Sexual selection, automata and ethics in George Eliot's The Mill on the Floss and Olive Schreiner's Undine and From Man to Man

This paper brings together two related areas of debate in the latter half of the nineteenth century. The first concerns how the courtship plot of the nineteenth-century novel responded to, and helped to shape, scientific ideas of sexual competition and selection. In The Mill on the Floss (1860), George Eliot strikingly prefigures Darwin's later work on sexual selection, drawing from her own extensive knowledge of the wider debates within which evolutionary theory developed. Maggie Tulliver's characterisation allows Eliot to explore the ethical complexities raised by an increasingly powerful scientific naturalism, where biology is seen to be embedded within morality in newly specific ways. The second strand of the paper examines the extension of scientific method to human mind and motivation which constituted the new psychology. It argues that there are crucial continuities of long-established ethical and religious ideas within this increasingly naturalistic view of human mind and motivation. The contention that such ideas persist and are transformed, rather than simply jettisoned, is illustrated through the example of Thomas Henry Huxley's 1874 essay on automata. Turning finally to focus on Olive Schreiner's Undine (1929) and From Man to Man (1926), the paper explores the importance of these persistent ethical and religious ideas in two novels which remained unpublished during her lifetime. It argues that they produce both difficulty and opportunity for imagining love plots within the context of increasingly assertive biological and naturalistic accounts of human beings

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)