Where the World Finds Bioethics Fri, 28 Aug 2015 18:08:58 +0000 en-US hourly 1 Are Arguments about GMO Safety Really About Something Else? Fri, 28 Aug 2015 14:54:00 +0000 0 Abortion: “Loopholes” and Attitudes Fri, 28 Aug 2015 00:21:20 +0000 Read More »]]> 0 Is ICU Treatment Inappropriate? Clinicians Now Have Guidelines Thu, 27 Aug 2015 22:35:00 +0000 0 Insured But Not Covered Thu, 27 Aug 2015 14:06:35 +0000 Under the Affordable Care Act, the percent of Americans who lack any health insurance has declined significantly. Put another way – more Americans have health insurance than ever. But having insurance coverage is different than being well covered by insurance. Sometimes a … Continue reading

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Child’s Garden for the ICU [EOL in Art 108] Thu, 27 Aug 2015 10:00:00 +0000 0 The Price of Academic Freedom Wed, 26 Aug 2015 19:31:03 +0000 by Craig Klugman, Ph.D.

Alice Dreger resigned from Northwestern University Feinberg School of Medicine/Memorial Hospital this week. The slash is because last year the hospital and the medical school merged. For the Medical Humanities & Bioethics program at Northwestern, that has meant a tumultuous year as it is readjusted to the new landscape.

Alice Dreger is a medical historian and advocate. Her position at the Medical Humanities & Bioethics program at Northwestern was a part-time, non-tenure track faculty member at Northwestern.…

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The Sale of Fetal Tissue Wed, 26 Aug 2015 15:04:00 +0000


Virtually everyone is familiar with Mitch Albom’s book, Tuesdays With Morrie. Myra Christopher (Foley Chair at the Center and former Center CEO) and Rosemary Flanigan (Retired Center Program Staff) have decided to regularly contribute to the Center for Practical Bioethics’ blog and call it “Tuesdays with Rosemary and Myra” (even though it won’t necessarily be published on a Tuesday). Read more about Rosemary and Myra at the bottom of this post.

The Sale of Fetal Tissue

M:  Rosemary, you know all the hub-bub about the video of the executive from Planned Parenthood being caught on tape talking about the sale of fetal tissue to two people posing as employees of a company looking to procure fetal tissue for research purposes. It’s been all over the Internet…

R:  I do know about it. It’s gone viral!

M:  It certainly has, and it has provided fodder for those hoping to be nominated by one of the parties for the 2016 presidential election. The video has been proven to be an example of “hit and run” journalism, but that doesn’t negate the ethical question that underpins it, i.e., “Is it acceptable to sell fetal tissue?” And that’s what I want to talk about.

R:  And I want to ask is there any difference in fetal tissue and other human tissue, all of which gets “sold.”


R:  Of course, there is something special about fetal tissue, but does that mean that it can’t be used for research. It’s not the same kind of tissue that comes off your elbow…

M:  Why not? What makes it different?

R:  It is because of the potentiality involved in what it can or could become, but let’s don’t have an argument about that right now. Even though it will certainly come up in our argument later, I’m still going to say that fetal tissue can be used for research purposes.

M:  Okay, but your first claim reminds me of one that Don Marquis, a philosopher at Kansas University, made in an argument against abortion years ago in an article he wrote for the Center. He said the difference between tissue from your elbow and a fetus is that the elbow has a past, i.e., we know something about the arm it hinged, but has no future, whereas a fetus has a future but no past that could reveal anything about its history or values. Is that your argument?

R:  No! It’s not just about tissue’s history; I am trying to skirt intrinsic worth. So, don’t you push me into talking about that, Myra Christopher. I hate objective whatevers!

M:  Whatevers? Sorry, Rosemary, but I want to push you just a little. Most all of us will say that human life is sacred/special, and what I want to talk about may align with your “potentiality” comment, but it may not; I don’t know. But I want to talk to you about the difference between human tissue and a human “being.”

R: I would find it morally reprehensible to use fetal tissue for insignificant research purposes.

M: You‘re still avoiding my issue, but OK….  Insignificant research like what?

R:  I’m trying to get circumstances involved here so that they cast a moral evaluation on their use in one instance and their not being used in another. For example, I would not object to fetal stem cells being used to find cures for cystic fibrosis or sickle cell disease, but I would find it morally reprehensible to use fetal tissue to find a better face cream and make old women look younger.

M:  I agree. I think it is repulsive. It reminds me of the former chair of the President’s Bioethics Commission Leon Kass’s determination based on what he called the “yuck factor”, i.e., if it is just plain old gross, it may be just plain old wrong.

R:  I’ve thought this for a long time, and there is something to be said that should lead us to reflect on why we feel the “yuck”, and maybe in some instances it should cause something to be tagged “unethical”, but in other instances it may simply be a societal “no-no”.

M: I think the point you are getting to is important – not just in this discussion, but in many arguments claimed to be “ethical arguments”. There are important distinctions that should be made between ethics, social norms, etiquette, and the aesthetic.

Last night, I was thinking about us possibly blogging about this topic today, and I remembered being at a women’s rights rally once and a person claiming to be absolutely opposed to abortion was walking around trying to force people to look at an aborted fetus she had in a box. It struck me as the epitomy of irony that a person crusading for the sanctity of life would objectify a fetus for political purposes. 

R:  Poor soul! She was very confused. 

M:  Rosemary, when I was thinking about this last night, I thought about the many, many times I have heard you ask (when teaching ethics committee members), “Is it wrong to torture little children?”

R:  “Needlessly, needlessly torturing little children!” Is what I asked? The point behind that was that, most often, general rules need to have adverbs to make them valid and true.

M:  I agree and add that speaking in “absolute” terms almost always forces you into a corner. But I want to go back to the distinction I need to make between human “tissue” and human “beings” Because it is critical to my position.

For me, “being” implies “personhood” and by that I mean an independent individual whether 1 day old or 100 years old. I would argue that it applies only to fetuses that are sustainable independent of the mother.

R:  You’re not placing the same meaning on potentiality that I am. So, you and I will have a different argument because we differ in the meaning of the potentiality involved in the fetus. That is so simple to me. You want to say that the point of differentiation is when it (the fetus) can live on its own. I say that is not the point; we have to respect it until it gets there; so I am going to call for more heavy arguments for the use of fetal tissue than you would before it is sustainable.

What I'm saying is that justification for use of fetal tissue ought to be weightier the closer the fetus comes to live birth before being aborted. I'm trying to show that potentiality develops and thus the arguments must take that development into account.

M:  I think that’s true. However, I think at a certain point in the development of the fetus our lines cross, and we find ourselves at the same place. However, I want to say that I agree wholeheartedly that fetal tissue, no matter the gestational age of the fetus from which it comes, should always be treated with respect. 

I am reminded of a situation years ago, probably 20 years ago, when a faith-based hospital reached out to the Center for help in deciding what to do with fetal tissue that was not suitable for research. Fertility specialists in their institution were burning such tissue in trash cans in their clinic. That is one extreme. Another was a time when the Center was contacted by a hospital because a group was demanding that the hospital “bury” fetuses with a proper ceremony – no matter its gestational stage.

R:  Why do you call burning tissue in a trash can an extreme?

M:  Good question, because I wouldn’t find it objectionable to burn it in the hospital’s incinerator.  I think the “aesthetics” of the situation were objectionable to me. The whole idea that it was “trash” bothered me and others in the hospital. 

R:  I see it’s not the “burning”; it’s the “trash” that bothers you. So much of these arguments depend on the way we use language and define specific terms.

M: Back to the Planned Parenthood fiasco; I think we agree and disagree about components of this situation. Although we get there along different paths, we agree that when used for significant research that could potentially help people living with disease and injury AND when conducted in done in a way that is respectful of the “donation”, the use of fetal tissue in research can be justified.

However, there are other important factors as well, including “tone”, context, and intent when in discussion about ethically sensitive issues.

About Rosemary and Myra

For several years before her retirement, Rosemary facilitated an online discussion group, primarily for ethics committee members, which had a faithful following. We hope some who participated and others will read our blog posts and respond with their thoughts on whatever subject we are writing about. We would also be grateful if you would provide suggestions for future blog topics. With your help, the two of us are moving into the 21st century, but for Pete’s sake, don’t expect us to tweet!

We have decided to write a regular blog for several reasons. First, there has never been a greater need for ethical reflection than there is today. We both agree about that, but we are very different people, and often disagree on issues. We hope it will be helpful for us to model respectful disagreement. In addition, we just finished writing a history of the Center which took us three years, and we enjoyed doing that so much that we need an excuse to continue writing together on a weekly basis. So, we don’t mind bothering you with our ideas.

I call myself a “philosophical Christian agnostic” and Rosemary is a member of the Sisters of St. Joseph of Carondolet. Rosemary taught high school English and philosophy at Rockhurst University. She is a stickler for the “King’s English” and proper grammar. I grew up in Texas and just like to talk. We are both old; I turned 68 in July; Rosemary is older. We both have had training and education in ethics, but Rosemary has a PhD. We have both worked in bioethics for many years, and we both LOVE to argue. As Rosemary says, “Doing ethics is all about argument.” But ethics is not about mean-spirited disrespectful exchanges that are so prevalent today in a “red-state/blue-state culture.” Through blogging, we hope that our agreements and disagreements will demonstrate that we can argue respectfully and still love and care about one another.]]> 0
Banning Abortion for Down Syndrome: Legal or Ethical Justification? Wed, 26 Aug 2015 14:54:00 +0000 Bonnie Steinbock]]> 0 Original Art in the ICU Waiting Room [EOL in Art 107] Wed, 26 Aug 2015 09:30:00 +0000 0 How Much Sugar Is in Your Beverage? Tue, 25 Aug 2015 13:20:09 +0000 Here’s a display from an elementary school science fair, cleverly showing how much sugar various beverages contain:

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Original Art in the ICU [EOL in Art 106] Tue, 25 Aug 2015 09:00:00 +0000 0 Canadian Medical Protective Association – End-of-Life Panel Tue, 25 Aug 2015 08:00:00 +0000 The Canadian Medical Protective Association works to protect the professional integrity of physicians and promote safe medical care in Canada.  Its annual meeting starts tomorrow in Halifax.  

The meeting includes a session on "End-of-Life Care: Medical Legal Issues." 


  • Mr. André Picard, Health reporter and columnist, The Globe and Mail


  • Dr. Douglas Grant, Registrar, College of Physicians and Surgeons of Nova Scotia
  • Dr. James Downar, Palliative care physician and intensivist, University Health Network
  • Mr. Eric van Wijlick, Senior policy advisor, Royal Dutch Medical Association
  • Mr. Domenic Crolla, Gowling Lafleur Henderson, CMPA General Counsel

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Reproducibility Project or Research Police? Tue, 25 Aug 2015 04:08:24 +0000 0 Seeing the Horror Tue, 25 Aug 2015 01:31:39 +0000 Read More »]]> 0 The "Dark Side" of Medical Education? Mon, 24 Aug 2015 16:32:00 +0000

It is rare that a medical journal would publish an essay by a physician anonymously which describes the "dark side of medicine" and perhaps including the "dark side" of medical education.  The article is in the August 18 2015 issue of the Annals of Internal Medicine 
and in an editorial  in the same issue, the following:

We hope that medical educators and others will use this essay as a jumping-off point for discussions that explore the reasons why physicians sometimes behave badly and brainstorm strategies for handling these ugly situations in real time. By shining a light on this dark side of the profession, we emphasize to physicians young and old that this behavior is unacceptable—we should not only refrain from personally acting in such a manner but also call out our colleagues who do. We all need the strength to act like the anesthesiologist in this story and call our colleagues “assholes” when that label is appropriate. We owe it to ourselves, to our profession, and especially to our patients. 

So this "dark side" can be said to also involves those of us in involved medical education such as myself.. Perhaps  medical educators are inadequately inspecting and controlling the content of the "hidden curriculum" being presented to medical students  and  not facilitating advice and support for those students and doctors who witness "dark behavior" to "speak up"  to the perpetrators but also to superiors in administration. 

By the way, if you want more, read the article in Better Health
an immediate response to the Annals essay.   ..Maurice.

Graphic: From Google Images and modified by me with ArtRage and Picasa3.

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“One Shoe Can Change Your Life”* Mon, 24 Aug 2015 11:00:55 +0000 by Jeanie Sauerland, BS, BSN, RN

I hate shopping for shoes – always have. Footwear was not the reason I chose nursing – but it sure made it nice, to be able to wear comfortable walking shoes without looking like you wore orthopedic shoes made for someone 90 years old. The world of white caps and starched uniforms disappeared long before I became a nurse. Even so, the shoes are still designed more for function than fashion: These are meant to be work shoes.…

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View from the Head End [EOL in Art 105] Mon, 24 Aug 2015 09:00:00 +0000 0 Do Not Leave Definition of Death Just to Doctors Mon, 24 Aug 2015 08:30:00 +0000 0 Ohio bill would forbid abortion of Down Syndrome pregnancies Mon, 24 Aug 2015 02:22:08 +0000 ]]> 0 Prescription for Medical Students: A Day at the Art Museum? [EOL in Art 104] Sun, 23 Aug 2015 10:00:00 +0000 0 Futility Dispute – Mary Jane Pierce v. B.C. Women’s Hospital Sun, 23 Aug 2015 10:00:00 +0000 0 600 Days of Death – Jahi McMath Sun, 23 Aug 2015 08:30:00 +0000 DocBastard posts some good thoughts on brain death and the Jahi McMath case by Cory Franklin, a retired ICU physician from Cook County Hospital in Chicago.  Franklin had a shorter version of his remarks in the San Francisco Chronicle.

"Any time you have a diagnosis with an outlier, it’s a good idea to review your original assumptions. In this case our assumptions about what brain death actually is."

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Stop Futile Treatment – Be Surgeons, Not Sissies Sat, 22 Aug 2015 09:00:00 +0000 At a recent panel discussion on geriatric medicine at Westmead Hospital (in Sydney) several leading specialists agreed doctors should be “surgeons not sissies” and objectively evaluate the prospects of successful treatment.

One surgeon, Henry Pleass, remarked:  “I work quite closely with physicians in renal transplantation and I’m amazed sometimes these people are still being dialysed. . . .  I think: ‘Why on earth are they doing that?’ because they are dialysing a corpse, so to speak."

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Music Thanatology [EOL in Art 103] Sat, 22 Aug 2015 08:00:00 +0000 0 The Private as Public: What it Means for Bioethics Sat, 22 Aug 2015 05:54:36 +0000 by Craig Klugman, Ph.D.

Today I was sitting in an outdoor coffee house and listened to the sounds around me. I heard the jackhammer from the street construction and the beep of a truck backing up. There was the gentleman working on his computer at the next table, playing music from his cell phone, out loud for everyone to hear. There were two women behind me (one actually moved so that she was next to me) speaking in very loud voices while one was convincing the other to use her as a web designer (and complaining about their boyfriends).…

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Man Experiencing First Real Moment of Peace in Years Resuscitated Fri, 21 Aug 2015 16:36:00 +0000 The Onion is so funny, because it is so true.

"Interrupting the only moment of genuine peace the man had known in several decades, a team of paramedics reportedly resuscitated area resident Alan Taborsky this morning following an apparent cardiac arrest."

"Reports indicated that just as Taborsky had reached a state of complete relaxation in which he felt unburdened by his life’s troubles for the first time in recent memory, medical technicians wrenched him back into consciousness with a pair of defibrillator pads."

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Humane Endeavor Fri, 21 Aug 2015 16:25:23 +0000 0 Is the Government Trying to Make Us Fat? Fri, 21 Aug 2015 12:53:07 +0000 The FDA has proposed new labels on grocery store food products, that adjust serving sizes to more accurately capture what Americans eat. Research I conducted with Steven Dallas and Peggy Liu suggests these labels could be a problem. Here is … Continue reading

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Some Reflections On Summer Vacation Reading Fri, 21 Aug 2015 09:08:03 +0000 0 Better to Burn Out than to Fade Away [EOL in Art 102] Fri, 21 Aug 2015 08:30:00 +0000 0 LaVecchia Brain Death Dispute Continues in NJ Fri, 21 Aug 2015 02:36:00 +0000 The New Jersey Record continues coverage of the Michael LaVecchia brain death dispute.

The family says that he was wrongly pronounced dead by St. Joseph’s Regional Medical Center.  They moved him to Robert Wood Johnson University Hospital.

The newspaper story includes a family-produced video showing relatives bending Michael’s bruised index toe on his left foot, which prompted a movement they believed to be a flinch.  His mother says: “He’s feeling something . . . to feel pain has to register in your brain somehow.”

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More about Doctor-Assisted Suicide—in California and Elsewhere Fri, 21 Aug 2015 01:21:49 +0000 Read More »]]> 0 Bioethics Deliberation and Education in Privacy and Progress Thu, 20 Aug 2015 18:36:15 +0000 0 Girlfriend in a Coma [EOL in Art 101] Thu, 20 Aug 2015 08:30:00 +0000 0 Minnesota Case Illustrates Importance of POLST Thu, 20 Aug 2015 02:58:00 +0000 0 More Brain Death Disputes – Michael Lavecchia III Wed, 19 Aug 2015 12:59:00 +0000 0 NIH Budget Increase on One Hand, Fewer Outputs on Another Wed, 19 Aug 2015 10:08:02 +0000 0 Don’t Fear the Reaper [EOL in Art 100] Wed, 19 Aug 2015 08:30:00 +0000 0 Aden Hailu – Another Brain Death Lawsuit Wed, 19 Aug 2015 08:30:00 +0000 0 Health Care Reform in Minnesota: Mission Advanced But Not Accomplished Tue, 18 Aug 2015 22:23:00 +0000 The Hamline Law Review has just published its Symposium Issue: Health Care Reform in Minnesota: Mission Advanced But Not Accomplished, Volume 38, Issue 2 (2015).  This is the printed product from the Hamline Health Law Institute's October 2014 conference.

Thaddeus M. Pope

Deborah Farringer

Autumn AmadouBlegen

Mary Pareja

Daryll Dykes

Lawrence Massa and Matthew Anderson

James Teufel and Shannon Mace

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Sleepless in the Hospital Tue, 18 Aug 2015 13:59:51 +0000   A while back, I wrote a piece on the problems caused when hospitals don’t coordinate care in a way that promotes patient sleep. Now Shefali Luthra, a reporter at Kaiser Health News, has written a great piece, delving deeper into this … Continue reading

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The Knife and Gun Club: Scenes from an Emergency Room [EOL in Art 99] Tue, 18 Aug 2015 09:30:00 +0000 0 A Matter of Ethics and Policy in the Era of Regenerative Transplantation in the United States Mon, 17 Aug 2015 20:41:08 +0000 by Macey L. Henderson and Brianna L Doby

Why do we need to care about the ethical development of health policies that impact research, donation, and transplantation in the United States? The story of Zion Harvey is a good place to start.

Zion lost all of his limbs to amputation from sepsis at the age of two. The infection that ravished his body and took his limbs also caused renal failure, resulting in a successful kidney transplant when he was 4 years old.…

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Rediscovering a history of trauma: An interview with Dr. Annita Sawyer Mon, 17 Aug 2015 18:20:22 +0000 0 Disliking Obamacare despite Benefiting from It Mon, 17 Aug 2015 12:22:27 +0000 No surprise to learn that the majority of Republicans dislike Obamacare. But did you know that the majority of Republicans, who SIGNED UP FOR INSURANCE through Obamacare, still dislike the law? That’s one finding from a recent Kaiser survey: Notably, … Continue reading

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Lessons from the Death of Charles II [EOL in Art 98] Mon, 17 Aug 2015 09:30:00 +0000 0 Rapping about Dying Mon, 17 Aug 2015 07:30:00 +0000 ZDoggMD is something of a celebrity among physicians and medical students. He is the “Weird Al” Yankovic of the medical world – parody songwriter extraordinaire, satirist of medical culture and, at his best, a seriously funny human being. Whether lampooning hospital readmissions or mocking anti-vaxxers, his music videos bring humor to physicians’ challenges as well as their follies.

But listen closely and you will find that, beneath the humor, there often lies a serious message in ZDoggMD’s lyrics. The parodies aim to entertain healthcare workers, of course. But they also seek to educate. “Let’s just prevent readmissions/manage those chronic conditions/need time preparing the handoffs/move along to other clinicians,” he raps in “Readmission,” a parody of the R&B hit “Ignition (remix).” In the music video, ZDoggMD utters these lines in a hospital ward, wearing a lavish fur coat and sunglasses in the fashion of a rap musician. The routine is absurd – and funny – but the goal is more than mere entertainment. ZDoggMD’s light touch of humor warms us up for a serious conversation on a topic that is no laughing matter.

Ain’t the Way to Die

For his latest video, “Ain’t the Way to Die” (a parody of Eminem’s “Love the Way You Lie”), ZDoggMD forgoes humor altogether – a first, according to his blog. Stripping away humor, the song takes a more direct approach to talking seriously about a topic that many of us prefer to avoid – death and dying. As ZDoggMD writes, “…we too often fail to have those difficult but crucial discussions about dying, and this failure leads to untold human suffering and billions in squandered resources. We are failing as caregivers, we are failing as family members, and we are failing as individuals – failing to simply have a conversation that ensures that we direct our own destiny. Plainly put, we need to talk about dying.”

Talking about dying is hard. It’s uncomfortable. As a medical student, I’ve become acutely aware of the discomfort. I feel it too, even as an observer. For all of us, the challenge is to communicate effectively about death and dying in spite of the discomfort, and in that regard ZDoggMD’s sentiment too often rings true: We are failing as caregivers, family members, and individuals to have these crucial conversation about the end of life.

Conversation Starter

Thankfully, there are people working to make these conversations a little easier. Caring Conversations, a resource developed by the Center for Practical Bioethics, for years has guided patients and their families through the process of advanced care planning. In its own way, ZDoggMD’s “Ain’t the Way to Die” can also facilitate these conversations, by melodically breaking the ice on death and dying: “Just gonna stand there and watch me burn/end of life and all my wishes go unheard/they just prolong me and don’t ask why/it’s not right because this ain’t the way to die, ain’t the way to die.” 

The musical stylings may be off-putting to some, but for those who enjoy rap music – and those who can tolerate it – the lyrics of “Ain’t the Way to Die” succeed in broaching a wide range of end-of-life issues, from family discord to resuscitation. And this brings us to what is perhaps the greatest virtue of “Ain’t the Way to Die” – that the breadth of issues addressed in the short video makes the parody a conversation-starter for healthcare workers and patients alike.  

All of us must find a way to communicate clearly in conversations about the end of life. “Ain’t the Way to Die” may help some of us find the words to do so. With that in mind, I encourage you to watch the video and share it with others.  No matter one’s background or profession, each of us will one day face the end of life. Starting a conversation about how you want to face it gives you the best shot at doing it on your own terms. 

Written By Joel Burnett. Joel Burnett is an MD candidate at the University of Kansas School of Medicine. ]]> 0
Comforting the Dying [EOL in Art 97] Sun, 16 Aug 2015 09:00:00 +0000 In "La Miseria"  Cristóbal Rojas depicts a man sitting vigil next to a female companion suffering from tuberculosis.

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POLST Designers Must Consult Medical Ethicists Sun, 16 Aug 2015 08:00:00 +0000 0 A biblical view of animals Sat, 15 Aug 2015 15:00:55 +0000 Read More »]]> 0