Cyanobacteria harmful algal blooms (cHABs) are increasing in frequency, intensity and duration in estuaries worldwide. In the upper San Francisco Estuary, also known as the Sacramento San Joaquin Delta (Delta), cHABs have been a topic of concern over the past two decades. In response, managers are urgently working to understand the factors that drive cHABs and identify feasible management options to avert ecological and human health consequences. We used a six year data set to explore relationships between flow parameters, temperature, and Microcystis biovolume to determine the potential for managing large scale hydrodynamic conditions to address Delta cHABs. We also looked at the relationship between Microcystis biovolume and the low salinity zone to see if it could be used as a proxy for residence time, because residence time is positively related to cyanobacteria abundance. We found the low salinity zone is not a useful proxy for residence time in the area of the Delta that experiences the most severe cHABs. Our finding suggest that climatic conditions (i.e., temperature and water year type) have the greatest influence on Microcystis biovolume in the Delta, with higher biovolume during years with lower flow and higher temperatures. Further, there are interannual differences in Microcystis biovolume that cannot be fully explained by flow parameters or temperature, meaning other factors not included in our model may be involved. We conclude that management actions to increase flow may be ineffective at reducing Microcystis to desired levels if water temperatures remain high.

BACKGROUND: Almost half of all women in the US experience intimate partner violence (IPV) in their lifetime. The US Preventive Services Task Force recommends IPV screening paired with intervention for women of reproductive age. We aim to understand clinical practices and policies that are beneficial, detrimental, or insufficient to support survivors of IPV in a safety-net healthcare system.
METHODS: We sampled 45 women who were 18-64 years old, had experienced IPV within the prior year and were patients in the San Francisco Health Network. We conducted in-depth, semi-structured interviews to elicit their perspectives on disclosing IPV and obtaining support within the healthcare system. We analyzed our data using thematic analysis and grounded theory practices informed by ecological systems theory.
RESULTS: We identified four themes regarding factors that impeded or facilitated discussing and addressing IPV across interpersonal and systemic levels relating to relationship-building, respect, autonomy and resources. (1) Interpersonal barriers included insufficient attention to relationship-building, lack of respect or concern for survivor circumstances, and feeling pressured to disclose IPV or to comply with clinicians\' recommended interventions. (2) Interpersonal facilitators consisted of patient-centered IPV inquiry, attentive listening, strength-based counseling and transparency regarding confidentiality. (3) Systemic barriers such as visit time limitations, clinician turn-over and feared loss of autonomy from involvement of governmental systems leading to separation from children or harm to partners, negatively affected interpersonal dynamics. (4) Systemic facilitators involved provision of resources through IPV universal education, on-site access to IPV services, and community partnerships.
CONCLUSIONS: Women experiencing IPV in our study reported that relationship-building, respect, autonomy, and IPV-related resources were essential components to providing support, promoting safety, and enabling healing in the healthcare setting. Successful trauma-informed transformation of healthcare systems must optimize interpersonal and systemic factors that improve survivor wellbeing while eliminating barriers.

Response to the coronavirus disease (COVID-19) pandemic revealed gaps in medical supply quality and personnel training and familiarity in San Francisco County, prompting the reexamination of county disaster supply caches and emergency medical services (EMS) system decompression protocols. Project RESPOND (Rapid Emergency Supplies for Prehospital Operations in Disaster) was developed to bridge the gap in patient care infrastructure during short- or no-warning disasters and enhance EMS system offloading by introducing a novel capacity for the safe treatment and discharge of patients with minor injuries from the scene of an event. This design, while scaled to the needs of a unique metropolitan population, can be used as a template for the reimagining of disaster response policy and development of disaster supply caches.

Demonstrating how psychoanalysts can be useful in community settings outside the conventional consulting room, this paper describes consultation and group interventions conducted at a San Francisco mental health agency serving a largely Asian community. In the traumatic context of the COVID-19 pandemic, agency staff became fragmented, due to remote working conditions and differential work assignments, including mandated deployments to emergency sites. Two psychoanalysts worked with agency leadership to devise a weekly process group held by video conferencing over 6 months, in an attempt to heal resentments and splits in the fabric of the agency. Examples of the group process, interventions, and major themes that emerged are described, as well as recommendations made, including the formation of an ongoing clinical consultation group. The paper situates these interventions in the greater context of the pandemic which exposed not only a universal threat to life and health, but also structural vulnerabilities organized along lines of (racial) difference and inequity. The dynamics at the agency are thus described as rooted within greater nested histories: of the clinic, its leadership, and their relationship with a strained public health system, and more broadly, of the tangled intersection of these histories with anti-Asian racism. These are understood as manifestations of the Social Unconscious, and the intervention as an example of Community Psychoanalysis.

This investigation explored (1) correlations between midlife and older adults\' air quality perceptions with objective particulate matter 2.5 (PM2.5) and diesel PM, and (2) correlations between air quality perceptions with health-related attributions among a sample of midlife and older adults (n = 66) living in or around senior affordable public housing sites in California\'s San Francisco Bay Area. The adapted air quality perception scale was used to measure perceptions of air quality, while health-related attributions were obtained from the vitality plus scale (VPS), with higher values indicating worse perceptions of air quality and poorer responses to health-related attributions, respectively. Self-reported data were linked to zip code level PM2.5 and diesel PM obtained from the CalEnviroScreen 4.0. All correlations were evaluated using Spearman\'s rank correlations. The mean (SD) age was 70.6 (9.1) years, and 75.7% were female. We observed moderate, positive correlations between both PM2.5 and diesel PM with three domains: perceptions related to protection measures against air quality, emotional/mental perceptions, and sensorial perceptions. We also found evidence of moderate, positive correlations between the domains of physical symptoms, perceptions related to protection measures against air quality, and emotional/mental perceptions with health-related attributions, such as sleep-related items and feelings of restlessness or agitation. Results from this exploratory study suggest that midlife and older adults\' perceptions of air quality may be moderately related to both objective air quality data and certain health behaviors and symptoms. Findings underscore the importance of considering individual perceptions as an additional area in public health strategies aimed at protecting midlife and older adults from the impacts of air pollution.

BACKGROUND: Mobile crisis teams (MCTs) can be important alternatives to emergency medical services or law enforcement for low-acuity 911 calls. MCTs address crises by de-escalating non-violent situations related to mental health or substance use disorders and concurrent social needs, which are common among people experiencing homelessness (PEH). We sought to explore how an MCT in one city served the needs and supported the long- and short-term goals of PEH who had recently received MCT services.
METHODS: We conducted 20 semi-structured interviews with service recipients of the Street Crisis Response Team, a new 911-dispatched MCT implemented in San Francisco in November 2020. In the weeks after their encounter, we interviewed respondents about their overall MCT experience and comparisons to similar services, including perceived facilitators and barriers to the respondent\'s self-defined life goals. We analyzed interview transcripts with thematic analysis to capture salient themes emerging from the text and organized within a social-ecological model.
RESULTS: Nearly all respondents preferred the MCT model over traditional first responders, highlighting the team\'s person-centered approach. Respondents described the MCT model as effectively addressing their most immediate needs (e.g., food), short-term relief from the demands of homelessness, acute mental health or substance use symptoms, and immediate emotional support. However, systemwide resource constraints limited the ability of the team to effectively address longer-term factors that drive crises, such as solutions to inadequate quality and capacity of current housing and healthcare systems and social services navigation.
CONCLUSIONS: In this study, respondents perceived this MCT model as a desirable alternative to law enforcement and other first responders while satisfying immediate survival needs. To improve MCT\'s effectiveness for PEH, these teams could collaborate with follow-up providers capable of linking clients to resources and services that can meet their long-term needs. However, these teams may not be able to meaningfully impact the longstanding and complex issues that precipitate crises among PEH in the absence of structural changes to upstream drivers of homelessness and fragmentation of care systems.

Harm reduction officially entered the public health lexicon in the 1980s as a response to the HIV/AIDS crisis and its spread amongst intravenous drug users, but risk prevention has been an important part of psychedelic consumption in ways that predate this formal conceptualization.We look at psychedelic drug trials in the 1950s and 1960s to consider how people-first perspectives informed those early clinical studies, and how pioneering psychedelic researchers themselves approached risk management at a time that predates the formal recognition of harm reduction. Next, we follow psychedelic drugs out of the clinic and into music scenes and festivals that proliferated during the war on the drugs, where community-based organizations stepped up to support music fans who chose to combine psychoactive substances with dancing and drugs at all-day festivals. Finally, we reflect on the longer history and traditions of the Native American Church as one specific example of how Indigenous ceremonies involving psychedelic substances combined spirituality and healing in a community setting curated to promote wellness. Ultimately, we argue that psychedelic risk management has deep historical roots in psychedelic communities representing biomedical, cultural, and Indigenous perspectives - we might heed these historical lessons as we consider how to promote sustainable risk management strategies with psychedelics going forward.

BACKGROUND: Dietary acculturation is the process by which diet and dietary practises from the environment of origin are retained or changed and/or those prevalent in a new environment are adopted. Despite rapid population growth the U.S., knowledge gaps exist on characterising dietary acculturation among Asian American, Native Hawaiian, and Pacific Islander communities (AANHPI). This study characterise dietary patterns in a sample representative of AANHPI on key demographic characteristics.
METHODS: Data were from a 2013-2014 population-based case-control study in the San Francisco Bay Area, U.S. Survey items were adapted from dietary acculturation scales developed for AANHPI populations. Validated measures assessed social capital, social standing, discrimination and immigration experiences. A principal components factor analysis was conducted to characterise dietary patterns of acculturation.
RESULTS: Three dietary patterns were identified: \"Asian,\" \"Western,\" and a distinct \"Multicultural\" factor. Respondents reporting a high-Asian diet tended to also report smaller social networks, higher levels of stress, and, among those born outside of the U.S., an educational standing that was better before immigration. Respondents reporting a high-Western diet tended to also report the highest level of discrimination. Those reporting a high-Multicultural diet tended to report higher neighbourhood collective efficacy.
CONCLUSIONS: The finding of a distinct \"Multicultural\" factor beyond the typical \"Asian\" and \"Western\" factors may reflect the multidirectional relationships between culture, diet, and dietary behavior, in which origin and destination cultures interact in complex ways and where foods from multiple ethnicities intermix.

BACKGROUND: Due to the significant increase in the prevalence of food-related diseases, the value that physicians place on nutritional advice may have implications for patient treatment. The objective of this study was to evaluate the perception of the importance of nutritional intervention among physicians in the Universidad San Francisco de Quito\'s (USFQ) healthcare system.
METHODS: This cross-sectional study employed a telephone survey administered to a subset of all medical doctors (MDs) working in the healthcare system clinics of USFQ between 2021 and 2022. Study participants were recruited through voluntary response sample from a complete list of 253 MD. The single time questionnaire consisted of a 22-item validated survey in which attitudes, self-perceived capacity, and knowledge about nutrition ofmedical doctors were evaluated. Data was analyzed using descriptive statistics, two-sided t test, bivariate associations and linear and logistic regressions.
RESULTS: 136 MDs completed the survey yielding a response rate of 54%. Our analysis grouped participants into clinical (CE) and non-clinical specialties, hereafter referred to as surgical MDs. While a higher percentage of physicians in CE are confident in their ability to provide examples of recommended food portions based on national or international guidelines, 1 in 10 do not know how to use and interpret BMI or waist circumference, and around 1 in 3 do not know how many calories there are in one gram of fat, protein, or carbohydrates, and their basic metabolic functions. Almost all survey participants believe MDs can have an impact on the eating behavior of a patient if time is used to discuss the problem, however, almost half of survey participants believe nutrition counseling is not an effective use of time.
CONCLUSIONS: It is important to explore the perceptions and self-confidence of physicians around nutrition related issues. Our results demonstrated that nearly 1 in 4 surgical MDs do not feel capable of recognizing nutritional risk in patients, which highlights the essentiality of physicians having an updated understanding of basic nutrition principles. Future research should examine how commonly MDs refer patients to nutritionists/dietitians, as well as strategies for improving physician knowledge on basic nutrition concepts.

BACKGROUND: Over 1 million people in the US are infected with human immunodeficiency virus (HIV). As of 2021, pharmacists in California can prescribe PrEP and PEP without establishing a collaborative practice agreement in an effort to reduce HIV transmission. However, in 2021 less than 3% of independent pharmacies in the San Francisco Bay Area did so. To our knowledge, there has been no follow-up research assessing potential changes in PrEP/PEP furnishing rates in the region.
OBJECTIVE: Assess the extent of PrEP/PEP furnishing in San Francisco Bay Area pharmacies 3 years after policy implementation.
METHODS: We conducted an observational, cross-sectional study to identify independent community and mail-order pharmacies furnishing PrEP/PEP in the 9-county San Francisco Bay Area in 2024. Furnishing pharmacies were identified via phone calls and the findings were validated with in-person visits. We also identified the number of retail chain pharmacies furnishing PrEP/PEP in San Francisco County.
RESULTS: We contacted 202 independent community and mail order pharmacies in the 9-county San Francisco Bay Area by telephone; of these, 16 reported furnishing PEP/PrEP and all confirmed their ability to furnish when visited in person. We contacted 67 retail chain pharmacies in San Francisco County; of these, 11 pharmacies reported furnishing PrEP/PEP (10 Safeway; 1 Walgreens).
CONCLUSIONS: More pharmacies furnished PrEP/PEP in the 9-county San Francisco Bay Area in 2024 (8%) than in 2021 (3%); in addition, one retail chain pharmacy had instituted a furnishing protocol. However, furnishing rates remained low. Past research suggests that advertising and the development of furnishing protocols may help increase furnishing and increase medication access.