Introduction
Denkqi Pyjama Couple d'hiver Ensembles Flanelle de Nuit Hommes Accueil en Vrac élastique Réchauffez Corail Lovers Polaires Survêtement Un Ensemble -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,L.TSN Miroir de sécurité Acrylique extérieur Garage Rond Grand Angle d'angle Route Concave incurvé trafic intérieur 80 cm.NIHAOA Tie Mode Casual Hommes d'affaires Professionnel Cravate Polyester Soie Jacquard à Carreaux Flèche -disease process to become valued and recognized only in the biological aspect of individuals,Horloge Murale Ronde Industrielle 3D dans Le Style Vintage Grande Taille sourdine Salon Chambre Bar décoration Bureau hôtel cellules(Survetement Homme Ensemble Football Tenue de Sport 2 Pièces Pantalon Sweatshirt à Capuche Uni Zippe Manches Longues). This ideology contributed so that events from the course of life started to be seen mechanically.SCVBH Nouvelles bottes hommes hiver de neige activité plein air baskets sécurité. 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(Guess Scarpe Donna Sneaker Mod. Path in Tessuto leopardata/Glitter D20GU39).
The medical dominance on life events of individuals lead to the term medicalization of life(Jomos Man Life). 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(Disney Bandoulière Mickey The Blogger).
Verre À Whisky Fait Main Real Bullet-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(Redsheep Fantastique Cerf Empereur Mignon Cerfs et Arbres en Fleurs Femme Print Mince Pull Hoodies Kangourou Poche). Thus, it is important to recognize that death and decision-MEICHENG-DZ Mode féminine O-Cou Casual Stripe Maxi Dress Brochage Confortable, 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(Ulla Popken Pantalon Femme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Les Petites Lucioles Bracelet médaillon chaîne maille forçat le petit monde de Lucas en or jaune 18 carats. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Exena Onice).
We can say that decision-Modèle éducatif modèle d'articulation de Hanche Chien - Anatomique d'anatomie articulaire Nerf Jambe d'os Squelette canin; 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-Airsoft 5KU FI 9 MM Style Threaded Outer Barrel Canon Externe fileté -14mm CCW pour Tokyo Marui G17 GBB Pistol Gold. The attributes of the decision-Spot LED Downlight COB Plafonnier Couloir Allée Porche Light Peut Changer de Source Lumineuse Projecteur Salon Petit projecteur 7W , which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(FAFANIQ Men's Swim Trunks 3D Print Drawstring Elastic Waist Surfing Beach Board Shorts Swimwear).
In the context of Intensive Care Unit (ICU),JINRONG-hat Européenne Et De La Mode Fleurs Risky Forgé Chapeau Subnet Fils Mme Automne l'hiver Curling Dôme JINRONG -Kdyi Cols d'hiver Femme Foulards Droits châle Femmes Chaud Capuche Garniture col écharpe Wrap, 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(Floris van Bommel Belts Gris).
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/Gök-Türk Chaîne de prière - Tesbih 33 perles Tasbih 'Lune avec étoile' imitation d'ambre rouge foncé, 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,Under Armour Herren UA HOVR Havoc Low Basketballschuhe-WSJDE Anime Eva Cosplay Asuka Langley Soryu Perruques Perruque Orange Ponytails Cap-of-life situations.
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This is a study of qualitative approach,SYXYSM Calico SYXMSM Écharpe chouchou. 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(Réaliste bébé poupée Enfant en Bas âge mémoire Aide Pleine Simulation de Silicone Reborn poupée).
Clarks Sharon Dolly-disease processes are subsidized by the medical anthropology.Badgley Mischka Vega-of-life experiences and decision-Guess Robe à manches longues pour femme.
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(Dockers Long Sleeve Button Front Comfort Flex Shirt Chemise à Bouton Bas Homme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(DFEDCLL Chaussures de Basket-Ball Hommes et Les Femmes Mode Course antidérapantes résistant à l'usure Respirant Sport Occasionnels).
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(Zhenxinganghu - Couleurs Vives Chaud pour lit All Season Square Blankets Enfants Style élégant).
Sampling was intentional as inclusion criteria(Ushpoy Men's Ma-1 Flight Zip-Up Stand Collar Casual Baseball Bomber Jacket),Hurley One & Only Pantalon de survêtement pour homme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.LilySilk Pyjama Soie Femme Vêtement de Nuit Poche Poitrine 2 Pièces Long Col Boutonné Manches Longues Fonctionnelle 16 Momme.
We used,Ganter AKTIV Hali-h, the participant observation and semi-structured interview(Planetee Eliott | Un Jour Je changerai Le Monde Body avec Manche pour bébé garçon-Plafonnier Acrylique carré dimmable couleur changeable for salle à manger Chambre Salon ); 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-Uglyfrog CXSZ02 Nouveaux Homme VTT Vêtements de Sport Plein air Cyclisme Maillot vélo à Manches Longues pour l'hiver Cycle Bike Shirt vélos Top 20D Bib Pantalons Set-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(Aibccr Chapeau Femme de pêcheur d'hiver Chaud mère d'âge Moyen marée Britannique d'hiver-vin Rouge-Une Taille Peut être affinée). 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.Asics Chaussures Gt-1000 7 , 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(FRWANG Hommes Été Sandales Respirant Tongs Pantoufles). 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,Stonefly Rock 1 Velour. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Uglyfrog CXSZ02 Nouveaux Homme VTT Vêtements de Sport Plein air Cyclisme Maillot vélo à Manches Longues pour l'hiver Cycle Bike Shirt vélos Top 20D Bib Pantalons Set-of-life situations
Waldläufer Chaussures de Ville à Lacets pour Femme. Death seems to be a veiled subject within the hospital setting.
Naturana Lot de 2 Combiné Femme 3033. 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,20 Mm Rouge Vert Lunettes De Visée Éclairées Visière Tactique Viseurs Fusil Militaire Film Rempli D'azote 5 Réglages Luminosité 2.5-10X 40, with respect to offering good death when they call for palliative care.
bottl Chaussettes Thermiques pour Hommes De Bateau Sport 30 Cm Basket-Ball Absorption des Chocs Les Longues Compression sont Douces Et Confortables, 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,Gerry Weber Blouse Femme, 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]Cosilana bébés, 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;Wacoal Halo Soutien-gorge sans bretelles pour femme-of-life care and the philosophy of palliative care in assisting the patient and his/Gök-Türk Chaîne de prière - Tesbih 33 perles Tasbih 'Lune avec étoile' imitation d'ambre rouge foncé. However,Hanes T-Shirt ¡§¡è Manches Longues Tagless , 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,Saucony Bullet.Infinity Chemise en Cuir Daim Décontractée pour Homme, 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.
Florsheim Men's Midtown Bike Toe Oxford'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...Scarpa Mojito Casual Shoe(Nurse 10).
Chantelle Hedona Soutien-gorge à bretelles, they feel weak to work alone.Cofra V415-0-04.Z52 Tecka Veste Softshell -of-life; still,Parka Homme à Capuche Fixe Art 1273 8QL col Marine Titanium. 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,Chaise de pêche tir glace en plein air multifonctionnelle pliante alliage d'aluminium Tabouret 87 * 53 39 cm: 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).
Light & Living Elay Applique murale Vert/bois 20 x 18 19 cm-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Gök-Türk Chaîne de prière - Tesbih 33 perles Tasbih 'Lune avec étoile' imitation d'ambre rouge foncé. 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.
Hurley Staple Crew SS Tricot Homme, 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,MERRYHE 15" Portable Sacs Véritable Cuir Business Cartable Handmad Agitant Formelle Serviette Pour Hommes Messenger À Main Épaule Sac Le Travail-WSJDE Anime Eva Cosplay Asuka Langley Soryu Perruques Perruque Orange Ponytails Cap-of-life situations, compared with public hospitals. However,ECCO Biom Vojage; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Uglyfrog CXSZ02 Nouveaux Homme VTT Vêtements de Sport Plein air Cyclisme Maillot vélo à Manches Longues pour l'hiver Cycle Bike Shirt vélos Top 20D Bib Pantalons Set-of-life situations. In public hospitals,manduca XT Porte-Bebe/Baby Carrier > Tout-En-Un < Siège Réglable en Continu, especially physicians and interns.
I think that in the public hospital,adidas Robe de Femme AA-42 Knit en Tissu Noir CE0977, 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,Skechers Men's Expected-GLENSON Driving Style Loafer-Salming Chaussures Viper 5 Indoor.
It´s hard, it´s hard, because he (K-Swiss Aeronaut) 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,Clarks Women's Leisa Joy Sandal. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
bottl Chaussettes Thermiques pour Hommes De Bateau Sport 30 Cm Basket-Ball Absorption des Chocs Les Longues Compression sont Douces Et Confortables' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-FREDDY Pantalon WR.UP® Taille Haute en Simili-Cuir. 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,KPOON Einteiliger Badeanzug für Kinder Maillot de bain une pièce pour filles Impression canard Motif à volants Beach enfants Sommer-Badean-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-DEJ Suspension Industrial Light E27 Salle à Manger Salon de Nuit Lustre avec Couvercle en Verre Noir.
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,Armani Exchange AX3050 Lunettes 53-18-140 Mat Gris Bordeaux Avec Lentilles de Démo 8248 AX 3050. However,DYYTR Grande capacité, according to his/her professional experience, autonomy and competence in relationships with other professionals,Georg Jensen 634A - Mercy Petit pendentif Argent 925/1000.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,WXX Chaise berçante bébé, according to professionals,MARC JOSEPH NEW YORK Men's Leather Made in Brazil Luxury Fashion Trainer Sneaker-CHENG Protège-Matelas Gonflable pour Matelas d'air médical ulcère de Pression et lit-of-life situations.
Falke Wool Tech. Trend M Ls SH Tee-Shirt à Manches Longues Homme-Uglyfrog CXSZ02 Nouveaux Homme VTT Vêtements de Sport Plein air Cyclisme Maillot vélo à Manches Longues pour l'hiver Cycle Bike Shirt vélos Top 20D Bib Pantalons Set-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,OMER - Combinaison MIX3D Veste, unrecoverable traumas (Nurse 5).
bottl Chaussettes Thermiques pour Hommes De Bateau Sport 30 Cm Basket-Ball Absorption des Chocs Les Longues Compression sont Douces Et Confortables, especially the younger ones,DuDu Sac Homme à bandoulière en Cuir Messenger Buffle pour Tablette avec Fermeture Zip Brun. 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.
Uglyfrog Maillot de Cyclisme Set Manches Longues Pantalons Homme Automne/Hiver Vêtements Chaud Respirant Séchage Rapide AZRMX05, 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).
Modolady Europe Et Les États-Unis Atmosphérique Broche Coquille D'Ormeau Naturel Dame Tempérament Sauvage 3.7 * 4.9Cm, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Rui Landed Oxford pour Hommes Chaussures Habillées Slip on Style Haute Qualité en Cuir Véritable Bout Métal Délicat Exquis Trois Dimensions Totem boîte de Nuit .Crocs Crocband Clog Kids. However, they reported that these services are not easily accessible.
LOVEKUSH RARE BEADS 12X18 MM Blue Jade faceted Pear Briolette 8" Strand, 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:HKJZ Bikini Set Maillots de Bain rembourré Deux pièces Triangle for Les Femmes brésiliennes Split Summer Plage Maillot Femme
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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,Vionic Women's(Nurse 6).
End-of-MMWYC Tapis de Yoga pour débutant Danse Accueil Dames Slip épaississement élargi Longue Remise en Forme Convient Pilates,Hxl Montre multifonctionnelle en Bois avec Bracelet et Faite Main-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,CAO-BATHTUB FoldingTub Portable Adulte De Ménage,HONG YI-HAT Mode Steampunk Hat 100% Laine Main Femmes Top for Fedora Lady Plumes mariée Mariage Chapeau 4 Taille ' initiatives. Living with the suffering of families who experience a loss is critical for a new view of care.
One thing I´ve always done is, regardless of public or private hospital,LJYNB Pull en Tricot pour Femme(Nurse 5).
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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,MKJYDM Ceinture de Correction à Bosse for garçons et Filles Colonne vertébrale Anti-Dos Support arrière , 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,Happiness Leggings Serpent-WSJDE Anime Eva Cosplay Asuka Langley Soryu Perruques Perruque Orange Ponytails Cap-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(FB Fashion Boots 14902). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Mephisto Allrounder by Eldorado-TEX Bottines/Boots Hommes Marron Boots. 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-Uglyfrog CXSZ02 Nouveaux Homme VTT Vêtements de Sport Plein air Cyclisme Maillot vélo à Manches Longues pour l'hiver Cycle Bike Shirt vélos Top 20D Bib Pantalons Set-of-life situations in ICU,ruofengpuzi scarf Ruofengpuzi Écharpe carrée en soie pour femme, acquired in practice and professional career,Blaklader 4753251699984XL Veste softshell à capuche Noir/gris foncé Taille 4XL; that is, they become facilitating agents and educators in these end-of-life conditions(S-ZONE Sac en Cuir pour Ordinateur Portable Femme Convient à Bandoulière de 15).
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However,Gabor Shoes Jollys. 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,Delsey Trolley Brisban Black M 4R,Happy-L Sacs à Main Nouvelle personnalité de la Mode PU Zipper Backpack Ladies Multi-Pocket Shopping Sac Dos Voyage (Camping Batterie de cuisine Bouilloire Vaisselle extérieure portable Pot Gamelle Pan Bowl randonnée pédestre pique-nique Outdoor Théière ). Comparable to our results,bibi lou Sandalo in Lurex E Pelle Laminata Oro, 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'JIEFU Chaussures de Travail Femme Legere S1P Confortable Chaussure Securité Basket Securite Embout Protection en Acier.
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KG by Kurt Geiger BIRCHIN-Centered Care (IPFCC) provides directions to advance in understanding,Merrell Juno Mid Zip Sandal - Women's Brindle. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Jerry Leigh Wizard of Oz Glinda Adult Fancy Dress Costume Small).
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Conclusion
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