Have an update to share? Research news, milestones, funding announcements, and events can be submitted via the Research Communications request form. In addition to the monthly newsletter, Manne Research Institute distributes a bi-weekly "Events and Opportunities" email featuring upcoming events, including virtual and in-person educational opportunities, and relevant research deadlines. All previous updates can be found in the Research Communications archive.

In the first of a new, monthly President's Message series for the Stanley Manne Children's Research Institute, Dr. Patrick Seed, President and Chief Research Officer, examined the concept of research as a team sport and also highlighted recent research advances from Amy Johnson, PhD.

To improve awareness of and access to research funding opportunities, the Office of Research Development has partnered with Lurie Children’s Health Sciences Library to develop an updated Funding Institutional tutorial.

Funding Institutional is a funding opportunity search engine which can be leveraged to create customized searches of funding opportunities, funders, and awarded grants drawn from a wide range of federal and private resources. This search engine is provided to faculty through a partnership with Northwestern University and can be accessed using your NU NetID and password.

To help investigators get the most out of Funding Institutional, the tutorial includes information on obtaining access, tips on conducting different types of funding searches, and guidance for creating alerts that meet specific research funding needs. Please visit the library services webpage to learn more.

For questions or concerns regarding library resources, please contact Andrea Fawcett.

The NUCATS team provides a variety of research study recruitment tools to assist in promoting active trials. The team’s goal is to provide participant recruitment resources to study teams with distinct instructions, templates, and editorial guidance to assist with implementation and dissemination of recruitment materials. Among the tools available are:

Contact Toddie Hays with questions.

Estella M. Alonso Receives $17 million NIH U01 Grant Award 

The National Institutes of Health–National Institute of Diabetes and Digestive and Kidney Diseases awarded $17 million to Estella M. Alonso, MD, to study immunosuppression therapy in children with acute liver failure.

Dr. Alonso, Sally Burnett Searle Professorship in Pediatric Transplantation and Medical Director of the Siragusa Transplant Center at Ann & Robert H. Lurie Children’s Hospital of Chicago and Professor and Vice Chair of the Department of Pediatrics at Northwestern University Feinberg School of Medicine, received the U01 grant award to fund the study, “Pediatric Acute Liver Failure Immune Response Network (PALF IRN): Treatment for Immune Mediated Pathophysiology (TRIUMPH).” The research team aims to determine if suppressing inflammatory responses with either corticosteroids or equine anti-thymocyte globulin therapy improves survival for children with acute liver failure. The award period is June 2021–May 2026. Her research team, pictured here left-to-right, includes Kaitlin Keeley, Primary Research Coordinator, Katie Neighbors, Research Scientist & Project Coordinator, Dr. Alonso, Mary Riordan, Secondary Research Coordinator, and Dr. Catherine Chapin, Site Investigator.

Pediatric acute liver failure (PALF) is a rare, devastating condition that affects an estimated 250 children per year in North America, causing death in approximately 15 percent and the need for liver transplantation in an additional 20–30 percent. The primary objective of the study is to identify a therapy that will improve survival and reduce the need for liver transplantation in children with acute liver failure. The TReatment for ImmUne Mediated PathopHysiology (TRIUMPH) trial is a double-blind, three arm, randomized, placebo-controlled trial with restricted response adaptive randomization testing the efficacy and safety of high dose methylprednisolone or equine anti-thymocyte globulin (eATG) as treatment for acute liver failure in pediatric patients. It is the first randomized trial of immunosuppression therapy in pediatric acute liver failure.

“There is a track record of multi-center collaboration and culture that supports adoption of evidence-based care, providing an excellent foundation for the TRIUMPH trial to investigate the effectiveness of T-cell directed therapy using eATG or high dose steroids as compared to supportive care, to reduce mortality and liver transplantation in this population,” said Alonso. She added that children with an undetermined or “indeterminate” pediatric acute liver failure diagnosis (indPALF) have lower spontaneous survival and higher rates of liver transplantation and death than other diagnostic cohorts. This trial seeks to redefine indPALF by leveraging emerging techniques to examine T-cell function and build upon recent findings in animal models of dysregulated immune responses.

This project represents a collaborative effort between Dr. Alonso, a pediatric hepatologist with long standing expertise in management of acute liver failure in children and in clinical research methodology, and Dr. Valerie L. Durkalski, Professor of Biostatistics and Director of the Data Coordination Unit in the Department of Public Health Sciences with Medical University of South Carolina and a clinical trials specialist with an extensive experience in running multicenter trials and consortium studies. Each of these two PIs bring unique but complementary skills to the TRIUMPH trial. The grant is a natural progression of the previous collaboration within the Pediatric Acute Liver Failure Study Group for which Dr. Alonso played a strong leadership role.

The Pediatric Acute Liver Failure Immune Response Network (PALF IRN) is a newly formed network focused on investigation of new therapies to improve survival in this patient population. The 20 study sites are established regional referral centers for pediatric acute liver failure and provide care to most patients that are eligible for this study in North America.

The Pediatric Academic Societies (PAS) recently appointed Todd Florin, MD, MSCE, Attending Physician and Director of Research, Emergency Medicine, and Head of the Grainger Research Program in Pediatric Emergency Medicine at Ann & Robert H. Lurie Children’s Hospital of Chicago, to its board of directors.

In this role, Dr. Florin, who is also Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine, will work with other PAS directors to provide fiduciary oversight of the organization and oversight of the implementation of PAS’s strategic plan. The PAS aims to be the premier scholarly child health meeting in North America. The meeting attracts more than 8,000 attendees from diverse child health disciplines to promote research and academics, explore professional education in basic and clinical sciences, and provide networking opportunities for its members and the broader pediatric community. The PAS Meeting is produced through a partnership with the American Academy of Pediatrics, Academic Pediatric Association, American Pediatric Society, and Society for Pediatric Research.

Congratulations to two administrators from Stanley Manne Children’s Research Institute—Jarrod Cunningham and Roman Gomez—for being chosen as finalists for the 2022 Chicago Admin Awards.

Cunningham is Manager of the Office of the Chief Operating Officer at Manne Research Institute. He is a finalist to receive the Leadership Award, which recognizes an administrator who leads others and demonstrates a variety of leadership qualities including persistence, focus, integrity, innovation, patience, decisiveness, open-mindedness, empowerment, generosity, and a passion for helping fellow employees and their organization succeed.

Gomez is Administrative Assistant for Smith Child Health Outcomes, Research and Evaluation Center. He is a finalist to receive the Rookie of the Year Award, which celebrates those with less than three years of service in the administrative profession and who demonstrate great potential to excel and grow in their role.

In total, 28 candidates from Ann & Robert H. Lurie Children’s Hospital of Chicago were chosen as finalists. Winners will be selected at the Admin Awards Gala on June 24. Please join everyone in celebrating Jarrod, Roman, and the other finalists.

Immune response and the lymphatic system are central to cardiac repair after a heart attack, according to a study from Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg Cardiovascular Research Institute. These insights into the basic mechanisms of cardiac repair are the first step towards developing novel therapeutic approaches to preserve heart function. Findings were published in the Journal of Clinical Investigation.

“We found that macrophages, or immune cells that rush to the heart after a heart attack to ‘eat’ damaged or dead tissue, also induce vascular endothelial growth factor C (VEGFC) that triggers the formation of new lymphatic vessels and promotes healing,” said co-senior author Edward Thorp, PhD, from the Heart Center at Lurie Children’s and Associate Professor of Pathology and Pediatrics at Northwestern University Feinberg School of Medicine. “Our challenge now is to find a way either to administer VEGFC or to coax these macrophages to induce more VEGFC, in order to speed the heart repair process.”

People who suffer a heart attack are at high risk for heart failure, even with the advances in medications to reduce mortality. This occurs in part because some macrophages that arrive at the site of damage are proinflammatory and do not induce VEGFC.

“It is a Dr. Jekyll and Mr. Hyde scenario, with ‘good’ macrophages that induce VEGFC and the ‘bad’ ones that don’t. We need to prevent the ‘bad’ macrophages from causing further damage,” said co-senior author Guillermo Oliver, PhD, Director of Feinberg Cardiovascular and Renal Research Institute–Center for Vascular and Developmental Biology, and Professor of Medicine at Northwestern University Feinberg School of Medicine. “We are working to understand more about the progression to heart failure after a heart attack, in order to intervene early and reset the course to cardiac repair.” Pediatric research at Lurie Children's is conducted through Stanley Manne Children's Research Institute.

Research Brief: Rabeprazole Shows Promise in Treating Severe Sepsis and Acute Respiratory Distress Syndrome  

Previous research has demonstrated that endothelial HIF-1α plays an important role in mediating endothelial regeneration and resolution of inflammation following sepsis-induced injury. Researchers from Ann & Robert H. Lurie Children’s Hospital of Chicago investigating FDA-approved drugs for potential repurposing to treat severe sepsis and acute respiratory distress syndrome by activating HIF-1α signaling identified Rabeprazole, which is used to treat ulcers and acid reflux, as an effective therapy. The study was published in Cells. Pediatric research at Lurie Children’s is conducted through Stanley Manne Children’s Research Institute.

Future research should include developing new formulation of Rabeprazole to increase its potency and evaluating other HIF-1a activators for potential better efficacy as a repurposing treatment of severe sepsis, acute respiratory distress syndrome, and severe COVID-19, explains Youyang Zhao, PhD, William G. Swartchild, Jr. Distinguished Research Professorship at Ann & Robert H. Lurie Children’s Hospital of Chicago and Professor of Pediatrics, Medicine, and Pharmacology at Northwestern University Feinberg School of Medicine.

Evans CE, Peng Y, Zhu MM, Dai Z, Zhang X, Zhao Y-Y. Rabeprazole Promotes Vascular Repair and Resolution of Sepsis-Induced Inflammatory Lung Injury through HIF-1 α. Cells 2022, 11(9), 1425. doi: 10.3390/cells11091425.

Improved therapies for children facing cancer can only be discovered through pediatric research. Placing a premium on innovation, Lurie Children’s Center for Cancer and Blood Disorders is committed to speeding up the development of new treatments by leading and participating in early phase clinical trials.

Recently neuro-oncologist Ashley Plant-Fox, MD, opened the first clinical trial for a novel heat shock protein vaccine targeting the fatal pediatric brain tumor diffuse intrinsic pontine glioma (DIPG), the deadliest brain tumor in children.

Dr. Plant-Fox worked in collaboration with Agenus Biotechnologies to use genetic sequencing information from patient tumors to identify tumor specific markers that could be used in a vaccine product. Together, they created the vaccine known as rHSC-DIPGVax. As of January 2022, this phase I clinical trial is open at Lurie Children’s for newly diagnosed patients after completion of radiation. Dr. Plant-Fox is the lead Principal Investigator at Lurie Children’s and the trial enrolled its first patient in early April.

To limit the distance families must travel to receive this novel therapy, the trial is also available at additional sites including Dana Farber Cancer Institute, Children’s Hospital Orange County, and Alberta Children’s.

Dr. Plant-Fox believes it is essential to collect biologic correlates during clinical trials in order to gather as much data as possible on responders and non-responders to novel therapies, especially in rare disease populations. The biologic correlates to this trial include evaluation of tumor biopsy samples as well as blood samples at various time points throughout each participant’s vaccine treatment. Michael DeCuypere, MD, PhD, a pediatric neurosurgeon at Lurie Children’s who specializes in brain tumor surgery and research, has joined Dr. Plant-Fox’s team to perform minimally invasive biopsies of these tumors. Lurie Children’s is one of only a few pediatric centers in the Midwest with the experience and state-of-the-art technology to perform these biopsies safely, given their risky location in the brainstem.

The blood samples will be evaluated for immune cell markers and immune cell response to vaccine peptides at Jason Miska’s laboratory at Northwestern University. Advanced epitope spread assays will be conducted at University of Calgary in the laboratory of Aru Narendran, MD, PhD, a pediatric neuro-oncologist who specializes in immune monitoring of vaccines.

This advanced assay will allow Dr. Plant-Fox to learn specifically what the immune cells are targeting post vaccine administration. This type of information can help improve the vaccine product in the future or predict which molecular alterations in a patient’s tumor will make them more or less likely to respond to the vaccine. Pediatric research at Lurie Children's is conducted through Stanley Manne Children's Research Institute.

Parents are generally receptive to the use of artificial intelligence (AI) tools in the management of children with respiratory illnesses in the Emergency Department (ED), according to a survey from Ann & Robert H. Lurie Children’s Hospital of Chicago. However, some demographic subgroups (non-Hispanic Black and younger age parents) had greater reservations about the use of these technologies. These findings point to the importance of involving a broad representation of parents from the earliest stages of development of AI systems for pediatric healthcare. The study was published in the journal Academic Pediatrics.

“Our results suggest that development of AI tools to improve the care of children in an acute care setting needs to involve a diverse set of patient and parent stakeholders early on in the process to ensure that they are comfortable with the technology and that the new tools do not contain unintentional bias,” said lead author Sriram Ramgopal, MD, Pediatric Emergency Medicine physician at Lurie Children’s and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine.

Currently, AI is rarely used in pediatric acute care settings, but there is an increasing research interest in its potential.

“In pediatric research, an increasing number of AI or machine learning-based models have been reported,” said Dr. Ramgopal. “These models promise to provide greater diagnostic accuracy, identify patients at risk of severe outcomes, or detect patients in need of diagnostic testing or treatment.”

For the current study, surveys were completed by 1,620 parents in Chicago. Most respondents were comfortable with the use of computer programs to determine the need for antibiotics (77 percent) or bloodwork (76 percent), and to interpret radiographs (77 percent). The greatest perceived benefits of computer programs were finding something a human would miss and obtaining a more rapid diagnosis. Areas of greatest concern were diagnostic errors and recommending incorrect treatment.

“It is inevitable that AI will make it into routine pediatric practice,” said Dr. Ramgopal. “In the ED, we already use computer-based decision supports systems, which are precursors to AI. For example, we use a sepsis prediction model that alerts physicians to patients with higher risk. As with all such tools, these systems don’t dictate a particular course of action, but rather inform a physician’s approach to care in situations where a human might easily miss an important pattern in how illness presents itself. Our goal is to provide the most accurate and timely management for children in our care.”

Pediatric research at Lurie Children's is conducted through Stanley Manne Children's Research Institute.

Research Brief: Virtual Reality Helps Engage and Calm Children in Intensive Care 

Virtual reality is an exciting technology that has been shown to reduce pain and anxiety during procedures, particularly through distraction. Little research has been done on hospitalized children outside of this setting. A team of researchers from Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine sought to examine how virtual reality might impact patients admitted to the pediatric intensive care unit (PICU) and found that virtual reality can enhance the hospital environment for these children. They published their findings in Frontiers in Digital Health. Pediatric research at Lurie Children’s is conducted through Stanley Manne Children’s Research Institute.

The cross-sectional study involved having children aged 3–17 years who were admitted to a PICU use a virtual reality headset that delivered 360-degree immersive experiences. The researchers used standardized behavioral coding, patient and parent surveys, and patient physiologic responses to measure engagement with and reactions to the virtual reality experience.

The results showed that both patients and parents enjoyed interacting with virtual reality while admitted to the PICU. Additionally, both patients and parents reported that virtual reality was a calming experience, and that children were highly engaged with the device, which supports further study in PICU populations undergoing painful or stressful procedures, said Colleen Badke, MD, Attending Physician, Critical Care at Lurie Children’s and one of the study’s authors. The researchers also examined some physiological variables, including heart rate variability, to see if there were immediate and/or sustained changes during virtual reality use. Badke explained that while there were some short-term changes in heart rate variability while using virtual reality, they didn’t find any sustained changes in these physiological variables, which may have been due to the short duration of virtual reality.

These promising results support further investigation of virtual reality in critically ill children. “Next steps for future research could be to incorporate virtual reality into more procedural and stressful settings in the PICU to better understand how it might help children cope with medical interventions,” said Badke.

Badke CM, Krogh-Jespersen S, Flynn RM, Shukla A, Essner BS and Malakooti MR (2022) Virtual Reality in

the Pediatric Intensive Care Unit: Patient Emotional and Physiologic Responses. Front. Digit. Health 4:867961. doi: 10.3389/fdgth.2022.867961.

Firearms are now the leading cause of death for children and adolescents 0–19 years of age, with a staggering 83 percent increase in youth firearm fatalities over the past decade, according to a commentary published in Lancet Child and Adolescent Health. Nearly two-thirds of youth firearm deaths were from homicides. Strikingly, Black youth had an unprecedented 40 percent increase in firearm fatalities between 2019 to 2020.

These tragic statistics come in the wake of the elementary school shooting in Texas, pointing to the urgent need to take action to prevent more youth from dying by firearms.

“We must reverse this deeply troubling and unacceptable trend in youth firearm fatalities, especially among youth of color,” said co-author Karen Sheehan, MD, MPH, Pediatric Emergency Medicine physician and Medical Director of Patrick M. Magoon Institute for Healthy Communities at Ann & Robert H. Lurie Children’s Hospital of Chicago, and Professor of Pediatrics, Medical Education and Preventive Medicine at Northwestern University Feinberg School of Medicine. “We need more funding allocated to research-based prevention efforts so that we can save young lives before it’s too late.”

The authors also note that although firearm fatality rates started to rise in 2014, the dramatic societal upheaval of the COVID-19 pandemic likely accelerated this increase with the escalation of mental health stressors and existential despair experienced by youth. The seismic shift in youths’ lives during the pandemic occurred in the context of a decades’ long void of prevention efforts to decrease firearm injuries and deaths.

After Congress passed the Dickey Amendment in 1996, federal funding of firearm research was effectively halted, until 2019 when $25 million in research funding was appropriated. This pales in comparison to research funding for other pediatric diseases and does not meet the current needs to advance the field. Congress has continued to fund firearm research at this same level for the last three years, while studies estimate that $600 million should be appropriated in fiscal years 2022–2026 for data infrastructure and research funding for firearm injury prevention research.

“In addition to better understanding the risk and protective factors for firearm injuries and deaths, more funding is essential to develop, implement, and evaluate firearm injury prevention interventions at the individual, hospital, community, and policy levels,” said co-author Samaa Kemal, MD, MPH, Pediatric Emergency Medicine Fellow at Lurie Children’s. Pediatric research at Lurie Children's is conducted through Stanley Manne Children's Research Institute.

Adolescents who had access to firearms had about 1.5 times higher odds for prior suicide attempt and current suicidal ideation, according to a study published in the journal Academic Pediatrics. The study also found that one-third of adolescents coming to the Emergency Department (ED) for any reason had moderate to severe depressive symptoms, and over 40 percent of this group had access to a gun. This data was collected before the pandemic, during which EDs across the country saw an overwhelming increase in mental health burden in youth.

“Our findings underscore the importance of screening all adolescents who present to the ED for suicide risk and access to firearms,” said lead author Samaa Kemal, MD, MPH, Pediatric Emergency Medicine Fellow at Ann & Robert H. Lurie Children’s Hospital of Chicago. “This is even more critical now that we are in the midst of a youth mental health crisis.”

Currently, the Joint Commission mandates that all children over 12 years old should be screened for suicide risk, and if this risk is identified, screening for access to lethal means is recommended. However, screening for firearm access tends to be inconsistent in the ED.

Suicide is the second leading cause of death among adolescents in the United States, and adolescent suicide death rates have almost doubled over the past 10 years. Firearms accounted for 44 percent of suicide deaths among adolescents ages 14 to 18 between 2015 and 2020, with an estimated 70 percent of firearm-related suicide attempts involving weapons that were obtained within the victim’s household.

Dr. Kemal and colleagues analyzed data from over 15,000 patients ages 14–18 years seen at a tertiary children’s hospital ED between June 2013 and March 2020. Fourteen percent of the overall sample reported access to a firearm in the home or ability to access one within the next 24 hours. A history of sexual assault significantly increased the odds of a participant reporting a prior suicide attempt. Participants reporting verbal bullying, intimate partner violence, and/or abuse by a caregiver also had significantly increased odds of reporting current suicidal ideation and prior suicide attempt.

“Universal mental health screening of adolescents is particularly important in the wake of the COVID-19 pandemic, which has led to both increased firearm availability and worsening indicators of youth mental health,” said Dr. Kemal. “Proper screening for both suicidality and firearm access can create the opportunity to offer effective firearm safety counseling, such as keeping all firearms locked, unloaded and separate from ammunition, as well as linkage to mental health resources. We must do everything possible to prevent tragic deaths among teens who are struggling.” Pediatric research at Lurie Children's is conducted through Stanley Manne Children's Research Institute.

Studies have demonstrated that exposure to physical and psychological abuse in childhood is associated with cardiovascular risk factors in adulthood, such as high blood pressure, high cholesterol and type 2 diabetes. A new study shows for the first time that well-organized households protect children who have experienced abuse from developing some precursors to heart disease. Findings were published in the Journal of American Heart Association.

“Our results provide a glimmer of hope that nurturing and predictable home environments may attenuate the harmful health impacts of childhood abuse,” said study co-author Nia Heard-Garris, MD, MSc, a pediatrician at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine.

The study found that among Black men and white women with a history of childhood abuse, increased risks of high cholesterol were diminished if they grew up in well-organized households.

“It is encouraging to observe that well-managed households, where family members are involved in children’s lives, help build resilience in kids who have suffered abuse, not only on the emotional and cognitive levels but physically as well,” said Dr. Heard-Garris. “Our findings also suggest that racial disparities that are usually seen in cardiac disease may play a lesser role when children are raised in homes that offer a stable environment, as opposed to chaotic and overly permissive settings.”

Dr. Heard-Garris and colleagues used data from the ongoing Coronary Artery Risk Development in Young Adults (CARDIA) Study. In 1985, the CARDIA longitudinal cohort began following 5,115 African American and white adults to investigate the evolution of coronary heart disease during young adulthood. From 1985–1986, participants aged 18 to 30 years were recruited in four urban areas: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota, and Oakland, California. As part of the study, childhood environments (i.e., exposure to abuse, nurturing, and well-organized households) were examined retrospectively during the assessment conducted 15 years after the baseline examination. Incidence of cardiovascular risk factors, such as obesity, type 2 diabetes, hypertension and hyperlipidemia outcomes, were examined prospectively from baseline.

“Insights from our study could inform early interventions designed to prevent heart disease after adverse childhood events,” said Dr. Heard-Garris. Pediatric research at Lurie Children's is conducted through Stanley Manne Children's Research Institute.

Research Brief: Seeking Out Counter Stories May Help Clinicians Provide More Equitable Care  

Reducing health care disparities is a growing concern in the medical community. Research from Aleksandra E. Olszewski, MD, MA, Pediatric Critical Care Medicine Fellow (2021–2024), Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, is generating new perspectives on addressing this challenge.

Applying the critical race theory concept of counter narrative (a story that gives voice to groups who have been historically marginalized by challenging a dominant narrative created and communicated by people in power) to medicine could help inform researchers and clinicians about the experiences and perspectives of patients and families that might be overlooked or ignored to better provide more equitable care, explained Dr. Olszewski in a recently published paper in AMA Journal of Ethics. To accomplish this, there are a few steps that researchers and clinicians should take when they work with patients and their families, she said. They need to understand that “knowledge” about a situation is shaped by perspective and informed by social position and then recognize that there may be contrasting dominant and counter stories brought about by different perspectives of everyone involved. Finally, clinicians and researchers should seek out counter stories and give a critical look to dominant stories in clinical cases and in the research they conduct.

Dr. Olszewski is involved in other research projects that focus on health care inequities, including a qualitative project aimed at improving communications in care conferences of seriously ill children, and normative research developing a novel framework for addressing racism and anti-Blackness in clinical ethics consultation. She is also examining risk factors for post-traumatic stress disorder following admission to the pediatric intensive care unit and studying disparities in frequency of ethics consultation for pediatric patients and disparities in outcomes following rapid response team evaluations. An important aspect of her work seeks to understand and improve conflicts that develop between patient families and clinical teams by learning about the strengths and weaknesses of the mediation strategies and behavior modification strategies that are used in times of conflict. “While the goals of supporting families and maintaining a safe environment cannot always be reconciled, there is a need to explore how to achieve both goals as optimally and equitably as possible,” she said.

Pediatric research at Lurie Children's is conducted through Stanley Manne Children's Research Institute.

Olszewski AE. Narrative, Compassion, and Counter Stories. AMA J Ethics. 2022; 24(3): E212–217. doi: 10.1001/amajethics.2022.212.

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