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OBJECTIVES/GOALS: Regardless of their career choices, today’s biomedical researchers need to blend great science with core skills ininnovation and entrepreneurship (I&E). The objective of this NIH-funded education program was to develop and test a pragmatic training program to teach relevant I&E skills. METHODS/STUDY POPULATION: We used a modified Delphi approach to identify 15 relevant competencies for I&E and the essential topics to include in the program. Learner interviews identified preferences for online training programs (short, high-quality audio-visual content, ability to self-navigate, peer and instructor interactions). The inaugural program included 7 short, online courses that addressed how to identify and validate opportunities for innovation, sell your innovation to diverse audiences, assess its ethical consequences, work in teams, and develop resilience as an innovator. It also included mentor support, a team-based capstone project, and an optional in-person boot camp. RESULTS/ANTICIPATED RESULTS: 51 students enrolled and 41 participants from 9 institutions completed the program, including pre- and post-doctoral students and junior faculty. They organized into 10 teams to complete the capstone project, with 6 teams pitching their innovation to fellow students and mentors at the boot camp. Students rated satisfaction with courses highly overall, with 79% stating they would be disappointed if the program was no longer available. Preliminary results suggest participants increased their knowledge about and ability to perform tasks taught throughout the program. Suggestions for improvement included providing more practical advice and real-world examples to complement educational videos. DISCUSSION/SIGNIFICANCE OF IMPACT: The inaugural E4B program was well received and effective in increasing I&E skills. Improvements will include increased opportunity for mentor interactions and for advanced entrepreneurial training. The program is open for biomedical research trainees from all institutions with a CTSA award.
A relatively small proportion of patients account for a disproportionate share of healthcare utilization and cost with, on average, 1% of patients responsible for 20-25% of cost, 5% of patients for 40% and 10% for two thirds. These “high-utilizers” frequently suffer from co-morbid medical and psychiatric illnesses, but they are not well characterized in terms of diagnoses, current treatment patterns, or long-term outcomes. We sought to characterize further such patients at a large inner city acute care hospital.
We applied a validated tool, Patients At Risk for Re-hospitalization, to the entire hospital population and then performed a mixed methods (quantitative/qualitative) study of 100 patients judged to be at high risk (>67%) of re-hospitalization during the ensuing year.
Of over 130,000 patients, 6,000 were identified. These individuals were overwhelmingly non-elderly adults (96% ages 18-64). Most common medical diagnoses were hypertension (49%), asthma (41%), diabetes (33%), and HIV/AIDS (32%). Schizophrenia, bipolar illness, or other psychosis was found in 48%. Over two-thirds had substance abuse diagnoses. Although 56% had made at least one emergency department visit in the past two years, only 37% had seen a primary care provider. Patient interviews revealed high rates of unstable housing, social isolation, and failure to appreciate the severity of health problems.
High utilizers of general health care have very high rates of serious mental illness and substance abuse. Interviews suggest need for improved medical/psychiatric coordination with community outreach. Although such interventions are resource intense, the economic and health benefits may be large.
Chapter 4 directly links the regulations introduced in Chapter 3 with public meetings. This chapter focuses on why proposals end up in public meetings and what types of issues members of the public and zoning officials raise. We introduce the novel data on meeting minutes from Massachusetts cities and towns that we use in Chapters 4, 5, and 6. Using these meeting minutes, we trace 100 randomly selected proposals in which we collected especially detailed project and meeting information. We show that once a project requires a public hearing, members of the public raise any and all concerns—not just those directly pertaining to the regulations that necessitated a meeting in the first place. The regulations described in Chapter 3 provide the opportunities for neighborhood defenders to air virtually all of their concerns and objections.
Chapter 2 develops our theory, highlighting how land use regulations and participatory inequalities come together to constrain the supply of new housing. We use a detailed case study of a Catholic Church redevelopment project to illustrate how neighbors opposed to development are able to delay development and reduce what gets built by participating in the planning and permitting process.
Chapter 1 uses several illustrative case studies to introduce the central argument of this book: that land use institutions ostensibly designed to empower underrepresented neighborhood groups actually amplify the power of neighborhood defenders to stop and delay the construction of new housing. We then situate this argument in the broader context of rising national housing costs, and the negative social, economic, and environmental consequences of the nationwide housing crunch.
Chapter 3 uses land use regulation and housing permitting data to: (1) clearly describe how land use regulations operate and (2) statistically link their proliferation with a diminished housing supply. We show how regulations create opportunities for opponents to file lawsuits, and how these lawsuits in turn reduce development. In order to address potential selection bias in our empirical analyses, we then use the redevelopment of Catholic Church properties across the greater Boston area as a natural experiment, and show that zoning regulations of all types decreased the density of the housing built on former church sites.
Chapter 6 then explores how these individuals stymy housing development using a mix of quantitative analysis of meeting minutes, in-depth case studies, and dozens of interviews with government officials, developers, and community activists. We analyze the wide range of concerns raised by meeting attendees and how commenters use in-depth knowledge of local zoning regulations to raise objections to special permits and variances.
Chapter 7 investigates potential policy solutions and the challenges facing building an affordable housing coalition. It uses a mix of elite survey data, interviews, and archival analysis to explore how gentrification has made prospects for reform more challenging, exploring the state-level politics surrounding SB 827 in California and Chapter 40B in Massachusetts. It concludes by outlining: (1) prospects for successful housing reform and (2) how the insights derived from housing politics might apply to other salient policy arenas, such as environmental and immigration policy.