Modified Blalock Taussig shunt: a not-so-simple palliative procedure.

OBJECTIVES: Thirty-two consecutive isolated modified Blalock Taussig (BT) shunts performed in infancy since 2004 were reviewed and analysed to identify the risk factors for shunt intervention and mortality. METHODS: Sternotomy was the only approach used. Median age and weight were 10.5 (range 1-74) days and 2.9 (1.9-4.4) kg, respectively. Shunt palliation was performed for biventricular hearts (Tetralogy of Fallot/double outlet right ventricle/transposition of great arteries_ventricular septal defect_pulmonary stenosis/pulmonary atresia_ventricular septal defect/others) in 21, and univentricular hearts in 11, patients. Hypoplastic left heart syndrome patients were excluded. Two procedures required cardiopulmonary bypass. Median shunt size was 3.5 (3-4) mm and median shunt size/kg body weight was 1.2 (0.9-1.7) mm/kg. Reduction in shunt size was necessary in 5 of 32 (16%) patients. RESULTS: Three of 32 (9%) patients died after 3 (1-15) days due to cardiorespiratory decompensation. Lower body weight (P = 0.04) and bigger shunt size/kg of body weight (P = 0.004) were significant risk factors for mortality. Acute shunt thrombosis was observed in 3 of 32 (9%), none leading to death. Need for cardiac decongestive therapy was associated with univentricular hearts (P < 0.001), bigger shunt size (P = 0.054) and longer hospital stay (P = 0.005). Twenty-eight patients have undergone a successful shunt takedown at a median age of 5.5 (0.5-11.9) months, without late mortality. CONCLUSIONS: Palliation with a modified BT shunt continues to be indicated despite increased thrust on primary corrective surgery. Though seemingly simple, it is associated with significant morbidity and mortality. Effective over-shunting and acute shunt thrombosis are the lingering problems of shunt therapy.

I-74 Iowa/Illinois Corridor Study Aesthetic Design Guideline April 6, 2009

The I-74 Aesthetic Design Guideline (ADG) document has two primary goals: To establish and identify an overall design theme To prioritize enhancement opportunities within the framework of corridor elements The recommendations of this report have been developed based on an “unconstrained” framework for future corridor–wide enhancements. Future funding availability, along with the recommendations of this report, will guide the final design process. ADG Future Uses: This document is intended to be used as a reference to future processes in the following ways: Guidance for I-74 final design teams Reference document for future local community redevelopment initiatives Inspiration for identification and development of other I-74 corridor aesthetic enhancement opportunities Process: As illustrated in Figure 1.3, the overall process for corridor aesthetics began traditionally with inventory and identification of potential aesthetic applications. The ADG does not document all the reports and presentations related to these early design stages, but has incorporated these efforts into the design theme, guiding principles and prioritized enhancements shown on the following pages of this report. The I-74 final design phase will incorporate these recommendations into the project. The consultant design team and representatives of the DOTs have worked with the CAAT members to facilitate community input and have helped develop recommendations for improving I-74 corridor aesthetics. CAAT recommendations have been advanced to the I-74 Advisory Committee for review and endorsement. Both DOTs have reviewed the CAAT recommendations and have endorsed the contents of this report. Figure 1.4 illustrates the status of corridor aesthetic design development. As of the date of this report, aesthetic design is approximately 50% complete. Future detailed design, cost evaluation, feasibility and prioritizations all need to occur for this process to be successfully completed.

I-74 Iowa-Illinois Corridor Study, Vol 3, Fall 2003

The I-74 Iowa-Illinois Corridor Study has been progressing since the last newsletter and the Public Information Meetings in July of 2002, and the Advisory Committee has been involved in every step. Our goal has been and continues to be ensuring that community priorities and goals are reflected in the I-74 project, and that local concerns are considered.

I-74 Iowa-Illinois Corridor Study, Vol 3, Fall 2003

The I-74 Iowa-Illinois Corridor Study has been progressing since the last newsletter and the Public Information Meetings in July of 2002, and the Advisory Committee has been involved in every step. Our goal has been and continues to be ensuring that community priorities and goals are reflected in the I-74 project, and that local concerns are considered.

I-74 Iowa-Illinois Corridor Study, Vol 2, Winter 2002

The I-74 Iowa-Illinois Corridor Study has been progressing since the last newsletter and the Public Information Meetings in July of 2002, and the Advisory Committee has been involved in every step. Our goal has been and continues to be ensuring that community priorities and goals are reflected in the I-74 project, and that local concerns are considered.

I-74 Iowa-Illinois Corridor Study, Vol 1, Winter 2005

The I-74 Iowa-Illinois Corridor Study has been progressing since the last newsletter and the Public Information Meetings in July of 2002, and the Advisory Committee has been involved in every step. Our goal has been and continues to be ensuring that community priorities and goals are reflected in the I-74 project, and that local concerns are considered.

I-74 Iowa-Illinois Corridor Study, Vol 4, Winter 2005

The I-74 Iowa-Illinois Corridor Study has been progressing since the last newsletter and the Public Information Meetings in July of 2002, and the Advisory Committee has been involved in every step. Our goal has been and continues to be ensuring that community priorities and goals are reflected in the I-74 project, and that local concerns are considered.

I-74 Iowa-Illinois Corridor Study, Vol 5, Spring 2006

The I-74 Iowa-Illinois Corridor Study has been progressing since the last newsletter and the Public Information Meetings in July of 2002, and the Advisory Committee has been involved in every step. Our goal has been and continues to be ensuring that community priorities and goals are reflected in the I-74 project, and that local concerns are considered.

I-74 Iowa-Illinois Corridor Study, Vol 6, Winter 2009

The I-74 Iowa-Illinois Corridor Study has been progressing since the last newsletter and the Public Information Meetings in July of 2002, and the Advisory Committee has been involved in every step. Our goal has been and continues to be ensuring that community priorities and goals are reflected in the I-74 project, and that local concerns are considered.

Interstate 74 Quad Cities Corridor Study Scott County, Iowa and Rock Island County, Illinois Project Number IM-74-1(122)0-13-82 FHWA-IOWA-EIS-09-01-F, February 2009

The Federal Highway Administration (FHWA) and the Iowa and Illinois Departments of Transportation (Iowa DOT and IDOT) have identified the Selected Alternative for improving Interstate 74 (I-74) from its southern terminus at Avenue of the Cities (23rd Avenue) in Moline, Illinois to its northern terminus one mile north of the I-74 interchange with 53rd Street in Davenport, Iowa. The Selected Alternative identified and discussed in this Record of Decision is the preferred alternative identified in the Final Environmental Impact Statement (FEIS). The purpose of the proposed improvements is to improve capacity, travel reliability, and safety along I-74 between its termini, and provide consistency with local land use planning goals. The need for the proposed improvements to the I-74 corridor is based on a combination of factors related to providing better transportation service and sustaining economic development.

[Voyage en Italie : 1824-1830]. , S. Miniato, sur une Echelle de 0,005 p.m : [plan] : [dessin] / h. L. [Henri Labrouste]

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[Voyage en Italie : 1824-1830]. , S. Miniato. Chapelle souterraine, sur une Echelle de 0,005 p.m. : [plan] : [dessin] / h. L. [Henri Labrouste]

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[Voyage en Italie : 1824-1830]. , S. Miniato, sur une Echelle de 0,005 p.m. : [coupe longitudinale] : [dessin] / h. L. [Henri Labrouste]

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[Voyage en Italie : 1824-1830]. , Temple de la Concorde à Agrigente, sur une Echelle de 0,005 P.M. : [plan] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 183

[Voyage en Italie : 1824-1830]. , Temple d'Esculape, sur une Echelle de 0,005 P.M. : [élévation principale, plan d'ensemble, coupe longitidinale et deux profils de détails] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 185