The model included Medicare and commercial health plans with 1 million hypothetical members. In the model, NGS saved as much as $2.1 million for Medicare, and more than $250,000 for commercial insurance providers. The study will be presented at the upcoming 20 ASCO Annual Meeting in Chicago.
"The field of lung cancer treatment is moving at a rapid pace, and we need to fully characterize genomic changes to determine the best treatment for patients shortly after they are diagnosed," said lead study author Nathan A. pennell, MD, phD, co-director of the Cleveland Clinic Lung Cancer program. "Today, many treatment decisions are guided by the presence or absence of certain genetic changes in a patient's tumor, and I expect that several more genes will be identified in the near future. Therefore, it becomes even more imperative to find a cost-effective gene test that can quickly identify a large number of gene mutations that can be targeted with treatments Varicella associated pneumonia."
Genetic testing of the tumor is crucial to guide optimal treatment for NSCLC. Many different tests are available today, but there is no accepted standard for when and how the testing should be performed. The authors designed their model to determine which gene testing approach is most cost-effective and time-efficient. The model uses data from the Center for Medicare and Medicaid Services (CMS) and U.S. commercial health plans to estimate costs for each modality.
The known genes that are altered in NSCLC include EGFR, ALK, ROS1, BRAF, MET, HER2, RET, and NTRK1 (of those, EGFR, ALK, ROS1, and BRAF can be targeted with approved treatments). The other genetic changes can be targeted with investigational agents that are being tested in clinical trials. Newer tests also look at pD-L1 expression to predict if a tumor is likely to respond to immunotherapy.
In the model, patients with newly diagnosed metastatic NSCLC received pD-L1 testing and testing for the known lung cancer-related genes using one of four different approaches:
- Upfront NGS (all eight NSCLC-related genes and KRAS were tested at once)
- Sequential tests (one gene at a time was tested)
- Exclusionary KRAS test, followed by sequential tests for changes in other genes if KRAS was not mutated (if KRAS mutations were found, the tumor was not tested for other mutations because it is rare to have more than one of these genes mutated in an individual lung cancer)
- panel test (combined testing for EGFR, ALK, ROS1, and BRAF), followed by either single-gene or NGS testing for changes in other genes
The model assumed that some participants who did not receive upfront-NGS might need to have another biopsy to test for additional genes (due to insufficient amount of tissue from the first biopsy) and that the need for re-biopsy would be lessened with upfront, comprehensive NGS testing. It also accounted for the time it took to get test results back after biopsy samples were sent to the lab, costs for each type of gene testing, and the estimated number of people with metastatic NSCLC in the U.S. that could be tested.
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Key Findings
Based on the number and age of people with metastatic NSCLC in the U.S. annually, the researchers estimated that for 1 million-member health plans, 2,066 tests would be paid for by CMS and 156 would be paid for by commercial insurers. The model also estimated that it would take two weeks for the NGS and panel results to be processed, while it would take 4.7 or 4.8 weeks to process the exclusionary and sequential tests, respectively.
Applying economic factors to CMS payments, NGS testing would save about $1.4 million compared to exclusionary testing, over $1.5 million compared to sequential testing, and about $2.1 million compared to panel testing. For commercial health plans, NGS would save $3,809 compared to exclusionary testing and $250,842 compared to panel testing.
Next Steps
A limitation of this study is that it the model is based on several assumptions. The authors' next step is to look at actual health systems and evaluate these differences, testing cost-efficiency in a real-world setting.
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Staff at the Open University have passed a vote of no confidence in its vice-chancellor, Peter Horrocks.
Members of the institution’s branch of the University and College Union (UCU) said Horrocks’s position was untenable after he claimed the OU had allowed academics to get away with not teaching for decades”.
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Horrocks, who later apologised for the comments, had already angered staff over his plans to reduce the number of staff and cut courses, which were revealed in the Guardian last month.
The plans, which aim to save £100m from an annual budget of £420m, include a reduction in the number of courses, qualifications and modules of more than one third. A voluntary redundancy programme is due to be launched on 9 April.
Lecturers say the proposals are so significant they will destroy the OU as we know it” and reduce it to a digital content provider”.
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.The UCU says Horrocks no longer commands the respect or authority of staff or the university council.
At an emergency meeting on Thursday, members passed a motion which said: This general meeting has no confidence in our current vice-chancellor, or in his plans and intentions for the future of our university.
On the basis of recent events, he has shown that he does not understand the university’s teaching model, nor the importance of the OU’s research base. We believe the best way of avoiding damage to the public image of the OU is for the VC to step down as soon as possible. We therefore call upon the vice-chancellor to resign.”
Lydia Richards, a regional official for the UCU, said it was time for a change at the top” and a halt to the cuts.
She said: Staff have made it quite clear what they think about the vice-chancellor’s recent behaviour. The Open University is a magnificent institution and it needs someone at the helm who understands its unique position and who will talk up its brilliant staff.”
An OU spokesman said the university was midway through an ambitious programme to transform the way we teach and support our students”.
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.He said: The plans have sparked a lively internal debate as well as a degree of concern. We can confirm that these concerns will be discussed more thoroughly at a special meeting of the university council and later at the OU’s academic governing body, the senate.”
Quality is king, standard first". The key to achieving the connotative development of higher education is to firmly grasp the "outline" of improving quality. The construction of educational standards is the basic project to improve the quality of education. The Ministry of Education has recently released the National Standard for Undergraduate Professional Teaching Quality (hereinafter referred to as the National Standard”), which is the first national standard for teaching quality of higher education released to the whole nation and the world, and the importance of talent cultivation worldwide. Consistent with the development trend, it has an important symbolic significance for the construction of a Chinese-characteristic, world-class quality standard system for higher education.
The foundation of colleges and universities lies in Lideshuren. To run a good university in our country and establish a world-class university, we must firmly grasp the core point of comprehensively improving the ability to train people. Undergraduate education is the foundation and foundation of higher education, and major is the basic unit and basic platform for personnel training. To improve the ability of personnel training in colleges and universities, we must establish national standards for undergraduate teaching quality, implement government standards management, colleges and universities to standard education, society to standard supervision, use standards to strengthen guidance, strengthen construction, strengthen supervision,Hep A vaccines Study demonstrates safety and immunogenicity of live-attenuated and inactivated formulations.
The "National Standard" was entrusted by the Ministry of Education to develop the teaching guidance committee of higher education institutions. The number of experts and professors involved has reached more than 5,000, including more than 50 academicians of the two academies and well-known experts. After more than four years of research and development, it has organized hundreds of workshops and soliciting opinions. The "National Standard" released this time covers all 92 undergraduate majors and 587 majors in the undergraduate professional catalogue of colleges and universities, involving more than 56,000 professional universities in the country,As one of the top unversities in Hong Kong, hong kong universities is committed to facilitating students' all-round development as well as supporting their professional competence and academic excellence.
According to reports, the "National Standard" grasps three major principles: First, highlight the student center. It focuses on stimulating students’ interest and potential in learning, innovating forms, reforming teaching methods, and strengthening practice, and promoting the transformation of undergraduate teaching from good teaching” to successful learning”. Second, it highlights the output orientation. Actively adapt to the needs of economic and social development, scientifically and rationally set personnel training goals, improve personnel training programs, optimize curriculum settings, update teaching content, and effectively improve the goal attainment of talent cultivation, social adaptability, conditional support, quality assurance effectiveness, and results. Satisfaction; third, highlight continuous improvement. Stressing that good teaching work must establish a school quality assurance system, we must organically combine normal monitoring with regular assessment, timely evaluation, timely feedback, continuous improvement, and promote the continuous improvement of education quality,ETG, based in Hong Kong, offers world-class video surveillance security system ranging from Wireless IP camera to video management software and provides professional and reliable monitoring solutions for the retailers.
The myth goes that the true artist is born, mysteriously fully formed in their own exceptional talent. A second myth holds that creativity thrives in adversity; a third that creative sorts are somehow morally wayward, something to be tolerated as long as the results are diverting, but not a model for citizenship. These three combine gloriously in the icon of a lascivious and poverty-stricken Mozart, writing sonatas while still in the womb.
It seems increasingly clear that the British government has bought into this fiction. What other explanation can there be for the baffling disconnect between its industrial strategy, which prizes the creative industries as a priority sector, and an education policy that is deliberately squeezing creativity out of our children’s learning Dream beauty pro?
At the heart of the government’s most recent industrial strategy, this simple statement stood out to me: Maths should not be perceived as an exceptional talent; it is a basic skill that can be mastered with the right teaching and approach.” This laudably pragmatic approach, reflected in education policy, supports and populates our financial, scientific, engineering and tech industries. During these uncertain times we must feed any golden geese we have, and a steady stream of qualified graduates and school-leavers is the strongest investment for the future we can make. So how is it that when it comes to the creative industries one of the most bounteous golden geese in this country’s history, the government doesn’t take the same approach?
The creative industries are the fastest growing part of the UK’s economy, one of the few sectors in which we are celebrated world leaders and in which there is huge employment growth. We are the world’s third largest cultural exporters, after China and the US. Last year the creative industries were worth £92bn to the UK economy. The sector returns more golden eggs every year to the Treasury than the automotive, oil, gas, aerospace and life science industries combined, and for every £1 invested in subsidy the government gets £5 returned in taxes.
These figures are not disputed, nor even particularly new – everyone knows that our writers, musicians, actors, IT innovators, fashion designers, architects and film technicians are world-class. They are all over the world, leading their fields.
It would seem careless in the extreme to endanger this success story. Particularly if the carelessness were based on myth.
At the National Theatre, we work in partnership with schools all over the UK, as most of the theatres across the country do; and, like them, we have had a series of consultations with headteachers, hearing first-hand about the changes in our state education system Dream beauty pro.
Since 2010 there has been a 28% drop in the number of children taking creative GCSEs, with a corresponding drop in the number of specialist arts teachers being trained. Hardly surprising when the Ebacc, a government school performance measure focusing on a core set of academic subjects studied for GCSE, does not include a single creative discipline. Add the funding squeeze into the mix, and the result is that the practice and study of drama, design, music and art are rapidly disappearing from the curriculum. The pipeline of talent into the industry is being cut off by the government’s misguided sidelining of creativity in education.
This is the opposite of what happens in our private schools, our top universities, and the state schools where inspired teaching and leadership pulls determinedly against the prevailing and constrictive tide. The three theatres at Eton are among the best equipped in the country because the school knows this is a crucial aspect of its offer. Creative confidence brings initiative and freedom of thought, an understanding of teamwork and communication that sits at the heart of a dynamic and successful working life. Both Justine Greening, and now her successor as education secretary, Damian Hinds, have commendable track records supporting social mobility. So why is the government pursuing creative education policies that actually exacerbate inequality of opportunity? Wasn’t unrelenting inequality part of the backdrop of the Brexit vote? Isn’t it the opposite of what Theresa May’s society that works for everyone” claims to stand for?
Maybe there’s a theory that if the whole sector is covered adequately within the private system, there is no need to add to the demands on the already-stretched state system. But whatever the reason, the result is that another myth, deeply embedded in our peculiarly British psyche, is being reinforced: that culture and creativity belong naturally to the elite, that they are not for everyone Dream beauty pro.
And this problem affects us all, because the whole economy needs creative skills. According to the World Economic Forum, by 2020 creativity will be in the top three most important skills for future jobs, alongside complex problem solving and critical thinking. Which are skills innate to and honed by a creative education.
Right now I’m in rehearsals for Macbeth, in a room full of actors, designers, stage managers, musicians, technicians and craftspeople. Like me, many of them would not have found their way to that room, were they at school today. Throughout my varied education, I was helped by teachers who had both the vision and, crucially, the space to create opportunity on and off the curriculum. As well as studying for my O-levels, I spent my time outside school playing the violin in youth orchestras, and scoundrels or old men in youth theatres.
And in my career I have known thousands of fellow practising artists – many regarded among the most talented” people in the world. Almost all have got there by two means: elbow grease and support for their creativity. This is what we have learned: just like maths, creativity should not be perceived as an exceptional talent; it is a basic skill that can be mastered with the right teaching and approach”,Reckoned as one of the top design universities with diversity of programmes, polyu fashion and textile, as well as applied science programme, which is committed to be a hub for innovative design education in Hong Kong.
Don’t believe the myths: do the maths. The government should scrap the Ebacc in its current form, and work with the leaders we have – in the arts, in science, in innovation – to equip our young people with the skills they need. We need an education system fit for the 21st century, one that champions this country’s creativity as the foundation of its economic health.
Okehampton to Belstone, Devon
Length 10 miles
Time 5 hours
Start/finish Okehampton Camp/Belstone
Google Maps Start/Finish
Grade Moderate (difficult in bad weather)
Refuel The Tors Inn, Belstone
Just a short way past the military camp north of Okehampton, the old country road passes between two of west Devon’s most walkable high places. Either can be attacked on its own as a two-to-three-hour stroll with a picnic, but for a good five-to-six-hour pre-lunch winter hike, I suggest doing both.
From Okehampton Camp, head in a slightly south-westerly direction to begin the long, slow hike up to Dartmoor’s second-highest summit, Yes Tor. This actually feels more prominent than High Willhays, which is your next target and is, at 2,039 feet (621m), the highest point on Dartmoor – and thus the highest point in the land south of the Brecon Beacons.
I live in South Devon and am more used to the photogenic but popular tors on my side of the moor (Haytor, Hound Tor, etc). The draw of the north of the county is that it feels more expansive and the skies are somehow bigger – and walkers are spread out, instead of congregating on rocks to do selfies or parkour.
From High Willhays, head down to the country road and curve round towards the stegosaurus-like granite outcrops of Higher Tor and Belstone Tor, with the rushing River Taw below you on the right.
Scramble slowly around the tors for half an hour to enjoy views back over Okehampton, before heading down past the Nine Stones Circle to arrive at The Tors Inn, a quiet and cosy little pub in Belstone that does a range of pies (stilton and leek is delish!), pasties with chips, ploughman’s lunches, baguettes and a full roast on Sundays. It also has rooms from £40pp per night.
• Chris Moss, writer, based in Totnes
Frogham to Fritham, HampshireLength 11 miles return
Time 3 to 4 hours, excluding time spent at the pub
Start/finish Abbots Well Car Park, Abbots Well Road, Frogham, near Fordingbridge, New Forest
Google Maps
Grade Moderate
Refuel Royal Oak, Fritham
Frogham to Fritham and back: even if you forget the pub, the music of the place names is alluring. The view at the start of the walk stretches for miles over rough, dark country: undulating heath, patches of rusty bracken, wooded valleys; not a house in sight, nor any signs to Fritham, but a footpath leads downhill and crosses a beautiful stream. A green pasture lies beyond. In November, the entire area was covered in pale, spider-sewn filaments, inches above the ground, billowing and shimmering in the low sun.
The tramp ahead is a leg-stretching, lung-expanding journey into the heart of the New Forest. The latter part of the route that I take – there are several possible – runs through a wild wood, a damp tangle of hollies and oaks. You emerge into open heathland, invigorated by the prospect of beer. Dating from the 17th century, with three snug rooms, the Royal Oak is a proper walkers’ pub – good food for a winter’s day, nothing too fancy. Try the ploughman’s, which on my last tasting came with two vast slabs of a nutty local cheddar.
Now for the best bit. Half a mile before the pub, on Fritham Plain, there’s a quiet pond surrounded by emerald-green sward. It’s not big, just a rough circle of shallow water around which a few shaggy ponies and some cattle usually graze, but it’s a thing of wonder. No stream feeds it, and there seems no reason for its existence. It feels like a holy site, a pond dropped from heaven. No other pond in England that I know is as magical as this.
• Christopher Nicholson, author of Among the Summer Snows (September Publishing)
Firle, East Sus
Length 4 miles
Time 2 hours
Start/finish Firle village car park
Google Maps
Grade Easy
Refuel The Ram, Firle
So many walks on my part of the Sus Downs take in the high points – Kingston Ridge, Mount Caburn, Ditchling Beacon – but in winter I like to swap midsummer hikes among the skylarks and paragliders for stumbles over ploughed fields, studded with flint and pheasants.
This circular route from the village car park begins on fairly bland open parkland towards Firle Place, but soon delivers you into the best textures of Sus: a beautiful flint and brick cottage by a chalky lane has the bridleway running through its garden, inviting a brief thrill of pretend ownership.
As you walk across the fields towards Charleston, once home to painters Vanessa Bell and Duncan Grant, startle the crows by saying poems aloud, as Virginia Woolf did whenever she walked this way to her sister’s. Then, at the farmhouse, rest a while and read about its journey from ruin to internationally renowned literary venue, before pushing on towards Maynard Keynes’ Tilton House, wondering at how many miles he and the rest of the Bloomsbury set did around art and amorous pursuits.
The walled road which drops back into the village takes you past Firle Estate’s beautifully preserved blacksmith, carpenter and paint shops, adding to the walk’s gentle, last-century sensation.
Candle-lined windows and three fires await at The Ram. It gets busy even on a winter weekday, so book a table in the snug and settle down with seasonal treats such as celeriac soup followed by pan-seared Sus pheasant breast (mains from £12).
• Tanya Shadrick, writer-in-residence at Pells Pools, Lewes and editor of Watermarks: Writing by Lido Lovers & Wild Swimmers (Frogmore Press)
Oxford Canal
Length 6 miles
Time 3 hours
Start/finish Oxford railway station
Google Maps
Grade Easy
Refuel The Plough, Wolvercote
There and back again can be a boring way to walk, but along the Oxford Canal there is no risk of that, as history, natural and otherwise, is everywhere.
Arriving at the station, ignore the first signs taking you to the canal and walk into town, until you come to the bridge over the canal and the start of the towpath on your left.
Residential narrowboats accompany the early stages of the walk, and soon you are into Philip Pullman Gyptian territory. Jericho used to be industrialised, and I can remember Lucy’s ironworks casting wild lights at night. Now it is housing. At this point you could take a detour out to your left, onto Port Meadow – a great, shallow ice-rink if it freezes.
This 78 mile-long canal was a crucial coal link between the east Midlands and London, but now it is a wonderful line for wildlife, and us, to follow. On more than one occasion I’ve found otter spraint beneath the beautifully humpbacked bridge at Wolvercote.
I tend to aim for Duke’s Cut, where friends used to live on their narrowboat, just beyond the elevated ring-road. The otters make good use of this linescape, bypassing the risk of the road.
Returning to the station, stop at The Plough in Wolvercote, just over the bridge (be careful not to tread in the otter poo). A plate of mucky chilli chips” – chips covered in vegetable chilli and topped with cheese (£9.95) – will keep you warm as you head home.
• Hugh Warwick is the author of Linescapes, a look at the ecological consequences of the lines we have drawn across our landscapes (Square Peg)
Bure Valley Circle, NorfolkLength 5 miles
Time 2 hours
Start/finish Horstead
Google Maps
Grade Easy
Refuel The Recruiting Sergeant
The Bure Valley is magical. It straddles rural Norfolk, from Melton Constable through the Broads to Breydon Water. Big skies, freshwater grazing marsh, woodland, fen, churches, a narrow-gauge steam railway and odd village names – it lacks nothing.
Park in Horstead, find the mill pool, then track the Bure up to Buxton with Lamas and back, changing river banks with the path. The valley is gentle and the pasture lush, even in winter. Dogwood, sweetcorn brushes and freshly turned soil are rich contrasts to the flashing greys of the river itself. Mayton Bridge, built as the Long Parliament was called in 1640, and the Tudor glory of Hautbois Hall are favourite waymarks.
In summer, you can drop your bags and find a spot to enter the river and swim. In winter the barn owls, marsh harriers and brown hares break the peace, as do the less glamorous but more reliable cattle, sheep and swans that roam the valley.
The approach to Buxton is glorious. The river bends, holds an island in its stream and the white mill towers above the race that gave the village its purpose and drove the great water wheel. Turn back here and return to Horstead, and the Recruiting Sergeant, whitewashed, pantiled and beamed. There’s pork from Swannington and longshore cod from Yarmouth way. And local gins for the really cold days (when someone else is driving). They have a deli over the road and rooms, should you choose never to leave.
• Chris Gribble, CEO, Writers’ Centre Norwich
Longshaw Estate to Fox House, Peak District
Length 6 miles
Time 2 hours
Start/finish Longshaw Estate Car Park
Google Maps
Grade Easy
Refuel Fox House
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This walk takes in some of the Peak District’s gentle but atmospheric eastern gritstone edges, traversing White Edge to Curbar Gap and returning along Curbar and Froggatt. There are good tracks and it’s hard to get lost, even in bad weather.
The starting point is a short journey from Sheffield, and a bus stops directly outside the Fox House pub. The route crosses part of the Longshaw Estate then climbs up White Edge. I’ve been coming to this part of Derbyshire to run and rock climb ever since I was little.
As you walk above Curbar, you’ll hear the sound of clinking karabiners and climbers calling to each other below. This moorland walk feels surprisingly varied. Early in the mornings, or at dusk, it’s not unusual to glimpse red deer in the distance, near the trig point along White Edge. You also pass some of Derbyshire’s intriguing Companion Stones, inscribed with poetry – a modern tribute to the Guide Stoops, which used to help travellers navigate moorland hundreds of years ago.
Afterwards, refuel at Fox House, a gastropub where decent wine, real ale and a roaring fire await. If you prefer your pubs more traditional, The Grouse (which you pass en route) is nearby and would make a perfect pit stop – the beer garden has excellent views.
• Helen Mort is a poet and editor. She edited One for the Road: An Anthology of Pubs and Poetry with Stuart Maconie (Smith/Doorstop)
Pass of Aberglaslyn and Cwm Bychan from Beddgelert, Snowdonia
Length 4 miles
Time 3 hours
Start/finish Beddgelert
Google Maps
Grade Moderate
Refuel Tanronnen Inn
At first glance, with its stone-and-slate charm, Beddgelert could be Wales’s answer to the chocolate box cosiness of the Lake District. But a short walk from the village takes you into Aberglaslyn Pass, where the exhilarating fisherman’s path” meanders feet above the rocky rapids of the Afon Glaslyn; and in Cwm Bychan the hard-bitten industrial past of the area is starkly visible. Few walks pack as much of Snowdonia’s geological, ecological and cultural flavour into one manageable mouthful LPG M6.
Stock up in Beddgelert (and pay the obligatory visit to the grave of Gelert, the ill-fated loyal hound who gives the village its name and fame) then head south to Aberglaslyn Pass. The path through the narrow gorge is wonderful, winding around boulders and buttresses, but requires due care – a mistimed trip in the wrong place could send you (or an exuberant child) headlong into the river.
At Pont Aberglaslyn, savour the odd thought that before the construction of the Porthmadog Cob (sea wall) in 10, some five miles away, the tide would have lapped against this bridge. In Cwm Bychan, lush woodland gives way to an atmospheric upland valley where the derelict pylons attest to a bygone age – they used to transport copper ore. From Bwlch-y-Sygyn, if you have time and energy, extend the walk to include an eye-opening visit to the Sygun Copper Mine. Back in Beddgelert, head for the pleasant Tanronnen Inn for good Robinsons beer.
• Carey Davies, hill walking development officer for the British Mountaineering Council
Whitby to Staithes, North Yorkshire
Length 10 miles
Time 5 hours
Start/finish Whalebone arch, Whitby/Cod & Lobster, Staithes
Google Maps Start/Finish
Grade Moderate
Refuel Cod & Lobster
Winter intensifies everything. During these cold months, the sun, peeping over the horizon for a few short hours, adds a contrast and vividness to the landscape. The greens seem greener and the blues bluer.
I gravitate to the coast for much of my winter walking. The drama that plays out is exhilarating, and the worse the weather the more powerful the narrative. Along this 10-mile stretch of North Yorkshire coast, the North Sea demonstrates its fearsome power against the huge cliffs. The birdlife and animals have to work harder, too. Little auks have been seen sheltering from the white-capped swell, while more common winter birds, including the red-throated diver and the great crested grebe, bob on the waves. Occasionally, a harbour porpoise can be seen too.
The walk starts in Whitby, by the famous whalebone arch, and heads north along the Cleveland Way, one of the 15 National Trails of England and Wales. It’s a gentle start to the day along the prom above Sandsend beach, but the views back across Whitby and its Abbey are every bit as evocative as Bram Stoker captured in Dracula LPG M6.
The cliff-top trail soon gains height above the battered rocks far below. As it turns west around Kettleness, the pleasingly ramshackle, red-roofed cottages of Runswick Bay come into focus. Climbing up again, the path becomes more exposed. In the sharp wind off the North Sea – or worse, biting rain – you might try to pretend it is invigorating, but your mind may well have wandered to thoughts of the pub.
This route saves the best views for last. Boulby Cliffs, the highest on England’s east coast, dominate the scene further north, but this walk ends at the fishing port of Staithes. The Cod & Lobster can be seen from up on the cliff, standing defiantly against the harbour. It’s a short jog down for a well-earned pint or two (although when the swell is high and a storm is in, it’s advised to use the rear door in case you get a bit wet).
It’s an effortlessly friendly pub – find the astonishing photos from a 1953 storm that tore the front of the inn. Today, it’s convivial and cosy, with a beer list worthy of mention in Camra’s Good Beer Guide; a place to settle into, order from the seafood-laden menu and watch the wind clatter the boats in the harbour through the windows.
• Daniel Neilson, author of Wild Pub Walks, published by Camra Books
Angle Tarn from Langdale, Lake District
Length 6 miles
Time 3 hours
Start/finish The Old Dungeon Ghyll
Google Maps
Grade Easy/Moderate
Refuel The Old Dungeon Ghyll
Drawing you away from the chocolate-box shops and crowds of Ambleside, the B5343 floats into the quiet, wide valley of Langdale. Wild piked, jewelled with hidden pools at its heights, this part of the Lake District provides an accessible but uncrowded retreat. Here, I’ve ghosted the lyrical, dirtbag memories of 60s nature writer and mountain guide Gwen Moffat, who spent seasons sleeping rough, thawing out in the pub and exploring the remote fells that still hold their silence – no phone signal, no 4G.
Begin the walk at the Old Dungeon Ghyll: go behind the pub to find the paved path that leads to the circlet of crests at the end of the valley. Look for climbers roosting in the cracks on Raven Crag as you head onto the Cumbria Way. Follow the river, looking out for plunge opportunities.
At the bridge, turn left and head up the path that climbs beside, and occasionally into, Stake Gill. Skip around the rolling mounds of moss at the back of Black Crag and look into uninhabited Langstrath bowl. Store that space for next time, turn left and trace the ridge behind Buck and Rossett Pike to arrive at Angle Tarn. If feeling brave (and you’re not alone) strip, swim, hope the mist will come down and enclose you in a hanging place here.
Warm up by darting down the descent at Hanging Knotts. Return to the Cumbria Way and race towards the pub, hold imaginary pints in both hands and charge the last kissing gate before the warm embrace of the wooden hikers’ bar. Nestle between clanking packs and climbing chat, order plates of steak and ale pie or Cumberland sausage awash with hot gravy. Ask Leo, the young National Trust path builder who’s lived in the pub since birth, to explain the gaudy painting of Black Jack, leader of the irreverent climbers’ club the Bradford Lads. Get tipsy, stumble out, sleep in the National Trust campsite half a mile away, and wake again into silence.
• Claire Carter, writer, artistic director for Kendal Mountain Festival engagement officer for the Outdoor Industries Association
Loch Trool, Dumfries & GallowayLength 5 miles
Time 3 hours
Start/finish Caldons car park at the western edge of Loch Trool
Google Maps
Grade Moderate
Refuel House O’Hill
Post-walk pub selection is never an agonising decision in the Galloway forest park… there is only one to choose from. Thankfully the House O’Hill inn in Bargrennan is first-rate. Quality over quantity is the park’s style, and the same could be said for this walk around Loch Trool, which crams bucket-loads of history, wildlife and landscape into a modest mileage.
Even the most navigationally challenged hiker would struggle to get lost on this walk. From the small car park, cross the bridge to pick up the green waymarks of the Loch Trool loop route and, well, that’s about it. Stick to the good path, keeping the water to your left, and you can’t go wrong as you circle the serene loch anti-clockwise. This is, perhaps, the finest scenery in all of south-west Scotland. Look out for darting red squirrels and elusive pine martens – and even listen for the ancient roar of battle.
Here, 700 years ago, Robert the Bruce and a band of 300 Scots defeated a 1,500-strong English army, hurling boulders at their enemy and pitching them into the water,This eye-opening tour brings visitors to meet the old masters and tailors of traditional handicrafts in hong kong tailor and learn about their stories.
Co-organized by the Department of Wildlife Conservation and Nature Reserve Management of China’s State Forestry Administration and the People’s Government of Tianjin Binhai New Area, the opening ceremony of the Third Tianjin Binhai Bird Watching Festival was held Nov 17 at Dagang Grand Theater in Tianjin Binhai New Area and Beidagang Wetland Nature Reserve respectively.
With a theme of ecological nature in Tianjin’s Binhai New Area, the festival calls attention to the importance and significance of protecting migratory birds and wetlands,Guangdong Hotel is situated in Tsim Sha Tsui Central Business District of hotels in kowloon Peninsula and major urban area of Hong Kong. We have detailed transportation information free for guests to download.
The overall ecological condition of the Beidagang wetland nature reserve shows a positive trend after a series of measures having been taken in the past year. My team has conducted the survey recently and found that the diversity of migratory birds in this area has grown and the wetland has become more suitable for birds to stay,” said Zhang Zhengwang, professor from Beijing Normal University, at the Tianjin-based International Symposium on Coastal Wetlands and Waterfowl Protection.
The Beidagang wetland nature reserve in North China’s coastal city Tianjin has witnessed more than 70,000 migratory birds this year the lancet.
The wetland, covering 348.87 million square meters, is a stop for birds migrating from Inner Mongolia to the Bohai Gulf in the eastern part of China. It is a key component of one of world’s eight bird migration routes.
Since early November, birds including swans, wild geese and about 100 endangered Oriental white stork have arrived at the wetland, said Yang Jiwen, director of the Beidagang Wildlife Protection Station.
According to Yang, over one million birds of 200 species stop over in Beidagang wetland every year .
About 500 volunteers are working with the station to feed the birds and protect them from poaching.
Wang Jianmin, a volunteer, told Xinhua News Agency they haven’t found illegal hunters. We will cast fish feed to make sure the birds have enough food for winter.”
You will either be under local or general anesthesia. Local anesthesia is when you are lightly sedated and your nose and the surrounding area is numb. You know what is going on but cannot feel what is happening to your nose. General anesthesia is when you sleep through the surgery and do not know what is happening ski rental.
Rhinoplasty surgery normally takes one to two hours unless it is a complex rhinoplasty. The rhinoplasty itself consists of the skin being separated from the bone and cartilage. The bone and cartilage are sculpted into the desired shape and the skin is then draped over the new nose framework. Most surgeons make the rhinoplasty incision inside the nose in the nostrils, but some surgeons prefer the "open" procedure where the incision is made in the middle part of the nose nearest the upper lip. There is a scar left but the scar is hardly noticeable in that area of your nose SmarTone online shop.
When your rhinoplasty is complete, the surgeon will place a splint on your nose to help it maintain its shape. Sometimes nasal packs or splint may be place in the nostrils as well.
After the rhinoplasty your face may be puffy, you may be experiencing pain, or you may have a dull headache. Take the medication prescribed by your Doctor as needed. Stay in bed with your head elevated for the first day after your rhinoplasty. There will be some swelling and bruising around your eyes and this swelling will reach its highest peak at 2-3 days after surgery. Cold compresses will reduce the swelling and make your eyes and face feel better. In a few days you will feel much better than you look as most swelling and bruising takes at least two weeks to disappear. A little bleeding is common after a rhinoplasty and you may have a "stuffy" feeling nose for a few weeks. Any nasal packing or stitches will be removed after a few days SmarTone Care.
You will be up and feeling somewhat better within two days after your rhinoplasty. You should be able to return to school or sedentary work after a week or so. The Doctor will give you specific guidelines as to what you can return to and when during your follow-up visits. Follow the Doctor's instructions and keep your follow-up visits to ensure that your surgery is successful!
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