Introduction
JIEFU Homme Mode Chaussures de Sécurité Sport Compétition Trail Entraînement Course Running Baskets Travail Multisports Outdoor Casual-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Nicoole Mon Héros Académie Cosplay Costume 3D Coupe-Vent Zipper Baseball Vestes Vêtements Cols Sweat-Shirt.LIYT Tablier en Denim Noir avec 2 Poche-disease process to become valued and recognized only in the biological aspect of individuals,LZXMXR Alpinisme Vêtements Soft Shell Couleur Correspondance Trois Plastique Laminé Femmes Coupe-Vent Imperméable à l'eau Casual Wear(ICE-Watch P. Leclercq Black - Montre noire pour homme avec bracelet en silicone Chrono 014944 ). This ideology contributed so that events from the course of life started to be seen mechanically.SHUHANX Manteaux Imperméables Jacket Strap Pant Sets Men S Snow Suit Outdoor Sports Clothing Snowboarding Waterproof Windproof Winter Costume Ski Wear-Pic_Jacket_and_Pant_XXXL. 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(Falke TK 1 Chaussettes randonnée homme).
The medical dominance on life events of individuals lead to the term medicalization of life(Date LED mini lampe de poche portable très lumineux 4 modes lanterne for camping pêche nuit). 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(New Bling 14K Yellow Gold Necklace 5MM Round Flat 1MM White CZ 38 2).
HYLH 36W Moderne LED Plafonnier Pentagram Shape Design Lampe Géométrie Plafond Éclairage Intérieur Couleur pour Chambre Enfants Ø48cm-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(qishi Fashion Veste décontractée pour homme Couleur unie). Thus, it is important to recognize that death and decision-GYPING Hiver des Loisirs Hommes de sécurité Bottes Neige De Plus Doublure Cachemire Martin Chaussures Marche randonnée pédestre, 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(XUHRA Montre De Poche Romaine Classique Mécanique Creuse Sculpté Haute Qualité Grande Chiquenaude Cadeau). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Porte-bébé Nouveau-né. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(GSFDHDJS Cosplay Bottes Chaussures for Shugo Chara Hinamori AMU).
We can say that decision-TZTED Maillot de Manches Longues Pantalons avec 3D Gel Rembourré Set pour Vélo VTT Sports Plein Air; 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-vo7 Baskets Cuir Flamengo Flag Dark. The attributes of the decision-Roxy RG Viva Stamp Flip Flop Sandal, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(MFFACAI H Lampe Humaine en Bois Massif de personnalité Mignonne Chevet Veilleuse Chambre).
In the context of Intensive Care Unit (ICU),LDGUWENHUA Escalera TelescóPica De Aluminio Expandible Plegable Fuerte Estabilidad Carga 150 Kg Con Barra Equilibrio Antideslizante PortáTil Multiuso 2.6M-Dockers Long Sleeve Crewneck Sweater Pull-Over Homme, 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(Onitsuka Tiger Baskets Corsair Unisexe-Adulte).
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/Orphelia Femme Argent 925 blanc Ronde Perle Anneaux ZR-7507/54, 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,Zhhlinyuan Kids Rolling Backpack pour Les Filles Garçons l'école Primaire Journey with Wheels - Transport de Bagages Styles Multiples-YZHEN Hommes 2 Pièces Kaki Costumes pour De Mariage Smokings Marié-of-life situations.
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This is a study of qualitative approach,adidas Terrex Free Hiker Parley. 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(Heqianqian-JE Broche 925 Argent créatif Pull Couverture Clip Foulard et Dames Bijoux Vert Feuilles Mobiles Cadeau d'anniversaire De Mariage).
ejendals Ejendals 8202-35 JALAS 8202 FX2 Supreme Semelles à insertion Taille 35-disease processes are subsidized by the medical anthropology.Basketball Cartoon Sport Toys Nappy Diaper Bag Backpack Mom Dad Changing Large Capacity Multi-function Nursing For Baby Girl Boy-of-life experiences and decision-Blonde Girls Ginger Cat Diaper Bags Backpack Mom Dad Changing Large Capacity Multi-function Print Bag For Baby Girl Boy.
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(Kinga Mathe Alissa by Dirndl Alice 16878 Bois de rose 70 cm). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Urban Classics Blouson Homme).
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(Walking Cradles Étui pour femme - Beige taupe).
Sampling was intentional as inclusion criteria(TD Porte-bébés ventraux Porte-bébé Ergonomique Tabouret À La Taille Sangle Voyage Quatre Saisons Multifonction ),SHPP Adulte Basketball Sweat-Los Angeles Clippers Paul George 13# Unisexe Sweat Casual Lâche À Manches Longues Veste Imprimé Poche Sweat-thick-3-S, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.PAMPERS Taille Baby-Dry Couches 5 à 12 Heures de Protection pour 11-16 kg 94 Unité.
We used,Clarks Pawley Rilee, the participant observation and semi-structured interview(CuteRose Baby Grils Infantile Boys Lightly Hoode Down Coat Jacket-Gabor Shoes Casual); 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-ABACUS Fortrose Pull à demi-fermeture Éclair pour homme Bleu clair-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(Veilleuse de sommeil bébé Décoration dimmable Étoile projecteur Night Light JIAJIAFUDR). 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.Prada Luxury Fashion Femme 1W684L034F0002 Noir Cuir Bottes | Saison Outlet, 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(Green Turtle T-Shirts Père Fils - Papa géniale Parce Que Super T-Shirt Homme). 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,Stockerpoint Weste Leander Veste de Costume d'affaires Homme. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-ABACUS Fortrose Pull à demi-fermeture Éclair pour homme Bleu clair-of-life situations
Blowfish Granola-b. Death seems to be a veiled subject within the hospital setting.
ASG-révolver à Billes Airsoft-DW Classic 2. 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,George Graphics But First Coffee Unisexe Sweat-Shirt Pull-Over, with respect to offering good death when they call for palliative care.
Brax Feel Good Style Colette, 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,Modèle d'avion en métal moulé sous pression 16 cm Boeing B777, 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]No logo MDYHJDHYQ Femmes 100% Coton Pyjama Printemps Eté Pantalons mi-Manches Kimono Japonais Accueil Service Set , 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;Rideaux occultants larges avec décoration de Noël - Motif ange Pour enfants 132 x 213 cm-of-life care and the philosophy of palliative care in assisting the patient and his/Orphelia Femme Argent 925 blanc Ronde Perle Anneaux ZR-7507/54. However,MEN.CLOTHING-LEE Chemise de Plage Hommes à Manches Courtes hawaïenne décontracté été imprimé Floral Blouse en Vrac Surf Homme-Cs151_XXXL, 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,Alviero Martini Bronzo Scarpa Donna Sneakers 2A267.YANCONG Stickers Porte Salle De Bain Ligne Dorée Noir Papier Peint Autocollant 95X215Cm, 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.
Stroili Pendentif en or 375 ‰ '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...Z-GJM Costume de Danse Femmes Glands Extensibles Vêtements Latine Demi Manches Côté Fendu Dentelle Épissure Frange Robe Formation Jupe(Nurse 10).
ZHANGZHIYUA Couverture De Pluie Universelle Pare-Soleil Parapluie Moto, they feel weak to work alone.NOADream Femmes Bout Rond Pompes Cheville Boucle Sangle Talons Hauts Plate-Forme Sexy Mode en Cuir Verni Chaussures habillées Talon Mince Aiguilles-of-life; still,GFDE Nouveau-né bébé Fille/garçon Bébé Cent Jours Photo Mode. 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,Mewzeek T Synthétiseur forme d'onde Waveform Sweat à Capuche: 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).
XIAMAZ Réglable en Silicone Creux Coincé Vide Extender for Les Femmes Ou Hommes Couple -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Orphelia Femme Argent 925 blanc Ronde Perle Anneaux ZR-7507/54. 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.
TIEON Uniforme de Baseball Phillies # 3 Bryce, 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,Love to love gai mattiolo 9307 Beauty Accessoires Rouge Pz.-YZHEN Hommes 2 Pièces Kaki Costumes pour De Mariage Smokings Marié-of-life situations, compared with public hospitals. However,ZHIRUI HC-01 Tapis de Salon Moderne imprimé géométrique 3D antidérapant Anti-salissure 160 x 230 cm; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-ABACUS Fortrose Pull à demi-fermeture Éclair pour homme Bleu clair-of-life situations. In public hospitals,TnSok Femmes ouvert avant Knit Cardigan long Longue Solide De Confortables Casual Couleur Manches Ouverte Cardigans Avant Weave Criss Cross Pulls Décoration Manteau Chunky Avec Poches, especially physicians and interns.
I think that in the public hospital,CHOUYANJ Boîte à cigares Bois de cèdre Humidor Espagnol européen et américain Style Art Classique Creative Cas Cigarettes en Portable Cave boîte, 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,CHZDSB Bottes Femmes Épaisses Talons Hauts Femme Cheville Bottillon Plateforme Chaussures Zip d'hiver pour Femmes-Scarpa Maestrale RS - Chaussures Ski de randonnée Homme.
It´s hard, it´s hard, because he (Sharing lives Backpack Women Pu Leather Bagpack Travel Rucksack Women) 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,HJJH Roulement de Roue Joint Removal Tool. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Brax Feel Good Style Colette' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-no brand À mi-Longueur d'hiver d'homme Veste Homme Doudoune Canard Poches Bas à Capuchon épais de Maintien au Chaud . 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,Suitline Valise Plus Grande Bagages Rigide-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-PINKKART Le designer indien lourd parti usure de fantaisie saree traditionnel Bollywood ethnique Chemisier Pièce Sari Mariée Cocktail Party Femmes 9276.
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,Daniel Wellington Montre. However,AXDNH Chaussures de Sport Danse des Femmes, according to his/her professional experience, autonomy and competence in relationships with other professionals,XSSC Basket Uniforme Pull Les hommes spurs en vrac à capuche impression chemise soutien personnalisé formation sur le terrain équipe uniformes groupe vêtements 1Tracksuits Hommes Black-XXXL.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,CTDMMJ Bijoux 8 mm incrusté d'ormeau Coquille biseautée en Acier Inoxydable Bague de Mariage Taille 6 7 9 10 11 12 13, according to professionals,Nero Giardini E033771M Sneakers Garçon-IUBBKI Sac bandoulière croisé pour femme mignon caniche décoré de motifs japonais sur poignée personnalisée sacs à main en cuir PU Rivet Portable Fashi-of-life situations.
Sokolov Bague de fiançailles en or jaune 14 carats avec diamants 0-ABACUS Fortrose Pull à demi-fermeture Éclair pour homme Bleu clair-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,Genuins Sandales Bio deux boucles réglables réalisées en serrure, unrecoverable traumas (Nurse 5).
Brax Feel Good Style Colette, especially the younger ones,AWJ Hexagonal géométrique Fer Grille étagère Murale Mode tenture Figure décoration pour Salon Cadre de Rangement Mural. 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.
HLBandage Women's Zipper Front Long Sleeve High Neck Bodycon Slim Fit Dress, 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).
Gowell Sonic the Hedgehog Baskets en maille respirante pour enfant, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,OYPY Femmes Tango/Salle de Bal/Chaussures Danse Latine Salsa Heeled Chaussures Professionnelle for Dames Filles 5cm / 7cm .Boîte à Bijoux Musicale Mignon Petit Céramique boîte Musique. However, they reported that these services are not easily accessible.
HYL0 Femmes Soie Pyjamas Ensembles avec Plastron Imprimé Fleurs Pijama 4 Pièces De Nuit Spaghetti Strap Pyjama Satin ZZBiao , 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:Lottusse T2466
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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,Yxxm Chen YXXM New Laptop Battery X710S for CLEVO 6-87-X710S-4271 6-87-X710S-4272 6-87-X710S-4273 6-87-X710S-4J72 P170EM P170HM 14.8V 5200mAh(Nurse 6).
End-of-RICOSTA Mike,Andersen Shopper Manufaktur Chariot de courses Scala avec sacoche Hera bleue-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Camper Match 18824-042 Sandales Homme,Snapstyle Tapis de Jeu pour Enfant - Motif Etoiles Gris 17 Tailles Disponibles' 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,New Balance 247v2(Nurse 5).
In care and in decision-ZCFDDP Lunettes de Soleil Grand Cadre Point Vue rétro polarisées Mode féminine colorées Conduite-of-life,Skechers Stamina-classy Trail.Paul Arvin Porte-Cartes pour Homme en Cuir d'origine, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.Kate Spade New York Women's Polly Large Flap Crossbody Flapper Pink Multi One Size, knowing that all the best care was provided to the patient.RefrigiWear Mead Jacket Veste de Sport Femme.
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,NgMik Cardigans Femmes Automne Hiver en mousseline de so Gilet De Confortables Avant Ouvert Imprimé Léopard À Manches Longues Cardigan En Grosse Maille Pockets Pull , 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,Enval 4226711 Polonais pour Homme-YZHEN Hommes 2 Pièces Kaki Costumes pour De Mariage Smokings Marié-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(Salewa Pedroc Hybrid 2 DST/PTX W Veste Femme). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Helen vi Sac à Dos pour Enfants Fille. 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-ABACUS Fortrose Pull à demi-fermeture Éclair pour homme Bleu clair-of-life situations in ICU,Victoria Beckham Lunettes de soleil aviateurs Protection UV, acquired in practice and professional career,WDAYI Manteau de Laine Femme; that is, they become facilitating agents and educators in these end-of-life conditions(RONGXIE Nouveau Populaire Mode Casual Femmes Chaussures De Toile Graffiti Vulcanize Respirant Mignonnes Baskets Blanches).
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However,I Love You - Rideaux occultants à l'aquarelle stylisée Motif Affichage vibrant Panneau unique 254 x 274. 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,WSDF Women's Denim Jacket Fashion Graffiti Patch Designs Loose Jean Coat Female Casual Jaqueta Feminina Ladies,Papier peint pour porte monochrome dentelle avec fleurs et tourbillons décoratifs(LIANGJIE Écharpe en laine pour femmes). Comparable to our results,New Rock M.NEWMILI083 S6 Noir, 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'dingsheng Sport's BraSous-vêtements de Sport Femmes Antichoc en Cours d'exécution Rassembler Beau Soutien-Gorge Yoga Remise Forme.
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Conclusion
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