AJWRB - New article

by Lee Elder 8 Replies latest watchtower medical

  • Lee Elder
    Lee Elder

    AJWRB has published a new article regarding the WTS most recent comments regarding their blood policy. The article can be viewed online:

    http://www.ajwrb.org/review6-15-04.shtml

    It is also available in PDF format:

    http://www.ajwrb.org/6-15-04response.pdf

    And we are making the article available in this forum as well. Text follows below.

    Lee Elder

    AJWRB

    Review of the

    By, Associated Jehovah's Witnesses for Reform on Blood (AJWRB)

    Available as a PDF file


    Introduction

    With its Watchtower journal the Watch Tower Bible & Tract Society (WT) has offered information intended to underpin its doctrinal position on blood as applied toward members of the religion known as Jehovah?s Witnesses (JWs).

    In a nutshell, the WT has a policy to enforce extreme shunning of JWs by fellow JWs for conscientiously accepting whole blood, red cell, white cell, platelet or plasma therapies (transfusions) even at the risk of premature death. By instigation of the WT, the same policy is also enforced by JW parents upon their unsuspecting children, again even if premature death is probable. The result of noncompliance for these parents is to face extreme shunning themselves. 1

    The June 15 2004 Watchtower journal also provides for the first time a clear diagram of what components 2 of blood are forbidden by the WT and which are not forbidden by the WT. This diagram illustrates that red cell, white cell, platelets and plasma constituents fractionated from blood are forbidden for JWs. The diagram also illustrates the acceptability of constituents resulting from different fractionation. So, for example, this doctrinal position requires JWs to shun JWs who conscientiously accept transfusion of a platelet agent fractionated from blood and at the same time requires JWs to respect JWs who conscientiously accept transfusion of a hemoglobin agent fractionated from blood.

    The Articles

    The journal has two articles regarding the WT doctrinal position on blood. The first is Rightly Value Your Gift of Life. The second is Be Guided by the Living God. What does the WT offer as underpinning for its doctrinal position on blood?

    The first article ends in emphasizing the atoning value of Christ Jesus?s shed blood. This article concludes by saying ?In his great concern even about our life, he determined to reserve blood for use in one highly important way, the only way that makes everlasting life possible.? The question is then asked, ?What impact should this have on our decisions and actions?? The second article is represented as answering this question.

    The second article eventually enters a discussion of medical use of blood. The subtitle, ?Blood as Medicine,? presents questions regarding JW acceptance of a component fractionated from blood such as red cells and JW acceptance of what it calls ?one small fraction extracted from a component?. 3 In answer, the following paragraph (11) states:

    ?Decades ago Jehovah?s Witnesses made their stand clear. For example, they supplied an article to The Journal of the American Medical Association (; reprinted in How Can Blood Save Your Life? Pages 27-0).* That article quoted from Genesis, Leviticus, and Acts. It said: ?While these verses are not stated in medical terms, Witnesses view them as ruling out transfusions of whole blood, packed RBCs [red blood cells], and plasma, as well as WBC [white blood cell] and platelet administration.? The 2001 textbook Emergency Care, under ?Composition of the Blood,? stated: ?The blood is made up of several components: plasma, red and white blood cells, and platelets.? Thus, in line with medical facts, Witnesses refuse transfusions of whole blood or of any of its four primary components.? * Published by Jehovah?s Witnesses

    With this statement the WT makes its religious position clear by stating what it forbids. It forbids ?transfusions of whole blood, packed RBCs [red blood cells], and plasma, as well as WBC [white blood cell] and platelet administration.? Why are these specific constituents forbidden and others?such as hemoglobin 4 ?not forbidden? The journal cites the book Emergency Care where it names the same constituents of blood and then says, ?Thus, in line with medical facts, Witnesses refuse transfusions of whole blood or any of its four primary components.?

    The WT cites a publication that agrees with its breakdown of blood components. However, the careful reader will note that "Emergency Care" is a textbook for EMT students (emergency medical technicians). Scientifically, the WTS breakdown is neither authoritative nor definitive. Alternatively, consider the list of major blood components as listed in Modern Blood Banking and Transfusion Practices by Denise M. Harmening, Ph.D.:

    "Red blood cells, RBC Aliquots, Leukocyte-reduced red blood cells, frozen - deglycerolized red blood cells, platelet concentrate, single donor plasma, cryoprecipitated antihemophilic factor, granulocyte concentrates, factor VIII concentrate, porcine factor VIII, factor IX concentrate (Prothrombin Complex), immune serum globulin, normal serum albumin, plasma protein fraction, Rho(D) immunoglobulin, antithrombin III concentrate." 5

    It is noteworthy that of the sixteen major blood components listed in this definitive and widely respected textbook on transfusion medicine, nine are definitely permitted by WT policy.

    The WT?s comments above leave readers with the question: How does the cited material offer substantiation in the way of ?medical facts? to underpin the WT doctrinal position on blood? In an apparent attempt to answer this question the article continues in the next paragraph to inform readers of reprinted material from the issue of the Watchtower journal. But the presentation from the 2000 journal does not offer a coherent basis upon which readers may form a rational conclusion as to which constituents from blood must be rejected under penalty of extreme religious shunning or premature death versus which constituents from blood may be accepted without consequence of religious rejection! Rather than coherent substantiation for its doctrinal position on blood, with the Watchtower the WT only underscores the fact that JWs do not abstain from the donated and stored blood supply because it admits that JWs do use from the donated and stored blood supply. This admission leaves readers in a quandary of trying to make sense of the WT doctrine on blood.

    The closest thing the 2000 journal has to rational reason for distinctions made by the WT doctrinal position has to do with pre-birth transfers between a mother and her unborn child in the womb. In general terms it alludes to healthy placental transfers as a potential basis for concluding that one need not abstain from every derivative from blood. However, a significant gap occurs in this reasoning given the fact that blood constituents forbidden by the WT make this transfer and blood constituents that do not make this transfer are not forbidden by WT policy. Therefore the bit of rationale applied in the 2000 article ends up as irrational because it is inconsistent with WT doctrine. 6 WT reasoning on this point is also diminished and contradicted because it completely ignores post-birth healthy transfers between a mother and her child by way of mammary gland secretions that contain white blood cells in abundance, whereas WT doctrine forbids white blood cell transfusion.

    Nevertheless, in the Watchtower is found a nugget of very beneficial candor?the chart on page 22. For the first time the WT has illustrated in clear and unambiguous terms what its doctrinal position forbids and what it does not forbid. 7 It clearly states that it is not forbidden for JWs to accept constituents from blood taken by fractionating any of the components of red cells, white cells, platelets or plasma. This clarity should help many JWs realize that the WT does not require an absolute abstention from the donated and stored blood supply. Rather, it only requires a partial abstention from using the donated and stored blood supply. Naturally, this will leave many JWs pondering the question: Now that the WT is so clear that JWs do not completely abstain from the donated and stored blood supply, how?and why?do we continue telling the world that we abstain from blood? More importantly, now that the WT is so clear that JWs do not abstain from the donated and stored blood supply, how?and why?do we continue tolerating premature death over medical use of donor blood? These questions the WT and its proponents must answer for.

    This article claims to speak for JWs by stating "Decades ago Jehovah?s Witnesses made their stand clear?. ruling out transfusions of whole blood, packed RBCs [red blood cells], and plasma, as well as WBC [white blood cell] and platelet administration.? But this statement does not speak for all JWs because all JWs do not reject uses of blood forbidden by the WT. Therefore the Watchtower is the WT speaking for JWs and not the whole JW community speaking by means of the WT. In essence, the Watchtower reflects how the WT wants JWs treated rather than how individual JWs want to be treated. This is a critical distinction for treating physicians to understand as they strive to treat the whole patient. It is also important for physicians to make this distinction for the JW patient asserting his or her privilege under the concept, My body, my choice! 8 Physicians should make sure they treat a JW patient as that individual patient wants to be treated rather than how the WT wants the patient treated.

    Does the WT speak for all JWs?

    In a study reviewing all the JW oncology patients treated at H. Lee Moffitt Cancer Center & Research Institute from October 1986 through February 1994 revealed that a full 10% of JW patients accepted WT forbidden blood transfusions or, in the case of minors, their JW parents accepted transfusions for them. Of the 58 JW patients six accepted and received allogeneic red blood cell transfusions, and two patients also received platelets. A finding of Dr. Benson states "while most adult Jehovah's Witness patients were unwilling to accept blood for themselves, most Jehovah's Witness parents permitted transfusions for their minor children, and many of the young adult patients also were willing to accept transfusions for themselves."?Kaaron Benson, MD, Management of the Jehovah's Witness Oncology Patient: Perspective of the Transfusion Service, Cancer Control Journal of the Moffit Cancer Center, Vol 2, No. 6 November/December 1995. 9

    The WT also admits that JWs have secretly accepted uses of blood forbidden under WT doctrine. The Watchtower journal of states that JWs had admitted to secretly accepting blood transfusion. (Anonymous, Setting Matters Straight Between God and You, The Watchtower, Watchtower Bible & Tract Society, 1987 10/15: 14) Furthermore, in personal correspondence JWs have expressed directly to the WT that medical use of donor blood should not be forbidden by WT doctrine. For example, from WT documents is found admission as far back as 1950 where the WT admits it has received repeated requests for it to pronounce support for the medical practice of blood transfusion. (Letter from a JW who is promised no spiritual action against her, The Watchtower 1950 5/1: 143)

    More recently the WT has received letters from one of its appointed elders who states "the apostolic decree does not require abstaining from medical transfusion of blood as practiced today." (Jensen, R., Personal letter to WT, page 4 of enclosure)

    Astonishingly, the same Watchtower that pretends to present the views of the JW community?the Christian community according to WT teaching?also contains a frank admission that a majority view of JWs is not essential to WT doctrine! It states, "Moreover, some products derived from one of the four primary components may be so familiar to the function of the whole component and carry on such a life-sustaining role in the body that most Christians would find them objectionable." (Emphasis added) If most Christians would object to behavior permitted by WT doctrine then how can the WT represent its related view as of the Christian community? It cannot and does not. The WT does not speak for all JWs.

    Conclusions

    The June 15, 2004 Watchtower makes several things clear:

    1. It makes clear what the WT organization permits and what it forbids to JWs in the way of using from the donated and stored blood supply.
    2. It makes clear that JWs do, in fact, use from the donated and stored blood supply.
    3. It makes clear that the WT does not necessarily speak for a majority view of the JW community.
    However the same article leaves many questions unanswered:
    1. Ethically: How?and why?do any JWs continue telling the world that JWs abstain from donor blood when JWs regularly use from the donor blood supply?
    2. Ethically: How?and why?do any JWs continue tolerating premature death over medical use of donor blood since JWs already regularly use from the donor blood supply?
    3. Theologically: If it were true that God "determined to reserve blood for use in one highly important way," then why would WT doctrine permit on one hand uses of blood in ways other than how God uniquely reserved, yet on the other hand forbid uses of blood in ways other than how God uniquely reserved?
    4. Medically: Should the medical establishment depend on the WT for information on what medical treatment is acceptable to the JW community?

    The June 15, 2004 Watchtower makes an attempt to substantiate the WT blood doctrine, but it fails in this attempt. It not only fails to provide rational bases for unique distinctions of what is forbidden and what may not be forbidden from a theological perspective, it also fails to provide scientific bases for distinctions it makes of constituents fractionated from blood. 10

    However, by means of a chart the WT does for the first time provide published information that clearly delineates what its doctrine forbids and what it tolerates. Members of AJWRB are concerned for the well-being of JWs and therefore want to further publicize the benefit of having this information so that more lives are not lost prematurely in the confusion of trying to figure out what the WT will permit them from blood and what the WT will shun them for regarding blood.

    Because the WT admittedly does not necessarily speak for a majority view of JWs, then treating physicians have all the more reason not to assume what therapies are acceptable to individual JWs based on what the WT says. Every reasonable effort should be exercised to provide individual JW patients with ample opportunity to communicate preferences privately and away from coercive requirements taught and enforced by the WT. Physicians should know and understand that the mere presence of another JW?including immediate JW family members?may be sufficient to hinder autonomous decisions because the WT teaches JWs to report any infraction of WT teaching for disciplinary action. 11 Again, it is essential that doctors treat JW patients as the individual JW wants to be treated rather than treating him or her as the WT wants them treated. If doctors do the former they nurture the patient. If doctors do the latter they nurture a religion. AJWRB1 The WT enforces shunning?which it calls disfellowshipping and/or disassociation?to the extent of refusing to speak with or even say a common greeting to an individual. The WT shunning doctrine is applicable to family members and non-family members. Early editions of WT teaching referred to the coercive effects of disfellowshipping as persecution and imprisonment. (Anonymous, Display Christian Loyalty When a Relative Is Disfellowshipped, Our Kingdom Ministry, Watchtower Bible & Tract Society, Inc., 2002 August: 3; Rutherford, J., MILLIONS OF PRISONERS TO HEAR THE GOSPEL [Fifteen-minute radio lecture], The Watch Tower, Watchtower Bible & Tract Society, Inc., 1930 10/1: 301.)

    2 A component is an individual part or element making up a whole. (Farmer, S and Webb, D., Your Body Your Choice, Media Masters 2000)

    3 Here the WT uses the term component in a special way to mean specific individual constituents fractionated from blood. These individual constituents are red cells, white cells, platelets and plasma.

    4 By no means is hemoglobin a small fraction of the red cell. Also, when applied for oxygenation therapy, hemoglobin is administered in rather substantial quantity.

    5 Harmening, D. Modern Blood Banking And Transfusion Practices, 4 th ed. F.A. Davis, , 1999, p 237-248.

    6 Further commentary on the June 15, 2000 Watchtower is available in the article Watchtower Blood Policy Changes Again, by AJWRB. (Available online at: http://www.ajwrb.org/basics/change.shtml)

    7 For the benefit of JWs and medical professionals, AJWRB published a very similar chart years ahead of the WT.

    8 For more on this concept see Patients and the Right to Decide and The Patient Comes First in Your Body, Your Choice, by Shannon Farmer and David Webb, 2000. (Pages 80 and 137) Shannon Farmer is one of Jehovah?s Witnesses and is Coordinator of the Center for Bloodless Medicine and Surgery at in . Your Body, Your Choice states: ?No Longer are [patients] prepared to be told what to do.? This is just as true of JW patients as any other.

    9 Available online at: http://www.moffitt.usf.edu/pubs/ccj/v2n6/article13.html

    10 More on this scientific perspective is available in the article The Watchtower Society redefines the guidelines for use of blood products, by Osamu Muramoto, M.D. (Available online at: http://www.ajwrb.org/6-15-04.shtml)

    11 Speaking to JWs, the WT teaches "if the [JW] does not report [their sin] to the elders within a reasonable period of time, then you should."?Anonymous, Why Report What Is Bad?, The Watchtower, Watchtower Bible & Tract Society, 1997 8/

  • blondie
    blondie

    Thanks for posting this, Lee.

    Nevertheless, in the Watchtower is found a nugget of very beneficial candor?the chart on page 22. For the first time the WT has illustrated in clear and unambiguous terms what its doctrinal position forbids and what it does not forbid. 7 It clearly states that it is not forbidden for JWs to accept constituents from blood taken by fractionating any of the components of red cells, white cells, platelets or plasma. This clarity should help many JWs realize that the WT does not require an absolute abstention from the donated and stored blood supply. Rather, it only requires a partial abstention from using the donated and stored blood supply. Naturally, this will leave many JWs pondering the question: Now that the WT is so clear that JWs do not completely abstain from the donated and stored blood supply, how?and why?do we continue telling the world that we abstain from blood? More importantly, now that the WT is so clear that JWs do not abstain from the donated and stored blood supply, how?and why?do we continue tolerating premature death over medical use of donor blood? These questions the WT and its proponents must answer for.

    I brought this up to several witnesses about the fact that the hemoglobin-based products such as Polyheme (now considered blood fractions by the WTS and acceptable) are made out of expired stored human blood asking how that was possible if as witnesses they could not store their own blood and that blood had to be poured out.

    It through them for a loop and they could see how it was conflicting; that now knowing that such products were made from stored blood, they could not use it. But another witness was angry and said that the WTS said it was all right to use so they were going to use it despite their knowledge of its coming from stored blood.

    That latter JW is how I expect most of the witnesses will respond; if the WTS says it is okay, it is okay.

    Blondie

    BTW, we have been discussing whether there were people who died by not accepting organ transplants during the 1967-1980 period. Do you have any information on that. I know it is not directly related.

  • blondie
    blondie

    bttt

    For those on JWD that don't know, Lee Elder and several others are responsible for this wonderful site that I quote from and is a source for many leaving the WTS.

    http://www.ajwrb.org/index.shtml

    It's one of those sites to be sure to bookmark.

    Blondie

  • Neo
    Neo

    Good article! I like the way you emphasize that the opinion of an individual JW is often distinct from the WT official stand. Thank you Lee, and keep up the good work!!!

    Here's the blood components chart the article refers to:

    Neo

  • candidlynuts
    candidlynuts

    the new stance by the wtbs just confuses me and i'm sure many others more.

    after being a JW all my life till just recently i retain an aversion to even thinking about taking blood. its helped me to personally know people who've had to take blood transfusions and their experiences.

    so.....just bumpin this up so it stays active for awhile so everyone can have an opportunity to view the article.

    thanks Lee Elder, and Blondie your comments are always insightful! thanks

  • AK - Jeff
    AK - Jeff

    Lee -

    As always, an excellent tool is here presented - thank you.

    Neo -

    I like the way you emphasize that the opinion of an individual JW is often distinct from the WT official stand. Thank you Lee, and keep up the good work!!!

    This is the way slavery gets abolished. Those slave-owners who think that slaves will never think on their own are just readying the revolt.

    Just my opinion

    Jeff

  • Thinking
    Thinking

    Thanks for posting and I bookmarked the site.

    I remember when the fraction article came out being at a gathering of witnesses And getting into a very heated arguement. I found it very wrong to accept fractions and not contribute to the supply.

    And felt very sorry for my dear friend in Canada that lost her fiance for refusing blood and now all she has, the abiblity to say he made a stand for the truth. And now........What really is the truth? Poor Family.

  • Lee Elder
    Lee Elder

    Hello Blondie,

    The answer to your question regarding organ transplants is yes. The ban claimed lives

    just as the ban on blood and some blood products continues to claim lives.

    Here is an experience involving a WT organ ban casualty:

    http://www.ajwrb.org/experiences/stories.shtml#kidney

    Lee

  • Neo
    Neo

    Another essay on the same 2004 WT article:

    The Watchtower Society redefines the guidelines for use of blood products Osamu Muramoto, M.D.


    In the June 15th 2004 issue of the Watchtower, the Watchtower Bible and Tract Society featured two articles on the use of blood products by Jehovah's Witnesses. The first article is titled "Rightly value your gift of life" and reiterated the long-held tradition of the scriptural interpretation to support the religious doctrine to prohibit medical use of blood products. The second article is titled "Be guided by the living God", which details the rules regarding which blood product is "unacceptable" and which is "Christian to decide." This issue of the magazine also included the reprint of the previous landmark article published on June 15th 2000 titled "Questions from readers: Do Jehovah's Witnesses accept any minor fractions of blood?", confirming the then new policy permitting any fraction of the "primary component" of the blood. The circumstances under which this new policy was promulgated in 2000 clearly showed that it was the preparation for allowing Jehovah's Witnesses to receive full benefit from the newly developed hemoglobin-based blood substitutes.

    While the two articles of June 2004 showed no substantial changes in the policy promulgated in June 2000, there are several interesting points which are worth discussing. First, the second article now depicts a new chart showing a clear horizontal line dividing the "unacceptable" and the "Christian to decide".

    The latter category include fractions from red cells, from white cells, from platelets, and from plasma. While there is nothing new in this chart compared to the "Questions from readers" article of June 2000, this chart now explicitly indicates the "fractions of red cells" as an acceptable fraction. This is an important emphasis, because until recently there have been no "fractions of red cells" which can be used medically. With the emerging technology of hemoglobin-based blood substitute in late 1990's, the Watchtower Society quickly paved the wide road for Jehovah's Witnesses to receive this "minor" fraction of the red cells, which in reality comprise 97% of the red blood cells.

    The other interesting point is the explanation for the refusal of the "primary component". After the lengthy biblical discussion and meticulous justification for refusing to "take in" blood for medical reasons, the article quickly concludes this:

    The 2001 textbook Emergency Care under "Composition of the Blood," stated: "The blood is made up of several components: plasma, red and white blood cells, and platelets." Thus, in line with medical facts, Witnesses refuse transfusions of whole blood or of any of its four primary components. (page 22)

    In essence, the article states that the reason for refusing "four primary components" is that it is "in line with medical facts" which is stated in "Emergency Care." While everybody agrees that there is no biblical reason to define the "four primary components" that must be refused, most readers would have expected that such a classification is based on well-established and sound "medical facts." Very interestingly, the book this article cites here is not an authoritative medical textbook. It is a textbook used by the students of the emergency medical technician courses. Why did the Watchtower Society not cite more authoritative medical textbook or scientific sources to base this critically important classification? The simple reason is that such a classification is not at all scientific, but it is simply a tradition in medicine. To use a parallel analogy, our food is traditionally classified into "major components" such as protein, carbohydrate, fat, minerals, etc. Is this classification the only classification considered as a medical fact? Of course not. This is only one of many ways to classify our food. We can also use such a classification as grains, meat, vegetable, fish, etc. This is another way to classify our food, which is equally valid. These classifications are just traditional and convenient tools to understand the various components of our food. Depending on the method of classification, what is considered "primary component" is different. The same is true for the classification of the blood components.

    In case of the classification of the blood components, there are many different ways to classify. It is true that the classification that blood banks most frequently use is the four components this Watchtower article states. However, medical textbooks use many different classifications. Often times, the blood is separated into "two major components", red blood cells (45%) and plasma (55%), because other smaller components such as platelets are usually taken as a fraction from one of those major fractions. Another classification which is frequently used in textbooks of anatomy and physiology is based on chemical composition. With this classification, the major and primary components of the blood are water (80%), hemoglobin (15%), albumin (2-3%), and globulin (1-2%).

    While the Watchtower Society adopted the classification of red cells, white cells, platelet, and plasma, as the "primary components" and specified those to be refused, what would happen if the Society adopted a different classification which is equally valid and "medical facts"? For example what would happen if the classification of hemoglobin, albumin, globulin as the primary components were adopted? This classification would have prohibited the use of hemoglobin-based blood substitutes and albumin as a plasma expander, which are now permitted to be used for Witnesses. What does this difference tell us?

    It tells us that what is "unacceptable" in the Watchtower doctrine has nothing to do with the biblical doctrine cited in the article. It only depends on what classification of the blood components the Watchtower Society adopted among several different classifications available in medical literature. Under one classification of the components (red, white cells, platelets and plasma), the most of the currently available blood products in medical practice are in the category of "Christian to decide", or the matter of conscientious decision. This is because the current technology no longer uses those crude fractions in pharmaceutical products. On the other hand, under the other classification based on chemical components (hemoglobin, albumin, globulin, besides water), the most of the currently available products become unacceptable, because this classification is more consistent with the current biochemical technology for producing blood-based pharmaceutical products. Under this alternative classification, however, the use of platelets may be acceptable because it is not considered a primary or major component under this classification. In other words, if the Watchtower Society had adopted the chemical classification of the primary components of the blood, which is more consistent with the current biotechnology, hemoglobin, albumin, and globulin, are all prohibited, but platelets and perhaps white blood cells may have been permitted.

    Which classification of the blood components the Watchtower Society adopts makes such a huge difference in terms of what is acceptable and what is unacceptable, and thus who can survive and who must die from catastrophic blood loss. This difference has nothing to do with the biblical doctrine, or not even with the current medical science. It only hinges upon the Watchtower Society's decision which classification of the blood components they adopt. The cold reality of Jehovah's Witnesses is that their life-and-death decisions are after all not directly based on any of the biblical arguments these articles discuss, because such biblical doctrines have no relevance to the classification of the blood components. And it is this classification that determines all the "unacceptable" components and thus the life-and-death decisions. It is ironical that the rules promulgated in this article titled "Be guided by the living God" are simply guided by the human decisions and old tradition. Should they adopt an alternative classification, which is more in line with the current medical technology, life and death of Jehovah's Witnesses would have been totally different.

    References Muramoto O. Bioethical aspects of the recent changes in the policy of refusal of blood by Jehovah's Witnesses. British Medical Journal 2001; 322: 37-39 [Full Text]

    Muramoto O. Recent developments in medical care of Jehovah's Witnesses. Western Journal of Medicine 1999; 170: 297-301 [Full Text]

    About the author

    Dr. Muramoto is a staff neurologist, lead physician, and a member of the Regional Ethics Council, Kaiser Permanente Northwest Division, Portland, Oregon. His views and opinions are his own and do not reflect those of Kaiser Permanente and Northwest Permanente P.C.

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