Time, Space and Dialogism in Robert Louis Stevenson’s Fiction

It is now something of a commonplace to discuss Robert Louis Stevenson as an innovator of romance. Genre debates at the fin-de-siècle have been well researched in relation to his fiction and, increasingly, his critical writings. Since Edwin Eiger (1966) and Robert Kiely (1964) published studies on Stevenson’s romance, the interplay between romance and realism that is evident in much of his work has been identified by Roslyn Jolly (1999), Roderick Watson (2004), Hilary J. Beattie (2004) and Michael Saler (2012) to name but a few. Rather than viewing this phenomenon through the lens of genre, which, as Anna Vaninskaya (2008) points out, can lead to unhelpful complications, it is more rewarding to understand Stevenson’s new romance aesthetic as related to his experimentation with time and space. Part of Stevenson’s approach to reviving the romance, set out in “A Gossip on Romance” and “A Humble Remonstrance”, involved adopting a serious literary perspective, rather than treating it as a lesser fictional mode. This aspiration included reinvigorating the traditional spaces of romance by investing them with a more complex temporality, creating new fictional worlds that operated as Bakhtinian chronotopes. Stevenson’s fiction invariably takes a “polychronotopic” form (following Pearce [1994]), which introduces a dialogic relationship between different methods of constructing time-space within a single text. Through this, Stevenson critiques traditional generic assumptions about the hero’s interaction with the romance world and applies a self-reflexive approach to understanding the text he is in the act of producing. This internal dialogic is often exposed in the narrative through Stevenson’s characters who behave beyond the scope of traditional “heroes”, often providing a mismatching perspective to that suggested by the worlds they inhabit over the course of their adventures. Stevenson transformed the romance for a new audience in a similar way to that which Bakhtin traces for the novel in Dostoevsky’s work

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research