Medical Humanities Commons^™

Efficacy Of Etvax, A Vaccine Against Enterotoxigenic Escherichia Coli-Positive Diarrhoea In Gambian Children: A Double-Blind, Randomised, Placebo-Controlled, Phase 2b Trial, M Jahangir Hossain, Fatou Secka, Lady C Sanyang, Raifu Taiwo, Emmanuel C Okoh, Olubunmi A Olubiyi, Mbemba Drammeh, Emmanuel U Richard, Ahmed D Balami, Mama Drammeh, Samba Juma Jallow, Bakary Sonko, Paticia Ezedimbu-Michael, Jacinta Obiaduo, Ousman Secka, Joanna Kaim, Björn Sjöstrand, Agneta Lissmats, Nils Carlin, Umberto D'Alessandro, Ann-Mari Svennerholm, Thomas F Wierzba

Faculty and Staff Publications

Background: Enterotoxigenic Escherichia coli (ETEC) causes 75 million diarrhoea episodes with up to 42 000 deaths annually in children. To prevent ETEC in children, we aimed to evaluate the safety, immunogenicity, and efficacy of ETVAX, an oral, inactivated, whole-cell ETEC vaccine with toxoid and double-mutant heat-labile toxin adjuvant.

Methods: In this phase 2b, double-blind, placebo-controlled trial, Gambian children aged 6-18 months were recruited from four enrolment centres and block-randomised (1:1) via a computer-generated sequence, stratified by enrolment centres, to receive ETVAX or placebo on days 1, 15, and 90. Parents, staff, investigators assessing outcomes, and investigators analysing the data were …

Limits On Wimp Dark Matter With Nai(Tl) Crystals In Three Years Of Cosine-100 Data, G H Yu, N Carlin, J Y Cho, J J Choi, S Choi, A C Ezeribe, L E França, C Ha, I S Hahn, S J Hollick, E J Jeon, H W Joo, W G Kang, M Kauer, B H Kim, H J Kim, J Kim, K W Kim, S H Kim, S K Kim, W K Kim, Y D Kim, Y H Kim, Y J Ko, D H Lee, E K Lee, H Lee, H S Lee, H Y Lee, I S Lee, J Lee, J Y Lee, M H Lee, S H Lee, S M Lee, Y J Lee, D S Leonard, N T Luan, V H A Machado, B B Manzato, R H Maruyama, R J Neal, S L Olsen, B J Park, H K Park, H S Park, J C Park, K S Park, S D Park, R L C Pitta, H Prihtiadi, S J Ra, C Rott, K A Shin, D F F S Cavalcante, M K Son, N J C Spooner, L T Truc, L Yang, Cosine-100 Collaboration

Faculty and Staff Publications

We report limits on weakly interacting massive particle (WIMP) dark matter derived from three years of data collected by the COSINE-100 experiment with NaI(Tl) crystals, achieving an improved energy threshold of 0.7 keV. This lowered threshold enhances sensitivity in the sub-GeV mass range, extending the reach for direct detection of low-mass dark matter. Although no excess of WIMP-like events was observed, the increased sensitivity enabled a model-insensitive comparison between the expected WIMP signal rate-based on mass limits from our data-and DAMA's reported modulation amplitude. Our findings strongly disfavor the DAMA signal as originating from WIMP interactions, fully excluding DAMA/LIBRA 3σ …

The 10-Year Functional Outcome Of Ponseti Treatment Of Idiopathic And Arthrogrypotic Clubfeet With An Age-Matched Control, Chris Church, Nicole Wang, Stephanie Butler, Jose J Salazar-Torres, John Henley, Freeman Miller, Nancy Carlin, Maureen Donohoe, L Reid Nichols

Faculty and Staff Publications

Background: The Ponseti method is accepted as an effective primary conservative treatment for idiopathic clubfoot (IC) using serial casting, percutaneous Achilles tenotomy, and prolonged bracing. The outcomes of its use in treating rigid clubfoot in arthrogryposis are unclear. This study assesses the outcomes of the Ponseti method in children with IC and arthrogrypotic clubfoot at an average age of 10 years.

Methods: Outcomes of the Ponseti method were retrospectively studied in ambulatory children ages 8.0 to 12.9 years in the gait lab between 2004 and 2024. Children were excluded due to the presence of nonidiopathic or nonarthrogryposis-related clubfoot and history …

Accreditation Standards Must Protect Trainees: Creating Ethical Fellowship Programs, Anna D Goff, Ryan J Dougherty, Joelle Robertson-Preidler

Faculty and Staff Publications

No abstract provided.

Combined Annual Modulation Dark Matter Search With Cosine-100 And Anais-112, N Carlin, J Y Cho, J J Choi, S Choi, A C Ezeribe, L E França, C Ha, I S Hahn, S J Hollick, S B Hong, E J Jeon, H W Joo, W G Kang, M Kauer, B H Kim, H J Kim, J Kim, K W Kim, S H Kim, S K Kim, W K Kim, Y D Kim, Y H Kim, Y J Ko, D H Lee, E K Lee, H Lee, H S Lee, H Y Lee, I S Lee, J Lee, J Y Lee, M H Lee, S H Lee, S M Lee, Y J Lee, D S Leonard, N T Luan, V H A Machado, B B Manzato, R H Maruyama, R J Neal, S L Olsen, H K Park, H S Park, J C Park, J S Park, K S Park, K Park, S D Park, R L C Pitta, H Prihtiadi, S J Ra, C Rott, K A Shin, D F F S Cavalcante, M K Son, N J C Spooner, L T Truc, L Yang, G H Yu, J Amaré, J Apilluelo, S Cebrián, D Cintas, I Coarasa, E García, M Martínez, Y Ortigoza, A Ortiz De Solórzano, T Pardo, J Puimedón, M L Sarsa, C Seoane

Faculty and Staff Publications

The annual modulation signal, claimed to be consistent with dark matter as observed by DAMA/LIBRA in a sodium-iodide based detector, has persisted for over two decades. COSINE-100 and ANAIS-112 were designed to test the claim directly using the same target material. COSINE-100, located at Yangyang Underground Laboratory in South Korea, and ANAIS-112, located at Canfranc Underground Laboratory in Spain, have been taking data since 2016 and 2017, respectively. Each experiment published its respective results independently. In this Letter, we present the results of an annual modulation search as a test of the signal observed by DAMA/LIBRA with the first three …

Cosine-100 Full Dataset Challenges The Annual Modulation Signal Of Dama/Libra, Nelson Carlin, Jae Young Cho, Jae Jin Choi, Seonho Choi, Anthony C Ezeribe, Luis Eduardo França, Chang Hyon Ha, In Sik Hahn, Sophia J Hollick, Eunju Jeon, Han Wool Joo, Woon Gu Kang, Matthew Kauer, Bongho Kim, Hongjoo Kim, Jinyoung Kim, Kyungwon Kim, Sunghyun Kim, Sun Kee Kim, Won Kyung Kim, Yeongduk Kim, Yong-Hamb Kim, Young Ju Ko, Doohyeok Lee, Eun Kyung Lee, Hyunseok Lee, Hyun Su Lee, Hye Young Lee, In Soo Lee, Jaison Lee, Jooyoung Lee, Moo Hyun Lee, Seo Hyun Lee, Seung Mok Lee, Yujin Lee, Douglas S Leonard, Nguyen Thanh Luan, Vitor Hugo De Almeida Machado, Bruno B Manzato, Reina H Maruyama, Robert J Neal, Stephen L Olsen, Byung Ju Park, Hyang Kyu Park, Hyeonseo Park, Jong-Chul Park, Kangsoon Park, Se Dong Park, Ricardo L C Pitta, Hafizh Prihtiadi, Sejin Ra, Carsten Rott, Keon Ah Shin, David F F S Cavalcante, Min Ki Son, Neil J C Spooner, Lam Tan Truc, Liang Yang, Gyun Ho Yu

Faculty and Staff Publications

For over 25 years, the DAMA/LIBRA collaboration has claimed to observe an annual modulation signal, suggesting the existence of dark matter interactions. However, no experiment using different target materials has observed a dark matter signal consistent with their result. To address this puzzle, the COSINE-100 collaboration conducted a model-independent test using sodium iodide crystal detectors, the same target material as DAMA/LIBRA. Analyzing data collected over 6.4 years by the effective mass of 61.3 kilograms, with improved energy calibration and time-dependent background modeling, we found no evidence of an annual modulation signal, challenging the DAMA/LIBRA result with a confidence level greater …

Teaching Pathographies Of Mental Illness, Nathan Carlin, Angela Gomez, Margarita Ortiz

Faculty and Staff Publications

This paper describes the content and evolution of a fourth-year course for medical students on teaching pathographies of mental illness. (It is a follow-up to Nathan Carlin's Pathographies of Mental Illness that appeared as an Element in the Bioethics and Neuroethics series published by Cambridge University Press.) The course originally centered on classic (and some contemporary) memoirs; however, responding to student evaluations, newer material now ensures more diversity, with material written by women and people of color, and describes the difference that can make.

The Climate Is Changing Should Clinical Ethics Change, Too?, Joelle Robertson Preidler, Keisha Ray

Faculty and Staff Publications

No abstract provided.

An Interview With Rita Charon, Nathan Carlin

Faculty and Staff Publications

This is an edited transcript of an interview with Rita Charon. Nathan Carlin conducted the interview in her apartment in New York City on October 18, 2024. They discussed a number of topics, including Charon's educational journey, her mentors, the founding of narrative medicine, the status of narrative medicine today as well as its future, the relationship between narrative medicine and literature and medicine, and the ethics of writing about patients.

Exploring Sexual Consent Capacity And Sexual Expression In Older Adults Living With Dementia, Renee J Flores, Carlos A Reyes-Ortiz

Faculty and Staff Publications

No abstract provided.

Assessment Of Biotransformation Rates, Biomagnification, And Bioconcentration Factors Of Difficult-To-Test Substances Using In Vitro Rainbow Trout Liver Subcellular Fractions, Mark A Cantu, Beatrice Chee, Talia R Cole, Yung-Shan Lee, Frank A P C Gobas

Faculty and Staff Publications

In vitro hepatic biotransformation assays have been proposed as methods for expediting and improving bioaccumulation assessment for substances that are difficult to test in conventional in vivo bioaccumulation assays and to reduce animal testing. However, to date, there has been no convincing evidence to demonstrate the ability and limitations of in vitro assays to estimate in vivo biotransformation rates and corresponding bioconcentration and biomagnification factors of difficult-to-test substances in fish. The present study presents the first measurements of in vitro biotransformation rates of superhydrophobic and highly volatile linear and cyclic siloxanes in rainbow trout liver S9 subcellular fractions and the …

The Structural Inequality Of Status Quo Clinical Communication, Joelle Robertson-Preidler

Faculty and Staff Publications

No abstract provided.

Use Of A Taqman Array Card For Identification Of Enterotoxins And Colonization Factors Directly From Stool Samples In An Enterotoxigenic E Coli Vaccine Study, Jie Liu, T Sakari Jokiranta, Nils Carlin, Suzanne Stroup, Jixian Zhang, Bjorn Sjostrand, Ann-Mari Svennerholm, Eric R Houpt, Anu Kantele

Faculty and Staff Publications

Enterotoxigenic Escherichia coli (ETEC) is a leading cause of childhood and travelers' diarrhea. The vaccine candidate ETVAX encompasses several ETEC colonization factors (CFs) with a hybrid LT (heat-labile toxin)/cholera toxin B subunit adjuvanted with a double-mutant LT. Stool samples from a Phase 2b ETVAX trial were tested by a PCR-based customized TaqMan Array Card (TAC), including three ETEC toxin genes (LT and heat-stable toxins, STh and STp) and 18 ETEC CFs. Stool samples were also tested with the molecular platform Amplidiag and culture, followed by GM1-enzyme-linked immunosorbent assay (ELISA) and inhibition GM1-ELISA for LT and ST and dot blot for …

Acute Hepatitis B Infection In A Patient With Confirmed Immunity On Long-Acting Cabotegravir/Rilpivirine, William K B Boateng, Neil Carlin, Etan Spira, Maria E Szabela, Kosisochukwu J Ezeh

Faculty and Staff Publications

Long-acting injectable formulation of cabotegravir/rilpivirine (CAB/RPV) is a promising novel maintenance therapy for HIV infection. However, coinfection with active hepatitis B virus (HBV) infection is a contraindication to initiating this therapy. Despite guidelines, patients with HBV immunity can still contract acute HBV infection. We report a case of a 30-year-old man with HIV who transitioned from antiretroviral therapy to CAB/RPV and had confirmed HBV immunity. The patient, though asymptomatic, showed significantly elevated liver function tests (LFTs) before his monthly CAB/RPV injection. He was hospitalized and diagnosed with acute HBV infection. His LFTs improved, and he was taken off CAB/RPV and …

“Nothing Is Going To Replace An In-Person Visit”: Canadian Long-Term Care Providers’ And Recipients’ Perspectives On When Telehealth For Physician Visits Is Not Appropriate, Tyler R Cole, Valorie A Crooks, Janice Sorensen, Sherin Jamal, Akber Mithani, Lillian Hung, Jeremy Snyder, Catherine Youngren

Faculty and Staff Publications

Background: Within long-term care (LTC) homes, telehealth use has been found to reduce unnecessary emergency department transfers, support the care needs of rural and underserved communities, and supplement in-person physician care. Despite these benefits, it is not well understood when telehealth is not an appropriate medium for providing physician care to residents with complex health needs. This knowledge gap must be addressed given the recent rise in telehealth use in LTC homes in many health systems following the COVID-19 pandemic, when virtual care use increased in many health care sectors to limit travel and in-person exposure risks, that is expected …

Whether To Offer Interventions At The End Of Life: What Physicians Consider And How Clinical Ethicists Can Help, Joelle Robertson-Preidler, Mikaela Kim, Sophia Fantus, Janet Malek

Faculty and Staff Publications

Background: Advances in life-prolonging technologies increasingly create dilemmas for physicians who must decide whether to offer various interventions to patients nearing the end of life. Clinical ethicists are often consulted to support physicians in making these complex decisions and can do so most effectively if they understand physicians' reasons for making recommendations in this context.

Methods: Semi-structured interviews were conducted with surgeons, nephrologists, intensivists, emergency physicians, and oncologists regarding the considerations they have used to make decisions about offering interventions for patients nearing the end of life. Interview transcripts were thematically analyzed.

Results: We identified six types of considerations physicians …

A Randomized Controlled Trial Of A Compassion-Centered Spiritual Health Intervention To Improve Hospital Inpatient Outcomes, Jennifer S Mascaro, Patricia K Palmer, Marcia J Ash, Marianne P Florian, Deanna M Kaplan, Roman Palitsky, Steven P Cole, Maureen Shelton, Charles L Raison, George H Grant

Faculty and Staff Publications

Background: Inpatient medical settings lack evidence-based spiritually integrated interventions to address patient care needs within a pluralistic religious landscape. To address this gap, CCSH™ (Compassion-Centered Spiritual Health) was developed to leverage the skillsets of healthcare chaplains to improve patient outcomes through spiritual consultation. Here, we report the results of a randomized, wait-list controlled, pre-registered (NCT03529812) study that evaluated the impact of CCSH on patient-reported depression and explored putative mediators of CCSH's effects.

Method: Chaplain residents were randomized to be trained in CCSH as part of their clinical pastoral education (CPE) residency in the fall (n = 8) or …

Citation Bias, Diversity, And Ethics, Keisha S Ray, Perry Zurn, Jordan D Dworkin, Dani S Bassett, David B Resnik

Faculty and Staff Publications

How often a researcher is cited usually plays a decisive role in that person's career advancement, because academic institutions often use citation metrics, either explicitly or implicitly, to estimate research impact and productivity. Research has shown, however, that citation patterns and practices are affected by various biases, including the prestige of the authors being cited and their gender, race, and nationality, whether self-attested or perceived. Some commentators have proposed that researchers can address biases related to social identity or position by including a Citation Diversity Statement in a manuscript submitted for publication. A Citation Diversity Statement is a paragraph placed …

The Case For Early Childhood Education As Health And Economic Policy, Jessica N. Wise, Katarina Reyes, Sandra Mckay

Faculty and Staff Publications

Families across the United States are facing significant challenges due to the limited availability and affordability of high-quality early childhood care options for children under the age of 6. Child care access is especially challenging for those seeking to reenter the workforce. Rethinking child care, especially early childhood education, as health care is essential for achieving a better future and economic security for children, families, and caregivers across the U.S.

A Case And Intervention For Older Adult Sexual Mistreatment, Renee J Flores, Cristina Murdock, John Halphen, Carlos Reyes-Ortiz, Jason Burnett

Faculty and Staff Publications

Background: The sexual mistreatment of older adults is a significant public health issue; like other forms of sexual violence, it is more prevalent than officially reported. Survivors often hesitate to speak out due to feelings of embarrassment, fear, or potential cognitive impairments. Moreover, the concealment of such mistreatment, coupled with societal stigmas surrounding aging and sexuality, creates challenges in recognizing sexual mistreatment during routine or emergency room visits.

Purpose: This paper provides a framework for informing physicians, psychiatrists, and other healthcare providers on best practices screening, detection, and management of sexual mistreatment in older adults.

Methods: A literature review of …

Vaccine-Sensitive Allocation - Another Divide To Divide Us?, Joelle Robertson-Preidler, Olivia Schuman

Faculty and Staff Publications

No abstract provided.

We Are Not Okay: Moral Injury And A World On Fire, Keisha S Ray

Faculty and Staff Publications

No abstract provided.

Improving Sexual Health Through Medical Education, Renee J Flores

Faculty and Staff Publications

No abstract provided.

Breathe, Renee J Flores

Faculty and Staff Publications

This is a personal essay about breasts. It focuses on my experiences as a young girl, moving through adolescence to a history of breast cancer in my family, including my mother's breast cancer diagnosis. As a physician, patient, and wife, I reflect on the choices that I have to make and what this means for my identity as a woman and mother.

A Mixed-Method Evaluation Of Implementation Determinants For Chaplain Intervention In A Hospital Setting, Jennifer S Mascaro, Marianne P Florian, Erin Brauer, Patricia K Palmer, Marcia J Ash, Maureen Shelton, Roman Palitsky, Deanna M Kaplan, Shaheen Rana, Cam Escoffery, Charles L Raison, George H Grant

Faculty and Staff Publications

Healthcare chaplains address broad social and emotional dimensions of care within a pluralistic religious landscape. Although the development and evaluation of chaplaincy interventions has advanced the field, little research has investigated factors influencing the implementation of new chaplain interventions. In this mixed-method study, we examined attitudes about evidence-based interventions held by chaplain residents (n = 39) at the outset of an ACPE-accredited residency program in the southeast United States. We also used semi-structured interviews (n = 9) to examine residents' attitudes, beliefs, and decision-making processes after they trained in the delivery of a novel manualized intervention, Compassion-Centered Spiritual Health (CCSH). …

A Perspective On The Strategy For Advancing Etvax, An Anti-Etec Diarrheal Disease Vaccine, Into A Field Efficacy Trial In Gambian Children: Rationale, Challenges, Lessons Learned, And Future Directions, M Jahangir Hossain, Ann-Mari Svennerholm, Nils Carlin, Umberto D'Alessandro, Thomas F Wierzba

Faculty and Staff Publications

For the first time in over 20 years, an Enterotoxigenic Escherichia coli (ETEC) vaccine candidate, ETVAX®, has advanced into a phase 2b field efficacy trial for children 6-18 months of age in a low-income country. ETVAX® is an inactivated whole cell vaccine that has gone through a series of clinical trials to provide a rationale for the design elements of the Phase 2b trial. This trial is now underway in The Gambia and will be a precursor to an upcoming pivotal phase 3 trial. To reach this point, numerous findings were brought together to define factors such as safe and …

Safety And Immunogenicity Of Etvax®, An Oral Inactivated Vaccine Against Enterotoxigenic Escherichia Coli Diarrhoea: A Double-Blinded, Randomized, Placebo-Controlled Trial Amongst Finnish Travellers To Benin, West Africa, Anu Kantele, Marianna Riekkinen, T Sakari Jokiranta, Sari H Pakkanen, Jukka-Pekka Pietilä, Anu Patjas, Mari Eriksson, Tamim Khawaja, Peter Klemets, Kati Marttinen, Heli Siikamäki, Anna Lundgren, Jan Holmgren, Agneta Lissmats, Nils Carlin, Ann-Mari Svennerholm

Faculty and Staff Publications

Background: No licensed human vaccines are available against enterotoxigenic Escherichia coli (ETEC), a major diarrhoeal pathogen affecting children in low- and middle-income countries and foreign travellers alike. ETVAX®, a multivalent oral whole-cell vaccine containing four inactivated ETEC strains and the heat-labile enterotoxin B subunit (LTB), has proved promising in Phase 1 and Phase 1/ 2 studies.

Methods: We conducted a Phase 2b double-blinded, randomized, placebo-controlled trial amongst Finnish travellers to Benin, West Africa. This report presents study design and safety and immunogenicity data. Volunteers aged 18-65 years were randomized 1:1 to receive ETVAX® or placebo. They visited Benin for 12 …

Search For Boosted Dark Matter In Cosine-100, G Adhikari, N Carlin, J J Choi, S Choi, A C Ezeribe, L E França, C Ha, I S Hahn, S J Hollick, E J Jeon, J H Jo, H W Joo, W G Kang, M Kauer, B H Kim, H J Kim, J Kim, K W Kim, S H Kim, S K Kim, W K Kim, Y D Kim, Y H Kim, Y J Ko, D H Lee, E K Lee, H Lee, H S Lee, H Y Lee, I S Lee, J Lee, J Y Lee, M H Lee, S H Lee, S M Lee, Y J Lee, D S Leonard, N T Luan, B B Manzato, R H Maruyama, R J Neal, J A Nikkel, S L Olsen, B J Park, H K Park, H S Park, K S Park, S D Park, R L C Pitta, H Prihtiadi, S J Ra, C Rott, K A Shin, D F F S Cavalcante, A Scarff, N J C Spooner, W G Thompson, L Yang, G H Yu, Cosine-100 Collaboration

Faculty and Staff Publications

We search for energetic electron recoil signals induced by boosted dark matter (BDM) from the galactic center using the COSINE-100 array of NaI(Tl) crystal detectors at the Yangyang Underground Laboratory. The signal would be an excess of events with energies above 4 MeV over the well-understood background. Because no excess of events are observed in a 97.7 kg·yr exposure, we set limits on BDM interactions under a variety of hypotheses. Notably, we explored the dark photon parameter space, leading to competitive limits compared to direct dark photon search experiments, particularly for dark photon masses below 4 MeV and considering the …

Safety, Tolerability, And Immunogenicity Of An Oral Inactivated Etec Vaccine (Etvax®) With Dmlt Adjuvant In Healthy Adults And Children In Zambia: An Age Descending Randomised, Placebo-Controlled Trial, Nsofwa Sukwa, Cynthia Mubanga, Luiza M Hatyoka, Obvious N Chilyabanyama, Mwelwa Chibuye, Samson Mundia, Masiliso Munyinda, Ethel Kamuti, Muyunda Siyambango, Sharif Badiozzaman, Samuel Bosomprah, Nils Carlin, Joanna Kaim, Björn Sjöstrand, Michelo Simuyandi, Roma Chilengi, Ann-Mari Svennerholm

Faculty and Staff Publications

BACKGROUND: Enterotoxigenic Escherichia coli (ETEC) is an important cause of moderate to severe diarrhoea in children for which there is no licensed vaccine. We evaluated ETVAX®, an oral, inactivated ETEC vaccine containing four E. coli strains over-expressing the major colonization factors CFA/I, CS3, CS5, and CS6, a toxoid (LCTBA) and double mutant heat-labile enterotoxin (dmLT) adjuvant for safety, tolerability, and immunogenicity.

METHODS: A double-blind, placebo-controlled, age-descending, dose-finding trial was undertaken in 40 adults, 60 children aged 10-23 months, and 146 aged 6-9 months. Adults received one full dose of ETVAX® and children received 3 doses of either 1/4 or 1/8 …

The Language Of Compassion: Hospital Chaplains' Compassion Capacity Reduces Patient Depression Via Other-Oriented, Inclusive Language, Jennifer S Mascaro, Patricia K Palmer, Madison Willson, Marcia J Ash, Marianne P Florian, Meha Srivastava, Anuja Sharma, Bria Jarrell, Elizabeth Reisinger Walker, Deanna M Kaplan, Roman Palitsky, Steven P Cole, George H Grant, Charles L Raison

Faculty and Staff Publications

Objectives: Although hospital chaplains play a critical role in delivering emotional and spiritual care to a broad range of both religious and non-religious patients, there is remarkably little research on the best practices or "active ingredients" of chaplain spiritual consults. Here, we examined how chaplains' compassion capacity was associated with their linguistic behavior with hospitalized inpatients, and how their language in turn related to patient outcomes.

Methods: Hospital chaplains (n = 16) completed self-report measures that together were operationalized as self-reported "compassion capacity." Next, chaplains conducted consultations with inpatients (n = 101) in five hospitals. Consultations were audio-recorded, …