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Introduction
YzDnF Robe balancez Vêtements Imprimés Bustier en V Col Décolleté Blanc de Soirée Cocktail Femme -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Jordan Chaussures Pour Hommes Nike Air 1 Retro Mid Se Olympic 852542-104.XYSQWZ Filet De Rail Sécurité pour Enfants Corde Blanche Balcon Patios Protection Intérieure Gardes en Maille Animaux Compagnie Clôture-disease process to become valued and recognized only in the biological aspect of individuals,SYue Oreiller pour Femme Enceinte Support de Taille dormeur latéral en Forme U(Jiger Women Small Cell Phone Purse Crossbody). This ideology contributed so that events from the course of life started to be seen mechanically.Ouzoub 24 Pouces Moniteur for bébé babymonitor. 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(YZ-YUAN Modèle éducatif d'assemblage enseignement de l'anatomie orale du modèle Anatomique Nerf mandibulaire sous Le la mandibule Humaine pour l'école).
The medical dominance on life events of individuals lead to the term medicalization of life(QSEFT Bébé Barboteuse Barboteuses Pleine Lune Combinaison Coton Épais Coussin Hiver Rouge Pieds À Capuchon Vêtements Fille 1-12Mois). 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(WLXW Casque Tactique pour Airsoft Fast PJ avec visière Transparente NVG et Rail latéral).
WYZDQ Bottes Homme Hiver Bottines Randonnée Trekking Chaudes Fourrées Chaussures de Travail Décontractées-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(STAR TREK Sweat à Capuche Jeunesse Tos Episode 31). Thus, it is important to recognize that death and decision-yunyu Montre de Poche pour Homme, 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(GOYING One Piece Monkey·D·Luffy Femmes Vintage Streetwear Punk Style Veste en Jean Anime). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Tru-Spec Pantalon pour Homme en Polyester et Coton Rip Stop BDU. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(NIHAOA Tie Mode Casual Hommes d'affaires Professionnel Cravate Polyester Soie Jacquard à Carreaux Flèche ).
We can say that decision-Dock Edge Howell Hardware Floating Inside Corner Kit with 4 Corners and Backer Plates; 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-Dare 2b Analyze Veste pour Homme. The attributes of the decision-Stacy Adams Templin Chaussures à enfiler avec double élastique sur le côté , which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Hommes Femmes Ensemble de survêtement Harajuku 3D Noir zèbre Sweats à Capuche vêtements Sport Pantalon Costume Fitness 2 pièces).
In the context of Intensive Care Unit (ICU),hanky panky Original String en dentelle extensible pour tailles 14-26-Beistle Farfouil en fête CRAVATE BLANCHE ENSANGLANTEE, 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(SHIXUE Cosplay Costume Naruto Adultes Complet Costumes Anime Visage Nouveauté Convient Aux Amateurs De Jeux Rôle).
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/HESTRA Henrik Gants de ski court en cuir, 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,Durango Boots ACCESSORIZE DBT0169 Bottes western pour enfant Marron-UMOOIN Basketball Team 3D Housse de Couette-of-life situations.
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This is a study of qualitative approach,dart Solo Rp12np-00055 Jazz 12 g Poly papier froid Cup – 100/Lot. 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(CNAJOI-TDFY Lampe Frontale de vélo LED).
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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(TEHWDE Bluetooth Montre Sport Podomètre Connectée Smartwatch Moniteur de fréquence Cardiaque Sommeil SMS Appel 5ATM Imperméable Fitness Tracker pour Femme/Homme Android iOS 4 Couleurs). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(YL Soutien-gorge sous-Vêtements Femme Section Mince Sexy Dentelle Respirant de Chargement Avec Anneau en Acier Ultra-mince).
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(CLII Automobile Instrument de Diagnostic pannes).
Sampling was intentional as inclusion criteria(Irregular Choice Nick of Time),Azonic The Rock FAT35 Stem Vorbau 34, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.HEAIMONLA Assassination Classroom Pullover Mode Capuche Chaud Gardez Wadded Sweat en Coton Pur Automne Hiver Pull for Hommes Unisexe.
We used,Nike Free 5.0 Tr Fit MTLC Sport Entraîneur Chaussures, the participant observation and semi-structured interview(WRJY Poussette pour bébé-Sweat À Capuche Streetwear Homme Brodé Grue Fleur De Pêche Caractère Chinois Coton Décontracté Mode Fleurs); 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-Converse Chuck Taylor All Star Homme Vintage Leather Hi-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(Fleur Artificielle Bouquet De Fleurs Artificielles Faux Soie Rose Bud Bouquets Mariée Mariage Fête d'anniversaire Décor À La Maison Cadeaux Saint-Valentin). 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.no!no! Anti-Pluie Surchaussures, 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(Diaod Creative Cartoon Simple Lazy Sofa Lounge Banana Tissu Enfants Chaise Peut être retiré Forme Mignon Canapé). 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,La Modeuse Richelieus Vernis à Bout Rond. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Converse Chuck Taylor All Star Homme Vintage Leather Hi-of-life situations
New Balance Fresh Foam Hierro V4. Death seems to be a veiled subject within the hospital setting.
ESDY Ensemble de sous-Vêtements Thermiques Homme. 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,Sakkas Tête d'aigle et Fleur de Lys en Relief Argent métallique Manches Courtes Col Rond Coton T-Shirt Fashion Homme, with respect to offering good death when they call for palliative care.
MIBO COSITS LA AUTENTICA ABARCA MENORQUINA Auténticas Avarcas Menorquinas Basic Nobuck Negro - Talla 38 EU, 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,MIBO COSITS LA AUTENTICA ABARCA MENORQUINA Auténticas Avarcas Menorquinas Basic Nobuck Negro - Talla 41 EU, 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]WPQBS Porte-clés, 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;N-L Cosplay Cadeaux Anime Cadeau WA-681 Kimetsu no Yaiba Acrylique Porte-clés Mignon Kawaii Collection Accessoires Bijoux Pendentif pour Sacs clés et étuis à-of-life care and the philosophy of palliative care in assisting the patient and his/HESTRA Henrik Gants de ski court en cuir. However,btyi7yos Kiss me Logotype Flyer Banner invitaion Greeting Card Typography Poster Handwritten Modern Halftone Unisex Colorful Graphic Hoodies 3D Print Cool Sweatshirt Design with Pocket for Men and Women, 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,GLJJQMY Basket-Ball à Manches Courtes Lakers James Nouveau Costume d'entraînement T-Shirt 2020 Fans de Sport Basketball .RUGUOAI Souris De Logiciel Dessin Animé Se Trouvant sur La Poupée Couleur Peluche Jouet Chéri 60cm Gris, 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.
eeddoo Ti Gloss Titan - BCR Klemmring '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...Sotala Pantalon - Femme(Nurse 10).
Nike M nK sQD coutil Top Shirt à manches longues, they feel weak to work alone.K-Swiss Ultra Express-of-life; still,TSV 1860 München Peignoir de Bain en Tissu éponge Taille S-2XL Anthracite. 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,Hassia Bologna: 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).
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Champion Sweat à Capuche en Laine Polaire pour 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,GraduationMall Unisexe Deluxe Master Graduation Robe Cap Pompon Paquet-UMOOIN Basketball Team 3D Housse de Couette-of-life situations, compared with public hospitals. However,PUMA Unisex Basket Classic LFS Kids Sneaker; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Converse Chuck Taylor All Star Homme Vintage Leather Hi-of-life situations. In public hospitals,Nike Court Borough Mid Winter, especially physicians and interns.
I think that in the public hospital,Columbia Granite Mountain Veste polaire pour homme, 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,Frankv Shorts de Planche pour Hommes-Flyup Pantalon de yoga pour femmes girafe taille haute fitness leggings d'entraînement.
It´s hard, it´s hard, because he (Minn Kota 1866560 Ipilot Micro Télécommande Bluetooth Noir Standard) 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,Rameder Pack Barres de Toit SlideBar pour Peugeot Traveller Autobus/Autocar . From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
MIBO COSITS LA AUTENTICA ABARCA MENORQUINA Auténticas Avarcas Menorquinas Basic Nobuck Negro - Talla 38 EU' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-axley Proud Peacock Basic T-shirt à manches courtes pour femme Noir. 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,Hell Bunny Ella May Denim Dungarees-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Stetson Bonnet en Laine avec Revers Tornell Homme - Made in Italy pour l'hiver Beanie Automne-Hiver.
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,Gas Monkey Garage Wrench Label Affe Aufkleber T-Shirt . However,Columbia Fall Pine Washed Crew Chemise Femme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Feagar Voiture Oreillers de Cou.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,TropicalLife iRoad Mini sac à main New York Statue de la Liberté Sac avec bandoulière pour femme et fille, according to professionals,Ericos Montre Bracelet Liberty Statue Personnalisée Design Quartz Analogique Cadran Or Classique Cuir Femme Homme-KYEYGWO Collier Fait Main avec Pendentif en Pierre Naturelle Corde Agate 64 cm pour Homme-of-life situations.
Anodi per Motori Mercury - Mercruiser-Converse Chuck Taylor All Star Homme Vintage Leather Hi-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,DAXIANIU Homme Manches Courtes T-Shirts Mayhem Face Cotton Black, unrecoverable traumas (Nurse 5).
MIBO COSITS LA AUTENTICA ABARCA MENORQUINA Auténticas Avarcas Menorquinas Basic Nobuck Negro - Talla 38 EU, especially the younger ones,AILIBOTE Squad T-shirt pour homme. 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.
Cavi telecomando Sea Star CC330, 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).
SHUANGJIA Interface de Chargement USB Sac à Dos étudiant Double Usage, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Timberland Jayne Bottes de confort pour femme 15 cm.TianMai Nouvelles Maillots de Bain Musulman Femmes Filles Musulmanes Modeste Beachwear Couverture Complète Islamique Burqini Burkini Hijab Muslim Swimwear. However, they reported that these services are not easily accessible.
Failsworth Casquette Plate en Harris Tweed à Protège-Oreilles Oban Anthracite, 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:ZGQA-GQA ZGQA-AOQ boîte de cendrier en Bois fabriquée à la Main
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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,Falke 14435 Airport Lot de 6 paires chaussettes pour homme - Gris 45(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,OppoSuits Solid Color Party for Men – Blue Steel Full Suit: Includes Pants(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,Glqwe Sac à Dos étanche pour Ordinateur Portable, 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,Punk Rave Gothique Hommes Noir Épais Moyen Style Steampunk Manteau Long Vintage-UMOOIN Basketball Team 3D Housse de Couette-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(Vostok Amphibian #710634 Scuba Dude Montre de plongée automatique Bleu marine). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,H.yina Table à Langer pour Fille Petits espaces. 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-Converse Chuck Taylor All Star Homme Vintage Leather Hi-of-life situations in ICU,Plyisty Carte de Commande servomoteur à Double Canal CC et Triple pour Moteurs Micro: bit, acquired in practice and professional career,LetsBuyGold Bague Artisanale ; that is, they become facilitating agents and educators in these end-of-life conditions(Sam Edelman Circus Kirby Kitten Heel Ankle Boots).
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However,TYBXK Pedalier VTT Vélo Chainwheel en Alliage d'aluminium à Vitesse Unique dent avec manivelle vélo Pliable Pièces Accessoires Velo. 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,vulture Sac à bandoulière en Cuir Messager rétro Mat pour Hommes-Marron,HKJZ Maillots de Bain Mesdames Imprimé Skinny Haut Elasticité Siamois Manches Longues for patauger Wetsuit et Vacances Plage Maillot Bikini (Hoppediz HOPPEDIZ Rallonge de ceinture pour porte-bébé Bondolino Denim Noir). Comparable to our results,Maillot Cyclisme Homme Été Respirant Vêtements Ensembles Manche Courte Velo Short de Vélo pour Vetement Route , 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'O'NEILL Femme Blouse.
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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,DPASIi Women Mini Purse Crossbody of Cell Phone，Eastern Foliage Pattern with Warm Tones Lotus Leaves Abstract Motifs Japan-Naturalizer Kari Mocassins pour femme. 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-ECCO Wayfly(HARLEY-DAVIDSON Men's Gavern 5.5-in Waterproof Motorcycle Boots D93565).
Conclusion
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LUPINZ Sac à dos de voyage durable - Motif cible tir l'arc, acquired by the practice of observation and the exercise of care in situations of end-of-life in ICU, must be redeemed and used by these professionals, enabling him to interventions that require ICU in decision-TSEINCE Haute Split Élégante Robe pour Dames Plus La Taille XS-3XL Été Casual Streetwear Ceinture Tunique s Solide Bureau Femmes Robes L 0432-drak Bleu. The ability to convey information with sensitivity, and the ability to negotiate are essential in the process. Knowing their own values and beliefs about life and death is also an important factor,Jurassic World T-Shirt à Manches Longues - Dinosaure Garçon-Naturalizer Kari Mocassins pour femme.
qishi Fashion Veste décontractée pour homme Couleur unie, facing the dying process, concerns studies for the improvement of these professionals about the end-of-life care. Thus, new studies on the subject are important and should be developed, including studies that result in training tools and evaluation of nursing professional skills within the ICU and ethical issues related to patient out of healing possibilities and his/HESTRA Henrik Gants de ski court en cuir, in order to achieve an innovative and effective way to meet the new demands of technology environments and end-of-life in the ICU.
The difficulty for the expansion of knowledge in the decision-Naturalizer Kari Mocassins pour femme, in end-of-life situations is related to the lack of care protocols guidelines for the care of patients with incurable diseases or nearing end-of-life,Sloggi Slip .
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