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Faculty of Dentistry

Course Outline
Academic Year 2017-2018

Course Name: Support Tissue


Course Number: DENT-218
Credit Weight: 3

Calendar Description: Examination, diagnosis, treatment planning and introduction to clinical


management of periodontal diseases

Division: Periodontology

Recommended Textbooks, References, Manuals:

1) Carranza’s Clinical Periodontology, Newman M, Takei H., Klokkevold P., Carranza F. 12th
edition.
2) Periodontics, Rose, L.F., Mealey B.L., Genco R.J., Cohen, D.W. Elsevier Mosby, 2004.
3) Selected readings to be posted on Website (myCourses)

Additional References, Manuals:

 Periodontal Surgery. Sato N. Quintessence Publishing, 2000.


 Color Atlas of Periodontology, Klaus H. & Edith M. Rateitschak, Ed. 2, Thieme Medical
Publishers, N.Y., 1989.
 Fundamentals of Periodontics, Wilson T.G., Kornman, K.S., 2nd ed. Quintessence Books,
2003.

Course Director:

Dr. Sara Behmanesh, D.D.S., M.S.D., Dip. Perio, ABP., FRCD(C)


Department of Periodontics
2001, McGill College Avenue, suite 500
Montréal, (Québec), Canada H3A 1G1
sara.behmanesh@mcgill.ca

Interim Course Director:

Dr. Omid Kiarash, D.M.D., M.S.D., Dip. Perio, ABP., FRCD(C)


Department of Periodontics
2001, McGill College Avenue, suite 500
Montréal, (Québec), Canada H3A 1G1
omid.kiarash@mcgill.ca

Academic Administrative Coordinator:


Ms. Lora-Mae Chartier
E-mail: lora-mae.chartier@mcgill.ca
Tel: 514.398.7203 ext. 09308

Instructors:

Dr. Paul Allison: paul.allison@mcgill.ca


Dr. Haider Al-Waeli: haider.al-waeli@mail.mcgill.ca
Dr. Fredrick Muroff: fredrick.muroff@mcgill.ca
Dr. Simon Tran: simon.tran@mcgill.ca
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Course Description:
The second year course in Periodontics is designed to build upon the basic sciences knowledge
acquired during medical school and undergraduate science studies. The second year curriculum
will demonstrate the relevance and integrate this foundation with respect to patient
management. The didactic portion of this course will take place at one of the 3 lecture halls at
our new facility. Pre-Clinical and Clinical instruction will occur in the Sim-lab and Main Student
Clinic, respectively, under the supervision of the department of Periodontics faculty. Clinical
emphasis shall be upon initial periodontal therapy and appropriate application of treatment
modalities in a proper sequence. Knowledge of the techniques, indications and desired
outcomes of periodontal non-surgical procedures shall be obtained.

Diagnosing periodontal disease is an essential aspect of the general dentist’s practice. It is


crucial for the graduating dentist to be able to;
- Conduct a comprehensive periodontal examination.
- Establish a periodontal diagnosis based on the currently accepted methodology
approved by the American Academy of Periodontology.
- Formulate a rational and effective comprehensive treatment plan.
- Deliver all aspects of non-surgical therapy.
- Be able to evaluate and understand the clinical outcomes of the therapy provided in
order to assess future needs of the patient (i.e.: surgical treatment, referral or
maintenance).

Course Content:

(see separate lecture schedule)

Review

 Definition of periodontal health and disease


 Epidemiology of periodontal diseases
 Clinical assessments and diagnosis
 Treatment Planning

Non-Surgical Periodontal Therapy

Self-supported care

 Daily mechanical plaque control


 Dental plaque and calculus
 Oral hygiene aids
 Bio-behavioral aspects and needs-related habits
 Effects of plaque control
 Scientific evidence of efficacy

Professional mechanical therapy

 Supra and sub-gingival plaque control


 Plaque retentive factors
 Root and alveolar bone anatomy
 Contaminated root surfaces
 Removal of calculus and cementum
 Instrumentation for supra- and sub-gingival scaling & root planing

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 Techniques (Hand instrumentation, ultrasonic therapy)

Outcomes
 Clinical outcomes assessment
 Wound healing (reattachment, repair, new attachment, and regeneration)
 Effects on microbiota
 Scientific evidence of efficacy

Chemical plaque control

 Chemical plaque control agents


 Antimicrobials rinses
 Local site specific antibiotic therapy
 Systemic antibiotic therapy
 Scientific evidence of efficacy

Supportive therapy - monitoring and reassessing health status

 Diagnostics
 Treatment of disease recurrence
 Treatment of periodontal emergencies
 Coordination of oral health care
 Scientific evidence of efficacy

Systemic Conditions and Interactions with Periodontal Diseases

 Smoking
 Diabetes
 Heart and pulmonary diseases
 Pregnancy
 Osteoporosis
 Medically compromised patients
 Effect of drugs on the periodontal condition
 Scientific evidence

Educational Objectives: (End point objectives of student performance in the course)


Upon successful completion of the course, the student will be able to: (list)

Epidemiology and Diagnosis

1. Explain the nature and etiology of periodontal diseases.


2. List all the steps in a comprehensive periodontal examination and report the results.
3. Assess a patient for the presence of etiologic and risk factors contributing to
periodontal diseases.
4. Formulate a periodontal diagnosis based on the Armitage classification.

Treatment planning
5. Analyze findings and determine a prognosis from a periodontal perspective.
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6. Assess patient’s goals, values, and concerns.
7. Sequence an interdisciplinary treatment plan with specific considerations to the
periodontium for patients with up to localized moderate chronic periodontitis.

Non-Surgical Therapy
8. Explain the rationale for non-surgical therapy.
9. Describe non-surgical therapy.
a. Periodontal prophylaxis.
b. Techniques of oral hygiene to the patient.
c. Selection and manipulation of appropriate periodontal instruments.
d. Integration of pharmacological management (anti-inflammatory and
antimicrobial agents) in the treatment of periodontal conditions.

Outcomes and Maintenance

10. Analyze the clinical outcomes of periodontal therapies.


11. Define and compare reattachment, repair, new attachment, and regeneration.
12. Propose maintenance periodontal therapy for patients with up to localized moderate
chronic periodontitis and maintain the patient in state of gingival health.
Key Words: (To be used for a curriculum inventory)
Periodontology, Periodontics

Student Responsibilities:

General Information

Lectures are mandatory and will begin at the times indicated in the schedule and conclude in
time for students to begin their clinical appointments. Students are responsible for providing
their laptop computers at all lectures and maintaining appropriate software and internet
connectivity on their laptop computers. Technical questions should be directed to the dental
school IT help desk at: Tel.: (514) 398-3398 or by email at: itsupport@mcgill.ca website:
www.mcgill.ca/it

Reading assignments are posted in the lecture outlines on myCourses and it is the student’s
responsibility to complete the assigned readings. Similarly, students are responsible for their
own notes taken at any lecture.

Periodontics Supervisor and Course Director can address questions regarding clinic protocol and
requirements. Please review the School policies concerning the consumption of food and drink
in lecture halls which is not permitted in our assigned lecture hall. Student dress and
comportment should reflect the standards of the profession at all times and the school dress
code policy.

Surgical Lab Information

Each student is assigned and must attend all periodontal lab sessions, as they are ALL
MANDATORY (PRE-CLINICAL EXERCISE IN THE LAB &/OR CLINICAL IN THE MAIN CLINIC).
Appropriate clinic attire (i.e. protective eyewear, clinic coat) is required. Your simulation
laboratory assignment is posted in a separate folder under myCourses information.

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Standards of Behavior

Students are expected to comply with university policy as outlined in article 5.6.1. of the
(2014-2015) Health Sciences Calendar.

http://www.mcgill.ca/study/2014-2015/sites/mcgill.ca.study.2014-2015/files/healthsciences2014-2015.pdf

“The teacher/learner relationship is based on mutual trust, respect, and responsibility.


The Faculty of Dentistry therefore has many legitimate expectations related to the
behavior of students and faculty members. A Code of Conduct for the medical program is
printed in the Student Handbook (distributed at orientation). The Faculty is committed to
providing a learning environment which respects this Code. Student/faculty harassment,
abuse, and mistreatment are not tolerated. An evaluation protocol for professional
behavior is in the development phase. Students who demonstrate inappropriate
professional conduct or are found guilty of a criminal offence may be dismissed from the
Program.”

Remediation:

Students are required to pass the final examination and obtain an overall mark of 70% or higher
to pass the course. Failure of either clinical and/or didactic portion of this course will dictate
the need to write a supplemental exam. The format of supplemental and/or deferred exams
remains at the discretion of the course director and may comprise of didactic and clinical
activities. Students who fail the supplemental exam are to repeat the entire course and will
not be promoted to DMD-III. No remediation will be offered for the midterm.

Grading and Evaluation:

This is a Pass/Fail Course.

Lecture (Didactic) Grade

Mid-term/Final Exams:

There are two examinations, a midterm and a comprehensive final, in this course. They
will be weighed as follows; 45% and 55% respectively. Missed examinations will be
given a permanent grade of zero, "0", unless the examination was missed due to
circumstances beyond the student's control. You are expected to notify the course
directors as soon as you return to school from your absence, if you believe that you
have a valid reason for not being present in lecture and/or for not taking an
examination. This notification should be by email to course director’s attention and
CC’ed to the Department of Periodontics Director, as well.
If you are aware ahead of time that you will be absent (e.g. religious holiday or school
sponsored function) please see the course director or her delegate so that individual
arrangements can be made in advance. No consideration will be given if
arrangements were not made prior to an anticipated absence.

A student's final grade in the didactic portion of the course will be determined by
addition of the 2 scores from the entire semesters. A final didactic average of at least
70% must be attained in order to pass the course regardless of the student's clinical
performance. All examinations are cumulative in nature. The final examination will be
cumulative. STUDENTS MUST PASS THE FINAL EXAMINATION IN THE SPRING IN ORDER
TO PASS THE COURSE.

Grading Scheme:

Pass 70–100%
Fail 0–69%
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Means of Evaluation:

Didactic/Theoretical Mark

I. 2 hours Progress Examination in Mid-Term: (May contain Multiple-choice and short


answers). This examination will be based upon the material covered until the
examination as well as assigned readings (including DMD II – Dec 2016) and will be
worth 45% of the year’s grade.

II. 3-hours Final Written Examination (May contain Multiple-choice short and/or long
answers). This examination will be based upon the entire course content (DMD II – Dec
2016 to June 2017) and the required readings (book and articles). This examination will
be worth 55% of the total grade.

General Information for Students:

 Students must attend lectures, and workshops except when they are on rotation. Lectures start on
the hour and students are expected to be on time. For more details on the matter, please consult
the DMD Absences and Leaves Policy:
https://www.mcgill.ca/dentistry/files/dentistry/mcgill_dmd_absences_and_leaves_policy_official.pdf
 The Faculty of Dentistry is dedicated to promoting integrity in the academic environment.
The McGill Handbook on Student Rights and Responsibilities is available at:
http://www.mcgill.ca/secretariat/policies/students/handbook-student-rights-and-responsibilities
 The McGill University Health Sciences e-Calendar is available at:
http://www.mcgill.ca/study/2016-2017/files/study.2016-2017/health_sciences_ecalendar_2016-
2017.pdf
 The Faculty of Dentistry Professionalism Standard:
https://www.mcgill.ca/dentistry/files/dentistry/professionalism_standard_official_passed_at_cc_2
1-sep-2012_ec_8-may-2015.pdf

 McGill University values academic integrity. Therefore all students must understand the
meaning and consequences of cheating, plagiarism and other academic offences under the
Code of Student Conduct and Disciplinary Procedures, please visit the site for more information
at (http://www.mcgill.ca/integrity/). | L'université McGill attache une haute importance à
l’honnêteté académique. Il incombe par conséquent à tous les étudiants de comprendre ce que
l'on entend par tricherie, plagiat et autres infractions académiques, ainsi que les conséquences
que peuvent avoir de telles actions, selon le Code de conduite de l'étudiant et des procédures
disciplinaires pour de plus amples renseignements, veuillez consulter le site
(http://www.mcgill.ca/integrity/).
 In accord with McGill University’s Charter of Students’ Rights, students in this course have the
right to submit in English or in French any written work that is to be graded.
 If you have a disability please contact the instructor to arrange a time to discuss your situation.
It would be helpful if you contact the Office for Students with Disabilities at 398-6009 (online at
http://www.mcgill.ca/osd) before you do this.
 End-of-course evaluations are one of the ways that McGill works towards maintaining and
improving the quality of courses and the student’s learning experience. You will be notified by e-
mail when the evaluations are available on Mercury, the online course evaluation system.
Please note that a minimum number of responses must be received for results to be available to
students.
 “In the event of extraordinary circumstances beyond the University’s control, the content and/or
evaluation scheme in this course is subject to change.”

 
 
   

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FIVE CORE COMPETENCIES of CBGD 2015: 
This course outline follows the recent recommendation by the Association of Canadian Faculties of
Dentistry (ACFD) educational framework for the development of competency standards in dental
programs. For more information, please consult the following link:
http://acfd.ca/files/2014/01/ACFD-Educational-Framework-for-the-Development-of-Competency-in-
Dental-Programs.pdf
 

PATIENT-CENTEREDCARE
COMPTENCY COMPONENTS AND INDICATORS:
1.1 Apply knowledge of the clinical, socio-behavioural, and fundamental biomedical sciences relevant to
Dentistry. (CMF2005)
1.2 Perform a complete and appropriate assessment of patients. (CMF2005)
1.3 Demonstrate appropriate diagnostic and treatment planning skills. (CMF2005)
1.4 Demonstrate appropriate preventive skills. (CMF2005)
1.5 Demonstrate appropriate therapeutic skills. (CMF2005)
1.6 Recognize own limits and seek appropriate consultation from other health professionals where
appropriate. (CMF2005)

PROFESSIONALISM
COMPTENCY COMPONENTS AND INDICATORS:
2.1. Demonstrate a commitment to patients and the profession by applying best practices and adhering to
high ethical standards. (CMF2015)
2.2. Demonstrate a commitment to society by recognizing and responding to the social contract in dental
health care. (CMF2015)
2.3. Demonstrate a commitment to personal health and well-being to foster optimal patient care. (CMF2015)
2.4. Demonstrate a commitment to the profession by adhering to standards and participating in profession-
led regulation. (CMF2015)

COMMUNICATION & COLLABORATION


COMPTENCY COMPONENTS AND INDICATORS:
3.1 Establish professional therapeutic relationships with patients and their families. (CMF2015)
3.2 Elicit and synthesize accurate and relevant information along with the perspectives of patients and their
families. (CMF2015)
3.3 Engage patients and others in developing plans that reflect the patient’s dental health care needs and
goals. (CMF2015)
3.4 Document and share written and electronic information about the dental encounter to optimize clinical
decision-making, patient safety, confidentiality, and privacy. (CMF2015)
3.5 Work effectively with other dentists and other health care professionals. (CMF2015)
3.6 Work with dentists and other colleagues in the health care professions to promote understanding,
manage differences, and resolve conflicts. (CMF2015)
3.7 Hand over the care of a patient to another health care professional to facilitate continuity of safe patient
care. (CMF2015)

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PRACTICE & INFORMATION MANAGEMENT
COMPTENCY COMPONENTS AND INDICATORS:
Components of Competency 4 - Practice and Information Management
4.1 Implement processes to improve professional practice. (CMF2005)
4.2 Employ information technology appropriately for patient care. (CMF2005)
4.3 Apply the principles of evidence-based decision making into practice. (AAC)
COMPETENCY 5 – HEALTH PROMOTION:
The responsible use of professional expertise and influence to advance the health and well-being of
individual patients, communities and populations. (CMF2005)

HEALTH PROMOTION
COMPTENCY COMPONENTS AND INDICATORS:
5.1 Work with patients to address social determinants of health that affect them. (CMF2015)
5.2 Work with patients and their families to increase opportunities to improve or maintain their health.
(CMF2015)
5.3 Respond to the oral health promotion needs of a community or population. (CMF 2015)
 
CROSS SECTION OF CBDP 2005, NDEB KSA 2014, and CBGD 2015
Competencies     
 
for the  MAJOR   
Beginning  (M),  Knowledge Skills  CBGD 
SUPPORT Competent Beginning  Compon
Dental  ING (S),  and Abilities  
Competency Chart  ASSUMP General Dentist   ent 
Practitioner  TIONS (A) 
(2014,  as per 
(2015)  Indicator
(2005 – now  the NDEB)  s 
replaced by the 
CBGD 2015) 
Recognize the determinants  S   
of oral health in individuals 
and populations and the role 
1  15.1  Health Promotion 
of dentists in health 
promotion, including the 
disadvantaged. 
Recognize the relationship  M   
Patient Centered Care 
between general health and  2  N/A 
Health Promotion 
oral health. 
M  Practice and   
Evaluate the scientific 
3a  12.1  Information 
literature 
Management 
M  Patient Centered Care   
Justify management 
Practice and 
recommendations based on 
3b  12.1  Information 
the level of evidence 
Management 
available. 
Health Promotion 
Communicate effectively  S   
with patients, parents or 
Communication and 
guardians, staff, peers, other  4  13.1 
Collaboration 
health professionals and the 
public. 
Identify the patient’s chief  S   
Patient Centered Care 
complaint/concern and 
5  1.1.1  Communication and 
obtain the associated 
Collaboration 
history. 
Obtain and interpret a  S   
medical, dental and 
psychosocial history, 
including a review of  Patient Centered Care 
systems as necessary, and  6  1.1.1  Communication and 
evaluate physical or  Collaboration 
psychosocial conditions that 
may affect dental 
management.  

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S  Communication and   
Maintain accurate and  Collaboration 
complete patient records in  7  14.2  Practice and 
a confidential manner.  Information 
Management 
Prevent the transmission of  M   
infectious diseases by 
8  2.1.4  Professionalism 
following current infection 
control guidelines. 
Perform a clinical  M   
9  1.1.2  Patient Centered Care 
examination.  
Differentiate between  M   
normal and abnormal hard 
10  1.2.1  Patient Centered Care 
and soft tissues of the 
maxillofacial complex. 
Prescribe and obtain the  M   
required diagnostic tests, 
11  1.3.1  Patient Centered Care 
considering their risks and 
benefits. 
Perform a radiographic  S   
12  4.1  Patient Centered Care 
examination. 
Interpret the findings from a  S   
patient's history, clinical 
examination, radiographic 
13  1.2.2  Patient Centered Care 
examination and from other 
diagnostic tests and 
procedures. 
Recognize and manage the  A   
anxious or fearful dental  14  2.2.1  Patient Centered Care 
patient. 
Recognize signs of abuse  A   
and/or neglect and make  15  14.4  Professionalism 
appropriate reports. 
Assess patient risk  M   
(including, but not limited 
16  1.1.3  Patient Centered Care 
to, diet and tobacco use) for 
oral disease or injuries. 
Develop a problem list and  M   
17  1.2.3  Patient Centered Care 
establish diagnoses. 
Determine the level of  M   
expertise required for  18a  1.3.1  Patient Centered Care 
treatment. 
Formulate a written request  M   
Communication and 
for consultation and/or  18b  1.3.2 
Collaboration 
referral when appropriate. 
Develop treatment options  M   
based on the evaluation of  19  1.3.3  Patient Centered Care 
all relevant data. 
Discuss the findings,  M   
diagnoses, etiology, risks, 
benefits and prognoses of 
Communication and 
the treatment options, with  20  1.3.4 
Collaboration 
a view to patient 
participation in oral health 
management. 
Develop an appropriate  S   
comprehensive, prioritized 
21  1.3.5  Patient Centered Care 
and sequenced treatment 
plan.  
Present and discuss the     
Communication and 
sequence of treatment,  22  1.3.4 
Collaboration 
estimated fees, payment 
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arrangements, time 
requirements and the 
patient’s responsibilities for 
treatment. 
Obtain informed consent  S   
including the patient’s 
Communication and 
written acceptance of the  23  1.3.6 
Collaboration 
treatment plan and any 
modifications. 
Modify the treatment plan  M   
as required during the  24  N/A  Patient Centered Care 
course of treatment. 
Provide education regarding  M   
the risks and prevention of 
Patient Centered Care 
oral disease and injury to  25  2.1.1 
Health Promotion 
encourage the adoption of 
healthy behaviors. 
Provide therapies for the  S   
prevention of oral disease  26  2.1.2  Patient Centered Care 
and injury. 
Recognize and institute  S  Professionalism   
procedures to minimize  Practice and 
27  14.3 
occupational hazards related  Information 
to the practice of dentistry.  Management 
Achieve local anesthesia for     
2.2.6 
dental procedures and 
28  2.2.7  Patient Centered Care 
manage related 
11.1 
complications. 
Determine the indications  A   
and contraindications for the 
use of drugs used in dental  29a  2.2.6  Patient Centered Care 
practice, their dosages and 
routes of administration. 
Write prescriptions for drugs     
29b  2.2.6  Patient Centered Care 
used in dentistry. 
Manage dental emergencies.  30    2.2.2  Patient Centered Care   
Recognize and manage     
systemic emergencies which  31  2.2.3  Patient Centered Care 
may occur in dental practice. 
Manage conditions and  M   
diseases of the  32a  5.1  Patient Centered Care 
periodontium. 
Provide periodontal  M   
treatment when indicated 
32b  5.1  Patient Centered Care 
and monitor treatment 
outcomes. 
Assess the risk, extent and  S   
33a  1.1.3  Patient Centered Care 
activity of caries. 
Recommend appropriate  S   
non‐surgical and surgical  33b  N/A  Patient Centered Care 
therapy. 
Manage dental caries, tooth     
defects and esthetic  34a  9.1  Patient Centered Care 
problems and, 
When restoration is  A   
warranted, use techniques 
that conserve tooth 
34b  9.1  Patient Centered Care 
structure and preserve pulp 
vitality to restore form and 
function. 

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Manage patients with  S   
orofacial pain and/or  35  11.3  Patient Centered Care 
dysfunction. 
Manage surgical procedures  S   
related to oral soft and hard 
36  10.1  Patient Centered Care 
tissues and their 
complications.  
Manage trauma to the     
37  2.2.4  Patient Centered Care 
orofacial complex. 
Manage conditions and     
38a  6.1  Patient Centered Care 
pathology of the pulp, and 
Provide endodontic     
38b  6.1  Patient Centered Care 
treatment when indicated. 
Manage abnormalities of  A   
orofacial growth and  39a  8.1  Patient Centered Care 
development and, 
Treat minor orthodontic     
39b  8.1  Patient Centered Care 
problems. 
Recognize and manage     
functional and non‐ 40  2.2.5  Patient Centered Care 
functional occlusion. 
Select and, where indicated,     
prescribe appropriate 
41  N/A  Patient Centered Care 
biomaterials for patient 
treatment. 
Manage partially and     
completely edentulous 
42a  7.1  Patient Centered Care 
patients with prosthodontic 
needs  
Including the provision of     
fixed, removable and  42b  7.1  Patient Centered Care 
implant prostheses. 
Make records required for     
use in the laboratory 
43  N/A  Patient Centered Care 
fabrication of dental 
prostheses and appliances. 
Design a dental prosthesis or     
appliance, write a laboratory 
44  N/A  Patient Centered Care 
prescription and evaluate 
laboratory products. 
Apply accepted principles of     
ethics and jurisprudence to 
maintain standards and  45  14.1  Professionalism 
advance knowledge and 
skills. 
Apply basic principles of     
practice administration,  Practice and 
financial and personnel  46  14.5  Information 
management to a dental  Management 
practice. 
Demonstrate professional  S   
behaviour that is ethical, 
supercedes self‐interest, 
strives for excellence, is 
committed to continued  47  N/A  Professionalism 
professional development 
and is accountable to 
individual patients, society 
and the profession. 
Legend:   M : Major,  S : Supportive,  A : Assumptions and Definitions 

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