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Palmer College of Chiropractic Syllabus (DOC)

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					                            Palmer College of Chiropractic Syllabus

                                   Spring 2011, March-June
                             Diagnosis and Radiology Department
                            Lisa Killinger, DC, Department Director

                                 Physiotherapy I - Active Care
                                   REHB7185101 4 credits
                                   REHB7185102 4 credits


Meeting Times and Locations: 01: MTH 7:30 am, P 201
                              02: MTF 11:10 am, P201
Lab Room: AL 01 (Admin. Bldg., Lower Level, room 1)

Course Instructors:

Robert M. Rowell, DC, MS
      Office Location: West Hall 315 D
      E-mail: robert.rowell@palmer.edu
      Work Phone: (563) 884-5250 (Ext. 5250 on campus)
      Office Hours: Mon: 9:20-10:10, Tue: 9:20-11:05 and Thu: 9:20-11:05
                     (and any other time by appointment)

Michael J. Tunning DC, ATC
      Office: AL 05 (Admin. Bldn., Lower Level)
      E-mail: michael.tunning@palmer.edu
      Phone: (563) 884-5865 (Ext. 5865 on campus)
      Office Hours: Tuesday 9:00-11:00, 2:00-3:30 pm; Thursday 1-3:30 pm; others by appt.


Course Website: http://w3.palmer.edu/rowell

Prerequisites: ANAT 61206 (neuroanatomy 2)
Co-requisites: N/A
Prerequisite for: CLIN82816 Clinic I



COURSE DESCRIPTION
This course will provide the chiropractic student with fundamental knowledge and skill which will
enable the student to make basic decisions about prescribing and using therapeutic exercise
and rehabilitation to restore or enhance function, improve physical skills, prevent re-injury,
correct and prevent subluxation, and promote wellness and active lifestyles. It will address the
relationship between subluxation and exercise. Using fundamentals developed in earlier
trimesters, the focus will be on prescription, development, and progression of rehabilitation and
exercise programs that will address the conditions most commonly seen in the general practice
of chiropractic. An overview of outcome measures will also be included.




PT 1 Syllabus Spring 2011                   1                                Last Revised: Feb 2011
COURSE OUTCOMES
Attitudes – upon completion of this course the learner will:
    A1. demonstrate an appreciation for the role of therapeutic exercise in chiropractic practice
    A2. value standards of chiropractic care (including exercise)
Knowledge – upon completion of this course the learner will be able to:
    K1. explain the relationship between exercise and a healthy spine
    K2. explain the fundamentals of exercise physiology
    K3. link kinetic chain changes to subluxation
    K4. choose appropriate outcome assessment tools
    K5. explain and contrast various rehabilitation techniques
    K6. understand functional anatomy, diagnosis and treatment
Skills – upon completion of this course the learner will be able to:
    S1. implement proper documentation, regarding patient management and assessment
    S2. create rehabilitation programs for the spine and extremities
    S3. demonstrate progressive patient management in relation to the stages of healing
    S4. confidently apply concepts of therapeutic exercise

EVALUATION METHODS
There will be 3 examinations, 2 exams worth 30 points and a final exam worth 40 points. Each
exam may include bonus (extra credit) questions at the discretion of the instructor. Students
may review their examination with the instructor. The laboratory section of the class will have
weekly quizzes covering information presented in lab, lab notes, required textbook and lectures
(See Appendix C, below). There are also 2 assignments worth 25 points (assignment 1) and 25
points (assignment 2). (See Appendix A, below) A minimum of 5 random lecture quizzes worth 2
points each will also be given.

Evaluation Schedule (subject to change at the course director’s discretion)
Exam 1 ................................. (APR 5) ................................................................30
Exam 2 ................................. (MAY 3) ...............................................................30
Exam 3 (Final)....................... (JUN 10) ..............................................................40
Assignment 1 ........................ (presentations during trimester) ...........................25
Assignment 2 ........................ (JUN 7) ................................................................25
Random Lecture Quizzes ...................................................................................10
Lab Attendance ..................................................................................................20
Lab Quizzes .......................................................................................................35
Lab Exam...........................................................................................................45
Total Points Possible ..................................................................................... 260

Missed Examinations/Unfinished Objectives
Missed examinations/assignments can be made up only if arrangements are made in advance
or in the case of extreme emergency situations. Written documentation of the emergency
situation must be provided to make up an examination or to turn in a late assignment. It is the
individual student’s responsibility to provide documentation prior to taking the makeup
examination or turning in the late assignment. Failure to make up missed examinations will
result in a score of zero for that exam. Without documentation of an emergency, late
assignments will be graded at a maximum of 90% credit. If an assignment is more than one
week late, it will not be accepted for any credit. Make-up exams will be held within 2 weeks of
the original exam. It is the student’s responsibility to contact Dr. Tunning or Dr. Rowell to make
arrangements to take a makeup. A second make up exam will be held on “study day” the
Thursday after the last day of class.



PT 1 Syllabus Spring 2011                                      2                                              Last Revised: Feb 2011
Examinations
The instructor of this course will not distribute examinations. Any student found in possession of
embargoed (stolen) exams will be in violation of the student code of ethics. No electronic
devices of any kind are permitted during the examination.

GRADING STANDARD
A (4) 93% - 100% (> 241.8 Points)
B (3) 83% - 92.9% (215.8 – 241.7 Points)
C (2) 73% - 82.9%   (189.8 – 215.7 Points)
F (8 NC) <73% (<189.7 Points)
I (6) Incomplete

Academic Performance Posting
Students at Palmer College are protected by federal law (Family Educational Rights and Privacy
Act) which safeguards against the public posting of any personally identifiable information
without their written consent. This information includes, but it is not limited to, performance on
examinations. The public posting by student’s name, matriculation number or social security
number without written permission is a violation of the law. Please contact the course director
as soon as possible if you do not wish to have your academic performance (scores)
posted by matriculation number.


COURSE POLICIES

Academic Adjustments for Qualified Students with Disabilities
Palmer College of Chiropractic makes reasonable academic adjustments for qualified students
with disabilities, as required by law. Any qualified student with a disability who requires a
reasonable academic adjustment to perform the academic and technical standards requisite to
participation in this course is to contact the Disabilities Coordinator to request such an academic
adjustment.

Religious Observance
In order to accommodate an individual student’s participation in religious observances, Palmer
College requires that the student advises each of their instructors, in writing, at the beginning of
an academic term the holiday and date of observance the student is requesting relief from their
course(s). This policy does not in any way release the student from the responsibility of
satisfying all requirements necessary for the successful completion of any course.

Academic Integrity
         Students are expected to comply with Palmer’s Student Code of Ethics. Students are
strongly encouraged to carefully read the entire Student Code of Ethics as published in the
Student Handbook. Cheating, plagiarism, other acts of dishonesty and/or any other violation of
Palmer’s Student Code of Ethics may result in the filing of a charge of misconduct under the
Student Disciplinary Code as described in the Student Handbook.
         Students charged with misconduct will be assigned a grade of “Incomplete” until the
charge(s) is concluded in accordance with the Student Disciplinary Code as described in the
Student Handbook.
         Sanctions up to and including denial of academic credit, suspension or dismissal from
the College may be imposed upon students found to have violated the Code of Student Ethics.
Please refer to the Palmer Student Handbook. You may access the Student Handbook online
at: http://www.palmer.edu/news2.aspx?id=1688.


PT 1 Syllabus Spring 2011                     3                                 Last Revised: Feb 2011
       Further, students, as a condition of admission, agree to abide by all Palmer College of
Chiropractic regulations contained in the College Catalog, Student Handbook, other publications
and notices placed on official College bulletin boards including its website.

Course Attendance:
Lecture: All scheduled lectures are mandatory. Attendance will be tracked by random
attendance sheets and quizzes. These will be unannounced. No late quizzes will be accepted.

Laboratory: Laboratory attendance is mandatory. No make-ups will be given for lab periods.
There will be a quiz at the beginning of every lab period. Quiz material will come directly out of
information presented in lab, lab notes, required textbook and from the lectures. Quizzes
cannot be made up and late arrivals to lab will not be able to take the quiz. It is your
responsibility to be marked present on the attendance roster at each lab period. Regardless of
circumstances, if you are not marked present on the attendance roster, you will not receive
credit. There will be no switching labs. You can only miss one (1) lab during the trimester.
Anyone who misses more than one lab must repeat the course. DO NOT MISS MORE THAN
ONE LAB!

Electronic and Recording Devices:
Cell phones should be turned “OFF” or to “SILENT or MANNER MODE” while the student is in
class. Any use of the cell phones (including text messaging) is to be done outside the
classroom; the student shall leave the room without disturbing the remaining students. Students
will not be allowed to use electronic devices or any type of recording devices in the classroom
without the prior written approval of the instructor. The instructor reserves the right to deny or
limit students’ use of electronic devices within the classroom or lab settings, including but not
limited to lap top computers, video and tape recorders, cameras, etc.

COURSE TEXTBOOKS AND MATERIALS
  Required text:
      Platzer, W. Color Atlas of Human Anatomy, Vol. 1: Locomotor System. Thieme.
      Class notes: available at the second floor library reserve desk and online at:
        http://w3.palmer.edu/rowell
      Lab packets: will be distributed on the first day of lab and are also available to
        download at: http://w3.palmer.edu/rowell
  Recommended resources:
      Rehabilitation of the Spine, 2nd ed. Liebenson. Williams & Wilkins. 2007.
      Low Back Disorders. Evidenced-Based Prevention and Rehabilitation. Stuart McGill.
        Human Kinetics. 2002.
      Therapeutic Exercise for Musculoskeletal Injuries. 2nd ed. Houglum. Human
        Kinetics. 2005
      Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd ed.
        Warren Hammer. 2007
      Conservative Management of Sports Injuries, 2nd ed. Hyde and Gengenbach. Jones
        and Bartlett. 2007.
      ACSM’s Guidelines for Exercise Testing and Prescription, 6th ed. Kenney. Williams
        & Wilkins. 2000
      Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain. Scientific
        Basis and Clinical Approach. Richardson. Jull, Hodges, and Hides. Churchill
        Livingstone. 1999.




PT 1 Syllabus Spring 2011                    4                                  Last Revised: Feb 2011
COURSE LECTURE SCHEDULE
The following section describes the competencies for each section and the approximate order in
which they are presented. Its purpose is to guide the student when studying for exams and in
understanding what is expected of the student in this course.

1. SUBLUXATION
     Be able to define subluxation, including the three most common terms utilized in our
      literature
     Identify the tissues involved in subluxation complex

2. STAGES OF HEALING
     State the Stages of Healing
     Identify the time frames for the stages of healing
     Identify the goals of management during the stages of healing
     Contrast motion versus immobility concerning healing of soft tissue
     Explain the relationship between inflammation and spinal stability

3. GOAL SETTING/CASE MANAGEMENT
     List the goals for each stage of healing during a rehabilitation program
     Be able to demonstrate progression during a rehabilitation program
     Give specific examples of exercises within a progressive rehabilitation program
     Recognize how individual exercises fulfill multiple goals

4. PRINCIPLES OF THERAPEUTIC EXERCISE
     Contrast therapeutic exercise and wellness exercise
     Explain how muscles grow
     Identify the relationship to cross sectional muscle area and strength gain (early and later
       in training)
     Contrast open and close chain exercises
     Explain Physiological Overflow in relation to isometric actions
     Define power
     Define plyometrics and explain its components
     Explain the SAID principle
     Explain the FIT principle
     Explain progressive overload
     Contrast isometric, isotonic, isokinetic, concentric, and eccentric muscle actions
     Identify exercises and lever mechanics
     Identify the elements of proprioceptive progression
     Define DOMS and explain its relationship to the different muscle actions
     Identify passive, active assisted, active and active resisted motions and explain when
       they would be appropriately implemented during a rehabilitation program
     Explain proper warm up and stretching technique
     Define periodization and the components of a Macrocycle
     Explain what occurs with overreaching, overtraining and detraining
     Demonstrate therapeutic exercise principles in a laboratory setting
     Define Cross Education
     Contrast various muscle actions ability to create a cross over effect
     Contrast voluntary versus involuntary muscle actions ability to create a cross over effect
     Explain current theories of the mechanism behind the cross over effect




PT 1 Syllabus Spring 2011                   5                                Last Revised: Feb 2011
5. PROPRIOCEPTION, STRETCHING AND PNF
     Define Proprioception and Kinesthetic Awareness
     Define open and closed chain kinetic activities
     Explain the progression of care concerning open and closed chain activities
     Contrast types of stretching
     Contrast models or mechanisms of increasing range of motion through stretching
     Explain the role of the FIT principle in stretching
     Explain how heat or cold affects stretching outcomes
     State the effect of stretching on muscle strength
     Define Facilitation
     Explain Reciprocal Inhibition
     Recognize specific PNF techniques including:
         o Rhythmic Stabilization
         o Slow Reversal
         o Fast Reversal
         o Hold-Relax
         o Contract-Relax
         o Contract-Relax Agonist Contract
     Identify the components of PNF movement patterns

6. ASSESSMENT AND REHABILITATION OF THE CERVICAL AND THORACIC SPINE
     Identify the components of an Upper Cross Syndrome
     Identify orthopedic and neurological conditions related to the cervical and thoracic spine
     Explain the order of treatment protocols within management plans
     Identify functional anatomy involved in common T/S and C/S injury
     Identify and design rehabilitation procedures to compliment adjustments and prevent
      and treat injuries
     Identify Yellow and Red flags for patient referral
     Relate the functional anatomy of the thoracic spine and movement to C/S, L/S, and
      upper extremity
     Know general guidelines for care of whiplash patients
     Explain the importance of thoracic spine extension
     Construct management plans for cervical and thoracic related conditions
     Demonstrate various therapeutic exercises including but not limited to: Mirror image
      exercises, PNF techniques for the cervical and thoracic regions, Open and Closed chain
      exercises

7. ASSESSMENT AND REHABILITATION OF THE PELVIS AND LUMBAR SPINE
     Explain Tissue loading and overloading in relation to job analysis and injury
     Identify the components of a Lower Cross Syndrome
     Identify, explain and test functional anatomy as it relates to spinal conditions
     Identify orthopedic and neurological conditions related to the pelvis and lumbar spine
     Explain the order of treatment protocols within management plans
     Differentiate postural, dysfunction, and derangement syndromes
     Identify yellow and red flags related to lumbar spine and pelvis
     Construct management plans for Lumbar and Pelvic regions
     Demonstrate various therapeutic exercises including but not limited to: Mirror image
      exercises, PNF techniques for the lumbar and pelvic regions, Open and Closed chain
      exercises utilizing available rehabilitation equipment (slant, wobble, and balance boards
      - dynamic balls - thera-band - Styrofoam logs - weights - or other non-specified
      equipment)


PT 1 Syllabus Spring 2011                   6                                Last Revised: Feb 2011
8. ASSESSMENT AND REHABILITATION OF THE UPPER EXTREMITY
     Identify the components of an Upper Cross Syndrome
     Identify orthopedic and neurological conditions related to the upper extremity
     Explain the order of treatment protocols within management plans
     Explain the mechanism behind impingement syndrome
     State the proper glenohumeral movement
     Differentiate the types of acromion morphology and explain their relation to shoulder
      impingement
     Identify the two most commonly inhibited shoulder muscles
     Differentiate painful glenohumeral arcs
     Construct management plans for cervical and thoracic related conditions
     Demonstrate various therapeutic exercises including but not limited to: Mirror image
      exercises, PNF techniques for the upper extremity, Scapular protraction and retraction
      exercises, Open and Closed chain exercises utilizing available rehabilitation equipment
      (slant, wobble, and balance boards - dynamic balls – thera-band - Styrofoam logs -
      weights - or other non-specified equipment)

9. ASSESSMENT AND REHABILITATION OF THE LOWER EXTREMITY
     Explain the order of treatment protocols within management plans
     Identify orthopedic and neurological conditions related to the lower extremity
     Construct management plans for lower extremity conditions
     Demonstrate various therapeutic exercises including but not limited to: Mirror image
      exercises, PNF techniques for the lower extremity, Open and Closed chain exercises
      utilizing available rehabilitation equipment (slant, wobble, and balance boards - dynamic
      balls – thera-band - Styrofoam logs - weights - or other non-specified equipment)

10. OUTCOME MEASURES
     Familiarity with common outcome measures for pain, disability, and psychosocial factors
            Pain Diagrams                           VAS (visual analog scale)
            Borg Scale                              Roland Morris Questionnaire (RMQ)
            Oswestry Low Back Pain Index            Psychosocial Outcomes
            Neck Disability Index                   Physical Baseline Measures
     Identify Waddell’s signs of abnormal illness behavior
     Identify proper documentation of patient management including examination, diagnosis,
      SOAP progress and referral
     Interpret various outcome measurement forms listed in the above cognitive
      competencies
     Demonstrate an attitude that values outcome measures

11. CARDIOVASCULAR TRAINING
     Define cardiodynamic terminology including: Cardiac Cycle, Stroke Volume, EDV, ESV,
      Ejection Fraction, Cardiac Output
     Explain the changes of cardiodynamics and blood flow with exercise
     Define cardiorespiratory endurance
     Define maximal oxygen consumption (VO2max)
     Recognize a MET as a baseline unit of oxygen consumption
     Define Anaerobic Threshold and Lactate Threshold
     Define EPOC excess post-exercise oxygen consumption and oxygen deficit and debt
     Explain what happens to total peripheral resistance with various forms of exercise
     Discuss cardiac changes with exercise including anatomy, heart rate, stroke volume,


PT 1 Syllabus Spring 2011                  7                                Last Revised: Feb 2011
        blood pressure and cardiac output
       Classify individuals as low, moderate or high risk patients
       List and define risk factors associated with cardiovascular disease
       List and define signs/symptoms associated with cardiovascular disease
       Be able to screen patients as to their readiness to exercise
       Calculate maximal heart rate
       Calculate target heart rates utilizing the Heart Rate Reserve Formula
       Screen potential patients for cardiovascular risks
       Understand the importance of monitoring perceived exertion utilizing a Borg Scale
       Understand the importance of monitoring changes in blood pressure during exercise

12. REHABILITATION FOR SPECIAL POPULATIONS
     Explain the needs of female athletes
     Explain the benefits, concerns, and recommendations regarding exercise for women
      who are pregnant
     Identify the modifications necessary for exercise in patients with arthritis.




PT 1 Syllabus Spring 2011                  8                              Last Revised: Feb 2011
                                          APPENDIX A


Assignment 1: 25 Points
Find an article relevant to active care and a given patient condition. A list of conditions will be
posted for you to choose from. In small groups you will create a presentation for the class
incorporating aspects of Evidence Based Clinical Practice, in particular “Ask, Acquire, Appraise,
Apply.” You will be graded on your presentation as well as participation in evaluating your
peers.

Assignment 2: 25 points
Create a patient handout, consisting of 5 stretches and 5 exercises that you might have a
patient perform who suffers from Low back, Hip or SI joint pain. These home exercises should
follow the information provided in this course and be consistent with the concepts described in
lab sessions. Information should be presented in a manner that is understandable to any
patient: avoid jargon. A hard copy (paper print-out) of this assignment is due on June 7th at
class time. Assignments will not be accepted by e-mail or on CD or DVD; it must be on paper.
Late assignments will be graded as outlined in the syllabus.

Examples of these tear off sheets will be provided. You will be graded on content, presentation,
description of technique and the appropriateness of the exercises and stretches. This
assignment should be done in groups with a maximum of 4 students (there is no minimum
number). Tear off sheets must include pictures of group members performing the exercises and
stretches. Each group member must be included in at least one picture. DO NOT USE
PICTURES FROM WEB SITES as this would constitute copyright infringement and plagiarism.

Please have the names of all group members listed in alphabetical order on the front of the
assignment along with the time of each member’s lecture section.




PT 1 Syllabus Spring 2011                    9                                 Last Revised: Feb 2011
    Sunday        Monday                Tuesday               Wednesday      Thursday               Friday            Saturday
    27            28                    1                     2              3                      4                 5
    6             7 Faculty             8 Syllabus            9              10 Stages of           11                12
M                 In-Service /New       ------------------                   Healing
A                 Student Orientation   Intro to Rehab
R
C 13              14 Stages of          15                    16             17                     18 No Classes –   19 National
H                 Healing                Goal Setting                        No lecture             National Boards   Boards

    20 National   21 Faculty            22                    23             24                     25                26
    Boards        In-Service            Therapeutic Ex.                      Therapeutic
                  No Classses                                                Ex./Stretching
    27            28                    29                    30             31                     1                 2
                  Stretching            Stretching/Yellow                    Yellow/Red flags
                                        flags
    3             4                     5                     6              7                      8                 9
                  Review                                                     Cervical Rehab
                                        EXAM 1
A   10            11                    12                    13             14                     15                16
P                 Cervical Rehab        Cervical Rehab                       Thoracic Rehab
R
I   17            18                    19                    20             21                     (22)No Classes-   23
L                 Lumbar Rehab          Lumbar Rehab                         Lumbar Rehab           Good Friday

    24            (25) No Classes -     26                    27             28                     29                30
                  Easter Monday         Core Stability                       Core Stability

    1             2                     3                     4              5                      6                 7
                  McKenzie/Review                                            Upper Extremity
                  for exam 2            EXAM 2
    8             9                     10                    11             12                     13 Part IV        14 Part IV
                  Upper Extremity
                                        Lower Extremity                      Lower Extremity        Boards            Boards
M
A 15 Part IV      16                    17                    18             19                     20                21
Y Boards          Lower Extremity       Outcome                              Outcome
                                        Measures                             measures
    22            23                    24                    25             26                     27                28
                  Cardio                Cardio                               Cardio

    29            (30) No Classes -     31                    1              2                      3                 4
                  Memorial Day          Female Athletes                      Exercise and
                                                                             pregnancy

    5             6                     7                     8              9                       10               11
                  Rehab                 Review for Final       Classes End   Study Day               Final EXAM
J                 considerations-       Exam                                                        1:05pm
U                 Case presentations    Assignment 2 Due                                            P201/202
N   12            13                    14                    15             16                     17                18
E                 Final Exams           Final Exams           Final Exams    Final Exams            Graduation
                                                                                                    Class 112T
    19            20                    21                    22             23                     24                25

    26            27                    28                    29             30




         3c3523a9-c8cc-4b60-b349-3f33fd251c05.doc            10                               Last Revised: October 2009
                                           APPENDIX C
Laboratory
Laboratory attendance is mandatory. No make-ups will be given for lab periods. There will be a
quiz at the beginning of every lab period. These quizzes will be covering any muscular
insertions/origins and innervations. Material presented in the quiz will be from anything
discussed in lab, lab notes, and from your required anatomy texts from 1st trimester. Quizzes
cannot be made up and late arrivals to lab will not be able to take the quiz. It is your
responsibility to be marked present on the attendance roster at each lab period. Regardless of
circumstances, if you are not marked present on the attendance roster, you will not receive
credit. You can only miss one (1) lab during the trimester. Switching lab times will not be
allowed. Anyone who misses more than one lab must repeat the course. DO NOT MISS MORE
THAN ONE LAB!

Required Apparel:
Laboratory sessions will involve physical activities requiring loose comfortable clothing. Dress
appropriately for the activities. Female students should bring a patient gown.

PT Lab Schedule
Date                    Lab Topic                              Quiz topic
Week 1                  Lower Extremity Stretching             Material in the syllabus
MAR 15/17               Spinal Stretching
Week 2                  Upper Extremity Stretching             Lower extremity muscle
MAR 22/23               Spinal Stretching                      attachments and actions

Week 3                  Stretching Quiz                        3 stretches-15 points
MAR 29/31
Week 4                  Cervical Spine                         SOAP Note
APR 5/7

Week 5                  Thoracic Spine                         SOAP Note
APR 12/14
Week 6                  Lumbar Spine                           SOAP Note
APR 19/21
Week 7-8                Core Stability                         SOAP Note
APR 26/28

Week 9                  Upper Extremity                        SOAP Note
MAY 3/4
Week 9                  Lower Extremity                        SOAP Note
MAY 10/12
Week 10                 Review for Final Practical
MAY 17/20

     MAY 24-26                  FINAL PRACTICALS                              45 pts




3c3523a9-c8cc-4b60-b349-3f33fd251c05.doc    11                            Last Revised: October 2009
                                           Appendix D




                                                                      PCC Matric number




                                                             michael.tunning@palmer.edu or
                                                             Robert.rowell@palmer.edu


                                                             R




3c3523a9-c8cc-4b60-b349-3f33fd251c05.doc    12          Last Revised: October 2009

				
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