further be used to show how reaction kinetic information on corrosion processes can be obtained with similar lateral resolution by means of the newly developed Scanning Electrochemical Nanocapillary (SEN) technique. After introducing the SEN technique and methodology, the presentation will focus on showing how the combination of these two approaches allows refining the local corrosion mechanism assessment of heterogeneous materials. The SEN technique is very versatile and allows various types of electrochemical measurements to be performed with constant tracking of the topography. The technique is based on a nanocapillary glass tip (< 100 nm) excited laterally by a piezoelectric element. A control of the capillary vibration damping when approaching the surface and a feedback loop (like the tapping mode in AFM) allows a very precise control of the approach and electrolyte contact on the surface. The glass capillary filled with the electrolyte of interest integrates a reference and Pt counter electrodes to perform electrochemical measurements exposing only the area of interest to aggressive electrolytes. Using its "hopping" mode (a scan with electrochemical characterization of successive individual nanoscale areas), corrosion initiation susceptibility can be addressed. This will be illustrated through the surface reactivity study of model Al-Cu-Mg microscale intermetallics and Mg-based alloys, using SEN OCP linescans. In addition information about extend of the attack can be subsequently retrieved from SEM observations. Using the precise positioning ability of the SEN setup with X, Y and Z direction piezos, potentiodynamic polarization measurements can furthermore be performed on selected area of interest. The example of an Mg-Fe composite material will be used to discuss its local electrochemical behavior. After the presentation of the SEN characterization results, additional aspects of the measured potential by AFM-SKPFM will also be discussed as adsorbed species, especially strong dipolar molecules, can significantly contribute to the measured signal [3]. Modification of the AFM-SKPFM setup towards atmospheric corrosion investigation will finally be presented. This environmental AFM/SKPFM bridges the gap between the full electrochemical local characterizations that can be offered by the SEN technique and an "electrochemical reaction" diagnostic obtained by SKPFM in thin water layer. The example of a very reactive WC-Co composite will be presented to demonstrate the reactivity issue, galvanic coupling controlling local dissolution processes [4]. Acknowledgements Gerald Frankel for the great time I spent at Ohio State University in the Fontana Corrosion Center developing the AFM-based SKPFM methodology. Empa for internal project financial support of the SEN instrument. References [1] P. Schmutz, G.S. Frankel, J. Electrochem. Soc., 145(7) (1998), 2285-2295 [2] P. Schmutz, V. Guillaumin, S. Lillard, J. Lillard, G.S Frankel, J. Electrochem. Soc., 150(4) (2003), B99-110 (2003) [3] A. Vetushka, L. Bernard, O. Guseva,, Z. Bastl, J. Plocek, I. Tomandl, A. Fejfar, T. Baše, P. Schmutz, Physica Status Solidi (B) Basic Research, 253(3) (2016), 591-600 [4] S. Hochstrasser(-Kurz), C. Latkoczy, D. Günther, S. Virtanen, P.J. Uggowitzer, P. Schmutz, J. Electrochem. Soc., 155(8) (2008), C415-C426

Over the past ten years, digital archives documenting underrepresented communities have been rising. For example, oral and print historical projects about minoritized communities and ethnic cultural heritage centers have existed for decades (Daniel, 2010), yet few are fully accessible online. The increased presence of these types of archives points not only to the need to document the histories of these communities but also to the interest in making this work accessible to all. There is an urgency in documenting, archiving, and curating histories—audio, print, video, and other ephemera—because minoritized communities have consistently faced exclusion from majority historical documents. As precarious and essential as this work is, important projects like the one discussed here are often shared as an in-process version. This process allows us to shape and consider new ways of archiving, perhaps even disrupting traditional collecting and accessioning methods beyond canonical (White) standards. This article shows our interest in developing a decolonized model for archiving digital oral history collections. Indeed, much of the way we are thinking about making the collection accessible is by centering it on bilingual descriptions of each item in the collection signals a non-traditional and, thus, decolonial way of documenting a community. “Archiving Bilingual Latin@ Oral Histories” is an initiative to make an already existing digital oral history archive accessible to the community it documents. From collecting stories, accessioning, and website design and content, it seeks to work collaboratively with students and the community to present a bilingual archive representing the Latina/o/x community in Ohio.

Today, there is a growing tendency towards tourism based economical activities. However, the impact of tourism particularly in the less developed countries can be very destructive in terms of the environment that is also an attraction point for tourists. It is widely acknowledged that tourists prefer to experience the natural environment, the social and cultural life, the historical heritage of the region they are visiting. Hence it is obligatory to answer these needs in a responsive tourism development process. When sustainable tourism is mentioned it includes conservation of natural and architectural environment, as well as the cultural identity while providing economical benefits. In this respect, sustainability of these particular natural, cultural and architectural environments is a crucial issue. The integration of tourism with the local environment and local community is another important factor in successful planning. In light of this discourse, the ongoing tourism developments in Bafra region in the north of Cyprus are standing at a very challenging position for decision makers in terms of balancing the impacts of tourism on these resources. Bafra's coastline is recently becoming a new center for mass tourism by its increasing number of hotels, holiday villages, recreation areas, etc. This study proposes sustainable tourism planning for a unique traditional rural settlement-Bafra Village- which is located in close vicinity of this heart of tourism. The continuity by conversion of existing traditional housing stock of Bafra village for tourism purposes is critically discussed in order to minimize the potential threats of increasing tourism demands.

To date, most of the literature on Muslims in the United States has discussedthe formation and growth of this population from a national perspective.Few studies, however, examine the dynamics of specific Muslim communitiesfrom a local, city-specific context. Mbaye Lo attempts to fill this gapthrough his research on the history of Muslims in Cleveland, Ohio, in hisbook Muslims in America: Race, Politics, and Community Building. Thisbook aims to present a “comprehensive historical assessment of Muslimcommunities in Cleveland” by providing a detailed examination of “theirhistory, their faith and the challenges they face as they establish mosques,develop Islamic centers, and create a multiethnic community” (p. 2). Using various sources of data, such as oral histories of influential figures in theCleveland area and local and national surveys conducted on Muslims in theUnited States, Lo discovers that “the history of Islam in Cleveland is a localphenomenon with both national and global derivations” (p. 3).American immigration policies, the civil rights movement, and newinterpretations of Islam are some of the factors that affected the growth ofMuslim populations throughout the nation and in Cleveland. Lo traces thegenesis of the Muslim community to Ahmadi missionaries who arrived inthe city from India in the early 1900s. Shortly after their arrival, Ahmadisfound great success in inviting African Americans to convert to Islam, creatingthe foundation for what was to become a burgeoning Muslim community.In the latter half of the twentieth century, the arrival of immigrantMuslims and members of the Nation of Islam to Cleveland helped the communityexpand, while also introducing new versions of Islam to the city’sresident Muslims. Ironically, this influx of Muslim outsiders to Clevelandresulted in both the growth and the division of its Muslim population ...

Abstract The Institute for Healthcare Improvement’s Triple Aim calls for measures of the ‘patient care experience’ to understand and improve the quality of care delivery. But, quality measures in the nursing home (NH) historically lack the resident perspective. Measuring whether residents are satisfied with the fulfillment of their care preferences using the Care Preference Assessment of Satisfaction Tool (ComPASS) has been encouraged nationally by the Centers for Medicare and Medicaid (CMS); however, the ComPASS has not been validated as a measure of the resident care experience. The purpose of this study was to compare ComPASS to the Ohio NH Resident Satisfaction Survey (a widely accepted quality measure for reimbursement). We examined 196 resident responses from 28 NHs in Pennsylvania using multilevel modeling to account for dependencies in the data (residents in the same NH may respond similarly compared to residents from different NHs). Residents were 81.2 years old (SD= 11.1), female (70.4%), and white (80.1%). Residents with higher scores on the ComPASS reported significantly higher levels of satisfaction with care (B=2.94, SE B=0.59, p&lt;0.000). Results from this study support the potential use of ComPASS to measure, track, and improve the quality of NH care. Using ComPASS aligns with CMS’s Section F of the Minimum Dataset, an assessment of residents’ preferences which promotes the delivery of more person-centered care. Ultimately, ComPASS can help benchmark the quality of the resident care experience across facilities which aids staff, facilities, policy-makers, and NH-shoppers in improving decision-making and care delivery.

In September 1978, Zagreb's Gallery of Contemporary Art staged the first survey exhibition of conceptual and performance art in Yugoslavia: The New Art Practice, 1966–78. Forty years on, the phenomenon continues to attract a substantial amount of scholarly and curatorial attention, largely because of its globally-renowned affiliates, such as Marina Abramović, Sanja Iveković and Mladen Stilinović, among others. But academic work has been hesitant to address the deeper political, economic and institutional factors that underpinned the New Art's emergence and secured its prolific development. This article proposes that the New Art both came out of, and responded to, a complex and contradictory moment in Yugoslavia's history, when the country began to integrate itself deeper into the Western capitalist world system. It follows the emergence of the OHO group in Ljubljana and two particular episodes in the youth centers of Zagreb and Novi Sad alongside a brief, but decisive, period of liberalization, which began with a massive economic reform in 1965 and was briefly interrupted by a crisis in federal politics in 1971/2. To this end, it examines how artists addressed the impact of these developments on Yugoslav “self-managing” socialism, and its promises of grassroots participation and a more experimental political culture. While stressing the absolute importance of situating the New Art Practice in its precise historical context, the article seeks to provide a new model for a transnational study with a Pan-Yugoslav focus – by mapping how artistic ideas circulated in the Yugoslav cultural space, it provides a glimpse into the tightly woven networks of exchange that enabled the New Art scenes to thrive.

Abstract ATG appears to reduce the incidence of acute and chronic GVHD after allogeneic hematopoietic stem cell transplantation (HSCT). Potential risks of this strategy include viral reactivation, delayed immune recovery and increased relapse rates. The ideal dosing of rabbit ATG in this context is largely unknown. We therefore hypothesized that low dose ATG would reduce the incidence of acute and chronic GVHD in matched unrelated donor (MUD) transplants without compromising survival and relapse rate. A retrospective analysis was performed of a cohort of high-risk MUD HSCT recipients treated since year 2013, when our practice changed to include rabbit ATG at 3 mg/Kg for all MUD transplants at the Case Medical Center in Cleveland, Ohio. Herein we present the results of this analysis. Methods. 58 MUD transplants were performed between years 2013 and 2016, with a median follow up of 262 days post-transplant. All donor-recipient pairs were matched by high resolution HLA typing at HLA-A, -B, -C, and DRB1, (8/8 matches) with the exception of 4 pairs (7/8 matches. Median age was 56 years (range, 53-64). Underlying diagnoses were AML (n=26), MDS (13), CML (n=5), NHL (n=9), Hodgkin's lymphoma (n=2), Multiple Myeloma (n=1) and myeloproliferative disorders (n=2). Preparative regimens were ablative in 26 cases (45 %) and of reduced intensity in 31 cases (55 %). Graft source was bone marrow (n=5) and peripheral blood (n=53). All but 4 pts received GVHD prophylaxis with tacrolimus, and mini-methotrexate (5 mg/m2 on days +1, +3, +6 and +11), in addition to rabbit ATG 3 mg/Kg divided in two doses on days -2 and -1 pre HSCT. Cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Human Herpes Virus (HHV6) PCR were conducted thrice weekly during the first 100 days after HSCT. Results. The 100-day cumulative incidence of grade II-IV acute GVHD was 41% (95% CI: 29-57; Fig 1), while the cumulative incidence of grade III-IV acute GVHD was 18% (95% CI: 9-35; Fig 2). 1-year cumulative incidence of chronic GVHD was 27% (95% CI: 17-42; Fig 3). At 180 days, the incidence of CMV viremia (defined as more than 1,000 copies/mL) was 25% (95% CI: 16-40), while the incidence of EBV and of HHV6 viremia was 35% (95% CI: 24-51) and 14% (95% CI: 8-27), respectively. There was no instance of EBV-related lymphoproliferative disorder. 3-year overall survival estimate is 48% (95% CI: 34-62). Cumulative incidence of Non-relapse mortality (NRM) and relapse at 1 year was 21% (95% CI: 12-37) and 44% (95% CI: 29-65), respectively. Conclusion. Our study shows that low dose rabbit ATG appears to reduce chronic GVHD rates without a major effect on acute GVHD incidence. CMV, EBV and HHV6 reactivation did occur, albeit at rates that are somewhat lower than those historically reported, without EBV-driven lymphoproliferative disorder. Disclosures Caimi: Genentech: Speakers Bureau; Roche: Research Funding; Novartis: Consultancy; Gilead: Consultancy.

Abstract Background Black women historically present with more advanced stages of breast cancer (BC). The 2019 novel Coronavirus (COVID-19) led to stressors on healthcare systems resulting in reduction of resources for non-urgent care needs including screening. Limiting screening access may further exacerbate already existing delays in cancer screening and potentially widen racial differences in stage of BC at diagnosis. We examined our institutional data to evaluate differences in the stage of BC at presentation between Black and White women before and during the COVID-19 pandemic. Methods This was a retrospective cohort study of self-identified Black and White women aged 18 and over with invasive BC at The Ohio State University Stefanie Spielman Comprehensive Breast Center between 2018 and 2021. Demographic and clinicopathological characteristics were obtained from medical records with geocoding based on census tract level used to generate a Yost index of neighborhood socioeconomic composition. Study variables included socio-demographic factors (race, age, education) and breast tumor information such as receptor status and clinical stage group early (Stages I and II) vs. late stage (III and IV). Categorical variables were analyzed by chi-square test or Fisher’s Exact test. Continuous variables were analyzed by Wilcoxon Two Sample tests. Logistic regression was used to assess associations between time (pre-COVID (2018-2019) vs. COVID era (2020-2021)) and sociodemographic factors, socioeconomic composition categorized by Yost index (categorized as low (1-33), medium (34-66), and high (67-100)), tumor status, and clinical stage group. Results The total sample included 3162 women (321 Black and 2831 White). More White women (35.2%) had a higher Yost index compared to Black women (16.7%) (P&lt;0.001, indicating higher socioeconomic composition). Pre-pandemic, 81.8% of Black women vs. 86.4% of White women were diagnosed with early stage BC (P=0.489) and 18.2% of Black women vs. 13.6% of White women with late stage BC (P=0.489). During the pandemic, 86.4% of Black vs. 86.7% of White women presented with early stage BC and 13.6% of Black (P=0.489) vs. 13.3% of White women with late stage BC (P=0.489). Results of the multivariate analysis show participants with a medium Yost index had a higher probability of a late-stage diagnosis compared to those with a high Yost index (P=0.0410). Significant predictors of the probability of a late-stage diagnosis included higher age at diagnosis (P=0.0002) and positive estrogen (P=0.0013), progesterone (P&lt;0.0001) and HER2 receptors (P=0.0032). Race and time (pre vs mid-COVID) were not significant predictors of late stage diagnosis. Conclusion Given the novel nature of the coronavirus pandemic, the clinical implications and effects on healthcare delivery will continue to be observed. It is reassuring that we found no significant change in the differences in the stage of BC diagnosis between Black and White women at our institution. On a national scale, how the pandemic will impact existing BC inequalities requires exploration. Citation Format: Ruvarashe P. Rumano, Nicci Owusu-Brackett, Akia Clarke, Robert Tamer, Elizabeth Ghias, Jesse Plascak, Electra D. Paskett, Bridgett A. Oppong. Effect of the COVID-19 pandemic on disparities in stage of breast cancer diagnosis [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B045.

Abstract Background Sickle cell disease (SCD) is an inherited hematologic disorder that affects approximately 100,000 Americans and results in over 200,000 emergency departments visits annually, largely due to pain (Lanzkron et al). Delay in treatment in emergency room has been a significant barrier to patients with SCD, particularly adults. The objective of this study is to determine the effects of utilizing individualized pain plans for the treatment of vaso-occlusive crisis (VOC) on the satisfaction of healthcare providers in the emergency department (ED). Methods The Ohio State University has a comprehensive sickle cell center which creates individualized pain plans for patients who present to the ED with pain related to VOC. In January 2015, these pain plans were implemented into the electronic medical record listed in the overview of the problem sickle cell disease in each chart. In addition to creating pain plans, an interdisciplinary team was formed consisting of hematologists, pharmacists, and ED providers with the goal of education regarding SCD and the new implementation of pain plans. Surveys, using the secure web application, RedCAP, were distributed to the emergency department providers at the OSU ED. Questions included responders' role in the ED, prior experience with treating pain crisis, time to make treatment management decisions for VOC, satisfaction with treatment decision, and the providers view of their relationship with patients. Wilcoxon signed-rank test and Fisher's exact test were applied to evaluate the differences between pre and post survey numeric and categorical responses. Results Surveys were sent electronically to 170 ED providers. Sixty-nine responses, making up 40.5% of those surveyed, were obtained from 30 attending physicians, 2 fellows, 22 nurse practitioners or physician assistants, 1 registered nurse, and 14 residents. Of those who answered the survey, 14 had experience with treating pain crisis prior to the implementation of individualized pain plans. Implementation of individualized pain plans led to a reduction in median time to make treatment decisions from 5.5 to 2.5 minutes with a p-value of 0.0161. Provider satisfaction with treatment decisions improved as well (p = 0.0029) (Figure 2). In addition, ED providers felt more satisfied with their relationship with patients (p = 0.0078) (Figure 3). The majority of responders (91.2%) also rated their satisfaction with the treatment decision as either satisfied or very satisfied (Figure 1). Seventy eight percent of those answering the survey rated with relationship with patients as being good or very good (Figure 1). In terms of the ease of finding the pain plan in the electronic medical record, 91.3% of providers found them to be either very easy or easy to locate with 94.12% responding that implementing the plan was either easy or very easy (Figure 4). Regarding efficacy of the pain plans, 89.85% found the pain plans to be either effective or very effective (Figure 5). Finally, of the 36 providers who worked elsewhere, about half of the institutions from which they came did not have pain plans. Discussion The results of this study show the importance of utilizing individualized pain plans in the treatment of VOC in the ED. As shown in our prior studies, the implementation of individualized pain plans for patients with SCD resulted in a 48% decrease in time to first opioid in the ED, thereby signifying more prompt treatment (Della-Moretta et al). Not only does the data support an improvement in time to make treatment decisions, which benefit the patients, but providers also appear to view their use as an advantage. Pain plan utilization also leads to an increase in provider confidence in their treatment plans as well as a perceived improvement in patient-provider relationships. This is particularly significant as historically the relationship between emergency room staff and sickle cell patients has been seen as challenging by both patients as well emergency room providers (Haywood et al). Making patient centered individualized pain plans readily available, easily accessible, and simple to enact, can further enhance the relationship between the patient, emergency room, and the hematology team. Ongoing communication and education between all parties is beneficial. With the combination of patient and provider data, we show that a win for the patient can also be a win for the provider. Figure 1 Figure 1. Disclosures Desai: Pfizer: Other: Publication Fee, Research Funding; Novartis: Research Funding, Speakers Bureau; Global Blood Therapeutics: Honoraria, Research Funding; Foundation for Sickle Cell Research: Honoraria; Forma: Consultancy.

Abstract Background Classical Hodgkin Lymphoma (cHL) is a highly curable disease; however, 10% of patients (pts) with limited stage and 20%-30% with advanced stage disease still fail first line-treatment. Autologous hemopoietic cell transplantation (auto-HCT) is the standard of care in pts who fail to achieve remission with first-line therapy, or who relapse after induction chemotherapy. However, approximately 50% of cHL pts will ultimately relapse post auto-HCT. These pts historically have had poor outcomes, with median survival in the 1.5 year range. In recent years, highly active new therapies such as brentuximab vedotin (BV), checkpoints inhibitors (i.e. nivolumab and pembrolizumab), and increased accessibility to allogeneic HCT (including utilization of haploidentical donors) have become more widely available. We hypothesized that, in recent years, survival has improved in cHL patients who relapse after auto-HCT since the introduction of these novel therapies into more widespread clinical practice. Methods We conducted a multi-center retrospective study from 3 academic institutions in the U.S. (Medical College of Wisconsin, Ohio State University, and Washington University in St. Louis) to evaluate survival of cHL pts after the failure of an auto-HCT. We reviewed 341 pts who received auto-HCT from 2006-2015. Among them, 126 (37%) pts relapsed post auto-HCT and were evaluated in more detail. For the purpose of analysis, pts were divided into 2 cohorts based on timing of auto-HCT; 2006-2010 (Cohort 1, n=57) and 2011-2015 (Cohort 2, n=69) to compare outcomes. Results The median age at auto-HCT, time from diagnosis to transplant, time from transplant to relapse were similar in Cohort 1 & 2 (see Table 1). The proportion of pts who achieved complete remission (CR) at the time of auto-HCT were 22.8% in Cohort 1 and 40.6% in Cohort 2. Whereas, 68.4% of pts in Cohort 1 and 52.2% of pts in Cohort 2 had partial remission (PR) at the time of auto-HCT. The median number of lines of therapy after relapse from auto-HCT were 2 each in Cohort 1 (range, 0-13) and Cohort 2 (range, 0-7), respectively (p= 0.74). Twenty-five (45%) pts in Cohort 1 and 49 (73%) pts in Cohort 2 received BV as a salvage therapy post auto-HCT (p= 0.002). Similarly, 3 (5.5%) pts in Cohort 1 versus (vs.) 21 (32%) pts in Cohort 2 received check point inhibitors as salvage therapy post auto-HCT relapse (p= <0.001). Fourteen (25%) pts in Cohort 1 and 26 (38%) pts in Cohort 2, received allogeneic HCT after relapse from auto-HCT (p= 0.10). At 5 years follow up after relapse from auto-HCT, 36.5% of pts were alive in Cohort 1 and 58.3% of pts in Cohort 2 (p= 0.03) (Fig. 1A). The proportion of pts alive at 5 years follow up from time of auto-HCT (using left truncation analysis) was 34% and not reached (NR) in Cohort 1 and Cohort 2, respectively (p= 0.02) (Fig.1B). We performed multivariate analysis for overall survival (OS) from time of auto-HCT relapse; Cohort 1 vs. 2 (HR; 0.35, 95% CI 0.18-0.65, p= 0.0009), disease status at auto-HCT (CR vs. progressive disease [PD]) (HR; 2.51, 95% CI 0.85-7.34, p= 0.01), age at auto-HCT (HR; 1.04, 95% CI 1.01-1.06, p= 0.0005) and time to relapse from auto-HCT (HR; 0.61, 95% CI 0.48-0.76, p= <0.0001), retained independent prognostic significance for OS. Conclusion Our analysis supports that survival of cHL pts post auto-HCT failure has significantly improved in recent years (2011-2015), most likely due to incorporation of novel therapies including BV, checkpoint inhibitors, and more widespread use of allogeneic HCT. Disclosures Shah: Miltenyi: Other: Travel funding, Research Funding; Juno Pharmaceuticals: Honoraria; Exelexis: Equity Ownership; Oncosec: Equity Ownership; Geron: Equity Ownership; Lentigen Technology: Research Funding. Hamadani:Celgene Corporation: Consultancy; Janssen: Consultancy; MedImmune: Consultancy, Research Funding; ADC Therapeutics: Research Funding; Takeda: Research Funding; Cellerant: Consultancy; Ostuka: Research Funding; Sanofi Genzyme: Research Funding, Speakers Bureau; Merck: Research Funding.

Abstract Background. CD5+ diffuse large B-cell lymphomas (DLBCLs) are an uncommon subgroup of DLBCLs representing 5-10% of de novo DLBCLs. Compared with CD5- DLBCLs, de novo CD5+ DLBCLs are associated with a more aggressive clinical course with higher international prognostic index (IPI), more frequent extranodal disease burden including central nervous system (CNS) involvement, and a significantly poorer overall prognosis with conventional anthracycline-based chemotherapy with or without rituximab (Miyazaki K et al. Ann Oncol 2011). Historically, most of these cases belong to the activated B cell (ABC)-type of DLBCLs (Jain P et al., Am J Hematol 2013). The vast majority of the published reports on CD5+ DLBCL are from Asia with limited data on outcomes in US or European patients (pts) in the modern era utilizing rituximab based therapy with no standard guidelines available for the management of this high risk disease. Methods. We reviewed pts with newly diagnosed de novo CD5+ DLBCL treated at the Ohio State University (OSU) from August 2000 to July 2014. Pts did not have an antecedent history of CLL or MCL and diagnosis was confirmed by centralized hematopathology review at OSU. We examined pts' characteristics, treatment response, and survival. Response to treatment was determined by PET/CT. Progression-free survival (PFS) was calculated as the time from diagnosis to the time of progression and/or death, and overall survival (OS) was calculated as time from diagnosis to the time of death. PFS and OS were summarized using Kaplan-Meier methods. Results. Of the 16 CD5+ DLBCL, 11 (70%) were male, and the median age at diagnosis was 58 (range 44-67). Eight pts had CD5+ DLBCL ABC-type, 4 had germinal center (GCB)-type and 4 were non-classifiable by Hans criteria. At diagnosis, 11 pts were stage III/IV; 6 pts had bone marrow involvement, 2 had CNS involvement; and 2 pts had bulky disease (≥10cm). IPI was ≥ 3 in 4 pts (unable to calculate in 6 pts due to unknown LDH) and 2 pts had B symptoms. The median Ki67 was 75% (range 50-95%), EBER was negative in all pts; 3 of 13 evaluable pts were positive for MYC gene rearrangement, and 0 pts had an IGH/BCL2 translocation. Therapies at diagnosis included R-CHOP (12 pts), R-EPOCH (2 pts), R-CHOP with 3 g/m2 of methotrexate (1 pt), and hyperfractionated cytoxan (1 patient). In addition, 2 pts received IT methotrexate prophylaxis and 5 pts received involved field radiation therapy to residual disease sites post frontline chemotherapy. None of the pts underwent autologous stem cell transplant (SCT) in first remission. Thirteen pts (81%) achieved a complete remission (CR) with frontline treatment. Three patients had primary refractory disease, 2 rapidly progressed and died within 1 month from diagnosis. Of the 13 pts in CR, 4 (31%) remain in remission with a median follow up of 28 months (range 10-61). Nine pts in CR relapsed (69%), including 6 pts who proceeded to salvage therapy and autologous SCT, 1 pt who received both autologous and allogeneic SCT, 1 pt who underwent allogeneic SCT, and 1 pt who received multiple lines of salvage chemotherapy with no transplant and eventually died. Five of the 6 pts (84%) that underwent autologous SCT relapsed and both pts that underwent allogeneic SCT relapsed. Ten pts (63%) received ≥ 3 lines of chemotherapy. Of the 16 pts, 5 (31%) have died from disease progression. At a median follow up of 32 months (range 9.4 to 99.4), the 2 year PFS and OS for all pts were 38% and 72%, respectively (Figure 1). The median time to progression (TTP) from frontline therapy was 14 months (95% CI 7-28 months). The median TTP from second line therapy in 10 pts was 17 months (95% CI 7-33 months). Conclusions. To the best of our knowledge,this is the first series of CD5+ DLBCL from Western countries in the PET/rituximab era reported to date. With the recognized limitation of a small sample size and retrospective analysis, our current study confirms that CD5+ DLBCL pts have a poor prognosis which appears to be inferior to CD5- DLBCL despite a multimodality approach. Interestingly, autologous as well as allogeneic SCT at relapse do not seem to improve outcome, raising the question if there is even a role for transplant in these pts outside the context of a clinical trial. Similar to the initial reports about the poor prognosis of MYC translocation and DLBCL (Savage KJ et al. Blood 2009), we suggest that CD5 positivity is a particularly poor prognostic marker and should be used for risk stratification in DLBCL clinical trials. Disclosures Jones: Pharmacyclics: Consultancy, Research Funding. Blum:Janssen, Pharmacyclics: Research Funding.

Background:Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening hyperinflammatory syndrome induced by aberrantly activated myeloid and T cells. Primary or familial HLH (pHLH) is a genetic disorder that typically presents in young children. Secondary HLH (sHLH), which can occur at any age but is most common in adults, is triggered by infection, autoimmune disease, malignancy, or other conditions. Without treatment, HLH is universally fatal; even with existing etoposide-based regimens, survival remains low, particularly for malignancy-associated sHLH. There are no approved therapies specifically for sHLH, and most of our understanding of HLH diagnosis comes from studies of pHLH. The aim of this study is to assemble historical cohorts of sHLH patients from two, large US medical systems to better understand and refine the sHLH clinical definition, characterize demographic, clinical, and treatment characteristics, and compare survival and healthcare resource utilization (HRU) of the cohorts to matched comparison groups. Preliminary findings on the identification of sHLH patients at one US site were previously described [Broome et al., Blood (2022) 140 (Supplement 1): 5490-5491]. Data on sHLH patient identification at both sites are presented here. Methods: Two Electronic Medical Record (EMR) systems were queried to identify potential patients (site 1: 2009-May 2022 with no age restrictions and site 2: 2006-2022 patients &gt;18 years of age). Three methods were developed for patient identification. Method 1 identified patients with any mention of an HLH-related ICD code (ICD-9 288.4; ICD-10 D76.1, D76.2, D76.3). Method 2 identified patients with combinations of an elevated ferritin value (1,000-10,000 ng/mL or &gt;10,000 ng/mL) or a sCD25 test (predictive markers of malignancy-associated sHLH from the Optimized HLH Inflammatory [OHI] index). Method 3 identified patients with etoposide and dexamethasone treatment, removing patients receiving this treatment as part of a chemotherapy regimen. Full chart review of some cohorts was not logistically feasible because of their size (no ferritin &gt;1,000 AND any sCD25 test, ferritin &gt;10,000 AND no sCD25 test, and etoposide and dexamethasone treatment); in these instances, patient records were screened for a mention of HLH or MAS. At each site, one clinician reviewed all charts, and a second clinician reviewed a random sample. HLH diagnosis was assigned based on expert judgement, and all diagnostic conflicts were resolved between the two clinicians. Clinical and diagnostic data on sHLH patients were pulled from the EMR by the reviewing clinician. Results: 528 patients were identified at site 1 via the three methods and their charts were reviewed confirming 65 patients with sHLH. Likewise, among 714 charts reviewed at site 2, 188 patients were confirmed with sHLH. Among all patients with an ICD code (Method 1), 17% (56/327) were determined to have sHLH at site 1 and 33% (162/488) at site 2. Among patients reviewed with ferritin/sCD25 features (Method 2), 4% (9/200) were determined to have sHLH at site 1 and 11% (25/212) at site 2. Among patients reviewed with Method 3, 0% (0/1) were determined to have sHLH at site 1, and site 2 data were not available. (See Table 1) Additional analyses on clinical and treatment characteristics of the sHLH cohorts and survival/HRU comparisons will be presented. Conclusions: Since HLH is a rare, heterogeneous, and complex disease to diagnose and treat, HLH-related ICD codes may not accurately and sufficiently capture the spectrum of HLH patients in EMRs.Clinical indicators of disease were essential for identifying additional patients with this rare disorder. The general consistency of the findings between the two study sites supports the application of this patient identification algorithm across diverse medical centers.

ObjectiveTo describe the development of an area-level measure of children's opportunity, the Ohio Children's Opportunity Index (OCOI).Data Sources/Study SettingSecondary data were collected from US census based-American Community Survey (ACS), US Environmental Protection Agency, US Housing and Urban Development, Ohio Vital Statistics, US Department of Agriculture-Economic Research Service, Ohio State University Center for Urban and Regional Analysis, Ohio Incident Based Reporting System, IPUMS National Historical Geographic Information System, and Ohio Department of Medicaid. Data were aggregated to census tracts across two time periods.Study DesignOCOI domains were selected based on existing literature, which included family stability, infant health, children's health, access, education, housing, environment, and criminal justice domains. The composite index was developed using an equal weighting approach. Validation analyses were conducted between OCOI and health and race-related outcomes, and a national index.Principal FindingsComposite OCOI scores ranged from 0–100 with an average value of 74.82 (SD, 17.00). Census tracts in the major metropolitan cities across Ohio represented 76% of the total census tracts in the least advantaged OCOI septile. OCOI served as a significant predictor of health and race-related outcomes. Specifically, the average life expectancy at birth of children born in the most advantaged septile was approximately 9 years more than those born in least advantaged septile. Increases in OCOI were associated with decreases in proportion of Black (48 points lower in the most advantaged vs. least advantaged septile), p &lt; 0.001) and Minority populations (54 points lower in most advantaged vs. least advantaged septile, p &lt; 0.001). We found R-squared values &gt; 0.50 between the OCOI and the national Child Opportunity Index scores. Temporally, OCOI decreased by 1% between the two study periods, explained mainly by decreases in the children health, accessibility and environmental domains.ConclusionAs the first opportunity index developed for children in Ohio, the OCOI is a valuable resource for policy reform, especially related to health disparities and health equity. Health care providers will be able to use it to obtain holistic views on their patients and implement interventions that can tackle barriers to childhood development using a more tailored approach.

Abstract Objective: To assess the relative risk of hospital-onset Clostridioides difficile (HO-CDI) during each month of the early coronavirus disease 2019 (COVID-19) pandemic and to compare it with historical expectation based on patient characteristics. Design: This study used a retrospective cohort design. We collected secondary data from the institution’s electronic health record (EHR). Setting: The Ohio State University Wexner Medical Center, Ohio, a large tertiary healthcare system in the Midwest. Patients or participants: All adult patients admitted to the inpatient setting between January 2018 and May 2021 were eligible for the study. Prisoners, children, individuals presenting with Clostridioides difficile on admission, and patients with <4 days of inpatient stay were excluded from the study. Results: After controlling for patient characteristics, the observed numbers of HO-CDI cases were not significantly different than expected. However, during 3 months of the pandemic period, the observed numbers of cases were significantly different from what would be expected based on patient characteristics. Of these 3 months, 2 months had more cases than expected and 1 month had fewer. Conclusions: Variations in HO-CDI incidence seemed to trend with COVID-19 incidence but were not fully explained by our case mix. Other factors contributing to the variability in HO-CDI incidence beyond listed patient characteristics need to be explored.

Appalachia is defined as a roughly 1,000-mile long region in the eastern United States nestled in and around the Appalachian mountains. It is roughly 205,000 square miles and contains all or parts of twelve states: Alabama, Georgia, Mississippi, Kentucky, Maryland, New York, Pennsylvania, Virginia, North Carolina, Tennessee, West Virginia, and Ohio. The area was home to about 25 million people as of the 2010 census. It is important to note that the region has struggled with outmigration since the 1930s beginning with the onset of the Great Depression. (Appalachian Regional Commission 2017). Historically, Appalachia has been known as a unique region in the United States. Beginning with roots as a common settlement region for fiery Scotch-Irish immigrants in the 1700s, continued by earning a reputation as a center for moonshine production during the 1930s, and now known as a region where the wealthy buy their second and third homes, the region has consistently been able to craft its own, particular culture. With a population that is 42% rural (compared to a 20% rural population for the entire U.S.) and overwhelmingly Scotch-Irish in ethnic composition, the area differs from the mainstream US. Beset by poverty, the region needs tourism to be a viable industry in many of its locales. A population that is relatively low in educational achievement (Appalachia as whole averages a 22% college completion rate per county compared with a US rate of 29% per county) and does not have easy access to intellectual resources in many places needs a stable, job-providing industry (Appalachian Regional Commission 2017). The area once had a legacy in the mining and forestry industries, but according to the Appalachian Regional Commission, that era has passed and people now rely on a rebirth of manufacturing, service industries, and tourism to provide jobs (2017). Fortunately, the situation in Appalachia has improved since 1960, as the number of economically distressed counties in the region has declined from 295 in 1960 to 91 in 2014 (Appalachian Regional Commission 2017). The poverty rate of 17.1% is slightly above the national average of 14.3% (Appalachian Regional Commission 2017). The region has come to increasingly depend on the tourism industry to fill an economic void as gaps in basic services and the continual draining of potential intellectual capital from population loss continue to plague the area. This paper will examine contemporary perspectives on tourism in the Appalachian region and analyze their economic and sociological effects.

Introduction: North American guidelines on stroke prevention recommend carotid artery revascularization for symptomatic carotid disease within 2 weeks of the index event. Achieving this benchmark has proven historically challenging in the context of the universal coverage afforded by the Ontario Health Insurance Plan (OHIP), which is the sole provider of healthcare in Ontario (approximately 13.5 million people). Recent literature has indicated that wait times for carotid revascularization are unacceptably high. We sought to examine how the implementation of a dedicated Acute Carotid Clinic (ACC) in a Canadian academic stroke center would impact this public health dilemma. Methods: Retrospective analysis was preformed on 48 consecutive patients with symptomatic carotid artery disease who underwent endovascular treatment (carotid stenting) via the Acute Carotid Clinic’s expedited evaluation process over a 13-month period (July 2012 to July 2013). All patients were triaged based on direct physician referral with concurrent vascular imaging demonstrating high-grade carotid stenosis in the appropriate vessel. Patients were not placed on wait lists, and seen urgently. Results: The average time from consultation to revascularization was under 1 week (mean time 6.7 days). Historical controls of average wait times in Ontario for Carotid Endartarectomy have been previously published at 25.7 days. The percentage of patients who achieved revascularization within 2 weeks of the index event was 38%. Previously published series from Ontario for Carotid Endartarectomy showed 8 to 30% of patients were revascularized within 2 weeks of the index event. Conclusion: The paradigm of an Acute Carotid Clinic could allow for the rapid triage, assessment, and treatment of symptomatic carotid disease for the 13.5 million residents of Ontario. Adoption of this paradigm by other centers in Ontario could significantly reduce the burden of cerebrovascular disease in the province. Further research and government wide initiatives could be aimed at increasing the awareness of referring physicians to this expedited evaluation process.

The Northern Panhandle is a culturally distinct, historically foundational region of West Virginia. Lying centrally within the Allegheny Plateau, its terrain is characterized by razorback ridges and steep, winding valleys, producing a dendritic stream pattern that drains westward into the Ohio River. This high-density stream network is nested within the urban centers of the Upper Ohio Valley; coupled with the region’s intensive coal, oil and gas resource extraction, surface waters in the Northern Panhandle are at an elevated risk of degradation. A paucity of biological water quality assessment has been conducted for streams in the Northern Panhandle, leaving our understanding of current impairments poorly understood, and our ability to evaluate restoration opportunities uncertain. We propose a comprehensive ecological assessment of six major streams in West Virginia’s Northern Panhandle. Tomlinson Run and Kings Creek each comprise HUC-12 watersheds, have less-developed catchments, and are more highly recreated. Cross Creek, Buffalo Creek, Wheeling Creek and Fish Creek each comprise HUC-10 watersheds, and have varying levels of development within their catchments. The effects of land use on watersheds occur across multiple scales (physical, chemical and biological), so the primary drivers of change are often difficult to disentangle. We will analyze water chemistry variables and multiple parameters of macroinvertebrate community data (diversity, biomass and functional feeding groups) to parse out these drivers. Our goals are to determine the ecological health of these streams and better understand the effects of land use on stream ecosystems in the Northern Panhandle.

ObjectiveTo build an open source spatiotemporal system that integratesanalysis and visualization for disease surveillanceIntroductionMost surveillance methods in the literature focus on temporalaberration detections with data aggregated to certain geographicalboundaries. SaTScan has been widely used for spatiotemporalaberration detection due to its user friendly software interface.However, the software is limited to spatial scan statistics and suffersfrom location imprecision and heterogeneity of population. RSurveillance has a collection of spatiotemporal methods that focusmore on research instead of surveillanceMethodsBased in Ontario, Canada, we used postal codes for determiningthe location of cases of reportable infectious diseases. The variationin geographic sizes and shapes of the case and census geographiescreated challenges for developing a uniform temporal spatialsurveillance system, including:Linking case and population data due to misclassification errors,Distance based correlations due to irregularly shaped areas(e.g. FSA’s), andVisualization bias due to variation in population density, e.g. largearea with little population.To overcome these challenges, we developed the Ontario HybridInformation Map (OHIM) boundary, which is a combination ofPublic Health Unit boundaries (rural areas), census subdivisions(rural urban mixed) and regular grid cells (urban). The goal is tocapture population details in urban areas without losing informationin rural areas. OHIM has around 4600 geographies with more thanhalf located in urban centers. Population distribution by gender andage group was calculated for each OHIM geography. A lookup filewas also created to link all Ontario postal codes to OHIM geography.To create baselines, historical data for influenza A were used tomodel the seasonality and calculate expected case count for eachOHIM geography for each week. Standardized incident ratios (SIR)were calculated as exploratory statistics, and a spatiotemporal Besag-York-Mollie (BYM) model was used to calculate the probability thatthe risk is higher than a pre-specified threshold. Integrated NestedLaplace Approximation (R-INLA) was used in R to explore differenttypes of spatiotemporal interactions and for fast Bayesian inference.The ability to apply the models was verified by examining previousoutbreaks and seeking the opinion of staff that routinely performsurveillance on influenza.To ensure the visualization integrates with the analysis, R packageShiny was used to build an interactive spatiotemporal visualizationon OHIM boundary utilizing Open Street Map and html5. Theapplication not only allows users to pan and zoom in space and timeto explore the results and locate high risk areas, it also gives users theflexibility to change algorithm parameters for instant feedback. Figure1 demonstrates a zoomed-in OHIM boundary with pointers signalfor “high risk” area at user specified statistics exceeds a threshold(e.g., SIR > 2). Using the algorithms and visualization tools,surveillance experts pick the optimal time and place to be notifiedbased on historical data and therefore the optimal threshold, whichwill be verified by prospectively running the algorithms.ResultsThe OHIM boundaries build the foundation for efficient spatialmodelling and visualization for public health surveillance in Ontario.Together with the integrated modelling and visualization system,staff are able to interactively optimize the aberration thresholds andidentify potential outbreaks in real time. Staff reported preference ofSIR due to its faster computations and easier interpretation.One major challenge was scalability: the ability to handle highresolutions of spatiotemporal data. When the system was applied on4600 polygons by 200 weeks, significant delays were encountered inboth analysis and visualization. Difficulties in computational time,memory requirement and visualization interactivity created delaysand freezing, thereby limited user experience. This problem waspartially addressed by optimizing parameters for fast computationsConclusionsThis work shows the “proof of concept” for an open source,customizable spatiotemporal surveillance system that overcomesexisting data challenges in Ontario. However, more work is requiredto make this fully operational and efficient in production.

Abstract Background Many people at risk for sexually transmitted infections (STIs) utilize the emergency department (ED) for evaluation and treatment of STI-related complaints. Syphilis testing rates in the ED have historically been low. Following the implementation of a joint ED and Infectious Disease (ID) multidisciplinary quality improvement initiative designed to increase syphilis testing in this setting, we sought to evaluate the demographics and clinical outcomes for patients diagnosed with early syphilis in the ED. Methods A retrospective chart review of patients with positive syphilis test results from ED encounters at the Ohio State University Wexner Medical Center East Hospital between 1 January 2019 and 31 December 2021 was performed. Demographic and clinical information was obtained for patients diagnosed with early syphilis (primary, secondary or early latent syphilis). Results Since 2019, we have observed a significant increase early syphilis cases identified in our ED despite stable rates of testing (Figure 1). There were 55 cases of early syphilis, 3 with neurosyphilis (NS) at the time of diagnosis (Figure 2). Most cases were men (38/55; 69%), Black/African American (44/55; 80%), and symptomatic (48/55; 87%). Nine of 55 patients (16%) had HIV co-infection, 2 were new diagnoses at time of syphilis diagnosis. Most patients (44/55; 80%) completed appropriate treatment. Of the symptomatic patients, 17/45 (37%) received presumptive treatment in the ED (3 cases of NS excluded). Of those who received treatment after discharge from the ED, the median time to treatment completion was 3 days (range 0-30), with 11/24 (46%) returning to the ED for treatment. Figure 1.Figure 2. Conclusion As a result of a collaborative ED/ID STI testing initiative established at our institution, we have observed a significant increase in the number of symptomatic early syphilis cases identified in our ED between 2019 and 2021, with most patients completing treatment in a timely manner. This data show that the ED is an important and feasible setting for syphilis diagnosis and treatment when appropriate support systems are in place, including established communications with ID colleagues. Disclosures Carlos Malvestutto, MD MPH, Gilead Sciences: Advisor/Consultant|Viiv Healthcare: Advisor/Consultant Susan L. Koletar, MD, Gilead Sciences: Grant/Research Support.

IntroductionTraditionally, the femme fatale has been closely associated with a series of noir films (such as Double Indemnity [1944], The Maltese Falcon [1941], and The Big Heat [1953]) in the 1940s and 50s that necessarily betray male anxieties about independent women in the years during and following World War II. However, the anxieties and historical factors that precipitated the emergence of the noir femme fatale similarly existed in the sixteenth century and, as a result, the femme fatale can be re-imagined in a series of Elizabethan and Jacobean plays. In this context, to re-imagine is to imagine or conceive of something in a new way. It involves taking a concept or an idea and re-imagining it into something simultaneously similar and new. This article will argue, first, that the noir femme fatale’s emergence coincided with a period of history characterised by suspicion, intolerance and perceived vulnerability and that a similar set of historical factors—namely the presence of a female monarch and changes to marriage laws—precipitated the emergence a femme fatale type figure in the Renaissance period. Second, noir films typically contain a series of narrative tropes that can be similarly identified in a selection of Renaissance plays, which enables the production of a new, re-imagined reading of these plays as tragedies of the feminine desire for autonomy. The femme fatale, according to Rebecca Stott, is not unique to the twentieth century. The femme fatale label can be applied retrospectively to seductive, if noticeably evil women, whose seduction and destruction of men render them amenable to our twenty-first century understanding of the femme fatale (Allen). Mario Praz similarly contends that the femme fatale has always existed; she simply becomes more prolific in times of social and cultural upheaval. The definition of the femme fatale, however, has only recently been added to the dictionary and the burden of all definitions is the same: the femme fatale is a woman who lures men into danger, destruction and even death by means of her overpowering seductive charms. There is a woman on the Renaissance stage who combines adultery, murder, and insubordination and this figure embodies the same characteristics as the twentieth-century femme fatale because she is similarly drawn from an archetypal pattern of male anxieties regarding sexually appetitive/desirous women. The fear that this selection of women elicit arises invariably from their initial defiance of their fathers and/or brothers in marrying without their consent and/or the possibility that these women may marry or seek a union with a man out of sexual lust.The femme fatale of 1940s and 50s noir films is embodied by such women as Brigid O’Shaughnessy (Maltese Falcon), Phyllis Dietrichson (Double Indemnity), and Ann Grayle (Murder, My Sweet), while the figure of the femme fatale can be re-imagined in a series of Elizabethan and Jacobean plays, including The Changeling (1622), Arden of Faversham (1592), and The Maid’s Tragedy (1619). Like the noir femme fatale, there is a female protagonist in each of these plays who uses both cunning and sexual attractiveness to gain her desired independence. By focusing on one noir film and one Renaissance play, this article will explore both the historical factors that precipitate the emergence of these fatal women and the structural tropes that are common to both Double Indemnity and Middleton and Rowley’s The Changeling. The obvious parallels between the two figures at the centre of these narratives—Phyllis and Beatrice-Joanna respectively—namely an aversion to the institution of marriage and the instigation of murder to attain one’s desires, enable a re-imagined reading of Beatrice-Joanna as a femme fatale. Socio-Cultural AnxietiesThe femme fatale is a component of changing consciousness: she is one of the recurring motifs of the film noir genre and takes her place amongst degeneration anxieties, anxieties about sexuality and race and concerns about cultural virility and fitness (Stott). According to Sylvia Harvey, the emergence of the femme fatale parallels social changes taking place in the 1940s, particularly the increasing entry of women into the labour market. She also notes the apparent frustration of the institution of the family in this era and the boredom and stifling entrapment of marriage and how the femme fatale threatens to destroy traditional family structures. Jans Wager likewise notes that the femme fatale emerged as an expression of the New Woman, whose presence in the public sphere was in opposition to her adherence to traditional societal values, while Virginia Allen argues that the femme fatale came to maturity in the years marked by the first birth control campaigns and female emancipation movement. The Renaissance femme fatale similarly emerged in the wake of historical trigger factors occurring at the time, namely the presence of a female monarch and changes to marriage laws. In 1558, Queen Elizabeth I assumed the throne, which had a profound impact upon relations of gender in English Renaissance society. She occupied a privileged position of power in a society that believed women should have none by virtue of their inferior sex (Montrose). This was compounded by her decision to remain unmarried, which ensured the consolidation of her power that she would have otherwise forfeited to her husband. The presence of a female ruler destabilised established notions of women as passive objects of desire and, as I argue here, contributed to representations of powerful women in Renaissance drama. Men created femme fatales in their work as an expression of what they saw in women who were beginning to declare their sexual and political freedom. In addition, changing conceptions of marriage from arranged practices (unions for social and economic reasons) to romantic idealism (marriage for companionship and affective ties) saw the legitimation of desire outside the holy sacrament. Plays depicting femme fatales, including The Changeling (1622), Arden of Faversham (1592) and The Maid’s Tragedy (1619) to name a few, appear to have fed off the anxieties that resulted from the shift from arranged marriages to individual choice of a spouse. Similarly, in the noir period, “restrictions on women’s rights ensured that married women had comparatively fewer rights than single women, who could at least lay claim to their own property and wages” (Braun 53). As such, the femme fatale represented an alternative to domesticity, one in which a woman could retain her dignity without a man.Re-imagining the Femme Fatale James Damico proposes a model of film noir’s plot structure and character type. The male protagonist is hired for a job associated with a non-innocent woman to whom he is sexually and fatally attracted to. Through his attraction, either because the woman induces him to it or because it is a natural result of their relationship, the man comes to cheat, attempt to or actually murder a second man to whom a woman is unhappily or unwillingly attached (generally her husband or lover). This act invariably leads to the woman’s betrayal of the protagonist and either metaphorically or literally results in the destruction of the woman, the man to whom she is attached, and the protagonist himself. In Double Indemnity, Phyllis Dietrichson lures her hapless lover, Walter Neff, into committing murder on her behalf. He puts up minimal resistance to Phyllis’s plan to insure her husband without his knowledge so that he can be killed and she can reap the benefits of the policy. Walter says, “I fought it [the idea of murder], only I guess I didn’t fight it hard enough.” Similarly, in The Changeling, Beatrice-Joanna’s father, Vermandero, arranges her marriage to Alonzo de Piracquo; however, she is in love with Alsemero, who would also be a suitable match if Alonzo were out of the way. She thus employs the use of her servant DeFlores to kill her intended. He does as instructed and brings back her dead fiancée’s finger as proof of the deed, expecting for his services a sexual reward, rather than the gold Beatrice-Joanna offered him: “Never was man / Dearlier rewarded” (2.2.138-140). Renaissance fears regarding women’s desirous subjectivity are justified in this scene, which represent Beatrice-Joanna as willingly succumbing to DeFlore’s advances: she came to “love anon” what she had previously “fear’st and faint’st to venture on” (3.4.171-172). She experienced a “giddy turning in [her]” (1.1.159), which compelled her to seduce DeFlores on the eve of her wedding to Alsemero. Both Phyllis and Beatrice-Joanna localise contemporary fears and fantasies about women, sexuality and marriage (Haber) and, despite the existing literature surrounding the noir femme fatale, a re-imagining of this figure on the Renaissance stage is unique. Furthermore, and in addition to similarities in plot structure, noir films are typically characterised by three narrative tropes (masquerade, the polarisation of the femme fatale with the femme attrappe and the demise of the femme fatale) that are likewise present in The Changeling. 1. Masquerade: Her Sexual Past Is the Central Mystery of the Narrative The femme fatale appropriates the signifiers of femininity (modesty, obedience, silence) that bewitch men and fool them into believing that she embodies everything he desires. According to Luce Irigaray, the femme fatale assumes an unnatural, flaunted facade and, in so doing, she conceals her own subjectivity and disrupts notions of what she is really like. Her sexual past is often the central mystery and so she figuratively embodies the hidden secrets of feminine sexuality while the males battle for control over this knowledge (Lee-Hedgecock). John Caleb-Hopkins characterises Phyllis as a faux housewife because of her rejection of the domestic, her utilisation of the role to further her agency, and her method of deception via gender performance. It is “faux” because she plays the role as a means to achieve her monetary or material desires. When Phyllis first meets Walter she plays up the housewife routine because she immediately recognises his potential utility for her. The house is not a space in which she belongs but a space she can utilise to further her agency and so she devises a plan to dethrone and remove the patriarch from his position within the home. Walter, as the last patriarchal figure in her vicinity to interfere with the pursuit of her desire, must be killed as well. Beatrice-Joanna’s masquerade of femininity (“there was a visor / O’er that cunning face” [5.3.46-7]) and her performance as a chaste virgin to please Alsemero, suggests that she possesses an ineffaceable knowledge that femininity is a construction that women put on for men. Having surrendered her virginity to DeFlores prior to marrying Alsemero, she agonises that he will find out: “Never was bride so fearfully distressed […] There’s no venturing / Into his bed […] Without my shame” (4.1.2-13). Fortunately, she discovers a manuscript (the Book of Experiments) that documents “How to know whether a woman be a maid or not” (4.1.41). Having discovered the book and potions, Beatrice-Joanna persuades her waiting-woman Diaphanta to take the potions so that she can witness its effects and mimic them as necessary. Thus instructed, Beatrice-Joanna is equipped with the ability to feign the symptoms of virginity, which leads us to the notion of female masquerade as a means to evade the male gaze by feigning virtue and thus retaining her status as desirable to men. Her masquerade conceals her sexual experience and hides the truth of female deceitfulness from the men in the play, which makes manifest the theme of women’s unknowability. 2. Femme Fatale versus Femme AttrappeThe original source of the femme fatale is the dark half of the dualistic concept of the Eternal Feminine: the Mary/Eve dichotomy (Allen). In film noir, the female characters fall into one of two categories—the femme fatale or woman as redeemer. Unlike the femme fatale, the femme attrappe is the known, familiar and comfortable other, who is juxtaposed to the unknown, devious and deceptive other. According to Jans Wager both women are trapped by patriarchal authority—the femme fatale by her resistance and the good wife by her acquiescence. These two women invariably appear side-by-side in order to demonstrate acceptable womanhood in the case of the femme attrappe and dangerous and unacceptable displays of femininity in the case of the femme fatale. In Double Indemnity, Phyllis is an obvious example of the latter. She flirts brazenly with Walter while introducing the idea of insuring her husband and when he finally kills her husband, she stares unflinchingly ahead and continues driving, showing very little remorse after the murder. Lola (Phyllis’s step-daughter and the film’s femme attrappe) functions as a foil to Phyllis. “Lola’s narrative purpose is to provide a female character to contrast with Phyllis to further depict her femininity as bad […] The more Lola is emphatically stressed as victim through Walter’s narration, the more vilified Phyllis is” (Caleb-Hopkins). Lola presents a type of femininity that patriarchy approves of and necessitates. Phyllis is the antithesis to this because her sexuality is provocative and open and she uses it to manipulate those around her (Caleb-Hopkins). It is Lola who eventually tells Walter that Phyllis murdered her mother and that her former boyfriend Nino has been spotted at Phyllis’s house most nights. This leads Walter to conclude, logically, that she is arranging for Nino to kill him as well (Maxfield). The Renaissance subplot heroine has been juxtaposed, here, with the deadly woman at the center of the play, thus supporting a common structural trope of the film noir genre in which the femme attrappe and femme fatale exist alongside each other. In The Changeling, Isabella and Beatrice-Joanna occupy these positions respectively. In the play’s subplot, Alibius employs his servant Lollio to watch over his wife Isabella while he is away and, ironically, it is Lollio himself who attempts to seduce Isabella. He offers himself to her as a “most shrewd temptation” (1.2.57); however, unlike Beatrice-Joanna, who engages in a lascivious affair with another man, Isabella remains faithful to her husband. In so doing, Beatrice-Joanna’s status as a femme fatale is exemplified. She is represented as a woman who cannot control her desires and will resort to any and all means necessary to get what she wants. 3. The Femme Fatale’s Demise The femme fatale is characterised by the two-fold possession of desire: desire for autonomy and self-government and the desire for death. Her quest for freedom, which is only available in death, explains the femme fatale’s desire to self-destruct in these plays, which guarantees that she will never deviate from the course she alighted on even if that path leads inevitably to her demise. According to Elizabeth Bronfen, “the choice between freedom and death inevitably requires that one choose death because there you show that you have freedom of choice. She undertakes an act that allows her to choose death as a way of choosing real freedom by turning the inevitability of her fate into her responsibility” (2004).The femme fatale will never show her true intentions to anyone, especially not the hero she has inveigled, even if it entails his and her own death (Bronfen). In Double Indemnity, Phyllis, by choosing not to shoot Walter the second time, performs an act in which she actively accepts her own fallibility: “I never loved you Walter. Not you or anybody else. I’m rotten to the heart. I used you just as you said. That’s all you ever meant to me. Until a minute ago, when I couldn’t fire that second shot.” This is similarly the case with Beatrice-Joanna who, only at the very end, admits to the murder of Alonzo—“Your love has made me / A cruel murd’ress” (5.3.64-5)—in order to get the man she wanted. According to Bronfen, the femme fatale turns what is inevitable into a source of power. She does not contest the murder charge because a guilty verdict and punishment of death will grant her the freedom she has sought unwaveringly since the beginning of the play. Both Beatrice-Joanna and Phyllis apprehend that there is no appropriate outlet for their unabashed independence. Their unions, with Alsemero and Walter respectively, will nevertheless require their subjection in the patriarchal institution of monogamous marriage. The destruction of the sanctity of marriage in Double Indemnity and The Changeling inevitably results in placing the relationship of the lovers under strain, beyond the boundaries of conventional moral law, to the extent that the adulterous relationship becomes an impossibility that invariably results in the mutual destruction of both parties. ConclusionThe plays of the Elizabethan and Jacobean period, like the noir films of the 1940s and 50s, lament a lost past when women accepted their subordination without reproach and anxiously anticipated a future in which women refused submission to men and masculine forms of authority (Born-Lechleitner). While the femme fatale is commonly associated with the noir era, this article has argued that a series of historical factors and socio-cultural anxieties in the Renaissance period allow for a re-imagined reading of the femme fatale on the Elizabethan and Jacobean stage. In The Changeling, Middleton and Rowley foreground contemporary cultural anxieties by fleshing out the lusty details that confirm Beatrice-Joanna’s status a female villainess. Throughout the play we come to understand the ideologies that dictate the manner of her representation. That is, early modern anxieties regarding the independent, sexually appetitive woman manifested in representations of a female figure on the Renaissance stage who can be re-imagined as a femme fatale.ReferencesAllen, Virginia M. The Femme Fatale: Erotic Icon. New York: Whitson Publishing Company, 1983. Born-Lechleitner, Ilse. The Motif of Adultery in Elizabethan, Jacobean, and Caroline Tragedy. New York: Edwin Hellen Press, 1995.Braun, Heather. The Rise and Fall of the Femme Fatale in British Literature, 1790-1910. Madison, NJ: Fairleigh Dickinson UP, 2012. Bronfen, Elizabeth. “Femme Fatale: Negotiations of Tragic Desire.” New Literary History 35.1 (2004): 103–16. Caleb-Hopkins, John. “There’s No Place like Home … Anymore: Domestic Masquerade and Faux-Housewife Femme Fatale in Barbara Stanwyck’s Early 1940s Films.” Masters thesis. Canada: Carleton University, 2014.Damico, James. “Film Noir: A Modest Proposal.” Film Noir Reader. Eds. Alain Silver and James Ursini. New York: Limelight, 1996.Double Indemnity. Billy Wilder. Paramount Pictures, 1944.Haber, Judith. “I(t) Could Not Choose But Follow: Erotic Logic in The Changeling.” Representations 81.18 (2003): 79–98. Harvey, Sylivia. “Woman’s Place: The Absent Family of Film Noir.” Women in Film Noir. Ed. A. Kaplan. London: British Film Institute, 1978. Irigaray, Luce. The Sex Which Is Not One. Ithaca, NY: Cornell UP, 1985.Lee-Hedgecock, Jennifer. The Sexual Threat and Danger of the Femme Fatale in Victorian Literature. East Lansing, MI: Michigan State UP, 2005. Montrose, Louis. The Subject of Elizabeth: Authority, Gender, and Representation. Chicago: U of Chicago P, 2006.Maxfield, James F. The Fatal Woman: Sources of Male Anxiety in American Film Noir. Madison, NJ: Fairleigh Dickinson UP, 1996.Praz, Mario. The Romantic Agony. Oxford: Oxford UP, 1951 [1933]. Stott, Rebecca. The Fabrication of the Late-Victorian Femme Fatale. London: Macmillan Press, 1992.Wager, Jans B. Dangerous Dames: Women and Representation in the Weimar Street Film and Film Noir. Athens, OH: Ohio UP, 1999.

For seven months in 1999/2000, six-year old Cuban Elián González was embroiled in a family feud plotted along rival national and ideological lines, and relayed televisually as soap opera across the planet. In Miami, apparitions of the Virgin Mary were reported after Elián’s arrival; adherents of Afro-Cuban santería similarly regarded Elián as divinely touched. In Cuba, Elián’s “kidnapping” briefly reinvigorated a torpid revolutionary project. He was hailed by Fidel Castro as the symbolic descendant of José Martí and Che Guevara, and of the patriotic rigour they embodied. Cubans massed to demand his return. In the U.S.A., Elián’s case was arbitrated at every level of the juridical system. The “Save Elián” campaign generated widespread debate about godless versus godly family values, the contours of the American Dream, and consumerist excess. By the end of 2000 Elián had generated the second largest volume of TV news coverage to that date in U.S. history, surpassed only by the O. J. Simpson case (Fasulo). After Fidel Castro, and perhaps the geriatric music ensemble manufactured by Ry Cooder, the Buena Vista Social Club, Elián became the most famous Cuban of our era. Elián also emerged as the unlikeliest of popular-cultural icons, the focus and subject of cyber-sites, books, films, talk-back radio programs, art exhibits, murals, statues, documentaries, a South Park episode, poetry, songs, t-shirts, posters, newspaper editorials in dozens of languages, demonstrations, speeches, political cartoons, letters, legal writs, U.S. Congress records, opinion polls, prayers, and, on both sides of the Florida Strait, museums consecrated in his memory. Confronted by Elián’s extraordinary renown and historical impact, John Carlos Rowe suggests that the Elián story confirms the need for a post-national and transdisciplinary American Studies, one whose practitioners “will have to be attentive to the strange intersections of politics, law, mass media, popular folklore, literary rhetoric, history, and economics that allow such events to be understood.” (204). I share Rowe’s reading of Elián’s story and the clear challenges it presents to analysis of “America,” to which I would add “Cuba” as well. But Elián’s story is also significant for the ways it challenges critical understandings of fame and its construction. No longer, to paraphrase Leo Braudy (566), definable as an accidental hostage of the mass-mediated eye, Elián’s fame has no certain relation to the child at its discursive centre. Elián’s story is not about an individuated, conscious, performing, desiring, and ambivalently rewarded ego. Elián was never what P. David Marshall calls “part of the public sphere, essentially an actor or, … a player” in it (19). The living/breathing Elián is absent from what I call the virtualizing drives that famously reproduced him. As a result of this virtualization, while one Elián now attends school in Cuba, many other Eliáns continue to populate myriad popular-cultural texts and to proliferate away from the states that tried to contain him. According to Jerry Everard, “States are above all cultural artefacts” that emerge, virtually, “as information produced by and through practices of signification,” as bits, bites, networks, and flows (7). All of us, he claims, reside in “virtual states,” in “legal fictions” based on the elusive and contested capacity to generate national identities in an imaginary bounded space (152). Cuba, the origin of Elián, is a virtual case in point. To augment Nicole Stenger’s definition of cyberspace, Cuba, like “Cyberspace, is like Oz — it is, we get there, but it has no location” (53). As a no-place, Cuba emerges in signifying terms as an illusion with the potential to produce and host Cubanness, as well as rival ideals of nation that can be accessed intact, at will, and ready for ideological deployment. Crude dichotomies of antagonism — Cuba/U.S.A., home/exile, democracy/communism, freedom/tyranny, North/South, godlessness/blessedness, consumption/want — characterize the hegemonic struggle over the Cuban nowhere. Split and splintered, hypersensitive and labyrinthine, guarded and hysterical, and always active elsewhere, the Cuban cultural artefact — an “atmospheric depression in history” (Stenger 56) — very much conforms to the logics that guide the appeal, and danger, of cyberspace. Cuba occupies an inexhaustible “ontological time … that can be reintegrated at any time” (Stenger 55), but it is always haunted by the prospect of ontological stalling and proliferation. The cyber-like struggle over reintegration, of course, evokes the Elián González affair, which began on 25 November 1999, when five-year old Elián set foot on U.S. soil, and ended on 28 June 2000, when Elián, age six, returned to Cuba with his father. Elián left one Cuba and found himself in another Cuba, in the U.S.A., each national claimant asserting virtuously that its other was a no-place and therefore illegitimate. For many exiles, Elián’s arrival in Miami confirmed that Castro’s Cuba is on the point of collapse and hence on the virtual verge of reintegration into the democratic fold as determined by the true upholders of the nation, the exile community. It was also argued that Elián’s biological father could never be the boy’s true father because he was a mere emasculated puppet of Castro himself. The Cuban state, then, had forfeited its claims to generate and host Cubanness. Succoured by this logic, the “Save Elián” campaign began, with organizations like the Cuban American National Foundation (CANF) bankrolling protests, leaflet and poster production, and official “Elián” websites, providing financial assistance to and arranging employment for some of Elián’s Miami relatives, lobbying the U.S. Congress and the Florida legislature, and contributing funds to the legal challenges on behalf of Elián at state and federal levels. (Founded in 1981, the CANF is the largest and most powerful Cuban exile organization, and one that regards itself as the virtual government-in-waiting. CANF emerged with the backing of the Reagan administration and the C.I.A. as a “private sector initiative” to support U.S. efforts against its long-time ideological adversary across the Florida Strait [Arboleya 224-5].) While the “Save Elián” campaign failed, the result of a Cuban American misreading of public opinion and overestimation of the community’s lobbying power with the Clinton administration, the struggle continues in cyberspace. CANF.net.org registers its central role in this intense period with silence; but many of the “Save Elián” websites constructed after November 1999 continue to function as sad memento moris of Elián’s shipwreck in U.S. virtual space. (The CANF website does provide links to articles and opinion pieces about Elián from the U.S. media, but its own editorializing on the Elián affair has disappeared. Two keys to this silence were the election of George W. Bush, and the events of 11 Sep. 2001, which have enabled a revision of the Elián saga as a mere temporary setback on the Cuban-exile historical horizon. Indeed, since 9/11, the CANF website has altered the terms of its campaign against Castro, posting photos of Castro with Arab leaders and implicating him in a world-wide web of terrorism. Elián’s return to Cuba may thus be viewed retrospectively as an act that galvanized Cuban-exile support for the Republican Party and their disdain for the Democratic rival, and this support became pivotal in the Republican electoral victory in Florida and in the U.S.A. as a whole.) For many months after Elián’s return to Cuba, the official Liberty for Elián site, established in April 2000, was urging visitors to make a donation, volunteer for the Save Elián taskforce, send email petitions, and “invite a friend to help Elián.” (Since I last accessed “Liberty for Elián” in March 2004 it has become a gambling site.) Another site, Elian’s Home Page, still implores visitors to pray for Elián. Some of the links no longer function, and imperatives to “Click here” lead to that dead zone called “URL not found on this server.” A similar stalling of the exile aspirations invested in Elián is evident on most remaining Elián websites, official and unofficial, the latter including The Sad Saga of Elian Gonzalez, which exhorts “Cuban Exiles! Now You Can Save Elián!” In these sites, a U.S. resident Elián lives on as an archival curiosity, a sign of pathos, and a reminder of what was, for a time, a Cuban-exile PR disaster. If such cybersites confirm the shipwrecked coordinates of Elián’s fame, the “Save Elián” campaign also provided a focus for unrestrained criticism of the Cuban exile community’s imbrication in U.S. foreign policy initiatives and its embrace of American Dream logics. Within weeks of Elián’s arrival in Florida, cyberspace was hosting myriad Eliáns on sites unbeholden to Cuban-U.S. antagonisms, thus consolidating Elián’s function as a disputed icon of virtualized celebrity and focus for parody. A sense of this carnivalesque proliferation can be gained from the many doctored versions of the now iconic photograph of Elián’s seizure by the INS. Still posted, the jpegs and flashes — Elián and Michael Jackson, Elián and Homer Simpson, Elián and Darth Vader, among others (these and other doctored versions are archived on Hypercenter.com) — confirm the extraordinary domestication of Elián in local pop-cultural terms that also resonate as parodies of U.S. consumerist and voyeuristic excess. Indeed, the parodic responses to Elián’s fame set the virtual tone in cyberspace where ostensibly serious sites can themselves be approached as send ups. One example is Lois Rodden’s Astrodatabank, which, since early 2000, has asked visitors to assist in interpreting Elián’s astrological chart in order to confirm whether or not he will remain in the U.S.A. To this end the site provides Elián’s astro-biography and birth chart — a Sagittarius with a Virgo moon, Elián’s planetary alignments form a bucket — and conveys such information as “To the people of Little Havana [Miami], Elian has achieved mystical status as a ‘miracle child.’” (An aside: Elián and I share the same birthday.) Elián’s virtual reputation for divinely sanctioned “blessedness” within a Cuban exile-meets-American Dream typology provided Tom Tomorrow with the target in his 31 January 2000, cartoon, This Modern World, on Salon.com. Here, six-year old Arkansas resident Allen Consalis loses his mother on the New York subway. His relatives decide to take care of him since “New York has much more to offer him than Arkansas! I mean get real!” A custody battle ensues in which Allan’s heavily Arkansas-accented father requires translation, and the case inspires heated debate: “can we really condemn him to a life in Arkansas?” The cartoon ends with the relatives tempting Allan with the delights offered by the Disney Store, a sign of Elián’s contested insertion into an American Dreamscape that not only promises an endless supply of consumer goods but provides a purportedly safe venue for the alternative Cuban nation. The illusory virtuality of that nation also animates a futuristic scenario, written in Spanish by Camilo Hernández, and circulated via email in May 2000. In this text, Elián sparks a corporate battle between Firestone and Goodyear to claim credit for his inner-tubed survival. Cuban Americans regard Elián as the Messiah come to lead them to the promised land. His ability to walk on water is scientifically tested: he sinks and has to be rescued again. In the ensuing custody battle, Cuban state-run demonstrations allow mothers of lesbians and of children who fail maths to have their say on Elián. Andrew Lloyd Weber wins awards for “Elián the Musical,” and for the film version, Madonna plays the role of the dolphin that saved Elián. Laws are enacted to punish people who mispronounce “Elián” but these do not help Elián’s family. All legal avenues exhausted, the entire exile community moves to Canada, and then to North Dakota where a full-scale replica of Cuba has been built. Visa problems spark another migration; the exiles are welcomed by Israel, thus inspiring a new Intifada that impels their return to the U.S.A. Things settle down by 2014, when Elián, his wife and daughter celebrate his 21st birthday as guests of the Kennedys. The text ends in 2062, when the great-great-grandson of Ry Cooder encounters an elderly Elián in Wyoming, thus providing Elián with his second fifteen minutes of fame. Hernández’s text confirms the impatience with which the Cuban-exile community was regarded by other U.S. Latino sectors, and exemplifies the loss of control over Elián experienced by both sides in the righteous Cuban “moral crusade” to save or repatriate Elián (Fernández xv). (Many Chicanos, for example, were angered at Cuban-exile arguments that Elián should remain in the U.S.A. when, in 1999 alone, 8,000 Mexican children were repatriated to Mexico (Ramos 126), statistical confirmation of the favored status that Cubans enjoy, and Mexicans do not, vis-à-vis U.S. immigration policy. Tom Tomorrow’s cartoon and Camilo Hernández’s email text are part of what I call the “What-if?” sub-genre of Elián representations. Another example is “If Elián Gonzalez was Jewish,” archived on Lori’s Mishmash Humor page, in which Eliat Ginsburg is rescued after floating on a giant matzoh in the Florida Strait, and his Florida relatives fight to prevent his return to Israel, where “he had no freedom, no rights, no tennis lessons”.) Nonetheless, that “moral crusade” has continued in the Cuban state. During the custody battle, Elián was virtualized into a hero of national sovereignty, an embodied fix for a revolutionary project in strain due to the U.S. embargo, the collapse of Soviet socialism, and the symbolic threat posed by the virtual Cuban nation-in-waiting in Florida. Indeed, for the Castro regime, the exile wing of the national family is virtual precisely because it conveniently overlooks two facts: the continued survival of the Cuban state itself; and the exile community’s forty-plus-year slide into permanent U.S. residency as one migrant sector among many. Such rhetoric has not faded since Elián’s return. On December 5, 2003, Castro visited Cárdenas for Elián’s tenth birthday celebration and a quick tour of the Museo a la batalla de ideas (Museum for the Battle of Ideas), the museum dedicated to Elián’s “victory” over U.S. imperialism and opened by Castro on July 14, 2001. At Elián’s school Castro gave a speech in which he recalled the struggle to save “that little boy, whose absence caused everyone, and the whole people of Cuba, so much sorrow and such determination to struggle.” The conflation of Cuban state rhetoric and an Elián mnemonic in Cárdenas is repeated in Havana’s “Plaza de Elián,” or more formally Tribuna Anti-imperialista José Martí, where a statue of José Martí, the nineteenth-century Cuban nationalist, holds Elián in his arms while pointing to Florida. Meanwhile, in Little Havana, Miami, a sun-faded set of photographs and hand-painted signs, which insist God will save Elián yet, hang along the front fence of the house — now also a museum and site of pilgrimage — where Elián once lived in a state of siege. While Elián’s centrality in a struggle between virtuality and virtue continues on both sides of the Florida Strait, the Cuban nowhere could not contain Elián. During his U.S. sojourn many commentators noted that his travails were relayed in serial fashion to an international audience that also claimed intimate knowledge of the boy. Coming after the O.J. Simpson saga and the Clinton-Lewinsky affair, the Elián story confirmed journalist Rick Kushman’s identification of a ceaseless, restless U.S. media attention shift from one story to the next, generating an “übercoverage” that engulfs the country “in mini-hysteria” (Calvert 107). But In Elián’s case, the voyeuristic media-machine attained unprecedented intensity because it met and worked with the virtualities of the Cuban nowhere, part of it in the U.S.A. Thus, a transnational surfeit of Elián-narrative options was guaranteed for participants, audiences and commentators alike, wherever they resided. In Cuba, Elián was hailed as the child-hero of the Revolution. In Miami he was a savior sent by God, the proof supplied by the dolphins that saved him from sharks, and the Virgins who appeared in Little Havana after his arrival (De La Torre 3-5). Along the U.S.A.-Mexico border in 2000, Elián’s name was given to hundreds of Mexican babies whose parents thought the gesture would guarantee their sons a U.S. future. Day by day, Elián’s story was propelled across the globe by melodramatic plot devices familiar to viewers of soap opera: doubtful paternities; familial crimes; identity secrets and their revelation; conflicts of good over evil; the reuniting of long-lost relatives; and the operations of chance and its attendant “hand of Destiny, arcane and vaguely supernatural, transcending probability of doubt” (Welsh 22). Those devices were also favored by the amateur author, whose narratives confirm that the delirious parameters of cyberspace are easily matched in the worldly text. In Michael John’s self-published “history,” Betrayal of Elian Gonzalez, Elián is cast as the victim of a conspiracy traceable back to the hydra-headed monster of Castro-Clinton and the world media: “Elian’s case was MANIPULATED to achieve THEIR OVER-ALL AGENDA. Only time will bear that out” (143). His book is now out of print, and the last time I looked (August 2004) one copy was being offered on Amazon.com for US$186.30 (original price, $9.95). Guyana-born, Canadian-resident Frank Senauth’s eccentric novel, A Cry for Help: The Fantastic Adventures of Elian Gonzalez, joins his other ventures into vanity publishing: To Save the Titanic from Disaster I and II; To Save Flight 608 From Disaster; A Wish to Die – A Will to Live; A Time to Live, A Time to Die; and A Day of Terror: The Sagas of 11th September, 2001. In A Cry for Help, Rachel, a white witch and student of writing, travels back in time in order to save Elián’s mother and her fellow travelers from drowning in the Florida Strait. As Senauth says, “I was only able to write this dramatic story because of my gift for seeing things as they really are and sharing my mystic imagination with you the public” (25). As such texts confirm, Elián González is an aberrant addition to the traditional U.S.-sponsored celebrity roll-call. He had no ontological capacity to take advantage of, intervene in, comment on, or be known outside, the parallel narrative universe into which he was cast and remade. He was cast adrift as a mere proper name that impelled numerous authors to supply the boy with the biography he purportedly lacked. Resident of an “atmospheric depression in history” (Stenger 56), Elián was battled over by virtualized national rivals, mass-mediated, and laid bare for endless signification. Even before his return to Cuba, one commentator noted that Elián had been consumed, denied corporeality, and condemned to “live out his life in hyper-space” (Buzachero). That space includes the infamous episode of South Park from May 2000, in which Kenny, simulating Elián, is killed off as per the show’s episodic protocols. Symptomatic of Elián’s narrative dispersal, the Kenny-Elián simulation keeps on living and dying whenever the episode is re-broadcast on TV sets across the world. Appropriated and relocated to strange and estranging narrative terrain, one Elián now lives out his multiple existences in the Cuban-U.S. “atmosphere in history,” and the Elián icon continues to proliferate virtually anywhere. References Arboleya, Jesús. The Cuban Counter-Revolution. Trans. Rafael Betancourt. Research in International Studies, Latin America Series no. 33. Athens, OH: Ohio Center for International Studies, 2000. Braudy, Leo. The Frenzy of Renown: Fame and Its History. New York and Oxford: Oxford UP, 1986. Buzachero, Chris. “Elian Gonzalez in Hyper-Space.” Ctheory.net 24 May 2000. 19 Aug. 2004: http://www.ctheory.net/text_file.asp?pick=222>. Calvert, Clay. Voyeur Nation: Media, Privacy, and Peering in Modern Culture. Boulder: Westview, 2000. Castro, Fidel. “Speech Given by Fidel Castro, at the Ceremony Marking the Birthday of Elian Gonzalez and the Fourth Anniversary of the Battle of Ideas, Held at ‘Marcello Salado’ Primary School in Cardenas, Matanzas on December 5, 2003.” 15 Aug. 2004 http://www.revolutionarycommunist.org.uk/fidel_castro3.htm>. Cuban American National Foundation. Official Website. 2004. 20 Aug. 2004 http://www.canf.org/2004/principal-ingles.htm>. De La Torre, Miguel A. La Lucha For Cuba: Religion and Politics on the Streets of Miami. Berkeley: U of California P, 2003. “Elian Jokes.” Hypercenter.com 2000. 19 Aug. 2004 http://www.hypercenter.com/jokes/elian/index.shtml>. “Elian’s Home Page.” 2000. 19 Aug. 2004 http://elian.8k.com>. Everard, Jerry. Virtual States: The Internet and the Boundaries of the Nation-State. London and New York, Routledge, 2000. Fernández, Damián J. Cuba and the Politics of Passion. Austin: U of Texas P, 2000. Hernández, Camilo. “Cronología de Elián.” E-mail. 2000. Received 6 May 2000. “If Elian Gonzalez Was Jewish.” Lori’s Mishmash Humor Page. 2000. 10 Aug. 2004 http://www.geocities.com/CollegePark/6174/jokes/if-elian-was-jewish.htm>. John, Michael. Betrayal of Elian Gonzalez. MaxGo, 2000. “Liberty for Elián.” Official Save Elián Website 2000. June 2003 http://www.libertyforelian.org>. Marshall, P. David. Celebrity and Power: Fame in Contemporary Culture. Minneapolis and London: U of Minnesota P, 1997. Ramos, Jorge. La otra cara de América: Historias de los inmigrantes latinoamericanos que están cambiando a Estados Unidos. México, DF: Grijalbo, 2000. Rodden, Lois. “Elian Gonzalez.” Astrodatabank 2000. 20 Aug. 2004 http://www.astrodatabank.com/NM/GonzalezElian.htm>. Rowe, John Carlos. 2002. The New American Studies. Minneapolis and London: U of Minnesota P, 2002. “The Sad Saga of Elian Gonzalez.” July 2004. 19 Aug. 2004 http://www.revlu.com/Elian.html>. Senauth, Frank. A Cry for Help: The Fantastic Adventures of Elian Gonzalez. Victoria, Canada: Trafford, 2000. Stenger, Nicole. “Mind Is a Leaking Rainbow.” Cyberspace: First Steps. Ed. Michael Benedikt. Cambridge, MA: MIT P, 1991. 49-58. Welsh, Alexander. George Eliot and Blackmail. Cambridge, MA: Harvard UP, 1985. Citation reference for this article MLA Style Allatson, Paul. "The Virtualization of Elián González." M/C Journal 7.5 (2004). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0411/16-allatson.php>. APA Style Allatson, P. (Nov. 2004) "The Virtualization of Elián González," M/C Journal, 7(5). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0411/16-allatson.php>.

One cannot use the Internet for long without encountering its many dead ends. Despite the adage that everything posted online stays there forever, users quickly discover how fleeting Web content can be. Whether it be the result of missing files, platform moderation, or simply bad code, the Internet constantly displaces its archival contents. Eventual decay is the fate of all digital media, as Wendy Hui Kyong Chun observed in a 2008 article. “Digital media is not always there”, she writes. “We suffer daily frustrations with digital sources that just disappear” (160). When the media content we seek is something trivial like a digitised vacation photo, our inability to retrieve it may merely disappoint us. But what happens when we lose access to Web content about significant cultural events, like viral misinformation about a school shooting? This question takes on great urgency as conspiracy content spreads online at baffling scale and unprecedented speed. Although conspiracy theories have long been a fixture of American culture, the contemporary Internet enables all manner of “information disorder” (Wardle and Derakhshan) to warp media coverage, sway public opinion, and even disrupt the function of government—as seen in the harrowing “Stop the Steal” attack on the U.S. Capitol on 6 January 2021, when rioters attempted to prevent Congress from verifying the results of the 2020 Presidential Election. Scholars across disciplines have sought to understand how conspiracy theories function within our current information ecosystem (Marwick and Lewis; Muirhead and Rosenblum; Phillips and Milner). Much contemporary research focusses on circulation, tracking how conspiracy theories and other types of misinformation travel from fringe Websites to mainstream news outlets such as the New York Times. While undoubtedly valuable, this emphasis on circulation provides an incomplete picture of online conspiracy theories’ lifecycle. How should scholars account for the afterlife of conspiracy content, such as links to conspiracy videos that get taken down for violating YouTube’s Community Guidelines? This and related questions about the dead ends of online conspiracy theorising are underexplored in the existing scholarly literature. This essay contends that the Internet’s tendency to decay ought to factor into our models of digital conspiracy theories. I focus on the phenomenon of malfunctional hyperlinks, one of the most common types of disrepair to which the Internet is prone. The product of so-called “link rot”, broken links would appear to signal an archival failure for online conspiracy theories. Yet recent work from rhetorical theorist Jenny Rice suggests that these broken hyperlinks instead function as a rhetorically potent archive in their own right. To understand this uncanny persuasive work, I draw from rhetorical theory to analyse broken links to conspiracy content on Reddit, the popular social news platform, surrounding the 2018 school shooting in Parkland, Florida, the worst high school shooting in American history. I show that broken links on the subreddit r/conspiracy, by virtue of their dysfunction, persuade conspiracy theorists that they possess “stigmatized knowledge” (Barkun 26) about the shooting that is being suppressed. Ultimately, I argue that link rot functions as a powerful source of evidence within digital conspiracy theories, imbuing broken links with enduring rhetorical force to validate marginalised belief systems. Link Rot—Archival Failure or Archival Possibility? As is suggested by the prefix ‘inter-’, connectivity has always been one of the Internet’s core functionalities. Indeed, the ability to hyperlink two different texts—and now images, videos, and other media—is so fundamental to navigating the Web that we often take these links for granted until they malfunction. In popular parlance, we then say we have clicked on a “broken” or “dead” link, and without proper care to prevent its occurrence, all URLs are susceptible to dying eventually (much like us mortals). This slow process of decay is known as “link rot”. The precise extent of link rot on the Internet is unknown—and likely unknowable, in practice if not principle—but multiple studies have been conducted to assess the degree of link rot in specific archives. One study from 2015 found that nearly 50% of the URLs cited in 406 library and information science journal articles published between 2008-2012 were no longer accessible (Kumar et al. 59). In the context of governmental Webpages, a 2010 study determined that while only 8% of the URLs sampled in 2008 had link rot, that number more than tripled to 28% of URLs with link rot when sampled only two years later (Rhodes 589-90). More recently, scholars from Harvard’s Berkman Klein Center for Internet and Society uncovered an alarming amount of link rot in the online archive of the New York Times, perhaps the most prominent newspaper in the United States: “25% of all links were completely inaccessible, with linkrot becoming more common over time – 6% of links from 2018 had rotted, as compared to 43% of links from 2008 and 72% of links from 1998” (Zittrain et al. 4). Taken together, these data indicate that link rot worsens over time, creating a serious obstacle for the study of Web-based phenomena. Link rot is particularly worrisome for researchers who study online misinformation (including digital conspiracy theories), because the associated links are often more vulnerable to removal due to content moderation or threats of legal action. How should scholars understand the function of link rot within digital conspiracy theories? If our academic focus is on how conspiracy theories circulate, these broken links might seem at best a roadblock to scholarly inquiry or at worst as totally insignificant or irrelevant. After all, users cannot access the material in question; they reach a dead end. Yet recent work by rhetoric scholar Jenny Rice suggests these dead ends might have enduring persuasive power. In her book Awful Archives: Conspiracy Rhetoric and Acts of Evidence, Rice argues that evidence is an “act rather than a thing” and that as a result, we ought to recalibrate what we consider an archive (12, original emphasis). For Rice, archives are more than simple aggregates of documents; instead, they are “ordinary and extraordinary experiences in public life that leave lasting, palpable residues, which then become our sources—our resources—for public discourse” (16-17). These “lasting, palpable residues” are deeply embodied, Rice maintains, for the evidence we gather is “always real in its reference, which is to a felt experience of proximities” (118). For conspiracy theorists in particular, an archive might evoke a profound sense of what Rice memorably describes as “Something intense, something real. Something off. Something fucked up. Something anomalous” (12, original emphasis). This is no less true when an archive fails to function as designed. Hence, for the remainder of this essay, I pivot to analysing how link rot functions within digital conspiracy theories about the 2018 school shooting in Parkland, Florida. As we will see, the shooting galvanised meaningful gun control activism via the March for Our Lives movement, but the event also quickly became fodder for proliferating conspiracy content. From Crisis to Crisis Actors: The Parkland Shooting and Its Aftermath On the afternoon of 14 February 2018, Nikolas Cruz entered his former high school, Marjory Stoneman Douglas, and murdered 17 people, including 14 students (Albright). While a horrific event, the Parkland shooting unfortunately marked merely the latest in a long line of similar tragedies in the United States, which has been punctuated by school shootings for decades. But the Parkland shooting stands out among the gruesome lineage of similar tragedies due to the profound resolve of its student-survivors, who agitated for gun policy reform through the March for Our Lives movement. In the weeks following the shooting, a group of Parkland students partnered with Everytown for Gun Safety, a non-profit organisation advocating for gun control, to coordinate a youth-led demonstration against gun violence. Held in the U.S. capitol of Washington, D.C. on 24 March 2018, the March for Our Lives protest was the largest demonstration against gun violence in American history (March for Our Lives). The protest drew around 200,000 participants to Washington; hundreds of thousands of protestors attended an estimated 800 smaller rallies held across the United States (CBS News). Furthermore, likeminded protestors across Europe, Asia, Africa, and Australia held allied events to show support for these American students’ cause (Russo). The broader March for Our Lives organisation developed out of the political demonstrations on 24 March 2018; four years later, March for Our Lives continues to be a major force in debates about gun violence in the United States. Although the Parkland shooting inspired meaningful gun control activism, it also quickly provoked a deluge of online conspiracy theories about the tragedy and the people involved, including the student-activists who survived the shooting and spearheaded March for Our Lives. This conspiracy content arrived at breakneck pace: according to an analysis by the Washington Post, the first conspiracy posts appeared on the platform 8chan a mere 47 minutes after the first news reports aired about the shooting (Timberg and Harwell). Later that day, Parkland conspiracy theories migrated from fringe haunts like 8chan to InfoWars, a mainstay of the conspiracy media circuit, where host/founder Alex Jones insinuated that the shooting could be a “false flag” event orchestrated by the Democratic Party (Media Matters Staff). Over the ensuing hours, days, weeks, and months, Parkland conspiracies continued to circulate, receiving mainstream news coverage when conversative activists and politicians publicly espoused conspiracy claims about the shooting (Arkin and Popken). Ultimately, the conspiracist backlash was so persistent and virulent throughout 2018 that PolitiFact, a fact-checking site run by the Poynter Institute, declared the Parkland conspiracy theories their 2018 “Lie of the Year” (Drobnic Holan and Sherman). As with many conspiracy theories, the Parkland conspiracies remixed novel information with longstanding conspiracist tropes. Predominantly, these theories alleged that the Parkland student-activists who founded March for Our Lives were being controlled by outside forces to do their bidding. Although conspiracy theorists diverged in who they named as the shadowy puppet master pulling the strings—was it the Democratic Party? George Soros? Someone else?—all agreed that a secretive agenda was afoot. The most extreme version of this theory held that David Hogg, X González, and other prominent March for Our Lives activists were “crisis actors”. This account envisions Hogg et al. as paid performers playing the part of angry and traumatised students for media coverage about a school shooting that either did not occur as reported or did not occur at all (Yglesias). While unnerving and callous, these crisis actor allegations are not new ideas; rather, they draw from a long history of loosely antisemitic “New World Order” conspiracy theories that see an ulterior motive behind significant historical events (Barkun 39-65). Parkland conspiracy theorists circulated a wide variety of media artifacts—anti-March for Our Lives memes, obscure blog posts, and manipulated video footage of the Parkland students, among other content—to propagate their crisis actor claims. But whether due to platform moderation, threat of legal action, or simply public pressure, much of this conspiracy material is now inaccessible, leaving behind only broken links to conspiracy content that once was. By closely examining these broken links through a rhetorical lens, we can trace the “lasting, palpable residues” (Rice 16) link rot leaves in its wake. “All part of the purge”: Parkland Link Rot on r/conspiracy In this final section, I use the tools of rhetorical analysis to demonstrate how link rot can function as a form of evidence for conspiracy theorists. Rhetorical analysis, when applied to digital infrastructure, requires that we expand our notion of rhetoric beyond intentional human persuasion. As James J. Brown, Jr. argues, digital infrastructure is rhetorical because it determines “what’s possible in a given space”, which may or may not involve human beings (99). Human intentionality still matters in many contexts, of course, but seeing digital infrastructure as a “possibility space” opens up productive new avenues for rhetorical inquiry (Brown, Jr. 72-99). This rhetorical perspective aligns with the method of “affordance analysis” derived from Science and Technology Studies and related fields, which investigates how technologies facilitate certain outcomes for users (Curinga). Much like an affordance analysis, my goal is to illustrate how broken links produce certain rhetorical effects, not to make broader empirical claims about the extent of link rot within Parkland conspiracy theories. The r/conspiracy page on Reddit, the popular social news platform, serves as an ideal site for conducting a rhetorical analysis of broken links. The r/conspiracy subreddit is a preeminent hub for digital conspiracy content, with nearly 1.7 million members as of March 2022 and thousands of active users viewing the site at any given time (r/conspiracy). Beyond its popularity, Reddit’s platform design makes link rot a common feature on r/conspiracy. As a forum-based social media platform, Reddit consists entirely of subreddits dedicated to various topics. In each subreddit, users generate and contribute to threads with relevant content, which often entails posting links to materials hosted elsewhere on the Internet. Importantly, Reddit allows each subreddit to set its own specific community rules for content moderation (so long as these rules themselves abide by Reddit’s general Content Policy), and unlike other profile-based social media platforms, Reddit allows anonymity through the use of pseudonyms. For all of these reasons, one finds a high frequency of link rot on r/conspiracy, as posts linking to external conspiracy media stay up even when the linked content itself disappears from the Web. Consider the following screenshot of an r/conspiracy Parkland post from 23 February 2018, a mere nine days after the Parkland shooting, which demonstrates what conspiracist link rot looks like on Reddit (fig. 1). Titling their thread “A compilation of anomalies from the Parkland shooting that the media won't address. The media wants to control the narrative. Feel free to use this if you find it helpful”, this unknown Redditor frames their post as an intervention against media suppression of suspicious details (“A compilation of anomalies”). Yet the archive this poster hoped to share with likeminded users has all but disintegrated—the poster’s account has been deleted (whether by will or force), and the promised “compilation of anomalies” no longer exists. Instead, the link under the headline sends users to a blank screen with the generic message “If you are looking for an image, it was probably deleted” (fig. 2). Fittingly, the links that the sole commenter assembled to support the original poster are also rife with link rot. Of the five links in the comment, only the first one works as intended; the other four videos have been removed from Google and YouTube, with corresponding error messages informing users that the linked content is inaccessible. Fig. 1: Parkland Link Rot on r/conspiracy. (As a precaution, I have blacked out the commenter’s username.) Fig. 2: Error message received when clicking on the primary link in Figure 1. Returning to Jenny Rice’s theory of “evidentiary acts” (173), how might the broken links in Figure 1 be persuasive despite their inability to transport users to the archive in question? For conspiracy theorists who believe they possess “stigmatized knowledge” (Barkun 26) about the Parkland shooting, link rot paradoxically serves as powerful validation of their beliefs. The unknown user who posted this thread alleges a media blackout of sorts, one in which “the media wants to control the narrative”. This claim, if true, would be difficult to verify. Interested users would have to scour media coverage of Parkland to assess whether the media have ignored the “compilation of anomalies” the poster insists they have uncovered and then evaluate the significance of those oddities. But link rot here produces a powerful evidentiary shortcut: the alleged “compilation of anomalies” cannot be accessed, seemingly confirming the poster’s claims to have secretive information about the Parkland shooting that the media wish to suppress. Indeed, what better proof of media censorship than seeing links to professed evidence deteriorate before your very eyes? In a strange way, then, it is through objective archival failure that broken links function as potent subjective evidence for Parkland conspiracy theories. Comments about Parkland link rot elsewhere on r/conspiracy further showcase how broken links can validate conspiracy theorists’ marginalised belief systems. For example, in a thread titled “Searching for video of Parkland shooting on bitchute”, a Redditor observes, “Once someone gives the link watch it go poof”, implying that links to conspiracy content disappear due to censorship by an unnamed force (“Searching for video”). That nearly everything else on this particular thread suffers from link rot—the original poster, the content of their post, and most of the other comments have since been deleted—seems only to confirm the commentor’s ominous prediction. In another thread about a since-deleted YouTube video supposedly “exposing” Parkland students as crisis actors, a user notes, “You can tell there’s an agenda with how quickly this video was removed by YouTube” (“Video Exposing”). Finally, in a thread dedicated to an alleged “Social Media Purge”, Redditors share strategies for combating link rot, such as downloading conspiracy materials and backing them up on external hard drives. The original poster warns their fellow users that even r/conspiracy is not safe from censorship, for removal of content about Parkland and other conspiracies is “all part of the purge” (“the coming Social Media Purge”). In sum, these comments suggest that link rot on r/conspiracy persuades users that their ideas and their communities are under threat, further entrenching their conspiratorial worldviews. I have argued in this article that link rot has a counterintuitive rhetorical effect: in generating untold numbers of broken links, link rot supplies conspiracy theorists with persuasive evidence for the validity of their beliefs. These and other dead ends on the Internet are significant yet understudied components of digital conspiracy theories that merit greater scholarly attention. Needless to say, I can only gesture here to the sheer scale of dead ends within online conspiracy communities on Reddit and elsewhere. Future research ought to trace other permutations of these dead ends, unearthing how they persuade users from beyond the Internet’s grave. References “A compilation of anomalies from the Parkland shooting that the media won't address. The media wants to control the narrative. Feel free to use this if you find it helpful.” Reddit. <https://www.reddit.com/r/conspiracy/comments/7ztc9l/a_compilation_of_anomalies_from_the_parkland/>. Albright, Aaron. “The 17 Lives Lost at Douglas High.” Miami Herald 21 Feb. 2018.<https://www.miamiherald.com/news/local/community/broward/article201139254.html>. Arkin, Daniel, and Ben Popken. “How the Internet’s Conspiracy Theorists Turned Parkland Students into ‘Crisis Actors’.” NBC News 21 Feb. 2018. <https://www.nbcnews.com/news/us-news/how-internet-s-conspiracy-theorists-turned-parkland-students-crisis-actors-n849921>. Barkun, Michael. A Culture of Conspiracy: Apocalyptic Visions in Contemporary America. 2nd ed. Berkeley: University of California Press, 2013. Brown, Jr., James J. Ethical Programs: Hospitality and the Rhetorics of Software. Ann Arbor: University of Michigan Press, 2015. CBS News. “How Many People Attended March for Our Lives? Crowd in D.C. Estimated at 200,000.” CBS News 25 Mar. 2018. <https://www.cbsnews.com/news/march-for-our-lives-crowd-size-estimated-200000-people-attended-d-c-march/>. Chun, Wendy Hui Kyong. “The Enduring Ephemeral, or the Future Is a Memory.” Critical Inquiry 35.1 (2008): 148-71. <https://www.jstor.org/stable/10.1086/595632>. Curinga, Matthew X. “Critical Analysis of Interactive Media with Software Affordances.” First Monday 19.9 (2014). <https://journals.uic.edu/ojs/index.php/fm/article/view/4757/4116>. Drobnic Holan, Angie, and Amy Sherman. “PolitiFact’s Lie of the Year: Online Smear Machine Tries to Take Down Parkland Students.” PolitiFact 11 Dec. 2018. <http://www.politifact.com/article/2018/dec/11/politifacts-lie-year-parkland-student-conspiracies/>. Kumar, D. Vinay, et al. “URLs Link Rot: Implications for Electronic Publishing.” World Digital Libraries 8.1 (2015): 59-66. March for Our Lives. “Mission and Story.” <https://marchforourlives.com/mission-story/>. Marwick, Alice, and Becca Lewis. Media Manipulation and Misinformation Online. Data & Society Research Institute, 2017. <https://datasociety.net/library/media-manipulation-and-disinfo-online/>. Media Matters Staff. “Alex Jones on Florida High School Shooting: It May Be a False Flag, and Democrats Are Suspects.” Media Matters for America 14 Feb. 2018. <https://www.mediamatters.org/alex-jones/alex-jones-florida-high-school-shooting-it-may-be-false-flag-and-democrats-are-suspects>. Muirhead, Russell, and Nancy L. Rosenblum. A Lot of People Are Saying: The New Conspiracism and the Assault on Democracy. Princeton: Princeton University Press, 2019. “I Posted A 4Chan Link a few days ago, that got deleted here, that mentions the coming Social Media Purge by a YouTube insider. Now we are seeing it happen.” Reddit. <https://www.reddit.com/r/conspiracy/comments/7zqria/i_posted_a_4chan_link_a_few_days_ago_that_got/>. Phillips, Whitney, and Ryan M. Milner. You Are Here: A Field Guide for Navigating Polarized Speech, Conspiracy Theories, and Our Polluted Media Landscape. Cambridge: MIT Press, 2021. r/conspiracy. Reddit. <https://www.reddit.com/r/conspiracy/>. Rhodes, Sarah. “Breaking Down Link Rot: The Chesapeake Project Legal Information Archive's Examination of URL Stability.” Law Library Journal 102. 4 (2010): 581-97. Rice, Jenny. Awful Archives: Conspiracy Theory, Rhetoric, and Acts of Evidence. Columbus: Ohio State UP, 2020. Russo, Carla Herreria. “The Rest of the World Showed Up to March for Our Lives.” Huffington Post 25 Mar. 2018. <https://www.huffpost.com/entry/world-protests-march-for-our-lives_n_5ab717f2e4b008c9e5f7eeca>. “Searching for video of Parkland shooting on bitchute.” Reddit. <https://www.reddit.com/r/conspiracy/comments/ddl1s8/searching_for_video_of_parkland_shooting_on/>. Timberg, Craig, and Drew Harwell. “We Studied Thousands of Anonymous Posts about the Parkland Attack – and Found a Conspiracy in the Making.” Washington Post 27 Feb. 2018. <https://www.washingtonpost.com/business/economy/we-studied-thousands-of-anonymous-posts-about-the-parkland-attack---and-found-a-conspiracy-in-the-making/2018/02/27/04a856be-1b20-11e8-b2d9-08e748f892c0_story.html>. “Video exposing David Hogg and Emma Gonzalez as crisis actors and other strange anomalies involving the parkland shooting.” Reddit. <https://www.reddit.com/r/conspiracy/comments/ae3xxp/video_exposing_david_hogg_and_emma_gonzalez_as/>. Wardle, Claire, and Hossein Derakhshan. Information Disorder: Toward and Interdisciplinary Framework for Research and Policymaking. Council of Europe, 2017. <https://rm.coe.int/information-disorder-toward-an-interdisciplinary-framework-for-researc/168076277c>. Yglesias, Matthew. “The Parkland Conspiracy Theories, Explained.” Vox 22 Feb. 2018. <https://www.vox.com/policy-and-politics/2018/2/22/17036018/parkland-conspiracy-theories>. Zittrain, Jonathan, et al. “The Paper of Record Meets an Ephemeral Web: An Examination of Linkrot and Content Drift within The New York Times.” Social Science Research Network 27 Apr. 2021. <https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3833133>.

Photo by Anna Hecker on Unsplash ABSTRACT All people deserve the legal ability to outline their care decisions in advance and expect their decisions to govern during a pregnancy. However, until advance directives govern without pregnancy exceptions, people will not uniformly retain the ability to formulate autonomous decisions about their health care planning. INTRODUCTION In the last few years, states have passed increasingly restrictive laws regarding abortion and reproductive health care. Recent legislation in Alabama effectively banned the procedure altogether, while more than a dozen states have passed or are currently in the process of enacting so-called “fetal heartbeat laws,” which ban abortion at roughly six weeks post-conception after the detection of electrical activity in what could develop into fetal cardiac tissue.[1] While courts rarely uphold outright bans and broad sweeping legislation, they garner significant media and public attention.[2] In practice, however, often smaller legislative changes that garner the least attention have the most significant impact by steadily chipping away at healthcare rights. Few people realize the ethical impact of the poorly understood legal means by which a pregnant woman has already lost her right to make autonomous healthcare decisions over her body using an advance directive in nearly every state. BACKGROUND Advance directives are one of modern medicine’s most powerful yet underused tools. Most clinicians and patients think of advance directives as being only for the elderly or terminally ill. This association stems from the 1991 Congressional Patient Self-Determination Act that requires hospitals, nursing homes, and hospice agencies receiving federal funding to inform patients of their legal right to prepare an advance directive. The 2015 announcement by the Center for Medicare and Medicaid Services (CMS) to reimburse for advance directives without requiring a diagnosis code recognizes that all adult patients can benefit from advance directives regardless of illness or life expectancy.[3] Providers should be aware of a small but significant exemption found in most state advance directive laws. This exemption, commonly known as the pregnancy clause, invalidates the advance directive of a pregnant woman, negating autonomy. The pregnancy clause can lead to treatment against medical standards of care and places private interests over public health. Advance directive statutes are frequently amended, but currently, only eight states allow patients to write their pregnancy-related wishes into their advance directive and guarantee that their instructions will be followed. Eleven states automatically invalidate advance directives during pregnancy, while 18 states permit physicians to disregard a pregnant woman’s (or her proxy’s) wishes based on the likelihood of viability, pain, and suffering, or conscientious objector clauses. Thirteen states remain silent on whether an advance directive is binding during pregnancy or have contradictory statutes.[4] Viability has no standard definition for the purposes of the clauses and viability-based pregnancy clauses can lead to the same loss of rights as pregnancy clauses that invalidate advance directives due to pregnancy without any exceptions. Many may wonder about the clinical relevance of pregnancy clauses. The likelihood that a woman will need to effectuate an advance care directive while pregnant is higher than many people would realize. This situation is most commonly assumed to occur in instances of a brain-dead pregnant woman, of which there are a few cases reported each year. But brain death and persistent vegetative states are just two reasons to look to an advance directive. Advance directives more commonly apply to patients with dementia, strong religious objections to medical care, or during cancer treatments, surgery, or acute injury with temporary loss of capacity. In surgery or acute lapses of capacity, a proxy may be asked to make decisions if complications arise. The number of women potentially affected by pregnancy clauses is significant. Each year, 75,000 pregnant women will undergo non-obstetrical surgery;[5] one in 1,500 pregnant women will be diagnosed with cancer;[6] and an estimated 250,000 Americans will exhibit early-onset Alzheimer’s symptoms between the ages of 30 and 50.[7] ANALYSIS Though pregnancy clauses are a seemingly narrow focus, they can nullify an entire advance directive and restrict care not related to the fetus. By negating entire advance directives, the clauses negate proxy appointments, allowing decision-makers other than the intended proxy. Providers and proxies are left with little guidance over who can make decisions on behalf of the patient. Many states will appoint a biological family member as the surrogate decision maker if there is no designated proxy or the directive is invalid. The outdated language and assumptions about nuclear families found in these structures could significantly impact unmarried couples, same-sex partnerships, and relationships that do not meet state-defined partnership standards where the courts may appoint someone other than the woman’s significant other even when she designated them as a proxy.[8] Members of religious groups whose doctrines prohibit certain medical therapies must be informed that if they become pregnant, their autonomous ability to decide about medical care through an advance directive and their right to freely practice religion can be voided entirely. In addition to infringing on patient autonomy, pregnancy clauses also restrict how clinicians might practice medicine by mandating medically inappropriate treatments against the provider’s recommendations. For example, Illinois’s pregnancy clause stipulates that “if you are pregnant and your health care professional thinks you could have a live birth, your living will cannot go into effect.”[9] This clause places providers in a difficult position of sacrificing their therapeutic obligation to their patients. It may require them to use futile therapy against the patient’s best interest and without regard for prolonged pain and suffering. Pregnancy clauses are void of any consideration of the best clinical interest of the patient or the fetus and instead promote conservative rhetoric that all potential fetal life is paramount. Numerous medical and chromosomal conditions are incompatible with life or present significant potential disabilities that may be accompanied by pain and suffering. The same conditions also pose risks to the mother, including death. Accordingly, the medical profession recognizes that there are instances in which it may not be in the best medical interest of the mother or the fetus to continue the pregnancy. Yet providers are seemingly required by pregnancy clauses to violate codes of conduct and subject pregnant patients and their nonviable fetuses to treatments to which other patients would not be subjected. Without evidence of a patient’s clear and convincing intentions, states have an interest in protecting life, preventing suicide, and maintaining the ethical integrity of the medical profession that could interfere with the person’s ability to refuse care.[10] The legal defense of pregnancy clauses is that the state’s interest in fetal life is sufficiently important to override the mother. As established in Planned Parenthood v. Casey (1992), however, the state’s interest only exists for fetal life post-viability.[11] Therefore, to allow the state interest to override the person’s advance directive when the fetus is not yet viable violates Casey. Individuals have a legal and ethical interest in maintaining bodily privacy, integrity, and freedom from unwanted touching. They have the right to appoint a proxy or use a directive to govern care in the case of incapacity. Even when contemplating brain death, organ donation, and whether to be cremated or buried, there is an expectation that personal wishes will govern. Honoring an advance directive allows providers to uphold the integrity of the medical profession by respecting the principles of autonomy and beneficence. Pregnancy clauses are inherently unethical as their creation was not to further the integrity of the medical or legal profession, nor protect a state’s interest in the patient’s life. In 2016, the American College of Obstetricians and Gynecologists issued a committee opinion that pregnancy is not an ethical exemption to the right of capable patients to refuse treatment.[12] The right to direct treatment while pregnant is consistent with modern medical practice, while the legislative promotion of a singular abstract interest in potential fetal life to the exclusion of all other medical and ethical considerations is not in line with the profession’s values.[13] Many pregnancy clauses are politically motivated, reflecting anti-abortion legality lobbying efforts and attempts to win over conservative voters. When Alaskan Attorney General Harold M. Brown argued the state’s pregnancy clause was unconstitutional, Governor Bill Sheffield – a Democrat in a historically red state – enacted the bill anyway. Georgia’s Governor Bill Kemp narrowly won his election, with some crediting his aggressive messaging against immigration and abortion.[14] With either advance directives, proxies, or even friends and relatives who know what the person (if not incapacitated) would have wanted, courts and legislatures should not have leeway to force care that a person, if conscious, would have refused.[15] The ability to harness advance directive law to force invasive and unwanted treatment upon a pregnant patient’s body continues to occur out of the fear of legal uncertainty. The lack of uniformity between states in their pregnancy clauses further adds to the confusion. Many advance directive statutes create a conditional proposition: if a provider acts in accordance with the carefully drawn circumstances of an advance directive, the provider is granted protective immunity from accusations of malpractice or wrongful death for that conduct. It is neither illegal nor unethical to remove a ventilator, for example, from a patient who has directed such a course of action in an advance directive. A pregnancy clause may remove that immunity making the unethical act of ignoring the directive legal, but the ethical act of following it (removing a ventilator, for example) could subject the practitioner to liability.[16] Without a pregnancy clause, providers retain the ability to both follow an advance directive and to act in the best medical interest of their patient. Pregnancy clauses create confusion over the permissibility of medical acts in an attempt to coerce providers into making decisions that violate the rights of their patients and their own ethical codes of conduct. Pregnancy clauses are a fallacy of consequentialist ethics in which the morality of the outcome justifies actions. Under consequentialist reasoning, any violation to the woman is justified if the fetus develops and results in a live birth. This reasoning is further faulty as it incorrectly assumes that mechanically ventilating an unconscious, sick, dying, or dead body will result in a live birth. Consequentialist theories should be limited to situations with predictable ends. Ethical medical providers refute consequentialism in certain contexts because it treats patients as a means to an end to produce benefit for others. In pregnancy, ignoring advance directives to achieve the chance that a fetus might survive is not justified by consequentialism. Pregnancy clauses also fail through the lens of deontological ethics in which an action must be ethical in and of itself and not based on outcomes. The choice to respect autonomy through an advance directive should be followed uniformly absent special circumstances. Proponents of pregnancy clauses may argue that pregnancy is an appropriate exception because a woman “has chosen to lend her body to bring [a] child into the world.”[17] Minnesota and Oklahoma echo this belief in their statutes, which contain an unjustified rebuttable presumption that all female patients would want life-sustaining treatment if they are pregnant.[18] Pregnancy should not abrogate the rights of a person to assign a proxy for access to an abortion or to control her medical treatment. Pregnancy exclusions are not grounded in the ethical “best interest” standards for the mother or the fetus. Instead, they are rooted in outdated expectations of female gender roles, which reaffirm a legislative assumption that a pregnancy is more morally valuable than a woman’s autonomy. CONCLUSION All people deserve the legal ability to outline their care decisions in advance and expect their decisions to govern during a pregnancy. Providers and the government do not have to approve of a person’s care decisions or values, but medical practitioners must respect a person’s right to dictate their own health narratives. With the push for more patients to execute advance directives, providers and patients must be aware that their advance directives may succumb to the authority of pregnancy clauses. Until advance directives govern without pregnancy exceptions, people will not uniformly retain the ability to formulate autonomous decisions about their health care planning. Advance directive law will continue to be hijacked by politically motivated legislators. When seeking to address inequities in healthcare laws and access, it is essential to take a closer look at not only the headline cases but also the clauses and exemptions to laws seemingly designed to benefit patients. [1] For proposed and current abortion legislation and maps, see https://www.guttmacher.org/state-policy# and Anne Godlasky, Nicquel Terry Ellis, and Jim Sergent, “Where is Abortion Legal? Everywhere, but…” USA Today, May 15, 2019, updated April 23, 2020 https://www.usatoday.com/in-depth/news/nation/2019/05/15/abortion-law-map-interactive-roe-v-wade-heartbeat-bills-pro-life-pro-choice-alabama-ohio-georgia/3678225002/ [2] https://www.guttmacher.org/state-policy# (Many bills fail in legislatures and are not enacted.) [3] Department of Health and Human Services Centers for Medicare & Medicaid Services; 42 CFR Part 405, 410, 411, 414, 425, and 495; “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016; Final Rule.” [4] DeMartino, E. S., Sperry, B. P., Doyle, C. K., Chor, J., Kramer, D. B., Dudzinski, D. M., & Mueller, P. S. (2019). US State Regulation of Decisions for Pregnant Women Without Decisional Capacity. JAMA, 321(16), 1629–1631. https://doi.org/10.1001/jama.2019.2587; Villarreal, Elizabeth. “Pregnancy and Living Wills: A Behavioral Economic Analysis.” The Yale Law Journal Forum. Vol. 128 (2019); 1052-1076. [5] “Surgery During Pregnancy.” Intermountain Healthcare: Fact Sheet for Patients and Families, (2018). https://intermountainhealthcare.org/ext/Dcmnt?ncid=520782026 [6] Basta, P. Bak, A. Roszkowski, K. “Cancer Treatment in Pregnant Women”. Contemporary Oncology, 19, no. 5 (2015): 354–360 [7] “31-Year-Old Woman Fights Alzheimer's While Pregnant.” San Francisco Globe. 9 July 2015, sfglobe.com/2015/02/19/31-year-old-woman-fights-alzheimers-while-pregnant. [8] “Health Care Proxies.” Human Rights Campaign, https://www.hrc.org/resources/health-care-proxy. [9] Illinois Department of Public Health website, Statement of Illinois Law on Advance Directives and DNR Orders, http://www.idph.state.il.us/public/books/advdir4.htm. [10] In the Matter of Karen Quinlan, 355 A.2d 647 (1976); Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990); and In re Conroy 486 A.2d 1209 (1985). [11] Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833 (1992). [12] The American College of Obstetricians & Gynecologists Committee on Ethics, Committee Opinion No. 664: Refusal of Medically Recommended Treatment During Pregnancy, (2016). [13] Lederman, Anne D. “A Womb of My Own: A Moral Evaluation of Ohio’s Treatment of Pregnant Patient’s with Living Wills”. Case W. Res. L. Rev. Vol. 45:351 (1995); 351-377. [14] Tavernise, Sabrina. “The Time Is Now: States Are Rushing to Restrict Abortion, or to Protect It.” The New York Times, 15 May 2019. [15] Cruzan. [16] Mayo, T.M. “Brain-Dead and Pregnant in Texas.” The American Journal of Bioethics, Vol. 14, no. 8 (Nov. 2014); 15-18. [17] In re A.C., 573 A. 2nd 1244 (1990). [18] Johnson, Kristeena L. “Forcing Life on the Dead: Why the Pregnancy Exemption Clause of the Kentucky Living Will Directive Act is Unconstitutional.” Kentucky Law Journal. Vol. 100 (2011-12); 209-233.

During World War II, the Soviet Union’s food supply was in a state of crisis. Hitler’s army had occupied the agricultural heartlands of Ukraine and Southern Russia in 1941 and, as a result, agricultural production for the entire nation had plummeted. Soldiers in Red Army, who easily ate the best rations in the country, subsisted on a daily allowance of just under a kilogram of bread, supplemented with meat, tea, sugar and butter when and if these items were available. The hunger of the Red Army and its effect on the morale and strength of Europe’s eastern warfront were causes for concern for the Soviet government and its European and American allies. The one country with a food surplus decided to do something to help, and in 1942 the United States agreed to send thousands of pounds of meat, cheese and butter overseas to help feed the Red Army. After receiving several shipments of the all-American spiced canned meat SPAM, the Red Army’s quartermaster put in a request for a more familiar canned pork product, Russian tushonka. Pound for pound, America sent more pigs overseas than soldiers during World War II, in part because pork was in oversupply in the America of the early 1940s. Shipping meat to hungry soldiers and civilians in war torn countries was a practical way to build business for the U.S. meat industry, which had been in decline throughout the 1930s. As per a Soviet-supplied recipe, the first cans of Lend-Lease tushonka were made in the heart of the American Midwest, at meatpacking plants in Iowa and Ohio (Stettinus 6-7). Government contracts in the meat packing industry helped fuel economic recovery, and meatpackers were in a position to take special request orders like the one for tushonka that came through the lines. Unlike SPAM, which was something of a novelty item during the war, tushonka was a food with a past. The original recipe was based on a recipe for preserved meat that had been a traditional product of the Ural Mountains, preserved in jars with salt and fat rather than by pressure and heat. Thus tushonka was requested—and was mass-produced—not simply as a convenience but also as a traditional and familiar food—a taste of home cooking that soldiers could carry with them into the field. Nikita Khrushchev later claimed that the arrival of tushonka was instrumental in helping the Red Army push back against the Nazi invasion (178). Unlike SPAM and other wartime rations, tushonka did not fade away after the war. Instead, it was distributed to the Soviet civilian population, appearing in charity donations and on the shelves of state shops. Often it was the only meat product available on a regular basis. Salty, fatty, and slightly grey-toned, tushonka was an unlikely hero of the postwar-era, but during this period tushonka rose from obscurity to become an emblem of socialist modernity. Because it was shelf stable and could be made from a variety of different cuts of meat, it proved an ideal product for the socialist production lines where supplies and the pace of production were infinitely variable. Unusual in a socialist system of supply, this product shaped production and distribution lines, and even influenced the layout of meatpacking factories and the genetic stocks of the animals that were to be eaten. Tushonka’s initial ubiquity in the postwar Soviet Union had little to do with the USSR’s own hog industry. Pig populations as well as their processing facilities had been decimated in the war, and pigs that did survive the Axis invasion had been evacuated East with human populations. Instead, the early presence of tushonka in the pig-scarce postwar Soviet Union had everything to do with Harry Truman’s unexpected September 1945 decision to end all “economically useful” Lend-Lease shipments to the Soviet Union (Martel). By the end of September, canned meat was practically the only product still being shipped as part of Lend-Lease (NARA RG 59). Although the United Nations was supposed to distribute these supplies to needy civilians free of cost, travelers to the Soviet Union in 1946 spotted cans of American tushonka for sale in state shops (Skeoch 231). After American tushonka “donations” disappeared from store shelves, the Soviet Union’s meat syndicates decided to continue producing the product. Between its first appearance during the war in 1943, and the 1957 announcement by Nikita Khrushchev that Soviet policy would restructure all state animal farms to support the mass production of one or several processed meat products, tushonka helped to drive the evolution of the Soviet Union’s meat packing industry. Its popularity with both planners and the public gave it the power to reach into food commodity chains. It is this backward reach and the longer-term impacts of these policies that make tushonka an unusual byproduct of the Cold War era. State planners loved tushonka: it was cheap to make, the logistics of preparing it were not complicated, it was easy to transport, and most importantly, it served as tangible evidence that the state was accomplishing a long-standing goal to get more meat to its citizenry and improving the diet of the average Soviet worker. Tushonka became a highly visible product in the Soviet Union’s much vaunted push to establish a modern food regime intended to rival that of the United States. Because it was shelf-stable, wartime tushonka had served as a practical food for soldiers, but after the war tushonka became an ideal food for workers who had neither the time nor the space to prepare a home-cooked meal with fresh meat. The Soviet state started to produce its own tushonka because it was such an excellent fit for the needs and abilities of the Soviet state—consumer demand was rarely considered by planners in this era. Not only did tushonka fit the look and taste of a modern processed meat product (that is, it was standard in texture and flavor from can to can, and was an obviously industrially processed product), it was also an excellent way to make the most of the predominant kind of meat the Soviet Union had the in the 1950s: small scraps low-grade pork and beef, trimmings leftover from butchering practices that focused on harvesting as much animal fat, rather than muscle, from the carcass in question. Just like tushonka, pork sausages and frozen pelmeny, a meat-filled pasta dumpling, also became winning postwar foods thanks to a happy synergy of increased animal production, better butchering and new food processing machines. As postwar pigs recovered their populations, the Soviet processed meat industry followed suit. One official source listed twenty-six different kinds of meat products being issued in 1964, although not all of these were pork (Danilov). An instructional manual distributed by the meat and milk syndicate demonstrated how meat shops should wrap and display sausages, and listed 24 different kinds of sausages that all needed a special style of tying up. Because of packaging shortages, the string that bound the sausage was wrapped in a different way for every type of sausage, and shop assistants were expected to be able to identify sausages based on the pattern of their binding. Pelmeny were produced at every meat factory that processed pork. These were “made from start to finish in a special, automated machine, human hands do not touch them. Which makes them a higher quality and better (prevoskhodnogo) product” (Book of Healthy and Delicious Food). These were foods that became possible to produce economically because of a co-occurring increase in pigs, the new standardized practice of equipping meatpacking plants with large-capacity grinders, and freezers or coolers and the enforcement of a system of grading meat. As the state began to rebuild Soviet agriculture from its near-collapse during the war, the Soviet Union looked to the United States for inspiration. Surprisingly, Soviet planners found some of the United States’ more outdated techniques to be quite valuable for new Soviet hog operations. The most striking of these was the adoption of competing phenotypes in the Soviet hog industry. Most major swine varieties had been developed and described in the 19th century in Germany and Great Britain. Breeds had a tendency to split into two phenotypically distinct groups, and in early 20th Century American pig farms, there was strong disagreement as to which style of pig was better suited to industrial conditions of production. Some pigs were “hot-blooded” (in other words, fast maturing and prolific reproducers) while others were a slower “big type” pig (a self-explanatory descriptor). Breeds rarely excelled at both traits and it was a matter of opinion whether speed or size was the most desirable trait to augment. The over-emphasis of either set of qualities damaged survival rates. At their largest, big type pigs resembled small hippopotamuses, and sows were so corpulent they unwittingly crushed their tiny piglets. But the sleeker hot-blooded pigs had a similarly lethal relationship with their young. Sows often produced litters of upwards of a dozen piglets and the stress of tending such a large brood led overwhelmed sows to devour their own offspring (Long). American pig breeders had been forced to navigate between these two undesirable extremes, but by the 1930s, big type pigs were fading in popularity mainly because butter and newly developed plant oils were replacing lard as the cooking fat of preference in American kitchens. The remarkable propensity of the big type to pack on pounds of extra fat was more of a liability than a benefit in this period, as the price that lard and salt pork plummeted in this decade. By the time U.S. meat packers were shipping cans of tushonka to their Soviet allies across the seas, US hog operations had already developed a strong preference for hot-blooded breeds and research had shifted to building and maintaining lean muscle on these swiftly maturing animals. When Soviet industrial planners hoping to learn how to make more tushonka entered the scene however, their interpretation of american efficiency was hardly predictable: scientifically nourished big type pigs may have been advantageous to the United States at midcentury, but the Soviet Union’s farms and hungry citizens had a very different list of needs and wants. At midcentury, Soviet pigs were still handicapped by old-fashioned variables such as cold weather, long winters, poor farm organisation and impoverished feed regimens. The look of the average Soviet hog operation was hardly industrial. In 1955 the typical Soviet pig was petite, shaggy, and slow to reproduce. In the absence of robust dairy or vegetable oil industries, Soviet pigs had always been valued for their fat rather than their meat, and tushonka had been a byproduct of an industry focused mainly on supplying the country with fat and lard. Until the mid 1950s, the most valuable pig on many Soviet state and collective farms was the nondescript but very rotund “lard and bacon” pig, an inefficient eater that could take upwards of two years to reach full maturity. In searching for a way to serve up more tushonka, Soviet planners became aware that their entire industry needed to be revamped. When the Soviet Union looked to the United States, planners were inspired by the earlier competition between hot-blooded and big type pigs, which Soviet planners thought, ambitiously, they could combine into one splendid pig. The Soviet Union imported new pigs from Poland, Lithuania, East Germany and Denmark, trying valiantly to create hybrid pigs that would exhibit both hot blood and big type. Soviet planners were especially interested in inspiring the Poland-China, an especially rotund specimen, to speed up its life cycle during them mid 1950s. Hybrdizing and cross breeding a Soviet super-pig, no matter how closely laid out on paper, was probably always a socialist pipe dream. However, when the Soviets decided to try to outbreed American hog breeders, they created an infrastructure for pigs and pig breeding that had a dramatic positive impact of hog populations across the country, and the 1950s were marked by a large increase in the number of pigs in the Soviet union, as well as dramatic increases in the numbers of purebred and scientific hybrids the country developed, all in the name of tushonka. It was not just the genetic stock that received a makeover in the postwar drive to can more tushonka; a revolution in the barnyard also took place and in less than 10 years, pigs were living in new housing stock and eating new feed sources. The most obvious postwar change was in farm layout and the use of building space. In the early 1950s, many collective farms had been consolidated. In 1940 there were a quarter of a million kolkhozii, by 1951 fewer than half that many remained (NARA RG166). Farm consolidation movements most often combined two, three or four collective farms into one economic unit, thus scaling up the average size and productivity of each collective farm and simplifying their administration. While there were originally ambitious plans to re-center farms around new “agro-city” bases with new, modern farm buildings, these projects were ultimately abandoned. Instead, existing buildings were repurposed and the several clusters of farm buildings that had once been the heart of separate villages acquired different uses. For animals this meant new barns and new daily routines. Barns were redesigned and compartmentalized around ideas of gender and age segregation—weaned baby pigs in one area, farrowing sows in another—as well as maximising growth and health. Pigs spent less outside time and more time at the trough. Pigs that were wanted for different purposes (breeding, meat and lard) were kept in different areas, isolated from each other to minimize the spread of disease as well as improve the efficiency of production. Much like postwar housing for humans, the new and improved pig barn was a crowded and often chaotic place where the electricity, heat and water functioned only sporadically. New barns were supposed to be mechanised. In some places, mechanisation had helped speed things along, but as one American official viewing a new mechanised pig farm in 1955 noted, “it did not appear to be a highly efficient organisation. The mechanised or automated operations, such as the preparation of hog feed, were eclipsed by the amount of hand labor which both preceded and followed the mechanised portion” (NARA RG166 1961). The American official estimated that by mechanizing, Soviet farms had actually increased the amount of human labor needed for farming operations. The other major environmental change took place away from the barnyard, in new crops the Soviet Union began to grow for fodder. The heart and soul of this project was establishing field corn as a major new fodder crop. Originally intended as a feed for cows that would replace hay, corn quickly became the feed of choice for raising pigs. After a visit by a United States delegation to Iowa and other U.S. farms over the summer of 1955, corn became the centerpiece of Khrushchev’s efforts to raise meat and milk productivity. These efforts were what earned Khrushchev his nickname of kukuruznik, or “corn fanatic.” Since so little of the Soviet Union looks or feels much like the plains and hills of Iowa, adopting corn might seem quixotic, but raising corn was a potentially practical move for a cold country. Unlike the other major fodder crops of turnips and potatoes, corn could be harvested early, while still green but already possessing a high level of protein. Corn provided a “gap month” of green feed during July and August, when grazing animals had eaten the first spring green growth but these same plants had not recovered their biomass. What corn remained in the fields in late summer was harvested and made into silage, and corn made the best silage that had been historically available in the Soviet Union. The high protein content of even silage made from green mass and unripe corn ears prevented them from losing weight in the winter. Thus the desire to put more meat on Soviet tables—a desire first prompted by American food donations of surplus pork from Iowa farmers adapting to agro-industrial reordering in their own country—pushed back into the commodity supply network of the Soviet Union. World War II rations that were well adapted to the uncertainty and poor infrastructure not just of war but also of peacetime were a source of inspiration for Soviet planners striving to improve the diets of citizens. To do this, they purchased and bred more and better animals, inventing breeds and paying attention, for the first time, to the efficiency and speed with which these animals were ready to become meat. Reinventing Soviet pigs pushed even back farther, and inspired agricultural economists and state planners to embrace new farm organizational structures. Pigs meant for the tushonka can spent more time inside eating, and led their lives in a rigid compartmentalization that mimicked emerging trends in human urban society. Beyond the barnyard, a new concern with feed-to weight conversions led agriculturalists to seek new crops; crops like corn that were costly to grow but were a perfect food for a pig destined for a tushonka tin. Thus in Soviet industrialization, pigs evolved. No longer simply recyclers of human waste, socialist pigs were consumers in their own right, their newly crafted genetic compositions demanded ever more technical feed sources in order to maximize their own productivity. Food is transformative, and in this case study the prosaic substance of canned meat proved to be unusually transformative for the history of the Soviet Union. In its early history it kept soldiers alive long enough to win an important war, later the requirements for its manufacture re-prioritized muscle tissue over fat tissue in the disassembly of carcasses. This transformative influence reached backwards into the supply lines and farms of the Soviet Union, revolutionizing the scale and goals of farming and meat packing for the Soviet food industry, as well as the relationship between the pig and the consumer. References Bentley, Amy. Eating for Victory: Food Rationing and the Politics of Domesticity. Where: University of Illinois Press, 1998. The Book of Healthy and Delicious Food, Kniga O Vkusnoi I Zdorovoi Pishche. Moscow: AMN Izd., 1952. 161. Danilov, M. M. Tovaravedenie Prodovol’stvennykh Tovarov: Miaso I Miasnye Tovarye. Moscow: Iz. Ekonomika, 1964. Khrushchev, Nikita. Khrushchev Remembers. New York: Little, Brown & Company, 1970. 178. Long, James. The Book of the Pig. London: Upcott Gill, 1886. 102. Lush, Jay & A.L. Anderson, “A Genetic History of Poland-China Swine: I—Early Breed History: The ‘Hot Blood’ versus the ‘Big Type’” Journal of Heredity 30.4 (1939): 149-56. Martel, Leon. Lend-Lease, Loans, and the Coming of the Cold War: A Study of the Implementation of Foreign Policy. Boulder: Westview Press, 1979. 35. National Archive and Records Administration (NARA). RG 59, General Records of the Department of State. Office of Soviet Union affairs, Box 6. “Records relating to Lend Lease with the USSR 1941-1952”. National Archive and Records Administration (NARA). RG166, Records of the Foreign Agricultural Service. 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