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Handoffs are critical points in transitioning care between multidisciplinary teams, yet data regarding intensive care unit (ICU) handoffs in pediatric noncardiac surgical patients are lacking. We hypothesized that standardized handoffs from the pediatric operating room (OR) to the ICU would improve physician presence, communication, and patient care parameters.This quality improvement initiative was performed at a tertiary children's hospital. Stakeholders (anesthesiologists, nurses, intensivists, and surgeons) developed a standardized OR to pediatric and neonatal ICU handoff process based on common goals and outcomes of interest. Baseline data were collected before intervention. Implementation was carried out in 2 phases, phase 1 with a written handoff and Phase 2 with a scripted handoff process. Data collected by trained observers included handoff attendance, distractions, and transfer of essential patient information. As a surrogate for outcomes, patient care parameter data were collected for 6 hours after transfer.After phase 1, surgery and ICU physician attendance increased significantly, distractions decreased, and communication of essential patient data improved. In phase 2 (scripted handoff), attendance continued to rise, distractions remained decreased, and transfer of essential information was still improved compared with baseline. Mean handoff duration did not significantly change throughout the study. Certain patient care parameters (escalation of respiratory support, additional laboratory studies, vasopressor administration, antibiotic administration and timing) remained unchanged compared with baseline. However, the need for resuscitative fluid bolus or blood products significantly decreased after implementation phase 2.Standardized handoffs for pediatric noncardiac surgical patients from the OR to the ICU can improve provider attendance and communication.

Portal venous thrombosis (PVT) is an uncommon disease associated with highly morbid conditions such as intestinal ischemia and portal hypertension. Patients at higher risk of developing PVT include those with cirrhosis, malignancy, or prothrombotic states. The mainstay of treatment is early initiation of anticoagulation. The first case is a 49-year-old female diagnosed with a cecal mass and PVT. She was started on anticoagulation and underwent a right hemicolectomy with several small bowel resections. She developed portal hypertension that required TIPS and mechanical thrombectomy. The second patient is a 65-year-old female found to have PVT. She was anticoagulated with heparin and given systemic TPA. She developed intestinal ischemia and portal hypertension requiring small bowel resection, TIPS, and mechanical thrombectomy. These cases give insight into the impact of a multidisciplinary team approach to PVT. The role and timing of endovascular treatment is not well established and needs to be further investigated.

We present the most complete emission spectrum for inflated hot Jupiter HAT-P-41b combining new HST WFC/G141 spectrum from the Hubble Panchromatic Comparative Exoplanet Treasury (PanCET) program with archival Spitzer eclipse observations. We found a near blackbody-like emission spectrum which is best fitted with an isothermal temperature-pressure (TP) profile that agrees well with the dayside heat redistribution scenario assuming zero Bond albedo. The non-inverted TP profile is consistent with the non-detection of NUV/optical absorbers in the transit spectra. We do not find any evidence for significant H$^-$ opacity nor a metal-rich atmosphere. HAT-P-41b is an ideal target that sits in the transitioning parameter space between hot and ultra-hot Jupiters, and future JWST observations will help us to better constrain the thermal structure and chemical composition., Accepted for publication in AJ

We present a comprehensive analysis of the 0.3--5\,$\mu$m transit spectrum for the inflated hot Jupiter HAT-P-41b. The planet was observed in transit with Hubble STIS and WFC3 as part of the Hubble Panchromatic Comparative Exoplanet Treasury (PanCET) program, and we combine those data with warm \textit{Spitzer} transit observations. We extract transit depths from each of the data sets, presenting the STIS transit spectrum (0.29--0.93\,$\mu$m) for the first time. We retrieve the transit spectrum both with a free-chemistry retrieval suite (AURA) and a complementary chemical equilibrium retrieval suite (PLATON) to constrain the atmospheric properties at the day-night terminator. Both methods provide an excellent fit to the observed spectrum. Both AURA and PLATON retrieve a metal-rich atmosphere for almost all model assumptions (most likely O/H ratio of $\log_{10}{Z/Z_{\odot}} = 1.46^{+0.53}_{-0.68}$ and $\log_{10}{Z/Z_{\odot}} = 2.33^{+0.23}_{-0.25}$, respectively); this is driven by a 4.9-$\sigma$ detection of H$_2$O as well as evidence of gas absorption in the optical ($>$2.7-$\sigma$ detection) due to Na, AlO and/or VO/TiO, though no individual species is strongly detected. Both retrievals determine the transit spectrum to be consistent with a clear atmosphere, with no evidence of haze or high-altitude clouds. Interior modeling constraints on the maximum atmospheric metallicity ($\log_{10}{Z/Z_{\odot}} < 1.7$) favor the AURA results. The inferred elemental oxygen abundance suggests that HAT-P-41b has one of the most metal-rich atmospheres of any hot Jupiters known to date. Overall, the inferred high metallicity and high inflation make HAT-P-41b an interesting test case for planet formation theories., Comment: Resubmitted to AAS Journals after revisions

We find evidence for a strong thermal inversion in the dayside atmosphere of the highly irradiated hot Jupiter WASP-18b (T$_{eq}=2411K$, $M=10.3M_{J}$) based on emission spectroscopy from Hubble Space Telescope secondary eclipse observations and Spitzer eclipse photometry. We demonstrate a lack of water vapor in either absorption or emission at 1.4$\mu$m. However, we infer emission at 4.5$\mu$m and absorption at 1.6$\mu$m that we attribute to CO, as well as a non-detection of all other relevant species (e.g., TiO, VO). The most probable atmospheric retrieval solution indicates a C/O ratio of 1 and a high metallicity (C/H=$283^{+395}_{-138}\times$ solar). The derived composition and T/P profile suggest that WASP-18b is the first example of both a planet with a non-oxide driven thermal inversion and a planet with an atmospheric metallicity inconsistent with that predicted for Jupiter-mass planets at $>2\sigma$. Future observations are necessary to confirm the unusual planetary properties implied by these results., Comment: 7 pages, 4 figures, 1 table, published in ApJ Letters 11/29

We re-visit the principles of transmission spectroscopy for transiting extrasolar planets, focusing on the overlap between the planetary spectrum and the illuminating stellar spectrum. Virtually all current models of exoplanetary transmission spectra utilize an approximation that is inaccurate when the spectrum of the illuminating star has a complex line structure, such as molecular bands in M-dwarf spectra. In those cases, it is desirable to model the observations using a coupled stellar-planetary radiative transfer model calculated at high spectral resolving power, followed by convolution to the observed resolution. Not consistently accounting for overlap of stellar M-dwarf and planetary lines at high spectral resolution can bias the modeled amplitude of the exoplanetary transmission spectrum, producing modeled absorption that is too strong. We illustrate this bias using the exoplanet TRAPPIST-1b, as observed using HST/WFC3. The bias in this case is about 250 parts-per-million, 12% of the modeled transit absorption. Transit spectroscopy using JWST will have access to longer wavelengths where the water bands are intrinsically stronger, and the observed signal-to-noise ratios will be higher than currently possible. We therefore expect that this resolution-linked bias will be especially important for future JWST observations of TESS-discovered super-Earths and mini Neptunes transiting M-dwarfs., Comment: Accepted for ApJ Letters