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Pulmonary alveolar proteinosis (PAP) is a rare diffuse lung disease in the pediatric population. There are currently few cases documenting hemophagocytic lymphohistiocytosis as a cause for secondary PAP. We describe an ex-preterm child with secondary hemophagocytic lymphohistiocytosis, complicated by PAP and hypoxemic respiratory failure.

Objectives: Small group learning is a well-established medical education strategy for cultivating essential communication skills. Yet, how best to measure communication quality in these groups remains understudied. This study aimed to adapt a communication assessment to medical education small group settings. Methods: This was an observational study of Preclinical Medical Humanities group discussions. Audio-recordings of 12 sessions (3 groups; n=22 students and 3 facilitators) were analyzed using Communication Quality Analysis. Three coders assessed communication quality by assigning numeric scores based on how well participants accomplished communication goals within five domains: content, engagement, relationship, emotion and identity. Coder reliability was assessed using intra-class correlations. Variance components were assessed using a generalized linear model.Results: High inter-rater reliability was established for each of five communication quality domains (ICC range 0.875 to 0.98). Variability in content, emotion, and engagement domains was primarily driven by the individual subjects (nested within the three communication groups)–accounting for 49%, 57% and 78% of the variability respectively; relational and identity domain score variability was accounted for by duration of class (accounting for 66% and 47% of the variability, respectively). Considerable variability was observed between participants, suggesting that the assessment is sensitive enough to detect nuanced differences between participants.Conclusions: Our study shows that CQA is reliable when adapted to medical education small groups.With further refinement, CQA provides an important measure that could be used in medical education to evaluate the impact of novel curricular activities or varied facilitation techniques on communication quality and other educational outcomes.

Recent gene association studies have implicated pituitary adenylate cyclase-activating peptide (PACAP) systems in several psychiatric disorders associated with stressor exposure, and we have argued that many of the behavioral consequences of repeated stressor exposure may depend on the expression of PACAP in the bed nucleus of the stria terminalis (BNST). One behavioral consequence of the activation of stress systems can be anorexia and subsequent weight loss, and both the activation of central PACAP systems as well as neuronal activity in the BNST have also been associated with anorexic states in rodents. Hence, we investigated the regulation of food and water intake and weight loss following BNST PACAP infusion. BNST PACAP38 dose-dependently decreased body weight, as well as food and water intake in the first 24 h following infusion. Because different BNST subregions differentially regulate stress responding, we further examined the effects of PACAP38 in either the anterior or posterior BNST. Anterior BNST PACAP38 infusion did not alter weight gain, whereas posterior PACAP38 infusion resulted in weight loss. PACAP38 infused into the lateral ventricles did not alter weight, suggesting that the effects of BNST-infused PACAP were not mediated by leakage into the ventricular system. These data suggest that PACAP receptor activation in posterior BNST subregions can produce anorexia and weight loss, and corroborate growing data implicating central PACAP activation in mediating the consequences of stressor exposure.