The fornaldarsogur : Stephen Mitchell's contribution

The fornaldarsogur (literally, "sagas of antiquity") have long been relegated to the status of "poor cousins" within the family of Old Icelandic literature. To a large degree this downgrading has occurred because the fornaldarsogur are often fantastic narrations that read very differently from the more sober and worldly islendingasogur [family sagas]. Written in the period from roughly the thirteenth to the fifteenth century, the fornaldarsogur, a mixture of tradition and invention, often recount legendary and mythic events from the recesses of Scandinavian folk memory. Sometimes a tale follows its hero or heroes into the supernatural world and also recounts quasi-historical memories of events that can be traced as far back as the migration period. In general, the fornaldarsogur focus on Scandinavia; southern Germanic matters and events are less evident and usually only enter the tales in connection with stories built on, or sharing motifs and traditions with, Eddic material, as they do in the Volsunga saga

Choices of honor : telling saga feud, thattr, and the fundamental oral progression

The family and Sturlunga sagas are not only narratives of "sophisticated conventionality," but it is precisely the unclear combination of mundane and refined that has made these medieval texts so hard to classify.1 On the one hand the sagas are a sophisticated written phenomenon. On the other, they are stories filled with repetitions and other conventions of oral, ethnographic narration recounting the social past. Can we determine the elemental, generative structure of the Icelandic texts? The answer is yes, since the sagas themselves, despite their overlay of sophistication, retain this primary repetitive progression. With our question in mind, let us look at just such a progression.Not

Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: A comprehensive review

Background: Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. Objectives: To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples’ preferences, needs, opportunities and barriers to palliative care. Methods: A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly’s hierarchy of evidence-for-practice in qualitative research. Results: Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples’ experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. Conclusions: The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas

A Bayesian approach to linking archaeological, paleoenvironmental and documentary datasets relating to the settlement of Iceland (Landnám)

YesIcelandic settlement (Landnám) period farmsteads offer opportunities to explore the nature and timing of anthropogenic activities and environmental impacts of the first Holocene farming communities. We employ Bayesian statistical modelling of archaeological, paleoenvironmental and documentary datasets to present a framework for improving chronological robustness of archaeological events. Specifically, we discuss events relevant to the farm Hrísbrú, an initial and complex settlement site in southwest Iceland. We demonstrate that tephra layers are key in constraining reliable chronologies, especially when combined with related datasets and treated in a Bayesian framework. The work presented here confirms earlier interpretations of the chronology of the site while providing increased confidence in the robustness of the chronology. Most importantly, integrated modelling of AMS radiocarbon dates on Hordeum vulgare grains, palynological data, documented evidence from textual records and typologically diagnostic artefacts yield increased dating reliability. The analysis has also shown that AMS radiocarbon dates on bone collagen need further scrutiny. Specifically for the Hrísbrú farm, first anthropogenic footprint palynomorph taxa are estimated to around AD 830–881 (at 95.4% confidence level), most likely before the tephra fall out of AD 877 ± 1 (the Landnám tephra layer), demonstrating the use of arable fields before the first known structures were built at Hrísbrú (AD 874–951) and prior to the conventionally accepted date of the settlement of Iceland. Finally, we highlight the importance of considering multidisciplinary factors for other archaeological and paleoecological studies of early farming communities of previously uninhabited island areas

Completion of Advance Directives: Do Social Work Preadmission Interviews Make a Difference?

Objectives: This study tests the efficacy of a preadmission, educational interview on advance directives, in this case, health care proxies (HCPs) offered to elective, orthopedic patients. Method: Using a quasi-experimental design, participants (n = 54) are assigned to either treatment group (who received the educational interview, conducted by a social worker, over and above the federally mandated written information on HCPs) or comparison group (who received the written information only). Results: Logistic regression analysis indicates there is a statistically significantly higher probability that a patient would sign an HCP if assigned to the treatment group than if assigned to the comparison condition. Conclusion: Benefits of educating patients about HCPs as part of routine social work practice are outlined

Gynecologic oncology patients' satisfaction and symptom severity during palliative chemotherapy

BACKGROUND: Research on quality and satisfaction with care during palliative chemotherapy in oncology patients has been limited. The objective was to assess the association between patient's satisfaction with care and symptom severity and to evaluate test-retest of a satisfaction survey in this study population. METHODS: A prospective cohort of patients with recurrent gynecologic malignancies receiving chemotherapy were enrolled after a diagnosis of recurrent cancer. Patients completed the Quality of End-of-Life care and satisfaction with treatment scale (QUEST) once upon enrollment in an outpatient setting and again a week later. Patients also completed the Mini-Mental Status Exam, the Hospital Anxiety/Depression Scale, a symptom severity scale and a demographic survey. Student's t-test, correlation statistics and percent agreement were used for analysis. RESULTS: Data from 39 patients were analyzed. Mean (SD) quality of care summary score was 41.95 (2.75) for physicians and 42.23 (5.42) for nurses (maximum score was 45; p = 0.76 for difference in score between providers). Mean (SD) satisfaction of care summary score was 29.03 (1.92) for physicians and 29.28 (1.70) for nurses (maximum score was 30; p = 0.49 for difference between providers). Test-retest for 33 patients who completed both QUEST surveys had high percent agreement (74–100%), with the exception of the question regarding the provider arriving late (45 and 53%). There was no correlation between quality and satisfaction of care and symptom severity. Weakness was the most common symptom reported. Symptom severity correlated with depression (r = 0.577 p < 0.01). There was a trend towards a larger proportion of patients reporting pain who had three or more prior chemotherapy regimens (p = 0.075). Prior number of chemotherapy regimens or time since diagnosis was not correlated with symptom severity score. Anxiety and depression were correlated with each other (r = 0.711, p < 0.01). There was no difference in symptom severity score at enrollment between those patients who have since died (n = 19) versus those who are still alive. CONCLUSION: The QUEST Survey has test-retest reliability when used as a written instrument in an outpatient setting. However, there was no correlation between this measure and symptom severity. Patient evaluation of care may be more closely related to the interpersonal aspects of the health care provider relationship than it is to physical symptoms

The Nikumaroro bones identification controversy: First-hand examination versus evaluation by proxy — Amelia Earhart found or still missing?

YesAmerican celebrity aviator Amelia Earhart was lost over the Pacific Ocean during her press-making 1937 round-the-world flight. The iconic woman pilot remains a media interest nearly 80 years after her disappearance, with perennial claims of finds pinpointing her location. Though no sign of the celebrity pilot or her plane have been definitively identified, possible skeletal remains have been attributed to Earhart. The partial skeleton was recovered and investigated by British officials in 1940. Their investigation concluded that the remains were those of a stocky, middle-aged male. A private historic group re-evaluated the British analysis in 1998 as part of research to establish Gardner (Nikumaroro) Island as the crash site. The 1998 report discredited the British conclusions and used cranial analysis software (FORDISC) results to suggest that the skeleton was potentially a Northern European woman, and consistent with Amelia Earhart. A critical review of both investigations and contextual evidence shows that the original British osteological analyses were made by experienced, reliable professionals, while the cranial analysis is unreliable given the available data. Without access to the missing original bones, it is impossible to be definitive, but on balance, the most robust scientific analysis and conclusions are those of the original British finding indicating that the Nikumaroro bones belonged to a robust, middle-aged man, not Amelia Earhart

Sedation in palliative care – a critical analysis of 7 years experience

BACKGROUND: The administration of sedatives in terminally ill patients becomes an increasingly feasible medical option in end-of-life care. However, sedation for intractable distress has raised considerable medical and ethical concerns. In our study we provide a critical analysis of seven years experience with the application of sedation in the final phase of life in our palliative care unit. METHODS: Medical records of 548 patients, who died in the Palliative Care Unit of GK Havelhoehe between 1995–2002, were retrospectively analysed with regard to sedation in the last 48 hrs of life. The parameters of investigation included indication, choice and kind of sedation, prevalence of intolerable symptoms, patients' requests for sedation, state of consciousness and communication abilities during sedation. Critical evaluation included a comparison of the period between 1995–1999 and 2000–2002. RESULTS: 14.6% (n = 80) of the patients in palliative care had sedation given by the intravenous route in the last 48 hrs of their life according to internal guidelines. The annual frequency to apply sedation increased continuously from 7% in 1995 to 19% in 2002. Main indications shifted from refractory control of physical symptoms (dyspnoea, gastrointestinal, pain, bleeding and agitated delirium) to more psychological distress (panic-stricken fear, severe depression, refractory insomnia and other forms of affective decompensation). Patients' and relatives' requests for sedation in the final phase were significantly more frequent during the period 2000–2002. CONCLUSION: Sedation in the terminal or final phase of life plays an increasing role in the management of intractable physical and psychological distress. Ethical concerns are raised by patients' requests and needs on the one hand, and the physicians' self-understanding on the other hand. Hence, ethically acceptable criteria and guidelines for the decision making are needed with special regard to the nature of refractory and intolerable symptoms, patients' informed consent and personal needs, the goals and aims of medical sedation in end-of-life care