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Tough question for hospitals: Who’s too risky to release? – Auburn Citizen

NEW YORK Four days before Alexander Bonds ambushed and killed a New York City police officer, he was in a hospital emergency room getting a psychiatric evaluation. The hospital released him the same day.

Now the hospital’s actions are under a state review ordered by the governor. St. Barnabas Hospital says it handled Bonds appropriately and welcomes the inquiry.

The decision was one psychiatrists across the country make regularly: whether patients pose enough danger to themselves or others to require hospitalization. Practitioners say that it’s often a difficult call to make and that even an experienced evaluator can’t predict someone’s behavior.

“Most of the time, it’s very complicated. You’re trying to make an assessment: Is the person going to a home? Is there family? Are they reliable? What was the specific reason they were brought in? Is that likely to occur again?” said Bea Grause, president of the statewide hospital and health system association HANYS and a former emergency room nurse.

Bonds, 34, evidently had a history of mental health problems. There were antidepressant and anti-psychotic medications in his apartment, and his girlfriend told officers she took him to St. Barnabas for the psychiatric evaluation July 1, police said.

He was observed for seven to eight hours in the emergency room, where he was seen by a physician and then a psychiatrist, hospital spokesman Steven Clark said.

“We believe the proper protocols and standards were met,” he said.

By the night of July 4, Bonds’ paranoid, erratic behavior worried his girlfriend enough that she called police to look for him. They didn’t find him before he marched up to a parked police vehicle and shot through the window just after midnight, striking Officer Miosotis Familia in the head. Soon after, officers shot and killed him after they say he drew a weapon on them.

The state Health Department said it plans to interview St. Barnabas staffers, conduct inspections and examine records to review Bonds’ case and the hospital’s policies and prescribing practices.

Under state law, people can be involuntarily hospitalized for at least 48 hours if they pose a substantial risk of causing serious injury to themselves or others.

“If you’re making a determination that someone’s a danger to themselves or others, you better be pretty clear about it. Because you’re taking away their liberties,” said Grause, whose association represents hospitals and nursing homes.

Psychiatrists caution that the risk can be difficult to pinpoint.

“While psychiatrists can often identify circumstances associated with an increased likelihood of violent behavior, they cannot predict dangerousness with definitive accuracy,” the American Psychiatric Association said in a 2012 position statement.

Doctors and other hospital staffers can encounter agitated emergency room patients they’ve never seen before.

While paying close attention to what patients say and do, doctors also might test to determine whether a medical problem or medication might be spurring the behavior. They consider whether the cause could be alcohol or illegal drugs, a clue sometimes illuminated by observing patients for hours. They may look into whether someone has dementia.

Some patients arrive clearly violent, and others are just having a bad drug reaction that will wear off. But “there’s this vast gray area in the middle that takes a lot of experience, a lot of knowledge and balancing all of the factors that go into a good assessment,” said Dr. Vivian Pender, a New York City psychiatrist and public affairs representative for the New York County Psychiatric Society.

Police have been working to determine Bonds’ motive in shooting Familia. Bonds, who had served prison time for a 2005 armed robbery, had railed about police and prison officers in a Facebook video last September.

Familia, 48, was a 12-year New York Police Department veteran and a mother of three. She was selfless, “incredibly funny” and full of warmth and wisdom, her 20-year-old daughter, Genesis Villella, said Friday.

She “went to work every day proud to do her job, to protect us,” Villella said.

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Tough question for hospitals: Who’s too risky to release? – Auburn Citizen


Patient, BBB seek change with Emergency Room "hidden charges" – FOX 46 Charlotte

CHARLOTTE, NC (FOX 46 WJZY) – Hidden charges at emergency rooms are causing transparency questions to be raised.

“Any other form of purchasing, people know what they’re paying,” patient Steve Komito said. “Somehow if you’re in the emergency room, you don’t have to know and I’m saying that’s wrong.”

Komito took his son to the Carolinas Healthcare Systems Emergency Room in Waxhaw this past Spring. X-rays were done but when Komito received his bill, he noticed a “room charge” for $1,244.44. Komito said, had he known about that charge up front, he would have taken his son elsewhere — adding, the X-rays were not even conducted in that general service room and they could have waited elsewhere.

“I guess my mission at this point is transparency,” Komito said.

Komito said, during his visit, someone with the E.R. told him they will not give pricing ahead of a visit because if the patient determines it’s too expensive and leaves — the E.R. will be held liable if something were to happen with their health.

The Better Business Bureau said it receives roughly 1,000 complaints a year for situations like this in the Greater Charlotte region.

“It’s not like going into a fast-food restaurant and seeing prices up on the board,” BBB’s Tom Bartholomy said.

FOX 46 Charlotte reached out to Carolinas Healthcare Systems earlier this Spring with a list of billing questions that have still not been answered. We sent them an email again on Friday and are waiting for a response. Here’s a portion of the email…

1.Will Carolinas Healthcare System give pricing information prior to service at the Emergency Room, upon request?

2.Does CHS stand behind this standard room charge and policy? When did this charge go into effect?

3.Weve heard talks about Level 3 and Level 4 E.R. room visit cases. What are the specific levels and what determines one of these levels?

4.What goes into the room charge? Is there a time limit a person has to be in there for a charge? A specific procedure? Does a doctor have to physically examine them? What warrants this charge?

5.Does CHS maintain that it will not release pricing prior to an E.R. patient being seen because it can be held negligent if the patients decides the cost is too high, and leaves without treatment?

FOX 46 Charlotte has now reached out to State Senator Tommy Tucker (Komito’s district) to see if he would be interested in any sort of legislation surrounding hospital charges being disclosed up front. Here’s a portion of that email…

Would Sen. Tucker support legislation demanding immediate transparency of ER pricing? As these bills are broken down into “Levels” — why can’t a patient know ahead of time the approximate costs of his service?

*This obviously does not include any additional testing that may be ordered or needed. But again, these prices – all pricing – is slotted ahead of time.

The Better Business Bureau told FOX 46 Charlotte there needs to be more transparency between E.R.’s and patients.

“If there’s going to be a basic charge for you for being in that emergency room no matter what you’re there for, then, yeah, why not?” Bartholomy added.

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Patient, BBB seek change with Emergency Room "hidden charges" – FOX 46 Charlotte


The ER, an out-of-network provider and then ‘surprise!’ –

Christopher Moriates and Victoria Valencia, For the Express-News

Photo: Mayra Beltran /Houston Chronicle

The ER, an out-of-network provider and then surprise!

Is there anything more emblematic of our troubled health care system than a patient receiving a surprise bill in the mail after getting emergency care?

The most egregious form of surprise medical bills, also known as balance bills, happens when an out-of-network provider bills a patient despite having delivered care at an in-network facility. Often this occurs when a patient goes to an emergency department or hospital that accepts that persons insurance, but then is seen by a physician who is not contracted with that insurance group.

As writer and physician Elizabeth Rosenthal recently wrote, Imagine if you paid for an airplane ticket and then got separate and inscrutable bills from the airline, the pilot, the co-pilot and the flight attendants. Even worse, the co-pilot could then tell you he is out of network and is going to bill you the full amount.

This practice of medical surprise out-of-network bills should be illegal. At this point, only the Legislature can solve the problem of surprise bills.

In 2009, Texas led the way by being the first state to put a mediation system in place for surprise bills. This past year, Senate Bill 507 was expanded to include mediation eligibility for bills of more than $500 from any provider type; facility bills from emergency care, including those from free-standing ERs; and to patients covered by the Teacher Retirement System, or TRS, health plan and the self-funded TRS ActiveCare program. This last change granted an estimated 680,000 additional individuals eligibility for the mediation process.

Prior to these changes, only bills from certain specialty providers were eligible for mediation, and ER facility bills were not eligible.

We should all thank our representatives for this bipartisan legislation, but it is nowhere near enough.

One indication the system is inadequate is how rarely it is used. A 2015 Consumer Reports survey found that 1 in 14 privately insured adult Texans reported getting a surprise, out-of-network bill within the previous two years, totaling about 250,000 Texans. However, according to the Department of Insurance, only 3,824 Texans have used the mediation process from its implementation in September 2009 through the end of last year.

Clearly, the system is not as accessible as it needs to be.

One major reason it is the responsibility of the patient to start the mediation process. This puts the onus on the patient to gather information, submit paperwork, make phone calls and attend at least one formal phone meeting. And that assumes the patient recognizes the bill is eligible for the process. Senate Bill 507 now specifies that when surprise bills are sent to patients, the sender must include language indicating the bill is the balance for out-of-network services and that it may be eligible for mediation. It is possible, however, that this language will be lost in all the other fine print on the mostly indecipherable bills.

Other states have passed much stronger protections than has Texas. New York passed a law in 2015 that requires hospitals negotiate directly with the insurer for all out-of-network payments, across all health care settings. This is how it should be.

Making the problem worse for patients, emergency departments in Texas can essentially charge whatever they want for services. Prices vary without any logic or reasonable guardrails. According to a recent study, emergency physicians reading an EKG (electrocardiogram) of your heart a mostly simple task performed many times each day charge patients anywhere from $18 to $317, which is 20 times the rate that Medicare would pay. If the doctor who read that EKG happens not to be in your network, guess who will be billed that full $317?

The Texas Legislature should consider capping all charges at a reasonable level above Medicare-allowable fees. There would still be variation in charges, but patients would no longer be subject to extreme markups.

Texas should lead once again in protecting patients from surprise medical bills.

Christopher Moriates, M.D., is assistant dean for health care value in the Dell Medical School at the University of Texas at Austin. Victoria Valencia is the assistant director for health care value in the Dell Medical School.

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The ER, an out-of-network provider and then ‘surprise!’ –


New RCMH emergency room now open – Richmond Daily News

The new emergency room at Ray County Memorial Hospital opened Thursday and is ready for use. Hospital staff, from left, are: Douglas McCune, director of the emergency room; Stacy Davidson, RN and supervisor of the emergency room; Earl Sheehy, hospital CEO/administrator; and Donna Lamar, RN and director of nurses. (Photo by Leah Wankum/Richmond News)

By Leah Wankum, Editor

The old emergency room at Ray County Memorial Hospital fit three beds comfortably, with just curtains for partitions separating them from each other and the nurses station. Built in 1989, the old space offered only one trauma room for more serious cases. The nurses station was small and cramped.

No more. The new emergency room opened Thursday and is ready for use.

The new space boasts six individual treatment rooms, two triage rooms and a new nurses station. Earl Sheehy, chief executive officer and administrator of the hospital, said the new ER is part of a $7 million project to upgrade a portion ofthe hospitals facilities. With 8,000 square feet for the new facility, the key word in the minds of the ER staff is privacy.

The complete story is in the Friday, July 7, 2017 Richmond News.

Click here for our E-edition and read the rest of the story.

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New RCMH emergency room now open – Richmond Daily News


New unit in UR Thompson Hospital aims to free up emergency room – 13WHAM-TV

A new 12-bed observation unit at UR Medicines Thompson Hospital will open next week. (Photo: Thompson Hospital)

Canandaigua, N.Y. (WHAM) – A new 12-bed observation unit at UR Medicines Thompson Hospital will open next week.

The space will be available to patients on July 12. The $2.1 million project is said to be the first of its kind in the Finger Lakes region.

The Observation Unit can accommodate patients at the hospital who need to be evaluated and treated in a short period of time.

In 2016, more than 27,000 Emergency Department visits were made to Thompson Hospital. Of these visits, approximately 7 percent resulted in an observation status.

The new unit will allow space to be freed up in the Emergency Department during peak times, such as flu season.

Now, patients who are low acuity and low risk will have a quiet, comfortable place geared specifically toward them where they can wait for the answers they need before returning in a timely fashion to the comfort of their own homes, said Dr. Ali Hamdan, Thompson Health Director of Hospital Medicine.

A ribbon-cutting ceremony took place June 30.

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New unit in UR Thompson Hospital aims to free up emergency room – 13WHAM-TV


Herman: How my drinking problem sent me to the emergency room –

I had a little (real little) medical incident the other day. All is well, and, more importantly, I did prove a medical theory of mine. This all stems from a drinking problem: Apparently, I dont drink enough.

I recently opined to friends and family that it is my semi-informed belief that before you reach the point of dehydration youll get thirsty. Kind of like youll get hungry before you starve. The body is a wonderful thing, equipped with all kinds of warning devices were free to ignore.

So it was fortuitous that I recently had the opportunity to test whether one indeed will get thirsty prior to getting dehydrated. Obviously, one has to reach the point of dehydration (which I maintain is beyond thirst) to run this test. So, in the name of research, I reached the point of dehydration. Youre welcome. And the short answer is yes, I did get thirsty before I was pushed on a gurney dehydrated into the ambulance.

RELATED: 10 tips for staying cool while running in the summer

This excitement went down when I couldnt get up last Saturday during a morning bike ride that started at 8 a.m. in Northwest Hills and ended in early afternoon in North Austin Medical Centers efficient (and well air-conditioned) emergency room.

Just over 28 miles into what would have been a 28.2 mile ride a routine distance for me and, lest you judge my mph, this ride included a leisurely breakfast stop at Sweetish Hill (and lest you judge my breakfast, it was eggish, not sweetish) fellow American-Statesman staffer and cyclist Ralph K.M. Haurwitz and I turned into Anderson High School to take a look at the new robotics building. After rolling by that, we dismounted to watch an inning of the adult baseball league game underway at the high school.

I felt a bit fatigued, hot and thirsty after a westbound, mildly uphill stretch of Steck Avenue, but nothing serious. Things got more serious when I tried to stand up and felt my field of vision narrowing like a curtain closing as nausea brewed within. I told Haurwitz to give me a few moments and Id be fine. I wasnt. I actually got less fine pretty quickly as seated on the bleachers advanced to prone on the ground. I still thought Id be OK, though I was pretty sure Haurwitz would not offer mouth-to-mouth resuscitation if needed.

So there was that.

Haurwitz quickly realized this was not going to end with me getting back on the bike and pedaling the few blocks back to my house. And I quickly realized I was on the verge of a Saturday nap. Dont get me wrong. Im pro-Saturday naps, but the scheduled, voluntary kind watching televised baseball in a comfy chair, not the unscheduled, involuntary kind watching live baseball prone on the ground.

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One thing led to another, though I dont remember all of them. Haurwitz later told me the real action began when he yelled Emergency! and called 911. Folks on hand for the baseball game gathered to help as I sat in a chair, apparently un- or semiconscious for a few seconds. (And here is where its OK for you to say, Oh, kind of like when you write columns?)

I recall some conversation, not including me, about the approaching ambulance. And I recall the two friendly and helpful EMS guys (I wish I got their names; thanks, guys) moving quickly to assess my situation by asking three questions, including one intended to shock my heart back to pumping if it had stopped:

Who is the president of the United States? he asked.

I answered correctly, somehow opting not to offer editorial comment. (Imagine the battery of psychological exams that would have ensued if, a mere three years ago, youd have answered that question with Donald J. Trump.) He also asked me what city we were in and, attempting to trip me up, added a math question: How many dimes in a dollar? Not bragging here, but I aced the exam.

They hooked me up to some fluids as I shared with them the coincidence of this happening a few days after my official pronouncement of my theory about thirst and dehydration. By the way, they agreed that youll get thirsty en route to dehydration.

I felt much better by the time we got to the hospital, where, shortly after being wheeled into a chilly ER treatment room, I quickly realized my next challenge might be frostbite. I got to meet lots of helpful ER folks, all of whom were affable and relaxed. Must be nice to go to work in your pajamas. They ran some tests and pronounced a diagnosis of dehydration and syncope. Id never heard of syncope until I saw it in the discharge paperwork.

You have been diagnosed with syncope (pronounced SINK-uh-pee). This is the medical term for a rapid loss of consciousness or a fainting episode. There are many causes of syncope. Some of these are life-threatening and others are not serious, it said, adding, Patients without life-threatening conditions may be sent home.

I was pleased to qualify for that. And I didnt need the hospital definition of dehydration. I know what that is. And I was correct. Its that thing beyond thirsty.

Now, having proven my point that youll get thirsty before you get dehydrated, Im working on my acceptance speech for the Nobel Prize for Medicine.

Friends, its hot out there. Youve probably not heard this from anyone, but, having road-tested this theory, let me recommend the introduction of orally administered liquids when youre thirsty. And sometimes water isnt enough. Electrolytes, yes. Alcohol, no (ever).

And, despite how you feel about it, endeavor to give the right answer, sans editorial comment, when a health care professional asks you whos the president of the United States. This is about your state of consciousness, not your state of confusion about how this particular president got to be this particular president.

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Herman: How my drinking problem sent me to the emergency room –


Rogersville man who pulled knife in emergency room disarmed at gunpoint – Kingsport Times News

RPD Detective Travis Fields said Jessie Darnell Rawlings never pointed the knife at nurses or doctors, nor did anyone in the E.R. during the incident feel as if they were being held against their will.

In fact, nurses indicated they were more concerned about Rawlings injuring himself.

However, Rawlings refused to drop the knife even after police arrived and drew their weapons. Fields said it took officers several minutes to talk him into dropping the knife.

Rawlings, 60, 346 Kite Road, Rogersville, initially went to the E.R. for mental issues following a domestic incident.

Shortly after 8 a.m., RPD officers Andy Banks and Joey Maddox responded to the hospital, where they found Rawlings standing at the nurses station holding an open pocket knife behind his back.

Upon speaking to Mr. Rawlings, I observed him to be unsteady on his feet and have the smell of alcohol about his breath and person, Banks stated in his report. There were two nurses and a doctor present in the nurse station during this time, and they were also telling him prior to our arrival to put the knife down, without success.

Officers eventually convinced Rawlings to drop the knife, at which time he was arrested and charged with public intoxication and disorderly conduct.

Fields said officers chose not to charge Rawlings with more serious charges such as felony aggravated assault because he didnt actually threaten anyone or prevent anyone from leaving.

Rawlings was arraigned Wednesday in Hawkins County Sessions Court and remained held in the Hawkins County Jail on $1,061 bond pending his next court appearance set for July 10.

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Rogersville man who pulled knife in emergency room disarmed at gunpoint – Kingsport Times News


Local emergency room sees influx of patients around 4th of July – WHSV

ROCKINGHAM COUNTY, Va. (WHSV) Many of us got to enjoy the fresh air on the night of Independence Day as we admired the firework displays happening around the Valley. However, some folks missed out, spending their evening in the emergency room instead.

According to WalletHub, 800 people go to the emergency room with firework-related injures each Fourth of July, and 67% of all fireworks-related injuries happen within a month of July 4th.

Over the holiday, the emergency department at Sentara RMH Medial Center experienced an influx of patients who were admitted with injuries related to fireworks.

Monday was the busiest day with 211 patients overall. On the Fourth of July, 161 people were admitted.

Brandy Sollenberger is the clinical nurse manager in the emergency department at Sentara RMH. She said the majority of folks were suffering from burns, but a few cases were more severe.

“They’ve all been kind of similar, very, very similar with hand injuries mostly. Hand and upper body,” said Sollenberger.

She added that those who needed surgery were taken to UVA Medical Center.

“From one careless second. It can only take a few seconds and if they’re not known anyone who’s been injured before or seen the impact of fireworks, the danger that they have, they’re going to take that chance because they want to celebrate,” said Sollenberger.

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Local emergency room sees influx of patients around 4th of July – WHSV


Belleville Board To Hear Clara Maass Emergency Room Proposal –
Belleville Board To Hear Clara Maass Emergency Room Proposal
BELLEVILLE, NJ The Belleville Board of Adjustment plans to hear a proposal to construct an addition and make alterations to the emergency room of Clara Maass Medical Center at 1 Clara Maass Drive on Thursday, July 6, according to the municipal …

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Belleville Board To Hear Clara Maass Emergency Room Proposal –


Monte Paschi looks to leave ’emergency room’ and return to profit – Reuters

MILAN Italian bank Monte dei Paschi di Siena (BMPS.MI) set out plans to get out of the “emergency room” and return to profit on Wednesday, clearing the way for a state bailout that should remove the biggest threat to the country’s financial stability.

The world’s oldest bank said on Wednesday it expected a net profit of more than 1.2 billion euros ($1.4 billion) in 2021, from a loss of 3.2 billion euros last year, as part of a restructuring plan approved by European authorities.

“It’s a conservative plan. We’re not shooting at unrealistic targets,” Chief Executive Marco Morelli told analysts on a conference call to present the new plan.

Morelli said no mergers were planned at the moment. “There is no Plan B on the table,” he said.

Burdened by bad loans and a mismanagement scandal, Monte dei Paschi has for years been at the forefront of Italy’s slow-brewing banking crisis.

Italy’s fourth-largest lender was forced to request state aid in December after its attempt to raise capital from private investors failed.

On Tuesday the European Union approved a 5.4 billion euro state bailout after it agreed to a drastic overhaul in a move that will leave Rome holding around 70 percent of the bank.

EU officials speaking on condition of anonymity said Italy would have to exit the bank at the latest by the end of the 5-year plan.

“What we experienced in the last nine months is pretty much unheard of: It’s like an ER department with an emergency every five minutes,” Morelli said.

Italy has pledged more than 20 billion euros of taxpayer money in the space of a week to rescue three of its banks, but the country’s wider financial sector is still weighed down by around 300 billion euros of non-performing loans (NPLs).

At the end of last month, Rome committed up to 17 billion euros to rescue regional banks Popolare di Vicenza and Veneto Banca though it said the final bill would be much lower, adding the state might even turn a profit from the bailouts.

“The Monte Paschi plan looks good but we need to see execution. Still, coming after the Veneto rescues it settles nerves about Italy’s banking system,” said Zenit fund manager Stefano Fabiani.


In its 2017-2021 plan, Monte dei Paschi sees a headcount reduction of around 5,500 to just over 20,000 and a fall in the number of branches to around 1,400 from some 2,000 in 2016 as it seeks to ensure the lender is profitable in the long term.

It expects to reach a return on equity of more than 10 percent in 2021 while its CET1 ratio, a measure of financial strength, is seen at 14.7 percent from 8.2 percent in 2016.

Crucially, the bank will sell 28.6 billion euros of gross bad loans, of which 26.1 billion will be securitized through a transfer to a privately funded vehicle on market terms, with the operation partially funded by bank rescue fund Atlante II.

The bank said it would sell securitized notes to Atlante II at 21 cents on the euro. “We are in line if not slightly above recent market transactions,” Morelli said.

The CEO, who expects the bank’s shares to relist in the second half of September, said 5.5 billion euros in deposits were recovered in the first quarter, adding liquidity was no longer an issue.

“The bank managed to stay alive,” he said, referring to the close shadowing of the lender by European authorities. “We negotiated the plan with the EU Commission line by line.”

Rome is under the spotlight for taking advantage of exceptions in EU rules designed to stop the use of taxpayer money to deal with bank crises.

Policymakers now want Italy to come up with a solution for tackling NPLs without requiring any more government money to prop up its beleaguered banking sector.

European Central Bank vice president Vitor Constancio said on Wednesday there needed to be swift action to establish a stronger secondary market in Europe for non-performing loans and policy changes to incentivise banks, investors and the authorities to tackle the issue more effectively.

“Partial solutions and further delays are not options if we want to tackle the problem of NPLs” he wrote in Italy’s main business newspaper Il Sole 24 Ore.

(Additional reporting by Agnieszka Flak in Milan and Foo Yun Chee in Brussels; Editing by Susan Fenton/Keith Weir)

BRUSSELS EU antitrust regulators have appointed a panel of experts to give a second opinion on their case against Google’s Android mobile operating system, two people familiar with the matter said, as they weigh another record fine against the company.

BERLIN Airbus has signed an agreement to sell 140 aircraft to China, it said on Wednesday, in a deal worth almost $23 billion at list prices.

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Monte Paschi looks to leave ’emergency room’ and return to profit – Reuters


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