Detailed statistical analysis plan for the Danish Palliative care trial (DanPaCT)

Acknowledgements We wish to thank the students who sent out the questionnaires, who entered and compared all data, help with data management, made material blind to the investigators, and were/will be outcome assessors of interventions given. They were: Nicla Rohde Christensen, Ellen Lundorff, Marc Klee Olsen, Charlotte Lund Rasmussen, and Nete Skjødt. This work was funded by the Tryg Foundation [journal number 7-10-0838A] and the Danish Cancer Society [journal number R16-A695]. Other than funding the trial, the funding body had no role in the design, conduct, analysis, or reporting of the present trial.Peer reviewedPublisher PD

Dissecting the interstellar medium of a z=6.3 galaxy: X-shooter spectroscopy and HST imaging of the afterglow and environment of the Swift GRB 210905A

The study of the properties of galaxies in the first billion years after the Big Bang is one of the major topic of current astrophysics. Optical/near-infrared spectroscopy of the afterglows of long Gamma-ray bursts (GRBs) provide a powerful diagnostic tool to probe the interstellar medium (ISM) of their host galaxies and foreground absorbers, even up to the highest redshifts. We analyze the VLT/X-shooter afterglow spectrum of GRB 210905A, triggered by the Swift Neil Gehrels Observatory, and detect neutral-hydrogen, low-ionization, high-ionization, and fine-structure absorption lines from a complex system at z=6.3118, that we associate with the GRB host galaxy. We study the ISM properties of the host system, revealing the metallicity, kinematics and chemical abundance pattern. The total metallicity of the z~6.3 system is [M/H]=-1.72+/-0.13, after correcting for dust-depletion and taking into account alpha-element enhancement. In addition, we determine the overall amount of dust and dust-to-metal mass ratio (DTM) ([Zn/Fe]_fit=0.33+/-0.09, DTM=0.18+/-0.03). We find indications of nucleosynthesis due to massive stars and evidence of peculiar over-abundance of aluminium. From the analysis of fine-structure lines, we determine distances of several kpc for the low-ionization gas clouds closest to the GRB. Those farther distances are possibly due to the high number of ionizing photons. Using the HST/F140W image of the GRB field, we show the GRB host galaxy as well as multiple objects within 2" from the GRB. We discuss the galaxy structure and kinematics that could explain our observations, also taking into account a tentative detection of Lyman-alpha emission. Deep spectroscopic observations with VLT/MUSE and JWST will offer the unique possibility of combining our results with the ionized-gas properties, with the goal of better understanding how galaxies in the reionization era form and evolve.Comment: Accepted Publication (In Press on A&A) - 22 pages, 10 figures, 6 tables - Appendix: 6 figures, 3 table

The cosmic build-up of dust and metals : Accurate abundances from GRB-selected star-forming galaxies at 1.7 < z < 6.3

© 2023 The Author(s), published by EDP Sciences. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/The chemical enrichment of dust and metals in the interstellar medium of galaxies throughout cosmic time is one of the key driving processes of galaxy evolution. Here we study the evolution of the gas-phase metallicities, dust-to-gas (DTG) ratios, and dust-to-metal (DTM) ratios of 36 star-forming galaxies at 1.7 40 000) spectroscopic data, including three new sources, for which at least one refractory (e.g., Fe) and one volatile (e.g., S or Zn) element have been detected at S/N > 3. This is to ensure that accurate abundances and dust depletion patterns can be obtained. We first derived the redshift evolution of the dust-corrected, absorption-line-based gas-phase metallicity, [M/H] tot, in these galaxies, for which we determine a linear relation with redshift [M/H] tot(z) = (- 0.21 ± 0.04)z - (0.47 ± 0.14). We then examined the DTG and DTM ratios as a function of redshift and through three orders of magnitude in metallicity, quantifying the relative dust abundance both through the direct line-of-sight visual extinction, A V, and the derived depletion level. We used a novel method to derive the DTG and DTM mass ratios for each GRB sightline, summing up the mass of all the depleted elements in the dust phase. We find that the DTG and DTM mass ratios are both strongly correlated with the gas-phase metallicity and show a mild evolution with redshift as well. While these results are subject to a variety of caveats related to the physical environments and the narrow pencil-beam sightlines through the interstellar medium probed by the GRBs, they provide strong implications for studies of dust masses that aim to infer the gas and metal content of high-redshift galaxies, and particularly demonstrate the large offset from the average Galactic value in the low-metallicity, high-redshift regime.Peer reviewe

The cosmic build-up of dust and metals. Accurate abundances from GRB-selected star-forming galaxies at 1.7<z<6.31.7 < z < 6.3

The chemical enrichment of dust and metals in the interstellar medium (ISM) of galaxies throughout cosmic time is one of the key driving processes of galaxy evolution. Here we study the evolution of the gas-phase metallicities, dust-to-gas (DTG), and dust-to-metal (DTM) ratios of 36 star-forming galaxies at $1.7 < z < 6.3$ probed by gamma-ray bursts (GRBs). We compile all GRB-selected galaxies with intermediate (R=7000) to high (R>40,000) resolution spectroscopic data for which at least one refractory (e.g. Fe) and one volatile (e.g. S or Zn) element have been detected at S/N>3. This is to ensure that accurate abundances and dust depletion patterns can be obtained. We first derive the redshift evolution of the dust-corrected, absorption-line based gas-phase metallicity [M/H]$_{\rm tot}$ in these galaxies, for which we determine a linear relation with redshift ${\rm [M/H]_{tot}}(z) = (-0.21\pm 0.04)z -(0.47\pm 0.14)$. We then examine the DTG and DTM ratios as a function of redshift and through three orders of magnitude in metallicity, quantifying the relative dust abundance both through the direct line-of-sight visual extinction $A_V$ and the derived depletion level. We use a novel method to derive the DTG and DTM mass ratios for each GRB sightline, summing up the mass of all the depleted elements in the dust-phase. We find that the DTG and DTM mass ratios are both strongly correlated with the gas-phase metallicity and show a mild evolution with redshift as well. While these results are subject to a variety of caveats related to the physical environments and the narrow pencil-beam sightlines through the ISM probed by the GRBs, they provide strong implications for studies of dust masses to infer the gas and metal content of high-redshift galaxies, and particularly demonstrate the large offset from the average Galactic value in the low-metallicity, high-redshift regime.Comment: Accepted in A&

Attitudes of Danish doctors and nurses to palliative and terminal care

Background: The WHO definitions of palliative care have been adopted in Denmark and implemented in The National Guidelines from 1999, but service developments have been very slow and not according to the recommendations. Attitudes to palliative care of Danish doctors and nurses may in part account for this. Objective: To assess the attitudes to issues related to palliative care of doctors and nurses in a Danish county hospital and the related primary care services.Design: Cross-sectional survey using a mailed, self-administered questionnaire answered anonymously.Participants: Nurses and doctors employed in a county hospital in Denmark, homecare nurses and general practitioners from the related primary care services. Outcome measures: The responses from the groups were compared by X2 statistics (where ordinal variables with X2 for trend). Data were analysed using SPSS 10.0. Results: 347 responded, response rate 76%. Eighty-one per cent of all respondents were currently caring for terminally ill patient(s), 94% had done so within the last six months. Hospital doctors see more terminally ill patients than GPs (P = 0.002). Comparison of doctors (both hospital and GPs) with nurses showed that nurses were more likely to definitely agree that palliative/terminal care was a rewarding part of their work (61% 'definitely agree' versus 30%), and they were less likely to prefer to leave care of these patients to others (4% 'definitely/probably agree' versus 9%). Nurses reflected more on existential matters (80% 'definitely/probably agree' versus 63%) and were more likely to agree that dealing with a dying patient made them aware of their own feelings regarding death (97% 'definitely/probably agree' versus 80%). Only 7% of all respondents reported 'being an active member of a religious community'. Ninety-two per cent of all respondents agreed that doctors play a key role in reducing the suffering of dying patients, but 59% of nurses versus 9% of doctors 'definitely/probably agree' that 'it is primarily the task of nurses to deal with patients reactions to death'. There were significant differences between hospital doctors and GPs, with the former less likely to agree that palliative and terminal illness is rewarding, more likely to leave care of dying patients to others, and more likely to 'probably' or 'definitely agree' that it is more satisfying to work with patients who will improve. Home care nurses reflected more on existential matters than their hospital colleagues, and were more likely to 'definitely agree' that palliative/terminal care is rewarding. Differences between groups seemed to be due to profession (doctor versus nurse) and setting (hospital versus community) rather than age or gender. Conclusion: These findings suggest that in Denmark nurses demonstrate more positive attitudes to the care of palliative/terminally ill patients than doctors, and that attitudes amongst doctors and nurses working in the community are more positive than those of the colleagues in hospitals. There is currently little education in the principles and practice of palliative care in Denmark. These findings will inform the development of appropriate palliative care education for doctors and nurses working both in the hospital and in the community in Denmark. They also raise the possibility that part of the inertia in the development of palliative care in Denmark is related to the lack of education and, in particular, to the need of support for doctors and nurses providing terminal care so they are enabled to be more reflective on the care they currently provide. There is evidence that education in palliative care can change health professionals' attitudes to palliative and terminal care, and this now needs to be investigated in Denmark