Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for diagnosing hilar and mediastinal lymph node enlargement; however, specimens obtained are often small and inadequate for pathologic diagnosis. In June 2017, EchoTip ProCore, a puncture needle with a side trap, was launched in Japan. In this single-center prospective interventional study, 57 patients with lymph nodes, intrapulmonary tumor or pleural mass were diagnosed using EBUS-TBNA with EchoTip ProCore between June 2017 and February 2020. EBUS-TBNA was performed for 57 patients and 53 patients had sufficient specimen for histologic diagnosis. The following pathologic subtypes were diagnosed: non-small cell lung cancer, 22; small cell lung cancer, 8; cancer of unknown primary, 2; neuroendocrine tumor (G2) recurrence, 1; lymphoma, 2; metastatic renal cell carcinoma, 3; thymoma recurrence, 1; sarcoidosis, 4; tuberculosis, 1; and non-malignancy, 9. In addition, the cytology showed Class V in 31 out of 57 cases (54.4%). In total, a definitive pathological diagnosis was obtained in 50 out of 57 cases (87.7%). The only complication was pneumonia caused by BAL simultaneously combined with EBUS-TBNA in one patient. Among 13 patients with inadequate specimens or without malignancy, only one patient was subsequently diagnosed with malignancy, and the median follow-up period was 300 days. EBUS-TBNA using EchoTip ProCore can obtain a sufficient specimen size for pathologic diagnosis. Tissue and cytological specimens can be obtained using EBUS-TBNA. Notably, tissue samples obtained using this technique can undergo tests for epidermal growth factor receptor (EGFR) mutations and immunohistochemical screening for anaplastic lymphoma kinase (ALK) rearrangement in patients with non-small cell lung cancer (NSCLC). However, the specimens obtained are often small and inadequate for pathologic diagnosis. Specifically, only 66% (19/29) of specimens obtained using EBUS-TBNA at our hospital between 2015 and 2016 were adequate for histological diagnosis.Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a useful diagnostic modality for thoracic lymphadenopathy, including primary lung cancer, malignant lymphoma, tuberculosis, and sarcoidosis4. This study aimed to investigate the diagnostic utility of EBUS-TBNA with EchoTip ProCore for mediastinal lymphadenopathy.In June 2017, EchoTip ProCore Endobronchial HD Ultrasound Needle , a puncture needle with a side trap that had been previously released for gastrointestinal endoscopes, was launched in Japan. EchoTip ProCore needles are available in different sizes, including 22- and 25-gauge needles. They are designed with a core trap proximal to the needle tip that receives the sample during fine-needle aspiration (FNA) through the needle tip . We included patients with radiological features of mediastinal or hilar lymphadenopathy who underwent EBUS-TBNA between June 2017 and February 2020. Chest computed tomography (CT) was performed before EBUS-TBNA, which revealed at least one enlarged mediastinal or hilar lymphadenopathy of > 10 mm in all patients except for two patients with a tumor around the trachea. Finally, we included 57 patients in this study.All enrolled patients underwent EBUS-TBNA using a convex endobronchial ultrasound bronchoscope probe  under fentanyl-induced sedation (0.025-0.05 mg/body) and midazolam (1–3 mg/body). A 22- and 25-gauge EchoTip ProCore Endobronchial HD Ultrasound Needle was used. The 25-gauge needle was employed if contrast-enhanced CT revealed blood vessel enrichment in a lymph node or if there was a high suspicion of hypervascular tumor metastasis, including renal cell carcinoma. We performed 2–4 punctures using the traditional vacuum syringe method and slow-pull technique. The specimens obtained with each needle pass were extracted to the dish by pushing the stylet and flushing the syringe with saline solution and air. Since rapid on-site cytological examination (ROSE) was not available at our hospital, the puncture was repeated up to 4 times when the volume of the collected sample was considered insufficient macroscopically. With regard to sample processing, each tissue from one puncture was placed in an embedding cassette and fixed in 10% neutral buffered formalin solution. A paraffin block of the sample was then prepared and histologically assessed. The remaining liquid components and small tissue fragments were collected with a dropper and placed in a spitz tube, a spitz tube was centrifuged at 2,000 rpm for 5 min and the sediment was subjected to liquid-based cytology (LBC) using CytoRich Red Preservative  and assessed by cytologic diagnosis. At our hospital, clinical laboratory technicians (some of whom are cytotechnologists) process samples in the bronchoscope room, and the tissue was fixed with formalin immediately after all punctures were completed. Cytological samples were taken back to the laboratory with spitz tubes and sample processing was started immediately.7. However, to obtain larger specimens, we used a modified version of the slow-pull technique. In short, although the stylet was slowly pulled out in 1 m, 10–30 to-and-fro movements with keeping negative pressure were repeated in every 5–10 cm up to the end.Originally, the slow-pull technique involved slow stylet retraction with needle fanning in the mass. Ten to twenty to-and-fro movements were made with minimal negative pressure provided by slow pulling of the stylet. The length of stylet retraction was about 1 m and the time of stylet retraction was from 40 to 60 sThe study protocol was approved by the independent ethics committee of the institutional review board of Yokohama Municipal Citizen’s Hospital (No. 20-11-11). Informed consent was obtained in the form of opt-out on the web-site. Those who rejected were excluded. Topical subheadings are allowed. Authors must ensure that their Methods section includes adequate experimental and characterization data necessary for others in the field to reproduce their work.All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.Table Figure As for the complications of EBUS-TBNA using EchoTip ProCore, none of the patients had massive bleeding, mediastinitis, or pneumothorax. Only one case of suspected sarcoidosis with bronchoalveolar lavage (BAL) developed pneumonia after bronchoscopy, probably owing to BAL, which was positive for the pneumococcal urinary antigen and was relieved by oral levofloxacin treatment.Among 57 patients, one had a cyst, one had necrotic tissue, and two had inadequate specimens; however, the remaining 53 (93%) patients had sufficient specimen for histologic diagnosis using EBUS-TBNA  of patients, and EBUS-TBNA with EchoTip ProCore was used for diagnosis in all patients, including cytological diagnosis.The PD-L1 status was measured based on IHC using the PD-L1 IHC 22C3 PharmDx assay . Among 22 NSCLC patients, IHC of PD-L1 using the 22C3 antibody was possible in 19 patients except for 1 patient each where EBUS-TBNA was performed to differentiate between lung and breast cancer recurrence for staging purposes and to search for T790M mutation in EGFR-positive NSCLC, respectively. The PD-L1 tumor protein scores (TPSs) were ≥ 50%, 1–49%, and < 1% in 8 (42%), 5 (26%), and 6 (32%) patients, respectively  were sequentially approved between the study period. Therefore, the frequency of each biomarker test was different among the patients.Among 22 NSCLC patients, 17 cases were adenocarcinoma, 4 cases were squamous cell carcinoma (Sq), 1 case was non-small cell lung carcinoma, not otherwise specified . In 18 cases of non-Sq-NSCLC, gene testing was performed except for one case of staging. EGFR mutations were wild/mutation/not examined: 12/4/1, ALK rearrangement were wild/ rearrangement/not examined: 15/0/2, and ROS1 rearrangement were wild/rearrangement/not determined but examined/not examined: 9/0/5/3 cases  and rarely in the respiratory field13. Furthermore, nivolumab, which is a programmed death-1 antibody, was approved in December 2015 in Japan; subsequently, multiple immune checkpoint inhibitors have been approved17. The PD-L1 expression rate in tissues is an important predictor of the effect of immune checkpoint inhibitors15. Therefore, EBUS-TBNA with mediastinal lymphadenopathy has been a useful procedure for lung cancer. There was an increasing need for a reliable method to obtain tissue samples.Treatment of advanced lung cancer has dramatically changed since the discovery of the EGFR gene mutation in the 2000s and various driver gene mutations, including ALK rearrangement18. Other reports showed the diagnostic rate using conventional EBUS-TBNA methods were in the range of 61 to 80%20. Although the patient characteristics between our study and other reports were different, the diagnostic rate of current study seems to be superior than that of conventional EBUS-TBNA methods.From 2015 to 2016, EBUS-TBNA was performed in 29 cases at our hospital; however, tissue diagnosis was possible in 19 cases (66%), and the diagnosis was confirmed using tissues in 10 cases (34.5%) and including cytology 13 cases (44.8%). In contrast, in the present study, tissue samples were available for 54 (94.7%) of 57 EBUS-TBNA cases using EchoTip ProCore, and a definitive diagnosis was obtained for 50 (87.7%) cases. A definite diagnosis was made for 30/31 (97%) lung cancer cases; a diagnosis was obtained for each of the 31 cases including cytological diagnosis. In the literatures, the diagnostic rate of EBUS-TBNA using a conventional puncture needle was reported to be about 51% for both 21-gauge and 22-gauge for mediastinal and hilar lymph nodes22, and EchoTip ProCore was safe as it did not increase the incidence of complications. Furthermore, several studies have reported that samples obtained using EBUS-TBNA as a cell block can allow PD-L1 staining24. The present study shows that EBUS-TBNA with EchoTip ProCore can consistently yield large tissues suitable for direct immunostaining of PD-L1 , there was no significant increase or decrease in the number of bronchoscopies in our hospital, suggesting an improvement in the tissue diagnosis rate after the introduction of EchoTip ProCore. Therefore, the introduction of EchoTip ProCore contributed to more accurate diagnoses. Three of 31 lung cancer cases were difficult to diagnose because of peripheral lesions that could not be pathologically diagnosed, and EBUS-TBNA was successfully used for tissue diagnosis. From this evidence, the diagnostic rate of EchoTip ProCore is superior to that of EBUS-TBNA using a standard needle. Regarding safety, only one of 57 patients who had punctured a cyst received prophylactic antimicrobials after EBUS-TBNA. None of the patients developed mediastinitis, and only one case of suspected sarcoidosis with BAL developed pneumonia after bronchoscopy, probably owing to BAL, which was positive for the pneumococcal urinary antigen and was relieved by oral levofloxacin treatment. No other complications were observed. The incidence of complications after EBUS-TBNA has been reported to be 0.15 to 0.46%This study had some limitations. First, it was difficult to puncture small lymph nodes with EchoTip ProCore given its side core. Second, this was a small uncontrolled study, a single-center study and did not perform comparisons with other needles. However, as shown in Fig. In conclusion, our method allowed pathological diagnosis of 54 of 57 patients using histology, cytology, or both. The PD-L1 TPS was successfully examined in all 19 patients with NSCLC who could yield histological specimens and required examination. Additionally, none of the patients had complications. Among 13 patients with inadequate specimens or without malignancy, only one patient was subsequently diagnosed as having malignancy with a median follow-up period of 300 days. Therefore, EBUS-TBNA using a puncture needle with a side trap should be considered for patients with hilar and mediastinal lymphadenopathy in routine clinical practice.


ABSTRACT IMPACT: Study findings can guide improvements of the Summer Food Service Program to maximize the program’s desired effects on child summer nutrition and related health outcomes. OBJECTIVES/GOALS: The Summer Food Service Program (SFSP) addresses food insecurity during summer months. Project specific aims are to: 1. Describe characteristics of children participating in the SFSP. 2. Determine the nutritional quality of the SFSP foods. 3. Evaluate changes in children’s food insecurity, diet quality, and body mass index by SFSP participation. METHODS/STUDY POPULATION: A single group, prospective, staggered cohort design will be used for the proposed study. Two cohorts of 30 (N=60) elementary students and their parents will be recruited during the 2021-22 and 2022-23 school year. Each participant will complete a measurement session at three time-points: Baseline (spring), Post-Program (program end), and Follow-Up (following spring). Parents will complete an online survey about household food insecurity and family socio-demographic characteristics. Children will complete three 24-hour dietary recall interviews, and their heights, weight and percent body fat will be measured. The menus of at least ten SFSP sites will be analyzed to determine the nutritional adequacy of the site menus by using the Healthy Eating Index-2015. RESULTS/ANTICIPATED RESULTS: Study hypotheses are as followed: Aim 1. Not all of the children participating in the SFSP are from food-insecure or low-income households. Aim 2. Meals served at the SFSP will be higher in sugar and fat and lower in fruits and vegetables compared to recommendations in the 2015-2020 Dietary Guidelines for Americans. Additionally, the Healthy Eating Index-2015 score of the SFSP menus will be lower than that of the National School Lunch Program menus. Aim 3. Consistent SFSP participation will have a positive effect on reducing food insecurity, but not on increasing diet quality and reducing body mass index and percent body fat in children. DISCUSSION/SIGNIFICANCE OF FINDINGS: Program user information will determine if the program is reaching the target audience. Program managers will utilize menu analysis results to improve their menu nutritional quality. Changes in food insecurity, diet quality and anthropometric measures will inform whether the program needs to be improved to prevent any untoward excess weight gain.


The current study examined the change in local government staff’s emotional distress over 7 years after the 2008 Wenchuan earthquake, and the influence of earthquake exposure and professional quality of life (ProQOL) on emotional distress.This longitudinal study assessed 250 participants at 1 year after the earthquake; 162 (64.8%) were followed up at 7 years. Emotional distress was assessed with the Self-Reporting Questionnaire (SRQ) at both time points. We assessed ProQOL, including compassion satisfaction, burnout, and secondary traumatic stress, and earthquake exposure at 1 year. Wilcoxon signed-rank tests were performed to test longitudinal changes in emotional distress. Hierarchical multiple regression was conducted to examine the effect of earthquake exposure and ProQOL.p < 0.001). Earthquake exposure and ProQOL predicted one-year (ps < 0.05) but not seven-year emotional distress, whereas burnout predicted both one-year (p = 0.018) and seven-year (p = 0.047) emotional distress.The positive screening rate of emotional distress (SRQ ≥ 8) was 37.6 and 15.4% at one and 7 years, respectively. Emotional distress scores declined over time (Although emotional distress can recover over time, it persists even 7 years later. Actions to reduce burnout during the early stage of post-disaster rescue have long-term benefits to staff’s psychological outcomes. The 2008 Wenchuan earthquake, as one of the most catastrophic natural disasters in China, left hundreds of thousands of people dead or missing and millions of people homeless . After tThe staff, while working as rescuers, were also survivors of the disaster. Their dual role thus exacerbated the development of psychological distress . The repDisaster exposure, such as bereavement and property damage, is widely known to have adverse effects on survivors’ mental health conditions , 8. PrevEngaging in the post-quake rescue and reconstruction work heavily influenced the psychological condition of local government staff , 3, 12. Indeed, the existing literature has several limitations. Firstly, although the local government staff are crucial manpower during post-quake relief and reconstruction, the psychological consequences to this special population tend to receive minimal research attention . SecondlIn light of the past studies and their limitations, the present longitudinal study aimed to describe the changes in emotional distress among local government staff over 7 years after the Wenchuan earthquake. The effects of earthquake exposure and ProQOL on the staff’s long-term mental health were also investigated.n = 2), refusal (n = 3), retirement (n = 41), exit from government service (n = 33), or relocation (n = 9) based on the report of the local county government. All the eligible government staff from the two counties were approached for the one-year assessment. Two hundred and fifty participants from 240 different villages were available and willing to participate in the study, representing 44% of the whole eligible staff at that time. With 250 participants at 1 year and 162 at 7 years, the power to detect a small (Cohen’s f2 = 0.02), median (f2 = 0.15), or large (f2 = 0.35) effect was 0.605, 0.999, or 1.000 at 1 year, and 0.432, 0.998, or 1.000 at 7 years, respectively. The study was approved by the Ethics Committee of Peking University Sixth Hospital, with written informed consent obtained from all participants.A total of 250 participants were recruited from two badly hit disaster areas, namely, counties of Beichuan and An. Eligible participants were those who experienced the earthquake and local government staff engaging in the post-disaster relief and reconstruction. The first assessment was conducted in September 2009, approximately 1 year after the earthquake. The follow-up assessment was in December 2015, 7 years after the earthquake; 162 (64.8%) participants completed the second assessment at 7 years. Among the 162 available participants at 7 years, 136 were still government staff and 26 were retired. Eighty-eight participants were not available at 7 years because of death  was used to assess the emotional distress of participants for the one- and seven-year assessments. It was developed by the World Health Organization (WHO) as a reliable and valid instrument designed to screen for depression, anxiety, somatic-related symptoms, and other symptoms –32. The Earthquake exposure was assessed with four self-designed items at the first time point (1 year after the earthquake). The first was house damage, for which three options were provided: “no,” “moderate,” and “severe,” recorded as “0,” “1,” and “2,” respectively. Moderate referred to the case where the house was partially damaged but habitable, whereas severe was defined as the total collapse of the house. The second item was the number of moves after the earthquake. The government established many temporary shelters after the earthquake. Survivors could leave the temporary shelters and return to their own house when their houses had been repaired and the public health emergency had stabilized. Some staff as survivors might have needed to move several times among different temporary shelters, as temporary communities were combined when a certain number of survivors returned home. A larger number of moves indicates higher earthquake exposure risk . The thiProfessional quality of life was assessed by the Professional Quality of Life Scale (ProQOL) at the one-year assessment. The ProQOL is a self-reported scale developed specifically for rescuers working with individuals who have experienced extremely stressful events, with demonstrated validity and reliability , 37. TheThe use of ProQOL was permitted by the ProQOL Office. It contains 30 items with three subscales: compassion satisfaction, burnout, and secondary trauma stress. Participants were instructed to answer how frequently they had experienced each situation when they were helping other survivors or engaging in the post-quake relief and reconstruction work in the last month. Each item is scored on a five-point Likert scale . Scores were calculated by separately summing items in the three subscales, with possible scores ranging from 10 to 50 for each subscale. Higher scores represent higher levels of compassion satisfaction, burnout, or secondary trauma stress , 40.For the longitudinal changes in emotional distress, Wilcoxon signed-rank tests were performed. Hierarchical multiple regression analyses were conducted to examine whether earthquake exposure and ProQOL, separately, would predict emotional distress at 1 and 7 years after the earthquake. All models were adjusted for demographic covariates, including age, sex, education, religion, marital status, and family income, which were entered as a block in the first step, followed by the earthquake exposure or ProQOL variables  in the next step.t or Mann–Whitney U tests  were used to compare between the followed-up group and drop-out group, in terms of demographics, earthquake exposure, ProQOL, and emotional distress assessed at 1 year.As 64.8% participants were retained at 7 years, we meant to examine whether the dropouts were selective which may induce bias. Chi-squared and independent sample The demographic characteristics, earthquake exposure, ProQOL, and emotional distress of all participants are presented in Table z = − 5.76, p < 0.001) and the percentages of SRQ score ≥ 8  declined significantly from 1 year to 7 years for the participants as a whole. In addition, the SRQ scores at the two assessment time points showed a significant correlation .The continuous SRQ scores were 6.31 (SD = 4.21) and 3.94 (SD = 3.77) at 1 and 7 years, respectively. The percentages of SRQ score ≥ 8 were 37.6 and 15.4% at 1 and 7 years, respectively. As shown in Fig. ∆R2 = 0.048, p = 0.021) but did not account for the seven-year emotional distress .Results from the regression models of earthquake exposure predicting emotional distress are shown in Table ∆R2 = 0.250, p < 0.001) while controlling for demographic covariates. In the prediction of seven-year emotional distress, ProQOL, in total, non-significantly explained the variance . To be more specific, higher levels of burnout  and secondary trauma stress  experienced by the staff at 1 year after the earthquake significantly predicted more severe emotional distress at the same time point, while controlling for demographic covariates. In prediction of seven-year emotional distress, the effect of one-year burnout was still significant , while compassion satisfaction  and secondary trauma stress was not .For the models of ProQOL  predicting emotional distress  was found to be slightly lower compared with general survivors at both time points , 41–45, Meaningful engagement, such as the pleasure when assisting others and feelings of fulfillment when contributing to society, could alleviate staff’s emotional distress , 16, 50.This study also examined the long-term impact of compassion fatigue in a disaster context. Although burnout and secondary trauma stress are both identified as compassion fatigue, burnout is a state of physical, emotional, and mental exhaustion that is caused by prolonged involvement in emotionally demanding situations , while sEarthquake exposure has been recognized as a risk factor for mental health issues within the first year following a disaster , while nThe authors are aware of the limitations of the present study. Firstly, although this longitudinal study provides evidence on the trends of change in local staff’s emotional distress from the earlier to later stages after a natural disaster, the time interval between the two assessments is relatively large. Future studies should track the staff more frequently over multiple time points to observe the developmental trajectories of their mental health status over time. Secondly, the SRQ used in this study is a screening instrument rather than a clinical diagnostic method. Thus, the positive screening rate of emotional distress may be considered with caution. Future research should implement a clinical diagnostic instrument when possible. Thirdly, as subjective measures of disaster exposure tend to be more important predictors of long-term psychological distress, further research could pay more attention to subjective disaster exposure and its impact on the progression of lasting mental health issues.The present findings contribute to the understanding of the long-term consequences of natural disasters, particularly in the field of mental health. As for clinical implications, our study suggests that health professionals should monitor the psychological distress of local government staff consistently during the entire post-quake relief and reconstruction progress, and subsequently deliver timely intervention to prevent deterioration and facilitate recovery. In addition, burnout tends to have lasting detrimental effects on staff distress. Effective solutions to reduce burnout, such as lessening the staff’s workload, avoiding extended working hours, carrying out shift-work schedules, providing continuous psychosocial interventions, and delivering professional capacity training, may be beneficial to improve future long-term mental health outcomes of local government staff and rescue workers after major disasters. Moreover, assessment and intervention addressing staff’s secondary trauma stress should be implemented immediately after a disaster.Despite emotional distress being liable to recover over time, it continues to persist among local government staff even 7 years after the Wenchuan earthquake. The findings underscore the importance of taking action to reduce burnout in local staff during the early stage of post-disaster rescue work, which would be salutary to their psychological outcomes in the long run.


To the Editor,Persistent sciatic artery (PSA) is a rare vascular anomaly resulting from incomplete obliteration of the embryonic dorsal axial artery , 2. The When we performed pre-scanning of ultrasound-guided popliteal sciatic nerve block for a 67-year-old female patient who was going to undergo left total knee replacement, a hypoechoic round pulsating structure was identified between TN and CPN within the paraneural sheath at the popliteal fossa Fig. . It turnIn the present case, a presumed PSA was identified within the paraneural sheath at the bifurcation of TN and CPN, which is usually filled with loose connective tissue and is a target of local anesthetic injection during the ultrasound-guided popliteal sciatic nerve block . Conside


Study 2 (n = 23) presents a 2-week proof-of-concept feasibility testing of iByte4Health, including participant acceptability, utilization, and engagement. Based on Study 1, iByte4Health was designed as a text-messaging program, targeting barriers and challenges identified by parents of young children for six key obesity prevention behaviors: (1) snacking; (2) physical activity; (3) sleep; (4) sugary drinks; (5) fruit and vegetable intake; and (6) healthy cooking at home. In Study 2, participants demonstrated high program retention (95.7% at follow-up) and acceptability (90.9% reported liking or loving the program). Users were engaged with the program; 87.0% responded to at least one self-monitoring text message; 90.9% found the videos and linked content to be helpful or extremely helpful; 86.4% found text messages helpful or extremely helpful. iByte4Health is a community-informed, evidenced-based program that holds promise for obesity prevention efforts, especially for those families at the increased risk of obesity and related disparities. Future work is warranted to test the efficacy of the program.This research describes the development and preliminary feasibility of iByte4Health, a mobile health  obesity prevention intervention designed for parents with a low-income of children 2–9 years of age. Study 1 ( Pediatric obesity remains a pressing public health issue and disparities persist among racial and ethnic minority youth and those living in low-income households ,2,3. InnTo date, however, a majority of parent-focused digital health interventions aimed at shifting weight status in children have been ineffective . Most mHThe purpose of this paper is to present an overview of the development and preliminary testing of iByte4Health, a mHealth obesity prevention program delivered via smartphone that integrates parent and child-facing content to facilitate discussion around key health behaviors, and allows parents and children to work together towards goals, and engage in behavior change as a family. The goal of iByte4Health was to develop a low-cost, scalable, entirely virtual, and evidence-based prevention program that could be easily disseminated to reach families with children at-risk of obesity. Using best-practice health communication principles, we used an iterative approach to develop a theory-informed and engaging mHealth intervention . FindingiByte4Health is a mHealth obesity prevention program delivered via smartphone, which addresses key barriers to implementing obesity prevention strategies for families with children who may be at increased risk for obesity. Specifically, the program provides tailored content that is evidence-based and community-informed. A key feature of the program is the integration of multimedia content  that facilitates discussion around key health behaviors and allows parents and children to work together towards goals and engage in behavior change as a family. The program also leverages technology to increase access and address barriers to recruitment, retention, engagement, and in-person attendance, which increases potential for addressing disparities among vulnerable groups. Lastly, the program integrates behavioral strategies like goal-setting and self-monitoring and provides interactive and personalized feedback to guide participants towards behavior change. The mHealth delivery platform also makes the program scalable, easy to disseminate, and allows for integration into clinical settings like primary care.In the first phase of formative work (June–August 2019), 36 parents and caregivers of children 2–9 years of age were recruited from a FQHC in North Philadelphia to provide insights, through in-depth interviews and questionnaires, on their primary health concerns for their child, technology use, preferences regarding an mHealth intervention  and key barriers to addressing health behaviors in their children. Parents/caregivers completed in-person surveys that were administered by trained study staff and included qualitative and open-ended questions. Participants were asked about their concerns and desired support for several obesity prevention targets including sugary drinks, physical activity, fast food intake, screen time, snacking, sleep, and fruit and vegetable intake. These obesity prevention targets were adapted from the Family Nutrition and Physical Activity (FNPA) Screening tool, a validated behaviorally focused measure that assesses obesogenic influences for young children ,19,20. AThis formative phase tested a variety of content and messages that were designed to address potential barriers to digital literacy and to make content more appealing. Messages included traditional text-based messages and picture messages. The survey contained about 75 questions, including demographics, and took approximately 15 min to complete on a digital tablet. Parents were then asked probing questions to provide additional insights and feedback about their impressions and preferences for messages. The brief interview, which lasted 10–30 min, was recorded electronically, transcribed, and synthesized to identify key themes and provide context for quantitative responses. Participants who were interested in participating in the survey but did not want to be recorded were still included in the study. The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of Temple University .Based on the formative work conducted with parents/caregivers, iByte4Health was designed as a parent-focused 6-week pilot mHealth text-messaging program that targets key health behaviors to prevent obesity in vulnerable children. The six obesity prevention targets were synthesized to align with the key content areas of parent interest and intended to cover one topic per week. The six topics include: (1) snacking, (2) physical activity, (3) sleep, (4) sugary drinks, (5) fruit and vegetable intake, and (6) healthy cooking at home. Barriers and challenges related to each of these key health behaviors including structure, feeding and mealtime practices, picky eating, and stress management were integrated within each of these overarching themes. The program was theoretically informed by social cognitive theory (SCT), seeking to influence parents’ knowledge, self-efficacy, and self-regulation  to directly influence children’s environment and routines . BehavioiByte4Health consists of four key components: (1) animated YouTube videos (<3 min each) that introduce the weekly themes and behavior change goals; (2) daily text-messages that provide strategies and tips for changing the weekly target behavior; (3) engaging supplemental content to provide additional support for each theme; and (4) twice weekly self-monitoring and feedback messages. Each week begins with a short, animated video that provides evidence-based information about the importance of the weekly target health behavior. Videos were created based on structured templates, which included age-specific evidence-based recommendations from the American Academy of Pediatrics, Bright Futures: Nutrition, the 2015–2020 Dietary Guidelines for Americans, and the Physical Activity Guidelines for Americans (2nd Edition) ,25,26. TShort, easy to understand, daily messages were created to support the weekly theme and provided simple, clear guidance to help address common barriers and challenges reported by parents in formative work. Messages were sent once daily in the morning (at approximately 10 a.m.) Every message was accompanied by supplemental content that included infographics or links to more information. Infographics were sent as text message images and could be saved directly to participants’ devices. Most of the visual content was developed by the study team and included tips , games , and other visuals to support text-message targets . Additionally, parents received two self-monitoring text-messages per week in the afternoon. Participants were asked to provide “YES” or “NO” responses to the self-monitoring messages and feedback was provided based on participant response. One message was sent mid-week to assess progress towards their weekly goal and to help troubleshoot challenges. If participants reported meeting their goal, they received a message to positively reinforce the behavior. If parents had not yet met the goal, they received a tip to help them achieve the goal before the end of the week. A final self-monitoring message was sent at the end of the week to assess goal attainment for the weekly target behavior before a new weekly theme was introduced. Examples of text-messages are presented in Proof-of-concept testing was conducted to determine preliminary usability, acceptability, and engagement with iByte4Health. Measures are detailed below. Delays in study timelines and program development occurred due to the COVID-19 pandemic, and as a result an adapted two-week version of the program was created for initial proof-of-concept testing. The pilot study was conducted remotely during April–May 2021. Snacking and physical activity were selected as the two health behavior targets for this two-week study, given that parents/caregivers reported significant interest in these targets during formative work. Additionally, these two behaviors were also significantly impacted by COVID-19 and were thought to be most relevant for parents and youth during the proof-of-concept testing .Participants were recruited through one of three methods: (1) referral from the integrated behavioral health counselor from two local FQHC partner clinics; (2) contacting families who participated in previous research at the center where the study was conducted and agreed to be contacted for future studies; or (3) friends and family referral. Parents completed an eligibility screener and consent form via a data management system, Research Electronic Data Capture (REDCap), a secure software program that is designed to capture data and support clinical and translational research projects . To be eProgram acceptability was assessed using responses to a series of five-point Likert scale questions for the overall program , and individual program components. For example, participants were asked to state how much they agreed or disagreed with the following statements about the overall program : “The overall program was engaging”, “I understood the messages and content in the program”, “The program is relevant for me and my family.” Questions also assessed how helpful participants found each part of the program  including: “How helpful or useful were the text messages received during the program?” “How useful or helpful were the videos received during the program?” and “How useful or helpful was the linked content that was provided with the text messages?” For each program component, program utilization was assessed by asking participants how much they viewed  and how they would rate the amount of content that was provided . Participants were also asked if they set new goals as part of the program (yes/no) and if they were able to achieve those goals (yes/no). Program engagement was assessed through text-message delivery confirmation on the carrier platform and by examining participant responses to self-monitoring text messages. Descriptive statistics were used to analyze baseline characteristics and responses to program utilization, engagement, and acceptability questions.A modified version of the 20-item FNPA was used to examine preliminary efficacy in parenting behaviors related to the intervention. Four questions, which were not directly related to the behavioral targets, were removed to reduce the participant burden. The survey was administered at baseline and follow-up. However, given the limited sample size, no statistical tests were used to examine pre-post differences and only descriptive results are presented for questions that assessed the key targets of the intervention, specifically, parent responses to the following four questions assessing snacking behaviors: “How often does your child eat fruits and vegetables at meals or snacks?”, “How often does your family monitor the amount of candy, chips and cookies your child eats?”, “How often does your family use candy, ice cream or other foods as a reward for good behavior?” and “How often does your child eat while watching TV?” These three questions were used to examine physical activity: “How often does your family encourage your child to be physically active?”, “How often does your child do physical activities with at least one other family member?”, “How often does your child do something physically active when he/she has free time?” Responses were provided using a 4-point Likert scale . SPSS Version 25 was used to calculate means, SDs, and percentages.Of the 36 participants in the formative study, 69.4% identified as African American/Black, 13.9% White, and 19.4% other (including mixed race). More than one-quarter identified as Hispanic (30.6%). The mean caregiver age was 33.5 years (SD = 10.5) and mean child age was 5.4 years (SD = 2.9). Approximately half (54.0%) of caregivers had a high school level education or less and on average participants had 3.0 (SD = 1.9) children living in their household. Many participants were mothers (58.3%), but fathers (22.2%) and other caregivers (including grandparents and stepparents) also participated (19.5%).Participants were interested in receiving information across a range of targets related to their child’s health, but a primary concern was their own feeding practices. Most parents/caregivers wanted tips on how to feed children (84.2%). Respondents provided additional insights on their challenges around feeding children which included mealtime practices , beverage selection , picky eating , screen time , and structure . Snacking habits (73.3%), stress (71.0%), physical activity (71.0%), and establishing family meals (71.0%) were also content areas of interest for most respondents. Parents/caregivers were also eager to get more information about how to improve the healthfulness of snacks. For example, one parent said, “If he sees junk food that’s all he wants- he doesn’t want the healthier snacks…so maybe tips on ways to make healthier snacks more appealing.” Parents also expressed challenges with sleep- “[their child] throws a fit when it’s bedtime and needs to learn routine”, and screen time- “Screen time is a big thing and trying to get a phone away from him is hard”. Parents were also generally concerned about stress for themselves and their child, with one parent saying, “Children deal with anxiety… and stress can affect parents.”When assessing technology access and preferences, 94.7% of parents/caregivers reported having a working cell phone, 84.0% had unlimited messaging and data plans, and 88.9% reported using their phones to access the internet. Most parents (78.4%) were interested in receiving text messages with health information about their child.Parents/caregivers provided significant insights on preferences for enhancing the digital program structure. When asked about messages, parents/caregivers reported liking both picture and text-based messages. Parents/caregivers shared that the picture messages were more engaging and could easily be shared with their children while the text-based messages were important for getting clear and detailed information. Most parents/caregivers (90%) expressed wanting additional content  and all parents wanted content that would promote conversation with their child. They liked the idea of setting goals and expressed that content should be clear and concise, easy to understand, and engaging. They also liked the idea of receiving pictures or content that they could save to their phone and refer to at a later time. When asked about their preference for frequency of message delivery, more than half of respondents said they would prefer one or more messages per day (53.2%). A little over half (51.7%) said they preferred messages be sent in the morning and 34.4% had no preference on timing. Parents/caregivers indicated that the consistent delivery of messages  would create a structure and help them prepare for the day or the week.A total of 23 parents  were recruited for the two-week pilot intervention. Parents were 95.7% female, 34.4 years (SD = 7.9), 65.2% identified as African American/Black, and 13.0% identified as Hispanic/Latinx. Most (65.2%) reported use of at least one form of government assistance, 39.1% had a high school education or less, 26.1% reported some college, and 30.3% were college graduates or higher. About half (47.8%) reported 1–2 children living in their household while 52.1% reported three or more children. Children were on average 6.6 years (SD = 2.0).All (100%) of the text-messages were successfully received by participants (according to carrier records on the text-message server) and all but one (95.7%) of the parents completed follow-up at the end of the two-week study. Responses to self-monitoring text messages were high with 87.0% responding to at least one of the four self-monitoring prompts. Responses to self-monitoring texts were higher at the end of the week (average response rate 80.4%) compared to the mid-week messages (average response rate 58.7%). In addition to engagement with self-monitoring texts, parents demonstrated other forms of unprompted engagement with the program including “liking” or “loving” text-messages as well as sending pictures of what children were eating and asking questions. The principal investigator responded to all participant questions within 24 h of receiving questions via text-message.Almost all parents (95.4%) reported reading all or most of the text-messages, 81.8% reported watching all or most of the videos, and 86.4% reported viewing all or most of the linked content. Most parents (81.8%) reported sharing the program content with their child and 66.6% reported that their children liked or loved the content while 27.8% of children felt neutral about it.Almost all parents (90.9%) reported liking or loving the iByte4Health program. Most parents (90.9%) reported setting new goals as part of the program and 87.0% reported achieving their goals. Overall, parents agreed or strongly agreed that the program was engaging (90.9%), that they understood the messages and content (90.9%), that the program was relevant for them and their families (86.4%), and that the program was helpful (86.4%). When asked about how helpful the program components were, parents reported the following to be helpful or extremely helpful: videos (90.9%), linked content (90.9%), and text messages (86.4%). All parents (100%) who responded to the follow-up agreed that the program was helpful for providing them with information to keep their children healthy.Overall, parents reported that the number of text-messages received during the program  was just right (95.5%), with only one parent saying it was not enough (4.5%). Most parents (90.9%) also said the amount of linked content was just right. In contrast, while a majority of parents (77.3%) reported that the number of videos received was just right (one per week), 13.6% said they wanted more videos, and several parents reiterated this point again in the open-ended feedback.When examining parent-feeding practices, parents reported a decrease in how often their child ate meals and snacks in front of the TV; 52.2% reported doing this often/always at baseline compared to 34.7% at follow-up. Parents reported increases in monitoring child intake of snacks; 69.5% reported doing this often/always at baseline compared to 77.3% at follow-up. Most interestingly, parents reported reducing the use of snack foods as a reward; 69.5% of parents reported doing this often/always at baseline while no parents (0%) reported doing this often/always at follow-up (31.8% reported never doing it and 68.2% reported doing this sometimes).When examining parenting practices around child physical activity, there was a slight increase in parent reported encouragement of child physical activity; 82.6% reported doing this often/always at baseline compared to 86.4% at follow-up. There was also a slight increase in the amount of physical activity that children engage in with family members; 65.2% reported doing this often/always at baseline compared to 68.2% at follow-up. Lastly, parents reported an increase in the amount of physical activity children do when they have free time; 73.9% reported this occurring often/always at baseline compared to 81.9% at follow-up.iByte4Health is a community-informed, evidence-based mHealth intervention designed to address barriers and challenges to obesogenic behaviors in families with young children 2–9 years from underserved populations who may be at-risk of obesity. Using an iterative evaluation strategy, results suggest that this program is feasible and acceptable to this target population and ensured input from the target population at each development stage. Almost all parents said that the program content was relevant to them and their families, highlighting the critical importance of formative work to develop the tailored content delivered in mHealth interventions. Overall, engagement in the iByte4Helath pilot program was high and program dose and content was highly rated among pilot users. Parents also used features of their smartphone like “loving” or “liking” a message sent from iByte4Health, and even though this was unprompted, it served as a quick but effective way to learn participant preferences without being burdensome. Preliminary findings suggest that text messaging is a feasible and interactive way for parents and caregivers in at-risk groups to engage in health communication and obesity prevention programming.Participants reported that daily messages (and sometimes twice daily) were not too burdensome and the video and other picture-based content was highly rated. Participants even requested additional child-facing content like YouTube videos. Parents found the additional resources helpful and relevant to improving the health of their children. Most parents shared the program content with their children, suggesting that the content was not only relevant and interactive for the parent but also served as a means of communicating with their child about ways to improve their health. This study also confirmed that smartphones are a feasible and effective way to leverage mHealth’s potential for engaging individuals living in low-income households in health education, which can lead to the adoption of health-promoting behaviors .A primary goal of this study was to develop an obesity prevention program that addresses current barriers in lack of access to obesity prevention programs for high-risk groups. This program can be readily and easily accessed by patients at any time via smartphones and is designed to enhance engagement and relevance. Additionally, this program can be scaled to provide a cost-effective approach for reaching larger audiences. In this pilot iteration, if participants sent questions or comments, they received individual responses from the principal investigator. However, text-messages could be automated if the intervention is scaled up. Additionally, individual responses could be managed by study staff or clinical teams and still be less burdensome and require fewer resources than other behavioral intervention approaches like traditional in-person sessions.While this study has strengths, there are also limitations to consider when interpreting findings from this work. First, study timelines and evaluation plans were significantly disrupted due to COVID-19. This extended the amount of time between Study 1 and Study 2, delayed contracts and IRB approvals, and precluded the ability to recruit in-person for Study 2 or conduct objective measures. Additionally, both studies used small, convenience samples limiting the generalizability of findings. Study 1 could have been influenced by response bias since participants responded to open-ended questions asked by the research team and Study 2 used a pre-post design and was not powered to detect meaningful differences in outcomes. Finally, given that Study 2 was only conducted for two weeks, it remains unknown if participants would stay engaged in the program long-term. Future studies should examine what level of engagement is required to achieve behavior change and determine the optimal length of the program.Partnerships with two FQHCs supported the development of this project. For future clinical integration, this program can serve as a referral program for providers to address current limitations to delivering obesity prevention care in the primary care setting. Primary care providers can screen for obesity risk as part of standard care, and then refer to behavioral health counselors who can assess familial needs and connect interested parents and caregivers with iByte4Health. To determine optimal implementation for this approach, further work is needed. In addition to examining the program impact on parenting and child weight-related behaviors, it will be important to examine whether this program is best utilized as an adjunct to care or as a standalone program.Finally, while all mHealth tools should use formative approaches to ensure content addresses the needs of the target audience, using a “person-centered” approach that highlights the need to understand the perspectives of the people who will use the tool is critical to the development of interventions that are salient and useful to the audience. This is a key component of whether the target audience will use, and continue using, a technology-based intervention . TargeteIn conclusion, this paper summarizes formative work conducted with parents in low-income communities with children who may be at risk for obesity, to determine preferences for an obesity prevention mHealth program and the preliminary feasibility of implementing this program. Key factors and barriers that influenced child health behaviors as well technology utilization and preferences were identified and guided the development of a comprehensive mHealth program delivered via text-message on smartphones. The iByte4Health program was tested using an initial proof-of-concept two-week pilot study and initial acceptability, satisfaction, and engagement were high. Given the findings, iByte4Health holds promise for engagement, scalability, and dissemination, especially for families at increased risk for obesity and related disparities. Next steps include testing the full 6-week program using a rigorous study design and integrating customization approaches to ensure that the program is responsive to personalized preferences and the unique needs of families.


D) as misfolded protein aggregates in the central nervous system (CNS). The recent development of the real-time quaking induced conversion (RT-QuIC) assay for ultrasensitive detection of αSynD aggregates has revitalized the diagnostic values of clinically accessible biospecimens, including cerebrospinal fluid (CSF) and peripheral tissues. However, the current αSyn RT-QuIC assay platforms vary widely and are thus challenging to implement and standardize the measurements of αSynD across a wide range of biospecimens and in different laboratories. We have streamlined αSyn RT-QuIC assay based on a second generation assay platform that was assembled entirely with commercial reagents. The streamlined RT-QuIC method consisted of a simplified protocol requiring minimal hands-on time, and allowing for a uniform analysis of αSynD in different types of biospecimens from PD and DLB. Ultrasensitive and specific RT-QuIC detection of αSynD aggregates was achieved in million-fold diluted brain homogenates and in nanoliters of CSF from PD and DLB cases but not from controls. Comparative analysis revealed higher seeding activity of αSynD in DLB than PD in both brain homogenates and CSF. Our assay was further validated with CSF samples of 214 neuropathologically confirmed cases from tissue repositories , yielding a sensitivity of 98% and a specificity of 100%. Finally, a single RT-QuIC assay protocol was employed uniformly to detect seeding activity of αSynD in PD samples across different types of tissues including the brain, skin, salivary gland, and colon. We anticipate that our streamlined protocol will enable interested laboratories to easily and rapidly implement the αSyn RT-QuIC assay for various clinical specimens from PD and DLB. The utilization of commercial products for all assay components will improve the robustness and standardization of the RT-QuIC assay for diagnostic applications across different sites. Due to ultralow sample consumption, the ultrasensitive RT-QuIC assay will facilitate efficient use and sharing of scarce resources of biospecimens. Our streamlined RT-QuIC assay is suitable to track the distribution of αSynD in CNS and peripheral tissues of affected patients. The ongoing evaluation of RT-QuIC assay of αSynD as a potential biomarker for PD and DLB in clinically accessible biospecimens has broad implications for understanding disease pathogenesis, improving early and differential diagnosis, and monitoring therapeutic efficacies in clinical trials.Definitive diagnosis of Parkinson’s disease (PD) and dementia with Lewy bodies (DLB) relies on postmortem finding of disease-associated alpha-synuclein (αSyn D), deposited as protein aggregates within the Lewy body inclusions in the central nervous system (CNS) , followed by homogenization in the presence of zirconia beads (1 mm) in a mini-Beadbeater-16 device  for 5 cycles of 1 min beating and 3 min cooling at 4 °C. Following a brief centrifugation for 5 min at 500 × g, a 10% brain homogenate (w/v) was prepared and stored at − 80 °C until use. For all peripheral tissues, previous studies included a 4-h enzymatic digestion step during tissue extraction , 23. ThiAll reagents used for αSyn RT-QuIC assay were obtained from commercial sources. Sodium phosphate  was from Boston BioProducts , sodium chloride (5 M) was from Invitrogen , thioflavin T (ThT) was from Sigma . HPLC-grade water from Thermo Fisher  was used to prepare solutions. Aliquots of individual stock solutions were stored at −20 °C until use. Lyophilized recombinant human αSyn (rec-Syn) were purchased from rPeptide  with catalog number S-1001–02 and lot numbers 082517AS (lot 1) and 111317AS (lot 2), and stored at −20 °C until use.–1 dilution] as prepared above was subjected to serial tenfold dilutions with sample diluent containing PBS supplemented with Gibco 1 × N2 supplement . RT-QuIC reactions were performed in Nunc black 96-well plates with optical flat bottom . Each well was preloaded with six 0.8 mm low-binding silica beads . Lyophilized rec-Syn (rPeptide) was reconstituted in HPLC-grade water to 1 mg/ml and filtered through Amicon 100 kDa filters  by centrifugation for 10 min at 4 °C. To measure αSyn RT-QuIC seeding activity, 2 μl of diluted tissue homogenate was added to individual wells containing 98 μl of RT-QuIC reaction mixture composed of 40 mM NaPO4 (pH 8.0), 170 mM NaCl, 20 µM ThT, 0.1 mg/ml rec-Syn. The plates were sealed with Nunc clear sealing film  and incubated at 42 °C in a BMG FLUOstar Omega plate reader  with cycles of 1 min shaking  and 1 min rest throughout the assay. ThT fluorescence  was recorded every 45 min for 60 h. For CSF samples, 2 μl of neat CSF or CSF serially diluted with sample diluent was added to individual wells containing 98 μl of RT-QuIC reaction mixture supplemented with 0.0005% SDS. Four replicate reactions were made for each sample. The plate reader was set up with optic gain setting (~ 1900) that would give a negative control baseline of ThT fluorescence around 15,000 relative fluorescence units (rfu). The maximal fluorescence response of the plate reader was fixed at 260,000 rfu. Raw data with ThT fluorescence intensity in rfu were normalized to a percentage of the maximal fluorescence at 260,000 rfu (defined as 100%). Positive RT-QuIC reactivity of individual wells is defined as enhanced ThT fluorescence above a predefined threshold within 60 h. This threshold was calculated as the average background fluorescence plus 5 standard deviations, equal to ~ 30,000 rfu or ~ 11% of maximum ThT response in our experiments. For RT-QuIC analyses, data from four technical replicates were examined for a given biospecimen. A biospecimen was considered positive when at least two out of the four replicates displayed positive ThT reactivity above the threshold. For each positive sample, the average fluorescence intensity from the positive replicates was calculated and plotted against time. For each negative sample, the average fluorescence intensity from the negative replicates was calculated and plotted against time. The lag phase of RT-QuIC reactions was defined as the time (h) to reach the threshold as defined above. Protein aggregation rate (PAR) was calculated as the inverse of lag-phase (1/h). For Spearman-Kärber analyses of end-point dilution RT-QuIC experiments, tenfold serial dilutions of a biospecimen were prepared. Each diluted sample was used to seed RT-QuIC reactions in quadruplicate. ThT fluorescence from individual replicates for each dilution were plotted against time. The dilution series continued until RT-QuIC reactivity reached ≤ 1 out 4 replicates. The seeding dose giving ThT positivity in 50% of replicate wells (SD50) based on the Spearman-Kärber equations was calculated as described . Analysis of the CSF seeding activity at the end of the 60 h RT-QuIC assay revealed an excellent analytical performance for both PD and DLB . As shown in Fig. D seeding activity displayed dose-dependent titration in serially diluted PD samples of BH, skin homogenate, and CSF, respectively. The Spearman-Kärber analysis of this PD case yielded SD50 values at 2.8 × 106/mg for the brain, 5.0 × 104/mg for the skin, and 2.8 × 103/µl for CSF. No seeding activity was detected in corresponding biospecimens from a control cadaver affected by AD , and sigmoid colon were available in addition to CSF. Using the same RT-QuIC assay protocol, αSynD seeding activity was examined in serially diluted tissue homogenates of skin, SMG, and colon, and in serially diluted CSF . The seeding activity in PD CSF was in the range of 102–103 per µl. For brain and CSF, the previously reported SD50 values in PD and DLB were in the range of 105–106/mg and 4–54/µl, respectively [D seeding activity across multiple biospecimens from the same patients affected by PD and other synucleinopathies.Finally, we examined whether our streamlined RT-QuIC assay can be used for different types of specimens without the need to modify assay conditions. Several types of biospecimens were collected from the same PD cadavers, subjected to the same processing and serial dilution procedure, and tested under the same RT-QuIC assay conditions. Spearman-Kärber endpoint dilution analysis was used to determine the seeding dose at which 50% of replicate reactions were positive, termed SD50 . In a neectively . Thus, oD seeding activity in various patient-derived specimens.To evaluate the reliability of our streamlined RT-QuIC protocol, we analyzed tissue homogenates from a third case of neuropathologically confirmed PD using different batches of rec-Syn substrate. Distinct patterns of RT-QuIC kinetics from reactions seeded by PD tissue homogenates from the skin, SMG, and colon were consistently reproduced when performed with two different lots of rec-Syn Fig. . In contD aggregates in clinical specimens. Initial applications have been demonstrated by several groups using BH and CSF of PD and DLB. However, existing αSyn RT-QuIC assay protocols vary in configuration, length of assay, tissue processing, as well as the compositions and sources of reagents [αSyn RT-QuIC has recently gained popularity due to its ability to detect the seeding activity of αSynreagents –17, 31. A key reagent for the αSyn RT-QuIC assay is rec-Syn that serves as the substrate for seeded fibrillization. In many published studies, rec-Syn is produced in-house, which often introduces batch-to-batch variability and requires considerable expertise and personnel to ensure the production of high quality rec-Syn protein during prolonged in-house preparation and purification steps (~ 5–7 days). We have developed a streamlined αSyn RT-QuIC assay based on the second-generation platform  and opteD seeding activity in a much lower sample volume (0.02–0.2 µl) of ventricular CSF obtained at autopsy than that required for premortem lumbar CSF (15–20 µl) [D in autopsy CSF than those in premortem patients. Alternatively, the assay sensitivity could be influenced by a difference in biochemical and cytological compositions between ventricular and lumbar CSF [We have extensively tested our streamlined αSyn RT-QuIC protocol against neuropathologically confirmed cases of PD and DLB using BH and CSF. To validate its diagnostic value for PD and DLB, we performed αSyn RT-QuIC analysis of a large panel of 214 CSF samples, yielding an overall sensitivity of 98% and a specificity of 100%. Our results are consistent with other reports of overall high diagnostic accuracy of αSyn RT-QuIC analyses of CSF from various PD and DLB cohorts from different populations , 31. The5–20 µl) , 31. Thimbar CSF , includimbar CSF  since sombar CSF . NonetheD among multiple tissue types. In our assay protocol, we extracted all tissues with bead-based homogenization in the same buffer, eliminated an enzymatic digestion step lasting for 4 h, and performed RT-QuIC assay under identical conditions. Thus, we have provided a single and simplified RT-QuIC protocol for concurrent detection of αSynD in different tissues. Using Spearman-Kärber analysis of endpoint dilution experiments, we have demonstrated the utility of our RT-QuIC assay for a parallel and quantitative comparison of αSynD seeding activity (in SD50 units) for multiple PD specimens including the skin, SMG, colon, and CSF, all of which are clinically accessible. In short, our RT-QuIC assay protocol supports the measurement of αSynD seeding activity in different biospecimens under the same assay conditions.Previous studies using IHC staining have observed abnormally phosphorylated αSyn in non-CNS organs of PD and DLB patients , 35–38. D seeding activity in highly diluted specimens of PD and DLB, up to million-fold dilution for BH and several thousand-fold dilution for peripheral tissues, and in nanoliters of CSF. Given the high costs of patient recruitment and specimen procurement, the extremely low sample consumption afforded by our RT-QuIC assay will facilitate the efficient use and sharing of scarce resources of biospecimens collected during various clinical studies. As a reliable and robust tool, the ultrasensitive RT-QuIC assay platform has several attributes that will allow for easy translation into the clinical arena, including rapid turnaround, high throughput, and ultrasensitive and automated readouts. Indeed, the prion RT-QuIC assay of CSF has been incorporated into the updated diagnostic criteria for Creutzfeldt-Jakob disease since 2018 [Our RT-QuIC assay has enabled ultrasensitive detection of αSynnce 2018 . Future D in a diverse array of biospecimens from postmortem PD and DLB patients. The streamlined protocol requires minimal hands-on time and technical expertise to set up the RT-QuIC assay. This optimized platform could facilitate easy implementation of this αSyn RT-QuIC assay in a routine laboratory, and enable the standardization of the assay across different sites. We have verified the analytical sensitivity and specificity of a streamlined RT-QuIC assay in a large number of postmortem CSF samples of PD and DLB cases. Moreover, we have demonstrated that a single RT-QuIC protocol is suitable to detect αSynD seeding activity in multiple tissue specimens such as the brain, skin, salivary gland, and colon. Finally, our assay is ultrasensitive, high-throughput, low on sample consumption, and easy to adapt to different biospecimens. The ongoing evaluation of αSynD as a potential biomarker of PD and DLB in clinically accessible biospecimens has broad implications for understanding disease pathogenesis, improving clinical and differential diagnosis, and monitoring efficacy of treatments and neuroprotective agents in clinical trials.In summary, we have developed a streamlined RT-QuIC assay platform for ultrasensitive detection of αSyn


Transcripts were analyzed using thematic analysis. Aspects that facilitated implementation included the organization's existing relationship with clientele, an established infrastructure to deliver community-based interventions, alignment of intervention goals with broader organizational aims, and funding to support dedicated program staff. Challenges to implementation included significant program staff time and resources, coordinating data sharing efforts across multiple project partners, participant and volunteer recruitment, and interruptions due to COVID-19. Implications of these facilitators and barriers for scalability of community-based ICT training interventions for older adults are described. Lessons learned include identifying successful participant and volunteer recruitment strategies based on organizational capacity and existing recruitment avenues; using a targeted approach to identify potential participants; incorporating flexibility into intervention design when working with the homebound older adult population; and monitoring the participant-volunteer relationship through volunteer-completed reports to mitigate issues. Findings from this formative evaluation provide insight on strategies CBOs can employ to overcome challenges associated with implementing technology training programs to reduce social isolation and loneliness for older adults, and thus improve overall well-being for homebound older adults. Recommendations can be integrated into program design to facilitate implementation of ICT programs in the community setting.Despite substantial evidence of the negative health consequences of social isolation and loneliness and the outsized impact on older adults, evidence on which interventions are most effective in alleviating social isolation and loneliness is inconclusive. Further complicating the translation of evidence into practice is the lack of studies assessing implementation and scalability considerations for socialization programs delivered by community-based organizations (CBOs). Our primary objective was to describe the implementation barriers, facilitators, and lessons learned from an information and communication technology (ICT) training program aimed at reducing social isolation and loneliness for homebound older adults in a home-delivered meals program. Participants received in-home, one-on-one ICT training lessons delivered by volunteers over a 14-week period with the goal of increasing social technology use. To assess implementation facilitators and barriers, 23 interviews were conducted with program staff ( Social isolation and loneliness are significant threats to physical and mental health, particularly among older adults. Both are associated with poor health outcomes including comorbid conditions , cognitiMeals on Wheels America (MOWA), the leadership organization that supports the national network of Meals on Wheels (MOW) programs, aims to alleviate social isolation and loneliness among homebound MOW clients. Studies suggest that receiving home-delivered meals through MOW can reduce loneliness and improve psychological well-being among homebound older adults due to the social interaction that accompanies meal delivery –11. HoweIn response to physical distancing orders enacted to mitigate the spread of coronavirus 2019 (COVID-19), organizations and researchers alike seek to develop and deliver solutions to combat social isolation and loneliness among older adults, who are at outsized risk of complications caused by COVID-19 , 14. EveInformation and communication technology (ICT) interventions are one potential solution for addressing social isolation and loneliness among older adults , 21 by hvia a community-academic partnership.The COVID-19 pandemic underscores the need for community-academic partnerships to translate evidence on social isolation and loneliness interventions into practice among frontline service providers, as well as cross-sector collaborations to leverage existing resources and infrastructure to enable continued delivery of services to older adults , 26. In via 1.5–2 h prepared modules. Talking Tech introduced participants to Well Connected, a national phone and internet-based virtual community that offers over 70 weekly activities, classes, and support and conversation groups. Program activities and timeline are described in Talking Tech is a 14-week in-home, one-on-one, volunteer-delivered ICT training intervention. Older adults were paired with a volunteer, called a TechMate, and provided a Surface Pro tablet and internet connection, if needed, to learn how to use a computer device and the internet to socially connect with new and existing contacts Talking Tech was designed by MOWA and the university team, which met weekly to determine program milestones and deliverables. Feedback was sought from MOWRI leadership. During implementation, all partner organizations met weekly to discuss successes and challenges and further refine program delivery. For example, partners discussed improvements to TechMate training in light of TechMate questions and challenges, including additional training on hotspot set up and device troubleshooting and parameters around escalating participant concerns.MOWRI recruited Talking Tech participants from their home-delivered meal program, using multiple methods including meal delivery driver referrals, program fliers accompanying delivered meals, and email outreach to clients who self-identified as lonely in an annual client survey. Participants were 60 years or older and homebound. Twenty-one MOWRI clients enrolled in Talking Tech. Volunteers were initially recruited from the existing pool of MOWRI's ~700 annual volunteers through a volunteer appreciation event, by email, and by social media. Due to challenges recruiting existing MOWRI volunteers described below, MOWRI then solicited volunteers through an online volunteer portal, corporate partnerships, and posting fliers at a local university. TechMates were required to have existing computer and internet knowledge. Eighteen individuals volunteered as TechMates.Tech4Life trained volunteers in a 1-h training session. Volunteers were given a manual containing program goals, expectations for TechMates and participants, module lesson plans with step-by-step instructions and objectives, participant worksheets, and a Well Connected catalog with class schedules. Instructional handouts on setting up the tablet and appropriate shortcuts, setting up a hotspot internet connection, and accessing Well Connected were also included. Training was offered in-person on two occasions in September and November 2019 and by video recording. Thirteen volunteers attended the in-person training and 7 volunteers viewed the recorded training; upon completing training, two individuals withdrew from participating as TechMates due to self-described limited technology comfort and knowledge.To understand participant experiences and satisfaction with Talking Tech, researchers conducted semi-structured interviews with 18 of the 21 participants after intervention completion; one participant withdrew and two participants were unable to be reached. Interview questions focused on technology usability, perceived impact of internet and Well Connected use on well-being, and satisfaction with Talking Tech components. Three TechMates and two MOWRI program staff were interviewed to understand implementation experiences, facilitators and barriers to program implementation and delivery, observed participant satisfaction, and suggestions for improvement. Initially, participant interviews were conducted within 2 weeks of intervention completion in participants' homes with written informed consent; however, due to COVID-19, only four interviews were conducted in-person. Remaining interviews were conducted by telephone and verbal consent was obtained. Participant interviews lasted between 20 and 90 min. Interviews with staff and TechMates were conducted by telephone after the intervention period and verbal informed consent was obtained. TechMate interviews lasted 40–60 min and staff interviews were 15–60 min. All interviews were audio recorded with consent and transcribed.During the first 4 weeks, TechMates submitted a report to the Talking Tech coordinator at MOWRI after each participant interaction, documenting the duration of the interaction, participants' questions, participant comfort level and interest with the technology, including the tablet, internet, and Well Connected, challenges, and ideas for program improvement . While oQualitative data were analyzed using a thematic analysis approach . Three rIn this paper, we describe facilitators, barriers, and lessons learned of Talking Tech implementation from the MOWRI perspective, as identified from interviews with Talking Tech participants, volunteers, and MOWRI program staff .Aspects that facilitated Talking Tech implementation included the existing relationship between MOWRI and its clientele; an established infrastructure to deliver community-based programs; alignment of intervention goals with broader organizational aims; and funding to support dedicated program staff and materials., “[TECHMATE NAME] delivers my meals so I had met him and knew him but he's just, it was nice having him here… I was very comfortable” (Participant 1). The existing relationship with MOWRI facilitated trust among participants and familiarity with whom to call if questions or issues arose. One participant described turning to the Talking Tech coordinator at MOWRI when they encountered technology issues since they already knew and were comfortable calling the organization phone number: “I tried to use [the tablet] quite a few times, and then I got stuck. I don't know what I did, but I called [Program Coordinator]. and she was able to get me out” (Participant 8).Both participants and organization staff noted the importance of participants' existing relationship with the delivery organization. For MOWRI, it enabled identification of potentially socially isolated homebound older adults, allowing for a targeted approach to participant recruitment. As existing clients, intervention participants had already developed a relationship with MOWRI personnel. In some instances, participants' regular meal delivery drivers also served as their TechMate. One participant, speaking to the relationship they had developed with their TechMate who also volunteered as their meal delivery driver statedI definitely think it's something that could be implemented here, for sure. It's a good fit” (MOWRI Staff 2). Additionally, MOWRI leadership stated that Talking Tech's aims to reduce social isolation and loneliness fit “perfectly” within their organization's mission, as well as their push to modernize services (MOWRI Staff 1). These factors led to leadership supporting the program, which facilitated prioritization of meeting program goals among staff.The home-based, volunteer-delivered model used to deliver Talking Tech was similar to the design of the home-delivered meal program in which volunteers deliver meals to clients homes, which allowed MOWRI to utilize existing volunteer recruitment and training workflows in the operation of Talking Tech. Speaking to the suitability of Talking Tech with existing workflows, one MOWRI staff member noted, “Once we moved [her] onto the project, I felt like we really kind of were able to better deliver on it. So, that was having a staff member that had organization and communication and management skills.” In addition to enabling MOWRI to dedicate a part-time staff member, funding ensured participant access to tablets and hotspot internet connections. By providing tablets and internet free of cost to participants, the intervention was accessible to the low-income, homebound older adult population that the organization serves. Program leadership noted that Talking Tech “created an opportunity for [clients] to get connected by breaking down barriers, such as access to a computer or access to the internet” (MOWRI Staff 1), and that the tablet was the “biggest benefit” because “clients that participated and received the Surface Pro in all likelihood never would've been able to purchase such a thing on their own” (MOWRI Staff 2).Funding to support the intervention was noted as a critical resource, as it allowed for dedicated staff time and the purchase of necessary materials . Staff reported that low digital literacy was common among their older adult clientele, which contributed to significant time spent recruiting participants, fielding questions, and supporting participants. Staff reported that to properly support MOW clients, at least one part-time staff member was needed to coordinate program implementation and delivery. One MOWRI staff member described the Talking Tech coordinator as key to the success of the implementation of the intervention, stating, “Challenges to implementation included the time- and resource-intensity of the intervention for MOWRI; data sharing restrictions across partners; participant and volunteer recruitment; and interruptions in program delivery due to the COVID-19 pandemic.Organization staff reported that they had not anticipated how much time and effort would be required for implementation. MOWRI leadership stated:It was a very labor-intensive project. Coordinating the volunteers, the seniors, so on and so forth, that we would have been able to maybe do a little bit more if we had a full-time person really focused on the work” (MOWRI Staff 1).“much more time involved” and “a lot more daily work” than they had anticipated due to “all of the calls” (MOWRI Staff 2). Recruitment calls were overwhelming not only because of the “volume of calls” but also because each conversation with a potential participant “was a very long conversation” due to the “isolated and lonely” nature of clients (MOWRI Staff 2). In addition to answering client and Talking Tech participant questions about the program, the Talking Tech coordinator reported that much of the unanticipated lift of the program involved acting as additional technology support and functioning as a liaison between participants and volunteers. Additionally, the coordinator reported spending unanticipated time outside business hours resolving logistical issues arising from tablet set up and hotspot issues.The Talking Tech coordinator described the program as “some confusion” among TechMates regarding when TechMate reports should be submitted, and that while she was able to “chase down” some reports she did not have the time to collect all reports (MOWRI Staff 2). The university team then tracked completion via participant interviews for evaluation purposes.While collaboration between partner organizations was necessary to develop and deliver the program without requiring greater resources from MOWRI, issues with implementing data sharing processes led to data tracking and reporting issues that impacted efforts to assess participation in Well Connected and TechMate lessons. Changes in data privacy policies prevented Covia from sharing complete records of participants' Well Connected use. To remedy this situation, Covia asked TechMates to track participant use of Well Connected and tell participants to include the tag “RI” in their username to identify participation in Talking Tech. Inconsistency among TechMates in submitting weekly TechMate reports complicated MOWRI and the university study team's ability to track TechMate lesson completion. The Talking Tech coordinator described “greatest challenges” encountered during implementation and that they “did not anticipate that we would have to work so hard at it” (MOWRI Staff 2). While MOWRI had pre-existing clientele and volunteer pools, the organization struggled initially to identify clients who were interested in participating in a technology-based program. The Talking Tech coordinator noted that clients declined participating because they “felt that they were just too old to learn something new,” were “hesitant to have a stranger in their home,” or that “they didn't want to make a commitment of meeting with somebody once a week” because it was seen by clients as “an extra responsibility,” despite its design to be a benefit. Additionally, MOWRI exhausted many channels to recruit volunteers, including both within and outside of the organization. Staff reported difficulty “getting enough people to sign up” as volunteers (MOWRI Staff 2), despite having a large volunteer pool, in part due to the multi-week time commitment required of TechMates.MOWRI staff described participant and volunteer recruitment as the “via telephone, many participants expressed disinterest in continuing lessons remotely during the pandemic. They preferred to either wait until the risk of disease transmission dissipated and social distancing restrictions were lifted, or they turned to family members for support.Due to the COVID-19 pandemic, many participants' training lessons were interrupted, and some stopped altogether. While MOWRI encouraged TechMates to continue lessons [W]hen the pandemic struck, we had to cease all in-person visits. Every TechMate was encouraged to continue the program via telephone. […] For some clients, I don't know if they felt like they couldn't do it over the phone because that was just too difficult. They had a hard enough time understanding things in person” (MOWRI Staff 2).“However, MOWRI staff noted:We discovered that [Talking Tech] was even more needed. During COVID-19, when Meals on Wheels recipients really didn't have any access to family members or friends, and we saw many more seniors at that point trying to access online resources” (MOWRI Staff 1).“Interviews yielded a wealth of information regarding lessons learned. These included the importance of identifying successful participant and volunteer recruitment strategies to inform future recruitment efforts; using a targeted approach to identify potential participants and volunteers; incorporating flexibility into intervention design when working with the homebound older adult population; and monitoring the participant-volunteer relationship through TechMate reports to mitigate issues.who had already indicated that they were comfortable using the internet… and who were open to an additional opportunity for something that would make them feel connected to the outside world” (MOWRI Staff 2). While challenges in recruitment were in part due to client hesitation, those who ultimately participated found free access to a computer device and online programming a strong incentive to join:Findings suggest that a targeted approach to identifying appropriate participants and volunteers needs to be considered when designing a technology-based program. As a pilot intervention, the purpose of this study was to determine which processes, including recruitment methods, should be implemented in a larger intervention. MOWRI staff identified targeting clients with an email address and who self-reported as lonely was the most effective participant recruitment strategy. However, the study team found that some participants were hesitant to discuss experiences of social isolation or loneliness with the research team during surveys and interviews, highlighting potential challenges for targeting and engaging isolated or lonely older adults in this work. The Talking Tech program coordinator at MOWRI described the easiest clients to recruit as those “The people who decided to participate and saw it as a very positive thing were floored that there was a program that was going to give them [a tablet]. They were very interested about the kinds of programming that they would have access to” (MOWRI Staff 2).“a volunteer pre-survey to give folks to judge their level of knowledge and comfort with technology would be good, especially considering that we looked to our existing volunteer base, which is largely older folks themselves” (MOWRI Staff 2). Volunteers, participants, and MOWRI staff also supported the recommendation of having a dedicated on-call technology support personnel to consult for advanced technology issues. Such a resource would expand the technological expertise available to participants and reduce the amount of time the Talking Tech coordinator spent fielding participants' technology-related questions. One TechMate suggested, “I don't know if there's a way to have a tech person who's assigned to this study that can help the participants. …That would be really great” (TechMate 2). As mentioned previously, two potential volunteers withdrew from participating after attending a training session because they felt that they would be unable to perform the technological tasks required of a TechMate, suggesting the need for targeted recruitment strategies and TechMate training evaluation to assess the effectiveness of training in preparing volunteers. While TechMates were asked about the effectiveness of training in interviews, no formal evaluation of TechMate training was performed in this pilot study. TechMates who were interviewed reported that the training was sufficient, however all three TechMates had extensive prior computer and internet experience.Given the range of technology comfort and experience among TechMates, the Talking Tech coordinator suggested screening potential TechMates based on technology knowledge and skills, stating “Further, organizations should consider the aims of an ICT training program and who the corresponding target audience is in order to tailor recruitment efforts. The program coordinator noted that while a broader program goal may allow a wider reach, it may be more difficult to implement and evaluate compared to a goal with a specific audience in mind. While the specific goal of Talking Tech was to reduce social isolation and loneliness with a broader aim of increasing access to and use of technology, MOWRI staff stated that:The [participants] that felt most comfortable using the technology had used some form of the internet or technology before. The folks that were targeted for this, the most elderly folks who did sign up and who had never used the internet on their own or anything were the folks that really became easily frustrated” (MOWRI Staff 2).“[clients'] top concerns were being able to utilize [the tablet] and the difficulty associated with accessing the [Well Connected] programs,” (MOWRI Staff 2), and as such volunteers should be prepared to address participants' technology concerns. TechMates described addressing clients' vision and dexterity impairments by changing font sizes and screen contrast and supplying stylus pens or computer mouses for those who were unable to use the tablet trackpad or touchscreen.At the same time, the Talking Tech coordinator described needing to be flexible in the approach to working with homebound older adults. As many homebound organization clients have multiple chronic conditions that cause health complications, the coordinator reported participants canceling lessons with volunteers at the last minute due to health-related problems as a common challenge to carrying out training lessons. When working with the homebound older adult population, organizations should be cognizant of the additional barriers they face to participating in a weekly program and build flexibility into programs to accommodate participant needs. As the coordinator stated, “In addition to flexibility and accommodating needs, TechMates who were not prior MOWRI meal delivery drivers noted that training on communicating with older adults and making accommodations for participants with audio, visual, or mobility impairments would be helpful additions to volunteer training. One TechMate spoke to this need, saying:I had worked with older adults before [.] so I felt fairly comfortable working with that population. But maybe others who haven't worked with older adults much would benefit from some guidance. And then maybe going into someone else's home, how you kind of navigate that setting” (TechMate 3).“While three TechMates were existing MOWRI volunteers who had received prior training and were accustomed to working with older adults in an individualized manner, these recommendations suggest that such interpersonal training is imperative for programs involving volunteers who work with older adults. For organizations with existing volunteer-based programs, volunteer-delivered ICT training programs can capitalize on or supplement existing volunteer training sessions.via weekly volunteer-submitted TechMate reports. These reports allowed MOWRI to identify emerging issues and intervene before escalation. For example, staff noticed via TechMate reports that one participant was becoming increasingly disengaged from learning as the intervention progressed, with the TechMate noting, “She shows less interest as she considers it too confusing for her” after the second lesson. The program coordinator was able to contact the participant, who ultimately decided to withdraw from the program, and reassign the TechMate volunteer to a new participant. The TechMate, who was highly engaged in Talking Tech, reported that this reassignment led to a rewarding relationship with their new participant and the participant's successful engagement with the program. In TechMate reports, the TechMate described the participant as “excited about learning” and that “she responded well to instruction and is excited to do her ‘homework' as she calls practicing basic use of the computer.”Finally, MOWRI monitored the participant-volunteer relationships over the course of the intervention This community case study reveals facilitators and barriers of implementing and delivering a community-based ICT training program for homebound older adults. We also include lessons learned and considerations for scalability and sustainability that may aid other CBOs in developing and implementing socialization programs for homebound older adults.While social isolation and loneliness worsened during the COVID-19 pandemic , one stuTo be effective among older adults, technology-based interventions must also incorporate elements of supportive training and ongoing assistance to overcome barriers specific to older adults, such as lack of experience, technology illiteracy, and fear of using technology , 34. As Our findings highlight recruitment and adherence considerations. During the program design phase, organizations should consider the interests, needs, and experiences of the target population in concert with the resources and approaches available to deploy for recruitment. We found that a targeted recruitment strategy involving direct outreach to self-identified lonely clients with an email address was the most successful recruitment approach. In order to perform targeted recruitment, programs will need systems in place to capture participant characteristics of interest, such as internet or technology use or comfort, assessed here by having an email address, and possible loneliness or social isolation. To identify who may be the most likely to benefit from the intervention, CBOs should consider using a validated screening scale such as the Upstream Social Isolation Risk Screener (U-SIRS)  to assesConsiderations central to scaling and sustaining ICT training interventions include the cost and resources needed to deliver such a program, including physical materials, staff, and training. Talking Tech's use of a volunteer-delivered model can be scaled with program expansion as layperson-delivered interventions can be brought to scale more quickly than interventions requiring licensed professionals. CBOs must consider recruitment strategies and balance the demand for volunteers and the available resources for a 14-week intervention such as Talking Tech. The experience of MOWRI suggests that a part-time or full-time staff position is necessary to coordinate implementation and delivery of the program, as participants will likely reach out to the organization directly with questions or concerns. Given the issues and concerns faced by the Talking Tech coordinator, we recommend that an individual with a background in social work is best suited to coordinate an ICT training program.Difficulties with tracking enrollment and Well Connected participation highlight the complexity of implementing an intervention involving multiple collaborating organizations. Data collection and monitoring challenges are common in health-related cross-sector collaborations, and overcoming these challenges are integral to success . In our One limitation of this pilot study is the small sample size of homebound older adults. However, as a pilot study reporting qualitative data, findings are not intended to be generalizable to other populations and are meant to be used to refine program development for future expansion. Additionally, interviews were conducted with only three volunteers and therefore may not capture the diversity of experiences among TechMates. Lastly, selection bias may have been introduced due to recruitment methods of participants and volunteers, as well as the absence of screening measures for social isolation, loneliness, and prior technology knowledge or use.In light of physical distancing resulting from the COVID-19 pandemic, older adults may benefit from technology-supported social interactions. As community-based organizations and researchers seek to address social isolation and loneliness in homebound older adults, they must consider organization-level implementation facilitators and barriers to develop sustainable and effective programs. The facilitators, barriers, and lessons learned identified in Talking Tech can inform development and implementation of ICT training programs by other community-based organizations and researchers to support homebound older adults both during and beyond the pandemic.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.JB, LF, EG, and KT contributed to conception and design of the intervention program. JB, EG, and KT contributed to conception and design of the study. FJ acquired the data and prepared the manuscript. JB, ND, EG, and FJ analyzed and interpreted study data. All authors contributed to manuscript revision, read, and approved the submitted version.This work was supported by Meals on Wheels America and the Aetna Foundation. Meals on Wheels America was involved in conception and design of the intervention, reviewed the manuscript, and approved the submitted version. MOWA was not involved in any aspect of study design, acquisition of subjects and/or data, or analysis and interpretation of data. The Aetna Foundation was not involved in any aspect of study concept and design, acquisition of subjects and/or data, analysis and interpretation of data, or preparation of manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. 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