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The Altered Vascular Endothelial Control of Facial Cutaneous Blood Flow in Rosacea
(Medical Journals Sweden AB, 2025-04-27) Ungureanu, C. Ilinca; Kube, Megan J.; Wilson, Thad E.; Metzler-Wilson, Kristen; Anatomy, Cell Biology and Physiology, School of Medicine
Naloxone Prescribing Among Long-Term Opioid-Prescribed Patients: Disparities and Opportunities
(Springer Nature, 2025-04-13) Yorkgitis, Brian; Harmon, Ira; Khan, Azad; Webb, Fern; Brat, Gabriel; Surgery, School of Medicine
Introduction: Opioids have a risk for opioid-induced respiratory depression (OIRD) that can be fatal. Naloxone has been proven to reverse opioid effects. However, co-prescribing of naloxone with opioids is underutilized. Through the query of a national outpatient healthcare dataset, the study aims to discern differences in co-prescribing naloxone to provide a framework of education to formulate recommendations on naloxone prescribing.
Methods: A retrospective review of a de-identified, national outpatient healthcare dataset was analyzed for patients with a pain-provoking condition and receipt of ≥3 opioid prescriptions. Demographics, medical history, and prescribing data were used to identify high-risk patients for OIRD along with co-prescribing of naloxone between 2015 and 2021 and analysis between 2022 and 2024.
Results: Among 181,964 patients, 1807 (1%) received a naloxone prescription of the total cohort. Examining co-prescribing for high-risk patients only, 107 (3.3%) were receiving >50 MME/day opioids, 468 (2.6%) were concomitantly prescribed benzodiazepines, and 273 (7.8%) who had opioid use disorder (OUD) history received naloxone prescriptions. Upon logistic regression, the likelihood of naloxone co-prescribing among patients with a history of OUD showed an odds ratio (OR) of 6.63 (95% CI 5.76-7.63; p>0.001), and that among patients concomitantly prescribed benzodiazepines showed an OR of 2.76 (95% CI 2.47-3.09; p>0.001). Hispanic patients (OR 0.87; 95% CI 0.76-0.98; p=0.27) and those uninsured or with unknown insurance (OR 0.65; 95% CI 0.51-0.81; p<0.001) were less likely to receive a naloxone prescription. Black (OR 1.30; 95% CI 1.15-1.47; p>0.001) and unknown race (OR 1.38; 95% CI 1.15-1.66; p=0.001) patients were more likely to receive naloxone prescriptions.
Conclusion: Despite recommendations that high-risk opioid-prescribed patients receive naloxone prescriptions, only a fraction are in receipt. There is variation among patient populations in co-prescribing, leaving opportunities to improve universal precautions that include naloxone co-prescribing to all high-risk patients for OIRD.
The impact of liver transplantation on endpoint selection in alcohol-associated hepatitis trials
(Wolters Kluwer, 2025-04-30) Liangpunsakul, Suthat; Krebs, William B.; Kwong, Allison J.; Kwo, Paul Y.; Brown, Robert S., Jr.; Lin, WeiQi; Sussman, Norman L.; Medicine, School of Medicine
Background: Alcohol-associated hepatitis (AH) is a serious liver disease caused by heavy alcohol consumption with severe cases exhibiting a 90-day mortality rate of ~30%. No drugs have been approved for AH, and regulatory approval currently requires evidence of improved survival. The lack of effective drug therapies and high mortality rates have fueled interest in early liver transplantation (LT), which has a survival rate that exceeds 90%. However, LT is resource-intensive and is available only in expert centers, where most AH trials are conducted. As a result, LT is overrepresented in recent AH studies, leading to confounding and unresolved questions regarding valid endpoints in therapeutic AH trials.
Methods: We propose methodological approaches to address the inclusion of LT in AH trials, supported by power calculations and data from the AHFIRM trial, a 300-patient multicenter study completed in late 2023. We demonstrate the impact of effect size, trial size, and statistical methods on trial design and interpretation.
Results: Effect size plays a crucial role in power calculations. While 90-day survival is the most efficient endpoint, competing risk analysis, primary stratum analysis, and win ratio are valuable tests for assessing the role of LT. The combined endpoint of death or LT is the least efficient method and requires the largest trial population to achieve statistical significance. We recommend using multiple statistical methods with adjustments for multiplicity.
Conclusions: The adoption of early LT complicates the assessment of new therapies for AH. Statistical methods and endpoints are critical in power calculations and when assessing the efficacy of new therapeutic agents. We recommend mortality as the primary analysis complemented by hierarchical secondary analyses that avoid problems of multiplicity.
217 The impact of preoperative glucagon-like peptide-1 receptor agonists (GLP1) utilization on bariatric surgery outcomes
(Cambridge University Press, 2025-04-11) Yuce, Tarik; AbuHasan, Qais; Kpormegbey, Daniel E.; Funk, Luke M.; Allison, David B.; Holl, Jane L.; Stefanidis, Dimitrios; Surgery, School of Medicine
Objectives/Goals: Glucagon-like peptide-1 (GLP1) use prior to bariatric surgery may represent a novel approach to treating obesity. The objectives of this study were to describe trends in pre-bariatric GLP1 use, investigate social and clinical factors associated with their use, and evaluate differences in clinical outcomes based on preoperative GLP1RA use. Methods/Study Population: Patients who underwent bariatric surgery at three Indiana hospitals from 2018 to 2023 were identified. Patients who utilized GLP1 in the year preceding surgery were compared to those who did not. Social determinants of health included insurance, income, and unemployment. Outcomes included rates of GLP1 use, 30-day postoperative readmissions, ED visits, and percent total weight lost (%TWL) at one year. Associations between preoperative GLP1 use and outcomes of interest were evaluated using multivariable logistic and linear regressions. Results/Anticipated Results: Of 2,169 patients who underwent surgery, 293 (13.5%) utilized GLP1 preoperatively. The rate of GLP1 utilization increased threefold from 2018 to 2023. Males were more likely to receive preoperative GLP1 (20.1% vs, 12.2%, p<0.001). There were no significant differences in social determinants of health or 30-day postoperative outcomes between patients who did and did not use GLP1RA preoperatively. Similarly, there were no significant differences in %TWL at one year postoperatively between groups (median 25.5% vs. 27.3%, coefficient: -0.78, 95%CI: -2.26–0.70). Discussion/Significance of Impact: Utilization of GLP1 in the year prior to bariatric surgery has significantly increased. Preoperative GLP1 use is not associated with worse 30-day outcomes or differences in %TWL at one year postoperatively. Further work is needed to evaluate whether GLP1 dosing and duration of treatment impact postoperative outcomes.
Author Correction: Single-nucleus chromatin accessibility and transcriptomic map of breast tissues of women of diverse genetic ancestry
(Springer Nature, 2025) Bhat-Nakshatri, Poornima; Gao, Hongyu; Khatpe, Aditi S.; Adebayo, Adedeji K.; McGuire, Patrick C.; Erdogan, Cihat; Chen, Duojiao; Jiang, Guanglong; New, Felicia; German, Rana; Emmert, Lydia; Sandusky, George; Storniolo, Anna Maria; Liu, Yunlong; Nakshatri, Harikrishna; Surgery, School of Medicine
Correction to: Nature Medicine 10.1038/s41591-024-03011-9, published online 9 August 2024.
This article was originally published under standard Springer Nature license (© The Author(s), under exclusive licence to Springer Nature America, Inc.). It is now available as an open-access paper under a Creative Commons Attribution 4.0 International license, © The Author(s). The error has been corrected in the HTML and PDF versions of the article.