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.

Narrative Acute emergency healthcare within a rural state varies, with marked disadvantages and poorer outcomes for emergency events occurring in rural areas. This program builds upon Maine Medical Center's exceptional clinical experience and strong basic/translational research program to create a framework for enhancing acute care research throughout our state. We will also address consent and inclusion for research in acute care to increase participation of rural subjects in clinical studies, with the long-term goal of improving acute care outcomes for patients in rural areas.