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URLEND Leadership / Research Project Description
Complete this form and send it to your group’s Faculty Mentor and individual Core Faculty
Member(s) by October 3, 2014 for initial feedback. Submit your approved Project Description
to Vicki Simonsmeier by October 10, 2014.
Trainee name(s) and discipline(s):
Initial URLEND Leadership / Research Project Description
Trainee name(s) and discipline(s): CMV Public Service Awareness
Ana Caballero – Audiology
Taylor Stevenson – Audiology
Kristy Rogers – Dentist
Janine Wood – Physical Therapist
Team leader (optional): We are working pretty good as a team, but based on our mentor
suggestions, it was suggested to chose a leader, because the topic is related to hearing loss,
we decided to select the Audiology students as the leaders.
Ana Caballero - Audiology
Taylor Stevenson - Audiology
Team Charter completed: _____ Yes X No (attach if yes)
Working title of the project: Cytomegalovirus Public Service Awareness (CMV PSA)
Faculty Mentor for project: Stephanie McVicar – Audiologist – Project Mentor/Advisor
Core Faculty Member(s):
Jim Bekker, Heidi Dalgren, Stephanie McVicar, Gwen Mitchell
Family / Consumer Consultant (required): Monica Chapman
Brief description of project purpose and objectives:
PURPOSE:
o Create a public service announcement to educate the public about CMV
o Create a product that can be used across states
o Utilize TV, radio, and/or social media
· Objectives:
o Get information to moms and potential moms explaining CMV
o Inform public about newborn hearing screenings and follow up screenings
o Educate professionals
o Motivate public and professionals to want to learn more about CMV
o Raise awareness about CMV
Is this project a component of a larger research / evaluation effort? Yes _X_ No ____
This is to support the newly mandated Utah CMV Public Health Initiative where the Utah
Department of Health must educate moms and future moms about the occurrence of CMV.
If yes, please describe the unique contribution of this effort to the overall project goals:
This project will help educate mothers, future mothers and the public at large about CMV. This
PSA will be utilized across states in an effort to decrease the occurrence of CMV and to educate
the public about how to prevent its transmission.
Will IRB approval be required for conducting/completing the project? (Please refer to the
attachment “Is Your Project Human Subjects Research”) Yes ___No X_
If yes, when/where (U of U, USU, IHC, UW etc.) will the IRB application be submitted?
Anticipated costs for this research project (be specific)
$7000.00
Literature Review / Evidence for your project
Knowledge and Awareness of Congenital Cytomegalovirus Among Women.
Jeon, J.,
Victor,M., Adler, P., Arwady,P., Demmler, A., Fowler, K., Goldfarb, J., Keyserling, H.,
Massoudi, M., Richards, K., Staras, S., and Cannon, P. Hindawi Publishing Corporation.
Infectious Diseases in Obstetrics and Gynecology. Volume 2006, Article ID 80383, Pages 1–7.
DOI 10.1155/IDOG/2006/80383.
● Congenital cytomegalovirus (CMV) infection is a leading cause of disabilities in
children, yet the general public appears to have little awareness of CMV.
● Women were surveyed about newborn infections at 7 different geographic locations.
● Results of the 643 women surveyed, 142 (22%) had heard of congenital CMV.
● Awareness increased with increasing levels of education (P < .0001).
● Women who had worked as a healthcare professional had a higher prevalence of
awareness of CMV than had other women (56% versus 16%, P < .0001).
● Women who were aware of CMV were most likely to have heard about it from a
healthcare provider (54%), but most could not correctly identify modes of CMV
transmission or prevention.
● Among common causes of birth defects and childhood illnesses, women's awareness of
CMV ranked last.
● Conclusion: Despite its large public health burden, few women had heard of congenital
CMV, and even fewer were aware of prevention strategies.
Congenital cytomegalovirus: Public health action towards awareness, prevention, and
treatment. Demmler-Harrison, G. J. (2009). Journal Of Clinical Virology, 46S1-S5.
doi:10.1016/j.jcv.2009.10.007
● Key awareness issues surrounding congenital CMV infection are outlined and discussed
to provide inspirational motivation for many diverse groups who may have the same goal
of reducing congenital CMV disease.
● To this end, steps for public health action towards awareness, prevention and treatment
are outlined.
● These steps include recommendations for universal screening for all newborns for
congenital CMV infection at birth to further define the public health impact and facilitate
early diagnosis and treatment of newborns, routine prenatal screening of all pregnant
women for the presence of CMV antibody to identify women at risk who may benefit
most from preventive behavioral interventions as well as to facilitate prenatal diagnosis
and therapies, and grassroots efforts to promote CMV awareness in the community.
Women's Knowledge of Congenital Cytomegalovirus: Results From the 2005 HealthStyles
Survey. Ross, D. S., Victor, M., Sumartojo, E., & Cannon, M. J. (2008). Journal Of Women's
Health (15409996), 17(5), 849-858. doi:10.1089/jwh.2007.0523
● Congenital cytomegalovirus (CMV) is as common a cause of serious disability as Down
syndrome and neural tube defects.
● When acquired prior to or during pregnancy, CMV can be transmitted transplacentally to
the fetus, sometimes causing serious temporary symptoms, permanent disabilities, or both
to the child.
● One way to prevent infection before and during pregnancy is through simple hygienic
practices, such as hand washing.
● This study used the 2005 annual HealthStyle survey, a mail survey of the U.S. population
aged <18 years, to assess knowledge of congenital CMV.
● Self-reports by female respondents measured willingness to adopt particular hygienic
behaviors to prevent CMV transmission.
● Results: Only 14% of female respondents had heard of CMV. Among women who
reported they had heard of CMV, the largest proportion said they had heard about it from
a doctor, hospital, clinic, or other health professional (29%).
● The accuracy of women's knowledge of what conditions congenital CMV can cause in
the fetus was limited.
● The prevention behaviors surveyed in the present study (i.e., hand washing, not sharing
drinking glasses or eating utensils with young children, and not kissing young children on
the mouth) appeared to be generally acceptable.
● Conclusions: There are prevention behaviors that have the potential of substantially
reducing the occurrence of CMV-related permanent disability in children. However, our
results suggest that few women are aware of CMV or these prevention behaviors.
Building Capacity to Communicate to Women about CMV. Levis, D., & Kilgo, C. Centers
for Disease Control and Prevention (2014).
● Materials need to be clear and concise.
● Greatest need for web materials.
● Various audiences have low awareness.
● Women - Some degree of skepticism and prevalence and severity since they haven't
heard about it.
● Health care providers - Want evidence-based recommendations; and don't think women
need to worry about CMV - too rare.
● Policy-makers - More interested in CMV than are health care providers.
● Media - More interested in science than in prevention.
● Method - Tell balanced stories about CMV because they can effectively: introduce CMV
to women, motivate women to learn, motivate prevention behaviors, increase perceived
severity and susceptibility.
● FOCUS ON WE CONTENT - Women want internet resources; partners need internet
resources - Include fact sheet/one-page and videos, both of which increased knowledge
and motivation in women.
● Use the following language based on clear communication principles - " 1 in 150"; or "1
in 1500" children is affected by....; "Congenital CMV is about as common as....{other
well-known disorders}".
● Focus on REDUCING rather than ELIMINATING the risk - Asking that women follow
the guidelines 100% of the time was perceived as unrealistic. Instead, encourage women
to incorporate the guidelines into their lives when and where they can.
● Keep prevention guidelines - clear and simple; providing examples and not overly
instructive.
Mother-to-Child Transmission of Cytomegalovirus and Prevention of Congenital Infection.
Journal of the Pediatric Infectious Diseases Society, Vol. 3, Suppl 1, pp. S2–S6, 2014.
● Can occur in mothers affected prior to and/or during current pregnancy
● Can shed the virus in urine, saliva, vaginal fluid and semen for months to years
● Must prevent moms becoming infected
● Congenital infections can cause hearing loss, visual impairment, cognitive impairment,
and neuromuscular disabilities (CP)
● Need to focus education on highest risk groups: low SES, mothers from under developed
countries, non-whites, Southern US, Daycare centers
● Disabilities tend to be worse if transmission occurs earlier in pregnancy
●
●
●
●
Maternal immunity from prior infections does NOT prevent transmission
6000 born in US will have significant disabilities resulting from congenital CMV
Congenital CMV is the most common congenital defect in developed countries
Half of those born with congenital CMV who have signs of intrauterine infection will
have disabilities
● 5-15% of those asymptomatic at birth will later develop disabilities
● Disease burden from congenital CMV is greater than that from Down Syndrome and
Spina Bifida combined
Prevention of Maternal Fetal Transmission of CMV. Adler S, Nigro G. CID 2013
December3:57. S189-92.
● Two possible ways to prevent: Hygienic protection, CMV immunoglobulin
● 40,000 pregnant women in US acquire a primary CMV infection
● Approximately 8000 infected infants born each year with severe neurological damage
● More prevalent in African American women and Hispanic women
● Primary infection in early pregnancy causes majority of congenital disease
● If immune before conception, intrauterine fetal infection rate is ~1% and at least 90% are
healthy
● If acquire CMV during pregnancy, infection rate is 33% - 75% and up to 50% if infected
during first ½ of pregnancy
● Most common means of infection is from a child <3 yo in the home or if the mom works
in a daycare
● Hygiene education appears to work. In a study of 37 seronegative pregnant women who
received hygiene education, and were exposed to a child shedding CMV only 1
contracted it
● Pregnant healthcare workers should avoid caring for children under 2 while pregnant
(however other studies reportedly show healthcare workers are not at greater risk due to
the required universal precautions they follow at work)
● Immunoglobulins are available but expensive and are not 100% effective. They decrease
the risk, but don’t eliminate it.
Congenital Cytomegalovirus Infection as a Cause of Sensorineural Hearing Loss in a
Highly Immune Population
APARECIDA YULIE YAMAMOTO, MD,1 et. al. Pediatr Infect Dis J. 2011 December ;
30(12): 1043–1046. doi:10.1097/INF.0b013e31822d9640.
● Congenital cytomegalovirus infection has been reported to be an important cause of
hearing loss in infants in North America and Europe.
● Children with Congenital CMV, it has been reported that between 9.3% and 17% have
sensorineural hearing loss ( SNHL).
● Children with symptomatic are significantly more likely to develop SNHL than those
with asymptomatic infection.
● Presence of CMV-related symptoms at birth is a strong predictor of hearing loss, even in
populations with high material CMV seroprevalence rate.
The “Silent” Global Burden of Congenital Cytomegalovirus: Sheetal Manicklal, Vincent C.
Emeryb, Tiziana Lazzarottoc, Suresh B. Boppanad and Ravindra K. Gupta
CMR Jornals ASM.orgClinical Microbiology Reviews p. 86-`02. January 2013, Volume 26 Number 1.
● CMV is a leading cause of congenital infections worldwide.
● Although a significant proportion of congenital CMV infections are attributable to
maternal primary infection in well-resourced setting, the absence of specific interventions
for seronegative mothers and uncertainty about fetal prognosis have discouraged routine
maternal antibody screening.
● CMV causes more cases of congenital disease than the combination of 29 currently
screened conditions.
● CMV has been neglected and this can be attributed to:
○ Most maternal and newborn infections are asymptomatic and therefore are not
recognized at birth.
○ Sequelae from congenital CMV infection are frequently delayed in onset,
○ Dogma that congenitally infected children what are born to women with
preexisting antibodies have normal outcomes has led to inattention to congenital
CMV in developing countries.
● The quest for active or passive immunization strategies is a challenge
○ High virus diversity and the propensity for infection with multiple different virus
strains pose an important biological barrier to the development of effective
vaccines.
● CMV is a host-restricted member of the herpesviridae family of viruses.
● Primary infection:
○ period of active virus replication with virus shedding in saliva, urine, milk, and
genital secretions, a viremic phase, and in some, an infectious mononucleosis
syndrome.
○ After several weeks, the viral latency is established.
● one in 10 newborns infected in utero have obvious clinical signs of congenital infection,
10% to 15% of those without clinical findings(symptomatic and asymptomatic congenital
CMV infection), develop long-term neurological sequelae. Specifically, sensorineural
hearing loss (SNHL) occurs in about 35% cognitive deficits in up to 2/3rds.
● Congenital CMV accounts for 21% and 24% of cases of hearing loss at birth and 4 years
of age.
● the risk of long-term outcomes appears to be highest in infants born to mothers with
primary infection in the first half of pregnancy.
● the majority of congenital CMV infections from both resource poor and upper income
setting are asymptomatic at birth, and the diagnosis of intrauterine infection relies on
virus detection by culture-based methods or PCR. Saliva or urine specimens should be
obtained within the first 2 weeks of life.
● For symptomatic children: antiviral agent for the treatment may be recommended.
● Maternal (prenatal) screening may permit early identification of at-risk pregnancies or
infected infants.
● Clinical suspicion of maternal primary infection, i.e., glandular fever or flu-like illness,
and the detection during routine ultra- sound screening of abnormalities suggestive of
intrauterine CMV that lack an apparent cause are the common indications for specific
diagnostic testing.
Prevention of Maternal and Congenital Cytomegalovirus Infection
Julie Johnson, MD, Brenna Anderson, MD, MSc, and Robert F. Pass, MD.
Clin Obstet Gynecol. 2013 JUne; 55(2): 521-530. doi: 10.109/GRF.0b013e3182510b7b
● Congenital Cytomegalovirus infection is an important cause of hearing impairment,
mental retardation and cerebral palsy.
● Principle sources of infection during pregnancy are young children and intimate contacts.
● There is currently insufficient evidence to support use of antiviral treatment or passive
immunization for post-exposure prophylaxis of pregnant women or as a maternal
treatment aimed at preventing fetal infection.
● the average birth prevalence of CMV in the United States is .5-1% which translates into
approximately 40,000 cases annually.
● CMV affects more children than other conditions, such as, Down Syndrome, fetal alcohol
syndrome, and spina bifida.
● Of the 400,000; 8000 develop permanent disabilities such a developmental delay and
hearing or vision loss.
● Transmission of CMV appears to require direct contact with body fluids from a person
who is shedding CMV.
● Source most likely someone close to the mother, such as a preschool age child, a spouse
or sexual contact.
● The only means of preventing maternal CMV infection that is available at this time is by
limiting exposure to the virus.
○ Efforts to limited the virus exposure include: hand hygiene in setting where
women who are or could become pregnant have contact with young children.
○ women in childcare and mothers with young children.
○ risks are reduces by safe-handling techniques, such as latex gloves and rigorous
hand washing after handling diapers or after exposure to respiratory secretions.
● Recommendations to preventing the risk
○ was your hands often with soap and water for 15-20 seconds, especially after
○
○
○
○
○
■ changing diapers
■ feeding a young child
■ Wiping a young child’s nose or drool
■ handling children’s toys.
Do not share food, drinks, or eating utensils used by young children.
Do not put a child’s pacifier in your mouth
Do not share a toothbrush with a young child.
Avoid contact with saliva when kissing a child.
Clean toys, countertops, and other surfaces that come into contact with children’s
urine or saliva.
Progress on pursuit of human cytomegalovirus vaccines for prevention of congenital
infection and disease Fu, T. M., An, Z., & Wang, D. (2014). Progress on pursuit of human
cytomegalovirus vaccines for prevention of congenital infection and disease. Vaccine, 32(22),
2525-2533.
● Congenital infection of human cytomegalovirus (HCMV) is the leading cause of
childhood hearing loss and mental retardation.
● Two strategies have been employed to develop HCMV vaccines, including (1)
attenuating HCMV to generate modified virus vaccines and (2) isolating subunit viral
antigen(s) to create individual antigen vaccines.
● This review summarizes the recent understanding of host natural immunity to HCMV,
including the importance of antibodies targeting HCMV epithelial tropism, and discusses
its implications for vaccine design.
● CMV causes con- genital infection in 0.5–2% of all pregnancies each year, particularly in
developed countries
● About 10% of newborns with in utero infection manifest clinical symptoms at birth, and
up to 15% of those with asymptomatic infection at birth endure neurodevelopmental
disabilities, commonly sensorineural hearing loss.
● HCMV infection has direct pathogenic effects incurring high morbidity and mortality
● One of the challenges for HCMV vaccine development has been how to define an
efficacy endpoint relevant and practical, and for vaccine manufacturers, that could be
accepted for regulatory filings supporting an indication of preventing congenital HCMV.
● Challenge to be considered for vaccination development because although the association
between maternal primary HCMV infection and congenital infection is strong, the
maternal- fetal transmission only occurs in about 30–40% of pregnant women of primary
HCMV infection
● The natural immunity to HCMV has been study and lines of evidence have led to the
optimism that a vaccine can be developed for preventing acquisition of HCMV infection
and more importantly, blocking congenital HCMV transmission to fetus.
● HCMV is a complex virus and can express more than 165 potential viral antigens during
its replication cycle.
● 2 approaches for vaccine design: modify the virus in a way that the virus would be
attenuated or replication-defective, present defined viral antigen(s) either in the form of
recombinant protein or delivered as a DNA vaccine or through a viral vector.
● the immunological goal is to mimic the natural HCMV immunity or a crucial component
of such immunity but we are limited to how we can replicate this natural immunity in
vitro
● Transmission from person to person, or mother to fetus, has not been defined until now
● CMV is limited to it’s natural host, and human pathogens, and cannot be tested or studied
on animals
● Horizontal CMV is caught through close contact, and prevention of the infection would
● need to prevent viral infection spread through mucous cells
● Mother to fetus transmission is much more complex
● Because HCMV infection in healthy subjects rarely presents any clinical symptom, it is
logistically challenging to catch viral episodes in pregnant women unless there is a
universal screening program
● The identification provides an opportunity not only for early counsels, close monitoring
of fetal infection and signs of fetal HCMV disease, but also for experimental
interventions such as adoptive transfer of HCMV hyperimmune globulin
● A universal screening program could allow for studies of primary HCMV infection in
pregnant women may provide important insights to understanding the host and viral
factors associated with maternal-fetal transmission.
● Despite the fact that prevention of congenital HCMV has been recognized of high
significance for public health since 1960s, an effective vaccine remains elusive
Long-term Outcomes of Congenital Cytomegalovirus Infection in Sweden and the United
Kingdom Townsend, C. L., Forsgren, M., Ahlfors, K., Ivarsson, S. A., Tookey, P. A., &
Peckham, C. S. (2013). Long-term outcomes of congenital cytomegalovirus infection in Sweden
and the United Kingdom. Clinical Infectious Diseases, 56(9), 1232-1239.
● Cytomegalovirus (CMV) is a common congenital infection, affecting approximately
0.2%–0.5% of newborns in Europe
● A substantial proportion of children born with congenital CMV (approximately 40%–
60%) develop long-term sequelae, such as sensorineural hearing loss (SNHL), cerebral
palsy, mental retardation, and visual impairments
● CMV-related problems, particularly SNHL, also develop in about 10%– 15% of children
who are asymptomatic at birth.
● Transmission of CMV from mother to fetus can result from primary maternal infection in
pregnancy or following reactivation of a previous infection or reinfection with a new
strain (non-primary infection).
● A better understanding of the natural history of congenital CMV infection is needed to
inform decisions about prevention and treatment, as well as cost-effectiveness analyses.
● Studies in Malmo and London were compared. Studies consisted of follow up with
children longer than the first 2-3 years of life. (Studies done over 20 years ago)
○ Study done in Malmo:
■ 16,474 of 19,589 live newborns (84%) were tested for CMV in the Malmö
study; 76 were positive, an incidence of 4.6 per 1000 births
○ Study Done in London:
■ 9354 of 21213 live-born infants (91%) were tested, following screening
of 21917 women. Congenital CMV was diagnosed in 61 infants, an
incidence of 3.2 per 1000 births
● Combining the populations, about 50000 infants were screened and 176 children with
congenital CMV identified.
● Eighty-two percent of children with known outcome at 5 years had no developmental
problems reported; 7% were classified as having mild, 5% moderate, and 6% severe
impairment, with no difference by study
● All moderate and severe sequelae were reported in the first year of life
● Eighty percent of London women were classified as having primary infection (confirmed
or presumed), compared with 48% in Malmö
● This analysis highlights the contribution of non-primary maternal infection to the burden
of congenital CMV disease in childhood, even in countries where maternal
seroprevalence is relatively low
● A better understanding of the relationship between presentation at birth and subsequent
outcome is required to inform consideration of the potential risks and benefits of
treatment.
Risk of cytomegalovirus-associated sequelae in relation to time of infection and findings on
prenatal imaging Lipitz, S., Yinon, Y., Malinger, G., Yagel, S., Levit, L., Hoffman, C., . . .
Weisz, B. (2013). Risk of cytomegalovirus-associated sequelae in relation to time of infection
and findings on prenatal imaging. Ultrasound in Obstetrics and Gynecology, 41(5), 508-514.
● The risk of seroconversion during pregnancy is 1 – 4% and the rate of congenital
infection following primary infection ranges from 4.6% in the periconception period to
72% during the third trimester
● Ten percent of infected infants are symptomatic at birth; approximately one third of them
will die and up to 90% of the survivors will develop long-term sequelae, e.g. hearing
impairment or neurological abnormalities
● 5–15% of asymptomatic newborns are at risk of developing hearing loss and other
neurological deficits.
● This study focuses on women whose fetus was infected during the first or second
trimesters to determine the outcome of the pregnancies
● A significantly greater proportion of fetuses of women with first-trimester infection had
abnormal intracranial ultrasound findings compared to those of women with secondtrimester infection
● The infants of patients with first-trimester infection had significantly more clinical
sequelae (any auditory damage or neurodevelopmental delay) compared to those of
patients infected during the second trimester
● CMV infection is particularly worrying when maternal infection occurs during the first or
second trimester of pregnancy
● Deafness occurred only after first-trimester infection while partial hearing loss also
occurred after second-trimester infection.
● The rate of abnormal intracranial sonographic findings was higher in infants of patients
with first-trimester infection
● The frequency of abnormal MRI findings was also significantly higher following firsttrimester infection
● The study concluded 3 major findings:
○ The high risk of deafness and any adverse outcome following first-trimester
infection when ultrasound findings are abnormal
○ The low risk of severe adverse outcomes such as deafness and developmental
disabilities even after first-trimester infection when ultrasound findings are
normal
○ the low risk of clinical sequelae following second- trimester infection when
prenatal imaging findings are normal
● Most CMV-infected fetuses prenatal ultrasound and MRI findings are normal.
● Patients should be encouraged to continue their pregnancy with strict follow-up.
Proposed method of dissemination of this project at the end of the URLEND year
● Work with Tom Hudachko in the Media Division at the Department of Health to help us
create an actual TV and/or radio spot.
● Websites review for future application - production of our PSA video:
● https://www.youtube.com/watch?v=BNHUXCNnWM0&index=29&list=PLBBE
98EADF73E7C95
● https://www.youtube.com/watch?v=iRPJFuzdzkY&list=PLBBE98EADF73E7C9
5&index=12
● https://www.youtube.com/watch?v=EyscMwFj6BI&list=PLBBE98EADF73E7C
95&index=2
● https://www.youtube.com/watch?v=YElr5K2Vuo&index=9&list=PLBBE98EADF73E7C95
● https://www.youtube.com/watch?v=nl5gBJGnaXs&list=PLBBE98EADF73E7C9
5&index=22
● http://www.heraldextra.com/news/local/sharing-a-spoon-virus-could-infectunborn-child/article_f0fdbadc-29a5-5d9d-9289-baf9dc3ae719.html
● http://cmv.usu.edu/Resources.cfm
● http://youtu.be/b1VUpNv80IQ
● http://youtu.be/n3CffwiKMuk
● http://youtu.be/iRN3oh5z4CU
● http://youtu.be/f2nFtTBDlZI
● http://youtu.be/cdbberw3Ym4
● http://www.viralviralvideos.com/2014/04/21/love-letter-to-food/
● https://www.youtube.com/watch?v=xUmp67YDlHY
● http://www.viralviralvideos.com/2014/02/20/jackie-chan-stars-in-anti-rhino-hornharvesting-commercial/
● http://www.viralviralvideos.com/tag/psa/page/3/
● https://www.youtube.com/watch?v=FjhF-pdlJ8M
● https://www.youtube.com/watch?v=_dzaM0fCqsg
● https://www.youtube.com/watch?v=MD8BkIgp9Fo
● https://www.youtube.com/watch?v=cQW4zOhFnDI
● http://www.youtube.com/watch?v=OAlyHUWjNjE
● http://www.youtube.com/watch?v=0DH1JGlYOL0
● http://www.youtube.com/watch?v=Ja9BFx5Mhqo
● http://www.youtube.com/watch?v=L_3S_93_jGE
● http://www.youtube.com/watch?v=KNAA7H--snU:
● http://www.youtube.com/watch?v=sUiJeKH6ulY:
● Educational resources:
○ http://cmvaction.org.uk/pregnant-women
○ http://www.cdc.gov/cmv/index.html
○ http://cmvregistry.org/
○ http://cmv.usu.edu/Schedule/Sch_AtAGlance.cfm