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Supporting the national target of net-zero greenhouse gas emissions in the United States by 2050, the Bipartisan Infrastructure Law (BIL) authorized investments into carbon capture and storage (CCS), highlighting the need for the safe and sustainable transport of carbon dioxide (CO2). Curated to support CO2 pipeline route planning optimization and assess existing energy transport corridors, the CCS Pipeline Route Planning Database is a compilation of 47 publicly available, authoritative geospatial data resources, spanning the contiguous U.S., and some including Alaska and Hawaii. Key considerations were identified following comprehensive literature review, which included state legislation, known pipeline stressors, and energy, environmental, and social justice (EJSJ) considerations. Data layers were sorted into relevant categories (i.e., natural hazards, boundaries) and assigned preliminary weights representing potential social, environmental, and economic costs associated with routing pipelines. Version one of the CCS Pipeline Route Planning Database, made available on the Energy Data eXchange® (EDX), contains categorized vector features representing protected areas, public and energy infrastructure, EJSJ factors, potential risks, federal and state regulations and legislation, and natural features, along with associated metadata. This paper provides details on individual layers, methods used to identify data needs, acquire, and process the disparate data, as well as planned enhancements to future versions of this database.

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BACKGROUND: Congenital talipes equinovarus (CTEV) is a congenital musculoskeletal deformity, which further leads to abnormal alignment of the feet in children. The aim of the present study is to assess perception and practice and explore lived experiences on the use of corrective braces among parents of children diagnosed with clubfoot. MATERIAL AND METHODOLOGY: A mixed method study approach with convergent parallel research design was used on 100 parents of children with clubfoot. For the quantitative strand, a total enumerative sampling technique was used to collect the data using self-structured tools-a 5-point Likert scale on perception and a checklist on practice at the clubfoot clinic of a selected tertiary care hospital, Rishikesh. For the qualitative strand, a purposive sampling technique was used to conduct the in-depth interview until data saturation from 17 participants using a semi-structured questionnaire. Analysis was done using the SPSS 23.0 software, descriptive statistics with the use of frequency %, whereas for correlation, Pearson's correlation coefficient was used. RESULTS: The mean age of participants was 31 years with a mean score of 30.54 ± 4.97. Among parents, 93% showed positive perception with a mean score of 67.16 ± 6.23 and 64% followed appropriate practice with a mean score of 12.44 ± 1.45. Coefficient correlation showed a statistically weak positive correlation between perception and practice (P < 0.001). The lived experiences of parents were reflected under six main themes, i.e., "personal experiences with wearing braces for correction," "encounters and barriers," "effects on one's social and personal life," "perceived answers," "any other previous practice," and "awareness about clubfoot." CONCLUSION: Present study concluded that parents had a positive perception and appropriate practice on the use of corrective braces, but there were a few issues such as relapse due to non-adherence, financial burden, and traveling distance, and noticeably more, which need to be addressed. Parental information is a very essential component that should be addressed by all treating physicians and nursing officers before starting treatment for clubfoot.

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CONTEXT: Malignant ovine theileriosis is a tick-borne disease of sheep and goats, caused by protozoan Theileria lestoquardi. The disease has serious economic implications for small ruminant production around the world. METHODS: An outbreak of malignant ovine theileriosis in a sheep flock was investigated from Hisar district of Haryana, India, in March 2022. The etiological agent was identified using polymerase chain reaction assay with genus specific primers targeting 18S rRNA gene and subsequently confirmed by sequencing. RESULTS: The morbidity, mortality and case fatality rate reported in the outbreak were 22.2, 18.8 and 85%, respectively. The phylogenetic analysis clustered the present study T. lestoquardi isolate in the same clade with T. lestoquardi from Iraq, Iran and Pakistan with maximum nucleotide identity of 99.37% with strains from Iraq. The tick vector Hyalomma anatolicum recovered from dead animals was implicated in the disease's transmission. CONCLUSIONS: Malignant ovine theileriosis resulted in high case fatality rate. This study presents the first molecularly confirmed outbreak of malignant ovine theileriosis outbreak in the North Indian region, with characteristic post-mortem findings.

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During February 2020 to October 2020, four outbreaks of theileriosis in small ruminants were recorded with overall morbidity, mortality and case fatality rates of 27.95%, 17.46% and 62.5%, respectively. The disease was characterized by high fever (up to 106°F), superficial lymphadenopathy, anaemia, anorexia, lethargy, respiratory distress and death. The presence of pleomorphic intra-erythrocytic piroplasms of Theileria species in Giemsa's stained blood smears was a common finding in all the episodes. Significant haematological alterations including high total leucocyte count and low haemoglobin and packed cell volume were characteristic. Necropsy findings of the icteric liver, enlarged spleen, pulmonary oedema and abomasal ulcerations were observed in three flocks. Smear-positive blood samples from all the episodes were screened by PCR using 18S rRNA gene-specific primer sets for T. lestoquardi, T. luwenshuni, T. uilenbergi and T. ovis. T. lestoquardi which was detected in all four flocks, while there was co-infection of T. ovis in two flocks. Phylogenetic analysis revealed that T. ovis and T. lestoquardi identified in this study had 100% and ~ 99.86% homology, respectively, with the published sequences used for comparison. This is the first confirmed report of outbreaks of malignant ovine theileriosis in the Haryana state of India which caused high morbidity, mortality and case fatality among sheep and goats. Further studies on theilerioses in small ruminants are required to understand epidemiology better.

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PURPOSE: The present study reports a very rare case of Trypanosoma theileri like infection in the peritoneal fluid of a 6-year-old female Holstein Friesian (HF) cattle brought to Veterinary Clinical Complex, Lala Lajpat Rai University of Veterinary and Animal Sciences (LUVAS), Hisar. The aim of the clinical study was to report an unusual case of T. theileri-like infection associated with peritonitis and its therapeutic management. METHODS: For confirmatory diagnosis, peritoneal fluid and blood sample was collected from animal for haemato-biochemical examination, buffy coat examination and detection of Trypanosoma antigen by monoclonal antibody-based latex agglutination test. RESULTS: Animal had history of anorexia, high fever, oedematous swelling on the abdominal area and decrease in milk yield since 1 week. Clinical examination revealed high fever, congested conjunctival mucus membrane and oedematous inflammatory swelling on the abdominal region. Haematological examination on Day 1 revealed relative neutrophilia and eosinophilia, whereas other parameters measured were on the lower side of normal range. Thin blood smear examination did not reveal any parasite on first attempt. However, after confirmation of Trypanosoma species in peritoneal fluid collected by FNAC, buffy coat examination of blood sample was also found positive for Trypanosoma species. On Day 2, haematological examination revealed neutrophilic leucocytosis, eosinophilia and anaemia. Blood sample was also found serologically positive for Trypanosoma antigen by monoclonal antibody based latex agglutination test. Biochemical examination revealed increased blood urea nitrogen (BUN), gamma glutamyl transferase (GGT) levels, hyperglycemia, hyperprotienemia and decreased levels of sodium and chloride ions. Animal was primarily treated with isometamidium chloride (Nyzom®) @ 0.5 mg/kg body weight (IM, single dose) along with supportive therapy. CONCLUSION: Animal showed clinical recovery after 10 days of treatment. Post-recovery, blood sample of the animal was re-examined for parasite and other blood parameters and it was found negative for presence of Trypanosoma infection along with restoration of haematological values. Hence, the present study concludes the confirmatory diagnosis and therapeutic use of isometamidium hydrochloride along with anti-inflammatory drugs to Trypanosoma infection.

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Orf is an acute, highly contagious, and economically important viral disease of small ruminants. In this study, six orf suspected outbreaks among goats and sheep were investigated from Haryana state and adjoining areas of Rajasthan state during the year 2021. The disease was diagnosed on the basis of clinical signs and molecular identification. The causative agent of the disease, orf virus (ORFV), was confirmed using polymerase chain reaction (PCR) targeting immunodominant envelope antigen (B2L) gene and confirmed by sequencing. The morbidity in goats ranged from 8.75 to 100%, whereas in sheep, it ranged from 0 to 8%. The higher mortality was observed among flocks with mixed infections of orf and peste des petits (PPR) or orf and haemonchosis as compared to other outbreaks. The phylogenetic analysis of sequenced PCR products clustered the current study strains in the same clad with Indian as well as strains from other countries with nucleotide identity more than 99%, signifying a close genetic relationship. The study highlighted the circulation of strains of a single cluster among sheep and goats in Haryana and adjoining areas. Prompt diagnosis of the disease is highly important for facilitating the implementation of control measures to minimize the losses suffered by small and marginal farmers in this region. Further detailed studies are required to delineate the molecular details of ORFV for better understanding the dynamics and molecular epidemiology of strains circulating in the country and for designing the effective vaccines against the disease which are currently lacking in the country.

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Background The number of confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections is vastly underestimated. In this context, seroprevalence surveys are of utmost importance to assess the proportion of the population that has already developed antibodies against the virus and might potentially be protected against subsequent infection. Health care workers (HCWs) face a greater risk of developing SARS-CoV-2. Therefore, the present retrospective study was undertaken to estimate the prevalence of antibodies against SARS-CoV-2 among healthcare workers at a tertiary care institute in Uttarakhand, India. Material and methods Data were gathered from hospital records of 704 healthcare workers admitted to the coronavirus disease 2019 (COVID-19) unit and attended the COVID OPD of the tertiary care institute between July 15 to Aug 14, 2020. Result Out of the 704 recruited participants, 14 (1.99%) were seropositive for immunoglobulin G (IgG) antibodies against SARS-CoV-2. The cumulative prevalence of SARS-CoV-2 infection (presence of antibodies or past or current positive reverse transcription-polymerase chain reaction (RT-PCR)) was 4.40%. Conclusion The present study shows a low prevalence of SARS-CoV-2 IgG antibodies among health care workers. In addition, posting in COVID-19-positive areas was not associated with increased seropositivity. More studies are warranted to assess IgG/IgM antibodies against SARS-CoV-2 among those HCWs who are exposed to COVID-19 patients.

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Paratuberculosis (ParaTB) in ruminants, commonly known as Johne's disease (JD)is caused by Mycobacterium avium subspecies paratuberculosis (MAP). Characteristic hallmark of JD is chronic inflammation of intestines. Similar infection of MAP in human population is called Crohn's disease (CD). In sub-tropical countries like India, domestic buffaloes are important source of milk and meat and vital for thenutritional security of human beings. Diarrhoea leading to weight loss and weakness invariably leads to reduced productivity, therefore huge financial losses to the livestock farmers. Evaluation of immuno-biochemical alterations and their management through appropriate therapeutic interventions would aid in preventing production losses caused by diarrhoea following MAP infection.Most of the studies were performed to understand immune-biochemical alterations in serum samples of cattle following experimental infections. But studies are limited in clinical cases of buffaloes suffering from diarrhoea and were suspected for MAP infection.We categorized diarrhoeic buffaloes brought at Veterinary Clinical Complex of Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, for therapeutic intervention; As MAP negatives / suspected, low positive, positive and strong positive based on indigenous ELISA kit results. We further compared immuno hemato-biochemical alterations in MAP negative/suspected low positive, positive and strong positive animals.Our major findings were; significant differences observed in creatinine, globulin, total leucocytic, neutrophils and in lymphocytes numbers. Decreasing trend in leucocytes was seen from suspected to strong positive animals, which indicated the progression of disease towards chronic paratuberculosis. However, differences were not observed in the Th1 cytokine levels.

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BACKGROUND: To reduce the likelihood of transmission of infection to health-care workers (HCWs), personal protective equipment is used. However, wearing personal protective equipment (PPE) increases the risk of heat stress and loss of dexterity, leads to poor compliance to PPE. To address the issues of poor compliance to PPE, it was necessary to gain a deeper understanding about the factors that influence compliance. Thus this qualitative study was planned to explore barriers faced by HCWs while using PPE during a pandemic situation in a tertiary care hospital, Uttarakhand, India. MATERIALS AND METHODS: A exploratory qualitative study was undertaken among health care workers involved in the care of COVID patients. FGDs were done and an unstructured interview guide with open-ended questions was used which helped to explore the factors which can be potential barriers to the HCWs while working wearing PPE. RESULTS: Organizational and individual factors acting as barriers such as unavailability of essential personal protective equipment, a disharmonious work environment, lack of comfort, inadequate size, and quality of PPE were identified as the major barriers in the present study. CONCLUSION: Future efforts to optimize PPE use should focus on to adequate supplies both in quality and quantity can help in avoidance of such barriers. Resources should be prioritized with the needs of the HCWs in the times of pandemic. Regular training and feedbacks are necessary for the satisfaction of HCWs and improving PPE compliance.

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Increased oxidative stress in diabetic wound areas impairs wound healing. Quercetin exhibits significant antioxidant properties. We investigated the effects of topical quercetin on antioxidant status in diabetic wound areas and its effect on wound healing in rats. A 2 cm2 cutaneous wound was produced on the back of streptozotocin induced diabetic and normal rats. Rats were divided into three groups of 20: normal healthy control group, diabetic group and quercetin treated diabetic group. The control and diabetic groups were treated topically with ointment base once daily for 21 days. The quercetin treated diabetic rats were treated similarly with ointment containing quercetin. The quercetin treated diabetic group exhibited increased levels of catalase, glutathione peroxidase, superoxide dismutase and total thiols compared to the diabetic group. Nitrite levels in the diabetic group were decreased significantly on day 3 compared to the healthy control group. Malondialdehyde levels were decreased in the quercetin treated diabetic group compared to the diabetic group. The expression of proliferating cell nuclear antigen) (PCNA) was greater in the quercetin treated diabetic group on day 7 compared to healthy control and diabetic groups. Formation of granulation tissue and the quality of healed tissue was improved in the quercetin treated diabetic group compared to the diabetic group. Quercetin improves antioxidant status in wounds of diabetic rats and stimulates the proliferation phase, which accelerates wound healing.

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Aim To assess the knowledge, attitude, and practice toward cleaning and disinfection among housekeeping (HK) staff amid the coronavirus disease 2019 (COVID-19) pandemic. Methods A quasi-experimental was undertaken among HK staff at a tertiary care hospital. A 30-item structured questionnaire was used in the study, which consisted of questions pertaining to knowledge (11), attitude (8), and practice (11) toward cleaning and disinfection. Result One-hundred-two participants were included by convenient sampling, with mean age = 30-37 years. There was an improvement in pre-test and post-test knowledge (6.21 to 9.7) and practice score (9.97 to post-test 10.52). However, the attitude score did not show a significant change in the post-test score (p=0.964), showing that they were having a positive attitude toward the practices before training too.  Conclusion Improvement in the post-test score shows that periodic targeted training sessions on cleaning and disinfection among housekeeping staff help improve their knowledge, attitude, and practices toward infection prevention and control (IPC) during the COVID-19 pandemic, thus minimizing the spread of the virus in a hospital environment, reducing their apprehension, and preparing them to work in such pandemic situations.

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BACKGROUND: During infectious outbreaks like COVID-19, it is essential that every healthcare personnel (HCP) strictly adheres to infection prevention and control (IPC) policies. To boost IPC measures, training to reinforce preventive practices, which are pertinent to needs and encompass the expectations of the HCP, is indispensable. Thus, these expectations of the HCP should be explored. METHODS: In this cross-sectional descriptive survey, we used convenience sampling technique to ask the participants to list their expectations on of covid-19 IPC training paper based forms. Using the category construction approach, we organised the expectations and grouped the participants on the basis of their work and place of work to analyse the association using the chi-square test. RESULTS: Many participants expected to learn about the use of PPE and masks, hand hygiene, physical distancing, cleaning and disinfection, basic precautions for personal protection during the training. Expectations also included various administrative queries, sample collection and clinical skills for diagnosis and management. There was significant association of many categories of expectations with the nature and place of work in the hospital. CONCLUSION: When planning IPC training, these expectations of the HCP may be carefully addressed. Information about causative agent, transmission and clinical aspects may will give a contextual meaning to IPC training. Some important preventive measures, which few participants expected to learn must be analysed in detail to understand the attitude of the HCP towards them. Efforts to appraise the HCP for the importance of these measures and promoting its practice may play a vital role to curb the spread of infectious diseases.

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Purpose: There is an urgent need of effective drug/formulation to speed up the healing process in diabetic wounds. In our earlier studies, quercetin has accelerated the healing of nondiabetic wounds. So, we investigated the wound-healing potentials of quercetin in diabetic rats.Materials and methods: A square-shaped cutaneous wound (≈400 mm2) was created on the back of nondiabetic and diabetic rats. They were divided into three groups, viz. healthy control (nondiabetic), diabetic control and diabetic-treated group. Ointment base was topically applied for 21 days in healthy and diabetic control groups. Quercetin (0.3%) ointment was similarly applied in third group. Effects of quercetin on repair and regenerations of diabetic wounds in terms of wound closure, inflammation, angiogenesis, fibroblast proliferation, collagen synthesis, epithelialization, axonal regeneration etc was studied.Results: Quercetin accelerated the wound closure and increased the expressions of IL-10, VEGF and TGF-ß1 in granulation/healing tissue of diabetic wound. However, quercetin decreased the expression of TNF-α, IL-1ß, and MMP-9. Histopathological evaluation revealed amelioration of persistence of inflammatory cells by quercetin in diabetic wounds. There was good quality of granulation tissue, marked fibroblast proliferation, well organized collagen deposition, early regeneration of epithelial layer etc. in the quercetin treated diabetic wounds in comparison to diabetic control group. Results of immunohistochemistry showed more angiogenesis, faster phenotypic switching of fibroblast to myofibroblasts and increased GAP-43 positive nerve fibers in quercetin-treated diabetic wounds.Conclusion: Quercetin ointment at 0.3% w/w concentration modulates cytokines, growth factors and protease, thereby improved repair and regenerations of cutaneous diabetic wounds in rats.

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BACKGROUND: Continuous pertinent trainings for infection prevention and control (IPC) measures are essential to ensure quality health-care services along with the safety of the health personnel. Amid the COVID-19 pandemic, the current study focusses on the utilization of explicated video modules training of all health-care personnel of the institute and assessment of the effectiveness of video training for IPC practices during COVID-19 pandemic. MATERIALS AND METHODS: A quasi-experimental study, one group pre- and posttest design, using Google Questionnaire forms was conducted at a tertiary care center. The training was assisted by trained tutors, and three in-house videos were demonstrated to the participants regarding specific IPC measures; "Do's and Don'ts;" "Hand hygiene and personal protective equipment's (PPE)" and "Environmental cleaning and disinfection." SPSS software version 23 (IBM Corp., N. Y., USA) was used for the analysis using the descriptive statistics, Chi-square test, Fisher's t-test, ANOVA, and post hoc Tukey's test. RESULTS: The level of knowledge increased significantly by 16% in the posttest. Statistically significant association between the levels of knowledge in pretest as well as posttest scores and age (P < 0.001), designation (P < 0.001), and years of experience (P < 0.001) was identified. The participants were satisfied with the video-assisted trainings and willing to use videos for revision. CONCLUSIONS: Video-assisted training modules similar to this study may be utilized to enhance the knowledge of various cadres of health-care staff regarding IPC practices.

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Murrah buffaloes, best breed for milk production are native of Haryana state. They contributes significantly to the farmer's income, livelihood and food (milk and meat) security, in the semi-tropical regions of North India. Johne's disease though endemic in the domestic livestock of the country, but reports are not available in the buffaloes suffering from morbidity due to progressive weakness and diarrhoea. We estimated the status of JD in diarrhoeic buffaloes and cattle reporting at Veterinary Clinical Complex of Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India, using conventional, serological and PCR assays.141 buffaloes suffering from chronic diarrhoea were screened to estimate sero-prevalence of MAP and 50.0 % young and 53.52 % adult animals were positive. Of 14 cattle screened, none of the young and 66.6 % adult cows were positive. In buffaloes, 66.1 and 6.77 %, fecal samples were positive in microscopy and IS900 PCR, respectively. Sero-prevalence of JD was very high in diarrhoeic buffaloes and cattle from Haryana state of India.Buffaloes positive for Mycobacterium avium subspecies paratuberculosis (MAP) infection had reduced total leukocyte count and lymphocytes.

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BACKGROUND: Around the globe, protocols for flushing the catheter to maintain the patency of central venous catheter (CVC) vary by institution to institution or by practitioner to practitioner. Therefore, this review was carried out with the aim of evaluating the efficacy of heparin flush vs. normal saline flush to maintain the patency of CVC among adult patients. METHODS: We followed the guidelines of Cochrane handbook for interventions and searched in MEDLINE, Embase, Cochrane library, Clinical trials database, and reference list of related articles, which were published from Jan. 2012 to 31 Dec. 2018 in English language. We included only randomized controlled trials, and nine studies were included in this review. The pooled standard mean difference and relative risk were calculated by using Rev Man Review Manager 5. RESULTS: We identified nine eligible studies with a total number of 3,113 participants. Consolidated results from eight studies conveyed little favorable effect to maintain patency of CVC with heparin when compared with normal saline as evident by risk ratio 0.83, 95% CI 0.50 - 1.40; P = 0.13. We also carried out analysis for secondary outcomes, and there was no evidence that heparin was better than normal saline in terms of safety except heparin-induced thrombocytopenia. CONCLUSIONS: Heparin has little favorable effects to maintain patency of catheter than normal saline but not in secondary outcomes. As the quality of evidence was very low, therefore, results should be comprehend with care.

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A 5 years old crossbred cow was brought to the Veterinary Clinical Complex of Lala Lajpat Rai University of Veterinary and Animal Sciences Hisar with history of progressive weakness, pale mucous membrane, anorexia, high fever (105 °F), tachycardia, laboured breathing and coffee coloured urine. Analysis of haematological parameters revealed severe anaemia, leucocytopenia, marked poikilocytosis of erythrocytes. Blood smear examination showed presence of signet ring shaped Theileria organisms, Babesia piroplasms and condensed dot forms of Anaplasma marginale in the stained erythrocytes. Further animal was treated with buparvaquone @ 2.5 mg/kg b.wt deep I/M in neck region and long acting oxytetracycline at 25 mg/kg b. W. slow I/V daily in normal saline solution for 5 days. Berenil (Diminazene aceturate 5%) injection was also administered @ 1 ml/20 kg b.wt. I/M along with supportive therapy. Clinical signs started to subside 3 days post treatment. Complete recovery was achieved by 4 weeks post treatment however animal succumbed to death due to immunosuppression.

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PURPOSE: The purpose of this study was to determine the clinical utility of an algorithm-based decision tool designed to assess risk associated with opioid use in the primary care setting. METHODS: A prospective, longitudinal study was conducted to assess the utility of precision medicine testing in 1822 patients across 18 family medicine/primary care clinics in the United States. Using the profile, patients were categorized into low, moderate, and high risk for opioid use. Physicians who ordered testing were asked to complete patient evaluations and document their actions, decisions, and perceptions regarding the utility of the precision medicine tests. RESULTS: Approximately 47% of primary care physicians surveyed used the profile to guide clinical decision-making. These physicians rated the benefit of the profile on patient care an average of 3.6 on a 5-point scale (1 indicating no benefit and 5 indicating significant benefit). Eighty-eight percent of all clinicians surveyed felt the test exhibited some benefit to their patient care. The most frequent utilization for the profile was to guide a change in opioid prescribed. Physicians reported greater benefit of profile utilization for minority patients. Patients whose treatment was guided by the profile had pain levels that were reduced, on average, 2.7 levels on the numeric rating scale. CONCLUSIONS: The profile provided primary care physicians with a useful tool to stratify the risk of opioid use disorder and was rated as beneficial for decision-making and patient improvement by the majority of physicians surveyed. Physicians reported the profile resulted in greater clinical improvement for minorities, highlighting the objective use of this profile to guide judicial use of opioids in high-risk patients. Significantly, when physicians used the profile to guide treatment decisions, patient-reported pain was greatly reduced.

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PURPOSE: The purpose of this study was to determine the clinical utility of an algorithm-based decision tool designed to assess risk associated with opioid use. Specifically, we sought to assess how physicians were using the profile in patient care and how its use affected patient outcomes. PATIENTS AND METHODS: A prospective, longitudinal study was conducted to assess the utility of precision medicine testing in 5,397 patients across 100 clinics in the USA. Using a patent-protected, validated algorithm combining specific genetic risk factors with phenotypic traits, patients were categorized into low-, moderate-, and high-risk patients for opioid abuse. Physicians who ordered precision medicine testing were asked to complete patient evaluations and document their actions, decisions, and perceptions regarding the utility of the precision medicine tests. The patient outcomes associated with each treatment action were carefully documented. RESULTS: Physicians used the profile to guide treatment decisions for over half of the patients. Of those, guided treatment decisions for 24.5% of the patients were opioid related, including changing the opioid prescribed, starting an opioid, or titrating a patient off the opioid. Treatment guidance was strongly influenced by profile-predicted opioid use disorder (OUD) risk. Most importantly, patients whose physicians used the profile to guide opioid-related treatment decisions had improved clinical outcomes, including better pain management by medication adjustments, with an average pain decrease of 3.4 points on a scale of 1-10. CONCLUSION: Patients whose physicians used the profile to guide opioid-related treatment decisions had improved clinical outcomes, as measured by decreased pain levels resulting from better pain management with prescribed medications. The clinical utility of the profile is twofold. It provides clinically actionable recommendations that can be used to 1) prevent OUD through limiting initial opioid prescriptions and 2) reduce pain in patients at low risk of developing OUD.