Neh Inc

NORTHERN NEW ENGLAND CLINICAL AND TRANSLATIONAL RESEARCH NETWORK

MESENCHYMAL AND NEURAL REGULATION OF METABOLIC NETWORKS

PA-22

HEAD START AND EARLY HEAD START

HEAD START

CENTER OF BIOMEDICAL RESEARCH EXCELLENCE IN ACUTE CARE RESEARCH AND RURAL DISPARITIES - ACUTE CARE RESEARCH CAN BE DEFINED AS INVESTIGATIONS INTO PREVENTIVE, CURATIVE, REHABILITATIVE, OR PALLIATIVE ACTIONS THAT DEPEND ON TIME-SENSITIVE AND URGENT INTERVENTION. THUS, ACUTE CARE ENCOMPASSES MULTIPLE MEDICAL SPECIALTIES, INCLUDING CRITICAL CARE SERVICES, EMERGENCY AND URGENT CARE, TRAUMA AND ACUTE CARE SURGERY, AND NEUROCRITICAL CARE. IN RURAL STATES, THE NEED FOR IMPROVEMENTS IN ACUTE CARE AND ACUTE CARE RESEARCH ARE PRESSING, AS MEDICAL ADVANCES HAVE INCREASED THE DISPARITIES BETWEEN URBAN AND RURAL AREAS. THESE DISPARITIES ARE DUE IN LARGE PART TO IMBALANCES IN ACCESS TO SPECIALTY-TRAINED CLINICIANS, RESOURCES AND FACILITIES, AS WELL AS CLINICAL RESEARCH. WE PROPOSE A NEW INTER-DEPARTMENTAL CENTER FOR BIOMEDICAL RESEARCH EXCELLENCE (COBRE) AT MAINE MEDICAL CENTER, A TERTIARY CARE CENTER LOCATED IN THE LARGEST POPULATION CENTER (PORTLAND) IN THE STATE OF MAINE. SERVING AS THE HUB OF ACTIVITIES, THIS PROGRAM WILL MENTOR COHORTS OF ACUTE CARE RESEARCHERS IN SIGNIFICANT CLINICAL/TRANSLATIONAL AREAS OF NEED WHILE PROVIDING A FOUNDATION FOR THESE STUDIES TO IMPACT COMMUNITIES AND PATIENTS IN ALL REGIONS OF OUR STATE. THIS COBRE IS LED BY DOUGLAS SAWYER MD, PHD, AN ESTABLISHED LEADER IN CLINICAL CARE SERVICES, MENTORSHIP, AND TRANSLATIONAL RESEARCH. THE AIMS OF THIS PROGRAM ARE: 1) PROVIDE THE LEADERSHIP, GOVERNANCE, AND ADVISORY NETWORK TO ESTABLISH A COBRE IN ACUTE CARE RESEARCH AND RURAL DISPARITIES AT MAINE MEDICAL CENTER; 2) PROVIDE PROJECT AND MENTORSHIP SUPPORT TO LAUNCH THE CAREERS OF PROMISING CLINICIAN-SCIENTISTS WITHIN THIS SCIENTIFIC PROGRAM, AND HELP ENSURE THEIR LONG-TERM SCIENTIFIC SUCCESS AS INDEPENDENT RESEARCHERS; 3) ENHANCE THE CAPABILITIES OF MAINE MEDICAL CENTER'S CORE FACILITIES AND RESEARCH INFRASTRUCTURE TO SUPPORT HUMAN SUBJECT RESEARCH OF BOTH OUR COBRE INVESTIGATORS AND OTHER INSTITUTIONAL AND EXTERNAL RESEARCHERS, AND TO STIMULATE INNOVATIVE RESEARCH METHODOLOGIES AND NEW COLLABORATIONS, AND 4) ENHANCE OUR EXISTING COBRE- AND CTR-SUPPORTED PILOT PROJECT PROGRAMS TO FOCUS ON TRANSLATIONAL AND CLINICAL OPPORTUNITIES RELATED TO ACUTE CARE AND RURAL HEALTH DISPARITIES. IN PHASE I, WE HAVE INITIALLY SELECTED 4 CLINICAL/TRANSLATIONAL PROJECT LEADERS WITH CLINICAL RESEARCH AREAS OF PRIMARY NEED. THESE INCLUDE: TERESA MAY DO, A CRITICAL CARE PHYSICIAN-RESEARCHER DEVELOPING A STANDARDIZED STATEWIDE SYSTEM OF CARDIAC ARREST POST-RESUSCITATION CARE, DAVID GAGNON PHARMD, A PHARMACIST-RESEARCHER TESTING THE BENEFITS OF PROPHYLACTIC ANTIBIOTICS IN CARDIAC ARREST SURVIVORS, DAVID SEDER MD, A CRITICAL CARE PHYSICIAN-RESEARCHER EXPANDING HIS CLINICAL RESEARCH PROGRAM TO INCLUDE TRANSLATIONAL MOLECULAR SIGNALING STUDIES OF INFLAMMATION IN CARDIAC ARREST, AND ALEXA CRAIG MD, A PEDIATRIC NEUROLOGIST ENGAGED IN RESEARCH UTILIZING TELEMEDICINE TO IMPROVE SURVIVAL AND NEUROLOGICAL OUTCOMES FOR NEWBORNS BORN AT RISK FOR ENCEPHALOPATHY. THESE RESEARCHERS WILL BE SUPPORTED BY A ROBUST MENTORSHIP AND ADVISORY NETWORK AND A COMMUNITY ENGAGEMENT, BIOETHICS, AND OUTREACH CORE THAT WILL DEVELOP STATE-WIDE HEALTH PROFESSIONAL AND COMMUNITY PARTNERSHIPS IN A LEARNING HEALTHCARE SYSTEM TO ENHANCE UNDERSTANDING OF AND INCREASE INCLUSION IN HUMAN SUBJECTS RESEARCH.

HEALTH CENTER CLUSTER

HEAD START

INTERDISCIPLINARY STUDY OF MARROW ADIPOSITY, MINERAL METABOLISM & ENERGY BALANCE

HEALTH CENTER CLUSTER

COBRE IN STEM CELL BIOLOGY AND REGENERATIVE MEDICINE

HEALTH CENTER PROGRAM

A PERIOD SEROPREVALENCE (SARS-COV-2) SURVEY IN MHCCN CANCER HEALTHCARE WORKERS (HCWS) PROVIDING PATIENT CARE DURING THE HEIGHT OF THE OUTBREAK: A REGISTRY STUDY

EARLY HEAD START/ CHILD CARE PARTNERSHIP

HEAD START AND EARLY HEAD START

EARLY HEAD START/CHILD CARE PARTNERSHIP

PHASE III COBRE IN STEM & PROGENITOR CELL BIOLOGY AND REGENERATIVE MEDICINE

SALINITY CONTROL

PHASE III COBRE IN VASCULAR BIOLOGY

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION - LINCOLNHEALTH’S RENOVATED INFUSION SPACE WILL PROVIDE FOR UP TO 11 INFUSION BAYS AND ALLOW FOR THE ONCOLOGY PROVIDERS AND EXAM ROOMS TO BE IN THE SAME FACILITY WHERE THEIR PATIENTS ARE RECEIVING IV THERAPY. RENOVATIONS WILL OCCUR IN THE CURRENT HOSPITAL AND WILL INCLUDE A +/-5000 SQUARE FOOT RENOVATION OF EXISTING SPACE, ADDING APPROXIMATELY SIX THERAPY BAYS, DIRECTLY CONNECTING TO THE ONCOLOGY PROVIDER PRACTICE, AND SHORTENING DISTANCE TO THE PHARMACY, A HIGHLY USED RESOURCE IN THIS CARE UNIT. THE INFUSION CENTER OFFERS MANY SERVICES, INCLUDING CHEMOTHERAPY, ANTIBIOTIC THERAPY, INJECTIONS, IV MEDICATION ADMINISTRATION, THERAPEUTIC PHLEBOTOMY, HYDRATION INFUSION, BLOOD AND PLATELET INFUSION, ONCOLOGY PROVIDER VISITS, PICC LINE PLACEMENT AND ULTRASOUND GUIDED IV PLACEMENT. EXPANSION OF SERVICES WILL REDUCE WAIT TIME AND LIMIT TRAVEL FOR THOSE WHO CANNOT WAIT FOR TREATMENT. THIS WILL FURTHER OUR MISSION OF PROVIDING THE HIGHEST QUALITY OF CARE, IN THE MOST EFFICIENT WAY POSSIBLE.

TRANSGENERATIONAL EPIGENETIC PROGRAMMING OF THE THYROID AXIS

COBRE IN VASCULAR BIOLOGY

REGULATION OF ARTERIAL PHENOTYPE BY PERIVASCULAR ADIPOSE TISSUE IN CARDIOMETABOLIC DISEASE

HIGHER EDUCATION EMERGENCY RELIEF FUND - IHE STONEHILL COLLEGE

RURAL MATERNITY AND OBSTETRICS MANAGEMENT STRATEGIES PROGRAM - ORG: MAINEHEALTH, 110 FREE ST., PORTLAND ME 04101-3908 TYPE: INTEGRATED HEALTH SYSTEM HTTPS://WWW.MAINEHEALTH.ORG/ PI: DORA ANNE MILLS, MD, MPH, FAAP, CHIEF HEALTH IMPROVEMENT OFFICER. TEL: 207-661-7069 EMAIL: DORAANNE.MILLS@MAINEHEALTH.ORG TITLE: THE MAINE RMOMS NETWORK REQUEST: Y1 $999,238; Y2 $999,988; Y3 $999,996; Y4 $999,999 (1) THE MAINE RMOMS NETWORK (THE NETWORK) IS A STATEWIDE 17-MEMBER, 36-SITE PRI-VATE/PUBLIC INITIATIVE LED BY MAINEHEALTH, MAINE’S LARGEST INTEGRATED HEALTH SYSTEM. IT IS AN EN-HANCEMENT OF THE NETWORK FOR THE STATE’S CMMI-FUNDED AND MAINECARE-LED MAINEMOM INITIA-TIVE SEEKING TO IMPROVE CARE FOR PREGNANT AND POSTPARTUM INDIVIDUALS WITH OUD AND THEIR INFANTS BY INTEGRATING MATERNAL AND SUBSTANCE USE TREATMENT SERVICES. THE EXPANDED NETWORK INCLUDES EVERY RURAL MAINE HOSPITAL OFFERING MATERNITY SERVICES, A LEVEL IV AND LEVEL III FACILITY, CAHS, RHCS, AN FQHC, STATE AGENCIES INCLUDING MAINECARE, ORGANIZATIONS WITH CQI AND TELEHEALTH EXPERTISE, AND THE ORGANIZATION RESPONSIBLE FOR HOME VISITS IN MAINE. MEMBERS INCLUDE HEALTH SYS-TEM ‘PARENTS’ WITH MULTIPLE AFFILIATED HOSPITALS AND/OR RHCS. NETWORK MEMBERS HAVE SIGNED THE MOU AND DATA USAGE AGREEMENTS. (2) THE TARGET POPULATION IS PREGNANT WOMEN IN RURAL MAINE, WITH A FOCUS ON THE PERINATAL NEEDS OF SPECIAL POPULATIONS: RURAL POOR; NATIVE AMERICANS; MIGRANT WORKERS; IMMIGRANTS; AND LGBTQ INDIVIDUALS. (3) THE TARGET SERVICE AREA INCLUDES ALL OF MAINE’S COMPLETELY RURAL COUNTIES: AROOSTOOK; FRANKLIN; HANCOCK; KENNEBEC; KNOX; LINCOLN; OX-FORD; PISCATAQUIS; SOMERSET; WALDO; AND WASHINGTON, AND RURAL CENSUS TRACTS IN THE OTHER FIVE COUNTIES. (4) THE NETWORK’S CAPACITY TO SERVE RURAL UNDERSERVED POPULATIONS IS CONSIDERABLE. ITS WORK WILL ENHANCE THAT OF A NUMBER OF STATE PROGRAMS TO STRENGTHEN MAINE’S PERINATAL SYSTEM OF CARE. AMONG THEM: STRENGTHENING THE PERINATAL SYSTEM OF CARE WORKGROUP; SAFE SLEEP; SEVER-AL TITLE V PROGRAMS; THE WIC PROGRAM; AND THE CMMI FUNDED AND MAINE CARE-LED MAINEMOM INITIATIVE. NETWORK MEMBERS ARE: (1) MAINEHEALTH, THE APPLICANT, PARENT OF MAINE MEDICAL CEN-TER (LEVEL IV), SIX PARTICIPATING RURAL HOSPITALS, A CAH, AND FIVE RURAL HEALTH CLINICS (RHCS): (2) NORTHERN LIGHT HEALTH, PARENT OF EASTERN MAINE MEDICAL CENTER (LEVEL III), AND FOUR PARTICIPAT-ING RURAL HOSPITALS, ONE A CAH; (3) MAINEGENERAL HEALTH, PARENT OF MAINEGENERAL MEDICAL CEN-TER, A PARTICIPATING RURAL HOSPITAL; (4) CENTRAL MAINE HEALTHCARE, PARENT OF A PARTICIPATING RURAL HOSPITAL (AND CAH); (5) MOUNT DESERT ISLAND HOSPITAL (RURAL AND CAH); (6) CARY MEDICAL CENTER (RURAL); (7) REDINGTON-FAIRVIEW GENERAL HOSPITAL (RURAL AND CAH); (8) DOWN EAST COMMUNITY HOSPITAL (RURAL AND CAH); (9) NORTHERN MAINE MEDICAL CENTER (RURAL); (10) HOULTON REGIONAL HOSPITAL (RURAL AND CAH); (11) THE PINES HEALTH SERVICES, WOMEN AND CHILDREN’S HEALTH CENTER RURAL FQHC; (12) MAINECARE (MEDICAID); (13) MAINE DHHS OFFICE OF RURAL HEALTH; (14) MAINE CDC - DIVISION OF DISEASE PREVENTION, PUBLIC HEALTH NURSING; (15) MEDICAL CARE DEVELOPMENT, SITE OF HRSA-FUNDED NORTHEAST TELEHEALTH RESOURCE CENTER; (16) MAINE MEDICAL ASSOCIATION, CENTER FOR QUALITY IMPROVEMENT; AND (17) MAINE CHILDREN’S TRUST, ADMINISTRATOR OF THE MAINE FAMILIES PROGRAM, A STATEWIDE HOME VISITING PROGRAM. OBJECTIVES INCLUDE ESTABLISHING A STATEWIDE TELEHEALTH NETWORK FOR RURAL MATERNITY AND OBSTETRIC CARE, AND IMPROVING THE CONTINUUM OF CARE, PARTICULARLY TO ADDRESS CARDIOVASCULAR COMPLICATIONS PRE- AND POST-PARTUM, INCLUDING BUT NOT LIM-ITED TO HYPERTENSION, OBESITY, AND DIABETES. AMONG EXPECTED OUTCOMES ARE DEVELOP-MENT/IMPLEMENTATION OF THE TELEHEALTH NETWORK, AND IMPROVEMENTS IN THE CONTINUUM OF CARE, LEADING TO IMPROVEMENTS IN MATERNAL AND INFANT MORBIDITY AND MORTALITY RATES. MAINEHEALTH IS REQUESTING A FUNDING PREFERENCE. WE ARE IN A PRIMARY CARE HPSA (ID 1234550771) AND THE CUMBERLAND SERVICE AREA MUA/P (ID 01442). WE ARE REQUESTING SPECIAL CONSIDERATION, BASE

MAINE BEHAVIORAL HEALTHCARE CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC - MAINE BEHAVIORAL HEALTHCARE (MBH) IS PROPOSING TO PLAN, DEVELOP, AND IMPLEMENT A CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC (CCBHC) FOR THE MAINE CITIES OF BIDDEFORD AND SANFORD, LOCATED IN YORK COUNTY. MBH WILL PROVIDE SERVICES TO INDIVIDUALS WITH SERIOUS MENTAL ILLNESS (SMI) AND SUBSTANCE USE DISORDERS (SUD), INCLUDING OPIOID USE DISORDERS (OUD); CHILDREN AND ADOLESCENTS WITH SERIOUS EMOTIONAL DISTURBANCES (SED) INDIVIDUALS WITH CO-OCCURRING MENTAL AND SUBSTANCE DISORDERS (COD); AND INDIVIDUALS EXPERIENCING A MENTAL HEALTH (MH) OR SUBSTANCE USE-RELATED CRISIS. SERVICES WILL BE PROVIDED REGARDLESS OF ABILITY TO PAY. IDENTIFIED SERVICE GAPS IN THE CATCHMENT AREA AND FOR THE POPULATION OF FOCUS INCLUDE LACK OF MENTAL HEALTH AND SUD PROVIDERS/TREATMENT SITES, SEVERE LACK OF PSYCHIATRISTS, LACK OF COORDINATION OF SERVICES, AND LACK OF STAFFING TO ADDRESS THE NEED. HEALTH DISPARITIES ABOUND WHERE 55% OF RESIDENTS RESIDE IN A RURAL AND UNDERSERVED AREA. NEARLY 1 IN 8 ADULTS AND 1 IN 5 CHILDREN ARE UNABLE TO GET ENOUGH HEALTHY FOOD ON A DAY-TO-DAY BASIS. NEARLY 1 IN 2 HAS NO HEALTH COVERAGE. THE RENTAL HOUSING MARKET IS AMONG THE LEAST AFFORDABLE IN THE NATION. THE CATCHMENT AREA IS PLAGUED BY SIGNIFICANT RACIAL DISPARITIES WHEN IT COMES TO ECONOMIC SECURITY. IN 2017, WHILE APPROXIMATELY 15% OF WHITE CHILDREN LIVED IN POVERTY, THE RATE WAS OVER 53% FOR CHILDREN FROM BLACK/AFRICAN AMERICAN FAMILIES. 26% OF THE HOMELESS POPULATION IS BLACK OR AFRICAN AMERICAN EVEN THOUGH THEY MAKE UP ONLY 1% OF THE POPULATION IN THE CATCHMENT AREA. MBH WILL SERVE 625 INDIVIDUALS OVER THE COURSE OF THE FOUR YEARS OF THE GRANT. GOALS ARE TO 1) INCREASE ACCESS AND AVAILABILITY TO BEHAVIORAL HEALTH SERVICES, 2) IMPROVE INTEGRATION OF SUD, MH, AND COD PROGRAMMING, AND 3) CONTINUALLY WORK TO MEASURE AND IMPROVE THE QUALITY OF SERVICES. THESE GOALS WILL BE ACHIEVED BY EXISTING AND ADDITIONAL KEY STAFF INCLUDING A MEDICAL DIRECTOR, CARE COORDINATORS, PEER SUPPORT SPECIALISTS, PSYCHIATRIST, CLINICIANS, CASE MANAGERS, AND A TRAINING MANAGER. ALL STAFF WILL BE CROSS-TRAINED IN MH AND SUD EVIDENCE-BASED PRACTICES INCLUDING THE USE OF THE STEPPED CARE MODEL TO IMPROVE PATIENT FLOW BY ENHANCING CARE COORDINATION; STRENGTHENING TEAM-BASED CARE INCLUDING PARTNERSHIPS WITH PRIMARY CARE, INPATIENT PSYCHIATRY SETTINGS, AND SUBSTANCE USE TREATMENT PROGRAMS; AS WELL AS MAXIMIZING REIMBURSEMENT AND VALUE-BASED PLANS ALONG THE CONTINUUM OF CARE. IN CONJUNCTION WITH THIS, THE COMPREHENSIVE, CONTINUOUS, INTEGRATED SYSTEM OF CARE (CCISC) MODEL FOR ORGANIZATIONAL CHANGE FOCUSED ON INDIVIDUALS WITH CO-OCCURRING PSYCHIATRIC AND SUBSTANCE DISORDERS (COD) WILL BE IMPLEMENTED. WORKFLOWS, PROTOCOLS, PROCEDURES, DATA-COLLECTION, AND QUALITY IMPROVEMENT MEASURES WILL ALL BE IMPROVED TO ENSURE COMPLIANCE WITH THE CCBHC CRITERIA BY THE END OF THE FIRST YEAR.

EPIGENETIC INFLUENCE ON THYROID HORMONE ACTION IN THE BRAIN AND ON BEHAVIOR

DEFINING THE PROGENITOR CELL NICHE OF THE DEVELOPING KIDNEY

HIGHER EDUCATION EMERGENCY RELIEF FUND - STONEHILL COLLEGE

NEUREGULIN SIGNALING IN MYELOID CELLS

CONTRIBUTION OF NOTCH SIGNALING TO VASCULAR REMODELING

HEALTH CENTER PROGRAM

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION

ECONOMIC DEVELOPMENT INITIATIVE, COMMUNITY PROJECT FUNDING, AND MISCELLANEOUS GRANTS

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION - FOR OVER 50 YEARS, MAINE MEDICAL CENTER (MMC) HAS MAINTAINED A TRADITION OF CARDIAC EXCELLENCE, RESULTING IN MANY FIRSTS. MMC WAS THE FIRST HOSPITAL IN NORTHERN NEW ENGLAND TO OFFER TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) AND PERCUTANEOUS MITRAL VALVE REPAIR SYSTEM (MITRACLIP), AS WELL AS VASCULAR SURGERIES SUCH AS AORTIC AND THORACIC ANEURYSM REPAIR. ALL OF THESE SURGERIES REQUIRE AN OPERATING ENVIRONMENT THAT SUPPORTS BOTH ADVANCED IMAGING AS FOUND IN A CARDIAC CATHETERIZATION LAB, AND A STERILE FIELD AS FOUND IN TRADITIONAL OPERATING ROOMS. THE COMBINATION OF THESE TECHNOLOGIES FORM WHAT IS CALLED A HYBRID OPERATING ROOM (HYBRID OR). THE NUMBER OF HEART VALVE SURGERIES AT MMC IS PROJECTED TO GROW 23% OVER THE NEXT FIVE YEARS. BUILDING HYBRID ORS IN THE NEW MALONE FAMILY TOWER WILL INCREASE ACCESS TO THE MOST SOPHISTICATED PLATFORM FOR COMPLEX CARDIOVASCULAR SURGERIES IN NORTHERN NEW ENGLAND. CURRENTLY MMC TREATS 240-250 TAVR CASES ANNUALLY, WITH 21 MITRACLIPS PLACED TO DATE. THE LENGTH OF STAY FOR THESE PROCEDURES RANGES FROM 2-3 DAYS, COMPARED TO 7-10 DAYS FOR OPEN HEART SURGERIES. MARCO DIAZ, MD, CHAIR OF MAINE MEDICAL CENTER’S DEPARTMENT OF CARDIOVASCULAR MEDICINE AND CHIEF OF THE MAINEHEALTH CARDIAC SERVICE LINE STATES “CARDIOVASCULAR MEDICINE HAS EVOLVED DRAMATICALLY OVER THE PAST FEW DECADES, AND THE TIME HAS COME FOR OUR PROCEDURAL AND SURGICAL SPACES TO EVOLVE AS WELL. OUR CURRENT SPACES CANNOT ACCOMMODATE THE LATEST EQUIPMENT AND TECHNOLOGY THAT ARE NOW CONSIDERED THE STANDARD OF CARE.” THE NEW FACILITY WILL ENABLE MMC’S TEAMS TO COLLABORATE IN REAL TIME LIKE NEVER BEFORE, TO PROVIDE: SAME-DAY COMBINATIONS OF CORONARY ARTERY INTERVENTIONS AND/OR MINIMALLY INVASIVE VALVE REPAIR OR REPLACEMENT; ENDOVASCULAR TREATMENT OF THORACIC AORTIC ANEURYSMS; STENT GRAFT TREATMENT FOR THORACIC AORTIC ANEURYSM IN COMBINATION WITH OPEN ANEURYSM REPAIR OR WITH MINIMALLY INVASIVE CARDIOVASCULAR PROCEDURES; ELECTROPHYSIOLOGY PROCEDURES, INCLUDIN G LEAD EXTRACTION AND REPLACEMENT OF PACEMAKER/ICD DEVICES, WATCHMAN PROCEDURES FOR LEFT ATRIAL APPENDAGE THROMBOEMBOLISM PREVENTION, AND AFIB CONVERGENT MAZE PROCEDURES; COMBINED OPEN SURGICAL AND ENDOVASCULAR PROCEDURES FOR PERIPHERAL ARTERIAL DISEASE; MECHANICAL SUPPORT PROCEDURES TO INCLUDE EXTRA CORPOREAL MEMBRANE OXYGENATION AND IMPELLA 5.5 SUPPORT FOR COMPLEX CORONARY TOTAL OCCLUSION INTERVENTIONS; AND COMPLEX CATHETER-BASED THERAPY FOR CONGENITAL CARDIAC CONDITIONS. THE PROPOSED FUNDING WILL PROVIDE EQUIPMENT FOR A HYBRID OPERATING ROOM (HYBRID OR) WITH AN OPERATING ENVIRONMENT THAT SUPPORTS BOTH ADVANCED IMAGING AS FOUND IN A CARDIAC CATHETERIZATION LAB, AND A STERILE FIELD AS FOUND IN TRADITIONAL OPERATING ROOMS. HYBRID ORS HAVE SIGNIFICANTLY MORE SOPHISTICATED MONITORING AND ELECTRICAL NEEDS, INCLUDING REINFORCED CEILINGS FOR BOOM MOUNTED EQUIPMENT; SURGICAL ILLUMINATION (500-1000 LUX); AND ADVANCED IMAGING/FIXED C-ARM ANGIOGRAPHY, WITHIN A 700-1000 SQ. FT. SPACE. THE PROPOSED FUNDING WILL PROVIDE A SINGLE PLANE WITH FLEX ARM IMAGING SYSTEM (A MOTORIZED CEILING SUSPENDED C-ARM); A MAPPING SYSTEM; ELECTROPHYSIOLOGICAL (EP) 3D PATIENT INTERFACE UNIT AND ADVANCED CATH LOCATION; A SYSTEM OF CEILING MOUNT BOOMS, SURGICAL LIGHTS, EQUIPMENT AND ACC ARMS; AN IMAGING ULTRASOUND SCANNER KIOSK SYSTEM WITH STAND, 19" LED MONITOR AND TOUCH SCREEN; HEMODYNAMIC MONITORING SYSTEM FOR CARDIAC CATH LAB, INCLUDING EV1000 PLATFORM AND FINGER CUFF; AN INTEGRATED SURGERY AUDIO/VISUAL SYSTEM, INCLUDING HEXAVUE INTEGRATED COMMUNICATION; A MINIMALLY INVASIVE SURGICAL SCOPE VIDEO SYSTEM, INCLUDING LIGHT SOURCE, INSUFFLATOR, ETC.; A HEIGHT-ADJUSTABLE SURGICAL OR TABLE SYSTEM/PATIENT TRANSFER SYSTEM; AN ANESTHESIA MACHINE (FABIUS TIRO, TROLLEY VERSION); A GENERATOR CARDIAC ABLATION SYSTEM; A COOL FLOW IRRIGATION PUMP; AN AUTOMATED MEDICATION DISPENSER, AND AN ANESTHESIA MEDICATION CART.

HUMAN GHRELIN AS AN EFFECTIVE MITIGATOR OF ACUTE RADIATION INJURY

CCBHC MIDCOAST - MAINE BEHAVIORAL HEALTHCARE (MBH) IS PROPOSING TO PLAN, DEVELOP, AND IMPLEMENT (PDI) A CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC (CCBHC) IN MIDCOAST MAINE (ME) ENCOMPASSING WALDO AND KNOX COUNTIES, WHICH INCLUDE THE ISLAND COMMUNITIES OF ISLESBORO, MATINICUS, MONHEGAN, NORTH HAVEN, AND VINALHAVEN (THE ISLANDS). MBH HAS ESTABLISHED CLINICS IN THE MIDCOAST AREA: ONE IN ROCKLAND (KNOX COUNTY) AND ONE IN BELFAST (WALDO COUNTY). EACH WORKS CLOSELY WITH COASTAL HEALTHCARE ALLIANCE (WALDO COUNTY GENERAL HOSPITAL AND PEN BAY MEDICAL CENTER) THE LOCAL HOSPITAL SYSTEM AND MEMBERS OF MAINEHEALTH. THESE TWO CLINICS, COLLECTIVELY LED BY A LEADERSHIP TEAM COMPRISED OF A REGIONAL MEDICAL DIRECTOR, PRACTICE MANAGER, AND CLINICAL DIRECTOR, WILL FORM THE MIDCOAST CCBHC. THE POPULATION OF FOCUS (POF) FOR THE MIDCOAST CCBHC WILL INCLUDE THOSE THAT ARE RURAL, LOW INCOME OR LIVING IN POVERTY, SENIORS, YOUTH, PREGNANT OR PARENTING, LIVING WITH DISABILITIES, AND HOUSING INSECURE. THE DISPARITIES THE CCBHC PROJECT WILL IMPACT ARE ACCESS; HEALTH INEQUITIES BASED ON RACE, POVERTY ESPECIALLY IN THE COASTAL FISHING COMMUNITY, ETHNICITY, OR CULTURE; STIGMA; AND THE LACK OF AVAILABILITY OF A CONTINUUM (SCREENING THROUGH ONGOING RECOVERY) OF INTEGRATED MENTAL HEALTH, SUBSTANCE USE DISORDER, AND PRIMARY CARE SERVICES AND SUPPORTS. THE MIDCOAST CCBHC WILL SERVE 625 OVER THE LIFETIME OF THE PROJECT (Y1=75, Y2=150, Y3=200, Y4-200). MBH HAS A HISTORY OF IMPLEMENTING RECOVERY-ORIENTED, TRAUMA-INFORMED, AND EQUITY-BASED PROGRAMS, PRACTICES, AND POLICIES THAT ARE THE PRIMARY MEANS FOR IMPROVING BEHAVIORAL HEALTH. MBH CURRENTLY PROVIDES, DIRECTLY OR THROUGH ITS DCO PARTNER (SWEETSER), MANY OF THE CORE CCBHC SERVICES. MBH UNDER THE GUIDANCE OF THE PROJECT DIRECTOR (PD) AND THE CLINICAL LEADERSHIP OF THE REGIONAL MEDICAL DIRECTOR AND CLINICAL DIRECTOR, WILL IMPLEMENT INFRASTRUCTURE ACTIVITIES TO ADDRESS THE OPERATIONAL CHANGES NEEDED TO MEET THE CERTIFICATION CRITERIA AND IMPROVE THE QUALITY AND EFFECTIVENESS OF SERVICES INCLUDING STRATEGIES TO ADDRESS BEHAVIORAL HEALTH WORKFORCE SHORTAGES AND IMPROVE ACCESS TO CARE BY IMPLEMENTING A TWO-YEAR ADVANCED CLINICAL TRAINING PROGRAM. GOALS FOR THE FUNDING PERIOD: 1) INCREASE ACCESS AND AVAILABILITY TO BEHAVIORAL HEALTH SERVICES, 2) IMPROVE INTEGRATION OF SUD, MH, AND COD PROGRAMMING, AND 3) CONTINUALLY WORK TO MEASURE AND IMPROVE THE QUALITY OF SERVICES. OBJECTIVES INCLUDE RECRUITMENT, HIRING, TRAINING, AND RETAINING STAFF POSITIONS; IMPLEMENTING TEAM-BASED CARE; EXPANDING THE EXISTING HUB AND SPOKE MODEL FOR SUD TO INCLUDE ALL BEHAVIORAL HEALTH POPULATIONS, IMPROVING PROTOCOLS AND PROCESSES; AND DEVELOPING AND IMPLEMENTING SYSTEMS TO TRACK CLINICAL AND PROGRAMMATIC DATA INCLUDING REFERRAL, SERVICES, WORKFLOW, AND OUTCOMES.

A NOVEL RECOMBINANT PROTEIN FOR MITIGATING ACUTE RADIATION INJURY

EARLY HEAD START

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION - WITH HRSA SUPPORT, MAINEHEALTH WILL RENOVATE TWO EXISTING PROPERTIES IN YORK COUNTY, MAINE, TO BETTER SERVE THOSE WHO SUFFER FROM SEVERE AND PERSISTENT MENTAL ILLNESS. THESE PROPERTIES WILL SERVE THOSE REFERRED BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES THROUGH RIVERVIEW PSYCHIATRIC CENTER AND DOROTHEA DIX PSYCHIATRIC CENTER. PROJECT 1: SACO, MAINE OUR SACO RESIDENTIAL TREATMENT FACILITY WILL BE EXPANDED WITH THE RENOVATION OF THE?FORMER?CRISIS STABILIZATION UNIT INTO AN 8-BED RESIDENTIAL TREATMENT PROGRAM SERVING PEOPLE WITH?SEVERE MENTAL ILLNESS. RENOVATIONS AND ADDITIONAL TREATMENT HOUSING OPTIONS WILL ALLOW US TO CONTINUE TO PROVIDE PRIVATE NON-MEDICAL INSTITUTION (PNMI) CARE TO THE PEOPLE OF MAINE. ADDITIONAL TREATMENT PROGRAMMING WILL MEET THE NEEDS OF THE COMMUNITY WHICH HAVE INCREASED DRAMATICALLY, AS WE TRANSITION PEOPLE OUT OF THE STATE AND LOCAL PSYCHIATRIC HOSPITALS FACILITATES INTO THE RIGHT CARE IN THE RIGHT LOCATION, TRANSITIONING INDIVIDUALS LANGUISHING IN EMERGENCY DEPARTMENTS INTO STRUCTURED AND SUPERVISED COMMUNITY SETTINGS. IMPROVEMENTS INCLUDE THE ADDITION OF EIGHT SINGLE PRIVATE ROOMS, THREE BATHROOMS WITH SHOWERS, SPACE TO ENGAGE WITH OTHERS, AS WELL AS QUIET SPACE TO READ OR ENGAGE IN HEALTHY SELF-CARE, A KITCHEN AND DINING SPACE FOR ALL RESIDENTS AND TEAM MEMBERS, AND SECURE STORAGE SPACE FOR MEDICATIONS AND MEDICAL SUPPLIES. PROJECT 2: BIDDEFORD, MAINE OUR BIDDEFORD RESIDENTIAL TREATMENT FACILITY WILL BE EXPANDED TO SERVE 8-12 ADULTS WHO ARE TRANSITIONING TO A LOWER LEVEL OF CARE BUT STILL REQUIRE 24/7 STAFF INVOLVEMENT. RENOVATIONS AND ADDITIONAL TREATMENT HOUSING OPTIONS WILL ALLOW US TO CONTINUE TO PROVIDE PRIVATE NON-MEDICAL INSTITUTION (PNMI) CARE TO THE PEOPLE OF MAINE. ADDITIONAL TREATMENT PROGRAMMING WILL MEET THE NEEDS OF THE COMMUNITY WHICH HAVE INCREASED DRAMATICALLY, OFFERING THE OPPORTUNITY TO TRANSITION PEOPLE OUT OF THE STATE AND LOCAL PSYCHIATRIC HOSPITALS BY PROVIDING A STRUCTURED GROUP HOME E NVIRONMENT AS WELL AS A SUPPORTIVE APARTMENT TREATMENT FACILITY FOR RESIDENTS WHO HAVE MET THEIR TREATMENT GOALS AND ARE READY FOR DISCHARGE TO A LESS STRUCTURED FACILITY AND MORE INDEPENDENCE. IMPROVEMENTS INCLUDE CONSTRUCTION OF SEVEN ONE-BEDROOM OR EFFICIENCY APARTMENTS. EACH APARTMENT WILL INCLUDE A KITCHENETTE AND BATHROOM. THE REMAINING SPACE IN THE BUILDING WILL PROVIDE A COMMUNITY SPACE WHERE GROUP ACTIVITIES AND MEALS WILL OCCUR.

DEFINING THE ROLES OF BONE MARROW ADIPOCYTES AND FABP4/5 SIGNALING IN MULTIPLE MYELOMA DRUG RESISTANCE

ENVIRONMENTAL CHEMICALS, ADIPOSITY, AND BONE ACCRUAL ACROSS ADOLESCENCE

GASTRIC ENDOCRINE FUNCTIONS IN SKELETAL HOMEOSTASIS - BARIATRIC SURGERY-ASSOCIATED SKELETAL COMPLICATIONS HAVE BEEN OBSERVED SINCE THE EARLY 1990S, AND ARE ASSOCIATED WITH INCREASED FRACTURE RISK. THE MOST PREVALENT BARIATRIC SURGERY IS VERTICAL SLEEVE GASTRECTOMY (VSG), WHICH REMOVES MOST OF THE STOMACH. BY 12 MONTHS AFTER SURGERY, BONE LOSS OF 4–8% IN THE HIP AND 3– 10% IN THE FEMORAL NECK INCREASES FRACTURE RISK 1.3 TO 2.3-FOLD. CURRENT CLINICAL MANAGEMENT INCLUDES BONE MINERAL DENSITY ASSESSMENTS, CONSUMPTION OF ADEQUATE DIETARY CALCIUM, VITAMIN D, AND PROTEIN, AND WEIGHT- BEARING EXERCISE. THESE COUNTERMEASURES MINIMIZE, BUT DO NOT FULLY PREVENT BONE LOSS SECONDARY TO BARIATRIC SURGERY. A CLEARER MECHANISTIC UNDERSTANDING OF BONE LOSS ASSOCIATED WITH BARIATRIC SURGERY IS NECESSARY TO PROPERLY DESIGN PREVENTIVE STRATEGIES. CHANGES IN GUT HORMONES AND MICROBIOTA HAVE BEEN PROPOSED TO DRIVE BONE LOSS, BUT THE EFFECTS OF LOSS OF THE STOMACH HAVE BEEN LARGELY NEGLECTED. WE PROPOSE THAT GASTRIC SECRETORY FACTORS CONTRIBUTE TO BARIATRIC SURGERY-INDUCED SKELETAL COMPLICATIONS. IN KEY PRELIMINARY DATA, WE FOUND A LOSS OF GASTRIC X/A-LIKE CELLS (P/D1 CELL IN HUMANS) AND A DECREASE IN SECRETED GHRELIN FOLLOWING VSG. GENETIC ABLATION OF X/A-LIKE CELLS WAS FOUND TO IMPROVE GLUCOSE METABOLISM AND IMPAIR TRABECULAR BONE MASS, WHICH MIMICS THE METABOLIC AND SKELETAL CONSEQUENCES OF VSG. HOWEVER, GHRELIN SUPPLEMENTATION ALONE DOES NOT PREVENT VSG-INDUCED BONE LOSS. OUR PROTEOMIC PROFILING IDENTIFIED GHRELIN AND SOMATOSTATIN AS THE TOP TWO SECRETORY PROTEINS ENRICHED IN X/A-LIKE CELLS AND DECREASED BY VSG. MOREOVER, CIRCULATING EXOSOME CONCENTRATIONS AND GASTRIC RAB27A, A RAB GTPASE CRITICAL FOR EXTRACELLULAR VESICLE (EV) SECRETION, WERE SIGNIFICANTLY UPREGULATED BY VSG. THESE DATA SUGGEST THAT X/A-LIKE CELLS ARE A SOURCE OF SECRETORY FACTORS VITAL TO BONE HOMEOSTASIS, AND BARIATRIC SURGERY DISRUPTS THIS BALANCE. THE SPECIFIC AIMS OF THIS PROPOSAL ARE: 1) TO DEFINE THE SKELETAL AND METABOLIC CONSEQUENCES OF GASTRIC X/A-LIKE CELL ABLATION AND IDENTIFY X/A-LIKE CELL- DERIVED SECRETORY FACTORS THAT AFFECT SKELETAL HOMEOSTASIS; AND 2) TO DETERMINE THE EFFECTS OF GASTRIC X/A-LIKE CELL-DERIVED HORMONAL FACTORS AND EV CARGOES ON VSG-INDUCED BONE LOSS. IN AIM 1, WE WILL UTILIZE THE X/A-LIKE CELL ABLATION MOUSE MODEL TO DETERMINE THE IMPORTANCE OF THESE CELLS IN SKELETAL HEALTH UNDER CONDITIONS OF METABOLIC STRESS, INCLUDING DIET-INDUCED OBESITY AND ESTROGEN DEFICIENCY. FURTHERMORE, WE WILL IDENTIFY SECRETORY FACTORS FROM X/A-LIKE CELLS AND DETERMINE THEIR ROLES IN OSTEOBLAST, OSTEOCLAST AND ADIPOCYTE DIFFERENTIATION AND FUNCTION. IN AIM 2, WE WILL TEST WHETHER SOMATOSTATIN CAN ENHANCE THE PRO-OSTEOGENIC EFFECTS OF GHRELIN AND PROTECT AGAINST VSG-INDUCED BONE COMPLICATIONS. IN ADDITION, WE WILL DELETE RAB27A IN X/A-LIKE CELLS TO DETERMINE ITS PATHOPHYSIOLOGICAL FUNCTIONS IN BONE, GLUCOSE AND LIPID METABOLISM UNDER LEAN HEALTHY, OBESE AND VSG CONDITIONS. UNDERSTANDING THE SIGNIFICANCE OF X/A-LIKE CELLS IN BONE METABOLISM HOLDS PROMISE FOR DEVELOPING NEW THERAPEUTIC TARGETS TO MANAGE BARIATRIC SURGERY-INDUCED BONE LOSS, WHICH REMAINS ONE OF THE FEW TIME-TESTED OPTIONS FOR IMPROVING HEALTH OF SEVERELY OBESE INDIVIDUALS.

HOMETOWNS PARTNERSHIP

DETERMINATION OF THE MECHANISMS BY WHICH IGFBP-2 STIMULATES BONE REMODELING

POISON CONTROL STABILIZATION AND ENHANCEMENT PROGRAM

EFFICACY OF TRANEXAMIC ACID TO REDUCE CAPILLARY LEAK, TISSUE EDEMA, AND FLUID RESUSCITATION REQUIREMENTS AFTER SEVERE BURN INJURY

EFFECT OF CTHRC1 ON ENDOTHELIAL CELL SURVIVAL AFTER ACUTE ISCHEMIA

MIR-27 MEDIATED REGULATION OF MITOCHONDRIAL FUNCTION IN THERMOGENIC ADIPOCYTES - PROJECT SUMMARY/ABSTRACT THE OBESITY EPIDEMIC IS A GLOBAL PUBLIC HEALTH ISSUE, THAT LEADS TO AN INCREASED RISK FOR TYPE 2 DIABETES AND CARDIOVASCULAR DISEASE. HYPERTROPHY, INFLAMMATION, AND EXCESS LIPID ACCUMULATION IN WHITE ADIPOCYTES WITHIN FAT TISSUE ARE HALLMARKS OF OBESITY THAT CONTRIBUTE TO METABOLIC DYSFUNCTION. UNLIKE WHITE ADIPOCYTES, BEIGE ADIPOCYTES ARE RICH IN MITOCHONDRIA, AND EXPEND ENERGY TO GENERATE HEAT (THERMOGENESIS) IN RESPONSE TO STIMULI SUCH AS COLD EXPOSURE. THIS ACTIVITY IS ASSOCIATED WITH RESISTANCE TO DIET-INDUCED OBESITY, AND THUS ACTIVATION AND EXPANSION OF BEIGE ADIPOCYTES CAN COUNTERACT THE OBESITY PHENOTYPE. DURING BEIGE ADIPOCYTE ACTIVATION, OPTIMAL THERMOGENIC FUNCTION IS MAINTAINED BY BALANCING MITOCHONDRIAL BIOGENESIS WITH AUTOPHAGY- MEDIATED MITOCHONDRIAL DEGRADATION (MITOPHAGY), WHICH IS FINELY COORDINATED TO MAINTAIN MITOCHONDRIAL HOMEOSTASIS. USING OUR NEWLY DEVELOPED MODEL OF BEIGE ADIPOCYTE DIFFERENTIATION AND ACTIVATION FROM HUMAN IPS CELLS, WE DISCOVERED THAT THERMOGENIC ACTIVATION OF BEIGE ADIPOCYTES OCCURS FOLLOWING ENHANCED SECRETION OF EXOSOMES CONTAINING A VARIETY OF MICRORNAS (MIRS), INCLUDING MIR-27A/B. MIR-27 HOMOLOGS (MIR-27A/B) ARE ANTI-THERMOGENIC MIRS THAT SUPPRESS GENES INVOLVED IN MITOCHONDRIAL BIOGENESIS (SUCH AS FOXJ3) AND MITOPHAGY (INCLUDING MFF). MIR-27A/B ARE DOWN-REGULATED IN BEIGE ADIPOCYTES DURING THERMOGENIC ACTIVATION, CONSISTENT WITH THEIR PREDICTED ROLE AS INHIBITORS OF MITOCHONDRIAL ACTIVATION, TURNOVER, AND BIOGENESIS. THIS PROJECT TESTS SEVERAL HYPOTHESES RELATED TO MECHANISMS OF BEIGE ADIPOCYTE ACTIVATION. WE PROPOSE THAT THE MIR-27 SUPPRESSES ADIPOCYTE THERMOGENESIS BY TARGETING FOXJ3 AND MFF AND THAT LOSS OF MIR-27A/B AND INCREASE IN FOXJ3/MFF-MEDIATED PATHWAYS ACTIVATE MITOCHONDRIAL ACTIVITY AND THERMOGENESIS. WE ALSO PROPOSE THAT IN VIVO GENETIC TARGETING OF MIR-27A/B WILL ALLOW US TO IDENTIFY THE IN VIVO ROLE OF THESE MIRS IN BEIGE ADIPOCYTE ACTIVATION, REGULATION OF MITOCHONDRIAL PROTEINS, THERMOGENESIS AND RESISTANCE TO OBESITY. THESE QUESTIONS WILL BE TESTED IN TWO FOCUSED SPECIFIC AIMS: SPECIFIC AIM 1. IDENTIFY THE MECHANISM OF MIR-27 REGULATION OF BEIGE ADIPOCYTE MITOCHONDRIAL FUNCTION. SPECIFIC AIM 2. DETERMINE THE EFFECT OF MIR-27 SUPPRESSION ON THE RESPONSE OF BEIGE ADIPOSE TISSUE TO TEMPERATURE CHALLENGE AND HIGH-FAT DIET. THESE STUDIES ARE EXPECTED TO IDENTIFY NOVEL MOLECULAR MECHANISMS THAT MAY PROVIDE A NEW PLATFORM TO INCREASE BEIGE ADIPOGENESIS AND REVERSE OBESITY-RELATED DISORDERS.

A NOVEL THERAPY FOR SEPTIC SHOCK

RURAL COMMUNITIES OPIOID RESPONSE-IMPLEMENTATION

RHMFG-E8 AS AN EFFECTIVE ADJUVANT THERAPY FOR HEMORRHAGIC SHOCK

COBRE IN STEM CELL BIOLOGY AND REGENERATIVE MEDICINE

A NOVEL CELL-AUTONOMOUS ROLE FOR ?-ADRENERGIC RECEPTOR SIGNALING IN OSTEOCLASTS - THE SYMPATHETIC NERVOUS SYSTEM (SNS) IS AN IMPORTANT REGULATOR OF BONE, AND MAY CONTRIBUTE TO BONE PATHOLOGY DURING AGING. SNS ACTIVITY IS ALSO HEIGHTENED IN POST-MENOPAUSAL WOMEN, CAUSING REDUCED BONE FORMATION BY OSTEOBLASTS AND INCREASED BONE RESORPTION BY OSTEOCLASTS, WHICH LEADS TO BONE LOSS. LARGE META- ANALYSES, OSTEOPOROSIS COHORT STUDIES (PRELIMINARY DATA FROM CO-I DR. LARY) AND NEW PROSPECTIVE TRIALS, CONSISTENTLY SHOW THAT SS-ADRENERGIC RECEPTOR (SSAR) ANTAGONISTS (I.E. SS-BLOCKERS) ARE ASSOCIATED WITH REDUCED FRACTURE RISK, INCREASED BONE MINERAL DENSITY (BMD), AND REDUCED BONE RESORPTION. HOWEVER, MECHANISTIC STUDIES HAVE FOCUSED LARGELY ON THE OSTEOBLAST AS THE TARGET OF SNS ACTIVITY. HUMANS AND MICE HAVE THREE SSARS: SS1AR, SS2AR AND SS3AR. THE GENE ENCODING SS2AR (ADRB2) IS HIGHLY EXPRESSED IN BONE, WHICH ALSO EXPRESSES LOWER LEVELS OF ADRB1, BUT DOES NOT EXPRESS ADRB3. IN MICE, ADRB2 DELETION IN OSTEOBLASTS IMPROVES BONE FORMATION AND PREVENTS RECEPTOR ACTIVATOR OF NUCLEAR FACTOR-KAPPA B LIGAND (RANKL)-MEDIATED OSTEOCLAST RECRUITMENT AFTER STIMULATION WITH A SS-AGONIST. IN HUMANS, SS1-SELECTIVE SS-BLOCKERS ARE USED MOST OFTEN, BUT THEIR SELECTIVITY IS NOT ABSOLUTE, AND MANY STILL BIND SS2AR. PROPRANOLOL, A NON-SELECTIVE SS-BLOCKER, INCREASES BMD IN THE MAJORITY OF PRECLINICAL STUDIES. RESULTS FROM OUR LABORATORY SHOW THAT PROPRANOLOL CAN LIMIT BONE RESORPTION DIRECTLY IN VITRO, AND IN VIVO WITHOUT CHANGING RANKL LEVELS. THIS IS IN CONTRAST TO THE ESTABLISHED DOGMA THAT OSTEOBLAST EXPRESSION OF SS2AR REGULATES OSTEOCLASTS ONLY INDIRECTLY VIA RANKL. OUR PROPOSED WORK WILL RESOLVE THE OUTSTANDING MECHANISTIC QUESTIONS OF HOW SS1AR AND SS2AR DIRECTLY INFLUENCE OSTEOCLAST DIFFERENTIATION AND WHAT THEIR CONTRIBUTIONS ARE TO AGE- AND SNS-RELATED BONE LOSS. WE PROPOSE A NOVEL HYPOTHESIS THAT SSAR SIGNALING IN OSTEOCLASTS PROMOTES DIFFERENTIATION AND RESORPTION AND CONTRIBUTES TO BONE LOSS IN VIVO. TO FULLY CHARACTERIZE SSAR RECEPTOR SUBTYPES AND NOVEL SIGNALING MECHANISMS IN OSTEOCLASTS, AND TO DETERMINE THE CONTRIBUTION OF SSAR SUBTYPES TO IN VIVO PHENOTYPES OF BONE DENSITY AND BONE REMODELING, WE PROPOSE A COMBINATION OF GENETIC AND PHARMACOLOGIC IN VIVO AND IN VITRO APPROACHES IN THE FOLLOWING SPECIFIC AIMS. SPECIFIC AIM 1: WE WILL IDENTIFY SIGNALING MECHANISMS ACTIVATED BY SPECIFIC SSARS IN OSTEOCLASTS. WE EXPECT THAT WE WILL IDENTIFY NOVEL AND ESTABLISHED TARGET PATHWAYS TO TEST IN VIVO FOR EFFICACY IN MODULATING BONE RESORPTION. SPECIFIC AIM 2: WE WILL TEST THE RELATIVE CONTRIBUTIONS OF OSTEOCLAST SS1AR AND SS2AR TO SNS- MEDIATED AND AGING-RELATED BONE LOSS IN VIVO. THE SNS HAS BEEN IMPLICATED IN OSTEOPOROSIS, BUT THE ROLE OF SSARS IN OSTEOCLASTS HAS NEVER BEEN INVESTIGATED IN THIS CONDITION. WE HYPOTHESIZE THAT BOTH DELETION OF SS1AR AND SS2AR, SPECIFICALLY IN THE OSTEOCLASTS, WILL ATTENUATE SSAR AGONIST-INDUCED AND AGING-RELATED BONE LOSS IN MICE. OUR WORK WILL PROVIDE A MORE COMPLETE UNDERSTANDING OF THE ROLE OF SNS SIGNALING IN AGE-RELATED BONE LOSS IN VIVO, AND WILL LEAD TO STUDIES TARGETING SPECIFIC OSTEOCLAST SSARS AND DOWNSTREAM SIGNALING PATHWAYS FOR TREATMENT OF BONE DISEASES.

MOLECULAR DETERMINANTS OF THE FATE OF HUMAN HEART MESENCHYMAL PROGENITOR CELLS

CTHRC1 FUNCTION AS A NOVEL TGF-BETA ANTAGONIST IN THE VASCULATURE

AMERICAN RESCUE PLAN ACT FUNDING FOR HEALTH CENTERS

PROTECTIVE ADAPTIVE IMMUNE MECHANISMS AFTER CARDIAC ARREST - CARDIAC ARREST INDUCES A SYSTEMIC INFLAMMATORY RESPONSE. SEVERAL STUDIES HAVE DEMONSTRATED THAT INCREASED SUSTAINED INFLAMMATION IS ASSOCIATED WITH POOR OUTCOMES, SUGGESTING A POSSIBLE ROLE FOR ANTI-INFLAMMATORY AND IMMUNOMODULATORY THERAPIES. HOWEVER, THESE STUDIES HAVE FOCUSED ON MECHANISMS THAT PROMOTE INFLAMMATION WITHOUT CONSIDERING PROTECTIVE MECHANISMS THAT ARE ALSO MEDIATED BY THE IMMUNE CELLS. OUR PRELIMINARY DATA FROM HUMAN PATIENTS WITH CARDIAC ARREST REVEALED AN ASSOCIATION BETWEEN THE HIGHER NUMBER OF CD73-EXPRESSING LYMPHOCYTES AND FAVORABLE OUTCOMES. CD73 IS A KEY ENZYME IN THE GENERATION OF ADENOSINE, A PURINE NUCLEOSIDE THAT IS CHARACTERIZED BY POTENT ANTI-INFLAMMATORY PROPERTIES. OUR NEW PRELIMINARY DATA GENERATED USING A MOUSE MODEL OF CARDIAC ARREST AND RESUSCITATION SUGGEST THAT CD73- EXPRESSING LYMPHOCYTES PLAY A ROLE IN THE CONTROL OF LOCAL INFLAMMATION IN THE HEART AND BRAIN TISSUES. IN SPECIFIC AIM 1, WE WILL DETERMINE THE FUNCTIONAL SIGNIFICANCE OF ADOPTIVE CELL THERAPY USING PROTECTIVE CD73- EXPRESSING LYMPHOCYTES AFTER AN ISCHEMIA AND REPERFUSION INJURY IN A MOUSE MODEL OF CARDIAC ARREST AND CARDIOPULMONARY RESUSCITATION. IN SPECIFIC AIM 2, WE WILL TEST THE HYPOTHESIS THAT CD73-EXPRESSING LYMPHOCYTES FORM T CELL-MONOCYTE COMPLEXES AND PROMOTE THE DIFFERENTIATION OF MONOCYTES TOWARD ANTI- INFLAMMATORY MACROPHAGES. IN SPECIFIC AIM 3, WE WILL DEFINE MOLECULAR MECHANISMS INVOLVED IN THE FORMATION OF ANTI-INFLAMMATORY LYMPHOCYTE-MACROPHAGES COMPLEXES. OUR NEW DATA WILL DETERMINE THE CONTRIBUTION OF CARDIAC ARREST-INDUCED INFLAMMATORY RESPONSE IN THE HEART AND BRAIN TISSUE DAMAGE AND IDENTIFY CD73/ADENOSINE/ADENOSINE RECEPTORS AXIS AS A POTENTIAL THERAPEUTIC APPROACH TO IMPROVE OUTCOMES AFTER GLOBAL ISCHEMIA AND REPERFUSION INJURY.

MOUSE MODELS TO DELINEATE A UNIQUE METABOLIC AND SKELETAL NETWORK

GENETIC REGULATION OF IGF-I IN PEAK BONE DENSITY OF MICE

ROLE OF THE MACROPHAGE DERIVED XL313 EPITOPE IN ANGIOGENESIS AND TUMOR GROWTH

POISON CONTROL STABILIZATION AND ENHANCEMENT PROGRAM

MISTY: A MODEL FOR CENTRAL REGULATION OF BONE REMODELING

MITOCHONDRIAL FUNCTION REGULATES ROS-MEDIATED PATTERNING FOLLOWING INJURY - ABSTRACT MITOCHONDRIA ARE CRITICAL FOR GENERATING ENERGY. RECENTLY A NEW ROLE FOR MITOCHONDRIA IN CONTROLLING METABOLIC SIGNALING THROUGH GENERATION OF REACTIVE OXYGEN SPECIES (ROS) HAS COME TO LIGHT. ROS HAS ALSO RECENTLY COME INTO THE SPOTLIGHT AS BEING A CRITICAL SIGNALING AXIS FOR LIMB REGENERATION, AND WHILE MITOCHONDRIAL SIGNALING HAS BEEN WELL-ESTABLISHED IN CELL HOMEOSTASIS, THE ROLE OF MITOCHONDRIAL GENERATED ROS AND ITS DOWNSTREAM MECHANISMS IN CONTROLLING REGENERATION IS NOT CLEAR. USING THE ESTABLISHED MOUSE DIGIT TIP AMPUTATION REGENERATION MODEL, SPATIAL TRANSCRIPTOMICS, AND UNIQUE TRANSGENIC MICE, WE UNCOVERED A UNIQUE ROLE FOR TWO MITOCHONDRIAL REGULATORY PROTEINS, BNIP3 AND NIX, IN REGENERATION. OUR PRELIMINARY FINDINGS SUPPORT THAT REGENERATION IS DEPENDENT ON THE MITOCHONDRIAL REGULATION PROTEIN BNIP3, AND THAT THIS PROTEIN SUPPORTS ROS- GENERATED, DIRECTIONAL MORPHOGENETIC SIGNALING GRADIENTS FROM THE WOUND EPITHELIUM. FURTHER, OUR PRELIMINARY DATA SUPPORT THAT A SECOND MITOCHONDRIAL REGULATORY PROTEIN, NIX, SERVES TO SUPPORT BLASTEMA MATURATION AND DIFFERENTIATION, A STRUCTURE CRITICAL TO REGENERATING THE BONE AND SOFT TISSUE. WE HYPOTHESIZE THAT BNIP3 AND NIX FUNCTION IN A SPATIALLY DISTINCT RELATIONSHIP WHERE NIX SUPPORTS DIFFERENTIATION IN THE BLASTEMA IN RESPONSE TO ADJACENT SIGNALING GRADIENTS GENERATED BY BNIP3 IN THE WOUND EPITHELIUM. THIS PROJECT WOULD PROVIDE THE FIRST EVIDENCE OF A BNIP3/NIX SIGNALING ACCESS IN INJURY, IMPLICATING MITOCHONDRIAL FUNCTION AND MITOPHAGY AS SPATIAL REGULATORS OF THE REGENERATION PROCESS, AND GIVING A BROADER CONTEXT TO A MITOCHONDRIAL HOMEOSTASIS MECHANISM THAT IS SALIENT TO MANY FIELDS.

GENETIC ANALYSIS OF SNAIL SUPERFAMILY GENES IN MICE

A CHROMOSOME 10 QTL ASSOCIATED WITH IGF-1 AND BONE MASS

REGULATION OF TGF-BETA RECEPTOR-DEPENDENT VASCULAR DISEASE

MOLECULAR AND CELLULAR MECHANISMS OF PREVENTION OF BONE LOSS BY BETA BLOCKERS - ABSTRACT/SUMMARY POST-MENOPAUSAL BONE LOSS HAS BEEN AN UNRESOLVED CLINICAL PROBLEM SINCE THE WOMEN’S HEALTH INITIATIVE SHOWED THE RISKS OF HORMONE REPLACEMENT THERAPY. TO ADDRESS THIS ISSUE, A CLINICAL TRIAL USING BETA BLOCKERS (BBS) TO IMPROVE BONE HEALTH HAS RECENTLY BEEN FUNDED ENTITLED, “BETA1-SELECTIVE BLOCKADE FOR PREVENTION OF POSTMENOPAUSAL BONE LOSS: A RANDOMIZED CONTROLLED TRIAL” (R01 AG065154-A1). WHILE THIS TRIAL WILL EVALUATE THE EFFICACY AND SAFETY OF BBS FOR THIS INDICATION, QUESTIONS WILL REMAIN ABOUT THE MECHANISM AND OPTIMAL USE OF THIS PREVENTION STRATEGY. HETEROGENEITY OF BB EFFECTS ON BONE OUTCOMES HAVE BEEN OBSERVED AND MAY BE DUE TO PHARMACOGENETICS, AS WE HAVE DISCOVERED AND VALIDATED PHARMACOGENETIC VARIANTS IN ADRB1 AND HDAC4. FURTHERMORE, THE MECHANISMS OF TREATMENT EFFECT REMAIN CONTROVERSIAL. ALTHOUGH PREVIOUS MOUSE STUDIES SHOWED THAT THE BENEFICIAL BONE EFFECTS OF BBS WERE DUE TO COMPETITIVE BINDING TO B2-ADRENERGIC RECEPTORS (B2-ARS) ON OSTEOBLASTS, MANY HUMAN STUDIES HAVE FOUND B1-SELECTIVE BLOCKERS TO BE ASSOCIATED WITH BETTER BONE OUTCOMES. IN ADDITION, WE HAVE DISCOVERED THAT MIR-19A-3P, WHICH WE HYPOTHESIZE TO TARGET B1-AR (ADRB1), IS ASSOCIATED WITH BB USE AND HIGHER BONE MINERAL DENSITY (BMD). WE ALSO SHOW A PHARMACOGENETIC ASSOCIATION IN AN ADRB1 VARIANT, WHICH IS POSITIVELY ASSOCIATED WITH MIR-19A-3P EXPRESSION. IN MOUSE STUDIES, WE HAVE SHOWN A NOVEL DIRECT EFFECT OF BB TREATMENT ON OSTEOCLASTS THAT IS NOT MEDIATED BY OSTEOBLAST SIGNALING. IN SUMMARY, OUR PRELIMINARY PHARMACOGENETIC AND MICRORNA RESULTS UNDERSCORE THE IMPORTANCE OF B1-AR IN ADDITION TO B2-AR SIGNALING FOR BB BONE EFFECTS, AND OUR MOUSE STUDIES SHOW EVIDENCE OF DIRECT EFFECTS OF BB TREATMENT ON OSTEOCLASTS IN ADDITION TO INDIRECT EFFECTS VIA OSTEOBLASTS. OUR CENTRAL HYPOTHESIS IS THAT GENETIC AND MICRORNA (MIRNA) VARIABLES ASSOCIATED WITH TREATMENT RESPONSE CONTRIBUTE TO MODULATION OF B1-AR AND B2-AR SIGNALING PATHWAYS IN OSTEOBLASTS AND OSTEOCLASTS. WE WILL TEST THIS HYPOTHESIS VIA THE FOLLOWING SPECIFIC AIMS: 1) MEASURE THE EFFECT OF IN VIVO ATENOLOL TREATMENT ON DIFFERENTIATION IN PARTICIPANT-DERIVED OSTEOCLASTS, DISCOVER AND VALIDATE PHARMACOGENETIC VARIANTS OF ATENOLOL TREATMENT RESPONSE, AND CHARACTERIZE THEIR FUNCTIONAL EFFECTS ON OSTEOBLASTS AND OSTEOCLASTS. 2) USE MIRNA-SEQ TO IDENTIFY CIRCULATING MIRNAS ASSOCIATED WITH TREATMENT RESPONSE, AND DISCOVER TARGETS AND VALIDATE MECHANISMS IN OSTEOBLASTS AND OSTEOCLASTS. WE PROPOSE TO RIGOROUSLY PERFORM THESE AIMS USING PARTICIPANT-DERIVED SAMPLES FROM THE PREVIOUSLY MENTIONED TRIAL. THIS PROPOSAL WILL ALLOW US TO CHARACTERIZE THE MECHANISMS OF BB TREATMENT EFFECT ON BONE IN POST-MENOPAUSAL WOMEN AND TO CREATE PERSONALIZED TREATMENT MODELS.

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION - STEPHENS MEMORIAL HOSPITAL’S PACE PARAMEDIC SERVICE PROVIDES EMS COVERAGE TO 10 LOCAL COMMUNITIES IN THE OXFORD HILLS REGION, SEASONAL COVERAGE OF SUNDAY RIVER SKI RESORT, AND BACK-UP COVERAGE FOR FOUR OTHER COMMUNITIES THAT HAVE SERVICES OF THEIR OWN. EACH YEAR, PACE CREWS RESPOND TO OVER 4,300 COMMUNITY EMERGENCIES AND PROVIDE CRITICAL TRANSPORT SERVICES BETWEEN HEALTH CARE FACILITIES THROUGHOUT THE REGION. IN 2021 STEPHENS INITIATED A COMPREHENSIVE FACILITIES PLANNING PROCESS TO ADDRESS AGING INFRASTRUCTURE AND FUTURE NEEDS OF OUR BUILDINGS AND SERVICES. AS PART OF THAT PROCESS THE PACE PARAMEDIC STATION WAS IDENTIFIED AS A PRIORITY FOR THE LOCAL COMMUNITY, REQUIRING SIGNIFICANT RENOVATIONS TO ITS PHYSICAL PLANT. OVERALL, THE BUILDING LACKS APPROPRIATE MECHANICAL VENTILATION WHICH RESULTS IN MOISTURE AND MOLD ISSUES, PARTICULARLY WHERE THE VEHICLES ARE STORED. THE EFFECTS OF THE HVAC DEFICIENCY CAN BE SEEN IN THE ACCELERATED RUSTING OF STORAGE UNITS AND THE STANDING MELT WATER THAT ACCUMULATES IN THE WINTER. THE STORAGE UNITS THEMSELVES ARE THE RESULT OF YEARS OF RETRO-FITTING, AS MEDICAL AND EMERGENCY RESPONSE SUPPLY REQUIREMENTS HAVE EVOLVED TO OUTSTRIP AVAILABLE, APPROPRIATE SPACE. THE BUILDING ITSELF CURRENTLY STRUGGLES TO HOUSE THE SIX AMBULANCES OPERATED BY PACE. AS PACE MIGRATES TO NOW-STANDARD FOUR-WHEEL DRIVE AMBULANCES THAT ARE LONGER IN BODY DESIGN, MORE SPACE WILL BE NEEDED. FURTHERMORE, OVER THE 22 YEARS SINCE THE BUILDING WAS CONSTRUCTED, PACE CREWS HAVE EVOLVED TO INCLUDE BOTH WOMEN AND MEN, MAKING GROUP BUNKING ARRANGEMENTS PROBLEMATIC. THE KITCHEN FACILITY IS SMALL AND INADEQUATE FOR PREPARING MEALS FOR A FULL STAFFING OF THE FACILITY. THERE IS ONLY ONE SHOWER AVAILABLE TO STAFF, ALSO INADEQUATE FOR THE NUMBER OF STAFF AND GENDER MIX. THE LIVING AND WORKING QUARTERS LACK A FIRE SUPPRESSION SYSTEM, A BASIC LIFE SAFETY CODE REQUIREMENT FOR MODERN FACILITIES. THESE IMPROVEMENTS WILL ENSURE THE LONGEVITY OF THE BUILDING WHI LE POSITIONING US TO MEET THE INCREASED VOLUME OF SERVICES NEEDED IN OUR COMMUNITIES. CONSTRUCTION / RENOVATION ACTIVITIES ARE AS FOLLOWS: - SCOPE OF CONSTRUCTION ACTIVITIES INCLUDES RENOVATION OF CURRENT SPACE AND AN ADDITIONAL 2925 SQ. FT. OF NEW SPACE TO LIVING QUARTERS AND STORAGE. - IMPROVEMENTS INCLUDE THE ADDITION OF EIGHT PRIVATE BUNK ROOMS, THREE STAFF BATHROOMS WITH SHOWERS, NEW PRIVATE SPACE FOR PATIENT CHARTING, AN ENLARGED KITCHEN, AND SECURE CLIMATE-CONTROLLED STORAGE SPACE FOR MEDICAL SUPPLIES. - MODIFICATIONS AND/OR REPAIRS TO THE BUILDING EXTERIOR INCLUDE REPLACEMENT OF WINDOWS TO MEET CURRENT EPA ENERGY STAR EFFICIENCY RATINGS. - HEATING, VENTILATION, AND AIR-CONDITIONING MODIFICATIONS INCLUDE UPGRADING THE CURRENT HVAC SYSTEM TO INCLUDE CLIMATE CONTROLS AND INSTALLING A VARIABLE REFRIGERANT FLOW HVAC SYSTEM WITH ASSOCIATED DUCT WORK. - ELECTRICAL UPGRADES AND/OR PLUMBING WORK INCLUDES THE ADDITION OF NEW PLUMBING FIXTURES THAT MEET EPA WATERSENSE SPECIFICATIONS. ELECTRICAL UPGRADES WILL INCLUDE NEW CONDUCTORS AND OUTLETS THAT MEET CURRENT CODE, ALONG WITH REDISTRIBUTED BRANCH CIRCUITRY. LIGHTING WILL BE CONVERTED TO LED. - PROJECT ACTIVITIES IN TERMS OF DIMENSION, SQ. FOOTAGE, AND TOTAL GROUND DISTURBANCE: THE ADDITIONS WILL INCREASE THE BUILDING BY 2925 SQ. FT. THE ADDITIONAL SQUARE FOOTAGE IS LOCATED ON BOTH SIDES AND THE BACK OF THE BUILDING. THE FIRST IS A SECURE STORAGE AREA OF 648 SQ. FEET ON THE LEFT SIDE OF THE AMBULANCE GARAGE, AND THE SECOND IS THE INCREASE TO THE LIVING QUARTERS ON THE RIGHT SIDE AND BACK OF THE BUILDING (2277 SQ. FT.). - THE PROPOSED METHOD OF CONSTRUCTION: CONSTRUCTION MANAGER AT-RISK DELIVERY METHOD.

PROJECT LIFE WORTH LIVING; - PROJECT LIFE WORTH LIVING, LED BY MAINE BEHAVIORAL HEALTHCARE (MBH), WILL REDUCE SUICIDE IDEATION, SUICIDE ATTEMPTS, AND DEATHS DUE TO SUICIDE AMONG ADULTS RESIDING IN EIGHT RURAL COUNTIES ACROSS SOUTHERN, WESTERN, AND COASTAL MAINE. MBH WILL LEVERAGE PROGRESS MADE TO IMPLEMENT ELEMENTS OF THE ZERO SUICIDE FRAMEWORK—DEVELOPING A LEADERSHIP COUNCIL, COMPLETING AN ORGANIZATIONAL SELF-STUDY AND WORKFORCE SURVEY, IMPLEMENTING C-SSRS AND CASE ASSESSMENTS, AND TRAINING AN INITIAL COHORT OF CLINICIANS IN CBT-SP—TO FULLY IMPLEMENT THE ZS FRAMEWORK ACROSS EIGHT OUTPATIENT CLINICS AND SEVEN EMERGENCY DEPARTMENTS. THE PROJECT WILL SERVE APPROXIMATELY 12,500 UNDUPLICATED INDIVIDUALS PER YEAR. THE TARGET REGION INCLUDES 56% OF MAINE’S POPULATION, APPROXIMATELY 625,000 INDIVIDUALS 18 YEARS AND OLDER, INCLUDING 51% FEMALE; 94% WHITE; AND APPROXIMATELY 5% LGBTQ+. THE SUICIDE RATE WITHIN THE REGION IS SIGNIFICANTLY HIGHER AND RISING MUCH MORE QUICKLY THAN THE NATIONAL AVERAGE. FIVE OF THE EIGHT TARGETED COUNTIES HAVE AMONG THE HIGHEST PER 100,000 RATES IN THE STATE (OXFORD 31.5; SAGADAHOC 28; KNOX 28.4; LINCOLN 27.5, AND YORK 25.1). SUICIDE RANKS HIGHER AS A CAUSE OF DEATH FOR VIRTUALLY EVERY AGE GROUP IN OUR TARGET AREA WHEN COMPARED TO THE REST OF THE COUNTRY. FOR 35-44 YEAR OLDS, SUICIDE IS THE 2ND LEADING CAUSE OF DEATH, COMPARED TO THE 5TH LEADING CAUSE OF DEATH NATIONALLY. FOR THOSE AGED 45-54 YEARS, SUICIDE IS THE 4TH LEADING CAUSE OF DEATH, VERSUS THE 7TH LEADING CAUSE OF DEATH NATIONALLY. EXACERBATING THIS ISSUE, MAINE HAS 19.7% OF THE PSYCHIATRISTS IT NEEDS, RANKING 37TH NATIONALLY IN PERCENT OF NEED MET. FIVE COUNTIES IN THE TARGET AREA ARE AMONG MAINE’S MOST UNDERSERVED FOR MENTAL HEALTH PROVIDERS, WITH POPULATION TO MENTAL HEALTH PROVIDER RATIOS AS HIGH AS 484:1 IN LINCOLN AND 441:1 IN SAGADAHOC COUNTY (COMPARED TO THE STATE 190:1 AND THE NATION 350:1). THE PROJECT WILL PURSUE THE FOLLOWING ZERO SUICIDE GOALS: (1) LEAD A SYSTEM-WIDE CULTURE CHANGE COMMITTED TO REDUCING SUICIDES; (2) DEVELOP AND IMPLEMENT TRAINING PROGRAMS FOR CLINICAL AND NON-CLINICAL HEALTHCARE WORKFORCE; (3) DEVELOP AND IMPLEMENT A PLAN TO SCREEN ALL INDIVIDUALS VIA COMPREHENSIVE SCREENING, ASSESSMENT, AND RE-ASSESSMENT (AS APPROPRIATE); (4) DESIGN SUICIDE CARE MANAGEMENT GUIDELINES AND IMPLEMENT SUICIDE CARE MANAGEMENT POLICIES SO INDIVIDUALS AT RISK OF SUICIDE ARE ENGAGED USING A SUICIDE CARE MANAGEMENT PLAN; (5) IMPLEMENT EFFECTIVE EVIDENCE-BASED TREATMENTS THAT DIRECTLY ADDRESS SUICIDAL THOUGHTS AND BEHAVIORS; (6) DEVELOP AND IMPLEMENT POLICIES AND PROCEDURES TO TRANSITION INDIVIDUALS THROUGH CARE WITH WARM HAND-OFFS AND SUPPORTIVE CONTACTS; (7) DEVELOP AND IMPLEMENT A STRATEGIC PLAN TO IMPROVE POLICIES AND PROCEDURES THROUGH A CONTINUOUS QUALITY IMPROVEMENT PLAN. THE PROJECT WILL UTILIZE FIVE EVIDENCE-BASED SCREENING AND ASSESSMENT TOOLS AND THREE EVIDENCE-BASED TREATMENT MODELS: (1) CHRONOLOGICAL ASSESSMENT OF SUICIDE EVENTS (CASE); (2) COLUMBIA-SUICIDE SEVERITY RATING SCALE (C-SSRS); (3) QUESTION, PERSUADE, REFER (QPR); (4) STANLEY-BROWN SAFETY PLAN; (5) SUICIDE ASSESSMENT FIVE-STEP EVALUATION AND TRIAGE (SAFE-T); (6) COGNITIVE BEHAVIORAL THERAPY (CBT); (7) COGNITIVE BEHAVIORAL THERAPY FOR SUICIDE PREVENTION (CBT-SP); (8) COLLABORATIVE ASSESSMENT AND MANAGEMENT OF SUICIDALITY (CAMS). THE PROJECT DIRECTOR AND LEAD EVALUATOR WILL PROVIDE TRAINING AND TECHNICAL ASSISTANCE FOR ALL PROVIDERS USING EBPS, ENSURING FIDELITY THROUGH LEARNING COLLABORATIVES, CHECKLISTS, AND INTERVIEWS.

PREVENTIVE MEDICINE RESIDENCY

PRIDE: PREVENTION, RECOVERY, INTEGRATION AND DELIVERY THROUGH ENGAGEMENT

PREVENTIVE MEDICINE RESIDENCIES

PRECLINICAL TESTING OF HUMAN GHRELIN AND GROWTH HORMONE FOR SEPSIS IN THE ELDERLY

REGULATORY ROLE AND SIGNALING MECHANISM OF R-SPONDIN IN CRANIOFACIAL DEVELOPMENT

SMOOTH MUSCLE CELL INTEGRATION OF DIFFERENTIATION SIGNALS

PROJECTCONNECT (COMMUNITY OUTREACH, NETWORK NAVIGATION, EVIDENCE-BASED CARE & TREATMENT) - MAINEHEALTH, THROUGH THE MAINE MEDICAL CENTER-PREBLE STREET LEARNING COLLABORATIVE (PSLC) SEEKS SAMHSA FUNDING TO LAUNCH PROJECTCONNECT, A MOBILE HARM REDUCTION, HOUSING AND TREATMENT PROGRAM DESIGNED TO OUTREACH, ENGAGE, AND HOUSE INDIVIDUALS EXPERIENCING, OR AT IMMINENT RISK OF, HOMELESSNESS, WITH CO-OCCURRING PSYCHIATRIC AND SUBSTANCE USE DISORDERS IN GREATER PORTLAND, MAINE. PROJECTCONNECT WILL ASSEMBLE THE CURRENTLY-DISPARATE PUZZLE PIECES THAT COMPRISE THE REGION’S HOMELESS RESOURCES, USING EVIDENCED-BASED PRACTICES AND LEVERAGING COMMUNITY-BASED RESOURCES TO MEET THE ESSENTIAL NEEDS OF UNHOUSED PERSONS AS THEY ENGAGE IN RECOVERY. THE PROGRAM TARGETS ADULTS UNSHELTERED OR IN SHELTER FACILITIES WITHIN THE COMMUNITIES OF PORTLAND, SOUTH PORTLAND, SCARBOROUGH AND WESTBROOK, MAINE, AND WILL PROVIDE DIRECT, ONSITE TREATMENT AT LOCAL ENCAMPMENTS AND OTHER SITES THROUGH A VAN-BASED MOBILE HEALTH UNIT THAT WILL SERVE AS THE PROGRAM’S SERVICE HUB. THE NUMBER OF CHRONICALLY HOMELESS PERSONS IN GREATER PORTLAND HAS SURGED IN RECENT YEARS, MORE-THAN-TRIPLING IN THE WAKE OF THE PANDEMIC. LIKEWISE, UNHOUSED INDIVIDUALS WHO ARE VETERANS AND SURVIVORS OF DOMESTIC VIOLENCE ALSO SPIKED POST-PANDEMIC, AS DID THOSE WITH CHILDREN (2022 POINT IN TIME SURVEY). SIGNIFICANT GAPS CURRENTLY IMPEDE PERSONS EXPERIENCING HOMELESSNESS FROM ACCESSING THE CONTINUUM OF OUTPATIENT PSYCHIATRIC AND CASE MANAGEMENT SERVICES AVAILABLE THROUGH COMMUNITY MENTAL HEALTH AGENCIES AND HOSPITAL-AFFILIATED OUTPATIENT CLINICS. EXTENSIVE WAITLISTS, RAGING FROM CLOSED ENTIRELY TO OPENINGS WITHIN TWO-TO-SIX MONTHS OR MORE, CAN DETER PEOPLE EXPERIENCING HOMELESSNESS WHO ARE READY TO INITIATE TREATMENT, AND MANY PROGRAM MODELS ASSUME PROSPECTIVE PATIENTS HAVE HEALTH INSURANCE, AS WELL AS A SMART PHONE WITH VIDEO AND INTERNET ACCESS, RELIABLE TRANSPORTATION, AND A LEVEL OF ORGANIZATION THAT IS INCONSISTENT WITH THE EXPERIENCE OF HOMELESSNESS, SMI AND ACTIVE SUBSTANCE USE. MOREOVER, NONE OF THE EXISTING OUTPATIENT CLINICS OFFER OUTREACH OR MOBILE TREATMENT AND ONLY A PORTION OFFER PEER SUPPORT. PROJECTCONNECT PARTICIPANTS INCLUDE THOSE WHO ARE: 1) UNABLE TO OVERCOME SYSTEMIC BARRIERS TO ACCESSING OUTPATIENT CARE, DUE TO SYMPTOMS OF THE VERY CONDITIONS FOR WHICH THEY NEED TREATMENT (E.G. DISORGANIZED THINKING AND BEHAVIOR, PARANOIA, IMPULSIVITY); 2) ‘LOST TO FOLLOW-UP’ AT CRITICAL CARE TRANSITIONS FROM EDS, CRISIS STABILIZATION UNITS, MEDICALLY SUPERVISED WITHDRAWAL CENTERS (DETOX), HOSPITALS AND CARCERAL SETTINGS; 3) OVER-RELIANT ON EMERGENCY DEPARTMENTS AND LAW ENFORCEMENT/EMS FOR CRISIS INTERVENTION; 4) UNLIKELY TO ACCESS BENEFITS AND HOUSING RESOURCES WITHOUT ASSERTIVE INTERVENTION AND SUPPORT; AND 5) UNSEEN BY FORMAL SYSTEMS OF CARE DUE TO THE ISOLATION OF HOMELESSNESS, SHAME OF SUBSTANCE USE, HISTORY OF NEGATIVE OR HARMFUL EXPERIENCES WITH HELPING SYSTEMS, AND THE UNIQUE SYMPTOMATOLOGY OF PSYCHOTIC AND AFFECTIVE DISORDERS THAT DISCONNECTS PEOPLE FROM COMMUNITY. THE PROPOSED PROJECT WILL ADDRESS THE COMPLEX NEEDS OF THIS POPULATION BY PROVIDING ESSENTIAL RESOURCES AND SERVICES, EITHER DIRECTLY OR THROUGH REFERRALS TO PARTNER ORGANIZATIONS. INTERVENTIONS TO BE PROVIDED INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: 1. INTEGRATED BEHAVIORAL HEALTH TREATMENT AND RECOVERY SUPPORT SERVICES, INCLUDING MEDICATIONS FOR OPIOID USE DISORDER (MOUD) AND PSYCHIATRIC MEDICATION MANAGEMENT; 2. SUPPORT TO ENROLL FOR HEALTH INSURANCE (MAINECARE), AND OTHER MAINSTREAM BENEFITS, SUCH AS TANF, SNAP, SOCIAL SECURITY INCOME AND/OR SOCIAL SECURITY DISABILITY INSURANCE; AND 3. COORDINATION OF HOUSING – THROUGH PARTNERSHIP WITH PREBLE STREET, A MAINEHOUSING CONTINUUM OF CARE PROVIDER, TO PROVIDE RAPID RE-HOUSING SERVICES AND CASE MANAGEMENT. THE PROGRAM WILL BE HOUSED WITHIN THE PREBLE STREET LEARNING COLLABORATIVE. MAINEHEALTH IS SEEKING GRANT FUNDS TOTALING $500,000 PER YEAR FOR FIVE YEARS UNDER THIS SAMHSA OPPORTUNITY (SM-23-006), WITH A START DATE OF SEPTEMBER 30, 2023.

ANTAGONISM OF ALPHA2A-ADRENOCEPTOR: A NOVEL ANTI-SEPSIS THERAPY

RURAL COMMUNITIES OPIOID RESPONSE PROGRAM ? NEONATAL ABSTINENCE SYNDROME - RURAL COMMUNITIES OPIOID RESPONSE PROGRAM – NEONATAL ABSTINENCE SYNDROME

IMPROVING RURAL NEONATAL BIRTH OUTCOMES THROUGH NEONATAL RESUSCITATION SIMULATION TRAINING - A RAPID AND SKILLFUL NEONATAL RESUSCITATION, PERFORMED BY A CONFIDENT AND KNOWLEDGEABLE MEDICAL TEAM, IS CRUCIAL TO REDUCING NEONATAL MORBIDITY AND MORTALITY. MAINE IS THE MOST RURAL STATE IN THE UNITED STATES AND TWO- THIRDS OF HOSPITALS HAVE LOW BIRTH RATES OF LESS THAN ONE NEWBORN PER DAY. THIS LOW BIRTH RATE PRECLUDES CLINICAL TEAMS FROM HAVING REGULAR OPPORTUNITIES TO MAINTAIN ESSENTIAL NEONATAL RESUSCITATION SKILLS. STRATEGIES TO IMPROVE AND MAINTAIN NEONATAL RESUSCITATION SKILLS AT RURAL HOSPITALS ARE URGENTLY NEEDED AND ESSENTIAL TO PRESERVE MATERNAL AND INFANT CARE AT CRITICAL ACCESS HOSPITALS. IN SITU SIMULATION TRAINING HAS BEEN SHOWN TO BE AN EFFECTIVE TRAINING TOOL, ALLOWING DELIVERY ROOM TEAMS TO DELIBERATELY PRACTICE RESUSCITATION SKILLS ON A MANNEQUIN IN THEIR NATIVE CLINICAL SETTING WITH EXPERTS PRESENT TO PROVIDE GUIDANCE AND LEAD A TEAM DEBRIEFING FOLLOWING THE TRAINING SESSION. THIS TRAINING ALLOWS RURAL CLINICIANS TO PRACTICE ESSENTIAL RESUSCITATION SKILLS INCLUDING ADHERENCE TO THE NEONATAL RESUSCITATION PROGRAM (NRP) GUIDELINES, TEAMWORK AND COMMUNICATION THROUGH SCENARIOS CREATED TO INTENTIONALLY REPLICATE CRITICAL CLINICAL SITUATIONS. CLINICIANS THEN RECEIVE DIRECTED FEEDBACK IN DEBRIEFING SESSIONS FOLLOWING THE SIMULATION TRAINING TO REVIEW THEIR PERFORMANCE AND ASSESS FOR AREAS OF IMPROVEMENT. THOUGH EFFECTIVE, IN SITU SIMULATION TRAINING IN RURAL HOSPITALS IS DEPENDENT UPON THE AVAILABILITY OF EXPERTS AND IS COST PROHIBITIVE DUE TO THE EXPENSIVE SIMULATION EQUIPMENT. TELESIMULATION IS AN ALTERNATIVE METHOD OF PROVIDING SIMULATION TRAINING AND EMPLOYS MANY OF THE PRINCIPLES OF IN SITU SIMULATION TRAINING, WITH REMOTE PARTICIPATION FROM EXPERTS FOR OBSERVATION AND DEBRIEF SUPPORT. IN A PILOT STUDY, WE DEMONSTRATED THAT REGULAR MONTHLY TELESIMULATION TRAINING FOR 12 MONTHS AT ONE RURAL HOSPITAL LED TO SUBSTANTIAL IMPROVEMENTS IN ADHERENCE TO NRP, TEAMWORK AND COMMUNICATION SCORES. IN THE PROPOSED RANDOMIZED NON-INFERIORITY CLUSTER TRIAL, WE WILL COMPARE TWO TYPES OF TELESIMULATION TECHNOLOGY AND EMPLOY IMPLEMENTATION SCIENCE TO ENSURE CONSISTENCY IN THE APPROACH ACROSS DIFFERENT INSTITUTIONS AS WELL AS DEVELOP A FRAMEWORK TO ENABLE IMPLEMENTATION AT OTHER SITES. SPECIFICALLY, WE WILL TEST AN INNOVATIVE MIXED REALITY HOLOGRAM (HOLOBABYTM) THAT OUR RESEARCH GROUP HAS DEVELOPED AND PATENTED AGAINST THE CURRENT HIGH-FIDELITY STANDARD MANNEQUIN TELESIMULATION USED IN OUR PILOT STUDY. THE PRIMARY OUTCOME IS THE PERFORMANCE OF THE MEDICAL TEAMS DURING A RESUSCITATION AS MEASURED BY A SCORE EVALUATING ADHERENCE TO THE GOLD STANDARD NRP GUIDELINE. COMMUNICATION AND TEAMWORK WILL ALSO BE ASSESSED AS SECONDARY OUTCOMES AND USING THE MAYO HIGH PERFORMANCE TEAMWORK SCALE. THE HOLOBABYTM LEVERAGES NOVEL TECHNOLOGY TO PROVIDE A LESS EXPENSIVE ALTERNATIVE TO MAKE SIMULATION TRAINING MORE WIDELY ACCESSIBLE TO RURAL COMMUNITY HOSPITALS ALLOWING RURAL CLINICIANS TO DELIBERATELY PRACTICE RESUSCITATION SKILLS, PRIORITIZING LEARNING AND COMPETENCE, WITHOUT COMPROMISING PATIENT SAFETY.

KA POU KŪ MAU: BUILDING CLIMATE AND OCEAN BASED LITERACY FOR KO‘OLAU, O‘AHU

NORTHERN NEW ENGLAND WIPA SERVICES

HIGH ENERGY COST GRANT

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION - MAINEHEALTH PLANS TO EXPAND ITS CURRENT THREE-BEDROOM TREATMENT PROGRAM AT 407 PLEASANT STREET IN ROCKLAND, MAINE CURRENTLY SERVING PEOPLE WITH SEVERE?MENTAL ILLNESS (SMI) TO AN EIGHT-BED RESIDENTIAL TREATMENT PROGRAM?THAT ALSO SERVES THOSE DIAGNOSED WITH SUBSTANCE USE DISORDER (SUD). TO DO THIS, MAINEHEALTH WILL DEMOLISH THE PRESENT BUILDING AND ERECT A NEW STRUCTURE ON THE SITE. THE BUILDING IS OWNED BY PEN BAY MEDICAL CENTER, A MEMBER OF MAINEHEALTH, AND LEASED TO MAINE BEHAVIORAL HEALTHCARE, ALSO A MEMBER OF MAINEHEALTH, FOR A DOLLAR A YEAR. THE DECISION TO FOCUS ON ONE LOCATION SERVING PEOPLE WITH SMI AND SUD IS DUE TO INCREASING CONSTRUCTION AND SUPPLIES COST. THE OVERDOSE RATE AND MORTALITY RATES FOR INDIVIDUALS WITH SMI AND SUD WHO GO UNSERVED OR ARE WAITING FOR APPROPRIATE TREATMENT PROGRAMS CREATE?HIGH COST TO MAINE'S COMMUNITY.? IN 2022, MAINE LOST 716 PEOPLE TO OVERDOSES ALONE. BY EXPANDING RESIDENTIAL TREATMENT OPPORTUNITIES TO THOSE DIAGNOSED?WITH SMI AND SUD, WE WILL?DECREASE THE NUMBER OF PEOPLE WHO UTILIZE EMERGENCY ROOMS FOR MENTAL HEALTH CRISES?AND OVERDOSES?AND ADDRESS THE HIGH RISK OF?HOMELESSNESS FOR THESE INDIVIDUALS. THIS TREATMENT FACILITY WILL PROVIDE MAINE CITIZENS WITH MEDICATION MANAGEMENT,?DAILY LIVING SUPPORT,?SKILL BUILDING, AND COMPLIANCE?WITH TREATMENT. THE FOCUS OF THE PROGRAM IS TO REINTEGRATE PEOPLE BACK INTO THEIR COMMUNITIES WHERE THEY CAN CONTINUE THEIR RECOVERY WITH THE APPROPRIATE COMMUNITY SUPPORTS. IN MANY CASES, RESIDENTIAL TREATMENT IS A STEPPINGSTONE TO VOCATIONAL SERVICES, INDEPENDENT LIVING, AND EMPLOYMENT.

CRYPTIC DOMAINS OF COLLAGEN-IV IN TUMOR GROWTH

NRAGE: A MEDIATOR OF P38 MAP KINASE AND CASPASE ACTIVITY IN THE CNS.

FEEDBACK INHIBITORY MECHANISMS IN SKELETAL DEVELOPMENT

THIS AWARD APPROVES FUNDING FOR THE 2023-24 VOLUNTEER GENERATION FUND ARP PROGRAM DESCRIBED IN THE APPROVED PROGRAM NARRATIVE AND BUDGET. THE PURPOSE OF THIS GRANT IS TO SUPPORT AND PROMOTE EDUCATIONAL ATTAINMENT AND HEALTHY LIVES. BY PERFORMING THE FOLLOWING HIGH LEVEL ACTIVITIES: VOLUNTEER RECRUITMENT, PLACEMENT, AND RETENTION FOCUED ON BUILDING RACIAL EQUITY AND DIVERSITY IN THE VOLUNTEER CORPS; INCREASING TUTORING AND MENTORING AND EXPANDING THE CAPACITY TO DELIVER HEALTHY AND CULTURALLY APPROPRIATE FOOD THAT WILL BENEFIT COMMUNITY MEMBERS IN RAMSEY, HENNEPIN, DAKOTA, ANOKA, WASHINGTON, AND SCOTT COUNTIES IN MINNESOTA.THE GENERAL EXPECTED OUTCOME INCLUDES IMPROVING THE FOOD INSECURITY PROGRAM BY INCREASING FOOD SERVED BY 250,000 POUNDS, THE EDUCATIONAL SUCCESS OF YOUTH BY INCREASED SEL BY 75% THROUGH A STAFF ASSESSMENT, AND AN INCREASE OF 325 VOLUNTEERS. YOUR 2023-24 REGULATORY MATCH IS 20%, AND YOUR BUDGETARY MATCH IS 27.0%.

MESODERM SPECIFIC TRANSCRIPT AND ADIPOSE TISSUE EXPANSION

TREATMENT OF SURGICAL SEPSIS WITH AM/AMBP-1

DIRECT BB TREASURY RATE GRANT - (FY09-10) STIMULUS

PROJECT REACH (RECOVERY, ENGAGEMENT, ACCEPTANCE, COMPASSION, HOPE) WILL PROVIDE ENHANCED AND EXPANDED SUBSTANCE USE TREATMENT FOR ADULTS IN MAINE THROUGH INCREASED OUTREACH SERVICES.

A NEW THERAPY FOR BOWEL ISCHEMIA-REPERFUSION INJURY

COMMUNITIES OF PRACTICE: TEACHER PREPARATION AND BEYOND

SINGLE SOURCE PARTICIPATION IN THE NASA HIGH-RATE COMPOSITES AIRCRAFT MANUFACTURING (HICAM) PROJECT PHASE 1 PERFORMING WORK APPROVED BY NASA AND THE ADVANCED COMPOSITES CONSORTIUM. P1.DFM.TDA.01: DESIGN FOR MANUFACTURING

PHASE III COBRE IN VASCULAR BIOLOGY

PROJECT DHARMA ? DISTRIBUTION OF HARM REDUCTION ACCESS IN RURAL MAINE AREAS - PROJECT DHARMA (DISTRIBUTION OF HARM REDUCTION ACCESS IN RURAL MAINE AREAS) WILL SERVE SYRINGE SERVICE PROGRAM (SSP) CLIENTS IN ALL SIXTEEN COUNTIES OF MAINE. BEING THE MOST RURAL STATE IN THE NATION, THIS GRANT WILL FOCUS ON CLIENTS IN RURAL COUNTIES, PARTICULARLY THOSE DEEMED HIGH RISK FOR HIV/HEPATITIS OUTBREAKS, AS WELL AS UNDERSERVED POPULATIONS SUCH AS LGBTQ+ INDIVIDUALS AND UNHOUSED INDIVIDUALS WHO USE DRUGS. DEVELOPED THROUGH AN UNPRECEDENTED COLLABORATION BETWEEN SYRINGE SERVICE PROGRAMS, MAINEHEALTH (THE LARGEST HEALTH SYSTEM IN MAINE), AND COMMUNITY ORGANIZATIONS ACROSS THE STATE, PROJECT DHARMA WILL INVOLVE THE DELIVERY OF EVIDENCE-BASED HARM REDUCTION STRATEGIES ACROSS THE STATE, WITH A FOCUS ON UTILIZING PEER SUPPORT WORKERS EMBEDDED IN SSPS TO FACILITATE HARM REDUCTION SUPPLY DISTRIBUTION AND LINKAGE TO CARE FOR INFECTIOUS DISEASE PREVENTION AND TREATMENT, WOUND CARE, AND SUBSTANCE USE. PROJECT DHARMA GOALS AND OBJECTIVES ARE AS FOLLOWS 1) EXPAND CAPACITY OF SSPS TO DELIVER OVERDOSE PREVENTION AND WOUND CARE THROUGH DISTRIBUTION OF 3,000 FENTANYL TEST STRIPS, 100,000 NALOXONE KITS, INNOVATIVE COMMUNITY DRUG CHECKING/SPECTROMETRY BASED-TESTING OF 1,000 SSP CLIENT SAMPLES, AND DISTRIBUTION OF 900 WOUND CARE KITS 2) EXPAND THE CAPACITY OF SSPS TO SCREEN FOR HIV, HEPATITIS B (HBV), AND HEPATITIS C (HCV) BY TRAINING 90% OF SSP STAFF IN RAPID HIV/HCV AND DRIED BLOOD SPOT HCV/HBV TESTING, TESTING 4,500 SSP CLIENTS TOTAL USING RAPID HIV/HCV TESTING, OFFERING CUTTING-EDGE DRIED BLOOD SPOT HCV/HBV TESTING TO 250 SSP CLIENTS, AND DEVELOPING AND MAINTAINING A DATABASE FOR HIV/HBV/HCV RESULTS 3) PROMOTE AWARENESS OF PRE-EXPOSURE PROPHYLAXIS (PREP) IN PERSONS WHO USE SUBSTANCES BY TRAINING 100 PRIMARY CARE PROVIDERS IN PREP, EXPANDING AWARENESS OF PREP HOTLINE THROUGH INCREASED SSP MESSAGING AND TRAINING 100% OF PROJECT PEER SUPPORT WORKERS, AND RETAINING 50% OF SSP CLIENTS REFERRED FOR PREP AT 6 MONTHS 4) INTEGRATE PEER SUPPORT WORKERS TO INCREASE LINKAGE AND COORDINATION NECESSARY FOR PEOPLE TO OBTAIN HIV, VIRAL HEPATITIS, WOUND CARE, AND SUBSTANCE USE SERVICES BY HIRING PEER SUPPORT WORKERS TO FILL 2.5 FULL TIME POSITIONS FOR PROVIDING INDIVIDUALIZED SUPPORT AND LINKAGE, CREATING AND MAINTAINING A PEER SUPPORT WORKER PROTOCOL FOR TESTING AND LINKAGE TO CARE FOR HIV, VIRAL HEPATITIS, WOUND CARE, AND SUBSTANCE USE SERVICES, LINKING 80% OF CLIENTS WITH VIRAL HEPATITIS OR HIV TO CARE, AND LINKING 80% OF ELIGIBLE CLIENTS TO TELEHEALTH AND/OR ONSITE WOUND CARE PROVIDERS 5) EXPAND THE CAPACITY OF SSPS AND ACADEMIC PARTNERS TO PROVIDE INTERPROFESSIONAL HARM REDUCTION TRAININGS BY IDENTIFYING SPECIFIC EDUCATIONAL NEEDS AND MESSAGING PREFERENCES THROUGH COMMUNITY PARTNER STAKEHOLDER INTERVIEWS, IMPLEMENTING HARM REDUCTION TRAINING WITH 500 INTERPROFESSIONAL STUDENTS AND PROVIDERS, AND IMPROVING HARM REDUCTION KNOWLEDGE AND REDUCING STIGMA BY 80%. BY PARTNERING WITH SSPS THAT COLLECTIVELY SERVE MORE THAN 2,500 CLIENTS THROUGHOUT MAINE (A NUMBER LIKELY TO INCREASE BECAUSE SOME SSPS ARE RELATIVELY NEW), PROJECT DHARMA REALISTICALLY PLANS TO SERVE AT LEAST 2,000 UNDUPLICATED CLIENTS IN YEAR 1, 2,250 CLIENTS IN YEAR 2, AND 2,500 CLIENTS IN YEAR 3, FOR A TOTAL OF 6,750 CLIENTS OVERALL. PROJECT DHARMA’S GOAL IS TO MAKE 7,500 REFERRALS AND 9,000 LINKAGES TO SUPPORT SERVICES OVER 3 YEARS. WITH SUPPORT FROM THE STATE (MAINE OFFICE OF BEHAVIORAL HEALTH), MAINE CDC, FOURTEEN FEDERALLY QUALIFIED HEALTH CENTERS, ACADEMIC PARTNERS AND TREATMENT PROVIDERS THROUGHOUT THE STATE, AS WELL AS A KNOWLEDGEABLE HARM REDUCTION ADVISORY COUNCIL, PROJECT DHARMA HAS THE POTENTIAL TO FACILITATE ACCESS TO HARM REDUCTION SUPPLIES AND SERVICES TO THE PEOPLE IN MAINE WHO NEED IT THE MOST.

HOA MAU: COMMUNITY VOYAGER PROJECT

THE MAINE CHILDREN'S TRAUMA RESPONSE INITIATIVE

TELEHEALTH NETWORK GRANT PROGRAM

FAMILY VIOLENCE PREVENTION AND SERVICES

CHILDREN'S ORAL HEALTHCARE ACCESS PROGRAM

CONGRESSIONALLY DIRECTED SPENDING FOR CONSTRUCTION PROJECTS

SEE NOTICE OF AWARD, ATTACHMENT 1 - TERMS AND CONDITIONS, ATTACHMENT D, STATEMENT OF WORK, ABSTRACT

OVERCOMING THE CHALLENGES TO THE SCIENCE EDUCATION OF A LIBERAL ARTS COLLEGE FOR ECONOMICALLY DISADVANTAGED STUDENTS

A NOVEL RESUSCITATION FOR HEMORRHAGIC SHOCK: AM/AMBP-1

MOUNT WASHINGTON VALLEY DEMENTIA CAPABLE COMMUNITY PROGRAM

RURAL COMMUNITIES OPIOID RESPONSE-IMPLEMENTATION

LOCAL COMMUNITY-BASED WORKFORCE TO INCREASE COVID-19 VACCINE ACCESS

THE RURAL DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, AND STALKING PROGRAM (RURAL PROGRAM) IS AUTHORIZED BY 34 U.S.C. § 12341. RURAL PROGRAM FUNDS ARE USED TO SUPPORT PROGRAMS THAT: A) IDENTIFY, ASSESS, AND APPROPRIATELY RESPOND TO CHILD, YOUTH, AND ADULT VICTIMS OF DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, AND STALKING IN RURAL COMMUNITIES; B) ESTABLISH AND EXPAND VICTIM SERVICES IN RURAL COMMUNITIES FOR CHILD, YOUTH, AND ADULT VICTIMS; AND/OR C) INCREASE THE SAFETY AND WELL-BEING OF WOMEN AND CHILDREN IN RURAL COMMUNITIES BY DEALING DIRECTLY AND IMMEDIATELY WITH DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, AND STALKING, AND CREATING AND IMPLEMENTING STRATEGIES TO INCREASE AWARENESS AND PREVENT THESE CRIMES. GRANTEES MUST USE AT LEAST ONE OF THE FOLLOWING STRATEGIES IN IMPLEMENTING THEIR PROJECTS: A) IMPLEMENT, EXPAND, AND ESTABLISH COOPERATIVE EFFORTS AND PROJECTS AMONG LAW ENFORCEMENT OFFICERS, PROSECUTORS, VICTIM SERVICE PROVIDERS, AND OTHER RELATED PARTIES TO INVESTIGATE AND PROSECUTE INCIDENTS OF DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, AND STALKING; B) PROVIDE TREATMENT, COUNSELING, ADVOCACY, LEGAL ASSISTANCE, AND OTHER LONG- AND SHORT-TERM ASSISTANCE TO ADULT AND MINOR VICTIMS OF DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, AND STALKING IN RURAL COMMUNITIES; C) WORK IN COOPERATION WITH THE COMMUNITY TO DEVELOP EDUCATION AND PREVENTION STRATEGIES DIRECTED TOWARD SUCH ISSUES; D) DEVELOP, ENLARGE, OR STRENGTHEN PROGRAMS ADDRESSING SEXUAL ASSAULT; AND E) DEVELOP PROGRAMS AND STRATEGIES THAT FOCUS ON THE SPECIFIC NEEDS OF VICTIMS WHO RESIDE IN REMOTE RURAL AND GEOGRAPHICALLY ISOLATED AREAS.    THE TIMING FOR PERFORMANCE OF THIS AWARD IS 36 MONTHS.

CAREER: GENETIC ARCHITECTURE AND PROXIMATE MECHANISMS UNDERLYING INDIRECT GENETIC EFFECTS ON COOPERATIVE ANTIPREDATOR BEHAVIOR

ECONOMIC DEVELOPMENT INITIATIVE, COMMUNITY PROJECT FUNDING, AND MISCELLANEOUS GRANTS

RURAL HEALTH NETWORK DEVELOPMENT PROGRAM

RURAL HEALTH NETWORK DEVELOPMENT PROGRAM

RELEASE OF FGF1 AND PATHOLOGY OF ANGIOGENESIS

FY 20 COSSAP PROGRAM

SETTING COURSE KE ALA O KANALOA

STAFFING FOR ADEQUATE FIRE AND EMERGENCY RESPONSE (SAFER)

AIR POLLUTION EXPOSURE DURING PREGNANCY, MATERNAL GLYCEMIA, AND OFFSPRING GROWTH

CANCER AND TOBACCO CONTROL TRAINING AND RESEARCH ACROSS THE LIFESPAN IN KENYA

REGULATION OF ENDOTHELIAL CELL FUNCTION BY SPROUTY

MAINEHEALTH ALZHEIMER?S PARTNERSHIP: EXPANDING TO MEET COMMUNITY NEEDS

WRE EASEMENT RESTORATION_GALASSI

THE LIPIDOMICS OF ADIPOSE TISSUE THERMOGENESIS

DOMESTIC WATER GRANTS - REGULAR

EVIDENCE-BASED TELE-BEHAVIORAL HEALTH NETWORK PROGRAM

DRUG-FREE COMMUNITIES (DFC) SUPPORT PROGRAM ? NEW

RURAL RESIDENCY PLANNING AND DEVELOPMENT PROGRAM - ELIGIBLE ENTITY/TYPE: TYPE 1–RURAL HOSPITALS PD: KALLI VARAKLIS, MD, MSED; CONTACT: (207) 662-7060; KALLI.VARAKLIS@MAINEHEALTH.ORG RESIDENCY PD: TO BE HIRED PATHWAY: GENERAL PRIMARY CARE SPECIALTY: FAMILY MEDICINE FORMAT: RURAL RESIDENCY PROGRAM (NON-RTP) SPONSORING INSTITUTION: MAINE MEDICAL CENTER (MMC), 22 BRAMHALL STREET, PORTLAND, ME 04102; ACGME SPONSOR PROGRAM CODE: 220384 RURAL TARGET AREA: FRANKLIN COUNTY, ME FUNDING REQUESTED: $750,000 (3 YRS.) SUSTAINABILITY OPTION: FINANCIAL SUSTAINABILITY WILL BE SOUGHT VIA MAINEHEALTH’S QUALIFICATION FOR MEDICARE GME, AND THROUGH INSTITUTIONAL AND SUPPORT. TOTAL # RESIDENTS: 6 EXP. ACGME ACCRED. & RES. MATRICULATION DATES: INITIAL APPLICATION FOR ACGME ACCREDITATION WILL BE SUBMITTED BY 11/30/2025, RECRUITMENT STARTING FALL 2026 FOR FIRST CLASS MATRICULATION ON 7/1/2027 PRIORITY PTS: NA LIST OF AWARDS: MAINEHEALTH (9 HOSPITAL SYSTEMS) HAS RECEIVED 20 HRSA AWARDS WITHIN THE LAST 5 YEARS. (ATT. 10), INCLUDING: D33HP31665 HRSA PREVENTIVE MEDICINE RESIDENCIES (MMC); D04RH40264 HRSA RURAL HEALTH CARE SERVICES OUTREACH (FCHN); GA1RH39574 HRSA RURAL HEALTH OUTREACH & RURAL NETWORK DEVELOPMENT (FCHN) P13RH33167 HRSA RURAL RESIDENCY PLANNING & DEVELOPMENT: RURAL TRAINING TRACK IN PSYCHIATRY (MMC, PEN BAY) ABSTRACT: WE WILL DEVELOP A NEW ACGME-ACCREDITED RURAL RESIDENCY IN FAMILY MEDICINE (RIFM) TO SUPPORT THE EXPANSION AND RETENTION OF MAINE’S RURAL PRIMARY CARE WORKFORCE. THIS RIFM BUILDS UPON MAINE MEDICAL CENTER’S (MMC) EXPERIENCE OF SUCCESSFUL IMPLEMENTATION OF SIMILAR RURAL RESIDENCY TRACKS. THE RIFM WILL ADD CLINICAL CAPACITY TO SERVE THE RURAL REGION OF FRANKLIN COUNTY, ME, OF WHICH 87% IS A PRIMARY CARE HPSA AND/OR DESIGNED MUA. MMC HAS DOCUMENTED SUCCESS IN RETAINING GRADUATES TO PRACTICE IN MAINE (~77% OF MMC FM RESIDENTS IN LAST 5 YEARS). WE BELIEVE A RIFM IN FRANKLIN COUNTY WILL BE A KEY STRATEGY TO ADDRESS THE COUNTY’S PHYSICIAN SHORTAGE AND POPULATION HEALTH NEEDS. GEOGR APHIC AREA/TARGET POP.: MAINE IS THE OLDEST AND SECOND MOST RURAL STATE IN THE U.S. FRANKLIN COUNTY HAS HIGHER POVERTY RATES THAN THE MAINE MEDIAN, MORE RESIDENTS WITH AT LEAST 3 CHRONIC CONDITIONS AND LOWER RATES OF ACCESS TO PRIMARY CARE SERVICES RELATED, IN PART, TO COST BARRIERS IN ACCESSING CARE. CLINICAL COLLABORATIONS: RESIDENTS WILL COMPLETE MOST OF THEIR TRAINING AT FRANKLIN MEMORIAL HOSPITAL AND ITS THREE MEDICAL PRACTICES. RESIDENTS WILL ROTATE AT MMC FOR AN INPATIENT PEDIATRICS ROTATION AND TWO MONTHS OF INPATIENT OBSTETRICS. RIFM RESIDENTS WILL HAVE FULL ACCESS TO THE EDUCATIONAL, SIMULATION AND RESEARCH OPPORTUNITIES OF MMC AND A CLOSE RELATIONSHIP WITH THE MMC FM RESIDENCY. ON-SITE AHEC AND DENTAL CLINIC WILL AFFORD ADDITIONAL CLINICAL OPPORTUNITIES. MEASURABLE OBJECTIVES: THE RIFM WILL ENROLL 2 RESIDENTS/YEAR BY JULY 2027, ACHIEVED BY MEETING THE FOLLOWING OBJECTIVES: (1) DEFINE COMPETENCIES FOR RURAL FAMILY MEDICINE (FM) PHYSICIANS AND DEVELOP EVIDENCE-BASED CURRICULUM AND COMPETENCY-BASED EVALUATION TOOLS THAT ENSURE GRADUATING RESIDENTS ARE WELL-EQUIPPED FOR INDEPENDENT PRACTICE OF FM; (2) DESIGN THE RIFM RESIDENCY, INCLUDING CLINICAL EXPERIENCES, LEADERSHIP, QUALITY IMPROVEMENT (QI) AND SCHOLARLY ACTIVITIES AND POPULATION HEALTH EXPERIENCES, TO MEET THE FM ACGME PROGRAM REQUIREMENTS (3) PROVIDE FM FACULTY DEVELOPMENT FOR TEACHING AND EVALUATION. PROVIDE PROGRAM DIRECTOR-SPECIFIC FACULTY DEVELOPMENT TO LEAD A RESIDENCY PROGRAM; (4) ACHIEVE ACGME ACCREDITATION; 5) RECRUIT TWO HIGH-QUALITY RIFM RESIDENTS TO ENROLL BY JULY 2027; (6) EMPLOY INNOVATIVE APPROACHES, EMERGING HEALTHCARE DELIVERY STRATEGIES AND EVIDENCE-BASED MEDICAL EDUCATION BEST PRACTICES TO ENHANCE THE QUALITY OF THE RIFM PROGRAM; (7) REPORT REQUIRED MEASURABLE OUTCOMES AND ENGAGE IN CONTINUOUS QI (8) TRACK RESIDENTS’ CAREER OUTCOMES FOR >5 YEARS, INCLUDING RETENTION IN FM AND PRACTICE IN RURAL AREAS, AS WELL AS OTHER KEY CAREER OUTCOMES; AND (9) DEVELOP, FINALIZE AND I MPLEMENT SUSTAINABILITY PLAN.

RURAL HEALTH CARE SERVICES OUTREACH GRANT PROGRAM

AMERICAN RESCUE PLAN ACT FUNDING FOR HEALTH CENTERS

INNOVATIVE INTERVENTION FOR REDUCING STRESS REACTIVITY AND RISK FOR PSYCHOSIS

CE25-149 - ENHANCING PROJECT DHARMA; EVALUATING A COMMUNITY-BASED DRUG CHECKING NAVIGATOR INTERVENTION TO PREVENT OVERDOSES

FINANCIAL ASSISTANCE AWARD

PREVENTIVE MEDICINE RESIDENCIES

CONTINUUM OF CARE PROGRAM

PROJECT BRAID: BUILDING RESILIENCE IN AREAS IMPACTED BY DOMESTIC VIOLENCE.

HEALTH CENTER CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY (CARES) ACT FUNDING

FINANCIAL ASSISTANCE AWARD

BENEFITS COUNSELING SERVICES

MIDCOAST MAINE MENTAL HEALTH AWARENESS TRAINING PROGRAM FOR SCHOOLS AND COMMUNITY - MID COAST HOSPITAL, BRUNSWICK, MAINE, UNDER A SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION TRAINING GRANT WILL IMPLEMENT THE “MID COAST YOUTH MENTAL HEALTH AWARENESS PROJECT”. MID COAST HOSPITAL WILL BE PARTNERING WITH NAMI MAINE AND OTHER COMMUNITY PARTNERS TO OFFER FREE TRAINING TO YOUTH SERVING AGENCIES, FAMILIES, CAREGIVERS AND PEER LEADERS IN SAGADAHOC COUNTY, BRUNSWICK AND HARPSWELL. MID COAST HOSPITAL’S GOAL IS TO INCREASE COMMUNITY AWARENESS AND ABILITY TO RECOGNIZE EARLY SIGNS OF MENTAL ILLNESS IN YOUTH, APPROPRIATELY RESPOND TO PREVENT AND DE-ESCALATE CRISIS SITUATIONS, AND CONNECT YOUTH TO LOCAL RESOURCES. TRAIN 1,810 UNIQUE INDIVIDUALS, 362/YEAR IN YEARS 1-5. GOAL 1: INCREASE COMMUNITY CAPACITY TO APPROPRIATELY RESPOND TO YOUTH AND YOUNG ADULTS, AGES 12-24, WHO HAVE SIGNS OF MENTAL ILLNESS BY SEPTEMBER 30, 2026, O 20 YOUTH MENTAL HEALTH FIRST AID TRAININGS WILL BE HELD TO INCREASE THE NUMBER OF ADULTS WHO RECOGNIZE THE SIGNS AND SYMPTOMS OF, AND LOCAL RESOURCES. O 14 INTERAGENCY ADVISORY MEETINGS WILL BE HELD (2 COMMUNITY GROUPS) TO INCREASE/MAINTAIN LINKAGES BETWEEN ORGANIZATIONS, SCHOOLS, AND COMMUNITY MENTAL HEALTH AGENCIES AND ELIMINATE DUPLICATION OF EFFORTS. O 4 CRISIS INTERVENTION TRAININGS WILL BE HELD TO INCREASE THE NUMBER OF LAW ENFORCEMENT AND EMERGENCY SERVICE PERSONNEL WHO ARE TRAINED IN CRISIS DE-ESCALATION TECHNIQUES. O 3 TRAUMA INFORMED MENTAL HEALTH SUPPORT TRAININGS WILL BE HELD FOR COMMUNITY PROVIDERS, SCHOOLS AND COMMUNITY LEADERS. O 5 MENTAL HEALTH MEDIA MESSAGE CAMPAIGNS WILL BE COMPLETED TO DECREASE STIGMA, INCREASE THE GENERAL PUBLIC’S AWARENESS OF SUPPORT AND RESOURCES. O 2 MID COAST BEHAVIORAL HEALTH STAFF MEMBERS WILL BE TRAINED IN CIRCLE OF SECURITY. UNIQUE INDIVIDUALS TRAINED GOAL 2: INCREASE RESILIENCY SKILLS IN YOUTH TO REDUCE THE EFFECTS OF SIGNIFICANT ADVERSITY ON MENTAL HEALTH. BY SEPTEMBER 30, 2026, O 20 EDUCATORS WILL BE TRAINED IN SOCIAL EMOTIONAL LEARNING FOR CLASSROOM. O 1 DISTRICT WILL BE TRAINED IN THE SOURCES OF STRENGTH CURRICULUM O RECRUIT 2 NEW COMMUNITY PARTNERS WHO WORK DIRECTLY WITH CHILDREN AND YOUTH

HEALTH CENTER INFRASTRUCTURE SUPPORT

TRPM8 IS A NOVEL REGULATOR OF BONE HOMEOSTASIS THROUGH NEURAL AND CELL-AUTONOMOUS MECHANISMS

ACCESS TO THE SCIENCE EDUCATION OF A FOUR-YEAR LIBERAL ARTS COLLEGE FOR ECONOMICALLY DISADVANTAGED STUDENTS

INCORPORATING TEMPORARY HEALTH STATES: INTO DECISION SUPPORT

TRAUMA SYSTEM EVALUATION WITH SURVIVAL TIME MODELS

HUMAN GHRELIN AS AN EFFECTIVE MITIGATOR OF ACUTE RADIATION INJURY

A NOVEL RECOMBINANT PROTEIN FOR MITIGATING TOTAL BODY RADIATION INJURY

FISCAL YEAR 2023 CAPITAL ASSISTANCE FOR HURRICANE RESPONSE AND RECOVERY EFFORTS (CARE)

CELLULAR MECHANISMS OF PTH1R ACTIVATION WITH OSTEOPOROSIS TREATMENTS

DRUG-FREE COMMUNITIES (DFC) SUPPORT PROGRAM- NEW

MAINEHEALTH ALZHEIMER'S DISEASE PARTNERSHIP

UV-INDUCED TRIGGERING OF A BIOMECHANICAL INITIATION SWITCH WITHIN COLLAGEN PROMOTES DEVELOPMENT OF A MELANOMA-PERMISSIVE MICROENVIRONMENT IN THE SKIN

SCIEX TRIPLETOF 6600+ SYSTEM MASS SPECTROMETER AND DEDICATED IN-LINE EKSPERT NANOLC 425 LIQUID CHROMATOGRAPHIC SYSTEM

HEALTH CENTER CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY (CARES) ACT FUNDING

AMERICAN RESCUE PLAN

DEVELOPMENT OF A NOVEL OVARIAN CANCER TREATMENT TARGETING A CRYPTIC ECM COMPONENT WITH A UNIQUE ANTIBODY CONJUGATE

DOMESTIC WATER GRANTS - REGULAR

HEALTH CENTER INFRASTRUCTURE SUPPORT

RURAL HEALTH CARE SERVICES OUTREACH GRANT PROGRAM

INTERDISCIPLINARY STUDY OF MARROW ADIPOSITY MINERAL METABOLISM AND ENERGY BALANC

USE OF TRANEXAMIC ACID TO REDUCE TISSUE EDEMA AND PREVENT BURN WOUND CONVERSION

FISCAL YEAR 2025 EXPANDED HOURS. - PROJECT TITLE: GENESIS HEALTHCARE, INC. PROJECT DIRECTOR: KATIE NOYES CONTACT PHONE NUMBER: 803-254-3676 CONTACT EMAIL ADDRESS: CHERIF@GENESISFQHC.ORG WEBSITE: HTTPS://GENESISFQHC.ORG/ HEALTH CENTER PROGRAM GRANT NUMBER: H80CS28973 ADDRESS: 8906 TWO NOTCH ROAD CITY & STATE: COLUMBIA, SOUTH CAROLINA 29223 GENESIS HEALTHCARE, INC. (GENESIS) IS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) HEADQUARTERED IN PEE DEE REGION, SOUTH CAROLINA. GENESIS PROVIDES TOP-QUALITY CARE TO UNDERSERVED COMMUNITIES IN THE PEE DEE AND LOWCOUNTRY REGIONS IN SOUTH CAROLINA. GENESIS’ GOAL IS TO PROVIDE TIMELY, AFFORDABLE, AND COMPASSIONATE CARE REGARDLESS OF A PATIENT’S ABILITY TO PAY. GENESIS WORKS HARD TO OFFER A ONE-STOP SHOP TO THOSE RESIDING IN THE SERVICE AREA, MEETING ALL OF A PATIENT’S HEALTHCARE NEEDS UNDER ONE ROOF. IN 2023, GENESIS WAS AWARDED THE HRSA HEALTH CENTER QUALITY LEADER AWARD FOR THE FOURTH CONSECUTIVE YEAR, DEMONSTRATING THEIR DILIGENCE IN PROVIDING HIGH QUALITY CARE TO ALL. TO MEET PATIENT DEMAND FOR PRIMARY MEDICAL CARE AND PEDIATRIC SERVICES, GENESIS IS PROPOSING TO UTILIZE HRSA FUNDS TO OFFER AN EXTENDED 3 HOURS AT 2 SITES AND 8 HOURS AT ANOTHER SITE FOR A TOTAL OF 14 ADDITIONAL HOURS. THE SITES WILL INCLUDE THE FOLLOWING: PEE DEE HEALTH CARE, LOWCOUNTRY PEDIATRICS, AND OLANTA FAMILY CARE. THE PROPOSED SERVICES OFFERED THROUGH HRSA EXPANDED HOURS FUNDING INCLUDE IN-SCOPE PRIMARY CARE SERVICES INCLUDING PEDIATRIC SERVICES. PROJECT ACTIVITIES INCLUDE: - LEVERAGING COMMUNITY PARTNERSHIPS AND CONDUCTING OUTREACH TO INFORM COMMUNITY MEMBERS OF THE NEW SCHEDULES; - EXPANDING STAFF TIME AND CAPACITY TO ACCOMMODATE EXTENDED HOURS; THE GOALS TO BE ACHIEVED THROUGH THESE ACTIVITIES ARE: - INCREASING THE NUMBER OF PATIENTS RECEIVING PRIMARY CARE SERVICES INCLUDING PEDIATRIC SERVICES; - INCREASING THE NUMBER OF NEW PATIENT VISITS; - INCREASING PATIENT SATISFACTION; - IMPROVING PATIENT HEALTH OUTCOMES.

PROJECT REMH (RURAL EDUCATION ON MENTAL HEALTH) - MAINE HEALTH, DOING BUSINESS AS MAINE BEHAVIORAL HEALTHCARE, PROPOSES TO ESTABLISH PROJECT REMH (RURAL EDUCATION ON MENTAL HEALTH) AIMED AT PREPARING AND TRAINING SCHOOL STAFF TO APPROPRIATELY AND SAFELY RESPOND TO STUDENTS WITH MENTAL HEALTH CHALLENGES. THE GEOGRAPHICAL CATCHMENT AREA OF PROJECT REMH IS WASHINGTON COUNTY, A RURAL COUNTY IN MAINE WITH HIGH RATES OF CHILD TRAUMA AND ADVERSE CHILDHOOD EXPERIENCES. IN ADDITION, THE PROJECT INCLUDES THE PASSAMAQUODDY TRIBAL RESERVATION AT PLEASANT POINT. PROJECT REMH’S TARGET POPULATION(S) ARE AS FOLLOWS: 1) CHILDREN AND YOUTH (GRADES K-8) WHO MAY BE PREDISPOSED TO, OR EXPERIENCING MENTAL ILLNESS; 2) SCHOOL STAFF (GRADES K-8); AND 3) STAFF OF COMMUNITY-BASED MENTAL HEALTH AGENCIES WITH THE POTENTIAL TO SUPPORT SCHOOLS (INCLUDING STAFF AND STUDENTS) WITHIN WASHINGTON COUNTY AND THE PLEASANT POINT RESERVATION. CURRENTLY THERE IS A PAUCITY OF TRAINING AND RESOURCES FOR SCHOOL STAFF IN COMMUNITIES WITH SIGNIFICANT MENTAL HEALTH NEEDS. TO ADDRESS THIS DEFICIT, PROJECT REMH EMPLOYS A MULTI-TIERED TRAINING FRAMEWORK AS FOLLOWS: TIER 1: PROVIDE UNIVERSAL TRAINING IN YOUTH MENTAL HEALTH FIRST AID TO ALL PARTNERING SCHOOLS; TIER 2: PROVIDE SMALL GROUP INSTRUCTION ON DE-ESCALATION STRATEGIES TO SELECT SCHOOL STAFF AND LEADERSHIP; TIER 3: PROVIDE TARGETED COACHING AND CONSULTATION TO INDIVIDUAL TEACHERS WITH STUDENTS AT RISK OF DEVELOPING SERIOUS MENTAL ILLNESS. IN ADDITION, PROJECT REMH WILL PRODUCE A RESOURCE AND TRAINING GUIDE FOR ALL TRAINING PARTICIPANTS AND PARTNER WITH LOCAL MENTAL HEALTH AGENCIES TO ENSURE EFFECTIVE REFERRALS OF STUDENTS WITH MENTAL HEALTH NEEDS. AN EVALUATION OF THE PROJECT WILL BE CONDUCTED TO MONITOR QUALITY AND OUTCOMES. IT IS ANTICIPATED PROJECT REMH WILL SERVE AN AVERAGE OF 229 UNDUPLICATED INDIVIDUALS EACH YEAR, FOR A TOTAL OF 1,146 THROUGHOUT THE PROJECT PERIOD.

FRANKLIN?S BLUEPRINT FOR MENTAL HEALTH AWARENESS - HEALTHY COMMUNITY COALITION, A SUBSIDIARY OF MAINEHEALTH AND PART OF FRANKLIN MEMORIAL HOSPITAL WILL IMPLEMENT A COMPREHENSIVE AND COORDINATED APPROACH IN FRANKLIN COUNTY, MAINE TO INCREASE MENTAL HEALTH AWARENESS AMONG INDIVIDUALS WHO INTERACT AND COME IN CONTACT WITH PERSONS EXPERIENCING OR EXHIBITING SYMPTOMS OF A MENTAL DISORDER. THROUGH IMPLEMENTATION OF EVIDENCED-BASED PROGRAMS THIS 5-YEAR PROJECT WILL INCREASE THE RECOGNITION OF MENTAL HEALTH PROBLEMS, PROVISION OF ADEQUATE SUPPORT, AND REFERRALS FOR HELP. THE PROJECT WILL: 1) TRAIN INDIVIDUALS TO RECOGNIZE SIGNS AND SYMPTOMS OF MENTAL DISORDERS AND EMPLOY CRISIS DE-ESCALATION TECHNIQUES; 2) ESTABLISH LINKAGES WITH SCHOOLS AND MENTAL HEALTH AGENCIES TO REFER INDIVIDUALS WITH SIGNS AND SYMPTOMS OF MENTAL ILLNESS TO APPROPRIATE RESOURCES; AND 3) EDUCATE INDIVIDUALS ABOUT RESOURCES THAT ARE AVAILABLE IN THE COMMUNITY FOR INDIVIDUALS WITH MENTAL DISORDERS. THIS PROJECT WILL IMPLEMENT A TRAIN-THE-TRAINER MODEL TO PROVIDE SUSTAINABLE AND EXTENSIVE COURSE OFFERINGS USING THE EVIDENCE-BASED MENTAL HEALTH FIRST AID TRAINING PROGRAM TARGETING THOSE WHOSE LIVES ARE TOUCHED BY THE SELECTED AT-RISK FOCUS POPULATIONS OF VETERANS, ACTIVE ARMED SERVICE MEMBERS AND SCHOOL-AGED CHILDREN. OVER THE COURSE OF THIS GRANT A CORE OF AT LEAST 920 UNDUPLICATED INDIVIDUALS WILL BE TRAINED ENGAGING BROAD SECTORS OF FRANKLIN COUNTY INCLUDING FAMILIES, VETERANS, LAW ENFORCEMENT AGENTS, EMERGENCY FIRST RESPONDERS, HEALTH CARE PROFESSIONALS, AND SCHOOL PERSONNEL. SOCIAL MEDIA AND MARKETING WILL HAVE AN EXTENSIVE REACH IMPACTING SEVERAL THOUSAND INDIVIDUALS WITH MESSAGING REGARDING MENTAL HEALTH SERVICES AND RESOURCES. PROJECT PARTNERS HAVE THE CAPACITY TO RESPOND EFFICIENTLY AND APPROPRIATELY TO THE ANTICIPATED 25% INCREASE IN MENTAL HEALTH CARE REFERRALS. THIS COMPREHENSIVE AND COORDINATED APPROACH TO MENTAL HEALTH AWARENESS TRAINING WILL STRENGTHEN THE COMMUNITY’S CAPACITY TO IDENTIFY AND SAFELY RESPOND TO INDIVIDUALS WITH SIGNS AND SYMPTOMS OF MENTAL HEALTH DISORDERS AND REFER THEM FOR APPROPRIATE TREATMENT ENHANCING THE SAFETY AND QUALITY OF LIFE IN FRANKLIN COUNTY.

COASTAL FORENSIC NURSE EXAMINER PROGRAM

POISON CONTROL STABILIZATION AND ENHANCEMENT PROGRAM

RURAL HEALTH CLINIC VACCINE CONFIDENCE PROGRAM

ENABLING HIGH-DIMENSIONAL FLOW CYTOMETRY AND EXTRACELLULAR PARTICLE ANALYSIS AT MAINEHEALTH INSTITUTE FOR RESEARCH - THE MAINEHEALTH INSTITUTE FOR RESEARCH (MHIR) IS DEDICATED TO ADVANCING RESEARCH CAPABILITIES WITHIN THE MAINEHEALTH NETWORK, COMPRISING TWELVE HOSPITALS AND HEALTH FACILITIES ACROSS MAINE AND NEW HAMPSHIRE. OUR FUNDING REQUEST FOCUSES ON ACQUISITION OF THE BD FACSYMPHONY A5 SE SYSTEM, A CRUCIAL ADDITION THAT WILL ENABLE HIGH-THROUGHPUT, HIGH-DIMENSIONAL FLOW CYTOMETRIC ANALYSIS OF CELLS AND EXTRACELLULAR VESICLES. OUR CURRENT FLOW CYTOMETRY CAPABILITIES ARE LIMITED TO DETECTING NO MORE THAN 12 PARAMETERS, HINDERING THE PROGRESS OF ONGOING NIH-FUNDED RESEARCH PROJECTS LED BY VARIOUS INVESTIGATORS WITHIN MAINEHEALTH. MOREOVER, ACQUIRING THIS INSTRUMENT WILL FOSTER COLLABORATION WITH NEIGHBORING INSTITUTIONS LIKE THE ROUX INSTITUTE AT NORTHEASTERN UNIVERSITY AND THE UNIVERSITY OF NEW ENGLAND, WHERE COMPARABLE CAPABILITIES ARE LACKING. IT WILL CREATE TRAINING OPPORTUNITIES FOR MEDICAL STUDENTS, ESPECIALLY IN SPECTRAL FLOW CYTOMETRY, THROUGH MHIR'S T35 PROGRAM. MAINE MEDICAL CENTER'S COMMITMENT TO SUPPORTING AND ENHANCING CORE FACILITIES, ESPECIALLY THE FLOW CYTOMETRY CORE, IS EVIDENT THROUGH SUBSTANTIAL FINANCIAL INVESTMENTS, ONGOING FUNDING SUPPORT, STRATEGIC PLANNING EFFORTS, AND A PLEDGE OF OVER $2 MILLION OVER THE NEXT FIVE YEARS TO ENSURE THE CONTINUED SUCCESS OF ALL ITS CORE FACILITIES. THIS DEDICATION REFLECTS THE INSTITUTION'S COMMITMENT TO FOSTERING CUTTING-EDGE BIOMEDICAL RESEARCH AND SUSTAINING A THRIVING RESEARCH ECOSYSTEM. THE IMPLEMENTATION OF HIGH-DIMENSIONAL FLOW CYTOMETRY WILL SIGNIFICANTLY ENHANCE THE SCOPE AND DEPTH OF BIOMEDICAL RESEARCH AT MHIR. THESE PROJECTS COLLECTIVELY AIM TO UNRAVEL THE COMPLEX CELLULAR AND MOLECULAR MECHANISMS INVOLVED IN VARIOUS HEALTH-RELATED PHENOMENA, SPANNING FROM IMMUNE RESPONSES FOLLOWING RESUSCITATION AFTER CARDIAC ARREST TO THE PREVENTION OF BONE LOSS IN POST-MENOPAUSAL WOMEN. THE CYTOMETER ENABLES PRECISE CHARACTERIZATION OF CELL POPULATIONS AND THEIR FUNCTIONAL STATES, FACILITATING THE IDENTIFICATION OF KEY CONTRIBUTORS TO TISSUE DAMAGE, INFLAMMATORY CASCADES, MITOCHONDRIAL FUNCTION, AND DRUG RESISTANCE, THEREBY DEEPENING OUR UNDERSTANDING OF UNDERLYING BIOLOGICAL PROCESSES AND PAVING THE WAY FOR DEVELOPING NOVEL THERAPEUTIC STRATEGIES ACROSS DIVERSE HEALTH CONDITIONS. ULTIMATELY, THE INTEGRATION OF HIGH-DIMENSIONAL FLOW CYTOMETRY ENHANCES THE INSTITUTION'S CAPACITY TO ADDRESS COMPLEX HEALTH CHALLENGES AND DRIVE TRANSFORMATIVE DISCOVERIES IN BIOMEDICAL SCIENCE. IN SUMMARY, THE ADDITION OF THE BD FACSYMPHONY A5 SE TO MHIR WILL SIGNIFICANTLY BENEFIT MAINE'S RESEARCH COMMUNITY BY DRIVING SCIENTIFIC INNOVATION, ATTRACTING FUNDING, AND FOSTERING ECONOMIC AND EDUCATIONAL GROWTH. IT WILL ELEVATE RESEARCH CAPABILITIES, SUPPORT THE DEVELOPMENT OF COBRE PROJECTS, EMPOWER PROJECT LEADERS TO ACQUIRE PRELIMINARY DATA FOR INDEPENDENT FUNDING, AND ENHANCE TRAINING OPPORTUNITIES FOR FUTURE SCIENTISTS. MOREOVER, IT WILL ENHANCE OPERATIONAL EFFICIENCY AND MAINTAIN COMPETITIVENESS IN HIGH-DIMENSIONAL FLOW CYTOMETRY RESEARCH, ENSURING THAT MHIR REMAINS AT THE FOREFRONT OF BIOMEDICAL RESEARCH.

RURAL NORTHERN BORDER REGION OUTREACH PROGRAM - ORGANIZATION NAME: THE MAINE RURAL GME EDUCATION (MERGE) COLLABORATIVE; APPLICANT ORGANIZATION: MAINEHEALTH. ADDRESS: 22 BRAMHALL ST., PORTLAND, ME 04102-3134. ENTITY TYPE: COMMUNITY-BASED ORGANIZATION. WEBSITE: HTTPS://WWW.MAINEHEALTH.ORG/MAINE-MEDICAL-CENTER MERGE COLLABORATIVE – MAINE RURAL GRADUATE MEDICAL EDUCATION COLLABORATIVE. PROJECT DIRECTOR: DAVID MCLELLAN, MBA; PRINCIPAL INVESTIGATOR: KALLI VARAKLIS, MD, MSED. PROJECT TITLE: THE MERGE COLLABORATIVE RURAL OBSTETRICS TRAINING INITIATIVE. PROJECT GOAL: TO IMPROVE RURAL MATERNAL CARE ACCESS BY PROVIDING HIGH QUALITY TRAINING IN RURAL SETTINGS TO INCREASE THE NUMBER OF OBSTETRICS AND GYNECOLOGY (OB/GYN) AND FAMILY MEDICINE (FM) RESIDENTS WHO WILL PROVIDE RURAL MATERNAL CARE. PROPOSED SERVICE AREA: RURAL COUNTIES IN ME AND EASTERN NH. THIS PROJECT IS PARTNERING WITH THE NEW ENGLAND RURAL HEALTH ASSOCIATION (NERHA) TO FACILITATE SPREAD TO RURAL VT AND NORTHERN NY. TARGET POPULATION: WOMEN AND BIRTHING PERSONS IN RURAL COMMUNITIES WHO HAVE DECREASED ACCESS TO MATERNAL HEALTH CARE. FOCUS AREA: RURAL MATERNAL HEALTHCARE ACCESS. CONSORTIUM MEMBERS/PARTNERS: JEANNETTE ANDREWS, DO–STEPHENS MEMORIAL HOSPITAL, NORWAY, ME; KATHRYN HOFFMANN, DO–MAINE-DARTMOUTH FM RESIDENCY, AUGUSTA, ME; SUSAN KEARING, DO–FRANKLIN MEMORIAL HOSPITAL, FARMINGTON, ME; JENNIFER LABUDDE, MD–MEMORIAL HOSPITAL, NORTH CONWAY, NH; KRISTIN HARTT, MD–NORTHERN LIGHT MAYO HOSPITAL, DOVER-FOXCROFT, ME; KATHERINE GASSMAN, MD–MOUNT DESERT ISLAND HOSPITAL, BAR HARBOR, ME; TBD – NERHA REP.; TBD–FM RESIDENT; TBD–OB/GYN RESIDENT; TBD–RURAL OB PATIENT. PROJECT ACTIVITIES: WE WILL CREATE A NEW RURAL OBSTETRICS EDUCATION CONSORTIUM TO DEVELOP AN INNOVATIVE RURAL OB TRAINING EXPERIENCE FOR FM AND OB/GYN RESIDENTS, INFORMED BY ONGOING PATIENT, TRAINEE AND PROVIDER PERSPECTIVES. A COMPANION RURAL OB CURRICULUM WILL BE CREATED. A STANDARDIZED PROCEDURE BY WHICH OTHER RURAL TRAINING INTENSIVES WILL BE DEVELOPED AND BROADLY DISSEMINATED. EXPEC TED LONG-TERM OUTCOMES: TO IMPROVE ACCESS TO MATERNAL CARE IN RURAL COMMUNITIES. EXPECTED SHORT-TERM OUTCOMES: CREATION OF A NOVEL RURAL OB TRAINING INTENSIVE TO PROVIDE CLINICAL, DIDACTIC, AND SIMULATION-BASED EDUCATION IN RURAL OBSTETRICS, SUPPORTED BY A NEW, PUBLICLY AVAILABLE RURAL OB CURRICULUM. THE PROPOSED PROJECT INTEGRATES PATIENT, TRAINEE AND CURRENT MATERNAL HEALTH PROVIDER INPUT INTO DEVELOPMENT AND ONGOING MANAGEMENT. A NEW ALLIANCE WITH THE NERHA AND THE ME-RMOMS TEAM WILL BUILD ON AND EXPAND EFFORTS TO SERVE RURAL PATIENTS. THE GEOGRAPHIC CO-LOCATION OF MOST CONSORTIUM MEMBERS IN RURAL SETTINGS PROVIDES A TRUE SENSE OF OWNERSHIP AND INVESTMENT. ORG. EXPERTISE & CAPACITY: MH HAS AN ESTABLISHED HISTORY OF ADMINISTERING FEDERAL GRANT FUNDS, MEETING REPORTING REQUIREMENTS, AND PROVIDING OVERSIGHT AND ASSISTANCE WITH RECORD-KEEPING, FUND MANAGEMENT, AND ADHERENCE TO ALL POLICIES. CURRENT EXPERIENCE: THE MERGE COLLABORATIVE HAS DEMONSTRATED SUCCESS IN CO-CREATING 33 NEW SHORT, ELECTIVE GME CLINICAL TRAINING SITES IN 13 DIFFERENT SPECIALTIES ACROSS RURAL MAINE. MERGE HAS FORGED NEW RELATIONSHIPS AND PARTNERSHIPS WITH RURAL PRACTICES, PROVIDERS AND EDUCATORS. EFFECTIVENESS OF MODEL(S): THE INITIAL SUCCESS OF MERGE HAS BEEN ENCOURAGING: OF THE 8 RESIDENTS WHO DID A MERGE ELECTIVE AND GRADUATED IN 6/2024 TO PRACTICE, 6 HAVE CHOSEN TO PRACTICE IN RURAL COMMUNITIES. GEOGRAPHIC RELATIONSHIP TO NBR: 7/8 OF THE PROPOSED RURAL OB EDUCATION CONSORTIUM MEMBERS ARE PHYSICALLY PRACTICING IN RURAL AREAS. FUNDING OPPORTUNITY NOTIFICATION: THE NERHA EXEC. DIRECTOR CONTACTED MERGE LEADERS TO LEARN MORE ABOUT OUR STRATEGIES AND SUCCESSES AND RECOMMENDED THIS GRANT AS AN “IDEAL” FIT TO EXPAND THE WORK OF MERGE. FUNDING PREFERENCE: OUR PROPOSED SERVICE AREA SUPPORT OUR APPLICATION’S ELIGIBILITY FOR FUNDING PRIORITIES QUALIFICATION 1: HPSA AND QUALIFICATION 2: MUC/P.

CONGENITAL ABNORMALITIES RESULTING FROM FETAL THYROTOXICOSIS

CONTINUUM OF CARE PROGRAM

RURAL RESIDENCY PLANNING AND DEVELOPMENT PROGRAM

EXPOSURE PATHWAYS AND MENTAL HEALTH IMPACT OF PFAS-CONTAMINATED BIOSOLIDS - PROJECT ABSTRACT PER- AND POLYFLUOROALKYL SUBSTANCES (PFAS) ARE PERSISTENT “FOREVER CHEMICALS” THAT MAKE PAPER AND OTHER PRODUCTS STAIN RESISTANT, BUT ALSO CONTAMINATE WATER AND FOOD AND ARE DETECTABLE IN ALMOST EVERY INDIVIDUAL IN THE US. AN UNDERSTUDIED EXPOSURE SOURCE IS FARMLAND THROUGHOUT THE RURAL US WHERE PFAS-CONTAMINATED BIOSOLIDS ARE APPLIED AS FERTILIZER. INCOMPLETE INFORMATION ABOUT NON-WATER EXPOSURE PATHWAYS LEAVES AFFECTED COMMUNITIES, MANY OF WHOM ARE DEPENDENT ON LOCAL AGRICULTURE AND GAME FOR WORK AND FOOD, UNCERTAIN HOW TO MINIMIZE EXPOSURE. PFAS-CONTAMINATED BIOSOLIDS THREATEN THE LIVELIHOODS AND FOOD SOURCES OF THESE AGRARIAN COMMUNITIES, AS PLANT AND WILDLIFE EXPOSURE TO PFAS FROM BIOSOLIDS MAKES SELLING AND CONSUMING LOCAL PRODUCE, ANIMAL PRODUCTS, OR WILD FISH AND GAME NO LONGER SAFE. MAINE HAS THE UNIQUE CAPABILITY TO INVESTIGATE THESE ISSUES BECAUSE OF 2021 STATE LEGISLATION THAT MANDATED PFAS TESTING ON LAND WITH PRIOR OR ONGOING APPLICATION OF BIOSOLIDS. ONE SENTINEL SITE, THE TOWN OF FAIRFIELD, WAS FOUND TO HAVE PFAS UP TO THE 1000’S MG/KG IN SOIL AND 30,000’S NG/L IN DRINKING WATER FROM PRIVATE WELLS—FAR ABOVE LOCAL AND NATIONAL HEALTH ADVISORIES (EPA’S DRINKING WATER ADVISORY IS 0.004 NG/L FOR PFOA). AS OF NOW, THERE ARE ENOUGH IMPACTED INDIVIDUALS ACROSS CENTRAL MAINE [319 WELLS WITH PFAS ABOVE THE MAINE HEALTH ADVISORY (SUM OF 6 LEGACY PFAS = 20 NG/L)] TO ESTABLISH A COHORT TO GUIDE OTHER COMMUNITIES AFFECTED BY BIOSOLIDS ACROSS THE US. IN THIS STUDY, OUR OBJECTIVE IS TO RECRUIT 300 ADULTS AT RISK OF EXPOSURE TO PFAS FROM BIOSOLIDS TO (1) QUANTIFY PFAS CONCENTRATIONS IN SERUM, (2) EVALUATE WATER AND NON-WATER EXPOSURE PATHWAYS, AND (3) CHARACTERIZE ASSOCIATIONS OF PFAS WITH ANXIETY AND PERCEPTIONS OF HEALTH RISK AND STIGMATIZATION. THE TIME-SENSITIVE R21 MECHANISM WILL ALLOW US TO OBTAIN AN IMMEDIATE ASSESSMENT OF SERUM PFAS LEVELS, WHICH IS CRITICAL BECAUSE SOME AFFECTED INDIVIDUALS LEARNED OF THE CONTAMINATION AND HAD A WATER FILTER INSTALLED UP TO 2 YEARS AGO. PFAS HAVE LONG HALF-LIVES (3-8 YEARS DEPENDING ON THE COMPOUND), AND SERUM MEASURES UP TO 2 YEARS POST-CLEAN WATER WILL BE CONSISTENT WITH OTHER COMMUNITY CONTAMINATION COHORTS. TO MINIMIZE RECALL BIAS, IT IS ALSO IMPERATIVE BEFORE MORE TIME ELAPSES TO ASSESS WATER INTAKE, OTHER POTENTIAL EXPOSURE PATHWAYS, AND ANXIETY AND PERCEPTIONS OF HEALTH RISK/STIGMATIZATION BEFORE AND AFTER KNOWLEDGE OF THE CONTAMINATION. OUR INTERDISCIPLINARY TEAM HAS EXPERTISE IN ENVIRONMENTAL EPIDEMIOLOGY, CLINICAL CARE OF PATIENTS WITH PFAS EXPOSURE, AND SOCIAL PSYCHOLOGY. WE WILL PARTNER WITH THE COMMUNITY THROUGH A COMMUNITY ADVISORY BOARD, CONTEXT-RICH REPORT BACK OF INDIVIDUAL RESULTS, AND PRESENTATION OF AGGREGATED STUDY RESULTS AT TOWN HALL MEETINGS. WE WILL BE THE FIRST TO OUR KNOWLEDGE TO ESTABLISH A COHORT WITH PFAS EXPOSURE FROM BIOSOLIDS, AND OUR RESULTS WILL HELP TO GENERATE EXPOSURE MITIGATION ADVICE AND INTERVENTIONS TO BUILD RESILIENCE AMONG INDIVIDUALS LIVING IN COMMUNITIES IMPACTED BY PFAS-CONTAMINATED BIOSOLIDS.

ENVIRONMENTAL INFLUENCES ON CHILD HEALTH OUTCOMES IN MAINE (ECHO-ME) - MAINE IS ONE OF THE MOST RURAL STATES IN THE NATION, WITH OVER HALF OF THE PEDIATRIC POPULATION LIVING IN RURAL AREAS. ABOUT 25% OF CHILDREN IN MAINE HAVE SPECIAL HEALTHCARE NEEDS, AND IT IS ESTIMATED THAT ONE IN THREE HAS A BODY WEIGHT DESIGNATION OF OVERWEIGHT OR OBESE. AS IS TYPICAL IN RURAL STATES, HEALTH CARE SERVICES ARE CLUSTERED IN MORE DENSELY POPULATED SOUTHERN PARTS OF THE STATE AND ALONG THE COAST, LEAVING LARGE AREAS OF MAINE IN THE NORTH AND IN THE INTERIOR WITH LESS ACCESS TO CARE. RURAL MAINE CHILDREN HAVE LIMITED OPPORTUNITIES TO PARTICIPATE IN HIGH-QUALITY PEDIATRIC CLINICAL TRIALS. THROUGH THIS APPLICATION, “ENVIRONMENTAL INFLUENCES ON CHILD HEALTH OUTCOMES IN MAINE (ECHO-ME),” MAINEHEALTH SEEKS TO JOIN THE IDEA STATES PEDIATRIC CLINICAL TRIALS NETWORK (ISPCTN) IN THE COMING FIVE-YEAR FUNDING CYCLE. TO ACHIEVE THE GOALS OF THE ECHO-ISPCTN, WE PROPOSE THE FOLLOWING AIMS: (1) DEVELOP, CONDUCT, AND DISSEMINATE FINDINGS FROM MULTICENTER CLINICAL TRIALS RESEARCH, ASSURING THE PARTICIPATION OF CHILDREN LIVING IN RURAL COMMUNITIES IN MAINE; (2) BUILD PEDIATRIC CLINICAL TRIAL RESEARCH CAPACITY IN THE MAINEHEALTH SYSTEM; AND (3) ENGAGE MULTIPLE INTERESTED PARTIES ACROSS MAINE SUCH AS COMMUNITY MEMBERS, FAMILIES WITH LIVED EXPERIENCE, NONPROFIT ORGANIZATIONS, AND PROFESSIONAL SOCIETIES TO ENHANCE ECHO-ISPCTN CLINICAL TRIAL IMPACT, TRANSFERABILITY, RIGOR, AND FEASIBILITY. PARTICIPATING IN THIS NETWORK WOULD BUILD LASTING CAPACITY, INFRASTRUCTURE, AND PROCESSES IN MAINE TO DESIGN AND CONDUCT MULTISITE CLINICAL TRIALS THAT ANSWER QUESTIONS OF CRITICAL IMPORTANCE TO PEDIATRIC HEALTH; INCREASE THE ABILITY OF RURAL CHILDREN TO PARTICIPATE IN CLINICAL RESEARCH THROUGH MAINEHEALTH (WHICH SERVES ABOUT ONE-THIRD OF CHILDREN IN MAINE); AND ALLOW THE RESEARCH TEAM TO PARTICIPATE FULLY IN A DYNAMIC, COLLABORATIVE NETWORK OF INVESTIGATORS COMMITTED TO IMPROVING PEDIATRIC HEALTH OUTCOMES FOR RURAL CHILDREN ACROSS THE COUNTRY.

CONTINUUM OF CARE PROGRAM

GENERATION OF HUMAN IPS CELLS VIA NON-INTEGRATING VECTORS

COUNTY TRAUMA SYSTEMS AND OUTCOMES DISPARITIES

OSTEOBLASTIC RESPIRATION AND IRS SIGNALING

STAFFING FOR ADEQUATE FIRE AND EMERGENCY RESPONSE (SAFER)

EXPANDING EMS RECRUITMENT, TRAINING AND RETENTION IN FRANKLIN COUNTY MAINE - MAINEHEALTH D/B/A HEALTHY COMMUNITY COALITION (HCC) WILL IMPLEMENT THIS RURAL EMERGENCY MEDICAL SERVICES TRAINING PROJECT TO RECRUIT AND TRAIN EMERGENCY MEDICAL SERVICES (EMS) PERSONNEL IN THE FEDERALLY DESIGNATED RURAL CATCHMENT AREA OF FRANKLIN COUNTY (FC), MAINE. HCC WILL PARTNER WITH NORTHSTAR, THE SOLE EMS PROVIDER IN FC TO ACCOMPLISH PROJECT GOALS. NORTHSTAR IS PART OF FRANKLIN MEMORIAL HOSPITAL, WHICH IS PART OF MAINEHEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. POPULATION SERVED IS 40,000 AND INCLUDES EMS PERSONNEL, THOSE WHO COULD BE RECRUITED AND TRAINED TO SERVE AS EMS PERSONNEL, AND FC RESIDENTS. THE POPULATION LIKE MANY OTHER RURAL COMMUNITIES IS OLDER, SICKER, AND POORER. OVER 50% OF THE AGING POPULATION HAVE MORE THAN 3 COEXISTING CHRONIC ILLNESSES, WITH 11.8% LIVING BELOW THE POVERTY LEVEL. THE MAJORITY OF THE POPULATION FACE MULTIPLE SOCIOECONOMIC VULNERABILITIES. GOALS AND OBJECTIVES INCLUDE: GOAL 1: INCREASE RECRUITMENT, TRAINING AND RETENTION OF EMS PERSONNEL IN FC, ME BY IMPLEMENTING RECRUITMENT AND TRAINING PROGRAMS. OBJECTIVES 1.1: BY 9/1/2026, PROGRAM STAFF WILL RECRUIT AND ORIENT 30 NEW EMS PERSONNEL. OBJECTIVE 1.2: BY 9/1/ 2026, PROGRAM STAFF AND PARTNERS WILL PROVIDE EMS CAREER EXPLORATION OR RECRUITMENT INFORMATION TO 1000 INDIVIDUALS AT 8 CAREER FAIRS AT STATE-WIDE MIDDLE/HIGH-SCHOOLS AND CAREER CENTERS USING BOTH FACE-TO-FACE, VIRTUAL, AND SOCIAL MEDIA PLATFORMS. OBJECTIVE 1.3: BY 9/1/ 2026, PROGRAM STAFF AND PARTNERS WILL PROVIDE EMS CAREER INFORMATION AND JOB-SHADOWING EXPERIENCES TO 30 HIGH-SCHOOL OR COLLEGE LEVEL STUDENTS. OBJECTIVE 1.4: BY 6/30/ 2026, NORTHSTAR WILL OFFER EMERGENCY MEDICAL RESPONSE TRAINING TO 20 LOCAL FIRE DEPARTMENT AND LAW ENFORCEMENT OFFICERS AND POTENTIAL VOLUNTEER FIRST RESPONDERS. OBJECTIVE 1.5: BY 9/1/ 2026, NORTHSTAR WILL STRENGTHEN RETENTION STRATEGIES TO ENGAGE 80% OF EMS PERSONNEL IN CAREER EXPANSION PROGRAMS (I.E., PROVIDING TRAINING TO EXPAND TRAINEES’ COMPETENCE, SKILLS, CERTIFICATIONS, AND CREDENTIALS). OBJECTIVE 1.6: BY 9/1/ 2026, TRAIN 10 EMS PROVIDERS TO THE INSTRUCTOR LEVEL TO SUPPORT EMS PROFESSIONAL DEVELOPMENT. GOAL 2: PROVIDE EMS PERSONNEL WITH TRAUMA-INFORMED, RECOVERY-BASED TRAINING TO UNDERSTAND AND PROVIDE SAFE, STIGMA FREE TREATMENT FOR MENTAL HEALTH AND SUBSTANCE USE DISORDERS (SUD), CO-OCCURRING DISORDERS (COD) IN EMERGENCY SITUATIONS, AND PROVIDE APPROPRIATE FOLLOW-UP CARE. THIS GOAL AND OBJECTIVES DIRECTLY ALIGN WITH THE NEED TO INCREASE EMS PERSONNEL’S KNOWLEDGE OF MENTAL HEALTH DISORDERS, SUD, AND COD, AND HOW TO CARE FOR THESE INDIVIDUALS IN EMERGENCY SITUATIONS. OBJECTIVE 2.1: BY 9/1/ 2026, 100 EMS PERSONNEL WILL HAVE RECEIVED MENTAL HEALTH AND SUBSTANCE USE DISORDER TRAINING VIA SAMHSA’S TECHNOLOGY TRANSFER CENTERS, OR ALTERNATE PLATFORM. OBJECTIVE 2.2: BY 9/1/ 2026, 100% OF NORTHSTAR EMS PERSONNEL WILL HAVE RECEIVED TRAINING FOR BEST PRACTICES IN HARM REDUCTION, INCLUDING NALOXONE ADMINISTRATION. OBJECTIVE 2.3: BY 9/1/ 2026, STIGMA PREVENTION, TRAUMA-INFORMED, RECOVERY-BASED CARE AND MOTIVATIONAL INTERVIEWING TRAININGS WILL BE PROVIDED TO REACH 75 EMS PERSONNEL, INCLUDING 911 DISPATCH OPERATORS. GOAL 3: TO ENSURE EMS PERSONNEL HAVE THE EQUIPMENT AND TRAINING TOOLS NEEDED TO PROVIDE HIGH QUALITY CARE. THIS GOAL AND RELATED OBJECTIVES ALIGN WITH THE NEED FOR FREQUENT TRAINING AND REFRESHER COURSES TO MAINTAIN COMPLEX SKILLS. OBJECTIVE 3.1: BY 9/1/ 2026, NORTHSTAR STAFF WILL HAVE PURCHASED AND PUT INTO SERVICE THE APPROPRIATE SAMHSA APPROVED EMS MEDICAL EQUIPMENT AND SUPPLIES NEEDED TO COMPLETE PROJECT GOALS.

HEALTH CENTER PROGRAM SERVICE EXPANSION - SCHOOL BASED SERVICE SITES (SBSS)

A NOVEL THERAPEUTIC APPROACH FOR LIVER INJURY

ONEHEART: MITIGATING BARRIERS TO UPWARD MOBILITY

EXPLORING AFFECT VARIABILITY, SYMPTOMS, AND SOCIAL CONTEXT IN PSYCHOTIC-SPECTRUM YOUTH

M-PALLIATIVE CARE LINK: IMPROVING SYMPTOM CONTROL AND INFORMATION EXCHANGE AMONG SPECIALISTS AND LOCAL HEALTH WORKERS TREATING LATE STAGE TANZANIAN CANCER PATIENTS

RESEARCH SPECIALIST SUPPORT FOR DEFINING THE ROLES OF BONE MARROW ADIPOCYTES AND FABP4/5 SIGNALING IN MULTIPLE MYELOMA - PROJECT SUMMARY CANCER DEVELOPS AND ULTIMATELY FLOURISHES DUE TO BOTH THE NATURE OF THE TUMOR CELLS THEMSELVES AS WELL AS THE MICROENVIRONMENT OR ‘SOIL’ IN WHICH THE TUMOR THRIVES. MULTIPLE MYELOMA, A BLOOD CANCER THAT RESULTS FROM MUTATED PLASMA CELLS, GROWS IN THE RICH SOIL OF THE BONE MARROW CAUSING BREAKDOWN OF THE BONE. THE RISK OF DEVELOPING MYELOMA IS GREATER IN OLDER INDIVIDUALS AND PEOPLE WITH HIGH BODY MASS INDEX WHO ALSO TYPICALLY HAVE MORE BONE MARROW ADIPOSE TISSUE, OR FAT, THAN YOUNGER OR LEANER INDIVIDUALS. HOWEVER, THE RELATIONSHIP BETWEEN BONE MARROW ADIPOCYTES (FAT CELLS) AND MYELOMA CELLS, AS WELL AS THE SPECIFIC MECHANISMS BY WHICH BONE MARROW ADIPOCYTES MODULATE MYELOMA DISEASE PROGRESSION ARE NOT WELL UNDERSTOOD. THEREFORE, WE AIM TO IDENTIFY NOVEL THERAPEUTIC AVENUES FOR THE TREATMENT OF MULTIPLE MYELOMA PATIENTS BY UNLOCKING NEW VULNERABILITIES SPECIFIC TO THE INTERACTIONS BETWEEN MYELOMA CELLS AND BONE MARROW ADIPOCYTES, WHICH CAN SERVE AS A SOURCE OF FATTY ACIDS AND PRO-MYELOMA CYTOKINES. OUR CELL CULTURE STUDIES SUGGEST BONE MARROW ADIPOCYTES INDUCE DRUG RESISTANCE IN MYELOMA CELLS- RECAPITULATING A COMMON PROBLEM FOR MYELOMA PATIENTS. WE HAVE FOUND THAT ONE MECHANISM OF CROSS-TALK LINKING ADIPOCYTES WITH MYELOMA CELLS IS THROUGH PROTEINS CALLED FATTY ACID-BINDING PROTEINS 4 AND 5 (FABP4 AND FABP5). WE WILL ANALYZE HOW BONE MARROW ADIPOCYTES CONTRIBUTE TO MYELOMA BY USING NOVEL, THREE-DIMENSIONAL (3D), TISSUE ENGINEERED CANCER MODELS WHICH CONSIST OF BONE MARROW ADIPOCYTES AND MYELOMA CELLS GROWN TOGETHER ON SILK SCAFFOLDS. BY GROWING MYELOMA CELLS IN THESE 3D MINI-BONE ENVIRONMENTS, WE CAN DETERMINE HOW MYELOMA CELLS CHANGE IN RESPONSE TO ADIPOCYTES AND DISCOVER NEW WAYS TO TARGET THIS INTERACTION. WE WILL ALSO USE OUR NOVEL MOUSE MODELS TO STUDY BONE MARROW ADIPOCYTE- MYELOMA CROSSTALK BY INCREASING OR REMOVING BONE MARROW ADIPOCYTES IN MICE AND QUANTIFYING EFFECTS ON TUMOR GROWTH AND DRUG RESISTANCE. WE WILL USE THESE IN VITRO AND IN VIVO MODELS TO SPECIFICALLY TEST THE ROLE OF FABP4 AND FABP5 IN TUMOR PROGRESSION AND DRUG RESISTANCE, AND WORK TOWARD OUR LONG-TERM GOAL TO BETTER UNDERSTAND THE MOLECULES AND MECHANISMS DRIVING MULTIPLE MYELOMA GROWTH IN THE BONE MARROW, AND HOW CANCER HIJACKS THIS NICHE FOR ITS OWN PURPOSES. THIS PROPOSAL SUPPORTS THIS ENDEAVOR BY PROVIDING SUPPORT FOR A RESEARCH SPECIALIST TO FURTHER DEVELOP, LEAD, AND EXECUTE THE EXPERIMENTS DESCRIBED WHICH INTERROGATE A NOVEL PART OF THE CELLULAR “SOIL” (THE BONE MARROW ADIPOCYTE), IN WHICH TUMOR CELLS, OR “SEEDS” LAND AND GROW.

PREVENTIVE MEDICINE RESIDENCIES

SKYSCAN 1276 CMOS IN VIVO MICROCT - THE SMALL ANIMAL IMAGING FACILITY IS A CORE RESEARCH RESOURCE AT THE MAINEHEALTH INSTITUTE FOR RESEARCH (FORMERLY MAINE MEDICAL CENTER RESEARCH INSTITUTE). CURRENTLY, IT CONSISTS OF A MAGNETIC RESONANCE IMAGER (MRI), A HIGH-RESOLUTION ULTRASOUND SYSTEM, AND A MICROCOMPUTED TOMOGRAPHY (MICROCT) SYSTEM. THE MRI WAS ACQUIRED IN 2005, IS AT THE END OF ITS SERVICEABLE LIFE AND CURRENTLY BEING DECOMISSIONED, AND THE SCANCO VIVACT40, WHICH WAS ACQUIRED IN 2008, HAS ALSO REACHED THE END OF ITS SERVICEABLE LIFE. WE PROPOSE TO MERGE THE IMAGING SERVICES WE PROVIDE USING A NEW STATE-OF-THE-ART, HIGH RESOLUTION, PRECLINICAL MICROCT SYSTEM. THIS PROPOSAL REQUESTS FUNDS TO REPLACE OUR SCANCO VIVACT40 MICROCT SYSTEM WITH A BRUKER SKYSCAN1276 CMOS MICROCT. OUR FACULTY HAVE STRONG, NIH-FUNDED PROGRAMS AND CENTERS THAT RELY ON HIGH RESOLUTION IMAGING OF CALCIFIED AND SOFT TISSUES, WITH CORRESPONDING QUANTITATIVE ANALYSIS. SINCE THE DEVELOPMENT OF OUR SMALL ANIMAL IMAGING FACILITY, WE HAVE SUPPORTED ALL OF OUR INSTITUTIONAL INVESTIGATORS, AND DEVELOPED A WIDE USER-BASE OF EXTERNAL CLIENTS WHO UTILIZE OUR IMAGING SERVICES. OUR MICROCT CURRENTLY SUPPORTS PROJECTS FROM 15 MAJOR AND 3 MINOR USERS, WITH A TOTAL OF 8 R01 FUNDED PROJECTS AND 2 COBRE SUPPORTED JUNIOR INVESTIGATORS. IN ADDITION, WE PROVIDE SIGNIFICANT SUPPORT TO 3 JUNIOR INVESTIGATORS, WHO RECENTLY RECEIVED THEIR FIRST R01 GRANTS. WE HAVE ATTRACTED EXTERNAL CLIENTS WITHIN NEW ENGLAND AND OTHER STATES. IN PARTICULAR, THE UNIVERSITY OF VERMONT AND THEIR CLINICAL AND TRANSLATIONAL RESEARCH PROGRAM STRONGLY SUPPORTS THIS PROPOSAL DUE TO THE LACK OF MICROCT SERVICES IN THEIR LOCAL AREA. THE BRUKER SKYSCAN1276 CMOS IS A DESKTOP, PRE-CLINICAL MICROCT SYSTEM WITH A RESOLUTION OF 3ΜM AND SCAN SPEEDS AS FAST AS 3.9 SECONDS. IT PROVIDES A FIELD OF VIEW WITH A LENGTH OF UP TO 210MM TO ALLOW WHOLE MOUSE AND SMALL RAT IMAGING. THE SYSTEM IS VERSATILE FOR EX VIVO SPECIMEN BONE IMAGING AND IN VIVO IMAGING DUE TO THE SLIDING SCALE ADJUSTMENT OF THE PEAK ENERGY FROM 40-100KV. ADDITIONAL FILTER SETS ALLOW FINE TUNING OF THE ENERGY LEVEL TO VERY LOW DOSE SETTINGS. THE 3D.SUITE IMAGING SOFTWARE IS STATE-OF-THE-ART, WITH SOPHISTICATED AND USER FRIENDLY AUTOMATED IMAGE ANALYSIS. THIS SOFTWARE PROVIDES EASY IMAGE ADJUSTMENTS WITHOUT THE NEED TO WRITE NEW IMAGE ANALYSIS ALGORITHM, AS IS NEEDED ON THE COMPARABLE NEW SCANCO SYSTEM. THE INSTITUTIONAL SUPPORT FOR OUR SMALL ANIMAL IMAGING CORE HAS BEEN VERY STRONG OVER THE LAST ALMOST TWO DECADES WITH SERVICE CONTRACTS AND PERSONNEL COSTS COVERED BY MAINEHEALTH AND THIS SUPPORT WILL CONTINUE TO PROVIDE OPERATIONAL FUNDS FOR THIS NEW MICROCT SYSTEM. WE HAVE ASSEMBLED A STRONG ADVISORY TEAM WITH EXTERNAL AND INTERNAL MEMBERS TO ASSIST WITH SCIENTIFIC AS WELL AS ADMINISTRATIVE CORE RELATED ISSUES. IN SUMMARY, WE REQUEST FUNDS TO PURCHASE A BRUKER SKYSCAN1276 CMOS SYSTEM TO MAINTAIN HIGH LEVEL IMAGING SERVICES TO OUR CLIENTS THAT SUPPORTS NIH LEVEL FUNDING, ENABLES GRANT RENEWAL AND ALLOWS THIS CORE FACILITY TO REMAIN COMPETITIVE.

TELEMEDICINE GRANT

ECIRP-NEUTRALIZING MAB FOR ACUTE LUNG INJURY IN SEPSIS - PROJECT DESCRIPTION: THE PRIMARY OBJECTIVE OF THIS PROJECT IS TO DEMONSTRATE THE FEASIBILITY OF DEVELOPING THE EXTRACELLULAR COLD-INDUCIBLE RNA-BINDING PROTEIN (ECIRP)-NEUTRALIZING MONOCLONAL ANTIBODY #14 (MAB14) AS A NOVEL TREATMENT FOR SEPTIC PATIENTS WITH ACUTE LUNG INJURY (ALI). ALI IS A CRITICAL COMPONENT OF THE ELEVATED MORTALITY RATE IN SEPSIS NO SPECIFIC TREATMENT HAS YET BEEN APPROVED TO REDUCE THE MORTALITY OF SUCH PATIENTS. WE HAVE DISCOVERED THAT ECIRP IS A CRITICAL INDUCER OF ALI CAUSED BY SEPSIS AND OTHER INFLAMMATORY DISEASES. IN OUR RECENT STUDIES, WE HAVE SHOWN THAT INCREASED LEVELS OF ECIRP AGGRAVATED ALI IN MICE WITH SEPSIS INDUCED BY CECAL LIGATION AND PUNCTURE (CLP). INJECTION OF RECOMBINANT ECIRP WAS SUFFICIENT TO INDUCE ALI IN OTHERWISE HEALTHY MICE. IN OUR PRELIMINARY STUDIES, WE HAVE GENERATED A LARGE PANEL OF ANTI-ECIRP MONOCLONAL ANTIBODIES TO DEVELOP AN ECIRP-TARGETING TREATMENT FOR ALI, AND SCREENED THEM FOR THEIR INHIBITION OF ECIRP-INDUCED RELEASE OF TNF-A BY MACROPHAGES. WE THEN USED THE MOST EFFECTIVE ANTI-ECIRP MONOCLONAL ANTIBODY, MAB14, TO TREAT MICE WITH CLP-INDUCED ALI. COMPARED WITH NON-IMMUNIZED IGG (CONTROL), CLP MICE TREATED WITH MAB14 HAD ATTENUATED LUNG INFLAMMATION AS INDICATED BY THE DECREASED LUNG GENE AND PROTEIN LEVELS OF TNF-A, IL-1SS, IL-6, CXCL1, AND CXCL2, AS WELL AS THE DECREASED NEUTROPHIL INFILTRATION OF THE LUNGS AS INDICATED BY THE MYELOPEROXIDASE ACTIVITY. BASED ON THESE NOVEL FINDINGS, WE HYPOTHESIZE THAT MAB14 CAN BE DEVELOPED AS A NEW AND EFFECTIVE DRUG TO TREAT ALI CAUSED BY SEPSIS. IN THIS PROJECT, WE WILL FURTHER DETERMINE MAB14’S ECIRP NEUTRALIZATION ABILITY IN VITRO AND IN VIVO. WE WILL THEN OPTIMIZE MAB14’S DOSE TO ATTENUATE SEPSIS-INDUCED ALI AND THERAPEUTIC WINDOW TO IMPROVE THE SURVIVAL OF SEPTIC MICE. WE WILL ALSO EVALUATE MAB14’S PHARMACOKINETICS (PK) AND PHARMACOTOXICITY PROPERTIES. OUR FUTURE STEPS WILL INCLUDE DEVELOPING A HUMANIZED FORM OF MAB14 AND THEN CONDUCTING ITS ADME, PK, ADVANCED TOXICOLOGY, AND IMMUNOGENICITY STUDIES. WE WILL THEN FILE WITH THE FDA AN INVESTIGATIONAL NEW DRUG (IND) APPLICATION TO INITIATE CLINICAL TRIALS TO TREAT ALI IN PATIENTS WITH SEPSIS. OUR ULTIMATE GOAL IS TO OBTAIN COMMERCIAL UTILIZATION OF MAB14 AS A SAFE AND EFFECTIVE DRUG TO TREAT PATIENTS WITH ALI IN THE CONTEXT OF SEPSIS.

REVERSING IMMUNOTHERAPY RESISTANCE IN OVARIAN CANCER BY TARGETING A NOVEL IMMUNE-SUPPRESSIVE FACTOR RELEASED BY TUMOR-ASSOCIATED MACROPHAGES (TAMS)

ADDICTION MEDICINE FELLOWSHIP - THIS PROPOSAL SEEKS FUNDING TO EXPAND THE MAINEHEALTH MAINE MEDICAL CENTER-PORTLAND (MHMMC-PORTLAND) ADDICTION MEDICINE FELLOWSHIP TRAINING PROGRAM BY ADDING TWO FELLOWS TRAINED SPECIFICALLY IN RURAL ADDICTION MEDICINE. MAINE, A PREDOMINANTLY RURAL STATE, FACES HIGH RATES OF SUBSTANCE USE DISORDERS (SUD) AND OVERDOSE DEATHS, ESPECIALLY IN WESTERN PUBLIC HEALTH DISTRICT COUNTIES LIKE FRANKLIN AND OXFORD. THESE COUNTIES HAVE ABOVE-AVERAGE SUD RATES, SIGNIFICANT OVERDOSE DEATHS, AND A SHORTAGE OF HEALTHCARE PROVIDERS, INCLUDING ADDICTION SPECIALISTS. THE GOAL IS TO TRAIN ADDICTION MEDICINE SPECIALISTS FAMILIAR WITH RURAL HEALTHCARE BARRIERS, INCREASING WORKFORCE CAPACITY AND IMPROVING ACCESS TO CARE. MAINE'S RURAL POPULATIONS FACE CHALLENGES SUCH AS GEOGRAPHIC ISOLATION, POVERTY, AND LIMITED HEALTHCARE ACCESS, EXACERBATED BY AN AGING POPULATION AND CHRONIC HEALTH ISSUES. RURAL AREAS LIKE FRANKLIN AND OXFORD COUNTIES SUFFER FROM HEALTHCARE SHORTAGES, ESPECIALLY ADDICTION MEDICINE SPECIALISTS, DESPITE HIGH SUD PREVALENCE. EXPANDING THE FELLOWSHIP TO TRAIN PHYSICIANS WITH EXPERTISE IN RURAL ADDICTION MEDICINE CAN HELP ADDRESS THESE SHORTAGES AND IMPROVE HEALTHCARE ACCESS, WITH EVIDENCE SHOWING THAT PHYSICIANS TRAINED IN RURAL SETTINGS ARE MORE LIKELY TO REMAIN IN THESE AREAS. MAINE IS THE MOST RURAL STATE IN THE U.S., WITH A POPULATION THAT IS OLDER AND ECONOMICALLY DISADVANTAGED. OVER 40% OF TOWNS IN FRANKLIN AND OXFORD COUNTIES ARE DESIGNATED AS MEDICALLY UNDERSERVED AREAS, AND MANY ARE HEALTH PROFESSIONAL SHORTAGE AREAS. THESE COUNTIES FACE LARGE DISTANCES BETWEEN RESIDENTS AND HEALTHCARE PROVIDERS, FURTHER HINDERED BY TRANSPORTATION ISSUES AND LACK OF AFFORDABLE HEALTHCARE. ADDITIONALLY, SUBSTANCE USE, PARTICULARLY RELATED TO OPIOIDS AND PSYCHOSTIMULANTS LIKE METHAMPHETAMINE, HAS WORSENED IN THESE REGIONS, WITH INCREASING OVERDOSE DEATHS AND SUBSTANCE-EXPOSED INFANTS. MAINEHEALTH’S ADDICTION MEDICINE FELLOWSHIP PROGRAM, ESTABLISHED IN 2019, HAS TRAINED NINE PHYSICIANS, EIGHT OF WHOM NOW PRACTICE IN MAINE. THIS PROGRAM HAS A 100% BOARD PASS RATE AND OFFERS A ONE-YEAR CURRICULUM, INCLUDING ROTATIONS IN INPATIENT AND OUTPATIENT ADDICTION MEDICINE AND SPECIALTY ELECTIVES. THE EXPANSION FUNDED BY THIS HRSA GRANT WILL ADD TWO FELLOWSHIP POSITIONS FOCUSED ON RURAL MAINE, SPECIFICALLY IN OXFORD AND FRANKLIN COUNTIES. THE FELLOWSHIP WILL INVOLVE CLINICAL TRAINING IN ADDICTION MEDICINE, INCLUDING THE MANAGEMENT OF OPIOID USE DISORDER, ALCOHOL WITHDRAWAL, PERINATAL ADDICTION CARE, AND HARM REDUCTION SERVICES. THE NEW FELLOWSHIP ROTATIONS WILL BE BASED IN NORWAY (OXFORD COUNTY) AND FARMINGTON (FRANKLIN COUNTY). IN NORWAY, FELLOWS WILL WORK AT MAINEHEALTH COMPREHENSIVE ADDICTION MEDICINE (CAM) IN COLLABORATION WITH LOCAL CLINICS AND RECOVERY PROGRAMS, WHILE IN FARMINGTON, FELLOWS WILL TRAIN AT A NEW ADDICTION MEDICINE PROGRAM INTEGRATED INTO A PRIMARY CARE PRACTICE, WORKING WITH LOCAL BEHAVIORAL HEALTH TEAMS AND AT THE FRANKLIN COUNTY CORRECTIONAL FACILITY. FELLOWS WILL ALSO CONTINUE PARTICIPATING IN EXISTING PORTLAND-BASED ROTATIONS, PROVIDING A COMPREHENSIVE TRAINING EXPERIENCE. FELLOWS WILL ENGAGE IN DIDACTIC TEACHING AND SCHOLARLY ACTIVITIES, INCLUDING CASE PRESENTATIONS, JOURNAL CLUBS, AND LECTURES ON ADDICTION MEDICINE. THEY WILL ALSO PARTICIPATE IN RESEARCH, QUALITY IMPROVEMENT PROJECTS, AND OTHER EDUCATIONAL INITIATIVES DURING THEIR FELLOWSHIP. THE PROGRAM INCORPORATES STIGMA-FOCUSED TRAINING, TEACHING FELLOWS TO PROVIDE TRAUMA-INFORMED, NON-JUDGMENTAL CARE AND ADDRESS HEALTHCARE-RELATED STIGMA. ADDITIONALLY, FELLOWS WILL RECEIVE INTERPROFESSIONAL TRAINING IN ADDRESSING SOCIAL DETERMINANTS OF HEALTH. THE EXPANSION OF THE FELLOWSHIP PROGRAM INTO RURAL AREAS WILL ADDRESS THE CRITICAL SHORTAGE OF ADDICTION MEDICINE PROVIDERS IN UNDERSERVED COMMUNITIES, IMPROVE ACCESS TO CARE, AND HELP REDUCE HEALTH DISPARITIES IN RURAL MAINE. BY TRAINING FELLOWS WITH A FOCUS ON RURAL ADDICTION MEDICINE, THE PROGRAM AIMS TO STRENGTHEN ADDICTION TREATMENT

INVESTIGATING THE IMPACT OF SOCIAL ISOLATION ON BONE METABOLISM - PROJECT SUMMARY SOCIAL ISOLATION IS A POTENT FORM OF PSYCHOSOCIAL STRESS, AND A GROWING PUBLIC HEALTH CONCERN. OLDER ADULTS, PARTICULARLY THOSE INDIVIDUALS ISOLATED DURING THE COVID-19 PANDEMIC, ARE PARTICULARLY VULNERABLE. ONE IN FOUR INDIVIDUALS OVER THE AGE OF 65 ARE ESTIMATED TO BE AFFECTED BY SOCIAL ISOLATION AND LONELINESS, WHICH ARE ASSOCIATED WITH AN INCREASE IN MORTALITY RISK BY UP TO 70%. PREVIOUS STUDIES HAVE SHOWN OTHER FORMS OF PSYCHOSOCIAL STRESS AND MENTAL ILLNESS ARE ASSOCIATED WITH INCREASED RISK FOR OSTEOPOROSIS AND RELATED FRACTURES, WHICH ARE LIKEWISE ASSOCIATED WITH INCREASED MORTALITY IN OLDER ADULTS. DESPITE THE INCREASE IN SOCIAL ISOLATION AND THE OVERLAP BETWEEN AT-RISK POPULATIONS, THERE HAS BEEN LITTLE RESEARCH ON THE EFFECTS OF SOCIAL ISOLATION ON BONE LOSS AND SKELETAL METABOLISM. THE LIMITED WORK THAT HAS BEEN DONE IN RODENTS SUGGEST THAT SOCIAL ISOLATION NEGATIVELY IMPACTS BONE HEALTH, LEADING TO DECREASED BONE MINERAL DENSITY. NONE OF THESE STUDIES, HOWEVER, HAVE EXPLORED THE MECHANISMS OF ISOLATION-INDUCED BONE LOSS, OR EXAMINED DIFFERENCES IN THE EFFECT OF ISOLATION ON BONE BETWEEN THE SEXES. MY OWN PRELIMINARY STUDIES SHOW THAT MALES EXPOSED TO SOCIAL ISOLATION HAD REDUCED FEMORAL BONE VOLUME FRACTION, BONE MINERAL DENSITY, AND CORTICAL THICKNESS. FEMALES, CONVERSELY, DID NOT HAVE ANY REDUCTION IN BONE MASS. MY DATA ALSO SHOWED CHANGES TO GLUCOCORTICOID RECEPTOR AND SS2 ADRENERGIC RECEPTOR EXPRESSION AS A RESULT OF SOCIAL ISOLATION, WHICH BOTH HAVE KNOWN EFFECTS ON BONE. THE GOAL OF THIS PROJECT IS THEREFORE TO TEST THE OVERARCHING HYPOTHESIS THAT SOCIAL ISOLATION LEADS TO BONE LOSS THROUGH ALTERED GLUCOCORTICOID (AIM 1) AND SYMPATHETIC NERVOUS SYSTEM (AIM 2) ACTIVITY. I WILL TEST THESE HYPOTHESES USING A 4 TO 8-WEEK-LONG MOUSE MODEL OF SOCIAL ISOLATION IN 16-WEEK OLD MICE, IN COMBINATION OF PHARMACOLOGICAL AND GENETIC APPROACHES. I WILL ALSO USE PROTEOMIC AND MICRORNA SEQUENCING APPROACHES TO IDENTIFY NOVEL SYSTEMIC CHANGES IN RESPONSE TO SOCIAL ISOLATION THAT MAY IMPACT BONE. THE PROPOSED PROJECT WILL BE THE FIRST STUDY TO IDENTIFY MEDIATING MECHANISMS OF SOCIAL ISOLATION-INDUCED BONE LOSS AND PRECISELY TEST THE EFFECTS OF ISOLATION ON BONE METABOLISM THROUGH A RANGE OF IMAGING, GENETIC, HISTOLOGIC, AND OMIC APPROACHES. THE RESULTS OF THIS PROJECT WILL INFORM FUTURE CLINICAL AND EPIDEMIOLOGICAL STUDIES, AND HELP IDENTIFY PREVENTION STRATEGIES AND TREATMENTS FOR INDIVIDUALS AT THE GREATEST RISK FOR SOCIAL ISOLATION.

EXECUTIVE SUMMARY TSF'S MISSION IS TO EMPOWER YOUTH BY SUPPORTING AND PROMOTING EDUCATIONAL ATTAINMENT THROUGH IN-SCHOOL AND AFTER SCHOOL SUPPORT, IMPROVE LIVES BY PROMOTING PROGRAMS THAT STRENGTHEN PHYSICAL HEALTH AND SOCIAL AND EMOTIONAL DEVELOPMENT, AND UNITE COMMUNITIES BY ADVANCING DIVERSITY, EQUITY, AND COMMUNITY WELL-BEING. THE PROPOSED VISTA PROJECT ALIGNS WITH EDUCATION PRIORITY AREA AND K-12 SUCCESS. THE VISTA CAPACITY BUILDING PROJECT WILL SEEK TO: 1) COMPLETE A SET OF CAPACITY BUILDING GOALS THAT EXPAND THE EFFICIENCY OF THE ORGANIZATION; 2) HARNESS THE INNOVATION, CREATIVITY AND EFFECTIVENESS OF YOUNG PEOPLE AND INDIVIDUALS JUST OUT OF COLLEGE TO ENHANCE, IMPROVE AND INNOVATE TSF IN THE AREAS OF COMMUNITY DEVELOPMENT, MARKETING AND COMMUNICATIONS, FUNDRAISING AND DEVELOPMENT, AND RESEARCH AND EVALUATION; 3) ASSIST TSF IN BUILDING CAPACITY TO CONCEPTUALIZE, CREATE, IMPROVE, MODIFY, FACILITATE AND IMPLEMENT PROGRAMS AND INITIATIVES WHICH HAVE THE SPECIFIC GOAL OF ELIMINATING AND/OR REDUCING POVERTY IN LOW-INCOME NEIGHBORHOODS AND COMMUNITIES THROUGH EDUCATION; AND 4) PROVIDE A MEANINGFUL, EDUCATIONAL, IMPACTFUL, AND POSITIVE LIFE-CHANGING PROFESSIONAL AND SKILL-BUILDING EXPERIENCE FOR VISTA MEMBERS, AND EXPECTS TO BENEFIT 1,000 BENEFICIARIES, ALONG WITH THEIR FAMILY AND COMMUNITY MEMBERS. SIX (6) VISTA SERVICE MEMBERS WILL CONTRIBUTE TO THE GOALS OF THE PROJECT BY PERFORMING ACTIVITIES SUCH AS: USING INNOVATION AND CREATIVITY TO BUILD SYSTEMS WHICH STRENGTHEN THE DREAMLINE PROGRAM'S LOCAL AND REGIONAL PARTNERSHIPS; IDENTIFY ADDITIONAL RESOURCES AND SERVICES WHICH STRENGTHEN DREAMLINE PROGRAM DELIVERY IN THE BENEFICIARY COMMUNITY; RECRUIT DREAMLINE COACHES WHO HAVE A SPECIFIC INTEREST IN PARTNERING AND MENTORING STUDENTS TO ENHANCE ACADEMIC SUCCESS FOR YOUTH POPULATIONS RESIDING IN LOW-INCOME COMMUNITIES AND COMMUNITIES OF COLOR; STRENGTHEN DREAMLINE'S SOCIAL MEDIA CAPACITY WHILE REFINING AND HONING TSF'S ONLINE PRESENCE TO BUILD AWARENESS OF DREAMLINE IMPACT AND TEACHER PATHWAY PROGRAM OPPORTUNITY; BUILD A SYSTEM WHICH HELPS SECURE GREATER FINANCIAL RESOURCES TO SUPPORT DREAMLINE PROGRAMMING AND ACTIVITIES ACROSS ALL BENEFICIARY COMMUNITIES; AND CONTRIBUTE TO THE DEVELOPMENT AND CONTINUOUS IMPROVEMENT OF MONITORING AND EVALUATING SYSTEMS WHICH CAN BE SUSTAINED THROUGHOUT THE PROJECT'S ANTICIPATED THREE YEARS AND AFTER CNCS RESOURCES ARE EXPENDED.

FINANCIAL ASSISTANCE AWARD

MAINEHEALTH ALZHEIMER'S DISEASE PARTNERSHIP

TOWN OF STONEHAM OVW FY2011 GRANT TO ENCOURAGE ARREST POLICIES AND ENFORCEMENT OF PROTECTION ORDERS PROGRAM

POISON CONTROL AND STABILIZATION AND ENHANCEMENT PROGRAM

GERIATRIC ACADEMIC CAREER AWARDS

REPROGRAMMING OF THE OVARIAN TUMOR STROMA BY ACTIVATIONOF A BIOMECHANICAL ECM SWITCH