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Introduction: Nirogacestat is a targeted gamma secretase inhibitor approved in the United States for adults with progressing desmoid tumors. In the phase 3 DeFi study (NCT03785964) of nirogacestat, ovarian toxicity (OT) was identified as a safety signal among females of reproductive potential (FORP). This analysis further describes the incidence, presentation, and resolution of OT., Methods: Patients were randomized to twice-daily oral nirogacestat (150 mg) or placebo, taken in continuous 28-day cycles. Investigator-identified OT in FORP was based on abnormal reproductive hormone values or perimenopausal symptoms (or both). Adverse event follow-up was conducted to assess OT resolution. Post hoc analyses included return of menstruation and return of follicle-stimulating hormone (FSH) to within normal limits (WNL) (≤20.4 mIU/mL)., Results: Of 92 randomized females, 73 in the safety population were FORP (n = 36 nirogacestat, n = 37 placebo). OT was identified in 75% (27 of 36) receiving nirogacestat and 0% (0 of 37) receiving placebo. As of October 24, 2022, investigators reported OT resolution in 78% (21 of 27) of patients, with median OT duration of 19.1 weeks. Off-treatment resolution was reported in all 11 patients (100%) who stopped nirogacestat treatment; of these, all nine with available menstruation information experienced return of menstruation and eight had FSH WNL at last reported assessment. Resolution was reported in 10 of 14 (71%) while on nirogacestat; of these, all 10 experienced return of menstruation and seven had FSH WNL. Two patients were lost to follow-up., Conclusion: Most FORP treated with nirogacestat experienced OT, with the majority resolving, including all who stopped treatment, suggesting that OT is transient., (© 2024 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Objective: To examine the impact of a results-based financing programme on patient satisfaction in Afghanistan., Methods: We analysed data collected from over 3000 patients from a stratified sample of 112 health facilities (56 results-based financing and 56 non-results-based financing) in 11 out of the 34 provinces of Afghanistan over a three-year period. The 112 facilities were part of 442 primary care facilities that were stratified on facility type and randomly assigned to the results-based financing (intervention) and non-results-based financing (control) groups in the 11 provinces. Data were obtained from the National Health Service Performance Assessment, a baseline survey of patients conducted in 2010, and two follow-up surveys in 2011 and 2012. Measurement of patient satisfaction used a questionnaire comprising 11 questions concerning overall satisfaction, and satisfaction with specific aspects of care, from provider behaviour (e.g. respectfulness, communication) to cleanliness, opening hours and waiting times of facilities. We used a regression adjusted difference-in-differences estimator to investigate the treatment effect on patient satisfaction at facility level., Results: There were some improvements in patient satisfaction in results-based financing facilities but these were not statistically significant. In 2011, 2 out of 11 aspects of satisfaction showed 5% improvement: satisfaction with the way health care providers explained the patient's condition and treatment. In 2012, patient satisfaction was higher for almost all aspects of care in results-based financing facilities, including the two aspects on health care provider respectfulness and facility opening hours, which had been 5% lower in results-based financing facilities than in non-results-based financing facilities in 2011. Overall satisfaction was almost 10% higher in results-based financing facilities than in non-results-based financing facilities in 2012., Conclusion: Even if not statistically significant, observed trends suggest some positive impacts of the results-based financing programme on patient satisfaction.

Background: Children with incarcerated mothers experience adverse health, social and emotional circumstances, and are a particularly vulnerable group. Mothers in custody face significant challenges in parenting their children., Aims: The study aimed to identify participants' views on impact of a parenting support programme for incarcerated mothers in NSW Australia., Methods: The mixed-methods study examined 134 responses to open and closed questions on a questionnaire for programme participants., Results: Participants found the programme worthwhile, engaging and relevant. It enhanced their parenting knowledge and confidence. Open-ended responses highlighted program elements which participants valued, specifically support for their parenting role in complicated circumstances, greater understanding of child development and perspectives, and practical strategies for facilitating connections with their children during their incarceration., Conclusions: The study informs nurses working with women who have experienced incarceration and their children, both in custodial and community settings.

Purpose: This study sought to determine how lactate threshold (LT) is related to running performance in older male and female runners, if LT changes significantly with age, and if gender alters the relationship between LT and performance in older runners., Methods: Subjects were 168 master runners (111 men, 57 women) selected from a longitudinal study, who ran at least 10 miles x wk(-1) for 5 yr or more. VO2max was measured on a treadmill and body composition by hydrostatic weighing. Blood samples taken each minute of exercise were analyzed for lactate concentration and LT determined as the breakpoint in lactate accumulation. Performance times and training histories were self-reported by questionnaire., Results: Men had significantly greater body mass, fat-free mass (FFM), and VO2max (L x min(-1); mL x kg(-1) x min(-1)) than women. FFM and VO2max (L x min(-1); mL x kg(-1) x min(-1)) declined with age in both men and women. Running performance was significantly different between men and women and declined with age in both. LT (L x min(-1); mL x kg(-1) x min(-1)) was significantly different between men and women, and declined significantly with age in men, whereas LT (%VO2max) did not differ between men and women and increased significantly with age in both. VO2max (mL x kg(-1) x min(-1)) was the most significant predictor of performance in both men and women, whereas LT (L x min(-1)) added to the prediction of 5-km and 10-km performance in women., Conclusion: The results of this study demonstrate that VO2max (mL x kg(-1) x min(-1)) is a better predictor of performance than LT in older male and female runners. Additionally, LT as a percentage of VO2max increases significantly with age.