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Spring 2006 Newsletter

On-Line Newsletter Volume 4, Number 3
Published May 13, 2006

Edited by Chaplain John Ehman, Network Convener

Network members are encouraged to submit articles for upcoming issues
of the Newsletter, which is published three times a year: Fall, Winter, and Spring.
The Fall 2006 issue is scheduled to be posted in October.

Table of Contents

  1. Note to the Network from the Co-Author of Healthcare and Spirituality
  2. Responses to the April 2006 Article-of-the-Month: an Ethnographic Study of Chaplains; and the Author's Reply
  3. Survey Available On-Line about CPE Supervisors' Responsibilities and Time Allocations
  4. Study Estimating How Many Hospitalized Patients Are Visited by Chaplains
  5. Update on the "Structured Descriptions / Ideal Interventions" Project
  6. Announcement of a New Center for Spirituality and the Mind
  7. Bibliography of Articles on Spirituality and Health Indexed on Medline in 2005
  8. Web Finds: An Annotated Bibliography on Dementia and Spirituality by the Christian Council on Ageing Dementia Group (UK)


1.     Note to the Network from the Co-Author of Healthcare and Spirituality

[Editor's Note: This new book (from Radcliffe Publishing, 2005/2006), by Stephen P. Kliewer, DMin, Assistant Professor, Department of Family Medicine, and John Saultz, MD, Professor and Chair, Department of Family Medicine, Oregon Health and Science University, is a thorough treatment of the subject for clinicians, with copious chapter notes/references, and appendices that include "Active Listening Skills," "The Spiritual Involvement and Beliefs Scale," and "Sample Meditations, Writing Exercises, and Drawing Exercises." Stephen Kliewer has written the following to our Network:]

Healthcare and Spirituality is an introductory textbook which emphasizes the need to integrate spiritual issues in the process of healthcare and introduces a patient-centered, holistic approach. The book begins by looking at the concept of personhood, and suggests that we must take seriously the multidimensional nature of human beings when addressing health care issues. Traditional treatment approaches have often artificially isolated the various aspects of the person, and spiritual, social, emotional and physical issues have been dealt with separately. This book suggests that we cannot place the various aspects of the self into such silos, but must honor the fact that they are profoundly integrated.

As it introduces an integrative approach, the book suggests that each person be treated as a "culture of one." Each person has a unique set of life experiences, values, beliefs, and environments that shape him or her. Thus, in approaching the client, we suggest what can be called "contextual care." This approach involves a process which begins with the gathering of information, moves to assessment, and then to intervention. Through this process the healer is challenged to look at all aspects of the person, and explore how what is happening in one facet of that person's life affects the whole person. This allows an approach to healing to be developed that addresses not only physical, but also social, emotional and spiritual issues. Only in this way can people be moved from a state of dis-ease to ease.

The book provides a wide variety of tools for gathering information and spiritual assessment. It also provides a number of suggestions about how physicians and other providers can facilitate appropriate interventions. It explores how to address spiritual issues that may be a barrier to healing, as well as how to access spiritual strengths that may be an aid to healing. It also looks at how various kinds of providers--physicians, mental health providers, chaplains, and other religious leaders--can work together in the healing process.


2.     Responses to the April 2006 Article-of-the-Month: an Ethnographic Study of Chaplains; and the Author's Reply

The April 2006 Article-of-the-Month, "The ambivalent chaplain: negotiating structural and ideological difference on the margins of modern-day hospital medicine," by Frances Norwood, PhD [Medical Anthropology 25, no. 1 (January-March 2006): 1-29], has stirred discussion in the Research Network and the ACPE in general. The following are two responses to the study and the author's reply.

From The Rev. Kyle D. Johnson, Chaplain, U.S. Army (Retired):

a) The article is about chaplains and CPE residents working in a hospital. This article adds to the discussion of our work at the very least.

b) The author correctly points out the different paradigms between medicine and pastoral care. She does a good job recounting the history of the two disciplines over the past few hundreds years. What is missing is the key reason these paradigms are different. The key reason is medicine went thru a "Kuhnian revolution" where a discipline becomes a scientific discipline. The language and concepts of science replaced the medieval ones. Pastoral care and counseling never underwent a Kuhnian revolution. Recognition of medicine's Kuhnian revolution is crucial to understanding how medicine’s paradigms are different from pastoral care and counseling.

c) The author omits a very important reality in medicine today, "legal liability." Hospitals and their staff face legal liabilities with every patient under their care. One reason medical staff are resistant to outside disciplines is because the hospital and hospital staff assume responsibility for the patient's total well being while that patient is under their care. Unintentional harm to a patient by nonstaff, including clergy, can result in legal liabilities for the hospital and staff.

d) The author's dated materials miss the growing responsibility of hospitals and hospital staff to address patients' spiritual needs. JCAHO now requires hospitals and hospital staff to assess and provide for patients' spiritual needs. Spiritual assessments are to be performed upon a patient's admission. While the JCAHO requirements are very flexible currently, hospitals and hospital staff responsibilities for insuring care for patients' spiritual needs are increasing.

e) One very important point that I find missing in the literature is the U.S. Constitution's right to the "free exercise" of one’s religion. The issue ties in nicely to the legal liabilities that hospitals and hospital staff assume. Patients retain their constitutional rights upon admission. Hospitals and hospital staff assume a legal responsibility to insure that patients' constitutional rights are respected. The chaplain is the most qualified hospital staff professional to insure that patients' constitutional "free exercise" rights are protected.

The constitution’s "free exercise" clause also includes the right of "freedom from religion." Chaplains are uniquely qualified to help hospitals and hospital staff to find that balance between a patient's "free exercise" of religion and a patient's "free exercise" from religion. No other profession devotes as much time to studying how to create ecumenical environments as chaplains do.

The increasing respect for patients’ spiritual needs and JCAHO's increasing requirement on hospitals and hospital staff to provide for those spiritual needs mean that hospitals and hospital staff are inching closer and closer to the day when neglect of patients' spiritual needs could become a financial liability as well as a legal one. The workplace and educational environments already have seen litigation and costly lawsuits of businesses and schools that refused to address an individual's spiritual needs. These lawsuits have included both the "free exercise" of religion and "free exercise" from religion issues.

Chaplains need to alert their hospital administrators and staff to patients' "free exercise" rights and increasing JCAHO requirements. The legal door may help chaplains level the playing field in the performance of their work and ministry.

From The Rev. Dr. Timothy A. Thorstenson, Allina CPE Center, Abbott Northwestern Hospital, Minneapolis MN:

The issue for me in the article is the polarized view, the two "valences," if you will, between which the author sees the chaplain as needing to choose. Beware of authors who write about chaplaincy from an objective position. If, in fact, the chaplains observed in her study need to align either with medicine or religion in order to survive, then the training program in that hospital has not progressed with the natural evolution of our role. It does, however, point up the very real challenge facing our organization, which I see as needing to articulate an integrated, holistic model in which spiritual reflection engages and interprets science in order to support and facilitate the processes of adaptation and meaning making. It's unfortunate that the stories she tells reflect traditional, intuitive models of pastoral care that do not capture the edges that many of us believe are where the real work of ministry happens. We have indeed become a disparate organization with a broad range of practices, and with an evolving core that remains shrouded in mystery.

Author's Reply by Dr. Frances Norwood:

First, I would like to thank the ACPE Research Network for featuring my article on its website. While I enjoy getting my work out to fellow anthropologists, I am thrilled to be able to reach chaplains and those interested in the place of spirituality and religious practice in modern-day healing. In the time I spent with chaplains and CPE interns I found myself drawn to the beauty and value of what they do, yet could not help but to see the structural and ideological barriers that they face in attempting to find place in such a highly technical, bureaucratic, and medicalized environment. This became the focus of my article.

In reading through the comments submitted by Chaplain John Ehman [--part of the Article-of-the-Month page], Reverend Dr. Timothy A. Thorstenson, and Reverend Kyle D. Johnson, I found a lot of good points that speak to how complex the relationships are among medicine, religion, chaplains, law and history. While these three authors bring up a number of excellent points, I would like to focus on two: (1) on generalizations and particulars in qualitative method and (2) on paradigm shifts and taking a polarized view of medicine and religion.


Ehman states, "the data here, taken from a single hospital setting and focusing on CPE interns, are not given to generalizations about chaplains per se." This, he says, is one of the more important limitations to my study that should have been addressed in the article. I agree with Ehman and if I could I would add some discussion like the following to my next article.

Qualitative methods have limitations and let me talk for a moment about what they are. We anthropologists have a history of struggling against a dominant paradigm that favors quantitative methodology (using structured, de-contextualized survey data from a larger sample that is selected to be as representative of the target population as possible) over qualitative methodology (using a large amount of contextual-based observation and interview data from a smaller, often non-representative sample). One common set of critiques of quantitative methods is that surveys do not always provide appropriate responses for those taking the survey, that too many of the variables that are removed, remove also the important context, and that the summation of responses represents an "average" that does not exist in reality. Life is nuanced and surveys are not the tool for capturing the nuances of living. Qualitative methods, on the other hand, tend to capture one or just a few highly nuanced experiences, but because of the limitations of small, often non-representative samples, it may be difficult to make generalizations about behavior based on qualitative samples.

These critiques of research methodologies oversimplify the limitations inherent in choosing one or the other technique of inquiry. Anthropologists attempt to address the limitations to qualitative method by increasing the amount of data collection that occurs and by triangulating data. We spend hours, days, months, years with study participants in their settings and then compare data collected from different participants, over time, in different settings, and via different data collection methods (observation and different styles of interview, for example). What happens when we begin to analyze these data is that we do find patterns of behavior that suggest generally held beliefs and practices. The question about generalizations made in my research, however, remains: "what is common to the hospital, time, and participants with whom I worked and what is common to all hospitals, chaplains or chaplain interns?"

Marilyn Strathern runs up against this similar quantitative-qualitative dilemma in her research for After Nature (1992). She suggests that there is no generalizing about human behavior because no one lives a "generalized life." Even so, she argues, general patterns are inherent to any collection of behaviors (in any repeated behavior you will find patterns) and so her task is not to describe a subculture within a culture, but to describe behavior that encompasses both the "representative" and the "unrepresentative." Thus Strathern uses qualitative methods to see what can be said about both the particular and the general (1992:22-30). Is what I found to be commonly held behaviors, ideas and values at "State University Hospital" and among chaplains and chaplain interns indicative of what are commonly held behaviors, ideas, and values elsewhere? Yes and no. Yes, it points to commonalities across the U.S. in other hospitals and possibly in other time frames and no, every detail will not resonate with every chaplain or in every hospital. In the end, I am suggesting that in general I do believe that there are ideological and structural barriers that chaplains (and CPE interns) learn to negotiate (or not). The details of what these barriers are, what chaplains do, and the power differential that exists, while they may be similar in other places, are more likely to be particular to my study setting. To me, one final check of whether I have described something that can be said to be representative beyond my sample is the reaction I get from readers and whether they find something that resonates for them in the text.


Thorstenson raises the important caution about looking at chaplain work from the polarized view of medicine versus religion. Johnson suggests that there is more to medicine and pastoral care than I covered in my article and Ehman suggests that since my research that the "structural and ideological dominance of medicine" may have changed. I agree with all of these critiques. I, too, think that "medicine" and "religion" are moving targets and are highly nuanced from time to place. As concepts, they are difficult to bind or describe such that they almost do not "exist" in any one time or place at all. Yet, what is that "thing" that you encounter (as a patient, a visitor, or staff member) when you walk into a hospital anywhere in the U.S.? The collection of activities, ideas, history, and consequences that is "medicine" and have emerged around "medical practice" has been different from those around "religion" and "religious practices. " I do not think that the differences can be well articulated by following the line of argument that medicine underwent a "Kuhnian revolution," while religion did not. There is a power differential that you feel when you walk into a hospital and begin to have interactions that I believe is better captured by a Foucauldian perspective, than by the presence or absence of "scientific revolution" as described by Thomas Kuhn.

Take, for instance, the history of chiropractic care and osteopathy and how these remarkably similar "alternatives" to medicine faired quite differently in relation to the dominant paradigm. Osteopathy was founded in 1872 by Dr. Andrew Taylor Still. Chiropractic was founded in 1895 by Daniel David Palmer, a former student of Dr. Still’s. Both osteopathy and chiropractic are based in a belief that a variety of health ailments can be cured by non-invasive techniques of spinal adjustment or manipulation, but where osteopaths aligned themselves early on within dominant medical paradigm(s), chiropractic and the American Medical Association (AMA) have a long history based in ideological and legal opposition. Over time, osteopathy has come to rest within medicine (for which I am certain there are consequences both pro and con) and chiropractic, after a long, legal battle with the AMA has found place outside of medicine, but now increasingly within the scope of HMOs and other private insurance coverage. This is important because where one is positioned in relation to dominant paradigms matters. It affects what you do and how you are able to do it, and these are the tensions that are illuminated when you choose an analytical position of examining concepts defined within a polarized framework. There are certainly shortcomings to taking this stance, but given the palpable nature of power that I felt when doing my fieldwork (and in subsequent fieldwork in medical settings), it was a stance I was willing to take to make a point.

I was so moved by what chaplains do, by those who knew both how to do their job well and knew how to work within the system to get their job done and by those who struggled both with who they were in relation to their religion and their profession and who they wanted to be in relation to the hospital and their patients. I was also struck by how much this kind of healing and connection is needed. It is my hope that my article sparks chaplains, CPE interns, and interested others to reflect on how they as a group are situated vis-ŕ-vis the system in which they work. Chaplains should have a presence in our hospitals and I look forward to seeing how they participate, adapt, and grow in relation to medicine and the people they serve.

Thank you to Joan Hemenway for submitting my article and thank you to John Ehman, the ACPE and everyone who shared comments. Please feel free to direct any further correspondence to

Frances Norwood, PhD
Inclusion Research Institute (

REFERENCES AND RESOURCES [re: Dr. Norwood's reply]

American Osteopathic Association --

The history of chiropractic. World Chiropractic Alliance. --

History of chiropractic care. American Chiropractic Association. --

The history of osteopathic medicine virtual museum. American Osteopathic Association. --

Howell, Joel D., M.D. 1999. "The paradox of osteopathy." The New England Journal of Medicine 341:1426-1431, 1465-1467. Found on Dr. Joseph Mercola website,

Kuhn, Thomas S. 1996 [1970]. The Structure of Scientific Revolutions. Chicago: University of Chicago Press.

Osteopaths and chiropractors: similarities and differences. Osteopathic Treatment Centre. --

Strathern, Marilyn. 1992. After Nature: English Kinship in the Late Twentieth Century. Cambridge University Press.

Survey of HMOs finds greater alternative care access. Dynamic Chiropractic 17(10) --


3.     Survey Available On-Line about CPE Supervisors' Responsibilities and Time Allocations

"A Survey of Responsibilities and Time Allocations, Including Supervision, Pastoral Care and Administrative Tasks, among Currently Practicing Supervisors of Clinical Pastoral Education," by Ken Blank and John W. Campbell, of the Oklahoma Health Center Clinical Pastoral Education Institute, is available on line through the Current Research section Institute's web site [--note: the site ceased operation in 2010]. Data collection from surveys returned by 22 supervisors occurred in 2003. Among the findings:

  • What specific types of tasks occupy the average CPE supervisor in CPE duties? About 40% of this time is group supervision activities. Twenty percent appears to be in individual supervision, with close to 20% percent in all other direct supervision. About 10% is reserved for didactics. The smallest component of CPE duties, around 5%, is devoted to direct supervision of the SIT. Over all, direct supervision of students occupies, on average, about 35% of the supervisor's time each month.
  • Forty percent of CPE supervisors carried the on-call pager for their institution, however of those who did, they carried it for only an average of 6% of their time per month. Twenty percent of CPE supervisors carried the pager as back-up chaplain. During this on-call period, the CPE supervisor had about a 50-50 chance of actually being paged on average.
  • Forty-four percent of those responding...claimed to work in excess of 200 hours per month on average, meaning essentially working nearly every weekend or late into several weeknights or a combination.
  • ...[T]he perception of CPE supervisors is that their current workload is significantly more demanding and the average number of hours worked each month significantly increased over the past five years. Sixty-four percent of supervisors stated their job has become more demanding, 14% believe it is less demanding, and 23% felt their job was about as demanding today as it was five years ago.
Rev. Blank is a CPE Supervisor and the Executive Director of the Institute, and Dr. Campbell is the Director of Research. They also regularly provide a Medicine & Spirituality column in their monthly publication, Oklahoma Health Center News, examples of which are available here (with permission) as PDFs: "Asking About Faith: A Clinical Professor Instructs Medical Students," "What Is On the Family Physician's Mind: Spirituality in Their Clinical Practice," "You Go First!: Bringing Up Religious Issues in Clinical Practice," "Motivation: Is Fear of Death the Only Reason for Religion?" "Spirituality of Medical Residents: A 'Vaccination' against Depression?" and "Transcendental Meditation: Any Effects on Health?." Other projects currently underway include a qualitative study of perceptions of clergy observing cardiac surgery, a survey of services provided by chaplains, and several educational initiatives with the University of Oklahoma College of Liberal Studies and the College of Medicine.


4.     Study Estimating How Many Hospitalized Patients Are Visited by Chaplains

A study by Kevin J. Flannelly, Kathleen Galek and George F. Handzo, "To what extent are spiritual needs of hospital patients being met?" has been reported in the International Journal of Psychiatry in Medicine [vol. 35, no. 3 (2005): 319-323]. The authors calculate an estimate based upon findings from earlier studies regarding patient referrals and their relation to actual visits. They conclude:

…[W]e estimate that chaplains visit 10% to 30% of patients who are hospitalized, with a point estimate of 20%. Naturally, these percentages only apply to hospitals that have chaplains. However, a national survey of hospitals that we conducted found 80–95% of hospitals with an average daily census of 100 or more patients employ chaplains. [p. 321]
While this is rough figure, it should be helpful both to researchers and to pastoral care directors in the task of assessing with increasing accuracy how chaplains are responding to spiritual needs. The authors point out, however, that future research should also consider how many patients are visited by their own clergy.


5.     Update on the "Structured Descriptions / Ideal Interventions" Project

Henry Heffernan has continued to develop the "Structured Descriptions / Ideal Interventions" project to create a databank resource of potential best practice approaches to pastoral care. As reported in the Winter 2006 Newsletter (§2), Supervisor John Gleason included the Ideal Intervention Paper Exercise in his Spring Extended CPE Unit at St. Vincent Hospital in Indianapolis, IN, and five student papers have now been submitted. Three other supervisors have stated their plans to incorporate the Ideal Intervention Paper Exercise into their curricula, and a number of others have indicated an interest in participating in this first phase of the project. Chaplain Heffernan is creating a series of supporting materials, and three are available here as PDFs for review and feedback: "A Databank Resource for Pastoral Research: Detailed Descriptions of Chaplains’ Visits with Patients," which gives an thorough overview of the project, "The Ideal Intervention Paper Exercise: The Learning and Maturing Experience for the CPE Student," which addresses the IIP Exercise in terms the fundamental purpose of CPE and the practical course of a student program, and "The Terminology and Concepts of Pastoral Practice," which lines out the variety of language used to describe what chaplains do. [Note also that a draft of a "CPE Student’s Manual for an Ideal Intervention Paper: A Structured Description of a Patient Visit" was published with the Winter 2006 Newsletter (§2).]

To offer feedback on the draft papers, or to explore the option of incorporating the IIP Exercise into upcoming CPE units, contact John Gleason ( or Henry Heffernan ( directly. Supervisors may also wish to contact John Gleason about his experience of introducing the exercise into a hospital-based CPE program. While the project is at this point focused on the place of the IIP in CPE curricula, the broader goal is to create a databank that includes input from a broad range of both students and professional/staff chaplains.


6.     Announcement of a New Center for Spirituality and the Mind

[Note (added 10/30/10): The Center for Spirituality and the Mind was dissolved in October 2010, when Andrew Newberg's moved from the University of Pennsylvania for Thomas Jefferson University.] A new Center for Spirituality and the Mind was announced on April 25, 2006, at the 9th annual Spirituality Research Symposium of the Pastoral Care Department of the Hospital of the University of Pennsylvania. The Center's mission is to explore the relationship between neuroscience, cognition, behavior and religious and spiritual phenomena through interdisciplinary research, education and dialogue. Organizing this initiative is Andrew Newberg, MD, author of Why God Won't Go Away: Brain Science and the Biology of Belief and Why We Believe What We Believe. Dr. Newberg's neurological research, especially his brain scans of Buddhists and Catholic nuns engaged in meditation and prayer, has received wide attention in recent years. (A 2001 interview on National Public Radio's Fresh Air offers a good introduction to his work--and may be heard through the NPR site.) He is also the project leader for the lecture series, Mind, Religion and Ethics in Dialogue --a winner of the Templeton Research Lectures Program on the Constructive Engagement of Science and Religion. It is noteworthy that the scope of the new Center is intentionally inclusive of chaplains, and initial projects include a web-based survey of spiritual experiences, a curriculum on psychology and health for clergy and chaplains, and the development of a "Systematic Spiritual History" for patients in health care settings. [For a recent popular article on Newberg's work, click HERE (PDF).]


7.     Bibliography of Articles on Spirituality and Health Indexed on Medline in 2005

The latest bibliography of Medline-indexed articles pertaining to Spirituality and Health, from the University of Pennsylvania Department of Pastoral Care ( is now available as a printable PDF at The full, annotated bibliography of 240 articles runs 40 pages and covers research reports, general reviews, and commentaries appearing in the health care literature. The following is a small sample of titles that have not already been noted in our Articles-of-the-Month pages or Newsletters from 2005:

Ano, G. G. and Vasconcelles, E. B. "Religious coping and psychological adjustment to stress: a meta-analysis." Journal of Clinical Psychology 61, no. 4 (Apr 2005): 461-480.

Bell, R. A., Suerken, C., Quandt, S. A., Grzywacz, J. G., Lang, W. and Arcury, T. A. "Prayer for health among U.S. adults: the 2002 National Health Interview Survey." Complementary Health Practice Review 10, no. 3 (Oct 2005): 175-188.

Berry, D. "Methodological pitfalls in the study of religiosity and spirituality." Western Journal of Nursing Research 27, no. 5 (Aug 2005): 628-647.

Brillhart, B. "A study of spirituality and life satisfaction among persons with spinal cord injury." Rehabilitation Nursing 30, no. 1 (Jan-Feb 2005): 31-34.

Chochinov, H. M. and Cann, B. J. "Interventions to enhance the spiritual aspects of dying." Journal of Palliative Medicine 8, suppl. 1 (2005): S103-115.

Holland, J. M. and Neimeyer, R. A. "Reducing the risk of burnout in end-of-life care settings: the role of daily spiritual experiences and training." Palliative and Supportive Care 3, no. 3 (Sep 2005): 173-181.

McCauley, J., Jenckes, M. W., Tarpley, M. J., Koenig, H. G., Yanek, L. R. and Becker, D. M. "Spiritual beliefs and barriers among managed care practitioners." Journal of Religion & Health 44, no. 2 (2005): 137-146.

Meert, K. L., Thurston, C. S. and Briller, S. H. "The spiritual needs of parents at the time of their child's death in the pediatric intensive care unit and during bereavement: a qualitative study." Pediatric Critical Care Medicine 6, no. 4 (Jul 2005): 420-427.

Okon, T. R. "Spiritual, religious, and existential aspects of palliative care." Journal of Palliative Medicine 8, no. 2 (Apr 2005): 392-414.

Stefanek, M., McDonald, P. G. and Hess, S. A. "Religion, spirituality and cancer: current status and methodological challenges." Psycho-Oncology 14, no. 6 (Jun 2005): 450-463.

Tartaro, J., Luecken, L. J. and Gunn, H. E. "Exploring heart and soul: effects of religiosity/spirituality and gender on blood pressure and cortisol stress responses." Journal of Health Psychology 10, no. 6 (Nov 2005): 753-766.

Wink, P. and Scott, J. "Does religiousness buffer against the fear of death and dying in late adulthood?" Journals of Gerontology Series B-Psychological Sciences & Social Sciences 60, no. 4 (Jul 2005): P207-214.


8.     Web Finds: An Annotated Bibliography on Dementia and Spirituality by the Christian Council on Ageing Dementia Group (UK)

The Christian Council on Ageing is an ecumenical Registered Charity organization in the UK devoted to the spiritual needs and development of older people. The bibliography is accessible on line as a PDF at (through the site for the Foundation of Lady Katherine Leveson at Temple Balsall, which notes also a variety of "Publications from the Leveson Centre" regarding work with older people).


If you have suggestions about the form and/or content of the site, e-mail Chaplain John Ehman (Network Convener) at .
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The ACPE Research Network. All rights reserved.