Genome-wide Association Study Identifies SESTD1 as a Novel Risk Gene for Lithium Responsive Bipolar Disorder

Lithium is the mainstay prophylactic treatment for bipolar disorder (BD), but treatment response varies considerably across individuals. Patients who respond well to lithium treatment might represent a relatively homogeneous subtype of this genetically and phenotypically diverse disorder. Here, we performed genome-wide association studies (GWAS) to identify (i) specific genetic variations influencing lithium response and (ii) genetic variants associated with risk for lithium-responsive BD. Patients with BD and controls were recruited from Sweden and the United Kingdom. GWAS were performed on 2698 patients with subjectively defined (self-reported) lithium response and 1176 patients with objectively defined (clinically documented) lithium response. We next conducted GWAS comparing lithium responders with healthy controls (1639 subjective responders and 8899 controls; 323 objective responders and 6684 controls). Meta-analyses of Swedish and UK results revealed no significant associations with lithium response within the bipolar subjects. However, when comparing lithium-responsive patients with controls, two imputed markers attained genome-wide significant associations, among which one was validated in confirmatory genotyping (rs116323614, P=2.74 × 10-8). It is an intronic single-nucleotide polymorphism (SNP) on chromosome 2q31.2 in the gene SEC14 and spectrin domains 1 (SESTD1), which encodes a protein involved in regulation of phospholipids. Phospholipids have been strongly implicated as lithium treatment targets. Furthermore, we estimated the proportion of variance for lithium-responsive BD explained by common variants ('SNP heritability') as 0.25 and 0.29 using two definitions of lithium response. Our results revealed a genetic variant in SESTD1 associated with risk for lithium-responsive BD, suggesting that the understanding of BD etiology could be furthered by focusing on this subtype of BD.

A Service Model For Delivering Care Closer to Home.

Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient. This is a practical example of early implementation of the principles underlying the Department of Health’s (DH) recent Best Practice Guidance, ‘Delivering Care Closer to Home’ (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the ‘Customer Care’ award by ‘Management in Practice’. The Surgery was also awarded the ‘Practice of the Year’ award for this and a number of other customer-focussed projects.

'It's Almost Like Talking to a Person': Student Discolsure to Pedagogical Agents in Sensitive Setting

Online chatbots (also known as pedagogical agents or virtual assistants) are becoming embedded into the fabric of technology, both in educational and commercial settings. Yet understanding of these technologies is inchoate and often untheorised, influenced by individuals’ willingness to trust technologies, aesthetic appearance of the chatbot and technical literacy, among other factors. This paper draws upon data from two research studies that evaluated students’ experiences of using pedagogical agents in education using responsive evaluation. The findings suggest that emotional connections with pedagogical agents were intrinsic to the user’s sense of trust and therefore likely to affect levels of truthfulness and engagement. They also indicate that the topic of the pedagogical agent-student interaction is key to the student’s experience. The implications of these studies are that truthfulness, personalisation and emotional engagement are all vital components in using pedagogical agents to enhance online learning.

Beyond Robotic Wastelands of Time: Abandoned Pedagogical Agents and New Pedalled Pedagogies

Chatbots, known as pedagogical agents in educational settings, have a long history of use, beginning with Alan Turing’s work. Since then online chatbots have become embedded into the fabric of technology. Yet understandings of these technologies are inchoate and often untheorised. Integration of chatbots into educational settings over the past five years suggests an increase in interest in the ways in which chatbots might be adopted and adapted for teaching and learning. This article draws on historical literature and theories that to date have largely been ignored in order to (re)contextualise two studies that used responsive evaluation to examine the use of pedagogical agents in education. Findings suggest that emotional interactions with pedagogical agents are intrinsic to a user’s sense of trust, and that truthfulness, personalisation and emotional engagement are vital when using pedagogical agents to enhance online learning. Such findings need to be considered in the light of ways in which notions of learning are being redefined in the academy and the extent to which new literacies and new technologies are being pedalled as pedagogies in ways that undermine what higher education is, is for, and what learning means.