Considering life and death:a qualitative vignette study among farm animal veterinarians in the Netherlands on considerations in end-of-life decision-making

Farm animal veterinarians are frequently involved in animals’ end-of-life (EoL) situations. Existing literature found that the decision-making process to end an animal’s life can be experienced as complex and stressful by veterinarians. The complexity of the process may find its origin in the multiple medical and non-medical aspects that veterinarians consider coming to their decision. Although research provides insight into what considerations are at stake, the literature does not provide information on how these aspects affect the decision-making process. This study explores how different considerations affect the decision-making process of farm animal veterinarians in EoL situations. Semi-structured interviews were conducted with nineteen farm animal veterinarians in the Netherlands. During the interviews, case scenarios in the form of vignettes were used to identify and explore the considerations that play a role for these veterinarians in EoL decision-making. Based on the analysis of the interview data, we discovered that farm animal veterinarians consider EoL situations using one of three identified frames: function, prospect, and duty. These frames illustrate one’s perspective on the interplay of medical and non-medical aspects. Whereas veterinarians for whom the function frame is dominant focus on the human-centred function that an animal fulfils, veterinarians for whom the prospect frame is dominant focus on an animal’s prospects based on the animal’s living conditions and the influence of the owner. Veterinarians for whom the duty frame is dominant focus on the owner’s legal position towards the animal, illustrating a clear distinction between the veterinarian’s professional duties towards the animal and the duty of care of the animal owner. As such, the key contributions of this study are the discovery of the importance of the interplay between considerations in EoL decision-making and the frame-specific approach of veterinarians. The identified frames may relate to the coping strategies of veterinarians dealing with the complexity of EoL situations.</p

Considering life and death:a qualitative vignette study among farm animal veterinarians in the Netherlands on considerations in end-of-life decision-making

Farm animal veterinarians are frequently involved in animals’ end-of-life (EoL) situations. Existing literature found that the decision-making process to end an animal’s life can be experienced as complex and stressful by veterinarians. The complexity of the process may find its origin in the multiple medical and non-medical aspects that veterinarians consider coming to their decision. Although research provides insight into what considerations are at stake, the literature does not provide information on how these aspects affect the decision-making process. This study explores how different considerations affect the decision-making process of farm animal veterinarians in EoL situations. Semi-structured interviews were conducted with nineteen farm animal veterinarians in the Netherlands. During the interviews, case scenarios in the form of vignettes were used to identify and explore the considerations that play a role for these veterinarians in EoL decision-making. Based on the analysis of the interview data, we discovered that farm animal veterinarians consider EoL situations using one of three identified frames: function, prospect, and duty. These frames illustrate one’s perspective on the interplay of medical and non-medical aspects. Whereas veterinarians for whom the function frame is dominant focus on the human-centred function that an animal fulfils, veterinarians for whom the prospect frame is dominant focus on an animal’s prospects based on the animal’s living conditions and the influence of the owner. Veterinarians for whom the duty frame is dominant focus on the owner’s legal position towards the animal, illustrating a clear distinction between the veterinarian’s professional duties towards the animal and the duty of care of the animal owner. As such, the key contributions of this study are the discovery of the importance of the interplay between considerations in EoL decision-making and the frame-specific approach of veterinarians. The identified frames may relate to the coping strategies of veterinarians dealing with the complexity of EoL situations.</p

Challenges of future vets – the impact of the killing of animals during education on veterinary students’ wellbeing

End-of-animal life (EOL) situations are a common phenomenon in veterinary practice. These EOL situations can lead to distress for the veterinarian when an ethical dilemma or conflict arises. This distress can have an impact on the personal and professional well-being of veterinary professionals. Such distress may already be present when veterinary students gain their first experience with ending an animal’s life in an educational setting. To study this claim, we set up an explorative study focusing on: (1) how veterinary students experience the ending of an animal’s life during an obligatory course; and (2) the impact of their experience on their wellbeing. Qualitative data were gathered via semi-structured interviews with twelve students. Template analysis was used to determine themes within the interview transcripts. The data reveal that students’ previous experiences with EOL situations were predominantly influenced by the student’s perspective on the motive of the owner, the bond with the animal, and the procedure. Students shared that their experience with ending an animal’s life during the course was mainly influenced by the health status of the animal, the bond with the animal, the procedure, and the learning environment. We observed that depending on the dynamic of these aspects a positive or negative impact on the well-being of the student is noticed during or shortly after the course. Based on this study we have more knowledge on what factors affect a student’s experience with an EOL situation and how this can affect the student’s well-being. These insights can be of added value in developing or evaluating veterinary education on EOL situations

Considering life and death: a qualitative vignette study among farm animal veterinarians in the Netherlands on considerations in end-of-life decision-making

Farm animal veterinarians are frequently involved in animals’ end-of-life (EoL) situations. Existing literature found that the decision-making process to end an animal’s life can be experienced as complex and stressful by veterinarians. The complexity of the process may find its origin in the multiple medical and non-medical aspects that veterinarians consider coming to their decision. Although research provides insight into what considerations are at stake, the literature does not provide information on how these aspects affect the decision-making process. This study explores how different considerations affect the decision-making process of farm animal veterinarians in EoL situations. Semi-structured interviews were conducted with nineteen farm animal veterinarians in the Netherlands. During the interviews, case scenarios in the form of vignettes were used to identify and explore the considerations that play a role for these veterinarians in EoL decision-making. Based on the analysis of the interview data, we discovered that farm animal veterinarians consider EoL situations using one of three identified frames: function, prospect, and duty. These frames illustrate one’s perspective on the interplay of medical and non-medical aspects. Whereas veterinarians for whom the function frame is dominant focus on the human-centred function that an animal fulfils, veterinarians for whom the prospect frame is dominant focus on an animal’s prospects based on the animal’s living conditions and the influence of the owner. Veterinarians for whom the duty frame is dominant focus on the owner’s legal position towards the animal, illustrating a clear distinction between the veterinarian’s professional duties towards the animal and the duty of care of the animal owner. As such, the key contributions of this study are the discovery of the importance of the interplay between considerations in EoL decision-making and the frame-specific approach of veterinarians. The identified frames may relate to the coping strategies of veterinarians dealing with the complexity of EoL situations

Positional mapping of loci in the DiGeorge critical region at chromosome 22q11 using a new marker (D22S183)

The majority of patients with DiGeorge syndrome (DGS) and velo-cardio-facial syndrome (VCFS) and a minority of patients with non-syndromic conotruncal heart defects are hemizygous for a region of chromosome 22q11. The chromosomal region that is commonly deleted is larger than 2 Mb. It has not been possible to narrow the smallest region of overlap (SRO) of the deletions to less than ca 500 kb, which suggests that DGS/VCFS might be a contiguous gene syndrome. The saturation cloning of the SRO is being carried out, and one gene (TUPLE1) has been identified. By using a cosmid probe (M51) and fluorescence in situ hybridization, we show here that the anonymous DNA marker locus D22S183 is within the SRO, between TUPLE1 and D22S75 (probe N25). A second locus with weak homology to D22S183, recognized by cosmid M56, lies immediately outside the common SRO of the DGS and VCFS deletions, but inside the SRO of the DGS deletions. D22S183 sequences are strongly conserved in primates and weaker hybridizing signals are found in DNA of other mammalian species; no transcripts are however detected in polyA+ RNA from various adult human organs. Probe M51 allows fast reliable screening for 22q11 deletions using fluorescence in situ hybridization. A deletion was found in 11 out of 12 DGS patients and in 3 out of 7 VCFS patients. Two patients inherited the deletion from a parent with mild (atypical) symptoms

The views of farm animal veterinarians about their roles and responsibilities associated with on-farm end-of-life situations

Farm animal veterinarians are often involved in on-farm end-of-life (EoL) decisions and questions concerning euthanasia. These decisions can be challenging for the veterinarian, particularly if the interests of the animal and owner conflict. Moreover, the challenge is related to fundamental assumptions about roles and responsibilities veterinarians ascribe to themselves in EoL situations. Getting insight into what roles and responsibilities veterinarians perceive in these situations is important to understand the challenges veterinarians face and to explore ways to enable them to manage such situations. Existing literature and professional guidelines do not provide sufficient clarity and guidance in terms of the role conception and responsibilities of veterinarians in on-farm EoL situations. The objective of the current qualitative study was to better understand the views of farm animal veterinarians in the Netherlands regarding their roles and responsibilities associated with on-farm EoL situations. In-depth semi-structured interviews were conducted with 19 farm animal veterinarians. In terms of roles in EoL situations, our analysis shows that 1) seven roles can be distinguished based on the interviews, 2) two contextual dimensions influence role perception: a) the stage in which a veterinarian gets involved at the end of an animal’s life and b) the question of whose interests should be taken into consideration and how to prioritize (conflicting) interests by a veterinarian, 3) veterinarians enact a number of the identified roles and the combination of roles varies between individuals and 4) the individual veterinarian changes between roles depending on contextual aspects. In terms of responsibilities in EoL situations, analyses show that 1) individual veterinarians perceive a combination of five identified responsibilities, and 2) the perception of responsibilities relates predominantly to specific animal sectors. This insight into the roles and responsibility perceptions of veterinarians facilitates understanding the challenges veterinarians face in on-farm EoL situations and creates a starting point for how veterinarians can be supported to deal with potential conflicts of interest. These insights could also be valuable in the training of future veterinarians and lifelong learning of veterinarians as it provides a starting point to reflect on, and discuss, one’s role and responsibility in EoL situations

Considering life and death: a qualitative vignette study among farm animal veterinarians in the Netherlands on considerations in end-of-life decision-making

Farm animal veterinarians are frequently involved in animals’ end-of-life (EoL) situations. Existing literature found that the decision-making process to end an animal’s life can be experienced as complex and stressful by veterinarians. The complexity of the process may find its origin in the multiple medical and non-medical aspects that veterinarians consider coming to their decision. Although research provides insight into what considerations are at stake, the literature does not provide information on how these aspects affect the decision-making process. This study explores how different considerations affect the decision-making process of farm animal veterinarians in EoL situations. Semi-structured interviews were conducted with nineteen farm animal veterinarians in the Netherlands. During the interviews, case scenarios in the form of vignettes were used to identify and explore the considerations that play a role for these veterinarians in EoL decision-making. Based on the analysis of the interview data, we discovered that farm animal veterinarians consider EoL situations using one of three identified frames: function, prospect, and duty. These frames illustrate one’s perspective on the interplay of medical and non-medical aspects. Whereas veterinarians for whom the function frame is dominant focus on the human-centred function that an animal fulfils, veterinarians for whom the prospect frame is dominant focus on an animal’s prospects based on the animal’s living conditions and the influence of the owner. Veterinarians for whom the duty frame is dominant focus on the owner’s legal position towards the animal, illustrating a clear distinction between the veterinarian’s professional duties towards the animal and the duty of care of the animal owner. As such, the key contributions of this study are the discovery of the importance of the interplay between considerations in EoL decision-making and the frame-specific approach of veterinarians. The identified frames may relate to the coping strategies of veterinarians dealing with the complexity of EoL situations

Statistical colocalization of genetic risk variants for related autoimmune diseases in the context of common controls.

Determining whether potential causal variants for related diseases are shared can identify overlapping etiologies of multifactorial disorders. Colocalization methods disentangle shared and distinct causal variants. However, existing approaches require independent data sets. Here we extend two colocalization methods to allow for the shared-control design commonly used in comparison of genome-wide association study results across diseases. Our analysis of four autoimmune diseases--type 1 diabetes (T1D), rheumatoid arthritis, celiac disease and multiple sclerosis--identified 90 regions that were associated with at least one disease, 33 (37%) of which were associated with 2 or more disorders. Nevertheless, for 14 of these 33 shared regions, there was evidence that the causal variants differed. We identified new disease associations in 11 regions previously associated with one or more of the other 3 disorders. Four of eight T1D-specific regions contained known type 2 diabetes (T2D) candidate genes (COBL, GLIS3, RNLS and BCAR1), suggesting a shared cellular etiology.MF is funded by the Wellcome Trust (099772). CW and HG are funded by the Wellcome Trust (089989). This work was funded by the JDRF (9–2011–253), the Wellcome Trust (091157) and the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre. The Cambridge Institute for Medical Research (CIMR) is in receipt of a Wellcome Trust Strategic Award (100140). ImmunoBase.org is supported by Eli Lilly and Company. We thank the UK Medical Research Council and Wellcome Trust for funding the collection of DNA for the British 1958 Birth Cohort (MRC grant G0000934, WT grant 068545/Z/02). DNA control samples were prepared and provided by S. Ring, R. Jones, M. Pembrey, W. McArdle, D. Strachan and P. Burton. Biotec Cluster M4, the Fidelity Biosciences Research Initiative, Research Foundation Flanders, Research Fund KU Leuven, the Belgian Charcot Foundation, Gemeinntzige Hertie Stiftung, University Zurich, the Danish MS Society, the Danish Council for Strategic Research, the Academy of Finland, the Sigrid Juselius Foundation, Helsinki University, the Italian MS Foundation, Fondazione Cariplo, the Italian Ministry of University and Research, the Torino Savings Bank Foundation, the Italian Ministry of Health, the Italian Institute of Experimental Neurology, the MS Association of Oslo, the Norwegian Research Council, the South–Eastern Norwegian Health Authorities, the Australian National Health and Medical Research Council, the Dutch MS Foundation and Kaiser Permanente. Marina Evangelou is thanked for motivating the investigation of the FASLG association.This is the author accepted manuscript. The final version is available at http://www.nature.com/ng/journal/v47/n7/full/ng.3330.html

Common and rare variant association analyses in amyotrophic lateral sclerosis identify 15 risk loci with distinct genetic architectures and neuron-specific biology

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with a lifetime risk of one in 350 people and an unmet need for disease-modifying therapies. We conducted a cross-ancestry genome-wide association study (GWAS) including 29,612 patients with ALS and 122,656 controls, which identified 15 risk loci. When combined with 8,953 individuals with whole-genome sequencing (6,538 patients, 2,415 controls) and a large cortex-derived expression quantitative trait locus (eQTL) dataset (MetaBrain), analyses revealed locus-specific genetic architectures in which we prioritized genes either through rare variants, short tandem repeats or regulatory effects. ALS-associated risk loci were shared with multiple traits within the neurodegenerative spectrum but with distinct enrichment patterns across brain regions and cell types. Of the environmental and lifestyle risk factors obtained from the literature, Mendelian randomization analyses indicated a causal role for high cholesterol levels. The combination of all ALS-associated signals reveals a role for perturbations in vesicle-mediated transport and autophagy and provides evidence for cell-autonomous disease initiation in glutamatergic neurons. A cross-ancestry genome-wide association meta-analysis of amyotrophic lateral sclerosis (ALS) including 29,612 patients with ALS and 122,656 controls identifies 15 risk loci with distinct genetic architectures and neuron-specific biology