Purpose The purpose of the study was to assess the feasibility of use and reliability of the Arabic version of the Newest Vital Sign (NVS-Ar) in parents of children with type 1 diabetes (T1D). Methods The final translated version of NVS-Ar was administered to 175 adult caregivers of children with T1D who are native Arabic speakers. The association between NVS-Ar scores for the parents/legal guardians and A1C for their children was assessed. The internal consistency was evaluated by Cronbach’s α, and reliability was assessed by test-retest method. Results The median (interquartile range) score was 4.0 (3-5). The internal consistency of the NVS-Ar was moderate (α = .58). The intraclass correlation coefficient was .61. There was no correlation between NVS-Ar score and A1C (Spearman’s ρ = .055; P = .62). Furthermore, there was significant inverse association between adequate health literacy and optimal glycemic control among the children, which remained evident even after adjusting for the duration of T1D, age, or education of the parents/guardians. However, it lost statistical significance after adjustment for treatment regimen. Conclusion Study findings indicate that the NVS is unlikely to be a predictive tool for functional health literacy in Arabic settings and that there is a need to properly translate and validate other tools such as the Test of Functional Health Literacy in Adults or, alternatively, to develop a reliable tool.

High-risk subtypes of B-cell acute lymphoblastic leukemia (B-ALL) are frequently associated with aberrant activation of tyrosine kinases (TKs). These include Ph+ B-ALL driven by BCR-ABL, and Ph-like B-ALL that carries other chromosomal rearrangements and/or gene mutations that activate TK signaling. Currently, the tyrosine kinase inhibitor (TKI) dasatinib is added to chemotherapy as standard of care in Ph+ B-ALL, and TKIs are being tested in clinical trials for Ph-like B-ALL. However, growth factors and nutrients in the leukemia microenvironment can support cell cycle and survival even in cells treated with TKIs targeting the driving oncogene. These stimuli converge on the kinase mTOR, whose elevated activity is associated with poor prognosis. In preclinical models of Ph+ and Ph-like B-ALL, mTOR inhibitors strongly enhance the anti-leukemic efficacy of TKIs. Despite this strong conceptual basis for targeting mTOR in B-ALL, the first two generations of mTOR inhibitors tested clinically (rapalogs and mTOR kinase inhibitors) have not demonstrated a clear therapeutic window. The aim of this review is to introduce new therapeutic strategies to the management of Ph-like B-ALL. We discuss novel approaches to targeting mTOR in B-ALL with potential to overcome the limitations of previous mTOR inhibitor classes. One approach is to apply third-generation bi-steric inhibitors that are selective for mTOR complex-1 (mTORC1) and show preclinical efficacy with intermittent dosing. A distinct, non-pharmacological approach is to use nutrient restriction to target signaling and metabolic dependencies in malignant B-ALL cells. These two new approaches could potentiate TKI efficacy in Ph-like leukemia and improve survival.

BackgroundLow level of health literacy (HL) has been linked to several adverse health outcomes independently from education, ethnicity and socio-economic status. There is a dire need for a reliable tool to assess HL of patients and general public in Arab countries. This study aimed to assess the feasibility of use and reliability of the Arabic version of the Newest Vital Sign (NVS) in parents of children with type 1 diabetes (T1D). MethodsTranslation and cross-cultural adaptation of the Arabic version of the NVS (NVS-Ar) was conducted according to established guidelines. In order to investigate the functionality of NVS, the nal version of NVS-Ar was administered to 175 adult caregivers of children with T1D, who are native Arabic speakers. We assessed the association between NVS-Ar score for the parents and HbA1C for their children. The internal consistency was evaluated by Cronbach's Alpha (CA) and reliability was assessed by test retest method. ResultsThe median (interquartile rang IQR) score was 4.0 (3-5). The internal consistency of the NVS-Ar was moderate (CA= 0.58). While the intraclass correlation coe cient (ICC) was 0.61. There was no correlation between NVS-Ar score and HbA1C (Spearman's rho = 0.055; p=0.62). Furthermore, there was signi cant inverse association between adequate HL and optimal glycemic control among children, which remained evident even after adjusting for the duration of T1D, age or education of the parents/child guardian.However, it lost statistical signi cance when we adjust for treatment regimen. ConclusionOur ndings demonstrate that NVS is unlikely to be a predictive tool for functional HL in Arabic settings and that there is a need to properly translate and validate other tools such as TOFLA or alternatively develop a reliable tool de novo.