12 research outputs found

    Hapruse mõju erakorralise laparotoomia ravitulemustele: prognostiliste mudelite ja otsustusprotsessi täiustamisest

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    Väitekirja elektrooniline versioon ei sisalda publikatsiooneAastaks 2050 on arenenud riikides peaaegu iga kolmas inimene üle 65-aastane. Siiski ei määra üksnes vanus inimese tervislikku seisundit. Mõned nooremad inimesed võivad olla kehva tervisega, samas kui osa üle 80-aastaseid on jätkuvalt oma vanuse kohta heas vormis. Siin tuleb mängu hapruse mõiste. Haprus tähendab kehalise vastupanuvõime vähenemist, mis muudab inimese haavatavamaks väliste mõjurite suhtes. Habrastel inimestel võib isegi väike sündmus—näiteks kukkumine või uus ravim—põhjustada tõsiseid tagajärgi, millest taastumine on raskem ja aeganõudvam, kuna kehal ei ole piisavalt reserve tekkinud probleemidega toime tulekuks. Hapruse hindamiseks välja töötatud mitmeid mõõdikuid, näiteks 9-astmeline kliiniline hapruse skaala (Clinical Frailty Scale). Käesolev uurimustöö käsitles hapruse mõju patsientidele, kes vajasid erakorralist laparotoomiat—eluohtlikes olukordades tehtavat kõrge riskiga kõhuõõne operatsiooni. Operatsioonieelse hapruse taseme hindamiseks kasutati kliinilist hapruse skaalat. Andmeid koguti enam kui 1800 patsiendi kohta Ühendkuningriigis ja Eestis. Selgus, et haprus on sage—mitte ainult eakate, vaid ka nooremate seas. Koguni 17% alla 50-aastastest patsientidest olid enam või vähem haprad. Kõrgem hapruse tase oli seotud suurema suremusega nii lühemas kui pikemas perspektiivis, pikema haigla- ja taastusravi ajaga ning sagedasema raskete tüsistuste esinemisega. Kuus kuud pärast operatsiooni polnud paljud, eriti üle 80-aastased, taastunud oma operatsioonieelsele iseseisva toimetuleku tasemele. Märkimisväärne oli see, et üle 50-aastaste seas ennustas haprus 180 päeva suremust paremini kui vanus või sugu. Hapruse seisundi lisamine olemasolevatele riski hindamise mudelitele, nagu NELA ja P-POSSUM, parandas nende täpsust, eriti vanemate patsientide puhul. See aitab kirurgidel, patsientidel ja pereliikmetel teha teadlikumaid ravivalikuid juba ravi algfaasis. Uurimustöö tulemused toovad välja hapruse hindamise tähtsuse erakorralises kirurgias—see võimaldab paremat riskihindamist, toetab patsientide, arstide ja lähedaste ühiseid otsuseid ning aitab ressursside planeerimisel ja taastusravi korraldamisel.By 2050, nearly one in three individuals in developed countries will be over the age of 65. However, chronological age alone doesn’t determine health. Some younger people can be in poor shape, while some over 80 remain robust. This is where the concept of frailty becomes crucial. Frailty refers to a loss of physiological resilience that makes people more vulnerable to stressors. In frail individuals, even a minor event—like a fall or a new medication—can cause a cascade of complications. It’s not just “being old”; it’s about how much reserve the body has to cope with problems. Fortunately, frailty can be measured using tools like the Clinical Frailty Scale, which rates frailty from 1 (very fit) to 9 (terminally ill). This research looked at how frailty affects patients undergoing emergency laparotomy—a high-risk abdominal operation often performed in life-threatening situations. Using the Clinical Frailty Scale, patients were scored before surgery. Data were collected from over 1,800 patients in the UK and Estonia across three studies. We found that frailty is common—not just in the elderly, but also among younger patients. For example, 17% of patients under 50 showed signs of frailty. Higher frailty scores were associated with increased short- and long-term mortality, longer hospital and rehabilitation stays, and a higher incidence of serious postoperative complications. Even six months after surgery, many had not regained their previous level of independence—especially those over 80. Notably, among patients over 50, frailty was a stronger predictor of 180-day mortality than either age or sex. The study also showed that adding frailty to existing risk prediction tools, like NELA and P-POSSUM, improved their accuracy, especially in older populations. This can help surgeons, patients, and families make more informed treatment decisions during the critical early stages of care. These results underline the importance of integrating frailty assessment into emergency surgical care. Recognising and quantifying frailty preoperatively can enhance risk stratification, inform shared decision-making, and support better resource allocation and postoperative planning.https://www.ester.ee/record=b575241

    The support worker's role in advocacy

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    Within this article, the author will be examining the supportworker’s role in advocacy, looking at exactly what advocacy isand what being an advocate means. Who should be an advocate,and when you should not be an advocate? The importance ofcommunication to the process and the ultimate aim of the clientbecoming a self advocate and the formation of self-advocacygroups will be discussed

    Appraisal and its benefits for the support worker

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    Within this article, the author will examine what an appraisal isand how, if done correctly, it supports and develops quality care.Appraisals receive a negative press with both employees andmanagers. Reasons for this will be explored before moving onto identify the purpose and benefits that following an appraisalprocess brings. The many different forms that appraisals cantake will be highlighted. What factors make up an appraisal willbe discussed, from reviewing past performance to the setting ofrealistic and yet challenging goals. The importance of preparationfor the support worker prior to the appraisal process will behighlighted as a key factor to success

    Perencanaan Strategi Sistem Informasi Penjualan Menggunakan Pendekatan Togaf Adm (Studi Kasus : Three Sister’s House Of Beauty)

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    Three Sister’s House Of Beauty is one of the several business located at karangtengah cibadak sukabumi. This Business offers all things about skincare, makeup and fashion for youngest to the oldest especially for a man. In the process business activity, Three Sister\u27s has implement strategic planning, but in this prospect the planning has a missed targeted so that it cannot be realized properly, the problems regarding data collection process of sold product and ordering data for customers sometimes just written, input into Ms.Word and Ms.Excel. In odd moment, Three Sister’s share and promotion product on social media, the community of beauty have every rules if want post on group. So that, Three Sister\u27s House of Beauty must planning of ISand IT strategies to be good business proces in future. The conclusion, strategic planning for implementing Enterprise Architecture is one of the best solutions for supports a business or organization. So with this, the author conducts research with the study of the Togaf ADM to support Sales Information Systems that are integrated, right on target, and support business processes in Three Sisters\u27 House of Beauty.Three Sister’s House Of Beauty is one of the several business located at karangtengah cibadak sukabumi. This Business offers all things about skincare, makeup and fashion for youngest to the oldest especially for a man. In the process business activity, Three Sister\u27s has implement strategic planning, but in this prospect the planning has a missed targeted so that it cannot be realized properly, the problems regarding data collection process of sold product and ordering data for customers sometimes just written, input into Ms.Word and Ms.Excel. In odd moment, Three Sister’s share and promotion product on social media, the community of beauty have every rules if want post on group. So that, Three Sister\u27s House of Beauty must planning of ISand IT strategies to be good business proces in future. The conclusion, strategic planning for implementing Enterprise Architecture is one of the best solutions for supports a business or organization. So with this, the author conducts research with the study of the Togaf ADM to support Sales Information Systems that are integrated, right on target, and support business processes in Three Sisters\u27 House of Beauty

    Perencanaan Strategi Sistem Informasi Penjualan Menggunakan Pendekatan Togaf Adm (Studi Kasus : Three Sister's House Of Beauty)

    No full text
    Three Sister’s House Of Beauty is one of the several business located at karangtengah cibadak sukabumi. This Business offers all things about skincare, makeup and fashion for youngest to the oldest especially for a man. In the process business activity, Three Sister's has implement strategic planning, but in this prospect the planning has a missed targeted so that it cannot be realized properly, the problems regarding data collection process of sold product and ordering data for customers sometimes just written, input into Ms.Word and Ms.Excel. In odd moment, Three Sister’s share and promotion product on social media, the community of beauty have every rules if want post on group. So that, Three Sister's House of Beauty must planning of ISand IT strategies to be good business proces in future. The conclusion, strategic planning for implementing Enterprise Architecture is one of the best solutions for supports a business or organization. So with this, the author conducts research with the study of the Togaf ADM to support Sales Information Systems that are integrated, right on target, and support business processes in Three Sisters' House of Beauty

    Blunt cardiac rupture in a toddler

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    Blunt cardiac rupture is typically a fatal injury with overall mortality exceeding 90%. Most of the patients never reach the hospital alive. In pediatric patients, only 0.03% of cases following blunt trauma admissions have a cardiac injury. This report presents a rare survivor of 16-months old toddler injured in a domestic accident suffering a right atrial rupture repaired through a median sternotomy. To the best of our knowledge this is the youngest case reported in the literature

    Simultaneous common bile duct clearance and laparoscopic cholecystectomy: experience of a one-stage approach

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    Introduction: The timing and optimal method for common bile duct (CBD) clearance and laparoscopic cholecystectomy remains controversial. Several different approaches are available in clinical practice. The current study presents the experience of two European hospitals of simultaneous laparoscopic cholecystectomy (LC) and intra-operative endoscopic retrograde cholangiopacreatography (IO-ERCP) done by surgeons.Methods: Retrospective analysis of all consecutive patients subjected to LC+IO-ERCP during their index admission between 4/2014 and 9/2016. Data accrued included patient demographics, laboratory markers, operation time (min) reported as mean (SD) and hospital length of stay (LOS) reported as median (lower quartile, upper quartile).Results: During the 29-month study, a total of 201 consecutive LC+IO-ERCPs were performed. The mean age of patients was 55 +/- 19years and 67% were female. The mean intervention time was 105 +/- 44min. The total LOS was 4 (3, 7) days and the post-operative LOS was 2 (1, 3)days. A total of 6 (3%) patients experienced post-interventional pancreatitis and two (1%) patients suffered a Strasberg type A bile leak. All patients were successfully discharged.Conclusion: Simultaneous LC+IO-ERCP is associated with few complications. Further studies investigating cost-benefit and patient satisfaction are warranted.</p

    Conservatively managed non-functioning pituitary macroadenomas - Cohort study from the UK Non-functioning Pituitary Adenoma Consortium

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    \ua9 2025 The Author(s). Published by Oxford University Press on behalf of European Society of Endocrinology.Objective: Surveillance is often adopted for asymptomatic non-functioning pituitary macroadenomas (macroNFPAs). Due to low-quality evidence, uncertainty remains on optimal frequency of imaging/biochemical monitoring and indications for surgery. We assessed the natural history and outcomes of patients with macroNFPA who had monitoring as initial management choice from the UK NFPA Consortium. Design: This was a multicentre, retrospective, cohort study involving 21 UK endocrine departments. Methods: Clinical, imaging, and hormonal data of 949 patients followed up between January, 1, 2005 and March, 1, 2022 were analysed. Results: Incidence rate for tumour enlargement was 9.8 per 100 patient-years (95% CI, 8.8-10.8), with cumulative probabilities 1.6%, 8.1%, 18.4%, 29.2%, and 43.6% at 6-month, 1-year, 2-year, 3-year, and 5-year follow-up, respectively; rates were higher in tumours abutting/displacing optic chiasm than those not in contact with it. Amongst macroNFPAs not in contact with optic chiasm showing enlargement within 6 months, none impacted visual fields. In tumours with enlargement and continued monitoring (median 2.6 years), further growth occurred in 60.5% (33.8% probability at 2 years), stability in 35.5%, and shrinkage in 4.0%. Rates of new pituitary hormone deficits were 4.0%-4.9%, mainly driven by tumour enlargement. After transsphenoidal surgery, rates of hypopituitarism reversal were 12%-17% and those of additional anterior pituitary hormone deficits were 12%-15% (permanent vasopressin deficiency 3.5%). Conclusions: Our data provide evidence for monitoring protocols. MacroNFPAs not in contact with optic chiasm require less frequent imaging, and first follow-up scan can be delayed to 1 year. After first enlargement, variable tumour behaviour can occur. New hypopituitarism in stable tumours is rare, challenging necessity of regular pituitary function assessment

    0004

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    PALU AL»1'0. BQ.IFORNIA, MONDAY, DEC. ia 1910. Wilspn's Glace Fruits i.v aovvEsm bibct-wood bo-.es abe most aphroi-ri. ATE atPTS TO SEXR TO VOIR EASTKn.\ ritlEMis. Th*-.-. ssathla. aksa ltM w„ s, „ taMUr _*fc „ „ ,1,1. ...bin. of OUII«.U .an,M„, r__M ,. ,„ „<», , „,„ tl.ro.*—CalKssntU frojts. -*S> w » LEAVE TOUR ORDERS kahi.v.* I'ALO ALTO &r-jr ' ---if 1 ! j ........s'*..,..,...sss^...s.. ....•■......••••••. •■••... ,*. . . '.-J-* . : **•*•"*.. -.'-- :--»**. -: is " ■ i ! Ideal Xmas Gift 1 : — • >: , - : S* Brown Basket, something new, I* v . *. • something useful, something to I-i' ■'"* • beautify your.home. ...-J* Ithe Nippon! IJ telephone txtX. -274 L'nlrerslty Avenue. • SEED! HEED! SEED! We have the largest display of packag* Flower snd Vegetable Seed i ever displayed In I'alo Alto. All tbe best label* and newest goods. Tall and seed Cor yourself. OOMI-TON'S \-L about onr S per reat discount BRIEFS A telegram received from C. E. I Child* from Stevens Point, WI*., stales thai his molher passed awayi at that place on Saturday. R- S. Jewell. 10 th* .Mullen build*'| [ing, 414-41* High street, tiunlr-g1 nJumblng. Pbon* 351. * „! Pocket cutlery and Parker*pens'| t sr.* al*a>s welcome as gifts, ollhei r Xmas or otherwise. The 8<enford'| | .Pharmacy-has full lines of batb.: IJThr* Dibert Dn/g Coin-lap--. Cnlvfr-j] r ; ally avenue on Hie Circle. *>,eee»e.e**e****ee»esee*s**e»<»»*»'^ The Commission £ Merchants Outdone i — if* We have a big lot of new Grapefruit j > ', direct from the packer at Lindsay which *', we will sell at 60c, 70c and 80c"a i • ' ."* "> dozen. . . ■ J | FULLER -& CO.;; Two Phones-751 aud 752 - :: ♦♦♦*.♦♦♦*♦♦♦♦♦♦♦♦; Rcajl onr classified columns. Miss Agnes Gregg hi home for the' l.ollday*. Best brtsd at Thompson's Oak' bakery. It. F. Qlckol was a visitor In Red* ■ i"i.i yesterday. Xmas tree depot at Compton'-.. Pbsrae p.*. Hurry. I2-l"-6t i Watt* Hughe* bts arrived home fr-im San Hits. MexIco.Tor a visit. Ic* crtam and water it«, -fl.bo * gallon, at th* Palo Alto'Crtamsry. Horn, on Saturdty. December IT. in Protestor and Ur*. R....M. Alden. a son. , g. Tb* same goods can be haoght for |e*a tin.ii.-> In Palo Alta: i - ' Mr. and Mr*. W. C How are pov-. tug from 32m Kipling streel lo sts Dtnerson. Clean 7-ro**nl Jkat* onpoaiXA- P. P., i '.. water paid. Apply G. w. Harm* Hohfrld Will i rqlatlres In ■U. bj r*Tnt Profattoc . W. sNtott Chrlatmai ' a I a Veda. Xma* tree depot i'lione B2. Hurry. {1-13-6''*. Bom, oa. Saturday. iiUcembcr IT. to Mr. and Mra. Frederick 11. Fowler, a son. t Fres> butter and »ggs dally at I'slo Alio Creamery, 111 University. I'rotessor and Mrs. Karl O. Rend* lorfl and daughter went to Carmol ibis morning tor the holidays. nest oak wood. 111 a cord. Kindling, li. Crotbsw. 4 66 Forest are. Sydney Klmber. who underwent o U'-cond operation. In Sao 1'ranclsco Tliursday, ahows a very sllsht Im* I -t'vemeni. Earl 11. Pier. SUnford 'OS. has been appointed assistant United •Stale* district attorney In San Francisco. Mrs. 10. A. Kidder of 327 Lytton • re tut Hill leave tonight for Ptsa- -iia to si><ml a month with her sls- ■t. Mrs. Wooslcr. Mr. and Mn, Karl Wolff, of San FranclicSr will be Hin^ui-*'- this eek of Mr. "vVolff'a mother, Mrs. --'•■ymour Chambers. We-^rlll meet or beat any price for any ma-fAlm- or combination' of magaaln-js* advsrtlsed by any responsible" parly. Congdon ft'Crome. 12,.12-Bt The dea-sVfif Mrs. A. oAkMtt, of Menlo Park, occurred Pridgy in Santa Barbara. Aecompanti ' Miss Amy Rassett. she hud**** several weeks nt the Poller to benefit her health, and death .fa-ne onei- pectedly. VVr' * Stanford Dyeing and Cleaning Works Is now ready tor business. We csn do any hind-of work ln\a^ satisfactory -manner. Glre ns a trial and you can ]udg-gf*|r yourself. > ""***. 12-1 Mt Officors or the Presbyterian Brotherhood elected officers at their metl- ing last-^reek:--Dwight w. Weln.j president; R. M. Alden. vice-president;^ W. H. Kelly, secretary, and G. R. Parkinson treasurer. Given away tree, on* ooi polish and cleanser for bath tubs and ba* sins lo^earh householder. Children mast have note from parents. Standard Plumbing and Metal Works. 1GT Hamilton avenue. 12-12-lw I MATTHEWS Trunk§, Bags and Suit Cases TEN PEIj^CENT.OFF TILL JANUARY 1. Palo Alto, Cal. CO-OPERATIVE . LAND AND TRUST CO. I 531 Emerson street Telephone 742 K Christmas Gifts COMPJ-KTK STOCK OF WAJCC'HEH AMI JEWELRY. I'HICES in SPIT THE TIMES. ALL GOOIKi GI'ARANTEEII. J. NEILSEN 1*1 I'nl,, i.nj A.iiiii. . naa K.ll, I. . I.Iitnc-far a taw |S ■ ' ■' ■■ C. a-. d.„,.,.. &mg\mfg*;, s-.jrtonnnent "society Woman .Dies 25DOLL25 DOLL 25 dlTKX AWAV FREE. TWO IMH.US. A ticket given wltb r-r.-rj «| pur.1 .-It.,., nn large doll. A HrLrt given irllli everj S.V |inrrha*e. Holiday Goods of Every Description OXKV-H PK1V ^AYR MORE We have Silk and Net WaJals, Srrk- wear. Hdk*.. Rath RoUe*. MsBer., Hterliiig Kllver Mnn I. un* «i[-. l-ealher and Velvet Hags, Infants' Wear, etc., de. G.OST-RANDER & CO. 273 I unit, i -11.1 Avenue. ll!' KeTljf."' I iTTfrl ved-'tt Seattle rrom flksgway on the steamer princess Beatrice. lie letvet ttrly Tbursdsy morning for Indiana lo spend the holidays with his parents. Captain Frank Barrett and daughter. Miss Orn Barrett, loft Saturday night for Los Angeles, where Miss Barrett Is contemplating attendltiR school after the holidays. They will spend Christmas wltb Miss Annie Barrett aud later Miss Ora will be a guest at the bom* of Mrs. B. Parkinson. HERE IS roCB OPPORTl'MTT , lo (et an tiTtf-at-a") farm' In Ml.llCEIi OOI/ONY oa tht tmOP-PAYMaWT* PLAN Om-iliiril of purs)as* price In caajh Balance, ont-talrd 'at rour"*-*erop each year until laad la paid for. Call at office ror ton particulars. co-operative I-AJ-m A THIST COMPANY. Beat A King, Iaxal Managers. SPAULDING«S DYEING AND CLEANING WORKS , Wi H. KNIOBT, Agent. 10» Circle, Palo AJto. Ph. mra—office, 402K; re*.. -USX. THE WETSEASON 1*- JPOX t'S, AT ' i: 1ST WE HOPS KO. KEEP WELL IXsi HKH JIST THK SAME. HTT Tl'RN VOIR AT- jTENTION TO HOLIDAYS .' AND * [GOOD CHEER. , i THE HRjrr lltESENT %& afAKE -1'Ot 11 it ill n (iM -, IS A LOT, HOt.SK AND i.'.l. APTLE mi. j CHARD OR BERRY FARM. SEND i FOR HY IsAND JOt'RNAI-. WHICH ! EXPLAINS FILLY. AND HAKE YOl'R SELECTION. JOHN F. BYXBEE 101 I.jtti.ii Are., mrnrr Alma St. fp BR1 OF SOrTHERS PAfrn-tc Sf PKR1NTENDKNT .AND MI MltKU OP OOl'NntY^CLl'H IHEH. Ni-ws has been received at MeDlo Park of Ihe death of Mrs. A. C. Basselt, a prominent member of the Country Club set here, at Santa Barbara etrfy d yesterday morning, I Mrs. Basselt went south on lasl who Tuesday seeking a beneficial change lhe[of climate and relief from asthma. Bering Teacher—And now, Willie, holda the ascension record at preaeat ttmeT Willie (Instantly)—[with wblch she had been Elijah!—Puck. (or several months. A. C. Bassolt has been for many Hospital Physician—Which ward do you wish to be taken to? A pay ward or a Maloney—Iny of thlm. doc, that's safely Dlmocradc. —Puck- years *uoerlnteadent or the local division of the Southern Pacific. As yet no arrangement* for the funeral have been made. USEFUL GIFTS Fdr Men and Boys IIKI/ra, BATHROBES, (.LOVES," SMOKING JACKETS. HAKP- KKRCHIEPS, SUITCASE-. HIITLEIB. SWEATER COATS. ItKE-t-ERS, BOX HOLEPROOF SOX, CUFF LINKS, BOX INITIAL IIAM.KERCHIEFS, SHIRT STUDS, PAJAMAS, SHIRT BUTTONS, FANCY SHIRTS, NEOKsVKAH. UNDERWEAR, SUSPENDERS. MEiit'llAVDISK ORDBR8. HAT ORDERS. OLOVE OB- H*IR8. - * Christy, Rhodes & Co. PHONE 200 REDUCED ROUND-TRIP FARES on account of Christmas Holidays New Year's Celebration The Souther* Pacific will place ln effect round-trip rates of one fare and one-third bee a tin nil points In California, where one way flrst-ciaaa fare I* 110 far stat, for tho above occasions, aa follows: December an. 25. -ML Okrlstiuat Holidays ..-Bal* Return limit January S, 1011 New Tear** Celebration—Sale data* December SO, SI, 1810; January 1 and S. 1911. RetNru limit J*uua«7 S, 1011. Ho stopovers allowed la either direction. For fall particulars inquire of LEWIS LITTLE, Agent. SOUTHERN PACIFIC TRUNKS Mo\ Hi AM» ("KECKKit FROM YOCH RKHIDENCB TO Ytll'It DBA* T1NATIOX, * in K PRICES ARK RIGHT. tn It BER VICE IS COO li- OUR DMYEBS ARE KIND AND COCRTEOI-. OCR STORAGE WAREHOUSE IB CROWDED. Onr piano aad f-raWt aamtam are tbt btat. OT furth-w p_rtlc*l_rs passm- Palo Alto *» «r -all at osr •*•» 101 Circle. Palo Alto Transfer Co 101 University Ave. Ranches Great Bargains NEAR I ■MVKB.SITY AND UOA ALTOfl. %. 10 and 3ft aerMsr improved; several amall tracts c)b*e lo, land rollinc. cood views, water. See at at onee. Ranch. . great bargain, 14 acres, almost Joining Stanford grounds; vineyard, j.000 gallons new and old wine, cooperage, farm loot*, etc t"l,00ft. Terms. H acres, unimproved, rolling, flae location. 3 miles in foothills. X miles Los Altos. "3,81)0. Terms. Frederic iiebard & Co. Well! Well! It's baked well It look* well ft sells well and Ix-it of all it taatea welt. HORWEGE-fJ BREAD SPAULDINQ'S For Xmas Candies Chnrcb Ordcra Boiidtad.,; .13**. Ctiaanlng Aveuu-p. PI— Ml • THERE IH NOTBIRG THAT IS MORE APPROPRIATE f*OR A • • * . CTHRIKTHAfl GIFT THAN A £ • • : | Stickley Chair or Rocker j a and we art goiac to give joa SO per cestt off from tW rrfskr * • • price for one week omty. TbU will give yon a chance to get these • • • i ' * ■ * • rocker* for below Use price Ihat they hare ever been sold at he- a : 1 a fort oa th* coast. Resoember Ihe time and place. • : : McKibben - Beal Co.: • 222 University Ave. phone 12
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