Landscapes of conversion in eighth century Hessia : an interdisciplinary approach to the Anglo-Saxon mission of St Boniface.

This thesis is the first large-scale study of the mission of the Anglo-Saxon Saint Boniface to Hessia, a region in the centre of modern Gennany, between 721 and 754. The aim of the study is to explore in more detail than has so far been achieved three aspects of the Bonifatian mission in Hessia: first, his fonnative years in Wessex and the political context of Hessia before his arrival; second, the ways in which the Anglo-Saxon missionaries represented certain aspects of mission in their literary discourse with Insular and Roman contacts; third, the specific challenges of the mission and the methods used by the missionaries to overcome them. The thesis takes an interdisciplinary approach that has not yet been attempted in Bonifatian studies. The historical sources chiefly include the surviving letters of Boniface and his associates as well as the later vitae of Boniface and several other figures connected to his mission. The archaeological sources include furnished burials, fortifications, settlements and ceramics. These sources are brought together with the aid of a considerable amount of original toponymical and topographical research within Hessia itself. The thesis is divided into three parts. In Part I, after an introduction and historiography (chapter 1), the theoretical and methodological foundations of the thesis are established (chapter 2). In Part II, Boniface's early years in the West Saxon church (chapter 3) and the development of Frankish rule in Hessia between the early sixth century and the beginning of Boniface's mission (chapter 4) are contextualised more fully than previous studies have attempted. In chapter 3 several features of the church and kingdom of Wessex are identified that would fundamentally infonn Boniface's approach in Hessia. In chapter 4 a new model for the development of Frankish influence in Hessia up to 721 is outlined, and its significance for the Bonifatian mission discussed. Part III focuses attention on the Bonifatian mission in Hessia. Chapter 5 offers a broad overview of the mission: important cronological matters are discussed and clarified and the progress and development of the mission between 721 and 754 is outlined. It is argued that Boniface made a concerted attempt to evangelise Saxony from 739 onwards, but that his efforts were thwarted by growing political instability 2 on the Hessian-Saxon borderlands and the opposition of elements of the Rhineland Frankish church to his mission. Chapters 6 and 7 explore two important aspects of the mission. First (chapter 6), the letters of Boniface and LuI are subjected to careful textual analysis. Second (chapter 7), several specific features of the Hessian mission are explored in more detail. In chapter 6 a distinction is identified in the nature of the literary discourse / between the missionary community and papal Rome on the one hand, and the missionary community and the Insular Anglo-Saxon church on the other. The argument is made that the literary representation of the mission in letters between Anglo-Saxons, in contrast to letters between Anglo-Saxons and Rome, reflected a distinctive conceptualisation of continental mission that combined emotive themes of peregrillatio, suffering and the concept of Germallia as an ancestral homeland that had been ensnared by Satan. In chapter 7 the Bonifatian mission In Hessia is examined from several viewpoints. Using topographical and toponymical evidence, an original argument is put forward for the existence of numerous pagan cult sites within Hessia that together constituted part of a pre-Christian 'sacred landscape'. This is followed by an examination of the earliest ecclesiatical foundations of Hessia. New observations and arguments are proposed concerning the development of Hessia's early ecclesiastical landscape during Boniface's mission, and this landscape is then discussed in relation to the 'pagan' landscape which it was intended to supplant. This is followed by a detailed discussion of Boniface's attempts to gain material support for his mission through his dealings with the Frankish clerical and lay elites, with a special emphasis, using original charter-based research, on his relationship with the local secular elites of Hessia. Finally, the ways in which Boniface evangelised and instructed the population of Hessia and attempted to maintain control of his mission territories are examined. T·_· . I / ( By taking a broad, contextualising, interdisciplinary approach, this study illuminates the ways in which Boniface, strongly influenced by the structure of the West Saxon church, made practical attempts to establish a coherent ecclesiastical network in a politically volatile region where pagan customs and identity were deeply inscribed in the landscape. Through the textual analysis of the letters, the dissertation also presents the argument that the conceptualisation of mission as an inherently painful peregrillatio encouraged Boniface and his fellow missionaries, despite 3 ---'''':':''''--'__oi -~.'-'-'-'-'-..:.::'-::..;.';.;..'..;;.'';';'';';''~;;..'';...' --'-' ---'__~_......_-==-~ -__c_'-_;...''';;;;;.'-=-r''. p' circumstances of extreme adversity in Boniface's final years, not to abandon their largely thwarted evangelisation of the Hessian-Saxon borderlands. In doing so, the study offers invaluable new perspectives on and insights into the Bonifatian mission in Hessia. The second volume of the thesis contains: three appendices giving the results of the textual analysis of the letters of Boniface and LuI discussed in chapter 6; two appendices li~ing the grantors of property to Hersfeld and Fulda referred to in the discussion of charter evidence in chapter 7; and all figures and plates referred to in the first volume

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Landscapes of Conversion in Eighth Century Hessia. An Interdisciplinary Approach to the Anglo-Saxon Mission of St Boniface

This thesis is the first large-scale study of the mission of the Anglo-Saxon Saint Boniface to Hessia, a region in the centre of modern Gennany, between 721 and 754. The aim of the study is to explore in more detail than has so far been achieved three aspects of the Bonifatian mission in Hessia: first, his fonnative years in Wessex and the political context of Hessia before his arrival; second, the ways in which the Anglo-Saxon missionaries represented certain aspects of mission in their literary discourse with Insular and Roman contacts; third, the specific challenges of the mission and the methods used by the missionaries to overcome them. The thesis takes an interdisciplinary approach that has not yet been attempted in Bonifatian studies. The historical sources chiefly include the surviving letters of Boniface and his associates as well as the later vitae of Boniface and several other figures connected to his mission. The archaeological sources include furnished burials, fortifications, settlements and ceramics. These sources are brought together with the aid of a considerable amount of original toponymical and topographical research within Hessia itself. The thesis is divided into three parts. In Part I, after an introduction and historiography (chapter 1), the theoretical and methodological foundations of the thesis are established (chapter 2). In Part II, Boniface's early years in the West Saxon church (chapter 3) and the development of Frankish rule in Hessia between the early sixth century and the beginning of Boniface's mission (chapter 4) are contextualised more fully than previous studies have attempted. In chapter 3 several features of the church and kingdom of Wessex are identified that would fundamentally infonn Boniface's approach in Hessia. In chapter 4 a new model for the development of Frankish influence in Hessia up to 721 is outlined, and its significance for the Bonifatian mission discussed. Part III focuses attention on the Bonifatian mission in Hessia. Chapter 5 offers a broad overview of the mission: important cronological matters are discussed and clarified and the progress and development of the mission between 721 and 754 is outlined. It is argued that Boniface made a concerted attempt to evangelise Saxony from 739 onwards, but that his efforts were thwarted by growing political instability 2 on the Hessian-Saxon borderlands and the opposition of elements of the Rhineland Frankish church to his mission. Chapters 6 and 7 explore two important aspects of the mission. First (chapter 6), the letters of Boniface and LuI are subjected to careful textual analysis. Second (chapter 7), several specific features of the Hessian mission are explored in more detail. In chapter 6 a distinction is identified in the nature of the literary discourse / between the missionary community and papal Rome on the one hand, and the missionary community and the Insular Anglo-Saxon church on the other. The argument is made that the literary representation of the mission in letters between Anglo-Saxons, in contrast to letters between Anglo-Saxons and Rome, reflected a distinctive conceptualisation of continental mission that combined emotive themes of peregrillatio, suffering and the concept of Germallia as an ancestral homeland that had been ensnared by Satan. In chapter 7 the Bonifatian mission In Hessia is examined from several viewpoints. Using topographical and toponymical evidence, an original argument is put forward for the existence of numerous pagan cult sites within Hessia that together constituted part of a pre-Christian 'sacred landscape'. This is followed by an examination of the earliest ecclesiatical foundations of Hessia. New observations and arguments are proposed concerning the development of Hessia's early ecclesiastical landscape during Boniface's mission, and this landscape is then discussed in relation to the 'pagan' landscape which it was intended to supplant. This is followed by a detailed discussion of Boniface's attempts to gain material support for his mission through his dealings with the Frankish clerical and lay elites, with a special emphasis, using original charter-based research, on his relationship with the local secular elites of Hessia. Finally, the ways in which Boniface evangelised and instructed the population of Hessia and attempted to maintain control of his mission territories are examined. T·_· . I / ( By taking a broad, contextualising, interdisciplinary approach, this study illuminates the ways in which Boniface, strongly influenced by the structure of the West Saxon church, made practical attempts to establish a coherent ecclesiastical network in a politically volatile region where pagan customs and identity were deeply inscribed in the landscape. Through the textual analysis of the letters, the dissertation also presents the argument that the conceptualisation of mission as an inherently painful peregrillatio encouraged Boniface and his fellow missionaries, despite 3 ---'''':':''''--'__oi -~.'-'-'-'-'-..:.::'-::..;.';.;..'..;;.'';';'';';''~;;..'';...' --'-' ---'__~_......_-==-~ -__c_'-_;...''';;;;;.'-=-r''. p' circumstances of extreme adversity in Boniface's final years, not to abandon their largely thwarted evangelisation of the Hessian-Saxon borderlands. In doing so, the study offers invaluable new perspectives on and insights into the Bonifatian mission in Hessia. The second volume of the thesis contains: three appendices giving the results of the textual analysis of the letters of Boniface and LuI discussed in chapter 6; two appendices li~ing the grantors of property to Hersfeld and Fulda referred to in the discussion of charter evidence in chapter 7; and all figures and plates referred to in the first volume.EThOS - Electronic Theses Online ServiceGBUnited Kingdo