The long-term goal of the Northern New England Clinical and Translational Research Network (NNE-CTR), composed of MaineHealth, the University of Vermont, and the University of Southern Maine, is to sustain a clinical and translational research infrastructure that supports improvements in community health for northern New England inhabitants. Maine and Vermont have the oldest populations in the U.S. and that, coupled with rurality, predisposes residents to a range of disorders ranging from cancer to substance use disorders, food insecurity, obesity, diabetes and cardiovascular disease. In addition, northern New England has a growing underserved immigrant population, as well as a Native American population. Our communities have been challenged by the Covid-19 pandemic, and we are addressing these challenges by linking primary care practice centers with academic centers and developing innovative approaches to community-based research. During our first four years, the NNE-CTR has built a strong foundation for clinical research. We partnered with the oldest regional practice-based research network (PBRN), the Dartmouth Co-Op, and actively supported successful NIH program applications, including two COBREs, two NCI program grants, an infrastructure grant for a new Center for Biomedical Shared Resources, and a HRSA grant to build on the opioid treatment model pioneered in Vermont. The NNE-CTR PI is playing a leadership role in coordinating a national CTR network, including the CTR National COVID Cohort Collaborative (N3C), a registry to share clinical data on Covid-19 nationally, and the NIH-sponsored RECOVER trial, which will define the long-term sequelae of Covid-19. In this renewal, we plan to expand our collaborations both regionally and nationally, strengthen our PBRN, and embrace cultural diversity. We will strengthen Core resources that include: the Biostatistics, Epidemiology and Research Design Core, which will improve data capability and research navigation services; the Professional Development Core, which will offer an array of new educational and mentorship opportunities; the Pilot Projects Program, which will provide new and flexible funding mechanisms to offer more support for community-based projects; the Translational Research and Technology Core, offering state-of-the-art technologies and training for new investigators, and the Community Engagement and Outreach Core, which will build stronger bridges to underserved communities. We propose three specific aims: 1-Expand infrastructure and resources to address clinical and translational research needs in northern New England; 2- Strengthen clinical and translational research that addresses health equity and disparities encountered by at- risk populations, including expansion of clinical trial access, telehealth, and mentored training programs for new investigators; and 3-Accelerate regional and national collaborative initiatives within the IDeA networks and through NIH such as N3C and RECOVER. In sum, we will strengthen the NNE-CTR through continuous learning and improvement supported by the principles of diversity, inclusion, and equity.

PUBLIC HEALTH NARRATIVE The aging and rural populations of northern New England suffer from numerous chronic health issues, including cancer, obesity, diabetes, cardiovascular disease, and substance abuse. The Northern New England Clinical and Translational Research Network, which includes healthcare, educational and research institutions in Maine, Vermont, and New Hampshire, has helped build a foundation for clinical and translational research in the tri-state region. In this renewal application, our goal is to strengthen our network of clinical and translational research through a learning infrastructure that is supported by the principles of diversity, inclusion, and equity, for the benefit of all residents in our region.