One of the aims of the ARES project is to “help to design reliable systems with embedded software that satisfy important quality requirements, evolve gracefully and may be built in-time and on-budget.” The development process should be designed to support this. If we simplify enough, each development process for product families looks like this: 
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Development Process

Understanding and addressing the unique health needs of people residing in rural America is critical to the American Heart Association's pursuit of a world with longer, healthier lives. Improving the health of rural populations is consistent with the American Heart Association's commitment to health equity and its focus on social determinants of health to reduce and ideally to eliminate health disparities. This presidential advisory serves as a call to action for the American Heart Association and other stakeholders to make rural populations a priority in programming, research, and policy. This advisory first summarizes existing data on rural populations, communities, and health outcomes; explores 3 major groups of factors underlying urban-rural disparities in health outcomes, including individual factors, social determinants of health, and health delivery system factors; and then proposes a set of solutions spanning health system innovation, policy, and research aimed at improving rural health.

Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association.

Over the past 15years social movements for community food security, food sovereignty, and food justice have organized to address the failures of the multinational, industrial food system to fairly and equitably distribute healthy, affordable, culturally ap- propriate real food. At the same time, these social movements, and research about them, re-inscribe white, patriarchal systems of power and privilege. We argue that in order to correct this pattern we must relocate our social movement goals and practices within a decolonizing and feminist leadership framework. This framework challenges movement leadership and scholarship by white people who uncritically assume a natural order of leadership based on academic achievement. We analyze critical points in our collabora- tion over the last four years using these frameworks. Doing so highlights the challenges and possibilities for a more inclusive food justice movement and more just scholarship.

Decolonizing Food Justice: Naming, Resisting, and Researching Colonizing Forces in the Movement

Importance Emergency medical services (EMS) provide critical prehospital care, and disparities in response times to time-sensitive conditions, such as cardiac arrest, may contribute to disparities in patient outcomes. Objectives To investigate whether ambulance 9-1-1 times were longer in low-income vs high-income areas and to compare response times with national benchmarks of 4, 8, or 15 minutes across income quartiles. Design, Setting, and Participants A retrospective cross-sectional study was performed of the 2014 National Emergency Medical Services Information System data in June 2017 using negative binomial and logistic regressions to examine the association between zip code–level income and EMS response times. The study used ambulance 9-1-1 response data for out-of-hospital cardiac arrest from 46 of 50 state repositories (92.0%) in the United States. The sample included 63 600 cardiac arrest encounters of patients who did not die on scene and were transported to the hospital. Main Outcomes and Measures Four time measures were examined, including response time, on-scene time, transport time, and total EMS time. The study compared response times with EMS response time benchmarks for responding to cardiac arrest calls within 4, 8, and 15 minutes. Results The study sample included 63 600 cardiac arrest encounters of patients (mean [SD] age, 60.6 [19.0] years; 57.9% male), with 37 550 patients (59.0%) from high-income areas and 8192 patients (12.9%) from low-income areas. High-income areas had greater proportions of white patients (70.1% vs 62.2%), male patients (58.8% vs 54.1%), privately insured patients (29.4% vs 15.9%), and uninsured patients (15.3% vs 7.9%), while low-income areas had a greater proportion of Medicaid-insured patients (38.3% vs 15.8%). The mean (SD) total EMS time was 37.5 (13.6) minutes in the highest zip code income quartile and 43.0 (18.8) minutes in the lowest. After controlling for urban zip code, weekday, and time of day in regression analyses, total EMS time remained 10% longer (95% CI, 9%-11%;P  Conclusions and Relevance Patients with cardiac arrest from the poorest neighborhoods had longer EMS times compared with those from the wealthiest, and response times were less likely to meet national benchmarks in low-income areas, which may lead to increased disparities in prehospital delivery of care over time.

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A US National Study of the Association Between Income and Ambulance Response Time in Cardiac Arrest.

This thesis analyses agrifood work in Hawaiʻi from an intersectional, gendered perspective. It examines the intersecting social relations of production, investigating how different agrifood practices address, if at all, intersecting social inequalities. It asks, how do agroecological ‘alternatives’ address intersecting inequalities, if at all, in their work? Do forms of ʻalternative agriculture’ offer more ‘gender-inclusive’ forms of work when intersecting inequalities are considered? The research sought to address these questions by analysing three case studies which can be said to represent ‘outliers’ compared to the majority of Hawaiʻi’s agrifood production. It examines particular cases of small and collective agroecological growing practices, as well as examples of transnational seed production. The thesis utilised methods of participant observation, interviews and document analysis in order to understand how different how agrifood work is organised and how different participants in these practices make meaning of their work. It drew on analytical frameworks from agrifood studies of labour and justice and intersectional feminist and anti-imperialist political economic and ecological theorising.
The research found that within the cases, agrifood practices are characterised by their diversity, and sought to draw out what I argue are nevertheless important tendencies within them. This entailed analysing the tensions, contradictions and possibilities these cases presented for addressing intersecting inequalities in their work. I showed that, in some ways, agroindustrial seed production offers more formal ʻgender-inclusive’ benefits but that agroecological practices create spaces to challenge gendered-norms on an individual and collective basis. At the same time, I suggested that projects for the recognition and inclusion of women and women’s work are highly limited when they fail to account for the ways gendered inequalities intersect with other differences of class and race, for example. At the same time, I argued that efforts to address intersecting gendered inequalities within agrifood work must attend to these contradictions, failures and possibilities and that doing so is not only revealing of some of the wider logics shaping agrarian ideals and agrifood practices, but potentially of how gendered colonialities operate.

Divergent economies of agriculture in Hawaiʻi:intersecting inequalities and the social relations ofagrifood Work

Fresh Fruit, Broken Bodies: Migrant Farmworkers in the United States

State Regulation of Community Paramedicine Programs: A National Analysis

Refusals After Prehospital Administration of Naloxone during the COVID-19 Pandemic.

Introduction We developed evidence-based recommendations for prehospital evaluation and treatment of adult patients with respiratory distress. These recommendations are compared with current protocols used by the 33 local emergency medical services agencies (LEMSA) in California. Methods We performed a review of the evidence in the prehospital treatment of adult patients with respiratory distress. The quality of evidence was rated and used to form guidelines. We then compared the respiratory distress protocols of each of the 33 LEMSAs for consistency with these recommendations. Results PICO (population/problem, intervention, control group, outcome) questions investigated were treatment with oxygen, albuterol, ipratropium, steroids, nitroglycerin, furosemide, and non-invasive ventilation. Literature review revealed that oxygen titration to no more than 94-96% for most acutely ill medical patients and to 88-92% in patients with acute chronic obstructive pulmonary disease (COPD) exacerbation is associated with decreased mortality. In patients with bronchospastic disease, the data shows improved symptoms and peak flow rates after the administration of albuterol. There is limited data regarding prehospital use of ipratropium, and the benefit is less clear. The literature supports the use of systemic steroids in those with asthma and COPD to improve symptoms and decrease hospital admissions. There is weak evidence to support the use of nitrates in critically ill, hypertensive patients with acute pulmonary edema (APE) and moderate evidence that furosemide may be harmful if administered prehospital to patients with suspected APE. Non-invasive positive pressure ventilation (NIPPV) is shown in the literature to be safe and effective in the treatment of respiratory distress due to acute pulmonary edema, bronchospasm, and other conditions. It decreases both mortality and the need for intubation. Albuterol, nitroglycerin, and NIPPV were found in the protocols of every LEMSA. Ipratropium, furosemide, and oxygen titration were found in a proportion of the protocols, and steroids were not prescribed in any LEMSA protocol. Conclusion Prehospital treatment of adult patients with respiratory distress varies widely across California. We present evidence-based recommendations for the prehospital treatment of undifferentiated adult patients with respiratory distress that will assist with standardizing management and may be useful for EMS medical directors when creating and revising protocols.

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Adult Patients with Respiratory Distress: Current Evidence-based Recommendations for Prehospital Care.

https://escholarship.org/content/qt6431j7pb/qt6431j7pb.pdf?t=pgc8wb

Emergency Medical Services Use Among Patients Receiving Involuntary Psychiatric Holds and the Safety of an Out-of-Hospital Screening Protocol to “Medically Clear” Psychiatric Emergencies in the Field, 2011 to 2016

Melody Glenn

Papers

Fresh Fruit, Broken Bodies: Migrant Farmworkers in the United States

State Regulation of Community Paramedicine Programs: A National Analysis

Refusals After Prehospital Administration of Naloxone during the COVID-19 Pandemic.

Adult Patients with Respiratory Distress: Current Evidence-based Recommendations for Prehospital Care.

Emergency Medical Services Use Among Patients Receiving Involuntary Psychiatric Holds and the Safety of an Out-of-Hospital Screening Protocol to “Medically Clear” Psychiatric Emergencies in the Field, 2011 to 2016