The ‘Insider Outsider’ in Iris Murdoch’s Bruno’s Dream and Kazuo Ishiguro’s The Remains of the Day

This paper compares and contrasts two novels that take as their theme the reflections and regrets of a lonely male protagonist entering the final phase of his life. The eponymous Bruno in Iris Murdoch’s Bruno’s Dream (1969) and the butler Stevens in Kazuo Ishiguro’s The Remains of the Day (1990) resemble each other in living only peripherally in the present. Bruno and Stevens are mainly preoccupied in old age with memories of times past and of family and friends who are dead or simply absent. The novels are of similar length. They were both published in the latter half of the twentieth century, and both take place in England although written by authors who were actually born in other countries: Murdoch in Ireland and Ishiguro in Japan. Murdoch was taken to England as a baby and Ishiguro when he was six. This paper argues that Murdoch and Ishiguo both present life as a dream from which their protagonists struggle to awaken as they realize they are approaching their end. It is also apparent that Murdoch and Ishiguro both wrote their stories out of a sense of personal need, an attempt to deal with demons or insecurities that were related in part to their feeling of being ‘insider outsiders’ in their adopted country. Ishiguo has admitted impatience with critics who try to identify him as a Japanese author simply because he was born in Japan. He claims that, in The Remains of the Day, he was trying to write as someone more English than the English. His sense of ambivalence about his nationality arises in part from the fact that, from an early age, he was thoroughly immersed in English culture outside the family home while within it he was raised as a Japanese by parents who intended, one day, to return to their home country. In Stevens, with his obsession about work, Ishiguro managed to create a curiously Japanese figure. Iris Mudoch was similarly conflicted about her identity. She liked to think of herself as Irish despite living in England almost all her life. In Bruno’s Dream, she wrote of an old man possessed by memories and regrets. At the time of writing this novel, she was worried about losing or becoming estranged from friends and also hurt by criticism that the two novels she had just published, set in Ireland, betrayed a fundamental incomprehension of Irish history and culture. In being both ‘insiders’ and ‘outsiders’, Ishiguro and Murdoch were uniquely placed to describe Stevens and Bruno, characters who embody some of their own thoughts and feelings, who wrestle with their own concerns

Isamu Noguchi and Me

Stor

Review of The Life to Come by Michelle de Kretser

Review of The Life to Come by Michelle de Kretse

A Trip to Singapore

A Trip to Singapore describes a clash of cultures and illustrates the curious paradox that by encountering 'the other' we can find ourselves

The ‘Insider Outsider’ in Iris Murdoch’s Bruno’s Dream and Kazuo Ishiguro’s The Remains of the Day

This paper compares and contrasts two novels that take as their theme the reflections and regrets of a lonely male protagonist entering the final phase of his life. The eponymous Bruno in Iris Murdoch’s Bruno’s Dream (1969) and the butler Stevens in Kazuo Ishiguro’s The Remains of the Day (1990) resemble each other in living only peripherally in the present. Bruno and Stevens are mainly preoccupied in old age with memories of times past and of family and friends who are dead or simply absent. The novels are of similar length. They were both published in the latter half of the twentieth century, and both take place in England although written by authors who were actually born in other countries: Murdoch in Ireland and Ishiguro in Japan. Murdoch was taken to England as a baby and Ishiguro when he was six. This paper argues that Murdoch and Ishiguo both present life as a dream from which their protagonists struggle to awaken as they realize they are approaching their end. It is also apparent that Murdoch and Ishiguro both wrote their stories out of a sense of personal need, an attempt to deal with demons or insecurities that were related in part to their feeling of being ‘insider outsiders’ in their adopted country. Ishiguo has admitted impatience with critics who try to identify him as a Japanese author simply because he was born in Japan. He claims that, in The Remains of the Day, he was trying to write as someone more English than the English. His sense of ambivalence about his nationality arises in part from the fact that, from an early age, he was thoroughly immersed in English culture outside the family home while within it he was raised as a Japanese by parents who intended, one day, to return to their home country. In Stevens, with his obsession about work, Ishiguro managed to create a curiously Japanese figure. Iris Mudoch was similarly conflicted about her identity. She liked to think of herself as Irish despite living in England almost all her life. In Bruno’s Dream, she wrote of an old man possessed by memories and regrets. At the time of writing this novel, she was worried about losing or becoming estranged from friends and also hurt by criticism that the two novels she had just published, set in Ireland, betrayed a fundamental incomprehension of Irish history and culture. In being both ‘insiders’ and ‘outsiders’, Ishiguro and Murdoch were uniquely placed to describe Stevens and Bruno, characters who embody some of their own thoughts and feelings, who wrestle with their own concerns

Whole-genome sequencing reveals host factors underlying critical COVID-19

Altres ajuts: Department of Health and Social Care (DHSC); Illumina; LifeArc; Medical Research Council (MRC); UKRI; Sepsis Research (the Fiona Elizabeth Agnew Trust); the Intensive Care Society, Wellcome Trust Senior Research Fellowship (223164/Z/21/Z); BBSRC Institute Program Support Grant to the Roslin Institute (BBS/E/D/20002172, BBS/E/D/10002070, BBS/E/D/30002275); UKRI grants (MC_PC_20004, MC_PC_19025, MC_PC_1905, MRNO2995X/1); UK Research and Innovation (MC_PC_20029); the Wellcome PhD training fellowship for clinicians (204979/Z/16/Z); the Edinburgh Clinical Academic Track (ECAT) programme; the National Institute for Health Research, the Wellcome Trust; the MRC; Cancer Research UK; the DHSC; NHS England; the Smilow family; the National Center for Advancing Translational Sciences of the National Institutes of Health (CTSA award number UL1TR001878); the Perelman School of Medicine at the University of Pennsylvania; National Institute on Aging (NIA U01AG009740); the National Institute on Aging (RC2 AG036495, RC4 AG039029); the Common Fund of the Office of the Director of the National Institutes of Health; NCI; NHGRI; NHLBI; NIDA; NIMH; NINDS.Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care or hospitalization after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes-including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)-in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used