Frederick S. Pardee RAND Graduate School

BACKGROUND:Food insecurity is associated with increased alcohol consumption among people living with HIV (PLHIV). Few studies have explored whether interventions to reduce food insecurity might also mitigate alcohol use. We examine whether a pilot urban gardens and peer nutritional counseling intervention ("ProMeSA") among PLHIV experiencing food insecurity in the Dominican Republic (DR) was associated with reduced alcohol consumption. METHODS:We recruited 109 participants from two HIV clinics: 1 intervention clinic (n = 46) and 1 control clinic (n = 63). The 12-month intervention included training, materials, and support to establish and maintain a garden; peer nutritional counseling sessions; and a garden-based nutrition and cooking workshop. Survey-based measures included a standard measure of alcohol use (AUDIT-C) and hazardous drinking derived from the AUDIT-C score. Intervention effects were analyzed using a differences-in-differences approach implemented via longitudinal multivariable regression accounting for serial cluster correlation. RESULTS:At baseline, the mean AUDIT score was 2.35, indicating low-risk for problematic drinking on average; however, one-third (34%) reported hazardous drinking. Between baseline and 6 months, AUDIT scores decreased by 0.6-points on average (p = 0.155; 95% CI: -1.45, 0.23) and the prevalence of hazardous drinking decreased by 11 % points (p = 0.146; 95% CI: -0.27, 0.04) in the intervention group compared to the control group. At 12 months, average alcohol use was lower for both intervention and control participants. CONCLUSIONS:Addressing food insecurity through urban gardening and peer nutritional counseling may decrease alcohol consumption among PLHIV. Larger trials are needed to confirm effects and examine if they are sustained across settings and timeframes.

Objective To quantify the costs associated with a stepped model of depression care—Integrated Chronic Care Clinics-Depression Module (IC3D)—in rural Malawi.Design Cross-sectional cost analysis.Setting Integrated chronic care clinics (n=14) throughout Neno District, Malawi.Interventions The stepped model of depression care provided behavioural therapy (Problem Management Plus (PM+)) to adults (aged 18+) with moderate depression and joint PM+ and antidepressant therapy (ADT) to those with moderate-to-severe and severe depression. The model incorporated two cost-saving features: treatment was integrated into existing chronic care services within the health system, and PM+ was group-based rather than one-on-one.Primary and secondary outcome measures We conducted time-driven activity-based costing to quantify the marginal economic cost of implementing PM+ and ADT, inclusive of training and supervision. We measured all costs in 2025 US dollars and quantified costs from a societal perspective—including human resources, infrastructure, equipment, consumables, indirect costs and opportunity costs.Results The marginal cost of PM+ was $90 per patient treated for five sessions over 2 months, while ADT was $138 for eight sessions over 8 months. In both instances, human resources (45% from PM+, 52% for ADT) and consumables (30% for PM+, 31% for ADT) represented primary health system cost drivers. In the first year of implementation, 15 002 depression screenings were conducted, 724 adults were evaluated with a diagnostic tool and 398 adults subsequently received care: 263 received PM+ alone, 31 received ADT alone and 104 received both PM+ and ADT. The total cost of introducing operations throughout Neno District was $62 806.Conclusions These findings indicate that integrating depression care services into the Malawian health system is financially feasible and successfully reached many individuals with major depressive disorder.Trial registration number NCT04777006.

The COVID-19 pandemic accelerated the adoption of telehealth services, including at mental health treatment facilities (MHTFs). Policy changes at federal and state levels facilitated this transition by allowing qualified providers to offer telehealth services and expanding the settings where such services could be delivered and reimbursed. Despite these policy changes, there remains considerable variation in the use of telemental health among MHTFs. Our goal was to explore the underlying reasons for this variation. We conducted 16 qualitative interviews with administrators from MHTFs across the United States. Through thematic analysis, we identified several key factors influencing the adoption and expansion of telemental health services. Clinic transformation was a significant challenge for MHTFs transitioning to telehealth, particularly for those without prior experience. Staff buy-in and motivation were crucial factors affecting the willingness of clinicians to offer telehealth services, some expressing discomfort or skepticism about its efficacy. Financial considerations, such as revised reimbursement guidelines, also played a role in facilitating the implementation or expansion of telemental health. Additionally, the policy environment, including changes in reimbursement and HIPAA compliance requirements, influenced MHTFs’ ability to provide telehealth. Administrators shared that telemental health offers several benefits, including increased flexibility for patients and staff. However, they also noted challenges, including issues related to internet connectivity and concerns about the quality of care. Overall, this study highlights the complex interplay of factors shaping adoption of telemental health services in MHTFs and underscores the importance of addressing barriers to ensure equitable access to care.

This article discusses considerations for implementing artificial intelligence (AI) into the corrections career fields through the lenses of internal control and mission operations. The corrections community of practice has a precedent for using technology to support both enabling functions, which are described as internal control, and mission functions, described as those directly associated with corrections operations. Corrections professionals can borrow from other more centralized arms of government for best practices in leveraging AI for the procedures and practices that are common law for all in the community to follow or that could be considered best practices but are not necessarily mandated by law. After a precursory discussion on the corrections career field not being new to the incorporation of technology, this article then discusses how AI implementation could be considered in corrections mission operations. The article then discusses considerations for AI in internal control functions through the lens of career development using a talent management construct, before concluding with limitations to consider when implementing AI into the corrections community.

Quantum computing is expected to eventually be able to break the public-key cryptography algorithms currently used throughout information technology (IT) infrastructure, undermining foundational tools used to maintain information security across the country's critical infrastructure. As these systems converge, the security posture of operational technology (OT) systems has to adapt to a new threat landscape and adopt some of the same security controls as those used in enterprise IT, especially cryptographic controls that rely on public-key cryptography, which are ubiquitous in enterprise IT systems. Operators and manufacturers of industrial control systems (ICSs) and OT systems will need to understand and address the unique ways in which these systems will be vulnerable to adversaries equipped with quantum computers. We assessed quantum computing–facilitated cryptographic vulnerabilities in ICSs and OT systems to identify the issues in need of the most-urgent attention from ICS and OT owners, operators, and manufacturers. Employing a modified consequence-driven, cyber-informed engineering process informed by literature review and analysis, we mapped protocols using or enabling cryptographic protections across common ICS network topologies as part of an assessment of how an attacker could cause harm, especially damaging physical consequences resulting from manipulation of cyber–physical systems, through the cryptographic compromise of ICS and OT networks and components. Our evaluation of identified and ranked risks to related control systems was also informed by relevant literature on ICS risk assessment and mitigation, cyber harms, and historical attacks on critical infrastructure. Using our analysis, we assessed the overall difficulty in mitigating risk from each of the identified vulnerability archetypes. The resulting analysis identified vulnerabilities associated with code-signing processes as the highest priority for attention when updating systems for a postquantum future. This risk was followed by vulnerabilities associated with forged certificates for identification and vulnerabilities associated with forged session keys, identified as lower priorities but still of concern. Informed by our findings, we offer recommendations related to the protection of these vulnerabilities and the improvement of ICS security in developed systems.