EPISODE TRANSCRIPT
Content may be slightly edited for clarity.
Bey
Hello and welcome to So Curious!, presented by the Franklin Institute.
Angelica
In this season, Human 2.0, we will be talking to scientists and non-scientists about technology, innovation and human experiences. We are your hosts. I’m Angelica Pasquini.
Bey
And I’m The Bul Bey. You can call me Bey.
Angelica
In this episode, we’re going to be talking to neurologist Roy Hamilton, and mental health journalist Courtney Harris Bond.
Bey
So today we’re going to be talking about TMS: Transcranial Magnetic Stimulation.
Angelica
Yeah.
Bey
Say that five times fast.
Angelica
Yeah. I’m amazed by this.
Bey
Yeah. It’s going to be what? Magnets? To treat…I don’t know…anxiety?
Angelica
Pulsating magnets are on your head.
Bey
Right.
Angelica
It’s actually apparently incredibly effective technology for treating not only depression… I’ve been reading about this because I love exploring different modalities for healing depression, considering that depression is essentially something that every person I know is dealing with in some capacity. And I think that this technology, apparently this therapy is extremely effective. I love learning about different modalities for treating depression. It’s such a big part of our world.
Bey
Yeah. And the brain continues to be a very complex, tricky thing to treat. Although we have all kinds of technology and therapy that has grown over the years, it’s still a little tricky to try to treat the brain and depression and anxiety and all these other different mental illnesses or harms or things that keep us from living full lives.
Angelica
Yeah.
Bey
It’s just so difficult to try to pin down. So this is a new technology that seems to be, as you said, effective and has a little bit of light at the end of the tunnel.
Angelica
Yeah. I can’t wait to learn about the different parts of your brain that affect your mood or maybe things like repetitive looping thoughts and how people explore using this technology, how to alleviate those symptoms.
Bey
Yeah.
Angelica
I know that we’re going to be talking to someone who used the therapy and we’re going to be talking to someone on the clinician side.
Bey
Yeah, getting those perspectives is going to be great. Right. Both sides. What is it like to use it, and then to receive it, and to talk about those parallels and where they align and overlap. It’s going to be a really good episode. And I know the brain is just, like, it’s such a weird organ, isn’t it? Because some people would argue that maybe the heart is more important. Maybe. I don’t know if the intestines are more important, but the brain continues to remain like top of the organ food chain. That’s a terrible analogy.
Angelica
It’s funny because we’re just using the brain to study the brain. We only have a human brain.
Bey
Right.
Angelica
So there is this meta element where it’s like, as much as, you know, there’s still so much mystery because you’re literally using the thing to study the thing.
Bey
Exactly.
Angelica
And it ends there. There is nothing more we have. So it’s pretty trippy, but it is what it is.
Bey
We’re using the thing to study the thing so we can get a better grasp of the thing that we have try to connect with these other things?
Angelica
Exactly!
Angelica
Our first guest is Roy Hamilton.
Bey
Dr. Roy Hamilton is an associate professor in the Neurology, Physical Medicine and Rehabilitation departments of the University of Pennsylvania. He has been in the field of brain stimulation since 1998, and uses TMS and tDCS to study topics including cognitive control, language production, semantic memory, and creativity. Dr. Hamilton’s work with TMS specifically focuses on how TMS can improve various aspects of cognitive functioning. Welcome, Doctor Hamilton. Can you introduce yourself in your own words?
Roy Hamilton
I am an associate professor at the University of Pennsylvania in the Department of Neurology. I’m a behavioral neurologist, which means that I see patients who have problems with aspects of their cognition, memory, other elements of thinking that arise from neurologic disease.
Bey
Why is treating the brain so tricky?
Roy Hamilton
First, we can think about the complexity of the system itself. We’re talking about a system that has approximately 100 billion neurons. Connections. Connections to connections. And connections to connections to connections to connections. They are essentially uncountable. So you’re talking about an extreme amount of complexity. Aside from that, there are also some basic mechanical challenges, especially if you’re someone who’s trying to affect that system from the outside without seeing it, hitting it with a magnet or an electrode. So that introduces a certain number of complexities.
Angelica
Let’s get right into Transcranial Magnetic Stimulation.
Bey
Say it five times fast!
Roy Hamilton
You can just go with TMS.
Angelica
Okay, so with TMS, I’d love to just talk about ….,You named them briefly, but what disorders that TMS can treat?
Roy Hamilton
Well, the one that it is principally known for right now is depression, and that’s the one that it has a clinical indication for. So in 2008, it was approved by the FDA for use in depression. Personally, myself, I’m interested in expanding its use into other spaces. I’m interested in the fact that it can be used to modulate brain activity in an enduring way. And so I, and obviously, a number of other investigators, are interested in its use in neural rehabilitation: the ability to help the brain remediate itself and to improve functions moving forward.
Angelica
And what exactly is it doing to the brain when it’s working?
Roy Hamilton
So even though it’s something that’s becoming better known now as a breaking technology, the actual technology that drives TMS is about 190 years old. So electromagnetic induction is the idea that if you generate current, let’s say you have a winding of wire, and you generate current in it. If you have something else that is capable of conducting electricity and you put it near that thing — it doesn’t have to touch it — you put it near that thing, and then you generate current in that first thing that you’re talking about, that first winding of wire. You’ll create –when you create that current — you’ll create a fluxing magnetic field. That fluxing magnetic field, which is invisible, will then generate current in that second thing. They don’t have to be touching. The brain, and specifically, the cells called neurons, have electrochemical properties. In other words, they use electricity to fire. They also have a certain, what they call, we call, threshold of current, where they say, “Okay, I’m past my threshold, now I’m going to fire. Now, I’m going to communicate with other neurons.” That’s how they work. So because they work via electricity, if you have something that generates enough current in them, they will fire.
Roy Hamilton
So now you see where we’re going. We’re going to take a magnet, we’re going to put it over the scalp. We’re going to generate a fluxing magnetic field. And the neurons that are right under it are going to say, “Oh, I’m having current generated in me now, and it’s so much that I think I’ll fire. And when I fire, I’m going to do all the things that I do as a neuron. I’m going to communicate to all the neurons I communicate with. I’m going to act like an active brain area.” So you can activate the brain focally from the outside.
Bey
You’ve been involved in research in this field since 1998, which is a long time. Could you talk more about tDCS?
Roy Hamilton
Thank you for asking about tDCS. So, TMS is one technology we can use to manipulate brain function. tDCS is Transcranial Direct Current Stimulation. Now, the idea there is a little bit simpler. You’re going to stick at least two electrodes on your scalp. One of them has to be positive, one of them has to be negative. The current is going to run through them, but the thing is, your head’s in between. And so the current is going to run from one electrode to the other through everything that’s in its way, including your skin, your scalp, the bone, and your brain. That’s how we get current in the brain using tDCS. Now, the amount of current is very small, so it works via a very different mechanism. With TMS, you are telling brain cells, “Fire! Right now!” With tDCS, you’re applying it over a longer period of time. And what you’re doing with this low current is you’re nudging millions of brain cells just a little bit closer or a little bit farther away from that potential that I told you about, where they’re going to fire. The net result of nudging millions of neurons, millions of brain cells a little bit closer to their firing threshold is that overall, if you look at them all at the same time, they might fire more rapidly, getting them to fire, and nudging them away a little less rapidly.
Angelica
So when you’re figuring out how to place it and what parts of the brain are perfect for that particular patient, are the brains looking similar to you? And is every single placement unique to that person’s brain, or is it like they’re similar?
Roy Hamilton
It’s actually, I think, one of the million-dollar questions of neuromodulation moving forward. So in the past, we thought about how brain areas were organized by looking at brains at the group level and say, o”kay, well, on average, when people are performing this kind of mental activity, this area, the brain activates,” or, “when they’re performing this other kind of activity, this area, this other area of the brain activates.” And so a lot of stimulation in the past was driven by this idea that there are these common areas that get activated based around the idea that our brains are kind of similar. But the more we learn about brain function and the association between the anatomy and function, and the differences between people, the more we realize that, oh, actually we should be sensitive to these differences. Maybe different people should be getting stimulated in somewhat different ways.
Angelica
Can you talk about using tDCS for creativity?
Roy Hamilton
I’ve been fortunate enough to be involved with a couple of teams that have used tDCS to try and explore what the brain basis of creativity is and to try and enhance it. There are two instances, one. And again, I want to credit where credit is due. So the big players here were Sharon Thompson-Schill, psychologist at Penn, and Lila Chrysikou, who is now at Drexel. And I just applied the brain stimulation. So they were looking at novel uses for common objects. It’s a kind of creativity, right?
Angelica
Yes, it is.
Roy Hamilton
Okay.
Roy Hamilton
So what we found was that we could stimulate the brain in such a way that individuals were faster at coming up with the novel uses for common objects. So see common objects and come up with some other use for it than the normal use. And also they were less likely to not be able to come up with something because it’s actually pretty hard. Once somebody shows you something, quick, come up with another use for this. So they were less likely to just go blank. Right. Because they were coming up with more creative uses. We also did some work with musicians trying to figure out if we could increase spontaneity in musicians.
Angelica
And?
Roy Hamilton
Well, the answer is kind of mixed. So, we brought in improvisational jazz artists.
Angelica
Right on.
Roy Hamilton
Okay. And we had other people who were jazz artists rate the quality of their improvisation before and after they got stimulation. And what happened was the individuals who weren’t that experienced as improvisational jazz artists, they actually got better at improvisation as a function of receiving brain stimulation.
Angelica
Wow.
Roy Hamilton
The people who are already really good at it, they actually got a little worse.
Angelica
That’s funny.
Roy Hamilton
Okay. So it’s not a one-size-fits-all.
Angelica
Do you think there’ll be a point where these devices are a household item in the future?
Roy Hamilton
There are a number of companies that are already trying to make these household items. They are already on the market commercially available, which introduces a whole host of questions as to what the strengths and weaknesses of doing that might be. There also are communities of individuals who are trying to figure out how to do stimulation themselves, so called do-it-yourself brain stimulation community. They are reading the papers that persons like myself publish. They are buying the electronic components and creating brain stimulation units for personal use.
Angelica
I could see the future of this being something that you put on and you feel stimulated, and then you go do something new in your day.
Roy Hamilton
Yeah.
Angelica
That’ll be something that people have a lot of opinions around, of course.
Roy Hamilton
They already do.
Bey
And Dr. Hamilton, you are also deeply involved in issues of diversity, inclusion and health equity in medicine. You hold the position of Assistant Dean of Diversity and Inclusion, and the inaugural vice-chair for inclusion and diversity in the Department of Neurology. Why is it important for you to hold these positions?
Roy Hamilton
Let me tell you a little bit about my story and my background.
Bey
Absolutely. Okay.
Roy Hamilton
So I’m originally from Southern California. I am Biracial So, my father, who’s passed, is African American. My mother is a Japanese immigrant. I am the youngest of a cohort of five brothers. I’m the only member of the American side of my family to pursue any form of higher education. I’m the only member of my sibling cohort to graduate from high school. A consequence of that kind of experience is that when I went to college and medical school, in this case, both of those being Harvard, and then came here to Penn for residency and then stayed on as faculty… Many, many times, I was experiencing things for the first time in anyone’s knowledge in the community in which I was raised. So I have very few points of contact, very few points of mentorship, aside from the very important mentors I made professionally. And so as I mature in my role, it’s important to me to try and lower the activation energy that… Basically lower those barriers, the ones that I found myself pushing through, to get to each stage that I wanted to achieve in my career, to make it that much easier for individuals who are faced with similar challenges.
Roy Hamilton
I’ll say one other thing about this and why it’s important. So that was from the perspective of the individuals themselves trying to make it through their journey. There is ample evidence now that practically every endeavor in which there is greater diversity, it’s shown that those institutions and environments outperform institutions and environments that are homogeneous. So not only is it better for individuals who are facing barriers to have those barriers taken away from them, it is better for the institutions who are bringing them in. It accelerates excellence to have more diverse environments. And so that’s why those are the two reasons why I pursued these roles.
Bey
And would you say, as a consequence, it’s better for science?
Roy Hamilton
It is absolutely better for science. There is evidence, for example, that scientific papers that have greater diversity in the authorships produce higher-impact science. They’re cited more, and they’re in higher-impact journals because they’re just better science. You can demonstrate the same thing with gender diversity as well. Diversity leads to excellence. It leads to excellence in science.
Angelica
Thank you for your time.
Roy Hamilton
Sure. Of course. My pleasure.
Bey
That was a fair amount of information. Nah, let’s be honest, that was a lot of information. Let’s take a moment to really sit with it and reflect.
Angelica
Roy. Wow. I learned a lot.
Bey
That was good. Sometimes I feel a little bit barricaded from these spaces of information around science and tech and the brain. And him pulling back those myths helped me feel like now, you know, a little bit more like “you’re not too far from where the truth is.”
Angelica
Yeah.
Bey
And apparently neither of the scientists, this technology is all new and they are on a bleeding edge. And I’m glad to be having these dialogues with them because it’s bringing us in on the good stuff, the secrets.
Angelica
Yeah. Also, I like learning about someone who has studied TMS. When you hear about a magnet on someone’s brain, it seems pretty far out. And then when you get to understand the science of it, it’s very simple and obviously deeply complex, but also where it’s going on, your brain is super complex, but the actual idea behind it is essentially just stimulating places in the brain that need more stimulation, repeatedly, and then seeing how that affects that person’s ability to… I like when he talked about how it can affect your ability to speak better. To feel better. Yeah. Why not?
Bey
It’s useful. It’s so useful. And I appreciate the work that he does away from the medicine in social spaces and representation. I love that.
Angelica
Okay. You know what’s incredible is that we’re actually able to speak to someone who’s had this treatment before.
Bey
Lucky for you, our next guest can speak to that. Let’s introduce her.
Angelica
Hi, Courtenay. Welcome. Can you introduce yourself in your own words?
Courtenay Harris Bond
My name is Courtenay Harris Bond, and I am a freelance journalist in the Philadelphia area.
Angelica
Courtenay has received transcranial magnetic stimulation to treat her chronic depression. And we’re going to talk to her today about that process. Thanks for coming to the show.
Bey
Thanks you so much.
Courtenay Harris Bond
My pleasure.
Angelica
Can you talk to us about your depression journey and your introduction to transcranial magnetic stimulation?
Courtenay Harris Bond
Yeah. So I’ve been struggling with depression and anxiety since I was very young and have been in treatment pretty much since the fourth grade on. I’ve had three different psychiatrists, all very good, done a lot of intensive therapy. I started medication at 18, and I’ve rolled through all different kinds of meds. And one day my psychopharmacologist, who handled my medication, said to me, you know, I think I’ve reached the limit of my knowledge to help you. But there’s this doctor, John O’Reardon, who pioneered this treatment called transcranial magnetic stimulation. And he said, I really think you should have a consultation with him. It was great. Dr. O’Reardon is an amazing person, and definitely said I was a candidate for TMS.
Bey
What were some of your first impressions and question, I guess, about TMS?
Courtenay Harris Bond
I was in a pretty low point. My depression kind of ebbs and flows. I’m a pretty high-functioning depressive. I usually can do everything I need to do, but there are times where I get so low that I really have to push to do even basic things. So I was in that state. So I’m totally open to trying any modality that might help me. I was very curious. It’s non-invasive, safer than meds. And I was like, sign me up. It involves placing magnets on very specific parts of the skull and then sending magnetic currents into the brain. Through a lot of research, they found this helps with everything from treatment resistant depression, to Parkinson’s, to PTSD, to OCD. There’s a whole list of things that it can help with. What I found with TMS… I think I had to go….my memory may not be correct, so forgive me, Doctor O’Reardon, but I think I had to go 36 days in a row. And Voorhees is not close to Philly, so… The good news is you can drive.
Bey
Yeah.
Courtenay Harris Bond
It doesn’t affect your driving. I drove back and forth to Voorhees for a long time, and it really did lift me out of the pit I was in. And then we began a maintenance schedule. For a lot of people, the maintenance is minimal. So I had an amazing reaction to begin with, but then it petered out for me. Part of it was just the maintenance was too much.
Bey
You mentioned just a while ago, before we got on that you do some freelance writing and you share your story as a way to break down stigma. Can you talk about the stigma that is around mental health and actually certain treatments like TMS?
Courtenay Harris Bond
I think people are afraid of mental illness. And as I’ve gotten older, one of my goals in my journalism is to help break down stigma around behavioral health issues, whether it’s substance use disorders or mental health issues. So I just think it’s really important to keep the conversation going.
Bey
Right.
Courtenay Harris Bond
Keep it a topic that people become less and less afraid to discuss, and that people will feel more open to share their struggles. So I’ve laid it all on the table, which some people might judge me for, but I feel like I’m doing what’s important to me.
Angelica
Would you be open to talking a little bit more about the different modalities that you’ve tried?
Courtenay Harris Bond
Yeah. So after TMS — and I’ve always been on medication, too, so I didn’t go off medication for TMS. I kind of rolled along for a while. I’m always in therapy with a psychiatrist, always doing the meds thing. Kind of hit another pretty rough spot and decided to try Ketamine.
Angelica
Oh, yeah. I read that article.
Courtenay Harris Bond
I wrote about that for Undar. Again, I had this experience where it lifted me it sort of buoyed me up. And I loved the experience of ketamine.
Angelica
It sounded like it! I was like, this sounds kind of relaxing.
Courtenay Harris Bond
Like high in the middle of the day or the morning or whatever. So it was a very soothing experience for me. Luckily I had a euphoria response to it. Some people have horrific responses to it. It lifted me out of a really bad place. And then again, with the maintenance, I was having to go all the time and I reached a point where I’m like, I just don’t think it’s good to keep doing this because I’m not sure how much it’s helping me. I am putting pretty serious drug in my body. It didn’t last, work for me long-term, but I will say again about the ketamine that there are people that I’ve spoken to and heard of who have had amazing life-changing results. So just because mine didn’t last doesn’t mean it’s not a great thing for other people to try.
Angelica
I think these alternative modalities are showing us that sometimes we can play a little bit around with the timeline, how long some things have to take. I am really curious about this conversation around maintenance that you brought up saying that that’s sort of where you have to stop because of price point and also availability. It’ll be interesting to see if those kinds of things become more accessible to the people who need them.
Courtenay Harris Bond
I mean, one thing I will say is that I truly do believe in psychotherapy and psychiatry. I do these things as a compliment to, I’m never out of my therapy, and I’ve not been off medication in many years. So for some people it can be a substitute or the only thing they do. For me, I have had to maintain a pretty high level of talk therapy at the same time, but it’s very grinding work.
Angelica
I’m also curious, has anything been particularly surprising on your journey, specifically with magnetic stimulation? Like either the way it literally felt, or how you felt after? Anything surprising that people would be interested in hearing?
Courtenay Harris Bond
Yeah, I think it seemed so Sci-Fi to me. I was like, can this really be true? I was sort of like, I’ll try it, but it seems like magical thinking that this could help. Yeah, but it’s true science.
Bey
What did you feel physically from TMS?
Courtenay Harris Bond
The first time I went and they had a cap, like a cloth cap, and they took all these measurements and made marks on the cap so they would know where to place the magnets. Every time I went in to put my cap on and placed the magnet or magnets on the exact spot. And then Dr. O’Reardon turned on the machine and it was like a rhythmic tapping. I kind of compare it to like a little woodpecker tapping on your head, but it doesn’t hurt at all.
Bey
Wow.
Courtenay Harris Bond
It’s a surreal experience.
Bey
And these are magnets?
Courtenay Harris Bond
Yeah. These are like giant magnets.
Bey
Wow.
Angelica
I have a question about your depression and creativity. Do you have anything that works for you to help you finish your work?
Courtenay Harris Bond
To be kind of cynical, I wonder if that’s been a little overblown because like I said, people with mental health issues are silent soldiers, so they really are pushing hard every day, or not every day, but a lot of days, to do sort of basic things that other people don’t even think about doing. Like, there are some days when it’s hard for me to take a shower. I would say occasionally I feel more creative because of my struggles. But the most important thing that I feel is that I have a huge capacity for empathy. Because of my own suffering, I feel I can engage with another person and their own issue, whatever it may be…. I write a lot about opioid use disorder… And really feel a lot of empathy and try to put myself in their shoes. And I think if you’ve experienced pain, any kind of pain or trauma, you can relate to different kinds of pain and trauma.
Bey
Are there any tangible things you can point out that may have come from the TMS?
Courtenay Harris Bond
I’m a big fan of TMS. I think it’s a great modality for people to try. It’s non-invasive. There’s no medication, it’s easy, it’s relaxing, it doesn’t hurt.
Bey
And you would say it helped your depression?
Courtenay Harris Bond
And it definitely helped my depression. I just couldn’t sustain it over time. But there are people who do TMS and it changes their life forever. They’re just like a new person. So I would highly recommend people suffering from treatment-resistant depression or different conditions to look up TMS and try to find a provider.
Bey
And if you don’t mind me asking, you mentioned a couple of seconds ago that some days it’s hard to just jump into the bathroom and take care of yourself when you need to. What does the experience of depression, what has it looked like for you?
Courtenay Harris Bond
It’s been a long, hard struggle. Some days are better than others. Mornings are really tough for me. Getting out of bed to get my kids off to school is a really hard time for me, usually, almost every day. Even though I don’t try to let them know that. They can’t listen to this.
Bey
They can’t hear this.
Angelica
Yeah.
Courtenay Harris Bond
No, it’s okay. I’ve written so much. It’s hard to hide depression from kids.
Angelica
It is. They know everything. And it’s so interesting because out of any kind of ailment that we would all face, right, in life, it just adds to it to have to keep it to yourself, right? Since you grew up with all of this too, and you’ve known it about yourself, am I right to assume that there was support around you and understanding?
Courtenay Harris Bond
I’m so glad you brought that up because I consider myself to be so fortunate. I have been able to receive all these different kinds of treatments throughout my life. There are people suffering in silence who don’t have access to anything. And my heart just breaks.
Bey
They don’t even have the language.
Courtenay Harris Bond
Right. Totally.
Angelica
They don’t even know how to say what’s wrong.
Courtenay Harris Bond
Well, and a lot of those people get so bad that they end up completing suicide, which is a huge problem in our country. So I am very blessed. Even though I struggle, I’m very blessed now. I grew up in a very traumatic household. But the one thing I will say is that my parents got me in to see a doctor early.
Angelica
And what would you say to someone who wants to take that first step and is completely exhausted by the idea of it?
Courtenay Harris Bond
Do it. It’ll be such a relief. You’ll feel good about yourself because you’re taking action. You’ll start to feel better. I do want to emphasize one other thing, if you guys don’t mind. I know there have been shifts in insurance, but I really think we need to make a hard push in this country to get insurance to cover. I mean, there’s this parody out there where insurance is supposed to cover mental health treatment equally as they do treatment of other illnesses.
Bey
Right.
Courtenay Harris Bond
But in practice, if you’re depressed or have PTSD or whatever it might be and your insurance is fighting you every step of the way to pay for the treatments, you’re just going to give up. And I think that’s unacceptable. And I think people like Patrick Kennedy are really pushing hard to change things. But I think this is a major issue in our country.
Angelica
Absolutely.
Bey
Courtenay Harris Bond, ladies and gentlemen. Thank you so much for sharing your story.
Courtenay Harris Bond
Thanks for talking about this stuff. It’s really important.
Bey
It really means a lot to us here. Thank you so much.
Angelica
Thank you.
Courtenay Harris Bond
Thank you.
Bey
Bye.
Angelica
Wow. That was reflection time.
Bey
I really have to take a moment to just say thank you to Courtenay Harris Bond for sharing her experience. Depression, anxiety. They’re serious, serious topics. And a lot of people really do move day-to-day with these burdens, essentially. And she’s doing it with her chin held high, fully functional. Great.
Angelica
Yeah. I really appreciated the honesty. Someone who can chronicle their experience this way. A lot of people just Google things to learn and they’re privately suffering. Right. So they could find someone like her, and find her work, and discover a way to feel better. And that whole thing can be private for them. Right?
Bey
Like she said, “silent soldiers.”
Angelica
Totally. And I love and honor and validate that. And then there’s someone like Courtenay, and they’re like, “I have to spread this message.” So it’s just, there’s different types of people that are struggling. And when she did say “silent soldiers,” I was like, yeah, that’s most people. Right? And we need to keep in mind that we just never know who is experiencing what she’s going through.
Bey
Absolutely.
Angelica
I also like that she talked about that she was able to afford these things until she couldn’t. Like, let’s be real. It’s extremely expensive.
Bey
Yeah. And I think on both sides of medicine, technology and advancement, we’re always going to have the scientists say, “hey, try this new thing, let us put this magnet on your head.” But I really appreciate her saying, hey, I have these really hard experiences and this technology helps. I think you need voices from both sides to really inform us fully, to really help us step forward into medicine with more of a heart and this discussion, definitely my heart grew three times.
Angelica
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Angelica
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