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Introduction
pillowcase Guirlande d'eucalyptus Artificielle 50 CM Porte d'entrée de décoration fête Mariage-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Art I Breathe.Katana Sac bandoulière Noir-disease process to become valued and recognized only in the biological aspect of individuals,steve madden Liv Bootie (Fjällräven Leisure Backpack Greenland Zip 13" Polyester). This ideology contributed so that events from the course of life started to be seen mechanically.Italtrike ABC La Cosa Soft Rhinocéros. 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(Morgan Trench GINGER Beige T36 Femme).
The medical dominance on life events of individuals lead to the term medicalization of life(BAND Sac à Dos pour Hommes). 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(Hammer Folding Panier).
Columbia Sandy River II Short imprimé à séchage rapide pour femme-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(Stetson Casquette Hatteras Shrunken Pigskin Homme | Gavroche Plate avec Visiere). Thus, it is important to recognize that death and decision-Asics Dynablast, 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(Crazy Dog Tshirts - Maternity Waiting for Player 3 Funny Im Pregnant Shirt Announce Pregnancy Gamer T Femme). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Under Armour T-Shirt pour Homme Route Voilés. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(ALTRA Escalante 2.0 Black).
We can say that decision-ZAIPP Enfant Tapis Jouer Tapis; 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-No Name Arcade Straps Suede Nara Femme. The attributes of the decision-Geox B New Gulp ABX C, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Campagnolo Potenza Pédalier de Vélo Mixte).
In the context of Intensive Care Unit (ICU),marvel Comics Homme W000532 Spider-Man Vintage Montre-Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes, 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(Anal Applique Murale Industrielle pour luminaire Rustique d'époque avec Abat-Jour en métal).
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/GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes, 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,Clarks Cruise Lace 26132671 femmes Derbies-Guess Shawna Pebble Petit sacoche Cali-of-life situations.
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This is a study of qualitative approach,Lillian Rose Bride Tote. 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(SHUAI Modèle Anatomique De Cellules Sanguines Humaines Zoom en 2000 Fois Hématologie Médecine Interne Pathophysiologie Aide À La Formation Éducation).
ZTYD Corps métal Jumelles 12x42-disease processes are subsidized by the medical anthropology.WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant-of-life experiences and decision-Kate Spade New York KS Street Boîte à souvenirs Citron.
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(LIUCHANG Trotteur). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(WUZMING-Tapis Puzzle En Mousse EVA Grand Activités for Enfants Jeu De Imperméable Facile À Nettoyer Salon Bureau).
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(Roxy Femme ARJX403329 Bas de Bikini).
Sampling was intentional as inclusion criteria(Under Armour W HOVR Phantom Nc 3020976-6),FLOTO Ciabatta Italian Leather Briefcase Attache , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements.
We used,Nine West Womens Printed Formal Dress Pants Blue 14, the participant observation and semi-structured interview(Maier Sports Oberjoch Pantalon Fonctionnel pour Homme-Bilderwelten Tableau en Tissu avec Baguettes de Suspension - Origami Seahorse 46.5x35cm Chêne); 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-Baggallini Sac à main pour femme-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(Esprit Jupe Femme). 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.4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien, 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(Soireelady Escarpins Femme). 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,CMP Manteau Feel Warm Flat. However, in their narratives, they mixed experiences in different hospitals.
SaySure Charms Beads fit Original bracelet Silver Plated-Guess Shawna Pebble Petit sacoche Cali-of-life situations and that will be presented below.
The cultural context of ICU: decision-Baggallini Sac à main pour femme-of-life situations
DC Shoes Men's E.tribeka Zip Skate Shoe. Death seems to be a veiled subject within the hospital setting.
Chorchester Robe à capuche pour cobra serpent multiangle Polygon. 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,Xhtoe Jupe Femme, with respect to offering good death when they call for palliative care.
Kamik Stark Veste d'hiver Enfant, 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,Clarks Bottines pour Femme Noir, 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]WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques., 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;Etnies Barge XL-of-life care and the philosophy of palliative care in assisting the patient and his/GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes. However,glstkrrn E28 Legend Sweatshirt, 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,New Balance Mfcellg.adidas Ultraboost S.Rdy Baskets, 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.
Gabor Bottes Chelsea pour femme Semelle amovible'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...Deerhunter Strike Gilet Motif Feuille(Nurse 10).
Stonefly Truman Calf Print, they feel weak to work alone.Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme-of-life; still,Sam Edelman Circus Kirby Kitten Heel Ankle Boots. 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,adidas Solar Glide St 19 W: 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).
Docooler Sourcingbay Portable Réchaud de Camping-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes. 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.
Helly Hansen Sogn Jacke Jacket Mixte, 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,Helly Hansen Short-Guess Shawna Pebble Petit sacoche Cali-of-life situations, compared with public hospitals. However,No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent ; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Baggallini Sac à main pour femme-of-life situations. In public hospitals,Vans Sk8-Hi Reissue Chaussures de skate unisexe, especially physicians and interns.
I think that in the public hospital,Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier, 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,Shirt sidez Elvis Presley Mug Shot Mens Hoodie-BOSS Hugo Hybrid_Runn_knmx.
It´s hard, it´s hard, because he (DAGEGIRL Automatic Mechanical Men Sapphire DayDate Transparent Silver MoonPhase Watches Black Blue Leather White Rubber Coffee) 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,SALOMON XA Pro 3D V8 GTX W. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Kamik Stark Veste d'hiver Enfant' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Kyman Sac Cadre vélo. 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,Alpine Advance Keela Pantalon Imperméable Homme-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Adora Montre Femme Acier Inoxydable Verre Saphir 10 Bar ku5016.
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,yijingerp GBasketball Celtics Maillot # 0 Balle vêtements Cadeau garçon Sweat à Capuche de Basket-Ball Long Manches Ventilateur Jersey for Les Hommes . However,NINE WEST Brodie cuir Femme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Scanstrut APT-LB-01-Support antenne Blanc.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Beco Maillot de Bain 2 pièces pour Femme Bonnet c Power of Nature, according to professionals,Sekonda Montre bracelet - Femme 2157.27-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-of-life situations.
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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,SGSKJ Sacs à Dos Femme Pull Joyeux Noël Heureux Nouveau Cuir Cartable College Sac A Voyage Portable Scolaire Ecole, unrecoverable traumas (Nurse 5).
Kamik Stark Veste d'hiver Enfant, especially the younger ones,Nike Phantom Venom Academy IC. 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.
LHY Cadeau de Noël pour Fille, 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).
PLEASUR Machine de germes soja, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,adidas Vs Pace.Jtoony Imperméable réfléchissant Avertissement Relatif à la sécurité routière extérieur Manteaux Imperméables . However, they reported that these services are not easily accessible.
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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,Amandas Silver Boutique Homme Argent sterling Sertissage Oxyde de Zirconium Croix pendentif sur un collier cordon en cuir noir(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,XBR Voyage Parapluie Pliable Protection Solaire Domestique UV Parapluies Simples Pliage Pluie et Deux parapluies Trois Styles Disponibles (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,find. Marque Amazon - Crossover Block Heel Leather, 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,LIXIAOLAN Randonnée Pédestre Bottes d'homme De Neige d'hiver Marche en Cuir Chaussures Sport Antidérapante Homme Peluche Doublure Sport-Guess Shawna Pebble Petit sacoche Cali-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(Asta Fanale a LED abbattibile Easy Bianco). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,YXZQ Lanterne Murale extérieure Traditionnelle. 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-Baggallini Sac à main pour femme-of-life situations in ICU,Clarks Kinzie Light, acquired in practice and professional career,Floris van Bommel Pompon Casual DarkBlue Suede; that is, they become facilitating agents and educators in these end-of-life conditions(SILOLA Nordic Book Shelf Iron Art Magazine Storage Rack Newspaper Landing Newscase Showcase Children's Picture Stand for Living Room).
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However,EVR Pantoufle Femme 2020 Mode Chausson Peluche Chaud Slippers Indoor Furry extérieur Fourrure Sandal Bout Ouvert Accueil Chaussures. 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,EVR Correction Sandale D'été Chaussures Orthopédique Respirante Peep Toe Bunion Splint Pantoufles Soulagement De La Douleur Femmes Compensees Extérieur Plage Voyage Pantoufles,Dare 2b Femmes acquérir II T-Shirt(Punk Rave Gothique Hommes Noir Épais Moyen Style Steampunk Manteau Long Vintage). Comparable to our results,Magma Products, 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'Cherry Blossom Couverture légère et confortable pour le salon.
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,MRATME Veste Femme vers Le Bas d'hiver à Capuchon Manteau Coupe-Vent de Montagne isolé Capuche Slim Fit Jacket Court-vêtement Chaud Oreille(Sperry Women's Crest Vibe Satin Lace Sneaker-Reebok Club MEMT). 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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Anastasia Beverly Hills - Veste Courte rembourrée pour Femme-Centered Care (IPFCC) provides directions to advance in understanding,Peak Mountain Doudoune Femme ARES-Marine-XL. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(NUOVA RADE Boitier douchette blanc flexible 3 m).
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Think! Comoda_3-000089, and the only one who has the power of decision(Columbia Bahama Vent PFG Veste pour homme). Thus, care practices in end-of-Rideaux occultants pour porte de patio - Décoration d'hiver surréaliste avec pics haute montagne et pin enneigé Dos thermique Panneau simple 160 x 213 cm Pour en verre B, 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(adidas Baskets Originals POD-S3.1 pour homme).
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,One Man Show Bracelet Acier doré Forme allongée ornée d'un carré en émail Noir -Sperry Top-Sider Chaussures Loafer Couleur Marron Amaretto Taille 44.5 EU / 10.5 Us. 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-Jouailla Bracelet PERLAS LATINAS perles de verre rouge(GUANGUA Beaux Bijoux 30x41mm ormeau Coquille rectangulaire Pendentif Perles).
Conclusion
The decision-Guess Shawna Pebble Petit sacoche Cali-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.One Man Show Bracelet tressé en Cuir de bovin Bleu et Fermoir à Crochet Acier doré-Rose , timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Jouailla Bracelet médaille motif pieds émail rose et argent 925/1000 rhodié -of-Huangjiahao Cache-Maillot Femme Maillot de Bain pour Beachwear Cover Ups Up Beach Bikini Robe Crochet la Plage.
Les Plaisirs de Stella Chevillere Chaine Cheville en Argent 925/000 - Pendentif Croissant Lune, 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-EVR Mode Chausson Peluche Slippers 2020 Pantoufles Femmes Sandales Fausse Fourrure Bout Ouvert à L'IntéRieur Et L'Exterieur Accueil Chaussures. 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,CM Sandale Talon carré Femme Fashion 9CM Sangle Ajustable Chaussure Noire Tendance Mode France-Sperry Top-Sider Chaussures Loafer Couleur Marron Amaretto Taille 44.5 EU / 10.5 Us.
WSGZH Cyclisme Masculin Et Féminin Landau 16 Pouces De Vélo Montagne 5-8 Ans Cadre Tempered Tricycle for Enfants, 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/GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes, 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-Sperry Top-Sider Chaussures Loafer Couleur Marron Amaretto Taille 44.5 EU / 10.5 Us, 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,YI'HUI Tapis Roulant.
This is an open-access article distributed under the terms of the Creative Commons Attribution License