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From the American Academy of Pediatrics
AMERICAN ACADEMY OF PEDIATRICS
David G. Jaimovich , Committee on Hospital Care, and Section on Critical Care
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Abstract

During the past 3 decades, the specialty of pediatric critical care medicine has grown rapidly, leading to a number of pediatric intensive care units opening across the country. Many patients who are admitted to the hospital require a higher level of care than routine inpatient general pediatric care, yet not to the degree of intensity of pediatric critical care; therefore, an intermediate care level has been developed in institutions providing multidisciplinary subspecialty pediatric care. These patients may require frequent monitoring of vital signs and nursing interventions, but usually they do not require invasive monitoring. The admission of the pediatric intermediate care patient is guided by physiologic parameters depending on the respective organ system involved relative to an institution's resources and capacity to care for a patient in a general care environment. This report provides admission and discharge guidelines for intermediate pediatric care. Intermediate care promotes greater flexibility in patient triage and provides a cost-effective alternative to admission to a pediatric intensive care unit. This level of care may enhance the efficiency of care and make health care more affordable for patients receiving intermediate care.

The purpose of this statement is to provide lists of criteria that may be incorporated into multidisciplinary guidelines for the admission and discharge of children requiring intermediate care. Because of the continuous and rapidly changing developments in critical care pediatrics, these criteria may require periodic revision. Equally important, because of significant differences in personnel, facilities, and diagnostic and treatment capabilities from hospital to hospital, no single set of criteria will apply to every institution providing intermediate care.

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Leaving the G7 summit on Saturday, President Trump said that the U.S. might end all trade with America’s closest allies if those countries don’t submit to his demands over reduced trade barriers. Trump also confirmed that he had told the leaders of Britain, France, Germany, Japan, Canada, and Italy that there should be no tariffs between them and the U.S. of any kind. Whether Trump’s characteristically hyperbolic threat, or overarching proposal, will be taken seriously is another matter.

Referring to what he called “ridiculous and unfair” tariffs on U.S. imports, Trump said, “It’s going to stop — or we’ll stop trading with them. And that’s a very profitable answer, if we have to do it.”

Trump vs. the West

“We’re the piggy bank that everybody is robbing, and that ends,” added Trump, who also repeated his exaggerations of U.S. trade deficits by tens or hundreds of billions of dollars. The president framed his trade attacks as a defense of U.S. national security, citing the weakening of the country’s “balance sheet” as the corresponding threat.

Regarding the elimination of tariffs, Trump confirmed that he had suggested totally free trade among the G7 during the summit, explaining that, “Ultimately, that’s what you want. You want a tariff free. You want no barriers. And you want no subsidies. Because you have some cases where countries are subsidizing industries and that’s not fair.”

But in regard to his his administration’s ongoing effort to renegotiate NAFTA with Canada and Mexico — an agreement aimed at literally promoting free trade between the U.S. and those countries— Trump suggested the U.S. would be better off without the pact at all.

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Trade tariffs around the world have been dropping as a result of agreements like NAFTA. The average tariff on imported goods to the U.S. is 2.4 percent, while Canada and the European Union impose average tariffs of around 3 percent, according to the World Trade Organization . Manufacturing makes up only 10 percent of the U.S. economy.

Even if Trump’s proposal is taken at anywhere near face value, it’s not clear how such an agreement would or could be reached and what impact it would have — Essential Top heating up by VIDA VIDA Official Cheap Online pIPuIsTQ
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The 21st-Century Musician Initiative is a complete re-imagining of the skills, tools and experiences necessary to create musicians of the future instead of the past – flexible, entrepreneurial musicians who find diverse musical venues and outlets in addition to traditional performance spaces, develop new audiences, and utilize their music innovatively to impact and strengthen communities.

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