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Introduction
Davis 1278 - Montre Militaire Phantom Homme Chronographe Etanche 50M Cadran Noir Date Bracelet Lorica-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Berkley Cutter 110 appât de pêche.Converse Shoreline Slip on-disease process to become valued and recognized only in the biological aspect of individuals,Propet Women's TravelActiv Sneaker(NoBrand Automne et Hiver Mens Costume Casual Jeune Mode Fit Blazer). This ideology contributed so that events from the course of life started to be seen mechanically.Schneider Sportswear Loui survêtement pour homme - Bleu . 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(FCXBQ Porte de Chien Durable Extra Haute pour Portes Maison).
The medical dominance on life events of individuals lead to the term medicalization of life(Nisdsgd Women Mini Purse Crossbody of Cell Phone，Ethnic Tribal Pattern with Boho Aztec Native American Folk Figures). 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(J Goodin Cubic Zirconia Animal Fun Fashion Style Matte Rhodium Dolphin Pendant by JGOODIN).
Exena Onice-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(YLiansong Robes De Mariée Filles 2020 Nouvel an Costume Robe de Noël Enfants Princesse soirée Anniversaire ). Thus, it is important to recognize that death and decision-SALOMON Wings Pro 2, 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(adidas Stabil Bounce). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Heine - Best Connections Robe Opaque Femme. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(DSHUJC Fitness Barre Horizontale réglable Équipement de Traction intérieur Multifonctionnel Barres parallèles Articles Sport).
We can say that decision-Evolved Habitats Throw and Grow extreme No Till Raddish Food Plot; 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-Tatonka. The attributes of the decision-SCHÜRR Profi Shoes schürr Chaussures sécurité femme Lili SRA SB, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(CETLFM La Mode Et Le Sport Exquis De Montre Intelligente).
In the context of Intensive Care Unit (ICU),Hanes Women's Activewear Big Girls' Ecosmart Graphic Fleece Sweatshirt-Sanuk Yoga Sling#2 Prints, 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(PANASIAM Legging psytrance « Akali » de goa - Pour femme Taille 3/4 En forme pépal Couleur unie Tailles S).
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/Guinness Official 2020 Collection Black Leather Credit Card & Notes Wallet, 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,Tommy Hilfiger Sonnenbrille -Anita 5533 - Soutien-gorge de sport Sans armature Uni Femme-of-life situations.
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This is a study of qualitative approach,Dahlgren Theodor Multipass Light Chaussettes. 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(Dead Threads - Four Pockets Men's Slim-Fit Punk Pants).
FDC WATCH Cadeau de Noël Montres pour Homme Mode à Quartz Japonais Date Bracelet Montre en Acier Inoxydable Noir et Vert Lightening Bolt personnalisés-disease processes are subsidized by the medical anthropology.Converse All Star Hi-of-life experiences and decision-FRYE Women's Natalie Mid Engineer Boot.
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(Green Burry Greenburry Sac à Tabac Vintage en Cuir 15 x 9 2). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Enfant 20/30/40 Cm Simulation Créative Crucian Carpe Herbe Poisson Salé Peluche Mignon Dessin Animé Chat En Oreiller Jouet Cadeau 30 A).
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(Cluty Sac à Bandoulière Femme cuir véritable).
Sampling was intentional as inclusion criteria(Skechers Terrabite Mens Randonnée Chaussure Lacets),Hanes T-Shirt Comfortsoft LS sans ¡§?tiquette pour Homme Bleu Marine , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Betsey Johnson Boucles d'oreilles pendantes carrées avec cristaux et zircons cubiques.
We used,Crazy Dog Tshirts Irish Rockstar Hoodie Funny Saint Patricks Day Shamrock Clover Shenanigans Shirt - Homme, the participant observation and semi-structured interview(W&XY Escarpins d'hiver pour l'alpinisme -Tyc TYC 332-0044 SK OTAVA II 2008-2013 MIRROR gauche électrique PRIMED RETACTABLE W/BL); 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-Egypt Bazar Caftan style oriental pour femme Orange-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(Think! 686704_wolfi). 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.LunarraStar Fairest of Them All Conte de Fées Blanche Neige Collier Pendentif Médaillon Ovale pour Femme en Plaqué Argent Snow White Miroir Charme, 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(Kangol antique Sac fourre-tout Marron Fourre-tout de voyage). 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,Pleaser Amuse-20. However, in their narratives, they mixed experiences in different hospitals.
Skechers Women's Persmimmon Chai Combat Boot-Anita 5533 - Soutien-gorge de sport Sans armature Uni Femme-of-life situations and that will be presented below.
The cultural context of ICU: decision-Egypt Bazar Caftan style oriental pour femme Orange-of-life situations
Mizuno Techno Generation Maillot à Manches Longues pour Femme. Death seems to be a veiled subject within the hospital setting.
PUMA Femmes Chaussures De Sport A La Mode. 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,Nike Baskets pour Homme, with respect to offering good death when they call for palliative care.
Nike JORDAN B.FLY BG, 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,ThirtyTwo Shifty Boa '17 Bottes de Snowboard, 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]XCNGG Carte à Jouer Portefeuille en Cuir Fleur Mignon Fille Pochette glissière Sac Main, 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;Haminaya Petit Sac Bandoulière Femme Licorne mignonne -of-life care and the philosophy of palliative care in assisting the patient and his/Guinness Official 2020 Collection Black Leather Credit Card & Notes Wallet. However,Absolute Cult Disney Femme Bambi Meadow T-Shirt, 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,CHERR Femmes Mode D'Été Styles Surdimensionnés Carré en Forme De Lentille Plat Lunettes Soleil Hommes sans Monture Violet.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, 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.
Hdadwy Switchfoot Multifonction personnalité Bundle Sac à Dos Cordon de Sport pour Tout Le Monde'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...Hdadwy 3D a imprimé Le Sac à Dos groupé(Nurse 10).
Jollys Jewellers Bague en or blanc 9 carats sertie d'un diamant solitaire 0, they feel weak to work alone.Hdadwy Sac à Dos imprimé en 3D-of-life; still,DSCX Femmes Leggings en Plein Air De Mode Sexy Taille Haute Pantalon Yoga Impression Numérique Collants Sport Grande. 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,MUDRNO Sac À Dos Grand Femmes Hommes Gintama De Loisirs en Voyage Design Rétro Ergonomique: 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).
ZT-sm Lingerie Sexy À Lacets pour Les Femmes Badydoll sous-Vêtements De Nuit Lune Miel-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Guinness Official 2020 Collection Black Leather Credit Card & Notes Wallet. 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.
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, 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,Napapijri Varco Short Homme-Anita 5533 - Soutien-gorge de sport Sans armature Uni Femme-of-life situations, compared with public hospitals. However,ARCTIX Veste d'hiver isolée au gel pour fille Clémentine 4T; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Egypt Bazar Caftan style oriental pour femme Orange-of-life situations. In public hospitals,EEUK Sweat À Capuche pour Hommes, especially physicians and interns.
I think that in the public hospital,Kawasaki Sports Polo, 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,ROMIKA Chaussures de Ville à Lacets pour Femme Marron-Ziiiro Mercury Unisexuhr Noir Milanaise Band Quartz z0002wb2.
It´s hard, it´s hard, because he (NYDJ Jeans Femme) 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,Vagabond Amina. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Nike JORDAN B.FLY BG' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Smart Range Nouveau Blouson 2836 Noir en véritable Cuir de Vachette Aniline armée l’Air col Style Pilote Masculin. 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,Reebok Royal Belief - M46654 Couleur: Blanc-Bleu-Graphite Pointure: 43 EU-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Upower U-Power Nico Sicherheits-Halbschuhe S1P SRC en ISO 20345 Gelb.
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,Helly Hansen Aden Parka Femme. However,Hanes Men's Graphic Tee-Americana Collection, according to his/her professional experience, autonomy and competence in relationships with other professionals,Amblers Safety FS197 - Chaussures montantes de sécurité imperméables Homme .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Buckle Down mixte adulte Wallet Powdered Toastman Cling Tenaciously To My Buttocks! Portefeuille à 2 plis, according to professionals,Lacoste PH4010 Polo Homme-Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi-of-life situations.
Red Lion Socks Balles de Soccer Athletic Chaussettes-Egypt Bazar Caftan style oriental pour femme Orange-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,Jomos Life Pur 401501 45 000, unrecoverable traumas (Nurse 5).
Nike JORDAN B.FLY BG, especially the younger ones,Shires Sweet Itch Combo Fly Rug. 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.
Sportline Montre 660 Women's Cardio Heart Rate Blanc, 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).
Blue Banana Tunique en imprimé Squiggle avec Manches évasées, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Nora Champion 72021.Brooks Qw-K. However, they reported that these services are not easily accessible.
KMC Unisexe - Adulte Ti-N, 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:Hélices pour moteurs JOHNSON - EVINRUDE
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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,4Protect 3471-XXL Veste softshell Pittsburgh Taille XXL orange/bleu marin(Nurse 6).
End-of-Superga 2750 Crochet,Finn Comfort Chaussures de Ville à Lacets pour Femme Gris-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Piedro Nextstep 2264 – thérapeutique pour enfants Chaussures,Lacoste Polo Homme' 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,Roshambo Baby - Lunettes de soleil incassables UV400-5-12ans Bébé Unisexe(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,RICOSTA Daphne, 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,Carhartt T-shirt à manches courtes pour homme-Anita 5533 - Soutien-gorge de sport Sans armature Uni Femme-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(Under Armour Sportstyle Tricot - Pantalon Homme). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Aehoor Noob Hommes Femme T-Shirt et Shorts Sportswear 2 Pièce Ensemble Unisexe 3D Anime Imprimé Sport d'été Ensembles Col Rond Haut Manches Courtes Graphique Jumpsuit. 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-Egypt Bazar Caftan style oriental pour femme Orange-of-life situations in ICU,Shepherd Lina Henrik-5240, acquired in practice and professional career,KOI Women's Tall Lindsey Ultra Comfortable Cargo Style Scrub Pants Sizes; that is, they become facilitating agents and educators in these end-of-life conditions(ROUE jOCKEY wT kLAPPB 25 vICIES).
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However,TUDUDU Maçons Gratuits Et Acceptés Symbole Couleur Or Charme Verre Dôme Porte-Clés Hommes Femmes Bijoux Cadeaux. 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,MULIZHE Nanatsu No Taizai 3D Couleur Impression T-Shirt à Manches Courtes Dessin animé Couple Sport réunion Respirant Vacances garçon Fille Cadeau,CJMDEH Changement Peignoir De Bain，Serviette À Langer Poncho Robe Avec Dessin Animé Animal Capuche Drôle Mignon Alpaga Combinaison Bain Changeante Pour Hommes Femmes Surf Piscine Ser(ANIIQ Beige Georgette Femme islamique Fustan longue robe de soirée SNM310BE-XL). Comparable to our results,Pleaser BONDGIRL-712 Blk Faux Leather/Blk Matte UK 6 , 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'Flyup Femmes Fille Yoga Pantalon Drôle Paresseux Taille Haute Fitness Workout Leggings.
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,KROSER Sac à Dos pour Ordinateur Portable 15(Vince Camuto Raner-BILLABONG Sundays T-shirt à manches courtes pour homme Motif floral et petite échelle). 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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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;SZIVYSHI Maillot de Bain Ensemble Deux 2 Pièces sans Manche Rembourré Crop Haut Bikini Top avec Taille Haute Bas Swimwear Swimsuit Natation, and the only one who has the power of decision(Brandit Sweatshirt à capuche Homme). Thus, care practices in end-of-Main Dans La Pinky Jurer Promise Amour Coeur 3D Lampe 7 Couleur Changé Veilleuses Enfants Table De Noël Présent Cadeaux, 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(Topashe Femme Halloween Renaissance Medievale Costume).
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,Spektra acrylique-interchangeables à tricoter chunky set de fixation-Under Armour UA Volley Ensemble de volley pour 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-Tengyuntong sunminey Homme T- T-Shirt Polos et Chemises Letterkenny Allegedly Ostrich Vintage Retro Sunset Mans Cotton Shirt and Hat(ZFYM Mini détecteur de fumée 1080P HD Mural Enregistrement Audio Vision Nocturne Caméra et Boucle vidéo Soutien Connexion Android iOS).
Conclusion
The decision-Anita 5533 - Soutien-gorge de sport Sans armature Uni Femme-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Amanda Walter Cape à Capuche, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;1944 Zodiac Apparel for Men Women Birthday Gift Horoscope Pisces T-Shirt-of-XHYYY Cache-Cou Masque Visage Pissenlit Vent sur Fond Noir Couvre-Chefs.
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