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This article details spirituality and the three main approaches that are found in academic and popular literature—theological, historical-contextual, and anthropological. It traces the etymology of the term and how thinking on it has developed. It offers carefully chosen case studies that show its use in the anthropological approach—the largest and fastest growing category.

ObjectivesDuring a prospective study of S. aureus carriage in Royal Marines (RM) recruits, six S. argenteus strains were identified in four recruits undertaking military training together. As S. argenteus sepsis leads to mortality similar to S. aureus, we determined the potential for person-to-person transmission, to evaluate future outbreak risk.MethodsWe used whole-genome sequencing to characterise S. argenteus and investigate phylogenetic relationships between isolates. Participant colonisation with S. aureus and skin and soft tissue infection acquisition were recorded.ResultsAll six S. argenteus strains were spa-type t5078, ST2250. Strains were detected in 4/40 recruits in the same troop (training cohort) in weeks 1, 6 or 15 of training. No mec, tsst or LukPV genes were detected. We identified differences of 10-35 core SNPs between S. argenteus from different recruits. In two recruits, two S. argenteus strains were isolated; these could be distinguished by 3 and 15 core SNPs in each case. S. argenteus was not identified in any one of the other 21 participating troops (1,012 recruits).ConclusionsThe identification of S. argenteus within a single troop from the total recruit population supports a common source for transmission, supported by SNP analysis. The high number of SNPs between some isolates may indicate a common source of diverse isolates or a high level of S. argenteus mutation in carriage. S. argenteus ST2250 is a newly recognised lineage; a better understanding of the frequency of genetic changes during transmission and transition from asymptomatic carriage to disease is required.

Objectives: During a prospective study of S. aureus carriage in Royal Marines recruits, six S. argenteus strains were identified in four recruits. As S. argenteus sepsis leads to mortality similar to S. aureus, we determined the potential for within same troop transmission, to evaluate future outbreak risk. Methods: We used whole-genome sequencing to characterise S. argenteus and investigate phylogenetic relationships between isolates. Results: S. argenteus strains (t5078, ST2250) were detected in 4/40 recruits in the same troop (training cohort) in weeks 1, 6 or 15 of training. No mec, tsst or LukPV genes were detected. We identified differences of 1-17 core SNPs between S. argenteus from different recruits. In two recruits, two S. argenteus strains were isolated; these could be distinguished by 2 and 15 core SNPs. Conclusions: The identification of S. argenteus within a single troop from the total recruit population suggests a common source for transmission, though high number of SNPs were identified, both within-host and within-cluster. The high number of SNPs between some isolates may indicate a common source of diverse isolates or a high level of S. argenteus mutation in carriage. S. argenteus is newly recognised species; and understanding of the frequency of genetic changes during transmission and transition from asymptomatic carriage to disease is required.

The introduction presents an overview of critical debates in relation to mysticism and medieval aesthetics, before offering a short case study of medieval and modern representation of the mystery of the Incarnation intended to highlight the key themes and tension address over the volume as a whole. An examination of the 'Incarnation Initials' of Insular Gospel Books and Gerald of Wales's discussion of the Gospels of Kildare highlights the importance of craft, materiality and the transcendent to these medieval works of art. Padraic Colum's mid-twentieth-century poem responds to the Book of Kells with a meditation on the practice of its creator. Finally, the paradox of worldly art being able both to facilitate and to hinder access to the divine is addressed in relation to some Middle English lyrics.

This essay argues that the glosses in the late fourteenth- to early fifteenth-century Middle English work þe Myrrour of Symple Soules are more theologically coherent than has previously been posited. Focusing on the discussion of “usages” that they contain, as well as on the importance of freedom, a case is made for reading many of the annotations as advocating a Thomist/ Bonaventurean account of deification, that is, an account of deification in which the soul loves God through a created habitus that allows the Holy Spirit to work in it through participation without obliterating it. Although a more theologically conservative understanding of deification than usually posited of the original Mirouer, it is argued that the translator demonstrates concern that his readers understand what it means to be deified in union with God, and as such sets out to offer them more than a “rhetoric of ecstasy.”

AIM To determine whether machine learning-based radiomic feature analysis of baseline integrated 2-[18F]-fluoro-2-deoxy- d- glucose (FDG) positron-emission tomography (PET) computed tomography (CT) predicts disease progression in patients with locally advanced larynx and hypopharynx squamous cell carcinoma (SCC) receiving (chemo)radiotherapy. MATERIALS AND METHODS Patients with larynx and hypopharynx SCC treated with definitive (chemo)radiotherapy at a specialist cancer centre undergoing pre-treatment PET-CT between 2008 and 2017 were included. Tumour segmentation and radiomic analysis was performed using LIFEx software (University of Paris-Saclay, France). Data were assigned into training (80%) and validation (20%) cohorts adhering to TRIPOD guidelines. A random forest classifier was created for four predictive models using features determined by recursive feature elimination: (A) PET, (B) CT, (C) clinical, and (D) combined PET-CT parameters. Model performance was assessed using area under the curve (AUC) receiver operating characteristic (ROC) analysis. RESULTS Seventy-two patients (40 hypopharynx 32 larynx tumours) were included, mean age 61 (range 41–77) years, 50 (69%) were men. Forty-five (62.5%) had chemoradiotherapy, 27 (37.5%) had radiotherapy alone. Median follow-up 26 months (range 12–105 months). Twenty-seven (37.5%) patients progressed within 12 months. ROC AUC for models A, B, C, and D were 0.91, 0.94, 0.88, and 0.93 in training and 0.82, 0.72, 0.70, and 0.94 in validation cohorts. Parameters in model D were metabolic tumour volume (MTV), maximum CT value, minimum standardized uptake value (SUVmin), grey-level zone length matrix (GLZLM) small-zone low grey-level emphasis (SZLGE) and histogram kurtosis. CONCLUSION FDG PET-CT derived radiomic features are potential predictors of early disease progression in patients with locally advanced larynx and hypopharynx SCC.

This chapter examines the concrete and the everyday within the Devotio Moderna movement of the late medieval-early modern period. Bocken argues that Nicholas of Cusa’s The Vision of God offers an insight into the devotional practices of this movement, which have too often been viewed as a simplistic rejection of intellectual theology. Examining a central text from this movement, Thomas a Kempis’s, Imitation of Christ, Bocken finds a call to recognise God’s action at work within the human order. The same dynamic is, Bocken maintains, at play in Cusa’s famous portrait exercise, in which monks are invited to circle a portrait whose eyes appear to follow the viewer no matter where they move. A similar process, Bocken argues, lies at the heart of Jan Van Eyck’s famous Ghent Altar piece, which, through a clever use of mirrors, reflections and viewing figures, draws the viewer into the painting. For Bocken, a Kempis, Van Eyck, and the Devotio Moderna all teach that God’s judgments, although unknown, are made manifest through the discernment of the concrete life of the individual. In this way one learns the true meaning of imitatio Christi, that is, how one may become an image of God oneself.

Operation RUMAN was the UK response in the Autumn of 2017 to the Category 5 Hurricane IRMA, which affected the British Overseas Territories in the Caribbean. The Joint Operations Area (JOA) spanned an archipelago of Islands over 1000 nm across, stretching logistical and medical doctrinal clinical timelines in a rapidly changing and generally high risk medical environment. Despite significant challenges and a relatively suboptimal start line position, the Operation was a success from a medical perspective, with lower than expected dNBI rates. This paper, written from the medical Operational in-Theatre HQ perspective, charts the phases of Operation RUMAN during Planning, Execution and Recovery. It examines the context and lessons that arose from the Operation RUMAN that could inform future fast-moving Humanitarian Aid and Disaster Relief Operations.