1. Sep 2026
    1. “How long have I been out this time? You're a lot taller than I remember. And whatever flowy thing is going on with your mane is not working for you.”

      Is it because of magic growth cream, or Interstellar Shine Shampoo?

    1. Identify and skeletonize the posterior belly of the digastric muscle. Do not dissect cephalad of the muscle as one may injure the facial nerve (Figure 16)

      Nguyên tắc ở bước này là chỉ bộc lộ thân cơ để làm "biển báo" dẫn đường, sau đó phẫu tích thật thận trọng ở góc giữa nó và mỏm trâm để tìm dây VII, tuyệt đối không xâm lấn lên vùng mô mềm phía trên cơ nếu chưa kiểm soát được dây thần kinh.

    2. Các nhánh thần kinh vùng giữa mặt có nhiều dây thần kinh chi phối chéo; tuy nhiên, các nhánh thần kinh trán và thần kinh hàm dưới không có dây thần kinh chi phối chéo và tổn thương các nhánh này sẽ dẫn đến liệt trán và các cơ hạ môi dưới ( Hình 4 ). Do đó, không giống như các dây thần kinh thái dương và thần kinh hàm dưới, một số nhánh thần kinh vùng giữa mặt có thể bị cắt bỏ mà không làm mất chức năng vùng mặt.

      Nhánh thái dương và nhánh bờ nền không có hoặc ít nhanh phụ, trong khi các nhanh khác thì có nhiều

    1. Case 3

      Case#: Case 3, Sex: Male, Age:21

      DiseaseAssertion: STGD

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: Text mentions BCVA of 20/200 in both eyes. Pigmentary changes in macula associated with flecks, small inferior juxta-papillar area of subretinal fibrosis in right eye, left eye legion localized in posterior pole macula temporally. Instable fixation in right eye. Low retinal mean sensitivity in both eyes.

      CaseNotHPOs:n/a

      CaseNotHPOFreeText: Healthy ocular adnexa and specular transparent and 'in situ' lens. Visual acuity stable. Stable fixation in left eye.

      Genotyping Method: genetic analysis

      PreviouslyPublished: n/a

      Variant: Variant is a heterozygous mutation given as NM_000350.3(ABCA4):c.3212C>T (p.Ser1071Leu) / NM_000350.3(ABCA4):c.667A>C (p.Lys223Gln) / NM_000350.3(ABCA4):c.3607G>A (p.Gly1203Arg)

      ClinVar: Variation ID: 99208 / Variation ID: 845426/ Variation ID: 417989

      SupplementalData: n/a

    1. Case 3: RP3.03

      Case#: RP3.03, 23yo, 21yo on set, Moroccan

      DiseaseAssertion: Retinitis Pigmentosa (RP19)

      FamilyInfo: Born into a consanguineous family, parents are unaffected, has five unaffected siblings

      CasePresentingHPOs: HP:0000505, HP:0007675, HP:0001133, HP:0007994, HP:0007843, HP:0000510, HP:0000580, HP:0007703

      CaseHPOFreeText: Abnormal epiretinal membrane formation, Altered ERG traces, rod and cone photoreceptor dysfunctions, hyper fuorescence ring surrounding macula and peripheral retina, absence of cystic spaces

      CaseNotHPOs: HP:0000551

      CaseNotHPOFreeText: Central vision loss

      Genotyping Method: Genomic DNA was extracted using QIAamp DND Blood Mini Kit, DNA underwent WES by BGI Tech Solutions, DNA was captured by MGIEasy Exome Capture V4 Probe Set, then Alligned using the Burrows-Wheeler Aligner and HaplotypeCaller of GAWK

      PreviouslyPublished: CRB1, PDE6B

      Variant: c.5908C>T, c.6148G>C

      ClinVar: 7892, 7884

      SupplementalData: Clinical data (table 1, figure 5), Genetic analysis (table 2), Patient Pedigree (figure 1.)

    1. ABCA4ARc.[1957C > T];[4605insT]WESHuang et al., 2013cHuang et al., 2013c, Rivera et al., 2000

      Case#: QT959, Chinese

      DiseaseAssertion: Cone-rod dystrophy

      FamilyInfo: no pedigree provided for this family in this paper

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: 23776498-more phenotype information available there

      Variant: c.[1957C > T];[4605insT] on WES

      ClinVar: n/a

      CAID: CA645372205

      SupplementalData: n/a

    1. The proband

      Case#: 34 y.o female proband, caucasian(German), diagnosed with Stargardt, late onset.

      DiseaseAssertion: STGD

      FamilyInfo: Unaffected father, mother exhibiting retinal disease. Biparental history of glaucoma and AMD, pattern dystrophy on maternal side.

      CasePresentingHPOs:HP:0001129, HP:0007722 ,HP:0007663, HP:0030329, HP:0007814, HP:0000608

      CaseHPOFreeText: Proband exhibits retinal thinning in all retinal layers, alongside chorioretinal atrophy. Experienced increased central vision loss over the course of a decade. At time of study, diagnosed with Stargardt disease. Visual acuity 20/200 in right eye and 20/40 in left. Additionally found granular molting of retinal pigment epithilium.

      CaseNotHPOs:n/a

      CaseNotHPOFreeText:n/a

      Genotyping Method: WES and variant calling performed at Columbia Institute for Genomic Medicine.

      PreviouslyPublished:n/a

      Variant: rs61751407, c.5714+5G>A

      ClinVar: 432057

      CAID: n/a

      SupplementalData: n/a

    1. We found statistically significant association for six variations (c.1268A>G, c.4203C>A, c.5603A>T, c.5682G>C, c.5843C>T, c.6249C>T) (FDR < 0.05, Supplementary Table S4)

      This paper is listed under the ClinVar citations for this variant, but only as a paper that references other variants in the initiator codon that have been observed in individuals with ABCA4-related conditions. The actual initiator variant included in this paper is c.1A>G

    1. Postmortem Retinal Structural and Metabolic Analysis After Human Embryonic Stem Cell–derived Retinal Pigment Epithelium Transplantation in a Patient With Stargardt Disease

      PCMID:*PMC12657203

      PMID41323838

      Gene: ABCA4

      HGNC ID: 34

      Case#:80 year old man,

      DiseaseAssertion:NA

      FamilyInfo:NA

      CasePresentingHPOs:NA

      CaseHPOFreeText:Diagnosed w/ targardt disease at the age of 18 years, medical retierment at 64 as result

      CaseNotHPOs:*parkinsons at 80

      CaseNotHPOFreeText:NA

      Genotyping Method:NA

      PreviouslyPublished:NA

      Variant:after gentic testing (unspecified) a pathogenic heterozygous mutation (G1961E) in ABCA4 gene a substiution, GAA) at amino acid position 1961, or c.5882 G>A at the complementary DNA level, or pGly1961Glu or G1961E at the protein level. No second mutation was identified. One of his 2 sisters had the same mutation.

      ClinVar:NA

      CAID:NA

      SupplementalData:this goes into how eye retina transplant results and outcomes.

    1. a 12-year-old female

      Case#: a 12-year-old female admitted to the B Department Hédi Raies institut of Ophtalmology in Tunis, Tunisia

      DiseaseAssertion: Cone rod dystrophy

      FamilyInfo: No parental consanguinity nor pathological or opthalmological history in the family

      CasePresentingHPOs: HP:0000529, HP:0000662, HP:0001141, HP:0000543,HP:0007737, HP:0030602

      CaseHPOFreeText: progressive visual loss, poor night vision, 1/20 visual acuity in both eyes, pallor of the optic disk, attenuated retinal vessels, paravascular bone spiculed pigmentations and an epimacular membrane, paravascular and macular heterogeneous hypoautofluorescence, diffuse alteration of ellipsoid zone, decreased photopic and scotopic responses.

      CaseNotHPOs: NR

      CaseNotHPOFreeText: NR

      Genotyping Method: Whole exome sequencing, Sanger sequencing

      PreviouslyPublished: NR

      Variant: c.885delC, NM_000350.3

      ClinVar: 438109

      CAID: CA958684

      SupplementalData: Karyotyping showed monosomy 45,X in the patient

    1. The landscape of genetic diseases in Saudi Arabia based on the first 1000 diagnostic panels and exomes

      PMID: 28600779

      Gene: ABCA4

      HGNCID: HGNC:34

      MonDO:

      Case: 16N-0520, Male, Saudi Arabia, 1 yo

      DiseaseAssertion:

      FamilyInfo: Consanguineous parents, positive family history

      CasePresentingHPOs: HP:0000618, HP:0000648 (Blindness, Optic atrophy)

      CaseHPOFreeText: Coloboma of eye

      GenotypingMethod: WES, analysis of Vision Panel, constituent genes are described in PMID 26112015.

      SupplementalData: Supplemental table

      Variant: ABCA4:NM_000350:exon49:c.6764G>T:p.S2255I

      CAID: CA202970

      gnomAD: 0.4845 (gnomAD v4.0.0, Grpmax Filtered AF African/African-American) https://gnomad.broadinstitute.org/variant/1-93996161-C-A?dataset=gnomad_r4

      VariantEvidence: Authors classified as VOUS. But later downgraded to LB in PMID 31130284.

    1. The study cohort consisted of 643 individuals of (mostly Eastern) European descent. Of these, 2 ABCA4 mutations were identified in 437 cases (68%), 1 mutation in 117 cases (18%) and 0 mutations in 89 cases (14%) (see online supplementary table 1), leaving ~23% of disease-associated alleles in 32% of patients yet to be identified. Almost all patients with no ABCA4 mutations and ~50% of patients with 1 mutation have been screened by whole exome sequencing to determine if variants in other genes were causal in these cases. All cases, where disease-associated variants in other genes were detected, were excluded from this cohort.

      Case#: Case #3483, likely European, 10yo at onset

      DiseaseAssertion: ABCA4 disease

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText: foveal sparing

      GenotypingMethod: NGS, Sanger

      PreviouslyPublished: n/a

      Variant: c.2453G>A (p.Gly818Glu); c.4462T>C (p.Cys1488Arg)

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: supplemental table 1

    1. STGD47/164 IVS13+1G→A 2588G→C Yes

      Case#: STGD47/164, 10-14yo at onset, German

      DiseaseAssertion: STGD

      FamilyInfo: segregation in family

      CasePresentingHPOs:

      CaseHPOFreeText: "The diagnosis of STGD was based on the demonstration of bilateral impairment of central vision and the appearance of perimacular and/or peripheral yellow-white flecks, with or without atrophy of the central retinal-pigment epithelium and a normal or only mildly abnormal flash electroretinogram when recorded in early stages of the disease."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: denaturing gradient gel electrophoresis, dHPLC, and SSCP analysis, PCR amplification of individual coding exons and flanking intron sequences, direct DNA sequencing

      PreviouslyPublished: n/a

      Variant: IVS13+1G→A; 2588G→C in trans "Correct segregation of disease alleles was demonstrated in all 39 cases in which family samples were available for study"

      ClinVar: 7879

      CAID: CA119128

      SupplementalData: n/a

    1. A total of 88 eyes of 44 patients (32 female [73%]) with a mean age at examination of 37.6 ± 2.5 years (±SEM; range, 9–77 years) were included in this study (Table 1, Supplementary Table S1). Forty-one patients were found to have two disease-causing mutations. Three patients had only one disease-causing mutation but showed a phenotype consistent with ABCA4-related retinopathy.

      Case#: Patients #33 and 34, female, 63 and 61yo at report, respectively, German

      DiseaseAssertion: ABCA4-related retinopathy

      FamilyInfo: n/a but they could be related

      CasePresentingHPOs:

      CaseHPOFreeText: "Inclusion criteria comprised the presence of at least one disease-causing mutation in ABCA4 and a phenotype consistent with ABCA4-related retinopathy, including RPE atrophy and flecks." BCVA [LogMAR] for patient #33: OD= 0.4, OS= 0.1. BCVA [LogMAR] for patient #34: OD= 1.5, OS= 1.0. Reduced (over 2 SD) photopic B-wave and 30-Hz flicker amplitudes

      CaseNotHPOs:

      CaseNotHPOFreeText: Insufficient pupil dilation, additional retinal pathology, previous vitreoretinal surgery, or other ocular comorbidities substantially affecting visual function (e.g., significant media opacity, amblyopia, or optic nerve disease) led to exclusion. Abnormal responses on scotopic and photopic full-field ERG

      GenotypingMethod:

      PreviouslyPublished: likely the same patients as other Muller papers in this curation

      Variant: c.3468C>G p.(Tyr1156*) and c.5059A>T p.(Ile1687Phe)

      ClinVar: n/a

      CAID: CA341290648

      SupplementalData: Table S1 has genotype/phenotype info for probands

    1. 1545c.6221G>Tp.G2074V (D; N)16c.2453G>Ap.G818E (D)Compound heterozygous

      Case#: Sporadic Case #15, Mexican

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosis based on: "onset of symptoms in childhood or early adulthood (before 20 years of age), bilateral central vision loss (central and peripheral visual field computerized testing), a retinal “beaten-bronze” foveal appearance and/or yellow-whitish flecks from the posterior pole to the mid periphery, normal caliber of the retinal vessels, no pigmented bone spicules in the retinal periphery, a normal to subnormal electroretinogram, and a typical dark choroid in fluorescein angiography."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: allele 1: c.6221G>T (p.G2074V) allele 2: c.2453G>A (p. G818E); direct sequencing of exons of ABCA4

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: n/a

    1. STGD in 48 patients (55%) was explained by recessive ABCA4 mutations (supplemental table S2). Only 22 patients could be solved using previously known STGD causing mutations. However, we identified 35 novel mutations in ABCA4 contributing to the diagnosis of 25 STGD patients. This contained 10 novel mutations leading to amino acid substitutions already known to cause disease and mutations known to cause diseases other than STGD. In addition, we identified 13 novel nonsense mutations. The remaining 12 novel mutations are well justified, and novel mutations were either completely absent or extremely rare in controls.

      Case#: Patient #9, Canadian

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs: "Clinical diagnosis of STGD was made when the patient, usually a child, developed central visual acuity loss with an atrophic maculopathy with or without flecks." No individual details

      CaseHPOFreeText: n/a

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      PreviouslyPublished: n/a

      Variant: c.6383 A>G p.(H2128R); c.785 G>A p.(G1961E)

      ClinVar: 99455

      CAID: CA227399

      SupplementalData: info found in table S2

    1. Figure 3: Protein yield and ATP-binding capacity of 37 naturally occurring ABCR variants produced in transiently transfected 293 cells.Membranes were analysed by immunoblotting with affinity-purified anti-ABCR antibodies (top) and photoaffinity labelling with α-32P azido-ATP (bottom). We loaded 1 μg (immunoblotting) or 2.5 μg (azido-ATP labelling) of total membrane protein, as determined by Bradford assay, per track. The mutations that reside in NBD-1 and NBD-2 are indicated above the corresponding lanes. The relative levels of the different variant proteins and the extent of azido-ATP labelling were observed to be highly reproducible in multiple independent experiments. ABCR (large arrowhead); an endogenous 55-kD protein (small arrowhead) serves as an internal control for azido-ATP labelling. Molecular mass standards are shown on the left in kD.

      This variant was transfected into HEK 293 cells and appears to show reduced expression and ATP-binding capacity, but no quantities were provided

    1. multiplication

      Composition in python

      ``` from sympy import symbols

      x, y = symbols('x y')

      def f(w): u, v = w return [5u + 6v, 7u + 8v]

      def g(w): x, y = w return [x + 2y, 3x + 4*y]

      f(g([x, y])) ```

    1. Egyptian kingship under the pharaohs wasbased on divine right. The future pharaoh wasconsidered a child of the sun god Ra and, uponcoronation, was deified as the god Horus. On hisdeath, the pharaoh became the god Osiris, thegod of the dead, who had it in his power to grantimmortality to his subjects. As a god, the rulerhad absolute power

      Ra-> Horus->Osiris

    Annotators

    1. "It is no use appealing to advances in agricultural science-'green revolutions' and the like. Increases in food production may temporarily alleviate the problem, but it is mathematically certain that they cannot be a long-term solution; indeed, like the medical advances that have precipitated the crisis, they may well make the problem worse by speeding up the rate of the population expansion." (Page 111)

      Our world is unable to withstand continued population growth & continued agricultural expansion. We will simply run out of resources, and it will lead to deaths on a mass scale. It makes sense that in many places the birth rate is falling.

      Given the world we live in and how aware many of us are that we are running out of resources, it is no doubt that many people are deciding not to have kids. As well it is a fact of life that the birth rate tends to fall in first world countries, as the child mortality rate lowers, the number of children people tend to have lowers. This combined with economic and social factors around having children, education for women, people getting married later in life, etc. It is no surprise that in many places the birth rates are falling.

      Global population growth is declining, it peaked in 1963 at ~2.2% according to the UN.

    2. "Depending on the ecological details of the species, various mixes of caring and bearing strategies can be evolutionarily stable. The one thing that cannot be evolutionarily stable is a pure caring strategy. If all individuals devoted themselves to caring for existing children to such an extent that they never brought any new ones into the world, the population would quickly become invaded by mutant individuals who specialized in bearing. Caring can only be evolutionarily stable as part of a mixed strategy-at least some bearing has to go on" (Pg 109) (I can't figure out how to do a highlight box on my laptop)

      It is interesting to consider the variety of strategies that different species have when it comes to birthing and raising young. This brings to mind when I learned about K species and r species, where K species have very few young but are very focused and grounded in the raising process of the young, so more of them are able to reach maturity, whereas the r species have a lot of young but less energy is put into raising and caring for them, so they have a higher mortality rate and fewer of them reach maturity. These are specialized strategies so that still a specific amount of the young of each type is able to reach reproduction age in order to continue the survival of the species.

    3. I think a lot of the takeaway I got from this chapter was in regards to individualism. I think now more than ever society is individualized, and this optimization of families birth rates rather than a restriction for the public good is a part of that. Instead of viewing birth with its effect on global population, it is viewed as an effect on the family. This has been a very interesting thing to think about while reading, and I'm curious if there are any newer anthropological studies on the same ideas?

    4. I think this is a good point, as of right now, almost everything we do is unnatural. We burn plastic down to wear as clothing, and have figured out ways to cure diseases and ailments with modified genes and viruses. The strength of the human population lies in these "unnatural" scientific advancements, and I think the author is correct to say that without it "...the end result will be misery."

    1. A few naturalists, endowed with much flexibility of mind, and who have already begun to doubt on the immutability of species, may be influenced by this volume; but I look with confidence to the future, to young and rising naturalists, who will be able to view both sides of the question with impartiality. Whoever is led to believe that species are mutable will do good service by conscientiously expressing his conviction; for only thus can the load of prejudice by which this subject is overwhelmed be removed.

      A very nice call to action here, he's simultaneously defending himself by anticipating the inevitable backlash while addressing those who may have taken his ideas to heart. Perhaps this is an example of a major social evolution, something that might become archeologically invisible far into the future but observable as of right now. He really believed in his ideas! It really exemplifies how revolutionary this book was, it really was the first of its kind.

    2. I believe that animals have descended from at most only four or five progenitors, and plants from an equal or lesser number. Analogy would lead me one step further, namely, to the belief that all animals and plants have descended from some one prototype.

      Really really interesting note here becuase Darwin brushes really close up against the idea of LUCA (last universal common ancestor). Darwin himself was never entirely clear on how old he thought the earth was. only that it was VERY old, so its really incredible that he was able to identify the possibility of a 4.3 billion year old living organism when at the time, people had only imagined as far back as 6000 years.

    3. Disuse, aided sometimes by natural selection, will often tend to reduce an organ, when it has become useless by changed habits or under changed conditions of life; and we can clearly understand on this view the meaning of rudimentary organs.

      Touches here on vestigial organs and how features that may be present on one organism may become obsolete on others. Environment and behaviour are driving forces behind evolution but there is little mentioning about the role that chance plays in evolution as well. Chance is also a driving force, random with respect to the environment. Genetic drifts like bottlenecks and founders aren't mentioned/thought of?

    4. It is inexplicable on the theory of creation why a part developed in a very unusual manner in any one species of a genus, and therefore, as we may naturally infer, of great importance to the species, should be eminently liable to variation; but, on my view, this part has undergone, since the several species branched off from a common progenitor, an unusual amount of variability and modification, and therefore we might expect this part generally to be still variable.

      Darwin directly contends with the idea that one God created all living things by pointing out the fact that the unique features of a species seem to not exist for an intended purpose. If all living things are a product of intelligent design, why are we all so highly variable and unique for seemingly no apparently reason? Highly variable traits are highly variable becuase evolution has no "selector".

    5. Dominant species belonging to the larger groups tend to give birth to new and dominant forms; so that each large group tends to become still larger, and at the same time more divergent in character. But as all groups cannot thus succeed in increasing in size, for the world would not hold them, the more dominant groups beat the less dominant.

      I think it's a really neat observation Darwin is making here about speciation as well as the beginnings of understanding interactions between organisms by what ecological niche's they fill. Additionally there is attention paid to the balance that is demanded by nature: if two dominant species occupy the same niche, one will eventually outcompete the other. Side note, I also really like the poetic language he uses here. "- for the world cannot hold them," so beautiful!

    6. We can clearly see why those animals which cannot cross wide spaces of ocean, as frogs and terrestrial mammals, should not inhabit oceanic islands; and why, on the other hand, new and peculiar species of bats, which can traverse the ocean, should so often be found on islands far distant from any continent.

      There are definitely some species found on islands that wouldn't be capable of crossing oceans. If they were there when for example a piece of land broke into 2 for example.

    7. In both varieties and species, use and disuse seem to have produced some effect; for it is difficult to resist this conclusion when we look, for instance, at the logger-headed duck, which has wings incapable of flight, in nearly the same condition as in the domestic duck; or when we look at the burrowing tucutucu, which is occasionally blind, and then at certain moles, which are habitually blind and have their eyes covered with skin; or when we look at the blind animals inhabiting the dark caves of America and Europe.

      If all species were created as they are, why would there be some traits that don't have a purpose? Wouldn't all species be created perfectly for their existence & survival?

    8. But on the view of each species constantly trying to increase in number, with natural selection always ready to adapt the slowly varying descendants of each to any unoccupied or ill-occupied place in nature, these facts cease to be strange, or perhaps might even have been anticipated.

      Species find their niches with the least competition / best ability to survive. Behavioural adaptations to find an ecological niche.

    9. there will be a constant tendency in natural selection to preserve the most divergent offspring of any one species. Hence during a long-continued course of modification, the slight differences, characteristic of varieties of the same species, tend to be augmented into the greater differences characteristic of species of the same genus

      the concept of 'divergent evolution', wherein individuals that lie on the far ends of the spectrum of varieties are more advantageous than those that lie somewhere in the middle. (Grizzly bear & polar bear) -> distinct differences that provide different advantages for the environments.

    10. This seems to be mainly due to the reproductive system being eminently susceptible to changes in the conditions of life; so that this system, when not rendered impotent, fails to reproduce offspring exactly like the parent-form. Variability is governed by many complex laws,—by correlation of growth, by use and disuse, and by the direct action of the physical conditions of life.

      Sort of referring to genetic mutation and recombination without an actual understanding of genetics and the fact that mutations exist??? I think that's pretty cool. Seemingly being aware that these changes occur regardless, and for many complex reasons.

      But further down in the paragraph, essentially saying as long as the mutation remains advantageous for the environment & conditions of life, the variation will continue to occur (because the individuals with the variation are more able to pass on the trait). His lack of understanding of genetics shows a bit here though, because as he says, "by use and disuse" - this aligns with the ideas of the 'Inheritance of Acquired Characteristics' theory by Lamarck, which we now know to be false.

    11. Numerous existing doubtful forms could be named which are probably varieties; but who will pretend that in future ages so many fossil links will be discovered, that naturalists will be able to decide, on the common view, whether or not these doubtful forms are varieties?

      i.e. when Darwin held the Neanderthal skull, just thinking it was a anatomically modern human skull.

    12. A broken or interrupted range may often be accounted for by the extinction of the species in the intermediate regions.

      Some environments are more suitable for certain species than others, therefore able to survive in some areas and not others, even in regions close to one another.

      Could this also be explained by the founder effect or bottleneck effect (genetic drift)? Maybe certain regions have more predators or competition for resources than others.

    1. But we can break this cycle of failure if instead ofblaming teachers we make sure they are properly trained

      He concludes by moving from personal thoughts to calling for wider change. Real progress happens when we improve teacher training and reading help, rather than just blaming the system.

    2. Adults who can't read are suspended in their childhoods,emotionally, psychologically, academically, spiritually. We haven't grown up yet.

      Corcoran argues that learning to read is essential for personal independence. When adults cannot read, they must constantly rely on others, which traps them in a vulnerable, helpless state similar to childhood.

    3. was 47 going on 48 when I saw Barbara Bush - then Second Lady of the US - talkingabout adult literacy on TV. It was her special cause. I'd never heard anybody talkingabout adult literacy before, I thought I was the only person in the world that was in thesituation I was in.

      Seeing people like himself on TV changed his mindset. It broke his isolation and shame, helping him realize his condition wasn't a personal failure. Instead, he saw it as a common challenge he could actively fix.

    4. My wife heard me trying to read from a child's book and that was the first time that itdawned on her. I had been asking her to do all this writing for me, helping me writethings for school, and then she finally realized, how deep and severe this was.

      For years he believed that his wife didn't know he was unable to read, which shows how a fixed mindset can isolated someone even from the people closest to you.

    5. I didn't belong in the classroom, Iwas trespassing. I wasn't supposed to be there and sometimes what I was doing mademe physically sick, but I was trapped

      The mental tool of the lie is seen here, the feeling of being an impostor and not deserving your own life.

    6. I remember how fearful I was. I couldn't even take the roll - I had to ask the students topronounce their names so I could hear their names.

      It took a lot of exhausting work to keep the cover on.

    7. So I graduated from college, and when I graduated there was a teacher shortage and Iwas offered a job. It was the most illogical thing you can imagine - I got out of the lion'scage and then I got back in to taunt the lion again.

      Choosing to become an educator introduced a contrast to his journey, as the position of authority offered the perfect cover for his secret.

    8. Why didn't I ask for help? Because I didn't believe there was anybody out there whocould teach me to read. This was my secret and I guarded that secret.

      This quote shows the severe damage a fixed mindset can have on someone, Corcoran viewed his struggles with literacy as a permanent flaw, which caused him to hide it even more as it made him afraid of public humiliation.

    9. But when I went off to college on a full athletic scholarship it was adifferent story.I thought, "Oh my gosh, this is way over my head, how am I going to be able to getthrough this?"

      The transition from highschool to college was terrifying for him as he felt it was going to be way harder to hide his secret, meaning he would have to better his cheating abilities.

    10. I wanted to besomebody else, I had a desire to succeed, I wanted to be a good student, but I justcouldn't do it.

      This highlights the painful experiences he went through as he wanted to participate in school activities but his struggles with literacy prevented him from achieving his goals.

    11. It was a hostile environment and I had to find a way to survive

      School had stopped being a place of learning and growth but it turned into a hostile environment where he needed to learn to survive.

    12. when you're in that dumb row you start thinking you'redumb.

      By being placed on the "dumb row" it only made the fixed mindset stronger, it made Corcoran internalized the label as part of his core identity.

    Annotators

    1. I got several reels with a special discount. Nylon 1005 yards was €60 each, Cotton red/black was 360 yard was €125. I got several reels. They gave me a big discount. I purchase often from them. They paid tariffs with the shipping.

      https://www.facebook.com/sameeranff/posts/pfbid0pvUFwLmTAA6tcmDHDCNVW88E3RYaar1bxHDcUJZCifKJfia2ubUXbbcaELBskULwl

      Sameera Sandaruwan Abeyrathna has had ribbon shipped from Europe before.

    1. R0:

      Reviewer #1: I found the study interesting and potentially publishable. The manuscript captures an important aspect of contemporary outbreak communication: new infectious-disease emergencies are being interpreted through pre-existing political, cultural, and institutional frames, particularly those developed during COVID-19. The authors' observation that Ebola discussion repeatedly invokes COVID-19, vaccination, institutional mistrust, international aid, preparedness, and geopolitical concerns is worthy of further development.

      My recommendation is major revision rather than rejection. In particular, I encourage the authors to:

      (1) temper claims concerning representativeness and public perception. Your sampling strategy does not lend itself to broad generalizability.

      (2) describe and validate the transition from LDA topics to qualitative themes. The context in which comments appear is important. I recommend providing, preferably in the main manuscript, descriptive information for each selected video: publication date, channel/uploader type, language, number of views, number of comments retrieved, and other relevant characteristics. This would allow readers to understand the informational environments from which the comments arose.

      (3) justify the 20-topic model. The manuscript provides detailed LDA parameters but does not explain the choice of k=20. Was this determined a priori, through topic-coherence measures, inspection of alternative models, or another procedure?

      (4) validate or substantially qualify the NRC sentiment analysis, especially the interpretation of “trust”.

      (5) provide video-level analyses to determine whether the major findings are broadly distributed or driven by particular videos.

      Addressing these issues would considerably strengthen what is already a timely and potentially useful contribution to the literature on outbreak communication, misinformation, and digital public-health discourse.

      Reviewer #2: Main comments Thank you for the opportunity to review this interesting paper which analyses public discourse and sentiment expressed in YouTube comments related to the 2026 outbreak of Bundibugyo virus in the DRC and Uganda. Data from social media platforms are now recognized as important sources for monitoring public discourse. As this outbreak continues to unfold, this analysis can offer potentially helpful guidance for health communication and community engagement. Reports of local hostility towards public health officials suggest the need for fuller understanding of public sentiment.

      While this is a clearly written paper, in my view, there are several ways that the authors could strengthen this paper to ensure a significant and original contribution to knowledge. First, the introduction could provide a fuller rationale for the study. The authors argue that there has been limited analysis of public reactions to this outbreak to date and that “effective risk communication” can benefit from this study. It would be helpful to provide more context on public reaction to the outbreak locally and internationally, and how this has impacted the response to date. The attacks on public health workers and clinics, and the international travel restrictions imposed, for instance, could be mentioned. A fuller explanation of how analysis of YouTube comments would be relevant to what is happening on the ground is then needed. Why do the comments on YouTube matter?

      Second, to reach meaningful results and draw conclusions from this data, the authors need to reflect more fully on the likely sources of the comments on YouTube. Who is the “public” making these comments? Currently, there is no information provided on who is actually making these comments other than they are on YouTube. Social media data is notoriously difficult to disaggregate but, without more knowledge of the sample, the observations reached are weakened. The authors note at the end of the paper that the “comments may not represent the full spectrum of public opinion.” Indeed, they will most definitely not be. Those who comment in social media tend to be from certain population groups. As a result, using social media alone skews towards those perspectives. The demographics of who comments on specific social media platforms is a research topic in itself. For example, X tends to skew right of centre politically. While half of all internet users watch YouTube, only a fraction actively comment. Studies indicate that a staggering 72.6% of YouTube videos have zero comments, meaning active participation is concentrated on a small portion of the platform. There is also evidence that, globally, those who comment tend to be younger and male aged 25 to 34. Thus, the authors need to say more about why YouTube was chosen (over other platforms), what profile might be assumed about those who comment on YouTube, and, importantly, how this then impacts data collection and analysis. Understanding who is commenting ultimately tells us how much we need to pay attention in public health. If the sentiments expressed are largely outside of the affected countries, for instance, what does this mean for the public health response? If they are local voices, what can we take away from these comments?

      Third, while the authors clearly describe their methods for collecting this data, more could be said about how the themes were derived to analyse the data. Some of the categories seem to oddly pair different topics such as geopolitics and cultural context. These seem very different things. Cultural context might be better paired with religious and spiritual interpretation perhaps. I also questioned why some comments were put into specific themes. In the geopolitics and cultural context, for example, border and flight restrictions were included, and yet this might arguably be more relevant to disease spread and transmission, or public health measures and preparedness (where they are also mentioned). The theme of public figures, conspiracy theories and misinformation seems an odd mix. Does this suggest discussion of named public figures is necessarily related to misinformation? An explanation in the methods of why these categories and the scope of what is included (and why) is needed. How these themes were validated is also important.

      Finally, much of what is currently in the Discussion could be relocated to the Results. This would strengthen the presentation of the results which reads a bit thinly and unsystematic. The Discussion should focus on the “so what” from the results. What meaning can we derive from the Results for understanding public discourse and sentiment, and for public health practice?

      Minor comments • I suggest swapping the sequencing of themes presented to start with the themes with the most to least comments (i.e., swap public figures etc. and geopolitical and cultural context).

    1. Use Chrome. You should be able to access and start using the application once you load the link at the bottom. If not, register for a Hypothes.is account with your SRJC email address. It's free:

      This is not a proper intro as there's no hook no thing to get the reader invested and while it does technically work as a way of communicating the exact information that you need it doesn't help actually getting someone into it even the blandest research article typically has some lighter concept up front in order to ease the reader into it

    2. Use Chrome. You should be able to access and start using the application once you load the link at the bottom. If not, register for a Hypothes.is account with your SRJC email address. It's free: https://hypothes.is/ Click on the below link.  Highlight some text and you'll get two options: the quotation symbol on the left that states "annotation"  is best for this assignment because it highlights what you have selected and opens a window for you to type something in. This is an annotation. The other option merely highlights, and this is not too helpful in the context of this assignment. Here are some basic tutorials on how to use hypothes.is.Links to an external site. You can reply to each other's questions. Or, if a classmate has already selected the passage you want to write about, you can either respond by opening their annotation and clicking “reply,” or annotate it yourself by re-selecting the same text. You can also select text within or that includes another highlight or annotation. To add images, click on the image icon in the toolbar. Your image will need to have a URL. Make sure that your setting at the top says "Public." When you post, make sure you have the "Post to Public" box selected. Don't worry, these aren't really public except for the few of us who are allowed into this Canvas page. Feel encouraged to keep using it beyond the minimum if you find it useful. Lastly, as with all digital writing, be sure to double-check, and proofread, your “published” explanations and suggestions to make sure links work and images and videos are properly embedded. You can edit your annotations if needed by clicking on the image of the little pen.

      Numbering each individual section of an article is a telltale sign of AI as it doing that to summarize however most humans don't actually do that when writing down their Article and only do that if there's A group of objects we're numbering them in order is important

    1. Like Spain, other European countries sought new trade routes and, failing that, coveted the new land as a source of commodities such as precious metals, fur, timber, and agricultural products and as an extension of their empires.

      So Christopher Columbus wasn't the only one who taught new trades and gather goods, but other countries were apart of this as well.

    1. Исскуственный - интелект это полноценная система, которая обладает интелектом на уровне человека.

      машинное обучение - это использование формул, формул проверки результата и эталонного решения.

    2. Прикольно что под каждую ситуацию создаёю формулу, а потом обучают её предсказывать.

      как я понимаю формула создаётся на основе дата сета. хотя в таком случае и не нужно обучать. формула и так же предсказывает

    3. Есть множество функции потерь, которые используется для балансировки весов в исскуственном интелекте

    1. They mourned (with their black faces) for their own losses, yet triumphed and rejoiced in their inhumane, and many times devilish cruelty to the English

      See, you say this, but the English army did the exact same thing. So why are we making the natives out to be the bad guys?

    2. I would take leave to mention a few remarkable passages of providence, which I took special notice of in my afflicted time.

      This sounds a lot more coherent than the rest of the removes and excerpts.

    1. R0:

      Reviewer #1:

      In general it didnt follow the guideline and the format of the journal.For example the abstract section. In addition, the abstract is not clear and it is shallow. The introduction is good but the contents are not fully presented. E.g. Where is the magnitude in detail,,is cervical cancer a fourth most common cuase of cancer among women? Where is the size distribution and associated factors and where is the exact gap and on how to fill the gap .The compherensive HIV services are not described, the services and how was this services delivered and what is wrong regarding cervical cancer screening? This was lacking in the introduction section.

      The methods section lacks study design, sampling procedure, the study tools .Pilot study was done in the same study area that ease information contamination. The type of interview, when and how the interview was conducted conducted cking. For instance, didi you interview them at entry or at exit of the services. How long was the interview took and where was the setting Why the interview was conducted by both Hausa and English language How was trustworthiness ensured particularly the type of analysis and use of software is again missed.

      The results section is written in wrong manner. The sociodemograohic characteristics are incomplete Try to consult on how to write good result of the qualitative study. Some of the tabular presentation can be narrated easily. It is disorganized and the quotations are very few and not detail and too short. The discussion focused more on SEM than the HBM. It lacks drawing theoreticalamd practical as well as clinical amd public health implications. Don't write uninterpreted results [quotations] in this section. The explanations, justification and arguments are shallow. I.e. despite free screening services they study participants described financial barriers? Amd what does this means? It is good to mention the strength and the limitations but why you ignored the age of the study participants among wh most of them were inm thier 40's?

      Reviewer #2:

      Greetings,

      Thank you for this opportuniity. It's a good article.

      The abstract provides essential information about the study and adequately reflects its overall content. However, as a scientific article abstract, it should present the key elements more explicitly and in a clearer structure, namely: a brief introduction to the topic, the study objective, methods, main results, and conclusion.

      At present, these components are included but are not sufficiently distinguished, which reduces the clarity and readability of the abstract. I recommend that the authors revise and restructure the abstract to follow a more conventional scientific format, ensuring that the background, objective, methodology, principal findings, and conclusions are presented in a concise, objective, and clearly identifiable manner. The Methods section is generally well described and provides sufficient information to understand how the study was conducted. However, there is considerable repetition of the same ideas and descriptions throughout the section. Several methodological aspects, including participant eligibility, recruitment procedures, and analytical approaches, are presented more than once using similar wording.

      I recommend that the authors revise this section to improve conciseness and readability. The Methods would benefit from a simpler and more streamlined narrative style, avoiding unnecessary repetition while retaining all essential methodological information. Reducing redundancy would make the section easier to follow and improve the overall quality of the manuscript.

      In addition, the reimbursement provided to participants for interview participation and other costs should be reported in a more internationally interpretable format. I suggest presenting the amount in purchasing power parity (PPP) terms or in US dollars (USD), while retaining the original amount in Nigerian Naira (₦) in parentheses, or vice versa. This would allow international readers to better understand the magnitude of the compensation provided to participants. The descriptive results are informative and appropriate for the study design. However, the presentation of findings could be strengthened through the use of additional visual displays. Some of the large tables contain substantial information and may be difficult for readers to interpret quickly.

      The authors may consider presenting selected findings using figures or graphs (e.g., frequencies of major barriers, perceived benefits, cues to action, or SEM domains). Visual summaries could facilitate interpretation and highlight the relative importance of the identified themes. Such figures would complement the qualitative narrative and improve the accessibility of the results section. The conclusion is clear, concise, and well aligned with the study findings. It appropriately summarizes the main barriers identified and highlights practical implications for cervical cancer screening programs among women living with HIV. No major revisions are required.

      Minor revision. Congratulations.

      Reviewer #3:

      1) The repeated decline is introduced quite late (lines 93–97) and could be foregrounded earlier. Please consider introduce the "repeated decline" framing earlier in the Introduction, ideally in the second paragraph, to clearly distinguish this study from one-time barrier assessments.

      2) Verify Reference 29 citation date; if this is an error, correct it.

      3) No field notes were maintained (line 170). This is a significant methodological limitation in qualitative research. Field notes provide contextual detail (non-verbal cues, environmental factors, emotional tenor) that enriches interpretation. The authors acknowledge this in the Limitations, but its absence should be flagged more prominently in the Methods as it affects dependability. Please, in the Methods, add a more prominent statement about the absence of field notes and its implications for contextual richness. Consider adding this to a "Limitations of the data collection approach" subheading.

      4) Please clarify the sampling process: how many WLHIV were initially identified from the screening register, how many were approached, and what proportion of those approached agreed to eligibility assessment? This establishes response rates.

      5) Justify the upper age bound (65 years) or note it as a limitation in the Methods.

      6) Describe how prior declines were documented in the screening register to validate the classification method.

      7) The results are extensive and detailed, but in places the narrative becomes somewhat repetitive of the table content. Tables 2 and 3 contain the same information as the narrative in many places.

      8) While participant-level counts are provided, there is limited exploration of patterns across participant characteristics (e.g., did women with no formal education express different barriers than those with tertiary education? Did married women differ from widowed women?). The sociodemographic data in Table 1 are not meaningfully integrated into the thematic analysis. Please consider integrating sociodemographic characteristics into the analysis where possible. For example, were there differences in barrier profiles by education level, employment status, or marital status? Even simple patterns would strengthen the analysis.

      9) The discussion of "intersectionality" is limited. WLHIV face intersecting stigmas (HIV-related, gender-based, poverty-related), and while HIV-related stigma and cervical cancer stigma are discussed, a more explicit intersectional framing could strengthen the analysis.

      10) The HPV self-sampling recommendation (lines 468–469) is introduced without prior discussion of participant views on self-sampling specifically. Was this explored in interviews? If not, the recommendation should be framed more cautiously. Please consider framing the HPV self-sampling recommendation more cautiously if this was not explored in the interviews e.g., " warranting exploration of acceptability" rather than direct recommendation.

      Reviewer #4:

      The manuscript is well written and simple to read. The topic is of great importance to public health. Comments: Introduction: The study is conducted in Nigeria. The sequence of statistics should start from Global to Africa to SSA, and lastly Nigeria. Exclusion criteria should not be the opposite of inclusion. You may want to remove “if they did not have an HIV diagnosis, accepted cervical cancer screening at the index visit” Line 186: This is the only mention of the framework. How was it done? Lines 231-233 read 92.6% willing to undergo screening. Table 1 title reads declined screening. Kindly clarify: prior to the study? Line 243 Notes: One “of the participants who”. Otherwise, it implies that there was only one participant that met the criterion. And how was the age estimated? Limitations: The authors rightly pointed out all limitations. However, the income may have been estimated if probed deeply starting from daily or weekly income, although this would have been time consuming.

      Guest Editor:

      Editor's Comments to Author The authors should respond systematically to each reviewer comment, revise the manuscript accordingly and provide a detailed point-by-point response indicating where and how each concern has been addressed.

    1. Then I took it of the child, and eat it myself, and savory it was to my taste

      Ew, they slobbered all over those. Also, SELFISH! They're starving too and you just took their food! What the heck!?

    1. No epilogue, I pray you. For your play needs 2151  no excuse. Never excuse. For when the players are 2152  all dead, there need none to be blamed.

      While Theseus jests about how awful the play was, there was most likely a part of the actors' minds, especially bottom, that believed that this line meant that they were all sentenced to death for putting on a bad show.

    2. THESEUS  1997 Now is the ⌜wall down⌝ between the two 1998 220 neighbors. DEMETRIUS  1999 No remedy, my lord, when walls are so 2000  willful to hear without warning.

      In an adaptation, I can imagine this being the breaking point in the event that the actors do take all the previous quips seriously somehow. The act of a wall moving out of the way is similar enough to the metaphor of a wall being broken down that it could represent the barrier of humor versus laughter collapsing on the spot.

    3. I wonder if the lion be to speak. DEMETRIUS  1940 No wonder, my lord. One lion may when 1941  many asses do.

      While they most likely laugh at such a joke in the situation, imagining this joke being so apt to describe the play that no one laughs out of mutual understanding is much more amusing.

    4. He hath rid his prologue like a rough colt; 1905  he knows not the stop. A good moral, my lord: it is 1906  not enough to speak, but to speak true. HIPPOLYTA  1907 Indeed he hath played on this prologue like 1908 130 a child on a recorder—a sound, but not in 1909  government. THESEUS  1910 His speech was like a tangled chain—nothing 1911  impaired, but all disordered. Who is next?

      By having many characters' views of the play, each comparison or metaphor that is made builds onto the concept of just how bad the play is. Even if the play already sounds horrendous to readers of Shakespeare's work, these lines that manage to insult the actors' work in so many unique and interesting ways create such an openly critical view of the play that not even viewers outside of an eighth wall can find anything about the performance to take seriously. This is a point to take into consideration when writing and directing an adaptation.

    5. Our sport shall be to take what they mistake; 1875  And what poor duty cannot do, noble respect 1876  Takes it in might, not merit.

      He's saying to acknowledge the effort that the actors put in, but this quite ironically foreshadows just how bad the play is that no one is quite capable of appreciating any semblance of effort in the performance.

    6. That is hot ice and wondrous strange snow!

      This could either be seriously asking how the play could resolve such outlandish conflict, or it could be satirically making fun of the play's title for being so outlandish that the plot doesn't sound real. I choose the latter to be the more entertaining option.

    7. Are of imagination all compact.

      This line means to compare all forms of crazed person and lump them into one group. While it is simply a phrase, I find it interesting to imagine the main characters lost in the forest to be direct comparisons of these. The lovers could be any of them is strange manners but applies most specifically to Lysander and Hermia. The lunatic is most likely Helena, as she was the one who caused part of the situation out of jealousy. the poets are, of course, the actors that were practicing in the woods. Calling Bottom a poet feels a little too kind to the character, though. Each of these definitions could factor into how they are depicted in any given adaptation.

    1. that whatsoever the Indians told me respecting him was vanity and lies.

      They could technically be lying to you again and just saying things to make you compliant.

    2. “Have pity upon me, O ye my Friends, for the Hand of the Lord has touched me.”

      I feel like this is what she always wanted. She wants everyone to feel bad for her. The way she writes exaggerates her pain above anyone else's, including this.

    3. his master roasted him, and that himself did eat a piece of him, as big as his two fingers, and that he was very good meat

      This is absolutely disgusting. Why would you eat someone?

    1. I told them the skin was off my back, but I had no other comforting answer from them than this: that it would be no matter if my head were off too.

      She uses this as an opportunity to demonize the Natives, but they say these things because it's what the English army do to them.

    2. at last an old Indian bade me to come to him, and his squaw gave me some ground nuts; she gave me also something to lay under my head, and a good fire we had; and through the good providence of God, I had a comfortable lodging that night.

      Older, female, native. Does she live alone? What is that dynamic? Why was she ok with allowing Mary into her space?

    3. I found six acorns, and two chestnuts, which were some refreshment to me.

      I find it interesting that she can recall these details ten years after experiencing them.

    4. my master being gone, who seemed to me the best friend that I had of an Indian

      I find it interesting that she calls her master her best friend of the Indian, when she hates all of them. Why would she admit this so flippantly in the text, when the reader knows her disdain for the Natives?

    5. redemption was not far off; and the rather because their insolency grew worse and worse.

      I wonder, with her word choice, does she know something they don't? Or is it purely based off of her belief and religion?

    6. she snatched it hastily out of my hand, and threw it out of doors.

      I find it interesting that the female seems to be the more aggressive one of the two natives. Or is it something against religion? Or maybe just Mary?

    1. If nothing anybody could have done would have changed the outcome of history, then nothing we can do now can shape our future: we are trapped in a further elaboration and extension of that which exists in the present, unless some huge accident of history such as a pandemic or a world war pushes us in a different direction.

      It would honestly be kind of scary to be trapped in a reality like this. Knowing that anything and everything we do has no purpose or meaning because there won’t be a changed effect or outcome. That would make life very depressing.

    2. The essence of Eurocentrism, according to the critics, is not merely that it views history from a European point of view (the “centrism” part). An ethnocentric perspective recognizes that there are many different peoples and cultures in the world, but that mine is better because it arises from my people and culture

      This is such a biased worldview! Wow! At least it still recognizes that there are many other, different peoples and cultures, but still. How are we supposed to get a clear, honest grasp on the truth if we just think of ourselves and our country as better in every category? We can’t!

    1. Effectiveness and User Experience of a Hybrid LLM-Based Conversational Agent (Chatbot) for Depression and Anxiety in Korean Young Adults: Randomized Controlled Trial and Thematic Analysis JongHwan Oh;  Hyewon Cho;  Sunyu Pang;  Seongil Heo;  Joonhwan Lee ABSTRACT Background: Depression and anxiety are highly prevalent among young adults, yet access to evidence-based psychological care remains limited by cost, stigma, and workforce shortages. Large language model (LLM)–based conversational agents have been proposed as scalable, low-barrier formats for delivering cognitive behavioral therapy (CBT), but rigorous randomized comparisons against established self-help interventions are scarce, particularly in non-English contexts. Objective: This study evaluated the effectiveness and user experience of a hybrid LLM-based CBT conversational agent (chatbot) for depressive and anxiety symptoms in Korean young adults, compared with CBT bibliotherapy as an active control. Methods: We conducted a 2-week, 2-arm, parallel-group randomized controlled trial. Korean young adults aged 19 to 29 years who self-reported depressive or anxiety symptoms were randomly assigned to a web-based hybrid LLM-based conversational agent (Mango) or to a CBT-based self-help book (bibliotherapy). The intervention was fully automated, with a single in-person onboarding session and no therapist involvement. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were self-administered online at baseline (T0), week 1 (T1), and week 2 (T2). All outcomes were analyzed using linear mixed models with an intention-to-treat approach; effect sizes were calculated as repeated-measures Cohen d (dRM) and Hedges g (gPPC2). A corresponding completer analysis served as a sensitivity analysis. Open-ended responses were analyzed thematically. The target sample (n=80) was based on feasibility rather than an a priori power calculation. Results: A total of 90 participants were randomized (experimental, n=49; control, n=41); 74 completed all assessments and adhered for at least 7 days. Baseline characteristics, including gender, age, occupation, and initial PHQ-9 or GAD-7 distribution, did not differ between groups. In the intention-to-treat analysis, both groups showed significant reductions from baseline to T2. In the experimental group, mean changes were −2.39 for PHQ-9 (95% CI −3.54 to −1.24; P<.001; dRM=−0.52) and −2.16 for GAD-7 (95% CI −3.07 to −1.26; P<.001; dRM=−0.59). Corresponding mean changes in the control group were −3.63 for PHQ-9 (P<.001; dRM=−0.81) and −3.15 for GAD-7 (P<.001; dRM=−0.83). Between-group differences in change were not statistically significant at either follow-up; at T2, the estimated differences were 1.24 for PHQ-9 (95% CI −0.44 to 2.92; P=.15; gPPC2=0.23) and 0.98 for GAD-7 (95% CI −0.34 to 2.30; P=.15; gPPC2=0.20). Thematic analysis indicated that, despite the absence of significant between-group differences, the 2 formats engaged users through different mechanisms: Mango users described contextualized emotional exploration and a perceived therapeutic alliance alongside the burden of sustained disclosure, whereas bibliotherapy users described declarative CBT learning without personalization. Conclusions: A hybrid LLM-based CBT conversational agent did not outperform CBT bibliotherapy over 2 weeks; significant within-group improvement was observed in both conditions in the completer analysis. Because the trial was underpowered and not designed for equivalence testing, these findings do not establish that the CBT conversational agent Mango is as effective as bibliotherapy. The study provides a transparent benchmark of a hybrid LLM architecture against an active comparator and qualitative evidence of distinct engagement mechanisms, informing adequately powered evaluation of future LLM-based interventions. Clinical Trial: Clinical Research Information Service (CRIS) KCT0012309; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=33449  Citation Please cite as: Oh J, Cho H, Pang S, Heo S, Lee J Effectiveness and User Experience of a Hybrid LLM-Based Conversational Agent (Chatbot) for Depression and Anxiety in Korean Young Adults: Randomized Controlled Trial and Thematic Analysis JMIR Preprints. 10/09/2026:111409 DOI: 10.2196/preprints.111409 URL: https://preprints.jmir.org/preprint/111409 Pusher.logToConsole = false; var articleId = '111409'; var version = 'submitted'; var pusher = new Pusher('11ced5c559070ec35363', { cluster: 'us2', forceTLS: true }); var channel = pusher.subscribe('preprint-' + articleId + '-' + version); channel.bind('created', function(data) { $('#pdf-viewer').attr("src", data).css('display', 'block'); $('.pdf-download-button').attr('href', data); $('#preprint-error-msg').html(""); $('#spinner').removeClass('fa fa-spinner fa-pulse fa-3x fa-fw'); }); channel.bind('error', function(data) { $('#preprint-error-msg').css('color', 'red'); $('#preprint-error-msg').html('There was an error while generating the pdf. Please contact support.'); $('#spinner').removeClass('fa fa-spinner fa-pulse fa-3x fa-fw'); }); $(document).ready(function() { $.ajax({ type: "GET", url: "/article/getPreprintPdf/" + articleId + "/" + version, contentType: 'application/json; charset=utf-8', dataType: 'json', async: true, success: function(data) { if (data && data['url']) { $('#pdf-viewer').attr("src", data['url']).css('display', 'block'); $('.pdf-download-button').attr('href', data['url']); } $('#preprint-error-msg').html(""); $('#spinner').removeClass('fa fa-spinner fa-pulse fa-3x fa-fw'); }, failure: function(errorMessage) { $('#preprint-error-msg').css('color', 'red'); $('#preprint-error-msg').html(errorMessage); $('#spinner').removeClass('fa fa-spinner fa-pulse fa-3x fa-fw'); } }); }) Download PDF

      Author note (17 Sep 2026)

      Tables 1–6 in the PDF of this preprint have lost their layout: each table cell appears as a separate line of running text. This is a file error on the authors' side (the table markup in the submitted Word file was lost during a last-minute edit before submission); the numerical content is complete and unchanged.

      A corrected manuscript with all six tables properly formatted has been placed in the JMIR submission system and will be the basis of peer review and of any subsequent version, including the version of record. JMIR does not alter posted preprints, so this PDF cannot be replaced.

      A PDF of the corrected tables is available at: https://drive.google.com/file/d/11pr8TJP9J00y9zwh2_9v8B38FLyeJzdU

    1. With growth in the use of communication technology in various aspects of social work practice, social workers need to be aware of the unique challenges that may arise in relation to the maintenance of confidentiality, informed consent, professional boundaries, professional competence, record keeping, and other ethical considerations. In general, all ethical standards in this Code of Ethics are applicable to interactions, relationships, or communications, whether they occur in person or with the use of technology. For the purposes of this Code, “technology-assisted social work services” include any social work services that involve the use of computers, mobile or landline telephones, tablets, video technology, or other electronic or digital technologies; this includes the use of various electronic or digital platforms, such as the Internet, online social media, chat rooms, text messaging, e-mail and emerging digital applications. Technology-assisted social work services encompass all aspects of social work practice, including psychotherapy; individual, family, or group counseling; community organization; administration; advocacy; mediation; education; supervision; research; evaluation; and other social work services. Social workers should keep apprised of emerging technological developments that may be used in social work practice and how various ethical standards apply to them.

      Within the last year , at my workplace we has had to eliminate an app that we were using on our phones and tablets to track behavioral data due to data breach issues, overall security, and financial concern. Social workers often have to rely on paper and pen if technology does not work. luckily we had it as a backkup. As a Rutger’s student in the last few years canvas has crashed and AI has made it increasingly difficult to get accurate and relevant data. The technology that is meant to alleviate workload and stress from staff to better support clients, but can cause much more stress when it doesn't operate properly and skews collected data.

    1. If the first woman God ever made was strong enough to turn the world upside down all alone, these women together ought to be able to turn it back , and get it right side up again! And now they is asking to do it, the men better let them.

      Sojourner Truth flips the narrative that women are fragile or weak by using the traditional religious story about Eve as proof of female strength. I interpret this means women are just as strong as men, and potentially even stronger especially when we come together in solidarity. By pointing this out Sojourner Truth challenges the 19th century myth that women are inferior or need protection, showing that as a collective female power is capable of changing the world and history.