Judy C Chang

University of California, San Francisco, San Francisco, California, United States

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Publications (41)122.26 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: β-thalassemia, one of the most common genetic diseases worldwide, is caused by mutations in the human hemoglobin beta (HBB) gene. Creation of human induced pluripotent stem cells (iPSCs) from β-thalassemia patients could offer an approach to cure this disease. Correction of the disease-causing mutations in iPSCs could restore normal function and provide a rich source of cells for transplantation. In this study, we used the latest gene-editing tool, CRISPR/Cas9 technology, combined with the piggyBac transposon to efficiently correct the HBB mutations in patient-derived iPSCs without leaving any residual footprint. No off-target effects were detected in the corrected iPSCs, and the cells retain full pluripotency and exhibit normal karyotypes. When differentiated into erythroblasts using a monolayer culture, gene-corrected iPSCs restored expression of HBB compared to the parental iPSCs line. Our study provides an effective approach to correct HBB mutations without leaving any genetic footprint in patient-derived iPSCs, thereby demonstrating a critical step toward the future application of stem cell-based gene therapy to monogenic diseases.
    Genome Research 08/2014; 24:1526-1533. · 14.40 Impact Factor
  • Judy C Chang
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    ABSTRACT: Intimate partner violence (IPV) is a prevalent, complex, and challenging women's health problem associated with a number of negative medical, reproductive, and mental health conditions. When clinicians bring up the topic with their patients, patients are more likely to disclose. Supportive counseling and referrals are associated with improved safety and health.
    Cleveland Clinic Journal of Medicine 07/2014; 81(7):439-446. · 3.40 Impact Factor
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    ABSTRACT: Children whose mothers are victims of intimate partner violence (IPV) are at increased risk of adverse health and psychosocial consequences, including becoming victims or perpetrators of violence in their own relationships. This study aimed to understand the role mothers may play in preventing the perpetuation of violence in their children's lives. We performed semistructured interviews with 18 IPV victims who are mothers and were living at the Women's Center & Shelter of Greater Pittsburgh from July through November 2011. We sought to understand how they communicate with their children about IPV and relationships. These mothers described a desire to explain their IPV experience and offer advice about avoiding violence in relationships. As foundations for these discussions, they emphasized the importance of close relationships and open communication with their children. Although mothers are interested in talking about IPV and relationships and identify communication strategies for doing so, many have never discussed these topics with their children. These mothers need and want an intervention to help them learn how to communicate with their children to promote healthy relationships. Development of a program to facilitate communication between IPV victims and their children could create an important tool to empower mothers to break the cross-generational cycle of domestic violence.
    Journal of Interpersonal Violence 06/2014; · 1.64 Impact Factor
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    ABSTRACT: Individuals homozygous for the C-C chemokine receptor type 5 gene with 32-bp deletions (CCR5Δ32) are resistant to HIV-1 infec-tion. In this study, we generated induced pluripotent stem cells (iPSCs) homozygous for the naturally occurring CCR5Δ32 mutation through genome editing of wild-type iPSCs using a combination of transcription activator-like effector nucleases (TALENs) or RNA-guided clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9 together with the piggyBac technology. Remark-ably, TALENs or CRISPR-Cas9–mediated double-strand DNA breaks resulted in up to 100% targeting of the colonies on one allele of which biallelic targeting occurred at an average of 14% with TALENs and 33% with CRISPR. Excision of the piggyBac using transposase seamlessly reproduced exactly the naturally occurring CCR5Δ32 mutation without detectable exogenous sequences. We differentiated these modified iPSCs into monocytes/macrophages and demonstrated their resistance to HIV-1 challenge. We propose that this strategy may provide an approach toward a functional cure of HIV-1 infection. homologous recombination | TTAA site | off-site target | cellular therapy T he C-C chemokine receptor type 5 (CCR5) is the major coreceptor used by HIV-1 to infect T cells, macrophages, and other cell types. Individuals who are heterozygous or homozy-gous for the CCR5Δ32 mutation in the CCR5 gene have slower progression or resistance to HIV infections, respectively (1–3). One patient has apparently been cured of HIV infection follow-ing allogeneic hematopoietic stem cell transplants from a homo-zygous CCR5Δ32 donor (4). This finding suggests a promising avenue for developing stem cell therapy to treat HIV infection. However, although it is encouraging, allogeneic transplantation is not likely to be widely applicable because the low frequency of CCR5Δ32 homozygotes in the general population plus the lo-gistics and feasibility of identifying suitable HLA-compatible donors with this mutation hinder practical applications. Further-more, this approach requires full bone marrow ablation and im-mune suppression. Autologous transplantations are less toxic, because they may not require complete bone marrow ablation or immune sup-pression for engraftment. In this setting, several studies have attempted to produce HIV resistance by disabling the CCR5 gene in CD34 + hematopoietic stem progenitor cells (HSPCs) or CD4 + T cells using shRNA or by gene disruption using zinc
    Proceedings of the National Academy of Sciences 06/2014; 111(26):9591-9596. · 9.81 Impact Factor
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    ABSTRACT: To describe the observed characteristics of first prenatal visit breastfeeding discussions between obstetric providers and their pregnant patients. This analysis was part of a larger study involving 69 health care providers and 377 patients attending their initial prenatal visits at a single clinic. Audio recordings and transcripts from the first 172 visits (including 36 obstetric-gynecology residents, six nurse midwives, and five nurse practitioners) were reviewed for breastfeeding discussion occurrence, timing and initiator of discussions, and adherence to American College of Obstetricians and Gynecologists (College) prenatal breastfeeding guidelines. Descriptive statistics were used to characterize the sample and frequency of breastfeeding discussions. Logistic regression and χ tests were used to examine patterns in women's breastfeeding discussion preferences and discussion occurrence. Conversations were qualitatively analyzed for breastfeeding content. Breastfeeding discussions were infrequent (29% of visits), brief (mean 39 seconds), and most often initiated by clinicians in an ambivalent manner. Sixty-nine percent of breastfeeding discussions incorporated any College breastfeeding recommendations. Breastfeeding was significantly more likely to be discussed by certified nurse midwives than residents (odds ratio 24.54, 95% confidence interval 3.78-159.06; P<.01), and certified nurse midwives tended to engage patients in more open discussions. Women indicating a preference for breastfeeding discussions at the first visit (n=19) were more likely to actually have the discussion (P<.001). Observed breastfeeding education at the first prenatal visit was suboptimal. The causes and effect of this deficiency on breastfeeding outcomes remains an important point of investigation. LEVEL OF EVIDENCE:: II.
    Obstetrics and Gynecology 11/2013; · 4.80 Impact Factor
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    ABSTRACT: Abstract Purpose. To use direct observations of first prenatal visits to describe obstetric providers' adherence to the evidence-based clinical practice guideline for smoking cessation counseling recommended by the American College of Obstetricians and Gynecologists, the 5 A's (Ask, Advice, Assess, Assist, and Arrange). Design. Observational study using audio recordings of first obstetric visits. Setting. An urban academic hospital-based clinic. Participants. Obstetric care providers and pregnant women attending their first obstetric visit. Method. First obstetric visits were audio recorded. Visits were identified in which patients reported smoking, and discussions were analyzed for obstetric providers' use of the 5 A's in smoking cessation counseling. Results. Obstetric providers asked about smoking in 98% of the 116 visits analyzed, but used 3 or more of the 5 A's in only 21% (24) of visits. In no visits did providers use all 5 A's. In 54% of the visits, providers gave patients information about smoking, most commonly about risks associated with perinatal smoking. Conclusion. Few obstetric care providers performed the recommended 5 A's smoking cessation counseling with their pregnant smokers. Effective and innovative methods are needed to improve obstetric providers' use of the 5 A's.
    American journal of health promotion: AJHP 01/2013; 27(3):170-6. · 2.37 Impact Factor
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    ABSTRACT: Training in intimate partner violence (IPV) improves health professionals' knowledge and comfort regarding IPV; the optimal training frequency and format is unknown. We assessed how various types and amounts of IPV education for medical students affected knowledge and attitudes. Medical students at a large, urban university completed a survey concerning IPV-related knowledge and attitudes and participation in didactic and experiential IPV training activities. This was a one-time assessment. Of 586 students, 279 (48%) completed the survey. IPV-related knowledge increased with increased number of training activities. Knowledge and attitude scores were higher (p < .001) for respondents with experiential, versus only didactic, activities.
    Violence Against Women 10/2012; · 1.33 Impact Factor
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    ABSTRACT: To compare in person versus computerized screening for intimate partner violence (IPV) in a hospital-based prenatal clinic and explore women's assessment of the screening methods. We compared patient IPV disclosures on a computerized questionnaire to audio-taped first obstetric visits with an obstetric care provider and performed semi-structured interviews with patient participants who reported experiencing IPV. Two-hundred and fifty patient participants and 52 provider participants were in the study. Ninety-one (36%) patients disclosed IPV either via computer or in person. Of those who disclosed IPV, 60 (66%) disclosed via both methods, but 31 (34%) disclosed IPV via only one of the two methods. Twenty-three women returned for interviews. They recommended using both types together. While computerized screening was felt to be non-judgmental and more anonymous, in person screening allowed for tailored questioning and more emotional connection with the provider. Computerized screening allowed disclosure without fear of immediate judgment. In person screening allows more flexibility in wording of questions regarding IPV and opportunity for interpersonal rapport. Both computerized or self-completed screening and in person screening is recommended. Providers should address IPV using non-judgmental, descriptive language, include assessments for psychological IPV, and repeat screening in person, even if no patient disclosure occurs via computer.
    Patient Education and Counseling 07/2012; 88(3):443-8. · 2.60 Impact Factor
  • Elizabeth E Krans, Judy C Chang
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    ABSTRACT: The objective of the authors in this study was to identify pregnant, low-income African American women's barriers and facilitators to exercise during pregnancy. A series of six focus groups with pregnant African American women were audio-recorded and transcribed verbatim. Focus group transcripts were qualitatively analyzed for major themes and independently coded for barriers and facilitators to exercise during pregnancy. A total of 34 pregnant, African American women participated in six focus groups from June through October of 2007. The majority of women were single (94%), had only a high school education (67%), received Medicaid (100%) and had a mean body mass index of 33 kg/m(2). All participants believed that exercise was beneficial during their pregnancy. However, participants faced multiple barriers including: (1) individual, (2) information, (3) resource, and (4) socio-cultural. African American women also described two facilitators to increase exercise during pregnancy: (1) group exercise classes, and (2) increasing the number of safe, low-cost exercise facilities in their communities. African American women living in low socioeconomic communities face several barriers to exercise during pregnancy. Targeted interventions to overcome barriers and facilitate exercise for this patient population should focus on increasing education from providers regarding the type and frequency of exercise recommended during pregnancy, enhancing social support networks with group exercise programs, and providing affordable and convenient locations to exercise.
    Women & Health 11/2011; 51(8):777-94. · 1.05 Impact Factor
  • Elizabeth E Krans, Judy C Chang
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    ABSTRACT: Exercise may decrease the incidence of obesity and obesity related complications during pregnancy including gestational diabetes and preeclampsia. African American women are at higher risk for obesity and physical inactivity during pregnancy when compared to other patient groups. The purpose of this qualitative study was to describe in detail the unique beliefs and perspectives regarding exercise during pregnancy of African American women. A series of 6 focus groups discussions with pregnant African American women were audio-recorded and transcribed verbatim. Focus group transcripts were qualitatively analyzed for major themes and independently coded for beliefs regarding exercise during pregnancy. A total of 34 pregnant, African American women participated in 6 focus group discussions. The majority of women were single (94%), had only a high school education (67%), received Medicaid (100%) and had a mean BMI of 33 kg/m(2). Three major themes emerged regarding our subjects' beliefs about exercise during pregnancy: (1) women had a broad definition of what types of activities constituted exercise, (2) women believed exercise was generally beneficial during pregnancy and (3) women believed certain types of activities or movements could cause problems with pregnancy. African American women overwhelmingly believe that exercise positively impacts pregnancy. A lack of knowledge concerning the benefits of exercise during pregnancy was not found to be a major contributor to inactivity in African American women. However, health care providers should be aware of cultural myths that prevent many African American women from performing certain activities during pregnancy.
    Maternal and Child Health Journal 09/2011; 16(6):1180-7. · 2.24 Impact Factor
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    Journal of Urban Health 03/2011; · 1.89 Impact Factor
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    ABSTRACT: Research addressing the impact of neighborhood factors on intimate partner violence (IPV) often lacks discussion of how and why such factors impact IPV. In order to address this gap, 16 prominent neighborhood individuals (PNI) from 4 low-income urban neighborhoods were asked to share through in-depth interviews their insights and perceptions of IPV as an issue in their neighborhoods, and the relationship between social and structural neighborhood-level factors and IPV. PNIs most often associated IPV with only physical violence. Several did not feel IPV was a significant issue in their neighborhood, confirming a lack of awareness and underreporting of IPV. However, other PNIs were able to speak of the relationship between IPV and neighborhood factors, including lack of opportunities for employment, vacant housing, trash management, lack of community awareness, and social capacity to act to address IPV. Results provide unique insights regarding the mechanisms linking neighborhood factors to IPV outcomes. These results contribute to a deeper understanding of contextual influences upon IPV, the development of tailored quantitative research and to the design of local multi-level public health IPV intervention and prevention efforts.
    Journal of Urban Health 02/2011; 88(2):214-24. · 1.89 Impact Factor
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    ABSTRACT: To study a mental health sample to assess (1) the prevalence of physical, sexual and emotional intimate partner violence (IPV) victimization and perpetration, (2) the extent this sample reported being asked about IPV by mental health clinicians and (3) how prevalence and screening rates varied by gender. Women and men receiving services at a large psychiatric facility completed anonymous written questionnaires. A total of 524 adults were approached for study participation, and 428 (158 men, 270 women) completed a survey. Over half (51%) of participants experienced some form of IPV; 63% of women and 32% of men reported IPV victimization. Experience of IPV was more likely if participants were women and had diagnoses of posttraumatic stress disorder, anxiety disorder or bipolar disorder. Both women (33%) and men (16%) reported perpetrating IPV. The reported IPV screening rate by mental health providers was 44% for the whole sample (women: 55%; men: 27%). IPV victimization and perpetration is a prevalent problem among women and men receiving mental health services. Clinicians are missing opportunities to screen for IPV as part of mental health evaluation and treatment.
    General hospital psychiatry 01/2011; 33(1):58-65. · 2.67 Impact Factor
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    ABSTRACT: To date, a large number of reports have described reprogramming many somatic cell types into induced pluripotent stem (iPS) cells, using different numbers of transcription factors and devising alternate methods of introducing the transcription factor genes or proteins into the somatic cells. Here, we describe a method using bacteriophage ΦC31 integrase to reprogram mouse embryonic fibroblasts and human amniotic fluid cells into iPS cells. These iPS cells showed morphology, surface antigens, gene expression, and epigenetic states similar to ES cells and formed teratomas with three germ layers in nonobese diabetic/severely compromised immunodeficient mice. Importantly, these iPS cells have only a single integration site in each cell line. The locations of integration favor the intergenic regions, and their distances from the adjacent genes extended from several hundred to >1 million bp. The effect of the insertion on the expression of these genes can be studied by RT-PCR. No insertion into microRNA gene loci was detected. Hence, it is possible to select cells in which adjacent gene functions are not affected, or the inserts can be removed if necessary. We conclude that phage integrase-mediated site-specific recombination can produce iPS cells that have undisturbed endogenous gene function and could be safe for future human therapeutic application.
    Proceedings of the National Academy of Sciences 10/2010; 107(45):19467-72. · 9.81 Impact Factor
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    ABSTRACT: The article discusses a study conducted between December 2007 and March 2008 that involved 19 gender-stratified focus groups with African American parents and adolescents from Allegheny County, Pennsylvania, to explore the process and content of parent-adolescent communication about sex. Discussions about intimate partner violence (IPV) and healthy relationships emerge inductively as critical topics in these conversations. The authors use a grounded theory approach to content analysis to identify and organize themes related to discussions on these topics. A total of 125 participants from 52 families are recruited for the study. Family history of child sexual abuse often motivates discussions. Mothers are described as the primary parent discussing sexual issues with children. Fathers primarily role model ideal male partnership behavior for sons and daughters. Parents seek to prevent daughters from experiencing sexual abuse or emotional manipulation by partners and focus on instilling a sense of responsibility to and respect for romantic partners in sons. Parents prioritize and express the need for tools to influence their adolescent's socialization as romantic partners. Mothers and fathers approach this process differently. Family-focused interventions to prevent unhealthy relationships can build on parent's efforts.
    Journal of Interpersonal Violence 10/2010; 26(11):2165-85. · 1.64 Impact Factor
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    ABSTRACT: Unplanned pregnancy is associated with psychosocial stress, post-partum depression, and future unplanned pregnancies. Our study describes how topics related to unplanned pregnancy were addressed with patients during the first prenatal visit. We audio-recorded and transcribed initial prenatal visits between 48 patients and 16 providers from a clinic serving racially diverse, lower-socio-economic patients. We conducted a fine-grained thematic analysis of cases in which the patient's pregnancy was unplanned. Of the 48 patients, 35 (73%) had unplanned pregnancies. Twenty-nine visits for unplanned pregnancies (83%) included discussion of the patient's feelings about the pregnancy. Approximately half (51%) of the visits touched on partner or other types of social support. Six patients (17%) were offered referrals to counseling or social services. Only four visits (11%) touched on future birth control options. Most initial prenatal visits for unplanned pregnancies included discussion of patient feelings about the pregnancy. However, opportunities to discuss future birth control and for more in-depth follow-up regarding social support and psychological risks associated with unplanned pregnancy were typically missed. Obstetrics care providers should be cautious about making assumptions and should consider discussing pregnancy circumstances and psychosocial issues in more depth when treating patients facing unplanned pregnancy.
    Patient Education and Counseling 09/2010; 81(3):462-7. · 2.60 Impact Factor
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    ABSTRACT: Medical students' choice of residency specialty is based in part on their clerkship experience. Postclerkship interest in a particular specialty is associated with the students' choice to pursue a career in that field. But, many medical students have a poor perception of their obstetrics and gynecology clerkships. To determine whether fourth-year medical students' perceptions of teaching quality and quantity and amount of experiential learning during the obstetrics-gynecology clerkship helped determine their interest in obstetrics-gynecology as a career choice. We distributed an anonymous, self-administered survey to all third-year medical students rotating through their required obstetrics and gynecology clerkship from November 2006 to May 2007. We performed bivariate analysis and used χ(2) analysis to explore factors associated with general interest in obstetrics and gynecology and interest in pursuing obstetrics and gynecology as a career. Eighty-one students (N  =  91, 89% response rate) participated. Postclerkship career interest in obstetrics and gynecology was associated with perceptions that the residents behaved professionally (P < .0001) and that the students were treated as part of a team (P  =  .008). Having clear expectations on labor and delivery procedures (P  =  .014) was associated with postclerkship career interest. Specific hands-on experiences were not statistically associated with postclerkship career interest. However, performing more speculum examinations in the operating room trended toward having some influence (P  =  .068). Although more women than men were interested in obstetrics and gynecology as a career both before (P  =  .027) and after (P  =  .014) the clerkship, men were more likely to increase their level of career interest during the clerkship (P  =  .024). Clerkship factors associated with greater postclerkship interest include higher satisfaction with resident professional behavior and students' sense of inclusion in the clinical team. Obstetrics and gynecology programs need to emphasize to residents their role as educators and professional role models for medical students.
    Journal of graduate medical education. 09/2010; 2(3):341-5.
  • Yuet Wai Kan, Judy C Chang
    Prenatal Diagnosis 07/2010; 30(7):608-10. · 2.68 Impact Factor
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    ABSTRACT: When counseling women experiencing intimate partner violence (IPV), healthcare providers can benefit from understanding the factors contributing to a women's motivation to change her situation. We wished to examine the various factors and situations associated with turning points and change seeking in the IPV situation. We performed qualitative analysis on data from 7 focus groups and 20 individual interviews with women (61 participants) with past and/or current histories of IPV. The turning points women identified fell into 5 major themes: (1) protecting others from the abuse/abuser; (2) increased severity/humiliation with abuse; (3) increased awareness of options/access to support and resources; (4) fatigue/recognition that the abuser was not going to change; and (5) partner betrayal/infidelity. Women experiencing IPV can identify specific factors and events constituting turning points or catalyst to change in their IPV situation. These turning points are dramatic shifts in beliefs and perceptions of themselves, their partners, and/or their situation that alter the women's willingness to tolerate the situation and motivate them to consider change. When counseling women experiencing IPV, health providers can incorporate understanding of turning points to motivate women to move forward in their process of changing their IPV situation.
    Journal of Women s Health 02/2010; 19(2):251-9. · 1.42 Impact Factor
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    ABSTRACT: To explore the effects of the students' gender on their perception of quality and quantity of teaching, the amount of experiential learning, and their interest in obstetrics and gynecology. Anonymous, self-administered surveys to third-year medical students rotating on the obstetrics and gynecology clerkship. Eighty-one of 91 students participated (89% response rate): 33 men, 46 women, 2 declined to reveal their gender. No significant gender differences existed regarding number of interactions with residents and faculty; number of deliveries, surgeries, or examinations performed; perceived quality of teaching; or feeling included as part of the clinical team. Male students were more likely to report performing specific surgical procedures, such as operating the bovie cautery during gynecological surgeries (p = 0.005). More men experienced patients refusing to allow them to participate in the clinical interview (p < 0.0001) and physical examination (p < 0.0001). Male students were also more likely to report feeling that their gender negatively impacted their clerkship experience (p < 0.0001). Although less likely to report preclerkship and postclerkship career interest in obstetrics and gynecology, male students were more likely to report that their interest increased at the end of the clerkship. Male students were more likely to experience gender bias from patients on the obstetrics and gynecology service. Male students also described feeling socially excluded from female-dominated clinical teams. Obstetrics and gynecology educators need to consider methods of encouraging patients to accept medical student participation regardless of gender. Obstetrics and gynecology faculty and residents need to be sensitive to subtle forms of gender bias and ensure equal inclusion for both male and female medical students.
    Journal of Women s Health 01/2010; 19(1):87-92. · 1.42 Impact Factor

Publication Stats

434 Citations
122.26 Total Impact Points

Institutions

  • 2006–2014
    • University of California, San Francisco
      • • Division of Hospital Medicine
      • • Department of Obstetrics, Gynecology and Reproductive Sciences
      • • Department of Laboratory Medicine
      San Francisco, California, United States
  • 2003–2013
    • University of Pittsburgh
      • • Center for Research on Health Care
      • • Department of Obstetrics, Gynecology and Reproductive Sciences
      • • Department of Pediatrics
      Pittsburgh, Pennsylvania, United States
    • University of North Carolina at Chapel Hill
      North Carolina, United States
  • 2005–2012
    • Magee-Womens Hospital
      Pittsburgh, Pennsylvania, United States
  • 2011
    • University of Michigan
      • Department of Obstetrics and Gynecology
      Ann Arbor, MI, United States
  • 2006–2008
    • CSU Mentor
      • Department of Medicine
      Long Beach, California, United States