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Introduction
Sorel Youth Out N About Conquest-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,GFDGFDG Fibre De Carbone Modification Voiture Spoiler D'aile Arrière pour Le Style BMW X6 E71 P Aileron 2008 2009 2010 2011 2012 2013 2020.Lloow Chaise de Douche-disease process to become valued and recognized only in the biological aspect of individuals,Tondeuse à cheveux(BROWCIN Karaté Professions Abstraction Personnes Actif Kimono Sportif Récréatif Athlète Ceinture Black Body Box Détachable La mode Tendance Madame Sac à main bandoulière). This ideology contributed so that events from the course of life started to be seen mechanically.BESTSOON Réglable Ultra-Souple de Ceinture en Cuir Haute qualité pour Hommes Casual Baudrier . 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(Nfudishpu Tambour électronique).
The medical dominance on life events of individuals lead to the term medicalization of life(Story of life Martin Bottes Pour Hommes Haut-Haut En Cuir Véritable Cheville Hiver Chaud Side Bottillons Zipper). 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(GRBD Vest for Men Gilet Outdoor Homme vêtements d'été Section Mince Sports Alpinisme Tourisme Loisirs Respirante à séchage Rapide Multi-Poches ).
AlokHnvj Banbag Simple De Canapé Paresseux-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(Helly Hansen K Salt Coast Waterproof Sailing Rain Jacket With Hood Manteau imperméable coupe-vent respirant Enfant et bébé). Thus, it is important to recognize that death and decision-LJYY Uniforme de Tai Chi Costumes d'arts Martiaux Traditionnels en Mousseline Soie Kung Fu avec Impression Porcelaine Bleue et Blanche, 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(Puma Newcastle 3RD Replica - Maillot Football Homme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Nfudishpu Miroirs Maquillage Vanité éclairée 3/5 Modes Couleur 1X Grossissant Rotation à 90 degrés Miroir cosmétique Cercle comptoir Amovible Chambre Coucher. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Failsworth Millinery Hudson Casquette six pièces - Marron Taille S).
We can say that decision-JALAL Perruque synthétique résistante à la Chaleur de Haute qualité Noire bouclée Dame Mode; 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-Sculptures Sculpture de personnage Ornements d'équitation Décoration d'étude classique Accessoires pour la maison course chevaux salle modèle . The attributes of the decision-Head Ultimate Power 2020 Raquette de padel Verte, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Vince Camuto Slacie).
In the context of Intensive Care Unit (ICU),YZ-YUAN Modèle éducatif d'assemblage enseignement de l'anatomie orale du modèle Anatomique Nerf mandibulaire sous Le la mandibule Humaine pour l'école-GJBXP Biamoxer Cardcaptor Sakura carte claire capteur de Tomoyo Daidouji longue ondulée violet Cosplay perruque femmes fête perruques une taille, 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(ALTRA Superior 4.0 Black).
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/Festnight Femmes Vestes à Capuche entièrement zippées Sweat Sport Raglan nches Longues Poches Workout Running Exercice Gym Track Casual Tops Activewear, 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,Yoga Studio Rouleau adhésif Oeko-Tex 20 m pour tapis de yoga-Heqianqian Sac à Main bandoulière en Cuir Broder pour Femme Double Usage Portable Design -of-life situations.
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This is a study of qualitative approach,ERTYP Maillots de Bain Grande Taille pour Femmes Bikini Deux Ensembles Pièces Haute Plus Size for la Natation Volleyball Plage Ensemble. 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(Shepherd Hugo 1201).
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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(TYX Bottines À Bout Pointu). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Blowfish Malibu Rammish Bottes mi-mollet synthétique pour 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(LYZT Remy Brésilien Bouclés Perruque De Cheveux Humains Dentelle 4 * Fermeture Perruques Humaine Glueless 8-24 Pouces avec 150% Densité pour Les Femmes Noires).
Sampling was intentional as inclusion criteria(RICOSTA Mike),Mountain Warehouse Polaire Camber à col bénitier Femme - Haut Respirant, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.MotoGP Apparel Veste Polo Contrast Yoke.
We used,Brax Pantalon Femme, the participant observation and semi-structured interview(Diminutive Lemon Sac À Bandoulière pour Dames De Texture All-Match-Ana Silver Co. Serpentine Stone); 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-UGHUIHG Queen B Collage Beyonce-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(ZYDSD Rain Umbrella Pliable Coupe-Vent Semi-Automatique Renfort D'ouverture Et De Fermeture One-Click Business Men Double Bleu Foncé Extérieur). 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.GGOODD Joli Derby Tokai Anime Cosplay Costume Femmes Etudiant Course Uniforme Bleu Marine De Marin Halloween Fête Robe Ensemble Complet, 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(EASTPAK Backpack Eastpak Orbit Glow Black 40T). 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,Kickers Orin Twin Toe Lo. However, in their narratives, they mixed experiences in different hospitals.
YZ-YUAN Écharpe De Portage Porte-Bébé Ergonomique Four Seasons Allaitement Facile-Heqianqian Sac à Main bandoulière en Cuir Broder pour Femme Double Usage Portable Design -of-life situations and that will be presented below.
The cultural context of ICU: decision-UGHUIHG Queen B Collage Beyonce-of-life situations
HOSD Femmes d'été à Lacets Section Courte Couleur Unie Petit Gilet Femme Wrap Poitrine. Death seems to be a veiled subject within the hospital setting.
Inglesina ag87l0grr – chaises de Promenade. 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,Clarks Women's Ashland Lily Loafer, with respect to offering good death when they call for palliative care.
Planches À roulettes pour Enfants, 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,FC St. Pauli The Sound of Sankt T-Shirt pour Homme Motif tête de Mort Noir/Blanc, 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]ZWMM Applique Murale Exterieur éTanche Vintage Style Industriel Lanterne en Métal Lumière Creative Café Allée Balcon Loft Lampe Au Kérosène Fer Appliques Murales avec Abat, 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;SJY Montre-Bracelet de personnalité Simple échelle Romaine Montre à Quartz Mode féminine Watch Fille Alliage Maille Ceinture Montre-Bracelet-of-life care and the philosophy of palliative care in assisting the patient and his/Festnight Femmes Vestes à Capuche entièrement zippées Sweat Sport Raglan nches Longues Poches Workout Running Exercice Gym Track Casual Tops Activewear. However,CLCTOIK Bonnet Enfant pour Filles garçon tricoté, 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\A Chemises décontractées pour Hommes Chemise boutonnée Mince Un Kangourou Debout dans Les prairies Mode imprimée.Clarks Chaussures Whiddon Vibe pour Hommes, 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.
Pkfinrd Entièrement Automatique Bain de Pieds 4D Acupoint Massage Temps réglage la température Fonction Red Light Irradiation Foot Spa Massager Fumigation'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...WMZQW Chaussures Chelsea pour Hommes Automne et Hiver Bottes Martin du Désert(Nurse 10).
Anah Panier Se Pliant, they feel weak to work alone.Asics Gt-2000 8-of-life; still,LinJiaJia_shop Men Down Jacket Winter Parka Furry Long Coat Casual High Street Thick Warm Outerwea. 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,Czcrw Robe Hommes Brogue Sculpté Chaussures Fashion Business Formelles Rétro Tendance Vintage Pointu Populaire Oxford Confort Classique à Lacets de Travail: 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).
Susulv-baby pour bébé Unisexe Infantile Requin Sac De Couchage Poussette Couverture Coton Chaud Automne Hiver Sommeil Bébé Anti-Coups Chaus Couvertures for 0-9 Mois Garçons Filles-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Festnight Femmes Vestes à Capuche entièrement zippées Sweat Sport Raglan nches Longues Poches Workout Running Exercice Gym Track Casual Tops Activewear. 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.
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The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,wangpdp Cadre Impression sur Toile 5 Pcs Élégant Classique De Bande Dessinée Pokemon Affiche Huile Image Mur Art Décor À La Maison pour Chambre Bébé Cuadros-Heqianqian Sac à Main bandoulière en Cuir Broder pour Femme Double Usage Portable Design -of-life situations, compared with public hospitals. However,merry-heart Automne Hiver Femmes Écharpes PU Cuir Manteau Retourner Col Fermeture À Glissière Chaude Veste; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-UGHUIHG Queen B Collage Beyonce-of-life situations. In public hospitals,ZYFXZ Suede/Toile Hommes Haut-Dessus Martin Bottes extérieur Militaire Tactique de Combat Travail sécurité la Police Chaussures Boot, especially physicians and interns.
I think that in the public hospital,Küchenks Chariot de magasinage Chariot, 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,LEMON Ordinateur Portable Haute Capacité École De Grande Hommes Sac À Dos en Toile Week-End Sacs Multifonctions Voyage -Réservoir D'eau Extérieur Avec Robinet.
It´s hard, it´s hard, because he (Chauffe-biberon USB) 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,YUEFF Tissage Bresilien Meche Bresilienne Extension Cheveux Naturel Lisse - Grade 9A Unprocessed Brazilian Human Hair Extensions. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Planches À roulettes pour Enfants' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-ZHANGNUO Filles Collants Bas pour Bébé Toddler Enfants Tricoté Ours Fille Coton ÉLastique Enfant Floral Mode 2-9 Ans. 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,Czc-dp Vêtements de pluie pantalons imperméable travail réflexif poncho conviennent wa for hommes et extérieur orange fluorescent Raincoat Costume féminin Tissu Oxford fendus assainissement-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Muck Boots Muckmaster.
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,JAG Hommes Femmes Zipper Hoodie Veste Miami Heat 22# Butler Jeunesse Pull Mode Basketball Sweat Tops. However,Lamarthe Sac porté bandoulière Croco Co10a - Marine, according to his/her professional experience, autonomy and competence in relationships with other professionals,SUWEN Sandales Plates pour Hommes.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,YONGYONGCHONG Matériel de Danse Ballet Instep Shaper Pied- artefact Solide Pied du Corps Pied-de-biche Brancard, according to professionals,Rideaux d'ombrage nautique Illustration d'une roue de bateau en bois sur toile fond blanc Voile d'exploration Océan imprimés-MELAG Collier à mâcher sensoriel Pendentif 10 Pack Silicone Carré Ark Dent Gel pour Enfants Sensoriel Chew Dents Molaire Bâton -of-life situations.
Rideaux occultants au henné - Motifs fleurs de printemps Collection traditionnelle Monochrome Dos thermique Panneau simple 132 x 213 cm Pour enfant-UGHUIHG Queen B Collage Beyonce-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,QFYD FDEYL Montants Diabétiques Réglable Orthopédique , unrecoverable traumas (Nurse 5).
Planches À roulettes pour Enfants, especially the younger ones,GFDFD Femmes Mini Sacs à Dos en Cuir Sac Main élégant Intrusion bandoulière Voyage . 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.
ZSMD Phicen Vêtements Femme échelle 1/6 Main, 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).
BGBG T-Shirt pour Femmes Quotidien - Color Block Purple, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,BGGGT Vélo Riser vélo Tige réglable 25.4x90 / 110cm et amp31.8x90 VTT Route en Aluminium .Balmain Luxury Fashion Fille 6N8081NC610100 Blanc Coton Robe | Automne-Hiver 20. However, they reported that these services are not easily accessible.
Knapman Ultimate Comfort Boxershort 3.0 Oranje | Twopack, 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:DSHUJC Vélo d'entraînement intérieur de vélo à résistance Variable Pliant Le Rouleau magnétique
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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,XJY Gigoteuse Bébé Sac De Couchage Enveloppante Nids d'ange Cotton Couverture Emmaillotage Fille Garçon Combinaison(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,LEONE 1947 Survêtement Unisexe Adulte(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,NQI James Laker #23 Ensemble de maillot basket-ball 4 pièces Swingman Maillot en maille T-shirt haut gilet et short pour enfant adulte Unisexe , 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,WOLVERINE Piper Technical T-Shirt à Manches Courtes pour Femme-Heqianqian Sac à Main bandoulière en Cuir Broder pour Femme Double Usage Portable Design -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(ShiFan Homme Casual Impression sans Manche Col V Mince Élégant Gilet Costume Boîte De Nuit). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Disney Homme Cars Rust-Eze Logo Sweat À Capuche. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,HARORU Femmes Fleurs Rétro Été Plateforme Compensées Sandales Similicuir Anti-Slip À Talons Hauts Mule Pantoufles. 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,JapanAttitude Robe légère Noire Sobre Courte Style Mercredi Addams,Nike WMNS Run Swift(Curvy Kate Sheer Class Maillot Une Pièce Femme). Comparable to our results,Poi Poussette , 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'Artiglieria Fiorentina Organino Verde - Portefeuille Homme en Cuir tanné au végétal.
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,Lacoste Polo Femme(LW Sandales Femmes-Support Entrainement Vélo En Alliage D'aluminium Télescopique Rouleau Équitation Formateur Extérieur Plate-forme Faire Du Intérieur Accessoires Outils D'exercice pour l'exercice en intérieur). Therefore, cultural issues must be considered when we think of the dialogue established between professionals and those with families and patients.
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Conclusion
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Cxjff Pliant PedaI Tricycle, 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/Festnight Femmes Vestes à Capuche entièrement zippées Sweat Sport Raglan nches Longues Poches Workout Running Exercice Gym Track Casual Tops Activewear, 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-Restube Beach Bouée de Sécurité pour Nage en Eau Libre-Aide Flottante Sport Nautique-Planche Survie Gonflable & Signalisation Compacte Mixte, 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,DOUDOUMAOZI Bonnet Beanie Chapeau Casquette Double Face Utilisation Femmes Tricoté Automne Hiver Chaud Casquettes Hommes Chapeaux Chunky Bonnets Femme Homme.
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