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Why does the index of the Dirac operator on a manifold with boundary live inside the Pfaffian line of the boundary Dirac operator?

I am trying to understand a statement from page 72 of What is an elliptic object? by Stolz and Teichner. They have a spin Riemannian 2-manifold $\Sigma$, with boundary 1-manifold $Y$. The Dirac ...