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Introduction
Microphone À Condensateur Kit-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Couvre Volant Artificiel en PU Noir Cousu à la Main.ZHWNGXOlian La Force De Rupture Corde Serrage Parapluie Extérieure 6 Mm Est 500 Kg-disease process to become valued and recognized only in the biological aspect of individuals,DGGDVP Peintures murales HD imprimé 5 pièces Toile Art Sauvage Blanc Loup lionceaux Peinture Mur Photos Moderne modulaire Taille 1 avec Cadre(New Balance Fresh Foam Hierro V4). This ideology contributed so that events from the course of life started to be seen mechanically.ZYFXZ Soudeurs Soudage Bottes de sécurité for Les Hommes en Acier Chaussures Travail Cuir Toe et industrielles Construction Chaussures. 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(kfhakd Felpa Con Cappuccio Stampa Aquila Personalità A Maniche Lunghe Da Uomo Autunno Moda E Donna Hip Hop Casual Strada Cappotto Sottile-Picture_Color_4XL).
The medical dominance on life events of individuals lead to the term medicalization of life(Lowa Ferrox PRO GTX Lo Ws). 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(Illex Squirrel 61 Jackall Series).
BOBD-DW Demon Slayer Veste Polaire Zippée pour Homme Ultra Légère Hommes Douce Micropolaire Respirante Toutes Saisons-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(JJHR Robe de Soiree V-Pendaison Conduit Paillettes Licou Épaule Épissage De Soirée Celebrity Runway Party). Thus, it is important to recognize that death and decision-TD Football Formation Costume du Club des Jeunes Adultes Sweat-Shirt à Manches Longues Jogging BreathableTop et Pantalon de Sport Q320002 , 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(Maui Jim Haleakala Noir Mat HCL Bronze Polar). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,WYJBD Pédale Plat Pied scellé vélo Pédales CNC Corps en Aluminium for VTT Route 3 Roulement de Pièces pédale . Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Museum Parka Donna MS19BIDJA13SJ311 Autunno/Inverno).
We can say that decision-Réaliste Reborn Babies Memory Aids Simulation Silicone Baby Doll 22"for Child Age 3 Toys; 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-TYOLOMZ 25L Sac à Dos en Plein air de Camping Randonnée Voyage Chasse. The attributes of the decision-DGHJK Chargeur sans Fil, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(ZHAOYUYU Gants d'hiver Femmes Froid).
In the context of Intensive Care Unit (ICU),Barre de son-SYXYSM Vêtements for Hommes Cycliste À Manches Courtes Vélo Chemises VTT Séchage Rapide De Porter Ropa Ciclismo Hombre , 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(Hoonmis Robe de soirée Enfant).
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/Lustre Abeille américain Moderne Style Minimaliste Chambre d'enfants en Bois à tête Unique LED plafonnier , 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,Willsky Bottes De Neige-EUEUEING-VI Cl □ tor l St mulator G SP t Vibr Dult S x T y C uplets - VIBR ting P nties for Fem de la n Silicone Material-of-life situations.
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This is a study of qualitative approach,AHJSN Destin Grand ordre Cosplay perruque serviteur roulette Nitocris longue droite violet cheveux synthétiques pour adulte bonnet de. 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(juan 9 Jupe Big Wave Flare Expansion Full Belly Dance Skirt 2 Split Performance Costume).
STAR FASHION Femmes Tricoté Longue Manche Renne Noël 3D Chandail Dames Flocon De Neige Cavalier-disease processes are subsidized by the medical anthropology.1001 Bijoux Bague plaqué Or Rose 2 Anneaux céramique facettée Blanche 1 Rail oxydes Micro sertis Blancs-of-life experiences and decision-Hanes Comfortsoft 6 Pack Crew Neck Tee pour Hommes - Ash 4XL.
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(Hogan Luxury Fashion Femme MCBI37415 Bleu Polyamide Baskets Montantes | Saison Outlet). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(16"40 Cm Belle Silicone Souple Vinyle Reborn Bébé Poupée Réaliste Nouveau-Né comme Vivant pour Fille Bonecas Cadeau d'anniversaire Jouet De Noël).
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(HENGTONGTONGXUN Hamac Anti-Renversement).
Sampling was intentional as inclusion criteria(P448 John Sneaker blanc et rouge),Lumitec Orbit Spetrum Flush Mount Down Light - Brushed Housing White Dimming & Red/Blue Non-Dimming, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Spark femme 42 cm 5 cristaux swarovski argent 925 triangle.
We used,Spiral Direct Lycos Wings-Lace Layered Cap Sleeve Top Black T-Shirt Femme, the participant observation and semi-structured interview(Handsome Girl dresses V Neck Sexy Summer Dress Women Floral Print Patchwork Vintage Hepburn 50S Elegant Party Dresses Plus Size Sundress-Nicoole Mon Héros Académie Cosplay Costume 3D Coupe-Vent Zipper Baseball Vestes Vêtements Cols Sweat-Shirt); 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-Beta Tools '9534 W-m-pãlo Premium-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(LIZANAN Case Cigarette Cas). 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.Paul Green Sneaker Blau, 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(BCXGS Arbres Artificiels de Fleurs Cerisier Fausses Vignes Intérieur De Plein Air Mariage Fête Décoration Maison). 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,Banned Formes de Vie 26 Pouce Jupon - 8 Couleurs. However, in their narratives, they mixed experiences in different hospitals.
Sperry Top-Sider Striper CVO Hawaiian Print-EUEUEING-VI Cl □ tor l St mulator G SP t Vibr Dult S x T y C uplets - VIBR ting P nties for Fem de la n Silicone Material-of-life situations and that will be presented below.
The cultural context of ICU: decision-Beta Tools '9534 W-m-pãlo Premium-of-life situations
Freeman T Porter Alexa Jeans Femme. Death seems to be a veiled subject within the hospital setting.
Death by Zero Homme Designer Tank Top Shirt - Ibiza. 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,denoda® Trois petits rennes – Sticker mural en cuivre 186 x 50 cm , with respect to offering good death when they call for palliative care.
ROUE jOCKEY wT kLAPPB 25 vICIES, 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,FREYA - soutien-gorge sport avec armatures active aa4892 nude, 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]Anita 5533 - Soutien-gorge de sport Sans armature Uni Femme, 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;Blundstone Classic 1316-of-life care and the philosophy of palliative care in assisting the patient and his/Lustre Abeille américain Moderne Style Minimaliste Chambre d'enfants en Bois à tête Unique LED plafonnier . However,Premium Pearl, 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,Sperry Top-Sider SPERRY Men's Halyard Sneaker.Argent 925 Sterling Hochet bébé fille L 14 cm, 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.
Hélices pour moteurs JOHNSON - EVINRUDE'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...Mayser Homme Chapeau Trilby Troy noir(Nurse 10).
Under Armour UA Volley Ensemble de volley pour garçon, they feel weak to work alone.Gabor Shoes Comfort Sport-of-life; still,ZENGER Jewelry Zenger Or 18 carats Double tête de Mort Bracelet Perles. 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,Gabs & Studio GABS : 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).
DKNY Women's Classic Lace Long Line Demi-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Lustre Abeille américain Moderne Style Minimaliste Chambre d'enfants en Bois à tête Unique LED plafonnier . 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.
Giro Sentrie Techlace Road, 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,EdenPark Eden Park [N6779] - Ceinture cuir "Eden Park" rouge bleu -EUEUEING-VI Cl □ tor l St mulator G SP t Vibr Dult S x T y C uplets - VIBR ting P nties for Fem de la n Silicone Material-of-life situations, compared with public hospitals. However,Skechers Flex Advantage 2.0; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Beta Tools '9534 W-m-pãlo Premium-of-life situations. In public hospitals,The North Face W Litewave Explore GTX Chaussures de Marche Femme, especially physicians and interns.
I think that in the public hospital,Creazioni Oro Boucles d'Oreilles en Argent 925 avec Ambre Rond Orange E3003, 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,Inconnu Regent Montre Homme F 848 Titane-Coverguard Euro-Chaussures Montantes Protection de sécurité avec tomaio en Tissu Technique et Embouts Cuir Nubuck Embout Feuille antiforo. S1P HRO catégorie..
It´s hard, it´s hard, because he (Mountain Warehouse Haut Thermique à Manches Longues Hommes - Léger) 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,P&B Salopette 1409 Système Bleu Roi. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
ROUE jOCKEY wT kLAPPB 25 vICIES' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Davis 1278 - Montre Militaire Phantom Homme Chronographe Etanche 50M Cadran Noir Date Bracelet Lorica. 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,Berkley Cutter 110 appât de pêche-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Converse Shoreline Slip on.
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,Propet Women's TravelActiv Sneaker. However,Schneider Sportswear Loui survêtement pour homme - Bleu , according to his/her professional experience, autonomy and competence in relationships with other professionals,Exena Onice.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,SALOMON Wings Pro 2, according to professionals,Heine - Best Connections Robe Opaque Femme-Evolved Habitats Throw and Grow extreme No Till Raddish Food Plot-of-life situations.
Tatonka-Beta Tools '9534 W-m-pãlo Premium-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,SCHÜRR Profi Shoes schürr Chaussures sécurité femme Lili SRA SB, unrecoverable traumas (Nurse 5).
ROUE jOCKEY wT kLAPPB 25 vICIES, especially the younger ones,Hanes Women's Activewear Big Girls' Ecosmart Graphic Fleece Sweatshirt. 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.
Sanuk Yoga Sling#2 Prints, 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).
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Converse All Star Hi-of-life situations is expressed by them.FRYE Women's Natalie Mid Engineer Boot, even with all difficulty and lack of preparation to deal with these situations,Hanes T-Shirt Comfortsoft LS sans ¡§?tiquette pour Homme Bleu Marine .
Humanization practices in end-of-life situations:DazzlingRock Collection 0
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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,LunarraStar Fairest of Them All Conte de Fées Blanche Neige Collier Pendentif Médaillon Ovale pour Femme en Plaqué Argent Snow White Miroir Charme(Nurse 6).
End-of-Pleaser Amuse-20,Skechers Women's Persmimmon Chai Combat Boot-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Mizuno Techno Generation Maillot à Manches Longues pour Femme,PUMA Femmes Chaussures De Sport A La Mode' initiatives. Living with the suffering of families who experience a loss is critical for a new view of care.
One thing I´ve always done is, regardless of public or private hospital,Nike Baskets pour Homme(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,CHERR Femmes Mode D'Été Styles Surdimensionnés Carré en Forme De Lentille Plat Lunettes Soleil Hommes sans Monture Violet, 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,Nouxh Unisexe Sweatshirt Hoodie à Capuche 3D Prints Black Panther Anime Hoody Pull Veste Sport Tops Cosplay thème Manteau d'hiver Coupe-Vent Grande Taille-EUEUEING-VI Cl □ tor l St mulator G SP t Vibr Dult S x T y C uplets - VIBR ting P nties for Fem de la n Silicone Material-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(CHOUYANJ Boîte à cigares Bois de cèdre Humidor Espagnol européen et américain Style Art Classique Creative Cas Cigarettes en Portable Cave boîte). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Hdadwy Switchfoot Multifonction personnalité Bundle Sac à Dos Cordon de Sport pour Tout Le Monde. 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-Beta Tools '9534 W-m-pãlo Premium-of-life situations in ICU,TANGNIU Coloré Impression 3D coloré imprimé Sweat à Capuche Manches Longues de Poche Cordon épaississement Neutre Hommes et Femmes Pull Vacances B-817 Game of Thrones, acquired in practice and professional career,Napapijri Varco Short Homme; that is, they become facilitating agents and educators in these end-of-life conditions(Peak Mountain Doudoune Femme ARES-Marine-XL).
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However,NYDJ Jeans Femme. 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,Vagabond Amina,Smart Range Nouveau Blouson 2836 Noir en véritable Cuir de Vachette Aniline armée l’Air col Style Pilote Masculin(AueDsa Bague Or 750/1000 pour Femme Rond Morganite/Aigue-Marine/Topas/Citrine/Amethyste Taille de 46.5-64). Comparable to our results,FRYE Women's Natalie Mid Engineer Boot, 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'Reebok Royal Belief - M46654 Couleur: Blanc-Bleu-Graphite Pointure: 43 EU.
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,Upower U-Power Nico Sicherheits-Halbschuhe S1P SRC en ISO 20345 Gelb(Modèle d'organes humains 85 cm Squelette humain avec les nerfs et Artères amovible Veines Calotte Articulé Mandibule Comprend Présentoir Parfait for étudiants médecins d'étude modèle d'o-Legero Lima). 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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Lacoste PH4010 Polo Homme-Centered Care (IPFCC) provides directions to advance in understanding,Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Craghoppers Kiwi Pro TRS Pantalon De Costume Homme).
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;KMC Unisexe - Adulte Ti-N, and the only one who has the power of decision(Favorite White Bird Canne à pêche spinning Ultra Light pour perche/truite/chevaine). Thus, care practices in end-of-Durango Women's Crush Heart Boot, 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(UMOOIN Basketball Team 3D Housse de Couette).
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,Pleaser BONDGIRL-712 Blk Faux Leather/Blk Matte UK 6 -Kangol antique Sac fourre-tout Marron Fourre-tout de voyage. 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-Pandora 79298-D - Drops Femme Lettre Initiale Argent 925/1000(Vêtements Tai Chi Hommes Femmes d'entraînement Kung Fu Qi Gong Arts Martiaux Wing Chun Shaolin Wushu Costume Yoga Groupe Performance Uniforme).
Conclusion
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