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What propelled the fusion of Roman fasces with Aesop’s moralizing tale of sticks was the Nova Iconologia of Cesare Ripa (1555–1622), a compilation of emblems first published in an illustrated edition in 1603. There both Justice and Concord suggestively receive as their attributes a fascio di verghe (“bundle of sticks”). Later editors of Ripa completed the conflation. In France, the powerful cardinal and statesman Jules Mazarin (1602–1661, chief minister to the crown from 1642) shamelessly exploited the fasces, ostensibly as a family heraldic emblem but with the effect of creating a personal brand. Mazarin attracted many encomiasts, who did much to promote the emphatically non-Roman idea that the fasces represented unity, and good government in general. This whole understanding of the fasces culminates in a bronze full-length portrait statue of Louis XIV (reigned 1643–1715), dedicated in 1689 at Musée Carnavalet in Paris. Here the sculptor Antoine Coysevox (1640–1720) portrayed the king in a Roman cuirass, resting his left arm on an axe-less fasces topped by a helmet. In its context, the fasces conveys a balanced message of strength, dominion, moderation, and unity through reconciliation, while also rekindling memories of Mazarin’s own policies as advisor to the king. Yet in this period no nation shows much interest in putting the fasces on civic coats of arms, flags, coins, and the like. Even in the 1760s, when the antiquarian obsessions of the Neoclassical movement were at their peak, the fasces seemed fated to find itself just one derivative antique decorative element among many.

The ancient Romans in both the Republic (as far back as one can trace) and Empire made a familiar and highly effective spectacle out of bundling wooden rods and a single-bladed axe with leather straps into a “fasces.” They presented this instrument as a mobile kit for punishment, one intended to induce feelings of respect for the relevant authority, as well as fear. So ubiquitous is the device in ancient sources that we frequently find the word “fasces” denoting high office in general. Renaissance humanists and artists readily comprehended the emblem’s basic appearance, use, and official symbolism. However, what demonstrably made less of an impression on thinkers of this and indeed later ages (until Mussolini) was the psychological terror generated by the original Roman fasces. For that development, one can blame a learned conflation in the Renaissance era of an antiquarian understanding of the fasces with a famous ancient moralizing tale of Greek origin attached to Aesop’s collection of Fables, in which an aged father uses a bundle of sticks to instruct his sons on the dangers of division and the strength that comes from unity. Paradoxically, Mussolini, who made the fasces his actual symbol of state, ran roughshod over the original Roman tradition he supposedly wanted to revive. The structure of the book is outlined, as well as its overarching argument: that today’s understanding of the fasces necessarily is mediated by layers of significance accrued over the centuries, and in assessing individual appearances of the symbol, context is key.

The defeat of the Axis powers in 1945 occasioned a comprehensive purge of the Nazi swastika emblem, and sent the image of the fasces sharply in retreat—even in the United States, where soon after war’s end it was dropped from the long-established (since 1916) 10-cent piece. However, Italy developed no master plan to address its now-ubiquitous Fascist symbols. Indeed, by 1953, its national Olympic committee was touting Rome’s former Foro Mussolini as an ideal site for the 1960 Summer Games. And once it won its bid, it made only a belated and feeble effort (quickly abandoned) to mitigate the effect of the hundreds of fasces embedded in the mosaic walkway that led to the principal stadium, which are still intact today. That said, in the post–World War II era—with the exception of a provocative twinned public sculpture (2001) on university campuses in Paisley (Scotland) and Princeton (New Jersey)—no one has been putting up new fasces in public art. However, the fasces’ long history, with all its twists and turns from antiquity through Fascist reimagining and then into present-day unfamiliarity, has given an opening to contemporary right-wing extremists searching for a symbol that is potent, but not widely provocative at first glance.

In the medieval period, the word “fasces” never fully fell out of Latin use, at least in a general sense of “supreme power” or “official honors.” Nor did the term “lictor,” because of its appearance in scripture, which preserved understanding of this attendant’s punitive role. Renaissance humanists mostly grasped the meaning of the “fasces.” Yet other than an isolated Anglo-Saxon representation of the fasces, artistic renderings of the fasces were slow to come—not until the last quarter of the fifteenth century, where they tend to signify the exercise of authority and the administration of justice. The artist Raphael (1483–1520), however, took a pronounced interest in the details of the Roman fasces, which he prominently incorporated into two high-profile Vatican commissions, which spectacularly reintroduced the fasces into the iconographic mainstream. In the next decades, papal efforts to control the administration of law in Rome culminated in a celebratory painting with—for the first time—the fasces as a key component in an elaborate allegorical scene. It was a powerful cardinal-nephew of Pope Paul III Farnese (reigned 1534–1549) who commissioned this piece in 1544 from Giorgio Vasari (1511–1574). Through this artist’s rendering of “Farnese Justice,” the fasces entered the rapidly expanding repertory of “emblems,” i.e., symbolic images with a moralizing purpose, a growth industry in the first half of the sixteenth century. Indeed, four popes over the next two centuries had their tombs adorned with the rods and axe as a symbol of justice, starting with that of Paul III himself.

After 1789, America’s early leaders, architects, and artists leveraged direct knowledge of classical antiquity (including the fable in Aesop that involved a fasces-like bundle of sticks), but also observed what individuals in Britain and France had made and were making of the emblem in the public sphere. Indeed, a major role in this iconographic effort was played by foreigners, culminating with Italian-born sculptor Enrico Causici (1790–1833), who was the first to introduce a representation of the fasces into the United States Capitol building (1817–1819). Starting in the early 1830s, escalating conflict over slavery raised questions about the long-term stability of the American union, and caused the fasces—now widely understood as the unity symbol par excellence—to proliferate, in everything from campaign broadsides to high art. By the mid-1850s, Southerners for their part seem to have regarded the fasces, especially when joined with a liberty cap, as promoting the abolitionist cause. Once actual civil war broke out between North and South in 1861, and especially after the assassination of President Abraham Lincoln in April 1865, the emblem grew only more powerful as a marker of American union. Decades later, this understanding recommended the fasces to Adolph A. Weinman (1870–1952) for his design of the “Mercury” 10-cent piece first issued in 1916, and to the designers of the Lincoln Memorial (dedicated in 1922) in their tribute to the slain president who had preserved the United States.

The fasces plainly had their limits in Rome, for the Republican system featured basic structural curbs regarding how officials who displayed them might exercise their official authority. Chief among them was the institution of the plebeian tribunes, said to be created in 493 bce to defend and support the Roman Plebs, deemed inviolable as to their persons and thus immune from physical contact by lictors—a situation that caught the imagination of Rome’s annalists, always interested in conflict. It was essential to an official’s dignity that he leave the lictors who carried his fasces to do their always unpopular and sometimes bone-chilling physical work, and not personally engage himself. Conversely, when lictors saw their fasces smashed or stolen, the disgrace rebounded onto their superior—and especially so if they could not protect his physical person. In all periods of Roman history into later antiquity, one can detect anxiety about improper use of the fasces and the power they represented. Non-Romans for their part hated the symbol of the fasces. Already in the mid-second century bce, Polybius counts it as the height of Greece’s misfortune that its free cities were compelled to admit Roman rods and axes within their gates. Even the peoples of Italy had much to fear from the fasces while they were still largely excluded from Roman political life before 88 bce. And so, when they could, Rome’s enemies made the most of ironic appropriation of captured insignia.

In the seventeenth and eighteenth centuries, theater and pageants played an especially powerful role in communicating the basic nature and functions of the fasces. In France, the emblem was familiar enough that after the storming of the Bastille in July 1789, the revolutionaries almost immediately chose the fasces as a symbol of their movement’s strength, power, commitment to justice, unity, and—with a conscientious nod to the tradition on the insignia in Rome’s Republic—dependence on the assent of the people. When combined with a Roman freedman’s cap, they meant for the fasces to connote liberty, too. In 1792, in a first for any nation, the fasces figured in the semi-official seal of the new revolutionary state. The spirit of revolutionary coin types with fasces had a certain influence in the Americas even beyond France’s colonies in the New World, finding a place on the money of Mexico (1823–1863), then Ecuador and Chile (after 1830). In North America, it was the distinctly non-Roman theme of the fasces representing unity that prevailed, facilitated by the Second Continental Congress’s decision in August 1776 to adopt e pluribus unum (Latin for “out of many, one”) as a national motto. Though the new nation’s official seal (adopted 1782) did not include the fasces, it soon featured prominently in the repertoire of patriotic images, including an official place in American political life when the House of Representatives in 1789 adopted a fasces-like mace to serve as the badge of its sergeant-at-arms.

When the institution of the fasces first confronts us in the visual medium, it appears quite evolved—and terrifying. That emerges from a second-century bce mural painting from the Esquiline in Rome which depicts lictors in distinctive dress, menacingly parading in triumph, and a coin (late second century bce) which represents a lictor about to dole out punishment. Moneyers of the Republic only sporadically include the fasces in their designs minted in Rome, and just once as an abstract symbol of state power. Rome’s emperors from Augustus through Nerva (i.e., 27 bce–98 ce) essentially avoid depicting the fasces on their coins, at Rome or in the provinces. The reason must be that the insignia primarily transmitted terror. In the second century ce, minters for Trajan, Hadrian, and Antoninus Pius revisited the fasces as a design motif, but with an emphasis on the lictors who carried them, sometimes acting as instruments of imperial philanthropy. By the early third century ce, the fasces had received a makeover, now as long curved rods with nonfunctional axe heads. This is the form that persists through late antiquity, certainly well into the sixth century ce in both West and East. Though the fasces proper does not play a major part in Byzantine ceremonial practices, lictor-like attendants with axes, twelve in number, show up in Constantinople at the coronation of the emperor Manuel II Palaeologus in the year 1391. All of this is powerful evidence for the tenacity of the basic institution.

Ancient tradition is unanimous that twelve attendants known as “lictors” each carried fasces, walking in procession before the old kings of Rome, to mark the king’s status as a holder of imperium (the full civil and military power) and with it, his capacity to inflict either corporal or capital punishment. Tradition also held that Rome of the kings had appropriated this institution from the Etruscans. The discovery in 1898 of a miniature fasces with double-headed axe in a mid-seventh century bce tomb at Vetulonia spectacularly confirmed the Romans’ basic understanding of the emblem’s origin. Yet ancient writers almost certainly undervalue the level of terror this severe Etruscan institution produced when imposed on a native Latin community at Rome. Indeed, it was so effective that when the Romans replaced their monarchy with a Republic headed by two annual consuls, traditionally dated to 509 bce, they claimed the fasces as their own. But 509 bce is noted as the occasion for a thorough revamping of the fasces, to assert tighter public control of the insignia. Henceforth, per this account, the two consuls had to take turns presenting the full regal kit to denote precedence, remove the axes from their bundles within the city, and dip the insignia in assemblies to show deference to the Roman citizenry, who now received the right of appeal against summary execution. These measures most certainly existed in the historical period, had an exceptionally long life, and set the tone for Rome’s political culture.

None of the many activist Italian political groups of the late nineteenth and earlier twentieth centuries that called themselves “fasci” (“bundles”) exploited the Roman device in their public messaging until 1919. In that year, the newspaper editor Benito Mussolini (1883–1945), as founder and leader of the “Italian Fasci of Combat,” embraced the (previously pejorative) tag “fascisti” for his supporters, and used a threatening representation of the fasces to identify his favored political candidates. Use of the historical Roman emblem served as branding for his rapidly growing party, and to a stunning degree also helped valorize its violent methods, which intensified especially from the spring of 1920. Soon after his movement’s largely bloodless “March on Rome” (October 28–30, 1922) that felled the elected government, Mussolini—now as prime minister—successfully forced the fasces into every crevice of Italian daily life, from coinage and postage stamps to cigarette packaging. What followed was a twenty-year program to make the fasces ubiquitous in Italy and the territories it colonized in Africa. Mussolini’s regime’s relentless focus on the fasces, and propagation of the image on a massive scale, had no close parallel in world history. And Mussolini seems to have been the first statesperson ever to interpret the fasces as an instrument for imposing political unity by means of authority. (Everyone else had it the other way around.) It also was a special innovation of Mussolini to idealize the humble lictor who lugged the fasces, and raise him to prominence.

For Rome’s magistrates, accompaniment by lictors with the fasces was the chief sign that one held the chief civil and military power (imperium), and the dismissal of those attendants formally signaled departure from office. That is true for the imperial era as well. In all eras, lictors with fasces functioned as the extension of the person of their superior. But the literary evidence suggests that they were notorious for engaging in gratuitous brutality on top of their fearsome official functions, which allowed them even to enter private residences. Class prejudice in the sources surely plays a role here: though slaves were excluded from serving in this role, freed slaves were not. If one were to take Christian polemicists at their word, it would seem that by later antiquity, lictors could be lumped together with torturers and executioners. What is secure is that display of the fasces—both authentic ones and ceremonial simulacra—continuously and forcefully reinforced power relations between higher and lower officials, magistrates and non-magistrates, nobles and non-nobles, citizens and non-citizens, and even heightened class consciousness and distinctions among women. (In the Republic, at least, lictors were forbidden to touch ones deemed respectable.)

For an astounding two millennia—from the Etruscans of the seventh century bce, then through the Romans under all their forms of government, indeed down to the last Byzantine dynasty—political authorities used the device known as the “fasces” to induce respect as well as fear. This was a bundle of wooden rods and a single-bladed axe bound with leather straps—in essence, a mobile kit for punishment. In the Renaissance, some writers and artists found it irresistible to associate the fasces with an old (and unrelated) didactic tale from Aesop illustrating how sticks are stronger once bundled. And so, over the course of the sixteenth through the early twentieth centuries, the Roman emblem came to represent not just expected concepts such as power, punishment, and justice, but now also strength, unity, and liberty against tyranny. The “Fascist” movement of Benito Mussolini, which seized power in Italy in October 1922, purported to revive the Roman emblem in its original form. But it retained aspects of the modern reimagining of the fasces, and introduced still further novelties, such as glorification of the “lictors,” the lowly attendants who carried the fasces in antiquity. Since World War II, the fasces has seen widespread but uneven eradication, in the context of a public that has grown progressively unconversant with the symbol. It is precisely the fasces’ long history and relative present-day unfamiliarity that have given an opening to right-wing extremists searching for a symbol that is potent, but not widely provocative at first glance.

Introduction The factors that influence deceased donor kidney procurement biopsy reliability are not well established. We examined the impact of biopsy technique and pathologist training on procurement biopsy accuracy. Methods We retrospectively identified all deceased donor kidney-only transplants at our center from 2006 to 2016 with both procurement and reperfusion biopsies performed and information available on procurement biopsy technique and pathologist (n = 392). Biopsies were scored using a previously validated system, classifying “suboptimal” histology as the presence of at least 1 of the following: glomerulosclerosis ≥11%, moderate/severe interstitial fibrosis/tubular atrophy, or moderate/severe vascular disease. We calculated relative risk ratios (RRR) to determine the influence of technique (core vs. wedge) and pathologist (renal vs. nonrenal) on concordance between procurement and reperfusion biopsy histologic classification. Results A total of 171 (44%) procurement biopsies used wedge technique, and 221 (56%) used core technique. Results of only 36 biopsies (9%) were interpreted by renal pathologists. Correlation between procurement and reperfusion glomerulosclerosis was poor for both wedge (r2 = 0.11) and core (r2 = 0.14) biopsies. Overall, 34% of kidneys had discordant classification on procurement versus reperfusion biopsy. Neither biopsy technique nor pathologist training was associated with concordance between procurement and reperfusion histology, but a larger number of sampled glomeruli was associated with a higher likelihood of concordance (adjusted RRR = 1.12 per 10 glomeruli, 95% confidence interval = 1.04−1.22). Conclusions Biopsy technique and pathologist training were not associated with procurement biopsy histologic accuracy in this retrospective study. Prospective trials are needed to determine how to optimize procurement biopsy practices., Graphical abstract

BACKGROUND AND OBJECTIVES: An increasing number of patients on the waitlist for a kidney transplant indicates a need to effectively utilize as many deceased donor kidneys as possible while ensuring acceptable outcomes. Assessing regional and center-level organ utilization with regards to discard can reveal regional variation in suboptimal deceased donor kidney acceptance patterns stemming from perceptions of risk. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We created a weighted donor utilization index from a logistic regression model using high-risk donor characteristics and discard rates from 113,640 deceased donor kidneys procured for transplant from 2010 to 2016, and used it to examine deceased donor kidney utilization in 182 adult transplant centers with >15 annual deceased donor kidney transplants. Linear regression and correlation were used to analyze differences in donor utilization indexes. RESULTS: The donor utilization index was found to significantly vary by Organ Procurement and Transplantation Network region (P

Background and objectives Long wait times for deceased donor kidneys and low rates of preemptive wait-listing have limited preemptive transplantation in the United States. We aimed to assess trends in preemptive deceased donor transplantation with the introduction of the new Kidney Allocation System (KAS) in 2014 and identify whether key disparities in preemptive transplantation have changed. Design, setting, participants, & measurements We identified adult deceased donor kidney transplant recipients in the United States from 2000 to 2018 using the Scientific Registry of Transplant Recipients. Preemptive transplantation was defined as no dialysis before transplant. Associations between recipient, donor, transplant, and policy era characteristics and preemptive transplantation were calculated using logistic regression. To test for modification by KAS policy era, an interaction term between policy era and each characteristic of interest was introduced in bivariate and adjusted models. Results The proportion of preemptive transplants increased after implementation of KAS from 9.0% to 9.8%, with 1.10 (95% confidence interval [95% CI], 1.06 to 1.14) times higher odds of preemptive transplantation post-KAS compared with pre-KAS. Preemptive recipients were more likely to be white, older, female, more educated, hold private insurance, and have ESKD cause other than diabetes or hypertension. Policy era significantly modified the association between preemptive transplantation and race, age, insurance status, and Human Leukocyte Antigen zero-mismatch (interaction P Conclusions Although the proportion of deceased donor kidney transplants performed preemptively increased slightly after KAS, disparities in preemptive kidney transplantation persisted after the 2014 KAS policy changes and were exacerbated for racial minorities and Medicare patients.

Calcineurin inhibitors (CNI) are narrow therapeutic index medications, with drug concentrations altered by factors such as drug-drug interactions, clinical symptoms including diarrhea, and hepatic dysfunction. Supratherapeutic CNI concentrations can produce a myriad of toxicities, the most worrisome of which are renal injury and seizures.

Prolonged warm (WIT) and cold (CIT) ischemia times are often important considerations in the discard of DCD kidneys, but their impact on post-transplant outcomes in the post-KAS era is unclear. We examined the association of ischemia time on delayed graft function (DGF) and death-censored graft failure for DCD kidneys. The 2018 SRTR SAF was utilized to identify post-KAS DCD kidney transplants occurring from 2015 to 2018. Relative risk and Cox regression were used to calculate risk of delayed graft function and hazard of death-censored graft failure, respectively. We identified 4,680 kidneys from DCD donors transplanted from 2015 to 2018 with recorded WIT and CIT times. Median WIT was 21.0 minutes (IQR 14.0-28.0), and CIT was 18.5 hours (IQR 13.9-23.5). The overall incidence of DGF was 42.7%. In a univariable relative risk regression model, extended CIT (24-30 hours:RR 1.37, 95% CI 1.15-1.77; >30 hours:RR 1.47, 95% CI 1.22-1.77) and WIT (20-40 minutes:RR 1.10, 95% CI 1.03-1.17) were associated with increased risk of DGF. When included in a multivariable model, neither prolonged CIT nor WIT were significantly associated with death-censored graft failure. Prolonged WIT and CIT are associated with increased DGF but not death-censored graft failure in recipients of DCD kidney transplants in the post-KAS era. Extended ischemia alone should not be used as a basis for discard or non-utilization of these organs.

In 2005, the Banff committee expanded the "borderline changes" category to include lesions with minimal (

Factors that patients value when choosing a transplant center have not been well studied. In order to guide the improvement of patient-facing materials, we conducted an anonymous electronic survey of patients that assessed the relative importance of patient experience, practical considerations, transplant center reputation, center experience, and waitlist when selecting a transplant center. A total of 409 respondents completed the survey, of whom 68% were kidney transplant recipients and 32% had chronic kidney disease or were on dialysis. Participants had mean age 56 ± 12 years and were predominantly female (61%), white (79%), and had an associate’s degree or higher (68%). Participants most often prioritized waitlist when evaluating transplant centers (transplanted 26%, chronic kidney disease 40%), and waitlist was almost twice as likely as outcomes to be ranked most important (30% vs 17%). Education level and transplant status were significantly associated with factors used for center prioritization. Waitlisted respondents most commonly (48%) relied on physicians for information when selecting a center, while a minority cited transplant-specific organizations. In order to improve shared decision-making, materials outlining center- specific waitlist features should be prioritized. Novel patient-oriented metrics for measuring transplant center quality that align with patient priorities must be explored.

Background and objectives Unfavorable histology on procurement biopsies is the most common reason for deceased donor kidney discard. We sought to assess the reproducibility of procurement biopsy findings. Design, setting, participants, & measurements We compiled a continuous cohort of deceased donor kidneys transplanted at our institution from 1/1/2006 to 12/31/2016 that had at least one procurement biopsy performed, and excluded cases with missing biopsy reports and those used in multiorgan transplants. Suboptimal histology was defined as the presence of advanced sclerosis in greater than or equal to one biopsy compartment (glomeruli, tubules/interstitium, vessels). We calculated κ coefficients to assess agreement in optimal versus suboptimal classification between sequential biopsy reports for kidneys that underwent multiple procurement biopsies and used time-to-event analysis to evaluate the association between first versus second biopsies and patient and allograft survival. Results Of the 1011 kidneys included in our cohort, 606 (60%) had multiple procurement biopsies; 98% had first biopsy performed at another organ procurement organization and their second biopsy performed locally. Categorical agreement was highest for vascular disease (κ=0.17) followed by interstitial fibrosis and tubular atrophy (κ=0.12) and glomerulosclerosis (κ=0.12). Overall histologic agreement (optimal versus suboptimal) was κ=0.15. First biopsy histology had no association with allograft survival in unadjusted or adjusted analyses. However, second biopsy optimal histology was associated with a higher probability of death-censored allograft survival, even after adjusting for donor and recipient factors (adjusted hazard ratio, 0.50; 95% confidence interval, 0.34 to 0.75; P=0.001). Conclusions Deceased donor kidneys that underwent multiple procurement biopsies often displayed substantial differences in histologic categorization in sequential biopsies, and there was no association between first biopsy findings and post-transplant outcomes.

While deceased donor renal transplants (DDRT) from donors with either acute kidney injury (AKI) or long cold ischemia time (CIT) are associated with increased risk of delayed graft function (DGF), recipients of these kidneys have good patient and allograft survival. There are limited data on whether kidneys with both AKI and long CIT have outcomes similar to kidneys with only one of these insults. Using data from the Scientific Registry of Transplant Recipients, we analyzed transplant outcomes in patients (2005-2015) receiving kidneys with AKI (terminal creatinine ≥2.0 mg/dl) and CIT 24-30 h (n = 1289), 30-36 h (n = 734), and36 h (n = 614), using kidneys with AKI and CIT24 h (n = 5434) as a reference. DGF was more common with increasing CIT up to 36 h, then decreased slightly (41.2% vs. 46.8% vs. 52.5% vs. 50.2%, P 0.001). Death-censored graft survival (DCGS) at 3 years was better with CIT24 h compared with other groups (92.5% vs. 90.8% vs. 92% vs. 89.2%, P = 0.018). On multivariable analysis, donor creatinine was predictive of DCGS, whereas only CIT36 h was predictive of DCGS (aHR 1.27, P = 0.03). Recipients transplanted with kidneys with both AKI and long CIT have excellent intermediate-term outcomes.

BACKGROUND Studies have demonstrated the Timed Up and Go Test's (TUGT) ability to forecast postoperative outcomes for several surgical specialties. Evaluations of the TUGT for waitlist and posttransplant outcomes have yet to be examined in kidney transplantation. OBJECTIVE To assess the prognostic utility of the TUGT and its associations with waitlist and posttransplant outcomes for kidney transplant candidates. DESIGN AND METHODS Single-center, prospective study of 518 patients who performed TUGT during their transplant evaluation between 9/1/2013-11/30/2014. TUGT times were evaluated as a continuous variable or 3-level discrete categorical variable with TUGT times categorized as long (>9 seconds), average (8-9 seconds), or short (5-8 seconds). RESULTS Transplanted individuals had shorter TUGT times than those who remained on the waitlist (8.99 vs 9.79 seconds, P

This epilogue first traces a common thread running through modern understandings of Sabina, from Antonio de Guevara in the 16th century to romantic novelist Kate Quinn in the 21st: Hadrian treated his wife poorly, as the ancient literary sources unequivocally tell us. Attention to Sabina is rare in modern history, art, or literature. Most representations of the empress through time are ancillary appearances in biographical or novelistic treatments of Hadrian; few are especially probing. When Antinoös is introduced, Sabina recedes. It was surely consequential that Hadrian’s successor Antoninus Pius lost his own wife, Faustina I, barely two years after accession, in 140. Her funeral and deification, commemorative post-consecration coinage, honorary statues and games, dedicated priestesses, and grand temple constructed in the Roman Forum evidently eclipsed Hadrian’s honors for his wife. Yet these very honors show that Antoninus observed and approved how Hadrian had promoted Sabina and the concept of empress.

The chapter first discusses the only purported quotation Sabina receives in our literary sources, a bitter boast about avoiding pregnancy with Hadrian. It seems her received stereotype was disagreeability, complementing Hadrian’s alleged pacifism and self-contradiction. The chapter then studies the first three years of Hadrian’s Third Journey of 128–133, in which Sabina clearly participated. Possible echoes of Sabina’s presence are evaluated for the first eastern stages, in Athens, Asia Minor, Syria, Arabia, and Judaea, followed by Alexandria in Egypt in fall 130. Dated Alexandrian coins suggest that Sabina changed her appearance during that visit, literally letting her hair down from its expected “Matidian” style. In late October 130 Hadrian’s companion Antinoös drowned in the Nile. The chapter treats Antinoös’ posthumous semi-divine honors and cult, and further describes his eponymous city, Antinoöpolis, in Egypt, which (it is argued) illuminates Hadrian’s and Sabina’s self-presentation in the 130s.

Sabina visited the famous “singing statue” of the Colossus of Memnon near Egyptian Thebes in November 130, just after Antinoös’ death. The proof is her first-person graffiti carved on a leg of this gigantic statue. Emperor and empress repeatedly visited the statue to hear its sound, as their companion the Seleucid princess Julia Balbilla records in her own verse graffiti on the stone. Her four poems, in a revival of Sappho’s Lesbian dialect with eroticized language, describe the empress, apparently to highlight the attributes of Sabina’s developed, official public persona: youthfulness, seductive beauty, piety, marital fidelity colored by institutionalized jealousy, and communion with the immortal. The chapter then reconstructs honors given Sabina in 131 in travel from Egypt to Anatolia and Athens. The chapter concludes with Hadrian’s forced return to Judaea in 132 to face the Bar Kochba revolt and examines recent evidence for extensive cultic honors to Sabina on Epirus.

This chapter discusses four close relationships Hadrian developed beyond his marriage: with Trajan’s niece (Sabina’s mother), Matidia I; Trajan’s widow, Plotina; the Bithynian youth Antinoös; and the consular L. Ceionius Commodus, whom Hadrian adopted and publicly promoted as his heir (restyled as L. Aelius Caesar). It is argued that one common denominator is Hadrian’s deep—even excessive—emotional attachment to these women and men. Another is the spectacular honors he paid Matidia and Plotina in his first decade of rule, in conspicuous contrast to what he allowed his wife. Particularly important is a speech, known through a now lost inscription, that Hadrian delivered on behalf of Matidia the Elder after her death and before her deification in 119. Hadrian’s praise—for her physical appearance, character, temperament—illuminates his ideals for Sabina. In conclusion, the chapter explains Hadrian’s adoption of Antoninus and his complex dynastic scheme, which succeeded surprisingly well.

This chapter discusses how Trajan after his accession in 98 reconsolidated the imperial house. Trajan was from the Spanish province Baetica, his wife, Plotina, likely from Narbonese Gaul, thus dramatically enhancing the status of provincial elites in imperial Rome. The childless couple built spectacular foundations for a true dynasty through lavish formal honors to family members. Within a few years Trajan elevated his wife and his older sister, Marciana, to Augusta. In 112 Trajan divinized his (long dead) father and (recently deceased) sister, and gave his niece, Matidia, the position of Augusta. Henceforth, Trajan could claim parentage from two deified figures (his adoptive father, Nerva, and now his biological father) and signal divine ancestry for Marciana, her daughter, Matidia the Elder, and his grandnieces Sabina and Matidia the Younger. It is argued that this status shaped Sabina’s own identity, her later standing as empress, and eventually her own deification.

Direct evidence for Sabina’s activities as Augusta in and around Rome is disappointing. Although inscriptions suggest some (limited) benefactions by the empress, the most conspicuous expression of Sabina’s heightened status comes from the Rome mint, which produced an impressive series of original images publicizing the empress’s imperial virtues. Changing titulature and hairstyles on Sabina’s Rome coins help establish a relative chronology and an understanding of the intended messages. The provincial coin issues bearing Sabina’s portrait are harder to assess: on their reverses their subject matter overlaps significantly with types showing the emperor. The regime also offered ever-changing sculptural images of Sabina. On both coins and sculptures, this era’s portrait artists, generally abandoning naturalism, pictured the middle-aged empress as a young serene beauty. The chapter also quantifies Sabina’s assimilation to specific goddesses in the eastern inscriptions, and seeks to understand how eastern communities balanced public honors for Hadrian, Sabina, and Antinoös.

This work aims to synthesize the textual and (massive) material evidence on the empress Sabina (born ca. 85–died ca. 137). The book traces the development of Sabina’s partnership with her husband, the emperor Hadrian (reigned 117–138), and shows the vital importance of the empress for Hadrian’s own aspirations. Sabina accumulated more public honors in Rome and the provinces than any imperial woman had enjoyed since the first empress, Augustus’ wife Livia. Indeed, Sabina is the first woman whose image features on a regular and continuous series of coins minted at Rome. She was the most traveled and visible empress to date. Hadrian also deified his wife upon her death. It is argued that Hadrian meant for Sabina to play a key role in promoting the public character of his rule, and that the emperor’s exaltation of his wife served to enhance his own claims to divinity. Yet the (sparse) literary sources on Sabina put the worst light on the dynamics of her marriage. There is a strong ancient tradition that Hadrian treated his wife little better than a slave, and forced her to suicide. The book fully explores the various (overwhelmingly negative) notions this empress’s life stirred up in historiography, and against the material record proposes a new and nuanced understanding of her formal role. This study of Sabina’s life sheds new light also more widely on Hadrian—including the vexed question of that emperor’s relationship with his supposed lover Antinoös—and indeed on Rome’s imperial women as a group.

Hadrian’s life was a string of controversial episodes, on which even our summary sources had to acknowledge variant traditions: Plotina’s alleged role in Hadrian’s adoption by Trajan, his execution of four consulars in 118, his relationship with Antinoös and the youth’s death in October 130. Add to that the nature of Hadrian’s marriage, his adoption of Lucius Aelius in 136 and Antoninus Pius in 138, the emperor’s death in July 138, and the ensuing fierce debate over his memory (including deification). Our literary sources, it is argued, use these incidents to illustrate a conventional notion of Hadrian’s complex, shifting personality, which was unable to control extremes of emotions. The late-second-century senatorial biographer Marius Maximus apparently was an influential source for later writers on this emperor’s life. The biographer’s picture of a self-contradictory Hadrian colored Maximus’ portrayal of Sabina, whom he presented so as to magnify the emperor’s shortcomings and failings.

The chapter places Sabina’s death firmly in late 137. It first studies a relief depicting Hadrian’s consecration ceremony for her on Rome’s Campus Martius. No literary source mentions her deification, but coinage and inscriptions confirm it. Perhaps Hadrian’s failing health and the intense political conflict following his adoption of Aelius Caesar provide a context for the empress’s death, especially given the ancient tradition that Hadrian forced her into suicide. Divinization came naturally to the deceased empress, even though Hadrian alienated the Senate thoroughly and quashed much of that body’s good will for Sabina’s memory. After Hadrian’s death, his adopted heir Antoninus did complete the late emperor’s Mausoleum and buried the imperial couple there in 139, but before the Senate allowed Hadrian the same divine honors as Sabina’s. The chapter also details how, after Sabina’s deification, Matidia II aggrandized herself in Antoninus Pius’ and Marcus Aurelius’ reigns.

This chapter emphasizes that for Rome, the title “empress” is a term of convenience. The closest Latin equivalent to “empress” is ‘Augusta,’ which by the later first century CE became expected for an emperor’s wife, but was extended to other women of the imperial family. This chapter explains ‘Augusta’ by highlighting the evolving distinctions for powerful women from the Triumviral era of the Republic and the era of Augustus (especially for his wife Livia). It also traces the formation of the imperial household (domus), and the granting of divine honors to women, in both life and death. However, the prominence that members of Rome’s imperial family enjoyed had its own dangers: in the mid-first century CE, seven of the eight empresses met unfortunate ends. Later, when the emperor Domitian’s rule grew intolerable, his wife introduced another potent precedent for an empress—by helping to assassinate him in the year 96.

Background and objectives Biopsies taken at deceased donor kidney procurement continue to be cited as a leading reason for discard; however, the reproducibility and prognostic capability of these biopsies are controversial. Design, setting, participants, & measurements We compiled a retrospective, single-institution, continuous cohort of deceased donor kidney transplants performed from 2006 to 2009. Procurement biopsy information—percentage of glomerulosclerosis, interstitial fibrosis/tubular atrophy, and vascular disease—was obtained from the national transplant database. Using univariable, multivariable, and time-to-event analyses for death-censored graft survival, we compared procurement frozen section biopsy reports with reperfusion paraffin-embedded biopsies read by trained kidney pathologists (n=270). We also examined agreement for sequential procurement biopsies performed on the same kidney (n=116 kidneys). Results For kidneys on which more than one procurement biopsy was performed (n=116), category agreement was found in only 64% of cases (κ=0.14). For all kidneys (n=270), correlation between procurement and reperfusion biopsies was poor: overall, biopsies were classified into the same category (optimal versus suboptimal) in only 64% of cases (κ=0.25). This discrepancy was most pronounced when categorizing percentage of glomerulosclerosis, which had 63% agreement (κ=0.15). Interstitial fibrosis/tubular atrophy and vascular disease had agreement rates of 82% (κ=0.13) and 80% (κ=0.15), respectively. Ninety-eight (36%) recipients died, and 56 (21%) allografts failed by the end of follow-up. Reperfusion biopsies were more prognostic than procurement biopsies (hazard ratio for graft failure, 2.02; 95% confidence interval, 1.09 to 3.74 versus hazard ratio for graft failure, 1.30; 95% confidence interval, 0.61 to 2.76), with procurement biopsies not significantly associated with graft failure. Conclusions We found that procurement biopsies are poorly reproducible, do not correlate well with paraffin-embedded reperfusion biopsies, and are not significantly associated with transplant outcomes.

Tribunicia potestas (tribunician power) refers to the rights granted to Rome’s tribuni plebis—including sacrosanctity, that is, personal inviolability while in office—and (later) to the claim by Roman emperors to the plebeian tribunes’ privileges, a status which they employed to reckon their own years of rule and also publicly designate a successor. In official titulature the emperors commonly list it second among their distinctions (with number of continuous years held, thus functioning akin to a regnal year), after the office of pontifex maximus and before the number of imperatorial acclamations and consulships (see imperator, consul). Tribunes originally received their prerogatives to defend and support the plebs, which essentially formed a “state within a state” in the Roman polity. But already in the mid-4th century bce, tribunes were using their powers more generally in senatorial politics; by the early 3rd century bce, the tribunes also had made themselves indispensable to the smooth functioning of the Roman legislative process. Though the plebeian tribunate lasted well into the imperial period, its practical and political importance faded swiftly with the demise of the Republic. Already in 48 bce the patrician Caesar received an extraordinary grant of tribunicia potestas (later confirmed for life) without having to hold the office of the tribunate itself. In 36 bce his adopted son Octavian seized upon the precedent in his struggles as triumvir; in the constitutional settlement of 23 bce as Augustus he formalized his tenure of annually renewable tribunicia potestas, henceforth reckoning his years of rule by it. This assumption of tribunician power, alongside enhanced imperium, definitively established the legal basis of his principate, and that of subsequent emperors for at least the next three and half centuries. Augustus also secured grants of tribunicia potestas for his successive sons-in-law to mark them off for dynastic succession—first Agrippa, then Tiberius. Here too he set a productive example for future emperors.