Therapy

Aptly known as the “talking cure,” therapy typically involves a client reflecting on their personal challenges and a provider guiding the conversation with feedback, questions, and non-verbal cues. How did this rare medical treatment of the early twentieth century evolve into a pervasive cultural trope and marketplace icon – and why? To answer these questions, this article offers three different histories of therapy: (1) an academic history of the schools of therapy, from psychoanalysis to positive psychology, (2) an economic history of the growth of therapy, from rare treatment to mainstream health-care, and (3) a cultural history of the diffusion of therapy, from health-care service to Hollywood movies, television serials, news programs, talk shows, reality TV, pop music, and everyday conversation.     

Women over 40, foreigners of color,and other missing persons in globalizing mediascapes: understanding marketing images as mirrors of intersectionality

ABSTRACT

Media diversity studies regularly invoke the notion of marketing images as mirrors of racism and sexism. This article develops a higher-order concept of marketing images as “mirrors of intersectionality.” Drawing on a seven-dimensional study of coverperson diversity in a globalizing mediascape, the emergent concept highlights that marketing images reflect not just racism and sexism, but all categorical forms of marginalization, including ableism, ageism, colorism, fatism, and heterosexism, as well as intersectional forms of marginalization, such as sexist ageism and racist multiculturalism. Fueled by the legacies of history, aspirational marketing logics, and an industry-wide distribution of discriminatory work, marketing images help to perpetuate multiple, cumulative, and enduring advantages for privileged groups and disadvantages for marginalized groups. In this sense, marketing images, as mirrors of intersectionality, are complicit agents in the structuration of inequitable societies.     

Cost-effectiveness of ceftolozane/tazobactam plus metronidazole compared with piperacillin/tazobactam as empiric therapy for the treatment of complicated intra-abdominal infections based on the in-vitro surveillance of bacterial isolates in the UK

Aims: An increase in the prevalence of antimicrobial resistance among gram-negative pathogens has been noted recently. A challenge in empiric treatment of complicated intra-abdominal infection (cIAI) is identifying initial appropriate antibiotic therapy, which is associated with reduced length of stay and mortality compared with inappropriate therapy. The objective of this study was to assess the cost-effectiveness of ceftolozane/tazobactam?+?metronidazole compared with piperacillin/tazobactam (commonly used in this indication) in the treatment of patients with cIAI in UK hospitals.

Methods: A decision-analytic Monte Carlo simulation model was used to compare costs (antibiotic and hospitalization costs) and quality-adjusted life years (QALYs) of patients infected with gram-negative cIAI and treated empirically with either ceftolozane/tazobactam?+?metronidazole or piperacillin/tazobactam. Bacterial isolates were randomly drawn from the Program to Assess Ceftolozane/Tazobactam Susceptibility (PACTS) database, a surveillance database of non-duplicate bacterial isolates collected from patients in the UK infected with gram-negative pathogens. Susceptibility to initial empiric therapy was based on the measured susceptibilities reported in the PACTS database.

Results: Ceftolozane/tazobactam?+?metronidazole was cost-effective when compared with piperacillin/tazobactam, with an incremental cost-effectiveness ratio (ICER) of £4,350/QALY and 0.36 hospitalization days/patient saved. Costs in the ceftolozane/tazobactam?+?metronidazole arm were £2,576/patient, compared with £2,168/patient in the piperacillin/tazobactam arm. The ceftolozane/tazobactam?+?metronidazole arm experienced a greater number of QALYs than the piperacillin/tazobactam arm (14.31/patient vs 14.21/patient, respectively). Ceftolozane/tazobactam?+?metronidazole remained cost-effective in one-way sensitivity and probabilistic sensitivity analyses.

Conclusions: Economic models can help to identify the appropriate choice of empiric therapy for the treatment of cIAI. Results indicated that empiric use of ceftolozane/tazobactam?+?metronidazole is cost-effective vs piperacillin/tazobactam in UK patients with cIAI at risk of resistant infection. This will be valuable to commissioners and clinicians to aid decision-making on the targeting of resources for appropriate antibiotic therapy under the premise of antimicrobial stewardship.     

An intersectional approach to diversity research

Diversity can be analyzed using one of two approaches. The dominant unidimensional approach examines diversity across a single dimension at a time (e.g. first by race, then by sex). By contrast, an emerging intersectional approach considers diversity across multiple dimensions at once (e.g. by race and sex). This article presents a visual study of marketing images using unidimensional and intersectional approaches to reveal the strengths and weaknesses of both approaches. Unidimensional research proves much easier to conduct, but its conclusions tend to be simplistic, misleading, and repressive. By contrast, intersectional research is cumbersome, but its relatively complex conclusions are more inclusive, precise, and radical. Only intersectional research can reveal how the multiply disadvantaged are often completely erased (intersectional invisibility) or disproportionately ridiculed (intersectional travesty), drawing overdue attention to the market's most marginalized segments.