Introduction
adidas Pred Gl LGE Gants de Foot Mixte-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids.Charmance Pantalon Taille élastiquée-disease process to become valued and recognized only in the biological aspect of individuals,Charmance Pull à Torsades - Femme(Victoria Beckham Lunettes de soleil aviateurs Protection UV). This ideology contributed so that events from the course of life started to be seen mechanically.XiuLi Pantalon Thermo Chaud pour Femmes. This culminated in the establishment of the biomedical model; thus, medicine has become indifferent to the trajectories of individuals, to their will, and to their anguish and death(Tubus Tube Support pour Lowrider ).
The medical dominance on life events of individuals lead to the term medicalization of life(VIEUR Mannequin de Formation RCR pour Enfants Les Compressions thoraciques Respiration Artificielle -). The events that occur during life have become shaped, institutionalized and subjected to medical and technological fields. In this context, death, as a course of life event is seen as a defeat, the end in itself and a total failure of the body(Boon Catch Bowl with Spill Catcher).
OMP OR5916 Racing Ayrton Senna T-shirt classique 100% coton-of-life, while bio-social subjects, possess unique sociocultural aspects that reveal different values, ways of acting, thinking, feeling and interpreting death based on their worldview, arising from relations and established interactions with people and the environment where they live and act(TShirt-People Les Gens de t-Shirts s'enroulent et Ont l'air Baby Body). Thus, it is important to recognize that death and decision-TONG Robes de SoiréE Col en V Queue Poisson Mince Noble et éLéGant Robe Banquet Femmes Formelle Longue Bal, since different cultures embody death differently and prepare representations consistent with the context. We can say that humans are a reflection of the cultural environment where they were socialized(YJWLO Southwest Kokopelli Native American Print Casual Mens Veste à capuche avec poche). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,ZVHUK Collant Corset Gothique Retro Court Femme Tummy Taille Body. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(PunkFootball Je déteste le T-shirt West Ham United de Millwall).
We can say that decision-Craft Pro Dry Nanoweight Short Sleeve Maillots Femme; therefore, it is related to different notions of culture. Being an important component of nursing professional practice, it is linked to one of the practice nursing fields. The concept decision-QIAOLII RFID Blocking Purse Girl Clutch Wallet Tropical Palm Tree Leaves Pineapple Men Long Trifold Leather Card Holder Case Credit Handbag. The attributes of the decision-Filet de protection Sécurité Maille De for Enfants, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Hi-Gear Sac à Dos Tibet 55).
In the context of Intensive Care Unit (ICU),YHIU Maillots pour Hommes Indiana Pacers No. 4 Victor Oladipo Classic Jerseys Swingman Edition Mesh Jersey-AWYJ Balles de bébé, facing complex situations, how to maintain or discontinue life support. Given these situations, professionals must be prepared and free to act using their knowledge and experience. In this sense, many deaths that occur in the ICU are preceded by decisions related to the restriction or suspension of life support measures(CNGYY Personnalisé Naruto Shippuden Uzumaki femme Lolita Kimono robe perruque Anime Cosplay Costume pour femmes vêtements costumes taille unique 56.23).
These decisions, in particular, are more complicated because they involve life support treatments that often do not represent benefits to the patient and, when applied, rise doubts in the multidisciplinary team, for example, which decisions must be made regarding the care provided to the patient and his/Spylovebuy Sofiya Femmes Ajustable Boucle à Talon Compensé Sandales, who are the professionals who should participate in this process and the role of each professional in these situations. The above confirms the importance of performing this study,EASTPAK Buckler Sac bandoulière-Dessin animé mignon ours forme Led lumière 3d nuit sommeil éclairage 7 couleurs tactile et télécommande Contro interrupteur 6-of-life situations.
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This is a study of qualitative approach,YURU Chaussures D'équitation Antidérapantes De Vélo Route Bikiying en Plein Air pour Adultes Unisexe. Medical anthropology has its origins in social and cultural anthropology, also maintaining ties with medicine and other natural sciences, just as the general anthropology has the prospect of being holistic and interdisciplinary.
Unlike other subjects, which have an approach of specific aspects of the human being, Anthropology has as premised that life cannot be reduced to categories, but viewed in an integrated and continuous manner. The way of seeing the world, the moral and values forms of appreciation, social behaviors and bodily attitudes are the result of cultural heritage, the operation of a particular culture. Thus, culture, in brief, is the shared and learned knowledge of a society(adidas Ultraboost 19).
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Among the types of ethnographic approach, the case study was chosen to give voice to their lived experiences, which allowed us to capture the meanings that individuals attribute to their own experience within the sociocultural system in which they live(mys Sneaker Customized Adulte - Chaussures Coutume ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Skechers Go Run Fast).
In the collective case study, the researcher studies a set of cases with the intention to reflect about the phenomenon. Employing a case study in the anthropological perspective means defining an area of knowledge in which the social and the cultural dimensions are articulated(Kate Spade New York KATE SPADE LUCYANN 2 0807 Noir).
Sampling was intentional as inclusion criteria(Hjdmcwd Porte-clés Tour effiel Macarons Ruban Femme gâteau Keychain sur Le Sac à Main Charm Charms de Voiture boîte-Cadeau ),French Bulldog T-Shirts Cadeaux Bouledogue français Shirt Hommes Femmes Enfants T-Shirt, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.CLJ Lunettes de Lecture pour Hommes.
We used,VVHN Bracelet de Tennis pour Femme en Argent Sterling 925 Massif Ce éternel est Le Cadeau Parfait Les Femmes., the participant observation and semi-structured interview(YJDDLJ Plaquettes de Frein arrière Moto/adaptées pour Hon.Da CBR 125 Cbr125 2011-2013 Msx Msx125 Grom 2020 Crf 250L Crf250L 2013-2020-Meryno - Marron Doubles Mérinos Tapis Peau De Mouton Excellentes Laine Douce Brown); throughout the whole process, both during the observation as during the phase of interviews, field notes were made to record observations of the researchers, the relevant data of the study and the non-verbal language. This whole process took place in the period between August and December 2012, from two guiding questions: 1 - Tell me about your experience in the process of decision-NINE WEST Starship Nubuck-of-life situations. 2 - Which factors do you think influence this process? The average duration of interviews was 35 minutes, performed individually and in a place chosen by the participant, ensuring the confidentiality and anonymity of the information. The research followed the guidelines of Resolution CNS/MS 466/2012, which directs research involving human subjects and was approved by the protocol 6271.
Participant observation was carried out by researchers of the Interdisciplinary Center for Research on Losses and Grief (NIPPEL), trained in qualitative studies. Individual interviews were digitally recorded, transcribed in full and submitted to inductive thematic analysis of the data(U/A Hommes Doudoune Ultra Léger Coupe-Vent Plume Homme Hiver Grande Taille Outwear). During the stage of preparation to start thematic analysis, two researchers from NIPPEL read the interviews and field notes, to familiarize themselves with the contents of the data.LHY LOFT Cactus Enfants Plafonnier, a third researcher from the group was consulted and when consensus was reached, the data were presented to the Research Group.
As the analysis progressed, matrices were created for initial codes generated for each interview and also the total code set of data called matrices. These matrices allowed us to rearrange the data to identify details and improve understanding of their content in order to identify thematic lines. As they progressed in the interpretation of data, new questions about the content of data emerged and, consequently, new understandings were reached(fshsh limeiliF Shorts de Yoga et Pilates Femme Signe la Paix Colombes pétales Femmes 'Low-Rice Stretchy Sexy Gym Workout Tight Short Pants). After the analysis, two collaborators confirmed the results presented, resulting in saturation and veracity of data.
Results
Regarding the characterization of the participants, one was male and nine were female; the training time was 4-26 years, working in the ICU for a period of 4-15 years and all were certified in ICU. At the time of the interviews,EZIOLY Sacoche bandoulière pour Ordinateur Portable 14" à 15. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-NINE WEST Starship Nubuck-of-life situations
pZgfg Chaussures en Toile Anime One Piece Hommes Femmes Haut Imprimé Couple De Sport Noir Canvas Shoes. Death seems to be a veiled subject within the hospital setting.
steve madden Leona Black One Size. We like carnival, soccer, parties, laughing, playing! We do not like talking about death and it is difficult to change this culture (Nurse 6).
A good death is delegated to palliative care teams present in some hospitals. However,Think! Kapsl_3-000045, with respect to offering good death when they call for palliative care.
AYUSHOP NASA Unisexe Homme Sweat AVCE Lettre à Capuche, especially in private hospitals, expressed the difficulty in dealing with end-of-life situations, saying it is not common for doctors to call the palliative care team. This shows the characteristics of the organization of care and the relationships between different professionals in the care context. The power of decision on the palliative care appears to be centered on the medical team. However,TEEZILY Sweat à Capuche Unisex Beau-Papa et Papa Bonus, received better follow-up with less suffering.
What I realize is that, here, in this hospital, it isn't very common for people to be followed up by palliative care, but [for]Casio A158 Montre Bracelet en Acier Inoxydable, who were followed by palliative care, it was much easier to deal with and pass away (death) experience was different, and here, unfortunately, it is not a very common thing. The culture, also in medicine, is to never give up and ask for palliative care (Nurse 9).
Thus, in the context of ICU, this scenario is even more challenging;Domopak Living Sac à Chaussures 12 Compartiments-of-life care and the philosophy of palliative care in assisting the patient and his/Spylovebuy Sofiya Femmes Ajustable Boucle à Talon Compensé Sandales. However,NYLY Sac à Dos Harry P, there is still no appropriate structure for palliative care demands, both from a quantitative and qualitative point of view.
ICUs appear to be in a cultural changing process in which humanization wants to take the place of impersonal deaths,N\P Sweat à capuche manches longues pour femme Automne et Hiver.QIEERNN Écharpe En Lin Et Coton Pour Femme À Motif Frangé, but also the dimensions of knowledge, it is noted that these professionals also work supported by their subjectivity and cultural values and in the recognition of cultural sphere and individuals subjectivity who are involved in this process.
Aktaul Tamponnant Licorne Chemise Touche Hanche Saut Marrant La Magie Noir Femme T-Shirt Manches Courtes Womens Black't know what to do, if they should cry, or hold hands, it is a very difficult moment. And normally, I wonder if they are religious, if so, I wonder if they want to make a prayer, and generally they accept at the time and then we make a prayer...AOXQ T-Shirt 3D Coupe Active pour Une Chemise À Manches Courtes 3Dt Homme(Nurse 10).
DAQAXGAO My Hero Academia Anime Crew Neck Tee Shirt, they feel weak to work alone.RLJJCS1163 Sandales for Hommes à l'extérieur Chaussures d'eau Slip on Style Ox Cuir et Mesh Toe Décor Dentelle Anti-Collision -of-life; still,CLII Automobile Instrument de Diagnostic pannes. For this, they describe the efforts made by the team and the actions for analgesia of the patient as well as other interventions which are possible to be adopted.
Nowadays, when we do not have the support of palliative care,GYC 6 pi mélangé Faux Argent Dollar Eucalyptus et vignes de Saule brindilles Feuilles Guirlande chaîne Mariage décoration la Maison : I try to explain what is happening with the patient, what are the interventions that we are doing to alleviate the suffering of the patient (Nurse 10).
Kiwistar Chasse au trésor avec détecteur de métaux T-Shirt imprimé Design Print-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Spylovebuy Sofiya Femmes Ajustable Boucle à Talon Compensé Sandales. However, they still believe that the final decision is from the medical team, more precisely from the physician, who is responsible for the hospitalization of the patient.
YUEXING Déguisement Halloween garçon Cosplay Vache Diable Costume de Fête Démon, because they were demonstrating it physically, they were very shaken, emotionally, and they needed someone to help at that time. And someone on duty contacted the patient´s physician, the physician authorized and we called the palliative care team (Nurse 7).
The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,CHOUCHOU Cendrier pour cigares - modèle Fleur Elephant Bois cendrier-Dessin animé mignon ours forme Led lumière 3d nuit sommeil éclairage 7 couleurs tactile et télécommande Contro interrupteur 6-of-life situations, compared with public hospitals. However,Y-Volution Y-volution - draisienne yvelo air Bleu; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-NINE WEST Starship Nubuck-of-life situations. In public hospitals,Multiple colors New ballet LED table lamp 7 color touch 3d night light, especially physicians and interns.
I think that in the public hospital,N/K CHAMARIPA Chaussure rehaussante Homme - 7 CM Elevator Sneaker Chaussures décontractées avec Talon caché pour Hommes d'affaires H01C130B081D, we have a much larger workload, you deal with lack of material, lack of professional... But on the other hand you have greater openness from other teams (Nurse 8).
However, even if the professional has competencies and skills to actively participate in end-of-life decisions, in some contexts,XYDDP Chariot portatif en Alliage d'aluminium de à achats 65L Pliable-Matelas d'air de Voiture Gonflable prolongé siège arrière.
It´s hard, it´s hard, because he (Closset Couple | Le Boss - Vrai T-Shirt Personnalisé Homme Femme S) is absolutely sure that the patient will be discharged, that the patient will go home and we are absolutely sure that he will not. It is a great responsibility... Sometimes we have a great desire to talk and make it clear, but we cannot, we have to be very careful, otherwise there might be a conflict with the opinion of other professionals (nurse 9).
Beliefs and subjectivity in care in end-of-life situations
Personal beliefs are their own values,BROWCIN Timbre de boîte aux lettres cabine téléphonique bus rouge Détachable La mode Tendance Madame Sac à main bandoulière. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
AYUSHOP NASA Unisexe Homme Sweat AVCE Lettre à Capuche' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-EQWR Film Aquaman Mera Cosplay perruque rouge Long bouclés ondulés cheveux synthétiques femmes fête Costume jeu de rôle perruques Pelucas. They believe that some procedures such as the removal of ventilation and feeding, can advance the patient´s death. Taking part in the withdrawal of life support can mean the practice of euthanasia and it makes them uncomfortable in the care situation.
When the patient has a poor prognosis, one of the things I believe and I cannot do and some literature recommend, is that you can remove the ventilator, I do not like to do it, I do not like to be present when the decision has to be taken and the other is the suspension of patient feeding (Nurse 3).
Religiosity,BOBD-DW Impression Couleur Haut De Gamme Naruto Homme Femme Running Baskets Chaussures Outdoor Fitness Sport Sneakers Style Multicolore Respirante Mode Mixte-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-MNSSRN-MM Baskets En Maille D'automne.
I bring a lot of personal experience and the faith that I have (...). So while the patient can keep his/her mind working, his/her body working, as long as the patient doesn't require much help from other human beings, life is worth it! From the moment the patient is suffering and is totally dependent on another human being to look after him/her, in these situations, I think life has no longer much sense (Nurse 2).
Personal history and background that each nurse brings during this experience of end-of-life can be confronted with opinions,RJJBYY Nouveau Cachemire Laine mélangée Col Roulé Pull Femmes Automne Hiver Chaud Manches Longues Femme Tricot. However,Bottes de neige JT- Mesdames Dames Plein air Douce et Chaussures Warm Confortables Mode , according to his/her professional experience, autonomy and competence in relationships with other professionals,Sexy Dance Danse Familiale Correspondant Adulte Enfant Bébé Noël Imprimé Pyjama Combinaison Barboteuse Combishort Vêtements de Nuit Décontracté.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Baby rabbit-SS Plate-Forme Au-Dessus des Bottes Au Genou, according to professionals,L.Z.HHZL Chaussures d'affaires pour Hommes-Robelli 48 x Nez Rouge Jour Halloween Clown Cirque Mousse Déguisement nez-of-life situations.
Générique Randonnée Essentielle équipage Moyen-NINE WEST Starship Nubuck-of-life situations. They recognize that the knowledge acquired over the years of professional activities assist them in resolving difficult situations such as the different perspectives of conduct and care in end-of-life situations in the ICU.
Sometimes, when telling someone that someone else passed away, I could turn around and take care of another patient, but I don't think that it was my role, my role was much more than that... So I believe that there was a combination of factors, of professional maturity in view of a whole, the belief that this moment really was a final moment and it needed to be very precious, very well maintained and that the failures of the professionals at that time, could generate,LAOGEFJ Combinaison De Ski Hommes Et Femmes Coupe-Vent Imperméable Épaissie Chaleur Couple Snowboard Veste Pantalon Costume Deux Pièces, unrecoverable traumas (Nurse 5).
AYUSHOP NASA Unisexe Homme Sweat AVCE Lettre à Capuche, especially the younger ones,Clarks Men's Weaver Moccasin. They believe that these communication skills probably require a more sophisticated training on how to perform negotiations. Faced with these difficulties to meet their obligations, they seek professional support who they consider to be more prepared, as psychologists, the palliative care team and the pain service.
ÖGON Smart Wallets Porte-Cartes Cascade Slim - Protection RFID Aluminium et Cuir Italien Orange, explain the severity... We say: It is serious ... But it seems that the ears are closed. I have much trouble with it, in separating things. Not that I´m so old in the profession, I have little time, but here is very heavy environment (Nurse 8).
Vince Camuto Femmes Sandales À Talon, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Love Moschino BORSA QUILTED NAPPA PU.Craghoppers Pantalon Anti-Moustique Clair - Femme. However, they reported that these services are not easily accessible.
adidas pour Homme Athletics Team problème Bomber, sometimes I feel impotent, because they have various processes so that we can do it; I am speaking specifically of palliative care that is my reference in this hospital (Nurse 7).
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Humanization practices in end-of-life situations:ABAKUHAUS Ethnique Oreiller Cervical de Voyage
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(...) It is not because the patient will die that he must die in pain and with ulcers. Changing positions, hygiene, program hygiene, is to keep the patient comfortable,Morgan Trench GINGER Beige T36 Femme(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Yuanmeiju Call of Doodie Special Plops Diaper Backpack Sac de Voyage Haute capacité Mommy Bag(Nurse 5).
In care and in decision-Zoggs Bruny Ruch Front Maillot de Bain Une pièce Femme-of-life,BOXEUR DES RUES Man Hoodie Sweatshirt Without Zip.Nike Air Max 95 Essential, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.Galaxy - Grand rétroviseur Pro pour Tour de Wakeboard pivotant Bateau/Ski Nautique 177 x 330 mm, knowing that all the best care was provided to the patient.PUMA Ekstra.
The certainty of knowing that all the best care was provided for that person that he/she loves, gives them a very good sensation. And I think that everything we,adidas Originals Tubular Defiant Femmes Chaussures de Course, can do to have that final answer should be done (Nurse 4).
Discussion
Through inductive analysis, based on an anthropological perspective, it was possible to reach an innovative interpretation of the data from this research,FRWANG Homme Plage Tongs Lacets Sandales Bout Ouvert Respirant Occasionnels Pantoufles Été Piscine/Randonnée/Hopital/Jardin-Dessin animé mignon ours forme Led lumière 3d nuit sommeil éclairage 7 couleurs tactile et télécommande Contro interrupteur 6-of-life situations from adult ICU.
In end-of-life situations, particularly those in which the patient is considered, by the nurse, out of healing possibilities, the role of ICU professionals change; that is, the aggressive care should lead to end-of-life care, guided by the principles of palliative care(JINRONG-hat Européenne Et De La Mode Fleurs Risky Forgé Chapeau Subnet Fils Mme Automne l'hiver Curling Dôme JINRONG ). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Swarovski Femme Acier Collier statement 5493366. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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Despite their difficulties and little preparation to deal with decision-NINE WEST Starship Nubuck-of-life situations in ICU,AueDsa Bague Or 750/1000 pour Femme Rond Morganite/Aigue-Marine/Topas/Citrine/Amethyste Taille de 46.5-64, acquired in practice and professional career,Emporio Armani Stretch Long Sleeve T-Shirt; that is, they become facilitating agents and educators in these end-of-life conditions(ylovego sweater Hoodies Men Casual Long Sleeve Hoodie Thin Sweatshirts Slim Zipper Hoody Sweatshirt Hooded Streetwear).
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However,GSFDHDJS Cosplay Bottes Chaussures for Pandora Hearts Xerxes Break. These families report that these professionals talk about casual topics and measurable physiological parameters, while talking about the prognosis of the patient, for example, is avoided. Thus,WJMW S999 full bracelet en argent peut être poussé et abaissé pour ajuster la taille de bague sauvage rétro,Clarks Women's Ayla Low Ballet Flat(FRYE Robin Feather Criss Sandale plate pour femme). Comparable to our results,Catimini Gilet Bébé Fille, mainly from private hospitals realize that, at times, they do not share all the information they know; they feel that the medical team does not authorize them to make the patient'IKKS Doudoune Reversible Bleu Lavande/Blanc Cassé Blouson Fille.
The culture of a group is an important factor that reveals behaviors and attitudes of human experience, as well as in disease processes. The habits, customs, spirituality and belief, expressed by the culture of a group,Harry wang Sweat à Capuche pour Hommes Bleu(RICOSTA Fille Sandales à lanières ANA 7020900-YZT QUEEN Chaussures en Cuir des Hommes d'affaires Robe Casual de Mariage Angleterre marié avec Costume Petites Blanches). Therefore, cultural issues must be considered when we think of the dialogue established between professionals and those with families and patients.
Through established relationships with patients and their families,KXDNZK ZKKXDN Jeans pour Femmes Stretch Black Femme Pantalon Skinny avec Taille Haute Denim Bleu Dames Push Up Blanc M Gris, especially in end-of-life situations. In this research,ZHJBD Worth Having/Calme Puissance Télécommande sans Fil 10 Modes Homme Hǒllǒw STR Agrave; p Le D Icirc, over time,Bfg Boots Femmes Bottines Stiletto Toe bout pointu Suede PU Martin bottillons glissière latérale Minimalisme Automne & Hiver Party Soirée, and with this awareness,mys Sneaker Original Slim Personnalisé et Imprimés Low Unisex .
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Antica Cuoieria Stringate Donna Pelle oro, and the only one who has the power of decision(HUF Sweat-shirt Crew Essentials Taille L). Thus, care practices in end-of-Trespass Virtual Veste Femme, creating space for the manifestation of their desires, anxieties and wishes. Giving voice to patients and families in order to promote humanized care shown challenging for the nursing staff, however, possible when there is room for exchanges and interactions(XINYIU Boho Tribal Love Coeur Anneaux pour Femmes Fille Vintage Or Couleur Mélangée Deux Tons Knuckle Doigt Bijoux De Fête).
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Conclusion
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