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"Den Hartog, Jonathan J"
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“Patriotism and piety”: Orthodox religion and federalist political culture
This dissertation argues that orthodox Protestantism played a significant role in the political culture of the northern federalist parry during the early American republic. It demonstrates that religion both fueled the intensity of federalist politics in the 1790s and ironically contributed to the party's decline in the early nineteenth century. The study brings together two sub-fields---the new political history of the early republic and religious history---to produce an interdisciplinary work which advances historical scholarship on a seminal period in American history. Confronted with religious inheritances from New England's colonial experience and the politicization of religion during the American Revolution, federalists sought to define religion's place in the republican experiment and apply it for political advantage. The interplay of orthodox religion with federalist politics changed both the party's political culture and the practice of religion in America. The study employs a biographical approach---using case studies of seven individuals to understand larger themes and trends---as a narrative strategy. It begins with John Jay, whose belief in a providentially-ordered national destiny for America expressed a \"Republican\" view of religion and politics, an optimistic approach which broke down under the partisan conflicts of the 1790s. The dissertation then traces how other federalists, including Timothy Dwight, Jedidiah Morse, Caleb Strong, and Elias Boudinot, responded to the shifting environment by enlisting the public in support of political and social stability. They opposed \"infidelity,\" the militant unbelief which they believed was undermining both belief and government. In so doing, they created a \"Federalist\" expression of religion, in which orthodox religionists rallied to defend what they perceived as their embattled faith and endangered republic. The dissertation concludes with a consideration of John Jay's two sons, who illustrate the transformation of a religiously-inflected federalism into attitudes which reflected an \"Antebellum\" view of religion's place in society: an individualized, issues-oriented religion with a greater stress on morality but less emphasis on politics.
Dissertation
Endovascular treatment in patients with renal dysfunction: results of the MR CLEAN Registry
Abstract
Introduction
It is unclear whether renal function is associated with outcome in patients with ischaemic stroke treated with EVT, as findings in existing literature have been inconsistent. We studied the association between renal function and outcomes in EVT-treated patients.
Patients and methods
We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry. We assessed the association between renal function using estimated glomerular filtration rate (eGFR) and functional outcome measured with the mRS score, mortality and the occurrence of sICH in ischaemic stroke patients treated with EVT. We used ordinal regression modelling to estimate common odds ratios (cOR) per 10-unit decrease in eGFR, adjusted for known prognostic factors.
Results
We analysed 4466 patients included between March 2014 and December 2018. Patients with lower eGFR were older, had more severe strokes at baseline, more comorbidities and higher pre-stroke mRS scores (all P < .001). In unadjusted analyses, higher eGFR was associated with better 3-month functional outcome (cOR 1.18; 95% CI, 1.15–1.21) and lower mortality (cOR 0.81; 95% CI, 0.78–0.83). After adjusting for demographic factors, only the association between eGFR and mortality remained significant. After further adjustment for medical history and comorbidities, no association was found between eGFR and mRS (adjusted odds ratio [aOR] 0.99; 95% CI, 0.96–1.02) or mortality (aOR 0.96; 95% CI, 0.93–1.01). There was no association between eGFR and sICH (cOR 0.95; 95%CI, 0.89–1.01, aOR 0.99; 95% CI, 0.93–1.06).
Conclusion
Renal function was not an independent modifier of outcome after EVT for ischaemic stroke although eGFR may serve as a predictor of increased risk of disability and mortality. Based on these results, renal function alone should not determine eligibility for EVT in ischaemic stroke patients.
Graphical Abstract
Graphical Abstract
Journal Article
Effect of first pass reperfusion on outcome in patients with posterior circulation ischemic stroke
BackgroundFirst pass reperfusion (FPR), that is, excellent reperfusion (expanded treatment in cerebral ischemia (eTICI) 2C-3) in one pass, after endovascular treatment (EVT) of an occluded artery in the anterior circulation, is associated with favorable clinical outcome, even when compared with multiple pass excellent reperfusion (MPR). In patients with posterior circulation ischemic stroke (PCS), the same association is expected, but currently unknown. We aimed to assess characteristics associated with FPR and the influence of FPR versus MPR on outcomes in patients with PCS.MethodsWe used data from the MR CLEAN Registry, a prospective observational study. The effect of FPR on 24-hour National Institutes of Health Stroke Scale (NIHSS) score, as percentage reduction, and on modified Rankin Scale (mRS) scores at 3 months, was tested with linear and ordinal logistic regression models.ResultsOf 224 patients with PCS, 45 patients had FPR, 47 had MPR, and 90 had no excellent reperfusion (eTICI <2C). We did not find an association between any of the patient, imaging, or treatment characteristics and FPR. FPR was associated with better NIHSS (−45% (95% CI: −65% to −12%)) and better mRS scores (adjusted common odds ratio (acOR): 2.16 (95% CI: 1.23 to 3.79)) compared with no FPR. Outcomes after FPR were also more favorable compared with MPR, but the effect was smaller and not statistically significant (NIHSS: −14% (95% CI: −51% to 49%), mRS acOR: 1.50 (95% CI: 0.75 to 3.00)).ConclusionsFPR in patients with PCS is associated with favorable clinical outcome in comparison with no FPR. In comparison with MPR, the effect of FPR was no longer statistically significant. Nevertheless, our data support the notion that FPR should be the treatment target to pursue in every patient treated with EVT.
Journal Article
National trends in patient characteristics, interventional techniques and outcomes of endovascular treatment for acute ischaemic stroke: Final results of the MR CLEAN Registry (2014–2018)
Introduction:
Endovascular thrombectomy (EVT) procedures and workflow have evolved over the years. We examined trends in patient characteristics, EVT techniques and outcomes over 5 years in the Netherlands.
Patients and methods:
Data from the MR CLEAN Registry (2014–2018) were analysed, including patients treated with EVT for anterior circulation acute ischaemic stroke (AIS). Patients were grouped by year of inclusion except for the linear regression analysis where the inclusion date was used. Baseline predicted probability of poor outcome (modified Rankin Scale (mRS) score 3–6) was calculated using a validated prediction model. Primary outcome was mRS score at 90 days. Secondary outcomes included workflow times, EVT techniques, successful reperfusion (eTICI ⩾ 2B) and symptomatic intracranial haemorrhage (sICH). Time trends were analysed using multivariable regression models (adjusted common odds ratios (acOR) per year).
Results:
5193 patients were included. Median age increased (from 66 in 2014 to 74 years in 2018 [p < 0.001]). Proportion of patients with pre-stroke dependence (mRS ⩾ 3) increased from 2014 through 2018 (9% to 16%, p < 0.001). Baseline predicted probability of poor outcome did not change (60% vs 66%, p = 0.06). Over time, functional outcomes improved (acOR 1.14 per year, 95%CI: 1.09–1.20); mortality decreased (aOR 0.88 per year, 95%CI: 0.83–0.94). EVT under local anaesthesia increased (from 46% in 2014 to 70% in 2018; aOR 1.15, 95%CI: 1.10–1.22), as did use of direct aspiration (13%–36%; aOR 1.43, 95%CI: 1.35–1.53). Successful reperfusion became more frequent (aOR 1.32 per year, 95%CI: 1.25–1.40), despite needing more attempts (1 in 2014 vs 2 in 2018, aOR 0.93 per year, 95%CI: 0.89–0.98). Incidence of sICH remained unchanged (5% vs 5%, aOR 0.99 per year, 95%CI: 0.89–1.09). Time from emergency room to groin puncture reduced by 7 min per year (95%CI: 5–8).
Discussion and conclusion:
Enhanced workflow and increased EVT experience may have led to shorter time to treatment and more frequent successful reperfusion, with better functional outcomes over 5 years, despite treating older, more dependent patients.
Graphical abstract
Journal Article