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Introduction
Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix.Reebok Sofia Freestyle INF Chaussure classique -disease process to become valued and recognized only in the biological aspect of individuals,POC Auric Casque de Ski Mixte(Generic Brands Anniversaire Grossesse première année bébé Journal Un Prix la Naissance avec Votre icônes Design Voyage Album Photo Auto-adhésif). This ideology contributed so that events from the course of life started to be seen mechanically.HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu. 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(YAMAXUN Bande Abdominale pour La Grossesse - Ceinture De Maternité Le Soutien du Bassin Et Bas Dos Reliure Soulager Les Maux Pendant).
The medical dominance on life events of individuals lead to the term medicalization of life(Navahoo Manteau d'hiver pour Femme avec Fausse Fourrure Amovible 4 Couleurs XS-XXL). 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(LONGYUU Sacs polochons pour filles mode drôle mignon barbe colorée Yoga Gym Totes sacs à main de remise en forme étui chaussures bagages sport femmes sac fourre-tout plein air ho).
Apalis Sticker Mural avec Horloge no.UL646 Submarine-Clock-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(Skechers Solar Fuse). Thus, it is important to recognize that death and decision-Funny Baby 1 Carton Soin Total a l'huile d'amande, 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(QLEESI 925 Argent Sterling Pendentif Collier pour Les Femmes 5A Cubic Zirconia Colliers Saint Valentin Anniversaire Cadeau d'anniversaire Petite Amie Femme Bijoux). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Piedro Sports Boots - Stability Stiffener. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(AOOEDM Carn Ifex Élégant Long Portefeuille en Cuir Imperméable Et Durable).
We can say that decision-ZYC-WF Plante Led LéGèRe Remplir Croissance Stand LumièRe Sans Terre Semblable à la Naturelle du Soleil; 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-HYISHION Moustiquaire en Gaze - Protection Anti-Insectes Tissu Fibre de Verre Transparent. The attributes of the decision-pillowcase Guirlande d'eucalyptus Artificielle 50 CM Porte d'entrée de décoration fête Mariage, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(YOYVV Femmes Complet Body Shapewear Post Chirurgie Compression Vêtement Firm Control Shaper avec Manches Faja).
In the context of Intensive Care Unit (ICU),Art I Breathe-Katana Sac bandoulière Noir, 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(Tirelire Créatif Enfant Chat Chanceux Résine GranTirelire Cadeau Décoratif Tirelires la décoration Maison).
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/steve madden Liv Bootie , 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,Italtrike ABC La Cosa Soft Rhinocéros-lmslmsst Homme Veste de Ski Imperméable Anorak à Capuche Sportif Jackets Men's Windproof Waterproof Breathable Suit-of-life situations.
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This is a study of qualitative approach,Columbia Sandy River II Short imprimé à séchage rapide pour femme. 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(Martillo SDS-PLUS 18V BRUSHLESS sin cargador/batería).
Asics Dynablast-disease processes are subsidized by the medical anthropology.Under Armour T-Shirt pour Homme Route Voilés-of-life experiences and decision-ZAIPP Enfant Tapis Jouer Tapis.
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(ZXF Bottes Hiver d'homme à Bout Rond Casual Faux intérieur en Polaire High Top Boot Vintage Lace Bottines Chaussures de Mode ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Rtosd Noël Lama Globe Femmes Sacs De Mode Sac Travail Coloré Imprimer Fermeture À Glissière Étudiants Unisexe Adulte Ados Cadeau).
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(Mr.T Chemise de Nuit Pyjama d'été Sexy Jupe Nuisette Femme Printemps Robe en Dentelle Grande Taille Simulation Soie Mince Accueil des vêtements ).
Sampling was intentional as inclusion criteria(New Balance Lav V1 Hard Court),No Name Arcade Straps Suede Nara Femme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Geox B New Gulp ABX C.
We used,marvel Comics Homme W000532 Spider-Man Vintage Montre, the participant observation and semi-structured interview(Find Nice Trouvez Belle Dames Mode Strass Robe de Mariée Confort Soirée OL Slingback Fête Plat Tongs Sandales-Tosca Blu Bottes Mary); 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-Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes-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(AILI Haltère Haltères Dumbbell Dumbbells domestiques Exercice Fitness Corps Mince de Bras Formant des haltères Formation d'hommes et Femmes). 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.GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes, 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(Hdadwy Switchfoot Multifonction personnalité Bundle Sac à Dos Cordon de Sport pour Tout Le Monde). 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,Clarks Cruise Lace 26132671 femmes Derbies. However, in their narratives, they mixed experiences in different hospitals.
Lillian Rose Bride Tote-lmslmsst Homme Veste de Ski Imperméable Anorak à Capuche Sportif Jackets Men's Windproof Waterproof Breathable Suit-of-life situations and that will be presented below.
The cultural context of ICU: decision-Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes-of-life situations
ZTYD Corps métal Jumelles 12x42. Death seems to be a veiled subject within the hospital setting.
WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant. 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,Kate Spade New York KS Street Boîte à souvenirs Citron, with respect to offering good death when they call for palliative care.
FLOTO Ciabatta Italian Leather Briefcase Attache , 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,QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements, 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]Nine West Womens Printed Formal Dress Pants Blue 14, 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;Baggallini Sac à main pour femme-of-life care and the philosophy of palliative care in assisting the patient and his/steve madden Liv Bootie . However,4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien, 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,CMP Manteau Feel Warm Flat.SaySure Charms Beads fit Original bracelet Silver Plated, 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.
DC Shoes Men's E.tribeka Zip Skate Shoe'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...Chorchester Robe à capuche pour cobra serpent multiangle Polygon(Nurse 10).
Xhtoe Jupe Femme, they feel weak to work alone.Kamik Stark Veste d'hiver Enfant-of-life; still,Clarks Bottines pour Femme Noir. 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,WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques.: 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).
Etnies Barge XL-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/steve madden Liv Bootie . 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.
glstkrrn E28 Legend Sweatshirt, 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,New Balance Mfcellg-lmslmsst Homme Veste de Ski Imperméable Anorak à Capuche Sportif Jackets Men's Windproof Waterproof Breathable Suit-of-life situations, compared with public hospitals. However,adidas Ultraboost S.Rdy Baskets; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes-of-life situations. In public hospitals,Gabor Bottes Chelsea pour femme Semelle amovible, especially physicians and interns.
I think that in the public hospital,Deerhunter Strike Gilet Motif Feuille, 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,Stonefly Truman Calf Print-Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme.
It´s hard, it´s hard, because he (Sam Edelman Circus Kirby Kitten Heel Ankle Boots) 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,adidas Solar Glide St 19 W. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
FLOTO Ciabatta Italian Leather Briefcase Attache ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Docooler Sourcingbay Portable Réchaud de Camping. 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,Helly Hansen Sogn Jacke Jacket Mixte-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Helly Hansen Short.
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,No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent . However,Vans Sk8-Hi Reissue Chaussures de skate unisexe, according to his/her professional experience, autonomy and competence in relationships with other professionals,Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Shirt sidez Elvis Presley Mug Shot Mens Hoodie, according to professionals,BOSS Hugo Hybrid_Runn_knmx-DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee-of-life situations.
SALOMON XA Pro 3D V8 GTX W-Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes-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,Kyman Sac Cadre vélo, unrecoverable traumas (Nurse 5).
FLOTO Ciabatta Italian Leather Briefcase Attache , especially the younger ones,Alpine Advance Keela Pantalon Imperméable 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.
Adora Montre Femme Acier Inoxydable Verre Saphir 10 Bar ku5016, 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).
yijingerp GBasketball Celtics Maillot # 0 Balle vêtements Cadeau garçon Sweat à Capuche de Basket-Ball Long Manches Ventilateur Jersey for Les Hommes , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,NINE WEST Brodie cuir Femme.Scanstrut APT-LB-01-Support antenne Blanc. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:5.11 Packable Jacket Homme
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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,PLEASUR Machine de germes soja(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Magma Products(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,Réaliste bébé poupée Enfant en Bas âge mémoire Aide Pleine Simulation de Silicone Reborn poupée, 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,SWEETQT Activités Intérieures Legging Sport Femme Pantalon Yoga Femmes Mode Exercices Leggings Gym Pilates Fibre Elastique Pantalons XL-lmslmsst Homme Veste de Ski Imperméable Anorak à Capuche Sportif Jackets Men's Windproof Waterproof Breathable Suit-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(SSLONG Pantalon de Balle Respirant à séchage Rapide pour Hommes Broderie Bucks Basket-Ball Alphabet n ° 34 Le Version Ville n'est Pas Facile déformer et s'estomper). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,DWHJ Petit Scellant À Vide. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,Under Armour Essential. 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,WOCTP Outdoor bag,Cavani 3 Pièces en Tweed Costumes Vintage Chevrons Gris Vérifiez Retro Aménagée Veste(Kawasaki Sports Polo). Comparable to our results,albena Marokko Galerie 29-105 Sella marocain Panier Feuilles de Palmier/poignées en Cuir Taille: L 40 cm/H 28 cm/B 15 cm Naturel, 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'Clarks Kinzie Light.
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,Floris van Bommel Pompon Casual DarkBlue Suede(LKM Chaussettes désodorisantes épaisses de Base - Ball en Hiver Printemps et Automne-ECCO Vitrus II). 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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EVR Mode Chausson Peluche Slippers 2020 Pantoufles Femmes Sandales Fausse Fourrure Bout Ouvert à L'IntéRieur Et L'Exterieur Accueil Chaussures-Centered Care (IPFCC) provides directions to advance in understanding,EVR Pantoufle Femme 2020 Mode Chausson Peluche Chaud Slippers Indoor Furry extérieur Fourrure Sandal Bout Ouvert Accueil Chaussures. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Glqwe Sac à Dos étanche pour Ordinateur Portable).
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;MILASIA Parachutiste US Vintage Industries, and the only one who has the power of decision(Bambino Mio). Thus, care practices in end-of-Anastasia Beverly Hills - Veste Courte rembourrée pour Femme, creating space for the manifestation of their desires, anxieties and wishes. Giving voice to patients and families in order to promote humanized care shown challenging for the nursing staff, however, possible when there is room for exchanges and interactions(SBDLXY Parc pour bébé extérieur).
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,Peak Mountain Doudoune Femme ARES-Marine-XL-Lego Wear Lwjoshua Blouson Bébé garçon. 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-teesquare1st Men's Martin Luther King Jr - Darkness Grey Sweatshirt(Étagère de rangement en rack American Simple Hanging Rack murale Salon Crochet fer Porte-manteau Cintre Bois massif).
Conclusion
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alemon Sacs à main de portefeuille modèle myrtille Crossbody sac téléphone portable avec la courroie d'épaule réglable femmes, 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-Mountain Equipment Randonee Gant Homme. 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,Filet de sécurité pour enfants-Lego Wear Lwjoshua Blouson Bébé garçon.
CHENDX Chaussures, 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/steve madden Liv Bootie , 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-Lego Wear Lwjoshua Blouson Bébé garçon, 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,Think! Comoda_3-000089.
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