Urban itineraries: Representations of the peasant in eighteenth-century French literature and painting

Urban Itineraries is an interdisciplinary study that examines representations of the peasant from a socio-cultural and historical perspective. Between the 17th and the 18th centuries, striking changes occurred in the way peasants were portrayed in French literature and painting. A far cry from Moliere\u27s dim-witted villager or the Le Nains\u27 tragic brute, the peasant in the 18th century is either dramatically depicted as a socially mobile, morally corrupt urban migrant or nostalgically portrayed as a virtuous member of a loving rural community. As these transformations suggest, the rapid urbanization taking place in 18th-century France created an opportune climate for authors and artists to cultivate and exploit public sentiment surrounding both the real and the imagined changes taking place in contemporary society. Tracing the development of the figure from the 1710s to the 1790s, this dissertation shows how the peasant serves as a realistic and a sensational symbol of the historical changes and shifts in mentality that occurred throughout the century. Chapter one examines Marivaux\u27s and Watteau\u27s portrayals of the masquerading of peasants and aristocrats, arguing that these works may have documented as well as influenced the more fluid social and sartorial hierarchy that developed in France over the course of the century. The second chapter discusses the sentimental images of the peasant family and egalitarian village community in the works of Rousseau, Graffigny, Favart, Sedaine, and Greuze, showing how these nostalgic country scenes may have both soothed and cultivated the public\u27s desire for a united community blind to social distinctions. Chapter three studies the contrasts between secret urban chambers and panoptic rural spaces developed in Retif de la Bretonne\u27s novels and Fragonard\u27s paintings, demonstrating how these works may have played on growing concerns about the relationship between urban spaces and moral corruption. The dissertation concludes with a discussion of how the peasant emerged as the ultimate French citizen during the Revolution, an image which proves to be the enduring legacy of these 18th-century portrayals, ironically re-emerging when the issue of essential Frenchness comes to the forefront during the anti-semitic and anti-immigration campaigns of Petain and Le Pen

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Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research