Postgraduate programme Odont Dr. Lars-Inge Norevall 2006-08-25

POSTGRADUATE TRAINING IN ORTHODONTICS Specialist training programme given by the Centre of Orthodontics and Pedodontics Linköping, Sweden in collaboration with the County Council of Östergötland

Centre for Orthodontics and Pedodontics, SE-581 85 LINKÖPING, SWEDEN Telephone: +55 13-22 88 30 E-mail: [email protected]

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Postgraduate training in Orthodontics given by the Centre of Orthodontics and Pedodontics in Linköping, Sweden.

The postgraduate education and training for specialist qualification is organized by the Centre of Orthodontics and Pedodontics in Linköping, commissioned by the County Council of Östergötland. Specialists within the Public Dental Service (PDS) at the Centre of Orthodontics and Pedodontics in Linköping, Norrköping and Motala will assist in the clinical training. The programme includes training of foreign dentists on commission. In this later case the agreement is signed by the County Council of Östergötland/Folktandvården i Östergötland and the foreign employer. Swedish dentists are employed during their training by the County Council of Östergötland. The Director of the postgraduate programme is responsible for the postgraduate education and training to be carried out according to directives and general guidelines given by the Swedish National Board of Health and Welfare (SOSFS 1993:M) and other special agreements (enclosure # 1a, b, c).

The aim with the postgraduate education and training

The postgraduate education and clinical training must meet the requirements called for specialist qualification in orthodontics by the Swedish National Board of Health and Welfare. The clinical training and the education will give knowledge, the skill and the professional approach given in the description of aims (SOSFS 1993:4), more specified in the approved Curriculum. Specialist training on commission will have the same objectives.

Institutional conditions

The postgraduate education and clinical training will take place within the Centre for Orthodontics and Pedodontics and the Centre of Oral rehabilitation (representing the Departments of Prosthodontics, Periodontology, Endodontics, and Stomatognathology). Additional training in Oral maxillofacial radiology and Maxillofacial/dentoalveolar surgery is given at the University hospital. Thus, all the specialities in odontology recognized by the Swedish Board of Health and Welfare are represented. Furthermore, the Centre for Orthodontics and Pedodontics gives education and training of general dental practitioners (advanced courses in orthodontics corresponding to 20 credits) as well as up-to-date courses for oral hygienists. The clinic is located within 10 minutes walking distance from the University Hospital and Health University (corresponding to Faculty of Medicine) close to the University campus.

For the studies the Health Science Library (HUB) is at disposal in the University Hospital. Centre for Orthodontics and Pedodontics, SE-581 85 LINKÖPING, SWEDEN Telephone: +55 13-22 88 30 E-mail: [email protected]

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The main part of the clinical training will take place in the in the orthodontic clinic at the Centre for Orthodontics and Pedodontics. The orthodontic treatment of congenital malformations is given at the Dept of Dentofacial Orthopaedics which is co-localized with the Departments of Oral Medicine, Hospital Dentistry, and Oral & Maxillofacial Surgery (Maxillofacial unit at the University Hospital). Beside this, some training in compulsory subjects required to reach the objectives will take place in other clinics (The Centre for Oral rehabilitation or the University Hospital), or as courses given together with other universities/institutes.

The County Council of Östergötland is the governing body and principal of medical and dental care. The Centre for Orthodontics and Pedodontics has the responsibility to provide orthodontic care of the patients in the Linköping administrative region of the County. Together with the Plastic surgery and Oral & Maxillofacial Surgery Departments, the Dentofacial Orthopedic Department is taking care of the patients with cleft lip and palate from five counties in the south-east part of Sweden.

2:0 Teachers and supervisors

An assisting professor and 5 specialists from the Centre of Orthodontics and Pedodontics are teaching and supervising the clinical training in orthodontics. The assisting professor is appointed by the National Board of Health and Welfare as the director of the postgraduate education and training. For the daily supervision of the clinical activity one selected specialist in orthodontics is assigned, supported by the other specialists.

For the personal records, see enclosure no # 2!

The contents of the postgraduate education and training

Regulations and guidelines about the contents of postgraduate training are given in SOFS 1993:4. According to this the training period will be at least three years fulltime, 40 hours a week. An adequately long-term engagement is required to reach good quality in the patient care as well as in the commitment by the staff, but also for recruitment of external lecturers. Aims in the training programme will normally be reached in three years with the main part of the training given at the Centre of Orthodontics and Pedodontics in Linköping.

Centre for Orthodontics and Pedodontics, SE-581 85 LINKÖPING, SWEDEN Telephone: +55 13-22 88 30 E-mail: [email protected]

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CURRICULUM 1. Postgraduate education in orthodontics 1:1 The aim with the education

General and more specific objectives are given in the Directives and General Guidelines from the National Board of Health and Welfare. The postgraduate training in orthodontics “should be structured to ensure the competence, knowledge and skill, ready to take a responsibility for and carry out orthodontic diagnosis and the treatment of children and adults”. The field of training includes the diagnosis of congenital and acquired deviations from the normal growth of the face and jaws, the requirements for an independent decision about the aim with the treatment, treatment planning, treatment, and making a prognosis of its long-term stability. Beside this, the education must give adequate knowledge in oral physiology, oral radiology, oral surgery, oral prosthetics, periodontology, paediatric dentistry, phonetics, genetics, paediatrics, plastic surgery and ear-, noseand throat illnesses. Regarding diagnosis and treatment in these various fields of dental care, the objectives are specifically listed below. In oral prevention the specialist “must have a good knowledge about the prevention of and interfering with the development of different malocclusions by interceptive measures”. The specialist also must “have knowledge about the organization and administration of an orthodontic specialist clinic, have knowledge about and experience from consultations and collaboration with other branches of the dental care and various medical specialities”. Below is given, more in detail, how these knowledge’s, skills and attitudes will be obtained.

1:2 Clinical training in orthodontics

The clinical training will be fulfilled under supervision from specialists from the Centre for Orthodontics and Pedodontics. The treatment of children with congenital deformities (e.g. cleft lip and palate) will be carried out at the Dept of Dentofacial Orthopaedics, at the University Hospital. Some of the training is given by an orthodontic consultant during visits to general practice clinics or other specialist clinics. The clinical training will take around 70 % (28 hours) of the weekly working time and goes on all the year around (4-6 weeks of vacation period are allowed). The theory courses are limited to the University semesters (late August to early June). The clinical training includes, beside treatment of the patients, therapy planning and discussions, and case reports/presentations. Centre for Orthodontics and Pedodontics, SE-581 85 LINKÖPING, SWEDEN Telephone: +55 13-22 88 30 E-mail: [email protected]

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1:3 Supplementary education in orthodontics

The remaining 12 of the weekly scheduled hours are used for organized theoretical education, such as courses or seminars (4 hours a week), working with special projects and own time for studying. An introductory concentrated theoretical course during the first month will be given to ensure the postgraduate students the basic knowledge for an early participation in patient care. The systematic theoretical studies will be conducted by the teachers from the Centre for Orthodontics and Pedodontics and/or external lectures. Some seminars and courses will be hold together with other departments such as the Centre for Oral Rehabilitation and the Dept of Dentofacial Orthopaedics. Still others will be arranged by the Swedish Association of Orthodontists or jointly arranged at a national level by postgraduate training departments. Some seminars will be planned and presented both written and as oral presentations. A literature list is given for own studies. This literature is a part of the compulsory course literature. Beside this other lists will be given or have to be produced for seminars, case presentations etc.

1:4 2. Clinical duty in other subject fields The national directives (SOSFS 1993:M) prescribe a number of other dental and medical fields in which a specified knowledge must be acquired by the postgraduates during the specialist training (i.e. oral physiology, oral and maxillofacial surgery, oral prosthetics, oral radiology, periodontology, paediatric dentistry, psychology, speech pathology, genetics, paediatrics, plastic surgery and ear- nose- and throat diseases). The scope of these knowledge’s, and how they will be trained in fields where clinical duties are required is given below. In cases of other ways of training according to an individually organized curriculum, a control will be made that the objectives are reached. The total clinical duty in these subject fields is maximum 6 months of a total education period of three years.

a. Knowledge in Oral Physiology

Objectives: To brush up the knowledge’s reached in the undergraduate studies in the Dental School, to increase the competence and experience in diagnosis of signs and symptoms of Temporo-Mandibular Disorders (TMD) and from surrounding areas in the head and the neck, to reach knowledge in contemporary diagnostic and therapeutic measures available in the speciality,

Centre for Orthodontics and Pedodontics, SE-581 85 LINKÖPING, SWEDEN Telephone: +55 13-22 88 30 E-mail: [email protected]

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to achieve increased knowledge in the correlation between morphologic and functional deviations in the masticatory system as well as the role of orthodontic methods in the treatment of TMD. Methods: The knowledge will be reached by clinical duties, by participating in some lectures given at the Dept of Stomatognathology, in departmental seminars and by independent study of the literature in this field. Special arrangement will be made with the Dept. of Stomatognathology. As an alternative the knowledge can be reached by attached courses, given by the Swedish Dental Association. Extent: In our programme at the present time 5 hours a week for 20 weeks (100 hours, according to the ERASMUS programme 20 hours).

b. Knowledge in Oral Radiology

Objectives: To brush up knowledge’s reached in the Dental School, to get an increased knowledge about and experience of evaluating x-ray quality for orthodontic diagnosis. By clinical duty reach insight in, and some experience from, specialized reproduction techniques available in this field as cinefluorographics, artrographics, scintographics, computerized tomography and special methods for x-ray analysis with emphasis on digitalized analysis. Methods: The knowledge will be reached by clinical duty at the Department of Maxillofacial and Oral Radiology, University Hospital, taking part of some lectures, working with seminars and studying the literature. Special arrangement will be made with the Department of Maxillofacial and Oral Radiology. Alternatively, special course arrangements will be given. Extent: In our program 100 hours. (According to the ERASMUS program 30 hours).

c. Knowledge in Oral & Maxillofacial Surgery

Objectives: To brush up knowledge reached in the undergraduate programme. Achieve deepened knowledge about surgical methods with special importance for orthodontic care, and insight into treatment methods in the specialized oral and maxillofacial surgery care, including pre- and post surgical care in orthodontic surgery. To receive training in collaboration with an maxillofacial surgeon in treatment planning, treatment, and the evaluation of orthognathic surgery patients. Methods: Clinical duty and auscultation at the Department of Maxillofacial and Oral surgery according to a special arrangement. Taking part of some of the lectures for the postgraduate students in oral & maxillofacial surgery; during the period of clinical duty follow and take part of therapy discussions between orthodontists and maxillofacial surgeons; during the whole training period treat a number of mutual patients in this field; participation in specially arranged education

Centre for Orthodontics and Pedodontics, SE-581 85 LINKÖPING, SWEDEN Telephone: +55 13-22 88 30 E-mail: [email protected]

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days for specialist trainees in the Department of Maxillofacial & Oral Surgery concerning correction of deviations in occlusion and the jaws. Extent: Special course 3 days and weekly activities of totally 40 hours a year. Clinical duty at surgical operations for 3 hours during 20 weeks during the second or the third years. (According to the ERASMUS project 20 hours).

d. Knowledge in Oral Rehabilitation (Prosthetics and Periodontology)

Objectives: Update knowledge’s from the undergraduate programme. Increase the knowledge in modern prosthetic methods in oral rehabilitation such as osseointegrated prosthetics. Experience from prosthetic treatment where orthodontic treatment gives better possibilities for a prosthetic treatment as in cases with spacing, severe attrition, malocclusion etc. Methods: Follow some lectures and demonstrations in the specialist training for postgraduate students in Prosthodontics and Periodontology. Together with specialists in Oral Prosthetics and Periodontology make the total plan for 5-6 rehabilitation cases, a few with a need of orthodontic treatment. Take part of seminars and therapy discussions with specialists in orthodontics, prosthetics, and periodontology with mutual questions about rehabilitation cases. Extent: Totally 20 hours of theoretically studies and 2 weeks of clinical duty. (In the ERASMUS project minimum 10 hours).

3. Complementary education in other subject fields. a. Paediatric dentistry

Objective: Update knowledge’s from the undergraduate programme; achieve an increased knowledge in odontologic care for children with mental, functional or other disabilities, medical or other conditions compromising an orthodontic treatment. Attain experience from treatment planning together with a specialist in Paediatric dentistry in cases, where an orthodontic aspect also can be taken as well as an increased knowledge about caries – and periodontoprofylactic methods for children. Methods: About 20 hours including individual study time. (The ERASMUS programme does not include this subject).

b. Phoniatrics

Centre for Orthodontics and Pedodontics, SE-581 85 LINKÖPING, SWEDEN Telephone: +55 13-22 88 30 E-mail: [email protected]

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Objectives: To gain insight into the normal production of sound and speech, and the impact various illnesses and changes in the oral cavity, including dental constructions, may have. Gain some knowledge how deviations in the creation of sound and speech can be diagnosed and the speech therapist’s role in diagnosis and treatment, an increased knowledge about the effect of various malformations, in particular cleft lip and palate, on the speech and how deviations can be taken care of or improved. Methods: The education is usually given as a special arranged course together with other training departments. Some auscultation important for the education is given while in clinical duty in the Dept. of Dentofacial Orthopedics. Extent: About 25 hours.

c. Genetics

Objectives: To update and increase the knowledge from the undergraduate programme about the genetically related illnesses and their etiology. Methods: The education is mainly given as an external course together with other training departments. Extent: About 25 hours.

d. Plastic surgery

Objectives: To get an understanding of plastic surgery methods and the role of the plastic surgeon in correcting malformations and defects in face and jaws, with focus on cleft lip and palate; knowledge about the organization of this medical speciality. Methods: Seminars together with plastic surgeons combined with the education in orthognathic surgery given by the department of Dentofacial Orthopedics, Maxillofacial Unit, Linköping Health University. Literature study. Extent: 2 days.

e. Psychology

Objectives: Increased knowledge about psychology of children, adolescents, and adults, related to opinions and principles; possibilities and shortcomings in modification of the behavious; psychological aspects upon patient motivation and rating the cooperation; psychological aspects upon puberty and young persons way of living, the perception of their ego and what impact mouth and face conditions may have on it. Centre for Orthodontics and Pedodontics, SE-581 85 LINKÖPING, SWEDEN Telephone: +55 13-22 88 30 E-mail: [email protected]

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Methods: The education is given as an external course together with other educational institutions. Literature course. Extent: 25-35 hours.

f. Ear- nose and throat diseases

Objectives: To considerably increase the knowledge from the undergraduate courses, in particular knowledge about acute and chronic infections in the ENT-region, and pathologic conditions in salivary glands. Especially different aspects upon infections in the upper respiratory tracts will be discussed as well as different factors important for the mode of breathing. Oncology, in particular conserning tumors in the upper jaw, nose and pharynx, will be penetrated. More importance is given knowledges about tinnitus and vertigo as well as differential diagnosis of the temporal region. A survey of audiology will be given. Methods: The education is given as an external course together with other educational institutions. Literature course. Extent: 16 hours.

1:5 4. Education in profylaxis, health economy, epidemiology etc. a. Health care administration

Objectives: To give basic knowledge about the organization and the management of community general health and dental health problems, the organization of Swedish health care and the system for financing. Methods: The education is given as seminars by lecturers from the Dept. of Public Health, Faculty of Health Sciences. Extent: Two days.

Centre for Orthodontics and Pedodontics, SE-581 85 LINKÖPING, SWEDEN Telephone: +55 13-22 88 30 E-mail: [email protected]

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b. Prophylaxis and epidemiology

Objectives: To get actual knowledge about the use of prophylactic methods in dental health care, and how the effects of prophylactic work, as well as the need of care, treatment demands and methods , can be analyzed and evaluated by epidemiologic measures. Methods: As seminars with teachers from the Dept. of Public Health, discussing the principles of prophylactic medicine , its possibilities and limitations. A survey of planning, carrying out and evaluating preventive programs. Basal epidemiologic concepts and methods will be exposed and training given in evaluating epidemiologic reports. In separate seminars, routines for caries – and periodontoprophylaxis in the own clinic and in the general practice will be exposed, based on current knowledge. Alternatively: The education is given as an external course together with other educational institutions. Extent: 14 hours plus reading time. (Prophylaxis in the orthodontic care is dealt with other connection).

c. Ethics in health care

Objectives: Improve the knowledge about the ethic attitudes towards patients, staff and colleagues, and try to influence the attitudes according to the insight of their importance. Methods: Course or seminar with a specially invited lecturer. Extent: 3 hours of seminars or lecturing (ERASMUS program 5 hours)

1:6 d. Educational training

Objectives: To be able to independently plan and carry out a small course for education of a group, and to carry out the task as a supervisor for dental staff in the clinical duty as a specialist. Methods: Taking part of an education for tutors arranged by the University (for Swedish dentists), planning and carrying out some practice in the up-to-date courses for dentists and oral hygienists. Practising by case presentations, seminars etc in the programme of their own. Some training and experience from teaching in English. Extent: Courses 6 hours. Taking part 1-2 days a year in the up-to-date courses in orthodontics for oral hygienists. Seminars each semester including an oral presentation given to an invited audience (examination).

Centre for Orthodontics and Pedodontics, SE-581 85 LINKÖPING, SWEDEN Telephone: +55 13-22 88 30 E-mail: [email protected]

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1:7 e. Collaboration with other dental and medical health care clinics

All clinical duties should be done with in an awareness of the possibilities of consultations with other dental and medical specialities. The clinical duty under supervision at the Centre of Orthodontics and Pedodontics will guarantee this, and the continuity of collaboration with public and private general dental care will be secured as well as the cooperation with the Health University in general and specialized health care. Objectives: During the education knowledge will be deepened in mainly odontological but, also, to some extent in the field of other medical specialities; besides this an attitude will be created to recognize the knowledge in these fields, aiming at a cooperation with their staff when it is to the benefit of the patient. Method: Theoretical seminars about the health care organizations. Participating in discussions about cases referred to the clinic, taking mutual care of patients registered at other dental or medical clinics, participating in the orthodontist’s consultations at the general practice and clinical duties in other clinics (see above!).

1:8 f. Scientific activity

Objectives: To get a broadened insight into the requirements for scientific knowledge, how this knowledge will be generated, and how it can be searched for; to get some knowledge about, and experience from, how daily activities significant to clinical care can be evaluated, tested and presented. Methods: Library knowledge as a course at the Health Science Library (HUB), searching for literature on own at HUB. Course in clinical research methods. Participating in the literature seminars, research reports from congresses and research presentations at the Centre of Orthodontics and Pedodontics. Working with a project during the education together with a graduated researcher, with an itention to be reported in an international journal. Taking part of a scientific congress. Extent: Courses of 4-5 days. Working with project 1.5 day a week during the second and the third year of education.

Centre for Orthodontics and Pedodontics, SE-581 85 LINKÖPING, SWEDEN Telephone: +55 13-22 88 30 E-mail: [email protected]

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5. Others a. International adaptation

In order to prepare for a position in an European labour market, some adjustments of this curriculum will be continuously made according to the one proposed for the European Union by the ERASMUS group. In seminars Swedish orthodontic care will be discussed in relation to the care offered in other countries.

b. Preparation for changes

In order to prepare for rapid changes concerning the need and the demand for orthodontic care, and also changes caused by medical-odontological-technical developments after the specialist training period, seminars will be held where consequences of and strategies for dealing with such changes will be discussed.

PATIENTS AVAILABLE FOR THE CLINICAL TRAINING The Centre for Orthodontics and Pedodontics have to meet up with the demand for orthodontic care from the population in the Linköping region. Patients adequate for the clinical training in orthodontics are taken from the waiting list for the clinic. For children and adolescents with special dental treatment needs, considered suitable for the training , treatment is given in cooperation with Pedodontists and/or other medical specialities respectively (the whole county of Östergötland). The same applies for adult patients registered at any medical or other odontological department, e.g. patients referred for orthognathic surgery, or oral rehabilitation. The Dentofacial Orthopedic department of the Maxillofacial Unit at the Univeristy Hospital is responsible for the orthodontic care of cleft lip and palate cases from the south-east part of Sweden, in cooperation with other clinics in the University Hospital, mainly the Plastic Surgery Clinic.

The population in Linköping Health Care region, our health administrative region, amounts to 150.000, and in the county 416.000 (2006-08-08).

Centre for Orthodontics and Pedodontics, SE-581 85 LINKÖPING, SWEDEN Telephone: +55 13-22 88 30 E-mail: [email protected]

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How are the objectives reached? The follow up! 1. The curriculum and the objectives in relation to earlier experience and personal qualiy of the dentist.

The proposed specialist training is based on a three year appointment by the County Council of Östergötland, and carried out by the Centre for Orthodontics and Pedodontics in Linköping. A shortened duty with reference to already reached competence will be considered on an individual basis, and accepted only if it has no negative effect for the quality level for the programmed training for the rest of the postgraduate students. The postgraduate education and training is open for applicants from the whole world. Foreign applicants must have signed a special agreement for the education with the County Council of Östergötland, and have a competence at least at the same level as the Swedish applicants. At least 2 years experience of general dental practice is compulsory. The programme supervisor is responsible for that every postgraduate student in all parts of the training reaches an acceptable level of knowledge and skill to allow for a continuing clinical duty and training. This responsibility will be carried out by examining theoretical parts and continously evaluating the clinical work together with the clinical supervisors.

2. Progress discussions and/or follow ups

The dentist in the specialist training will have, as the rest of the staff, progress discussions according to regulations given by the responsible body of clinical duty, the County Council of Östergötland. For the postgraduate student it is important: that supervisors and dental assistances to the postgraduate student make comments at once, but in loyal spirit, about observations, positive as well as negative, considered important for a higher personal and professional development; that observations of mutual interest for the education and the clinical training will be discussed at weekly meetings, with special emphasis on creating attitudes according to the Swedish dental law, the ethical rules for the profession and the regulations for the activity; that the head supervisor at least once per semester, personally with every postgraduate student, discusses the development of his/her competence in accordance to the objectives in the curriculum, trying to identify possible obstacles to reach the objectives; that the Centre for Orthodontics and Pedodontics at least once per semester, evaluates its achievements for reaching the objectives; and that the evaluation is made according to regulations by the Health University.

Centre for Orthodontics and Pedodontics, SE-581 85 LINKÖPING, SWEDEN Telephone: +55 13-22 88 30 E-mail: [email protected]

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3:0 Documentation

For the dentist in the postgraduate education a personal book for marks will be kept by the responsible supervisor. In this book special mark will be made for: a) If special considerations have been taken for the postgraduate students earlier experience and personal qualifications att the acceptance for education, that have made it necessary to make an individual curriculum beside the ordinary. b) Fulfilment of courses and duties, which in the objectives of the education are considered valuable for the education and clinical training. c) An evaluation of the personal development after each semester regarding attitude-, knowledge and manual objectives.

4:0 Final examination

Certificate of reached objectives of education and clinical training will not be issued until the postgraduate student has been approved in a final examination. The final examination is made up by the written reports of the treatment of 30 patients, as well as an oral examination in the presence of the responsible supervisor and the head supervisor from an other clinic, approved by the National Board of Health and Welfare for postgraduate training in orthodontics. The written case reports have to be made available for study by the external examinator before the examination.

Centre for Orthodontics and Pedodontics

The County Council of Östergötland

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Lars-Inge Norevall

Raimo Pälvärinne

Director of the postgraduate programme

Chief Dental Officer

Centre for Orthodontics and Pedodontics, SE-581 85 LINKÖPING, SWEDEN Telephone: +55 13-22 88 30 E-mail: [email protected]

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