To live and age as who we really are: Perspectives from older LGBT+ people in Ireland.

This Open Letter discusses the theme of 'diversity in brain health' in research, practice and policy for older LGBT+ people. It is written by a multidisciplinary group of Atlantic Fellows for Equity in Brain Health at the Global Brain Health Institute in Trinity College Dublin (TCD), from a variety of disciplines (health economics, human geography, anthropology, psychology, gerontology) and professions (researcher, clinicians, writers, practicing artists). The group developed a workshop to explore the theme of 'Diversity and Brain Health' through the lens of lesbian, gay, bisexual, transgender/transsexual plus (LGBT+).  . Guided by two advisors (Prof Agnes Higgins, TCD; Mr Ciaran McKinney, Age and Opportunity), we invited older LGBT+ people and those interested in the topic of LGBT+ and ageing, healthcare providers, policy makers and interested members of the research community. We partnered with colleagues in the School of Law to include socio-legal perspectives. Following the workshop, Roe and Walrath wrote an opinion editorial, published in the Irish Times during the 2019 PRIDE festival, and were subsequently invited by HRB Open Research to provide a more detailed expansion of that work. In this Open Letter we describe the theme of 'diversity and brain health' and some of the lessons we learned from listening to the lived experience of older LGBT+ people in Ireland today. We illustrate why it's important to understand the lived experience of older LGBT+ people and highlight the failure of the State to evaluate the experience of LGBT+ people in policy implementation. We call on researchers, clinicians, service planners and policy makers, to recognize and address diversity as an important way to address health inequities in Ireland.

A gain in cultural competence through an international acupuncture elective.

OBJECTIVE: This study describes an international acupuncture elective and its impact on medical students' development of cultural competence. METHODS: Collaborating with Chinese colleagues, we created a 4-week elective that teaches medical students about acupuncture in its native cultural environment. Three focus groups were conducted to elicit students' experiences. RESULTS: Students' reflections indicated that studying an alternative medical system in its own cultural setting helped them become open to other medical beliefs and realize the importance of culture in health care delivery. Further, being linguistically isolated allowed students to personally experience what it is like for those patients with limited language proficiency. CONCLUSION: Studying an alternative medical system while immersed in another culture maybe an effective way to enhance cultural competence.

Reliability test of the visual assessment of cranial traits for sex determination.

Interobserver variation in visual evaluation was analyzed for 10 cranial traits in a homogeneous archaeological series. Two observers independently scored cranial traits commonly used for determination of sex. Though determination of sex did not differ significantly for the two observers, individual traits had different levels of interobserver reliability. In addition, indices of relative "maleness" and "femaleness" derived by the two observers differed at statistically significant levels. Because such indices are used in cross-population comparisons of relative gracility and robusticity of diverse samples, these comparisons should be interpreted with caution when more than one investigator has performed an assessment. Most of our instances of interobserver discordance derived from character traits described in subjective terms without accompanying diagrams. Clarity of definition, rather than number of character traits, was found to be critical for effective determination of sex by the visual assessment method. Use of fewer, more precisely defined character traits can improve interobserver reliability.

Adapting root cause analysis to chronic medical conditions.

BACKGROUND: Root cause analysis (RCA), used to study the conditions leading to acute accidents, was adapted to analyze adverse events in chronic medical conditions. METHODS: RCA was modified to investigate "trigger events"--markers of potential adverse events--in outpatient diabetes care. For 20 cases with the trigger event of hypoglycemia evidenced by an A1C of > or = 11%, a multidisciplinary team reviewed the findings of medical record abstractions, provider interviews, and patient interviews for each case. The RCA team identified active failures, error-producing conditions, latent conditions, and defenses leading to the trigger event in each case. RESULTS: The methodology identified potential root causes of persistent hyperglycemia. Latent conditions, error-producing conditions, and active failures occurred at the assessment, planning, and implementation phases of a diabetes visit. Recurring failure modes were identified within and across cases. CONCLUSION: RCA can be used to study trigger events in medical care for chronic conditions. Although the data collection occurs months after the event, this methodology can identify variations in chronic care and stimulate discussion about potential solutions.