Infectious Disease Commons^™

Home-Based Pre-Exposure Prophylaxis (Prep) Services For Gay And Bisexual Men: An Opportunity To Address Barriers To Prep Uptake And Persistence, Steven A. John, H Jonathon Rendina, Christina Grov, Jeffrey T. Parsons

Publications and Research

Gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by the HIV epidemic. Despite the promise of pre-exposure prophylaxis (PrEP) in reducing HIV transmission risk, barriers for uptake and persistence exist. We sought to identify whether GBM in a nationwide cohort who have not yet initiated PrEP (n = 906) would prefer to get PrEP-related care from a primary care provider (PCP) compared to a specialist clinic or provider. We then sought to identify their level of interest and factors associated with preference for using home-based PrEP services (i.e., HB-PrEP), defined to participants as conducting …

Outbreak Response And Incident Management: Shea Guidance And Resources For Healthcare Epidemiologists In United States Acute-Care Hospitals., David B Banach, B Lynn Johnston, Duha Al-Zubeidi, Allison H Bartlett, Susan Casey Bleasdale, Valerie M Deloney, Kyle B Enfield, Judith A Guzman-Cottrill, Christopher Lowe, Luis Ostrosky-Zeichner, Kyle J Popovich, Payal K Patel, Karen Ravin, Theresa Rowe, Erica S Shenoy, Scott Stienecker Md, Pritish K Tosh, Kavita K Trivedi

Hospital Medicine

This expert guidance document was developed as a resource to provide healthcare epidemiologists working in acute-care hospitals with a high-level overview of incident management for infectious diseases outbreaks and to prepare them to work within an emergency response framework. It addresses how the epidemiologist’s skills and expertise apply to scenarios that require enhanced preparedness and response efforts, eg, when pathogens associated with outbreaks are poorly characterized or when outbreaks require additional interventions including, but not limited to, healthcare personnel education, enhanced infection prevention and control measures, added staffing, supplies, and resources, adjustments to clinical and support activities, and external communications. …

Development Of A Broadly Protective Modified-Live Virus Vaccine Candidate Against Porcine Reproductive And Respiratory Syndrome Virus, Haiyan Sun, Aspen Workman, Fernando A. Osorio, David J. Steffen, Hiep L.X. Vu

Nebraska Center for Virology: Faculty Publications

Modified-live virus (MLV) vaccines are widely used to protect pigs against porcine reproductive and respiratory syndrome virus (PRRSV). However, current MLV vaccines do not confer adequate levels of heterologous protection, presumably due to the substantial genetic diversity of PRRSV isolates circulating in the field. To overcome this genetic variation challenge, we recently generated a synthetic PRRSV strain containing a consensus genomic sequence of PRRSV-2. We demonstrated that our synthetic PRRSV strain confers unprecedented levels of heterologous protection. However, the synthetic PRRSV strain at passage 1 (hereafter designated CON-P1) is highly virulent and therefore, is not suitable to be used as …

Efficacy Of An Adenoviral Vectored Multivalent Centralized Influenza Vaccine, Amy Lingel, Brianna L. Bullard, Eric A. Weaver

Nebraska Center for Virology: Faculty Publications

Mice were immunized with Adenovirus expressing the H1-con, H2-con, H3-con and H5-con HA consensus genes in combination (multivalent) and compared to mice immunized with the traditional 2010–2011 FluZone and FluMist seasonal vaccines. Immunized mice were challenged with 10–100 MLD50 of H1N1, H3N1, H3N2 and H5N1 influenza viruses. The traditional vaccines induced robust levels of HA inhibition (HI) titers, but failed to protect against five different heterologous lethal influenza challenges. Conversely, the multivalent consensus vaccine (1 × 1010 virus particles (vp)/mouse) induced protective HI titers of ≥40 against 8 of 10 influenza viruses that represent a wide degree of divergence within …

Six-Year Experience Of Influenza Vaccination As A Condition Of Employment For A Large Regional Health Care System, John R. Brill, Mark Hermanoff, Angela Tonozzi, Mary Jo Capodice, Jennifer Farrar, Zarina Dawoodbhai

Journal of Patient-Centered Research and Reviews

Background: Influenza remains a significant contributor to morbidity and mortality in the United States. Health care workers (HCW) can be both victims and vectors of influenza. Influenza vaccination of HCW is protective for both caregivers and patients, but voluntary programs generally fail to achieve rates recommended by the Centers for Disease Control and Prevention. Despite a complex, multifaceted influenza program initiated in 1996 that included significant education and promotion as well as free on-site vaccination, annual Aurora Health Care caregiver immunization rates remained in the mid-70s until adoption of a “condition of employment” strategy in 2011.

Purpose: Discuss the annual …

Fmt Placed By Colonoscopy: Systematic Review And Meta-Analysis, Nadia Huq, Veena Kumaravel, Aboud Affi, Maharaj Singh

Journal of Patient-Centered Research and Reviews

Background: Fecal transplants are successful in the treatment of recurrent or refractory Clostridium difficile infections (CDI), but there is no consensus on the best method of instillation. Studies have shown greater success with lower gastrointestinal tract placement, but technical aspects of placement are not validated.

Purpose: This review aims to identify common traits and procedural techniques of successful fecal microbiota transplant (FMT) therapy via colonoscopy.

Methods: An electronic search was conducted using OVID Medline and PubMed for articles published from January 2010 to January 2016. The primary outcome of interest was cure by FMT placed via colonoscopy.

Results: Of the …

Multisite Evaluation Of The Bd Max Extended Enteric Bacterial Panel For Detection Of Yersinia Enterocolitica, Enterotoxigenic Escherichia Coli, Vibrio, And Plesiomonas Shigelloides From Stool Specimens., Patricia J Simner, Margret Oethinger, Kathleen A Stellrecht, Dylan R Pillai, Ram Yogev, Helene Leblond, Joel Mortensen

Articles, Abstracts, and Reports

The purpose of this study was to perform a multisite evaluation to establish the performance characteristics of the BD Max extended enteric bacterial panel (xEBP) assay directly from unpreserved or Cary-Blair-preserved stool specimens for the detection of Yersinia enterocolitica, enterotoxigenic Escherichia coli (ETEC), Vibrio, and Plesiomonas shigelloides The study included prospective, retrospective, and prepared contrived specimens from 6 clinical sites. BD Max xEBP results were compared to the reference method, which included standard culture techniques coupled with alternate PCR and sequencing, except for ETEC, for which the reference method was two alternate PCRs and sequencing. Alternate PCR was …

Qi Assessment Of Attending Physician Burnout At Lehigh Valley Health Network (Lvhn) Using The Maslach Burnout Inventory (Mbi)., Pooja Shankar Md, Suzanne J. Templer Do

Department of Medicine

No abstract provided.

Frequently Identified Gaps In Antibiotic Stewardship Programs In Critical Access Hospitals, Philip Chung, Regina Nailon, Kate Tyner, Sue Beach, Scott Bergman, Margaret Drake, Teresa Fitzgerald, Elizabeth Lyden, Mark Rupp, Michelle Schwedhelm, Maureen Tierney-Brenran, Trevor Van Schooneveld, Muhammad Salman Ashraf

Posters and Presentations: Nebraska ASAP

Background: Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a CDC funded project. ICAP team works in collaboration with NE Department of Health and Human Services (NEDHHS) to assess and improve infection prevention and control programs (IPCP) in various health care settings including resource limited settings like critical access hospitals (CAH). Little is known about the existing gaps in antimicrobial stewardship programs (ASP) of CAH. Hence, we decided to study the current level of ASP activities and factors associated with these activities in CAH.

Methods: NE ICAP conducted on-site surveys in 36 CAH from October 2015 to February …

Community Perception Of The Hiv Vaccine In Western Kenya: Acceptability, Potential Behavior Changes, And Views On Compulsory Vaccination, Deborah Keen

Independent Study Project (ISP) Collection

Human Immunodeficiency Virus (HIV) suppresses the immune system by attacking T cells, leading to the development of acquired immunodeficiency syndrome (AIDS). HIV affects over 30 million people around the world and 1.6 million people in Kenya. On August 18, 1987, the FDA sanctioned the first human testing of a candidate vaccine for HIV. Currently, multiple HIV vaccines—projected to be on the market in five to ten years—are being tested for efficacy and safety. The goal of this study was to explore opinions related to the HIV vaccine so that there is a guide for future policy development in Western Kenya. …

A Rare Presentation Of Hsv Type 2 Hepatitis., Jahangir Khan Md, Anam Malik Md, Sandhya Venkataraman Do, Hina A. Sheikh, Amy Slenker Md

Department of Medicine

No abstract provided.

Evaluation Of Mothers And Infants With Presumed Exposure To Zika Virus: A Look Into The Lehigh Valley Experience, Tibisay Villalobos Md, Michelle Maron Rn, Jeanette Taveras Do

Department of Pediatrics

No abstract provided.

The Latex Journey: A Narrative Approach To Exploring Condom Use, Stigma, And Education From The Perspective Of Women In Masxha, Kylie Yocum

Independent Study Project (ISP) Collection

Although the South African National Department of Health (NDOH) is spending increasing amounts of money on improving their HIV programs (including the rollout of new, scented condoms for their condom distribution program), the rates of condom use at last sexual encounter are declining. This inquiry focused on young women in the neighborhood of Masxha, Cato Manor, and their opinions surrounding how condoms are being used or misused, as well as the gender norms that perpetrate this (mis)use. This inquiry demonstrated the narratives of these young women on factors such as condom acquisition, gendered stigma, and condom education, including the Life …

Characterization Of Different Molecular Markers For Identification Of Salmonella Enterica Serovar Typhi In Pakistani Population, Faizan Muttiullah, Fida Muhammad Khan, Fakhar-I- Abbas, Sabiha Shamim

Journal of Bioresource Management

Typhoid is caused by Salmonella enterica serovar Typhi that is usually diagnosed by using serologic and immuno-chromatographic techniques in developing counties including Pakistan, which is thought to be an unreliable diagnostic method. For accurate diagnosis we used molecular techniques to amplify 204 bp StyR-36 and 498 bp flagellin gene for the identification of Salmonella enterica serovar Typhi. This study was done on 58 individuals diagnosed positive of typhoid via serologic tests and 50 healthy individuals as a control group. Success rate of amplification for flagellin gene was 77.58% while that for StyR-36 gene was 68.97% showing that flagellin gene primer …

A Protocol For Quality Improvement Programme To Reduce Central Line-Associated Bloodstream Infections In Nicu Of Low And Middle Income Country, Ali Shabbir Hussain, Syed Rehan Ali, Shabina Ariff, Saba Arbab, Simon Demas, Jehan Zeb, Arjumand Rizvi

Department of Paediatrics and Child Health

Introduction: Central line-associated bloodstream infections (CLABSI) are the most important cause of morbidity and mortality in critically ill patients. Evidence-based interventions when used in form of a bundle have proven to decrease CLABSI. Our unit has a high CLABSI rate (9/1000 central line days). Therefore, we intend to introduce evidence-based CLABSI prevention package in our practice to improve CLABSI rates in our NICU within limited resources.
Methods and Analysis: The study will be conducted using preanalysis and postanalysis design from January 2016 to December 2017. It is going to be conducted in three phases with phase I being the preimplimentation …

Prevalence Of Kaposi’S Sarcoma-Associated Herpesvirus In Uygur And Han Populations From The Urumqi And Kashgar Regions Of Xinjiang, China, Jun Zheng, Yang Yang, Meng Cui, Zhan-Jun Shu, Li-Li Han, Zhen-Qiu Liu, Charles Wood, Tiejun Zhang, Yan Zeng

Nebraska Center for Virology: Faculty Publications

Kaposi’s sarcoma-associated herpesvirus (KSHV) is the infectious etiologic agent associated with Kaposi’s sarcoma (KS), primary effusion lymphoma, and multicentric Castleman disease. It has been shown that high KSHV prevalence and high incidence of both classic KS and AIDSassociated KS are found mostly among people of Uygur ethnicity in Xinjiang, while people of Han ethnicity in Xinjiang have a higher KSHV seroprevalence than those of other Han populations in mainland China. However, it is still unclear why there is such geographical and population variation in KSHV distribution in China. In this work, we focused on the populations in the Kashgar region …

Reactive Arthritis With Intra-Articular Inclusion Body Neutrophilia., Thomas Quinn Do, Samer Bolis Do, Rajesh Essrani Md, Aylin Colpan Md, Susan Kim Md

Department of Medicine

No abstract provided.

Neurosyphilis Increases Human Immunodeficiency Virus (Hiv)-Associated Central Nervous System Inflammation But Does Not Explain Cognitive Impairment In Hiv-Infected Individuals With Syphilis., Emily L Ho, Clare L Maxwell, Shelia B Dunaway, Sharon K Sahi, Lauren C Tantalo, Sheila A Lukehart, Christina M Marra

Articles, Abstracts, and Reports

Background: Individuals infected with human immunodeficiency virus (HIV) who have previously had syphilis may have cognitive impairment. We tested the hypothesis that neurosyphilis causes cognitive impairment in HIV by amplifying HIV-related central nervous system (CNS) inflammation.

Methods: HIV-infected participants enrolled in a study of cerebrospinal fluid (CSF) abnormalities in syphilis underwent the mental alternation test (MAT), venipuncture, and lumbar puncture. CSF concentrations of chemokine (C-X-C motif) ligand 10 (CXCL10), chemokine (C-C motif) ligand 2 (CCL2), and neurofilament light (NFL) were determined by commercial assays. The proportion of peripheral blood mononuclear cells (PBMCs) and of CSF white blood cells (WBCs) that …

A Global Staphylococcus Aureus Proteome Resource Applied To The In Vivo Characterization Of Host-Pathogen Interactions., Stephan Michalik, Maren Depke, Annette Murr, Manuela Gesell Salazar, Ulrike Kusebauch, Zhi Sun, Tanja C Meyer, Kristin Surmann, Henrike Pförtner, Petra Hildebrandt, Stefan Weiss, Laura Marcela Palma Medina, Melanie Gutjahr, Elke Hammer, Dörte Becher, Thomas Pribyl, Sven Hammerschmidt, Eric W Deutsch, Samuel L Bader, Michael Hecker, Robert L Moritz, Ulrike Mäder, Uwe Völker, Frank Schmidt

Articles, Abstracts, and Reports

Data-independent acquisition mass spectrometry promises higher performance in terms of quantification and reproducibility compared to data-dependent acquisition mass spectrometry methods. To enable high-accuracy quantification of Staphylococcus aureus proteins, we have developed a global ion library for data-independent acquisition approaches employing high-resolution time of flight or Orbitrap instruments for this human pathogen. We applied this ion library resource to investigate the time-resolved adaptation of S. aureus to the intracellular niche in human bronchial epithelial cells and in a murine pneumonia model. In epithelial cells, abundance changes for more than 400 S. aureus proteins were quantified, revealing, e.g., the precise temporal regulation …

Persistence Of Macrocytosis After Discontinuation Of Zidovudine In Hiv-Infected Patients, Inski Yu, Richard N. Greenberg, Timothy N. Crawford, Alice C. Thornton, Thein Myint

Internal Medicine Faculty Publications

The duration of macrocytosis after stopping zidovudine (ZDV) is unknown. Among 104 HIV-infected patients treated with ZDV for more than 1 year, 84 patients had macrocytosis at ZDV discontinuation. The median mean corpuscular volume (MCV) was 114.6 fL (range 100-128 fL). Patients were divided into 2 groups: those who did (resolved macrocytosis, n = 36) and did not (persistent macrocytosis, n = 48) normalize MCV at 3 to 6 months after ZDV discontinuation. Alcohol use (P = .02), smoking (P = .03), and lower (but within normal range) folic acid levels (P = .05) were related to …

Cross-Reactive Immunity To Porcine Reproductive And Respiratory Syndrome Virus And Its Contribution To Protection, Ignacio Correas

School of Veterinary and Biomedical Sciences: Dissertations, Theses, and Student Research

Due to the vast geographical distribution and significant economic losses generated, porcine reproductive and respiratory syndrome virus (PRRSV) can be considered the most important swine pathogen of contemporary times. Current control and eradication strategies against PRRSV have difficulty succeeding because of their complex nature and the absence of an effective vaccine. A major obstacle for PRRSV vaccine development is the broad heterogeneity of the virus, both at the genetic and antigenic level, its rapid evolution, and an incomplete knowledge of the immune responses responsible for clearing the virus from the host. Specifically, how known correlates of protection against PRRSV—neutralizing antibodies …

Trends In Hpv Vaccine Initiation And Completion Among Girls In Texas: Behavioral Risk Factor Surveillance System Data, 2008–2010, Tatjana Gazibara, Haomiao Jia, Erica I. Lubetkin

Publications and Research

Objective: The objective of this study was to evaluate the trend of HPV vaccine initiation and completion among girls in Texas from 2008 to 2010.

Methods: Data were obtained from the Behavioral Risk Factors Surveillance System (BRFSS) over 3 years (2008–2010). The information regarding HPV vaccination was gathered from the parents of 9- to 17-year-old daughters (choosing only 1 per household) in randomly selected households in the sample area.

Results: The highest prevalence of vaccine initiation and completion were detected in 2010 (20.9% and 9.7%, respectively). Over the study period, HPV vaccine initiation statistically significantly increased (2008, 14.9%; 2009, 20.7%; …

Relative Contribution Of Porcine Reproductive And Respiratory Syndrome Virus Open Reading Frames 2–4 To The Induction Of Protective Immunity, Katherine Kimpston-Burkgren, Ignacio Correas, Fernando A. Osorio, David Steffen, Asit K. Pattnaik, Ying Fang, Hiep L. X. Vu

Nebraska Center for Virology: Faculty Publications

The minor glycoproteins (GPs) of PRRSV, GP2, GP3, and GP4, form a heterotrimer that is required for viral infectivity, presumably due to its interaction with the key cellular receptor CD163. These 3 GPs are encoded by open reading frames (ORFs) 2a, 3, and 4 (herein referred to as ORFs 2–4), respectively. The goal of this study was to investigate the immunogenicity of the PRRSV-2 minor GPs. Through the use of reverse genetics, a chimeric virus (designated SDFL24) was constructed by replacing ORFs 2–4 of the PRRSV-1 strain SD01-08 with the corresponding genes of the PRRSV-2 strain FL12. While the parental …

Effects Of Acute Sepsis On Renal Structure And Sympathetic Innervation In Mice, Tuqa Alkhateeb

Electronic Theses and Dissertations

Sympathetic nerves are important for renal physiology and sepsis pathophysiology. A recent study showed sprouting of sympathetic nerves in spleen of septic mice. This study was done to test if renal sprouting of sympathetic nerves also happens and to investigate renal morphology in septic mice. Cecal ligation and puncture (CLP) was used to induce sepsis and kidneys were removed for evaluation. Bowman’s space was diminished with cortical bubble cells present suggestive of acute renal pathology, however, renal function was unchanged. Acute sepsis did not affect either renal sympathetic innervation or non-neuronal cholinergic cells. Mouse kidneys had more epinephrine (EPI) than …

Two-Year Antibody Persistence In Children Vaccinated At 12-15 Months With A Measles-Mumps-Rubella Virus Vaccine Without Human Serum Albumin., Andrea A. Berry, Remon Abu-Elyazeed, Clemente Diaz-Perez, Maurice A. Mufson, Christopher J. Harrison, Michael Leonardi, Jerry D. Twiggs, Christopher Peltier, Stanley Grogg, Antonio Carbayo, Steven Shapiro, Michael Povey, Carmen Baccarini, Bruce L. Innis, Ouzama Henry

Manuscripts, Articles, Book Chapters and Other Papers

One combined measles-mumps-rubella (MMR) vaccine without Human Serum Albumin (HSA) is currently licensed in the USA (M-M-R II; Merck, USA) and another has been developed (Priorix™ [MMR-RIT, GSK, Belgium]). In this follow-up study, children from USA or Puerto Rico, who had received one dose of M-M-R II or MMR-RIT at 12-15 months of age in the primary study (NCT00861744), were followed-up for 2 y post-vaccination. Anti-measles and anti-rubella antibodies were measured using Enzyme-Linked Immunosorbent Assay (ELISA), and anti-mumps antibodies using ELISA and plaque reduction neutralization (PRN) assays. Serious adverse events (SAEs) were recorded during the entire follow-up. The according-to-protocol (ATP) …

Mortality In Patients With Respiratory And Nonrespiratory Carbapenem Resistant-Multidrug Resistant Acinetobacter Infections, Nosheen Nasir, S Mahmood

Department of Medicine

Background: Mortality from carbapenem-multi-drug resistant Acinetobacter infections may vary according to site of infection. The objective of this study was to compare mortality in respiratory vs. non-respiratory infection with Carbapenem-Multi-drug Resistant Acinetobacter (C-MRAB).

Methods: We conducted a prospective cohort study to compare mortality rate in patients with respiratory vs. nonrespiratory infection (n=30 each).

Results: Results showed that mortality was 40% in the respiratory group compared to 23% in non-respiratory group; the difference was not statistically significant (p=0.165, RR=1.71, CI=0.73-3.75). There was a significantly higher prior admission rate in patients with respiratory infection (p=0.028). Logistic regression did not reveal any modifier …

Experience With The Quantitative Lyta Gene Real-Time Polymerase Chain Reaction For The Detection Of Streptococcus Pneumoniae From Pediatric Whole Blood In Pakistan, Furqan Kabir, Sahrish Muneer, Adil Kalam, Ana Sami, Shahida Qureshi, Aneeta Hotwani, Atif Riaz, Syed Mohiuddin, Mohammad Tahir Yousafzai, Sara Hussain, Syed Asad Ali, Sadia Shakoor

Department of Paediatrics and Child Health

Background: We present our experience with optimization and diagnostic use of quantitative real-time polymerase chain reaction (PCR) targeting the lytA gene of Streptococcus pneumoniae for the detection of S. pneumoniae in whole blood of children ≥5 CFU/10 μl or 1 copy of DNA/2 μl of blood.
Methods: This assay was applied on 1912 whole blood specimens collected from children pneumonia, of which 35 specimens were lytA positive. The bacterial loads were determined through categorization of load into five different categories, i.e., very high load, high load, moderate load, low load, and very low load.
Results: Of the 35 lytA-positive …

Outcomes Of Post-Neurosurgical Ventriculostomy-Associated Infections, Muhammad Ehsan Bari, Ghani Haider, Komail Malik, Muhammad Waqas, Syed Faisal Mahmood, Mubbashira Siddiqui

Section of Neurosurgery

Background: Ventriculostomy-associated infection (VAI) is a major concern to physicians. Limited studies have looked at the outcomes of external ventricular drain (EVD) infection and predictors of unfavorable outcomes. In this study, we assessed the outcomes of EVD infection and predictors of unfavorable outcomes.
Methods: This was a retrospective medical chart review, conducted at the Aga Khan University Hospital. All the patients irrespective of age and gender, fulfilling the diagnostic criteria of VAI were included. Patients with preexisting bacterial meningitis or ventriculitis were excluded from the study. Outcome assessment was based on Glasgow outcome scale (GOS) at 1 and 3 months …

Safety Of Induced Sputum Collection In Children Hospitalized With Severe Or Very Severe Pneumonia., Andrea N Deluca, Laura L Hammitt, Julia Kim, Melissa M Higdon, Henry C Baggett, Daniel E Park, +Several Additional Authors

Epidemiology Faculty Publications

Background.: Induced sputum (IS) may provide diagnostic information about the etiology of pneumonia. The safety of this procedure across a heterogeneous population with severe pneumonia in low- and middle-income countries has not been described.

Methods.: IS specimens were obtained as part a 7-country study of the etiology of severe and very severe pneumonia in hospitalized childrenbefore, during, and after the procedure to record oxygen requirement, oxygen saturation, respiratory rate, consciousness level, and other evidence of clinical deterioration. Criteria for IS contraindications were predefined and serious adverse events (SAEs) were reported to ethics committees and a central safety monitor.

Results.: A …

Data Management And Data Quality In Perch, A Large International Case-Control Study Of Severe Childhood Pneumonia., Nora L Watson, Christine Prosperi, Amanda J Driscoll, Melissa M Higdon, Daniel E Park, Megan Sanza, Andrea N Deluca, Juliet O Awori, Doli Goswami, Emily Hammond, Lokman Hossain, Catherine Johnson, Alice Kamau, Locadiah Kuwanda, David P Moore, Omid Neyzari, Uma Onwuchekwa, David Parker, Patranuch Sapchookul

Epidemiology Faculty Publications

The Pneumonia Etiology Research for Child Health (PERCH) study is the largest multicountry etiology study of pediatric pneumonia undertaken in the past 3 decades. The study enrolled 4232 hospitalized cases and 5325 controls over 2 years across 9 research sites in 7 countries in Africa and Asia. The volume and complexity of data collection in PERCH presented considerable logistical and technical challenges. The project chose an internet-based data entry system to allow real-time access to the data, enabling the project to monitor and clean incoming data and perform preliminary analyses throughout the study. To ensure high-quality data, the project developed …