Bob Bollinger, MD, MPH

Role: 
Faculty
Raj and Kamla Gupta Professor of Infectious Diseases, Professor of Medicine, Public Health, and Nursing

Dr. Bollinger is the Raj and Kamla Gupta Professor of Infectious Diseases at the Johns Hopkins University (JHU) School of Medicine. He holds joint appointments in International Health at the Johns Hopkins (JH) Bloomberg School of Public Health, and in Community Public Health at the JH School of Nursing.  From 2005-2022, he was the Founding Director of the JH Center for Clinical Global Health Education (now CCGHE-ID), which was the home of the Johns Hopkins Division of Infectious Diseases research program in Pune, India until the establishment of the Center for Infectious Diseases in India (CIDI).  He is Associate Director for Medicine of the JH Center for Global Health and is a member of the Faculty Steering Committee of the Johns Hopkins Gupta Klinsky India Institute.  Is a member of the faculty advisory group for the JH Precision Medicine Center of Excellence for COVID-19 and the JH Center for Innovative Diagnostics in Infectious Diseases (CDID).  He has served as a member of the US Presidential Advisory Council for HIV/AIDS (PACHA), the PACHA International Sub-committee, the Institute of Medicine Forum on Public-Private Partnerships for Global Health and Safety, and the US National Institutes of Health (NIH) Fogarty International Center Advisory Board.

Dr. Bollinger has worked for more than 40 years with partners in India on a wide range of public health, clinical research, and education programs, including projects focused on HIV/AIDS, malaria, tuberculosis, leprosy, dengue, antibiotic resistant infections, COVID-19 and other emerging diseases. His research interests include identifying biological and behavioral risk factors for HIV and TB transmission; characterizing the clinical progression and treatment of HIV, TB and related infections; development/evaluation of novel point-of-care diagnostics and implementation of research projects to optimize equitable access to healthcare capacity and delivery in resource-limited communities.

In 1991, he initiated an NIH-funded Indo-US HIV research program in Pune, India, involving the National AIDS Research Institute/ICMR and the BJ Government Medical College. He has served as Principal Investigator for many NIH-supported studies and clinical trials in Pune, including the SWEN study, which led to changes in World Health Organization (WHO) guidelines for treatment of infants born to HIV positive mothers to prevent mother-to-child transmission. Under his 26 years as leader of the Hopkins India Fogarty International Research Training Program, short-term and degree training was provided to more than 140 visiting Indian scientists at JHU, and in-country training provided to more than 2,000 Indian scientists. His commitment to education has been honored with the Johns Hopkins Department of Medicine David M. Levine Excellence in Mentoring Award.

Dr. Bollinger is author of more than 220 peer-reviewed research publications and 15 book chapters, including the first and largest studies of risk factors for HIV transmission in India, the cloning and sequencing of the first HIV viruses from India, the only studies characterizing the primary immune response to HIV in India, and the demonstration of increased risk of HIV acquisition with recent HSV infection and lack of circumcision. Dr. Bollinger received an undergraduate degree from Haverford College, a Doctor of Medicine from Dartmouth Medical School, and a Master of Public Health from JH Bloomberg School of Public Health. He completed his internal medicine training at the University of Maryland Medical Systems, followed by a post-doctoral fellowship in infectious diseases at JHU School of Medicine. He is board certified by the American Board of Internal Medicine in internal medicine and infectious diseases. 

Impact of Malnutrition on HIV Treatment Failure in Resource-limited Settings

Post Date: 
2009-04-02
   |   
Countries: 
   |   
Clinical Sites: 
This study, NWCS 319, was terminated August 20, 2019. Highly active antiretroviral therapy (HAART) has reduced morbidity and mortality among HIV-infected persons worldwide. However, early treatment failure (i.e. WHO stage 3 or 4 illnesses or death...

A5253: Sensitivity and Specificity of Mycobacterium Tuberculosis Screening and Diagnostics in HIV-Infected Individuals

Post Date: 
2009-03-19
   |      |   
Clinical Sites: 
This study was terminated October 15, 2014. An estimated 3 million HIV-infected individuals will enter programs for antiretroviral (ARV) treatment in the coming year, with projected rates of requirement for ARV therapy extending to more than 10 million in sub-Saharan Africa...

Evaluation of the Impact of Distance Learning For Expanding Capacity for Clinical Research in India

Post Date: 
2009-02-13
   |   
Countries: 
This study ended in March 2012. The Office of AIDS Research has initiated a comprehensive program to expand clinical research capacity in India. This program has utilized a number of platforms for providing research training, including intensive in-country workshops and conferences. These programs...

The Presentation and Disease Progression of HIV Infection Among Indian Children

Post Date: 
2008-09-22
   |   
Countries: 
This study was terminated July 24, 2010.

The Association of Umbilical Cord Blood IgG Streptococcus pneumoniae and Hemophilus influenzae Antibody Titers with Mortality and Morbidity among HIV-exposed Infants in India

Post Date: 
2007-08-30
   |   
Countries: 
   |   
Clinical Sites: 
This study ended in August 2010. In India, HIV-exposed infants (infants born to HIV-infected mothers), bear a large burden of mortality and morbidity from S. pneumoniae and H. influenzae type b infections. These bacterial respiratory pathogens are responsible for the majority of mortality and...

Calibration and Application of a Simple Sensitive/Less Sensitive Assay Applicable to Resource-Limited Countries for Determination of Recent HIV Infection and Incidence Estimates

Post Date: 
2007-03-22
   |   
Countries: 
This study was terminated March 31, 2007. Sensitive/Less Sensitive assays (S/LS) to distinguish between recent and established HIV infections have been successfully applied to identify recently infected persons and determine HIV incidence. However, all currently used S/LS assays require laboratory...

BWI CTU: Baltimore-Washington-India Clinical Trials Unit

Post Date: 
2007-02-02
   |   
Countries: 
   |   
Clinical Sites: 
Comprising clinical trial sites at Johns Hopkins Medicine in Baltimore, Whitman Walker Health in Washington, DC, and the BJGMC-CCGHE collaboration in Pune, India, the Baltimore-Washington-India Clinical Trials Unit (BWI-CTU) is one of only 25 international HIV/TB clinical trial sites funded by the...

BJGMC-JHU Fogarty HIV-TB Training Program

Post Date: 
2007-01-01
   |   
Countries: 
   |   
Clinical Sites: 
Funded by the Fogarty International Center at the National Institutes of Health, the JHU Fogarty program has nearly 20 years of success with providing training, professional development, and mentorship to clinicians and scientists in low and middle income countries. CCGHE's latest efforts in...

A Stand Alone Study for Participants of A5175 (A Phase IV, Randomized, Open-Label Evaluation of the Efficacy of Once-Daily Protease Inhibitor and Once-Daily Non-Nucleoside Reverse Transcriptase Inhibitor-Containing Therapy Combinations for Initial Treatme

Post Date: 
2006-05-02
   |   
Globally, 40 million individuals are HIV-infected with 5 million new infections occurring each year; rates are increasing. Three million individuals died from HIV/AIDS in 2003. The global burden of the HIV epidemic is staggering, but in the short term, it is largely unfelt in the developed world...

P1060: Phase II, parallel, randomized, clinical trials comparing the responses to initiation of NNRTI-based antiretroviral therapy in HIV-infected infants who have not previously received Single dose Nevirapine for prevention of Mother-to-child HIV...

Post Date: 
2006-03-27
   |   
Countries: 
   |   
Clinical Sites: 
This study ended June 28, 2015. This multi-country trial was conducted in India, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe under the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Network and funded by the U.S. National Institutes of Health...

A5207: Maintaining Options for Mothers Study (MOMS): A Phase II Randomized Comparison of Three Antiretroviral Strategies Administered for 7 or 21 Days to Reduce the Emergence of Nevirapine Resistant HIV-1 Following a Single Intrapartum Dose of Nevirapine

Post Date: 
2004-12-20
   |   
This study was terminated January 16, 2014; it was conducted under the AIDS Clinical Trials Group (ACTG) and funded by the U.S. National Institutes of Health. A major disadvantage of giving SD NVP is the potential for maternal development of NVP resistance and additional...

A5175: PEARLS Evaluation of the Efficacy of Once-Daily Protease Inhibitor and Once-Daily Non-Nucleoside Reverse Transcriptase Inhibitor- Containing Therapy Combinations for Initial Treatment of HIV-1 Infected Individuals

Post Date: 
2004-07-27
   |   
Countries: 
Full Title: A Phase IV, Prospective, Randomized, Open-Label Evaluation of the Efficacy of Once-Daily Protease Inhibitor and Once Daily Non-Nucleoside Reverse Transcriptase Inhibitor Containing Therapy Combinations for Initial Treatment of HIV-1 Infected Individuals from Resource-Limited...

Evaluation of Provider, Patient and Pharmacy Knowledge, Attitudes and Practices Regarding HIV Care and Use of Antiretroviral Therapy in Pune, India

Post Date: 
2004-03-29
   |   
Countries: 
This study ended in 2007. Antiretroviral therapy (ART) has dramatically affected morbidity and mortality among HIV-infected persons in industrialized countries. In India, where approximately 4.3 million persons are estimated to be HIV-infected (NACO), the use of ART has been limited because of the...

A Study to Validate New Assays for Measuring HIV Seroincidence in Indian HIV Subtype C Seroconverters

Post Date: 
2003-08-05
   |   
Countries: 
This study ended in July 2006.

Mother-to-Child Transmission (MTCT) of HIV: India SWEN Study

Post Date: 
2002-06-07
   |   
Countries: 
   |   
Clinical Sites: 
This study was officially terminated August 2018. Primary and secondary analyses of the India SWEN study, an NIH-funded phase III randomized controlled trial of an extended nevirapine prophylaxis regimen among 783 HIV-infected pregnant women and their...

HPTN HIV Prevention Preparedness Study Protocol Pune, India

Post Date: 
2001-10-15
   |   
Countries: 
As described most recently by the researchers, health care providers, and community representatives who attended the International AIDS Conference this year, HIV/AIDS continues to exact a devastating toll on the health, economic and political infrastructure, and social fabric of communities...

Pages

Efficacy of six-week extended-dose nevirapine varies by infant birth weight with greatest relative efficacy in low birth weight infants

Post Date: 
2016-09-30
   |   
Countries: 
   |   
Clinical Sites: 
Publication: 
PLOS One
Low birth weight (LBW), defined by the World Health Organization (WHO) as birth weight less than 2500 g, is a significant public health issue in resource-limited settings, particularly in Sub Saharan Africa and South Asia where the estimated annual incidence is 14% and 28–31%, respectively,...

Continued elevation of interleukin-18 and interferon-γ after initiation of antiretroviral therapy and clinical failure in a diverse multicountry human immunodeficiency virus cohort

Post Date: 
2016-07-27
   |   
Countries: 
Publication: 
Open Forum Infectious Diseases
Background: We assessed immune activation after antiretroviral therapy (ART) initiation to understand clinical failure in diverse settings. Methods: We performed a case-control study in ACTG Prospective Evaluation of Antiretrovirals in Resource-Limited Settings (...

Inflammation and change in body weight with antiretroviral therapy initiation in a multinational cohort of HIV-infected adults

Post Date: 
2016-07-01
   |   
Countries: 
Publication: 
Journal of Infectious Diseases
Background: Both wasting and obesity are associated with inflammation, but the extent to which body weight changes influence inflammation during human immunodeficiency virus infection is unknown. Methods: Among a random virologically suppressed participants of the...

Inflammation and change in body weight with antiretroviral therapy initiation in a multinational cohort of HIV-infected adults

Post Date: 
2016-04-01
   |      |   
Clinical Sites: 
Publication: 
The Journal of Infectious Diseases
Background: Both wasting and obesity are associated with inflammation, but the extent to which body weight changes influence inflammation during human immunodeficiency virus infection is unknown. Methods: Among a random virologically suppressed participants of the...

Persistently elevated C-reactive protein level in the first year of antiretroviral therapy, despite virologic suppression, is associated with HIV disease progression in resource-constrained settings

Post Date: 
2016-04-01
   |      |   
Clinical Sites: 
Publication: 
The Journal of Infectious Diseases
A case-cohort analysis of human immunodeficiency virus (HIV)-infected individuals receiving antiretroviral therapy (ART) was performed within a multicountry randomized trial (PEARLS) to assess the prevalence of persistently elevated C-reactive protein (CRP) levels, based on serial...

Tuberculosis risk among medical trainees, Pune, India

Post Date: 
2016-03-22
   |   
Countries: 
   |   
Clinical Sites: 
Publication: 
Emerging Infectious Diseases
During 2012–2013, at a public hospital in Pune, India, 26 (3.9%) cases of tuberculosis were reported among 662 medical trainees, representing an estimated incidence of 3,279 cases/100,000 person-years. Three of these infections were isoniazid-resistant, 1 was multidrug-resistant, and 1...

Soluble CD14: An independent biomarker for risk of HIV mother-to-child transmission in setting of pre- and post-exposure antiretroviral prophylaxis

Post Date: 
2015-10-06
   |      |   
Clinical Sites: 
Publication: 
The Journal of Infectious Diseases
Elevated soluble CD14 (sCD14) concentrations, a marker of monocyte activation, predicts adverse outcomes in human immunodeficiency virus (HIV)-infected adults. To examine the association of sCD14 concentrations with the risk of mother-to-child transmission (MTCT) of HIV, we nested a case-...

Pre-cART elevation of CRP and CD4+ T-cell immune activation associated with HIV clinical progression in a multinational case-cohort study

Post Date: 
2015-10-01
   |      |   
Clinical Sites: 
Publication: 
Journal of Acquired Immune Deficiency Syndromes
Background: Despite the success of combination antiretroviral therapy (cART), a subset of HIV-infected patients who initiate cART develop early clinical progression to AIDS; therefore, some cART initiators are not fully benefitted by cART. Immune activation pre-cART may predict clinical...

Contraceptive use and factors associated with postpartum surgical sterilization among HIV-infected women in Pune, India

Post Date: 
2015-08-21
   |   
Countries: 
   |   
Clinical Sites: 
Publication: 
Journal of HIV/AIDS & Social Services
The authors desire to better understand contraceptive practices and factors associated with surgical tubal ligation (STL) among HIV-infected women. Secondary data were obtained from HIV-infected women enrolled in a National Institutes of Health–funded clinical trial assessing the efficacy of...

Failure to use and sustain male condom usage: lessons learned from a prospective study among men attending STI clinic in Pune, India

Post Date: 
2015-08-13
   |   
Countries: 
Publication: 
PLOS One
Background: Sustained or consistent use of condoms by men remains a challenge. A study was carried out to identify factors associated with failure to use condoms consistently by men attending STD clinics in Pune, India. Method: Among 14137 STI clinic...

Development of global health education at Johns Hopkins University School of Medicine: a student-driven initiative

Post Date: 
2015-07-27
Publication: 
Medical Education Online
Global health is increasingly present in the formal educational curricula of medical schools across North America. In 2008, students at Johns Hopkins University School of Medicine (JHUSOM) perceived a lack of structured global health education in the existing curriculum and began working with...

GETHealth Summit Report—2014, Conference Proceedings

Post Date: 
2015-07-08
The GETHealth Summit brought together healthcare professionals, representatives from the technology and education sectors, academic researchers, global health experts from backgrounds including non-governmental organisations to government. This diverse group of delegates were brought together to...

Concurrent anemia and elevated CRP predicts HIV clinical treatment failure, including TB, post-antiretroviral therapy initiation

Post Date: 
2015-07-01
   |      |   
Clinical Sites: 
Publication: 
Clinical Infectious Diseases
Background: Anemia is a known risk factor for clinical failure following antiretroviral therapy (ART). Notably, anemia and inflammation are interrelated, and recent studies have associated elevated C-reactive protein (CRP), an inflammation marker, with adverse human immunodeficiency virus (...

Dengue and chikungunya co-infection associated with more severe clinical disease than mono-infection

Post Date: 
2015-04-15
   |   
Countries: 
Publication: 
International Journal of Healthcare and Biomedical Research
Background: Dengue and chikungunya infections appear to be increasing in India. While Aedies aegypti is the transmitting vector for both viruses and co-infection occurs in the same communities, studies on the clinical significance of co-infection are limited. Materials and Methods: We conducted a...

Vitamin D deficiency and risk of postpartum tuberculosis among HIV-infected breastfeeding mothers in India

Post Date: 
2015-03-15
   |   
Countries: 
   |   
Clinical Sites: 
Publication: 
International Journal of Tuberculosis and Lung Disease
Some studies have associated low vitamin D levels with the risk of tuberculosis (TB), but its association in human immunodeficiency virus (HIV) infected mothers in a TB-endemic region has not been well studied. We conducted a nested 1:2 case-control study among HIV-infected mothers in western...

C-reactive protein (CRP), interferon gamma-inducible protein 10 (IP-10), and lipopolysaccharide (LPS) are associated with risk of tuberculosis after initiation of antiretroviral therapy in resource-limited settings

Post Date: 
2015-02-26
   |   
Publication: 
PLOS One
Objective: The association between pre-antiretroviral (ART) inflammation and immune activation and risk for incident tuberculosis (TB) after ART initiation among adults is uncertain. Design: Nested case-control study (n = 332) within ACTG PEARLS trial of...

25-Hydroxyvitamin D insufficiency and deficiency is associated with HIV disease progression and virological failure post-antiretroviral therapy initiation in diverse multinational settings

Post Date: 
2014-07-15
   |      |   
Clinical Sites: 
Publication: 
The Journal of Infectious Diseases
Background: Low 25-hydroxyvitamin D (25(OH)D) has been associated with increased HIV mortality, but prospective studies assessing treatment outcomes after combination antiretroviral therapy (cART) initiation in resource-limited settings are lacking. Methods...

Impact of maternal hepatitis B virus coinfection on mother-to-child transmission of HIV

Post Date: 
2014-07-15
   |   
Countries: 
   |   
Clinical Sites: 
Publication: 
HIV Medicine
Objectives: Despite high hepatitis B virus (HBV) endemicity in various resource-limited settings (RLSs), the impact of maternal HIV/HBV coinfection on infant health outcomes has not been defined. We aimed to assess the prevalence of HBV coinfection among HIV-infected pregnant women and its...

Maternal pneumococcal capsular IgG antibodies and transplacental transfer are lower in South Asian HIV-infected mother-infant pairs

Post Date: 
2014-03-14
   |   
Countries: 
   |   
Clinical Sites: 
Publication: 
Vaccine
Background: Our understanding of the mother-to-child transfer of serotype-specific pneumococcal antibodies is limited in non-immunized, HIV-positive women. Methods: We compared geometric mean antibody concentrations (GMCs), geometric mean transplacental...

India’s new policy to protect research participants

Post Date: 
2013-07-31
   |   
Countries: 
Publication: 
The BMJ
Editorial Introduction: India, the country with the largest disease burden in the world,1 is now a major international hub for clinical research. However, a recent policy that was meant to mitigate important ethical concerns may have profound and unintended consequences for public health and...

Pages

VERIFY: What do we know about the coronavirus strain in South Africa?

Post Date: 
2021-01-25
Source: 
Radio Health Journal
Dr. Robert Bollinger
Here’s what we know about the strain found in South Africa. According to Dr. Bollinger, it looks to be more contagious than the original. “That's true, not just about the South African variant...

Covid Vaccination Incentives: The Risks And Rewards For Employers

Post Date: 
2021-01-16
Source: 
Forbes
Dr. Robert Bollinger
Dr. Bob Bollinger: “To stop this epidemic and get us all back to a new normal as soon as possible, we will need all segments of society to increase community uptake of vaccination[s]."

Experts say COVID-19 mutations are normal

Post Date: 
2021-01-15
Source: 
messenger-inquirer.com
Dr. Robert Bollinger
Dr. Robert Bollinger: “... As with any virus, changes are something to be watched, to ensure that testing and vaccines are still effective.

A New Strain of Coronavirus: What You Should Know

Post Date: 
2021-01-06
Source: 
hopkinsmedicine.org
Dr. Robert Bollinger
Dr. Bollinger: "All viruses mutate over time, some more than others. For example, flu viruses change often, which is why doctors recommend that you get a flu shot every year."

World Renowned Infectious Disease Doctor on New COVID-19 Vaccines and Recommended Thanksgiving Precautions

Post Date: 
2020-11-23
Source: 
The Leslie Marshall Show
Dr. Robert Bollinger
Leslie Marshall Show: Dr. Bollinger provides updates about the COVID-19 pandemic and issues a holiday travel warning.

Leslie Marshall interviews Dr. Bob Bollinger on Latest COVID-19 News, Including Vaccines

Post Date: 
2020-10-07
Source: 
The Leslie Marshall Show
Dr. Robert Bollinger
CCGHE's Bob Bollinger talks with Leslie Marshall about the latest COVID-19 news, including vaccines.

Global Pandemic: The Value of Telemedicine and Concerns with Returning to School

Post Date: 
2020-08-20
Source: 
Fox News Rundown
Dr. Robert Bollinger
Fox News Rundown : Dr Bob Bollinger dicusses the uptick and importance of telemedicine during the pandemic and concerns with schooling.

Research Story Tip: International Johns Hopkins Study Says Broad Measures Needed to Prevent TB Spread in India

Post Date: 
2020-08-06
Dr. Mandar Paradkar
Johns Hopkins News Release: News release highlights study findings published in PLOS One by Dr. Mandar Paradkar and colleagues.

Broad measures needed to check spread of TB in India, say researchers

Post Date: 
2020-08-05
Source: 
The Tribune (India)
Drs. Mandar Paradkar and Robert Bollinger are quoted in this article that highlights their recent paper about administration of TB preventive therapy for household contacts of confirmed TB cases in India.

Can We Reverse the Pandemic’s Deadly Trajectory Before it is Too Late?

Post Date: 
2020-07-20
Source: 
Background Briefing with Ian Masters
Dr. Robert Bollinger
Background Briefing : Bob Bollinger discusses the US response to COVID-19 with Ian Masters and what we could have learned from European countries.

Why the Virus is Winning

Post Date: 
2020-07-16
Source: 
The Mark Levine Show
Dr. Robert Bollinger
The Mark Levine Show : Bob Bollinger discusses the COVID-19 situation in the US, and why the virus is spreading so quickly.

World Renowned Infectious Disease Doctor Talks Latest COVID-19 News

Post Date: 
2020-06-26
Source: 
The Leslie Marshall Show
Robert Bollinger
Leslie Marshall Show: Bob Bollinger discusses COVID-19 and the state of the epidemic in the US.

The Coronavirus Isn't Gone. An Expert Answers Your Questions

Post Date: 
2020-06-25
Source: 
Spectrum News NY1
Robert Bollinger
NY1 News : Bob Bollinger discusses a wide range of issues related to COVID-19 testing, immunity and transmission in this broadcast.

Dr. Robert Bollinger on the Coronavirus Pandemic

Post Date: 
2020-06-12
Source: 
C-SPAN
Robert Bollinger
C-SPAN, Washington Journal: Dr. Bob Bollinger fielded viewer questions on COVID-19 during this hour-long broadcast.

Coronavirus: Is herd immunity possible and if so, what’s the threshold?

Post Date: 
2020-06-04
Source: 
FOX News (Via Yahoo! News)
Robert Bollinger
FOX News: Dr. Bob Bollinger discusses COVID-19 and the use of masks, infection, and antibody testing

UK coronavirus death toll is now the highest in Europe

Post Date: 
2020-05-05
Source: 
BBC World News Radio: Newshour
Dr. Robert Bollinger
BBC: World News Radio : Bob Bollinger discusses COVID infection, mortality, and disease spread.

World Renowned Infectious Disease Doctor on COVID-19 Testing Policy

Post Date: 
2020-05-04
Source: 
Leslie Marshall Show
Dr. Robert Bollinger
CCGHE Director Dr. Bob Bollinger is interviewed.

The Covid-19 Riddle: Why Does the Virus Wallop Some Places and Spare Others?

Post Date: 
2020-05-03
Source: 
New York Times
Dr. Robert Bollinger was interviewed for this article "[young people] are less likely to have certain health problems that can make Covid-19, the disease caused by the coronavirus, particularly deadly, according to the World Health Organization."

Want to end state lockdowns? Send in the coronavirus detectives.

Post Date: 
2020-04-21
Source: 
The Christian Science Monitor
Contact Tracing
CSM: Bob Bollinger discusses limitations in US capacity for tracing contacts of confirmed COVID-19 cases.

Crowd-Sourcing COVID-19 Knowledge: Doctors turn to social media

Post Date: 
2020-04-16
Source: 
NBC News (via WDTN, Dayton, OH)
Approved followers can see videos of nurses teaching others how to safely roll over a patient, or how to use a ventilator. Dr. Bob Bollinger of Johns Hopkins says medicine is changing. “I think it can be a very important tool, but it has to be leveraged in a way that it supports the other parts of...

Pages