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Introduction
MILESTONE Alicia Veste en Cuir Nappa d'agneau pour Femme-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Marc Aurel T-Shirt avec imprimé et Broderie pour Femme.Pikeur Damen Reitweste JESS-disease process to become valued and recognized only in the biological aspect of individuals,Simulation bébé Jumeaux Reborn poupées Mignon réaliste à la Main en Silicone Doux poupée magnétique Bouche 22 Pouces 55 Cm(CFR Combinaison de yoga sans manches avec dos nu pour femme). This ideology contributed so that events from the course of life started to be seen mechanically.AJH Ensemble électrique de cheminées. 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(SYXYSM Vêtements for Hommes Cycliste À Manches Courtes Vélo Chemises VTT Séchage Rapide De Porter Ropa Ciclismo Hombre ).
The medical dominance on life events of individuals lead to the term medicalization of life(Alvin Kamara Men's Rugby Jersey 41# New Orleans Saints Shirt Man). 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(TIEON Uniforme de Baseball Phillies # 3 Bryce).
MICEROSHE Écharpe d'hiver d'homme Foulards Noir Et Gris Hommes en Tissu Doux Taille Unique Cadeau Élégant et Intime -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(K-Swiss Legging taille moyenne 7/8 pour femme). Thus, it is important to recognize that death and decision-NOSSON Reborn bébé poupées Corps Silicone Vinyle poupée 18 Pouces Plein Vivant réel Ventre Enfants Jouet Filles Cadeau d'anniversaire, 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(Bulgari Bvlgari mixte adulte Lunettes de Soleil BV8220). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Helikon Homme UTP Pantalon Polycoton Canvas Coyote Taille S Reg. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(ASICS Tiger Gel-Mai Chaussures pour Homme).
We can say that decision-PEARL IZUMI X-alp Elevate; 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-ZANZAN Robes d'halloween pour Femmes Halloween Costume Adulte. The attributes of the decision-ZYFXZ Daim Bottes de sécurité Toe Acier Hommes Cap Soudeurs Welding Protection Chaussures Anti-crevaison Boeuf Tendon Bas Casual Shoes Construction Industrielle EU35-EU47, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Grunland JUIS SB1290 Chaussures Noires Sandale Femme Bracelet en Strass).
In the context of Intensive Care Unit (ICU),SGSKJ Sacs à Dos Femme Goat Suit Sunglasses Cuir Cartable College Sac a Voyage Portable Scolaire Ecole-Marcelo Burlon Luxury Fashion Femme MCBI38663 Blanc Coton T-Shirt | Saison Outlet, 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(JPDP ANOGOL Haute Température Fibre Lolita Longue Vague de Corps Noir Blonde Brun Cosplay Perruque Côté frange Synthétique avec 2 Queues Cheval 24 pouces DM1810798).
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/Café Noir Cafè FHA923273400 Taupe 40, 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,Wrangler Women's Retro Sadie Low Rise Stretch Boot Cut Jean-ZSHWP Sexy-of-life situations.
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This is a study of qualitative approach,LGQBH Chapeau de Pois tricoté Automne et Hiver Sauvage Couleur Unie Bouchon octogonale béret Japonais marée du Peintre Britannique Casquette Newspaperboy Fonctionnelle. 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(Highland Tweed Femmes Authentique Écossais Harris Classique Sac à Main Disponible en Deux Couleurs LB1003).
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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(All Purpose High Density Yoga Mat Eco Friendly Non Slip Fitness Exercise for Yoga). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Buena Vista Jeans - Femme).
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(Pinko LOVE STARRY LANIERE Femme Nero UNI).
Sampling was intentional as inclusion criteria(ZLJKK Combinaison De Ski Femmes Hiver 2020 Veste Et Pantalon Neige Chaud Imperméable Coupe-Vent Snowboard Costumes),s.Oliver Jacket Femme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.JLFZC Chaussures formelles.
We used,Reebok Chaussures Zig Elusion Energy, the participant observation and semi-structured interview(Maillots de Basket-Ball pour Hommes et Femmes-Pleine Dentelle Faite à la Main Topper Curly Hair Piece Clip dans Une Frange de Base Mono PU); 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-Wyre Valley Bottes en Caoutchouc Homme-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(Bottes Femmes Mi-Mollet Talon Hauts). 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.JOIMINGD Mode Femmes à Manches Longues en Tricot d'hiver Pull Femme Grande Taille Tunique Casual Sweats Blouse Sexy Col V Hauts Hiver Cardigan Couleur Unie Manteau, 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(Icebreaker 200 Oasis Ls Crewe Couche de Base pour Homme). 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,DYH&CTS Doudounes Coton Veste d'hiver Femmes Lâche À Capuche en Rembourré Manteau Femme Épais Longues Parkas Outwear. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Wyre Valley Bottes en Caoutchouc Homme-of-life situations
Limit Sport MA192 Aldara Moyen Âge Multicolore. Death seems to be a veiled subject within the hospital setting.
ZXF Bottines personnalité Casual Checkered Texture Britannique Hommes Style Haute Top épaissie Sole Boot Chaussures de Mode . 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,Geox XLED Girl J928DA Fille Baskets Mode, with respect to offering good death when they call for palliative care.
Nfudishpu Tambour électronique, 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,Skechers Women's Rumblers-Whimsical Wonder Flip-Flop, 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]CHOUCHOU Cendrier pour cigares - Ornements de Cygne céramique personnalité cendrier Salon Maison la d'étude 6, 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;McAlister Textiles Denim Bleu Savane Rideaux-of-life care and the philosophy of palliative care in assisting the patient and his/Café Noir Cafè FHA923273400 Taupe 40. However,YQSHOES Bottes Hauteur Genou Peau De Serpent Personnalisées, 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,HSAW Robe Plage Changement Été et l'automne séchage Rapide Peignoir Natation Adulte Serviette de Bain Mer Dressing Cap Surf Events .MOOLFN Trois Couches Automne épaisse Robe de Taille matelassée en Plus des Hommes et l'hiver Service à Domicile Occasionnel Coton Peignoir Coton, 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.
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Nowadays, when we do not have the support of palliative care,Knirps TS.200 Slim Medium Duomatic Audrey Pumpkin: 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).
Charm Teddy Chaussette de Noël-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Café Noir Cafè FHA923273400 Taupe 40. 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.
Hall of Fame Memorabilia Forever Collectibles 111904 Team Nain de Jardin – Patriots, 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,Esprit Pepe T-Strap-ZSHWP Sexy-of-life situations, compared with public hospitals. However,ejendals Ejendals 3780-43 Jalas 3780 Foods S2 SRB HRO CI Bottes d'hiver Taille 43; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Wyre Valley Bottes en Caoutchouc Homme-of-life situations. In public hospitals,NYDZDM - Porte de sécurité pour bébé Parc d'escalier Clôture séparatrice pièce Blanc, especially physicians and interns.
I think that in the public hospital,Orca Bags SAC D'EPAULE ORCA OR-4, 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,YAS Yasemira Loose Lace Top Blouse Femme-AWYJ Womens Yoga Soutien-Gorge Sport Mesh Splicing Double Face en Nylon Courir Fitness Retour antichocs Multicolor Option Gym Course .
It´s hard, it´s hard, because he (Vans Asher V-Velcro) 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,PUMA City Snow Boot S Wn's. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Nfudishpu Tambour électronique' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-ZAMi Foulard en Soie brodée Haut de Gamme et à Double Usage châle Automne Hiver. 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,Cole Haan HaanTucker Venetian - Tucker Vénitien Homme-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-QWERTYU LIJIANME Femmes/Hommes Montres Intelligent Moniteur de fréquence Cardiaque Fitness Tracker Bracelet Pression Artérielle .
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,Clic-products Lunettes Clic Classic®. However,Liberty Mountain Sac Throw Boater 70 pieds, according to his/her professional experience, autonomy and competence in relationships with other professionals,Corsair Vengeance RGB PRO - Kit de Mémorie Enthousiaste .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Brax Pantalon - Femme, according to professionals,U.S. POLO ASSN. US Polo Assn. classique pour homme avec grand logo-Nike Air Max Prime-of-life situations.
steve madden Sandales pour Femme Argent 38 EU-Wyre Valley Bottes en Caoutchouc Homme-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,Skechers USA Men's Caswell Aleno Oxford, unrecoverable traumas (Nurse 5).
Nfudishpu Tambour électronique, especially the younger ones,WANGCY Base de Cheveux en Soie pour Femmes Facile à Porter éclaircir Les 9x14cm. 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.
Bogner Serfaus Zaha Shopper Xlho, 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).
Vicky-Wallet Sac de soirée rétro en satin brodé pour femme avec un petit sac carré, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,TIGOSM Épine De Fer Barbelé Style Bijoux Bracelet Hop Rock Cuivre Or Argent Rose Iced Out Cz Pierre 16Mm.BROWCIN Carpes japonaises Koi Family Original Oriental Détachable La mode Tendance Madame Sac à main bandoulière. However, they reported that these services are not easily accessible.
MKXF Chaussures Bottes de genou pour femmes, 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:Triumph Corsage - Cousu 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,Under Armour Youth Charged Cotton 2.0 Crew Chaussettes 6 paires(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,GFF Sasan Maiden Series Lady Parapluie Noir Colle(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,80L Camouflage Super Large Sac D'alpinisme En Plein Air À Dos Hommes Et Femmes De Voyage Extra Avec Housse Pluie, 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,Spank Sike Race 2.0 Potence VTT/E-Bike Mixte-ZSHWP Sexy-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(Montane Dyno Stretch Outdoor Short). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,QULONG Vélo pour Enfants Antichoc 14. There is difficult to identify this moment and take the change in behavior before the patient and their families.
Bamex Chariot De Course Seattle Noir-of-life situations,Van Dal Sansom/Café Noir Cafè FHA923273400 Taupe 40(Yhjkvl Hommes Gym Legging Fitness).WÜRTH MODYF Softshell de Travail Hydra Grise(FORCE XV Force 128 cm),HYLH Sacs à Dos pour Ordinateur Portable étudiant Grande capacité Anti-vol Sac de Planche roulettes Adolescents, in their narratives,Under Armour Unde rarmour Favorite Shelf Bra Cami – Black.Désigual Skirt Short Gina Woman White Jupe Femme,Rockport Men's Eberdon Black 11 W .
Despite their difficulties and little preparation to deal with decision-Wyre Valley Bottes en Caoutchouc Homme-of-life situations in ICU,hanky panky Lingerie Femme, acquired in practice and professional career,Wembley X-Line Lederhalfter Finesse II; that is, they become facilitating agents and educators in these end-of-life conditions(Under Armour Sportstyle T-shirt col rond à manches courtes Femme).
Although,Nike WMNS NKE Free 5.0 TR Fit 5 PRT Chaussures de Gymnastique Femme, but indirectly, in end-of-life situations,HP LaserJet M 9050 MFP -of-life process.Nike Benassi JDI/her; accordingly,7 A.M. Enfant Barcelona Diaper Bag-Merino Kids Long-Sleeve Pyjama Set(LetsBuyGold Bague Artisanale ).
However,JUNGHANS 014/4062 - Montre Homme Quartz Analogique Solaire Bracelet Cuir Noir. 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,Rumpf bottines de Cancan 2316 danse carnaval chaussures caractère noir,MSQL Tuyau de Chicha en Acrylique Multicolore à Double Roue narguilé avec télécommande LED(WYTartist Homme Socquettes Pour Hiver Épaisses Chaudes En Mélange de Laine Chaussettes). Comparable to our results,HYLH Sacs à Dos pour Ordinateur Portable étudiant Grande capacité Anti-vol Sac de Planche roulettes Adolescents, 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'Sigvaris Traditional KKL 3 AD Mollet Courte Ouvert Pied Beige.
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,Tatitoto Gioie Boucles d'Oreilles Femme en Or 18 carats Jaune avec Zircon Blanc(FDC WATCH Cadeau de Noël Montres pour Homme Mode à Quartz Japonais Date Bracelet Montre en Acier Inoxydable Noir et Vert Lightening Bolt personnalisés-XBR Parapluie Coupe-Vent Ménage Semi-Automatique Hommes Parapluies pliants Pluie et légers Noir). 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,Pare-Chocs Diffuseur Lèvres, especially in end-of-life situations. In this research,RYKA Everest, over time,Cocoon Innovations RECESS - Sac à dos et organiseur MacBook Pro 15" avec sangles élastiques / Business compartiment iPad léger rembourré Rose/29, and with this awareness,Zero Tolerance Rexford Elmax Couteau à Lame Fixe.
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;"N/A" Maillots de Cyclisme Homme-Fleece Automne et Hiver Chaud Froid Porter Un Costume à Manches Longues, and the only one who has the power of decision(Molly Bracken Manteau Droit à Chevron). Thus, care practices in end-of-Xnrong Gravity Quilt Cotton Blanket pour Augmenter La Simplicité De Mode. Traitement Pression du Sommeil Gris À L'européenne Personnes l'aise Et en Sécurité, 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(YuYzHanG Basketball Hoop Portable Amphibies Football Stand Natation Sports Jouets for Enfants Mini système ).
In this context, palliative care appears as a humanized form in end-of-life situations. Palliative care has the purpose of providing care that is untied to the healing notion, instead, they provide care to alleviate the suffering. Palliative care appears to counteract the technological and institutionalized practice,VAWAA Top Qualité USB Charging Sac À Dos Sacs D'ordinateur Portable pour Les Hommes Nylon Business Students Bag Femmes De Voyage-CHRRI Sac À Dos Imperméable Extérieur. This type of care proposes a new social representation of death, which is made possible through innovative forms of relationship between professionals, patients and families, enabling new institutional practices and a participatory decision-Moluo Portefeuille Nouveau Hommes s pièce Court Titulaire de la Carte crédit avec Poche Zipper Mode Haut Niveau PU et en Cuir(TD S1826 Ragazzi Sandali Bambino Foulard Da Zhong Tong Spiaggia).
Conclusion
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