Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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The goal of sex and gender analysis is to promote rigorous, reproducible and responsible science. Incorporating sex and gender analysis into experimental design has enabled advancements across many disciplines, such as improved treatment of heart disease and insights into the societal impact of algorithmic bias. Here we discuss the potential for sex and gender analysis to foster scientific discovery, improve experimental efficiency and enable social equality. We provide a roadmap for sex and gender analysis across scientific disciplines and call on researchers, funding agencies, peer-reviewed journals and universities to coordinate efforts to implement robust methods of sex and gender analysis.

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Nature
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Londa Schiebinger
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Hans Asperger, the pioneer of autism and Asperger syndrome in Nazi Vienna, has been celebrated for his compassionate defense of children with disabilities. But in this groundbreaking book, prize-winning historian Edith Sheffer exposes that Asperger was not only involved in the racial policies of Hitler’s Third Reich, he was complicit in the murder of children. 

As the Nazi regime slaughtered millions across Europe during WWII, it sorted people according to race, religion, behavior, and physical condition for either treatment or elimination. Nazi psychiatrists targeted children with different kinds of minds―especially those thought to lack social skills―claiming the Reich had no place for them. Asperger and his colleagues endeavored to mold certain “autistic” children into productive citizens, while transferring others they deemed untreatable to Spiegelgrund, one of the Reich’s deadliest child-killing centers.

In the first comprehensive history of the links between autism and Nazism, Sheffer uncovers how a diagnosis common today emerged from the atrocities of the Third Reich. With vivid storytelling and wide-ranging research, Asperger’s Children will move readers to rethink how societies assess, label, and treat those diagnosed with disabilities.

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Edith Sheffer
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Axel PolleresAxel Polleres is currently a visiting professor at Stanford under the Distinguished Visiting Austrian Chair Professors program hosted by The Europe Center in the Freeman Spogli Institute for International Studies.
 
During his stay at Stanford, Axel will work mainly with the Biomedical Informatics Research Center (BMIR). At his home institution he heads the Institute of Information Business of Vienna University of Economics and Business (WU Wien) which he joined in September 2013 as a full professor in the area of Data and Knowledge Engineering. Since January 2017 he is also a member of the Complexity Science Hub Vienna Faculty. Apart from his research in the area of efficient and intelligent Data management, Semantic Web and Web standards, he recently co-founded a research lab on Privacy and Sustainable Computing at WU where he works on projects about privacy and lowering the entry barriers to Open Data on the Web
 
While visiting Stanford, he plans on transfer his work on Linked Data, which he so far applied mostly in the are of Open Government Data, to other domains such as biomedical research data or in the library domain, both areas where the integration of vast amounts of heterogeneous (meta-)data from different sources and lowering entry-barriers to access this data are likewise important.
 
Axel will be giving a talk on Digital transformation of democracy? Challenges and Opportunities at The Europe Center on May 17, 2018. He will discuss the challenges and opportunities of various digital initiatives and their potential to affect democracy. More concretely, he will discuss the status of Open Government Data, eID, and Online privacy in Austria and in an international context:
 
Open Government Data (OGD) is a global trend to enable transparency by making public data accessible to citizens, providing trustworthy and transparent information in machine readable form, not least promising to counter populism and "fake news". Austria's OGD initiative is a success story, but also faces many challenges. Electronic IDs can provide means to make eGovernment and interaction with public institutions more efficient, but depending on how hey are implemented, also provide a potential threat to privacy and enable surveillance: this holds both IDs provided by international companies but also for national eIDs: against this background, we shall compare the Austrian eID system with other, alternative models. Lastly, he will speak about transparency and accountability of processing of personal information by both private and public institutions. The new European General Data Protection Regulation (GDPR) provides both an opportunity, but also imposes several challenges to the government economically and in terms of preserving the citizens' rights.

 

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The United States is embroiled in a debate about whether to protect or deport its estimated 11 million unauthorized immigrants, but the fact that these immigrants are also parents to more than 4 million U.S.-born children is often overlooked. We provide causal evidence of the impact of parents’ unauthorized immigration status on the health of their U.S. citizen children. The Deferred Action for Childhood Arrivals (DACA) program granted temporary protection from deportation to more than 780,000 unauthorized immigrants. We used Medicaid claims data from Oregon and exploited the quasi-random assignment of DACA eligibility among mothers with birthdates close to the DACA age qualification cutoff. Mothers’ DACA eligibility significantly decreased adjustment and anxiety disorder diagnoses among their children. Parents’ unauthorized status is thus a substantial barrier to normal child development and perpetuates health inequalities through the intergenerational transmission of disadvantage.

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Jens Hainmueller
David Laitin
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In the natural course of events, humans fall sick and die. The history of medicine bristles with attempts to find new and miraculous remedies, to work with and against nature to restore humans to health and well-being. In this book, Londa Schiebinger examines medicine and human experimentation in the Atlantic World, exploring the circulation of people, disease, plants, and knowledge between Europe, Africa, and the Americas. She traces the development of a colonial medical complex from the 1760s, when a robust experimental culture emerged in the British and French West Indies, to the early 1800s, when debates raged about banning the slave trade and, eventually, slavery itself.

Massive mortality among enslaved Africans and European planters, soldiers, and sailors fueled the search for new healing techniques. Amerindian, African, and European knowledges competed to cure diseases emerging from the collision of peoples on newly established, often poorly supplied, plantations. But not all knowledge was equal. Highlighting the violence and fear endemic to colonial struggles, Schiebinger explores aspects of African medicine that were not put to the test, such as Obeah and vodou. This book analyzes how and why specific knowledges were blocked, discredited, or held secret.

 

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John L. Hinds Professor of History of Science
Director, Gendered Innovations in Science, Health & Medicine, Engineering, and Environment
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Londa Schiebinger is the John L. Hinds Professor of History of Science in the History Department at Stanford University and Director of the EU/US Gendered Innovations in Science, Health & Medicine, Engineering, and Environment Project. From 2004-2010, Schiebinger served as the Director of Stanford's Clayman Institute for Gender Research. She is a member of the American Academy of Arts and Sciences.

Professor Schiebinger received her Ph.D. from Harvard University in 1984 and is a leading international authority on gender and science. Over the past thirty years, Schiebinger's work has been devoted to teasing apart three analytically distinct but interlocking pieces of the gender and science puzzle: the history of women's participation in science; gender in the structure of scientific institutions; and the gendering of human knowledge.

Londa Schiebinger presented the keynote address and wrote the conceptual background paper for the United Nations' Expert Group Meeting on Gender, Science, and Technology, September 2010 in Paris. She presented the finding at the United Nations in New York, February 2011 with an update spring 2014. The UN Resolutions of March 2011 call for "gender-based analysis ... in science and technology" and for the integrations of a "gender perspective in science and technology curricula."

In 2011-2012 and 2018-2020, Schiebinger entered into major collaborations with the European Commission and the U.S. National Science Foundation to promote Gendered Innovations in Science, Health & Medicine, Engineering, and Environment. This project draws experts from across the U.S., Europe, Canada, Asia, and was presented at the European Parliament, July 2013. For a popular overview, see Gendered Innovations: Harnessing the Creative Power of Gender Analysis.

Schiebinger has also addressed the Korean National Assembly (2014). In 2015, she addressed 600 participants from 40 countries on Gendered Innovations at the Gender Summit 6—Asia Pacific, a meeting devoted to gendered innovations in research, development, and business. She spoke at the Gender Summit 10 in Tokyo in 2017. She has given seminars at the Japanese Science and Technology Agency in Tokyo, the Japanese Science Council, at Nature magazine in London, the George Institute in Sydney, the Royal Palace in Amsterdam, L'Oréal and UNESCO in Paris, the Global Research Council in São Paulo, the German Science Foundation in Bonn, and UK Research and Innovation in London, and the EDIS Symposium on Inclusive Research and Experimental Design, Francis Crick Institute in London, among others.

Schiebinger recently moderated the launch of American Association of University Women's launch of Solving the Equation: The Variables for Women's Success in Engineering and Computing at Samsung's Mountain View Campus (2015). Schiebinger also helped launch the League of European Research Universities' major report Gendered Research & Innovation, Brussels (2015).

Her study, "Housework is an Academic Issue," with Shannon Gilmartin, Academe (Jan/Feb. 2010): 39-44, was profiled on ABC News. A 30-minute interview on gender in science can be seen on Belgian television. Recent podcasts include: Does gender diversity lead to better science? (2018), Skeleton Wars, the History of Women in Science (2018), and The Secret Cures of Slaves (2018), and The Future of Everything (2019). See also The Robots are Coming! But Should They be Gendered? Schiebinger is a member of the Faculty Planning Committee for Stanford Human-Centered AI Institute. Her work on gender in AI was featured in Nature comment: Design AI so that it's Fair.

Schiebinger's work in the eighteenth century investigates colonial science in the Atlantic World. In particular she explores medical experimentation with slave populations in the Caribbean. Her project reconceptualizes research in four areas: first and foremost knowledge of African contributions to early modern science; the historiography of race in science; the history of human experimentation; and the role of science in the eighteenth-century Atlantic world.

Londa Schiebinger has been the recipient of numerous prizes and awards, including the prestigious Alexander von Humboldt Research Prize and John Simon Guggenheim Fellowship. Schiebinger has just been appointed a Distinguished Affiliated Professor at the Technische Universität, Münichen, and member of their Institute for Advanced Studies. She has also served as a Senior Research Fellow at the Max-Planck-Institut für Wissenschaftsgeschichte in Berlin, the Jantine Tammes Chair in the Faculty of Mathematics and Natural Sciences at the University of Groningen, a guest professor at the Georg-August-Universität in Göttingen, and the Maria Goeppert-Meyer Distinguished Visitor, Oldenburg University. Her research has been supported by the National Science Foundation, National Institutes of Health, National Endowment for the Humanities, Rockefeller Foundation, Fulbright-Hays Commission, Woodrow Wilson Foundation, and Deutscher Akademischer Austauschdienst.

Londa Schiebinger was awarded an honorary doctorate from the Vrije Universiteit Brussel (2013), the Faculty of Science, Lund University, Sweden (2017), and the University of Valencia, Spain (2018); the Interdisciplinary Leadership Award from Women's Health at Stanford Medical School, 2010; Prize in Atlantic History from the American Historical Association, 2005 and the Alf Andrew Heggoy Book Prize from the French Colonial Historical Society, 2005, both for her Plants and Empire: Colonial Bioprospecting in the Atlantic World. She also won the 2005 J. Worth Estes Prize from the American Association for the History of Medicine for her article "Feminist History of Colonial Science," Hypatia 19 (2004): 233-254. This prize goes to the author of an article of outstanding scholarly merit in the history of pharmacology. Her work has been translated into thirteen languages.

Londa Schiebinger's research has been featured in Forbesthe Times Higher EducationLe MondeLa RechercheWorld Economic Forum, El PaísThe New YorkerDiscovHerEuroScientistUniversity World NewsMoneyish, the New York Times, Die Zeit, Frankfurter Allgemeine Zeitschrift, La Vanguardia, at the London Museum of Natural History, on NPR, and elsewhere. She speaks and consults nationally and internationally on gender in science, medicine, and engineering.

Schiebinger is currently accepting graduate students in Gendered Innovations in Science, Health & Medicine, Engineering, and Environment and the History of Science.

 

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Sergio Rebeles, the first student to graduate with a Global Studies minor in European Studies, received his B.S. in Biology in June.

One of Sergio's earliest impetuses towards a global focus for his education was becoming aware of the Sinjar massacre of Yazidis in northern Iraq in 2014. At Stanford, Sergio's native Spanish-speaking abilities led him to volunteer as a medical Spanish Interpreter at free clinics at Stanford and in San Jose. This solidified his desire to attend medical school in the future.

Sergio's interest in international affairs led him to study abroad with Stanford's Bing Overseas Studies Program in Madrid and Paris. After considering both the French and International Relations minors, Sergio ultimately chose the European Studies minor because of its "flexibility and interdisciplinary/comparative focus." Sergio's favorite class of those specifically taken for the minor was History of the International System (INTNLREL 102), taught by Norman Naimark.

In Madrid, Sergio interned at a Catholic school where he gave English lessons to first graders. In France he enjoyed a French art history class that included trips to the Louvre and Musee d'Orsay. While abroad he also "treasured the time I spent with my host family, which included two young boys, and thus very stimulating dinners."

Sergio is confident that studying both science and the humanities at Stanford helped to make him a well-rounded graduate. "There’s certainly a difference in personality type between the ‘hard’ and ‘soft’ sciences, and it was refreshing to experience both during my time on the Farm. Believe it or not, I would even describe it as cathartic to work on an essay between bouts of memorizing biochemical pathways or practicing genetic crosses."

Sergio's one regret is that, because the minor program was new, he was not able to take the introductory courses (Global 101 and International Relations 122) before his study abroad, and he found that what he learned in them would have been useful in framing his European experience. In planning his studies, Sergio appreciated the guidance of advisors Ken Scheve, director of The Europe Center (TEC), and Christophe Crombez.

Sergio's immediate plans include studying for the MCAT and working for two years as a high school math teacher in Miami for Teach For America. We wish him the best of luck in his future endeavors!


Learn more about the Global Studies Minor with a Specialization in European Studies.

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For 14 years, Mariano-Florentino Cuéllar has been a tireless Stanford professor who has strengthened the fabric of university’s interdisciplinary nature. Joining the faculty at Stanford Law School in 2001, Cuéllar soon found a second home for himself at the Freeman Spogli for International Studies. He held various leadership roles throughout the institute for several years – including serving as co-director of the Center for International Security and Cooperation. He took the helm of FSI as the institute’s director in 2013, and oversaw a tremendous expansion of faculty, research activity and student engagement. 

An expert in administrative law, criminal law, international law, and executive power and legislation, Cuéllar is now taking on a new role. He leaves Stanford this month to serve as justice of the California Supreme Court and will be succeeded at FSI by Michael McFaul on Jan. 5.

 As the academic quarter comes to a close, Cuéllar took some time to discuss his achievements at FSI and the institute’s role on campus. And his 2014 Annual Letter and Report can be read here.

You’ve had an active 20 months as FSI’s director. But what do you feel are your major accomplishments? 

We started with a superb faculty and made it even stronger. We hired six new faculty members in areas ranging from health and drug policy to nuclear security to governance. We also strengthened our capacity to generate rigorous research on key global issues, including nuclear security, global poverty, cybersecurity, and health policy. Second, we developed our focus on teaching and education. Our new International Policy Implementation Lab brings faculty and students together to work on applied projects, like reducing air pollution in Bangladesh, and improving opportunities for rural schoolchildren in China.  We renewed FSI's focus on the Ford Dorsey Program in International Policy Studies, adding faculty and fellowships, and launched a new Stanford Global Student Fellows program to give Stanford students global experiences through research opportunities.   Third, we bolstered FSI's core infrastructure to support research and education, by improving the Institute's financial position and moving forward with plans to enhance the Encina complex that houses FSI.

Finally, we forged strong partnerships with critical allies across campus. The Graduate School of Business is our partner on a campus-wide Global Development and Poverty Initiative supporting new research to mitigate global poverty.  We've also worked with the Law School and the School of Engineering to help launch the new Stanford Cyber Initiative with $15 million in funding from the Hewlett Foundation. We are engaging more faculty with new health policy working groups launched with the School of Medicine and an international and comparative education venture with the Graduate School of Education. 

Those partnerships speak very strongly to the interdisciplinary nature of Stanford and FSI. How do these relationships reflect FSI's goals?

The genius of Stanford has been its investment in interdisciplinary institutions. FSI is one of the largest. We should be judged not only by what we do within our four walls, but by what activity we catalyze and support across campus. With the business school, we've launched the initiative to support research on global poverty across the university. This is a part of the SEED initiative of the business school and it is very complementary to our priorities on researching and understanding global poverty and how to alleviate. It's brought together researchers from the business school, from FSI, from the medical school, and from the economics department.  

Another example would be our health policy working groups with the School of Medicine. Here, we're leveraging FSI’s Center for Health Policy, which is a great joint venture and allows us to convene people who are interested in the implementation of healthcare reforms and compare the perspective and on why lifesaving interventions are not implemented in developing countries and how we can better manage biosecurity risks. These working groups are a forum for people to understand each other's research agendas, to collaborate on seeking funding and to engage students. 

I could tell a similar story about our Mexico Initiative.  We organize these groups so that they cut across generations of scholars so that they engage people who are experienced researchers but also new fellows, who are developing their own agenda for their careers. Sometimes it takes resources, sometimes it takes the engagement of people, but often what we've found at FSI is that by working together with some of our partners across the university, we have a more lasting impact.

Looking at a growing spectrum of global challenges, where would you like to see FSI increase its attention? 

FSI's faculty, students, staff, and space represent a unique resource to engage Stanford in taking on challenges like global hunger, infectious disease, forced migration, and weak institutions.  The  key breakthrough for FSI has been growing from its roots in international relations, geopolitics, and security to focusing on shared global challenges, of which four are at the core of our work: security, governance, international development, and  health. 

These issues cross borders. They are not the concern of any one country. 

Geopolitics remain important to the institute, and some critical and important work is going on at the Center for International Security and Cooperation to help us manage the threat of nuclear proliferation, for example. But even nuclear proliferation is an example of how the transnational issues cut across the international divide. Norms about law, the capacity of transnational criminal networks, smuggling rings, the use of information technology, cybersecurity threats – all of these factors can affect even a traditional geopolitical issue like nuclear proliferation. 

So I can see a research and education agenda focused on evolving transnational pressures that will affect humanity in years to come. How a child fares when she is growing up in Africa will depend at least as much on these shared global challenges involving hunger and poverty, health, security, the role of information technology and humanity as they will on traditional relations between governments, for instance. 

What are some concrete achievements that demonstrate how FSI has helped create an environment for policy decisions to be better understood and implemented?

We forged a productive collaboration with the U.N. High Commissioner for Refugees through a project on refugee settlements that convened architects, Stanford researchers, students and experienced humanitarian responders to improve the design of settlements that house refugees and are supposed to meet their human needs. That is now an ongoing effort at the UN Refugee Agency, which has also benefited from collaboration with us on data visualization and internship for Stanford students. 

Our faculty and fellows continue the Institute's longstanding research to improve security and educate policymakers. We sometimes play a role in Track II diplomacy on sensitive issues involving global security – including in South Asia and Northeast Asia.  Together with Hoover, We convened a first-ever cyber bootcamp to help legislative staff understand the Internet and its vulnerabilities. We have researchers who are in regular contact with policymakers working on understanding how governance failures can affect the world's ability to meet pressing health challenges, including infectious diseases, such as Ebola.

On issues of economic policy and development, our faculty convened a summit of Japanese prefectural officials work with the private sector to understand strategies to develop the Japanese economy.  

And we continued educating the next generation of leaders on global issues through the Draper Hills summer fellows program and our honors programs in security and in democracy and the rule of law. 

How do you see FSI’s role as one of Stanford’s independent laboratories?

It's important to recognize that FSI's growth comes at particularly interesting time in the history of higher education – where universities are under pressure, where the question of how best to advance human knowledge is a very hotly debated question, where universities are diverging from each other in some ways and where we all have to ask ourselves how best to be faithful to our mission but to innovate. And in that respect, FSI is a laboratory. It is an experimental venture that can help us to understand how a university like Stanford can organize itself to advance the mission of many units, that's the partnership point, but to do so in a somewhat different way with a deep engagement to practicality and to the current challenges facing the world without abandoning a similarly deep commitment to theory, empirical investigation, and rigorous scholarship.

What have you learned from your time at Stanford and as director of FSI that will inform and influence how you approach your role on the state’s highest court?

Universities play an essential role in human wellbeing because they help us advance knowledge and prepare leaders for a difficult world. To do this, universities need to be islands of integrity, they need to be engaged enough with the outside world to understand it but removed enough from it to keep to the special rules that are necessary to advance the university's mission. 

Some of these challenges are also reflected in the role of courts. They also need to be islands of integrity in a tumultuous world, and they require fidelity to high standards to protect the rights of the public and to implement laws fairly and equally.  

This takes constant vigilance, commitment to principle, and a practical understanding of how the world works. It takes a combination of humility and determination. It requires listening carefully, it requires being decisive and it requires understanding that when it's part of a journey that allows for discovery but also requires deep understanding of the past.

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Abstract:

OBJECTIVE Human blood glucose levels have likely evolved toward their current point of stability over hundreds of thousands of years. The robust population stability of this trait is called canalization. It has been represented by a hyperbolic function of two variables: insulin sensitivity and insulin response. Environmental changes due to global migration may have pushed some human subpopulations to different points of stability. We hypothesized that there may be ethnic differences in the optimal states in the relationship between insulin sensitivity and insulin response.

RESEARCH DESIGN AND METHODS We identified studies that measured the insulin sensitivity index (SI) and acute insulin response to glucose (AIRg) in three major ethnic groups: Africans, Caucasians, and East Asians. We identified 74 study cohorts comprising 3,813 individuals (19 African cohorts, 31 Caucasian, and 24 East Asian). We calculated the hyperbolic relationship using the mean values of SI and AIRg in the healthy cohorts with normal glucose tolerance.

RESULTS We found that Caucasian subpopulations were located around the middle point of the hyperbola, while African and East Asian subpopulations are located around unstable extreme points, where a small change in one variable is associated with a large nonlinear change in the other variable.

CONCLUSIONS Our findings suggest that the genetic background of Africans and East Asians makes them more and differentially susceptible to diabetes than Caucasians. This ethnic stratification could be implicated in the different natural courses of diabetes onset.

Canalization is the way in which organisms develop phenotypic robustness as a response to genetic or environmental perturbations. This process ensures the stability of critical biological processes like blood glucose regulation. Canalization of this trait can be represented by a hyperbolic function of two underlying variables: insulin sensitivity and insulin response, as primarily described by Kahn et al. (1,2).

Global migration in the early history of Homo sapiens placed people in new environments, resulting in novel diets, food scarcity, different climates, and exposure to novel pathogens. These changes may have shifted population averages of factors that influence insulin sensitivity and secretion. They include body size, body composition, energy expenditure, storage, and heat production. As these factors changed, they may have disclosed cryptic genetic variation or adopted novel mutations, leading to disruption of the unique point of stable equilibrium of ancestral populations. As this process continued over hundreds of millennia, specific genetic and environmental perturbations may have pushed some subpopulations to different points of stability (1,35).

We hypothesized that there may be ethnic differences in the optimal states in the relationship between insulin sensitivity and insulin response and that these differences may depend on a population’s genetic or evolutionary history. To assess this hypothesis, we performed a systematic review and a meta-analysis of studies of the insulin sensitivity index (SI) and the acute insulin response to glucose (AIRg). Our analysis was done in cohorts in any of the three major ethnic groups: Africans, Caucasians, and East Asians. We found significant differences between the groups.

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Topics in the Neurobiology of Aggression: Implications for Deterrence. A Strategic Multilayer (SMA) Publication, Pentagon Press
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