text:
Page 1
Waterpipe Tobacco and Cigarette Smoking Direct Comparison of
Toxicant Exposure
Thomas Eissenberg, Ph D1,2 and Alan Shihadeh, ScD3
1 Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth
University, Richmond, Virginia
2 Syrian Center for Tobacco Studies, Aleppo, Syria
3 Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
Background—Waterpipe (hookah, shisha) tobacco smoking has spread worldwide. Many
waterpipe smokers believe that, relative to cigarettes, waterpipes are associated with lower smoke
toxicant levels and fewer health risks. For physicians to address these beliefs credibly, waterpipe and
cigarette must be compared directly.
Purpose—The purpose of this study is to provide the first controlled, direct laboratory comparison
of the toxicant exposure associated with waterpipe tobacco and cigarette smoking
Methods—Participants (N=31; mean=21.4 years, SD=2.3) reporting monthly waterpipe use (mean
5.2 uses/month, SD=4.0) and weekly cigarette smoking (mean= 9.9 cigarettes/day, SD=6.4)
completed a crossover study in which they each smoked a waterpipe for a maximum of 45 minutes
or a single cigarette. Outcomes included expired air carbon monoxide (CO) 5 minutes after session's
end, and blood carboxyhemoglobin (COHb), plasma nicotine, heart rate, and puff topography. Data
were collected in 2008–2009 and analyzed in 2009.
Results—CO increased, on average, by 23.9 ppm for waterpipe (SD=19.8) and 2.7 ppm for cigarette
(SD=1.8) while peak waterpipe COHb levels (mean=3.9%, SD=2.5) were three times those observed
for the cigarette (mean=1.3%, SD=0.5; Ps<0.001). Peak nicotine levels did not differ (mean ng/ml
waterpipe=10.2, SD=7.0; cigarette=10.6, SD=7.7). Significant heart rate increases relative to pre-
smoking were observed 5, 10, 15, 20, 25, and 35 minutes during the cigarette session and at every
5-minute interval during the waterpipe session (Ps<0.001). Mean total puff volume was 48.6 liters
for waterpipe as compared to 1.0 liters for cigarette (P<0.001).
Conclusions—Relative to a cigarette, waterpipe use is associated with greater CO, similar nicotine,
and dramatically more smoke exposure. Physicians should consider advising their patients that
waterpipe tobacco smoking exposes them to some of the same toxicants as cigarette smoking and
therefore the two tobacco smoking methods likely share some of the same health risks.
Address correspondence and reprint requests to: T. Eissenberg, Virginia Commonwealth University, Box 980205, Richmond, VA, 23298.
No financial disclosures were reported by the authors of this paper.
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers
we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting
proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could
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NIH Public Access
Author Manuscript
Am J Prev Med. Author manuscript; available in PMC 2010 December 1.
Published in final edited form as:
Am J Prev Med. 2009 December ; 37(6): 518–523. doi:10.1016/j.amepre.2009.07.014.
NIH-PA Author Manuscript
NIH-PA Author Manuscript
NIH-PA Author Manuscript
Page 2
Smoking tobacco using a waterpipe (hookah, narghile, shisha; Figure 1) is a global
phenomenon,1 especially among adolescents and young adults. For example, among
adolescents current waterpipe tobacco smoking prevalence is approximately 30% in Estonia,
2 Latvia,3 and Beirut, Lebanon;4 5%–17% of some adolescent populations in the U.S. may be
current waterpipe tobacco smokers.5,6 Among university students, current waterpipe tobacco
smoking prevalence is 33% in Karachi, Pakistan7 and 10%–20% in the U.S.8,9 Where no data
are available, waterpipe tobacco smoking's popularity is demonstrated by businesses that
facilitate it (e.g., hookah cafés) in countries like Australia, Brazil, Canada, France, New
Zealand, and South Africa. Thus, physicians across the globe can expect that some of their
patients are current waterpipe tobacco smokers. The more informed these physicians are about
the risks of this tobacco use method, the better they can address these risks with their waterpipe-
using patients.
One way of estimating waterpipe risk is to compare waterpipe smoke toxicant content (or yield)
to cigarette smoke toxicant content. Such comparisons are made using smoke generated by a
machine and reveal that, relative to smoke generated from a cigarette, the smoke generated
from a waterpipe yields alarming quantities of carcinogens, carbon monoxide (CO), nicotine,
and "tar".10–12 However, machine-generated smoke toxicant yields may not be an accurate
indication of actual smoker toxicant exposure, and no controlled, head-to-head comparison of
smoker toxicant exposure for waterpipe and cigarette has been reported. Such a comparison
would address the oft-reported perception that, relative to cigarette smoking, waterpipe tobacco
smoking presents reduced health risks.13–15
Indeed, understanding the relative smoker toxicant exposure associated with waterpipe and
cigarette smoking is of great interest: the two have been compared briefly and indirectly in
virtually every empirical study in which waterpipe toxicant exposure has been measured.16–
20 However, comparisons of toxicant exposure across different tobacco use methods are more
than inherently interesting: the observation that cigarette and smokeless tobacco use are
associated with equivalent peak blood nicotine concentration21 provided support for the use
of nicotine replacement medications for treatment of smokeless tobacco users.22 Perhaps most
important, comparing the waterpipe and cigarette toxicant exposure can help physicians and
other public health professionals address misperceptions driving waterpipe's global spread.
Thus, the purpose of this study is to provide the first controlled, direct laboratory comparison
of the toxicant exposure associated with waterpipe tobacco and cigarette smoking.
Waterpipe tobacco smokers who also smoked cigarettes participated in two laboratory sessions
in which they smoked a waterpipe or a cigarette ad libitum. Outcomes included expired air CO
concentration, carboxyhemoglobin (COHb) and plasma nicotine level, heart rate, and puff
topography. Based on cross-study comparisons,23 it was hypothesized that, relative to cigarette
smoking, waterpipe tobacco smoking would be associated with greater CO and nicotine
exposure, as well as greater puff number and volume.
Thirty-nine participants recruited in 2008–2009 from the Richmond, Virginia community using
advertisements and word-of-mouth provided informed consent for this study that was approved
by the Virginia Commonwealth University IRB. Of these 39, 2 withdrew and 2 were
discontinued due to scheduling difficulties or protocol noncompliance. The blood samples for
4 of the remaining 35 participants returned results that were not valid, so that the final sample
consisted of 31 individuals (21 men; 22 Caucasian, 3 Asian, 1 African-American, and 5 mixed
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or other ethnicity). These participants were healthy, aged 18–50 years (mean age = 21.4 years,
SD = 2.3), and reported at least monthly waterpipe tobacco smoking (mean 5.2 uses/month,
SD = 4.0) and weekly cigarette smoking (mean 9.9 cigarettes/day, SD = 6.4). Exclusion criteria
included self-reported history of chronic health conditions, current pregnancy or breastfeeding,
use of tobacco products other than waterpipe or cigarettes, currently attempting to quit
smoking, or use of marijuana for more than 5 days of the last 30 (we did not exclude all
marijuana use because as many as 36% of U.S. waterpipe tobacco smokers may also use
Study design and procedures
This laboratory study used a two condition crossover design in which all participants completed
two, approximately 2-hour sessions that differed by product used (waterpipe or cigarette):
condition order was counterbalanced. Pre-session abstinence (≥ 12 hours) was required before
each session. Once abstinence was verified (i.e., by measuring expired air CO and requiring ≤
10 ppm), a catheter was inserted into a forearm vein and the session began with continuous
heart rate recording. Breath and blood were sampled after 30 minutes of heart rate data had
been recorded and then session-specific product was administered. For a waterpipe session, a
waterpipe with 15 g of tobacco in the foil-covered head was presented and a lit charcoal
briquette (sold for waterpipe use) was placed on the perforated foil. Participants were instructed
that the waterpipe would be available for 45 minutes (approximate waterpipe smoking episode
duration24) and that an additional half briquette could be added on request. For a cigarette
session, a lit cigarette was placed into a mouthpiece that was connected to a topography
measurement device. In each session participants were seated comfortably and viewed a video
of their choice. Blood was sampled at 5, 15, 30, and 45 minutes after smoking began. Breath
was sampled before smoking and at 50 minutes in order to avoid contamination of the sample
with smoke that remained in the lung or oral cavity. Payment for completing both sessions was
$175. The laboratory was ventilated with exhaust fans, and ambient CO levels (measured for
19 participants) never exceeded 7 ppm in any session (mean 4.2 for waterpipe sessions, 0.4 for
cigarette sessions).
The waterpipe consisted of a chrome body (height = 43 cm) screwed into an acrylic base (height
= 24 cm; volume = 1230 ml; www.myasaray.com). Water (870 ml) was placed into the base,
submerging about 2.5 cm of the body's conduit. The head (height = 7.6 cm;
www.HookahCompany.com) was made of glazed ceramic with 5 holes in the bottom (each
approximately 6 mm diameter). The leather hose was fitted with puff topography measurement
hardware25 and terminated with a wooden mouthpiece (see Figure 1). A circular sheet of
aluminum foil (diameter = 11.5 cm; www.smoking-hookah.com) separated the quick-lighting
waterpipe charcoal briquette (Three Kings, Holland) from the tobacco, after the foil had been
perforated with a "screen pincher" (see www.smoking-hookah.com). A sterile plastic tip
(www.hookahcompany.com) was added to the mouthpiece for each participant.
Participants smoked their preferred waterpipe tobacco flavor. Fruit flavors were most common
(e.g., 9 participants, chose strawberry, 6 mango, 5 apple/double apple). Frequently participants
were unable to name a preferred tobacco brand so "Nakhla" (Egypt) was used (N = 22). Other
brands included Al-Fakher (United Arab Emirates; N = 5), Al-Amir (Saudi Arabia; N = 2),
and Starbuzz (U.S.; N = 2; all purchased from www.HookahCompany.com).
Using available data for 23 participants,26 preferred brand cigarettes yielded, on average, 0.9
mg nicotine (SD = 0.2), 12.0 mg CO (SD = 2.2), and 11.7 mg tar (SD = 2.5).
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Outcome measures
Expired air CO was assessed with a BreathCO monitor (Vitalograph, Lenaxa, KS). COHb level
was analyzed less than 1 minute after sampling (NPT7 Blood Gas Analyzer; Radiometer
America, Inc, Westlake, Ohio) and then 10 ml of blood was centrifuged, plasma stored at −70°
C, and analyzed for nicotine level (limit of quantitation or LOQ = 2.0 ng/ml27). Heart rate
(HR) was measured every 20 seconds (Model 506, Criticare Systems, Waukesha, Wisconsin
fitted with a reusable finger pulse oximeter sensor).
To measure waterpipe puff topography, a differential pressure flow sensor was integrated into
the waterpipe hose.25 For cigarettes, participants smoked through a mouthpiece orifice that
was connected to a pressure transducer (CReSS Lab, Borgwaldt KC, Richmond, VA). In both
cases, previously calibrated software converted digital signals to air flow (ml/sec) and
integrated these data to produce measures of puff volume, number, and interpuff interval (IPI).
Data preparation and analyses
Data were analyzed in 2009. For plasma nicotine, results below the LOQ were replaced with
the LOQ. HR data were averaged for 5-minute periods beginning with the 5 minutes preceding
product administration. Data were analyzed using a repeated measures ANOVA with two
factors: session (waterpipe or cigarette) and time (levels varied by measure). In addition, each
sessions' peak COHb and plasma nicotine level was determined and these data were analyzed
using a single factor (session) repeated measures ANOVA. Topography data were averaged
within each session to obtain a single value for puff volume and IPI and these measures and
puff number and total puff volume were analyzed using a single factor (session) ANOVA (data
for two participants were missing thus N = 29 for topography only). Huynh-Feldt corrections
were used to account for violations of sphericity and, for comparisons between means,
Bonferroni-corrected dependent t tests were conducted.28
Of the 31 participants, 5 chose to use an additional half charcoal briquette during their waterpipe
session; the pattern of results was not influenced by these 5 participants, so their data are
included in all analyses described below.
For expired air CO, statistical analysis revealed a significant condition by time interaction [F
(1,30) = 36.9; P < 0.001)]. For cigarette, mean (±SEM) pre-smoking CO level was 5.1±0.5
ppm and increased to 7.8±0.6 after smoking while, for waterpipe, mean pre-smoking CO level
was 4.7±0.5 ppm and increased to 28.7±3.5 after smoking [t(30) > 6.7; Ps < 0.001]. The higher
postsmoking CO associated with waterpipe tobacco smoking was significant [t(30) = 5.8; P <
The mean COHb data are shown in Figure 1 (top), and analysis revealed a significant condition
by time interaction [F(4,120) = 35.6; P < 0.001)]. For cigarette, mean (±SEM) pre-smoking
COHb level was 0.95±0.08% and increased to 1.1±0.11% at 5 minutes, 1.2±0.10% at 15
minutes, 1.2±0.10% at 30 minutes, and 1.1±0.08% at 45 minutes [t(30) > 4.7; Ps < .001]. For
waterpipe, mean pre-smoking COHb level was 0.75±0.09% and increased to 1.8±0.21% at 5
minutes, 2.7±0.29% at 15 minutes, 3.6±0.41% at 30 minutes, and 3.9±0.46% at 45 minutes [t
(30) > 5.1; Ps < .001]. The higher COHb associated with waterpipe tobacco smoking relative
to cigarette smoking was significant at every postsmoking time point [t(30) > 6.7; Ps < 0.001].
Analysis of peak data revealed a significant effect [F(1,30) = 35.0; P < 0.001)], with a mean
peak COHb for cigarette of 1.3±0.10% and for waterpipe of 3.9±0.5%.
The mean plasma nicotine data are shown in Figure 1 (bottom), and analysis revealed a
significant condition by time interaction [F(4,120) = 14.5; P < 0.001)]. For cigarette, mean
Eissenberg and Shihadeh Page 4
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(±SEM) pre-smoking plasma nicotine concentration was 2.1±0.1 ng/ml and increased to 10.0
±1.4 ng/ml at 5 minutes, 6.8±0.7 ng/ml at 15 minutes, 5.0±0.6ng/ml at 30 minutes, and 4.1
±0.4ng/ml at 45 minutes [t(30) > 5.1; Ps < 0.001]. For waterpipe, mean pre-smoking plasma
nicotine concentration was 2.0±0.2 ng/ml and increased to 6.1±1.1ng/ml at 5 minutes, 6.4±0.8
ng/ml at 15 minutes,7.9±1.0 ng/ml at 30 minutes, and 8.5±1.0 ng/ml at 45 minutes [t(30) > 3.6;
Ps < 0.001]. The higher nicotine associated with waterpipe tobacco smoking relative to
cigarette smoking was significant at 45 minutes [t(30) = 4.3; P < 0.001]. Analysis of peak effect
data revealed no significant effect [F(1,21) = 0.07; n.s.], with a mean peak plasma nicotine
concentration for cigarette of 10.6±1.4 ng/ml and for waterpipe of 10.2±1.3 ng/ml.
Analysis of heart rate data revealed a significant condition by time interaction [F(9,261) = 24.2;
P < 0.001)]. For cigarette, a significant increase in heart rate was observed when pre-smoking
data are compared to the first 5, 10, 15, 20, 25, and 35 minute time points while, for waterpipe,
a significant increase relative to pre-smoking data was observed for all time points [t(30) >
4.1; P < 0.001]. For cigarette, mean (±SEM) pre-smoking heart rate was 68.9±1.8 bpm and
was 81.2±2.2 bpm at 5 minutes, 85.7± 2.1 bpm at 10 minutes, 72.2±1.8 bpm at 30 minutes,
and 69.6±1.6 bpm at 45 minutes. For waterpipe, mean pre-smoking heart rate was 69.2±1.6
bpm and was 73.3±1.6 bpm at 5 minutes, 80.0±2.2 bpm at 10 minutes, 76.6±1.9 bpm at 30
minutes, and 75.5±1.8 bpm at 45 minutes. The greater heart rate associated with cigarette
smoking relative to waterpipe smoking was significant at 5 minutes, while the reverse
relationship was true at 35 and 45 minutes [t(30) = 3.9; Ps < 0.001].
Table 1 shows the means and SDs for each puff topography measure and, as shown in the
Table, significant differences were observed across conditions for each measure [Fs(1,28) >
68.4, Ps < 0.001]. Relative to a cigarette, waterpipe was associated with 4.7 times the number
of puffs and 48.6 times the amount of smoke. Each puff from the waterpipe involved 12.0 times
the smoke as a cigarette puff.
Relative to a single cigarette, a single waterpipe use episode is associated with similar peak
plasma nicotine levels and three times greater peak COHb levels. The first 5 minutes of
waterpipe smoking produced more than four times the increase in COHb as smoking an entire
cigarette (i.e., first-5-minute increase of 145% for COHb versus 34% for cigarette). The
observation that heart rate changes mirrored blood nicotine levels supports the notion that, for
waterpipe and cigarette, nicotine doses were physiologically active. Finally, puff topography
data suggest that, relative to a cigarette, a 45-minute waterpipe tobacco smoking episode
generates over 40 times the smoke volume. Previous analyses of waterpipe smoke demonstrate
that, in addition to CO and nicotine, it contains carcinogenic polycyclic aromatic hydrocarbons,
12 pulmonary disease-causing volatile aldehydes,29 and a variety of heavy metals,10 and, as
indicated by ambient CO elevation in this study, at least some of these toxicants are also present
in environmental tobacco smoke produced by the waterpipe30. Taken together, these data
provide no support for the notion that waterpipe tobacco smoke is less lethal than cigarette
smoke. Instead, despite the lack of waterpipe-specific epidemiologic studies of health risk, the
weight of the evidence provided here and in previous reports1,10,12,23,29 suggests that
waterpipe tobacco smoking is likely associated with many of the same tobacco-caused diseases
as cigarette smoking, including cancer, cardiovascular and lung disease, and nicotine
While peak nicotine concentrations are similar for cigarette and waterpipe conditions, the
relatively long duration of a waterpipe use episode (45 minutes in this study, see also10,13,
31) results in considerably greater effective nicotine exposure. Using a single-compartment
pharmacokinetics model with linear clearance kinetics,32 and a nicotine clearance constant of
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ModelingModeling (1921) - Out of the Inkwell Theatrical Cartoon Series
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- Inkwell Studios
- Out of the Inkwell Theatrical Cartoon Series
- Featuring: The Clown.
- Live-Action Characters: Max Fleischer, Roland "Doc" Crandal.
- Originally Released in October of 1921 (Estimate).
- Originally Released Theatrically.
- Black & White
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Cartoon Summary:
Max draws some ink drops, which coalesce partially, then fully, into The Clown. The Clown seems listless and complains that Max needs to use fresh ink. Max draws the scene on an ice-coated pond and puts The Clown on ice skates to "energize" him. The Clown shows... (more)
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Trading Companies and Distributors
Company Overview of Camping World RV Sales
Company Overview
Camping World RV Sales supplies RV accessories and camping equipment. The company sells its products through its own retail outlets, Web site, and catalogs. Camping World RV Sales offers three convenient venues for purchasing product. The retail stores are stocked with over 8,000 RV-specific products from 4,000 suppliers. Camping World RV was formerly known as Sonny's Camp-N-Travel and changed its name to Camping World RV Sales in 2007. Camping World RV Sales was founded in 1969 and is based in Charleston, South Carolina.
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Charleston, SC 29406
United States
Founded in 1969
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If you want my business, try the novel idea of actually conducting one. Read More »
Home » Tag Archives: customer service
Tag Archives: customer service
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June 25, 2006 in Nation/World on Page A7 Rescuers on Saturday recovered the remains of an amateur explorer who died 41 years ago in a treacherous cavern, closing a memorable chapter in American caving history. The body of …
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Cause I can go solo, like a Tyson bolo
Lyric Meaning
An odd line as Mike Tyson isn't known for throwing Bolos. You get the idea though: Chuck D's rhymes pack a hell of a punch.
In the original version (and the lyric sheet that came with the album), the lyric is Sugar Ray bolo. This makes more sense as the move was a favourite of Sugar Ray Leonard. But Leonard was past his prime by 1987 whereas Tyson was the brand new heavyweight champion.
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Dental insurer Denplan has developed a new quality programme specifically for the oral health needs of child patients.
The Excel Accreditation Programme for Children and Young People is a totally new concept within children's dentistry in the UK.
The growing consensus that no child should ever experience dental decay and as such never needing a filling has led to the development of an innovative child dental programme. The programme radically changes the way we measure child dental health and gives dental staff, parents and the child a much better understanding of their oral health, well-being and risk.
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Watch: Locals reflect on shutdown
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Fair City October 4 - 7
This week on Fair City, Deirdre, Jo and Dermot prepare to say goodbye as they leave for America. Jo and Dermot are heartbroken saying farewell.
Eastenders October 5 - 9
Elaine's toyboy Jason makes himself at home at The Vic, but Linda struggles to warm to him. After an incident upstairs, Linda tells Jason that he needs to leave and reveals to her mum that she can't accept him. Mick senses there is something more to it.
Ros na Rún October 6 - 8
Niamh is arrested, while Berni voices her suspicions to Laoise. Bobbi Lee acknowledges her feelings for Vince.
Coronation Street October 5 - 9
As Sally makes last-minute preparations for her wedding, Sophie is amazed to realise that Tim hasn't backed down and Sally is just banking on him turning up. Sophie tells Kevin that she fears Sally is having a breakdown, refusing to accept the wedding is
Hollyoaks October 5 - 9
This week on Hollyoaks, Dr S'Avage tells Cindy that the strand of hair they found in the Gloved Hand Killer's locker belongs to Tegan.
Emmerdale October 5 - 9
Vanessa tries to hide her dread at having to spend another day at the hospital. She arrives at the vets eager to help, but Paddy and Rhona insist that she should take as long as she needs with Johnny. She leaves frustrated.
Home and Away October 5 - 9
Things are all-go for Zac this week as he finds Charlotte and Hunter a place to live.
Fair City September 28 - October 2
Orla's drinking is causing Wayne and Dolores a lot of concern, while Charlotte finds herself between a rock and a hard place when Decco finds out about her dodgy dealings.
Emmerdale September 28 - October 2
There's a big whodunit in the dales this week with Robert's life hanging in the balance after the shooting.


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H.R.296 - Treatment of Children's Deformities Act of 2003108th Congress (2003-2004)
|Rep. Kelly, Sue W. [R-NY-19] (Introduced 01/08/2003)
|House - Energy and Commerce; Ways and Means; Education and the Workforce
|Latest Action:
|02/21/2003 Referred to the Subcommittee on Employer-Employee Relations.
This bill has the status Introduced
Here are the steps for Status of Legislation:
- Introduced
Subject — Policy Area:
- Health
- View subjects
Summary: H.R.296 — 108th Congress (2003-2004)All Bill Information (Except Text)
There is one summary for this bill. Bill summaries are authored by CRS.


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Here we go again…
In what could only be described as a continuation of its miserable anti-Apple advertising campaign, Samsung has hired people to wear backpack-mounted banners advertising its Galaxy smartphones to folks who queued up for iPhone 6s launch this morning outside the Apple Store in London's Regent Street, The Inquirer reported.
The banners promote Samsung's latest Galaxy S6 edge and S6 edge+ flagships and carry the provocative tagline "The itch to switch just got bigger." In addition, International Business Times is reporting that Samsung even gave queued customers bright blue pillows and bottles emblazoned with the hashtag #NextIsNew.
But wait, there's more. Read More


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Chard & Sweet Pepper Stir-Fry
From EatingWell: May/June 1994
Sweet and tangy hoisin sauce is a delicious base for stir-fried chard and bell pepper. You can substitute escarole for chard; reduce the cooking time to 2 to 3 minutes.
Makes: 4 servings
Active Time:
Total Time:
Nutrition Profile
Diabetes appropriate | Low calorie | Low carbohydrate | Low cholesterol | Low saturated fat | Heart healthy | Healthy weight | High fiber | High potassium | Gluten free |View Our Nutrition Guidelines »
- 1 tablespoon canola oil
- 1 onion, halved and thinly sliced
- 1 large red bell pepper, seeds and ribs removed, thinly sliced
- 3 tablespoons vegetable broth, or water
- 1 1/2 teaspoons hoisin sauce
- 1 pound chard, washed, stems diced, leaves shredded (6 cups)
- Salt, to taste
- Heat oil in a wok or large deep skillet over high heat. Stir-fry onion until they are translucent and slightly soft, about 2 minutes. Add bell pepper, broth (or water) and hoisin sauce; bring to a boil. Reduce heat to medium-low and simmer, covered, for 2 to 3 minutes.
- Add chard stems and leaves, tossing to combine. Simmer, covered, just until the chard is tender, 3 to 5 minutes. Season with salt.
Per serving: 80 calories; 4 g fat (0 g sat, 2 g mono); 0 mg cholesterol; 11 g carbohydrates; 0 g added sugars; 3 g protein; 4 g fiber; 371 mg sodium; 566 mg potassium.
Nutrition Bonus: Vitamin A (165% daily value), Vitamin C (149% dv), Potassium (16% dv), Magnesium (24% dv).
Carbohydrate Servings: 1
Exchanges: 1 1/2 vegetable, 1/2 fat
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Recipe Categories
- Total Time
- 30 minutes or less
- Health & Diet Considerations
- Low carbohydrate
- Low cholesterol
- Low saturated fat
- Heart healthy
- Healthy weight
- High fiber
- High potassium
- Gluten free
- Diabetes appropriate
- Low calorie
- Servings
- 4
- Main Ingredient
- Vegetarian, other
- Preparation/ Technique
- Stir-Fry
- Meal/Course
- Dinner
- Style/Theme
- Entertaining, casual
- Vegan
- Vegetarian
- Type of Dish
- Side dish, vegetable
- Ethnic/Regional
- Asian
- Ease of Preparation
- Easy
- Publication
- May/June 1994


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26 March 2010MAJOR MARKETING CAMPAIGN PROMOTES SCOTLAND'S HERITAGE ATTRACTIONS AND THREE MONTHS FREE MEMBERSHIP INCENTIVE
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Curt tubular hitch for 2003 Chevy Blazer
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... decker tour and that didn't help. However, we happen to meet another family from MN and they suggested the Casements, an enormous underground military defense system of tunnels - starting in 1644. It was over 14 miles worth of tunnels with many openings for cannons. Very narrow stairs and hallways and also a few very large rooms. It was dark and kinda creepy. Overall, in case of an attack, it could hold ...
... 50,000 people about 2000 years ago. We visited a Roman ampitheater that held shows of gladiators fighting to death with one another
or with a bear or lion or a wild boar. It is hard for me to imagine watching this entertainment
Until someone was dead. This outdoor theater held 20,000 attendees, two tunnels for watchers to access the stadium, a room for the wild animals, ...
History of the Romans
Today we got up and had breakfast. It was the typical hostel/hotel breakfast.
Once we ate we went on the tourism hop on hop of tour. The information was pretty dull for a roman city with so many UNESCO sites.
We went to the amphitheatre which was pretty cool. There was the big fighting ring and the gladiator's cells which were tiny.
We also went to the hop ...
Pizza, Cheese and Please!
... fortress style gate as you enter the city center. It is called Porta Nigra. Simply amazing what the Romans could build. There are the ancient Roman baths on the other end of town which is a catacomb of underground tunnels that were unearthed years ago. Trier is such a nice city. Lots of visitors and locals walking around the large pedestrian area full of stores, restaurants and bars. This is the perfect town to spend the night in. Speaking of, I'm off to bed!! 'Til next ...
Roman, Middle Ages and current times
... periods. Check the pictures. There is roman, baroque, and renaissance.
Have I told you we are staying in a Senior center??? Don thought we were staging an intervention! Actually, we understand this is a very exclusive senior home, and the hotel is a part of their business plan. Rooms are big, beds are soft and the showers are huge since they need to be able to put a wheelchair in them. Not bad really. Maybe an idea ...
Other places to stay in Trier
Park Plaza TrierNikolaus-Koch-Platz 1, Trier | 4 star hotelfrom $175
Pentahotel TrierKaiserstrasse 29, Trier | 4 star hotelfrom $119
Mercure Hotel Trier Porta NigraPorta Nigra Platz 1, Trier | 4 star hotelfrom $103
Arcadia Hotel TrierMetzer Allee 6, Trier | 4 star hotelfrom $95
Nells Park HotelDasbachstr. 12, Trier | 4 star hotelfrom $124
Hotel RoemerbrueckeAachener Strasse 5, Trier | Hotelfrom $109
Hotel DeutschherrenhofDeutschherrenstrasse 32, Trier | Hotelfrom $101
Berghotel KockelsbergKockelsberg 1, Trier | 3 star hotelfrom $79
Hotel Villa HugelBernhardstrasse 14, Trier | 4 star hotelfrom $197
Hotel Garni Casa ChiaraEngelstrasse 8, Trier | 3 star hotelfrom $122
Aulmann HotelFleischstrasse 47-48, Trier | 3 star hotelfrom $107
Altstadt HotelAm Porta-Nigra-Platz, Trier | Hotelfrom $172
Residenz am ZuckerbergFrauenstr. 7, Trier | 3 star hotelfrom $119
Hotel Deutscher HofSuedallee 25, Trier | 4 star hotelfrom $116
Blesius GartenOlewigerstr. 135, Trier | 4 star hotelfrom $121
Romischer KaiserAm Porta Nigra Platz 6, Trier | Hotelfrom $172
Astoria HotelBruchhausenstr.4, Trier | Hotelfrom $117
Hotel ConstantinSt. Barbara Ufer 1-2, Trier | 3 star hotelfrom $88
Cityhotel PrimaveraJohannisstrasse 16, Trier | Hotelfrom $101
Hotel Ehranger HofEhranger Str. 207, Trier | 3 star hotelfrom $38
Weinhaus Becker HotelOlewiger Strasse 206, Trier | 4 star hotelfrom $203
Hotel Zur PostRuwerer Strasse 18, Trier | 3 star hotelfrom $103
Hotel Eurener HofEurener Strasse 171, Trier | Hotelfrom $146
PetrisbergSickingenstrasse 11, Trier | Hotelfrom $72
Hotel PaulinPaulinstrasse 13, Trier | Hotelfrom $119
Hotel Restaurant PieperThebäerstrasse 39, Trier | Hotelfrom $81


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Orange Slices: These brawlers are fighting for a shot at the 'big time'
Jacob Rosales, of La Habra, and Israel Cruz, of Fountain Valley, both had their professional mixed martial arts debut last week. It didn't last long. Rosales beat Cruz in a first-round victory and the competition was over for both of them. Rosales now has a win and with it moves a step closer to the big time. &ldquo


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Pop Culture
Natalie Portman's Directorial Debut & Paper Towns' Nat WolffBy Gerri Miller
See how Portman is making her big splash in Israel and don't miss Paper Towns with Nat WolffGo To Pop Culture
Up and Dancing in Circles
I just loved this piece I heard on NPR last night about Abraham Inc., a joint project of classical clarinetist Dave Krakauer, funk trombone player Fred Wesley Jr. (who backed James Brown and Parliament Funkadelic, among others) and one of my favorite young musicians, hip-hop/klezmer maestro DJ Socalled, the performance name of Josh Dolgin. I just think DJ Socalled's music is amazing–and as you know, I love cultural mash-ups.
There's a documentary about Dolgin's music on Youtube, which I knew was coming but didn't realize had finally been released! It's $.99 to view on youtube, here. Can't believe I missed that. I'll try to watch it in the next week and let you know what it's like.
I was very tempted to include at least an introduction to other Jewish-African-American musical collaborations, but the list was immense. Then musicians who are both African American and Jewish–also too long. Another day! Enjoy the video
Note: All comments on InterfaithFamily are moderated. Any comment that is offensive or inappropriate will be removed.
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People tend to check in during these times:
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The Magic of Macy's. Shop, explore and so much more!
Based on 29 votes
People like this place
same as every other Macy's...blah
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Department Store
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Coffee Shop · $
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5935 N Illinois St (at W US 50)
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Revisiting Oligopolistic Reaction: Are FDI Decisions Strategic Complements?
Knickerbocker (1973) introduced 'oligopolistic reaction' to explain why firms follow rivals into foreign markets. We develop a model that incorporates central features of Knickerbocker's story-oligopoly, uncertainty, and risk aversion-to establish the conditions required to generate follow-the-leader behaviour. We find that rival foreign investment will make risk-neutral firms less inclined to move abroad once its rivals have done so. We show that the Knickerbocker prediction relies on risk aversion and derive an expression for the minimum amount of risk aversion needed to generate oligopolistic reaction.
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References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Ottaviano, Gianmarco & Thisse, Jacques-François, 1998.
"Agglomeration and Trade Revisited,"
CEPR Discussion Papers
1903, C.E.P.R. Discussion Papers.
- Gianmarco Ottaviano & Takatoshi Tabuchi & Jacques-FranÁois Thisse, 2002. "Agglomeration and Trade Revisited," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 43(2), pages 409-436, May.
- Gianmarco Ottaviano & Takatoshi Tabuchi & Jacques-Francois Tissse, 1999. "Agglomeration and Trade Revisited," CIRJE F-Series CIRJE-F-65, CIRJE, Faculty of Economics, University of Tokyo.
- OTTAVIANO, Gianmarco & TABUCHI , Takatoshi & THISSE, Jacques-François, . "Agglomeration and trade revisited," CORE Discussion Papers RP 1553, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
- OTTAVIANO, Gianmarco & THISSE, Jacques-François, 1999. "Agglomeration and trade revisited," CORE Discussion Papers 1999041, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
- Aron, Debra J & Lazear, Edward P, 1990. "The Introduction of New Products," American Economic Review, American Economic Association, vol. 80(2), pages 421-26, May.
- Anderson, Simon P & Neven, Damien J, 1991. "Cournot Competition Yields Spatial Agglomeration," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 32(4), pages 793-808, November.
- James W. Friedman & Jacques-Francois Thisse, 1993. "Partial Collusion Fosters Minimum Product Differentiation," RAND Journal of Economics, The RAND Corporation, vol. 24(4), pages 631-645, Winter.
- Ramon Fauli-Oller, 2000. "Takeover Waves," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 9(3), pages 189-210, 06.
- Ramon Fauli-Oller, 2000. "Takeover Waves," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 9(2), pages 189-210, 06.
- Bulow, Jeremy I & Geanakoplos, John D & Klemperer, Paul D, 1985. "Multimarket Oligopoly: Strategic Substitutes and Complements," Journal of Political Economy, University of Chicago Press, vol. 93(3), pages 488-511, June.
- Narayana R. Kocherlakota, 1996.
"The Equity Premium: It's Still a Puzzle,"
Journal of Economic Literature,
American Economic Association, vol. 34(1), pages 42-71, March.
- Narayana R. Kocherlakota, 1995. "The equity premium: it's still a puzzle," Discussion Paper / Institute for Empirical Macroeconomics 102, Federal Reserve Bank of Minneapolis.
- Kocherlakota, N., 1995. "The Equity Premium: It's Still a Puzzle," Working Papers 95-05, University of Iowa, Department of Economics.
- Banerjee, Abhijit V, 1992. "A Simple Model of Herd Behavior," The Quarterly Journal of Economics, MIT Press, vol. 107(3), pages 797-817, August.
- repec:cup:cbooks:9780521171960 is not listed on IDEAS
- Pierre-Philipe COMBES, 1997. "Industrial Agglomeration under Cournot Competition," Annales d'Economie et de Statistique, ENSAE, issue 45, pages 161-182.
- Motta, M., 1991.
"International trade and investments in a vertically differentiated industry,"
CORE Discussion Papers
1991050, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
- Motta, Massimo, 1994. "International trade and investments in a vertically differentiated industry," International Journal of Industrial Organization, Elsevier, vol. 12(2), pages 179-196, June.
- repec:cup:cbooks:9781107001411 is not listed on IDEAS
- James Brander & Paul Krugman, 1980.
"A "Reciprocal Dumping" Model of International Trade,"
Working Papers
405, Queen's University, Department of Economics.
- Brander, James & Krugman, Paul, 1983. "A 'reciprocal dumping' model of international trade," Journal of International Economics, Elsevier, vol. 15(3-4), pages 313-321, November.
- James A. Brander & Paul Krugman, 1983. "A 'Reciprocal Dumping' Model of International Trade," NBER Working Papers 1194, National Bureau of Economic Research, Inc.
- James Brander & Paul Krugman, 1982. "A 'Reciprocal Dumping' Model of International Trade," Working Papers 513, Queen's University, Department of Economics.
- Sushil Bikhchandani & David Hirshleifer & Ivo Welch, 1998. "Learning from the Behavior of Others: Conformity, Fads, and Informational Cascades," Journal of Economic Perspectives, American Economic Association, vol. 12(3), pages 151-170, Summer.
- Horstmann, Ignatius J. & Markusen, James R., 1992. "Endogenous market structures in international trade (natura facit saltum)," Journal of International Economics, Elsevier, vol. 32(1-2), pages 109-129, February.
- Fujita, Masahisa & Thisse, Jacques-François, 1996.
"Economics of Agglomeration,"
CEPR Discussion Papers
1344, C.E.P.R. Discussion Papers.
- Fujita, Masahisa & Thisse, Jacques-Francois, 1996. "Economics of Agglomeration," Journal of the Japanese and International Economies, Elsevier, vol. 10(4), pages 339-378, December.
- Fujita, M. & Thisse, J.-F., . "Economics of agglomeration," CORE Discussion Papers RP 1250, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
- Vincent Aussilloux, 1998. "Investissement direct à l'étranger et entrée séquentielle sur le marché," Revue Économique, Programme National Persée, vol. 49(3), pages 607-615.
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Stalham, Norfolk
Real reviews, from customers like you.
Pity about the weather but as first timers our experience on the Broads has given us the 'bug' and we are already thinking about returning. Getting used to handling the boat was a challenge to start with but the staff at Richardsons boatyard in Stalham were really helpful and after our tutorial and a couple of hours motoring along a couple of us had a real feel for it. Loved the peace and tranquility even though it was fairly busy on the river. Great to see the wildlife and natural habitat going past at 4 mph. Had to stop off at pubs along the way but the map we were given helped us work out where to moor up. Next time would like a boat with a high driving position which could be covered in case of rain. Having 2 loos/shower was good for 2 parties on board but be prepared for a bit of a squeeze below decks. Galley was good had power for IPads/pods. Didn't use TV/DVD. Hired boat for 3 nights and went to Wroxham and Acle. Filled up with water once. Loved it. Will definitely go again.
Great holiday made even better by fab weather !
Only complaint was cleaner came barging in door on last morning at 840am whilst I was getting changed in bedroom didn't knock and we didn't have to be off until 930am !
Very poor sleeping arrangements for those sharing the supposed double bed plus single cabin . Double bed tiny and tapering at the end so really only big enough for 1 normal sized person. Boat generally small and cramped ; not big enough for 5 people; seats hard and uncomfortable. Having said that , boat handled well . Would suit fishermen who don't care about comfort or space!
An excellent weeks cruising enjoyed by all on board
If you plan to cook onboard, check the dishes and pans available.
A well layed out boat with plenty of space to move around,that was also easy to handle. Our groups only niggle was the low headroom in both shower /toilets. But still worth the money.
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Our Current Weather
Shipping Seasons
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About Gardens of The Blue Ridge
We are a family owned-and operated company now in our 4th generation. In fact, we are the oldest licensed Nursery in North Carolina, serving customers from across the U.S. and around the world. Read More
Our periodic newsletter, packed with news and reviews of the
Visit our SPECIALS page for great savings!!
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Fall shipping season has begun!! Now is a great time to plant for spring flowers. We have a great selection of wildflowers after a good growing season here at the nursery. Save money by purchasing mature bareroot plants. Our bareroot plants have been raised in our beds here at the nursery and are nice, healthy and most will provide you with magnificent blooms next year. The advantage of Fall planting is the root growth the plants are able to establish during the fall – this allows for the plants to be ready to flourish once spring arrives.
We are also stepping up our seedlings into larger pots to get them rooted in for next year sales.
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T4C is Going Back To School!
Posted: Jul 31 2015 in Realmud
School Days, School Days, specials from us to all you days! (updated 8-28-15)
Welcome! to all the eA People
Posted: Jul 24 2015 in 4th Saga
Want to Welcome all the eA people for a t4c reunion.
Content Comes to T4C.com
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We have updated t4c.com to include more of the original content plus server specific content into our site.
Happy 4th of July, Realmud!
Posted: Jul 04 2015 in Realmud
Realmud Staff wishes everyone a fun and safe 4th of July Weekend!
2015 Summer Screenshot Contest
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It's that time again, Realmudders! Grab those cameras! Realmud Staff is proud to present the 2015 Third Annual Summer Screenshot Contest!
Spring Cleaning on Realmud
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We've been spending some time cleaning up on Realmud a bit. Here are the latest changes.
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Saga Staff and Dialsoft Staff wants to wish everyone a Happy! Easter.
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Happy! Spring! Starting Monday March 23 Monday Manic Madness will begin.
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Happy Valentine's Day From Realmud
Posted: Feb 13 2015 in Realmud
We at Realmud would like to wish everyone a Happy Valentine's Day! And as a special celebration bonus....


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Birchwood House
from £136 /night help Price for guests, Nights approx:
from £136 /night help Price for guests, Nights approx:
Estimated nightly price based on a weekly stay. Contact the advertiser to confirm the total cost.
Cottage / 8 bedrooms / sleeps 15 Home 1208075
Availability Your dates are available
Cottage / 8 bedrooms / sleeps 15
|Key Info
Birchwood House is a detached stone cottage in the wooded hamlet of Ramshorn, just 2.5 miles from the Alton Towers theme park. There are two ground floor doubles, two doubles on the first floor, a single, and adult bunk bedroom and two twins. There are also two wet rooms on the ground floor, and a bathroom and shower room on the first floor. Downstairs is a spacious open plan living area, with a well-equipped kitchen, dining area and a sitting area as well as an additional WC and utility room. Outside, the large lawned garden has a patio and hot tub, perfect for relaxing after a day exploring the area. There is ample off road parking. With Alton Towers and the delights of the Peak District National Park so close, Birchwood House makes a great base for family or friends.
|Sleeps up to 15, 8 bedrooms
|Family friendly
|Suitable for children over 5
|Pets welcome, No smoking at this property
Features and Facilities
|Dishwasher, Washing machine
|8 bedrooms, 4 bathrooms of which 4 Family bathrooms
|Double beds (4), Single beds (1)
|High chair
|Private garden
|Parking, Not suitable for wheelchair users
|Further details
Oil central heating with woodburning stove. Electric cooker, microwave, 2 fridges, freezer, washing machine, dishwasher, TV with Freeview, DVD. Fuel, power & starter pack for woodburning stove inc. in rent. Bed linen & towels inc. in rent. Highchair on request. Lawned garden & patio with furniture & BBQ. Hot tub. Ample off road parking. Sorry, no smoking. Two well-behaved dogs welcome at £25 pppw. Shop & pub 3 miles. Alton Towers 2.5 miles. Note: Not all rides/attractions at Alton Towers open all year round - check with theme park for further information. Note: No stag/hen or similar. Note: Depending on previous booking, hot tub may not always be at full temperature on arrival, please contact owner for more information.
The Staffordshire region
The ultimate in "year-round" appeal, the Peak District offers countryside, picturesque villages and magnificent scenery. It touches upon six counties and encloses 555 square miles of open moorland, flowing rivers, and wooded dales.
The lovely wooded hamlet of Ramshorn is only a 15 minute walk from the entrance of Alton Towers, the popular theme park. There are so many attractions and activities at the park and it caters for all ages and abilities. The nearby market town of Ashbourne is 12 miles away and offers a variety of shops and places to eat and has a rich history, making it an interesting town to explore. Chatsworth House and Park and the halls of Haddon and Hardwick are all within reach as are a myriad of fascinating little towns and villages such as Bakewell, Hartington, Tissington and many more. There are walks aplenty, golf, cycle trails and even rock climbing in this fabulous area making it a wonderful base for a family holiday.
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Sykes Cottages (Property Manager Sykes Holiday Cottages)
- 7 Years listed
Calendar last updated:26 Jun 2015
Based in United Kingdom
- English


text:
Jil Sander
classic formal shirt
Out of stock
Unfortunately this item is out of stock
White cotton blend shirt from Jil Sander featuring a short classic collar, a front button fastening, long sleeves with button fastening cuffs and a curved hemline.
Item ID: 10468607
- Height:
- 191
- Bust/Chest (cm):
- 93
- Waist (cm):
- 77
- Hips (cm):
- 98
- Model is wearing size:
- 40
Models Measurements
- Composition
- Cotton 97%
- Composition
- Spandex/Elastane 3%
- Machine Wash
- Brand Style ID
- Lm740826mb253472
Your order will be shipped directly from the boutique to you. Farfetch ships worldwide using DHL and UPS, and you will be able to track your order at any time. The cost of shipping your order will be calculated at the checkout.
Import duties information
Delivery duties are included in the item price when shipping to all EU countries plus USA, China, Canada, Switzerland, Singapore, Australia, Japan, South Korea, Kuwait, Qatar, U.A.E, Saudi Arabia and Taiwan.This means all import duties are included in your order, so the price you see is the price you pay. You will not receive an additional duty bill from the courier to receive your shipment. If you are ordering from within your own customs zone or country, import duties will not be applicable anyway, however you may have to pay VAT or local Sales Taxes where applicable (for the UK and USA these are included at the checkout).
Delivery duties are not included in the item price when shipping to all other countries. This means you may be liable to pay import duties on receipt of your order.
Free returns pick-up
You have 14 days from receiving your order to return the item to the boutique using our free returns pick-up service. We strongly recommend that you book your free returns pick-up within 7 days of receiving your order to ensure that it arrives back to the boutique in time. Please note for standard orders we can only collect returns from the same country to which your order was delivered. For click and collect orders we can collect your return from the country your order was delivered to and also the country of the original boutique you ordered from. We are unable to accept returns of earrings for hygiene reasons. We are also unable to accept returns of fine Jewellery. Click here to read our full returns policy.
Minimalism, simplicity and quality - or 'less and luxe' - are the cornerstones of Jil Sander and have elevated the label from its modest beginnings in Hamburg to international powerhouse producing timeless, clean-lined classics.
Mantova , Italy
Mantova was a centre of the Italian Renaissance; now it's at the heart of another art form. The small northern city is home to one of the longest standing fashion boutiques in the country, where Bruna Casella and Stefano Gozzoli, the husband-and-wife team behind Bernadelli, aim to nurture new and emerging designers.


text:
Opportunistic Relaying in Two-Way Networks
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Date Added: Jul 2010
Format: PDF
This paper is on opportunistic relaying for networks with two-way communications. For a network with two users that exchange information with each other through multiple amplify-and-forward relays, the authors propose a single-relay selection scheme. Since the communication is two-way, the proposed scheme aims at optimizing the worse performance of the two communication tasks between the pair of users. An approximation on the Cumulative Distribution Function (CDF) of the effective worse Signal-to-Noise Ratio (SNR) of the two users using the proposed scheme is obtained, based on which the BLock Error Rate (BLER) and the diversity order of the two-way network are derived.